Category Archives: Diets - Page 15

Experiences, Good and Bad, On the Diet

Posted by on January 4, 2011 185 comments

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.

Old Diets, New Knowledge: For Auld Lang Syne

Posted by on December 31, 2010 79 comments

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

The State of Dietary Science

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

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

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

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

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

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

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

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

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

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

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

Popular Paleo Diet Books

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

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

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

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

I have a few objections:

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

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

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

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

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

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

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

Food Toxins: Weston A Price Lives!

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

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

I agree.

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

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

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

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

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

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

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

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

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

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

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

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

Integrating Medicine and Diet

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

In his review, Chris states:

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

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

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

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

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

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

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

Conclusion

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

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

Reflections on Our Book Inspired by Chris Masterjohn, I

Posted by on December 30, 2010 58 comments

Chris Masterjohn has put up a detailed review of our book. He calls my wife and I “awesome,” the book “excellent,” and awards “two thumbs up.” Thanks Chris!

Chris’s review led me to reflect a bit on our book, and I thought it might be appropriate to close the blogging year with a couple of posts about it. Specifically, I will:

  1. Clarify our argument for optimal macronutrient ratios. Chris spends a substantial part of his review discussing the issue of carbs, and I think readers may be interested in my perspective on the issues he raises.
  2. Look at the “big picture”. What is the state of dietary science, and where does it need to go? How close are bloggers and scientists to integrating the various perspectives and reaching the truth? What does our book in particular contribute to both popular and scientific debates?

Today I’ll discuss the carb issue.

Macronutrient Ratios and Carbohydrate Intake

Step One of our book is about macronutrient ratios. The key goal of Step One is to help readers understand how much of each macronutrient they need to avoid deficiencies and what levels will produce toxicity conditions.

For some macronutrients this is easy, because the evidence is fairly clear:

  • Protein. Roughly 5% of energy as protein is sufficient to avert a deficiency, and the evidence of toxicity is also fairly clear: protein over 40% of energy can be fatal, and there are less severe indications of toxicity at about 30% for adults, 20% for pregnant women, and 9% for infants.
  • Polyunsaturated fats. About 0.5% of energy will avert deficiencies of both omega-6 and omega-3 fats, and there are subtle indications of toxicity above about 4% of energy, with the indications becoming obvious above 10%-15% of energy.
  • Saturated and monounsaturated fats. These are benign at all intake levels: non-toxic in high doses, and impossible to become deficient in (except during starvation) because the body will manufacture them from carbohydrate or protein.

But determining the optimal intake range of carbohydrates is difficult, because unlike the other macronutrients there is no data that lacks confounding factors.

The main problem is that the main sources of carbohydrates in western diets – grains and sugar – contain food toxins such as gluten and fructose. So any benefits from reducing carbs could be the result of reduced toxin intake, not reduced carbohydrate calories.

We know these plant toxins are important, because populations that obtain carbs from “safe starches,” such as yam-eating Kitavans, rice-eating Chinese and Japanese, and potato-eating Irish have been notably healthy. (See, for instance, our China Study posts, our wheat series, and Stephan’s Kitava and potato posts.)

However, in none of those “safe starch” eating populations do we have good data on how health outcomes vary with a differing mix of carbohydrates vs. saturated and monounsaturated fat.

With data lacking, our prescriptions have to be based largely on biologically-informed theory – theory instructed by, as Chris puts it, “circumstantial evidence.”

The “Eat What We Are” Argument

A good first estimate for carb intake comes from the simple precept that we should “eat what we need.” The body’s glucose utilization level, about 600 calories per day, tells us how much we need. The simple prescription, then, would be to eat about 600 calories, or 30% of energy for a slender person, as carbs. Let’s call this intake a “moderate carb” diet.

Evolutionary Arguments

Another place to look for guidance is evolution: what macronutrient ratios has evolution selected for?  Here we do not place much weight on ancestral Paleolithic diets, which varied substantially from place to place and time to time. Rather, we place more weight on animal diets and the composition of mother’s milk.

Both human and animal breast milk is majority-fat, moderate-carb, low-protein. In milk of all species, the carb percentage closely tracks the infant’s glucose needs.

In animal diets, the macronutrient ratios delivered to the body depend on the design of the digestive tract, which transforms the macronutrient content of food. Digestive tracts are generally good at transforming carbs into fat. As a result, after transformation most animals have carb intakes equal to or below their carb needs. In ruminants and foregut fermenters, the transformation of carbs into fats is virtually complete; in hindgut fermenters, it is only partial.

Many animals achieve so many of their calories from bacterial fermentation of dietary carbs that their diets are actually highly “ketogenic” and nearly zero-carb.

Thus, evolutionary considerations suggest:

  • Optimal human carb intake is probably close to or below our glucose utilization of 600 calories per day.
  • Ketogenic diets with substantial calories from short-chain fats are probably healthy.

I find evolutionary logic convincing. Since healthy creatures will generally have more descendants than unhealthy ones, evolution surely selects for health.

The Argument From Palatability

In addition to being healthy, a diet should be tasty – palatable. People should enjoy it and be pleased to eat it.

This has an influence on macronutrient ratios. Fatty animal foods in general have higher caloric density than carb-rich plant foods. Fruits and berries have 200 calories per pound; potatoes and sweet potatoes 300; taro 600; white rice 1300. In contrast, meat often has about 1000 calories per pound; bacon has about 2400. To eat 30% of calories from carbs, while avoiding toxic foods like grains and sugar, requires eating substantially more plant food than animal food.

But people generally find food most palatable when there is a mix of plant and animal foods. Since carbs come exclusively from plant foods (excepting milk), which have lower caloric density, this means a tasty diet inevitably has more fat than carb calories.

The Argument From Toxicity

As we note in the book, plant foods have more toxins than animal foods. This is because they use toxins to poison animals that might eat them, while animals cannot easily poison predators without also poisoning themselves.

Toxins are found in nearly all plant foods. Peter at Hyperlipid has a post today about berry toxins, pointing out that they have a similar biological effect to a pharamaceutical drug, anacetrapib, that raised the death rate in clinical trials. (I note in the comments that the benefits from poisoning gut pathogens and cancer cells might outweigh the damage from direct toxicity. This is why I eat “Neo-Agutak” – cranberries. )

If it’s desirable to avoid toxins, it’s desirable to keep plant food intake down and animal food intake up. Given the low caloric density of most plant foods, that also implies that carb calories will need to be low on an optimal diet.

Plateau Ranges

As Chris notes, we do not define precise optima for each nutrient, but rather suggest “plateau ranges” that achieve all the benefits and none of the toxic effects.

Based on the above reasoning, for carbohydrates, our estimated plateau range is from 10% of energy on the low end (which we recommend for therapeutic ketogenic diets) to 30% on the high end (a “moderate carb” diet in which all the body’s glucose needs are met from diet).

We do suggest specific values of 20% carbs, 15% protein, and 65% fat. These are mid-range values which casual dieters may wish to aim for; even if they miss by 10% of energy on any macronutrient, they will still be in the plateau range.

What Happens If You Deviate From the Optimum?

But if this logic tells us what the optimal carb intake is, it does not tell us how much harm is done by carb intakes different from the optimum.   

Here I agree with Chris that in healthy people, the damage to health from changes in the carb:fat ratio could be very small, as long as the carb sources do not contain appreciable toxins. The body has a great capacity to convert carbs to fat. So long as that transformational capability remains undamaged, a very high-carb diet may be functionally very little different from an optimal diet.

In metabolically damaged people, however, transformations from one macronutrient to another may be impaired. In this case, the body may have very little flexibility in repairing a suboptimal carb:fat ratio.

I thus agree with Chris’s conclusion:

I thus find it very difficult to believe that humans must maintain their diets within a very narrow range of macronutrient ratios. More likely, the human body is extraordinarily flexible and can tolerate a wide range of carbohydrate and fat intakes.

That said, it may well be the case that in modern folks with damaged metabolism, low-carb is the way to go. Indeed, well controlled studies have clearly shown that low-carbohydrate diets are superior to low-fat diets by a multitude of criteria for people with various markers of the metabolic syndrome (references here, here, and here).

Nothing in the book contradicts this conclusion. As an editorial decision, we chose to describe the “perfect” diet for health without spending space discussing imperfect diets. Given that decision, we didn’t need to address whether a 90% carb diet is only marginally worse, or much worse, than a 30% carb diet.

But that is an appropriate topic for discussion on the blog. I’ve begun a “zero-carb dangers” series; perhaps I should do a “high-carb dangers” series too.

Conclusion

Much research will be needed to disentangle the relative contributions of plant toxins and carbohydrate calories to health.

It looks from early evidence that intake of plant toxins may be much more consequential for health than the overall carbohydrate level. This is good news, since selection of low-toxicity foods and preparation methods that detoxify foods may enable big improvements in human health.

Nevertheless, even if most toxins can be removed, there are reasons to believe that a low- to moderate-carb (10% to 30% of calories as carbs) diet will be optimal for human health. Such a diet seems to work well for nearly everyone, even the metabolically damaged; and it produces a tasty diet that is a pleasure to eat. It therefore seems the most prudent recommendation for diet book authors to make. And we stand by it!

Fasting and the Ketogenic Diet for Migraines

Posted by on December 21, 2010 82 comments

We’ve previously argued that people with migraines should try a ketogenic diet. There are two reasons: (1) ketones can evade certain mitochondrial defects which might cause migraines, and (2) ketones reduce glutamate levels, and glutamate toxicity is implicated in migraines.

Reader Rob Sacks has had lifelong migraine headaches. As an experiment he turned to desperate measures – a long fast. Here’s his story:

I fasted for 30 days.   When I say “fast” I mean that I stopped eating all food.   I consumed only water and occasionally sea salt and potassium tablets.

As part of the fast I stopped taking Imitrex which I had been using almost daily to control my migraines.   I did this because I thought Imitrex was increasing the number of migraines due to a rebound effect.   I also stopped consuming caffeine to which I was addicted.

As the fast went on, my migraines lasted for shorter periods of time, and they became less painful. 

By day 23 I became free of headaches.  There was still some sort of migraine activity — I could often feel the sensations that in all my previous life, had always been followed by a headache — but no headache resulted.   Judging from what I could feel, there is a cascade of events that leads to a migraine, and the metabolic changes induced by the fast were interrupting the cascade at a certain point.

I was quite happy with this result and continued the fast as long as I could in the hopes that this would increase the chances that the change would be permanent.

Unfortunately, after the fast ended, the headaches gradually came back. I think this happened because after the first few post-fast meals, I made no effort to keep my diet ketogenic. An intense craving for fruit developed and once the danger of refeeding syndrome seemed to be over, I gave in. This was interesting because before the fast I had been on low carb diets since 2007 and hadn’t craved carbs in years.

When I saw the gains slipping away, I fasted again for two days to get back into ketosis as quickly as possible. Then I started following a diet similar to those used by neurologists at Johns Hopkins to treat children with epilepsy, with calorie restriction, frequent meals, and a ratio of fat to protein (by weight) of four to one. After two days of this diet, my headaches stopped again. That was only 48 hours ago but I’m sure the diet is working because I challenged myself last night with a sure-fire migraine trigger by staying up past my bedtime to watch the eclipse. Normally this would create a debilitating headache, but the only result was a slight migrainy feeling that was easily controlled with two aspirin. Before the fast, aspirin had no apparent effect on my migraines.

The next step will be to try more moderate diets and find the least extreme one that controls the headaches.

The fast proved that migraine headaches can be stopped by the metabolic changes induced by fasting.  Hopefully I can find a way to make that same metabolic state occur permanently.

Incidentally, the fast had some unexpected beneficial effects.  A bad varicose vein is dramatically improved, and a teary eye problem (which I think was caused by a clogged tear duct, and which I previously controlled with large amounts of vitamin C) has resolved almost completely.

I think this kind of experimentation is extremely important. Through experiments like Rob’s we can learn more about the causes of these seemingly incurable health conditions and find dietary and nutritional methods for healing or mitigating them. Experiments in lab mice are important, but the mice don’t tell us what they’re experiencing!

Rob lost 22 pounds during his 30-day fast, equivalent to 2200 calories per day if taken equally from protein and fat. Such an extended loss of lean tissue can be quite dangerous. If he had taken coconut oil or medium chain triglycerides during his fast, he would have conserved lean tissue mass and might have actually increasing ketone availability.

Fortunately it looks like ketogenic dieting is the key to Rob’s migraine relief, so extreme fasting should not be necessary.

Fasting does have therapeutic actions apart from its elevation of ketones. For instance, it promotes autophagy. It is possible that the fasting, not the ketones, was responsible for Rob’s cure of his varicose vein and teary eyes.

Rob might wish to experiment with protein restriction and other techniques for autophagy promotion, in order to see if they might also be beneficial in addition to ketosis.

Also, experimenting with micronutrients is important. Magnesium and riboflavin are often helpful for migraines.

Good luck Rob! Keep us posted.