Low-Carb Diets On The Rise

I’ve been paying close attention to diet this past year. It’s something I’ve had some focus on for decades now, but new info has recently changed the public debate going on. For example, a few years back, the research data from Ancel Keys was reanalyzed and an entirely different conclusion was found to be more plausible — instead of blaming saturated fat, the stronger correlation was to sugar. So much of what mainstream dietitians and nutritionists asserted as fact was based on Keys’ work, but it has since come under a dark cloud of doubt. Simply put, it was horrible science and even worse public health policy.

My own recent interest, though, was piqued in watching the documentary The Magic Pill. It came out in 2017 and several other great documentaries have come out in the last few years, with Nina Teicholz’s documentary in the works. In playing around with diet in the broad sense, I didn’t find much that helped, beyond limiting added sugar and throwing in a few healthy traditional foods (e.g., cultured dairy). It’s not that I ever was much interested in formal diets — some combination of laziness, apathy, and being too independent-minded, hence figuring something out for myself or else failing on my own terms, no doubt plenty of failure was involved and long periods of depressive despair and frustration. I’ve always been more about experimenting and finding what works or doesn’t work for me, if for no other reason than being stubborn in going my own way.

The problem was that nothing fundamentally had worked for my depression that plagued me my whole life nor for the weight gain that hit me as I approached my 40s. It is damn hard struggling to be healthy while depressed, but I did try such things as exercising regularly for it had some immediate palpable effect. Still, it was strange to exercise and yet not lose weight, even if aerobics did lift my mood ever so slightly. I was literally running to stay in place.

That is where The Magic Pill came in. I randomly came across it and watched it out of passing curiosity. Something about the case made was compelling to me, a blend of science and personal experience that rang true to my decades of reading and experimentation. It brought many pieces together: the whole foods emphasis on quality, the vegetarian emphasis on plant foods, the traditional food emphasis on nutrient-density, the low-carb emphasis on avoiding grains, legumes and sugar, the ketogenic emphasis on shifting metabolism, mood and much else, the alternative health emphasis on eliminating processed foods and additives, and the holistic/functional medicine emphasis on seeing the body as a system and part of larger systems.

So, what miraculous diet brings all of this diversity of views together under the umbrella of a coherent understanding? It’s the paleo diet, although some prefer to call it a lifestyle or a philosophy as it isn’t a singular dietary regimen or protocol. It’s about learning how to be healthy by following the examples of traditional societies in combination with the best science available, not only research in diet and nutrition as narrow fields but also research from dentistry, anthropology, archaeology, etc — any and all info that helps us understand the evolution of human health, specifically in explaining what has gone so terribly wrong in industrialized societies with the diseases of civilization. Diet is important, but only one part. Through an alliance with functional medicine, there is a greater focus on what makes for a healthy lifestyle: exercise, stress reduction, toxicity elimination, forest bathing, sun exposure, learning new things, etc… and don’t forget about play, something lost to so many modern adults.

Despite that greater focus of concern, it is the dietary angle that draws people in. Simply put, a lot of people feel better on the paleo diet, often in healing numerous conditions or at least reversing some of the worst symptoms, from conditions like obesity and diabetes to autism and depression to Alzheimer’s and multiple sclerosis, and much else. The paleo diet, as with traditional foods (both inspired by the work of Weston A. Price), is a good introduction to an alternative way of thinking not only about diet but health in general. It seems to be a gateway diet for many who go on to try related diets: primal (paleo plus dairy), Whole30, ketogenic, ketotarian, pegan, pescatarian, carnivore, etc. Primal, as one common example, demonstrates how paleolists have a tendency of drifting toward the similar traditional foods. Paleo is more of a framework than anything else, to the extent that it requires or promotes a paradigm change in one’s attitude.

The greater issue at hand is a potential paradigm change of society. That is the battle going on right now, those promoting that shift and those defending the status quo. Most figures and institutions of authority attack diets like paleo and keto because they are threatening. And the reason they are threatening is because of their growing popularity which in turn comes from their being highly effective for their intended purposes, while also being followed and sometimes promoted by many famous people, from media figures to politicians, including plenty of athletes (according to various sources, and in no particular order):

Bill Clinton, Madonna, Drew Carey, Renee Zellweger, Katie Couric, Al Roker, Halle Berry, Kim Kardashian, Kourtney Kardashian, Vinny Guadagnino, Jordan Peterson, Vanessa Hudgens, Megan Fox, Adriana Lima, Jessica Biel, Blake Lively, Channing Tatum, Eva La Rue, Phil Mickelson, Aisha Tyler, Matthew McConaughey, Edgar Ramirez, Jeb Bush, Kanye West, Christina Aguilera, Jack Osbourne, Kelly Osbourne, Sharon Osbourne, Miley Cyrus, Ursula Grobler, Becca Borawski, Aaron Rodgers, Andrew Flintoff, Jenna Jameson, Savannah Guthrie, Chris Scott, Tamra Judge, Grant Hill, Uma Thurman, Kobe Bryant, Gwyneth Paltrow, LeBron James, Alicia Vikander, Tim McGraw, Kristin Cavallari, Tom Jones, Grant Hill, Mick Jagger, Melissa McCarthy, Jennifer Lopez, Robin Wright, Cindy Crawford, Jennifer Aniston, Guy Sebastian, Elle Macpherson, Courteney Cox, Catherine Zeta Jones, Geri Halliwell, Ben Affleck, Joe Rogan, Brendan Schaub, Shane Watson, Tim Ferris, Jessica Simpson, Rosie O’Donnell, Lindsey Vonn, Alyssa Milano, Kendra Wilkinson, Christina Aguilera, Britney Spears, Joe Manganiello, Tom Kerridge, Jessica Alba, Mariah Carey, Tobey McGuire, Jennifer Hudson, Shania Twain, etc.

These low-carb diets work. People feel better, lose weight, go off their meds, have a lot of energy, and on and on. It’s a paradigm change with a real kick and so the change is largely coming from below, from probably hundreds of thousands of individuals experimenting similar to what I’ve done, including individual doctors who decide to buck the system and sometimes are punished for it (a few key examples are: John Yudkin, Tim Noakes, and Gary Fettke). And every individual this works for ends up being an inspiration to numerous others, even if only to the people they personally know such as family members, friends, neighbors, and coworkers. Other people see it works and so they try it themselves. This is how it went from a minor diet to its present growing momentum and did so in a fairly short period of time.

As I was saying at the beginning of this piece, I’ve been observing this shift. And I’ve come to realize it might be a seismic change going on. Every now and then, I see hints of the impact in the world around me. These alternative views are taking hold and won’t remain alternative for long. They are forcing their way into mainstream awareness. Unsurprisingly, there is backlash.

There is the corporate media, of course, with their typical attack pieces on “fad diets”, ignoring the fact that the keto diet has been medically researched since the early 1900s, the low-carb diet having been the first popular diet starting back in the 1800s, the traditional foods diet based on thousands of years of shared human experience, and the paleo diet as the diet hominids have thrived on for millions of years. The corporate media prefers to ignore what is threatening, until the point it no longer can be ignored, and so we are in that second phase right now, maybe a bit beyond since the mainstream authorities have already adopted some of the alternative views without acknowledging it (e.g., AHA quietly lowering its recommendations of carb intake after pushing a high-carb diet for a half century, as if hoping no one would notice this implicit admission to having been wrong, and wrong in a way that harmed so many). Local media is sometimes more open to new views, though.

The whole EAT-Lancet issue demonstrates the sense of conflict in the air. The authors of the report frame the situation as a crisis for all of humanity and the earth. And they use that as a cudgel to bash the new low-carb challengers, to nip them in the bud, even to the extreme of pushing for international regulations that would force conformity with the high-carb approach of conventional diets that have risen to prominence these past decades — mainstream versions of: vegetarianism, veganism, and Mediterranean (the modern Mediterranean diet as studied after World War II, not the traditional one with high levels of animal foods that existed for millennia before 20th century industrialization of the food system, no noodles or tomatoes prior to modern colonial trade, and surprisingly not much if any olive oil since according to ancient texts it was mainly used for lamp fuel, with animal fat being preferred for cooking). We’ve seen this push with such things as “Veganuary”.

It has become an overtly ideological fight, but maybe it always was. The politicization of diet goes back to the early formalized food laws that became widespread in the Axial Age and regained centrality in the Middle Ages, which for Europeans meant a revival of ancient Greek thought, specifically that of Galen. And it is utterly fascinating that pre-scientific Galenic dietary philosophy has since taken on scientific garb and gets peddled to this day, as a main current in conventional dietary thought (see Food and Faith in Christian Culture ed. by Ken Albala and Trudy Eden with an excerpt to be read here; I made this connection in realizing that Stephen Le, a biological anthropologist, was without awareness parroting Galenic thought in his book 100 Million Years of Food).

But the top-down approach to pushing dietary regimens hasn’t been all that successful in more recent years, maybe because of growing cynicism about past failures. Even with it being heavily promoted by well-funded organizations and government agencies, the high-carb plant-based diets are beginning to find it hard to maintain their footing in the tides of change. According to various data, it’s easy to get people to try veganism for a short period, but few maintain it. Vegetarianism is less restrictive, of course, but consistent adherence is still rare. The vast majority who start veganism or vegetarianism either occasionally eat meat or fish or else eventually give up on the diet. There is big money, including corporate money, behind the campaigns promoting it (most processed foods, including junk food, are technically vegan and big food has come to realize this is an effective way of marketing unhealthy food as healthy). Still, it doesn’t seem to be catching on with the general public, not that I doubt there will be those who continue their games of propaganda, persuasion, and perception management.

People have gotten the message that a plant-based diet is good. That part of the official messaging machine has been successful. Indeed, for decades, most Americans have been increasing their intake of fruits and vegetables and that is a good thing, but as far as that goes the paleo diet and many related diets also tend to recommend high levels of fruits and vegetables. The main advantage the low-carb diets have is that it’s easier to give up bread than to give up all animal foods (including eggs and dairy), though vegetarianism is a decent compromise since it allows some animal foods and that increases availability of the key fat-soluble vitamins. It’s not that low-carb, keto, or paleo vegetarianism is hard to do — so it isn’t an either/or scenario, but many pushing a so-called “plant-based” diet for some reason want to portray it in such dualistic terms, maybe as a way of falsely portraying low-carb as an anti-plant caricature in order to make it seem ridiculous and extremist.

Despite the ideological reaction, there is the growing realization that maybe there is some profit to be had in this emerging trend, as most businesses ultimately don’t care about dietary ideology and will go where the wind blows. New products cater to these alternative diets (paleo creamer, keto supplements, etc) or else old products are repackaged (“Keto Friendly!”). This is why it gets called a “fad diet”. But if being heavily marketed makes a diet a fad, then the same label applies to conventional diets as well that are more heavily marketed than any alternative diet. I’ve also begun seeing paleo and keto magazines, guides, and recipe booklets in grocery stores. Even when dismissed by experts such as in rankings of recommended diets, these “fad diets” nonetheless get mentioned, albeit usually tossed to the bottom of the list. As all this demonstrates, we are long past the silent treatment.

Furthermore, it goes beyond the products specifically marketed as paleo or keto or whatever. Demand has been increasing for organ meats, coconut products (from coconut milk to coconut oil), cauliflower, etc; consumption of eggs is likewise on the rise — all favorites on the paleo diet, in particular, but also favorites for similar diets. Prices have been going up on these items and, because demand sometimes exceeds supply, they can go out of stock at stores. Why are they so sought after? Organ meats are nutrient-dense, coconut milk is a good replacement for dairy and coconut oil for unhealthy vegetable/seed oils, and cauliflower can be used as a replacement for rice, mashed potatoes, tater tots and pizza crust (“The weird thing about cauliflower, though, is that while it has allies, it doesn’t really have adversaries.” ~Rachel Sugar); as for eggs, their popularity needs no explanation now that the cholesterol and saturated fat myths are evaporating.

Even Oprah Winfrey, though financially invested in the conventional Weight Watchers diet (in owning 8% of the company) and a self-declared lover of bread (actual quote: “I love bread!”), has put out a line of products that includes a low-carb pizza with cauliflower crust. This is interesting since, as low-carb diets have gained popularity, the stock of Weight Watchers has plunged 60% and Oprah lost at least 58 million dollars in one night and a loss of 500 million over all, putting Oprah’s star power to a serious test — maybe Oprah decided it is wise to not put all her eggs in one basket, in case Weight Watchers totally tanks. The company is finding it difficult to gain and retain subscribers. Those profiting from established dietary ideology are feeling the pinch.

It’s amusing how Weight Watchers CEO Cindy Grossman responded to the low-carb threat: “We have a keto surge,” she said. “It’s a meme, it’s not like a company, it’s people have keto donuts, and everybody on the diet side look for the quick fix. We’ve been through this before, and we know that we are the program that works.” And that, “We’ve lived through this [competition from fad diets] for 57 years and we’re not going to play a game and we never have.” Good luck with that! Maybe in reassuring stockholders, she also stated that, “We’re going to be science informed and we’re sustainable for the long term.” That is great. Everyone should be science informed. The problem for those trying to hold onto old views is that the science has changed and so has the public’s knowledge of that science.

Most people these days aren’t looking for complicated diets with eating plans and paid services, much less pre-prepared meals to be bought. A subscription model is becoming less appealing, as so much info and other resources are now available online. Besides, the DYI approach (Do It Yourself) is preferred these days. Diets like paleo and keto are simple and straightforward, and they can be easily modified for individual needs or affordability. But even for those looking for a ready-made system like Weight Watchers, there are other options out there that are looking attractive: “Wall Street is clearly nervous, too. JPMorgan analyst Christina Brathwaite downgraded the [Weight Watchers] stock to “underperform” last week and slashed her price target. One of the reasons? She was worried about competition from rival weight-loss service Diet Doctor, which is a proponent of keto.”

In whatever form, like it or not, low-carb diets are on the rise. Even among vegans and vegetarianism, the low-carb approach will probably become more common. Maybe that is why we’ve suddenly seen new low-carb, plant-based diets like Dena Harris’ paleo vegetarianism (2015), Will Coles’s ketotarianism (2018), and Mark Hyman’s peganism (2018). Do a web search about any of this and you’ll find numerous vegans and vegetarians asking about, discussing, or else praising low-carb diets. The same is true in how one sees broad interest in thousands of websites, blogs, and articles. Hundreds upon hundreds of organizations, discussion forums, Reddit groups, Facebook groups, Twitter alliances, etc have sprouted up like mushrooms. More and more are jumping on the low-carb bandwagon, as apparently that is what a large and growing part of the public is demanding. Whether or not it ever was a fad, it is now a movement and it isn’t slowing down.

Fasting, Calorie Restriction, and Ketosis

What we eat obviously affects gut health such as the microbiome and through that, along with other mechanisms, it affects the rest of our body, the brain included (by way of permeability, immune system, vagus nerve, substances like glutamate and propionate, and much else). About general health, I might add that foods eaten in what combination (e.g., red meat and grains) is also an issue. Opposite of what you eat impacting neurocognition and mental health, not eating (i.e., fasting, whether intermittent or extended) or else caloric restriction and carbohydrate reduction, ketogenic or otherwise, alters it in other ways.

Fasting, for example, increases the level of neurotransmitters such as serotonin, dopamine, and norepinephrine while temporarily reducing the brains release and use of them; plus, serotonin and its precursor tryptophan are made more available to the brain. So, it allows your reserves of neurotransmitters to rebuild to higher levels. That is partly why a ketogenic diet, along with the brains efficient use of ketones, shows improvements in behavior, learning, memory, acuity, focus, vigilance, and mood (such as sense of well-being and sometimes euphoria); with specific benefits, to take a couple of examples, in cerebral blood flow and prefrontal-cortex-related cognitive functions (mental flexibility and set shifting); while also promoting stress resistance, inflammation reduction, weight loss, and metabolism, and while decreasing free radical damage, blood pressure, heart rate, and glucose levels. Many of these are similar benefits as seen with strenuous exercise.

We know so much about this because the ketogenic diet is the only diet that has been specifically and primarily studied in terms of neurological diseases, going back to early 20th century research on epileptic seizures and autism, was shown effective for other conditions later in the century (e.g., V. A. Angelillo et al, Effects of low and high carbohydrate feedings in ambulatory patients with chronic obstructive pulmonary disease and chronic hypercapnia), and more recently with positive results seen in numerous other conditions (Dr. Terry Wahl’s work on multiple sclerosis, Dr. Dale Bredesen’s work on Alzheimer’s, etc). By the way, the direction of causality can also go the other way around, from brain to gut: “Studies also suggest that overwhelming systemic stress and inflammation—such as that induced via severe burn injury—can also produce characteristic acute changes in the gut microbiota within just one day of the sustained insult [15].” (Rasnik K. Singh et al, Influence of diet on the gut microbiome and implications for human health). And see:

“Various afferent or efferent pathways are involved in the MGB axis. Antibiotics, environmental and infectious agents, intestinal neurotransmitters/neuromodulators, sensory vagal fibers, cytokines, essential metabolites, all convey information about the intestinal state to the CNS. Conversely, the HPA axis, the CNS regulatory areas of satiety and neuropeptides released from sensory nerve fibers affect the gut microbiota composition directly or through nutrient availability. Such interactions appear to influence the pathogenesis of a number of disorders in which inflammation is implicated such as mood disorder, autism-spectrum disorders (ASDs), attention-deficit hypersensitivity disorder (ADHD), multiple sclerosis (MS) and obesity.” (Anastasia I. Petra et al, Gut-Microbiota-Brain Axis and Its Effect on Neuropsychiatric Disorders With Suspected Immune Dysregulation)

There are many other positive effects. Fasting reduces the risk of neurocognitive diseases: Parkinson’s, Alzheimer’s, etc. And it increases the protein BDNF (brain-derived neurotrophic factor) that helps grow neuronal connections. Results include increased growth of nerve cells from stem cells (as stem cells are brought out of their dormant state) and increased number of mitochondria in cells (mitochondria are the energy factories), the former related to the ability of neurons to develop and maintain connections between each other. An extended fast will result in autophagy (cellular housekeeping), the complete replacement of your immune cells and clearing out damaged cells which improves the functioning of your entire body (it used to be thought to not to occur in the brain but we now know it does) — all interventions known to prolong youthful health, lessen and delay diseases of aging (diabetes, cancer, cardiovascular disease, etc), and extend lifespan in lab animals involve autophagy (James H. Catterson et al, Short-Term, Intermittent Fasting Induces Long-Lasting Gut Health and TOR-Independent Lifespan Extension). Even calorie restriction has no effect when autophagy is blocked (Fight Aging!, Autophagy Required For Calorie Restriction Benefits?). It cleans out the system, gives the body a rest from its normal functioning, and redirects energy toward healing and rebuilding.

As a non-human example, consider hibernation for bears. A study was done comparing bears with a natural diet (fruits, nuts, insects, and small mammals) and those that ate human garbage (i.e., high-carb processed foods). “A research team tracked 30 black bears near Durango, Colo., between 2011 and 2015, paying close attention to their eating and hibernation habits. The researchers found that bears who foraged on human food hibernated less during the winters — sometimes, by as much as 50 days — than bears who ate a natural diet. The researchers aren’t sure why human food is causing bears to spend less time in their dens. But they say shorter hibernation periods are accelerating bears’ rates of cellular aging” (Megan Schmidt, Human Food Might Be Making Bears Age Faster). As with humans who don’t follow fasting or a ketogenic diet, bears who hibernate less don’t live as long. Maybe a high-carb diet messes with hibernation similarly to how it messes with ketosis.

Even intermittent fasting shows many of these benefits. Of course, you can do dramatic changes to the body without fasting at all, if you’re on a ketogenic diet (though one could call it a carb fast since it is extremely low carb) or severe caloric restriction (by the way, caloric restriction has been an area of much mixed results and hence confusion — see two pieces by Peter Attia: Calorie restriction: Part I – an introduction & Part IIA – monkey studies; does intermittent fasting and ketosis mimic caloric restriction or the other way around?). I’d add a caveat: On any form of dietary limitation or strict regimen, results vary depending on specifics of test subjects and other factors: how restricted and for how long, micronutrient and macronutrient content of diet, fat-adaptation and metabolic flexibility, etc; humans, by the way, are designed for food variety and so it is hard to know the consequences of modern diet that often remains unchanged, season to season, year to year (Rachel Feltman, The Gut’s Microbiome Changes Rapidly with Diet). There is a vast difference between someone on a high-carb diet doing an occasional fast and someone on a ketogenic diet doing regular intermittent fasting. Even within a single factor such as a high-carb diet, there is little similarity between the average American eating processed foods and a vegetarian monk eating restricted calories. As another example, autophagy can take several days of fasting to be fully achieved; but how quickly this happens depends on the starting conditions such as how many carbs eaten beforehand and how much glucose in the blood and glycogen stores in the muscles, both of which need to be used up before ketosis begins.

Metabolic flexibility, closely related to fat-adaptation, requires flexibility of the microbiome. Research has found that certain hunter-gatherers have microbiomes that completely switch from season to season and so the gut somehow manages to maintain some kind of memory of previous states of microbial balance which allows them to be re-established as needed. This is seen more dramatically with the Inuit who eat an extremely low-carb diet, but they seasonally eat relatively larger amounts of plant matter such as seaweed and they temporarily have digestive issues until the needed microbes take hold again. Are these microbes dormant in the system or systematically reintroduced? In either case, the process is unknown, as far as I know. What we are clear about is how dramatically diet affects the microbiome, whatever the precise mechanisms.

For example, a ketogenic diet modulates the levels of the microbes Akkermansia muciniphila, Lactobacillus, and Desulfovibrio (Lucille M. Yanckello, Diet Alters Gut Microbiome and Improves Brain Functions). It is the microbes that mediate the influence on both epileptic seizures and autism, such that Akkermansia is decreased in the former and increased in the latter, that is to say the ketogenic diet helps the gut regain balance no matter which direction the imabalance is. In the case of epileptic seizures, Akkermansia spurs the growth of Parabacteroides which alters neurotransmission by elevating the GABA/glutamate ratio (there is glutamate again): “the hippocampus of the microbe-protected mice had increased levels of the neurotransmitter GABA, which silences neurons, relative to glutamate, which activates them” (Carolyn Beans, Mouse microbiome findings offer insights into why a high-fat, low-carb diet helps epileptic children), but no such effect was found in germ-free mice, that is to say with no microbiome (similar results were found in human studies: Y. Zhang, Altered gut microbiome composition in children with refractory epilepsy after ketogenic diet). Besides reducing seizures, “GABA is a neurotransmitter that calms the body. Higher GABA to glutamate ratios has been shown to alleviate depression, reduce anxiety levels, lessen insomnia, reduce the severity of PMS symptoms, increase growth hormone, improve focus, and reduce systemic inflammation” (MTHFR Support, Can Eating A Ketogenic Diet Change Our Microbiome?). To throw out the other interesting mechanism, consider Desulfovibrio. Ketosis reduces its numbers and that is a good thing since it causes leakiness of the gut barrier, and what causes leakiness in one part of the body can cause it elsewhere as well such as the brain barrier. Autoimmune responses and inflammation can follow. This is why ketosis has been found beneficial for preventing and treating neurodegenerative conditions like Alzheimer’s (plus, ketones are a useful alternative fuel for Alzheimer’s since their brain cells begin starving to death for loss of the capacity to use glucose as a fuel).

All of this involves the factors that increase and reduce inflammation: “KD also increased the relative abundance of putatively beneficial gut microbiota (Akkermansia muciniphila and Lactobacillus), and reduced that of putatively pro-inflammatory taxa (Desulfovibrio and Turicibacter).” (David Ma et al, Ketogenic diet enhances neurovascular function with altered gut microbiome in young healthy mice). Besides the microbiome itself, this has immense impact on leakiness and autoimmune conditions, with this allowing inflammation to show up in numerous areas of the body, including the brain of course. Inflammation is found in conditions such as depression and schizophrenia. Even without knowing this mechanism, much earlier research has long established that ketosis reduces inflammation.

It’s hard to know what this means, though. Hunter-gatherers tend to have much more diverse microbiomes, as compared to industrialized people. Yet the ketogenic diet that helps induce microbial balance simultaneously reduces diversity. So, diversity isn’t always a good thing, with another example being small intestinal bacterial overgrowth (SIBO). What matters is which microbes one has in abundance and in relation which microbes one lacks or has limitedly. And what determines that isn’t limited to diet in the simple sense of what foods we eat or don’t eat but the whole pattern involved. Also, keep in mind that in a society like ours most of the population is in varying states of gut dysbiosis. First eliminating the harmful microbes is most important before the body can heal and rebalance. That is indicated by a study on multiple sclerosis that found, after the subjects had an initial reduction in the microbiome, “They started to recover at week 12 and exceeded significantly the baseline values after 23–24 weeks on the ketogenic diet” (Alexander Swidsinski et al, Reduced Mass and Diversity of the Colonic Microbiome in Patients with Multiple Sclerosis and Their Improvement with Ketogenic Diet). As always, it’s complex. But the body knows what to do when you give it the tools its evolutionarily-adapted to.

In any case, all of the methods described can show a wide range of benefits and improvements in physical and mental health. They are potentially recommended for almost anyone who is in a healthy state or in some cases of disease, although as always seek medical advice before beginning any major dietary change, especially anyone with an eating disorder or malnourishment (admittedly, almost all people on a modern industrialized diet are to some degree malnourished, especially Americans, although most not to a degree of being immediately life-threatening). Proceed with caution. But you are free to take your life in your hands by taking responsibility for your own health through experimentation in finding out what happens (my preferred methodology), in which case the best case scenario is that you might gain benefit at no professional medical cost and the worst case scenario is that you might die (not that I’ve heard of anyone dying from a typical version of a diet involving fasting, ketosis, and such; you’re way more likely to die from the standard American diet; but individual health conditions aren’t necessarily predictable based on the experience of others, even the vast majority of others). Still, you’re going to die eventually, no matter what you do. I wish you well, until that time.

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Let me clarify one point of widespread confusion. Talk of ‘diets’, especially of the variety I’ve discussed here, are often thought of in terms of restriction and that word does come up quite a bit. I’m guilty of talking this way even in this post, as it is about impossible to avoid such language considering it is used in the scientific and medical literature. So, there is an implication of deprivation, of self-control and self-denial, as if we must struggle and suffer to be healthy. That couldn’t be further from the truth.

Once you are fat-adapted and have metabolic flexibility, you are less restricted than you were before, in that you can eat more carbs and sugars for a time and then more easily return back to ketosis, as is a common seasonal pattern for hunter-gatherers. And once you no longer are driven by food cravings and addictions, you’ll have a happier and healthier relationship to food — eating when genuinely hungry and going without for periods without irritation or weakness, as also is common among hunter-gatherers.

This is simply a return to the state in which most humans have existed for most of our historical and evolutionary past. It’s not restriction or deprivation, much less malnourishment. It’s normalcy or should be. But we need to remember what normalcy looks and feels like: “People around the world suffer from starvation and malnutrition, and it is not only because they lack food and nutrients. Instead they suffer from immature microbiomes, which can severely impact health” (AMI, The effects of fasting and starvation on the microbiome). Gut health is inseparable from the rest, and these diets heal and rebalance the gut.

We need to redefine what health means, in a society where sickness has become the norm.

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Genius Foods:
Become Smarter, Happier, and More Productive While Protecting Your Brain for Life
by Max Lugavere

Baby Fat Isn’t Just Cute—It’s a Battery

Have you seen a baby lately? I’m talking about a newborn, fresh out of the womb. They’re fat. And cute. But mostly fat. Packed with stored energy prior to birth in the third trimester, the fatness of human babies is unprecedented in the mammal world. While the newborns of most mammal species average 2 to 3 percent of birth weight as body fat, humans are born with a body fat percentage of nearly 15, surpassing the fatness of even newborn seals. Why is this so? Because humans are born half-baked.

When a healthy human baby emerges from the womb, she is born physically helpless ad with an underdeveloped brain. Unlike most animals at birth, a newborn human is not equipped with a full catalogue of instincts preinstalled. It is estimated that if a human were to be born at a similar stage of cognitive development to a newborn chimp, gestation would be at least double the length (that doesn’t sound fun—am I right ladies?). By being born “prematurely,” human brains complete their development not in the womb, but in the real world, with open eyes and open ears—this is probably why we’re so social and smart! And it is during this period for rapid brain growth, what some refer to as the “fourth trimester,” that our fast serves as an important ketone reservoir for the brain, which can account for nearly 90 percent of the newborn’s metabolism. Now you know: baby fat isn’t just there for pinching. It’s there for the brain.

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Mitochondria and the Future of Medicine:
The Key to Understanding Disease, Chronic Illness, Aging, and Life Itself
by Lee Know

Ketogenic Diets and Calorie Restriction

Ketone bodies, herein also referred to simply as ketones , are three water-soluble compounds that are produced as by-products when fatty acids are broken down for energy in the liver. These ketones can be used as a source of energy themselves, especially in the heart and brain, where they are a vital source of energy during periods of fasting.

The three endogenous ketones produced by the body are acetone , acetoacetic acid , and beta-hydroxybutyric acid (which is the only one that’s not technically a ketone, chemically speaking). They can be converted to acetyl-CoA, which then enters the TCA cycle to produce energy.

Fatty acids are so dense in energy, and the heart is one of the most energy-intensive organs, so under normal physiologic conditions, it preferentially uses fatty acids as its fuel source. However, under ketotic conditions, the heart can effectively utilize ketone bodies for energy.

The brain is also extremely energy-intensive, and usually relies on glucose for its energy. However, when glucose is in short supply, it gets a portion of its energy from ketone bodies (e.g., during fasting, strenuous exercise, low-carbohydrate, ketogenic diet, and in neonates). While most other tissues have alternate fuel sources (besides ketone bodies) when blood glucose is low, the brain does not. For the brain, this is when ketones become essential. After three days of low blood glucose, the brain gets 25 percent of its energy from ketone bodies. After about four days, this jumps to 70 percent!

In normal healthy individuals, there is a constant production of ketone bodies by the liver and utilization by other tissues. Their excretion in urine is normally very low and undetectable by routine urine tests. However, as blood glucose falls, the synthesis of ketones increases, and when it exceeds the rate of utilization, their blood concentration increases, followed by increased excretion in urine. This state is commonly referred to as ketosis , and the sweet, fruity smell of acetone in the breath is a common feature of ketosis.

Historically, this sweet smell was linked to diabetes and ketones were first discovered in the urine of diabetic patients in the mid-nineteenth century. For almost fifty years thereafter, they were thought to be abnormal and undesirable by-products of incomplete fat oxidation.

In the early twentieth century, however, they were recognized as normal circulating metabolites produced by the liver and readily utilized by the body’s tissues. In the 1920s, a drastic “hyperketogenic” diet was found to be remarkably effective for treating drug-resistant epilepsy in children. In 1967, circulating ketones were discovered to replace glucose as the brain’s major fuel during prolonged fasting. Until then, the adult human brain was thought to be entirely dependent upon glucose.

During the 1990s, diet-induced hyperketonemia (commonly called nutritional ketosis ) was found to be therapeutically effective for treating several rare genetic disorders involving impaired glucose utilization by nerve cells. Now, growing evidence suggests that mitochondrial dysfunction and reduced bioenergetic efficiency occur in brains of patients with Parkinson’s disease and Alzheimer’s disease. Since ketones are efficiently used by brain mitochondria for ATP generation and might also help protect vulnerable neurons from free-radical damage, ketogenic diets are being evaluated for their ability to benefit patients with Parkinson’s and Alzheimer’s diseases, and various other neurodegenerative disorders (with some cases reporting remarkable success).

There are various ways to induce ketosis, some easier than others. The best way is to use one of the various ketogenic diets (e.g., classic, modified Atkins, MCT or coconut oil, low-glycemic index diet), but calorie restriction is also proving its ability to achieve the same end results when carbohydrates are limited.

Features of Caloric Restriction

There are a number of important pieces to caloric restriction. First, and the most obvious, is that caloric intake is most critical. Typically, calories are restricted to about 40 percent of what a person would consume if food intake was unrestricted. For mice and rats, calorie restriction to this degree results in very different physical characteristics (size and body composition) than those of their control-fed counterparts. Regarding life extension, even smaller levels of caloric restriction (a reduction of only 10–20 percent of unrestricted calorie intake) produce longer-lived animals and disease-prevention effects.

In April of 2014, a twenty-five-year longitudinal study on rhesus monkeys showed positive results. The benefit of this study was that it was a long-term study done in primates—human’s closest relatives—and confirms positive data we previously saw from yeasts, insects, and rodents. The research team reported that monkeys in the control group (allowed to eat as much as they wanted) had a 2.9-fold increased risk of disease (e.g., diabetes) and a 3-fold increased risk of premature death, compared to calorie-restricted monkeys (that consumed a diet with 30 percent less calories).

If other data from studies on yeast, insects, and rodents can be confirmed in primates, it would indicate that calorie restriction could extend life span by up to 60 percent, making a human life span of 130–150 years a real possibility without fancy technology or supplements or medications. The clear inverse relationship between energy intake and longevity links its mechanism to mitochondria—energy metabolism and free-radical production.

Second, simply restricting the intake of fat, protein, or carbohydrates without overall calorie reduction does not increase the maximum life span of rodents. It’s the calories that count, not necessarily the type of calories (with the exception of those trying to reach ketosis, where type of calorie does count).

Third, calorie restriction has been shown to be effective in disease prevention and longevity in diverse species. Although most caloric restriction studies have been conducted on small mammals like rats or mice, caloric restriction also extends life span in single-celled protozoans, water fleas, fruit flies, spiders, and fish. It’s the only method of life extension that consistently achieves similar results across various species.

Fourth, these calorie-restricted animals stay “biologically younger” longer. Experimental mice and rats extended their youth and delayed (even prevented) most major diseases (e.g., cancers, cardiovascular diseases). About 90 percent of the age-related illnesses studied remained in a “younger” state for a longer period in calorie-restricted animals. Calorie restriction also greatly delayed cancers (including breast, colon, prostate, lymphoma), renal diseases, diabetes, hypertension, hyperlipidemia, lupus, and autoimmune hemolytic anemia, and a number of others.

Fifth, calorie restriction does not need to be started in early age to reap its benefits. Initiating it in middle-aged animals also slowed aging (this is good news for humans, because middle age is when most of us begin to think about our own health and longevity).

Of course, the benefits of calorie restriction relate back to mitochondria. Fewer calories mean less “fuel” (as electrons) entering the ETC, and a corresponding reduction in free radicals. As you know by now, that’s a good thing.

Health Benefits

As just discussed, new research is showing that judicious calorie restriction and ketogenic diets (while preserving optimal nutritional intake) might slow down the normal aging process and, in turn, boost cardiovascular, brain, and cellular health. But how? We can theorize that the restriction results in fewer free radicals, but one step in confirming a theory is finding its mechanism.

In particular, researchers have identified the beneficial role of beta-hydroxybutyric acid (the one ketone body that’s not actually a ketone). It is produced by a low-calorie diet and might be the key to the reduced risk of age-related diseases seen with calorie restriction. Over the years, studies have found that restricting calories slows aging and increases longevity, but the mechanism behind this remained elusive. New studies are showing that beta-hydroxybutyric acid can block a class of enzymes, called histone deacetylases , which would otherwise promote free-radical damage.

While additional studies need to be conducted, it is known that those following calorie-restricted or ketogenic diets have lower blood pressure, heart rate, and glucose levels than the general population. More recently, there has been a lot of excitement around intermittent fasting as an abbreviated method of achieving the same end results.

However, self-prescribing a calorie-restricted or ketogenic diet is not recommended unless you’ve done a lot of research on the topic and know what to do. If not done properly, these diets can potentially increase mental and physical stress on the body. Health status should be improving, not declining, as a result of these types of diets, and when not done properly, these diets could lead to malnutrition and starvation. Health care practitioners also need to properly differentiate a patient who is in a deficiency state of anorexia or bulimia versus someone in a healthy state of ketosis or caloric restriction.

I’ll add a final word of caution: While ketogenic diets can be indispensable tools in treating certain diseases, their use in the presence of mitochondrial disease—at this point—is controversial and depends on the individual’s specific mitochondrial disease. In some cases, a ketogenic diet can help; in others it can be deleterious. So, of all the therapies listed in this book, the one for which I recommend specific expertise in its application is this diet, and only after a proper diagnosis.

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Grain Brain:
The Surprising Truth about Wheat, Carbs, and Sugar–Your Brain’s Silent Killers

by David Perlmutter

Caloric Restriction

Another epigenetic factor that turns on the gene for BDNF production is calorie restriction. Extensive studies have clearly demonstrated that when animals are on a reduced-calorie diet (typically reduced by around 30 percent), their brain production of BDNF shoots up and they show dramatic improvements in memory and other cognitive functions. But it’s one thing to read experimental research studies involving rats in a controlled environment and quite another to make recommendations to people based upon animal research. Fortunately, we finally have ample human studies demonstrating the powerful effect of reducing caloric intake on brain function, and many of these studies have been published in our most well-respected medical journals. 13

In January 2009, for example, the Proceedings of the National Academy of Science published a study in which German researchers compared two groups of elderly individuals—one that reduced their calories by 30 percent and another that was allowed to eat whatever they wanted. The researchers were interested in whether changes could be measured between the two groups’ memory function. At the conclusion of the three-month study, those who were free to eat without restriction experienced a small but clearly defined decline in memory function, while memory function in the group on the reduced-calorie diet actually increased, and significantly so. Knowing that current pharmaceutical approaches to brain health are very limited, the authors concluded, “The present findings may help to develop new prevention and treatment strategies for maintaining cognitive health into old age.” 14

Further evidence supporting the role of calorie restriction in strengthening the brain and providing more resistance to degenerative disease comes from Dr. Mark P. Mattson, chief of the Laboratory of Neurosciences at the National Institute on Aging (NIA). He reported:

Epidemiological data suggest that individuals with a low calorie intake may have a reduced risk of stroke and neurodegenerative disorders. There is a strong correlation between per capita food consumption and risk for Alzheimer’s disease and stroke. Data from population-based case control studies showed that individuals with the lowest daily calorie intakes had the lowest risk of Alzheimer’s disease and Parkinson’s disease. 15

Mattson was referring to a population-based longitudinal prospective study of Nigerian families, in which some members moved to the United States. Many people believe that Alzheimer’s disease is something you “get” from your DNA, but this particular study told a different story. It was shown that the incidence of Alzheimer’s disease among Nigerian immigrants living in the United States was increased compared to their relatives who remained in Nigeria. Genetically, the Nigerians who moved to America were the same as their relatives who remained in Nigeria. 16 All that changed was their environment—specifically, their caloric intake. The research clearly focused on the detrimental effects that a higher caloric consumption has on brain health. In a 2016 study published in Johns Hopkins Health Review, Mattson again emphasized the value of caloric restriction in warding off neurodegenerative diseases while at the same time improving memory and mood. 17 One way to do that is through intermittent fasting, which we’ll fully explore in chapter 7 . Another way, obviously, is to trim back your daily consumption.

If the prospect of reducing your calorie intake by 30 percent seems daunting, consider the following: On average, we consume 23 percent more calories a day than we did in 1970. 18 Based on data from the Food and Agriculture Organization of the United Nations, the average American adult consumes more than 3,600 calories daily. 19 Most would consider “normal” calorie consumption to be around 2,000 calories daily for women and 2,500 for men (with higher requirements depending on level of activity/exercise). A 30 percent cut of calories from an average of 3,600 per day equals 1,080 calories.

We owe a lot of our increased calorie consumption to sugar. Remember, the average American consumes roughly 163 grams (652 calories) of refined sugars a day—reflecting upward of a 30 percent hike in just the last three decades. 20 And of that amount, about 76 grams (302 calories) are from high-fructose corn syrup. So focusing on just reducing sugar intake may go a long way toward achieving a meaningful reduction in calorie intake, and this would obviously help with weight loss. Indeed, obesity is associated with reduced levels of BDNF, as is elevation of blood sugar. Remember, too, that increasing BDNF provides the added benefit of actually reducing appetite. I call that a double bonus.

But if the figures above still aren’t enough to motivate you toward a diet destined to help your brain, in many respects, the same pathway that turns on BDNF production can be activated by intermittent fasting (which, again, I’ll detail in chapter 7 ).

The beneficial effects in treating neurologic conditions using caloric restriction actually aren’t news for modern science, though; they have been recognized since antiquity. Calorie restriction was the first effective treatment in medical history for epileptic seizures. But now we know how and why it’s so effective: It confers neuroprotection, increases the growth of new brain cells, and allows existing neural networks to expand their sphere of influence (i.e., neuroplasticity).

While low caloric intake is well documented in relation to promoting longevity in a variety of species—including roundworms, rodents, and monkeys—research has also demonstrated that lower caloric intake is associated with a decreased incidence of Alzheimer’s and Parkinson’s disease. And the mechanisms by which we think this happens are via improved mitochondrial function and controlling gene expression.

Consuming fewer calories decreases the generation of free radicals while at the same time enhancing energy production from the mitochondria, the tiny organelles in our cells that generate chemical energy in the form of ATP (adenosine triphosphate). Mitochondria have their own DNA, and we know now that they play a key role in degenerative diseases such as Alzheimer’s and cancer. Caloric restriction also has a dramatic effect on reducing apoptosis, the process by which cells undergo self-destruction. Apoptosis happens when genetic mechanisms within cells are turned on that culminate in the death of that cell. While it may seem puzzling at first as to why this should be looked upon as a positive event, apoptosis is a critical cellular function for life as we know it. Pre-programmed cell death is a normal and vital part of all living tissues, but a balance must be struck between effective and destructive apoptosis. In addition, caloric restriction triggers a decrease in inflammatory factors and an increase in neuroprotective factors, specifically BDNF. It also has been demonstrated to increase the body’s natural antioxidant defenses by boosting enzymes and molecules that are important in quenching excessive free radicals.

In 2008, Dr. Veronica Araya of the University of Chile in Santiago reported on a study she performed during which she placed overweight and obese subjects on a three-month calorie-restricted diet, with a total reduction of 25 percent of calories. 21 She and her colleagues measured an exceptional increase in BDNF production, which led to notable reductions in appetite. It’s also been shown that the opposite occurs: BDNF production is decreased in animals on a diet high in sugar. 22 Findings like this have since been replicated.

One of the most well-studied molecules associated with caloric restriction and the growth of new brain cells is sirtuin-1 (SIRT1), an enzyme that regulates gene expression. In monkeys, increased SIRT1 activation enhances an enzyme that degrades amyloid—the starch-like protein whose accumulation is the hallmark of diseases like Alzheimer’s. 23 In addition, SIRT1 activation changes certain receptors on cells, leading to reactions that have the overall effect of reducing inflammation. Perhaps most important, activation of the sirtuin pathway by caloric restriction enhances BDNF. BDNF not only increases the number of brain cells, but also enhances their differentiation into functional neurons (again, because of caloric restriction). For this reason, we say that BDNF enhances learning and memory. 24

The Benefits of a Ketogenic Diet

While caloric restriction is able to activate these diverse pathways, which are not only protective of the brain but enhance the growth of new neuronal networks, the same pathway can be activated by the consumption of special fats called ketones. By far the most important fat for brain energy utilization is beta-hydroxybutyrate (beta-HBA), and we’ll explore this unique fat in more detail in the next chapter. This is why the so-called ketogenic diet has been a treatment for epilepsy since the early 1920s and is now being reevaluated as a therapeutic option in the treatment of Parkinson’s disease, Alzheimer’s disease, ALS, depression, and even cancer and autism. 25 It’s also showing promise for weight loss and ending type 2 diabetes. In mice models, the diet rescues hippocampal memory deficits, and extends healthy lifespan.

Google the term “ketogenic diet” and well over a million results pop up. Between 2015 and 2017, Google searches for the term “keto” increased ninefold. But the studies demonstrating a ketogenic diet’s power date back further. In one 2005 study, for example, Parkinson’s patients actually had a notable improvement in symptoms that rivaled medications and even brain surgery after being on a ketogenic diet for just twenty-eight days. 26 Specifically, consuming ketogenic fats (i.e., medium-chain triglycerides, or MCT oil) has been shown to impart significant improvement in cognitive function in Alzheimer’s patients. 27 Coconut oil, from which we derive MCTs, is a rich source of an important precursor molecule for beta-hydroxybutyrate and is a helpful approach to treating Alzheimer’s disease. 28 A ketogenic diet has also been shown to reduce amyloid in the brain, 29 and it increases glutathione, the body’s natural brain-protective antioxidant, in the hippocampus. 30 What’s more, it stimulates the growth of mitochondria and thus increases metabolic efficiency. 31

Dominic D’Agostino is a researcher in neuroscience, molecular pharmacology, and physiology at the University of South Florida. He has written extensively on the benefits of a ketogenic diet, and in my Empowering Neurologist interview with him he stated: “Research shows that ketones are powerful energy substrates for the brain and protect the brain by enhancing antioxidant defenses while suppressing inflammation. No doubt, this is why nutritional ketosis is something pharmaceutical companies are aggressively trying to replicate.” I have also done a lot of homework in understanding the brain benefits of ketosis—a metabolic state whereby the body burns fat for energy and creates ketones in the process. Put simply, your body is in a state of ketosis when it’s creating ketones for fuel instead of relying on glucose. And the brain loves it.

While science typically has looked at the liver as the main source of ketone production in human physiology, it is now recognized that the brain can also produce ketones in special cells called astrocytes. These ketone bodies are profoundly neuroprotective. They decrease free radical production in the brain, increase mitochondrial biogenesis, and stimulate production of brain-related antioxidants. Furthermore, ketones block the apoptotic pathway that would otherwise lead to self-destruction of brain cells.

Unfortunately, ketones have gotten a bad rap. I remember in my internship being awakened by a nurse to treat a patient in “diabetic ketoacidosis.” Physicians, medical students, and interns become fearful when challenged by a patient in such a state, and with good reason. It happens in insulin-dependent type 1 diabetics when not enough insulin is available to metabolize glucose for fuel. The body turns to fat, which produces these ketones in dangerously high quantities that become toxic as they accumulate in the blood. At the same time, there is a profound loss of bicarbonate, and this leads to significant lowering of the pH (acidosis). Typically, as a result, patients lose a lot of water due to their elevated blood sugars, and a medical emergency develops.

This condition is exceedingly rare, and again, it occurs in type 1 diabetics who fail to regulate their insulin levels. Our normal physiology has evolved to handle some level of ketones in the blood; in fact, we are fairly unique in this ability among our comrades in the animal kingdom, possibly because of our large brain-to-body weight ratio and the high energy requirements of our brain. At rest, 20 percent of our oxygen consumption is used by the brain, which represents only 2 percent of the human body. In evolutionary terms, the ability to use ketones as fuel when blood sugar was exhausted and liver glycogen was no longer available (during starvation) became mandatory if we were to survive and continue hunting and gathering. Ketosis proved to be a critical step in human evolution, allowing us to persevere during times of food scarcity. To quote Gary Taubes, “In fact, we can define this mild ketosis as the normal state of human metabolism when we’re not eating the carbohydrates that didn’t exist in our diets for 99.9 percent of human history. As such, ketosis is arguably not just a natural condition but even a particularly healthful one.” 32

There is a relationship between ketosis and calorie restriction, and the two can pack a powerful punch in terms of enhancing brain health. When you restrict calories (and carbs in particular) while upping fat intake, you trigger ketosis and increase levels of ketones in the blood. In 2012, when researchers at the University of Cincinnati randomly assigned twenty-three older adults with mild cognitive impairment to either a high-carbohydrate or very low-carbohydrate diet for six weeks, they documented remarkable changes in the low-carb group. 33 They observed not only improved verbal memory performance but also reductions in weight, waist circumference, fasting glucose, and fasting insulin. Now here’s the important point: “Ketone levels were positively correlated with memory performance.”

German researchers back in 2009 demonstrated in fifty healthy, normal to overweight elderly individuals that when calories were restricted along with a 20 percent increase in dietary fat, there was a measurable increase in verbal memory scores. 34 Another small study, yes, but their findings were published in the respected Proceedings of the National Academy of Sciences and spurred further research like that of the 2012 experiment. These individuals, compared to those who did not restrict calories, demonstrated improvements in their insulin levels and decline in their C-reactive protein, the infamous marker of inflammation. As expected, the most pronounced improvements were in people who adhered the most to the dietary challenge.

Research and interest in ketosis have exploded in recent years and will continue. The key to achieving ketosis, as we’ll see later in detail, is to severely cut carbs and increase dietary fat. It’s that simple. You have to be carb restricted if you want to reach this brain-blissful state.

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Power Up Your Brain
by David Perlmutter and Alberto Villoldo

Your Brain’s Evolutionary Advantage

One of the most important features distinguishing humans from all other mammals is the size of our brain in proportion to the rest of our body. while it is certainly true that other mammals have larger brains, scientists recognize that larger animals must have larger brains simply to control their larger bodies. An elephant, for example, has a brain that weighs 7,500 grams, far larger than our 1,400-gram brain. So making comparisons about “brain power” or intelligence just based on brain size is obviously futile, Again, it’s the ratio of the brain size to total body size that attracts scientist’s interests when considering the brain’s functional capacity. An elephant’s brain represents 1/550 of its body weight, while the human brain weighs 1/40 of the total body weight. So our brain represents 2.5 percent of our total body weight as opposed to the large-brained elephant whose brain is just 0.18 percent of its total body weight.

But even more important than the fact that we are blessed with a lot of brain matter is the intriguing fact that, gram for gram, the human brain consumes a disproportionately huge amount of energy. While only representing 2.5 percent of our total body weight, the human brain consumes an incredible 22 percent of our body’s energy expenditure when at rest. this represents about 350 percent more energy consumption in relation to body weight compared with other anthropoids like gorillas, orangutans, and chimpanzees.

So it takes a lot of dietary calories to keep the human brain functioning. Fortunately, the very fact that we’ve developed such a large and powerful brain has provided us with the skills and intelligence to maintain adequate sustenance during times of scarcity and to make provisions for needed food supplies in the future. Indeed, the ability to conceive of and plan for the future is highly dependent upon the evolution not only of brain size but other unique aspects of the human brain.

It is a colorful image to conceptualize early Homo sapiens migrating across and arid plain and competing for survival among animals with smaller brains yet bigger claws and greater speed. But our earliest ancestors had one other powerful advantage compared to even our closest primate relatives. The human brain has developed a unique biochemical pathway that proves hugely advantageous during times of food scarcity. Unlike other mammals, our brain is able to utilize an alternative source of calories during times of starvation. Typically, we supply our brain with glucose form our daily food consumption. We continue to supply our brains with a steady stream of glucose (blood sugar) between meals by breaking down glycogen, a storage form of glucose primarily found in the liver and muscles.

But relying on glycogen stores provides only short-term availability of glucose. as glycogen stores are depleted, our metabolism shifts and we are actually able to create new molecules of glucose, a process aptly termed gluconeogenesis. this process involves the construction of new glucose molecules from amino acids harvested form the breakdown of protein primarily found in muscle. While gluconeogenesis adds needed glucose to the system, it does so at the cost of muscle breakdown, something less than favorable for a starving hunter-gatherer.

But human physiology offers one more pathway to provide vital fuel to the demanding brain during times of scarcity. When food is unavailable, after about three days the liver begins to use body fat to create chemicals called ketones. One ketone in particular, beta hydroxybutyrate (beta-HBA), actually serves as a highly efficient fuel source for the brain, allowing humans to function cognitively for extended periods during food scarcity.

Our unique ability to power our brains using this alternative fuel source helps reduce our dependence on gluconeogensis and therefore spares amino acids and the muscles they build and maintain. Reducing muscle breakdown provides obvious advantages for the hungry Homo sapiens in search of food. It is this unique ability to utilize beta-HBA as a brain fuel that sets us apart from our nearest animal relatives and has allowed humans to remain cognitively engaged and, therefore, more likely to survive the famines ever-present in our history.

This metabolic pathway, unique to Homo sapiens, may actually serve as an explanation for one of the most hotly debated questions in anthropology: what caused the disappearance of our Neanderthal relatives? Clearly, when it comes to brains, size does matter. Why then, with a brain some 20 percent larger than our own, did Neanderthals suddenly disappear in just a few thousand years between 40,000 and 30,000 years ago? the party line among scientists remains fixated on the notion that the demise of Neanderthals was a consequence of their hebetude, or mental lethargy. The neurobiologist William Calvin described Neanderthals in his book, A Brain for All Seasons: “Their way of life subjected them to more bone fractures; they seldom survived until forty years of age; and while making tools similar to [those of] overlapping species, there was little [of the] inventiveness that characterizes behaviorally modern Homo sapiens.”

While it is convenient and almost dogmatic to accept that Neanderthals were “wiped out” by clever Homo sapiens, many scientists now believe that food scarcity may have played a more prominent role in their disappearance. Perhaps the simple fact that Neanderthals, lacking the biochemical pathway to utilize beta-HBA as a fuel source for brain metabolism, lacked the “mental endurance” to persevere. Relying on gluconeogenesis to power their brains would have led to more rapid breakdown of muscle tissue, ultimately compromising their ability to stalk prey or migrate to areas where plant food sources were more readily available. their extinction may not have played out in direct combat with Homo sapiens but rather manifested as a consequence of a simple biochemical inadequacy.

Our ability to utilize beta-HBA as a brain fuel is far more important than simply a protective legacy of our hunter-gatherer heritage. George F. Cahill of Harvard Medical School stated, “Recent studies have shown that beta-hydroxybutyrate, the principle ‘ketone’ is not just a fuel, but a ‘superfuel’ more efficiently producing ATP energy than glucose. . . . It has also protected neuronal cells in tissue culture against exposure to toxins associated with Alzheimer’s or Parkinson’s.”

Indeed, well beyond serving as a brain superfuel, Dr. Cahill and other researchers have determined that beta-HBA has other profoundly positive effects on brain health and function. Essentially, beta-HBA is thought to mediate many of the positive effects of calorie reduction and fasting on the brain, including improved antioxidant function, increased mitochondrial energy production with an increased in mitochondrial energy production with an increase in mitochondrial population, increased cellular survival, and increased levels of BDNF leading to enhanced growth of new brain cells (neurogenesis).

Fasting

Earlier, we explored the need to reduce caloric intake in order to increase BDNF as a means to stimulate the growth of new brain cells as well as to enhance the function of existing neurons. The idea of substantially reducing daily calorie intake will not appeal to many people despite the fact that it is a powerful approach to brain enhancement as well as overall health.

Interestingly, however, many people find the idea of intermittent fasting to be more appealing. Fasting is defined here as a complete abstinence from food for a defined period of time at regular intervals—our fasting program permits the drinking of water. Research demonstrates that many of the same health-providing and brain-enhancing genetic pathways activated by calorie reduction are similarly engaged by fasting—even for relatively short periods of time. Fasting actually speaks to your DNA, directing your genes to produce an astounding array of brain-enhancement factors.

Not only does fasting turn on the genetic machinery for the production of BDNF, but it also powers up the Nrf2 pathway, leading to enhanced detoxification, reduced inflammation, and increased production of brain-protective antioxidants. Fasting causes the brain to shift away from using glucose as a fuel to a metabolism that consumes ketones. When the brain metabolizes ketones for fuel, even the process of apoptosis is reduced, while mitochondrial genes turn their attention to mitochondrial replication. In this way, fasting shifts the brain’s basic metabolism and specifically targets the DNA of mitochondria, thus enhancing energy production and paving the way for better brain function and clarity . . .

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Insights into human evolution from ancient and contemporary microbiome studies
by Stephanie L Schnorr, Krithivasan Sankaranarayanan, Cecil M Lewis, Jr, and Christina Warinner

Brain growth, development, and behavior

The human brain is our defining species trait, and its developmental underpinnings are key foci of evolutionary genetics research. Recent research on brain development and social interaction in both humans and animal models has revealed that microbes exert a major impact on cognitive function and behavioral patterns []. For example, a growing consensus recognizes that cognitive and behavioral pathogenesis are often co-expressed with functional bowel disorders []. This hints at a shared communication or effector pathway between the brain and gut, termed the gutbrain-axis (GBA). The enteric environment is considered a third arm of the autonomic nervous system [], and gut microbes produce more than 90% of the body’s serotonin (5-hydroxytryptamine or 5-HT) []. Factors critical to learning and plasticity such as serotonin, γ-aminobutryic acid (GABA), short chain fatty acids (SCFAs), and brain derived neurotrophic factor (BDNF), which train amygdalin and hippocampal reactivity, can be mediated through gut-brain chemical signals that cross-activate bacterial and host receptors []. Probiotic treatment is associated with positive neurological changes in the brain such as increased BDNF, altered expression of GABA receptors, increased circulating glutathione, and a reduction in inflammatory markers. This implicates the gut microbiome in early emotional training as well as in affecting long-term cognitive plasticity.

Critically, gut microbiota can modulate synthesis of metabolites affecting gene expression for myelin production in the prefrontal cortex (PFC), presumably influencing the oligodendrocyte transcriptome []. Prosocial and risk associated behavior in probiotic treated mice, a mild analog for novelty-seeking and risk-seeking behaviors in humans, suggests a potential corollary between entrenched behavioral phenotypes and catecholamines (serotonin and dopamine) produced by the gut microbiota []. Evolutionary acceleration of the human PFC metabolome divergence from chimpanzees, particularly the dopaminergic synapse [], reifies the notion that an exaggerated risk-reward complex characterizes human cognitive differentiation, which is facilitated by microbiome derived bioactive compounds. Therefore, quintessentially human behavioral phenotypes in stress, anxiety, and novelty-seeking is additionally reinforced by microbial production of neuroactive compounds. As neurological research expands to include the microbiome, it is increasingly clear that host–microbe interactions have likely played an important role in human brain evolution and development [].

Ancient human microbiomes
by Christina Warinner, Camilla Speller, Matthew J. Collins, and Cecil M. Lewis, Jr

Need for paleomicrobiology data

Although considerable effort has been invested in characterizing healthy gut and oral microbiomes, recent investigations of rural, non-Western populations () have raised questions about whether the microbiota we currently define as normal have been shaped by recent influences of modern Western diet, hygiene, antibiotic exposure, and lifestyle (). The process of industrialization has dramatically reduced our direct interaction with natural environments and fundamentally altered our relationship with food and food production. Situated at the entry point of our food, and the locus of food digestion, the human oral and gut microbiomes have evolved under conditions of regular exposure to a diverse range of environmental and zoonotic microbes that are no longer present in today’s globalized food chain. Additionally, the foods themselves have changed from the wild natural products consumed by our hunter-gatherer ancestors to today’s urban supermarkets stocked with an abundance of highly processed Western foodstuffs containing artificially enriched levels of sugar, oil, and salt, not to mention antimicrobial preservatives, petroleum-based colorants, and numerous other artificial ingredients. This dietary shift has altered selection pressure on our microbiomes. For example, under the ‘ecological plaque hypothesis’, diseases such as dental caries and periodontal disease are described as oral ecological catastrophes of cultural and lifestyle choices ().

Although it is now clear that the human microbiome plays a critical role in making us human, in keeping us healthy, and in making us sick, we know remarkably little about the diversity, variation, and evolution of the human microbiome both today and in the past. Instead, we are left with many questions: When and how did our bacterial communities become distinctly human? And what does this mean for our microbiomes today and in the future? How do we acquire and transmit microbiomes and to what degree is this affected by our cultural practices and built environments? How have modern Western diets, hygiene practices, and antibiotic exposure impacted ‘normal’ microbiome function? Are we still in mutualistic symbiosis with our microbiomes, or are the so-called ‘diseases of civilization’ – heart disease, obesity, type II diabetes, asthma, allergies, osteoporosis – evidence that our microbiomes are out of ecological balance and teetering on dysbiosis ()? At an even more fundamental level, who are the members of the human microbiome, how did they come to inhabit us, and how long have they been there? Who is ‘our microbial self’ ()?

Studies of remote and indigenous communities () and crowdsourcing projects such as the American Gut (www.americangut.org), the Earth Microbiome Project (www.earthmicrobiome.org), and uBiome (www.uBiome.com) are attempting to characterize modern microbiomes across a range of contemporary environments. Nevertheless, even the most extensive sampling of modern microbiota will provide limited insight into Pre-Industrial microbiomes. By contrast, the direct investigation of ancient microbiomes from discrete locations and time points in the past would provide a unique view into the coevolution of microbes and hosts, host microbial ecology, and changing human health states through time. […]

Diet also plays a role in shaping the composition of oral microbiomes, most notably by the action of dietary sugar in promoting the growth of cariogenic bacteria such as lactobacilli and S. mutans (). Two recent papers have proposed that cariogenic bacteria, such as S. mutans, were absent in pre-Neolithic human populations, possibly indicating low carbohydrate diets (), while evolutionary genomic analyses of S. mutans suggest an expansion in this species approximately 10,000 years, coinciding with the onset of agriculture (). […]

Ancient microbiome research provides an additional pathway to understanding human biology that cannot be achieved by studies of extant individuals and related species alone. Although reconstructing the ancestral microbiome by studying our ancestors directly is not without challenges (), this approach provides a more direct picture of human-microbe coevolution. Likewise, ancient microbiome sources may reveal to what extent bacteria commonly considered ‘pathogenic’ in the modern world (for example, H. pylori) were endemic indigenous organisms in pre-Industrial microbiomes ().

The three paths to reconstructing the ancestral microbiomes are also complimentary. For example, analysis of the gut microbiome from extant, rural peoples in Africa and South America have revealed the presence of a common, potentially commensal, spirochete belonging to the genus Treponema (). Such spirochetes have also been detected in extant hunter-gatherers (), and in 1,000-year-old human coprolites from Mexico (), but they are essentially absent from healthy urban populations, and they have not been reported in the gut microbiome of chimpanzees (). These multiple lines of evidence suggest that this poorly understood spirochete is a member of the ancestral human microbiome, yet not necessarily the broader primate microbiome. Future coprolite research may be able to answer the question of how long this microbe has co-associated with humans, and what niche it fills.

* * *

Ketogenic Diet and Neurocognitive Health
Spartan Diet
The Agricultural Mind
Malnourished Americans

Neuroscientist Shows What Fasting Does To Your Brain & Why Big Pharma Won’t Study It
by Arjun Walia

Does Fasting Make You Smarter?
by Derek Beres

Fasting Cleans the Brain
by P. D. Mangan

How Fasting Heals Your Brain
by Adriana Ayales

Effect of Intermittent Fasting on Brain Neurotransmitters, Neutrophils Phagocytic Activity, and Histopathological Finding in Some Organs in Rats
by Sherif M. Shawky, Anis M. Zaid, Sahar H. Orabi, Khaled M. Shoghy, and Wafaa A. Hassan

The Effects of Fasting During Ramadan on the Concentration of Serotonin, Dopamine, Brain-Derived Neurotrophic Factor and Nerve Growth Factor
by Abdolhossein Bastani, Sadegh Rajabi, and Fatemeh Kianimarkani

Gut microbiome, SCFAs, mood disorders, ketogenic diet and seizures
by Jonathan Miller

Study: Ketogenic diet appears to prevent cognitive decline in mice
by University of Kentucky

Low-carb Diet Alleviates Inherited Form of Intellectual Disability in Mice
by Johns Hopkins Medicine

Ketogenic Diet Protects Against Alzheimer’s Disease by Keeping Your Brain Healthy and Youthful
by Joseph Mercola

The Gut Microbiota Mediates the Anti-Seizure Effects of the Ketogenic Diet.
by C. A. Olson

Is the Keto Diet Bad for the Microbiome?
by David Jockers

Does a Ketogenic Diet Change Our Microbiome?
by Christie Rice

Can Health Issues Be Solved By Dietary Changes Altering the Microbiome?
by Russ Schierling

Some Benefits of Intermittent Fasting are Mediated by the Gut Microbiome
by Fight Aging!

RHR: Is High Fat Healthy for the Gut Microbiota?
by Chris Kresser

A Comprehensive List of Low Carb Research
by Sarah Hallberg

Randomised Controlled Trials Comparing Low-Carb Diets Of Less Than 130g Carbohydrate Per Day To Low-Fat Diets Of Less Than 35% Fat Of Total Calories
from Public Health Collaboration

Spartan Diet

There are a number well known low-carb diets. The most widely cited is that of the Inuit, but the Masai are often mentioned as well. I came across another example in Jack Weatherford’s Genghis Khan and the Making of the Modern World (see here for earlier discussion).

Mongols lived off of meat, blood, and milk paste. This diet, as the Chinese observed, allowed the Mongol warriors to ride and fight for days on end without needing to stop for meals. Part of this is because they could eat while riding, but there is a more key factor. This diet is so low-carb as to be ketogenic. And long-term ketosis leads to fat-adaptation which allows for high energy and stamina, even without meals as long as one has enough fat reserves (i.e., body fat). The feast and fast style of eating is common among non-agriculturalists.

There are other historical examples I haven’t previously researched. Ori Hofmekler in The Warrior Diet, claims that Spartans and Romans ate in a brief period each day, about a four hour window — because of the practice of having a communal meal once a day. This basically meant fasting for lengthy periods, although today it is often described as time-restricted eating. As I recall, Sikh monks have a similar practice of only eating one meal a day during which they are free to eat as much as they want. The trick to this diet is that it decreases overall food intake and keeps the body in ketosis more often — if starchy foods are restricted enough and the body is fat-adapted, this lessens hunger and cravings.

The Mongols may have been doing something similar. The thing about ketosis is your desire to snack all the time simply goes away. You don’t have to force yourself into food deprivation and it isn’t starvation, even if going without food for several days. As long as there is plenty of body fat and you are fat-adapted, the body maintains health, energy and mood just fine until the next big meal. Even non-warrior societies do this. The meat-loving and blubber-gluttonous Inuit don’t tolerate aggression in the slightest, and they certainly aren’t known for amassing large armies and going on military campaigns. Or consider the Piraha who are largely pacifists, banishing their own members if they kill another person, even someone from another tribe. The Piraha get about 70% of their diet from fish and other meat, that is to say a ketogenic diet. Plus, even though surrounded by lush forests filled with a wide variety of food, plants and animals, the Piraha regularly choose not to eat — sometimes for no particular reason but also sometimes when doing communal dances over multiple days.

So, I wouldn’t be surprised if Spartan and Roman warriors had similar practices, especially the Spartans who didn’t farm much (the grains that were grown by the Spartans’ slaves likely were most often fed to the slaves, not as much to the ruling Spartans). As for Romans, their diet probably became more carb-centric as Rome grew into an agricultural empire. But early on in the days of the Roman Republic, Romans probably were like Spartans in the heavy focus they would have put on raising cattle and hunting game. Still, a diet doesn’t have to be heavy in fatty meat to be ketogenic, as long as it involves some combination of calorie restriction, portion control, narrow periods of meals, intermittent fasting, etc — all being other ways of lessening the total intake of starchy foods.

One of the most common meals for Spartans was a blood and bone broth using boiled pork mixed with salt and vinegar, the consistency being thick and the color black. That would have included a lot of fat, fat-soluble vitamins, minerals, collagen, electrolytes, and much else. It was a nutrient-dense elixir of health, however horrible it may seem to the modern palate. And it probably was low-carb, depending on what else might’ve been added to it. Even the wine Spartans drink was watered down, as drunkenness was frowned upon. The purpose was probably more to kill unhealthy microbes in the water, as was watered down beer millennia later for early Americans, and so it would have added little sugar to the diet. Like the Mongols, they also enjoyed dairy. And they did have some grains such as bread, but apparently it was never a staple of their diet.

One thing they probably ate little of was olive oil, assuming it was used at all, as it was rarely mentioned in ancient texts and only became popular among Greeks in recent history, specifically the past century (discussed by Nina Teicholz in The Big Fat Surprise). Instead, Spartans as with most other early Greeks would have preferred animal fat, mostly lard in the case of the Spartans, whereas many other less landlocked Greeks preferred fish. Other foods the ancient Greeks, Spartans and otherwise, lacked was tomatoes later introduced from the New World and noodles later introduced from China, both during the colonial era of recent centuries. So, a traditional Greek diet would have looked far different than what we think of as the modern ‘Mediterranean diet’.

On top of that, Spartans were proud of eating very little and proud of their ability to fast. Plutarch (2nd century AD) writes in Parallel Lives “For the meals allowed them are scanty, in order that they may take into their own hands the fight against hunger, and so be forced into boldness and cunning”. Also, Xenophon who was alive whilst Sparta existed, writes in Spartan Society 2, “furnish for the common meal just the right amount for [the boys in their charge] never to become sluggish through being too full, while also giving them a taste of what it is not to have enough.” (from The Ancient Warrior Diet: Spartans) It’s hard to see how this wouldn’t have been ketogenic. Spartans were known for being great warriors achieving feats of military prowess that would’ve been impossible from lesser men. On their fatty meat diet of pork and game, they were taller and leaner than other Greeks. They didn’t have large meals and fasted for most of the day, but when they did eat it was food dense in fat, calories, and nutrition.

* * *

Ancient Spartan Food and Diet
from Legend & Chronicles

The Secrets of Spartan Cuisine
by Helena P. Schrader

Paleo Diet, Traditional Foods, & General Health

Diet & Lifestyle

Basic Guidelines (LCHF):

  • low carb (LC)
  • high fat (HF)
  • moderate protein

Eliminate or Lessen:

  • industrially farmed & heavily processed foods, especially with many additives, including when labeled as healthy.
  • foods from factory farmed animals.
  • vegetable oils, especially hydrogenated seed oils (e.g., canola) & margarine; but some are good for you (see below).
  • carbs, especially simple carbs with high glycemic index & load: potatoes, rice, bread, etc; sweet potatoes a better choice but limit consumption; better to eat raw carrots than cooked carrots; but cooking & then cooling carbs creates resistant starches that turn into sugar more slowly.
  • grains, especially wheat; some people better handle ancient grains, sprouted or long-fermented breads (sourdough); but better to avoid entirely.
  • added sugar, especially fructose; also avoid artificial sweeteners (causes insulin problems & cause diabetes); if sweetener is desired, try raw stevia.
  • fruit, especially high sugar: grapes, pineapple, pears, bananas, watermelon, apples, prunes, pomegranates, etc.
  • dairy, especially cow milk; some handle better non-cow milk, cultured milk, & aged cheese; but better to avoid entirely.

Emphasize & Increase:

  • organic, whole foods, locally grown, in season.
  • foods from pasture raised or grass fed animals.
  • healthy fats/oils: animal fat, butter/ghee, avocado oil, & coconut oil for cooking; coconut milk/cream & almond milk for drinks (e.g., added to coffee); cold-pressed olive oil for salads or adding to already cooked foods; cold-pressed seed oils used sparingly; cod liver oil, krill oil (Neptune is best), flax oil, borage oil, evening primrose oil, etc for supplementation (don’t need to take all of them); maybe MCT oil for ketosis (seek advice of your physician).
  • fibrous starches & nutritious vegetables/fruits: leafy greens, broccoli, green beans, onions, garlic, mushrooms, celery, beets, black cherries, berries, olives, avocados, etc.
  • nutrient-density & fat-soluble vitamins, besides healthy fats/oils: eggs, wild-caught fish, other seafoods, organ meats, bone broth, aged cheese (raw is best), yogurt, kefir, avocados; nutritional yeast (gluten-free), bee pollen, & royal jelly.
  • protein: eggs, fatty meats, nuts/seeds (handful a day), & avocados.
  • probiotics (from fermented/cultured foods preferrably): traditional sauerkraut, kimchi, miso, natto, yogurt, kefir, kombucha, etc; not necessarily recommended for everyone, depending on gut health.
  • supplements (besides already mentioned above): ox bile for fat digestion, turmeric/curcumin & CBD oil for inflammation, CoQ10 if you are on statins, etc; only take as needed.
  • seasoning: black pepper contains bioperine which helps absorption of nutrients; onions and garlic are also great sources of nutrients and the specific soluble fiber that feeds microbes.

Other Suggestions:

  • fasting: occasionally/intermittently, starting with a single day & maybe eventually increasing length (the immune system is replaced/recuperated after 2-3 days); an extended fast can be good to do around once a year, assuming your in relatively good health.
  • restricted eating period: limit meal time to a 4-8 hour window of the day (even limiting it to 12 hours will be beneficial as compared to eating non-stop from waking to sleeping) followed by a short-term fast; start by skipping a meal & work up from there (some people find going without breakfast to be the easiest since you are already in fasting mode from the night’s sleep).
  • ketosis: if carbs are restricted enough or fasting continues long enough (glucose & stored glycogen is used up), the body will switch from burning glucose to burning fat, the latter turning into ketones (MCT oil will aid this process); for carb restriction, body burns fat consumed; for fasting, body burns body fat.
  • salt & water: body can become depleted if diet is strictly low carb & high fat/protein, especially in ketosis; salt is needed to metabolize protein.
  • exercise: aerobics & strength training (especially beneficial is high intensity for short duration); improves metabolism & general health; helps get into ketosis.
  • stress management: get plenty of sleep, spend time in nature, regularly socialize with friends & family, try relaxation (meditation, yoga, etc), find ways to play (games, sports, be around children), etc.
  • sunshine: get regular time outside in the middle of day without sunscreen to produce vitamin D & improve mood (for those not near the equator), as studies correlate this to lower skin cancer rates & longer life.

Resources:

Documentaries/Shows:

(lists here & here)

The Perfect Human Diet
The Magic Pill
The Paleo Way
We Love Paleo
Carb Loaded
My Big Fat Diet
Fed Up
Fat Head
What’s With Wheat?
The Big Fat Lie (coming soon)
The Real Skinny on Fat (coming soon)

Books:

Gary Taubes – Good Calories, Bad Calories; & Why We Get Fat
Nina Teicholz – The Big Fat Surprise (being made into a documentary)
Tim Noakes – Lore of Nutrition
Robert Lustig – Fat Chance
Loren Cordain – The Paleo Diet; & The Paleo Answer
Robb Wolf – The Paleo Solution
Mark Sisson – The Primal Blueprint
Nora T. Gedgaudas – Primal Body, Primal Mind
Sally Fallon Morell – Nourishing Diets
Catherine Shanahan – Food Rules; & Deep Nutrition
Sarah Ballantyne – The Paleo Approach; & Paleo Principles
Mark Hyman – Food: What the Heck Should I Eat?
David Perlmutter – Grain Brain
William Davis – Wheat Belly
John Yudkin – Pure, White and Deadly
Weston A. Price – Nutrition and Physical Degeneration
Francis Marion Pottenger Jr. – Pottenger’s Cats: A Study in Nutrition

Blogs/Websites:

(recommendations here)

Gary Taubes
Nina Teicholz
Tim Noakes
Robert Lustig
Gary Fettke
Loren Cordain
Robb Wolf
Mark Sisson
Nora Gedgaudas
Jimmy Moore
Pete Evans
Zoe Harcombe
Chris Kresser
Chris Masterjohn
Sarah Ballantyne
Catherine Shanahan
Terry Wahls
Will Cole
Josh Axe
Dave Asprey
Mark Hyman
Joseph Mercola
David Perlmutter
William Davis
Paleohacks
The Weston A. Price Foundation
Price-Pottenger

Obesity Mindset

There is a piece from The Atlantic about weight loss, The Weight I Carry. It’s written from a personal perspective. The author, Tommy Tomlinson, has been overweight his entire life. He describes what this has been like, specifically the struggle and failure in finding anything that worked. One has to give him credit for trying a wide range of diets.

It was sad to read for a number of reasons. But a point of interest was a comment he made about carbs: “I remember the first time carbohydrates were bad for you, back in the 1970s. The lunch counter at Woolworth’s in my hometown of Brunswick, Georgia, sold a diet plate of a hamburger patty on a lettuce leaf with a side of cottage cheese. My mom and I stared at the picture on the menu like it was a platypus at the zoo. We pretended to care about carbs for a while. Mama even bought a little carbohydrate guide she kept in her pocketbook. It said biscuits and cornbread were bad for us. It didn’t stay in her pocketbook long.”

That is what I’ve read about. Into the 1970s, it was still well known that carbs were the main problem for many health problems, specifically weight gain. This was part of mainstream medical knowledge going back to the 1800s. It was an insight that once was considered common sense, back when most people lived on and around farms. Everyone used to know that how cattle were fattened for the slaughter was with a high-carb diet and so the way to lose weight was to decrease carbs. There was nothing controversial about this old piece of wisdom, that is until the government decreed the opposite to be true in their 1980s dietary recommendations.

The sad part is how, even as this guy knew of this wisdom, the context of understanding its significance was lost. He lacks an explanatory framework that can sift through all the bullshit. He writes that, “I’ve done low-fat and low-carb and low-calorie, high-protein and high-fruit and high-fiber. I’ve tried the Mediterranean and taken my talents to South Beach. I’ve shunned processed foods and guzzled enough SlimFast to drown a rhino. I’ve eaten SnackWell’s cookies (low-fat, tons of sugar) and chugged Tab (no sugar, tons of chemicals, faint whiff of kerosene). I’ve been told, at different times, that eggs, bacon, toast, cereal, and milk are all bad for you. I’ve also been told that each one of those things is an essential part of a healthy diet. My brain is fogged enough at breakfast. Don’t fuck with me like this.”

His frustration is palpable and reasonable. But I notice all that gets left out from his complaints. A low-carb diet by itself very well might feel impossible. If you aren’t replacing carbs with healthy fats and nutrient-dense whole foods, you will be trying to swim upstream. Carbs is used by the body as a fuel. Take it away and you better give the body a different fuel. And after a lifetime of nutrient deficiency as is common in modern industrialization, you’d be wise to rebuilding your nutritional foundations.

That is the failure of the deprivation model of diets. They eliminate without offering any good advice about what to add back in. The advantage of traditional foods and paleo is that they are less diets in this sense. They are simply seeking scientific knowledge based on how humans live in traditional communities in the world today and how humans have lived going back to the ancient world and beyond. The point is finding what naturally works for the human body, not forcing restrictions based on ideological demands. If a diet feels like a constant struggle, then you are doing something wrong. For most of human existence, the vast majority of individuals maintained a healthy body weight with no effort whatsoever. The epidemic of obesity is extremely and bizarrely abnormal. Obesity indicates something is seriously out of balance, specifically with insulin sensitivity and the related hormonal hunger signals. Deprivation simply antagonizes this state of disease.

We already know that the ketogenic diet is the most effective diet for weight loss. Not only in the losing part but also in maintaining one’s optimal weight. No other diet decreases hunger and eliminates cravings to the same extent. More generally, a recent study showed that a low-carb diet beat a low-fat diet in burning fat, even when protein and calories were exactly the same in both groups. This possibly indicates that, as some have speculated, a diet low enough in carbs may increase metabolism in burning more calories than one is consuming. Then when you reach your preferred weight, you can add back in some calories to attain an equilibrium. This is apparently the one thing the author didn’t try. He did try the South Beach diet, but it is only moderately low-carb and unfortunately is also low-fat, a bad combination — this diet, for example, recommends low-fat milk which is not only eliminating the needed fats but also the fat-soluble vitamins, especially in the form of dairy from cows that are pastured/grass-fed.

The author is trapped in the dominant paradigm. He doesn’t need to “Eat less and exercise.” And he recognizes this is bad advice, even as he can’t see an alternative. But he should look a bit further outside the mainstream. On a ketogenic diet, many people can lose weight while eating high levels of calories and not exercising. It’s more of a matter of what you eat than how much, although in some cases where there are serious health problems as is typical with lifelong obesity more emphasis might need to be given to exercise and such. But the point is to find foods that are satisfying without overeating, which generally means healthy fats. Your body gets hungry for a reason and, if you don’t feed it what it needs, it will remain hungry. Calorie counting and portion control won’t likely help anyone with long term weight issues. It will just make them frustrated and hangry, and for good reason. But when the old patterns repeatedly fail, it is best to try something new. Sadly, the author’s conclusion is to more fully commit to the old way of thinking. His chances of success are next to zero, as long as he continues on this path.

It’s an obesity mindset. The individual blames himself, rather than blaming the bad advice. He just needs more self-control and less gluttony. This time, he tells himself, it will work. I doubt it. I hope he doesn’t spend the rest of his life on this endless treadmill of self-defeat and self-blame. Life doesn’t need to be so difficult. Rather than losing weight, he should focus on what it takes to be and feel healthy. But it is hard to convince someone of that when their entire identity has become entangled with obesity itself, with their appearance as judged by the same society that gave the bad advice.

* * *

The Weight I Carry
What it’s like to be too big in America

by Tommy Tomlinson

I remember the first time carbohydrates were bad for you, back in the 1970s. The lunch counter at Woolworth’s in my hometown of Brunswick, Georgia, sold a diet plate of a hamburger patty on a lettuce leaf with a side of cottage cheese. My mom and I stared at the picture on the menu like it was a platypus at the zoo. We pretended to care about carbs for a while. Mama even bought a little carbohydrate guide she kept in her pocketbook. It said biscuits and cornbread were bad for us. It didn’t stay in her pocketbook long.

I’ve done low-fat and low-carb and low-calorie, high-protein and high-fruit and high-fiber. I’ve tried the Mediterranean and taken my talents to South Beach. I’ve shunned processed foods and guzzled enough SlimFast to drown a rhino. I’ve eaten SnackWell’s cookies (low-fat, tons of sugar) and chugged Tab (no sugar, tons of chemicals, faint whiff of kerosene). I’ve been told, at different times, that eggs, bacon, toast, cereal, and milk are all bad for you. I’ve also been told that each one of those things is an essential part of a healthy diet. My brain is fogged enough at breakfast. Don’t fuck with me like this.

Here are the two things I have come to believe about diets:

1. Almost any diet works in the short term.
2. Almost no diets work in the long term.

The most depressing five-word Google search I can think of—and I can think of a lot of depressing five-word Google searches—is gained all the weight back. Losing weight is not the hard part. The hard part is living with your diet for years, maybe the rest of your life.

When we go on a diet—especially a crash diet—our own bodies turn against us. Nutritional studies have shown that hunger-suppressing hormones in our bodies dwindle when we lose weight. Other hormones—the ones that warn us we need to eat—tend to rise. Our bodies beg us to gorge at the first sign of deprivation. This makes sense when you think about the history of humankind. There were no Neanderthal foodies. They ate to survive. They went hungry for long stretches. Their bodies sent up alarms telling them they’d better find something to eat. Our DNA still harbors a fear that we’ll starve. But now most of us have access to food that is more abundant, cheaper, and more addictive than at any other time in human history. Our bodies haven’t caught up to the modern world. Our cells think we’re storing up fat for a hard winter when actually it’s just happy hour at Chili’s.

Even worse, when people succeed at losing a lot of weight, their bodies slam on the brakes of their metabolism. […] Other studies had already shown that the body’s metabolism slows down as people lose weight, which means they have to eat fewer and fewer calories to keep losing. But this study showed that, for the contestants who lost weight quickly, their metabolism kept slowing even when they started gaining weight again. Basically, however fat they had been, that’s what their bodies wanted them to be. […]

“Eat less and exercise.”

That’s what some of you are saying right now. That’s what some of you have said the whole time you’ve been reading. That’s what some of you say—maybe not out loud, but you say it—every time you see a fat person downing fried eggs in a diner, or overstuffing a bathing suit on the beach, or staring out from one of those good-lord-what-happened-to-her? stories in the gossip magazines.

“Eat less and exercise.”

What I want you to understand, more than anything else, is that telling a fat person “Eat less and exercise” is like telling a boxer “Don’t get hit.”

You act as if there’s not an opponent.

Losing weight is a fucking rock fight. The enemies come from all sides: The deluge of marketing telling us to eat worse and eat more. The culture that has turned food into one of the last acceptable vices. Our families and friends, who want us to share in their pleasure. Our own body chemistry, dragging us back to the table out of fear that we’ll starve.

On top of all that, some of us fight holes in our souls that a boxcar of donuts couldn’t fill.

My compulsion to eat comes from all those places. I’m almost never hungry in the physical sense. But I’m always craving an emotional high, the kind that comes from making love, or being in the crowd for great live music, or watching the sun come up over the ocean. And I’m always wanting something to counter the low, when I’m anxious about work or arguing with family or depressed for reasons I can’t understand.

There are radical options for people like me. There are boot camps where I could spend thousands of dollars to have trainers whip me into shape. There are crash diets and medications with dangerous side effects. And, of course, there is weight-loss surgery. Several people I know have done it. Some say it saved them. Others had life-threatening complications. A few are just as miserable as they were before. I don’t judge any people who try to find their own way. I speak only for myself here: For me, surgery feels like giving up. I know that the first step of 12-step programs is admitting that you’re powerless over your addiction. But I don’t feel powerless yet.

My plan is to lose weight in a simple, steady, sustainable way. I’ll count how many calories I eat and how many I burn. If I end up on the right side of the line at the end of the day, that’s a win. I’ll be like an air mattress with a slow leak, fooling my body into thinking I’m not on a diet at all. And one day, a few years down the road, I’ll wake up and look in the mirror and think: I got there.

Clearing Away the Rubbish

“The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue”
~Richard Horton, editor in chief of The Lancet

“It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor”
~Dr. Marcia Angell, former editor in chief of NEJM

Back in September, there was a scientific paper published in Clinical Cardiology, a peer reviewed medical journal that is “an official journal of the American Society for Preventive Cardiology” (Wikipedia). It got a ton of attention from news media, social media, and the blogosphere. The reason for all the attention is that, in the conclusion, the authors claimed that low-carb diets had proven the least healthy over a year period:

“One-year lowered-carbohydrate diet significantly increases cardiovascular risks, while a low-to-moderate-fat diet significantly reduces cardiovascular risk factors. Vegan diets were intermediate. Lowered-carbohydrate dieters were least inclined to continue dieting after conclusion of the study. Reductions in coronary blood flow reversed with appropriate dietary intervention. The major dietary effect on atherosclerotic coronary artery disease is inflammation and not weight loss.”

It has recently been retracted and it has come out that the lead author, Richard M. Fleming, has a long history of fraud going back to 2002 with two FBI convictions of fraud in 2009, following his self-confession. He has also since been debarred by the U.S. Food and Drug Administration. (But his closest brush with fame or infamy was his leaking the medical records of Dr. Robert Atkins, a leak that was behind a smear campaign.) As for his co-authors: “Three of the authors work at Fleming’s medical imaging company in California, one is a deceased psychologist from Iowa, another is a pediatric nutritionist from New York and one is a Kellogg’s employee from Illinois. How this group was able to run a 12-month diet trial in 120 subjects is something of a mystery” (George Henderson). Even before the retraction, many wondered how it ever passed peer-review considering the low quality of the study: “This study has so many methodological holes in it that it has no real value.” (Low Carb Studies BLOG).

But of course, none of that has been reported as widely as the paper originally was. So, most people who read about it still assume it is valid evidence. This is related to the replication crisis, as even researchers are often unaware of retractions, that is when journals will allow retractions to be published at all, something they are reluctant to do because it delegitimizes their authority. So, a lot of low quality or in some cases deceptive research goes unchallenged and unverified, neither confirmed nor disconfirmed. It’s rare when any study falls under the scrutiny of replication. If not for the lead author’s criminal background in the Fleming case, this probably would have been another paper that could have slipped past and been forgotten or else, without replication, repeatedly cited in future research. As such, bad research builds on bad research, creating the appearance of mounting evidence, but in reality it is a house of cards (consider the takedown of Ancel Keys and gang in the work by numerous authors: Gary Taubes’ Good Calories, Bad Calories; Nina Tiecholz’s The Big Fat Surprise; Sally Fallon Morrell’s Nourishing Diets; et cetera).

This is why the systemic problem and failure is referred to as a crisis. Fairly or unfairly, the legitimacy of entire fields of science are being questioned. Even scientists no longer are certain which research is valid or not. The few attempts at determining the seriousness of the situation by replicating studies has found a surprisingly low replication rate. And this problem is worse in the medical field than in many other fields, partly because of the kind of funding involved and more importantly because of how few doctors are educated in statistics or trained in research methodology. It is even worse with nutrition, as the average doctor gets about half the questions wrong when asked about this topic, and keep in mind that so much of the nutritional research is done by doctors. An example of problematic dietary study is that of Dr. Fleming himself. We’d be better off letting physicists and geologists do nutritional research.

There is more than a half century of research that conventional medical and dietary opinions are based upon. In some major cases, re-analysis of data has shown completely opposite conclusions. For example, the most famous study by Ancel Keys blamed saturated fat for heart disease, while recent reappraisal has shown the data actually shows a stronger link to sugar as the culprit. Meanwhile, no study has ever directly linked saturated fat to heart disease. The confusion has come because, in the Standard American Diet (SAD), saturated fat and sugar have been conflated in the population under study. Yet, even in cases like that of Keys when we now know what the data shows, Keys’ original misleading conclusions are still referenced as authoritative.

The only time this crisis comes to attention is when the researcher gets attention. If Keys wasn’t famous and Fleming wasn’t criminal, no one would have bothered with their research. Lots of research gets continually cited without much thought, as the authority of research accumulates over time by being cited which encourages further citation. It’s similar to how legal precedents can get set, even when the initial precedent was intentionally misinterpreted for that very purpose.

To dig through the original data, assuming it is available and one knows where to find it, is more work than most are willing to do. There is no glory or praise to be gained in doing it, nor will it promote one’s career or profit one’s bank account. If anything, there are plenty of disincentives in place, as academic careers in science are dependent on original research. Furthermore, private researchers working in corporations, for obvious reasons, tend to be even less open about their data and that makes scrutiny even more difficult. If a company found their own research didn’t replicate, they would be the last in line to announce it to the world and instead would likely bury it where it never would be found.

There is no system put into place to guard against the flaws of the system itself. And the news media is in an almost continual state of failure when it comes to scientific reporting. The crisis has been stewing for decades, occasionally being mentioned, but mostly suppressed, until now when it has gotten so bad as to be undeniable. The internet has created alternative flows of information and so much of the scrutiny, delayed for too long, is now coming from below. If this had happened at an earlier time, Fleming might have gotten away with it. But times have changed. And in crisis, there is opportunity or at very least there is hope for open debate. So bring on the debate, just as soon as we clear away some of the rubbish.

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Retracted: Long‐term health effects of the three major diets under self‐management with advice, yields high adherence and equal weight loss, but very different long‐term cardiovascular health effects as measured by myocardial perfusion imaging and specific markers of inflammatory coronary artery disease

The above article, published online on 27 September 2018 in Wiley Online Library (wileyonlinelibrary.com), has been withdrawn by agreement between the journal Editor in Chief, A. John Camm and Wiley Periodicals, Inc. The article has been withdrawn due to concerns with data integrity and an undisclosed conflict of interest by the lead author.

A convicted felon writes a paper on hotly debated diets. What could go wrong?
by Ivan Oransky, Retraction Watch

Pro-tip for journals and publishers: When you decide to publish a paper about a subject — say, diets — that you know will draw a great deal of scrutiny from vocal proponents of alternatives, make sure it’s as close to airtight as possible.

And in the event that the paper turns out not to be so airtight, write a retraction notice that’s not vague and useless.

Oh, and make sure the lead author of said study isn’t a convicted felon who pleaded guilty to healthcare fraud.

“If only we were describing a hypothetical.

On second thought: A man of many talents — with a spotty scientific record
by Adam Marcus, Boston Globe

Richard M. Fleming may be a man of many talents, but his record as a scientist has been spotty. Fleming, who bills himself on Twitter as “PhD, MD, JD AND NOW Actor-Singer!!!”, was a co-author of short-lived paper in the journal Clinical Cardiology purporting to find health benefits from a diet with low or modest amounts of fat. The paper came out in late September — just a day before the Food and Drug Administration banned Fleming from participating in any drug studies. Why? Two prior convictions for fraud in 2009.

It didn’t take long for others to begin poking holes in the new article. One researcher found multiple errors in the data and noted that the study evidently had been completed in 2002. The journal ultimately retracted the article, citing “concerns with data integrity and an undisclosed conflict of interest by the lead author.” But Fleming, who objected to the retraction, persevered. On Nov. 5, he republished the study in another journal — proving that grit, determination, and a receptive publisher are more important than a spotless resume.