Over a half decade ago Professor Jared Diamond, in his Pulitzer Prize-winning book Guns, Germs, and Steel, famously wrote

“The adoption of agriculture, supposedly our most decisive step toward a better life, was in many ways a catastrophe from which we have never recovered.”

Dr Diamond was referring, of course, to the devolution of human health that took place as mankind suffered the corporal transformation driven by the mismatch between hunter-gatherer genes and an agricultural diet and lifestyle. Smaller stature, decreased cortical bone thickness, obesity, increased incidence of infectious diseases, dental caries, periodontal disease, vitamin deficiencies, and even famine – all common in agriculturists – were not, for the most part, the lot of pre-agricultural man.

Humanity doubtless gained more than it lost in this hunter to farmer changeover when viewed in a big-picture sort of way.  Farming made possible larger communities filled with workers, workers who, for the first time, made specialization of labor a possibility.  And fewer people could till the fields and provide food for the many, freeing the others to pursue the arts, business, politics, and warfare.

Stephen Budiansky, author of one of my favorite books, Covenant of the Wild, describes how domestic animals formed a pact with humans in which the animals traded a period of safety and survival for their lives.  Had this covenant not been made, it is highly likely – virtually a certainty – that cows would now be extinct.  Big, slow, stupid and tasty, had they not been amenable to domestication and entered into the covenant with their domesticators, cattle would have been hunted to extinction long, long ago.  But they did – however unwillingly – make the covenant and so exist by the tens of millions today.  The deal they cut was a phenomenal deal for cattle as a species, but not a particularly good deal for the individual cow when the time comes to pay up at slaughter.

Homo sapiens entered an almost mirror image of this same covenant when they domesticated cereal grasses.*  We gave up our independence and mobility for the promise of a constant and plentiful food supply.  But, as with our covenant with domestic animals, there is a catch.  And this time it’s with us.  Humans emerged from this deal with the short end of the stick.  In the same way as did cattle, we made a good-for-humans-as-a-species/bad-for-the-individual-human trade.  Like it or not, we traded the health of the individual human for the overall good of mankind and the development of civilization.

We traded a diet based primarily on fat and protein with a little carbohydrate thrown in from roots, shoots and tubers for one centered predominantly on carbohydrate.  The main source of the carbohydrate was cereal grains, chiefly ancient forms of wheat, the predecessor of the wheat that now occupies a large part of the human diet everywhere.  Ancient forms of wheat didn’t do our forebears a lot of good, and, according to Dr. William Davis’s new book Wheat Belly, the modern forms of the grain do us even less good.

Before we get to the problems modern hybrid wheat causes us, let’s take a look at the afflictions a diet of primitive wheat visited upon our predecessors.

The ancient Egyptians consumed a diet that would be considered optimal by many people today.  Both wealthy and poor Egyptians consumed primarily bread and a type of cloudy, almost gruel-like beer.  To these staples were added a variety of vegetables (mainly onions), and a small selection of game, fish and meat.  The bread was made from coarse ground, whole grain emmer wheat, a primitive, high-protein wheat.  Sugar didn’t come on the scene until about 1000 AD, so the Egyptians used honey sparingly (it was expensive) as a sweetener along with figs.  In short, these people consumed a diet the vast majority of modern nutritionists would prescribe to people to prevent obesity, heart disease, obesity and the rest of the diseases associated with the Western diet.

But, as their mummified remains and their contemporary artwork demonstrate, the ancient Egyptians were often fat and were riddled with heart disease, dental caries, bad periodontal disease and no doubt diabetes and hypertension.  Many people have argued that since only the wealthy were mummified, the mummy data applies only to them, and since the wealthy ate more red meat, the rates of obesity, heart disease and the other disorders common to them didn’t apply to the rest of the population.  Even the common man, however, was often portrayed as obese in Egyptian artwork, and despite greater consumption of meat, the main staple of even the wealthy was bread and beer. And it didn’t do them a lot of good.

The 5,300 year old mummy of Ötzi the Iceman found in the Italian Alps showed a bad case of dental caries and periodontitis along with a stomach-full of einkorn wheat (another primitive variety). Said the researchers who examined Ötzi:

Although the Iceman did not lose a single tooth until the his death at an age of about 40 years, he had an advanced abrasion of his teeth, profound carious lesions, and a moderate to severe periodontitis.

In particular, the molars of the upper jaw showed loss of alveolar bone as a sign of periodontitis (inflammation of the ligaments and bones that support the teeth), while evidence of “mechanical trauma” was found on two teeth.

…the most surprising find is the high frequency of cavities.

These dental pathologies are a sign of change in the Neolithic diet.

We already know that he was eating grains, such as einkorn or emmer. The contained carbohydrates clearly increased the risk of developing dental diseases

One would assume these findings would be common among the rest of Ötzi’s contemporaries, who doubtless consumed a similar diet.

Sadly, these same findings are also common among modern man who consumes a more malign version of primitive wheat.

Until I read Dr. Davis’s book Wheat Belly, I didn’t really think much about wheat other than its being a major source of carbohydrate in the American diet.  It never had occurred to me that the wheat we eat today is not the same wheat of our great-grandmothers cooked with nor probably even our grandmothers.  And it really hadn’t dawned on me how pervasive wheat is in the diet.  Since reading Michael Pollen’s The Omnivore’s Dilemma I had been conscious of the amount of corn in our modern diet, but I hadn’t thought much about wheat.  As Yogi Berra supposedly said, “You can see a lot just by looking.”  So I went out and looked.  And I can tell you that we are much more Children of the Wheat than we are Children of the Corn.

In most grocery stores, an entire aisle is devoted to nothing but bread in all its forms.  Then there is typically another large aisle full of cakes, cupcakes, cookies, pies, tarts, sweet rolls, bagels, croissants, brownies, and other sweet baked goods.  The vast majority of the cereal aisle displays products containing primarily wheat.  And if you look at processed foods of all kinds, you’ll find wheat in there.  If you make or buy gravy, roux, or just about any kind of sauce, you’ll find it’s thickened with wheat flour. (MD bought some demiglace a few days ago, and noticed as she was removing it from the container that even it had added wheat.) Then there is the aisle full of different beers, many of which are made with wheat.  These are just a few of the items you can find containing wheat in a grocery store; don’t even get me started on restaurant fare.  Wheat is everywhere – corn should be so lucky.

When I was roaming around looking for pictures of dwarf wheat (more about which later), I came upon the website for the Kansas Wheat Commission that listed a few facts about wheat.  Here are several that caught my eye.

Wheat is the primary grain used in U.S. grain products.  Approximately three-quarters of all U.S. grain products are made from wheat flour.

More food is made with wheat than any other cereal grain.

U.S. Farmers grow nearly 2.4 billion bushels of wheat on 63 million acres of land.

About half the wheat grown in the United States is used domestically.

A little back-of-the-envelope calculating using the above statistics tells us that each of us in the United States consumes about four bushels of wheat per year.  Another statistic from the linked website states that each bushel of wheat makes about 90 one-pound loaves of whole wheat bread.  So, we all eat the equivalent of 360 loaves of bread per year, or approximately one loaf per person per day. That’s a lot of wheat, in fact, it’s almost approaching ancient Egyptian levels. (Moreover, since MD and I don’t eat any, that means two other people out there are each eating two loaves per day.)

It would be bad enough if we consumed all this wheat as emmer or einkhorn or other primitive varieties, but we don’t.  We get most from a hybrid of Triticum aestivum – our great grandmother’s wheat – called dwarf (or semi-dwarf) wheat, which now comprises more than 99 percent of all wheat grown worldwide.

As Dr. Davis tells it, the hybridization of wheat came about in an effort to improve yield, which is now about tenfold greater per acre than it was a century ago. Older strains of wheat were taller and more prone to damage from wind and rain.  And

When large quantities of nitrogen-rich fertilizer are applied to wheat fields, the seed head at the top of the plant grows to enormous proportions.  The top-heavy seed head, however, buckles the stalk.  Buckling kills the plant and makes harvesting problematic. A University of Minnesota-trained geneticist…is credited with developing the exceptionally high-yielding dwarf wheat that was shorter and stockier, allowing the plant to maintain erect posture and resist buckling under the large seed head.  Tall stalks are also inefficient; short stalks reach maturity more quickly, which means a shorter growing season with less fertilizer required to generate the otherwise useless stalk.

In the photos below you can see the difference between wheat grown in the Middle Ages and the dwarf wheat grown today.

Dr. Davis writes that modern wheat is approximately 70 percent carbohydrate by weight.  The carbohydrate is in the form of a starch called amylopectin A.

The most digestible form of amylopectin, amylopectin A, is the form found in wheat.  Because it is the most digestible, it is the form that most enthusiastically increases blood sugar.  This explains why, gram for gram, wheat increases blood sugar to a greater degree than, say, kidney beans or potato chips.  The amylopectin A of wheat products, “complex” or no, might be regarded as a supercarbohydrate, a form of highly digestible carbohydrate that is more efficiently converted to blood sugar than nearly all the other carbohydrate foods, simple or complex. [Italics in the original.]

But what about the much vaunted whole grains.  Won’t ‘whole grain’ bread or wheat products be better?  Not according to Dr. Davis:

…the degree of processing, from a blood sugar standpoint, makes little difference: Wheat is wheat, with various forms of processing or lack of processing, simple or complex, high-fiber or low-fiber, all generating similar high blood sugars.  Just as “boys will be boys,” amylopectin A will be amylopectin A.  In healthy, slender volunteers, two medium-sized slices of whole wheat bread increase blood sugar by 30 mg/dl (from 93 to 123 mg/dl), no different from white bread.  In people with diabetes, both white and whole grain bread increase blood sugar 70 to 120 mg/dl over starting levels.

And aside from the blood sugar and, consequently, insulin problems caused by the consumption of too much wheat, there are other problems.  As with almost any food, the newer the food, the greater the likelihood that it will be problematic to some humans who consume it.  Since dwarf wheat has been around for less than 50 years, it should come as no surprise that it does indeed cause it’s share of problems.  Dr. Davis spends the better part of his excellent book detailing many of these problems and describing his clinical experience in helping many of his patients shuck their wheat habit.  He describes the increase in celiac disease over the past 50 years and believes, as I do, that celiac disease is a continuum.  The severe form of it that is recognized as celiac disease is pretty easy to diagnose (if a doctor has sense enough to look for it), but there are milder forms that manifest themselves as anything from mysterious rashes that come and go to diarrhea and other GI disturbances to arthritic aches and pains. And we can’t forget a number of other afflictions that may well have their basis in wheat intolerance that include osteoporosis, acne (bagel face?), neurological disorders, and the creepily- dubbed ‘man boobs.’

It’s good to learn in Wheat Belly that Dr. Davis has finally shucked his bred-in-the-bone cardiologist’s antipathy toward fat in general and saturated fat specifically and has come over to what most of his peers must view as the dark (read: low-carb) side:

The fat phobia of the past forty years turned us off from foods such as eggs, sirloin, and pork because of their saturated fat content — but saturated fat was never the problem.  Carbohydrates in combination with saturated fat, however, cause measures of LDL particles to skyrocket.  The problem was carbohydrates more than saturated fat.  In fact, new studies have exonerated saturated fat as an underlying contributor to heart attack and stroke risk. [Italics in the original.]

Dr. Davis wraps up his meticulously researched book with a straightforward plan to help free the reader from the tyranny of wheat, while at the same time providing instructions for a delicious and satisfying wheat-free diet.  He furnishes an extensive list of wheat-containing foods that should be avoided and imparts his caveats about going facedown in products advertised as being gluten-free.  And best of all, he provides a short section filled with matchless wheat-free recipes for many meals that would otherwise be wheat-laden. (MD and I have tried a few of these recipes and found them to be superb.  I especially enjoy his wheat-free granola recipe even though I go a little easy on the rolled oats part of it.)

Wheat Belly hit the New York Times Bestseller list shortly after it came out (and has been there for two weeks now), which I can tell you from experience, is not an easy thing to do.  As a result (because being on the NY Times list means a book has had big sales numbers), the wheat producers have not taken their hits lying down.  They’re fighting back with full venom, because a book like this one can do them serious economic damage. Expect it to get worse. (Remember all those shelves in the grocery stores stuffed with wheat-containing products? They don’t want to see that go away.)  You can read about some of their tactics here and read Tom Naughton’s interviews with Dr. Davis here and here.

I can’t recommend this terrific book highly enough.  Wheat Belly is fully referenced and indexed (unless you somehow got the little freebee paperback review version that I received from the publisher), and is a must have for the library of any serious low-carber or anyone concerned about health.

*MD and I wrote about this domestication of humans by grains in The Protein Power LifePlan.  In that book we referenced an interesting paper by a couple of Australian researchers on the hypothesis that the addictive nature of cereal grains helping this domestication along.

In an example of more brain damage from the mainstream medical press, a recent online article from heartwire savaged the low-carb diet as a treatment for diabetes along with one of its main academic proponents.  This piece, when read critically, provides a blueprint for how to subtly (and not so subtly) disparage an idea that doesn’t meet mainstream approval.  And it shows why the low-carb diet – despite the mountains of evidence demonstrating its superiority – continues to have difficulty gaining traction.

Here’s the story.  Dr. Eric Westman, from Duke University, gave a talk at the European Association for the Study of Diabetes (EASD) conference last month in Stockholm.  Dr. Westman made the point in his talk that since 98 percent of the research presented at diabetes meetings involved a pharmaceutical approach to treatment perhaps it was time to take a look at the benefit of lifestyle changes, specifically diet, to treat the disease.  He went on to provide data showing the benefits of low-carbohydrate diets in the care of diabetic patients.

As might be expected, the mainstream – and let me assure you, the EASD meeting was the most mainstream of mainstream meetings – didn’t like what they heard.  Neither, apparently, did the writers at heartwire, another mainstream organization.

(Heartwire is an online magazine, available to anyone but requiring free registration, that goes out to physicians – cardiologists, primarily – and provides the latest news of various drugs, procedures and therapies for heart disease.  Heartwire is owned and operated by another mainstream medical news agency, Medscape, which is owned by the even more mainstream (if possible) WebMD.)

Let’s take a look at this abysmal excuse for balanced coverage and see how the writer sprinkled seeds of doubt about the efficacy of the low-carb diet throughout the article.  As we go through this exercise, bear in mind that most readers of this piece are busy cardiologist who most likely scan these pieces in an effort to get the gist of them without spending the time reading the entire thing.

(In case you don’t want to register for heartwire to read this piece online, I’ve uploaded a pdf for you to read here Kill or cure? Atkins diet debated in diabetes )

The bias starts early: right with the title:

Kill or cure?  The Atkins diet debated in diabetes

Most cardiologists (and other physicians) reading this article more than likely already have a bias against the low-carb diet.  Imagine for a moment that you are a busy cardiologist and have come across this article as you scan your emails between patients. (Heartwire is delivered to subscribers via email.)  You’ve had a few patients who have done well on low-carb diets, and you’ve heard about these diets in the media, but you don’t really know all that much about them.  You do have a bias, however, because you are a cardiologist, after all,  and therefor you are more than likely to be a believer in the lipid hypothesis, and you know that these diets are high in fat. Reading this title, most will assume the article is anti-low-carb and that it will confirm their own anti-low-carb bias.  And even the little picture at the top of the piece (reproduced above left) hints at bias because of the large chunk of red meat the questioning physician is holding.  You will then scroll down, skim through and have your eyes caught by the bold quotes set apart from the body of the piece.  If you’re in a hurry, these quotes are probably all you’ll read.  They tell you everything you need to know: heartwire – and by extension, mainstream cardiology – believes these diets to be bad.

Read these quotes as a stand alone substitute for the meat of the article and see what you think the takeaway message is.

I would never prescribe an Atkins diet to a person with type 1 or type 2 diabetes.

There are no long-term data comparing the different diets in diabetes management.

Low-carb is not defined consistently across all the research studies, it’s very confusing.

If you want your patients to love you, improve their glucose; get them off insulin and injections.

It’s my hunch that it’s both—it’s the weight loss, but how you do it gives you a little extra power.

With these diets there is no suffering, no hunger and there is a feeling of satiety.

Atkins is atherogenic. I’m concerned about . . . its impact on LDL cholesterol.

The ADA does not recommend an Atkins type low-carb diet because of the concerns about the impact of that fat load on heart health.

Based on these quotes, the low-carb diet doesn’t sound like an effective option for diabetes treatment, does it?

But what about the body of the article?  Let’s take a look.

The piece starts out presenting the crux of the problem.

The fact that lifestyle interventions can often do better than drugs at controlling type 2 diabetes is recognized by many in the field, but implementation of this approach is hampered by the fact that it is difficult to get busy general physicians to actively encourage lifestyle change or to get affected individuals to alter lifelong habits.

The next paragraph introduces Dr. Westman, who may have a solution for the problem.  But let’s take note of how they introduce him.

But one nutrition expert believes he has the answer: the Atkins diet. Dr Eric C Westman (Duke University, Durham, NC) admittedly has vested interests in promoting this approach—he is the coauthor of the latest Atkins book and receives honoraria from Atkins Nutritionals—but argues that he values his reputation above all else and that his aim is to convince people that the science exists to back his claims.

The above is absolutely outrageous!  I’ve read many articles about statin drugs in heartwire, Medscape and WebMD (and countless other mainstream publications), and I’ve never seen this kind of introduction.  Could you imagine reading the following:

But one expert believes he has the answer: statin drugs.  Dr. Joe Blow (Harvard University, Cambridge, MA) admittedly has vested interests in promoting this approach – he is paid tens of thousands of dollars every year as a consultant to several pharmaceutical companies that make statin drugs – but argues that he values his reputation above all else and that his aim is to convince people that the science exists to back his claims.

Believe me, that would never, ever happen despite the fact that in the majority of cases it is true.  Most of the people who promote statins in print and in lectures are on the payroll of the statin companies.  Annoying as this is, it is even more abhorrent since most of the controlled studies that have been done (and there have been many) demonstrate the efficacy of the low-carbohydrate diet whereas controlled trials showing any benefit from statins are scarce as hen’s teeth.

As you read on through the piece, you’ll find Dr. Westman’s answers to questions being characterized in the following ways:

Westman acknowledges…

Westman admits…

Westman concedes…

This way of stating Dr. Westman’s responses imply that he is, well, admitting or conceding to the other point of view.  When describing the responses of those chosen to refute Dr. Westman – all lipophobes to their very cores – the writer uses a different characterization.

Eckel [Dr. Robert Eckel] says…

Eckel believes…

says Eckel…

And he [Eckel] is keen to stress…

Eckel begs to differ

Dietitian Stephanie A. Dunbar…says…

she adds…

Dr. Arne Astrup says…

Astrup says…

Dunbar says…

she notes..

You can see that all the mainstreamers trotted out to refute the low-carb guy all ‘say’ and ‘believe’ and ‘note’ and ‘add’ and ‘beg to differ’ and are ‘keen to stress.’  They don’t ‘concede,’ ‘admit’ or ‘acknowledge.’ (They actually do in one or two places, but mainly they ‘say’ whereas Dr. Westman ‘concedes’ or ‘admits’.)  This is a subtle but effective way of presenting material to the reader in an appallingly biased way.  The writer should be ashamed.

I’ll leave it to readers of this blog to peruse the entire heartwire article to notice the rest of the bias that runs throughout.  Those who choose to go ahead and register (free) can read the rollicking debate following the article containing comments by Gary Taubes, Richard Feinman and a number of other people most will recognize.

I do want to take a moment to show how easily a mind can be closed.  I would like to look at a couple of specific responses from Dr. Robert Eckel, the academic heavy hitter the author used to refute Dr. Westman’s approach.  Dr. Eckel is a professor of medicine at the University of Colorado and has held numerous lofty positions in the academic world including the presidencies of the American Heart Association and the North American Association for the Study of Obesity, now the Obesity Society, the organization of academic obesity researchers.  (Full disclosure: I am a member of the Obesity Society.) Dr. Eckel has written and lectured extensively on the dangers (as he perceives them) of the low-carb diet, and has attacked numerous specific low-carb diets and their developers, including yours truly.

Throughout the article while Dr. Westman is ‘admitting,’ conceding’ and ‘acknowledging,’ Dr. Eckel is (pompously, in my opinion) is attempting to refute whatever it is Dr. Westman admits, concedes, etc.  It quickly becomes clear that Dr. Eckel is so close minded about the subject of low-carb diets that he has lost all objectivity.

Dr. Westman makes the case that a recent study in the Annals of Internal Medicine demonstrated that low-carb diets raised HDL-cholesterol levels.  Most of the readers of this blog – at least those who have gone on a low-carb diet – know that HDL-cholesterol goes up on such a diet.  We all know that saturated fat raises HDL-cholesterol levels.  And we all have seen or at least know of the countless studies showing the benefits of having higher levels of HDL-cholesterol.  In fact, a number of studies performed over the past few years have shown that infusing HDL into subjects with coronary plaque brings about a reversal of the plaque.  Dr. Eckel has got to be aware of at least some of these studies, but look what he says when Dr. Westman raises the issue:

“This claim that Atkins preserves the HDL level” is irrelevant, he [Eckel] says, since “the science is not advanced enough yet to say whether a rise in HDL is a good thing. To make any conclusions on this is really premature.”

The very model of a modern closed-minded academician.

And it’s obvious that Dr. Eckel wants to remain close minded.  He doesn’t even want there to be the possibility that the low-carb diet could be shown to be beneficial.

At the end of this extended attack on him, Westman, disappointingly to me since there is so much data already out there, seeks not to do battle with the large body of existing research showing the benefits of the low-carb diet but instead bolts for the ever-present refuge of all researchers and recommends even more research.

Westman says a long-term outcomes study comparing low-carb and low-fat diets is sorely needed; such data do exist for the Mediterranean diet, he notes.

“Everyone talks about the Mediterranean diet, but the low-carb one looked just as good in the DIRECT study. I’m an advocate for studying this kind of approach within mainstream medical research; it’s been avoided, and that’s too bad. It needs to be given the same attention as other approaches,” he concludes.

Surely, you may think, Eckel would agree with this.  Let’s gather some good data and settle this once and for all.  But that’s not the case.

But Eckel is vehemently opposed to any such outcomes study with Atkins, telling heartwire: “I feel that would be an irresponsible trial.”

Irresponsible?  Why?  Because just about every study done so far shows the low-carb diet to stabilize blood sugar, reduce high blood pressure, and improve the lipid levels Dr. Eckel so believes in.  It seems unbelievable.  But maybe not so unbelievable when you dig a little deeper.

Why, you might ask, is this scientist so obdurate in the face of all the evidence that’s out there?  Perhaps because much of the evidence isn’t in accord with his religious beliefs.  I try never to mention a person’s religious faith, but when it impacts his scientific thinking it at least needs to be made known.  Unless he’s changed his thinking recently, Dr. Eckel apparently is one of the few academic scientists who are literal interpreters of the bible.  I assume this because Dr. Eckel serves on the technical advisory board of the Institution for Creation Research, an organization that believes that not only is the earth only a few thousand years old , but that the entire universe in only a few thousand years old.  And they believe that man was basically hand formed by God on the sixth day of creation.  And Dr. Eckel’s own writings on the subject appear to confirm his beliefs.

I don’t have a problem with people who have such beliefs (or any other beliefs, for that matter) as long as they don’t conflict with my own life and activities.  But when my own notions of what constitutes the most healthful diet based upon my education, study and work with thousands of patients is denigrated as hucksterism, as it has been by Dr. Eckel, then I do take exception.

Part of my own coming around to the low-carb diet was driven by my many hours of study in the anthropological and paleopathological literature.  Using technology available today, it’s possible to see what early man ate, and it’s very easy to determine his health.  As it turns out, when early man made the conversion from a hunter-gatherer diet and lifestyle to an agricultural one, he experienced an enormous decline in health.

In a post I recently wrote, I put up the graphic below showing all the factors confirming the low-carb diet to be the best for the greatest number of people.

Of all the evidence that exists, I think the evolutionary/natural selection data and the anthropological data are the most compelling because they provide the largest amount of evidence over the longest time.  To Dr. Eckel, however, these data aren’t applicable because in his worldview prehistoric man didn’t exist and therefore wasn’t available to be molded by the forces of natural selection.  I haven’t a clue as to what he thinks the fossil remains of early humans really were or where they came from.  Perhaps he believes – as I once had it explained to me by a religious fundamentalist – these fossilized remains of dinosaurs, extinct ancient birds and mammals and prehistoric man were carefully buried by the devil to snare the unwary and the unbeliever.  If this is the case, I guess I’ll have to consider myself snared.

In Dr. Eckel’s view, man was created post agriculturally.  In fact, in his view, there was never an pre-agricultural era, so how could man have failed to adapt to agriculture?

Whatever the reason, Dr. Eckel seems to have a preternatural hatred for anything low-carb.  His mind is made up, and not only does he not want to be confused with the facts, as the old saying goes, he doesn’t even want research to be done to perhaps come up with the facts that might confuse him.  It is even more troubling that he sits as an editor and is a reviewer for numerous mainstream medical and nutritional journals.  What chance do you think a low-carb paper has to make it through his review?  Until he retires, all we can do is understand his biases and try to work around them.  I would suggest that whenever you read or hear reported anything Dr. Eckel says or writes about low-carb dieting – including his responses in this piece to Dr. Westman – you should take it with a very large grain of salt.

When I wrote the Overcoming the Curse of the Mummies chapter in Protein Power, I wrote mainly about the evidence of disease found in the mummies of ancient Egyptians and correlated this disease with their high-carbohydrate diet.  Along with all the material on mummies, which is the part everyone seems to remember, I wrote about a study done in the United States in the 1970s that persuasively demonstrated the superiority of the hunter diet as compared to an agricultural diet, which no one seems to remember.  I came across that study a couple of days ago and decided to present it in a little more detail than I was able to in Protein Power.

The anthropological record of early man clearly shows health took a nosedive when populations made the switch from hunting and gathering to agriculture. It takes a physical anthropologist about two seconds to look at a skeleton unearthed from an archeological site to tell if the owner of that skeleton was a hunter-gatherer or an agriculturist.

Unlike the Egyptian mummy data, there is usually no soft tissue material left when remains of early man are found.  But the skeletal remains of hunter-gatherers show them to be much healthier than agriculturalists.  Hunter-gatherers had better bones, had no signs of iron-deficiency anemia, no signs of infection, few (if any) dental cavities, fewer signs of arthritis and were in general larger and more robust than their agriculture-following contemporaries.  One of the theories as to why postulates that hunter-gatherers lived in smaller, more mobile societies.  Consequently, they weren’t as likely to get communicable diseases and were able to travel to find food, whereas agriculturists were rooted to one spot, lived in larger groups, making the spread of disease more likely, and they were subject to lack of food if a drought or other natural disaster decimated their crops.

The study we’re going to look at today is unusual in several respects.  First, there is a large amount of data, i.e., a lot of skeletons of both groups.  Second, it compares sedentary hunter-gatherers to sedentary agriculturalists.  And it compares peoples who probably had the same genetic heritage to one another.  Finally, it compares hunter-gatherers to agriculturalists living in the same general area.  The only real difference between the two groups of people is the time in which they lived and diet.

The group of agriculturalists lived in an area called Hardin Village, which is a famous archeological site located in Kentucky on the bank of the Ohio River across from the current day city of Portsmouth, Ohio.  These people farmed the area from about 1500 AD to 1675 AD.  There is no indication in the archeological record of any European contact with these Hardin Villagers.

The hunter-gatherers lived in the same general area in an archeological site called Indian Knoll, which is a large midden (an ancient refuse heap) located on the Green River in western Kentucky.  Carbon-14 dating dates the age of habitation of these hunter-gatherers to about 5000 years ago.  Based on the excavation of the deep midden, these people lived at this site for a long period of time, i.e., they stayed in one spot instead of roving as most hunter-gatherers did.

Writes Claire Cassidy, Ph.D., author of the study:

Available fauna and flora, water, and climate were so similar in the two areas that it may be assumed that whatever natural stresses existed at one site were probably existent at the other also, and therefore, in themselves, these should not affect the health and nutrition differently.

Population size and degree of sedentarism affect disease spread.  In the cases of the Hardin Village and Indian Knoll, since both are sedentary or semisedentary, this variable should be negligible in explaining differences in disease experience between the sites.

Archeological-reconstructable variability in material culture is also fairly small (though Indian Knollers used the spear-thrower and spear, while Hardin Villagers had pottery, permanent houses, and the bow and arrow).  Thus, in all probability the most significant difference between these two populations is in subsistence technique, with agriculture at the later site, and hunting-gathering at the earlier.

So, we have two societies who both lived in the same area and didn’t move around much, if at all.  One lived by agriculture and one lived by hunting and gathering.  Genetically they were probably the same, although there is no way to tell for sure.  Both groups had the same climate, weather, water, etc.  Neither group had contact with Europeans, so there is no contamination that way.  The groups are separated by only diet and time.  The hunter-gatherers lived in the area approximately 3500 years before the farmers did and had a substantially different diet.

(When I first went through this paper, I went nuts trying to remember whether the Hardin Villagers were the agriculturalists or whether the Indian Knollers were.  After whipping back to the start of the paper a half dozen times to check and recheck on it, I decided to come up with a mnemonic for it.  I started thinking of the Villagers part of Hardin Village as being farmers.  Village = farm.  Farmers live in villages – at least they do in my mind, so it’s easy for me to remember that the Hardin VILLAGERS are farmers.  Readers of this blog are probably smarter than I am and won’t have to go to such lengths, but if any do, this will help.)

What did these folks eat?

At Hardin Village, primary dependence was on corn, beans, and squash.  Wild plants and animals (especially deer, elk, small mammals, wild turkey, box turtle) provided supplements to a largely agricultural diet.  It is probable that deer was not a quantitatively important food source…  At Hardin Village, remains of deer were sparse.

At Indian Knoll it is clear that very large quantities of river mussels and snails were consumed.  Other meat was provided by deer, small mammals, wild turkey, box turtle and fish; dog was sometimes eaten ceremonially.

There are several other dietary differences.  The Hardin Village diet was high in carbohydrates, while that at Indian Knoll was high in protein.  In terms of quality, [some] believe that primitive agriculturalists got plenty of protein from grain diets, most recent [researchers] emphasize that the proportion of essential amino-acids is the significant factor in determining protein-quality of the diet, rather than simply the number of grams of protein eaten.  It is much more difficult to achieve a good balance of amino-acids on a corn-beans diet than when protein is derived from meat or eggs.  The lack of protein at the Hardin Village signaled by the archaeological data should prepare us for the possibility of finding evidence of protein deficiency in the skeletal material.

The Hardin Village site yielded 296 skeletons and the Indian Knoll site 285.

What did this skeletal data show?  Let’s take a look.

Based on the ages of the people whose skeletons were found (anthropologists can easily tell age from skeletal remains), the life expectancies for people of both sexes and all ages were lower at Hardin Village as compared to Indian Knoll.  And infant mortality was higher at Hardin Village as well.

Iron-deficiency anemia of sufficient duration to cause bone changes was present at Hardin Village but absent at Indian Knoll.  And half the cases of serious iron-deficiency anemia occurred in children at Hardin Village.

Iron-deficiency anemia is a true deficiency disease, often an accompaniment of low-meat diets, long-term infection, or chronic disease.  It is also frequently found in cases of protein-energy malnutrition. The classic sign of iron-deficiency anemia presents as a couple of conditions seen in the skull called porotic hyperostosis and cribra orbitalia.   8.2 percent of the Hardin Villagers had iron-deficiency anemia severe enough to cause one or both of these conditions.  These conditions are extremely painful and those afflicted had to have been miserable, especially the children, most of whom were under five years old.

Porotic hyperostosis

cribra orbitalia

There were signs of malnutrition in both populations, but the signs differed between them.

There are a couple of ways anthropologists look for periods of malnutrition.  One is by examining the tibias (lower leg bones) with X-ray looking for a finding called Harris lines (or growth arrest lines).

Harris lines

All these Harris lines indicate is that an episode of malnutrition occurred during childhood while the bones were developing, causing a period of growth arrest that lasted at least ten days or more.  But since these lines appear after the period of malnutrition, they can’t provide information as to the total duration of the lack of food.  The total number of lines found tells approximately how many episodes of dietary lack occurred that were serious enough to halt bone growth.

To determine the severity of periods of malnutrition, anthropologists look for enamel hypoplasia.  Enamel hypoplasia derives from periods of ill-health or hunger lasting long enough to interrupt the deposition of enamel on the teeth.  These defects, like Harris lines, represent periods of growth arrest in childhood, but unlike Harris lines, enamel hypoplasia quantifies the severity of the period of malnutrition.  The worse the defect, the worse the malnutrition.

Enamel hypoplasia

Enamel hypoplasia

Interestingly, there were more Harris lines found in the specimens from Indian Knoll, but these lines were regularly spaced, “indicating that malnutrition occurred at periodic intervals, perhaps as a “normal part of life.”  There were an equal number of jaws at both sites demonstrating teeth with enamel hypoplasia, “but the frequency of severe episodes of arrest was significantly higher at Hardin Village.”

The most parsimonious interpretation of this information is that mild food shortages occurred at regular intervals at Indian Knoll; perhaps late winter was a time of danger.  [Researchers] using growth arrest lines [Harris lines] and … archaeological data, have similarly concluded that in the hunter-gatherer populations they studied, food shortages occurred regularly, probably on a yearly basis.  At Hardin Village growth arrest was caused by illnesses or crop failure which resulted in long-lasting, but randomly-occurring episodes of growth arrest.

Bones can also exhibit signs of certain types of infection.  Bone infections affected an equal number of people at both sites, but affected significantly more children at Hardin Village than at Indian Knoll.

A specific type of infectious disease showing up in skeletal remains and identified as the syndrome of periosteal inflammation was present at both sites, but was thirteen times more common at Hardin Village.  No one knows for sure what causes this disorder, but it is thought to be caused by a treponematosis, a disease caused by a similar but not identical agent as that that causes yaws, pinta or even syphilis.

The author of this study attributes the greatly increased incidence of this disease in the Hardin Villagers to “lack of resistance in the host because of poor diet and general health.”

Teeth are often a window into the diet of ancient populations.  Based on the wear patterns and number of caries (dental cavities), teeth can provide much information on the quality of the diet.  Teeth ridden with decay are typically associated with poor quality diets, and the unhealthy teeth themselves can be a major factor in the overall poor health of an individual.

Tooth decay was rampant at Hardin Village, but uncommon at Indian Knoll.  Adult males at Hardin Village had an average of 6.74 carious teeth per mouth, while at Indian Knoll the corresponding frequency was 0.73 per mouth.  For women the rates were 8.52 and 0.91 per mouth respectively.  No Indian Knoll children under twelve years of age had caries, whereas some Hardin Village children already had developed caries in milk teeth in their second year of life.  Tooth decay is closely associated with sugar content and consistency of food, occurring with higher frequency in sweet or high carbohydrate diets which are soft and sticky.

Dental caries

Here is the summary of the findings of this analysis of skeletal data as tabulated by the author:

1.    Life expectancies for both sexes at all ages were lower at Hardin Village than at Indian Knoll.
2.    Infant mortality was higher at Hardin Village.
3.    Iron-deficiency anemia of sufficient duration to cause bone changes was absent at Indian Knoll, but present at Hardin Village, where 50 percent of cases occurred in children under age five.
4.    Growth arrest episodes at Indian Knoll were periodic and more often of short duration and were possibly due to food shortage in late winter; those at Hardin Village occurred randomly and were more often of long duration, probably indicative of disease as a causative agent.
5.    More children suffered infections at Hardin Village than at Indian Knoll.
6.    The syndrome of periosteal inflammation was more common at Hardin Village than at Indian Knoll.
7.    Tooth decay was rampant at Hardin Village and led to early abscessing and tooth loss; decay was unusual at Indian Knoll and abscessing occurred later in life because of severe wear to the teeth.  The differences in tooth wear and caries rate are very likely attributable to dietary differences between the two groups.

Her analysis based on this data:

Overall, the agricultural Hardin Villagers were clearly less healthy than the Indian Knollers, who lived by hunting and gathering.

The author raises a couple of interesting questions about the diet of early populations and the drive to eat carbohydrates in place of real food once the taste is acquired.  Before we get to these interesting issues, however, I want to delve into a sad situation that obviously prevailed in the Hardin Villagers and continues to be present in some modern day agriculturalists.

Below is a chart from the paper showing the life expectancies by age of people living in Hardin Village and Indian Knoll.  Look at the enormous increase in mortality in the agricultural Hardin Villagers between the ages of two to four.

Why this rapid increase in mortality in these young children.  The author tells us:

The health and nutrition situation at Hardin Village may profitably be compared with that in modern peasant villages.  In may of these, children are typically fairly healthy until weaned.  At this time they are introduced to a soft diet consisting largely of carbohydrates (in much of Africa and Central America, a pap is made of sugar, water, and maize flour: in Jamaica green bananas replace maize).  In many cases, within a few weeks or months these children develop diarrhea, lose weight, suffer multiple infections, and may eventually develop the form of protein-energy malnutrition called kwashiorkor.   In this disorder caloric intake is usually adequate, but protein and other nutrient intakes are extremely limited; without modern hospital care many victims die.

At Hardin Village the highest rate of death occurs between the second and fourth years of life.  This is typical for a population experiencing weaning problems.  Considering the softness of the adult diet and the high caries rate of both children and adults, it is not unlikely that the children were weaned onto a corn pap of some type.

The high prevalence of childhood infection, severity of growth arrest in the first few years of life, and the existence of iron-deficiency anemia all point to a situation at Hardin Village analogous to those in modern peasant villages.  In other words the evidence supports a hypothesis that malnutrition began with weaning at Hardin Village, sometimes resulted in kwashiorkor, and continued at low level – just enough to reduce the resistance of the population to infectious disease – throughout the life of the individual.

Think about this the next time you hear a pediatrician recommend that babies who are being weaned start out on some sort of Pablum or other processed cereal for infants.  And they virtually all recommend it.  Our grandchildren’s pediatrician recommended it, but MD and I interceded after the first feeding.  From then on they all got pureed turkey, pork, chicken or other meat along with pureed vegetables.  They had no grain.

Dr. Cassidy, the author of this fascinating paper, speculates in the discussion section about why a society would abandon hunting and gathering for agriculture when the diet quality provided by an agricultural subsistence is so inferior.  She writes about the possibility of all the game being decimated by over hunting, and she mentions the possibility of inter tribal warfare reducing the male hunting population to the point that those remaining standing couldn’t provide enough food for all by hunting alone.  Then she gets to the heart of the matter, and asks some questions that are pertinent not just to ancient agricultural societies, but to us today.

Thus population expansion, inefficient hunting techniques, loss of game from the area by migration and overkill, and warfare, all may have contributed to force the Hardin Villagers to become more and more dependent on a small number of high-carbohydrate agricultural foods of limited quality, and this may have been so even were they aware of an increase in physical ill-health in the group.

Finally, we must also wonder if people didn’t ultimately begin to prefer corn and beans to meats?  There is some evidence that carbohydrates can become so palatable to humans that they eat them in preference to other foods; such a situation may have further limited the appeal of hunting.

If this is the case, the Hardin Villagers are not the only society in history who have chosen carbohydrates in preference to other foods.  And they certainly aren’t the only ones to prefer corn and beans to meats.  I would venture that most people today prefer carbs to meat, a notion that is confirmed in the nutritional data.  Carbs play a far larger role in the American diet than do meats of all kinds.  And if many so-called nutritional experts had their way, we would all eat even more.

The next time you may be tempted by the siren song of the high-carb pushers, remember what happened to the Hardin Villagers and do the Nancy Reagan: Just say no.

*Cassidy CM. Nutrition and health in agriculturalists and hunter-gatherers: a case study of two prehistoric populations. in Nutritional Anthropology. Eds Jerome NW et al. 1980 Redgrave Publishing Company, Pleasantville, NY pg 117-145

Ten or twelve years ago we wrote in Protein Power about the data contained in the vast amount of ancient Egyptian mummies. We pointed out that several thousand years ago when the future mummies roamed the earth their diet was a nutritionist’s nirvana. At least a nirvana for all the so-called nutritional experts of today who are recommending a diet filled with whole grains, fresh fruits and vegetables, and little meat, especially red meat. Follow such a diet, we’re told, and we will enjoy abundant health.

Unfortunately, it didn’t work that way for the Egyptians. They followed such a diet simply because that’s all there was. There was no sugar – it wouldn’t be produced for another thousand or more years. The only sweet was honey, which was consumed in limited amounts. The primary staple was a coarse bread made of stone-ground, whole wheat. Animals were used as beasts of burden and were valued much more for the work they could do than for the meat they could provide. The banks of the Nile provided fertile soil for growing all kinds of fruits and vegetables, all of which were a part the low-fat, high-carbohydrate Egyptian diet. And there were no artificial sweeteners, artificial coloring, artificial flavors, preservatives, or any of the other substances that are part of all the manufactured foods we eat today.

Were the nutritionists of today right about their ideas of the ideal diet, the ancient Egyptians should have had abundant health. But they didn’t. In fact, they suffered pretty miserable health. Many had heart disease, high blood pressure, diabetes and obesity – all the same disorders that we experience today in the ‘civilized’ Western world. Diseases that Paleolithic man, our really ancient ancestors, appeared to escape.

The press has been filled with reports of the recent discovery – thanks to DNA analysis – of the mummy of Queen Hatshepsut, who ruled Egypt for around 15 years 3500 years ago.

According to the New York Times, Hatshepsut’s mummy is that of an obese, diabetic 50 year old woman with bad teeth. All the conditions that nutritionists today would have us believe would be prevented by Hatshepsut’s diet. It certainly didn’t work for her. And she is not a special case – most Egyptian mummies show the same disorders, especially the bad teeth. The skeletal remains of Paleolithic man, who consumed a meat-based diet, showed strong, perfect teeth. Bad teeth are the hallmark of carbohydrate consumption.

Here is an X-ray of Hatshepsut’s mouth. You can see cavities, lost teeth, and evidence of severe tooth abscesses, which had to have been miserably painful.

Hatshepsut’s statue pictured to the right shows her in her idealized form. I’m sure most of the Egyptian graphics and statuary of the time represented people in a thin, healthy state instead of the shape they were really in. Based on the mummy data many ancient Egyptians were obese, which is clearly not represented in their contemporary artistic renditions. If one were to look through on issue of Cosmopolitan or GQ or virtually any magazine to day and look at the people in all the ads, one would think no one is obese now. Which clearly isn’t the case. I suspect that the ancient Egyptians intuitively figured that thin and trim people were more attractive than obese ones and created their pictures accordingly.

One other interesting aspect of Hatshepsut’s mummy is that it appears that she died from metastatic cancer. Cancer has been tough to find in mummified and skeletal remains, leading most researchers to assume that the rates of cancer today are driven by environmental contaminants that weren’t present in ancient times.

The moral of this tale of ancient poor health is that a whopping load of carbs – even non-refined carbs – didn’t do Hatshepsut a whole lot of good, and they don’t do us much good either irrespective of the bleatings to the contrary by today’s nutritionists, who are woefully unaware of the history of the high-carb diet.

An intriguing article appeared in the Journal of the National Cancer Institute showing a correlation between periodontal disease and the development of pancreatic cancer. There have been a couple of studies correlating tooth loss with pancreatic cancer, but this is the first study I’ve seen that looks at periodontal disease and cancer of the pancreas.

You don’t want to get any kind of cancer if you can help it, but you really don’t want to get cancer in your pancreas. The virulence of cancers are usually defined by their 5-year survival rates, meaning what percentage of people who are diagnosed with a particular cancer are still alive 5 years later. The lower the 5-year survival rate, the deadlier the cancer. According to the latest statistics from the American Cancer Society (ACS), breast cancer has a 5-year survival rate of 88.5 percent, which means that out of 100 patients who are diagnosed with breast cancer, 88.5 of them will still be alive 5 years later. For lung cancer, a pretty deadly cancer, the 5-year survival rate is 15 percent. The 5-year survival rate for pancreatic cancer is 5 percent, making it the most deadly of all the cancers listed in the ACS list. Pancreatic cancer is a good one to avoid.

According to most papers I’ve read the only established modifiable risk factor for pancreatic cancer is smoking. There is evidence is starting to accumulate suggesting that diabetes, obesity and insulin resistance are also associated with increased risk. Recently a number of papers have been published showing that sugar, sugar-sweetened beverages, and high-glycemic-load diets are associated with an increased risk for this deadly cancer.

Now comes this paper showing that male health professionals with periodontal disease have significantly higher rates of pancreatic cancer. And the more severe the periodontal disease, the higher the correlation. Why should periodontal disease predispose to pancreatic cancer? I think the reason is pretty obvious, but the authors of the paper dance all around the issue.

According to the authors

Several mechanisms could potentially explain the observations from this study. Inflammation appears to play an important role in pancreatic cancer pathogenesis, although the inflammatory mediators that lead to the development of pancreatic cancer remain poorly defined. An association between periodontal disease and systemic inflammation has been observed using biomarkers. In the HPFS [Health Professionals Follow-Up Study, the study from which the database for this analysis was drawn], plasma C-reactive protein levels were 30% higher in individuals with a history of periodontal disease than in those with no history. We hypothesize that periodontal disease may promote pancreatic carcinogenesis through inflammation.

Alternatively, periodontal disease could influence pancreatic carcinogenesis through increased generation of carcinogens, namely nitrosamines. Individuals with periodontal disease and poor oral hygiene have elevated levels of oral bacteria and have much higher nitrosamine levels in their oral cavity due to nitrate-reducing bacteria. Nitrosamines and gastric acidity have been hypothesized to have an important role in pancreatic cancer; numerous studies support this hypothesis [I found only one].

To summarize, the authors hypothesize that the inflammation caused by the infection in the gums causes the pancreatic cancer and/or the increased gastric acidity from the nitrosamines produced by action of the infectious bacteria.

I suppose that inflammation and increased gastric acidity could cause it, but I don’t believe those are the most likely causes. Remember, we’ve got a number of studies showing that the consumption of sweets and a high-glycemic diet appears to increase the risk for pancreatic cancer. There is evidence that obesity, diabetes and insulin resistance are correlated with increased rates of pancreatic cancer. And now we’ve got periodontal disease to add to the mix.

What causes periodontal disease? I’ll give you a clue. Just as with dental caries (cavities), periodontal disease doesn’t appear in the remains of pre-agricultural man. Periodontal disease is easily recognizable from skeletal remains, and it just ain’t there in our meat-eating ancestors. Once agriculture took root (no pun intended), dental caries and periodontal disease became common. It’s hard to find an ancient Egyptian mummy without severe dental disease. And remember, ancient Egyptians lived in the days before sugar, so we can’t blame sugar for their dental disease. They ate a huge amount of grain and grain-based foods, a fari amount of fruits and vegetables, and very little meat. In fact they ate pretty much the kind of diet that today’s nutritionists would have us all eat to prevent disease. It didn’t do the Egyptians a whole lot of good. The calculus (tartar) deposits on their teeth were often so extensive that they held the teeth in place after death for 2,000 years. The result of these deposits is early bone loss, loose teeth, infection, and tooth loss. In addition, the ancient Egyptians had arteriosclerosis, obesity, rampant tooth decay, and a host of diseases that we consider ‘modern’ diseases.

Sticky, high-carb foods cause periodontal disease. The obesity, diabetes, and insulin resistance mentioned above are probably caused by high-carb diets. The papers mentioned above show that high-carb diets are associated with pancreatic cancer. So, despite the authors speculating about inflammation and increased gastric secretions, I think the periodontal disease data further confirms the hypothesis that excess carbohydrate consumption is more than likely the driving force behind pancreatic cancer.

As if you needed more, this is just another reason to follow a whole-food low-carbohydrate diet.