Ok, I finished the Perfect Health Diet (PHD) book by Paul Jaminet and his wife, Shou-Ching Jaminet (I notice she doesn’t get much credit in PaleoLand, but she’s the co-author and also a Ph.D.). I was drawn to it in the first place because they advocate a moderately low-carbohydrate diet (just enough carb to meet the body’s needs, which they say is around 600 calories or 150g per day), and that a good chunk of those carbs should be starches, which I’ve recently started eating.
I thought it would be fun to compare the recommendations made by Ray Peat and those made in the PHD. First, let’s look at the similarities. They both recommend a whole-food diet, liver once a week, shellfish once a week, and both caution to avoid PUFAs, grains (though both seem to make exceptions for rice), and legumes. Peat says keep PUFAs low – real low – like 1-2% of your dietary calories low. The PHD says under 4% is probably ok. Potatoes seem to be ok with both of them. Both say that saturated fats are awesome – butter, coconut oil, and cream being fabulous in both camps. Both are fairly noncommittal about non-starchy vegetables: Peat says they’re ok if they’re well-cooked, but I get the distinct impression he finds them fairly optional, and the PHD says you can eat around a pound per day of non-starchy veggies, but there’s no firm guideline. They say, “Eat vegetables to taste – they are nourishing and add flavor to meals – but don’t consider them a calorie source.” (PHD, KL 3217). Both recommend getting lots of your nutrients from liver, shellfish, eggs and bone broth.
Ok, that’s about where the similarities end. The greatest areas of disagreement between Peat and the PHD are with regard to calcium/dairy/phosphorus, fructose/sugar, and Omega 3s. Peat strongly recommends getting enough dietary calcium to maintain between a 1:1 and a 1:2 ratio of calcium to phosphorus, ideally closer to the former. His views on this topic are expressed well here:
A diet that provides enough calcium to limit activity of the parathyroid glands, and that is low in phosphate and polyunsaturated fats, with sugar rather than starch as the main carbohydrate, possibly supplemented by niacinamide and aspirin, should help to avoid some of the degenerative processes associated with high phosphate: fatigue, heart failure, movement discoordination, hypogonadism, infertility, vascular calcification, emphysema, cancer, osteoporosis, and atrophy of skin, skeletal muscle, intestine, thymus, and spleen (Ohnishi and Razzaque, 2010; Shiraki-Iida, et al., 2000; Kuro-o, et al., 1997; Osuka and Razzaque, 2012). The foods naturally highest in phosphate, relative to calcium, are cereals, legumes, meats, and fish. Many prepared foods contain added phosphate. Foods with a higher, safer ratio of calcium to phosphate are leaves, such as kale, turnip greens, and beet greens, and many fruits, milk, and cheese. Coffee, besides being a good source of magnesium, is probably helpful for lowering phosphate, by its antagonism to adenosine (Coulson, et al., 1991).
The PHD barely mentions phosphorus. A search of the Kindle version of the book indicates it’s mentioned 7 times within the body of the text, each time as part of a list of nutrients (e.g., “magnesium, calcium, and phosphorus…”). There’s no discussion at all about potential deleterious effects associated with high phosphorus intake. It’s interesting because overall the PHD does a great job of describing deficiencies and toxicities of all of the main micronutrients. They didn’t touch on this one though. The calcium/phosphorus ratio recommended by Peat is one of the things I’d never heard before I began studying his work. He says that calcium gets blamed for a lot of negative effects in the body when phosphorus is the real culprit.
The PHD talks about the effects of too much calcium, citing studies that indicate 600mg per day is adequate and maximizes bone health (PHD, KL 5175). It goes on to say:
Calcium supplementation was a mistake. The true culprits in osteoporosis are deficiencies of Vitamin D, Vitamin K2, and magnesium.
Studies have found that supplemental calcium increases the incidence of strokes and heart attacks by over 30 percent and increases the overall risk of death by 9 percent. One analysis concluded, “Treating 1,000 people with calcium or calcium and vitamin D for five years would cause an additional six myocardial infarctions or strokes and prevent three fractures. (PHD, KL 5183)
It goes on to blame calcium for brain lesions, the promotion of biofilms, and hypercalcemia. Apparently this study found that calcium balance occurs at an intake of 741mg/day – that’s the amount of calcium retained by the body each day. So that’s what the PHD recommends – about 700mg/day, in the form of bone broth, green leafy vegetables, maybe some dairy. The PHD was kinda wishy washy on the dairy thing. They didn’t give it a section in the book, which I find odd. I mean, “Alcohol” had it’s own section. Lots of people eat dairy and to not really acknowledge it doesn’t make sense to me. Plus in the beginning “Milk” is listed among the items to avoid, “…but DO eat fermented or fatty dairy products: butter, sour cream, ice cream, cheese, yogurt,” (PHD, KL 198). I should avoid milk (and sugar!) but ice cream is ok? Kinda loopy.
Ok, so Peat says we’re gonna die if we don’t get enough calcium, and PHD says we’re gonna die if we get too much.
Another big area of disagreement between these guys is with regard to fructose. The PHD says fructose is only bad in high doses or when eaten with PUFAs – but since most Americans eat a high-PUFA diet, it’s a big deal on a societal scale.
Fructose appears most problematic when study subjects are obese or overweight and when they are eating diets high in polyunsaturated fat.” (PHD, KL 3904)
The PHD goes on to say that fructose is toxic to the liver and causes metabolic syndrome, diabetes, endotoxemia, poor blood lipid profile, high uric acid (an aside: my uric acid went DOWN on a higher-fructose diet), gout, kidney disease, obesity, liver disease, cognitive impairment, and retinopathy. Still though, they recommend up to 25g of fructose per day, and at most 10g per meal. The dose makes the poison, apparently. Keep your PUFAs low and a little is fine.
Peat says fructose has been wrongly maligned:
Many people lately have been told, as part of a campaign to explain the high incidence of fatty liver degeneration in the US, supposedly resulting from eating too much sugar, that fructose can be metabolized only by the liver. The liver does have the highest capacity for metabolizing fructose, but the other organs do metabolize it.
If fructose can by-pass the fatty acids’ inhibition of glucose metabolism, to be oxidized when glucose can’t, and if the metabolism of diabetes involves the oxidation of fatty acids instead of glucose, then we would expect there to be less than the normal amount of fructose in the serum of diabetics, although their defining trait is the presence of an increased amount of glucose. According to Osuagwu and Madumere (2008), that is the case. If a fructose deficiency exists in diabetes, then it is appropriate to supplement it in the diet.
And regarding the effect of fructose on obesity:
Starch and glucose efficiently stimulate insulin secretion, and that accelerates the disposition of glucose, activating its conversion to glycogen and fat, as well as its oxidation. Fructose inhibits the stimulation of insulin by glucose, so this means that eating ordinary sugar, sucrose (a disaccharide, consisting of glucose and fructose), in place of starch, will reduce the tendency to store fat. Eating “complex carbohydrates,” rather than sugars, is a reasonable way to promote obesity. Eating starch, by increasing insulin and lowering the blood sugar, stimulates the appetite, causing a person to eat more, so the effect on fat production becomes much larger than when equal amounts of sugar and starch are eaten. The obesity itself then becomes an additional physiological factor; the fat cells create something analogous to an inflammatory state. There isn’t anything wrong with a high carbohydrate diet, and even a high starch diet isn’t necessarily incompatible with good health, but when better foods are available they should be used instead of starches. For example, fruits have many advantages over grains, besides the difference between sugar and starch. (Emphasis his.)
I can say my own experience of eating sugar (mostly fructose/glucose in fruit juice and honey) did not result in fat production – my weight was stable the entire time I avoided starches. So score one for Peat. However, I was hungry all the time. And in the past week or two of eating starches it has NOT been the case for me that they stimulate my appetite. I can forget about eating now for the first time in months – what a relief. Starches do make me sleepy though.
Speaking of which, I’m getting tired…time to wrap this up!
The last big area of disagreement seems to be regarding Omega 3 fatty acids – should we eat salmon and other fatty seafood or not? Peat says NO, PHD says YES (once a week). I’ll go into this in greater detail in another post. I have more reading to do on this topic.
My conclusions (for me): I think I’m going to keep eating dairy. Peat makes a better case. And I think I’ll avoid fructose – not because of what the Jaminets have to say, but because I don’t particularly like fruit and I don’t miss it at all…and because it did seem to mess up my lipid profile to a point that I’ve become concerned…but seriously, I’m pretty broken. It probably doesn’t take much to tip those scales into the danger zone. As for omega 3s – the jury is still out. So dairy is a YES, with phosphorus limited relative to calcium intake. Fructose, for me, is a NO. But just cuz I don’t like it. You go ahead. Just keep your PUFAs low and you’ll probably be just fine.