Grain Brain – Take It With a Grain of Salt

Estimated reading time: 9 minutes

During the last couple of decades Alzheimer’s disease and other types of dementia have become increasingly common. Today it is estimated that about 34 million people suffer from Alzheimer’s disease worldwide and the number is increasing rapidly.

It is expected that the number of individuals with Alzheimer’s disease will triple over the next forty years. Therefore, preventing or reducing the risk of this incurable disease is one of the biggest challenges facing modern healthcare.

15612550_mA couple of years ago a paper written by two US researchers on how reducing modifiable risk factors might cut the prevalence off Alzheimer’s disease was published in The Lancet Neurology.

The authors pointed out seven of the most important risk factors for Alzheimer’s disease: diabetes, midlife hypertension, midlife obesity, smoking, depression, cognitive inactivity or low educational attainment, and physical inactivity.

They  concluded that a 10—25% reduction in all seven risk factors could potentially prevent as many as 1.1—3·0 million cases of Alzheimer’s disease worldwide and 184.000—492.000 cases in the USA. Most importantly, the authors highlighted that to a certain degree, Alzheimer’s disease is a preventable disorder.

In his recently published book Grain Brain, renowned US neurologist David Perlmutter points out that for years the brain has been excluded from discussion about preventive medicine. He believes that lifestyle choices play a fundamental role in determining the brains destiny. Alzheimer’s disease, depression, Parkinson’s disease and ADHD are all preventable. Perlmutter believes that the fate of our brain is in the food we eat.

In the first chapter of Grain Brain you get a feeling of where Dr. Perlmutter is going. “Brain dysfunction starts in your daily bread, and I’m going to prove it”….. “Modern grains are slowly destroying your brain”….. ” I’m referring to all the grains that so many of us have embraced as being healthful – whole wheat, whole grain, multigrain, seven-grain, live grain, stone-ground and so on. Basically, I am calling what is arguably our most beloved dietary staple a terrorist group that bullies our most precious organ, the brain”….. ” I will demonstrate how fruit and other carbohydrates could be health hazards with far-reaching consequences”….. This isn’t science fiction; it’s now documented fact”….. “This is not just another diet book or generic how-to guide to all things preventitive health. This is a game changer.”

Although it is admirable when experts deliver such a simple and clear message, this is also where we should get suspicious. Biologic science is very rarely so black and white.

Perlmutter writes: “This book is about those lifestyle changes you can make today to keep your brain healthy, vibrant, and sharp, while dramatically reducing your risk for debilitating brain disease in the future”.

Is this a sales rep talking or a medical doctor? Either way, I’m quite amazed by Dr. Perlmutter’s conviction and persuasiveness.

Sorry, but before I go further I have to tell you about a psychological phenomenon called cognitive dissonance. I believe it deserves a mention here because I think it often seriously affects how we interpret scientific data and how we present them, or decide not to present them, to other people.

Cognitive Dissonance

In December, almost sixty years ago, Dorothy Martin (alias Marian Keech) and her followers believed they would be celebrating christmas far away from planet earth. Keech claimed to have received a message from a planet named Clarion revealing that the world would end in a great flood before dawn on December 21, 1954. Her group of believers, located in Michigan, had taken strong behavioral steps to prepare for this moment. They had left jobs, college, and spouses, and had given away money and possessions to prepare for their departure on a flying saucer which was to rescue the group of true believers.

Cognitive dissonance is the distressing mental state that people feel when they “find themselves doing things that don’t fit with what they know, or having opinions that do not fit with other opinions they hold.” This produces a feeling of discomfort leading to an alteration in one of the attitudes, beliefs or behaviors to reduce the discomfort and restore balance. You can imagine the stress imposed on Marian Keech and her group when they realized that they were not going to be rescued by a flying saucer, and the second shock when realizing that Apocalypse was not imminent.

Later, psychologist Leon Festinger wrote his famous book “When Prophecy Fails: A Social and Psychological Study of a Modern Group That Predicted the Destruction of the World“. Festinger and his associates had read an interesting item in their local newspaper headlined “Prophecy from planet Clarion call to city: flee that flood.” They recruited a team of observers, joined Marian Keech’s group, and watched it from within. The story and the psychological reaction of the group members lead to the definition of the term “cognitive dissonance”.

Ok, I know what you’re thinking. Now the Doc’s gone completely mad. Telling a sixty year old story about UFO’s and Armageddon. Then trying to explain a psychological phenomenon he knows nothing about.

So, I’ll try to get back on track. One of the biggest problems with many books being written about health issues is information bias. If I have a belief or a point to make, I’m already biased. That’s quite obvious isn’t it? However, if I understand and respect scientific methods, I will present data that support may view as well as data that don’t support it. That’s honest. If I can’t make my point by doing this, I probably don’t have a case.

However many books on medical issues are written by individuals who tend to seek out information confirming their point of view and reject information on the contrary. This may be done on purpose, but it may also be done “unwillingly” to reduce the discomfort of cognitive dissonance. Okay, there you have the connection with the UFO’s.

Both medical writers and their readers suffer from cognitive dissonance. The reader usually prefers to read books or articles that support or confirm his own beliefs. Keep in mind though, that cognitive dissonance is not a disease. It’s quite normal indeed.

Remember the story about the Fox and the Grapes. It’s a classic example of cognitive dissonance. In the story, a fox sees some high-hanging grapes and wishes to eat them. When the fox is unable to think of a way to reach them, he decides that the grapes are probably not worth eating, with the justification the grapes probably are not ripe or that they are sour.

Dietary Habits and Brain Health

Let’s get back to the grains and the brain. Dr Perlmutter provides historical and scientific evidence indicating that a diet rich in carbohydrates may damage our brains. Consequently, a diet rich in fat, and low in carbohydrates will protect our brain.

In a radio interview following the publication of his book he said: “It turns out that humans have never eaten grain. In 99.9 percent of our time walking this earth we have never eaten grain. What is wrong with wheat barley and rye is that it contains this very powerful protein called gluten”…. “Grain brain was written based upon my review of about 250 peer reviewed scientific journals with specific articles dealing with gluten issue”….. “We’ve never in 99.9 percent of our time on this planet eaten carbohydrates. They weren´t available”.

How about fruit? Dr. Perlmutter must know that our ancestors were not only “hunters”, they were “gatherers” as well. The “gatherers” found their food in what came out of the ground. They ate carbohydrates and proteins in the form of fruit and vegetables. So, apparently his historical argument doesn’t hold.

A number of studies have shown that a Mediterranean type diet has favorable effects when it comes to cardiovascular prevention. Actually, Dr. Perlmutter mentions the Mediterranean Diet once in his book: “In March 2013, the New England Journal of medicine published a large landmark study showing that people age fifty-five to eighty-five who ate a Mediterranean diet were at lower risk of heart disease and stroke by as much as 30 percent – than those on a typical low fat diet. The results were so profound that scientists halted the study early because the low-fat diet proved to damaging for the people eating lots of commercially baked goods rather than sources of healthy fats. The Mediterranean diet is famous for being rich in olive oil, nuts, beans, fruits and vegetables, and even wine with meals. Although it does allow room for grains, it’s very similar to my dietary protocol. In fact if you modify the traditional Mediterranean diet by removing all gluten-containing foods and limiting sugary foods and non-gluten carbs, you have yourself the perfect grain-brain-free diet.”

Okay, if this isn’t cognitive dissonance I must have completely misunderstood the term. The Mediterranean diet contains whole grains, including gluten, and lots of fruit. These are exactly the things Dr. Perlmutter wants us to skip to protect our brains. But still, he believes it’s very similar to his dietary protocol. Doesn’t make sense to me. Anyway, why should someone switch from a Mediterranean style diet which is supported by a lot of scientific evidence to a grain-free Perlmutter type diet that is based on limited evidence.

A recipe for a best selling health book
Click on the picture for another Grain Brain review: “A Recipe For a Best Selling Health Book”

We don’t have to look further than the most recent issue of the American Journal of Clinical Nutrition to find a paper contradicting Dr. Perlmutter’s claims. The study addresses the associations between The DASH diet and Mediterranean-style dietary patterns and age-related cognitive change in a prospective, population-based study. Higher levels of accordance with both the DASH and Mediterranean dietary patterns were associated with consistently higher levels of cognitive function in elderly men and women over an eleven year period. Whole grains and nuts and legumes were positively associated with higher cognitive functions.

Don’t misunderstand me though. I’m not saying that Grain Brain is necessarily a bad book, although personally I had huge problems with it. It touches on a number of important issues relating to obesity, diabetes, brain disease and heart disease, and there certainly are some good healthy tips on nutrition and lifestyle in general. However, in my opinion, it is too biased to be taken seriously. I would have preferred if Dr. Perlmutter had addressed his issues in a more balanced manner. In my opinion “Grain Brain” should definitively be taken with a grain of salt.

Remember that Alzheimer’s disease has many risk factors, some are known and some are unknown. Maybe a grain-free high fat diet according to Dr. Perlmutter is more likely to prevent Alzheimer’s disease than a Mediterranean type diet or a typical “heart healthy diet” low in fats. However, until a scientific study comparing these diets has been performed, we don’t have they answer. Until then, nobody can claim to know what’s right or wrong.

115 thoughts on “Grain Brain – Take It With a Grain of Salt”

  1. “…Mediterranean style diet which is supported by a lot of scientific evidence…”

    Sure… Lots… …and remember all those
    ‘golden waves of grain’ surrounding
    the Med? Just which country had those?

    You just go right ahead and eat your grains.
    Many of us out here have found great benefits
    to excluding them from our diets.

    • Thanks Bill. This is exactly the issue. Everybody has to find their own way when it comes to dietary choices. Many people eat grains and fruits and feel great. Others feel better by skipping the grains. I’m fine with that. Never said that skipping grains is bad. Never said I eat them either. Let’s not get emotional about it though 🙂

      • Then what the hell are you saying? Do you eat grains? I like to know how the doc leads his personal eating habits so I can determine his immediate personal bias. Sounds like someone that does not want to change his or anyone else’s eating habits no matter what emerging science and technology are telling us.

      • Doc, one of the issues I experienced with the Paleo diet was a sharp increase in stressed kidney function. This was after six months of highly monitored and faithful adherence to the diet. Contrary to the claims of Taubes and others, LDL did not decrease significantly, though triglycerides did drop significantly. This was likely a function of the decrease in sugar intake. The significant strain on my kidneys was a bit of a scare and so I modified my diet back to a more balanced approach, though I have cut out refined carbs. I also don’t drink, which can contribute to sugar intake. Have you seen any studies about the effects of these no and low-carb diets on kidney function? None of the other many experts in your comments section has mentioned this issue. Perhaps they haven’t had kidney function tested.

      • Thanks for your article. It made me realize I definitely experience cognitive dissonance. I am very much anti-grain and firmly believe cutting wheat and refined carbohydrates out of a diet can only improve overall mental and physical health. But I am happy to have a reminder to make to critically interpret and evaluate information presented on this and all other subjects. Thanks again for your helpful comments. Cheers!

      • Thanks Julie. I respect your opinion. Many individuals feel better by skipping grains and carbs. Actually I’m generally in favor of that approach as you can see elsewhere on my website. In fact cognitive dissonance is very normal. But being aware of it, as you are, is important.

    • The issue with finding the right diet is to look at the original diet. It is likely, but not certainly, to be the correct template for our modern foods to follow.
      By saying that some people can eat grains and fruits and seem to alrigbht, does not make them alright.

      I take that to mean that some people can cope better than others with grains and fruits but that is not an necessarily an optimal state of affairs. The truth is, we have to be able to explain why there are 400 million diabetics on the planet when based on 1900 data, there should only be 45,000 or so. Clearly something changed! And it is pretty obvious!

      I have over 3,500 patients in my practice and 200 are on a strict LCHF diet. Gary Taubes would be wrong if he still believes that LDL falls on this diet- it doesn’t. It nearly always goes up. But who cares? It DOES NOT cause cardiovascular disease and never has. There is simply no proof that that is true. It is clear that the underlying mechanism is an inflammatory response to something- possibly grain proteins and insulin and glucose.
      No one knows but it is not FAT and it is not cholesterol.

      Stains clearly don’t work– but vitamin K2 might well be the answer. This needs to be studied but no drug company will finance that, though some food company might fund such as study if they though that they could sell more vitamin K2 containingf foods! Good luck!

      As for kidney stress, I do not know what that means exactly- elevated creatinine and BUN would not be alarming in and of themselves except to point out that there might already be some underlying pathology. Amino acids have not been proven to cause renal failure! Too often we confuse an association with the pathology.

  2. Hi Doc,
    Cognitive dissonance is happening all the time. A human being is cognitive dissonance. Humans keep thinking they are going to live forever and not get sick – this is patently cognitive dissonance.

    Well it must all be placebo effect with my husband when he began taking coconut oil, after getting more and more distressed and depressed about his memory lapses, he said it was like coming out of a fog.

    We decided to go full Paleo as we believed this would help the brain even more by providing even more ketones. When he lapsed on the diet at the beginning the resultant loss of memory & hand to eye co-ordination that occurred was very obvious to observe as things just kept getting broken in the kitchen!

    After 4 years he can now lapse on the diet for a while to no ill effect. I guess the placebo effect of the diet has allowed for more cognitive dissonance of his brain and we as a couple as completely cognitively dissonant.

    • Hi Cassie. It’s great that you and your husband have found a dietary approach that has improved your health. I wish more people had the courage and discipline to try different options when it comes to diet.

      Although I have some problems with Perlmutter’s approach in his book, I have nothing against Paleo or carbohydrate restriction in general. Indeed if you look through my blog you can see that I’m certainly in favor of these approaches for the overweight/obese or those with metabolic syndrome.

      However, when reading books on health related issues I prefer a balanced, informative approach where I can see all the cards. I want to hear all the facts and see all the data. Otherwise I will not buy the message.

    • Cassie, there simply isn’t any way of inspecting & examining oneself with the kind of accuracy and reliability that is required in scientific studies. In other words, the effects you mention could be due to placebo, coconut oil or a number of other factors.

      • Really Mie? Elimination and introduction one at a time over time isn’t close for a “study” on oneself? Hmm, seems when something is approved by studies, like SSRI’s for example, then a patient still must try it out to see if it affects them like others in the study or whether they need a different one even though the studies say one should be better for them than the rest. Thus the opposite can be true, that testing on yourself can be far better at determining effectiveness of many items for an individual.

  3. Population studies are crap. They prove nothing. One of the biggest problems in nutrition is the slave-like devotion to epidemiological studies. Worse, these nutritional epidemiological studies are notorious for mis-reported self-reporting of diet. Anybody who has spent time looking into knows the mis-reporting is so bad, making any conclusions from them (even as hypotheses for randomized, controlled studies) is, well, impossible.

    My point is Perlmutter’s cognitive dissonance is very minor compared to the nutrition field as a whole. Do I think he got everything right? Of course not. This is very new science. But to fall back on the piss-poor studies that have come out of the field of nutrition for 50 years (even now, nobody can actually define this miraculous Mediterranean diet) is not the way to prove it.

    • That’s what I was trying to get across:

      “…nobody can actually define this
      miraculous Mediterranean diet”

      …but it certainly didn’t/doesn’t contain
      many grains.

    • This is how the Mediterranean diet was defined in the ATTICA study and most other trials: “A diet rich in fruits, vegetables, legumes, whole grains, fish, nuts, and low-fat dairy products. Fat consumption is generally around 40 percent of total energy consumption, compared to ca. 70 percent in Perlmutter´s diet.

      • “rich” is a relativistic term as it is being compared to other diets that can be qualified as “lacking” (ex. DASH)…the whole grains in the Med. diet nowadays are NOT prepared traditionally and are eaten in much bigger quantities than they would’ve have even in the recent past

      • Raphi, repeating an irrelevant point over and over again doesn’t make it relevant.

        Axel, your well-written blog post has indeed brought out cognitive dissonance in many of the people commenting here. Good job. 🙂

      • Low-fat dairy is not consumed in the Mediterranean, and has only existed for a short time. It seems that biases (maybe unconscious) exist in everything, and the idea that low-fat dairy is part of a mediterranean diet seems like some sort of bias since we’ve had it drummed into us for so long that low-fat dairy is healthy. Heard of Greek yogurt? I mean real Greek yogurt, not the americanized versions with thickeners etc. Mediterranean dairy products such as cheese, yogurt and milk (from cows, goats, and sheep) are full fat! (also this is healthier, contrary to what we are told – especially from naturally raised animals). They also eat full fat olive oil, olives, nuts and get some fat from fish and other animals foods (lamb and some poultry, for example). Probably includes some grains, but not a large part of the diet and prepared with more traditional methods like soaking or fermenting, and probably some healthier grains and not as much wheat or gluten or processed carbs consumed. Perlmutter doesn’t say that everyone should get rid of all grains, btw. To me this “Mediterranean Diet” is just a balanced whole foods diet, that includes natural fats, like humans have always eaten. So I could see this type of diet being comparable to Perlmutter’s ideas. Is he really recommending 70% fat? To me, Perlmutter is just trying to get us away from the idea that all fat – including the evil saturated fat – is bad and also the idea that whole grains are always healthy. Even if these two “diets” aren’t exactly the same, they are similar. But either of these aren’t of eating exact little ‘diet plans’ anyway. You seem to be nitpicking about amounts of fat, and that is has some grains etc. And I agree that the understanding of what constitutes a Mediterranean diet isn’t clear and we end up with biased interpretations of what it even is.

      • And historically didn’t many of these studies involve cultures that exercised or moved around daily far more and thus a higher percentage of carbs was needed and were used quickly and entirely by their bodies as compared to our obese society that eats a larger percentage of carbs while being far more sedentary. And much of the shorter life expectancy of the past was due to the lack of antibiotics, medicines, and the technology we have today, not their diet (and additionally includes the huge infant mortality rate of the past that we do not have nearly as high today). You are comparing apples to oranges to try to justify your personal opinions. What was that term you call those people?

    • Whenever a person dismisses a particular line of evidence or type of study outright by using cliches such as “we-don’t-know-nothing-because-of-misreporting”, alarm bells should go off. This is precisely the case with Travis’ post.

      Of course, it isn’t simply the case of misreporting (which, as Travis should have realized, itself has been studied and the effects can be quantified to some extent), but also the case of RCT evidence suggesting that Mediterranean diet is indeed healthy. Ever heard of Lyon Heart Study? PREDIMED?

      As for Mediterranean diet (as defined and studied) not being rich in grain produtcs … Please. Go read a study. Start with e.g. those two I just mentioned.

      • Mie, your comments are mostly lame and biased, like this “doc’s” blog. Glad he is not my doc. You two stay with the old data that created an obesity epidemic and I’ll side with the research that is emerging and making far more sense. Mie sounds like the doc who only believes what she thinks and never believes there could be people/patients more informed and intelligent. Remember, every profession has plenty of unintelligent people. And if Perlmutter is mostly correct then how embarrassing for so many of you that espoused the wrong information and put your patients in a worse condition for so many years. Every person I know that has gone gluten-free has found lots of health and physical benefits and not one has mentioned any negative health reaction, and all are highly intelligent people, telling me Mie and this doc are full of crap.

      • Kevin, you’re just trolling now. If you don’t agree with the doctor, fine. You made your concerns known in your first comment. Now you’re just using ad hominem attacks (i.e., bullying) to support your ideas. Write your own blog if you’re so sure there’s a conspiracy of wheat eaters out there, but please quit bashing people who actually provide names of or links to studies that reasonable people can use to make an informed decision about their own lives and food choices. Believe it or not, it’s ok if not everybody agrees with you and Dr. Perlmutter.

      • I was gluten and dairy free for two years, trying to control chronic migraine which many suspect to involve inflammation. It did not help me in any quantifiable way. My migraines continue at the same rate/duration/ and intensity and the accompanying body aches and brain fog are unabated. Does that mean it doesn’t work for everyone? No. But, my experience leads me to question the vast claimed benefits of a gluten free diet.

    • Great point Travis. The so-call Mediterranean Diet is an invention- a fantasy.
      I have asked many Italian and Greeks who lived on the islands and seaports just before and after WW2 what they ate and it is not the Mediterranean Diet!

      The real Mediterranean diet was mostly fish, more fish and some chicken and goat/sheep Small servings of a pasta came first and though bread was eaten, the total amount of grains was far less than in the “Mediterranean Diet” proffered by the USDA. I have over 80 people eating a “Leangains” type of pattern (see Martin Berkhan or Andy Morgan) and with exclusion of grains, high protein, a smattering of complex carbs and very little fruit. To see reversal of metabolic syndrome eg, and profound fat loss and plummeting triglycerides over a 6 month period, paticularly in those who were already exercising regularly was astonishing given that the only changes were dietary. As a side observation of all this, I noted that there was also a clear inverse relationship with homocysteine and folate/B12: and being in the lower part of the normal range for the latter is no reason not to increase B supplements as the highest levels had the most impact on lowering homocysteine to the low-mid range in many individuals. We have a lot to learn about lifestyle and disease but diet IS critical. It informs our DNA.

    • Could be. Unless you are ready to look into every corner in search for the truth, not only seeking things you want to find on order to support your opinion, but everything else as well.

      • Listening to the “Doc’s” comments are like listening to those that say global warming is not happening and giving that less than 1% of scientists equal weight. Then you say we really don’t know for sure. The emerging science clearly points away from high carbs and gluten, so we’ll move forward while Doc and Mie remain in their past.

  4. I see the same sort of cognitive dissonance when the meat, fish/seafood and animal fat in the Mediterranean, Okinawan, and Kitavan diets, and full fat dairy in the Mediterranean diet are ignored. Some people would have us believe that Mediterraneans rarely ate meat or fish, and the Okinawan and Kitavan diets are vegan, when they most certainly are not. Hungry people don’t keep pigs for pets (nor fowl, sheep, goats, or cattle)and people surrounded by the sea most certainly enjoy it’s bounty.

    In The Splendid Table podcast #519, host Lynne Rosetta Casper says there’s a
    “Clinker” in the theory that Mediterranean people lived primarily on olive oil and grains, and ” the clinker is the pig.” Olive oil was valuable. If the poor had olive oil they sold it to survive (along with better cuts of meat from the pig). “The one thing they kept was the lard”. Lard was the subsistence food for many, only wealthy Mediterraneans had the luxury to consume olive oil in quantities. The theoretical Mediterranean diet for health is not what true Mediterraneans traditionally ate.

    • Living in the South of France (both at sea level & in the mountains) I second Janknitz’s opinion as regards the actual Mediterranean diet (not the theoretical one).
      Simple thought experiment: if people eating a Mediterranean diet were forced to eliminate 1, 2 or 3 elements of their diet? Which would they choose? I doubt you’d hear “yes, please take my fish/meat/or raw dairy so that so I can keep grains and a little fruit”…

    • This

      “Some people would have us believe that Mediterraneans rarely ate meat or fish, and the Okinawan and Kitavan diets are vegan, when they most certainly are not. Hungry people don’t keep pigs for pets (nor fowl, sheep, goats, or cattle)and people surrounded by the sea most certainly enjoy it’s bounty.”


      “Lard was the subsistence food for many, only wealthy Mediterraneans had the luxury to consume olive oil in quantities. The theoretical Mediterranean diet for health is not what true Mediterraneans traditionally ate.”

      this are excellent examples of people focusing on something meaningless when there’s an important message to be learnt.

      Even if the abovementioned was the case (which it isn’t, since ecological studies conducted in the area simply don’t provide evidence of diet in that are being rich in animal fat), this means nothing in the sense that Mediterranean diet mentioned here is the diet used in SCIENTIFIC STUDIES. Whether or not it corresponds to the traditional diet of a given area is OF NOT IMPORTANCE in the discussion of what kind of diet is healthy and why.

  5. This is anecdotal, n=1 family, but in my extremely insulin-resistant family, eliminating most carbohydrates has resulted in reversal from a plethora health issues including ADHD, anxiety, insomnia, depression, eating disorders (bulimia and anorexia), chronic fatigue, obesity, and pre-diabetes (reactive hypo/hyper-glycemia). In my case, a ketogenic diet has proven to be nearly miraculous in improving my health and giving me phenomenal strength and energy along with keeping my weight at an optimal level while eating to satiety at every meal. I am nearly 61 and feel better than I did at 40 when I was eating “heathy whole grains” and restricting fat. I am of the strong opinion that following Dr. Perlmutter’s dietary guidelines is worth a try for anyone. One size does not fit all and each person may find a tolerance for varying amounts of starches and fruits (Dr. Atkins’s concept of the individual “critical carb level” is a vary valid approach) but there is no danger whatsoever to at least giving the low-carb, ketogenic lifestyle a try. I will never “go back.”

  6. When you the steps with the intent of arriving at destination that is no more than a few steps away the stance you’ll finish up with will be a function of which foot you led with.

    Can I suggest you give thought to whether you always begin from the same spot, and whether you may do better leading with the right, instead of always leading with the left?

    To help:

    The relationship with saturated fats in the diet and with lipoproteins in human physiology is one which is essentially adaptive. The numbers don’t matter, they’re ar merely the evidence of an automaton doing its best to get on with business as usual despite the insults and maladaptive arrangements we cast its way.

    Lipoproteins may matter, but if they do it is odds on they do so in a qualitative sense and not one that is as quantitative and as infantile as is the lipid profile test. The ere is substantial scope for variation in the constituency of a lipoprotein (in qualitative terms) and that gives scope for variation in properties. Back in 1913 Anichkov reported upon the effects of cxy-cholesterols and their ability to induce and hasten onset of atherosclerosis only he, his team, and Ancel Keys later, thought the effect was down to cholesterol.

    An intelligent mind would have to wonder in oxidative stress conveyed with lipoproteins may be involved in atherosclerosis and or cardiac events, and oxidative stress could be a common link in the chain of causality in eventualities which are so frequently described as multi-factorial. Hormones, especially fight or flight ones, act in ways in keeping with, or capable of, conveying oxidative stress.

    Do white carbohydrates increase oxidative stress? Yes, through the action of insulin.


  7. I’ve spent quite a lot of time in Spain from the north to the south, particularly on the Costa del Sol ie on the Mediterranean, ate a lot of chorizo, Serrano ham, pork, chicken, beefsteak,fish and seafood, I can’t remember a damn thing that was whole grain, does paella count, there was white bread, ate tons of salad, but vegetables usually were the bottled vegetale mixta.

    • I think we can find all kinds of diet in the Mediterranean countries. However, in terms of nutritional research the term “Mediterranean Diet” covers a certain definition. It is well outlined on the OLDWAYS website here.

      • I’ve read Oldways notion of a Mediterranean diet, it seems more of a wish list, a blend of smoke and mirrors to hide the enormous amounts of saturated fat in their everyday diet, from full fat hard cheeses, lardons in casseroles, lamb fat in stufado and moussaka and cured meats and sausages, chorizo, salami etc. Drinking wine in the sunshine, and considering manana to be not a contract, but merely not today. A combination of good real food, full of fat, good wine and good company in a warm climate with low stress, no wonder they are healthier!!

  8. I agree that it sounds like Grain Brain may take a core kernel of truth and exaggerate it beyond its true relevance, which may be as much a reflection on the nature of marketing books as anything else, however there seems to be a lot of at least indirect evidence that wheat is a problem in general and likely not worth the risk of eating it. I looked at the AJCN study and it seems like a stretch for them to say that wheat in particular is actually protective. I don’t see how they could have isolated that as an independent variable based on their methodology, and even if they did, wheat seems to be associated with consistent health problems where rice and other nuts and grains are not (or much less of a problem). For those following along who can’t get enough of this, the following link references a fantastic read on the topic, and the comments in the main post are very interesting as well.

    It’s also interesting that the evidence from Egyptian mummies is that they had very poor health similar to modern western diseases, and they apparently ate a diet that was heavily wheat-based. There is a good article on Dr. Eades blog about that.

    Personally, I was heavy wheat eater all my life (whole wheat) and I gave it up as part of going lowish carb about six months ago. I can’t say for sure, however a lot of joint pain and inflammation that I sometime had which I had always blamed on weightlifting and basketball has substantially cleared up. It could be coincidence but it seems like it is worth a try. My understanding was that there was absolutely no benefit to wheat that couldn’t be found elsewhere, so the point about whether or not wheat itself is actually protective for the brain seems like an important detail.

    • “It’s also interesting that the evidence from Egyptian mummies is that they had very poor health similar to modern western diseases, and they apparently ate a diet that was heavily wheat-based. There is a good article on Dr. Eades blog about that.”

      Dr Eades and “good” don’t go together very well. 🙂

      Anyway, when looking at archaeological evidence, you’d do well to bear in mind that e.g. rich Egyptians also exercised very little, ate more animal products and refined products than most of the population etc. etc. Therefore isolating wheat per se as the main source of problems is a bit far-fetched, in my opinion.

  9. I’m not as educated as most of the people commenting here but have spent a lot of time doing ‘research’ into LCHF diets. The anti-carb movement seems to be moving about as slowly as the anti-tobacco movement did initially. However there does seem to be more and more evidence supporting the fact that carbs are unhealthy at best and possible even dangerous. The problem I see is that governments are going to be very reluctant to admit they were wrong and sadly the this will mean more deaths relating to obesity and diabetes. That is the saddest part for me. People are posioning themselves while thinking they are being healthy. Perhaps a reference to the Jim Jones cult would’ve been more appropriate.

    • Of course David, you neglected to mention that the difference between anti-tobacco and anti-carb movements is that only the former is based on solid evidence.

      I’ve yet to see evidence pointing out that whole grains or legumes or fruit etc. are dangerous.

      • You never will see evidence that they are dangerous. They are not. Our species is simply very poorly adapted to the large majority of grains, to a lesser but similar extent to legumes as well. What fruit are we talking about? How much? Seasonal berry consumption or bowls of apple, oranges and melon?

      • The argument of adaptation often comes out, but – yet again – without evidence. There’s nothing in epidemiological evidence or RCT data to suggest that.

        But of course, if you happen to be an exception and can actually provide proof of this, I’d be happy to hear it.

      • Of course, but I’m sure the tobacco companies said the same at the time. In fact, didn’t doctors advertise cigarettes at one stage? (Which reminded me of statins but don’t get me started on that ) 😉

      • David, don’t worry. Judging from your squirming tactics, you’re obviously a “man of faith” and therefore I’m not under any false assumptions concerning the nature of your beliefs.

      • Fruit is dangerous? Typical Mie b.s. “Good” and Mie don’t go together very well either. Sugar is the culprit dummy, so you eat far less fruit with a higher sugar content. You miss his whole point Mie, but I’m not surprised after reading your other comments.

  10. Doc Sigurdsson,
    While I have my well-investigated dietary ideas and opinions, I know that ultimately, I could be right, I could be wrong.
    More importantly, though, I’d like to compliment you on your patience and good humour in responding to comments. You are a model of courtesy and supportiveness. Thank you for that

  11. Some strategies work for everybody. Most do not. I don’t know which nutritional tribe I belong to but am increasingly aware of which foods do and do not agree with me, thanks to what I call a compass in my gut. Now 80 years old, I’ve been using trial and error to identify which foods contribute to well-being and which ones disturb sleep or otherwise make me feel unwell. First to go were high carbs, then caffeine, alcohol and grains. Most recently I’ve given up dairy products, though I long suspected they weren’t good for me. Even fruit had to go because, again by trial and error, I seem to be fructose intolerant. Life is about letting go. You might say my diet is more extreme than Perlmutter’s but it works for me. I miss chocolate, coffee and whipped cream, among other things, but gratifying taste buds takes second place to feeling good 24/7. I’m not recommending my diet to anybody else. But I’m grateful to Perlmutter for alerting me to the possibility that I might feel and function even better at age 80 if I gave up foods containing casein. Luckily, we had access to tubs of great homemade ice cream, loaves of fragrant homemade bread, etc. when we were young, so I have a lot of delicious memories to look back on.

  12. Doc,

    the working hypothesis among Alzheimer scholars is that saturated animal fats have an important role.
    Moreover, you failed mention the (perhaps) most important risk factor for Alzheimer’s. Elevated blood cholesterol at midlife.

    Midlife serum cholesterol and increased risk of Alzheimer’s and vascular dementia three decades later.

    Too Much Saturated Fat Tied to Alzheimer’s Risk?

    There are several exceptionally well studied populations that have extremely high carbohydrate intake and very low levels of chronic disease including Dementia & Alzheimer’s. The popular example may well be the people in Okinawa island. The longevity and heath of Japanese elderly made its way to Western medical journals already in late 19th century. Carbohydrates accounted for ~80% calories at the time, and Japanese peasants ate very little beyond their staple diet of rice and soy beans. And of course, as we know from detailed accounts, the traditional Mediterranian diet of Southern Italy was a wheat-based one, and low in fat (~20% calories).

    • Some researchers are suggesting that sugar (rather than fat) may raise cholesterol levels (Mary Enig, Robert Lustig, Gary Taubes and others). I am no expert at all, but this all seems interesting…

      • One more indication that “Grain Brain” is pure s*it.

        Just like 99% of that diet guru, alternative/integrative medicine, paleo etc. etc. nonsense out there.

        You could do a blog post on that Axel. Think about it: what could be more important to an ordinary Joe than to learn to recognize pseudoscience from science?

      • Now the true Mie. Many good points backed by emerging science in Perlmutter’s book. The fact you call it this tells me no one here should be listening to anything said by Mie. I know, the globe isn’t warming either and playing football over a lifetime doesn’t lead to huge increases in dementia issues. Stay in the past Mie while the rest of us move forward.

      • Hilary,

        Several things for you..

        – There are two podcasts with Dr. Permutter on and on the one that is part of the ask-the-low-carb-experts series there was a question about half-way through where he explains his point on cholesterol. Neither he nor anyone else I am aware of in the cholesterol world thinks total cholesterol is itself meaningful, but total to HDL is a good predictor of issues, and the real problem is oxidized cholesterol (which I think is the same as small particle LDL but I am not sure.) Anyway, Dr. Perlmutter said that the truly bad cholesterol is highly correlated with A1C so if your A1C is good ( and he uses a lower reading than what is apparently the official guideline) then your cholesterol is what it is and is fine, even if it is higher than the official go-straight-to- statins guidelines. I don’t know the science well enough to confirm that, but that was his point.

        – I would check out the wholehealthsource blog for some fantastic writing on this topic. Bottom line there are high carb (potato eating) cultures which are very healthy, and high saturated fat eating cultures (the inuit and Tokelau) who are also very healthy with no heart disease, so anyone who sites one or the other is likely cherry-picking data, and the real answer to health is not just one or the other.

        – You might also want to check out Chris Masterjohn’s interview with Dr. Mercola on his daily lipid blog from about a year ago. He has some interesting theories and most importantly, he stresses that in his view, truly bad cholesterol of wildly high or low readings are markers for other root cause problems like insulin resistance, and if you fix those, then the cholesterol will resolve itself, but just fixing the cholesterol (such as via statins) doesn’t address the root cause issue.

      • “he stresses that in his view, truly bad cholesterol of wildly high or low readings are markers for other root cause problems like insulin resistance, and if you fix those, then the cholesterol will resolve itself, but just fixing the cholesterol (such as via statins) doesn’t address the root cause issue.”

        Too bad this isn’t the case. Or what kind of “root cause problems” do e.g. FH patients have?

  13. “The Mediterranean diet contains a lot of whole grains”
    I live in a country bordering the Mediterranean, with the second lowest rate of CHD in the world, and the diet here does NOT contain a lot of whole grains. The vast majority of grains eaten are refined to within an inch of their lives—and they do not constitute a large proportion of the total calorie intake.

    As for Okinawa, the islanders’ nickname for their homeland is not “The Island of Whole Grains and Beans” but “The Island of Pork”. Enough said?

    • Yet another “anecdote warrior” surfaces.

      I can’t hep but wonder what people like you hope to achieve with such displays of problems in reading comprehension.

      • Mie, your own comprehension is no broader than the pig wallow between your ears. When you learn how to participate in a civilised discussion, let us know.
        But I’m sorry to have have had the temerity to question Axel’s wisdom…

      • Mie, you are lame. Hopefully you never get to treat any real patients. Thankfully all of your comments help “Doc” lose even more credibility.

  14. “The dietary approach in this study was to switch the treated group to a Mediterranean style diet and to add supplementary alpha-linolenic acid in the form of an enriched margarine (free of trans-fats) thus increasing the n-3 content of the diet. This study, known as the “Lyon Diet Heart Study” underscores the importance of the n-3 essential fatty acids in connection with heart disease.”

    So the Med diet was supplemented with something extra.

  15. I’m having a bit of cognitive dissonance right now. I went from Paleo to HFLC and my ldl’s went through the roof, i.e. 356! my ldl particles were 1650. that’s not good. many of my parameters were good, but not ldl’s, total cholesterol or PLAC test for vascular inflammation. Now I’m not sure what to do. I was eating between 1.5 to 3 lbs of animal flesh daily. perhaps that was too much. I clearly have to do something different, and i guess that means less fat and more healthy carbs? any suggestions?

    • Craig. Some individuals on a low carb high fat diet respond with a dramatic increase in total cholesterol, LDL-C and LDL-P, in particular if high amounts of saturated fat is consumed. This is indeed not very uncommon. However, it is unknown why this occurs in some individuals but not others. We also don´t know what this means in terms of risk. However, the only way to improve the numbers is to reduce saturated fat consumption.

  16. Some good points raised in the critique, but I question Doc’s fruit claim. In non-tropical latitudes, fruit is only available to hunter-gatherers for a very short period of time. What would the source of carbohydrates have been for the other 9-10 months of the year???

  17. The comments here remind me of the discussions we used to have in my health statistics class in college, back in the day. Nothin’ like a healthy debate> lol…. I liked the book, not because I interpreted it as biblical law but because it prompted me to be more thoughtful in my eating habits. That’s all.

  18. Okay, to start off pointing out that the author of the book claimed in an interview that: [99.9 percent of humans existence on earth was sustained sans carbohydrates] and then challenging the statement by reminding us readers that we ( humans) have consumed fruits and vegetables (since practically forever HELLO) is exactly why the book should be read with a “grain of salt”. There is so much human suffering in the world, And often people are quick to try the next great idea/ theory/concept, hoping for some relief. If practicing the suggestions given in the book “Grain Brain” enriched your life, great. Final thought: “The Snake Oil salesman may have been merely selling alcohol, but it probably did make a person feel better, at least for a little while.” 😉

    • I think your statements are incorrect. Please provide your links to all this public contradiction you allege. You keeping eating lots of carbs and gluten, and I’ll keep feeling way better without them.

  19. Coming a little late to the party here, but I just started reading The Grain Brain yesterday. I find it very interesting. Fortunately, I already have a really good diet that includes nuts, lots of veg, some fruit, and although I don’t eat meat or fish, I do eat eggs (we have our own spoiled hens in our backyard) and cheese on occasion. I agree with the Doc that we won’t know if the hypothesis of the Grain Brain is true unless there is a long-term study. It would have to involve many people over many years into their dotage to determine whether or not avoiding grains really does prevent dementia or Alzheimer’s. But I was thinking, if I reach my elder years and find out I’m getting fiffy anyhow after denying myself Olive Garden breadsticks for thirty years, I might be a little peeved. 😉 However, joking aside, I think much of the advice in the book is great – and I especially like what he said about the cholesterol issue (dare I say scam), which seems to be breaking through on many fronts.

  20. Doc,
    I respect the fact that you are the only person I have found thus far to offer a scientifically presented counter-argument to ‘Grain Brain’. I appreciated your insights and professionalism. For my own take, I think it’s odd that while people are touting all these ‘original’ diets that existed before grains came into our every day lives, they ignore the higher mortality rates of the people who lived in those times. Can that mortality rate really be contributed only to the fact that modern medicine’s (which apparently is as worthless as our modern diets) impact on our lifespans? The fact of the matter is that we need calories to survive, and we are drawn to the foods that supply the most calories. Before modern agriculture the best chance of obtaining those calories was through eating fatty foods, which potentially supports the ‘Grain Brain” argument. But if we think about the caloric intake of future generations, what better delivery system do we have than whole grains? Animal farms are destroying our environments and supposedly our bodies. I would love the idea of three almond trees in every yard in america, but the reality is grains are the cheapest most efficient way to feed our people. This is why we started growing them in the first place.
    In the end there are so many factors at play that tell us what to eat and why, that it’s gotten to the point where none of us really know what is in fact the best option. I think we should value the fact that this ‘Doc’ posted with experience and wisdom and offered us another perspective without any persuasion from the grain industry.

    Thanks Doc,

    • You are right. Producing toxic alien grains is really cheap. That does NOT make them good. Forget the effects of grains on the body (elevated triglycerides, IBS, inflammation etc) but look at the environment. Massive swathes of land have been destroyed with the ecosystems shot to pieces in order to grow grains etc. This is a catastrophe. The real problem is US- There are far too many humans on the planet and we are destroying it to produce cheap useless polyscaccharides. The balance of animal to grass is what has made the world ecologically stable. We, humans, have blown it. Some scientists have suggested that there is not going to be a balance until we are reduced to a few million. Unlikely, through our own efforts; but Mother Nature will always ensure that balance is restored. I would rather think that will occur through our efforts rather than having a plague or famine dictate the outcome.

      Doc is totally wrong about reducing saturated fat consumption. I have hundreds of patients’ blood work on file showing how reparative a high fat, high protein diet is. So have many others. The idea of eating lots of fruit and grains in abundance now makes my skin crawl.

    • Okay, forget Grain Brain. There is ample evidence that grains have not helped ONE bit, the onslaught of modern diseases. They HAVE kept people alive, though I think that the evidence strongly suggests a negative role in people’s health. It is no coincidence that the human race was physically worse off after the widespread introduction of grains, I onlay have to look outside my window to see the effects of the modern diet. It is appalling!

  21. Thanks Axel, for braving your opinion. I listened to Perlmutter on tv. last night and noted the camera shots of adoring, admiring faces nodding and oh so ready to idolize this next great diet guru. Like you, I thought, “he must be selling something”… or “poor old guy, he just wants to be worshipped…”
    There was not a mention of the genetics of Alzheimers, or the recognition that advancing age is a factor because we weren’t designed to outlive our fertility. And his proof was laughable. Such is science in America…

  22. Go to love Paleomorons, always so sure of themselves. They’re the same type of people who in the 80’s admonished anyone who dared eat a fat filled, artery clogging avocado.
    Besides, don’t you guys know that paleo is so mid decade? All the coolest health nuts have moved onto something else.

    Look, If a low grain diet helped you in some way, great for you. But please don’t shove your dietary dogma down everyone else’s throats.
    The whole paleo idea is interesting, and no doubt useful in certain circumstances. But it was never close to anything paleolithic, that’s a pure golden age fantasy.

    In the end, use some commonsense , there are entire countries of long lived and active people who eat grains.

  23. After reading all these comments…..

    Almost every diet book I’ve ever looked at seems to have ‘scientific’ study references showing that it is the only correct diet. If you pay attention to health related TV and magazines, you could end up taking hundreds of supplemental pills every day. If you want to show that Paleo, or Adkins, or Mediterranean diets are bad, you can find studies that will support pretty much any diet you want to support.

    Time after time, I hear that caloric restrictive diets are the only answer, yet many of the textbooks used in Nutritional classes state that caloric restrictions in diet don’t work for weight loss.

    Until proven otherwise, I feel quite strongly that nutrition is a pseudo science, highly questionable, and the scientific folks need to get their acts together.

    If you feel better eating Paleo, or Mediterranean, or whatever, stick to it. Let your body decide by trying different foods and diets. The scientists/doctors are only confusing us.


    • It is clear that a disaster has occurred to all westernized consumers of food. So, eat what you feel like is not working. Scientists may be honest or not so many published studies may not be factual. This is confusing but one thing is certain, we are not eating correctly and that IS a fact.

  24. I think it’s all a grand personal experiment. My husband and I thrive on different diets. I feel better with fewer carbs and little to no grains and he is the opposite. We mostly manage this by eating different portions of the same foods. But what we do have in commmon is our passion for quality. We choose pasture raised over grain fed animals, we choose organic over conventional produce. We have a tiny pantry for things in cans and boxes and have multiple fridges and freezers for real food. We cook our our own meals 98% of the time.

  25. what do you’all think of confirmation bias…selecting those “facts” that confirm your beliefs as true and
    ignoring those details that maybe contradict your opinions.
    not cognitive or dissonant, just masquerading as (pseudo-) scientific.
    good health and good nutrition are both multi-determined and obviously over-discussed phenomenon today and far more complex than what I can know of using any science I know (BS Physics and MS General Science) and any available information as public/research statistical studies or the newspapers may generate and report.
    too much info (and money) from too many sources about too many diverse issues is going to complicate the whole situation too much.
    the truth will eventually come out but when and what is still to be determined.
    i agree with art, robin and tara mostly … with moderation and good sense, good nutrition is not all that complicated.
    we all should eat what will keep us healthy.

  26. Well I have read high carb diet gurus Esselystyn,Cambell, Ornish and low carb gurus Atkins,Agatston,Perlmutter ect. Perlmutter says fruits are seasonal, this can be true in some areas but not in tropics and subtropics. For me, without a doubt low carb is better and results to prove it with having better energy and proper weight. The wheat argument saying the ancestors ate no wheat. Well in the Hebrew scriptures going back 4,000 years ago they made bread. “Take also unto thee wheat, and barley, and beans, and lentils and millet, and spelt and put them in one vessel…” Ezekiel 4:9
    I agree all the diet gurus are biased.
    For me I pick what works from each. Every guru can site there source of some tribe or peoples that were vegetarian, meat eaters or a mix of all. According to WHO (World health Organization)France has very low heart desease with high fat diet. 91 out of 92 countries. The Difference is no refined sugar and low sugar diet. Atkins hit this point well, the Americans eat 10 times for sugar then the French!!!!!!!
    In my opinion it is sugar that is number one problem. The bible encourages only a little honey, and alot of honey bad. I think this is symbolic of all sugars. I know some of you do not believe the bible, that is fine. For me I do.
    I will take a whole country study lasting 1000 of years with high poplulation over any study of 100 to 1,000 people. I do agree fresh food with no persevatives and limited to no processing is the key. And most important reducing stress. The Okanowans,French, Spanish along med all seam to have less stress. My humble comments, thanks for reading, Brad

  27. Good point Brad! People tend to get so worked up arguing over which diet is truly the best and which “expert” is telling the truth. At the end of the day we are choosing to eat various diets in order to live long and feel good. I’m definitely of the mindset that low carb is a healthier choice than low fat/high carb, but I also pick and choose tips from various other diet theories and apply them to my life. If they work, I stick with them. If not, I chuck them. Thanks for your comments.

  28. i am swiss. perlmutter is making more and more money by selling books and supplements. i am not sure about his motivation.
    however i cured myself from the uncurable rheuma AS within weeks. docs don’t believe me. acne and other skin and eye inflammations cure within 3 weeks. the solution: no carbs, no starch, no sugar (no fruit) and as much vegs as possible, half of it raw. low diary.

  29. Doctor, thank you for your post. Not as a criticism, rather as a suggestion, I wish you would offer some guidelines to your readers about decorum in comments. To have these kinds of ad hominem attacks precludes any serious discussion about the substance of your original post. As a high school teacher, it reminds me of the worst kind of class I could imagine. If students (here, readers) can’t keep their comments respectful, I would simply block them (my last resort remedy is to remove them from the class). There are many of us who value honest disagreement as a part of any scientific process, especially one so complex as health. Thank you again for your work. : )

    • Frank

      A good point. Mutual respect is the key to a fruitful and informative discussion.
      In fact there are a number of comments I don’t accept, but I’m aware that I should do better.

      Thanks for the comment. Appreciate it.

  30. I would really love to know what someone in my predicament is supposed to do. I am a 46 year old woman in the early stages of chronic pancreatitis. No, this was not brought on by drinking or smoking. It is idiopathic in my case. People with CP do best if they get only about 20 grams of fat per day. When you consider that only one tablespoon of almond butter has 8 grams of fat, you can see how precious little fat I can consume, so obviously, few of my calories can come from fat sources. I also eat lean protein which is low in calories. If I were to adopt a low carb diet, there would be no way for me to get enough calories to live! I try to get a lot of my carbs through tubers and root vegies, such as potatoes, sweet potatoes, carrots, etc. But, I do need to fill in with pasta, bread, etc. I NEVER hear doctors address what in the world people in my situation are supposed to do. I guess we have no choice but to eat an unhealthy, carb-heavy diet?

  31. My comment is not so much about your entry because I agree.

    I suffer from eczema, anxiety, depression and moodiness. There is so little we know about the gut and how it is connected to our immune system and our brain that sometimes I feel like one has to take a leap to figure out what is best for you.

    I have noticed back-lash over people going gluten free without proper evidence, which I think is highly unnecessary because looking for your ideal diet is not easy! There are so many things we still do not know about our gut, but does that mean I should stop trying because there aren’t enough studies on the topic? I noticed that when I removed gluten from my diet for a couple weeks my symptoms subsided. I do not know if the issue is that I was eating less carbs or if it was actually the gluten, but researchers are only just breaching the topic of non-celiac gluten sensitivity and there is no medical test for it; you can only remove it from your diet and see if it helps. Although there is no evidence I have a gluten sensitivity, I cannot help but try removing it because why not?

  32. While some people have talked about the seasonality and the availability of grains and fruits, nobody has mentioned that fruits and grains as they exist today, due to selective breeding techniques, are bigger in size, have a larger yield per plant and in the case of fruit, are much sweeter than when they existed in the wild for the vast majority of their existence. We’ve only been cultivating grains and fruits for 10,000 years – a virtual blink of the eye in terms of our evolutionary period.

    Here’s an article that shows how corn, watermelon and peaches have changed over the past few thousand years – first off notice the locale where these foods were found in their natural state (very limited) and then take a look at the size of these foods. I’ve seen a similar article done on the adaptation of wheat so I doubt this is unique to the three foods shown here. I highly doubt that in a wild state it would have been possible for grains and fruit to be anything more than an occasional snack (with the possible exception of berries) for the vast majority of our evolutionary ancestors.

    Personally I don’t eat much fruit due to the fructose content (it’s my personal hypothesis that substances metabolized in the liver are segregated there because they’re generally toxic and should be avoided – just a suspicion).

  33. Hey Doc – I get the impression that you didn’t read the whole book before you wrote your review. I think there’s some cognisant dissonance on your part. You found one paper that kind of went against the message of the book so you think you’re right and he’s wrong. I’d hate to have you has my doctor.

    • Hi Jimmie.
      Absolutely. I’m sure I also have cognitive dissonance. It’s quite normal in fact.
      By the way, I never said Perlmutter is wrong and I’m right. I only said he ignores contradictory evidence which makes his claims unconvincing.
      Thanks for the comment.
      Merry Christmas.

  34. I find it incredibly alarming that Dr. Pearlmann does not present both sides of the coin. As you mentioned, ‘good’ scientific literature is that which seeks to be disproven, and if it cannot be disproven, then the paper may have some merit. We cannot say absolutely that we know ‘how’ or ‘why’ diseases such as Alzheimer’s or autism work. Science is very complex and as you mentioned, it is rarely ever black and white. For Pearlmann to say with 100% certainty that HE knows the truth about what causes these diseases, is a fallacy.

    Americans already receive a small portion of dietary fiber in their diets, and to tell people to avoid all grains (which are richly nutritious in fiber and myriad of vitamins and minerals) is a disservice to the public. Aside those who have a diagnosed intolerance or metabolic issue with grains, it is irresponsible to advise all people against a food that has been a historical staple in diets around the world for thousands of years.

    Similarly, encouraging a high fat diet is a dangerous line to walk unless much clarification is made. For instance, Pearlmann advises eating lots of avocados but what should be be saying is that avocados are rich in unsaturated fatty acids, which have been known to raise HDL, lower LDL and lower overall cholesterol. On the other hand he recommends lots of coconut oil, which is high in saturated fatty acids and will pack and store in the body much like animal fats will. What exactly is he getting at here?

    Objectivity is the most important thing a scientist can do to ensure that information is presented to the public in a non-biased way. In many cases we do not fully understand what causes or encourages disease. For Dr Pearlmann to say that HE has found the answer, is misleading and hurtful to society, who is trying to find real answers to the medical issues of today.

    Thank you for taking the time to peer-review this book, I am thrilled to have found a health professional who is as skeptical as I am about wildly unfounded nutritional claims.

    Perhaps he should make his book available free of cost to the public if money is not the end goal?

  35. I keep seeing posts on this site from people who have obviously only read excerpts or chapters from Taubes’ and Perlmutters’ books. Your article also misrepresents what is actually said in Grain Brain about hunting gathering cultures of yesteryear. Perlmutter makes it very clear that fruits, nuts and seeds were eaten when available by ancient cultures. He makes the point that those foods were not the norm though. He uses historical data to make the point that the body’s ability to survive off the ketones from fat that was accumulated during those seasonal times of abundance is the key to understanding how to maintain a healthy lifestyle today. More importantly, the scientific evidence he uses to support his assertions should at least leave the reader wondering why these findings have been suppressed for so long.

    Taubes repeatedly references the fact that overall cholesterol will predictably increase on a LCHF diet in his book. He also quotes data sources that prove the total lack of a evidence linking high LDL to heart attacks. READ THE WHOLE BOOK PEOPLE. Don’t just read a few chapters and then go on spewing half truths and misrepresentations of what these authors wrote.

    • Hi Corey C

      Thanks for the comment.
      There’s a huge difference between Taubes’ books and Perlmutter’s Grain Brain. In my opinion, Perlmutter is way behind Taubes when it comes to argumenting his cause.
      Actually, I read the whole book (Grain Brain) but I have to admit it took a lot of effort.

  36. I love your questions about Perlmutter’s book. As a former marketing person, I have a cynical reaction to most things, and I wondered if he is writing to maximize book sales. But it’s easy to question and hard to provide answers. Where do you think the answers should come from?

    However, 3 years ago I went on a meat, eggs, vegetables and yogurt diet and transformed my health – lost weight, cured my arthritis, itching skin, restless leg syndrome, and neuropathy in my toes. Was it eliminating sugar? Was it eliminating the gluten (which I had never heard of)? Was it because I now avoid all genetically modified organisms (GMO) and only eat organic foods and meat from grass fed animals? I DON’T KNOW! WHY DON’T I KNOW?

    Because the only people with money to do conclusive research (I want double blinds with control groups followed over decades, etc.) are big pharma and big chemical companies (i.e. Monsanto) and the universities whose research they fund. The last thing big pharma wants is to eliminate their billion dollar industry of addressing all issues with pills, and the chemical companies who patented GMO seeds don’t want us to know if GMO is killing us (what about the bees who fertilize most of the crops we eat?).

    Because every human being is totally unique. Think nature vs. nurture. Some people have a genetic endowment that allows them to handle foods that in another person would cause cancer or diabetes. OR some people are brought up with lifestyle habits that cause these kinds of chronic conditions even though they are not genetically disposed to get them. (Think about the food industry and their research scientists who add thousands of chemicals to recipes guaranteed to increase sales by combining sugar, salt and fat in delicious combinations.) Dr. Perlmutter mentions this, by the way. Our genes, our environment, and the profit motive – a perfect storm.

    These 3 industries (pharma, food, and chemicals) own the FDA, USDA and politicians. The only way to get answers is to get funding from a source without a motive to profit from the “right” answer. Where could that source be?

    • That’s a good question Nancy. Who can we trust?
      Another important thing that you mentioned is the individual variation. We are all different. What works for some doesn’t work for others. So, generalising may be problematic and misleading.
      Thanks for the comment.

  37. You quoted the book but then referred something different: “It turns out that humans have never eaten grain. In 99.9 percent of our time walking this earth we have never eaten grain. What is wrong with wheat barley and rye is that it contains this very powerful protein called gluten.”

    Then you said a joke that we’ve never as humans ate carbs.

    The thing is the book is talking about GRAINS. Humans eat carbs all the time. It’s the difference between a circle and square. They are both shapes, but not one in the same. In fact personally, I eat just as many carbs with veggies and fruits on my current diet then I did with bland pasta and bread beforehand. This is the same thing when people who aren’t vegetarians ask where vegetarians get their protein if they don’t eat meat. For God sakes protein is in vegetables like broccoli and so on!!! I’m a whole30 person and like to eat real food that’s best for human consumption. Whereas I understand cognitive association, I also think you have a bad case of it. Start separating the words carbohydrate and grain as they have different definitions.

    • Lisa

      You wrote: “You quoted the book but then referred something different: “It turns out that humans have never eaten grain. In 99.9 percent of our time walking this earth we have never eaten grain. What is wrong with wheat barley and rye is that it contains this very powerful protein called gluten.”

      As I said, these words are taken from a radio interview with Dr. Perlmutter shortly after the publication of his book.

      You wrote: “Then you said a joke that we’ve never as humans ate carbs.”

      I never sad that. I only quoted Dr. Perlmutter.

  38. 世間で|世の中で|行う悩んでいる女性|女子|女の人が多い|いっぱい|たくさんですね。脱毛の悩み|苦悩|恥ずかしいことを少しでも|ちょっとでも|わずかでも減らせればいいなと思って|考えて|感じてサイト|WEBサイト|情報を立ち上げ|作り|まとめました。悩み|苦悩|恥ずかしいことは誰にも|他の人|他人相談できないので、自分も|私も|自分自身も悩んでました|困ってました|つらかったです。脱毛|ムダ毛|ボディの悩み|苦悩|恥ずかしいことは自分一人で解決する|なんとかすることも難しい|大変|困難ですよね。

  39. Wow, it’s amazing that you spent the time writing about cognitive dissonance but fail to see it in your own writing. You either misrepresent his arguments, or you aren’t actually familiar with them because you didn’t read the book.

    1: You intentiaionally misrepresent him. You quote him saying “99% of human history we haven’t eaten grain.” You then say that humans got their carbs from fruits & protein. He didn’t say humans didn’t eat CARBS for 99% of history, he specifically said GRAIN.

    2: With regards to the Mediterranean diet. You undercut him again by questioning how could the Mediterranean diet be both good & bad for us? Because some of it is good & some not so much; nuance isn’t that hard to understand. Also at no point does he suggest cutting fruit completely out of your diet. He does suggest cutting down on fruit with a very high glycemic index though. Again thanks for misrepresenting by just saying the all encompassing word, ‘fruits’

    3: You fault him at cherry picking the studies he wants and then turn around with one study that supports your opinion. Instead of playing this game how about from now on we have actual discussions on the validity & quality of the studies.

    • You’re absolutely right about my cognitive dissonance. In fact I think we all suffer from it to a certain degree. Thank you for pointing out mine.

      I said: “The “gatherers” found their food in what came out of the ground. They ate carbohydrates and proteins in the form of fruit and vegetables.”
      I didn’t say they got their carbs from fruits and protein (not possible).

      A Mediterranean diet is a Mediterranean diet with all its ingredients. It’s not a ketogenic low-carb diet.

      I’m generally in favor of low carb-diets for people with carbohydrate intolerance and insulin resistance. In fact I may agree with Dr. Prelmutter on a lot of things. But I don’t think current evidence supports the conclusion that skipping grains will prevent Alzheimer’s disease.

      “Existing evidence indicates that whole grains have a beneficial health effect; much of the evidence comes from observational studies that have demonstrated an association between whole grain intake and disease risk reduction. Evidence from intervention studies is variable. There is consistent epidemiological evidence that whole grain foods substantially lower the risk of chronic diseases such as CHD, diabetes, and cancer and also play a role in body weight management and digestive health. The essential macro- and micronutrients along with the phytonutrients present in whole grains synergistically contribute to their beneficial effects. Current evidence lends credence to the recommendations to incorporate whole grain foods into a healthy diet and lifestyle program.”

      These are not my words, but this is the opinion of many experts (based on science). If Perlmutter wasn’t cherry picking he wouldn’t have left this out.

      • And herein lies the problem… these are observational studies and are therefore no controls. Who eats whole grains instead of white flour? People who are concerned about their health and are more likely to exercise, get more sleep, drink less, smoke less, eat less sugar… you name it. You can’t adjust for all those variables. Looking at a lot of inconclusive studies and gathering a consensus opinion isn’t science, it’s pseudoscience and drawing conclusions from it is not a good idea.

        And every study I’ve ever seen where the benefits of whole grains are touted does a comparison between refined white flour and whole grains which might be akin to claiming filtered cigarettes are healthy because they are less damaging than unfiltered cigarettes. That seems like a problem. If the goal is to eat a “less bad” diet than someone eating Wonder Bread all day then a diet filled with whole grains would probably do the trick. But does that make it actually healthy or just a not as bad as the Wonder bread diet. I would say the latter.

      • I know Bob.
        But this is really not the issue here. It’s not about choosing teams. It’s not about whole grains or not. We’re talking about how to honestly present an argument. The main reason I disliked Grain Brain was because reading it was like listening to a vacuum cleaner salesman.

        You see:
        “My dream is to write a book on health that will sell millions of copies. I’ll introduce a great new dietary solution. I already have a strategic plan. Firstly, I am going to select a target group. Obviously, it has to be a large group of people.

        I’m going to write exactly what my target audience wants to hear. I’m pretty sure what it is. I am going to refer to the scientific literature (when it suits me). This will be expected of a doctor. However, I’ll only cite papers that support my dietary solution. Otherwise, I might confuse my readers.

        I’ll definitively challenge mainstream medicine and public health guidelines because I know my readers will love that.

        My target will probably be Paleo and low carb enthusiasts, mainly because this is a huge and rapidly growing group. Furthermore, these people are often very interested in nutrition and how to improve health. I know that for a fact because I often consider myself to be among them.

        There are certain issues I know my readers will love to hear. I’ll tell them that many of the things government and official guidelines say about nutrition is wrong. I’ll tell them that eating lots of fat is good and will protect them from getting dreadful diseases like heart disease, depression, Parkinson’s disease and Alzheimer’s. I’ll tell them that if they eat carbs, grains in particular and even fruit, their brains will get sick. I’ll tell them that gluten is dreadful. I’ll tell them that cholesterol is good and that statins…”

  40. “…Mediterranean style diet which is supported by a lot of scientific evidence…”

    There is no Mediterranean diet today except in remote areas of Greece and the islands. The original dietary pattern was fish, goat, lamb, pork ( these last three in small amounts but including the fat with the meat), the offal, whole cream milk, butter, cheeses, olive oil, some bread ( a loaf had to feed up to 12 people), pasta (same issue as bread), vegetables and fruits in season and wine. Heaps of pasta, pizza and fruit were NOT the diet, and since no one in the world is conducting any dietary study with a group of people locked up for decades there never will be a PRCT, period. We can, however, deduce from the Hadza, Inuit, Maasai and the San what a diet that humans likely evolved on was like- and a low carb diet with fat in it and some protein is what we see ( the fish and fruit eating Kitava of New Guinea for this discussion).

    The most logical diet that can be inferred for our long term health and survival is surely what we ate for eons, not the plastic, gene-altered, high sugary, carbohydrate laden diet that MUST have contributed to the obesity and T2D explosion we have seen these last 30 odd years.

    There is no reason to think that the Mosanto monsters our kids are eating with gut-bacteria killing properties is healthy. Paleo and or low carb high fat are effective for weight loss and reversal of T2D and metabolic syndrome as is being demonstrated in various groups. Will that lead to better health and longevity? Highly likely…


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