No, Paul Jaminet, the LoBAG Diet Isn't "Close" to the Perfect Health Diet Either

Is it just me or has the IHC* gone just totally off even its own loosely secured rails lately?   Between the summits by "functional medicine" practitioners to tell you everything your doctor is hiding from you (a silence bought and paid for by Big Pharma and apparently the only thing they learn in medical school) and this resistant starch vs. keto war waging out there ... it is truly nuts.   I simply don't have time to cover it all between "real life" and projects in the works.  

But ...

Have you heard?  Good old Fat Head is eating more carbs these days, including resistant starch supplementation, and following the lead of an unlikely diet/health guru in one former astrophysicist named Paul Jaminet, author (with his wife Shou Ching in name only it would appear) of Perfect Health Diet.  It's quite an about face for the former comedian and mocker of starches.

you can click to enlarge

The mixture of cognitive dissonance and need for validation makes for strange bedfellows indeed.  But ultimately this is not about FH, rather it ties into something else I've been blogging on quite a bit recently ... this trend of My Special Diet is the same as (or similar enough to draw the inference) XYZ Diet.

• In Chapter 25, Paul proclaims: "The Perfect Health Diet is a Pacific Islander diet!".  This includes:  Okinawan, Kitivan and Hawaiian diets.  (blogged on Hawaiian diet debacle here)
• On the "Buy Our Book" page, and in various interviews and appearances, Paul claims:  "The food is delicious – it resembles gourmet cuisines such as French, Thai, and Chinese."  (I blogged on this issue and the Thai diet here)
• The book is well sprinkled with paleo diet references and Paul dedicates Chapter 2 to convincing readers PHD is a "paleo diet".  PHD runs around 15-20% protein, 20-30% carb and 60+% fat.  As you can see, it resembles none of the theoretical nor the clinical paleo diets.

from Paleo ~ Still a Fad Diet in 2014

So what IS the Perfect Health Diet?  

"Our strategy is this: let nutrients guide us to the best foods."  

In the end, I suppose it could be best described as a toxiphobic effort at a balanced diet. Paul applies his knowledge of economics (presumably more vast than nutrition, to this day) to nutrition and believes strongly in the concept of declining marginal benefits.  Translating that to a health benefits curve he arrived at the diagram below:

There is an optimum quantity of most nutrients, located over the range in the curve where the marginal benefits are close to zero. This range, which we call the peak health range, encompasses doses for which all the benefits of the nutrient are captured, but none of the toxicity.  {~ KL 1380, before diagram above}

Here are the PHR's and recommendations in PHD and I'll use my own acronyms of LDB (lower deficiency bound) and UTB (upper toxicity bound) to indicate the ranges of each.

Perfect Health Diet Peak Health Ranges

Protein:

LDB = 50g/day or roughly 10%
UTB = 600 calories/day (150g)

The peak health range for protein is, in healthy adults with good digestion eating sufficient carbs, fairly broad: about 200 to 600 calories per day, or 10 to 30 percent of energy. As a rule, 15 percent of energy as protein is close to optimal for any adult eating sufficient carbs.   {KL 1493-6}

Carbohydrates:

Interestingly in all of Chapter 10, I could not find a definitive LDB or UTB.  Although Paul is somewhat famous for talking about glucose deficiency he does not define some minimum to avoid it in the book.  Perhaps with the Kitavan in the back of his mind, he was wary of defining a UTB either.  Instead he puts forth the graph below and posits a narrow range of 

from the book

natural carbohydrate intake ...[where]... the carb calories eaten exactly equal the body’s glucose utilization. {KL 1648-50}

edited in this better image, PHD link, showing actual recommendation below tipping point

This is of course based on fasting glucose production rates, and based on the above curve necessarily presumes "glucose disposal" is a bad thing?   In any case, basically:

600 calories = 150 grams

Fructose is singled out at a UTB of 25g per day.  (oh and check out Lustig on YouTube!)

Also, there's a section entitled Glucose as a Killing Agent.  SIGH!   And, interestingly, instead of addressing glucose as a dietary nutrient, a good chunk of the chapter is devoted to "glucose excursions" which are not caused by the carbs per se or else we'd all be hyperglycemic ... right?  This includes food combining strategies and glycemic index, etc. in terms of food choices rather than addressing any sort of peak health range.

Fats:

PUFA:  "The Dangerous Fats"

LDB = perhaps 1-2% for O6,
UTB = 4%  O6 is the threshold for health impairment, and it gets worse over 6%
Although there is a section on O3 toxicity, I didn't see a value

SaFA and MUFA:  "The Safe Fats" (remind me how this is "paleo" again?)

The macronutrients we’ve considered so far all become toxic above a threshold: protein above 600 calories per day ; carbs (if there is any impairment of disposal pathways) above 600 calories per day plus up to 500 calories per hour of athletic training; PUFA above 100 calories per day.  {KL: 2702-6}

We’ve considered every macronutrient except SaFA and MUFA— and we have only about 1,300 calories per day before toxicity effects begin.

That these are taken together as a single "class" of fats is absurd on its face.  The scientific literature is full of comparisons of MUFA versus SaFA, and not only that but metabolically these behave very differently in the human body.  For shame!

LDB = ??
UTB = None

SaFA and MUFA are nontoxic; they are beneficial, for that matter, even when eaten in very large amounts.  {KL 2708}

The above sentiment is repeated several times in the chapter.  Whatever happened to the curve?  Paul defines no "peak health range" for these, they are simply to make up the rest of the diet.

The LoBAG Diet ... Remember?

OK ... sorry ... but I had to lay the groundwork here.   You see, as I mentioned in the opening, there's a bit of a bromance brewing between Fat Head and Paul and Paul did a Q&A for Fat Head readers.  The response to this question is fascinating (and not in a good way):

Vlc eater:  “Do you recommend PHD for diabetics and prediabetics? If VLC eliminates fasting glucose issues and leads to better glocose levels overall, do you see a problem? Also, is it possible that the self-reported mood issues reported here are a manifestation of mild carb addiction?”

Paul:  ... The basic biology here is that the body’s physiology is optimized for a carbohydrate intake of around 30%.

For someone consuming 2000 calories a day.  In PHD the case was not so much about percentage of intake but total calories and grams.    

Paul:  ... In diabetes, the body does not dispose of excess carbohydrate properly, so carb intakes above about 30% are harmful. However, al carb intakes of 30% or lower are handled quite well in terms of blood glucose levels. This has been demonstrated in many studies. I like the LoBAG (Low Bio-Available Glucose) diet studies of Mary Gannon and Frank Nuttall, which are quite close to PHD. They tested both 20% carb and 30% carb diets in diabetics, and both carb levels were handled quite well.

I altered the links to the full text studies.  Ummm ... NO PAUL, THEY ARE NOT.

Long time inmates here at the Asylum might recall that the LoBAG diets were some of the very first I blogged on.   First in general HERE, and specific to diabetes and the range of diets (20,30 and 40% carb) HERE.     I'm not sure how I even missed it, but these were older, heavier men and their intake was around 2800 calories (in the 20% study, 2825 on average) .  There's a table right there in the 20% paper showing the macro breakdown for the control diet and the LoBAG-20 diet.   So I put those quickly into a spread sheet and added a column for the PHD using 15% protein, a maximum of 150 g carb, and limited PUFA at 4%.  I generously split the MUFA/SaFA 50/50.    There's a slight discrepency with fat grams not adding up to total in the LoBAG study diets but it's minor.   Here are the diet comparisons:

If we upped protein towards toxicity limits, PHD would be at 20% protein and keeping PUFA below alert levels (somehow) we'd still be at 85 grams each for MUFA and SaFA.  Yeah ... that's REALLY similar to LoBAG, what with it's near-ammonia toxicity (and longevity robbing) levels of protein and saturated fats at 10% of intake.  

Perhaps Paul should have looked more closely at the diet in the study, although I have come to realize he picks out only that which appears to resemble the PHD and ignore the rest.   LoBAG increased PUFA intake by almost 50% in absolute quantities, 3% increment in total energy.  Pegging SaFA at 10% is no small matter when PHD comes out at 30% SaFA.   The researchers likely wanted to at least control for saturated fat in their study -- as "high fat" intake studies often do -- which should have at least prompted Paul to wonder why.  The comparison would only get worse for the LoBAG-30 where protein and carb would exceed 200 grams each and top the 600 calorie mark both.   Then there's the IGF-1 and longevity stuff ....

click to view

EDIT 5/9:  I hadn't read the entire Q&A when I wrote this post.  Later in that post, Paul responds to a question definitively that PHD is:

15% Protein , 30% Carb , 55% Fat

Sorry, but this "definition"  would make PHD even further from LoBag-20 (which is the study the curves he used came from) or you might as well state that PHD is like just about any diet used in any study where fat is over, say, 45% ... "close enough" ??  Or carb is 30% or less (but not keto) .... "close enough"??   Or protein is 15-30% ... "close enough"????

Heck, it's close enough to what he says the Paleo diet is, the cannibal diet (what our bodies "eat" while fasting) and breast  milk.  It's all right there in the book!  {KL 744}   Or how about other mammals like gorillas?  {KL 836}

The PHD macro ratios seem to be shifting  ....

"Wild mammals, no matter what foods enter their mouths, provide their bodies with very similar macronutrients: • 0 to 16 percent carbohydrates • 15 to 25 percent protein • 56 to 77 percent saturated and monounsaturated fats • 1 to 11 percent polyunsaturated fats.   An equivalent diet for humans would have more carbs (to feed our larger brains) and less protein and fat.

We might infer, then, that the optimal human diet is something like 20 percent carbs, 15 percent protein, 60 percent saturated and monounsaturated fat, and 5 percent polyunsaturated fat." {KL 898-904} 

So the optimal human diet per PHD "the book" is 15% Protein , 20% Carb, 65% Fat.   It must get confusing trying to please everyone Paul :(

/EDIT

On the LoBAG Diets:

It's always interesting to look back at some older blog posts.  I completely missed the increased MUFA in the LoBAG-20 study back when.  

image link

Yes, they reduced the carb intake to one-third of original levels, that the glucose spikes went down is uneventful in this context.  The lowering of the fasting blood glucose is NOT dependent on dietary carbohydrate intake, and the researchers attribute this to stimulation of IGF-1 when carb was increased to 30%.    These men were not well in the study, and although described as mild diabetics, had HbA1c, FBG and OGTT results indicative of rather severe diabetes.  It is impressive that they could get the type of improvement that they did.  The following questions remain:

• Would the same have happened if fat were merely increased proportionally to roughly 50 grams each (and ~17% SaFA total energy)?   
• What impact did the MUFA have?  It wasn't addressed at all.
• What would the long term effect be?
• Would this have been even more profound if calorie restriction and weigh loss were involved?

In light of recent trends of cutting protein for diabetics favored by the ketotic, I'm glad that once again Paul has highlighted these diets, even if he misrepresented them, or rather misconstrued them to be PHD-like.

To Summarize:  

PHD not like the French, Thai, Hawaiian, Mediterranean or Paleo Diet(s).  

The Perfect Health Diet -- Unlike any other diet ever consumed by man!  

I would be remiss if I didn't mention that I still believe that most of the basics of the content of the diet are sound.  This is where there's a real disconnect (for me at least) between his blogging circa 2010-11, the book (maybe its having it all in one place that makes the inconsistencies and absurdities jump out at you), and public presentations since the late 2012 release of the current version.  

Real, whole foods, some "real" carbohydrate, and protein sufficient. You can't really argue too much with that. At my calorie levels, and eating a bit higher on the protein side of things, PHD worked out more isocaloric than anything for me.  But this notion that calories above these basal levels should be comprised of fat is not an idea that Paul puts forth any convincing data to support.

Even if saturated fats aren't harmful, it is difficult to take a diet philosopy seriously that (a) is based on treating SaFA and MUFA interchangeably, and (b) presumes everything is toxic at relatively low levels BUT these two nutrients.  Not in the face of billions of healthy humans consuming far greater quantities of protein and especially carbohydrate for thousands of years.

If you take 90% of Paul's recommendations out of context, and don't look too closely at what the studies actually say or show (vs. what the blogger he snagged the research from interpreted the study to show, or the abstract seemed to imply) the PHD seems sound.  Also if you don't do the combined math on all of his recommendations.   In this case, the old "devil is in the details" cliche really holds true.

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*IHC = Incestral Health Community ... a play on words describing the wider LC/paleo/primal/WAPF/alt.med./ancestral/whatever community and it's many and several interlinked and co-dependent factions.