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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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. http://nyti.ms/WIzATn
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.
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.
A very relevant post on Kris Gunnars website today: http://authoritynutrition.com/10-myths-within-the-low-carb-community/
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.
Example
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2716748/
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.
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.
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.
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.
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.
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.
Could someone please comment on the benefits, if any, of sprouted grains vs non sprouted.
I remember reading that sprouted grains were worse than non sprouted grains in greenmedinfo.com
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…
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.
Actually Asprey cycles in and out of ketosis. He advocates occasional high carb meals, more of these meals for women.
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.
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.
I agree L-Glutamine, away from food, is highly desirable. For anyone over 50, it should be on their necessity list, IMHO.
~~~
Blood brain barrier instead becomes more permeable.
http://www.wholehealthinsider.com/newsletter/alzheimers-type-3-diabetes/
Please give a reference to the blood brain barrier tightening in alzheimer.
Please give a reference to the benefits of l-glutamine to a brain or a starving brain.
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!
THANK YOU! It troubles me when anyone takes a one-size-fits-all approach to diet. My clients all thrive on different diets. I always enjoy your balanced approach. 🙂
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?
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.
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
http://www.nejm.org/doi/full/10.1056/NEJMoa1215740
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.
Respectfully,
Julie
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.)
http://elife.elifesciences.org/content/2/e01608
http://www.ncbi.nlm.nih.gov/pubmed/23885333
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. .
http://www.theatlantic.com/health/archive/2013/12/this-is-your-brain-on-gluten/282550/
“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?
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.