Old Diets, New Knowledge: For Auld Lang Syne

As I said yesterday, Chris Masterjohn’s review has inspired me to wrap up the year with a look at the big picture. What is the current state of dietary knowledge, and where is it heading? What can we, the blog community, do to help people become healthier?

The State of Dietary Science

For decades it seems the dominant paradigm shaping official dietary recommendations has been the lipid hypothesis, which engendered hostility to dietary fat. But not all fats: in short term animal studies polyunsaturated fats sometimes lowered blood lipids. As a result, industrial seed oils, which are PUFA rich, were encouraged and natural animal and dairy fats, which are rich in saturated fats, were discouraged.

But evidence has piled up that low-carb Paleo diets high in animal foods are beneficial, and that the lipid hypothesis was mistaken about the dietary causes of bad blood lipids. It looks like the old paradigm is finally dying a well-deserved death.

But what would science be without a scapegoat, a witch for burning? Modern science needs villains, and if fat no longer serves another macronutrient will have to fill in. Many in the low-carb Paleo blogosphere took note of this comment by Dr. Walter Willett in the Dec. 20 Los Angeles Times story “A Reversal on Carbs”:

“Fat is not the problem,” says Dr. Walter Willett, chairman of the department of nutrition at the Harvard School of Public Health. “If Americans could eliminate sugary beverages, potatoes, white bread, pasta, white rice and sugary snacks, we would wipe out almost all the problems we have with weight and diabetes and other metabolic diseases.”

Of course this comment lumps safe starches like potatoes and rice with toxic carb sources like sugar and wheat. The scientists continue to overlook the overwhelming important issue of food toxins, and focus on the minor issue of macronutrient toxicity.

I was not quite sure how significant this story was until I remembered that the reason Chris Voigt started his all-potato diet was to protest the US government’s move to ban potatoes from school lunches and the WIC welfare program:

[T]he Institute of Medicine, the health arm of the National Academy of Sciences, recommended that the U.S. Department of Agriculture stop participants of the federal Women, Infants and Children program, known as WIC, from buying potatoes with federal dollars. The institute also called for the USDA-backed school lunch program to limit use of potatoes.

Under an interim rule, the USDA agreed to bar WIC participants from buying potatoes with their federal dollars. Potatoes are the only vegetable not allowed. Next year, the agency will roll out a final rule …

From a scientific perspective it’s puzzling that potatoes, one of the healthiest starch sources, would be singled out. I think this is yet more evidence that IoM and USDA dietary guidelines serve political rather than health goals, and that the strongest lobbying come from within the government itself. Potatoes are an important US crop, but they do not receive government subsidies. The major subsidized crops, wheat, corn, and soybeans, always seem to be the most highly recommended foods in IoM and USDA analyses. News reports suggest that a reason for the potato ban is the desire to get kids eating more whole grains.

Many Paleo bloggers took the new criticism of carbs as a positive sign. I’m not so sure it represents progress.

Prediction for 2011: Politics, not science, will continue to determine official dietary guidelines.

Popular Paleo Diet Books

If Dr. Willett is serious about eliminating starches and sugars, then his recommended diet will presumably look like the Cordain – Eades – Sisson – Wolf – de Vany low-carb Paleo diet: the recommended plant foods must be fruits and vegetables.

I think this illustrates the power that popular diet books have over scientists and doctors. Paleo diet books have been out for over 10 years now, and millions of people have experienced improved health on these diets. Powerful scientists are starting to surrender to this evidence. Peer review cliques can restrain the progress of science, but not so thoroughly that scientists trail more than a decade behind the general public!

This year saw Robb Wolf and Art de Vany come out with their Paleo books. I collected some diet books for Christmas, and have been perusing them. I am afraid I don’t see much progress from the books of Cordain and Eades a decade ago.

Robb Wolf’s book devotes 32 pages to a “Thirty-Day Meal Plan.” There isn’t a safe starch in the whole month!

I have a few objections:

These Diets Aren’t Paleo Diets: They are really hybrid diets pairing the animal foods of a savannah hunter with the plant foods of chimpanzees and mountain gorillas. But for at least 3 million years ancestral humans have flourished mainly in open woodland habitats near rivers, lakes, and seashores. The available plant foods were mainly the pith and underground storage organs of starch-containing plants. Archaeological evidence confirms that starches have been, with animal foods, the primary calorie sources of ancestral humans for millions of years.

These Diets Aren’t Tasty. Menus like “tuna and cabbage salad,” “chicken apple hash,” “turkey over spinach,” “pork and roasted veggie salad,” “slow-cooked rosemary veggies and meat,” “flank steak, bacon and greens,” “lamb sausage with artichokes,” “chicken and cauliflower,” “tip steak and steamed vegetables,” and “rotisserie chicken, steamed broccoli, side salad” (all taken from Robb’s meal plan) – in short, “lean meat with vegetables” – have never excited me. Such meals assist weight loss, I’m sure, but for most people such an overly restrictive diet unnecessarily removes some of the savor from life.

These Aren’t the Optimal Diets for Human Health: This is the really important issue. Now I am a fan of all of these writers: their diets are big improvements over the Standard American Diet, and they have improved the lives of millions. But their diets are not optimal for longevity or immune defense due to excessive protein and, in some cases, insufficient glucose.

Fortunately it appears that popular Paleo diets may soon evolve to include more starches. In October 2010 Mark Sisson, a bellwether, gave a partial endorsement to the potato:

Potatoes should be limited, or even outright eliminated, for this (large) subset of the population. For the lean and active, however, I don’t think a few red potatoes with dinner are anything to worry about.

A few potatoes – if they are red, and if you are an athlete. Grudging, perhaps, but a big step forward. Since the Harvard Department of Nutrition follows Mark Sisson after 10 years, we can expect potatoes to get off the government’s proscribed list by 2020.

Prediction for 2011: Paleo will become ever more popular. But it will flourish even more if “safe starches” are recognized as genuinely Paleo foods, and lean meats and protein are de-emphasized.

Food Toxins: Weston A Price Lives!

In his review, Chris called our discussion of food toxins “incredibly important.” As he points out, this very important but very complex topic could easily warrant a book (or several) in its own right:

I believe a more complete discussion of food toxicity would include the methods that humans have developed to detoxify these foods, variation in susceptibility to food toxins, the role of nutrition in preventing food intolerances, and a number of other food toxins that occur in foods …

I agree.

In framing the subject of nutrition and food toxicity, I think our “economic” analysis makes an important contribution. In this analysis, increasing doses of a nutrient provide first declining marginal benefits, then inconsequential effects throughout a “plateau range,” and finally increasing marginal toxicity.

A slight complexity is that some nutrients are complements for one another, so that (for instance) omega-6 and omega-3 fats or vitamins A and D need to be in balance.

I found that this method of analysis makes sense out of the many seeming paradoxes and contradictions in the literature. A nutrient can be “good” or “bad” depending on whether it is present in deficiency or in excess in the diet.

If this approach is correct, then the key to health is providing adequate amounts of nutrients and avoiding toxins. This way of thinking would require a big conceptual change on the part of many dietary scientists. The concepts of nutritional context and food toxicity would become unifying concepts in nutrition.

This way of thinking holds the potential to integrate distinct strands of dietary thought. An important line of dietary research studies traditional diets and their methods of food preparation. Weston A. Price and the Weston A. Price Foundation are exemplars of this approach. Stephan Guyenet of WholeHealthSource is a blogger who writes with great respect for traditional diets.

The congruence of Stephan’s approach to diet and ours is apparent in the fact that he is the most cited blogger in our book – mentioned 23 times.

Traditional cultures tended to eat a diversity of “safe” (i.e. low-toxicity) starches, and also had elaborate food preparation methods that tended to de-toxify foods. Soaking, sprouting, fermenting, and long cooking can often make toxic foods into safe foods, as Chris notes in his review.

Traditional cultures probably ate more authentic “Paleo” diets than the popular Paleo diets!  The diet of Kitava, for instance, has probably changed little in the last 40,000 years. We know that early “Out of Africa” settlers to that area around 45,000 BC were already clearing forests in order to plant yams; and were notable boaters and fishermen. Fish, coconuts, and yams remain the staples of the Kitavan diet.

There is no reason why the Paleo and traditional food communities should not reach a mutually pleasing synthesis:

  • The Paleo community should accept low-toxicity starchy plants as a healthy part of the human diet; recognize that Paleo cultures were willing to eat any food that was nourishing and low in toxins; and recognize traditional food preparation methods as genuine Paleolithic technologies for food de-toxification that enabled a broadening of the diet.
  • The traditional foods community should recognize that Neolithic foods like wheat are among the most toxic foods, and that in practical life it is not always feasible to detoxify highly toxic foods, so that it a “Paleo” style diet will most often be most healthful for most people.

One of the most exciting aspects of the current blogosphere is the emergence of bloggers who link these two communities and scientists. Stephan and Chris are two scientist-bloggers who are helping to synthesize the best threads in contemporary dietary thought.

Prediction for 2011: The dichotomy between low-carbers and traditional dieters will continue to narrow. More people will happily identify themselves as Paleo dieters and fans of traditional food cultures. In particular, increasing numbers of young scientists and doctors will be in our corner.

Integrating Medicine and Diet

The part of our book which may attract the least attention in the short run, but which we hope will have the most long-term impact, is Step Four. This part of the book stresses pathogens as the cause of most diseases, and diet as the essential therapy for chronic infectious diseases.

In his review, Chris states:

Rather than considering sanitation, hygiene, or vaccines to be the most important tools in the fight against infectious disease, the Jaminets provide a refreshing integration of the fields of immunology and nutrition. They discuss eleven dietary and lifestyle strategies one can enlist in this fight …

We’ll be discussing additional ways to strengthen immunity and heal disease in the New Year. Using diet to modulate immunity is really one of the most overlooked pathways to good health, and we have only begun to scratch the surface here.

Most doctors are unaware of the prevalence of chronic infections. New chronic pathogens are rapidly being discovered and linked to diseases. Just this year, a new human gamma retrovirus was linked to chronic fatigue, and several viruses were linked to cancers. Evidence continues to grow linking both viral and bacterial infections to neurological disorders.

Doctors are even less aware of the powerful influence of diet and dietary practices like fasting upon immune function. Patients have the ability to modulate their diet to optimize immune function and direct it specifically against the type of pathogen – intracellular or extracellular – that causes their disease.

In a recent comment, gunthergatherer introduced me to an e-book by Ron Mignery suggesting alternate-day protein elimination (a “protein cycling diet”) as an autophagy-promoting practice that should help prevent neurological disorders. This is a variation of our protein restriction, fasting, and ketogenic dieting techniques, all of which are designed to promote autophagy. Autophagy is the key intracellular immune mechanism that protects against bacterial and viral infections.

It is good to see that other people are developing the same ideas we are. Hopefully these ideas can spread beyond a few scientist-dieters into general practice.

Prediction for 2011: Evidence will continue to pile up linking bacteria, viruses, protozoa, and fungi to chronic disease. New pathogens will be discovered to cause disease in humans. But diet and nutrition will continue to be overlooked as potential therapeutic steps. Meanwhile, bacterial resistance to antibiotics will continue to outpace the development of new antibiotics. Concern by doctors, scientists, and patients will continue to largely go unheeded by the FDA and funding agencies.

Conclusion

It’s been an exciting year for us:  we published our book and began this blog. In the new year, we hope to delve more deeply into the issues discussed in the book, and explore more thoroughly how dietary and nutritional practices can help heal disease. We are excited to see if our ideas will be as beneficial for others as they have been for us.

Of course, if we didn’t have a delightful community of readers, commenters, and fellow bloggers, this would neither be fun nor productive. Therefore, we thank you all very much, and wish you a very happy and healthy new year!

Leave a comment ?

79 Comments.

  1. As one of the many who have eased into paleo from low-carb, and as a confused bystander, I would appreciate if you would address this analysis by Dr. Eades:

    ‘So, we eat our half cup of cooked potato, and what do we get? We get almost three teaspoons of sugar and carb that convert almost immediately to glucose and head directly into the bloodstream. The blood volume of a person with a normal blood sugar contains about a teaspoon of sugar, which means that consuming the potato almost quadruples the amount of sugar in the blood. The pancreas then secretes insulin to drive this excess sugar into the cells. This extra insulin then does all the things excess insulin is famous (or infamous) for doing.’

    (which comes from his blog, http://www.proteinpower.com/drmike/metabolism/resistant-starch/ ).

    I’m in the camp that considers potatoes to be a decent food . . . but I don’t know how what to think about this type of argument. I’m hoping you have given it some thought.

  2. Great post, thanks for the help, and Happy New Year.

  3. @ R.K.
    Hi, I’ll try and muddle an answer:
    The PHD prescribes enough carbs (or a tad less) to meet daily requirements (for certain body cells and tissues e.g. red blood cells and neurons, muscle and the liver (to store as glycogen)) to avoid any hyperinsulinemia or hyperglycemia. So on the PHD, for most people, those 3 teaspoons of glucose in the blood stream are easily going to be soaked up by these cells/tissues, and there’s not going to be any ‘extra’ insulin required. The amount of carb calories the PHD prescribes (~20% of total intake) will easily account for this. I.e.
    Glucose has 4 calories per gram,
    4 grams of glucose make up a teaspoon.
    Thus 12 calories/teaspoon, and 36 calories per 3 teaspoons.
    The body utilises maybe 300-400 carb calories per day (about 20% of total intake; see the PHD book), so unless you’re eating the SAD (with carbs at 55% of intake; along with a bunch of toxins) you should handle 1/2 a cup of potato (or even a cup or two of potatoes a day) with ease.
    I’d suggest picking up the book, it’s fantastic read and I suspect will help answer many questions.

    @ Shou-Ching and Paul
    Thank you for your fantastic book and blog.
    A very healthy and happy new year to you both too! 🙂

  4. Hi Shou-Ching and Paul

    I jumped over to your blog as a result of reading Chris Masterjohn’s review. I am completely fascinated by your approach. I have dabbled in the low-carb paleo world for about 3 years now and recently realised that many of these diet proponents are carb-phobic despite many hunter-gatherer civilizations, like the Kitavans and Hadzas, enjoying their primary fuel from starchy tubers.

    My rationale for this view of these new-wave paleo proponents are to provide guidance/solutions for people who’s metabolisms have been messed up by modern diets full of refined foods. They generally come from a food quality perspective, so for people looking to lose weight, or fix metabolic issues, a low-carb paleo approach might be the best way to go.

    I went low-carb paleo for about 12 months. Initially I felt absolutely amazing. But after about 12 months I realized that I needed some carbs back in my diet. About 6 months ago I started adding in sweet potatoes and rice as my main source of carbs, as from my previous research, these seemed to be the least problematic. Lo and behold, I started to feel a hell of a lot better and surprisingly I have maintained my weight. I suppose I’m now eating a PHD! I agree with your views on the popular paleo diet books.

    I am also fascinated by your views on integrating medicine and diet. 10 years ago I was diagnosed with chronic Hepatitis B. I have no idea where or how I contracted it. I am under constant care of a specialist. My liver function is normal, yet I have a very low level of viral replication and a small amount of fibrosis. Besides that, I feel great and otherwise live a normal life. Throughout my research, all dietary recommendations for those with HepB revolve around a “healthy” high-carb (at least 50%), low fat diet. Much of the information states that fat and protein are “hard on the liver”, so carbs should be the main source of calories. Based on my past paleo research and experience, I cannot fathom why this type of toxic diet would be beneficial! I would be interested in your views on this and whether the PHD would be beneficial, or the ideal diet for someone with my condition. I’m obviously not searching for a cure here (although that would be excellent!), but really looking for a way of eating that will not put any undue stress on my liver. from what I’ve read on your blog so far, I suspect that the PHD is the way to go.

    Many thanks
    David

    PS: I’m about to order your book. Can’t wait till it comes so I can learn more about your approach.

  5. Peter Silverman

    If a “safe starch” raises.my blood sugar dramatically, is it a safe starch for me?

  6. The “holidays” are over! After visiting my wife’s brother and his wife, the latter being an excellent cook of the SAD persuasion, upon our return home I found myself mysteriously craving some wholesome fermented sourdough bread. Well, actually, any artisan type of bread.

    Yesterday I bought a loaf of sourdough French bread, and since I live at the Gulf coast, made a sauteed oyster po’ boy (sub, grinder, etc). After about half an hour I noticed how crummy I had begun to feel, so I decided to check my blood sugar at the one hour after eating point. It was an astounding 180 !!!!! (10 mmol).

    At hour two, it was back down to a more reasonable 82. I guess this means no mo’ po’ boys.

  7. I’m certainly interested in an approach that is a middle ground between the paleo/primal and the WAPF/traditional foods ground, so greatly appreciate your book and blog.

    One suggestion to help spread the word: I’d encourage you to incorporate social media more in your efforts. It’d be really great if you got on Twitter.

    At the same time, you might also consider adding share links to your blog which is easy to do with WordPress. If your blog is on wordpress.com, you can do this on the dashboard under Settings -> Sharing. If not, there are multiple plug-ins that will also work, like http://wordpress.org/extend/plugins/share-this/

  8. You have an excellent book and I appreciate your approach (by the way, I know your wife is involved with this project-is she also going to blog?).

    I have also migrated toward Stephen Guynet and Chris Masterjohn (as well as you guys) as important and reliable sources of good diet advice. I like Chris kresser too, although he takes a more traditional alternative approach.

    I am excited to implement some of these immune strengthening techniques, especially after having a two and a half week long cold over Christmas (The official photo title for this Christmas was “2010-Sick Christmas” as 5 out of 6 of my family became ill). I remember listening to an interview of Dr. John Hernandez (MD) several years ago and he used the analogy of draining the swamp to make life inhospitable for the pathogens rather than trying to kill each individual mosquito with a fly swatter in a filthy swamp to describe the importance of nutrition in fighting pathogenic disease. He was also very big on biofilms (something I hadn’t really heard of before that interview). Obviously, if we drain the swamp first, using medications to clean up the rest is more like using heavy artillery than a fly swatter.

    I am excited to read more posts-keep up the important and great work. Happy new year!

  9. Hi RK,

    Glenn did a pretty good job.

    To start with, we should distinguish between glucose and sucrose which is half fructose. Fructose is much more toxic than glucose. By calling glucose “sugar” he is calling to mind associations with the harmful effects of table sugar / fructose. This is a bit of a rhetorical trick which makes potatoes sound scarier.

    A half cup of potato weighs 125 g and has about 83 calories of carbs, which digest to glucose.

    The human body uses about 600 calories of glucose per day, some for energy, some to make glycoproteins such as mucus for the intestine and respiratory tracts, tears and saliva, joints, and cellular junctions, and some for immune response.

    So this half-cup of potatoes is supplying about 3 hours worth of the body’s glucose needs.

    The liver can store around 300 g / 1200 calories glucose as glycogen. When blood glucose is high after a meal glucose is put into these glycogen reservoirs; when it is low, e.g. during the overnight fast, it is released to maintain blood glucose levels.

    An advantage of eating a low-carb diet (less than 600 carb calories per day) is that these glycogen reservoirs don’t fill up and the body can readily manage its blood glucose levels without having to use “fallback” devices such as converting glucose to fat. (Not that those devices are necessarily unhealthy!)

    Insulin in the low doses necessary to manage daily glucose levels contributes to good health. Type I diabetics, who can’t produce insulin, have impaired health even if they never eat carbs.

    So, we don’t want an excess of either glucose or insulin, but eating a pound of potatoes a day won’t produce either, except in some people with severely damaged metabolisms.

    Best, Paul

  10. Hi DMF,

    Your experience is similar to mine and very common. The body adapts to glucose scarcity by downregulating production of glycoproteins (like mucus) and this has many negative intermediate-term and long-term consequences.

    I do think the Perfect Health Diet is more or less optimized for immunity to viruses, so it should be great for you. I would agree that protein is undesirable, you want to promote autophagy and protein restriction is very helpful here. In trying to recycle protein, your cells will destroy viruses in order to recycle them for their nutrient value.

    Dietary saturated and monounsaturated fat is good for you but polyunsaturated fat does need to be limited. I am sure the “research” you cite is concerned about fatty liver disease, but this is primarily caused by mixing polyunsaturated fats with fructose or alcohol, or by nutrient deficiencies such as choline deficiency. Fatty animal foods and eggs are rich in choline and low in fructose, alcohol, and (in most cases) polyunsaturated fat, so will do you good.

    Carbs should be fine for you as long as they are “safe starch” low-toxicity carbs. You do want to minimize fructose, but no need to avoid fruits and berries.

    I think you’ll find our book helpful and we’ll continue to refine the book’s advice on this blog.

    Best, Paul

  11. Hi Peter,

    Maybe not … or the quantity may be too large … or you may just be unadapted to starches. I would need more details and personal history to answer this question.

    Hi Jim,

    Quite a jump! Does rice do that to you too, or is it just wheat?

    Hi Beth,

    Thank you very much for the helpful advice. Facebook etc. are very much on my list for the new year along with Kindle / ebook versions.

    Hi Thomas,

    Shou-Ching doesn’t want to write blog posts because she works 70 hours a week writing grant applications and papers and working in the lab and doesn’t want to do science writing at home as well. But she likes to discuss the science and to do the food/cooking posts and photography. If you see any cartoons, they’ll be her work too.

    We like Chris Kresser very much, I didn’t mean to leave him out! We discovered him a little late, after most of the book was written, so he didn’t have as many chances as Stephan to get cited, but he’s certainly worthy of citations.

    Dr. Hernandez’s analogy is very good. The world is swamped in germs and we are exposed to millions of germs a minute all the time. It’s necessary to have a well-functioning immune system or these germs will eventually weigh us down.

    Best, Paul

  12. Paul, you’re probably aware of Paul Ewald’s hypothesis that many common illnesses are in fact infectious.

    https://secure.wikimedia.org/wikipedia/en/wiki/Paul_W._Ewald

    I’ve said before that I think your book is the best of the paleo/low carb books that I’ve read; you are to be congratulated not only on such a fine piece of work, but for the fact that you and your wife are helping so many people. When everything is going well, most people pay little attention to nutrition, but when they’re ill, they look for answers, and many of the answers are to be found in your book.

  13. I also think that your version of paleo is by far the most adequate. I noticed taht on traditional paleo diets, the concept of fructose is mostly misunderstood or simply not adressed, as well as the going too low starch in that mucus membranes dry out. I am glad that you guys share the opinion that when given the choice between a safe starch or fruit, the safe starch should be chosen.

    Also, I was wondering why you recommend nuts at all? I mean, I know that eating almonds would be better than eating flax seeds (high polyunsaturates), but nuts are very high in plant proteins (with the exception of coconut and maybe macademia nuts, right?). If I can, would it be ideal to entirely avoid nuts, and get all my fats from olives/olive oil, coconut/coconut oil, butter, cheese, yogurt, and fatty meats/fish?

    By the way. Yours is the only paleo diet that seems to be working for me. All the others stress too much lean protein and too many fruits and vegetables and not enough fat. I noticed that when on these, I dry out, can’t concentrate, and have low energy levels.

    I have stopped eating all lean meats and have also stopped consuming isolated whey protein suppplements. In only the past three days, I’ve noticed a significant difference in many aspects including but probably not limited to vastly improved digestion, improved concentration, and improved athletic endurance. I’ve been keeping my fats very high, at about 50%, carbs at about 30% (sweet potatoes, yukon golds, and jasmine rice), and protein at about 20%. This seems to be working well for me. However, last night I did eat a half of a whole chicken, but I don’t really see a problem with this, becuase it is what my body seemed to be craving. I think our ancestors would gorge like this sometimes, just not at every meal.

    Keep up the good work. YOur really doing great things and improving the lives of many!

  14. “The body adapts to glucose scarcity by downregulating production of glycoproteins (like mucus) and this has many negative intermediate-term and long-term consequences”.

    Could you expand on the specific consequences of glucose scarcity or direct me to where you may have already discussed it? I’ve been very low-carb for 8 years now but have not felt as good as I think I should and have a few minor health niggles. I’ve ordered the PHD but I’m still waiting for it to arrive – is it covered in the book?

    Like others I’m also gravitating towards more of a middle ground between the low-carb/paleo approach and traditional foods. Yourselves, Chris M, Chris K and Stephan are at the top of my bloglist now.

    Just recently I’ve added small amounts of potatoes back into my diet with no ill-effect and intend to start adding in a few rice dishes too. It certainly makes a difference – in my opinion cauliflower rice and faux potatoes are no substitute for the real thing!

  15. Hi Dennis,

    Happy New Year! I’m grateful for your praise of our book, I just got an email today from someone who learned about our book from your site and says it has helped him already.

    I was vaguely aware of Ewald but had forgotten him when I came to the same conclusion independently as a result of learning that my own disease was due to chronic infections. Now if I were revising our book I would cite him and say that we totally agree. I believe that toxins, malnutrition, and pathogens together cause nearly all diseases.

    Hi Nelson,

    Nuts are varied in their nutritional value and toxicity. Macadamia nuts are very safe and healthy.

    I’m glad you’re doing well and hope you have a very healthy new year!

    Hi GeeBee,

    The best discussion of problems of glucose scarcity would be our zero-carb dangers series, which is still in progress but taking a break for the holidays.

    The first four installments are:
    http://perfecthealthdiet.com/?p=1032
    http://perfecthealthdiet.com/?p=1077
    http://perfecthealthdiet.com/?p=1139
    http://perfecthealthdiet.com/?p=1177

    Happy New Year!

    Best, Paul

  16. Such a soft stance on wheat et al. Why attempt to treat a poison when it can be simply avoided? Yes, you can somewhat reduce the antinutrient content in some of them, but wheat(and other gluten grains), soy and corn are not, and never will be, ‘wholesome’ or ‘nourishing’. It’s garbage. And putting tedious effort to turn it into less poisonous garbage seems like a waste of time. An even greater waste of time is making any of them a dietary staple.

  17. Hi Kirill,

    We recommend complete avoidance of wheat, and have frequently called it the “most toxic food” (see e.g. the posts in this category: http://perfecthealthdiet.com/?cat=57). We also favor complete avoidance of soy and corn.

    So I’m a little confused about where your comment is coming from. Are you assuming that because I respect the Weston A Price folks that I would endorse all of their views? If so you are mistaken. I am expecting a middle ground to be reached on a non-toxic diet, and don’t believe that food preparation methods can totally detoxify the most dangerous foods.

    Best, Paul

  18. Hi Paul

    Many thanks for your response. When you refer to polyunsaturated fats needing to be limited, I assume you mean omega-6 fats? Or should I be limiting omega-3’s as well? I used to take fish oil, but I stopped about 6-9 months ago as I was concerned about their rancidity, both with the manufacturing process and inside my body. I now try to eat fish whenever I can, usually several times a week.

    Regards
    David

  19. I would like to ask a further question concerning nuts: I like to bake with nutmeal as I like some baked low-carb food in my diet and coconut flour, which does not contain PUFAs, isn´t ideal for baking, I feel. Is it dangerous (oxidisation of PUFAs)? And what about fish? I always bake/cook/fry it. Is it dangerous because it is high in omega 3 that might oxidise as well??
    Thank you!

  20. gunther gatherer

    Paul, can you elaborate further on how to implement a ketosis/protein cycing strategy?

    It is pretty simple to restrict either protein or carbs, flipping back and forth at will. But problems start when you enter the “safe starches” such as potatoes and white rice. These foods contain high enough amounts of both carbs and protein to ruin one’s efforts at staying in one state or the other.

    In order to keep ketosis clearly separate from protein restriction, my only choice has been to avoid these “crossover” foods entirely. It’s interesting to note that they are pretty Neolithic in origin too, though they may not cause outright health problems. Of course, liver and thymus have some glucose in them too, so there seems to be a fair amount of grey area between these keto/protein-restricted states… Just wondering what your thoughts are on this, cheers.

  21. gunther gatherer

    Come to think of it, nuts and dark chocolate blur the line as well due to high carb/high protein overlap. Prolly best to restrict these things for special occasions?

  22. Hi David,

    Yes, I mean both. We recommend eating 1 lb/week salmon or sardines for omega-3s; but no supplements, due to rancidity concerns. See http://perfecthealthdiet.com/?p=55. However, omega-6 restriction is important, and omega-3 also should be limited. You can get too much omega-3 also.

    Hi Iris,

    Oxidation of PUFAs is a concern. You should look up the PUFA content of the nuts you’re using. A lot of people use almond meal, in which about a quarter of the fats are PUFA.

    Lower temperature cooking is safer. We bake salmon rather than broil or grill it. Poaching is good. Cooking in water or fluid so that the temperature doesn’t rise past boiling helps avoid toxin production.

  23. Hi gunther,

    Well, I think there’s a lot of leeway if you’re on low-carb diets because protein will be used for gluconeogenesis. So you can create a scarcity of protein even while eating some.

    Let’s say glucose needs are 500-550 calories per day and you eat a pound of potatoes a day containing 370 carb calories and 30 protein calories. So you’re in a glucose deficit of 130-180 calories per day which is made up by gluconeogenesis and if the potato is your only protein source, you’re taking 100-150 calories protein from muscle or autophagy (not counting other sources of protein loss).

    The body tries to preserve muscle so it will trigger autophagy fairly early.

    Now, I don’t think it’s that safe to be below this level of carb+protein routinely, that leads to the “zero-carb diet dangers” of insufficient glucose. But you can be below this level transiently almost every day by living at the margin (e.g 600 carb+protein calories per day) and intermittent fasting. 12-16 hours into the fast, autophagy should be strongly turned on.

    What may be even better is to try to average 600 calories per day carb+protein, but go below some days (“autophagy days”) and above others (“muscle building days”). Then you would catabolize muscle due to protein scarcity on the autophagy days and anabolize it on others. This could be integrated with workout days, e.g. if you lift weights 2 days a week, time protein+carb consumption within a 24 hour window to maximize muscle synthesis following workouts, then have a 48 hour period of protein scarcity.

    Coconut oil is another wrinkle, since ketosis independently promotes autophagy, and conserves protein and glucose. If you eat shorter-chain fats, you can make ketones even if glucose is abundant. So you could try a glucose + MCT + fats diet for autophagy days.

    These are just ideas. Another complexity is that instead of eating complete protein you could design an amino acid mix to promote autophagy. Eating a lot of ketogenic amino acids but few gluconeogenic ones might promote autophagy and preserve muscle better than a complete protein diet.

    Best, Paul

  24. Hi Paul,

    Following your advice, I added back a bit of “safe starch” last week, and decreased protein intake, keeping sat fat and MCF pretty high. Well, I got on the scale today and have managed to put on 5 pounds! I’m trying to figure out what is going on and what I need to tweak. I do need to lose a good 20-30 lbs, and while I don’t want to compromise health, I also don’t want to put back on what I managed to lose doing a VLC diet.

    Is this an adjustment period I need to get through? Maybe I’m one of those broken metabolism folks who has to stick with VLC?

    Any advice would help.

  25. gunther gatherer

    Thanks for your reply. Given this mechanism, and short of having your own lab to design special amino acid mixes, the best method is probably the evolutionary one: eating fruits and vegetables for a day or two and then punctuating this with “successful hunts” (protein).

    And thanks for the MCT tip: this would be an excellent tool to use for protein restriction days in order to “fake” ketosis even while eating only fruits and vegetables for the day. I suppose you could have ketosis every day with a spoonful or two of coconut oil, regardless of whether you’re restricting carbs or not. Maybe that’s the secret of the Kitavans?

  26. Hi Maggy,

    5 pounds in a week is a lot of excess calories. If that’s fat then it is 20,000 extra calories which in a week is 3,000 extra calories per day.

    I don’t think we can infer any hormonal or metabolic issues, except in appetite regulation. This kind of weight gain is too rapid to be anything other than appetite exceeding caloric needs.

    There is a lot of research on leptin resistance in the hypothalamus impairing the brain’s awareness that calories are going into storage and leading to an excessive appetite. It could be that something like that is going on in your case. If so you have to make up for it by consciously controlling your appetite.

    One benefit of the “lean protein and vegetable diets” is that they don’t stimulate appetite. That’s about the least appetizing (most satiating) diet known. Whereas carbs and fat together tend to stimulate appetite.

    I think it’s healthiest to eat in the Perfect Health Diet proportions, but you may need to adapt the diet to your tastes and appetite control needs.

    The first step is probably to count calories for a few days and get a clearer understanding of what you are eating.

    The second step may be just to focus on losing weight for a few weeks. That will give you a feeling for both sides of equilibrium — weight gain and weight loss diets — and help you find the place you want to be.

    For that, I would suggest carbs+protein adding to 600 calories per day, and then just enough fat to make foods palatable. Maybe 400 calories per day fat. So that would be 1000 calories per day. This will be a weight loss diet for anyone. Be sure to supplement with all the recommended micronutrients. If you’re getting adequate carbs+protein and micronutrients, this will be healthy and should not make you hungry. Eat 3 egg yolks a day as part of your fat intake to insure adequate choline.

    This is basically eating carbs and protein in Perfect Health Diet ratios and restricting fat a bit so that the extra fat is coming out of storage.

    I normally don’t like to suggest severely calorie restricted diets but I think it’s important for you to experiment a bit to understand how your appetite and weight changes depend on the mix and quantity of foods you eat.

    I am very interested in understanding what is going on so I hope you will keep experimenting and keep me posted on your experiences.

    Best, Paul

  27. Hi gunther,

    There’s no doubt that coconut oil has a big impact on Kitavans – it is their primary source of dietary fat, and they have very low blood glucose levels as a result, fasting glucose is about 60 mg/dl.

    Would be nice to have thorough longevity, disease, and biomarker data on the Kitavan population but alas we will have to generate that data ourselves!

  28. Paul, I will track on fitday starting tomorrow and let you know what happens. Am I correct in assuming that the protein + carbs should be held at the 600 calorie goal, while decreasing fat calories? (Seeing the carbs as the non-negotiable part is a pretty big paradigm shift for me.)

    My thought was to do a 36 hour fast and see if that kick starts things. Perhaps I’m misunderstanding the purpose of the long fast?

  29. Hi Maggy,

    Yes, that’s right. Carbs are the non-negotiable part, fat you have stored in large quantity in your body so you can go without that easily, not so with carbs. You can mix up carbs with protein to some degree, eat fewer carbs and more protein, many people find this helps them lose weight.

    I do think fasting is a great idea and a big help for weight loss. You can also try intermittent fasting for 16 hours each day, you’ll tend to eat less if eating is compressed into an 8 hour window. Be sure to drink plenty of water and electrolytes while fasting (at a minimum, some salt).

    Experiment and see what works for you. But I think tracking calories on fitday for a few days will be a big help, it will help us understand what’s going on. Keep in mind that fat is 9 calories/g and they can add up quickly, so a visually small amount of fat can be a very large number of calories.

    Best, Paul

  30. Yours is by far, the best Paleo / Ancestral diet that makes sense. And finally someone with some balls to stand up to people like Sisson, deVany and Wolf on the stance of a flamin potato. I was very strict Paleo for a good 8 months, and yes felt fantastic and lost 10ks etc. But then started feeling tired, moody. Enter some carbs (from the suggestion of your book) in the source of potato and rice and taro – and now I’m feeling a whole lot better. Did I put on weight. Of course not! Essentially now I eat what my body craves. I can listen to it now and it responds accordingly. It knows when it needs more carbs (eg., after exercise). And it knows how much as well. There are 2 blogs I follow now. Carb Sane Asylum and yours. Just brilliant.

  31. THe protein restriction is interesting for autophagy. Chris Masterjohn mentioned a vegan diet that he did for 2 weeks that restricted protein and it got rid of the warts on his hands which haven’t come back since he commenced eating meat.

  32. Hi Sue,

    For viral infections, there’s nothing better than inducing autophagy.

  33. “For viral infections, there’s nothing better than inducing autophagy.”

    Hi Paul,

    Do you think this statement applies to a cold virus and to an individual in the initial stages of a cold, or just to the deeply embedded virus types you have implicated in disease elsewhere, CHD, Alzheimers, etc?

    My experience has been that fasting, even moderately with IF, seems to lead to colds. It really is hard to say though because some of this experience could easily be coincidental.

    I suppose it possible autophagy could theorectically hunt out some virus types while weakening the immune system aginst another invader?

    Thanks and Happy New Year to you and yours!

  34. Hi Perry,

    “Feed a fever, starve a cold” = feed many bacterial infections, starve viral infections.

    I wonder if you may be malnourished in some way, or if you have some kind of chronic infection that flares up when glucose is low.

    Yes, autophagy helps only against intracellular pathogens (which tend to produce chronic issues). Fasting / glucose deprivation hurts immunity against extracellular pathogens like fungi and some bacteria. So if, e.g., you had some chronic fungal infection of the sinuses it could flare up during a fast and produce a sinusitis.

    Best, Paul

  35. Hello Paul and a late happy new year!

    Your last post make me think as I just have had a (albeit mild) sinusitis. I am and always was prone to this and when I was younger it got to me quite often (3-4 times per year). Nowadays it’s maybe one time per year, rarely two, and less sever and this time it was over after 6 days with doubling my vitamine C dose to 2000mg and early treatment with inhalation of menthol (tiger balm).
    Anyways, I never heard before that it might be a chronic fungal infection!
    Do you have any further dietary advice on how to get ridd of it completely?

  36. Hi Paul,

    The one thing I struggle with is how best to consume the large amount of fats required once meeting the 600 calories per day of carbs+protein.

    Typically I consume butter, cheese, heavy cream and olive oil (homemade salad dressing) to attempt to reach this. I haven’t found great ways to incorporate coconut oil in sufficient quantities. I still end up struggling to eat sufficient fat.

    Do you have any recommended strategies for getting 1,000-1,400 calories of fat per day?

    Thanks!

  37. Hi Franco,

    I think with good diet and nutrition and time, your immune system should gradually clean it up. If it’s fungal, epithelial surfaces throughout the body are reservoirs so you want to provide bacteria that can outcompete them. The gut is the main one. Fermented foods can therefore be helpful.

    Hi Ken,

    You can eat more than 600 calories carbs+protein if you like. That’s our minimum and there’s plenty of headroom to increase carbs and protein if those are more to your taste.

    But we’ve never had difficulty getting fat. Choose fatty cuts of meat – salmon and fatty cuts of beef with the fat still on the steak. Put butter or cream cheese on potatos/starches. Add egg yolks to rice and other foods. That should do it.

    Best, Paul

  38. So when you have fatty meat how do you work out how much of that piece of meat is fat calories?

  39. Hi Sue,

    You can look it up at fitday.com or nutritiondata.com.

    However, as a general rule of thumb, fattier cuts of meat like salmon or ribeye steak with the fat untrimmed are about 2/3 fat, 1/3 protein. Moderate cuts like round steak are maybe 1/2 fat, 1/2 protein. Dry, lean meats like chicken breast or white fish are more like 1/3 fat, 2/3 protein.

    We favor bringing all meats toward the 2/3 fat, 1/3 protein ratio. So salmon or untrimmed ribeye or eggs (68% fat) you would eat as is, moderately fatty cuts you would cook in oil or add a small amount of fat, and lean meats you would add more fat to them.

    Similarly if you mix some fats with your starches, then you’ll get to a 65% fat 35% carb+protein ratio fairly easily.

    So if you think of bringing all foods by taste to the level of fattiness of eggs, salmon, or untrimmed ribeye, then you should be good.

    Best, Paul

  40. I’m suspecting that the five pounds that Maggie gained were water and not fat. When you are very low carb, glycogen in the liver and muscles becomes depleted. When you add carbs back in, it replenishes the glycogen and pulls a fair amount of water in with it.

    When I was zero carb, I would lose a lot of weight during the first week or two and then at a much slower rate after that. If I had a “carb day”, I would easily gain five pounds or more overnight. There is no way I can eat that many calories in one sitting, so I am sure most of it was water. It would generally drop off in a week or so after going back to zero carb.

    I’m not suggesting that she go back to VLC to lose the water weight – just that she may have to live with until her body compensates. It’s body composition that matters, not a number on the scale.

  41. Thanks, Frosty. It sounds like a good explanation. Maggy’s experimentation should give a clearer picture of what’s going on.

  42. Hello Paul. Frosty, thanks for your input.

    So, here’s my macronutrient breakdown in calories for today:

    Fat: 835
    Carbs: 85
    Protein: 207

    I fasted until about noon, taking only coffee with about 3 tbsp. heavy cream in the morning.

    I am glad, Paul, that you have not demonized coffee, as so many who blog on health and diet seem to do. I drink about 3-4 cups a day, with 2-3 tbsp. heavy cream (@ 50 calories/tbsp) each time. This is where the majority of my fat calories come from. Sometimes I’ll put a spoonful of coconut oil in as well. I find coffee plus cream helps curb my appetite tremendously, and is very soothing in the cold weather.

    I stayed on the low side with carbs today. My total caloric intake was close to 1100, so a little bit over what Paul suggested, but still pretty low. Tomorrow I will make a point to keep the protein lower than carbs.

    Maybe some additional detail will be helpful in figuring out what’s going on. In the week or so prior to the day I weighed myself and discovered the 5 extra pounds, I had done several very vigorous sessions of Vinyasa yoga (in a heated studio). It involved a lot of movement, long holds, and much sweat. I hadn’t exercised for about a month before that due to an injury (the injury actually being the catalyst for my decision to put my health in a position of priority, work on losing weight, improving my diet, etc.). I am fully aware that exercise does not translate into weight loss, at least not in the short run. But could an increase in physical activity coupled with adding carbs result in weight gain, be it water weight or whatever? I’m thinking about Frosty’s suggestion about glycogen pulling in water; specifically, whether depleting the muscle of glycogen through exercise and then introducing starch might have triggered water weight gain.

    I am wondering when I should weigh again. I know that daily weighing is not really informative, and I don’t want to get hung up on numbers, but I would like to have more data to go by and to offer for consideration.

    • Hi Maggy,

      That’s interesting about the coffee. I drank a lot of coffee and cream over the summer, and found it really suppressed appetite but surprisingly didn’t lead to any weight loss even though it seemed I was eating much less. But the coffee led to significant bloating for Shou-Ching, I think she had an allergy to it; and I dislike the coffee taste so I was covering it up with cream (usually 50-50 mix) and getting a lot of calories from cream, and I wanted more real food. So we went back to green tea.

      I’m still confused over what changed in your diet at the time of the weight gain. Do you think you were eating a lot of calories during the period it happened? Did you start drinking more cream at the time?

      I think a little bit of time may be needed to sort this out, but it’s very interesting. Thanks for keeping us posted. As long as weighing doesn’t bother you, I think more data is better, although we must keep in mind that it is noisy data.

      Best, Paul

  43. Hi Paul
    Re Maggy C. post of Jan 2/ 5# gain. A long shot is that some of the gain may be increased inventory of feces if the added carbs contained a lot of fibre. Of course, fibre could not account for most of the gain. My personal experience is an estimated loss of 2 lbs weight (feces) over a period of 10 days as a result of deliberate and severe fibre restriction. The motivation for this post is the hope that you will post on effects of high/low fibre diet. My experiment has had interesting effects on nocturia and colon motility, but this is not the place to discuss that.
    Morris

  44. Hi Morris,

    I’d be curious to hear your experiences. We’ve had a really tough time making up our minds about fiber. I think quality is more important than quantity. It might not be bad to starve the gut bacteria once in a while.

    Best, Paul

  45. Paul, I don’t think I was drinking more cream. If anything, I was replacing some cream with coconut oil. Who knows? What I will try to do is to recreate for the next few days my macronutrient intake prior to adding carbs, see what that does, and then add a bit of starch and see what happens. I am wondering if my high level of fat intake in the presence of even a little starch isn’t working. Dang! I really love my heavy cream! Given the option, I’d take cream over starch any time. I’m not crazy about rice or potatoes, but understand the important role glucose plays in human wellness. Eating starch results in me feeling hungry in a way that I don’t experience when I leave it out. Maybe this is something that passes with time and adjustment?

    Regarding coffee n cream, I should mention that I don’t guzzle it. I’ll make a cup and sip as I go about my stuff. Very often, I will get involved in something and forget all about it and end up not even finishing the cup.

    Will weigh in the morning and let you know.

  46. Hi Paul
    In brief, separate from low carb experiment (ie 4months into LC) I began to starve gut bacteria by restricting fibre from an estimated 30-40 gm/d to a measured 10-15gm/d (averages include fast days) and by a weekly fast of 36hr in addition to eating only during an 8hr window for 3-4 days /week. My estimate of feces inventory change (2 lb) is very rough, ie belly protrusion, it could be more. I am lean and the amount of belly visceral fat has not changed. At first there was no noticeable change but after week 4 of fasting there was a very noticeable change in belly protrusion, coincident with reduced volume of BM, to roughly 1/3 of previous. Feces transit time decreased to 3-4 days, gauged by time to zero output from day of total fast. Previous transit time is only rough estimate of say 5-7 days. In addition, from (friendly) colon noises and sensations, I infer that motility is much increased. During week 1 & 2, there were very minor and brief stabs of discomfort in the lower left colon region on days of total fast. Stool morphology underwent some interesting changes but that is too gross to discuss. Interesting effect on my nocturia (3-4 times per night previously) began after about week 6. Now nightly urination is sometimes only once and more often only on waking (after ~8hrs). My Polyuria is also much improved, I no longer find johns irresistible. BTW, I am 71yo. My naïve explanation is 1) Reduced stool pressure on bladder so larger available volume and 2) Shorter residence time of smaller feces -> less water extracted from feces -> is less water for kidneys and bladder to process/store. There may be longer term benefits to BPH but that would take 1-2 years to show up.
    Morris

  47. gunther gatherer

    Hi again Paul. Since the coffee thing was brought up, I was going to ask if you use it for autophagy too. It seems caffeine is an autophagy inducer. I think Art de Vany and Ron Mignery both point this out in their separate dietary regimes.

    Perhaps the “autophagy days” you recommend could be further boosted by protein restiction+MCT+coffee?

  48. Morris, fwiw, I don’t think my issue was an increase in fiber. I made it a point to add sweet potato and white rice. I wonder, though, if it might be worth adding starch more gradually, a half oz or so at a time, to allow for adjustment? I also wonder if it matters at what time of the day the carbs are eaten. I was putting them with my main meal in the evening, but now I wonder if eating the starch earlier in the day might be better?

  49. Since a potato is ok to each, and since humans convert the starch in potatoes to glucose almost immediately, than pure glucose should be similarly ok?

    In other words, it should be ok to eat candy and chocolate, etc., as long as it is sweetened with dextrose (glucose), rather than sugar?

    Any flaws in the logic?

    Albert

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