I wanted to give Paul an opportunity to respond and share his thoughts on the various counterarguments that were expressed about this subject.
Just as I did with the responses in my original post, none of the following has been edited in any way, shape, form or fashion. This is straight from Paul Jaminet himself and I’m happy to give him this platform to explain and clarify more about his plan in greater detail. Feel free to respond to what Paul share in this guest blog post in the comments section at the end.
Not many people could bring such a roundtable together, and it’s an honor for us to be part of it.I think unfortunately the discussion began with a few misunderstandings. Thus wheat, which includes gluten and various inhibitors of digestion that survive cooking, is an unsafe starch, while white rice, in which the known toxins (possibly excepting a recently discovered miRNA) are destroyed in cooking, is a safe starch. To say that something is a “safe starch” is not to imply that it is a desirable food for, say, a Type I diabetic.Our “regular” diet is not specifically directed at diabetic or metabolically damaged persons.
We have a basic diet that is designed for healthy people (represented in the apple – food plate) and we recommend modified versions of the diet for various health conditions – including diabetes.We agree that diseases of metabolic derangement may benefit from lower carb consumption than our regular diet. This is especially the case in diabetes, if beta cell loss has reduced basal insulin levels and excessive gluconeogenesis is occurring.
In this case, replacing protein rather than providing dietary carbs may be a more helpful strategy.We agree that there is no single prescription that is optimal for every person. We often say, borrowing from Tolstoy, that “every healthy person is biologically alike, every diseased person is unhealthy in his own way.” Obesity, for instance, is a heterogeneous disease and there is not a single prescription that will be optimal for every obese person. Diseases of metabolic derangement raise rather complex issues which we explore regularly on our blog. Allow me to discuss the biology in some detail.Glucose Utilization of the Human BodyBrain and nerves typically consume about 480 calories per day of glucose. Ketones can displace up to perhaps 60% of this, but ketones do not diffuse well into cortical areas of the brain and the brain always requires some glucose.After 3 days of fasting, when the brain’s glucose consumption has been roughly halved by ketosis and the rest of the body is conserving glucose, the body’s rate of glucose manufacture in liver and kidneys is about 600 calories per day. Glucose needs are slightly reduced by some endogenous sources of glucose, such as from glycerol released from lipolysis of triglycerides or phospholipids. So the body’s net glucose needs are on the order of 600 to 800 calories per day.As I noted above, we consider Perfect Health Diet to be a low-carb diet because we favor eating fewer carbs than the body utilizes.
For most people, we suggest 400 to 600 carb calories per day, about 200 less than the body utilizes.
We are a slightly or moderately low-carb diet.The Human GlycomeWhy is so much glucose consumed outside the brain? Immune function (which may utilize significant glucose in people with infections) and glycogen replacement (high utilization in athletes) are two reasons that can be significant in some persons, but in the vast majority of people the biggest reason for glucose utilization is the construction and maintenance of the human glycome.There are about 20,000 human genes and, due to transcriptional variants and manufacture of proteins from multi-gene subunits, about 200,000 human proteins. However, these proteins are subject to various post-translational modifications, chief of which is glycosylation.
Over half of all human proteins need to be glycosylated for proper function, and such is the variety of ways in which they can be glycosylated that there are an estimated 2,000,000 compounds in the human glycome.These glycosylated proteins coat the plasma membrane of all cells. Glycosaminoglycans such as hyaluronan and proteoglycan components such as heparan sulfate and chondroitin sulfate are important building blocks of the extracellular matrix. Proteoglycans in general mediate all intercellular interactions.All the body’s lubricating molecules are rich in carbohydrate.
Mucins, the most important molecules in mucus, tears, and saliva, are predominantly composed of carbohydrate.
Mucin-2, the dominant mucin of the intestine, is 80% sugar by weight.Production of hyaluronan alone consumes 5 gm, or 20 calories, of glucose per day.
Why, if cells can run on glucose and blood glucose remains normal, do starving people die?A clue is the fact that starving people develop a hacking cough in their final weeks of life. The brain may import glucose passively, driven by a concentration gradient, but not so the rest of the body. During times of glucose scarcity, blood glucose levels are maintained to sustain brain and nerve function, but hormonal patterns change to prevent peripheral tissues from using glucose to make compounds like hyaluronan and mucin.What are the hormones that regulate glucose utilization? This is an understudied area of physiology, but the primary regulators seem to be thyroid hormones.
During glucose deficiency, T3 thyroid hormone levels decrease and reverse-T3 levels increase. I discussed this in a recent blog post (Carbohydrates and the Thyroid, Aug 24, 2011).Decreased production of molecules like hyaluronan and mucin and reduced levels of T3 thyroid hormone, then, are outcome of dietary glucose deficiency.

Since that was published, well over 50 low-carb Paleo dieters have reported to me that dry eyes and other mucin deficiency symptoms were cured by adding safe starches to their diet.I have put up a “Results” page which has case studies drawn mainly from the comment section of my blog.
This includes many cases of glucose deficiency symptoms that developed on very low-carb Paleo or GAPS diets and were cured on our diet. At the Ancestral Health Symposium, two dozen people came up to Shou-Ching and I and told us their health had been improved by adding safe starches to their low-carb Paleo diets. The immune defense against these infections is glucose-dependent (as it relies on production of reactive oxygen species using glucose) and thyroid hormone-dependent (as thyroid hormone drives not only glucose availability, but also the availability of iodine for the myeloperoxidase pathway).
Thus, anti-fungal immunity is downregulated on very low-carb diets.Moreover, eukaryotic pathogens such as fungi and protozoa can metabolize ketones.
Thus, reduced production of mucus can impair intestinal immunity and promote gut dysbiosis or systemic infection by pathogens that enter through the gut.Finally, a very low-carb diet is not entirely free of risks of gut dysbiosis, and not just from fungal infections.
Bacteria can metabolize the amino acid glutamine as well as mucosal sugars, so it is not possible to completely starve gut bacteria with a low-carb diet. Nor is it desirable, as this would eliminate a protective layer against systemic infection by pathogens that enter the body through the gut. As our “Results” page shows, several people who had gut trouble on the very low-carb (and generally excellent) GAPS diet were cured on our diet.The Possibility of Slow-Developing Problems Cannot Be Ruled OutThe majority of very low-carb dieters may experience no immediate ill effects. However, this does not guarantee that problems cannot develop over time.Is it possible that peripheral downregulation of glucose utilization may increase the risk of some chronic diseases? There is too little experience with very low-carb diets to answer this question, but I think no biomedical scientist would exclude the possibility.Biomedical researchers are gradually realizing the importance of glycosylation defects in leading diseases.
A few papers:N- and O-glycosylation of proteins in Golgi bodies is impaired in cancer cells. Protection from disease was conferred by enforced beta cell-specific GnT-4a protein glycosylation and involved the maintenance of glucose transporter expression and the preservation of glucose transport. We observed that this pathogenic process was active in human islet cells obtained from donors with type 2 diabetes … [7]I report these papers, not because I think they tell us how many carbohydrates we should eat – they don’t – but to remind everyone of the complexity of biology.We lack data on the long-term effects of very low-carb diets. On the Standard American Diet, many diet-induced diseases do not show up for 40 to 50 years. We cannot be sure that there may not be negative health effects from severe carb restriction that will show up only after decades.I am not saying that such insidious health effects exist.
Now we reach the question of which plant foods should provide them.The main choice is between starchy plants and sugary plants. Glucose is more nutritious because, as noted above, it has structural uses throughout the human body. First, it is less reactive, less likely to glycate (fructate) proteins or promote lipid peroxidation.
Second, Paracelsus’s rule tells us that the “dose makes the poison.” Dietary glucose is distributed via the blood throughout the body, so that levels are low in any one location. Fructose, however, is concentrated in the liver.The body’s evolved machinery for handling glucose and fructose is a good indicator of their relative healthfulness. Glucose is treated by our evolved physiology as a non-toxic nutrient: it is allowed free entry to the blood where it is accessible to all cells of the body. Here is a figure from our book (p 4):A “glycemic load” can be understood as a bolus of glucose delivered to the body. At very high carb intakes, a “glycemic load” may become dangerous.So knowing a plant’s “glycemic index” or “glycemic load” cannot tell us whether it is good to eat some. On a low carb diet, a safe starch is likely to be nourishing, regardless of its glycemic index.Issues of Glycemic ControlIn interpreting the safety of glucose, there is also the issue of whether postprandial increases in blood sugar can create transient toxicity effects.
This is, indeed, an unsafe blood glucose level.But he eats a very low-carb diet, and very low-carb diets induce hormonal changes that lead to glucose conservation. One result of these changes is insulin resistance and impaired glucose tolerance.Thus, an isolated glucose tolerance test is not necessarily a fair test of glycemic control in a very low-carb dieter. Were Tom to eat 400 calories per day from safe starches for a week, he might find his glycemic control was considerably improved. Or, he may find that he is somewhat diabetic and intolerant of carbs in all circumstances.What is a normal blood glucose response to consumption of a starchy meal?
A typical vegetable has about 80 carb calories per pound, half as glucose and half as fructose. The digestive tract typically consumes about 50 calories of glucose in digesting a pound of vegetable matter, due to intestinal and immune utilization.

Some fructose may be converted to glycogen and then to glucose, but some may be converted to fat and much may be intercepted by gut bacteria.
So the net contribution of vegetables to the body’s glucose status is small and may be negative.Since we recommend counting calories only for a few days until one learns how much one must eat to obtain our recommended 400 calories per day of glucose, there is no reason to include vegetables in calorie counting. Vegetables are recommended in our diet due to their micronutrient and fiber content, not their carbohydrate content.Improved Weight Loss with Consumption of Safe StarchesSince many of Jimmy’s readers eat low-carb diets in the hope of losing weight.
We do not come from a “glucose mentality” and agree that fat and ketones are fine metabolic fuels. We agree that glycation is bad.I’d like to thank Robb Wolf for his point of view, which is quite reasonable. I am not asserting that no one can do well on a very low-carb diet, only that as carb consumption approaches zero risks of health problems increase.
That Robb himself experienced problems on sustained very low-carb is a helpful data point.I’d like to thank Chris Masterjohn for his contribution.
I think Chris has read enough of our work to know that we recommend ketogenic diets as a therapy for various conditions, including neurological disorders of all kinds, and generally hold that dietary adjustments are desirable in many health conditions. So we do not consider that a single macronutrient ratio applies to everyone, but we do believe that intolerance of a “normal” macronutrient ratio is diagnostic of a dysfunction of some kind.Chris is quite right that it’s a “safe[r] bet” to meet the body’s physiological need for glucose in part by eating glucose. This reduces the risk of failing to provide adequate glucose for optimal cellular and extracellular function.I’d like to thank Dr. The most frequently cited benefit was feeling better after adding safe starches to the diet, with relief of dry eyes the most common symptomatic improvement. So if symposium attendees were not dropping like flies, perhaps we deserve a bit of the credit.Dr.
Loren Cordain’s assertion that eating sugary plants like yams, sweet potatoes, and berries is preferable to eating starchy plants like rice and potatoes may be a defensible position, but we believe the evidence is strong that glucose is preferable to fructose as a carb source, and does not support the notion that rice or white potatoes are intrinsically dangerous foods.Dana Carpender links to one of Mike Eades’s best posts, which we cite and quote in our book’s discussion of why wheat bran is unhealthy. I agree with Anonymous Prominent Member’s point about the importance of practical experience.
Thousands of copies of our book have been sold, and hundreds of people have reported results back to us. On the blog, I answer questions from people with health problems, ask them to report back results, and many return weeks or months later to report cures or improvements. Uffe Ravnskov can find the scientific studies in support of our views on our blog and in our book.
The issue Mike discussed, of an excess of mucus due to intestinal injury, is unrelated to the issue we discuss, of a mucus deficiency due to glucose deficiency.About vitamin C, I think Jimmy may have given this issue quite a bit more prominence than it deserves. It happens that the incidence of kidney stones, glutathione deficiency, and vitamin C deficiency is increased on very low carb ketogenic diets for epilepsy, and other very low carb diets.
To answer Adele, part of the issue is likely a protein deficiency: the need to utilize protein for gluconeogenesis may induce a protein deficiency on an otherwise adequate dietary intake. Other factors are that vitamin C degrades through a pathway that generates oxalate in the kidneys, a risk factor for calcium oxalate stones. Vitamin C does indeed share insulin-dependent receptors with glucose, which implies that glucose competes with C but also that insulin promotes C entry into cells for recycling, so the overall effect of consuming carb-rich foods is unclear.
On a low-carb diet adding a little dietary glucose is unlikely to be pro-inflammatory.About cancer, this is an interesting scientific question. I’ve explained above why a glucose deficient diet can downregulate production of glycoproteins and other structural glucose-containing compounds. However, cancers often evolve an ability to take in glucose independently of insulin and other hormones that regulate glucose utilization in normal cells. He is quite right that cancers disable glycosylation by suppressing enzymes involved in it. This is speculative science, but speculation is the first step in scientific discovery.Dr McCleary is quite right that depriving cancer cells of glucose is an attractive therapeutic strategy for cancer. However, except in the brain (where ketogenic dieting can significantly reduce glucose levels) this is a difficult strategy to implement.

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