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Perfect Health Diet Q&A with Paul Jaminet

Perfect Health Diet Q&A with Paul Jaminet
Angelo Coppola

Review Overview

Readability
9
Information Density
9
Potential to Change Your World View
10

As of this writing, this is the diet book I will recommend to people.

A sane approach to calories, macronutrients, and food quality all in one place. Jaminet may have even succeeded in convincing me that some supplementation can be a good thing. If you've read all of the Paleo diet books, you owe it to yourself to read this one for the sake of balance and for all of the new information it contains.

Recently, I was asked by someone who had just completed reading two of the most popular Paleo diet books, which books I would recommend for further reading.

My response was something like, “Maybe you’ve read enough, and it’s time to ask yourself, ‘what’s next?’ What do you want to do with the Paleo approach, besides read about it?”

Well, my answer would have been different had he asked me this question after I had gotten my hands on the latest edition of The Perfect Health Diet.This idea of “What’s next?” has been stewing in my head for some time now. It will even be the theme of an upcoming episode of Latest in Paleo.  But without going too deeply into this right now, let me just say that whatever is next on your journey, I strongly recommend a short detour through Paul & Shou Ching Jaminet’s latest research.

recently spoke with Paul of PerfectHealthDiet.com, and I gave listeners the opportunity to help me ask follow-up questions.  Some responded via Twitter (@PaleoPodcast@angelocoppola), while others responded on the Latest in Paleo facebook page. Their questions are in bold, followed by Dr. Jaminet’s responses. Like in his book, and like in his blog, he offers real answers and real positions — as opposed to the fluffy, ambiguous, non-answers that are so common.

Here we go…

How important is it to have carbs with every meal vs. ‘backloading’ them all after a workout? – Phil U. (@philsplace)

Hi Phil, The most important thing for recovery and strength gains is to backload calories (more than carbs) after a workout. You need to eat extra food post-workout to promote recovery and muscle synthesis.

So I would make every meal balanced in terms of carb-protein-fat, but workout in a relatively fasted state and eat extra food after intense workouts. Eat less on rest days, so you can load up the calories after workouts. Make sure your fats are mostly saturated after workouts – dairy fats are good.

The general principle is that carbs, protein, and saturated fat are the most muscle friendly macronutrients. You also want balanced nutrition including micronutrients and extracellular matrix materials like collagen which you can get from joint broth / knuckle bone / ox tail soups.

You talked about the correlation between the increase in omega-6 fats and overweight.  Please explain why omega-6 fats contribute to weight gain. – Jack

Hi Jack, that’s a big topic because there are multiple mechanisms and there’s not a scholarly consensus. We discuss evidence and mechanisms in the book. Some reasons an excess of omega-6 is obesogenic include:

  • it generates a dysbiotic gut flora and increases the risk of metabolic endotoxemia (an influx of endotoxins into the body), which causes metabolic syndrome;
  • omega-6 fats are largely rejected by cells that have little use for them, and this means they accumulate in adipose tissue, because they have no place else to go;
  • they suppress omega-3 lengthening and disturb membrane fatty acid profiles with inflammatory effects … this can promote macrophage and adipocyte activation which causes adipose tissue to hold onto fat … it can also suppress or distort immune function increasing the risk of infections which may promote obesity;
  • it leads to higher levels of lipid peroxidation in mitochondria, damaging the mitochondria and impairing their ability to dispose of an energy excess;
  • omega-6 fats are intrinsically less able to generate ROS (reactive oxygen species) in mitochondria, which limits the ability of mitochondria to regulate energy influx and increases vulnerability to mitochondrial dysfunction;
  • omega-6 fats are precursors to endocannibinoids which increase appetite (see this article).

The relative importance of different mechanisms is not known; different mechanisms may be operative in different people. However, that dietary omega-6 fat consumption is highly correlated with adipose tissue omega-6 concentration and with general obesity seems very clear at this point.

Do you have any specific tweaks or recommendations for those with autoimmune conditions? – Erin L.

Hi Erin, This is a difficult but important question. It is difficult because autoimmune conditions are not well understood and may be quite different from one person to another, so it is hard to generalize.

A first tweak is to try to identify food sensitivities and avoid foods which generate an immune response. A good place to start is a list of the most common food allergies and try removing individual items for a few weeks at a time, then returning the item and see if you notice a negative effect upon its return. However, it’s important to be careful not to restrict the diet so severely that it becomes unbalanced or malnourishing.

Autoimmune conditions usually coincide with chronic infections, and it’s likely that many autoantibodies are generated as a result of the immune system’s attempts to clear foreign bodies – either food particles/toxins that have entered the body or microbial proteins/compounds generated during a chronic infection. So removing toxin-rich foods like wheat can help, as can diagnosing and treating chronic infections.

And with respect to infections, is the most common concern gut infection, or are there other types that people should be aware of to consider or look for in their attempts at healing? – Erin L.

Infections can be either systemic or confined to the gut. I would guess that rheumatoid arthritis is probably frequently the result of chronic infections in which microbes are harbored in joint tissue. The body has systems for clearing microbial and food compounds from the gut, but sometimes these don’t work well. A key in clearing microbial and food toxins from the gut are IgA antibodies, and some people have deficient production of IgA antibodies; these people have high rates of autoimmune diseases including Graves’ disease, lupus, type 1 diabetes, celiac disease, and others (see this article). So clearly microbial and food compounds from the gut are major causes of autoimmune disease, if for some reason they are not being cleared properly and are entering the body in large numbers.

Because symptoms overlap, it can be difficult to diagnose what is going on. It’s not uncommon for Lyme disease and lupus to be misdiagnosed for each other, or similar confusions. Often what is seen is a high level of immune activity, but it is not obvious what prompted it, an infection locally or autoimmunity generated remotely, perhaps in the gut. I think on general principles it is good to pursue diagnostic strategies, such as a stool test to look for gut pathogens. Sometimes dietary experiments can help with diagnosis – does a ketogenic diet make you better or worse? In general these conditions take a long time to recover from so patience and careful, scientist-like controlled experimentation are virtues.

I’d love to hear Paul’s thought on Andrew Kim’s 4-part Series of blog posts on “Fructose > Glucose”. – Michael Allen Smith, CriticalMAS

It’s a very long series and so a complete response would take quite a bit of time. In general I think it tends to overgeneralize from a number of short-term studies (often looking only at the immediate response to a single meal) and to rely too much on speculations about the meaning of changes in molecular biomarkers (which can have quite complex behaviors, we evolved each molecule because it has beneficial functions, and there is generally no one optimum amount of a molecular biomarker, rather the best amount is context dependent, so showing eg that TNF-alpha rises after a glucose meal doesn’t tell us anything about the healthfulness of a glucose meal).

A few observations:

  • While I would tend to agree with Kim that fructose isn’t very obesogenic by itself (though I think it may greatly aggravate the obesogenic effects of omega-6 fats) and that some people (eg Gary Taubes, Robert Lustig) may overstate the role of fructose in obesity, I think there’s substantial evidence that high fructose intake promotes endotoxemia, giving us a causal mechanism linking it to metabolic syndrome, and it is quite clear that high fructose intake promotes obesity in animals, and is correlated with obesity in human populations. The fact that many researchers use very high doses of fructose (in order to generate clear results in a reasonably short period of time) doesn’t prove that fructose is benign at lower doses; so while Kim may succeed in instilling doubt in the minds of the jury over the degree of fructose’s guilt, he doesn’t prove fructose’s innocence.
  • Kim seems to think it’s a good sign that “fructose ingestion induces thermogenesis”. However, in my view thermogenesis is a bad sign. It implies the presence of an energy excess (or a toxic macronutrient) which had to be disposed of. If you were providing only what the body needed, then your body would be quite happy to take in a minimum of calories and waste nothing. This is a general observation, I think the excess calorie utilization on some diets that has been dubbed “metabolic advantage” is really a health disadvantage; and the healthiest diet is the diet that eliminates hunger with the smallest calorie intake.
  • He makes rather selective citation of the literature. For example, “the consumption of fructose is not associated with unfavorable changes in serum uric acid levels (Sun et al. 2011).”  That’s this paper. It is an observational study (comparing reported sugar consumption on a food questionnaire with serum uric acid levels; no data on relationships to health outcomes, and no one is followed over time). Other studies on the same NHANES data reached opposite conclusions, finding that higher fructose intake does raise uric acid levels (eg. this and this). So the NHANES data is not dispositive; one can analyze it different ways to reach different conclusions. Regardless, it is well established that high intake of fructose often generates high levels of uric acid and raises risk of gout, kidney stones, and related conditions. See, for example, a 12-year prospective cohort study, the correlation of increasing sugar intake with rates of gout in early modern England, and the correlation of sugar intake with gout inmodern western countries. We even know the mechanism by which this happens: fructose depletes ATP in the liver, causing the release of adenosine, which is degraded to uric acid; thus coconut milk can act as an antidote to fructose-induced hyperuricemia by regenerating ATP in the liver, preventing release of adenosine. If you eat fructose, eat it with coconut milk!

I won’t go further through his whole series, I’ll just observe that it’s easy to go astray when you focus on molecular biomarkers, hormones, or short-term responses to meals. The body is a very complex organism and every change in one molecule or place ramifies through every other molecule and organ, and generates feedback effects. It is very risky to generalize from what happens to an individual molecule at a specific time or in a specific organ.

If you look at our book, very rarely do we mention any of the body’s hormones or intermediate signaling molecules and base any argument on their levels. We argue from evolutionary lines of argument, or from direct links between nutrients themselves and diseases. This greatly reduces the chances of going astray.

What are your thoughts on the Potato Diet, which has been gaining some popularity in online Paleo communities as a short-term solution for weight loss? – Angelo (Yes, I snuck in one more question…)

Hi Angelo, the Potato Diet like all highly restrictive diets is very effective for weight loss in the short term. It is probably better than many restrictive diets because potatoes are a healthy, nourishing food, and have relatively few toxins (thus we classify them as a “safe starch” and recommend their regular consumption). They also have a lot of an especially beneficial form of fiber.

Eating potatoes only is a lipid deficient diet, and this will have negative effects within a few months. Chris Voigt was on his Potato Diet for only 60 days and his serum cholesterol dropped from 214 mg/dl (perfect) to 147 mg/dl (severely deficient). This impairs immune function and over time would have negative effects. The Irish were famously healthy on a diet high in potatoes, but they drank large quantities of milk daily and that rounded out the diet, making it healthy.

If one were to stick to the Potato Diet for an extended period of time, two months as Chris Voigt did or longer, nutrient deficiencies would develop and the Potato Dieter would become increasingly hungry. The effect of malnutrition on hunger is discussed in our new edition (chapter 17). This would eventually make the diet intolerable.

So I would suggest that the best strategy is to eat a nutritionally balanced diet from the beginning – at a minimum, potatoes and milk, like the Irish, but preferably also with eggs, seafood, organ meats, and vegetables – and use intermittent fasting and conscious effort to achieve a calorie restriction similar to that achieved on the Potato Diet. This more nourishing diet is likely to be equally effective for weight loss and healthier in the long run.

Of course, with those changes the Potato Diet becomes an implementation of the Perfect Health Diet!

Wow! What great information from Paul.  I thank him for taking the time to answer my listeners’ questions so thoroughly. Between his interviews, these responses, all of the great information at PerfectHealthDiet.com, his balanced food plate [yin-yang, get it? :)], and everything else he offers to the community…you might wonder what more you could get from the book?  Simply stated: it’s everything in one place, cleanly laid out, plainly written, indexed, and worth reading.

For better reviews than I can muster up, see:

To purchase the book on Amazon through the Latest in Paleo affilicate link, here’s the hardcover and here’s theKindle edition.