Do Carbs Kill Your Brain? | Chris Kresser

Do Carbs Kill Your Brain?

by Chris Kresser

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Recently, I’ve been hearing from many patients who have read Dr. Perlmutter’s new book, Grain Brain, and are now concerned about their carb intake. In his book, Dr. Perlmutter suggests that dietary carbohydrates cause high blood sugar, inflammation, and other effects that lead to a “toxic brain,” which can then develop into neurological conditions such as Alzheimer’s, Parkinson’s, depression, and others. Based on this line of causality, he recommends that everyone consume a very low carb diet (<60g per day) in order to prevent neurological disease.

First of all, I’d like to point out that very low carb (VLC) and ketogenic diets can be effective therapeutic tools for treating many neurological disorders. I touched on this briefly a while back in my podcast with Emily Deans, and initial studies on low-carb diets and mental health have shown promise. (1, 2, 3, 4) Because Dr. Perlmutter is a neurologist, it makes sense that he would be a proponent of low-carb diets for his patients based on these therapeutic effects.

Does eating carbs destroy your brain and lead to neurological disease?

However, recommending a low-carb diet as an intervention for sick people is very different from promoting it as a preventative measure for the entire population, which is what Dr. Perlmutter does in Grain Brain. His approach would be somewhat akin to recommending that everyone go on the Autoimmune Protocol to prevent autoimmune disease, which would be unnecessarily restrictive and unhelpful. It’s important to realize that just because a low-carb diet can help treat neurological disorders, doesn’t mean the carbs caused the disorder in the first place. While I don’t argue with the idea that refined and processed carbs like flour and sugar contribute to modern disease, there’s no evidence to suggest that unrefined, whole-food carbohydrates do. In fact, there are three compelling reasons why this is not the case.

#1 – We evolved eating whole-food carbohydrates

The first reason it doesn’t make sense that carbohydrates cause neurological disorders is that we’ve been eating carbs for a very long time, and we’re well adapted to digesting and metabolizing them. For instance, fruit has been part of the human diet for longer than we’ve been recognizably human, and while starch hasn’t been part of the human diet for quite as long, it’s clear that we’ve evolved mechanisms to digest and utilize it efficiently.

Compared with most primates, humans have many more copies of the gene AMY1, which is essential for breaking down starches. (5) This gene is unusual in that the number of copies varies greatly between populations, with more copies present in populations that consume more starch. This indicates that starch played a significant role in our evolution, and some scientists have even argued that consumption of starch was partially responsible for the increase in our brain size.

In addition to possessing the ability to break down complex carbohydrates, our bodies require glucose to function properly and maintain homeostasis. The fact that humans can produce glucose from protein is often used as an argument that we don’t need to eat glucose, but rather than viewing this as evidence that that glucose isn’t important, we might view it as evidence that glucose is so metabolically essential that we evolved a mechanism to produce it even when it’s absent from the diet.

#2 – There are many traditional cultures with high carb intake and low or nonexistent rates of neurological disease

If carbohydrates cause neurological disorders, one would expect to see high rates of dementia and similar diseases in populations where carbs constitute a significant portion of the diet. But as it turns out, many of the cultures that maintain the lowest rates of neurological and other inflammatory disease rely heavily on carbohydrate-dense dietary staples. For example, the Hadza of north-central Tanzania and the Kuna of Panama obtain a high percentage of their total calories from foods that are high in natural sugars, such as fruit, starchy tubers and honey, yet they are remarkably lean, fit and free of modern disease. (6, 7)

Other examples include the Kitava in the Pacific Islands, Tukisenta in the Papa New Guinea Highlands, and the Okinawans in Japan. The Kitavan diet is 69% carb, with a high reliance on starchy tubers such as yams, and sugary tropical fruits such as banana and papaya. (8) The Okinawan diet is even more carb-heavy at 85% carbohydrate, mostly from sweet potato. (9) Finally, the Tukisenta diet is astonishingly high in carbohydrate at over 90%. (10) All of these cultures are fit and lean with practically non-existent rates of neurological disorders and other modern chronic disease. (11)

#3 – Modern research does not support the notion that ‘safe’ carbs are harmful

The claim that carbohydrates from whole-food sources cause neurological disorders is not supported by anthropological evidence. In addition, modern studies on the health effects of carb-dense foods such as fruit also fail to support Perlmutter’s hypothesis. In fact, studies overall suggest that eating whole, fresh fruit may actually decrease the risk of health issues such as obesity and diabetes, and that limiting fruit intake has no effect on blood sugar, weight loss or waist circumference. (12, 13)

As you may know if you’ve been following my website, there is plenty of modern research demonstrating that diets rich in refined and processed carbohydrates are harmful. However, this is not due to carb content alone, and there’s no evidence that whole-food carbs have the same effect. When an author or expert recommends excluding or severely limiting one of three macronutrients that humans consume, the evidence demonstrating harm should be strong—not only because of the inconvenience of following such a restricted diet, but because extreme diets (ketogenic or VLC diets in this case) are not always harmless. In my practice I’ve seen many patients who’ve worsened on long-term VLC diets, including those with adrenal issues and poor thyroid function. Long-term VLC diets can also lead to imbalances in gut bacteria due to a lack of prebiotic fiber, which can result in digestive issues.

As I’ve always maintained, you need to find out what works for you and tailor your diet to your specific health goals, rather than follow a canned approach. This is exactly what I’ll teach you to do in my book, Your Personal Paleo Code (published in paperback as The Paleo Cure in December 2014), which is coming out at the end of December.

Have you read Grain Brain? What do you think about very low carb diets? Share your thoughts in the comments!


Join the conversation

  1. Hang on a second, the high carb diet tribes and peoples you mentioned aren’t eating refined wheat, that has been contaminated with gliphosate and wasn’t GMO, the epidemic sickness from what is due to this, and before the what wasn’t refined, it was whole!! Secondly the peoples you mentioned dare eating sweet potatoes , tubers, yams, bananas,fruit and honey.. all extremely healthy.. they are eating cornflakes, white bread, doughnuts, crackers, bagels etc!!! on these grounds your argument doesn’t stand especially as you said at the beginning the VLC and ketogenic can be healing diets!!

    • Yes, yes, and yes to what you’ve stated! It’s what has been done to our grains and other crops: GMO’s and Monsanto’s Glysophate are some of the biggest culprits for diabetes, Alzheimer’s, Celiac, Gluten insensitivity, hypothyroidism, multiple sclerosis, and a host of other autoimmune diseases.
      It’s stifling our youth and they are going to be the ones who will have the shortest life span despite all the medical advancements in the last 50 years. Unfortunately, it’s all about the money and controlling society by the FDA, insurance companies, and big corporations. I’ll bet that the top echelon aren’t eating these damaging “foods”.

      • I’d like to add one more tidbit to Audri’s comment. One particular grain – wheat – has been heavily hybridized in America resulting in a chromosomal count that goes through the roof. Humans were never meant to digest such monstrous protein tangles (gluten), which are suspected of causing the epidemic of allergies and “sensitivities,” headaches and constipation. Those not having full-blown gluten allergies are finding enormous relief – as I am – by turning to the primitive einkorn wheat. And it’s so flavorful that close friends I introduced it to now use it routinely in their baking! Thank you, Dr. Kresser for your balancing viewpoint.

  2. Totally agree with your points here.

    Also, children who are treated with ketogenic diets for epilepsy, not responding to medications, have suffered from increased incidences of kidney stones and diminished growth/disruption in normal growth patterns.

  3. I just wanted to say that after my mother made me read this book, and after only 28 pages I found this article and translated it in French for her. Maybe I will read the rest of the book but I’m not too sure I would learn much more. Thank you!

  4. I went on a VLC diet in order to combat systemic candida. As I did feel quite a bit better, my TSH went through the roof, my SHBG shot up to 94 (completely no libido) and my resting glucose was at 104. I understand the resting glucose can be a bad measurement when ketones are present and something maybe not to be too concerned with, however moderation seems to be a much better approach. Paul Jaminet (Perfect Health Diet) recommends about 400cal from starchy carbs and 200 cal from other safe sources for most people and even when battling candida. I will stick with moderation and hope things level out.

  5. You are what you eat. In his article Do Carbs Kill Your Brain?, Dr. Kresser states that one should tailor their diet to their specific health goals and should not adopt a one size fits all type of diet. I agree with Dr. Kresser that personalized nutritional plans are beneficial to developing your individual care plan. Nutritional diets plans should be formulated on an individual basis, determined by the individual’s health conditions, deficiencies and nutritional needs. For example, one person may need more protein or calcium than another and as Dr. Kresser states that people at high risk of neurological disorders might need to decrease their intake of carbohydrates (Kresser). For people with neurological disorders, ketogenic or very low carb (VLC) diets have been found to be very beneficial even to the point of eliminating seizures, but I also advocate that reducing carbohydrates may benefit your health even if you are not at risk for neurological disorders.
    Studies have shown that the ketogenic diet, a high-fat, adequate-protein, low-carbohydrate diet that forces the body to burn fats rather than carbohydrates, originally used primarily for treatment of epilepsy, may also provide symptomatic as well as disease – modifying activity for a broad range of brain disorders as well as neuroprotective activity in traumatic and ischemic brain injury (Gasior, Rogawski, & Hartman 431). A study, performed on children with intractable epilepsy, were put on a ketogenic diet for more than a year, and forty-nine percent of these children experienced almost compete resolution of seizures in their three and six year follow-ups. Another neurological disorder that has resulted in positive outcomes using a ketogenic or VLC diet is the ever-increasing incidence of Alzheimer’s disease. It was found that acute administration of medium-chain triglycerides increased memory abilities in patients with Alzheimer’s disease. The degree to which memory improved was linked to plasma levels of β-hydroxybutyrate produced via the oxidation of the medium-chain triglycerides. The ketogenic diet results in increased levels of β-hydroxybutyrate, thus it would be expected that a ketogenic diet would increase memory function in Alzheimer’s patients (Gasior, Rogawski, & Hartman 433). The ketogenic diet also effects neuroprotective activity such as energy metabolism. As stated above a ketogenic diet results in an increase in ketone bodies like β-hydroxybutyrate, which may be a more efficient source of energy for the brain per unit oxygen than glucose (Veech, et al 241; Reger, et al 311). The ketogenic diet helps neurons resist metabolic stress in two ways: a greater mitochondrial load as well as a more energy efficient fuel. With this increased metabolic ability neurons may be able to handle metabolic tasks that may have otherwise resulted in cellular elimination (Gasior, Rogawski, & Hartman 431). The positive effects that the ketogenic and very low carb diet have on individuals suffering from neurological disorders go beyond these individuals; the diets have also resulted in positive health benefits for those not at risk for neurological disorders.
    A low carbohydrate diet is not only be beneficial for preventing and treating degenerative disease such as multiple sclerosis but also for treating conditions such as diabetes (Paoli, et al 789). Dr. Wahls, a clinical professor of medicine, was diagnosed with multiple sclerosis (MS) in 2000. In the beginning she underwent chemotherapy, but soon she was in a tilt-recline wheelchair due to weak muscles. In 2007, after researching vitamins and supplements that help with progressive brain disorders, Dr. Wahls developed a diet that incorporated these brain nutrients. This nutrient-rich paleo diet, including foods such as meats, fish, fresh fruits, vegetables and nuts, allowed Dr. Wahls to get out of her wheelchair and even complete an 18-mile bicycle tour within a year of staring the diet (Moore). The ketogenic diet has also shown positive results in treating type-2-diabetes, the most common diabetes affecting 27 million Americans (“Statistics About Diabetes”). Numerous studies have been done in which individuals were put on ketogenic or very low carb diets for varied amounts of time, resulting in improved glucose control due to the decrease of glucose intake as well as improved insulin sensitivity (Paoli, et al 791). More recently there has also been emerging evidence that a ketogenic diet could also reduce the severity and progression of acne through reduce IGF-1 skin action, influenced by glycaemic load (Paoli, et al 792).
    I appreciate the insight Dr. Kresser has brought to the arena of disease prevention and treatment using individually designed diet plans. Reducing carbohydrates using the ketogenic diet or VLC diet are not only beneficial to those with neurological disorders but also for those not at risk for neurological disorders- the remainder of the people. You are what you eat continues to motivate researchers to further understand the interactions of what we eat with our body’s physiology in the prevention and treatment of diseases.

    • What we need to remember is the TYPE of carbs we are consuming. It is the grain carbs that are of concern! The vegetable and fruit based carbs are not as detrimental to our health as are the wheat, corn etc starches. We need to separate out the two when discussing carbs. Sweet potatoes are very good for us as are bananas. But loaves of bread made out of wheat, rye, oats, etc. are not!

  6. The “secret” of Life is balance. With that in mind, the real issue in ‘diet’ is that grains eaten with fats–and remember: QUANTITY CHANGES QUALITY–grains eaten with fats in unnatural proportions, upsets balance, and asks the body to spend much energy re-balancing energy vs. storage “disputes”. Trying to determine if a particular grain, amino acid, or (even) macro-nutrient is “good” or “bad” is absurd, because these intellectual dead-ends are always out of context, the context being life.

    • I thought the secret to life was getting your own TV show like Oprah and making all your dreams come true… you know, an easy thing like that.

  7. In your defence of carbohydrates, you mentioned countries that ate a lot of starches, as in potato etc. My understanding is that it is the grain form of carbohydrates that is the problem, not the starchy vegetables.

  8. I’m very confused about Dr. McDougall’s high carb low fat diet vs Perlmutter’s claims about brain dementia on grains, specifically wheat products and high fructose corn syrup. SO IS BROWN RICE OK FOR THE BRAIN? No one seems to answer this, also organic white/Basmatic rice is less glycemic load than sushi rice. Is rice OK to eat? I think Perlmutter has written a book out what could be an essay about the evils of wheat products and processed foods. Anyone, is brown rice harmless to the brain?

    • JJ,

      We recently investigated the accounts of brain dementia from grains, and discovered that it was flat out bogus. Dementia and Alzheimer’s has now been closely linked to the accumulation of iron in the brain. It’s unclear if the metal is getting in the brain through inhalation (polllution, mining, “Arctic Haze,” etc.) or through diet, but the accumulation and the inability to clear out the brain appears to be what researchers are now honing in on.

      This should not be surprising since most free-radical injury is iron-related (not grain related).

      Many studies show that consumption of whole grains is protective against Alzheimer’s and Dementia. In fact, just this year a new diet high in whole grains was shown to do just that…

      A New Diet Is Linked to a Lower Alzheimer’s Risk

      “Called the MIND (short for Mediterranean-DASH Intervention for Neurocognitive Delay) diet, the regimen combines elements of the Mediterranean diet, which is high in fish, olive oil, whole grains, and fruits and vegetables, and the DASH (Dietary Approaches to Stop Hypertension) diet, which emphasizes fruits, veggies, and low-fat dairy products. Both diets have been shown to reduce the risk of cardiovascular events like heart attacks and stroke, while also offering protection against dementia.

      The new regimen, which recommends at least three daily servings of whole grains, a salad and one other vegetable, snacking on nuts, a daily glass of wine, eating beans every other day, consuming poultry and berries (especially blueberries and strawberries) at least twice a week, and eating fish at least once a week, reduced Alzheimer’s risk by as much as 53 percent in people who followed it to the letter and 35 percent in people who followed it moderately well, according to results published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association.”

      As you can see, the latest research is showing the opposite of Perlmutter’s claims. Why? Likely because the phytates in whole grains are known to chelate excess iron from the body and the full array of minerals in the bran/germ that compete with iron for absorption and manage its efflux.

      The caveat is that refined wheat and refined rice in the US, Canada and UK are enriched with lots of iron, which is counterproductive. Not coincidentally, these are the developed nations with the most health problems. This explains why France can consume 40% more wheat than Americans with far less health issues than we do here in the States.

      Whole grains, non-wheat products, and all organic flours are not fortified with iron.

      Brown rice is obviously a whole grain, but brown rice from the Carolinas is known to have high arsenic due to residual arsenic pesticides used in the cotton belt during the 1900s.


      • And this just in…

        Paleo diet: Big brains needed carbs
        Importance of dietary carbohydrate in human evolution

        “Understanding how and why we evolved such large brains is one of the most puzzling issues in the study of human evolution. A new study argues that carbohydrate consumption, particularly in the form of starch, was critical for the accelerated expansion of the human brain over the last million years. Eating meat may have kick-started the evolution of bigger brains, but cooked starchy foods together with more salivary amylase genes made us smarter still.”

      • Duck Dodgers, what about the link between mercury and Alzheimer’s? Or maybe it’s all metals that are problematic. Mercury is the one that scares me most, though.

  9. Such a radical approach to completely eliminate wheat and wheat products. I worry when GRAIN BRAIN goes totally overboard on gluten. If gluten is not a problem than it might be prudent to reduce gluten by 50% or even 80%. But it scares me when Dr. Perlmutter recommends 99.999% off any gluten. Nothing has been shown why such a radical and total elimination of wheat grain. A very small % of people can’t tolerate wheat glutten. BUT most of us are NOT allergic to wheat gluten so maybe such a radical food switch is wrong.

    • Elsewhere on this site, there’s a transcript of Kresser’s interview with Dr. Alessio Fasano ( Fasano’s work established everyone has a response to the gliadin protein in wheat — a response that lets partially digested food into the bloodstream, where it wreaks havoc at remote sites and causes systemic inflammation. In addition, wheat germ agglutinin (WGA) is a universal toxin, and it’s not deactivated by dry-heat cooking or digestive enzymes (; see the comment from the commenter named “Ray”).

      A wheat allergy (using the classic definition) is not required for wheat to be a dangerous food.

      • In a healthy person, these “toxins” are often metabolized by our gut flora. There are healthy longevity cultures that consumed gluten and WGA without it being “dangerous” to them. It’s certainly possible that these could be problematic for those with compromised guts, but to say that they are “universal” is nothing but scare-mongering. Humans did not evolve by cowering to toxins. Virtually all indigenous cultures ate toxins. Each person is different, and Chris is often dealing with sick people who need to heal their guts.

    • It’s hard to completely frown upon gluten when the French eat ~40% more wheat than we do, yet they have very few chronic health issues. And yes, they eat vast quantities of modern “hard winter wheat”.

      Gluten has toxic properties, but in a healthy gut your flora should metabolize it. A “gluten sensitivity” is probably mainly due to bad gut flora.

      The “baguette de tradition” uses pure unadulterated flours and a sourdough fermentation, which breaks down excess gluten.

      The key seems to be that most European nations, including the French, do not fortify their flour with iron. Iron fortification has been shown to disrupt the gut flora. So, it may be that Americans have poor guts from iron fortification, and this makes it difficult for American guts to metabolize gluten.

      Italians have very high celiac, which is technically different than the high “non-celiac gluten sensitivity” we see in countries that fortify their flour. But, pasta is not fermented with yeast, so they consume very high quantities of gluten. (However, it should be noted that some traditional French pastries are made from choux pastry dough, which contains no yeast—they are puffed by steam from water in the dough).

      For more information, read a new theory we put together on the subject of iron and carbohydrate intolerance:

      Iron, Food Enrichment and The Theory of Everything

      When you put an average American next to an average European, the American looks plump and inflamed. It’s as if the American’s food has been poisoned in some way. The evidence mounting in the literature suggests its the fortified iron.

  10. “Please do not mislead people. Vegetables and fruits are carbohydrates. We have know for over 15 years that inflammation is the leading cause of heart disease and grains esp wheat are the major contributors to inflammation.”

    Dr. Carol Rossetti …

    you being a doctor, you should know better.

    It isn’t the inflammation in itself that is causing health issues but the things that cause the inflammation. Eating too much junk food, stress, not getting enough sleep…are just some of those things.

    Complex carbs are need for athletes and hard-thinking students alike.

    Carbs add plenty of good nutrition and more variety to our diet.

    Complex carbs are just fine for just about all of us. There would be an epidemic if it wasn’t.

    Common sense.

  11. Please do not mislead people. Vegetables and fruits are carbohydrates. We have know for over 15 years that inflammation is the leading cause of heart disease and grains esp wheat are the major contributors to inflammation. People do not realize that fruits and vegetables are carbohydrates so to say to them lower your carbohydrates is not being honest. Those of us who have studied extensively with a number of very educated physicians know well what grains can do to the body and the brain. Please do not mislead the public.

    • It is my understanding that vegetables only have enough carbohydrate to be digested. They dont really add any for energy or to be stored.
      The question is what is low carb. Is it very low carb or is it only just below what the body needs.

    • Dr. Carol Rossetti said: “We have know for over 15 years that inflammation is the leading cause of heart disease and grains esp wheat are the major contributors to inflammation”

      15 years ago that information might have been groundbreaking, but, unfortunately, today it’s been shown to be an oversimplified and misleading sound bite.

      First of all, researchers are now considering that physiological levels of oxidative stress may in fact be beneficial and promote longevity while avoiding or suppressing normal levels oxidative stress can be harmful as it interferes with reactive oxygen species (ROS) signaling that would ordinarily upregulate hormetic endogenous defense mechanisms (i.e. antioxidants).

      So, telling people that they need to fear carbohydrates, because their metabolism causes normal levels of oxidative stress, may in fact be a counterproductive recommendation. ROS and oxidative stress are normal and unavoidable consequences of metabolic processes in a healthy individual.

      Secondly, avoiding carbohydrates over the long term—for fear of oxidative stress—is also counterproductive as well as counterintuitive since the mechanism for ketosis generates oxidative stress (via methylglyoxal) and appears to deplete liver glutathione—described by researchers as a “Tylenol effect”.

      Finally, even plants generate oxidative stress from their own sugar metabolisms. This is not a flaw. Sugars and ROS are used for stress signaling to self-regulate metabolism and upregulate endogenous defense mechanisms. The process is strikingly similar between plants and animals. Insulin signaling in mammals is highly protective against glycation and ROS, so its loss in conditions like diabetes is a major contributor to damage. How do we keep insulin signaling functioning normally? Plants may have the answer…

      Plants evolved to acquire the very minerals, and generate the very antioxidants and fibers necessary to keep their own sugar and ROS signaling working properly. This is why unrefined, whole starches, legumes and grains are extremely rich in metabolic-modulating minerals like manganese, copper and magnesium as well as fibers and antioxidants too.

      This is no accident. High sugar plants evolved to incorporate these compounds into their sugar metabolism cycles and these metabolic cycles are surprisingly similar between plant and animal species. If you take the time, you will find a wealth of information linking diabetes to deficiencies in the very minerals, fibers and antioxidants found in unrefined carbohydrates.


  12. Hi,
    I’ve read your discussion. Does the level of glucose really mean? I heard, not. For me, toxines are the real problem. What do you think? Some days ago I’ve found a website with a colon cleansing method. Fibre Primvital. What do you think?

    • When you artificially push down your sugar (glucose) with drugs, your isulin increases. It is increased insulin the body and the brain that shortens your life not to mention causes brain loss.

    • If you have been diagnosed with Type II Diabetes, you should not have ANY fruit till your numbers are in the normal range without meds. Look into information by Dr. Gabriel Cousens who has worked successfully in the field for many years.

  13. The diets you listed of people in other cultures that consumed starch were all natural starches. I would think that anything natural or grown on earth is healthy for us. The starches that are harmful are the ones that are processed.

    • That was the first thing I noticed too. Plus the fact none listed where wheat or gluten related. I imagine those cultures diets have been as such for thousands of years longer than the rest of us as well, thus their digestive systems have had thousands of years longer to adjust.

  14. Kay said:

    “I could not disagree more. Our state of health is the worst it has ever been in human history. disease is epidemic. good medicine is keeping us alive but not vital.”

    Ya better check the facts.

    More are living longer and healthier. They are walking more, eating less junk food and eating wholesome foods, like those evil carbs and grains. . .

  15. Hi Chris,
    I have’t read Grain Brain but I had assumed obviously the book was centered around grain consumption and not so much on whole fruit and vegetable consumption. I came to this article looking for your thoughts on grains but since it was more about fruits and veg, can you direct me to any articles of yours on grains? I’ve just started eating oats for breakfast and realised I feel quite sluggish, spacey and tired afterwards. It could of course be something else I’m using in the oats but it seemed like the signs of grain brain to me. So, having said all that can you direct me to some of your work on grains?

    • I think you’ve answered your own question. If you feel sluggish or uncomfortable (not well) after eating a particular food, your body is telling you it doesn’t like that food.
      I eat fruit and oatmeal (or granola) for breakfast almost every morning, and I feel charged up through lunch. My husband often eats eggs because he says that high protein breakfast gives him that energetic feeling. When I eat eggs for breakfast, I feel sick to my stomach and can barely move through the morning.
      Your body knows what it wants, and it will tell you.

      • I’ve always thought of carbs as being the fuel of what I eat.
        Different foods provide fuel and digest and process differently.
        It is important to understand this.
        Higher glycemic foods such as fruits or those with higher sugar and starch values occupy one side of the food fuel spectrum.
        Whole grain and high fiber type foods which digest and release their fuel value more slowly occupy the other side of the spectrum.
        Other foods may be more in the middle of the spectrum, not particularly high in fuel content but digest easily and provide a wide variety of vitamins, nutrients and the like.
        Unfortunately, there are a lot of little or no-value things out there too. And some of them are not good for us at all. It’s important to recognize the value of all the foods we are eating.

        But if I want quick energy and a pick-me-up I go to the higher glycemic side. If I want a longer lasting full tank, I tend toward heavier, slower metabolizing foods. I need fiber, but I’m not a horse-so I don’t eat like one. Whole grain is good, but I don’t rely on it wholly. I’m no hummingbird either. I know that I can’t sustain without sugars, but I don’t expect that I can fill my nutritional needs all at once. I need a combination of various foods in my diet that provide all the nutrition I need without creating imbalances, digestive slowdowns and chemical disturbances that have negative impacts on my overall health.
        Overconsumption and overloading of otherwise perfectly healthy foods can cause problems too. Rich, high value foods are fine for me but I wouldn’t think that overconsuming them would be. The same is true whether it is carbs, fats, proteins or fiber. I only need what I use so why force my body to process “stuff” I’m not going to use anyway, particularly if it is harder to digest or lower value anyway. Even good food can cause harm if over consumed. I think we have all experienced this at one time or another. That can be just as much a negative to our health as deficiencies, regardless of the food type or it’s nutritional value.

        Overall, we need the fuel and nutrition to keep us healthy over the long run. What we eat today makes a big difference today, but also down the road. We just need to know what our bodies need and how much of which foods can give us that.

        As for Dr. Perlmutter’s research and findings- I think that he is moving forward in a very specialized and promising field. I hope that he (and other researchers in the medical field) continue this work. In my opinion though, more evidence is needed.

        • Yes! The most sensible comment. I think that not only should we worry about which foods we should be eating, but how much we are eating! I think we are used to eating several times a day from habit. Most of the time we eat when we are not even hungry. Cutting down on the amount of food we eat would see some benefits.

    • In response to Kristian’s post of Dec, 3, 2014.
      Here is a link and title to an article that may help you to understand the “modern” grain of wheat. There is a huge difference in “modern” wheat compared to heirloom wheat which the article will point out. The wheat God created is designed for us, where as the wheat that man has altered contains a very different ratio of soluble to insoluble proteins which is where problems from “modern” wheat comes from. Keep learning, Neal.
      Red Fife heritage wheat – hypoallergenic food – Loiselle Organic Family Farm

    • Yeah but that was written by someone in the business of promoting vegetarian diet, who makes a living from it. He’s an internist, not a neurologist, so that’s not a peer critique. Just because someone else’s science (specifically gluten and the neurological effects of consuming it) don’t fit his environmental or philosophical agenda (“eating [fat from] animals is bad”), doesn’t mean they’re wrong. You’d expect those folks to gloss over the essential fact at hand which Chris re-iterated already:

      “It is high gluten and modern food processing methods compounding gluten levels which are the factors suggesting the need for dietary changes.”

      As for the carbs… as an athlete I am about as familiar as I’ll ever want to be with high carb intakes. I don’t recommend it for anyone who isn’t putting those carbs to use. And I don’t generally subsist on a high carb diet. In my experience it is too easy to unintentionally gain weight with sustained high carb loads in a diet. I’ve acquaintances who ride 100+ miles on a bike in a day on weekends yet are walking around with beer bellies (well modest ones, but what an athletic trainer would refer to as ‘de-conditioned’) not from beer, but from carbs they don’t burn during inactive periods in which they continue to consume fairly high carb diets.

      The rest of Perlmutter’s book contained interesting things anyone concerned with long term neurological well being (ergo everyone) should at least give a good impartial reading.

      • So you say he is biased yet don’t mention the studies unrelated to him? Does his preference for a vegetarian diet make all those studies false? I don’t think so. As for neurological issues, the single most effective way to prevent this is not via diet but with Intermittent Fasting. Go 16-17hrs a day without food and you will never have a brain issue no matter what carbs or gluten you eat. – so really, scientifically Grain Brain is barking up the wrong tree.. well.. not even in the same forest imo.

    • This is just a political piece from the vegetarian lobby. I lived vego for 13 years and now Paleo for 1 year. I won’t be going back. My lipids are good my weight easy to maintain and I eat a high fat low/moderate protein low carb diet.

  16. Re: Grain Brain – I have been listening to the audio version this book while driving it is the first book in all of my 35 years or so of being interested in natural health approaches that is motivating me to change my diet. In the book, he not only talks about diet but the need for regular exercise and the strong power of that also. As someone who has had family members with chronic illnesses, mental health problems, and dementia, I found the research he quoted and evidence very strong for this approach. I have had problems with chronic muscle/tendon pain for years and wonder if this will help me. It does make sense to me not to throw out from my diet things like whole fruits but his book has definitely made me want to change some things because of the evidence he presents. Makes sense to me. I think all can agree we have way to much sugar and refined processed foods in our diets and way too little exercise that is having lots of negative effects.

    • Dr Permuttler is a good dr! His book makes complete sense except for the fruit part. I’m sorry but fruit is both good and healthy for us. This is only my opinion and I will stand by it. I myself have Parkinson’s disease and have been searching for ways to tame my tremors and other things. So far I’ve been wheat free and no sugar except 2-3 servings of fruit. At first I follwed Dr Permuttler’s advice for a year and nothing has changed. I still have tremors, and very bad migraines with facial numbness. My whole body still trembles when I get over excited. My voice still stutters and these are all PD. (Except headaches) so after a year of being grain free and consuming no more than 60g of fruits I still dealt with this terrible disease. So now I just learn that I must deal with this terrible disease as best as I can. I still will be grain free as well no sugar except that in fruits and live my life and not worry about this or that or if I’m eating too many fruits, life is too dang short!! So Don’t worry about such things cause if you tried with all your heart and nothing’s changes its ok at least for the most part you are healthy and just enjoy life like I am doing…
      God bless 🙂

      • PS I am eating quinoa, buckwheat, brown rice, amaranth, and wild rice. I just gave up wheat and gluten-free products. Even if it’s gluten-free it still has nasty sugars in them so that’s still not healthy. Evwrythimg that goes into this body is fresh fruits, and vegetables, lean proteins and quality carbohydrates like quinoa and wild rice. If I want a dessert I have a machine that makes healthy homemade ice cream from frozen fruits. That’s the only way for me… 🙂

      • Eating fruit is fine, in very small quantities imo. When fruits started to be mass produced in the last century or so, this is what happened: Take the sweetest and most delicious fruits of the yield, and plant those seeds, repeat the next year, repeat the next year, etc. The fruit we eat today is VERY different from the fruit we evolved eating.

  17. Wow, driving home today and radio news alerts me on a new study showing low carb diets are believed responsible for rise in bowel cancer. This is not surprising to me at all. Many whole grains have been irrefutably linked to decreased risk of bowel cancer -but why? This leans on further new research that our gut biome relies on certain key carbohydrates. Once wiping those carbs from the menu these bacteria which promote good bowel health die off leaving you open to bowel cancer and other disease. I’m not saying people should go out and eat dominoes pasta bread bowls, but DO NOT wipe high quality carbs from your diet, or do so at your own peril.

  18. i’m eating loads of carbs, through veg intake rather than grains. I think the value in Grain Brain is recognising carbohydrate as a sugar, and too much of that (including from grains) is proven to be bad for you.

    • You are correct. I am 63 years old now. I ate carbs all my life and was a very health and energetic person. NOW, I suffer from belly bloating, headaches, constipation, insomnia, etc. When I fast, or go without breads and grains, I feel wonderful.
      However, I am practically addicted to carbs, and find it very difficult to give them up, even though I know I will suffer when I eat them. Anyone can become sensitive to certain foods at any age, even if you have eaten them all your life.

  19. “Some people are saying that they eat carbs and are fine and healthy, and I believe you are, but what about when you get older, and you have all sorts of issues. It might take a long time to start showing problems in your health.”

    Brittany, if that were the case, the hospitals would be overflowing.

    Seniors are healthier than ever before.

    We have been eating carbs, oats, beans, wheat…for centuries.

    It’s the wrong carbs, along with stress and other separate issues that are the problems.

    And Perlmutter is not one of the top neurologists in the world.

    Frankly, I think the guy is off his rocker.

    His claims are really off the chart.

    • Don’t hastily assume that the major findings coming out of Dr. Perlmutter’s research is based on a high carbohydrate diet itself.
      His scientific findings are more directly related to gluten and the chemistry our bodies use to deal with it.
      It is high gluten and modern food processing methods compounding gluten levels which are the factors suggesting the need for dietary changes. Low-carb in general is one method proposed to begin to achieve better brain health chemistry because high-gluten is effectively removed from the diet. Gluten is the major component found to be restrictive to ideal neurological chemistry, so it makes sense to limit it in our food choices. Other dietary modifications are aimed at supplementing natural brain chemistry in order to enhance and restore it’s optimal function. And yes, a higher protein/fat, low carb diet is suggested to achieve results.
      I’m on board with Dr. Perlmutter’s research’s findings. I believe that many ailments and diseases which hamper and restrict human health can be attributed to imbalances in the body’s normal function. Our diet’s are one of the most controllable factors in preventing chemical imbalances, whether excess or lacking.
      I am 57 years old and in good overall health. I too, have sustained over the years by consuming a diet fairly high in carbs. My choices had been mostly whole grain and oats, so-called complex carbs, pasta and rice and of course too much high-fructose. I am gradually changing my eating habits:

      Opting out about 30% of gluten carbs for non-gluten grain choices
      Limiting overall sugar and high fructose intake
      Opting out on “Nutrasweet,” “Equal” and the like altogether
      Including more lean pork and chicken
      Avoiding the packaged food aisles in favor of the produce department.

      Replacing typical sauce “mix” and packaged “flavor-enhanced-starchy-gluteny-sugary” prepared foods

      Adding extra virgin olive and coconut oils
      And seasoning less and tasting the basic food more overall

      So far, I am more relaxed and headache-free
      My energy levels are more consistent and I have more digestive “I’m Happy” sensations
      I am carrying more lean muscle and less fat (protein/carb ratio?)

      Now, I’m not saying that there is a “one size fits all” diet. I’m also not saying that low carb diets are necessarily the right direction from a nutrition standpoint. And I definitely do not buy into any “you should do this and believe that” sort of thing just because of a book based on some scientific findings. No doubt, Dr. Perlmutter is just as guilty as so many others in promoting his research as a means of attaining “the limelight” as well as lining his pockets. Who wouldn’t? But if the scientific findings are accurate, then one should be open to the possibilities which can come from them.
      Scientific research is always ongoing-one fact adding to another over time. Evolutionary, not necessarily revolutionary.And we know that the progress science makes for us is ultimately good. If in his zeal Dr. Perlmutter has “over-promoted” and caused people to view his work in a too pro versus con perspective, well that is unfortunate. It’s not like “we’ll die” if we eat carbs or “become ascended geniuses with special mental powers” if we don’t. It’s just that the science appears to be there-maybe we should be too.
      Evolution needs proponents of new ideas-and it can’t happen without followers as well. My eyes are open.

      • I’ve looked at the research over and over again and I’m fairly convinced that some version of the Mediterannean Diet that avoids gluten but includes some high protein grains (like quionia) lots of fish, moderate (smaller) amounts of grass-fed meat, pastured eggs, olive oil, coconut oil, some grass-fed butter, some nuts, and lots of low GI fruits and vegetables is ideal.

      • I think cutting down on carbs is more realistic than cutting them out completely. If we eat less of them we can replace them with more healthy choices like vegetables.
        Less bread, more veg.

    • “seniors are healthier tha ever”

      I could not disagree more. Our state of health is the worst it has ever been in human history. disease is epidemic. good medicine is keeping us alive but not vital.

    • A well respected Neurologist like Perlmutter versus an idiot who says he’s “off his rocker”. Wow, whose theory on what is plaguing our health should believe? Hmmmmm……

      Exactly what are your qualifications and what peer reviewed studies (Perlmutter refers to hundreds of them) can you refer me to.

  20. I refuse to believe some overweight, horribly unfit dude chowing down on dead refined carbs all day, can be compared to my lifestyle (extremely fit, healthy, eating whole foods, some UNREFINED carbs, etc). Research is also constantly changing. In fact it is not so much carbs but they are now finding it’s the makeup of the gut biome. Dead refined carbs can change the biome, bolstering gut bacteria that excrete chemicals that cause these brain issues -where some whole food carbs bolster groups of bacteria that actually provide protective effects throughout the body. Also, long term ketosis is looking very bad in some research. Eat food, not too much, mostly plants. + exercise daiy, avaoid added sugar, additives, preservatives, flavourings, colourings, etc. Not rocket science folks.

    • How can you say “not rocket science folks”? Creating a generalized diet plan for humans as a whole, or for any sub-population is one of the most imprecise things to do. You even said at the beginning that you can’t compare your lifestyle to some other “dude.” The fact that you then proceed to spew your opinion on a healthy diet at others is absurd.

      • Seen the new research just out? Low carb diet fads look to be the cause of recent explosion in bowel cancer. Not surprising as low carb kills off the strains of gut flora which reduce risk of bowel cancer.

          • “Researchers gave 19 obese men a high carbohydrate diet (399g a day) for 3 days, followed by a medium carbohydrate intake (164g a day) for a month and then a very low intake of carbohydrate (24g a day) for another month.

            At the end of each study period, researchers collected stool samples and measured levels of a fatty acid called butyrate. This fatty acid is produced by bacteria in the gut and helps to kill cancerous cells. The scientists discovered that low-carb diets were linked to a reduction in gut bacteria. Furthermore, there was a four-fold drop in cancer-fighting butyrate between the high carb diet and the low-carbohydrate diet.

            Speaking of low-carb diets, Professor Harry Flint who led the research says, “In the long run, it is possible that such diets could contribute to colorectal cancer.””

            I suppose you’ll link me to Atkins blogs scrambling to find was to discredit this research. Of course they will, their incomes depend on it.

  21. Dr.Perlmutter is one of the top neurologists in the world. I think that we can trust what he is saying is at least some what true. Some people are saying that they eat carbs and are fine and healthy, and I believe you are, but what about when you get older, and you have all sorts of issues. It might take a long time to start showing problems in your health. You don’t even have to cut all carbs from your diet, just eat less of them and eat foods that are good for you that contain low carbs. Then you could have a lot less of a chance of developing a neurological problem.

    • Perlmutter is a quack. Google him and you’ll find complaints bordering suggesting neglect at best, complete malpractice at worst. He has jumped on the band wagon of low-carb craze to sell a book. Eat a balanced diet with mostly fruits and vegetables, avoid chemicals, get exercise and sleep, and pay attention and listen to your body (avoid things that irritate). Simple. Like a previous poster said – it’s not rocket science. Fad diets are dangerous.

      • I think diet fads tend to survive due to their incredibly powerful ability to elicit strong placebo effects. Never underestimate the financial fortunes that can be made via placebo effect (homeopathy for example, even most prescription anti-depressants perform no better than placebo in most cases). These diet fads all share a similar formula: -you feel like crap? it’s your diet! -your current diet is KILLING you find out why! -Our diet will restore your health, longevity and happiness just listen to those who have tried it -Now, buy our book, DVD, supplements, subscribe to our website, etc.

  22. I’m In the process of reading Dr. Perlmuter’s book. I think he is s brilliant neurologist, a courageous trail blazer and has discovered the crux of disorders in many of his patients. The key is that these people are patients and patients have problems that are not necessarily in the rest of the population(s).
    Another point is that we are not all the same, yet there are similarities. Cholesterol is a key component in making most of our hormones, testosterone, estrogen, progesterone, DHEA and cortisol. All these hormones serve important unique functions. However, so far I have not come across any mention that the liver makes about 80% of our cholesterol from other food components.

  23. I have read many books about diet, including the Atkins diet, the raw foods diet, veganism, Paleo, etc. and there are a few common elements to all of them that can be summarized thus–if God made it and it is being raised the way that He designed it to be raised, grown the way it was designed to be grown, if you can grow it or raise it or make it yourself (not in a lab or factory only), then it is good to eat. Each individual needs to decide the amount of meat or grain that is tolerable to him/her according to their own genetic makeup and geographic environment. If you espouse this basic principle, you will not be swayed by fad diets.

    • Which ‘god’ are you talking about? Some advocate for no animal consumption, some prohibits certain specific food like pork or shellfish, and some seem to not have any specific guidelines. I think it’s best to leave ‘god’ to metaphysical purposes, and out of physical world, which science is better at explaining. God also “designed” inedible food for us, and some that may even fool us to eat despite their lethal poison.

  24. My doctor put me on this diet and I am a vegetarian and I don’t eat meat,fish or chicken-I’ve been on it for two weeks and have stomach aches and a smell from my body-I feel like im flooting in oil-he put me on this for restless legs-

  25. I don’t subscribe to any low carb diets for the purpose of losing weight or for maintaining good health. In my experience, low carbs give me low energy. I need protein, carbohydrates, and fats in order to look and feel my best. That means whole grains, fruits, and vegetables and some meat, fish, or poultry along with nuts, seeds and good cheese. The fats I choose come from grass fed and/or organic beef, poultry, high quality fish oil, coconut oil, cold pressed olive oil, ghee, and high quality butter.
    Another words, I eat like my grandparents did!!

    • Same here! I add to this daily exercise and a daily 16hr fast plus plenty of RO water remineralized with a dash of celtic salt. Doc says my bloods and BP are that of a fit 16yr old, cardiologist says I am top 3% of heart health (41yrs old). Yet, most in this thread think I am killing myself!

  26. “If he’s right about his claims. . . .”

    Since there are tens of millions of people eating plenty of carbs, and over half live off potatoes beans and bread, and we are all doing just fine, it’s obvious to anybody who uses his or her brain that he is flat out wrong.

    Unfortunately, very few use their brain.

    • you say we are doing fine? Did you not know there is an epidemic of obesity, type 2 dibetes and all forms of autoimmune diseases??

    • I agree. I really don’t think whole carbs are a problem. I’m pretty wary of gluten, and know that it kills my GI track and makes me break out in terrible acne, but I’m all for some brown rice, some quoinea, and some other “ancient” grains. I do think there is something wrong with wheat.

  27. If I feel good on a specific diet then I think that warrants continuing the diet. I have never felt better in my life than when I was following a strict ketogenic diet, so that’s what I try to do. I think your body will tell you what it likes you to eat. My mother has tried going low-carb and she doesn’t do well with it. Would I encourage her to try it again, this time following all of Dr. Perlmutter’s advice with exactness? Sure. But if she still feels better eating a higher percentage of carbohydrates, then I think that’s what she should do, regardless of what an MD has to say about what those carbohydrates will do to her brain.
    Our own bodies are our best and most reliable source of data. If you consistently follow a specific diet, you’ll know it’s sound, healthy, and right for you if you start feeling and looking better (more energy and focus, brighter skin, leaning up, current diseases/problems are resolved). That’s really all the research you need. But be a good researcher – if you’re going to experiment with something new, don’t do only 50% of it, or even 95%, and then collect your data and expect the results to be an accurate measure of its effectiveness. You have to give it a 100% try. Until you’ve done that, you really shouldn’t be spreading your opinion about whether it works or not.

    Dr. Perlmutter suggests a 4-week plan for better health. If he’s right about his claims, you have the opportunity to save your brain by taking the plunge and trying it out. Awesome! If it turns out he’s wrong, you will have spent a whole four weeks of your life (big whoop-dee-doo) doing some quality experimental research. You can then move on to something else if you don’t like your results, with full confidence that Dr. Perlmutter’s advice was not right for you. Nothing lost, plenty gained.

    • Perlmutter and other low carber/ketogenic dieters have no idea what they are doing to their gut microbiomes. Yes, dead carbs are bad, but good carbs are shown to vastly improve populations of the most beneficial gut bacteria. low carb/ketogenic will be killing them off in mass and once that happens long term you will be in trouble. A healthy diet is 90% ensuring this microbiome is fed the right sustenance. Why? Because these bacteria excrete compounds which are becoming linked to nearly every health problem. Auto-immune? wrong bacteria, food allergies? wrong bacteria, depression other mental disorders? wrong bacteria, obese? wrong bacteria, brain disorders? wrong bacteria. Feed the bacteria good whole foods (yes even carbs, especially resistant starches) are you will maintain their health and yours.

  28. I am currently reading Grain Brain and taking some of it with a grain of salt. I am 50-something, suffer from brain fog, fatigue, frequent insomnia, occasional joint pain, and am about 15 pounds overweight. Most or all of these conditions are probably caused, at least in part, by my high-refined-carb diet. I know that without reading this book. I already enjoy vegetables and have slowly gotten my family to do the same, although perhaps on a smaller scale. I am pretty sure that if I *significantly reduced* the amount of refined carbs and sugar in my diet and *slightly increased* the amount of whole grain carbs in addition to making better protein choices (less red meat, more fish and vegetable sources) and exercising most days instead of some days, I would probably see a fairly speedy improvement in most if not all of the areas where I’m feeling less than young. The main reason I chose to read Grain Brain is to see what the hype is about, but also to find recipe and menu ideas to encourage my husband to make some of these changes with me so we can try to feel less like our elderly parents and more like ourselves.

    • Well, I just got done with experimenting. I went 100% grain free for 3 weeks. I tell you I felt no difference AT ALL. The only difference was dealing with hunger and frustration with trying to find enough to eat. I avoided all “packet” foods and gluten free packet foods. Just whole foods, vege, fruit, nuts, legumes, etc. I literally had no grain. I just wanted to see what happened. Now.. I’ll tell you what had an absolutely incredible impact on me. I started taking Nordic Naturals fish oil, 1 at breakfast and 1 at dinner. I also started having a small handful of organic walnuts and brazil nuts daily (both combined). 2 Weeks after doing this daily I feel incredible. I can’t describe how much better my mood is, energy levels and mental clarity.

      • I have been grain free for over 12 months and have not experienced a single epilectic episode in this entire time. this has not happened since my first episode in 1978. My experience with hunger is the opposite of yours. I go hours longer between meals, energy levels high and lost 16lbs. I do eat plenty of vegies and small amount of meat, fish etc. I eat plenty of healthy fat.

  29. Average Joe here. Was terrible at science, yada – yada. But, this is how I understand things:
    1. You cant compare the USA with other countries in regards to high carb consumption and health because the USA has too many other dietary factors at play. So saying, “other countries eat a high carb diet and they’re fine”, doesn’t work, because they are also not eating all the other types of garbage Americans are eating. So naturally, yes, other countries who eat a high carb diet are way healthier than the USA, but that’s because they don’t eat as much other garbage the USA does (as a whole. I know; you ,of course, don’t eat unhealthy stuff. i.e. preservatives, processed foods, chemical additives, etc, but most of the USA does).
    2. We’ve only been cultivating crops for about 10,000 years, and even then our grain consumption was still lower than today. 10,000 years is only a small smudge on the timeline of the human dietary evolution. Our dietary evolution happened over hundred of thousands of years, where we were only eating a very very small amount of grains. We also ate fruit very selectively because it was harder to obtain than vegetables. Read this article. Take note on the section on agriculture:
    Kinda of a sloppy explanation (sorry at work. trying to crank this review out), but I think you’ll get my point.

    • I have just read over comments on this website regarding the book and research of Grain Brain (yet to read!).
      I would like to know if you have and data on this type of diet being helpful for reducing ocular pressure associated with glaucoma? Some specialists say glaucoma is a brain disorder like Parkinson’s. Also aside from the genetic potential to manifest this disorder that past family links to other eye disorders such as MD may also contribute to glaucoma.
      Interested in insights you may have on this diet help such disorder..

  30. I would have thought that fruit and vegetables being anti inflammatory and packed with anti oxidants would actually be good for brain health. I started to read Grain Brain today and only reached a few pages in… just the mention of fruit being bad, was enough for me to put the book down.

    As you say, it’s high time experts started to look realistically at our diet as it was before the introduction of grain, because I feel some of them are way off base. It is confusing a lot of people out there and really it is a no brainer at the end of the day. Most disease stems from the introduction of wheat, gluten etc.

    • There is a lot of sugar in the fruit we eat now, so just read the whole book before you rubbish it. I am a 66 year old male, living in Ne Zealand, I find for myself I need to be careful about the amount of sugars and starchy carbs I consume, as they make my joints ache, whereas Low carbs, plenty of green vegetables seem ok. If you suffer from joint pain try cutting out all starchy carbs and grains stick mainly with green vegetables unprocessed meats and fats. no seed oils. Use butter, olive oil, avocado and its oil. for 2 weeks then start adding low carb veg like carrot and tomato back into your diet slowly and see how that works for you. good liuck.

    • If you would have read the whole book, you would have seen that he was not suggesting that you do not eat fruits. The suggestion simply that you do it in moderation.

  31. I think that the carbs that those specific groups eat are better than the highly processed carbs that Americans eat today. The problem of obesity is because of this and that’s what is killing brains.

  32. Seems to me the problem is not carbs, but the fact that we don’t move about enough to burn them off. That plus the fact that they are usually combined with vegetable fats and grains.

    I notice a massive difference if I eat carbs with vegetable fat added – much more sluggish.

  33. “The science indicates that the more you keep insulin elevated the more prone you are to a range of bad health outcomes.”

    Uhhh, that’s on bad carbs, in addition to other crap out there.

    Of the seven billion people on this planet, over five billion eat grains and carbs.

    If there was a problem, the medical est. would be overwhelmed. We’d be dropping like flies.

    Once again, China, the oldest nation eating grains, wouldn’t be the largest nation in the world.

    Ya don’t need science or studies.

    Jesus…it’s common sense,

    Damn, some people can be dumb.

    • This medical est. of which you speak is overwhelmed, and they are loving it. So is the insurance est.

      I’d also wager that China is not the oldest nation eating grains.

      Looking out my window, I can plainly see the world is flat. That is common sense.

      I do agree with you. Some people can be dumb. Maybe some science and study is in order?

      • There is plenty of evidence that whole grains greatly reduce risk of bowel cancer/colon cancer. Also evidence that they boost key bacteria in the gut biome resulting in better health outcomes. Some of these bacteria keep us from getting auto-immune disorders, cancers, brain disorders etc. Avoid grains at your own risk. Now… boxes of Kraft mac & cheese, yeah sure avoid crap like that.

        • You don’t need grains for fibre. You can get it from veg. Grains are harmful to everyone with compromised gut health unless they are well fermented. People can feed their microbiome with potato starch, green bananas, inulin etc.

    • People breed early in life usually, before they get most of their health problems, so a nations population doesn’t say much about its health.
      A quote from “Food Enzymes for Health and Longevity” by Edward Howell:
      “The available evidence indicates that Orientals on a high-carbohydrate cooked diet, essentially rice, display a pancreas approximately 50% relatively heavier than that of Americans. The salivary glands of Orientals are also larger…This indicates that the pancreas and salivary glands were forced to undergo considerable hypertrophy to furnish the additional enzymes required.”

    • Spoke my mind….hmm..what’s next?…people who drink some water everyday are likely to get cancer? Oh…eating protein will shorten your lifespan? What other ways can “Dr.s” trick us into getting paid by evil “companies”?

  34. There are people who are genetic outliers. They are fit and have rippling muscles and never exercise and eat junk. There are people who smoke for decades and live to 104.

    There are people who have eaten lots of grains and carbs their entire life and have no trace of dementia and live a long life span.. It’s a mistake to look to them to set a standard.

    Based on credible science, that continues to be reconfirmed as time goes by, most people are not well adapted to a diet high in carbs, especially grains and sugar. The science indicates that the more you keep insulin elevated the more prone you are to a range of bad health outcomes.

    • The problem with studies is the variables are very small. Even if a study purported increased alzheimers from carbs, the study will fail to take into account dozens of other variables that could negate the data. For example let’s say mice fed high carbs are slightly more likely to get alzheimers than mice fed low carb. Now, what if the mice on a high carb diet are also exercised, what if they are given a lot of water/hydration, what if they are put on an intermittent fasting diet, suppose they were fed sourdough processed whole grain carbs instead of dead white flour carbs. These additional variables could end up with a high carb mouse with no alzheimers and better health than the low carb mouse. We just don’t know. Which is why I think these studies are cherry picking single issues and extrapolating that. It’s misleading and certainly does not give us the big picture. Now, if they fed mice high carb sourdough processed grains, had them exercise a few hours a day and not be sedentary, gave them plenty of water, had them on an intermittent fasted diet, etc and THEN these mice were getting sick I might find it interesting. Until then, diet and health are too complex to deem any of these studies fool proof.

  35. One part of the vegetarian myth is that growing crops is more sustainable than raising meat.. That may not be true at all. In fact mono-cropping, growing on crop on a parcel of land like corn etc is destroying the ecosystem. It wipes out all natural life in that field except for the one plant.
    It is estimated that there will be no topsoil left in about 40 years,
    Left to nature, most fields in North America would return to grass land. We could then graze beef and bison and other animals on their natural food which is grass. We can then rotate them out and bring in other animals like chickens. Rotate them out and the grass quickly grows back because it has been well fertilized by these animals and we rotate back in the beef. Stir..repeat.
    Where this has been done, the birds come back, the insects come back the critters come back.
    Search Your Tube for Polyface farms.. They are the most productive farm acre for acre in the Shenandoah Valley.

    • So Polyface farms is always being held up by everyone as, THE MODEL of sustainable animal agriculture. Yet few people who revere them seem to be aware of one little important fact:

      Polyface is not able to provide for all those animals using just the resources grown on that farm — they import a lot of feeds that are grown other places.

      Check out the book, Meatonomics for the rest of this story!

  36. Oh my, Tom! The horror of it all!

    Hey, man, didn’t you hear? I’m a suit-wearing exec from the grain society? lol

    Get some therapy.

    I, for one, don’t push carbs and grains. Just like Chris, I am saying that there is no proof that carbs and grains do harm to nearly all of society.

    In fact, these are a vital part of many people’s diet, as I mentioned before.

    Oh, but you’re right. In fact, hospitals and doctors’ offices are filling up with the sick and dying as we speak.

    The Chinese, the oldest nation to eat carbs and grains are quickly dying off. . ..

    The hundreds of millions of people around the world are dropping like flies. . .

    Get a clue, brainstorm.

  37. There is some very suspicious misinformation being posted on this site. Since the forum is unmoderated, there isn’t much that can be done about it.

    But I would warn anyone reading this to beware of two posters who are posting almost daily. It is easy to identify them because they post constantly and because they seem to have no interest in discussing Grain Brain or the issues Perlmutter raises. They are only interested in pushing a particular (pro-grain, pro-carb) point of view. I would not be surprised if they are being paid to do this or if they have some personal or financial interest.

    I would not pretend to know whether Perlmutter is right or wrong, but he is scientifically substantial, he is anything but a quack, and the science he discusses in his book is very real. The two people who are constantly posting against Perlmutter and against low-carb do not ever offer any real science (other than citing things like “common sense” and grain industry and bakery p.r.) They do seem to be intent on out-posting everybody else. They should be ignored.

  38. Hello, I want to Share a book for the grain brain readers who are brainwashed (excuse the pun) into thinking that ALL carbs and wheat is bad for EVERYONE.

    It’s called the “Drain Brain.”

    Now showing at a bookstore near you.

    • Keep an eye out for my new book “Carrot Catastrophe” it discusses the ravages caused by eating carrot. Already those who have read the book and gone off carrots are reporting that they feel incredible. Brain fog has lifted, adrenals are functioning again, their bodies once ravaged by acidosis are now completely alkaline, energy levels have returned. Beware the carrot.

    • you need to get informed. Permulter is not against all carbs? he is against processed carbs (grains) and fruit is ok in moderation. Cruciferous vegetables contain low levels of carb but are very healthy for the gut and he is pro these. Stop banging on about China they are not the first people to eat carbs and their health is nothing to write home about in any case! We never ate grains for the first 2.5 million years of existence only introduced 10,000 years ago!

  39. I personally have noticed an improvement in my mood since adopting some of Perlmutter’s dietary suggestions. I respectfully ask anyone who feels incited to become insulting and abusive in an otherwise calm, rational discussion to carefully consider the possibility that their diet may be contributing to the way they feel.

  40. Chris you say that glucose is so important, that we have evolved a way of making it in the body, if it isn’t part of our diet. Why, then, haven’t we evolved a way to supply protein, if it isn’t part of our diet?

  41. Well think of it this way: If carbs are so bad for us, why aren’t the hospitals and cemeteries filled to the rim?

    Why is it that the biggest carb-eating nations are healthier than us???

    Think about it.

    Use your common sense, don’t make eating complicated–and the best of luck to ya! 🙂

    • Thanks – and same to you. I know what you’re saying. I don’t want to spend too much time obsessing over just what to eat and supplement. I know what you mean.

    • Not so much carbs are bad for us, but too many carbs are bad for some of us, especially fast acting carbs. The cemeteries would be filled to the brim if it were not for medical intervention, think about diabetes, in its many forms, if it were not for insulin injections,where else would they be, but in a grave.

    • Perry wrote: “Well think of it this way: If carbs are so bad for us, why aren’t the hospitals and cemeteries filled to the rim?”

      That is a straw man argument. I think Perry displays a fundamental miss undestanding of the case against eating too many carbs ,

      No one is saying that carbs are a poison.. You dont eat some and then get very ill or drop dead on the spot. Carbs are not arsenic.

      And there is a proper way to eat some carbs, in the form of vegetables, especially leafy green ones. But starchy foods are to be avoided..

      Plus, the advice to lower carb consumption is not isolated. The other end is that we must eat far more healthy fats. Low carb diets without the right fat intake is also not the very best thing for people.

      Once again, keeping your insulin elevated too much above what a low carb diet will affect has been shown to shorten life and create all kinds of health conditions ..Period

      And yes, the hospitals are full up with people sick from a diet too rich in carbs and too low in fat. .

  42. Debbie, when I lost 31 pounds of pure fat, I made sure to have as many nutrients in my diet as possible. It helps the body lose weight.

    Plus, when you eat less food, you need to choose foods that have the highest nutrients.

    Sweet potatoes are loaded, I mean, LOADED with nutrients.

    It’s also a great comfort food–and comfort foods can also help you lose weight.

    The more mentally satisfied you are, the easier the diet is.

    Not to mention you need carbs for muscle and brain energy.

    During my diet, a lot of the times I would have a bowl of oatmeal or a sweet potato with a four-ounce chicken breast.

    You can go as high or as low as you want on the carbs–whatever works for YOU.

    I ate and still eat 300+ carbs a day.

    Carbs aren’t the evil doers…

    it’s the overall calories.

    Just watch the overall calories, your protein and the necessary nutrients–and move more.

    That’s all there is to it, basically.

    • Thanks so much for these responses. Perry, you’re right, and your advice pretty much correlates with what I do. At this point, I’m fine tuning according to what I believe might be the healthiest way to eat for me – but there are contradictory views on what that is (Grain Brain vs. Perfect Health Diet), and even the extensive testing that is available is far from definitive, and practioners also disagree as to treatment.

      So, I assume we all check out the blogs we respect – Chris Kressler I respect more than any other – and try to adjust what we learn to our situations.

      I’d like to lose weight, but when I go below where I am now begin to feel extremely low energy. None of this is simple I already eat a fairly low number of nutrient dense calories per day – I’m probably where I should be, or even a little low – and I’m not skinny.

      I’m not sure about the carbs, even nutrient dense “safe starches.” Thanks for the feedback!

    • sweet potato is great but grains are not nutient dense. In fact they are very low in bioavailable nutients. All processed foods are nutrient deficient but high in calories.

      • Grains sound so evil right? What do these Harvard guys know anyway compared to a guy trying to sell books?


        A growing body of research shows that returning to whole grains and other less-processed sources of carbohydrates and cutting back on refined grains improves health in myriad ways.

        As researchers have begun to look more closely at carbohydrates and health, they are learning that the quality of the carbohydrates you eat is at least as important as the quantity. Most studies, including some from several different Harvard teams, show a connection between eating whole grains and better health.

        Cardiovascular Disease

        Eating whole instead of refined grains substantially lowers total cholesterol, low-density lipoprotein (LDL, or bad) cholesterol, triglycerides, and insulin levels. Any of these changes would be expected to reduce the risk for cardiovascular disease. In the Harvard-based Nurses’ Health Study, women who ate 2 to 3 servings of whole-grain products (mostly bread and breakfast cereals) each day were 30 percent less likely to have a heart attack or die from heart disease over a 10-year period than women who ate less than 1 serving per week. (1) A recent meta-analysis of seven major studies showed that cardiovascular disease (heart attack, stroke, or the need for a procedure to bypass or open a clogged artery) was 21 percent less likely in people who ate 2.5 or more servings of whole-grain foods a day compared with those who ate less than 2 servings a week. (2)

        Type 2 Diabetes

        In a study of more than 160,000 women whose health and dietary habits were followed for up to 18 years, those who averaged 2 to 3 servings of whole grains a day were 30 percent less likely to have developed type 2 diabetes than those who rarely ate whole grains. (3) When the researchers combined these results with those of several other large studies, they found that eating an extra 2 servings of whole grains a day decreased the risk of type 2 diabetes by 21 percent.

        More recent findings from this study (the Nurses’ Health Studies I and II) and the Health Professionals Follow-Up Study suggest that swapping whole grains for white rice could help lower diabetes risk: Researchers found that women and men who ate the most white rice—five or more servings a week—had a 17 percent higher risk of diabetes than those who ate white rice less than one time a month. Those who ate the most brown rice—two or more servings a week—had an 11 percent lower risk of diabetes than those who rarely ate brown rice. Researchers estimate that swapping whole grains in place of even some white rice could lower diabetes risk by 36 percent. (4)


        The data on cancer are mixed, with some studies showing a protective effect and others showing none. (5) A large, five-year study among nearly 500,000 men and women suggests that eating whole grains, but not dietary fiber, offers modest protection against colorectal cancer. (6, 7)
        Digestive Health

        By keeping the stool soft and bulky, the fiber in whole grains helps prevent constipation, a common, costly, and aggravating problem. It also helps prevent diverticular disease (the development of tiny pouches inside the colon that are easily irritated and inflamed) by decreasing pressure in the intestines.

        Staying Alive

        An intriguing report from the Iowa Women’s Health Study linked whole-grain consumption with fewer deaths from noncardiac, noncancer causes. Compared with women who rarely or never ate whole-grain foods, those who had at least two or more servings a day were 30 percent less likely to have died from an inflammation-related condition over a 17-year period. (8)

        How Do Whole Grains Improve Health?

        Whole grains don’t contain a magical nutrient that fights disease and improves health. It’s the entire package—elements intact and working together—that’s important.

        The bran and fiber in whole grains make it more difficult for digestive enzymes to break down the starches into glucose. Soluble fiber helps lower cholesterol. Insoluble fiber helps move waste through the digestive tract. Fiber may also kindle the body’s natural anticoagulants and so help prevent the formation of small blood clots that can trigger heart attacks or strokes. The collection of antioxidants prevents LDL cholesterol from reacting with oxygen. Some experts think this reaction is a key early step in the development of cholesterol-clogged arteries. Phytoestrogens (plant estrogens) found in whole grains may protect against some cancers. So might essential minerals, such as magnesium, selenium, copper, and manganese. These minerals may also help reduce the risk for heart disease and diabetes. And then there are the hundreds of substances that haven’t yet been identified, some or many of which may play as-yet-undiscovered roles in health.

  43. Without doing extensive texting I’m currently confused as to how low or high to go with consuming carbs. Other than that, I’m very happy with my current diet. Because I have a long history of metabolic derangement – eating disorders, obesity, bulima – and am now for the past 25 years maintaining an 80 pound weight loss, I wonder if I should automatically restrict my carbs more than I am. I currently eat a good amount of sweet potato and butternut squash, and wonder if that’s not a great idea for me. I enjoy eating a late dinner and then becoming sleepy and pretty much falling asleep. I don’t know how bad that is…

    • People vary in their tollerence and ability to digest carbs/starch.. If you are maintaining your weight, sweet potato is a fine choice because it does not spike up your insulin very hard. If you feel stronger with it in your diet, then I would continue… But if you need to lose some weight, drop the sweet potatoes for a while.

      To maintain most people eat about 50 to 100 carbs per day.. To drop weight keep your carb intake to 20 or less… Unless… you are carb senstive. I need to keep carbs to 20-30 per day just to maintain… Anything more than that and I put on lbs. You should go trail and error to find the right level of carbs for you.

    • Lose the butternut squash, sweet potato and other high carb foods. You’ll feel better and be less sleepy after dinner. I’d also eat earlier in the evening to unburden your gut before going to bed. Trial and error seems to be in order. Good luck!

      • Three square meals with the biggest meal at the end of the day may not be what we are most adapted to. Meal timing is an interesting subject. A larger protein and fat rich breakfast may provide enough energy for you to last until late afternoon without needing a “Lunch” break.

        • Debbie,

          If you want to eat what you like (within reason and whole foods) just intermittent fast. It improves all health markers and increases longevity (plenty of research out there). Basically for females eat in a 10hr window and fast for 14hrs straight (for 14 just water). If you want, take it up to 16hrs fast. Or you can do 5:2 diet, eat what you want for 5 days, then fast 2 days in a row (max 600 calories per day). Google the BBC Horizons documentary ‘Eat, Fast and Live Longer’ it’s fascinating! When IF catches on I think most health blogs and supplement companies will go out of business, it’s that simple and beats any ‘diet’ plans out there. Diet bloggers and diet authors should be worried.

      • I agree with you about the timing of dinner, but I just don’t want to eat earlier, I admit it. Just not willing. About the carbs, that’s the issue we’re discussing here. I don’t think there is a definitive answer for me yet. Thanks, though for the feedback.

  44. Not a darn thing, Pam. 🙂

    But when he, and others say that grains and carbs are bad for everyone–and they don’t use any common sense–that is something else.

    Good luck with it.

  45. I am currently reading the Grain Brain and although I feel some of the advice on elimination of 90% of all grains and sugars seem out of the norm, it is well known that most of our grains are genetically modified which I believe is more the problem and causing reactions in the human body. I found that I was gluten sensitive a year ago after participating in a cleanse – when adding gluten back to diet, an immediate mental response of anxiety, brain fog resulted. This is before I had any pre-conceived notion about the harms of gluten. However, after I experienced this, I began to learn of gluten’s harmful effects on people that are sensitive. I still battle a slight depression problem, but not as bad as before. I may not follow the Brain Grain book to the letter, but I intend to give the plan a try and see how it works for me – what is the harm in that?

  46. Do your research. You’ll be surprised by what you’ll discover–and how much their lifestyles have actually changed.

    • Perry,

      You mentioned you were a writer for a health company. You should have this information at your fingertips. Why not post some links here?

      Besides you keep missing the point. The point is you keep changing your own arguments. Like trying to nail jello to a wall.

      “China is one of the leading pasta eaters, dating back to before Christ was born. Look up their health stats.

      “The Unites States is among the unhealthiest because of all the sugars, processed foods and dirty oils that fast-food is cooked in. ”

      Remember that post you made? Here you are trying to contrast China with the US. You are implying the Chinese were healthy, while the US is not. You had an opportunity to admit the Chinese were not exactly healthy, but you didn’t make the case.

  47. The traditional Chinese diet is high fat and low sugar with few processed foods. It’s not because of the rice and noodles that they do well, it’s in spite of this. Eating enough animal fat is the key

  48. “The health of the Chinese is declining..”

    With more and more of them eating junk carbs, in the past decade or so, along with the U.S. bringing in their franchise restaurants…it’s no wonder.

    Their parents, grandparents, great grandparents, and so on who all ate healthy carbs and grains, would be shaking their head in disappointment at their poor eating habits.

    Plus, the Chinese of today are a hell of a lot less active, and spoiled due to their now successful economy and building boom.

    They are a perfect example on what can happen very quickly when a nation becomes less active and eats crap carbs, along with crap food in general.

    • You’re like a shifting target, always changing your argument and the facts to get ahead. First the Chinese eat lots of “pasta” and are very fit, then now they eat junk carbs and that’s why they are getting sick. *shakes head* Ok I get it. You’re one of those people who can’t stand to lose a point in a debate, and so when facts are presented, you backpedal and pretend that’s what you were arguing all along. Maybe you need to add “Perry Backpedal” to your list of aliases.

  49. Okinawa’s also eat lots of sweet potatoes, which does not spike insulin all that much. Plus, they had a famine at the end of the War which may have killed off the less hardy. Sweet Potatoes + Pork and fat+ vegetables and some fish is a fine diet. Add in good genetics and lots of being outside in the air and sun and we shouldn’t be surprised at their longevity..

  50. I am reading the book and find some very fascinating findings with facts and research that support the concepts. I think that What Kris Kresser raises balances perspective. As I am reading the book, it definitely challenges the common practices that have been taught over the past 30 years.

    A family member of mine died from complications of Alzheimer, it was a terrible, painful and long time. That person was doing all the things the doctors told that person to do (statens, heart medication, antiswelling medication, stay away from eggs, use canola oil and carbohydrates are ok). What David Perlmutter raises explains at a biochemical level how the carbohydrates and medications will damage the brain. He builds a very compelling case and educates on the way the body functions that so far when I fact check, they are true.

    However, I still think there is a balance. Still working on that.

  51. The Okinawans eat a lot of pork and cook in pork fat.
    The Okinawans live the longest.
    I’m sure the reasons are varied as to why but to use Okinawans to promote carbs is ludicrous.

  52. You’re right, beakernz.

    Many people eat too much, and too often. A lot of the times they will eat because it is time to eat. It’s a routine.

    It’s not that they are hungry.

    Breakfast is a perfect example. They get up. They get dressed. They shave. They put on makeup…they eat. And many of them aren’t even hungry yet.

    Heck, many times I’ll eat two to three hours after getting up.

    I’ll have a big ol’ bowl of oats, and peanut butter toast. Yum.

    Oh, know–it’s carbs! I’m going to get Alzheimer’s!

    I’m going to die!

    • Just out of interest, what are the oats you are eating? Are they rolled oats? Are they whole oat groats, or have they been hulled, husked, polished? Have you soaked the groats? How long do you soak the groats? Do you ferment your grains? Do you practice lacto-fermentation? Are you aware that many traditional farming societies did not eat unsoaked, unfermented grains?

      Try this: put your oat groats in a bowl, cover with water. If you want, add a little whey. Then put your bowl in a warm place overnight. Heck, try a day or two. Now eat it, either raw, or cook it a little.

      Those peanuts, are they out of a jar, or did you grind your own peanut butter (btw, peanuts are mostly fat, with some protein). Just a thought, did you work out the fat/protein/carb ratio of your oats, peanut butter, bread meal? You might just be surprised at how much fat and protein you were consuming.

  53. “…that enable you to speak so authoritatively?”

    Say what?

    Wow, really, Brian? You actually said that?

    Um, it doesn’t take a rocket science to see that if carbs–and grains in general–really are bad for us, everybody would be suffering, especially the highest pasta consuming nation, which is China.



    And it has nothing to do with science. It’s just plain ol’ common sense–which most people don’t have.

    That’s one of the reasons why such books as Grain Brain and Wheat Belly (or whatever the hell it’s called) are bestsellers.

    Or, wait–you’re right, it’s bad for us. People by the billions are getting sick, and dying due to carbs and grains.

    *rolls eyes*

    • “Wow, really, Brian? You actually said that? ”

      My name is Bruce, not Brian. I know that they both start with a B and a r, but where the similarity ends.

      “…especially the highest pasta consuming nation, which is China. ”

      And do you have a citation for that, or am I supposed to just take your word for that? See that’s my point. Almost everyone of your posts, we are supposed to just take your word for it.

      “And it has nothing to do with science. It’s just plain ol’ common sense–which most people don’t have. ”

      So we can just save ourselves a whole bundle of money and just hire you to dispense “common sense”? I suppose much of what Aristotle wrote was just common sense as well. We really didn’t need this silly thing called “science” to separate out “common sense” from “false beliefs”, “erroneous beliefs” “mistaken beliefs”, etc. Just good old fashion “common sense” which “most people don’t have”.

      Well, if it was so common, then most people would have it. See how you just contradicted yourself? Since most people don’t have it, then its not so common. Its “uncommon sense”, since only a chosen few seem to have it.

      “That’s one of the reasons why such books as Grain Brain and Wheat Belly (or whatever the hell it’s called) are bestsellers.”

      You remind me of the people who protested “The Last Temptation of Christ” but knew nothing about the movie. They “knew” the movie was bad because their pastor told them so, and their pastor “knew” the movie was bad, because someone higher up in authority told him so. How can you “know” the books are so wrong, when you haven’t read them? Just working on your superior “common sense”?

      “Or, wait–you’re right, it’s bad for us. People by the billions are getting sick, and dying due to carbs and grains.”

      No one has argued that. What you are committing is a classic logical fallacy called The Straw Man Argument. You state a false argument, pretend that is what your opposition is arguing, then proceed to falsify the argument. The “straw man” is the false argument that gets knocked down with your “superior” argument.

      “*rolls eyes*”

      So very true. And when I read your little rants, I add in *heavy sighs* *face palms* *guffaw* *chortle*.

      I thought you said you were a writer for a health company. I assumed that then you understand how to cite sources. If not, I suggest taking a freshman English 101 class to learn how, its very helpful in a writing career, unless you are a PR flack, and actual sources are little nuisances you don’t need to bother with.

      But anyway this is how it works: Italy leads the world in pasta consumption per capita (per person) 26k This link is called my source. This is the source of my information.

      So what is the Chinese per capita consumption of noodles? “Per capita consumption of wheaten products was 19.9 Kg in 2013, “specifically, per capita consumption of fine dried noodles, instant noodles, biscuits, cakes and fast frozen wheaten and rice food was 1.85Kg, 8.21Kg, 5.05Kg, 1.35Kg and 3.45Kg” a bit less than Italy’s 26k . As far as the leader in per capita consumption of instant noodles, it’s South Korea 69 packets to China’s 32 .

      This is rather a fun game of scouring the Internet looking for actual sources to back up what you say. I do hope you want to play.

    • I agree with Tom, If you are in good health eating the way you are, and are happy eating the way you are, good for you, but don’t knock people who have things wrong with them and are looking to find some relief through, diet cheers

  54. I suggest everyone watch online the BBC Horizons documentary on intermittent fasting. It’s becoming obvious (much to diet fads, diet writers and diet bloggers) that there is one simple way to vastly improve ALL health markers. it does not take special diets. All it involves is eating sensibly + only eating for 8hrs a day. The other 16hrs are just water. I’ve been doing this for 2 months now and GP was flipping out over my blood work, said “you might be 40, but your blood work is that of a healthy 16yr old, what are you doing?”. There are many people who had horrific numbers (headed for heart disease and a plethora of medications) and now completely normal bloods simply by intermittent fasting. That’s right, no diet changes, no removing grain, dairy, etc JUST fasting. Even the 52yr old on the documentary was in dire health heading for medications but he did intermittent fasting for 5 weeks and his markers improved over 50%! So what does this mean? It means you are not likely to find fad diet advocates or health bloggers mentioning IF at all. If the truth about IF became main stream they would literally be out of business over night.

  55. All U.S. grains? Really?

    Um, GM wheat isn’t legally approved anywhere in the world.

    100% oats are also not GM.

    Show where they are.

    Show concrete evidence where GM foods like, say, corn, soy and potatoes are hurting the world’s population as a whole.

    Show where this is slowly killing us as a whole.

    With millions upon millions of people from around the world eating these GM foods, mostly in poor nations, don’t ya think there would be SOME evidence?

    Like, say, cigarettes?

    This would affect especially the children, the elderly, and..the undernourished populations who all have fragile immune systems.

    It hasn’t. Not even close.

    As an alternative-health researcher and writer for health companies, I haven’t found not one single piece of evidence.

    However, there is PLENTY of evidence that it has saved millions of lives because more crops can be grown faster and are more resistant to infestations.

    It’s the junk carbs, sugars, dirty frying oil in restaurants, pollution, stress, depression…that is slowly killing many people.

    By the way, did ya know that milk is GM?

    It has been for years.

    Uh-oh, folks, you better throw the milk out also.

    • “As an alternative-health researcher and writer for health companies, I haven’t found not one single piece of evidence. ”

      What health companies? Could you be more specific? What exactly, are your credentials that enable you to speak so authoritatively?

      Evidence is a tricky thing. Remember how well the Tobacco companies played that card? As I recall, it was no slam dunk that smoking lead to lung cancer. In fact, the Tobacco companies funded their own studies to show the opposite, that smoking cigarettes did not, in fact, cause cancer. Of course then they created think tanks that seemed neutral, but were in fact PR organizations created to downplay the negative health effects of smoking. They also placed expensive ads in news magazines, and threatened to pull lucrative ads if the paper or magazine wrote critical articles on the Tobacco Industry.

      Its kinda strange, but I got a definite Deja Vous feeling when reading your post. Perhaps you took a page out of their playbook?

      So, really, what “Health” company do you research and write for? Do you write in a journalistic capacity, or more for “opposition” research?

      So what evidence can you provide for the statements you made? You seem to make a lot of assertions, but provide no evidence of your own, yet you demand it of others.

  56. The Grain Brain book throws the baby out with the bathwater.

    Many, MANY people have totally stopped eating sugars and processed carbs, but…

    they still continue to eat healthy carbs, like oatmeal, whole wheat bread and potatoes…

    and they too have lost weight, and felt great.

    • All U.S. grains are now genetically modified (which is the reason other countries are rejecting US imports of grains, including oatmeal, unfortunately). It is the genetic modification of our grains that has made them unhealthy to consume.

  57. I read Grain Brain (recommended by my doctor) and totally stopped eating grains, sugar, and processed carbs Jan 2, 2014. Four months later, I have lost 25 lbs. My blood sugar has normalized, and I am off all meds for diabetes and hypertension. Furthermore, I have the clearest thinking in YEARS…possibly decades. No more stiff joints, either. People are amazed and want to know my secret. My Secret?? I read GRAIN BRAIN.

  58. Great points Chris. And I thought your comments in the review of Grain Brain which appeared in The Atlantic were excellent as well. If anyone has not read that review it is quite informative…and the reference to The China Study in that review is interesting……in that study meat is the root of all disease and natural grains the key to good health. Like everything in life………balance and moderation.

  59. Please, please do not take the word of people like Trundle, who is posing as some kind of expert here with faux medical terminology like “carb deficiency.” Really the thread should be closed but I would encourage people to NOT use it as an advice thread, but rather read the various viewpoints (starting with Kresser, who has lots of great ideas), do some research and make your own decisions (with consultation with YOUR doctor if you have complicated health conditions).

    There are people who have participated on this thread who either work for the grain industry or have some kind of personal axe to grind. I don’t pretend to know what is the best way for anyone to eat, and anybody on here who pretends to know is misleading you.

  60. Matt is having some trouble with evolution and how religion is concordant with it. He said there was no Adam and Eve for example and then, jumped to conclude there is no need for a “Savior”

    Actually, scientist do think humans have a single common ancestor , female that we are all related to. Go figure.

    And all modern Humans living outside Africa are related to a small band of about 150 people who crossed out of Africa about 60,000 years ago into Yemen which was a lush garden at that time……….Sound familiar?

    It’s pretty easy to see a point in human development when “we ate from the tree of knowledge” when we crossed the line from simple reactive animal behavior to more sophisticated thinking.

    As Zen masters like to say, birds are merely birds living out their “birdness” Only humans have a thick overlay of “thinking” that covers our humanness… That’s the fall.

    “And he said: “Truly I tell you, unless you change and become like little children, you will never enter the kingdom of heaven.”
    Mathew 18:3

    First, Creation..Then the Fall… Then Redemption.

    God, the Creator, comes to earth in the flesh to
    re harmonize our existence after we degenerated into the likes of the Roman Empire.. Here is a way, with all of our passions and propensity for doing very nasty things ( “Evil”) to live out an ideal human life and then inherit eternal life after our death..

    Evolution as a philosophy is easy to see in shows like Star Trek..Things get better and better and better ( they “evolve”) with technology as the Savior….Good luck with that 🙂

    God shows us a better way to live and die vs, faster computers.

  61. Some of you are not getting the complete picture of David Perlmutter. I’ve called him a “huckster” and I had my reasons for doing so. He is indeed considered something of a leader in his field, i.e., the treatment of Parkinson’s and other neurodegenerative diseasese. However, he’s long been considered an opportunist and prone to hyperbole even by his own peers in the profession. The oft-cited Atlantic article makes that clear:

    But the article fails to mention the particular money-making core practice of Perlmutter: the intravenous glutathione therapy for those with Parkinson’s, which he conducts at his Florida clinic. This is an expensive and invasive practice for those with the unfortunate condition. There are tales of modest success in a prior clinical trial, and a trial is currently under way at USF. What’s unfortunate is that most people discontinue the therapy because it’s too expensive and the improvements are fleeting; as soon as you stop the mega dose antioxidant, whatever improvements you had disappear. But it is a successful business model if there ever was one; you can’t replicate it and you constantly have to be on it.

    He’s been considered a “pioneer” mainly for this therapy, though more for his business practice than his thought leadership. Some mainstream neurologists consider it to be “Botox” for the neurodegenerate, an expensive therapy with zero staying power for those who can afford it, contrived in a way to exaggerate its marginal benefits and marketed to desperate people who’ll do anything to see small improvement — equivalent to price-gouging victims of a train wreck or an earthquake.

    The Atlantic article, written by an MD, cites Kresser’s sensible position on the issue, and exposes Perlmutter:

    (1) Dr. Lustig says about his hyperbolic claim that gluten is behind all neurodegenerative ills: “I can’t say that Dr. Perlmutter is right, wrong, or anything else. It may be they have some data of which I’m unaware … [but] I think I’m pretty up-to-date … [Lustig] says that at this point gluten is a grab bag. ‘I have taken kids off of gluten, but in no way, shape, or form do I think this is a panacea.'”

    (2) The prestigious Mayo Clinic study that he always cites during interviews, including with Dr. Oz, are based on 13 Celiac patients who displayed “possible correlation” between gluten and dementia. The Atlantic: “[this] … is far from well-established causation that gluten is a mechanism for dementia in people with celiac disease, much less all people.” Gluten wreaks havoc in those who suffer from Celiac disease and is positively inflammatory. Is there any doubt that dementia could be linked to gluten among Celiacs? But it’s inordinately misleading to suggest this would apply to normal people.

    (3) Dr. David Katz of Yale Prevention Research Center: “I find the whole thing a little bit sad … I actually like Dr. Perlmutter … He’s cutting edge and is doing stuff that’s a little bit out there. … I think the public is being misled .. his book is filled with a whole bunch of nonsense, that’s why it’s a bestseller … that’s how you get on the bestseller list. You promise the moon and stars, you say everything you heard before was wrong, and you blame everything on one thing. You get a scapegoat; it’s classic. Atkins made a fortune with that formula. We’ve got Rob Lustig saying it’s all fructose … we now have Perlmutter saying it’s all grain. There’s either a scapegoat or a silver bullet in … every bestselling diet book.”

    (4) The Atlantic on the seductiveness of Perlmutter’s message: “The recurring formula is apparent: Tell readers it’s not their fault. Blame an agency; typically the pharmaceutical industry or U.S. government, but also … the medical establishment. Alluding to the conspiracy vaguely will suffice. Offer a simple solution. Cite science and mainstream research when applicable; demonize it when it is not.”

    This is a formula perfected to seduce lay people, especially desperate people suffering from incurable neurodegenerative diseases. Identify a singular villain. Keep it simple. Highlight the good vs. bad duality. Fat = Good. Carbs = Evil. Never intimate that anything other than the single villain is responsible. Demonize it to the nth degree. This also happens to be a time-honored technique used in politics and religion to attract a following; the masses are easy to seduce and manipulate. So are desperate people suffering from incurable diseaes.

  62. By the way…many diabetics can and do eat complex carbs. They just know how to do it.

    No sense throwing the baby out with the bathwater…that too many clueless doctors do.

    And, many people have lost weight by simply reducing their overall calories and being more active.

    I’m one of them. I lost 30 pounds, and I kept on eating my comfort-food carbs.

    I still do to this day. I just don’t overeat and sit on my rump all day!

  63. Joe, can you show conclusive studies, mainly from the Alzheimer’s Association, that complex carbs, like potatoes, whole pastas, oats, beans and bananas causes Alzheimer’s?

    In fact, show studies on WHITE flour.

    And it’s around 500,000, not 15,000,000.

    If carbs caused such a disease, the majority of the 300,000,000+ Americans would have it.

    Come on, man, use your common sense.

    Are you getting that shit out of that fear mongering/idiot’s book???

    China is one of the leading pasta eaters, dating back to before Christ was born. Look up their health stats.

    The Unites States is among the unhealthiest because of all the sugars, processed foods and dirty oils that fast-food is cooked in.

    America is a spoiled nation that eats what they want.

    They are now paying the price.

  64. I had diabetes 11 years ago and the hemotologist told me to stop eating carbs because the body converts them to sugar. I cut all carbs from my diet and in three months I no longer had diabetes. I know Dr. Perlmutter is right, read the book. I have again been on a no carb diet and have lost 15 lbs in six weeks and feel lots better in many ways. If you want to get set to an early grave, keep on eating carbs. 15 million Americans are now dying of Alzheimers and in 20 years 30 million will be dying of Alzheimers and 40 million of diabetes. The Swedes eat a low carb, high fat diet, and 50% live more than 89 years.

    • Joe, you still have diabetes. You’re maintaining it by low-carbing. You go and take the OGTT test, you’ll still be diabetic. That insulin resistance and glucose tolerance you developed 11 years ago is permanent and will follow you until the day you take your last breath. There is a difference between diabetic “reversal,” as in reversal of hyperglycemia and diabetic complications through carb restriction, and a “diabetic cure.” You’re not cured. You’re just masking hyperglycemia by not eating carbs, just like a blind person avoids getting hit by a truck by staying at home and avoiding traffic stops.

  65. This is why I dislike Perlmutter (“The Grain Brain”) so much.

    Lynn, do a search on what the Alzheimer’s Association says on good and bad carbs.

    It’s the bad processed foods and white flour in general you need to worry about, among other things.

    Like Chris said, there is no solid proof that carbs, and gluten are to blame.

    In fact, if these were, don’t you think that anybody who eats wheat would have serious health issues?

    That would account to well over half of the planet’s population.

    Also, if you haven’t already done so, consider doing “brain games,” like puzzles, and read more. This helps brain cells.

    After awhile, you will actually notice a difference in how well you can focus.

    Carbs also help give you energy, along with fats.

    If you can’t get up in the morning without feeling a little weak, if you can’t bend over to tie your shoes and reel yourself back up without feeling a bit lightheaded, you may need more carbs.

    You now know that many who say that carbs are not necessary, that they rely on fats for energy are full of it.

    Mark Sission, the health blogger, and his merry band of followers are big on that crap.

    They are in their own little world.

    Beans, oats, whole wheat and whole grain bread, potatoes. . . .

    It’s what’s good for ya.

    But when in doubt, listen to your body!

    • People who eat the same number of calories from either low carb foods or high carb foods get different results. Same calories from High Carb adds weight but not from the exact same number of calories from Low Carb.

    • Thanks for your suggestions, Perry Rose. I have been doing “brain games” for five years due to a TBI. I will check into the Alzheimer’s Association’s website.

      Since I have asthma, hypoglycemia, and hypothyroidism, and a ton of food allergies, I think restricting myself even further is more than my body/brain can take! I’ve been eating organic foods for 20 years, and gluten free for two years, since I do have a gluten intolerance.

      And, despite working out at the gym, I notice I’m still losing instead of gaining muscle mass. So, I may go back to healthy carbs to gain the weight back, and then try a low carb diet for maintenance, and see what happens.

  66. I’ve been trying the Grain Brain diet for the past several months, because my father had Alzheimer’s. I want to reduce my chances of getting it, so I’ve cut out carbs and grains. since then, I’ve been feeling weak all the time. Also my normal weight is 107, now I’m down to 105. I can’t afford to loose five pounds having a petite frame at 5’2″. So, I’m stuck on what to do now. (I’ll ask my primary care doctor.) Any thoughts?

    • Many people suffer something called the “Atkins Flu” when they go low carb. They feel weakness as you describe. This happens when your body switches from sugar burning to fat burning for energy. It doesnt last long.
      If you feel really terrible and need to work add back in something like sweet potatoes which have starch and carbs but tend not to spike you insulin too high.

      • That’s not the Atkins flu. It’s glucose deficiency and signals the start of hormonal dysregulation. More collateral damage to follow later depending on whether you decide to keep going. You’ve been brainwashed by low-carb fiends, including the very opportunistic David Perlmutter, who think fat is the “preferred fuel” for the brain. In most people, even among those who claim to be fat-adapted, you see symptoms of glucose deficiency. Dry eyes, eyeballs, mouth, esophagus, digestive tract, colon, dry skin, and high fasting blood sugar. Poke them in the solar plexus and ask them whether they have such symptoms. Most will admit, when confronted. Many, however, lie because they’ll gladly compromise their own health for weight loss and blood sugar control.

        • I have been low carb for the last 2 or 3 years and have exactly none of those symptoms you are describing, my fasting blood sugar is as low as it’s every been and I feel better than I ever have. You are a joke.

    • Keep your carbs above ketosis and VLCing levels, which in someone like you should be above 70 grams of total carbs if your protein intake is about 20-30%. But keep it above 100 grams as you need some starchy carbs in the form of tubers and rice for your gut bugs, immune and hormonal homeostasis. That feeling of weakness is probably tied to carb deficiency and hormonal dysregulation. You’re not eating or converting enough glucose for the brain and the brain can only do so much to withdraw gluclose from your mucous membranes. Check the dryness of your mouth, gums, esophagus, eyes, and colon.

  67. I’m just wondering whatever happened to good ol’ common sense.

    Why are so many people making such a simple thing so complicated.

    Don’t fix something that isn’t broke: cutting back on calories…and being more active.

    It’s overall calories that need to be reduced, not just carbs.

    As mentioned before, I lost around thirty pounds in around four months. I didn’t cut out wheat, potatoes, beans and oats.

    In fact, those foods helped me lose weight because it wasn’t one of those boring, torturous diets.

    Yes, for many people, carbs can help one lose weight.

    I cut back on the portions.

    I had one person ask me if I was on a low-carb diet.


    “No,” I said. “I was on a low-CALORIE diet.”

    Again, don’t fix something that isn’t broke.

    And stop listening to stupid crap that is spread out there.

  68. Now new research is indicating low carb diet causes decreased coronary blood flow, which explains reduced lifespan of low carb dieters. Scary stuff, you low carbers be safe.

  69. I agree that carb restriction can be helpful for obesity and in the short term for a therapeutic effect. But to categorize an entire macro nutrient group as bad is something I cannot get on board with.

    For those of you dismissing people who have experienced low energy and other symptoms of thyroid issues while on low carb, you might find this eye opening. Scroll down to the very end labeled “Telltale signs you need more carbs”.

    I’d also like to know where those of you who claim that babies are in ketosis while breastfed until solids are introduced got your information. I just don’t see how that is possible given the high composition of carbohydrate in breast milk. I have yet to find a reliable source that agrees with this position. Please share.

  70. I have to agree with Dr. Perlmutter’s position on carbs & gluten sensitivity. Why? Based on my own experience of cutting out “bad carbs” & going gluten free for over 12 months now. The result? My C-Reactive Protein level went from 47.02 (yes, it was that high) to 0.54 in 12 months. Hard to argue that inflammation in the arteries & probably the rest of my body wasn’t helped by following Dr. Perlmutter’s eating recommendations.

    45 pounds lighter, healthier test results; I’d say thank you Dr. Perlmutter. He is onto something.

    • That’s not surprise, you were probably grossly overweight, had aretrial inflammation that jacked up your CRP, was probably prediabetic if not diabetic, and had fatty liver. Whatyou did is caloric restriction via carb restriction and gluten avoidance, as proteins and fat induce satiey and gluten containing foods tend to be hyperglycemic. But the end result is caloric restriction, which you achieved via carb and gluten-restriction. Sensible plans such as that which is not hypocaloric and not ketogenic nor VLCing, there is no problem. It’s when Perlmutter starts making preposterous claims about fat being the preferred fuel for the brain, how ancestral diet was 70%+ fat and starts linking carbs and gluten to everything from dementia to Lou Gherig’s disease that he loses credibility. But you lost your weight and rid yourself of inflammation through caloric restriction; carb and gluten avoidance was a means to an end.

  71. Fantastic article in the Atlantic today!

    Researchers asked if one diet could be crowned best in terms of health outcomes. If diet is a set of rigid principles, the answer is a decisive no. In terms of broader guidelines, it’s a decisive yes.

    Looks like more ammo against low carb and no grain to be honest. It is scientifically sound that removing entire food groups from diet or restricting certain foods is detrimental.

    Overall this champions common sense and shows the real culprit is “fake food”.

    • Katz’s guidance might be helpful for the average person. Some of us, however, are not average and do need special diets, which, for example, rule out grains. I would not rule out any particular food for everybody, but I know what works for me and what does not.

      • About gluten — I can see that gluten can be a problem for lots of people. (I have not been diagnosed with gluten sensitiity, but i have never had a test.) What I have been wondering is, do you have to cut it out completely to feel the benefits, or is just a little gluten OK? So if I basically cut out gluten at home, will the occasional sandwich outside nullify my efforts?

        Thanks, Elisabeth

  72. “And now I’m going to say goodbye to this thread because it’s long enough”

    OK, then, see you later on today or tomorrow.

    In the meantime, find a good therapist for your conspiracy theories and delusions.

    For all of you who have health issues with gluten, here’s a great blog page that tells even more about “Wheat Belly.”

    The authors are also hardcore researchers, in addition to writers and authors of several books on a non-gluten lifestyle.

    It’s not an attack on Davis’ “Wheat Belly,” but they also feel that a good diet should, and can include wheat for a lot of people, if done right.

    In addition to Dr. Julie Jones’ piece that shows how all these people lie and misinform, I think you may find this interesting also.

  73. > In other news, water is wet.

    Yes, you dive in water, it’s not coincidence that you get wet. . And if you’re on the advisory board of a marketing organization for the wheat and bread industry, it is probably not coincidence that you think Wonder Bread is just about the perfect human food.

    It is partly because of “science” like what you’ve cited that we are headed for 100 million obese Americans, a diabetes epidemic like the world has never seen, and an explosion of blood sugar-associated cancers and Alzheimers.

    Perlmutter doesn’t necessarily have the answers, but he is at least one eminent doctor who is sincerely asking the right questions instead of just cashing checks from corporate sponsors and drug companies.

    Fortunately we are in the midst of a scientific awakening on this issue. As we pass 40 percent and head for 50 percent of our adult population headed for obesity and early death, there are definitely more doctors and scientists starting to wonder — there’s got to be something wrong here that we didn’t understand. Maybe it’s not just fat people’s fault for not all running 10 miles a day and living in a constant state of hunger for their entire lives Maybe they might just be eating the WRONG FOOD.

    The American food industry cannot be expected to look out for our health. They serve their stockholders — so their job is to box up the most inexpensive raw materials they can find (corn, wheat and soybeans) into products that sell in the greatest volume possible. Their interest in science is what formulations taste best and sell the most; and what shreds of scientific research can be spun into advertising slogans like “healthy whole grains.” I wouldn’t expect anything else.

    And now I’m going to say goodbye to this thread because it’s long enough and I doubt anybody but Perry is actually reading.

  74. Gee, ya think, Tom?

    In other news, water is wet.
    Now do a little more digging and you will see that she has been doing studies on all kinds of foods long before.

    She knew long before that wheat, and carbs in general is not the problem. It’s mainly overeating and not exercising.

    And let’s go ahead and discount all her commonsense comments on whole wheat bread. Like, it having around 1 1/2 tsp of sugar, instead of 6, 10…teaspoons.

    Brilliant, Tom. Brilliant.

    You’re just too smart for me.

  75. “But I do think you need to be aware of where Perry’s info is coming from.”

    *Jumps up and down with hand in the air*

    Oh, oh, oh! Let me tell them! Let me tell them!

    The article is written by St. Catherine University Professor and consultant Dr. Julie Jones.

    Her article was published in a whole array of websites, with many being scientific literature sites.

    Many scientists have questioned Dr. Davis’ use of the science that he backs up his claims with.

  76. I decided to see who was behind Perry’s “why eat bread” link.

    According to whois, the domain was registed in December 2013 by Lewis Bakeries. Lewis is a large industrial bakery based in Evansville, Indiana.

    Lewis’s signature product is “Bunny Bread” — a white sandwich bread similar to Wonder Bread:

    (As a foodie I have nothing against Lewis or the joys of white sandwich bread. Little quarter sandwiches of Spam salad! Pigs in blankets! Yum!)

    But I do think you need to be aware of where Perry’s info is coming from.

    There may be good reason to disagree with Gary Taubes, Perlmutter etc., but they are not, to my knowledge, being sponsored by the food industry or the drug industry.

  77. For those of you who want even more sources on why wheat is not bad for you (if you don’t have any issues with wheat, that is), and why there is so much bullshit out there spread by complete idiots, you may find this pretty interesting

    Julie Jones, along with so many others, also addresses this idea that wheat gives you a higher blood sugar level than a Snickers bar.

    Speaking of bullshit…

    there are a lot of idiots parroting this Snickers bar nonsense without doing their own research.

    Some fools are saying that whole wheat bread has 6 teaspoons of sugar. Some say there are 10!

    Two slices of bread, at 3 ounces, has around 6 grams of sugar.

    (Most bread brands are 2 ounces, so. . . .)

    Folks, um–that’s around 1 1/2 teaspoons of sugar!

    A carrot–A CARROT–has about half that.

    And natural sugar, when in a complex carb, is just fine.

    It’s what our body needs. We wouldn’t be here without carbs.

    Don’t believe the crap that whole wheat is bad–or even addictive.

    It’s spread by dumbasses, like Mark Hyman, William Davis (“Wheat Belly”), Perlmutter, Taubes, posters, and soooooo many people with their own stupid little websites.

    “Everything you see I owe to spaghetti.”
    Sophia Loren

  78. Beaker: The best diet possible imo is to feed the good gut bugs and starve the bad ones.


    I think this is a really promising idea, but 1) we don’t know if it’s true; 2) if it’s true, we don’t really know what are good bugs and bad bugs 3) Sorting out #2 is an enormous task that might take decades, because there are hundreds, probably thousands of bug types, and “good” or “bad” might depend on the context.

    It’s so complicated. Everybody who has experimented with low-carb/paleo knows the tremendous changes your gut goes through when you restrict the supply of sugar and starch. To me it feels better to lose the 4-6 pounds of fluid, the “wheat belly/beer belly.” Inflammation goes down, and inflammation is probably bad, but who knows.

    Being keto-adapted FEELS healthier but is it? It will take a long time to know for sure. Are some carbs necessary to maintain a healthy flora? That’s one of the big ideas of the Perfect Health Diet and I wouldn’t dismiss it. But there is certainly very little data at this point.

    As for Perry, he’s a classic troll and responding only encourages him. He doesn’t back up anything he says, doesn’t add any information. He is highly persuaded of the superiority of his own opinions and the inferiority of everybody else’s — but that is not someone I would want to have a conversation with.

  79. Perry,

    You are obviously very passionate about your beliefs so DUDE chill on the cursing. This is a great blog with really passionate people wanting to just be healthier. I really enjoyed reading your post. You had very compelling thoughts that to many will just not read and bypass when your using profanity. All that time you spent on your very well thought out points will be wasted when use profanity and blast others the way you do. What’s amazing is that “to each is own ” is still super important. I can’t do wheat, donuts, fast food anymore or I add serious pounds and loose energy. For myself and family Gluten Free and an organic and holistic lifestyle works for us and keeps us trim, fit and super vibrant. My medical tests of the last couple years has been incredible since switching to gluten free. We don’t preach to others unless they ask or we see an opening. We have seen so much research and heard people try to prove that organic vs. no organic and gluten vs non gluten and we just don’t care. We know it works for us. So my point is chill on the cursing as others who really could learn from you won’t give you the chance. If I have offended you my apologies….

  80. Marc, you’re just showing yet another bullshit person talking about this.

    Yeah, and?

    Her, Perlmutter, Taubes…they are all the same.

    Just like all the others, she starts out by talking about other races of people eating fat and meat.

    Yeah, so what?

    ‘And because she doesn’t know about how the Inuits get their carbs through meat is enough to tell me she doesn’t know as much as she leads on.

    The Inuit Paradox

    And of course fats, and meats, play a very important role in our diet, duh, but these races also got their carbs through other means.

    They also did not have Cheetos all the time or overeat either.

    They were also a hell of a lot more active.

    Damn, some people drive around and around to find a parking space close to the entrance.

    Also, these races were not as healthy as these “experts” claim, either. Look up their health history.

    They aren’t like many unhealthy Americans, but they aren’t super healthy either.

    These quacks and idiots just parrot one another, saying the same thing. “Oh look how healthy they are.”

    None of them do any real research.

    I suspect Gedgaudes is one of the parrots.

    I know many people, myself included, who are just as healthy, if not healthier.

    And ya know what? We eat plenty of carbs. We also eat junk food. We just don’t over do it and we are more active.

    This is common sense—that sooooo many freakin’ people don’t have.

    I’m not saying that these races NEED carbs, I’m saying they are getting more carbs than you think.

    I really hate that shit!

    What’s really ridiculous is when this woman compares us to mammals, like the gorilla.

    Uhhh, the human body is not like theirs.

    Eat a bunch of leaves and stalks, and see what happens.


    She talks about how our body is designed for a fat diet.

    Duh. Of course it is. But so what? We are talking about carbs here, and with the exception of certain individuals, they are not bad for us.

    Stress, pollution, sadness, eating bad foods all the time, not being active enough is!

    Also, having to deal with stupid people on a daily basis.

    When she said that “the brain runs better on fat” tells me right there she is isn’t very bright.

    Yes, of course the brain converts fat to glucose for energy, but it cannot convert enough and fast enough for those times when we put the brain through its paces.

    It’s impossible for the body to do it.

    It’s biology 101.

    It’s the same with muscles.

    Show me one marathoner or triathlete who can perform on fats just as well as the one on carbs.

    Just one.

    You can’t, and neither can these blowhards.

    If they could, they would have.

    Fats are for hiking.
    Carbs are for running.

    The fat cannot convert fast and well enough for that much much energy.

    Again, just like the brain.

    You are listening to a bunch of fools who don’t do enough research, and they are not including those of us who work our body harder.

    It’s basic biology 101 that a med student in neurology knows.


    Yes, fats are vital for babies, but we are talking about the development stages.

    There’s a BIG difference between that and keeping an already-developed brain functioning properly when we overwork it.

    You see, they take stuff like this, twist it around, and leave out little bits of info to make their case.

    They also think that just because a baby needs fat for the brain means he needs it for primary energy throughout his life.


    There was a study done on epileptic children, and it showed that it slowed down seizures, but what were they eating and drinking, and how much, before the study???

    Besides, those on such a diet also do more than just eat less carbs. They stopped eating junk food. They are now more active. They are eating more nutrients in general. They stopped smoking. . . .

    In other words: They are taking better care of themselves
    across the board–period!

    The medical est. already knows that diseases and overall health can dramatically go down when these are included.

    But, hey, let’s give this ketogenic diet the credit, right?

    Of course fats help with things like, say, nerve health and slowing down tumor growth, but we simply do not know for a fact that it helps with diseases, along with epilepsy to a point where it makes a difference.

    You also have to keep in mind that many of these case studies are done on individuals who eat 300 plus carbs, on a daily basis, with many of the carbs being simple.

    Some people cannot handle that, though many can.

    Hell, there are some whose brain goes haywire from eating carbs, There is a very small class of people who are like this.

    Just like there is a very small class of people who can’t drink milk.

    I suspect that many of these case studies included these people who have such rare low tolerance levels.

    I agree that fats are healthier for the brain than carbs, I have never said otherwise–what I am saying is that carbs are also not bad for our health. And they certainly are not killing our brain!

    For nearly everyone, that is.

    If that were not the case, you’d see people walking around like the Walking Dead,” and dropping like flies.

    Most of the world eats plenty of carbs…and that includes some of the world’s smartest/healthiest/fittest/fastest humans.

    Gee…hmmm…how is that possible???

    *scratches head*

    Those who are anti-carbs couldn’t compare to those who eat 100 on up to 200 carbs, especially in races and other such sports.

    Common sense!

    A ketogenic diet is not bad, of course, but it’s simply not needed in nearly all cases either.

    It’s overkill by a bunch of drama queens.

    I’m 50-years old. I have a calorie intake of around 2,500. Most days around 1,116 are from carbs, which come from two cups of oatmeal, a couple of slices of whole wheat bread, peas, corn, a couple of cups of beans, and a potato.

    I can outperform guys twenty years younger, both mentally and physically.

    That includes eating candy bars and doughnuts and going to McDonalds every now and then!


    She said that the body cannot digest roots for its carbs.

    Wow, she said that?!

    They are hard to digest–LIKE MANY VEGETABLES–but the body gets enough carbs, and nutrients from it.

    I didn’t watch the whole video. That woman was giving me a fucking headache.

  81. Perry, have you ever heard of ketones? Seems to me your confidence belies a basic lack of background reading. I am not going to engage with you because you respond with insulting remarks But I think if you read up on ketones that might help you realize there is a world of good information out there that will be new to you. Don’t presume that what you were taught in 1972 or 1980 is still true.

  82. I think the mystery is nearing an end. It’s now been found that “grain brain” is not what is going on here. The real issue is more likely “Melatonin Brain”. It is exposure to blue wavelength light during night hours that is causing the rise in brain disease. This light (screens, phones, LED, TV, tablets, etc) halts melatonin production, thus leading to the exact symptoms claimed by “grain brain”. It’s now even been found that shift workers are getting brain damage. The balance of circadian rhythms and melatonin production is far more plausible a culprit that “grain” imo. This will become far more apparent in the near future.

  83. Many people, who are anti-carbs, don’t do enough research. If they did, and they were big enough to admit they were wrong, they’d see that the brain does indeed need carbs to function properly.

    Yes, fats play a role, but only a minor one.

    Our brain is a constantly-running “mechanism” that needs a continuous and fast-acting energy supply.

    Fats on their own cannot do this.

    The harder one works the brain, the more fast-acting energy it needs.

    This is basic biology 101

    The reason I mentioned students is because, of course, they put extra work on the brain. The fat cannot keep up.

    I will agree that fats are our primary fuel for everyday normal physical activities.

    Every now and then, some meat-eater, who thinks he or she knows it all, will try to run for over two hours on a mostly fat diet.

    The body cannot turn fat into energy that fast. That is what carb stores are for.

    They are left far behind by the ones who fill up on carbs.

    Look it up.

    They “hit the wall” a hell of a lot faster.

    Give me the name of one athlete, just one, who is at the top of their game on a fat diet.

    Save the fat diets for hiking, and, long-distance biking. As long as the peddling is kept at a certain speed, that is.

    I don’t know what you were thinking when you wrote out that post, Marc.

  84. “1) Old beliefs (carbohydrates are essential fuel for brain function/exercise; saturated fat causes heart disease etc. ) are super hard to kill off — it’s gonna take decades.”

    Oh boy.

    Uhhhh, the brain’s primary source of energy are from carbs.

    Ask any marathoner or endurance athlete who uses their body for fast sports and to overwork the muscles. Ask any student who uses their brain into overtime.

    Back in the olden’ times, they used carbs for instant energy to run away from danger. That is what carbs are for when we first started on this planet.

    Fats are mainly for keeping us going to the very last second of breath when there isn’t any food around.


    “2) Especially when it come to diet, people get so emotional. Fruit, for example, is a treat that has been successfully dressed up as healthy. You get to have your sugary banana and grapes and yogurt with corn syrup jelly at the bottom”

    Show me where I said “corn syrup.”

    Many people get emotional mainly because there is so much misinformation and stupidity out there.

    Like this thread, for example.

    “Your oatmeal, your corn chips are labeled “rich in fiber/heart healthy” so you think that means good for you.”

    Wow…you actually said that about whole oatmeal.

    That’s just too stupid to give any more of my time to.

    I couldn’t make heads or tails from the rest of your rambling.


    • The brain can certainly run on sugar ( carbs). If you feed it a carb rich diet it can and will run on that fuel. But it’s a question of which came first, the chicken or the egg.

      The Brain can run on suger if that is what you feed to your body to use for fuel. The same with athleitic performance. But it certainly doesnt have to or need to use sugar for it’s primary fuel.Human infants who breast feed are all keto adapted. The child’s metabolish does not change until we purposefully feed it sugar and carbs and drop the fat intake.

      Keto adapted athletes may well outperform a sugar adapted athlete. Dr. Phinney and Voleck have just published a new book about keto adapted athletic performance:

      “The Art and Science of Low Carbohydrate Performance”.

  85. Perry’s comments (like Brittdoc’s above) are worth saving as examples of a couple of things:

    1) Old beliefs (carbohydrates are essential fuel for brain function/exercise; saturated fat causes heart disease etc. ) are super hard to kill off — it’s gonna take decades. The new research is breaking down a paradigm that we’ve lived with for 50 years, so the resistance/cognitive dissonance is extremely high among lay people and health professionals. Which is why books like Perlmutter’s (and Gary Taubes “Why We Get Fat” are so important because they put the paradigm breakage into plain language so lay people can participate.

    2) Especially when it come to diet, people get so emotional. Fruit, for example, is a treat that has been successfully dressed up as healthy. You get to have your sugary banana and grapes and yogurt with corn syrup jelly at the bottom, and you eat them happily in the belief that they’re good for you. Your oatmeal, your corn chips are labeled “rich in fiber/heart healthy” so you think that means good for you. So when someone comes along and suggests fruit juice is not much different than soda, that much of supermarket fruit isn’t much better than candy, that “whole grain” is in fact not heart-healthy — that really sets people off.

    Really, diet should be a taboo subject for polite company — right up there with politics and religion — because people take it so personally.

    3) People defending the dominant paradigm have a tendency to go ad hominem — nut job, quack etc. The ad hominem attack provides a powerful chilling effect for scientists who might otherwise be tempted to question the dominant paradigm. In fact this is why in the history of science, paradigm shifts have usually come from rebels outside the established academy whose careers don’t depend on the approval of their scientific peers.

    It’s why that with THIS paradigm shift, lay people like the people taking part in this discussion have an important role to play, because there are a lot of powerful medical professionals and food companies and drug companies who have a lot invested in the old paradigm and will have to be dragged to the new one kicking and screaming.

  86. Hey Chris. I also posted another comment just before the one you put up.

    I’m just wondering if you got it.

    Maybe you think it was too harsh.

    Heh, maybe.

    I couldn’t find an e-mail link to send you this, so . . .

  87. Oh, and even the Inuit got plenty of carbs.

    Ever heard of the “Inuit Paradox”?

    It’s estimated that they get over 100 carbs.

    Other cultures, that are supposedly just meat eaters, also get plenty of carbs. They eat roots, along with growing certain vegetables.

    Tribes in Africa often trade with other tribes for vegetables.

    (Man cannot live by bread alone.

    Man cannot live by meat alone.)

    It’s not reported as such because of the low-carb nut jobs out there.

    Now if you’ll excuse me, I’m off to have a big bowl of alfredo and garlic pasta and garlic bread, which brings my total carb intake to around 200.

    I’m going to have a Snickers bar for dessert.

    Maybe even two.

    Gee, I hope I don’t die in my sleep.

  88. In most if not nearly all cases, carbs aren’t the problem–stupid people are.

    And, personally, I think Perlmutter and Gary Taubes are a little bit of a quack.

    They have ZERO common sense.

    Hello Chris.

    I want to thank you for that great article.

    As a health writer and researcher for the health industry, I know exactly where you are coming from.

    Also, kudos for having the patience for putting up with a lot of the dumb posts here.

    There are some real whoopers here.

    “Carbohydrates are not essential.”

    Tell that to runners, weightlifters, and especially college students who put their brain through the paces.

    The more the brain is used, the more carbs are needed. There are times when the body cannot convert enough and fast enough.

    “But think of each blood sugar spike as similar to, say, a single puff of cigarette smoke. The danger is lifetime cumulative exposure. The more exposure to high blood sugar over a lifetime, the higher your risk for so many health problems.”

    Wow. Really?

    Um, the human body is a pretty remarkable piece of engineering. It can handle simple carbs now and then. It can handle a Big Mac and greasy fries now and then (hell, it can handle it every day). It can handle a candy bar now and then.

    And ya know what–it can even handle a single puff of cigarette smoke.

    “…fruit can spike as much as ‘healthy whole grain’ bread.”

    Um, whole gran bread does not spike to unhealthy levels. It is released slowly, like oats.

    And, raising insulin level is not a bad thing. It is a normal bodily function.

    Wow. *shakes head in disbelief*

    Then there are soooooo many people making claims of feeling so much better. They can now sleep better. Their inflammation has gone down. They take fewer meds. . . .

    Yeah, what is probably really going on is that they are taking better care of their health overall. They are eating better in general. They are exercising. They stopped eating so much of the simple carbs (junk food). . . .

    But, of course, there are those rare exceptions. There are a slim few who can’t handle carbs.

    For practically everyone, complex carbs don’t put on the weight and create health issues. Not being active enough and eating too much is what does it.


    There are, who knows how many millions of people out there who eat up to and over half of their calories from carbs, and they are doing juuuuuuuust fine.

    Just because a very small percentage can’t handle carbs, for whatever, reason doesn’t make them bad.

    As for insulin spiking…uh, again, that’s a normal bodily function.

    Leave it to some doctors, and a lot of foolish people in general who equates “spike” and “sugar” as bad.

    Bad carbs are–bad.

    Such drama queens.

    I lost thirty pounds in about four months, and I usually had two cups of oatmeal, two cups of beans or pasta, and some bread and meat at night.

    Piece of cake. I just watched my calorie intake and outake, and became more active.

    Wow, rocket science.

    Oatmeal is loaded with nutrients and fiber.

    Steel cut is great!

    A big ol’ bowl, along with a cup of milk can keep you full for up to four hours–if not longer.

    The same as eggs and a couple of pieces of meat.

    AND, the oats have fewer calories, along with being three times cheaper!

    I also saw a few doozie comments about bananas.

    Oh, those bad bananas, huh? *rolls eyes*

    Bananas contain the amino acids tryptophan which help your body to produce Serotine and vitamin B6 which helps to regulate your mood.

    Carbs, in genearal does that.

    Bananas also contain Dopamine, which also regulates moods and the ability to concentrate, and emotional ability.

    Banana, along with beans, oatmeal, AND meat are great when dieting.

    For those of you who are confused–just use your common sense.

    Eat right (eating the wrong foods is OK if you don’t over do it), be more active–and have a happier outlook on life (being depressed, sad and angry is just as bad as simple carbs for many people).

    • Perry wrote:
      There are some real whoopers here.

      “Carbohydrates are not essential.”

      I was referring to the definition of what an “Essential Nutrient” is. It’s does not indicate if you like to use the nutrient for whatever purpose you may have in mind ( athletic performance for example).

      An essential nutrient provides your body with something it needs but can not make on it’s own. You MUST consume it to get it.

      Carbohydrates are not essential. The amount of sugar your body must have to function properly can be made by the liver in sufficient quantities. Therefore, you don’t have to eat a single carb to have optimal health, you will be missing nothing “essential”.
      That doesn’t mean you cant choose to consume carbs for whatever benefit you want to assign to them.
      I hope that helped.

      • You say the carbs are not essential, but what about the nutrients we normally get by eating them? Don’t b-complex come primarily from complex carbs? I am sure there are alot of vitamins/minerals and nutrients you are losing when you cut out “all carbs ” as bad.
        I really think the culprit here is the toxins and GMO’s that are in the carbs. Its more of an environmental issue. Look at all the other cultures that don’t have this toxin load and still eat mostly carbs and are healthy and lean.

        • There is research to suggest diet alters gut flora BIG time, and those on a HFLC style diet experience significant changes here. Let’s just say most of the beneficial flora documented in healthy long living humans wastes away when these fad/restrictive diets are embraced. The best diet possible imo is to feed the good gut bugs and starve the bad ones. Certain restrictive diets do the opposite. It may takes years before it hits you but look out for IBS, IBD as your bowels become inflamed. I even suspect a state of ketosis will ultimately lead to IBD and various gut disorders. These people think they are very clever getting “energy” from fat, all the while their gut biomes are turning into a toxic wasteland.

  89. I have been studying the widely varied and contradicting subject of diets, foods, gluten etc etc these past few years. All I can say if that every health problem large and small was resolved when I did a session with a kinesiologist which tested what foods were good or bad for ME. Not everyone else but what worked for my body. I stuck to the food exactly and lost weight so fast, 5kg in one week, cured a bacterial infection, stomach issues, skin problems and a host of other problems. I gained energy, clarity and peace of mind.

  90. In current times, everyone feels they not only can, but should hold forth on just what it is that they believe with all the gusto, if not necessarily the panache, that they can! That is the direct opposite of our ancestors who just a few decades ago would have left the prognostications to “experts.” What has changed? Communication via all kinds of media, that’s what! And, that is exciting, elucidating, enlightening, and confusing as all get out! If your post- education was not a major in nutrition, chemistry, technology, or physics, chances are you are making decisions based on what you’ve read online, in magazines, or books by self-made experts; in addition your information may have been from friends and acquaintances, but rarely, from your family doctor. Now, experts can be, and have been proven wrong many times, but more importantly, who are the experts we should listen to? Is Dr. Perlmutter an expert with all kinds of valid research? That is question number one.

    Two: Has any of the anecdotal evidence we’ve read in the responses to Chris been analyzed or validated by medical or scientific research? Come on folks, you’ve got to know how many variables there are when it comes to the human body! One cure does not a body of evidence make!

    Three: If you believe something with all of your heart, does that mean you should ram it down everyone else’s throat?

    Finally: There are still no definite answers that suit everyone’s actual health profile, but common sense dictates that one size does not fit all! What works for you may not work for your wife, friend, her boyfriend, or your son or daughter. We have to learn this lesson: everyone is different ; what works for you nutritionally is not necessarily someone else’s “fountain of youth” in the words of another so-called expert of yore who thought if he drank from an elusive fountain of water, he would find eternal youth.

    As strange as that seems, we are in essence still stuck on that same old search. There is still no one answer, but we all realize that a healthy diet is part of it. So, if you can but give this all some time and distance, the future will tell us who had the best answers. In the meantime, could we all just give each other a gift of tolerance? Wait for the proof, question research that seems to good to be true, practice common sense balanced with a love of culture and the gathering for meals that makes our memories and family history so rich. This might in the long run be the best answer of all!

  91. “Britt Doc and Mr. Haines: I’m about 2/3 through Perlmutter’s book and I really appreciate his references to current research. I notice you don’t include any links to back up your assertions so for me right now it’s Perlmutter one / you guys zero.”

    Actually it’s looking like Perlmutter’s research is already out dated. The latest (within weeks) is showing ALS patients fared best on high calorie/high carb diets. A strong neuro protective effect. The researchers even optimistic high calorie/high carb could benefit additional brain disorders. If Perlmutter was so right this would not have even come close to what was discovered. If Perlmutter was right those ALS patients would have deteriorated big time, when they actually improved. Here’s hoping Perlmutter is not treating ALS patients. And another recent study showed in an animal model, those animals on a high carb diet bested all others in longevity by a high margin. This is enough evidence for me to warrant not removing entire food groups from diet. I believe a predominantly plant based mediterranean diet, coupled with very low to non-existent added sugar is the way to go. Plus adequate water, exercise, sleep and stress reduction 🙂

  92. The title of the blogpost is: Do carbs kill your brain?

    After reading almost all posts here, my conclusion would be: No, carbs don’t kill your brain, as long as you don’t take the kind and the amount of carbs YOUR system cannot handle.

    What kind and what amount of carbs can your system truly handle, especially long term? (The same goes for fats, proteins and vegetables, I guess).

    It is an individual quest for each one of us, isn’t it?

    Any suggestions on how to go about this?

    • Carmen,

      I have a suggestion. But, to start with, you are right that it depends on the kind and amount (quality and quantity) of carbs your body can handle and it is true with fat, proteins, fruits and vegetable, considering that there is no “One Size Fits All” anything, whether what and how we eat, lifestyle, etc. etc. – bioindividuality.

      “Any suggestions on how to go about this?” Yes the best is to work with a holistic health and wellness coach who will start by meeting you where you are with regards to what and how you eat, the lifestyle you live, your physical, mental and spiritual state, and support and guide you step by step as you make sustainable changes steadily but surely.

      I have been doing this with my clients and have had successful results. The key to such succes depends on the client’s committment to the program.

      • Philomina, you said: “The key to such succes depends on the client’s commitment to the program.”

        I would add: ” it also depends on the openness of mind of the coach. Since most health consultants I know of are heading in one specific direction which is usually their own preferred diet. Like vegan, Ayurveda, Paleo, etc.”
        I would need a coach who’s willing to inquire with me what is right for me, unbiased.

        Any ideas for what I can do myself, without coaches?

        • Trial and Error is the name of the game. If you eat something that makes you feel bad or makes you gain or lose weight that you don’t want to gain or lose, don’t eat it. Pro-biotics and digestive enzymes are also a great help once you’ve eliminated foods that aren’t right for you. Aloha!

          • Trial and error, yes, the obvious. Yet I was hoping for something less time-consuming. A shortcut maybe.

            I am new to all this and just happened to stumble upon this thread. Turns out that the blogger Chris himself, has written a book on this very subject: about customising your (Paleo) diet.

            I’ll have a look at it in “amazon”.

        • “it also depends on the openness of mind of the coach. Since most health consultants I know of are heading in one specific direction which is usually their own preferred diet. Like vegan, Ayurveda, Paleo, etc.”
          Yes I agree with your addition. I was talking about the type of coaches you have alluted to – opened minded coaches who listen very carefully to the clients and work with them as appropriate. A true Certified Holistic Health and Wellness Coach would do just that. I am one and that is exactly what I do. With regards to “Any ideas for what I can do myself, without coaches?” I need to visit with you listen and understand where you are at the moment with regards to Food, Nutrition and Lifestyle, in order to tell you what I think. If you are interested, you can send me a private e-mail and we go from there.

    • In response to Carmen, Perlmutter is most concerned about gluten, sugar and grains. The diet he recommends is not zero carb so implicitly even Perlmutter is suggesting there is a level at which carbs are not going to cause problems.

      The Atkins organization in my opinion is the most scientifically mainstream of all the low-carb variants. And Atkins has, from Robert Atkins 40 years ago, always supported the idea that everybody has a different tolerance for carbohydrates.

      How do you find out if you’re exceeding your body’s tolerance? Easy. Just watch the scale. If you are putting on weight, you’re clearly getting too many carbs, which are raising your blood sugar, provoking an insulin response, and the presence of insulin puts your fat cells into storage mode. (And by the way the insulin hypothesis is well established science and was developed in the early 20th century — before Atkins was even born).

      • Interesting and simple. “Just watch the scale!” 🙂
        I like that!

        Btw: how would I know when I’m getting too little carbs?

        • Technically, there is no such thing as too few carbs in the human diet. Carbohydrate is not an essential nutrient. In other words, whatever carbs can contribute is already being made by our own body. We dont have to have an outside source for something we lack. They are not “essential”

          You can certainly add carbs to give you quick energy or they may be cheap and convenient sources of calories for you but no one has to eat a single carbohydrate in order to achieve the best possible health.

          • I thought that this statement is one of the points that are subject to contradicting opinions and research.

            It is not my intention to start the debate above all over again. I hope it doesn’t, it’s lengthy enough already.

            Just looking for some ideas to customise my diet to my individual needs. Suppose there is an individual case where someone, for whatever reason, does need carbs. Who knows… Then how would you know what is the right amount and right kind of carbs for you?

            • Learn to count carbs rather than calories. Keep them to 100 grams per day at first and then go lower if you want to. Or start low at 20 -30 grams and then slowly go higher. Once you gain weight you know that your body is now storing them as fat. But you do not need to worry about not getting enough carbs as I said before.
              People have differing tolerance for carbs, which means the point at which they gain weight or have negative health effects vary. But that is different from worrying about not getting enough.
              Worry about the other end, and observed when you are getting too many
              ( weight gain) and then cut back.


    Commenting on the findings, Dr. Wills says:

    “Although the sample size was small, we are optimistic about these results, because they are consistent with previous studies in ALS mouse models that showed that hypercaloric diets improve survival.

    Not only could this type of nutritional intervention be a novel way to treat and slow down the progression of ALS, it might also be useful in other neurological diseases.”

    But the researchers say these findings should be “interpreted with caution,” noting that larger studies are needed to determine the association between high-carbohydrate/high-calorie diets and ALS disease progression.

    In an editorial linked to the study, Dr. Ammar Al-Chalabi, of King’s College London in the UK, says that although he will not be changing his diet advice to patients based on these findings, he is keen to see what results come from larger trials.

    concerning the study from your link, one commenter said:

    “Jason Cholewa, Ph.D.
    Take a deeper look at the raw data and some serious concerns are raised.

    The original study this article was based upon had some serious methodological flaws.

    A 24 hour dietary recall was used to classify subjects and then they were followed for 18 years. Is it possible their diets changed over that time?

    Next, the work in humans was correlative and observational. It was not an intervention or controlled study. All we can conclude is there is a relationship.

    Most importantly is the authors statistical analysis of the data and their interpretation. If we look at the raw data we see that the rate of cancer across the low, medium, and high protein groups was actually 9.8, 10.1, and 9.0%, respectively. There is no difference. However, the authors did some funky math to come up with this huge difference.

    In mice, there was no difference in the rate of cancer growth between the vegan protein (soy) and the animal protein (casein); however, the authors claim there was a “non-significant trend” but they do not report the probability value. If we look at the graph, it is barely discernible and does not exceed the standard deviation.

    Why then might the researchers make their conclusions off this lack of evidence? Its quite simple, the senior researcher, V. D. Luongo is the founder and has equity in L-Nutra, a Vegan Based Nutrition System. Luongo designed the study, obtained funding, and played a major role in the writing of the manuscript. This is a serious conflict of interest, and we should hold the publisher of the study, Cellular Metabolism, and their peer reviewers responsible for not identifying these issues. If you want to read more about it you can here at my objective critical analysis.”

    Both of these studies are associative studies, and for a critique, read Tom Boyers’ response, and the comments to the study in your link (the far right tab).

    I don’t have a problem with a diet high in carbs from time to time. Humans are omnivores, and are quite flexible in our dietary needs. What I find fascinating is the howls that go up when it is suggested one go low carb (60g or lower) although the human metabolism is perfectly suited to do so. In fact I went several weeks at 20g (atkins recommend 6 to 8 weeks before increasing your carb intake.) Its hard at first, but it can be done. Similarly, some people have trouble on a high protein diet at first, but over several weeks adapts to the higher protein levels.

    I personally prefer protein and fats over sugar and starch, but i can derive them from non-animal sources, and have done in the past quite well. But being an omnivore, i must be flexible and eat what is available, whats in season, and what I can afford (if I am lucky, what I can hunt/forage). Acorn mush, anyone?

    • Julie, that Linus Pauling Award is not the same one given by the American Chemical Society, which is indeed prestigious. Instead, it’s given by the Institute for Functional Medicine and is largely ceremonial. In 2013, they gave it to Alessandro Fasano, who, I’m sure, cringed, as he does not treat patients and is a researcher. In 2009, they gave it to Mark Hyman, another functional doc who used to be at Canyon Ranch. In 2010, it was Dean Ornish, yes Ornish!, who got the award. The commonality among all these awardees? They “stick it” to the medical establishment. They defy conventional medicine and the standard of care.

      In 2011, they gave their “Lifetime Achievement Award” to Jeffrey Bland, the functional medicine guru for “exceptional creativity in … advancing principles of … functional medicine.” This is the same Jeffrey Bland that appears frequently in QuackWatch and is considered the godfather of functional medicine. Bland was charged in 1991 by the FTC for claiming that his diet causes weight loss by changing metabolism and induces fat loss through body heat, kind of like Cold Thermogenesis. He was charged again in 1995 for making false weight loss claims and had to make a settlement. On average, he gets cited either by the FTC or the FDA every 3 years.

      And get this: Bland is the founder of the IFM and he gave himself the “Lifetime Achievement Award!” — like the Grammy’s Lifetime Achievement Award given out by the Recording Academy.

      But most importantly, the award is in memory of not Linus Pauling the chemist who won two Nobel Prize awards (1 in chemistry and 1 in peace). Rather, it’s named after Linus Pauling the chemist-turned-health guru who, in his 70s, became obsessed with Vitamin C and started pitching it as a cure-all for cancer and heart disease. He was uniformly criticized and his papers were thoroughly discredited. His obsession probably had something to do with his dementia and perhaps Perlmutter could have been helpful on this score. Pauling thought the Holy Grail was megadose Vitamin C; Perlmutter thinks its gluten/carb avoidance. Do you see the commonality? A simple, one-size-fits all solution to complex problems.

      The Pauling Award is given to mavericks who happen to be pioneers, like Fassano, but also to the outcasts, eccentrics, oddballs, and crackpots of alternative and integrative medicine, who dot the landscape. They came up with the award to seek publicity and to promote a fraternity of like-minded practitioners who eschew standard medical procedures. You should give it as much credence as an award given by the Bigfoot Field Researchers Organization.

  94. It’s important to remember that even though we see “M.D” after his name, doctors have VERY LITTLE, if any nutritional education in medical school. For that, you’d want a nurse and a nutritionist, not a doctor.

  95. OK, one more post on nutritional epidemiology, because doing my taxes gave me a good example.

    1) Socioeconomic status correlates very strongly with health outcomes and longevity.

    2) Therefore, if you do the 1040 EZ tax form, you are more likely to be overweight, have diabetes, have heart problems, have cancer and live a significantly shorter life.

    So let’s say I get the data for 100,000 Americans and find a significant correlation. (and let me note, when your N > 10,000, it is hard NOT to find significant correlation — that is the nature of statistics).

    3) So now I’ve got my data, and I publish this in a journal and send out a press release. 1040EZ is bad for your health! 1040EZ makes you fat and takes 5 years off your life! If you want to avoid diabetes and live longer, USE THE LONG FORM!

    It sounds ridiculous, right? So why do we accept that very same logic when it comes to “eating hot dogs kills you” or “people who eat tofu/kale/spinach/avocados live longer” or “kids who are breast-fed turn out smarter” or “people who eat organic rutabagas have better sex lives.” All these studies are pretty much doing the same thing — drawing causal conclusions from NON-DIRECTIONAL ASSOCIATIONS.

    This kind of study is mostly worthless and people need to be aware of it speak up about it.

  96. Thank goodness the New York Times did not pick up this crappy overhyped “protein kills” study.

    But there is a great story in the Times today on breast feeding that everybody here should read.

    As it turns out, all the “breast feeding is good for babies” research is based on the same worthless nutritional epidemiology type studies that like “people who eat hot dogs die earlier” or “people who eat kale are smarter.”

    Some very good researcher found an effective way to control for socioeconomic effects — they identified sibling pairs where one kid was breast-fed and one kid was bottle fed. Surprise, surprise, raised by the same parents in the same household, as it turns out the outcomes for the two kids are the same.

    Breastfeeding (like eating kale or tofu) is nothing more than a market of higher socioeconomic status. It is not a panacea nor does it make kids more intelligent. It’s just that moms who breastfeed are health conscious and well educated so their kids get all the advantages of that.


    • Dear Tom Boyer,
      Although some interesting items did come out of that study, be aware that it also had some serious flaws. For example, one of the health outcomes they measured was Body Mass Index (BMI) years after weaning. In other words, the researchers found little difference in the BMI between the different siblings later on in life. I would ask: how is that striking news? The siblings would have been eaten relatively similar diets and potentially experienced similar weight gain. The study did not examine features such as gastrointestinal tract health (i.e., probiotic flora) and immune system strength (given the absence of colostrum in the bottle fed group). If you pay close attention to the comments made by the researchers, they appeared to have an agenda of making it more socially acceptable to bottle feed (they noted a strong pressure toward breastfeeding, and wanted to show this pressure was not warranted given the absence of clear benefits). Because of the particular health indices they chose, I’m not that surprised they did not find significant differences. I believe this paper, despite its drawbacks, is going to be used in a way that is not beneficial to newborns. Best wishes to you. (I realize this post is somewhat off topic, apologies to everyone but I wanted to politely respond to Tom.)

      • Arthur, the study isn’t saying that breast feeding isn’t of value.

        What it’s saying is that we shouldn’t believe PREVIOUS studies that made outlandish claims in favor of breast based on non-causal correlations — i.e. the notorious “nutritional epidemiology.” It’s saying when you have a really good control variable (in this case, siblings who grew up in the same household) the correlation between breast feeding and health outcomes mostly disappears – poof!

        Really, it’s obvious that breast feeding is a good thing. Assuming the mother is healthy and not drinking or taking drugs, breast feeding is the lowest-cost way of giving a baby a food that is designed exactly for them. You hardly need a study to prove that.

        Where things go off the rails is when pro-breast-feeding researchers use non-causal associative data to argue that if you don’t breast feed, your kids will grow up unhealthy or with low IQ or bad breath or whatever.

        The issue is of interest to me because I have three bottle-fed kids (because breast feeding was not possible for us), and all three turned out normal, healthy and bright.

        My point in bringing the breast-feeding study into this thread was that it debunks the KIND OF RESEARCH that does such a disservice by drawing causal conclusions from non-causal data associations. I.e. the “protein kills” study that Beaker brought to our attention earlier.

        When you see studies like that, you should know by now to say, well, that’s nice, and then forget about them because another study next year will come to the opposite conclusion.

        When you have survey data large sample size and hundreds of variables, you basically have a cornucopia of non-causal correlations staring you in the face.

        Which correlations you choose to publish and turn into headlines probably say more about your biases as a researcher than they do about what people should and shouldn’t eat.

        • Dear Tom,

          I agree with a great deal of what you have written. Nutritional studies, without some type of grounding, are not as useful as many would claim. There needs to be a lens of some kind to view the studies through, a way of truthing the claims made by the researchers (such as comparisons against healthy populations that live free of chronic disease). It is clear that all of the contradictory information from dietary studies point to their near uselessness.

          When it comes to breast milk, it is also clear we can point to a wide variety of factors that are not present in formula, especially when we look at the realm of the immune system. Bottle-fed babies acquire a completely different flora (just like those born to C-sections). If the researchers had chosen different indicators of health outcomes, they may have had different results. You note one benefit, that it is a low-cost way of feeding a child. Politely, I do not agree. If the mother is serious about nutrition, acquiring (for example) pastured animal products (rather than CAFO animals) is more costly. As is organically raised produce, etc. (for most people, because they do not wild collect or grow their own). And there are some differences in breast milk depending on the diet of the mothers (especially in regards to some fats, such as AA and DHA).

          Please don’t take what I’m about to write the wrong way. I don’t mean it in a rude or degrading manner. You mention that your children are healthy. By what standards? Comparing against other American children, I would politely argue, is a poor standard. 1 in 3 born in the new millennium will develop diabetes in their lifetime. 1 in 9 have asthma. 1 in 50 are somewhere on the autism scale. 1 in 5 (while teenagers) will have suicidal thoughts. I’m hoping you get my point–I don’t consider these to be statistics to indicate a healthy young population. Equally as important, almost no children I witness develop straight, un-crowded teeth with broad palates such that their wisdom teeth emerge (a common trait in hunter-gatherer children whose parents consumed their traditional diet). Malocclusion has been demonstrated to be a nutritional deficiency. It is extremely common (to some degree) in Americans. As such, I don’t consider our population to be a good standard by which to measure the health of children. Again, I am making no claims that you are a bad parent, have failed to do everything you can for your children, etc. I am responding to a statement that I often read or hear: my children are healthy. My question is always: how was the health measured? I wonder if any Americans have ever seen truly healthy, well-formed children.

          Thank you the discussion and best wishes to you and your family.

  97. I’m not going to bother to explain this for the THIRD TIME in the same thread, but, no, epidemiology studies like this should NOT be used to advise people about what to eat because they have not established causal relationships — only correlations.

    Example — in a dietary survey, the person who eats at McDonald’s every day might be the person who gets marked down as “high protein diet.” Is it the protein that leads to worse health outcomes — or is it the french fries and the coke that get eaten with the protein? Or is it the fact that the person who eats at McDonald’s is poor, doesn’t exercise, is overweight and doesn’t care about their health.

    In fact studies like this are exactly why we have this research roller coaster of conflicting findings. Applying epidemiology statistics to nutrition, you can probably reach whatever conclusion you desire.

    Please read this Beaker and then report back:

    • This is a very interesting study. But before we declare victory and loot and plunder, some questions need to be asked.

      What is the relevance of a diet of special kibble fed to transgenic lab mice (genetically engineered mice) to humans? In other words, for this study to have real meaning, the next step of the study would be to feed humans a similar diet (with our own special kibble). Oh we would have to find about 800 transgenic humans engineered for nutrition studies.

      Was this study peer reviewed?

      Mice, for their size, higher metabolism, etc. of course need a higher carb diet. Comparing omnivores of varying body size really doesn’t have much relevance, like how we try to learn genetics from a fruit fly. The survival strategies of a fruit fly is vastly different from homo sapiens.

      I would much rather see a study using normal mice feed a diet that is closer to what a mouse would feed on in the wild.

      Overall, this is yet another study using mice to try to figure out what humans should eat, and has incredibly little relevance to humans. A colossal waste of taxpayer money.

      So in the end, this just tells us what might be good diet for a lab mouse. That’s about it.

      Beaker, one thing you should be aware of, is that in the Pharmaceutical industry, many drugs do well in the early stages of trials, when only lab animal are being used. The vast majority fail when it comes to human testing. Why do you suppose that is? Why is the drug so amazing and shows so much promise on animal testing, only to fizzle when it moves to human trials? The obvious answer is that our physiologies differ enough from lab animals, that the chemistry simply doesn’t have the desired effect. So what works for a lab mouse, rat, dog, cat, pig, doesn’t necessarily work for humans.

      So what is great for lab mouse chow, isn’t necessarily good for human consumption. But hey, if you are a scientist looking to publish, and the government is handing out cash…well…

      • You could be right Bruce. What are your thoughts on the ALS study and high carb benefiting those patients (and speculation could also benefit patients with other brain disorders), those were human subjects. I would like to see Chris comment on these two recent studies, that would be interesting. Also in the news today a study claiming animal protein is worse than smoking:

        High protein intake is linked to increased cancer, diabetes, and overall mortality
        High IGF-1 levels increased the relationship between mortality and high protein
        Higher protein consumption may be protective for older adults
        Plant-derived proteins are associated with lower mortality than animal-derived proteins

        Welcome to the never ending nutritional roller coaster ride..

    • Go ahead and worry about it if I eat low-carb. No skin off my nose. I’m fine. In fact it wasn’t until I was low carb that I:

      1. Reduced my medication list down to 3 from over 10 medications including controlled.

      2. Reduced my neurological events down to 1 or none per month from 4-6.

      3. Reduced my medical expenses per month from $300+ per month to a more manageable $50.

      5. Was able to return to the workforce and have a real life again.

      Now tell me to eat carbs.

  98. Man, nobody has a clue about anything. One guy tries to come up with a solution and people knock it down. But at the same time people complain that doctors just want to treat the symptoms and not the problem. So this guy throws out an idea and all hell breaks lose. FUNNY LOL

    Screw it. Eating his way isn’t gonna hurt. All you can do is try it on yourself. If you forget its working, then you probably have Alzheimers, and at that point you don’t care. If you remember its working, well guess what.. it works.

    I had NO health problems at all until I got my first gout attack at 29. We had 4 gigs outside in the hot memphis heat with no water and I had an injury to my foot.

    The next few days, my foot swelled up like Obama’s failures. So, the idiot government doctors (military) told me, eat more grains and quit eating meat. I said ok. So, 5 years into this craziness. I have been diagnosed with depression, arthritis, Low T, and for the first time in my life I have brain fog. I can’t concentrate on anything and my mood swings are worse than my 16 YO daughter. Not to mention, for the first time in 15 years I didn’t make weight. I gained 20 pounds and I have a gout attack every 3 weeks or so. They are so frequent, that exercising is something i can only dream about.

    I hate my life and can’t stand getting up in the morning knowing that i will be in pain. I hate it. With that said, I had NO problems at all until i started eating all that grain stuff and not eating ANY meat at all. Except Chicken

    Well I’m starting his diet and ill see what happens.. My life couldn’t get any worse. As a military family we can’t afford to eat like rich paleo people and we probably never will. Pretty sad

    • Hi TheMac, I like your post!

      Just wanted to tell you not to be discouraged because you can’t eat like Rich Paleo People. I can’t either, but it is possible to cut the grains and eat better without breaking the bank. Remember that going lower-carb Perlmutter style doesn’t have to mean loading up on grass-fed meat (like I can even find that where I am, much less afford it!). It doesn’t even mean that you have to increase your protein. My main animal source of protein is eggs, which are actually not that high in protein. The key to low-carb is actually increasing fat. My go-to sources are coconut (all types, including full-fat coconut milk), butter, avocadoes, nuts and olive oil/olives. You can even try hemp seeds (blended in soups and smoothies). And of course, how could I forget, coconut oil!

    • “Not only could this type of nutritional intervention be a novel way to treat and slow down the progression of ALS, it might also be useful in other neurological diseases.”

      double ouch.

  99. A couple of observations. First, if you read the book as only slamming cards, you missed the point. The major consideration is gluten and there is more than sufficient evidence in support of the damage of gluten on insulin receptors. Second, the mechanism of diabetes is well known and does relate to damaged insulin receptors. Third, there are several subtle points that seem to be missed. One such is the fact that a high percent of American are vitamin D deficient. Vitamin D is produced by the skin from exposure to the sun. Individuals who have more than enough exposure to the sun are also in the category. The pathway for this creation involves a derivative of cholesterol. Low cholesterol, low vitamin D regardless of the sun exposure. Dr. Levine of UT Southwestern Medical Center has verified in independent studies that lowering caloric intake (a point made in the book) and reducing insulin resistance increased life span in test organisms by as much as a factor of two. There is growing evidence from these same studies that these changes initiate autopathy whereby the body actively rids itself of not essential cells in a very healthy manner.

    • Totally. With the rise of our chemical lifestyles and over use of antibiotics, plus lack of breastfeeding it’s no wonder brain disorders are becoming the norm -we’ve damaged our micro biome. I’m sure another “grain brain” book targeting gut biome as the key will be released soon and make the best seller list. I drink 2 cups a day of home made milk kefir and other cultured foods. Another possible cause of brain disorders would be the rise of looking at screens all day and night. This cuts out melatonin production leading to all manner of illness. I would like to see a study of those who turn screens off at 5pm every day and at night are in subdued lighting. I doubt you will see them developing brain disorders -but let’s just blame everything on grains.

      • To Beaker: I don’t know that everything can be blamed on grains, but probably a lot of things can.

        We live in a country that is awash in cheap processed food made from corn, wheat, soybeans and sugar. Is it a coincidence that we live in a country where obesity, diabetes, cancer and Alzheimer’s are growing at almost unbelievable rates?

        In 1960 when people unapologetically ate food fried in lard and bacon fat, the adult obesity rate was 17%. Today we’re headed for 40% even though we exercise far more than we did 50 years ago. Have we magically turned into a country of gluttons and sloths? No. It is the composition of our diet that has changed for the worse.

        There are a lot of unknowns, but the evidence is strong that sugar and grain are not only part of the problem but probably the biggest part of the problem.

        Denying that grains and sugar are a problem in the American diet strikes me as pretty similar to denying that the burning of fossil fuels could be contributing to climate change.

        I can’t do much about climate change or the American diet on a macro level, but I can make choices to reduce my risks, and I encourage you to do the same.

  100. Several of my doctors have suggested that I get The Grain Brain. So I downloaded it from Audible and find the information extemely helpful in my case. During the 80’s I went to Pritikin on the advise of a friend/doctor and followed the low fat high carb diet. I lost a lot of weight and thought I was doing the right diet. I told my Mother to follow the diet too and within a few years she started to lose her memory and ended up with dementia and we didnt know why it happened. She is the only one in our family to do so. And In my case I became borderline diabete with high blood pressure, required sleeping pills to sleep and recently treated for lymphoma. I thought at my age 66 it was normal. Since listening to The Grain Brain I tried eating a good fat and low carb diet and the results are; my blood pressure dropped to a normal range, my blood sugar is now normal without meds, I can sleep with out meds and all my allergies are gone. Needless to say I feel better, my eye sight, my hearing, my memory have all improved. I am not a guten intolerant I wasn’t eating the good fats and too much carbs.
    I have told numerous friends and family about The Grain Brain and I think there is some valuable information about what we are eating.

    I think we all know someone who has benefiitted by going guten free and some people that should give it a try.
    I had a fellow worker that fought depression and went guten free and is doing fine now.
    I have a relative that enjoys her guten rich diet and takes meds for mental and skin issues.
    Good luck

  101. Hi Steve,

    So sorry to hear about your kidney troubles and confusion. I really don’t know that much about kidney problems, but I have experienced a lot of confusion about what to eat (join the club 😉

    One comment I will make is that, from what I have read, a high protein diet is very bad news for someone with kidney trouble. I used to eat a high-meat low-carb diet but after a few years I started to feel really sick on that. I went completely vegan for like 10 days as a kind of experiment, and then I decided to eat just a large portion of roast chicken for lunch one day. I was so sick–I was nauseated all night long. It was when I started searching for the reasons why I would have felt so bad that I learned that some people’s kidneys can’t handle high-protein meals, and it causes the symptoms I experienced.

    However, having to do a low protein diet definitely does not mean you can’t go low carb! People confuse low-carb/paleo with high protein. Some people do it that way, but it’s definitely not the way to go (particularly for you). You have to increase fat–fat that is not attached to a dense protein source like meat.

    Also, you may want to cut back on the juicing. That can spike your blood glucose for sure. And you can restrict the whole-food starches (like squash, potatoes etc.) and ditch the grains (even whole grains) if you are worried about gaining weight.

    Also, keep in mind that eggs and dairy are not really that high in protein. So I would think you could have those in limited amounts on a low protein diet.

    In terms of getting dietary fat without too much protein, many people tend to cook vegetables in coconut oil or butter. Some of them also put butter or coconut oil in coffee. You can also make yummy blended soups with low-carb veggies and full-fat coconut milk or fresh coconut meat. When you do have cooked squash or sweet potato, don’t hold back on the butter. You can also do green smoothies (little or no fruit) with coconut oil, coconut milk or coconut meat and avocado. Hemp seeds are another kind of high-fat thing that people put in smoothies. When you have salads don’t skimp on the olive oil in the dressing, and put avocado in there too.

    Also, I should point out that this thread is just a discussion gone wild due to the blog article. You should probably head over to Mark’s Daily Apple forum or to Robb Wolf’s forum ( There is also a forum called lowcarbfriends. In those places you can post a topic about low-carb paleo for people with reduced kidney function, and you will get lots and lots of help and advice!

  102. OMG and WOW. I wanted to check out feedback on Brain Grain by Dr. Perlmutter and discovered the longest blog I have seen in my life. Such interested reading comments. First off “Thanx” to everyone who took the time to blog. OK so I am 54 with a history of kidney disease in my family and some diabetes. My Kidney Doc said I have 50% usage of my kidneys after doing ultra sound. That was ten years ago. My Creatine is stable and I feel great with lots of energy and a 163 LB frame after reading Wheat Belly last year and going gluten free. I am confused because I eat really well. We only buy organic, free range poultry, meats, wild caught fish and no gluten. Almost zero processed foods too. I do like goat yogurt once or twice a week and eat mostly berries and nuts each day with some fruit mixed in plus lots of juicing. Carbs are really low to keep my weight down. Where I need helps is that being of kidney disease I am seeing all research indicate a high carb diet and very low protein intake. If I follow that then I can’t keep my weight down. If I gain weight then my blood press and cholesterol goes up and I will be depressed. Now I am in the best shape of my life and my creatine levels have been stable for years, low cholesterol, low blood pressure and todays physical make my internist very happy. SO any feedback as I am so freaking confused how to stay trim and prevent kidney disease. Thanx…

  103. It’s terrific that books like these come out and help us question what we do.

    I agree that we need to use common sense and research.

    Wheat and grains have been used for a very long time. The changes in the last 50-70 years to mass produce foods and process them may be a much great culprit than the food itself.

    Orange juice from and orange sounds healthy using common sense.

    Once the juice is squeezed and stored in gigantic vats, they start removing oxygen. Why? Because removing oxygen from the juice allows the liquid to keep for up to a year without spoiling. But! Removing that oxygen also removes the natural flavors of oranges. Yeah, it’s all backwards. So in order to have OJ actually taste like oranges, drink companies hire flavor and fragrance companies, the same ones that make perfumes for Dior, to create these “flavor packs” to make juice taste like, well, juice again.

    So I think processes like these which permeate our food supply really cause problems our bodies weren’t designed for…

  104. I have one criticism of using isolated groups of people to demonstrate their results from consuming carbs. Those people probably don’t sit a desk all day like many of us do in the western world. Like you said, the diet needs to be structured toward the individual. I think reducing carbs might be a good idea for those of us who do not burn a lot of calories in a day. I have been trying the diet myself and I have lost weight, my digestion has improved and I don’t get that bloated feeling after meals. I still eat some carbs like fruit but I have cut out starches like bread, potatoes, rice and pasta. I have also noticed I don’t get those blood sugar ups and downs during the day. I eat because it’s time to eat not because I feel like I am going to pass out. Maybe I’m pre-diabetic. I also find eating protein instead of carbohydrates curbs my hunger.

    • Yes, it does demonstrate the problem with trying to draw conclusions from international health statistics. I.e. Japanese eat rice and live long — but the WAY they eat rice bears no resemblance to the way Americans eat rice — i.e. a quart at a time with pork and pineapples, swimming in sweet-sour sauce made up of corn syrup and corn starch.

      The French do love bread but they don’t eat foot-long Subway rolls or giant stacks of waffles and syrup. The Italians do eat pasta but not a freaking pound at a time — if you visit Italy and frequent non-tourist restaurants, you’ll notice pasta portions are like a QUARTER of what you see at Olive Garden — let alone the free refills.

  105. Did anyone else catch Chris on Dr. Oz today? He was great; really cute too, his photo does not do justice 🙂

    The big news…the diet he described today was IDENTICAL to the one Dr. Perlmutter prescribed for me over a year ago. Both recommend limited legumes and dairy- unusual for Paleo. Both recommend limited starchy veg, like sweet potatoes. But, what almost knocked me off my treadmill, was when Chris warned against potatoes, rice, corn, grapes because they were too high in glucose! EXACTLY what we’ve been saying for months now. Yes, some whole foods DO raise blood glucose.

    If you missed it, you can catch the flip on Dr. Oz’s site tomorrow, It was honestly hard to reconcile the man I saw on TV today with this blog post. Could our message have finally gotten through? Ladies and gentleman, dare I say…our work here is done. LOL.

    • Yes Julie, glad to hear Kresser is talking about blood sugar because that is the single most important thing people should be aware of.

      I’ve been reading obsessively on health and food for close to five years and most of the big questions have really not been answered — with one big giant exception.

      There is one thing that seems to be to be incontestable — there is so much data and it all points in the same direction on this. And that is the need for everybody to be aware of blood glucose and not live in a way that they are constantly spiking it.

      In a way it is easier for those of us who have a tendency to put on weight. If you are eating too many things that spike your blood sugar, you will see the extra pounds on the scale and that will inform you of the need to change.

      Unfortunately, people who are naturally thin don’t get that feedback from their bodies, but they should watch their blood sugar too because there is so much data indicating elevated blood sugar leads to inflammation, and those two things raise the risk of just about every nasty disease — heart problems, autoimmune disorders, cancers, brain disorders.

      The difficulty in all this is there is no way to test your blood glucose in real time other than finger pricks. The fasting glucose test you do for your doctor is only going to flag very serious problems. So, in the absence of testing, you just have to generally avoid what raises blood sugar and try to do things (primarily exercise and fasting) that lower blood sugar.

      I think if everybody would try to get a little of the mindset of a diabetic, we would all be significantly healthier for it.

      We definitely not evolved to live a lifestyle where our blood sugar is perpetually elevated (i.e. no exercise and living on abundant starches and fruits/sugars).

      No single blood sugar spike will kill you. You should enjoy the occasional smoothie or banana or bread or pastry — even the occasional white potato or burrito or bowl of gnocchi or bowl of Cheerios.

      But think of each blood sugar spike as similar to, say, a single puff of cigarette smoke. The danger is lifetime cumulative exposure. The more exposures to high blood sugar over a lifetime, the higher your risk for for so many health problems.

      That’s a complex message unfortunately, but if I were king of the world, that would be what I would put in place of the food pyramid.

  106. I am reading this because of a friend touting Perimutter’s diet. New information automatically prompts me to search for the most intelligent-seeming counterpoint. I appreciate Chis Kesser’s remarks, but I do have one, perhaps silly, question: If Kesser is a doctor, why doesn’t he use the title? I never met a bonafide physician who didn’t put Dr. in front of his name or MD after it. Just seemed odd to me.

  107. You can write a “danger” story about every single food. The most people killed by a food in the last two decades was the 70-some people in Europe who died from e coli they got from — bean sprouts.

    We have little choice but to rely on mass-produced food. But things weren’t perfect before mass-produced food either. Life comes with risks. This thread contains a lot of good information that people can put to use trying to improve their odds, as well as some bizarre claims. We have to sort through.

    BTW I like bean sprouts and have no intention of giving them up. If chickens are “fed arsenic,” that is certainly bad news but I’m not giving up chicken either.

  108. Hi all!

    I don’t really think it’s accurate to say that vegans are “deafeningly silent” on the dangers of industrial fruits and vegetables. I think they just sort of take it for granted that it’s best to buy organic/local where possible. They are obviously more adamant about industrial meat, because one of the reasons underlying their dietary choice is the issue of cruelty.

    I am not a vegan and I don’t intend to become one, but I am currently experimenting with a plant-based diet in attempt to lose some weight and feel better (so far the results are encouraging!). One of my major hobbies has long been reading diet/nutrition books and for a long time I have been exclusively reading books from the paleo/low-carb world. As I’m sure some of you know, some of these books offer extremely compelling arguments and, like most of us, I don’t look up and analyze the citations. So needless to say I was totally sold.

    Then recently I decided to do a bit or reading on the other side of the nutritional divide, as a way to get ideas on how to do a plant-based diet correctly and stay motivated. Low and behold, the books I have read are also very compelling, although in many cases they draw the opposite conclusions as in the Paleo world, with an equal number of supposedly solid citations.

    I don’t know about ya’ll, but I don’t have the time/energy to sift through thousands of citations and weigh the evidence. I’m leaving that to Denise Minger (I highly recommend her book, and am looking forward to subsequent posts/books from her!).

    I actually think it’s time for people to start talking about what the plant-based (vegan) movement and the paleo movement have in common with each other, rather than bashing each other (I am totally not suggesting that Bruce was engaging in vegan bashing with his respectful comment, only that there is a lot of bashing going on out there).

    That’s why I think this is such a great thread. We even had a fruitarian stop by! I mean, where else could a fruitarian and a ketogenic paleo (“caveman”) diet adherent actually have a discussion?

    • Beaker, next task is to Google “tainted vegetables”. That too is an eye opener. I am not sure why vegans are so quick to point out the issues with industrial raised animals, but are deafening silent on industrial raised fruits and veggies. You really can’t eat that carrot guilt free if it came from a supermarket.

      • Very true. Google “budnip” and see what most people don’t even realise is added to potatoes, kumara, etc. I try to get a bulk of my produce from local organic or spray free farms close by. Several have prominent stalls at the local farmers market here in NZ. Is it perfect? Probably not but likely better than mass produced grocery sources. My ultimate dream is to see vertical farming take off. Indoor growing towers that use LEDs to grow 24/7, no sprays used and water quality is monitored. This is a ways off unfortunately. We are quickly heading to a point that we eat poison and get sick, so all we can really do is hope for good cures with minimal side effects for the sickness. A contaminated food supply is another nail in the coffin of nutritional science though. How can we truly base studies on foods when those foods are poisonous?

        • Food in the USA is rarely “poisonous”

          Factory meat has the wrong ratio of omega 6 to omega 3 fats and the anti-biotics add to our load unnecessarily.
          Those are problems, not absolute stoppers that prevent investigation of proper nutrition to go forward.
          Organic veigtables from a known source, with lots of added grass fed butter is fine. So is grass fed or naturally fed meat.

          Store bought meat is good enough if replaces too many carbs in your diet. You can do things to help fix the fat ratios.

          Too many carbs are the main villain, not the anti-biotics shot into animals. It’s a concern but a secondary concern IMHO

          • It sounds like you did not read the article. Antibiotics were merely one of the 6 concerns. The others clearly indicate the meat is poisonous. You mention farm grown grassed meats, these can cost up to 4x as much so I doubt everyone on LC*HF* are eating quality meat. The article also missed out #7 Arsenic.. American chickens are fed arsenic which is making it into the human system via ingestion.

  109. > Since changing my diet to a high fat high protein, low carb, I have experienced a significant reduction of migraines.

    Yes, the whole less-carbs more-fat less-inflammation thing really seems to make sense based on what I’ve experienced and read. Blood pressure drops quite a bit — sometimes so dramatically that people feel faint while their body is adjusting.

    After years of requiring antacids at night, my reflux simply disappeared — within the first week. Dr. Eric Westman at Duke says this is common — reflux simply goes away, often within a few days of starting low carb.

    My breathing passages are so much more open, I don’t snore any more. My wife and I (we are both low carb but not super strict) were just talking the other day about how much less Kleenex gets used in our house. We don’t get stuffy noses, we hardly ever get colds. I can go on and on. It’s just amazing how many things are different when you just cut the carbs.

    And of course the blood lipid profile improves so dramatically. My family doctor asked how I had lost 20 pounds; I broke the news I was eating high fat low carb, and she said, no, you shouldn’t do that. And then when we looked at my blood lipid workup, it was the best I had ever had — all the key markers improved significantly. The doc didn’t like the diet at all but couldn’t argue with the results.

  110. I suffer from migraines. Since changing my diet to a high fat high protein, low carb, I have experienced a significant reduction of migraines. Additionally, I have lost body fat and increased muscle mass.

  111. Julie,
    I truly respect how you are taking charge of your health. Your limited study on APOE4s should prove interesting. I think Perlmutter’s research is especially useful for people with your genetic predisposition. I have a close friend whose parents both died of Alzheimer’s and she is terrified by it. I mostly take issue with Perlmutter’s sweeping recommendation that this diet is good for everyone. I don’t believe in a one size fits all approach to diet. But, I can understand being in your position, and thriving on the diet would make me feel differently about it.

    I think we tend to focus on what we should eliminate from our diets (carbs), when in fact a body that is in balance and nourished (with cholesterol, adequate antioxidants, plenty of fats, and balanced gut flora) can operate quite well without manifesting disease. For me, the key is focusing on nutrient density. A nourished body doesn’t become inflamed as easily. I know Perlmutter focuses on brain foods (grass fed beef, eggs and avocado). But I just don’t see how he can also advocate “garnishing with meat” and a say that it’s possible to do Grain Brain Diet as a vegetarian. I don’t think one could attain the necessary level of cholesterol and an appropriate Omega balance without eating plenty of meats, stocks and animal fats. I think it’s far wiser to focus on nourishing.

    Anyway, I thought you might find the following links interesting. Just something more to consider. Seneff is a senior researcher at MIT, she focuses on deficiencies as pathways to disease- including Alzheimer’s. Sulfate deficiency, Vit D deficiency, Cholesterol deficiency as a result of
    statin drugs, lowfat diets and sunscreen. That APOE4s have an impaired ability to transport cholesterol and fats to the brain. She advocates a keto diet. Do you think it’s possible that VLC diets work not because people have drastically reduced carb consumption, but because by doing so, they dramatically increased their fat consumption (which most of our bodies are starved for)?

    Best of luck on your journey.

  112. There are plenty of places to look up glycemic load; here’s a good starting one:

    Just to cherry-pick one example, which would you guess has the higher glycemic index — a banana or a Snickers bar? Look it up.

    I agree most of this thread is supposition and theory, and we are years if not decades from knowing the answers definitively.

    But if we can’t agree on very simple factual things, it is hard to have any useful dialogue. Some people are clinging very hard to belief. (And btw one person posting is simply trolling at this point and should be ignored)

    Here’s the wikipedia entry on fructose, which is as good a starting point as any. It is fairly simple chemical compound. Whether you get it from bananas or corn or maple syrup, it is the same chemical compound.

    I’m not arguing that fructose is any worse or better than other forms of sugar.

    I’m merely trying to point out the cognitive dissonance taking place when someone tries to claim that the sugar in fruit isn’t really sugar, or that the fructose in corn syrup is somehow different from the sugar in grapes or oranges.

    Or that the sugar in a Snickers bar is bad but the sugar in a banana is good.

    I you think soda may be harmful because of the amount of sugar it contains, you should pay attention to the sugar in fruit juice and high sugar fruits.

    Claiming that soda is bad and, say, Odwalla juice is good is the same kind of marketing hooey that leads people to believe that white flour bagels are bad but “multigrain” bagels are magically healthy. Most “multigrain” and “whole wheat” products are basically white flour with a little ground up chaff added for color (Michael Pollan discusses this at length in his latest book, “Cooked.”)

    Yes the fiber in whole wheat (or a banana) does slow the blood sugar impact, but not a whole lot, and there is not proof that the slower impact is better.

    In fact some experts argue the slower, more sustained impact that happens because of the fiber could actually be a bad thing because it keeps your blood sugar high for a longer period of time. I.e. the banana might be worse than a glass of sugar water because you get an extra half-hour of elevated blood sugar.

    There is a brand of expensive pasta called Dreamfields that marketed to low-carb eaters and diabetics claiming to be better because it bound up the starches in fiber to slow the glycemic impact.

    The technology was real, but when diabetics with their blood glucose meters started checking it out, they found out that Dreamfields pasta still slammed their blood sugar — it just took much longer for the hit to happen, and once the blood sugar was elevated, it stayed elevated for a longer time. So there was no benefit.

    Anyway, I believe Dreamfields has been pretty well exposed by now. But the same arguments that company was making are the same arguments made by the American fruit industry as well as the breakfast cereal industry — that fiber magically renders the sugar less harmful. That is an unsupported assertion and people should be very wary of who is making these claims — there are a lot of dollars at stake.

  113. Julie,

    One more question: are their people in the HC group that are grain-free? Are some eating low-fat, meat free?

    In other words, it would be really interesting to have more information about what the different groups are eating specifically!

  114. Hi Julie,

    Wow, this is really interesting. How many people are in this group that you are part of, and how many people are HC/LC? When you say chronometer data, what does that mean?

    Have you noticed other differences between the whole foods HC and LC groups? Are people tracking insulin levels through other tests? If people are tracking blood glucose, does that seem to correlate with this LPIR score?

    Of course I would love to know what is going on with me disease-risk-wise now that I have transitioned to a whole foods HC diet (at least temporarily), but the only thing I could really track on my own is blood glucose, and I’m not sure if that would be useful.

    My main concerns are CVD and cancer, as my father had early CVD and I have had symptoms that suggest I could be affected, and there is lots of cancer on the other side of my family. On these two points, the plant-based diet doctors are still saying basically the exact opposite of what the paleo community is saying in terms of fat/cholesterol and animal foods (and then we have Gary Taubes admitting that we don’t really know anything for sure based on the poor state of nutritional science), so it gets VERY, VERY confusing!

    As for Brittdoc, I think she “exited gracefully”–ha ha! Perhaps she decided instead to go harangue the people in her personal life who may (or may not) deserve it.

  115. Brittdoc, aren’t you just a girl with a theory? Where is your evidence, my friend? We don’t throw titles around here; rather, we respectfully share ideas.

    I don’t have a controlled medical study, but I DO have an interesting observation to share that begins to refute Chris’s point that whole food carbs are harmless. As some of you already know, I come to the conversation at very high risk of Alzheimer’s by carrying two copies of the Apoɛ4 allele. I’ve banded together with a group of other ɛ4 carriers. We are pooling data, comparing and contrasting our lipid and glucose responses to dietary interventions via LipoScience’s NMR LipoProfile test.

    For those who don’t know, ɛ4 is a relatively rare ApoE genotype. Researchers guess that 25% of the population carries one copy of the allele, while only 2% carry two copies. ɛ4 predisposes us to both Alzheimer’s and CVD in a dose dependent fashion. This ApoE group is an excellent one to observe as we tend to respond quickly and decisively to dietary interventions.

    Now, to my observation. We have two subsets of folks both eating only whole foods. One is low carb; the other is high carb. The low carb (LC) group is eating ala “Grain Brain” (less than 100 grams of daily carbs.) The high carb (HC) group is eating apples, bananas, beans, rice, sweet potatoes, broccoli, etc. (We have chronometer data on both groups.) Very consistently, the HC group is demonstrating LPIRs that are in the yellow to red zone. See at the bottom of this reference meant for physicians.

    For anyone unaware, LPIR is a measurement of insulin resistance that often predicts metabolic syndrome years before actual diagnosis.!po=2.77778 Those following the LC diet have numbers in the single digits. My last LPIR was 5. This is far from proof, but certainly demonstrates that whole food CAN push one towards metabolic derangement.

  116. Yes I think lost in the din of discussion about Perlmutter is that his actual diet recommendations are fairly mainstream — nothing radical at all.

    He’s saying avoid gluten (i.e. wheat and wheat products), and corn products, avoid sugar, eat low-carb (but not no-carb or even very low carb). Eat healthy fats, oily fish — rich in omega 3, DHA etc. Eat eggs. And of course lots of non-starchy vegetables. Really who (besides dogmatics like Brittdoc, Coke and Pepsi and the processed food industry) could argue with a diet that follows those general principles?

    Seems to be there would be almost no downside risk to eating the way Perlmutter (and, for that matter, Atkins) recommends. You keep your blood sugar lower, it helps you maintain healthy weight, you improve your cardio risk factors. And the bonus: even if there’s just a reasonable chance that Perlmutter is right, that you’re reducing your risk of Alzheimer’s 20 or 30 years from now — well that is quite a POTENTIAL bonus.

    Eating this way doesn’t cost you anything. And falling off the wagon once or twice a week probably doesn’t hurt you. I happily enjoy beer or bread or pretzels or pastry from time to time — I’m just aware of making those times count.

    BTW I think CDW’s point about low-sugar fruit is a great one. Even fruit advocates probably agree that low sugar fruit (i.e. berries) is desirable.

    Low sugar fruit gives the benefits of fruit (micronutrients, fiber) without the downside (the blast of fructose). Just like low-starch vegetables like broccoli, snow peas, leafy greens, cauliflower give you fiber and great nutrients without a lot of starch calories.

  117. I have read Grain Brain and many other similar schools of thoughts such as GAPS and SCD. All of them advocate the same thing – poly- and bi-saccharide carbohydrates, in the portions that we currently consume them, are fundamenally bad for us. And they are, not matter how we look at them. We do not consume complex carbohydrstes in small portions with no additives and added sugars like many “traditional cultures”. When we start eating the wholefood diet of “traditional cultures”, then we too would have no neuroligical conditions. Our carbs and their carbs differ fundamentally!

    In addition, in my understanding, Dr Perlmutter does say do not eat carbs from whole-food sources. What is considered whole food? Bread, muffins, potato? We get plenty of crbs from whole-food sources such as pumpkin, marrow, mushrooms, etc. In addition, Dr Perlmutter says carbs like rice and quinoa are fine on an irregular basis, not as a default filler on a daily basis. In fact, if you read the recipes he has at the back, several include rice.

    He also doesn’t say don’t eat fruit. Drinking one glass of freshly squeezed orange juice is the equivalent of 4 to 5 oranges. That is a lot of sugar. Pumps up the glyceamic index sending your body into insulin overdrive. He recommends eating low sugar fruit occasionally as opposed to being the four-times a day “healthy” alternative to a McD burger.

    I think every singly one of us could stand to seriously improve our diets with eating more really WHOLE food such as vegetables and nuts and cut down on our western diet desperately dependent on grain-based carbohydrates. The quantities and quality of grain-based carbohydrates we eat are seriously dangerous for us. Wake up before it is too later.

    Please note, he called the book Grain Brain. Not Carbohydrate Brain.

  118. Hi all,

    Thanks Tom for the link–fabulous stuff from Gary Taubes. Really made my morning. And I know you don’t want to get into it with Brittdoc, so I will point out the obvious: He so needs to read that article! Maybe he will deign to have a glance despite his utter confidence that mountains of irrefutable evidence supports his views given that the article is in the New York Times (not just anybody, they have degrees and such, no?)

    Bob, welcome to our discussion! I think it’s actually quite funny that you really think Chris is actually moderating this. What is he, crazy?–it’s up to almost 500 comments! If you really feel strongly that we are polluting his thread you should e-mail him about it. If he prefers we take the discussion elsewhere he can tell us that (he has our emails).

    Marc, thanks for the very interesting information about orthodox diets and fasting (as well as the nice rant about why we can’t trust our doctors for nutritional advice–so true!). Maybe I should consider something like that for myself. I live in Montreal in the same neighborhood as a Greek Orthodox community, so I would feel right at home!.

    Beaker, yes it’s all so interesting. Reading about nutrition has actually been a major hobby of mine since I was young. I am glad I found this discussion, as it helped me try a new style of eating after years and years of low carb (which worked marvelous for me when I first adopted it, but then stopped working). I have actually lost 4 pounds after about two weeks of my tweaked version of the Eat to Live diet. Actually, though, I suspect that the major effect is from the complete lack of snacking between meals (which that diet prohibits) and my acceptance that I just may have to feel a bit of hunger now and again if I want to lose this weight…

    • Yes, all my exentricies are coming to together in the same place.
      Something similar happened a few months ago. I was searchng for something written by Dr. Chris Masterjohn, the nutritionist for the Weston Price Foundation and all these Orthodox links and pictures came up. It turns out that he is also Orthodox.. Crazy. He promises to write an article about Orthodox fasting and eating “Healthy”.

      One or two more words about it. When vegitarians point to what can be eaten during fasting days or the long fasts like Lent, they see “No Fish” on the list and may think it is all vegitarian.

      Define “Fish”

      What is meant is no Fish with a backbone. Other seafood is eaten even during the fasts, like octopus, shrimp, squid and yes lobster. Also, some fast days allow wine or oil or “fish” . Somedays all of them. You need an Orthodox Calander to tell you which foods are Lenten for which days..and a buddy who knows what he is doing.

      I have no objection to people designing a diet around some of these patterns. Just keep in mind this is part of a very serious religious practice “Prayer and Fasting”, so handle with care.

    • (Can’t seem to find Brittdoc’s reply to Mary, so am replying here)

      Tut tut, Brittdoc, remember your bedside manner. It is not helpful to be so dismissive of other people. As for this biochemistry background of which you keep reminding us, how about sharing some of the knowledge and data you have. Just because I am not a biochemist doesn’t mean I can’t follow. any lucid arguments or evaluate data.
      People on this thread are for the most part genuinely interested in improving their lives and the lives of people around them.

      Please help, and add something concrete to the discussion. Explain to us why you believe some of us have it wrong. We are all on the same quest.

  119. I want to add one more comment about the Monks of Athos and their diet.

    As I said Orthodox Bishops are all monks but they don’t live on Athos. They eat the same diet as the Monks on Athos minus the stress free lifestyle. A fair share are Obese. They get heart disease and diabetes and dementia and have normal longevity. Same diet… Different stress level. Less very fresh fish and premium olive oil perhaps.. Different longevity outcome.

    I have regular contact with two Metropolitan s ( High ranking Bishops)..Both are obese..

  120. I don’t want to get into a flame war with Brittdoc so this will be my last response to him.

    However, I am waiting for some basis to the assertion that fructose in fruit is different from fructose in corn syrup. I believe the claim was made that they are chemically different. Now someone is backing and filling and talking about fiber and micronutrients. This kind of arrogance is exactly why our society is having so much weighing the risks and benefits of various patterns of eating.

    I wouldn’t claim that drinking Sprite is the same as drinking juice, but in terms of their impact on the body, they are more similar than they are different. In both cases they are slamming your system with sugar, creating a huge insulin response, causing a blood sugar rise to be followed by a blood sugar fall. For some people — particularly young people — this causes no problem other than the familiar blood sugar rush and crash. But over a lifetime, eating sugary food — including fruit — is at very least something should be examined.

    If you believe that sugar is harmful, to give fruit a free pass is absolutely ridiculous. If you think it’s okay to eat Thompson grapes 200 grams at a time, or feed babies apple juice, then don’t condemn soda or candy.

  121. Beaker, you’ve forgotten one important point: these guys are monks, so moderation as a guiding principle likely dictates everything they do, even on “feast” days. Just because they are allowed to eat all of those things on certain days, doesn’t mean they do eat them all in quantity.

    I also want to make the observation that people seem to be attacking Perlmutter just because he set a certain limit on carbs (60 grams), which people feel is low. But we have to take into account the population he is dealing with and his target audience: mostly people eating a diet high in refined carbs and, more specifically, people that may have Alzheimer’s in their family and are particularly concerned about that. And let’s not forget that he is dealing with the devastating effects of Alzheimer’s on families and individuals on a daily basis. Maybe his recommendation is relatively low because he is trying to err on the side of caution when speaking to a general audience, and also because he realizes that people tend to naturally creep above a certain carb allotment.

    I honestly don’t think anyone on this thread has suggested that everyone should eat a Grain Brain diet–am I wrong about that? What started me posting here is that I really did not like the way Chris just brushed the carb/glucose issue under the rug in a general manner by saying “whole food carbs don’t contribute to disease”. Let’s just say that if I had obvious blood sugar control issues AND Alzheimer’s in my family (or the gene that greatly increases Alzheimer’s risk) I would be paying a HECK of a lot of attention to Perlmutter’s theory/recommendations and I would most certainly not be eating fruit/beans/squash they way I am now.

    Back to the monks, I bet if Perlmutter could sit down with each of them, he would not be telling each one “no more than 60 grams of carbs!” Honestly, I think some people just like to attack people who write popular books and end up on the Dr. Oz show.

    And more personally Beaker, why are you so upset about this? You are obviously doing something right (being so ripped and all 😉 so why are you so bugged about this? Maybe you should be telling us more about what you eat so we can all try the Beaker Diet–hey, that has a ring to it. You could end up on Dr. Oz!

    • “And more personally Beaker, why are you so upset about this? You are obviously doing something right (being so ripped and all 😉 so why are you so bugged about this? Maybe you should be telling us more about what you eat so we can all try the Beaker Diet–hey, that has a ring to it. You could end up on Dr. Oz!”

      Don’t give me any ideas, but hey it could be a new revenue stream for me. It might be bigger than paleo! I guess diet discussion needs to be more fragmented and that is why I am being pedantic. Tom, etc are somewhat painting with one brush. The Monks are practically eating all the no-nos and experience longevity and health. I would consider the monks routine more applicable to those with a normal BMI before I would consider LCHF for normal BMI folks. Even then use ketosis to drop weight then shift to the monks routine sounds plausible. I’m not seeing LCHF longevity reports where the monks have what 1,500 years under their belt. I’m also not seeing how the monks are performing poorly by NOT being LCHF. The fall back for LCHF proponents always seems to be obese Americans could benefit from it. But it does seem we are getting to the point where there is some agreement that LCHF does not need to be a prescription for all. Anyway, I find this discussion fascinating and it’s sent me in many directions looking for answers. It seems to me moderation of food intake, exercise, meditation (or ultra low stress) are far more important than exact ingredients ingested. When things go horribly wrong (obesity) then maybe drastic measures such as LCHF & ketogenic diets are valuable.

  122. The Mt. Athos diet.. These monks have incredible long lives with virtually no ill health reported. “they live long lives with shockingly low levels of cancer and heart disease. Alzheimer’s is virtually unheard of.”

    about the diet: (source )

    Fast days – Monday, Wednesday, Friday
    This day broadly follows the fasting style of the Greek Orthodox religion in small portions. Your eating should be restrained and minimal, and follow these basic rules:

    no animal protein, ie. no dairy (milk, butter, cheese etc), eggs, red meat, fish or chicken
    no alcohol
    oils and fats kept to a minimum
    Can eat: unlimited fruit and vegetables, also pasta, potatoes, rice; beans, lentils, pulses, soya and soya products; nuts and seeds (keep portions small).

    Moderation days – Tuesday, Thursday, Sunday
    A more varied diet is allowed, but all in moderation, and still try to keep your portions small.

    Can include dairy products, eggs, fish and chicken, but not red meat.
    Olive oil allowed – but keep it limited
    Alcohol allowed – 2 units of (preferably) red wine per day
    evening meal followed by a small pastry eg. baklava or square of chocolate (one small indulgence allowed)

    Feast day – Saturday
    Eat and drink what you like on one day a week – a chance to eat meat and indulge a little (if you want to).
    However, it’s likely that what you desire to eat on these days will change the longer you are on the diet.

    Other principles

    salt and processed foods – keep to an absolute minimum (ie. sausages, burgers, ham and other cold meats etc).
    sugar and sugary drinks – keep to a minimum.
    fats – try to keep butter, margarine and cream to a minimum. Use olive oil as preferred fat.
    snacking – choose fruit, vegetables (as much as you like) and plain crackers, dried fruits and nuts (in moderation).
    eat organically produced food as much as you can and grow your own vegetables if possible.
    exercise regularly – very important! Be as active in your every day life as you can, so it’s good to walk (briskly), use the stairs, and do housework, gardening, dancing as energetically as you can. If you enjoy food and don’t want to be overweight, you need to be active.
    flexibility – fasting days can be moved around if necessary to fit in with changing social plans. Though it’s best to try to stick to a weekly pattern as much as possible and it’s best to have days in between fasting days. If circumstances lead to a small deviance on a fast day – just try to eat/drink as little of the ‘not allowed’ food as you can, and include some ‘fasting’ meals on subsequent moderation days.

    So… we have 1500 old dudes eating the above which would make LCHFers heads explode with rage.. yet these guys are doing GOOD! Better than anyone else for that matter. Another example of conflicting diets and somewhat shows Perlmutter is on thin ice. All those monks should have some moderate rates of brain disorders but they don’t. I mean c’mon, 3 days a week are “unlimited fruit and vegetables, also pasta, potatoes, rice; beans, lentils, pulses, soya and soya products; nuts and seeds”, then we have 1 day a week eat whatever you want. Non fasting days no fats, some oil. These guys should be dropping like flies right?

    • I happened to be Orthodox and follow the fasting rules as best I
      I would have you know that Paleo and LCHF is very popular among my Orthodox friends. There is even a facebook page “Orthodoxy and the Paleo Lifestyle”.

      Intermittent fasting is turning out to be healthful. There is no command for the fast to be high carb and low fat.

      The monks on Athos eat lots of fresh fish caught daily just off their shore and lots of olive oil and wine even with breakfast.
      They certainly do restrict calories during fasting periods like for Pascha and Nativity and Wednesday and Friday’s and often Mondays too with several exceptions ( it get’s complicated). Orthodox lay people do the same btw.

      Our Bishops are all Monks first. Some are thin, some are obese, some have Alzheimer’s and some don’t. I think it depends on how they employ fat and carbs in their diets, just like everyone else.
      I had a chance to speak with the BlueZone guys a few years ago and I pointed them in the direction of Orthodox fasting as something they should look into.

      You should note that they are careful to tell people that there are many factors that relate to longevity and to be careful not to think there is a longevity diet.

      Our monks on Athos live in a close supportive community with long periods of spiritual practice and solitude. Elderly monks are revered. This is more likely the key to their longevity.

      I would not forget to factor their low stress levels and sense of fulfillment before you jump to conclusions about why they live so long.

  123. This Brittdoc is pretty hilarious. Telling us we shouldn’t listen to Perlmutter because he is an MD, and then spouting off although he obviously has done no research of his own and constantly mentioning that HE is an MD. And “the biochemistry is too complex, so I won’t go into it”–please!

    Any jerk with a blood glucose meter can tell you that fruit can spike BG as much as “healthy whole grain” bread. If this guy really is a doctor, maybe he should go find some patients, and ask the diabetics among them who track their BG and actually want to control it how the healthy whole grains and fruit as part of a low-fat diet are working out for them.

    This guy sounds like he is actually on the payroll of some fruit juice association. Troll alert!

  124. Yes, Atkins took so much vicious, pig-headed abuse from the dietary establishment — and as it turns out he was right and they were wrong about almost everything.

    I’ll grant you — it is counterintuitive, very counterintuitive to say what Americans need is more fat in their diet and a lot less sugar. That fruit juice isn’t much different from soda. That adding more fat and dietary cholesterol would help people to lose weight and improve their outcomes for heart disease, and, if Perlmutter is right, for Alzheimer’s as well. But it is where a lot of science seems to be pointing.

    What I find inexcusable is people in positions of authority continuing to carry on as if nothing has changed in the last 30 years, continuing to cling to the low-fat diet dogma. Meanwhile we are headed for 100 million obese Americans who are going to die prematurely in huge numbers of heart disease, diabetes and complications, and obesity-associated cancers. This is to such a large degree preventable.

    It’s actually a very exciting time for this field. There is so much new information being discovered and such tremendous opportunities for improvements in public health. It’s not the end of the scientific work to figure out what we should be eating, it’s not even the beginning of the end, to paraphrase Churchill, but it may be the end of the beginning.

    Look at the state of American public health and you can at least have a pretty good idea of what doesn’t work. It’s a pity there are still physicians out there still defending it.

  125. Thank you, Tom Boyer, for that level-headed reply to Brittdoc. He/she sounds just like the dogmatic doctor I have been trying to avoid all my life. And unfortunately he/she says he/she is a young doctor. I had hoped that old-fashioned dogmatic ideas would be dying out soon as older doctors retired, but oh no, here comes another generation.

    I particularly object to the statement that Atkins was a fad diet. So far from the truth. My son’s life was saved by following his protocol. Just as we see here, people don’t actually look at what Atkins advised, bt simply spout the stuff that they read in magazines or hear from their friends. All the objections I hear are based on the induction phase of two weeks — seems like detractors couldn’t be bothered to read the whole story.

    I am not saying that the Atkins way is perfect — it worked for my son, who went from 130kg and a fatty liver to 83 kg and health, and I am not sure about everything that Perlmutter is saying yet, but am willing to keep informed. The more research I read into our health, the more I think that Atkins was unfairly villified. Reminds me of what Monsanto did to scientists who pointed out the dangers of GM.

    BTW, there was a British doctor called John Yudkin, who authored a book called This Slimming Business in 1970. He also advocated low carb eating. He was my first introduction to thinking about what I eat. Unfortunately the lowfat craze started shortly afterwards, and he hasn’t got the recognition he deserves.

    There is a lot more research to be done, but Brittdoc is saying dangerous things without backing them up with real data.

    Choose your physician with care!

  126. You sound so confident, Brittdoc, but you are simply wrong. Fructose is fructose, sucrose is sucrose, glucose is glucose.

    Why don’t you try to find a source for your assertion that fructose in fruit is somehow different chemically from fructose in corn syrup (i.e. Sprite).

    Why don’t you explain to me how 20 grams of sugar in apple juice has a different effect on the body than 20 grams of sugar in soda. There is chemically no difference. And don’t talk to me about micronutrients. Explain to me how “fruit fructose” is chemically different from “corn syrup” fructose. I bet it will sound like those claims that “organic” sugar is different from table sugar. Or sea salt is different from Morton’s.

    You are spouting the same misinformation that doctors have spouted for 3 decades in advocating a diet that is undoubtedly linked to an unprecedented epidemic of obesity, diabetes and — now — Alzheimers.

    I’m not saying there are easy answers or explanations here. In fact that is precisely my point. The status quo of dietary advice has failed our population. We are dying, millions of us, eating the diet that the American and British medical establishment advised us to eat.

    • I suspect HFCS in a can of soda probably does not send any signaling of satiety to the brain, but eating a banana with some berries would due to the extra nutrients. So then people drink the sprite, then figure.. I’m hungry and have a banana. So at least fruit is filling you up a bit. I don’t eat huge amounts of fruit. In a day I have 1/4 blueberries, 1 banana, 3 kiwi fruit. Sometimes I’ll have an organic raisan bar directly after a workout (nothing in it but raisans, sultanas, touch of honey, wrapped in a thin wholemeal shell).

  127. Hi Marc,

    Thanks for your cautions. I agree that ultra-low fat is a terrible idea, which is why I am not following the plan as it is laid out in the book. I am eating good amounts of avocado, nuts, coconut and some oil for dressings and butter for cooking. Still, this is much less fat than I was eating on the keto diet, and I still get hungry between meals.

    Also, remember that I have 20 pounds of fat to lose. So if I am actually losing weight on this diet, my body is also metabolizing my body fat. That may be why thin vegans get so sick if they continue the low-fat eating–their body and brain become fat starved. That won’t happen in my case any time soon!

    Yes, Perlmutter–I do remember him (ha ha, that’s what started this epic thread). Once I am able to lose this weight, I will likely transition to more of a Perlmutter diet. I also plan to buy the Wahls Protocol book when it comes out. That also focuses on nutrient density, which is what I like the most about the Eat to Live approach (but I trust Terry Wahl more on what foods are the most nutrient dense and what the essential components of a long-term diet should be).

  128. Hi Tom,

    Actually, this 20 pounds is not the last 20 pounds, but rather the same first 20 pounds that I have ever gained over my healthy weight (except for my pregnancies), which I have gained and lost at least twice.

    The first time I lost it with low carb and it was quick and easy, and I felt fabulous, but then carb creep set in and I gained it back. Since then I have tried keto (down to 30 grams of carbs) but without losing and I was even gaining (plus having problems sleeping and palpitations). Recently I decided to take a break from low carb, at least for awhile, because I had gotten to the point that I literally couldn’t stomach the food any longer and I was fatigued all the time. I felt like I just needed to change things up a bit.

    You are right about the low-fat veganish eating–I get a bit irritable between meals. I feel like my body is liking the micronutrients from all the veggies though–my energy is good. I don’t feel like I am getting sugar crashes, because I am not eating any grains at all and I am limiting starchy vegetables and fruit. I think the fiber load is enough to prevent the peaking and crashing, though I suppose my blood sugar may be somewhat elevated over a longer period.

    One insight that I got from the Eat to Live is, I think, worth the price I paid for the book: to really be healthy we need to NOT be overweight. Of course I knew that, but he really drives it home in that book. He says to prevent/reverse heart disease, people need to really be thin. Part of the reason I have not been feeling well may be that the fat around my middle is wreaking havoc with my system. I just really feel that it needs to go, and I am going to try different plans until I get there. Once I stop losing with the plan I am doing now I will definitely look into the fasting idea!

  129. Yes, by all means lose weight… But with a a few cautions.

    If you read some of the Vegan and Raw Vegan blogs and vids you will notice a rash a deaths. They cant understand why vegans are dropping dead. They are eating “Healthy” and were nice and thin.

    Vegans can become very thin, too thin. They also become depressed and infertile too often. They may have traded one problem, belly fat, for other problems. Fruit for example will put fat around your heart and liver but not your belly and hips.. So you can get skinny but less healthy.. Skinny and infertile, depressed or even dead is not desirable.

    Dr. Perlmutter ( remember him?) eats mostly vegetarian but minus all grains and with lots of added fat. That is the key, enough fat and no grains. Low fat and vegetarian or Vegan is a recipe for disaster.

  130. Mary, I agree, a real-time insulin metering system would be a great help to all of us.

    Once you get to a healthy weight, losing the last 10-20 pounds is REALLY hard pretty much no matter what method you do.

    Obviously you can lose the last 20 eating high-carb vegan, but you have to do it the old fashioned way with calorie restriction and/or exercise. And that means putting up with a lot of hunger and probably a blood-sugar roller coaster.

    My personality is affected when I eat that way. I have a tendency to get very mean and nasty at the bottom of the blood sugar roller coaster when I’m ravenous — kind of like those old Disney cartoons when Mickey hallucinates his friend Donald as a roast duck.

    IMHO you could lose the last 20 a lot more painlessly by going low-carb AND low-calorie.

    One way to do it is the “fast” diet. There is recent book out about this — for 2-3 days a week you “fast” on about 600 calories, but make those calories as much fat and protein as you can (especially protein, so your body doesn’t try to burn your muscles), and you don’t have the hunger pangs beating on you all day. I’ve done that, it’s remarkably painless, but it is still a routine that is hard to sustain, and to do the last 20 pounds you have to sustain it for 3 months or so.

  131. Interesting discussion, including the fact that beaker is so ripped (good for you beak ;-).

    Seriously, I too am so discouraged by all the competing claims and counter claims. One thing that I think everyone (everyone here, anyway) would agree on is that it’s unhealthy to be overweight, especially when fat is accumulating around the middle.

    So, I have decided to basically do whatever it takes diet-wise to lose the 20 or so extra pounds I am carrying around (I want to be like you beak–six pack here I come!). I have specifically decided to look at plans other than low-carb paleo-type plans, which obviously are not working for me anymore. I even read a book called Eat to Live that recommends veganism (or quasi-veganism at the very least), and is supposed to be about nutrient density (and yes, it’s true, this guy makes the exact opposite claims regarding saturated fat/animal protein from what we hear in “our” world–what gives???).

    I am not doing this plan as is (it’s extremely low fat/protein) but I have been inspired by it to include tons more vegetables, including raw vegetables, to quit snacking COMPLETELY between meals, to cut all dairy except for butter, limit the oil I use in dressings and for cooking and to try adding beans to see what happens. So far, so good–I have lost a few pounds and I feel pretty good. I do get hungry between meals, but I’m starting to think that I part of my problem has been the need to never be hungry. If I just chill when I start getting hungry it seems to go away.

    Of course I have been wondering what is happening to my blood sugar after an Eat-to-Live-inspired meal. I have a meter, but I need to purchase some new strips. The problem, though, is that my blood glucose after a meal will not be any indication of what my insulin level is like, which is what is more concerning. Does anyone know of any way I could evaluate this? My doctor is never willing to order test like this, so that is not an option.

    If not, would I be able to judge just according to whether or not I lose weight on this plan? I’m assuming that if my insulin is running high due to the high carb intake, I would NOT lose weight–is that accurate?

  132. If I can add just one or two more words about eating fruit, I would point out that modern fruit has been manipulated to be much sweeter and less fibrous than what was found in the wild.
    Natural fruit, the kind our ancestors ate, was much smaller, harder and far less sweet, almost sour.

    Plus, as Tom pointed out, when nature makes fruit is wraps it within lots of fiber. Sugar cane is looks like a tree branch. If you try to get the sweetness out of it, you would need to chew through wood.

    Sugar is sugar is sugar. Fructose builds fat around the heart and liver.. Cavet Emptor

    • And chewing it is exactly how people got that sweetness. Same can be done with a variety of plants, including grass. Masticate the plant fiber, swallowing the juice, but not the fiber/cellulose. Takes some effort to get to that sweetness.

  133. Live on fruit if you want, Robbie. But read about Steve Jobs and his carrot/apple diet (which is discussed in the new Water Isaacson biography). Jobs’ pancreatic cancer was probably not a spontaneous random occurrence.

    Fructose is fructose. It is a total mythology that “fruit” fructose is different from “corn” fructose. It is the same molecule. Fructose in “high fructose corn syrup” is absolutely the same chemical as fructose in fruit. I almost hate to tell people that because no one wants to hear the can of Sprite is packed with the same exact stuff as a banana.

    Yes, I’m familiar with the Robert Lustig video (which is great stuff). Lustig does not in any way argue that fructose in fruit is different from fructose in soda. His argument is that the plant material (largely fiber) packaging the fructose ameliorates the impact of the fructose on the body. In particular it dampens the impact on blood sugar. Also, fruit helps fill you up so you don’t consume as much sugar. A lot of people drink 40 or 50 ounces of soda a day (I probably did at times in my life) but they’re unlikely to eat 10 bananas. So Lustig is saying, if you avoid refined sugar and get your sugar from food, you are cutting out most of the danger, and I think that is a valid thing to say.

    I just think fruit should not get a free pass. People are definitely waking up to the fact that orange juice is NOT how most people should start their day. Apple juice is NOT good baby food. I think people should look a lot harder at the super-sugary supermarket fruit in general — Thompson Grapes, navel oranges, Cavendish bananas, even modern apples that have been bred for extreme sweetness. It’s not as concentrated a source of fructose as corn syrup or soda, but if soda didn’t exist, fruit juice would be right up there.

    Sugary fruit is like candy. I don’t think fruit is equivalent to cigarettes. But I think people are in denial about the downside of fruit almost in the way people were blind to the downside of cigarettes. If you largely take sugar (in all forms) out of your diet, you will feel an enormous difference and you see how much impact that sugar has on almost every single function of your body. For some people the result is not a good feeling but for a lot of people it is. Count me among the latter.

    • Hi Tom,

      Yes, pancreatic cancer could be caused by wrong food intake, from fruit, I doubt it.
      Funnily enough, I had that argument with a work colleague the other day. He said that my high intake of fructose would cause my pancreas to produce too much insulin, hence the cancer possibility.
      I told him that in order to digest the fructose from fruit, the body does not need to produce any insulin (look up fructose metabolism in any 1st year biochemistry book -> not involving the pancreas)
      Then he changed his mind and said: “Maybe it is because the pancreas is underused then.”
      So far, not very convincing for me. Also, with all arguments around Steve Jobs’ problems, the only thing I could find was “suspicions” that his high fruit intake could have caused it, but no proof whatsoever.
      Pancreas cancer can also be caused by radioactivity and long term exposure to electromagnetic fields. Not sure what Steve has been playing with in his life..

      Robert Lustig does make a distinction between fructose from fruit and other sources. It is somewhere in the first third of the video where he says: “Fructose, and I don’t mean fructose from fruit… causes…..”
      When he talks about fructose he is always referring to the artificial one. I had to watch the video twice to get this, because first, I could not believe what he was saying about it. The comments on youtube also refer to this misunderstanding.

      I am not sure why you take it as a myth that “fruit” fructose is different from “corn” fructose.
      It is a known fact that artificially created supplements are not absorbed by the body the same way that natural minerals are, even though identical in chemical structure.
      Sorry, no reference at hand right now for that one.

      You are saying that fruit is equivalent to cigarettes and that it makes addictive.
      Well, my own experience right now (I have started to live on fruit 3 weeks ago) is that I am craving cooked foods as much as I have been craving cigarettes when I was still smoking. It is not the fruit I am craving at all!
      Just because it is sweet, it does not mean that it is like candy. Processed sugar (and I do not even mean artificial fructose here) is addictive. Try giving it to a baby and watch how that baby will not loose sight of you while you are in the room.

      Oh by the way, tomato, cucumber, avocado, pumkin, squash, zucchini, capsicum, chilli – those are all fruit as well even though we classify them as vegetables. Nothing sweet about those…

      Anyway, you have your beliefs and I have mine. The question is on what knowledge are those build on.

      I have tried to stay away from all science as I have found only conflicting information in that area.

      Instead, I ask myself:

      What does nature want us to eat?

      And I use reasoning, history (factual and biblical), scientific analysis of the biochemistry structure of humans, experiences of other fruitarians and personal experiences as the basis for my understanding.

      And talking about personal experiences, when I went on a fruit diet last year, I did it for 3 months. After 2 months the most incredible changes occurred in how the body functions.
      Just to name two:
      No more sunburn, even after being exposed to the sun all day (except from 12-2) in the Australian tropics.
      No more toilet paper (an invention of humans, because the food intake is wrong and digestion does not work as suspected).

      So I am not sure if you have ever tried it. It is hard, as you get cravings, feel the detox and have to confront your own mind.
      But until you do, all that can be said is what others have written with no own experience to check whether it is actually true.

      When you talk about people being blind to some things. Yes, we all have our illusions of the world. You got it, too though. 😉

      Alright, off to return to Eden now

      All the best on your own journey.


      • Hi there Robbie,

        One thing about your comment that I am really starting to relate to is the bit about staying away from science given all the conflicting notions. When people (including MDs and other seeming authorities) are claiming the EXACT OPPOSITE on certain points based on the same scientific studies (or selected studies among the huge pool of studies) one starts to realize that we cannot really believe any science-based claims.

        At this point, I am taking everything I read about nutrition as a theory, no matter what the author claims about it!

  134. I bow down to you and your amazing body, Beaker. Why are you reading this thread — let alone posting so much — if you have nothing to worry about?

    Seriously, you’re right there are contradictory findings and beliefs on so many things. The quality of research in the field of nutrition/dietary science is so abysmal that the whole field is considered by some to be a pseudoscience, kind of like psychology came to be seen in the 70s and 80s as Freudian theory and all its tentacles collapsed.

    Unfortunately there is no unbiased authority to help you separate the stupid diet research from the good research. The government and most of the health advocacy groups have a lot of agendas and financial interests that shape their outlook. I don’t know who to trust.

    There are only two things coming out of the recent research that seem pretty solid — not religion, just findings on the verge of being well established theory. The first is a growing understanding (I wouldn’t call it a consensus but it is a very solid run of findings) that sugar and refined carbs are bad for you in multiple ways — though even then, detrimental to some people more than other people, and exactly HOW detrimental it is hard to say. But yes, Virginia, sugar DOES cause diabetes and heart disease. That should be a big duh but unfortunately a lot of doctors, including even diabetes doctors, are still resisting that idea.

    The second finding that has been demonstrated, overwhelmingly and repeatedly, in excellent studies, is that “Mediterranean” (meaning higher fat, lower carb, more protein,fish, vegetables, less starch and grain) produces better health outcomes.

    The rest of it — seeds, vitamins, organic/nonorganic, green smoothies, fermented foods, fish oil and other supplements, blueberry extract, red wine, chocolate etc.. — I think people should believe what they want to believe, eat the foods they want to eat (as long as they don’t go too heavy on carbs), and let that old placebo effect do its magic! Because regardless of what you read in the newspaper, there is no clear plan of action backed by research. You might as well use astrology to choose what to eat for dinner.

    • I’m posting so much because I became more interested in nutrition last year. I then got sucked into the relentless vortex and have been trying to make sense of it all. Turns out it was a slippery slope which ultimately has made me feel that it’s all over analysed and overhyped. Now why is this? Because the diet industry is multi-billion dollar (everything from foods, supplements, lectures, blogging and more). My 98 year old grandmother is fit as a fiddle, still drives and works part time. She doesn’t give too much thought to diet other than: you are what you eat & everything in moderation. AND she adds to this her philosophy of life: work hard, keep moving and never, ever stress about anything, ever. It has served her well. So in some ways there are 4 main components to health:

      1. you are what you eat
      2. everything in moderation
      3. no room for stress
      4. work hard / exercise

      Now if you apply the 4 points above, the food industry, diet and diet blog industry instantly miss out on 100’s of billions of dollars. Could a healthy life be as simple as those 4 steps? I guess I will be a living experiment. I’ll post back here every 10 years for an update. After going from not knowing much about diet/nutrition, to falling into the rabbit hole I think it’s time to take a step back from the madness. Thanks Grandma, I think I’ll follow your lead..

  135. Part of my problem with this thread is that most advice/assumptions made here are directed to those who need to lose weight. My situation seems to throw a spanner in the works because I am 40, 5-11, 165lbs highly athletic (exercise 12-15hrs a week at minimum), when not exercising I use a standing desk all day, etc. I am basically totally ripped with no body fat that I can see. I am pretty much all muscle, a 6pack with no abdominal fat, etc. I would hate to think what would happen to me if I went into ketosis and my body began to burn what little fat is left. I think I would begin to look grotesque. My diet is 100% whole foods. Roughly- variety of vegetables, home made yogurt, home made kefir, aged cheddar, berries, kiwis, some banana, ground flax, variety of organic nut and seed butters, home made sourdough bread, legumes, eggs, meat a couple times a week, occasional fish, coconut oil, organic butter, various herbs and spices, high quality fish oil, emu oil, RO water, lemon water, coconut water, etc. I recently had a full cardio workup (treadmill test, ECG, echocardiogram) the cardiologist said I was top 1% that he can’t recall seeing anyone my age in such condition. I haven’t tried to determine my carb intake but a rough guess would be 300-500 a day. I feel phenomenal, high energy, mentally sharp, mood is great. I meditate regularly and stress levels are low. Now, if I present my routine to nutritionists, dieticians, pale dieters, LCHF dieters, GAPS dieters, FODMAP dieters, Perfect Health Dieters, Atkins and 100 other dieters on various diets -one thing is certain. 100 people would say keep up the great work! And 100 people would say I’m killing myself and dying. I’m not sure I am cut out for trying to find the right diet. Everything contradicts everything.. 10 reasons not to eat legumes, 10 reasons to eat legumes and on and on and on. It’s a minefield of good studies, dubious studies, flawed studies, studies propped up by industry. Various diet regimes have become churches with evangelical followers lining the pews and judging those who don’t believe. Their bible and god is the right one, and I’m set to burn in nutritional hell.. I’m slowly heading to the approach of eat whole foods and avoid all junk foods, exercise regularly, don’t sit around, keep stress levels way low and get on with life. If that’s going to kill me then so be it.

    • One misnomer I would like to clear up: if you went into Ketosis (which you do every night you go to sleep. how else is your brain getting glucose?) you don’t just burn your body fat, you are burning the fat that you have ingested. So suppose you have zero body fat (which is highly unlikely or else your internal organs would have no cushion), and you have been eating big chunks of cheese for a week. Your body would be burning the fat in the cheese, not necessarily your body’s fat. What Atkins was trying to achieve was getting your body to burn both fat and sugars during your waking hours. Unfortunately, because people eat a high starch/sugar diet, they never go into ketosis for any length of time, something our ancestors regularly went into.

      The part about exercise and stress free thoughts is key though, Too many focus strictly on diet, and not about their activity and mental health. Our ancestors were very active creatures. Sitting at a desk all day does all kinds of harm to our bodies.

      Since your level of activity is much higher than the average person, you can consume more carbs without gaining weight. But that would also be true if you ate a higher fat diet. The problem I think you are having is you are trying to put everything into nice neat categories. I would suggest learning more about human metabolism from a good A&P source. This is the basis everyone should start at.

  136. Paleo can get a little dogmatic about beans IMHO.

    To me, beans need to be considered like root vegetables — something to be eaten in small quantities. They are highly concentrated calories and they are also carb calories so they flow RIGHT into your fat cells.

    I don’t ever eat a big baked potato any more, but I will cut a little bit of potato, sweet potato, parsnip or carrot into a stew.

    Similarly, I would avoid a pile of beans in chili or a bean burrito, and pasta e fagioli is a total carb calorie bomb, delicious but BAD.

    But I will have a FEW black beans in soup or some lovely French flageolets if I’m making a cassoulet.

    If you’re trying to lose weight, avoid starches completely. But if you’re in maintenance mode, you can allow them in with very limited quantites IMHO.

    • I agree with you, Tom…FWIW, so does Dr. Perlmutter.

      Beans (chick peas, garbanzo beans-low in phytic acid) and tubers (sweet potatoes) are often components of my 55-75 grams of daily carbs. There are excellent health benefits from both.

      Think moderation.

  137. > Chickpeas are phenomenal for blood sugar, yet they are extremely high carbs.

    More junk science. Legumes are most certainly NOT “phenomenal” for blood sugar. They raise your blood sugar for a sustained period of time, and they are a very high calorie food, so they are very fattening if you eat them in quantity.

    If you have diabetes, sugars, grains and yes, legumes are not what you should be building a diet around. Many in the medical profession are still “treating” diabetics by having them eat carb food and then inject themselves with prescription meds. Good for drug companies, good for generating billings for the doctor, not so great for patients.

    I love beans but they should be eaten sparingly, occasionally, with plenty of protein, fat and veggies.

    Just try living on beans and tortillas for a little while and see what happens to your waistline — which by the way is a pretty good indication of what’s happening to your diabetes and heart disease risk.

  138. Can some anti-carbers comment on this info regarding beans?


    For people who have diabetes, controlling blood glucose is paramount in preventing long-term complications such as heart disease, nerve damage and kidney disease. For people with pre-diabetes, managing blood glucose levels can prevent a future diagnosis of Type 2 diabetes.

    Diet is a key to blood sugar management, whether a person is taking diabetes medication or not. When added to a high-fibre diet or a low-glycemic diet (one with complex carbohydrates that allow the slow release of sugar into the bloodstream), legumes have been found to lower fasting blood glucose and insulin readings.

    Research even suggests that eating legumes can substantially reduce the risk of developing Type 2 diabetes.

    In the new study, researchers from the Risk Factor Modification Centre at St. Michael’s Hospital in Toronto analyzed the results of 41 randomized controlled experimental trials to assess the evidence that beans benefit blood sugar control.

    The trials were conducted in a total of 1,674 people with and without diabetes. The review included studies measuring blood glucose control when legumes were eaten alone, when added to a high-fibre diet, or when part of a low-glycemic diet.

    When eaten on their own or part of a high-fibre or low-glycemic diet, legumes lowered fasting glucose and insulin levels. Legumes were also found to improve glycosylated hemoglobin (HbA1c), a marker for longer-term blood sugar control. (The HbA1c blood test provides an average of blood glucose measurements over the past six to 12 weeks.) In fact, when legumes were eaten as part of a high-fibre or low-glycemic diet, the significant reduction in HbA1c seen in people with Type 2 diabetes was comparable to that achieved by oral medications.

    The blood-glucose-lowering effect of legumes was strongest for chickpeas. But benefit was also seen with black beans, pinto beans and red and white kidney beans. And it didn’t take a large portion to see improvement in blood sugar control. Eating only ahalf cup (125 ml) lowered fasting glucose and insulin levels.”

    So… Chickpeas are phenomenal for blood sugar, yet they are extremely high carbs. This seems to fly in the face of carbs wreaking havoc on blood sugar, so what gives?

    • “Atkins for Life” by Robert C. Atkins: page 42 “step 5: Beans and Legumes. Don’t skip lentils, kidney beans, pinto beans, black beans, and some fifty other varieties of legumes. Their relatively high carb content is offset quite a bit by their high fiber content, which slows their impact on blood sugar. Nonetheless, you still need to keep the portions small. You’ll get about 12 grams of Net Carbs from just a quarter-cup of cooked beans. By themselves or added to soups, stew, and sauces, beans are very satisfying.”

      I think if you picked up a copy from your local library and actually read it, you can save everyone a lot of time.

      • From :”New Atkins Diet for a New You”.. latest edition

        “Eat absolutely no fruit, bread, pasta, grains, starchy vegetables or dairy products other than cheese, cream or butter. Do not eat nuts or seeds in the first two weeks. Foods that combine protein and carbohydrates, such as chickpeas, kidney beans and other legumes, are not permitted at this time.”

        Beans are clearly not phenomenal for blood sugar control. They are better than processed foods for sure since they have a good deal of fiber. Atkins does not allow them when you are trying to induce your metabolism to switch from sugar burning to fat burning. You can use them a later in Atkins in low amounts. That is not exactly a ringing endorsement.

        Legumes are shunned more strictly on the Paleo Diet. They are low in nutritional value. They also contain properties that prevent nutrients from other foods from being absorbed properly and they may help to cause leaky gut syndrome.

        Here is a link to a good article, “10 Reasons to Avoid Eating Legumes”

  139. Nobody knows for sure what early humans ate but we do have detailed reports of isolated aboriginal populations before their diets were transformed by Western flour and sugar. There is a pretty good discussion of this in Gary Taubes’ book “Why We Get Fat.”

    The Inuit lived on seals, fish, whale blubber — no plants whatsoever. And were remarkably healthy — no cancer, no diabetes, no autoimmune diseases — until flour and sugar reached them. The Maasai of Africa were exclusively meat eaters and extremely healthy until they started eating flour and sugar. South Pacific islanders were living on coconuts, fish and pigs and were extremely healthy — until sugar and flour arrived. The Kiyuku of Kenya by contrast were plant-eaters — they were farmers for at least 1,000 years — and they, too, didn’t start seeing western diseases until they were explosed to western sugar and grain.

    There is simply no basis for saying meat and dairy is the cause of western diseases because meat and dairy aren’t what was shipped around the world. The thing that had shelf life without refrigeration was flour and sugar and products made from them.

    • You don’t hear much about bugs. I suspect paleos actually consumed a lot of bugs and meal worms. This is something I hope to get into in the near future. There are even projects attempting to bring this to the average consumer:

      • Just for the record, Paleolithic people’s diet varied tremendously, depending on what was available in their environment. Sweeping generalizations only muddy the issue.

    • Weston A Price’s book Nutrition and Degeneration is also an excellent resource. He studied isolated peoples all over the world in the 1920s. He did a very thorough analysis of dental caries in peoples who had maintained their traditional diet and those who had begun to incorporate “foods of modern commerce.” He thought of the teeth as a window to internal health. His book is fascinating. He noted that people ate vastly different macro nutrient ratios, but all their diets had the following commonalities (listed under “Characteristics of Traditional Diets”):

    • And yes, I think it’s just a lot of speculation to assume that people ate primarily vegetables. The fact remains that without the fat soluble vitamins (A,D and K2), the body cannot utilize the nutrients from all those vegetables. Perlmutter seems to go this route too. I really think it is to make their views more acceptable to the majority of the public who simply can’t wrap their heads around the idea that fats, especially animal fats, are very healthy and very necessary even more so than vegetables.

    • I do blame white flour and sugar as the culprits. As well as the demonizing of the healthy animal fats, in favor of inflammatory seed oils. These foods change the gut flora, which dictates what we crave and how we hold onto weight.

      I am not fully convinced grains belong in this group though.

      The isolated Swiss of the Loetschall Valley ate primarily a dense rye bread with a thick slice of cheese (equal in size to the bread). The cheese was made from Spring cow milk (exceedingly high in the fat soluble vitamins- especially K2).

      The isolated Gaelic of the Outer Hebrides ate primarily oats (in the form of cereal and oat cakes) with fish and barley.

      Neither of these populations ate many vegetables (except those grown in summer). They thrived on these diets. Their health was far superior to those living nearby in urban areas. Price determined that the modernized Gaelic had 23 times the rate of tooth decay as their isolated counterparts. Along with the increase in dental caries and cavities, the people who had adopted modern foods showed other signs of degeneration and an increased susceptibility to disease.

        • Yes exactly. They were all long fermented. In every culture surveyed that ate grains and starches, they were ALWAYS fermented. The Swiss rye bread was a true sourdough. The oat porridge was often 24 hour fermented. The Polynesians ate poi (fermented taro root). The Peruvians fermented yucca.

          So the problem is not inherent in the grains/starches, but in the processing, refining and loss of traditional preparation techniques.

  140. I think the idea of sugars and starches being the main cause of our problems compelling. Especially when you consider the fact that in the 80’s the government reworked the food pyramid to take in less fat and more carbs and we got fatter. In the 80’s the average american ate a diet that contained aprox. 30% fat, which has actually been reduced to 20% now…. and the obesity rates when from growing slowly to skyrocketing. Dr. Lustig, the endrocrinologist, who wrote Fat Chance and says that it is likely that our problem stems from having a High Fat/High Carb diet. He says that we need to see early man not as hunter/gathers but as hunters or gathers and that they were rarely both at the same time. When vegetables were plentiful they didn’t run out and risk their lives to kill a wild boar, they just ate the vegetables and when the vegetables were gone they went out and risked their lives and killed an animal. I myself have no gluten allergy and diabetes does not run in my family but I have lost weight and my thyroid function has improved living a lifestyle with almost no starch or sugar.

    • I think Dr. Lustig has engaged in some speculation when he said hunter gatherers ate plants preferentially because it was safer than hunting.
      Try going out into the woods or a savanna are gather up enough wild plants to sustain you and your little band of 20 souls. It’s very very had to get enough to eat that way.

      Plus, many plants will poison you if you pick wrong. Plus, many plants and especially starchy tubors and roots must be cooked to be rendered safe to eat. Pottery has only been around for about 6,000 years. I am sure there were some cruder cooking methods, but eating lots of plants and tubors was not at all ‘safer’.

      Rather, our Paleo Ancestors hunted mega fauna, large animals. One moose or elk could last many weeks .A mamouth could feed a band of people all winter.
      Plants are a supplement.

      Lustig is right about the sugar of course. But we must also eat far more fat then we have been led to think is healthy. We are starved for fat and it’s lack in our diet is as big a problem as too much suger.

  141. Dr. Perlmutter recommends a mostly vegetarian diet with meat only as a “Garnish”..

    He is spot on about very low carb and high fat, but he seems to diverge from other experts like Dr. Eenfeldt and another popular low carb high fat advocates on meat eating.

    I wonder if he was a vegetarian before he came upon low carb high fat and maybe brought some of that paradigm over?
    Or does he have some credible evidence about meat eating past that it should be grass fed?

    Does anyone on this thread know or have an insight?

    • I hate to rain on the Grain Brain parade but this just made the news:


      New molecule protects brain from detrimental effects linked to diabetes and high blood sugar

      “Recent studies indicate that high levels of sugar in the blood in diabetics and non-diabetics are a risk factor for the development of dementia, impaired cognition, and a decline of brain function. Diabetics have also been found to have twice the risk of developing Alzheimer’s disease compared to non-diabetics. Now, researchers from the Hebrew University of Jerusalem have found a potential neuro-inflammatory pathway that could be responsible for the increases of diabetics’ risk of Alzheimer’s and dementia. They also reveal a potential treatment to reverse this process.”


      This almost makes the grain brain argument obsolete. I predict within 15-20 years technological manipulation of the human body (aging reversal, ability to freely regulate key and deep biological components, genetic modification, human microbiome modification, etc) will leave us with little to worry about. Also in the news, a cheap and abundant way to produce stem cells, heralded as one of the biggest medical breakthroughs yet:

      In that case if diet damages gut, liver, pancreas, etc then no problem these organs are easily regenerated.

      Then you might say, what about bad diet causing cancer? Well, it looks like cancer is about to be completely eradicated as well with a new breakthrough announced this week:

      All forms of cancer reverted back to normal tissue with one treatment. Scientists claiming “the dream of the eradication of cancer is at hand.”

      It’s even looking like development of a pill that simulates exercise is at hand.

      So in conclusion, at the rate of medical advancement which is growing at a wildly exponential rate. In 15-20 years spending half the day worrying about what we ingest could be a thing of the past. I also suspect we will see nano-tech pill treatments that reduce blood sugar and fat levels only when those levels get out of hand. They will be like a daily multi-vitamin. We’ll see nano-tech pills that gently cleanse arteries of plaques within 5-10 years.

      Exciting times. I doubt I will ever use such technology as an excuse to be a gluttonous pig, but we are quickly heading to a level of biological manipulation that should soon make all this worry and debate a thing of the past.

      • Yeah….. I dunno.

        Occam’s razor, the simplest solution is probably the best.

        Depend on the bandits in the pharmaceutical industry to come up with super sophisticated nano technology, wiz bang pills, implants and injections.


        Eat lots more butter.

        I think….. the latter

      • Well….I suppose when scientists are looking to scare up some more investors, they issue a glowing press release. One only need review past articles trumpeting the latest “breakthrough” to see the pattern. I will take those with a healthy dose of skepticism.

  142. All this talk of ketosis has me thinking…

    I do not monitor anything really- ketones, blood sugar, calories or carbs. This works for me. I don’t like fixating or feeling restricted. I prefer to go off how I feel. So anyway this laissez faire approach means that I probably don’t know the mechanisms that have helped me to maintain a healthy weight.

    In my last pregnancy, nearly every time the midwife tested my urine, I was spilling ketones. I usually eat a protein rich breakfast. typically 3 eggs with salsa Verde (garlic, parsley, lemon zest, olive oil) and some cheese with a few slices of apple. I usually had late morning appts. I think I typically eat 175-200 carbs a day (I’m guessing). I also nurse my toddlers while pregnant. Do you think I am fairly regularly in ketosis even while consuming this many carbs due to the caloric requirements I have due to nursing and pregnancy? Thanks in advance.

    • Even at some appts later in the afternoon, I spilled ketones. I did not feel hungry. I eat a lot while pregnant. Well, actually always. I find it hard to keep up with feeding three young kids and myself. I usually gain 40-50 lbs while pregnant. I usually lose all but 10 lbs within the first 6 months and the last 10 within a year.

  143. Great stuff, Julie, thanks for posting.

    What you are basically doing is trying to improve your risk profile by maintaining low blood sugar and low insulin for as much of your day as possible. There really isn’t conclusive proof that it will work, but the circumstantial evidence is awfully intriguing, isn’t it?

    We do the same thing — eat low carbs, and low-glycemic carbs, with generous fat and protein. And we do a lot of small fasts — skip breakfast, not eating much on weekends. We eat when we’re hungry and it’s amazing how often we’re NOT hungry because we’re off the blood-sugar roller coaster. One your body’s ketosis function is working properly, you can fast pretty much without being hungry — it feels good in fact. I’m fairly certain I am using my body fat as it was designed to be used — as an active short-term supply of energy between meals. It’s like using any other organ or group of muscles.

    Think about how humans were evolved to survive on always varying (and frequently scarce) food sources. Were our bodies evolved to live with perpetually elevated blood sugar due to the introduction of carb food and sugar snacks every 60 to 90 minutes, 15 hours a day, 365 days a year, for decades?

    How did anybody ever get the idea that it would be a normal healthy lifestyle to be eating 5-6-10 times a day? No wonder Americans are getting sick in such huge numbers. It’s a a testament to the incredible durability of the human body that we don’t ALL have type 2 diabetes.

    People (and unfortunately their doctors, who should know better) are frightened by “ketosis” or “ketogenic diet” because it just SOUNDS exotic.

    But fasting is something we all do every night. If you go to bed without a late night snack, your body will almost certainly be generating ketones by morning — otherwise your brain would shut down for lack of fuel.

    Fasting even for several days is something that people have been doing for thousands of years as part of religious and health rituals.

    One of the most ridiculous things the medical establishment does is tell people they need to lose weight, but if they actually exercise or fast enough that they burn fat, the establishment says, don’t do that — it could be dangerous!

  144. Just read a little Beaker before you try to speculate.

    If you want to know about ketosis (and low-carb in general), a really good starting point (and very scientifically mainstream) is the “New Atkins” book overseen by Eric Westman at Duke University.

    Ketosis is indicated by the presence of ketones in the urine, and you can buy test strips at Walmart that will tell you not only whether you’re producing ketones but at what levels. It’s not the precision that you would get from a lab but it can give you a pretty good idea, and it is basically real time data.

    A lot of low-carbers use these religiously because if you’re making ketones, it’s a pretty good indication you are burning fat and on track to lose weight.

    The Atkins method is all about finding each individual person’s tolerance for carbohydrates, so the test strips are very useful when you’re trying to find out whether your threshold is 20 grams or 50 or 100.

    Ketosis is nothing exotic at all and not dangerous. If you’ve gone to bed without a nighttime snack (i.e. it’s been 10-12 hours since your last meal) your body is probably in mild ketosis. It just means your blood sugar is low so, in order to maintain brain function, your body burns a little fat for fuel. It’s all good and normal for a human body to do.

    What is abnormal, and toxic, is the American style of eating which is to stuff your face with carb snacks every waking hour so your body is UNABLE to ever burn fat. Everybody should be burning fat at one time or another or everybody would end up obese.

  145. This makes me so angry when people believe stuff like this. Beaker, nutritional epidemiology used to draw conclusions about what to eat is simply garbage science. There is a great discussion of this by Gary Taubes here:

    When you survey huge numbers of people on what they eat and then run correlations with health outcomes you WILL get correlations. if you have a large enough sample and a big enough survey, you can get hundreds and hundreds of correlations that meet the test of statistical validity. You can cherry pick them and get your name in the newspaper. But you don’t get causation and you definitely shouldn’t be drawing conclusions on what is safe to eat. What you don’t have is actionable knowledge.

    Say there is a correlation between people who report eating beef and bowel cancer. Say people who report eating beef are likely to eat it in the form of hamburgers with buns, and french friends and sodas. Maybe they’re also likely to smoke more cigarettes. Maybe they eat more fast food and watch more TV and spend more time in their cars and don’t care about their health generally.

    Meanwhile people who report eating less beef are more health conscious — they exercise, don’t smoke, maintain their weight, eat more vegetables and tofu. Maybe it’s the smoke, the sodas and white bread buns, the obesity and the lack of exercise that really causes the cancer. Maybe tofu prevents cancer. Or maybe it’s the sauce you put on the tofu. Or the sake you drink with the tofu. You can run all the regressions you want to TRY to control for factors like that but you really can’t get to the bottom of it. Patterns of behavior are very, very complicated.

    As Taubes rightly points out, survey type studies should be used to develop HYPOTHESES. The hypotheses need to be tested with controlled studies. And only THEN do you begin to have causation and enough information to make recommendations.

    The problem is controlled studies are expensive and, especially in the area of diet, very difficult to design. So unfortunately a lot of people in the dietary science field just SKIP THE ACTUAL SCIENCE and draw conclusions based on survey data. Which helps get them journal publications and grants and cushy jobs but doesn’t really advance our knowledge of what to eat.

    Really it’s terrible because not only are you getting pseudo knowledge, you may be actually recommending the OPPOSITE of what people should be doing to make themselves healthy.

    And that is how we got where we are today — with government policy recommendations for a “heart healthy” low-fat high-carb diet that has resulted in an epidemic of obesity, diabetes and Alzheimer’s.

    Bad science is making a hundred million people sick and causing what is increasingly looking like the greatest public health crisis in American history. We are literally eating ourselves to death here in the USA.

    • I would add that these studies don’t differentiate between feed lot meat and grass fed/pastured. That is a huge factor. They aren’t even the same food. The Omegas are completely out of ratio in conventional meat.
      I think a lot of our problems come from grouping these foods together as the same thing. They are not. One is a food and the other a frankenfood. Same with organic vs non organic. It’s crazy that we even think in these terms. There is only what the body perceives as food and what it doesn’t. Anything it doesn’t perceive as food puts it in a constant state of inflammation.

      • …not to mention, Dr. Perlmutter NEVER recommended heavy meat or cheese. I think he recommends 2-3 ounces of wild-caught, free-range, or grass-fed IF you even chose to eat animal protein. His recommendations are also completely compatible with a vegan diet.

        Beaker, you’ve clearly not read the book. Here’s a recent Medscape article that offers a great synopsis. Note, Dr. Perlmutter recommends GARNISHING with high quality meat.

        I’m guessing all these haters would realize Dr. Perlmutter’s recommendations are far from draconian IF they actually took the time to read the book. Just saying…

    • Here is one thing that we do know from a well controlled study by Dr’s Phinney and Volek.

      There is good evidence that the saturated fat circulating in your blood is a strong indicator of future heart disease.

      Phinney and Voleck have clearly shown that when you keep carbs very low and eat high levels of fat thereby becoming Keto adapted, the saturated fat circulating in your blood GOES DOWN.

      That may seem counter intuitive but when you are keto adapted you burn fat preferentially for your fuel. It doesn’t stay in your system very long as it is snapped up and quickly used for energy.

      When you eat too many Carbohydrates, your blood fat levels go up… Go figure

      So dont be too worried about observational studies that show low carb diets hurt you. Credible scientific evidence is quite the contrary.

      • Most people who think they are in “ketosis” are dreaming. Show me the blood work being taken every hour for weeks to confirm this. So at best most are likely swinging in and out of ketosis which is highly detrimental. Until personal (smart phone/device) 24/7 blood monitoring comes of age these people will not truly know if they are in ketosis or not. I think this tech will be available within 5years.

        • I use ketostix throughout the day- not blood work- but pretty accurate. I’m fairly consistently in mild ketosis. Pass along your address & i’ll be happy to send them over 😉

          • Hi Julie,

            Just wanted to jump in here to recommend that you visit Jimmy Moore’s posts on his nutritional ketosis experiment (n=1). He had compared the sticks and blood metering and claims that the sticks are extremely inaccurate. I’m not suggesting you are not actually in ketosis, just wanted to mention this in case you hadn’t read about it.

            • Thanks, Mary.

              I am aware that ketostix are not as accurate as actually serum testing, but they are a useful tool. Jimmy’s podcast actually points out that IF you are not achieving a pink color, you may still be in ketosis IF your body is using the ketones as quickly as you are making them. Mine are pretty consistently pink, sometimes darker.

              I eat between 55-75 grams of carbs daily but also practice intermittent fasting and caloric restriction- contributing to my ketone production. I usually eat two meals a day and let 12-16 hours go between my last meal of the day and the first of the next- easy to do with a mildly ketogenic diet. This is an important part of Dr. Perlmutter’s protocol that I rarely see discussed. How we eat is just as important as what we eat. And, the importance of daily exercise must be emphasized. Diet alone is not enough. This is a lifestyle makeover.

              I have 2 copies of Apoe4. Statistically, I have very high odds of developing Alzheimer’s and CVD. Homozygotes, who live in developing parts of the world, do NOT go on to develop these Western diseases. These conditions are a direct result of our affluent society.

              • Hi July,

                Now I remember you from earlier in the thread, where you spoke about your high risk for Alzheimers. I would like to commend you for following such a careful diet to reduce your risks. That’s one of the main reasons that I really didn’t like this article–it seemed to be sweeping the keto diet as a means of Alzheimer’s completely under the rug. There was a woman who posted earlier that also had Alzheimer’s in her family who was quite relieved to hear Chris say that whole-food carbs were not an issue.

                Certainly, the keto diet is not for everyone. I have tried it to lose weight but it has not worked for me–and I am really tired of eating so much fat–so I am exploring other options. If I had Alzheimer’s in my family though, I would definitely be paying close attention to Perlmutter’s recommendations (even though there may not be hard scientific proof yet).

      • Hi Marc,

        I think this is a really important point that people tend to forget (I saw this in one of the interviews with them on youtube, but I had forgotten about it).

        The crucial thing to remember is that their study subjects were truly keto-adapted, such that fat really was the preferred fuel and thus got whisked out of their blood. Many people doing Paleo are not keto-adapted because they are not restricting whole-food carbohydrates/safe starches.

        Even the Perlmutter recommendation of 60 gr. of carb may not be keto for some people, who need to go quite low on carbs to start producing significant amounts of ketones.

        I for one feel that if a person is going to do really low carb, they are better to really do it right to ensure they are keto-adapted and burning all of the fat they eat.

        • Here is info from Phinney- Volek about their study that demonstrated a high fat diet lowers fat in your bloodstream:

          Comment. Among many original findings in this study of 40 people with metabolic syndrome put on either a high carb or a low carb weight loss diet, there were two that are extremely important. One, this is the first human study to show that humans who are keto-adapted have decreased blood levels of saturated fats despite eating more of them (Forsythe 2008). A couple years later we replicated this remarkable finding in a controlled feeding study in normal-weight men fed isocaloric weight maintenance diets (Forsythe 2010). Two, this study definitively demonstrated that being keto-adapted is associated with significant, across-the-board reductions in a host of biomarkers of inflammation. In a follow up paper, we published data showing that the low carb diet improved fasting and postprandial vascular function in response to a high fat meal (Volek et al. 2009).

  146. It’s a little scary to see people here promoting such much in animal products and animal fats. Many studies echo the below text:

    “The study found that men and women who eat a high protein diet which consisted of a high percentage of meat and cheese, had a higher risk of early death. The study found, on the other hand, that those that eat a high protein diet which consisted of mostly plant-based protein had a lower risk than average of early death.

    The study holds a lot of weight because it was far-reaching and included more than 85,000 women and 44,500 men studied for a period of 20 to 26 years. Lifestyle factors like alcohol intake, exercise, and multivitamin use were taken into account as well and the participants all started with a clean bill of health–no cancer, diabetes, or heart disease.

    According to the study:

    A low-carbohydrate diet based on animal sources was associated with higher all-cause mortality in both men and women.”

    Maybe these folks on LCHF diets don’t have brain issues because well… they don’t live long enough to. That’s one way around the problem I guess.

  147. Tom and Bruce,
    Thank you for your responses. I understand your perspectives more clearly now. I think we probably share more in our approach, than we disagree on. Tom, your Meditteranean approach is far from VLC, so I appreciate that. I am a huge believer in the importance of fat and cholesterol, so you will get no argument there from me. I think low carb can be very helpful for obese people and people heading down the metabolic syndrome route. No argument from me there either. I think the part that bothered me was this idea that carbs are bad for everyone and the only reason people eat them is that they don’t have enough self control. I can honestly say I do NOT crave carbs, but my body runs better if I eat a moderate amount of them. I have also been pregnant and/or nursing for over 6 years now. And that requires a huge hormonal and caloric requirement. For some reason my body does better with this burden when I include carbohydrate. It is in no way the mainstay of my diet. I think carbohydrates definitely can be addicting. They were for me before I healed my gut and I do think many people are not aware of the importance of fermented foods in maintaining gut flora (Kresser is an exception).

    I appreciate carbs for things like:
    Sourdough bread with loads of pastured butter and 3 poached eggs.
    Smoothie- 2 1/2 cups full fat milk kefir, healing 1/4 cup coconut milk, 4 raw egg yolks, with 2-3 cups berries
    Soaked baked oatmeal with lots of butter, egg and cream
    Mashed potatoes with lots of butter and gut healing gravy

    I find that it’s even easier for me to include ample fats with little bit of carbohydrate. I don’t believe cereals and doritos are even food, so I don’t consider those carbohydrates. I speak of properly soaked and soured grains, potatoes, fruits. These things my family thrives on to deliver those healthy fats.

  148. Elizabeth asks: If 60% of the calories of my diet should be fat, how do I get that? I can’t stomach eating spoonfuls of butter

    First of all, 60% of calories from fat is a lot. You don’t have to be that radical. How about aim for two thirds of calories from protein and fat and see how you feel on that. If you don’t need to lose weight, one-third of calories from good quality low-glycemic-index carbs is probably great.

    You get there easily and naturally if you just stop avoiding fat. People are so accustomed to doing “low-fat” versions of everything — just quit that. Eat food food with the amount of fat that comes naturally in the food.

    Enjoy nuts, avocados, soft cheese (goat cheese and good mozzeralla and swiss are mainstains for us). Don’t automatically skim all the fat out of your soups and stews. Go ahead and eat dark meat chicken and enjoy oily fish — anchovies, sardines, wild salmon and haddock. If you’re having white meat chicken, cook it with generous olive oil or butter — it will taste so much better.

    Go ahead and enjoy a little steak every couple of weeks. Make sauces from pan drippings, wine and a little cream — a mainstay of French cooking. Eat an egg every day for breakfast — eggs have been vindicated by almost everybody. We eat our egg with a little leftover roasted veggies, and occasionally melt in half a slice of swiss cheese. Or good quality bacon (cooked right, not incinerated!). Or a salmon omelette with a little goat cheese or cream cheese, which is wonderful.

    If you drink milk, just drink whole milk. If you drink your coffee with cream, just use heavy cream instead of that lethal fake “nonfat” creamer (ever read the ingredients list for that dreck?). Buy whole milk mozzarella, stay away from reduced-fat sour cream. Don’t be afraid to melt a little a little butter to your veggies — it will make green veggies taste much better and might help you eat more veggies — which you should be doing if you’re cutting down on carbs.

    You really don’t have to do anything special to add fat to your diet. You just need to discard all the “low-fat” junk foods and food recommendations that have led to this epidemic of obesity in America and eat the level of fat that your grandparents probably ate.

    One final note, which goes without saying. Don’t add fat and continue to eat lots of sugar or refined grain — if you are eating high-glycemic-index carbs, the extra dietary fat may well be harmful.

    But if you’re cutting the carbs, your body will handle the fat well, you won’t put on weight, you’ll feel great and probably your blood lipid profile will improve. LDL will go up but your ratio will be far better and your triglicerides (which are really a better marker than LDL for heart problems) should go down.


    • And one more though on adding fat to the diet — if you allow natural levels of fat back into your diet, you will almost certainly start to eat smaller portions, and have less of a need to snack, because the food will taste better, you’ll feel more satiated, and you won’t have the blood sugar spikes that cause you to get hungry an hour later.

      One experiment everybody can do that is very telling. One day for breakfast, have a one of those commercially baked “low fat” multigrain banana muffins and a glass of organic fresh-squeezed juice. It will be close to 1000 calories. And then see how long it takes you to get hungry again — chances are, inside of 2 1/2 hours (and sometimes in as little as an hour), you’ll need a snack or an early lunch.

      Then another day for breakfast, have a high-protein, high-fat, low-carb breakfast — an egg, cooked in butter, some bacon or sausage (not cooked dry but with some of its fat), or fish (fish and eggs for breakfast with capers and lemon, cooked in olive oil, is a Mediterranean staple BTW) . Or if you like them, just have a can of sardines for breakfast. Or some veggies with melted swiss or mozzarella or full-fat goat cheese. But — no sugars, no grains, no fruit of any type. And coffee or tea with cream. This breakfast will be well under 500 calories and probably closer to 300. And then see how long it takes you to get hungry. You will probably be amazed by the result.

  149. Re carb “addiction” — at first glance it doesn’t seem right to compare food addiction to substance addiction (narcotics, alcohol, nicotine, caffeine)

    But when I actually try to draw a line between food and substances, I have trouble.

    1) Your body becomes accustomed to the constant presence of a chemical (alcohol, opium, caffeine). In the case of someone on a primarily carbohydrate diet, that substance is a constantly elevated blood glucose.

    2) When you cut down on the substance, your body has an adjustment period that can be uncomfortable, even painful. When I stop drinking coffee, I get headaches. When an alcoholic stops drinking, he/she can get the DTs.

    Those of us who have cut carbs (Atkins Induction or something similar) know how uncomfortable it is while your body adjusts to lower blood sugar. You get the shakes, the cravings are intense, you can have trouble sleeping, you can faint, you can get headachy, constipated — all kinds of symptoms that are really quite similar to substance abuse withdrawal.

    3) After the adjustment period you feel fine again, and in many ways better than before. After a week without coffee, the withdrawal headaches go away. Similarly, after a few days (or sometimes 7 to 10 days) with little carbs, all the symptoms above subside. Withdrawal for heroin and alcohol is much more severe, which is why those substances are so dangerous. But the withdrawal/adjustment pattern is the same.

    4) The cravings in some ways never go away, and rexposure to the substance causes problems. Does that mean an ex-heroin addict NEEDS heroin? Does it mean someone who used to live on bagels/bananas/Doritos NEEDS those things to elevate their blood sugar. No.

    But the cravings never completely go away. After 5 years of generally avoiding sugar, I still crave sweets — but I no longer them enjoy very much it because it tastes too sweet. Most pastry and desserts are too sugary. However, if someone brings chips or pretzels to my table, I have tremendous difficulty resisting. It gives me a little bit of insight into what it must be like when a crack addict is offered some of that substance.

    Anybody who’s quit smoking knows how hard it is to not want a cigarette when someone else is around you smoking. Carbs present the exactly the same problem because carbs are still tolerated — even encouraged — in a work environment.

    I know it sounds silly, it sounds overly PC, but people should be discouraged from bringing cookies and doughnuts to the office because it is so hard for us “recovering carbaholics” to resist — I would guess eventually carb junk food will be discouraged in an office environment just like cigarettes are now.

    Things that spike your blood sugar are trouble. Office snacks should be low-glycemic-index — vegetables, dips, hummus, nuts, olives, cheese avocados etc.

    When I see people in an office all gathered around a cake, I can’t help thinking — this is what it was like 40 years ago when everybody would gather to enjoy a “smoke break” together. Made it so much harder to quit tobacco.

  150. There are some new personal diagnostic devices coming out soon. One is like a watch that shines an LED into your skin and then uses a sensor to monitor blood glucose levels and nutrient levels. I’m looking forward to wearing a device like this that monitors 24×7 and collates the data to a smartphone app. I think this will go a long way to everyone being able to customize their diet. Your phone could even alert you to spikes or deficiencies throughout the day. However, we also have a new device in the news an ‘artificial pancreas’ that is the size of a watch, fits in the abdomen, monitors glucose levels and secretes insulin as required. So what will technology do for us? Will it allow people to tailor their diet and maintain healthy glucose levels, or will it allow them to say “woopeee! my new artificial pancreas means I can eat whatever I want!”. Interesting times..

    • Ah, and also new possible nano-technology that will allow people to take insulin pills. If they need no insulin nothing happens, but if blood sugar passes a threshold the pills release insulin.

  151. Exactly. When my wife proposed the family go on a diet, her mother’s immediate reaction was “I don’t want to have to give up my Cokes!” Both my wife and I have experienced this with family and co-workers. Its amazing what people will give up for a diet, but heaven forbid you take away my starches/sugars.

    One thing I picked up from my research is that when people ingest a large amount of carbs, serotonin is also produced. Serotonin helps sedate the nervous system. It occurred to me that when I craved carbs the most, is when I was stressed or bored. Once I made this connection, then came the long process of understanding how to unhook my mind/body from this stress=carb craving and to sedate myself through other means. This lead to higher protein intake, higher fat intake (nuts fill the bill nicely) hydration, and some type of physical workout program (hiking and tai chi).

    So of course if we are craving carbs and then consume carbs, we feel better. A smoker does the same thing with cigarettes. Of course, sometimes we have a protein craving, and we sure feel better when we eat some. But does the craving represent a need, or is it more an emotional/stress stimulas, or something entirely else?

    One weird thing my wife went through some years back was having intense cravings to chew ice. Its was getting so bad that she was actually getting sick by chilling her body. Finally we learned that ice chewing cravings are related to iron anemia. Image that! So she upped her iron intake, and presto her cravings went away. But to follow Megan’s logic, she should have just eaten more ice.

    • I read that carbs are needed to release serotonin and I know serotonin is not bad.
      When you incresed your protein and fat intake did you experienced some changes in your mood?

      Thank you

      • When you have adequate fat in your diet and are not eating very many carbs, you are signalling your body that all is well.
        For a woman the signal to her body can mean that there is sufficient good food around so it’s okay to bare a child… She may then go looking for you.

        “Oh little pussycat..Where arrrrre yoooou?”

        • At the risk of sounding flippant, I had sudden images of women tearing off their children’s clothes! (bare a child?). But I do want to ask a question. If 60% of the calories of my diet should be fat, how do I get that? I can’t stomach eating spoonfuls of butter, or knocking back coconut oil from the bottle. What is a realistic way to incorporate that amount of fat? Now that I am low carbing, it is more difficult. No bread to spread butter on, no mashed potato oozing with butter and cream. Seriously, what do people do?

          • You burn both the fat you eat and the fat you have stored to equal 60% plus of your energy resources once you are keto adapted..

            Upping your dietary fat intake simply means choosing fattier cuts of meat, especially organ meats. Add butter to everything or add oil or coconut oil or lard. Cook with it, add it.
            Use heavy cream, snack on cream cheese or other high fat cheese. Eat fatty types of fish.

            When you feel like you need more fat, simply add more grass fed butter. If you do have the stomach for straight butter, make bullet proof coffee.
            Make coffee then put in blender along with a generous amount of butter and or coconut oil… Sounds gross but is actually creamy and delicious. Easy way to get your fat intake up.

            Give to your wife or girlfriend, start college fund.

      • Yes I did, and do. While sugars satisfy the “sweet tooth”, fats and proteins provide satiety, a feeling of satisfaction, and I no longer experience the spikes and dips. It took two weeks of being on 20 carbs a day to finally shake my last bits of cravings. I tend to have more “desires” now, rather than cravings.

        What I have been experiencing now is more of a more normal “hunger” when I haven’t eaten in a stretch, rather than a severe hypoglycemic state in which I lost my ability to focus and deal with even mild stresses. I would lose my temper, and generally become unable to perform simple tasks until I snacked or ate a decent size meal.

        Of course, all this changes based on my level of physical activity. I can hike all day long with little need to eat. Twice I experienced a severe drop in blood sugar, and I simply rested until I felt better (exercise will drop blood sugar levels). I even feed on some Miner’s Lettuce once to help recover.

        So in short, yes, since my whole life breads and starches held a powerful pull over me (sugar not so much, not sure why), and upping my protein and fat intake, while restricting my carbs, has broken this hold, and as a consequence I have been feeling much better.

  152. The science on gut flora is bleeding edge right now and probably 75%-80% of what you are reading these days is going to turn out to be at least partially wrong. So it is hard to know what to do with any of that information. We know gut bacteria are beneficial — essential. Beyond that we know very little.

    By contrast, the relationship between carbs, blood sugar, insulin and fat storage is very well established scientifically. The key science was done 60 or 70 years ago. There is no debate about it.

    When you eat carbohydrates, your blood glucose rises, and your your pancreas produces insulin. Insulin opens gateways in your fat cells so that the insulin is stored as fat. That is metabolism 101. When your blood glucose is low, the opposite happens — fat is released from your fat cells and burned for energy.

    The reason people lose weight on low-carb diets — even eating lots of calories — is that they’re keeping their blood glucose low so their body just happily burns their fat.

    The reason Americans are fat is because they eat too many calories but more importantly because they eat primarily carbohydrates and snack a lot (and drink purified sugar products such as sodas and juices). That maintains their blood sugar in a more or less continuous elevated state during every waking hour.

    It makes sense that we are experiencing an epidemic of obesity, diabetes, certain cancers, and alzheimers and it certainly won’t surprise me if it all turns out to be related to our diet and our WAYS of eating (i.e. constant snacking to maintain high blood sugar levels).

    This part of Perlmutter’s reasoning lines up nicely with the research and I bet it will turn out to be true. It seems very logical to me that you could reduce your risk of a whole lot of problems by eating less carbs and eating more fat and protein (which does not impact your blood sugar as much). Basically eat like a diabetic eats and plan your carbs to minimize your impact.

    Genetics, gut flora, exercise level, red wine and fish oil or coconut oil — who knows how much impact any of these things have. But it is well established that if you reduce and control your consumption of carbs, you will keep your blood sugar stable-low and lower blood sugar is probably very good for you in a myriad ways.

    Similarly, this is one of the many reasons exercise is beneficial — it lowers your blood sugar. It’s why not eating between meals may be beneficial. It’s why it may be beneficial to eat a late breakfast (or no breakfast), as they do in many Mediterranean countries — that is keeping your blood sugar at low levels all morning.

  153. I have read the following arguments against carbs in the Paleo world often and they have been echoed here. Just wanted to point out that they are illogical…

    “People don’t need to eat sugars because the body can make all that it requires.”

    Makes no sense. Would you ever use that argument for cholesterol? Our bodies can make it, but we all realize that DIETARY cholesterol is ;important for maintaining many bodily processes. As is DIETARY glucose. You can’t have it both ways

    “You crave carbs. You eat them. The craving goes away just like the smoker’s craving for nicotine.”
    Makes no sense. Would you ever extend this line of thinking to protein or fat cravings? No. Only because of bias- you have deemed fats and proteins “healthy and necessary” and carbs “unhealthy and unnecessary.”

    I will say that people who have a gut flora imbalance do get unnecessary cravings for carbohydrate. On that issue, I agree. I don’t think you can trust your cravings until you get your gut flora in a healthy place. I know I couldn’t. And I do think LCHF can be helpful for those people, but it’s important to acknowledge there are other healthy ways to reset your body. And the only lasting changes come from reseting your body at the gut flora level. To do this, you must not only remove the offending foods (for many- due to Candida overgrowth- this IS carbohydrate), but also incorporate gut healing foods. This is where most LCHF diets fail to give people the lasting changes they seek. Low carb diets keep them tied to carb restriction indefinitely. The problem is the have not altered the gut flora sufficiently and fall victim to intense cravings. Healing the gut is a long term solution.

    Sorry for any typos on my phone.

    • Hi there Megan, burning up your smart phone I see ;-)))

      I think you are right that the gut dysbiosis thing is not on people’s radar as much as it should be. Certainly I was not aware that starches specifically could be at the root of my issues. Now some of the bloating reactions that I’ve had in the past are starting to make sense (like very suddenly 9-months-pregnant-like bloating after eating white rice or white rice crackers, for example).

      However, to be fair to the person who made the comments about carb addiction, the analogy you are making is not truly accurate due to the nature of addiction itself. To be defined as addiction, something that is bad for you has to be done repeatedly/to excess–often in response to uncontrollable cravings that go way beyond satisfying a need–in a way that causes negative repercussions. Many people DO have that sort of relationship with carbs, and the negative repercussions are often very clear (obesity).

      Of course no one is going around saying fat is addictive, but it’s not necessarily because they have a pro-fat bias. Rather, we are not seeing people having this type of dynamic with fat consumption, whereas there are many people who have this type of dynamic with highly refined carbs (I observe this constantly all around me–just look at the grocery carts and the people they are “associated” with the next time you go to the supermarket!).

      Also, I don’t think saying that carbs are addictive precludes the notion that gut dysbiosis may be contributing to the addiction cycle. I think the person who made the remark was commenting on my post, where I was describing craving carbs and eating way too much of them and getting fat. We could say that, possibly due to gut dysbiosis, I am caught in an addictive cycle with carbs. I don’t think the implication was that carbs are inherently addictive, in every context, in any person. That is obviously not the case.

      But look at the wider healthcare context: so many people are obese and diseased, yet talking about the benefits of carb restriction (which IS a proven weight loss method, even if it does have some potential side effects) triggers MAJOR, hysterical backlash in many quarters. I think this is also what prompted the sentiments that were expressed re addition–one wonders if the carb lovers are so hysterical because they are addictively clutching onto their drug of choice!

      I don’t know where you live, but I live in Quebec, where we have a government healthcare system that is completely falling apart under the “weight” of obesity and preventable disease. The wait times even for required surgeries and procedures are way longer than medically acceptable, partly because the system is plugged up with people who are eating themselves sick! So yeah, it’s an issue that touches a cord with me. It’s a “big” deal (pun intended). Yet Perlmutter goes on a popular show and recommends that people eat lowish-carb (60 grams not really being all that low) and people just FREAK out…

    • I made the comment I did because your logic was flawed. Cravings are just that, cravings. They can be your body signaling a need, a deficiency, or it may be related to something else. Your logic was flawed because you assume that if your body was craving carbs, therefore you should eat them. That might be so, but it might not. Can you be fair and objective and consider the possibility that there might be other factors? For example, in a personal experience, cravings to chew ice is often related to severe iron anemia. In this case, the craving to chew ice can actually make one sick, as all that ice chills the bodies core temperature. Up the iron intake, and the cravings disappear.

      So while we ask others to be open minded, please follow your own recommendations. I know personally, from my experience, and from others, that the craving for starches/sugars has nothing to do with help, and everything with abusing sugar as mood elevator. This is why Coca-Cola remained popular even when they took the cocaine out.

      Did you know excessive salt can elevate your mood? I had a friend that put copious amounts of salt on his food. In fact, he suffered if couldn’t salt his food. And its no accident that Coca-Cola has a lot of salt. So if someone is craving salt, as i do often, it may because they genuinely need more salt (since it does function as an electrolyte), or it may be that they are feeling a little low, and need the pickup that it gives some people.

  154. Interesting study on plosone:

    “Results and Discussion

    Fermentable dietary fibre decreased weight gain, liver fat, cholesterol and triglyceride content, and changed the formation of SCFAs. The high-fat diet primarily reduced formation of SCFAs but, after a longer experimental period, the formation of propionic and acetic acids recovered. The concentration of succinic acid in the rats increased in high-fat diets with time, indicating harmful effect of high-fat consumption. The dietary fibre partly counteracted these harmful effects and reduced inflammation. Furthermore, the number of Bacteroides was higher with guar gum, while noticeably that of Akkermansia was highest with the fibre-free diet.”

    another high fat study regarding damage to the hypothalamus:

    “The effect of the diet upon the expressions of pro- and anti-apoptotic genes was remarkable. The modulation of 57% of the targets, including proteins involved in both pro- and anti-apoptotic activity, suggests that the fat-rich diet indeed has a damaging effect. As observed in other experimental settings, we suspect that the activation of some anti-apoptotic proteins provides a transient protection against the harmful effects of the diet [21], [22]. However, as shown by distinct methods, ranging from TUNEL to transmission electron microscopy, in spite of the presence of anti-apoptotic activity, apoptosis was significantly increased in the hypothalamus of the HF rats. This was an anatomical- and cell-specific phenomenon since it was detected predominantly in the hypothalamus and affected mostly neurons.”

    I’m not going into details, just making a point that 1,000’s of studies can be cherry picked to promote whatever you want them to. I could do it all day.

    • Yes, it’s a pity so many in the vegan/vegeterian community are so militantly anti low-carb because they view low-carb as pro-meat. It really doesn’t need to be. I don’t know why one couldn’t receive the full benefit of low-carb or Mediterranean lifestyle eating only plants. It’s undoubtedly more of a challenge to not rely on grains and starches — but if you’re a vegan, you’re used to challenges.

      Some of the vegetarians are just lazy and want to live on sugar (fruit) and starch (bread and pasta). That for most people is certainly not a recipe for good health.

    • Thanks for the link. My parents switched to low fat vegan a few years ago and I’m always on the hunt for good info to share with them. They eat the polar opposite of what I do and it can be challenging to find middle ground.

  155. Some of you may be intererested in Andreas Eenfeldt. He’s a Swedish doctor who writes that country’s most influential health blog, which unequivocally advocates LCHF. is an English version of the blog, which is also translated into a number of other languages.

    In part because of Eenfeldt, LCHF is more mainstream in Sweden than just about any other place in the world.

    The Swedish Council on Health Technology Assessment, a government panel of experts, last year issued a landmark report saying low carb high fat was the best answer to obesity and diabetes.

    It’s the closest thing to a government endorsement of LCHF — and a reflection of how in this issue, like so many others, the Scandinavians are a few years ahead of the Americans, maybe because their governments are not so dominated by moneyed special interests.

  156. Yes I think people should be very careful of claims about “healthy” sugar or “healthy” carbs. Just because it comes from a plant doesn’t mean it’s necessary or good for you. If you guzzle 12 ounces of organic Odwalla juice, it will send your blood sugar and insulin skyrocketing just as effectively as a Sprite, and the fiber and micronutrients in the juice are not beneficial unless you actually need them (and you probably don’t).

    Similarly, while coarse grain and whole grain breads are beautiful and tasty, people should be very wary of claims that they’re all that healthier for you than white bread. First of all, as Michael Pollan discusses in his latest book, “Cooked,” most “whole wheat” flour is simply white flour with some bran additives mixed back in. It’s not anything like real stone ground flour from 200 years ago.

    From the perspective of someone who is sensitive to blood sugar spikes, whole-grain products are no better and may actually be worse. The extra fiber may slow the impact of the grain on blood glucose levels — they smooth the curve out. But that could actually be WORSE for many people because it means there is a more SUSTAINED insulin spike.

    If you are overweight, a sustained insulin spike means a longer period of time when your body is forced to store fat instead of burn fat. So it’s possible that if you’ve got to have 20 grams of carbs, better that they come from a candy bar (which will be processed by your system quickly) than a “whole grain” muffin loaded with “complex carbs.”

    Finally, the argument for the muffin will be that it includes fiber, which is good for you. But study after study has failed to demonstrate any long-term health benefit for fiber. There’s very good theory that fiber should reduce, say, bowel cancer, but every study that has been done to try to prove this has come up empty. Fiber is, at least in the studies that have been done so far, a bust.

  157. One more general comment for those who are having trouble with whole-food starches despite the PHD and CK seal of approval: people with small intestinal bacteria overgrowth (SIBO) cannot tolerate any starches well. The specific diets that address this are the SCD (specific carbohydrate diet) and the GAPS diet. I’m wondering if these may be why I haven’t been able to tolerate moderate carb that includes “safe starches” without out-of-control cravings.

    • Just saw this! (It’s hard to navigate on my smartphone). You’re on the right track! Correct the problem at the root- your gut. It’s the only lasting solution. I used GAPS Diet. It’s been three years and I have maintained a healthy weight and have zero cravings.

      • Hi Megan,

        Thanks for your input about the gut dysbiosis. Were you actually diagnosed with anything specific, or did you just figure it was that and start following the diet?

        You say you did the GAPS. I have read that the SCD is supposed to be somewhat similar. Do you know what would recommend one over the other?

        For the SCD there is a list online of allowed/disallowed foods, so I guess I will start with that and see how it goes!

        • Hi Mary,
          GAPS is based on SCD. I am not very familiar with SCD, other than what I know of it from GAPS. There were quite a few people on GAPS forums that hadn’t achieved the level of healing that had hoped for in SCD and had moved onto GAPS. I believe GAPS focuses more on the healing properties of broths. The GAPS book is great reading even if you don’t decide to follow the diet. It gave me great insight into digestion and gut health. The website is a little hard to navigate. Hope you find the answers you’re searching for.

          • Hi Megan, thanks for the info re GAPS/SCD. Following the SCD list of allowed foods seems like a simple solution for now and I already do bone broth. If things don’t go well perhaps I can move into GAPS (which I’ve heard is complicated).

            Just realizing that my problem may be difficulty digesting starches is a major step in the right direction. None of the Paleo books I’ve read mention this possibility (nor does the PHD book that I can remember).

            I’m so glad I read Denise Minger’s book, as that is what put me onto this (she doesn’t advocate against starches per se, but discusses the wide variability in the starch-digestion gene AMY1).

            Her book really helped me come to a much-needed attitude adjustment with respect to all the diet claims flying every which way). I am now so OVER reading these diet books–thank you Denise! If anyone else is truly sick of this never-ending debate, get her book! She makes a very limited number of recommendations based on the preponderance of good science, minus the guru-ism and scare mongering!

            • Thanks for the book recommendation. I saw Denise speak at a WAPF conference. And also read her takedown of the China Study. I tend to agree with her from what I know so far.

  158. Perfect Health Diet is interesting, and Jaminet’s blog has a lot of thoughtful and interesting speculation, but it is mostly speculation. To assert that carbohydrate restriction is somehow harmful to thyroid based on Jaminet’s ideas about mucous — well, that amounts to believing what you want to believe. There are alternate theories that are just as valid IMHO.

    Meanwhile, there are 18 or 19 quality studies over the last 20 years that have shown the effectiveness (and safety) of carb reduction for weight loss — don’t you think if carb control led to thyroid problems that we would have seen it noted in the studies?

    Secondly, the argument is made that if you crave something, your body must need it in some way. That is simply not valid in many cases. Many of the things human beings crave the most — nicotine, caffiene, cocaine, sugar — are clearly not necessary or desirable for human health.

    Sugar is clearly highly addictive. If you, like most Americans, drink a lot of sugary beverages — from fruit juice to drink sugary beverages — if you stop drinking them, you are going to struggle with cravings for a long time. It doesn’t mean those cravings are a good thing.

    The blood sugar/insulin roller coaster is an extremely powerful and destructive thing, but you have no idea how powerful until you get off. Because of our high-carb low-fat diet, Perlmutter argues, so many Americans have permanently elevated insulin levels that our doctors have a distorted idea of what “normal” baseline insulin levels should look like.

    No question, many people who go low-carb have trouble making making it sustainable in the long term. It really does require rethinking the way you buy food, the way you cook, the choices you make at restaurants — everything. I respect that.

    But please don’t draw the conclusion that because some people can’t resist the big bowl of pasta or the baked potato, carb restriction is unhealthy or ineffective. That conclusion does not square with the science at all. (and not that an OCCASIONAL bowl of pasta or potato is a bad thing, it’s just not the basis of a good diet)

    I think there almost no doubt that most Americans would benefit greatly from drastically reducing the amount of carb food they eat — processed and unprocessed. If the government started campaigning about carbs the way it has campaigned about dietary fat and salt, we might begin to make some progress against the obesity epidemic.

    That said, I’m certainly not arguing for a hard core ketogenic diet for everyone. The Atkins philosophy is to restrict carbs, lose weight, and when you get to a healthy weight, put the carbs back in until you are weight stable. There are people out there who advocate for long-term VLC, permanent ketosis, and the science may well validate that approach someday, but that is beyond what the literature says to this point.

    Likewise, if you’re currently maintaining a healthy weight eating what you’re eating, that’s a pretty good indication your body is handling whatever level of carbs you’re throwing at it. You might feel better without that breakfast of a bagel and orange juice, but if your weight and lipid profile are good, there’s certainly nothing definitive out there saying you need to change.

    • Hi Tom. I like your post. I too have the feeling that the PHD site contains a fair amount of speculation. Interesting, yes, but not much there to base a diet decision on for someone who really needs to lose weight and can’t seem to do so without restricting carbs.

      You mentioned that there are 18 to 19 quality studies showing the effectiveness and safety of carb restriction for weight loss. Do you know what the study period was in these studies? Obviously, if the period was only a few months that says nothing about the safety of longer periods of carb restriction.

      • Study length is a great point. My issues didn’t start until a year in.
        And I can most certainly assure you that just because Jaminet mentions PUFAs as the cause of VLC Thyroid issues that was not what caused it in me.
        I still think it’s important not to dismiss testimonials. These stories are powerful. And to say, people fail at VLC because they’re unable to resist their bowls of pasta and Cheerios is incredibly dismissive.

  159. Patti and anyone else interested,

    I have started to look at the first link provided by Patti from the PHD site. It states very clearly at the beginning that the sole conclusion that can be drawn from direct evidence is that a high-PUFA diet is detrimental to thyroid health. It also states specifically that there are no human studies looking at low-PUFA high fat diets in relation to thyroid health.

    It then goes on to detail indirect evidence that may be suggestive. I am going to look into this indirect evidence, but for now I wanted to point out that providing a link specifically stating there is no firm evidence that LCHF in and of itself is detrimental is not a great argument in favour of the “LCHF is dangerous” view, is it?

  160. I also feel compelled to make a general comment about the article that kicked off this epic thread in light of Denise Minger’s interpretation of the evidence.

    If you go back to the first paragraph of the article above, you will see that Chris’ thesis is that unrefined whole-food carbohydrates do not contribute to modern disease. (If anyone is tempted to come on here and say, “oh no, that’s not what the article was meant to support”, please go back and read the first paragraph of the article).

    One of the arguments is that, compared to primates, humans have many more copies of the gene AMY1, which is essential for breaking down starches. Chris mentions in passing that the number of copies of this gene does vary greatly between human populations, but then sweeps this directly under the rug in the interests of supporting his argument that unrefined whole-food carbohydrates do not contribute to modern disease.

    Denise Minger, on the other hand, discusses this wide variation in AMY1 copies among human populations at length. In people with very low numbers of AMY1 copies, starch spikes glucose even higher than pure glucose (and yes, she cites a study that shows this).

    So, clearly, one’s interpretation of the evidence can clearly be influenced by the argument one is trying to make. Denise is making the point that starches CAN in fact be a big problem for certain people, while Chris is supporting the statement that whole-food starches do not contribute to modern disease (and again, if you don’t think that is what he was trying to argue when he wrote the article, please go back and reread that first paragraph).

    I don’t know about the rest of you, but, in my book, the fact that AMY1, a gene that is essential for processing starch in a healthy manner, is SO variable among humans (from 1 copy to like 8) supports the contention that whole-food starches can, and do, contribute to modern disease.

  161. But, I really think it’s close minded and harmful to dismiss the fact that VLC diets are not the answer for everyone. Do you agree Tom?


    Absolutely. Carb restriction in some form or another is a very good PROVEN option for people who need to lose weight.
    If you are overweight and showing signs of metabolic disorder (reduced insulin sensitivity, high triglicerides, bad HDL etc.), low carb is something people absolutely should consider. It’s not the only way to get to healthy weight but it might be the most effective way to get there for a lot of people.

    The only other thing that has been proven to work is bariatric surgery, which is of course a big moneymaker for docs and hospitals. Outside of people who need to lose weight (which is half of American adults, including me), I find the arguments for LCHF intriguing but not compelling.

    My only real quarrel was with “I know someone who has thyroid disease after being on a low carb diet” — therefore low carb can cause thyroid disease. People shouldn’t be scared that way.

    There have been lots of good studies now — something like 19 of them — and the contention that carbohydrate restriction is dangerous has been pretty well ruled out. Our bodies are designed to do quite well with minimal carbs and many tribal people did exactly that before the fruits of modern agriculture arrived.

    I would make two other points Megan.

    1) The Atkins foundation — which is probably the most scientifically mainstream of all the low-carb variants — does not really advocate “very” low carb — say, 20 grams a day — as a permanent lifestyle. The Atkins method is to restrict carbs to lose weight, and once you reach a good weight, then gradually add back in carbs to the point that your body can handle them. So everybody knows how many grams they can handle without putting fat back on. That point is going to be different for each person depending on their genetic makeup, exercise level, body type, insulin sensitivity — lots of things.

    2) LCHF for brain health is not scientifically proven. Perlmutter connects the dots of the research in very compelling ways IMHO but there is no study evidence saying that eating less carbs and eating more fat and cholesterol will reduce your risk of Alzheimer’s or benefit your brain or body. Perlmutter is a very physician with a very good clinical and research background IN THIS FIELD but the book is his opinion as an expert. It is not definitive.

    There is of course a lot of pseudoscience out there about diet. I’d stick with what has been scientifically tested over the last 20 years and especially the last 5. The closest thing to a gold standard study was the one released in mid-2013 that showed overwhelmingly positive results for Mediterranean diet as a way to reduce heart attack risk. It was beautifully designed and the results were so striking that they discontinued it early because it wasn’t fair to the subjects on the conventional “American” diet — their death rate was so much higher. That should tell you something. Mediterranean is not “very” low carb but it is lower than the American diet, and it is considerably higher in fat — mainly oil and nuts.

    • Tom,

      Thanks for the info about the Mediterranean diet study you mentioned. Do you have a link by any chance?

      I agree with many of your points. It does seem that all the people screaming about thyroid health are pointing only to anecdotal evidence. You say that there are no studies supporting their claims. I would like to invite the people freaking out about the thyroid connection to please post links to actual studies if they have any. If they don’t, and really are basing this only on anecdotal evidence, I would like to know what the proposed mechanism of action would be. If there is some argument that makes sense as to why lack of carbohydrate would cause thyroid disorder (other than, it happened to my sister, so it could happen to you!), I would like to hear it.

      I also agree with Tom’s point about weight loss. I have not found it easy to follow a low-carb high fat diet by any means, but I seem to gain weight like crazy on anything else. I am now 5 ft tall and coming up on 145 pounds, with a lot of the extra around the middle. I think there are ample studies proving that THAT is unhealthy. The only thing I have found to even maintain my weight without losing is LCHF, but I have been scared off of that by all the screaming about thyroid health and “listening to my body”.
      Unfortunately, my body is screaming for carbs, all kinds of carbs–especially refined carbs–because it REALLY WANTS to get even fatter. So, I should listen to it, and go from overweight to obese???

      Instead of all the scare-mongering, I invite people to share ideas about how thyroid issues can be prevented while doing a LCHF diet. I mean everything has side effects, and I’m thinking that bariatric surgery (the only other proven method for weight loss, according to Tom) has a lot more potential side effects than LCHF. So why aren’t people discussing how to mitigate that potential side effect, rather than throwing the baby out with the bath water?

      • Mary, Paul Jaminet (from the Perfect Health Diet blog) has written several blog posts on the dangers of zero carb diets. I think you will find his arguments compelling. He writes specifically about thyroid in these posts:

        Also, to state that VLCD are safe because there are no studies proving otherwise makes no sense to me. I don’t think there are any verifiable scientific studies that prove jumping from a third story window is harmful, but there is enough anecdotal evidence out there to convince me not to try it. The scores of people coming forward who’ve had problems with VLCD is undeniable.

        If you are craving carbs, it is likely because your body is trying to tell you something. Your body is not out to sabotage you. It is trying to obtain what it needs to function optimally. When I include some quality carbs in my diet, my cravings for junk carbs go away. And I am not the only one to have this experience. It is actually much easier for me to stick to my eating plan when it includes some carbs.

        In the end, each of us must decide for ourselves how we will eat. I’ve read so many convincing “scientific-based” arguments on every side of this issue that I have come to realize the only real way to choose is to weigh all of the evidence I’ve read and go with what seems right, and make adjustments based on how my body responds.

        I wish you all the best in your journey.

        • Patti,

          Thanks for the link re thyroid from the PHD site. I will definitely look at these. I have in fact done the PHD. I felt quite good on it, but I was gaining weight. Part of the problem is that, unlike you, being on moderate carb is what makes me crave more carbs so badly. I have tried again and again and again to do some form of moderate carb, but each time the cravings become so bad that I end up eating way too much high carb food and I gain weight.

          It’s not purely a problem of discipline, because I have had long periods in the past when I was able to maintain very low carb (keto) and I had no cravings for carbs whatsoever. I did have relatively low energy though, and that (along with all the warnings about the dangers of LCHF) has me in search of some other form of eating plan (or some tweak that will improve LCHF for me). Right now I am eating moderate carb (with occasional high carb meals when I give in to the constant cravings). My energy is not that much better, and I am steadily gaining weight!

          You said you thought my carb cravings were trying to tell me I needed more carbs to function optimally, but because I only get the cravings when I am on moderate carb (and giving in to the cravings makes me gain weight), I think my body is trying to tell me it wants to be fat. This is why calls to “just listen to your body” really frustrate me–it’s nice if you can do that and it leads in a healthy direction. For me it really doesn’t.

          I also would like to comment on your idea that the dangers of LC are undeniable given that scores of people are coming forward after having problems with low carb. Have you considered the possibility that MORE scores of people are doing great on low carb, and are therefore quietly going about their business without “coming forward”? I’m not saying that there is no issue, but arguments that rely on faulty reasoning like this are not very helpful.

          On this note, I would like to recommend a book to everyone on this thread: Death by Food Pyramid, by Denise Minger. She goes into great detail about the strengths and weaknesses of dietary studies and gives good advice about how to weight the evidence for individual diet decisions. There is also a section about potential impacts of LC on thyroid, which she says merits further research.

          Personally, pending that further research, I would like to hear about supplements or other measures that people like myself, who can’t seem to lose any weight without doing LCHF, can implement to mitigate any possible affects of LCHF on thyroid or adrenal function and to increase energy and maintainability. Instead, all anybody ever says is “add in more carbs–it worked wonders for me!”

          I am looking forward to the book by Dr. Wahls that is coming out soon (The Wahls Protocol). It’s intended for chronic autoimmune diseases, not weight loss, but I’m still hoping there may be some clues in there to help me!

          • I understand your frustration and I hope you can find something that works for you. We are all different and what works for one doesn’t always work for someone else. I wish you the best.

            On another note…I just started reading Denise Minger’s book and am enjoying it so far.

      • Mary,
        Have you ever looked into candida as a possible cause of your cravings for carbs? It may be that you could benefit from consuming more pre and probiotics.

        I think it is one reason that coconut oil eaten raw can help.

        • Thanks for the idea Thomas. I am indeed starting to wonder if I am having problems with candida or some type of bacteria overgrowth. Lately I can’t seem to eat much of anything without getting a very full, uncomfortable feeling. And I seem to get major bloating especially after eating a significant amount of starch. I am going to try and good probiotic and see if that helps!

        • I think that a major part of this discussion that has been ignored is the role of gut flora. Mary, I had unbelievable carb cravings before restoring my gut flora to a healthy place. For me, it all starts with the gut. If you have an overgrowth of Candida or some other sorts of bacteria/yeasts, it will be very hard for you to control your carbohydrate intake.
          Being the daughter of an anesthesiologist, I was given antibiotics frequently for ear infections in my youth and acne in my adolescent years- which led to terrible dysbiosis. There was a time when I could not drive past our local bakery without tasting the bread in my mouth. After going on a gut healing diet, breads no longer have that almost magical power over me.
          The two keys were: restoring my gut flora to a healthy balance, which led to #2…correcting nutrient deficiencies (because with healthy flora, I was now absorbing all the nutrients from my nutrient dense diet). If I maintain a nutrient dense diet, I am completely free of all cravings. I can trust my body now and listen to it.
          I don’t really believe in restrictive diets in the long term. I believe in using diets as a therapeutic tool to get your gut to a place where you don’t need to do long term restriction of an entire macronutrient group. I think the emotional effects of long term restriction (which are immeasureable by studies) have a profound affect on our outlook and overall health. So my goal was to correct the issue at the root with a therapeutic diet (this took about 2 years) and then begin to live without major restriction. I used Gut and Psychology Syndrome Diet by neurologist and nutritionist Natasha Campbell McBride.
          I really think that blaming and restricting carbs is symptom treating. Healing the gut corrects the problem at the root. I encourage you to look into it. It truly is a lasting solution.

  162. There is a little bit of informational fog creeping in here and I just want to respond briefly to a few things.

    1) There really is no real data connecting low-carb diet (even very low carb) to health problems, only anecdotes. Every study done has reinforced that it is quite safe. That said, if you have health issues like thyroid problems obviously you would want to have a doctor involved before you make significant changes to diet. Changing your diet, say, from 15% of calories from fat to 60% is going to affect lots of things – fasting blood sugar, lipid profile, body fat level, and certainly thyroid hormone. Most of those changes, for most people, will be clearly beneficial but your mileage may vary. Eating less carbs will reduce your level of a key thyroid hormone, so if you are already low, it could make you too low. But it would be wrong to say a low-carb diet has been shown to cause thyroid disease. If that were the case, everybody from the American Heart Association to Archer Daniels and Coca-Cola would be shouting it from the rooftops: “Save your thyroid – eat more Doritos, drink more Coke!”

    2) Everybody is on the “real foods” bandwagon, and I feel the same way about getting away from factory/processed foods. But we should always be aware of what is supported by science and what is not. There really isn’t proof that eating “real food” whatever that is will make you healthy. There IS very strong evidence that eating less carbs and more fat, if you are overweight and pointing toward metabolic disorder, will help you control your weight and improve your risk factors. There IS strong evidence that Mediterranean diet is highly beneficial for heart attack risk – though we don’t know why (Mediterranean is relatively low carb high fat but it is also lots of other things). There is NO study that I’m aware of that attempts to measure the health effects of eating “real foods.” I don’t even know how you would do that study. I love Michael Pollan but there are definitely times factory food is better. Just one example — canned tomatoes are of far better quality than the dessicated fresh ones you see at the produce stand in the winter.

    3) People who are not familiar with low-carb, and even some people who are, get confused in the complexity of human metabolism. But really there is a very simple mechanism of the heart of it: Carbs drive blood sugar which drives insulin which drives the storage and retrieval of fat. Reduce your carbs, reduce your blood sugar and you will incrementally store less fat and burn more of it. Increase your carbs, you will burn less fat and store more fat. This is why, to fatten up pigs, they feed them the ultimate high-carb diet — flavored corn meal.

    Eat an 80% carbohydrate diet like a lot of Americans do, and it is VERY difficult to avoid becoming obese. But if you are not overweight eating an 80% carbohydrate diet, I don’t know whether low-carb is going to be beneficial to you.

    My advice is limited to people like me – which is probably 60-75% of the population – we will benefit from reducing carbohydrate consumption to one extent or another and increasing the percentage of calories we get from “healthy” fats. That should be pretty indisputable by now. It hasn’t been established what the right macronutrient levels should be — and it almost certainly varies from person to person, and from one time in a person’s life to another.

    4) A lessening of mucous is certainly a side effect of eating less carbohydrates. The Perfect Health Diet folks (who are well intentioned, and well educated but basically amateurs) make a big deal of lack of mucous as a bad thing. But all they are doing is theorizing. There is no real data to back up what they say. As long as the lack of mucous doesn’t make you uncomfortable, it might actually be a good thing. The counter-argument is made by Perlmutter (who BTW has MUCH better health research credentials than the Perfect Health couple). Perlmutter argues that carbs, and particularly wheat gluten, have an inflammatory effect on the entire body, and that’s why you have more mucous – because your immune system is a permanent state of agitation. So is mucous good for you or is it a sign of inflammation, which gets a lot of bad press these days?

    I consider it an open question. I certainly blow my nose less and I breathe a lot better at night now that we limit our carbs (and btw we are not strict low carb – we indulge in French fries and chocolate and wine popcorn fairly frequently). If you are uncomfortable though and your nasal passages get too dry and irritated, that might be a reason to add back some potatoes as Perfect Health recommends. I have read the Perfect Health book. Perfect Health’s recommendations sound good to me — I like their web site — but a lot of it is very speculative.

    • Lack of mucous in the gut is now irrefutably linked to Inflammatory Bowel Conditions. They actually alleviated IBD by supplementing intestinal mucous. This is headed to be a huge treatment for several varieties of IBD. If VLCD reduces intestinal mucous then this is hugely frightening to say the least.

      • Beaker-
        Have you read Gut and Psychology Syndrome by neurologist Natasha Campbell McBride? If not, I think you would find it fascinating. I really do think that the gut is the root of it all. There is so much we don’t know about the microbiome. Anyway, I appreciate reading your constantly returning the discussion back to the gut- that’s probably where it belongs.

    • Let’s get back to basics here. The article argues that Perlmutter recommends a VLC diet for everyone as an effective preventative against neurological disorders. Kresser says Perlmutter is confusing therapetic effect with cause. There is no hard evidence except for one small study done in rats (which I, admittedly, have not looked at). Kresser also says that this one size fits all approach is actually dangerous.

      VLC is a rather new approach and therefore there is no hard clinical evidence as to the long term effects of a VLC diet. There are however hundreds of testimonials from people who went into the diet with a healthy thyroid and came out months later with terrible outcomes. So, Tom, I guess I am confused as to what basis you have for dismissing all these peoples testimonials? Is it simply waiting on some official study? Because we all know that science has its limitations. And studies are notoriously unreliable. How have we become a society that worships expertism to the point of ignoring human experience?
      I don’t think anyone is arguing that VLC diets are bad for everyone. Surely, some people thrive on them- at least in the short term- only time will tell for long term (they may set the stage for other chronic disorders). But, I really think it’s close minded and harmful to dismiss the fact that VLC diets are not the answer for everyone. Do you agree Tom?

      • “Because we all know that science has its limitations. And studies are notoriously unreliable.”

        Why basing huge life decisions on “studies” could get your health into trouble:

        “Based on a review of 53 published papers on cancer, Begley and Ellis discovered that only six of them could be reproduced and confirmed in a clinical setting. And the worst part was that the 53 papers were considered to be “landmark,” which means they are generally recognized as having had a significant impact on cancer research due to presenting some new cancer treatment approach or novel therapy for targeting cancer cells.

        “It looks like the scientific literature is contaminated with a growing number of tainted studies, which may reach 89 percent, the results of which are not reproducible by any means,” writes Eleni Roumeliotou for about the shocking findings. “This means that to an extent, we have based our healthcare and clinical guidelines on fake studies that reported untruthful results in order to accommodate the interests of industrial corporations.”

        • Exactly. Science worship is dangerous. But we are taught from a very young age to trust experts opinions over our own intuition and observation. We are not taught logic in schools, but instead encouraged to trust the experts and regurgitate their opinions. And to become successful in the conventional channels, these experts have to comply with corporate agendas. Money rules all. It even dictates how we view our own bodies and what we should be fueling them with. I think we’d all feel a lot better if we started listening to our bodies and attempting to reason things through ourselves rather than relying on studies and experts.

  163. Jeff, Sorry to hear that about your sister. The very same thing happened to me. That is how I came to find testimonial after testimonial from those who experienced it too. I am 34, healthy and active, mother of three. I followed a real foods diet before going on GAPS to heal my gut. My gut healed, which is amazing- I can now eat sourdough w/o breaking out in hives and my digestion is greatly improved. While on GAPS, I went too low carb and suffered thyroid and adrenal issues, hair loss, low libido, low energy, unbelievable fatigue. I went from a healthy 125 to a skeletal 115 (at 5’7″). It was obviously not good for my body. I reincorporated carbs and felt better. It has been almost three years now and I feel great. I always have to be conscious of eating lots of cholesterol and fats. I eat a WAPF Diet for Pregnant and Nursing Mothers and it truly saved me. I really don’t eat a ton of carbs, just let my body tell me what it needs. On a typical day I eat 1 quart of raw milk, a couple pieces of sourdough, 1-2 pieces of fruit and maybe some rice or potatoes at dinner with my meat. I hope she finds what works for her. The fatigue was horrible and made cooking adequately for myself difficult. If she has anyone that can help her cook, I’m sure she would find it helpful.

  164. I still maintain that recommending a VLC diet as a preventative is irresponsible. Many people experience thyroid and adrenal issues by going too low carb. It is not “Atkins flu” as the body adjusts to fat burning. I have read hundreds of testimonials from people who at first felt great on low carb and then afters months things went wrong as the body could no longer compensate. If you search around a little you will too. I think it’s important to realize, that as Weston A Price documented, humans can thrive on vastly different macro nutrient ratios. Some people feel good on VLC, others don’t. But recommending a one size fits all approach is dangerous.

    • Megan, my sister is 35, slim, healthy and active. A year ago her nutritionist put her on a VLC diet and she did this for months. Things went horribly wrong, she became very lethargic and tired all the time. Going off the diet and back on carbs helped a little but not much. She went through doctors and specialists and now has to be on thyroid medication. No one in our family has any history of thyroid problems. So not only is it possible VLC can impact you, but the damage could be permanent or long lived. It’s been a real nightmare for her to try to get her life back.

  165. Patti writes: I don’t know why LCHF advocates have such a hard time believing that many people actually thrive on higher carbs.

    But then she adds: And I am an average sized 52 year old female with no known health problems. I lost over 30 pounds when I went LCHF and I haven’t gained it back since adding quality carbs.

    Patti, I agree with you, what works is what works. If you’re healthy on the diet you’re eating, then that is the most important piece of data.

    I do find curious your comments that LCHF didn’t work when you go on to say you lost 30 pounds on LCHF. That is a lot of weight and dropping that much weight probably improved your risk factors for a lot of things. Your blood lipids are probably better for it, and your insulin sensitivity may be improved — which may be partly why you can handle carbs now without gaining weight.

    By adding carbs back in, you’re actually following what Atkins has preached for 40 years. Once you’ve lost the weight, gradually add back in carbs to the level your body can handle. For some people that’s 50 grams a day, for some it’s 250.

    But 500-600 grams a day, the typical American intake, is a recipe for obesity for most people, which is why the United States is on track to have 100 million obese people fairly soon.

    There are a lot of unanswered questions about healthy diet, but there should be no debate that we have a health crisis in the United States. Obesity completely dwarfs all other healthy problems in our society, and diabetes and Alzheimers (which both track obesity very closely) are going to swamp our medical care system if we don’t do something SOON.

    And right now there are only TWO successful treatments for obesity. One is surgery — stomach staples and stomach bands — and one is LCHF/Paleo/Mediterranean/Atkins — which are all variations on the same thing, carb restriction. They are the only things that have been demonstrated to work in significant numbers of people. Exercise and calorie restriction have simply proven to be ineffective for most people. You HAVE to control your blood sugar, and that means controlling carb intake.

    • What Judi may have gone through when she lost energy is commonly known as the “Atkin’s Flu”. After a lifetime of eating sugar and too many carbs the body takes awhile to adjust to burning ketones rather than sugar ( Glucose).

      Many people feel terrible as their body changes from one fuel source to another. Adding some carbs back in will certainly make you feel better. But..If you can get through this phase you will will come out on the other side with a more efficient, fat burning metabolism.

      Often people need to see to their gut health first and repair their digestion. Probiotics and fermented foods for a few weeks will set you up to tolerate a big change in your diet better.
      And of course some people tolerate carbs better than other people. If you want to or need to add carbs I highly recommend the sweet potato. It is slow burning, low on the glycimic index and full of nutrients.

      • Marc writes: What Judi may have gone through when she lost energy is commonly known as the “Atkin’s Flu”. After a lifetime of eating sugar and too many carbs the body takes awhile to adjust to burning ketones rather than sugar ( Glucose).


        Yes, for a few days to about a week of eating low carb, people with slightly elevated fasting blood sugar will feel listless when their blood sugar is lower than their bodies are used to. In addition, a person’s blood pressure drops — sometimes quite significantly — with the loss of 3-6 pounds of fluid weight that typically happens when you go low-carb. (A very simple solution is to drink a little salty broth when you feel weak or shaky.) These symptoms are short term though and go away once your body gets used to a lower baseline blood sugar and blood pressure (which are both quite good for you, by the way).

        From the studies that have been done of low-carb and other diets, there really is no statistical evidence of health problems from longer term restriction of carbohydrates. There are lots of carbohydrate defenders who would be all over it, but the evidence isn’t there.

        There is a lot of scaremongering about gut dysbiosis if you stop eating bowls of spaghetti and Cheerio’s but I wouldn’t buy it. If you’re concerned about keeping a good healthy gut flora, you can do that quite well with 20-50 grams of carbs. Eat veggies and nuts and lower-carb starches like sweet potatoes (and dairy! — some of the most important gut bacterial thrive on dairy). You may crave french fries, Doritos, coke, fruit juice, bananas, bagels, ice cream etc… but your gut flora don’t need any of it.

    • Tom, yes, I lost weight on low carb, but after a few months, I started to have very low energy and muscle aches in my legs. I also had dry eyes and dry skin and my weight loss had stalled. Dry eyes are a common symptom of too few carbs because mucous production requires carbohydrates. I learned a lot about low carb dangers from reading the Perfect Health Diet blog. I increased my carbs and began to feel so much better. My energy increased, my leg pains went away and my eyes and skin are no longer dry. And I didn’t gain any weight back. I don’t really count carb grams or anything else because I just eat what I feel like eating, but I include white potatoes, sweet potatoes, white rice, fruit, and occasional properly-prepared legumes and grains (usually oats) regularly into my diet. I would guess that I eat between 150-200 carbs most days. In reality, that IS a low carb diet compared to the SAD. But it is not a VLCD which is what most low carb proponents seem to be advocating. I’ve been eating the increased carbs for over a year now.
      I never said low carb wasn’t effective for losing weight. And for people who have a great deal of weight to lose, it’s probably a good starting point. But I believe most people would lose weight just as effectively by keeping their carbs in a more moderate range of 100 grams per day and they would likely avoid a lot of the low carb dangers that so many people have experienced. I am on a couple of Facebook groups and there are many former low carbers out there dealing with diminished thyroid function and other health problems as a result of keeping their carb counts too low (under 60 grams per day). Not everyone will have problems with it. But I become concerned when very low carb is pushed as the only way to eat healthy. It is NOT healthy for everyone. If it works for you, great. But don’t ignore the message from so many people who have had a different experience.
      I’ve been reading about health and nutrition for about 2 1/2 years now and almost every WOE has people who claim their health improved when they changed to “x” diet. But if you notice, the common factor among all of them is that they cut out the processed garbage. I think THAT is the key. Stick to real, traditional foods.

      • Well, white rice is not even close to being a “whole food”. It has been polished to the point that only the starchy kernel remains. Since the bran and fiber have been removed, how could little starch kernels be considered “quality carbs” and a whole food?

  166. Jeff Volek in Art of low Carb living suggested that 25% need a low fat high carb diet. as Volek is a ketosis kind of guy, it would seem to me that lchf can have no trouble with differing diets based on individual needs.

    I just heard Perlmutter on Fat burning man and he said that his approach was NOT based on meat.

  167. You have missed the point! He advocates eliminating WHEAT! He does NOT argue for eliminating carbs, but reducing them due to the impact they have on blood sugar, insulin, etc., and not consuming WHEAT.

  168. “Ok, so could someone authoritative just give me some general advice re how to eat?”

    What a great question and I don’t think anybody should claim to know the definitive answer. Many of the “authorities” are still giving really bad advice (a low-fat high-carb diet as a prescription for obesity?! That’s like recommending that asthma sufferers smoke more cigarettes!)

    The closest thing to a really solid finding that we have right now is that Mediterranean works — it DRAMATICALLY reduces death rate probably from a variety of diseases. But why it works we don’t really know yet.

    Basically, if you’re not overweight and your lipid profile is good, I’d say whatever you’re doing is probably working OK. Whether to follow Perlmutter’s advice and avoid grains is up to you, and probably can’t hurt, but it certainly hasn’t been proven that avoiding wheat will reduce your Alzheimer’s risk — it’s only a very intriguing theory.

    However, I think by now it’s pretty well established that if you’re overweight and or showing signs of metabolic disorder, with high trigliceride levels and a bad LDL to HDL ratio, you need to ignore the Heart Association (and maybe your own doctor) and cut your carbs. Whether to do that really drastically (20 grams) or mildly (100-120 grams) is up to you but you should be increasing the percentage of your diet that is fat, and reducing the percentage that is carbs. Counting carbs is far more important than counting calories, but counting calories is almost certainly a good thing too.

    The rest of it is really still subject to very live debate. Mediterranean clearly produces good outcomes but we don’t know exactly why — is it because it’s low carb, or because it’s low-sugar, or because they don’t snack as much so there’s more time with an empty stomach/low blood sugar — or because they get more fish and olive oil and wine?

    Eating more “Mediterranean” is probably a good approach though, maybe for all those reasons.

    The final thought I’d leave you with — EXPERIMENT ON YOURSELF. What is beautiful about diet is you can make changes and then measure your own outcomes. What is happening with your weight and blood pressure? How does your lipid workup look after 3 months of different eating? How do you feel? How’s your alertness, your need for sleep? If you have reflux, does it get better if you cut down on carbs?

    I think our bodies can give us a lot of data about how various diets work on US and that is a lot better data than the so-called experts. Try some different diets for a few weeks at a time – if you seem to do well on it, it is probably because it is working for you.

    In my personal experience, and to my total surprise, increasing fat in my diet (olive oil, nuts, cheese, butter) has made me thinner and healthier.

    But other people seem to feel great living on an entirely carb diet — banana-strawberrie smoothies, pasta, corn chips, subway sandwiches etc. If that produces good outcomes, fine. But it doesn’t for me and probably most people.

  169. Ok, so could someone authoritative just give me some general advice re how to eat?

    I don’t have enough either time or money or geographic opportunity to obsess endlessly over food choices. I also distrust anything too faddish. Many persons in my family have lived fairly long, reasonably healthy lives, eating some combos of health + junk, though I worry that the modern world is increasingly unhealthy (less in terms of toxic environments, which anti-pollution laws may have made better, but more wrt nutritional values from depleted soils as well as modern pesticides).

    I have tried to eat moderately healthy (as conventionally defined in the USA in the late 20th/21st century), but I think I may have been eating all my life extremely unhealthily.

    Yes, I eat junk food (more in the past few years due to loss of willpower stemming from being overwhelmed by too many exogenous problems, including some health ones – though these were all orthopedic injuries affecting my ability to exercise, which I like). But I always tried to “balance” the junk with lots of “health” foods: tons of fruits (!), whole grains (which I also eat because cereals are cheap – and what else can you eat at breakfast besides fruit and cereal and whole grain bread with nut butter?! I don’t have time in the mornings to prepare meat & eggs), some veggies, salads when convenient, fish when possible.

    Anyway, what is a REASONABLE diet (in terms of: ease of preparation or restaurant location, cost, availability, balancing health vs weight loss)?

    I would really appreciate any insights. If fruits are bad (I’ve read so often how good they are!), then I really don’t know what I should be doing.

    • It’s at the point now that it’s become a religious style issue. Each diet has rabid supporters and will foam at the mouth anytime someone speaks negatively of their chosen dietary beliefs. It’s become quite scary. My own belief is that exercise and active lifestyle is key. Eating whole foods, fermented foods, sourdoughs for bread etc. I eat a couple pasture fed eggs a day around 1kilo of mixed vegetables, beans, 1.5-2 cups of home made 24hr yogurt, a couple servings of fruit, etc. If you have no prior health issues, are fit and active, eat only whole foods I think this is on the right track. I feel fantastic and simply can’t believe I am doing 50 wrongs things and feel so phenomenal. But, like I say, according to the frothers I am on the road to hell and early death (with much suffering and pain) -whatever can scare me enough to join their religion.

      • Agree. It’s become a religion.

        Eat real, whole foods. Avoid processed junk. And enjoy! Stress will kill you faster than food!

  170. Actually in this case, Dr. Perlmutter proved that it is not just correlation with wheat and starches being linked to DEVELOPING neurological diseases… it is causality! The experiment he conducted with the mice/ rats shows that the ones who were fed grains and starches developed tumors, had slower cognitive responses and died sooner, than those which were fed no grains, over their lifetime of about 2 years.

    How can you make statements contradicting this convincing evidence?

  171. There is a lot more here than meets the eye. It’s now becoming obvious that our gut biome is responsible for health and longevity. For example people with chronic illness have different gut biomes than healthy individuals. A study just the other day showed the gut bacteria b.fragilis creates a compound that instructs our guts immune system to not attack gut tissue.. and the conclusions were rats lacking b.fragilis developed inflammatory bowel disease. They are finding those with diabetes or on the way to diabetes have different gut flora. Gut bacteria is now linked to RArthritis, those with RA have a specific bacteria overgrowth that non RA folks do not have. We also now know that what we eat greatly affects our gut biome. The biome of a meat eater if vastly different to a Vegan, etc. Gut bacteria now implicated in metabolism. 100’s of issues are now being linked to our microbiome. I am beginning to think the biome determines how well we tolerate and process carbs. I have no issue with moderate carbs, am fit and have bloodwork to indicate this. Suppose I started eating JUST carbs and sugar and dead food. This then changes my gut biome and the beneficial bacteria that used to keep me in check die out THEN causing diabetes or brain disorders. I suspect in the not too distant future we will comprehend that it’s not what we eat it’s what our biome eats that determines our human outcome. In other words I seem 100% fine with moderate carbs but I exercise and I also eat a great deal of vegetables etc. Also, exercise and stress affect the biome. Look for a shift from “You are what you eat” to “You are what your biome eats”. As this proves to be the case, specific colonizing gut bacteria can be supplemented in pill form to correct 100’s of illnesses.

  172. Yeah Judie, seems there is a lot of talk on other boards more Adkins/weight loss oriented that have chat about lc and hair loss. The idea posed is that this diet creates such a hormonal shift as to jolt the hair into telegen phase. Eades addresses it on his blog. I ended up with horrific hair shedding from going lchf when my iron intake become greatly enhanced. Haven’t had the chance to dig in and research more about the increased absorption of minerals eating high fat, but it exists. There is also the angle of lower carb often meaning less fiber intake to bind up minerals. I can say like many other with the lc hair shedding, Never felt better eating lchf, hair just went weird!

    Did your hair loss clear up when you added carbs? Could be some people’s hair likes more carbs-?

    • Thank you for responding. Yes, my hair did grow back in after stopping lc for a while. I will check out your suggestions. Thanks.

  173. I so appreciate the information from the books; Grain Brain, Wheat Belly and Paleo Diet. I have read the first two and I’m learning more about the Paleo approach. It’s about time we all get on board. If your blood sugars rise from fruits, grains, potatoes and other carbs, the results over time can damage all of the cells in your body including the brain. Everyone has different metabolisms and each have a varied amount of insulin the body requires. Unless you are already diabetic (Type 1) like me. I know for a fact that I cannot eat fruit without cause unless I’m exercising. Even carrots, onions and tomatoes affect my blood sugars. Grain Brain, Wheat Belly and Dr. Richard Bernstein all want no elevation or spike in your blood sugar. So, why do some other cultures tolerate a high carbohydrate diet without illness? I would like more information on specifically the types of fruit, their sweetness for example and the level of activity these people have on a daily basis. If I was a marathon runner or hunting, gathering my food all day, I would be able to burn the extra glucose without harm. But, with a more sedentary lifestyle, these extra carbs- in any form are mere poison.

    • Ann,
      I come from a culture where carbohydrates (corn, cassava, cocoyam, plantains, Irish and sweat potatoes, all kinds of yams etc.) are staples. Of course, theses are consumed with all kinds of green leafy vegetables and oilseeds (peanuts, egusi, pumpkin seeds, and other seeds), beans, and little meat and/or fish in some areas. Carbs makes up about 80% to 90% of their meals.

      I think it is important to be specific about the types and sources of the carbs and not just say low carbs. We now know that the wheat we have now has been adulterated and reason not to eat it. It is also important to be specific about the types and sources of the high fats, now the GMO is spreading. Coconut oil is one of the good fats, but can you imagine if the coconut tree is genetically modified or the plantation is spread with GMO insecticides? I believe there is much more involved here than just low carbs high fat or low carbs. Human being is more complicated than that.

      I believe in the principle of bio-individuality. No one-size fits-all anything. The culture I come from seems to tolerate very high carbs well.

      Even with the Paleo diet, Kris is now coming up with “your personal paleo.” I might not have quote him right but it is something in that line. What does that tell us?

  174. Chris, there was a question posted earlier regarding hair loss on a low carb diet which I haven’t seen answered and the answer would really be helpful to me.
    I lost about half my hair several years ago while on a low carb diet. I want to do low carb again but need to what to do to prevent the hair loss.

    • Hair loss is a symptom of low thyroid, which, in some people, can be caused by low carb eating. (It happened to me.) If you want to avoid hair loss, avoid low carb eating. Keep your carbs at 100 grams per day or possibly higher if needed to avoid hair loss. That is still much lower in carbs than the SAD. Every person is different so you have to see what works for YOU.

    • “However, this analysis is based on limited observational studies and large-scale trials on the complex interactions between low-carbohydrate diets and long-term outcomes are needed.”

      do you understand the word “limited”? It means this study has limited value.

  175. Eden: Your comments suggest a question I have, namely, I wonder if some people are pre-disposed toward problems with blood sugar. I have been on a Paleo diet for some time, with excellent results in terms of how I feel. So I was surprised to find my blood sugar is fairly high, high enough to be alarmed about, after having read GRAINBRAIN. I have experimented with cutting back on carbs (fruit, sweet potato) and feel my mind is clearer. My mother spent the last 15 years of her life with dementia, a warning bell for me.

  176. I realize that this is the sort of comment that scientists will scoff at, because I hold no science degree, and my experience is anecdotal–but the grain-brain diet makes sense to me. I remember a few years ago trying to combat my depression. Depression runs in my family, as does alcoholism, hypoglycemia and diabetes. And I remembered hearing once that hypoglycemia is often misdiagnosed as depression (and even schizophrenia)–and I start to think about how all of these things–the alcoholism, the depression, the blood sugar problems were probably all the same thing. So I did some research and discovered that most alcoholics have blood sugar problems (makes sense since alcohol converts to sugar), and of course they also frequently suffer from depression. It was also a curious thing to me that in times of depression, I not only wanted to binge, but wanted to binge on carbohydrates specifically (where you’ll find most of the gluten–it seems to me these things are connected). So I tried going largely carb free, excepting salads or fruit, but nothing overflowing with carbs. And yes, it helped my depression tremendously. Not only that, but it made me far less premenstrual. Not only that, but it also took away my cramps on my period (which have always been incredibly severe). And yes, it also made me lose weight (though not to a scary degree. It seems to me that anything that can change your brain in the short term can also change your brain in the long term. And since diabetes is linked to dementia (and that is true), this seems to me to be true. It makes a lot more sense than the diet we currently use. And as they say, the simplest explanation is often the best. Now, all of that being said, I’m currently not on a low carb (or low gluten or low sugar) diet (and I’m also currently depressed). Why? Because I fell off the wagon. Because I like pasta and bread. And I think that may be why we resist these sorts of claims–because we like our bread, we like our beer, we like our pasta and we don’t want to give it up. Do I think that this is something that should be recommended to everyone or just people with blood sugar problems? I don’t know. I don’t think it would necessarily hurt, but I know for me, this morning I had eggs for breakfast, and I think I might just make some fish for lunch and get back on the wagon. Because I’m depressed. And I KNOW from my own experience that grain doesn’t help that–it fuels it. Considering how many people are on anti-depressants in this country, I might suspect that more people than we realize should perhaps try eliminating carbohydrates. Perhaps there isn’t enough research done…but I don’t mind volunteering myself as a guinea pig, because it’s clear to me that diet DOES affect brain function (why wouldn’t it?) and that it’s worth a shot. If everyone buys this book and the diabetes rate (and thus the dementia rate) goes down? Then we’ll have our research. If it doesn’t? I doubt it will go up much higher than our current system.

  177. I did read the book and I totally agree with Dr. Perlmutter. I do not agree with you. First of all I believe this book was written for people who are NOT sick. Dr. Perlmutter states very clearly, once we contract some of the chronic diseases which plague people eating a North American diet there is no cure…only management from then on. However, following his dietary recommendations gives people the change to AVOID the chronic conditions which can rob us of our health.
    Furthermore, it seems Dr. Perlmutter is targeting people who do not and probably never lived in places like Tanzania or if they did, it was thousands of years ago. He is right when he says humans had access to fruits in season. Those populations ate fruits like berries which we now know are very high in antioxidants and take note these are listed as preferable foods in his book.
    After reading your article there are many other comments I don’t agree with after reading the book twice. I wonder if you read it or just perused it?

  178. The whole debate about carbs being unhealthy for brain seems baseless on first look because if we see many tribes prevailing in several parts of the world, we see that they mostly consume high carbs but there are no instances of such brain related diseases found for them.

    Also, the ability to digest carbs depends on our own physical activity as people who do more of physical work can digest carbs easily but people who have mostly “sitting jobs” may see ill effects of carbs.

  179. Lots of commenters have talked about the fact that today’s wheat is totally different from ancient varieties. Does anyone know if these ancient varieties are being grown anywhere? I know Kamut is toted as an ancient wheat, and also spelt, but how about other varieties?

    BTW, I remember reading somewhere, probably in Atkins, that the ancient Egyptians, who presumably ate ancient varieties of wheat, had atherosclerosis.

  180. I am sorry i was expecting a more thoughtful article and debate. Folks talk about a lack of peer reviewed science with respect to gluten and I wonder if folks have really looked for it ( there is a mountain out there ) . Start with Prof Michael Marsh (Oxford) , Alessio Fasano, Adj Prof Umberto Volta, Aristo Vojdani, Prof. Marios Hadjivassiliou, Prof. Yehuda Shoenfeld just to start ( I can think of another 5 at least ) all of them have over 150 peer reviewed papers each.

    • +1 I understand there is way too much science to read, but it is unfortunate that docs tend to have that mindset “If I haven’t read it, it must be quackery.”

      Amazingly, in this day and age with information (including medical journal abstracts) so widely available and easy to locate, sometimes patients are better informed than their docs, who are still stuck in the scientific paradigms that they were taught in medical school 20 years ago (paradigms which in turn were based on science done 20 years before that). It is only because of this terrible inertia that doctors are still pushing the low-fat high-carb “healthy grains and fruits” diet that is doing so much harm.

      At least Chris Kesser provides this forum where alternate points of view are tolerated!

  181. I have type 2 diabetes (along with 18 million other Americans that have been diagnosed) We’ve done it to ourselves (or the food industry in their greed for profit) with fast food, sugar, salt, fat and food that has little or zero nutrient value. We didn’t eat this way fifty years ago. I know Dr. Perlmutter has his critics, but I’m not one of them. We’re facing serious health epidemics in this country. If we don’t make some changes in the way we eat we’ll cripple our health care system and have a disaster that may be impossible to recover from.

  182. Dr David Perlmutter’s name does not appear in Medline, the abstracting service for all medical journals at the National Library of Medicine. There is a D Perlmutter who has done liver work in the past. Also I could not find any studies concerning gluten free, low carb diets as a significant protective factor for dementia. As all scientists know the plural of anecdote is not data. Clearly Perlmutter has made a bundle off his books but the science is thin or likely non-existent. There may be some biological plausibility but plausibility is not fact and most hypotheses evaporate in the face of a well designed study. Very few survive real scrutiny. This may be no different or it could be actually true, but Perlmutter clearly does not have enough, maybe any evidence that what he is promoting is true. Buyer beware.

    • I found this in Forbes:

      A Mayo Clinic study published earlier this year in the Journal of Alzheimer’s Disease found that people 70 and older with a high-carbohydrate diet face a risk of developing mild cognitive impairment 3.6 times higher than those who follow low-carb regimens. Those with the diets highest in sugar did not fare much better. However, subjects with the diets highest in fat were 42% less likely to face cognitive impairment than the participants whose diets were lowest in fat.

      Further research published in the New England Journal of Medicine in August showed that people with even mildly elevated levels of blood sugar — too low to register as a Type 2 diabetes risk — still had a significantly higher risk of developing dementia.

    • “Well designed study”. This was the game my Anthropology professors loved to play. You see, they didn’t believe homo sapiens set foot in North America before 12,000 years. They could debunk any archeological site that was dated before 12,000 years. They would go through the evidence with a fine tooth comb and find fault with how the evidence was prepared, stored, interpreted, etc. They had a whole range of semantic arguments and such to knock down any student who dared expressed the opinion that Native Americans may have been in the Americas for 50,000 to 100,000 years. Nothing could shake them in their position.

      So I did find a study at NIM thru Medline, but hey, its obviously not a “well designed study” meeting your high standards.

  183. First of all, half the reason I read these posts is to hear what Chris says and the other half is the comments. I always learn so much from the comments. I subscribed to comments on this post, so it has been on my mind a lot as I get the email alerts. I really think people could argue back and forth on the benefits of keto, VLC and moderate carb diets all day long. There is so much grey area- even for people who are very well read on the topic. Studies are never perfect and everyone has different life experience. This is fine. I don’t think it is a black and white issue.

    What is black and white, is the logical fallacy that Chris Kresser points out in this article. Kresser is not dismissing Perlmutter’s work with Alzheimer’s patients, he is merely saying that correlation does not equal causation. Don’t confuse therapeutic effect with causation. Perlmutter is recommending a VLC diet as a preventative. The problem with this approach is that it doesn’t account for confounding factors. Here is an excerpt from wiki on logical fallacies…

    “The logical fallacy can be expressed as follows:
    A occurs in correlation with B.
    Therefore, A causes B.
    In this type of logical fallacy, one makes a premature conclusion about causality after observing only a correlation between two or more factors. Generally, if one factor (A) is observed to only be correlated with another factor (B), it is sometimes taken for granted that A is causing B, even when no evidence supports it. This is a logical fallacy because there are at least five possibilities:
    A may be the cause of B.
    B may be the cause of A.
    some unknown third factor C may actually be the cause of both A and B.
    there may be a combination of the above three relationships. For example, B may be the cause of A at the same time as A is the cause of B (contradicting that the only relationship between A and B is that A causes B). This describes a self-reinforcing system.
    the “relationship” is a coincidence or so complex or indirect that it is more effectively called a coincidence (i.e. two events occurring at the same time that have no direct relationship to each other besides the fact that they are occurring at the same time). A larger sample size helps to reduce the chance of a coincidence, unless there is a systematic error in the experiment.
    In other words, there can be no conclusion made regarding the existence or the direction of a cause-and-effect relationship only from the fact that A and B are correlated. Determining whether there is an actual cause-and-effect relationship requires further investigation, even when the relationship between A and B is statistically significant, a large effect size is observed, or a large part of the variance is explained.”

    So until there is further evidence to support Perlmutter’s argument, it is dangerous to recommend that everyone go VLC. And for those of you who think that carbohydrates are unnecessary, I ask you this…

    Why does human breastmilk contain approximately 40% carbohydrate? Why would babies, whose brains are developing faster in infancy than at any other point in their life, thrive on a 40% carbohydrate diet? Carbs don’t seem so unnecessary when you look at it from this perspective.

    I think most of us who read this blog try to look to the root of the issue. And I think pointing fingers at carbohydrates is a gross oversimplification. I suspect the root problem is gut dysbiosis.

    I’m curious to hear what others think….

    • First, a food that contains 40% carbohydrates, contains 60% protein and fats. So yes, the baby is being fed a food that is 40% carbohydrates because it needs to grow. So the point is not that we don’t need carbohydrates (we do obviously) but that an adult, an individual that is more concerned with maintenance rather than growth, does not eat to eat carbs at every meal, nor do they need to eat them every day. People such as the Inuit are proof of this. Since we are aware of at least two metabolic pathways: carbs to fats, and fats to carbs, its clear that we can consume either. What amazes me, is that this is common knowledge in the A&P fields, but seems virtually unknown in the dietary field. If I can survive on a low fat diet, surely I can survive on a low carb one as well.

      • I wholeheartedly agree that people can thrive on vastly different macronutrient ratios. That was my point. Carbs are not poison and neither is fat.
        I understand that babies have a higher carbohydrate requirement for growth, but my question is: how can something so necessary for a baby, become poison to an adult? The adult may not require 40%, but certainly carbs cannot turn to poison at some point in our development.
        That problem is not the carbs, but the gut dysbiosis that people who eat modern foods have. Fix the gut, you fix the problem. I tolerate carbs very well. I do not crave them anymore than I crave fat and protein.

        • I am not sure if anyone really believes that carbs are poison. Its simply that sugars and starches (and to a lesser extent sugar alcohols) are much more easily available today than to people even a hundred years ago. and thus easy to over consume to our detriment. Over much of our history as human beings, the only quick source of sugars was found in raw honey. Otherwise sugars were to be found in fruits and vegetables, something clearly seasonal. In the temperate regions, carbs would be scarce in the Winter, and plentiful in the late Spring and early Summer. Fruits of course, such as wild berries, would be consumed whole.

          It should be noted that in the entire course of agriculture, the motive behind developing cultivars was to increase size, yield, and sugar content of the plants. Most of what we grow has no wild counterpart, instead they are hybrids of hybrids, with a much higher sugar content than in any wild plant. Ever seen a wild strawberry and compare it to the strawberries in the supermarket?

          Anthropologists (yes, I was one for a short while), noted two driving appetites in Hunter Gather and primitive agriculturalists, and that is for starches/sugars and for fats. Protein, of course was desired, but not as esteemed as the other two. Fat was so esteemed it was not usual to find people simply scooping up the fat from a freshly slaughtered bull and eating it in vast quantities. After fat, blood was highly valued, and eaten raw or cooked into dishes, often mixed with fermented milk.

          I remember watching one film in which two African boys from a village came across a wild honeybee colony. They proceeded to pull big chunks of honey comb out dripping with honey, and proceeded to eat the entire thing; wax, honey, and larvae. That, I suppose is the reality of the human diet, and something the average Western surburbanite will probably never grasp.

    • The problem with bringing up this particular logical “fallacy” is that there may be no way to definitely prove most things, given that level of stringent “proof”. The argument you just gave was the exact argument the tobacco industry used to deny the involvement of cigarette smoking in lung cancer deaths.

      So the counter argument runs thus. Whenever A is found, B is found as well. We are not sure of causality, but it doesn’t seem to matter, because there seems to be no exception to this occurrence. Now we add in many more factors. Whenever A is found, we find B, C, D, and F.

      This is what circumstantial evidence is: evidence based on circumstances. So suppose you walk into a room and see a dead body. Also in this room is your good neighbor, Frank. Did Frank commit murder or was an innocent bystander? Next week you find another dead body. Once again Frank is near the dead body. We are unable to prove with 100% certainty that Frank killed the victim. This goes on several more times. So while we cannot “prove” with 100% certainty that Frank killed anyone, we suspect that Frank has something to do with all these deaths. We don’t know if its intentional killings, unintentional killings, or what. But we at this point have enough circumstantial evidence to warrant a closer look at Frank, or to start avoiding him altogether, or perhaps “quarantining” him.

      The reality is, if we waited for 100% proof of causality, Science would simply not be possible. This is why scientist develop models and create theory to guide their work.

      From what I read of Dr. Perlmutter, he is not making simple errors of logic. He is looking at a preponderance of evidence, some of it circumstantial, and drawing conclusions. Have you actually read his material?

      • @Bruce, there is a good study showing mortality is higher in low carb dieters.


        Low-carbohydrate diets were associated with a significantly higher risk of all-cause mortality.

        What is your take on this?

        • The problem with discussions of this sort is that studies are used like proof verses in theological arguments. Each study must be analyzed as to its merits, and then considered along side other studies. All studies must be looked at, including those that seem to give contrary results.

          In light of all this, Science itself has its limitations (an excellent book along these lines is “Limitations of Science” by Sullivan. Science that uses studies use the Socratic Method, which was originally designed, not to discover “truth” but rather to show errors in logic, or to show the futility of using logic to discover “truth”. Hence, to show us the limitations of Science, not to discover the operating principles of Nature.

          The problem with all studies is that they can be designed, whether consciously or unconsciously, to confirm or discredit any particular premise. One thing to keep in mind is that large studies are quite expensive, so where is the money coming from? So who would benefit if we ate more carbs? Or if we ate more protein?

          So its rather pointless to talk about “good studies”. Which study is it, and can the general public access the write up and data?

          For example, information concerning the Kitava in the Pacific Islands mentioned in this article are not to found anywhere, except for a single researcher. A Swedish doctor lived among these people several decades ago, and there is not one other source concerning these people and their dietary habits. For Chris to cite them shows how weak his argument his. In addition, this doctor did not actually perform any physical exams, he simply asked people if they displayed symptoms of heart disease, etc, or if they knew anyone else who did. So without any objective evidence, this testimony is subjective. In addition, according to source, these people actually ate a fair amount of coconut fat, and smoked a fair deal. Oh yea, they also were field laborers, working at hard physical labor for 8 hours. They also were quite small. And so on. You see, details matter. There are probably more important details, but we don’t know them, because we don’t have any other researcher to cite. Just the one, with questionable research methods.

  184. Perhaps it’s what carb-rich foods contain that is truly important – the antioxidants. Maybe that’s why we have a taste for them? I often get cravings for something “fruity” after eating protein, which can be alleviated by taking vitamin C powder.

  185. This argument that just because an intervention can be used to treat a problem doesn’t necessarily mean it caused the problem, or can be used to prevent the problem, is really disingenuous.

    Think about it with respect to cancer. Ketogenic diets are being used to treat cancer with good outcomes. According to the argument above, this is not enough to suggest that someone should restrict carbs if they really want to prevent cancers from developing. But think about the mechanism underlying the treatment of existing cancers with keto diets: the lack of glucose spikes starves the cancer of the only fuel it can use. So it stands to reason that eliminating glucose spikes would prevent cancers from developing in the first place. Is there actually any scientific EVIDENCE that this is true? Not yet, but that doesn’t mean that people with lots of cancer in their families should buy the argument that keto diets shouldn’t be used to prevent cancer.

    As for Alzheimer’s, although the mechanism may be a bit more complex, I think the argument for prevention is even stronger, given that there are no effective treatments available!

    • Mary: This argument that just because an intervention can be used to treat a problem doesn’t necessarily mean it caused the problem, or can be used to prevent the problem, is really disingenuous.
      Yes exactly. It is as disingenuous as the tobacco companies maintaining, as they did for decades, that it was just a coincidence that people’s lung cancer rates went down when they gave up cigarettes.

      Low carb is grounded in some excellent science over the last 20 years. The question of effectiveness and safety of low-carb diets has been SETTLED folks. It’s almost a waste of time to continue to debate it.

      It is not surprising that Coke and Pepsi and ConAgra are not happy about this science.

      But it is disappointing that groups like the American Heart Association and the American Dietetic Association, whose mission should be to promote good health, are so closely allied with (and receive so much money from) the processed food industry that they are pretty much still endorsing a high-carbohydrate lifestyle that is without a doubt killing millions of Americans. We deserve better.

  186. I think studies can be cherry picked to show just about anything. Here is one highlighting increased risk of death for those on low carbohydrate diets:

    Low-carbohydrate diets were associated with a significantly higher risk of all-cause mortality and they were not significantly associated with a risk of CVD mortality and incidence.

    Then there is this recent news about reproducibility of scientific studies:
    “The Truth Is Many Scientific Studies Can’t Be Trusted”

    So where does this leave us? Plenty of info to claim LCD causes early death, that Ketosis long term causes Liver and Kidney damage, that HCD causes problems AND that most studies in some cases 88%!! can’t be reproduced!

    It becomes apparent that for many of us the best we can do is exercise, eat whole foods and listen to our bodies.

    • If all of these low carb diets are so great why is it that the cultures who eat the most unprocessed whole food sources of carbohydrates, not animal protein, and not fat, live the longest and have the least of metabolic diseases? It’s not the carbs that are causing metabolic diseases. It’s a combination of too much sugar, too much refined starch (flour), too much fat, too many animal products, too much oxidized vegetable oil, and not enough unprocessed whole food, mostly plant based foods. But unfortunately that’s not sexy enough for the majority of the public, so sensible advice doesn’t sell very well. What does sell is the great conspiracy, the notion that someone or something else is to blame. It’s the governments fault, it’s the USDA’s fault, it’s fructose, it’s wheat, or gluten. When people start taking responsibility for their own health and start spending more time in the produce section rather than more time debating on which fat-free, low carb snackwell cookie to purchase, they’ll start to see their health improve.

      • Ryan’s comments kind of exemplify some of the confusion and misinformation out there. Example: “It’s not the carbs, it’s the sugar and refined starch …” Well what are sugar and refined starch exactly?

        In fact low-carb (and all its forms, such as Paleo and Atkins and Perfect Health and LCHF) have caught on like wildfire, despite almost total hostility from the health establishment, because THEY WORK.

        In fact focusing on limiting carb consumption is very much backed by science (at least 18 peer-reviewed studies have now validated low carb as a weight loss strategy). It is much more scientifically sound than sprouted grains or “raw foods” or “whole foods” or organic vegetables or any one of the hundreds of other diets out there.

        There really should be no debate about what to do if you’re overweight. Cutting the carbs will result in weight loss in an overwhelming percentage of people.

        The only thing that is problematic is that low carb is hard to do in a society where cheap tasty carb junk food is everywhere. You can’t work in an office without people bringing in doughnuts, cookies, candy etc.

        Imagine what it was like when scientists started to realize how toxic cigarette smoke was, but it was so hard to quit smoking because everybody in your office was bringing in cigarettes and smoking them in front of you! Low carb is hard to do in a world full of junk food. That’s the main reason it doesn’t work for so many people.

        What is interesting about LCHF scientifically is no longer weight loss — that question should be regarded as settled. What is interesting is LCHF’s potential for alleviating other illnesses from bowel disorders to brain disorders, autoimmune problems and potentially some cancers.

        That’s why Perlmutter’s book is significant — he represents the next wave of thinking about LCHF — applications to neurology. He’s an eminent neurologist with a very respected practice where he’s been working with diet therapies for decades — and he is absolutely, passionately persuaded that limiting carbohydrates is good for your brain.

        People may have all kinds of reasons to be hostile to low-carb — the official government diet recommendations, based on some bad science from the 1960s, are still pushing a high-carb low-fat diet. But anybody who is really paying attention to the research knows that is wrong.

        Some of the hostility is also coming from the vegan/animal rights community worried that low-carb means more meat. Be wary of these people because they are not interested in your best health — they are trying to protect animals, and that is a conflict of interest.

        Whether or not we should kill animals for food should be a separate question from what is the best diet for maintaining weight or maintaining your brain in good condition. Both are questions worth asking, but they should not be intertwined.

        If someone is overweight and/or pre-diabetic or exhibiting other symptoms of metabolic disorder, then they should be looking at low carb. That is just the truth. If they’re vegetarian/vegan, then find vegetarian/vegan ways to do LCHF — and they do exist.

        The other question that is open scientifically is what low-carb looks like. Is it 20 grams a day or 50 or 100? And the answer to that one is clearly going to be different for every person — based on size, exercise habits, genetic makeup etc. Everybody has a tolerance for carbohydrates and the only way to find out what it is is to vary carb consumption and find the carbohydrate level at which you are weight-stable. Some people can eat 2,000 carb calories a day and maintain weight but most of us cannot.

      • Ryan, it’s always frustrating when people refuse to help themselves and put everything in the too hard basket (just give me a pill). My 76yr old father-in-law has severe reflux and Gerd. I have tried talking to him about things he needs to do in order to alleviate it. I got nowhere. For breakfast he has sausages, bacon, eggs and coffee, more coffee throughout the day, and in the evening he has several soda waters with whiskey along with more reflux triggering foods. He’s made no effort to change anything, instead he has been put on PPI’s. So now he’s tried to mask the problem which will lead to further gut dysbiosis (he already has signs of IBS from being on the PPIs). ALl of this could be avoided but his mindset is that he went to a doctor and the pills will fix him up. Typical.

        • Beaker, I have a lot of experience with reflux firsthand and in my family. This is another area where people are getting terrible advice from their family doctors.

          People are prescribed Prilosec without any warning of the serious dangers of taking it for extended periods. And they’re told to avoid greasy/salty/acid foods

          The one thing they are almost never told is the thing that will work — cut down on wheat, corn and sugar. Dr. Eric Westman of Duke University, who oversees the Atkins Foundation, says reflux symptoms typically cease completely within a few days of starting a low-carb regimen, and that was certainly my experience. It’s magical. Gerd just plain goes away. That by itself should be enough to get a lot of people to try low-carb.

          If I eat badly (I typically fall off the wagon during holiday feast times), it comes back. If I eat a plate of spaghetti or a pizza, GERD often returns. But then it ceases the day I get back on the wagon and avoid sugar and grains. it’s like magic.

          Otherwise we don’t follow any of the conventional advice. We drink a lot of coffee, and our breakfast is typically eggs and some combination bacon, vegetables, fish, cheese. We don’t avoid acid, salt, grease, spicy foods. We do avoid wheat and sugar. Heartburn is basically nonexistent for us.

      • I agree with you. I come from a tribe and I know other tribes in Cameroon that eat the most unprocessed whole food sources of carbohydrates, corn/maize, cocoyam, plantains etc. very little animal protein and fat, mostly red palm oil locally processed. For my life in my village I only saw three truly obese individuals in the village and I would say little metabolic diseases. That was then, things have probably changed with the infiltration of processed food products and so on. “It’s not the carbs that are causing metabolic diseases. It’s a combination of all what is added to the carbs in the process of processing and preparation. The wheat itself is adulterated. So what is the source of carbs that is being debated here that needs to be eaten in less quantity. It seems as if we have totally ignore the principle of bio individuality.

  187. Hate to jump in here but I would like to counter this with Dr. Schwarzbein’s view who is an endocrinologist in Santa Barbara who manages her patients blood sugars, etc by optimizing their hormones. She lectured where I was studying and she advocates eating just enough carbs to maintaining the building functions (anabolic) of the body. When the liver has to create energy, that is a catabolic state – which over the long run leads to aging and stress on the body which has a cascade of consequences. For those interested her website is:
    Her first book is really informative.

  188. Technically, there is no essential human requirement for carbohydrates in the diet. The liver can make all the glucose we need to maintain proper functioning without eating a single carb. Therefore, there really is no such thing as a diet too low in carbs.
    Rather, we may have impaired digestion from eating the Standard American Diet for our entire life. We can also get accustomed to the feeling we get from fueling our energy from carbs/sugar. We may like the fast energy like being on rocket fuel. But at the end of the day, if we can adapt our bodies to running on ketones and get a nice slow burn of energy without spiking insulin we are much better off.

    • The fact that the liver can produce carbohydrate from other substrates is better viewed as evidence of how important glucose is to physiological function rather than an argument against eating carbs. That has never made any sense at all to me. There’s no evidence at all (as I’ve pointed out many times) that being in ketosis is optimal for healthy people, though it is effective as a therapeutic approach in some conditions.

      • I think what Chris is referring to with the liver is ketones.

        In the absence of glucose, when glygogen stores are depleted, the liver processes fat (dietary fat or body fat) into ketones — which is essentially a second fuel the body and brain can live on. This is ketosis. Far from being an inferior fuel, there is evidence that the brain functions BETTER on ketones — cognitive function improves, and a variety of brain disorders see a lessening of symptoms. This is also why low-carb dieters generally report feeling more alert and needing less sleep.

        Perlmutter’s core theory, which is certainly unproven but very plausible, is that ketosis is critical for the brain’s maintenance and regenerative function. But unfortunately most Americans don’t get to experience ketosis much because they are told by their doctors that it is healthy to constantly stuff themselves with “low-fat” sugar and processed grain products.

        With all due respect to Chris, there is a lot of evidence that ketosis is a normal and healthy human condition. If you don’t reach ketosis, you can never burn body fat, only spend your life accumulating it — which unfortunate is how it is with 80 million obese Americans.

        • I was saddened to read Chris’s comments in the recent article, “This Is Your Brain on Gluten” in The Atlantic.

          Rather than hearing our comments, he seems to be even more firmly entrenched into his position. I get the feeling that being “right” means more than fully exploring or understanding the issue.

          At least here, he acknowledges the benefits of ketosis for some populations. “First of all, I’d like to point out that very low carb (VLC) and ketogenic diets can be effective therapeutic tools for treating many neurological disorders.” BUT, he (perhaps correctly) questions the wisdom of applying this approach to all patients.

          In the more recent article, he reduces the scientific basis for this dietary intervention to one rat study showing effectiveness in Parkinson’s patients and a single small study showing “some” effectiveness in “some” patients with dementia. As a patient at high risk of Alzheimer’s, I find his dismissal disingenuous, at best. I can find hundreds of studies and decades of clinical practice backing up Dr. Perlmutter’s approach. So could he… just by reading the book.

          Chris then goes on to say “It’s important to realize, that just because a low-carb diet can help treat neurological disorders, doesn’t mean the carbs caused the disorder in the first place.” Once again, I think Chris is missing the point. Dr. Perlmutter, as a neurologist who’s devoted his life to preventing neurodegenerative disease- like Alzheimer’s- is keenly aware of it’s multifactorial etiology. Keeping blood glucose low is simply one factor we CAN control; Dr. Perlmutter is suggesting we should.

          Chris then cites the Kitivans and other similar traditional groups as “proof” that carbohydrates are healthy without acknowledging that the quality of the carbohydrates they consume (much lower in glucose than our hybridized versions of the same) and the vast difference in their lifestyle (much more physically active than the typical Westerner) most certainly plays a part in their tolerance level. Kitivans also get the majority of their protein from the sea; rich in Omega 3s. Their fat is almost all SFA from coconuts- falling fairly closely in line with what Dr. Perlmutter recommends.

          In Chris’s defense, as Dr. Perlmutter’s publicity tour commenced, he DID seem to become more restrictive of carbs. As his patient (of almost a year) I was told to keep my intake under 75 grams. I now see he’s lowered his recommendations to 60 grams. I eat somewhere in between and my plate is piled high in vegetables, hardly VLC.

          Rather than attacking Dr. Perlmutter’s approach which is VERY controversial for my population (ApoE4/4), I would greatly appreciate his take on what he would do to prevent Alzheimer’s knowing he was at very high risk. Stop hating, Chris. Work on the problem with us.

          • {“I would greatly appreciate his take on what he would do to prevent Alzheimer’s knowing he was at very high risk.”}

            I’m not Chris, but in addition to what you’re already doing, I’d make sure I was eating at least 3 Tbsp. of Coconut Oil/day, taking plenty of Tumeric and a few other herbs, plenty of bioavailable B12, and so on.

            What great is, like all good holistic protocols, you’re working on preventing Alzheimer’s, but at the same time doing so many other good things for your body.

          • It’s become crystal clear to me that Chris is not interested in an open-minded discussion of Dr. Perlmutter’s recommendations, or the views of people who can benefit from an inexpensive, self-managed preventive approach involving drastically cutting carbs from all sources. He is interested in driving internet surfers to his site, and his book. I personally have chosen a ketogenic diet for now, but I am interested in hearing about pros and cons from people who are willing/able to really look into the research and debate openly about the benefits and possible risks. Instead Chris just keeps saying “there is no evidence that whole fool carbohydrates contribute to neurodegeneration” when everyone with a brain knows full well that many whole food carbs (starches) can have a very significant impact on blood sugar, and therefore could be very much of a problem for many, many people. I guess he would have everyone eat whole-food carbs to their heart’s content until they begin to suffer problems, at which time he would recommend they find an integrative medicine practitioner and shell out 1000+ bucks on expensive consultations and tests. Many people fault the Paleo movement with being a bit elitist–a diet for rich folks who are starting out so much healthier than the rest of us and can easily afford grass-fed meat/butter etc. and fancy gyms and trainers (and launch parties). No wonder Chris Kresser is the darling of this movement. I’ll take Dr. Perlmutter’s preventative approach for the rest of us any day.

          • I’d just like to point out that the quotes in The Atlantic are word-for-word from this article; I’m guessing those weren’t new, unique comments from Chris that they got during an interview or anything.

            As to whether whole-food carbs cause neurological diseases, I think the point was that if you don’t have issues with blood sugar or metabolizing carbs, whole-food carbs aren’t a problem. If a person can’t metabolize carbs without experiencing huge blood sugar spikes and dips, it’s pretty clear that a lower-carb approach is probably better for them (at least temporarily).

            • Thanks for your thoughtful responses. Jake, you KNOW as Dr. Perlmutter’s patient, I’m on an awesome supplement regimen, including curcumin, B-12 and many others. And, Beaker- right on with the exercise recommendation.

              The coconut oil regimen, however, is controversial for my genotype as carriers of ApoE4 tend to hyperabsorb cholesterol. Some get really high LDL-Ps with higher fats, especially SFA. I’m still mildly keto-adapted, but use primarily MUFAs and some limited SFA. Also, Dr. Samuel Henderson’s large body of work (not ONE study) has shown inconsistent/disappointing results with a ketogenic diet for ApoE4 carriers.

              Our population truly is the modern day canary in the coal mine. We live with the knowledge that we have a great likelihood of developing Alzheimer’s with NO consensus from the medical community on the best preventative diet. Most docs (like Dr. William Davis) advise low-fat. Others, like Perlmutter, advise the opposite. Drs. Dayspring, Attia, Jaminet have hinted they concur with Dr. Perlmutter for E4s…but no one has tackled the issue head-on. To date there are NO studies that have separated subjects by ApoE genotype and tested a quality HFLC diet on humans with regards to preventing dementia. Instead Big Pharma spends millions of dollars on one failed drug after another.

              Alyssa, re-read both articles. They are similar, but different, quotes. Chris appears to be dialing back his support of a ketogenic diet for even high-risk patients by minimizing the scientific groundwork that has already taken place…perhaps he’s unaware???

              Mary, I hope you’re wrong about Chris’s disinterest. Resolving the conflicting dietary advice to prevent Alzheimer’s is a big issue for ApoE4 carriers (25% of the population), especially homozygotes like me (2% of the population) and other high-risk folks. We could use his help in figuring out what DOES work.

              • No, the quotes are exactly the same. From the article above: “It’s important to realize that just because a low-carb diet can help treat neurological disorders, doesn’t mean the carbs caused the disorder in the first place.”

                From the Atlantic: ““It’s important to realize,” Kresser says, “that just because a low-carb diet can help treat neurological disorders, doesn’t mean the carbs caused the disorder in the first place.””

                From the article: “[T]he Hadza of north-central Tanzania and the Kuna of Panama obtain a high percentage of their total calories from foods that are high in natural sugars, such as fruit, starchy tubers and honey, yet they are remarkably lean, fit and free of modern disease.”

                From the Atlantic: ““The Hadza of north-central Tanzania and the Kuna of Panama obtain a high percentage of their total calories from foods that are high in natural sugars, such as fruit, starchy tubers and honey, yet they are remarkably lean, fit and free of modern disease.””

                From the article: “All of these cultures are fit and lean with practically non-existent rates of neurological disorders and other modern chronic disease.”

                From the Atlantic: ““All of these cultures,” Kresser notes, citing Swedish researcher Staffan Lindeberg’s book Food and Western Disease (and, I would add, Dan Buettner’s The Blue Zones) “are fit and lean with practically non-existent rates of neurological disorders and other modern chronic disease.””

                Plus, they introduce the section by saying “He wrote recently on his website about how he responds,” so it’s pretty clear they just took quotes from this article.

                I suppose it doesn’t make much difference either way; I just wanted to point that out 🙂 And I highly doubt Chris is disinterested; I think he’s just busy.

                • Alyssa, you are correct; there are many similarities between the two articles. BUT what prompted me to post was Chris’s dialing back his support for a ketogenic approach in The Atlantic article.

                  Perhaps, I’m splitting hairs (forgive me if I am), but after literally hundreds of posts in support and defense of Dr. Perlmutter, (more comments than ANY other blog post) Chris seems to be moving in the OPPOSITE direction by minimizing the scientific evidence.

                  From this blog post:

                  First of all, I’d like to point out that very low carb (VLC) and ketogenic diets can be effective therapeutic tools for treating many neurological disorders. I touched on this briefly a while back in my podcast with Emily Deans, and initial studies on low-carb diets and mental health have shown promise. (1, 2, 3, 4) Because Dr. Perlmutter is a neurologist, it makes sense that he would be a proponent of low-carb diets for his patients based on these therapeutic effects.”

                  From The Atlantic:

                  Kresser tells his patients that initial studies on low-carb diets and mental health have shown promise. He notes scientific articles that look at why low-carb diets are sometimes effective in managing epilepsy, rat models that have shown positive effects in Parkinson’s, and a small study that showed some cognitive improvement in patients with dementia.

                  With all due respect, there is a much larger body of work in support of this dietary approach, not just ONE rat study and a single SMALL study in humans. By minimizing the scientific evidence, Chris seems to be withdrawing his already tepid support.

              • Julie, I figured you were on a good supplement protocol, but always good to hear.

                As to the tendency to hyperabsorb cholesterol, I’d be interested in how that is managed with ApoE4 carriers, as I would think the last thing you’d want in an Alzheimer’s prevention protocol would be a controlled, low cholesterol.

                • Very astute observation, Jake. I’m interested in figuring that out too.; my very life depends upon it 🙂

                  My best guess, at this point, is that higher cholesterol may be optimal for E4s. We know that our version of apolipoprotein carries and delivers cholesterol less efficiently than other ApoE genotypes. For that reason alone, limiting this vital fuel makes little sense. However, ApoE4 also CLEARS lipid depleted apoliprotein less efficiently than other genotypes; which could be an argument for limiting fat intake. While consuming a ketogenic diet, we BURN lipids as fuel which may ultimately prove to be the best clearance mechanism.
                  There is a body of work, led by Drs. Neal Barnard, Rudy Tanzi suggesting that maintaining very low cholesterol levels, and little to no animal products, is the best dietary prevention strategy for preventing Alzheimer’s. This is based upon interventions, in which animals fed high cholesterol diets, developed high levels of amyloid-beta plaque. (Similar interventions in humans have been mixed.)

                  For now, we observe that E4 carriers tend to develop high TC, LDL-C and LDL-P when consuming a higher fat diet. Some, like Dr. Stephanie Seneff and Chris Masterjohn, suggest that’s because we NEED the higher levels. Conventional wisdom, however, still advises us to eat a low-fat and/or take statins.

                  Why should Chris or anyone who doesn’t carry ApoE4 care? My guess is that figuring out what works for our population may unravel the Alzheimer’s prevention puzzle for EVERYONE. Alzheimer’s currently affects over 5 million people in the United States alone. As our population ages, experts estimate that more than 14 million Americans will develop the disease by 2050. The ApoE4 variant is the strongest genetic risk factor for late-onset Alzhimers. Almost all E4 homozygotes, like me, will go on to develop the disease.

                  E4 carriers are navigating our dietary path without a map. There is NO consensus from the medical establishment for us. We are on the precipice of an epigenetic brave new world, one step ahead of the scientific community. If this canary is still tweeting in about ten years; I may have taught you all that a mildly ketogenic diet IS a viable prevention strategy for everyone.

              • {” E4 carriers tend to develop high TC, LDL-C and LDL-P when consuming a higher fat diet. “}

                Julie, what exactly do you mean by high TC, LDL-C, & LDL-P? What ranges are you referring to, and what do the overall lipid numbers look like?

                • Jake, if you look within the Paleo community, you’ll find about one fourth of folks who begin the diet are impacted with previously unseen high LDL-C and LDL-P. Not surprisingly, many are found to carry the ApoE4 allele. Some argue, these high numbers are suggestive that a HFLC diet is inappropriate for this population. Those who disagree have yet to tell us what a good lipid profile for an ApoE4 carrier looks like.

                  I was generally unwell, “functionally ill” for much of my life when I subscribed to the low fat dogma. I always had LDL around 80. Since greatly increasing my my dietary fat to around 65% of my calories my LDL has skyrocketed to 150, TC of 250. Fortunately, the rest of my numbers are ideal and my LDL-P is discordant (in a good way) at 1,100. Other E4s aren’t so lucky. Many end up with LDL-Ps in the 2,000s.

                  As you know, high LDL-Ps are correlated with greater risk of CVD…what implications does this have for the E4 community? Should we be eating less fat, more carbs- driving up small LDL-P and LPIR- to keep LDL-P down? Many of us are struggling to find the right combo and ratios of healthy fats to be both neuro and cardio-protective. We’d greatly appreciate having some experts, like Chris, weigh in on our dilemma.

          • “In the more recent article, he reduces the scientific basis for this dietary intervention to one rat study showing effectiveness in Parkinson’s patients and a single small study showing “some” effectiveness in “some” patients with dementia.”

            To be fair, it appears to me that the author of this article in The Atlantic was probably just rehashing what Chris had said in the original article, and used his own language to describe the 4 different citations Chris listed in that opening paragraph. I don’t think Chris was actually interviewed, but I could be wrong.

            The point is that Chris doesn’t believe that everyone should be on a low carb diet “or else”. I haven’t read the Grain Brain book yet, but I recently saw Dr. Perlmutter on Dr. Oz suggesting that EVERYONE should eat low carb to prevent neurodegeneration. I think that’s Chris’s main point here, that whole-food carbs don’t necessarily cause neurodegeneration, and that keeping carbs under 60 g/day is not necessary for the public at large. Especially for those people eating a nutrient dense, moderate carbohydrate diet

            Also, I think Chris would agree that Americans should increase their activity and eat more fatty fish, since those are some of the main recommendations he makes time and time again. I would bet that Chris would suggest that all Americans focus more on those two risk factors (inactivity and inflammatory diets) before they skip right to a <60g carb diet.

            Ultimately, the point here is that there is no one-size-fits-all approach to nutrition and health, and if Dr. Perlmutter is suggesting that ALL people consume a low-carb diet no matter what their situation, then I think Chris is right to critique his recommendations.

      • The point I want to make is that you cant classify carbohydrate as an “Essential Nutrient” Essential nutrients are those that we must eat because our bodies can not manufacture them.

        Carbs do not fall into that category. In fact, our liver can and will make all the glucose we need for proper functioning.

        That does not detract from the importance of glucose to the proper functioning of our systems.We must have it, so our bodies make it. No additional glucose is really necessary. Once our muscles and brain have their max fill, the body turns it into fat.
        Burning fat for energy rather than glucose is far more efficient than burning sugar. I would suggest reviewing the work of Nora Gadgaudes, Stephen Phinny and Jeff Volek for for the scientific evidence that this is true.

        • It’s not about the glucose. It’s about the other things that carb-rich foods contain. Our bodies need more than just fat, protein and glucose.

          • PC asked: Perhaps it’s what carb-rich foods contain that is truly important – the antioxidants. Maybe that’s why we have a taste for them?

            That’s a hard question to answer. Carb food can contain a lot of things. I wonder which of these are essential for human health:

            Whole corn, vegetable oil (contains one or more of the following: corn, soybean, and/or sunflower oil), salt, cheddar cheese (cultured milk, salt, enzymes), maltodextrin, wheat flour, whey, monsodium glutamate, buttermilk solids, romano cheese from cow’s milk (part-skim cow’s milk, cheese cultures, salt, enzymes), whey protein concentrate, onion powder, partially hydrogenated soybean and cottonseed oil, corn flour, disodium phosphate, lactose, natural and artificial flavor, dextrose, tomato powder, spices, lactic acid, artificial color (including yellow 6, yellow 5, red 40), citric acid, sugar, garlic powder, red and green bell peppe powder, sodium casinate, disodium inosinate, disodium guanylate, nonfat milk solids, whey protein isolate, and corn syrup solids.

            That is the ingredients list for Doritos (Nacho Cheese), which I get cravings for all the time. I wonder which of these chemicals my body is crying out for?

            Or might it just be the blood sugar rush I get when I down a bunch of processed and heavily flavored corn meal, washed down with water and corn syrup and caramel color?

            I’ll take my tongue out of cheek. The reason carb food is so addictive is NOT because it is nutritious. It is no more nutritious than cigarettes. Carbs food is addictive because it is addictive. What is nutritious about french fries, coke, ice cream, crackers, “multi-grain” sugar cereal, sugared yogurt, fruit juice and twinkies — which most of us crave like a smoker craves nicotine.

            Carb food is highly, highly addictive, which is what makes it so dang profitable — you can add sugar to carbonated water and sell it for $1 a liter. You can mash up corn and wheat for pennies a pound and sell it as “heart-healthy multigrain” products and people can’t stop eating it.

            • I hardly think using Doritoes as an example of carbs is a good example. I eat white potatoes (with real butter and real sour cream). I enjoy them but I don’t find them addictive. In fact, when I was eating LCHF and NOT eating potatoes, I had cravings for carbs. Now that I’m eating a moderate amount of carbs, I no longer have cravings of any kind. My appetite is under my control. I eat when I’m hungry and I stop when I’m satisfied.

              • Right. Your craved carbs, and when you ate them, the craving goes away. Just like a smoker’s cravings for nicotine go away when they smoke a cigarette.

            • Tom,

              I think this is smoking gun. I have been following this debate for the last few months, and have been amazed by the level of rhetorical gymnastics going on. It reminds me of the same debates I would engage with addicts, and maybe not surprisingly, with diabetics who refuse to lower their carb intake, because they like the “buzz” they get. I am still amazed by how many people complain about cravings for carbs/fruit, but not about protein/fat cravings. Now why is that?

  189. Beaker writes: It’s almost as if some are saying everyone that eats moderate carbs is obese? How do you explain people like me who work out 6 days a week, eat a variety of whole foods + moderate (sometimes high) carbs and are slim/atheletic.

    Obviously not all people who eat a carb-based diet are obese. If your diet is working for you, that’s great. I know young people who live largely on pizza, Doritos, burritos, candy bars and beer, and maintain a healthy weight. Doesn’t mean that diet works for most people.

    What I would assert are two things: If you are struggling with weight, blood pressure, bloating, acid reflux, high blood sugar, afternoon drowsiness, snoring, high triglicerides, difficulties with memory — all these things are symptoms of metabolic syndrome, and the research of the last 20 years tells us — quite clearly — that the best intervention is to cut down on carb consumption. Exercise is good, exercise is helpful, but exercise will NOT, by itself, turn an obese person into a fit one. The data is abundantly clear on that point: Exercise does not lead to weight loss, contrary to conventional wisdom.

    The other thing Beaker is suggesting that I take issue with is the idea that “healthy” carbs — presumably fresh fruit and “whole grain” wheat products — are a lot better for you than “unhealthy” carbs like pizza or french fries. If your problem is too many grams of carbs, switching from white bread bagels to wheat bagels does not help at all! Switching from coke to organic fruit juice does not help! Sugar is sugar. Wheat is wheat. Organic starch is essentially the same thing as industrial starch.

    As a matter of taste I like whole grain baked goods but, despite the enormous amount of marketing behind them, there really is no solid evidence that whole grains are particularly good for you.

    In fact whole grains raise your blood sugar for a longer period of time than sugar or white flour. For
    someone whose problems are caused by elevated blood sugar, that may not be a good thing.

    As counter-intuitive as it is, having a Hershey bar for breakfast might actually be better for you than a “whole grain” and “organic” blueberry muffin, because the candy bar’s impact on blood sugar would at least be short-lived. The best breakfast, for anyone who wants to control blood sugar (which is most of us), would be foods that do not jack up your blood sugar at all. Or of course no morning meal at all, which is one of the less talked about features of the Mediterranean diet.

    Getting back to Beaker — if whole grains, fruit and exercise works for you, that’s great. Just don’t try to impose that solution on the entire population — that’s what the American diet establishment tried to do, and the result was (and is) a public health calamity in the United States.

    • Hi Tom,
      Beaker was actually speaking about sourdough breads and he went on to say that he didn’t think anyone should eat grains that had not been properly prepared (ie soured). Souring greatly reduces reduces phytates, predigests starches and has been shown to improve glucose metabolism in compromised individuals. I think he would agree with you that eating a whole wheat bagel for breakfast is a bad idea.

      Do you agree that there is a difference in properly prepared, organic grains and conventional breads?

      I do think that many people cannot tolerate grains (properly prepared or not) at all, but there are some of us who do better on a diet which includes some. I guess the part of this whole debate that bothers me is that people seem to fail to recognize that there is more than one possible answer. I can honestly say I have used and value both a grain free, moderate carbohydrate diet and one that includes carbs. i think it’s important to recognize that carbs are not evil. Grains, properly prepared, are not evil. And we are all designed differently. Even the same individual will have different carbohydrate needs at different points in their life. It is not a black and white issue.
      Here is a study for reference:

      • Regarding use of fermentation on grains — I’m skeptical until I see data. The core thing I believe is that most Americans need to focus on keeping their blood sugar down — that’s how we maintain weight and reduce our cardiovascular risk.

        IF it is true that keeping blood sugar down, and insulin levels low, is the most important thing, then whether your wheat is fermented, or organic, or includes the husks may not matter all that much.

        Carbs drive blood sugar which drives insulin which drives body fat. Elevated insulin is the devil.

        The gut biome is important, but to me it’s secondary to keeping insulin levels low. Nevertheless the research on biome has only really just begun, so who knows — I wouldn’t be surprised if you can improve your cardio risk factors by eating live-culture sauerkraut.

        I’d encourage people to read Gary Taubes — “Good Calories, Bad Calories” is probably the most detailed discussion of the insulin hypothesis that you can find. Taubes may be wrong, and he admits he may be wrong — which is one of the things I like about him. But the recent research seems to point in that direction. Blood sugar seems to be of paramount importance.

        • I am on the same page as Tom. Keeping insulin low is paramount. However one word in defense of the WAPF diet that would have you ferment grains.

          Compared to the Standard American Diet (SAD) a WAPF diet is light years ahead. Grains are consumed fermented which adds valuable enzymes and other things to your system which are valuable.

          A certain portion of our diet should be raw but this goes against the American pallet. Fermented foods are “Super Raw” and add nutrients that are hard to find elsewhere.

          A WAPF type diet with limited grains only eaten if fermented is a fine diet especially when compared to S.A.D.. The problem is that you will have a hard time switching to ketones for energy if you eat too many grains even fermented.

  190. Sorry Chris I absolutely cannot believe we read the same book. Did you get a partial version or something?

    Perlmutter clearly says to eat vegetables & non-gluten grains. On page 5 a paragraph begins “Eat your vegetables.”

    On page 129 he says “eat. . .a wonderful abundance of vegetables.”

    On page 226 he offers a list of vegetables to eat as much of as possible, including all kinds of leafy greens & even includes things like starchy water chestnuts.

    On page 227 he supports occasional consumption of 1/2 cup servings of things like teff, sorghum, rice, tapioca, quinoa. This makes him more liberal and open in the starch department than even Jaminet, I believe.

    I urge you to reconcile your post with the final version of the book. Best wishes.

  191. It’s almost as if some are saying everyone that eats moderate carbs is obese? How do you explain people like me who work out 6 days a week, eat a variety of whole foods + moderate (sometimes high) carbs and are slim/atheletic. If carbs were as evil as presumed, being 40 I should be massive by now but I have virtually no body fat, very lean 165lbs. Mind you if I do eat “carbs” they are whole food based carbs, not refined crap from a packet. My wife has more carbs than I do and she is 105lbs, fit, atheletic and 43. I would like to see studies of people like my wife and I who eat well, eat plenty of carbs, exercise a great deal, etc.

    I have a theory about this carb war and exactly what it is and why nearly everyone has it wrong. I believe that poor diet and lifestyle choices cause vast changes in the gut microbiome. Once these changes take hold your biome will contribute to Obesity, brain issues, inflammation, mental disorders, arthritis and much more. If you eat a wholesome diet, exercise, reduce stress, eat fermented foods (sourdoughs, yogurts and more) you keep a beneficial gut biome in check. There are no insulin issues, obesity issues etc. I don’t think carbs are to blame, I think it’s a sedentary lifestyle + the wrongs foods (tending to be refined carbs) that drastically alter the gut biome and BAM, you’re in big trouble. Bad gut bacteria feed on refined carbs and sugar, pushing out the good bugs. This is one reason behind IBS and other bowel disorders. New research is already showing Obese have far different gut biomes to skinny atheletic people. Things like the microbiome project are going to turn current nutritional thinking on it’s head. This Grain Brain book will be obsolete very soon when the root cause (the gut biome) is fully realized. We must eat to feed the good bugs and starve the bad bugs.

    • Totally agree that it is more about feeding our gut flora than anything else- this has been my primary focus for our family for the last 5 years- and it really works.

      We did a grain free, moderate carbohydrate diet (GAPS) to heal our guts and it was very helpful. We healed behavioral issues in our now 6 year old. Allergy issues in me. And auto immune issues in my husband.

      But, in the long term, I needed more carbs. So, following a WAPF Diet has been hugely beneficial to me in healing my adrenal issues that arose from years of vegetarianism and later too low carb on GAPS.

      I also think that the psychological effects of constant deprivation from carbs goes unrecognized. Food can create all kinds of stressful situations in life because we gather around food. Everything social involves food. I am not saying we should all be eating store bought cake with food colored frosting or store bought potato salad with seed oil, but for our family, eliminating grains entirely makes for way too many awkward situations with kids and stress with extended family. Anyway, ending this long soliloquy, I agree with much of what you’ve said, I think some people get trapped in black and white and begin to respond out of fear- they fear carbs because of all these studies and stop listening to their bodies. I think some can thrive on a low-moderate carb diet and others may need more, And this is not a bad thing if their blood sugar can handle it. And for these people who need more, it can actually be harmful to stay too hard line against carbs. There are hundreds of testimonials of people going into adrenal crisis, which then sets of hormonal or thyroid issues as their bodies try to compensate for lack of carbs.

    • I couldn’t agree more. After reading and learning about nutrition over the past two and a half years, I’ve come to believe that many of our health problems would improve with a more “whole foods” based diet. The reason so many people experience benefits on low carb diets is because eating that way requires removing most processed foods from the diet. But is it necessary to restrict carbs like that? Would one still benefit if they cut out the junk but still ate carbs?
      I know I felt great at first on a LCHF diet, but over time, my metabolism dropped and I had no energy at all. Increasing carbs (but still avoiding processed garbage) IMPROVED my health. It’s not the carbs! It’s the junk!
      I don’t know why LCHF advocates have such a hard time believing that many people actually thrive on higher carbs. I don’t care if they stay low carb if it works for them. Why should they care if I eat higher carb if it works for me?
      And I am an average sized 52 year old female with no known health problems. I lost over 30 pounds when I went LCHF and I haven’t gained it back since adding quality carbs.

  192. Back in the 70’s when I was a teenager- before I was aware and had two degrees I noticed when Mom cooked chicken, green beans and potatoes, I was always better off losing the TATERS. I still am.

  193. First, I am very impressed with the thoughtfulness of many of the people that have responded here. It is indeed unfortunate that the medical community does not seem to have the same integrity, open-mindedness, and the in-depth critical thinking that one would assume would go along with their profession, especially considering how much they charge for their services. (truly they seem to be the last to know about nutritional research) I came across this blog as a function of having just watched and being disillusioned by Dr. Oz’s show on the dangers of eating all carbohydrates. Time and again he never feels he has to substantiate nutritional opinions with research (as in citing particular studies), no exception with their claims about eating fruit and complex carbohydrates. Beyond that he never entertained the rather obvious idea that cross cultural studies would assuredly blow a hole in their theory that all carbohydrates are “bad”. There was no mention of high insulin levels causing the inflammation, nor did they ever speculate that the damage to the brain was possibly the result of gluten.

  194. Well, you make the same points that have supported the anti-low carb people for years and our society is still fat, diabetic and addicted to sugar. And now we have passed this carb-based diet onto our obese children. Hmmmm

    The small tribes you mention above? Living in poverty in a rain forest? Really? Pick a set in downtown LA, London, Tokyo, Peking, Rio, then show me your conclusions.

  195. I think at this point the data strongly supports limiting carbs — but what that limit should be probably depends on the individual person. In fact that was one of the features of the original Atkins diet 40 years ago.

    Atkins wasn’t telling people to eat no carbs. His approach was for each person to gradually phase carbs back in, and as long as they didn’t start bloating or putting on weight, that was the sign their body was tolerating the carbs well.

    So whether you’re at 20 grams a day or 150 grams a day doesn’t matter as long as it works for you. And it may not matter terribly what the carbs look like. Maybe you love beer, or bananas, or beans, or pastry — enjoy it but budget your consumption.

    The only thing I take issue with is a suggestion that it’s unhealthy to be at the lower limit or that you somehow need sugary fruit or beans or whatever to be healthy.

    There really isn’t any evidence that we’ll get sick if we don’t get carbs — especially in contrast with the very strong evidence that eating too much carb food — mostly the processed grain products and sugar that the American food industry churns out — destroys our health in myriad ways.

  196. Re Kurt’s comments on carbs being necessary for “explosive” energy — as it turns out this is another kind of urban myth not supported by the data.

    In fact the L.A. Lakers, after a great deal of study, have gone very low carb in their approach to training, and found that even for professional athletes needing to perform at the very highest level, fat as fuel is much more effective than glucose fuel. If ketone fuel produces enough explosiveness for NBA athletes it’s going to be plenty explosive for you and me.

    There’s great work being done in this subject by people like Jeff Volek (who has been working in the field of nutrition for athletic performance for decades) and Peter Attia (a physician who is a huge fitness buff).

    I have not read the research in detail, but my sense is that for sprint-type events at a very high level of performance, carbs may give you a little bit of an edge. But for everything else, low carb or no carb may well be better.

    Certainly in my experience when I’m in full ketosis, I have much better endurance on my bike rides — ketosis is like being in your second wind all the time — there is no hitting the wall experience whatsoever because your blood sugar levels start low and stay low.

    Finally there is interesting historical data. The Masai, certain Plains Indians, and the Inuit lived almost entirely on high fat meat, fish and blubber despite the fact that their lifestyle required tremendous physical strength and endurance. And their health, as documented by westerners who visited them, was exemplary in the years before western flour and sugar began making its way into their diet.

    • Nicely stated. I also highly recommend the lectures by Peter Attia on ketogenic diets. He is a major fitness buff and has noticed that his swimming performance on the sprint swims is a tad slower, but that other than that his performance equal or better. He feels that the tradeoff is well worth it, as all his health markers are stellar.

  197. I just saw Perlmutter’s interview on Fat Burning Man. He did say that his commendations were meat based. Personally I do not see that as needed. He also said that while he favored ketosis, he was not necessarily advocating it. I think someone could follow his protocol at higher levels of carbs than he would prefer.

    I do not think that grass fed meat is crucial, but I do think it important, and we are making that transition, starting with the item most important to that-liver. I have a feeling that a family avoiding McDonalds, fruit loops, lucky charms and snicker bars will probably save enough money to buy the grass fed meats. I would add that bones for broth would also be high priority for grass fed.

    • People have to remember that ketosis is not some exotic or risky thing. Burning fat is absolutely necessary to a healthy functioning human body — if you don’t eat a midnight snack, ketosis is how your body keeps your brain operating through the night.

      Perlmutter doesn’t talk about ketosis so much — his concern is brain health more than weight loss per se. But he is clearly arguing that ketones are a better fuel for human brains than glucose. When he speaks of miracle cures for people with brain disorders and emotional problems, what he is saying is that when patients switch over to ketone fuel, their brains often do much better.

      A super easy way to experience more ketosis in your life is to is just to not eat breakfast (which is normal practice in Mediterranean countries) or at least eat no carbs for breakfast — eggs, cheese and veggies for example. When you wake up in the morning, you are probably burning fat and you’re blood sugar is low and stable. Why not leave it that way for the morning at least.

  198. “Grain Brain” is next reference book on my study list.

    However, I can comment that for the followers here who are unsure of what their own carb tolerance level is, or whether their carb intake is excessive to their current/future needs, it is straightforward and quick to determine this through kinesiological manual muscle testing. Gathering such information takes the guesswork out of determining “What should I eat and how much, for how long?” (relative to one’s own specific current goal)… eg: What types of carbs best suit me? Will my body tolerate this type of carb? If so, how much? For what length of time? Such testing can show up very specific useful information… giving confidence in adjusting intakes up or down according to changing needs, specific to generic heritage, specific to increases/decreases in physical activity, specific to changing desires…. relative to an overall goal of optimal performance.

    What’s more, the way the testing is done (during a balancing session) the person’s perception of the adverse, neutral or beneficial “bodily sensations” any particular substance can have is rather obvious and therefore very educational.

    The most common “significantly out-of-whack” nutritional excess that shows up in my clients (who are generally moderately healthy yet slightly overweight middle aged people) is excess “carbs” (often 200 < 300% above their individual tolerance level). I don't witness this degree of excess in any other class of food.

    From my observations, in general, one in three people in my community probably ingest levels of carbohydrate in excess of their individual tolerance level and level of physical exertion.

    By excess I refer to "excess over and above their individual tolerance level"… one person's may be 60 grams, another's may be 100 grams per day. The body instinctively "knows" when there is an excess of any substance that has adverse consequences (of one kind or another). The body will reliably tell you what it does/does not want (for optimal performance) if you ask in the right manner.

    What is today's mild "moderately overweight" middle class suburban adult is fundamentally undiagnosed metabolic syndrome… left unchecked becomes something more chronic (diabetes)… left unchecked?? …well! there has to be a consequence of such a marked degree of nutritional imbalance, doesn't there?

    I would prefer to "nip things in the bud" with relevant education to prevent progression (& determining individual carb tolerance levels for example), at this stage of the game… in preference to reversing decline and attempting to bring about recovery 20 to 40 years down the track.

    I know the dominance of excessive low nutrient carbs being ingested in this community will have long term detrimental effects. There is no doubt in my mind.

    • I would encourage people who are curious about low-carb high-fat to just try it. Ignore the old wive’s tales (which are typically spread by the vegan and animal rights zealots). There is absolutely no data to suggest LCHF is harmful and a huge and growing pile of data that it is safe and tremendously effective.

      Just because Perlmutter has written a best-seller that is written for lay readers doesn’t mean anybody should underestimate him. Unlike Atkins, Perlmutter has top-tier scientific credentials in both neurology and nutrition science. There’s hardly anyone in the country better qualified than he to examine the relationship between diet and brain health.

      It doesn’t cost anything or require any great expertise — just a commitment to avoiding grains, sugary foods and starches. You can get your protein and fats a bunch of different ways; you can do this as a vegetarian (though difficult if you’re vegan).

      The worst side effect you have to worry about is lower blood pressure, which is actually a positive side effect except you you can feel faint or queasy while your body is adjusting. So most low-carb keto regimens encourage you to increase salt intake during the adjustment period. If you don’t feel well a couple of days into a low-carb regimen, just drink a little warm broth.

      After a few days as your body becomes keto-adapted, all sorts of wonderful things happen — your belly shrinks as you retain less water, you often stop snoring if you’re a snorer, acid reflux pretty much goes away. You have much less gas and indigestion. Once your digestive system settles in you will often be more regular.

      You will need less sleep, and if you’re exercising, you will actually have more sustained performance as your whole body learns to use ketone fuel. If you have a neurologically intensive job you may find your performance improves. Emotional performance can be better too — certainly it is better without blood sugar ups and downs.

      And I have found you don’t have to be low-carb all the time. You can enjoy these benefits even if you “fall off the wagon” once or twice a week. In our family we try to be very low-carb for about 5 days a week and then enjoy our beer/bread/chocolate during the other two days.

      It’s amazing to me that the low-carb movement gains momentum steadily — and with many different valid approaches — despite hostility from the medical establishment and the anti-meat crusaders. It is because people find out in their own lives that low-carb works. It just simply works.

      • My issue with “Hi Fat” is that often or mostly includes animal products. Now… if you are wealthy no problem you can eat free range healthy organic animal products. You can eat organic pasture fed butter and dairy, organic meats etc. But most people on this LCHF diet will be eating sick cage fed animals pumped full of god knows what. That is going to be more healthy that a predominantly plant based diet with vegetarian based fats? Can’t see that.

        • Beaker, if you want to have the best likelihood of good outcomes, you need to try to separate what is supposition, what is theory backed by a lot of good data, and what is proven.

          To argue that low carb requires spending $20 a pound for grass fed beef is a kind of a straw man argument and really is not supported by the data.

          Here’s what IS supported. We’re now up to 18 significant studies since the mid-90s that have validated the benefits of carbohydrate restriction for weight loss. That question should regarded as settled. The hard core deniers will never come around but they should be ignored just like climate change deniers.

          We also have extremely compelling evidence based on an ingenious study released in 2013 that a Mediterranean diet relatively high in fat (olive oil mainly) and relatively low in cereal grains produces good outcomes.

          By contrast there is supposition and good theory behind the idea of grass fed beef and free range poultry, but there not actually data yet proving that it is that much better for you than Perdue chicken and feedlot beef.

          If you want to spend the money for organic produce and grass fed meat, it can’t hurt and may benefit you but there isn’t actual study evidence proving it is effective in any way.

          Ethical vegetarians, vegans, committed environmentalists seem to want to fight low-carb because they fear its adoption would mean more meat consumption.

          But I don’t think anyone, even with good intentions, should be in the business of denying what the data says. It erodes one’s credibility in the long term.

          It would be better for vegeterians and vegans to focus on the myriad ways one can be meatless and also low-carb. I personally think red meat and butter belong in a good diet, but one can certainly achieve similar results with tofu and coconut oil. The point is to avoid pasta and sugar and margarine whether you’re carnivore or herbivore.

          Similarly, low-carb and exercise do not need to be seen in opposition in any way. One is not a substitute for the other.

          Studies of exercise as a weight-loss strategy have consistently failed to show success, but the data is overwhelming that exercise is good for you in dozens of other ways. If you want to follow what the data says, as opposed what various special interest groups want you to believe, the best approach is going to be low-carb AND exercise.

          • Tom, good to have your attention, you seem to know your stuff. I have no weight or health issues to consider. I’m 40yr, 165lbs, muscular build, predominantly plant based diet and exercise 6 days a week for 1.5hrs or so. Feel pretty awesome. I am curious of your thoughts on grains processed using sourdough cultures. I only eat grains long fermented in sourdough. Recent studies indicate better blood sugar stability for those eating sourdough. Those eating sourdough were stable all day vs. those eating non-sourdough having spikes all day. I think judging by how I feel (great) that a fair bit of long fermented sourdough daily is not bad. I tend to have 5 slices a day smeared with organic nut butters (brazil, almond, cashew). No brain fog here. I am full of enery, sleep well etc. I have 1-2 pasture fed hard boiled eggs a day, a lot of kidney beans for protein (also soaked and prepared properly), for dairy I have 24hr brewed yogurt that I make myself and 48 month aged cheddar. I eat a ton of steamed veggies. I have 2 bananas a day plus mixed berries. I am probably in violation of carb limits, but think something is to be said for properly processed grains. I don’t think anyone should be eating non-sourdough grains. My culture spends 48hrs fermenting the grains in a way I believe opens them up to benefits for the body. It is a shame that I never here sourdough mentioned in so many diet fads, hopefully research will continue.

            • Beaker, you might want to read Michael Pollan’s latest book, “Cooked,” a significant portion of which is devoted to fermentation and food.

              There are lots of good arguments, if not real study evidence, for the benefits of fermented food and eating active cultures to help maintain a good diverse gut flora. And frankly whether it’s good for you or not, I couldn’t live without good vinegar, cheese, salami, pickles…

              I would be a little skeptical that fermentation would do much to ameliorate the impact of bread on blood sugar and insulin levels. You should read Perlmutter and see whether you find his arguments persuasive, but he is arguing passionately that constant consumption of carbs — and the resulting constant elevation of blood sugar levels — is a major cause of a host of brain disorders including Alzheimer’s.

              Perlmutter argues that blood sugar levels considered normal in our society are actually quite high and damaging. We just all eat so many carbs that we don’t even know as a society what normal blood sugar looks like (i.e. blood sugar levels in societies that didn’t have such a plethora of cheap carb food).

              If you believe the insulin hypothesis — the idea that obesity, diabetes and much heart disease results from elevated blood sugar and insulin levels — then suddenly all kinds of foods marketed as healthy are really just the opposite.

              For example “whole wheat bread” — which is basically white bread flour supplemented with ground wheat husks — has a greater glycemic impact than a candy bar or a soda. Multi-grain bread products are delicious, but why are they marketed as healthy food in a society where the number one core health problem may be chronically elevated blood sugar.

              • Thanks Tom, I’ll check out that material. One thing that frustrates me about all these diets ‘backed by studies’ is studies simply can’t take into account certain individuals. Oh they try to say “we factored in for x lifestyle but I don’t buy it’. I’m 40 and fighting fit, actually also had a full cardio workup done last month and cardiologist said I was in the top 2% of heart health. Can they really say moderate levels of carbs are bad for someone that is lean, fit, exercises 1.5hrs a day, eats whole foods only, drinks 2 litres or more of RO water a day, avoids all junk foods, additives, etc. I am not likely the average person involved in most of these studies. I would like to see a study comprising of 2,000 of me to see what happens. I might buy a blood glucose monitor and spend a week or so monitoring and charting my levels. Overall I feel like the average person in these studies is probably far from fit, eats pre-packaged foods and refined carbs and who knows what else. I just find it hard to believe I feel so insanely great, as if I’m in my prime and am not on a LCHF diet. I’ll also note everyone in my family has lived to an old age. My Grandmother is 98 still drives and works part time. She’s sharp as a tack and certainly doesn’t restrict carbs to say the least. Anyway, will stop rambling.

                • Beaker, I agree with you, everybody’s different and if what you’re doing seems to work, it probably is working.

                  I subscribe to the insulin hypothesis which says obesity is not from overeating per se (because everybody overeats); obesity is simply a symptom of metabolic syndrome — one’s body is struggling to deal with high blood sugar and insulin levels and is beginning to become insulin resistant. If you’re putting on weight, whatever you’re eating isn’t working. If you’re lean, that’s an indication that your body is tolerating carbohydrates well. Perlmutter goes further and suggests that even if you’re at a healthy weight, high blood sugar could be causing your brain to age faster. I don’t know if I believe that, but I sure hope it gets tested.

                  The only thing that seems obvious to me is that low-fat high-carb diets are a bad idea for people who are overweight. That’s like prescribing more cigarettes for people with early stage lung disease. If people are overweight, they need to heed their great-grandmother’s advice and cut the sugar and products made from wheat and corn.

        • Actually, it’s not necessary to really increase meat all that much. I too am on a very limited budget and I can’t afford high quality meat. I eat small amounts of the meat I can afford cooked with a lot of coconut oil and low carb vegetables. The one thing I definitely spend more on is high quality eggs. I very seldom eat chicken, because the cheap stuff is just so utterly disgusting.

  199. My husband and I read the book. We were both vegans for 25 years and after reading this book were convinced of the importance of adding eggs in our diet and more healthy fats like raw nuts and seeds. We cut out all grains, all starchy foods like potatoes, corn, rice. In 6 weeks we both lost weight, but more importantly than that we have only experienced GOOD results such as sleeping better and longer, our hair is not as dry and it’s more shiny, my fingernails don’t break as easily, our skin is healthier looking and overall we feel great. We eliminated more foods than we added to our diet. Only eggs we added in. We had always eaten healthy fats, but started eating them more. I still eat fruit, but not as much as before and my husband reduced his fruit intake much more than me. It makes sense to me as he says in his book that our brains need the fat. That the low fat diets are not healthy because our bodies need fat.

    Plus he even sites in his book that ancient grains are way different that the overly processed grains of today are. The grains even a couple of decades he says are different than today. The ancient grains were okay to eat, but today’s grains are different with all the gmo and pesticide use, etc. Is it any wonder there is a huge number of people with gluten intolerance and celiac disease? Not to mention obesity and diabetes. Grains turn to sugar and diabetics shouldn’t be eating them. The grain industry is a huge business. Just look at any grocery store there in an entire isle dedicated to just cereal and another to just bread! Now because so many people cannot consume gluten there are hundreds of gluten free products out there, however consuming those aren’t any better in terms of health. He says the foods they feed cattle (grains, corn, soy, oats…which they shouldn’t eat either as they are grass eaters by nature) are all designed to fatten the cows as quickly as possible in order to sell them. Hmmm eating those foods will fatten a cow so it stands to reason why there are so many obese people in this country too eating the same thing as the cows. If that puts the weight on cows quickly then it puts the weight on people quickly. He also mentions the fatter the person the smaller their brain is! I found that to be very interesting indeed!

    • “Grains turn to sugar and diabetics shouldn’t be eating them.”

      As I mentioned, newer research shows sourdough based breads actually regulate blood sugar levels to normal throughout an entire day thus preventing any spikes. I won’t touch grain unless it’s been long fermented in sourdough cultures.

    • It’s nice indeed that you experienced good results.
      But you need to be very objective when treating this topic.
      1. Not only grains are GMO but also vegetables and some fruits are. And also pesticides are used to grow them too.
      2. Even if you eat cabbage a whole week you will anyways have some sugar in your blood. Sugar is necessary for our body, the problem with it is when it’s high. Diabetics are allowed to eat either fruits and grains in limited amount.
      3. You cannot blame grains for weight gain. I went low carb at the beggining of this year and ate more fat instead (walnuts, coconut oil and dairy). In the beggining I lost some weight but after I gained more than I lost. I know people that eat a lot of bread and aren’t overweight but normal, and they’re not even exercising…Maybe U.S.A. really has some weird grains that are different from those we have here in Europe.
      Hope this helps!

  200. I am reading “grain brain” at the moment and my concern is how it goes against previous studies related to the consumption of high saturated fat,high cholesterol and cardio-vascular disease. I’m at risk of type 2 diabetes and metabolic syndrome as it is prevalent in my family. I have lost considerable weight with limiting my carbs but I’m wondering if my high intake of fat now will negatively impact my risk of metabolic syndrome. Eating fat for your brain heath is one thing, but increasing your risk of other diseases like cardi vascular is another. What is your thoughts on that ?

  201. As someone with the beginning stages of autoimmune thyroid disease (high antibodies but hormones are still low-normal), I have had very bad side effects from low carb diets. I have tried LC and VLC on five occasions and each time I have developed depression, excessive tiredness, coldness of extremities, and even severe panic attacks. In my low carb diets I have always consumed sufficient micronutrients (lots of low-carb veggies and grass fed meats) as well as including MCTs from coconut oil and MCT oil.

    Thank you Chris for teaching me that low-carb diets are no good for people with autoimmune thyroid disease. I’ve been intentionally eating 100-200g of starchy carbs (minimal sugar) daily and I have been feeling a bit better.

  202. With reference to point #2.
    “yams, tropical fruits, banana, papaya, sweet potato” are not grains.
    In his book (Called GRAIN Brain)
    He mentions Gluten and grains and lack of fats and essential fatty acids as being all contributors to neurological disorders, not high carb diet.
    He talks about VLCD as being a solution to diabetes and insulin resistance he also mentions that these are correlative and not necessarily causative.
    So the examples you cherry picked are beside the point and in fact support his argument as they were all absent of grain or gluten containing carbohydrate and mostly lower Gi than processed western carbohydrates.

  203. Non medical ind, but have read much of Dr Perlmutter’s book. I totally agree with your analysis. I know of a 95 year old man who works in a large car dealership that he started yrs ago and all he eats for lunch is a really large bowl of fruit all to himself and he is sharp as can be. On the other hand, my own mother has Demensia and i oversea her care and in knowing what type of eater she was earlier in life, I would say that she was on a high fat diet, was heavy, but I would not say I obese..

  204. Unfortunately, the wheat we’re eating now isn’t the wheat we evolved with. It has been extensively modified to grow shorter, be more disease resistant, etc. Check out “Wheat Belly” I think more study is needed, but I know since my 11 year old Asperger’s Syndrome son and I have gone gluten free, our stomaches are much happier. He went from having diahrrea 4-5 a week, to twice in the past 6 months. My husband and nuero-typical son still love gluten, but seem fine. I think we are so complex that nothing works the same for every body. More study is needed. Thanks!

  205. Carbs are starting to become the new bogeyman just like fats were before. However it all depends on what type of carbs you eat and what your activity levels are. People now days just sit around all day and no wonder they are going to get fat. In other societies, such as the ones mentioned above, with high percentage carb diets, people are usually slimmer and that is because of their lifestyle.

  206. I can appreciate the various arguments over this topic. 14 years ago I used ‘carbohydrates’ as a weight gaining fuel for wieghtlifting: and it worked – I gained 16 lbs. (muscle) in 10 weeks.
    Currently, I have been diagnosed with ALS. In no way do I feel ‘carbohydrates’ led to my demise. I still consume plain bagels, homemade bread, and baskets of fruit: and my condition is relatively ‘stable’.
    Consuming refined sugars is different than consuming carbohydrates. ALS is essentially the destruction of mitochondrial dna. Free radicals yield destruction, and refined sugars speed up this process.
    There are scrolls of chemicals and compounds in the foods we eat (preservatives, sweeteners…) which also fuel this destructive process, but no Dr. with an agenda would study this to any end.
    The resiliance of the human body is truly amazing, as many alcoholic chainsmokers usually die of loneliness rather than disease; but the evolution of mankind is in-debted to purity and simplicity of foods.

  207. Well, I’m in top shape, feel great, bloodwork is great. I eat a decent amount of carbs but most of my carbs come from long fermented sourdough bread. Interestingly enough there is some indication that sourdough actually helps to control blood sugar levels. Chris, what are your opinions on sourdough? Here are the basics of the research:

    “The study involved men between the ages of 50 and 60. They were given four different kinds of bread – white, whole wheat, whole wheat with barley, and sourdough white bread – and their levels of blood sugar and insulin were measured.

    “With the sourdough bread, the subjects’ blood sugar levels were lower, with a similar rise in blood insulin,” Graham says. “What was even more interesting was that this positive effect remained during their second meal and lasted even hours after.”

    And subjects did not have to eat additional bread at the later meal for the benefits to persist.

    The reason for this effect is not known for certain, but is probably the way the fermentation of the sourdough changes the starches in the bread, increasing its health benefits. Unlike most breads, which are leavened with yeast, sourdough bread is leavened with a “starter” bacterial culture that begins the fermentation process, giving the bread its familiar sourdough tang. ”

    So in reality, good fermented foods could allow for grain and carbohydrate consumption AND stabilize blood sugar levels it seems. A big issue I have with low carb diets is the “meat” side of it. I do not want to consume animal products if I can help it. Doesn’t animal protein come with it’s own set of health risks? Why would any diet plan advocate increasing consumption of it?

    Anyway, I am highly active and somewhat plant based diet, so without some carbs and my sourdough bread I would be starving mad. I can say without doubt once going on sourdough my digestion improved as well as energy levels. Wouldn’t it be a shame that some are missing out on something as beneficial as sourdough due to mislabeling of it as “bad”.

  208. Here’s the results of a study about consumption of different food categories and colorectal adenoma risk from Malaysia that seems like I could benefit from further explanation about:

    Soy bean and soy products were associated with a reduced risk for CRA (OR = 0.38, 95% CI = 0.15-0.98), while tubers were associated with increase in risk four-fold (OR = 4.14, 95% CI = 1.60-10.70) and red meat intake was found to increase the risk two and a half-fold (OR = 2.51, 95% CI = 1.02-6.28). Higher servings of fruits and vegetables were found to significantly decrease the risk (OR fruits = 0.47, 95% CI = 0.30-0.74; OR vegetables = 0.49, 95% = 0.29-0.80).

  209. #2 – There are many traditional cultures with high carb intake and low or nonexistent rates of neurological disease

    This is actually not true. Japan for instance — has a higher PERCENTAGE of their calories from carbs (rice). But their OVERALL consumption of carbs per capita is just a fraction of what Americans eat. People should most definitely not look at Japanese eating habits and conclude it’s healthy to eat that giant teriyaki rice bowl slathered in sugar sauce. Or rice cakes with syrup for breakfast. Nothing could be further from the truth.

    The one unifying concept that makes all of this make sense is the Insulin Hypothesis. It should be treated like the theory of evolution — it explains almost everything and it gives you many paths to good health.

    The research clearly is telling us: Keep your insulin levels down as much as possible, as long as possible.

    You can do that by avoiding foods (carbs) that spike your blood sugar levels and trigger insulin production. But you can also help by exercising to burn excess glucose and glycogen. You can help by doing what the traditional Japanese diet does — small portions, limited meals, no snacks. You can do it by making fasting part of your routine — say, skipping breakfast (which is surprisingly easy to do, and good for you, once you’re used to it).

    What made the traditional Japanese healthy wasn’t the rice. It was the fact that food was expensive in Japan so people ate small portions and didn’t snack.

    Whether you eat live cave man, or the traditional Japanese, or do Atkins, or become a running fanatic — your’e doing the same thing to your blood sugar. You are keeping it down and tamping it down. That is not that hard to understand, is it?

    • Good point. I lived in Japan for a year and the portion sizes are SO MUCH SMALLER than in the US. You get a little tiny bowl of rice with your dinner, which is probably about 1/5 of the typical carb servings in US restaurants. They also have a saying that you should stop eating before you are 100 percent full.

  210. I have been vegetarian/vegan for 7 yrs and also had a few serious head traumas in life so far, and now appear with degenerating brain and nervous system damage, along with other systemic damage related to endocrine, immune, digestive, etc. Have seen lots of doctors, specialists, practitioners, etc and no improvement. They say there is nothing to do that hasn’t been tried and things will only get worse. According to Paleo or “Grain Brain” concepts, I would have to eat meat right?

    For ref, I did the “elimination/anti-inflammatory diet” thing for several years with no improvement, but that included whole soaked/sprouted grains and pulses. If trying “no grains”, how long does it take to notice if it will help? Weight is not a factor.

    Also, here is “cured of cancer” story, which some might find interesting.

    • Perlmutter has done a few podcasts (Robb Wolf’s and Jimmy Moore’s among them) and I remember specifically a question from a vegetarian. He claimed that his approach was definitely doable by a vegetarian. You would certainly not have to eat meat, although I think it would be difficult to eat optimally without eggs and dairy. Check out the podcasts if you can, and you might also want to check out The Vegetarian Myth, which is a book by a woman who switched from veganism to Paleo following neurological problems. I think there is also something on Youtube.

  211. I recently found your website searching for a light in all of the darkness of blood sugar issues. I have not been able to leave the site! I have been reading tons of articles, and I am addicted. Thanks so much for providing sound, logical information that always seems to be missing when visiting the doctor.

  212. Trundle sounds very authoritative, but note his citations are not actually supporting his arguments. The theory that LCHF or Paleo could wreck your immune system or hormone balance in 3 years or 10 years is interesting, and alarming if true, but the data for it is just no data to back this up and without knowing more about Trundle I’m not inclined to take his word for it.

    Old paradigms die hard. We know in the days of Robert Atkins, many in the medical profession spread old wives tales trying to scare people away from low-carb eating (such as intentionally confusing ketosis with ketoacidosis) — but as the research has been done, the old wives tales fell by the wayside and Atkins — to a lot of people’s surprise — has been scientifically vindicated. (And for what it’s worth the Atkins regimen is controlled carb, but not any kind of strict Keto diet)

    There is obviously not much literature on long term effects of a ketogenic diet, but what has been done has shown almost entirely positive outcomes. And we also know of aboriginal populations (the Masai, the Inuit) who lived on a diet of nearly 100% fat and meat (blubber, in the case of the inuit) and were long-lived and disease free before carbohydrates were imported into their societies.


    A great source for people who want to know more, much more scientifically detailed than Perlmutter, is Gary Taubes, who has written “Good Carbs, Bad Carbs” and “Why We Get Fat.” Taubes is a journalist, not a practitioner or an advocate and is very balanced and fair in his approach — but has concluded the evidence overwhelmingly supports a low-carb diet.

    • Tom,

      The Masai have always consumed large quantities of raw milk and honey. Honey is extremely important to the Masai. In fact, this — as well as their weekly habit of trading their meats for sweet potatoes and bananas with neighboring tribes — was well documented even in 1895.

      Secondly, the published scientific literature on the Inuit shows that they were obtaining sufficient carbohydrates from the glycogen in the raw meat they consumed (Heinbecker, 1928, Ho 1972),

      Heinbecker wrote: “…Average daily food partition is about 280 gm. of protein, 135 gm. of fat, and 54 gm. of carbohydrate of which the bulk is derived from the glycogen of the meat eaten.”

      Ho (1972) wrote: “Carbohydrate accounted for only 15% to 20% of their calories, largely in the form of glycogen.”

      Yiu H. Hui, Ph. D. (1985) wrote: “Eskimos actually consume more carbohydrates than most nutritionists have assumed. Because Eskimos frequently eat their meat raw and frozen, they take in more glycogen than a person purchasing meat with a lower glycogen content in a grocery store. The Eskimo practice of preserving a whole seal or bird carcass under an intact whole skin with a thick layer of blubber also permits some proteins to ferment into carbohydrates.” (Principles and issues in nutrition: Yiu H. Hui, Ph. D., p.91 (1985))

      The Inuit ate 8 to 10 pounds of raw meat per day (Sinclair 1953), and raw meat has relatively small amounts of glycogen (animal starch) in it. Diving marine mammals have significant glycogen stores to assist them on their extended dives. And even if their meat only contained the conservatively low levels of glycogen found in Western beef, at 8-10 pounds of meat per day, they were consuming 48 to 60 grams of glycogen per day. Of course they also loved the glycogen-rich muktuk and livers too. High levels of glycogen in muktuk were discovered as far back as 1912 (JAMA: Volume 57, 1912).

      Interestingly, Heinbecker (1928) showed that the Inuit exhibited normal glucose tolerance when fed their traditional diet. But, when Stefansson and Anderson did their year of Western-style meats, Tolstoi (1929) found that they failed their glucose tolerance tests. This suggests that Stefansson and Anderson were unable to replicate the Inuit diet at Bellevue.

      I should also point out that the Masai also preferred their meat raw and fresh. They even drank blood raw and fresh from the leg of their cattle. My guess is that most Western VLCers do not eat this way.

      As the literature shows us, both the Masai and the Inuit consumed sufficient levels of carbohydrate and the Western VLC diet is nothing like what these cultures were doing.

      Every indigenous culture made an effort to consume sufficient carbs. Chronic ketogenic diets are a modern invention, which may be beneficial to those who need it, but haven’t been tested by any indigenous populations.

  213. I appreciate Kessler’s thoughtful response to the book.

    Keep in mind the thing that Perlmutter is most concerned about is gluten — which is pretty much avoided if one follows a Paleo approach.

    To the extent there are aboriginal people who live on carbohydrates and are healthy, I’m fairly certain they aren’t living on modern hybrid wheat, corn and soybeans — they’re living on tubers and fruit.

    I don’t think fruit should get a free pass though. Some supermarket fruit is essentially candy that would never have existed in nature — such as Thompson grapes, Cavendish bananas, navel oranges. We know the sugar in fruit is chemically identical to high fructose corn syrup — why would you want to put that in your body repeatedly. Why not think of fruit as a candy or dessert — enjoy occasionally, in moderation, but if you’re eating it constantly you are probably addicted to the sugar.

    Truth is, there is a great deal in common between LCHF and Paleo — both are on the right track and both approaches should produce considerable health benefits over a conventional diet based on cereal grains. Whether you eat fruit or a lot of sweet potatoes may not matter greatly as long as you are getting sufficient fat and protein.

    As Kessler notes, the beauty of the debate over diet is that everyone is free to run their own experiments and see what works in their case. The biggest problem with changing diet is what people are capable of sustaining over the long term. So if you need bananas in your life, then you work around that. If you need pasta, or bread, or oatmeal, perhaps you try to restrict it to one day a week to minimize the inflammatory and blood-sugar effects.

  214. I hate to jump in the fray…but feel compelled after reading Trundle’s comments. YOU, Sir, have my attention and rather perfectly describe my condition (hypogammaglobulinemia/CVID, gut dysbiosis, and leukopenia) PRIOR to beginning Dr. Perlmutter’s protocol. I’ve been on the diet he prescribed for me for a year now and ALL of those conditions (and more: mast cell activation, severe reynaud’s, reactive hypoglycemia,etc.) have virtually disappeared. My IgG is now in a normal range after years of being around 400-500. My white cells are in the 4’s- up from 2.3.

    I consulted him after learning of of my APOE4/4 status, which predisposes me to a high risk of developing Alzheimer’s. He prescribed a Paleo-ish Diet for me, fat:65%, protein:20%, carbs:15%. My carbs are around 60-70 grams a day- all whole food. My plate is primarily organic, seasonal veggies, high Omega-3 proteins, and healthy fats. I SEE that Dr. Perlmutter seems to have gone slightly lower carb in his new book, but I haven’t. I’m mildly ketoadapted at best, but cognitively sharper than I’ve ever been, healthier and stronger than I thought possible. (FWIW, I wasn’t eating a SAD before, but rather a typical “healthy” American Diet, lowish fat/lowish carb- some refined carbs.)

    I found Dr. Perlmutter after seeing an impressive lecture he did at NYU, entitled “Alzheimer’s Can be Prevented.” It blew me away. I read some of his old books, checked out his resume- have you? Wildly impressive, former Linus Pauling award winner, etc. I don’t think he’s jumping on anyone else’s bandwagon…but rather bringing life saving, life-EXTENDING advice to a nation poised to implode from an Alzheimer’s epidemic.

    Maybe, Trundle, all of those things you predict will return for me. I hope not…. Alzheimer’s is currently considered incurable. The pathology occurs years before symptoms show up. If you wait until they do, it’s too late. I have a predicted risk of 50-100% based upon which research I read and when you take my other risky genes into account.. Dr. Perlmutter’s message is nothing short of earth-shattering to my population and for anyone concerned about cognitive health. I wouldn’t be so quick to dismiss, my friend.

    • Way to go Julie. I commend you, not just for your fabulous health reversal, but for your extremely well-stated (and respectfully stated) support for Dr. Perlmutter and his contribution.

  215. These sort of trends scare me, because they often get interpreted in the extreme.

    1. Not all dietary carbs cause high blood sugar. People need to first understand glycemic index and where their favorite carbs fall in the categories. Second, some carbs are also relatively high in fiber, which slows glucose uptake in the intestines, preventing spikes in blood sugar (i.e. berries). In general, avoid high glycemic foods!

    2. Once you’ve got glycemic index down, understand that wheat is not what it used to be. The wheat we consume today, even organic wheat, is a hybrid of wheat from the days of old. Wheat has lost many of its critical nutrients. I cut-out bread, cereal and wheat products from my diet and I felt great! No more bowel issues. Less inflammation. And I’m not even gluten intolerant.

    3. The brain absolutely positively requires glucose as it’s energy source to function. No other will do. Not fats! Not protein!

    • #3 is just wrong. The brain can also burn ketones, which are derived from fat. Please see the lectures by Jeff Volek and Peter Attia before you start throwing misinformation like this around.

  216. Where have you got this miss information that the older generation of okinawans eat a high carbohydrate diet…THEY DO NOT!

    Their diet is high fat, moderate protein and low carb.

    Get your facts right!

    • I agree with Joakim. I grew up on Okinawa and I laugh at all the assertions that the Okinawan diet is 85% carbs. You can cite all the studies you want to claim that, but anyone who has sat at an Okinawan’s table can tell you it’s not true. It’s and island–they eat lots of fish, seafood, sea vegetables. They eat pork and cook in its fat. They eat eggs, chicken, and beef. During famine, they even ate the poisonous habu snakes on the island. They eat a lot of veggies, especially Goya–bitter melon, and fermented pickles and sauces. They drink astringent green tea. Yes, they eat rice and noodles, too. But not 85% carbs.

      I think there are many factors that went into their healthy traditional diet, but to claim it’s starch-based just isn’t true.

  217. It seems to me that the issue at hand concerning fruit and simple starches is one’s personal carbohydrate tolerance. Both Chris and Dr. Perlmutter agree on the subject of gluten, and grains–like corn and soy. If one’s HbA1C, fasting blood glucose, and post meal blood sugars are in a healthy range when consuming fruit and starches, then why would it matter how much they consume?

    On the other hand, if you’re obese, insulin resistant, and/or diabetic, then you will probably do best limiting fruit and starches…at least until you are able to correct the metabolic derangement. I once was rather dogmatic about LC. But it’s difficult to argue with the data on populations that consume carbohydrate rich diets and not only survive, but thrive. What these populations don’t eat is refined sugar and processed foods, and that is likely the reason they are able to avoid the degenerative diseases that those on the Standard American Diet are suffering from in increasing numbers.

    As Chris said, there is no compelling evidence that consuming fruit and starches will cause neurological disorders. And I would add, as long as one’s postprandial blood sugars are in a healthy range (under 140 mg/dl) after eating fruit and starches then there is no need to be too restrictive.
    I have found Chris to be rather unbiased, reasonable, and not too dogmatic. He follows the science and takes rational stances based on a preponderance of the evidence. I think he’s spot on here.

  218. All that needs to be recognize is that (before the wonderful world we live in today) we wouldn’t be eating the same way year round, and that there would be periods of fasting and over eating- high carbohydrate and low carbohydrate. Would save everyone a lot of headache…

  219. Great post! It seems like the LCHF/Paleo crew is becoming almost cult like against carbs. Especially with ketosis being the big craze these days. I have to admit I was more towards that boat until I came across you, Paul Jaminet, and Dave Asprey. Now I use a combination of all your diets and feel a lot better than I did on a very LC diet… Thanks so much for all your insight!!!

    • I don’t know how you came across Asprey, but he’s one of the low-carb hucksters who believe in the metabolic advantage nonsense. He’s in ketosis and believes that allows him to eat more and not gain fat. Perlmutter here hopped on the low-carb bandwagon without doing proper due diligence on the dangers of ketosis and VLCing. What I see is a bunch of ardent low carbers all getting excited because of their weight loss and BG numbers. Then after 2-3 years, they all develope side effects and all drop off and move onto higher-carb Paleo. But there are some hardcore ones who stick to ketosis due to morbid obesity, t2 diabetes, neurological problems, etc. These guys who go onto do long-term ketosis for that long will develope serious autoimmune diseases, immuen deficiency, hormonal dysfunction, and gut dysbiosis. I’ve seen these guys develope serious conditions like lupus and scleroderma; these are lifelong conditions they must contend with.

  220. There is a huge disconnect in the paleo community that irks me to no end, and some of these comments help reinforce it. Remember in the 70’s and 80’s when all fat was demonized? The paleo community seems to recognize that all fats are NOT created equal – fats from fresh beef, fish, eggs and nuts DOES NOT EQUAL fats from refined seed oils, margarines and hydrogenated biscuit dough. However, the paleo community as a whole cannot seem to understand that potatoes and fruit DOES NOT EQUAL high fructose corn syrup, saccharine and aspartame. The average paleo enthusiast will blame the addictive properties of cookies, ice cream, brownies, Cheetos and Doritos on the “carbs” but all of these ‘foods’ are as high if not higher in fats than carbs. Check the labels.

    There are many comments here that seem to automatically discount fruits and starches with the argument that “our ancestors didn’t have fruits and starches available all year round and modern fruits/starches have been engineered to have more sugar and less fiber.” Human beings evolved at the Equator, which means we DID have access to fruits and starches all year round, and the meat that tends to populate that area tends to be lean and gamey. The few hunter-gatherer and traditional cultures left tend to eat far more carbs than fats because of this, yet they are free of modern disease. You can bet our ancestors would’ve rather gone out and leisurely picked fruit than painstakingly chased after potentially dangerous animals for hours on a hunt. We’ve probably been eating fruit longer than anything else on Earth, and while modern fruit may not be the same as ancient fruit, neither is modern meat. Cows, chickens and pigs are engineered hybrid animals bred over generations to have different flavors, fat compositions and tolerances to the environments they are raised in. Modern meat is no less engineered than modern fruits and starches, so if you let “perfect” be the enemy of good, you will starve to death.

    Fruit is awesome, and sugar is incredibly healthy provided the source is of high quality. Refined sugars are nutritionally equal to refined fats, and honey, maple syrup and molasses all run circles around fats like coconut oil, olive oil and tallow in terms of nutrient density per calorie. Instead of arguing over fats and carbs, just eat real foods and focus on nutrient density per calorie while minimizing anti-nutrients. It is a massive disconnect that it is acceptable to drink coffee with half a stick of butter emulsified in it but a packet of white sugar in your coffee is blasphemy. Empty calories are empty calories, and eating butter is no different nutritionally than eating sugar. Trace Vitamin A you say? There are more trace minerals in dark brown sugar than grassfed butter due to the molasses content, so relax and eat real food, not tubs of coconut oil.

    • Did you know that butter is the richest source of butyric acid after ghee, which is clarified butter ? And benefits of it ? No.
      Did you know that macronutrients may be isocaloric but not isometabolic ? And which macronutrients had the difference ? No.
      You might have been eager to find the truth about things you said but apparently, you couldn’t yet. Some people, like Chris Kresser, may know much more than you seem to think they do. Try to talk less about an issue when there are people that know much more than you about it and are supposed to explain, and are already explaining it…
      Someone may leave a better reply.

  221. Question: did anyone take AGE into account here? When people of both genders turn 50, the blood-brain barrier tightens to the point that glucose cannot get through to the brain, because the hormones that use to wrap around glucose molecules are no longer present–all the glucose ingested (directly or as digested carbs) merely goes to raising your BG levels, because the biggest consumer of the glucose (your brain) has been lost.

    At that point, all these neurological conditions becoming common nowadays (re: Alzheimer’s) are really THE BRAIN STARVING and pruning dendrites to save the central core. Get fat-adapted all you want, but it may not be enough in the end. We simply DO NOT produce enough ketones for the brain to run on them alone!

    So how do we stop this brain-starvation in spite of the pesky blood-brain barrier thing? We take L-glutamine on an empty stomach–why an empty stomach? That’s the only way it passes through the barrier sans hormones. Take this stuff with a meal, and all it does is get into your blood, raise your BG, and possibly feed your muscles.

  222. Hi Chris,

    Excellent response! I not yet read this book, but it’s certainly on my list. My impression from listening to Dr. Perlmutter on the various podcasts he’s been on was that he wasn’t necessarily advocating the elimination of all carbs. Perhaps he hasn’t clarified, or perhaps he has and I missed it. I interpreted his stance as similar to everyone else in the Paleosphere’s, that highly processed and manufactured carbs should be eliminated and that fruits and veggies from whole-food sources were perfectly acceptable.

    I agree with you that the recommendation to keep intake to <60g/day is highly restrictive and the only obvious way to do that is to also restrict intake of whole-food carb sources as well. Which, as you point out, seems excessive and lacks supporting anthropological evidence.

    As Tyler said, we need to find out what works for us and go with that. And I too, would be interested in Dr. Perlmutter's response to your thoughts. Any chance of getting him on your podcast? He's been on all the others! 🙂

    Thanks again for all the great work you do, I've learned a ton from you! Keep it up!

  223. I recently had blood work done and have a TSH of 13. This would indicate I have an issue with low T3 or T4, but if I don’t have symptoms, I wonder how concerned I need to be. I eat a relatively low carb diet, but definitely not VLC. Based on this logic, should I eat more fruit to raise my carb intake and possibly correct the TSH levels?

  224. I don’t remember what it’s called, but my friend Brad has a disorder. If he eats bread he develops a learning disability. It’s like the bread puts a roadblock in his brain. When he doesn’t eat bread, he’s really smart and alert.

  225. Hey Chris,

    I’m a fan & grateful for all I’ve learned from you. You may have a partial point here, but I’m getting the feeling that you might have missed the bigger picture on this one. Your repeated requests for research to back Dr. Perlmutter’s recommendations lead me to think you might not have read the book…and are basing your opinion on a knee-jerk reaction.

    I get that limiting carbs for everyone seems restrictive. Easy for me, as I’m at high-risk of a neurodegenerative disorder, being homozygous APOE ϵ4. Research illustrates that ϵ4 carriers (in a dose dependent fashion) do demonstrate glucose uptake/metabolism dysfunction years before symptoms appear. A mildly keto-adapted diet provides my brain with an alternative (preferential) fuel. This application is ground-breaking for high-risk patients like me. To date, the medical establishment has no treatment, nor agreed upon prevention measures for Alzheimer patients. To have healthy dietary parameters spelled out is nothing short of a lifeline for many of us with risky genes or a strong family history.

    Is it excessive to recommend this way of eating for everyone? More and more research is demonstrating that elevated blood glucose levels (even within normal ranges) DO lead to an increased risk of dementia.

    Glucose Levels and Risk of Dementia

    Can whole foods cause or contribute to elevated blood glucose levels? Sure, many fruits, corn, potatoes, etc. are metabolized very similarly to highly processed foods and most definitely can elevate blood glucose. I keep my carbs between 60-70 grams, basically unlimited above-ground vegetables and a few small servings of fruit a day- hardly VLC- loads of healthful whole foods.

    I would respectfully recommend that you take the time to read the book- if you haven’t. It’s based on real science, is quite do-able (I’m 8 months in), and may offer a plan to prevent a plethora of brain disorders, heart disease, obesity, cancer, and more.


    • You’re looking at one sided research. You can design any research to implicate high BG with neurodegenerative diseases. Does anyone doubt that hyperglycemia, everything else being equal, could lead to conditions like Alzheimer’s. The problem here is that even an isolated neorological condition like Alzheimer’s is multifactorial. It’s not controlled entirely by the ApoE4 genotype; nor is it by hyperglycemia. There are other factors involved and a huckster like Perlmutter looked at research designed for the neurologically impaired and how their symptoms ameliorated after shor-term ketogenic diets.

      Your problem with such a diet is that a ketogenic diet will straighten out your BG, give you stellar lipid numbers, and may prove palliative for neurological symptoms, if you have any. But it will lead to immune and hormonal dysfunction. The effect is stealthy and latent, so you’ll never be able to tell via symptoms. “Well, I feel great!” Of course, you feel great. It’s like asking a heavyweigth boxer like Ali while he was beating up everyone. Hey, Muhammad, do you think 20 years fro now, you could be feeling the effects of Parkinson’s?

      A ketogenic diet results in immune deficiency by kickstarting autoimmune pathogenesis and/or immune deficiency. This usually starts out by slashing your WBCs by 25-50%. They will keep falling for some people. That absence of gas you because you no longer ferment starches and fiber will lead to dysbiosis where microbes that play important immune function will be eviscerated. That’s why most ketogenic dieters go onto develop autoimmune disease 5-10 years down the road; it’s not just the low T3, high cortisol, and low T, which are hormonal issues. I’ve seen some of you guys develop a serious condition like Common Variable Immunodeficinecy, which is considered idiopathic by modern medicine and takes 10-15 years to diagnose. If you’ve been in long-term ketosis, get your immunoglobulins and igg subclasses checked. Chances are, that after 2-3 years, at least one will be deficient. This is a long-term health disaster you’re courting by believing a huckster like Perlmutter. He hopped on the bandwagon to expand his South Florida practice; but he’s a clinican who hasn’t done sufficient due diligence.

      • Hi Trundle, can you add some links to back up what you say? I would like to do some of my own research on this – a lot of people say ketosis can cause immune problems or disrupt gut bacteria, such as Paul Jaminet, but I’m not sure where the evidence is coming from?
        For example how do you know that ketosis slashes WBC count? As someone with already low WBCs and who is doing a keto diet and has a friend who is doing it too, I really need some answers.

        • PC, listen to your body and look at your own blood labs. Compare WBC counts before and after your diet. I’ve seen hundreds. Go over to Dr. Kruse’s forum where people post blood labs. Their WBCS fall by 25-75%. For some, this is normal and healthy; if your WBC is in the 7s, that’s inflammatory. But I’ve seen some who fall into the 3s and 2s. That’s automatically lymphocytopenic or neutropenic or both. The cause for that has to do with at least 4 factors that get kickstarted when you go ketogenic: (1) triglyceridemia — high serum FFA and very low triglycerides are a breeding ground for autoimmunity; (2) mucin deficiency in the digestive tract, especially in the small intestine, which parallels secretory IgA deficiency — this is caused by glucose deficiency that Jaminet talks about — all lead to the worsening of intestinal permeability and autoimmune pathogenesis; (3) T lymphocyte dysfunction due to low leptin and thymus atrophy — this could show up as low WBCs and low lymphs but not always — you need igg and immunoglobulin subclasses to check this; and (4) gut dysbiosis which is intimately linked to immunity This is breaking news: your microbiome imbalance is beling linked to autoimmune diseases T1 diabetes, RA, etc. (Go over to Dr. BG and check her blog on the human microbiome.)

          You see how gas disappears when you low carb? Some low-carbers are overjoyed that they no longer fart. You can’t fart because there is no fermentable starches and that leads to an imbalance of the microbiome where beneficial bacteria like Bacteroides are overtaken by predatory, pathogenic bacteria like Prevotella copri. (See the RA article). Your gut microbes play an indispensable immune function; ketosis and VLC dieting decimate many of the essential bacteria; that’s what a no-starch diet does to you. That shows up as long-term immune deficiency or autoimmune diseases, if you’re genetically susceptible. But who’s not susceptible these days? That explains why so many people develop food allergies upon going Paleo: these are all low carbers who’ve compromised their immunity. Worse, it takes 5-10 years to correctly diagnose autoimmunity or immune deficiency. You’ll never know since it’s asymptomatic. But it’s progressive and degenerative and once it gets kickstarted, it cannot be reversed. Among Dr. Bernstein’s diabetic patients, autoimmunity is 100%, hypothyroidism is 90%, Raynaud’s is 80%, serious immune deficiency like CVID is 33%. That’s coming from the good doctor’s mouth; I’m not making this stuff up. He himself takes immnoglobulin injections every 3 weeks to fight off infections; many of his patients do after being in ketosis for 10+ years. Many of these guys go on to develop lymphoma. He’s been claiming that such disease are comorbidities of diabetes but he knows what we’re dealing with. Long-term ketosis and VLCing will lead to a train wreck. Just because you feel great doesn’t mean you’re healthy.

          You seem like a bright guy, PC. Go look up those citations, google other terms, and make up your own mind about Perlmutter and his ilk. What they’re promoting is based on shallow science, short-term trials, and inadequate examinations of hormonal and immune dysregulation. There is a plethora of current literature that’s linking gut dysbiosis, which is almost automatic when VLCing, with autoimmune diseases. To say it’s disturbing is an understatement.

      • Julie, I suggest that you have a look at the lectures on ketogenic diets by Peter Attia and Jeff Volek (search Youtube). There is also a really good (though technical) series on keto-adaptation on Peter Attia’s blog the Eating Academy.

        I am on a ketogenic diet and I am not without concerns. I have tried a moderate carb diet but cannot seem to maintain it (any appreciable amount of carbs causes me to crave high-carb foods so much that I eventually lose all control 😉 so for now I am choosing a ketogenic diet, partially due to Perlutter’s arguments in conjunction with the fact that I have signs of insulin resistance and cognitive decline.

        Jeff Volek and Steve Phinney are the experts on keto diets–they do lots of ongoing research, have two books out and lectures on Youtube as I mentioned. Before letting the comments from Trundle scare you off your diet, check out these sources so you can make a considered decision given your genetic susceptibility to Alzheimer’s.

        • Mary, do you know anything about the condition Julie suffers from? Do you even know how to spell it? Let me spot you the first 3 letters: CVI. The reason why a ketogenic diet is ill-advised for someone with Julie’s problems is that it she already has severely compromised immune defenses. She should be under the care of a qualified hematologist but she is instead following a rogue neurologist who’s regarded “out there” even by those in the profession. Even Dr. Lustig doesn’t agree with him. Do some research on this rogue neurologist who’ll “promise you the moon and stars” in the argot of his colleague and fellow neurologist, and blame everything on one thing, carbs.

          It’s a simple and seductive message, easy to digest. Being healthy and avoiding dementia is really simple if you only cut the carbs. These are one-trick ponies who’ve been at it for years. You, as much as you do not understand the research of Volek, Phinney, Perlmutter and other opportunists with a single villain theory, are an unfortunate victim to his publicity stunt. You do not understand what Volek and Phinney are talking about, right? You are not very cerebral and have to get it down to soundbytes: Insulin is gonna drive me mad. Hyperglycemia is gonna hit me with Parkinson’s. Free radicals are gonna inflict Alzheimer’s on me!

          I’d say you need to develop a bit more analytical skills before offering advice to someone with a serious and life-long condition such as Julie. It’s not your own health; it’s someone else’s. .

          • “Do you even know how to spell it? Let me spot you the first 3 letters: CVI.” Why don’t you humor us and spell it out yourself? Otherwise you come across as a pompous ass.

            So do you have any actual scientific credentials, or are you self-educated internet know-it-all that likes to respond to posts four months after they have been posted?

  226. Personally, I am grateful that this philosophy is finally making it into mainstream media. (in spite of corporate sponsors….Dr Oz!!). And yes it is the extreme side of low carb, which is what I feel MOST of the average American population needs to reverse the effects of the SAD. You are preaching to the choir so your audience who may not need to take it to this level but I know for a fact that this is having impact on those who have ignored it all together in the past (my family). This is a new beginning. Now if we can get Oprah on board it will be a shoe in….

    • Actually, it’s not the extreme end of low carb. Ketogenic diets (Jimmy Moore style) are what I would call the extreme end of low carb. There are a couple of excellent lectures about these diets on Youtube by Peter Attia and Jeff Volek. I think some people would say that Perlmutter’s recommendation of 60 grams of carbs may be harder to maintain than a keto diet or a moderate carb diet, because it’s low enough to restrict the energy available from carbs but not low enough to produce substantial amounts of ketones.

  227. In central and western Asia there are wild fruit trees, some with fruit the same size as in modern orchards. Full-size apples, for instance. I am sceptical of “killer apples” unless one’s body has been so badly damaged that one has developed type 2 diabetes.

    If fructose turns out to be more of a problem than glucose, there are other fruits which are a bit lower in fructose than apples and still very sweet; e.g., apricots.

    Even where I live in England it is possible to eat home-grown fruit from May/June through to March/A

  228. Hello Everyone,

    I’m hearing a lot about white rice in this thread as a safe carb. I’ve avoided it because I’ve always assumed it was processed and most of the nutrients removed during “enrichment”. I’ve gone for brown rice instead but rarely eat it because it doesn’t feel right somehow.

    Can anyone clear this up? Is brown rice superior to white rice?


    • Ivey — if I understand things correctly, the reason white rice is considered a “safe starch” is because the problematic proteins and other substances that make brown rice difficult to digest are removed during the “polishing” that makes white rice. White rice does lose some nutrients compared to brown, but in brown rice, some of those nutrients are bound up to phytic acid, which makes them less bioavailable anyway, unless the rice is soaked/sprouted.