Paleo seems to be all over the news lately. The Pete Evans baby book controversy has sparked a flurry of opinions and argument, but I am not getting in to that particular issue here. However, an article caught my eye recently from Jason Wilson in the Guardian that I found particularly interesting (in terms of how people perceive the lifestyle) and which certainly warrants a response.
Although Mr Wilson has a problem with Paleo recommendations concerning diet (which we will come to presently), his strongest criticism is reserved for the seemingly sexist underpinning to the lifestyle. This caught my eye as it is an argument that has popped up before and one that continues to rear its head intermittently. In conversation with someone recently from a well-known organisation, I was surprised to hear them remark that the Paleo lifestyle does not accord women the status they deserve – that it was too ‘male-focused’. The fact that they were talking to a woman (me) who was vocally championing Paleo and in the process of describing how it had changed her life was neither here nor there. Clearly I was either a) brainwashed by men and/or b) too stupid to realise the enormous sexism that existed within the scene. I was very amused by this encounter and laughed it off. I’m very much of the opinion that everyone is entitled to say what they think and the Paleo/Ancestral Health is not immune from criticism in any way. I like to read articles and listen to others when they vocalise a contrary opinion on Paleo. I just have my own opinion too and it’s great to be able to say what I think on my own blog (as they like to say what they think on theirs/in their columns etc.). So here goes…
The problem with ‘The Paleo Diet’
Mr Wilson acknowledges a ‘superficial plausibility’ to the idea that many aspects of modern life such as diet, stress and technology place a burden upon a species that has only relatively recently abandoned a hunter-gatherer lifestyle, and whose biological make-up is at odds with this change.
‘The undeniable fact that Western affluence has produced many unintended consequences for public health – many modern processed foods are nutritionally valueless, and a lot of us don’t do as much exercise as we ought. It may also connect with the undeniable alienation many of us feel in a world where technology, fast food and urban living can sometimes seem like a self-imposed prison.’
Such thoughts seem perfectly sensible to me so I’m not sure why they are only ‘superficially plausible’. It is undeniable that since the emergence of the human genus Homo about 2.4 million years ago, our ancestors, for approximately 84,000 generations, have survived as hunter-gatherers. The transition to agriculture took place astonishingly recently on the timeline of our evolution, with the introduction of processed foods taking place even later (the last few seconds perhaps?). It is no wonder that some argue that we have not fully adapted to this radicle change in our diet and the enormous consequences to our health that this transition has caused. Why does Mr Wilson think this is this only ‘superficially plausible’?
Although we may agree that modern lifestyles jar with our hunter-gatherer selves, Mr Wilson stresses that there was ‘no one, uniform diet‘ that Stone Age people ate. They were adaptable – just like us. Therefore because of this, the whole argument is ‘intellectually bankrupt’. He states:
‘The presumptions about what people in the old stone age ate are anthropologically naive: many experts argue we can’t make universal claims about that with any degree of certainty, and inconveniently, evidence keeps emerging that people then did help themselves to high-carb foods when they were available. That’s because they were versatile, opportunistic and adaptable, like us.’
Mr Wilson’s argument goes something like this: Paleo people make ‘certain, universal’ claims that there was only one type of diet ate in the Stone Age. Experts say this is not true as evidence suggests that Stone Age people ate carbohydrates if available and were therefore adaptable. Modern humans are likewise adaptable to eat a range of foods such as gluten and dairy. Therefore the Paleo diet is ‘anthropologically naïve’ and:
‘… premised on a false image of stasis and harmony projected from an entirely arbitrary point in the long history of human evolution.’
This straw man argument has so many holes in it and makes so many assumptions that it is hard to know where to begin. I’ll keep it short as the real focus of Mr Wilson’s polemic is yet to come.
1. Paleo does not believe with certainty that there was one uniform diet that all Stone Age people followed. It is widely acknowledged that traditional hunter-gatherer diets range from the Innuit (protein-based diet with little or no fruit and vegetables) to the Kitavans (around 70% carbohydrate-based diets). The modern Paleo diet takes the hunter-gatherer as a blueprint and simplifies food choices around the basics of meat, fish, fowl, eggs, vegetable, fats, nuts and fruits and eliminating grains, industrial seed oils, dairy and processed foods. Again, there is no one Paleo diet for everyone. People are encouraged to experiment and see what works for them.
2. A Paleo diet does not cut out carbohydrates. It is lower in carbohydrates than the standard western diet. Carbohydrates come from a wide range of vegetables and limited fruit. Some may choose to eat higher carbohydrates than others according to their health and fitness regime. For instance a 65 year old diabetic may eat fewer carbohydrates than a sporty 25 year old (or a sporty 65 year old for that matter).
3. It is true that various groups around the world have evolved in a relatively short amount of time to tolerate certain foods. Northern Europeans have evolved to tolerate dairy compared to African and Asian populations. However, there is a huge difference between tolerating certain foods and eating foods that have sustained us for the vast majority of our time on earth; foods which we have not only survived on but thrived upon. In the case of gluten in particular, the mounting evidence suggests that we have failed to adapt to this recent change in our diet and the full consequences are yet to be realised. It is widely recognised that when societies move away from their native diet and adopt non-traditional foods, they begin to suffer health problems. This can be seen in documentaries such as My Big Fat Diet.
We do not feed our dogs grains even though they may be able to ‘cope’ with them. Nor do we believe that cows should eat grains either. ‘Coping’ is not thriving. The practice of fattening up cattle with grains, both in the UK and the US is a concern and the importance of 100% pasture raised meat is something that the Paleo scene strives hard to raise awareness of.
For some thoughts about meat production, see my reviews of the BBC programme Should I Eat Meat here and here. Regarding pasture raised meat see my article Finding 100% pasture raised meat – a journey. See also my articles on the Savory Institute and the Oxford Real Farming Conference.
Additionally, if what Mr Wilson argues is true – if we are able to adapt to any food – then maybe we shouldn’t seek to cut out high- carbohydrate, processed, chemically-laden foods. We will eventually just adapt to tolerate them more successfully, so what’s the problem?
‘Understanding the diet of past human species closely related to our own will help us gain perspective on our evolutionary constraints and adaptability.’ Ainara Sistiaga, a Geoarchaeologist at the Massachusetts Institute of Technology and University of La Laguna
‘Nobody tells a giraffe how to eat. But for the first time in history, humans don’t know what to eat. We no longer know what human food is.’ Jeff Leach
4. Adherents regard the Paleolithic era as ‘false image of stasis and harmony’. Who would suggest that human development within the Paleolithic period ranging from around 2.4/2.6 million years ago to around 10,000 years was static? Who would suggest it was harmonious? Really, these arguments are ridiculous. If we are talking about stasis in terms of diet, we do know that populations ate a hunter-gatherer diet with regional differences and seasonal availability. Diets also changed according to migratory patterns. But one thing is for certain, these diets had more in common with each other than with contemporary diets and when taken together, they form a suitable blueprint with which to emulate a hunter-gatherer diet (as much as it is possible to do) in modern times.
As for harmonious, we know that if Stone Age man or woman managed to avoid accidents, traumatic childbirth and being killed in a fight, they went on to live relatively long lives. Was it idyllic? Who would think that? We may be able to look at contemporary hunter gatherer societies to get a suggestion of what it may have been like but we absolutely cannot make assumptions that it was harmonious any more than we can assume Paleolithic people were in a constant state of stress and terror.
See this very interesting discussion on modern hunter-gatherers at How the Light Gets In philosophy festival 2014 (with Daniel Everett and Bruce Parry amongst the guests)
5. Paleo adherents project their argument ‘from an entirely arbitrary point in the long history of human evolution’. It is widely believed that the agricultural revolution which marked the end of the Paleolithic Era is one of the most defining – if not the defining – moments in our evolution. Whether or not one believes it was ‘…the worst mistake in the history of the human race’ as Professor Jared Diamond stated, we cannot fail to concede that what happened after the Paleolithic Era fundamentally changed humanity.
For further reading on the impact of the agricultural revolution and the move away from hunter-gathers to farmers, see the following:
The Other Side of Eden: Hunter-Gatherers, Farmers and the Shaping of the World by Hugh Brodie – a beautifully written book that explores the triumph of farming over the hunter-gatherer.
Against the Grain by Richard Manning – I cannot recommend this book enough; a wonderful examination on the impact of agriculture on the development of the human race.
The problem with the Paleo ‘Ideology’
Leaving diet aside we move on to the meat (excuse the pun) of Mr Wilson’s argument. The discussion about nutrition and evolution is used merely as a way to get at the heart of what he sees as the real problem with Paleo – social hierarchies and in particular sexism.
Why ‘pick’ the Paleolithic Era as a model on which to base a lifestyle? According to Mr Wilson it has nothing to do with food and more to do with the ‘desire to justify or reimpose certain social hierarchies, especially those concerning gender.’ He adds that advocates are ‘dedicated to a selective denial of modernity, which in some cases is accompanied by anti-feminist attitudes’.
This is perplexing. I have to begin by saying that I can only speak as I find. Perhaps there are hordes of Paleo people out there – I am assuming both the men and women are culprits here – who seek to impose social hierarchies and gender stereotypes but I have yet to read or hear about them, let alone to meet them.
I travelled to Paleo f(x) 2014 in Austin, Texas – read all about it here – and so I guess that of all places, this would be where I would find a true representation of Paleo people and find out what they were really like. I was one of only 2 people from the UK at the event (the other was a speaker) and I stayed for quite a few days and travelled alone. I was the proverbial ‘outsider’ from across the pond, so I was able to get a clear insight into the scene and its adherents. What did I find?
I went to the social events in the evenings as well as the talks from 8.30am to 5pm each day. I joined a meet-up group and we shared lunches. I met men, women, young people, older people, singles, couples expecting their first baby and families who travelled together. I met Paleo celebrities and total beginners. I met doctors and patients. People went out of their way to be kind, knowing that I had travelled all the way from the UK. We exchanged stories about how we found Paleo and the benefits it had given us. I met people who had experienced illness and had come through the other side. I met people who were planning to ditch jobs and change their careers because the lifestyle had such a profound effect on them. I can honestly say that I did not meet anyone – anyone – who wanted to ‘impose social hierarchies and gender stereotypes’. The women that I met were strong (many both mentally and physically) and positive. Why would they – and I include me here too – be so dedicated to a lifestyle that in any way advocated a restrictive definition of gender, for both men and women? Are we all deluded or stupid? Too busy thinking about kittens and chocolate to see what was in front of us?
There was no doubt that people were enthusiastic and committed. Were they evangelical? Yes, maybe they were and are – myself included. I will talk about Paleo to anyone that shows an interest. Otherwise I keep quiet in social situations unless asked. Then I am happy to talk about it to my heart’s content. Is it an ideology? Yes, maybe it is in that it spreads outwards from food choices to affect the way we think about many other areas of our lives. I would say that vegetarianism and veganism are ideologies and I respect people’s right to choose those just as much as I respect their right to choose Paleo. Is it a harmful ideology? Well, each is entitled to their opinion on that. I could think of worse.
Ideology or not, the ironic thing about all this is that as a woman, I have redefined what I think is desirable in terms of visual appearance. This has happened subtly over the course of the last few years since adopting Paleo. Women are bombarded in magazines by pictures of uber-thin models and celebrities to aspire to. Throughout my life I have been no more immune to this than the next woman. Alternatively we have constant reminders that the nation is getting fatter with pictures of obese people on every other news item. These two extremes are the norm for visual references of women in our society. Finding Paleo has meant that for the first time in my life I have placed strength (and its consequence, health) above all else. Strength comes in all shapes and sizes (tall and lean to short and stocky) but there is no mistaking it when you see it. Paleo f(x) was the first time I had seen so many strong men and women (both mentally and physically) in one place and it was fantastic.
There were just as many well-known women Paleo women as men. Some of the biggest figures in Paleo are women – Nora Gedgaudas, Dr Terry Wahls, Michelle Norris, Sarah Fragoso, Michelle Tam, Melissa Joulwan, Melissa Hartwig … the list goes on and on. These women are strong and knowledgeable. They create businesses, give lectures, practise medicine, write bestselling books, manage illness and hold successful careers, often while raising families. Is Mr Wilson really saying that they have had the wool pulled over their eyes, or that they are implicitly advocating gender stereotyping in which women are solely regarded as ‘gatherers’ or delicate creatures that rely completely on their strong ‘hunter’ men?
One of the most interesting talks for me at Paleo f(x) 2014 was the panel on masculinity called Cultivating the Well Adjusted Male (including Mr Wilson’s Paleo Public Enemy No.1, John Durant) You can read my notes here. This was a fascinating debate and one that I thought a lot about afterwards. I have been thinking about it again in the context of Mr Wilson’s article. It is widely acknowledged that men face increasing rates of suicide (the suicide rate in men in their forties and fifties has risen 40% in ten years), unemployment, mental illnesses and criminality. There is debate about their role within society and within the family, about their academic performance and issues of identity, about the lack of role models for young boys.
For further information regarding men and depression see Depression and suicide in men and The silent epidemic of male suicide. See also this article: Why do so many men like my friend take their own lives?
For an interesting take on this issue see Our attitude to violence against men is out of date
The panel focused on the need for men to be given the space to be themselves but stressed that there is no one definition of masculinity. It was a hugely interesting discussion (please read the short notes) and one that highlighted the fact that men – as much as women – need the space and encouragement to just be themselves, in all of their different ways. Acknowledging a need for competition or an enjoyment of hunting seems perfectly harmless in the great scheme of things and is certainly not anti-women. Why should a man be suppressed from exhibiting these traits if he so chooses? Why shouldn’t men and women be free to express their identity in the way they choose? Mr Wilson’s concern over gender stereotypes misses the greater issue of freedom of choice and the importance of mutual respect, of working together, of finding one’s strengths. The freedom to ‘be a man’ (however that is interpreted) does not automatically imply that women are reduced to powerless gender stereotypes. There should be freedom for both sexes in choosing the roles they wish – hunter, gatherer, housewife, career woman, stay at home dad, gay or straight. What is important is mutual respect and support for the decisions we make, for the roles that we willingly choose, and for the people that we are. If we lose this, we run into problems.
The most outrageous claim by Mr Wilson is perhaps his assertion that Paleo:
‘…expresses a belief that the bones and guts obtained by the hunter can not only supplant the products of modern medicine, but can effectively substitute for mother’s milk.’
This really is so outlandish that it is off the scale. Anyone who has the slightest knowledge of the Paleo/Ancestral Health scene, knows that there is much talk about the possible advantages of breast-feeding from the aspect of the baby’s gut health and in particular the development of a healthy microbiome. As I said, I am not getting into the whole baby feeding, Pete Evans argument but needless to say this is a gross misrepresentation of Paleo and one that shows wildly imaginative speculation.
For more information on the effect of breastfeeding and the baby’s microbiome see:
Likewise, the idea that Paleo seeks to supplant modern medicine is both simplistic and erroneous. If Mr Wilson means that the ideal would be a world in which people are healthier, stronger, live longer and do not fall prey to diseases such as cancer, heart disease, diabetes and dementia, relying less on drugs and medical intervention and more on prevention through diet and lifestyle then yes, the Paleo/Ancestral Health scene does desire that. If he means that Paleo adherents believe that modern medicine can be done away with – that’s right, there’s no need for any of it – and that we should all go back to how it was 20,000 years ago, dying from wounds and traumatic childbirth, well that really is stretching things.
As I said at the beginning of this article, I approve wholeheartedly of Mr Wilson’s right to his opinion. It’s great to hear what people think of Paleo and I can only speak how I have found things. However, in view of all of this, the most upsetting thing is the real persecution, hatred and violence towards women (and men) around the world which stands in stark contrast to this imaginary sexism that Mr Wilson has pulled out of thin air from the remnants of the Pete Evans controversy. There is enough of this to keep the most avid feminists and people like Mr Wilson busy for the next 100 years. Perhaps he would do better to focus on that and leave Paleo – a scene which he clearly knows nothing about – well alone.
‘What is a little worrying that when asked, more than half of consumers didn’t know that sodium chloride was salt. We shouldn’t be surprised that consumers don’t understand a lot of the ingredients on the back of the pack but that doesn’t make them bad ingredients… It’s a complicated area. I wouldn’t expect consumers to understand the ingredients or I wouldn’t expect them to understand the regulatory framework but I would expect them to trust the people that are making the food for them because that’s what they do.’
Alice Cadman: Leatherhead Food Research
Some time ago I listened to a discussion regarding the processing of orange juice labelled as ‘not from concentrate’. Although I don’t drink juice, I did drink it before Paleo and naively assumed that ‘not from concentrate’ juices were made from freshly squeezed oranges and nothing else. I had no idea about flavour packs that are added to the juice (which is heated, stripped of flavour and sits in vats for up to a year) and the chemicals they contain, expertly adjusted in the laboratory to mimic the taste of fresh orange juice as closely as possible.
Of course this is only the tip of the iceberg. The ability to manipulate words to suggest a ‘natural’ product is rife within food manufacturing and I am sure that we are all aware of it, but the recent edition of the Radio 4 Food Programme ‘The Clean Label Question’ was still an eye-opener as to what goes on behind the scenes.
Avoiding processed foods is a major part of adopting Paleo but the addition of chemicals to even the most basic packaged foods without having to label them (for instance to a tub of fruit salad or pack of frozen vegetables), means that it is becoming increasingly difficult to make informed judgements on the quality of the food that we are buying. Joanna Blythman’s new book Swallow This: Serving Up the Food Industry’s Darkest Secrets lifts the lid on processes that the food industry employs to convince consumers that what they are buying is ‘natural’. Termed ‘clean labelling’ it is an advertising method that ensures big profits for food companies at the expense of unsuspecting consumers looking to make healthier choices.
Joanna assumed a false identity and went ‘undercover’ in the food industry to attend some of the big trade shows where such chemicals and manufacturing processes are showcased. She admitted that her book merely scrapes the surface of what is going on in the production of our food.
Of course, when reading the list of ingredients for many processed foods we are taken aback by the sheer number of them; many of which do not sound like food at all. Using the example of a cherry bakewell cake which should really only have a handful of ingredients, Joanna listed the contents of the processed version which included 4 types of sugar, modified maze starch, vegetable oil, emulsifiers, cornflour, flavouring, acidity regulators, fruit and vegetable extract (radish) used as colouring. She explained that the issue is primarily one of cost. Since the traditional ingredients of a cherry bakewell are so expensive, the food economist seeks to replicate these flavours through the use of chemicals and creates a cheaper product for the consumer.The same with vanilla beans; Joanna explained how it is much cheaper to use synthetic vanilla flavouring which replaces the flavour lost in processing and masks off the unpleasant tastes produced in the factory process. Through such additives, cheap, ‘tasty’ food can be brought to those who may otherwise be unable to afford it. But is that really the full story?
‘All sorts of bad things are done to food in the name of feeding poor people’ Joanna Blythman
We can maybe argue that this is a question of choice. If foods contain chemical additives and the consumer chooses to ignore this and buy them anyway what’s the problem? Perhaps they like the taste. Shouldn’t we be free to choose? Joanna points out that the issue is one of deception. Many consumers want ‘natural’ foods and go out of their way to make the right decisions but the ‘clean label’ methods used by the manufacturers are deliberately obscuring the true extent of food additives and confusing the consumer.
The presenter asked Alice Cadman, Director of Marketing at Leatherhead Food Research about the addition of chemicals to our food, first brought to widespread attention by Maurice Hanssen’s bestselling book E for Additives (1987). Ms Cadman noted the irony over the panic about E numbers as they ‘…were created to assure consumers that additives had been tested and approved.’ She went on to issue what sounded like a veiled threat: ‘…when you remove additives that are there to keep food safe, you have to be aware of the consequences.’
There was also a very interesting conversation with John Forbes Global Support Manager at Treat in Bury St. Edmunds (a company specialising in citrus flavours). John described how scientists (which he likened to artists) create synthetic versions of natural essences by analysing the key substances that tell us it is (for instance) an orange flavour. These key molecules are then reproduced in synthetic form to produce a convincing flavour. Artistic merits aside, Mr Forbes explains how the primary issue is always cost; it is much cheaper to use a non-natural material.
We then hear about the ‘Southampton Six’ (Tartrazine (E102), Ponceau 4R (E124), Sunset Yellow (E110), Camoisine (E122), Quinoline Yellow (E104) and Allura Red (E129)); artificial colourings that were labelled with danger warnings after research found them to be linked to ADHD in children (see here.) I’m not sure how this fits in with Alice Cadman’s comment (above) but it is obvious that we do not know enough about the long-term effects of thousands of chemicals added to our food. Chemicals such as the Southampton Six were added to food first before knowing finding out the full consequences afterwards.
Joanna explained that with colourings there is no distinction between natural and synthetic. The methods used to produce each may be indistinguishable and even the food industry finds it hard to draw a distinction. Artisan packaging, together with language such as ‘extracts’, ‘essences’ and ‘concentrates’ obscure this even further. Yet Barbara Gallani, Director of Regulation of Science and Health at the Food and Drink Federation assured us that ‘labels have never been so clear and transparent as they are now.’ She added that information is also available on official/government websites and that consumers have hotlines to get specific information if they are concerned about additives. She also raised the issue of safety and appearance through storage and transport. There seemed to be a desire to swing the argument away from producing cheap food to one of chemical additives being essential for the safety of our food.
‘I just don’t think that people realise just how much sophisticated interference with their food is going on behind the scenes’. Joanna Blythman
The most surprising part of the programme for me was the discussion of enzymes (biological catalysts that speed up chemical reactions). The consumer does not need to be notified when food contains these and all processed food is thought to contain at least one ingredient that is treated with an enzyme. There are around 150 enzymes used in food processing and even foods such as tubs of fruit salad and frozen fruit and vegetables are treated with them to extend shelf life. We heard how enzymes are accorded the rather worrying status of GRAS ‘generally regarded as safe’ (my italics); thus insuring that manufacturers are covered should any future problems arise. There is evidence that enzymes are potentially allergenic (for instance bakery enzymes may cause respiratory problems and allergies).
George Cass, Professor of Toxicology at the European Food Safety Authority (EFSA) based in Parma, Italy described the process in assessing the safety of various chemical compounds. Companies contact the Authority with information on the particular substance and then the compound is analysed to see whether it is safe for the consumer. There are currently 2700 flavouring compounds used in Europe and they are all being re-evaluated as there was no consistent evaluation process in the past (being left to individual states). We heard that the Authority is currently involved in checking the safety of enzymes – especially with regards to allergenicity. If any problems are identified, the Authority will inform EU.
As Joanna concluded the discussion by stressing the need for people to cook, there was a very interesting exchange over the issue of class. The presenter voiced concerns that any talk about the importance of learning to cook strayed into Baroness Jenkin territory: the Conservative peer who recently suggested that poor people don’t know how to cook (see here). Joanna agreed that the prevailing attitude here in the UK is that it is OK not to cook but emphatically denied that this is just about working class people, noting that Baroness Jenkin’s mistake was linking it to class (although the terms ‘poor’ and ‘working class’ seem to have been confused). She added that if we are discussing class, in many ways it is actually middle class people who are being conned the most as they are paying a premium for processed food that they think is ‘superior’ to the more obviously cheaper processed food.
Class distinctions aside, listening to all this is obviously disheartening. The onus is – as always – put on to the consumer to ferret out the information about the food they are buying. At what point did we think it normal to have to consult government websites and hotlines about the food we eat? Of course there is a danger of being completely overwhelmed by all this and just saying ‘to hell with it’, but food labelling is one of the tools we use to help us choose food that is healthy and safe. ‘Clean labelling’ is a deliberate attempt to confuse the artificial with the natural and makes these choices even harder.
By following a Paleo diet we attempt to simplify food choices to the essentials, avoiding processed food as much as we can (I still regard things like coffee and coconut milk as processed), and sticking to basics. Sometimes when I walk around a shop, service station or airport while travelling and without pre-prepared food I often toy with the question ‘What would a hunter-gatherer recognise as food here?’ It’s not a perfect test but it helps. In a sea of sandwiches, panini’s, pies, cakes and confectionary, a tub of fruit may look like the nearest thing to natural food but after listening to this programme I realise that I might be wrong. Then again, even if I choose a piece of fruit, what about the chemicals that may have been sprayed on it? Some would argue that we could we could drive ourselves crazy with all of this but I think that the key is mitigation. Choose real food as much as possible in its natural state without the packaging (meat, fish, veg, fruit, fats, nuts and seeds, herbs and spices) from sources you trust, try to avoid processed foods and anything with ingredients that sound more at home in the laboratory and when you see a label that screams ‘natural’, just don’t believe the hype.
Ninety years ago, a German scientist named Otto Walberg put forward a theory of cancer that was to radically alter the way we think about this devastating disease. However, a change in thinking would not happen immediately. It would take many years before his theory finally gained ground. In 2014 there is increasing attention being paid to the work of Otto Warburg and the implications his theory has for the prevention, cause and treatment of cancer. The journey has really only just begun…
‘Could we have mischaracterized the true nature of cancer?’
I have just finished reading Tripping Over the Truth by Travis Christofferson. As I closed the last page, I turned back to the first and started it again. That’s how good this book is. In fact, I don’t know if I can do it justice but here goes…
I first heard about Travis via an article he posted on Robb Wolf called The Origin of Cancer last year. I thought it was one of the most fascinating articles* I had ever read and was keen to find out more about the foundation Single Cause Single Cure, which Travis founded. I had also been interested in the work of Dr Colin Chapman, Professor Thomas Seyfried and Dr Dominic D’Agostino and their research into ketogenic diet therapies for cancer using the Warburg Hypothesis, so Travis’s article sparked a real desire to learn more about the metabolic theory of cancer. As I always say about Paleo, I was led down the proverbial rabbit-hole of discovery and so I was very excited to hear that Travis had written a book which was released in the UK last month.
This book will hook you from the first page. Firstly, I want to say that it is neither a medical textbook nor a heavy scientific tome that will require prior knowledge to understand its argument (although I had read the excellent The Emperor of All Maladies by Siddhartha Mukherjee, which gives an overview of the story of cancer.*) Tripping Over the Truth is for everyone; doctors, patients, medical professionals or simply people like me who are interested in this field of cancer research and the possibilities of nutritional therapy as an aid to treatment. It is an incredibly well-crafted, easily-read and profoundly moving account of the fight against cancer, detailing a theory of its origins that was all but forgotten save for a handful of scientists over the last 100 years.
As we know all too well, each of us has been touched by cancer in some way. It is hard to write about, to read about and to talk about yet as Travis points out, one in two men and one in three women will be diagnosed at some point in their life. It is all around us, yet we are silenced by it. These figures are astounding.
‘Cancer stands alone as our most ardent, confusing, shapeshifting and devastating enemy.’
Tripping Over the Truth takes us on a journey from the Chimney Boys of Percival Potts 19th Century London and the discovery of carcinogens to the very latest drugs such as 3BP and therapies such as Hyperbaric Oxygen Therapy (HBOT) and the Restricted Ketogenic Diet (R-KD). We learn about chromosomal abnormalities of cancer cells, about viral infections, the discovery of DNA and its implications for cancer research, the advent of chemotherapy (born from the toxic weapons of World War II), Nixon’s ‘War on Cancer’ and the new generation of drugs such as Herceptin that target oncogenes (genes that have the potential to cause cancer).
We discover why much of what we know about the prevention, causes and treatment of cancer is rooted in a deeply-held belief about its origins which – at its very core – may be erroneous. To say that writing a book like this will bring Travis in for some hard criticism is an under-statement. As with anyone involved in this area of research, going against the conventional thinking in the fight against what is undoubtedly our most feared disease will invite much condemnation, as well as praise.
This book questions why a cure for cancer continues to hover outside of our reach. Why have we not seen the breakthroughs that we hoped? Why does the complexity of the disease continue to confound scientists? Why have the billions that we have spent on research not succeeded in improving overall death rates since the 1950s? These are questions that must be asked if we are to move forward in our understanding of cancer.
Current thinking posits the origins of cancer as resulting from damage to our DNA; the genetic or Somatic Mutation Theory (SMT) of cancer. This idea dominates research and since the remarkable discovery of DNA in the 1950’s, it has been the one overarching theory that researchers hoped would unite cancer research and provide the elusive cure. Travis describes how the ongoing project The Cancer Genome Atlas which was started in 2006 aims to sequence the entire genome of a cancer cell (all the DNA inside the gene) and thus elucidate the mutations that cause the disease. When Travis looked at the research coming out of this project, he was struck by the failure to provide consistent data along with its apparent randomness: ‘No single mutation or no combination of mutations could be identified that were absolutely required for the disease to start.’ In addition to this, Travis explains that the new drugs developed to target these mutations have not lived up to their promise for the following two reasons:
1.‘TCGA failed to identify the mutations that definitively caused any given type of cancer’ and
2. ‘The mutational targets are not only vastly different from person to person, but they can even vary spectacularly from cell to cell within the same tumour.’
‘Comprehensive sequencing was unable to find a single mutation responsible for the most important quality of cancer, the single feature of cancer responsible for 90% of all cancer deaths’ (metastasis).
It is particularly upsetting to hear of the failure of many targeted therapy drugs; with 700 alone being tested in the past decade. Travis quotes Antonio Tito Fojo PhD of the National Cancer Institute in Bethesda: ‘Zero is the number of targeted therapies that have prolonged survival by one year, when compared to a conventional treatment.’
In contrast to the SMT theory, Travis explains how the concept of cancer as a disease of ‘defective metabolism’ first put forward by Otto Walburg takes a different approach. We can define metabolism as the range of biochemical processes that occur within a living organism, including the breakdown of food and its transformation into energy. Warburg’s observation that cancer cells generate most of their energy from glucose (sugar) through the process of fermentation rather than through respiration via oxygen posits a root cause to the disease.
‘The reversion from aerobic to anaerobic energy creation was the signature that defined the difference between cancer cells and normal cells. Nothing was more fundamental to a cell than energy creation. Nothing could be further reduced.’
The uptake of glucose can be detected clinically by positron emission tomography (PET) scans. The metabolic theory places genetic mutation and a host of other symptoms as secondary side effects, rather than as causes. However, it was largely ignored.
Travis discusses the work of Pete Pederson, whose research continued to focus on the Warburg hypothesis from the 1970s onwards and who has been one of the few consistent voices in the metabolic theory of cancer. His discovery of the corruption of the protein Hexokinase by Hexokinase II in the 1970s, which resulted in the abnormal overproduction of cells was an important development in metabolic theory research. Pederson’s lab made the further discovery that Hexokinase II binds to another protein called VDAC (voltage dependant anion channel) and thus effects the ability of the cell to self-destruct (apoptosis) resulting in the proliferation of cancer cells. We also learn how Pederson’s student Dr Young Ko worked beside him to develop the drug 3BP which targets the metabolism of cancer cells and which may offer promising treatment when funding is obtained and trials are completed.
Travis highlights the work of Professor Thomas Seyfried at Boston University and in particular his seminal book ‘Cancer as a Metabolic Disease’ (2012) which expands the Warburg theory even further. When the energy-generating powerhouses in our cells called mitochondria suffer damage they begin to send out signals that result in changes to the ‘entire complexion of the cell.’ These destabilising changes include the way that cells generate energy, pushing them over to fermentation rather than oxygenation and also resulting in the genetic mutations that we see in cancer cells.
Professor Seyfried uses a restricted ketogenic diet R-KD in his practice; in particular in the treatment of aggressive brain tumours. This diet naturally reduces calories (as it has been shown that calorie restriction shrinks tumours) but it also does something else: through the restriction of carbohydrates and protein together with high amounts of fat, the diet forces the body to manufacture ketones as an alternative fuel source in the absence of glucose. Cancer cells cannot use ketones; only normal cells can make the switch and the R-KD starves cancer cells of their energy. You can read more about the ketogenic diet in Jimmy Moore’s latest book Keto Clarity and for therapeutic use in cancer treatment, check the links at the bottom of the page.
In addition to this, Travis describes how Seyfried discovered the R-KD was ‘antiangiogenic – it choked off the production of new blood vessels supplying the tumour’ as well as being ‘proapoptotic, in that it facilitated orderly cell death.’ By weakening cancer cells, the diet can be used as a way to prepare the body for additional conventional treatments and mitigate their side-effects.
‘Seyfried modified the ketogenic diet to put as much metabolic stress on the cancer cell as possible.’
As we know, the ketogenic diet has been used since the beginning of the 20th Century to treat epilepsy, falling out of favour with the rise of seizure-control drugs. Charities such as Matthew’s Friends in the UK and The Charlie Foundation in the US are at the forefront of raising awareness and promoting research into ketogenic therapies for epilepsy and related neurological disorders, but there is also a growing interest in using this dietary therapy for cancer patients (alongside conventional treatments). The 4th Biannual Ketogenic Dietary Therapies Symposium took place in Liverpool UK this year and doctors such as Dominic D’Agostino and Professor Adrienne Scheck attended. With 500 representatives from 27 countries, the conference is becoming increasingly popular and with the amazing work done by Matthew’s Friends and the Charlie Foundation, press awareness continues to grow, such as in articles here and here.
In addition to ketogenic diet therapies, the development of Hyperbaric Oxygen Therapy (HBOT) alongside the R-KD is an exciting development that Travis describes. He tells us how Dr Dominic D’Agostino (see the resources at the bottom of this article for more on Dr D’Agostino) and Professor Seyfried have combined the two therapies with promising results. Through his work with Navy SEALS researching methods to prevent seizures from oxygen toxicity, Dr D’Agostino discovered that cancer cells were irretrievably damaged in the presence of high levels of oxygen. As Travis notes, these two therapies represent ‘a massive step in the direction of cheap, nontoxic, effective health care’ but warns ‘It is not unrealistic to expect friction.’ There is no money to be made in these sorts of therapies and as Travis notes, in terms of opposition, therein lies the problem.
‘When cancer is framed as a metabolic disease, the entire paradigm of treatment is turned inside out.’
The metabolic theory of cancer and books such as Tripping Over the Truth offer new hope, but Travis stresses the importance that (as in all good science) there must always be room for the prospect of error or revision: ‘It may be that the SMT of cancer and the metabolic theory are intertwined – a chimerical monster, existing in two realms at once.’ Indeed, eradication of this disease may never be achieved but as Travis notes our understanding of cancer is still in its infancy. Despite this, perhaps we are turning a corner in the prevention, treatment and ultimately the cure of cancer.
I really cannot recommend this book highly enough. The work of these pioneering researchers deserves a wide audience. Yes, it is controversial. Anything that deals with the subject of cancer ultimately is because we are so fearful to even discuss it, let alone depart from conventional thinking with regards to its cause and treatment. This horrible disease touches all of us in some way and yet when I began researching the subject and reading only a tiny fraction of the information out there, I realised I knew nothing about it. Yet the story of cancer is a gripping and spellbinding odyssey that transcends disease and cuts to the heart of what it means to be human, to be mortal. Tripping Over the Truth shines a light on our most feared enemy and encourages us to understand the potential we have at our fingertips to exploit its greatest weakness. Time will tell if we are successful, but for now let’s hope that things are about to change.
‘The therapeutic implications of metabolic therapy are that every type of cancer is treatable, because every type of cancer has the same, beautiful, metabolic target painted on its back, regardless of origin or type of cancer.’
Thank you to Travis Christofferson, Robb Wolf and all those people who work relentlessly to bring the metabolic theory of cancer and the work of these researchers to a wider audience.
Listen to an interview with Travis Christofferson on Robb Wolf’s podcast here.
*It was through Travis’s original article that I discovered the book The Emperor of All Maladies by Siddhartha Mukherjee and ordered it immediately. If you have not read this book, please do. It is a breath-taking achievement and brilliantly written. It puts the history of humanity’s battle with this terrible disease into perspective and gives a primer for reading subsequent works such as Tripping Over the Truth (although Mukherjee’ theory is firmly placed in genetics).
As well as the links above, here are a few more websites, articles and videos. Many of these are also listed over on the Resources pages and I will be adding to these as time goes on.
Dr Dominic D’Agostino’s Keto Nutrition
What is the Origin of Cancer? byTravis M Christofferson –one of the most fascinating articles that I have ever read
Can a High-Fat Diet Beat Cancer? Richard Friebe,Time Magazine (obviously the seed oils and soy products as mentioned in this article would not be ideal food sources from a Paleo perspective)
An excellent summary of the Seyfried book (see Books below):
Targeting insulin inhibition as a metabolic therapy in advanced cancer: A pilot safety and feasibility dietary trial in 10 patients. Eugene J. Fine M.D., M.S., C.J. Segal-Isaacson Ed.D., R.D., Richard D. Feinman Ph.D.,Silvia Herszkopf M.S., R.D., L.M.N.T., Maria C. Romano M.S., R.D., C.D.N., Norica Tomuta M.D.,Amanda F. Bontempo M.S., R.D., C.D.N., Abdissa Negassa Ph.D., Joseph A. Sparano M.D.
Oxidants, antioxidants and the current incurability of metastatic cancers: Jim Watson – this article is discussed at some length in Tripping Over the Truth
Single Cause Single Cure interviews Dominic D’Agostino, Ph.D – check out all the videos on the SGSC website
The Obesity-Cancer Connection Panel: from the Metabolism, Diet and Disease conference held in Washington DC from 29-31 May 2012. – with interesting input from Gary Taubes regarding carbohydrate restriction
I have been so looking forward to reviewing this book!
I am a big fan of Jimmy Moore. He has tirelessly and fearlessly charted his health journey over many years in full glare of the public eye. He has been unafraid to discuss his struggle or to challenge and debate alternative views via his extremely successful podcasts and blog. He has a thirst for knowledge which I admire and also a strong desire to help others who have suffered – or continue to suffer – with health issues. His story is one that many of us can identify with and because of this; he has a huge and loyal fan base.
The latest book Keto Clarity is written with co-author Dr Eric C. Westman and is a follow on to the extremely successful Cholesterol Clarity that they released last year. Jimmy and Dr Westman have assembled an impressive array of experts from the medical and nutritional world to discuss ketogenic diets and provide a thorough and definitive guide to a very misunderstood way of eating.
For those of you unfamiliar with Jimmy’s story, he saw amazing health results after starting the Atkins diet in 2004 and began blogging about low carbohydrate high fat diets in 2005 in an effort to help others and spread the word. You can read more about Jimmy’s story here. The shift to a fully ketogenic diet seems a natural transition for Jimmy and there is no doubt when reading the book and listening to Jimmy’s podcasts, he is experiencing many benefits brought about by ketosis. Dr Westman is Associate Professor of Medicine at Duke University in Durham, NC, and Director of the Duke Lifestyle Medicine Clinic, specializing in disease prevention and the treatment of obesity and diabetes. Dr Westman also co-wrote New Atkins for a New You with Dr Stephen Phinney and Dr Jeff Volek.
I read this book in record time – I couldn’t put it down! I would say that the first thing that struck me is how incredibly easy to read it was. I’m not one to shrink from trying to understand detailed medical texts (although Peter Dobromylskyj at the excellent Hyperlipid has me stumped much of the time). I was anticipating quite a hard read, having not read Cholesterol Clarity. I needn’t have worried – everything in this book is superbly explained and very clearly laid out. The text is interspersed with ‘Moments of Clarity’ quotes from ketogenic experts, as well as ‘Doctor’s Notes’ from Dr Westman. At the end of each chapter there are handy bullet points that succinctly sum up the information contained in the text. There is also a fantastic resources section at the back of the book with medical papers, book lists, websites and even films that relate to the ketogenic diet; a real wealth of information for anyone interested in finding out more.
I came to the book having also read The Art and Science of Low Carbohydrate Living and The Art and Science of Low Carbohydrate Performance, both by Drs Volek and Phinney. I had also done quite a bit of reading on the diet out of general interest in the benefits, particularly as a therapeutic tool for cancer and epilepsy (the work of Thomas Seyfried, Dominic D’Angostino and Travis M. Christofferson of Single Cause, Single Cure is particularly exciting). The third stage of the Wahls Protocol (Wahls Paleo Plus) is also ketogenic (see my review here) and in Brain Grain Dr Perlmutter advises a ketogenic diet for optimum brain health also (see my review here), so I was very excited to read Jimmy’s book and find out more.
Many people that follow Paleo are well-researched in the ketogenic diet. The benefits of switching from the standard high carbohydrate, low fat diet to one that is rich in fat and lower in carbohydrates brings a myriad of benefits that Paleo adherents can testify to, not least of which the absence of hunger and the ability to go for long periods without food. A ketogenic diet takes these practices one step further. However, the debate within the community concerning carbohydrates and ‘safe starches’ shows no sign of abating and the issue of ketosis continually crops up. As always, I try to keep an open mind on the various arguments and go along with the importance of tailoring the diet according to the individual’s medical history, combined with the ‘experiment and see how you feel’ school of thought. However, I do believe that the ketogenic diet as a therapeutic tool in the treatment of various conditions is proving to be an exciting field of research and if this is true, then it may act as a preventative measure too.
In Keto Clarity, we learn exactly what a ketogenic diet entails and the many benefits that it brings about. For those of you who are new to a ketogenic diet, this is a high fat, moderate protein, low carbohydrate diet. Typically this would be less than 50 grams of carbohydrate per day and around 80 grams of protein per day (this varies according to the individual and ketone testing is necessary to determine optimum levels). The remainder of the daily calorific requirement (again varying between individuals) should be made up of fat. Fat equates to typically around 70-80% of calories. Short- and medium-chain fats such as butter and coconut oil are preferable as they convert easily to ketones. Some people supplement with MCT oil and there is also research into ketone ester supplements that help to push ketone levels up.
Excess carbohydrates and protein will push the body out of ketosis and precipitate a return to carbohydrates as the primary fuel source. Jimmy notes:
‘If you are especially sensitive to carbohydras (like me) then you will be more sensitive to protein.’
In view of this, fatty meat is preferred over lean because of the fat ratio and portion sizes need to be controlled.
As a response to this way of eating, the body switches from burning carbohydrates for fuel to fat for fuel and this brings about a myriad of benefits including mental clarity, stabilized blood sugar, lowered blood pressure, reduced triglycerides, reduced inflammation, increased energy, the list goes on and on… There are many who believe that a ketogenic state is the preferred, natural state for us to be in and that evolutionary speaking, it is one in which we would have spent the majority of our time. There is an argument that we may have cycled in and out of ketosis according to food sources, availability, seasons etc. That can be (and currently is) debated until the cows come home so I am leaving it up to you to read up on the various arguments for and against. I think that Jimmy puts it perfectly:
‘Ketosis is something you may want to pursue if you are dealing with weight or health issues and you are not getting the results you desire with your current strategy.’
Upon reading about the many benefits and therapeutic effects, a ketogenic diet may be something that some people will wish to explore, not only for the treatment of specific diseases but as a preventative measure. Keto Clarity gives them the perfect starting point.
I found the history of ketogenic diets and their current use in a variety of conditions particularly interesting. They have been used in the treatment of epilepsy and seizures since the 1920s but were superseded when new drugs appeared in the 1950s. Therapeutic ketogenic diets are still used now and you can find out more about this at websites such as The Charlie Foundation and Matthew’s Friends.
To successfully remain in ketosis it is important to find your personal carbohydrate and protein threshold, so the success of this diet involves a fair amount of self-experimentation. An excess in either of these will bump you out of ketosis. It is very easy to over-consume carbohydrates and if protein levels are too high, the liver will convert excess protein to glucose via gluconeogenesis (although again this is a debated point – see the article from Ketotic here). Jimmy explains clearly how to go about testing for ketones. There are currently 3 methods to do this – each measuring different ketone bodies:
a) Urine strips which measure acetoacetate in the urine such as these. As ketones become the primary source of fuel, the body switches to Beta-hydroxybutyrate, so urine strip readings will decrease although you are still in ketosis. For that reason it is essential to use an additional method of testing
b) Blood meters which measure Beta-hydroxybutyrate in the blood such as these.
c) Breath meters which measure acetone in the breath – Ketonix is a new device on the market. Acetone correlates to Beta-hydroxybutyrate so is a more reliable method of testing than urine strips. I have been reading some reviews of this device and they have been very positive.
Testing is essential and Jimmy lists the pros and cons of each method. He also stresses the fact that just because a person is following a low-carb diet, this does not guarantee that they will be in a state of ketosis. Tinkering around with macro-nutrient ratios according to your personal requirements is the key here! At the time of writing, Jimmy was eating 80% fat, 15% protein and 5% carbohydrate.
‘Knowing the difference between how you feel in and out of ketosis is key.’
There is a great chapter on trouble-shooting, with tips to help you overcome the most common mistakes as well as a FAQ chapter that deals with some of the more contentious issues around ketosis (such as the effect on thyroid and adrenal function). I was particularly interested in the subject of gut microbiota in relation to ketosis after reading this article by Jeff Leach over at Human Food Project. It will be interesting to see how Jeff’s research pans out. The book goes on to address criticisms of the diet in a clear and easy to understand way – it really is essential reading for anyone that is confused by the conflicting arguments out there at the moment.
The culmination of the book – and probably my favourite part – is the chapters that deal with current research on the therapeutic effects of the ketogenic diet. They are split into three distinct sections: ‘Solid Science’, ‘Good Evidence’ and ‘Emerging Areas’. These chapters are preceded by an excellent guide to using the current information out there with a clear explanation of the various types of studies used in medical research: epidemiological, observational, controlled etc. Knowing how to isolate the strong and relevant studies from the thousands of papers published each year is crucial.
It is absolutely fascinating to read about the various conditions that are currently treated with ketogenic diets, as well as some of the emerging areas of study. I have reproduced the list of these in full below as it exciting to see the importance of nutrition coming into play in such a wide range of health problems. It is worth researching the ketogenic diet if you suffer from any of these. This information is supplemented by an extensive list of research papers at the back of the book.
Solid science: Epilepsy, Type 2 Diabetes, obesity, cardiovascular disease, metabolic syndrome and contributing factors, Polycystic Ovary Syndrome (PCOS, Irritable Bowel Syndrome (IBS), GERD and heartburn, Non-alcoholic Fatty Liver Disease (NAFLD)
Good evidence: Alzheimer’s, Parkinson’s and Dementia, Schizophrenia, Bipolar and other mental illnesses, Narcolepsy and other sleep disorders
Emerging areas: Cancer, Autism Fibromyalgia, chronic pain and Migraines, Traumatic Brain Injury and Stroke, Gum Disease and Tooth Decay, Acne, Eyesight, ALS, Multiple Sclerosis, Huntington’s disease, Kidney disease, Restless Leg Syndrome (RLS), Arthritis, Alopecia and hair loss, GLUT1 Deficiency Syndrome.
Keto Clarity finishes with some shopping lists, recipes and meal plans to get you started and as well as the excellent Resources section there is even a Glossary of frequently used terms.
This really is a great book for anyone interested in ketogenic diets. Jimmy Moore and Dr Eric Westman have done a fantastic job in bringing together vast amounts of information into a concise and enjoyable read.
What is clear from reading this book, and particularly reading some of stories of people who are finding benefits from the ketogenic diet, is that increasingly we are turning to n=1 experiments to treat a variety of conditions. Physicians may still be reluctant to recommend the ketogenic diet as a therapeutic tool – see for instance this story behind Matthew’s Friends – but those who are prepared to investigate may just find unexpected success. The research is clearly taking off and is much needed, but there is a whole community of people that are willing to experiment themselves rather than wait for randomized controlled trials to be published. Some may warn against this and argue that people should wait to hear conclusive evidence before embarking on a ketogenic diet. However, this diet is not a new development or fad and there is already a hefty body of research behind it, together with nearly 100 years of experience in using ketosis to treat epilepsy. As discussed in the context of an evolutionary perspective, ketosis may be a perfectly natural and preferred state for the body given that we went for long periods without food and mostly favoured high fat meat with limited carbohydrates (yes, I know about the Kitavans…). This is an extremely exciting time for nutritional research and I expect to hear much more about the benefits of a ketogenic diet in the years to come. Well done for Jimmy Moore and Dr Westman for helping to bring the ketogenic diet to a whole new audience.
For an overview of the ketogenic diet in addition to the links contained in the text above(please check those out!), see the Ketogenic Diet Resource and the Ketogenic Diet for Health. Also check out the Resources page and of course the resources section in Keto Clarity.
Interview with Jimmy on Robb Wolf’s recent podcast here.
Interview with Dr Kenneth Ford on Robb Wolf podcast here. This is a fascinating!
‘Man is an omnivore, best adapted to fat and protein. Just as man’s basic mental drives which determine much of his behaviour have not changed in millions of years…so his physical adaptation to his food has remained unchanged and there is ample evidence to show that he can avoid obesity and keep his nervous system intact by sticking to the food which helped to determine the change from ape to intelligent man: fat meat.’
Born in 1916 in India, Mackarness interestingly began his career as an artist training under Mervyn Peake at Westminster Art School. After moving on to study at the Westminster School of Medicine, he served as an army medical officer and then took various hospital posts. General practice followed, with Mackarness moving into hospital psychiatry in 1965 and later setting up an allergy clinic to treat mental illness. Richard Mackarness died in 1996 and you can read an obituary for him here.
Eat and Grow Slim
His first book Eat Fat and Grow Slim (1958) was a best seller and advocated a high fat, low carbohydrate diet based upon pre-cereal, hunter gatherer diets which is described as the ‘Stone Age Diet’. Dr Mackarness discusses the history of high fat, low carbohydrate diets including the story of William Banting (I first read about Mr Banting in Good Calories, Bad Calories by Gary Taubes). He also looks at the work of his (then) contemporary physicians such as Professor Kekwick and Dr G.L.S. Pawan at the Middlesex Hospital in London. Their research studied Banting’s diet and concluded that reduction of carbohydrate rather than fat was the key to treating obesity (their work was also an influence on Dr Atkins).
Dr Mackarness disputes the calorie hypothesis with some wonderful arguments. He stresses the importance of eating food that we have evolved to eat over millions of years, with an emphasis on fat and meat together with a reduction in carbohydrates.
The work of several pioneering physicians who warned against the excessive consumption of carbohydrates is discussed (some of whom were also mentioned by Gary Taubes in GCBC). These physicians linked a high carbohydrate, low fat diet to many diseases – diseases that we are still struggling with in the 21st Century.
Interestingly, Dr Mackarness recounts an interview with Dr Blake Donaldson, a Scottish cardiologist who moved to New York in the 1920s and who treated 17,000 people over 40 years. In 1919, faced with a growing number of patients suffering from heart disease and other assorted ailments Dr Donaldson went to the American Museum of Natural History and studied the teeth of ancient skulls. He was particularly fascinated with their apparent lack of caries and the excellent condition of their teeth:
‘Donaldson thought that the cells of which we are made might have common nutritional needs. The same food that keeps teeth healthy might prevent cataracts from developing in the eyes, and might also be good for the cells involved in the mysterious diseases like duodenal ulcer, migraine, high blood pressure and obesity…’
Dr Donaldson went on to treat many patients using a diet based around pre-agricultural foods and Dr Mackarness interviewed him in 1964:
‘Dr D: ‘I now have a group of about 1500 patients over the age of 75, who from five to forty years have avoided flour and have kept primitive food as their basic way of maintaining health.
Dr M: This is what I call a Stone Age diet. Would you agree with that description? It is a pre-cereal diet.
Dr D: Well, I should say that it is perhaps 6000 years old and twenty years ahead of its time. I think this will be a popular idea in twenty years; that flour is a bad thing for about 80% of the population.’
Dr Donaldson wrote Strong Medicine in 1963 and I would be very interested to read it.
Another notable pioneer that Dr Mackarness discusses is the cardiologist Dr Alfred Pennington. Dr Pennington placed executives of the US Chemical company Du Pont on a diet that eliminated starch and sugar and increased fats and protein, with excellent results. The work of Dr Wolfgang Lutz, author of Life without Bread is also mentioned and Dr Mackarness quotes the following observation from Dr Lutz:
‘I arrived at the conclusion that only by returning to the nutritional habits of our ancestors would people be able to overcome the diseases of civilization.’
Towards the end of the book, Mackarness makes the following very interesting observations on why the medical industry continues to promote a low fat, high carbohydrate diet in the treatment of disease.
1. ‘the medical education is still, in spite of attempted reforms, among the most authoritarian and hierarchical in the world, partly because of the mass of facts that have to be crammed into the unfortunate medical student’s head in a short space of time.’
2. ‘…because of the ladder structure of advancement in hospital medicine, the junior who questions the dogmas of his teachers and seniors is branded as a trouble-maker and his progress to consultant status made that much more difficult.’
3. ‘Textbooks take a long time to write and publish, and bringing them up to date is a formidable task.’
4. ‘Finally, more perhaps than people in any other profession, doctors are conventional and hate changing their ideas. Also, in common with the rest of humanity, they are lazy and nothing is such hard work as constructive thinking. But to be fair, there are shining examples to this rule and it has been my good fortune to know and work with some of them. It is really the middle-echelon consultants who are stuffy. The real big boys are not.’
I wonder if this still holds true today? Why is it that the work of Dr Mackarness and others like him has seemingly no influence on mainstream dietary advice? Why is the myth that saturated fat causes heart disease still pushed by many nutritionists and doctors?
Not All in the Mind
The second book that Dr Mackarness wrote Not All in the Mind followed 17 years after Eat Fat, Grow Slim. It proposes a connection between diet and mental illness due to allergic reactions to certain foods. Again, Dr Mackarness advocated a return to the foods that we have evolved to eat – the Stone Age diet – as a way of treating many of the neurological problems presented in the modern world.
‘If wrong food can make people fat and rot their teeth, why should it not, in some susceptible people, injure their brains as well and make them appear mad?’
Dr Mackarness was particularly influenced by the work of Dr Theron Randolph, a Chicago physician who pioneered the study of allergies and is considered as the godfather of environmental medicine, as well as Dr Albert Rowe of San Francisco, who created the concept of the elimination diet in the 1920’s.
In Not All in the Mind we learn about some of the patients that Mackarness has successfully treated by removing certain foods from their diet. The case of Joanna, a 27 year old woman who had tried to slash her wrists and was subsequently been treated with ECT is particularly striking. She is placed on an elimination diet with dramatic results and is able to live a normal life at last. The foods that she particularly reacted to were bacon, egg, porridge, veal, tongue and instant coffee.
We also hear of ‘Mrs A’ whose story Dr Mackarness reported in his article ‘Stone-Age Diet for Functional Disorders’ in Medical World July 1959*. Displaying an array of symptoms and after undergoing many tests including barium follow-throughs and x-rays (rather like myself!) she approached the doctor for help. Upon testing, Dr Mackarness found that cereal foods caused the most extreme reaction and after removing these from her diet, Mrs A was able to live a symptom-free life. Dr Mackarness notes that it is not always the foods themselves that cause trouble, but their chemical contaminants such as monosodium glutamate.
What is particularly interesting is the way in which Dr Mackarness talks of adaptation, evolution and stress. Here are some fantastic quotes:
‘It is a rule of ecology that living creatures show better adaptation to those things to which they have been exposed the longest: it is very much rarer to find a patient disabled by eating meat or by normal exposure to sunlight (I am not talking about sunburn), than it is to find one made ill be eating wheat or inhaling the petro-chemicals in the air on a street full of heavy motor traffic.’
‘Man’s diet has evolved over millions of years, from the monkey-type vegetarian diet of the forest-dwelling gatherers to a carnivorous one. Meat has been man’s main food for over nine-tenths of the time since he learned to walk upright and use his hands as tools. Starches and sugars as a basis for nutrition are a very recent introduction: they have been part of our diet for 10,000 years at most, as against 2-3 million years on meat, fat and protein.’
‘The primitive hunter in pursuit of food uses exactly the same nerve signals as the NASA scientist programming the computers which guide a landing on the moon. The difference is only in complexity. In both cases the work is done by the same sort of nervous system built of the same basic materials, chiefly animal fats. No nervous system has ever been built of starch and sugar and to base a diet on carbohydrates, as millions do today, is to invite the problems of inadequately constructed and malfunctioning brain and nerves.’
Adaptation in relation to the rate of change is clearly a concern:
‘The adaptation of a species can fail in two different ways: the organism may not be able to reproduce quickly enough to evolve in the face of new stress; or it may be subjected to unrelieved exposure to too much stress over too long a period’
This theory of stress was heavily influenced by Professor Hans Selye who defined stress as ‘the struggle to adapt to a noxious agent’. Read more about professor Selye here. Stress was not just a mental manifestation but a wider disease defined as ‘the rate at which wear and tear is induced in the body by the process of living.’ Certain foods are one of the many potential stressors and the struggle of the body to adapt to these causes an array of symptoms, of which psychological factors may be only a part of the whole story.
The stress response is divided into distinct stages; that of alarm, apparent adaptation, exhaustion and death. Dr Mackarness notes that patients do not contact their doctor until entering into the stage of exhaustion and herein lies the problem. This leads to diagnosing the symptoms as the cause for the illness (as in the case of the patient Joanna) rather than dealing with the exhaustion brought about by constant exposure to allergic foods.
‘Many, if not all typically ‘Western diseases’ derive from cultural trends that have changed our environment and by which we have voluntarily pushed the conditions of existence beyond our evolutionary-established flexibility to adapt’
Dr Mackarness develops the theory of a ‘masked’ (delayed or chronic) allergy as put forward by Dr Herbert Rinkel. The victim actually feels better after exposure to the allergen and consequently continues to – in the case of food – ingest the offending substance on a regular basis (perhaps with every meal) over many years, believing it to be beneficial. Symptoms of any allergic reaction are reduced or eradicated to such an extent that the person never suspects that the allergy exists until they reach a stage of exhaustion.
Dr Theron Randolph was influenced by both Selye and Rinkel and adapted Seyle’s three stages to the problem of addiction. This included food addiction, such as carbohydrates. The victim resorts to increasing amounts of the offending substance in order to remain ‘normal’ before eventually succumbing to exhaustion.
Believing that allergy (after infection), is the number one cause of illness in Western society, Dr Mackarness quotes Sir James Mackenzie in his call for the ‘simplification of medicine.’ He admits that he does not know why the allergic ‘target organ’ is ‘in the gut in one patient and the nervous system in another’, but current research into the human biome would suggest that there is a direct relationship between the two and that problems in the nervous system may have direct causation in the gut. This reminded me of the extremely interesting passage in The Wahls Protocol by Dr Terry Wahls, in which she discusses the possibility that there may be a single underlying cause to many of the diseases we face in the 21st Century. Currently, we treat the myriad of symptoms classified as separate diseases but not this primary cause. She states: ‘In a very real sense, we all have the same disease…’
The work of Dr F. Curtis Dohan of Pennsylvannia University and his research into the possible causes of schizophrenia is also discussed by Dr Mackarness. You can read more about Dr Dohan’s work here.
Towards the end of the book, Dr Mackarness gives a warning:
‘We are not infinitely adaptable animals, and there is mounting evidence that many of us have already adapted as much as we can to today’s increasingly sophisticated and chemically contaminated diet. It is time to call a halt to this appallingly risky experiment in human nutrition and to look again at the relationship between the food we eat and the changing pattern of disease in industrialized countries.’
He notes with amazement that everything that he has talked about in his book has been written in medical books and journals dating back to the 1920s, yet only a handful of doctors have used these methods. Reading this book 38 years later, (and 56 years on from the first edition of Eat Fat, Grow Slim) I wonder if anything has changed much. Are we finally recognising the critical importance of food (and gut health) in dealing with a myriad of conditions, including neurological diseases? Is nutrition given the status it deserves in medical education? Have we realised that returning to eating the real food that has sustained us for the majority of the time on this planet will not cause diseases such as cancer and atherosclerosis? Are we closer to successfully preventing the diseases of Western civilization, rather than treating symptoms? These are all questions that Dr Mackarness may have pondered decades ago and still we go round and around in circles. If we were losing the ability to adapt in the era of Dr Mackarness, what is happening now? In 2014, his books are a wonder to read but did his call for action fall on deaf ears? Let’s hope not.
‘Time is running out for us; a complete reappraisal of environmental and dietary politics in Europe and Americais literally a matter of life and death, and long overdue.’
*I have tried to locate the article by Dr Mackarness entitled ‘Stone-Age Diet for Functional Disorders’ but cannot get access to it. If anyone has a copy – do let me know.