Sunday, January 29, 2012

The Nutrition Debate #38: The Perfect Health Diet

“The Perfect Health Diet is more than just a diet – it is a program for perfect health, “ say Paul Jaminet, Ph.D., and Shou-Ching Shih Jaminet, Ph.D., who developed it. “A diet like the Perfect Health Diet should be the first treatment option in most diseases and an adjunct to therapy in all,” they say at I say, you don’t have to have a disease to eat a diet for perfect health. After all, as we all know, “you are what you eat.”

The Perfect Health Diet was developed by “two scientists with a longstanding interest in diet and health. We have been experimenting with low-carb diets since 2005,” they say, and “have successfully healed our own ‘middle-age’ and chronic health problems through diet.” Their plan has adherents eating about two-thirds plant foods and one-third animal based foods by weight. Besides a high fat content, the diet is further characterized by complete avoidance of sugar and cereal grains. On their website they say, “Do not eat toxic foods, notably:

• Do not eat cereal grains – wheat, barley, oats, and corn – and foods that contain them – bread, pasta, breakfast cereals, and oatmeal. The exception is white rice, which we count among our “safe starches.” Rice noodles, rice crackers, and the like are fine.
• Do not eat calorie-rich legumes. Peas and green beans are fine. Soy and peanuts should be absolutely excluded.
• Do not eat food with added sugar or high-fructose corn syrup. Do not drink anything that contains sugar. Healthy drinks are water, tea and coffee.
• Polyunsaturated fats should be a small fraction of the diet (~4% of total calories). To achieve this, do not eat seed oils such as soybean oil, corn oil, safflower oil, sunflower oil, canola oil, or the like. The best cooking oils are coconut oil, clarified butter, and beef tallow; palm oil, lard, olive oil and avocado oil are next best.

“Eat nourishing foods: liver, egg yolks, seaweeds, and shellfish, vegetable and bone broths. Make sauces from an acid (lemon juice, vinegar), an oil, and herbs. Get sufficient salt.

“Take care to obtain adequate amounts of eight critical micronutrients: vitamin D, vitamin K2, iodine, selenium, magnesium, copper, chromium and vitamin C. Many of these can be obtained from sunlight (vitamin D) or what we call ‘supplemental foods:’ seaweed for iodine, Brazil nuts for selenium, beef liver for copper. Others may need to be supplemented.” They don’t recommend fish oil supplements, but they do recommend oily fish like salmon and sardines.

The authors of the Perfect Health Diet (PHD Diet, as they’re both PH.D.’s, get it?) consider their program low-carb. With 400-600 calories (100-150 grams) from carbohydrates (mostly “safe starches” like rice, potatoes, sweet potatoes, taro), plus fruit and berries, it is lower than the Standard American Diet (SAD) which recommends 1200 calories (300 grams) a day from carbs. They suggest that if your metabolism is compromised (for example, by obesity or other manifestations associated with Metabolic Syndrome), you should lower the carbs further to ~200 carb calories (50 grams), a level they consider a “therapeutic ketogenic diet.”

Protein should be, they say, “a modest fraction of daily calories,” which they define at 200-400 calories (50-100 grams). That’s the same amount as in the SAD and about the same as I try to eat as well. “Fats should supply most (50-70%) daily calories,” they conclude. Taking the middle value for all three macronutrients, that produces 500 carb calories (125g), 300 protein calories (75g), and 1200 fat calories ( ̴ 133g) = 2000 calories total. The therapeutic ketogenic version would be 200 carb calories (50g.), 1700 calories total, and a good formulation for both weight loss and therapeutic features.

In many ways the Perfect Health Diet is similar to the Archivore program developed by Kurt Harris, M. D., discussed in columns #18 and 19 in this series. You can read them at The principles are similar, but Harris says his program is more rooted in ethnography and anthropology. Jaminet points to evolutionary indicators of the optimal diet for perfect health (e.g., breast milk for infants) and mammalian diets in general. Both agree, Jaminet concludes, “Fortunately, all of these sources of insight seem to be consistent in supporting low-carb, animal-food-rich diets – a result which is gratifying and should give us confidence.”

My absolute favorite thing about the PHD Diet is the graphical symbol (a pictogram) for the program that they created to depict the foods they recommend we eat and not eat. Check it out here:

© Dan Brown 1/29/12

Sunday, January 22, 2012

The Nutrition Debate #37: Therapeutic (vs. Prophylactic) Dieting

A prophylactic diet is designed to lose weight and to prevent the health consequences of weight gain: the advent of disease. A therapeutic diet is designed to lose weight and to address the consequences of the onset of disease. A select list of therapeutic diets illustrates how a diet can be designed both to lose weight and to improve your health.

The Ketogenic Diet
The original Ketogenic Diet, developed in the early 1920’s to treat epilepsy in children, was an effective medical therapy. Its popularity waned with the introduction of modern drugs. The diet is 90% fat by calories. Think cod liver oil.

The Atkins Diet
Atkins is considered to be low carb (which it is), and high protein (which it isn’t!), because nobody is willing to mention high fat. It is high fat. Atkins is a modified version of the ketogenic diet at 55-65% fat. It gained favor as a weight loss diet especially for people with medical conditions, such as dyslipidemia (cholesterol issues), hypertension (high blood pressure), and Type 2 diabetes mellitus. It is also an especially effective approach for those just manifesting symptoms of Metabolic Syndrome. Re-read column #9 (Metabolic Syndrome – the American Disease of Civilization) to review the symptoms and to evaluate yourself.

The Bernstein Diet
Richard K. Bernstein, M. D., has been a Type 1 diabetic for about 60 years. He developed a very low carb, moderate protein diet (30 grams of carbohydrate a day: 6-12-12 for breakfast, lunch and dinner). This WOE (way of eating) emphasizes “eating to meter” in order to control post prandial blood glucose levels. This diet program is a very effective way to lose weight, without hunger or lethargy, and to improve your laboratory test results (blood sugar, blood lipids and often blood pressure as well), but it requires major changes in what you eat and strict compliance. It’s challenging, unless you realize your life and good health depend on it. Many Type 2’s and others who wish to avoid becoming T2 eat 6-12-12. By “eating to meter” you learn to maintain glucose homeostasis, and thus avoid worsening insulin resistance.

The Diet Doctor’s LCHF Diet
Column # 35 in this column introduces this program. LCHF stands for Low Carb, High Fat. There, I’ve said it again. Eating high fat is a great way to lose fat for most people. It provides satiety, a sense of fullness that permits you to eat three small meals a day with no snacks and maximize fat burning. According to Dr. Andreas Eenfeldt, the ‘Diet Doctor,’ twenty-three percent of Swedes are trying to eat low carb.

These diets are all safe and effective therapeutic diets. They are mostly designed for Type 2 diabetics (like me), or pre-diabetic, or overweight with symptoms of Metabolic Syndrome. They require major changes in your diet and a lot of self control, but they are life changing in their benefits: dramatic and simple weight loss without hunger and with lots of energy, and most important, equally dramatic improvements in health by all clinical measurements (blood lipids, i.e. cholesterol, blood glucose and blood pressure). But because they require major changes, and strict compliance (no cheating!) most people won’t even give them a brief trial.

Besides, unless your doctor tells you that you are sick, you may not think there is reason to change your lifestyle. And, if you believe him when he says ‘take this pill (and eat less and exercise more) and you’ll be healthy, you won’t think it necessary to undertake major changes. Consider taking responsibility for your own health. After all, most people, still, are not diagnosed with a chronic disease, yet, but they often have unrecognized symptoms, particularly high post prandial blood glucose readings. And if they do have the symptoms of one of the emergent Diseases of Civilization, when a doctor recognizes them, they prescribe a pharmacological solution (a statin, blood pressure pill(s), Metformin). Sure, for the ‘healthy’ population out there (and most of you think that includes you, right?), the easy thing to do is kick the can down the road a few more years. The sinister thing is: the symptoms of these Diseases of Civilization are progressive. A few more pounds, a few more pills. A prophylactic diet today, a therapeutic diet tomorrow. Is there an alternative? I think there is. Think different (sorry, Steve Jobs): The Perfect Health Diet, next.

© Dan Brown 1/22/12

Sunday, January 15, 2012

The Nutrition Debate #36: Modern Trends in Dieting

This column inaugurates a three part series on dieting, both prophylactic and therapeutic. We emphasize this distinction because we think it is generally unrecognized in the public health community (e.g. “Dietary Guidelines for Americans”). As a consequence most medical practitioners are unaware of it and, in my experience, diabetes educators simply refuse to accept it. The result: the general public does not see the importance of the distinction to their health and well being.

I just rolled by eyes in disbelief when I read that U.S. News and World Report earlier this month had a “panel of 22 experts” rate 25 diet plans and that Weight Watchers and Jenny Craig were among the top rated. These programs emphasize a “balanced diet,” eating less, and exercising more. The reason they continue to be popular, I think, is that the subscriber has to keep coming back year after year after regaining the weight they lost before. They are prophylactic in the sense that the goal is to prevent the consequences to health of being overweight, if they have not yet manifested themselves. (For a discussion of Metabolic Syndrome, see #9 at

The South Beach Diet
Another prophylactic program, The South Beach Diet (a trademarked term), is the creation of cardiologist Arthur Agatston and dietician Marie Almon. It is an ‘alternative’ to low fat approaches such as the Ornish Diet and the Pritikin Diet, advocated by the American Heart Association in the 1980’s. Agatston accepts the prevailing wisdom among cardios that low-fat diets reduce cholesterol and prevent heart disease; however, lower fat means higher carbohydrates, as there are only carbs, fat and protein as calorie sources. Sugar, a simple carb, and other simple carbohydrates, which are rapidly reduced to sugar (glucose) by the digestion process, lead to cycles of hunger. As a result, patients were consuming excess calories and gaining weight. Ironically, the attempt to reduce the risk of heart disease actually increased it, according to Wikipedia.

The South Beach Diet is relatively simple in principle: Replace “bad carbs” and “bad fat” with “good carbs” and “good fat.” The glycemic index (see column #7 in this series) is the scale on which bad carbs and good carbs are measured. And, being designed by a cardiologist, it should be no surprise that the South Beach Diet discourages all saturated fats and favors unsaturated fats, both monounsaturated and polyunsaturated. In sum, the South Beach Diet emphasizes eating the “right carbs,” the “right fats,” and lean protein. Eating this way helps to keep your blood sugar steady. And at the same time you avoid the highly processed, refined carbs that cause drastic swings in blood sugar. Once you stabilize your blood sugar, cravings are virtually eliminated. As a prophylactic plan, the South Beach Diet has some worthy aspects.

The Mediterranean Diet
Another popular prophylactic program is the Mediterranean Diet. Its origins date to the deservedly much maligned Seven Countries Study by Ancel Keys, based on his work in the 40’s and 50’s in which he carefully selected data from 7 countries out of a 22 country study to bolster his hypothesis. It lead to the diet-heart or Lipid Hypothesis (see columns #1 & #3), which in turn lead to the American Heart Association’s endorsement of the hypothesis. This let ultimately to U. S. government policy, through the 1977 McGovern Committee’s work, and the cataclysmic low-fat vs. low carb dichotomy we have in dietary theory today.

Nevertheless, in the 1990’s Dr. Walter Willett of Harvard University’s School of Public Health again helped popularize this diet program. Its main tenets are: high amounts of olive oil, the principal source of fat on the diet; low to moderate amounts of dairy products (principally cheese and yoghurt), fish, poultry and red wine; and low amounts of eggs and red meat. Interestingly, it is a diet high in salt (olives, salt-cured cheese, anchovies, capers, salted-fish roe, and salads dressed in olive oil). It emphasizes abundant plant foods, including legumes, and fresh fruit daily, typically for dessert. The total amount of fat calories in the diet is, however, about 30%, with less than a third from saturated fats. This is not dissimilar to the current Dietary Guidelines for Americans recommended percentages. One of the main differences is the high level of monounsaturated fats, most notable oleic acid, for olive oil. My personal favorite aspect of this diet is the glass or two or red wine daily, although a bowl of berries in full cream for desert once or twice a week would be a close second.

© Dan Brown 1/15/12

Sunday, January 8, 2012

The Nutrition Debate #35: The Diet Doctor and the LCHF Diet

Norway and Finland are running out of butter and Sweden’s gets 19,000 hits a day. The “real food” revolution has come to Scandinavia, according to a presentation that Andreas Eenfeldt, M. D. made at the Ancestral Health Symposium 11th annual meeting in Los Angeles in August 2011. I plan to attend the society’s 12th annual symposium at Harvard Law School, with the Harvard Food Law Society, from August 9-12, 2012, in Cambridge, MA.

Dr. Eenfeldt came to my attention from a video link on Jimmy Moore’s Livin’ la Vida Low Carb website Eenfeldt told how physician Annika Dahlqvist, who pioneered Low Carb High Fat (LCHF) diets in Sweden after failing to lose weight herself, was reported to the authorities for not adhering to the government’s healthy eating program in her practice. She was turned in for malpractice! Naturally, the Swedish National Board of Health and Welfare, Sweden’s highest medical authority, decided to investigate. Fortunately, after a thorough investigation, they declared the LCHF diet was “compatible with scientific evidence and best practice.” Dr. Dahlqvist became an instant sensation and national hero. Today, twenty-three percent of Swedes are trying to eat low carb.

Personally, I think the National Board of Health and Welfare deserves a lot of credit too. They made what amounts to a paradigm shift in national nutrition policy, albeit two generations overdue. In this country, we have not made nearly as much progress, despite the fact that most respected scientific journals now openly trumpet the news that there is “… no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD” and “…there were no clear effects of dietary fat changes on total mortality and cardiovascular mortality.” The 2010 USDA’s Dietary Guidelines for Americans published last January govern school breakfasts and lunches, the WIC program, food stamps, and prison and other institutional dietary programs and they call for very strict limits on saturated fat (see #3, 4, 8 & especially #14 at And our media and most clinical practitioners still preach the low fat gospel.

In Sweden, Dr. Eenfeldt reports that Göran Berglund, Professor of Internal Medicine at Lund, said, “Two generations of Swedes have been given bad dietary advice and have avoided fat for no reason. It’s time to rewrite the dietary guidelines and base them on modern science.” Fredrik Nyström, Professor of Internal Medicine at Linköping, said, “People have been recommending low fat diets for 30 years, and then it turns out to be completely wrong! There is no proven correlation between saturated fats and cardiovascular disease.”

Peter Nilsson, Professor of Cardiovascular Research at Lund, said, “It’s time to face the facts. There is no connection between saturated fats and cardiovascular disease.” Dr Eenfeldt, who provided these quotes in his video presentation to the AHS meeting, then states: "Fear of saturated fats and cholesterol is the foundation for what has become known at the diet-heart or lipid hypothesis." Eenfeldt then states, “When the foundation falls, the entire low fat advice falls.” In other words, the Low Fat diet that we have been misled into following, NOT the currently surging LCHF diet, is the fad diet.

What we are seeing, Dr. Eenfeldt says, is a paradigm shift. Saturated fat which was bad…is now good. Carbohydrates that were once thought to be good…now make us fat and sick when we eat too many. Diabetics are getting sicker every year, based on the bad dietary and medical advice they are getting. And it is getting worse. Under the current circumstances, Dr. Eenfeldt asks on the video, who thinks that the U.S. Department of Agriculture, under whose auspices the Dietary Guidelines are prepared, is going to stop recommending that we eat grains anytime soon? His website lists fourteen randomized controlled trials that show significantly more weight loss with low carb diets than low fat diets. All have links to the respected peer-reviewed journals that published them.

Dr. Eenfeldt’s presentation was well received by a sympathetic audience of scientists, doctors and interested lay people. He concluded with a quote from Victor Hugo: “All the forces in the world are not so powerful as an idea whose time has come.” “The paradigm shift is coming,” he said. “We can change the world.” It’s a hopeful way to start the year, anyway.

© Dan Brown 1/8/12

Sunday, January 1, 2012

The Nutrition Debate #34: Foods that Raise HDL

“HAPPY HOLIDAYS TO YOU ALL,” my doctor, an internist and cardiologist, wrote in an email that he broadcast, I assume, to his friends and selected patients. I replied with a similar wish and a request of him for fresh ideas for subjects/titles for my blog,, which he reads. To my delight he replied with four pithy subjects, the first of which was “Foods that raise HDL.” HDL is “the good cholesterol” in your blood lipid profile.

Actually, I was not surprised by this suggestion. My HDL has almost doubled from 43 average to 78 average since I began eating the way I do. And it was my doctor who suggested that I start this Way of Eating 10 years ago in 2002.

Before I started Low Carbing, my HDL was, in reverse order, 48, 44, 61, 53, 50, 42, 41, 39, 38, 37, 38, 38, 39, 41, 39 & 42 (average of 16 HDL’s over 22 years: 43). The desired range for men is ≥40mg/dl, and for women ≥ 50mg/dl. My recent HDL values, again in reverse order: 67, 92, 78, 71, 78, 81, 86, 91, 98, 67, 57, 63, 79 & 86 (average of 14 HDL’s: 78). I don't know what has caused my HDL to go up since I started Low Carbing. I wish I did. But it's gotta be the foods I eat, right?

The other lipid test that has dramatically improved over the same period is my triglycerides. Before I started Low Carbing, my triglyceride average of 21 previous lipid tests was 137. My triglycerides average for the last (most recent) 21 lipid tests has been 54. I attribute this dramatic improvement primarily to taking fish oil supplements (4 grams daily initially, down to 2 grams a day today). I also eat a can of sardines packed in olive oil almost every day for lunch.

For breakfast I eat 2 fried eggs with 2 strips of bacon and a big cup of coffee with full cream and two Splenda. For lunch I usually eat a can of sardines packed in olive oil and some Splenda sweetened ice tea. Water would be a better choice, of course, but the critical point is: for breakfast, no juice or fruit or bread or cereal or jelly or milk or sugar. They are all high in carbohydrates. And worse, table sugar, and the sugar content of fruits, including whole fruit and fruit juices, is at a minimum fifty percent fructose, which is a liver toxin when taken in large amounts over a long period of time (see #30).

For these two meals, every day, I eat a very small meal of just fat and protein. I eat no snacks whatsoever mid morning or mid afternoon. I don’t need them. I’m not hungry. The fat and protein provide satiety and support my muscle needs. My body is running on fat, my fat, both the fat I eat and my body fat. I am a ‘fat burner,’ not a ‘sugar burner.’ The body (the brain mostly) gets the small amount of glucose it needs from the small amount I eat and from ketone bodies from the breakdown of fat cells, and from gluconeogenesis. Gluconeogenesis occurs when the amino acids from the protein I eat that is not taken up by muscles, etc. is stored in the liver and is then reconstituted as glucose when the body calls for it.

For dinner I eat a small portion of protein (roasted, baked or broiled), a selected vegetable, and sometimes a glass or two of red wine. With rare exception I don’t eat carrots, peas, corn or beets. They all contain too much sugar. And, of course, I don’t eat pasta or starchy vegetables like potatoes and winter squash or grains like rice and couscous. I also try to avoid anything fried or cooked in vegetable oil, -- any seed vegetable oil. The oils I use liberally are olive oil, butter and lard. I own a jar of coconut oil, a very good (for you) medium chain triglyceride, but I haven’t worked it into my diet yet. It’s a saturated fat, but because of its chain length, it ‘burns’ quickly and easily for energy, instead of being stored.

I intentionally select fatty meats and fish, eat chicken with the skin on (the skin is mostly monounsaturated fat), and like to slow cook (braise) grass-fed cuts of meat (brisket, osso bucco, shanks, hocks, etc. I do not limit dietary saturated fats or cholesterol. I eat all the shrimp and liver and (free-range, pastured) chicken eggs I want. And the result? Well, look at the beginning of this column. My HDL has gone from 43 to 78 and my triglycerides from 137 to 54 as a result, on account of what I eat. My LDL cholesterol and Total Cholesterol have both remained essentially constant, and both within range.

So, my answer to your question, doc, is that I really don’t know what SPECIFIC foods have raised my HDL. My answer is it’s the Way of Eating YOU SUGGESTED way back in August 2002 after you had read Gary Taubes’ “What If It’s All Been a Big Fat Lie” in The New York Times Sunday Magazine July 7th cover story, and tried the diet yourself (and lost 17 pounds).

© Dan Brown 1/1/12