Sugar? Fructose? Carbs? What's the Difference!

A friend asked about the difference in impact between blood sugar that is created from excess consumption of carbs that are not sugar, and from carbs that are sugar.  That is to say, why does high carb intake absent a high sugar intake seem to have a different impact than does the high carb/high sugar combination?

First, two facts:
There are islanders who eat at least 60% of their calories as starchy carbs, but they have very little sugar intake.  About 95% of the men smoke.  They have no heart disease.
Additionally, when studied it is often observed that there are healthy fat folks and non-healthy fat folks.

What happens in a very abbreviated answer is that fructose is processed via the liver, and when consumed in excess it seems to make the liver insulin resistant.  This seems to be a stage in development of full insulin resistance.  Insulin resistance is detected as metabolic syndrome, a precursor to diabetes, and a strong predictor of disease in and of itself.

You can find more about various elements of fructose ingestion here:
Fructose link: http://fireofthegodsfitness.blogspot.com/search/label/Fructose

Also, at Gary Taubes blog Gary summarizes three studies on this topic here:
Taubes summary of the three:  http://garytaubes.com/2011/11/catching-up-on-lost-time-–-the-ancestral-health-symposium-food-reward-palatability-insulin-signaling-and-carbohydrates…-part-iib/

The best, most solid science on this topic includes this study:
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0057873 ... which is summarized well here:
http://opinionator.blogs.nytimes.com/2013/02/27/its-the-sugar-folks/?_php=true&_type=blogs&_r=0

So here's my concept of the progression:

First, we find those who eat too many carbs, and store them as excess fat, but they are not insulin resistant, do not develop metabolic syndrome, and are healthy by most measures.
Second, we find those who eat "too much" sugar (too much is different by individuals for a variety of reasons like ethnicity, activity level, alcohol consumption, etc) and become insulin resistant.  For these folks, all carbs now become a driver of excess blood sugar, inflammation, and often progress to metabolic syndrome and diabetes.  Once sugar and carbs are reduced, these folks often become normal in their tolerance of non-sugar carbs.
Lastly, we find those with metabolic syndrome and diabetes.  Because they have become insulin resistant, often any kind or dose of carbs will make them fatter and sicker.

The implications for this model include the idea that eating meat, vegetables, nuts and seeds, little fruit or starch and no sugar/wheat is a strong preventative for progression through these stages.  I would bet that it is not possible to eat enough of the above prescription to become insulin resistant.  Once one is in stage 2 or 3 as described above, it may take a more careful approach that includes measured carb restriction, and perhaps induction of ketogenic metabolism.

Fat Trap or Cognitive Dissonance?

http://www.nytimes.com/2012/01/01/magazine/tara-parker-pope-fat-trap.html?pagewanted=all&_r=0

For 15 years, Joseph Proietto has been helping people lose weight. When these obese patients arrive at his weight-loss clinic in Australia, they are determined to slim down. And most of the time, he says, they do just that, sticking to the clinic’s program and dropping excess pounds. But then, almost without exception, the weight begins to creep back. In a matter of months or years, the entire effort has come undone, and the patient is fat again. “It has always seemed strange to me,” says Proietto, who is a physician at the University of Melbourne. “These are people who are very motivated to lose weight, who achieve weight loss most of the time without too much trouble and yet, inevitably, gradually, they regain the weight.”

Anyone who has ever dieted knows that lost pounds often return, and most of us assume the reason is a lack of discipline or a failure of willpower. But Proietto suspected that there was more to it, and he decided to take a closer look at the biological state of the body after weight loss.

Beginning in 2009, he and his team recruited 50 obese men and women. The men weighed an average of 233 pounds; the women weighed about 200 pounds. Although some people dropped out of the study, most of the patients stuck with the extreme low-calorie diet, which consisted of special shakes called Optifast and two cups of low-starch vegetables, totaling just 500 to 550 calories a day for eight weeks. Ten weeks in, the dieters lost an average of 30 pounds.

At that point, the 34 patients who remained stopped dieting and began working to maintain the new lower weight. Nutritionists counseled them in person and by phone, promoting regular exercise and urging them to eat more vegetables and less fat. But despite the effort, they slowly began to put on weight. After a year, the patients already had regained an average of 11 of the pounds they struggled so hard to lose. They also reported feeling far more hungry and preoccupied with food than before they lost the weight.

While researchers have known for decades that the body undergoes various metabolic and hormonal changes while it’s losing weight, the Australian team detected something new. A full year after significant weight loss, these men and women remained in what could be described as a biologically altered state. Their still-plump bodies were acting as if they were starving and were working overtime to regain the pounds they lost. For instance, a gastric hormone called ghrelin, often dubbed the “hunger hormone,” was about 20 percent higher than at the start of the study. Another hormone associated with suppressing hunger, peptide YY, was also abnormally low. Levels of leptin, a hormone that suppresses hunger and increases metabolism, also remained lower than expected. A cocktail of other hormones associated with hunger and metabolism all remained significantly changed compared to pre-dieting levels. It was almost as if weight loss had put their bodies into a unique metabolic state, a sort of post-dieting syndrome that set them apart from people who hadn’t tried to lose weight in the first place.

“What we see here is a coordinated defense mechanism with multiple components all directed toward making us put on weight,” Proietto says. “This, I think, explains the high failure rate in obesity treatment.”

This is one of the most interesting articles on fat loss I’ve ever read - I’ve read it several times - that does nothing to help anyone lose weight or be healthy.  The point of the article seems to be “it’s hopeless, you may as well not even bother.”  

And that is an experience with weight loss many people encounter, some many times in their lives.  As I read it, I try to stack up my own experience - that my body weight is very responsive to carbohydrate restriction and to “eating quality food”, and that I’m 35 pounds lighter than I was 8 years ago when I was 42, and that I know I’m not working out more or exercising generally more than I was then.

The article is lengthly and detailed and describes what is known at the starvation response - the tendency of the body to increase appetite and decrease activity when it is subjected to caloric deprivation over a long enough period of time.  One of the story’s protagonists is getting all scientific about the mechanisms that enable the body to conserve energy, but to me there’s a huge pink elephant in the article - at no time does the author delve into the question of what type of diet the researchers are using to get their fat loss-to-starvation-response cycle?

Here’s why this is a pivotal question to me.  Nearly every study on the topic shows that those who lose weight by restricting carbohydrates have lower appetites and spontaneously reduce food intake.  So if you and your buddy both diet, and the buddy goes with caloric restriction (and perhaps exercise), and you just cut carbs (smartly) and sit on the couch texting with your significant other, you very well may lose as much fat, and with less hunger.  

The author of the article is an interesting study - to the best of my knowledge, she avoids the topic of low carb because she hob nobs with the scientists who have been in vogue over the last ten years or more who advocate a low fat diet for health and weight loss.  When our society went all fat crazy starting about forty years ago - we began to tell people not to eat saturated fats (“bad for your heart”), and to tell people to eat industrially produced polyunsaturated fats (“heart health fats”) - we also began a long experiment with the “a calorie is a calorie” idea.  That is to say, we looked at the first law of thermodynamics, which states that energy may not be created or destroyed it simply changes forms, and extrapolated that the human body worked like a bomb calorimeter.  

If you stuff a quantity of fat, protein or carbohydrate into a steel ball, and ignite the contents, and measure the change in heat that results from the incineration, you can derive that fat yields 9 kcal/gram, and protein/carbohydrates yield 4 kcal/gram.  With this nifty bit of data, folks decided that fat loss should be a simple proposition - eat less, move more.  

If you combine these two unproved propositions - fat is bad and has more calories - then fat loss and health should magically result when we eschew fats and exercise more.  After all, people who exercise are leaner than those who do not.  

Only one problem - systematically depriving an overfat person of calories via a low calorie and low fat diet with exercise only works for a while.  And if you read the whole article above several times, that is the stunning conclusion.  And the prestigious scientists the author quotes are figuratively scratching their heads like the clowns in the Monty Python skit trying to sort it all out, since it doesn’t fit their “calorie is a calorie” paradigm.  They have cognitive dissonance - “we’re doing everything right, we have to figure out why these peoples’ bodies are fighting so hard to regain the lost fat so we can create a drug to circumvent that.”  

The question for me is - are they asking the right question?  Are they really doing everything right?  What if the problem is just this simple - they are feeding humans low quality food they were not meant to eat (IOW low cal low fat), and humans are reacting with predictable problems.  What if a simple restatement of the topic of this very long, and very detailed article published in the new york times is “We fed people a small amount of stuff they were never designed to eat and it didn’t work out so great.  They acted like they were starving.”

The section of this article - which in some ways seems to be a lengthy defense for why the NYT editor for a wellness blog is 60 pounds overweight - which is most resonant for me is the portrait of a lady who has taken the calorie in calorie idea to its natural conclusion.  She spends what seems like every waking moment making sure she gets only the right amount of calories and the right amount of exercise, every single day of her life.  Her story is an amazing show of discipline and determination.  This lady is used by the author to kind of illustrate how nearly impossible it is to lose fat and keep it off.  

For the record, I think it is in fact just about this impossible to lose fat and keep it off for some people.  Fat storage is a function of hormonal and other responses that have been refined over the entirety of animal existence on this planet.  The human genome you have was developed to make sure you had just the right amount of fat stored on your body to optimize your chances for survival through reproduction (and survival of your offspring).  It is an impossibly well developed system, that worked nearly without fail until we starting eating the crap we eat now.  I’m not sure it is possible to undo a lifetime of eating like we eat, at least not for all people, and not in terms of getting to an keeping an idea body weight.  

And the problem is not just what we eat.  It’s how we sleep or don’t sleep, and how our hormonal cycles seem to have been disrupted by the ways we no longer live as we were designed to - the novelty of lights, the sleep disruption, the non-optimal food, and the loss of seasonal food variation, the practice of fasting and seasonal carb restriction; and who knows what else.  I’ve recently been around a female who is working to get her hormones optimized - better living through chemistry - and the way her body deposited fat changed over night.  So, yes, I think there’s more to the “fat trap” than just the “low calorie, low fat, more exercise” hoax.  

“Well, how will you wrap this one up Paul?”  Here’s the wrap up - start out by eating for healthy blood sugar levels.  Attack the problems that remain one by one.  Body fat - there are things you can do if you find that just eating good food isn’t enough to get lean.  Sicknesses?  There are things you can do to to heal the gut and for many that addresses autoimmune and inflammatory processes.  The road that has worked for me is chasing improvement over time, which for me started in about 1996, but didn’t really become consistent in my life until 2007, when I found a way to eat that I could live while I stayed/became more healthy.  Prioritize health, and get better day after day, week after week.

How USA Goalie Tim Howard Stays In Shape - Business Insider

http://www.businessinsider.com/how-usa-goalie-tim-howard-stays-in-shape-2014-6

"I've been paleo for about a year, and what I miss most is the Philosopher's Pie from [the chain] Mellow Mushroom in Memphis, where my wife and I have a home.
All else pales in comparison — it's a pizza topped with strips of filet steak, black olives, Feta cheese, and artichoke hearts. My cheat meal would be that and a microbrew. Good thing I live in England.
"My personal trainer suggested paleo to build muscle while staying lean, and it's one of the first plans that's worked for me. Sure, I like ice cream, but when you keep a healthy lifestyle, it's: Do you prefer sweets and crappy food, or do you prefer to have a nice body? It depends on what you want more. Breakfast is meat or eggs, and nuts. Lunch and dinner are more meat and a steamed green vegetable. Depending on how intense training was, I throw in extra carbs, like sweet potatoes."

The Good, Bad and Ugly of the NYT Paleo Article

The ugly:

Pound for pound, beef production demands at least ten times as much water as wheat production, and, calorie for calorie, it demands almost twenty times as much energy. Livestock are major sources of greenhouse-gas emissions, not just because of the fuel it takes to raise them but also because they do things like belch out methane and produce lots of shit, which in turn produces lots of nitrous oxide. One analysis, published in the American Journal of Clinical Nutrition, concluded that, in terms of emissions, eating a pound of beef is the equivalent of driving forty-five miles. (Grass-fed beef—recommended by many primal enthusiasts—may produce lower emissions than corn-fed, but the evidence on this is shaky.)

http://www.newyorker.com/magazine/2014/07/28/stone-soup
Not untrue, just irrelevant.  If you grow beef from corn grown from oil produced ammonium nitrate, it's certainly not going to help reduce emissions, if you are into that sort of thing.  So let's stop doing that, shall we?

I love her summary of this event:

Agriculture was “invented” several times, in different parts of the world, by people making use of the plants they found growing wild around them. The first time was probably about ten thousand years ago, in southeastern Turkey, when early farmers began cultivating einkorn wheat. The crop was a big hit, and, at least by the standards of the day, it spread rapidly. (This is sometimes referred to as the Big Agricultural Bang.) Wheat was being sown in Greece around eight thousand years ago, in the Balkans and in Italy seven thousand years ago, and in India and Scandinavia five thousand years ago. Meanwhile, around nine thousand years ago, a group of proto-farmers in southwestern Mexico began cultivating maize. It, too, quickly caught on, and was being grown in Panama seven thousand years ago and in Colombia six thousand years ago. Also sometime around nine thousand years ago, rice was domesticated in the Yangtze Valley.

This is also good:

“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” is Jared Diamond’s dour assessment, offered in an essay titled “The Worst Mistake in the History of the Human Race.”

Like Stone Age hunter-gatherers, early farmers left little behind—just some burnt grain, mud foundations, and their own bones. But that’s enough to reveal how punishing the transition to agriculture was. According to a study of human remains from China and Japan, the height of the average person declined by more than three inches during the millennia in which rice cultivation intensified. According to another study, of bones from Mesoamerica, women’s heights dropped by three inches and men’s by two inches as farming spread. A recent survey of more than twenty studies on this subject, published in the journal Economics and Human Biology, found that the adoption of agriculture “was observed to decrease stature in populations from across the entire globe,” including in Europe, the Middle East, Asia, and South America.

Early farmers were not just shorter than hunter-gatherers; they were also more sickly. They had worse teeth—one analysis from the Near East suggests that the incidence of cavities jumped sixfold as people started relying on grain—and they suffered from increased rates of anemia and infectious disease. Many now familiar infections—measles, for instance—require high population densities to persist; thus, it wasn’t until people established towns and cities that such “crowd epidemic diseases” could flourish. And, by living in close proximity to their equally crowded farm animals, early agriculturalists helped to bring into being a whole set of diseases that jumped from livestock to people.

“The adoption of agriculture,” Diamond notes in his most recent book, “The World Until Yesterday,” provided “ideal conditions for the rapid transmission of microbes.” According to Daniel E. Lieberman, a professor of evolutionary biology at Harvard and the author of “The Story of the Human Body,” “farming ushered in an era of epidemics, including tuberculosis, leprosy, syphilis, plague, smallpox and influenza.”

It took thousands of years for human bodies to recover; Lieberman reports that “it wasn’t until the twentieth century that Europeans were the same height as cavemen.” And, almost as soon as the stature gap closed, new problems arose. People began to grow not just taller but also wider. During the past several decades, rates of obesity, hypertension, fatty-liver disease, and Type 2 diabetes have soared. 

For millions of years bison and other grazing animal ran around and helped grasses build top soil.  That's the way our ecology worked, as elegantly summarized in "the Vegetarian Myth".  I doubt we could recreate that, but if restoring natural processes that sequester carbon in soil is your goal, that's the way ahead.

Personal Paleo Code - Eat Real Food

You might be thinking a multivitamin can prevent nutrient deficiency, but supplemental nutrients do not have the same effect on the body as nutrients gotten form food.  Humans have evolved to get their nutrients from whole foods - not supplements.  Most nutrients require specific enzymes and other substances to be properly absorbed.  While these are naturally present in foods, they are often not included in synthetic vitamins and isolated nutrients.  This may explain why several trials have shown that adding antioxidant supplements to a typical American diet not only doesn't prevent people from getting heart disease and cancer but may actually increase their risk.  While supplements can (and should) be used for therapeutic effect in specific health conditions or to replace certain nutrients that are difficult to obtain from food, they should never be used to replace nutrients that can be found in a  nutrient-dense diet.
Chris Kresser, Your Personal Paleo Code

This is as good as it gets for learning how to eat for health, including how to address your specific issues of health and wellness.

Obese But Healthy?

These articles are always interesting to read.  The BLUF on this one - they've discovered a discrete molecule that correlates with those who are obese and sick.  Blocking the production of that molecule via gene therapy shows positive results in mice.  
http://www.realclearscience.com/articles/2014/07/05/how_some_people_can_be_obese_and_healthy_108731.html

That's all good and I hope they keep figuring out how to manipulate genes to make us less sick from eating the food we eat.  But the real secret is - don't overcarb yourself.  You can eat enough carbs and fat to make your body think that carrying a lot of fat is a good thing - raising the "set point".  However, if while at that set point, you don't overdo the carbs, fructose, alcohol, caffeine and medications - in other words, you don't sabotage liver function - you can hum along fairly well with healthy blood sugar levels and be "healthy".  In this case, healthy just means you don't have out of control blood sugar.  You may still feel like crap and have many of the other manifestations that come along with eating crappy mass produced food, but you don't share the risks for chronic and terminal illnesses that full blown diabetics have.

There are many things that raise the set point, including age, changing hormones (especially in ladies), genetics and dietary factors - even whether or not one practices fasting.  For those of us who want to have better body composition and health, and to help others with those goals, eating the best quality food, getting better sleep, and wrestling with the nasty and ever present sugar beast of the industrial food giants will gain us more than waiting for a lab guy to figure out how to shut off our genes. 

You, like me, are likely shaking off the effects of a holiday weekend - too much booze and sugar, too little sleep and not good sleep quality.  Then you can add the stress of catching up at work after the long weekend.  It's not a great formula for health and happiness.

What to do?  Eat high quality food, keep carbs to under 150g/day (much less if you know that helps you), back off on the coffee and booze, take a nap (45 minutes or less), make time for at least a walk (and better yet, a CrossFit WOD), and enjoy some time in the sunshine every day you can.

Dietary Cure for Acne: Interview with Dr. Loren Cordain by Robb Wolf

I understand you have some projects relating to intermittent fasting and autoimmunity. Can you share any tidbits about those or any other projects in the works our readers should know about?

Meal timing and frequency are poorly studied topics. Despite the almost complete lack of scientific evidence, many nutritionists and physicians as well believe that many small meals are more healthful and may help to promote weight loss than fewer larger meals. Once again I look to the evolutionary template to help unravel difficult diet/health questions. We have preliminarily compiled data from hunter-gatherers, and their meal patterns typically involve a single large meal at the end of the day and sometimes a light morning meal. They almost never eat three large meals a day with snacking in between—a pattern that seems to have become the norm in the U.S.

Experimentally, we have on our plates a project that will examine whether or not dietary lectins (in particular, wheat germ agglutinin [WGA]) can cross the intestinal barrier and enter the bloodstream. We suspect that dietary lectins may play a key role in certain autoimmune diseases like rheumatoid arthritis, irritable bowel syndrome, multiple sclerosis and others.

http://www.catalystathletics.com/articles/article.php?articleID=14

This is a great and short read.  When a dietary change affects something as pernicious and obvious as acne, that's is what you might think of as "a clue".  

Kresser: Your Personal Paleo Code

This book is not new news, but it is the best book on eating for health I've yet to read.  It's not too sciency, but it's authoritative in its arguments.  It's not off the paleo deep end, but it's detailed enough to help ANYONE sort through their diet/health issues.  It is laid out very, very well, and easy to read.  Here's an excerpt I like early on:

"The inuit are a group of hunter-gatherers who live in the Arctic regions of Alaska, Canada, and Greenland. They eat primarily fish, seals, whale, caribou, walrus, birds and eggs: a diet very high in fat and protein, with very few vegetables or fruits.  They live in a harsh environment that is marginal at best for human habitation yet early explorers, physicians and scientists unanimously reported that the inuit they encountered enjoyed excellent health and vitality.

"Dr. John Simpson studied the inuit in the mid-1850s. He noted that the inuit were "robust, muscular and active, inclining rather to spareness, rather 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."  This is especially remarkable considering the inhospitable environment the inuit lived in, and it's a testament to nutrient density of the animal foods that made up the majority of their diet."

Saturated Fat Is Your Friend

A very nicely written summary of why:
-Saturated fats were never proven to be unhealthy, and why other foods we've been substituting for sat fats may be "really" unhealthy
-Why polyunsaturated oils, recommended for years for their cholesterol lowering qualities, may be much worse for you than sat fats, especially when hydrogenated
-Why carbs are problematic as substitutes for fat in the diet, and have been a part of making us fat, sick and diabetic
-Why women in particular need to think about cholesterol levels differently than we've all been told

Eat meat, vegetables, nuts and seeds, little fruit or starch, no sugar/wheat.

http://online.wsj.com/news/articles/SB10001424052702303678404579533760760481486?mod=WSJ_hppMIDDLENexttoWhatsNewsSecond&mg=reno64-wsj&url=http%3A%2F%2Fonline.wsj.com%2Farticle%2FSB10001424052702303678404579533760760481486.html%3Fmod%3DWSJ_hppMIDDLENex

Dr. Mike about Denise and Death by Food Pyramid

She discusses the notion that the meat eaten by our Paleo ancestors was different than the meat we eat today, and implies that those following a Paleo type of eating regimen aren't really eating Paleo. Why? Because Paleo man ate from nose to tail. He ate the entire animal, including all the parts modern man avoids, such as the viscera, offal, and organs. Typically, if reports from contact with contemporary hunting societies are indicative of how Paleo man behaved, the muscle meats — the ones most of us Westernized folk eat — were not prized as much as the organs and offal and were often fed to the dogs.

I have a little different perspective.

The organs, offal and viscera supposedly contain a lot more nutrients than the muscle meat. And, compared to muscle meat, they are filled with considerably more fat, much of which is saturated. Consequently, those following an ancestral diet are encouraged to limit muscle meat and increase consumption of organs, offal, and viscera, i.e., eat nose to tail. I have no argument with this other than it's often difficult to find organs, viscera, and offal unless you are on a farm or in a major city. Santa Barbara, where we live part of the time, is an upscale small city with three or four natural food grocers, including Whole Foods, and about the most exotic organ meat I can regularly find is liver. I suspect it's the same in most other places. Those of you who live in foodie towns, such as Seattle, San Francisco, Portland, Chicago, and New York can probably find all kinds of organ meats, but the rest of us either have to resort to ordering online, butchering our own, or doing without.

But all is not lost. First, although organ meats have more nutrients than muscle meats, it's not all that much more. Run a search on the USDA Database of Foods, and you'll see what I mean. Compare beef steak to beef liver or kidneys. Not a lot of difference except for the vitamin A in the liver.

A muscle meat diet can provide most, if not all, of what you need nutrient-wise. If you're worried, supplement with a multi vitamin.

I suspect our ancient ancestors were drawn to the organ meats and offal not because they knew they were more nutrient dense (how did they know?), but because of their greater fat content. Thankfully, agricultural science has come to our rescue. We modern folk enjoy steaks and chops and roasts more than we do the inner organs of beasts and fowls, so modern farmers now produce muscle meats that contain more fat than wild game. So we can get the fat of the organ meats while at the same time getting almost the same level of nutrients.

Many purists consider the muscle meats to be overloaded with fat and turn to the organ meats and offal instead. I say, what's the difference? I would much prefer a juicy, medium rare ribeye steak than I would a kidney or spleen or lung (and I've eaten them all), so why not get the fat in my steak?

http://www.proteinpower.com/drmike/low-carb-library/death-food-pyramid/

Denise's book is a great read for several reasons, I highly recommend it as a foundational book in understanding the diet wars, and several nuances in the science of diet and health that are not well articulated elsewhere.

I like Dr. Mike Eades' point also - organ meats from grass fed and healthy animals are very potent in nutrients, but modern and unusually fat muscle meat is a more reasonable substitute than many would think.

The Right Nutrition for You - No One Knows

The links that follow tell an interesting story.  The author makes the case that very low carb is not a good formula for fat loss for a female CrossFitter who is perhaps over training, who is not consistent yet in low carb (binging occasionally on carbs/booze), and who is therefore hungry.

I think her advice is solid, but if the client really needed to be low carb, there's an option that was apparently not tried - using blood measures of beta-hydroxy butyrate (ketones).  If the athlete were able to fly right for 3 weeks, and thus convert to a therapeutic production of ketones, she may find her physical performance would improve, and her appetite would be moderated even while losing fat.

The other option to test is an AM carb fast (just protein/fats for breakfast), with minimal carbs for lunch, and a generous portion of carbs for dinner.  This may also generate a therapeutic level of ketone production, and deliver this athlete from her hunger and poor physical performance.

But there's no way to be sure without testing!  Different folks will have different needs and preferences.  This is why the food prescription based on the paleolithic model is so potent.   Eat meat, vegetables, nuts and seeds, little fruit or starch, no sugar/wheat/industrial oils.

http://paleozonenutrition.com/2013/02/10/crossfit-and-low-carb-paleo-why-isnt-this-client-losing-weight/

http://paleozonenutrition.com/2013/02/20/low-carb-paleo-crossfit-not-losing-weight-my-recommendations/

"True Paleo Diet"? We Don't Know

The anthropological record provides a framework for further examination of nutritional science; it does not prescribe a diet. It gives us somewhere to start so we’re not flailing blind men dropped off in the middle of a strange city. That is why we’re interested in what early humans ate (and didn’t eat).

It may surprise you to know that I think the first assertion is absolutely right. We don’t know exactly what our ancestors were eating. There are no pleistocene food journal entries scrawled on a cave wall someplace, and many of the primary sources we can access – phytoliths (which indicate the presence of vegetal material) and stable carbon/nitrogen isotopes (which indicate the source of dietary protein) – require analysis and interpretation, thus becoming secondary sources. If you thought food frequency questionnaires were unreliable, try figuring out if the phytoliths found on Neanderthal dentition originated from the direct consumption of plants or the consumption of fermenting plant inside a recently hunted animal’s stomach, or whether the isotope analysis of African hominins from a few million years ago indicate diets high in grass seeds or diets high in grass seed-eating herbivores.

However, we absolutely do know what early humans did not eat:

• Industrial seed oils high enough in linoleic acid to crowd omega-3 out of their tissues.
• A diet where refined sugar made up either 17% or 15% of the total caloric intake.

We know these things because these foods either didn’t exist until the late 1880s (seed oils like corn) or only graduated from expensive luxury item to widely-used staple food in the 1700s (white sugar).

As to the second claim, of course there is no one true ancestral diet with a strictly curated, specific list of dietary DOs and DON’Ts. Humans have managed to populate every barely hospitable nook and cranny of this planet. If living things grow, slither, crawl, flap, swim, or otherwise reside there, we will set up shop in order to eat them.

Read more: http://www.marksdailyapple.com/we-dont-know-what-constitutes-a-true-paleo-diet/#ixzz2wjCYnUVI

We also didn't eat modern wheat and it's processed products (bread, bagels, breakfast cereals, etc), nor did we dress up the old variants of wheat in so many processing steps nor consume it under a pile of sugar.  And when we did eat primarily wheat/grains, we got short and fat, bad bones and bad teeth, and other nastiness.

This is why I like the idea of the paleolithic model of nutrition, not a blind devotion to "paleo".  Some neolithic foods have little impact on some people - I can eat cheese and feel great, for example.

Eat meat and vegetables, nuts and seeds, little fruit/starch, no sugar/wheat/industrial oils.

WHS on the Masai

At approximately 14 years old, Masai men are inducted into the warrior class, and are called Muran. For the next 15-20 years, tradition dictates that they eat a diet composed exclusively of cow's milk, meat and blood. Milk is the primary food. Masai cows are not like wimpy American cows, however. Their milk contains almost twice the fat of American cows, more protein, more cholesterol and less lactose. Thus, Muran eat an estimated 3,000 calories per day, 2/3 of which comes from fat. Here is the reference for all this. Milk fat is about 50% saturated. That means the Muran gets 33% of his calories from saturated fat. This population eats more saturated fat than any other I'm aware of. 

How's their cholesterol? Remarkably low. Their total serum cholesterol is about half the average American's. I haven't found any studies that broke it down further than total cholesterol. Their blood pressure is also low, and hypertension is rare. Overweight is practically nonexistent. Their electrocardiogram readings show no signs of heart disease. 
http://wholehealthsource.blogspot.com/2008/06/masai-and-atherosclerosis.html

It is hard to draw firm conclusions from this data, beyond the fact that about half of the people I see everyday would like to be as healthy as these Masai eating high fat animal products.

Fat Healthier than Skinny? Kind of ...

American culture tends to vilify fat and fat people. You mention a particular instance in 2004 when the director of the Centers for Disease Control and Prevention appeared on national television claiming that obesity was approaching the No. 1 preventable cause of death. You think this crusade was misguided. Why?

Many M.D.s have bought this fallacious line that the optimal weight for women in terms of their health is what M.D.s call normal weight, a BMI between 18.5 and 25. And they have thought this to be true because women with higher BMIs exhibit a series of physiological measures that are indeed risk factors for disease in men. But they are not systematically risk factors for disease in women. If you actually look at the data from the National Health and Nutrition Examination Survey and data from studies done in other countries, the optimal weight for women who have had a kid is what doctors currently call “overweight.” I’m not saying that obesity is optimal, but all the findings show that overweight women survive better than normal weight women. We walk a fine line in the book because we argue that being overweight is not nearly as bad as your doctor has been telling you, but on the other hand, Americans are heavier than they need to be. There are diseases that still correlate with heavier weights, like diabetes. But if we ate a more natural diet, by that I simply mean the diet that we evolved to eat, we would all weigh less.

http://www.salon.com/2011/12/19/why_women_need_fat/

It's pretty simple stuff until you try to figure it out.

To me, true north for health starts with - what's your blood sugar?  There's no one with out of control blood sugar that is healthy, but there are folks who carry more body fat than the minimum who are healthy.  This author thinks you can eat grains and be healthy - some folks can.  But if your health and blood sugar isn't what you want it to be, the best starting point is sugar and wheat elimination.

This article is a good read - another perspective on why you want to avoid those omega6 laden industrial seed oils.

Jakers: The Paleolithic Model

From my good friend Jason "Jakers" Parent:

The Paleolithic Diet is the diet that we humans are genetically adapted to eat. The paleolithic age is the same as the Stone Age – so this is a stone age diet or life style. This has been humanity’s preferred diet for something like 2.5 million years, and humans have only genetically changed 0.005% since the introduction of agriculture (the Neolithic). As a rule, agricultural (and technological) products are not healthy to eat, and we should predominantly try to eat only those whole foods that are healthy in their raw state (though almost all humans, including hunter-gatherers cook their food).

This is not a quick-fix diet but a way of life. You’re not supposed to starve when you eat only paleo foods. Eat when you’re hungry!

http://tribal-fitness.com/start-here-or-how-to-join-the-tribe/nutrition/

Type III Diabetes - ?

To reach her conclusions, de la Monte examined the brains of 45 deceased elderly Alzheimer's patients and found that among those "in the most advanced stage of Alzheimer's, insulin receptors were nearly 80 percent lower than in a normal brain." In healthy brains, insulin stimulates the enzyme that produces the neurotransmitter acetylcholine, the lack of which is seen as a key marker of Alzheimer's disease. In patients with Alzheimer's, de la Monte believes, the brain gradually becomes resistant to insulin.

Previous animal brain studies by de la Monte and others have supported the hypothesis that insulin resistance may be a root cause of Alzheimer's, although many researchers believe that it will emerge as just one of several possible causes, including genetics. Most Alzheimer's patients are not diabetics and while many appear to have insulin-signaling concerns, not all do.

Like Alzheimer's, diabetes has no cure. According to the American Diabetes Association, there are already nearly 26 million diabetics in the country, a number that is growing. Many diabetics do not develop Alzheimer's, but there is measurable overlap and the rates of both diseases are rising. If fatty foods provoke insulin resistance in our brains, then, as New Scientist magazine put it in a recent cover story about the link between diabetes and Alzheimer's, "we may be unwittingly poisoning our brains every time we chow down on burgers and fries."

In the New Scientist article, SUNY-Albany neuroscientist Ewan McNay said: "The epidemic of Type 2 diabetes, if it continues on its current trajectory, is likely to be followed by an epidemic of dementia. That's going to be a huge challenge to the medical and care systems."
http://www.nextavenue.org/blog/alzheimers-really-type-diabetes

This one is a great example of how one wrong conjecture shapes another.

The issue is whether diabetes results from too much ingestion of sugar, or too much ingestion of fat.  For those who have bought the "too much fat is bad" conjecture, the other issues become confusing.  For example, fat in the blood (triglycerides) is a better correlate for heart disease than is cholesterol, and if you reduce carb consumption (especially sugar/fructose) triglycerides decrease significantly for almost all folks.  But fat intake is the problem, right?  But if you eat more fat, lots of fat - up to 85% of total intake - trigs plummet.  Why?  Most likely because when carb intake goes below the toxic level, the liver can stop making trigs out of sugar (especially fructose), and the body learns how to run on fat (in the presence of high sugars, the body will run on sugar).  In short, when the body is fueled with high fat, moderate protein and the right amount of carbs, the body burns fat, does not make much fat in the liver, and regains insulin sensitivity.  These factors are all measurable - so it makes me scratch my head when I read of professionals in the field who still believe that "high fat ingestion" causes diabetes via obesity.

Burgers and fries may play a role in this, but not because they include fat.  It's the bun, the potatoes, ( especially the giant helpings and free refills of Dr. Pepper and other HFCS laden colas) that crush liver function and pile on with excess blood sugar that brings fat burning to a screeching halt and eventually leaves a person with a big belly, insulin resistant, and with chronically high blood sugars (aka, with metabolic syndrome) - almost begging to get alzheimer's or CVD or cancer (which those with metabolic syndrome and diabetes get at disproportionately high rates).

The fact that you can find cultures eating high carb diets (60% carbs), and who smoke heavily (95% in males), and don't have the diseases of civilization, while you can also find populations that eat sugar and don't smoke who do have the diseases of civilization, indicates that sugar (meaning table sugar or HFCS, both of which are 50% fructose) is likely more toxic than are cigarettes.

I think of the rumored last Japanese soldier on some pacific island who was supposedly still waiting as ordered in defense of the turf for the battle with the Americans - who will be the last medical or scientific professional to believe that fat makes you fat and sick, while sugar/carbs are the innocent bystander?

"Grain Brain" Author's Core Message Is Perfect

Changing minds, however, is an uphill climb. “The idea that grains are good for you seems to get so much play,” he says. “But grains are categorically not good for you,” not even whole grains.

“We like to think a whole-grain bagel and orange juice makes for the perfect breakfast,” Perlmutter continues. “But that bagel has 400 calories, almost completely carbohydrates with gluten. And the hidden source of carbs in this picture is that 12-ounce glass of fresh-squeezed orange juice. It has nine full teaspoons of pure sugar, the same as a can of Coke. It’s doing a service with Vitamin C, but you’ve already gotten 72 grams of carbs.

“It’s time to relearn,” he says. “You can have vegetables at breakfast – the world won’t come to an end. You can have smoked salmon, free-range eggs with olive oil and organic goat cheese and you’re ready for the day. And you’re not having a high-carb breakfast that can cause you to bang on a vending machine at 10 a.m. because your blood sugar is plummeting and your brain isn’t working.”

http://www.forbes.com/sites/nextavenue/2013/11/14/what-grain-is-doing-to-your-brain/2/

Some folks don't like the good doctor's "low carb extremism", but his bent towards a VLC diet has resulted from his success helping those with diminished brain function.  I doubt you can prove that 60g/day or less is necessary for the healthy among us, but it makes perfect sense to me that carb restriction to that level protects the brain from glucose injury, including accumulation of beta amyloid and AGEs.  

Wolf on Low Carb Paleo - Or Not?

Slowly I realized, both by experimentation and by really looking at the literature: CALORIES MATTERED MORE THAN CARBS FOR BODY-COMP.

I have to say this was a pretty big shake-up for me. I’d assumed one could eat as much fat as one desired and STILL get leaner. As I mentioned above, when I first started eating LC, or more specifically, cyclic low carb (CLC) I was leaner than ever in my life. I know based on blood work and fat deposition that I had insulin resistance while vegan, and CLC helped with this immensely, but it was my new-found energy and activity level that drove my leanness, not an inability to store fat in the absence of significant insulin. I think this is one of the most damaging messages that comes out of the LC camp to this day, I was duped by this, so I’m not going to do what a lot of other recovered LC writers do and make folks out to be idiots for still believing this…but, it is time to face facts. In every damn study it is clear that for fat loss we’d like adequate protein, and a calorie restriction scenario. LC is fantastic for this in that one typically feels satisfied on high protein, moderate fat, loads of veggies. If one is insulin resistant, this approach can be nothing short of miraculous. HOWEVER! If one manages to cram enough cheese, olive oil and grass-fed butter down the pie-hole, this is in fact, a “mass gain” diet.

http://robbwolf.com/2012/12/19/carb-paleo-thoughts-part-1/

I think there were a few of us that thought this was true, but we all learn - low carb is like magic for rapid weight loss when one is fat, insulin resistant and sick.  Low carb done with good precision can make it easy to be healthy - 10-15% body fat and insulin sensitive - but that won't get you to epic leanness and magazine cover ready.  And that's just fine, we should probably have known better anyway.

Strangely, body builders use low carb to get that epic low fat at the end of their cycle because they are not low carb otherwise - so there seems to be an efficiency factor - those who do low carb all the time get better at using fewer calories than those who are new to low carb.  If you are trying to lose fat and regain lost health while attack correlates of poor health like gout, hypertension and reactive hypoglycemia, low carb is of course the heavy weaponry at your disposal.

All that being said, it is still easier to eat less on a carb restriction plan than on any other approach I have tried because of the excellent appetite control.

Taubes in Scientific American

In the September 2013 issue of Scientific American, the topic is nutrition.  One of my heroes in the nutrition science wars is Gary Taubes, and he authored an article in this magazine.

Taubes frames up the critical debate about how to be healthy and lean between two camps -
1. Calories in, calories out, or "a calorie is a calorie", or "just eat less and move more", which is essentially a moral story - "people get fat because they are gluttonous and lazy."
2.  The carbohydrate or alternative hypothesis, or the "hormone hypothesis of obesity" - consumption of excess carbohydrate leads to a cycle of high blood sugar leading to high insulin levels which biases the body towards storage of ingested carbs as fat, but also makes us hungry and makes us feel lethargic.    In other words, "People feel lethargic, and accumulate body fat, because they induce hormone dis-equilibrium through excess carbohydrate consumption."

There are folks in both camps who are quite persuasive, but of course, that's the rub - if the science on the matter was conclusive, there would be no need to persuasiveness!  Let me provide what I see as the main lines of argument from the two camps:

The laws of thermodynamics are clear - for a body to gain or lose energy (aka fat which is stored energy), the body must ingest more energy than is expended, or ingest more energy than is expended.  In other words, it is a simple matter of mathematics - reduce caloric intake and increase caloric expenditure to induce an energy imbalance.  Anyone who is gaining weight, or cannot lose unwanted weight, is simply too lazy or too gluttonous.
And, we get sick because being fat makes us sick, so diseases such as insulin resistance, metabolic syndrome, and ultimately type II diabetes result from the obesity created by an energy imbalance that lazy, gluttonous populations routinely create for themselves.

Some things that might be worth considering to fully consider this perspective:
-Just because a gram of fat creates 9kcal of energy when combusted in a bomb calorimeter, does that mean it always adds 9 kcal of energy to our bodies every time we eat a gram of fat?  Ditto for carbs and protein - do we really know how many of the potential units of energy we receive from each gram of the various macronutrients we ingest?  Interestingly, there's an article in the same Scientific American which seems to indicate the answer is "no".  In other words, a potential calorie in food is not always a calorie of energy in the body.
-If a "calorie is a calorie" is such a simple matter of mathematics, why in all of the studies done on such matters has no one every lost the forecast amount?
-If a "calorie is a calorie" is in fact the guiding principle of fat loss, we are all screwed; if we miss our calorie calculation each day by 20 kcal, which for me would be an error of less than 1%, we will gain a pound of fat per year.  Considered from this perspective, as Taubes has pointed out, it's a miracle we are not all carrying the spare tire.
-All fat people are not sick; why?  Some people who are relatively skinny are sick in the same way as sick fat people (loss of glycemic control); why?
-In many intervention studies which test low carb v. high carb diets, folks on a carb restricted diet spontaneously reduce caloric intake.  In correlation with carbohydrate restriction, many sick people begin to get well before they get lean; gout, hypertension, and non-alcoholic fatty liver disorder, for example, can be reduced in as few as 3 days of carb restriction.
-We can observe that folks accumulate excess fat differently.  For example, endomorphs always have more sub-cutaneous fat than ectomorphs - if fat accumulation is just a matter of calories in, calories out, why do bodies allocate fat differently based on phenotypes?
-Why do pregnant ladies and people in puberty eat more?  Certainly no one would suggest their appetites changed because they became lazy and gluttonous.
-How is it that we could have such excess "energy" stored as fat, but still feel hunger?
-How could we interpret the well known phenomenon of caloric restriction over time leading to the "starvation effect", in which the metabolism slows, and fat re-accumulation is nearly inevitable?

Here are some answers which may be tested via Taubes' NuSI - the Nutrition Science Initiative, which was founded to test these two hypotheses - to see if science, despite the incredible challenges of doing it well on the human animal, can point to one or the other as more correct for more people.
-Sick fat people are those who have glycemic dis-regulation, healthy fat people have not lost glycemic regulation, because they are not insulin resistant.  Why these people are fat isn't clear, it could be they ate too many carbs for a time and now are at a "maintenance intake" of carbs but not a fat loss intake.  However, it is possible to discern a healthy fat person from a sick fat person just by looking (at least in some cases) at their faces.  You can see this in the "Biggest Loser", as the contestants all arrive with their fat, sick faces but soon their faces shift to the "healthy but fat" face.  If you've seen that show, you know what I mean.
-How come I could eat anything I wanted when young but now I can't?
I think this question may be where fructose comes into play. There's some evidence that fructose pushes us over the edge into insulin resistance, by essentially forcing the liver to work too hard processing fructose, so that it cannot do what insulin commands it to do.  As the body secretes more insulin to get the liver into gear, other cells in the body risk damage due their responsiveness to insulin.  They seem to protect themselves through insulin resistance.  That creates a re-inforcing loop for insulin and blood sugar levels that seems to drive us towards metabolic syndrome.  Metabolic syndrome leads to everything bad - diabetes which then is a predictor for gout, hypertension, stroke, alzheimer's, heart attack, etc.

One way or the other, due to Taubes' passion and his unrelenting focus on how much the existing science does not answer, but could, I think Gary will end up fundamentally changing how science and nutrition are pursued in our lifetimes.  We may be only a year or two away from preliminary results from NuSI's first experiments.  That's amazing!

The stakes are enormous. Between the insanity in the way our government tries to provide and regulate health care, and the remarkable and accelerated pace that our population is getting sick, and the vast array of medications that our health care system will provide to people to keep them alive while sick; our health care system is wrecking the fiscal health of our federal government.

Every day, I see and confront an amazing amount of mis-information about what a "healthy" diet is or is not.  If the science could get us to the point of all knowing what makes us sick, it would be an incredible step forward. Go Gary go!

Confessions of a Low Carb, Paleolithic Model Advocate

Here's the truth, which I freely confess.

I drink raw cow's milk, in violation of USDA recommendations.
I never take multi vitamins.
I avoid flax seeds and flax seed oils, "heart healthy" industrially produced polyunsaturated fats, wheat germ, cholesterol lowering oatmeal, and heart healthy whole grains for the same reason I avoid rat poison.
I don't really care what my cholesterol numbers are, because if they were high I wouldn't try to lower them.
I eat eggs most days, unless I'm not hungry, then I throw out the whites but eat the yolks.
I eat chocolate 5 days a week, and drink bourbon every other day.
I add salt to food and water.
Fat, mostly saturated, makes up 60-80% of my caloric intake.
Just to make sure I get enough saturated fat, I add butter to my coffee, and I look at veggies as a good way to eat more butter.  Butter like cheese, strait up, as a snack?  Guilty!
I also supplement with coconut oil - sometimes for cooking, sometimes with dark chocolate or nuts. Man is that good!
I eat red meat and "artery clogging saturated animal fats" like it is going out of style, which it used to be, by the way.  I mean I'm knocking back stuff like bacon or sausage or hamburger, every day.
I eat processed foods like salami and sausage whenever I like.
I eat veggies once per day at most.
I generally eat fruit a max of once per day, except in summer time when I enjoy it a bit more.
Have no idea how many calories per day I consume - more than 2400, less than 3000, most days, based on a two week sample I made three years ago.  Whatever.  I eat when I'm hungry.  I eat a little extra when I train hard.  Sometimes I eat for fun, but mostly just for hunger or because I know after 10-14 hours, I need food.
I drink coffee - a minimum of five cups/day, and load most of those cups with heavy cream.
I smoke cigars when I want one.
You know that "most important meal of the day"?  I almost never eat breakfast.
On a typical week I may never exceed 100g/day of carbohydrate, or perhaps I do but only once.
I brush my teeth once per day, max, and never floss.

What kind of carnage am I wreaking on my health, appearance, and performance?

Well, I'm 49 years old, I'm six feet, 2 inches tall and weight 205 pounds.  At 42 years of age, I was 225 and weaker than I am now.  I could not tell you last time I had a cavity, it has been since 1997 at least.  I have shifted from being a sugar craver who couldn't walk past a doughnut to being a sugar agnostic. I get sick sometimes, but it is unusual.

I never do cardio and I have no idea how many calories I burn when I work out, because I could not care less about burning calories.  I work out to develop the physical capacities I would like to have or improve.

I train with barbells several times a week but I have no idea how many inches my arms or legs are, I never feel the pump and don't measure my success in terms of the mass of muscles.
On any given day, you could tell me to:
Run 6 miles
Deadlift 375+
Compete in the CrossFit Games Open WODs in top 30% in the world for my age, and top 50% for any age
Do a pullup - with 75+ pounds
Box jump 40+ inches
Clean 225 pounds
Climb that rope hands only, or climb that rope 25 times for time
I could most likely do it.  If I couldn't do it that day, I could do it within a week with a few practice sessions.

The changes I've experienced since I learned my way of eating - high fat, high nutrition, low carb, and moderate protein - include near elimination of IBS (pun intended), my teeth feel better, harder and cleaner, I have reduced my ibuprophen intake from an average of 1600mg/day to perhaps a monthly dose after a mis-step that sets my knee off.  I used to inhale steroids to keep my nasal passages closed at night, now I just remember how nice it is to not have to do that.  My ear canals are not chronically irritated, and I'm not spending the extra fifty cents for the dandruff shampoo.

My blood pressure runs about 120/70, much better than when I was a college athlete. My triglycerides vary between 25 and 75, HDL is around 70, and LDL is estimated at 114 (meaning it is actually lower given my triglycerides), with a total cholesterol around 200.  Waist tapes out around 36 inches, and body fat percent is 10-12 percent (who really knows this anyway).

Am I trying to brag about being a bad ass?  I would if I could, but in the CrossFit world, I'm just another athlete, there's nothing I can brag about.  I'm more interested in making a point, as dramatically as I can for today, that they've been lying to you.

They said you need low fat, high carbs and compulsively high cardio.  They said cut back on cholesterol, move more, eat less, and eat whole grains.  It is just not the truth for most folks.  Most of you need fat for fuel with a little protein and some high quality vegetables.  If you are already skinny, eat more carbs if you like them.  Ratchet way back on fructose intake (meaning sugars, which are generally 50% fructose), and if you want to lose your belly, also cut out the beer.  You don't need to move more and eat less, you need to eat real food (or as the man Sean Croxton puts it, JERF: Just eat real food).

The best advice you've ever received about health and diet was never proved by science - because good science is so hard to do on humans that it has not been done.  We're feeling around in the dark.  The best you can do is eat a certain way long enough to evaluate the effect, and refine from there.  There is one thing you can bank on though - no one with out of control blood sugar is healthy.  There are folks with low cholesterol who die young every day, and there are folks with "high" cholesterol who live long and well.  There are folks with too much body fat who live long and well, and those who are "skinny" who die young from vascular diseases and cancer.  The common denominator for most if not all of these who are not heathy is they have wrecked their glycemic control, generally from eating too many carbs, or too many carbs in combination with too much sugar.

So should you be an unapologetic low carb paleo model eating whacko like I am?  I don't know.  It's up to you to decide.  Give it a shot.  See if you like not being hungry, and see if you belly gets smaller and your blood sugars get under control.  See if you feel good, and perform well.  If these things line up  you will have run the best and most scientific test that can be run for your own health and well being.