A Song of Fats & Carbohydrates - Does it Matter Who is the King?

A common critique of following an ancestral template is that there was no one “Paleo Diet.” While true, this falls prey to the assumption that individuals are advocating for a strict reenactment, rather than using it as a logical framework based on our evolutionary history, upon which to examine the science and self-experiment. In my own study, I have often found that keeping things on the lower carbohydrate end of things seems to be the superior way to go.

It has benefits on blood glucose and insulin levels [1], triglycerides and the other blood lipid biomarkers [2], neurological function [3] and satiety and weight loss [4, 5], amongst other benefits. As such, my recommendations have generally always leaned to that end of the spectrum.

But then the researcher extraordinaire, Denise Minger, of RawFoodSOS, just released this doozy titled In Defense of Low-Fat: A Call for Some Evolution of Thought (Part 1). Now, if you are not familiar with her work, I highly suggest you check out her book Death by Food Pyramid or her decimations of The China Study and the “documentary” Forks over Knives. These posts are quite literally almost books in and of themselves. Needless to say, if she speaks, you should probably listen because you can be sure that she did her homework.

So back to the point, while reading her latest post, I literally felt like I was in an episode of The Twilight Zone (My favorite show of all time, along with The Walking Dead, in case you were wondering). There were points were I probably looked like the Nazis gazing upon the ark in Raiders of the Lost Ark, with my brain literally melting away.

Could I have been wrong all this time?

Have I been biased by my personal issues with carbohydrates? Could it be possible that the Durian Rider was right all along and I should be eating 30 bananas a day, mate?

Well no, he's still crazy, and if you don't know who he is, consider yourself lucky.

But, it did get me thinking critically. As she so aptly addresses, a key component to the scientific process is not to simply cherry pick data simply because it corroborates your current ideas. While there is a wealth of literature that supports the low-carbohydrate paradigm, there is still a ridiculous amount that supports the low-fat side of things.

Just as we criticize the low-fatters for not looking at the whole picture, it would be intellectually dishonest to do the same.

So going back to original point of the optimal human diet and which macronutrient paradigm is best; for every indigenous tribe that thrives on a high-fat diet, e.g. the Inuit, the Massai or Tokelau, there is an equally healthy one on a high-carbohydrate diet, e.g. the Okinawans, the Pima or the highlanders of Papua New Guinea.

Now, this is not to say that low fat is inherently better, but that perhaps, similar to the Transformers, there's more than meets the eye.

I would highly recommend that you read that article, but be aware, it is ridiculously long, as is her style, so be sure you have some time and possibly a dictionary and some Ritalin*. But, it is an incredible piece of work and a fascinating read, and scarily enough, it is only Part I!

*Please, on a serious note, I am not actually recommending you abuse Ritalin*

However, the basic premise is that in the macronutrient world, there are two magical lands, kind of like The Lands of Always Winter Vs. The Shadow Lands. On one end is the super low-carb ketosis and on the other side super low fat, which she aptly named, carbosis. On both ends there appears to be some serious therapeutic potential, but in the middle is what she terms the “swamplands,” but what I will call the Red Waste, just to stick with this analogy.

The problem with much of the current research is that much of it lies somewhere in the middle, and that, while yes, mathematically 30% is less than 34%, a diet containing 30% fat, does not a low-fat diet make. Similarly, it would not be fair to drop carbohydrate from say 50% to 46% and expect to call it a low-carb diet.

So what does this actually mean?

Well, apparently, just as inducing a ketogenic diet with ~90% fat, ~10% protein and barely registering carbohydrate has incredible therapeutic potential, there is something magical that occurs when fat is maintained at >10%, with protein and predominantly carbs filling out the rest.

Throughout the article, she details in depth, with an insane amount of literature to support it, the last 100 years of low-fat research, with astonishing results. The one, in particular, that blew my mind was that by a man by the name of Walter Kempner, who placed, wait for it, over 18,000 patients on what was termed, “The Rice Diet.” Wherein, they generally consumed a breakdown of 94% carbohydrate, 4% protein and 2% fat.

Now, to be clear, this was generally not a calorically restricted diet, as the subjects consumed roughly 2400 calories per day with an average 5g fat, 25g protein and 565g carbohydrates!! Even more bizarre still, this was not necessarily from vegetables, most grains or potatoes. The diet predominantly consisted of rice, fruit, fruit juice and refined table sugar!!! He actually eliminated vegetables in the induction phases as they were “too high” in sodium, which he also restricted.

Let that sink in for a minute! These were unhealthy people, often obese and/or diabetic and he was feeding them an average of 2260 calories a day or pure starch and/or sugar.

Surely, their health ran off the rails.

Nope, one of his studies examined 106 of his patients who lost AT LEAST 100 pounds, with an AVERAGE of 140 pounds [6]. While more of his research, bafflingly found that most had reductions in their triglycerides, blood glucose and insulin usage.

Again, can someone please bring me back out of The Twilight Zone??

Now, let's be clear on this, do I think this is a good and sustainable way to improve health? No, there are definitely other and likely more beneficial ways of improving your health that are more tolerable (apparently he actually had to literally whip some patients into compliance, which is somewhat eerily ironic given he was Jewish and fled to America to escape Nazi Germany). But does this negate the fact that he was able to achieve something remarkable with his protocol?

So at this point, I am sure you are thoroughly confused.

Again, I definitely recommend you give it a read because this was just a really, very, absolutely, small, tiny, minuscule sampling of the work that Denise put into researching this topic and in no way does her effort justice. (Did I add enough adjectives there?)

But, that being said, what does it mean for you today?

As anyone who has ever worked with me can attest to, one of the first things I always say is that if you are going to go low-carb, you have to increase the fat, but if you are going to go low fat, you have to increase the carbs.

Does this mean I have changed my mind that people are better off on the lower carb end of the spectrum? No, it does not. There are simply too many nutritious things on the protein and fat side of things that severely limiting them is probably is not the best way to go.

What it does mean, however, is that being intellectually honest means admitting that low-carb is not necessarily the only paradigm to health.

Moreover, perhaps we are focusing on the wrong thing by engaging in the macronutrient wars. While we are focusing on which macro is the rightful king, perhaps we should be focusing on The Others.

So, what are The Others?

Well, if you know me or have been following my work at all, you know that I am immensely interested in micronutrient sufficiency and gut microbiome status.

A common thread between the indigenous tribes mentioned before was that regardless of their macros, they were all eating nutrient-rich, whole foods diets, generally full of fermented foods of one type or another. Now, as Kempner's work showed, this is not the only to achieve “health,” but if you are really looking to optimize your health, it would definitely be more prudent to focus on real foods.

Unfortunately, industrialization and modernization, for all the wonders that it has provided, has left us in a state where we are not necessarily working on the same playing field that we once were. As such, I almost always recommend to people I am working with to supplement their real food diet with a quality multivitamin like Nutreince and a probiotic like MegaSporeBiotic, to insure that The Others are still being addressed.

So hopefully you made it here to the end and your head hasn't exploded yet. I know mine was definitely spinning while going through her article. But honestly, just try not to stress or lose sleep over what macronutrients are optimal and focus on just eating real foods and supplementing where necessary and you should be well on your way to living your optimal life!

References:

1) Krebs, J.D., Bell, D., Hall, R., Parry-Strong, A., Docherty, P.D., Clarke, K. & Chase, J.G. (2013). Improvements in glucose metabolism & insulin sensitivity with a low-carbohydrate diet in obese patients with type 2 diabetes. J Am Coll Nutr. Vol. 32(1):11-17.

2) Bazzano, L.A,. Hu, T., Reynolds, K., Yao, L., Bunol, C., Liu, Y., Chen, C.S., Klag, M.J., Whelton, P.K. & He, J. (2014). Effects of low-carbohydrate & low-fat diets: A randomized trial. Effects if low-carbohydrate & low-fat diets: A randomized trial. Ann Intern Med. Vol. 161(5):309-318.

3) Stafstrom, C.E. & Rho, J.M. (2012). The ketogenic diet as a treatment paradigm for diverse neurological disorders. Front Pharmacol. Vol. 3:59.

4) Paoili, A., Bosco, G., Camporesi, E.M. & Manger, D. (2015). Ketosis, ketogenic diet & food intake control: A complex relationship. Front Psych. Vol. 6:27.

5) Hu, T., Mills, K.T., Yao, L., Demanelis, K., Eloustaz, M., Yancy, W.S., Kelly, T.N., He, J. & Bazzano, L.A. (2012). Effects of low-carbohydrate diets versus low-fat diets on metabolic risk factors: A meta-analysis of randomized controlled clinical trials. Am J Epidemiol. Vol. 176(Suppl 7):S44–S54.

6) Kempner, W., Newborg, B.C., Peschel, R.L. & Skyler, J.S. (1975). Treatment of massive obesity with rice/reduction diet program. An analysis of 106 patients with at least a 45-kg weight loss. Arch Intern Med. Vol. 135(12):1575-1584.

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