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

Posted by on November 15, 2010 308 comments

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

Kwasniewski recommended that adults should eat in the ratio

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

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

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

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

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

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

Gastrointestinal Cancers in Optimal Dieters

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

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

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

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

Zero-Carb Diets Can Induce Mucus Deficiency

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

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

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

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

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

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

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

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

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

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

Mucin Deficiency Causes Cancer

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

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

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

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

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

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

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

Nutrient Deficiencies Can Also Play a Role

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

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

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

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

Conclusion

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

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

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

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

Related Posts

Other posts in this series:

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

References

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

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

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

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

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

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

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

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

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

Reader Reports

Posted by on September 12, 2014 14 comments

It’s been a while since we’ve shared reader feedback – too long!

In the last few months, readers have reported good results against: obesity; underweight; joint pain; anxiety and panic attacks; autoimmune thyroid conditions; infertility; back, neck, and stomach pain; insomnia; hunger; menstrual cramps and pain; fatigue; bipolar disorder; scoliosis and back pain; prediabetes; eczema; skin quality; multiple sclerosis; irritable bowel syndrome; heart palpitations; leg cramps; low energy; low libido; flat mood; gingivitis; type 2 diabetes; ringworm; seborrheic dermatitis; back pain again; thyroid, adrenal, and gut issues; autism; arthritis pain; and headaches.

Thank you to everyone who shares results! If, by chance, you want to cure some of these conditions yourself, the quickest way forward is to attend our Perfect Health Retreat.

From Amazon reviews

Taylor wrote:

This book is great. I’ve been on the diet for about two months and have already lost ten pounds, and I feel a lot healthier.

Charlie wrote:

Lost already 12 pound in 6 weeks. Simple advice with big impact.

Healthy pursuit wrote:

I have been waiting for this book all my life. I have tried every diet with no success. I knew there had to be a diet that was nourishing but also did not create constant cravings. I have been on this diet for just a few days, but already feel much better and have less cravings. I will be recommending this book to all my family and friends.

Mary Joy Fant wrote:

Both of my grandmothers lived to be in their hundreds. They both cooked their own meals and ate lots of potatoes and onions. Neither had ever been hospitalized. Both died from complications from broken hips. I have been low carb for a couple of years but after the first 40 #s I am just stuck. Can’t lose more weight and still need to release about 50 more to be at a health weight. After I got the book I started immediately with adding potatoes and rice and lost 2 # this week. I liked that I had the bare bones of the book with diet info at the very beginning. Took me a week to finish the book. Now I feel like I too will be able to be a spry healthy person in my later years. I am a 57 year old female and looking forward to life with a healthy and strong body. Thanks for such an informative book and for the hope it gives us all.

Mallory Osugi wrote:

It’s been said before…but it really is the sanest book on health. No exaggeration or gimmicky ideas, just very sound and practical information that completely makes sense. I am rereading for the fourth or fifth time and still having dozens of epiphanies. This is one book I am buying for as many loved ones as I can convince to accept it. I started on zero-carb, lean-meat-and-veg Paleo, and became painfully thin and developed some health problems, and now I have gained weight, but in a good way–I get some compliments on looking toned or, once, to my surprise and delight, like a runner (though I exercise little). And I have fixed several other problems. I am just dying to give this to everyone

D&S wrote:

In short, this book has changed my life. Since adopting the PHD shortly before Thanksgiving, I have lost 25 pounds. I have not “dieted” at all. I just simply removed the foods the book suggested and ate more of the foods recommended. I have also practiced the intermittent fasting suggested in the book.

I feel unbelievably better. I have 10 times the energy and the pain in my joints is gone. Consequently, I have been exercising more regularly. The pounds are just melting off. I have not been at my current weight since I was in High School over 25 years ago. I can’t wait to go to my physical and see my blood work. In addition, it is now fun to sit by the pool in my bathing suit and wear my entire new wardrobe.

From the PHD Facebook group

Go to the PHD Facebook group page and click “Join Group” to join:

Leo wrote:

my bad anxiety and panic attacks came from following Atkins … this was my first attemp at dieting, thankfully my second attempt 3 years later was with phd, lost 4 pounds/month for 8 months

Angela wrote:

I have been a type 1 diabetic for almost 30 yrs-low carb was life changing for me for a good number of yrs. I was 30 grams or below each day without cheating (ever) for a few yrs with really great results. I truly thought I found the magic fix! after I developed an autoimmune thyroid problem things went south and no matter what I felt bad-very low carb can cause issues with converting t4 into t3….I explored adding the PHD safe starches back in with good results. for me, carb balance is a must. if I am too low carb for a wk or so I can tell. As soon as I up the starches I get some relief.

From Anonymous:

So here’s a story for you. Friend just gave birth. Baby and mom are great. Mom is 36. First two babies were at age 21 and 24. Then despite best efforts, no babies came–and mom was so, so sad. At 32, she decided the age span was too large and she didn’t want to keep trying. They started using birth control.

A year ago March, mom was diagnosed with Crohn’s and she could only tolerate those awful elemental diets. Slowly, she added joint stock (pressure cooked) with feet, joints. Then little bits of egg yolk and liver in the stock. Then meat. Then bits of blended veggies. Eventually, she was eating essentially a Sarah Atshan version of PHD (lots of soup!)

Around the same time, they stopped using birth control thinking that it was pointless anyway because, after all, they’d tried for 9 years to no avail.

Then, after 5 or so months on PHD/AIP/traditional foods, at age 36, she was pregnant! **After 9 years of trying**

Uneventful pregnancy.… Amazing n=1 for treating infertility that was, in this case, likely both male- and female-factor.

Kathy James wrote:

I also switched from VLC. I’m about 5 weeks in, and I already consider this a success.

When I switched to PHD, I had just gained over 20 lbs on low carb Paleo, with thyroid symptoms (terrible!!). I continued to gain after starting thyroid meds. Then after switching meds, and starting the PHD, I gained another 8 lbs. However, in spite of the gaining, I feel DRAMATICALLY better. More clear headed, more energy. I’ve included resistant starch and my gut is doing so much better!!!

I believe I may have just lost a couple lbs. I’m trying to not get on the scale, and focus on healing and taking care of myself. Trust me, would LOVE to lose these 28 lbs!! However, I want to be healthy, and this is getting me there, I believe it.

I like the saying “you don’t lose weight to get healthy, you get healthy to lose weight”.

Pola wrote:

Hi everyone, thanks for adding me. My story, if anyone is interested: I had been on the paleo diet for over 4 years, getting more and more low carb until I went ketogenic for over 1 year, eating just fat and meat, zero or close to zero carbs and I was getting more and more more fatigued. I started experiencing increased stiffness in my body, especially my neck. I seemed to be always in a sort of spasm around my shoulders. I was feeling constantly nauseous and I had recurring sharp pain in my stomach area. A visit to the doctor could not explain what it was. I started experiencing something I never had before: a burning sensation in my mouth, an insatiable thirst. I could drink as much water as I wanted, it was to no avail. It was literally as if my mouth was on fire. I also started having the sensation of head pressure and head pulling that felt like there were strings attached to my brain and somebody was pulling down on them. For the first time in my life I started developing insomnia problems. I would sleep only 5 or 6 hours, sometimes wake up in the middle of the night. Then there was phlegm in my throat. Years ago it used to be extreme and it improved dramatically since i stopped eating grains but then came back on the low carb and ketogenic diet. I kept on spitting out clear phlegm. Most curious of all: I gained weight! That was truly baffling to me. I was literally not eating any carbs. It was just meat and fat. Organic 100% grass-fed burgers with 20% fat content and slabs of organic grass-fed butter on it – and I was gaining weight. Or I would drench everything in coconut oil. When I mean no carbs, I mean not only no potatoes, rice etc, but also no starchy veggies like carrots, beets, winter squash, not even salads. I would eat a salad maybe once every 3 or 4 months. so then somehow by accident I came across mark sisson’s article on marksdailyapple.com about candida and him mentioning Paul’s theory that candida feeds more readily on ketones than on carbs and I decided to put it to the test. Given that sweet potatoes were part of the paleo diet I thought that that allowed me to safely test the claim without me having to break my paleo/keto diet strain and still remain at least a “pure paleo dieter”.

By the time I had returned from the grocery stores on the day of the test I hadn’t eaten for a good 3 hours and with a now sober eye I noticed that the head pressure had increased and the stiffness in my neck and body was escalating as well. I cooked and ate the sweet potatoes I had just bought and the relief I felt was nearly instant. Within 20 or 30 minutes the head pressure which had been unrelenting for good 1 year, just dissolved. Fatigue improved markedly as well as the body and joint stiffness.

The painful insatiable thirst that not even a gallon of water a day was able to quench? The sweet potatoes took care of that. The constant nausea? I wasn’t even done eating before I noticed an immediate relief.

I had taken a theory, tested it and verified it. Within 3 or 4 days I had lost the extra weight I had accumulated around my waste on the ketogenic diet. I stopped spitting out clear phlegm. My energy was better and the body stiffness stayed better as well. The heart palpitations which hadn’t allowed me to sleep, stopped. I haven’t experienced them since.

I was sold.

That was around 9 months ago. Since then I kept proving Paul’s theory correct every day, several times a day. I’ve learned to tune into my body and know now when my body goes into ketosis and when it’s time to eat some carbs to not allow things to escalate. And it works every time.

Paul, feel free to add this to your testimonials on your website if you want.

Anyways, thank you so much for helping me out of my ketogenic diet delusion.

Thanks, Paul!

From email

J wrote:

Just to let you know I have been on phd for about 7 months, my body is in amazing shape feeling awesome.

Kathy wrote:

Just a few days on the diet and I can’t believe how much better I am sleeping and how little hunger I have.

K wrote:

My menstruation cramps have completely diminished and that has never happened before. I almost get it always the first day menses and it usually keeps me doubled over in pain for at least 10-15 minutes and for the rest of the day it would just be a gnawing pain at my side. So the fact that I barely have fatigue (except from my finals) and that I feel no painful cramps anymore has completely blown my mind. I have always had pain and it always incapacitated me for the week. I am so fascinated by this fact.

G wrote:

I have Bipolar type II. It’s been a month and a half [since I started PHD] and I am not looking back. Eating along the lines of the PHD is definitely having a positive effect on my moods – significantly reduced diurnal mood variation, less depressed mood and much better sleep.

KM wrote:

I would like to thank you from the bottom of my heart for writing one of the best books ever written.  Your research is so thorough and your conclusions are so enlightening.  Your work has greatly improved my life and my health and for that I will be forever grateful.

When I was 16 years old, I was diagnosed with scoliosis which caused me pain and hardship.  Every doctor I went to said basically the same thing, “It’s not so much the degree of curvature that is plaguing you, it’s the inflammation.”  In 30 years of seeking treatment, not one doctor ever asked me what I was eating.  After beginning the Perfect Health Diet in order to lose some weight, I ended up curing my back pain in the process.  The inflammation was aggravated by a diet high in carbohydrate and low in fat.  In fact, when I was 16, I had been on a Weight Watchers program that allotted me one tablespoon of olive oil a day and that’s when I had the first flare up.  In hind sight, each time I would attempt to lose weight, my back would freeze up and I then I couldn’t exercise, so I would gain more weight.

Now, at 46 years old, I have reached the goal weight that was set for me when I was 16–and the process is so enjoyable!  I now go for weeks without even thinking about my back pain!  It’s a miracle!

Alfred wrote:

Hi Paul. Quick feedback. My concern was prediabetes and eating a pound of potato/ day. Well for 1 year now I have consumed half a pound a day and been fully complient with PHD. One year ago A1C was 6.6, this week A1C is 6.1. Thank you for all you do.

Helen wrote:

I have been wanting to let you know that I tried your eczema recommendations for my pre school daughter and within only a couple of days the eczema dramatically reduced and it was completely gone within a week. I also start taking choline, along with the standard supplements you recommend and I actually feel a lot better.

Floyd wrote:

First I just want to say thank you PHD. I truly believe the book you co-wrote is one of the best books ever written and should really be taught in schools. I follow your diet and it has changed my life for the better.

Koustav wrote:

I wanted to send you a thank you note for your work on the blog and the book. Like a lot of other people, I have been looking for a more healthy diet for ages, and found the cornucopia of diet information available on the internet to be highly confusing, if not downright misleading. I found your blog after reading recommendations on Chris Kresser and Mark Sisson’s blog, read through the a lot of it, and ordered a copy of your book.

This was in February of this year. Since then, I have lost about 25lbs and have run a 10K with my wife. My wife, who was fit to begin with, jumped on board early, and not only has she reached her goal weight, but her skin looks so clear that people have commented on it. I got additional copies of the book for my parents, sister and extended family, and everybody who has read the book has lost weight after following the diet. My father has lost lost 10lbs, which has been amazing, since his doctor has been recommending that he lose weight for years! I did not expect to convince people this easily, but after all, nothing works as well as results!

Dorothy wrote:

I have been following your PHD closely for 6 months including 16 hour fast daily, eating only twice and taking a course of probiotics. I have a fairly benign form of MS but 18 months ago got a bad outbreak of eczema which I have never had before, combined with a deterioration in my MS. This was arrested after a few months of PHD incl all supplements as well as the additional Lysine and Arginine you advised for MS….

But just to say again, I have had a wonderful improvement to my general health and MS and I attribute this to the daily fasting, eating your recommendations and the hour- long strength/ weight training twice a week. The combo is very very powerful medicine :))

Lisa wrote:

Reading your book and practicing the diet has been very beneficial to me. I was diagnosed with Irritable Bowel Syndrome and have been suffering pain, bloating, et cetera for 30 years. My symptoms are now 80% reduced. I am trying to perfect my diet using your guidelines to alleviate the other 20%.

From PHD comments

Kathy wrote:

My husband and I had purchased your book a few months ago, and I had been reading your blog for awhile. We have fully implemented the PHD way of eating and it has been about three months now. It has made a big difference for us both, in improved health and weight. I have had no more heart palpitations, and my leg cramps have subsided. (and i lost 4 lbs) …

My husband and I have both had significant improvement on your Perfect Health Diet and were low carb before so enjoyed the addition of the safe starches. Thank you for such a great, great book!!

Nick wrote:

I would like to thank Paul and his wife from the bottom of my heart. I was on Gaps for 2 months to deal with digestive disorders and pain. I noticed good results on GAPS but after 2 months looked like I was wasting away. I had very low energy; dry mouth; low libido, yellow, gelatinous semen; flat mood; gum infection (lowered immunity). It seemed to me that carbs and starch were the ultimate “bad guys.” After reading Paul’s work, I realized they are actually necessary. Within 2 days all the above symptoms reversed, and I am feeling better than ever. This is a detail that the current low carb fad has not addressed. I was really worried for my health, and can’t even imagine going years on very low carb. For someone like me with a fast metabolism, I would probably end up dead. Thank you again – you guys are a great light in the dark.

TC wrote:

Heartfelt thanks for creating such an erudite comprehensive and lifeimproving work. A friend of mine who is suffering from type 2 diabetes and non alcoholic fatty liver disease adopted PHD some 15 months ago and for the first time [she has tried scores of diets] in her life has not felt hungry! She has taken all the recommended supplements[other than coconut oil which causes indigestion]and after 9 months and 2 daily fasts a week she is now consistently loosing weight.

Joseph Downey wrote:

I had ringworm and seborrheic dermatitis and lots of amalgam fillings. I still have the fillings, but fungal problems went away on PHD. The ringworm went away immediately. The dermatitis took six months. For a while, it would come and go depending on stress or circadian rhythms. If I stayed up late watching TV too many nights, it would flare up. Hasn’t flared up for at least 8 months now.

Matt wrote:

After reading your book, I’ve been following the Perfect Health Diet for some time now, and have never felt better!

JR wrote:

I came to the PHD after a very mixed experience with the GAPS diet, which I tried after a recommendation from my sister in law. I have had chronic health problems since I was 18, and have been diagnosed with mild CFS/ME, IBS among other things. For the last 10 years I have had chronic inflammatory back pain, which remarkably is much better after I started changing my diet. Having taken NSAIDs for a decade I found after some time on the GAPS program that my pain recovered enough that I could manage without them. However after about a month and a half on the program I began to feel really ill. My GAPS practitioner encouraged me to stick it out, but I needed to work and was feeling so ill that driving was difficult, let alone doing my job, which requires me to think fairly hard at least some of the time! I decided to try a medically trained GAPS practitioner, and she basically had me eat loads of butternut squash, a safe starch according to the PHD! This helped a lot, but in the process I had come across the PHD and bought the book. As a scientist your book was a breath of fresh air, I had resigned myself to accepting what I thought was essentially a trial an error approach to diet based on intuition (GAPS/Western A Price style), or the medical establishment approach (when I consulted my doctor during my GAPS issues he told me I was a hypochondriac as I was not overweight so why should I be on a diet?!). Now I follow the PHD and my back pain is 90% resolved, although I still have some health issues.

Primal J wrote:

Hi, Paul. You’ve helped me tremendously with issues I’ve had with my thyroid, adrenals, formerly VLC woe and the issues that resulted, gut health, the whole lot

Marcia wrote:

My 5 year old son, diagnosed with autism, does very well with a no fructose version of the PHD. But there have been a couple foods that have been incredibly good for him, and I just had to share our experience. The first is raw egg yolks. I know from your book that having 3 yolks a day is good for many people, but I find that when my son has 2 yolks, 3 times a day (each serving about 4 to 6 hours apart) his language and eye contact is so much better. The positive effects seem to wear off in a few hours, so we find that multiple doses throughout the day works well. Sadly, cooked egg yolks have had no good results.

The second food that has been really good for him is resistant starch. We give him 1 TB of raw potato starch with his probiotic, 3 times a day, and he is so much more social and more affectionate than ever before! I was nervous to try it because my son does not digest most carbs or fiber well, and I was worried about the potential increase in SCFA (since some very compelling research by Dr Derrick MacFabe implicates propionic acid in autistic symptoms). But so far, we have seen no negatives and only wonderful results.

For my son, his autistic symptoms will wax and wane depending on what he eats. And trust me, I know how crazy this may sound, but we actually have days now where it seems like his autism has nearly vanished. I have no doubt that his gut plays an utterly profound role in his mental health.

Rebecca wrote:

Hello, My family has been following your food program for 30 days and we can tell the difference … no more arthritis pain every day, no more low-level chronic headaches, more energy, better digestion … we love it! … Thank you so much!! You have really changed our health for the better in only a month…I’m looking forward to seeing more changes over the next years!!

Jeff wrote:

My wife and I have both been trying the PHD diet this spring. We both feel better, have more energy and certain acute symptoms (e.g. IBS) are gone. But our experiences with weight loss are very different–I have lost 25 pounds since February with limited exercise, she has lost nothing.

From Twitter

@ppedrazzi wrote:

PHD transformed me. If it was a pill it would be impossible to keep in stock.

We are grateful to all readers who share their stories! Thank you!

Around the Web; Steve Jobs Memorial Edition

Posted by on October 8, 2011 38 comments

Note: I’ve been overwhelmed with work lately and have fallen behind on the comment threads. I will get to comments on the Anti-Cancer and Q&A threads as soon as I can.

Appeal for Help: One of our readers is a dear lady in Queensland, Australia, near Brisbane. She is a chronic disease patient and housebound. She would like to have an assistance dog for emotional support, and would like to have a puppy that she can train. Australian law requires housing units to permit certified support dogs, but her housing complex is denying permission for a puppy that is not yet certified. If any Australian lawyer would be willing to provide her with advice on her legal rights pro bono, please send an email to pauljaminet@perfecthealthdiet.com and I will put you in touch.

[1] Jimmy Moore’s symposium: I’d like to thank Jimmy Moore for organizing his symposium on “safe starches.” It’s a great topic and only Jimmy could have brought together so many interesting people to discuss it.

It might have worked better if I had been able to provide some background to the panel. As it was, too many of the responders were unfamiliar with what we mean by “safe starches” and many may have supposed that our diet was designed for diabetics.

Kurt Harris did yeoman’s work this week, commenting on my post, Jimmy’s, and threads on PaleoHacks. It was great to have someone of like mind taking the time to comment. Thank you, Kurt, Melissa Hartwig, Emily Deans, Praguestepchild, and everyone who wrote supportive comments.

Some humor did come out of the discussions. My favorite was a PaleoHacker consoling Jack Kruse: “It’s just pillar envy, Quilt.”

I expect to post my reply on Tuesday.

[2] Music to read by: Brook Benton and Dinah Washington have what it takes:

[3] Interesting posts this week:  Michael A Smith of Critical MAS tests our ideas about ketogenic fasting and finds that he can eliminate hunger while fasting by eating coconut oil and fermented vegetables.

Sean at PragueStepChild reminds us of some great posts by an outstanding blogger who has gone silent, Robert McLeod, on the subject of macrophages and the role of chronic infections in disease. Start with Sean, but be sure to finish at Robert’s blog.

Chris Masterjohn reports that AGEs come from … ketones!

We know God is jealous, but is He also female? Sex outside of marriage may raise the risk of penile fractures. Via Tom Smith.

Stephan Guyenet continues his series defending the food reward hypothesis of obesity. JS Stanton of Gnolls.org has been doing a closely related series, here’s his Part VI which explains key concepts relating to food reward, and has links to Parts I through V. Part IV was my favorite.

Two economists took their hand at finding the cause of the obesity epidemic. The biggest cause they found? Declines in smoking rates, which explained about 2% of the weight gain since 1979.

Peggy the Primal Parent has had a fascinating experience with gut dysbiosis. Fiber and fructose give her hypoglycemic episodes, but pure glucose doesn’t.

Bruce Charlton notes that scientists tend to develop theories into taboos, so that “using the taboo concept in reasoning triggers nerves and hormones and alters the body state to feel bad.” This may explain the reaction of some low-carb gurus to the word “starch.”

Emily Deans and Melissa McEwen both reviewed Wheat Belly; Melissa emphasizes what’s not in the book.

Don Matesz proposes the unconventional idea that strength training reduces protein requirements.

Jamie Scott, That Paleo Guy, produced the ultimate primer on phytic acid. Chris Kresser recently advised not going nuts on nuts, because of their phytic acid.

Chris Highcock reports that Shift Work at Young Age Is Associated with Elevated Long-Term Cortisol Levels and Body Mass Index. This fits with our theme that proper circadian rhythms are important for many aspects of health including weight regulation.

Frank Hagan of Low Carb Age dissects a study we mentioned last week, that recommended a diet of 1/3 carb 1/3 protein 1/3 fat. Turns out they found that 1/3 carbs is better than high carb, but didn’t have any data to show that lower carb was worse.

Michael Greger, the vegetarian doctor, asks if animal food lovers are missing “vitamin S” – salicylic acid.

Mark Sisson at Mark’s Daily Apple has been holding reader video contests and has a ton – metric ton even – of reader workout and food videos. “Tuna Tataki with Gazpacho” won the prize for best recipe video.

Peter of Hyperlipid blames the Denmark saturated fat tax on Unilever. This story he linked says that Denmark has a low obesity rate – below 10%. Look for that to change now that saturated fats are more expensive.

Via John J. Ray, the sad story of a 25-year-old woman who killed herself with cough medicine. The acetaminophen was destroying her liver, but she thought she had a cold and kept taking more.

At PaleoHacks, a healthy 34 year old had a heart attack. Did his doctors misdiagnose a protozoal infection?

[4] Cute animal photo:

[5] Remembering Steve Jobs:

Steve Jobs passed away Wednesday night. When we got the news, we had just finished a dinner with the Living Paleo in Boston group and Julie Mayfield, author of Paleo Comfort Foods. We stopped at Shou-Ching’s office so that, coincidentally enough, she could finish submitting a pancreatic cancer grant application before a midnight deadline.

A commenter asked if I had anything to say about his health history. No; we don’t know the causes of Jobs’s cancer, and have no reason to assume he wasn’t following the best available health advice. Indeed, he survived pancreatic cancer longer than most.

It is true that Jobs was a close friend of Dean Ornish – one of his last meals was with Dr. Ornish at a Palo Alto sushi restaurant, Jin Sho. After his diagnosis with pancreatic cancer in 2003, he apparently tried to treat his cancer with a vegetarian diet under Dr. Ornish’s direction, but it didn’t go well. He finished his life eating a pescetarian diet.

Jobs leaves a wife and four children. I like this photo of Jobs leaning on his wife Laurene after an exhausting talk:

Jobs was always a bit of a rebel; in the third grade he released snakes into the classroom and exploded bombs. At Apple the early ads celebrated rebelliousness in pursuit of progress:

We’ll remember Jobs as the greatest entrepreneur of his time, a man who did exactly what Apple’s ads said: “push the human race forward.” If you doubt how far the human race has come, watch the 28-year-old Steve Jobs introducing the “insanely great” Macintosh computer:

UPDATE: A modification of the Apple logo, by a student from Hong Kong:

[6] Let’s buy a lemon tree honey: It’s time for civil disobedience:

Several years ago, Bridget Donovan, who has now been dubbed “The Lemon Tree Lady,” purchased a Meyer lemon tree from meyerlemontree.com. A resident of Wisconsin, Donovan purchased the tree legally and in full accordance with all federal and state laws regulating citrus transport, and had lovingly cultivated and cared for her indoor citrus plant for nearly three years.

Then, out of nowhere, Donovan received an unexpected letter from the USDA informing her that government officials were going to come and seize her tree and destroy it — and that she was not going to be compensated for her loss. The letter also threatened that if Donovan was found to be in possession of “regulated citrus” again, she could be fined up to $60,000.

Donovan was shocked, to say the least, as her tree was not a “regulated citrus.” The store from which she purchased it is fully legitimate, and she had done absolutely nothing wrong. But it turns out Donovan and many others who had also purchased similar citrus plants had faced, or were currently facing, the very same threats made against them by the USDA.

Most of those targeted simply surrendered their trees without trying to fight back, Donovan discovered. And while she, herself put up a hefty fight in trying to get honest answers in order to keep her tree, Donovan was eventually forced to surrender it as well. And worst of all, many of those who were told that a replacement tree would be in “compliance” later had those trees confiscated, too.

Why has the USDA been targeting lemon tree owners? The answer is unclear, other than that they are a supposed threat to the citrus industry. And a USDA official admitted to Donovan that the agency has been spying on those suspected of owning lemon trees, and targeting all found to be in possession with threats of fines and raids if they failed to give them up — and the agency has been doing this without a valid warrant.

UPDATE: Apparently the threat is “citrus greening disease.” Hat tip James.

One of the comments: “First they came for the raw cow’s milk and I didn’t speak out, as I prefer raw goat’s milk. Then they came for the vegetable gardens in the front yards and I didn’t speak out, as I have my vegetable garden elsewhere. Then they came for the citrus trees and I didn’t speak out, as I prefer someone else to squeeze them …”

[7] Best comments this week:

Vincent explains the tuber fermentation strategy that helped cure his gut dysbiosis. He followed instructions at wildfermentation.com. Bella, like Vincent, cured her constipation with anti-fungal strategies.

We had great comments on both sides of the food reward issue. The general consensus: Perfect Health Dieters have substantially reduced food cravings and appetite, and can easily ignore most junk food, but there are still some combinations of food that create cravings or addictive eating. Here’s Stabby:

I have been eating the PHD for a while, and it has really reduced any sort of cravings and tendency to mow down, even if the food is really yummy. But indeed, I will down a bag of potato chips in an instant, because it is just that cracktastic, pretty much designed to stimulate me in every possible way.

Erp:

I’ve tried to lose weight by going low carb. The weight losses were successful, but I didn’t stop craving high carb/sugary stuff and would always gradually go back to the bad old ways and gain the weight back.

One year later strictly following the PHD, I lost almost 40 lbs and not only don’t I crave carbs and sugar, I am actually repelled by the smell of a bakery. Yeast and cinnamon are off putting.

Peter:

After approximately six months of PHD I have zero craving for sweets and have easily resisted entire tables groaning with plates of cakes, doughnuts, cookies and so forth. Resisted is the wrong word though – it’s as if all desire for a (formerly craved) substance has left my body. I’m not sure if it’s related, but I have no desire to drink alcohol these days.

Nancy:

I am maintaining my weight loss without cravings or white knuckling and feel great. Thank you! Thank you!

Interestingly, it seems to be the richer, more complex taste combinations that stimulate addictive eating. For Ellen, it’s a dessert made from “rice krisps, coconut flakes, macadamias, rice syrup, coconut oil, ghee, salt and cinnamon”; for Shelley, “trail mix of chopped up 85% dark chocolate, raisens, dry roasted salted macadamia nuts and unsweetened coconut flakes”; for Jaybird, wheat-based cake batter. Ellen writes:

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.

Shelley writes:

I have made PHD ice cream, sweetened berry compotes, etc and this doesn’t happen. So far it’s just this one combination of products. strange?!

Fascinating.

[8] Not the weekly video: Cat and mouse:

Via Pål Jåbekk.

[9] Shou-Ching’s Photo-Art:

[10] Weekly video: Robb Wolf was the hero of Discovery Channel’s “I, Caveman.” They have selections from the show online. This one is about their difficulty obtaining potable water:

About the Food Plate

Posted by on August 16, 2011 37 comments

Thanks to everyone who gave us advice on the Perfect Health Diet food plate:

It’s very helpful to hear your thoughts. I thought I’d respond here.

Supplements

Garymar asks “where are the supplements?” Perhaps this was tongue in cheek, but it’s a fair question. To be honest it never occurred to us to put supplements in, as the graphic was meant to address the question “How do I construct a meal [or a day’s food]?”

That said, I notice the Harvard Healthy Eating Pyramid features a multivitamin plus vitamin D. Moreover the base of their pyramid has “Daily Exercise & Weight Control” sections! So there is a precedent.

On the other hand, they consider beef, rice, and potatoes foods to “Eat Sparingly,” and wheat as foundational, so I’m not sure they’re a good model.

YinYang

Kirk thought our diet is unbalanced toward fat, and so a symbol indicating balance was inappropriate. However, foods and macronutrients are different things; fat can come from plants (coconut oil, olive oil) as well as animals. Moreover, the plate is oriented toward meal construction, ie food, not nutrients.

Michelle, for one, was unsure how to relate macronutrients to food:

I am a reader who never quite caught on to how much of every macronutrient I should be eating in order to be PHD compliant.

Upon reading the book, I could not picture how much “400-600 carb calories” were, or “200 protein calories”.

One purpose of the food plate is to help solve this problem. Kirk himself took the correct inference from the diagram:

To my eye, the proposed diagram insinuates there should be equal servings of meat/fish/eggs/sauces/soups as balanced with servings of vegs/herbs/spices/safe-starches.

Yes! Because the plant foods we recommend have 100 to 600 calories per pound, while the animal foods and fats have 600 to 3,500 calories per pound, a diet that obtains most calories from animal foods can still get most of its matter from plant foods. As Gary pointed out:

On a high fat diet, the quantity of fat looks small compared to the quantity of vegetables.

Our diet really is fairly balanced between the food groups.

Our thanks to those who stuck up for the symbol, including Pam (“I like the yin-yang symbol a lot! i believe this is meant for portion (volume) right?”) and especially Ellen, who is an authority:

I like the use of the Taiji symbol…. I did not think it was meant to convey equal amounts of each food group as much as the *concept* of balance (and change) over all. This, in spite of having studied (with Master Jou among others) and taught Taji.

Artistry

Beth had a number of great suggestions. One was to merge the “Do Not Eat” foods into the apple by putting them in the apple’s shadow. In fact, we do have an apple with a shadow, and that might work well.

Erp suggested a snake (carrying the apple as in Genesis) or a worm coming out of the apple to represent forbidden foods. Sorry, erp, doesn’t sound appetizing!

Howard suggested we use the Zone Diet plate as a model. This is interesting because it actually has 3 plates, showing a 3-part strategy for constructing a meal. This “dynamic” imagery is something to consider.

Paul A had an excellent suggestion:

Nitpicky comment: wouldn’t it be more intuitive to have meats in the red section and plants in the green?

Yes. Another aspect we hadn’t thought of: in Chinese theory, most plant foods are considered “yin” (thus belonging on the left) and meat, fish and eggs as “yang” (on the right).

Next question: If we’re moving Safe Starches to the left and Meats to the right, would this be interpreted as a “farewell to Paleo”?

Are the “Pleasure Foods” too small?

Bethany asked if dairy was such a small part of the diet? The same could be asked for fruits and berries. (Mallory said, “I like fruits more than your plate does.” So do we, Mallory!) Or even for the “fructose-free sweeteners,” such as rice syrup, which are as fundamentally benign as the safe starches they are derived from.

Maybe we need to add more leaves to the apple stem. Especially if we take up erp’s suggestion to devote the stem to the chocolate food group!

On a related matter, Dale asked why sugar was excluded:

I like it … except for the no sugar part. People are going to eat it anyway so why not be sensible and suggest it in moderation?

Well, we support fruit, berries, and starch-derived sweeteners such as rice syrup. We’ve got ways to satisfy a sweet tooth. Is there really a rationale for including table sugar in a diet? I’m sure everyone will eat sucrose from time to time, but why should we endorse it?

Right Amount and Kind of Information?

Ellen thought we could include more information:

This might be too wordy, but perhaps you could indicate the range under the sections, i.e. meat, eggs, fish (1/2 to 1 lb/day).

MarkES (“a simple visual of food proportions when people look at their own plates”) and Erik (“I also agree with some of the other posters that there are too many words”) wanted less information. Mike Gruber was in the same camp:

Just a quick visual comparison between your chart and the competition leaves me with the impression that yours has too many words … will people read them? A chart is supposed to summarize something, and the more briefly the better.

This is an issue with no perfect solution. I don’t think we can put all information in the apple, and there will usually be some companion text that provides deeper explanations. But I don’t think we need to go quite so kindergartenish as the USDA Food Plate.

Michelle thought we might have missed the most important point of all:

[O]ur message at home is Eat Real Food, & Avoid Food Toxins. I’m not sure a glance at the PHD food plate would help them make sense of what to eat, in practical terms.

Hmmm. I had hoped the text made clear what desirable “Real Foods” and forbidden “Toxin-Rich Foods” were. Is there a better way to communicate the use of real foods? Perhaps little food images would work better than text.

A possible defect of including representative foods in text is that someone might mistakenly infer that un-named foods are forbidden. Hilary asks:

Should lime juice be included? Should yams be included on the list of safe starches?

Those are fine foods, but I don’t want the apple-plate to contain a laundry list of foods. The listed foods are representative — similar foods may also be eaten.

Conclusion

You’ve certainly given us food for thought — and ideas for desirable revisions. Thanks much!