At a party a month ago, someone in my conversation rosette brought up a book she said had changed her life. I can’t now remember the book because I immediately began ruminating on books that had changed my own life. Over the next few weeks, I roamed through my own libraries – both physical and mental – seeking a core selection of books that radically altered my own world view.
As I am sure is true of most people, I have a multi-faceted life with many and varied interests. I remembered books that had a profound effect on my political and philosophical thinking. Others about business, technology, and relationships. And yet others about engineering and science, especially physics. But this blog is mainly about nutrition and medicine, so I decided to share the short list of books that provoked substantive shifts in my nutritional and medical paradigms. This won’t be a list of every book that influenced my thinking on these subjects – in fact, it is far from it – but it catalogs the books that steered me down specific pathways I follow to this day. Some of these books are not the best on the subject; they are simply the first ones I read, the ones that inspired my interest and drove me to dig deeper. For instance, I wouldn’t particularly recommend the book I’m writing about in this post because much more information has become available since. It’s not an earth-shattering book – it was simply the catalyst for me.
Napoleon’s Glands was the first book to really send me off down a rabbit hole of discovery. Via a single sentence, this book tripped me to a line of inquiry that threatened to take over the writing of Protein Power. Because of the momentous changes it caused, I’m going to devote this first post to this book alone.
A little history. In the late 1980s I wrote Thin So Fast, a book on how to do a Medifast/Optifast type diet at home. It’s hard to believe now, but at that time, people undertook these protein-sparing, modified fasts (PSMF) only under physician supervision. I was treating obese patients with low-carb diets, and many were clamoring to go on one of these fasting programs. I relented and ended up successfully treating countless patients with my own low-carb version of a PSMF program. After watching my first hundred or so patients closely, I realized that this program was one that dieters could easily do at home on their own, if they but had a way to do so.
In the late 1980s, there were almost no commercially available protein supplements. It’s difficult to imagine now when they are everywhere you look, but then protein powders were not common. There were a couple, but they were hard to find, usually sold only at health food stores (which, at that time, were also thin on the ground), tasted wretched, and were used mainly for supplementing other foods, not as a meal replacements. People then had no ready access to meal replacement protein powders – Medifast, Optifast and a handful of others were distributed only through physicians. I realized it was kind of a racket, so I decided to write a book explaining how a PSMF could be safely done at home.
The first problem, though, was in coming up with a recipe for a suitable protein shake that could put together from available ingredients. I had MD help me fiddle around with it until we (mainly she) came up with something palatable and effective. Thus, my first book.
In order to flesh out Thin So Fast, I wrote sections on all kinds of diet-related material. One of the chapters, The Insulin Connection, was about all the things insulin did besides drive sugar into the cells. I suspected insulin was a primary driver of obesity, elevated cholesterol, high blood pressure, and a host of other disorders, so I speculated on some of the mechanisms involved, most of which have since proven to be correct. A few years after the publication of Thin So Fast, I had read everything I could get my hands on about the effects of insulin and wanted to write about it, so I submitted a proposal for a new book called The Insulin Connection. The book publisher loved the idea but hated the title; he figured it would appeal only to people who were diabetic. They changed the title to Protein Power, which I hated at the time and am still not too crazy about, though it has grown on me.
Between the writing of Thin So Fast and Protein Power, I had been in discussion with the publisher about writing what he called a medical narrative. I have always been interested in the history of medicine and the impact of specific diseases on the course of history. Some authors had written such books, but no one I knew of had written a book describing the actual diseases in a way laymen could understand. Most people know about syphilis, tuberculosis, plague, malaria, yellow fever, rabies, etc., but they don’t really understand what happens physiologically and pathologically when one of these diseases sets in. I was going to write a book explaining it all for the layman. But Protein Power came along, and the medical narrative was back-burnered, where it still simmers to this day.
While doing the research for this medical narrative, I came across the book that would profoundly change my thinking. Napoleon’s Glands and Other Ventures in Biohistory, by science writer Arno Karlen, is a series of essays on intriguing episodes in the history of medicine. Though hard at work on Protein Power, I continued my habit of omnivorous reading, and, still with the idea of the medical narrative in mind, decided to dip into Napoleon’s Glands at bedtime one night. At this point, Protein Power was going to be my argument as to why the untoward effects of excess insulin validated the low-carb diet as the preferred way of eating for most people. But then I came to the chapter in Napoleon’s Glands titled “Mummy Powder, Mummy Blood, Toward a Biohistory of Peoples.”
“Mummy Powder, Mummy Blood” was about early paleopathologists, who autopsied ancient Egyptian mummies, and about their modern counterparts who were continuing those studies with much more sophisticated equipment, including X-ray and CT studies and, believe it or not, even labwork. These mummy autopsies revealed that ancient Egyptians were crawling with parasites, had dental caries and even a fair amount of arthritis. In reading through the roll call of these disorders, the following sentence leaped out at me:
Blood-vessel disease was common, contrary to assumptions that it rises from urban stress and a modern high-fat diet.
As I recall, I was starting to get a little sleepy, but I bolted alert when I read then reread this sentence. I remembered reading somewhere that the ancient Egyptian diet was heavy in carbohydrates, and I started wondering…
Wide awake, I raced through the rest of the chapter and on to the next – “Dry Bones, the Unwritten Past” – about the diagnosis of ancient disease through skeletal remains. I was hooked. I flipped to the back of the book where, to my absolute delight, I discovered a bibliography listing a host of sources and journals that theretofore had been completely unknown to me. I was unable to sleep, so I got up, went down to our library and rummaged through all our books I could find on Ancient Egypt. There were a few, and all seemed to confirm that the early Egyptian people, the ones whose mummies I had just been reading about, did indeed subsist on a diet heavy in carbohydrate, primarily wheat.
I made a copy of the bibliographic pages in the book, took them to bed and began marking them up so that I could track them down more easily when I went to the medical library the next day. As I turned to those pages again today while preparing to write this post, just the memory of the excitement I felt when I first encountered them started to get me a little fired up. Not quite the Chris Matthews’ thrill up the leg, but almost. (I don’t have my original marked up biblio so I scanned these pages from my copy of the book and converted them to pdf. Here they are so you can see what kind of stuff really gets me worked up. Napoleon’s Glands Ch 4 & 5 Biblio I guess I need to get out more. Pretty pitiful.)
The next day, as soon as I had seen my last patient, I made my way to the medical library and began pulling all the references. Reminiscing about this makes me realize what huge strides have been made over the past 18 years in the ability to do this kind of research. Today I would sit down in front of my computer and start going to the journal websites and accessing the papers. Back then – which was in the early 1990s – I had to go to the medical library and start wandering through the stacks of bound journals. They were all stacked alphabetically, which was how I marked up my copies of the bibliography pages so that I could start at the As and go from there. I would remove the bound journals – which were often the size of large phone books – and stack them on a cart I pushed along with me. I roamed through the stacks, piling the journals on the cart, and ended up in the copy room. I would then have to copy each paper page by page. Today, in the same time it took me just to drive to the medical library, I can grab more papers from the web than I gathered all that afternoon. And they wouldn’t cost me ten cents per page to copy as they did then. Ain’t technology grand?!
As I read these papers at home in my study, I checked citations and gathered a list of yet more papers to get. It was off to the medical library the next day to get those papers. Then read them, made another list, and repeated. Until I had pretty much all the papers I could track down that had anything to do with paleopathology and diet.
Many of these references were books, so I had to track those down, too. A number of the references cited Paleopathology at the Origins of Agriculture. Because I couldn’t get my hands on it any other way, I ended up forking over $140 or so for this book (it’s now about $300), but it was well worth it, because through it I got on the track of Claire Cassidy, Ph.D., whom I wrote about in Protein Power, and who wrote the paper I wrote about here.
I joined the Paleopathology Association and immediately purchased all back issues of the Paleopathology Newsletter. I dragooned MD into going to Paleopathology Association meetings, which I loved, and which are still my favorite medical meetings. There we could converse, confab and otherwise hobnob with all the nabobs of academic paleopathology, all of whom have written books at some point, and all of whose books I now own.
After attending these meetings and poring over my ever-growing mountain of paleopathology and anthropology literature, it became more and more apparent to me that although the agricultural revolution was a good thing for mankind it was a bad thing for individual men. I learned that the health devolution that took place due to dietary changes incurred as a result of man’s turn to agriculture were so substantive that at a glance an anthropologist could identify skeletal remains as being those of a agriculturalist or a pre-agriculturalist. How? Because as compared to agriculturalists, pre-agriculturalists had greater stature, stronger bones, better teeth, fewer signs of infection, less evidence of malnutrition and/or vitamin deficiencies – all signs visible to the trained eye. And not only were the pre-agriculturalists more robust, studies on groups of their remains showed they even experienced greater longevity than their agricultural progeny.
Agriculturalists replaced their previous diet of primarily fat and protein with high-starch plant foods and paid for it with their health. It didn’t take a rocket scientist to realize that modern man was treading the same path. And with the same results.
Problem was, that the nutritional ‘experts’ of the late 20th Century had deemed the diet man evolved over multiple millennia to thrive upon – one of primarily protein and fat – as extremely unhealthful. And to make matters worse, modern nutritional dogma glorified as optimal the self-same grain-based, meat-poor, low-fat diet that had cratered the health of our post-agricultural ancestors .
I was gearing up to write a book showing how low-carb dieting would treat not just excess body fat, but most of the diseases common to modern man. My plan was to develop the hypothesis that the insulin to glucagon ratio was the metabolic underpinning for both the development of – and thus the treatment of — obesity, high blood pressure, elevated blood sugar, heart disease and hyperlipidemia (which at that time I still thought was a disease). I was going to marshal the evidence from all the studies I could find (there weren’t a lot at that time) to explain the results I was seeing in myself and in my patients.
And then, thanks to that one sentence about coronary artery disease being a common finding in Egyptian mummies, this mountain of paleopathological data I was unaware of dropped into my lap.
The realization that a major argument on behalf of the low-carb diet lurked in the literature of Paleolithic disease led me to the orgy of study mentioned above and threatened to take over the book I was writing. This anthropological material so fascinated me that I didn’t want to read anything else. I missed my deadline because I kept finding just one other thing to add, and, ultimately, my editor left (not because of my delay, but because she went to work for another publisher) leaving me with an orphaned book. My agent said I needed to find another publisher, so I went to New York to do yet another dog and pony show for a handful of book companies. An editor from Bantam Books finally decided to buy my contract from my former publisher. MD went with me to the presentations, and the Bantam group liked the idea of the two of us being co-authors, so that’s how our publishing collaboration began. I had written This So Fast by myself, and MD had by then written four or five books on her own. Since that time, we’ve co-written every book.
Our new editor indulged me in the chapter on anthropology and diet I called “Curse of the Mummies,” but, alas, when it came time for the paperback our editor had left Bantam (an occupational hazard of mainstream publishing), and the new editor assigned to us did not like the Paleo stuff, so she militated to have it removed. As you might imagine, I went berserk. It was my favorite part of the book and the one I felt most strongly argued the notion that we were genetically programmed to thrive on low-carb diets. She disagreed. She had her own ideas as to what a diet book should be, and a chapter on the anthropology of diet didn’t fit her script. Out of frustration, I let her browbeat me into moving the chapter to the back of the book. So, if you have a hardback of Protein Power, you’ll find “Curse of the Mummies” as Chapter Two, right up front where it belongs. If you have the paperback, it will be way in the back in an epilogue right in front of the appendix. And it will be titled “Overcoming the Curse of the Mummies.” It wasn’t until I just now went back to look at it in the paperback that I realized that not only had this editor moved the chapter to the back of the book, she changed the title as well. What a troll!
(Thanks to the success of Protein Power, we had vastly more pull with our next publisher, so we wrote The Protein Power LifePlan as a total evolutionary-based, Paleo kind of book. Maybe our former editor was right because the PPLP never sold as well as Protein Power.)
Another benefit of reading that one little sentence in Napoleon’s Glands and acting on it was a great and lasting friendship. Upon publication of Protein Power, Loren Cordain, whom I had never met, contacted me, introduced himself and asked me to speak at the Colorado State University in Ft. Collins, CO. I accepted. Loren and I became friends, and when he wanted to write his book on the Paleo diet, I lent him my agent, who has been his agent since. Through Loren I met Rob Wolf, Staffan Lindeberg and a host of other writers and researchers the world over. Which would doubtless have never happened had we just written a typical diet book.
After receiving all the feedback on the Paleo stuff in our book, I began to think Protein Power was the first book for the layman using the Paleolithic diet to argue for low-carb eating.
I knew the Paleolithic Prescription was out there, but it was written in an attempt to shoehorn the real Paleo diet into a low-fat framework. Which was bizarre because the authors of the book wrote a groundbreaking paper on the Paleo diet in the New England Journal of Medicine that got them much notoriety along with a book contract. From what I’ve since heard, their editor strong-armed them into making their diet low-fat, because that was what ‘everyone’ believed in then.
I then remembered Neanderthin, a book that came out while Protein Power was going through the publication process. It originally was a little, self-published paperback I happened upon in a Borders (RIP) in Dallas. And it probably would have escaped my notice had I not been so attuned to dietary anthropology. I tracked down the main author, Ray Audette, who lived in Dallas. MD and I had dinner with him and his wife a time or two, and after his little paperback had sold enough copies, he got a mainstream contract, and I agreed to write the forward to his mainstream-published book.
I’ve since found two more books published before Protein Power that based their diets on Paleolithic principles.
(Actually four if you count books by Vihljalmur Stefansson and Wolfgang Lutz. Stefansson wrote Not By Bread Alone in 1946 and it’s expansion and sequel The Fat of the Land in 1956. These were not really diet books but were more descriptions of the diets followed by the early peoples who populated North America. Lutz wrote Dismantling a Myth: The Role of Fats and Carbohydrates in Our Diet, which was an actual textbook and a follow up to his book in German, Life Without Bread. Dismantling a Myth, published in 1987, contains a chapter titled “Evolution as an Argument,” which is his argument that anthropology shows man to be designed to consume a diet of primarily protein and fat. I wish I had had this book when I wrote the relevant material in Protein Power, but I didn’t know of it’s existence until the early 2000s. It is almost impossible to find — I was not able to get my own copy until just a few years ago.)
The two low-carb low-carb, Paleo diet books were written by two physicians on opposite sides of the country. In 1961, Blake F. Donaldson, M.D. wrote Strong Medicine, a book describing his methods of treating pretty much anything that ailed his patients. His book contains one of my all time favorite lines that I quote often.
During the millions of years that our ancestors lived by hunting, every weakling who could not maintain perfect health on fresh fat meat and water was bred out.
Dr. Donaldson was having trouble getting his overweight patients in his practice in New York to drop the pounds. He had heard of Stefansson’s experiment in which he and another explored went a year under supervision at Bellevue Hospital on a meat-only diet and emerged from the experience lighter and in better health. Donaldson invited Stefansson to dinner and picked his brain. As a result, Donaldson began treating his own obese patients on basically an all-meat diet. (His actual diet was a half pound of meat, one small boiled potato, and a half cup of black coffee or tea at each meal – and nothing else throughout the day.) He had such success that he began treating just about every health problem presenting to his clinic with his almost all-meat diet. Unlike with Dismantling a Myth, you can find copies of Donaldson’s Strong Medicine pretty easily. It makes an interesting read. But beware. It will show you how much times have changed since 1961. By today’s standards, it is sexist and racist to the max.
The Stone Age Diet, written in 1975 by Seattle gastroenterologist Walter Voegtlin, M.D., is the second book I’ve found using a Paleolithic rationale for the low-carb diet. Dr. Voegtlin was a GI doc and a comparative anatomist. He noticed the similarities in the GI tracts of carnivores and humans and concluded that the human GI tract was essentially that of a carnivore. He then reasoned that maybe a fair number of the GI problems he was seeing in his practice arose as a consequence of the high amount of carbohydrate in the typical diet, an amount no carnivore would eat. He tried treating some of his patients with GI disorders with all-meat diets and saw them experience dramatic improvement. He, like Donaldson, began treating most of his patients with such diets and found that not only did their GI symptoms improve, but they lost weight, too. Dr. Voegtlin couldn’t interest a publisher in his book, so he self published. Consequently, his book is almost impossible to find. I had to search for years before finding a copy and ended up dropping $200 for it. It’s a shame this book didn’t have wider distribution because it is elegantly written and a delight to read. Dr. Voegtlin must have spent a lot of time thinking about these dietary issues because his book is full of insights I’ve never read anywhere else. If enough people ask, via the comments, I’ll take the time to transcribe his chapter on the difference between the digestive tracts of carnivores and herbivores and make it available. It is illuminating.
These are the only books I’m aware of that pre-date our own using paleopathology to argue for low-carb. If anyone knows of any other books published prior to Protein Power (1996) using the Paleo diet or an evolutionary/natural selection basis as the rationale for a low-carb diet, I would love to hear about them. I will seek them out to add to my collection and mention them in an addendum to this post.
I promise my next post/posts on books that changed my life will not be this lengthy. I will try to put them in a single post with a paragraph about each one and a brief description of why and how each affected me. I planned to do that with this one, but the change was so momentous that I decided to take it and run with it. I hope you enjoyed reading about the odyssey as much as I enjoyed reliving it.
ADDENDUM: A hat tip to commenter Ash Simmonds who posted a link to the complete version of The Stone Age Diet. If you want to read the parts about the comparative anatomy of carnivores, herbivores and humans take a look at chapters 4, 5 and 6.
And a hat tip to commenter Monkeyman, who found a full-text, online version of Stefansson’s The Fat of the Land. (Clicking the link will download the entire book in pdf.)