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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don’t forget this study:
https://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0055030
—–
Conclusion
Low-carbohydrate diets were associated with a significantly higher risk of all-cause mortality
——
“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.
Wanted to add, I appreciate having this forum to discuss these issues.
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.
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.
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?
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.
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.
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!
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.
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:
https://www.forbes.com/sites/nextavenue/2013/11/14/what-grain-is-doing-to-your-brain/
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.
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.
———————–
Conclusion
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.
Italy ranks LOW on the WHO list of death from Alzheimer’s…..and they consume pasta almost daily!
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.
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.
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:
https://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0055030
———————-
Conclusion
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: https://www.businessinsider.com.au/reproducibility-initiative-study-replication-2012-8
“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.
Tom,
Bravo
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.
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:
https://www.schwarzbeinprinciple.com/pgs/home.html
Her first book is really informative.
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 would also do around 30-45mins a day of moderate cardio exercise. This has shown a protective effect on the brain iirc.
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?
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: https://www.ncbi.nlm.nih.gov/pubmed/18317680
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.
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.
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.