For the guy several comments above me:

I watch travel shows alot. Many Asian nations are featured. Asians eat a lot of organ meats, bugs, insects,(Thailnad) seafood like Octopus(China) etc. and fish in Japan. And in the case of Vietnam- snake ,snake, snake, snake and more snake- even the blood. There are a lot of American myths about the Asian diet that are made up by low fat advocates.

They definitely consume a lot of animal / and or insect based protein too, very similar to a true paleo diet- like what Bear Grylles or Les Stroud eat on their shows.

-Excerpt from…

Cleave, T.L. and G.D. Campbell. Diabetes, Coronary Thrombosis, and the Saccharine
Disease. John Wright & Sons LTD.: Bristol, UK, 1969.

This is in reference to lack of obesity amongst rural Zulu’s on a diet of 90% carbohydrates.

And “uh” yes, I’ve read all of Cleave’s work, who was a proponent of a diet high in natural, unrefined carbohydrates for the prevention of every known modern illness.

I’ve also read your book, and literally hundreds of others – enough to know that “protein’s power” is the remarkable ability to slow down the human metabolism when eaten in excess, making it easier to gain weight on smaller amounts of calories than a diet rich in fat.

This is why Atkins stated on page 313 of Dr. Atkins New Diet Revolution that his diet “tends to shut down the thyroid,” which is the exact pitfall of a low-carbohydrate diet that contains more than 20% of calories from protein – a common mistake in the fat-phobic world.

Why not eat in a manner that improves the metabolism instead of catering to its insufficiencies?

Ah, a different book than the one I have. Sorry. But, irrespective of whether it actually says what you claim or not, I don’t believe it. Had he written that 90 percent of the foods eaten by the Zulu were of plant origin, I could maybe buy it, but not the idea that 90 percent are carbohydrate. That’s not a sustainable diet.

If you think that protein slows down metabolism, I would suggest a serious reading of the medical literature, not a cherry picking of those few papers that confirm your bias.

“You can “prove” anything with statistics.” That was a comment from my father when I was about twelve. He then added “Just dont believe it.”

There are even US university departments that (jokingly?) suggest that they will “prove”
anything you want (if you have enough money).

I have no conclusive research to say they don’t but so far all my observations failed to show that they do.

Most of my East-asian friends cook regularly and they do NOT consume a lot of rice, it’s a side dish to accompany all the sauces, soups and meat/fish dishes they prepare.

This is the same story as Italians and pasta, Italians use pasta as a side dish and in small amounts. The french and their pastry, tiny portions after a meal.

I spent a week in Japan eating with locals and yes rice and noodles are on the menu but so are heavy sauces, fish and meat. And no, these are not fancy restaurants, these are fill to the brim with locals, 5€-a-meal places.

Thailand is the same story, it was 2 weeks of mostly meat and fish stews next to rice, the rice portion was small. And again this was local non-touristy restaurants and at the home of a Thai family.

I think what happens is when Asians go to the west, money is not exactly flowing, so they focus more on the cheaper part of the meal: rice and noodles.

For one, it is overly simplistic. To say that carbs cause a release of insulin, and that insulin causes one to store fat and become resistant to insulin over time is completely wrong. Examples of people who eat massive quantities of carbohydrates without running into obesity, type II diabetes, and early death from related complications is endless. Look no further than Tabues’ beloved Saccarine Disease by T.L. Cleave for evidence of that, where Cleave noted a lack of obesity, type II diabetes, and health problems amongst rural Zulus eating a diet consisting of 90% of calories as carbohydrates.

Or Kitavans…

Or the Japanese…

For an even better example, go straight to Taubes’ reliance on the Pima Indians to prove the ‘carbs make you fat’ theory. Pima Indians living in Mexico off of traditional carbohydrate staples – corn and potatoes (high GI BTW), have no such health problems like their Northerly Pepsi-slugging American Pima brethren.

Clearly, the carbohydrate does not, in and of itself, cause obesity. If we found it to cause obesity in the United States for example, that still wouldn’t answer why carbohydrate-based diets around the world in Asia and in numerous primitive rural cultures don’t cause obesity there.

If a person is deemed “carbohydrate sensitive” or has a metabolic problem (insulin resistance) that is apparently exacerbated by carbohydrate ingestion, then avoiding them is certainly one route to take. However, that still doesn’t ‘cure’ the problem, it just avoids it, like someone with allergies wearing a gas mask for life, or someone with a broken leg lying in bed for the rest of their lives. I think there is a much greater goal that can be achieved in the world of health, and that is overcoming insulin resistance and carbohydrate intolerance – instead of avoidance. That would be healing. True healing, instead of admonishing oneself to poor health and carb abstinence forever and ever, amen.

Dr. Bray is at least acknowledging that carbohydrate consumption does not cause insulin resistance, but that there are other underlying conditions that cause it. Hypercortisolemia is certainly one of them, which also causes leptin resistance and many other health problems. A low metabolism is yet another.

All in all, both Taubes and Bray, even though both have made some key contributions, are blind. Carbohydrate consumption, meat consumption, fat/natural sugar consumption in combination, fat consumption – you name it – they all predate the obesity/hyperinsulinemia epidemic.

Uh, did you actually read the Cleave’s The Saccharine Disease? I have my copy in front of me, and I looked up every reference to the Zulu in the index. Nowhere does it say that the Zulu eat a diet that is 90 percent carbohydrate, unrefined or otherwise. Such a diet would be unsustainable. Even such anti-fat zealots as Ornish, McDougal and others don’t recommend a 90 percent carb diet.

Provide the papers, and I’ll put them up for all to see.

http://www.healthzone.ca/health/article/617976

i can already see the support this will garner. i just never understood where people got the idea that southern italians and greeks eat a “mediterainian diet” of whole grains, olive oil and wine… spend a short amount of time at an italian or greek bakery and youll see white bread with olive oil, stewed meats with pasta sauces and pastry treats for every special occassion.

youll also see the most obese of european immigrants around in southern italians. half my family is obese eating this so-called traditional southern italian diet. a quick look at northern greeks (macedonians) and northern italians shows the meat heavy diet results in slimmer people period. this is cultural ignorance at its best. i honestly cant believe enough north americans think southern italians and greeks sit around eating whole grains, olive oil and some feta as a meal and thats why they are healthy….. go to a southern italian wedding, stuff yourself on the carb rich diet, enjoy the view of the majority obese people there and wonder where in gods name did anyone come up with this mythic dietary notion.

http://www.nytimes.com/2009/04/14/health/nutrition/14qna.html?partner=rss&emc=rss

1. Specifically note the variance of the benefits according to sex, age, other co-morbid conditions such as Type 2 diabetes etc.
2. Note the variance of side effects and lifestyle impacts for each of the the same groups of people.

The Mayo professor specifically notes that when patients are presented with such evidence tailored to their circumstances, via some form of simple “expert system”, patients appear to act rationally, viz:

1. Those in low risk groups avoid the therapy in droves, as the supposed benefit is very small compared with the cost, side effects and/or lifestyle inconvenience – that is they react rationally
2. Those in higher risk groups also in many cases avoid the therapy, as they do not see that their increased risk outweighs the disadvantages and they often seek alternative therapies such as lifestyle, diet and/or exercise changes – for many this may be rational
3. Those who undertake the therapy do so knowing that their probability of preventing disease is quite low, but still consciously decide to accept this plus the risks
4. More generally, the positive outcome is more targeted therapy, that avoids issues such as “Statins for all middle aged men”

All in all, I was quite impressed, even if the initial data input may not be as good as we would like. The key appears to be to tell the patient the truth (even if independent of the physician) about the statistical likelihood of a therapy either preventing or remedying a condition, plus side effects, for a specific target group. This allows them to weigh such a therapy up against all sorts of other factors.

Would you be able to comment on the article from Nutrition and Metabolism that MAC posted? In a comment in an older post, you mentioned that 60 grams/day of protein was the minimum for a woman. I’m 67, 5′2″ tall and weigh about 120 pounds, so I’ve been trying to maintain that level of protein intake/day. The article indicates that to prevent muscle loss, elderly people should eat 30 g/protein at a single meal at least twice a day. The problem for me would be that as a T2, 30 g at a sitting would probably raise my bg to an unacceptable level. However, if it would prevent sarcopenia and osteoporosis, I’d be willing to sacrifice my stellar A1C or look into metformin or insulin in order to be able to increase my protein intake.

Not asking for specific advice, here, just would like your take on whether 60 g of protein a day is sufficient to prevent muscle and bone density loss in the elderly.

Thanks.

Maggie

I would think it was a little low, especially for one on a low-carb diet. A lot of the dietary protein is used to make glucose if carb intake is low.

I am a 6 months reader of your blog. I appreciate three features of your approach, viz:

1. Step 1 – Increased individual healthcare knowledge (achievement) – As a statistician by original training (many years ago!), I appreciate the rigour with which persons such as Taubes and yourself argue your case. I find myself arguing with some friends that there is a rational position on self-health care, which is evidence based, which supports the low carb end of the spectrum. However, I also see that some in your camp are as religious and irrational as those in the opposing camp(s).

2. Step 2 – Increased health IQ, or ability to make reasoned judgements – This is the process of making judgements regarding the weight of evidence about the causality of many modern diseases and the appropriate preventive or treatment regimes. Your discourses on how to weigh the strength of various studies, are a good tutorial on the process of thought in science. Consequently we might disagree sometimes!

3. Step 3 – Increased healthcare emotional intelligence – You have made some early attempts to assist your audience to put all of these judgements about the evidence within a broader framework as to how they might make decisions regarding their individual lifestyle, including “treatment” regimes.

Much of the debate is still (appropriately) on the first step. Nevertheless, for a revolution to take place the second and third points will probably need to be addressed. They certainly will if one wishes to follow in John Gants footsteps and focus on the individual!

It is in the context of thinking about the third issue that I stumbled across a recent radio show in Australia. On a government owned, Australian Broadcasting Commission (ABC), radio station there is a credible show called “The Health Report”, which tries to adopt an evidence based approach to reporting on health issues.

Recently the show interviewed Professor Victor Montori from the Mayo Clinic, regarding work he has been doing on developing processes for patients to become involved in patient health care decision-making. Whilst I can pick holes (see above Step1) in the causality and outcomes information he has presented to patients in proper double blind clinical trials, I was fascinated by the algorithms he is attempting to develop about patient choices in an evidence based medical delivery system.

Hear the show at: http://www.abc.net.au/rn/healthreport/stories/2009/2532951.htm .

I am not an expert on the issue of “patient healthcare choices systems”, but can see an analogy with other areas of consumer skilling. Increasingly, the emphasis in such systems, leveraging off increased levels of education, is upon inculcating in the consumer a generalised algorithm that is aimed at promoting rational thinking, given their individual situation, where this situation includes not only rational evaluation of disease diagnosis and treatment options, but also all sorts of variables such as budgets, convenience, assessment of side effects etc.

One can sense the possibilities if an evidence based choices system, aided by physicians, might be presented to patients during consutlations.

Will the low carb folks obtain their proper market share for such systems?

I hope so. My only problem with the evidence-based medicine that is worshiped so highly by so many is that often the evidence used to base medical decisions is flawed or meaningless. For instance, many hundreds of thousands of statin prescriptions are written using evidence-based medicine, when the evidence is a handful of observational studies that mean nothing. Yet those writing the prescriptions think they are adhering to the highest standards. It’s really pitiful.