Dangers of Zero-Carb Diets, II: Mucus Deficiency and Gastrointestinal Cancers

Jan Kwasniewski developed his Optimal Diet something like 40 years ago and it has become extremely popular in Poland.

Kwasniewski recommended that adults should eat in the ratio

60 g protein – 180 g fat – 30 g carbohydrate
(Source).

In terms of calories this is roughly 240 calories protein / 1640 calories fat / 120 calories carbohydrate on a 2000 calorie diet.

The Perfect Health Diet proportions are more like 300 calories protein / 1300 calories fat / 400 calories carbohydrate.  So the diets would be similar if about 300 calories, or 15% of energy, were moved from fat to carbohydrate in the form of glucose/starch (not fructose/sugar!).

Note that we recommend obtaining at least 600 calories per day from protein and carbs combined. This ensures adequate protein for manufacture of glucose and ketones in the liver. But the Optimal Diet prescribes only 360 calories total (less in women), suggesting that gluconeogenesis cannot, over any long-term period, fully make up for the dietary glucose deficiency.

In the book, we note that a healthy body typically utilizes and needs about 600 glucose calories per day. On the Bellevue All-Meat Trial in 1928 Vilhjalmur Stefansson ate 550 protein calories per day, which is probably a good estimate for the minimum intake needed to prevent lean tissue loss on a zero-carb diet.

With only 360 carb plus protein calories per day, the Optimal Diet forces ketosis if lean tissue is to be preserved. Since at most 200 to 300 calories per day of the glucose requirement can be displaced by ketones, the Optimal Diet is living right on the margin of glucose deficiency.

Gastrointestinal Cancers in Optimal Dieters

I learned over on Peter’s blog that Optimal Dieters have been dying of gastrointestinal cancers at a disturbing rate. Recently Adam Jany, president of the OSBO (the Polish Optimal Dieters’ association), died of stomach cancer at 64 after 17 years on the Optimal Diet. Earlier Karol Braniek, another leader of the OSBO, died at 68 from duodenal cancer.

A Polish former Optimal Dieter who has now switched to something closer to the Perfect Health Diet noted that gastrointestinal cancers seem to be common among Optimal Dieters:

The impression we get is that there’s rather high occurrence of gut cancer, including stomach, duodenum, colon … [source]

I want to talk about why I think that is, since the danger that the Optimal Dieters are discovering was one of the key factors leading us to formulate and publish the Perfect Health Diet.

Zero-Carb Diets Can Induce Mucus Deficiency

I ate a high-vegetable but extremely low-carb diet from December 2005 to January 2008. At the time I thought I was getting about 300 carb calories a day, but I now consider this to have been a zero-carb diet, since I don’t believe carb calories are available from most vegetables. Vegetable carbs are mostly consumed by gut bacteria, whose assistance we need to break down vegetable matter, or by intestinal cells which consume glucose during digestion.

Throughout my 2 years on this zero-carb diet, I had dry eyes and dry mouth. My eyes were bloodshot and irritated, and I had to give up wearing contact lenses. Through repeated experiments, I established that two factors contributed to the dry eyes – vitamin C deficiency and glucose deficiency. After I solved the vitamin C issue, I did perhaps 50 experiments over the following few years, increasing carbs which made the dry eyes go away and reducing them which made them immediately come back. This established unequivocally that it was a glucose deficiency alone that caused the dry eyes.

Rebecca reports similar symptoms in herself and her low carb friends.

This is also a well-known symptom during starvation. As a review cited by LynMarie Daye (and referenced by CarbSane in the comments) notes,

Since hepatic glycogen stores are depleted within 24 h of fasting, blood glucose concentrations are maintained thereafter entirely through gluconeogenesis. Gluconeogenesis is mainly dependent on protein breakdown (a small amount comes from the glycerol released during lipolysis) and it thus results in protein wasting. It is the effects of protein malnutrition that lead to the eventual lack of ability to cough properly and keep the airways clear, in turn leading to pneumonia and death during prolonged starvation; hypoglycaemia does not occur. [1]

Another common symptom of very low carb diets is constipation. This is often attributed to lack of fiber, but I am skeptical. I will get to the various possible causes of constipation in a future post, but for now I’ll just point out that a deficiency of gastrointestinal mucus would create a dry colon and cause constipation.

What connects a zero-carb diet to dry eyes, dry mouth, dry airways, and dry gastrointestinal tract?

Tears, saliva, and mucus of the sinuses, airways, and gastrointestinal tract are all comprised substantially of glycoproteins called mucins. Mucins are primarily composed of sugar; they typically have a number of large sugar chains bound to a protein backbone.

For instance, the main mucin of the gastrointestinal tract, MUC2, is composed of a dimerized protein – each protein weighing 600,000 Daltons individually, so 1.2 million Daltons for the pair – plus about 4 million Daltons of sugar, for a total mass of 5 million Daltons. In the mucus, these large molecules become cross-linked to form “enormous net-like covalent polymers.” (source)

If, for whatever reason, mucin production were halted for lack of glucose, we would have no tears, no saliva and no gastrointestinal or airway mucus.

Mucin Deficiency Causes Cancer

There is a strong association between mucus deficiency and gastrointestinal cancers.

H. pylori is the strongest known risk factor for stomach cancer. [2] H. pylori infection is found in about 80% of gastric cancers. [3] One reason H. pylori promotes stomach cancer so strongly may be that it diminishes mucus in the stomach, as this photo shows:

Top: Normal stomach mucosa. Bottom: Stomach mucosa in an H. pylori infected person.

Scientists have created mice who lack genes for the main digestive tract mucins. These give us direct evidence for the effects on cancer of mucin deficiency.

Experiments in Muc1 knockout mice and mice with Muc1 knockdown have shown that under Helicobacter infection, mice deficient in Muc1 develop far more cancer-promoting inflammation than normal mice. [4]

The main mucin of the intestine is Muc2. The group of Leonard Augenlicht of the Albert Einstein Cancer Center in New York has studied mice lacking Muc2. They develop colorectal cancer. [5]

Tracing backward one step toward the source of mucin deficiency, the sugars in mucin are built from smaller pieces called O-glycans. It has been shown that mice that are deficient in O-glycans are prone to colorectal cancer: “C3GnT-deficient mice displayed a discrete, colon-specific reduction in Muc2 protein and increased permeability of the intestinal barrier. Moreover, these mice were highly susceptible to experimental triggers of colitis and colorectal adenocarcinoma.” [6]

Nutrient Deficiencies Can Also Play a Role

Some micronutrients are required for mucin production – notably vitamin D. [7, 8] Poland is fairly far north, and many of the Optimal Dieters could have been low in vitamin D.

Other important micronutrients for cancer prevention are iodine and selenium. Poland in particular had the lowest iodine intake and among the highest stomach cancer death rates in Europe. After Poland in 1996 began a program of mandatory iodine prophylaxis, stomach cancer rates fell:

In Krakow the standardized incidence ratio of stomach cancer for men decreased from 19.1 per 100,000 to 15.7 per 100,000, and for women from 8.3 per 100,000 to 5.9 per 100,000 in the years 1992-2004. A significant decline of average rate of decrease was observed in men and women (2.3% and 4.0% per year respectively). [9]

So among the Polish Optimal Dieters, the elevated gastrointestinal cancer risk caused by mucin deficiency may have been aggravated by iodine and sunlight deficiencies.

Conclusion

A healthy diet should be robust to faults. The Optimal Diet is not robust to glucose deficiency.

There’s good reason to suspect that at least some of the Optimal Dieters developed mucin deficiencies as a result of the body’s effort to conserve glucose and protein. This would have substantially elevated risk of gastrointestinal cancers. Thus, it’s not a great surprise that many Optimal Dieters have been coming down with GI cancers after 15-20 years on the diet.

We recommend a carb plus protein intake of at least 600 calories per day to avoid possible glucose deficiency. It’s plausible that a zero-carb diet that included at least 600 calories per day protein for gluconeogenesis would not elevate gastrointestinal cancer risks as much as the Optimal Diet. But why be the guinea pig who tests this idea?  Your body needs some glucose, and it’s surely less stressful on the body to supply some glucose, rather than forcing the body to manufacture glucose from protein.

Fasting and low-carb ketogenic diets are therapeutic for various conditions. But anyone on a fast or ketogenic diet should carefully monitor eyes and mouth for signs of decreased saliva or tear production. If there is a sign of dry eyes or dry mouth, the fast should be interrupted to eat some glucose/starch. Rice is a good source. The concern is not only cancer in 15 years; a healthy mucosal barrier is also essential to protect the gut and airways against pathogens.

Related Posts

Other posts in this series:

  1. Dangers of Zero-Carb Diets, I: Can There Be a Carbohydrate Deficiency? Nov 10, 2010.
  2. Danger of Zero-Carb Diets III: Scurvy Nov 20, 2010.
  3. Dangers of Zero-Carb Diets, IV: Kidney Stones Nov 23, 2010.

References

[1] Sonksen P, Sonksen J. Insulin: understanding its action in health and disease. Br J Anaesth. 2000 Jul;85(1):69-79. http://pmid.us/10927996.

[2] Peek RM Jr, Crabtree JE. Helicobacter infection and gastric neoplasia. J Pathol. 2006 Jan;208(2):233-48. http://pmid.us/16362989.

[3] Bornschein J et al. H. pylori Infection Is a Key Risk Factor for Proximal Gastric Cancer. Dig Dis Sci. 2010 Jul 29. [Epub ahead of print] http://pmid.us/20668939.

[4] Guang W et al. Muc1 cell surface mucin attenuates epithelial inflammation in response to a common mucosal pathogen. J Biol Chem. 2010 Jul 2;285(27):20547-57.  http://pmid.us/20430889.

[5] Velcich A et al. Colorectal cancer in mice genetically deficient in the mucin Muc2. Science. 2002 Mar 1;295(5560):1726-9. http://pmid.us/11872843.

 [6] An G et al. Increased susceptibility to colitis and colorectal tumors in mice lacking core 3-derived O-glycans. J Exp Med. 2007 Jun 11;204(6):1417-29.  http://pmid.us/17517967.

 [7] Paz HB et al. The role of calcium in mucin packaging within goblet cells. Exp Eye Res. 2003 Jul;77(1):69-75. http://pmid.us/12823989.

[8] Schmidt DR, Mangelsdorf DJ. Nuclear receptors of the enteric tract: guarding the frontier.  Nutr Rev. 2008 Oct;66(10 Suppl 2):S88-97. http://pmid.us/18844851.

[9] Go?kowski F et al. Iodine prophylaxis–the protective factor against stomach cancer in iodine deficient areas. Eur J Nutr. 2007 Aug;46(5):251-6. http://pmid.us/17497074.

Leave a comment ?

275 Comments.

  1. Hi Paul, I don’t understand if optimal dieters have similar cancer rate of other polish or higher.

    Maybe gastrointestinal cancer may be due to high iron consumation. Iron is higher in red meat, ODers may be overeating it because they are not scared about satured fats.

    If in excess it can be very dangerous:
    http://www.lewrockwell.com/orig/sardi10.html

    What do you think?

  2. Hi Kratos,

    Iron is definitely dangerous in excess. Anthony Colpo has written a lot about that.

    Since the OD like the Perfect Health Diet is not a high protein diet, I don’t think the iron intake would be that large even if they got all their meat from red meat. A half pound of beef has only 4 mg iron.

    So I don’t think that would explain a higher cancer rate in ODers.

    Best, Paul

  3. Hello Paul,
    i have just received your book and may not have gotten so far in reading but i would like to ask your opinion on sprouted grains such as sprouted oats and buckwheat.
    Do you consider these toxic too? Is there a timeframe for how long these should sprout?
    Thank you
    Irmgard

  4. Hi Irmgard,

    Nutrient availability is higher and toxins are downregulated at sprouting time. So these are healthier than the regular seeds. Personally, I am still cautious. If you do decide to eat them, I would go with the buckwheat ahead of the oats.

    Best, Paul

  5. Hey there Paul. I’ve just started working with Chris Kresser on modifying my vegetarian diet to be more in line with what you guys are recommending.

    A couple of questions:

    1) To expand on the previous commenter’s question…I had typically eaten sprouted lentils, sprouted quinoa and germinated brown rice fairly frequently. Is that something you would recommend cutting out altogether?

    2) Is there anything that can be done in preparing beans that would make them healthier? I’ve never heard of sprouting a black bean for example, but is there something akin to that?

    3) I’ve decided to start eating fish. Is salmon pretty much my best bet? Are there other types of fish that you would recommend that would have similar health benefits?

    Thanks very much,

    Scott

  6. Hi Scott,

    For vegetarians I would relax the toxic food strictures a bit, since (a) food variety is important for dietary happiness and (b) by eating a wider range of plants, the dose of any one poison is reduced and since “the dose makes the poison,” the diet may be safer. Since you have to eat more plants than normal dieters, it makes sense to include a few more marginally toxic plants and not let any one plant species be a large part of your diet.

    Have you read the “vegetarian” section at the end of our book? (If you can I would read the whole book, since it provides a lot of background knowledge enabling you to evaluate the pros/cons of straying from the diet in a particular way.)

    Re the specific foods you mention, I think you can include those in a vegetarian version of our diet. However, I think you should read up on traditional methods of preparation like soaking and I would thoroughly cook them.

    Beans for instance should be soaked overnight and then thoroughly cooked.

    The Weston A Price Foundation has some good information on traditional methods of food detoxification, as does Stephan Guyenet’s blog.

    Salmon is an outstanding choice. Fish generally is free of natural toxins, but many kinds of fish are high in protein and low in fat. We favor fattier fish like salmon. Shellfish are also nutritious, though relatively low in calories. Of course, you can always add butter / oils / fatty plants (avocado, nut butters) to fish, as we would to lean chicken meat, to improve the macronutrient ratio. Fish eggs are also a very nutritious food.

    For omega-3 fats, any cold water ocean fish is good. Anchovies, herring, sardines, tuna, mackerel, char, … many more.

    Best, Paul

  7. Season’s Greetings, Paul

    Okay, so I’m one of those who can count the number of servings of fruit/starch I’ve had in the past 7 years on one hand. (I don’t restrict green veg.) Just now I’m developing the dry, red eyes you mention; and yes, as I type I’m wearing eyeglasses instead of my contacts.

    Once you upped your glucose did the situation resolve? Are you back in your lenses comfortably? I infer a “yes,” but want to make sure.

    My late Mother was diabetic, and I am deeply (underscore that) influenced by the writings of Dr. Richard K. Bernstein. His dietary strategy, as I’m sure you know, is centered around eliminating just the glucose carbs you’re
    recommending. A bit of irony in that, taken in the proper amount, they might actually be healthful for the eyes!

    Best, & thanks, KKC

  8. Hi KKC,

    Vitamin C and glucose did resolve the situation. Both were important.

    After 4 years of wearing glasses I recently went back and got a new contact lens prescription. But I haven’t been wearing them much yet, I got out of the habit. I’m planning to get habituated to them again in the new year, since I look better with them and expect to spend more time out in public.

    My eyes are quite moist so I don’t envision any problems with wearing them all day.

    I’m sorry about your mother. Diabetes can be devastating.

    I’m a fan of Dr. Bernstein’s but if you’re not actually diabetic, I don’t think you need to be that careful. He was Type I, and many Type IIs have enough insulin function to handle a diet with ~400 carb calories a day. It’s helpful for diabetics to stay below 600 calories a day, and thus retain the glycogen pathways for glucose disposal, but if there’s some residual insulin function I don’t think it’s desirable to go fully zero carb. Even if you adopt a ketogenic diet, it’s still beneficial to get some carbs to avoid the dry eyes etc. problems that can arise from glucose deficiency.

    So I would aim for 200-400 carbs a day, take some C, and you should be OK. If you actually have diabetes, then a low-carb ketogenic diet is probably best. But in all diets, you should strive to stay out of glucose deficiency.

    Best, Paul

  9. Thanks Paul, for the quick response and specific suggestions. I already take the C, and shall add the carbs. No, I’m not diabetic, and having seen what Mom went through I would exist on wood chips were that the only preventative. The dear woman progressed from gestational diabetes, to poorly managed T2, to very poorly managed insulin dependency. She was hospitalized following a nasty fall in which she broke her ankle. The ankle never healed; she contracted MRSA – the following year ’til her passing was a nightmare and a real education. Perhaps you can understand why I would follow *too* strict a diet.

    I also look better in contacts, and perhaps more importantly I see much better. Hope you effortlessly become habituated to your new lenses! And that your public appearances expose your work to the very many who could benefit.

    Best, KKC

  10. Shane,

    I know this is an oldish topic, but I hope you will read this anyway. I would be very happy of you could link to that page at dr K’s site, translated or not, as it doesn’t sound in line with what I’ve read at all.

    I have followed ON, or close to, for a little more than 5 years. I have read the two books available in English. I think there is some misunderstandings here.

    The proportions between macro-nutrients are general. For a short person, like a woman of medium height or shorter, they do not apply straight off. No one should eat less than 50 g of carbs. With time though, after several years on ON, carbs may be further reduced, but not by much.

    The 50 – 100 grams statement you had read Shane, definitely must be a misunderstanding. I think I’ve also seen that somewhere. 100 g is the upper limit for what you can allow yourself on rare occasion. K says up to 100 grams occasionally won’t harm an optimal eater but this shouldn’t be taken as an excuse for frequently eating that much. He also states that 150 g is directly harmful.

    So you can see why I’m curios about that article at his site. I do hope you will see this and can provide the link.

    Paul,
    I just received your book in the mail today and am looking forward to reading it. At the moment I’m reading your blog from back to front so to speak, but I’ll try not to dig up any more old topics. 😉

  11. I’ve been eating very low carb and I don’t have any issues, but then again I’m not restricting my calories (I eat between 3000 – 5000 calories a day).

    I also do intermittent fasting. I do have to admit an above normal thirstiness, but it seems to have stabilized after a couple of days of beginning the diet.

    What’s amazing is that even though I’m gaining strength and adding muscle while in ketosis, I can’t seem to keep fat. My rate of fat loss has slowed as I’ve increased carb consumption (I really missed my dark chocolate), but I have no problem losing a lb or two per week.

  12. A water carafe by the bedside « Suzqueue - pingback on March 27, 2011 at 4:30 pm
  13. On another thread, Kiran notes:

    Here’s another anecdote for a Zero Carb diet increasing risk of GI cancer. Bear Stanley (of LSD fame) ate a meat and dairy diet for a few decades and wound up with throat cancer.

    http://en.wikipedia.org/wiki/Owsley_Stanley#Diet_and_health

    (source: http://perfecthealthdiet.com/?p=2899&cpage=1#comment-20263)

  14. I am pretty much confused and could use some clarity. Low carb 10 years or so ago dropped my weight to normal and fixed some very painful stomach issues. I ate about 50 grams of carbs per day, I would guess. Smoking cessation weight gain in 2007-08 of 50 pounds (did not go off low carb) had me at the end of my rope, so I went very low carb (Atkins style). In 2009 I developed dry eyes which have ruined my life, frankly. Some stomach issues remain now and then. It didn’t work, either: I’ve been on 15 grams of carbs/1500 calories a day and still can’t budge the scale. So, question: how can I lose weight (which is a must for overall health and inflammation issues) AND solve this dry eye problem if the solution is eat more carbs? Can I have both? can I really get healthy again at 49 and pre-menopausal? You have no idea how much I want the answer to be “yes”. Suggestions?

  15. Hi Barbra,

    YES!

    Vitamin C and starches for the dry eyes.

    For weight loss, read all our “Weight Loss” category posts, but especially this one: http://perfecthealthdiet.com/?p=2145.

    Keys are intermittent fasting, 16 hour daily fast and 8 hour feeding. Be extremely well nourished — eat very nutritious foods, take our supplements to make sure there are no micronutrient deficiencies — and remember well-nourished includes about 100 g carb per day. Take 1 tsp to 1 tbsp coconut oil during the fast. Try to get some exercise during the fast, and sun exposure. Be active.

    Best, Paul

  16. Paul

    I appreciate the swift reply, thank you! I think you might have a solution to my eye problems, but the diet….

    What you seem to suggest from the link is really a pretty balanced macro, low fat, low cal diet, supplements and some exercise. Isn’t this South Beach, basically? Or maybe Zone? This certainly didn’t work for me in 2008, when I tried a low fat, low cal diet with hiking and weight training. I was just hungry and miserable and didn’t lose a pound. Are we talking 1000 cals a day? 1200? 1500?

    I have ordered your book but it will not arrive for a couple of weeks, so I don’t know quite what is in there, but maybe some background would help.

    I have a history of gestational diabetes (1988) and don’t tolertate sugar or grains well at all (so I avoid both). I don’t drink, touch trans fats or most omega 6’s (I recently started experimenting with GLA supplements to help with inflammation). I cook with
    coconut oil and olive oil, eat organic veggies, grass fed meat, avoid fruit, take fish oil, a multi–all in the interests of finding better health. So low carb seemed the perfect answer for more than just weight loss. But low fat?

    Perhaps I am misreading or misunderstanding your suggestions. I do think there’s something in your dry eye theory, all right, but the diet makes me uncertain and afraid of weight gain and insulin problems. I want to rid myself of these dry eyes and I need to drop the weight…what if I raised my carbs to 40 or 50 a day with some starchy veggies and kept the calories to 1400 or so? I’d like to stay in ketosis if possible…or do you think this necessary? My history and sudden belly fat suggest I am certainly insulin resistant, so upping carbs to 100 a day makes me very, very nervous.

    I still want that “yes”, though! 🙂 How much Vit C do you recomend? If I get brave enough to try this, I may be a good case study for you! I’ll let you know how it goes, shall I?

    Thanks again for replying.

  17. Hi Barbra,

    We’re in general a high-fat diet, so the counsel to reduce fat in the weight loss diet is from a very high-fat base — like yours.

    Everyone is a little bit different, and the optimal amount of carbs for you is something you’ll have to work out with a bit of experimentation. But it’s probably more than what you’re now consuming.

    The key to weight loss is to be well nourished and non-hungry. Your hunger on South Beach & Zone indicates some kind of malnourishment.

    To be adequately nourished in carbs and protein requires at least 600 calories total carbs+protein, and I believe at least 200 calories from safe starches is prudent. So, 50 g starches and total calories of 1400 would be sort of a minimal intake, but should be healthy if you get enough protein and enough of all needed micronutrients.

    I don’t think you want to be in ketosis all the time – this promotes Candida and other infections. Intermittent fasting will put you in ketosis 6-8 hours a day which will give you most of the healing benefits of ketosis.

    Vitamin C – I would try starting with 4 g/day to relieve any deficiency. Once you’re replete you can drop back to 1 g/day (500 mg/day is OK if you’re eating more carbs).

    Yes, please keep me informed!

    Best, Paul

    PS – Check out today’s post, item 8: http://perfecthealthdiet.com/?p=3338#8

  18. That all makes sense to me, thank you. I will start today, wait for your book to arrive, and yes, will keep you updated.

    I really apprecitate your research, your dedication, and your willingness to help. Thanks, Paul!

  19. Thomas Kwasniewski son of John Kwasniewski say:
    Defecation reflex is an individual that can build up a. For example: smokers’ kupciaj?cy “after the morning haze sit down on the toilet seat after the first of spent cigarette. Therefore, in them without inflammation – often together is not.

    With long-term eating without residual (mainly protein and fat with a high biological value), eg offal, butter, egg yolks to the cream (do not remember the number-u KK?) Can “kupcia?” once a week, but it is not reasonable conduct. Therefore, it is always safer to eat some meat, cheese, vegetables or fruit that was what the “ferment” (because the intestinal bacteria produce a lot of useful compounds), and rather try to empty once a day.
    ————————————————–
    What is it with cigarettes, it’s about stimulation of przywspó?czulny
    – Parasympathetic
    Parasympathetic system (przywspó?czulny)

    Parasympathetic activity predominates during sleep, rest and mental relaxation, and thus intensity, in circumstances conducive to vegetative processes.
    Depth parasympathetic nerve is the vagus nerve, which sends a branch of the ventral branches including to the gastrointestinal tract, trachea, bronchi, lungs, heart, liver, pancreas, spleen, kidneys.

    Many internal organs have dual innervation of the autonomic sympathetic and parasympathetic.

    -Sympathetic
    Sympathetic (sympathetic)

    The function of the sympathetic nervous system is thus raising the overall activity of the organism. It plays a leading role in stressful situations, in circumstances that cause emotional stress, requiring a full mobilization of the body. Then has an advantage over antagonistic parasympathetic system, which usually acts as a brake on the innervated organs, however, stimulates the digestive and glandular and accelerating the processes of etching, simultaneously induces a decline in body temperature, heart rate deceleration, etc.
    ———————————————–
    Cigarettes at a dose of transfixing the parasympathetic system, ie up to 15 pieces a day, unconsciously increase the intake of carbs and coffee. Paper at a dose of transfixing the sympathetic, which is above 25 to 30 cigarettes a day, also affect the composition of the diet, pushing it toward the trough. Cigarettes at a dose of up to 15 per day, shift the composition of the diet in the direction of pastures (vegetarian diet). Smokers smoke less vegetarian in order to boost up.
    In each of the army before the attack is always the cigarettes were available, the soldiers before the battle smoked cigarettes to boost up. The Polish army after the war, each soldier received after 100 cigarettes for every 10 days. Since it was always (almost) more smokers than non-smokers in the army, the average dose for smokers were about 15 pieces a day.
    The dose of stimulating the sympathetic, cigarettes, and the impact on the composition of the diet, contribute to the development and progression of many diseases classified as pasture – for example, Buerger’s disease, rheumatoid spondylitis, chronic progressive rheumatism and many other diseases. They protect against the onset of the disease included korytkowych, such as ulcerative colitis, colorectal cancer, Crohn’s disease-Lesniewski, and many other diseases. Of the patients suffering from various diseases, most schizophrenics smoke. With cigarettes at a dose stimulates the sympathetic system can operate.
    http://dr-kwasniewski.pl/?id=2&news=747

  20. Thomas Kwasniewski wrote
    An interesting fact: the presence of Helicobacter pylori are found in people who do not get sick, or inflammation of the stomach or the stomach ulcers, or cancer, but also inflammation and ulcers, and gastric cancer also occur in people who are short free from this bacterium. In Poland, it is estimated that this symbiotic bacterium occurs in 70-80% of the population, and “ulcers
    ‘is no more than 350tys. or about 10%!

    PS
    with “pylori” is like the claim that “the cause of rain is spreading umbrella. ”
    And that is biochemically bidulka hydrochloric acid and neutralizes some toxins – that is, in theory, works against ulcers and cleansing …
    ——————————————
    http://news.bbc.co.uk/2/hi/health/6338357.stm – Helicobacter pylori – always?.
    Reminder – the cause of stomach ulcers are abnormal autonomic nervous system necessitated a specific composition of the diet. Selekwtywne currents and the corresponding optimal diet by removing the real cause of the disease, cause the fast to get rid of it.

    —————————
    I see it:
    Do you eat enough carbohydrates, eat foods rich in cholesterol, fats give the most energy, because the acetyl-CoA is formed cholesterol, and with carbohydrates (averaging 0.8g/kg +/-0.2g, but everyone is different) formed an adequate number of NADPH-produced hormones

  21. Hey Paul re: some coconut oil or MCTs during a fast- what are your thoughts on using some coconut “cream”?

    http://www.tropicaltraditionscanada.com/coconutcreamconcentrate.html

  22. Hi Greg,

    Coconut cream (and coconut milk) are great. If I recall correctly coconut cream is 85% coconut oil by calories, and much of the rest is fiber, so it’s not much different in terms of macronutrient composition and ketogenicity.

  23. Hello,

    I was wondering if there are still benefits of intermittent fasting if there is less than 16 hours, say 14 hours?..my lifestyle often makes it difficult to eat satisfying meals within an 8 hour window.

    Also, is there any merit to food combining (one shouldnt mix protein with starches, etc..)?

    Lastly, do potatoes cause or contribute to leaky gut? I am enjoying them now that Ive added starches back to my diet yet do not want to cause any disturbances in my gut as I suspect I may have some dysbiosis issues.

    Thanks,
    Kayla

  24. Hi Kayla,

    Yes, there are benefits to 14-hour intermittent fasting. All of these numbers are only rules of thumb, not hard metrics.

    I don’t think how foods are combined matters much. The body has a pretty effective machinery for food handling. Possibly in diabetics / metabolic syndrome this may be significant.

    Potatoes are pretty good for the gut, but they can carry some gut-damaging toxins. These are located near the skin or in discolored areas. Just peel the potatoes, skin plus 1-2 mm (0.05-0.1 inch) underneath, and remove any discolored flesh. Then you should be fine. Also, store potatoes in dark, cool, dry places. Light exposure causes them to generate toxins.

    Best, Paul

  25. Hi Paul

    I am curious as to how long it would take for my dry eyes to begin to regain their moisture. I’ve added safe starches to my diet (raising the carb level up to about 60) and my eyes are much, much worse this week. I’m also up 4 pounds. Is this a temporary response that reverses itself later? I’d love to hear your (or others’) experience(s) so I can gauge whether or not I’m on the right track. So far, it feels like a misstep. Thoughts, anyone?

    Thank you!

    Barbra

  26. Hi Barbra,

    If starches are at 60 g/day carbs = 240 calories, that should be sufficient. It should resolve very quickly. Note that it’s the weight of the glucose, not the food, that matters.

    Are you taking 4 g/day vitamin C?

    Any kind of immune activity in the eye can cause dry eyes. Have you been to a doctor? Are the eyelids swollen, crusty, etc.?

    Any gut ailments? Allergies? Have you tried different kinds of “safe starch” to see if there is a sensitivity? Rice is usually well tolerated.

    Best, Paul

  27. Barbra’s question got me thinking about something. What do you suspect your diet’s effect might be on Glaucoma? Which aspects of your diet do you think would have the most impact? If you don’t know, I’ll help gather data for you. For the past 8 years I have taken Lumigan, an intra-ocular pressure (IOP) reducing drug. It has reduced my IOP from 27mmHg to around 20 in both eyes. I get my IOP checked every 3 months. The Lumigan worked fine until last year. Lately my pressures have increased to 26-28mmHg again, My eye dr. changed my medication to Xalatan, and I’m getting checked again later this month. If there is no improvement, he recommends increasing my medication to 2x/day, or get laser surgery. I’m not a huge fan of laser surgery because he tells me that having it done makes the pressure check less viable as a means of checking disease progression. Also not a fan of having to take the drops 2x/day.

    Do you think that some factor of my low carb diet experiences might have increased my optical pressure? Do you think with my recent adherence to PHD, increasing starch, my eye pressure might reduce? Does IOP even matter? I suspect it might, as my optic nerve has not been further damaged since starting the Lumigan, and going in at my first check, there was indeed some damage.

    Unfortunately it’s not going to be a controlled experiment, since I’m also currently on new medication. In addition, I’ve lost 7% body weight and 2% body fat over the past month, and had been at the higher for my two previous pressure checks. Obviously, either of those changes may impact my eye pressure.

  28. Hi Matt,

    Since nerves are involved, I would do intermittent fasting, with a bit of coconut oil during the daily fast, and then 400 calories or so of starchy carbs during the feeding window. This will give a period of ketosis and autophagy each day which should help the nerves.

    Also, I’d do the optional B vitamin supplements, especially B6 50 mg and B12 500 mcg. B12 promotes nerve regeneration, B6 can also aid nerve function. Riboflavin in conjunction with UV light is anti-viral/anti-microbial. So take plenty of riboflavin and get out in the mid-day sun with no glasses or contact lenses.

    Third, I’d make a point to get plenty of potassium daily. There is evidence that potassium deficiency may be an important cause of glaucoma (http://www.ncbi.nlm.nih.gov/pubmed/19372634, http://www.ncbi.nlm.nih.gov/pubmed/18546005, others). Eat your vegetables! Bananas, potatoes, tomatoes are all good sources. Try to get 4 g/day potassium. You’ll probably feel that’s a ton of plant food, but you need an excess to recovery in a month or two from a deficiency. Normal male bodily potassium is 130 g.

    Then I’d look into possible infectious pathogens that might underlie the problem. However, unless you have other symptoms of infection, perhaps you should do the other things first and see if the ocular pressure is fixed before trying anything here. Otherwise if you change too many things at once it’s hard to tell what’s going on.

    Best, Paul

  29. Hi Paul

    Yes, I have been taking Vit C, but not quite that much (GI doesn’t seem to tolerate more than about 2.5 g/day). Yes, I have seen doctors, optometrists and an ophthalmologist. And yes, I do have GI issues which I mostly resolved when I went low carb and off all grains, starches and sugar about 10 years ago.

    However, I would not presume to elicit a diagnosis from you; I was more interested in how long the process of reversing dry eye took for you (and for others). I was trying to gauge the effectiveness of adding starches. The first week saw a dramatic decline in my tear film. I then stopped eating white rice and potatoes 5 days ago to see what would happen. My eyes became immediately better (although they are still not normal by any means). I imagine my dry eye issue, then, is not so directly tied to mucus as it is to a bacterial or parasitic infection of the lid margins/meibomian glands. It could be that the carbs/glucose is feeding the problem somehow. So, alas, it does not look like this will be solved by a simple change in my diet. But thank you for your input and information. I’m sure others with different dry eye causes will benefit from your work.

  30. Hi Barbra,

    I had a big improvement when I started vitamin C and another big improvement when I added starches. Both effects were almost immediate, and the two combined pretty much cured my dry eyes.

    It sounds like some kind of immune issue possibly driven by gut dysbiosis. An influx of bacterial toxins when you eat starches aggravates immune reactions everywhere including the eyes.

    You might try as an experiment eating starches alone without any fat. In the absence of fat they won’t carry in as many toxins.

    A possible treatment is cholestyramine/charcoal/chlorella to help clear fat-soluble toxins, plus lots of salt and water to clear water-soluble toxins.

    Best, Paul

  31. hemul,

    I just noticed your comment on this thread.

    Regarding the “50 – 100 grams” statement, I found that information from the “Optimal Nutrition versus Atkins Diet” article that I found on the internet while researching the diet. The article is mentioned on numerous websites, but one copy is found at

    http://www.cybernaut.com.au/optimal_nutrition/information/articles/optimal_nutrition_vs_atkins.pdf

    The “A SHORT GUIDE HUMAN” article from his website also mentions the 50-100 grams:

    When a person eats, instead of about 50 grams of carbohydrates per day to 100 grams, nothing bad happens, but the body is a bit weaker. Never exceed more than 150g/day carbohydrate intake.

    The address for that article can be found at http://dr-kwasniewski.pl/?id=2&news=79 I use google translate to read the article.

  32. Shane,
    do you know if the ON diet uses a different (non standard) energy multiplier for Fat?
    if you look at the ON formulas in the pdf you linked, the conversion multiplier from fat grams to Kcal is approx 10.7 (1g fat=10.7Kcal).
    whereas the Atkins formulas use the ‘standard’ x9 (1g fat=9Kcal).

    also on pg2 there’s a line that reads “…fuel giving 11 Kcal from 1 gram…”, which seems to back this up?

    if there is some basis to this, that could go some way to explaining why i gain more weight (fat & muscle) than i expect based on calorie counting on a high (good) fat diet….because i am actually eating more calories than i think. could be in the order of an extra 245 calories a day for me.

  33. Here are some thoughts for those with dry eye and/or blepharitis who have not experienced improvement when adding starches.

    I think if someone has been low-carbing for 5-10 plus years and experiences dry eye — a confounding factor is simply normal hormonal declines that come with age yet vlc gets blamed. Most of America is not on vlc yet the drug stores shelves are lined with eye drops and dry eye remedies. I too have had blepharitis and dry eyes that wax and wane but then again, so does my husband who eats a high carb mixed diet. So does my middle aged eye doc who eats a high carb mixed diet. I am approaching menopause (late 40s) and think hormonal fluctuations as well as stress, seasonal changes, allergies, pollution, computer overuse and even sluggish thyroid (so common as we age) can cause this yet very low carb diet seems to be blamed.

    If someone’s eyes feel better on daily starch, then they have their answer. My eyes do not improve with forcing additional starch from yam/potato/rice and I do not like the cravings these foods induce. My eyes also seem to worsen with adding too much cheese or too many nuts (allergy? molds?).

    What is “too much” of course varies per person. I don’t count carbs and am now experimenting with meal timing and frequency as well as reducing my protein rather than eating huge portions just because it’s zero carb. I usually eat 2 meals a day but sometimes 3. Typical menus: AM — 2-3 soft boiled pastured eggs plus very small portion of berries or apricot or other low carb fruit. Lunch : Leftover steamed salmon or canned salmon or sardines with bones or leftover meat/foul + kim chi and/or other veggies; Supper: Organic protein — usually grass-fed beef and non-starchy veggies plus 2 oz bar of 87% organic dark chocolate. I add fat like butter or coconut oil now only if the meal is too lean to satiate me rather than ladeling them on by rote. I am 5’3″ tall and currently weigh 107. Cheats/treats would be hazelnuts/almonds/macs– way too many. They are a total trigger food so I simply don’t buy them every day anymore because I’ll polish off whatever I buy. Unlike many women my age — late 40’s — I do not crave baked goods or starches as comfort foods — rather — I would reach for nuts or very dark chocolate — way more caloric but don’t seem to pack on fat for me as readily as less calories of starchy foods. I don’t count carbs and the amounts vary but I can’t see how one could ever devise a “necessary” amount of starch that is truly “necessary” for everyone.

    I think the mucin argument may have validity for some but not all. In fact, as a hypothyroid — it’s excessive mucin that I worry about – that puffy look so common in people with untreated hypothyroidism. Broda Barnes and Mark Starr’s book have interesting info on mucin excess.

  34. Hi Annie,

    Thanks, all good thoughts.

    Dry eye can have multiple causes. I focused on the glucose/C deficiencies because we have a large low-carb Paleo audience and that’s common among that audience.

    But in high-carb dieters, the most common cause is probably high immune activity, usually due to infection, autoimmunity induced by infection, or circulating toxins (often from an infection elsewhere, such as the gut).

    I have had recurrent Candida outbreaks over many years and I would get hypothyroid symptoms during them and blepharitis whenever I was recovering from one, I believe from toxins released during die-off. So it wouldn’t surprise me at all if fungal toxins from moldy cheeses and nuts, or environmental molds, could cause your dry eye.

    Infections can cause hypothyroidism, as my Candida experience shows.

    Thanks for all the info!

    Best, Paul

  35. Barbra might also wanna look into autoimmune-related causes of dry eyes, particularly if she has gut-related issues suggesting autoimmunity. Sjogren’s will give you dry eyes (as well as dry mouth and throat). If you have Sjogren’s, then increasing your starch allocation will not help your dry eyes. Being on a gut-friendly diet that’s gluten-, dairy-free and perhaps nightshade-free could improve the dryness. But there seem to be additional issues that govern the dryness of eyes and throat in Sjogren’s. On the other hand, if you don’t have a dry throat (mornings upon waking up), you probably don’t have Sjogren’s.

  36. Darrin,

    That might be correct.

    One thing with OD articles I found is that the information is very confusing in some parts with the translation software. On Kwasniewski’s website, he speaks about hydrocarbons in fat calories and calculates calories based on chemical formulas.

    From the translation: “The best ‘fuel’ in the art and the body is hydrogen. With 1 gram of hydrogen can be obtained 34.3 kcal, 1 gram of carbon – 7.87 calories, 1 gram of glucose only 3.73 kcal when it is burned, and much less when it is processed in other ways. Man can only obtain energy from the combustion of hydrogen or carbon, which are bound in organic compounds. It can not burn hydrogen directly. The fully saturated fatty acids, hydrogen, a long chain of 1 carbon atom 2 hydrogen atoms falls. Animal fat rather than hydrogenated, are theoretically and practically the best numbering in the “fuel” for man.”

    Maybe if someone speaks Polish (so they can read the original article) and has a better background in chemistry would be able to comment on whether his math is correct.

  37. Halfway through this incredibly long and useful comment thread there was a discussion of the difficulties that digesting coconut oil (in large quantities) poses. The idea of lipase was raised but frowned-upon as potentially unsafe–i.e., use with caution and for short periods.

    Bile salts (e.g. http://www.iherb.com/Nutricology-Ox-Bile-100-Veggie-Caps/3451?at=0) were also mentioned. Anecdotally, reviewers suggest that this product has helped them digest fats. Does anyone here have experience with bile salts as an aid to digesting coconut oil? If so, can we consider it safe (I’m assuming that it is distinct from lipase–though I imagine they work together in the digestive tract)?

    I, like many on this thread, respond poorly to large amounts of coconut oil (bloating, diarrhea, etc.), making it difficult to stick to any kind of ketogenic regime (the body rather convincingly calls out for relief from the bloating etc. everytime). Having some sort of magic bullet digestion aid (bile salts?) would be wonderful. I’ll give them a try and report back if we can at least presume that they are safe.

  38. Hi RW,

    Yes, bile salts are OK, much better than lipase.

  39. I don’t agree that glucose deficiency is a necessary consequence of a ketogenic diet. Fat is used to produce glucose, hence why ketogenically adapted endurance athletes are able to perform the same on ketogenic diets as on carb diets. If there was a glucose deficiency created by ketosis, then these athletes should have had impaired performance due to the glycogen demands of exercise. Since they didn’t and were able to perform at normal rates, I assume there’s not a glucose deficiency associated with ketogenic diets.

    There are people who have below optimal glucose levels on ketogenic diets, but this isn’t a necessary effect of being in ketosis.

    Thanks for the post, I hope you check older comments 🙂 I appreciate your take on health

    P.S. One other factor to consider, despite the two you mentioned — Poland being naturally high in stomach cancer probbaly due to lack of iodine and selenium and them potentially having low Vitamin D — is BHA’s role as a potential carcinogen. BHA is found in the lard’s here in the US, and it could also be found in the lard’s that Polish Optimal dieters are eating

    – Arbo
    allmeatdiet.com
    (coming soon)

  40. Hi Arbo,

    The glycogen in stored fat only provides about 10% of calories as glucose, whereas the body’s glucose utilization is more like 30% of energy, and ketones can make up less than half of that. So fat alone cannot meet glucose needs.

    I would expect those athletes to show hormonal signs of glucose conservation, eg low T3 and high rT3. See these posts, especially the first: http://perfecthealthdiet.com/?p=4383; http://perfecthealthdiet.com/?p=4446; http://perfecthealthdiet.com/?p=4457.

    I agree that ketosis is possible without a glucose deficiency, in fact we recommend ketogenic diets as therapies for some conditions and recommend designing them to provide adequate glucose and protein while still generating ketosis. See eg http://perfecthealthdiet.com/?p=2479 and http://perfecthealthdiet.com/?p=2638.

    Thanks for the tip about BHA, I haven’t seen that before.

    Best, Paul

  41. Hmm… Paul, I want to make sure we’re not talking past each other — I’m saying that once you’re ketogenically adapted, fat becomes your source of glucose. So when you say that, ‘Fat alone can’t meet glucose needs’ are you saying that people KA can’t get the glucose their body needs from dietary fat?

    I want to make sure we’re not using the word ‘fat’ differently with me using it to describe dietary fat and you using it to describe body fat

    But interesting thoughts on the low carb diets and T3 — I want to explain this real quick and hopefully you or J. Stanton can make a post about this so people don’t leave low carb diets for the wrong reasons : Cortisol increases as glucose decreases. If someone eats a low carb diet and also has chronically low glucose, then they’ll have chronically high cortisol.

    I don’t know if high cortisol causes low T3 or if low glucose directly causes both or if T3 isn’t effected by either glucose or cortisol and is low in LC dieters for another reason — but now that we know that glucose

    I just formatted my PC, Paul, if I didn’t I’d post the link to the study that shows athletes on a ketogenic diet can perform well and where the researchers said they think the reason why previous studies showed impaired performance in KA athletes was because they weren’t eating enough dietary fat. That study suggests that low glucose was the reason why some KA athletes had worse endurance performance and that increasing fat will increase glucose levels. Summary : for KA adapted individuals, fat increases glucose levels

    If low glucose is causing the problems with high cortisol, and dietary fat raises glucose, then the way to deal with that is to eat more dietary fat. If low T3 is associated with low glucose — which I don’t know but I would be very surprised if the glucose/cortisol connection aren’t effecting low T3 — then you can fix this by eating more dietary fat.

    This sounds like a leap by me, but every problem I’ve seen in myself or heard about in others following VLC diets is caused by low glucose. When I research this later, I’m sure I’ll see that high cortisol and low T3 go together

    One thing we know is that cortisol depletes our vitamin C stores — cortisol increases as glucose levels decrease and decreases as glucose levels increase — Therefore your scurvy was very likely caused by low glucose due to low fat(if fat is the primary glucose source for KA individuals)

    I respect your blog and the discussion that it gets going around very low carb diets vs a relatively low carb diet like you recommend, but I think the common theme behind your ‘Dangers of Zero-Carb Diets’ is all based on glucose deficiencies, with the possible exception being stomach cancer in Optimal Dieters

    Dietary fat = glucose levels for KA individuals.

  42. Hi Arbo,

    Yes, that’s what I’m saying. Dietary fat and stored adipose fat are both in the form of either triglycerides or phospholipids, so the glycerol content is similar.

    Cortisol and reduced T3 are different aspects of the hormonal adaptation to low glucose. Reduced T3 stimulates glucose conservation; cortisol stimulates glucose manufacture from protein.

    Fat increases glucose levels, but only 10% of fat calories are available as glucose; 100% of starch calories are available as glucose. Why not eat 100 calories of starch rather than an extra 1,000 calories fat to get the same amount of glucose? Over-eating fat, forcing disposal of excess calories through higher energy expenditure, isn’t likely to be optimal.

    My scurvy certainly wasn’t caused by low fat. I was eating over 5,000 calories a day, probably 80-90% fat. As soon as started supplementing vitamin C, calorie intake dropped to 2,000 calories per day.

    Yes, I would agree that the “Zero-Carb Dangers” are almost always problems that arise in glucose deficiency. That’s why eating some carbs fixes them.

  43. On a low carb paleo regimen (75g or less) while lifting weights/being very active, I felt my skin dried up (not puffed out, healthy) and my lips noticeably dry as well. My airways also felt dry…so that any mucus in there often hardens and obstructs my breathing. Does this happen to anyone else? I also tend to feel slightly less energetic, like in a sluggish mode, but not overly fatigued.

    Thank you,
    Dan

  44. ps. I have been very obese in the past, so I’m afraid of increasing my carbs to 20% (which is 600cal on a 3000cal rough diet). I’m still in my last phases of losing the last 10-15lbs.

    It was specifically this article that drew me to your book and diet, as I was unable to explain why my skin/mucus membranes felt drier than they should be for the past 2 months. Any input would be appreciated.

  45. Hi Dan,

    Yes, this is very common. Try adding starches until you find the amount that makes your epithelial surfaces moist.

    This shouldn’t affect your weight more than a few pounds of water weight, but in any case you shouldn’t fixate on weight at the cost of health. Eat a healthy amount of each nutrient and then lose weight with that healthy diet.

    Best, Paul

  46. Hi Dr. Jaminet,

    I noticed it’s a little over a year since my first post on this subject.

    During a trip, I befriended a few people out in Chicago, and I ended up meeting a few people who were actually treated by Kwasniewski. I also got a first hand translation of portions of his book from Polish.

    As a FYI, I figured I would give you some more info on what I was told is Kwasniewski’s opinion on certain subjects.

    The 1P:2.5-3.5F:0.5C ratio is the introductory phase of the diet. It is to be started immediately by adults who are not considered “overweight”. If the adult is overweight, the fat ratio should be reduced to 1.5-2. This introductory phase varies by person, but can be as little as a month or 2 years.

    A person knows when they are adapted when they are following the above ratios and find themselves in ketosis. At this point, Kwasniewski says to lower the fat ratio to 1.5-2x, lower the protein ratio to 0.5-0.8x and “possibly” the carb ratio to 0.5-0.8x as well.

    This carb ratio is where I think the confusion begins with his diet. Kwasniewski seems to be very specific with his ratios, but he also is really specific with min/max grams per day for proteins and carbs.

    In the intro phase, if a person is overweight or sick, Kwasniewski says that the person will probably have to increase his daily intake of protein to the range of 100-150g a day (with 1.5-2x F grams and 0.5x body weight in Carb grams). Once they are healthy, however, a healthy adult should only require 30-50g of protein a day from ideal sources (eggs, organ meats).

    Kwasniewski also states that ketosis is the worst state that a person can be in. He says that some people are so afraid of carbs that they will never eat any, and believes that is a mistake. So it seems that he is against zero carb as well. Even in the intro stage of the diet, a person should eat at least 50g of carbs a day. Now, once they are adapted to the diet, they might be able to stay at 50g a day and stay out of ketosis once they drop their protein and fat grams. But, if they drop their protein to 30-50g and lower their fat grams as well, and are still in ketosis, then the person has to increase their carbs until they are out of ketosis. His ideal range for carbs is 50-100g/day once adapted, but says that a person should not go beyond 150g/day.

    He prefers the carbs to be mostly starchy, and non-fibrous vegetables. He doesn’t eliminate different groups, but does not like foods high in fiber.

    I think that’s about it for my notes.

    Thanks.

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