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:

  1. 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.
  2. 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.
  3. 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.

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55 Responses to “Paul Jaminet Answers Your Questions, Part One”
  1. Martin says:

    Lots of great information, thanks!

  2. rs711 says:

    Hi Dr. Jaminet,

    First off, I would love to send my friends and family to a retreat such as yours….It seems very effective and a modern, holistic approach to health – congratulations!

    My question/comment: There are so many variables changing when going from a 30% carb diet to a ketogenic diet or vice-versa; macronutrient profiles, energy intake/expenditure, hunger etc..

    You appear very certain about the fact that your health issues were due to a macronutrient variable issue (aka lack of glucose). I understand that this it is a likely candidate and deserves attention – but, how do you justify your degree of certainty? It seems somewhat strongly stated considering how easy it is to point to other variables and find plausible mechanisms.

    For context and full disclosure: I am on a LC/VLC diet most of the time and I eat cups and cups of non-starchy veg, starches a few times a week and fruit here and there with great pleasure. I also realise that the Kitavans exist and am fascinated by this apparent contradiction to how well a lot of people do on a carb-restricted diet.

    • Tom Naughton says:

      We’re done with the Q & A, but after reading the book, I’ll hazard a guess at what Jaminet would say: his macronutrient ratios are based on ancestral diets, the experiences of himself and others, and clinical evidence that a diet too low in carbs can cause high fasting glucose because of physiological insulin resistance — i.e., the body finding a way to conserve limited glucose for the brain.

      • rs711 says:

        “his macronutrient ratios are based on ancestral diets” – but ancestral diets vary wildly in macronutrient distributions whilst still allowing for great health. The diets of some animals are very narrow (a whale), while that of a chimp is quite varied. Humans are obviously part of that wider spectrum. So is the 30% carb simply an average of anthropological data? It is hard to say a ratio is optimal and still maintain that everyone needs substantial adjustment – maybe the ratio is more of a reasonable/logical starting point but but calling it optimal suggests it is the end goal.

        “clinical evidence that a diet too low in carbs can cause high fasting glucose because” – again, because 2 things happen at the same time doesn’t mean they are in a causal (direct or indirect) relationship. Dr. Jaminet has been very diligent about presenting mechanisms and well-controlled studies about the vast majority of his prescriptions but when it comes to carb-thyroid of physiological insulin resistance there only **seems** to plausible mechanisms that have yet to bear out in way where the variables are controllable.

        The ‘GNG being insufficient for brain glucose requirements’ argument has a substantial number of points suggesting it is correct but also a lot of solid data pointing to the opposite. It’s great and normal to have people lean to 1 side more than the other – but to make stalwart recommendations based on that implies the question has already been settled beyond reasonable doubt, which it has not.

        It is a case of trying to reconcile contradictory data again (as it so often is).

        • Tom Naughton says:

          The 30% is both an average of ancestral diets and the level at which Jaminet believes we avoid glucose deficiency and avoid glucose excess. Personally, I’d think more in grams of carbohydrate … i.e., if I need between 100 and 150 grams of glucose per day for basic biological functions, then that’s what I’d consume, no matter what percent of my diet it worked out to be. There were ancestral diets closer to 15% carbohydrate as well, so I suspect there’s a difference between relying somewhat on gluconeogenesis vs. relying totally on gluconeogenesis as far as the risk of a glucose deficiency over time.

          Physiological insulin resistance (which leads to higher fasting glucose) and a change in thyroid function as results of a very-low-carb diet are both well-understood and neither is controversial or speculative. Dr. Rosedale, in fact, freely admits both occur on a low-carb diet but insists they’re healthy adaptations, not problems.

          Peter at Hyperlipid (a science geek if there ever was one) explains physiological insulin resistance (which, like Rosedale, he considers not to be a problem as long as you stick with a LC diet) this way:

          “Well, the first thing is that LC eating rapidly induces insulin resistance. This is a completely and utterly normal physiological response to carbohydrate restriction. Carbohydrate restriction drops insulin levels. Low insulin levels activate hormone sensitive lipase. Fatty tissue breaks down and releases non esterified fatty acids. These are mostly taken up by muscle cells as fuel and automatically induce insulin resistance in those muscles.

          This is patently logical as muscle runs well on lipids and so glucose can be left for tissues such as brain, which really need it. Neuronal tissue varies in its use of insulin to uptake glucose but doesn’t accumulate lipid in the way muscle does, so physiological insulin resistance is not an issue for brain cells.”

          However, while muscles are in “refusal mode” for glucose the least input, from food or gluconeogenesis, will rapidly spike blood glucose out of all proportion.

          • tony says:

            Tom, you stated “if I need between 100 and 150 grams of glucose per day for basic biological functions, then that’s what I’d consume, no matter what percent of my diet it worked out to be.”

            To me it would be easier to count carbohydrate and protein grams per day than count percentages, given your statement.

            Would it be correct to aim for 100-150 grams of carbohydrates per day?

            What about proteins; 50-75 grams per day?

            More, less?

            Thanks!

            • Tom Naughton says:

              As a rough guideline, that sounds about right. I’m pretty sure I end up at or a little below the 100 grams of carbohydrate.

            • Charlie - a biochemist says:

              Tony – please remember that the quantity of glucose the body uses a day is not the same as the quantity that needs to be consumed.

              We can make all the glucose we need from the bulk of the amino acids we release on the digestion of proteins. This synthesis is made in a controlled way (gluconeogenesis) and does not produce the large spikes that are produced on the consumption of carbohydrates.

              The glucose that we make can then be made into all the various sugars that the body needs – for example ribose and deoxyribose – and the various sugars that are bound to proteins and mucopolysacchrides to enhance their hydrophilic nature.

              It is vital that diabetics do not have large and prolonged spikes of glucose in order to reduce the amount of advanced glycation end-products.

              • Tom Naughton says:

                “We can make all the glucose we need from the bulk of the amino acids we release on the digestion of proteins.”

                The $64,000 question is: is that true for everyone? Since some people end up with symptoms of glucose deficiency that go away when they consume a bit of glucose, as Chris Kresser discovered with his patients, I’d guess it’s not true for everyone. It could be that some people’s livers just aren’t up to the task of producing all the necessary glucose via gluconeogenesis in perpetuity. We can debate about whether or not their livers should be up to the task, but if they’re not, then eating a potato is better than living with dry eyes and the other symptoms of glucose deficiency.

                • Charlie - a biochemist says:

                  Hi Tom – nice to “talk” to you after all these years of following and enjoying your blog.

                  Yes all proteins are susceptible to mutation – the mutated site may not affect enzymatic activity (and may even increase it) and can be classified as a “silent” mutation, or it may be near the active site and reduce to varying extents the enzymatic activity and be classified as a “leaky” mutation, or it may be at the active site and obliterate all activity and thus be classified as a “lethal” mutation. So we are not all identical – but fit under a bell shaped curve – with the vast majority of people who have survived in the womb and childhood able to complete a given reaction or pathway.

                  My point being that just because a small proportion of people cannot easily perform all reactions, such as gluconeogenesis, then we should tell all people that they need to take large amounts of carbohydrate – which are detrimental to most people and especially to diabetics.

                  • Tom Naughton says:

                    Agreed. However, I wouldn’t consider 100 grams or so per day to be a large card load. That’s 1/4 to 1/3 of what most people consume, which is why the Jaminets consider PHD to be a low-carb diet. I certainly considered my Fat Head fast-food diet to be low-carb, despite averaging around 100 grams per day.

                    For a type 1 diabetic, yup, even that may be too much.

          • rs711 says:

            Thank you for your thoughtful response Tom. Peter @ Hyperlipid is a scientific-mentor of sorts to me (without his knowledge hehe).

            Simply stated, the phenomenon of physiological insulin resistance does not mean mean “poor glucose tolerance”. The same way the ketosis and ketoacidosis are different but have similar underlying mechanisms. This is where we have to take into account the ‘sick’ population we’re working with. Like when athletes are tested on LC diets but aren’t given enough time to adapt.

            Anyhow, this Q & A is very valuable, thanks and please continue :D

            • Tom Naughton says:

              Correct, that’s Peter’s position as well as Dr. Rosedale’s. Both agree that physiological insulin resistance is a result of a VLC diet, but don’t see it as a problem — and it probably isn’t for people who 1) stay low-carb (because a high-carb meal will jack your glucose in a major way if you have PIR) and 2) don’t experience the symptoms of glucose deficiency the Jaminets describe.

  3. Fritters says:

    THANK YOU SO MUCH FOR ANSWERING MY QUESTION!!

    *does a little happy dance*

  4. Ellen says:

    Tom, thanks for a great series of extremely informative posts! I appreciate the time you put into this and I admire you for publishing your change of mind regarding Paul Jaminet and the Perfect Health Diet. You are a stand up guy (as well as a stand up comedian) with a heck of a lot of integrity. Kudos!

  5. It seems to me that the Perfect Health Diet really suits only people like Paul Jaminet who can’t handle a low carb diet.

    • Tom Naughton says:

      In which case, the question is: how many people can’t handle a very-low-carb diet in the long term? And the other question is: will people who can handle a very-low-carb diet be better off or worse off adding a few servings of starch to their diets? If they end up better off, it’s a no-brainer. If they’re no better off and no worse off, then it comes down whether or not they’d enjoy a potato with dinner.

      • Tom, those are good questions.

        I think I’m going to err on the side of low carb for life–unless I run across more serious problems than say e.g., my weight loss stalling: (1) My problem eating carbs is the cravings that they cause–even a small amount of “safe” carbs is very unhelpful in this regard. And there have been cases of diabetics who started eating a little carbohydrate then couldn’t stop and fell back into their health problems of obesity and high blood sugars. For some people there are no safe carbs. (2) I agree with Perlmutter, that a low carb diet is probably better for the brain. I love the effect of my LCHF on my brain in the short term–it helps me to think clearer, and I have more mental energy. (3) Even carbs do not offering me very much nutritional bang for the buck. I am currently starting the Wahls Protocol because of its potential in restoring health to people with autoimmune and mitochondrial problems: this is a diet very dense in nutrition in which the strictest form is also very low carb paleo. Carbohydrate dense foods just don’t have same level of nutrition per calorie as what I am currently eating.

        • Tom Naughton says:

          I’ve moved my diet more towards a Perfect Health Diet for reasons I described in a couple of posts, and the results have all been positive so far. But I’ll also reiterate that I don’t think it’s the best diet for everyone — because I don’t believe there is a diet that’s best for everyone. PHD is a low-carb, high-fat diet (roughly double the fat and half the carbs the USDA goofs recommend), but it may not be low-carb enough for some people. On the other hand, a ketogenic diet or Atkins-induction diet may be too low-carb for some people in the long term. Atkins himself only recommended staying on the induction phase of his diet for two weeks.

          What I hope people take away from this series of posts is that we’re all different and have to find what works best for each of us. And if what works for me doesn’t work for you or vice versa, it doesn’t mean one of us is sick or not doing it “right.” It means we’re different.

          • Stipetic says:

            This can’t be said enough in these discussions.

            Although I’ve chosen VLC for myself for health reasons (and I also perform better mentally and physically on it), my kids and wife follow PHD, and I recommend PHD for others who I know would find my diet too extreme and dismiss it out of hand.

      • I should also allow that Jaminet’s Perfect Health Diet would be a great diet for people not suffering from metablic syndrome at all–i.e., for people who don’t need low carbohydrate diet to thrive. Perhaps if we all started there in the first place everything would be fine. But after years of Standard Western Diet, many of us have carbohydrate fatigue. I had a head start on the fatigue because my mother was diabetic when she carried me.

        • Tom Naughton says:

          Agreed. That was basically my response when someone pointed out the Kitavans live on a diet that’s 70% starch and are healthy. Good for them, but I’m not a Kitavan. I sincerely doubt my Irish paleo ancestors ate anywhere near that much starch, and I grew up eating Captain Crunch and Wonder Bread with sugar and cinnamon on top, so I didn’t do my metabolism any favors. Working up to around 80 to 100 grams of carbohydrate has worked out for me, but that doesn’t mean it would work for everyone.

        • Martin says:

          There is a third way: carb cycling. I myself had been on a strict ketogenic diet for a few years and only recently started introducing a carb night (following Kiefer’s protocol) once every week.

          If you listen to Kiefer, he is a very strong advocate of using fat as the main energy source and his interpretation of the research behind convinces me more than what Jaminet, Wolf, Sisson, et al. talk about.

          • Tom Naughton says:

            Jaminet also believes fat should be your main energy source. In the PHD book, he writes that most of our cells run better on fatty acids than on glucose. He recommends consuming some glucose (in the form of safe starches) only fort the sake of providing the 100-150 grams per day our bodies need for the brain, red blood cells, tears, saliva, mucous, etc. His relatively low glucose intake is intended to prevent you from using glucose as a primary source of energy.

            • Martin says:

              And I am definitely going to experiment with reintroducing glucose at the level of ~100g / day at some point (after I have tested carb nite). For somebody who lived on < 50 for a few years, it sounds a bit scary though ;-)

  6. Rick says:

    Interesting reading. What about things like gluten free bread and pasta made with rice flour, tapioca flour and potato starch? As these considered “safe”?

    • Tom Naughton says:

      They’re considered safe from a toxin standpoint, yes. They can also jack your blood sugar, though, so I’d check your glucose reaction. After being very-low-carb for an extended period, a load of any kind of starch will likely cause a spike, so if you’re adding safe starches back into your diet, I’d suggest working your way up to a higher carb count and giving your body time to adjust.

  7. Pierre says:

    Well I have added potato starch to my VLC diet. Eat once a day 5 days a week and do suffer a bit from dry eyes in the morning…they are very red and dry mouth in the morning. Have already gone through one bag…but discovered I was shooting myself in the foot because I was still using splenda…a lot. The past 3 days I have avoided all traces of splenda and have upped my potato starch to 8 table spoons a day. Will keep you abreast of any improvements to my eye and mouth dryness.

    • Tom Naughton says:

      I’m all for the potato starch for the RS and gut health, but Jaminet attributes the dry eyes and lack of saliva to a glucose deficiency — i.e., the body preserving what little glucose is available for the brain and not caring so much about making tears and saliva. So you may find you need to add a little regular starch before those symptoms go away. The potato starch will provide butyrate in the colon, but not much in the way of glucose. That’s why it doesn’t usually kick ketogenic dieters out of ketosis.

      • Martin says:

        Tom, why don’t you ask Steve Phinney and/or Jeff Volek to comment on that? It would make a great follow-up installment of the super interesting Q/A series.

        • Tom Naughton says:

          Ask them to comment on which part? The glucose deficiency?

          • Martin says:

            Yes, they have been studying low-carb diets for many years/decades now, and I would presume that if there is a real physiological effect of glucose deficiency (as opposed to e.g. hormones downregulation) then they should know something about it.

            Notice that I am starting to reintroduce carbs into my low carb diet myself and I am open to new ideas.

            But Phinney & Volek are the experts in this field, and if anybody, e.g. Paul Jaminet says “low carb diet causes X” I want to know what the real experts think about it.

            Notice finally, that, as showed by Jimmy Moore’s example, different flavors of low-carb diet are possible. Jimmy struggled to lose weight on one flavor, then switched to another one and was quite successful. Are you sure that all issues Paul Jaminet mentions he experienced are not due to some ‘mistakes’ that he made?

            • Tom Naughton says:

              I have great respect for Phinney and Volek, but I wouldn’t label them as the only experts in the field, and in fact I wouldn’t want to label anyone as the Final Word Expert on a subject and stop considering what other researchers have to say.

              Going ketogenic worked out very well for Jimmy. The Perfect Health Diet didn’t. So Jimmy should go with what works. I’d same the same about people who struggle on a ketogenic diet but feel great and become healthier on PHD.

        • Liza says:

          Great common sense here. Wish I’d thhguot of that.

  8. Adam says:

    Hi Tom and Paul,

    Thanks for the posts and the provocative discussion.

    I have two basic thoughts/questions here:

    1) We have relatively limited data even about the long term efficacy of low carb diets. I don’t doubt that some people might thrive more on higher carb levels than lower levels, for whatever reasons. But once we get into the terrain of “tweaking” your basic Atkins diet with things like resistant starches and safe starches and what have you, aren’t we getting into the realm of speculation?

    Not that I’m opposed to speculation or self-experimentation. But given the limited good science we have on the long term effects of these diets, I’m dubious that we have enough research to make claims like 30% carbs is better than 15% carbs for the general population or even for specific cohorts. And I’d personally prefer it if people used language to the effect of “XYZ diet hack seems to work for ABC folks, but we need more science” than what we usually see in these discussions. We’re speculating on mechanisms and results.

    2) We may have evolved to eat some starch — I’ve read articles in the lc/paleosphere that dispute this idea, but let’s assume it’s true. Besides, we know that some cultures thrive on higher carb diets, so even if we are not evolutionarily predisposed to eating starch/sugar/etc, at least some of us can eat that stuff and be fine.

    However, once people have been metabolically broken by the SAD, perhaps their ability to tolerate carbohydrate breaks down as well. In other words, people can tolerate diverse diets. But feed them the SAD, and now they must watch carbs. Not because carbs are inherently evil or that we didn’t evolve to eat them. But because the body has become intolerant to them.

    In some ways, maybe it’s like drinking. Normal folks can tolerate a reasonable amount of alcohol. But someone who’s an alcoholic and who suffers liver damage may no longer be able to drink even a glass of red wine a night because of the liver damage. (This is one of my main issues with Paleo, btw. Doing the opposite of what broke you won’t necessarily fix you!)

    Anyway, my concern is: once you’re broken (or somewhat broken) metabolically, like 2/3rds of the American population seems to be, is eating even “safe” starches the equivalent of drinking a glass of red wine a night on a bum liver?

    That said, I appreciate Paul’s fascinating perspective and I’m enjoying this discussion and your posts as always!

    • Tom Naughton says:

      Those are all good points, and I’d add that even when there are long-term studies, the results are reported as averages. A diet that produced good glucose control on average can still produce lousy glucose control for the outliers. So it’s always best to monitor your own results.

  9. Adam says:

    True dat! Hopefully, when nutrition science stops being an embarrassing basket case, we can do trials that will test these intriguing hypotheses more effectively…

  10. George says:

    Tom, great stuff here. I had submitted a question to Paul and when this post popped up on one of the twitter feeds this morning it was there. It was a question from George on whether or not the calories of resistant starch (Bob’s RM Unmodified PS) should be counted on one’s carb count or since it bypasses the stomach/small intestine it doesn’t count. That question and Paul’s answer was here this morning but I know longer see it now. Was it edited out or rolled over to Part 2??

    • Tom Naughton says:

      It’s in part two on this blog. Paul elected to run the whole Q & A yesterday because he was leaving town for a retreat.

  11. johnny says:

    Tom, everyone of your articles this year have been succinct, clear, excellent and informative.

    Reading them I saw so many mistakes in my diet and surely you see it all clearly. Of course neither I nor the rest of us can put the issue as squarely as you can.

    I will do my best to study from you how to diet as necessary. I’ll do everything to learn your lessons so it will serve me well in my subsequent diet under your fatherly leadership.

    • Tom Naughton says:

      Here I am trying to figure out if you’re being sarcastic.

      • johnny says:

        I’m not. As a matter of fact you should write a book “PHD for idiots” like the well known series ( no sarcasm intended).

        • Tom Naughton says:

          Well, we’re working on a kids’ book, and as any parent will tell you, kids are idiots at times. Even mine.

  12. HxH says:

    I believe there is a lot of merit to the PHD for many of us with normal metabolisms but I have apprehension when he talks about 30% carbs for those with diabetes, particularly type 1. What about Dr. Bernstein and the decades of research/treatment he has done both with his patients and himself? He recommends only 30g of carbs per day for type 1. My husband is type 1 so I’ve tried to study up as much as I can on that. He does have issues with having too much protein because he can turn that into glucose but it seems the solution is to have more fat vs. carbs. The only problem he finds with a very low carb diet (although he is more just low carb – under 100g per day) is when he has a large meal too late at night. Because low carb does digest so much more slowly it doesn’t give him time to digest the food before bed and adjust his insulin. He can’t give himself too much too quickly or he will go too low. Even though the protien will convert it does it slowly so doesn’t give himself enough insulin and will wake up with a high blood sugar. He does have a pump with a sensor but it takes recalibrating multiple times a day and is not yet a perfect system (but much better than what was available in the past:-). I try to fatten up our meals as much as possible but other than beef fat he just doesn’t like the other meat fat as much as I do! We are going to start doing some experimenting with resistant starch and have started the soil based probiotic to see how he reacts to that. His last A1C was not very good (7.2) but he thinks that had a lot to do with a lingering cold he had which will affect his blood sugar. He’s normally in the low 6′s.

    • Tom Naughton says:

      I’d be apprehensive about 30% carbs for a type I diabetic as well.

    • Bret says:

      Certainly a valid point that caution is required in the presence of T1D. However, based on Dr. J’s thesis that a chronic VLC diet desensitizes the body to glucose homeostasis (much like a muscle that goes unchallenged for a prolonged period) and Tom’s suggestion that there may be a “burnout” of our gluconeogenesis pathways on chronic VLC, the question is: which is the bigger threat? Is it the higher glucose, which requires more insulin and thus more attentiveness, or is it the other things aforementioned?

      I suspect the right answer to that question depends a lot on whether you buy into those ideas mentioned above, how sensitive to glucose your husband currently is, what your lifestyle is like, how meticulous (possibly even obsessive) you and he are willing to be with exogenous insulin control, and so on.

      Tim, Grace, and Richard have all suggested–Dr. J too, I believe–that RS decreases the blood sugar spike and resultant insulin impact. If some experimentation leads you to believe that such is the case for your husband, perhaps you can comfortably and confidently add more carbs to his diet in the context of plenty of RS.

      I’m no expert of any flavor–just my $0.02, for whatever it’s worth. :-)

      • HxH says:

        Thanks, I agree that VLC may not agree with him (particularly since that normally results in high protein – it’s hard to get 60% fat:-). I don’t know if this is the right conversion but I read that 1 gram of carbs is about 4 calories. If he eats about 2000 calories (active male, 5’11″) that would be about 165g of carbs a day. I’m aiming for no more than 20% for him (100g).

        As we’ve been relaxing on potatoes and sweet potatoes, particularly with a lot of fat, we find his blood sugar doesn’t spike up nearly as much as with wheat and added sugar. Most of this has been without cooling the potato first (still working on our timing with that) so haven’t gotten the advantage of RS. But, should RS even be considered part of the 30% (or 20%) since that is not digested?

  13. MC says:

    I think having more starch in your diet is usually a benefit to most on a long term VLC diet, but I don’t know that you’ll become glucose deficient if you don’t have 100-150 grams of carbs everyday.

    If you had one sweet potato a day(about 30 grams of starch), 5 days a week, and 2 days of the week were days you had 100-150 grams of starch, and you also included a teaspoon of raw honey on all 7 days, with an additional 2 cups of broccoli or whatever non-starchy vegetable, everyday, you’d have on average 65-80 grams of carbs a day, not including fiber or resistant starch.

    Is Jaminet claiming you would become glucose deficient on such a diet, or is his 100-150 number/everyday, more of an educated guess?

    • Tom Naughton says:

      He believes that’s the range at which you draw all the benefits without getting too much. The sweet spot, if you’ll pardon the pun.

  14. Linda says:

    I have been reading all the info on resistant starch with great interest and have to say, for me, I don’t think it works. I was sick (almost diabetic) and grossly overweight when I went on VLC, ie. Atkins at first. Over a period of 16 months, I lost nearly one hundred pounds, and have found that if I veer very much from 50 carbs and under per day, my weight starts piling back on. Reading about resistant starch, I feel I have given it a fair trial- figured I was eating starches before just cooked and too hot. Over a period of nearly three weeks, I have been cooking potatoes and making small portions of potato salad the next day. In that period, my weight went up 8 pounds. (the calorie counters would have a field day with that and I’d probably be strung up!) Not only that, but cravings for carbs came back big time and I found my skin not so healthy, constipation back, etc.- all the woes of my carb-loading days. I am back on VLC for a while to get that weight off. I will not go back to the way I was!

    Like others on this post, I do wish Mr. Jaminet did not state so positively that a certain percentage of carbs is what the whole population needs. I can’t believe that! I really appreciate you, Tom, repeatedly stating that everyone needs to find what works for them! In my case I don’t think I need to be near ketogenic, but I do need to be under 50 carbs per day the greatest majority of the time. Most of my carbs need to come from what’s in green veggies, occasional carrots, etc., not starchy vegetables. I am very happy the way I am and do not feel deprived at all.

    • Tom Naughton says:

      Yup, I think it all comes down to individual variability. Add a few safe starches to a low-carb paleo diet, some people will end up better off, some will end up worse off. What I want people to take away from this discussion is that if you’re experiencing the problems the Jaminets describe on a VLC diet, you should consider trying something more along the lines of PHD and seeing if it helps. Find the diet that’s best for you health is more important than wearing a particular dietary label.

  15. Lawrence says:

    Hi Tom,
    This is in regards to the question asked to Mr Jaminet from Charles Grashow. He asked if an increase in LDL was bad regardless of the particle size. Mr Jaminet said it was. This goes against pretty much all the information out there in the LC community. In Fat Head, all the doctors/researchers said that there were two types of LDL. The small dense and the large fluffy buoyant. The latter being harmless and maybe even beneficial. Is that what you believe too now?
    I know when I went low carb (~100/day) over two years ago, my HDL increased, my TRIGs decreased, and my LDL increased (tested to be the large buoyant size through VAP test). Everything happened just like all the information said it would.
    How does Jaminet justify that statement?

    • Tom Naughton says:

      I think that one’s still up in the air. There are people with low LDL who have heart disease and people with high LDL who don’t. Peter Attia believes the total particle number does play a role. But if your LDL particle size has significantly increased, you can have a higher LDL reading but still have fewer LDL particles. Think of them as tennis balls and basketballs. A hundred basketballs will give a higher “total ball volume” reading than 400 tennis balls, but there are fewer “ball” particles.

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