Here’s part two of the Q & A with Paul Jaminet. Except where otherwise noted, reader questions are in bold and Jaminet’s answers are in plain text.
Norm: 1. Why do hunger and cravings for carbs increase for some people by introducing rice and potatoes whereas most of the people do not have that being low carb?
2. How do we know that symptoms associated with low carb like cold hands and feet, low thyroid etc. are NOT from eating less as hunger is dramatically reduced on a low carb diet?
3. Paul highly recommends 16 hours of fasting, would PHD provide the same benefits especially weight loss without 16 hours of fasting? Probably standard American diet would be a lot healthier with 16 hours of fasting? If calorie restriction is not good or creates problem for people especially in term of weight loss then why calorie restriction is achieved via intermittent fasting on PHD?
Many people on very low carb diets have hunger and cravings for carbs. Often it gets displaced into a craving for sweets or for alcohol.
For many low-carbers, adding rice and potatoes leads rapidly to a feeling of well being and satisfaction. It quiets appetite.
For others, eating rice or potatoes can trigger strong cravings for more. There are usually two components to this. First is a need for the body to replenish glucose-dependent proteins such as extracellular matrix; typically this takes at most a few weeks to a month, after which appetite diminishes. Second is an inflammatory reaction from gut pathogens that feed on the carbs. This requires fixing the gut dysbiosis or infections.
The low thyroid is a hormonal reaction to conserve glucose, and associated phenomena like cold hands and feet illustrate the inability of the body to properly maintain homeostasis when it is starved of a key nutrient. As far as reduced appetite on low-carb, there is a difference between reduced appetite due to a body being well nourished, and the anorexic lack of appetite that is induced during chronic starvation. The first is desirable, the second is not.
16 hour intermittent fasting is beneficial for health so long as the 8 hour feeding window falls in the daytime. PHD would still be an excellent (nourishing, low toxicity) diet without intermittent fasting, but this is another opportunity to improve health. Lifestyle is as important as diet for health.
It is not so much that PHD with intermittent fasting restricts calories, it is that it achieves optimal nourishment with the smallest possible caloric intake. In other words, one eats fewer calories without any restriction of nourishment when eating PHD. If this is hard to understand, try reading Chapter 17 of our book.
Gerard Pinzone: I’m interested in trying this out to see what difference it might make. I’ve heard that there may be an initial period of weight gain. If true, why? Can you provide a recommended schedule? Something like, “1 tablespoon of potato starch in the morning for one week, then increase by 1 tablespoon each week until you reach 4 tablespoons.” Is it better in the morning than night? Also, what issues are signs that we should stop and which should we grin and bear? Can we start/continue to take a probiotic? Should we?
Coming from SAD, people almost invariably lose weight when adopting PHD. I haven’t heard of any cases of weight gain in people coming from the standard American diet.
Coming from lower-carb diets, the immediate reaction can be either weight loss or weight gain. There are two principal reasons why weight gain may occur. It is partly a matter of low-carbers “adopting PHD” by simply adding starches to their Paleo diet, thus adding calories; and partly a matter of a gut dysbiosis or infection leading to greater inflammation when carbs are added. The solutions are (a) emphasize nutrient density and dietary balance so that hunger abates with lower calorie intake – that is, implement PHD more fully; and (b) address gut health through immune support and fermented foods and fiber.
I recommend just adopting PHD in toto from the beginning. There’s no reason to delay a good thing.
It’s fine to take probiotics but fermented vegetables usually contribute more.
JD: Just like all of this rethinking about RS, I’ve been rethinking the theory about optimal omega 3:6 ratios. Everything I remember reading about it recommends the ideal ratio is between 1:1 and 1:4. But what if it’s less about the ratios and more about eliminating bad fats (franken oils, factory farmed animals). Let’s say someone is following the Perfect Health Diet almost to a T, except most of their fat calories are coming from a high quality olive oil so the O3:6 ratio is closer to 1:8; is there any reason to think that person might less healthy than someone with a more ideal ratio? I do remember reading about how essential fatty acids from O3 and O6 fats compete for the same enzymes, but are there any studies out there that suggest excessive olive oil consumption interferes with therapeutic doses of O3 EFAs?
I guess my question could really be simplified to this; Is there any reason I should stop drowning my salads in olive oil?
Our peak health ranges are about 1% to 4% of calories from omega-6 fats (mainly linoleic acid) and 0.5% to 1.5% of energy from omega-3 fats (mainly from marine sources).
If you eat at the high end of the omega-6 range (4%) and the low end of the omega-3 range (0.5%), you’ll still have perfect health according to our analysis, and you’ll have an 8:1 ratio.
However, you have to hit fatty acid quantities spot on to be the peak health range for both with that ratio. If you have a 3:1 ratio, you could eat omega-6 anywhere from 1.5% to 4% of energy and still be in the peak health range for both. So that is a more desirable ratio to aim for.
Drowning your salads doesn’t sound good. How about flavoring your salads with olive oil?
Amberly: If using RS as a supplement (i.e. Potato Starch in a smoothie or cup of warm water), is there a “best” time of day to take it? In the morning? Before bed? All at once? Split into two or three doses?
Also, I am very sensitive to carbs and need to lose quite a bit of weight. What is the lowest number of carbs you would recommend going? Is it possible to stay in ketosis? Can you get the same health benefits from a cyclical ketogenic diet– i.e., VLC most of the time with one or two evenings a week of safe starches? Can you get health benefits by adding just RS (Potato Starch) but not the safe starches?
Take RS before your first meal. If you do intermittent fasting and your feeding window is 11 am to 7 pm, take the RS at 11 am.
I would recommend getting at least 20% of calories from carbs, but I think 30% is better for most people.
Lower carb diets should be seen as only temporary therapeutic diets, forms of extended fasting, not as permanent diets. Ketosis is fine, unless you have certain infections, but chronic starvation of desirable nutrients is not. I think it’s best to eat starches daily. No, your body needs glucose as well as a healthy gut flora.
MikeG: I believe you mean the enzyme amylase, rather than lipase? Amylase will hydrolyze the starch into maltose disaccharides first, then maltase (on the villi of the small intestine) will digest the maltoses into glucoses. Then the glucoses can be easily absorbed via transporters on the villi surface. This is why I cannot wrap my head around how fatty acids could blunt glucose spikes, or insulin spikes. Do the fatty acids bind to the glucoses? I suppose they could, given that we have glycolipids on our cell membranes.
I don’t know what this is referring to. If it’s our recommendation to combine starches with fats in order to reduce their glycemic index, the reason blood glucose is lowered by eating starches with fat has to do with delayed stomach emptying and improved metabolic regulation.
Troysdailybacon: With regards to Xylitol – I use it as a tooth protocol to fight cavities, but end up ingesting a small amount. I’ve heard that it acts like a prebiotic as well. But in the mouth, bad bacteria try to metabolize it, but can’t, so the bacteria die off. How does Xylitol react in the gut? Will it feed the good bacteria and produce butyrate? Or, like in the mouth, will it kill off good and/or bad bacteria in the gut?
Xylitol like other sugar alcohols can be fermented by some bacteria, and it has antimicrobial effects against others, so it will alter the gut flora (and the oral flora). I am not sure we know enough to say whether the changes are good or bad.
In in vitro studies, xylitol doesn’t seem especially effective at preventing cavities – it doesn’t do nearly as well as fluoride; and it also appears ineffective in human studies. This may be one of those cases where positive early studies don’t seem to be replicable.
Rob: Do you recommend supplementing with additional resistant starch (potato starch) and other fermentable fibers (inulin, pectin, etc.) or just getting these things from food? What are the potential negative effects of too much resistant starch and fermentable fibers?
I recommend getting fiber from food, but designing one’s diet and preparing food to make it fiber-rich. This can be done by eating natural whole foods, copious fruits and vegetables, and pre-cooking and refrigerating starches.
It is unclear what the negative effects of too much fiber would be, but there is surely a point when you can get too much.
I think of it in ecological terms. You are crafting an ecosystem in your gut, and you want an ecology that favors evolution of a healthful flora.
Humans have an overnight fast of 12-16 hours and a daily feeding window of 8-12 hours. Gut bacteria have a reproductive life cycle of about an hour when food is available. So during your daily feeding, your bacteria have enough food to reproduce and could potentially double their numbers 8 times, or increase their population 256-fold. Then they go through an overnight fast, and their numbers diminish. Ecologically it is a boom-bust cycle similar to deer multiplying when food is abundant and then starving in the winter.
Within the overnight fast, your immune system has an advantage in shaping the ecology. Where probiotic flora are present, it can reward them by generating mucus; where inflammatory pathogens are present, it punishes them with antimicrobial peptides. During the fast, microbes are relatively defenseless due to lack of resources. During feeding, microbes have the upper hand.
Providing lots of fiber creates a boom-bust ecology on a daily cycle, while a low-fiber diet creates more stable bacterial population levels.
In general, you want to eat the amount of fiber that maximizes microbial diversity (that is, genetic diversity) in the gut. Low microbial diversity is associated with disease, high diversity with great health.
Boom-bust ecologies create a different set of selective pressures on bacteria than ecological systems with stable food supplies. Potentially, too great an amount of fiber might reduce microbial diversity by rewarding species that are able to reproduce most rapidly during the food “boom” and preserve their numbers by hibernating during the overnight “famine”. Many beneficial species may not compete successful with hyper-growers like E. coli in such an ecosystem.
Low microbial diversity in the gut is associated with many diseases. Usually low diversity results from starvation of fiber, but conceivably supplementation with large doses of resistant starch could bring about a similar result.
I consider the optimal amount of fiber to still be an open research question. We don’t know the answer. But I am confident the optimal amount is not “infinite fiber.” There will be some amount that is too much.
Incidentally, getting a diversity of fiber types – not just resistant starch – will be important, as this too will promote microbial diversity. This is one reason a natural whole foods approach is likely to be optimal.
TMA: I haven’t read your book but what I’ve read about your diet on your website sounds appealing. One concern I have though is the number of different supplements you recommend. I’d be leery of low dose lithium for example. Do you discuss your rationale for these supplements in your book? And how would you suggest that people gauge their responses to a given supplement when there are so many and the purported effects are subtle and subjective?
Yes, we discuss the rationale for supplements in our book. I think if you compare our supplement list to the list of ingredients in a multivitamin, you’ll see that our list is much shorter.
Lithium is a good example. It is one of those compounds we seem to need for optimal health, longevity, and neurological function, yet it is removed from the modern water supply and is depleted in soils by repetitive annual planting of plants in agriculture. Compounding those environmental reductions is the fact that most people don’t eat many vegetables. So it is easy for a diet to be deficient in lithium.
It’s a good practice to stop supplements entirely for a few weeks every once in a while and see if you feel better or worse without them.
Gabe: I’ve heard you refer to your own experience in dealing with and/or eliminating chronic infections. Can you offer us some insights or advice on the solutions you found to these chronic infections, and/or what kind of medical practitioner one should consult? If one is already seeing a medical practitioner, what kinds of testing would indicate that practitioner is thoroughly considering what you know to be the right kinds of tests?
My personal solution was PHD plus antibiotics. I would recommend trying PHD (including the lifestyle advice – intermittent fasting, daily exercise, circadian rhythm entrainment) first and trying antibiotics as a last resort.
Testing is a complex question. The patient’s symptoms provide clues, lab tests provide clues, the practitioner has to understand biology and interpret them. There is no recipe that fits every patient, and you can waste a lot of money on uninformative tests. It’s best to find a clinician with good judgment to help you.
Howard Lee Harkness: Is the “soluble fiber” in chia seed (gel) a suitable “resistant starch” for the PHD? I’ve been experimenting with chia seed gel, and I have noticed that when I eat a serving (about 3 tbl chia seed soaked in 8 oz water about 15 minutes & added to a 20g protein shake with ice, coconut oil and MCT), I am not hungry again for a very long time (12 hours or more). However, I have not noticed any weight loss over the past week. My other main source of soluble fiber is raw carrot (about 1/2 cup per day), which I’ve been trying for about 3 weeks, again with no change in weight. Background: I easily lost a bit over 100 lbs on an Atkins-style diet starting in late 1999, but have remained weight-stable at roughly 50 lbs over goal (give or take about 10 lbs) since 2002.
I am not familiar with chia seeds, although I do see that they can help rats with dyslipidemia and fatty liver. You might ask Tim and Grace about their resistant starch content.
Kathy from Maine: 1. Tom said at the end of the post, “Perhaps you’ll be persuaded to eat a potato smothered in grass-fed butter.” From my limited reading of PHD, I took away the message that the plan is higher fat (65%), but that fat should come from what naturally occurs in foods and NOT ADDED to foods, like butter on the baked potato, etc. Did I misread this?
2. I’m confused on the 140 degrees. I thought that after the initial cooking and cooling, it was critical that the food NOT be reheated more than 140 degrees to reap the most resistant starch.
3. PHD recommends approximately 15% protein, which on a 2000-calorie diet would be 300 calories, or just 75 grams of protein. How does this correlate to Phinney & Volek’s advice in “Art & Science of LC Living” (and in a podcast I heard from Phinney) that everyone needs three 30-gram servings of protein daily, for a total of 90 – 100 grams or more in order to trigger protein muscle synthesis? In that book, they showed a table of a weight loss plan for a woman, and it advocated 100 grams of protein through all stages of the weight loss from “induction” through maintenance. Also, Dr. Eades notes in his Lifeplan book that women over 50 actually need more protein than men (and recommends at least 100 grams daily) because women of that age don’t absorb as much of the protein as do the men. I’ve always tried to get at least 100 grams a day. Is that too much, in Jaminet’s thinking? Or is 75 – 100 grams a good ballpark figure?
The recommended PHD macronutrient ratios are 30% carb, 15% protein, 55% fat.
Yes, most fat should come from natural whole foods, but most people will probably eat 2-4 tbsp per day of oils from cooking oil, salad dressing, coconut milk, butter, and other oils. It’s good to put butter or sour cream on a potato.
Resistant starch starts to melt (become digestible) with cooking above the boiling point of water, and the strongest rise in melting occurs between 60˚C and 70˚C (140˚F and 160˚F). Five minutes of cooking at 70˚C / 160˚F will eliminate nearly all resistant starch. It can take several days of refrigeration to restore the resistant starch content.
However, briefly warming a potato in the microwave will not raise the potato temperature to 70˚C, and will not destroy much resistant starch.
It’s true that if you want to maximize muscle mass, you should eat more protein than 15%. However, if you want to maximize longevity, 15% is a good number.
We actually give a peak health range for protein that ranges up to 150 grams (600 calories) per day. So the Phinney & Volek numbers are compatible with PHD. Where you choose to fall within that range is a matter of personal preference.
I’ve seen no evidence that elderly women need more protein than elderly men. All studies of centenarians show that elderly women eat less protein than men, and they outlive the men. It would be strange if they ate less and lived longer even though they needed more.
Amberly: In creating the most RS from a SS, does it matter how the item is cooked/cooled? IE does it matter if you bake the potato and then eat it immediately after it has mostly cooled (below 140), or does it form more RS if it is baked/boiled then put in the refrigerator overnight, and then reheated? Same type of idea with rice. Does the longer a food is cooled the more RS it creates, or is it pretty much the same?
General principles, you don’t want starches to become dehydrated. So use gentle water-based cooking methods like boiling or steaming. If you have an autoimmune disease or food sensitivities, favor cooking them in a pressure cooker.
You don’t need to cook starches for a long time to gelatinize them – just cook them as you would normally – but you do need to cool them for a while if your goal is to form extra resistant starch. Refrigerate them at least overnight, and resistant starch content actually continues to increase through 4 to 7 days of refrigeration.
Daci: What about green bananas as a safe starch? I really miss them since being on a lchf diet. I like them better than ripe ones. Always have. Any thoughts?
Eat them! Bananas are a great food, green or yellow.
George: Big fan of PHD and have been incorporating resistant starch particularly in the form of 4 Tbl of Bob’s Red Mill Unmodified Potato starch. Question: Give the nutritional breakdown of 4 Tbl of Potato Starch (160 calories/40 grams of carbohydrate): do does amounts contribute to the PHD minimum levels of starch 400-600 calories per day if this form of starch bypasses digestion in the stomach and small intestine and instead is largely digested by gut bacteria in the large intestine/colon? Or is it recommended to eat some starch that is not “resistant”? If so, how much of “resistant” and non-resistant starch should be consumed or does it not matter?
No, resistant starch does not count as a carbohydrate source. It is a short-chain fatty acid source providing about 1 to 1.5 calories fatty acids per gram. It doesn’t provide any carbohydrates. Of course, it is always accompanied by digestible starch in real foods. Those count as carbohydrates.
Yes, you should always combine resistant starch with digestible starch. In general, I think a natural whole foods approach is going to work out best in the end.
General guidelines, you want about 20-25% of calories as digestible starch from “safe starches,” about 10% of calories as sugars from fruits, beets, carrots, and the like, and about 2% of calories from maybe 30 grams of fiber per day, probably about half from resistant starch naturally formed in “safe starches” and half from a diverse array of fruits and vegetables.
Pam: You have milk as a not to be consumed. But, what about raw milk? I have been drinking raw goat milk for about a year. And then there is the Milk Cure from the early 20th century. Your thoughts?
Hi Pam, as we say in the book, milk is in many ways close to the ideal food, but our food production system does not inspire confidence in it. I would say you do need confidence in your dairy farmer, that he uses aseptic procedures to prevent contamination of the goat milk by goat dung (easy to occur, in nature the udders are often contaminated by stool as a means to pass maternal gut microbes to offspring) and keeps his goats healthy. There is a risk of infections such as brucellosis. Overall I am somewhat doubtful of the advantages of habitually drinking even well sourced milk, but I don’t have strong feelings about it. It can be curative for some conditions, though a good diet would also generally be curative of those conditions. Milk is simply an easy way to obtain a good diet.
Fight! (Just kidding)
The Internet is large, everyone’s got opinions, and we could waste a lot of time trading opinions. For that reason I think critics should generally be ignored, if all they have is opinions without any specific (which is to say, constructive) criticism.
However, once in a while it may be educational to see what authors think of their opinionated critics, so I thought I’d offer comments on a conversation between Harry and Tom. Harry in bold, Tom in italic, my commentary in regular font:
Harry: Paul’s central thesis (that toxins cause disease, and should therefore be minimised) is a leap of faith.
Paul: That is overstating our thesis. First, our diet is primarily focused on nutrient optimization, not toxin minimization. Toxin reduction is a secondary goal; the idea is that given two equally nourishing alternatives, say wheat or white rice, if there is evidence that one is significantly more toxic than the other (in this case, wheat more toxic than rice), we should avoid that one and get the nutrition from the safer source.
Harry continues: If toxins do in fact cause disease (that is, chronic consumption of low doses of toxins; we all know that consumption of high doses makes one very ill…or dead), then it simply does not follow that they should be minimised.
Hormesis in the body occurs in many systems, including the digestive/metabolic systems. It would certainly strike us as strange if we surmised that, since working to exhaustion causes death, then lying prone all day is the best way to avoid death. Similarly, it is strange (although understandable) that one might think that toxins should be avoided at all costs. Just like exposure to bacteria challenges and ultimately strengthens the immune system, so too it is possible that exposure to a certain level of dietary toxins is preferable to a completely ‘safe’ diet.
Paul: We discuss hormesis prominently in the book; see pages 192-193 at the beginning of Chapter 18, Food Toxins. The reason we aren’t concerned about the toxins in vegetables is that the doses are usually at hormetic or inconsequential levels.
Harry: The resolution to this question ultimately lies with controlled studies…but given the difficulty of assessing variables in the human diet, this may be a long time coming.
Paul: It is virtually impossible to do controlled studies of low-level toxicity. We are concerned about effects that may take a month or two off an 80 year life. To detect such effects would require an experiment lasting at least 80 years.
Harry: In the interim, how about we swear off alarmist diet gurus that demonise foods that have been eaten by humans for centuries…and instead just shoot for a balanced diet that is mostly unprocessed foods? Too boring?
Paul: I object to the claim that we “demonize” any food. No, we weigh the evidence for each food’s merits and demerits, and find some foods wanting.
Harry’s main objection is to our eschewal of certain foods, such as wheat and soy, which have been eaten by humans for centuries. But is it really alarmist to point out that many people have noticed health improvements from removal of wheat, that the biomedical literature notes many cases of people harmed by wheat consumption, that research is exposing mechanisms by which wheat compounds do harm, that statistically countries that don’t eat much wheat tend to have longer lifespans (especially after correcting for income), and that there is no evidence for the presence of nutrients in wheat that cannot be obtained equally well from our “safe starches”?
In order to maximize the healthfulness of a diet – and finding the maximally healthful diet was the purpose of our book, thus the aspirational name “perfect health diet” – we have to weigh risks, such as the loss of sperm in men eating soy, and the cognitive impairment experienced by people eating tofu, against the benefits of eating a food, assessed in an “opportunity cost” sense against alternative food choices. Soy and wheat, in our judgment, do not pass this test.
Tom Naughton: A balanced diet of mostly unprocessed food is exactly what he recommends. As for toxins, he’s quite clear that it’s a matter of “the dose makes the poison.” He describes safe starches as low-toxin foods, not no-toxin foods. So I think you’re more in agreement than not.
Paul: Thank you Tom. Exactly right.
Harry: Yes, of course the dose makes the poison. My point exactly.
Paul’s view is that the dose should always be as low as possible. This is where we are getting into pure hypothetical territory. There is a possibility (one that is reasonable given what we know about hormesis) that a dose of certain toxins somewhat higher than the lowest possible is superior in terms of promoting good health (just as exposure to some bacteria is far better for the immune system than living in a sterile environment).
Paul: Again, a mis-statement of our views. We discuss many cases of toxic foods that we recommend eating. For example, on page 195 we discuss the case of a woman who nearly died from eating raw bok choy. We recommend cooking vegetables to reduce toxicity and eating a variety of vegetables, not the same vegetable every day, to reduce toxin dosage. We don’t say, “eat the lowest possible dose of bok choy,” rather, “eat bok choy in moderation prepared in a way that reduces toxicity.”
Harry: As I said, it would be wickedly difficult to determine the optimal levels of dietary toxins using the scientific method, but it is just conjecture to argue that since a high dose of toxicity is bad for health, the lowest possible dose should be recommended. This is a classic case where ‘common sense’ (a priori reasoning and induction) does not necessarily yield the truth…hence the need for empirical testing.
Paul: The same straw man again, we don’t make that argument. More empirical testing is desirable, yes, but we have to make decisions about what to eat on the evidence available now. Harry appears to favor the decision rule, “eat everything until empirical testing convicts it beyond a shadow of doubt,” but we prefer our rule, “weigh the evidence and avoid foods that appear to deliver an excess of harm over help.”
Harry: I guess I’m just over people running a contestable notion up the flagpole and passing it off as truth. The history of dietary advice is replete with such ideas, which while superficially attractive, turned out to be fruitless.
Tom Naughton: Well, I personally like the idea of running a contestable notion up the flagpole. The passing it off as truth part is a different matter.
Paul: Well said, Tom.
Forming contestable hypotheses and evaluating evidence pro and con in order to come to judgments of their truth is science. Many judgments are tentative and subject to later correction. Harry here comes perilously close to rejecting science per se on the ground that scientific judgments might later turn out to be have been mistaken.
On the other hand, if it is only duplicitous judgments and foundationless claims that Harry objects to, his objection does not apply to us. We show our reasoning and cite the evidence that supports our conclusions.
However, Harry’s concern may apply to himself. Is he certain he is not spreading foundationless claims about diet book authors on the Internet?
Thank you, Tom, and Fat Head readers for the opportunity to answer your questions. It’s been my pleasure!
It’s been our pleasure reading your answers, Paul. Thank you very much for taking the time — Tom.