Last week in An Anti-Cancer Diet (Sep 28, 2011), I recommended that cancer patients eat 400 to 600 carb calories per day, but combine it with a program of daily intermittent fasting plus longer “ketogenic fasts” and periods of ketogenic dieting or low-protein dieting to promote autophagy.
The recommendation to eat some carbohydrates, plus my statement that it was possible for cancer patients to develop a “glucose deficiency” which might promote metastasis and the cancer phenotype, seems to have stirred a bit of a fuss.
In addition to making @zooko sad, it led Jimmy Moore to reach out to a number of gurus to ask their opinion. On Twitter, Jimmy says:
Working on an epic blog post today about @pauljaminet and his “safe starches” concept. Input from numerous #Paleo and #lowcarb peeps.
I’m excited to have this discussion. As Jimmy later tweeted:
Should be fun to hash all this out publicly for ALL of us to understand better about your concepts. Here’s to education.
So far, I have seen responses from Dr. Kurt Harris and Dr. Ron Rosedale. On PaleoHacks, there is an extensive discussion on a thread started by Meredith.
UPDATE: Jimmy’s post is up: Is There Any Such Thing as “Safe Starches” on a Low-Carb Diet?.
I think this discussion is wonderful. With so many people putting effort into this, I have an obligation to respond. I’ll start with Kurt’s perspective today, then Ron Rosedale’s early next week, then whoever else participates in Jimmy’s epic post.
PHD and Archevore: Similar Diets
Kurt and I have essentially identical dietary prescriptions. However, our reasoning sometimes works from different premises. Kurt observes:
My arguments are based more on ethnography and anthropology than some of Paul’s theorizing, but I arrive at pretty much the same place that he does.
An example of a point of agreement is Kurt’s endorsement of glucose-based carbs:
[I] see the human metabolism as a multi-fuel stove, equally capable of burning either glucose or fatty acids at the cellular level depending on the organ, the task and the diet, and equally capable of depending on either animal fats or starches from plants as our dietary fuel source …
We are a highly adaptable species. It is not plausible that carbohydrates as a class of macronutrient are toxic.
I think that if there is no urgency about generating ATP then fatty acid oxidation is slightly preferable to glucose burning. But essentially, I share Kurt’s point of view. Our ancestors must have been well adapted to consuming high-carb diets, and necessity surely thrust such diets upon some of our ancestors. Certainly there’s no reason why consuming starch per se should be toxic.
Kurt and I also agree on which starches are safe:
These starchy plant organs or vegetables are like night and day compared to most cereal grains, particularly wheat. One can eat more than half of calories from these safe starches without the risk of disease from phytates and mineral deficiencies one would have from relying on grains.
White rice is kind of a special case. It lacks the nutrients of root vegetables and starchy fruits like plantain and banana, but is good in reasonable quantities as it is a very benign grain that is easy to digest and gluten free.
We agree that safe starches are a more useful part of the diet than fruits and vegetables:
[E]ating starchy plants is more important for nutrition than eating colorful leafy greens …
I view most non-starchy fruit with indifference. In reasonable quantities it is fine but it won’t save your life either. I like citrus now and then myself, especially grapefruit. But better to rely on starchy vegetables for carbohydrate intake than fruit.
We agree on the optimal amount of carbs to eat:
I personally eat around 30% carbohydrate now and have not gained an ounce from when I ate 10-15% (and I have eaten as high as 40% for over a year also with zero fat gain) If anything I think even wider ranges of carbohydrate intake are healthy.
One can probably eat well over 50% of calories from starchy plant organs as long as the animal foods you eat are of high quality and micronutrient content.
I think being slightly low-carb, in the sense of eating slightly below the glucose share of energy utilization which I estimate at about 30% of energy, is optimal. However, I think we are metabolically flexible enough that a very broad range of carb intake may be nearly as good. I would consider 10% a minimal but healthy intake of carbs, and 50% a higher-than-optimal, but still healthy, intake so long as the carbs are “safe” and the diet is nourishing.
Differing Origins of Our Ideas
Kurt mentions that his ideas are more derived from ethnography and anthropology than mine.
I give great weight to evolutionary selection as an indicator of the optimal diet, and am friendly to ethnographic and anthropological arguments. If I don’t give tremendous weight to such arguments, it’s because I think some other lines of argument give us finer evidence about the optimal diet.
Here, from a paper by Loren Cordain et al [1], are representations of hunter-gatherer diets:
The top graph shows plant food consumption by calories, the bottom graph animal+fish consumption by calories. The numbers are how many of 229 hunter-gatherer societies ate in that range. Typically, hunter-gatherers got 30% of calories from plant foods and 70% of calories from animal foods.
I think the Cordain et al data supports my argument that obtaining 20% to 30% of calories from carbs is probably optimal. However, it’s hardly decisive. There is considerable variability, mainly in response to food availability in the local environment. Inuits, who had few edible plants available, ate hardly any plant foods; tropical tribes with ready access to starchy plants, fruits, and fatty nuts sometimes obtained a majority of calories from plants.
Hunter-gatherer diets, therefore, are a compromise between the diet that is healthy and the diet that is easy to obtain. A skeptic could argue that hunter-gatherers routinely ate a flawed diet because some type of food was routinely easier to obtain than others, and thus systematically biased the diet.
I believe evidence from breast milk is both more precise about what diet is optimal, and much harder for skeptics to refute. Breast milk composition is nearly the same in all humans worldwide, and it has been definitely selected to provide optimal nutrition to infants.
So breast milk, I think, gives us a much clearer indication of the optimal human diet than hunter-gatherer diets. It is an evolutionary indicator of the optimal diet, but it is not ethnographic or anthropological.
There are other evolutionary indicators of the optimal diet — mammalian diets, for instance, and the evolutionary imperative to function well during a famine — which, as readers of our book, we also use to determine the Perfect Health Diet. So, while I think ethnographic and anthropological findings give us important clues to the optimal diet, I think there are plenty of other sources of evidence to which we should give weight. Fortunately, all of these sources of insight seem to be consistent in supporting low-carb animal-food-rich diets — a result which is gratifying and should give us confidence.
Food Reward and Obesity
Kurt seems to have been more persuaded than I am by Stephan Guyenet’s food reward hypothesis (which is, of course, not of Stephan’s creation – it is the dominant perspective in the community of academic obesity researchers). Kurt writes:
Low carb plans have helped people lose fat by reducing food reward from white flour and excess sugar and maybe linoleic acid. This is by accident as it happens that most of the “carbs” in our diet are coming in the form of manufactured and processed items that are simply not real food. Low carb does not work for most people via effects on blood sugar or insulin “locking away” fat. Insulin is necessary to store fat, but is not the main hormone regulating fat storage. That would be leptin.
I agree with Kurt in rejecting what he calls the carbohydrate-insulin hypothesis of obesity, but I am uneasy at the confident assertion that “reducing food reward” is the mechanism by which excluding flour, sugar, and omega-6 fats helps people lose weight.
Let me say first that there is no doubt that the brain has a food reward system that regulates food intake, and also an energy homeostasis system that regulates activity and thermogenesis, and that these systems are coupled. The brain is the coordinating organ of metabolic activity. And the brain’s food reward and energy homeostasis systems are altered in obesity.
But the direction of causality is unclear. Is “reducing food reward” the best strategy against obesity, or is “maximizing food reward with nourishing food” the best strategy?
Some data may illustrate what I mean. Here’s an investigation of how the food reward system in rats controls appetite to regulate protein and carbohydrate consumption. The data is from multiple studies and was collected by Simpson and Raubenheimer [2].
Rats were given a chow consisting of protein and carbohydrate in varying proportions. The figure below shows how much of the protein-carb chow they ate.
I’ve drawn a kinked blue line to show what a “Perfect Health Diet” analysis would consider optimal. Protein needs consist of a fixed amount of protein, around 70 kJ, to meet structural needs, plus enough protein to make up any dietary glucose deficiency via gluconeogenesis. Glucose is preferable to protein as a fuel. Glucose needs in rats are in the vicinity of 180 kJ. When dietary glucose intake falls short of 180 kJ, rats eat extra protein; they seek to make carb+protein intake equal to 250 kJ so they can meet both their protein and carb needs, with gluconeogenesis translating the dietary protein supply into the body’s glucose utilization as necessary.
As the data shows, the food reward system in rats seems to organize food intake to precisely match this:
- When the chow is low-carb, the food reward system directs rats to eat until carb+protein intake is precisely 250 kJ – then they stop eating.
- When the chow is high-carb, the food reward system directs rats to eat until protein intake is precisely 70 kJ – then they stop eating.
I interpret this to show that the food reward system evolved to optimize our health, and in healthy animals does an excellent job of getting us to eat in a way that achieves optimal health.
Note that if the chow is high-carb, rats eat more total calories. Is this because their diet has “high food reward”? No, it is because it is malnourishing. It is protein deficient.
Now, a diet of wheat, sugar, and omega-6 fats is malnourishing. There are any number of nutrients it is deficient in. So the food reward system ought to persuade people to eat more until they have obtained a sufficiency of all important nutrients, and rely on the energy homestasis system to dispose of the excess calories in one way or another. But if the energy homeostasis system fails to achieve this, then obesity may be the result.
If this picture is correct, then what is the solution to obesity? Is it to eat a diet that is bland and low in food reward? I don’t think so; the food reward system evolved to optimize our health. Rather the diet that defeats obesity will be one that is efficiently nourishing and maximally satisfies the food reward system at the minimum possible caloric intake.
A good test of these two strategies is the severely calorie (and nutrient) restricted diet. It would be hard to conceive of a diet lower in food reward than one with no food at all. Yet severe calorie restriction produces temporary weight loss followed by regain – often to even higher weights. This “yo-yo dieting” cycle may be repeated many times. I think this proves that at least some methods of “reducing food reward” – the malnourishing ones – are obesity-inducing.
So I would phrase the goal of an anti-obesity diet as achieving satisfaction of the food reward system, rather than as reducing food reward; and would say that wheat, sugar, and seed oils are obesogenic because they fail to provide genuine food reward, and thus compel the acquisition of additional calories.
Conclusion
Jimmy Moore is friends with the smartest people in the low-carb movement, so this discussion is sure to be interesting. I’m grateful that he’s persuaded people to comment on Shou-Ching’s and my ideas, and I’m eager to hear what Jimmy’s experts have to say.
One thing I’m sure of, the discussion will help us understand the many open issues in low-carb science. It should be a lot of fun!
References
[1] Cordain L et al. Plant-animal subsistence ratios and macronutrient energy estimations in worldwide hunter-gatherer diets. Am J Clin Nutr 2000 Mar;71(3):682-92. http://pmid.us/10702160.
[2] Simpson SJ, Raubenheimer D. Obesity: the protein leverage hypothesis. Obes Rev. 2005 May;6(2):133-42. http://pmid.us/15836464.
via this link:
Hi Paul,
Thanks so much for your response. I’ve been to numerous doctors and consulted with several alternative practitioners and never had one tell me those symptoms (inner ear itching, bloating, etc) are just general signs of immune activity. They have all indicated it must be yeast or parasites.
By saying “general signs of immune activity” I’m assuming you mean that this shows my immune system is working and battling a pathogen? So this isn’t necessarily a bad thing?!?!
You mentioned starting with rice syrup – I’ve only ever seen brown rice syrup in the store. Is that what you mean?
And yes, the Great Plains Lab stool test is supposed to show candida, but as I said my results didn’t show ANY harmful pathogens which really surprised me.
Hello Paul,
I wanted to throw in my 2 cents in response to the comments made by Dr. Harris with my own n=1 as the basis.
I am 42 years old and have been overweight my entire life, not morbidly obese but definitely overweight. On January 1, 2011, I weighed 195 lbs and implemented a toxin free diet that was Archevore and PHD compliant (excluding macronutrient ratios). On February 20, I weighed 180 lbs. On August 15, I still weighed 180 lbs – so weight stable for 6 months and still 15-20 lbs above a healthy set point based on my height (5’11”) and build.
On August 15th, I kept my dietary staples the same but ONLY lowered the reward of my diet following the “rules” outlined by Stephan. This morning I weighed 169 lbs (my weight when I graduated from high school). So I have lost 11 lbs solely via reward reduction (i.e. no spice, seasonings, salt, liquid calories, in between meal snacks, etc).
The staples of my diet – pastured eggs, potatoes, sweet potatoes, white rice, ghee, green vegetables, milk/yogurt – have not changed at all from before implementation of the new diet. So diet quality has remained constant. Once I adapted to this style of eating, there has been spontaneous caloric reduction and I maintain satiety eating 3 square meals and no snacking at all. Even on a toxin free diet with a higher reward at the beginning/middle of the year, I felt the need to eat and snack more even though the quality of the diet was very high.
Additionally, prior to this experiment, I would estimate I was eating 40-50% carbohydrates. My current ratios are 60% carbs, 20% protein, 20% fat. So this weight loss has occurred with a percentage increase of carbohydrate intake. Since I am hypocaloric, I realize that the absolute levels are arguably lower.
Anyway, the notion of “maximizing food reward with nourishing food” is inconsistent with my n=1 experience. In part the terminology of “reward” is getting in the way as many have noted. That one should avoid wheat, sugar, and vegetable oils for “perfect health” is unquestionable to me. But I do think there is merit to food reward with respect to weight loss as a therapeutic measure to the extent it has served me well. I am not suggesting it is the only factor. YMMV.
Love the book and the blog!
Aravind
Daniel said:
“Some of the responses on Jimmy’s site show the ignorance of these supposed “experts.””
This is a side benefit for me. Before today I was unsure how some experts stacked up against others. A lot has been clarified on that front by Mr. Moore’s exercise. ‘Twas a very useful service, though perhaps not in the way he intended.
“This experiment, and subsequent perusal of the literature, is what first made me think that being VLC is self-defeating in the blood glucose spike realm.”
I should perhaps make clear that this experiment was done 2 years ago when I ate VLC, not just recently..
Hi Kurt, CarbSane,
Important point about the blood glucose. Somebody in the comment thread at Jimmy’s (http://livinlavidalowcarb.com/blog/is-there-any-such-thing-as-safe-starches-on-a-low-carb-diet/11809#comment-328586738) reported blood glucose response to a challenge with ~100 carb calories. Blood glucose peaked at 7.7 mmol/l = 139 mg/dl. A subsequent test with sweet potatoes peaked at 6 mmol/l = 108 mg/dl. The commenter inferred that (s)he couldn’t tolerate carbs. Robert Su agreed. I don’t get it. They are terrified of even normal increases in blood glucose.
Hi Melissa,
I don’t follow why you think we can’t translate infant diets to adult diets, albeit with some error. What is so different about infant brain metabolism?
Hi Jean,
It is likely that you have some kind of gut dysbiosis, and yeast or parasites are plausible candidates. But the Great Plains test is counter-evidence. I guess we have to judge how reliable that is. I think the first step of restoring some glucose might improve intestinal barrier integrity and spawn some improvement. Leaky gut and food sensitivities could be significant contributors.
Yes, brown rice syrup is fine.
Once you stabilize after adding some carbs, you might try testing cholestyramine / bentonite clay / charcoal to see if one of these improves symptoms. But only one change at a time.
Usually the immune activity you notice is a response to toxins more than pathogens. There are a lot more toxins than pathogens. But the toxins might be generated by pathogen die-off, eg LPS or fungal cell wall components.
Hi Aravind,
Thanks for sharing. Score one for Stephan! Interesting experience.
i have to agree with kurt’s point about food, nutrition,etc being more complex than nutrients=no cravings. i find that even if i eat “perfectly” but VLC with my activity level being what it is (super athlete) i cant go but a couple of days without some kind of carby food. and if you put a bunch of junk in front of me, if i haven’t taken care of just that one need, i will totally destroy all that junk. so i’ve found that tweaking my carbs per my activity level does totally circumvent that issue. now, i had made a comment on JS’s blog about how “out of sight, out of mind” is extremely helpful in staying on track diet-wise. my wife is a sugar junkie and is in no way on track with me. so she has all her junkie stuff lying about and sometimes i will partake. if i’m taking care of my INDIVIDUAL needs, ie calories, nutrients, macros, i feel LESS inclined to eat that stuff. but it doesn’t just take it away or “make it taste yucky”. the psychological effect of food is real (cultural, mental, social)and cannot be underestimated concerning our decisions. there is no magical brain goblin that forces us to eat certain things. there is no single nutrient or pathway or whatever that will allow us to have the “perfect” diet. sometimes it just depends on my mood. if i’ve had a really tough week and my body is tired, so is my mind, and i may eat something i wouldn’t normally eat.
JS agreed with me on this point(i was speaking of all this in relation to the perfect storm of “addiction” that is spawned by food scientists that understand food reward alot better than we think). so, while eating nutritious foods can and will help with cravings and such, i think it is only because you are taking care of that one particular need. the body can never reach it’s stable point on junk food only so i would believe the opposite to be true as well-nutrients do help. but they dont cover everything.
willpowering you way through the day isn’t a good option either as it drains vital glucose away from the brain making it that much harder to stay away from higher carb foods. if that’s your thing. personally i feel great on VLC as long as my activity level is something along the lines of barely above sleeping. but that’s just me.
Jimmy Moore went about it the wrong way with that silly post. He should have asked you to clarify what you meant by safe starches and then invited comments from others. I’m totally over low carb dogma.
Jimmy did himself no favours with that post.
Hey Paul, just wanted to let you know the comments RSS seems to be missing a lot of these comments, at least on my Google Reader.
Aravind,
Thank you for posting this. I have been having many health improvements on PhD but have not lost the 15 pounds I would like to be rid of.
My experience yesterday makes me suspect that trying some of Stephan’s recommendations might do the trick for me and what you said just reinforced that.
Here’s what happened yesterday: For breakfast I ate one smallish lamb chop and felt completely satisfied. But because it was the only time I would have to do it, I then proceeded to put together a new recipe for a crunchy dessert to have after dinner. I needed to taste it to know if I was on the right track with regard to sweetness and spice. I really, really didn’t want to, wasn’t even vaguely hungry, so I actually forced myself to take a bite. And then I was off to the races. For the next hour I kept coming back for just one more bite until I had consumed about a cup and a half. My concoction included rice krisps,coconut flakes, macadamias, rice syrup, coconut oil, ghee, salt and cinnamon. A perfect storm.
I think that there is a continuum and that some of us are more sensitive to what Stephan calls the the high reward foods, while others can achieve their weight loss goals without adding Stephan’s tweaks to a PhD diet.
As you demonstrate, there does not have to be a conflict in practice with incorporating some of Stephan’s recommendations into the PhD diet.
At any rate I am going to experiment with it and see if I can have to same benefit you achieved.
Hi Daniel,
I agree, I never wanted to claim that being well nourished will eliminate all cravings. Only that being poorly nourished is a source of cravings, and if you don’t eat a nourishing diet, you have no idea whether your cravings are something you should resist or satisfy.
If you do eat a nourishing diet, cravings will diminish, and you can better evaluate how to respond. Some people may find they no longer have cravings at all. Others, like Ellen, will find they are without cravings until they start tasting a rice krisp – macadamia – rice syrup – ghee – salt – cinnamon dessert.
(Ellen, can I have some?)
Sue – Yes, exactly. It would have saved a lot of time for the responders and avoided some confusion if I had been able to clarify some points upfront.
Hi Jaquen – I’ve raised the number of comments sent out in the feed to 100 at a time. I don’t know why readers don’t pick up comments as they’re issued, I guess the feed connection breaks.
Hi Ellen,
Thanks for experimenting, let us know how it goes!
Hello Ellen,
I have noticed the same things you have. I eat the PHD way. I lost weight and lost my cravings. I had no trouble for the longest time. I could even have a square or two of 85% dark chocolate and have no desire to come back for more. Then school started back up and i was trying to make “snacks” for the kids lunch. I made a trail mix of chopped up 85% dark chocolate, raisens, dry roasted salted macadamia nuts and unsweetened coconut flakes. I went off the deep end. If I have a handful of it even after a satisfying dinner, i come back over and over again for more sometimes until its gone and then head straight for more of the chocolate. I dont know if its the sweet/salt/fat combo or what, but I have made PHD ice cream, sweetened berry compotes, etc and this doesnt happen. So far its just this one combination of products. strange?!
Shelley,
I would first suspect the raisins. Something about them can be terribly addictive. At least they were for me.
Maybe try it without any dried fruit first. Then with a different dried fruit each time like apricots or cranberries.
But I suspect that the foods or combinations of foods that do this to some of us are specific to each individual even though there may be general categories that seem to apply to all. Maybe some epigenetic thing caused by what our Mom’s did or didn’t eat when we were in utero.(I love epigenetics. I blame it for everything now 😉
@Paul
“Blood glucose peaked at 7.7 mmol/l = 139 mg/dl. A subsequent test with sweet potatoes peaked at 6 mmol/l = 108 mg/dl. The commenter inferred that (s)he couldn’t tolerate carbs. Robert Su agreed. I don’t get it. They are terrified of even normal increases in blood glucose.”
Thanks for doing the conversion. That’s pretty amusing. Doing a self experiment on VLC whose result is predictable based on already published value for GI of different foods. This drives me nuts, really. All these folks are taught to fear carbs, they stop eating them, their peripheral IR goes up, they read Davis or Su or other “experts” who seem to never pubmed for articles about normal glucose physiology, they test them selves, and what do you know? They are glucose intolerant!
Aravind-
“Even on a toxin free diet with a higher reward at the beginning/middle of the year, I felt the need to eat and snack more even though the quality of the diet was very hEven on a toxin free diet with a higher reward at the beginning/middle of the year, I felt the need to eat and snack more even though the quality of the diet was very high.”
Ellen_
“My concoction included rice krisps,coconut flakes, macadamias, rice syrup, coconut oil, ghee, salt and cinnamon. A perfect storm.”
Shelley-
“I made a trail mix of chopped up 85% dark chocolate, raisens, dry roasted salted macadamia nuts and unsweetened coconut flakes.”
Paleo junk food is more nutritious than store bought, but it may still function as high reward food and we are susceptible to overeating it even if our brains and body and diet are otherwise perfect.
My 2 cents from n=1…
I still don’t think I have my head wrapped around this topic especially with everybody on different blogs changing concepts and definitions. Per KH, people are talking past each other.
I had to make a “bad” cake for my nephew’s birthday and they didn’t want my “substitutions.” So I was tempted to sample the batter…whoah! I could have eaten the whole thing. But then the cooked cake was just OK. This was at a no hunger nor desire position at the time. I was surprised because I had sampled things like my old frien…err umm…nemesis, coke. I was surprised there too. It tasted more salty than sweet..and a little “metalic-like”…weird, bleh! And I haven’t wanted one since. This coming from a renowned coke-a-holic. I guess the only difference between the two was wheat and the fat (butter/eggs – its not these per my experience). On these occasions only within this last month, I had an increased hunger the following day. I had been remarkably hunger free throughout the day for 7 months dieting on 1200-1400 calories. Then, I eat a cake of wheat and sugar or drink a coke and wham-o, strong hunger in the morning and throughout the day. Reminded me of my roller coaster gut journey of the past! Not fun. As an analogy, it’s like getting drunk, but at least now I am fully aware of the cause-effect and that I will have a painful hangover if I drink too much alcohol. Too bad others haven’t even made the connection yet!
Like Aravind , I’ve only tried my own n=1 for two days, but its been interesting. I haven’t salted my rice or potatoes both days, but I still used spices. During the last 7 months dieting, I have been weighing and measuring the starches and that took care of how much I was eating of it. However, I think I could have easily eaten more if put on my plate on many days even though I wasn’t hungry for it. Whereas, without the salt recently, I definitely didn’t desire more after my normal amount. I think my experience might be skewed considering the 7 months were a fat guy eating a calorie deficit and now a skinny guy eating a calorie balanced diet amount. Nevertheless, the mental experience was enlightening to me.
As for now, I’m narrowed my villain list for me for FR to salt/sugar/wheat. And even worse than separately, these villains, as other commenters have said, are the perfect combination with a touch of fat, even healthy fat, that becomes the perfect storm for humans.
So could it be that instead of this generalized “palatability” which would include all flavors and food, instead it’s a more narrow type of foods that are the culprits? So we have the 4 evils for health (fructose, O-6, wheat/grains, beans) and then 4 evils for Food Reward and overeating (fructose, O-6, wheat/grains, salt?)?
Paul,
Would a high fiber source of carbohydrates such as coconut flour prevent glucose deficiency? Just curious as I’ve been using that in smoothies instead of oats.
Kurt:
“Paleo junk food is more nutritious than store bought, but it may still function as high reward food and we are susceptible to overeating it even if our brains and body and diet are otherwise perfect.”
Yes! And even tho my diet may be perfect, my brain and body will never be. That is what I am coming to accept thanks to this excellent exchange of ideas.
Because I had seen some positive changes in my blood sugar from incrementally increasing my starches ( and also from the PhD regimen of supplements especially high dosage of iodine) I got carried away and thought maybe I was getting closer to perfect and I could handle dessert type treats. It has only been two weeks, but I have been creating more and more of them. A bad sign.
I am sure some of us are more susceptible to High Reward Food than others and I am clearly one of those in the “more” category.
I may never completely restore normal glucose regulation but I see that if I stay away from the complex concoctions and stick with plain starches I have a better chance. And I may even lose some weight.
Just read the Jimmy Moore Post and comments in its entirety. Wow.
First, I am so glad this topic is being explored by the low carb community.
Colpo has blogged about the vitriol of low carbers before from him recommending more carbs. I always assumed it was just the amateurs with simple minds that get caught up in defending their notion of the only truth. However, I was surprised and shocked to read such disrespectful responses from some of the “experts.” What reading the responses did for me was of great benefit since now I have a “do not read” list and a “read” list. The read list was already most of my favorites. Now I know about the rest though.
Paul, since you do actually “work” with people like me and not just a “theorist”, you might “find” that an obese guy like me lost 75 lbs on 600 calories a day of safe starches, too!
“ANONYMOUS PROMINENT MEMBER OF THE LOW-CARB COMMUNITY
Jaminet is not a clinician seeing patients …In that sense, he’s a theorist….
Now here’s the issue: if he was treating obese individuals …he might find out that 600 calories of glucose a day is too much for weight loss”
I am glad Jimmy did it, but if the discussion was framed better in the beginning, it definitely would have clarified matters more clearly and not wasted time on so many strawmen arguments you don’t advocate.
Lastly, I found it entertaining to see the troops rally to defend the Jaminets…coherently and respectfully. Yeah, PHDers got your back Paul and Shou-Ching!
Thanks for the enthusiastic response to my blog post everyone. I’m willing to work with Paul on adequately testing this “safe starch” theory from PHD in an n=1 experiment. The purpose of my column was to have this conversation and I’m happy it has ensued. I respect the work of the Jaminets and their willingness to share what they have learned.
Jimmy, don’t need you to test the theory. It doesn’t make a difference how you react – doesn’t relate to anyone else. You went about that post the wrong way and should apologize to the Jaminet’s IMO.
I told Paul about this post and was nothing but respectful and complimentary towards him in how I wrote the post. Yes, some of the people who chimed in said things about the Jaminets that was unflattering and uncalled for. But I was not going to edit any of the comments. The point of my post was to talk about “safe starches” and their purpose. That’s what has ensued–a good thing.
Jimmy, thanks for creating a forum for this discussion. I agree with you, it’s a good thing.
If some of the people said inappropriate things, it reflects badly on them, not on me or you. I don’t mind it personally and look forward to responding. I am looking forward to being able to engage your readers on the topic, as I think many of them might benefit from a more relaxed attitude toward starches.
Best, Paul
I’m interested Paul. Definitely want to talk to you about how to best test your PHD concept complete with the 150g safe starches daily for a week to gear up for proper testing. Let’s talk about it because I sincerely want to test your theory for myself.
That’s great, Jimmy, let’s figure out how to do it.
I’m with other folks on “reward” being the wrong concept (but one which may particularly appeal to those who are stuck in the “obesity as character deficit” paradigm). Food products that are engineered to provide the sensory cues of high nutrient density (especially protein) but fail to deliver would be better described as having “negative satiety”.
Paul — your unfailing politeness and consideration in these responses are an example to us all.
I agree with you over the difficulty of pinning down the definitions of food reward and palatability — even “low FR does not necessarily mean a bland diet” leaves plenty of wiggle-room around “bland” for example.
This leads me to wonder if the longevity of CIH is down to the ease of which blood glucose can be measured (and therefore defined).
Seeing as there is no equivalent easily conductable test for FR (apart from weight loss claimed by n=1 experiments like Aravind’s interesting comments) I can see this being a big sticking point.
I have to admit to not looking forward to the brave new world of unbuttered potatoes and unadorned eggs. Although as Stephan Guyenet has commented he is not into selling snake-oil and we take the evidence as we find it.
Seeing as the spice trade is thousands of years old (for preserving as well flavouring) there must surely have been some communities using the benefits of this trade for perking up their food and remaining unobese during this period of time?
I’m not suggesting that we ignore the nutritional evidence from our hominid forebears or contemporary hunter-gatherers but are there not any societies historically who live in closer resemblance to ours who were not generally obese?
Could we not take (for example) the emergent middle class of the 18th and 19th century in the UK, Europe and North America? Were they suffering from obesity to the level we have today? I appreciate that there were obese individuals like William Banting but were the majority of the middle class really not adding salt or other spices to their food? And if so, were they suffering from it?
I sometimes feel our looking back to hunter gatherers as a “gold standard” is a bit like Kurt Harris’s point about equating potatoes with cans of coke. Not all carbs are bad and not all societies are unhealthy if they aren’t the Kitavans?
“Seeing as there is no equivalent easily conductable test for FR”
But actually that is the easiest thing of all to test.
1) What do you eat that you can’t stop eating?
2) On your new diet plan (whatever it is), what food do you really look forward to eating when you first wake up in the morning (Credit my wife Victoria Berry DDS for that one) Eliminate it.
These tricks actually work really well to re-start fat loss.
They also make people really, really angry when you propose them. I actually have had people respond by saying they would rather be dead than live life this way. They would rather be fat or have diabetes. Literally. We can’t get people with metastatic cancer to stay on ketogenic diets, so this should be no surprise.
The elephant in the room for fat loss is that for many if not most people they will never achieve healthy fat levels until they stop using food for stimulation and entertainment beyond their nutritional needs.
“I have to admit to not looking forward to the brave new world of unbuttered potatoes and unadorned eggs.”
You are not alone. I think this would be required in principle (not everyone needs to go this far) to actually reverse the obesity epidemic. Most people can get away with buttered eggs and potatoes if they just can the caloric drinks and limit restaurant fare. But the resistance to even these steps is monumental.
For that reason, I predict there will be no progress made at large. There will be victorious skirmishes for a subset of the population that read PHD or maybe my blog and others, but we will not save the world from obesity any more than we will eliminate late industrial corporate capitalism or stop using petroleum.
I did not always see it this way, but 4 years of seeing how people fail eating even the highest quality foods has me fairly convinced this may be true. I do not think obesity can be cured with food quality and macro ratios anymore, even if NAD removal may be of benefit for cancer or inflammation independently of obesity.
Unless you have favorable D2 alleles, EFFORT may be required. But people are too busy playing fantasy football and watching Idol.
Eating a lot and often is just part of the entire expanding western culture of serial entertainment. It will not go away any more than our iPhones will…
Just wanted to agree with Simon – Paul your politeness and magnanimity in this debate has been exemplary.
There is something that aek hinted at of which I’ve been aware for a good while and through which I filter material from some sources. That is the issue of conflict of interest. Many of the low carb “experts” have careers, websites, books, blogs etc to defend. They have incomes to maintain. Not wishing to single out Jimmy M in particular, but “Living La Vida Low Carb” by definition will struggle to accommodate the concept that carbs as such are not an issue. The very name of the site, its concept and associated income streams would be at risk.
It has been exciting and fascinating in recent months how the understanding and communication of issues around diet has grown and become more refined, particularly around food reward and neolithic agents of disease. The PHD has been at the forefront of all this. I think some of the traditional low carb “experts” are struggling to keep up.
Another ditto here for your unfailing politeness and extreme magnanimity is dealing with the hot mess of Jimmy Moore, Inc.
Chris, I’m glad to read that you are filtering nutrition claims through the lens of conflicts of interest.
Cynically, I view what Moore is doing as a self serving marketing ploy to gin up a contrived controversy, drive traffic to his website and increase sales. That he’s now “interested” in doing yet another n=1 trial stunt is underwhelming.
It would be more than acceptable if Paul didn’t rise to that stinking bait and refused to engage.
Moore seems to have such a large presence in this nutrition arena that most of the Paleoish/primal folks let him use them so they can be interviewed on his podcasts and I presume, help to drive up their own traffic and sales.
Maybe it’s time to bite the bullet and do a “not nice, but real” number a la Emily Deans and confront Moore on his claims.
That might mean hitting a number of people in the pocketbook, but the science and evidence demands a reckoning, no?
Paul got to see Moore’s Twitter response to me yesterday when I confronted his “respectful and polite” claims. (@aek2013)
It’s time that everyone gets a good gander at how he operates.
Where is the “like” button? aek, you are right on the money.
But I’m torn.
As much as we’d all like to rub the faces of Moore and his followers in their own fallacious thinking, it wouldn’t advance the starch discussion. Paul is catching flies with his honey. He’s got an opportunity to shift the paradigm here and, bless the man, he’s not letting mud-slinging distort his focus.
I agree that he would be justified in telling JM to stick it. Fortunately, Paul is too smart and composed to take the easy and reactionary route. The Paleo world has a chance to actually get somewhere in these discussions if we follow his lead.
@ Kurt re: “They also make people really, really angry when you propose them. I actually have had people respond by saying they would rather be dead than live life this way. They would rather be fat or have diabetes. Literally. We can’t get people with metastatic cancer to stay on ketogenic diets, so this should be no surprise.”
Nodding my head remembering patients’ reactions to therapeutic diets and my own dread of making fundamental diet changes.
Part of the picture is engaging people in being motivated to change. Once that’s accomplished or at least in progress, framing specific changes as having options instead of deprivations is sometimes useful.
Once strategy that I used was to keep the option “open” of eating the baseline foods but only after I had eaten the preferred foods.
The “magic” of that was that the preferred foods re-regulated appetite and hunger, and then I could control/eliminate cravings by simply keeping the baseline non-preferred foods out of sight (not watching/reading food product advertising, programming, having those foods in the house and skipping the food shopping locations for them – aisles, vending machines, restaurants, etc).
Where it remains difficult is where the individual and significant others interact around food: office meetings, catered meals, social gatherings, family meals, etc. Culture and social norms are powerful things, and eating a la PHD/EM2 is noticeably different. This may be where it’s most difficult to reduce NAD exposure. Perhaps this is where policy/practice/business opportunities lie to make the preferred diet the default choice.
As an aside, I appreciated your generous and detailed explanations on the comments threads at Jimmy Moore’s hit piece. I hadn’t realized how little he and his followers understand basic nutrition and physiology principles. You performed a great service there.
Thanks for your comments Dr Harris — I didn’t want to come across as an ungrateful reality-denying happy-but-obese diabetic (because I am not).
You are absolutely right that we have an unhealthy relationship with food as entertainment and in many lives eating cheap but heavily flavoured processed food is a highlight.
For me, that is the key. How do we stop people looking at food as a sensual entertainment when they feel the rest of their lives are so hard?
Resolving that issue may be harder than focusing on the obesity epidemic itself.
@Occam re: “As much as we’d all like to rub the faces of Moore and his followers in their own fallacious thinking, it wouldn’t advance the starch discussion. Paul is catching flies with his honey. He’s got an opportunity to shift the paradigm here and, bless the man, he’s not letting mud-slinging distort his focus.
… The Paleo world has a chance to actually get somewhere in these discussions if we follow his lead.”
I agree that the nutrition discussion can be advanced and that Paul’s blog is an optimal place to do that. As he has stated that a response is forthcoming, I look forward to that.
I wish no ill will to Moore, nor do I seek retribution or retaliation for what he’s done. My point is that the fallacies and misrepresentations should be confronted and clarified, and that he shouldn’t profit from having created/promoted/advanced this situation.
If Paul and other evidence-based writers wish to engage Moore, I would hope that they do it on their own turfs, so to speak, and not drive business to Moore.
It’s of interest that I haven’t seen Moore’s readers/commenters/clients comment on this blog. As the Jaminets are the most forgiving and hospitable possible blog hosts, I don’t ascribe it to anything other than Moore’s failing to point his readers this way.
Which returns us to the COI issue and business practices aspect…
Dr Harris,
Regarding your comment – “I do not think obesity can be cured with food quality and macro ratios anymore, even if NAD removal may be of benefit for cancer or inflammation independently of obesity.”
I agree with this based on my experience that I shared, however perhaps some people will be content being 20-30 lbs overweight which is better than being 50-100 lbs overweight, and make the willful decision to remain a foodie rather than undertake the austerity (from their POV, not mine) required to become truly lean.
In my case, I feel that being lean is merely an ancillary benefit of living a low reward lifestyle, of which diet is only 1 component. Moreover, having lost a father to cancer at age 52, there are certainly things that are more important than having a beach body. It would be nice to see a shift of focus to other health issues in the blogosphere. There is more to health than having a 6 pack, right?
Lastly, I think a big disservice to the community is the notion of 80-20 rule incorrectly applied to diet and nutrition. What if 20% of diet (i.e. cheats) leads to 80% of your metabolic derangement?? If so, the decision to eat healthy 80% of time with 20% cheats might not be good enough for leanness or even general health. People seem equally unwilling to accept this concept, in part because of misunderstanding of the Pareto principle.
Paul,
I agree with the other commenters. You are a class act!
Regards,
Aravind
Aravind – interesting idea about the 80/20 and the damage that might accrue from that 20%. I have a feeling that you might be right, although I fear that could tip me into orthorexia…. Then again eating right is not that hard.
Hi Aravind, Great point about the 80/20 rule. I agree wiht you. I also think the desire for cheats reveals a deficiency in the diet.
On “lean meat and vegetables” Paleo, of course, people should cheat — it will make them healthier. But I think most people can follow PHD without any great desire to cheat, as long as they avoid the few foods that are addictive for them.
Re Kurt’s point about food quality and macro ratios as a cure for obesity, I agree that that is not the whole story, but I still hold out hope for food quality, macro ratios, and curing chronic infections. Inflammation and infections are a significant cause of weight gain and metabolic dysregulation — see eg Mario’s cite at http://perfecthealthdiet.com/?p=4822#comment-32948, just removing infected teeth can reduce HbA1c from 8.6 to 7.3 in diabetics.
By the way, everyone, please lay off Jimmy. He’s giving me ample opportunity to respond and is going to try our diet for a week, using a meal plan Shou-Ching and I design. I don’t think anything he did reflects badly on us, and if it could have been executed better, he’s more than making up for it with a generous allocation of time and attention to explore the issue fully.
Thanks Paul. I do agree diet plays a huge role, but I think a desire for a cheat could simply reflect non dietary issues in your life. Years of conditioning that when you are stressed out or emotionally strained, stuff your face in the pint of ice cream, or crack open a few beers to drown your sorrows. Next thing you know, you’ve eaten a large pizza.
Or it could simply be social pressure. How can I not eat the cake at my friend’s birthday party? That would be rude! And everyone else is having a drink, so I need to or they will think something is wrong with me.
In a food abundant environment with modern emotional issues, I do not think we can discount non dietary factors as well. We all need some therapy from Dr. Emily Deans 🙂
@Aravind
“I think a desire for a cheat could simply reflect non dietary issues in your life.”
I’d go a step further. I think it usually has nothing to do with diet or adequate nutrition.
Any more than the desire to smoke or surf internet porn is caused by dietary deficiency.
Thanks for your thoughts and looking forward to your guest post on “technology reward”.
Now I am going to turn off my macbook air and iPhone and go shooting ; )
“technology reward” now that is interesting….. Most of us commenting here are probably almost addicted to the reward of these debates, updates and information
“The elephant in the room for fat loss is that for many if not most people they will never achieve healthy fat levels until they stop using food for stimulation and entertainment beyond their nutritional needs.
“I have to admit to not looking forward to the brave new world of unbuttered potatoes and unadorned eggs.”
You are not alone. I think this would be required in principle (not everyone needs to go this far) to actually reverse the obesity epidemic. Most people can get away with buttered eggs and potatoes if they just can the caloric drinks and limit restaurant fare. But the resistance to even these steps is monumental.
For that reason, I predict there will be no progress made at large. There will be victorious skirmishes for a subset of the population that read PHD or maybe my blog and others, but we will not save the world from obesity any more than we will eliminate late industrial corporate capitalism or stop using petroleum.”
This is really the central issue…. whether we face up to it or not.
I am most fascinated with the fungus aspect of a very low carb diet. Thank you Paul for pointing this out.
I have been on a very low carb diet for 11 years now. I am very strict with what I eat. I feel well, I have managed a terrible case of ADHD and a tick and haven’t raised my carb level much at all due to the fear of both returning. (I also have a terrible fear of ever being fat again) However, after much study, I believe my issues came more from wheat than blood sugar control.
Thank you Paul, I too plan to practice the PHD for the next 30 days for my own n=1 experiment.
Misty, I look forward to hearing about your experiment and if the ADHD and tick stay away.
The meal plan that you design for Jimmy is it one that others can try or will it be specifically tailored for Jimmy?
Hi Misty,
Is the “tick” a tick bite (which may have given you an infection) or a tic (an involuntary spasm)? ADHD and tics may often be helped by ketogenic diets. You can still maintain ketosis even after eating starches like rice by eating some coconut oil, and by doing intermittent fasting.
Let me know how things go!
Hi Sue,
I’ll have to discuss Jimmy’s personal health situation with him. If he has blood glucose regulation issues, or problems with certain foods, then we may modify the meal plan for him and his wife Christine. But if he doesn’t have diabetes/pre-diabetes or food sensitivities, we’d just propose our regular diet, adapted for his taste in food.
We’ll publish the meal plan and anyone will be able to follow along.
Thanks Paul.
“So good to see my 3 favorite thinkers in one spot. I am a 64 year old woman who has fought weight control all my adult life. January 2011 I started following Dr. Harris’ 12 steps, J Stanton’s “Eat Like a Predator” and the Jaminets PHD” – Nancy
Agreed. Each are fantastic individually (possibly the 3 best from a holistic health perspective- Sisson is a little too populist these days; Guyenet and Masterjohn are awesome but not as holistic). To see them comparing notes is a huge boon.
Paul, Kurt and JS: Thanks for all you do to push our collective knowledge forward, and for all the time you sacrifice in the process.
@James
Thank You!
I’ve been quoted as saying I have no interest in saving the world at large, but I am very happy if any of my musing help appreciative seekers who find their way to these corners of the interwebz : )
Wow, I really couldn’t believe that so many people replying to Jimmy didn’t bother reading or at least skimming the PHD book. They clearly didn’t understand the definition of “safe starches”, but yet some were rude and dismissed this idea without even understanding the concept!!!
This reminded me of the phrase popular in former USSR: “I did not read Pasternak, but I condemn him”.
It’s sad really that Jimmy published some of these replies.
Paul and Dr. Harris thank you for what you do to help others!!!
I’m with Kurt on the idea that, in many cases, cheats have very little to do with the nutrients (or lack of) in the diet. My experience on PHD is that a nutritious diet gets you pretty darn far. But if you’ve been trained over decades to turn to SAD foods for all sorts of non-nutritive reasons, breaking that pattern requires more than nutrition.
That said, the one thing that I’ve noticed is that when I do have urges, it is much, much easier to see them as triggers that are responses to something else.
Me, I’m attributing my 60 sessions of neurofeedback as helping a LOT with this; too bad it’s not yet recognized/covered by insurance. But I’m still doing the off-diet meal once a week, mostly as a way to make it easier to accept that I’m doing this as a lifestyle, not a short duration weight loss effort.
I suspect that over time, it will be like learning to ski. You start on the bunny slope, and with some time and effort, you’re soon doing the double blacks ;).
Hi Paul,
Thanks so much for your responses. Lately I’ve been noticing a very strong ammonia smell in my urine – wondering if you’ve ever heard of that and have any possible explanations? Thanks!
Jean