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 and searching for a diet that would help them heal, and the 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.
The Jaminets make very well developed arguments for their macronutrient ratio recommendations, but I think these are best used as a starting point for each individual rather than as rigid ratios that will work best for everyone. The discussion of food toxins is extensive but not nearly comprehensive. The micronutrition section is very high quality, and the presentation of pathogenic infection as both a pervasive cause of chronic disease but one that is largely modifiable by diet is a welcome integration of these two fields. Ultimately, the book promotes a whole lot of great food and provides a useful starting point to put someone on the path towards healing and health.
The Jaminets run a great blog over at PerfectHealthDiet.Com where they regularly expand on their recommendations, post recipes, present new ideas, post occasional fun stuff, and allow readers to comment on their posts.
The Perfect Health Diet At a Glance — Great FoodsThe 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.
Optimizing Protein, Carb, and Fat Ratios on The Perfect Health DietThe Perfect Health Diet is 20% carbs, 65% fat, and 15% protein by calories. By weight, it is 65% plants and 35% 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 both macronutrients — protein, carbohydrate, and fat — and micronutrients — vitamins and minerals — to 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 bodys 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 bodys 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. The Jaminets make a strong case that it is preferable to include at least 200 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 many people whose livers do not make glucose robustly may be vulnerable to glucose deficiency on such a diet.
They 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? The Jaminets make a compelling argument that eating fat might be much safer than letting excess glucose hand around until it is eventually converted to fat anyway.
How do they 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 serve as an ideal starting point for many people.
Their first piece of circumstantial evidence is Loren Cordains analysis of 229 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% carb, 50-70% fat, and 15-25% protein.
These ratios are similar to those obtained from human breast milk, after adjusting for the excess of carbohydrate provided for the infants 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 constitute the final word.
Katherine Milton has pointed out (here) found grain residues in the teeth of Neanderthals in Belgium and Iraq who are believed to have lived 36-46,000 years ago.
At the Iraq site, they found evidence of the consumption of 73 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 136 dental starch residues at the Belgium site were more difficult to identify, but they included sorghum relatives.
The authors 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 could be quite unique among mammals in their dietary needs, just as they are quite 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 (a recording will be available soon here), where he uncovered health-promoting diets that were over 90% carbohydrate and others that were mostly fat, with a whopping 50% 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 in a blog soon after his talk (here), 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: carbohydrate-feeding 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, low-carb is the way to go. Indeed, well controlled studies have clearly shown that low-carbohydrate diets are superior to low-fat diets by a multitude of criteria for people with various markers of the metabolic syndrome (references here, here, and here). Although I find it unlikely that 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.
An Extensive But Not Comprehensive Coverage of Food ToxinsPerfect Health Diet offers an incredibly important discussion of food toxins that is likely to benefit a great number of people. The section is entitled Eat Paleo, Not Toxic, and as such the toxins considered are limited to those 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.
While I think this section is likely to help a great many of people who have unidentified intolerances to these foods, I think it would best serve as a starting point from which many people will have to branch out, either including some of these foods or excluding others.
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.
Chris Kresser, who recommends Perfect Health Diet to all his patients and readers, wrote a recent blog post, Food Fascism and the 80/20 Rule, in which he argued that Paleo should be used as a starting point, but not a rigid rule.
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 (reference), but sufficient fermentation of wheat renders it non-toxic to celiacs when actually fed to them, at least over a short period of time (reference). 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 higher quality and more advanced.
Many people have intolerances to salicylates, amines, amino acid neurotransmitters like glutamate, oxalates, and a host of other natural food chemicals. Emma Davies runs a good site on this topic.
Although sweet potatoes are considered a safe starch on the 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 more harm than good.
Matt Metzgar recently blogged about a study showing that beef intolerance was an important cause of asthma in one set of patients, being apparently much more important than wheat and other common suspects. In other words, modern food intolerances are rampant, and they can occur to wide variety of foods that are otherwise healthy.
I'll be commenting more on food intolerances in upcoming posts on The Daily Lipid. I do think that non-Paleo foods constitute an important subset of likely candidates for food intolerance, and I think Perfect Health Diet does a fantastic job bringing these candidates to peoples attention, but I think 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. I agree with Chris Kresser, then, that drawing peoples attentions to certain food intolerances is likely to offer most people a great deal of help, but has to be seen as a starting point. Perfect Health Diet will definitely provide a great starting point for many people.
Optimizing Micronutrition on The Perfect Health DietThe 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. I have expressed similar views in recent blog posts, including Are Some People Pushing Their Vitamin D Levels Too High?, Is Vitamin D Safe? Still Depends on Vitamins A and K!, and Vitamin D — Problems With the Latitude Hypothesis.
The Jaminets provide a discussion of seven nutrients we may be tempted to supplement with 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 Ive 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 with a tentative best guess 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 importantly, 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.
Combating Infectious Disease With The Perfect Health DietThe Jaminets link infectious disease to atherosclerosis, stroke, Alzheimers, multiple sclerosis, arthritis, rosacea, high-risk behavior, traffic accidents, stomach ulcers, cancer, chronic fatigue syndrome, Parksinsons, Lou Gherigs disease, schizophrenia, mood disorders, cognitive impairment, and likely a whole host of other diseases for which the links to pathogens have not yet been found.
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, supplementing with iodine, 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 generates 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.
Conclusion and Who Should Read The Perfect Health DietOverall, The Perfect Health Diet is an excellent introductory book for just about anyone to the world of paleo/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 someone who is looking for someone to just tell me what to eat, but most readers with an interest in nutrition or another science should find the book very readable. This book is especially preferable to some of the more low-fat versions of ancestral nutrition, and would be an excellent book to read as an introduction to ancestral nutrition or to recommend to a friend or family member in need of such an introduction. The excellent discussion of the interconversion of different macronutrients that the Jaminets provide would certainly shake anyone out of their fat-phobia, once they realize that any excess carbs they eat are just turned to fat anyway.
I give Paul and Shou-Ching Jaminets Perfect Health Diet two thumbs up.