Tuesday, September 17, 2013

carbohydrate


Is There Any Such Thing As ‘Safe Starches’ On A Low-Carb Diet?


I’ve literally heard it all over the past eight years of dedicating my life to promoting healthy low-carb living that rarely am I ever surprised anymore by any dietary concept that I am introduced to that supposedly improves upon the high-fat, moderate protein, low-carb nutritional approach that is right for me. It’s important to discover what works for you and your individualized situation because it’s far too easy to get sidetracked by information that floats around out there in the blogosphere. I’m all for staying on top of the latest cutting-edge information about healthy eating, but it’s gotta make sense for me or I have a difficult time embracing the change. Such is a concept that has gained traction this year to the worrisome concern of many of my readers.

Following my March 2011 podcast interview with a man named Paul Jaminet, author of The Perfect Health Diet, there has been a steadily increasing amount of concern from low-carbers writing to me about whether he is on to something with what he describes in his book and blog as “safe starches”–namely white rice, white potatoes, yams and more. Say what?! Wait wait wait, NOW starches are GOOD for you and can even be deemed as “safe” for people who are obese, diabetic or otherwise metabolically compromised in some way? The reasoning behind this I gotta hear.

For those of you unfamiliar with who Paul Jaminet is, he is an astrophysicist at the Harvard-Smithsonian Center for Astrophysics and was able to beat a chronic health issue in his life by using the strategies implored in The Perfect Health Diet. His wife Shou-Ching Shih Jaminet, who co-authored the book with Paul, is a molecular biologist and cancer researcher at Beth Israel Deaconess Medical Center and Harvard Medical School. They have combined their efforts to educate the masses about what they have learned about human nutrition through their web site PerfectHealthDiet.com (in fact, you’ll see I have Jaminet’s blog listed on the right-hand side of my blog in “The Best Blogs” section). I am not one to just throw the baby out with the bathwater when it comes to those who offer up an alternative hypothesis to what I believe is true, especially when it comes to nutrition. But it’s gonna take a whole lot of convincing, scientific evidence and massive amounts of n=1 stories of people finding success eating white rice, white potatoes, and the like to get me to buy into this notion of “safe starches.”

To describe this concept of “safe starches” as controversial is a massive understatement. So many of my fellow low-carbers view the idea of purposely consuming starchy foods on a regular basis as blasphemy. You know, it kinda defeats the purpose of consuming a carbohydrate-restricted diet for the benefits of controlling blood sugar/insulin levels, right? Dr. Atkins has got to be turning over in his grave at the very thought of reintroducing a food into a low-carb diet as “safe” when all indicators show it is anything but. However, this “safe starches” concept has caught on among many of the most prominent members of the Paleo community this year, namely people like Dr. Kurt Harris, Robb Wolf, Chris Kresser, and Diane Sanfilippo, for example. And Jaminet is right there in the thick of it actively promoting the consumption of foods like white rice, white potatoes, taro, plantains, etc. through his own graphical representation of what he promotes as The Perfect Health Diet:



My primary concern with what Jaminet has come up with here is this promotion of starches as something that is “safe.” In a perfect world where the modern-day food system hasn’t been compromised, consumption of unnatural additives and chemicals in foods isn’t the norm, and obesity, diabetes and chronic disease is virtually nil, then perhaps there would be merit to the idea of “safe starches.” But for anyone who has been morbidly obese like I was once weighing in at over 400 pounds, diabetic with heart disease like my brother Kevin was, or dealing with a whole myriad of other cardiometabolic health issues, I think it is potentially dangerous to give people like this a virtual green light to consume these foods they hear are “safe” for them to eat. How can someone who is metabolically-deranged consume a food that will spike their blood sugar and insulin levels and consider that anything close to being “safe” for the their health? If you give people permission to eat these starches by calling them “safe,” then it can give the false impression that there will be no consequences on their weight and health. Unfortunately, that’s just not the case for everyone.

It all goes back to livin’ la vida low-carb 101. One of the basic principles of the healthy low-carb lifestyle is cutting down on starch and sugar as a means for controlling blood sugar spikes and the associated increase in insulin. When you consume starchy foods like rice or potatoes, your body breaks them down into simple sugar (glucose) which then raises blood glucose leading to an insulin response to deal with it. An overabundance of sugar in the blood (whether consumed directly or if the body converts starch into sugar) that goes beyond the needs for energy will then become stored body fat. This is why low-carb diets have worked for so many of us because we’ve come off the blood sugar roller coaster once and for all.

This is why controlling starch consumption is essential to lowering body fat, increasing insulin sensitivity, improving cardiovascular health through improved lipids (namely higher HDL, lower triglycerides and less small LDL particles) along with positively impacting various other metabolic health markers. Plus, consuming more carbohydrates in your diet pulls you away from using fat for fuel to a greater reliance on using carbohydrate for fuel in your body. If you’ve been low-carbing for any length of time, then you know how difficult those few weeks of transitioning from a carb/sugar burner to a fat burner can be. Why would you want to go through all of that yet again just because somebody labels an off limits food as “safe” to eat? Incidentally, I plan on testing this “safe starches” concept on myself in and upcoming n=1 blood sugar testing experiment.

It really all boils down to this for me: Why does Jaminet advocate for the consumption of what he describes as “safe starches” when everything about what we seem to know about these foods indicates they are anything but “safe” for most of the population that is metabolically damaged in some form or fashion? I felt this question was far too important for me to ignore any longer because it goes to the very heart of why I support low-carb nutrition for most people to begin with. In my search for answers, I personally contacted many of my fellow low-carb/Paleo expert friends to have them chime in with their thoughts about this idea of “safe starches.” An e-mail from one of my readers was the inspiration for me sending the following out to a wide variety of medical professionals, researchers and nutrition experts for a response:


I’ve been getting a lot of questions this year from my “Livin’ La Vida Low-Carb” blog readers about the concepts in Paul Jaminet’s book “The Perfect Health Diet.” He advocates for eating white potatoes and white rice as part of a low-carb eating plan. Here’s a one-page explanation and illustration of Jaminet’s program.

Several places in the book and on Jaminet’s blog he specifically warns against the danger of a very low-carb diet (defined as less than about 300-400 calories per day (~100 grams) from so-called “safe starches”–taro, plantains, yams, white potatoes, sweet potatoes, white rice and berries) because less than this leads to the risks, including:

1) “insufficient production of mucus in the digestive tract” leading to dysbiosis
2) vitamin deficiencies (he particularly mentions Vitamin C and glutathione on pages 253-254)

In particular he emphasizes these calories need to come from “safe starches and berrries” and “don’t count vegetables as as a carb source (because) they are a fiber (and therefore a fat) source” (page 45).

A recent post he wrote for cancer patients revealed his recommendion of obtaining 400 to 600 glucose calories a day, mainly from these safe starches. He says it is important to avoid a glucose deficiency, since glycosylated proteins are the means of intercellular coordination, and defects in glycosylation are characteristic of the cancer phenotype. He notes, “You don’t want to aggravate this with a self-induced glucose deficiency.”

I’d like to write a blog post about this topic of “safe starches” to help my readers understand fact from fiction and will quote from your response. THANK YOU! If you cannot assist me, then please let me know so I ask someone else to contribute.

I knew I’d get a strong response, but this was even more overwhelming than I could have ever expected. It was gratifying to hear back from so many in both the low-carb and Paleo communities who had very solid opinions about what they thought about “safe starches” so there would be no ambiguity about it. I’m listing all the comments in random order as they were submitted back to me. Get ready to absorb a whole lot of information on a subject that is critical if you are seeking optimal health and weight loss in the body you’ve been given. ENJOY!

ATKINS.COM NUTRITIONIST COLETTE HEIMOWITZ
A quote is fitting here–“That’s the most ridiculous notion I’d ever heard!”

The Atkins program is specifically formulated to minimize the impact of carbohydrates on a person’s blood sugar level because elevated blood sugar and the resulting excess insulin production can inhibit weight loss, weight management and increase the risk of disease and illness. We accomplish this by understanding that not all carbohydrates behave the same way in a person’s body. While most carbohydrates – sugar, which imparts 4 calories per gram, is the best example – are digested by your body and turned into blood sugar very quickly, other carbohydrates behave differently. Some carbs, such as vegetables have the least impact on blood sugar. And, some carbs – such as fiber – can impart as little as 0 calories per gram, are not digested at all and pass through your body as waste. Any way you look at it, if an individual is trying to gain the Atkins Edge of fat burning, consuming high glycemic carbohydrates such as rice or potatoes will throw them back into a glucose metabolism thus throwing them out of fat burning.

These “safe carb” recommendations are based on a glucose metabolism mentality and hypothesis. If your energy supply is coming from carbohydrates, which turn to glucose in the blood, there maybe some truth we can squeeze from these assumptions. However, when you burn fat for energy, the story is quite different. The brain and every cell in the body use glucose and ketones for fuel very efficiently. In fact, ketone experts say the body functions more efficiently on ketones especially when glucose metabolism is broken. Moreover, glucose is tightly regulated and there is never a deficiency of glucose on Atkins because glucose is formed from substrates such as gluconeogenesis. Paul Jaminet’s guidelines also do not take into consideration genetic differences, age, gender, activity level, medication usage and individual metabolism. These factors must be considered when finding the program that will assist you to improve or maintain health as you age.

This is also the first time I have ever heard that glycation can be good for you. Researchers have suggested that spikes in blood sugar can in fact accelerate the aging process. Glucose can react with proteins and nucleic acids (the building blocks of proteins) to form new structure, known as advanced glycosylation endproducts (or AGE). AGE, appropriately named, are believed to be involved in the aging process. Over time, AGE can cause connective tissues to lose strength and elasticity, resulting in skin sagging. In other words, wrinkles will develop with AGE, as well as with age! This is also why Diabetics have so much inflammation and organ failure over time. By avoiding spikes in blood sugar with a diet that regulates blood sugar response with foods that are low glycemic, you can slow down the formation of AGE. With less AGE, you will have less wrinkles, less inflammation, and you’ll continue to look and feel your age (or even younger if you consider the other great health benefits you experience when you follow a healthy lifestyle).

ROBB WOLF, AUTHOR OF THE PALEO SOLUTION
I think it all depends. Some people do GREAT on very low-carb diets. I used to…like for 10 years. Then, I think stress and too much activity increased my glycogen needs. Prior to that however I was just bulletproof. With the recent findings of MiRNA from rice influencing mammalian LDL signaling, I’m still not a big fan of consistent rice consumption. I think many people go too low-carb for too long (i.e. they cease thriving on low carb) and fail to shift gears…but I’m nervous of these across-the-board recommendations. For more on this, read Robb’s September 29, 2011 post “What is the Paleo Diet?”

CHRIS MASTERJOHN, PHD CANDIDATE IN NUTRITIONAL SCIENCES
As a broad general principle, I support what the Jaminets have written about glucose requirements, except to add that I find it unlikely there is any particular optimal macronutrient ratio that applies to everyone. Their argument as I understand it is that the body has a physiological need for glucose. This is true. The need for glucose can be reduced on a ketogenic diet, but it cannot be eliminated. The body can make glucose from protein, so the physiological need for glucose does not mean there is a dietary need for glucose.

That said, some people might be better at making glucose from protein than others, and some adverse circumstances may compromise an individual’s ability to make glucose from protein. Thus a “safe bet” would be to meet the minimal glucose requirement with glucose rather than with protein. Ultimately, however, one needs to determine one’s own responses to diet, because everyone is a little different. So I think the Jaminets provide a good starting point by attempting to identify the most “probable” ideal ratio, but a starting point is a just a starting point. Find what works for you.

DR. KURT HARRIS FROM THE “ARCHEVORE” BLOG
I also have come to see most starchy plant organs as perfectly legitimate fuel sources. Low-carb plans have helped people lose fat by reducing food reward from white flour and excess sugar and maybe linoleic acid. This is by accident as it happens that most of the “carbs” in our diet are coming in the form of manufactured and processed items that are simply not real food. Low-carb does not work for most people via effects on blood sugar or insulin “locking away” fat. Insulin is necessary to store fat, but is not the main hormone regulating fat storage. That would be leptin.

My reading of the anthropology and ethnology literature, as well as my current understanding of biochemistry and metabolism, lead me to see the human metabolism as a multi-fuel stove, equally capable of burning either glucose or fatty acids at the cellular level depending on the organ, the task and the diet, and equally capable of depending on either animal fats or starches from plants as our dietary fuel source, depending on the biome (biological environment) we find ourselves born in or that we migrate to. We are a highly adaptable species. It is not plausible that carbohydrates as a class of macronutrient are toxic.

Diabetics need to avoid high carbohydrate intake the same way those with gall bladder disease need to avoid fat, but carbohydrates do not cause obesity or diabetes and fat consumption does not cause gall bladder disease (in fact low fat diets may contribute to gallstone formation via stasis). My list of “safe starches” is white potatoes, sweet potatoes, white rice and bananas. If more exotic fare like plantains and taro is available to you, that is fine, too. Except for white rice, these are all whole food starch sources with good mineral and micronutrient content that have been eaten in good health for thousands of years in many environments by genetically diverse populations.

These starchy plant organs or vegetables are like night and day compared to most cereal grains, particularly wheat. One can eat more than half of calories from these safe starches without the risk of disease from phytates and mineral deficiencies one would have from relying on grains.

White rice is kind of a special case. It lacks the nutrients of root vegetables and starchy fruits like plantain and banana, but is good in reasonable quantities as it is a very benign grain that is easy to digest and gluten-free. I think consumption of quality animal products is the sine qua non of a healthy diet. Once you have that, then eating starchy plants is actually more important than eating colorful leafy greens – the veggies that are high fiber and low starch. Primitive populations practicing horticulture or hunting and gathering do not eat big green salads with lots of variety, but they do eat healthy starchy plant organs with monotony on top of their foraged animal foods.

I now view eating a very low-carb (VLC) diet for a period of time can be a good fat loss maneuver, acting via the effects of ketosis on appetite suppression. I also like to see people limit themselves to two or three meals a day with absolutely no snacking, and it may give benefits via hormesis for longer periods of fasting (24 hours or more) once in a while. But a long term VLC ketogenic diet is not a good idea. It does not mimic the ancestral diet in general, even if some populations have tolerated it when they had to.

There is no need for most people to do it to lose fat, as food reward effects are more powerful. I would advocate long term ketosis in those with neurodegenerative brains diseases like Alzheimer dementia and Parkinson disease and a 10-day water fast followed by long term ketogenic diet is worth trying if you have cancer. But I would not recommend VLC ketosis as a long term way of life the way I would not recommend running a half marathon every day, or lifting weights to failure on a daily basis, or taking chemotherapy drugs when you don’t have cancer. Ketosis probably stresses the body and works via hormesis. The clean up and repair response cannot happen if there is no rest from it.

My arguments are based more on ethnography and anthropology than some of Paul’s theorizing, but I arrive at pretty much the same place that he does. I personally eat around 30% carbohydrate now and have not gained an ounce from when I ate 10-15% (and I have eaten as high as 40% for over a year). If anything I think even wider ranges of carbohydrate intake are healthy. One can probably eat over 50% of calories from starchy plant organs as long as the animal foods you eat are of high quality and micronutrient content.

Grass-fed ruminants, pastured butter, eggs and wild-caught cold water fish are the kernel of a healthy diet, but the fuel source can be larger than the kernel on a caloric basis if the kernel is high-quality and consistent. For more on his philosophy on this, read Dr. Harris’ September 29, 2011 blog post “Jimmy Moore inquires about “safe starches.”

DR. JONNY BOWDEN, HEALTH BLOGGER AND BESTSELLING AUTHOR
I remember skimming through the book and thinking it was pretty good but not going into many details. I think this subject deserves a little time and investigation and I just can’t take any time out to look into it right now. If I had the info on the top of my head I’d be happy to comment, but I’d want to be more sure of what I’m talking about before going on the record.

One thing I can tell you from the research I’m reading for my new cholesterol book–the ONE thing those “starches” have going for them that OUR high-sugar diet does not, is that those starches contain virtually no fructose. So while they may still impact blood sugar unfavorably, they do not necessarily do the metabolic harm that regular sugar (50/50 glucose fructose) or HFCS (same basic thing, slightly different percentages) do.

I have absolutely no idea where he got the mucous thing from, and I can’t see in a million years how you would have a vitamin C “deficiency” if you ate berries, etc. But again, I’d want to read more before commenting too decisively.

DR. ROBERT SU, MD, FROM “CARBOHYDRATES CAN KILL”
For a long time, we had falsely believed that carbohydrate was our best energy source because it neither was greasy nor caused us fat, and that we could not live without it. Now, we know that carbohydrate can harm our health and develop diseases such as morbid obesity, diabetes mellitus, cardiovascular diseases, cancer, Alzheimer’s disease, and many more. Dr. Su recommends you read his column “Is There Essential Carbohydrate?” for more information.

TOM NAUGHTON, FILMMAKER BEHIND THE DOCUMENTARY FAT HEAD
I can’t answer the question because I don’t actually exist. My pre-agricultural ancestors in Ireland didn’t have access to rice, white potatoes, sweet potatoes, yams, or plantains — and certainly didn’t have access to safe starches of any kind for much of the year — so they became extinct due to vitamin C and glucose deficiencies thousands of years before I was born.

If I did actually exist, I’d reply that a limit of 400-600 calories per day from starches — 100 to 150 grams of carbohydrates — would be a vast improvement over the carb-heavy, grain-heavy diets most Americans consume, so I certainly wouldn’t oppose that diet plan for most people. I consumed around 100 grams of carbohydrates per day during my fast-food diet and still lost weight. However, I’m leaner and healthier now, and I don’t consume safe starches, unsafe starches, reckless starches, highly cautious starches, or any other starches except on very rare occasions. Despite that, my glucose level is usually around 90 to 100 mg/dl. If I eat a white potato, it shoots up to 175 or so and stays elevated for two hours or more. That doesn’t sound like a safe starch to me.

DR. RICHARD FEINMAN FROM THE NUTRITION & METABOLISM SOCIETY
Yes. Great dangers here. I remember at the Ancestral Health Symposium where people were dropping like flies. The only part worth considering is the remark about glycosylated proteins. The normal processing of many types of proteins involves the enzymatic addition of molecules of carbohydrate, sugars or what are called glycosaminoglycans (sugar amines). This is an important part of biochemistry but completely different from the non-enzymatic non-specific glycosylation of proteins which occurs due to excess of blood glucose and which is measure, for example, as hemoglobin A1c. The former is part of normal metabolism and is necessary for the normal function of those proteins. The non-specific glycosylation is not normal and impairs the function of the glycosylated protein.

DR. LOREN CORDAIN, AUTHOR OF THE PALEO DIET
I am unfamilar with Jaminet’s book, but anyone who advocates eating white rice and potatoes obviously is unaware of the concept of either glycemic index or glycemic load which is unfathomable for any contemporary nutritionist who reads the literature. Yams, sweet potatoes, plantains and berries are healthful carb sources that most people can eat without a problem. The only exceptions would be obese or insulin resistant disease patients

LOW-CARB COOKBOOK AUTHOR AND WEIGHT LOSS SUCCESS DANA CARPENDER
First of all, as you and I very well know, there is no need for dietary carbohydrate to maintain healthy glucose levels. You and I do not suffer a glucose deficiency. That’s just ridiculous.

So is the claim that carbs that come from vegetables “don’t count” because they are a “fiber (and therefore a fat) source.” What kind of hooey is that? 4 cups of fresh spinach — enough for a nice big salad — have 4 grams of carb, three of them fiber, and only the merest trace of fat. Going with a carbier vegetable, the average onion has 9 grams of carb with 2 grams of fiber, and still only a trace of fat. That this guy somehow equates vegetable fiber with fat is sufficient to make me question anything else he has to say. It’s also silly to suggest that carbs from vegetables somehow don’t count. A molecule of glucose is a molecule of glucose, regardless of the source. Your cells have no way of knowing if that glucose came from rice or from a salad — or, for that matter, if it was manufactured in the liver via gluconeogenesis.

I admit to not being up on my glycosylated proteins, but again, my handy glucometer makes it quite clear that my low carb diet has not induced any sort of glucose deficiency. I am not particularly excited about the whole “production of mucus in the digestive tract” thing. Dr. Mike Eades points out that apparently the gut secretes mucus when irritated, perhaps in an effort to get the irritant to move on down the line. This does not mean that deliberately irritating the gut is a good idea.

I am *very* clear on the dangers of high blood sugar. I know from testing that a cup of rice will drive my blood sugar over 180. Back in my low fat days, baked potatoes were a staple for me, but all they ever did was make me hungry, a clear sign that they, too, were jacking my blood sugar around. For those who have a robust carbohydrate metabolism, sweet potatoes and plantains seem like good foods. Potatoes and taro, both toxic eaten raw, strike me as iffier. Don’t get me started on rice. Berries, of course, are a fine, fine food.

I wonder, though, why he limits his root vegetables? What does he have against turnips, rutabaga, Jerusalem artichokes, jicama — all of which, unlike his toxic-when-raw “safe” starches are perfectly edible raw? Indeed, I don’t know why he considers these starches “safe.” A search of his website turned up no explanation.

ANONYMOUS PROMINENT MEMBER OF THE LOW-CARB COMMUNITY
Jaminet is not a clinician seeing patients and he’s never been obese. In that sense, he’s a theorist. His background isn’t in medicine, and it’s his Harvard affiliation that gives him cache. Like many bloggers in the field, he knows what worked for him and that his informed his opinions.

Now here’s the issue: if he was treating obese individuals or type 2 diabetics, he might find out that 600 calories of glucose a day is too much for weight loss. He might also find out that some people have to go far below 300 to 400 calories a day to lose weight. He might find that safe starches and berries aren’t “safe” for some, even if they are “safe” for others. Or maybe not. But the key is to make a prescription based on what works for you is always a bad idea. What he did, though, is cut carbs considerably and then, in effect, add them back to deal with problems from eating so few.

Compare Jaminet, say, to people like Dr. Steve Phinney, Dr. Jeff Volek and Dr. Eric Westman who have spent their lives working on this in the clinic and the laboratory would give different explanations for all that Jaminet is describing.

So my main point is this: telling people they have to eat or should eat 600 calories of carbohydrate a day based on “book learn’n” is maybe not the best idea.

“CHOLESTEROL MYTHS” PHYSICIAN/RESEARCHER DR. UFFE RAVNSKOV
This is nonsense. We are able to synthesize glucose ourselves. How have the Inuits, the Sami people of Northern Scandinavia and the Masai people been able to survive? They live almost entirely of animal food. Ask him for the scientific studies that support his ideas.

ADELE HITE FROM THE “HEALTHY NATION COALITION”
Let me begin by saying that I have not read the book, so I’m not sure I’m qualified to comment. However, their overall approach is very reasonable: whole foods with no grains and sugar. Hard to argue with that. Otherwise, and with all due respect to Drs. Jaminet, whom I think have provided an approach to diet that may be useful to many people, here are my thoughts:

1) regarding mucus: I’m sure you’ve seen Mike Eades’ commentary regarding the production of mucus in the digestive tract?

I’m not sure what I could add to this, as this is a very accurate depiction of the physiology of the digestive tract. In short, if you are consuming an excess amount of glucose, the overgrowth of the bacteria who feed on it, plus the irritating effects of the fiber that may accompany it, may very well warrant the production of mucus. How much is excess? That’s a personal variable, but the liver–unless damaged or dysfunctional–is very good at fine-tuning the amounts we need. Anything that disrupts that regulation to a significant extent could be considered excessive, again, a personal matter.

2) Vitamin C? Glucose and vitamin C compete for the same receptor in the intestines. I’m not sure how increasing your consumption of glucose is going to assist your absorption of vitamin C, but maybe this is in the book. Given a sufficient intake of essential amino acids, your body makes its own glutathione, so again, I’m not sure how that relates; perhaps the book explains. It’s true that vitamin C and glutathione are important antioxidants, but elevated glucose and insulin are pro-inflammatory states, so if you are consuming glucose in excess (an individual matter, as above) to increase your antioxidant levels, you may be creating the very physiological state that leads to increased oxidative stress.

3) Warburg determined back in the 40s that cancer cells meet their energy needs in large part by fermentation (of glucose). Unless there’s something wrong with your liver, your body is going to produce the basal amounts of glucose necessary for structural needs. Glucose in excess (an individual matter, as above) may simply “feed” cancerous cells, although the jury is still out on this.

In the end, there’s no such thing as “perfect health”–I’m not even sure there’s such a thing as “optimal health” as the conditions under which we experience health change constantly with environment, age, and activities. The body is in a constant state of damage and repair, cell proliferation and cell death. We should pay attention to how our food makes us feel and act, short term and long term.

Bottom line: Starches are not essential; it is arguable (as is clear from this discussion) as to whether or not they are beneficial. For a person already experiencing metabolic dysregulation related to glucose/insulin issues (obesity, diabetes, inflammatory conditions), I would recommend proceeding with caution. Even a “safe” starch is not safe if it negatively impacts eating and activity patterns; that is what matters in the long run. My biggest concerns would be protein and appetite/activity regulation.

I am not convinced that 50g (200 kcals) of protein would be sufficient for most people’s physiological needs (adequate protein is also a key aspect of appetite regulation), and I would be concerned that–for some–these starches may increase appetite and/or fatigue. For those who are not self-aware enough to recognize a tendency toward “carb addiction,” these “safe” starches may become a justification to indulge in the drug of choice (and let’s be honest, if we’re “addicted” we are always looking for these justifications). That would be like telling someone with an alcohol addiction that wine is “safe” because it has antioxidants.

So folks taking this approach should monitor two things: Are those “safe starches” taking up protein space on my plate? Also, how are these “safe starches” affecting my appetite and my energy levels? It may be a fine approach for some folks, but not for everyone.

DR. LARRY MCCLEARY, AUTHOR OF FEED YOUR BRAIN LOSE YOUR BELLY
First, I read his linked reference about defects in O-glycosylation that he listed in his blog (regarding cancer and dysbiosis) as supporting his recommendations for adding carbs as a source of glucose to reduce the impact of an O-glycosylation defect.

If you read the paper you see that O-glycosylation defects have been associated with the cancer phenotype and alterations in mucin production in the gut. They are important for mucin production and he mentions that. However, that paper is more about scientific findings that suggest that the quartenary structure of glycosylation enzyme complexes are much more efficient than activity of the same unassociated enymes. I’m not sure what this has to do with his recommendation to avoid a glucose (and ? hence glycosylation) deficiency by consuming large amounts of glucose. If anything, this type of diet can enhance HbA1c which is glycosylated hemoglobin!

As you well know, when an enzyme acts on a substrate (such as an enzyme that adds a sugar molecule to an enzyme side chain — as discussed in his reference) the pathway involves the action of an enzyme on a substrate (here the sugar molecule). The defects in glycosylation that the researchers are referring to involve decreases in enzyme activity, not deficiencies in available substrate (such as glucose). Usually in biological reactions of this type there are literally billions of sugar molecules available, so lack of substrate is rarely an issue. The main problem is inactivity of the enzyme itself, which is not impacted by how much sugar is available. So suggesting that we eat high glucose to avoid a glycosylation problem doesn’t have any scientific validity, in my opinion.

The other issue I have is I don’t understand what he means by “safe” starch. Is this resistant starch? If so, the % of resistant starch in most carbohydrates is less than 10% of total starch. So to get a little naturally occurring resistant starch, you need to eat a lot of regular starch. The consumption of manufactured resistant starch, free of regular starch, could have benefit because it passes through the small bowel undigested and is fermented by gut bacteria with the generation of healthy short-chain fatty acids such as butyrate.

So, I don’t think you can’t call veggies carbs because they might contain a little fermentable fiber (?safe starch) because the % is small and they contain a lot of other carbohydrate. If they contain sufficient fiber to slow absorption and digestion, then the veggie will have minimal impact on insulin, which is good but is not really related to “safe starch.”

Also, eating this much glucose one could argue is bad for someone with cancer because most cancers are easily identified on PET scans because of their extremely high metabolic rate of glucose use. Dr. Tom Seyfried (at Boston College) has even recommended a low-carb diet for a number of patients with brain cancers and has had some success with this approach (and has published it, as have others). When he puts these patients on low-carb diets the PET scan findings improve (reflecting less tumor metabolism and growth).

CHRIS KRESSER, ACUPUNCTURIST, POPULAR HEALTH BLOGGER AND PODCASTER
I see a fair number of patients in my practice struggling with symptoms like hair loss, cold hands and feet, plateaued weight loss, low energy and mood imbalances after following a VLC diet for several months. In many cases they adopted this approach to lose weight, which was successful – at least to a certain point. However, others were not overweight to begin with and simply chose to eat VLC because they got the impression that “carbs are bad”, even for people without metabolic problems. I believe many of these issues are related to the decrease in thyroid hormone levels seen on VLC diets.

In cases where there is no significant metabolic damage, when I have these folks increase their carbohydrate intake (with starch like tubers and white rice, and fruit) to closer to 150g a day, they almost always feel better. Their hair loss stops, their body temperature increases and their mood and energy improves.

For people that are overweight and are insulin/leptin resistant, it’s a bit trickier. In some cases increasing carbohydrate intake moderately, to approximately 100g per day, actually re-starts the weight loss again. In other cases, any increase in carbohydrate intake – in any form – will cause weight gain and other unpleasant symptoms. A different approach is required for these patients.

As always, there’s no simple answer and no one-size-fits-all approach. If I could leave your readers with one point, that would be it.

DR. DAVID DIAMOND, NEUROSCIENTIST AT THE UNIVERSITY OF SOUTH FLORIDA
I’ve checked out Paul Jaminet’s blog, and I think his advice, in general, is good. He emphasizes a diet that’s 50-70% of calories from fat, which is good, and, in general, I agree with his fat/protein/carb recommendations, which include limiting PUFAs, cereals, legumes and, of course, refined sugar. His recommendation of 400-600 calories (100-150 gm) from carbs/day does fit with a relatively low carb lifestyle and can contribute to stable weight or weight loss, depending on the individual’s metabolism, activity, etc. This has been my basic diet plan for the past 6 years and my blood lipids have responded in the right directions and I’ve lost about 25 lbs (although I do try to keep my carbs closer to 100 g/day).

However, his warning about slipping to 300-400 calories of carbs/day as unhealthy just doesn’t make sense. The Inuit, as well as white Arctic explorers (e.g., Stefansson), thrived on diets that are very low in carbs. I know of no evidence that there is any requirement for carbs in the diet whatsoever. As to vitamin C deficiency, scurvy was found in populations that ate simple carbs w/o fruit (e.g., sailors), but not in populations that didn’t consume simple carbs. That is, there’s no scurvy found in the Inuit or Maasai, despite the fact that they don’t eat obvious sources of C, such as fruit. Although people can’t produce C, they probably recycle C, which keeps them from getting scurvy as long as there isn’t much glucose around to interfere with C transport and recycling.

I’ve seen a lot of commentary on low carb diet and hypothyroidism, but so far everything I’ve seen has been on measures of biomarkers, such as LDL, but I haven’t actually seen adverse health outcomes for most people who eat 50-100 gm of carbs/day. Of course, if you’re a marathon runner or some other endurance athlete, perhaps carbs would be a better source of energy than ketones.

As to cancer, his recommendations to eat 400-600 calories from glucose make no sense. Cancer cells have a powerful craving for sugar. Their mitochondria are impaired at utilizing ketones and, instead, cancer cells have an incredibly high metabolic rate and utilization of glucose. Cancer tissue has the highest density of insulin receptors in the body, so why would anyone want to elevate their blood glucose just to feed their cancer cells? Ketosis is not a cure for cancer simply because gluconeogenesis from proteins will maintain blood glucose levels in a normal range, which will fuel the cancer cells even when glucose is not consumed. Still, maintaining stable and low blood glucose has been shown to reduce cancer growth in animals and there are positive effects in people, as well (see work of Thomas Seyfried, Boston College). I do agree with Jaminet’s recommendation that you become ketotic before getting chemo, but I would further recommend that one should remain in ketosis until the cancer is gone. Watch Dr. Diamond’s video presentation on diet for more information.

LIVIN’ LA VIDA LOW-CARB BLOG READER RESPONDING TO DR. HARRIS
I follow your blog as well as a great many others on low-carb/paleo/etc. I just saw Kurt’s item on safe starches as a response to you. I have some serious concerns about this idea of safe starches without significant qualification. For those who are pre-diabetic or have a family history of diabetes then I would suggest that so-called “safe starches” are not safe and are quite dangerous.

I have attached a chart (hope you can see it) I produced as a result of my own experiments on myself. I had been attempting to introduce more carbs into my VLC regime, after reading the “Perfect Health Diet”, and sweet potatoes seemed like a good start. But my blood sugar readings showed the danger of such polysaccharide nutrients. After 6 hours my blood sugar had not returned to normal – I’d have tested further but that last reading was midnight and I needed to sleep.

For comparison I did the same tests on some Ice-Cream and a high protein/fat meal. I recovered far faster from a full pint of Ben and Jerry (something I do not consider healthy), than the supposed healthy safe starch of a sweet potato. Note that my normal typical meal of something like eggs and liver did not show a significant change in blood sugar. The ice-cream is some 50% fat and the 100g of sugar I suspect are primary monosaccharides, which my body seemed to deal with pretty quickly.

Some background on me: I am 59, I was some 233lbs in 2003 and diagnosed as pre-diabetic (FBS of 125). My doctor suggested I reduce my carb intake so I started looking at Atkins and others. I am now 170lbs (BMI 26), so almost normal, and I am no longer pre-diabetic. So I have lost some 63lbs, although I did reach 160lbs earlier in the year, before I started trying to introduce some so called safe starches. I reached this point with a nearly zero-carb regimen – pretty much any carbs for me stalls weight loss, even milk or cheese is disastrous. My mother is diabetic and so were her sisters and their mother – it is very much a family trait. My mother is 95 – so I have longevity in the family. I suspect that with a careful restriction on carbs I should be able to avoid diabetes permanently as I suspect will be the case for other potential pre-diabetics.

My A1c self tested last month was 5.9%. While officially below 7% is considered safe others with greater expertise say it should really be below 5% with 4.5% as an optimum. I am pretty sure that if I adopted these so called safe starches and saw consistent prolonged high glucose levels as I saw in my experiment then my A1c is not going to come down. My family has no history of heart disease. My father at 92 died of the effects of head injuries sustained from WWII – I suspect he would have lasted a lot longer otherwise – he heart was very strong, similarly for my mother.

For me, VLC or near zero-carb works very well, but this trend in the Paleo movement I am seeing for a creeping increase in carbs is a real concern. I suspect that long term those extra carbs and hence higher levels of continuous insulin over decades will turn out to be a negative result.

For those who do not have a genetic diabetes trait then I suspect the higher carb paleo regimen may work fine, but not for those like me. I would like to see all this advice about paleo and so-called safe starches be more carefully qualified so that people like me will not go astray. My pancreas is now likely seriously impaired through decades of high wheat, sugar, and Omega-6 consumption, and I suspect I am very much on the borderline of staying healthy – safe starches are not the way to go.

DR. ANDREAS EENFELDT, SWEDISH PHYSICIAN KNOWN AS “THE DIET DOCTOR”
While most people can probably obtain “perfect health” on 400 to 600 calories from “safe starches and berries” a day, some do not. Specifically people with diabetes type 2 and metabolic syndrome generally do better on lower carb intakes. It may also aid weight loss.

Regarding “insufficient mucus” in the intestines I have never heard of this problem. It sounds weird to me, but if there is any good science behind this idea I would certainly take a look at it.

Regarding “glutathione deficiency”: Glutathione is not an essential nutrient, it is produced by our bodies from amino acids i.e. protein. I have never heard of deficiencies of glutathion on low carb diets. My guess is that this idea is controversial at best.

There is no need to eat starchy food for vitamin C. You get plenty from low starch vegetables, so there is no need to eat more than a few grams of carbs to get all the vitamin C you need.

You do not get “glucose deficiency” on strict low carb. The glucose levels in the blood stays within the normal range even on zero carb diets, because of gluconeogenesis and ketosis.

DR. JEFF VOLEK, LOW-CARB DIET RESEARCHER AT UNIVERSITY OF CONNECTICUT
Claiming you need carbs to prevent scurvy is a red flag this guy is a nut job. Tell him to eat a red pepper. There is no evidence what so ever the human body has any dietary requirement for the nutrient class of carbohydrate (i.e., there is no defined condition associated with not consuming carbs).

DR. JEFFRY GERBER, AKA “DENVER’S DIET DOCTOR”
This sounds like a glycemic index type of diet with the starches added into the mix. To me starch is just a carbohydrate like any other and based on the science of insulin metabolism drives inflammation. I do not know anything about deficiencies and mucus.

The comment about cancer. Patients who are ill such as cancer, post surgical, after the hospital are stressed and their basic metabolic rate is increased. In this situation I have found that there is an increased caloric demand. Patients require more calories from fat protein and carbs.

DR. JACK KRUSE, NASHVILLE, TN-BASED NEUROSURGEON AND BLOGGER
I read Kurt and Jaminet’s take. I think these recommendations are madness based upon the totality of the data we have today. I think avoiding anything that stimulates the IGF1 pathway is “smart” based upon current knowledge and i think using a ketogenic diet is also prudent. While i like both of these guys, neither one has any clinical experience treating cancer patients. They read literature. When kurt was a practicing doc he spent time in a dark room with films not patients. I showed our oncologist these comments and they both shook their head. I spent four years getting these guys to come over to evolutionary biology based upon science and now these two primal insiders decide damn be the science?

I think the science is far from worked out but nothing i have read critically reviewed support jaminet’s claims. My personal opinion is this……..the best way to show someone they are wrong is allow them to go down the path they choose and let them learn for themselves. Some people may do the same but when they see their clinicians and the news is not good…….then there testimony will shine sunlight on who’s interpretation of science is correct.

If you remember our podcast……i told you i am wary of authors with books to sell on diets. Here is a perfect example of someone trying to fit their theory into everything. Id rather use evolutionary biology to give us a custom health care plan instead. I wrote a blog on what to do for a new cancer diagnosis–and its completely opposite these recommendations. I guess the new cancer patient will have to choose who is more correct.

This is a sad state of affairs in my opinion.

DR. FRED PESCATORE, NEW YORK CITY-BASED LOW-CARB MEDICAL DOCTOR
In all honesty, this diet just doesn’t make any sense at all. If you are eating 400 calories from starch and 200 calories from animal protein and then 600 to 1200 calories from fat – where is the nutrition?

Not eating fish oils is just lunacy as he says to get them from oily fish; yet, a can of tuna is 200 calories which is above his recommended daily intake and still only gives you about 500 mg of EPA/dha. This is a really contrived diet and not based on science of any sort that I am aware of. Here are my thoughts about this:

PEOPLE WHO ARE DOING LOW CARB JUST HAVE TO FACE THE FACTS THAT THERE ARE NO SAFE STARCHES. NATURALLY THEY ARE GOING TO WANT TO BELIEVE SOMEONE WHO TELLS THEM THEY CAN EAT POTATOES, RICE, ETC BECAUSE THEY WANT TO EAT THEM. YOU HAVE TO COMMIT TO A LOW CARB LIFESTYLE OR NOT – THERE IS NO ROOM FOR COMPROMISE. ALSO, IN HIS BOOK, 200 CALORIES FROM STARCH WILL TAKE THE AVERAGE PERSON OUT OF KETOSIS SO WHAT IS HE TALKING ABOUT?

DYBIOSIS IS OFTEN CURED BY A LOW CARB DIET. THERE IS NO SCIENCE TO BACK UP THE VITAMIN DEFICIENCY CLAIMS. VEGETABLES ARE CARBOHYDRATES AND TOO MANY OF THEM CAN KNOCK SOMEONE OUT OF KETOSIS ERGO, THEY COUNT AS CARBS. RICE IS NOT A FAT SOURCE EITHER AND NEITHER ARE BERRIES OR POTATO SO WHAT?????

CANCER CELLS FEED PRIMARILY ON GLUCOSE – ANYONE WHO HAS EVER SEEN A PET SCAN KNOWS THAT. YOUR BODY WILL GLYCOSYLATE PROTEINS WITHOUT ANY ADDED SUGAR – IT WILL DERIVE IT FROM ANY FOOD YOU EAT JUST LIKE THE BRAIN; DEFECTS IN COMMUNICATION NOT GLYCOSYLATION ARE CHARACTERISTIC OF CANCER

DR. ERIC WESTMAN, LOW-CARB RESEARCHER AND PRACTITIONER AT DUKE UNIVERSITY
I don’t know much about this book. Have there been any studies of this diet book specifically? I doubt it. I’m confused now because I found this at the Jaminet’s web site: Some conditions, such as epilepsy, brain and other cancers, and some mental health and neurological disorders, may benefit from very low-carb ”ketogenic” diets.

I know of no studies to support these assertions about the bad effects of low carbohydrate diets. Our bodies are able to make glucose internally, so this excerpt makes no sense: He says it is important to avoid a glucose deficiency, since glycosylated proteins are the means of intercellular coordination, and defects in glycosylation are characteristic of the cancer phenotype. He notes, “You don’t want to aggravate this with a self-induced glucose deficiency.”
I have never heard of a “glucose deficiency” in a relatively healthy individual.

PETER D. FROM THE “HYPERLIPID” BLOG
Paul did send me a copy of his book when it came out but I’ve not had time to read it in any detail. He did contribute to the discussion we had on Hyperlipid about the incidence of cancer in OD eating people in Poland, where GI cancers are over represented in the OD (LC) eaters and in the general population too.

I have no real faith in the concept that we might damage our mammalian lectin signalling system (which is very important, I never even got time to start thinking about posts on mammalian lectins, we do in fact use them everywhere, maybe a post there some day) and failed mucus production through glucose deficiency. In particular I can’t see glucose deficiency being a gut problem as this is the organ with the highest exposure to dietary glucose.

We none of us know exactly how little we know. I had no handle on the likelihood of developing cancer on a LC diet until I realised that a) you cannot always normalise blood insulin levels by LC (or even by starvation) and b) this is probably mitochondrial in origin. There are suggestions that cancer may well be a mitochondrial problem. So now I have my own ideas about cancer, insulin, ILGF-1 receptors and the limits on the ability of any given person to normalise insulin… This seems more believable to me.

Safe starches? Yes, if you have a decent population of mitochondria which don’t need to be surrounded by high levels of intra cellular fatty acids to function normally (ie if you are not severely insulin resistant). If you have a poor population of mitochondria to choose to breed from (looking to cure, rather than side step, IR) there may be limits to what you can manage and what starches of any sort you can consume.

If Paul is correct I would like to see the long term outcomes. The OD has been around for decades and its limitations are only just beginning to show.

I have to say I feel Paul’s approach is reasonable for a fair swathe of the population but it will not suit all of us, exactly as applies to the Optimal Diet I eat. I’m sort of loathe to go head-to-head as you then end up like Colpo vs Eades. That is arguing semantics and nit picking. Coplo is a LC-er, he just doesn’t see it as effective for ultra athletes. But 600g/d of carbs for an Iron Man is LC and AC actively suggests that normal LC for sedentary folks is a reasonable idea. Or you end up making the criticisms I have reluctantly had to make of Stephan’s retaliation against Gary Taubes.

Can you heal your mitochondrial population to a level where you can tolerate safe starches? I don’t know and I doubt anyone else knows. In terms of academic research to pick over we are still at the level of LC vs LF, which LC wins most of the time. The occasional success of LF is probably explicable in terms of mitochondrial function too. Perhaps, seems to be anecdote from chronic LC-ers. For some.

So I guess this is a big “I don’t know”, which is probably not a lot of help.

DR. WILLIAM DAVIS, NEW YORK TIMES BESTSELLING AUTHOR OF WHEAT BELLY
Interesting concept. However, I see something different.

I agree that the starches designated as “safe starches” are indeed safer, i.e., lack inflammatory triggers like gluten, lack the appetite-stimulant gliadin, do not have destructive lectins, etc. However, this quantity of carbohydrate (100 grams per day) exerts variable effects on different individuals, depending on carbohydrate sensitivity.

An established type 2 diabetic, for instance, can have blood sugars of 300 mg/d–very high–after a serving of one of these foods. Someone with pre-diabetes can easily have blood sugars of 200 mg/dl or higher after one of these foods. Recall that, in 2011, type 2 diabetes and pre-diabetes includes the majority of adults around us.

And it’s not just about blood glucose. Repetitive high blood glucose triggers the process of glycation, meaning glucose-modification of proteins. Glycate the proteins in the lenses of your eye = cataracts; glycate artery tissue = atherosclerosis; glycate cartilage cells = brittle cartilage and arthritis.

These starch in this quantity also trigger formation of small LDL particles, the most common cause of heart disease and heart attack in the U.S. This is why I advise patients who are susceptible to these effects to limit carbohydrates more towards the range of 50 grams or less per day, 30 grams or less per day if they are already diabetic.

Overall, I believe his diet seems a rational, workable program. I’d be concerned, however, that the quantity of these “safe starches” are likely to lead to an excess triggering of the above patterns and all their consequences.

VALERIE BERKOWITZ, RD WHO BLOGS AT “FOR THE HEALTH OF IT”
Dysbiosis was originally introduced by Dr. Eli Metchnikoff in the early 1900s describing an imbalance of the bacteria in the gut. The word comes from ‘symbiosis’ meaning to reside together harmoniously with the ‘dys’ meaning the opposite. Dysbiosis refers to a bacterial imbalance in the gut, which can compromise the immune system. The main causes of Dysbiosis are believed to be antibiotics and pesticides along with other environmental and dietary factors. In other words yeast overgrowth…Yeast loves the sugar in potatoes …the best way to reduce yeast overgrowth (I’ve been doing this as far back as Dr. Atkins) is to restrict simple and total carbs to starve the harmful bacteria and supplement with a probiotic. If you feed the harmful gut bacteria, you can compromise your immune system leading to other illnesses.

Tomatoes are a good source of vitamin C and when cooked the lycopenes help prevent prostate cancer are you gonna avoid them because they are not on the “safe starch” list? Jimmy you have the research on AGE products and insulin like growth factor and cancer. Why is he putting vitamin C and calories together? Vitamins provide nutrition and not calories? I have never heard of a fiber being called a fat and quite frankly omega-3 fats (from free range/grass fed organic meats) can reduce inflammation that can be caused by “safe vegetable starches” omega 6’s.

Cancer cells need glucose to multiply Ketosis helps to starve the cancer cell. You know they are doing research on brain tumors and ketosis. There is no glucose deficiency due to gluconeogenesis which is why starches are not essential. He’s gonna get more glycosylation with potatoes (AGE products) with his diet than he will with my diet and not as many vitamins/minerals.

Seriously someone should report them I guess I feel so strongly because of their use of the word “safe” in such a general and global population when there is no support in most of the claims they make. And especially because with all the research and information out there about spiking blood sugar and heart attacks (even if you do not have diabetes) and all the other associated morbidities and what about the carb cravers, most people who do low carb do so because they are addicts, that could send someone into a tail spin.

The total carbs is lower than someone doing 300 g but in my opinion the choices they encourage defeat the purpose of lowering total carbs because of the spikes and dips in blood sugar that his “safe starches” cause.

DIANE SANFILIPPO, PALEO NUTRITIONIST FROM “BALANCED BITES”
I think they make sense in terms of healthy carb sources for those who want/need them for activity or life/food enjoyment as well as for gut motility/feeding beneficial bacteria, though saturated fat can do the same. I still think it’s an individual thing to consider and test out for each of us as well as to play with over time. Perhaps today someone doesn’t do well with much starch, but in 3 months, 6 or a year, they will do perfectly fine with them.

DR. WILLIAM YANCY, LOW-CARB RESEARCHER AT DURHAM, NC VA MEDICAL CENTER
Not sure where to start here!

I am wondering if he considers these “safe starches” because they do not have gluten. Some of the ‘toxic’ ones he lists do.

I haven’t heard of dysbiosis or that low carbohydrate intake might lead to mucus problems in the gut. I looked up dysbiosis—now that I know the word, I can say yes, this is a health issue that is discussed and that diet changes can impact the bacterial flora present in the gut. I’m not sure about the mucus.

Fiber is not a fat (if anything it is a sugar), and anyway most vegetables are quite low in fat, not that fat should be shunned.

I don’t think a carbohydrate deficiency exists, much less a glucose deficiency, although severe hypoglycemia (low blood sugar) is a serious health problem. I wouldn’t call that a deficiency in the sense of the way we usually use that word in regard to nutrients.

DR. ANN CHILDERS, PSYCHIATRIC PHYSICIAN WITH A DIETARY FOCUS
One diet does not fit all. To insist that a very low carbohydrate diet is hazardous to human health is to overlook the history of human survival in the Ice Age, and the generations of Inuit and other First Nations people who thrived on traditional diets consisting entirely of animal-derived foods in robust health, without cancer, diabetes, tooth decay, glutathione deficiency, vitamin C deficiency or gut dysbiosis. Dr. Childers recommends reading “The Inuit Paradox: How can people who gorge on fat and rarely see a vegetable be healthier than we are?” to learn more about this.

DR. CATE SHANAHAN, A WEIGHT LOSS PHYSICIAN AND AUTHOR
Starch safety 101

There are two issues to cover before we can close the door on the starch safety class: 1) Are some carb/sugar sources better for us than others, and 2) do we need to eat any glucose or can we truly make all we need from conversion from proteins

I’ll address the first question first:

Are some carbs safe and some unsafe?

You can apply the same rule to good/bad starches as we can to good/bad fats. In Chapter 8 of Deep Nutrition we explain why “Nature doesn’t make bad fats.” What makes bad fats for us is all the high-temp and chemical processing, which distorts the molecules and generates toxic, self-replicating MegaTrans fats.

The same applies to starches: Nature doesn’t make bad starches. What makes starches bad for us is processing, which, in this case distorts proteins in the starch, rendering them potentially immuno-reactive so we are likely to create antibodies against them and thus to get a variety of inflammatory reactions upon repeated exposure to the same protein.

Food allergies are dramatically on the rise, especially in kids, and it’s not just because of the GMOs. It’s because of the processing and the fact that we eat foods that promote glycation and lipid oxidation, which derange our cell membrane function and make our immune systems go haywire. White blood cells mistake proteins in foods for pathogens, and make antibodies against protein components of food. This could make any food unsafe. But it has to have that protein component. Wheat, soy, corn, all have alot of protein compared to the “safer” starches like potatoes, yams, and rice. When these starchy foods are processed their protein componenets are distorted in such a way as they attract the attention of the immune system and in the background of a diet that causes glycation and lipid oxidation (that is to say, promotes inflammation) the immune system is even more likely to react to proteins in the foods as if they were toxic compounds.

At this point in our history of eating, when we’ve been feeding kids with developing immune systems processed foods containing wheat, corn, barley, soy, and other starches on the “unsafe” list, we’ve created a generation of children with antibodies to the proteins in these common starchy ingredients.

I am about to complete a video I am making on food intolerances and specifically gluten intolerance that will explain why some people have intolerances to these processed foods and not to things like rice, yams, and sweet potatoes—how often have you seen those on the list of ingredients in your cereal? This concept of processing underlying the safety of starches is very important because as manufacturers start using substitutes for consumers with celiac disease, they are simply replacing corn, wheat, and so on with rice, potato, yam etc, and these currently safe starches may soon become less safe. The good news is, rice, potato and yam have less protein and so they are also less likely to trigger an antibody reaction than the higher protein starches they are replacing.

Do we need to eat any sugars or can we make all we need from proteins?

There is research to support the idea that our bodies need some sugars, xylose for instance, that our enzymes cant manufacture. However we are likely to get these from vegetables, mushrooms and micro-organisms in our intestines can, so as long as we have a balanced diet and healthy gut flora, we should be just fine.

The Jaminet’s assertion that we need to eat at least 100gm per day of carb is based on the fact that many of our cells are coated with patterns of sugar molecules that are like fingerprints identifying the cell as part of us, and not a cancer cell or an infecting organism. Some of these may be familiar to your readers, called HLA haplotypes. These molecular fingerprints are genetically inherited and are the “types” that define organ donor and blood type matches.

I had not considered this a significant issue and found it intriguing enough, when I met with them and they explained it to me, to change my way of thinking.

Why? Because if I say we dont need to eat any glucose because we can make all the glucose we need out of protein I could be making the same flawed argument our counterparts in the anti-cholesterol camp make, that is because we can manufacture cholesterol fat we don’t need to eat any. But I believe we do need to eat foods containing cholesterol because cholesterol also plays a role in the absorbtion and assimilation of fat soluble nutrients into chylomicrons, so it plays a role in facilitating digestion and nutrition in addition to its better known role as a main ingredient in our cell membranes. And though we CAN manufacture it, forcing our bodies to manufacture it may not be that good for us either. The same applies to sugar, even the non-essential sugars.

However, there is no data I am aware of that cites exactly how much sugar we need to coat our cells, and because too much glycation is a bad thing, as I describe in chapter 9 of Deep Nutrition, the number 100gm seems potentially too high.

So we need a new term to accompany safe-carbs: safe-glycation! Some glycation is essential to bodily function, but out of control glycation causes weight gain, metabolic imbalance, lipid abnormalities and more.

For my patients who want to achieve rapid weight loss, I continue recommending they cut their carbs down to 30 gm because of the need to reduce insulin resistance and harmful glycation. However, if they start feeling bad after a while (which I have yet to encounter), then I plan to advise them to eat up to 75-100 gm one to two days per week to see if that helps.

Here’s a bullet of how i define a safe starch:

Non-processed carb sources to include: starchy veggies, grains and legumes (preferably partially sprouted), and fruits….and dark chocolate.

I don’t recommend all people need to avoid grains and legumes as a blanket rule, only those who have developed an intolerance to wheat or corn or any other starch. If they’re not sure if they’ve got an intolerance, the best thing to do is to try an elimination diet and see if the symptoms in question go away. Most antibody testing is woefully inaccurate. For more information on Dr. Shanahan’s philosophy on a gluten-free diet, read “What is celiac disease? A recipe for recovery beyond gluten free.”

AMY KUBAL, PALEO RD WHO BLOGS AT “FUEL AS RX”
I am not ‘on-board’ with the 1lb of starchy carb for everyone recommendation that Jaminet makes. I feel that there is a place for starchy carbohydrate in a ‘low-carb’ diet for some people depending on goals and overall health status. It is definitely not a blanket recommendation for everyone.

Post workout is going to be the BEST time to incorporate the starchy carb, with portions depending on workout length, type and individual goals. Choices that work include sweet potatoes, yams, winter squash, beets, taro, rutabaga, white potatoes with skin removed, other roots and tubers and in the case of hard charging endurance athletes some white rice, tapioca and even corn tortillas from time to time can fit. For an extremely lean individual some starchy carb is going to be great. If weight loss and leaning out are the primary goals – then I recommend not getting all ‘starched up’.

As far as other vegetable based carbs not ‘counting’ because of the fiber… I’m not completely on board with that either. It is possible to get adequate carbohydrate via non-starchy vegetables. This is especially true in the non-active, overweight population.

The cancer argument – whoa! I can send you a boatload of articles on the benefits of a ketogenic diet for cancer. I’ve attached some of them and can send more if you would like. The diets that I have put together for cancer patients are low in carbohydrate (only from non-starchy vegetables), moderate to low in protein and rich in fat, primarily from MCT’s. Cancer cells live on sugar regardless of the source.

DR. ROBERT SU FROM “CARBOHYDRATES CAN KILL”
For a long time, we had falsely believed that carbohydrate was our best energy source because it neither was greasy nor caused us fat, and that we could not live without it. Now, we know that carbohydrate can harm our health and develop diseases such as morbid obesity, diabetes mellitus, cardiovascular diseases, cancer, Alzheimer’s disease, and many more. Read more about Dr. Su’s philosophy on this in his column “Is There Essential Carbohydrate?”

MARK SISSON, AUTHOR OF PRIMAL BLUEPRINT AND “MARK’S DAILY APPLE” BLOG
I see an unnecessary trend towards differentiation in the ancsetral/paleo/primal/lowcarb world. We are somehow trying to find all the ways we are different (which only confuses people) rather than identifying all the ways in which we are very alike and aligned, and then understanding the subtle differences that remain.

From my perspective, the Jaminet’s “Perfect Health” and my “Primal Blueprint” are quite close. Paul and Shou-Ching say not to eat cereal grains, legumes, high sugar/HFCS foods, and keep PUFAs low. I agree totally. Everyone is well-served by that.

They say you should take in 400-600 calories in the form of carbohydrate a day. I have said for years that 100-150 grams a day was the “Maintenance Zone” once you are at your ideal body composition. That equals 400-600 calories a day from carbs.

Jaminets allow temporary forays into low carb, “ketogenic” periods (at around 50 grams carbs a day). I agree that for rapid weight loss or on IF days that works well. Be clear that I am not a “carb hater” but prefer to look at carbs as an elective macronutrient. I am also a big fan of ketosis (I’m not sure Paul is as big a fan) and believe that being fat-adapted and keto-adapted greatly reduces the body’s need for glucose. I see no harm in staying in the 50-100 gram range for long periods ever, provided you’re otherwise eating primally and you are not a physical laborer or chronic-cardio participant.

The Jaminets say not to count vegetables in among your carb sources. Here’s a place we disagree. I argue that vegetable carb calories/grams are perfectly legitimate and a great source of micronutrients not otherwise present in modern high-fat or protein-based foods. I also believe that the only fiber we need is that found in adequate servings of fruits and veggies – and maybe the occasional tuber.

I agree that it’s fine to “supplement” carb intake with tubers (plaintains, sweet potatoes, etc) if needed or desired. He adds rice and white potatoes to that list. I have no problem with that, other than they are a bit further down the “acceptable” spectrum for me. I don’t pay much attention to GI, so that’s not an issue. So we’re still close. If his and my adherents are getting 100 grams of carbs a day from starches and 50 or so from veggies, we’re both in the ideal range (he’ll argue that we’re at the low end with 100 and not counting the veggies – I’ll argue that we’re at the high end, counting the veggies). No problem. A 50 gram swing here or there, day-to-day makes little difference over the long haul.

I am a fan of berries and not so much of other fruits, certainly not in copious amounts. He agrees.

I agree with Paul that dysbiosis is a problem with many people, but I believe the FOS in vegetables, along with an occasional (or regular) probiotic supplement, can offer a benefit. He might disagree with the FOS thing, but he still encourages copious vegetable intake, so it can’t be all that bad…

We both agree that fats should supply most of the calories.

Overall, I see how closely aligned we are. As we evolve in this way of thinking, the one truth that emerges is that our avoiding grains, HFCS, and seed oils will have a far greater impact on health than agonizing over dialing in all the rest of the minutiae. That’s where the n=1 starts to become valuable.

DR. LAUREN NOEL, NATUROPATHIC DOCTOR AND HOST OF “THE DR. LO SHOW”
According to my knowledge, the only cells that require glucose for fuel are RBC’s because they lack mitochondria. Otherwise, all tissues can run on ketones. I’m not sure where his thought process comes from. I also see candida frequently in my practice, and putting patients on white rice and sweet potatoes is not a good idea. It would aggravate their condition. Perhaps in a completely healthy human being this may be a good diet, but most humans aren’t healthy. Everyone is uniquely different and therefore require a uniquely different diet.

DR. DANIEL CHONG, NATUROPATHIC PALEO PHYSICIAN
This is an area that I have been interested in now for the last year or so. However, I have to admit, aside from some info I have read from Stephan Guyenet and the Kitava study, and Anthony Colpo, I haven’t researched it much (just learning a lot of different things in medicine these days). I am well aware of the Perfect Health Diet and think there are some very valid points. I just haven’t had the time to pick through it all.

My biggest concerns with low carb are its apparent effects on cortisol output and serotonin levels. I have yet to come across

1) “insufficient production of mucus in the digestive tract” leading to dysbiosis
2) vitamin deficiencies (he particularly mentions Vitamin C and glutathione on pages 253-254)

Nor am I aware of such advice for cancer patients either.

It all sounds quite interesting though. I just wish I could be a better source of info for you. If you want to talk about the dangers of EMFs and Earthing, though are two of my current areas of ongoing learning, as I think you heard my recent interview on that subject at Dr. Lo’s radio show.

I guess I’d just say that what first got me thinking about this whole topic was common sense. Common sense is why I got interested in the Paleo diet in the first place. There are studies out there to prove everything, so I don’t put all my eggs in the research basket. It does, however, make sense to eat what humans have eaten for the longest and what allowed us to grow big brains and separate from the rest of the animal world. However, it doesn’t make sense that the best diet within that umbrella would be low in starch, as that was the most common staple for the most people evolving during that time.

DR. GREG ELLIS, PROLIFIC LOW-CARB AUTHOR
I did not buy the book and can only go from what I’m reading on the website. I can’t specifically find a definition for a “safe starch.” My thought is that much of this is just made up.

We have no need to eat any carbohydrates at all and glucose is one of the nastiest things we can eat. If you want to talk about toxins then glucose is at the top of the list. The body will produce all the glucose it needs via gluconeogenisis. If glycosylation is truly important there is enough glucose available to perform this function without eating glucose or carbs.

The distinction must be made between glycation of proteins and glycosylation. The first is not an enzymatic reaction and glucose just binds willy-nilly to the proteins of the body causing glycated proteins. There is no need for this process to occur and it is the root of most diseases including cancer.

All carbs digest to glucose and that means all of them are unsafe. There is no such thing as a safe carb and, yes, the quantitiy does matter because although glucose is dangereous we were built to handle a certain amount of many different toxins. Based on his calorie record, one would consume 100-125 grams of carb/day which is not terribly bad. His therapeutic ketogenic diet would supply 50 grams.

Therapeutic for what? Cancer. We know it will work for that but then he says wait a minute, we need glucose to make glycosylated proteins so this is a contradiction.

He also appears to be yet another advocate of a plant-based diet as are so many today and I’m sure has bought into the dangers of fat and cholesterol. Yet he recommends that 50-70% of calories come from fat. Pretty difficult to do on a plant-based diet. He says 2/3 plant foods.

My thought is that he just constructed this out of thin air, I don’t see any science here but just opinions and then the plan.

Why would a fungal condition benefit from more starch. Fungi must produce energy anaerobically as they have no mitochondria so can’t process it via oxygen. They thrive on sugar and so do cancer cells.

I just can’t see it and to me it’s just another form of zealotry which sucks everyone in since they can’t analyze anything he says.

DR. RON ROSEDALE, LOW-CARB PHYSICIAN SPECIALIZING IN LEPTIN
i.e. so-called ‘safe starches’, diabetes, and blood glucose;

A major factor that is being missed as is true about almost everybody talking about anything to do with diabetes is that diabetes, is not a disease of blood sugar (which is secondary), but a disease of abnormal hormone signaling, especially insulin and even more-so leptin, and this is primary. When one is relatively young or pre-diabetic, the secretion of insulin and leptin when one eats non fiber carbohydrates can compensate for the moderate intake of starch and other sugars, but it does so at the expense of greater and greater insulin and leptin resistance accumulated over months and years. One should not be fooled by focusing on so-called normal blood sugars. That is what the medical profession is and has been doing for the last half a century by giving patients unlimited amounts of insulin and multiple drugs that raise insulin while only looking at their blood sugar while ignoring the copious detriments of elevated insulin. The results are deadly as the ACCORD study showed, and that basic science has shown for at least two decades, that ‘medical science’ has also ignored. It is what goes on behind the glucose scene especially pertaining to metabolic hormones and future damage that must be paramount in ones thinking.

Also, there is really no totally safe level of blood sugar that will not cause non-enzymatic glycation or damage. The thresholds for diagnosing diabetes are arbitrary numbers. As such, I consider most everybody to have diabetes; just different degrees. Is the intake of 100 g daily of starch/sugar terrible? No, compared to the vast majority of diets being consumed. Can one hundred grams starch be tolerated? Yes, by most. Can it be called healthy? That depends on if one means healthy or healthier than what is unhealthy. My answer would be no.
i.e. so-called ‘safe starches’, reduced metabolic stress, and manufacture of mucous;

Gluconeogenesis from amino acids/proteins is unhealthy, I agree. However, manufacturing glucose from glycerol is not a stressful or difficult process. One glycerol + one glycerol equals one glucose… The glycerol comes from the backbone of triglycerides when one is burning off the fatty acids. The key is to be able to burn the fatty acids i.e. burn fat. And the only way one can do that is by keeping insulin and glucose low.

One also cannot ignore the massive change (for the worse) in genetic expression pertaining to maintenance and repair, i.e. health, when one raises nutrient sensing hormones and pathways, especially insulin, leptin, mTOR, that almost 2 decades of very robust science has taught us.

When well adapted to burning fat, perhaps after 2 to 3 months, a person can derive virtually all their energy needs from fatty acids, ketones, and glucose derived from glycerol from fat. Also, it is virtually impossible not to ingest some sugar that would be found in nuts and vegetables even on a good low-carb RR diet.

Therefore, going out of your way to eat “safe starches” to raise blood sugar, is like going out of your way to glycate. Oh yeah, that is what safe starch proponents are also suggesting.. Eating extra glucose will not make mucus any more than taking calcium will make bone. There must be instructions to do so, and it must be an enzymatically directed. Enzymatically directed and beneficial glycation will happen regardless of our glucose intake, and damaging non-enzymatic glycation will happen far sooner and more often than we would care to realize and contribute to accelerated aging, disease, and our ultimate demise. It doesn’t need our help.

i.e. ‘safe starches’, cancer and glucose;

First, it must be noted that we all get/have some cancer cells most, if not all of the time…the below is pertinent to all people.

Aggressive cancer, meaning cancer that is outpacing its blood supply, meaning anaerobic cells, require glucose as fuel. The vast majority of our other noncancerous cells do fine, actually better, burning fatty acids and ketones.

We must minimize excessive instructions for cells to reproduce/divide, therefore we must keep insulin/IGF, mTOR as low as possible. To do this, eliminate as much sugar/starch from the diet as possible. Therefore, one must keep glucose down. Ingest as little glucose/starch and other sugars as possible–not 100 gm, perhaps less than 50 gm. most days (and do not eat excess protein).

i.e. Paul Jaminet’s blog post ‘Can there be a carbohydrate deficiency?’ i.e. Is there a need for carbs?;

Paul Jaminet answers his question affirmatively by stating, “The brain is the biggest determinant of glucose needs. While other primates need only about 7% of energy as glucose or ketones, humans need about 20%. Compared to other primates, humans have a 12% smaller liver. This means we can’t manufacture as much glucose from protein as animals can. Humans also have a 40% smaller gut. This means we can’t manufacture many short-chain fatty acids, which supply ketones or glucogenic substrates, from plant fiber. So, while animals can meet their tiny glucose needs (5% of calories) in their big livers, humans may not be able to meet our big glucose needs (20-30% of calories) from our small livers. So any carbohydrate deficiency disease will strike humans only, not animals.”

I must disagree with Paul conceptually and factually. The brain needing 20% glucose is only under conditions of insufficient adaptation to burning ketones. Basic metabolic textbooks talk about adaptation to carbohydrate “starvation” when the brain starts deriving the vast majority of its energy needs from ketones derived from fat metabolism. After several weeks of adaptation the brain can derive at least 80% of its energy needs from ketones. After a longer period of time it can derive more. Regardless, the remainder of the brain’s energy needs can be met from gluconeogenesis using glycerol derived from the breakdown of triglycerides as substrate such that gluconeogenesis derived from amino acids is minimal to nonexistent, sparing lean mass. In fact, my patients who strictly adhered to my very low carbohydrate dietary recommendations generally increased lean mass without increasing exercise.

The size of the human liver has little to nothing to do with its metabolic abilities. Rather, it’s adaptation to available nutrients and even more importantly its control by, and indeed its sensitivity to metabolic hormones such as insulin and leptin are much more important to its function. Eating 100 g of glucose forming carbohydrates daily is enough to sufficiently raise insulin to shut down ketone production by the liver resulting in the necessity to use glucose as fuel by the brain. As such, what Jaminet is recommending is a self-fulfilling prophecy; requiring the consumption of glucose forming carbohydrates such as potatoes and rice increases blood glucose and insulin enough to greatly reduce ketone production, necessitating the use of glucose by the brain. This is not good. I have talked decades about the change in brain function when it converts from glucose to primarily ketone use; it becomes much healthier. Studies are now pouring in on the connection between glucose and chronic brain diseases. Jaminet rightly mentions the benefit of increasing ketone use in epilepsy. Epilepsy is an extreme of an over excitable brain. Is it possible that a brain primarily burning ketones as its primary fuel may function better all of the time? I believe strongly that the answer to this is yes.

Further counterpoints to the need for carbs;

I have never seen a list of essential nutrients that included a single carbohydrate. This means, that as far as current science knows, a human being does not have to take a single gram of carbohydrate their entire life to maintain health. This is because it is well known that although there is a certain need for carbohydrates and sugars, the body can make what it needs from other sources, either triglycerides or proteins. If the body is using fat as its primary fuel, then it needs (much) less glucose. The glucose that is necessary (more for anaerobic red blood cells than the brain) can either come from glycerol from the breakdown of triglycerides or from glucogenic amino acids that would be much less desirable. Deriving glucose from amino acids from protein requires either the consumption of excess protein–not good (I have written much about this previously) or the breakdown of lean mass–obviously not good, but no choice if one can’t eat i.e. while sleeping. So the real question becomes, not whether carbohydrates are needed, but what other sources will the body use as substrates to make the glucose that it needs while not necessitating oral consumption. By far, the best substrate for glucose manufacture is glycerol, but this is largely only available if one is oxidizing fatty acids from triglycerides, and this is not possible when one consumes glucose forming foods such as rice and potatoes thus raising insulin and leptin and shutting off fatty acid oxidation.

i.e. Leptin and a point of major importance that is a prime source of confusion, error, and division in the paleo and other health communities;

It appears to me that the paleo community has now been divided between a faction that backs Taubes who believes that insulin is supreme and the major cause of obesity, and a faction backed by Harris, Jaminet, Guyenet, and others who believe that insulin and glucose is less important and that leptin is more important in obesity and perhaps other diseases, and therefore eating so-called “safe starches” is OK if not even desirable. The major issue and source of confusion that I see, is that they are both half right and half wrong, but opposite halves. Taubes is right that sugars, starch, and elevated insulin are a major source of disease if not obesity that I heralded 2 decades ago, but not fully correct as to why. The Jaminet, Guyenet, Kruse, and Harris group is right that leptin likely supersedes insulin as far as importance in obesity, diabetes, and other chronic diseases, at least in humans. However, they are quite wrong in believing that it is therefore okay to consume “safe starches” that will largely digest into glucose. Though true that leptin, more than insulin, controls fat storage and perhaps even blood glucose levels, this does not mean that raising insulin levels via glucose is unimportant. It still plays a huge role in the control of genetic expression influencing the aging and chronic disease phenotype.

However they all, including Harris, Jaminet, Guyenet, Kruse, Taubes, and even those who have written books after me about leptin, seem to be missing a very critical and main functional point about leptin… Leptin levels and ultimately leptin resistance, and therefore chronic diseases of aging including obesity and diabetes, are determined more from spikes and elevations in glucose following meals than anything else including the amount of one’s stored fat. Though elevations in glucose raising insulin may not be the major cause of obesity and fat accumulation (though still very important), the fact that glucose spikes leptin still places sugars, including glucose from so-called “safe starches” and fructose, at the centerpiece of obesity and disease.

i.e. the longevity of the Okinawans and Kitavans:

First of all, population studies are the least scientifically robust form of health science. That being said, there are many speculations of why Okinawans have a high number of centenarians. Firstly, we must distinguish between increasing maximal lifespan that CR has been shown to do and I believe my diet can also do, and increasing average lifespan. Increasing average lifespan is nice but not near as powerful as extending youth and increasing maximum lifespan. For that there are no human counterpart and we have no footsteps to follow, only science as revealed in animal studies. That being said, the Okinawans eat considerably more fish than other groups and a higher percentage of carbohydrates as vegetables i.e. fiber as opposed to starches. Most of the fiber gets excreted, so Okinawans are likely relatively calorie restricted. Also, overindulging in food among Okinawans is very frowned upon.

What Nick Lane has said in his book “Oxygen” is the following, p 275; “based on a 25 year study, the book [The Okinawa Way written by a Japanese cardiologist] argues that the secret of the Okinawans… goes beyond genes, diet, and exercise to their relaxed lifestyle and low level of stress. The Okinawans have a word for it, “tege”, which means ‘half-done’: forget timetables, forget finishing today things that can be done tomorrow. I suspect they are probably right.”

In the most comprehensive study pertaining to the Okinawan diet and longevity entitled, “Caloric Restriction, the Traditional Okinawan Diet, and Healthy Aging” published in the Annals of the New York Academy of Sciences, the following was found; “Findings include low caloric intake and negative energy balance at younger ages, little weight gain with age, life-long low BMI…and survival patterns consistent with extended mean and maximum life span.” The study concluded; “This study [Caloric Restriction, the Traditional Okinawan Diet, and Healthy Aging] lends epidemiologic support for phenotypic benefits of CR in humans and is consistent with the well-known literature on animals with regard to CR phenotypes and healthy aging.”… I have not seen a breakdown of the calories eaten, but it’s known that they eat more fish and fibrous vegetables and lower calories. Simple logic could conclude that they eat fewer non-fiber carbohydrates, which, along with reduced stress, may account for their increased average lifespan.

Though my knowledge of the Kitavans is less, I believe much the same applies to them, and there are similar myths based on poor science and falsities that is being written about them that unfortunately is getting much unwarranted publicity.

DR. JOE LEONARDI, CHIROPRACTOR AND AUTHOR OF FAT THEN FIT NOW
I have to admit that I am not very familiar with Dr. Jaminet’s work, I checked out his web site and with just a quick glance, he doesn’t seem extremely different from my thinking, with the exception of the starches. I am interested to learn more about his theories, however for now, I am forming my response based upon the contents of your email.

On the topic of “safe starches,” one of the aspects I have mentioned in interviews and speaking engagements is the fact that many of what Dr. Paul Jaminet refers to as “safe starches” are not what they once were. With the advent of global agribusiness and genetic engineering, many of these starches contain an over abundance of polysaccharides per item. A white potato, when I was younger was on average about 1/2 the size of my fist, today it is about 1/2 the size of my upper arm. This increase in size is all saccharides and if one were to consume potatoes he or she would have to be aware of this, however, Dr Jaminet’s recommendations do have a restriction on the total amount of consumed carbohydrate, and since he his recommending a prescribed amount, the size of an individual potato is irrelevant in his methodology.

I have read from other sources about some of his rational for consuming carbohydrates. Regardless if what he says is 100% accurate, I am of the belief that our bodies do in fact require some carbohydrates. Human physiology functions on ingestion of all the macro-nutrients. The issue for optimum health and weight management is the source and proportion. Those of us who advocate a more whole food, primal/paleo, lower carbohydrate diet are concerned with avoiding overly processed foods including breads, pastas, cereals, etc. Moreover, we don’t accept the vilification of dietary fats from as close to natural sources as possible. From what you have sent me, it appears that his “safe starches” are all foods that can be found in a natural state.

Paul Jaminet’s recommendations do not really fall to far from the mark, from what I recall, of Dr. Atkins’s original recommendations. Dr. Atkins did not recommend long term carbohydrate restriction in the 20 gram range. If my memory serves me correctly, he stated as we moved into maintenance, we should add carbohydrates back into our diet, while monitoring our weight, until we reached an appropriate balance.

In my book I don’t give breakdowns in grams, calories or percentages, I give guidelines, which if followed, keep an overall balance. When I am maintaining my weight, I keep my carbohydrate consumption in the 60-80 gram range. For me personally, anything above that and I start to add some weight and my energy level drops. Additionally in my book, in the second and third dietary stages, I recommend eating carbohydrates from fresh fruit sources.

Since all polysaccharides are broken down into component parts of glucose, fructose and galactose, depending on their source, I don’t really have an issue with his “safe starch” list. I tend to go more for fresh, small farm, locally grown fruits, simply because many of the “safe starches” have been so modified I am unsure of the quality of their nutrient content. This may be a risk with the fruits I consume, of course, but I am personally more comfortable with fruit as a source of carbohydrate.

DR. BG FROM THE “ANIMAL PHARM” BLOG
My ideas on safe starches revolves around repairing adrenal function. So many of us are damaged adrenally. Carbs improve the situation! It can be anything (even sugar)! According to Wilson’s book Adrenal Fatigue he advises ~2 carbs per meal and 1/2 -1 carb per snack–105 grams or more per day in other words. Before I cycled 40 grams on low carb days up to 80 grams on work out days. I’ve been doing upwards of 100-120 grams on the ‘cortisol’ days because Schwarzbein advises in order to fix the adrenals, the serum insulin needs to be higher than the cortisol. I don’t recall her being too specific with the labs but I feel ‘better’ on higher carbs for the adrenals.

According to a lot of statistics, a lot of people have incompetent adrenals. On Paleohacks there are countless stories of people on VLC paleo who feel dizzy or lightheaded. H-E-L-L-O this is cardinal signs and symptoms of adrenal fatigue. Many of these folks are also doing HIIT and hard core CROSSFIT!

My thoughts involve getting diagnosed for adrenal incompetence then treat accordingly with carbs (any carbs). When the adrenals perk up, then the thyroid will perk up as well. Men with low Testosterone will start experiencing improved libido, higher free T and s*xxxiness again. Women — infertility, PCOS and menstrual dysfunction also improve! Adrenals are the spark plugs for our energy flow. Unfortunately they require adequate cortisol. Again cortisol gets pounded by low blood glucoses, ketosis, fasting and other forms of glycolytic ‘stressors’ like endurance or high intensity exericse or heavy lifting.

ZOE HARCOMBE, BRITISH OBESITY RESEARCHER AND AUTHOR
When asked any question about what we should eat, I always go back to first principles – we eat because we need fuel (calories), macro nutrients and micro nutrients. We can safely assume, in the ‘developed’ world, that we no longer have difficulty getting enough fuel – the debate is more – in which form should that fuel come. The macro nutrients that we need are fat (not least for the essential fats) and protein (essential and other amino acids). I do not believe that we need carbohydrates – but that’s what this query is about, so we’ll come back to that. We also need 13 vitamins and c. 16 minerals.

All fuel, fats, proteins, vitamins and minerals can be supplied by animal foods and this must be the case or our ancestors would not have survived the 30,000 year ice age, which ended but 10,000 years ago. Liver (and animal glands) can supply vitamin C and our need for vitamin C is substantially reduced if we don’t eat carbohydrates (vitamin C uses the same receptors as glucose to enter the cell membrane, so, if we have eaten lots of carbs, less vitamin C can be absorbed because the receptors are in use and therefore we need more.) Hence we can obtain all the nutrition that we need from food without eating carbs.

My preferred way to get vitamin C is from vegetables, not raw liver (vit C is largely destroyed in cooking). Hence I’m pleased to see that vegetables are ‘free’ in Paul Jaminet’s plan, as I think most people should be eating non starchy vegetables and salads freely. Only the most carbohydrate sensitive people may need to count carbs to the level of those in vegetables and salads.

I haven’t got Paul’s book, so I can only go on the query as emailed from Jimmy. On this basis I understand that ‘safe’ starches are considered to be potatoes, sweet potatoes (as the name suggests – sweeter than normal potatoes), rice, yams, plantains etc. As raw products, these range from 18g of carb per 100g weight (normal potato) to 80g of carb per 100g for white rice. Cooked, rice comes down to about 28g of carb, as water is absorbed. (Sunflower seeds have 20g of carb per 100g and almonds have 22g – these are far more nutritious foods if you want to go to that level of carb and get a better ‘bang for the buck’ – especially sunflower seeds for vitamin E. Dairy too – at c 5% carb, as a rule of thumb and packed with calcium and vitamins A and D – would be far higher on my list than any starches).

It may be a minor point, but we also eat for taste and these products are simply tasteless in my view. Rice is nothing without an awesome curry; potatoes are nothing without melted cheese and butter – so have the curry, cheese and butter and ditch the bland starches! I gagged when I first tried plantain, or was it a yam – same difference. No wonder these were not under the “pleasure foods” label!
Do we need carbs in the diet at all? No. We simply cannot have evolved to need them or we wouldn’t be here.

Do we need carbs for fuel? No. Mark Sisson sums it up perfectly.

Do we need carbs for vitamin C? No. Vitamin C can be amply supplied in Paul’s plan by vegetables – raw yellow pepper being one of the best sources; raw broccoli similarly. They can be supplied without carbs, period.

Do we need carbs to counter dysbiosis? I can only see how carbs would make digestive flora more imbalanced – not less. We know that Candida is one of the major gut inhabitants prone to overgrowth. Bacterial dysbiosis flourishes in similar circumstances of imbalance and Candida loves to feed on sugars. The glucose into which starchy foods are broken down feeds Candida beautifully. When I wrote “Why do you overeat? When all you want is to be slim” (2004) and explored Candida at length, as a driver of food cravings, I researched the original experts in the field of Candida: Chaitow (Candida Albicans: Could yeast be your problem?); Trowbridge & Walker (The Yeast Syndrome) and Crook (The Yeast Connection). Chaitow, Trowbridge & Walker all banned potatoes and Crook’s advice was to eat them with caution. Chaitow allowed brown rice; Trowbridge & Walker allowed none and Crook again advised eating rice with caution. Hence I really cannot see how eating carbs would help with gut balance.

The other concerns I have about starches, which do not make me consider them safe, are:

1) There are 171 million diabetes sufferers worldwide and the World Health Organisation XE “World Health Organisation” estimate is that this will rise to 366 million by 2030. 95% of these are type 2. The macronutrient that can cause diabetes is carbohydrate. Why do we want to encourage consumption of starches in this circumstance?

2) The normal blood glucose range is 0.8 – 1.1 grams of glucose per litre of blood. An average human has 5 litres of blood, so that’s 4 – 5.5 grams of glucose needed in the blood stream at any time. With glucose approximating to 4 calories per gram, this equates to about 16 – 22 calories of glucose. That’s a teaspoon of sugar. This page recommends “Daily carbohydrate intake should be 400-600 calories, primarily from starches”. That’s 25-38 times the amount needed to get the body to the bottom of the normal range – and we would not be starting from 0. This is frightening.

3) I specialize in obesity and weight loss – that’s my passion. As Gary Taubes beautifully explained – gaining weight is defined by creation of triglyceride (fat structure) and weight loss is defined by breaking down triglyceride. The former happens when carbs provide glucose to provide the glycerol ‘backbone’ to join three fats together. The latter happens when there is no glucose available and the body can break down the triglyceride to get glycerol/glucose and fat for fuel. Again – why would we want to encourage consumption of starch (glucose) in the midst of an obesity epidemic?

I like a great deal about Paul’s plan: real food, not processed; no sugar or grains; no vegetable oils; proper fats like lard and butter; plenty of meat, fish and eggs; fruits only in moderation; chocolate (I assume very dark) rightly recognized as a pleasure – and a fantastic source of many difficult-to-get minerals like copper, iron, magnesium and manganese etc. There are only two things I don’t like – sweeteners and starches. Ditch those and this would be great advice.

DR. STEPHEN PHINNEY, LONG-TIME LOW-CARB DIET RESEARCHER AND AUTHOR
On the topic of dietary carbohydrates of any kind and blood glucose regulation:
Clearly some carbohydrate foods raise blood glucose more than others, which is the basis for both the ‘glycemic index’ and presumably the ‘safe starches’ concepts. In part, how fast your body absorbs the carbohydrates you eat influences how these energy sources are processed.

The other half of this picture is how promptly your body can ‘tuck away’ the absorbed carbohydrate, which passes through the blood stream mostly as glucose (which means you need both adequate insulin in the blood and insulin sensitive cells to clear it).

Insulin resistance (the hallmark of both metabolic syndrome and type-2 diabetes) occurs to a varying degree in many of us. Thus the more insulin resistant we are, the less tolerant we are of dietary carbohydrate from the different dietary sources (i.e., one persons ‘safe starch’ may far exceed the carbohydrate tolerance of someone else who is more insulin resistant). Many people with type-2 diabetes go into complete remission when they eat less than 50 grams per day of total carbohydrate, but remain diabetic if they eat 100-150 grams (400-600 Calories) of carbohydrate (independent of what grain or tuber it comes from).

There is no absolute human requirement for dietary carbohydrate. In our many published studies of human research subjects given well-formulated very low carbohydrate diets (e.g., 5-50 grams of total carbohydrate per day), we never observed low blood sugar levels. In fact, in my 1983 study of bicycle racers eating an Inuit diet, even when we exercised them to exhaustion, their blood glucose values remained normal. Simply put, if the body maintains a normal blood glucose level with little or no carbohydrate sources in the diet, how can one argue that they are required?

If the level of glucose during a well-formulated very low carbohydrate diet is maintained in the normal range, how can one credibly postulate inadequate glucose availability for glycosylation?

On the topic of vitamins
In both his Arctic experience and his Bellevue experiment, Stefansson dealt with the issue of vitamin deficiencies on the aboriginal Inuit diet. If anything, the inclusion of white rice in one’s diet (which has been stripped of its vitamins including thiamin) raises more concerns than answers. There are no reports of vitamin inadequacy in people eating well-formulated ketogenic diets (including the copious vegetables and moderate berry fruit recommended in our two recent books).

On the topic of dysbiosis
Various parts of the body produce mucous under inflammatory challenge (e.g., the nose when challenged by a virus or allergen). Multiple human studies (some by us) have demonstrated that dietary carbohydrates increase the body’s level of inflammation, so it is not surprising that adding more carbohydrate to the diet increases intestinal mucous production. But what puzzles me is why one would think this is a good thing? As we have repeatedly demonstrated, when fluids and minerals are properly managed, digestion and colon functions are well maintain (if not markedly improved) during a well-formulated ketogenic diet.

DR. RICHARD BERNSTEIN, LOW-CARB DIABETES PHYSICIAN AND AUTHOR
This sounds like BS to me!

Now that you’ve heard from the low-carb and Paleo experts, let’s hear from YOU and what you think about this whole controversy surrounding the so-called “safe starches” promoted by Paul Jaminet in his book The Perfect Health Diet. This is an important discussion and I look forward to the open exchange of ideas on this. Let the conversation begin!