Monday, September 29, 2008

Acne: Disease of Civilization

I often focus on the bigger facets of the disease of civilization. Things like cardiovascular disease and cancer, which are major killers and the subject of intensive research. But the disease of civilization is a spectrum of disorders that affects the body in countless ways, large and small.

I recently read an interesting paper written by an all-star cast, including Loren Cordain, Staffan Lindeberg and Boyd Eaton. It's titled "Acne Vulgaris: A Disease of Western Civilization". The paper presents data from two different groups, the Kitavans of Papua New Guinea and the Ache hunter-gatherers of Paraguay. Both were systematically examined by doctors trained to diagnose acne. Out of 1,200 Kitavans and 115 Ache of all ages, not a single case of acne was observed. Hunter-gatherers and other healthy non-industrial cultures have nice skin. I dare you to find a pimple in Nutrition and Physical Degeneration.

In Western societies, acne is a fact of life. The paper states that 79 to 95% of modern adolescents suffer from some degree of acne, along with about 50% of young adults. That's an enormous difference.

The paper presents a very Cordain-esque hypothesis to explain the high incidence of acne in Western societies. In sum, they state that the Western diet causes hyperinsulinemia, which is thought to promote acne. This is due to insulin's effects on skin cell proliferation, its interference with the retinoid (vitamin A) signaling pathway, and its effect on sebum production.

They then proceed to point the finger at the glycemic index/load of the Western diet as the culprit behind hyperinsulinemia. It's an unsatisfying explanation because the Kitavans eat a diet that has a high glycemic load due to its high carbohydrate content, low fat content, and relatively high-glycemic index foods. I think the answer is more likely to reside in the specific types of carbohydrate (processed wheat) rather than their speed of digestion, with possible contributions from refined vegetable oil and an excessive sugar intake.


Methuselah said...

I had bad acne as a teenager and although the worst of it did clear up for as I got older (this seems to be the pattern, so presumably there are hormones other than insulin involved,) I still had spotty skin into my 20s and 30s. When I went onto a Paleo diet my skin cleared up totally. From the perspective of my case study, this puts dairy or processed carbs squarely in the frame....

Ike said...

I think Cordain has some good thoughts, but it isn't so simple like that. You have nice skin if your blood is "clean". If you have problems with your liver, bowel or any other major organ , you can't elimanite the toxins from your blood or the extra hormones which teenagers usually have. I don't think hunter-gatherers in their youth don't have "hormonal imbalance" like teens have in present time. But the HGs had/have strong, healthy organs to work these extra difficulties out. Of course acne is diet related, because we can ruin our body by eating junk. For example, if we have inflammation on our bowel we can't adsorb vitamins or minerals efficiently, so the organs can't work like they should.

Neil said...

I am lucky enough to have reasonable skin already, but reducing carbs and vegeatable oils has at the least coincided with a notable improvement

Scott W said...

I agree that Cordain's work is flawed by cognitive dissonance...HG's who eat high carb have healthy skin, but high carb is bad for your skin. As I have said in the past,I agree with your position. But a question, to avoid further dissonance:

Why is sugar, per se, bad? The starches that the Kitavans eat convert to glucose. They eat a high load of tropical fruit, which must contain high loads of fructose. Sugar is a 50/50 mix. The foods they eat have a high glycemic index and so convert to glucose/fructose quickly, just like sugar.

Stephan Guyenet said...

Methuselah and Neil,

Thanks for your perspective. I've heard a number of anecdotes like that. My skin improved as my diet improved as well.


You bring up a fair point. I've been trying to pick my way through that issue as well. As you point out, starch turns to glucose at some point. The Kitavans also eat a large amount of fruit.

I think there are two points to note here. First, I don't believe glucose has the same effects on the body as starch, even though starch is made from glucose and can digest rapidly. The reason has to do with the sweet flavor itself. It has effects on the nervous system and feeding behaviors that starch doesn't. Even non-caloric sweeteners cause abnormal feeding behaviors, metabolic changes and addiction in rodents.

The second point is the fructose. Fructose, at least in large doses, impairs insulin sensitivity. I don't think that's a problem if you live on Kitava and your lifestyle is otherwise excellent. It may even be adaptive under those circumstances. But if someone already has impaired insulin sensitivity, like most Westerners, then fructose could compound the problem. Particularly through its interaction with n-6 fats in the liver.

Kitavans and the Kuna of Panama both eat a fair amount of fructose and are healthy, but I feel that a high fructose intake on top of a poor lifestyle to begin with may be a bad idea. That's what I think at this point.

Jeff said...

Similar anecdotes from me. I used to get a version of my "time of the month" when my wife did and it resulted in 2-3 pimples most months. Since I have gone Paleo I have had not a single pimple in 8 months.

ItsTheWooo said...

Very interesting blog. I had terrible acne that lasted from 9 yrs right up until 20 years - the same week I started the atkins diet. Then it stopped.

I think acne is mostly related to excess testosterone and other androgens. Insulin is significant only in so much that it promotes excesses of androgens in both men and women.

Carbohydrate is significant only in that it promotes high insulin. I doubt the kitavans have high insulin if they are at all healthy, they probably do not eat enough calories or carbohydrates in order to create hyperinsulinemia.

Stephan Guyenet said...

Hi itsthewoo,

Glad your acne disappeared. Cordain mentioned androgens in the paper.

The Kitavans eat a high-calorie, high-carbohydrate diet but have a low fasting insulin. They eat about the same number of calories as the average American, more carbohydrate and less fat.

That's why I think carbs per se don't cause hyperinsulinemia. I believe there's something special about wheat, sugar and perhaps vegetable oil that are responsible.

Unknown said...

I've also noticed the link between androgens and acne. I had to use a prescription skin cream containing androgens when I had bad rashes on my arms (the cause of which I'm still not sure). It did clear up the rashes but soon after I started getting acne on my face and back.

Sue said...

I read an interesting piece from Williams: Some Dermato-Therapeutic Notes written in June 1930.

Regarding treatment for acne:
"The patient must of course avoid overeating and drinking, food which upsets the stomach, and food containing much oxalates.... "patient to avoid altogether rhubarb, spinach, pineapple and to only take moderate amounts of beans, cauliflower, and tea".

"Always investigate what oxalic foods the patient is taking, and if much oxalate lime is found in the urine, treat your patient for a time with small doses of hydrochloric acid with meals and magnesia between meals".

Unknown said...

Couldn't the different results from similar diets in different people be as a result of unique biochemistry?

Roger Willams wrote a book that classified people into 2 groups- fast and slow oxidizers and then related that to different effects of diet on the same groups

I believe he said that about 25% of the population were better equipped chemically to deal w'/ carbs

Stephan Guyenet said...


I don't believe genetics explains the difference between our health and the health of non-industrial cultures.

I can't speak to acne specifically, but if you look at the Kitavans' closest relatives (other Pacific Islanders), they seem even more susceptible to the disease of civilization than Westerners. As soon as their native diet of tubers, coconut, fruit and fish is replaced by modern processed foods, their health deteriorates dramatically.

I do think genetics plays a role, but I believe it determines susceptibility to modern food toxins (gluten, excess linoleic acid) rather than carbohydrate per se. Of course, if you are susceptible to gluten and you develop glucose intolerance or diabetes as a result, you will be sensitive to all carbohydrate at that point. That will be easily confused with a genetic susceptibility to carbohydrate.

ItsTheWooo said...

Hi again Stephan,

Do you have any resources I could use to read more about the diet of the Kitavans?
Most cultures in the world who are healthy yet eating high carb low fat diets are usually eating low calorie diets (i.e. most of asia). Carbs lose their power to make you sick if you are borderline starving. I would be very interested in learning more about this culture which eats a high calorie, high carb diet.

I think there are lots of things about our culture that make us hyperinsulinemic too, so I agree that it is incorrect to blame carbs exclusively.
1) Chronic loss of sleep is common in modern societies, which pretty much makes it impossible not to be hyperinsulinemic when eating
2) Industrial pollutants induce IR and mess up blood sugar regulation too (e.g. biphenol A, and other endocrine disruptors)
3) Too much industrial grain oil causes an excess of omega 6 fats in the diet which can promote insulin resistance and inflammation.
4) Sugar is significant because it is an abnormally concentrated source of carbohydate that is rarely found in nature. We aren't meant to eat 200 grams of carbs in a meal, every meal, but this becomes possible with sugar syrup.
5) Some people find wheat (and dairy) to be addictive and it interferes with endogenous opioids which can produce overfeeding and high insulin.

Ultimately I think carbs are the biggest factor because the bottom line is, everything else can stay constant but if you remove carbs from the picture, high insulin normalizes, hormone imbalances fix themselves and significant obesity becomes impossible.

So, it is more than carbs for sure but ultimately carbs have the final say in the process.

Robert Andrew Brown said...

Thank Stephan for another thought provoking thread.

Kitavians have a low Omega 6 intake, maybe under 1/2% of calories, and a high intake of long chain Omega 3s through fish.

Omega 6 ultimately controls the hormones through the cholesterol pathway enzymes. High Omega 6 intake is linked with hormonal disturbances.

Excess Omega 6 and lack of long chain 3s lead to low level inflammation which is a factor in acne.

Fish oil has been shown to moderate the effects of acne.

Refined sugar is empty calories and devoid of minerals, which adds to Ike's point of poor absorption.

I agree with a lot of the points Isthewoo is making. But poor sleep is arguably at lest in part a down stream effect of excess Omega 6 etc rather than a true full external factor.

Isthewoo - Thanks - The points on Opiods and endocrine disruptors are intriguing and information I have not seen before.

Robert Brown

Author: Omega Six The Devils Fat

Stephan Guyenet said...

Hi Itsthewoo,

I'm glad to have you on the blog; you are clearly very knowledgeable. The two sources I have for the Kitavans' diet composition are

Lindeberg SL et al. "Lipoprotein composition and serum cholesterol ester fatty acids in nonwesternized melanesians". Lipids 31(2):153-157. 1996.

Lindeberg SL et al. "Age relations of cardiovascular risk factors in a traditional melanesian society: the Kitava study". Am J Clin Nutr 66:845-52. 1997.

You will need access to a medical library to get these because they're not available online to my knowledge. I had to photocopy them at my library.

Here's what they say about diet: they eat a total of 9,200 kJ/day. 5,600 of it comes from yam, sweet potato and taro. 1,865 comes from coconut. 920 from fruit. 445 from fish. 360 from "other vegetables". 20 from "Western food".

These data come from a 7-week visit during which he lived with a host family and recorded the food history of 5 different families. He weighed portions to get a quantitative estimate of intake, and interviewed inhabitants about their food habits over the past 12 months. I don't consider the data bullet-proof, but they seem acceptable and they're the best I'm aware of.

SL mentions repeatedly in the series of papers that the Kitavans have abundant food and virtually do not know shortage. So I think their diets are pretty much ad libitum.

I think that amount of carbs could harm many Westerners because our metabolisms are already somewhat broken. But on a cultural level, the diet can be healthy if you are on it from the beginning.

I fully recognize the efficacy of low-carb diets to improve health. But you have to ask, how much of it is the carb per se and how much is the removal of refined grains? I'm sitting on a couple of diet trials of the "paleolithic diet" that show reductions in caloric intake, weight and insulin when grains are eliminated but tubers are retained. The reduction in caloric intake is spontaneous, not imposed by the study.

Stephan Guyenet said...


I take it back, you can actually get the 1997 AJCN article online. Free full text.

ItsTheWooo said...

Totally fascinating paper, thanks!

One thing that seems really significant is the fact that the kitavans eat a whole lot less omega 6 than do the swedes. I've always suspected omega 6 plays a role in insulin resistance and disease, via its ability to cause inflammation.

Also, it seems like most all of their fat comes from either coconut or fish. Coconut is thermogenic, increases metabolism and promotes ketosis, and this might help improve any tendency to insulin resistance.

I found it pretty interesting that the females had higher BP than the males.

I would love to know how much they sleep. I bet they sleep 9 hrs per day/avg and they don't have exposure to a lot of artificial light at night. I also bet their average psychological/social stress is really low.

I also doubt they were exposed to even a fraction of the endocrine disrupting pollutants swedes are.

If I sleep 5 hrs a night (some people do this *every night*) to be on time for an appointment, the next day my blood sugar is totally screwed up, I can't tolerate any carbs and I'm ravenous. I don't think kitavans do that ever really.
The stress we put up with every day - sitting in traffic on the new jersey turnpike freaking out about being late - kitavans don't do that, they kinda lay around and eat coconut, right? When they encounter stress it is short, rational (e.g. predator) and ends quickly.
As I'm sitting in my car on the turnpike, I'm breathing in sick smelling fumes from factors. I'm drinking out of a plastic cup. These are chemicals, who knows what they do to the body, the brain? They used to call this area "cancer alley". All kitavans smell are natural smells, coconut and sea.

I know that for me at least, as long as I keep the carbs low I can circumvent a lot of the nastiness that would otherwise befall upon me due to the way I live. I can eat wheat and nothing bad happens... only if I raise carbs do I have problems. If I eat tubers like sweet potato and potato, I only have problems if I raise carbs too much. I have noticed some carbs are worse than others (things with glutamates and cooked tomatoes do a major wallop on my sugar) but for the most part "carbs is carbs is carbs".

I know a lot of people react terribly to wheat and find it makes them really hungry (among other symptoms)... I think this is probably a reaction to opioid peptides in wheat. I don't have this reaction.

A lot about our diet and lifestyle messes us up real bad. I don't think it's appropriate to attribute it to wheat anymore than it is to attribute it to carbs... but the best evidence shows that removing the carbs has the most powerful protective effect against things.

I don't see grain free or sugar free or anything else doing what low carb did for me and lots of others. Even if someone went and ate like a kitavan, I don't think it would work because of the endocrine disruptors and pathological stress/sleep deprivation that is par for the course of being a westerner, it would make it impossible to correctly metabolize that mass of carbohydrate.

Stephan Guyenet said...


I agree the low n-6 is probably significant. They also eat very little PUFA in general. Their serum cholesterol esters are highly saturated (with low PUFA and very low linoleic acid).

That's partly from the coconut and partly from the saturated fat their livers make from all the carbs (which explains their high palmitic acid that does not exist in their diet!). As Peter points out, one of the best ways to dump saturated fat into the bloodstream is with a low-fat diet. I find that extremely ironic.

I agree that there are a lot of factors that probably contribute to Kitavans' health, but I disagree that carbohydrate is bad per se. Kitavans eat 69% carbs by calories, plus they nearly all smoke! Even with the smoking, they have undetectable rates of heart attack and stroke. They aren't even familiar with the symptoms.

Smoking is considered to be one of the biggest risk factors for cardiovascular damage, possibly the biggest. Yet even that wasn't able to give them a single heart attack (or its antecendents like hypertension). I think if their lifestyle were borderline unhealthy, it would just be a shifted gaussian curve. But there isn't a curve at all for them.

I used to think carbohydrate was the culprit as well, but I have changed my hypothesis. If you read through Nutrition and Physical Degeneration, there are plenty of healthy cultures that eat carbohydrate. If I recall correctly, there isn't a single one that eats wheat. The closest are the Swiss villagers who ate sourdough fermented rye.

I believe there are two reasons low-carb diets work so well. First, reducing carbs reduces gluten, sugar and most processed crap. Second, some people have glucose intolerance due to preexisting damage so low-carb sidesteps that.

ItsTheWooo said...

Hi again stephen,

Your view of things is very logical and supported by evidence... the reason I have trouble accepting that carbohydrate is insignificant is because I am a living case study of carbohydrate intolerance. It doesn't matter if I eat potatoes or not, it's all going to cause hypoglycemia and screwed up moods and other health problems. The only way for me to avoid this response is to either restrict calories a lot like someone in asia (which would leave me more hypoglycemic over all), or alternately to restrict carbohydrate. Even if I restrict calories, I can't eat a normal amount of carbs without a hypo.

So this seems to suggest to me that something about our lifestyle can cause screwed up glucose / insulin regulation (which is not related to sugar OR wheat, because I eat insubstantial amounts of both).

Or alternately, I am a genetic freak.

I wonder what would happen if I adopted the diet of a kitavan. Coconuts and fruit for breakfast, potatoes with a small bit of fish for lunch, and more potatoes and fish for dinner. I don't think this would work at all, my natural impulse would be to eat fish and coconut because these are satiating and mentally balancing whereas fruit and potatoes would make me feel pretty terrible.

Scott W said...

Very good discussion. I have mentioned in a comment before that I was previously a die-hard low-carber and the information that Stephan is presenting would have caused severe cognitive dissonance. After years of eating as low as zero carb and still having difficulty not gaining weight, combined with mood instability at times and an almost complete inability to recover from workouts, I have had to rethink my approach on carbs.

I avoid grains and N-6 fats. Unlike isthewoo, I have found that I'm tolerating dramatically increased carbs very well, which I never would have guessed since I had a terrible time with binging before I started low-carb years ago.

So, two things may have happened. One, I "healed" my metabolism with years of low-carb. Or, two, the problem for me personally was grains all along.

I do know that I can safely eat potatoes or any other non-grain starch source (or even straight glucose, which I have experiment ed with to test my hypothesis) and not have even a slight desire to binge. But if I eat cookies or bread...I eat until it is gone.

I do realize personal anecdote is interesting, but not a sample upon which to base conclusions for others.

Confounders for me:

1 - Of course, I never change one variable at a time. The carbs allowed me to exponentially increase my weight and sprint workouts (which I love doing and had sorely missed), so I'm exercising a lot more. Exercise increases insulin senstivity of muscles.

2 - I also practice a daily fast of about 18 to 20 hours. I just find it works best for me. But it can increase insulin sensitivity as well. It also trains my body, I think, to switch fuel sources without much issue.

3 - Family history. No diabetes in my family on either side at all. My grandma is 96, still eats donuts every morning, has never exercised a day in her life and her blood sugars are fine.

So...I love this discussion becuase it makes us question our belief systems and keep pushing for knowledge. But the personal stories do point out one thing: We each must find what works for us. And if it is not working, then we must not be afraid to defy someone's dogma and try something else.

We are all descended, in general, from one of the groups profiled in Physical Degeneration. Those groups thrived on a wide variety of diets. It is no surprise that each one of use may have the genes to thrive on a different carb/fat/protein ratio.


ItsTheWooo said...

I agree, it is perfectly possible that some people who think they are carb intolerant, are actually just intolerant to specific things. If I drink 50 g of glucose, my sugar is 140 after 1 hour, and it is 45 by 2 hours. I don't seem to regulate glucose and insulin properly, so for me, any carbohydrate I eat beyond the 60 g a day I can tolerate is bad news.

I have no problem moderating cookies or bread or any other food really. I cannot relate to people who describe that feeling. When I was 300 pounds I was hungry, that's why I ate a lot. Hunger. I never binged. My insulin was too high and it was shoving everything into fat cells and not letting it out. I was hungry and lethargic.

It comes back extremely quickly the moment I try to do the "healthy" dried fruit hippy bullcrap. I get massive hypo, then I can barely move.

Scott, do you have this issue with wheat only or is it any "fun carb" type food? Would you have an issue with skittles and twizzlers too?

Scott W said...

Itsthewoo, I don't have as much of a problem with eating just a little candy if that is what I start with. But if I've had a cookie or something, then all carbs are fair game.

Hunger for me is something that I feel pretty much every day but doesn't particularly bother me, or I got used to it. I've learned that if I eat to avoid hunger, regardless of macronutrient ratio, I end up consuming loads of food and getting energy swings. Even fat binging is a problem in that circumstance. So maybe that was the issue all along - eating too much in general which triggered more eating and binging - not carbs per se. But I did blame carbs for a long time.

This need to control total input in general is why I have always drifted back to fasting from dinner at night to lunch the next day. Easier to just ignore the hunger and then eat a normal amount of calories in a compressed window than to try to spread those calories out over an entire day, but fail and eat more because food triggers a greater desire to eat. Works for me pretty well.

I will say that lack of sleep, as you or someone else mentioned, is a sure trigger for unstable blood sugar and unstable eating patterns. I can feel it after just one night.

Stephan Guyenet said...


I fully recognize that some people are never going to have a healthy relationship with carbohydrate from any source. When I write for this blog, I typically take a big picture approach: what is a healthy way for a culture to live.

But of course that won't work for every individual. My opinion is that problems handling carbohydrate are not genetic, but the result of damage from the prior lifestyle. It seems to be reversible to varying degrees.

When I say it's not genetic, what I mean is that a person probably isn't born with an inherent sensitivity to carb per se, but perhaps a sensitivity to something else that eventually leads to carb intolerance. So it does have a genetic component, like all things.

Take type I diabetics for example. They will never really be able to tolerate carbs normally. But like most if not all autoimmune disorders, it's probably environmentally caused. For example, there is a striking association between celiac disease/gluten sensitivity and type I diabetes. There may be an inherent genetic sensitivity to gluten involved in many cases, but once it runs its course, the gluten isn't the issue anymore because there are no beta cells.

I'm using type I diabetes as an example but I think there may be other less easily identifiable disorders that have effects on various parts of the metabolism. So that's where I'm coming from when I say I think high-carb diets can be healthy. I'm really talking about being born and raised on it.

Stephan Guyenet said...


That's very interesting. Many people have speculated about the addictive nature of gluten. The opiate-like peptides in gluten could play a role, or maybe something the gluten does to hormone secretion by the intestine.

There's a lot of in vitro data but empirical evidence is lacking as far as I know. I would love to see that investigated more thoroughly. No one wants to look into it because they don't want to challenge the wheat hegemony. Thank goodness for celiac researchers and Loren Cordain or we'd be going nowhere!

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

There are many theories about what causes acne and there are probably many cures that can work. You need to have a combination of things to cause most diseases probably - not just one "hit." Most of the gluten people eat is accompanied by HFCS, PUFA oils, flavor enhancers, toxic additives, etc. Try finding breads that only have flour: no enriching, bleaching, PUFAs, sugars, or yeast. Few breads like that exist.

I'm skeptical when people blame all problems on wheat. I had no trouble with French Meadow Sourdough Bagels (no yeast, no oil, no sugar, and no preservatives). Any breads that are not refrigerated are probably full of preservatives and other junk. I defy you to find any bread outside of health food stores that doesn't have soybean oil, canola oil, HFCS, yeast, or some kind of sugar. Even most health food store breads have those ingredients.

Most rice is enriched with iron and other harmful additives. (More iron than there was even in the original grain.) I eat organic white rice w/ no enriching, once or twice a week, and have no problems with it. Brown rice or enriched white rice causes bloating and other problems. There are so many additives in foods that people ignore. Those are the first things I am suspicious of. The PUFA oils added to almost everything now are a serious health hazard.

Stephan Guyenet said...


In my opinion, there is a lot of evidence that points to wheat as a major culprit in the diseases of civilization. In Nutrition and Physical Degeneration, as well as other accounts of nutrition transitions, white flour seems to be about all that is required to destroy the health of native cultures. It's the common thread in all these cases.

Then if you look at clinical trials like the ones I posted on recently, the most successful are typically those that reduce or eliminate wheat. Think paleolithic and low-carbohydrate diet trials.

Another piece of the puzzle is gluten sensitivity. An estimated 12% of people have gluten sensitivity, which puts them at an increased risk for a large number of diseases. That's an estimate based on anti-gliadin antibodies in the blood, which are only a measure of activation of the adaptive immune system. There are preliminary data that the majority of people have an innate immune response to gluten even in the absence of antibodies.

In NPD, the only culture I can think of that ate gluten grains was the Swiss villagers. They ate sourdough fermented whole grain rye bread (lower in gluten than wheat), and had an exceptionally high intake of protective fat-soluble vitamins.

Do I think wheat is the only problem? No. But I do think it's probably a major contributor, at least for many people.

Anonymous said...

"In Nutrition and Physical Degeneration, as well as other accounts of nutrition transitions, white flour seems to be about all that is required to destroy the health of native cultures. It's the common thread in all these cases."

They were eating white flour as the main source of calories. Of course that would cause disease. Also the flour might have been bleached and/or enriched. Bleach is highly toxic. It's filled with all kinds of industrial chemicals, heavy metals, motor oil, etc. Synthetic vitamins and minerals added to white flour are also highly toxic. Unbleached and unenriched flour like Hodgson Mills is the safest, IMO. Jan Kwasniewski thinks white flour and potatoes are the best carbohydrate sources, probably due to their low level of fiber and PUFAs.

It's difficult to isolate the variables in the observations of those explorers. Maybe white flour's the main problem or maybe it's the lack of animal foods and fats in their diets. According to Price, the people ate sugar, flour, and rancid oils almost exclusively. But what would have happened if they ate a diet with a moderate carb intake, 50-100g / day, as refined sugar and unbleached unenriched flour? Maybe none of the problems would have occurred. Unless someone studied a group of people eating refined carbs in the context of a low-carb low-PUFA diet, you can't prove that refined carbs were the problem. Refined carbs might be far healthier than whole grains, fruits, or vegetables for all we know.

Anonymous said...

Also, we should look at whether flour is fermented before blaming the problems on wheat. How many people had problems with gluten before the advent of modern quick rising breads and so forth? In the past, breads were fermented overnight. Now the breads are fermented in hours. They also bleach and enrich the flour, add in lots of PUFA oils, sugar, high fructose syrup and all kinds of preservatives.

The bread in stores today is garbage. It has little reseblance to the breads made 50 years ago, let alone 1,000 years ago. The problems with grains may be entirely due to the incompetent modern methods of preparation and the toxic additives like bleach, yeast, PUFA oils, refined sugar, corn syrup, preservatives, and the phony vitamins and minerals.

Stephan Guyenet said...


Flour is bleached using oxidizing gases rather than actual bleach. It mimics the process of aging flour to improve its flavor. I can't say I really trust the process either way.

I think it's notable that (IIRC) none of the groups Price wrote about ate wheat. Only one ate gluten grains, and that was the Swiss villagers eating sourdough fermented rye with large amounts of protective fat-soluble vitamins and low PUFA. I'm not aware of a single wheat-eating culture that's documented to be as healthy as the cultures Price found, or the truly healthy non-industrial populations that have been characterized since Price.

I have a hard time trusting wheat on anything less than a fully empirical basis. Hypothetical arguments about the refining/bleaching being unhealthy and fermentation breaking down the gluten aren't going to convince me until I can see solid evidence of a healthy wheat-eating culture.

It's possible that thorough fermentation can make wheat a healthy food, but that rests on hypothetical arguments as far as I can tell.

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

"When flour is oxidized the gluten proteins present in the flour are altered. More specifically, the oxidation process enhances the formation of disulfide bonds between gluten proteins. These bonds make the flour more suited for baking, as it enables the flour to form stronger, more elastic dough."

I don't use bleached or enriched flours, or any foods made with them. John Yudkin regarded refined flour as healthier than sugar. I think Jan K. would agree, since he allows white flour and refined sugar, and says it's better to eat starch than sugars. Of course, his diet is quite low in carbs, so maybe at that level it does not make much difference. Though I would still only use unbleached and unenriched flour (ex: Hodgson Mills, pref organic).

I feel better with unbleached unenriched white flour than I did eating yeast-free sourdough bread fermented over 24 hours. (Berlin Natural Sourdough Spelt.) It had no preservatives, no PUFA oils, no sugar or additives. Just flour, water, and sea salt. They sell it at Whole Foods in the frozen section. Before, I used sourdough white bread with hardly any ingredients: flour, water, sea salt. I never felt any problems at all with it.

I don't any bread now, just some organic white rice (un-enriched) once or twice a week, and baked/boiled/fried potatoes. I think avoiding grains, esp wheat, is the safest idea. But traditional sourdough's OK. It shoudl be fermented at least 6 hr (pref 24+) and frozen / refrigerated (NO preservatives, yeasts, oils, or sugars). That way it is fermented long enough to break down and change the gluten, IMO. I would eat no more than 1-2 pieces of the traditional sourdough bread. It's highly perishable, IMO. Toasting it too much or leaving it out of the refrigerator (pref freezer) degrades the quality.

It's a hypothetical argument to say that wheat is unhealthy, unless you have some double-blind studies using organic stone ground unbleached unenriched white flour fermented without yeast or sugars for at least 6-24 hours, with no PUFA oils, and no preservatives. None of the bread most people eat fulfills any of that criteria as far as I know. I've have been able to find two breads in health stores that do and one of them is no longer made. Where is the proof that wheat like that is bad for health? I agree that bleached, quick rise, yeasted, sweetened, pesticide, and preservative-laden wheat is toxic. Also, any PUFA oils (soy or canola) added to a bread would disqualify it for me.

The burden of proof should rest on those asserting that wheat is harmful, not the people who point out that the "evidence" is based on wheat filled with additives, or processed in harmful ways. Maybe it's harmful inherently and maybe it isn't. I see no evidence that separates the wheat from modern processing and additives. My experience and many other people's shows that there is a difference between foods that are prepared in traditional ways or foods processed with modern methods that emphasize profits over health.

Stephan Guyenet said...

Hi Bruce,

I don't assume a food is healthy until proven unhealthy. I'm suspicious of any food that doesn't have a proven track record. The fact that I'm not aware of any well-documented healthy culture that eats wheat as a staple makes me suspicious of it.

So while I don't have any double-blind studies proving unenriched wheat flour is unhealthy, I also don't have any proving it's healthy. And I would say the data are consistent with it being unhealthy. If you look at low-carb diets and paleo diets, both of which seem to be pretty effective at getting peoples' metabolism back on track, they both reduce wheat considerably. Paleo diets aren't necessarily low-carb, so it's not the carbohydrate per se.

Add to that the considerable data linking gluten sensitivity to a large number of diseases, plus the ecological studies like Nutrition and Physical Degeneration, and it paints a pretty damning picture.

JMC said...

Just stumble upon this post.

I've read Cordain's book on acne and his papers:

He provides good evidence that high glycemic load foods, milk, fructose, lectins (he explains a causal mechanism implicating WGA in his book), high Omega 6/Omega 3 ratio and low zinc status leads to Acne.

I've checked his references and found other references in Pubmed and there are 3 epidemiological studies linking Dairy with Acne, and one study by Mann from Australia, showing a low glycemic load diet improves symptoms.


John said...

I believe that most disease that makes its presence in this world of ours is really caused or created by man himself.

Most diseases including the widely know ones in the west are very local to the west and this shows that there is nothing natural about it. Instead it shows that these disease have one thing in common and that is that we buy our food from shopping centers which are processed in factories.

Factory processed foods are lethal and open up avenues and revenues for chemical companies to rake in profits.

THe subject here is disease of civilization - this can be eliminated if an only if strong laws are brought in to stop manufactured food from entering the food shelves in supermarkets.

Go natural.

Unknown said...

as technology progress, the diseases are also evolving, hard to cure so the medications before are no longer effective like acne, some natural or even home medications are not effective to a sufferer, really needs a serious medication to treat it.
I'm suffering acne for how many years but luckily I've found the one that cleared it up.

eyecandy_babydoll said...

I don't know, if wheat is to blame, then all Italians and the French should have just as much acne as American citizens - or anyone who eats wheat for that matter. Not only do the French eat wheat, but they eat products made with white flour and sugar (with butter and other wholesome ingredients). But nevertheless they consume white flour. So do the Italians. I'm not defending wheat, I just want to understand why acne isn't more prevalent in those countries. My personal hunch tells me it could be vegetable omega6 oils or perhaps sugar (especially HFCS).