Sweet. Looks like it’s the Mediterranean diet for me, since glycemic control is my biggest problem.

Why are you talking about bread and not Batman?

No talking about Batman ‘til after 5:30pm tomorrow!

HB,

If for nothing else, thank you for giving my the opportunity on a Saturday morning to cozy up to the NEJM with a mug of Joe. I’m about to read the study.

P.S.

On a different note, I think the New England Journal of Medicine has one of the most graphically please presentations. You may want to check it out to see if you agree.

As we might expect from the boys and girls publishing in Boston this seemed like a good study. There are a couple points of caution, however. The study was conducted with 86% male participation which causes one to wonder about universalizing the results to the total population of both men and women. Also, the study was conducted all with Israeli participants. Concerns of universalizing the results on a genetic basis may arise because Jewish populations have characteristic genetic patterns. Lastly, table two shows that participants in the “low carb” group still have 40% of their calories coming from carbs so we need to be careful about not letting the word “low” affect us too much: both other diets had ~50% of their calories from carbs so the issue is that 10% absolute difference. Would the results be more pronounced if the % calories from carbs were reduced further? That would be an interesting study too.

The part of the study that excites me is “This trial also suggests a model that might be applied more broadly in the workplace. As Okie
recently suggested, using the employer as a health coach could be a cost-effective way to improve health. The model of intervention with
the use of dietary group sessions, spousal support, food labels, and monthly weighing in the workplace within the framework of a health promotion campaign might yield weight reduction and long-term health benefits.” An employer using his own resources to help the health of his employees seems like a high example of liberality as a virtue.

Virtue my rear-end! Healthy employees means more productivity and lower healthcare costs. It’s simply good business.

A book I reading by Christine Lydon, a Yale MD, makes two interesting points…

1) When the Cro Magnons and Neanderthols (sp?) left their hunting and gathering ways, and moved to agrarian food, the lost one foot (12”) in height, over time. She attributes this to moving from a high protein diet of wild game and an occasional tubor, to a grain based diet (including an occassional the fatted [tamed] calf.)

2) bad science makes bad public policy… and mix in politics, and chaos results. She notes the 1977 report DIETARY GOALS FOR THE UNITED STATES from a committee led by Senator George McGovern. They reached the conclusion that fat in the American diet was causing Americams to become obese. They knew that scientific tests had not shown this to be true, but the National Institute of Health held the thought to be factual, so Sen. McGovern decided to publish the national goals, and let science prove then right later. But to date, no scientific report has shown a positive correlation between low caloric diet, and fat loss from the body. They have all shown the contrary, that a low fat and low caloric diet causes the body to hoard more fat, as it thinks it is starving and it needs to protect itself.

In 1960, 13% of Ameicans were considered obese. In 1979 14% of Americans were considered obese. During the fat-free 80’s, the percentage of obesity grew to 22%. Today 33% of Americans are considedred medically obese. So much for low fat.

Another book, by Will Clower, notes his observations on fat in the diet of the French people. He is a blood scientist by trade, and went to France with his family (including Mother) for some post doctoral work in Lyon. All members of his family lost weight during their two years in France. His book is THE FAT FALACY. He also notes that his Mom now pours cream into her yogurt in America so she can enjoy it like it is France. Because no dairy will make full fat yogurt.

Once an institutional orientation begins (everything should be low fat), it is heck to change it!

Let me add to Rachel’s accurate critique my general and inchoate suspicion about having private employers be responsible for their employees’ well-being. Pensions have turned out to be such an albatross for modern American companies, and they only end up being taken over by the government (specifically, the Pension Benefit Guarantee Corporation) anyway once they become sufficiently inconvenient, so I’m pretty well convinced that the employer’s role in the retirement transaction should be entirely up-front and monetary (e.g. a matching 401(k) contribution or matching payroll taxes). Based on this experience, I’m wary of giving much credit to employers doing things for apparently altruistic reasons. That is, I suspect that corporations should be in the business of making money (what they do best) and not very much involved in enacting social goods. They’re not good at the latter and we can more efficiently achieve these goals through other means (yes, classical economists, primarily governmental).

That said, I think Martin’s admiration arose from an attitude rather like the theory of “freedom of contract,” which takes as a given that nominally self-interested parties should be allowed to contract for whatever they want to. So, good on that enlightened employer who chooses to help society through means at his command. It’s both good business and a virtuous thing to do because it’s a proper exercise of liberality, which I take Martin to be using in its more Aristotelian sense, namely, the mean with respect to wealth. Freedom of contract is rather out of favor these days, I believe, but it’s a pleasant enough theory, and it certainly accords easily with a certain account of virtue (as opposed to the almost thoroughly modern notion of governmentally-mandated socioeconomic policies).

i remain suspicious of any one-size-fits-all approach to diet, i think. the most convincing explanation i’ve seen for the efficacy of the low-carb diet comes from one of those largely-science-free dieting books, this one about blood type. it’s the only explanation i’ve seen so far which takes into account my own personal reaction to a low-carb diet, which is to feel like utter crap and gain large amounts of weight.

i’m increacingly of the mind that medical guidelines for diet and weight just make matters worse. god knows the BMI, and the educational programs stemming from its use, only make a bad situation worse, at least. improving urban access to fresh foods and exercise opportunity seems like a much better use of time, energy and funding than endless low fat/low carb studies and federal programs to encourage BMI scaremongering.

Leon: I’ve heard those claims before, and they’re pretty convincing to me. I need to find a more reputable-seeming source than Ms. Lydon on the fat study question (her book covers make her subject to criticism from some quarters), since I was pretty astounded when I first read that accusation.

Anon: I’m with you on providing easier access to actual food, a la Michael Pollan. And I suspect that what Martin called characteristic genetic patterns have large effects that the research study model can’t take into account. Plus, there’s the whole fallacy of modern science (if you get enough rectangles, you’ll make a curve, etc.) to support the existence of an individual anomaly.

…he said provocatively.

I’ve read your last comment a number of times over a number of days and I’m not sure what you mean HB.

I guess there are two kinds of “covers” of note here……. one is the dust cover that no author has control over, nor input into. Dust covers are the solitary domain of the publisher and the marketing majors who are attempt to push towards the impulse buyers. I am reluctant to say it, but “Don’t judge a book by it’s cover,” and I blush, because my Dad always said that, and yes, we do become our parents. Watch for it.

And the second “cover,” is the authors own physiognomy which is a gift from her parents, and her Creator. I know she has long fine hair, clear skin (airbrushed?) and big bulging bicepts (on my book cover). I am more interested in her brain activity. I am not a model like she is, I am more in line with Bill Nye the Science Guy.

And she has an MD. I know Kivorkian did too, but I hope she paid more attention in the ethics classes.

The only paper I have been able to find on the diet of man in the far past suggests that our diets are very similar in terms of distributing carbohydrates, proteins, fats, etc. I think we need to be careful not to think that their diet is primarily meat based simply because our image of Cro Magnons and Neanderthals has them clothed in skins and running around with spears hunting. That may be myth and we need to be open to that possibility until we have some firm evidence.

Also, I caution against putting too much weight on how much credibility an MD degree ought to lend in matters of nutrition never mind ancient history. Doctors don’t receive much training in this. As in all matters we ought to weigh the argument on its own merits before we are convinced by who is delivering the argument.

Martin G -

If you’re looking for research on the diet of ancient man, thepaleodiet.com has a section of published research, which includes many papers on the subject that you can download for free. I think it’s a very valuable resource for anyone interested in nutrition.

I was just skimming the papers, and it looked like number 21 might be of interest. It is entitled “The paradoxical nature of hunter-gatherer diets: Meat based, yet non-atherogenic. Eur J Clin Nutr 2002; 56 (suppl 1):S42-S52.” Here is the abstract:

Field studies of 20th century hunter-gatherers (HG) showed them to be generally free of the signs and symptoms of cardiovascular disease (CVD). Consequently, the characterization of HG diets may have important implications in designing therapeutic diets that reduce the risk for CVD in westernized societies. Based upon limited ethnographic data (n = 58 HG societies) and a single quantitative dietary study, it has been commonly inferred that gathered plant foods provided the dominant energy source in HG diets.

In this review we have analyzed the 13 known quantitative dietary studies of HG and demonstrate that animal food actually provided the dominant (65%) energy source, while gathered plant foods comprised the remainder (35%). This data is consistent with a more recent, comprehensive review of the entire ethnographic data (n = 229 HG societies) that showed the mean subsistence dependence upon gathered plant foods was 32%, whereas it was 68% for animal foods. Other evidence including: isotopic analyses of Paleolithic hominid collagen tissue, reductions in hominid gut size, low activity levels of certain enzymes, and optimal foraging data all point toward a long history of meat based diets in our species. Because increasing meat consumption in western diets is frequently associated with increased risk for CVD mortality, it is seemingly paradoxical that HG societies, who consume the majority of their energy from animal food, have been shown to be relatively free of the signs and symptoms of CVD.

The high reliance upon animal based foods would not have necessarily elicited unfavorable blood lipid profiles because of the hypolipidemic effects of high dietary protein (19-35% energy) and the relatively low level of dietary carbohydrate (22-40% energy). Although fat intake (28-58% energy) would have been similar to or higher than that found in western diets, it is likely that important qualitative differences in fat intake, including relatively high levels of MUFA and PUFA and a lower ω-6/ω-3 fatty acid ratio, would have served to inhibit the development of CVD. Other dietary characteristics including high intakes of antioxidants, fiber, vitamins and phytochemicals along with a low salt intake may have operated synergistically with lifestyle characteristics (more exercise, less stress and no smoking) to further deter the development of CVD.

some other papers of note…… Cardiovascular disease resulting from a diet and lifestyle at odds with our Paelolithic genome. Mayo Clinic proceedings, (79) (2004): 101-8. Biological and clinical potential of a Paleolithic diet. Jrnl of Nutritition and environmental medicine 13(3) (Sept 2003) 149-60. Stone Agers in the fast land: Chronic degenerative diseases in evolutionary perspective. Am Jrnl of Medicine 84 (1988): 739-49. The nutritional charactristics of a congtemporaty diet based on Paelolithic food groups. Jrnl of the Am Neutraceutical Assn 5(3) (2002)