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.
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(cont. last post) April (stored apples) so it’s hardly restricted to the autumn.
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
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?
Thanks.
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.
Thanks, Amy. Makes sense.
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Chris,
I am new to your website and I am also knew to lots of incredible information you put on your website. I am trying to change my diet to improve many symptoms I have from autoimmune diseases so I am trying to educate myself. I have been advised to remove all grains, dairy, legumes, nightshades, sugars but I really have hard time because by removing all grains and white potatoes I don’t eat enough carbs and I feel worse than before. I really don’t do well on a low-carb diet and I don’t need to be on it, I just don’t know how to get my carbs without eating pasta, rice, or white potatoes. Do you have an article on what food provide the best source of safe carbs? tHANK YOU
Hi Mary, I would recommend looking into The Perfect Health Diet by Paul Jaminet or buying his book. He recommends eating carbs from safe starches like rice and sweet potatoes as well as getting plenty of good fats. This plus supplements and probiotics supposedly helps autoimmune problems.
Thank you! I will look into it.
I second the Perfect Health Diet recommendation for someone who wants to do moderate carb rather than low carb. Great book, and Paul Jaminet will often respond to specific questions by email.
Hi Mary. I wrote his earlier and the effects of very low carb sound similar to mine. In terms of eating the right kind of carbs then I do well on white rice, white and potato and over ripe banana’s. I seem to do well on high glycemic paleo carbs which give me a quick hit all at once rather than eating carbs throughout the day. Experiment yourself on this and also try roots and tubers that fall under the paleo diet. Here is what I wrote.
“I myself have suffered from severe depression for years (it’s my go to illness) and I have had a significant head trauma after bashing my head and fracturing my skull with bleeding on the brain.
I have tried ketogenic diets to help alleviate some of the symptoms after hearing some of the beneficial effects it can have for people with neurological conditions such as mine. And I fully believe that ketogenic diets can be an extremely powerful diet for people with neurological conditions such as depression and brain injury.
However, for me, it absolutely wrecks my health. My sleep tanks, I feel even more depressed and anxious, my cognitive ability goes downhill and my physical performance drops. I did it for several months and I actually lost 8lbs in muscle. I was only doing powerlifting at very low reps.
So I myself now eat very low carb in the morning and afternoon (less than 30 grams of carbs) and then for my evening meal most days I’ll have between 100 to 150 grams of carbs. I must add I eat copious amounts of coconut products for its ketogenic inducing properties and I do love all things coconut. Alas, after doing this I now sleep well, feel good about myself and can function properly. It’s all paleo of course as grains and dairy (again, individual with dairy) are what makes me feel like real crap.”
I actually have the same problem with low carbs but the problem for me is that the autoimmune paleo doesn’t allow white rice or white potatoes. So I don’t know what to eat to get a good carb intake. I hope Chris will answer this for me.
Sweet potatoes, winter squash, rhutabega and turnip I think are OK on autoimmune, carrots, onions are also relatively high in carb so a nice leek soup is good. Fruit is OK on autoimmune, I think, so that is also a very good source for people that don’t want to do low carb. Robb Wolf has a lot of free stuff on his website which could be useful to you, plus a good forum. Mark’s Daily Apple is also a great forum.
To clarify for people, I am a different Mary than the one who asked the question 😉
Hi Mary,
My book, Your Personal Paleo Code, which comes out on 12/31 will go into a lot of detail on this.
Great article and great follow up discussion. Such an active post! When was “grain brain” released? It seems a little like you’re jealous of all the attention he’s getting and so had to nit pick some of the minor details rather then commending him for a job well done. Then you go on to plug your own upcoming book! This is certainly a good way to piggy back off someone else’s success since your article probably comes up when someone types “grain brain” into their search engine. Regarding the merits of the research: I think the author of “grain bran” went out on a limb to make a guideline of 60g of carbohydrates a day. The danger in doing this is a lot of people obsess over meeting exact numbers. Others, like me, add it to a pile of knowledge from different experts and try to set up rough guidelines for eating. We keep in mind that our bodies are capable of reaching homeostasis in a lot of different dietary conditions and that it’s those fluctuations that create resiliency. So, maybe restricting to somewhere around 60g per day over a lifetime is a good loose rule. Maybe that number can increase during the sun exposure months when the fruit is ripe and our vitamin D and cholesterol sulphate levels are high and it lowers in the winter months when animals are fat for hibernation and they are our only source of food. So how about everyone keep in mind, including the author of the “grain brain”, that fluctuations are not only okay but probably exactly what the body needs. Not a continual source of HFCS nor a complete elimination of carbs.
I myself have suffered from severe depression for years (it’s my go to illness) and I have had a significant head trauma after bashing my head and fracturing my skull with bleeding on the brain.
I have tried ketogenic diets to help alleviate some of the symptoms after hearing some of the beneficial effects it can have for people with neurological conditions such as mine. And I fully believe that ketogenic diets can be an extremely powerful diet for people with neurological conditions such as depression and brain injury.
However, for me, it absolutely wrecks my health. My sleep tanks, I feel even more depressed and anxious, my cognitive ability goes downhill and my physical performance drops. I did it for several months and I actually lost 8lbs in muscle. I was only doing powerlifting at very low reps.
So I myself now eat very low carb in the morning and afternoon (less than 30 grams of carbs) and then for my evening meal most days I’ll have between 100 to 150 grams of carbs. I must add I eat copious amounts of coconut products for its ketogenic inducing properties and I do love all things coconut. Alas, after doing this I now sleep well, feel good about myself and can function properly. It’s all paleo of course as grains and dairy (again, individual with dairy) are what makes me feel like real crap.
Jamie, it sounds like a ketogenic diet *does* work for you–just not a low carb ketogenic diet. 😀
Bang on there Katherine
I’m just going to modify what I said previously. When I wrote the original comment I had only just started adding carbs back in and initially I found some success with it. However I found that just adding carbs back in the evening didn’t help me enough so now I eat plenty of carbs throughout the whole day. I’m talking 200 grams plus with plenty of coconut products of course.
I just sometimes forget to eat food as I never get hungry cos I eat plenty of coconut and paleo foods.
I can honestly from my n=1 experiment that carbs are not the devil incarnate and very low carb shouldn’t be the defacto way to go.
Anyway, it seems to be working a lot better for me.
I am a neurologist interrested in functional medicine, particularly as it relates to regaining/optimizing health in the face of neurological conditions. Admittedly, my experience in the area of functional medicine is limited. Thanks, to solid thinkers like Chris Kresser, and others, my knowledge base — and personal philosophy — is growing. Helping individuals improve their health must take into account their own individual journey through life, where they are at the moment in time when they encounter the powerful information conveyed by a paleo/ancestral diet and lifestyle. That said, there is a body of neurological literature which correlates both cognitive decline and brain atrophy with increasing serum glucose/hemoglobin A1c levels, even when these levels would be considered “normal.” So, what do I personally do? I have trained my body to be a better fat burner. I start my day with Dave Asprey-styled coffee and snack on nuts (almonds, Brazil nuts) during the pre-noon hours, if I feel a little hunger. My noon meal is typically a salad with olive oil, sometimes nuts, bacon, often protein. But at this point in the day I am introducing carbohydrates by way of some root vegetables (like beets and carrots), and then the balsamic I use on my salad. Mid-afternoon a snack is a piece of fruit (often a banana). Dinner is usually fish/grassfed beef and vegetable, and occasionally sweet potato (particularly if there has been a work out), and often I’ll have some blueberries for dessert. Generally, I’ve been enjoying a glass of wine in the evenings. So, this is a low carb-ish approach that periodizes carbs for the second have of the day and around the time of work outs. This approach has controlled my appetite, improved my gut health, evened out energy levels, and helped keep me “sharp.”
Hi Ken,
To be clear, I haven’t argued that increased glucose and A1c levels aren’t correlated with neurological disease. I’ve argued that there’s no evidence that consuming whole-food carbohydrates like starch and fruit contributes to chronically elevated insulin or glucose. That is a key distinction and one that many seem to have glossed over in the article and comments.
So, you are admitting that glucose disregulation (increased blood glucose and A1C levels, chronically elevated insulin) is linked to neurological disease, but you are arguing that there is no evidence that whole-food carbs (starch or fruit) can contribute to this?
So, if a person (diabetic, pre-diabetic or just a cautious “healthy” person) tracks his or her blood glucose with a glucose monitor and notices that whole-food potatoes, rice and fruit affect their blood sugar as much as bread or pasta, then what–their meter is just wrong, and they can ignore it because there is no specific evidence that these whole-food carbs can contribute to neurological degeneration?
Chris you just said: “To be clear, I haven’t argued that increased glucose and A1c levels aren’t correlated with neurological disease.”
Immediately after you said: ” I’ve argued that there’s no evidence that consuming whole-food carbohydrates like starch and fruit contributes to chronically elevated insulin or glucose.”
Ive worked as a pathologist for 9 years and do a lot of glucose, insulin, lepton tests. The way we test for insulin RESISTANCE is 3 tests over a 4 hour period. testing on an empty stomach. Then eating 40g of carbs from eating measured green apple WHOLE. Waiting 1 hour and testing again and then another hour and then another hour.
The way it works is if you’re producing insulin but its not working properly (insulin resistance), your body produces more insulin to take care of the carbs you eat. (literally ALL forms of carbohydrates turn into blood sugar (glucose) so after each hour if you’re resistant then there will be an increase and its clear then if your insulin is working correctly.
Youd be surprised at the results. After thousands of tests I’ve found that there has been increased levels of insulin from ingesting whole fruits.
You used the term chronic, well if people are eating the same foods daily then you could call regular carbohydrate intake chronic elevation of insulin in the blood.
Chris,
I did read Grain Brain several weeks ago and I am happy that you cleared up the information. I did buy into it and implemented a low carb diet with new found conviction because getting Alzheimer’s for me would be worse than death and if this diet could inoculate me then eating this way was easy. I did have reservations about his theories too. The good news is that after eating this way I finally sleep better, usually through the night. I use to need naps during the day or find myself nodding off at work, this does not happen anymore. I also lost 17 pounds! I am saddened by the fact that this diet will not stop me from getting Alzheimer’s, but I always new in the back of my head it had many flawed theories, I am also happy that I can enjoy some carbs knowing that it will not kill my brain. I am curious how all my levels will look when you check my blood next time. Thanks Chris you are a calming voice in the storm!
Paul wrote, “I am saddened by the fact that this diet will not stop me from getting Alzheimer’s…” This is not the point that Chris has made in his article. He is making the point that there is no evidence that eating particular kinds of whole food “safe” starches will cause Alzheimer’s. That’s not the same thing.
It is the way we grow the wheat today that causes to problem.
Chris, did you actually read Grain Brain in its entirety? There were 250+ citations supporting his statements; did you review them?
I think it’s so important to do what’s right for you, when it’s right for you. Which is so, so different from an ‘all or nothing diet’.
I’ve eliminated grain, alcohol and refined oils.
I’ve cut down on sugar.
While increasing good fats and mineral/nutrient dense foods like bone broth.
I eat unlimited veggies, herbs and potatoes. Limited fruit.
I am refraining from calling it low carb or high fat. It’s rather a series of tweaks that work for ME.
Cut the processed crap. Eat real food. As Chris advocates, it’s not all or nothing but a series if tweaks! Don’t get caught up in the black and white thinking.
I think it is very important to add here what protects the brain: healthy fats, exercise, etc. I’d love to see a link at the bottom of this article to your work (and likely agreement with Dr. Perlmutter) on nutrition and brain health! 🙂
Chris, Thanks so much for the information in this post. Because of it, I will neither buy the book (which would no doubt even increase my confusion and anxiety about what I eat even more) or heed his advice. I happened to see Dr. Perlmutter on Dr.Oz while I was waiting for my daughter at the orthodontist. You should have seen the reactions of the people in the room while he was on. He showed a model of a brain with a big chunk of it having been destroyed by “carbs.” People’s mouths were just hanging open in disbelief with lot’s of comment like; “Oh no, I thought X, Y and Z were good for me and now this guy is trying to tell me they aren’t…”
Yes, for example I know an Ethiopian who says he has ‘coeliac disease’, yet can tolerate fermented pancakes (injara) made from Indian origin chappati flour (whole wheat) and rice flour but he can’t of course tolerate the other forms of fermented whole wheat available here in New Zealand (prob. NZ or Australian origin).
The “Mediterranean diet” with its various grains might not work for some of us because in Europe most grains have less gluten than ours. Also, pastas in Europe are typically made fresh from softer flour, which contains less gluten. If this is true, someone who can’t tolerate the American “Mediterranean diet” might do better with a real Mediterranean diet: Pasta freshly made from grains with less gluten. Or so I’ve read.
There was an article in Life Extension mag recently titled “Elevated Glucose Increases Incidence of Breast Cancer and Brain Shrinkage” Which states:
“A large body of published scientific research documents that people with higher after meal glucose spikes have sharply increased risks for most of the diseases we associate with aging, such as Cancer, Alzheimer’s, kidney failure, retinal damage, and vascular blockages” They cite 13 different studies.
A low carb diet certainly has helped my health and energy, it just makes so much more sense than to risk damage from higher blood sugar.
Number 13 is a type of study I call useless. It gives people an advice to restrict fruits to 2 pieces or less, or an advice to eat at least 2 pieces of fruits a day but there’s nothing to say when it comes to what they eat instead of fruits and instead of what they eat fruits.
This is enough not to draw conclusions from but this is not good also in the study:
“Fruit intake was self-reported using 3-day fruit records and dietary recalls.”
Other than that this is a very good article and since an average person might take the issue of fruits just like that in the study, just to increase or decrease it without any other knowledge, that part may be better than nothing also; but the audience is better than average here already…
Ever since listening to Dr. Barry Groves, PhD, Real Food Summit presentation “Homo Carnivorus: What We Are Designed to Eat”, I have looked at the “safe starch” debate with a greater emphasis on gut flora.
First, let me say that I share the opinion with the likes of yourself, Paul Jaminet, and Stephan Guyenet in this regard.
In Barry’s presentation he breaks down the energy extraction from 100 g of dry matter in a gorilla’s diet after accounting for fermentation of fibre to SCFA as follows:
11.8 g PRO, 47 kcals, 20.5%
7.70 g CHO, 30 kcals, 13.1%
0.50 g FAT, 4-5 kcals, 1.9%
SCFA, 148 kcals, 64.5%
Ever since, I have wondered what percent of SCFA from fermentation constitute the diet of populations such as the Kitavans, Tukisenta, and Okinawans, and how that plays into this whole story. Now, I’m not ignoring the fact that a significant portion of the diet of these populations will directly consist of sugars and starches, but I’m just curious what significance SCFA from fermented fibre plays in distinguishing the differences between refined foods and whole foods. The other notable distinguishing factors being nutrients, minerals, water content, etc.
Just like amylase expression, gut flora may be another likely reason explaining individual variances in “carbohydrate tolerance”. I hypothesize that those who have flora dysbiosis, hindering their ability to convert significant amounts of fibre to SCFA will not be deriving energy from SCFA that they would be otherwise. Thus, they a lesser satiety signal will be perceived and they will still seek to satisfy their hunger. If they choose to satisfy themselves with more carbohydrates, rather than a fat, to compensate for the SCFA that they did not produce, this could lead to an increased glucose load on the body with increasingly possible adverse affects as that glucose load increases.
To illustrate this concept more clearly, say we have two age matched, genetically identical subjects; subject A and subject B. Subject A has the gut flora to efficiently ferment fibre, whereas the flora of Subject B completely lacks this ability. Both are metabolically identical with identical energy requirements of 2000 kcal. Both are fed meals consisting of a whole food starchy carbohydrate, say yams, ad libitum. I would expect subject B to eat 500 g of carbohydrate and Subject A would eat an amount less than that, with the balance of calories coming from SCFA, which was fermented form the fibre naturally found in the yam.
It may seem like I am putting a large emphasis on this aspect of the argument, but in reality I simply want to bring my thoughts to the attention of others here that are like minded, because I haven’t seen this been given much attention.
My take is that carbs are just a source of energy. The problem I see is that we do not walk 10 miles per day or climb up a tree to get those sources… we take a car and go to the supermarket.
Also, carbs are addictive. That is a good thing and probably is driven by evolution: in the past it pushed our ancestors to walk those 10 miles and climb that tree to get them. Today we have easy access to abnormal quantities of refined sugars, and all we have to do is to sit at a desk 8 hours per day to earn the money to buy them later.
Personally, I found my balance. The days I don’t workout (or just do low cardio like walking or hiking) I get most of my calories from fats and try to stay low in carbs. On days of weightlifting or HIIT sessions I enjoy my baked potatoes, some fruits, etc. I guess I eat about 120-150 grams those days (but that’s just a guess, I do not like counting). The insulin spike is not a concern: muscles are severely depleted, the liver possibly is, too. Insulin will drive glucose into them, while promoting protein anabolism by inhibition of muscle protein breakdown.
“We cannot command nature except by obeying her.” – Francis Bacon (1561 – 1626)
As one who could not seem to control herself in between meals, but was continually snacking, this diet has helped break an addiction cycle. I can go four to five hours in between meals now and for me, this is a great thing. This is my one month anniversary since starting the diet; I’ve come down 15 lbs., and my blood sugars are now consistently in the 90s, sometimes the 80s for mg/dL, whereas before they were in the pre-diabetic to diabetic range. For helping me to stop that continual grazing, to pointing me to information about supplements that are of epigenetic interest, I cannot thank him enough.
I think if we consider not only neurological conditions, but the possible forerunners or conditions which exacerbate neurological diseases — namely, the increasing obesity and prevalence of type ii diabetes in our culture, what Dr. Perlmutter proposed in his book has great potential. Diabetes is a key issue here, and it’s on the rise. There’s no question if you drastically reduce carbohydrates, eat good fats and proteins, exercise aerobically, drink lots of water, and try to sleep well, that your risk for diabetes plummets – and with that, a whole host of issues, such as heart disease, kidney disease, peripheral neuropathy – AND the effects Dr. Perlmutter says diabetes has on the brain. Since there is an epidemic of diabetes and obesity in our culture, and assuming there is a connection between these conditions and the neurological diseases of the brain, the brain grain diet has a much wider application to our modern culture than I perceive you are stating.
I do agree with you about the importance of eating whole grains with fiber.
I think the question for me is – do the inflammatory and free radical issues brought on by type ii diabetes contribute to neurological disease? The answer appears to be that they do, and this diet is an antidote for that. Diabetes and obesity must be considered here, and the main cause of diabetes and obesity is over consumption of carbohydrates. Dr. Perlmutter’s diet has a big population in this country that it could help.