Saturday, December 13, 2008

The Myth of the High-Protein Diet

The phrase "low-carbohydrate diet" is a no-no in some circles, because it implies that a diet is high in fat. Often, the euphemism "high-protein diet" is used to avoid the mental image of a stick of butter wrapped in bacon. It's purely a semantic game, because there is no such thing as a diet in which the majority of calories come from protein. The ability of the human body to metabolize protein ends at about 1/3 of calories (1, 2), and the long-term optimum may be lower still. Low-carbohydrate diets (yes, the ones that are highly effective for weight loss and general health) are high-fat diets.

Healthy cultures around the world tend to consume roughly 10 to 20% of calories from protein:

Masai - 19%
Kitava - 10%

Tokelau - 12%
Inuit - 20%, according to Stefansson
Kuna - 12%
Sweden - 12%
United States - 15%
Human milk - 6%

The balance comes from fat and carbohydrate. Ask a traditional Inuit. If there's no fat on your meat, you may as well starve. Literally. "Rabbit starvation" was a term coined by American explorers who quickly realized that living on lean game is somewhere between unhealthy and fatal.

In the early 1900s, anthropologist and explorer Vilhjalmur Stefansson lived for several years among completely isolated Canadian Inuit (Eskimo) who had never seen a white person before. They were literally a stone-age culture, completely uninfluenced by the modern world. They are representative of how some of our paleolithic ancestors would have lived. Here's Stefansson, quoted from My Life With the Eskimo (1913):
In certain places and in certain years, rabbits are an important article of diet, but even when there is an abundance of this animal, the Indians consider themselves starving if they get nothing else, - and fairly enough, as my own party can testify, for any one who is compelled in winter to live for a period of several weeks on lean meat will actually starve, in this sense: that there are lacking from his diet certain necessary elements, notably fat, and it makes no difference how much he eats, he will be hungry at the end of each meal, and eventually he will lose strength or become actually ill. The Eskimo who have provided themselves in summer with bags of seal oil can carry them into a rabbit country and can live on rabbits satisfactorily for months.
Dr. Loren Cordain, in his excellent paper "Plant-Animal Subsistence Ratios and Macronutrient Energy Estimations in Worldwide Hunter-Gatherer Diets", argues based on calculated estimates that historical hunter-gatherers generally consumed between 19 and 35% of calories from protein:
This high reliance on animal-based foods coupled with the relatively low carbohydrate content of wild plant foods produces universally characteristic macronutrient composition ratios in which protein is elevated (19- 35% of energy) at the expense of carbohydrates (22- 40% of energy).
Later, he states that the most plausible range of fat intakes is 28- 58%. I agree with his assertion that hunter-gatherer diets tended to be relatively high in protein compared with contemporary diets, but I think his protein numbers are a bit high. Why? Because he calculates macronutrient composition based on the whole-carcass fat content of "representative" animals such as deer.

It's clear from the anthropological literature that hunter-gatherers did not go after representative animals. They went after the fattest animals they could find. They knew exactly which animals were fattest in which seasons, which individuals were likely to be fattest within a herd, and which bodyparts were fattest on an individual animal. For example, Stefansson describes how the Inuit relied on (extremely fat) seal in the spring, wolf in the summer, and caribou and bear in the fall and early winter. If necessary, they would discard lean meat in favor of tongue, marrow, internal organs, back fat and other fat-rich bodyparts. This was in order to obtain a minimum of 65% of calories from fat.

Hunter-gatherers would sometimes even provision themselves with enough fat in advance to last a lean season or two. This was true for dozens of tribes along the Northwest coast of North America that relied chiefly on animal foods. Here's another excerpt from My Life With the Eskimo:
...[spring] is the season which the Eskimo give up to the accumulation of blubber for the coming year. Fresh oil is not nearly so palatable or digestible as oil that has been allowed to ferment in a sealskin bag through the summer, and besides that it is difficult often to get seals in the fall... Each family will in the spring be able to lay away from three to seven bags of oil. Such a bag consists of the whole skin of the common seal... This makes a bag which will hold about three hundred pounds of blubber, so that a single family's store of oil for the fall will run from nine hundred to two thousand pounds.
That's a lot of oil! Some of it would have been used to light oil lamps, but much of it would have been eaten. I think Cordain's estimate of the protein intake of hunter-gatherers is a bit high due to his underestimating fat intake. His paper shows that if you break historical hunter-gatherer cultures into 10 groups based on their reliance on animal foods, the most numerous group (46 out of 229) obtained 85- 100% of their food from animal sources. In other words, approximately 20% of historical hunter-gatherers were carnivorous or nearly so. If the human protein ceiling is 35% of calories, that means roughly one fifth of hunter-gatherers ate 65% or more of their calories as fat. It also means carnivory and high-fat diets are not just anomalies, they are part of the human ecological niche. Zero out of 229 groups obtained less than 16% of calories from animal foods. Vegetarianism is not part of our niche.

Further, although the human body can theoretically tolerate up to 35% protein by calories, even that amount is probably not optimal in the long term. I think that's suggested by the fact that diverse cultures tend to find a source of fat and/or carbohydrate that keeps their protein intake roughly between 10 and 20%. I think it's fine to eat plenty of protein, and there's no need to deliberately restrict it, because your tastes will tell you if you're eating too much. However, "high-protein diet" as a euphemism for low-carbohydrate diet is a misnomer. Low-carbohydrate diets are, and have always been, high-fat diets.

19 comments:

Scott Miller said...

Superb article. I always tell people I'm on a "high-fat" diet (rather than a "low-carb" diet). For one, it's the truth. But I love the shock value, too. Especially since my bodyfat is about 10% and at 47 I'm in athletic shape, and this clearly doesn't jive with the image of someone who treats fats and oils as their primary caloric source.

When do you expect to get your doctorate?

Stephan said...

Scott,

I love the shock too. I eat a lot of fat compared to the average person, but I still manage 30% carb or so. The most common response I get when I tell people how much fat I eat is "well you can do that because your metabolism is fast, but I could never get away with it". It's interesting how conventional wisdom is so far off the mark on that.

Stephan said...

Oh, and I expect to graduate at the end of the summer. But we'll see how it goes. That will be seven years!

Half Navajo said...

hey stephan,

you and peter got to be the best blogs out there! anyways...i was wondering if you have read the book The Fiber Menace by Konstantin Monastyrsky? He recommends if your 155lbs to lose weight...one would have to consume under 75g of fat, and eat no less than 55g of protein, and eat no carbs or fiber. I like his views on fiber...there the same as J.K.'s. But that strays way away from what the Optimal Diet recommends for fat. Konstantin says if you eat more fat than 75g you will store it under your skin as fat. I always thought if you kept the calories really low and stayed nourished off of animal fat and protien you would lose fat...but this has got me thinking....i guess you would have to keep the fat low and protein hight to tap into your own fat stores...even more than the 2:1 ration J.K. advises...i don't know...I would like your opinion on this!

troy

Stephan said...

Hi Troy,

I haven't read that book, but I'm superficially familiar with his approach.

I disagree with the idea that you will store fat if you eat more than 75g a day. I eat quite a bit more than that, and I'm lean. Carnivorous cultures like the Inuit didn't get fat, to the contrary.

I don't think too hard about macronutrients in my diet.

Scott Kustes said...

Hey Stephan,
Great set of posts you've had recently. I agree with you that most h-gs probably ate only 10-20% of their calories as protein. When I was training for a track meet over the summer, I was hitting 62% fat, 15% carbs, and 20% protein (with 3% alcohol) on a pretty much Paleo-type diet (though higher saturated fat...my melding of Paleo with WAPF).

It seems when sticking to the standard selection of foods our ancestors would've eaten, 60F/20C/20P or thereabouts is simple to achieve. To stray from that starts to take gaming.

So do you think it's actually the fat that is so important or is it the vitamins that the fat brings with it?

Cheers
Scott Kustes
Modern Forager

Debs said...

There's a website (http://www.dietitian.com/calcbody.php) I ran across that allegedly calculates a healthy weight range for your body type looking at factors like activity level and so forth.

In one section, you're supposed to enter what percent of your diet comes from fat, from carbs, and from protein. I plugged in my approximated fat-loving numbers for the hell of it, but I got the following error messages:

Fat calories must be a number between 20 and 40

Carbohydrate calories must be a number between 45 and 65

And this wasn't the part telling me what they thought was optimal (which wasn't terribly), it was what they thought was possible.

Meanwhile, I cooked two brunch dishes for some friends at a potluck yesterday. In addition to the cream and eggs, I used about two sticks of butter, maybe a little more...

Debs
Food Is Love/Seattle Local Food

Scott said...

Scott Kustes brings up an interesting point that I remember Stephan noting some time ago in one of his comments on a post (I've read everything on this site...love it!): Namely, Stephan's hypothesis regarding the causative factor for the "diseases of civilization" was that a culture became deficient in fat-soluble vitamins A, D and K.

This deficiency may come from anti-nutrients (such as wheat) that interfere with vitamin absorption or contain unhealthy elements such as Omega-6, or it may come from these modern foods displacing A/D/K foods, or from a combination. But the bottom line was that it was the lack of those three vitamins that caused the problems - lack of all three in northern cultures, A and K in tropical cultures that still had access to D from sunlight.

Forgive me Stephan if I am improperly paraphrasing. And as I re-read the paragraph above I see that I have added the effect of Omega-6 to your hypothesis, but still...

I have been thinking a lot about this as I read Nutrition and Physical Degeneration for the first time. This book should be a must-read for anyone interested in nutrition and for anyone who likes to treat nutrition as a religion rather than a science and declare that all fat is bad and/or all carb is bad.

We in the northern hemisphere seem to like our hunter-gathers modeled after the Native Americans or Inuit, who tended to hunt more, partly or mainly due to scarcity of plants in winter. We seem to ignore or discount those cultures from further south who thrived as plant/tuber/fruit gatherers or subsisted healthily as partial agriculturalists (who knew how to pepare grains for consumption) or pastoralists.

While protein intake appeared to remain at a stable and fairly low percentage among the primitive cultures Price studied, the human nutritional niche was extremely wide regarding carb/fat ratio with no observable adverse impact on health, as long as their fat or protein source (dairy, fish, organs, etc.) contained the proper fat-soluble vitamins.

Stephan has updated this line of thinking with his posts on the Kitavans and the Kuna.

So we come back again to the hypothesis that seems to be woven throughout this blog: It's not the fat, its the fat source; it's not the carb, it's the carb source. As long as your intake is not blockng A/D/K by damaging you (gluten/gut issues), is not deficient in A/D/K, is not overloading you with Omega-6, and contains a small or moderate amount of protein, you should thrive.

A study to examine this hypothesis would seem to be not too difficult to design. At a minimum, wheat and vegetable oil should be treated as a confounding factor in any study that could potentially negate any conclusions regarding the effect of fat or carb.

Scott

Stephan said...

Scott K.,

That sounds about right. I don't think it's strictly necessary to eat high-fat, but it does seem to help many people. I won't pretend to know why for sure, but here's what I suspect:

-Decreased wheat, sugar and processed grains
-Increased fat-soluble vitamins
-Less pressure on glucose metabolism, which is an issue for some people

Debs,

That reminds me of the CVD risk calculator based on the Framingham score! I think I broke it because it couldn't compute my HDL.

Scott,

"It's not the fat, its the fat source; it's not the carb, it's the carb source. As long as your intake is not blocking A/D/K by damaging you (gluten/gut issues), is not deficient in A/D/K, is not overloading you with Omega-6, and contains a small or moderate amount of protein, you should thrive."

I would say that's a good summary of my current thinking. By the way, the wheat/ADK connection is mostly speculation. I'm pretty convinced wheat is a problem, but I'm not 100% sure it's due to effects on vitamin status. It may be that plus something else, such as chronic hyperactivation of the innate immune system.

I agree that wheat and n-6 should be treated as a confounding factor in any study. I'm in the process of revising a letter to the editor about that very problem (International Journal of Obesity). It looks like it's going to be accepted eventually. I'll post a link if it's published.

darwinstable said...

Great post Stephan!!!!!

I think that you have finally quelled any reservations I had about saturated fats!

Also how did you manage to get your hands on that book.

Stephan said...

Hi Dan,

I bought it right off Amazon! I believe the book has been continuously in press since it was published. It's a fantastic read, I highly recommend it.

JLL said...

I've seen that book mentioned several times on different health related websites, seems like a very interesting read. Good post.

Nick said...

Stephan, how does the nutrition of wheat compare to rice? Are both equally bad, in terms of carbohydrate content?

Stephan said...

Nick,

In my opinion, the difference between wheat and rice isn't so much about the nutritional value as the presence of toxins. Wheat contains gluten, while rice doesn't (at least not the problematic type). Rice doesn't seem to lead to the same metabolic problems as wheat, on a cultural level. When rice-based cultures switch to wheat, health seems to consistently deteriorate.

Tumerica said...

Brilliant post! Loved this and am chewing on some of your insights for an article on high-protein diets I am doing. Thank you for your contribution to human knowledge.

TT said...

Hi Stephan,

I am new here and enjoy reading the different views on high-Protein and high-fat diet here. The evidence presented points to the many benefits of this type of diet. Something I do not understand and would be gratful if you could point me to the right direction, is that if this diet promotes the general health and helps people to steer away from the many degenerative diseases, why many of the cancer diets out there do not encourage animal meats,fats and dairy intake? Are they mis-informed or they have good reasons for doing so?

Many thanks
Tom

24andsomuchmore said...

Okay, but what about Cholesterol and triglycerides and things like that that are supposed to be very unhealthy for your heart?

Jee said...

Hi Stephan,

I've been learning so much from your excellent blog... I'm now at Dec 08, slowly catching up to the present.

Thought you might find this article of some interest: http://www.scientificamerican.com/article.cfm?id=carbs-against-cardio

The author still doesn't have the complete picture, but it looks like she's brought her readers one (half?) step closer.

Thanks for generously sharing your knowledge!

Gluten Free Food Freak said...

Really interesting article Stephan - kind of explains why I have so much problem keeping weight on.

I eat as much fat as I can (60%+), but have to be very careful to keep the omega 6's down.

I'm surprised, and heartened to see that you eat so much carbohydrate. I'm a bit wary about eating much with a high fat diet because of the insulin resistance caused by saturated fat, and the subsequent insulin/blood sugar related danger.

What do you think of that? Do you separate your carbs and fat, or don't you think there's much of a problem with this so long as the carbs are natural and non-gluteny?

Thanks again for an interesting post on protein.