The Lens of a Peat-a-tarian Part I: The Perfect Health Diet
Jan 16, 2012 | by Danny Roddy 
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.
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Reader Comments (31)
Danny, I owe you an emai. Don't think I've forgotten.
Fructose does indeed increase cellular energy from a biochemIcal perspective. It is able to skip the two key control points of glycolysis and them becomes a product (hexokinase/glucokinase and pfk-1) that stimulates the final step(pyruvate kinase). The are a few vitamins and minerals that need to be around to promote glycogen use but on a proper Peat diet you should be getting them in excess.
Your milk intolerant friend,
Andrew
Danny,
Interesting post and quite thought provoking.
I like how you politely disagreed with Paul Jamminet's diet and views without getting personal, and doing it in a gentlemanly fashion.
Keep it up!
You are a great resource for easy to understand info about Ray Peat.
@Andrew,
You don't owe me anything brother. Thanks for bringing some biochem to this post, good stuff.
@Mike,
Thanks Mike.
Hi Danny,
It's nice to hear the Peat-atarian take on our diet. It deserves a considered response. But I have to say, you chose a most unflattering picture of me!
Best, Paul
Hey Paul,
Hah!
Looking forward to it Paul!
Hi Danny,
I am fascinated by yours and Peat's philosophies. I am one of those that didn't do well with a low carb diet, then started to follow the PHD, but have a feeling the high fat isn't good for me. I am a woman who started with hair loss at the onset of the lc diet. I also started hormone replacement at the same time though.
I notice that your blog is geared toward men and wonder if that is why estrogen seems to be portrayed as evil (by both you and Peat). Couldn't really find any info on either of your websites re if ever estrogen replacement is a good idea, such as in menopause. Do you, or do you know Peat has any thoughts on this issue? Thanks.
@Lucy,
Peat has many thoughts on menopause:
http://raypeat.com/articles/articles/menopause.shtml
Estrogen isn't evil, it's just an adaptive hormone that can get out of hand very fast. Estrogen in conjunction with serotonin and cortisol can cause a lot of different problems.
I don't think estrogen replacement is ever a good idea. Progesterone replacement is a different story however:
http://raypeat.com/articles/articles/progesterone-summaries.shtml
My article on sugar and estrogen:
http://www.dannyroddy.com/main/2011/3/21/the-root-of-all-evil-sugar-or-estrogen.html
Hey Danny,
First off, I'd like to thank Paul for showing me a different perspective on this whole low-carb paleo dogma crap. If it wasn't for his book or his articles I would have still been ignoring obvious escalating problems that I was having on a high fat diet. The introduction of starch improved my libido, energy levels, and constipation problems, and for the last 2-3 months I have been following a high carbohydrate version of the PHD with lots of tubers and veggies but very limited fruit. The foods allowed on PHD work for me but the macronutrient ratios don't quite agree with me. When I add a butload of fat to my starches to "lower the glycemic index," and make fat my primary source of energy, it makes me feel like shit. Paul has mentioned that there is likely some kind of dysbiosis that doesn't allow me to eat fat and carbs together.
I have thought about introducing fruit because my diet is becoming quite redundant and boring, but there is just to much studies against fructose that it's hard me to accept fruit as healthy in large amounts. I am curious to know if you have ever tackled the issue about fructose being more prone to glycation than glucose? Or how likely is fructose to be shuttled in to muscles to refill glycogen? I always had the idea in my head that glucose is the only carbohydrate to be able to replenish muscle glycogen.
Thanks Danny for posting on two subjects close to my heart at the moment PHD & Peat.
With regards to liver glycogen; is it your view that people following the default/normal PHD recommendations would Not have full (optimum, sufficient?) liver glycogen stores. I got the impression that there were plenty of carbs in the PHD diet to (easily?) keep the the liver glycogen store full/topped up.
@Rob,
Keep in mind that the fear of fructose arose in a time when cholesterol was being hailed as a killer. Fructose increasing cholesterol (a protective mechanism) was very often the root argument against consumption.
Chris Masterjohn has a great article on glycation:
http://blog.cholesterol-and-health.com/2011/10/where-do-most-ages-come-from-o.html
He found zinc status to be a significant factor.
@Daz,
I'm honestly not sure. Hypoglycemia and waking up in the middle of the night are two problems a lot of LC paleo people face. I wouldn't be surprised if inefficient glycogen storage was at the root of those issues.
Peat has suggested that "the taste for sweet" is an accurate guide for determining glycogen status.
One study I found showed that sucrose refilled muscle glycogen the fasted when compared to fructose and glucose. It also did it with the less insulin than the glucose. Peats diet is by far the best for recovery in my experience and I've pretty much experienced it all.
Danny - Your blog as well as Matt Stone's are my two favs...keep up the good work!
Do you have any recommendations on blood tests to get for hair/overall health?
(So far I've seen ferritin, calcium, prolactin, tsh, dht, T4, T3, CO2 & serum copper)
A good post. Thanks. Like you, I have great respect for Paul Jaminet and the PHD. I am grateful to Paul and Shou-Ching for their work. That being said, based on personal hard-gained experience in trying to overcome the consequences of a two week low-carb stint, observations of literally thousands of slim & healthy people eating plenty of fruits and drinking fruit juices daily (I have lived in South East Asia for five years), and from becoming increasingly convinced of the pertinence of Ray Peat's theories, I think the general PHD statement on fructose in excess of some servings per day being toxic and the general recommendation "do not eat sugar", are plain wrong. Some people seem to do well on low-carb and even ketogenic diets. I have seen it myself, so I wont deny that it can be therapeutic.
But, as you imply, for people with thyroid issues, the PHD carbohydrates in the form of "safe starches" in the range of 400-600 calories per day, might not be enough to kick start the metabolism. It might not even be enough for healthy maintenance for a lot of people. And, starchy carbohydrates might not be optimal for certain conditions, or maybe certain "metabolic types". It just cannot be one ideal macro nutrient ratio - not only across individuals, seasons, climates and ethnic groups, but not even for one single individual over time.
As for my own hormonal response to aggressive overfeeding (a thank you to Matt Stone also) of fructose and sucrose, it was pretty good. After about five months on the PHD on the high end of the carb range, I started to add sugar aggressively to the diet. For almost six weeks, I overate every single day, ie. I ate beyond full for breakfast (I had two) and lunch. Every day, I drank at least half a litre of filtered orange juice, I ate 3-5 servings of tropical fruits, had sweet desserts (panna cotta, creme brulle, ice cream etc.). I increased my diary intake. I continued eating the basic PHD with plenty of organ meats, broths, fish and shellfish, eggs, some cooked vegetables, coconut oil, "safe starches" etc. My guess is that I ate 5000-6000 calories per day. And I started with a weight of 50 kg / 110 lbs, so yes, I was overeating. The result after 6 weeks was a 3 kg weight gain, BUT, I lost body fat (from 21% to 14.5% according to my Tanita scale). I only did some basic body weight strength training (as opposed to lifting weights before - not very successful, as I did not gain lean mass) a couple of times a week in this period, but I seem to have gained lean mass (arms more defined and I am a bit stronger on the basic lifts). I have cut back on desserts a little bit, but I still eat plenty of fruits and drink orange juice. My weight is stable. I had some other favourable hormonal responses too (described in another comment), but they might have been due to taking desiccated thyroid, which I started in the last two weeks of the overeating phase. But the body fat % reduction started before I started taking thyorid, so increased sugar must have played a role.
I had excess estrogen and adrenaline when I started overeating sugar, but my body did not seem to "misuse" the sugar as your post might imply. It must have increased T3 production in the liver, and thereby lowering adrenaline and increasing progesterone, ie. lowering the estrogen excess.
Well, I must still have an estrogen excess, judging by the length of my comments, which continue to be never ending ramblings...
Danny,
this statement confuses me:
"Martin also notes the ability of serotonin (a marker that is increased in all the gentleman I coach"
According to Ray Peat, isn't excess serotonin harmful? Why would you want to see it increase?
I think study cliff mentions can be found here:
http://www.ncbi.nlm.nih.gov/pubmed/21407126
"Fructose and galactose enhance postexercise human liver glycogen synthesis"
& a similar study here:
http://www.ncbi.nlm.nih.gov/pubmed/18202575
"Superior endurance performance with ingestion of multiple transportable carbohydrates"
This article references them both:
http://well.blogs.nytimes.com/2011/05/04/how-sugar-affects-the-body-in-motion
Do you remember the article about HFCS having more sugars than stated on the label?
A little anecdote. I noticed that when I drank a lot of pop that for some reason I farted a TON. Not a definite, but strong association I've noticed. Weird since I thought that it should absorb completely.
Now barring fructose malabsorption, why would this occur? Today a possible explanation hit me.
What *if* those oligosaccharides in the HFCS get fermented by bacteria before we actually get a chance to digest them? I remember reading on the GAPS (or SCD?) website about how they don't recommend buying powdered dextrose because they often have large portions of non-hydrolized complex carbs mixed even, even if they claim it to be dextrose.
I *wonder* if a possible negative portion of the negative health consequences of HFCS could be attributed to pathogenic bacteria fermenting undigested complex sugars?
As you know HFCS is labeled % glucose/fructose, which assumes that there are no complex carbs in there. Now I'm no chemist so I can't validify testing methods to verify that. An interesting muse nonetheless.
I think that the following scenario may not be uncommon.
John Doe's blood sugar is out of whack and he hasn't yet figured out why, though "lack of oxidative cellular energy stimulated by stress" seems like a good way to view it, as he is fit and does not appear to be suffering any sort of autoimmune insult to the pancreas. He succeeds in stabilizing blood sugar with a very high fat, moderate protein, very low carb diet and is convinced, for a while, that he is heading in the right direction. But with time this diet seems a mere band-aid, as his metabolic/hormonal health continues to deteriorate. He discovers Ray Peat and is persuaded to increase carbohydrate in order to reduce stress and restore hormonal balance.
The question:
How does he begin, when reintroducing carbohydrate in any significant amount (and in any form -- no matter whether Peat's fruit & milk or Jaminet's safe starches) causes blood sugar to start swinging up and down again?
Or more pointedly:
If Peat is correct, John Doe needs carbohydrate to fix his hormones, but his hormones are making it impossible to metabolize carbohydrate properly. How does he escape this Catch-22?
I wish that Ray would spend a little more time addressing the subject of infectious pathogens
@daz-
Nice find but no I wasn't talking about those studies, this is the one I was referring too http://ukpmc.ac.uk/abstract/MED/3316904
@TO-
Ray cites a study done on HFCS and it has long chain sugars in it that aren't accounted for. Can't find it but I think danny has it.
>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.
The two concepts are linked. A stressed body is exploited by microbes, and microbes are a chronic stress on the body. A nutritious diet fuels effective immune responses and protects the gut.
I think Peat has talked about how most serotonin comes from the gut (where all the microbes live), and part of serotonin's function is to stimulate peristalsis, peristalsis probably being an anti-microbe function similar to diareeha.
The PHD fructose misconception derives from 2 factors:
The first is that pure fructose is malabsorbed while sucrose is not. I've heard peat advocate pure fructose in an interview so I don't think he's aware of this point either. Malabsorbed fructose feeds pathogens and subsequently terrible damage is done. Fatty liver is typical of fructose-fed mice, but the fatty liver is prevented if the mice are given antibiotics http://www.ncbi.nlm.nih.gov/pubmed/18395289 . Most all the anti-sugar studies are done with fructose rather than sucrose. There is some evidence that HFCS is also malabsorbed at a greater rate than pure sucrose, It should be noted that common soft drinks have higher fructose contents than reported on the label, to the extent that Soda/soft drinks may have fructose that is being malabsorbed, especially when paired with other digestive-enzyme blocking foods.
The second is that fructose/sucrose likely requires certain nutrients for proper utilization, without which, damage is done. Choline is a good candidate, and possibly zinc. Inadequate choline consumption is common. Most anti-sugar studies are also preformed on mice eating purified, very deficient diets. Mice eating nutritious wholesome diets have consumed extreme amounts of sugar without harm.
http://flare8.net/health/doku.php/when_fructose_is_bad
@Steve,
I'm not saying it's a good thing, simply that all of the gentleman I coach have elevated levels.
@T_O
Here is the article:
http://www.fasebj.org/cgi/content/meeting_abstract/24/1_MeetingAbstracts/562.1
@MM,
When in doubt, get some blood work done. This can reveal problems without having to guess.
@Quinn,
Flowers of sulfur + bottle of vodka + irish carb bomb will kill the infectious pathogen as well as the host.
thx for the link cliff.
I just realised that you were talking 'muscle glycogen' , i misread & was thinking 'liver glycogen'.
The liver glycogen subject interests me, it would be great if we had a liver glycogen "fuel gauge". Then we could tell if we were running on empty through to over-flowing.
In the first study i linked, the scientists used magnetic resonance imaging. Which enabled them to measure the size of each rider’s liver as an indicator of liver glycogen content.
"All of the cyclists lost liver volume during their workouts, a sign their livers were depleted of glycogen. But those who afterward drank fructose replaced the lost volume rapidly, showing a 9 percent gain in volume after six-and-a-half hours versus a 2 percent gain among the riders drinking glucose-sweetened drinks"
@Daz,
Peat has suggested that "the taste for sweet" is an accurate guide for glycogen stores.
If "over-flowing" your liver glycogen were a problem, these people would be dead:
http://www.30bananasaday.com/forum/topics/811-gladiators
Danny this is awesome and I'm a few days away from jumping into the diet outlined in your book (I've bought it already).
Quick question: I can't currently afford grassfed meats and dairy, is it still O.K. (although not ideal) to consume grainfed eggs, meats, dairy and from-concentrate OJ than to not consume them at all? I've got to make this diet work on a college budget and I'm worried about doing more harm than good consuming foods from suboptimal sources.
I intended the John Doe scenario to be a "theoretical situation" like the one posed by Jimmy Moore to Paul Jaminet. It seems to be a crucial general question right now because it is common to read about very-low-carb paleo dieters caught in precisely this Catch-22: they need more carbohydrate to heal a broken metabolism but cannot eat more carbohydrate because of a broken metabolism.
Jaminet has addressed the issue somewhat directly by emphasizing the importance of eating safe starches only as part of "balanced" meals that minimize the risk of hyperglycemic toxicity.
But I have not seen the issue addressed within the Peat paradigm, except perhaps for Matt Stone's aggressive carbohydrate overfeeding approach, which seems highly risky for the population in question. (I am glad that it worked for commenter ET, who does not seem to have had a problem metabolizing carbohydrate in the first place.)
So the question is, theoretically, within the Peat paradigm, how can a "carbohydrate intolerant" person get from A to B?
(I suspect that Peat fans, if pressed, would say hormone supplementation -- but is there no other way? Perhaps starting with tiny quantities of milk and OJ and ramping up slowly, or some other gradual approach?)