Warning: this is a loooooooong review. Skim the section headlines and highlighting if you’re low on time or have ADHD. Part 2 is going to deal with some specifics nutrient recommendations from the book– I’m going to argue against a couple of them in a valiant but likely losing effort. Here we go…

Why is it called “Perfect Health Diet”?

The most popular paleo books to this point have been, chronologically, by Loren  Cordain  (2002), Mark  Sisson  (2009), Robb  Wolf  (2010), Melissa and Dallas  Hartwig  (2012), and Dianne  Sanfilippo  (2012). These were good books. But for the academic-leaning nutrition enthusiast or someone wanting all the details filled in, Perfect Health Diet (or [highlight type=”yello”]PHD[/su_highlight], as it’s coincidentally called) is paleo on steroids. Not the bad steroids that give you acne and make you aggressive, but the good steroids that improve your health and make you think deep thoughts.

The title rubs some people the wrong way. They may think Paul and Shou-Ching are smack-talkers, touting their perfect diet compared to all those imperfect diets. This is not the case. Read 20 pages or so, and you can see that they are sincerely trying to find the highest quality evidence for how to construct a diet for health and longevity. Being lucky enough to live in the vicinity of the Jaminets and sharing some common friends, I’ve badgered them with questions a few times. They are as gracious in person as they are online. I only wish they were were shameless in their self promotion, so maybe they could force their way onto Dr. Oz or Oprah.

Is it worth buying if you have the 2010 edition?

In a word, yes. In five words, better organized and more thorough. The  recommendations  have changed, which I’ll touch on later. If you haven’t read the first or second edition, the primary reason to read PHD even if you know the basics of whole-foods eating is this: “JUST EAT REAL FOODS” is enough for some people to obtain great health, but not for all people. Nutrition for therapy is a little different than nutrition for disease prevention, and optimal nutrition can make life even better than pretty good nutrition.

What’s good about it, and what’s bad about it?

The best part about the book, in my humble opinion, is that it is  SYSTEMATIC . A bit of background on me: half way through my nutrition PhD, I ran out of funding and had some crazy joint problems and surgeries. To pay the rent while on medical leave, I got a job, which randomly ended up being helping out in the research leading up to the 2010 vitamin D guidelines. For the next three years I learned the ins and outs of nutritional epidemiology and systematic reviews. So my main complaint when reading many popular nutrition books is they tend to be biased — starting with a hypothesis and only citing evidence to support that hypothesis. PHD crams in more aspects of systematic review and nutritional epidemiology than any other non-academic book I’ve seen.

It’s not all sunshine and ponies though. I’ve got three main gripes with the book. First: I don’t totally agree with the  supplementation strategy . Second: The book is a bit  too academic  to be a New York Times best-seller (hopefully I’m wrong about this). Third: I thought the sweet potato on the cover looked like salmon at first, which confused me mightily. Paul acknowledged this though, so I’ll drop this issue. I’ll explain each of the first two points in this post, and then continue with an analysis of specific nutrients discussed in the book in Part 2 next week. Also, I urge you to read other reviews that include logical criticism of the book, such as the one by Emily Deans.

PHD might recommend too many supplements, but there’s probably little to no risk

When people recommend supplements, it’s really an educated guess based on personal experience, anecdotes, studies, and biological plausibility. The Jaminets use all of these, and do an excellent job of conveying the  dose-response relationship  of supplementation — get enough to attain substantial benefit but not enough to risk adverse effects. Compared to the first version, the 2012 PHD offers a more specific and well-researched supplementation strategy. Namely: no more multi-vitamins, and daily plus weekly recommendations for different nutrients. For example, B vitamins and some minerals are now taken weekly, whereas the most nutrients like vitamin D, vitamin K, and vitamin C are taken daily.

Before getting critical, let me just say that the Jaminets’ knowledge of nutrients is like the Milky Way, and mine is like Pluto. I’m not even a planet any more! But here goes. Studies are generally one of three types:  cohort studies  (tracking a group of people over time to see which diseases develop),  case-control studies  (comparing diseased and non-diseased people to see which factors are related to disease), and  trials  (typically comparing a randomly selected control group against an intervention group to see if the intervention helps anything).

A coworker of mine did her PhD thesis on an interesting topic — for which nutrients do RANDOMIZED CONTROLLED TRIAL results conflict with the results of other types of studies? Well, there’s no great way to predict this. But there are some things we know. Foods typically do better than individual nutrients in studies, because nutrients work in concert. Nutrients sometimes have unexpected negative results, such as with vitamin A and vitamin E in recent years. In fact, my primary care doctor while I was a student at Johns Hopkins weirdly happened to author the big vitamin E meta-analysis, which showed an increase in mortality for those taking vitamin E regularly.

When the Jaminets found enough evidence of benefit from higher nutrient dosages than food could provide, they recommended supplementation (in addition to recommending supplementation for nutrients lost in soil, in treated water, etc). But while the studies they cite are good at showing a lack of toxicity for supplementation, in my opinion they are not always great at showing a solid benefit to supplementation. Why? Two reasons. First, the high-dose groups typically did much better than the low-dose groups, but not much better than the fairly-high dose group. In other words, if you eat a nourishing diet, will supplementation help you much? Maybe not, but the specifics differ by nutrient. We’ll cover this in part 2 next week. Second, nobody in these studies eats exactly PHD style. They might be avoiding sugar, vegetable oil, and gluten, but there’s no way in heck they’re getting over 100% of their RDA for pretty much every nutrient  every single day , like in PHD. Even those taking multi-vitamins won’t be getting enough of bulky nutrients like magnesium, plus they’ll typically be getting wonky ratios. The Jaminets discuss how over-nutrition can be detrimental for certain things like infection, but I’ve got some thoughts about other considerations when being super-well-nourished every single day. I’ll put these thoughts together for Part 2.

Perfect Health Diet is surprisingly easy to read, but is it easy enough?

The Jaminets were in a unique position when they wrote this book. They had already written a pretty excellent first edition of this book, followed by two solid years of reader experiences and discussions on their blog. Consequently, PHD 2012 is littered with highly-relevant testimonies of Perfect Health Dieters. Maybe littered isn’t the right word, but I certainly found them helpful — especially as PHD practitioners seem sharper than the average nutrition enthusiast. If you’re active in the paleo blogosphere, you might even notice some familiar names such as Stabby the Raccoon. (<–That’s Stabby’s post on how to drink too much yet avoid a hangover. Is getting drizzzunk paleo?)

not PHDUnfortunately, attention spans dwindle every year, and many will be turned off by the  sheer amount of cited studies  and in-depth analysis provided by PHD. I feel conflicted about this. A gimmicky PHD would be more attention-grabbing, but would sully the message. A recipe-filled, weight-loss focused book might sell more copies. A Choose Your Own Adventure PHD may help sales in the 8 to 12 year old target market, but maybe ditch the Sisson forward and get a Bieber blurb.

I don’t foresee PHD being a #1 New York Times bestseller, simply because it is quite thorough, contains long and sciency words, and doesn’t try to trick you with gimmicks. That being said, it might have even GREATER potential to impact things than a typical best-seller. At some point, there’s a decent chance that a member of the US Dietary Guidelines Committee or an influential politician will run across this book. I already missed my chance to slip this book into conversation at work, when we randomly had three Dietary Guidelines Committee members on a conference call. You might not agree with everything in PHD (common reasons: low carb 4 lyfe, vegetarian, anti-rice), but you can’t deny the sheer mass of evidence analyzed. So if you buy the book,  maybe pass it on when you’re done?  And if you have a friend who happens to be the Secretary of the USDA, buy him a copy. The easiest way to change policy is donating millions of dollars by way of sketchy lobbies, but another good way is presenting decision-makers with a massive amount of clearly synthesized evidence. PHD is the book I’d feel most comfortable giving to my nutrition school professors, so if you know of any academic types that might be open to an alternate perspective, consider PHD!

All that fluff was meant to balance the hyper-critical Part 2, which is coming up next week.

Up next in Part 2:

[ul type=”check-bold”]Which supplement recommendations in PHD are solid and which are…gaseous?[/ul] [ul type=”check-bold”]What is the most important aspect of nutrition not addressed by PHD?[/ul] [ul type=”check-bold”]The Insulin Hypothesis versus the Food Reward Hypothesis: Where does PHD stand?[/ul] [ul type=”check-bold”]Is it worth reading PHD if you are zero-carb or very-low carb?[/ul] [ul type=”check-bold”]Is there another French-Canadian nutrition researcher lurking? Jaminet, Guyenet, …[/ul]

 

 

10 Comments

  1. I wonder if the PHD will sit on the same shelf with Taubes’ tome ‘Good Calories, Bad Calories’ which had a wide readership. Perhaps the Jaminet’s should produce a succinct easy-read pocket follow-up like ‘Why we Get Fat’.

    Reply
    • That’s a great idea, Mash. The writing is already quite good. If they just got rid of those pesky numbers and molecule names…

      Reply
      • They have a cookbook coming out soon right? Perhaps this would be a good vehicle.

        Reply
  2. A great take on a book that I enjoyed. Looking forward to part 2, as it looks to address some of the issues I had with the book. Specifically, the bias for a moderate-carb (20-40% of energy) approach, when seemingly many of the arguments support a lower amount than that. I’m not convinced on the thyroid/mucous issues or the insistence that just because we have bigger brains our carb intake should fall higher than that of the other mammals used for comparison.

    Reply
    • It must be difficult to condense analysis of so many nutrients into one rather slim volume. Maybe some of the Jaminets’ viewpoints don’t seem 100% obviously correct because of lack of space. I will give an opinion or two on the carb level debate, but nothing earth-shattering.

      Reply
  3. Looking forward to part 2. Supplement recommendations should be critically reviewed, so thanks for doing so.

    Reply
  4. Is part two out yet? I’m anxiously waiting for the shocking conclusion! :)

    Reply
  5. part2! part2! i’m intrigued.

    Reply
    • Apparently three reminders is a charm, I’ll get back to writing lickety split. Thanks for the gentle push :)

      Reply

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