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Nutrition Transition
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In the book, Good Calories, Bad Calories, author Gary Taubes related the story of Captain Charles Wilkes exploration of the Polynesian atolls of Tokelau in January of 1841. The scientists who went along expressed surprise that the islanders appeared to thrive on a diet of mostly coconuts and fish. They also ate a starchy melon known as breadfruit (introduced in the late nineteenth century). At least from 1841 until the introduction of the breadfruit, more than 70 percent of the calories in their diet came from coconut, 50 percent from fat of which 90 percent was saturated fat.

Tokelau is administered by New Zealand since the mid-1920s and the atolls remained isolated except for occasional visits from trading ships from Samoa. By the mid-1960s the population grew to almost two thousand and the New Zealand government became concerned about the threat of overpopulation and initiated a voluntary migration program. Half of the Tokelauans moved to the mainland.

Ian Prior led a team of anthropologists, physicians, and epidemiologists studying the health and diet of the emigrants as they resettled. They also studied those who remained behind on the atolls as their diets became progressively westernized. The study was called the Tokelau Island Migration Study (TIMS) and was a remarkably complete survey of the health and diet of all men, women, and children. It was likely the most comprehensive migration study ever carried out in the history of nutrition and chronic-disease research.
In the mid-1970s, imported foods became available and refined carbohydrate consumption went from 12 pounds per person per year to 70 pounds. By 1980 they were eating significantly more meat. Through the 1960s the only noteworthy problems were skin diseases, asthma and infectious diseases. In the decades that followed, just as diabetologist George Campbell predicted, diabetes, hypertension, heart disease, gout and cancer appeared. This coincided with a decrease in cholesterol levels, consistent with the decrease in saturated fat consumption. Average weights increased twenty to thirty pounds. A smaller trend was seen in Tokelauan children.

The only conspicuous departure from these trends came in 1979 when the chartered passenger and cargo ship Cenpac Rounder ran aground and the islanders went five months without a food or fuel delivery. The New Zealand Herald reported

“There was no sugar, flour, tobacco and starchy foods and the atoll hospitals reported a shortage of business during the enforced isolation. It was reported that the Tokelauans had been very healthy during that time and had returned to the pre-European diet of coconut and fish. Many people lost weight and felt very much better including some of the diabetics.”

The migrants to New Zealand suffered immediate and extensive changes in diet. Fat and saturated fat consumption dropped and were replaced by carbohydrates. Their weight and blood pressure went up and their cholesterol levels decreased. Hypertension, diabetes, gout and osteoarthritis were at “exceptionally high” incidence levels.

This higher incidence among the migrants was very difficult to explain especially according to the Ancel Keys hypothesis (that excess fat consumption causes heart disease) and the exercise hypothesis to name a few. First, the migrants smoked fewer cigarettes than those who remained behind so tobacco was ruled out. The migrants were younger which suggested that there should be less chronic disease on the mainland. Obesity became a problem even though the migrants’ lifestyle was more rigorous than those left behind. The work was more strenuous for men and women and they all walked significant distances. The migrants consumed considerably less fat than those left behind so there should have been less incidence of heart disease, not more. In fact, there was more incidence of all chronic disease among the migrants.

Prior and his colleagues acknowledged that their data made this difficult to explain in any simple manner. They used an old standby: “that a different set of relevant variables might account for observed differences in incidence.” They tried to explain each thing in isolation like excess weight “caused” increased hypertension, diabetes, coronary heart disease and gout. They appeared to have more salt so that might explain the hypertension along with stress related to the migration. The red meat might have contributed to the gout and the asthma was likely caused by allergens in New Zealand that were absent in Tokelau.

Transitions like this are very common and I’ve written about many of them on this blog. Once the isolated population abandons the native diet which is invariably high in fat and consumes a carbohydrate-rich diet, they quickly develop all the diseases of civilization. They have no genetic or racial protection. These histories demonstrate how fast these diseases appear yet they also demonstrate how quickly they can be brought under control. Your low carbohydrate diet may not be doing everything you expect it to do, but there are far more reasons than weight loss to consider such a diet. Even if you have to go to the more extreme restricted versions for a while to get everything working, it just might be worth it when you consider what happened on Tokelau. Obesity is one of the many symptoms of a metabolic disorder caused by chronically-high insulin. This is the result of excessive consumption of refined and easily digestible carbohydrates. Controlling insulin is necessary to protect against all the symptoms of the disorder regardless of whether you reverse obesity.

The “experts” response to the Tokelau study was to assume that the simultaneous appearance of the diseases of civilizations was a coincidence and that each disease had its own causal factors. However, Peter Cleave believed that the diseases are a manifestation of a single underlying pathology. Cleave argued that this was the simplest possible explanation for the evidence and that it deserved a presumption of truth until compelling evidence refuted it. This was Occam’s razor (When a simple solution explains all the observations then it is not necessary to search for a more complex one) and it should be a guiding principle for all scientific endeavors.

In the 1950s, clinical investigators began to construct the basis for the carbohydrate hypothesis which could explain the appearance of the diseases of civilization going back over a century. Their research evolved in multiple threads that resulted in some of the most fundamental discoveries in heart disease and diabetes research.

In 1980 the research came together when Stanford diabetologist Gerald Reaven proposed the name Syndrome X to describe the metabolic abnormalities common to obesity, diabetes, and heart disease. All of these, at the very least, are exacerbated by the consumption of sugar, flour, and other easily digestible carbohydrates. Syndrome X includes elevated triglycerides, low levels of HDL cholesterol, hypertension, chronically high insulin, insulin resistance, and glucose intolerance. Over the years they added small dense LDL particles; high levels of a protein called fibrinogen that increases the likelihood of blood-clot formation; elevated uric-acid concentrations in the blood – the precursor to gout; and, chronic inflammation marked by a high concentration of C-reactive protein. Despite an acknowledgement that this collection of diseases is related, Dr. Reaven does not believe metabolic syndrome is caused by consuming refined and easily digestible carbohydrates. Call it cognitive dissonance.

The National Heart, Lung and Blood Institute finally recognized Syndrome X in 2001 calling it metabolic syndrome. Some called it MSX to cover all bases but the result is a disorder of carbohydrate metabolism and is certainly a consequence of eating refined carbohydrates such as sugar and white flour as Peter Cleave predicted with his Saccharine Disease hypothesis, which was stolen by Dennis Burkitt and his fiber crusade.

Only in the late 1990s did metabolic syndrome have an influence outside of diabetes research. Only recently has the potential implications of metabolic syndrome on heart disease and other chronic diseases began to be appreciated by the research community. However, metabolic syndrome is still widely viewed as a minor modification to Keys’ hypothesis even though metabolic syndrome implies that Keys is incorrect. Saturated fat is still seen as the primary evil in modern diets.

The stories of the Tokelau, Inuit, Zulus, West Africans of Gabon, the Native Americans of the Great Plain, among others, stand as an example. The pattern of disease was caused by the increased sugar and flour in their diets. The pattern in the United States seems different but it’s really not.

Many of our “experts” such as Ancel Keys believed in a very flawed notion of the “changing American diet” which envisioned an idyllic era free of chronic disease until Americans were sickened by the spread of fat and meat into their diet. This has been repeated so often it has taken on the appearance of truth; however this conclusion is based on remarkably insubstantial and contradictory evidence.

Historians of American dietary habits observed that Americans, just like the British, were traditionally a nation of meat-eaters, suspicious of vegetables and expecting meat three to four times a day. Historian Harvey Levenstein estimated in 1793 that American ate eight times as much meat as bread. The USDA provided an estimate that the typical American was eating 178 pounds of meat annually in the 1830s, forty to sixty pounds more than was reportedly being eaten a century later. Fanny Trollope (mother of novelist Anthony Trollope) documented this fact in her book, Domestic Manners of the Americans. She wrote of her impoverished neighbor who had “plenty of beefsteaks and onions for breakfast, dinner and supper, with very few other comforts.”

The population underwent a doubling between 1880 and 1910 and the livestock production could not keep pace according to the Federal Trade Commission report of 1919. “This lower rate of increase among meat animals caused the amount of meat consumed per capita in the United States to decline.” There was another decrease between 1915 and 1924 likely due to war rationing.

This “changing American diet” argument has been used to support the proposition that Americans should eat more grain, less fat, and particularly less saturated from red meat and dairy products. The same food-disappearance reports used to bolster the low-fat high-carbohydrate diet also provided trends for vegetables, fruits, dairy products, and the various fats themselves. These numbers tell a different story and might have suggested a different definition entirely of a healthy diet if they were taken into account. During the decades of the so-called heart disease “epidemic”, vegetable consumption increased dramatically, as consumption of flour and grain products decreased. American nearly doubled their consumption of leafy green and yellow vegetables, tomatoes, and citrus fruit.

This change was clearly the result of nutritionists emphasizing the need for vitamins from the fruits and green vegetables that were conspicuously lacking in our diets in the nineteenth century. University of Kansas professor of medicine Logan Clendening wrote in The Balanced Diet in 1936:

“The preponderance of meat and farinaceous foods on my grandfather’s table over fresh vegetables and fruits would be most unwelcome to modern palates. I doubt he ever ate an orange. I know he never ate grapefruit, or broccoli or cantaloupe or asparagus. Spinach, carrots, lettuce, tomatoes, celery, endive, mushrooms, lima beans, corn, green beans, and peas were entirely unknown rarities. The staple vegetables were potatoes, cabbage, onions, radishes, and the fruits – apples, pears, peaches, plums, and grapes and some of the berries in season.”

From the end of World War II, when the USDA statistics became more reliable, to the late 1960s while coronary heart-disease mortality rates supposedly soared, per-capita consumption of whole milk dropped steadily and the use of cream was cut in half. We ate dramatically less lard(7 pounds per person per year, compared with 13 pounds) and less butter (4 pounds versus 8.5) and more margarine (9 pounds versus 4.5 pounds), vegetable shortening (17 pounds versus 9.5 pounds), and more salad and cooking oils (18 pounds versus 7 pounds).

As a result, during the worst decades of the heart-disease “epidemic” vegetable-fat consumption per capita in America doubled from 28 pounds during 1947-49 to 55 pounds in 1976 while the average consumption of animal fat (including the fat in meat, eggs, and dairy products dropped from 84 pounds to 71.

The increase in total fat which Ancel Keys attributed to the epidemic of heart disease paralleled not only the increased vegetable and citrus fruit consumption but also the increased vegetable fat consumption which is considered “heart healthy”. During all this time, we decreased animal fat consumption.

Perhaps we need to learn the lessons of the Tokelauans and increase consumption of saturated fat and eliminate our consumption of vegetable fats, sugars and refined and easily digestible carbohydrates. It’s interesting that when the experts were able to find cancer in laboratory rats, they were only able to do so after feeding the rates polyunsaturated fats, never saturated fats. Interesting…