Saturday, August 15, 2009

Ischemic Heart Attacks: Disease of Civilization

Or, more precisely, disease of industrial civilization.

The scientific literature contains examples of cultures that don't suffer from the chronic non-communicable diseases that are so common in modern societies. Much of what I've read indicates that heart attacks are practically unique to cultures that have adopted industrial foodways and a modern lifestyle, being infrequent or entirely absent in those that have not.


I recently came across an incredible paper from 1964 in the American Journal of Cardiology, titled "Geographic Pathology of Myocardial Infarction", by lead author Dr. Kyu Taik Lee (Am. J. Cardiol. 13:30. 1964). This was published during a period of intense research into the cardiovascular health of non-industrial cultures, including Dr. George V. Mann's famous
study of the Masai.

The first thing Lee and his colleagues did was collect autopsy statistics from San Francisco and Los Angeles hospitals. They analyzed the data by race, including categories for Caucasian-Americans (white), Japanese-Americans, Chinese-Americans, and Filipino-Americans. All races had a similar incidence of autopsy-proven myocardial infarction (MI = heart attack), including both silent (healed) and fatal MI. For comparison, they included a table with autopsy data from hospitals in Tokyo, South Japan and North Japan. I'm including the data from Tokyo in the graph because it's also an urban environment, but the finding was the same in all three regions. Here's what they found, by age group:
The Japanese had a very low rate of MI compared to both Caucasian-Americans and Japanese-Americans. The rate of MI in Caucasian-Americans and Japanese-Americans did not differ significantly. Thus, location but not race determined the susceptibility to MI.

Next, the investigators collected autopsy data from hospitals in New Orleans, again divided by race. This time they exained Caucasian-Americans and African-Americans. Both groups had a very high rate of MI, as expected, although the African-Americans had a lower rate than Caucasian-Americans. They also collected data from autopsies in Nigeria and Uganda for comparison. Here are the data for men:
And for women: Again, location but not race largely determined the incidence of MI. MI was extremely rare in the African autopsies. Here's what they had to say:
There was only 1 case of healed myocardial infarction among over 4,000 adult autopsies in the Uganda series, and only 2 cases of healed myocardial infarction among over 500 adult autopsies in the Nigerian series. In the New Orleans Negro series the occurrence rate was far greater in every sex and age group than in either one of the Negro series in East and West Africa.
Over 4,500 autopsies and not a single fatal MI. If this isn't worth studying, what is? These data should be part of first-year training in medicine and health programs.

To satisfy the skeptics, Lee and colleagues imported hundreds of hearts from consecutive autopsies in Albany (USA), Africa, Korea and Japan. They had an American pathologist analyze them side-by side to eliminate any diagnostic bias. Here's what they found:
In the African Negro series no infarct was found in any age group [out of 244 hearts, 39 over 60 years old]. In the Korean series there were only 2 cases of myocardial infarction [out of 106 hearts] and they were both women... In the Japanese series there were 8 cases of myocardial infarction in 259 hearts. All were men...
In the American sample, nearly 40% of the hearts of men and women over 60 showed signs of MI. The findings of the American pathologist confirmed the international autopsy data, showing that diagnostic bias did not contribute to the results significantly. They also took measurements of the thickness of the coronary artery wall, an index of atherosclerosis. They found that the Americans had the most atherosclerosis, but all cultures had some degree of it and there was overlap in the amount of atherosclerosis between samples. This led the investigators to state:
Myocardial infarction and coronary thrombosis are almost nonexistent in Uganda and Nigeria, and the amount of coronary arteriosclerosis is significantly less in Africans than in whites. However, in the two groups there was some overlapping in the degree of arteriosclerosis. No Africans had infarcts, but some had the same or a greater degree of coronary arteriosclerosis as a few whites who had myocardial infarctions. One explanation for this may be that some difference in clotting or clot-lysis mechanisms is present in the two groups. In a previous study, we showed that the incidence of thromboembolic phenomena in the pulmonary circulation [blood clots in the lungs] was low in East Africans as compared with Americans.
Now, the authors' conclusions:
These data strongly suggest that among the Orientals the environmental factor is playing a major role in the etiology of myocardial infarction and coronary thrombosis. If the genetic factor is an important one, those Orientals who moved to this country many years ago or who were born in this country should still maintain their low occurrence rate of myocardial infarction at least to some extent, and one would not expect to see similar occurrence rates of myocardial infarction in Orientals and whites as old as 50 to 59 years... As with the Orientals, this suggests that for Negroes in the United States environmental factors are more important than genetic factors in the etiology of myocardial infarction.
Africans in Africa and Japanese in Japan = low incidence of MI. Africans, Japanese and Caucasians in the US = high and similar incidence of MI. Genes only influence a person's susceptibility to MI when they live in an environment that promotes MI. Otherwise, genes are basically irrelevant.

What do the traditional diets and lifestyles of Japan and Africa have in common? Not much. Even within Nigeria, the diet varies from heavily starch-based (root vegetables, soaked/fermented non-gluten grains, beans, plantains) to mostly reliant on high-fat dairy and meat, though the former is much more common and I'm not sure how much the latter is represented in the data. In fact, I believe it's the wrong question to ask. A better question is "what do we eat/do in the US that traditional Japanese, Koreans, Chinese, Polynesians, Melanesians and Africans don't"? For starters, none of them rely on industrially processed foods. Their food is generally prepared at home using wholesome ingredients and traditional methods.


There are a number of lifestyle factors that probably play a role here.  They probably get more exercise than Americans, even if it's only walking in Tokyo or domestic tasks for women in parts of Africa. Traditional Africans surely get more sunlight and thus more vitamin D. I can't imagine life is less stressful in Tokyo than in San Francisco or Los Angeles.  Cigarettes are probably much less prevalent in parts of Africa than in the modern US.

I really like this study, and I think these graphs should be disseminated as much as possible. I've prepared high-resolution versions in JPEG, Powerpoint and PDF formats. E-mail me (click on my profile for the link) if you would like a copy. Let me know which format(s) you want.

131 comments:

Robert Andrew Brown said...
This comment has been removed by the author.
Robert Andrew Brown said...

Another highly thought provoking set of data that must have taken ages and much wide reading and searching to find.

I suspect we have been burrowing in the same direction.

The recognition that some Africans and Japanese had vascular deposits, but plaque build up was not expressed as MIs begs some questions.

It suggest that you need both inflammation / immune response and plaque build up for an MI.

What increases inflammation based immune response? - An excess of Omega 6 and lack of Omega 3.

What does plaque contain? - Large amounts of Omega 6 LA ester a lot of which is oxidised.

What promotes oxidation of LDL? - Omega 6.

What an triggers immune response in the vascular lining and calls the macrophages to arms? - Oxidised LDL.

Why does Omega 6 reduce LDL? - Because it increases the rate of take up and fat deposition.

So it is arguable that Omega 6 increases oxidised LDL, and increases the uptake of LDL. Oxidised LDL will trigger the macrophages, which in time can lead to a build up of debris which eventually can erupt leading to an arterial blockage.


Common vegetable oils are high in Omega 6. Are common vegetables oil going to be proved to be heart healthy in the long term?

Of course it is more complex and interrelated, multifactorial etc but for me it looks pretty unavoidable that excess Omega 6 and lack of Omega 3 will in time be recognised as a factor in cardiovascular disease.



Author Omega Six The Devils Fat.

OmegaSixTheDevilsFat.com

(rewrite / update / much new material, 1700 refs etc hopefully not too far away now)

Steve Parker, M.D. said...

Very interesting. I'm glad you point out there are differences between the New World and Japan and Africa, other than just diet. You could probably come up with a list of 50 differences.

Did the ancestors of African Americans in New Orleans come mostly from Nigeria and Uganda?

Michelle said...

Remarkable data. Out of curiosity, and to play devils' advocate, what was the primary cause of death of the Africans and Japanese? (Could their primary cause of death have superceded mycardial infarct?)

Bris said...

This study was made in 1964:

Japan was still recovering from WW2. Incomes were low and car ownership was uncommon. The autopsies were performed on people who would have been raised in a semi-industrialised largely traditional lifestyle. Kimonos were still the normal daily clothing of women only 20 years earlier. Traditional Japanese society emphasised harmony and societal cohesion.

I suggest you read David Suzuki's very unhappy experiences as an outcast Japanese-Canadian in Vancouver before claiming that Tokyo and San Francisco had similar stress levels.

The USA was still basically segregated on racial lines. African-Americans suffered immense discrimination, poverty and very severe psychosocial stress during this period. Lynchings were still occcurring in the early 1960s.

Most Japanese Americans were interred as enemy aliens during WW2 and had their property confiscated.

The Centres of Origin Theory of evolution tells us that black Africans from different regions are actually very different genetically. In fact there is often far more genetic variation between two African villages 20km apart than between Finns and Greeks.

Very few Nigerian slaves went to American and none were taken from Uganda. Virtually all African Americans have some (often very substantial) White (and often also Native American or Hispanic) ancestry. Studies of genetic markers have shown that some African Americans can be considered on a genetic basis to be 100% White.

Virtually every plantation was known to have slave children who bore a remarkable resemblance to the white owner. People who were only 1/8th Black could be kept as slaves. Sally Helms the slave mistress of Thomas Jefferson was described as having olive skin, light brown hair and green eyes. Mary Todd Lincoln described her disgust at seeing "white" women being auctioned as slaves.

So the study is actually:

a) a comparison of Black Africans living traditional lifestyles and genetically unrelated people who have variable levels of Black African origin suffering extreme psychosocial stress.

and

b) Japanese people raised in a harmonious and inclusive traditional lifestyle compared with highly-stressed Japanese people raised in an very unwelcoming foreign country.

Not to mention that other very major confounding factors such as very different vitamin D levels or high levels of gut parasites (which reduce inflammation) in Africans aren't even considered.

Robert Andrew Brown said...

Steve Parker said

"You could probably come up with a list of 50 differences."

But how many apart from diet how many external factors could biologically account for the variations seen?

I acknowledge vitamin D has a role.


Bris

I acknowledge that stress is a factor in health.

Do you acknowledge diet has a role in health?

Do you acknowledge food alters gene expression.

Bris said...

Michelle:
Remarkable data. Out of curiosity, and to play devils' advocate, what was the primary cause of death of the Africans and Japanese? (Could their primary cause of death have superceded mycardial infarct?)

Dr Wolfgang Lutz author of 'Life Without Bread' has stated that what you die of is irrelevant because the outcome is exactly the same - death. Heart attacks kill you quickly and cancers kill you slowly. (Sudden massive heart attacks are probably are far better way to die.)

I will readily accept that dietary changes may improve your health. But there is far less evidence that they will make you live longer.

Life expectancies are virtually identical in affluent countries so the whole argument on the causes of death is really moot. People in different countries die from different things - if you don't die of one cause you will simply die of another.
http://www.nia.nih.gov/NewsAndEvents/PressReleases/PR20000614LifeExpectancy.htm


According to the World health Organization the top three causes of death in Japan are strokes, heart attacks and lung cancer. Both strokes and heart attacks have similar causes. Japanese doctors are notorious for changing the cause of death from "shameful" heart attacks to "noble" strokes so it is obvious that the Japanese aren't really protected by their diet from heart disease.

The elderly Japanese who are creating the death statistics have generally lived on a reasonably traditional diet for most or all of their lives. So it can't really be argued that westernised food is now suddenly causing massive rates of heart disease, strokes and lung cancer.

http://www.who.int/whosis/mort/profiles/mort_wpro_jpn_japan.pdf

Robert Andrew Brown said...

Bris

The Japanese do not die of the same things Americans do.

See Lands Fish, Omega-3 and human health.page 7. They have much higher rates of cerebro vascular disease and lower ischemic heart conditions, and the profile has changed substantially since the 1960s.

Of course sadly we all die, but the issue is how well we remain in the intervening years.

Western conditions which are so costly in health terms in the intervening years were not seen in those on traditional diets.

There is also the issue as to how well our brains function the rising levels of neurological disorders, and evolution rather than devolutions.

Jeff said...

Stephan,

Great article as always. The comments are also excellent. RAB I must get your book.

jeff

Bris said...

robert:

The Japanese do not die of the same things Americans do.

Yes they do they do according to the World Health Organization official statistics.

In fact the four leading causes of death are then same in both the USA and Japan: strokes, heart disease, cancers and pneumonia. The only difference is that the stroke and heart disease rates are swapped. Stokes and heart disease are both related vascular diseases.

It is well known that in Japan it is considered shameful to die of a heart attack but not from a stroke. Japanese doctors frequently write false death certificates if the family request it.

Western conditions which are so costly in health terms in the intervening years were not seen in those on traditional diets

What you mean is traditional lifestyles because it is impossible to to separate traditional diet and traditional lifestyle factors such as high levels of physical activity.

The European aristocracy were eating a diet very high in white bread and sugar 800 years ago. By 150 years ago daily white bread and high sugar consumption were normal even for the poor. Yet heart attacks were quite rare.

Per capita sugar consumption in Australia is now less than it was in 1900. Yet heat attacks, diabetes and obesity are vastly more common.
A natural part of life: The Australian sugar industry's campaign to reverse declining Australian sugar consumption, 1980-1995

A natural part of life: The Australian sugar industry's campaign to reverse declining Australian sugar consumption, 1980-1995. Journal of Australian Studies, 87 . pp. 141-154. ISSN 1444-3058
http://eprints.jcu.edu.au/344/

This paper explains very clearly that it was primarily a reduction is physical activity not a change in diet that resulted in increased heart disease.

A history of physical activity, cardiovascular health and longevity: the scientific contributions of Jeremy N Morris, DSc, DPH, FRCP
International Journal of Epidemiology 2001;30:1184-1192

http://ije.oxfordjournals.org/cgi/content/full/30/5/1184

Tom said...

We have Bris to thank for this excellent post. It's contraians who bring out the best in brilliant people !

Melchior Meijer said...

Stephan,

This post really blew me off my socks. Thanks!

Bris,

Do you really believe that Australians were eating more sugar in ~1900 than they do today? And that this wonderful fact has been accomplished by the sugar industry? As we say in Holland when we are flabberguasted: you broke my wooden shoe! I don’t think you believe this *** yourself.

Aristocrats were eating high amounts of sugar 800 years ago? Not in Europe. ‘We’ started sailing in and distributing sugar cane from the East Indies in the Golden Age. The refined end product made in Amsterdam was extremely expensive. Beat sugar was brought to the world by Napoleon.

You say myocardial infarctions where quite rare at the turn of the 19th century. A few days ago – when I posted Heberden’s letter – you said exactly the opposite. Could the real Bris please stand up?

Robert Andrew Brown said...

"The only difference is that the stroke and heart disease rates are swapped. Stokes and heart disease are both related vascular diseases."

A stroke can be due to a vascular blockage or a haemorrhage.

In 1960 according to Lands figures 216 of 758 died of cerebral bleeding, and 283 of 758 died of cerebro vascular conditions. 36 died of ischemic heart disease.

He also said that haemorrhagic stroke was common in Eskimos.


Bris you said

"The European aristocracy were eating a diet very high in white bread and sugar 800 years ago."

"Yet heart attacks were quite rare. "

Sugar consumption has risen from a few pounds to 60 lbs a year based on Cleaves figures.

Can you substantiate your claim that sugar consumption was high and heart attacks rare in the aristocracy in the 1200s.

Was anybody keeping figures? It was not until 1600 Harvey published his book on circulation. "An Anatomical Exercise Concerning the Motion of the Heart and Blood in Animals."


On sugar consumption in Australia I noted the reference you gave included the following comment "Despite spending $20 million on the campaign, it failed to achieve its goal of reversing the decline in apparent Australian sugar consumption."


A book "Australian Agriculture: Its History and Challenges By Ted Henzell" states " Fortunately for Australia, which had entered the world sugar trade very late global demand increase substantially in the 20th century. was this was partly due to population growth, per capita consumption also rose strongly from an average of about 5 kg per person per year at the beginning to 20 kg at the end"

http://books.google.com/books?id=vNj-OKU4CFwC&pg=PA173&lpg=PA173&dq=sugar+consumption+australia+historical+figures&source=bl&ots=NLf__eE13A&sig=NPi-O3LyB30SwwHVAiGhcwS1A_w&hl=en&ei=-gSISoTQDtmgjAfmlKmjCw&sa=X&oi=book_result&ct=result&resnum=4#v=onepage&q=&f=false

This book looks like a fairly authoritative source on the Australian agricultural industry, and begs the question where the sugar industry's own figures came from.

As to the risk of cardiovascular disease, calorie intake and exercise, I do not dispute that those with a greater calorie expenditure-general terms going to be healthy and that those with a lower calorie expenditure where food intake is likely to be above calorific need.

When I used the phrase traditional diets I meant exactly that, and in the sense of largely natural foods which did not include in industrialised process nutrient depleted foods.

Kitavans were noted to have a relatively activity rate and yet were very healthy, and as you pointed out earlier had a high carbohydrate diet.

Would you by any chance ever have been employed by an industrial food manufacturer?

Terry H said...

Bris,

Your claim on Australian sugar consumption may be dodgy. For instance see:

http://www.illovosugar.com/worldofsugar/internationalSugarStats.htm

This table suggests that Australians are amongst the highest consumers of sugar in the world (second only to Brazil?). Comparison of this figure with your own reference and other posters suggests it has considerably increased in the last century.

Jenny said...

One thing to keep in mind. All the people involved in the autopsies were dead. So when they didn't die of heart attack, you'd like to know what they DID die of.

From what I have read, the Japanese are likely to have died from gastrointestinal cancers, since they had the highest rate of stomach cancer in the world.

I don't know about what mainly killed the Africans.

Whatever causes heart disease long term survival in the US has improved greatly over the century and recent studies tracking interventions for heart disease in diabetes have run into the problem of far fewer deaths than predicted making it hard to get statistically significant results.

We must be careful not to romanticize the past or other cultures. Women in these traditional cultures did not routinely live to be very old no matter how much healthful exercise they got. As a whole Americans are living longer and healthier lives as a group than any humans who have ever lived.

Adolfo David said...

STEPHAN,

Dark skin people like Africans synthesize vitamin D from sunlight much poorer than light/clear/white skin people.

Stephan Guyenet said...

Steve,

My understanding is that most African-Americans had ancestors in West Africa, in the coastal region from Senegal to Nigeria. But their origins are pretty diverse, and many also have European blood at this point. The comparison between Africans and African-Americans is not as controlled for race as the comparison between Japanese and Japanese-Americans. But I do think it's interesting that Africans are developing the diseases of civilization as they urbanize.

Michelle,

I don't know the primary causes of death in Africa or Japan but I would suspect it's infection in the former and possibly stroke in the latter. The data are all age-matched so that shouldn't be a major confound.

Jenny,

I don't have any romantic ideas about life in Africa. Their life expectancy was shorter than ours for sure, although the difference is in large part due to infant mortality. Some of these near-vegetarian groups had nutritional deficiencies due to a lack of animal foods-- vitamin A deficiency, rickets from high phytic acid consumption, protein malnutrition, etc. I do think it's interesting that they weren't having heart attacks though. I have to dispute your statement that Americans are living healthier lives than any humans in history. I think we're a sick nation, and medical technology is holding us together.

Adolfo,

Yes, but when you're in the equatorial sun all day, you still end up making a lot of vitamin D, regardless of skin color.

Gyan said...

What is the basis of including gluten grains among dietary evil category of vegetable oils and sugar?
How about traditional wheat eating societies eg Sikhs or Europeans?.
How about their MI statistics?

Could it be that vegetable oil consumptions increases gluten problems?

Bris said...

Do you really believe that Australians were eating more sugar in ~1900 than they do today? And that this wonderful fact has been accomplished by the sugar industry? As we say in Holland when we are flabberguasted: you broke my wooden shoe! I don’t think you believe this *** yourself.

Australian sugar consumption was 55kg per head from 1900 until 1980 and has fallen since. The Australian sugar industry has failed to raise consumption.

A natural part of life: The Australian sugar industry's campaign to reverse declining Australian sugar consumption, 1980-1995. Journal of Australian Studies, 87 . pp. 141-154. ISSN 1444-3058
http://eprints.jcu.edu.au/344


You obviously know absolutely nothing about Australia or you wouldn't make such nonsensical claims. Due to a hot climate and no refrigeration the 19th century diet consisted almost entirely of meat, cheese, white bread, jam, tea and sugar. Fruit and vegetable consumption was totally non-existent in many isolated areas. Many shepherds and farm workers ate only meat, white bread, tinned jam, tea and sugar. Wholegrains were never eaten.

Food has always been extremely cheap and hyper-abundant in Australia. Even the poorest people could afford as much food as they wanted 150 years ago.

In Australia fruit, vegetable and fibre consumption have all increased since 1900 while salt and caloric intake has fallen.

Aristocrats were eating high amounts of sugar 800 years ago? Not in Europe. ‘We’ started sailing in and distributing sugar cane from the East Indies in the Golden Age. The refined end product made in Amsterdam was extremely expensive. Beat sugar was brought to the world by Napoleon.

Totally wrong. Sugar beets have been cultivated for 5000 years in Egypt. Beet sugar was imported from by the wealthy. Tooth decay was becoming common in the rich by the 1500s.

King Henry VIII of England (1491-1557) had massive (5-10kg) sugar sculptures made for him every day.

Tooth decay was rampant amongst the wealthy in Europe from about 1700 due to high consumption of West Indian and South American sugar. Wealthy women used fans to hide their rotten teeth and stinking breath. George Washington had such bad tooth decay from eating sugar that he had no teeth.

Cheap sugar was widely available from the 1840s.

Napoleon introduced beet sugar because Britain was preventing their access to cheap cane sugar from the New World. However the British had access to cane sugar.

It is a complete and utter myth that diets rich in refined carbohydrate only date from the early 1900s. This was the normal diet in Australia in the mid 1800s.

Bris said...

This book looks like a fairly authoritative source on the Australian agricultural industry, and begs the question where the sugar industry's own figures came from.

Australia only had one sugar company - CSR - until the 1980s. All sugar imports were banned and corn syrup wan't used. So the sugar industry knows exactly how much sugar was used in Australia.

Bris said...

Adolpho:

Dark skin people like Africans synthesize vitamin D from sunlight much poorer than light/clear/white skin people.

Most African American people have some form of vitamin D deficiency. Even New Orleans has only sufficient UV for dark skinned people in Summer. In Boston there is never sufficient UV for African Americans to synthesise adequate vitamin D.

Stephan Guyenet said...

Gyan,

Wheat consumption was high in the UK/US around 1900, but heart attacks were rare at that time. I think white flour is not healthy, but it isn't sufficient to cause CHD by itself. North India 50 years ago was another example.

Vegetable oil could conceivably contribute to gluten damage by making the immune system hyperactive.

Bris,

Please be more respectful to other commenters.

In most Western countries, sugar consumption increased greatly
immediately preceding and during the 20th century.

White flour was widely used by the mid-1800s, but it was a higher extraction rate and thus less refined.

Bris said...

Jenny:
One thing to keep in mind. All the people involved in the autopsies were dead. So when they didn't die of heart attack, you'd like to know what they DID die of.

The traditional Japanese weren't dying of heart attacks but they weren't living much longer. So they were just trading a quick death from heart disease for a slow and agonising death from cancer.

Bris said...

Stephan:
In most Western countries, sugar consumption increased greatly
immediately preceding and during the 20th century.


I also showed proof that sugar consumption was higher in 1900 in Australia than now but heart disease and obesity was far less. This is consistent with reduced physical activity not an increase in refined carbohydrates (which have actually reduced).


White flour was widely used by the mid-1800s, but it was a higher extraction rate and thus less refined.


A higher extraction rate simply means that more flour is recovered from each grain. This just makes white flour cheaper not more refined. White flour is always sifted multiple times to remove the bran. The white flour of 200 or (even 500 years) years ago was essentially as refined as now. Even the ancient Egyptian wealthy ate refined white bread 5000 years ago.

Numerous epidemiological studies by Jeremy N Norris in Britain showed that workers who were physically active had significantly lower rates of heart disease than matched sedentary workers. The 1966 London Bus Study demonstrated that physically active conductors suffered less disease than drivers, despite a more stressful job. The pay, status and diets were essentially identical

TL Cleave noticed that Zulu cane cutters who ate a lot of sugar juice and had 91% carbohydrate intake had less heart disease than Zulu city workers who ate 81% carbohydrate. However Cleave totally misinterpreted the results by claiming the sugar juice wasn't refined and therefore wasn't harmful. Raw sugar is nothing more than 97-99% sucrose with a little colour, a tiny amount of other sugars such as fructose and traces of a few minerals. So there is no possibility it is healthier than refined white sugar. In fact the cane cutter had a worse diet than the city workers.

What Cleave failed to recognise is that the extremely arduous physical activity of the cane cutters protected them from disease.

The eminent English physician Joseph Heberden noted in 1772 that one of his patients almost totally cured himself of severe angina pectoris by vigorously sawing wood each day.

Jacqueline said...

If anyone wants the most authoritative info on sugar consumption and the sugar industry in Australia try this from the FAO:
http://www.fao.org/docrep/005/X0513E/x0513e04.htm

Sugar first cultivated commercially in Oz from 1860s. Consumption may have begun falling due to health messages but we are only talking about a 10% decline - from about 55kg per capita to about 50kg per capita. Of course, increasingly through the first half of the 20th century up to a peak in the 60s, Australia was also one of the worst places for heart attacks.

Bris is right about the 'meat, sugar, white flour, tea and jam' thing - and that's exactly why the Weston Price found the aborigines living on white man's food in such an abysmal state health and teeth wise - because they went from their traditional diet to one dominated by sugar, white flour, tea and jam.

Robert Andrew Brown said...

Bris said

"Australia only had one sugar company - CSR - until the 1980s. All sugar imports were banned and corn syrup wan't used. So the sugar industry knows exactly how much sugar was used in Australia."


The book cited above said

"Australia did not produce any significant amount of sugar until the 1860s and it was still importing part of its requirements at the end of World War I. The reason why sugar cane made such a slow start was not for lack of trying, although it took some time for people to realise that most of the present-day New South Wales was to cool for this tropical crop, but it was not an obvious choice for development under Australian conditions"


The book also suggest that the CSR records of the turn-of-the-century are limited, that records were discarded, and that they were by no means universal. How that reflects on figures for production is not specified.

It is also not clear in the book if the CSR controlled the whole of the sugar industry at that time, but it seems unlikely.

According to the book sugar cane production in Australia in 1860 was almost non-existent.


Bris

What is your exact contention in terms of the impact of sugar on health.

Sugar is clearly a highly refined nutrient depleted carbohydrate source, essentially made of half fructose and a half glucose.

You yourself make the point in graphic terms that it is associated with teeth decay.

Are you trying to say that the value of highly refined carbohydrates depleted of nutrients, and carbohydrates still containing mineral and other nutrients have equal value in health terms?

Bris said...

The most melanin-pigmented African people have about 45x as much UV blocking ability as the least pigmented Europeans. So a European will usually get their entire vitamin D quota of 10,000iu in 10-15 minutes of moderately strong sunlight (eg New Orleans in summer). An African American may need to spend the entire day outside to get the same level of vitamin D synthesis.

Vitamin D is only stored for 2-3 months so nearly all African Americans will be vitamin D deprived for most of the year. Further north eg Chicago there is never sufficient UV exposure for a typical African American to get even the minimum 400iu/day let alone the natural 10,000iu/day their African ancestors would have obtained.

American Heart Association (2008, January 8). Lack Of Vitamin D May Increase Heart Disease Risk.

In a study of 1,739 offspring from the Framingham Heart Study participants (average age 59, all Caucasian), researchers found that those with blood levels of vitamin D below 15 nanograms per milliliter (ng/mL) had twice the risk of a cardiovascular event such as a heart attack, heart failure or stroke in the next five years compared to those with higher levels of vitamin D.

Overall, 28 percent of individuals had levels of vitamin D below15 ng/mL and 9 percent had levels below10 ng/mL. Although levels above 30 ng/mL are considered optimal for bone metabolism, only 10 percent of the study sample had levels in this range.

Note that all the subjects were white but 90% still had suboptimal vitamin D levels. For blacks that would become 100% with low vitamin D levels.

Low serum vitamin D is known to increase calcification of arteries:

- the Kitivans and Okinawans live in the tropics and don't consume dairy foods.

- the Masai live in the tropics. They have very high milk consumption and severe atherosclerosis. (Mann 1964)

- Japanese people have very little skin pigmentation and Tokyo has high levels of UV in Spring and Summer ensuring adequate vitamin D for much of the year. The traditional Japanese diet is low calcium with no dairy foods.

- traditional Inuits have low serum vitamin D but also have very low calcium intake and no dairy foods.

Andy said...

Bris, you said:

"Numerous epidemiological studies by Jeremy N Norris in Britain showed that workers who were physically active had significantly lower rates of heart disease than matched sedentary workers. The 1966 London Bus Study demonstrated that physically active conductors suffered less disease than drivers, despite a more stressful job. The pay, status and diets were essentially identical"

How much less is significantly lower? Did it come anything near the 76% reduction of cardiovascular deaths achieved by diet in the Lyon study?

I do recognize that exercise plays an important role and so does vitamin D. I think we all want you to clarify whether you believe that diet has a major role as well or not. So far, it seems to me that you are suggesting other factors are much more important and diet is basically irrelevant. If that is true, how do you explain the Lyon study?

Bris said...

What is your exact contention in terms of the impact of sugar on health.

Sugar unequivocally causes tooth decay. and contains empty calories which contribute to obesity.

High carbohydrate diets are a major contributor to gastrointestinal disease and diabetes. I also think they are a major contributor to cancers.

I will also add that regular intense physical activity reduces/eliminates most or all of the metabolic effects of carbohydrates (except gastrointestinal problems) . Endurance athletes such as professional road cyclists have few health problems despite consuming up to 2000g/day of refined carbohydrates.

I very seriously doubt that sugar or refined carbohydrate alone is a major contributor to CHD. I would rate high milk/calcium consumption, lack of vitamin D, lack of antioxidants and EFA and low levels of physical activity (primary cause) as far more serious problems.

The Okinawan and Kitivan cases suggest that high carbohydrates don't matter if all the other risk factors are reduced. Carbohydrate doesn't get much more high GI or refined than white rice.

I would argue that eliminating dairy, considerably increasing antioxidants and considerably more physical activity are the best way to avoid CHD.

Bris said...
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Bris said...
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Bris said...

How much less is significantly lower? Did it come anything near the 76% reduction of cardiovascular deaths achieved by diet in the Lyon study?

The Lyon study was a small scale (605 men) multiple-intervention study of men who had already had a heart attack. They were only followed for 46 months not until death. So there is no evidence that long term mortality was reduced. They showed a 50-70% reduction in cardiovascular events during this period


The American Heart Association isn't so sure:

What were the problems with the study?


However, limitations in study methods raise questions about the true impact of this diet on risk of recurrent heart disease and related measures. Specifically, the baseline diet was only assessed in the experimental group at the start of the study. The control group's diet was only assessed at the conclusion. This was done to avoid influencing the dietary behavior of these subjects. Thus, it's not clear whether there were any dietary changes made by the control group.

Dietary data at the final visit are reported for only 83 out of 303 subjects (30 percent ) in the control group and 144 out of 302 (less than 50 percent) in the experimental group. The diet of the other subjects who completed the study is unknown.This raises questions about the role of diet in explaining the results reported for recurrent coronary events.

Translation: there is no proof the diet worked.

http://www.americanheart.org/presenter.jhtml?identifier=4655

jacob said...

Great comments, Bris. Question everything.

Now your point about exercise is perhaps true only up to a point, though. Physical activity (outside) is certainly important, but might not *intense* physical exercise be a destructive stressor long-term? The post-career health and longevity of professional athletes, as I understand it, tends not to be good. (Perhaps there are studies refuting this.)

Could you develop your argument against dairy? Is it the calcium content you find dangerous? Why so?
I'm particularly interested because I eat a lot of dairy at the moment. Red meat is overly high in iron, and I avoid PUFAs from fatty fish, based on Ray Peat's advice (see raypeat.com/articles); very pro-sugar and anti most vegetables and starch - stressing fruit, but not excluding white sugar). Aren't iron and PUFAs strong pro-oxidants? Why would a high iron / pufa intake be better than a high calcium intake?

Melchior Meijer said...

Bris,

Your take on dairy is interesting. According to Lindeberg there is a strong correlation between milk consumption and CHD (he is aware of the Masai as a black swan), but an inverse correlation between cheese consumption and CHD. If milk is a causal factor, what part of it would be the culprit? Cheese has almost no lactose. Is lactose atherogenic? Is the casein altered in some way during the cheese making process? Does cheese have less or no insulin like proteins?

You aknowledge sugar’s (glucose/fructose) possible role in the etiology of type 2 diabetes above a certain treshold of consumption (if I haven’t misunderstood you). Don’t you agree that a diabetogenic factor almost certainly also is atherogenic?

LeenaS said...

I do not know, how harmul pastorised lowfat dairy may be, but butter and cream are staple foods in Kwasniewski diet (and ours, too).

With this diet he managed to stop and reverse arterosclerosis in a clinical study reviewed by Polish Academy of Sciences (see his book Homo Optimus).

That fits well with case reports and anecdotal evidence collected from hereaboust, too.

jacob said...

Any thoughts on this study?

The survival advantage of milk and dairy consumption: an overview of evidence from cohort studies of vascular diseases, diabetes and cancer.

http://www.ncbi.nlm.nih.gov/pubmed/19155432

Where's the cheese vs milk study?

Thanks,

Jacob

Adolfo David said...

STEPHAN,

about abundant sun exposure and vitamin D theoretically yes, but...

sun exposure is not a guarantee of vitamin D

"Low vitamin D status despite abundant sun exposure". J Clin Endocrinol Metab. june 2007 -> Study done in Hawaii, 50% of people studied were deficient in vitamin D.

For this reason I think its so important using supplements when we talk about vitamin D.

Bris said...

Now your point about exercise is perhaps true only up to a point, though. Physical activity (outside) is certainly important, but might not *intense* physical exercise be a destructive stressor long-term?

There has been a lot of work done at the University of Queensland, Australia by Dr Jeff Coombes in this area. It seems that even very extreme physical activity such as Iron Man triathlons doesn't cause permanent damage to the cardiorespiratory system.

The post-career health and longevity of professional athletes, as I understand it, tends not to be good. (Perhaps there are studies refuting this.)

Anabolic steroid abuse is rife is - estimated to be as high as 90% in some sports. This can cause massive long term damage. Many professional athletes are also crippled by arthritis and are unable to exercise at any level.

Tall people have shorter lifespans than people of average high. Professional male athletes are typically (much) taller than average

Findings based on millions of deaths suggest that shorter, smaller bodies have lower death rates and fewer diet-related chronic diseases, especially past middle age. Shorter people also appear to have longer average lifespans. The authors suggest that the differences in longevity between the sexes is due to their height differences because men average about 8.0% taller than women and have a 7.9% lower life expectancy at birth.

Animal experiments also show that smaller animals within the same species generally live longer.


Life Sciences
Volume 72, Issue 16, 7 March 2003, Pages 1781-1802

It should be noted that traditional Okinawans are amongst the smallest people on Earth. Kitivans are also relatively small. Northern Europeans who have the highest rates of heart disease are the tallest (and amongst the heaviest) people in the developed world. Masai also have extreme atherosclerosis and are very tall. Being big places a greater stress on the heart and vascular system because a considerably greater blood flow and higher blood pressure in the aorta are required.

Very large dogs such as Great Danes and Irish Wolfhounds typically only live half as long as small breeds.

Bris said...

Loren Cordain considers milk to be the primary contributing factor to CHD. Some research shows A1 milk to be extremely strongly associated with virtually every disease of civilisation. A1 milk is produced by Friesian-Holstein cattle which provide most of the milk in the English speaking world. Most other places have A2 milk.

Mann also considered milk to be responsible for the extreme atherosclerosis in the Masai - he argued it was only their vigorous activity that prevented heart attacks.

Milk contains beta casein protein which is highly inflammatory. If a "leaky gut" is present it can enter the blood provoking immune reaction. Cheese making denatures beta casein as does prolonged boiling and yoghurt making. Butter has almost no casein and cream has less than 1/10th as much protein as milk. Skim milk use is associated with increased heart attacks as it has more protein.

Dairy eaters have far higher calcium intake than non-dairy eaters which may increase arterial calcification.

Bris said...

Adolpho:


"Low vitamin D status despite abundant sun exposure". J Clin Endocrinol Metab. june 2007 -> Study done in Hawaii, 50% of people studied were deficient in vitamin D.

They have low vitamin D because they are avoiding UV by not going out in the sun or wearing sunscreen. In Hawaii it takes whites only 10-15 minutes sun exposure a day on the arms and face to get 10,000iu of vitamin D.

Bris said...

Any thoughts on this study?

The survival advantage of milk and dairy consumption: an overview of evidence from cohort studies of vascular diseases, diabetes and cancer.


Meta-analyses are extremely hard to extract meaningful information from.

Robert Andrew Brown said...

Bris said

"They have low vitamin D because they are avoiding UV by not going out in the sun or wearing sunscreen."

Not in this trial (-:

"Subjects older than 18 yr were recruited approximately equally from the University of Hawaii at Manoa (UH) and from patrons of the A’ala Park Board Shop, Honolulu, Hawaii . . . Volunteers were required to have self-reported sun exposure of 3 or more hours per day on 5 or more days per week for at least the preceding 3 months, and not to be currently taking phenobarbital, phenytoin, or prednisone."


Does sea water wash off / inhibit vit D?


Thank you for being more specific on your position on Carbs.

Robert Andrew Brown said...

Bris said

"Milk contains beta casein protein which is highly inflammatory. If a "leaky gut" is present it can enter the blood provoking immune reaction. Cheese making denatures beta casein as does prolonged boiling and yoghurt making. Butter has almost no casein and cream has less than 1/10th as much protein as milk. Skim milk use is associated with increased heart attacks as it has more protein."

Thank you for flagging up casein and where it si found.

Ashu said...

Bris,

Do you have any real, conclusive evidence to the harmful effects of Milk (or beta-casein)?

When I say that, I don't mean epidemiological studies, I mean controlled clinical studies in humans.

Epidemiological Studies are great and all but they don't allow one to make a causative claim about something all by their lonesome.

Loren Cordain and Michael Mann's opinions are pretty sweet too, it's just that their opinions are backed by epidemiological studies, so they're pretty much inherently flawed opinions.

Lastly, you mention that the Masai have a high Milk consumption and severe atherosclerosis, you must know Mann's studies were not the only one on the arteries of the Masai, their have been others if I'm not mistaken and those ones found little to no plaque inside their arteries.

Yet, they most likely had the same degree of milk consumption (it's a big part of any Masai's diet.)

It's premature to just come out and say one should avoid dairy to avoid IHD, their isn't any good evidence of the matter whatsoever.

Adolfo David said...

BRIS,

ONE MINUTE OF SUN EXPOSURSE WITH NO UVA-UVB PROTECTION RESULT IN SKIN DAMAGE. No one honest dermatologist could say the opposite.

Nobody should be exposed to sunlight with no UVA UVB protection all days of year.

American Academy of Dermatology recommends taking vitamin D3 supplements.

Every skin and health conscious people should do the same.

Adolfo David said...
This comment has been removed by the author.
Adolfo David said...

Bris,

"Low vitamin D status despite abundant sun exposure". J Clin Endocrinol Metab. june 2007

The 93 participants in the study spent an average 22.4 hours per week outside without sunscreen and 28.9 hours per week outside with and without sunscreen. This translates to a mean of 11.1 hours per week of total body skin exposure with no sunscreen used, the authors calculate.


http://www.asiaone.com/Health/News/Story/A1Story20070703-17005.html

Anyway, any sun exposure damages skin

LeenaS said...

And, as for the Japanese and vegetable oils, the consumption has increased fourfould in 40 years, according to FAO

In 1961: 9 grams total ov veg. oils
In 2001: 39 grams...

Stephan Guyenet said...

Bris,

The extraction rate determines the amount of bran left in the refined grain, that's the whole point. 90% extraction was the norm in the UK until the early part of the 20th C. 90% contains more than twice the bran of 80% or 70%, which was (and still is) the subsequent standard extraction rate. Robert McCarrison showed that the extraction rate of white rice has a profound effect on the health of several experimental animals.

The commentary you quoted on the Lyon trial was written by the AHA. The AHA was pissed about Lyon for two main reasons. a) it put another fat nail in the coffin of the "prudent diet", which they had been promoting for decades, and b) it showed that reducing omega-6 is part of an effective strategy for preventing cardiac death, which is the opposite of their position.

The study's size was not a problem, it was obviously big enough to detect a highly significant difference. If diet wasn't responsible for the 77% reduction in cardiac mortality and 70% reduction in total mortality, would you like to give us an alternative hypothesis? Maybe the intervention group all decided to start jogging 3 miles a day without telling the investigators? Or maybe they all spontaneously evolved genetic resistance to heart attacks?

George Mann did not think milk caused atherosclerosis or heart attacks in the Masai. The abstract of that article is misleading. If you read the full text, he clearly states that neither genetics nor fatty milk had anything to do with the atherosclerosis he observed. Besides, none of them were having MIs regardless of atherosclerosis.

A1 milk is only correlated with CHD in international "ecological" comparisons. When you look at individuals within a country, milk (including whole milk) has most often been associated with lower rates of heart attack and stroke. I think the international association is likely to be spurious, although I agree it's striking to look at. It's probably a marker of something else, like an industrialized food system. Holsteins (A1) are the most productive breed. They make tons of watery milk that's generally adopted in industrialized food systems because it's the cheapest to produce.

Robert Andrew Brown said...
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Robert Andrew Brown said...
This comment has been removed by the author.
Adolfo David said...
This comment has been removed by the author.
Adolfo David said...

I work as journalist on health/nutrition and cosmetic dermatology, so understand I cannot approve sun exposure with no sun protection. Some conditions as psoriasis, although, can improve with some limited sun exposure.

There are great anti-UVA ingredients, here in Europe we europeans can enjoy the best anti-UVA ingredients in the world, like Tinosorb M, Tinosorb S and Mexoryl XL. In USA Mexoryl SX (or ecamsule) from Loreal group is great, and its fine an avobenzone formula well stabilized. Zinc Oxide is a worldwide excellent UVA UVB blocker. You americans can buy in internet european sunscreens.

Probably, two best antiUVA (and at the same time antiUVB) agents are Tinosorb M and Zinc Oxide.

Robert Andrew Brown said...

Adolpho David and not me said "ONE MINUTE OF SUN EXPOSURSE WITH NO UVA-UVB PROTECTION RESULT IN SKIN DAMAGE. No one honest dermatologist could say the opposite."

Most sunscreens offer every little UVA protection and block UVB which is needed to make vitamin D.

Living is damaging to health.

Sunshine is needed to make vitamin D.

There is a valid argument to be had if we should get vit D by supplementation or skin exposure, but exposure with sunscreen that bock UVB and not UVA is some argue is much worse in health risk terms than no sun screen and modest planned exposure for the vitamin D benifit.

Please find below some excellent videos from the University of California that make a thought-provoking case that many are vitamin D deficient, and vitamin deficiency is having significant negative health consequences.

I also include a link to another board where there have been discussions on vitamin D.

Vitamin D Prevents Cancer: Is It True?
http://www.uctv.tv/search-details.aspx?showID=16940


Skin Cancer/Sunscreen - the Dilemma
http://www.uctv.tv/search-details.aspx?showID=15770


Dose-Response of Vitamin D and a Mechanism for Cancer Prevention
http://www.uctv.tv/search-details.aspx?showID=15767


Vitamin D & Cardiovascular Disease- New Frontiers for Prevention
http://www.uctv.tv/search-details.aspx?showID=15772

http://her2support.org/vbulletin/showthread.php?t=40695

Adolfo David said...

It would be interesting to talk about best possible nutritional and natural approaches against H1N1. Which foods and supplements you feel valuable against H1N1?

Bris said...

The extraction rate determines the amount of bran left in the refined grain, that's the whole point. 90% extraction was the norm in the UK until the early part of the 20th C. 90% contains more than twice the bran of 80% or 70%, which was (and still is) the subsequent standard extraction rate. Robert McCarrison showed that the extraction rate of white rice has a profound effect on the health of several experimental animals.

I suggest you don't take opinions on face value.

I am trained as a food scientist and have worked extensively in the food processing industry. The millers always tried to maximise profits by using as much worthless bran as possible. But the bakers always further processed flour by sifting to remove the bran before use. This occurred in both commercial and home situations. Wholegrain flour was considered a mark of poverty in the English speaking world.

The cause of the animal deaths was most likely due to B group vitamin deficiencies. The animals would have developed pellagra, beri beri and pernicious anaemia. This occurred in the Japanese prisoner of war camps during WW2 because the prisoners were fed on white rice. The medical staff solved the problem by growing yeasts which provided high levels of B group vitamins.

Pellagra was very common in the US South before WW2 because many poor people lived mainly on refined maize flour. This is the origin of the term "redneck" because pellagra causes the skin to crack and redden.

It is far more likely that a lack of B group vitamins in the white rice that causes the problems rather than "refinement". It was well understood in the 1920s that simply supplementing refined flour with B group vitamins solved most of the problems. This is why the Marmite and Vegemite yeast extracts were developed.

Stephan Guyenet said...

Bris,

You said "I suggest you don't take opinions on face value." I'm not quite sure whose opinions you're referring to here, but I'll be sure to keep that in mind as I read your comments.

I went back to look at the data on extraction rate and bran content, as presented in "The Saccharine Disease" by T. L. Cleave. What I said in my last comment about milling wasn't totally correct. 80% extraction was the norm in the UK until the introduction of steel roller mills in the 1880s. Subsequently, the standard became 70%, which contains roughly half the bran of 80%.

About McCarrison's findings: yes, it was due to the B vitamins. That's exactly the point. Bran contains nutrients.

Bris said...

The commentary you quoted on the Lyon trial was written by the AHA. The AHA was pissed about Lyon for two main reasons. a) it put another fat nail in the coffin of the "prudent diet", which they had been promoting for decades, and b) it showed that reducing omega-6 is part of an effective strategy for preventing cardiac death, which is the opposite of their position.

This just a nonsensical conspiracy theory position.

The AHA (and most cardiologists) strongly support aspects of Mediterranean Diet so they would be vigorously promoting the Lyon Heart Study if they thought it was was supported by hard evidence.

The AHA states:

The incidence of heart disease in Mediterranean countries is lower than in the United States. Death rates are lower, too. But this may not be entirely due to the diet. Lifestyle factors (such as more physical activity and extended social support systems) may also play a part.

http://www.americanheart.org/presenter.jhtml?identifier=4644

The AHA actually said the results seemed impressive on initial examination. They then went on to state clearly why the methodology was deeply flawed.

Uffe Ravnskov has done a thorough dissection of the Mediterranean Diet science and shown that there is little evidence it prevents heart attacks. On Capri heart attacks are 6x as high as on Crete despite virtually identical diets. Even Artemis Simopolous (born on Crete) has said that the Mediterranean Diet no longer seems to as protective in the context of the modern Greek lifestyle. Australian studies have shown that the that a Lyon-style Mediterranean Diet seems far less effective in an Australian context (there are 300,000 Greek-born immigrants in Melbourne).

It seems to me that everything that agrees with your opinion is first rate science. However anything you disagree with is always dismissed as worthless epidemiology, a conspiracy by the medical profession or sloppy record keeping.

You seem to rate the work of Weston Price as gospel. Price was driven out of the dental profession because he was considered an utter lunatic prone to ranting diatribes against root canals. Several medical experts have carefully dissected Price's work and have shown that many of his conclusions are just plain wrong. In particular Price selectively used data (like Keys) that supported his arguments and ignored that which didn't (eg high rates of iodine deficiency and malnutrition in alpine Switzerland).

The Weston Price Foundation has some particularly bizarre views such as Sally Fallon promoting raw milk and "traditional" diets. This is despite the overwhelming evidence that consuming unpasteurised milk is potentially extremely risky (and justifiably banned in most developed countries). Nutritional deficiencies (pellagra, rickets, goitres etc) and even malnutrition were common in western nations on "traditional" diets until the 1920s when fortified processed foods became widespread

There is an extremely scholarly book called the 'Paleopathology of Australian Aborigines' (http://www.amazon.com/Palaeopathology-Aboriginal-Australians-Hunter-Gatherer-Continent/dp/0521460441#reader). I have read this book in it's entirety. It is a very detailed academic examination of health of first-contact totally traditional aborigines in the early 1900s in Australia. These Aborigines are shown to have many very serious health problems including malnutrition, serious infectious, parasite-borne diseases and many traumatic injuries. Their health was nothing like that glowingly described by price.

Barry Groves one of the Weston Price Foundation directors thinks that tobacco is harmless and that very high UV exposure doesn't cause cataracts or skin cancer despite overwhelming evidence to the contrary.

Bris said...

About McCarrison's findings: yes, it was due to the B vitamins. That's exactly the point. Bran contains nutrients.

You are just shifting the goalposts. You claim is is "refined" carbohydrates that cause disease. In fact the problem is vitamin deficiencies which is a totally different issue.

Rath has argued that simply providing a daily multivitamin (without any other dietary changes) would solve most of the world's health problems.

The Okinawans eat a lot of refined carbohydrate but get plenty of vitaminns.

Kurt G. Harris MD said...

Bris

Your comments and attacks are becoming tiresome, especially as fact checking continues to show you are misunderstanding or misrepresenting your own references.

It is time for you to start your own blog.

I suggest: "Its all in the genes and every demic group is genetically distinct enough to explain everything we observe" - or something like that.

Stephan Guyenet said...

Bris,

I agree with Kurt, I think you're just here to be a contrarian and it's getting old. Why do you bother hanging out on this nutrition blog if you think nutrition is irrelevant? Someone with your intimidating qualifications should surely have something better to do with his/her time. You have a million different explanations for findings that could be explained by one factor-- diet.

I'm not shifting the goalposts on refined carbs, that was my position all along-- it's all about the nutrients. Don't pigeonhole me without having read my posts.

You said "Several medical experts have carefully dissected Price's work and have shown that many of his conclusions are just plain wrong." OK, you're going to have to back that one up, buddy. I've done quite a bit of reading in the medical anthropology literature (much of which I've written about on this blog if you care to have a look) and I can tell you unequivocally that the dental changes Price described were accurate. They are continuing to this day in cultures adopting Western food. See this post:

http://wholehealthsource.blogspot.com/2009/01/tokelau-island-migrant-study-dental.html

As a matter of fact, Price gets cited fairly often in the dental anthropology lit by such authors as Drs. Robert Corruccini and Edward Hunt (because Price published in high-impact peer-reviewed journals such as JAMA and JADA, and was editor of the Dental Cosmos for years) so maybe you should re-evaluate your opinion of these so-called experts that have "dissected" Price's work.

Anyway, this is more words than I wanted to write to convey my message, which is: piss off. I'm perfectly fine with people disagreeing with me and other commenters. What I don't tolerate is big egos or science abusers. You've been warned.

Robert Andrew Brown said...
This comment has been removed by the author.
Robert Andrew Brown said...

And just in case anybody is about to claim that UC TV is some crackpot broadcaster;


http://www.uctv.tv/about/

"Launched in January 2000, University of California Television (UCTV) is a non-commercial channel featuring 24/7 programming from throughout the University of California, the nation’s premier research university made up of ten campuses, three national labs and affiliated institutions."



Vitamin D Prevents Cancer: Is It True?
http://www.uctv.tv/search-details.aspx?showID=16940


Skin Cancer/Sunscreen - the Dilemma
http://www.uctv.tv/search-details.aspx?showID=15770


Dose-Response of Vitamin D and a Mechanism for Cancer Prevention
http://www.uctv.tv/search-details.aspx?showID=15767

August 17, 2009 10:39 PM
Delete

Colldén said...

Bris

I was wondering, since you accredit so many of our modern health problems to a lack of physical activity: What do you think about the reports now emerging from all over the westernized world, about blue collar workers consistently having the poorest health and being the most overweight, in spite of their physically demanding professions?

gunther gatherer said...

Bris,

Though you say you eat a high fat diet, you sound suspiciously like a shill for many mainstream industrial food producers. Your arguments are just as biased, lopsided and roundabout as theirs and you interpret data in a very similar way. You're attempt to get us to believe we can't change through diet and that industrial civilisation is not at fault for modern disease epidemics sounds as if you were pushing a product. So, are you?

And your assertions against Sally Fallon and unpasteurised milk are once again unfounded. Where's your evidence that consuming unpasteurised milk, which the Masai and the Swiss have been doing every day for thousands of years, is "potentially extremely risky"? You yourself said Crohne's was caused by a bacterial infection in milk. Why do no hunter gatherers, exposed to 100 times more bacteria than we in the modern world, have no Crohne's?

Honestly, are you some kind of government worker paid to go on blogs to distract and divert discussion, refute hard evidence, and discredit independent researchers like Stephen by hijacking the comments using fake and misinterpreted information perhaps?

I don't know you, but I think anyone with the kind of training and time you seem to have would be doing something else if he weren't being paid or didn't have some lucrative incentive.

Mikael said...

I am bewildered that anyone would claim the diet on Capri, which essentially is like a small Disneyland and, is the same as the traditional diet of Crete or even the diet consumed in Crete today.

Those questioning the importance of the diet in the Mediterranean context could perhaps have a look at the Maltese islands. I would say that it is fits perfectly in the diet causes disease hypothesis.

The health of the Maltese is deteriorating. As was seen already in the early 1980s mortality from cardiovascular disease was rising. http://www.ncbi.nlm.nih.gov/pubmed/6697418

Today, the Maltese have some of the highest rates for obesity and diabetes is Europe. Frankly when you walk around in Malta, you will at times think you are in the United States. A large number of the diseases we discuss here are rapidly increasing.

What happened? It is simple, the Maltese gradually started to eat mainly English food and fast food. The Maltese eat a lot of refined carbohydrates, such as sugar and wheat and a lot of vegetable oils.

Local animal produce is basically only of inferior industrial quality. For example, pastured eggs are not possible to obtain, because keeping life stock outside is basically illegal. Long ago there was probably a good food culture in Malta when they still ate snails, rabbits and fish, but today that is mostly gone. Some traditional dishes are still consumed but the bulk of the food today I would say is based on refined carbohydrates and vegetable oils. The contrasts when comparing with France are staggering. It is enough to walk into a supermarket in Malta and compare it with a supermarket in France. Just one anecdote, marrowbones are sold everywhere in France and they are not in the “for pets” section. If you ask for marrowbones in Malta, they ask you if it is for you dog. Only in Malta will they on the fishmarket sell frozen fish.

The pace in Malta is still very much laidback and relax. People don’t stress. I would say there are few Mediterranean places left like Malta in that sense. It is little industrialized but has some of the best healthcare in Europe despite low per capita income.

That lack of exercise would play any role is highly unlikely. I cannot think of any Mediterranean city where you can see so many fat (or non fat for that matter) people exercising as in Malta, although it seems with no avail.

Also, Malta would prove wrong the genetics causes disease hypothesis. Otherwise the health of the Maltese would not deteriorate from their diet changes. It is rare that the Maltese marry foreigners and it has always been the case.

For me, Malta is the perfect real life case that changes in diet to more refined carbohydrates and vegetable oils result in poorer health.

Despite being convinced that Stephen is right, I am as I think Melchior mentioned, tortured by the wheat consumption in France. By early 1900 the French ate approx 900 grams of bread per person and day. Yes you read right, almost a kilo of bread a head per day. Sure that is not dry weight, but still.

jacob said...

My two pence -I don't see what the point of comments are if they're just to say 'great job, I agree with everything'. Knowledge emerges through debate. If you forcibly eject people from a discussion - even if they have an oppositional stance - it makes your arguments seem weaker - even if they are in fact closer to the truth.

What if above a certain baseline, nutrients are irrelevant, and only calories count? Wouldn't this explain traditional Asian diets high in refined rice, the French eating baguettes along with their butter, cheese, meat, and the possibility for small amounts of white sugar in the diet without producing the negative effects associated with its overuse displacing essential nutrients? Might not an otherwise healthy Japanese person actually reduce their health by switching from white to brown - the additional fiber, antinutrients, etc. making digestion less efficient? Obviously, if a diet is low in micronutrients, the additional nutrition provided by unrefined grains (properly prepared) is important and useful. But it isn't necessarily.

Jacqueline said...

Hi everyone,
Bris does have a blog:

http://modernhg.blogspot.com/

gunther gatherer said...

That blog was strangely begun two days ago. It has 3 posts, none of which are as near to fully written as his comments here.

Seed oil manufacturer association?

Sugar industry?

Which would pay a medical professional to go on natural health and diet blogs in order to distract discussion with scientific-sounding jargon with essentially no substance...?

Melchior Meijer said...

Mikael,

A very compelling (and sad) observation. I agree that diet is almost certainly the main problem here. Just out of curiosity: has anything changed on Malta regarding social structures (work, family ties, the sense of playing a role as an individual)? I can hardly imagine it from what you already described, but one has to ask.

Jacob,

Energy intake is a massive confounder and it’s almost always massively overlooked; agree. Unlike Bris, I think it’s silly to assume that humans would react less favorable on mild energy restriction than most other organisms. But if you blame calories, the question remains: what causes people to overeat? Apart from the mechanisms proposed by Gary Taubes, I would suggest overexposure to wheat and fructose. Both induce leptin resistance.

As to your question for refs re milk versus cheese: I will look it up in my Lindeberg later (the guy has written a phenomenal textbook).

pelotkin said...

Bris said:
"...I am trained as a food scientist and have worked extensively in the food processing industry..."

Now, I love being a contrarian myself. Almost the only time I bother posting on blogs at all is when I don't agree with something. But here is the guy who worked as a scientist for industrial food makers and his message is basically this: what you eat doesn't matter much, food is not a big issue. Just don't stress, exercise more, and it's all in your genes anyway (translation: you CAN’T change it). Carbs are fine, even refined carbs (that is sugar and HFCS), meaning basically that the official food pyramid based on grains and carbs is just what the (big pharma) doctor ordered. And if you do develop one of those pesky "diseases of civilization" - just go pop a multivitamin and you'll be fine. Am I forgetting anything? Oh yes, here is another one: whatever you guys discussing doesn’t even matter in the long run, because basically you are choosing slow and painful death from cancer (or something like that) over a quick and merciful death from a massive heart attack. And here is the kicker: no matter what you guys do is going to change your life span! So let’s see: live the same number of years and 1) die quickly or 2) die slowly and painfully, what’s YOUR choice?!

And just to confirm his paleo HG credentials - MILK IS VERY BAD, especially raw milk (milk, not sugar). No industrial food scientist was involved in making raw whole milk, so drink at your own risk.

I mean c’mon.

Ashu said...

I don't see what's the problem here.

Like Jacob said, what's the point of having this blog if all you want is people to comment and say great job?

Ejecting Bris, attacking him with ad-hominems, making dumb conspiracies about some group hiring him, just throwing away his argument for no good reason -- just because you don't agree/want to agree with it.

It makes your arguments look pretty weak, again like Jacob said.

Why would you get mad at the guy for arguing in this comment section when this post was kinda aimed at some of the stuff he was saying in a recent post's comment section?

I say let him be, if this truly is supposed to be the "Whole Health Source" than Stephan shouldn't mind the arguments Bris faces him with, he should be able to refute them, clearly and concisely without banning him from the debate and without other users attacking Bris.

Seth said...

I'd suggest addresing Bris' arguments not his possible unproven affiliations with the food industry. On the other hand Bris' posts do have an aggressive "feel" to them.

gunther gatherer said...

Ashu, you are not reading his comments carefully enough. They are a thinly disguised "gluttony and sloth" accusation as to why people are sick and fat. He covers them in technical jargon and unrelated data to throw you off.

I cured too many ailments (one of them a diagnosis of MS) by simply changing diet to go back now. It's important to "out" these guys when you see them, whether they are paid or not.

jacob said...

"I will readily accept that dietary changes may improve your health. But there is far less evidence that they will make you live longer." - Bris

mess talker said...

Wow. Like a train wreck. Can't stop reading even though I should just ignore the Bris. The only remark I'm somewhat qualified to make is in regards to Bris' comment on cyclists with high carb diets being extremely healthy. These guys fear a slight breeze at night for fear of getting sick. They're very hard men on the bike but fragile in all situations. Team Garmin is the first team to my knowledge to train the guys to ride on fat more than carbs and have had luck getting guys with chronic inflammation to have good seasons. Otherwise, these guys fall prey to illness on a regular basis.
Thanks Stephan for the great blog.

Stephan Guyenet said...

Jacob and Ashu,

I've never kicked anyone off the blog for disagreeing with me, not once. There is only one rule here, and that is to be polite. If you've been around for a while you know I've had polite discussions with people who have alternative viewpoints on a number of occasions.

Bris was dominating the comments section with his/her rapid-fire, self-contradictory, superficially thought-out comments and was bullying other commenters. Bris was here simply for the sport of having an argument. It was reducing the quality of the blog and getting on peoples' nerves. It's a waste of everyone's time.

Kurt G. Harris MD said...

I've seen this happen before. It's like having a nice restaurant

A disruptive diner, perhaps a little drunk and belligerent, starts to come in regularly. The new patron is loud and obnoxious. The other patrons have a variety of conversations but in general can't have a good time because of the racket.

A some point, the restaurant (domain) owner may decide he cares enough about his regular well-behaved patrons, and his restaurant, to ask the disruptive new customer to find another restaurant.

Even if Bris is not an industry shill, the fact that his arguments could plausibly be taken for one is meaningful.

Ashu said...

Stephan,

I agree, Bris did get out of hand by attacking/insulting the members (even though they are doing the same of him).

Can't we just focus on the arguments however? No need for silly analogies, Kurt.

We should all stop insulting people and argue our side to the best of our ability, not get frustrated when we can't properly refute the opponent's argument and resort to personal attacks and insults (this goes for everyone, because everyone/the majority of people here are doing it).

theoddbod said...

I must say I do love the debates going on, very passionate all around!
I think having commenters like Bris are important, for a site such as this because it means that you are reaching more people other than those of us with more or less the same viewpoint. It's much easier to "preach to the converted" than someone who has a totally different point-of-view. I think it's fantastic that a food-industry "big-shot" is this interested and dare I say scared of your fantastic research and ability to interpret the literature. These are the types of people that need to be convinced if there is to be continued progress in emphasizing the effect of food on health vs. simply bad genes and pills.
keep on keepin' on

LeenaS said...

Like Kurt, I've been in situations like this many enough times, too.

Polite answers and patient argumentation, time after time, does not really work when the one addressed never replies on factual correctons of his/her own ungrounded opinions (should someone point such an unthinkable thing out, as has happened here), but keeps on repeating his/her own opinion without listening at all. Real discussion means respect for others, and respect for facts. Without this nothing evolves.

Bris may have his reasons for opinions so solid that he/she could no longer listen any facts against them? That is not a big surprise in nutritional issues. Yet this takes away all grounds for meaningul discussion, too.

But then again, he can now be asked directly at his own blog, by anyone.

Kurt G. Harris MD said...

Ashu

You may think its silly - I can assure you it is apt.

When I go to blog that has an uninvited attack dog with an incoherent message, I usually leave until they go away. Other busy people do the same.

It's Stephan's domain so I support him either way

Stephan Guyenet said...

Ashu,

I'm open to discussing Bris's arguments in a civilized manner. Is there anything in particular you're interested in?

Senta said...

Stephan said:

"Bris was dominating the comments section with his/her rapid-fire, self-contradictory, superficially thought-out comments and was bullying other commenters. Bris was here simply for the sport of having an argument. It was reducing the quality of the blog and getting on peoples' nerves. It's a waste of everyone's time."

I wholeheartedly agree. It's one thing to have a civil disagreement, it's another to have to constantly refute someone who keeps moving the goal posts, has internally inconsistent arguments and is also rude. At first I was interested in Bris' posts but eventually I began skipping over them.

I've been reading this blog long enough to know that Stephan does not ban people for disagreeing with him. He spends an inordinate amount of time in intelligent, well-referenced, polite debate. He has every right to expect his commenters to behave in the same manner.

Jenny Light said...

Stephan:

I just want to thank you for showing Bris the door.

It is rather an easy thing to refute any theory posed here (or anywhere) by examining medical literature, the Internet, or heck, even Steven King's latest novel, and then cutting and pasting an excerpt (out of context) here. The result is, that you either come off sounding like an idiot, or a prophet (and everyone will have a different opinion).

Your blog is right at the top of my list of required reading on a daily basis! Reading non-stop commentary from one individual who seems to be making a sport out of refuting everything that is said by you or others is downright tiresome and should not have to be tolerated!

Bravo Stephan, and please keep up the excellent work!

Dave Moss said...

For what it's worth I was quite enjoying reading the interchange between Bris, Stephan et al, but that's largely because the topics that've been raised on this blog have been so interesting.

"I'm open to discussing Bris's arguments in a civilized manner. Is there anything in particular you're interested in?"

This topic isn't exclusively a Brisism, but it has been raised in this thread and I've been interested in hearing your thoughts on it for a while (indeed I think you mentioned that you needed to address it before)... Anyway I've been waiting for a while for the dairy (and especially casein) question to be covered. Obviously the masai seem to suggest that it's not a complete disaster, but there seem plenty of reasons for suspecting that it might be sub-optimal, so I'd love to hear a Stephanly dissection of the subtleties. (Still I can't complain given the fascinating other topics covered of late!)

P.S. Also thanks for the blog and keep up the good work etc. (I read every update avidly, but only comment every now and again since filling up the comments with "and another superlative post!" seems gratuitous.)

gunther gatherer said...

Stephen,

I second Dave Moss regarding casein, its different types and any questionable effects thereof. Nothing to do with "catching MS or Crohne's" from milk. :-) Just the issue of whether A1 milk protein actually would be harmful in an otherwise healthy gut (read, no gluten).

Also I'd be interested in your thoughts on whether fermentation is a way of making milk more bio-available, if modern pasteurisation alters milk proteins to make them harmful or able to pass the gut wall, and how you feel about Cordain's assertion that milk is an allergen whose ingestion actually lowers calcium levels as opposed to raising them.

Robert Andrew Brown said...

Bris posts are a mix between challenging thought provoking and trying to pin down a hyper rabbit.

I found this while wondering how Pygmies fared. A quick skim did not help but physical size and the risk of disease is clearly a serious topic.

Human body size and the laws of scaling: physiological, performance, growth ...
By Thomas T. Samaras

http://books.google.com/books?id=PCU0RwDI6c4C&pg=PA90&lpg=PA90&dq=okinawans+height&source=bl&ots=sxYF0jF4Xg&sig=ow9tbPOyofGynzEDM0t7_NcirXI&hl=en&ei=UdeKSrm2EuOgjAeX3OxX&sa=X&oi=book_result&ct=result&resnum=9#v=onepage&q=okinawans%20height&f=false

Adam Wilk said...

Stephan,
I 'third' Dave and Gunther's request--this dairy thing is making me nervous, and to hear the 'dangers' or 'benefits' of consuming milk, cheeses, and other dairy products explained by you would definitely help me sleep better at night, I remember reading one of your brilliant posts regarding vitamin K2 and its benefits with regard to heart disease--I'm clinging to your every word here!
Great stuff.
-Adam

Carl M. said...

I was enjoying the controversy, though I admit Bris was weaving and dodging a bit -- and being rude.

But for controversy, how about this article which I found when browsing around the paleosphere:

http://www.diseaseproof.com/archives/diet-myths-the-misinformation-of-barry-groves-and-weston-price.html

What struck me the strongest was this quote:

"When Barry Groves and the Weston Price Foundation people listed above rest their laurels on the health of high meat eating tribes, we have to counter that with real research, not phony claims. The research on the life expectancy of these people is clear. The Inuit Greenlanders have the worst longevity statistics in North America. A careful literature search reveals multiple studies documenting an earlier death in these people as a result of their low consumption of fresh produce and their high consumption of meat. "

And this one:

"Similar statistics are available about the Maasai in Kenya. The Maasai are best distinguished by their jewelry and ornamentation in their "self-deformation" of the body: elongated or torn ear lobes and stretched out lips. They do eat a diet rich in wild hunted meats and have the worst life expectancy in the modern world today. Maasai women have a life expectancy of 45 years, and men only live 42 years. I know these red-meat loving nuts will claim that those statistics are of the modern Maasai, not those of years gone by, but the data is also damaging even if you bring up statistics from 20 or more years ago, when good data was collected. Real African researchers, not Weston Price who just briefly visited them, or the list of Groves' Weston Price Foundation compatriots, documented that a Maasai rarely lived past the age of 60 and when they did, they were considered a very old man."

On the other hand, I wonder about the Mediterranean diet as well. I had a once-vegetarian friend who had to give it up when she went to live in Greece for a time. In Greece, vegetarianism was not a viable option.

Chandler said...

Carl M.,

"But for controversy, how about this article which I found when browsing around the paleosphere"

Although I don't know much for the Masai, I do know that the diseaseproof site also hosts an excellent back-and-forth between Dr Furhman and Chris Masterjohn as Chris details what is and isn't known about Inuit longevity.

You can find it here; just make sure to read down into the comments.

darnoconrad said...

pelotkin; great summary!

I'm glad the blog is back on track.

To add to the milk topic; I drink fine filtered milk.

"Pasteurization works by heating milk to a specific temperature for a set period of time. The most common method of pasteurization in Ontario consists of raising milk temperature very rapidly to at least 72oC for not less than 16 seconds, followed by rapid cooling."

"To maximize its freshness, Natrel Fine-filtered milk undergoes the process of microfiltration. Here milk is forced through an incredibly fine filter that removes most of the bacteria that regular pasteurization can not. This specially designed filter allows all of the natural protein, vitamins and minerals to pass through ensuring that Natrel Fine-filtered milk retains all of its original nutritional goodness.After the microfiltration process the milk is then pasteurized and filled into sanitized packaging. Because over 99% of the natural bacteria is removed, microfiltered milk enjoys a richer, creamier taste that stays fresh longer than regular pasteurized milks."

I've drank milk all my life, then when I was about 18 I started to have periods where I could not drink the regular milk (Toilet Trip!) which would disappear and re-appear seeemingly randomly. But then I discovered the fine filtered milk and have never had the problem re-occure.

Stephan Guyenet said...

Mikael,

Thanks for the information.

Dave,

Here's my opinion on dairy. I think it's still an open question (for me personally and in general). Non-human dairy is not "paleo", so for that reason it needs to be examined as potentially problematic. Casein is the second-most common allergen, right after gluten, and I know a number of people who tolerate cow's milk products poorly. On the flipside, dairy, especially pastured dairy, is an exceptionally nutritious food that fills some important gaps in the modern diet (particularly vitamin K2).

I read the original study correlating A1 milk with international heart attack deaths, and the correlation is indeed striking (at least in the countries considered). But when you consider observational studies that have been done within countries on an individual person level, dairy is most often protective against heart attacks, regardless of fat content. So this presents a paradox. There are two ways to resolve it. One is to say that the reason the individual level observational studies couldn't detect an effect is because everyone was eating dairy to some degree, and the required amount for toxicity is very low. The other way to resolve the paradox is to say that A1 milk is simply a marker of an industrial food system, because Holstein cows are A1 and they make the largest quantity of watery milk so they're used in most industrial food systems (except parts of France). The Masai drink A2 milk.

I favor the latter explanation, and in any case you can circumvent the potential problems with dairy protein by eating butter. My best guess is that dairy is generally healthy if tolerated, but many people do better without it.

As far as the other issues with milk, pasteurization etc. It's probably mainly an issue because it destroys enzymes such as lactase that aid in its digestion.

Gunther,

I do think fermenting milk makes it more digestible, particularly if it's been pasteurized. The bacteria add lactase back and break down some of the lactose. Milk is a common allergen, Cordain is right about that. He raises some potentially valid points about excessive calcium, but it's hard to take them too seriously if you drink milk for 20% of your calories or less. After all, the Masai were up to 100% in many cases and they didn't show any obvious signs of skeletal problems.

Stephan Guyenet said...

Carl,

Those people have a serious axe to grind. They call Price's claims phony, but they might be surprised to learn if they open a medical anthropology book that not only was Price right about the dental health of non-industrial people, he gets cited by other respected scientists in the literature. The authors of that post are totally ignoring Price's main point-- non-industrial people have good teeth-- which has been corroborated beyond a shadow of a doubt by dozens of independent investigators. They try to paint him as a crackpot, but crackpots don't get published repeatedly in JAMA and JADA.

Price didn't made claims about the longevity of the people he was studying, that attack is a complete straw man. What he said is that they're robust, healthy and they have good teeth.

Of course the traditional Inuit didn't have a long lifespan, they were hunter-gatherers in an extremely unforgiving environment. Near-vegetarian African agriculturalists didn't live any longer, in fact, in general agriculturalists had shorter lifespans than HGs when neither had access to modern medical care. I wonder if the authors of that post could explain to us why eating veggies and whole grains didn't make the African Bantu live to 110?

The authors of that article have totally missed the point, which is that non-industrial people are escaping chronic disease. Traditionally-living Inuit, although I don't consider their lifestyle/diet to be the paragon of health, had exceptionally low rates of overweight, diabetes and cancer. Modern-day partially modernized Inuit in Canada have the lowest heart attack death rate in the industrial world, much lower than Japan. Greenland Inuit, on an age-adjusted basis (same ages compared) had less than 1/10 the heart attacks, just over 1/10 the diabetes, and 1/20th the psoriasis of Danish people in the 70s (Acta Med Scand 208:401. 1980).

The same goes for the Masai. Yes, they were dying young, because they were getting infections, killing each other and having accidents. But they weren't dying of heart attacks, and there's no evidence that their diet was shortening their lives in any way.

If you actually look up statistics for the lifespan of the Inuit, you find that their maximum lifespan was similar to ours. The average was lower, yes, but yours would be too if you had a 10% chance per year of getting carried into the ocean on an ice floe. Here's a post I did on Inuit lifespan:

http://wholehealthsource.blogspot.com/2008/07/mortality-and-lifespan-of-inuit.html

The authors of that post are using misleading arguments and straw-man attacks rather than facing the facts head on.

Melchior Meijer said...

In 1916 a doctor Sippy introduced the Sippy diet for patients with ulcers: copious amounts of milk. From 1940 to 1959 they did unrandomized studies in the USA and in the UK, where they compared patients who were treated in 'Sippy diet hospitals' with patients who got the usual (non milk) care. The patients treated with the Sippy diet suffered far more myocardial infarctions than the patients who didn't have to drink milk.

The study is seldom cited, because it is theoretically possible that the patients in both groups were somehow different.

Milk is one of the most insulinotrophic foods there is. Not so good, or? The homogenisation thing (xantine oxidase being brought into the endothelium by extremely tiny fat globules) has been disproven, I believe, but still...

maxwell said...

Melchior,

Don't you think there were too many variables within the Sippy Diet to put the blame squarely on milk?

The Sippy diet consisted of measured amounts of milk and cream, farina cereal (a bland powdered cereal made from mixed roots and/or grains including wheat), and egg, taken at hourly intervals for a period of time. Patients were simultaneously treated with alkaline powders every half an hour. The powders were known as “Sippy powders” and consisted of sodium bicarbonate and calcium carbonate.

Further reading:

Diet lists of the Presbyterian hospital, New York city (1919) (Open full text and search for Sippy Diet)
http://www.archive.org/details/dietlistspresbyt00cartiala

ps. great blog Stephan! Long time reader first time poster :)

Melchior Meijer said...

Thanks Maxwell, for that info. I have no idea. Would it be the (maybe oxidized) egg powder?

LeenaS said...
This comment has been removed by the author.
LeenaS said...

Maxwell, fascinating document!

Melchior, where did you see powdered eggs?
The description of the Sippy diet is in Maxwell’s link, and it had no such things.

So, Sippy's was a fully vegetarian diet consisting mainly of cooked cereal (10 ounces a day) and cream-milk (10-30 ounces) while eliminating (sorry, neturalising) all stomachs acids with multiple alkaline treatments a day? And, according to the report, daily alkaline treatments and fully non-meat diet continued for up to one year, while the milk-cream was only for few weeks? Furthermore, there were only three daily eggs for protein supplementation.

Deliberately eliminating the acid defence of HCl in the stomach (that normally keeps the foreign invaders at bay) sounds scary, very scary.

I’m curious, though. Melchior, who claimed that the problems would be in milk, that every newborn sips rather similar amounts but for months - and definitely without excess alkalines or cereals??

Kind of sad and comical, at the same time.

Melchior Meijer said...

Leena,

No egg powder there indeed, sorry. Mixed things up. I just re-read the whole paper, which is free. The authors blame butter fat, but admit that association does not imply causation. They dismiss the possibility that changing stomach pH could affect cardiovascular outcomes.

LeenaS said...

@ Melchior

Oh dear :)

You must be referring to this very old 1964 article, written at the Keys prime time, when cholesterol and saturated fat just had to be guilty, one way or another? Anything was ok, including a vegetarian diet overloading people with antacids for up to 10 years. And even including a “Sibby diet” patients which were not treated according to Sibby diet rules.

http://www.ajcn.org/cgi/reprint/15/4/205

You cannot be serious – or can you? If so, there is an explanation much more viable and the writers actually do mention it. It has nothing to do with milk fats (or even vegetarism), both of which were part of the Sippy. You only need to look WHY the Sippy treatment was eventually abandoned.

William S. Haubrich tess us on Sippy and the Sippy diet:
“An ardent believer in Schwartz’ dictum (“No acid, no ulcer”), he promoted for the treatment of acute peptic ulcer disease a strict regimen of hourly milk and cream feedings supplemented by frequent, large doses of antacids and often by periodic gastric aspiration. A generation of physicians found this a highly effective means of hastening the healing of peptic ulcers. Unfortunately, the Sippy regimen did little to prevent ulcer recurrence, and Sippy’s program was later superceded by more efficacious therapy.”

... and the rest is in the paper that you have just read. See the connection?

Nope, it is not cholesterol or saturated fat, because literally hundreds of real clinical intervention tests have been made, and neither the cholesterol nor butterfat has been the villain. And I do not believe in vegetarism or grains either, although that would be tempting. But they do say that MI occurrence is higher for patients with chronic peptid ulcers – which seems to be a quite probable outcome for persons chronically on antacids. Or on Sippys diet sort of cure.

With regards, LeenaS

Melchior Meijer said...

Argh, must be the heat...

Forgot the link for a download:

http://circ.ahajournals.org/cgi/reprint/21/4/538

LeenaS said...

So it seems that Dr Hartroft was able to produce two publications out of the same data?

Not bad for productivity numbers.

Melchior Meijer said...

Leena,

I don't mean to imply anything at all, I just want to show that there is a study out there in which one group of patients with peptic ulcers gets more heart attacks than the other group. One of the main differences is milk intake. No idea how we have to interprete this. I don't suspect butter fat, of course ;-), although that ref to the rat study (also freely available) is interesting.

I'm pretty sure Stephan will help dissect this curious old thing when it starts to dawn overthere.

Best!

LeenaS said...

So you did not not get the point? Pity. The problem seems to lie in the Sippy treatment strategy itself. And it seems to be nicely confirmed by the ulcer mortality numbers given in both articles.

Btw, opposite to the claim by the authors, according to FAO data the English consumed more (not less) milk fat than the Americans at the time of these publications (1961, 1964).

Melchior Meijer said...

Sorry Leena, I’m probably missing something. Will look better later. In the mean time, this one is also strange:
http://www.ajcn.org/cgi/reprint/15/4/205.pdf. I always thought it was completely impossible to give a rat an MI without binding off it’s coronary arteries.

Carl M. said...

@Chandler: Thanks for the link. Those on the vegetable side of the Force are quite strident. We can safely rule out their diet conferring inner tranquility. Chris Masterjohn came to the debate much better prepared.

@Stephan: good to know Price was published in refereed journals along with his book. And good points about lifespan. I wish they would come up with a standardized measure of life expectancy which removed infant and child mortality, "adult life expectancy" or some such. It would make for easier comparisons of studies relating to degenerative diseases.

That said, shorter life expectancy could hide degenerative disease problems. Infections can cause later heart problems. Those who die of strep in childhood could be those more likely to have heart problems later. Or, possibly more correlated, those with clogged arteries might be more likely to die in battle or fall off the ice floe...In other words, age adjustment helps with the comparisons, but it might not be sufficient -- which is what keeps the debate interesting.

Stephan Guyenet said...

Carl,

Your point is well taken. Even an age-matched comparison is not perfect.

However, you would have to invoke a mechanism whereby people become much more susceptible to non-MI death before they have a heart attack. I'm not aware of any evidence that's the case.

These types of cross-cultural comparisons aren't good for detecting small differences because there are confounding variables. But when I see differences that are 100-fold or higher, it's going to raise my eyebrows.

Stephan Guyenet said...

Melchior,

I can't say I find the Sippy diet study very concerning regarding milk. There are so many variables, like chronically killing stomach acid. That could cause nutrient deficiencies and intestinal dysbiosis.

Several observational trials have found that dairy consumption is associated with lower rates of heart attack and stroke, regardless of fat content. Some of these have been conducted in the UK, where they drink A1 milk. It's just an association, but at the very least it isn't consistent with the idea that dairy is behind CHD.

Carl M. said...

@Stephan: re 100 fold differences, I most certainly agree. Just trying to keep the error bars wide open enough.

Part of my concern with going too far with the Omega 3 connection is I personally respond poorly to fish oil supplements save perhaps in quite small amounts. And I do experience significant improvements in endurance when I cut back on the saturated fats, especially dairy fats. (Cutting back on the Omega 6 seems to cause no problems, however.)

I wonder if the high 3/6 ratio advocated here isn't a sort of medicine for a different problem -- such as K2 deficiency. That is, high 3/6 repeatably slows clotting time, and this is certainly important if the arteries are getting gummed up. But I'd like to stop the gumming in the first place. TQM and all that.

Correct me if I am wrong, but I seem to recall that the Masai have significant gumming up of the arteries, but this is offset by alternate paths and the like from exercise. (And lack of MI from good 3/6 ratio, etc.)

(This is not to say the 6/3 ratio isn't way too high in the U.S. Only that going for the high 3/6 ratios of some of these outlier groups is perhaps overcompensation, with potential negative side-effects.)

Stephan Guyenet said...

Carl,

In an ideal world, there would be no need for omega-3 supplements because we would all be eating wild game and minimal seeds, except perhaps seasonally. The only reason I think omega-3 is helpful is it appears to restore fatty acid balance. If you eat nothing but grass-pastured ruminants and no foods containing vegetable oils, then there's probably no need or advantage to taking extra omega-3.

You aren't the first person to remark that they feel worse when they supplement with fish oil. High-dose supplementation is probably harmful in my opinion. I don't know how much you take, but my feeling is 1/2 teaspoon of fish/cod liver oil per day is enough, in the context of a healthy diet low in omega-6. Some people may not even tolerate that much, which is probably a sign to stop taking it.

The Masai do have significant atherosclerosis, but only after they start eating processed food, not while their diet is restricted to milk, meat and blood. Even when they adopt a partially modernized diet, they still don't have heart attacks, despite the atherosclerosis. I wrote about the Masai autopsy studies here:

http://wholehealthsource.blogspot.com/2008/06/masai-and-atherosclerosis.html

sandra said...

"Milk is one of the most insulinotrophic foods there is."

So could drinking milk lead to insulin resistence or other diseases that could be related to too much insulin (like cancer)? What about yogurt?

I've switched out the whole wheat zucchini muffins for full fat(mostly) grass-fed yogurt at snack time... is this pointless (or worse) if I'm only concerned with insulin?

David said...

I too think that dairy deserves further investigation. There are studies linking dairy to acne click. There is speculation that this may be caused by "bio-active" molecules. Is it possible for these "bio-active" molecules to mess with hormone balances in the human body click? Not everything looks bad about milk though click. This deserves a bit more honest research. It would be pity if milk turns out to be not as good as once thought because it's really a convenient food. And now that i've eliminated gluten (which is obviously an improvement since my acne has been reduced) i need my calories from somewhere (i'm a student on a student's budget ;)).
I hope you'll delve into this stephan! You've a great blog, keep up the good work, and thanks for the work already done, it has been appreciated!

Stephan Guyenet said...

David,

Cow's milk dairy gives me acne, there's no doubt about it. I've done the experiment roughly 10 times now. If I eat cheese, in the next day or two I'll get a couple of pimples. If I avoid all dairy, I rarely get acne.

jacob said...

Have you isolated variables, though? All cheese is not the same. Aged/fresh? Pasteurised? Would raw cheese give you acne? What are the ingredients in your cheese - I'm told people are often allergic either to additives, or to the purified enzymes and/or artificial molds used to curdle/culture modern cheese.

Another point is that perhaps if you kept eating the cheese, your acne would go away. Your body would adapt to the new nutrients. Might not this be a factor in the health of traditional peoples - that, regardless of whether they ate low or high fat, grains, dairy, whatever, they ate it consistently?

David said...

No Jacob, i ate very "healthy" for more than four years: mostly organic whole grain bread, whole milk (raw goat milk and fermented in kefir, homemade), butter and cheese (every day), a decent amount of fruit and vegetables (fresh), some nuts here and there and organic meat and eggs. Basically what the WAPF would recommend, but i still had acne during all these years, no adaptation even though my diet didn't change, i read "Nutrition and Physical degeneration" from W. A. Price and thought i was doing the best i could. Couple of months ago i noticed a slightly receding hair line (male pattern baldness) and that of course freaked me out because i'm only 24. So i figured out there must be something terribly wrong with my diet (i dont believe men are supposed to go bald from the age of 24), and I read some stuff here and there and eliminated gluten from my diet (now for 1 month), and i notice an improvement, but i'm still not clear and zits keep coming up (although at a slower rate). I noticed a great improvement in bowel movements: a reduction in quantity (both volume and frequency) and an increase in "quality". So the gluten free diet is a keeper for me.
The next thing i will eliminate is dairy because i suspect it to be a cause of both acne and baldness.
Now that i'm myself dealing with this problem, i notice it in a lot of other (young) people too. I searched the web for health guru's with hair, but there are not many health guru's with good hair (mercola for example blames it all on the carbs and grains, but the chinese eat a lot of grain (rice, although low in gluten still carbs) and dont go bald as much as we here in the west (btw, there was a study that male pattern baldness increased in japan after WW2, might it be because of the introduction of dairy?), and since mercola is now "grain free" for couple of years i think that he must have regrown some hair if grains were the cause (follicles dont die, i think they go into hibernation mode or something like that).
Weston Price himself was bald too (from the picture in his book), as is andrew weil and a lot of other diet preachers, vegetarian or not. Might dairy be the common denominater? I suspect so, but i'm not sure. I'll start dairy-free, gluten-free next week. Hopefully with results after couple of months. Anyway, i know that baldness concerns a lot of men, so i'll surely report it if i've got significant results.
Best regards,
David

sandra said...

How would dairy cause hair loss though...and wouldn't baldness be even more common?

I looked back at Stephan's charts on food trends and noted that milk consumption has been declining...for now I'm clinging to this in order to avoid associating milk with metabolic disturbances. I also wonder if pastured or raw dairy is different - esp full fat. I found one study that linked milk to elevated plasma insulin, but they used non-fat milk. I doubt any others have used full fat, cream line grass fed milk.

The higher quality pasturized milk may not have an effect on acne, but perhaps raw dairy would (less allergenic and more beneficial organisms?). Stephan, have you tested raw dairy and acne?

I'm curious to know where folks who don't consume much or any dairy get calcium...

PaleoRD said...

W. Price did report that the Australian Aboriginal population did not have hair loss. Also, most pictures of the African tribes in his book displayed shaved heads! Perhaps at this point, hair is no longer an essential element to human survival. Notice that most Asian and Native Americans races have little to no body hair. Perhaps the fact that hair is not important to human survival has allowed the genetic expression of baldness to flourish because there is no selective pressure against it?

Melchior Meijer said...

Sandra,

It's been well documented that milk is a potent insulin trigger. The whey fraction is responsible for most of this effect. The question is: how bad is this? Milk consumption certainly plays a role in acne, as explained on several places by Loren Cordain (you find most of his research on his website, thepaleodiet.com). Here are some other refs.

Hoppe C,Molgaard C,Vaag A,et al.,“High intakes of milk,but not meat,increase s-insulin and insulin resistance in 8-year-
old boys”,Eur J Clin Nutr(2005);59(3):pp.393–398.

Holt SH,Miller JC,Petocz P,An insulin index of foods:the insulin demand generated by 1000-kJ portions of common foods”,
Am J Clin Nutr(1997);66:12”pp.64–76.

sandra said...

Melchior:

"It's been well documented that milk is a potent insulin trigger. The whey fraction is responsible for most of this effect"

But how many of the studies used whole milk? Doesn't whole milk have less whey than the same volume of skim? Or could the fat somehow slow down the breakdown of sugars and protein so as to trigger less insulin?

Also, if it's the whey, cheese would be better as the whey is removed...also maybe strained yogurt??

The acne issue is interesting...My 8 year old does get single pimples on his legs every once in awhile- I've always thought this was odd. He also has some small patches of dermatitis on his scalp that do not go away. He does not care for milk, but loves cheese and yogurt. I have insisted on at least some milk, but I'll experiment w/o it and see what happens.

On the other hand,this study implicates meat and NOT dairy... but I do not have a background in science, so maybe it is not a good study:

http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=17491696

Senta said...

Just to add to the mix here - I had to eliminate cow's milk to solve skin and asthma problems (eliminating other things, especially grains and sugar definitely were needed too). Even raw cow's milk was no good. I'm pretty sure all the milk to which I have access is the "bad" kind, containing A1 casein. I can have the fat portion of cow's milk with no problems, so things like heavy cream, butter, cream cheese and mascarpone are fine (raw or pasteurized).

I have no problem with raw goat's milk although pasteurized goat's milk causes the skin and asthma problems. Goat's milk contains the "good" casein, A2, but apparently pasteurization ruins even that.

As far as milk being insulinptrophic, designed by nature to help the baby animal grow quickly, I definitely notice it impossible to lose any weight even eating very low carb unless I cut way back on the goat's milk. If it truly is the whey portion that causes this, I may try making cheese out of it instead!

Anna said...

Sandra said "I'm curious to know where folks who don't consume much or any dairy get calcium..."

Bone broths are a great way to get absorbable calcium. I always add a glug of vinegar or a squeeze of lemon juice to slightly acidify the water.

I cook boneless cuts of meat far less often now, generally opting for bone-in when possible. If I am braising a boneless cut of beef or bison, I toss in a small section of oxtail or meaty neck bones to enrich the sauce. The bones add enormous flavor, moisture, lots of nutrients, and also help conduct heat into the meat while cooking. An added bonus is that the bone-in cuts are far cheaper than boneless, too. I no longer see bones as "waste" to be avoided.

We don't avoid dairy, though, but our milk "as a beverage" consumption has gone down a great deal this past year (I buy a quart a week and it's raw and whole cow's milk). Most of the milk is drunk by our son, but I do use it whatever isn't consumed as a beverage in cooking or GF baking. The other dairy foods we consume are pasteurized (not ultra-pasteurized) grass-fed butter, ghee, half-and-half, heavy cream; raw milk aged cheeses; chevre; and varying amounts of cottage cheese and yogurt.

Dave Moss said...

Many thanks for your thoughts on dairy! It's been quite a major source of food for me over the years (originally for cheap protein, now mostly just cheese for calories, non-0-6y protein and K2).

For what it's worth I agree with you about the former interpretation of the dairy-correlation being more plausible. That said I'll definitely be getting as much goat/sheep dairy as I can whenever cost isn't an issue! Unfortunately I think that I'm pretty much borderline with dairy tolerance (no lactose, just casein) so it's an open question for me practically as well.

Stephan Guyenet said...

Just to clarify about dairy and acne, butter doesn't do it, and in fact, the more butter I eat, the nicer my skin looks. The same things happens when I take a vitamin K2 supplement (which is rare).

sandra said...

Anna,
Thanks for the reminder on bone broths... I did some awhile ago, but since the warm days of summer I haven't thought about soups. I'm making some now though!

It is hard to overcome the years of thinking of dairy as the only source of calcium. With dairy it's also easy to see how much we're getting by reading labels. How do I calculate how much calcium is in a cup of homemade beef stock?

Anna said...

Sandra,

"How do I calculate how much calcium is in a cup of homemade beef stock?"

You know, I haven't a clue how to estimate mineral content without obtaining a lab analysis, but I don't sweat it, either. And my broth is different each time I make it anyway. I just try to make sure my family's food is full of a variety of healthy real foods, prepared in a way that makes the most sense (& tastes good). The trend towards boneless meat cooking doesn't make a lot of sense to me anymore.

For instance, the other night I made a boneless (chuck cut ) pot roast overnight in the slow cooker, so in the bottom of the crock I placed a small section of oxtail (beef tail-bone, cut into sections). In the morning when the roast was cooked, I removed it to cool off (I planned to reheat it for our supper later). Then I "reduced" by 2/3 the remaining liquid (red wine and a bit of balsamic vinegar) and oxtail section in an open pan on the stove, which became a delicious, rich thick sauce that improved the boneless pot roast immeasurably.

Keep in mind, it isn't how much calcium you ingest, it's how much and how well you absorb the calcium (and other minerals), too. Bone broths are purported to be very easy to digest and absorb. Also, calcium absorption appears to be related to having adequate Vitamin D3, too, so also that's a factor to consider. I make sure we are not Vitamin D deficient now.

I usually don't supplement calcium, but I do supplement magnesium and some trace minerals. My "gut feeling" is the calcium we get in food is probably fine.

Anna said...

Sandra,

Even in the summer I try to keep some small containers of bone broth in the freezer. After I roast or grill a chicken or bison/beef with bones I use the slow cooker on the patio or in the garage to keep the aroma and the heat out of the house while the bone broth is simmering away.

My son loves chicken soup in any season, even summer. It's a fast meal to make for him. I melt the frozen broth in a small saucepan, toss in a few chunks of carrots, cauliflower, chopped tomatoes, etc. and cook until they are tender, just a few minutes. Then I add a few chunks of leftover chicken, shrimp, or meatballs to heat. In about 10 minutes his lunch is ready. Often I have a diced half avocado in the bowl already to cool off the soup as I ladle it, sort of like tortilla soup without the tortillas.

When I make rice for my son (not that often anymore) I cook it with chicken bone broth, not water. The flavor of the rice is enhanced as is boosts the nutrient content.

sandra said...

Anna,
Thanks for all the great info and ideas... I see you have a website so I will visit to get more tips!

Dana Seilhan said...

There are still obese people in Africa, even among the traditional indigenous, as Gary Taubes documented in his book. But I think it doesn't progress to heart disease, necessarily, because of their lesser access to sugar and vegetable oils. But a starchy diet is "natural" for no human being. It just happens that it doesn't kill us before we reach reproductive age.

The Maasai apparently have a high rate of arteriosclerosis as well, but they don't have heart attacks. Similarly, someone did a study after WWII where they compared autopsies of Japanese and Westerners and found that the two groups had equivalent incidence of artery-hardening and yet the Japanese had far less heart disease.

I really think it's eventually going to be found that artery-hardening is a natural part of aging for many people, and doesn't contribute to heart attacks. I read an interesting piece by a doctor, in this vein (no pun intended), from the Weston A. Price Foundation site and he thinks it may be another mechanism entirely. He believes the artery-clogging they find in autopsies of heart attack deaths occurs after the heart attack and not before; it may be "inflammatory debris" piled up post-MI. What he thinks is going on is something similar to lactic acid buildup in the muscles after extreme exercise, except you can rest your skeletal muscles and you can't rest your heart. Eventually it seizes up. He thinks capillary death around the heart plays a role. I can't remember if he mentioned endothelium death in the arteries as well, but I've seen that mentioned elsewhere as another contributing factor. High insulin will screw your endothelial layer six ways to Sunday. That could be what's killing the capillaries around the heart, too.

Wait, I just found it again.

http://westonaprice.org/moderndiseases/heart-attacks.html

I'm stunned Dr. Cowan had never heard of digitalis as a treatment for heart disease. I have been interested in herbal medicine for years and have known for almost as long that foxglove was the source of one of the more important cardiac drugs. Has digitalis fallen that far out of favor that MDs are coming out of school now without having heard of it?

Digitalis is hard to find without a prescription unless you're willing to raise medicinal foxglove and take your chances with the tea, but it seems cholesterol is a raw material for cardiotonics in the human body. This may explain why statins cause more heart problems in some people.

Anyway, hopefully you find the link interesting.

taw said...

A better question is "what do we eat/do in the US that traditional Japanese, Koreans, Chinese, Polynesians, Melanesians and Africans don't"? For starters, none of them rely on industrial vegetable oils, sugar and wheat to nearly the same extent as modern America. Their food is generally prepared at home using wholesome ingredients and traditional methods.

Numbers from FAOSTAT data for 1961 and 2007. First, percent of calories from sugar and vegetable oil.

Japan - 15.37% and 27.45%.
Nigeria - 20.93% and 19.35%.
USA - 28.92% and 36.06%.
UK - 23.54% and 23.97%.

Sugar, vegetable oil, and wheat:

Japan - 25.06% and 40.29%.
Nigeria - 21.83% and 24.94%.
USA - 46.42% and 52.38%.
UK - 45.72% and 45.76%.

Data seems to disagree very violently with any simple hypothesis.

The big difference in 1961 was mostly poverty and malnutrition, which seem to prevent hearth disease all right, quite reliably.

If Japan still has much less heart disease than USA and UK, this falsifies industrial food hypothesis right away.

If UK changed at all (and it did very much), this also falsified industrial food hypothesis just as quickly.

If US changed at all (and it did), this falsifies hypothesis that wheat is pretty much as bad as vegetable oil and sugar, what you often imply.

Nigeria 1961 is mostly palm kernel oil, which I didn't bother to exclude as it was tiny % of global total, like olive oil etc.

There are many plausible environmental factors other than food composition - cars, very low activity levels, bisphenol A, use of TV, computers, and artificial light causing disruption of melatonin production and sleep cycle, lower levels of sun exposure, all kinds of low level industrial pollutants etc. - unfortunately I don't think there's any good data source about these, so I won't say anything more.

But seriously now - is there any hypothesis about food composition causing obesity, heart problems etc. that cannot be disproved in 5 minutes with FAOSTAT data alone?

(if you hate FAOSTAT data access system but want data itself, email me for nice csvs)

Stephan said...

Hi Taw,

I don't find those data in conflict with my hypothesis at all. By 1961, the diseases of civ were in full swing in Western nations. In Japan, they were still developing.

In 1961 Nigeria, the main "vegetable oil" in rural areas was red palm oil, with smaller amounts of peanut. Red palm oil is a traditional healthy oil that has been used in the region for thousands of years. It has a very different fatty acid composition than industrial seed oils. It is well documented throughout Africa that populations transitioning from a rural diet/lifestyle to one including much larger amounts of seed oils, white flour and sugar have higher obesity, hypertension, CHD, gout and many other disorders. If you want more info, I suggest the book "Western diseases: their emergence and prevention", edited by Trowell and Burkitt.

I think those data are consistent with the hypothesis that industrial foods including seed oils, white flour and sugar contribute to CHD.

You said that poverty and malnutrition prevent heart disease, but I have to disagree. Some of the highest CHD rates in the world are among extremely poor populations such as S India and E Europe.

The key factor is not poverty, it's access to industrial foods. If you're so poor you can't afford anything but the food you grow yourself, then yes you will be protected. For example, 70 years ago African-Americans were thought to be genetically resistant to CHD because they had so few heart attacks. Now they have a higher CHD rate than Caucasians, so scientists are wondering why they're genetically susceptible. The thing that changed is they used to be too poor to afford processed food; now a large proportion are still poor but in 2010 processed food is the cheapest thing around.