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If your blood pres­sure is high, it is usu­al­ly a sign that your arter­ies are tight or clogged. The solu­tion to that prob­lem is to eat a diet of low-fat, plant-based foods. This can bring a big drop in pres­sure with­in a few days, as tight arter­ies relax. In the long run, it can help to unclog clogged arter­ies. Preg­nant women are prone to a dan­ger­ous form of high blood pres­sure called pre-eclamp­sia. Pre-eclamp­sia results when the woman’s blood vol­ume does not expand enough to sup­port the preg­nan­cy. Her blood ves­sels then tight­en down, to main­tain cir­cu­la­tion to her brain. But this means less cir­cu­la­tion to the pla­cen­ta and to oth­er tis­sue, such as the liv­er.  To pre­vent pre-eclamp­sia, women need to eat enough calo­ries, and the calo­ries should come from starch, not fat.  

Con­tin­ue read­ing “Do I Need Blood Pres­sure Med­ica­tion?”

An arti­cle pub­lished in the Novem­ber 28, 2017 Pro­ceed­ings of the Nation­al Acad­e­my of Sci­ences (PNAS) claims that Amer­i­cans would get nutri­ent defi­cien­cies if they go veg­an. Yet the authors are not experts on human nutri­tion or pub­lic health. Instead, they are experts on how to feed live­stock. Their con­clu­sions were not based on any stud­ies of the health of veg­an human beings.

Con­tin­ue read­ing “Sci­ence jour­nal spreads false rumors about veg­an diet”

Late­ly, food fad­dists have been claim­ing that coconut oil is a health food. They claim that it will help you lose weight. In real­i­ty, coconut oil is as fat­ten­ing as any oth­er fat. Some peo­ple even claim that coconut oil can cure Alzheimer’s dis­ease. In real­i­ty, coconut oil can pro­mote ath­er­o­scle­ro­sis, which is an impor­tant cause of vas­cu­lar demen­tia. Also, fats of any kind, includ­ing coconut oil, tend to make your body less sen­si­tive to insulin. For this rea­son, eat­ing coconut oil would prob­a­bly make type 2 dia­betes worse. Coconut oil could even make Alzheimer’s dis­ease worse, since Alzheimer’s dis­ease seems to be relat­ed to insulin resis­tance in the brain. So why are peo­ple pro­mot­ing coconut oil for brain health? The idea that coconut oil is good for your brain came out of the fact that some of the fat­ty acids from coconut oil are use­ful as part of a diet for chil­dren with severe epilep­sy.

Epilep­sy is a con­di­tion in which peo­ple suf­fer from seizures. A seizure is an elec­tri­cal storm with­in the brain. In ancient times, epilep­sy was called “the falling sick­ness” because it often caus­es peo­ple to lose con­scious­ness sud­den­ly. How­ev­er, “par­tial” seizures may sim­ply cause altered men­tal states or uncon­trolled move­ments of the body. Many ancient peo­ple thought that epilep­sy was caused by the gods or by evil spir­its. How­ev­er, the ancient Greek physi­cian Hip­pocrates explained that epilep­sy was an ordi­nary phys­i­cal dis­ease, with phys­i­cal caus­es. The ancient Greeks knew that some peo­ple with epilep­sy did not have seizures while they were fast­ing. Of course, you can­not fast for­ev­er. You have to eat some­thing even­tu­al­ly, or you will starve to death. Once the per­son with epilep­sy resumed eat­ing food, the seizures would start up again.

By the 1920s, physi­cians were look­ing for a way to mim­ic some of the effects of fast­ing, with­out starv­ing the patient to death. They knew that fast­ing caus­es keto­sis, which is the buildup of chem­i­cals called ketone bod­ies in the blood­stream. But they knew that you could also get keto­sis from eat­ing an extreme­ly low-car­bo­hy­drate diet. For rea­sons that are still unclear, keto­sis sup­press­es seizures in many peo­ple with epilep­sy. For this rea­son, an extreme­ly high-fat, low-car­bo­hy­drate “keto­genic” diet has been used since the ear­ly 1920s for the man­age­ment of treat­ment-resis­tant epilep­sy in chil­dren.

Why does an extreme­ly low-carb diet cause keto­sis? Even in the 1920s, it was obvi­ous that keto­sis meant that the liv­er was mak­ing huge amounts of sug­ar. Much of the sug­ar in the blood­stream of some­one with untreat­ed dia­betes does not come from the starch or sug­ar in the food. Instead, it has been made out of pro­tein from the food and from the body’s tis­sues. If the insulin-pro­duc­ing beta cells in the pan­creas stop mak­ing insulin, the alpha cells in the pan­creas assume that the blood sug­ar lev­el must be low. As a result, the alpha cells will make huge amounts of a hor­mone called glucagon. Glucagon tells the liv­er to make glu­cose, to bring blood sug­ar lev­els back up to nor­mal. An over­dose of insulin kills peo­ple by pre­vent­ing their pan­creas from releas­ing glucagon, which would tell the liv­er to release glu­cose to cor­rect the low blood sug­ar. That’s why glucagon is used as an anti­dote to insulin over­dose.

The liv­er makes a lot of glu­cose out of its stores of a starch called glyco­gen. How­ev­er, the liv­er can also make glu­cose out of amino acids (the build­ing blocks of pro­tein) and oth­er non­car­bo­hy­drates. When the liv­er is mak­ing a lot of glu­cose, it may start to use up one of the mate­ri­als that it needs for break­ing fat down com­plete­ly into car­bon diox­ide and water. As a result, more of the fat is processed through an alter­na­tive path­way that pro­duces ketone bod­ies as byprod­ucts.

If you are fast­ing, a lit­tle bit of keto­sis is a good thing. Some of your brain cells can use some of the ketone bod­ies as an alter­na­tive fuel source. But the severe keto­sis that goes along with severe­ly high blood sug­ar in some­one with untreat­ed type 1 dia­betes is a life-threat­en­ing emer­gency.
You can get keto­sis from fast­ing, but you can also get it from an extreme­ly low-car­bo­hy­drate diet. That is why chil­dren with severe epilep­sy are some­times fed an extreme­ly low-car­bo­hy­drate (keto­genic) diet. This keto­genic diet has some impor­tant draw­backs. For one thing, it tends to stunt children’s growth, and it can lead to some severe side effects, includ­ing inflam­ma­tion of the pan­creas. Anoth­er draw­back is that chil­dren do not like the diet, main­ly because their food choic­es are lim­it­ed. Eat­ing even a lit­tle bit of car­bo­hy­drate stops the keto­sis. For this rea­son, it is hard to get chil­dren to stick to the diet well enough to get ben­e­fits.

Most of the fats in our food con­tain main­ly long-chain fat­ty acids. How­ev­er, nutri­tion researchers real­ized that short- and medi­um-chain fat­ty acids are bet­ter at pro­duc­ing keto­sis. Per­haps it is because the short­er-chain fat­ty acids go straight to the liv­er from the intes­tine. The longer fat­ty acids are absorbed through a dif­fer­ent path­way, which does not go through the liv­er before it reach­es the gen­er­al cir­cu­la­tion. Coconut oil is a rel­a­tive­ly rich source of medi­um-chain fat­ty acids. So if you feed an epilep­tic child coconut oil, you can let them eat a bit more car­bo­hy­drate and pro­tein, while still keep­ing them in keto­sis.

Since coconut oil is so good at gen­er­at­ing ketone bod­ies, there has been some inter­est in it for patients with Alzheimer’s dis­ease. In Alzheimer’s dis­ease, the brain is hav­ing some trou­ble with using glu­cose for ener­gy. For this rea­son, some researchers sus­pect that the brain of some­one with Alzheimer’s dis­ease might work bet­ter if some ketone bod­ies were avail­able. Yet this the­o­ry remains unproven.

The keto­genic diet is use­ful in cas­es of child­hood epilep­sy that do not respond to any oth­er treat­ment. How­ev­er, it is not a health-pro­mot­ing diet for the gen­er­al pub­lic. No soci­ety on earth has ever sub­sist­ed on a keto­genic diet for any length of time. Even Inu­it (Eski­mo) peo­ple, who lived on noth­ing but fat­ty meats and fish dur­ing the win­ter, did not go into keto­sis unless they were fast­ing. Also, there is plen­ty of evi­dence that high-fat, low-car­bo­hy­drate diets lead to rapid aging and ear­ly death, even if they do not pro­duce keto­sis.

Like anti­seizure drugs, a keto­genic diet may be good for some chil­dren with epilep­sy but should not be rou­tine­ly giv­en to peo­ple who do not have epilep­sy. Unless you have treat­ment-resis­tant epilep­sy, you would be bet­ter off eat­ing an extreme­ly low-fat, high-car­bo­hy­drate diet based on starch­es and veg­eta­bles. The soci­eties that have tra­di­tion­al­ly used coconut oil tend to have low rates of heart dis­ease. How­ev­er, that is usu­al­ly because their over­all intake of fat and cho­les­terol is low. Most of their calo­ries came from car­bo­hy­drates (starch­es and sug­ars) in the rice and starchy veg­eta­bles (such as sweet pota­toes and poi) that made up the bulk of their diet. Since these peo­ple lived in the trop­ics, they also ate a lot of fruit and veg­eta­bles. Some Poly­ne­sians eat a lot of coconut. How­ev­er, they are gen­er­al­ly eat­ing whole coconut, rather than coconut oil. As a result, they get a lot of pro­tec­tion from the fiber con­tent of the coconut. In the intes­tine, fiber binds to the cho­les­terol that the liv­er pro­duces to help you digest fat. As a result, the cho­les­terol can leave the body with the feces, rather than being reab­sorbed into the blood­stream.

If you want to lose weight and pro­tect your heart and brain, don’t add coconut oil to your diet. Instead, remove oils and ani­mal-source foods from your diet. The pop­u­la­tions that eat a starchy, high-fiber diet based on low-fat plant-source foods have the clean­est arter­ies and the best chance at a long and healthy life.

 

Keto­sis does not mean that you are los­ing weight. It real­ly just means that your liv­er is turn­ing a lot of pro­tein and oth­er non­car­bo­hy­drates to sug­ar. Today, many peo­ple on the Inter­net are urg­ing peo­ple to eat a keto­genic diet: a diet that is so high in fat and so low in car­bo­hy­drates that it caus­es peo­ple to go into a state of keto­sis. Keto­sis means that “ketone bod­ies,” which are the chem­i­cal byprod­ucts of an alter­na­tive method of burn­ing fat, build up in the blood­stream. Keto­genic diets are often described as “Paleo” because many lay­men imag­ine that human beings must have eat­en keto­genic diets dur­ing the Pale­olith­ic era (ear­ly stone age). Yet there is no rea­son to believe that stone age peo­ple ate a keto­genic diet.

Most peo­ple in the stone age would have eat­en the starchy plant mate­r­i­al, espe­cial­ly roots and tubers, that they could safe­ly and eas­i­ly obtain from their envi­ron­ment. As a result, stone age peo­ple would have got­ten more than enough car­bo­hy­drate to keep them from going into keto­sis. In fact, when anthro­pol­o­gists look at the skele­tal remains of stone age peo­ple, they find starch grains embed­ded in the tar­tar on their teeth. Even the Inuit’s (Eski­mos’) tra­di­tion­al win­ter diet, which con­sist­ed entire­ly of fat­ty meats and fish, did not pro­duce keto­sis. Stud­ies done in the ear­ly 20th cen­tu­ry found that the Inu­it did not get keto­sis unless they were fast­ing. The Inu­it were eat­ing raw meat that was either fresh­ly killed or frozen imme­di­ate­ly after being killed. Unlike the meat you would buy at a super­mar­ket, this fresh or rapid­ly frozen meat still con­tained a starch called glyco­gen. The Inu­it also used a method of meat preser­va­tion that con­vert­ed some pro­tein to sug­ar. As a result, the Inuit’s tra­di­tion­al diet con­tained a sur­pris­ing­ly large amount of car­bo­hy­drate: enough to keep peo­ple out of keto­sis.

It is good that the Inu­it diet did not cause keto­sis. The Inu­it already had extreme­ly high rates of osteo­poro­sis, because of the meta­bol­ic aci­do­sis caused by their high-pro­tein diet. Adding even more acid, in the form of ketone bod­ies, would have made this prob­lem even worse. Eat­ing a lot of cal­ci­um, in the form of fish bones, did not solve this prob­lem.

Some “Paleo” advo­cates claim that keto­sis means that you are burn­ing fat and are there­fore los­ing weight. Some of them even claim that you can­not lose weight or burn fat unless you are in keto­sis, which is total non­sense. The Krebs cycle, which is the body’s nor­mal way of burn­ing fat, does not pro­duce ketone bod­ies. Hav­ing ketones in your urine does not even guar­an­tee that you are los­ing weight. To lose weight, even on a keto­genic diet, you must burn up more calo­ries than you take in. Even on a keto­genic diet, you can still gain weight. The burst of insulin that is released in response to eat­ing foods that con­tain pro­tein could dri­ve the fat from the food into the fat cells.

The keto­sis does not mean that you are los­ing weight. It is sim­ply a sign that your liv­er is turn­ing a lot of non­car­bo­hy­drate sub­stances, includ­ing pro­tein, into a sug­ar called glu­cose. Your liv­er is work­ing so hard to make glu­cose, to com­pen­sate for your low car­bo­hy­drate intake, that it is even using up oxaloac­etate, which is one of the chem­i­cals involved in the Krebs cycle. As a result, some of the fat gets bro­ken down through an abnor­mal path­way that pro­duces ketone bod­ies.

Dur­ing a fast, a lit­tle bit of keto­sis is a good thing. Your brain can use a lit­tle bit of the ketone bod­ies as an alter­na­tive fuel source. In con­trast, the severe keto­sis that results from a severe short­age of insulin in peo­ple with untreat­ed type 1 dia­betes mel­li­tus is life-threat­en­ing. Before the dis­cov­ery of insulin, peo­ple with what is now called type 1 dia­betes would always progress to ketoaci­do­sis, coma, and death. Ketoaci­do­sis means that the keto­sis is so bad that it low­ers the blood pH. Patients with dia­bet­ic ketoaci­do­sis have four prob­lems at once: high blood sug­ar, dehy­dra­tion, low blood pH, and an elec­trolyte imbal­ance. These prob­lems must be cor­rect­ed care­ful­ly, in an inten­sive care unit.

In a healthy per­son, the total amount of ketone bod­ies in the blood is usu­al­ly less than 1 mg/dL. The amount of ketone bod­ies in the urine is nor­mal­ly too low to be detect­ed by rou­tine urine tests. You can boost your pro­duc­tion of ketone bod­ies by fast­ing or by eat­ing a low-car­bo­hy­drate diet. You can get into a state of keto­sis either way. How­ev­er, the effects of a fast are far dif­fer­ent from the effects of a low-car­bo­hy­drate diet. Sci­en­tists are only begin­ning to under­stand the poten­tial ben­e­fits of peri­od­ic fast­ing. Besides being a sure-fire way to lose weight, fast­ing can help to sup­press a run­away inflam­ma­to­ry response. A med­ical­ly super­vised water-only fast is also a use­ful first step in iden­ti­fy­ing which foods might be trig­ger­ing a patient’s health prob­lems. The Paleo advo­cates are hop­ing that eat­ing bacon and eggs—but no toast—would pro­duce the same effect as eat­ing noth­ing at all. It is a fool­ish hope.

Many peo­ple swear by the Paleo diet. They have man­aged to sur­vive on it for months or even years, and they claim that they have achieved oth­er ben­e­fits, such as weight loss. Yet these tes­ti­mo­ni­als should be viewed with great skep­ti­cism. No pop­u­la­tions any­where on earth have man­aged to achieve good health sta­tis­tics or a long life span on a keto­genic diet. The pop­u­la­tions who eat a diet that is most like the keto­genic diet may seem healthy while they are young, but they have long been known to suf­fer from rapid aging and a short life expectan­cy. In con­trast, the pop­u­la­tions with the longest, health­i­est lives are the ones who are eat­ing the oppo­site of a keto­genic diet: they eat a diet based on low-fat plant-based foods. One of the impor­tant find­ings of an enor­mous epi­demi­o­log­ic study called the Chi­na-Cor­nell Oxford Project was that the less ani­mal-source food a pop­u­la­tion eats, the low­er its aver­age cho­les­terol lev­el is and the low­er its risk of death from chron­ic dis­ease is. There did not seem to be any safe lev­el of intake of ani­mal-source foods.

A keto­genic diet may be a use­ful as a des­per­ate attempt to sup­press seizures in chil­dren with some severe forms of epilep­sy. Yet in those chil­dren, the diet can have side effects. It can cause dehy­dra­tion, con­sti­pa­tion, vom­it­ing, high cho­les­terol, and kid­ney stones. Some chil­dren have had severe side effects, such as heart rhythm prob­lems, inflam­ma­tion of the pan­creas, and pos­si­bly loss of cal­ci­um from the bones. In short, a keto­genic diet may be use­ful as a way to treat some rare but seri­ous dis­eases that respond poor­ly to any oth­er avail­able treat­ment. How­ev­er, it is unlike­ly to improve health for the gen­er­al pub­lic in the long run.

Some researchers in Bel­gium just did an inter­est­ing study about how can­cer cells use sug­ar. The researchers found that one of the byprod­ucts pro­duced as a result of can­cer cells’ abnor­mal metab­o­lism could be pro­mot­ing the growth of the can­cer. In short, the researchers have fig­ured out a plau­si­ble expla­na­tion for some­thing that had been known since the 1920s: most can­cer cells use anaer­o­bic metab­o­lism, even when plen­ty of oxy­gen is avail­able. By the 1950s, it was clear that tumors that are most like­ly to use anaer­o­bic metab­o­lism tend to be the most aggres­sive. Unfor­tu­nate­ly, the reporters who have been cov­er­ing this study for the pop­u­lar press do not under­stand what the study is about or what its results real­ly mean. Many of the reporters have false­ly con­clud­ed that the study shows that some­thing in sug­ar is some­how caus­ing can­cer. As a result, they are urg­ing peo­ple to avoid eat­ing car­bo­hy­drates. Unfor­tu­nate­ly, if peo­ple avoid car­bo­hy­drates, they will end up eat­ing more fat and more pro­tein, and we know that high-pro­tein diets are the real cul­prit in pro­mot­ing the growth of can­cer.

Con­tin­ue read­ing “Dietary Pro­tein, Not Sug­ar, Pro­motes the Growth of Can­cer”

New York Times colum­nist Jane E. Brody has writ­ten a sil­ly attack on the doc­u­men­tary What the Health. Germany’s Iron Chan­cel­lor Otto von Bis­mar­ck sup­pos­ed­ly once quipped, “Nev­er believe any­thing in pol­i­tics until it has been offi­cial­ly denied.” Since the New York Times is regard­ed as the “News­pa­per of Record” in the Unit­ed States, we could amend this say­ing to “Nev­er believe any­thing in Amer­i­can pol­i­tics until it has been offi­cial­ly denied in the New York Times.”

Brody focused on one alarm­ing state­ment about the harm­ful effects of eat­ing eggs. She then con­clud­ed that the entire doc­u­men­tary was full of bad sci­ence. Some­how, she failed to men­tion the main mes­sage of the doc­u­men­tary, which is that the major health-focused non­prof­its are tak­ing mon­ey from the food indus­try. Not coin­ci­den­tal­ly, those non­prof­its are sys­tem­at­i­cal­ly fail­ing to warn peo­ple of the health risks posed by the foods that their spon­sors are sell­ing. What the Health even showed that these non­prof­it orga­ni­za­tions have some­times been urg­ing peo­ple to eat the very foods that are known to con­tribute to the dis­ease that the non­prof­it is sup­pos­ed­ly try­ing to fight. If the New York Times were real­ly serv­ing as the “watch­dog press,” then it would have been sound­ing sim­i­lar warn­ings for many years. (I sound that warn­ing in my book Where Do Goril­las Get Their Pro­tein? What We Real­ly Know About Diet and Health.) Instead, the pub­lic had to wait for an inde­pen­dent doc­u­men­tary film­mak­er to artic­u­late this mes­sage, and for Net­flix to broad­cast it.

What the Health is report­ing on a sto­ry that the News­pa­per of Record pre­sum­ably finds “not fit to print.” Word about What the Health is spread­ing via social media. Since our News­pa­per of Record can no longer ignore the doc­u­men­tary, it is time for one of its colum­nists to tell us to “move along, there’s noth­ing to see here.” Brody claimed that sev­er­al of her “well-mean­ing, health con­scious young friends” (a descrip­tion that sim­ply drips with con­de­scen­sion) urged her to watch the doc­u­men­tary, but that she had to quit watch­ing it part­way through, sup­pos­ed­ly because the sci­ence report­ing was intol­er­a­bly bad. Yet sev­er­al of the peo­ple inter­viewed in the doc­u­men­tary are promi­nent sci­en­tists, while Brody is just a news­pa­per colum­nist.

The online ver­sion of Brody’s screed was enti­tled “Good Veg­an, Bad Veg­an.” The “bad veg­ans” are pre­sum­ably “those who dis­tort sci­ence.” Yet Brody her­self is guilty of that offense. The research real­ly does show that egg con­sump­tion, like cig­a­rette smok­ing, is cor­re­lat­ed with the buildup of plaque in the arter­ies. If the effect of eat­ing two eggs a day is equiv­a­lent to half of the effect of smok­ing a pack of cig­a­rettes a day, that would work out to a five cig­a­rettes per egg ratio, which is not unre­al­is­tic. The research also shows that eat­ing processed meats real­ly is asso­ci­at­ed with an increased risk of type 2 dia­betes. As a con­sumer of eggs and meat, Brody is pre­sum­ably unhap­py about those find­ings, but her unhap­pi­ness does not make those find­ings untrue.

Although Brody rails against bad sci­ence, she pro­mot­ed some of the worst of it in her col­umn. In par­tic­u­lar, she put forth the long-dis­cred­it­ed myth that plant pro­teins are incom­plete and that veg­ans must there­fore com­bine dif­fer­ent plant pro­teins in the same meal to get a com­plete pro­tein. In real­i­ty, nutri­tion sci­en­tists have known for more than 100 years that any prac­ti­cal plant-based diet would auto­mat­i­cal­ly pro­vide enough pro­tein for a human being, as long as the per­son ate enough food to get enough calo­ries. In the 1950s, William Cum­ming Rose showed that ordi­nary sta­ples, such as rice and pota­toes, pro­vide more than enough of all of the amino acids that are essen­tial in human nutri­tion. There has nev­er been any evi­dence that human beings need to com­bine dif­fer­ent plant-based foods to “com­ple­ment the pro­teins.” If Brody had read even an intro­duc­to­ry-lev­el text­book on nutri­tion, she would know this.

Brody con­cedes that “respon­si­ble, well-informed sources” already rec­om­mend a plant-based diet. Then she assures us, on the basis of no evi­dence what­so­ev­er, that a plant-based diet can be “fleshed out” with low-fat pro­tein sources from ani­mals. In con­trast, one of the major find­ings of the Chi­na-Cor­nell-Oxford project was that even a small amount of ani­mal-source food in the diet was asso­ci­at­ed with an increased risk of death from degen­er­a­tive dis­ease. There did not seem to be any safe lev­el of intake. T. Col­in Camp­bell, who is a nutri­tion­al bio­chemist and a pro­fes­sor emer­i­tus of Brody’s alma mater, Cor­nell Uni­ver­si­ty, was the lead author of the arti­cle that report­ed that find­ing. Brody has no excuse for being igno­rant of it. If Brody is will­ing to run the increased risk of ear­ly death that results from eat­ing foods from ani­mal sources, that is her choice. But as a jour­nal­ist, Brody has a pro­fes­sion­al and human­i­tar­i­an respon­si­bil­i­ty to tell peo­ple that the risk exists, so that they can make informed deci­sions.

Brody warns, “A veg­an diet laden with refined grains like white rice and bread; juices and sweet­ened drinks; cook­ies, chips and crack­ers; and dairy-free ice cream is hard­ly a health­ful way to eat.” Yet that is a straw-man argu­ment. Nobody inter­viewed in What the Health endors­es junk-food veg­an­ism. On the oth­er hand, Dr. Wal­ter Kemp­n­er of Duke Uni­ver­si­ty dis­cov­ered in the 1930s that he could save the lives of patients with malig­nant hyper­ten­sion by hav­ing them eat a diet of noth­ing but white rice, fruit, and sug­ar. Brody’s audi­ence deserves to know things like that.

Brody’s choice of title is telling. It alludes to Gary Taubes’ book Good Calo­ries, Bad Calo­ries. On July 7, 2002, the New York Times Mag­a­zine launched Gary Taubes’ career as a nutri­tion guru by run­ning his arti­cle “What if it’s all been a big fat lie?” That arti­cle claimed that the low-fat, high-car­bo­hy­drate diet that doc­tors had sup­pos­ed­ly been rec­om­mend­ing was real­ly the cause of our obe­si­ty epi­dem­ic. Like Brody, Taubes has no for­mal train­ing in nutri­tion or dietet­ics or epi­demi­ol­o­gy. Thus, like Brody, Taubes does not even rec­og­nize the mis­takes that he makes in his writ­ings about nutri­tion. Note that Taubes has been round­ly crit­i­cized by nutri­tion sci­en­tists for mis­rep­re­sent­ing their views by mak­ing it seem that they endorsed a low-car­bo­hy­drate diet.

Some of the peo­ple inter­viewed in What the Health are famous sci­en­tists who did land­mark research relat­ed to the effects of dietary choic­es on health. Brody is not a peer of the sci­en­tists inter­viewed in What the Health. Thus, she is not qual­i­fied to serve as a review­er for any of the jour­nals that pub­lished their sci­en­tif­ic work. Yet because of Brody’s plat­form at the New York Times, she has been able to encour­age a broad read­er­ship to “skip” watch­ing a doc­u­men­tary in which these sci­en­tists explain their find­ings to the pub­lic. The peo­ple who take her advice will miss the chance to hear a poten­tial­ly life-sav­ing mes­sage that they will nev­er read in the News­pa­per of Record. For­tu­nate­ly, they may hear about it through social media.

Since the 1970s, there has been a lot of hype about the diet of the Inu­it, who were indige­nous peo­ple in Green­land as well as north­ern Cana­da and Alas­ka.  (The Inu­it were often called Eski­mos, but that name is con­sid­ered offen­sive. The cor­rect name is Inu­it. The sin­gu­lar form of the word is Inuk.) The Inu­it had man­aged to sur­vive in a hos­tile envi­ron­ment: one that was frozen and cov­ered in snow for many months out of the year. As a result, the Inuit’s tra­di­tion­al diet for most of the year con­sist­ed of meat and fish, often eat­en raw. Since the 1970s, many food fad­dists have been claim­ing that the Inuit’s diet some­how mag­i­cal­ly pro­tect­ed the Inu­it against coro­nary artery dis­ease. The goal of this pro­pa­gan­da is to encour­age peo­ple to eat meat and fish and to take fish oil cap­sules but to shun car­bo­hy­drates. Yet even the ear­li­est out­side observers of the Inu­it noticed some­thing odd about them. The young Inu­it seemed hale and hearty, but the Inu­it seemed to age quick­ly, and there were prac­ti­cal­ly no Inu­it old­er than 60 years. Stud­ies of mum­mi­fied and skele­tal remains of Inu­it who had died before the arrival of the Euro­peans con­firmed that the tra­di­tion­al Inu­it diet caused ath­er­o­scle­ro­sis and osteo­poro­sis.

The Inu­it have always had a remark­ably short life expectan­cy because they were at risk for both of the major cat­e­gories of caus­es of death: dis­eases of pover­ty and dis­eases of afflu­ence. The dis­eases of pover­ty are the things that tend to afflict the poor: star­va­tion, expo­sure, acci­dents, and gen­er­al lack of med­ical care and social sup­ports. The dis­eases of afflu­ence are the things that tend to afflict the rich: main­ly a diet that is high in fats and cho­les­terol. In trop­i­cal and tem­per­ate regions, only the rich could afford to eat meat and oth­er ani­mal-source foods on a reg­u­lar basis. But in the Arc­tic, meat was the only avail­able food for much of the year. Thus, the Inu­it were poor peo­ple eat­ing a rich diet. As a result, they aged rapid­ly and died young.

The Inuit’s tra­di­tion­al diet of fat­ty meats and fish can sus­tain a young per­son. Oth­er­wise, the Inu­it would not have suc­ceed­ed in set­tling in the Arc­tic region. How­ev­er, the Inu­it diet is bad for your health in the long run, for sev­er­al rea­sons:

• Peo­ple can catch par­a­sitic dis­eases by eat­ing raw meat. (More than 12% of elder­ly Inu­it in Green­land had trichi­nosis).
• The high fat and cho­les­terol con­tent of the Inu­it diet leads to clog­ging of the arter­ies.
• A high-pro­tein diet increas­es the risk for liv­er and kid­ney dis­ease, as well as osteo­poro­sis.
• Ani­mal-source food con­tains a con­cen­trat­ed dose of pol­lu­tants from the envi­ron­ment.

Advo­cates of a keto­genic diet often use the Inu­it diet as a mod­el. The goal of a keto­genic diet is to put some­one into a state of keto­sis. Keto­sis means that the per­son has an abnor­mal­ly large amount of keto acids in the blood. This con­di­tion nor­mal­ly hap­pens dur­ing fast­ing or when the per­son is eat­ing no car­bo­hy­drates. It can also result from insulin defi­cien­cy. Since the Inu­it were eat­ing prac­ti­cal­ly no plant mate­r­i­al for months at a time, many peo­ple assume that the Inu­it would have been in a state of keto­sis most of the time. Yet a study done in the 1920s showed that Inu­it who were eat­ing their tra­di­tion­al diet did not have keto­sis unless they are fast­ing. By the 1980s, the expla­na­tion was clear: the Inu­it were eat­ing far more car­bo­hy­drate than you might expect. The Inu­it were eat­ing a lot of raw meat that was fresh-killed or had been frozen imme­di­ate­ly after being killed. For this rea­son, the meat that the Inu­it were eat­ing con­tained far more glyco­gen (ani­mal starch) than you would find in meat that you buy at a butcher’s shop or gro­cery store. Also, the Inu­it had a way of pre­serv­ing a whole seal or bird car­cass under an intact whole skin with a thick lay­er of blub­ber. This method of preser­va­tion allowed some of the pro­tein in the meat to fer­ment into car­bo­hy­drate.

Back in the 1970s, some sci­en­tists from Den­mark wrote some arti­cles that claimed that the Inu­it of Green­land were being pro­tect­ed from coro­nary artery dis­ease by the large amounts of omega-3 fat­ty acids in their diet. In real­i­ty, the Inu­it have a high risk of coro­nary artery dis­ease. The ear­li­er research sim­ply under­es­ti­mat­ed the num­ber of fatal heart attacks because the caus­es of deaths among the Inu­it pop­u­la­tions were not being accu­rate­ly record­ed. In the 1970s, the Inu­it in Green­land sel­dom got med­ical atten­tion while they were alive, and they sel­dom under­went autop­sy after their death. So the true cause of death was sel­dom record­ed.

The Inuit’s diet is a mod­el for how Stone Age peo­ple can sur­vive in the Arc­tic. It is not a mod­el for how to live a long and healthy life when you have many food choic­es. The pop­u­la­tions that live the longest, health­i­est lives are those who have access to mod­ern med­ical care but eat a diet sim­i­lar to that of peas­ants in the tem­per­ate and trop­i­cal regions: a prac­ti­cal­ly veg­an diet based main­ly on starch­es and veg­eta­bles.

Pho­to by Inter­net Archive Book Images

The food indus­try has been urg­ing me to eat fish. The sup­ple­ment com­pa­nies have been urg­ing me to take fish oil sup­ple­ments. They claim that omega-3 fat­ty acids pre­vent heart attacks. Some peo­ple even claim that a baby can­not devel­op a nor­mal brain unless its moth­er ate fish or took fish oil sup­ple­ments. In con­trast, nutri­tion sci­en­tists tell me that green plants are an excel­lent source of the only omega-3 fat­ty acid that is essen­tial in human nutri­tion. This could explain why pop­u­la­tions that rarely if ever eat fish can have healthy hearts and healthy brains. In fact, the health­i­est pop­u­la­tions are the ones that eat very lit­tle fat of any kind and lots of veg­eta­bles.

All of the omega-3 fat­ty acids in the food sup­ply came orig­i­nal­ly from the green plants and blue-green algae (cyanobac­te­ria) that are at the bot­tom of the food chain. An omega-3 fat­ty acid called alpha-linolenic acid is an impor­tant part of the thy­lakoid mem­branes that are involved in pho­to­syn­the­sis. No ani­mal can make an omega-3 fat­ty acid. Ani­mals do not have the enzymes that would be need­ed to put a dou­ble-bond in the omega-3 posi­tion in the hydro­car­bon chain of a fat­ty acid. How­ev­er, ani­mals can length­en the car­bon chain of an omega-3 fat­ty acid. Thus, fish and oth­er ani­mals (includ­ing human beings) can con­vert alpha-linolenic acid to longer-chain omega-3 fat­ty acids, such as eicos­apen­taenoic acid (EPA) and docosa­hexaenoic acid (DHA). For this rea­son, you can find EPA and DHA in fish but not in ordi­nary plant-source foods.

Accord­ing to the Food and Nutri­tion Board of the Nation­al Acad­e­my of Sci­ences, there is only one omega-3 fat­ty acid that is essen­tial in human nutri­tion. It is the alpha-linolenic acid that is found in thy­lakoid mem­branes of the chloro­plas­ts of green plants. For this rea­son, you can get this omega-3 fat­ty acid from eat­ing green veg­eta­bles. Flaxseeds, hempseed, and wal­nuts are also good sources of alpha-linolenic acid.

You need only a lit­tle bit of alpha-linolenic acid from your food. The dietary require­ment for the two essen­tial fat­ty acids (alpha-linolenic acid and an omega 6 fat­ty acid called linole­ic acid) was dis­cov­ered only after hos­pi­tal­ized patients start­ed being fed fat-free solu­tions for an extend­ed peri­od. Yet even their need for these essen­tial fat­ty acids could be met by rub­bing a lit­tle bit of veg­etable oil on the skin.

For years, many peo­ple have been urg­ing the pub­lic to eat fish or take fish oil sup­ple­ments, to reduce the risk of heart attack. Pop­u­la­tions that eat a lot of omega-3 acids, from cold-water fish, do have a some­what low­er-than-expect­ed rate of fatal heart attacks. How­ev­er, this is prob­a­bly because of the blood-thin­ning effects of omega-3 fat­ty acids, which could also lead to more deaths from major bleed­ing. If you real­ly want to make your­self heart-attack-proof, eat a low-fat, plant-based diet to keep your total cho­les­terol below 150 mg/dL.

Some man­u­fac­tur­ers of baby for­mu­la have been adding DHA so that the for­mu­la will have a DHA con­tent sim­i­lar to that of breast milk. Yet whether the addi­tion­al DHA pro­vides real ben­e­fits to the baby is still unclear. How­ev­er, these stud­ies do raise con­cerns about giv­ing too much long-chain omega-3 fat­ty acid with­out also pro­vid­ing a sup­ple­ment of arachi­don­ic acid.

I do not know whether any veg­ans (such as preg­nant women or the elder­ly) would ben­e­fit from sup­ple­men­ta­tion with the longer-chain omega-3 fat­ty acids. If these sup­ple­ments are ben­e­fi­cial, it would be best for them to come from a plant source. Plants are less like­ly to be con­t­a­m­i­nat­ed by the pol­lu­tants that build up in ani­mal tis­sue.

Pho­to by albert­straub

Beta-carotene is a yel­low pig­ment that is found in many yel­low, orange, and dark-green veg­eta­bles. For human beings and many oth­er mam­mals, beta-carotene is a provi­t­a­min of vit­a­min A. This means that beta-carotene does not have vit­a­min A effects until the body con­verts it to retinol. Human beings can con­vert beta-carotene to retinol. Thus, human beings can get vit­a­min A from the beta-carotene in fruits and veg­eta­bles. In con­trast, cats can­not con­vert beta-carotene to retinol. Retinol is found only in meat and oth­er ani­mal prod­ucts, such as egg yolk. For this rea­son, cats can­not sur­vive on a pure­ly plant-based diet. If you want to make a pure­ly plant-based (veg­an) cat food, you must add the nutri­ents, such as retinol, that nor­mal­ly come only from ani­mal sources.

Cats must get their vit­a­min A in the form of retinol or relat­ed com­pounds (such as retinyl palmi­tate). In con­trast, it is bet­ter for human beings to get their vit­a­min A in the form of beta-carotene. The human body con­verts beta-carotene to retinol on an as-need­ed basis. If you eat a huge amount of the fruits and veg­eta­bles that con­tain beta-carotene, some of the extra beta-carotene might build up in your skin. As a result, you will get a healthy gold­en glow that is more attrac­tive than a sun­tan. In con­trast, if you over­dose on retinol, either from tak­ing sup­ple­ments or from eat­ing polar bear liv­er, you will get a poten­tial­ly fatal swelling of the brain. This con­di­tion is called pseudo­tu­mor cere­bri (which lit­er­al­ly means fake tumor of the brain). If the brain swelling dam­ages the nerves that con­nect the eyes to the brain, the result can be per­ma­nent blind­ness.

Human beings should get their vit­a­min A in the form of beta-carotene. And they should get their beta-carotene from fruits and veg­eta­bles, rather than from pills. Peo­ple who eat a lot of fruits and veg­eta­bles tend to have bet­ter health, includ­ing low­er rates of can­cer. You can­not get the same effect by tak­ing the vit­a­mins in pill form. In fact, the vit­a­min pills might actu­al­ly increase the risk of can­cer.

In the 1980s, the Nation­al Can­cer Insti­tute launched a major study called the Carotene and Retinol Effi­ca­cy Tri­al (CARET). The pur­pose of the study was to see whether pills con­tain­ing beta-carotene and retinol (in the form of retinyl palmi­tate) could reduce the risk of can­cer in peo­ple who were at high risk for lung can­cer. The study was stopped ear­ly because the can­cer rate turned out to be high­er in the peo­ple who got the vit­a­min A pills than in peo­ple who got a place­bo.

Pho­to by mattbuck4950

The major caus­es of death and dis­abil­i­ty in the Unit­ed States today are diet-relat­ed dis­eases. As I explain in my book Where Do Goril­las Get Their Pro­tein?, you can pre­vent heart attacks and many can­cers by eat­ing a low-fat, pure­ly plant-based (veg­an) diet. That same diet can also pre­vent and even cure some seri­ous autoim­mune dis­eases, such as rheuma­toid arthri­tis. Yet doc­tors are not being taught about diet. Instead, they learn how to use med­ica­tions and surgery to treat diet-relat­ed dis­eases. To avoid pay­ing for those expen­sive treat­ments, insur­ance com­pa­nies are putting restric­tions on what kind of care they will cov­er.

Often, insur­ance com­pa­nies refuse to pay for an expen­sive treat­ment until the doc­tor has proved that all of the cheap­er treat­ments have failed to help that patient. This pol­i­cy is called “fail first” or step ther­a­py. Unfor­tu­nate­ly, a patient with a seri­ous con­di­tion could die or end up per­ma­nent­ly dis­abled unless the right treat­ment is used right away. As a result, doc­tors have been spend­ing more and more of their time in nego­ti­a­tions with insur­ance com­pa­ny clerks. Trag­i­cal­ly, those clerks often end up mak­ing the treat­ment deci­sions, even though they are not qual­i­fied to prac­tice med­i­cine and have nev­er even met the patient. To solve this prob­lem, we must give doc­tors bet­ter train­ing in nutri­tion, and then let the doc­tors, rather than insur­ance com­pa­ny clerks, prac­tice med­i­cine.

Step ther­a­py is a per­ver­sion of a good med­ical idea called stepped care. Stepped care is the idea that patients with a less urgent or less seri­ous case should get treat­ment of a low­er inten­si­ty, at least at first. For many ill­ness­es, it makes sense to start with a less-inten­sive treat­ment (such as a change in diet) rather than using a more-inten­sive treat­ment (such as med­ica­tion). Even if med­ica­tion is need­ed, it may make sense to start with a cheap gener­ic med­ica­tion with a well-estab­lished safe­ty pro­file, rather than using an expen­sive new drug whose long-term safe­ty is unknown. Yet even if doc­tors are using the stepped care mod­el, they do not need to start with the bot­tom step. They can jump to a mid­dle step or even the top step in seri­ous cas­es.

In stepped care, the doc­tor and the patient make the med­ical deci­sions. But in “fail first” or step ther­a­py, the bean-coun­ters at the insur­ance com­pa­ny make the med­ical deci­sions. By requir­ing “fail first,” insur­ance com­pa­nies ensure that a lot of patients will have treat­ment that fails. In con­trast, doc­tors want to pick the ther­a­py that is most like­ly to suc­ceed.

Since so many dead­ly and dis­abling dis­eases are caused by an over­ly rich diet, dietary man­age­ment should be the first step in man­ag­ing them. Dietary ther­a­py itself can fol­low a stepped care approach. For arthri­tis patients, the first step in dietary man­age­ment is a low-fat veg­an (pure­ly plant-based) diet. Ani­mal pro­teins and fat­ty foods pro­mote arthri­tis. If the ani­mal pro­teins enter the blood­stream before they are bro­ken down into indi­vid­ual amino acids, they can pro­voke the immune sys­tem to make anti­bod­ies. Since the ani­mal pro­teins resem­ble human pro­teins, those anti­bod­ies can then attack the person’s own tis­sue. Diets that are high in fat and cho­les­terol make this prob­lem worse by dam­ag­ing the lin­ing of the intes­tine, mak­ing it leak. (Some of the med­ica­tions used to treat arthri­tis pain also dam­age the intes­tine.)

If a low-fat veg­an diet does not pro­vide ade­quate relief with­in a few weeks, the patient can also elim­i­nate the gluten-con­tain­ing grains (wheat, rye, and bar­ley). If prob­lems per­sist, the patient can be taught how to fol­low a for­mal elim­i­na­tion diet, which excludes the oth­er plant-source foods that are known to cause prob­lems in some patients (e.g., corn, soy, straw­ber­ries, cit­rus fruits). After the patient feels bet­ter, plant-source foods can be care­ful­ly rein­tro­duced, one at a time, to iden­ti­fy the foods that were caus­ing prob­lems.

In severe cas­es, such as a flare of rheuma­toid arthri­tis, the doc­tor may want to start with a ther­a­peu­tic fast, which is the top step in dietary man­age­ment. A ther­a­peu­tic fast involves tak­ing noth­ing but water by mouth for days to weeks, in a set­ting of com­plete rest. This is the ulti­mate elim­i­na­tion diet. By eat­ing noth­ing at all, the patient avoids all pos­si­ble dietary trig­gers of dis­ease. A ther­a­peu­tic fast also caus­es hor­mon­al changes that stop run­away inflam­ma­tion. After the fast, foods should be rein­tro­duced care­ful­ly, one at a time. Ther­a­peu­tic fast­ing should be done only under med­ical super­vi­sion. It is pow­er­ful med­i­cine against the dis­eases of over­nu­tri­tion, such as type 2 dia­betes and hyper­ten­sion (see chap­ter 9 of my book Thin Dia­betes, Fat Dia­betes: Pre­vent Type 1, Cure Type 2). It has long been known to be a safe and effec­tive treat­ment for a flare of rheuma­toid arthri­tis.

Insur­ance com­pa­nies devel­op poli­cies to boost their own prof­its, not to pro­tect their sub­scribers from get­ting the wrong treat­ment. There is a bet­ter way to con­trol health­care spend­ing, while improv­ing pub­lic health. Give doc­tors basic train­ing in nutri­tion. Teach them how to use diet rather than drugs to solve diet-relat­ed prob­lems. Then, let the doc­tor decide what oth­er kinds of treat­ment his or her patient needs, even if that treat­ment is expen­sive. Let the doc­tors, not the accoun­tants, prac­tice med­i­cine.