Experiences, Good and Bad, On the Diet

A number of people have now given us feedback after starting the diet, and I think this is a good time to review the effects, good and bad, that people have experienced.

In upcoming posts, I’ll discuss the negative experiences further and explore possible causes.

Positive Experiences

It’s gratifying that most people who have tried our diet have reported very positive experiences. Those who read the comment threads or Amazon reviews will have seen some of them; I get others via email.

Here are two from Amazon reviews:

I have battled Celiac disease for some time and got about 80% better with a Paleo diet… but the Perfect Health Diet was the first book that could finally answer that last 20% with science based logic. (Jordan Reasoner)

UPDATE: Jordan has an e-book, SCD Lifestyle: Surviving to Thriving, which looks great for bowel disease sufferers. He gives us an update on his personal progress in the comments.

I can’t believe how much better I feel!…

I had been eating (very) low-carb and high-protein for the better part of a decade – and I had gotten a lot of practice arrogantly dismissing suggestions (from any source) that I should change anything about my diet….

Results: (after 1.5 months or so.)

  1. I’m no longer “brain-dead” and unable to think in the evenings after work.
  2. I no longer have fruit or chocolate cravings.
  3. I’m much happier, and wake up looking forward to the day.
  4. I’ve been much more social.
  5. The extra starch has not resulted in weight gain. (I always gained weight when eating carbs before.)
  6. It looks like the fasting (which I’ve never tried before) is helping my alertness and also contributing to healthy weight loss.

It took less than a week for me to notice dramatic changes….

I can’t recommend this book highly enough. (gp2x)

Here are two from the last few days’ comments.

Yours is by far, the best Paleo / Ancestral diet that makes sense….  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. (Lisa Weis)

Since reading Gary Taubes’ Good Calories, Bad Calories my life has been transformed. Who knew that butter was a healthy food.  Previous to reading GCBC I was a fruit fiend.  I ate bowls and bowls of cherries this past summer and wondered by I could not lose weight.  I reached my weight loss goals by eliminating grains and limiting dairy to butter and cream and reducing fruit intake.  That said, over the last month or so, I was wondering why my body seemed to be drying out from the inside out.  I want to tweak my diet to optimum health and found your book. The information about the importance of mucin was helpful.  What was missing in my diet was the carbs that you and the missus recommend.  Sweet potatos, white rice etc.  Maybe less protein than I’ve been eating and more saturated fat.  (I’m alarmed by the stomach and other cancers suffered by long term adherence to the Optimal diet …)  I’m having better results every day.  I am fascinated that I have a laboratory of my own body to put your ideas to a test and have them show positive results.  Thank you both so much for your work and above responses to questions and comments. (Doris)

I think these positive experiences are impressive considering that most of our readers have come from the low-carb Paleo community. Low-carb Paleo diets are far healthier than the Standard American Diet, and so improving health further is quite an accomplishment.

Another group that we are trying to help are people with chronic diseases. Probably most readers who did not arrive from the low-carb Paleo community have come from the chronic disease community. It’s a little early to report results, but at least some people are finding promise in our diet. Natalie wrote:

As someone dealing with chronic disease (a very unfun combination of Lyme, Babesia, and Bartonella), I know I’m always looking to find out more of what has worked and what did not work for others.

This blog along with many of the readers of this blog have been a tremendous help to me personally.  For example, I now know I can avoid the daily “coma naps” if I don’t go crazy on the carbohydrates.  I’ve actually received some excellent diet advice from my doctor, but he never told me to chill on the carbs!  (Natalie)

Ketogenic diets are frequently mentioned by us as potentially therapeutic for many diseases. I’ve blogged previously about Claire’s discovery that ketogenic diets help her gastroparesis and Rob’s suppression of his lifelong migraines through fasting and ketogenic dieting.  

As more chronic disease sufferers try the diet – for instance, Darren who has Lyme disease – we hope to prove that the Perfect Health Diet in conjunction with antibiotic therapies can lead to cures for these difficult-to-treat conditions.

Negative Experiences

So far, all the negative experiences I am aware of have come from low-carb dieters who had difficulty after adding carbs and/or cutting protein.

Don Matesz is an interesting case, because his own diet was already a “Perfect Health Diet.” His diet, if I’m not mistaken, was in the low end of our carb range and high end of our protein range. As a test he reduced protein and added carbs, heading toward the high end of our carb range and low end of our protein range. He didn’t like the results:

Just to experiment, for a couple of days Tracy and I reduced our meat intake by half.  I reduced my meat intake from more than a pound daily to just about one-half pound, and, as the Jaminets suggest, replaced the protein with starchy carbohydrates (potatoes and sweet potatoes).  For both Tracy and I, this resulted in a noticeable decline in mood and a dramatic increase in hunger and intestinal gas, along with a disruption of bowel function….

UPDATE: Don says that he does best eating above the bottom end of our optimal carb range, but that for years he has gotten into trouble whenever carbs reach 100g/day (the middle of our optimal range). It sounds to me like an unresolved gut dysbiosis.

Don’s commenter SamAbroad had a similar experience with reducing protein intake:

But I’ve also been following the PHD, and to be honest, I am so hungry and cranky when I restrict protein.

UPDATE: SamAbroad turns out to be our Sarah, and she says that the Perfect Health Diet “has been one of the best things I’ve ever done for my health.” Maybe we should move her to the Positive Experiences group!

I’m still following the diet, I eat circa 100g carbs from starch a day not including veg and this has been one of the best things I’ve ever done for my health along with including a vitamin C supplement. My low-level depression and anxiety have completely disappeared and the diet is considerably more varied and easier to stick to than VLC.

Sarah’s issue is that she needs to eat at least the midrange of our carb+protein “plateau range,” for reasons as yet unknown.

Chris Masterjohn had trouble with sweet potatoes:

Although sweet potatoes are considered a safe starch on the Perfect Health Diet, they are not very safe for me. When I discovered how yummy sweet potato fries are, I started eating several sweet potatoes per day. Within a few days, I was limping and my neck was stiff. By the end of the week, my limp was extreme. I looked online to see if I was eating anything high in oxalates, and sure enough, sweet potatoes are loaded with them. My symptoms dramatically improved after one day off sweet potatoes and were gone the second day.

Chris’s commenter Lisa also had trouble with sweet potatoes:

I’ve been very achy since I started eating sweet potatoes daily. Why would some of us be maladapted to oxalates?… I’m wondering if after a long stint of LC/paleo eating I’ve become intolerant to oxalates or to starch in general.

UPDATE: We discuss possible reasons for problems with sweet potatoes here.

Several people have gained weight after starting the diet. This Amazon review doesn’t come right and say that the reviewer experienced weight gain, but I’m guessing that was the case:

It is worth emphasizing what another reviewer noted: The Perfect Health Diet is not focused on weight loss. In fact, if you are coming to the diet from a zero-carb or very-low-carb regimen, you can count on an immediate and substantial weight gain if you suddenly adopt the recommended intake of “400 carb calories [100 grams] per day of starchy tubers, rice, fruit, and berries.” (K. Hix)

From the comments, Maggy reported weight gain:

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? (Maggy)

These negative experiences will be the subject of my next few posts.

Because individuals are so variable, it is often not possible to figure out what is going on without experimentation with different dietary variations and considerable communication. Therefore, I’m most grateful to people like Maggy who are willing to experiment and share their experiences with us.

Conclusion

It’s interesting that the same dietary change – adding “safe starches” to a low-carb Paleo diet – made some people feel better and others worse.

This series may also lead us into the question of trade-offs in diet. These trade-offs may cause different people to prefer different diets. For instance:

  • Shifting from lean-meat-and-vegetables to starches and fats may increase the pleasure of eating and improve health in some, but promote weight gain in others.
  • Higher protein may promote athleticism and fertility, but shorten lifespan (as it does in some animals).

In writing our book, we tried to present the evidence underlying all of our recommendations, and provide healthy ranges for the various nutrients with explanation why the reader might prefer to be at the high or low ends of the range. Our goal was to empower each reader to find his or her own “perfect health diet,” not to rigidly prescribe a specific way of eating.

But negative experiences on a diet can also have diagnostic value. For instance, when I first adopted a low-carb Paleo diet I developed severe fungal skin infections. The new diet revealed an infection I hadn’t known I had. For this reason, even negative experiences can be beneficial, as they may open a path to curing an underlying but hitherto concealed health problem.

We see this blog as a communal enterprise, in which we and our readers together try to discover the truth about diet and health. Therefore, we hope that anyone who does have negative experiences on the diet will not hesitate to report them in the comment threads and work with us to discover the cause.

Leave a comment ?

185 Comments.

  1. Jordan,

    Did you read “Gut and Psychology Syndrome” (http://gaps.me)? I think it’s a great book.

    Did you buy the sauerkraut or was it home-made? Commercial sauerkraut is often not fermented long enough.

    Go easy on the magnesium and iodine. Start with little and increase gradually.

  2. Hi Thomas,

    Yes, it’s very easy to eat less until you find new foods. It’s very important to cook, so much healthier and cheaper. In the end, it’s more fun too.

    Eat plenty of rice, meat, and egg yolks and you’ll be OK. Cream can add a lot of calories fast. But be sure to be well nourished. Best of luck!

  3. Hi Suzan,

    I don’t believe there’s any such thing as “too late.” Some people are healed, some are unhealed. There may be some diseases that don’t heal, but I would be shocked if weight is one of them.

    First, I’d say if you’re only now on a good micronutrient supplementation program, getting rid of fructose/sucrose, pufa, and dairy if you’re sensitive to it, and haven’t yet tried consciously restricting calories, it’s still quite early to be wondering if weight loss is hard for you.

    Aside from compliance with a healthy diet, from my reading of the literature there are two main problems obese people commonly have:

    1) Some people have (through leptin resistance in the hypothalamus) lost the ability to autoregulate their food intake. This can be got around by conscious control of food intake until the hypothalamus heals.

    2) In some people most cells have some metabolic damage which impairs their ability to utilize glucose or long-chain fats. These cells may be starving even though nutrients are available but not useable. This can be got around by supplying ketones with a ketogenic diet.

    The point of a ketogenic diet is not to assist with weight loss — actually, the coconut oil supplies more calories and tends to promote weight gain — but the ketones may help those cells heal and become better able to use fats and glucose. This healing leads to better overall health and easier future weight loss.

    If you’re having trouble losing weight, here’s what I would suggest. First, get wholly on the diet and nutritional supplements. Second, try intermittent fasting — restrict food to an 8-hour window each day, but drink lots of water. Third, try conscious control of calorie intake for a while – say, a month.

    The target would be a calorie-restricted version of the Perfect Health Diet — something like, 400 carb calories, 300 protein calories, 700 fat calories, total of 1400 calories, plus all of our micronutrient recommendations including the “micronutritious foods.” This will be healthy and sufficient.

    A typical day’s food would look like: 1 lb potato or sweet potato; 1/2 lb meat or fish; 3 egg yolks; vegetables; and modest oil, just enough to achieve palatability.

    This should keep you well nourished, appetite low, and force weight loss. I would definitely try to squeeze in 3 egg yolks a day, since choline deficiency is obesity-inducing in mice.

    Then, once you’ve gotten used to this level of food intake, adjust intake so you like how you feel and like the pace of weight loss.

    Walking and standing rather than sitting will strongly promote weight loss too.

    I’m very eager to learn about what works for “hard” weight loss so I’ll hope you’ll keep giving us updates!

    Best, Paul

  4. Any thoughts on some of the newer non-standard stool tests. i’ve been dealing with ongoing gut issues for years. dietary changes alone (in line with your suggestions) have made some progress, but going on 6 months and losing hope that things will click. there is a stool test from metametrix (and others) that uses PCR technology that claims is more sensitive than the standard culture (since its actually looking at the DNA). i figure if diet isn’t the culprit, some type of infectious disease may be the issue. any experience with this?

  5. Hi steve,

    My wife is an expert in PCR and runs a core facility for researchers; she’s invented some new methods for measuring gene expression on a per-cell basis that might produce a lot of new diagnostic tools in the future. PCR is indeed much more sensitive than conventional measurement methods.

    I do believe that gut issues are almost always caused by infections. I’m not familiar with this particular test but I would encourage you to try it and see what it says. It could be insightful.

    I would also encourage talking to your doctor about a fecal transplant, since that is the most effective way to provision your gut with “good” bacteria. Sometimes this can produce a miracle cure for longstanding gut diseases.

    Best, Paul

  6. Paul, re: 3 egg yolks/daily

    How, other than frying them or putting them in soup, can they be eaten (I assume you don’t eat them uncooked)?

  7. Hi erp,

    When I eat lunch, which is almost always leftovers from earlier dinners, I put them in with my rice-or-potatoes/meat/vegetables and microwave it.

    You could also cook them into your dinner.

    I do think cooked is better because cooked egg is well digested and won’t cause any digestive problems. But some people eat them raw.

    Best, Paul

  8. I am very sensitive to getting acne if I eat any quantity of sugar containing foods. That is, five bananas, 6 ounces of dates, and 8 ounces of fruit juice is enough to give me a pimp. I generally eat a paleo diet with lots of meat, very low carb and high fat. The only fat I add is tallow; I don’t use coconut oil.
    I tried out the recommendation to eat starches. I found that if I eat more than a pound of sweet potatoes, I get acne. I know this level is above your recommendation. It seems like a chore to always be conscious of the portion sizes of carbohydrate containing foods and to only eat one sweet potato at a time.

    I noticed that carrots and parsnips both contain sugar and starch, with a lot more of the former than latter. A good area of investigation would be to look for cultivars that contain more starch than sugar.

  9. Hi JRM,

    Thanks for that.

    Conventional American sweet potatoes do have more sugar than starch and therefore perhaps I shouldn’t include them among our “safe starches.”

    However, the Asian varieties that we eat are very tasty and not very sweet (we like a chestnut-flavored yellow variety). I think they must be predominantly starchy.

    I absolutely agree that sugars are bad and it’s much better to replace fructose with glucose-starch. That’s why “safe starches” are so central to our diet and, I think, essential to any diet that has significant carb calories.

    I think it’s most likely that the troubles Chris and Lisa had with sweet potatoes are due to oxalate, but it’s possible that fructose could also have contributed.

    Best, Paul

  10. Hi Tim,

    I did read the GAPS book – good read. I like that they approach SCD diary free, I think that’s important.

    I do make all my sauerkraut homemade for 7 days. I’m still experimenting with fermentationg length and adding other veggies like Carrots.

    Thanks for the tips.

    Jordan

  11. Paul, thanks for your quick reply and the information you provided. Just as an FYI, the reason why I am concerned about not being able to lose any weight, is because I have been doing intermittent fasting for over a year, I eat 2 meals a day within an 8-hour window and most of the time I’m not very hungry. I haven’t been counting calories, but I will try that. Your suggestions shouldn’t be too difficult, as my typical daily meals are already quite similar to what you suggested, except I haven’t been mindful about measuring out coconut oil/ghee used for cooking. I will be more careful to use Fit Day and keep a caloric record. I will also cut back on coconut oil, and see what happens. I am also thinking of getting extensive thyroid function testing. Thanks again!

  12. Paul, why only the egg yolks and not the whole eggs? Is there something in the white that cancels the benefits of choline?

    How do you feel about choline supplements on days when 3 egg yolks don’t happen for whatever reason?

    I’m very interested in trying out the eating pattern recommended for Suzan, as I am in a similar boat as she. I feel like if women in our age/life-stage group can lose weight in addition to achieving better health through your recommendations, then just about anyone can.

    I would just like to submit that I, too, have been experiencing increased gut discomfort upon adding starch back. It’s mostly lower abdominal discomfort rather than stomach issues.

    One thing I was able to avoid while VLC was pre-menstrual breast swelling and tenderness. I will be curious to see what happens now that I’m no longer VLC. I’ll keep you posted.

  13. Suzan, one of the things I’d seriously consider to help boost weight loss when seemingly stalled is high-intensity interval training. This article has some good info on how and why:

    http://thehealthyskeptic.org/how-to-lose-weight-and-prevent-diabetes-in-6-minutes-a-week

  14. Hi Maggy,

    The egg whites are fine, but they are pure protein and have no nutritional value.

    I prefer to get protein from meat and use the egg yolks for nutrients and fat.

    Choline supplements are fine as a substitute.

    If starches produce lower abdominal bowel discomfort, then eat rice instead of potatoes or sweet potatoes. It will give less fiber and more of it will be digested in the small intestine.

    But keep the rice down to ~300 calories.

    You might be able to cut calories further, but be sure to get ~600 carb+protein calories per day, and adequate micronutrition.

    Best, Paul

  15. I eat the egg yolks mainly for lecithine/choline thus it makes sense to eat them raw as cooking destroys those easily.
    After all in a soft cooked breakfast egg the yolk is just warmed too.
    It is very well digested.
    The egg white is the part of the egg which is hard on the stomacch and contains some anti-nutritions (histamines).

  16. Hi Franco,

    According to nutritiondata.com, cooking only reduces the choline content of egg yolks by about 10%.

    I sometimes get a very mild nausea from eating raw egg yolks, but perhaps this is not common.

  17. Hi Paul,

    Would you mind explaining exactly how one counts’carb calories’?

    And for those of us who are pre-diabetic: how VLC can we safely eat in your opinion?

    Sorry for the off-topic. I’m new to all this and am trying to get up to speed.

    Many thanks.

    Peter

  18. Hi Peter,

    To count carb calories, you buy a kitchen scale, measure the weight of your food, and look up its carb calorie content on sites like http://nutritiondata.com or http://fitday.com.

    It’s a nuisance but unfortunately there’s no other way. However, after a few days you’ll get pretty good at “eyeballing” the carb content of your favorite foods.

    For low-carb, we don’t like to see people go below 200 calories per day. Most people, even diabetics, do OK with that. See the “zero-carb dangers” series for info on why we don’t like to go too low in glucose.

    Best, Paul

  19. Paul, I never thought of nuking the egg yolks. Thanks.

    BTW – at your suggestion for weight loss, I stopped eating fruit and nuts (except six pistachios and a banana/day) and limited all food intake (except one coffee w/heavy cream in the morning) to the seven hours between noon and 7 PM. Result: Absolutely no gas or bloating (previously problematic) and a loss of three pounds!!!

    BTW 2 – I’m still not getting all the posts and comments from Google Reader, so please forgive asking my questions already answered. 🙁

  20. Hi erp,

    Great! Nuts with their omega-6 and some allergens, and fruit with its fructose, are potentially problematic. Safest to stick with potatoes or rice and vegetables as plant food sources.

    Please forgive my lazy RSS feeds … Your questions are always welcome, repeat or not!

    Not long ago I had memory loss such that I couldn’t remember names. Asking people their name over and over again would have been annoying, so I didn’t … but then I was sometimes embarrassed … I try to be as generous to others as I hope they are to me.

  21. Hi Paul!

    You’re correct! I was confusing myself with the high numbers for yolk only which are almost triple then whole eggs cooked. But of course that’s partially due to the simple fact that choline content is given per 100 g and not per number!
    Still, I like to have my breakfast in liquid form and feel especially well with raw yolk.

  22. Perfect Health Diet » What’s the Trouble With Sweet Potatoes? - pingback on January 11, 2011 at 3:46 pm
  23. Interesting reading. I have just finished reading PHD and it’s given me a lot to think about. I have a lot of empathy with Suzan as I am also a 50+ female who seems unable to lose weight. I read Taubes’s “Good calories, Bad Calories” in December of 2008, and decided to change my life around with a New Year’s Resolution for 2009. At that point I eliminated grains from my diet – especially wheat/gluten, eliminated sugar, eliminated all high-PUFA vegetable oils, went low carb, began using coconut oil…

    Between January and September of 2009 I lost about 40-45 pounds, but nothing since then even though I still have well over 100 to go! And that’s just to get in the high-end of normal. Even if I can lose the 100 pounds I still won’t be thin by any means, just not morbidly obese.

    I admit that cutting my intake to 1400 calories a day seems sort of depressing. I often weight and measure my foods and monitor my intake. When I eat to appetite my normal caloric intake runs in the 1900-2200 range which doesn’t seem excessive for someone with 100+ pounds to lose!

    I did try IF for a while, but didn’t lose an ounce more when I was IFing, so I gave up on it.

    I did begin adding in some safe starches when I tried following the Optimal Diet for a while, that enabled me to lose 10 more pounds, but then the weight loss stopped again.

    I guess I can try what you have suggested to Suzan. Just that 1400 calories sounds so much like a deprivational diet – they sort of thing I have been trying to avoid as it usually seems to boomerang.

    For full disclosure I’ll also say that I was diagnosed in the fall of 2009 (right around the time I stopped losing weight) with Hashimoto’s thyroiditis and have been unable aot achieve optimum thyroid levels since then also. I keep thinking that Armour thyroid (providing both T4 and T3) might be what I need, but my doctor as well as the specialist she referred me to are violently opposed to it, want me on the synthetic T4-only thyroxine (Levoxyl in my case) and seem to feel that Armour et all is little better than witch-doctorism.

    And even on Levoxyl my TSH is still over 5, but my doctor doesn’t want to increase my dose of that, saying she fears I will become HYPERthyroid if she increases the dose…so I am fighting battles on several fronts. (I think the doctor realizes at least that she has lost the battle to put me on statins, though she wants me to go in high-dose niacin instead if I insist on refusing the statins). I think I really need a new doctor, but finding one is hard too. I wish there were times we could control our own health a little more.

  24. Hi Debbie,

    I agree that 1900-2200 does seem like it should be calorie restricted for someone who is 100 pounds overweight.

    I don’t like to suggest calorie deprivation either — in general for healthy dieting there should be no hunger — but as an experiment to see what happens I think it’s fine. You might find the effects are better than you expect.

    Also, you might consider going ketogenic for a while. This may allow some cells to heal and help move your fat/appetite “set point” lower.

    I definitely think the hypothyroidism should be a high priority to work on.

    I don’t know why your doctors oppose T3. So many people do better with some T3, and recently there has been a spate of papers showing that mixed T3-T4 usually works better than T4 only.

    If they don’t like natural hormones, there is a synthetic T3 they can prescribe along with your T4 – also a pill that’s a mix on synthetic T4 and synthetic T3.

    Are you taking selenium, magnesium, etc? I would add some iodine, starting at very low doses (500 mcg/day) and working up with one doubling per month. This will help relieve iodine deficiency conditions and help excrete some thyroid toxins like bromine, flourine, etc. Iodine is very slow to help but it can be very beneficial over the years.

    Your doctor fears hyperthyroid symptoms – well, what are your symptoms now, still hypothyroid? If you develop hyperthyroid symptoms you can just lower the dose again. The changes are not permanent.

    We like coconut oil better than niacin as you know.

    I do think a new doctor might be very good for you. This one sounds uncooperative.

    I also wish we could control our care more. Few things are more frustrating than trying to get care from an uncooperative doctor, who is more concerned with what his fellow doctors would think than with what you need.

  25. Debbie C: There are many over 50 females on the various LC forums who have been on all different types of low-to-medium carb diets for a couple of years, and their weight loss has come to a standstill, and they are very frustrated, and have recently grown more frustrated after reading Gary Taubes interview with Tom Naughton where Gary indicated that some of us simply won’t lose much more weight…:-(
    http://www.fathead-movie.com/index.php/2011/01/13/why-we-get-fat-interview-with-gary-taubes/

    I hope it isn’t true for us. I wish you the best! I hope you can figure it out. 🙂

  26. Suzan, I read that interview that Tom had with Gary, and it depressed me too, LOL. Also I think it was in Gary’s new book where he quoted Dr. Lutz as saying that he occasionally had some patients, all of whom seemed to be obese women “of a certain age”, who just never could lose weight at all no matter what things Dr. Lutz tried with them, and he basically concluded that after a certain point of bad eating and obesity they were just irretrievably broken metabolically. I sure hope not!

    I do take magnesium daily, and a few brazil nuts (for selenium). I used to take Iodoral but I stopped it when I read somewhere it was bad for Hashimoto’s patients to supplement with Iodine as it caused an even more aggressive autoimmune attack against the thyroid.

    Good luck to you too. I’ll see how it goes. 1400 calories?

  27. Hello ladies! I’m in somewhat of a similar position. I’m not yet 50, but I am officially menopausal at this point. I do not know if that has anything to do with my weight plateauing out at a level that is, even considering my density, probably ~30-40 lbs more than I should weigh. I’ve probably lost like 3 pounds in the last year. Whoopdeedoo! From the *it’s not fair* department, “Natural menopause is associated with reduced energy expenditure during rest and physical activity, an accelerated loss of fat-free mass, and increased central adiposity and fasting insulin levels. Also, James Kreiger had a pretty depressing post here. Basically, our bodies respond to weight loss by getting more efficient at doing stuff than had we never gained and lost the weight. 🙁 🙁

    I remember my maternal grandmother eating very little. One could say she did IF before anyone knew about it. I also remember hearing women advised to reduce intake to two meals/day as they get older.

    A heavier body is supposed to use more calories, but I think the formulas grossly overestimate this. I’ve considered having my RMR measured (there’s a 10 minute test where your exhaled CO2 is measured), and rather than guessing at the cause of being unable to lose weight, it may be worthwhile finding out what your metabolism really is. RMR is ~60% of TDEE for most people.

    I’m considering re-adopting IF as it resulted in ~10 lb weight loss in Summer 09. I had to actually “force” myself to eat more than 1000 calories, so if nothing else, it may be a way to make 1400 cals more workable.

    Best wishes

  28. “I used to take Iodoral but I stopped it when I read somewhere it was bad for Hashimoto’s patients to supplement with Iodine as it caused an even more aggressive autoimmune attack against the thyroid.”

    This idea is being promoted by Dr. Datis Kharrazian and some others. But the doctors with the most experience using high-dose iodine have not found this fear to be valid. In fact, many with Hashimoto’s have been able to substantially reduce their thyroid meds by taking iodine. I have reduced mine by half. Others seem to stabilize their need for medication (which usually increases over time in hypothyroidism). This is not consistent with the idea that iodine is “fuel for the fire” of Hashimoto’s.

    In any event, it’s easy enough to see what happens to your thyroid function if you supplement with iodine. You can always stop, though there can be some odd, temporary and benign, effects, such as TSH elevation that an experienced doc can help you interpret.

    I recommend Dr. David Brownstein’s book on iodine as an antidote to the scare stories about iodine. He’s used it with thousands of patients. He does discuss some rare problems with iodine, but in the vast majority of people the results are excellent. I also recommend the Yahoo! iodine discussion group, which includes many members’ personal experiences with iodine supplementation. Most of them seem to have autoimmune thyroid disease, and their experiences have been good.

  29. Hi Paul,

    My question is does protein raise or lower blood glucose? I ask this as if I understand correctly your book implies that any excess protein (over about 50g) is converted into glucose, but only when needed. Most sources state that protein lowers BG due to the body’s secretion of insulin in response to it. So will the net effect be higher or lower BG when protein is ingested, or will protein only raise BG when insufficient carbs have been eaten?

  30. Hi Bill, Debbie,

    It’s certainly possible for there to be bad reactions to iodine, but my sense is that they mainly happen from increasing the dose too fast. If you go slow I think negative effects are pretty rare.

    It seems to me that since the benefits of higher iodine are well attested, while the risks are in dispute among the clinicians as Bill says, the evidence favors cautious iodine supplementation.

    Our commenter Mario is a fan of iodine for Hashimoto’s and linked to a whole bunch of relevant papers: http://perfecthealthdiet.com/?p=258#comment-618.

    Best, Paul

  31. Hi Richard,

    Protein doesn’t have a big impact on blood glucose in healthy people. In diabetics, blood glucose is better regulated after protein consumption than after carbohydrate consumption.

    This paper — http://www.ajcn.org/content/78/4/734.full — summarizes the single-meal evidence as follows:

    However, as early as 1913 (5), it was reported that the ingestion of egg white protein in a single-meal study did not result in an increase in the blood glucose concentration in healthy persons. Subsequently, data from several laboratories (6, 7; reviewed in reference 8)—including our own (9–13)—indicated that the peripheral glucose concentration does not increase after protein ingestion in healthy persons or in persons with type 2 diabetes. In persons with type 2 diabetes, protein ingestion actually results in a small decrease in postprandial glucose concentrations (8, 14). In a single-day study in which mixed meals of various composition were fed to healthy young subjects, the protein content of the meals was calculated to also lower the blood glucose concentration (15).

    Best, Paul

  32. Hi Paul,

    As we discussed in our e-mails, I thought I’d give my story and effects of the PHD (and other treatments) so far, with perhaps periodic updates; hopefully this will be useful for other folks (and I hope it will ultimately be a success story!). Briefly: I grew active, athletic, and mentally sharp, but in my mid-twenties I developed unexplained aches and pains, and sometime in my mid-thirties I began to notice that I didn’t have as much energy as others I knew; this became a very steep decline in energy a couple of years ago (I’m now 56). Tests show: 1) obstructive sleep apnea (even though I am lean); 2) a very large number of food allergies; and 3) past and possibly continuing infection with Lyme and a number of other pathogens including C. pneumoniae and EBV (for which the antibody pattern indicates “chronic recurring infection” according to the lab). I noticed no improvement in energy from treatment for the sleep apnea (CPAP therapy) or for the allergies (total avoidance of allergenic foods for three months)—indeed, that was what led to the tests for Lyme and other pathogens. Last September I started on antivirals, in late October my Lyme doc added antibiotics and in November, she further added Mepron, an antimalarial (she thinks I have babesiosis, a common co-infection with Lyme). No improvement thus far, unfortunately, but if chronic infections are, indeed, part of the puzzle then I’m still pretty early in the treatment game, which as you know can take months or even years.
    I was pretty excited when I found your website and read your book, as it synthesized a number of elements that may be the missing links in my treatments. So since Jan. 1 I have been going by the book—your book. In particular, I’m following PHD’s macronutrient, micronutrient, and toxin avoidance suggestions pretty much to the letter, except I eat more protein—I’m specifically trying to avoid autophagy right now because one of the effects of chloroquine, an antimalarial drug (and thus possibly Mepron) is to inhibit autophagy (see http://knol.google.com/k/protein-cycling-diet-19#) , and I don’t want to be working at cross-purposes while I’m on this drug. Also, in addition to your suggested supplements I take an acetyl-l-carnitine/alpha-lipoic acid combo for a total of 2000 and 600 mg, respectively, and I added NAC, 1000 mg/day.
    Of course, the most exciting part of the book for me was the fourth part, Heal and Prevent Diseases. In terms of those suggestions: the PHD should be effective at lowering blood glucose and keeping insulin low, lowering omega-6 and optimizing omega-3, and avoiding toxic foods. My vitamin D levels are quite high as I’ve been supplementing for some time; in terms of iodine I’m very interested in increasing this but will do so as you suggest, starting low (about 600 mcg right now) and doubling monthly. I already use melatonin and use a sleep mask which eliminates all light and, aside from the stress of feeling like crap most of the time, my stress levels are pretty low. I’m waiting until I’m off the Mepron to try the strategies aimed partially or entirely at autophagy (IF, extended fasts, low protein). I’m also not doing the “Herbivore option” because I’m not sure what autophagy effect it would have. Autophagy strategies intigue me more than anything else, as in the past I have tried juice fasts (up to 11 days) and intermittent fasting, both of which should have induced autophagy, and felt very good doing both; so I’m chompin’ at the bit to try a coconut oil fast and IF again. To round out the picture, I’ve been working for several years with a doctor whose emphasis is hormones, and I’m on supplemental T3 and T4, as well as testosterone.
    Obviously, it’s very early days yet for all of this—the only effect I’ve seen so far is that I’ve gained a bit of fat, probably about 5 pounds judging by how my pants feel. Any suggestions on improvements or tweaks are welcomed; I hope to keep you posted periodically on any developments.
    And finally, a big thank you to you and Shou-Ching for synthesizing and presenting all this info, and for providing this forum!

  33. Hi Eric,

    Thank you for sharing! I’m looking forward to hearing how things go.

    I’m glad that you have a doctor who is willing to be aggressive. I hope these are the right drugs.

    Re the fat, we’ll be talking about weight gain and loss over the next few weeks.

    Good luck and thank you!

    Best, Paul

  34. Perfect Health Diet » How Does a Cell Avoid Obesity? - pingback on January 18, 2011 at 7:24 pm
  35. Re: weight gain

    When I added white potatoes (only major carb source) back to a very low carb diet (~1 year), I found them irresistible, ate way too many, and gained more than 10 lbs, a good bit of it fat.

    Now after two months I am finding it much easier to eat only about one a day so I can stick to ~400kcal/day from starch.

    Maybe there is some in-built tendency to binge after long-term carb deprivation.

    Just wanted to add my experience to the thread. (I’m 25 and otherwise healthy)

  36. Hi Brandon,

    Interesting! Maybe your body was missing a lot of glycoproteins and that stimulated appetite for carbs.

    Now that you’re replete, 400 calories/day is sufficient.

    I think your temporary weight gain puts in perspective how disabling the fears of weight gain among people with a history of obesity can be. Sometimes, a modest weight gain may accompany a switch to a healthier diet. The thing to keep in mind is that on the healthier diet, it will be easy to lose any extra fat mass later. Meanwhile, along with extra fat you may be adding valuable tissues — glycoproteins, bone density, muscle.

    Best, Paul

  37. Perfect Health Diet » Perfect Health Diet: Weight Loss Version - pingback on February 1, 2011 at 7:47 pm
  38. Hi,

    I wanted to share my experiences thus far on the PHD. I guess I’ll start with my backstory.

    About 5 years ago, I started having horrible stomach problems (pain, bloating, etc.), extreme fatigue, weight gain of about 15 lbs, and anemia. After many useless visits to traditional doctors, I finally went to see a naturopath who put me on a restricted diet: no sugar (or fruit), no grains other than rice, no cow dairy, no legumes, no nuts. It was actually pretty much a PHD diet. Within 4 months on this diet I felt 80% better; the fatigue was gone, I lost the weight, and the anemia went away (with some help from iron supplements), and my stomach pain was intermittent and brief when it did occur. I went on like this for about 2 years.

    Then, about 2 years ago, I discovered the paleo diet. It was already similar to the way I was eating with some minor tweaks: upping the fat content of my diet, eliminating rice and sweet potatoes, adding back some moderate fruit. Within a year of eating this way, I began experiencing some additional stomach discomfort, more bloating and pain.

    I went to see a doctor for some help. Unfortunately, she just made the situation worse. She believed my stomach problems were due to low thyroid hormone (even though my TSH was a respectable 1.5). I took armour thyroid for 6 months, which were literally the worst 6 months of my life: unrelenting fatigue, severe depression, heart palpitations, etc. I stopped taking the thyroid hormones and all of those symptoms went away, but I gained 10 lbs. (without any changes in diet/exercise) and my stomach problems persisted.

    Well, I adopted the PHD in October 2010 and I am happy to say that my stomach issues are almost completely gone. I’m still trying to figure out how to lose those 10 lbs; I haven’t lost any weight going from paleo to PHD, but I haven’t gained any either. I’m gently experimenting with the iodine supplements, but taking more than about 400mcg seems to elevate my pulse and make me light-headed.

    I would definitely recommend PHD to anyone looking for a healthy way of eating. I would also recommend it for anyone who is still experiencing stomach issues while on a paleo diet.

    Thanks!

  39. Thanks, Brussie!

    Sounds like the Armour made you hyperthyroid. Thyroid hormones should always make you feel better, not worse. Your doctor should have taken you off them immediately.

    Go very slow with the iodine and you should be able to gradually build up the dose.

    The stomach problem sounds like an infection – possibly fungal, given that starches fixed it. (Bloating and fatigue are common symptoms of fungal infections.) But anemia sounds more bacterial. Whatever it was, I’m glad it’s going away!

    Weight loss is an issue we’re still trying to figure out, so please give us updates as time goes on. Hopefully, with more time on the diet and supplements the body will heal itself and the weight will come off naturally.

    Best, Paul

  40. Brussie,

    I had very similar symptoms. About a year ago, I decided to lose weight and cut down drastically on carbs, but my overall diet was still terrible.

    I lost weight, but started bloating and became very gassy and uncomfortable. Then last fall, I discovered this website and PHD. Since then I have lost only three pounds, mainly I think because of a sedentary life style which I hope to improve soon with a knee replacement.

    I also had the same reaction to the iodine supplement, but I followed Paul advice of taking sea salt in a little warm water and drinking lots of water. I only had to do that once (Thank G*d because the gastro-intestinal eruptions were violent) and since then I’ve upped the dose slowly and have had no more problems. I am still drinking a lot of filtered water and feel fine.

    When Paul and Shou-Ching solve the weight loss problem, we’ll all be slender as well as healthy and they’ll be rich — all without a single federal/state/local grant!

  41. Hi erp,

    You don’t need to take the salt and water together! Put the salt on your food and drink the water separately.

    I love your fantasy! We would be delighted to get rich because then we could fund Shou-Ching’s research. But even if we remain impoverished bloggers, we’ll be happy. It’s been great fun sharing our ideas, making Internet friends, and hearing everyone’s experiences.

    I really think diet is the way to health. The future of medicine is with doctors like Maggy and Emily Deans who integrate diet and nutrition into their practices. If we can help the movement along, will be very satisfied.

  42. Now you tell me!

  43. Just thought I would post this after doing a little bit of digging around on IGF-1, including on this site. I too am concerned about cancer growth and perhaps more concerned about it reducing longevity. Now I’m not so worried:

    Abstract:We have previously reported that centenarians (persons?100 y old) in Tokyo prefer dairy products. Dietary preferences may be associated with longevity…….In 2001, 28 centenarians were still alive. The survival rate for those preferring dairy products was the highest of the four dietary patterns; in particular, being significantly higher than the pattern preferring beverages (p=0.048). A dietary pattern preferring dairy products was associated with increased survival in Tokyo-area centenarians.

    http://www.journalarchive.jst.go.jp/english/jnlabstract_en.php?cdjournal=jnsv1973&cdvol=49&noissue=2&startpage=133

    I still to choose to stick with cultured dairy though.

  44. Dieting is not just about the looks. “Good dieting” should be about feeling good in general, it’s a lifestyle choice. Anorexia is not the way to go, common sense is. Lots of good stuff on the web, see e.g. http://www.2bready.com

  45. Hello

    I recently finished reading your book after being introduced to it by Chris Kresser’s website and I really enjoyed it. I started on the paleo/primal diet at the beginning of January and have seen some great improvement. I was already pretty healthy before cutting all grains and legumes, but I feel much better and I have lost about 10 pounds of excess fat. After finishing your book I decided to add some more starches back into my diet, in particular white rice (I had already been eating sweet potato). I noticed that after eating the rice I felt bloated and became quite gassy. Is that something to expect when reintroducing rice? It’s only been 3 months since cutting it out. My step-mom thinks I don’t have the enzymes to digest the rice now. Or is this a sign that I should be avoiding rice?

    Thank you
    Seth

  46. Hi Seth,

    It means that gut microbes, possibly undesirable microbes like yeast, are eating your rice instead of you.

    A temporary deficiency of enzymes could be a factor. You could try building up the rice dose slowly, starting with small quantities, and chew the rice thoroughly in your mouth, to expose surface area and mix it with salivary amylase and ptyalin, before swallowing. Also, eat the rice warm.

    If rice syrup (basically, a pre-digested rice starch) doesn’t cause the problem, then that would support the enzyme theory.

    However, a more likely possibility is a mild gut dysbiosis, possibly consisting of Candida overgrowth. Bloating is often a sign of yeast/fungi. Very low-carb diets tend to suppress gut immunity generally, but especially anti-fungal immunity which is glucose-dependent. The winter with its low vitamin D also suppresses gut immunity.

    I think I would start working small amounts of rice in, but also work on anti-Candidal steps. The most important:

    (1) Fermented foods and probiotics. You need good bacteria to replace whatever’s there.
    (2) Anti-Candidal foods like vinegar and garlic and traditional herbs such as turmeric with black pepper and oregano. So salads with Italian dressings will help you.
    (3) Supplements that support anti-fungal immunity. All the supplements in our recommended list are important, but especially: vitamin C, copper, selenium, iodine.
    (4) Digestive enzymes that contain polysaccharide digesting enzymes like cellulase and hemicellulase.

    These are basic steps for improving gut flora. It may take a little time but I think you’ll gradually find rice more tolerable and more satisfying. If indeed you do have a Candida infection, eating rice will improve your immunity and help you defeat the yeast and replace it with commensal bacteria.

    Best, Paul

  47. Hi Paul,

    Thought I’d post an update here since lots of topics get touched…

    Supplementing with iodine proved a problem, maybe a big one. I never got over 600 mcg due to right side weakness in my arm and leg. At really low doses, 250 mcg, stopping supplementation would stop the symptoms. Going to 600 mcg produced more weakness and this time, it has not gone away when I stopped taking it. Has been this way about 10 days without taking any iodine.

    Went to my family doctor on Monday…he checked thyroid output, TSH was 2.91, T4=7.4 (4.5-12), T3=36 (24-39 range), did not do a reverse t3 but said he wanted to. In October of 2010 on a yearly physical TSH was 1.88, T4 was 7.1. He does not think it thyroid related because of those numbers.

    He ran a panel of antibody tests for MS, lupus, RA, and maybe others (I don’t understand these tests yet) but the were all negative or within limits. CRP was 0.5

    An MRI was mentioned but at this point, he is not concerned – but I am! I have a follow up visit in 3 weeks and I will push for an MRI. I want to know if there are lesions on my spine and brain. I am not liking my symptoms… right side weakness, mental cognitive decline and others. I had an 2 month sore spine at the base of my neck when I reintroduced starch this past fall with a lot of nerve pain in the extremities.

    At this point going forward with iodine does not seem wise. I have no idea if I am experiencing typical die off effects like an MS patient might under antibiotics or the iodine is doing something else entirely? I am in disbelief because of the low doses involved…never even got over a milligram!

    One thing though, I felt very health taking the iodine from a cold and flu perspective. Going off it immediately got me sick, very bad sore throat and cold.

    I’m questioning everything now. All the MS diet info and forums say high fat will trigger MS and in fact most of the popular diets are very low fat, Swank and others (excepting PHD of course.)

    I’ve even stopped taking the multi because the 125 mcg iodine does help produce the symptoms. This is a bad position to be in. My doc is not open minded, gets defensive if I ask many questions and does not want to do anything (I feel) until I present much stronger symptoms. Telling him about CAP (CPN) will make him flip.

    As and aside they checked my cholesterol too even though they did it just this past October? (Actually when the lab tech called with the results which I was nervous about, she first told me my cholesterol numbers and said the doc wants me on statins!!!) I kid you not, here I am worried about MS and I get the statin speech – it figures. Of course all she could say about the nuclear antibody tests were they were negative. So now I have to wonder for 3 weeks what they checked and deal with a clumsy right leg and hand.

    Any way back to the aside. In Oct. I had both an NMR and standard cholesterol test. They were both close to each other. At that time I had just reintroduced starch after being on PANU V1.0 for 4 months and sick just like Paul predicts with VLC. I was reading the PHD website but hadn’t read the book or adopted all the recommendations yet. Since that time, total cholesterol is about the same at around 240 vs 228 but hdl went up 71 to 81 and ldl about the same at 150. So it looks like coconut oil did raise my hdl from an already high value about 10 more points. Trigs 45 both cases. The Oct NMR test showed Ldl to be in the large fluffy range at 20.5 just barely. I wonder how that compares today but I can’t know because the NMR wasn’t done. Sorry for the long post. Regards, Perry

  48. Thanks so much Paul!

  49. Hi Perry,

    You certainly do have a tricky case.

    Limb weakness is very concerning. Did your doctor refer you to a neurologist? I would pursue diagnostic options.

    If you suspect MS then an MRI of the brain is necessary.

    Some of these symptoms are consistent with a bacterial infection of the CNS. Have you tried doxycycline or other antibiotics? Often there is an immediate effect, and this has diagnostic value.

    The high TSH is concerning even though T4 and T3 are normal. He should measure anti-thyroid antibodies as well as rT3.

    I don’t believe that high fat diets are bad for MS – quite the opposite. Epidemiologically countries with low MS rates (Asia) tend to eat low-carb diets.

    Total cholesterol of 240 is fine, especially with HDL of 81. Something about the math doesn’t work, LDL should be lower than 150. Certainly don’t take statins.

    Neurological symptoms – often neuronal (or axonal) loss can happen from oxidative stress, so glutathione/C/mitochondrial support can help. Vitamin B12 accelerates nerve healing.

    I think the first step should be better diagnosis. There are a lot of tests that can be done. You might want to ask for a referral to a naturopathic or infectious disease doctor with experience testing for chronic infections, a neurologist for nerve issues, possibly an endocrinologist. I know doctors are hard to deal with, but diagnosis has to be the first priority.

    Best, Paul

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