PaNu - The paleolithic nutrition argument clinic

[rogermexico]

Re: PaNu - The paleolithic nutrition argument clinic

Hello Bart

I've seen that one before - its a good review

Thank you for posting it.

Re: PaNu - The paleolithic nutrition argument clinic

The tone and the substance of his comments is indeed exceedingly America-centric, and limited by that, IMO. Americans are far too abjectly in awe of doctors and scientists telling them what is healthful for them to eat. It is an approach which is *culturally impoverished*.

[rogermexico]

Re: PaNu - The paleolithic nutrition argument clinic

another thought: something i often say to patients is that the most striking thing i've learned in my years of practice is how much individual variability there is: in symptoms and presentation, in response to various treatments, and in ability to tolerate various treatments. put that together with the many testimonials out there for any diet you care to name: mediterranian, chinese, low carb, vegan, paleo, and so on. why should we assume that we all would do best on any one particular regime? why should we assume that any one of us will do best on only one particular regime? it seems to me more likely that there will be a variety of healthy diets, each more or less suitable for any individual. what we do know for sure, however, is that some diets are bad for all comers.

All good speculation. The analogy I might use is drug treatment. Individual response to psychotropic medication, I am guessing, is a big part of your practice. That in no way stops us from formulating and testing hypotheses about medical treatments that might be applied to large populations, and on average might be useful to them or even curative more often than not.

The human body, and even most mammals have an endocrine system that is pretty similar and insulin has pretty invariant role in all animal life, even if there are genetic variations in receptor sensitivity (which there clearly are)

That is why in starting to identify what might be "bad for all comers" I start with cellular and tissue metabolism and not with archaeology.

The rules are just an arbitrary construct to help the average joe deal with the world of superabundant garbage we call food - you can see that there can be huge variation in the actual diet as long as one is avoiding high carb intake and grains.

Results using indirect markers of health like % body fat and indicia of inflammation like CRP and cardiovascular markers is for now the best we have clinically, and for me they all go in the same positive direction.

Re: PaNu - The paleolithic nutrition argument clinic

Americans, gastronomically speaking, are barbarians. We have no culinary history worth a damn, and what we have is not particularly healthy.

It seems to this reader, that this swarm of American MD's writing one learned and exotic theory of nutrition after another, while they blithely ignore the excellent nutrition traditions of dozens of other countries around the world, and indeed, arrogate the wisdom to sally forth and denigrate those nutrition traditions when they countervene these US doctors pet theories - this whole tribe of American doctors are making the US look slightly ridiculous in the eyes of other cultures, who are far older and wiser about food than we are.

A US MD setting out to write a book on good nutrition would impress me a lot more if they humbly went out and collected healthful recipes from around the world. Brash, intellectually arrogant - indoctrinating Americans who are by and large, abjectly submissive to the notion of the "scientific method" being the sole font of reliable insights - all of this is quintessentially American, and speaking as someone who is half Italian by cultural upbringing, I can only say that I am decidedly not under it's spell. There is something a bit pathetic about seeing Americans flock to the next scientist who wishes to inform them about their nutrition.

I like Raja's advice better - my instinct tells me it is more down to earth and less enamored of grand unifying theories.

[ThePythonicCow]

Re: PaNu - The paleolithic nutrition argument clinic

JK - your comment makes no mention of the patronising responses obtained to date.

I will agree, Lukester, that Roger might not be the paragon of virtue when it comes to the tone of his replies. But the strongest of your objections seem to be over whether his comments are too American-centric, not over the tone of his replies.

[jk]

Re: PaNu - The paleolithic nutrition argument clinic

JK - your comment makes no mention of the patronising responses obtained to date. Also, I not you do not press your skeptical questions beyond Roger's first dismissals, nor seem to have much conviction in the doubts you express. These are the differences between us.

if you find the comments patronizing, i suggest you ignore the tone and focus on the content. you reinforce whatever it is you respond to. respond to a [perceived] negative tone and you cultivate discord. ignore it to reinforce discourse.

i have no need to press my questions. i asked them, i got rm's answers. i plan to do a bunch of reading [this has been a periodic interest of mine] and draw my own conclusions. to date the most persuasive thing i've read is joel fuhrman's "eat to live," which also eliminates refined carbs, but in a very different, low-fat way. but i remain open to learning more.

i am most convinced by the notion that we do not have definitive answers. also, i don't know if you noted an earlier post of mine, which i'll repost here:

another thought: something i often say to patients is that the most striking thing i've learned in my years of practice is how much individual variability there is: in symptoms and presentation, in response to various treatments, and in ability to tolerate various treatments. put that together with the many testimonials out there for any diet you care to name: mediterranian, chinese, low carb, vegan, paleo, and so on. why should we assume that we all would do best on any one particular regime? why should we assume that any one of us will do best on only one particular regime? it seems to me more likely that there will be a variety of healthy diets, each more or less suitable for any individual. what we do know for sure, however, is that some diets are bad for all comers.

Re: PaNu - The paleolithic nutrition argument clinic

JK - your comment makes no mention of the patronising responses obtained to date. Also, I note you do not press your skeptical questions beyond Roger's first dismissals, nor seem to have much conviction in the doubts you express. These are the differences between us. I find US doctors (he's a radiologist BTW, not a general practitioner) who assume this paternalistic, dismissive tone grate upon my cultural upbringing from childhood in another country. That was a country whose entire population amply evidenced outstanding health characteristics in flat contradiction to Roger's haughtily asserted theories (you are seriously out of your depth Lukester - implies a supreme assurance he's figured all the angles).

I have the impulse to tell the armies of American diet doctors to take a hike, because *actually* I know such theories are based upon a core of bunk which they don't care to squarely address. Notice Roger mentioning how the studies you dig up are busily engaged in self-reaffirmation whereby they systematically cull out all research contrary to their thesis? Then take note of how Roger skates right past points such as I made above, that you can point to a dozen countries in the world where a diet rich in carbohydrates and grains does not produce any trace of the illnesses he warns are it's dire and immediate consequences.

I actually think it is you who could benefit by being maybe just a little more challenging when your intuitions hint to you that something is amiss in the theory. I assure you, based upon my 25 years in another country which had some of the best fitness stats in Europe, that there is indeed something amiss at the core of this theory.

lukester, you should really think about pythoniccow's comment. there is no need to be hostile or unpleasant here. i think i have a lot of the same questions you do, but i manage to ask them in a spirit of inquiry, not debate let alone dispute. [not that i'm any paragon:rolleyes:] there's no need to be strident. the more strident you are, the less you are heard. the tone drowns out the content.

[jk]

Re: PaNu - The paleolithic nutrition argument clinic

lukester, you should really think about pythoniccow's comment. there is no need to be hostile or unpleasant here. i think i have a lot of the same questions you do, but i manage to ask them in a spirit of inquiry, not debate let alone dispute. [not that i'm any paragon:rolleyes:] there's no need to be strident. the more strident you are, the less you are heard. the tone drowns out the content.

Re: PaNu - The paleolithic nutrition argument clinic

Roger - you've mentioned elsewhere, with dismissive tone, how all the "pop science" practitioners skate over any data not consonant with their theories.

Meanwhile, you've posted a large number of comments on diet here in the past week, yet don't choose to discuss those instances where an entire nation's demographic health stats ran flatly counter to your thesis for 40 years?

And how about the question (third or fourth time I've asked) about the appropriateness of a 60% fat component in the diet of a 75 year old? If you hesitate to recommend such a high fat component to someone that age, then maybe this regimen is less "natural" than you like to assume?

(ANSA) - Rome, October 10 - Farmers warned on Tuesday that soaring obesity levels in Italy would soon undermine the country's record for healthy long living ...

thanks to the Mediterranean diet, Italian men currently had a life expectancy of 77.4 and Italian women of 83.6. It stressed these figures were far higher than the European Union average ... children of this generation could be the first in history to have a shorter life than their parents because of illnesses caused by obesity," it said . ... "The reason is that the traditional Italian diet based on bread, pasta, fruit, vegetables and olive oil has been abandoned," Coldiretti said . ... The union called on the government to act immediately, saying that one of the first things to do would be to ensure that healthy food was served in school canteens..

The most telling information on the virtue of any dietary philosophy ... emerge when you compare entire nations to each other, which have vastly different dietary traditions, and you adopt multi-decade time spans ... For forty years, the Italians had the lowest incidence of obesity ... of any country in Europe ... And famously, the very cornerstone of their diet was conceived around meals rich in grains, fruit and vegetables.

The classic Italian diet of the post WWII era left them the healthiest and slimmest of all Europeans. ... But this is the point Roger does not address satisfactorily ... The Italians captured the "most healthy and slim" title undisputably for 30 or more years after WWII. ... they were far slimmer than Germans and Britons (who traditionally eat a fair quantity more meat than the Italians) for decades.

If he had grown up in Italy in the 1950's and 1960's as I did, when bread and pasta were part of every meal, he would today find his theories backed into a corner - because at no time was obesity in any particular evidence in that country - that is not a "sampling anomaly" or a "statistical anomaly" or "mainstream media hype" ... I grew up there. I saw with my own eyes for decades how a carbohydrate laden diet actually produces slim people.

Rogers theories contain lots of truthful insights, but they also contain at least one really large, America-centric canard at their very core. Carbohydrate based diets "Italian style" have historically been proven, at a nationwide level, and across decades to NOT be fattening, nor unhealthy, nor leading inexorably to diabetes. I call this notion bunk, because I have seen the opposite in my youth, incontrovertibly.

Another question Roger has not answered is what advisability there is to keep a 70 year old on a diet consisting of 60% fats? And if the advice in the 70 year old's case is that they reduce this percentage, then evidently the 60% fat consumption is not quite as "inherently natural" to humans as has been portrayed by this theory? A truly balanced and wholesome ratio of foods should be good for all age groups.

Meanwhile it is the heavily patronising tone of your replies - (while the core of your thesis is still in reality very much in discussion) that grates on skeptics like me. Your "Stick to economics Lukester, you are seriously out of your depth" comment arrogates to you a wisdom on nutrition which you assume anyone who is not a doctor must lack. Americans bow instinctively before such claims to authority. For an American, wisdom about food is something which must be referred to scientists for insights. :rolleyes: This speaks of a cultural poverty - it actually says very little that is definitive on what a truly healthy diet actually should be. The American doctor arrogating a wisdom about nutrition greater than that of centuries of tradition elsewhere - this grates upon my clutural upbringing.

[ThePythonicCow]

Re: PaNu - The paleolithic nutrition argument clinic

This is at the core what irks me about the plethora of diet books being written in America today.

There is a difference, Lukester, between observing something and being irked by it.

Perhaps it is true (I lack the personal experience to comment) that Roger's comments are more relevant to the typical American diet than to many other traditional diets about the world.

Eh - so what if that is so?

That this irks you probably says more about you than about Roger's comments.

Usually when I find myself chronically irked by certain behaviour or comments of others, it is an indicator of something in myself that I have not yet integrated and instead project onto others, some part of myself that I don't like and thus far refuse to accept. (On this matter I unfortunately do have the personal experience to support my comment .)

[rogermexico]

Re: PaNu - The paleolithic nutrition argument clinic

rogermexico, found your views on diet quite intriguing

Was wondering if you could clarify your views on the differences between grains and starches, i.e., although they are both packed with carbs, the former may have the vitamins and fiber that have been hyped for the last generation - I myself am a fan of wheat fiber (insoluble) in that it appears to regulate bowel activity (e.g., prevent contstipation) - do you see any issues with wheat fiber?

Starches are polymers of simple sugars. Starches and sugars are all equally bad for your insulin levels, IMO

Grains are plant seeds. They contain carbohydrate as starches in the kernel.

Carbs are not good for reasons outlined

Unfortunately, plant seeds have carbs in the center, surrounded by fiber and some vitamins in the hull, along with glycoproteins that are not good for you.

White flour avoids some of the nasties of the hull, but then you have carbs with no vitamins. That is why flour has to be enriched to avoid nutritional diseases. So what is the point of white flour unless you are starving?

With whole wheat, you are adding back the vitamins, but also the nasty lectins in the hull and there is still too much carbohydrate. Worse than white bread for that reason. Plenty more vitamins in your meat and veggies.

Wheat fiber has zero nutritive value, and portions of the hull you are trying to avoid due to the lectins.

Eating fiber that is not already in the vegetables you have is of zero benefit IMO

Best to stick to green vegetables, nuts and berries and eat no grains.

If you want pure starch eat yams. Much better than bread.

With

Also, how does the basal metabolic rate figure into your views on diet. I've long been convinced that the calories in/calories out is not a sufficient metric to gauge weight gain/loss. I believe there is a genetic component involved; we all know thin people who appear sedentary and load on the food as well as those who seem perpetually chubby and don't appear to over-indulge.

Lots of nuance to this but treated well by Taubes in GCBC - there are genetic difference in susceptibility to bad health effects of high carb diets -less time exposed to agriculture, more benefit to low carbs and no grains. Pima indians of Arizona.

Any views of vitamin C?, Coffee?, EtOH?

No vitamins necessary with adequate animal products and green veggies.
Vit D is really a prohormone more than a vitamin and only necessary if you get no daily sun.

Coffee is harmless in moderation. Red wine, ditto. Beer is loaded with sugar.

Good Questions

Re: PaNu - The paleolithic nutrition argument clinic

The most telling information on the virtue of any dietary philosophy cannot be found in close up detailed studies. The real truths emerge when you compare entire nations to each other, which have vastly different dietary traditions, and you adopt multi-decade time spans as your sample window. Then you are getting past all the smoke, claims, obfuscations and easy disclaimers to see what it all boils down to.

For forty years, the Italians had the lowest incidence of obesity, the lowest incidence of the insulin dysfunctional illnesses, of any country in Europe - and **by far** the lower incidence of these diseases compared to the US. They were (and still are) the second or third longest lived people in the world. And famously, the very cornerstone of their diet was conceived around meals rich in grains, fruit and vegetables.

It has been heavily bastardized in it's exportation to American culture, and is indelibly ingrained in American views as a heavy, doughy, carb laded diet - well the carbs are there most certainly, but there is a large paradox to Rogers theories nested in there (which JK intuited in a couple of cited objections, but which Roger swats aside and JK compliantly discards. JK should trust his intuitions more.). The classic Italian diet of the post WWII era left them the healthiest and slimmest of all Europeans.

Today that primacy is shattered, and I read with surprise that there is an alrming reversal of trend in the young in that country. Their children are becoming obese - - but what has changed so drastically from 20 years ago, when it was well known that you could travel the breadth of the country and they were far slimmer and more long lived than their English, or Dutch, or German brethren?

Fast food, and the Americanisation (processed everything) has invaded Italy and their weight issues have exploded.

But this is the point Roger does not address satisfactorily - the most definitive assessment of any dietary tradition is captured by putting the largest set of parentheses possible around the sample group. Go large, and sample an entire nation to derive truly robust and inescapable statistics. The Italians captured the "most healthy and slim" title undisputably for 30 or more years after WWII. It is right there in the record, they were far slimmer than Germans and Britons (who traditionally eat a fair quantity more meat than the Italians) for decades.

And they did this by keeping a balance of grains and fruit and vegetables at the front and center of their diet, with meat distinctly in a second position on the dinner table.

I grew up in that country. I am 53 and remember growing up in Italy from the late 1950's and all through the 1960's. The food of Italy was exceedingly healthy, and I remember very few obese people all around me through those decades. I don't even remember many obese people from the 1980's when I came home there to visit family and friends many times. What changed in Italy over those years to cause the epidemic of obesity?

The proliferation of processed foods as American style industrialised food production took over. This is Roger's cultural viewpoint. He may have traveled, but his dietary theses are parochial to America.

If he had grown up in Italy in the 1950's and 1960's as I did, when bread and pasta were part of every meal, he would today find his theories backed into a corner - because at no time was obesity in any particular evidence in that country - that is not a "sampling anomaly" or a "statistical anomaly" or "mainstream media hype" - that is an honest to goodness report to people here from me. I grew up there. I saw with my own eyes for decades how a carbohydrate laden diet actually produces slim people.

Rogers theories contain lots of truthful insights, but they also contain at least one really large, America-centric canard at their very core. Carbohydrate based diets "Italian style" have historically been proven, at a nationwide level, and across decades to NOT be fattening, nor unhealthy, nor leading inexorably to diabetes. I call this notion bunk, because I have seen the opposite in my youth, incontrovertibly.

Understand this - I'm offering you an eyewitness account of the degree of obesity or carbohydrate induced ill health in an old European country - spanning **decades** in the post war years. Either I am a liar, or there is a singular misapprehension in Roger's thesis that lots of carbs produce hyperglycemia. My suggestion is that Roger's culinary breadth of horizons is limited by A) his American upbringing, and B) his incuriosity to explore paradoxes such as the Italian one.

My personal experience growing up in another country informs me that Roger is putting a large falsehood over on everyone here with this theory about carbohydrate rich diets.

Another question Roger has not answered is what advisability there is to keep a 70 year old on a diet consisting of 60% fats? And if the advice in the 70 year old's case is that they reduce this percentage, then evidently the 60% fat consumption is not quite as "inherently natural" to humans as has been portrayed by this theory? A truly balanced and wholesome ratio of foods should be good for all age groups.

__________________


Obesity threatens Italian longevity


Obesity threatens Italian longevity / 24% of children have weight problems

(ANSA) - Rome, October 10 - Farmers warned on Tuesday that soaring obesity levels in Italy would soon undermine the country's record for healthy long living .

In a report marking Obesity Day, farmers' union Coldiretti said that, thanks to the Mediterranean diet, Italian men currently had a life expectancy of 77.4 and Italian women of 83.6. It stressed these figures were far higher than the European Union average but were destined to fall because of growing obesity problems, particularly among Italian youngsters .

"The children of this generation could be the first in history to have a shorter life than their parents because of illnesses caused by obesity," it said .

Coldiretti noted that more children are overweight in Italy than in any other European country .

Statistics show that 24% of children and teenagers in Italy have major weight problems while 4% are "seriously obese". Among Italian ten-year-olds, more than 35% are dangerously overweight or obese .

That puts Italy at the top of the European rankings although Malta, Greece and Spain follow close on its heels .

"The reason is that the traditional Italian diet based on bread, pasta, fruit, vegetables and olive oil has been abandoned," Coldiretti said .

The union called on the government to act immediately, saying that one of the first things to do would be to ensure that healthy food was served in school canteens. Recent studies show that obese children are more likely to have high blood pressure as adults, or suffer from a stroke .

Research has also shown that the average life expectancy of obese male kids is 13 years shorter than their slimline peers, with the figure dropping to eight for obese girls .

Experts emphasise the potential psychological damage or suffering caused by obesity, pointing out that overweight children tend to be picked on or teased and are at risk of developing low self-esteem and depression.

Obesity threatens Italian longevity

__________________

IMO all the people here prattling on about the "innate wholesomeness of a diet based upon wild game" have one ailment in common - they lack a foundational experience in childhood, in a very old country with a depth and wisdom of dietary traditions. So they go chasing off in search of exciting sounding theories of nutrition which extol the regenerative properties of wild game. It they had grown up in a country with a 1000 year old deep and well anchored tradition of wholesome food balancing, they would regard such off-beat wild game enthusiasms with mirth. Such enthusiasms speak more of cultural impoverishment than they do of the fountain of good health.

/

[rogermexico]

Re: PaNu - The paleolithic nutrition argument clinic

70's study -- in South Asians

Incidence of diabetes

Rural South Asians 4%
Urban South Asians 12%
South Asians in the US and UK 35%

Diet very similar except more meat and dairy for South Asians in the US and UK

So what is the difference between the three cohorts?

Degree of cooking and processing of the carbohydrates and legumes!!

Think amylase and sucrase inhibitors that get denatured by cooking and processing!

Look at lbs per year sugar and flour consumed - it will track

[rogermexico]

Re: PaNu - The paleolithic nutrition argument clinic

thanks for your thoughtful reply, rm. i hope you don't mind my raising these questions, but [obviously] i find this topic both interesting and important. here's another quote, from a review of taubes' "good calories,..." with its implicit question.


http://www.nytimes.com/2007/10/07/bo...0taubes&st=cse

ps re data mining- good for generating hypotheses, just not conclusions.

Yep, Kolata is 100% predictable. Read Taubes GCBC, whose book contains 459 references and whose bibliography is over sixty pages and decide for yourself whether Kolata or Taubes is leaving more out.

As far as the metabolic advantage, although neither psychiatrists nor neuroradiologists run metabolic wards, you and I both know that it if a Type I diabetic is deprived of insulin, they absolutely waste away even if eating 3000 calories a day. Both glucose uptake and storage of triglycerides is 100% dependent on insulin. Calories in is absolutely not calories out. How could it be if the wastage of calories consumed is under hormonal control?

FWIW, low carb advocates fight over this issue, with Eades on one side and Anthony Colpo on the other.

My own view is the same as Taubes, which is that the metabolic advantage exists, but who cares if you lose weight because of satiety (eating less calories because fat intake decreases hunger) or because of greater wastage of calories with higher fat intake.

If I had to guess, satiety due to more stable glucose and insulin levels is the more powerful effect but it does not matter to my patients, who all lose weight and none of whom measures a single thing before they eat it.

Key to my hypothesis is that obesity is a pathologic state. Paleo era humans did not avoid obesity by measuring either calories or carbs on a per food basis and they did not have calculators and notepads. The obeyed the rules of what was available and most efficient to spend time harvesting, i am trying to make artificial rules that emulate what their bodies were exposed to, especially hormonally.

[jk]

Re: PaNu - The paleolithic nutrition argument clinic

thanks for your thoughtful reply, rm. i hope you don't mind my raising these questions, but [obviously] i find this topic both interesting and important. here's another quote, from a review of taubes' "good calories,..." with its implicit question.

But the problem with a book like this one, which goes on and on in great detail about experiments new and old in areas ranging from heart disease to cancer to diabetes, is that it can be hard to know what has been left out. For example, Taubes argues at length that people get fat because carbohydrates in their diet drive up the insulin level in the blood, which in turn encourages the storage of fat. His conclusion: all calories are not alike. A calorie of fat is much less fattening than a calorie of sugar.

It’s known, though, that the body is not so easily fooled. Taubes ignores what diabetes researchers say is a body of published papers documenting a complex system of metabolic controls that, in the end, assure that a calorie is a calorie is a calorie. He also ignores definitive studies done in the 1950s and ’60s by Jules Hirsch of Rockefeller University and Rudolph Leibel of Columbia, which tested whether calories from different sources have different effects. The investigators hospitalized their subjects and gave them controlled diets in which the carbohydrate content varied from zero to 85 percent, and the fat content varied inversely from 85 percent to zero. Protein was held steady at 15 percent. They asked how many calories of what kind were needed to maintain the subjects’ weight. As it turned out, the composition of the diet made no difference.

http://www.nytimes.com/2007/10/07/bo...0taubes&st=cse

ps re data mining- good for generating hypotheses, just not conclusions.