Kurt Harris MD

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Main | Stress does not imply hormesis »

Jimmy Moore inquires about "safe starches"

This morning I got an email from Jimmy Moore inquiring what I thought about Paul Jaminet’s ideas about safe starches as espoused on his blog and in his book The Pefect Health Diet. I am not sure if Jimmy has noted the updates I’ve made in the Archevore diet, or if he has seen where I have come down on the issue of the CIH ( the carbohydrate-insulin hypothesis of obesity), as he would have to be scouring the nooks and crannies of blog comments all over the nutrition blogosphere ; )

I’ve not had time to write the magnum opus blog posts that the repuditation of the CIH really requires (and not much can be added to what Stephan has already written), so I thought this was a good opportunity to get the message outside of my own echo chamber by responding in detail to Jimmy’s inquiry. My response to him is pretty long, and I doubt if he will quote much of it, so I’ve reproduced the email response, with his inquiry broken into bits in italics and my responses afterward in roman.

Kurt, 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 "Perfect Health Diet."  He advocates for eating white potatoes and white rice as part of a low-carb eating plan.

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) 

Here's a one-page explanation and illustration of Jaminet's program:http://perfecthealthdiet.com/?page_id=8

Several places in the book and on Jaminet's blog (http://perfecthealthdiet.com) 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

I have not looked into that claim enough to comment in detail, but it seems plausible. 

 2) vitamin deficiencies (he particularly mentions Vitamin C and glutathione 

Yes I would agree with that. Whites and sweets are loaded with ascorbic acid.

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).

My list 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. Many of these plants have spread far from their biomes of origin and serve as staples for populations who have adopted them with success over just the past few thousand years.

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 more important for nutrition than eating colorful leafy greens - the veggies that are high fiber and low starch. (Some green leafy vegetables are good sources of folate and along with some fruits are sources of flavonoids that may benefit you via hormesis.)

I view most non-starchy fruit with indifference. In reasonable quantities it is fine but it won't save your life either. I like citrus now and then myself, especially grapefruit. But better to rely on starchy vegetables for carbohydrate intake than fruit.

Primitive populations practicing horticulture or hunting and gathering do not eat a lot of big green salads with lots of variety, but they do eat healthy starchy plant organs with monotony on top of their foraged animal foods.

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. But the clean up and repair response cannot happen if there is no rest from it. 

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.

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 also with zero fat gain) If anything I think even wider ranges of carbohydrate intake are healthy. 

One can probably eat well 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 and 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.

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've given you plenty to quote from, Jimmy. Go for it!




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Reader Comments (74)

As Jimmy's audience tend to be those, like me, who show evidence of metabolic derangement, the next question is of course, well what about safe starches for us? I think the LC movement puts too much emphasis on treating the symptom (removing carbs) rather than restoring metabolic flexibility.

In related news, Robb Wolf posted a link today to a paper* by Lindeberg et al showing improved glucose tolerance by diabetics consuming tubers compared to those following a grains-based Med. diet.

  • http://www.staffanlindeberg.com/DiabetesStudy.html

KGH: Thanks Beth. I think whatever diet you can shed fat with is the one to use, whatever the carb fraction happens to be. Diabetes is reversed (if it can be) and metabolic flexibility restored by no longer eating hypercaloric, not be limiting carb intake per se. Low carb is only required or most prudent if actually diabetic.

September 29, 2011 | Unregistered CommenterBeth@Weightmaven

Thank you, Kurt, for writing this. I have been trying to follow the whole Taubes-Guyenet false dichotomy since the whole issue broke light. Following your appearance on Robb's podcast, this has been a very healthy and condensed follow up that I've been looking for. Your opinions and thoughts are much appreciated.

I think that it's important to remember that Guyenet's theory doesn't necessarily contradict Taubes' and the whole paleo/primal world's observations. I think there's quite a bit going on here and that we shouldn't worry ourselves too much with developing a homogenous dietary approach, recognizing the inherent variation featured amongst all people who have to deal with their own genes.

I think that Wheat Belly is another strong notch in building our understanding of what exactly is going on here. I feel that Dr. Davis is right in identifying wheat as the number one source of change our modern diet needs. Then we couple that with Guyenet's theories as a framework that may help us understand what leads to metabolic syndrome while recognizing Taubes' position as a solidification process that keeps one locked in this syndrome, all working underneath the destructiveness of wheat.

Of course, I may be completely off in how I am understanding these things. Perhaps Taubes, Davis, and Guyenet are all completely wrong... all I know is that I feel better eating the way I do and many of my inflammatory issues have completely disappeared.

And I've never felt bad about eating homemade sweet potato fries in the oven.

Thanks again for posting this.

September 29, 2011 | Unregistered CommenterTyler Tyssedal

In regards to rice, this article is interesting:

miRNA in rice may end up in the bloodstream and alter gene expression -- one effect being higher LDL levels. I don't know if the rice in the study was refined or brown rice.

September 29, 2011 | Unregistered CommenterJD Moyer

Hi Kurt,

This is exactly the shift I wanted to see in paleo dogma. I feel vindicated after my ban from paleohacks (my own fault).

You've moved white rice up from where it was way down on your previous list. Agree with your reasons 100% - it is a special case.

I also agree 100% that eating starches is more important than leafy greens, after you're getting your animal nutrients. And that fruits belong below leafy greens.

I can confirm that eating well over 50% calories from starches is no problem for body fat, even without exercise.

The ONLY thing I would change is to cite shellfish at the top of the animal nutrient hierarchy. This is particularly true in today's soil-depleted agricultural system. Wild-caught fish are actually more dangerous because of mercury, not to mention more expensive. Also fish won't work for people with fat intolerance, but shellfish will.

Your point about indigenous cultures monotonously eating starches but NOT eating leafy greens is well taken... it's hilarious that paleo has taken so long to catch on to this... a holdover from the Atkins diet I think. Or just sloppy theorizing without checking the evidence. This concept is gradually penetrating amongst the gurus, but far less so the followers, who still tend to view starches as bad.

I very much appreciate your capacity to evolve your model, and the fact that you primarily take the approach of breaking down the biological mechanisms involved lends a valuable alternate perspective to the usual evo-theory.

Keep leading the vanguard!

Best regards,
Joseph Buchignani

PS My current diet is composed of three ingredients:
1. Boiled scallops, no browning or burning. 600 - 1200 grams per day (frozen weight)
2. Boiled rice, no browning or burning. Unlimited.
3. Water.

I eat with my hands to increase the sensory feedback loop which increases gustatory satisfaction and satiety. I eat maybe 2 meals a day (naturally, not as a result of self discipline), with maybe a rice ball or two as a snack.

I had to drop to this extreme elimination diet to fix chronic IBS-D. I had a sensitivity to fat that increased as my fat intake decreased, in addition to burnt food, fructose intolerance, and many other food intolerances. The source of the disease was partly genetic but exacerbated by a round of Accutane in college.

So knowing the true fundamentals of the minimal human diet can change people's lives who might otherwise have no hope.

September 29, 2011 | Unregistered CommenterJoseph Buchignani

It's always great to see a new post from you Dr. Kurt. I think we're splitting hairs at this point, but I'm just curious if you have actually found puffed white rice. All I can ever find is puffed brown rice.

KGH: ????

September 29, 2011 | Unregistered CommenterKevin

Hi Tyler

The CIH has been proved wrong to my satisfaction. Obesity is not caused by hyperinsulinemia related to carbohydrate consumption, even if wheat proteins and excess fructose are neolithic agents of disease that dysregulate metabolism. The critique of the diet/heart hypothesis in GCBC is very good and worth the read, but the parts about mechanisms of obesity are not recommended as they are simply not correct.

I don't think there is false dichotomy in Taubes/Guyenet. Taubes is wrong and Guyenet is right about the CIH.

As far as the food reward hypothesis, that is an idea independent of the CIH and will stand or fall on its own merit. I think it has plausibility.

I have not read "Wheat Belly", but if it at all follows Dr. Davis' blog content I cannot recommend it. I have been fingering wheat publicly for as long, if not longer than Dr. Davis but I think it is critical that our arguments be grounded in defensible science and not hype designed to maximize book sales. Wheat is suspect because of gluten and gliadins and the food reward effects of white flour, not because of dwarfism or the glycemic index of amylopectin A and "blood sugar and insulin" effects. That is just more of the CIH.

Davis has on his blog recommended n-6 heavy plant oils over saturated fat, nuts over fatty meat, claimed that animal protein causes cancer, advocated massive doses of fish oil to "treat" high triglycerides, pushed the idea that anyone with a TSH of over 1.5 (more than half of the elderly!) be considered "hypothyroid", and claimed that there are genetic types of small dense LDL. He has also stated that rises in blood glucose with a meal that the literature tells us are perfectly physiologic are pathological.

None of these ideas of his are scientifically sound. Look, we all make mistakes. I used to think low carb consumption was a part of the EM2, but I have since corrected course. Maybe in time Dr. Davis will reject these manifold unfounded and dangerous ideas as I now eat potatoes.

I am very glad you are getting great results, but if we are to progress we need to know we are right for the right reasons

September 29, 2011 | Registered CommenterKurt G. Harris MD


"Wild-caught fish are actually more dangerous because of mercury, not to mention more expensive. "

Mercury in most fish except swordfish and shark is bound in a form that makes it less bioavailable to us, and the weight of the evidence is that wild caught fish is more good than harm. I do not avoid it at all due to mercury fears.

And sardines and other lower down the food chain species are wild caught and have little mercury anyway.

September 29, 2011 | Registered CommenterKurt G. Harris MD


This is the point I have reached as well. I eat about 100-150 grams carbohydrate a day with the bulk of that in the post workout meal. I used to be much lower carb, but I'm thinner and perform better with this level.

I'm curious if you'd care to comment on something I'm trying to figure out. My dad was about 325 pounds or so, and went low carb paleo/primal. He read Mark Sisson's book and was basing his diet on meat, low carb veggies, and very occasional starches such as sweet potato. In about 6 months he was down to 265. Then he had to have surgery, and went off the diet (stress no doubt) prior to and after the surgery. He got back up to 295 or so before getting back to his attempt to shed the pounds.

In 3 months of eating identically to his first attempt, he got down to 280 and just wouldn't go any lower. He's tried restricting total food intake, no change. He's tried adding and removing dairy, and no change. He fluctuates between 280 and 284 and has stuck there for two months now.

He got a glucometer and started measuring his blood glucose, and noticed it was never below 100. Often it was 110-115 in the morning, but would drop closer 100 later in the day. Post meal blood sugar usually didn't go over about 140. But never below 100.

So a doctor wanted to put him on Metformin and did some bloodwork first. His A1c was 5.1, so the doctor said he didn't need to be on Metformin.

All of which is a long lead-in to where I am on it. I think he needs to slowly add in some carbs and not keep chasing ketosis for weight loss. I hesitate to suggest it with blood sugars that never drop below 100, but it sure seems that what he's doing isn't working and perhaps a higher carb approach is worth experimenting with.

If you have the time for comments based on that limited info, I'd love to hear your thoughts.

September 29, 2011 | Unregistered CommenterBill Strahan

Why is wild caught more harm then good? You avoid it but not because of the mercury?
Thanks for your blog Dr. Harris It has changed everything for me.

KGH: No, I don't avoid it. I eat it. It is more good than harm. I've edited that typo...

September 29, 2011 | Unregistered CommenterBonnie Temple

thanks for your speedy response!

September 29, 2011 | Unregistered CommenterBonnie Temple


Beautiful1 Thank you. I came to this similar conclusion by simply "feeling and experimenting' my way through. (and of course constant reading and questioning) I will tell you that (again from feeling and experimenting) rice IS different. I have a tough time controlling my quantities with rice. Not so witth all the various potatoes. could be a "comfort food/food reward thing" but not sure.

My question for you;
How do you feel about tapioca flour?
Dr. Davis argues against it based on the '"glycemic index" and insulin spike from it...
As it fall in the tuner/strach category, i suspect its fine and I do feel fine from it.

For all you cooks, I like making little puffs/rolls that I use for making sliders with it.

Thank you Kurt! Extremely grateful for all you share.



Forget about glycemic index unless you have diabetes. Its BS. And insulin spikes are normal. Only pathological IR and chronic hyperinsulinemia is a problem and that is not caused by "spikes".

September 29, 2011 | Unregistered CommenterMarc

1. When we lived in Northern Alberta, we were told to hang our whole fresh caught fish in the freezer head down. Theoretically, the mercury should make it's way to the head. Take the fish out, cut off the head and voila - most of the mercury gone. Is this an old Native's tale or is there any truth to this?

2. Is there any difference whatsoever between beets, carrots, potato, turnip or parsnip? Are they all considered starches? Or are some considered vegetables?


The fish drainage thing sounds like nonsense.

Anything that is not an animal and is food is a vegetable. I think they are all fine but carrots are pretty sweet and have more fructose. I favor white and sweet potatoes and especially white potato varieties from my local farmer's market.

September 29, 2011 | Unregistered CommenterShanta

Dr. Harris:

Where do you think the calories in/out fits in all of this? Many LC and VLC proponents assert that not all calories are created equal and that some food (usually referred to in macronutrient terms) are uniquely fattening. Is this maybe more a case of excessive indulgence in high reward foods?

KGH: Read my comments on Stephan's blog or listen to my 1:45 interview with Robb Wolf.

September 29, 2011 | Unregistered CommenterJimmy Gee

What it comes down to, and always has, is to eat real foods (some may be better than others, but this rule in general will put you in a good place). Stay away from processed food. That is number one in my book. There are always way to optimize it, but beware that today's optimization's are tomorrows no-no's (ie. Chris Kresser's post on omega 3 fish oil supplements).

September 29, 2011 | Unregistered Commenterpbo

One thing I have noticed is that when on a lower carb diet, I was able to reduce my snacking dramatically (mostly a sugar addiction). This is probably a result of eating more protein (as well as fat) and less with the carbs themselves? I have since started slowly increasing my carbs eating potatoes and white rice. My only fear is bringing back or triggering some sort of sugar craving, but I am pretty sure as long as stick to "safe" starches I should be good.

September 29, 2011 | Unregistered Commenterpbo


Thank you for your response. I suppose I misrepresented my opinion of the false dichotomy I mentioned--I agree that they are at odds when it comes to the CIH. I consider his critique of the diet/heart hypothesis to be what I recognize him for, which it doesn't seem Guyenet has any issue with(?). I apologize for my confusing lack of clarity on that.

Beyond that, however, I have still been having a few issues with fully resolving Guyenet's complete dismantling of the CIH, which it unfortunately seems is engrained in almost all of the paleo/primal theories' backbone. Wolf, Wisdom, and so on have all referenced the CIH as to why we should avoid these things. How do we grapple with that?

And one thing I am still having trouble understanding, if the CIH, GI and insulin spikes are of nonvalue, why do I become hungry after eating a cookie, even though I was full only moments before from a delicious meal?

I have never been overweight, but I've lost fat and gained muscle since cutting out grains and legumes from my diet. I'd love to know these methods have been working.

Regarding Dr Davis, here's a quote from page 96 of his book: "Because of wheat's incredible capacity to send blood sugar levels straight up, initiate the glucose-insulin roller coaster ride that drives appetite..."

Is this line of thought still valid or does it rest on the CIH?

Thank you for taking the time to help us all sort this out.

September 29, 2011 | Unregistered CommenterTyler

While I agree with and generally follow the Perfect Health Diet carb recommendations (though I don't count calories - I find myself there by choice and taste), I'm not ready to ascribe the known weight loss functions of LC/VLC/keto purely to food reward.

The reward system has been well-studied for a long time, there exists extensive scientific research and literature about it, and I've found it more than adequate to explain and understand observed phenomena. In fact, the more time I've spent researching the issue, the more I believe that the term "food reward" is actively misleading us - because it lumps together multiple concepts ( hedonic impact, or "liking", and incentive salience, or "wanting") that need to be addressed separately in order to make any sense of our behaviors around palatable food. (And, for that matter, to define concepts like "palatability" that are still causing debate.)

For those interested, I've done my best to summarize the current state of understanding here, in Part VI of my long-running series on hunger. (And there is more to come.)



"I'm not ready to ascribe the known weight loss functions of LC/VLC/keto purely to food reward.

Who said this? not me.

I ascribe the effects partially to FR, partially to NADs that are well known, and partially to ketosis and or increased protein.

Same hold for low fat diets.

September 29, 2011 | Unregistered CommenterJ. Stanton

I'm from Spain, here we've been eating wheat since the Roman Empire. I guess the same happens in Fance, Italy, Greece, Morocco, Lebanon, etc... Rice and potatoes started to be consumed more recently. These populations have prerty long life spectancies consuming a wheat based diet. Not until modern processed foods and non olive oils have been introduced is when we've faced obesity and mayor disease problems. What's your opinion about that? Does not it seems like a "wheat mediterranean paradox"? Are meditterranean populations better adapted to wheat than northen european (saxons & german) ones?


No. Rates of celiac are quite common in the middle east and mediterranean. Approx. the same as north america at around 1%. Italy has a public awareness campaign around celiac.

There is no potato analogue to celiac disease. Most humans would be better off as individuals eating nutrient rich starchy vegetables in lieu of gluten grains for reasons I've outlined.

September 29, 2011 | Unregistered CommenterAitor Calero

I like how the Archevore Diet has evolved. It has really taken the edge of my temptations to add back a bit of rice, an occasional yam and a daily small banana. My question is whether an occasional use of buckwheat would be advisable? OTOH I've followed the argument agains quinoa: despite its lack of gluten, the saponins are a human antagonist. Does buckwheat suffer the same judgment. I was a lonely man at a pancake breakfast last week. OTOH the thought occurred to me that a savory buckwheat crepe once a fortnight might be a nice treat.

KGH: Stephan has a buckwheat pancake recipe somewhere

September 29, 2011 | Unregistered CommenterMaus

I should explain my above statement "I'm not ready to ascribe the known weight loss functions of LC/VLC/keto purely to food reward."

Mitochondrial dysfunction in the pre-obese, the formerly obese, and the obese who are still gaining weight is an known and quantified problem. The carnitine shuttle and the entire TCA cycle are impaired, leading to a lack of metabolic flexibility. (Normally we switch back and forth to burn glucose when our blood sugar is high or we're exerting ourselves over 50-60% VO2max, and to burn fat at rest...while the impaired are stuck burning a combination of both in all circumstances.) I first explored this subject here, and Peter investigates it further here.

I don't claim to understand how this dysfunction comes about, although Peter has found some intriguing leads. This is an active research area. However, the fact that this dysfunction exists and is empirically measurable, both via RER/RQ and via studies that actually radiolabel parts of the citric acid cycle, means that the pre-obese/obese/formerly obese have a metabolic defect that causes carbohydrate restriction to become a useful dietary strategy.

So while the precise mechanism of carb-insulin may not be correctly stated, it's much closer to practical truth than any hypothesis that simply denies it and claims "carbs are fine for everyone". As Tyler notes and hundreds of thousands of people have found, carbs are NOT fine for everyone - and now we're beginning to understand the underlying dysfunction that explains why that might be. It's not just because carbs are "rewarding".


September 29, 2011 | Unregistered CommenterJ. Stanton

But... has anyone looked at what happens to LDL pattern, trigs, HDL, and A1C as a result of a higher starch diet component? You may not have frank weight gain, but what about the longevity component?


HBA1c is misleading to measure in normal people as it depends on red cell lifespan and is rather variable at levels below 6.0.

It is the loss of glucoregulation - primarily the loss of the ability of insulin to stop the liver from releasing glucose - that leads to the chronic hyperglycemia that glycates your proteins. It is not caused by eating starch unless you have diabetes.

lipoprotein patterns reflect dietary carbohydrate. In the west, high carb diets are hypercaloric junk food diets loaded with fructose, white flour and excess linoleic acid. So in the west (read - in the epidemiology literature studying western populations) these pattern correlate with disease.

To see that these patterns are confounded and merely correlated with the other components of diet that are causing the disease, see Lindeberg's papers on the Kitavans, who have low HDL but no detectable heart disease.

In my view, there is no reason to even measure these parameters* and no reason at all to think they add anything to the value of a tape measure and mirror and scale....

*Postprandial glucose measurement and A1c are useful to prove you are not diabetic or to monitor glucoregulatorry control once you know they are abnormal. "Cholesterol" measurements are useless. If you are concerned about thyroid status, measure thyroid hormone.

September 29, 2011 | Unregistered CommenterMichael

"Only pathological IR and chronic hyperinsulinemia is a problem..."

This seems like THE problem to figure out. The phenotypic expression of this problem likely manifests itself in different ways. Some people get fat, others don't. Some develop full blown diabetes and other diseases, others don't. A friend of mine ran some obesity and T2DM stats through Bayes Theorem. Stats from wikipedia. "o"=obese or overweight, and "D"=T2DM.

P(o) 65.00% (probability someone is overweight)
P(D) 7.80% (probability someone has diabetes)
P(o|D) 85.20% (probability that someone with T2DM is also overweight)
P(D|o) 10.22% (probability that someone overweight/obese is also T2DM)

If IR and hyperinsulinemia (metabolic syndrome) is the path to T2DM, then being overweight only increases your risk of T2DM by 2.5% compared to a normal weight person (assuming the data from wikipedia is correct).


There has to be better metrics of health than simply weight gain/loss. It's clearly a hormonal problem; and our hormones will not violate any Laws of Science. While "carbs" by itself doesn't explain the mechanisms of insulin resistance, neither does "food reward." Talking about obesity per se seems to be a distraction from the real problem of IR and hyperinsulinemia.


Are these numbers derived from actual empirical data? Or by assuming BT and independence? If the latter, then that is not warranted.

But let us stipulate they are accurate.

An increase from 7.8% to 10.22% is a 33% increase or RR of 1.3 compared to non-obese, not 2.5%.

The other thing to account for is that obesity as assssed by BMI is very crude - especially in terms of sensitivity. If one did CT scans to look for visceral fat or MRS to look for fatty liver you would see very few people that have Type II DM that have no abnormal visceral or liver fat. There are simply too many people who are metabolically obese (skinny fat) that don't meet BMI criteria for obesity for BMI based obesity to be a sensitive measure of DM or metsyn risk.

It seems most likely that most metabolic syndrome and Type II DM is due to overnutrition or excess energy availability at the cellular level. The normal response to overnutrition is to accumulate storage fat. At some point, the fat storage meets a limit and IR sets in, insulin levels (esp basal) rise and if later yet, elevated free fatty acids and then hyperglycemia damage the pancreas and you have diabetes. There is probably some nuance int the sequence of IR in different organs that affects how obviously obese you are when this happens. Load your liver with excess fructose and have more IR earlier for a given fat mass?

This cellular toxicity is probably happening at different levels of fat mass in different people. I hypothesize that anyone it happens to is metabolically fat regardless of their BMI. They only differ in how soon it happens. This is all we need to observe that one can be obese with no metsyn and one can have metsyn without obvious (BMI based) obesity.

PS I think the "loss of metabolic flexibility" J Stanton is writing about is most likely an acquired defect that is the result of lipotoxicity due to overnutrition at the cellular level. This explains its early appearance in the soon to be obese and formerly obese, etc. I personally am a bit skeptical of the epigenetic explanation offered by Peter, at least as an explanation for the entire obesity epidemic, but anything is possible and maybe further research will tell us.

September 29, 2011 | Unregistered Commenterjs290

Hi Dr. Harris. It is good to see you posting again. Nutrition seems to be a very confusing, complex topic. I would like to know what your take is on triglycerides, high or otherwise. Must we all have a level under 150, and how was that number arrived at? Dr. Ravnskov does not seem to have a problem with triglycerides. Is this just another component of the "Lipid Hypothesis"? On many of the low-carb/paleo blogs, they scorn the Lipid Hypothesis, but seem concerned about triglycerides, sdLDL, etc. There seems to be some kind of disconnect, which I do not understand. I do not believe in the Lipid Hypothesis, and therefore do not check my cholesterol and am not concerned about it. I focus on eating the healthiest way possible, which can change as I learn more. I am not sure of the wisdom of regularly checking blood sugar levels either. .I agree that the most important thing is to eat real food. Any thoughts?

September 29, 2011 | Unregistered CommenterStacie

@JS -

Normally we switch back and forth to burn glucose when our blood sugar is high or we're exerting ourselves over 50-60% VO2max, and to burn fat at rest...while the impaired are stuck burning a combination of both in all circumstances.

Thank you for posting this explanation. That's kind of how I understood low carb to have an advantage for weight loss in the first place. If you're not feeding your body carbs for fuel, it only has fat to burn. So as long as you're not eating more fat than your body can use up (or slightly less fat so your body will burn stored fat), you'll lose weight. I don't think the obese care what the exact mechanism is.


"If you're not feeding your body carbs for fuel, it only has fat to burn."

No, this is misleading.

If you substitute fat for carbs on an isocaloric basis, you will have exactly the same amount of fat put into storage if you are hypercaloric (technically slightly more, actually)

If you eliminate carbs and that puts you in caloric deficit, THAT will make you not store fat, but only because of the caloric deficit.

Even if you are "stuck burning both fuels" this will not affect the need to be in caloric deficit in order to lose fat mass. Get a pencil and paper and work it out. Energy stores are fungible - there is no free lunch as a practical matter.

September 29, 2011 | Unregistered Commentermarilynb

Can anybody explain, or point to some sources on:

why "eating starchy plants is more important for nutrition than eating colorful leafy greens"???

I don't see why broccoli is worse then potatoes?


KGH: There are basically no starches in broccoli. No fuel to live on. Read "William Munny Eats his vegetables"

September 29, 2011 | Unregistered CommenterAnna K.


Great post -- I'm wavering more on my connection to the CIH camp but not 100% so yet.

I'm VLC, have been for 4 years (lost 70# and am at a stable 145# at 5'8"), but when I attempt to introduce safe starches into my diet, I get the opposite of the carb flu for an entire day after.

A serving of potatoes with my grass-fed beef? Light headed, bloated, cranky.

Rice with sashimI? Light headed, extra bloated, cranky.

At 37, I don't seem to have any signs of diabetes (dad is borderline at 70), my weight is fine, I can build muscle if I worked the weights and I've no signs of hypotension or orthostatic dizziness at VLC, but I'd love to expand my eating options.

I noticed on some other blogs you comment on that people have asked the same question and I didn't see a response. Going from VLC to moderate safe starches seems to shove most of us into an anti-carb flu type of deal. Is this just something we should try to adapt to and let it be overcome?

Note that I'm sure most people share: I refuse to be fat again, I will never live unhealthy if I can control it.


I've not had a huge number of people I've observed directly go from VLC (the old 12 steps) to 30% or more carbs as safe starches. But at least a half dozen and many who have emailed me or commented elsewhere in the blogsphere.

Among those I've worked with directly, none has gained significant fat going from 10% to 30% or more carbs in the form of potatoes or white rice. Most of these folks were not morbidly obese, so YMMV. My wife and I have maintained over 35 lbs weight loss between us for over 4 years at age 50 + and the fat mass has been the same at 7% carbs as at 30 + %. The only side effect is that some get a bit more gas during the reintroduction if they were VLC to start. I now have much more normal gas/motility pattern than when I was VLC.

Start with a half cup of white rice at each meal. Add grass fed butter, salt and pepper (unless it makes you go nuts)...

Let's be clear what I mean when I say the CIH is disproven. I mean that carbohydrates as a class do no uniquely drive fat storage - they are not a toxin causing fat gain via insulin spikes.

This does not mean there is no such thing as diabetes or that everyone will tolerate them equally. But I do suspect there is an army of people in paleoland who think they will die or get fat if they eat them, but they will do fine if they do...

September 29, 2011 | Unregistered CommenterA.B. Dada

".....elevated free fatty acids and then hyperglycemia damage the pancreas and you have diabetes"

Perhaps two reasons to monitor triglycerides and blood sugars then?


Serum triglycerides are not free fatty acids. These are not routinely measurable. Make sure you are not diabetic once. Then just use a mirror and tape measure.

Lab tests cannot unwind disease.

September 29, 2011 | Unregistered CommenterBill


Dr. Davis has an interesting section on AGE and aging in Wheat Belly. He says that "the higher your HbA1c, the faster you are aging", and that "HbA1c ... can also serve as a simple index of glycation" . He suggests that foods with a high GI can raise HbA1c even in non-diabetics. (Perhaps mainly in the metabolically deranged, which could explain why Kitavans can handle high carb). He even says that fructose increases AGE formation up to "several hundredfold more than glucose".

Based on your early comments, I take it that you disagree with much of what Dr. Davis proposes. Do you think he is correct about fructose vs glucose in AGE formation?


I don't have time to unpack everything he says. Foods with a high GI are of no clinical significance if your glucoregulation is normal. Your carb handling improves in response to eating them more often.

Fructose causes glycation more readily than glucose by about 10x if it makes it into the systemic circulation, which it usually does not, thanks to your liver which tries to sequester it. This is well known and one reason to not go nuts on fructose.

September 29, 2011 | Unregistered CommenterWayne

@KGH - I do get that calories matter and noted you'd need to eat "slightly less fat [than you need for fuel] so your body will burn stored fat". But It still sounds to me that your body can more easily burn excess stored fat by eating lower carbs.



More easily than by creating the same deficit by undereating fat? NO!

LC just makes it easier to lower caloric intake for most people, it has nothing to do with "ease of burning"

September 29, 2011 | Unregistered Commentermarilynb

Thanks, Dr. Harris -- I'll be giving it a little more leeway over the next few weeks and see how I handle things. Sweet potatoes have been really easy to add to my eating platform; I've probably overdone the amount of rice recently when I've tried it. I don't measure anything, but in this case I'll give it a go in smaller amounts and see how quick my body starts accepting it.

A little side question that doesn't need to be answered but I was curious about: what about avoiding galactose. We've got FODMAPs (more fructose than glucose), but there's really no easy to find information on galactose... I know celery is supposedly high in galactose, as is (supposedly) beets. Also I've found some information on people with GALT that they should avoid organ meats, against due to "high" galactose content.

Since we all tend to focus on PUFAs and fructose consumption abuse, should galactose be tossed in there as something to watch for?


I recommend avoiding milk altogether as I think all caloric drinks are problematic. If you do so you are not getting any galactose as you have to eat lactose to get galactose.

September 29, 2011 | Unregistered CommenterA.B. Dada

"I recommend avoiding milk altogether as I think all caloric drinks are problematic."

So you are not too keen on coconut water (straight from the coconut)?

Thanks for your blog!

September 29, 2011 | Unregistered CommenterSam

A.B Dada and Dr. Harris,

This type of sensitivity to starch may be indicative of an underlying bacterial infection, as seen in the thoughts of Jaminet and work of Ebringer (i.e. Ankylosing Spondylitis, Starch and Klebsiella). It may very well be that those who can tolerate the introduction of starches do not have a bacterial infection and those who experience an exacerbation of symptoms (fatigue, bloating, iritis, joint pain, irritability, etc.) do.



I disagree that this is a common explanation for "intolerance" of reintroduced safe starches. I think there is just a certain time it taks to re-jigger your gut flora to get used to higher insoluble fiber intake and that this is actually beneficial..

One should not hypothesize an infection or SIBO or autoimmune disorder without specific evidence of actually having these disorders.

September 29, 2011 | Unregistered CommenterRich

"Coconut water is basically potassium-rich water with 11 grams of sucrose."

-Mat "The Kraken" Lalonde

September 29, 2011 | Unregistered CommenterBrian Kerley

Dr. Harris: what is your feeling about the cause of small LDL and its dangers? Is there a level of carbs that will cause you to generate small LDL? Many seem to feel oxidized small LDL is the cause of heart disease, and carbs may contribute to their creation. At what level of carbs in the diet is this likely to happen?


KGH: Long complicated answer.... Carbs per se not likely a culprit in anything IMO.

September 29, 2011 | Unregistered Commentersteve

I'd be interested to hear Dr. Cynthia Kenyon's thoughts on all this. Granted, we're not worms, but when she feeds her research worms glucose, they don't live as long.


Well, you said it, we are not worms and we probably had a common ancestor with them about 500 million years ago or more :)

September 29, 2011 | Unregistered CommenterMichael


It's possible I have a bacterial infection, but I'd be surprised if it was the case. I've gone between VLC and LC since 2004, and have always had issues introducing starches, but I've generally backed off after a day or two. Dr. Harris' theory that it might be gut flora that has to get used to the soluble fiber doesn't violate anything because I haven't given it time.

Since winter is approaching Chicago, and I am planning on spending as much time as possible in Florida and the Caribbean this winter, I'll be adding safe starches slowly and increasing my physical play (surfing, paddleboarding, hiking, etc) and see how it goes. I'm in no rush -- if I happen to gain some weight, it's not like I'm going to fall into a rut again.

I definitely do fine with sweet potato. A recent mid-term set of flights mixed me up with some commercial plant oils, and I can definitely say that affected me far worse than a serving of white potato or rice -- n=1, but the difference was evident when I returned and my employees asked if I was feeling ok!

I also can't imagine having an autoimmune disorder -- I'm fairly certain any issues there were resolved a long time ago, but it's only been 6 months since I cut wheat out entirely, so maybe there's some underlying gut issues that still need some healing.

September 29, 2011 | Unregistered CommenterA.B. Dada

"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)"

Dr. Harris,
I'm curious about what you said about gallbladder disease. Almost all of the women on my mothers side of the family have needed their gallbladders removed at 30-50 yrs of age. I have been trying to find information on anything I can do to hopefully prevent this from happening to me.

I have read gallbladder problems seem to be related to gluten intolerance or celiac. The conventional wisdom of course says stay away from fat. You said those with gallbladder problems should avoid fat, but then point out that that can also trigger gallstones via stasis. Should I stay away from fat or eat more of it? Any suggestions for me? I don't have gallbladder disease yet.. though I am 28 now. I do think I may be gluten sensitive though I don't believe I am celiac. I changed to a paleo type of diet 2 months ago and have been losing weight. I am still overweight though. I really want to try to avoid any gallbladder problems if I can so I would love any advice or information you can give me.

Thank you

September 30, 2011 | Unregistered CommenterErica

This post has put a lot of my experience over the past year into perspective - very good. More to the point, you made the whole food reward concept accessible in a way that I haven't found it explained elsewhere.

I added in a small serve of sweet or white potatoes per day about a week ago and my weight loss actually started again. Cutting dairy and particularly milk has had the most notable effects as well. I don't think I can handle any more than 45-50% of my daily calories from fat, especially if I want to create some sort of caloric deficit.


I find potatoes and white rice just as satiating, yet more physically comfortable to eat than big doses of added fat. I understand some people may be hyperphagic on the "safe starches" but I have not encountered any of them personally.

The evening meal always has meat like a rare lambchop or GF burgers, plus spuds or just white rice with butter salt and pepper. If still hungry, a bit more of the starch.

My meals are still very very simple and relatively monotonous. I now think that one way to fail with any diet, to find food very entertaining, organize social events around it, and generally think about food a lot.

September 30, 2011 | Unregistered Commenterbec

Dr. Harris, thanks for the thoughtful reply. Yes, compared to non-overweight, overweight people are 3x more likely to develop T2DM compared to normal weight people.

P(D|o) 10.22% (probability that someone overweight/obese is also T2DM)
P(D|~o) 3.3% (probability that someone normal weight is also T2DM)

As you're pointing out, what you don't see can be far more deadly than what's obvious. Metrics of health should at least determine how metabolically broken we may be. The more broken one is, the more toxic glucose will be. I definitely like what J Stanton has been uncovering about metabolic flexibility. I concluded about a year ago when I found your blog from a health perspective being keto-adapted is the preferred state. And, since insulin is a primary player in fatty acid oxidation, being insulin sensitive is absolutely important. Obesity seems like a phenotypic expression of insulin resistance. That is to say obesity, and hence "food reward," is a symptom of a much larger problem. It's similar to people getting all excited about "taxing the rich" and completely disregarding the inflationary tax that the poor has to pay on our fiat currency.

Dr. Kenyon and epigenetics were mentioned in other comments. I found the following links relevant.



I'd prefer links to peer reviewed research here, people are free to google her name..

"Obesity seems like a phenotypic expression of insulin resistance."

Some level or kind of energy excess and metabolic obesity is present BEFORE there is insulin resistance. IR is a response to pathology not the pathology itself...

"Metrics of health should at least determine how metabolically broken we may be. The more broken one is, the more toxic glucose will be. I definitely like what J Stanton has been uncovering about metabolic flexibility."

This "being broken" is effect, not cause. The CIH says we get broken by eating carbohydrate, there is no good evidence for this. If we prove that there is a mitochondrial defect in energy processing, it actually argues against the CIH, as how did we get that way? Not by eating starch.

The therapy does not demonstrate the cause.

Also, it is likely that fatty acids can be toxic (not in the diet, metabolically) BEFORE glucose is.

September 30, 2011 | Unregistered Commenterjs290

It is good to see that Paleo has been taken down a notch. The subject is complex and the discussion will now proceed. Up to this point, it appeared that Paleo would solve from acne to cancer and then move on to do greater things... want to colonize Mars? Forget rocket science, a Paleo lifestyle promised to do that for you too.

Some people will think this is a rift. It isn't. It is just our good luck that the folks involved in the argument do not indulge in self-deceit and their points of view evolve as their understanding deepens. This is great news for everyone on the sidelines.

September 30, 2011 | Unregistered CommenterTxomin

"Low carb plans have helped people lose fat by reducing food reward from white flour and excess sugar and maybe linoleic acid."

Why is white flour less rewarding than white rice or other refined starches? (I'm also assuming that you don't mean that the only benefits of reducing white flour (and other gluten grains) are from food reward).
Also, are you saying the benefits come from reduced reward from sugar and linoleic acid, or from reducing excess sugar and linoleic acid independent of food reward?

"Diabetics need to avoid high carbohydrate intake the same way those with gall bladder disease need to avoid fat."
I'm not sure whether the answer to this is going to be too complex for you to reasonably detail or so obvious that I will be chastised for even asking, but why? The underlying query I have, which depends on what your position on this first question, is whether this same reason might not apply to people in the non-diabetic population but who are somewhat insulin resistant.

A minor practical point that I found perplexing was the claim that "eating starchy plants is more important for nutrition than eating colorful leafy greens - the veggies that are high fiber and low starch." Is this simply based on the anthropological-paleo reasoning that our ancestors would have preferred the starches? I can quite see that if you need a source of calories, regardless of micronutrition, the starches are the way to go, but most people in industrial countries aren't in that situation (and, indeed, are in the reverse situation). Brocolli or spinach or most vegetables come to that, would seem to have more micronutrients and more soluble fibre than equivalent mass or calories of starchy foods.


"Why is white flour less rewarding than white rice or other refined starches?"

It use results in more FR not less. Dehulling brown rice is hardly the same as running wheat througha a steel roller mill, which results in a fine industrial powder vs grains of rice in close the the state of nature.

Could white rice FLOUR be as rewarding as white flour if as ubiquitous in the food system? maybe, but white rice is no more processed than a steak or a peeled potato, really.

The gallbladder contracts each time you eat a fatty meal. If the gallbladder is not contracting you have stasis of bile. If you eat very low fat esp very high sugar, I have observed anecdotally that BG disease - stones seems more likely. This makes sense physiologically and I think it is likely inadequate fat intake may contribute to gallstones. But I can't be sure. as it could be the high sugar as well..

So once you develop gallstones, the same fat that might have helped you prevent them by giving your GB a workout may now precipitate biliary colic, as your GB contracts and a stone gets stuck in the duct.

Does that answer your question?

Generally, root veggies are loaded with micronutrients and minerals and soluble fiber and have starch to keep your metabolic fires burning, just like animal fat.

Alternatively, leafy greens and starch poor veggies have more INSOLUBLE fiber which is useless, not enough starch to live on, and are oversold for their antioxidant effects, especially with respect to any particular leaf or plant.


It is not plausible on an evolutionary basis that we need any one particular plant in our diets as there are none that occur with enough consistency in all biomes we have occupied during our recent evolution

September 30, 2011 | Unregistered CommenterDavid Moss

Thank you Dr. Harris, for continuing with the blog. I am happy to the find open mindedness in the Paleo world (you and the Jaminets among others) who seem to question (very) low carb! My question is why you consider potatoes/rice more important than greens? Is it because a diet with a focus an meat/fish offers all necessary micro-nutrients? Or is it more important to focus on macronutrients? Also, there seems to be some agreement now that the idea of carbs-insulin-fat gain/no fat gain without carbs is flawed. Now it is focused on leptin`s role that determines fat gain/loss. Could you provide a link that explains the connection for laymen? I know there are very well researched scientific articles out there but I am just looking for a brief summary...
Thank you!


Hunter gatherer tribes and primitive horticulturalists focus on starchy veggies. They may view greens medicinally but do not spend inordinate amounts of time assembling complex big green salads that are poor in starch just for the sake of variety.

Re: Leptin - just use pubmed there a lot of review articles. Type "Leptin" and "review"...

For references and arguments about insulin vs leptin in fat mass regulation see Stephan's blog.

September 30, 2011 | Unregistered CommenterI. G.

KGH: Long complicated answer.... Carbs per se not likely a culprit in anything IMO.

Dr Hsrris i have noted through my own dietary experimentation that the more carbs in my diet( good starch only, minimal berries only) that ny NMR profile shifts to where many more small LDL particles are generated, say on the level of 45% of total LDL particles. When i restrict them to a low level of caloric intake or eliminate them i have virtually no small particles, 200 small LDL one time, and less than 90 another time. If not the carbs casuing the difference in small LDL generation what might it be? Perhaps inadvertent reduction in fat calories? I Any thoughts or recommendations?
Thanks again


Like HDL and triglycerides in the Kitavans, which are "very bad" despite their absence of heart disease, other markers that are merely a sign of carbohydrate intake may also become more "bad" when you raise your starch intake.

sdLDL may be such a marker, and probably is.

I find the idea that your body makes sdLDL in order to burrow into your intima and kill you implausible - the Lipid hypothesis 4.0...

I can't and won't comment on your specific case, except to say your health is your business.

I personally would not monitor anything more than waist size and blood pressure and how I feel and make sure I don't have diabetes. Maybe make sure you are not hypothyroid ONCE...

September 30, 2011 | Unregistered Commentersteve

Hi Dr. Harris,

I enjoy your blog and hope you are able to ramp up the writing soon (this is self serving as I enjoy your presentation). It is interesting to see the CIH slowly being rejected-it's really starting to take off now from what I can tell (at least amongst the blogs I read that used to support it).

I don't think Stephen really ever supported the CIH (I'm not saying you said he did, btw), he was just biting his tongue a bit and being respectful of his mostly paleo and LC audience by not writing much about it. I heard him mention from time to time that he didn't think insulin and insulin spikes had much to do with obesity. His exchange with Gary Taubes at the AHS seems to have given him the "hell with it" attitude and he is now in full force rejecting the CIH. It's nice to see he has an alternative, interesting hypothesis in food reward, although it really isn't that new.

I fully believed the CIH after reading Taubes (it made sense), but empirically had my doubts. then I started to read Carbsane and that's what started to changed my mind.

Anyway, great stuff and I hope you keep writing more on your blog, although your comments on others blogs are just as informative, interesting and sometimes funny.


Thank you Thomas!

"I don't think Stephen really ever supported the CIH (I'm not saying you said he did, btw), he was just biting his tongue a bit and being respectful of his mostly paleo and LC audience by not writing much about it."

Stephan admits to being convinced by the CIH portions of GCBC maybe four years ago, but I agree has not likely agreed with it for at least the past 2 years. As you say, he has been dropping hints for a while.

I knew he felt this way about it, and I had rejected it myself on mostly ethnological grounds, so when I saw the AHS video I encouraged him to repudiate the idea is as completely as he felt he could, so that we could all benefit from knowing what he really thought.

He has done so in thorough and convincing fashion, adding to the technical details outlined by Evelyn, which you would probably admit, were not likely to reach as wide an audience.

September 30, 2011 | Unregistered CommenterThomas

Re: Hanging the fish - I always thought that was a load because the Natives always eat the heads.

Re: Types of starchy vegetables. Thanks for the face palm. Of course they are all vegetables. That's what years of carbs vs. everything else does to a person.

Re: Comment about Spain and Spanish people eating wheat and being fine. They aren't. I've lived in Spain for 2 years now, along the Costa Blanca, a well known European Expat haven. It is my astute observation that the Spanish people develop a barrel type shape as they age, starting around age 40. Most elderly have very swollen ankles. And they eat bread with everything, morning, noon and night. Gluten intolerance is a very big problem here. Spain has the best promotion for Sin Gluten (Gluten Free) and they even go so far as to label the meat and milk with the official stamp. I really enjoy grocery shopping here because of that awareness.

Now, the Germans, Norwegians and Dutch who live here, (the ones who aren't big beer drinkers and prefer wine), are slender/weight appropriate and seem to be very active. I"m not saying they don't eat bread/wheat because they do, but certainly not in the same quantities as the Spanish. There is definitely a notable body shape difference and it has nothing to do with height. We even play "Spot the Nationality" with surprisingly accurate results.

I'm not saying what causes the body differences, it could be what they eat, it could be what they don't eat or it could be their level of activity. But the Dutch and Germans are known for their potato consumption and the Dutch are especially known for their fatty dairy consumption.

KGH: Very intersting. I can't tell you how many arguments I have had with people about the Italians who allegedly are all fantastically slim on bread and pasta and very little meat, etc..

Well, I lived in Naples from 1970-73 and this is a southern city, much poorer than the north, especially at the time. (Think of the film "The bicycle Thief) The staples of the diet were foot long loaves of bread and pasta with marinara sauce - very little meat on a daily basis.
Most of the men, even very active ones working construction and such, were more obese than Americans, and I can't recall a woman over forty who was not fat. Seriously. Now, traveling north to Florence, things looked a little slimmer as that was a much more european and less "third world" environment.

But the bread and pasta gradient absolutely tracked the obesity gradient in the early 70's in Italy.

Here is a challenge - find me a single population that relies on the potato as a staple and has a lot of obesity. From the Andes 6000 years ago to Ireland in the 19th century.

September 30, 2011 | Unregistered CommenterShanta

On another note, the "rule #1" under Rule 3 in the Archevore Diet description should now read "rule #2" with the addition of sleep as the first rule. It's such a great summary that it might as well be perfect!

KGH: Thanks, Jeff, I made it 12 steps again and neglected to make that edit... should make more sense now I hope.

September 30, 2011 | Unregistered CommenterJK

I'll back you up on the Italian observation as well. I find Northern Italy more European overall. Not only do they use more meat, they also use more cheeses in the north - there's that animal fat again.

KGH; Southern Italy at the time was kind of third world like Mexico. But there seemed much less obesity in Mexico, which was more maize-based than wheat. Don't know how they would compare now with Mickey D's everywhere.

September 30, 2011 | Unregistered CommenterShanta

Dr. Harris - thanks for your blog. I wonder if you have any advice for me. My wife and I have both been eating paleo-inspired diets for a while now, with great results. Our daughter who is two and a half has classical PKU. As far as our new understanding of nutrition is concerned, this is approximately equivalent to having a diet where you are basically only allowed to eat the unhealthiest 20% of foods along with lab-generated amino acid/corn syrup shakes. We feed her a decent amount of pastured butter, starchy (and other) vegetables, and fruit. If you had to construct a diet without animal protein, is there anything you would be sure to include that might not be obvious?

September 30, 2011 | Unregistered CommenterHgFalling

Interesting you should bring that up. Way back BF (before Facebook) I worked as an Admin Asst in the Health Sciences at the university. Our keynote speaker cancelled at the very last minute and one of the attendees was kind enough to fill in. I can't remember what the original topic was, but this researcher went on to present his findings on the dangers of eating corn. Their early research was showing that corn does something to intercept the notification that you are full. It disables it, if you will. This reaction is not removed when the corn is turned into HFCS. They were on the verge of discovering WHY HFCS can make you obese, and it wasn't the sugar, it was this reaction with the corn. (Sorry, I'm not a scientist and I didn't remember his name!).

Anyway, he was heading down to Mexico with a team to look at why the native Mexicans could eat corn and did not seem to have this problem. His hypothesis was that there was something in the stones they used to grind the corn, that disabled this reaction that interfered with our ability to know when to stop eating. He was very excited about this because he was sure it was the calcium in the stone that was binding to the corn to render it safe to eat, and if it was, it would be something to study further.

He was also doing a study at the same time with Mexicans who still eat corn but not prepared the original stone ground way. He never said it was the carbs/sugars in corn, it was this one reaction that was the problem that caused us to gain weight from eating corn. And the problem is a big one because HFCS is in everything. I'll Google about and see if I can find any links for you.

OTN, my European grandparents refused to eat corn; they called it pig food, and it is here in Europe. I've noticed more and more corn served over here, especially in the past 10 years.

September 30, 2011 | Unregistered CommenterShanta

Thank you Dr. Harris for blogging, and answering so many questions!

Recently I watched the recorded version of Lindeberg's talk at the AHS (http://vimeo.com/28792391). One theme is the relative health of the Kitavans vs Swedes. One of the several markers he discussed is fasting serum glucose, which is two standard deviations lower for the Kitavans than modern Swedes (the chart appears at 14:45 in the talk, showing trends with age).

How important is the fasting serum glucose level for health (production of AGEs, likelihood of developing diabetes, and so on)? What kind of diet would keep this low? The intuitive answer would be a LC diet, but the Kitavans show the opposite. I suppose the answer might depend on whether an individual is insulin resistant or not. Perhaps someone with IR should start on a LC diet, and then gradually reintroduce safe starches, while someone without IR should work to avoid IR by not eating sugar/grains/industrial oils but could safely eat a high carb diet.

Also, muscle mass might play a big role. This would give the Kitavans a big advantage over many western societies.


"The intuitive answer would be a LC diet, but the Kitavans show the opposite. I suppose the answer might depend on whether an individual is insulin resistant or not."

Yes. IR is an effect, though, not a cause.

The fallacy is to equate eating glucose with hypergycemia. You can be hyperglycemic due to failure to suppress glucose release from the liver without eating ANY glucose.

The proposal: eat more glucose, have higher blood glucose is the fallacy. In fact, eating VLC usually results in HIGHER fasting glucose to protect your brain, not lower - this is physiologic insulin resistance.

September 30, 2011 | Unregistered CommenterWayne
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