Saturday, December 22, 2012

The New "Perfect Health Diet" and "Sex At Dawn"

One of the perks of being a Psychology Today blogger (besides a small quarterly paycheck) is that I get a ton of newly released books sent my way. Unfortunately, as my daughters are getting older and our lives more complicated, schedule-wise, I have less time to read and less time to post. In the fall, when I teach, my time goes to zero. Unless I forgo sleep (not a feasible option for very long, as I'm not young anymore!), I will be behind on book reviews for quite some time. I feel especially guilty about Toni Bernhard's How To Be Sick and Dr. Drew Ramsey's The Happiness Diet. Eventually I will get to you!

The very first freebie book I was sent came from Dr. Chris Ryan and Caclita Jetha, Sex At Dawn. As I had read Geoffrey Miller's The Mating Mind (which I loved) and Matt Ridley's The Red Queen (also very interesting), Sex At Dawn was an interesting counterpoint to round out the trilogy. Evolutionary Psychology's sexual selection meme is the sobering characterization of women as prostitutes of a kind, trading sexual access for wealth for her children by a powerful male, whereas men are ravening beasts, driven by sexual needs to spread semen every which way. It's not a particularly kind way to look at the human race, your mother, or your father… but science doesn't judge. Enter Sex At Dawn, with the idea that humans are more like bonobos than hierarchical chimpanzees.

The basic message of Sex At Dawn is this one: Humans lived in small, highly related tribes. Sex and marriage were malleable and polyamory was common. Within the tribe, relations were so close that it wouldn't matter much if your woman's child were yours or someone else's in the tribe. "Cheating" is normal and doesn't reflect lack of moral fibre or willpower. It's human nature.

In many ways I like Sex At Dawn, though I do tend to agree with criticisms that it misuses the science to promote one couple's view of polyamory. Having witnessed jealousy amongst my small children from day one, it is hard for me to imagine that sexual jealousy is not a natural human trait (which Ryan and Jetha argue). But from a clinical psychiatry perspective, when I deal with patients who are dealing with infidelity, I do like having the wildly dissident views from Sex At Dawn to discuss with patients. Like 50 Shades of Gray (disastrous from a literary perspective and weirdly conventional, it is widely read so a useful tool to discuss sexual power, the difference between men and women's sexuality, and the power of fantasy), Sex At Dawn sets out a different sexual milepost. A new way to think about human sexuality. My favorite part of it is the determination to cast humans as loving, sensual, social creatures rather than the jealous hoarders we often play. Whether S@D's characterization is accurate is a lesson in critical thinking. I think it is important to read the critiques along with the book.

Which brings me to the new Perfect Health Diet, sent to me not so long ago by Paul and Shou-Ching Jaminet. Disclaimer, they are adorable (as a loving and devoted couple) and amazing and guided me around the Asian grocery store in addition to giving me a copy of both editions of their book. I can't say enough positive about Paul and Shou-Ching in person. Now there is basically no sex in Perfect Health Diet, but it has some similarities to Sex At Dawn. Mostly that it is an earnest, aggressive take on the mainstream, with Paul and Shou-Ching's patented mild smarty-pants writing style. Sodium? Eat more of it. Saturated fat? Healthy! Omega 6 and legumes? Poison in excess! (One of my favorite chapters is the one on Omega 6 fatty acids. The science of eicosanoids is hideously complex, but Paul and Shou-Ching have done their best to discuss the complexity and break it down.

I think that anyone following the food recommendations of the Perfect Health Diet would find themselves in a healthier and happier state of being.  They are straight-up paleo + rice and a bit of dairy with a good amount of carbohydrate, but are moderately low carb and high healthy fat.  I don't always agree with Paul and Shou-Ching with regards to chronic infections, as I feel we have co-evolved with parasites, and our immune systems function best with certain chronic infections on board. I don't know about the safety of their aggressive message for eliminating chronic infections, which our immune system may have sequestered and dealt wih on its own terms. Certainly we did not co-evolve with our modern epidemic viruses and herpes and all that…but it is a complicated area that deserves close study. Anti-fungals and anti-virals tend to be uniquely toxic to the liver and human health.

The reasoning behind the PHD has been enhanced and modified for the new version. They have a breezy, intellectual style, but I think (a bit like Sex At Dawn) they can be a bit guilty of misrepresenting the literature. For example, they credit me (thank you!) for a study I blogged about way back when…Wheat, Rice, and Children's Brains.  We all know it was a crap study in a crap journal (sorry, PLoSOne) and we came up with some damning unaccounted for confounders in the comments. But in Perfect Health Diet, they postulate that the difference between wheat and rice as a staple could account for the differences in IQ between Asian and other children. The literature on sodium is also not as damning as they represent, with some very thoughtful critiques of the key studies easily found in major medical journals.

That said, I like their reasoning about mammalian diets, fasting, and breastmilk as models for human diets. Why not? It gives us something to wrap our heads around. I like the no holds barred questioning of the status quo. One must just keep in mind that no guru has all the answers. No one does.

From a public health perspective, my main message owuld be to eschew processed foods, don't worry about labels and calculations, and to focus on foods which bear no label. I suppose some grains like oatmeal are fine for most, in the context of nutrient rich diets. I'm not the biggest fan of wheat, though some may tolerate it. I love the nutrients in dairy though I don't tolerate it well myself. Corn has some cross reactivity and is certainly guilty by association in processed food.  Rice…I like Chris Kresser's take. I prefer potatoes, squash, pumpkin, tapioca, banana, etc. for starches.

So for people wanting to tweak, and for those wanting to look at a therapeutic ketogenic diet, I do prefer the Jaminets' flexible take. I don't agree with killing all infections at all costs. Not sure the Jaminets do either, though they are far more aggressive than I am.

The new version of the Perfect Health Diet has far more explanation, up to date literature cites, and a more reasonable take on the science behind the macronutrient recommendations. I still think Paul and Shou-Ching are thoughtful like few in the paleosphere. Am I as certain as they are? No, and that gives me pause. But read their book. Like Sex At Dawn, it will open your mind.


  1. I just finished reading Sex At Dawn today, and I loved it. It didn't so much as challenge my thinking, as it expanded it. I was already of the mind that monogamy is not a natural state for humans, but I couldn't say why with any sort of coherence. Now I can.
    I also liked that he mentioned Jared Diamond in a favourable light, and reinforced the belief that the agricultural "revolution" was a huge mistake, from which we are still reeling.
    Oh, and he listed Daniel Quinn's Ishmael in his references, which made me grin widely.

  2. "in Perfect Health Diet, they postulate that the difference between wheat and rice as a staple could account for the differences in IQ between Asian and other children."

    So why do those differences persist essentially unchanged with Asians in America, in Europe, and so on--eating & having kids while eating crappy SADs (and their EU variants)?

    Did he see they see this?

    Two books of possible interest:

    Do the Jaminets advocate @15% of dietary calories from protein (not sure if I'm recalling that correctly)? If so, all I can say is that I'd turn rapidly into a gummy-person on such an intake...

  3. I don't agree with condemning beans. They are healthy, specially if properly soaked and cooked. They are rich in folate, minerals and a great source of slow-digesting carbs.

    Disclaimer: I'm a brazilian, so beans are a staple for me. But rice is a staple too and I think it's less healthy.

    1. I mean black and kidney beans, not soybeans lol

    2. I also think that most people can tolerate cooked beans. The main legumes I try to avoid are soy and peanuts. I think it is reasonable to go without them for a time to see if they bother you.

  4. Emily, thanks for the review; it's already a compliment that you made time to read it!

    Re the rice-wheat-IQ issue, it's not so much a postulate as an arithmetic calculation: the IQ difference is about 6 points and that study identified a difference in Japanese rice vs wheat eaters of 3.8 points in IQ -- 3.8 points is most of 6, so eating rice "could account for most of the IQ difference", emphasis on could, if the study itself is valid and generalizable.

    The chances that the study results are universally valid is probably low, but ... further research is needed. Bone Daddy Dawg, the high IQ of Asians in America and Europe suggests either that Asians continue to eat rice in America and Europe, or that the study exaggerated the effect of rice vs wheat on IQ. It's a good question but which answer is correct isn't obvious.

    On infections, whether to treat any particular infection is an open question; as we note chronic infections are inevitable and universal. We're sort of agnostic about treatment but we're strong advocates of the idea that chronic infections are major causes of disease and major factors in health.

    Emily, thanks again, and have a very merry Christmas!

    1. I was being particularly picky… and partly I just want to remind people to use their thinking caps when reading any of these books, even yours! I agree the infection question is very tricky. I don't think we know the answers.

    2. Even if Asians in Western countries promptly begin eating Western foods (uh, "foods"), we would not necessarily expect IQs in children to quickly drop to Western levels. There are factors, both dietary and cultural, that could reasonably be expected to compound over generations. That is, the first generation could be slightly worse, the second more so, etc.

      There is also the quite reasonable possibility that at least some Asian populations are in fact more intelligent from the getgo. All that would be required is historically heavier selection pressure, which seems not unreasonable, for example, for parts of China.

  5. "Sex at Dusk" is a bit of a fantasyland. Quite a bit.
    They get the basic evolutionary psychology wrong.
    See this book review:

    For book-length rebuttal, see "Sex at Dusk":

    1. you saw that I linked that critique in the post, correct?

    2. For any readers confused about the double reference to "Sex at Dusk" above ... In the comment "Unknown" made above, I believe they meant to say "'Sex at DAWN' is a bit of a fantasyland." The link is to an article that reviews both Dawn and Dusk and is very critical of Dawn.

  6. No sure how useful this study is but...

    IQ tests are 'fundamentally flawed' and using them alone to measure intelligence is a 'fallacy', study finds

    1. IQ is a very interesting metric. Despite it's limitations (I think in most tests it is more a test of RAM than general "intelligence"), I've seen interesting correlations between IQ and longevity, and even survival of certain infectious diseases.

  7. Concerning rice and arsenic, here's my n=1.

    I love Asian food, and frequently eat at Asian restaurants, including the normal quantities of white rice. I've been doing this for years.

    I recently had an iodine-provoked toxic metals test performed (as part of an iodine loading urine test).

    My arsenic levels are extremely low (and as with all these tests they use unprovoked levels to establish the reference range).

    Maybe the Asian white rice doesn't have much arsenic. Or maybe the 50 mg per day of Iodoral I'm taking is keeping me detoxed, since apparently iodine drives out heavy metals as well as toxic halogens.

    Either way, thank God I can continue to guiltlessly enjoy the scrumptious Vietnamese, Japanese, and Thai food in my city!

    It's also hard not to notice how incredibly lean the Asian people around here are, despite that white rice.

  8. My view on wheat harks back to PaNu and Dr. Harris, with the question being why anyone would eat it, except to avoid starvation? Thus it does not take much to nudge my Bayes-like meter back to advocating complete avoidance. Further, the IQ analysis, flawed as it may be, is, as you say, very interesting as a number and in its correlations. Why eat the proteins in wheat that we know are in general, and in the long term, harmful to most people? Even if the results seem to be sub-clinical? (Until Alzheimers sets in, of course...) Thus, as I see it, someone needs to show that there are real health benefits associated with eating wheat as a staple of the diet.

  9. Any chance you will be reviewing the GAPS BOOK, anytime soon, pretty please. I am a big fan, and four years into GAPS (treating autism in kids) I am eager for more professional reviews on this protocol.

  10. More hot criticism / defense of "Dawn"

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