Thursday, August 16, 2012

Ancestral Health Symposium 2012

I recently returned from AHS12 and a little side trip to visit family.  The conference was hosted at Harvard University through the Harvard Food Law Society.  Many thanks to all the organizers who made it happen.  By and large, it went smoothly.

The science as expected ranged from outstanding to mediocre, but I was really encouraged by the presence and enthusiastic participation of a number of quality researchers and clinicians. The basic concept of ancestral health is something almost anyone can get behind: many of our modern health problems are due to a mismatch between the modern environment and what our bodies "expect".  The basic idea is really just common sense, but of course the devil is in the details when you start trying to figure out what exactly our bodies expect, and how best to give it to them.  I think our perspective as a community is moving in the right direction.

Not surprisingly, the carbohydrate and insulin controversies loomed large over the AHS once again.  Several of the talks were aimed at defending the carbohydrate-insulin hypothesis of obesity, and it was clear that a subset of the low-carb community was reacting to the writing myself and others have published on this subject in the last year.  I don't feel the need to further explain why this idea doesn't have much traction among obesity researchers (i.e. the idea that elevated insulin due to carbohydrate consumption is the central cause of common obesity), but those who are interested can read what I've written about it previously.  In particular, I periodically update the key post "The Carbohydrate Hypothesis of Obesity: a Critical Examination", and it now has a section addressing the most common arguments in favor of the insulin hypothesis, so if you haven't read it in a while, have a look.

The "safe starch debate" was kind of entertaining.  There was a panel of people basically debating whether or not starch can be part of a healthy diet, moderated by Jimmy Moore (who I think did a good job).  The fact that this debate even took place is absurd—this is the kind of thing that makes it so hard to get research funding to study the Paleo diet.  But in the end, thanks to Chris Kresser and Paul Jaminet, carbs prevailed.  One of the most surreal moments happened right after Kresser brought up the Okinawans, the longest-lived culture and one of the healthiest in the world, and cited a paper showing that their traditional diet was ~85 percent carbohydrate, mostly from sweet potatoes.  Shanahan and Rosedale decided, based on thin air, that the Okinawans actually didn’t eat much carbohydrate, and Shanahan even went so far as to say “I don’t believe you”, even though Kresser was staring right at the citation on his laptop!  This is the kind of head-in-the-sand approach to science that we need to move beyond in the ancestral community.  It was also amusing to watch Rosedale proclaim that we should get over our obsession with the Kitavans, to scattered applause.  I suppose if there were a culture that was lean and healthy eating cake for breakfast and driving from the house to the mailbox to get the mail, I might want people to stop talking about it too.

Food reward also came up a few times in the talks.  From a scientific perspective, the discussions on food reward ranged from reasonable to bizarre.  On the reasonable side, Andreas Eenfeldt made an important point that I've tried to convey on my blog at times.  It's basically this: if you think junk food is fattening (regardless of why), and you think one of the reasons people eat junk food is that they're drawn to it and they like it, then you believe food reward contributes to obesity.  For example, if soda weren't tempting and enjoyable to drink, people wouldn't choose it over water.  Regardless of whether you think it's the excess calories, the sugar, or something else that's fattening at that point, food reward is what got it to your lips.

On the head-scratching side, there was J. Stanton's talk.  Stanton spent about half his talk flailing around at my writing in a thinly veiled manner.  He even went so far as to label food reward the “naïve hypothesis”.  Yes, an entire field of full-time researchers is naïve; good thing we have a fantasy novel author to point it out to us.  He seemed so focused on tearing down the food reward hypothesis that he undermined his own ideas in the process.  For example, he showed data on trends in fast food spending and total away-from-home food spending (which are data that I've presented on several occasions and which Jeremy Landen and I introduced to the community), and attempted to argue that they don't line up well enough with obesity trends to support a connection.  Besides being a rather imaginative interpretation of the data (see graph below), particularly considering that obesity can take many years to develop, this was counterproductive since one of his central messages revolves around explaining why junk food isn’t satiating and therefore leads to overeating and presumably fat gain.  So is it fattening, or not?  And if it isn't, why should we care about how satiating it is?  I probably would have let the whole mess slide if he hadn't equated food reward with the “moral failure” meme-- the idea that obesity is due to gluttony and laziness.  This was nothing more than a crass attempt to inflame the audience's emotions.


It was really awesome to connect with people who my writing has helped.  In particular, I had several people come up to me and share food reward fat loss experiences.  Aravind Balasubramanian and Kamal Patel have continued to lose fat since they started using the technique in the summer of 2011, and Aravind in particular looks a lot leaner than he did at AHS11.  Aravind also explained how the concept has helped him in other aspects of his life.  I had another gentleman tell me how the concept helped him lose fat and overcome overpowering food cravings.  A fourth gentleman explained that dietary changes he made based on my writing have halted a serious form of inflammatory bowel disease that at one point required the removal of part of his large intestine.  Frankly there are times when I wonder why I spend so much time sharing my work for free, when I often get as much resistance as support for it, but this kind of thing definitely helps.  I receive very little compensation for the work I do here, and in fact AHS12 cost me about $800 out of my own pocket-- but I do get a few donations here and there from kind folks.

My talk was titled "Digestive Health, Inflammation and the Metabolic Syndrome", and it contained a fair amount of information I haven't covered on the blog yet.  I started off by stating that I wasn't going to talk about carbs, which got a laugh.  I'm sure many people were glad for the break, and so was I.  The talk went well and I think it was well received.  It will eventually be freely available online.  The Q and A was interesting too.  Robert Lustig asked why I hadn’t mentioned fructose.  In retrospect, you can always think of better ways to answer a question than you did when you were on the spot.  My response was OK, but I think I was a little bit more dismissive than I should have been.  Basically, it’s not that I think fructose is irrelevant to the metabolic syndrome, it’s just that 1) it doesn’t strike me as central to the main focus of the talk, and 2) it’s a complex issue that I didn’t have time to get into.  I could make a whole presentation or three just about fructose.

Other talks I enjoyed were by Chris Kresser on iron overload, James O’Keefe on the harms of excessive exercise (and the massive benefits of moderate exercise), Maelan Fontes Villalba on antinutrients, Lynda Frassetto on Paleo diets and blood glucose control, and Chris Masterjohn on oxidative stress and carbohydrate intolerance.  Chris Masterjohn in particular hit it out of the ballpark—he was right on the cutting edge, and he has a way of cutting through the BS without offending anyone.  Unfortunately I missed most of the talks I was interested in, for various reasons, but they will all be freely available online thanks to AHS and Harvard! 

After the conference, I visited my parents in Virginia for a few days.  We had a nice relaxing time together.  We gorged on tomatoes, watermelon, and cherries from the garden, and swam in the river.  We also went foraging for pawpaws in the forest (see photo below of my dad shaking a pawpaw tree).  Pawpaws are one of North America’s largest indigenous fruits, but most people have never heard of them.  They grow on smallish trees, have creamy orange-yellow flesh, and taste like a cross between mango, banana and cantaloupe, with a slightly astringent edge.  If you live in the mid-Eastern or central US, you may well have them in your neighborhood.





102 comments:

Al said...

Nice wrap-up Stephan. I really enjoy reading J Stanton's blog (and yours of course), so I'm keen to watch the video of his presentation.

Mark M said...

Thank you for sharing your work with us. I'm not a scientist in this field so many things go over my head but I'm certain that food reward exists. What else would make me cykle 5k to buy a chocolate bar?
Linda

Stabby said...

*hugs Stephan* thanks for all you do! Don't let the haters keep you down. You be shining.

Will Hui said...

The bit about the Okinawans made me laugh :)

Sadly, I didn't get to attend AHS '12. I'm looking forward to the online videos.

Cassandra said...

I caught another AHS wrap that mentioned you were there so I was waiting and waiting to see if/when you'd post something bout it. Your writing has definitely been eye opening for me in different ways and I definitely appreciate everything you do.

Ivor Goodbody said...

Stephan, I hugely value the scientific content, thoughtfulness and balance of your posts, frequently retweet them for others to appreciate and learn from, but have not yet said THANK YOU for the generous contribution you make to the ancestral debate, and community, for free.

Permit me to do so now.

And please don't ever let the rhetoric of your opponents tempt you to respond in kind. The clarity and force of your arguments will make their own case well enough.

Wishing you lifelong health, naturally, Ivor

SamAbroad said...

Hi Stephan,

I initially had failure on the Low Reward diet having switched from LC (which after 3 years had started to cause issues with hypoglycaemia - I suspect we get a limited capacity for gluconeogenesis and I appear to have 'burned' mine out)

I went to step 5 which caused almost compelling binging after a few days, I dismissed the whole concept until I went back and did level 2 with zero wheat and low FODMAPs since I have IBS. It's working really well, I'm losing slowly and steadily and not counting anything.

One thing I have noticed is more fruit = faster weight loss.

Anyway sorry for the rambling anecdote, just wanted to let you know that I appreciate all you have done over the years for free!

Catherine said...

You really shine through in this community - a beaming light! Thanks for your all your amazing contributions. You are very talented at explaining the science and informing the debate.

Kris said...

Thanks for all you do, Stephan. I sure do appreciate it and I mention you often and link to you from my blog.

The food reward hypothesis is "uncomfortable" as it undermines the carb-insulin-weight gain hypothesis but ignoring it and sticking our heads in the sand is definitely not the answer. If we do that, we're no better than the saturated fat and cholesterol scarecrows.

I am a big believer in LC diets (due to the immense RCT evidence-base) and I often use the insulin mechanism to explain how it works because it holds up in practice, but I do sometimes mention that the exact mechanism of their effectiveness is up for debate and that it may be related to other factors such as the reward value of the food.

I also believe that excessive food reward does lead to full-blown addiction, being someone that has experienced addiction to other substances first-hand and realizing that if feels exactly the same. This compounds the problem even further.

Ron Rosedale said...

Cate merely said that she lived in Okinawa and related her experiences of their diet. I have written about the Okinawans and Kitavans in my blog posts as part of the "safe starch" debate where I listed dozens of studies. You seem to have ignored all of this science. I reiterated some of this at AHS 2012 such as Kitavans being very small people, males averaging 5'4" and females 5'1" with likely low IGF-I, and the considerable mistake of confusing correlation with cause. It is for these reasons and others, based on very sound science that I was giving that refuted the Kitavans as being good example of carbohydrates being healthy, that I received considerable applause. Your twisting of the truth here indicates that it must've bothered you that many in the audience understood and apparently agreed. 

Tuck said...

"Your twisting of the truth here..."

Dr. Rosedale, before you accuse Stephan of this please at least get your facts straight. Dr. Cate didn't say "that she lived in Okinawa", she said that she lived in Hawaii and knew Okinawans who lived there.

That has no bearing on what Okinawans ate in Okinawa in the 1950s, which is what Kresser was discussing, and was likely from before Dr. Cate's birth.

Her experiences were irrelevant to Kresser's point, as irrelevant as if she'd pointed out that the Okinawans ate McDonalds...

Ron Rosedale said...

The Okinawans have been shown to merely be excellent examples of the benefits of calorie restriction. My major point, however, was that using Kitavans as prime examples of carbohydrates being healthy to eat was extremely poor science. They are very short, likely indicating low IGF-I and protein restriction for at least most of the day. Short members of a species generally are healthier and live longer perhaps for those reasons. They also eat a diet high in MCT's from coconut oil. I have mentioned these reasons several times to those often citing Kitavans and these are generally ignored.. It is Stephen who mentioned head in the sand.

LeonRover said...

Ron Rosedale

You said

"I have mentioned these reasons several times to those often citing Kitavans and these are generally ignored."

So, your Kitavan Hypothesis is:

When a sub-population eats Root Starches in the presence of Coco MCTS and adopts Protein Restriction it will end up with low IGF-1, slight posture, healthy blood numbers etc.

So, does Staffan Lindeberg agree with this?

I do note that Lindeberg's own diet interventions operate at 40% CHO level.


Slainte

PS Kitavans are brought up to point out that labelling food merely as gms of macronutrient - CHO or otherwise is poor science.

Too much modern flour is bad. But root foods are not wheat flour.

Dan said...
This comment has been removed by the author.
Dan said...

Hi Stephan, where are the talks posted? Or if they're not, could you let us know when they will be?

Joe Berne said...

I wonder how much of the hostility directed towards the food reward hypothesis is because of the effect it could have on the paleo industry. If the key (or at least one key) to successful weight loss is eating relatively plain food with little variety how are we going to continue to churn out food porn blogs, cookbooks, and so forth? Your work is endangering the entire economic foundation of the paleo movement. (On a personal level, I like tasty food, so I hope the food reward thing is wrong, but I don't really think it is.)

Aravind said...
This comment has been removed by the author.
Aravind said...

Thanks Stephan for all the great work you do to help people!!!

Bryce said...

Stephan,

Thanks for your continued, and astonishingly free, sharing of logically presented science. You have been extremely influential to my thinking, and incorporating the food reward hypothesis into a paleo (with occasional IF) diet has made weight maintenance at lean levels literally effortless (from a formerly fat guy).

I will say that it is refreshing to see you recognize where you could have handled a situation better. Everyone believes they are in the scientific or moral right, but the better man acknowledges his limitations and deals gently with dissenters. After all, is the goal to win a debate, or to convince? The two are not the same, and it's difficult to curb our enthusiasm and pride at times (for me especially).

I encourage you to continue presenting the truth in a winsome way. Keep up the great work. And if you need funding for continued web support and conferences, organize your best posts into a paperback! I frequently wish I had all of your posts in a handy format that I could give to friends. I would buy several copies, and I'm sure many of your readers would as well.

Best,
Bryce

Melissa said...

So Ron, according to you I am also a very short person at five feet two inches, so I should be able to eat the Kitavan diet right?

You are speculating, since there is no data on IGF-1 for Kitavans that I can find anywhere. In the past when I have argued using a variety of data from a variety of populations on many different diets, you have insisted that this data doesn't matter because they did not collect all the biomarkers you feel are important.

You write as if it's perfectly logical if you look at the science to agree with you on everything, but readers should be aware that such ideas controversial within the scientific community to say the least. It is very deceptive to layman the way you portray yourself and your ideas.

The worst part about AHS is that so few of the actual researchers in medical anthropology were there to defend their ideas from attacks like this. I imagine reception would be a bit more chilly at an evolutionary medicine or physical anthropology conference.

Stephan, great post!

Bryce said...

You could call your paperback: "Good obesity research, bad obesity research."

Just kidding.

Bryce

Julian said...

Welcome back Stephan, looks like you had an awesome time in Virginia.

I can't wait to see your talk. I'm still working on finishing reading all your posts.

Also, I encourage everyone who feels they get value out of your blog to donate.

Tuck said...

Dr. Rosedale said: "My major point, however, was that using Kitavans as prime examples of carbohydrates being healthy to eat was extremely poor science."

The point that they're making isn't that the Kitavans prove carbohydrates to be healthy, it's that they disprove the hypothesis that carbohydrates are universally bad for us. Since it takes only one such example to disprove a hypothesis, that one is disproven. There are other cultures that are far healthier than Americans who also eat lots of carbs: Prof. Lieberman just came back from studying such people in Kenya.

I have a great deal of sympathy for your position and that of Gary Taubes. Both myself and my wife are on a low-carb ketogenic diet.

But I agree with Stephan that some other factor than the simple presence of carbohydrates in the diet is to blame.

If you (and Gary Taubes, who I also have a great deal of respect for, aside from sandbagging Stephan last year) persist in advocating a hypothesis that's been demonstrated to be false, you're going to turn yourself into a crank.

I hope that doesn't happen.

Alex said...

However I think it's a bit of a strawman to suggest that their hypothesis is that carbs are universally bad for all humans.

Tuck said...

@Alex:

"I believe, quite simply, that all sugars, and foods that convert into sugar, will have a detrimental effect if eaten, and therefore the fewer non-fiber carbohydrates that a person has, the better..."

"The studies presented previously on glucose levels and health are to be taken as a whole to show that there is no threshold for a safe level of blood glucose that Paul has based his ‘safe starch’ recommendations on; no more, no less. That glucose can be toxic is very well known, however it is the effect of glucose on hormonal signals that is the most important."

"Is the term, ‘safe starches’ an oxymoron?"
http://drrosedale.com/blog/2011/11/22/is-the-term-safe-starches-an-oxymoron/

Dr. Rosedale's own words. No strawman here...

M. said...

"I think it's a bit of a strawman to suggest that their hypothesis is that carbs are universally bad for all humans."

Not so much in regards to Rosedale. He's out there.

Alex said...

In that very link Rosedale says his diet might not be optimal for all humans. So I do think you guys are making a mountain out of a molehill here.

Also, you should keep in mind that a high carb diet can be worse than a low carb diet but still be much better than a standard western diet. So when he's talking about raising carbs being bad it's outside the context of the standard western diet. That's another thing he goes over in that link.

Tuck said...

"He's out there."

In Rosedale and Taubes' defense, if you only look at modern Americans, it's a pretty plausible hypothesis.

And his prescription is pretty effective fror modern Americans.

I think that figuring out why it applies to Americans but not to Kitavans is key to the whole enterprise...

Tuck said...

@Alex: There are 21 instances of "optimal" in that link. Most of them (in red) are quotes. Rosedale says this:

"Jaminet’s diet is certainly not a bad diet, and I hope that I have never given the impression that it is. It is better than most other diets generally being touted. Optimal for some? I can’t say."

And this:

"We are talking about an optimal diet, a “Perfect Health” diet, as it were. That diet, as far as promoting a long, healthy and happy life would be as I have recommended for so many years, and would entail reducing consumption of sugars and starch as much as possible."

How you can construe that to mean, "In that very link Rosedale says his diet might not be optimal for all humans." I don't know.

And at any rate: "So I do think you guys are making a mountain out of a molehill here."

I didn't post first here and accuse Stephan of being dishonest, now did I?

Alex said...

he literally says

"I suppose my diet may not be optimized for every single person"

Sorry, I changed optimized to optimal and you thus couldn't find it easily. But the part you quoted where he says that maybe the 20% carb diet is optimal for some, also allows that sort of wiggle room that you accuse him of not having.

Stephan Guyenet said...

Hi SamAbroad,

Thanks for sharing your experience, I'm glad it's been working for you. Sounds like you had some kinks initially-- this kind of feedback is useful for me.

Hi Kris,

Thanks. I also think LC is a useful tool in some circumstances.

Hi Dr. Rosedale,

Dr. Shanahan said she spoke with some Okinawans while she was in Hawaii, and this was the basis of her argument that the Okinawans didn't eat very much carbohydrate. To the best of my recollection, you agreed with her. This level of evidence qualifies as "thin air", particularly considering Chris Kresser had cited a peer-reviewed paper on the matter not 5 minutes before that. People can watch the video and decide for themselves who is giving the accurate account.

Regarding the Kitavans, they refute the idea that a high-carbohydrate diet leads to modern diseases. The reason the study is so important is that Dr. Lindeberg characterized them in greater physiological detail than most other studies in the medical anthropology lit. The Kitavans are not an isolated example: they are consistent with many other high-carbohydrate non-industrial cultures throughout the world that also have exceptionally low rates of modern disease. You will have a lot of refuting to do if you want to make it through all of them.

Regarding body size, the uncomfortable fact that is not usually discussed in these circles is that almost ALL contemporary hunter-gatherers and non-industrial agriculturalists are small by modern standards, regardless of carbohydrate intake. Typical average adult male height for non-industrial cultures is 5'1" to 5'5". The only exceptions I'm aware of are cultures that consume a lot of dairy (e.g. Dinka and Maasai).

Yes, these cultures are "calorie restricted" compared to us, but that's only because people in affluent nations eat an excessive amount of food.

I have not seen a single study demonstrating that replacing carbohydrate with fat extends life in a vertebrate species. If you know of such a study, please cite it. To the contrary, I have seen numerous studies demonstrating that high-fat diets in multiple species lead to fat gain, accelerated disease, and early death. To be fair, these studies usually compare unrefined high-carbohydrate diets to refined high-fat diets, but if carbohydrate were the dominant factor this shouldn't matter.

Peter said...

Ron Krauss's recent view that there are two dietary routes to heart disease: overdoing carbs and overdoing saturated fats makes sense to me.
however my. credentials include failing high school chemistry and a D in college biology, so don't
t put any weighton this opinion.

M. said...

Tuck said “And his prescription is pretty effective for modern Americans.”

Not really any more effective than any other type of diet though.

Tuck said “I think that figuring out why it applies to Americans but not to Kitavans is key to the whole enterprise...”

I think the question is what is it about Western diet and lifestyle that damages the health of cultures that begin to mimic it. Sugar and refined flour isn’t really a novel answer. That’s where the “healthy whole grains” thing came from – whole grain is the anti-refined flour.

It is unfortunate that somebody like Taubes, instead of looking more deeply into the issue, pulled out a box of crayons and decided that a whole class macronutrients was to blame.

Most of Rosedale’s stuff just seems like nonsense to me. I’m surprised the AHS invited him.

Sanjeev said...

> They are very short, likely indicating low IGF-I and protein restriction for at least most of the day
________
tiny, isolated, micro-mechanistic, nano-mechanistic, yocto-mechanistic, reductionist measurements of allegedly "health markers" trump documented and repeatedly verified overall health.

cool.
yocto: http://en.wikipedia.org/wiki/Metric_prefix
or yocto

Flowerdew Onehundred said...

When I was backpacking last year, I found and ate a bunch of Paw Paw. Isn't it a little early for them to be ripe now?

I picked mine on the Appalachian Trail in Northern Virginia, but I do live pretty nearby there.

Stephan Guyenet said...

Hi Flowerdew,

Yes, it is a little early! Only one of them was ripe (the one in the picture). The main crop should be ripe in a week or three.

bentleyj74 said...

I've lived in a few places that should have had paw paw [including northern Va...lol...we were probably neighbors at some point] but I've never found any!

Chuck Currie said...

Stephan - I find your work interesting and thoughtful, however, using "an entire field of full-time researchers is naïve" and "peer review papers" is a very weak and precarious perch to place your arguments; there are plenty of the same on the other side.

From what I've been able to discern from the reviews of Masterjohn's presentation, is that the amount of amylase in humans varies from one population to another; this appears to be a sort of amylase persistence, or adaptation similar to lactose persistence.

Since becoming a high-fat low-carb paleo eater, I'm no longer able to tolerate fruit - I use to consume five pieces of fruit a day, minimum; now I can track the progress of a single peach from mouth to elimination and, all the digestive discomfort that comes with it. Yet, I consume lots of raw milk and pasturized grassfed butter, cream and yogurt, without nary a complaint; in addition I have lost a little more than an inch of belly fat that just wouldn't go away before raw milk became part of my regular diet (fyi, I am of Swiss ancestry, so that may be a genetic factor).

To the commenters - when discussing macro-nutrients (ala Taubes & CHO), it would be helpful if you distinguished between whole foods (sweet potatoes) and refined (wheat flour & sucrose/HFCS).

Looking forward to seeing your AHS12 prsentation.

Gretchen said...

Stephan, I'm glad your ideas have helped some people lose weight. But we have to accept that different people do best on different diets. There's no one diet that is best for everyone.

Some people rave about the healthy benefits they see on a vegan diet. Others say the vegan diet made them sick. Etc. Too many people cite their own experience as proof that it will work for everyone.

If you want people to accept that food reward is the primary factor in weight gain/loss, you have to explain Jimmy Moore's recent experiment. He was unable to lose weight until he went on an extremely high fat diet that seems to be rewarding for him (some of his meals look vile to me, even though I'm on a LC diet). But he says he loves them.

So clearly in this case, food reward is not what is most important for him, and if it's not important for one person, it's likely not important for others.

We all have different genes and different tastes. LC is especially beneficial for people with metabolic syndrome. For those without it, any kind of food restriction seems to work. And cutting out anything -- fat or carbs -- reduces food intake in most cases.

I was ravenously hungry 24/7 on a low-fat, high-carb diet and decided I didn't want to live if it meant I spent all my time thinking about food and when my next meal was. Others on the same diet would feel fine.

Those studies saying that carbs are more satiating than fat have problems and contradict the experience of a lot of people. Different metabolisms, different results.

Sanjeev said...

> (ala Taubes & CHO), it would be helpful if you distinguished between whole foods (sweet potatoes) and refined (wheat flour & sucrose/HFCS).
________
Why? Page numbers from books, please (which is what I've provided when criticizing Taubes)

I don't recall this distinction in gc,bc; Potato versus white bread, sugar versus pasta, refined versus unrefined was NOT a big issue at all.

Has Taubes changed his stance yet again?

Stephan Guyenet said...

Hi Chuck,

You said, "using 'an entire field of full-time researchers is naïve' and 'peer review papers' is a very weak and precarious perch to place your arguments; there are plenty of the same on the other side."

If you know of peer-reviewed papers showing that the Okinawans ate a low-carb diet, or if you have found "plenty of" peer-reviewed papers arguing against the food reward hypothesis, I'd like to see them.

Interesting observations about your fruit tolerance.

Chris Kresser said...

If anyone would like to read about the composition of the traditional Okinawan diet, there's a free full-text paper available here. The one I cited on the panel is here, but the full-text isn't available. There's a great description of the traditional Okinawan diet early in the paper, and it doesn't include rice or SPAM!

This table shows the macronutrient composition of the Okinawan diet. As I said in the panel, the traditional diet (before Westernization and Japonification) was 85% carbohydrate, 9% protein and 6% fat. After modernification it changed significantly: 58% carbohydrate, 15% protein and 27% fat.

Dr. Rosedale is correct that caloric restriction is the likely explanation for the longevity of the Okinawans. But as others have pointed out, I did not claim that starch was a determining factor in increasing their lifespan. What I said was that it's highly unlikely that they could live to be so old on a diet consisting of 85% "toxin" (i.e. glucose) – especially since traditional Okinawans did not have access to modern medical care and their mortality rates from acute infection were quite high (a point I did not have the chance to make on the panel, unfortunately).

If there is a protective factor that enabled the traditional Okinawans to eat mostly "toxic" carbohydrates and still live as long as they did, in spite of their poor access to medical care, I'd like to see some evidence for what that might be.

As others have noted, I mentioned the Kitavans and Tukisenta as examples of other cultures that consume large amounts of carbohydrate, but have extremely low to non-existent rates of modern, inflammatory disease – in spite of the fact that, in the case of the Kitavans at least, many of them smoke. I did not claim that they are particularly long-lived or models of ideal health. If glucose is as bad as Ron and Cate let on, why aren't the Tukisenta and Kitvans fat, diabetic and riddled with heart disease?

As for correlation not equaling causation, I couldn't agree more. That's why we can't rely on studies correlating high blood sugar with disease outcomes. It's entirely plausible that it's not the high blood sugar causing these outcomes, but the insulin/leptin resistance and other metabolic abnormalities underlying the high blood sugar that is to blame. One might argue that they always go together, which makes this a moot point. But when you look at 24-hour continuous blood glucose monitoring studies in healthy people with no insulin resistance, you see quite a wide variation of readings including some well above the recognized targets for fasting and post-meal glucose.

It's also one of many reasons why we can't infer that the correlation between higher glucose intake and decreased longevity in C. elegans (roundworm) has any bearing whatsoever on human macronutrient intake on longevity.

I think it's a waste of time and energy to continue this "debate". Most people have been exposed to the arguments on both sides ad nauseam, and they've made up their minds one way or the other. That's how I feel about it, at least.

Chris Kresser said...

Correction: when I said "the full-text isn't available" on for the second paper, I meant it's not available for free so I can't link to it.

Jack Kruse said...

Dr. G you are aware that the translation into English of the word “Okinawa” is “The Island of Pork” not carbs in Japanese, correct? I’d like to direct your attention to the work of Tanaka published in the Lancet in 1998 on the real reasons behind the Okinawan longevity. It is a genetic defect of cytochrome 1 of the mitochondria to cause less ROS and therefore less aging. Moreover, Dr. Lane published in his book that there has never been a supercentenarian from this area ever been found to not have the defect. It has the same mechanism of action of metformin in vivo. Nick Lane has these published in two of his books as well on mitochondria evolution. I reference both of these in my Paleo Fx talks. -Jack Kruse

1. Tanaka M, Gong JS, Zhang J, Yoneda M, Yagi K. Mitochondrial genotype associated with longevity. Lancet 1998; 351: 185-186.

2. http://www.okicent.org/docs/bjw_jgbs_sibling.pdf

Jenny said...

Their having written novels is no reason to ignore what a person might have to say about nutrition.

That said, in all these battles the one thing that keeps sticking out to me is that over the past century human health and lifespan had increased enormously, despite most people eating very high carb diets full of all kinds of crap.
Things started to change in the 1950s when plastics entered our environment along with much heavier use of agricultural chemicals and pharamceutical drugs, all of which have been shown to damage the metabolism.

So many artificially introduced organic chemicals permeate our environment now that have been linked to obesity that it seems crazy to discuss diet without full awareness of the way that this burden of toxins has changed the way our bodies store fat and regulate appetite.

The chemical industry loves it when people squabble about macronutrients, because that keeps all that energy tied up in flamewars and diverts the energy of otherwise effective people away from the kind of political action it would take to get these toxins out of our air, water, and food.

Jack Kruse said...

their longevity has nothing to do with their diet and or CRON. We have to get this correct before we confuse it all. The Tanaka data is 14 yrs old now and quite well accepted in many disciplines.

Sanjeev said...

> translation into English of the word “Okinawa”

Genetic fallacy

Nominal fallacy

> work of Tanaka published in the Lancet in 1998 on the real reasons behind the Okinawan longevity.

Assigning excessive probative value to a promising proposal

StanM said...
This comment has been removed by the author.
StanM said...

Aren't people different!
After eliminating dairy apart from butter I never had congested nose or pimples on my back. Just for the open nose I could never go back to milk or cheese which is sad cause I used to like cheese. But I don't crave for it now. Is 30% carb callories considered LC?

Chuck Currie said...

Stephan - I didn't mean to infer that there were papers refuting your hypothesis - only that there is a mountain of papers all proposing a different hypothesis. And,some of which, researchers have been unable to replicate; either the conclusions where in error or the papers where/are completely fraudulent.

In addition to eating a lot of fruit in my past life, I also consumed a lot of wheat (whole and refined), oats, rice, potatoes (white), pop corn, non-fat milk/yogurt, low fat meat/poultry/fish and an occasional cherry coke. I was a walking advertisement for the food pyramid. Consequently, I suffered from bloating, gas and GERD and was on PPIs for about eight years. I also put on twenty-five pounds (a twenty percent weight gain) and added three plus inches to my waist - all of which I have now lost.

Other things I don't tolerate: kale, raw onion, egg-whites (yolks - no problem), more than a small amount of sweet potato, eaten occasionally, bacon :( and most, but not all, nightshades.

Another hypothesis I find interesting is the effect of mycotoxins on health and obesity (ala Dave Asprey).

Melissa said...

Dr. Kruse, that is not a paper, that is a research letter and it proposes it as one factor of Okinawan longevity. Studies on Okinawans who have emigrated elsewhere and adopted other diets show that while they still tend to live longer, they do have higher levels of Western disease.

"The results of the present study suggest that coronary risk factors and cardiovascular health are not only regulated by genetic factors, but that the impact of lifestyle (mainly diet) can be large enough to modulate the expression of genes."

DOI: 10.1111/j.1440-1681.2004.04119.x

Also "The origin of the term "Okinawa" remains unclear, though there was a divine woman named Okinawa in the book Omoro Soshi, a compilation of ancient poems"

Stephan Guyenet said...

Hi Dr. Kruse,

Are you aware that 85% of "Greenland" is a permanent ice cap? Names can be deceiving. Okinawans ate pork in small quantities, but traditionally their diet was largely carbohydrate, as reported by every single peer-reviewed paper on the matter.

Thank you for the citations. I know there has been some work on the genetics of Okinawans. It wouldn't surprise me if they had some protective genetic factors, although the research you cited doesn't actually demonstrate that the mutation in question is THE reason for longevity on Okinawa. Our ancestors have apparently been under positive selection for longer lifespan for over 1 million years, and it is entirely possible that each population has a unique, partially overlapping set of longevity genes.

Chuck Currie said...

StanM - I to suffered from sinus congestion which cleared up when I eliminated dairy (except butter) - but, I also eliminated wheat at the same time and, I too was worried about it returning if added the dairy back. I started with heavy cream (but it cannot contain any additives, I go without if it does) and that was ok, then I tried pasteurized milk - my sinus was ok, but not my stomach. So I stayed clear for more than a year. Then I went completely dairy free (not even butter) for a month and then reintroduced dairy slowly, starting with full fat goat kefir. Next it was clarified butter, then raw milk.

The raw milk was the biggest, and most pleasant, surprise. What I thought was a dairy issue, has, so far, turned out to be a pasteurized dairy issue.

And, I must say, a cold glass of milk is vastly under appreciated. Talk about food reward!

marchwinds said...

Stephan,

I greatly appreciate your blog and read it regularly, and keep up with all your new posts. You are a balanced, clear-minded thinker and a very good writer. I have learned a great deal reading your work. It is unfortunate that so many people treat nutrition as if it were a religion and dig their heels in, refusing to learn anything new that might upset their deeply held beliefs about what they think is the right way to eat. I was first introduced to Paleo/nutrition research and discussion through Gary Taubes, but feel that he is no longer progressing in his research and analysis of the causes of obesity, because he rejects evidence that would force him to move beyond his carb hypothesis, and refuses to recognize the complexity of human biology, which unlike the hard sciences (such as physics), cannot be reduced to one or two simple concepts.

I will continue to follow your work!

Jennifer

Tim Terlegård said...

WAPF says animal fats are important for jaw, teeth and what not. But here Chris says Okinawans only eat (or did eat) 6% fat. I guess we don't really need that much of the animal fats then?

Seth said...

Thanks for all your work Stephan.

People on the Internet can definitely suck, but there's still plenty of reasonable people who appreciate everything you've done.

I myself was following Taubes/Peter's writings and ended up 8 pounds heavier (probably overeating things like chocolate and hardboiled eggs with butter, for some reason they're ridiculously delicious to me). Then when your food reward posts came out I tried a simple diet with lots of plain potato and sweet potato and bam, back down to perfect slimness.

So thanks for that man.

pawpaw said...

Stephan,
Pawpaws (Asimina triloba), contain all essential amino acids. Also high, for a fruit, in total protein, mono- and polyunsaturated fats, and carbs. High in a number of minerals. Both palatable and rewarding, we like the frozen pulp. See http://www.pawpaw.kysu.edu/pawpaw/cooking.htm#Nutritional Information

Here in SW VA/NE TN, there are native stands that ripen from mid-Aug to mid-Oct. Though most in Sept, when native mammals can bulk up for hibernation on this hi-caloric fruit.

Desoto and Lewis and Clark expeditions valued the fruit, especially the latter. Native Americans took the fruit with them, perhaps helping this tropical family expand over what is now 26 eastern states.

Great source of balanced calories, nutrient dense. There is a USDA germplasm collection in Corvallis, OR, if you can't get back to VA, and a couple of nurseries in Western Wash (Burnt Ridge among them) have short (cool) season cultivars that can ripen in the PNW.

Sara said...

Stephan, yes, haters gonna hate. that shows you are making an impact. I get no haters, but that's because I'm completely mediocre and post lots of cake photo's on my blog.

About the AHS. Was there anyone examining the differences in macronutrient metabolism between men and women? I am researching sports nutrition for strength athletes at the moment (somewhat tedious postgrad report) and keep accidentally coming across this fact I had not encountered before: that when exercising (and not even for very long) and recovering, men use more carbs, women rely more on proteins and fats. I wish I had more time to look into it.

Anyway, if you know of other bloggers blogging about the AHS please could you link it up? @will Hui, where does one find the online vids?

Will Hui said...

Sara,

Interesting info about preferred exercise fuel across genders! Do you have a reference I can look at?

I don't think the online videos are available yet (that would have been very fast!), but I'm assuming they will be found at the same place as the AHS 2011 videos from last year:

http://vimeo.com/ancestralhealthsymposium

Chris Kresser did a nice blog post about AHS '12 here:

http://chriskresser.com/take-home-messages-from-ahs-2012

Fiona said...

Thank you Stephan for this post. I agree with Rosedale actually, listening and reading a lot from both sides, including Rosedale's latest summary that clearly outlines the questions that came up. It is an awesome read and just set in stone for me the bigger picture, and the roots of the truth. Each to their own. I would much rather continue my paleo healthy, and if I want to cheat.. then i will have a starchy treat once in a while, but not because i believe it is healthy. ... and if I am going to cheat, then it would never be with rice/potatoes/sweet potatoes but something really yummy bad.. that is if I ever felt the need. Which i don't... I am on a VLC, mod protein, high fat.. keep it clean, organic, grass fed and I feel great... and plan to keep it that way.

http://drrosedale.com/blog/2012/08/18/a-conclusion-to-the-safe-starch-debate-by-answering-four-questions/

aangel said...

"The land of Pork:" very interesting!

I've learned that when there is an outlier in the data (Okinawa's eating 85% of their calories as carbs and living long, healthy lives), less than half the time it is accurate. Mostly it indicates that an error was made. I'm not saying this is the case here because Stephan has indicated their are many papers that support this high ratio of carb ingestion.

So I went looking and found:
http://www.westonaprice.org/traditional-diets/food-in-china

"Okinawans eat about 100 grams of meat per day-compared to 70 in Japan and just over 20 in China-and at least an equal amount of fish, for a total of about 200 grams per day, compared to 280 grams per person per day of meat and fish in America. Lard-not vegetable oil-is used in cooking."

Now, 200 grams of meat and fish is just 800 calories but with a smaller statured human that is already more than 15% that's left if 85% were to be carbs, the number being used here. Add in the lard and the portion goes higher.

This is starting to look to me like the data that is providing 85% carbs may be suspect. Going back a step and getting folks to agree on the actual data seems to be appropriate here.

I write peer-reviewed papers on worldwide oil reserves and one of the "bibles" of the field is the report BP issues every year ("BP Statistical Review of World Energy") . It is treated with great respect by economists, politicians and others.

However, in the mid 80's, several Middle Eastern countries increased their oil reserves by 300 billion barrels almost overnight.

Some increase was warranted (perhaps as much as 50 billion barrels) but that number is astonishing. Did they really find that much more oil? No, they didn't. A small arms-race had occurred in which countries increased their stated reserves so that they could export more oil under the agreement in effect at the time (OPEC allowed countries with more reserves to pump more oil). Increasing the reserves was the only way to "legally" pump more oil and thus earn more revenue. These are the so-called "paper barrels," as in they exist on paper and not in actual reality.

Yet BP to this day still reports their reserve numbers as though they are accurate. There isn't even a footnote to tell readers that the numbers are extremely suspect (to put it mildly).

In other words, published numbers are sometimes wrong in very, very significant ways! (Many peer-reviewed papers use BP's numbers also with no mention of why they are extremely unlikely to be true.)

Do the Okinawan's eat as much carbs as some believe? Getting the data straight is the thing to do here.

Stephan, would you be willing to point out which page on your blog lists the papers you refer to? The Weston A. Price article casts some doubt in my mind.

Thank you in advance!

-André

Sanjeev said...

So I went looking and found:
http://www.westonaprice.org/traditional-diets/food-in-china
_______________
Current consumption is irrelevant; effects on 110 year survival will not be evident for a long time

the historical consumption that led to longevity outliers differed

> "The land of Pork:" very interesting!

Genetic fallacy tends to give a superficial cast of plausibility, and "depth".

Rob said...

@Gretchen

Jimmy has no problem losing weight and has shown that many times in the past, the problem is he keeps re-gaining. He's been yo-yo dieting for years now, remember eggfest? kimkins? And he lost 170 pounds doing a low-fat diet.

And you are misunderstanding the food reward hypothesis, it's not about something being simply tasty (although palatability plays a role). I'm sure Jimmy loves all the food he's eating but it's making him unconsciously eat less w/out excessive hunger. Not hyper-rewarding.

We'll see if he keeps off the weight this time. In cases like him we're he's been obese for so long, he'll most likely need to monitor his caloric intake if and when he gets to a healthy body fat level. Sucks but as we all know not everyone can go LC or paleo and maintian fatloss without watching calories.

Adam Noel said...

Maybe I'm wrong, but the whole low carb insulin hypothesis thing seems strangely similar to the entire low fat lipid hypothesis that has plagued the medical field for the last 50 years.

If I remember correctly the entire fatphobia craze of the last five or so decades began with observational studies on the effects of excess fat consumption on rabbits. Apparently the fat had some pretty... terrible effects on the health of the rabbits and even in that case the rabbits died from a fat induced form of starvation. These observations from this study were extrapolated to humans and falsely construed to mean humans cannot and should not consume fat of any kind.

A similar thing is being done with Rosedale's observations that starchy carbohydrates increase mortality. Rosedale conflates that observations of consumption of starchy carbohydrates in worms increased mortality and that this can be extended to humans.

A logical stepping stone between worms and humans would be rats and then eventually some sort of omnivore. A diet with carbohydrates of the starchy variety versus the non starchy variety would need to be undertaken and experiments performed.

Even then we should caution ourselves in extending these results to humans. If we evolved eating roots and the likes then why would roots impact longevity.

Rosedale argues that this is due to oxidation stresses caused by the utilization of glucose as a fuel source. This raises (at least in my mind) a few questions.

If starches causes oxidative stress then why do fats and the critical amount of required protein not? If the body creates glucose as required and this protects the body from oxidative stress then why would a proper amount of glucose below the required amount (as required) not reduce the amount that the body has to convert and then save the body possibly damaging processes?

He claims that nature has tricks up their sleeve to allow members of the species to live as long as necessary to impart a reasonable chance of reproductive success. He then states

"Tricks such as intracellular antioxidant up regulation, DNA repair, increased autophagy (cellular garbage collection), are all enhanced when nature believes this is necessary, including times of hardship such as perceived famine. Those nutrient sensors are controlled by the amount of macronutrients in each meal, sugars and proteins raising all of them…but not fat"

The thing that makes me skeptical of such claims is that our preferred food source throughout human history would be nutrient dense foods such as meat and in times of famine it would likely be these foods that are the hardest to come by.

Why would the dominant macro-molecule in these foods be the one that keeps the body in a state where it feels it is in starvation mode and is working to preserve it's genome when in times of famine it would be subsisting off of other food sources.

Shouldn't these substandard food sources have pathways to protect against free radical stress by this logic? Wouldn't it be then that the body signals with "We need to stay alive at all costs so we can mate when times are good again"?

I'm not convinced.

Adam Noel said...

Sorry to ramble on,

It seems that Dr. Rosedale believes ketogenic diets are evolutionary adaptations to times of famine caused by a shortage of carbohydrate and protein. This adaptation is meant to preserve the genome during that time.

Wouldn't an equally plausible hypothesis be that the body favors the use of carbohydrates as fuel but in environments where carbohydrates are scarce a mechanism to allow the direction conversion of fats to a similar fuel source as that of carbohydrates would be favored.

This would not serve to enhance longevity as proposed by Dr. Rosedale but would rather allow business as usual to continue. If framed in this way, there really wouldn't need to be longevity enhancing effects as proposed by Dr. Rosedale.

In such a case Ketones are a just below substandard fuel source but business as usual can continue. The body prefers carbohydrates but mating can continue normally and no resources are wasting protecting the genome from oxidative harm.

Paleo Phil said...

Stephan Guyenet wrote: "Okinawans, the longest-lived culture"

Okinawa is long-lived, but it no longer has the longest avg life expectancy at birth of Japanese prefectures:
> Life Expectancy Of Okinawan Is Shortening, Who Is The Culprit? Fast Food. February 9, 2010, http://eming.com/en/life-expectancy-of-okinawan-is-shortening-who-is-the-culprit-fast-food/
> Declining longevity advantage and low birthweight in Okinawa. Asia Pac J Public Health. 2008 Oct;20 Suppl:95-101. http://www.ncbi.nlm.nih.gov/pubmed/19533867

According to 2012 estimates in the CIA Factbook (https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html), Monaco (89.68 overall) and Macau currently rank higher than Japan.

PMC said...

Stephan, your work in the lab and in the blog is very important. Thank you very much for giving away so much high quality information for free. I imagine how demanding it most be for you to do your work and write these great blog posts in your free time.

Regarding AHS, I didn't go, so I can only comment based on what friends who have been there have told me (I apologize for any flawed commentary):

1) Scientific talks didn't gather much attention. For instance, Dr. Lynda Frassetto's lecture with data from her new unpublished study with a Paleo type diet in TII diabetes had very little attendees. She is one of the few MDs/researchers who has actually done RCTs with a Paleo type diet. Another researcher, a young dutch MD, PhD, Remko Kuipers, who has studied traditional Tanzanian populations (including the Masai) also had very little attendees. From what I've seen in the program, this guy was probably the only one at AHS who has actually done field work regarding evolutionary nutrition and he was basically ignored.

2) Very few talks with a real evolutionary perspective.

3) Not a single fish-based meal. It seems omega-3 fatty acids are bad is becoming a fashion these days.

4) Many talks about low carb. It seems Paleo is becoming = to low carb, at least in the US.

5) Surreal panel about safe starches. The critic of the paper about Okinawa's diet that Kresser presented was completely ridiculous. If this how AHS is moving forward, then the evolutionary nutrition movement is never going to be truly accepted by scientists. Where were the researchers who have actually done RCTs with various types of diets and the researchers who have studied the dietary habits of traditional populations???

Regarding Okinawa, I believe Chris Kresser has already provided the link to the studies. Concerning Kitava, if one reads the Kitava papers by Dr. Staffan Lindeberg and his PhD thesis, along with his book, will see that: 1) they eat 3 times a day and not just once a day, as some people have suggested; 2) they do not eat much fish (3 times a week on average); 3) the basis of their diet is tubers; 4) they have high de novo lipogenesis (which is an indicator that their carb intake is high), but have low fasting insulin, low fasting leptin, zero Diabetes and zero obesity. Since some people from Kitava have migrated to the nearest cities and are obese and sick, the genetic protection seems to be nonexistent. Nevertheless, it is plausible to think that there are genetic differences between populations who are eating a high carb diet for thousands of years and populations who are eating low carb diets for a long time. Only a few RCTs have been performed (based mostly on fasting or postprandial insulin), but they show promising results.

6) Ancestral health, and especially ancestral diet movements would not exist if it wasn't for the work of many pioneers (some of which you have recognized in your blog), some of which (such as Staffan Lindeberg, Loren Cordain, Boyd Eaton, Michael Crawford, among others) are still alive and kicking and are basically ignored by the younger generation or even heavily criticized in a very rude way.

Stephan Guyenet said...

Hi All,

Thanks for the excellent discussion and support.

Hi Fiona,

You have a right to your opinions, and I'm not really going to try to change your mind. However, I would like to point out that Dr. Rosedale's discussion of the Kitavans is based on a fundamentally faulty premise (in addition to the fact that he has apparently not read the papers in question).

He is saying that the Kitavans don't support the idea that carbohydrate makes people healthy and live a long time. No one ever claimed either of those things. What the Kitavans (among many other cultures) demonstrate is that carbohydrate is not fundamentally harmful to health. That's a very different claim. The Kitavans aren't a model of longevity and no one ever claimed they were. They don't have enough modern medicine for us to know what their lifespan would be compared to ours-- they die of infectious disease and accidents just like we used to. All we can say is that they rarely develop the "diseases of affluence" when compared to people of the same age in our culture, and this is the assertion Rosedale cannot refute.

Aaron said...

I think I'm going to have to agree with Stephan that the arguments for or against carbs are continuing to be uninteresting.

I still feel there at a large number of people who buy into "paleo fantasy". Eating a real diet based on natural unprocessed foods is always going to be better than a diet of processed foods. However, when it comes to maximizing longevity, we may have to start tweaking a diet to such an extent that we start to eat a diet that doesn't look exactly like our ancestors. Maybe that means we start to increase carbs -- or eat foods that decrease IGF-1. Maybe we take drugs to optimize insulin. Everything could be on the table.

I wanna know why a large number of individuals use worm and mouse studies and act as they are the final say on what is going to be optimal for humans. Look at the diet of whales -- they eat a diet almost purely of krill. Surely that must be a "nasty" oxidation prone diet with the massive amount of omega 3 (unbalanced too with little omega 6). Maybe we should get them on a diet of butter and protein. <--- maybe they would live longer (don't think so). Oh yeah, they are a mammal too.

What about a turtle? Should we take them away from there vegetable based diet and feed them a fat based one to increase there already impressive lifespan. Surely, as stated by a large number of people on forums -- that all diets are really fat based diets. Who cares about the micronutrients in vegetables. It the gut bacteria converting everything to fat that matters. (Sigh)

Basically, in general, I don't think people should focus in on the small amount of people who have a real problem processing carbs. Or the ones that have food allergies to certain foods. This is a small group of people when you consider the population as a whole.

As it stands right now -- the majority of people on this planet can be healthy eating a diet based on carbs and plant based foods. It is the cheapest and most sustainable diet on the planet.

As a species we are much more likely to increase lifespan though drugs and gene manipulation then any kind of diet tweak. There are so many great minds debating nutrition. Let's put there brainpower to better use for the human race.

I'm tired of a large number of people on forums making fun of those who choose vegetarian or even natural diets that includes a small amount of meat and little amounts of fat.

As a human experiment. The high carb diet has shown promise for billions of people (even over time). When I can see data like that for high fat paleo diets -- I'm open to changing my opinions based on data.

deepsharma said...

You made a few fine points there. I did a search on the matter and found most people will go along with with your blog.
Byron Bay Health Retreat

Jane said...

Here's a few quotes from Ron Rosedale (thanks, Fiona):

'..Furthermore, when you eat the glucose [it] leads to a spike in insulin and leptin...that over time will contribute to insulin and leptin resistance…that ultimately contributes to metabolic chaos and resulting chronic diseases of aging including obesity, diabetes, cardiovascular disease, osteoporosis, autoimmune disease, cancer, and others...'

This is a very common misunderstanding. The metabolic chaos is not caused by the glucose, it's caused by a malfunctioning endocrine system which does not have the micronutrients it needs for maintenance and repair.

'..What about intracellular glucose? If you eat that sugar and it’s not in the circulation, where is it? Much gets pushed inside cells causing intracellular glycation and cellular harm. ..'

Another misunderstanding. Glucose is actually part of the cell's antioxidant system. Its metabolism through the pentose phosphate pathway produces NADPH, which works together with antioxidants such as glutathione. Without a constant supply of NADPH, glutathione is useless.

'..Being ignored is the effect of eating glucose on the above extremely important nutrient sensing pathways that help regulate the genetic expression of extremely powerful repair mechanisms. To dig into this ancient health-promoting pathway, one must simulate glucose deprivation and eat far less glucose forming carbs than recommended by ‘safe starch’ advocates. ..'

The 'extremely powerful repair mechanisms' are antioxidant upregulation, DNA repair, and autophagy, he says. They are indeed very powerful. They require micronutrients, which means eating starch without its micronutrients will inhibit them. Once again, it isn't the glucose that's the problem.

Marwan Daar said...

PMC,

Thanks for the very interesting summary. I hope these other speakers were video taped!

George Henderson said...

Lots of good ideas here.
We can easily erect a false dichotomy between what the brain does (reward) and what the cells do (insulin resistance/sensitivity).

Between free will and predestination.
As Lichtenberg said "freedom is how it feels to know the clockwork is running smoothly".
(not the exact words, but close enough)



Every esoteric knows "As Above, So Below".

It is a coupled system, so to speak.
Does the tail wag the dog?
They must both wag together if they can wag at all.

Of course carbs are Paleo.
Are carbs medicinal, and if so how, is the real question that Jaminet and others are exploring.

Your advice was plenty good enough before you discovered food reward. It's just another string to your bow, another explanation that works for some who might not have listened before.
Whatever it takes.

As Georg C. Lichtenberg also said:

"Food probably has a very great influence on the condition of men. Wine exercises a more visible influence, food does it more slowly but perhaps just as surely. Who knows if a well-prepared soup was not responsible for the pneumatic pump or a poor one for a war?"

Sanjeev said...

> Does the tail wag the dog?

IMHO it's a dys-regulation of tail wagging tissue accumulation

Shinta Gebby said...

Your post is very interesting. I am very
Thanks I From Indonesia...

Peter said...

Stephen wrote: "Regarding body size...ALL contemporary hunter-gatherers and non-industrial agriculturalists are small by modern standards..."

Except....for Central-Africans who make up one of the biggest people on the planet.

1) "As to the risk factors in predominantly rural African populations in southern Africa, the principal dietary sources of energy were in the past and still are to an extent cereals (maize and kaffir corn or sorghum) and their products, wild spinaches, and a variety of legumes (cowpeas, sugar beans, Jugo beans), along with relatively low intakes of most vegetables and fruits and infrequent consumption of small quantities of milk and meat".

"Serum cholesterol levels of rural Africans in the past ranged from about 3.0 to 3.5 mmol/l and remain low. The range of mean serum cholesterol levels of urban Africans was 3.5 to 4.40 mmol/l and later increased to 4.0 to 5.0 mmol/l". (3 mmol/ = 116mg/dl)

Nutrition and Heart Disease Causation and Prevention Edited by Ronald Ross Watson and Victor R . Preedy

2) The epidemiology of coronary heart disease in South Africa

"Numerous reviews, past and present, have emphasised the rarity of coronary heart disease (CHD) in Africa. In 1960 in Uganda, CHD was considered to be 'extremely rare'.I In 1977, black Africans were described as being 'virtually free of hypertension and CHD'.' In the same year, at Enugu, Nigeria, over a 4-year period, not one patient out of 348 with cardiac disorders had the disease.In 1983, in the UK, a leading article entitled 'British and African hearts' underlined the tremendous contrast between the experience of CHD in the two population groups: From 1988 to 1993 in Zimbabwe, at Parirenyatwa Hospital, the main referral centre for the country, there was an annual average of 6 black patients with acute myocardial infarction.' Even at present, as concluded in a comprehensive review compiled in Nigeria,'CHD is still rare ... despite its increased incidence in recent years.' This rarity applies particularly to rural dwellers, as recently noted in Tanzania.'"

".....Soweto (which now has a population of 3 - 4 million), according to records of the Department of Cardiology at Baragwanath Hospital (3 200 beds), 35 blacks were diagnosed with CHD in 1992,51 in 1993, and 62 in 1994. However, of the latter number only 36 were Sowetans; the rest lived elsewhere.I' Clearly CHD remains very uncommon in urban blacks in South Africa. To afford perspective, it could be asked how uncommon CHD is in urban blacks, compared with its occurrence in Western populations? Of the population of Soweto, almost all attend Baragwanath Hospital when serious illness occurs. If it is assumed that all the 36 patients with CHD mentioned ultimately died from the disease, CHD would be responsible for only about 0.2% of the roughly 20000 deaths occurring annually in Soweto, an extremely low proportion even allowing for uncertainties. In Europe, in the Seven Countries Study,16 for those in the Mediterranean countries and inland the age-standardised 25-year CHD mortality percentages were 4.7% and 7.7%, respectively. The proportions reported for countries in Northern Europe and for the USA were far higher, namely 16.0% and 20.3%, respectively. These comparisons with Western populations underline the very low occurrence of CHD in urban blacks".

http://archive.samj.org.za/1999%20VOL%2089%20Jan-Dec/Articles/02%20February/4.2%20THE%20EPIDEMIOLOGY%20OF%20CORONARY%20HEART%20DISEASE%20IN%20SOUTH%20AFRICA.%20A.R.P.%20Walker.pdf

Peter said...

I don't understand some of the comments I see here. 3/4 of the world lived on a high-starch diet still few decades ago, diabetes, obesity, breast cancer were rare. People who followed basically ultra-high carb vegeterian diets were exceptionally healthy as Western medical professionals documented already hundred years ago:

"In 1940, I confirmed De Langen’s results . . . by the observation that in North China, coronary disease, cholesterol [gall]stones and thrombosis were practically nonexistent among the poorer classes. They lived on a cereal-vegetable diet consisting of bread baked from yellow corn, millet, soybean flour and vegetables sautéed in peanut and sesame oil. Since cholesterol is present only in animal food, their serum cholesterol content was often in the range of 100 mg. per cent. These findings paralleled the observation of De Langen that coronary artery disease was frequent among Chinese who had emigrated to the Dutch East Indies and followed the high fat diet of the European colonists (Snapper 1963, 284)".

De Langens observations from Java, Indonesia are classics.

"After thus documenting the rarity of gallstones, de Langen wrote about his observations of vascular phenomena: “. . . thrombosis and emboli, so serious in Europe, are most exceptional here. This is not only true of internal medicine, but also on surgery, where the surgeon needs take no thought of these dreaded possibilities among his native patients. Out of 160 major laparotomies and 5,578 deliveries in the wards, not a single case of thrombosis or embolism was seen” (de Langen and Lichtenstein 1936, 491-492)".

"De Langen made similar observations on the absence of angina pectoris and the by-then-recognized syndrome of myocardial infarction. In contrast, his Dutch colonial patients had the frequency of such conditions expected among his fellow countrymen at home. The following confirmatory account is from the memoir of Isidore Snapper:

My friend and former co-resident in Groningen, C. D. de Langen, had discovered in 1916 in Indonesia, that the obligatory vegetarian Oriental, whose intake of cholesterol was practically zero, does not develop gallstones. Soon it appeared that not only cholesterol stones of the gall bladder but also arteriosclerosis and phlebitis (also lung emboli) hardly ever occur among the Orientals (van Lieburg 2004, 171)".

http://www.epi.umn.edu/cvdepi/essay.asp?id=111

Jorge Tafich said...

It would be important to include the vitamin D variable to every cholesterol topic as it has the mechanism to lower it. The latitude also would be relevant.

Manual azaa said...

wow your very interesting article to read. I was nice to be able to follow your articles

EF said...

I find the cancer/insulin connection concerning and that serves partly as the basis for my moderate calorie, high fat, low carb diet. I

Jane said...

@EF
Cancer is largely a problem of non-functional mitochondria, not of insulin. Have a look at this article about the remarkable effects on cancer cells of waking up their mitochondria with dichloroacetate.

'Evangelos Michelakis of the University of Alberta in Edmonton, Canada, and his colleagues tested DCA on human cells cultured outside the body and found that it killed lung, breast and brain cancer cells, but not healthy cells. Tumours in rats deliberately infected with human cancer also shrank drastically when they were fed DCA-laced water for several weeks.

'DCA attacks a unique feature of cancer cells: the fact that they make their energy throughout the main body of the cell, rather than in distinct organelles called mitochondria. This process, called glycolysis, is inefficient and uses up vast amounts of sugar.

'Until now it had been assumed that cancer cells used glycolysis because their mitochondria were irreparably damaged. However, Michelakis's experiments prove this is not the case, because DCA reawakened the mitochondria in cancer cells. The cells then withered and died (Cancer Cell, DOI: 10.1016/j.ccr.2006.10.020).

'Michelakis suggests that the switch to glycolysis as an energy source occurs when cells in the middle of an abnormal but benign lump don't get enough oxygen for their mitochondria to work properly (see diagram). In order to survive, they switch off their mitochondria and start producing energy through glycolysis.'
http://www.newscientist.com/article/dn10971-cheap-safe-drug-kills-most-cancers.html

Cancer cells should normally be sought out and killed by cells of the immune system, which can't do it if their own mitochondria aren't working well. If you want to avoid cancer, look after your mitochondria. They need micronutrients. Don't eat any food that has had micronutrients removed, however tempting it may be.

Kurt G. Harris MD said...

Joe Berne said:

"I wonder how much of the hostility directed towards the food reward hypothesis is because of the effect it could have on the paleo industry. If the key (or at least one key) to successful weight loss is eating relatively plain food with little variety how are we going to continue to churn out food porn blogs, cookbooks, and so forth? Your work is endangering the entire economic foundation of the paleo movement."

Check out the big brain on Joe : )

I would also add that in addition to being threatening to cookbook generation and the manufactured complexity that is required to sell books, FR is extremely threatening to the larger cultural force that fast food and food as entertainment are really subsets of - the constant entertainment, short attention span culture of late industrial capitalism.

People are seeking and routinely having too much mindless "fun" when they eat. This is a really radical idea, actually. Some do it with doughnuts and chips, some do it with bacon and coconut.

Nothing could be more disruptive to an idea that everyone from vegans to butter and bacon lovers shares - the idea that everything we do, including eating, must be entertaining and fun and instant. (Aravind gets this and has applied the lessons learned to other areas of life, including digital life, as have I...)

And then there is the threat to "man the hunter" paleofantasies if it is acknowledged that copious starches from whole food sources are not after all poisonous and that our needed animal products can include small game and insects ...... no clovis points might be needed for the whole lifespan of a human...

Plenty of reasons to be really upset about food reward if you think about it......

Stephan, thank you for your continued generosity and diligent work here.

LeonRover said...

Kurt Archevore

What you just said.

Slainte

gallier2 said...

You know what , Kurt? Keep your puritanism and shove it where the sun doesn't shine. What next? Cutting the end of people penises to avoid masturbation.
Meanwhile let me enjoy my food like every other Frenchman who would laugh you out if ever you suggested, bland, fatless food was any good.

Alex said...

If food simply being tasty drives one to overeat, then perhaps a bland diet is called for. For me, the only aspect of food reward that comes into play is the addictive nature of fatty carbs, so I avoid starch, which eliminates both the addictive foods and the appetite increasing effects of slamming glucose into the bloodstream. I greatly value the sensual pleasure of food, and the food I do eat is delicious, but my diet does not drive me to overeat. There's nothing inherently wrong with sensual pleasure; the problem is addiction to sensual pleasure to the point of dysfunction.

Delphia Chu said...

Your blogs and accumulation attracts me to arrive rearward again n again
kenistylessupermanstamina

Delphia Chu said...

Howdy dudes! Wonderful stuff protects it up.
Adelina Berney

Kurt G. Harris MD said...

@Gallier2

You look more than a bit fat in your picture, about a size 19 neck maybe?

Thanks for insulting me so I could feel more comfortable in pointing that out. It's struck me as funny for a long time that someone who looks like you is advocating for a high fat VLC diet, but maybe you don't "eat your own cooking" as they say, or maybe you'd be Jimmys' size without your fear of glucose.

It's not puritanism to note that most of the western world is getting fat because of cheap available food engineered to be hard to resist and that this is, in fact, hard to resist.

Even for me. And that is the point.

Everyone thinks it's about macronutrients or metabolic magic, but it is really about culture subverting nature.

And neither I nor Stephan ever said a damned thing about the necessity for bland, fatless food for everyone. I eat plenty of animal fat in my home prepared meals.

To say that some people need to "blandify" their diet to reduce its entertainment factor is no more of a moral judgement than saying some people need insulin injections and some people don't.

But if my necktie only came to mid sternum after wrapping it around my neck I would go for a bit more blandness for sure. Have you tried it?

Maybe you should before telling me to shove it....

screennamerequired said...

Joe Berne said:

"I wonder how much of the hostility directed towards the food reward hypothesis is because of the effect it could have on the paleo industry. If the key (or at least one key) to successful weight loss is eating relatively plain food with little variety how are we going to continue to churn out food porn blogs, cookbooks, and so forth? Your work is endangering the entire economic foundation of the paleo movement."
I could definitely see a
"Low food reward Low palatablity Cookbook" hitting the amazon best sellers. Followed by Low food reward Low palatablity cooking shows and maybe even a "Low food reward" annual cruise.

Jovita Graficom said...

waw this is very interesting. I am happy to visit on your site

ankush said...

Very nice.. I like your blog. indoor cycling courses

Sarah said...

Hi Stephan,
I agree that J. Stanton is oddly vitriolic, but here's one thing he made me think about in his series 'Why Are We Hungry?', and that I keep hoping you'll address: our sense of satisfaction and desire to stop eating seems to be both physical and psychological. That is, we have to satisfy our body's need for nutrients, but we also have to satisfy our mind's idea of what a satisfying meal is. In this sense, 'food reward' can be used positively to get us to eat healthy foods.

I get that the food reward hypothesis is actually pretty simple, but I wonder whether the low-food-reward diet you suggest is problematic because it seems to aim to reduce food reward down to zero, and thereby eliminate the role of psychological satiation.

I actually find the food reward concept to be helpful in other ways in my diet, but I find J. Stanton's argument that psychological satisfaction is crucial to feeling satiated to be a powerful one.

Thanks for all your work--you and Paul Jaminet have become the only people I trust in the world. I mean, about nutrition.

Stephan Guyenet said...

Hi Sarah,

I hear what you're saying. I want to clarify that I never suggested we should "reduce food reward down to zero". It's frustrating for me to see my writing become twisted as it makes its way through the Internet. I simply pointed out that reducing reward/palatability can be a useful fat loss tool, and excessive reward/palatability can cause fat gain.

Stanton has tried to argue that we need a certain amount of reward/palatability to feel satisfied. It's possible that's true to some extent (at least in the beginning until adaptation occurs), but the evidence he used to support that idea was not convincing and didn't really address the point he was trying to make.

The studies that actually measured food intake showed that within a meal, higher palatability = higher food intake. Very consistent. If you look at the studies that measured hunger, cravings, or food intake following a meal, they're all over the place and you can support any hypothesis you want if you're willing to cite the evidence selectively. Stanton took advantage of this.

It is possible that some people seek a certain level of pleasure from their food, and they won't feel totally satisfied if they don't get it. Part of this is simply that we're accustomed to high-reward food, just like one becomes accustomed to having coffee and cigarettes. Getting a certain amount of satisfaction from food may be a good thing in the long run, but we overdo it today. Keep in mind that there's nothing physically or psychologically necessary about the food we eat today, since no culture has ever eaten this way before. If you aren't willing to put aside the most highly palatable foods, you will undermine your fat loss efforts.

Sanjeev said...

I want to clarify that I never suggested we should "reduce food reward down to zero". It's frustrating for me to see my writing become twisted as it makes its way through the Internet. I simply pointed out that reducing reward/palatability
____
My understanding has always been that the "reward" systems are intricately intertwined with the systems that provide pleasure, but the reward systems themselves do not PROVIDE reward, they PROMISE reward.

That's the reason one eats more: these systems hold out the promise of happiness, satisfaction ... "something good out THERE", but once one eats that food that activates the reward system the promise is unfulfilled, thus one wants more.

one keeps eating "rewarding" food because that food triggers more WANTING, but little satiety.

the reward systems MOTIVATE and only satisfy incidentally. When one reduces food that stimulates the "reward" system one is motivated to eat less yet one could easily feel more satisfied and happier and feel more pleasure.

Gambling doesn't satisfy yet gamblers are motivated. Many freely admit they get no pleasure from gambling but gamble because there's some undefinable promise lurking behind that next bet.

IMHO the reward system doesn't really make one want; wanting (one of the concepts JS concentrates on) and motivation can be two separate things.

Sanjeev said...

> J. Stanton's argument that psychological satisfaction is crucial to feeling satiated to be a powerful one
_____
Apples and oranges.

Look up Olds and Milner's experiments @McGill and their descendants.

Some of the behaviourists, building on Olds & Milner's work tried stimulating the equivalent human systems (there is overlap but I forget if hand if they're the exact same centres we're discussing).

The patients that got those treatments (electrical stimulation[0]) felt NO satisfaction.

[0] it may have been these experiments that inspired Larry Niven's "Wireheads", but he too got it extremely wrong.

Sanjeev said...

another thing occurred to me a while back, just a pet theory/proposal: the reward system has hooks into memory systems to motivate forgetting the promise so the promise can keep motivating.

If the whole thing were connected up in a feedback loop that measured let's say the "amplitude" of pleasure/satisfaction/pleasure that was originally promised, and the eventually-delivered amplitude, and compared the two (promised versus delivered) one could quickly figure out what's going on.

Sarah said...

That's a helpful clarification; thank you. If it's any comfort, the 'reducing food reward down to zero' bit didn't come from the internet, but rather was my interpretation of Levels 3-5 of your simple food diet. It's not totally inaccurate--based on your arguments here, it sounds like reducing the role of food reward in one's diet as much as possible is actually a worthy goal (though I fully understand that others will use the suggestion as an excuse to dismiss you). I know that since I started reading your research I've been consciously trying to reduce the role of food-generated dopamine in my life and replace it with dopamine from non-food activities.

It also makes sense that the results are so inconsistent on the role of psychological satisfaction in one's diet, as one's sense of satisfaction/meaning, is radically subjective. Thanks again--you're a star:)

Sarah said...

Thanks, Sanjeev--another helpful clarification. I looked up the Olds and Milner experiments, and the proposed distinction between desire and pleasure (wanting and liking) makes a lot of sense. I like your memory hypothesis, too--it fits with my experience in which I have absolutely zero memory of how unsatisfying it is to eat junk food.

Sanjeev said...

Most languages don't provide enough precision to tease out the various specifics

Keeping the historical names, like "reward system" loses casual readers at the get-go and leaves a huge hole ... critics that understand the theory can exploit these mis-understandings (and others like the circularity thing, or choosing arbitrary or confusing conscious/unconscious or brain/body demarcation lines) when targeting a lay audience, and critics that don't understand just muddy the situation all around.

bentleyj74 said...

@ Sanjeev and Stephan

"My understanding has always been that the "reward" systems are intricately intertwined with the systems that provide pleasure, but the reward systems themselves do not PROVIDE reward, they PROMISE reward.

That's the reason one eats more: these systems hold out the promise of happiness, satisfaction ... "something good out THERE", but once one eats that food that activates the reward system the promise is unfulfilled, thus one wants more.

one keeps eating "rewarding" food because that food triggers more WANTING, but little satiety. "


This has been my understanding as well, is that where you meant to go with it?

Sanjeev said...

I commented just because I thought it would clear something up for the discussion that was ongoing above

some internet experts are using the regular meaning of reward in reward system and they're mixing the 2 meanings haphazardly, regularly confusing laypeople

That was what I wanted to add

Sarah said...

Hi Sanjeev,
I think it's more radical than that--all languages are nothing but socially-constructed meaning. So I understood one thing by 'reward system' before this clarification; now I understand another thing. Stephan can continue to use the term 'reward system', but he can't control the meaning inferred by people who are interested in criticizing him. It's not a matter of right or wrong; it's a matter of reaching consensus over the term's meaning among people who are interested in doing so. J. Stanton's loyal readers will accept his meaning; Stephan's loyal readers will accept his; a newspaper like USA Today could generate a completely different meaning for its readers.

Differences in meaning are inevitable, and happen in every field. My mother is an expert in education; it drives her crazy to see the mainstream media's portrayals of good teaching. I'm an expert in the Middle East; I've had to stop reading about the subject in U.S. newspapers because it makes me so angry. I think you kind of have to accept how people's brains work, and figure out the best places to direct your energy.