So lately I've been pretty in to the Tim Ferris Show podcast on my commute. He talks to interesting people (the ones with Arnold and Peter Attia are particularly good) and has quite a few episodes on health. He's practicing the Ketogenic diet currently and rolling around SF consuming lots of butter tea. That was essentially the catalyst of jumping into this book: Grain Brain by Dr. Perlmutter, a University of Miami neurologist. Dr. Perlmutter claims that a diet high in fat, adequate in protein and low in carbs ("Ketogenic Diet") is the key to curing a range of metabolic and neurological disorders from your everyday blues to bi-polar disorder.
Jumping right in to Chapter 3, Dr.Perlmuttter cites the 1992 food pyramid recommendations as THE relevant fact to the sharp rise in obesity thereafter. I know the food pyramid impacts the structure of government-funded food programs but there'd be a certain time lag to those effects. (The government has definitely played its role -- check out Fed Up on Netflix.) There are numerous other factors contributing to the early '90s being the point at which obesity levels (he is discussing levels, not rates, which is odd) began to climb -- the manufacturing of foods having infiltrated American life while real manufacturing and labor jobs (the kind of jobs that got us off our asses) having exited the market, the increase in more sedentary leisure activities, the baby boomers aging, and the increase in dual-income households and fewer meals prepared at home. But no, he points to the government food pyramid because that's what everyone pays attention to when they purchase and consume food. Umm, OK. (It's like when restaurants started to post calorie counts, studies have shown the calorie information was thoroughly ignored. Food choices are generally driven by preference, habit and availability; not posted calories...or cute government charts.)
Chapter 5 is where he really gets into the structure of the ketogenic diet (more on that means metabolically over here) which is primarily used to treat epilepsy and sounds just dandy as long as you don't have symptomatic ketosis. Also if you aren't already nauseous from the ketones, maybe the the sound of getting 80-90% of your calories from fat on the ketogenic diet is enough to make you feel sick to your stomach. That is a whole lot of fat people. If you're on a 1600 calorie diet, that's like eating over 10 tablespoons of butter worth of fat. Yum.
Chapter 6 is where he elaborates on his perceived connection of a gluten diet and mental illness. Grain Brain also thoughtfully includes a letter from a bi-polar woman who claims that a low-sugar, low-carb, high fat diet "cured" her bi-polar disorder. Seems legit, right? He includes other letters from former patients for which a ketogenic diet has done a 180 on their lives. The letter part really lets him off the hook on any real medical evaluation by him, which is a stark contrast to someone like author and neurologist Oliver Sacks who details his evaluations and follow-up assessments. Since he's a neurologist writing a book, not a Dear Abby column, I think a complete assessment of case study patients would be relevant.
Continuing on in Chapter 6, Dr. P states that "In addition to watching your mood brighten up, you'll watch your weight go down, and your energy soar in just a few weeks" on the ketogenic diet. He could write scripts for late-night infomercials I tell ya.
Some of the studies he cites are interesting; although the way he states them and pieces them together he's very much struggling to make a real case for the high fat, low carb diet. Not to mention this diet seems highly unrealistic and unsustainable for the majority of people. Parts of the book got my blood pressure up more than a bowl of fruit salad. Yes, he discuses how fruit elevates your blood pressure and promotes inflammation. (Yeah, really.) As a result of reading Grain Brain though I have been paying more attention to sugar content and how even "good" sugar like honey or very sweet fruits like pineapple should be used in heavy moderation.
A note by my inner statistician on the way he cites studies in the book: There are simply certain ways you don't phrase statements when discussing results of studies. There are instances when he uses "proves" instead of "shows" or "indicates." Like, you fail Stats 101 if you throw out "prove" in your final. He gets deep in to biochemistry but never once mentions a p-value. He's clearly counting on the reader to follow biochem processes but discounts their understanding of what should be the crux of his discussion, data. Read it with a large ol' grain of salt.