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.
Better supplementation. Fewer supplements.
Close the nutrient gap to feel and perform your best.
A daily stack of supplements designed to meet your most critical needs.
Nobody knows for sure what early humans ate but we do have detailed reports of isolated aboriginal populations before their diets were transformed by Western flour and sugar. There is a pretty good discussion of this in Gary Taubes’ book “Why We Get Fat.”
The Inuit lived on seals, fish, whale blubber — no plants whatsoever. And were remarkably healthy — no cancer, no diabetes, no autoimmune diseases — until flour and sugar reached them. The Maasai of Africa were exclusively meat eaters and extremely healthy until they started eating flour and sugar. South Pacific islanders were living on coconuts, fish and pigs and were extremely healthy — until sugar and flour arrived. The Kiyuku of Kenya by contrast were plant-eaters — they were farmers for at least 1,000 years — and they, too, didn’t start seeing western diseases until they were explosed to western sugar and grain.
There is simply no basis for saying meat and dairy is the cause of western diseases because meat and dairy aren’t what was shipped around the world. The thing that had shelf life without refrigeration was flour and sugar and products made from them.
You don’t hear much about bugs. I suspect paleos actually consumed a lot of bugs and meal worms. This is something I hope to get into in the near future. There are even projects attempting to bring this to the average consumer: https://www.tiny-farms.com/
Just for the record, Paleolithic people’s diet varied tremendously, depending on what was available in their environment. Sweeping generalizations only muddy the issue.
Weston A Price’s book Nutrition and Degeneration is also an excellent resource. He studied isolated peoples all over the world in the 1920s. He did a very thorough analysis of dental caries in peoples who had maintained their traditional diet and those who had begun to incorporate “foods of modern commerce.” He thought of the teeth as a window to internal health. His book is fascinating. He noted that people ate vastly different macro nutrient ratios, but all their diets had the following commonalities (listed under “Characteristics of Traditional Diets”): https://www.westonaprice.org/basics/principles-of-healthy-diets
And yes, I think it’s just a lot of speculation to assume that people ate primarily vegetables. The fact remains that without the fat soluble vitamins (A,D and K2), the body cannot utilize the nutrients from all those vegetables. Perlmutter seems to go this route too. I really think it is to make their views more acceptable to the majority of the public who simply can’t wrap their heads around the idea that fats, especially animal fats, are very healthy and very necessary even more so than vegetables.
I do blame white flour and sugar as the culprits. As well as the demonizing of the healthy animal fats, in favor of inflammatory seed oils. These foods change the gut flora, which dictates what we crave and how we hold onto weight.
I am not fully convinced grains belong in this group though.
The isolated Swiss of the Loetschall Valley ate primarily a dense rye bread with a thick slice of cheese (equal in size to the bread). The cheese was made from Spring cow milk (exceedingly high in the fat soluble vitamins- especially K2).
The isolated Gaelic of the Outer Hebrides ate primarily oats (in the form of cereal and oat cakes) with fish and barley.
Neither of these populations ate many vegetables (except those grown in summer). They thrived on these diets. Their health was far superior to those living nearby in urban areas. Price determined that the modernized Gaelic had 23 times the rate of tooth decay as their isolated counterparts. Along with the increase in dental caries and cavities, the people who had adopted modern foods showed other signs of degeneration and an increased susceptibility to disease.
I bet those grains were also fermented for long periods 🙂
Yes exactly. They were all long fermented. In every culture surveyed that ate grains and starches, they were ALWAYS fermented. The Swiss rye bread was a true sourdough. The oat porridge was often 24 hour fermented. The Polynesians ate poi (fermented taro root). The Peruvians fermented yucca.
So the problem is not inherent in the grains/starches, but in the processing, refining and loss of traditional preparation techniques.
I think the idea of sugars and starches being the main cause of our problems compelling. Especially when you consider the fact that in the 80’s the government reworked the food pyramid to take in less fat and more carbs and we got fatter. In the 80’s the average american ate a diet that contained aprox. 30% fat, which has actually been reduced to 20% now…. and the obesity rates when from growing slowly to skyrocketing. Dr. Lustig, the endrocrinologist, who wrote Fat Chance and says that it is likely that our problem stems from having a High Fat/High Carb diet. He says that we need to see early man not as hunter/gathers but as hunters or gathers and that they were rarely both at the same time. When vegetables were plentiful they didn’t run out and risk their lives to kill a wild boar, they just ate the vegetables and when the vegetables were gone they went out and risked their lives and killed an animal. I myself have no gluten allergy and diabetes does not run in my family but I have lost weight and my thyroid function has improved living a lifestyle with almost no starch or sugar.
I think Dr. Lustig has engaged in some speculation when he said hunter gatherers ate plants preferentially because it was safer than hunting.
Try going out into the woods or a savanna are gather up enough wild plants to sustain you and your little band of 20 souls. It’s very very had to get enough to eat that way.
Plus, many plants will poison you if you pick wrong. Plus, many plants and especially starchy tubors and roots must be cooked to be rendered safe to eat. Pottery has only been around for about 6,000 years. I am sure there were some cruder cooking methods, but eating lots of plants and tubors was not at all ‘safer’.
Rather, our Paleo Ancestors hunted mega fauna, large animals. One moose or elk could last many weeks .A mamouth could feed a band of people all winter.
Plants are a supplement.
Lustig is right about the sugar of course. But we must also eat far more fat then we have been led to think is healthy. We are starved for fat and it’s lack in our diet is as big a problem as too much suger.
Dr. Perlmutter recommends a mostly vegetarian diet with meat only as a “Garnish”..
He is spot on about very low carb and high fat, but he seems to diverge from other experts like Dr. Eenfeldt and another popular low carb high fat advocates on meat eating.
I wonder if he was a vegetarian before he came upon low carb high fat and maybe brought some of that paradigm over?
Or does he have some credible evidence about meat eating past that it should be grass fed?
Does anyone on this thread know or have an insight?
I hate to rain on the Grain Brain parade but this just made the news:
————–
New molecule protects brain from detrimental effects linked to diabetes and high blood sugar
https://www.mdconnects.com/articles/288/20140128/new-molecule-protects-brain-detrimental-effects-linked-diabetes-high-blood.htm
“Recent studies indicate that high levels of sugar in the blood in diabetics and non-diabetics are a risk factor for the development of dementia, impaired cognition, and a decline of brain function. Diabetics have also been found to have twice the risk of developing Alzheimer’s disease compared to non-diabetics. Now, researchers from the Hebrew University of Jerusalem have found a potential neuro-inflammatory pathway that could be responsible for the increases of diabetics’ risk of Alzheimer’s and dementia. They also reveal a potential treatment to reverse this process.”
—————
This almost makes the grain brain argument obsolete. I predict within 15-20 years technological manipulation of the human body (aging reversal, ability to freely regulate key and deep biological components, genetic modification, human microbiome modification, etc) will leave us with little to worry about. Also in the news, a cheap and abundant way to produce stem cells, heralded as one of the biggest medical breakthroughs yet:
https://www.independent.co.uk/news/science/stem-cell-breakthrough-japanese-scientists-discover-way-to-create-embryoniclike-cells-without-the-ethical-dilemma-9093235.html
In that case if diet damages gut, liver, pancreas, etc then no problem these organs are easily regenerated.
Then you might say, what about bad diet causing cancer? Well, it looks like cancer is about to be completely eradicated as well with a new breakthrough announced this week:
https://en.rocketnews24.com/2014/01/30/tottori-university-researchers-discover-a-simple-way-to-possibly-cure-all-forms-of-cancer/
All forms of cancer reverted back to normal tissue with one treatment. Scientists claiming “the dream of the eradication of cancer is at hand.”
It’s even looking like development of a pill that simulates exercise is at hand.
So in conclusion, at the rate of medical advancement which is growing at a wildly exponential rate. In 15-20 years spending half the day worrying about what we ingest could be a thing of the past. I also suspect we will see nano-tech pill treatments that reduce blood sugar and fat levels only when those levels get out of hand. They will be like a daily multi-vitamin. We’ll see nano-tech pills that gently cleanse arteries of plaques within 5-10 years.
Exciting times. I doubt I will ever use such technology as an excuse to be a gluttonous pig, but we are quickly heading to a level of biological manipulation that should soon make all this worry and debate a thing of the past.
Yeah….. I dunno.
Occam’s razor, the simplest solution is probably the best.
Depend on the bandits in the pharmaceutical industry to come up with super sophisticated nano technology, wiz bang pills, implants and injections.
Or
Eat lots more butter.
I think….. the latter
Well….I suppose when scientists are looking to scare up some more investors, they issue a glowing press release. One only need review past articles trumpeting the latest “breakthrough” to see the pattern. I will take those with a healthy dose of skepticism.
All this talk of ketosis has me thinking…
I do not monitor anything really- ketones, blood sugar, calories or carbs. This works for me. I don’t like fixating or feeling restricted. I prefer to go off how I feel. So anyway this laissez faire approach means that I probably don’t know the mechanisms that have helped me to maintain a healthy weight.
In my last pregnancy, nearly every time the midwife tested my urine, I was spilling ketones. I usually eat a protein rich breakfast. typically 3 eggs with salsa Verde (garlic, parsley, lemon zest, olive oil) and some cheese with a few slices of apple. I usually had late morning appts. I think I typically eat 175-200 carbs a day (I’m guessing). I also nurse my toddlers while pregnant. Do you think I am fairly regularly in ketosis even while consuming this many carbs due to the caloric requirements I have due to nursing and pregnancy? Thanks in advance.
Even at some appts later in the afternoon, I spilled ketones. I did not feel hungry. I eat a lot while pregnant. Well, actually always. I find it hard to keep up with feeding three young kids and myself. I usually gain 40-50 lbs while pregnant. I usually lose all but 10 lbs within the first 6 months and the last 10 within a year.
What does it mean when the ketosticks turn completely black ?
Great stuff, Julie, thanks for posting.
What you are basically doing is trying to improve your risk profile by maintaining low blood sugar and low insulin for as much of your day as possible. There really isn’t conclusive proof that it will work, but the circumstantial evidence is awfully intriguing, isn’t it?
We do the same thing — eat low carbs, and low-glycemic carbs, with generous fat and protein. And we do a lot of small fasts — skip breakfast, not eating much on weekends. We eat when we’re hungry and it’s amazing how often we’re NOT hungry because we’re off the blood-sugar roller coaster. One your body’s ketosis function is working properly, you can fast pretty much without being hungry — it feels good in fact. I’m fairly certain I am using my body fat as it was designed to be used — as an active short-term supply of energy between meals. It’s like using any other organ or group of muscles.
Think about how humans were evolved to survive on always varying (and frequently scarce) food sources. Were our bodies evolved to live with perpetually elevated blood sugar due to the introduction of carb food and sugar snacks every 60 to 90 minutes, 15 hours a day, 365 days a year, for decades?
How did anybody ever get the idea that it would be a normal healthy lifestyle to be eating 5-6-10 times a day? No wonder Americans are getting sick in such huge numbers. It’s a a testament to the incredible durability of the human body that we don’t ALL have type 2 diabetes.
People (and unfortunately their doctors, who should know better) are frightened by “ketosis” or “ketogenic diet” because it just SOUNDS exotic.
But fasting is something we all do every night. If you go to bed without a late night snack, your body will almost certainly be generating ketones by morning — otherwise your brain would shut down for lack of fuel.
Fasting even for several days is something that people have been doing for thousands of years as part of religious and health rituals.
One of the most ridiculous things the medical establishment does is tell people they need to lose weight, but if they actually exercise or fast enough that they burn fat, the establishment says, don’t do that — it could be dangerous!
Just read a little Beaker before you try to speculate.
If you want to know about ketosis (and low-carb in general), a really good starting point (and very scientifically mainstream) is the “New Atkins” book overseen by Eric Westman at Duke University.
Ketosis is indicated by the presence of ketones in the urine, and you can buy test strips at Walmart that will tell you not only whether you’re producing ketones but at what levels. It’s not the precision that you would get from a lab but it can give you a pretty good idea, and it is basically real time data.
A lot of low-carbers use these religiously because if you’re making ketones, it’s a pretty good indication you are burning fat and on track to lose weight.
The Atkins method is all about finding each individual person’s tolerance for carbohydrates, so the test strips are very useful when you’re trying to find out whether your threshold is 20 grams or 50 or 100.
Ketosis is nothing exotic at all and not dangerous. If you’ve gone to bed without a nighttime snack (i.e. it’s been 10-12 hours since your last meal) your body is probably in mild ketosis. It just means your blood sugar is low so, in order to maintain brain function, your body burns a little fat for fuel. It’s all good and normal for a human body to do.
What is abnormal, and toxic, is the American style of eating which is to stuff your face with carb snacks every waking hour so your body is UNABLE to ever burn fat. Everybody should be burning fat at one time or another or everybody would end up obese.
This makes me so angry when people believe stuff like this. Beaker, nutritional epidemiology used to draw conclusions about what to eat is simply garbage science. There is a great discussion of this by Gary Taubes here: https://garytaubes.com/2012/03/science-pseudoscience-nutritional-epidemiology-and-meat/
When you survey huge numbers of people on what they eat and then run correlations with health outcomes you WILL get correlations. if you have a large enough sample and a big enough survey, you can get hundreds and hundreds of correlations that meet the test of statistical validity. You can cherry pick them and get your name in the newspaper. But you don’t get causation and you definitely shouldn’t be drawing conclusions on what is safe to eat. What you don’t have is actionable knowledge.
Say there is a correlation between people who report eating beef and bowel cancer. Say people who report eating beef are likely to eat it in the form of hamburgers with buns, and french friends and sodas. Maybe they’re also likely to smoke more cigarettes. Maybe they eat more fast food and watch more TV and spend more time in their cars and don’t care about their health generally.
Meanwhile people who report eating less beef are more health conscious — they exercise, don’t smoke, maintain their weight, eat more vegetables and tofu. Maybe it’s the smoke, the sodas and white bread buns, the obesity and the lack of exercise that really causes the cancer. Maybe tofu prevents cancer. Or maybe it’s the sauce you put on the tofu. Or the sake you drink with the tofu. You can run all the regressions you want to TRY to control for factors like that but you really can’t get to the bottom of it. Patterns of behavior are very, very complicated.
As Taubes rightly points out, survey type studies should be used to develop HYPOTHESES. The hypotheses need to be tested with controlled studies. And only THEN do you begin to have causation and enough information to make recommendations.
The problem is controlled studies are expensive and, especially in the area of diet, very difficult to design. So unfortunately a lot of people in the dietary science field just SKIP THE ACTUAL SCIENCE and draw conclusions based on survey data. Which helps get them journal publications and grants and cushy jobs but doesn’t really advance our knowledge of what to eat.
Really it’s terrible because not only are you getting pseudo knowledge, you may be actually recommending the OPPOSITE of what people should be doing to make themselves healthy.
And that is how we got where we are today — with government policy recommendations for a “heart healthy” low-fat high-carb diet that has resulted in an epidemic of obesity, diabetes and Alzheimer’s.
Bad science is making a hundred million people sick and causing what is increasingly looking like the greatest public health crisis in American history. We are literally eating ourselves to death here in the USA.
I would add that these studies don’t differentiate between feed lot meat and grass fed/pastured. That is a huge factor. They aren’t even the same food. The Omegas are completely out of ratio in conventional meat.
I think a lot of our problems come from grouping these foods together as the same thing. They are not. One is a food and the other a frankenfood. Same with organic vs non organic. It’s crazy that we even think in these terms. There is only what the body perceives as food and what it doesn’t. Anything it doesn’t perceive as food puts it in a constant state of inflammation.
…not to mention, Dr. Perlmutter NEVER recommended heavy meat or cheese. I think he recommends 2-3 ounces of wild-caught, free-range, or grass-fed IF you even chose to eat animal protein. His recommendations are also completely compatible with a vegan diet.
Beaker, you’ve clearly not read the book. Here’s a recent Medscape article that offers a great synopsis. https://www.medscape.com/viewarticle/819232 Note, Dr. Perlmutter recommends GARNISHING with high quality meat.
I’m guessing all these haters would realize Dr. Perlmutter’s recommendations are far from draconian IF they actually took the time to read the book. Just saying…
Here is one thing that we do know from a well controlled study by Dr’s Phinney and Volek.
There is good evidence that the saturated fat circulating in your blood is a strong indicator of future heart disease.
Phinney and Voleck have clearly shown that when you keep carbs very low and eat high levels of fat thereby becoming Keto adapted, the saturated fat circulating in your blood GOES DOWN.
That may seem counter intuitive but when you are keto adapted you burn fat preferentially for your fuel. It doesn’t stay in your system very long as it is snapped up and quickly used for energy.
When you eat too many Carbohydrates, your blood fat levels go up… Go figure
So dont be too worried about observational studies that show low carb diets hurt you. Credible scientific evidence is quite the contrary.
Most people who think they are in “ketosis” are dreaming. Show me the blood work being taken every hour for weeks to confirm this. So at best most are likely swinging in and out of ketosis which is highly detrimental. Until personal (smart phone/device) 24/7 blood monitoring comes of age these people will not truly know if they are in ketosis or not. I think this tech will be available within 5years.
I use ketostix throughout the day- not blood work- but pretty accurate. I’m fairly consistently in mild ketosis. Pass along your address & i’ll be happy to send them over 😉
Hi Julie,
Just wanted to jump in here to recommend that you visit Jimmy Moore’s posts on his nutritional ketosis experiment (n=1). He had compared the sticks and blood metering and claims that the sticks are extremely inaccurate. I’m not suggesting you are not actually in ketosis, just wanted to mention this in case you hadn’t read about it.
Thanks, Mary.
I am aware that ketostix are not as accurate as actually serum testing, but they are a useful tool. Jimmy’s podcast actually points out that IF you are not achieving a pink color, you may still be in ketosis IF your body is using the ketones as quickly as you are making them. Mine are pretty consistently pink, sometimes darker.
I eat between 55-75 grams of carbs daily but also practice intermittent fasting and caloric restriction- contributing to my ketone production. I usually eat two meals a day and let 12-16 hours go between my last meal of the day and the first of the next- easy to do with a mildly ketogenic diet. This is an important part of Dr. Perlmutter’s protocol that I rarely see discussed. How we eat is just as important as what we eat. And, the importance of daily exercise must be emphasized. Diet alone is not enough. This is a lifestyle makeover.
I have 2 copies of Apoe4. Statistically, I have very high odds of developing Alzheimer’s and CVD. Homozygotes, who live in developing parts of the world, do NOT go on to develop these Western diseases. These conditions are a direct result of our affluent society.
Hi July,
Now I remember you from earlier in the thread, where you spoke about your high risk for Alzheimers. I would like to commend you for following such a careful diet to reduce your risks. That’s one of the main reasons that I really didn’t like this article–it seemed to be sweeping the keto diet as a means of Alzheimer’s completely under the rug. There was a woman who posted earlier that also had Alzheimer’s in her family who was quite relieved to hear Chris say that whole-food carbs were not an issue.
Certainly, the keto diet is not for everyone. I have tried it to lose weight but it has not worked for me–and I am really tired of eating so much fat–so I am exploring other options. If I had Alzheimer’s in my family though, I would definitely be paying close attention to Perlmutter’s recommendations (even though there may not be hard scientific proof yet).
Oops, I meant to write “Hi Julie”!
Hi Marc,
I think this is a really important point that people tend to forget (I saw this in one of the interviews with them on youtube, but I had forgotten about it).
The crucial thing to remember is that their study subjects were truly keto-adapted, such that fat really was the preferred fuel and thus got whisked out of their blood. Many people doing Paleo are not keto-adapted because they are not restricting whole-food carbohydrates/safe starches.
Even the Perlmutter recommendation of 60 gr. of carb may not be keto for some people, who need to go quite low on carbs to start producing significant amounts of ketones.
I for one feel that if a person is going to do really low carb, they are better to really do it right to ensure they are keto-adapted and burning all of the fat they eat.
Marc, if you happen to know the title of the Volek-Phinney study (or have the link) could you maybe post it?
Here is info from Phinney- Volek about their study that demonstrated a high fat diet lowers fat in your bloodstream:
https://www.artandscienceoflowcarb.com/research/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2974193/
Comment. Among many original findings in this study of 40 people with metabolic syndrome put on either a high carb or a low carb weight loss diet, there were two that are extremely important. One, this is the first human study to show that humans who are keto-adapted have decreased blood levels of saturated fats despite eating more of them (Forsythe 2008). A couple years later we replicated this remarkable finding in a controlled feeding study in normal-weight men fed isocaloric weight maintenance diets (Forsythe 2010). Two, this study definitively demonstrated that being keto-adapted is associated with significant, across-the-board reductions in a host of biomarkers of inflammation. In a follow up paper, we published data showing that the low carb diet improved fasting and postprandial vascular function in response to a high fat meal (Volek et al. 2009).
It’s a little scary to see people here promoting such much in animal products and animal fats. Many studies echo the below text:
“The study found that men and women who eat a high protein diet which consisted of a high percentage of meat and cheese, had a higher risk of early death. The study found, on the other hand, that those that eat a high protein diet which consisted of mostly plant-based protein had a lower risk than average of early death.
The study holds a lot of weight because it was far-reaching and included more than 85,000 women and 44,500 men studied for a period of 20 to 26 years. Lifestyle factors like alcohol intake, exercise, and multivitamin use were taken into account as well and the participants all started with a clean bill of health–no cancer, diabetes, or heart disease.
According to the study:
A low-carbohydrate diet based on animal sources was associated with higher all-cause mortality in both men and women.”
Maybe these folks on LCHF diets don’t have brain issues because well… they don’t live long enough to. That’s one way around the problem I guess.
Tom and Bruce,
Thank you for your responses. I understand your perspectives more clearly now. I think we probably share more in our approach, than we disagree on. Tom, your Meditteranean approach is far from VLC, so I appreciate that. I am a huge believer in the importance of fat and cholesterol, so you will get no argument there from me. I think low carb can be very helpful for obese people and people heading down the metabolic syndrome route. No argument from me there either. I think the part that bothered me was this idea that carbs are bad for everyone and the only reason people eat them is that they don’t have enough self control. I can honestly say I do NOT crave carbs, but my body runs better if I eat a moderate amount of them. I have also been pregnant and/or nursing for over 6 years now. And that requires a huge hormonal and caloric requirement. For some reason my body does better with this burden when I include carbohydrate. It is in no way the mainstay of my diet. I think carbohydrates definitely can be addicting. They were for me before I healed my gut and I do think many people are not aware of the importance of fermented foods in maintaining gut flora (Kresser is an exception).
I appreciate carbs for things like:
Sourdough bread with loads of pastured butter and 3 poached eggs.
Smoothie- 2 1/2 cups full fat milk kefir, healing 1/4 cup coconut milk, 4 raw egg yolks, with 2-3 cups berries
Soaked baked oatmeal with lots of butter, egg and cream
Mashed potatoes with lots of butter and gut healing gravy
I find that it’s even easier for me to include ample fats with little bit of carbohydrate. I don’t believe cereals and doritos are even food, so I don’t consider those carbohydrates. I speak of properly soaked and soured grains, potatoes, fruits. These things my family thrives on to deliver those healthy fats.
Elizabeth asks: If 60% of the calories of my diet should be fat, how do I get that? I can’t stomach eating spoonfuls of butter
————————————————–
First of all, 60% of calories from fat is a lot. You don’t have to be that radical. How about aim for two thirds of calories from protein and fat and see how you feel on that. If you don’t need to lose weight, one-third of calories from good quality low-glycemic-index carbs is probably great.
You get there easily and naturally if you just stop avoiding fat. People are so accustomed to doing “low-fat” versions of everything — just quit that. Eat food food with the amount of fat that comes naturally in the food.
Enjoy nuts, avocados, soft cheese (goat cheese and good mozzeralla and swiss are mainstains for us). Don’t automatically skim all the fat out of your soups and stews. Go ahead and eat dark meat chicken and enjoy oily fish — anchovies, sardines, wild salmon and haddock. If you’re having white meat chicken, cook it with generous olive oil or butter — it will taste so much better.
Go ahead and enjoy a little steak every couple of weeks. Make sauces from pan drippings, wine and a little cream — a mainstay of French cooking. Eat an egg every day for breakfast — eggs have been vindicated by almost everybody. We eat our egg with a little leftover roasted veggies, and occasionally melt in half a slice of swiss cheese. Or good quality bacon (cooked right, not incinerated!). Or a salmon omelette with a little goat cheese or cream cheese, which is wonderful.
If you drink milk, just drink whole milk. If you drink your coffee with cream, just use heavy cream instead of that lethal fake “nonfat” creamer (ever read the ingredients list for that dreck?). Buy whole milk mozzarella, stay away from reduced-fat sour cream. Don’t be afraid to melt a little a little butter to your veggies — it will make green veggies taste much better and might help you eat more veggies — which you should be doing if you’re cutting down on carbs.
You really don’t have to do anything special to add fat to your diet. You just need to discard all the “low-fat” junk foods and food recommendations that have led to this epidemic of obesity in America and eat the level of fat that your grandparents probably ate.
One final note, which goes without saying. Don’t add fat and continue to eat lots of sugar or refined grain — if you are eating high-glycemic-index carbs, the extra dietary fat may well be harmful.
But if you’re cutting the carbs, your body will handle the fat well, you won’t put on weight, you’ll feel great and probably your blood lipid profile will improve. LDL will go up but your ratio will be far better and your triglicerides (which are really a better marker than LDL for heart problems) should go down.
Tom
And one more though on adding fat to the diet — if you allow natural levels of fat back into your diet, you will almost certainly start to eat smaller portions, and have less of a need to snack, because the food will taste better, you’ll feel more satiated, and you won’t have the blood sugar spikes that cause you to get hungry an hour later.
One experiment everybody can do that is very telling. One day for breakfast, have a one of those commercially baked “low fat” multigrain banana muffins and a glass of organic fresh-squeezed juice. It will be close to 1000 calories. And then see how long it takes you to get hungry again — chances are, inside of 2 1/2 hours (and sometimes in as little as an hour), you’ll need a snack or an early lunch.
Then another day for breakfast, have a high-protein, high-fat, low-carb breakfast — an egg, cooked in butter, some bacon or sausage (not cooked dry but with some of its fat), or fish (fish and eggs for breakfast with capers and lemon, cooked in olive oil, is a Mediterranean staple BTW) . Or if you like them, just have a can of sardines for breakfast. Or some veggies with melted swiss or mozzarella or full-fat goat cheese. But — no sugars, no grains, no fruit of any type. And coffee or tea with cream. This breakfast will be well under 500 calories and probably closer to 300. And then see how long it takes you to get hungry. You will probably be amazed by the result.
Re carb “addiction” — at first glance it doesn’t seem right to compare food addiction to substance addiction (narcotics, alcohol, nicotine, caffeine)
But when I actually try to draw a line between food and substances, I have trouble.
1) Your body becomes accustomed to the constant presence of a chemical (alcohol, opium, caffeine). In the case of someone on a primarily carbohydrate diet, that substance is a constantly elevated blood glucose.
2) When you cut down on the substance, your body has an adjustment period that can be uncomfortable, even painful. When I stop drinking coffee, I get headaches. When an alcoholic stops drinking, he/she can get the DTs.
Those of us who have cut carbs (Atkins Induction or something similar) know how uncomfortable it is while your body adjusts to lower blood sugar. You get the shakes, the cravings are intense, you can have trouble sleeping, you can faint, you can get headachy, constipated — all kinds of symptoms that are really quite similar to substance abuse withdrawal.
3) After the adjustment period you feel fine again, and in many ways better than before. After a week without coffee, the withdrawal headaches go away. Similarly, after a few days (or sometimes 7 to 10 days) with little carbs, all the symptoms above subside. Withdrawal for heroin and alcohol is much more severe, which is why those substances are so dangerous. But the withdrawal/adjustment pattern is the same.
4) The cravings in some ways never go away, and rexposure to the substance causes problems. Does that mean an ex-heroin addict NEEDS heroin? Does it mean someone who used to live on bagels/bananas/Doritos NEEDS those things to elevate their blood sugar. No.
But the cravings never completely go away. After 5 years of generally avoiding sugar, I still crave sweets — but I no longer them enjoy very much it because it tastes too sweet. Most pastry and desserts are too sugary. However, if someone brings chips or pretzels to my table, I have tremendous difficulty resisting. It gives me a little bit of insight into what it must be like when a crack addict is offered some of that substance.
Anybody who’s quit smoking knows how hard it is to not want a cigarette when someone else is around you smoking. Carbs present the exactly the same problem because carbs are still tolerated — even encouraged — in a work environment.
I know it sounds silly, it sounds overly PC, but people should be discouraged from bringing cookies and doughnuts to the office because it is so hard for us “recovering carbaholics” to resist — I would guess eventually carb junk food will be discouraged in an office environment just like cigarettes are now.
Things that spike your blood sugar are trouble. Office snacks should be low-glycemic-index — vegetables, dips, hummus, nuts, olives, cheese avocados etc.
When I see people in an office all gathered around a cake, I can’t help thinking — this is what it was like 40 years ago when everybody would gather to enjoy a “smoke break” together. Made it so much harder to quit tobacco.
I got an interesting link on my Facebook feed today to a blog post on food addiction: https://drhyman.com/blog/2011/02/04/food-addiction-could-it-explain-why-70-percent-of-america-is-fat/#close
There are some new personal diagnostic devices coming out soon. One is like a watch that shines an LED into your skin and then uses a sensor to monitor blood glucose levels and nutrient levels. I’m looking forward to wearing a device like this that monitors 24×7 and collates the data to a smartphone app. I think this will go a long way to everyone being able to customize their diet. Your phone could even alert you to spikes or deficiencies throughout the day. However, we also have a new device in the news an ‘artificial pancreas’ that is the size of a watch, fits in the abdomen, monitors glucose levels and secretes insulin as required. So what will technology do for us? Will it allow people to tailor their diet and maintain healthy glucose levels, or will it allow them to say “woopeee! my new artificial pancreas means I can eat whatever I want!”. Interesting times..
Ah, and also new possible nano-technology that will allow people to take insulin pills. If they need no insulin nothing happens, but if blood sugar passes a threshold the pills release insulin.
Exactly. When my wife proposed the family go on a diet, her mother’s immediate reaction was “I don’t want to have to give up my Cokes!” Both my wife and I have experienced this with family and co-workers. Its amazing what people will give up for a diet, but heaven forbid you take away my starches/sugars.
One thing I picked up from my research is that when people ingest a large amount of carbs, serotonin is also produced. Serotonin helps sedate the nervous system. It occurred to me that when I craved carbs the most, is when I was stressed or bored. Once I made this connection, then came the long process of understanding how to unhook my mind/body from this stress=carb craving and to sedate myself through other means. This lead to higher protein intake, higher fat intake (nuts fill the bill nicely) hydration, and some type of physical workout program (hiking and tai chi).
So of course if we are craving carbs and then consume carbs, we feel better. A smoker does the same thing with cigarettes. Of course, sometimes we have a protein craving, and we sure feel better when we eat some. But does the craving represent a need, or is it more an emotional/stress stimulas, or something entirely else?
One weird thing my wife went through some years back was having intense cravings to chew ice. Its was getting so bad that she was actually getting sick by chilling her body. Finally we learned that ice chewing cravings are related to iron anemia. Image that! So she upped her iron intake, and presto her cravings went away. But to follow Megan’s logic, she should have just eaten more ice.
I read that carbs are needed to release serotonin and I know serotonin is not bad.
When you incresed your protein and fat intake did you experienced some changes in your mood?
Thank you
When you have adequate fat in your diet and are not eating very many carbs, you are signalling your body that all is well.
For a woman the signal to her body can mean that there is sufficient good food around so it’s okay to bare a child… She may then go looking for you.
“Oh little pussycat..Where arrrrre yoooou?”
At the risk of sounding flippant, I had sudden images of women tearing off their children’s clothes! (bare a child?). But I do want to ask a question. If 60% of the calories of my diet should be fat, how do I get that? I can’t stomach eating spoonfuls of butter, or knocking back coconut oil from the bottle. What is a realistic way to incorporate that amount of fat? Now that I am low carbing, it is more difficult. No bread to spread butter on, no mashed potato oozing with butter and cream. Seriously, what do people do?
You burn both the fat you eat and the fat you have stored to equal 60% plus of your energy resources once you are keto adapted..
Upping your dietary fat intake simply means choosing fattier cuts of meat, especially organ meats. Add butter to everything or add oil or coconut oil or lard. Cook with it, add it.
Use heavy cream, snack on cream cheese or other high fat cheese. Eat fatty types of fish.
When you feel like you need more fat, simply add more grass fed butter. If you do have the stomach for straight butter, make bullet proof coffee.
Make coffee then put in blender along with a generous amount of butter and or coconut oil… Sounds gross but is actually creamy and delicious. Easy way to get your fat intake up.
Give to your wife or girlfriend, start college fund.
Yes I did, and do. While sugars satisfy the “sweet tooth”, fats and proteins provide satiety, a feeling of satisfaction, and I no longer experience the spikes and dips. It took two weeks of being on 20 carbs a day to finally shake my last bits of cravings. I tend to have more “desires” now, rather than cravings.
What I have been experiencing now is more of a more normal “hunger” when I haven’t eaten in a stretch, rather than a severe hypoglycemic state in which I lost my ability to focus and deal with even mild stresses. I would lose my temper, and generally become unable to perform simple tasks until I snacked or ate a decent size meal.
Of course, all this changes based on my level of physical activity. I can hike all day long with little need to eat. Twice I experienced a severe drop in blood sugar, and I simply rested until I felt better (exercise will drop blood sugar levels). I even feed on some Miner’s Lettuce once to help recover.
So in short, yes, since my whole life breads and starches held a powerful pull over me (sugar not so much, not sure why), and upping my protein and fat intake, while restricting my carbs, has broken this hold, and as a consequence I have been feeling much better.
The science on gut flora is bleeding edge right now and probably 75%-80% of what you are reading these days is going to turn out to be at least partially wrong. So it is hard to know what to do with any of that information. We know gut bacteria are beneficial — essential. Beyond that we know very little.
By contrast, the relationship between carbs, blood sugar, insulin and fat storage is very well established scientifically. The key science was done 60 or 70 years ago. There is no debate about it.
When you eat carbohydrates, your blood glucose rises, and your your pancreas produces insulin. Insulin opens gateways in your fat cells so that the insulin is stored as fat. That is metabolism 101. When your blood glucose is low, the opposite happens — fat is released from your fat cells and burned for energy.
The reason people lose weight on low-carb diets — even eating lots of calories — is that they’re keeping their blood glucose low so their body just happily burns their fat.
The reason Americans are fat is because they eat too many calories but more importantly because they eat primarily carbohydrates and snack a lot (and drink purified sugar products such as sodas and juices). That maintains their blood sugar in a more or less continuous elevated state during every waking hour.
It makes sense that we are experiencing an epidemic of obesity, diabetes, certain cancers, and alzheimers and it certainly won’t surprise me if it all turns out to be related to our diet and our WAYS of eating (i.e. constant snacking to maintain high blood sugar levels).
This part of Perlmutter’s reasoning lines up nicely with the research and I bet it will turn out to be true. It seems very logical to me that you could reduce your risk of a whole lot of problems by eating less carbs and eating more fat and protein (which does not impact your blood sugar as much). Basically eat like a diabetic eats and plan your carbs to minimize your impact.
Genetics, gut flora, exercise level, red wine and fish oil or coconut oil — who knows how much impact any of these things have. But it is well established that if you reduce and control your consumption of carbs, you will keep your blood sugar stable-low and lower blood sugar is probably very good for you in a myriad ways.
Similarly, this is one of the many reasons exercise is beneficial — it lowers your blood sugar. It’s why not eating between meals may be beneficial. It’s why it may be beneficial to eat a late breakfast (or no breakfast), as they do in many Mediterranean countries — that is keeping your blood sugar at low levels all morning.
Here is a good article on this subject. I haven’t read all the comments above so don’t know if anyone else has posted the link.
https://www.theatlantic.com/health/archive/2013/12/this-is-your-brain-on-gluten/282550/
I have read the following arguments against carbs in the Paleo world often and they have been echoed here. Just wanted to point out that they are illogical…
“People don’t need to eat sugars because the body can make all that it requires.”
Makes no sense. Would you ever use that argument for cholesterol? Our bodies can make it, but we all realize that DIETARY cholesterol is ;important for maintaining many bodily processes. As is DIETARY glucose. You can’t have it both ways
“You crave carbs. You eat them. The craving goes away just like the smoker’s craving for nicotine.”
Makes no sense. Would you ever extend this line of thinking to protein or fat cravings? No. Only because of bias- you have deemed fats and proteins “healthy and necessary” and carbs “unhealthy and unnecessary.”
I will say that people who have a gut flora imbalance do get unnecessary cravings for carbohydrate. On that issue, I agree. I don’t think you can trust your cravings until you get your gut flora in a healthy place. I know I couldn’t. And I do think LCHF can be helpful for those people, but it’s important to acknowledge there are other healthy ways to reset your body. And the only lasting changes come from reseting your body at the gut flora level. To do this, you must not only remove the offending foods (for many- due to Candida overgrowth- this IS carbohydrate), but also incorporate gut healing foods. This is where most LCHF diets fail to give people the lasting changes they seek. Low carb diets keep them tied to carb restriction indefinitely. The problem is the have not altered the gut flora sufficiently and fall victim to intense cravings. Healing the gut is a long term solution.
Sorry for any typos on my phone.
Hi there Megan, burning up your smart phone I see ;-)))
I think you are right that the gut dysbiosis thing is not on people’s radar as much as it should be. Certainly I was not aware that starches specifically could be at the root of my issues. Now some of the bloating reactions that I’ve had in the past are starting to make sense (like very suddenly 9-months-pregnant-like bloating after eating white rice or white rice crackers, for example).
However, to be fair to the person who made the comments about carb addiction, the analogy you are making is not truly accurate due to the nature of addiction itself. To be defined as addiction, something that is bad for you has to be done repeatedly/to excess–often in response to uncontrollable cravings that go way beyond satisfying a need–in a way that causes negative repercussions. Many people DO have that sort of relationship with carbs, and the negative repercussions are often very clear (obesity).
Of course no one is going around saying fat is addictive, but it’s not necessarily because they have a pro-fat bias. Rather, we are not seeing people having this type of dynamic with fat consumption, whereas there are many people who have this type of dynamic with highly refined carbs (I observe this constantly all around me–just look at the grocery carts and the people they are “associated” with the next time you go to the supermarket!).
Also, I don’t think saying that carbs are addictive precludes the notion that gut dysbiosis may be contributing to the addiction cycle. I think the person who made the remark was commenting on my post, where I was describing craving carbs and eating way too much of them and getting fat. We could say that, possibly due to gut dysbiosis, I am caught in an addictive cycle with carbs. I don’t think the implication was that carbs are inherently addictive, in every context, in any person. That is obviously not the case.
But look at the wider healthcare context: so many people are obese and diseased, yet talking about the benefits of carb restriction (which IS a proven weight loss method, even if it does have some potential side effects) triggers MAJOR, hysterical backlash in many quarters. I think this is also what prompted the sentiments that were expressed re addition–one wonders if the carb lovers are so hysterical because they are addictively clutching onto their drug of choice!
I don’t know where you live, but I live in Quebec, where we have a government healthcare system that is completely falling apart under the “weight” of obesity and preventable disease. The wait times even for required surgeries and procedures are way longer than medically acceptable, partly because the system is plugged up with people who are eating themselves sick! So yeah, it’s an issue that touches a cord with me. It’s a “big” deal (pun intended). Yet Perlmutter goes on a popular show and recommends that people eat lowish-carb (60 grams not really being all that low) and people just FREAK out…
I made the comment I did because your logic was flawed. Cravings are just that, cravings. They can be your body signaling a need, a deficiency, or it may be related to something else. Your logic was flawed because you assume that if your body was craving carbs, therefore you should eat them. That might be so, but it might not. Can you be fair and objective and consider the possibility that there might be other factors? For example, in a personal experience, cravings to chew ice is often related to severe iron anemia. In this case, the craving to chew ice can actually make one sick, as all that ice chills the bodies core temperature. Up the iron intake, and the cravings disappear.
So while we ask others to be open minded, please follow your own recommendations. I know personally, from my experience, and from others, that the craving for starches/sugars has nothing to do with help, and everything with abusing sugar as mood elevator. This is why Coca-Cola remained popular even when they took the cocaine out.
Did you know excessive salt can elevate your mood? I had a friend that put copious amounts of salt on his food. In fact, he suffered if couldn’t salt his food. And its no accident that Coca-Cola has a lot of salt. So if someone is craving salt, as i do often, it may because they genuinely need more salt (since it does function as an electrolyte), or it may be that they are feeling a little low, and need the pickup that it gives some people.
Interesting study on plosone:
“Results and Discussion
Fermentable dietary fibre decreased weight gain, liver fat, cholesterol and triglyceride content, and changed the formation of SCFAs. The high-fat diet primarily reduced formation of SCFAs but, after a longer experimental period, the formation of propionic and acetic acids recovered. The concentration of succinic acid in the rats increased in high-fat diets with time, indicating harmful effect of high-fat consumption. The dietary fibre partly counteracted these harmful effects and reduced inflammation. Furthermore, the number of Bacteroides was higher with guar gum, while noticeably that of Akkermansia was highest with the fibre-free diet.”
another high fat study regarding damage to the hypothalamus:
“The effect of the diet upon the expressions of pro- and anti-apoptotic genes was remarkable. The modulation of 57% of the targets, including proteins involved in both pro- and anti-apoptotic activity, suggests that the fat-rich diet indeed has a damaging effect. As observed in other experimental settings, we suspect that the activation of some anti-apoptotic proteins provides a transient protection against the harmful effects of the diet [21], [22]. However, as shown by distinct methods, ranging from TUNEL to transmission electron microscopy, in spite of the presence of anti-apoptotic activity, apoptosis was significantly increased in the hypothalamus of the HF rats. This was an anatomical- and cell-specific phenomenon since it was detected predominantly in the hypothalamus and affected mostly neurons.”
I’m not going into details, just making a point that 1,000’s of studies can be cherry picked to promote whatever you want them to. I could do it all day.
https://www.foodandhealing.com/articles/article_healthy_vegan.htm
For all those who complained about craving carbs, take a look at this website. Low protein intakes, low calories can induce a craving for carbs.
I was vegan for several years, but I could not understand why other vegans were having issues. But then again, I ate a wide variety of foods, mostly produce, nuts, seeds, etc. I definitely did not eat low fat.
Yes, it’s a pity so many in the vegan/vegeterian community are so militantly anti low-carb because they view low-carb as pro-meat. It really doesn’t need to be. I don’t know why one couldn’t receive the full benefit of low-carb or Mediterranean lifestyle eating only plants. It’s undoubtedly more of a challenge to not rely on grains and starches — but if you’re a vegan, you’re used to challenges.
Some of the vegetarians are just lazy and want to live on sugar (fruit) and starch (bread and pasta). That for most people is certainly not a recipe for good health.
Thanks for the link. My parents switched to low fat vegan a few years ago and I’m always on the hunt for good info to share with them. They eat the polar opposite of what I do and it can be challenging to find middle ground.