by Tim Noakes
Malhotra also noted that the fats ingested by the two populations differed: in the north, the preponderant fat was saturated fat mainly from milk and fermented milk products, whereas in the south, vegetable fats dominated. Naturally, he concluded that his data did ‘not fit the hypothesis that low ratios of poly-unsaturated to saturated fatty acids in food, or even an excess of sugar in food, contribute to an increased incidence of ischaemic heart disease’.60
Malhotra also compared rates of gallstone formation (cholelithiasis) – seven times higher in the north than in the south;61 peptic ulceration,62 including the effects of wheat or rice diets in recovery;63 gastrointestinal cancers64 – more stomach and colon cancers in the south, more liver and gallbladder cancers in the north; and varicose veins, which were more common in those living in the south.65
Africa
One of the first observations made by early medical missionaries in Africa was the apparent absence of cases of cancer. Albert Schweitzer, who worked as a physician in Gabon for 41 years, wrote:
On my arrival in Gabon in 1913, I was astonished to encounter no case of cancer … I cannot, of course, say positively that there was no cancer at all, but like other frontier doctors, I can only say that if such cases existed they must have been quite rare. In the course of the years, we have seen cases of cancer in growing numbers in our region. My observation inclines me to attribute this to the fact that the natives were living more and more after the manner of the whites.’66
Denis Burkitt, considered the father of the dietary-fibre hypothesis, spent 24 years in Uganda during and after the Second World War. He wrote that 44 hospitals he surveyed had never seen a case of colon cancer, heart disease, diverticulitis or appendicitis.67
Africa also includes ethnic groupings that chose to eat different diets either predominantly carnivorous or plant-based. In 1931, J.B. Orr and J.L. Gilks compared the health and physical attributes of the Akikuyu, a ‘vegetarian tribe’ eating predominantly cereals supplemented with roots and fruits, with the ‘largely carnivorous’ Masai, whose diet comprised milk, meat and raw blood. Compared to adult Akikuyu, adult Masai were about five inches taller, 23 pounds (10 kilograms) heavier, and 50 per cent stronger when tested with a hand dynamometer. In addition, bony deformities, dental caries, anaemia, pulmonary conditions and tropical ulcers were much more prevalent in the Akikuyu, whereas rheumatoid arthritis and ‘intestinal stasis’ were more common in the Masai.68
When the diet-heart hypothesis began to attract serious attention in the 1960s, some scientists wondered about the health of the carnivorous Masai and Samburu tribes of Tanzania and northern Kenya. If the diet-heart and lipid hypotheses were true, these groups would exhibit high blood cholesterol concentrations and rampant rates of heart disease. But neither proved true: both tribes had low to normal blood cholesterol concentrations and an apparent absence of coronary heart disease, although, interestingly, the Masai did have ‘extensive atherosclerosis but very few complicated lesions’.69 Complicated lesions occur when the arterial plaque ruptures. Thus, the apparent immunity to heart disease in the Masai must be because their diet and lifestyle protect them from coronary artery plaque rupture, not from atherosclerosis.
Another nomadic population eating the same diet as the Masai and Samburu, the Anagamba of eastern Niger, also had low blood cholesterol concentrations despite eating a diet comprising 73 per cent fat.70 Interestingly, and seemingly forgotten, the Anagamba’s blood cholesterol concentrations were no higher than those of the Kanouri, who ate an LFHC diet of millet and sorghum, and deriving just 9 per cent of calories from fat.
Multiple populations studied by Dr Weston Price
Perhaps the person who has made the greatest contribution to our understanding of how dietary changes influence human health is Dr Weston Price, a dental surgeon from Cleveland, Ohio. In 1931, Price and his wife, Florence, embarked on an epic medical journey to discover why the prevalence of dental caries in patients treated in his dental practice had suddenly increased so dramatically.71
Price’s thinking would have been influenced by a 1928 paper that reported the serendipitous finding that children with T1DM treated with insulin and a LCHF diet, as was the practice in the 1920s, showed reversal of their dental caries.72 The diet was made up of milk, cream, butter, eggs, meat, cod liver oil, bulky vegetables and fruit. It seems that before he left on his world tour, Price tested this theory for himself. He showed that feeding one meal a day high in fat-soluble vitamins to a group of 30 children with active dental caries prevented the progression of dental decay.73
In the course of his investigations, Price had also discovered South African fossil evidence showing that dental caries were not present in prehistoric humans;74 thus, by the time he left Cleveland, he must have strongly suspected that dental decay had a purely nutritional cause. But to prove this hypothesis, the Prices realised that they had to measure the prevalence of dental caries in populations still eating a ‘control diet’, i.e. populations that have continued to eat the same foods their forefathers ate before the agricultural revolution and the more recent introduction of industrial, processed foods.
Over the next decade, the Prices examined the teeth and general health of the Swiss inhabitants of the Lötschental Valley; of Scottish families living on the Outer and Inner Hebrides; of the Inuit (Eskimos) of Alaska; of the Indians of north, west and central Canada, the western United States and Florida; of the Melanesians and Polynesians inhabiting eight archipelagos of the Southern Pacific; of six tribes in eastern and central Africa, including the Masai; of the Aborigines of Australia; of Malay tribes living on islands north of Australia; of the Maori of New Zealand; and of South Americans in Peru and the Amazon Basin. Wherever possible, the health of those continuing to eat the traditional foods was compared with others in the area who had begun to eat the imported diet of processed foods.
Without exception, the findings in all these populations were the same. Specifically, those who continued to eat the foods of their ancestors showed:
an almost total absence of tooth decay;
broad faces, wide nostrils and perfect dental arches;
superior immunity, demonstrated by an absence of tuberculosis in some communities (such as the Swiss of the Lötschental Valley); and
an absence of most of the modern ‘chronic diseases of lifestyle’, including cancer, rheumatic diseases and other autoimmune diseases.
Yet dental decay and the other ‘chronic diseases of lifestyle’ started to appear in the first generation of those who began to eat what Price called the ‘displacing foods of modern commerce’, including ‘chiefly white flour, sugar, polished rice, vegetable fats and canned goods’. To which Price should perhaps have added other sources of sugar, such as confectionery and soft drinks.
Price concluded that
the diets of the primitive groups which have shown a very high immunity to dental caries and freedom from other degenerative processes have all provided a nutrition containing at least four times these minimum requirements; whereas the displacing nutrition of commerce … have invariably failed to provide even the minimum requirements. In other words the foods of the native Eskimos contained 5.4 times as much calcium as the displacing foods of the white man, five times as much phosphorus, 1.5 times as much iron, 7.9 times as much magnesium, 1.8 times as much copper, 49.0 times as much iodine, and at least ten times the number of fat-soluble vitamins.’75
Price also noted: ‘As yet I have not found a single group of primitive racial stock which was building and maintaining excellent bodies by living entirely on plant foods.’76 In part, he thought this might be because vegetables do not contain vitamin D (or the most usable form of vitamin A).
Price’s overriding conclusion is perhaps that traditional diets produce robust health by providing a high intake of minerals together with ‘known and unknown vitamins particularly the fat-soluble’.77 In essence, he concluded that the diet that prevents dental caries promotes optimum health. Or, stated in the c
onverse: any diet that promotes dental caries, promotes chronic ill health.
According to Ron Schmid,78 Price uncovered that peoples immune to the modern ‘diseases of civilization’ valued nutrient-dense animal fats: organ meats, especially liver (often eaten raw), bone marrow, fish oils and roe, egg yolks, lard and butter. They also considered foods from one or more of six different groups to be absolutely essential:
Seafood: fish and shellfish, fish organs, fish liver oils and fish eggs.
Organ meats from wild animals or grass-fed domestic animals.
Insects.
Fats of certain birds and single-stomached animals, such as sea mammals, guinea pigs, bears and hogs.
Egg yolks from pastured chickens and other birds.
Whole milk, cheese and butter from grass-fed animals.
Price believed that fat-soluble vitamins acted as ‘catalysts’ or ‘activators’, optimising the assimilation of all other nutrients – proteins, minerals (especially phosphorus and calcium) and fats. We now know that the fat-soluble vitamins – D, E, A and K, and perhaps especially vitamin K2 – serve these functions, as Price concluded. So ‘it is possible to starve for minerals that are abundant in the foods eaten because they cannot be utilized without an adequate quantity of fat-soluble activators’.79
A subsequent study that has also been lost to time confirmed that a diet high in fat and essential vitamins, especially vitamin D, could prevent or reverse dental decay. M. Mellanby and C.L. Pattison compared the effects of eight different diets, given for six months, on the progression of dental caries in five-and-a-half-year-olds. They showed that a diet high in calcium and vitamin D, and free of cereals, ‘almost eliminated’ the ‘initiation and spread of caries’.80
It is perhaps not surprising that these studies, showing that dental caries can be prevented by high-quality diets, have been essentially forgotten or, perhaps, actively suppressed.
Figure 16.8
Mellanby and Pattison found that, whereas a cereal-free diet rich in vitamin D reduced the initiation of dental cavities (caries) and produced ‘hardening’ of established cavities (left columns), a diet high in oatmeal without added fat-soluble vitamins A and D was associated with an increased number of dental cavities and little evidence of hardening of established cavities (right columns)
Reading Price’s book should be sufficient to convince even the most wary sceptic that basing a diet on the ‘displacing foods of modern commerce’, as current dietary guidelines would have us do, is not a particularly clever decision. Rather, it appears to be the single cause of the devastating ‘chronic (modern) diseases of lifestyle’.
The Inuit
Price studied the Inuit of Alaska and described them as ‘an example of physical excellence and dental perfection such as has seldom been excelled by any race in the past or present’, and as ‘robust, muscular and active, inclining rather to sparseness than corpulence, presenting a markedly healthy appearance. The expression of the countenance is one of habitual good humor. The physical constitution of both sexes is strong.’81
Harvard biologist Vilhjalmur Stefansson wrote a number of books describing his experiences of living with the Inuit for many years eating a very low- or no-carbohydrate diet.82 His observations match those of Price. When he returned to New York, Stefansson chose to subject himself to a year-long experiment during which he and a friend ate only meat.83 He wished to prove that it was possible to survive without developing scurvy if one ate lightly cooked meat daily (which contains just enough vitamin C to prevent scurvy). If anything, their health improved over the period of the experiment.
In a fourth book, Stefansson, who observed no evidence of cancer in the Inuit, postulated that cancer is a disease of modern civilization.84 Schmid includes quotes from three doctors who worked among the Inuit, all of whom confirmed that ‘cancer was unknown’ there. But once the Inuit adopted the industrial diet, cancer ‘frequently occurred’, as did tuberculosis.85
The absence of cancer in mummies from Egypt and South America86 led one study to propose: ‘In industrialised societies, cancer is second only to cardiovascular disease as a cause of death. But in ancient times, it was extremely rare. There is nothing in the natural environment that can cause cancer. So it has to be a man-made disease, down to pollution and changes to our diet and lifestyle.’87
Studies of less-isolated Inuit like those in Greenland show that they have undergone a major dietary change over the past 150 years. The intake of sugar by Greenland Inuit increased thirtyfold, and refined carbohydrates five- to sevenfold, between 1855 and the 1970s.88 As a result, carbohydrate intake increased from 2 to 8 per cent to 40 per cent of daily calories in the same period. This increase in carbohydrate intake and fall in fat intake is associated with the dramatic appearance of ill health and the chronic diseases of insulin resistance. Samuel Hutton noted: ‘I have seen how the natives degenerate when they take to European food. They lose their natural coating of fat to a great extent, and need more clothing to withstand the cold; they become less robust, less able to endure fatigue, and their children are puny.’89 It is as Weston Price wrote: ‘Like the Indian, the Eskimo thrived as long as he was not blighted by the touch of modern civilization, but with it, like all primitives, he withers and dies.’90
Today, cancer is the leading cause of death among the Inuit in Alaska. Tuberculosis is rife, T2DM is considered to be an epidemic, and the Inuit’s life expectancy is 11 years less than the Canadian average. In addition, the mental health of the Inuit has declined.91 These outcomes are the precise opposite of the predictions of Keys’s diet-heart hypothesis.
The Australian Aborigines
Weston Price reserved special praise for the health and physical abilities of those Australian Aborigines who continued to live according to their traditional ways, yet he also saw that, like the Inuit and the American Indians, Aboriginal health deteriorated catastrophically once they adopted the white man’s ways:
While these evidences of superior physical development demand our most profound admiration, their ability to build superb bodies and maintain them in excellent condition in so difficult an environment commands our genuine respect. It is a supreme test of human efficiency. It is doubtful if many places in the world can demonstrate so great a contrast in physical development and perfection of body as that which exists between the primitive Aborigines of Australia who have been the sole arbiters of their fate, and those Aborigines who have been under the influence of the white man. The white man has deprived them of their original habitats and is now feeding them in reservations whilst using them as laborers in modern industrial pursuits.92
As a result, Price noted, their health was now as poor as that of Caucasian Australians. Today, it is much worse.
Urbanised Australian Aborigines have rates of T2DM that are four to six times higher than Caucasian Australians.93 With high rates of obesity, 40 per cent of those over 55 years are now diabetic. There is good evidence that Aborigines are genetically insulin resistant,94 so that some of their metabolic traits ‘are associated with being Aboriginal (mild impairment of glucose tolerance, hyperinsulinemia and elevated total and VLDL [very low density lipoprotein] triglycerides)’.95 In such a population, replacing ancestral food choices with the ‘displacing foods of modern commerce’ must predictably lead to high rates of T2DM.
In one remarkable study that has also gone ‘missing’, Kerin O’Dea returned 10 urbanised Aborigines with T2DM to their traditional hunting grounds in north-western Australia, where for seven weeks they reverted to eating the foods of their ancestors. The results were perhaps predictable – the biochemical markers of T2DM were either ‘greatly improved or completely normalized’.96
Yet the Australian Dietary Guidelines continue to dictate that urbanised Aborigines must eat low-fat diets deriving 45 to 65 per cent of their energy from carbohydrates.
The saccharine diseases
In the course of his career as a naval surgeon travelling the world, Captain T.L. Cleave
,97 together with South African physician G.D. Campbell, formulated the hypothesis that a variety of medical conditions – including dental caries and associated periodontal disease, peptic ulcers, obesity, diabetes, colonic stasis ‘and its complications of varicose veins and haemorrhoids’, heart attack (coronary thrombosis) and certain gut infections – are caused by diets high in sugar and refined carbohydrates, and should therefore be termed the ‘saccharine diseases’. As a result, ‘in any disease in man due to alterations in his food from the natural state, the refined carbohydrates, both on account of the magnitude and the recentness of the alterations, are always the foods most likely to be at fault; and not the fats’.98
Cleave and Campbell built their hypothesis on the evidence that global sugar consumption began to increase exponentially after 1850, increasing fivefold within the next century, reaching 110 pounds per individual per year in the UK by 1950. They next compared the health and diets of Indians living in India with those in South Africa. Despite eating less carbohydrate and more protein and fat, the South African Indians had much higher rates of T2DM, which Cleave and Campbell concluded must be due to the roughly 10-times higher consumption of sugar (110 vs 12 pounds) by Indians living in South Africa.
Next they showed that urbanised Zulu-speaking South Africans in Durban also ate more sugar than their rural compatriots and developed high rates of T2DM after living in the city for 20 or more years. This became known as the Rule of Twenty Years, as it takes 20 years of exposure to a high-sugar diet before T2DM develops.99
Cleave and Campbell also confirmed my suggestion that ‘until the disastrous rinderpest of 70 years ago the Zulus have been predominantly meat-eaters’, so that they wondered if ‘the more carnivorous peoples of the world are more vulnerable to the diabetogenic effects of the consumption of refined carbohydrates than are the more vegetarian peoples, or are they less vulnerable?’100 The studies of O’Dea clearly establish that Australian Aborigines show this very obviously, as they are insulin resistant even when eating a low-carbohydrate diet. I suspect that this can perhaps be generalised to all populations traditionally eating carnivorous diets.