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“But here we have a diabetic patient eating from five to eight ounces of sugar daily, and not only rallying from a stage of disease which Dr. Prout describes as being all but irretrievable, but adding in little more than a month a full seventh part to her weight, and becoming the while gradually less diabetic.”
Before I start, Dr. Paul Jaminet is the bomb. I really respect him and even had the chance to meet him and his lovely wife Shou-Ching at AHS 2011. What did we talk about? Ray Peat of course.
While I dig Paul and find myself nodding at most of what he says, high-fat, low/moderate-starch, low-protein diets like the one described in The Perfect Health Diet (PHD) are somewhat confusing when looking through the lens of a Peat-a-tarian.
Although I understand that PHD is a great middle ground for low-carb refugees looking to get off no-glucose island, I have reservations about accepting the usefulness of these types of diets in the long-term.
When compared to Peat's philosophy, an extreme amount of overlap is evident. Both are pro-saturated fats, favor nutrient-dense animal products, both believe that the intestine is an extremely important variable in health (perhaps the most important), and both believe that grains have some inherent toxic properties.
The differentiator between paradigms lays in the variables each believes to be responsible for poor health. While the starting point for Peat is a the lack of oxidative cellular energy stimulated by stress (estrogen, serotonin, endotoxin, etc.), Paul believes that most diseases are caused by the interaction of a bad diet with infectious pathogens.
Carbohydrate Intolerance Was So 2011
The Perfect Health Diet acknowledges that very low-carb diets are usually counterproductive. While I get the impression that most people think Peat-a-tarianism is some gigantic sugar orgy, Paul and Peat have similar recommendations for carbohydrate consumption. Paul's recommendations hover around 150 grams while Peat usually recommends 180-250 grams, but he himself eats closer to ~400 grams.
In a recent interview with Jimmy Moore, Paul corrected Jimmy, explaining that diabetes was NOT a disease of carbohydrate intolerance and that there are numerous physiological and hormonal events that contribute towards poor glucose tolerance. Neither Paul nor Peat believes that carbohydrates cause disease, but Paul has noted that more than 30% of calories as carbohydrates is "higher-than-optimal."
My interpretation of Peat's philosophy is that excess sugar will be used "constructively" in an organism with an efficient oxidative metabolism. It is only in the face of excess PUFA, estrogen, serotonin, cortisol, and adrenaline that sugar is misused by the body.
Estrogen and serotonin seem to be two often overlooked factors in blood sugar handling. Constance R. Martin, author of Endocrine Physiology (1985) notes that besides wasting vitamin B6 and increasing prolactin, estrogen has a direct effect on blood sugar:
"Sustained high estrogen concentrations increase both insulin requirements and insulin secretion."
Martin also notes the ability of serotonin (a marker that is increased in all the gentleman I coach) to inhibit insulin secretion:
"Effects on peripheral glands include inhibition of insulin, gastrin, and HCl secretion."
I'm not sure what Paul thinks about these hormones and their ability to influence blood sugar, but Paul has written about serotonin here, and briefly mentions estrogen in this article.
Starch vs. Sugar
Peat and Paul are at the opposite ends of the spectrum when considering whether to eat starch or sugar. While Peat is fond of the potato for it's high quality protein, and doesn't seem to mind corn-tortillas or rice cooked in lye on occasion, he considers sugar, in the form of fruit, to be far superior.
In Ray Peat's November 2011 newsletter, entitled "Sugar Issues," Peat explains that diabetes was originally thought of as a wasting disease due to the amount of glucose passed in the urine. Neither sugar restriction nor elimination would prevent the diabetic patient from passing glucose in the urine.
In 1878, instead of restricting sugar, Dr. William Budd decided to "replace" the glucose being lost in the urine with white sugar (sucrose). The results?
"But here we have a diabetic patient eating from five to eight ounces of sugar daily, and not only rallying from a stage of disease which Dr. Prout describes as being all but irretrievable, but adding in little more than a month a full seventh part to her weight, and becoming the while gradually less diabetic."
When Jimmy asks Paul about fructose, Paul states that fructose "has no useful functions in the body" and that it gets converted into fat or glycogen (stored glucose).
Peat has stated that before fructose gets turned into triglycerides, it "powerfully" refills glycogen and stimulates the metabolism. If you'll remember from previous post, Peat has mentioned that the glycogen content of the liver affects the liver's conversion of T4 to T3.
Considering how many people are dealing with chronic stress, low T3, and poor sleep, which all inhibit proper glycogen storage, I would consider the ability to refill glycogen (minimizing adrenaline & cortisol release) to be an important factor in health and stress resistance.
High-Fat Diets & Mr. Randle
At the heart of The Perfect Health Diet is a high-fat intake (50-70% of calories) coming from predominantly saturated fats.
A good amount of starch (roughly 20-30% of PHD's calories) along with this much fat makes me think of the metabolic process known as "The Randle Cycle." As I understand it, this metabolic process is the competition between glucose and free fatty acids, and if I had to guess, is why people gain a lot of weight when eating high amounts of carbohydrates and fat together:
"The last of these mechanisms, discovered by Denis McGarry and Daniel Foster in 1977, provides an almost exact complement to the mechanism described in the glucose-fatty acid cycle whereby high concentrations of fatty acids inhibit glucose utilization. These additional discoveries have not detracted from the important of the glucose-fatty acid cycle: rather, they have reinforced the importance of mechanisms whereby glucose and fat can interact."
- From: Rob Turner (PUFA Causative in Diabetes – Randle Cycle) more studies in the link.
Broken Metabolisms
Jimmy asked Paul on the theoretical situation of someone stalling on PHD. Paul replied that there are many variables, but to watch out for hypoglycemia as sign to LOWER carbohydrate intake. Now, I may be oversimplifying here, but I'm under the impression the liver's ability to store glycogen is an important factor in overcoming hypoglycemia. Naturally, this is interesting considering Paul's view towards fructose, which is excellent at refueling liver glycogen.
Paul goes on mentioning that nourishing one's self, regulating gut flora, and becoming healthy are the important factors in weight regulation, but is not opposed to restricting calories, fasting, and possibly reducing carbohydrates (less than 20-30%) as other tactics to explore.
In the light of Peat-a-tarianism, if someone wanted to lose weight, I believe the most relevant question is regarding his or her metabolic health. What's their pulse? What's their body temperature? Are they exhibiting signs of chronic stress/hypothyroidism? If so, fasting, caloric restriction, and carbohydrate restriction (all forms of stress) may complicate their issues further.
WHY IT PROBABLY WORKS:
- Low PUFA (~under 10g), higher if consuming a lot of fatty fish.
- PHD serves very low-carb refugees by adding "safe starches" back in their diets, increasing the metabolism/decreasing dependence on stress hormones for sugar.
- Emphasis on gelatin and other nutrient-dense foods (eggs, offal).
POTENTIAL PROBLEMS:
- May not be an optimal diet to treat hypothyroidism/chronic stress (inefficient glycogen storage, elevated free fatty acids).
- Insulin sensitivity may be compromised with a high fat and moderate starch intake (probably depends on stored PUFA).
- Weight gain seems to be a common on PHD (anecdotal forum chatter).
- Diet provides a high phosphate/calcium ratio.
