When I reviewed (rather belatedly) the Perfect Health Diet book, a reader asked in comments if we could do a Q & A with Paul Jaminet. Great idea, and Jaminet agreed to monitor the comments section for questions. I suggested picking the questions he found most relevant, but I’m pretty sure he found them all relevant, so this is a long Q & A that I’ll post in two parts. Except where otherwise noted, the questions are in bold and anything in plain text is Jaminet’s reply.
Jeanne Wallace: Should we eat a serving of safe starch daily? And must a baked potato be cold in order to be healthful or is room temp okay?
You should eat a serving of safe starch several times a day – with every meal! No, baked potatoes do not have to be served cold. Room temperature is OK but body temperature or warmer is even better. Make your potatoes enjoyable.
Vlc eater: Do you recommend PHD for diabetics and prediabetics? If VLC eliminates fasting glucose issues and leads to better glocose levels overall, do you see a problem? Also, is it possible that the self-reported mood issues reported here are a manifestation of mild carb addiction?
Yes, I do recommend PHD for diabetics and pre-diabetics.
I discussed this question in a previous blog post (“Safe Starches Symposium: Dr Ron Rosedale,” Nov 1, 2011). The basic biology here is that the body’s physiology is optimized for a carbohydrate intake of around 30%. At higher carbohydrate intakes, glucose disposal pathways (such as switching muscle cells from fat to glucose burning) are invoked; at lower carbohydrate intake, “triage” of glucose occurs, reserving it for the brain, and some useful carb-dependent functions are lost. Both extremes are stressful, and in metabolic disorders, both extremes may be difficult to handle.
In diabetes, the body does not dispose of excess carbohydrate properly, so carb intakes above about 30% are harmful. However, all carb intakes of 30% or lower are handled quite well in terms of blood glucose levels. This has been demonstrated in many studies. I like the LoBAG (Low Bio-Available Glucose) diet studies of Mary Gannon and Frank Nuttall, which are quite close to PHD. They tested both 20% carb and 30% carb diets in diabetics, and both carb levels were handled quite well. Here is data from Gannon & Nuttall’s 2004 study of a 20% carb diet (graph is actually from a later paper by Volek & Feinman).
Over a 24 hour period, blood glucose levels were tracked in Type II diabetics on their usual diets (blue and grey triangles) and after 5 weeks on a 55% carb – 15% protein – 30% fat (yellow circles) or 20% carb – 30% protein – 50% fat diet (blue circles):
You can see that on the 20% carb diet blood glucose came close to non-diabetic levels. The same thing happened in later studies of a 30% carb diet.
What happens when diabetics go to very low carb diets, 10% carb or less? The body invokes “triage” mechanisms for glucose conservation under carbohydrate starvation. Among these are hormonal changes including low T3 thyroid hormone and high cortisol. This condition makes fasting problematic and diabetics tend to develop high blood glucose levels in the morning after the overnight fast. Due to high fasting glucose and severe insulin resistance, HbA1c may be elevated by this strategy compared to a 20% or 30% carb diet. Various pathologies, including hypoglycemic episodes, dysregulation of serum fatty acid levels, ketoacidosis, and adrenal dysfunction become more likely. The long-term dangers described in our “zero-carb dangers” series are also present, including a higher risk for some infections, kidney stones, and other ailments.
Evidence that resistant starch helps diabetics also supports the prescription of starchy foods. It’s likely that natural whole foods will be found to be the best source of fiber, and resistant starch in nature is always accompanied by digestible starch.
PHD has generated very good results in diabetics and so, while diabetics might possibly benefit from a slight bias toward lower carbohydrate and higher protein vis-à-vis the healthy, the ordinary version of PHD seems to be very close to optimal for diabetics.
Ben: Where can I see a very recent photo of you and your wife? (I see the author/advocate’s physical appearance as a data point when considering a proposed approach to nutrition.)
We haven’t taken many photos lately, but you can see a video of me from January this year at a blog post we did for Dr. Alejandro Junger’s Clean Program. Here’s a look:
Our May Perfect Health Retreat begins next week and we’ll take photos and post them to our blog and social media. Keep an eye out there for up-to-date photos and maybe video.
Allison: I want to know recommendations of how to use “safe starch” for weight loss.
Eat it! Getting about 20%-25% of calories as safe starches (30% of calories as carbs) is optimal for weight loss. It’s best to cook them in a batch and save them in the refrigerator until meal time, when you can quickly re-heat them. This is both convenient and generates more resistant starch.
Maggie: One of my Resting Metabolic Rate test results showed that my fat burning/glucose burning ratio is .98, meaning I burn .98 glucose. I do not burn much fat (a better score would be .85, for example). Does this mean my dietary fat percentage should be lower than Paul’s recommendations for weight loss because my body is a slow fat burner? What can I do to increase my fat burning rate?
I am not sure what test you took. A standard test to assess fat burning vs glucose burning is the Respiratory Quotient, which is close to 1.0 when burning glucose exclusively and close to 0.7 when burning fats exclusively. But no one gets a number as high as 0.98 at rest, though it can get that high during intense exertion.
At rest, the Respiratory Quotient should approach 0.7, but in the obese it tends to get stuck at maybe 0.85. To enable it to go lower, you want to support mitochondrial health and train yourself to burn fats better. Supplementing vitamin C and pantothenic acid may help, also daily exercise and circadian rhythm entrainment.
Martin: What’s your opinion on a cyclic-ketogenic diet, with a carb refeed once a week only? Also, does it matter when one eats carbs during a day (e.g. morning vs. evening) and how it is combined with protein and fats?
I think once a week is too infrequent for carb feeding. I think daily carb feeding is best.
Carbs are best eaten during the daytime in a fairly narrow feeding window. Relative to protein, carbs should be biased later in the feeding window, protein earlier. But both should be eaten together. Just make the first meal a little more protein rich, the last meal a little more carb rich, or follow it with a sweet dessert.
Fritters: I own your book, but the whole idea of organ meats, bone broth and fish nauseates me. Also, I’ve heard people with AI problems are sometimes fixed by removing nightshades from their diet. In any case, I have an AI problem and am on prednisone all the time, which shoves my blood sugar way up. I’ve felt a LITTLE better on less nightshades, so I want to keep doing that, but I want to eat closer to the Perfect Health diet without gaining too much weight because of the increased blood sugar from the prednisone. What areas do you think I should concentrate on to get closer to perfect health? I’m already avoiding sugars, wheat and crap-oils.
Yes, it’s true that many people with autoimmune issues benefit from dropping nightshades. In general, autoimmunity originates with foreign compounds entering the body through a leaky gut, which is the same way food sensitivities originate. Nightshade toxins are immunogenic and can easily generate food sensitivities in people with a leaky gut.
PHD with nightshades removed is essentially a Paleo autoimmune protocol.
Prednisone is a drug I don’t like, it suppresses immunity which suppresses symptoms but often worsens the underlying disease – and it has negative side effects as you’ve experienced.
Focus on eating PHD meals in which starches are paired with meats, vegetables, fats, and acids; support immune function with vitamin A (liver, spinach, carrots), vitamin D (sunshine), daily exercise, intermittent fasting, circadian rhythm entrainment, zinc, iodine, and vitamin C; include collagen (bones, joints, tendons in soups and stews) for wound healing and gut barrier integrity.
Teresa Grodi: My question for Paul is regarding the “Candida Diet”. I know lots of people, especially postpartum women dealing with bad thrush, who are on the anti-candida diet, which prohibits what you would determine “safe starches”. I think I saw in passing that you had some problems with the anti-candida diets, regarding the prohibition of safe starches, and I thought maybe you could elaborate, with an eye to postpartum/breast feeding mothers. I would love to be able to help my fellow mothers.
Very low-carb diets will flare fungal infections by suppressing antifungal immunity and reducing the population of probiotic bacteria in the gut, which compete with fungi. A balanced diet with 30% carbs is best for candida.
My answer to vlc eater above about why 30% carb is best for diabetes also applies to Candida: you want a well nourished body, including nourishment with glucose, but without an excess that could feed the infection. It’s only carb intakes above 30% that provide that excess. Carb intakes below 30% starve immune function, extracellular matrix maintenance, and mucus production, all of which help defend against Candida.
Eating liver, getting sunshine, intermittent fasting, circadian rhythm entrainment, and eating fermented vegetables are other elements of a good anti-Candida strategy.
Tony: Dr. Jaminet’s phd proposes safe carbohydrates to replenish daily glucose stores. He proposes safe carbs because of the damaging health effects of grain carbs (except rice). If a subject occasionally (1,2,3 times a week?) consumed bad starches instead of good starches won’t these bad starches still replenish his glucose stores? Won’t the good fats blunt any insulin spike from the bad starches? In other words, phd with bad starches, wholly or partially, occasionally. Would subject’s health still go down the tubes? Would subject gain weight or stall a weight loss?
Yes, all starches will replenish glycogen (glucose stores). What makes a starch “good” or “bad” (we use the terms “safe” and “toxic”) is not the starch but associated compounds which can be toxic to us.
I can’t say that your health will go down the tubes if you eat bad starches like wheat. Only that they appear to be risky things to eat. They do harm some people. It’s possible that even in people who appear to be unharmed, they do insidious damage. We can’t know for sure, we just think that it’s prudent to avoid wheat.
No, wheat won’t necessarily cause weight gain by itself. It is associated with higher body mass indexes, however, and there may be mechanisms by which it can promote leaky gut which is inflammatory and promotes weight gain. I think it will be slightly easier to lose weight without it.
Lily: I am sensitive to sugar, and have a huge addiction to it. Starches like white rice tend to raise my blood sugar too much and I end up binging (even if I have it with a fat source). Are there safe starches that I can eat that won’t raise my blood sugar so much? Potatoes seem to affect me the same way white rice does. I would eat potatoes with the peel, or try brown rice, but don’t those have anti-nutrients? Are there starches that are safe for me, a sugar addict with a body that doesn’t handle sugar very well?
I’ve heard many stories like yours and people are often surprised to find that all of those things clear up pretty quickly on PHD. The pattern:
- Binging and cravings and addictive behaviors typically follow starvation, so I’ll guess you’ve been too low carb for too long. Your brain knows your body needs carbs and when it’s available says, “Ah! We’ve found the nutrient we need! Go eat this precious sugar/starch before this rare and vital food disappears!” To fix this, eat PHD levels of carbs. Over time the craving/addiction will go away.
- Weight gain from eating carbs usually indicates a leaky gut and a dysbiotic gut flora, such that when you expose your gut to carbohydrates you get inflammation which activates adipose tissue (an immune organ) and causes it to grow. It also relates to the binging, after past starvation your appetite is upregulated temporarily when you get a chance to repair malnourishment.
- High blood sugar upon eating starch indicates that (a) you are cooking and eating it incorrectly and/or (b) you lack the gut flora needed for proper glycemic regulation. To fix (a), read this post, and to fix (b), you need more fiber, including some resistant starch, and fermented vegetables.
Above all, you need a balanced, nourishing diet and immune support. See my previous answers to Teresa Grodi and Fritters for some tips. Your mindset should be oriented toward health, not weight. You should accept that an initial weight gain may be “baked in the cake” so to speak, it is already inevitable thanks to past deprivation, accept it and move on to healing yourself and once healed you will be able to re-lose the weight in a natural and healthful way, and reach your goal weight safely.
Carnivore: My dilemma is when on a VLC diet my blood sugar (A1C test) very good, fasting glucose very high (I am diabetic) When I start some safe starches (tried potatoes and beans) morning fasting glucose excellent – blood sugar throughout the day – way too high after the meals – and even with medication is coming down in a few hours (too slow). So, my question is: how can one determine how much safe starch is safe? (for a female diabetic approaching the retirement age) and what kind of starch: potatoes, beans, sweet potatoes? I assume rice is out of question for diabetics like me.
This is a very common pattern. See my answer to vlc eater above. 20% to 30% carbs is best. If postprandial blood sugars are high, make sure you are cooking and eating starches properly and working on your gut flora with fiber and fermented vegetables.
Chad: When weight lifting to gain muscle, most experts say you need to consume massive amounts of carbs in order to gain muscle. Then when you wish to slim down you reduce carbs. I prefer paleo style diets and it makes sense, but I also want to lose fat and gain muscle. The instructions to do so seem to directly conflict with the Paleo Diet idea. How do you induce your body to increase muscle size without consuming nothing but carbs only to go LC to get super lean later? Is increased insulin production necessary to increase muscle size? How do you do that and not become insulin resistant? Body builders get huge muscles and super lean all the time on this super high carb/super low carb cycle and its just so confusing.
The main instrument to vary is total calorie intake, and the relationship between calorie intake, periods of fasting, and the timing and intensity of workouts. Macronutrient proportions should be close to PHD ratios at all times, with slight variations synchronized with workout schedule.
High calorie intakes lead to gain of mass (both lean mass and adipose tissue); low calorie intakes lead to slimming (both lean mass and adipose tissue). The type of physical activity you undertake places the focus on a different mass reservoir. When you do intense workouts, you are focusing the body on muscle; you want high calorie intake at this time to promote muscle growth. When you are resting, you are focusing the body metabolically on adipose tissue – at this time you want to fast and reduce calorie intake to promote loss of adipose mass.
Macronutrient ratios should vary toward more fat and carbs when your calorie intake is high (e.g. eat more dessert like foods) and less fat and carbs when your calorie intake is low – in other words, your protein intake should be more stable than your fat and carb intake. But this is something you will do naturally. It doesn’t need to be consciously directed, and it doesn’t need to be extreme. You do need to direct your conscious mind to varying total calorie intake in sync with your workout intensity, and vary your workout intensity.
Work out every day, but vary the intensity, and vary the calories in sync with workload.
Pierson: Regarding fructose, what is his opinion on foods like fruit, honey, and sweet syrups? While it does make sense to avoid processed industrial anything, what about whole-foods sweeteners?
A little bit of honey or sweet syrups is OK. I think you’ll find that on low-carb diets without added sugar, your tastes change and very little honey is needed to make foods taste appealingly sweet. If you weighed the honey and calculated how many calories it had, you’d find it was very small. One teaspoon of honey weighs about 6 grams and has about 18 calories, about 9 calories of fructose or 0.4% of daily energy intake. That’s not going to kill you. We recommend getting about 100 calories of fructose daily from all sources, including fruit.
Fruit and berries are excellent foods and not to be avoided. We recommend eating 2-3 pieces of fruit or servings of berries daily.
Charles Grashow: If LDL-P increases isn’t that bad regardless of the particle size? Larger particles can still get thru the endothelium and become oxidized it just might take longer.
Yes. The LDL particles get oxidized in the bloodstream and then taken up by white blood cells, activating inflammation and potentially turning them into “foam cells” and assisting formation of atherosclerotic plaques. Endotoxemia (influx of endotoxins from the gut) is usually the biggest driver of LDL particle oxidation. More LDL particles and more endotoxins = more oxLDL reaching white blood cells = more inflammation and faster plaque formation.
Steve Parker MD: The preface of the Scribner edition mentions your health issues while eating the standard Amercian diet: neuropathy, memory loss, impaired mood, physical sluggishness, and rosacea. You attribute your subsequent scurvy to the very-low-carb paleo diet you adopted to resolve the original issues. Did your personal physician(s) make the diagnoses and say they were diet-related? Uptodate.com says this about rosacea: “The pathways that lead to the development of rosacea are not well understood. Proposed contributing factors include abnormalities in innate immunity, inflammatory reactions to cutaneous microorganisms, ultraviolet damage, and vascular dysfunction.” Your other three SAD-related problems each have easily 10-20 things that can cause them, many of them unrelated to diet. By the way, I enjoyed the book and learned a fair amount from it. Folks eating the standard American diet should be better off switching to PHD.
My doctor acknowledged the symptoms but was baffled about the cause, as was I. Rosacea was diagnosed by multiple dermatologists. After we optimized PHD my rosacea faded over a period of about 2-3 years. I would not be diagnosed with it today, though at times I still see traces of it.
The memory loss went away during a three month course of antibiotics, taken in the later stages of transitioning from Paleo to PHD.
The things my doctor was clearly able to diagnose were not very helpful to me. For instance, after my VLC and scurvy phase, my belly became bloated and a fairly hard nodule formed which my doctor said was a lipoma. We did a barium enema and it found diffuse diverticulosis. But that was not a cause of my health problems, it was an effect of the VLC-scurvy mistake. I found the various testing we did interesting and educational, but in the end it didn’t show me a path forward. It was diet, lifestyle, and a somewhat speculative round of antibiotics that cleared things up.
Thanks for the praise!
Ryan H: In your book you explain that fats and acids (ex: vinegar, lemon/lime juice) blunt the insulin spike of starches. To my knowledge you do not mention or recommend cinnamon doing the same. I am just wondering what your take on cinnamon is? I have heard that it lowers blood glucose levels. P.S. Cinnamon on a sweet potato is pretty good!
Cinnamon is good, but like all good things, it’s possible to get too much. Eating to optimize flavor is a good guide to the optimal amount. I agree, cinnamon and butter on sweet potatoes is delicious!
Mike W: Do you make any distinction, health-wise, between short-chain saturated fats and long-chain? The reason I ask is that foods heavy in short-chain sat fats (bovine milk, coconut oil, palm kernel oil) seem to give me clogged pores and acne, so I avoid them. This is no hardship for me, I was never big on cheese, butter, or coconut anyway. The fatty foods I do eat – eggs, meat, nuts, chocolate – don’t bother my skin at all, and in my research I’ve found their sat fats are almost exclusively 14-carbons or longer. Besides keeping my skin clear, I can justify my short-chain avoidance from an ancestral standpoint. I doubt my distant ancestors had access to coconuts, and as I understand it, human milk has a lot less short-chain fats than bovine milk. So… are short-chain saturated fatty acids an essential nutrient? Am I missing something by avoiding them?
Yes, short-chain and long-chain saturated fats are discussed in different chapters of our book because their biological effects are quite different.
I suspect your problem is more related to consuming oils, than to the chain-length of the fatty acids. Try supplementing pantothenic acid, zinc, and choline (or eat egg yolks and liver) and I bet you will tolerate the oils a lot better.
Coconut milk is not an essential food, but it is a healthful one, and we recommend it.
Ryan H: You advise if one needs to consume something during a fast (for hunger reasons), a spoonful of coconut oil or mct oil is allowed without it hindering the fast. What is your take on butter or cream during a fast (like in coffee)? Will it break the fast and autophagy? I am just wondering since some LC people recommend it and say you are still reaping the benefits of fasting since you’re not consuming protein or carbs.
Protein disrupts a fast the most, carbs next, fats the least. If you want a bit of cream in your coffee, that’s fine. If you are concerned about its effect on autophagy, delay your breakfast an extra 10 minutes, that will get the lost autophagy back.
Becky: For the nightshade avoiders among us: Does packaged tapioca starch serve as a resistant starch? If so, can it be eaten like potato starch … in water, raw? I use it to make baked biscuits. Will they, cooled, provide resistant starch? Cassava, sago and taro are not available here. I like to keep rice to a minimum. Plantains, green bananas and sweet potatoes are my starches. I got diverticulitis on VLC and am enormously vested in getting my gut biome fed with resistant starch. I am the Becky quoted in your book, in the thyroid discussion. To update, Hashimoto’s antibodies DISAPPEARED from my TPO blood tests, and my doctor says I no longer have Hashimoto’s. He thinks it was probably giving up wheat.
Hi Becky, it’s great that your Hashi’s is gone! And thanks for contributing your story to our book!
Detailed questions about resistant starch content of various foods under various cooking methods should be directed to Tim and Grace, who have been researching those things.
I would say however that you should not eat tapioca starch in water raw. Rather, make it into foods like your biscuits and eat them as parts of meals in the PHD manner, accompanied by butter, vinegar, vegetables, and meat. Or at least, as a dessert with butter and vinegar.
Tom: Thank you, Paul. There’s a lot to digest here (pun intended), so I’ll post the rest on Monday.