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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Some of you may be intererested in Andreas Eenfeldt. He’s a Swedish doctor who writes that country’s most influential health blog, which unequivocally advocates LCHF. Dietdoctor.com is an English version of the blog, which is also translated into a number of other languages.
In part because of Eenfeldt, LCHF is more mainstream in Sweden than just about any other place in the world.
The Swedish Council on Health Technology Assessment, a government panel of experts, last year issued a landmark report saying low carb high fat was the best answer to obesity and diabetes.
It’s the closest thing to a government endorsement of LCHF — and a reflection of how in this issue, like so many others, the Scandinavians are a few years ahead of the Americans, maybe because their governments are not so dominated by moneyed special interests.
Yes I think people should be very careful of claims about “healthy” sugar or “healthy” carbs. Just because it comes from a plant doesn’t mean it’s necessary or good for you. If you guzzle 12 ounces of organic Odwalla juice, it will send your blood sugar and insulin skyrocketing just as effectively as a Sprite, and the fiber and micronutrients in the juice are not beneficial unless you actually need them (and you probably don’t).
Similarly, while coarse grain and whole grain breads are beautiful and tasty, people should be very wary of claims that they’re all that healthier for you than white bread. First of all, as Michael Pollan discusses in his latest book, “Cooked,” most “whole wheat” flour is simply white flour with some bran additives mixed back in. It’s not anything like real stone ground flour from 200 years ago.
From the perspective of someone who is sensitive to blood sugar spikes, whole-grain products are no better and may actually be worse. The extra fiber may slow the impact of the grain on blood glucose levels — they smooth the curve out. But that could actually be WORSE for many people because it means there is a more SUSTAINED insulin spike.
If you are overweight, a sustained insulin spike means a longer period of time when your body is forced to store fat instead of burn fat. So it’s possible that if you’ve got to have 20 grams of carbs, better that they come from a candy bar (which will be processed by your system quickly) than a “whole grain” muffin loaded with “complex carbs.”
Finally, the argument for the muffin will be that it includes fiber, which is good for you. But study after study has failed to demonstrate any long-term health benefit for fiber. There’s very good theory that fiber should reduce, say, bowel cancer, but every study that has been done to try to prove this has come up empty. Fiber is, at least in the studies that have been done so far, a bust.
One more general comment for those who are having trouble with whole-food starches despite the PHD and CK seal of approval: people with small intestinal bacteria overgrowth (SIBO) cannot tolerate any starches well. The specific diets that address this are the SCD (specific carbohydrate diet) and the GAPS diet. I’m wondering if these may be why I haven’t been able to tolerate moderate carb that includes “safe starches” without out-of-control cravings.
Just saw this! (It’s hard to navigate on my smartphone). You’re on the right track! Correct the problem at the root- your gut. It’s the only lasting solution. I used GAPS Diet. It’s been three years and I have maintained a healthy weight and have zero cravings.
Hi Megan,
Thanks for your input about the gut dysbiosis. Were you actually diagnosed with anything specific, or did you just figure it was that and start following the diet?
You say you did the GAPS. I have read that the SCD is supposed to be somewhat similar. Do you know what would recommend one over the other?
For the SCD there is a list online of allowed/disallowed foods, so I guess I will start with that and see how it goes!
Hi Mary,
GAPS is based on SCD. I am not very familiar with SCD, other than what I know of it from GAPS. There were quite a few people on GAPS forums that hadn’t achieved the level of healing that had hoped for in SCD and had moved onto GAPS. I believe GAPS focuses more on the healing properties of broths. The GAPS book is great reading even if you don’t decide to follow the diet. It gave me great insight into digestion and gut health. The website is a little hard to navigate. Hope you find the answers you’re searching for.
Hi Megan, thanks for the info re GAPS/SCD. Following the SCD list of allowed foods seems like a simple solution for now and I already do bone broth. If things don’t go well perhaps I can move into GAPS (which I’ve heard is complicated).
Just realizing that my problem may be difficulty digesting starches is a major step in the right direction. None of the Paleo books I’ve read mention this possibility (nor does the PHD book that I can remember).
I’m so glad I read Denise Minger’s book, as that is what put me onto this (she doesn’t advocate against starches per se, but discusses the wide variability in the starch-digestion gene AMY1).
Her book really helped me come to a much-needed attitude adjustment with respect to all the diet claims flying every which way). I am now so OVER reading these diet books–thank you Denise! If anyone else is truly sick of this never-ending debate, get her book! She makes a very limited number of recommendations based on the preponderance of good science, minus the guru-ism and scare mongering!
Thanks for the book recommendation. I saw Denise speak at a WAPF conference. And also read her takedown of the China Study. I tend to agree with her from what I know so far.
Perfect Health Diet is interesting, and Jaminet’s blog has a lot of thoughtful and interesting speculation, but it is mostly speculation. To assert that carbohydrate restriction is somehow harmful to thyroid based on Jaminet’s ideas about mucous — well, that amounts to believing what you want to believe. There are alternate theories that are just as valid IMHO.
Meanwhile, there are 18 or 19 quality studies over the last 20 years that have shown the effectiveness (and safety) of carb reduction for weight loss — don’t you think if carb control led to thyroid problems that we would have seen it noted in the studies?
Secondly, the argument is made that if you crave something, your body must need it in some way. That is simply not valid in many cases. Many of the things human beings crave the most — nicotine, caffiene, cocaine, sugar — are clearly not necessary or desirable for human health.
Sugar is clearly highly addictive. If you, like most Americans, drink a lot of sugary beverages — from fruit juice to drink sugary beverages — if you stop drinking them, you are going to struggle with cravings for a long time. It doesn’t mean those cravings are a good thing.
The blood sugar/insulin roller coaster is an extremely powerful and destructive thing, but you have no idea how powerful until you get off. Because of our high-carb low-fat diet, Perlmutter argues, so many Americans have permanently elevated insulin levels that our doctors have a distorted idea of what “normal” baseline insulin levels should look like.
No question, many people who go low-carb have trouble making making it sustainable in the long term. It really does require rethinking the way you buy food, the way you cook, the choices you make at restaurants — everything. I respect that.
But please don’t draw the conclusion that because some people can’t resist the big bowl of pasta or the baked potato, carb restriction is unhealthy or ineffective. That conclusion does not square with the science at all. (and not that an OCCASIONAL bowl of pasta or potato is a bad thing, it’s just not the basis of a good diet)
I think there almost no doubt that most Americans would benefit greatly from drastically reducing the amount of carb food they eat — processed and unprocessed. If the government started campaigning about carbs the way it has campaigned about dietary fat and salt, we might begin to make some progress against the obesity epidemic.
That said, I’m certainly not arguing for a hard core ketogenic diet for everyone. The Atkins philosophy is to restrict carbs, lose weight, and when you get to a healthy weight, put the carbs back in until you are weight stable. There are people out there who advocate for long-term VLC, permanent ketosis, and the science may well validate that approach someday, but that is beyond what the literature says to this point.
Likewise, if you’re currently maintaining a healthy weight eating what you’re eating, that’s a pretty good indication your body is handling whatever level of carbs you’re throwing at it. You might feel better without that breakfast of a bagel and orange juice, but if your weight and lipid profile are good, there’s certainly nothing definitive out there saying you need to change.
Hi Tom. I like your post. I too have the feeling that the PHD site contains a fair amount of speculation. Interesting, yes, but not much there to base a diet decision on for someone who really needs to lose weight and can’t seem to do so without restricting carbs.
You mentioned that there are 18 to 19 quality studies showing the effectiveness and safety of carb restriction for weight loss. Do you know what the study period was in these studies? Obviously, if the period was only a few months that says nothing about the safety of longer periods of carb restriction.
Study length is a great point. My issues didn’t start until a year in.
And I can most certainly assure you that just because Jaminet mentions PUFAs as the cause of VLC Thyroid issues that was not what caused it in me.
I still think it’s important not to dismiss testimonials. These stories are powerful. And to say, people fail at VLC because they’re unable to resist their bowls of pasta and Cheerios is incredibly dismissive.
Patti and anyone else interested,
I have started to look at the first link provided by Patti from the PHD site. It states very clearly at the beginning that the sole conclusion that can be drawn from direct evidence is that a high-PUFA diet is detrimental to thyroid health. It also states specifically that there are no human studies looking at low-PUFA high fat diets in relation to thyroid health.
It then goes on to detail indirect evidence that may be suggestive. I am going to look into this indirect evidence, but for now I wanted to point out that providing a link specifically stating there is no firm evidence that LCHF in and of itself is detrimental is not a great argument in favour of the “LCHF is dangerous” view, is it?
I also feel compelled to make a general comment about the article that kicked off this epic thread in light of Denise Minger’s interpretation of the evidence.
If you go back to the first paragraph of the article above, you will see that Chris’ thesis is that unrefined whole-food carbohydrates do not contribute to modern disease. (If anyone is tempted to come on here and say, “oh no, that’s not what the article was meant to support”, please go back and read the first paragraph of the article).
One of the arguments is that, compared to primates, humans have many more copies of the gene AMY1, which is essential for breaking down starches. Chris mentions in passing that the number of copies of this gene does vary greatly between human populations, but then sweeps this directly under the rug in the interests of supporting his argument that unrefined whole-food carbohydrates do not contribute to modern disease.
Denise Minger, on the other hand, discusses this wide variation in AMY1 copies among human populations at length. In people with very low numbers of AMY1 copies, starch spikes glucose even higher than pure glucose (and yes, she cites a study that shows this).
So, clearly, one’s interpretation of the evidence can clearly be influenced by the argument one is trying to make. Denise is making the point that starches CAN in fact be a big problem for certain people, while Chris is supporting the statement that whole-food starches do not contribute to modern disease (and again, if you don’t think that is what he was trying to argue when he wrote the article, please go back and reread that first paragraph).
I don’t know about the rest of you, but, in my book, the fact that AMY1, a gene that is essential for processing starch in a healthy manner, is SO variable among humans (from 1 copy to like 8) supports the contention that whole-food starches can, and do, contribute to modern disease.
But, I really think it’s close minded and harmful to dismiss the fact that VLC diets are not the answer for everyone. Do you agree Tom?
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Absolutely. Carb restriction in some form or another is a very good PROVEN option for people who need to lose weight.
If you are overweight and showing signs of metabolic disorder (reduced insulin sensitivity, high triglicerides, bad HDL etc.), low carb is something people absolutely should consider. It’s not the only way to get to healthy weight but it might be the most effective way to get there for a lot of people.
The only other thing that has been proven to work is bariatric surgery, which is of course a big moneymaker for docs and hospitals. Outside of people who need to lose weight (which is half of American adults, including me), I find the arguments for LCHF intriguing but not compelling.
My only real quarrel was with “I know someone who has thyroid disease after being on a low carb diet” — therefore low carb can cause thyroid disease. People shouldn’t be scared that way.
There have been lots of good studies now — something like 19 of them — and the contention that carbohydrate restriction is dangerous has been pretty well ruled out. Our bodies are designed to do quite well with minimal carbs and many tribal people did exactly that before the fruits of modern agriculture arrived.
I would make two other points Megan.
1) The Atkins foundation — which is probably the most scientifically mainstream of all the low-carb variants — does not really advocate “very” low carb — say, 20 grams a day — as a permanent lifestyle. The Atkins method is to restrict carbs to lose weight, and once you reach a good weight, then gradually add back in carbs to the point that your body can handle them. So everybody knows how many grams they can handle without putting fat back on. That point is going to be different for each person depending on their genetic makeup, exercise level, body type, insulin sensitivity — lots of things.
2) LCHF for brain health is not scientifically proven. Perlmutter connects the dots of the research in very compelling ways IMHO but there is no study evidence saying that eating less carbs and eating more fat and cholesterol will reduce your risk of Alzheimer’s or benefit your brain or body. Perlmutter is a very physician with a very good clinical and research background IN THIS FIELD but the book is his opinion as an expert. It is not definitive.
There is of course a lot of pseudoscience out there about diet. I’d stick with what has been scientifically tested over the last 20 years and especially the last 5. The closest thing to a gold standard study was the one released in mid-2013 that showed overwhelmingly positive results for Mediterranean diet as a way to reduce heart attack risk. It was beautifully designed and the results were so striking that they discontinued it early because it wasn’t fair to the subjects on the conventional “American” diet — their death rate was so much higher. That should tell you something. Mediterranean is not “very” low carb but it is lower than the American diet, and it is considerably higher in fat — mainly oil and nuts.
Tom,
Thanks for the info about the Mediterranean diet study you mentioned. Do you have a link by any chance?
I agree with many of your points. It does seem that all the people screaming about thyroid health are pointing only to anecdotal evidence. You say that there are no studies supporting their claims. I would like to invite the people freaking out about the thyroid connection to please post links to actual studies if they have any. If they don’t, and really are basing this only on anecdotal evidence, I would like to know what the proposed mechanism of action would be. If there is some argument that makes sense as to why lack of carbohydrate would cause thyroid disorder (other than, it happened to my sister, so it could happen to you!), I would like to hear it.
I also agree with Tom’s point about weight loss. I have not found it easy to follow a low-carb high fat diet by any means, but I seem to gain weight like crazy on anything else. I am now 5 ft tall and coming up on 145 pounds, with a lot of the extra around the middle. I think there are ample studies proving that THAT is unhealthy. The only thing I have found to even maintain my weight without losing is LCHF, but I have been scared off of that by all the screaming about thyroid health and “listening to my body”.
Unfortunately, my body is screaming for carbs, all kinds of carbs–especially refined carbs–because it REALLY WANTS to get even fatter. So, I should listen to it, and go from overweight to obese???
Instead of all the scare-mongering, I invite people to share ideas about how thyroid issues can be prevented while doing a LCHF diet. I mean everything has side effects, and I’m thinking that bariatric surgery (the only other proven method for weight loss, according to Tom) has a lot more potential side effects than LCHF. So why aren’t people discussing how to mitigate that potential side effect, rather than throwing the baby out with the bath water?
Mary, Paul Jaminet (from the Perfect Health Diet blog) has written several blog posts on the dangers of zero carb diets. I think you will find his arguments compelling. He writes specifically about thyroid in these posts:
https://perfecthealthdiet.com/2011/08/low-carb-high-fat-diets-and-the-thyroid/
https://perfecthealthdiet.com/2011/08/carbohydrates-and-the-thyroid/
https://perfecthealthdiet.com/2011/08/mario-replies-low-carb-diets-and-the-thyroid-ii/
Also, to state that VLCD are safe because there are no studies proving otherwise makes no sense to me. I don’t think there are any verifiable scientific studies that prove jumping from a third story window is harmful, but there is enough anecdotal evidence out there to convince me not to try it. The scores of people coming forward who’ve had problems with VLCD is undeniable.
If you are craving carbs, it is likely because your body is trying to tell you something. Your body is not out to sabotage you. It is trying to obtain what it needs to function optimally. When I include some quality carbs in my diet, my cravings for junk carbs go away. And I am not the only one to have this experience. It is actually much easier for me to stick to my eating plan when it includes some carbs.
In the end, each of us must decide for ourselves how we will eat. I’ve read so many convincing “scientific-based” arguments on every side of this issue that I have come to realize the only real way to choose is to weigh all of the evidence I’ve read and go with what seems right, and make adjustments based on how my body responds.
I wish you all the best in your journey.
Patti,
Thanks for the link re thyroid from the PHD site. I will definitely look at these. I have in fact done the PHD. I felt quite good on it, but I was gaining weight. Part of the problem is that, unlike you, being on moderate carb is what makes me crave more carbs so badly. I have tried again and again and again to do some form of moderate carb, but each time the cravings become so bad that I end up eating way too much high carb food and I gain weight.
It’s not purely a problem of discipline, because I have had long periods in the past when I was able to maintain very low carb (keto) and I had no cravings for carbs whatsoever. I did have relatively low energy though, and that (along with all the warnings about the dangers of LCHF) has me in search of some other form of eating plan (or some tweak that will improve LCHF for me). Right now I am eating moderate carb (with occasional high carb meals when I give in to the constant cravings). My energy is not that much better, and I am steadily gaining weight!
You said you thought my carb cravings were trying to tell me I needed more carbs to function optimally, but because I only get the cravings when I am on moderate carb (and giving in to the cravings makes me gain weight), I think my body is trying to tell me it wants to be fat. This is why calls to “just listen to your body” really frustrate me–it’s nice if you can do that and it leads in a healthy direction. For me it really doesn’t.
I also would like to comment on your idea that the dangers of LC are undeniable given that scores of people are coming forward after having problems with low carb. Have you considered the possibility that MORE scores of people are doing great on low carb, and are therefore quietly going about their business without “coming forward”? I’m not saying that there is no issue, but arguments that rely on faulty reasoning like this are not very helpful.
On this note, I would like to recommend a book to everyone on this thread: Death by Food Pyramid, by Denise Minger. She goes into great detail about the strengths and weaknesses of dietary studies and gives good advice about how to weight the evidence for individual diet decisions. There is also a section about potential impacts of LC on thyroid, which she says merits further research.
Personally, pending that further research, I would like to hear about supplements or other measures that people like myself, who can’t seem to lose any weight without doing LCHF, can implement to mitigate any possible affects of LCHF on thyroid or adrenal function and to increase energy and maintainability. Instead, all anybody ever says is “add in more carbs–it worked wonders for me!”
I am looking forward to the book by Dr. Wahls that is coming out soon (The Wahls Protocol). It’s intended for chronic autoimmune diseases, not weight loss, but I’m still hoping there may be some clues in there to help me!
I understand your frustration and I hope you can find something that works for you. We are all different and what works for one doesn’t always work for someone else. I wish you the best.
On another note…I just started reading Denise Minger’s book and am enjoying it so far.
Mary,
Have you ever looked into candida as a possible cause of your cravings for carbs? It may be that you could benefit from consuming more pre and probiotics.
I think it is one reason that coconut oil eaten raw can help.
Thanks for the idea Thomas. I am indeed starting to wonder if I am having problems with candida or some type of bacteria overgrowth. Lately I can’t seem to eat much of anything without getting a very full, uncomfortable feeling. And I seem to get major bloating especially after eating a significant amount of starch. I am going to try and good probiotic and see if that helps!
I think that a major part of this discussion that has been ignored is the role of gut flora. Mary, I had unbelievable carb cravings before restoring my gut flora to a healthy place. For me, it all starts with the gut. If you have an overgrowth of Candida or some other sorts of bacteria/yeasts, it will be very hard for you to control your carbohydrate intake.
Being the daughter of an anesthesiologist, I was given antibiotics frequently for ear infections in my youth and acne in my adolescent years- which led to terrible dysbiosis. There was a time when I could not drive past our local bakery without tasting the bread in my mouth. After going on a gut healing diet, breads no longer have that almost magical power over me.
The two keys were: restoring my gut flora to a healthy balance, which led to #2…correcting nutrient deficiencies (because with healthy flora, I was now absorbing all the nutrients from my nutrient dense diet). If I maintain a nutrient dense diet, I am completely free of all cravings. I can trust my body now and listen to it.
I don’t really believe in restrictive diets in the long term. I believe in using diets as a therapeutic tool to get your gut to a place where you don’t need to do long term restriction of an entire macronutrient group. I think the emotional effects of long term restriction (which are immeasureable by studies) have a profound affect on our outlook and overall health. So my goal was to correct the issue at the root with a therapeutic diet (this took about 2 years) and then begin to live without major restriction. I used Gut and Psychology Syndrome Diet by neurologist and nutritionist Natasha Campbell McBride.
I really think that blaming and restricting carbs is symptom treating. Healing the gut corrects the problem at the root. I encourage you to look into it. It truly is a lasting solution.
There is a little bit of informational fog creeping in here and I just want to respond briefly to a few things.
1) There really is no real data connecting low-carb diet (even very low carb) to health problems, only anecdotes. Every study done has reinforced that it is quite safe. That said, if you have health issues like thyroid problems obviously you would want to have a doctor involved before you make significant changes to diet. Changing your diet, say, from 15% of calories from fat to 60% is going to affect lots of things – fasting blood sugar, lipid profile, body fat level, and certainly thyroid hormone. Most of those changes, for most people, will be clearly beneficial but your mileage may vary. Eating less carbs will reduce your level of a key thyroid hormone, so if you are already low, it could make you too low. But it would be wrong to say a low-carb diet has been shown to cause thyroid disease. If that were the case, everybody from the American Heart Association to Archer Daniels and Coca-Cola would be shouting it from the rooftops: “Save your thyroid – eat more Doritos, drink more Coke!”
2) Everybody is on the “real foods” bandwagon, and I feel the same way about getting away from factory/processed foods. But we should always be aware of what is supported by science and what is not. There really isn’t proof that eating “real food” whatever that is will make you healthy. There IS very strong evidence that eating less carbs and more fat, if you are overweight and pointing toward metabolic disorder, will help you control your weight and improve your risk factors. There IS strong evidence that Mediterranean diet is highly beneficial for heart attack risk – though we don’t know why (Mediterranean is relatively low carb high fat but it is also lots of other things). There is NO study that I’m aware of that attempts to measure the health effects of eating “real foods.” I don’t even know how you would do that study. I love Michael Pollan but there are definitely times factory food is better. Just one example — canned tomatoes are of far better quality than the dessicated fresh ones you see at the produce stand in the winter.
3) People who are not familiar with low-carb, and even some people who are, get confused in the complexity of human metabolism. But really there is a very simple mechanism of the heart of it: Carbs drive blood sugar which drives insulin which drives the storage and retrieval of fat. Reduce your carbs, reduce your blood sugar and you will incrementally store less fat and burn more of it. Increase your carbs, you will burn less fat and store more fat. This is why, to fatten up pigs, they feed them the ultimate high-carb diet — flavored corn meal.
Eat an 80% carbohydrate diet like a lot of Americans do, and it is VERY difficult to avoid becoming obese. But if you are not overweight eating an 80% carbohydrate diet, I don’t know whether low-carb is going to be beneficial to you.
My advice is limited to people like me – which is probably 60-75% of the population – we will benefit from reducing carbohydrate consumption to one extent or another and increasing the percentage of calories we get from “healthy” fats. That should be pretty indisputable by now. It hasn’t been established what the right macronutrient levels should be — and it almost certainly varies from person to person, and from one time in a person’s life to another.
4) A lessening of mucous is certainly a side effect of eating less carbohydrates. The Perfect Health Diet folks (who are well intentioned, and well educated but basically amateurs) make a big deal of lack of mucous as a bad thing. But all they are doing is theorizing. There is no real data to back up what they say. As long as the lack of mucous doesn’t make you uncomfortable, it might actually be a good thing. The counter-argument is made by Perlmutter (who BTW has MUCH better health research credentials than the Perfect Health couple). Perlmutter argues that carbs, and particularly wheat gluten, have an inflammatory effect on the entire body, and that’s why you have more mucous – because your immune system is a permanent state of agitation. So is mucous good for you or is it a sign of inflammation, which gets a lot of bad press these days?
I consider it an open question. I certainly blow my nose less and I breathe a lot better at night now that we limit our carbs (and btw we are not strict low carb – we indulge in French fries and chocolate and wine popcorn fairly frequently). If you are uncomfortable though and your nasal passages get too dry and irritated, that might be a reason to add back some potatoes as Perfect Health recommends. I have read the Perfect Health book. Perfect Health’s recommendations sound good to me — I like their web site — but a lot of it is very speculative.
Lack of mucous in the gut is now irrefutably linked to Inflammatory Bowel Conditions. They actually alleviated IBD by supplementing intestinal mucous. This is headed to be a huge treatment for several varieties of IBD. If VLCD reduces intestinal mucous then this is hugely frightening to say the least.
Beaker-
Have you read Gut and Psychology Syndrome by neurologist Natasha Campbell McBride? If not, I think you would find it fascinating. I really do think that the gut is the root of it all. There is so much we don’t know about the microbiome. Anyway, I appreciate reading your constantly returning the discussion back to the gut- that’s probably where it belongs.
Let’s get back to basics here. The article argues that Perlmutter recommends a VLC diet for everyone as an effective preventative against neurological disorders. Kresser says Perlmutter is confusing therapetic effect with cause. There is no hard evidence except for one small study done in rats (which I, admittedly, have not looked at). Kresser also says that this one size fits all approach is actually dangerous.
VLC is a rather new approach and therefore there is no hard clinical evidence as to the long term effects of a VLC diet. There are however hundreds of testimonials from people who went into the diet with a healthy thyroid and came out months later with terrible outcomes. So, Tom, I guess I am confused as to what basis you have for dismissing all these peoples testimonials? Is it simply waiting on some official study? Because we all know that science has its limitations. And studies are notoriously unreliable. How have we become a society that worships expertism to the point of ignoring human experience?
I don’t think anyone is arguing that VLC diets are bad for everyone. Surely, some people thrive on them- at least in the short term- only time will tell for long term (they may set the stage for other chronic disorders). But, I really think it’s close minded and harmful to dismiss the fact that VLC diets are not the answer for everyone. Do you agree Tom?
“Because we all know that science has its limitations. And studies are notoriously unreliable.”
Why basing huge life decisions on “studies” could get your health into trouble:
“Based on a review of 53 published papers on cancer, Begley and Ellis discovered that only six of them could be reproduced and confirmed in a clinical setting. And the worst part was that the 53 papers were considered to be “landmark,” which means they are generally recognized as having had a significant impact on cancer research due to presenting some new cancer treatment approach or novel therapy for targeting cancer cells.
“It looks like the scientific literature is contaminated with a growing number of tainted studies, which may reach 89 percent, the results of which are not reproducible by any means,” writes Eleni Roumeliotou for GreenMedInfo.com about the shocking findings. “This means that to an extent, we have based our healthcare and clinical guidelines on fake studies that reported untruthful results in order to accommodate the interests of industrial corporations.”
Exactly. Science worship is dangerous. But we are taught from a very young age to trust experts opinions over our own intuition and observation. We are not taught logic in schools, but instead encouraged to trust the experts and regurgitate their opinions. And to become successful in the conventional channels, these experts have to comply with corporate agendas. Money rules all. It even dictates how we view our own bodies and what we should be fueling them with. I think we’d all feel a lot better if we started listening to our bodies and attempting to reason things through ourselves rather than relying on studies and experts.
Jeff, Sorry to hear that about your sister. The very same thing happened to me. That is how I came to find testimonial after testimonial from those who experienced it too. I am 34, healthy and active, mother of three. I followed a real foods diet before going on GAPS to heal my gut. My gut healed, which is amazing- I can now eat sourdough w/o breaking out in hives and my digestion is greatly improved. While on GAPS, I went too low carb and suffered thyroid and adrenal issues, hair loss, low libido, low energy, unbelievable fatigue. I went from a healthy 125 to a skeletal 115 (at 5’7″). It was obviously not good for my body. I reincorporated carbs and felt better. It has been almost three years now and I feel great. I always have to be conscious of eating lots of cholesterol and fats. I eat a WAPF Diet for Pregnant and Nursing Mothers and it truly saved me. I really don’t eat a ton of carbs, just let my body tell me what it needs. On a typical day I eat 1 quart of raw milk, a couple pieces of sourdough, 1-2 pieces of fruit and maybe some rice or potatoes at dinner with my meat. I hope she finds what works for her. The fatigue was horrible and made cooking adequately for myself difficult. If she has anyone that can help her cook, I’m sure she would find it helpful.
I still maintain that recommending a VLC diet as a preventative is irresponsible. Many people experience thyroid and adrenal issues by going too low carb. It is not “Atkins flu” as the body adjusts to fat burning. I have read hundreds of testimonials from people who at first felt great on low carb and then afters months things went wrong as the body could no longer compensate. If you search around a little you will too. I think it’s important to realize, that as Weston A Price documented, humans can thrive on vastly different macro nutrient ratios. Some people feel good on VLC, others don’t. But recommending a one size fits all approach is dangerous.
https://perfecthealthdiet.com/2011/08/carbohydrates-and-the-thyroid/
Megan, my sister is 35, slim, healthy and active. A year ago her nutritionist put her on a VLC diet and she did this for months. Things went horribly wrong, she became very lethargic and tired all the time. Going off the diet and back on carbs helped a little but not much. She went through doctors and specialists and now has to be on thyroid medication. No one in our family has any history of thyroid problems. So not only is it possible VLC can impact you, but the damage could be permanent or long lived. It’s been a real nightmare for her to try to get her life back.
Yes, thank you. Couldn’t agree more.
Patti writes: I don’t know why LCHF advocates have such a hard time believing that many people actually thrive on higher carbs.
But then she adds: And I am an average sized 52 year old female with no known health problems. I lost over 30 pounds when I went LCHF and I haven’t gained it back since adding quality carbs.
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Patti, I agree with you, what works is what works. If you’re healthy on the diet you’re eating, then that is the most important piece of data.
I do find curious your comments that LCHF didn’t work when you go on to say you lost 30 pounds on LCHF. That is a lot of weight and dropping that much weight probably improved your risk factors for a lot of things. Your blood lipids are probably better for it, and your insulin sensitivity may be improved — which may be partly why you can handle carbs now without gaining weight.
By adding carbs back in, you’re actually following what Atkins has preached for 40 years. Once you’ve lost the weight, gradually add back in carbs to the level your body can handle. For some people that’s 50 grams a day, for some it’s 250.
But 500-600 grams a day, the typical American intake, is a recipe for obesity for most people, which is why the United States is on track to have 100 million obese people fairly soon.
There are a lot of unanswered questions about healthy diet, but there should be no debate that we have a health crisis in the United States. Obesity completely dwarfs all other healthy problems in our society, and diabetes and Alzheimers (which both track obesity very closely) are going to swamp our medical care system if we don’t do something SOON.
And right now there are only TWO successful treatments for obesity. One is surgery — stomach staples and stomach bands — and one is LCHF/Paleo/Mediterranean/Atkins — which are all variations on the same thing, carb restriction. They are the only things that have been demonstrated to work in significant numbers of people. Exercise and calorie restriction have simply proven to be ineffective for most people. You HAVE to control your blood sugar, and that means controlling carb intake.
What Judi may have gone through when she lost energy is commonly known as the “Atkin’s Flu”. After a lifetime of eating sugar and too many carbs the body takes awhile to adjust to burning ketones rather than sugar ( Glucose).
Many people feel terrible as their body changes from one fuel source to another. Adding some carbs back in will certainly make you feel better. But..If you can get through this phase you will will come out on the other side with a more efficient, fat burning metabolism.
Often people need to see to their gut health first and repair their digestion. Probiotics and fermented foods for a few weeks will set you up to tolerate a big change in your diet better.
And of course some people tolerate carbs better than other people. If you want to or need to add carbs I highly recommend the sweet potato. It is slow burning, low on the glycimic index and full of nutrients.
Marc writes: What Judi may have gone through when she lost energy is commonly known as the “Atkin’s Flu”. After a lifetime of eating sugar and too many carbs the body takes awhile to adjust to burning ketones rather than sugar ( Glucose).
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Yes, for a few days to about a week of eating low carb, people with slightly elevated fasting blood sugar will feel listless when their blood sugar is lower than their bodies are used to. In addition, a person’s blood pressure drops — sometimes quite significantly — with the loss of 3-6 pounds of fluid weight that typically happens when you go low-carb. (A very simple solution is to drink a little salty broth when you feel weak or shaky.) These symptoms are short term though and go away once your body gets used to a lower baseline blood sugar and blood pressure (which are both quite good for you, by the way).
From the studies that have been done of low-carb and other diets, there really is no statistical evidence of health problems from longer term restriction of carbohydrates. There are lots of carbohydrate defenders who would be all over it, but the evidence isn’t there.
There is a lot of scaremongering about gut dysbiosis if you stop eating bowls of spaghetti and Cheerio’s but I wouldn’t buy it. If you’re concerned about keeping a good healthy gut flora, you can do that quite well with 20-50 grams of carbs. Eat veggies and nuts and lower-carb starches like sweet potatoes (and dairy! — some of the most important gut bacterial thrive on dairy). You may crave french fries, Doritos, coke, fruit juice, bananas, bagels, ice cream etc… but your gut flora don’t need any of it.
Tom, yes, I lost weight on low carb, but after a few months, I started to have very low energy and muscle aches in my legs. I also had dry eyes and dry skin and my weight loss had stalled. Dry eyes are a common symptom of too few carbs because mucous production requires carbohydrates. I learned a lot about low carb dangers from reading the Perfect Health Diet blog. I increased my carbs and began to feel so much better. My energy increased, my leg pains went away and my eyes and skin are no longer dry. And I didn’t gain any weight back. I don’t really count carb grams or anything else because I just eat what I feel like eating, but I include white potatoes, sweet potatoes, white rice, fruit, and occasional properly-prepared legumes and grains (usually oats) regularly into my diet. I would guess that I eat between 150-200 carbs most days. In reality, that IS a low carb diet compared to the SAD. But it is not a VLCD which is what most low carb proponents seem to be advocating. I’ve been eating the increased carbs for over a year now.
I never said low carb wasn’t effective for losing weight. And for people who have a great deal of weight to lose, it’s probably a good starting point. But I believe most people would lose weight just as effectively by keeping their carbs in a more moderate range of 100 grams per day and they would likely avoid a lot of the low carb dangers that so many people have experienced. I am on a couple of Facebook groups and there are many former low carbers out there dealing with diminished thyroid function and other health problems as a result of keeping their carb counts too low (under 60 grams per day). Not everyone will have problems with it. But I become concerned when very low carb is pushed as the only way to eat healthy. It is NOT healthy for everyone. If it works for you, great. But don’t ignore the message from so many people who have had a different experience.
I’ve been reading about health and nutrition for about 2 1/2 years now and almost every WOE has people who claim their health improved when they changed to “x” diet. But if you notice, the common factor among all of them is that they cut out the processed garbage. I think THAT is the key. Stick to real, traditional foods.
Great post, Patti.
Well, white rice is not even close to being a “whole food”. It has been polished to the point that only the starchy kernel remains. Since the bran and fiber have been removed, how could little starch kernels be considered “quality carbs” and a whole food?
Jeff Volek in Art of low Carb living suggested that 25% need a low fat high carb diet. as Volek is a ketosis kind of guy, it would seem to me that lchf can have no trouble with differing diets based on individual needs.
I just heard Perlmutter on Fat burning man and he said that his approach was NOT based on meat.
You have missed the point! He advocates eliminating WHEAT! He does NOT argue for eliminating carbs, but reducing them due to the impact they have on blood sugar, insulin, etc., and not consuming WHEAT.
“Ok, so could someone authoritative just give me some general advice re how to eat?”
What a great question and I don’t think anybody should claim to know the definitive answer. Many of the “authorities” are still giving really bad advice (a low-fat high-carb diet as a prescription for obesity?! That’s like recommending that asthma sufferers smoke more cigarettes!)
The closest thing to a really solid finding that we have right now is that Mediterranean works — it DRAMATICALLY reduces death rate probably from a variety of diseases. But why it works we don’t really know yet.
Basically, if you’re not overweight and your lipid profile is good, I’d say whatever you’re doing is probably working OK. Whether to follow Perlmutter’s advice and avoid grains is up to you, and probably can’t hurt, but it certainly hasn’t been proven that avoiding wheat will reduce your Alzheimer’s risk — it’s only a very intriguing theory.
However, I think by now it’s pretty well established that if you’re overweight and or showing signs of metabolic disorder, with high trigliceride levels and a bad LDL to HDL ratio, you need to ignore the Heart Association (and maybe your own doctor) and cut your carbs. Whether to do that really drastically (20 grams) or mildly (100-120 grams) is up to you but you should be increasing the percentage of your diet that is fat, and reducing the percentage that is carbs. Counting carbs is far more important than counting calories, but counting calories is almost certainly a good thing too.
The rest of it is really still subject to very live debate. Mediterranean clearly produces good outcomes but we don’t know exactly why — is it because it’s low carb, or because it’s low-sugar, or because they don’t snack as much so there’s more time with an empty stomach/low blood sugar — or because they get more fish and olive oil and wine?
Eating more “Mediterranean” is probably a good approach though, maybe for all those reasons.
The final thought I’d leave you with — EXPERIMENT ON YOURSELF. What is beautiful about diet is you can make changes and then measure your own outcomes. What is happening with your weight and blood pressure? How does your lipid workup look after 3 months of different eating? How do you feel? How’s your alertness, your need for sleep? If you have reflux, does it get better if you cut down on carbs?
I think our bodies can give us a lot of data about how various diets work on US and that is a lot better data than the so-called experts. Try some different diets for a few weeks at a time – if you seem to do well on it, it is probably because it is working for you.
In my personal experience, and to my total surprise, increasing fat in my diet (olive oil, nuts, cheese, butter) has made me thinner and healthier.
But other people seem to feel great living on an entirely carb diet — banana-strawberrie smoothies, pasta, corn chips, subway sandwiches etc. If that produces good outcomes, fine. But it doesn’t for me and probably most people.
Ok, so could someone authoritative just give me some general advice re how to eat?
I don’t have enough either time or money or geographic opportunity to obsess endlessly over food choices. I also distrust anything too faddish. Many persons in my family have lived fairly long, reasonably healthy lives, eating some combos of health + junk, though I worry that the modern world is increasingly unhealthy (less in terms of toxic environments, which anti-pollution laws may have made better, but more wrt nutritional values from depleted soils as well as modern pesticides).
I have tried to eat moderately healthy (as conventionally defined in the USA in the late 20th/21st century), but I think I may have been eating all my life extremely unhealthily.
Yes, I eat junk food (more in the past few years due to loss of willpower stemming from being overwhelmed by too many exogenous problems, including some health ones – though these were all orthopedic injuries affecting my ability to exercise, which I like). But I always tried to “balance” the junk with lots of “health” foods: tons of fruits (!), whole grains (which I also eat because cereals are cheap – and what else can you eat at breakfast besides fruit and cereal and whole grain bread with nut butter?! I don’t have time in the mornings to prepare meat & eggs), some veggies, salads when convenient, fish when possible.
Anyway, what is a REASONABLE diet (in terms of: ease of preparation or restaurant location, cost, availability, balancing health vs weight loss)?
I would really appreciate any insights. If fruits are bad (I’ve read so often how good they are!), then I really don’t know what I should be doing.
It’s at the point now that it’s become a religious style issue. Each diet has rabid supporters and will foam at the mouth anytime someone speaks negatively of their chosen dietary beliefs. It’s become quite scary. My own belief is that exercise and active lifestyle is key. Eating whole foods, fermented foods, sourdoughs for bread etc. I eat a couple pasture fed eggs a day around 1kilo of mixed vegetables, beans, 1.5-2 cups of home made 24hr yogurt, a couple servings of fruit, etc. If you have no prior health issues, are fit and active, eat only whole foods I think this is on the right track. I feel fantastic and simply can’t believe I am doing 50 wrongs things and feel so phenomenal. But, like I say, according to the frothers I am on the road to hell and early death (with much suffering and pain) -whatever can scare me enough to join their religion.
Agree. It’s become a religion.
Eat real, whole foods. Avoid processed junk. And enjoy! Stress will kill you faster than food!
Actually in this case, Dr. Perlmutter proved that it is not just correlation with wheat and starches being linked to DEVELOPING neurological diseases… it is causality! The experiment he conducted with the mice/ rats shows that the ones who were fed grains and starches developed tumors, had slower cognitive responses and died sooner, than those which were fed no grains, over their lifetime of about 2 years.
How can you make statements contradicting this convincing evidence?
There is a lot more here than meets the eye. It’s now becoming obvious that our gut biome is responsible for health and longevity. For example people with chronic illness have different gut biomes than healthy individuals. A study just the other day showed the gut bacteria b.fragilis creates a compound that instructs our guts immune system to not attack gut tissue.. and the conclusions were rats lacking b.fragilis developed inflammatory bowel disease. They are finding those with diabetes or on the way to diabetes have different gut flora. Gut bacteria is now linked to RArthritis, those with RA have a specific bacteria overgrowth that non RA folks do not have. We also now know that what we eat greatly affects our gut biome. The biome of a meat eater if vastly different to a Vegan, etc. Gut bacteria now implicated in metabolism. 100’s of issues are now being linked to our microbiome. I am beginning to think the biome determines how well we tolerate and process carbs. I have no issue with moderate carbs, am fit and have bloodwork to indicate this. Suppose I started eating JUST carbs and sugar and dead food. This then changes my gut biome and the beneficial bacteria that used to keep me in check die out THEN causing diabetes or brain disorders. I suspect in the not too distant future we will comprehend that it’s not what we eat it’s what our biome eats that determines our human outcome. In other words I seem 100% fine with moderate carbs but I exercise and I also eat a great deal of vegetables etc. Also, exercise and stress affect the biome. Look for a shift from “You are what you eat” to “You are what your biome eats”. As this proves to be the case, specific colonizing gut bacteria can be supplemented in pill form to correct 100’s of illnesses.
Yeah Judie, seems there is a lot of talk on other boards more Adkins/weight loss oriented that have chat about lc and hair loss. The idea posed is that this diet creates such a hormonal shift as to jolt the hair into telegen phase. Eades addresses it on his blog. I ended up with horrific hair shedding from going lchf when my iron intake become greatly enhanced. Haven’t had the chance to dig in and research more about the increased absorption of minerals eating high fat, but it exists. There is also the angle of lower carb often meaning less fiber intake to bind up minerals. I can say like many other with the lc hair shedding, Never felt better eating lchf, hair just went weird!
Did your hair loss clear up when you added carbs? Could be some people’s hair likes more carbs-?
Thank you for responding. Yes, my hair did grow back in after stopping lc for a while. I will check out your suggestions. Thanks.
I so appreciate the information from the books; Grain Brain, Wheat Belly and Paleo Diet. I have read the first two and I’m learning more about the Paleo approach. It’s about time we all get on board. If your blood sugars rise from fruits, grains, potatoes and other carbs, the results over time can damage all of the cells in your body including the brain. Everyone has different metabolisms and each have a varied amount of insulin the body requires. Unless you are already diabetic (Type 1) like me. I know for a fact that I cannot eat fruit without cause unless I’m exercising. Even carrots, onions and tomatoes affect my blood sugars. Grain Brain, Wheat Belly and Dr. Richard Bernstein all want no elevation or spike in your blood sugar. So, why do some other cultures tolerate a high carbohydrate diet without illness? I would like more information on specifically the types of fruit, their sweetness for example and the level of activity these people have on a daily basis. If I was a marathon runner or hunting, gathering my food all day, I would be able to burn the extra glucose without harm. But, with a more sedentary lifestyle, these extra carbs- in any form are mere poison.
Ann,
I come from a culture where carbohydrates (corn, cassava, cocoyam, plantains, Irish and sweat potatoes, all kinds of yams etc.) are staples. Of course, theses are consumed with all kinds of green leafy vegetables and oilseeds (peanuts, egusi, pumpkin seeds, and other seeds), beans, and little meat and/or fish in some areas. Carbs makes up about 80% to 90% of their meals.
I think it is important to be specific about the types and sources of the carbs and not just say low carbs. We now know that the wheat we have now has been adulterated and reason not to eat it. It is also important to be specific about the types and sources of the high fats, now the GMO is spreading. Coconut oil is one of the good fats, but can you imagine if the coconut tree is genetically modified or the plantation is spread with GMO insecticides? I believe there is much more involved here than just low carbs high fat or low carbs. Human being is more complicated than that.
I believe in the principle of bio-individuality. No one-size fits-all anything. The culture I come from seems to tolerate very high carbs well.
Even with the Paleo diet, Kris is now coming up with “your personal paleo.” I might not have quote him right but it is something in that line. What does that tell us?
Chris, there was a question posted earlier regarding hair loss on a low carb diet which I haven’t seen answered and the answer would really be helpful to me.
I lost about half my hair several years ago while on a low carb diet. I want to do low carb again but need to what to do to prevent the hair loss.
Hair loss is a symptom of low thyroid, which, in some people, can be caused by low carb eating. (It happened to me.) If you want to avoid hair loss, avoid low carb eating. Keep your carbs at 100 grams per day or possibly higher if needed to avoid hair loss. That is still much lower in carbs than the SAD. Every person is different so you have to see what works for YOU.