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The Official Newsletter of
updated December 10, 2017

Fruitarian Diets: 
How to Make Them Healthy

by Ron Brown, Ph.D., B.Sc. Dietetics, author of The Body Fat Guide 

"Ron Brown is a certified fitness trainer who doesn't have an inch of flab on his body. He'll tell you what you can do to become fit and trim too." 
Washington DC

DO YOU eat only fruit until noon as recommended in the popular book Fit For Life? Do you believe carbohydrates in fruit are better than refined sugar? Do you follow a low-fat fruitarian diet? If you answered yes to any of these questions you are probably a health-minded person who may be susceptible to misinformation about fruit. I do not mean to pick on fruit, because it is one of my favorite foods. But like any unbalanced intake of food or drink, an improperly balanced fruitarian diet lacks vital nutrients that can harm your health. This article will show you how to make a fruitarian diet healthy.

Whole, ripe, unprocessed, raw fruit is full of fiber, pure water, vitamins, minerals, small amounts of protein, and other micronutrients that are essential to health and which are missing in refined carbohydrates. Fructose and glucose, the monosaccharides contained in a predigested form in fruit, are simple carbohydrates or sugars that, along with fat, supply important energy to the human body. 

A common question people ask when hearing about a fruitarian diet is "Isn't that too much sugar from fruit?" But, as every diabetic patient who has been instructed to count carbs knows, dietary sugar intake has no greater effect on blood sugar levels than the same amount of calories from starch. All starch food must be digested to glucose before it can be used by the body for energy, so it makes sense to make fruit a significant source of carbohydrates in your diet. People who load up on bread, crackers, potatoes, rice, beans, corn, peas, lentils, oatmeal, pastries, breakfast cereals, and pasta are misguided in accusing fruit eaters of taking in too much sugar because these people are producing just as much or more sugar through digestion. And that's in addition to consuming refined sugar added to processed foods as well as natural sugars in dairy products. The so-called feelings of "satiety" provided by cooked starch foods are often just fatigue and drowsiness brought on by prolonged digestive strain.

Research studies showing that fructose is harmful were based on refined carbohydrates such as high fructose corn syrup and pure sucrose, not on natural whole food like fruit. Sugar in natural food is combined in organic compounds with vitamins and minerals which are stripped away in processing. In the body, refined sugar and other refined carbohydrates like white bread and white rice leach out these missing nutrients from bone and other tissue during metabolism. 

When people first discover the health value of eating fruit they may be inclined to mentally associate extreme amounts of fruit intake with health. For example, Dr. Stanley S. Bass described how he went on an orange juice diet to recover from ailments as a young man. The benefits he received from the large amount of orange juice he consumed helped put his body into a better nutritional balance after unhealthy eating throughout his life. However, an unfortunate outcome of this early experience is that it seems to have led Dr. Bass to mentally associate large amounts of fruit intake with health. This eventually led to more excessive fruit intake, which eventually led to more health problems, such as missing teeth! Dr. Bass then conducted a series of dietary experiments on mice and came to a startling conclusion that finally broke his mental association between excessive fruit intake and health: A diet containing the proper balance of nutrients, including the proper amount of carbohydrates, fat, protein, vitamins, minerals, and other factors is essential for health! 

An important limitation of Dr. Bass's experiments is that mice are an omnivorous species with higher protein requirements needed for growth who prefer to cannibalize each other rather than eat only fruit. By contrast, orangutans, a species more closely related to humans, are frugivores who eat nothing but fruit for months at a time when it is available, as noted in a 1998 article in the International Journal of Primatology by Cheryl D. Knott who studied changes in orangutan calorie intake and fruit availability. Note that orangutans include generous quantities of durians in their fruitarian diet, which are fruits that provide 30% of calories from fat. Avocados, ackee, and olives are other fruit sources of concentrated fat, demonstrating that a 100% fruit diet does not have to be a low-fat diet. Botanically, high-fat nuts are also classified as fruits and may be rightfully included in a fruitarian diet. In a 1978 article by King in the British Journal of Nutrition, Comparative feeding and nutrition in captive, non-human primates, it was found that captive apes voluntarily chose a diet of 20% calories from fat. Furthermore, according to a study by Popovich et al. that examined the diet in the Western Lowland gorilla, gorillas derive as much as 57.3% of their calories from short-chain fatty acids created by fiber fermentation in their colons. In humans, the Mediterranean Diet provides 35-40% fat calories from healthy sources including olives and nuts.

In his book that advocates consuming 80% of calories in the form of carbohydrates from fruit and no more than 10% calories each from fat and protein, The 80/10/10 Diet, Doug Graham states, "Ask a dentist what percentage of his or her patients have problems with their teeth because they ate too much fruit. The percentage will be so low as to approach zero" (p. 4748). This misleading statement hides the fact that the average person in the U.S. barely eats more than one serving of fruit a day. In a 2005 Bulletin of the World Health Organization titled The role of diet and nutrition in the etiology and prevention of oral diseases, Moynihan described epidemiological and animal studies that showed fruit is non-cariogenic (doesn't form cavities) when normally consumed, but is cariogenic in excessive amounts. This raises the question: what conditions determine when fruit intake is excessive? Also, what other nutrients are lacking when eating mostly fruit?

Doug Graham claims it is impossible to get too much glucose from fresh fruit. Yet, his followers boast about eating 30 bananas a day which provides over 800 grams of carbohydrates or over 53 servings each containing 15 grams of carbohydrates. By comparison, a normally balanced 2,000-calorie diet with 60% of calories from carbohydrates provides only 300 grams of carbohydrates and 20 15-gram servings. Low-fat fruitarian advocates claim that fruit sugar only causes health problems when it accompanies excessive fat intake. This is a convenient twist of logic to justify a low-fat bias. Obviously, eating excessive amounts of calories from fat and sugar, a combination typically found in refined foods, will stress the body's ability to regulate energy intake, causing blood sugar problems, digestive issues, diabetes, and disturbances in calcium metabolism. On the other hand, advocates of low-carb diets could just as easily argue that dietary fat only causes health problems when it accompanies excessive sugar intake! The ideal solution is to find the right balance between dietary sources of glucose and fat that is not excessive to the body's needs.

In his book, Graham acknowledged Natural Hygiene practitioner Virginia Vetrano's expertise in applying the principles of a raw vegan diet of fruits, nuts, and vegetables to help people recover and maintain health. Ironically, in her book published online in 2012, Atherosclerosis--Avoidable and Remedial without Medication, Vetrano said, "Those who advocate a fruit, vegetable, and nut and seed diet but who limit fats to 10 per cent of the diet are terribly misguided and are completely wrong." Fat does not stick to and gum up the body, as Graham claims. The internal body is a watery-environment, and fat is a non-polar hydrophobic molecule, meaning that fat cannot freely circulate throughout the body. It must be emulsified by bile salts and packed into micelles as it travels to the small intestines where it is bound with protein to form chylomicrons that are released through the lymphatic system and into the general circulation. At no time does fat float around freely and stick to the inside of the body. Fat is naturally emulsified in whole plant-based foods unless refined to produce oil.

Graham also acknowledged his mentor T. C. Fry, who taught that humans require very low amounts of dietary fat and protein. The authors of the 1985 bestseller Fit for Life, Harvey and Marilyn Diamond, followed the teachings of T. C. Fry as well, and they mistakenly wrote that the body required 90% of its energy from glucose and only 1% from fatty acids. The truth is that the body actually derives 70% of energy at rest from fat to maintain muscle and organ cell function. Muscle and liver cells can breakdown both fat and glucose to acetyl-CoA, a substance that is used by the cells' mitochrondria to generate energy in the form of ATP. A molecule of fat provides much more ATP than a molecule of glucose, which is why fat is the preferred fuel for long-term low-intensity activity. Fat is what you burn when you go for long walks. Only the brain and central nervous system cannot breakdown fat for energy, relying on glucose or ketones manufactured by the liver. 

Dietary Protein

In Orthotrophy, Shelton quoted from a study of healthy fruitarians: "They were able to live on fruits by including nuts, which are very rich in protein and fat, neither of which elements exist in fruit proper to a sufficient degree to maintain normal life." In Errors in Hygiene?!!?; T.C. Fry's Devolution, Demise and Why, Vetrano said that diets consisting of mostly sweet fruits often lack protein, and that having sufficient protein in salvia helps to restore tooth enamel when fruit acid is eaten, but other factors are involved such as dysregulated phosphorus metabolism, discussed later. Although there is protein in fruit, Vetrano said most people are unable to eat sufficient quantities of fruit to provide all the protein they need. Vetrano claimed that T. C. Fry suffered from malnourishment due to his refusal to eat sufficient protein. Fry had argued that human milk is very low in its percentage of calories from protein, yet human milk still provides enough protein for an infant to double its weight in six months and triple its weight in a year, so Fry thought there is no need for a fully-grown adult to worry about getting adequate protein from natural foods. Vetrano criticized Fry's analysis by pointing out that the protein content in the human milk he was analyzing was naturally more diluted as the infant transitions to solid foods. But Fry was aware of this, and I think there is a better reason to explain why he, like so many other fruitarians today, mistakenly ignored or underestimate protein needs.

Estimating protein intake by percentage of calories in one's diet can be misleading depending on the overall amount of calories eaten. For example, human milk, though lowest among all mammal milks in percentage of calories from protein, is nevertheless very rich in calories, especially due to having over 50% of calories from fat! Therefore, the absolute amount of protein in human milk is higher when measured by grams of protein rather than by percentage of calories. Likewise, the absolute amount of protein in a low-fat fruitarian diet depends on how many calories are eaten. T. C. Fry discouraged counting calories and measuring grams of nutrients—this may have been a fatal flaw in his attempt to live on an optimal fruitarian diet. In addition, recent body composition evidence shows that the rapid growth of infants measured by weight is mostly body fat, not lean tissue, and an exclusive human breast milk diet provides a mere 0.5 grams of protein per kilogram of an average infant's bodyweight. Nevertheless, on a diet of only 1% protein by weight in breast milk, infants grow up to six inches in length in the first six months, and add approximately another 2 inches in the next six months. This provides strong evidence that protein needs for adults is actually less than recommended.

The recommended protein intake for adults is 0.8 grams per kilogram of bodyweight, regardless of one's calorie intake! Vetrano suggested that people on a balanced raw-food diet with better protein assimilation can be adequately nourished without needing the 30% extra protein included in this recommendation, reducing it to approximately 0.56 grams per kilogram, which is considered a low-protein diet often used in renal dietetics. Notice that this amount is also close to that provided in human milk. Therefore, a 170-pound male eating a raw vegan diet would require 43 grams of protein at 0.56 g/kg bodyweight. T. C. Fry recommended even less protein on a raw diet—1 gram of protein/5 pounds of bodyweight, or about 0.4458 g/kg bodyweight, which covers the obligatory degradation of proteins in the body of 20-30 grams a day, as mentioned in Guyton and Hall's Textbook of Medical Physiology.

To get sufficient protein, the more calories consumed, the fewer concentrated-protein foods are needed, and the fewer calories consumed, the more concentrated-protein foods are needed. For example, eating a few ounces of concentrated protein in nuts like walnuts, filberts, almonds, cashews, pistachios, etc. provides sufficient protein when calorie intake is low, as when dieting to lose weight or when recovering from a fast or wasting illness, and smaller amounts of less concentrated protein in macadamias, pecans, avocados, and coconuts helps provide sufficient protein when calorie intake is high, as when attempting to gain healthy weight or providing energy for high levels of physical activity. 

In my own experience, after a series of fasts, I used weightlifting and a low-calorie raw vegan diet containing 4 ounces of nuts and an average of about only 34 grams of protein a day to recover 30 pounds of muscle in six weeks, increasing my bodyweight from 150 pounds to 180 pounds with a 30" waist at 5'9." This is equivalent to about 0.4 grams of protein per kilogram body weight—half the conventional recommended amount of protein. I ate my food in two meals, omitting breakfast. At the time, the people who ran the American Natural Hygiene Society were all practitioners of fasting institutes, like Vetrano. The "hygienic diet" they recommended was the diet of raw fruit, nuts, and vegetables that they found suitable to feed their patients after undergoing fasting. This allowed their patients to slowly regain healthy bodyweight, just as I had. But my gain was not new muscle growth; it was simply replenished muscle that had been depleted by my fasting. It doesn't take many calories to replenish depleted muscle...its like allowing a squeezed sponge to soak up water. After a fast, people regain lean weight consuming an amount of calories on which they would normally lose weight! The practitioners just assumed people could sustain themselves indefinitely on this type of temporary low-calorie refeeding program, but obviously they had little experience living on it themselves without adding in extra meals or cooked food.

After recovering my lost weight, I eventually realized that I needed to obtain more calories and more meals consisting of less concentrated protein sources like fruit, avocados, and low-protein nuts like coconuts and macadamia nuts. T. C. Fry pointed out that a raw fruitarian diet yields 90% of its calorie potential to the body compared to only 65% of calories yielded from cooked food—in other words, less food is required to meet energy needs on a raw fruitarian diet because fewer of the calories in fruit are wasted in the metabolic conversion to energy. By comparison, wrote Shelton, "The digestion of starch foods consumes much more energy than does the digestion of sweet fruits." Additional energy is required to cook both starch and protein, thus contributing to green house gas emissions. T. C. Fry also claimed caloric needs on a raw fruitarian diet were reduced by as much as 50% when avoiding the additional energy used by the body to resist and eliminate the toxic effects of cooked food. For example, much of cooked protein is wasted due to coagulation, making the protein less bioavailable and contributing to toxicity. See: Cooking Clogs Your Arteries and Brain.

Fruit has variable amounts of protein ranging from very small to quite a bit. For example, large servings of melons and oranges provide a significantly greater concentration of protein than most other fruits, and it is easier to meet protein requirements eating these fruits. However, a 170-pound person would have to burn off the sugar in enormous amounts of other types of fruit (e.g., 30 bananas a day and more) through vigorous physical activity to receive a sufficient amount of protein—approximately 3500 calories from bananas to obtain 43 grams of protein! This explains why the strongest vocal advocates of low-fat fruitarian diets tend to be distance athletes who require and eat enormous amounts of calories. But this is probably not what Shelton meant when quoting how fruitarians maintained a "normal life." Forcing oneself to become a distance athlete when adopting a low-fat fruitarian diet is a case of fitting the person to the diet rather than fitting the diet to the person.

Instead of eating voluminous amounts of fruit, it would be more practical for distance athletes and others to add smaller amounts of concentrated plant fat to their diets to help meet resting and low-activity energy requirements. This spares carbohydrates for more active energy use, and spares protein from being broken down for energy, thus allowing better tissue growth and maintenance. For these reasons, Shelton suggested, "it is, at least, a great saving [in energy] to the body if some fat is supplied."

Long-term dieters on a low-fat fruitarian diet who ignore protein and restrict calories to lose weight are particularly susceptible to develop a protein deficiency over time. Our 170-pound male dieting on 1500 calories from eating mono-meals of bananas totaling 14 bananas a day would receive only 18 grams of protein. This is less than the amount needed to cover obligatory nitrogen loss. Mono-meals, where only one food is eaten at a time, are double-edged swords. They allow the eater to feel satisfied on less food and calories, but they can eventually lead to imbalances and deficiencies. For example, a mono diet of bananas is severely deficient in calcium which requires a large amount of dark green leafy vegetables like kale and collards to balance properly. 

A person who is not a distance athlete would also consume an unhealthy high amount of sugar on a mono diet of bananas. The original concept of mono meals and eliminating diets which were popularized by early health reformers was never intended to provide a maintenance amount of calories to sustain weight. For example, an apple diet would provide no more than the normal amount of carbohydrates on a maintenance diet while eliminating concentrated sources of fat, starch, and protein. Turning mono meals and eliminating diets into high-calorie diets by doubling one's carbohydrate intake, as in The 80/10/10 Diet, misses the point of the eliminating diet and invites trouble. By the way, blood tests showing normal calcium levels on a fruitarian diet can be very misleading because the body breaks down calcium stored in bone to release into the blood to restore higher calcium levels. The net result over time is osteoporosis, a silent disease that goes undetected until fractures appear. Serum levels of parathyroid hormone, a substance that triggers the release of calcium from bone, is a better indicator of bone loss.

T. C. Fry claimed some people of the Caribbean were "thriving" on as little as 15 to 20 grams of protein a day, but that depends on how you define thriving. According to the Food and Agricultural Organization of the United Nations, the daily protein intake in the Democratic Republic of the Congo between 2005-2007 was 24.7 grams. With 69% of the nation's population undernourished, these people would be more accurately described as barely surviving rather than thriving. Remember, the obligatory degradation of proteins in the body is 20-30 grams of protein a day, so not everyone in the population would be receiving an adequate amount.

It's no wonder that people experimenting with low-calorie fruitarian diets often have dental issues. As registered dietitian Brenda Davis and Vesanto Melina noted in their book, Becoming Raw: The Essential Guide to Raw Vegan Diets, consuming sufficient protein is essential to maintain the collagen matrix, a type of connective tissue that provides the scaffolding to retain minerals in bone and teeth. As this collagen matrix breaks down from lack of protein, bones and teeth begin to lose minerals and deteriorate. Small amounts of additional protein obtained from green vegetables is helpful, but a better alternative for those who aren't distance athletes and who aren't capable of burning off large amounts of fruit is to supply adequate amounts of protein and calories simply by eating a few more nuts and seeds. 

Vetrano described a case of a young woman with a history of restricting her food intake to stay thin who was able to rapidly recover from edema, hair loss, and collagen tissue atrophy by including more concentrated sources of protein in her fruitarian diet from eating nuts, but much of the woman's improvement is also likely due to the additional calories supplied in nuts. Both protein and energy must be fed in sufficient amounts to prevent PEM, protein-energy malnutrition. Feeding excess protein without supplying enough calories to meet energy needs is likely to result in the body burning the excess protein for energy instead of using it for tissue growth, repair, and maintenance. 

In The Great Protein Fiasco, McLaren described how the overemphasis on protein needs in malnutrition was based on a misinterpretation of early studies of kwashiorkor in African children. It has since been found that protein deficiencies in these children occurs as a result of feeding inadequate calories from a mixed diet of whole foods, not from the low-protein content of the food itself. For example, human milk is a low-protein food, but it is obviously adequate for growth and development in children. Nevertheless, commercial marketing of high-protein foods for profit keeps the high-protein myth alive. Why else would people think they need to eat animal-based foods?

Copenhagen's historic nutrition researcher, Mikkel Hindhede, noted that adequate protein intake was often not a concern "provided sufficient calories were furnished." Of course, he was referring to a properly balanced diet of mostly whole, natural foods that meets one's resting and active energy needs. According to Davis and Melina, the average sedentary to moderately active woman requires 1,800-2,000 calories a day, and moderately active males require 2400-2600 calories, based on size and energy expenditures. However, the average person lives on cooked food. A person living on a properly balanced raw fruitarian diet is much more efficient at metabolizing energy from calories in raw fruit, vegetables, and nuts compared to cooked starch and protein. T. C. Fry claims that physically active people following raw fruitarian diets rarely need more than about 2,000 calories a day, which is 23% fewer calories than an active male requires on a cooked diet. Davis and Melina cited a raw food survey showing that participants received favorable health results consuming 27% fewer calories than the standard calorie recommendation; females averaged only 1,460 calories and males averaged only 1,830 calories. If you are maintaining a healthy lean weight, and you observe that your nails are growing quicker and stronger on a fruitarian diet, then you are likely getting sufficient calories along with adequate protein to synthesize collagen tissue. 

My experience regaining 30 pounds of muscle on 0.4 grams of protein per kilogram of body weight implies that actual protein needs could be as low as half the conventional recommendation, in agreement with T. C. Fry's recommendation. If you are eating sufficient calories from natural foods to meet your energy needs, it is impossible to consume fewer than 0.4 grams of protein per kilogram of body weight! In Superior Nutrition, Shelton verified, "I have watched hundreds of men, women, and children make steady (often rapid) gains in weight and strength following lengthy fasts, while consuming less than half the protein daily that is required." The rapid replenishment of depleted lean tissue following a fast in these cases proves that the amount and quality of dietary protein provided is adequate for growth. Note that the protein fed in these cases is mostly uncooked, which has a much higher bioavailability than heated protein. Thermally treated protein coagulates so that its amino acid strands fuse together and do not unfold or denature properly during gastric digestion, thereby wasting much of the protein.

In addition to collagen breakdown from lack of calories and protein, too much fruit acid is claimed to breakdown tooth enamel. Shelton warned against eating citrus fruit in excess, although he acknowledged that citrus fruits are wholesome foods. The acidic nature of these foods is entirely different from the acid-forming nature of some foods when they have been metabolized. Citrus fruits are alkaline when metabolized, but their acidic effect before metabolism means they should be eaten in limited amounts. To reduce the potential harm on defective tooth enamel from eating acidic fruits, it may be best to consume small amounts of acid and sub-acid fruits that have a low pH (2-4.5) like oranges, pineapple, mangoes (which contain malic acid and tartaric acid), berries, grapes, peaches, apples, and pears, by blending them with non-acidic fruits that have a higher pH (4.5-6.5) like melons, papayas, avocados, cherimoyas, durian, jackfruit, bananas, persimmons, dates, and figs along with nuts, vegetables, and water. Shelton pointed out that nature designed sweet fruit like dates and bananas for the tropics, where humans developed, and this implies that non-acidic fruit may be more naturally suited for human consumption. Citrus fruit is more commonly grown in semitropical regions, and apples were only recently cultivated in temperate climates where other acidic and sub-acidic fruits like berries, peaches, and grapes are grown. Acid in unripe fruit also decreases as fruit ripens and its sugar content increases. Chimpanzees eat mostly ripe figs.

Mothers are instructed to feed their toddlers diluted fruit juice to protect their toddlers' teeth from baby-bottle tooth decay due to prolonged exposure to fruit acid, sugar, and also to lactic acid from milk. If you soak a chicken bone in vinegar overnight it turns rubbery as the acid removes the bone's calcium phosphate. Obviously, we don't soak our bones in acid, and bones lack protective dental enamel found on teeth. A sound tooth is able to restore and maintain enamel due to a small amount of acid erosion on a daily basis. Shelton wrote that experimenters found no injury to sound teeth that were submerged in fruit acid for several months, and that lactic acid also does not harm sound teeth. Since then, research has shown that enamel hypoplasia is caused by a high-phosphorus diet, and this could be an important determinant in weakening a sound tooth's resistance to acid erosion. Breastfed infants have a much lower prevalence of dental caries than bottle-fed infants, which could be explained by bottled cow milk containing six times more phosphorus. 

Most people, including dietitians, are not aware that the average amount of protein per calorie in fruit is similar to human milk—approximately 0.014 grams of protein per calorie (TABLE 1.), all in a predigested form as free amino acids and ready for immediate absorption. This implies that raw fruit has excellent potential as a bodybuilding food if fed as part of a well-balanced diet.

TABLE 1.               Protein per Calorie in Fruit

  Protein g/calorie   Protein g/calorie
Pomegranate Juice 0.0028 Honeydew  0.0150
Apple 0.0050 Dried Peach  0.0151
Persimmon 0.0063 Soursop  0.0152
Date (Medjool) 0.0065 Plum 0.0152
Pear  0.0066 Tangerine  0.0153
Pineapple Juice 0.0068 Orange Juice  0.0156
Mango 0.0078 Jackfruit  0.0156
Kaki  0.0083 Cherry  0.0168
Dried Plum  0.0091 Cactus Pear  0.0178
Durian  0.0100 Kiwi  0.0187
Fig  0.0101 Orange  0.0200
Raisin  0.0103 Watermelon  0.0203
Grapes 0.0104 Cherimoya  0.0209
Pineapple  0.0108 Strawberry  0.0209
Papaya  0.0109 Raspberry  0.0231
Dried Banana 0.0112 Lime  0.0233
Lychee  0.0121 Peach  0.0233
Banana  0.0122 Nectarine  0.0241
Avocado  0.0125 Cantaloupe  0.0247
Blueberry 0.0130 Apricot  0.0292
Dried Fig 0.0133 Blackberry  0.0323
Human Milk  0.0143 Lemon  0.0379
Grapefruit, Red 0.0150 Casaba Melon  0.0396

Note the important distinction between measuring protein by grams per calorie rather than by percentage of calories. It is easy to fool yourself into believing that you are getting sufficient protein from a low-calorie diet when you measure protein by percentage of calories instead of by grams per calorie. Confusing these two measurements seems to have misled many fruitarians into believing that human protein needs are lower than they actually are. For example, I can diet on just 2 peanuts a day and say that I am getting 16% of calories from protein, but that is obviously barely enough protein to nourish a mouse. A 170-pound person dieting on 1500 calories would need to increase their minimum required protein intake to 11.5% of calories—exceeding Graham's nutrient ratio of 80/10/10—but this is not possible on a fruitarian diet without adding more concentrated protein foods. 

It's worth repeating: Attempting to lose weight for long periods with a low-calorie diet that consists exclusively of fresh raw fruit and vegetables is not adequate in protein without adding concentrated sources from nuts, seeds, coconuts, avocados, etc. Vetrano pointed out that the human body is equipped with organs to digest concentrated protein foods like nuts and seeds, so sufficient quantities of these foods belong in the natural diet of humans. Contrary to fruitarian Michael Arnsteins's opinion, most nuts and seeds including pecans, pistachios, almonds, filberts, cashews, coconut, etc. are naturally delicious to our species! In a recent interview, Arnstein admitted that more dietary fat is probably needed.

Graham claimed to have coined the term "caloronutrient" to describe his 80/10/10 nutrient ratio. Dr. T. Colin Campbell also identified the ratio of nutrients in an ideal plant-based diet as 80% carbohydrate, 10% protein, and 10% fat by calorie, however, he is not referring to a raw fruitarian diet. Campbell's version of a plant-based diet includes cooked grains, starchy vegetables, and legumes which easily push the protein percentage of calories to 10% or more. But Campbell admits that 5-6% protein is really all that is required by most people, which is provided on a raw fruitarian diet that maintains weight.

Campbell also says that health problems begin when the total calories from fat plus protein exceeds 20%, but he was referring to a conventional diet. His comments imply that the percentage of fat on a raw fruitarian maintenance diet can safely provide at least 14% to 15% of calories or more. On the other hand, proponents of a diet of 30 bananas a day and other raw fruit diets that provide only 5% calories from fat have demonstrated that living on such a low amount of fat is unsustainable, and they have reverted to eating cooked foods "after 4:00 pm."

Dietary Phosphorus

Fruit also has variable amounts of phosphorus and calcium. Excessive intake of some types of fruit high in phosphorus per calorie, similar to other carbohydrates like grains and legumes, can provide too much phosphorus to the body, which disturbs calcium metabolism and causes bone disorders and soft tissue calcification. In chemistry, phosphorus is more than twice as electronegative as calcium, which means phosphorus attracts and controls chemical reactions with calcium, forming a serum calcium phosphate product, Ca(HPO4)2. Shelton wrote, "phosphorus is as essential as calcium to the bones and the latter is usable in proportion to the amount of the former." If serum phosphorus levels rise too high, free calcium in the serum is removed to form excessive amounts of calcium phosphate product which may be deposited in soft tissue such as in the lining of arteries. As serum levels of free calcium fall, parathyroid hormone reacts within seconds to restore calcium levels by releasing calcium from bone. Because dietary phosphorus is absorbed into the blood quicker than calcium, any extra dietary calcium that was consumed is eliminated once normal calcium levels have been restored from bone loss or resorption.

A healthy diet supplies a calcium: phosphorus weight ratio of at least 1.3 mg calcium to 1 mg phosphorus (or a 1:1 molar ratio, i.e., each molecule of calcium weighs 30% more than each molecule of phosphorus that bonds with calcium). In Superior Nutrition, Shelton wrote, "Most fruits are deficient in calcium, most green leaves contain an abundance of calcium. Nobody lives on fruit alone, so the calcium deficiency of fruits is supplemented by the calcium richness of green leaves."

Shelton also wrote in Orthotrophy, "Green leaves are indispensable to the biologic diet. Fruits will not take their places." However, even eating very large amounts of green vegetables to supply calcium does not eliminate the bone-loss damage from excess phosphorus. The best solution is to keep phosphorus intake under control with a balanced diet. The Recommended Dietary Allowance (RDA) for phosphorus set by the Institute of Medicine is 700 mg a day for adults, which is the amount needed to maintain normal serum phosphorus levels in the fasting state. The RDA for calcium is 1,000-1,200 mg, which provides a calcium: phosphorus ratio of about 1.4-1.7:1. The National Kidney Foundation recommends 800-1000 mg phosphorus a day for Stage 1 kidney disease patients, and other authorities set the phosphorus requirement at between 10 mg/kg body weight, for Stage 4 kidney disease, to 12.6 mg/kg body weight. For more information on phosphorus and bone health, see: Cows Don't Drink Milk: Unraveling the Calicum Paradox.

If careful attention is not given to select fruits low in phosphorus per calorie on a low-fat fruitarian diet, problems can quickly develop as phosphorus levels rise. For example, a 2500-calorie diet made up of equal calories from peaches, nectarines, strawberries, grapes, and kiwis provides 1265 mg of phosphorus, which is 80% above the recommended amount and well within the high-phosphorus range. A 1800-calorie diet of tomatoes provides an astounding 2700 mg phosphorus! On the other hand a 2500-calorie diet of low-phosphorus fruit like apples provides only 529 mg of phosphorus, although it is low in calcium at only 289 mg. These foods should not be eaten in excessive amounts and need to be properly balanced with raw leafy green vegetables. 

But isn't fruit an alkaline-forming food? Nutritional concepts such as Potential Renal Acid Load (PRAL) are used to sum and compare the amount of alkaline-forming minerals and acid-forming minerals in a food to determine which type of element predominates. The body has a great need for alkaline minerals, which the conventional diet does not provide. Unfortunately, even though fruit is predominately composed of alkaline-forming elements, the formula for PRAL ignores the independent relationship between calcium and phosphorus. For this reason, Shelton warned of classifying almonds as an alkaline food. He pointed out that almonds contain very high amounts of phosphorus, an acid-forming element. The alkaline elements like potassium, sodium, and magnesium do not balance out disturbances in calcium and bone metabolism caused by high phosphorus levels with a relatively low ratio of calcium to phosphorus. On the other hand, dairy products have a good calcium to phosphorus ratio, but because they contain so much acid-forming sulfur, nitrogen from protein, as well as phosphorus, they have an overall acidic effect in the body, producing excessive amounts of sulfuric acid, nitric acid, and phosphoric acid. Fed daily in large amounts, dairy products may be suitable for rapidly growing calves, but not for humans, young or old. Cow milk contains 300% more acid-forming protein than human milk.

Shelton quoted Harvard dental researcher Percy R. Howe, "the body calls on the bones for calcium when it is needed in the blood." As previously mentioned, when serum phosphorus levels rise, parathyroid hormone releases calcium from bone into the blood, even if the food eaten already contains much calcium. To prevent bone loss, it is important to limit the total amount of acid-forming minerals ingested. Howe further said "the blood gives calcium back when there is an abundance of this element." To restore bone's mineral content, obtain a good calcium to phosphorus ratio in the diet by consuming fruit that is low in phosphorus, per calorie and per gram, and consume an abundance of high-calcium green vegetables along with a balanced amount of carbohydrates, fat, and protein.

The typical vegan diet contains more than twice the RDI for phosphorus, and it may be possible that dietary phosphate toxicity from consuming excessive amounts of legumes, grains, nuts, and other high-phosphorus foods contributed to Steve Jobs' cancer. For information on phosphorus and cancer, and for a list of natural foods lowest in phosphorus per calorie, see Prevent Chronic Disease with A Phosphorus-Restricted Raw Vegan Diet

T. C. Fry claimed there was no need to be concerned about replacing the calcium lost from bone each day because the body recycled the lost calcium and returned it to bone. Although some calcium is normally reabsorbed in the kidney, excess plasma calcium levels are excreted in the urine. Fry's advice is ridiculous and dangerous, and he appeared to have a spinal kyphosis indicating that he suffered from severe osteoporosis. The claim that "you can't help but get enough calcium" from eating natural plant-based foods is equally false and dangerous. Although it is true that countries with high calcium intake have more osteoporosis, this is because more phosphorus and protein is also consumed. But among nations with lower rates of osteoporosis from eating more plant-based foods, higher calcium consumption is associated with lower fracture rates!

In Doug Graham's book that recommends a low-fat fruit diet, calculating nutrients in Autumn Menu Plan: Day One (p. 190) shows a phosphorus level over 1,000 mg and low calcium: phosphorus ratio of 0.69:1. This plan could be improved by reducing calories from fruit and adding calories from low-phosphorus high-fat plant-based foods. Weston Price hypothesized that there was a mysterious X factor in butter and other high-fat animal-based foods in the diet of healthy people. Although this has been identified as vitamin K (found abundantly in green vegetables), it also seems likely that health improvements resulted from a better balance of nutrients, including balanced levels of phosphorus, glucose, fat, and calcium. For more information on the nutritional value of high-fat coconuts, see: Bananas, Coconuts, and Green Smoothies: Nature's Perfect Foods. Is fear of dietary saturated fat causing you to eat an unhealthy, unbalanced diet? See Is the Lipid Theory Dead? 

One factor that may have misled T. C. Fry into disregarding his protein requirements was his unsuccessful attempt to regularly consume a protein meal of 4 ounces of nuts with a large green salad daily, as was recommended by Shelton and the American Natural Hygiene Society. This recommendation was based on the food-combining rule to separate protein and starch meals, but the rule doesn't apply on a starch-free raw diet. Fry complained that so many nuts at one meal upset his system, which is understandable considering that a meal of 4 ounces of almonds with a green salad provides about 637 mg of phosphorus—almost a full day's recommended intake at one time, not including the phosphorus from the remainder of the diet. 

By contrast, a 4-ounce serving of beef contains only 160 mg of phosphorus, which is equivalent to only about one ounce of high-phosphorus nuts like cashews. The drawback of meat, however, is that it provides a high density of phosphorus per calorie, which makes it more difficult to limit overall daily phosphorus intake while consuming sufficient calories to meet energy needs. Although many types of nuts match the protein content of meat ounce per ounce while providing more calories to meet energy needs, it is a serious mistake to ignore the exceedingly high absolute amount of phosphorus in these nuts. Feeding so many nuts in a misguided attempt to match the unhealthy high-protein standard of animal-based foods floods the body with too much phosphorus and has done more harm than good. The majority of dietary protein should come from fruits (TABLE 1.) and vegetables.

This does not mean that there aren't times when more nuts are required, as when recovering from a fast and when calorie intake is low, as previously mentioned. Nevertheless, limiting nut intake to just an ounce or two at a meal reduces the phosphorus load in the blood and is less likely to elevate serum phosphorus levels. One or two ounces is just the right amount of nuts to blend into a salad dressing or add to a smoothie. 

In addition, it is important to control your dietary phosphorus intake throughout the day to avoid overly increasing the phosphorus load in your blood. For example, if phosphorus intake is low during most of the day, especially if one is fasting or eating extremely lightly as T. C. Fry often did, the body maintains normal serum phosphorus levels by reabsorbing more of it in the kidneys. Later on, if one breaks the fast and suddenly eats a very large amount of nuts at one meal, additional phosphorus and nitrogen enters the blood before the body has had time to readjust and lower phosphorus re-absorption in the kidneys, thus flooding  blood, liver, bones, intestines, and kidneys with too much acid. Eating meals too close together could also overload your blood with too much phosphorus.

Virginia Vetrano noted how T. C. Fry eventually made the error of avoiding nuts altogether, saying to him, "Sure you can stay off nuts, but look what it makes you do: overeat on sweet, dried fruit!" In response to Fry's death related to protein-energy malnutrition, Vetrano acknowledged that many people have experienced problems consuming large quantities of nuts as recommended by her mentor, Herbert Shelton and the American Natural Hygiene Society. Now in her eighties, Vetrano has had two hip replacements which could be related to her high-phosphorus "Hygienic diet." In later life, Shelton was severely stooped over, had difficulty walking, had lost all his teeth, and eventually became bedridden and unable to carry out normal life functions. Although he appeared to have signs of Parkinson's disease, perhaps related to his dairy intake (which may cause an autoimmune response in the brain) and having been kicked in the head by a stallion, Shelton's illness was never diagnosed. Nevertheless, most of Shelton's debilitating conditions are similar to those seen in very severe and often fatal cases of osteoporosis. An analysis of a menu plan provided by Shelton shows a very low calcium to phosphorus ratio of 0.34: 1, which is even worse than the 0.5:1 ratio in the conventional Western diet! A young beauty contest winner representing Natural Hygiene died from severe osteoporosis. Vetrano now recommends feeding smaller quantities of nuts, starting at half an ounce and increasing by half-ounce increments until a proper amount of nuts is reached to maintain weight and health. Joy Gross, another popular Natural Hygiene author who is now in her eighties, disclosed that she developed cervical cancer, which may also be related to a high phosphorus intake.

Vetrano suggests soaking nuts to improve their digestion. Phytates, a water soluble form of phosphate stored in plant-based foods like nuts, seeds, and grain, disturb mineral bioavailability, but phytates may be reduced by soaking and discarding the liquid, according to Bioavailability of iron, zinc, phytate and phytase activity during soaking and germination of white sorghum varieties, by Afify et al., 2011. In Superior Nutrition, Shelton says, "The skin covering the kernels of some of our best nuts are poisonous to man, and must be removed before the nut is eaten. So far as is known, these nut skins are not fatal to man, but they are best removed." Shelton recommends blanching the skins of nuts for a few minutes in very hot water to wipe off the skins, although soaking nuts between 12 and 24 hours at room temperature is also recommended. The brown skin on coconut can be peeled away with a vegetable peeler, or grated off with a cheese grater. 

Doug Graham claims mature coconut meat is "almost impossible to digest," but the medium chain triglycerides in coconut are easily digested. In addition, the mature coconut seed, which we refer to as the common coconut, sprouts when soaked with water, changing the enzyme content of the meat and forming a spongy sweet coconut apple.  As in the germination of other soaked nuts and seeds, soaking and rinsing mature coconut meat may reduce any anti-nutrients that may be present to protect the seed, thus making the meat more digestible.  Research that found little mineral-binding effect of phytate in coconut had studied heat treated coconut flour instead of raw coconut meat. Heat treating and roasting nuts is sufficient to break down phytate, but heat treating also destroys enzymes and produces harmful oxidation in the fat.  Also, even though the coconut seed contains water inside, this is not sufficient to rinse away any phytates that may form. In a study by Macfarlane et al., Inhibitory effect of nuts on iron absoprtion, the amount of phytate in 100 g of coconut was listed as 357 mg. 

Although author Bruce Fife claims phytates in coconut are harmless, I have experienced a heavy feeling in my stomach when eating raw mature coconut meat, but I experienced no unpleasant symptoms when the coconut meat was soaked and rinsed. Until more research is conducted in this area, it may be prudent to soak and rinse raw mature coconut meat like other germinating nuts. By contrast, young coconut jelly and water from an immature seed may not have developed the same protective anti-nutrients as in the mature seed. Blending dry mature nuts with water and discarding the watery bottom as the fat rises to the top is another way to quickly remove the water soluble phytic acid.

There are additional concerns associated with phytates other than their mineral-binding or chelating effects. Like bisphosphate drugs used to treat osteoporosis, phytates inhibit the genesis of osteoclasts in bone which are cells that normally break down old bone tissue. Thus, phytates temporarily increase bone mineral density as old bone tissue is retained, but the failure to remodel bone with new tissue eventually undermines bone architecture and results in more serious problems like fractures. Other "medicinal" effects of phytates should be considered with suspicion as all medicines are poisons that cause adverse effects.

Graham says truly raw nuts are naturally high in water content, but this is so only when the nuts germinate. Fruitarian author Johnny Lovewisdom described how prior fruitarians had experienced adverse effects eating nuts "due to the lack of the life-giving living water in nuts." Ideally, our ancestors foraged for nuts by gathering them a few days after the nuts fell naturally to the damp ground and had already begun to germinate. In this state, the nuts contained more water and fewer anti-nutrients. However, modern commercial agricultural methods harvest nuts like macadamias, walnuts, pistachios, and almonds directly from the tree and dry them, thus retaining and concentrating their anti-nutrients. In The Life Science Health System, T. C. Fry mentions soaking grains, dried fruit, legumes, and sunflower seeds, but he never mentions the need to soak and germinate tree nuts. Neither did the Natural Hygiene Society ever mention soaking nuts. This may account for the heavy uncomfortable feeling in T. C. Fry's stomach that he and many others have complained about when consuming unsoaked nuts which contain phytates. 

Vetrano attributes the improved digestion of soaked nuts to "making them crispy and less dry," but she dismisses the effect of "protease inhibitors." Had she investigated the science of germination further, as did Sally Fallon in Nourishing Traditions and Dr. Edward Howell in Enzyme Nutrition, Vetrano may have been able to offer T.C. Fry a better solution to nut consumption which might have saved his life. In my own experience recovering after a fast, the nuts I consumed were mainly blanched almonds and unsoaked "raw" cashews, both nuts which were heat treated, and I experienced none of the digestive problems associated with phytates. 

A 2013 study in The New England Journal of Medicine titled Association of nut consumption with total and cause-specific mortality found that as little as a daily one-ounce serving of nuts independently reduced overall death as well as death specifically from respiratory disease, heart disease, and cancer. The cardioprotective ability of nuts and seeds to reduce the risk of heart disease in a dose-dependent manner is so well established by scientific research that a 2014 Harvard meta-analysis estimated almost 2.5 million deaths occurred around the globe in 2010 due to low intake of nuts and seeds in the diet (Consumption of nuts and legumes and risk of incident ischemic heart disease, stroke, and diabetes). This must come as a shock to practitioners who prescribe very low-fat diets with low intake of nuts and seeds. 

In The 80/10/10 Diet, Doug Graham allows only one ounce and sometimes half an ounce of nuts or seeds a day, sometimes skipping days altogether. Thus, along with other very low-fat diet advocates like Doctors Esselstyn, Barnard, Fuhrman, McDougall, and Ornish, Graham advocates a diet for heart disease patients that actually increases heart disease risk. In his summer menus, Graham allows a total of only two ounces of nuts a week! Avocados are another of Graham's fat scapegoats, and he recommends consuming the equivalent of just one medium avocado every three days! Yet, a 2014 study in the FASEB Journal, titled Avocado consumption decreases LDL particle number and small, dense LDL cholesterol in overweight and obese subjects, found that the cardioprotective effect of eating one whole avocado each day outperformed  both a diet with similar amounts of monounsaturated fat from oil, and a moderately low fat diet.

Graham attacks unbalanced vegan diets which supply 60-70% or more calories from fat while he and other advocates of very low-fat diets conveniently ignore or dismiss the proven benefits of the Mediterranean diet which supplies 40% or more of calories from healthy plant-based fats. Summing up over 50 years of research studies, Dalen and Devries (Diets to Prevent Coronary Heart Disease 1957-2013: What Have We Learned?) concluded that the Mediterranean diet has proven to be more effective in reducing mortality from heart disease than low-fat diets which only tamper with cholesterol levels. The American Heart Association released new guidelines in 2014 for the primary prevention of stroke in which they recommend a Mediterranean diet supplemented with nuts to lower stroke risk. By contrast, in The Life Science Health System, T. C. Fry wrote about living for months at a time without eating high-fat natural foods, implying that he purposely derived most of his calories from an unbalanced low-fat diet of sugary fruit which likely contributed to his death. Graham was obviously very influenced by T. C. Fry's approach, and the low-fat craze of the 1980s along with the problems associated with phytates and excess phosphorus from overconsuming commercially dried and ungerminated nuts and seeds only seemed to reinforce Graham's beliefs.

T. C. Fry also discouraged the need to eat vegetables; a belief and practice that was probably a leading factor that contributed to his anemic complications leading to his death. Fry wrote, “some vegetables can be added to the human diet with benefit, though their rich content of nutrients is really unneeded if we partake liberally of fresh raw fruits.” This is in direct contradiction to Shelton’s admonishment that fruits cannot take the place of green leafy vegetables. Fry further wrote, “many, if not most, vegetables have liabilities that make them less than ideal, even undesirable, as foods,” and, “Vegetables or plant fare as leaves, stalks, stems, grasses, etc. cannot comprise the mainstay of the human dietary because we cannot obtain our caloric needs from these types of foods. Few vegetables appeal to the palate as such anyway.” And finally, Fry wrote, “I find my desire for vegetables and nuts waning and my desire for fruits increasing with the years. I feel very comfortable after fruit meals whereas sometimes I feel a bit uncomfortable after vegetable meals. I sleep more and feel more sluggish when I’ve had a nut and vegetable meal. I don’t feel as alive, alert and zippy on mornings after vegetable and nut or avocado meals.”  

Had Fry eaten complete nutrient-balanced meals combining fruit and dark green leafy vegetables blended into green smoothies or dressings with small amounts of germinated nuts, seeds, or avocados, he probably would have experienced much more satisfying results. Nevertheless, Fry insisted that, “If one lives in a climate where the fruit and nut supply is abundant throughout the year, he should have no difficulty in providing himself with adequate nourishment without eating vegetables.” Here, Fry completely ignores the blood- and bone-building necessity of consuming green leafy vegetables that contain concentrated sources of chlorophyll, iron, folate, and a very high ratio of calcium to phosphorus, which are generally lacking in fruit. A molecule of chlorophyll is almost identical to a molecule of hemoglobin, except chlorophyll contains magnesium instead of iron. But Fry dismissed the nutritional need for chlorophyll, writing, "Chlorophyll is normally bitter and we’re turned off by bitter substances."  

In my opinion, the blood albumin deficiencies that Vetrano claimed caused Fry's death were signs of the deterioration of Fry's blood formation ability, which no amount of stuffing with protein from nuts could remedy. The gastritis that prevented Fry from producing intrinsic factor needed to prevent his anemia was also probably made worse by attempting to digest large portions of unbalanced "vegetable and nut or avocado meals." Vetrano misinterpreted T. C. Fry's laboratory values, specifically his albumin levels. Low albumin levels do not reflect a patient's protein status! In fact, a patient undergoing starvation will have normal albumin levels. According to Krause's Food and the Nutrition Care Process, serum levels of albumin, which are known as negative-acute-phase proteins, are lowered in response to acute illness. Protein-energy malnutrition was probably a result of, not the cause of, Fry's acute illness. In addition to a lack of essential fatty acids, his severe anemia was caused by lack of blood-building nutrients from avoiding dark green leafy vegetables, especially with no other secondary dietary sources of these nutrients from animal-based foods. This does not mean that humans must rely on animal-based foods for essential nutrients. Essential amino acids, organic mineral compounds, and vitamins are synthesized by plants, not animals. Just as animals obtain all the blood, bone, nerve, and muscle building nutrients they require from plants, so too can humans. But you have to actually eat the green leaves of plants!

Glycemic Control & Dietary Fat

Low-fat and very-low-fat diets continue to be popular in treating chronic diseases and obesity. Once fat is removed, most of the remaining energy supplied by these diets comes from carbohydrates, which supply up to 80% or more of calories, in contrast with the average diet that supplies energy from 40% or more calories from carbohydrates and 42% calories from fat. Research of Weston Price, although biased towards animal-based foods, demonstrated that populations that include a balanced distribution of calories from unprocessed dietary fat and unrefined carbohydrates have fewer dental caries. 

Researchers from Columbia University Medical Center demonstrated that bone breaks down to regulate high blood sugar levels. A 2010 article in e! Science News titled Breakdown of bone keeps blood sugar in check, new study finds explained how osteocalcin is released from bone, which stimulates the pancreas to release more insulin and lower serum glucose. This implies that  a person feasting on sugary fruit may appear to have normal blood sugar levels at the expense of bone loss. By contrast, a 1997 study titled Regulation of osteoclastic bone resorption by glucose published in Biochemical and Biophysical Research Communications found that fatty acids do not cause bone breakdown. 

These findings confirm David Wolfe's advice in The Sunfood Diet Success System that, "Too much sugar in the blood triggers the release of alkaline minerals, such as calcium, from the bones and tissues to buffer sugar's acidifying effects," and, "This condition is completely reversible through regular exercise, considerably decreasing the intake of sugary fruits, and by adding a large portion of dark green-leafy vegetables and a variety of raw plant fats to the diet." In other words, consume a balanced diet with more calories from fat and less from carbohydrates. He further notes that a diet high in acid-forming minerals like phosphorus and low in alkaline minerals like calcium damages teeth. Unfortunately, Wolfe's sample diet provides excessive amounts of fat at almost 60% of calories, and his diet's phosphorus levels are 45% higher than the RDA. Menus in the raw vegan diet book by dietitians Melina and Davis are also excessively high in phosphorus.

Graham claims that the generally low glycemic index (GI) of fresh whole fruit is proof that large amounts of carbohydrates from fruit have little effect on one's overall blood glucose response. However, in their webpage titled Glycemic Index and Diabetes, the American Diabetes Association refers to research showing that "the total amount of carbohydrate in food, in general, is a stronger predictor of blood glucose response that the GI." In addition to the glycemic index, glycemic load is calculated by multiplying the amount of carbohydrate consumed in one standard serving of food by the food’s glycemic index, and it is a much more useful tool for glycemic control. Although Graham points out that the glycemic load in one serving of fruit is lower than in one serving of foods high in starch, he fails to consider the glycemic effect of the number of servings consumed in large portion sizes. Excessively large portions of fruit quickly add up to a very high overall glycemic load which stresses the body and stimulates the skeletal system to control blood sugar levels. 

Supporting the 2010 findings from Columbia University Medical Center researchers, Karsenty and Ferron, in a 2012 article in Nature titled The contribution of bone to whole-organism physiology, described how osteoclast cells in bone are signaled by osteoblast cells when insulin is lacking to absorb glucose. Osteoclasts break down bone, lowering tissue pH which releases osteocalcin stored in the bone matrix. Osteocalcin then loops back to signal the pancreas to release more insulin for use by osteoblasts to absorb additional glucose. This confirms that bone loss is a necessary step in the body's response to lower excessive blood glucose levels. Catalfamo et al., in a 2014 article in Oral Diseases titled Hyperglycemia induced and intrinsic alteration in type 2 diabetes-derived osteoclast function, confirmed that hyperglycemia increases osteoclast function which leads to bone loss. Shivaswamy and Larsen, in a 2011 article in the Journal of Diabetes & Metabolism titled Diabetes, bone density and fractures, noted that hyperglycemia in diabetes is associated with bone loss and increased risk for fracture.

In contrast to excessive fruit intake, a 2008 article by O'Keefe et al. (Dietary Strategies for Improving Post-Prandial Glucose, Lipids, Inflammation, and Cardiovascular Health) states that  higher fat intake from healthy natural sources like nuts blunts spikes in blood glucose levels. In a 2011 study, Nuts as a Replacement for Carbohydrates in the Diabetic Diet, Jenkins reported that "Two ounces of nuts daily as a replacement for carbohydrate foods improved both glycemic control and serum lipids in type 2 diabetes." According to Dietary fat, insulin sensitivity and the metabolic syndrome by Riccardi et al., monounsaturated fat found in nuts and avocados stimulates insulin sensitivity and actually lowers blood glucose levels. Although pregnant women with pre-existing or gestational diabetes are not advised to lose weight to reduce diabetes, they benefit from consuming as much as 30-40% calories from fat to help control blood glucose levels, according to guidelines published in 2010 by the Joslin Diabetes Center. 

These findings contradict claims by low-fat fruitarians that dietary fat increases blood sugar levels. Fat only raises blood sugar in association with excessive fatty acid and calorie intake that leads to overweight, obesity, and diabetes. This produces a pathological condition called lipotoxicity or ectopic fat storage, in which fat storage overspills into non-adipose cells of the liver, heart, kidney, pancreas, muscles, and blood vessels, damaging the cells (Antic et al., 2004, Ectopic fat stores: Housekeepers that can overspill into weapons of lean body mass destruction). The truth behind the omega-3 fat craze is that when these fatty acids are consumed in large doses, such as in fish oil supplements, they harm the body by interfering with and suppressing the defensive and healing function of the inflammatory response, similar to the effect of aspirin.

Fruitarians who attempt to replace carbohydrates from starches with an equal amount of carbohydrates from fruit should remember that starch is often eaten with fat such as oil, cream, and butter with potatoes, corn, bread, cereal, rice, pasta, etc., which helps control glucose levels. In fact, it seems almost impossible to eat starches without fat. This helps explain why starch-based very low-fat vegetarian diets to reverse heart disease have not caught on with the general public. On the other hand, fruitarians can easily eat all the carbohydrates they want in fruit without any added fat, but the drawback is that fruitarians are more susceptible to neglect eating adequate amounts of fat to help control glucose levels. Avocados, nuts, as well as greens added to the raw diet are free from harmful thermal oxidation, they contribute healthy amounts of omega-3 fatty acids, and mature coconut meat provides medium chain triglycerides for easily digested energy.

The above information does not mean a diet high in natural raw fruit always leads to high blood sugar problems, as long as the diet is properly balanced in fat and calories. It is only when sugar from fruit intake is excessive for active energy needs that a problem develops. This explains why active athletes do better with a higher percentage of carbohydrates in their diet. Within reasonable limits, the extra sugar athletes consume is not excessive of the body's energy needs as long as it is burned in high-intensity activity. Extra calories provided from carbohydrates lowers the athlete's percentage of calories from fat, but the absolute amount of fat needed for resting and low-intensity activities remains the same. For example, if an active athlete burns 5,000 calories a day, eating 10% calories from fat provides 500 calories or about 56 grams of fat. However, the same amount of calories from fat doubles to 20% of the diet if the athlete takes a day off to rest and burns only 2,500 calories. Arbitrarily assuming a person needs a daily fixed percentage of calories from fat and carbohydrates, as in the 80/10/10 Diet, is wrong! The percentage of calories needed from fat and carbohydrates can fluctuate enormously depending on daily active energy needs.

The American College of Sports Medicine recommends consuming 30-60 grams of carbohydrates (2-4 servings) for each hour of exercise, depending on exercise intensity level. When consuming 800 grams of carbohydrates from eating 30 bananas a day, about 300 grams will be burned off during normal resting and low-intensity daily activities, based on 60% of calories from carbohydrates on a 2000-calorie diet. This leaves an additional 500 grams of carbohydrates to burn off at the rate of 60 grams per hour for more than eight hours of high-intensity exercise. Few if any athletes can sustain this amount of high-intensity exercise on a daily basis. Normal blood test readings do not indicate the bone loss that occurs when the body's compensatory mechanisms are forced to lower excessive blood glucose levels. The conclusion is that 30 bananas a day provides a high amount of glucose that is excessive and harmful for most people, even for many endurance athletes. Although the menus in Graham's book do not contain 800 grams of carbohydrates, some menus contain over 500 grams of carbohydrates for approximately 2,000 calories or less, which is proportional to 800 grams of carbohydrates at 3,200 calories.

In an article by Parks and  Hellerstein titled Carbohydrate-induced hypertriacylglycerolemia: historical perspective and review of biological mechanisms, published 2000 in The American Journal of Clinical Nutrition, 71, 412-433, the researchers write: "Current trends in health promotion emphasize the importance of reducing dietary fat intake. However, as dietary fat is reduced, the dietary carbohydrate content typically rises and the desired reduction in plasma cholesterol concentrations is frequently accompanied by an elevation of plasma triacylglycerol." The researchers also note, "Decreasing fat without increasing carbohydrate (i.e., replacing dietary fat with protein) does not appear to elevate triacylglycerol. This suggests that it is the addition of carbohydrate, not the removal of fat, that is associated with HPTG [hypertriaclglycerolemia]." In other words, if you replace calories from fat with excess calories from fruit carbohydrates, those excess fruit carbohydrates are just changed to fat! Triglycerides are the primary source of stored energy in the body, which are burned off between meals to keep you energized throughout the day and to maintain your metabolism overnight. 

On the other hand, if you replace calories from fruit with excess calories from fat and protein, as in low-carb diets, those excess fat (triglyceride) and protein calories are just changed back to glucose through gluconeogenesis, and fatty acids are converted to ketones to provide energy when glucose is lacking. In other words, the body, through action of organs like the liver, automatically converts all ingested nutrients to the right mix of glucose, fatty acids, and triglycerides for circulation in the blood and lymphatic systems—we do not need to micromanage this process by tampering with our diet. Instead, we just need to focus on ingesting sufficient amounts of energy (calories) and nutrients to maintain a healthy weight.

In their book, Low-Fat Lies, Kevin Vigilante, M.D., and Mary Flynn, Ph.D warned of "the rising tide of triglycerides that is frequently triggered when a diet drops below 25 percent of calories from fat." However, a high triglyceride level is associated with cardiovascular disease only when it occurs along with at least two other disorders that form the metabolic syndrome, which include hypertension, elevated serum cholesterol levels, glucose resistance, and obesity. Therefore, it is a mistake to assume that an elevated triglyceride level by itself without at least two other signs of metabolic syndrome in a healthy, fit person eating a low-fat diet carry's the same risk of disease. It's more likely that the elevated levels are due to the liver manufacturing and distributing triglycerides from excess carbohydrates to compensate for the low fat intake. Low-fat diets are also associated with depression and suicide, lowered HDL levels (the good cholesterol), and inadequate absorption of vitamins A, D, E, and K. However, these problems are more likely to occur when the overall calorie intake is insufficient. 

Let's review: Proponents of 5%-fat raw fruitarian diets have not been able to sustain themselves without adding cooked food (often containing oils and other fats), Vetrano claims 10% fat on a raw diet is insufficient, Campbell implies that it may be safe to eat as much as 15% fat, apes voluntarily choose to eat 20% fat, and triglyceride levels rise as the body is forced to compensate for an excess of glucose when fat falls below 25%. Nutrition experts label 25% of calories from fat a moderately low-fat diet. Adults may safely increase fat intake to 30-40% of calories from healthy sources, as in the Mediterranean Diet. Vetrano approves of this higher amount of fat, citing Guyton's Textbook of Medical Physiology. On the other hand, Campbell does not even list the Mediterranean Diet in the indices of his popular books, The China Study and Whole, a stunning tacit admission of his low-fat bias! According to Davis and Melina, the average raw vegan diet contains 36% of calories from fat, which they claim is the same as in the average Western diet. 

In addition, the United States Department of Agriculture's Dietary Guidelines for Americans 2010 suggests that less than 20% fat increases the risk for inadequate intake of vitamin E and essential fatty acids, and 20% to 35% is recommended. This is equivalent to the Institute of Medicine's Acceptable Macronutrient Distribution Range (AMDR) for fat. However, the World Health Organization recommends from 15% fat up to 35% for very active people (Graham neglects to mention this upper limit in his book). Physician Joel Furhman found dangerously low serum levels of essential fatty acids in vegan patients, a condition which may have contributed significantly to T. C. Fry's death.

Unlike Western diets, the traditional Asian plant-based diets of Japan and China provide around 15% calories from fat, but they also provide 15% calories from protein due to their large amount of grains and legumes, thus leaving no more than 70% calories from carbohydrate. Nowhere in the world do people eat a diet with the high amount of 80% calories from carbohydrates that Graham and Campbell recommend! These authors with no professional credentials in dietetics need to rethink the application of their high-carbohydrate theory, or should I say their high-carbohydrate myth? Furthermore, unlike easily digested and absorbed carbohydrates from fruit, the more starch in the diet, the more calories are required to convert starch to energy. In addition, a large portion of starch in the traditional Asian diet is insoluble plant fiber that provides very little if any digestible energy, which explains why one may "eat more and weigh less" on this diet. Even a world-class biochemical researcher like Campbell is not above using this trite marketing slogan in place of scientific evidence to promote the traditional Asian diet. Yes, you will have less heart disease eating the traditional Asian diet, but that has little to do with the diet's fat and carbohydrate content and more to do with lower amounts of cholesterol oxidation products and lipid oxidation products from fewer thermally treated (cooked) animal-based foods.

Provided from whole plant-based sources like nuts and avocados, 30% calories from fat is sufficient to increase insulin sensitivity, prevent hyperglycemia and related bone disorders due to excessive carbohydrate absorption, and satisfy one's appetite while improving fat-soluble vitamin absorption. Thirty percent fat is also consistent with the Natural Hygiene recommendation of four ounces of nuts a day from the lower phosphorus nuts when combined with a sufficient amount of carbohydrates and total calories to meet energy needs. See Sample Menu below. 

Vetrano pointed out that eating an adequate amount of fat avoids health problems related to excessive intake of fruit acid and sugar. Shelton described how excessive absorption of carbohydrates is related to catarrh or excessive buildup of mucous in the upper respiratory tract. In an article titled The Sleep-Diabetes Connection: Not sleeping? Check your blood sugar levels, Web MD reports that high blood sugar levels are associated with sleep disturbances, including the need for more frequent urination at night as the kidneys attempt to reduce serum glucose levels. The liver normally releases glucose throughout the night to raise blood glucose levels, so there is no need to eat extra carbohydrates in the evening, despite sleep-inducing claims about tryptophan in carbohydrates. In addition to eating enough fat to help avoid blood sugar spikes, eating a sufficient amount of nuts also adds just enough insoluble fiber to a diet of fruits and green leafy vegetables to facilitate normal bowel elimination while lowering intra-luminal pressure to maintain intestinal and colon health. Sufficient protein from nuts is also necessary to maintain serum albumin levels that prevent fluid swelling in the peripheral limbs and that maintain normal hormonal levels with normal hair, enamel, and nail growth.


So, what are the rules for eating a healthy fruitarian diet? It all depends on what you eat.

  1. Eat as much fresh raw ripe fruit as you need for energy, but there is no evidence to support eating more than 65-70% calories from carbohydrates, especially from fruit sugar. If you eat 5-10% calories from protein, that leaves 20-30% calories from raw plant fat to fully meet your calorie allowance (See: The Body Fat Guide). A sufficient amount of healthy fat helps avoid excessive glucose intake that raises triglycerides and harms bone. If you are an athlete, increase your calorie intake by adding carbohydrates for active energy use, which lowers your percentage of calories from fat, although the absolute amount of dietary fat remains the same to meet resting energy needs. 
  2. Eat sufficient amounts of protein and calories for your weight on a raw diet, with no more than about 0.6-0.8 grams/kilogram bodyweight or less. Do not be misled by low calorie percentages of protein in food! Add more grams of raw plant protein from nuts and seeds when your overall calorie intake is low, as when dieting to lose weight (See: The Body Fat Guide). On the other hand, do not make the mistake of eating too many nuts to match the high-protein content of animal-based foods.
  3. Adults should reduce their phosphorus intake to approach the RDA of 700 mg/day, or about 10-12.6 mg phosphorus/kilogram body weight. I find that a mid-range of 11.4 mg phosphorus/kg body weight is acceptable for an adult who requires a sufficient amount of protein and fat from natural whole food sources to increase healthy lean body weight. This is the approximate amount of phosphorus prescribed for patients with mild chronic kidney disease, at around 800-1000 mg phosphorus/day. The average adult male, vegetarian and omnivorous, consumes almost twice this amount of phosphorus. Select mostly fruits and nuts that are lowest in phosphorus per calorie, like apples, pears, pineapple, macadamias, coconut, etc. However, be aware that the absolute amount of phosphorus in macadamias, coconut, and avocados quickly adds up if you overeat these foods. Oils provide calories without phosphorus, but oils lack fiber and other nutrients, and these should be avoided as empty-calorie foods. The body functions best when the proper ratio of calcium and phosphorus in your meals and in your blood remains consistent throughout the day. Avoid large differences in phosphorus intake at meals which can cause the phosphorus load in your blood to build up, even if you remain within your daily phosphorus allowance. See Prevent Chronic Disease with A Phosphorus-Restricted Raw Vegan Diet.
  4. Eat sufficient quantities of leafy green vegetables to help keep your dietary calcium: phosphorus ratio at between 1.4-1.7:1. Some authorities recommend a 2:1 ratio with as much as 1500 mg of calcium. The best greens in salads and smoothies are the darker, low-oxalate leaves of radishes, bok choy, kale, collards, arugula, etc. These foods are the best sources of alkaline minerals needed for healthy bone, teeth, nerves, and blood. Do not repeat T. C. Fry's fatal error: fruits cannot replace green leafy vegetables!

    Vetrano's main argument is that if you attempt to lose weight over long periods of time by eating mostly sugary fruit, your diet will lack protein. I would emphasize that if you attempt to sustain your normal body weight by eating calories mostly from sugary fruit, even if  your protein intake is adequate and your activity level is high, your diet will provide excessive and harmful amounts of glucose and fruit acid. In both cases, the very low-fat fruitarian diet (10% calories from fat) fails to provide an adequate nutrient balance, whether for losing weight or for maintaining weight on an active lifestyle. Strive to eat a balanced amount of fat, carbohydrates, protein, calcium, and phosphorus throughout the day to help maintain normal serum levels. Eating a properly balanced fruitarian diet is easy, healthy, and enjoyable provided you assemble your nutrients in the correct proportion for fat, protein, carbs, calories, and micronutrients to meet your needs. Use or to help monitor your dietary intake.

Sample Menu

The menu in Table 2. provides 2,000 kcal, 30% calories from fat, 6% calories from protein, and 64% calories from carbohydrates, with a 1.7:1 calcium phosphorus ratio. Add water to desired thickness for smoothies, dressings, and soups, or chop dry ingredients into salads. You can also create smoothie bowls by combining blended and chopped ingredients, or eat whole fruits, avocados, and nuts on the side. Grinding fruits and raw dark leafy greens in a food processor and adding small amounts of nut or avocado dressings makes novel slaws that substitute for lettuce-based salads. Today's romaine lettuce and other popular fruits and vegetables cultivated with high amounts of phosphate fertilizers have low calcium-phosphorus ratios, and are insufficient by themselves to raise the calcium-phosphorus ratio in a vegan diet to healthy levels.

Table 2. Menu
Breakfast Smoothie
Pineapple 150g 
Arugula 125g
Avocado 90 g
Apple 250 g
Honeydew 125 g
Orange 150 g
Lunch Soup 
Coconut 60 g
Kale 125 g
Date 35 g
Banana 250 g
Afternoon Smoothie
Pear 250 g
Orange 200 g
Avocado 90 g
Grapefruit 250 g
Dinner Soup 
Macadamia 26 g
Collards 125 g
Blueberries 70 g
Grapes 100 g
Papaya 200 g

Food Combining & Portion Sizing

The old mono-meal feeding plan helps avoid wrong food combinations of concentrated protein and starch, but as has been pointed out, eating large mono meals of high-phosphorus and high-protein nuts, high-sugar fruit, or high-acid fruit can present other health challenges by overloading the system with concentrated levels of single nutrients or acid. The above menu demonstrates an alternative plan that combines small amounts of these foods at meals in proper portion sizes throughout the day without interfering with digestion or overloading the system with any one nutrient or acid. Human breastfed infants don't take all their protein at one feeding, or all their carbohydrates and fat at another feeding. Nature combines the proper portions of all these nutrients in one balanced liquid meal. This combination works well because human milk is relatively low in protein (one gram of protein per 100 gram serving) and contains no starch—its carbohydrate content is galactose, a disaccharide formed from the sugars lactose and glucose, thus eliminating problematic digestive combinations of starch and protein. Likewise, based on the nutrient content of human milk, we can use food combinations and portion sizing to balance the nutrients in low-protein starch-free raw fruitarian meals. This allows us to receive a full complement of balanced nutrients consistently at each meal, and it also allows us to efficiently combine any non-starchy raw fruit, nut, or vegetable together. Because only 1% of the weight of breast milk is protein, our meals, including added water, should contain a concentration of no more than 1% protein by weight.

Avocados contain twice the concentration of essential amino acids provided in human milk, and in Food Combining Made Easy, Shelton classifies avocados as a high-protein food. One large avocado (200 grams or about 7 ounces) has four grams of protein. By the way, if you subtract the water weight of the avocado, the water weight of the mature coconut, and the water weight of macadamia nuts, these foods contain very similar amounts of protein by dry weight per gram (0.07, 0.06, and 0.08 grams, respectively). Shelton recommends eating avocados with green vegetables and also with acid fruit because of avocados' high fat content. In addition, Shelton allows feeding melon with fresh fruit. Shelton also classifies coconut as a "starchy" low-protein nut, although an analysis of coconut shows its carbohydrate content is actually all sugar with no starch. Concentrated sweet fruit like bananas, raisins, figs, dates, sweet grapes, and persimmons inhibit gastric secretion and motility during protein digestion, and Shelton says these foods should never be combined with foods high in protein like whole large avocados or large servings of nuts (4 ounces), "despite the delightful flavor of the mixture." 

However, when combining fruit, nuts, and vegetables into meals, smoothies, or dressings, we can use portion sizing to lower the protein concentration to no higher than that of human milk, thereby avoiding problems digesting high amounts of protein combined with sugar. For example, 30 grams of coconut (about 1 ounce) contains one gram of protein, as does 13 grams of macadamia nuts (about half an ounce), and 51 grams of avocado (about 1.5 ounces or one quarter of a large avocado). Therefore, for every 30 grams of coconut, blend 70 grams of water to make 100 grams of low-protein coconut milk, blend 13 grams of macadamia nuts with 87 grams of water to make 100-gram servings of low-protein macadamia nut milk, and blend 51 grams of avocado with  49 grams of water to make 100-gram servings of low-protein avocado milk. These blended milks each contain one gram of protein per 100-gram serving, or 1% protein by weight, the same as human milk. Fruits and vegetables that contain less than one gram of protein per 100-gram serving can be combined with these milks, thus further reducing the meal's protein concentration.

Putting this into practice, I find that an apple and a small amount of honeydew combined with acid fruit in the Breakfast Smoothie helps dilute the fruit acidity and adds sweetness when mixed with low-protein avocado milk. I find that low-protein coconut milk made from soaked and rinsed coconut digests well with non-acidic sweet fruit like bananas and dates, along with green vegetables in the Lunch Soup. Coconut's lack of starch also means it may be combined with acid fruit. Low-protein macadamia milk, which is also low in carbohydrates, combines well with sweet fruit in the Dinner Soup, or it may be combined with acid fruit or made into a sauce or dressing. 

The following Low-Protein Milk table shows the amount of water needed to blend high-protein fruit, nuts, and vegetables (which contain more protein than human milk) into 100-gram servings of low-protein milk with a protein concentration of only one gram, equivalent to human milk. For example, to make low-protein durian milk, blend each 70 grams of durian with 30 grams of water, or blend 45 grams of water with each 55 grams of dates to make low-protein date milk. You can combine any of these milks together into meals without exceeding the protein concentration of human milk. You can also use a food tracking program to determine the percentage of protein in your meals relative to the total weight of the food and added water.

TABLE 3. Low-Protein Milk
(100-gram serving)
(1 g protein)
Grams Water
Canary Melon 90 10
Lemon 91 9
Napa Cabbage 91 9
Cherry 94 6
Banana 92 8
Blackberry 72 28
Apricot 72 28
Coconut Jelly 50 50
Romaine 81 19
Kiwi 88 12
Jackfruit 68 32
Bok Choy 67 33
Durian 70  30
Arugula 39 61
Avocado 51 49
Date 55 45
Collards 33 67
Kale 36 64
Dried Fig 31 69
Raisin 33 67
Coconut 30 70
Macadamia 13 87
Pecan 11  89
Pine nut 8   92
Filbert 93
Cashew 94
Pistachio  95
Almond  96
Walnut 94
Brazil nut  93
Sunflower Seed 5 95
Tahini 6 94

Vitamin B12

One final word on vitamin B12 promotional scare tactics used by the animal-based food industry against vegans to protect industry profits: Animal-based foods, the leading cause of alimentary anaphylaxis according to Shelton, are the recommended sources for vitamin B12. Yet, animals do not make B12, nor do plants. As explained in an article by Martens et al., Microbial production of vitamin B12 in Applied Microbiology and Biotechnology, this vitamin is made only by bacteria which reside in the animal and human gut. Digestive issues that interfere with B12 bacterial production and metabolism in the gut are the real cause of B12 problems, not dietary deficiencies of B12 intake. The evidence for this is that most B12 problems occur in people who ingest plenty of B12 in animal-based foods and who take commercial supplements. 

In a society where practically everyone eats animal-based foods, the average B12 serum level is likely to be above normal. Although exogenous sources of B12 may raise serum levels, higher serum levels alone do nothing to correct the gastrointestinal issues in people, vegan or omnivorous, which interfere with B12 metabolism. For example, malnutrition problems like pernicious anemia result from impaired synthesis of intrinsic factor in the stomach which is necessary for B12 intestinal absorption. If you have gastrointestinal issues, B12 dietary sources alone aren't likely to help. In fact, because animal-based foods are the leading cause of alimentary anaphylaxis—food allergies to flesh, milk, and eggs—they often cause or exacerbate gastrointestinal issues. And if you don't have gastrointestinal issues, B12 dietary sources aren't necessary because bacteria in your gut will produce sufficient B12, just as it does in animals. Taking supplements as "insurance" is not supported by the evidence.

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