Perfect Health Diet: Four Steps to Renewed Heath, Youthful Vitality, and Long Life
By Paul and Shou-Ching Jaminet
YinYang Press, 2010
Creating a diet that can be described in fewer than 300 pages and has as its primary aim not merely fat loss, muscle gain, heart health, better sex, or the treatment of a specific disease, but rather the all-encompassing pursuit of “perfect health” is an insurmountable task. It would be almost certainly impossible to accomplish in a way that is not subject to at least a few caveats and criticisms, but in writing Perfect Health Diet the Jaminets have done a stellar job in assembling a beginner’s guide and starting point for pursuing the perfect health we should be inheriting from our ancestors.
Paul Jaminet, PhD, is a physicist, software entrepreneur and entrepreneurial consultant, and Shou-Ching Jaminet, PhD, is a vascular biologist. They each recovered from chronic illness after searching for a diet that would help them heal, and Perfect Health Diet is the result. It is composed of four strategies for achieving optimal health: optimizing macronutrient ratios, minimizing food toxins, optimizing vitamin and mineral (micro) nutrition, and combating infectious disease.
Perfect Health Diet is based on “nutrient-rich superfoods” like egg yolks, liver and other organ meats, bone and joint soups, brain and bone marrow, seafood, seaweed, green leafy vegetables and fermented vegetables. It includes a number of other meats, fats, oils, and “safe starches” to provide sufficient protein and calories. With great foods like this, Perfect Health Diet gets my stamp of approval.
The diet is composed of 20 percent carbs, 65 percent fat, and 15 percent protein by calories. By weight, it is 65 percent plants and 35 percent animal foods. As such, it is a low-carb diet, but not a low-plant diet. Most of the carb calories come from the “safe starches,” while most of the plant material consists of low-calorie, low-carbohydrate vegetables and a small amount of fruit.
The Jaminets consider that both macronutrients— protein, carbohydrate and fat—and micronutrients— vitamins and minerals—each have their own “marginal benefit curve,” where there is an optimal intake that constitutes the “plateau range.” Below the plateau range, deficiency sets in; above the plateau range, toxicity develops.
Although the Jaminets advocate a low-carb diet, they put a lot of emphasis on the body’s need for glucose as a structural molecule, a brain and muscle fuel, and an immune booster. They likewise recognize that although protein is critical, not only may large excesses lead to “rabbit starvation,” but even small excesses may decrease longevity and hamper the immune system. Glucose, for all its necessity, can poison the body’s tissues in excess, contributing to nerve damage, diabetes, strokes, heart attacks, bacterial infections, cancer and virtually every other disease. While polyunsaturated fats may contribute to oxidative stress and inflammation when provided in excess or in the wrong omega-3-to-omega-6 ratio, saturated and monounsaturated fats are the safe, non-toxic macronutrients.
The Jaminets make important points about the interconversion of carbohydrate and protein. The liver can make glucose from protein, so carbohydrates are not technically essential. However, the Jaminets make a strong case that it is preferable to include at least two hundred calories of carbohydrate in the diet, but allow flexibility in whether carbohydrate or protein is used to fulfill the remainder of the glucose requirement. There are people who do well on zero-carb diets, but those whose livers do not make glucose robustly may be vulnerable to glucose deficiency on such a diet.
The Jaminets also make important points about the conversion of carbohydrate to fat. If our livers convert much of the carbohydrate in a high-carb diet to loads and loads of saturated fat, how can eating saturated fat itself be harmful? Eating fat might be much safer than letting excess glucose hang around until it is eventually converted to fat anyway.
How do the authors arrive at the 20:65:15 ratio? The Jaminets rely largely on the convergence of four pieces of circumstantial evidence, supplemented with a copious amount of data gathered from free-living humans. None of this evidence is fool-proof, and I suspect that humans have the capacity to eat a much broader range of macronutrient ratios, but this ratio may nevertheless serve as an ideal starting point for many people.
Their first piece of circumstantial evidence is Loren Cordain’s analysis of two hundred twenty-nine hunter-gatherers, who ate an average 30:50:15 macronutrient ratio with a 65:35 plant-to-animal ratio. They supplement this with isotope evidence suggesting our Paleolithic ancestors ate even more animal foods than this, and suggest that the encroachment of civilization on hunting territories may actually have increased carb intake. The Jaminets believe that our Paleolithic ancestors ate a range of 5-35 percent carb, 50-70 percent fat, and 15-25 percent protein.
These ratios are similar to those obtained from human breast milk, after adjusting for the excess of carbohydrate provided for the infant’s growing brain, and are similar to the composition of the human body. Some research, moreover, shows that mice prefer high-fat diets. Beyond these studies in mice, however, the Jaminets provide a full chapter arguing that most mammals eat a high-fat diet, whether they are carnivores, omnivores or herbivores, because the plant foods that omnivores and herbivores eat are so fibrous that they obtain the bulk of their calories from short-chain fatty acids produced by fermentation of fiber in the gut. Together, these observations constitute the last three pieces of circumstantial evidence. The Jaminets further cite metabolic data from living humans about the capacity to handle carbohydrate. All of these pieces of evidence are interesting and deserve consideration, but none of them constitutes the final word.
Katharine Milton has pointed out in a letter in the December, 2000 issue of the American Journal of Clinical Nutrition that when “casual agriculturists” and modern hunters using guns are excluded, Cordain’s two hundred-twenty-nine “hunter-gatherers” are reduced to only twenty-four. Although Milton often seems biased in favor of plant foods, I’m not sure how much “hunter-gatherers” hunting with modern guns can tell us about what humans were eating forty thousand years ago.
Likewise, archaeological evidence will be subject to endless debate as new discoveries are made and as people argue about whether absence of evidence can truly indicate evidence of absence. The Jaminets cite “clear evidence for the grinding of cereal grains” dating to 21,500 BC, well within the Paleolithic era, and cite evidence of sorghum grain residues on stone tools at an African site dating to 103,000 BC. Researchers believe they used the sorghum grasses for bedding, kindling and possibly baskets. An eternity could be spent debating whether they were actually eating the grains, and if so, what proportion of their diet those grains constituted.
Hot off the presses, and adding grist, as it were, to the mill, a new report published in the Proceedings of the National Academy of the Sciences (December 27, 2010) found grain residues in the teeth of Neanderthals in Belgium and Iraq who are believed to have lived 36,000-46,000 years ago.
At the Iraq site, they found evidence of the consumption of seventy-three starch grains. Ten were members of the Triticeae tribe that includes wheat, barley and rye, and most likely close relatives of barley. Fifteen appeared to be members of the Triticeae tribe that had been cooked with moist heat. They also found sixteen dental residues of different species of the fruits of the date palm, and four other unidentified tree fruit residues. The one hundred thirty-six dental starch residues at the Belgium site were more difficult to identify, but they included sorghum relatives. The authors of the report noted that the finding of starchy plant food consumption does not contradict isotope data, which can only detect meat and protein-rich plant foods. In other words, the types of evidence do not overlap enough to determine proportions of different food groups with any confidence.
The other evidence for an ideal macronutrient ratio presented in Perfect Health Diet is also subject to a number of caveats. Adult humans may have similar nutritional needs as infants, or they may not. Our nutritional needs may be similar to our body composition, but not if the turnover rate of different macronutrients is different. Short-chain fatty acids are metabolized quite differently from long-chain fatty acids, so it is difficult to see the metabolism of carnivorous and herbivorous animals as fundamentally the same, although it may be true that most mammals consume a diet low in carbohydrate. While the diet of other mammals is interesting, however, it is quite plausible that humans are unique among mammals in their dietary needs, just as they are unique in their technological and intellectual capacities. Long-term carbohydrate consumption, among a number of other variables, will alter our capacity for utilizing carbohydrate.
At the 2010 Wise Traditions Conference, Dr. Stephan Guyenet gave a presentation on the traditional diets of the Pacific islands where he uncovered health-promoting diets that were over 90 percent carbohydrate and others that were mostly fat, with a whopping 50 percent of calories as saturated fat. None of the populations had insulin resistance, diabetes or cardiovascular disease, and none of the islands’ inhabitants were fat. In came refined foods, and they became vulnerable to all of these diseases. As Stephan pointed out on a blog soon after his talk (wholehealthsource. blogspot.com), these natives on high-carb diets had extraordinarily low fasting glucose and low postprandial glucose. This reflects what has been known for almost a century: carbohydratefeeding actually increases glucose tolerance, and oral glucose tolerance tests are misleading unless the subjects have been consuming a relatively constant intake of carbohydrate in the days preceding the test.
I thus find it very difficult to believe that humans must maintain their diets within a very narrow range of macronutrient ratios. More likely, the human body is extraordinarily flexible and can tolerate a wide range of carbohydrate and fat intakes.
That said, it may well be the case that in modern folks with damaged metabolism, lowcarb is the way to go. Indeed, well controlled studies have clearly shown that low-carbohydrate diets are superior to lowfat diets by a multitude of criteria for people with various markers of the metabolic syndrome. Although it remains to be seen if this is a universal law, it is quite clear that this approach has helped not only the Jaminets but many others as well. I therefore consider the macronutrient advice in Perfect Health Diet to be an excellent starting point for many people, so long as they maintain the flexibility to adjust their macronutrient ratios in the ways that most benefit them.
Perfect Health Diet offers an important discussion of food toxins that is likely to benefit a great number of people. The section is entitled “Eat Paleo, Not Toxic,” and includes toxins in what are generally considered Neolithic foods. They include grains, legumes, vegetable oils,and fructose, with a small section on sugar-cured meats, nightshades, foods cooked with high heat, and genetically modified foods.
I believe a more complete discussion of food toxicity would include the methods that humans have developed to detoxify these foods, variation in susceptibility to food toxins, the role of nutrition in preventing food intolerances, and a number of other food toxins that occur in foods that might not be conventionally limited to the Neolithic era. Indeed, while the research on non-celiac gluten sensitivity is in its infancy, so is the research showing that food preparation can be used to detoxify wheat and possibly make it safe even for celiacs. Treating isolated pieces of intestine from non-celiacs with crude gluten and known toxic peptide fragments elicits an inflammatory response, but sufficient fermentation of wheat renders it non-toxic to celiacs when actually fed to them, at least over a short period of time. While neither of these hypotheses—that gluten is toxic to everyone or that gluten is only toxic if improperly prepared—have a large amount of support, the evidence that fermentation mitigates the toxicity of gluten is of higher quality and more advanced.
Although sweet potatoes are considered a safe starch on Perfect Health Diet, they are not very safe for me. When I discovered how yummy sweet potato fries are, I started eating several sweet potatoes per day. Within a few days, I was limping and my neck was stiff. By the end of the week, my limp was extreme. I looked online to see if I was eating anything high in oxalates, and sure enough, sweet potatoes are loaded with them. My symptoms dramatically improved after one day off sweet potatoes and were gone the second day. By contrast, I went gluten-free, casein-free (GFCF) for a year and a half, and FAILSAFE (low-amine, low-salicylate) for several months, and both diets did me more harm than good.
Matt Metzgar (mattmetzgar.com) recently blogged about a study showing that beef intolerance was an important cause of asthma in one set of patients, apparently much more important than wheat and other common suspects. In other words, modern food intolerances are rampant, and they can occur with a wide variety of foods that are otherwise healthy. I do think that non- Paleo foods constitute an important subset of likely candidates for food intolerance. Perfect Health Diet does a fantastic job bringing these candidates to people’s attention, but the food toxin issue is ultimately likely to be much more complex, dependent in part on genetics, nutritional status during development, present nutritional status, intestinal flora and proper preparation of potentially toxic foods, and ultimately to a large degree modifiable with the correct therapeutic approaches.
Nevertheless, it is important to remove foods to which one is intolerant while one is trying to heal, even if the intolerance itself can be healed, and it may turn out that some intolerances can never be healed. Perfect Health Diet will definitely provide a great starting point for many people.
The Jaminets make the case that malnutrition is a pervasive problem even in the land of abundance. They focus their discussion on eight vitamins and minerals whose deficiencies they consider especially problematic: vitamin D, vitamin K2, selenium, iodine, magnesium, copper, and chromium.
Their discussion of vitamin D is well balanced. They recommend keeping 25(OH)D levels between 35 and 50 ng/mL for people of European descent and between 30 and 40 ng/mL for people of African descent. They include a discussion of the potential harms of going much higher than 50 ng/mL. The Jaminets provide a discussion of seven nutrients we may be tempted to supplement but should avoid in most cases. These include vitamin A, calcium, zinc, niacin, vitamin E, folic acid and fish oil.
I think they come down on vitamin A a little harder than this poor little vitamin deserves, and I’ve expressed my views on this most recently in “The Cod Liver Oil Debate.” Nevertheless, the Jaminets provide a reasoned discussion of the interactions between vitamins A and D and conclude that the ratio of these two vitamins should be about 3:1 in terms of IU. This conclusion seems within the range of plausibility. Most important, they recommend eating liver! Any discussion of vitamin A that results in a recommendation to eat liver is a good one.
Their discussions of the other nutrients are very well reasoned and very valuable. This is probably one of the best overviews of vitamin and mineral nutrition available as part of a larger diet book.
The Jaminets link infectious disease to a long list of diseases, including neurological ones. Rather than considering sanitation, hygiene, or vaccines to be the most important tools in the fight against infectious disease, the Jaminets provide a refreshing integration of the fields of immunology and nutrition. They discuss eleven dietary and lifestyle strategies one can enlist in this fight, including keeping blood glucose and insulin low, optimizing essential fatty acid intake, avoiding toxic foods, optimizing vitamin D levels, taking iodine supplements, restricting protein, regular short fasts, eating ketogenic on certain days, long ketogenic “fasting” periods, getting high-quality sleep and relieving stress.
The Jaminets make an important point that much of the benefit of “fasting” comes from the production of ketones. Thus, both fat and fiber, which generate short-chain fats in the colon, can be allowed during a fast. They also discuss potential benefits of restricting protein intake, which can serve both to starve pathogens of needed amino acids and to jump start a process called autophagy, wherein the cells begin digesting damaged or unneeded proteins and which can initiate the killing of intracellular pathogens. This section of the book contains some of the most up-to-date and cutting-edge ideas about the relationship between infectious diseases and health and the relationship between diet and lifestyle and the defense against pathogens.
Overall, Perfect Health Diet is an excellent introductory book to the world of paleo and traditional eating. It is well referenced, well reasoned, and should be convincing to both the lay reader and the professional. The content ranges from practical to technical, and some of the more technical sections may be intimidating to readers looking for someone to “just tell me what to eat,” but most people with an interest in nutrition or another science should find the book very readable. This book is especially preferable to some of the more lowfat takes on ancestral nutrition, and would be an excellent book to read as an introduction to that topic. The outstanding discussion of the interconversion of different macronutrients that the Jaminets provide would certainly shake people out of their fat-phobia, once they realize that any excess carbs they eat are just turned to fat anyway.
This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly magazine of the Weston A. Price Foundation, Summer 2011.