NO LOW-CARB FOR YOU!

I am emerging (briefly) from grad school hibernation–my husband jokes that I’m taking all my classes “pass/flail”–for a special cause that hits close to home, even though Jennifer Elliott, a dietitian who has been going the rounds with her various professional organizations and institutions, lives in Australia.

She apparently had the gall to suggest to a patient with type 2 diabetes that a low-carbohydrate diet might be beneficial.  Heavens.  What is the world coming to?  Next thing you know, people will start telling us that if we are allergic to poison ivy and it makes us itch all over, we might not want to roll in it.

If you haven’t had a good eyeball roll or facepalm for the day, you should check out her blog, where she recounts one episode after another of Orwellian-level doublespeak with the Dietitian Association of Australia.  It’s a situation I’m quite familiar with, albeit on a much smaller scale and with our homegrown Academy of Nutrition and Dietetics here in the US of A.

The most recent episode reveals her local health district administration (Southern New South Wales Health, SNSW Health to the locals), her former employer, forbidding Jennifer–or anyone else, one must presume–from offering advice about low-carbohydrate diets to patients or clients with diabetes.  What caught my attention was this remark, by Jennifer:

“Can you imagine having to tell a client with diabetes, who has lowered his BGLs [blood glucose levels], lost weight and come off all diabetes medications by reducing his carb intake, that he now has to start eating more carbs because SNSW Health says so !?”

Well, cue the Twilight Zone music, because we are going there.

What would it be like to tell someone (like my dad, another way this story hits close to home) who has been controlling their diabetes very-well-thank-you with a low carb diet, that they now must eat more carbs, cuz we said so?  Samuel Beckett, eat your heart out.**

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Enter “patient who could be my dad.” Let’s call him Mr. Louis Corbin (LC).  He greets the dutiful dietitian (DD) who is determined to adhere to SNSW Health policies.

LC:  G’Day Ms. Dietitian.

DD:  Hello, Mr. Corbin.  How can I help you?

LC:   Well, I feel like I need to change up my diet a bit, and I’d like some help from a wise, caring, trained professional who will treat me like an individual and not like an aggregated average of a dataset.

DD:  (Laughs demurely.) Well, of course.  As a trained professional, it’s my job to use my clinical judgment to help patients find out what works best for them.

LC:  Beauty!  So, I was diagnosed with pre-diabetes about 10 year ago.

DD:  Really?  Looking at your lab report, your blood sugar and HgA1c levels look perfectly normal.  Tell me about the medications that you are using.

LC:  Well, I’m not actually on any medications.  When I got my diagnosis yonks ago, I borrowed my cousin’s glucometer and figured out which foods were making my blood sugar go up.  I really limit those in my diet now, and my blood sugar seems to be well under control. But I’m getting a little tired of eggs and sausage for brekky every morning.

DD:  Eggs and sausage?  Is that it?

LC:  And some sautéed spinach or sliced tomatoes, most days.  But I’m hoping you can help me with some other brekky ideas.

DD:  Wait now.  There’s simply too much fat in the eggs and sausage, and there’s really not enough carbohydrate–you know, sugars and starches–in that meal–or in your diet in general it seems.  You’ll need to add some fruit and a couple of servings of whole wheat bread or cereal to your breakfast and …

LC:  But tomatoes are technically a fruit …

DD:  But they are a “low carbohydrate” fruit and so they don’t count.

LC:  … and I don’t eat bread or cereal–not even whole wheat.  Those were the things that made my blood sugar go up!

DD:  Of course. We need your blood sugar to go up.  You do know that your brain won’t work without glucose from healthy, whole grains, right?

LC:  My brain seems to be working fine.  I finished “The Age” crossword puzzle while I was in the waiting room!

DD:  Well, it’s quite clear to me that your brain must not be working properly–you’ve put yourself in grave danger.  You need AT LEAST 3 servings of carbohydrate per meal, and not just at breakfast I might add, in order for your body to function properly.

WTF

LC:  Three servings per meal!  Crikey! That will make my blood sugars go up for sure!

DD:  Well, yes.  As I said, your blood sugars need to go up.  You see, Mr. LC. , in your addled state, you’ve failed to understand that diabetes is a PROGRESSIVE disease.  And your diabetes hasn’t progressed at all.  In fact, it seems to be quite stalled.

Without progression, we’ll be unable to prescribe pre-insulin drugs like metformin and engage you in the numerous diabetes education programs we have ready and waiting.  Once you’ve been thoroughly well-versed in carbohydrate counting, let’s hope that we can get your diabetes back on track.  Hmmm.  We may need to start you out at 4 servings of carbohydrate per meal …

LC:  But, but, I don’t really want my diabetes to progress.

DD:  Nonsense.  That’s what diabetes does.  You’re deluding yourself if you think otherwise.  I’ve seen hundreds of patients with type 2 diabetes, and I treat them all the same way–with the official Australian Diabetes Society diet–and they all have gotten progressively worse.  So there.

Yes, I understand that your diabetes hasn’t progressed in 10 years on a low carbohydrate diet, but it’s clear why that is.  It’s good that you’ve come to me so we can reverse that trend.  I can help you choose foods that will be sure to start you down the road to full-blown diabetes.

LC:  But I’m feeling bloody top notch.  I’ve even lost a little weight since I started reducing my sugars and starches.

DD:  Oh dear.  I didn’t realize that.  You’ll really need to fill your plate with healthy whole grains so we can get some of that weight back on.  You’re never going to end up on insulin at the rate you’re going.  But no worries.  If you can stick with at least 4 servings of carbs per meal, we might be able to get you on insulin in a few years or so.  Once we’ve got you on a regular dose of insulin, you’ll keep packing the weight on, no problem.

LC:  But I don’t want to be on insulin …

DD:  No “buts.”  Sir, you don’t realize the seriousness of this situation.  It’s not just about the insulin.  Not only do we have prescriptions that need prescribing and diabetes educators that need to educate, we have wound clinics that need wounds, dialysis clinics that need failing kidneys, testing laboratories that need labs to test.  Have you any idea how many people you might put out of work by stalling your diabetes in its tracks?

Sponsors of the ADS

A “Who’s Who of pharmaceutical and medical supply companies”? Nah, just the sponsors of the last Australian Diabetes Society conference.

DD (Continuing): You’ve not only put yourself in danger, you’ve endangered our whole healthcare supply economy!  We have injections to make your blood sugar go down.  We have glucose tablets to make your blood sugar go back up.  We have monitors and supplies and diaries and trackers and coolers and carriers for all of the THINGS you will need when you have diabetes.

We have diabetes foot cream, insoles, socks, and shoes.  And wheelchairs for when your toes rot off–which I can assure you they will if you’ll only improve your diet.  Then you’ll get to use the freight elevator and get one of those special parking passes.  If you play your cards right and follow your diet as I prescribe it , you may even end up with one of those cute little scooters for getting around the grocery store.

LC:  But …

DD:  Now then.  Not to worry.  You’re on the right path now.  You wanted some brekky ideas? Here’s a low-fat, vegetarian recipe for blueberry hotcakes, with 46 grams of carbs.  It’s from “Diabetes Australia,” so you know it’s perfect for someone with diabetes!  It should get your blood sugar going for sure!  And here’s some coupons from the Australian Breakfast Cereal Manufacturers.  I picked up tons of them at my last dietitians conference–they’re working with us to make sure everyone has a healthy, whole grain, cereal product brekky EVERY DAY!

LC:  But …

DD:  No “buts.”  I’ll expect to see you back in about 6 months.  We’ll get that HgA1c moving in the right direction this time and have you on the road to complete and total dependence on the health care system in no time!  Bye now!

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What can you do besides resolve not to move to New South Wales anytime soon?  Write a quickie email to the New South Wales Health Minister, Jillian Skinner, telling her about your experiences as a patient, clinician, family member in successfully managing type 2 diabetes/pre-diabetes/metabolic syndrome/etc. with a carbohydrate-reduced diet.

Email:   office@skinner.minister.nsw.gov.au

CC Jennifer at:  jennifer@babyboomersandbellies.com

And, what the hey, let the Dietitians Association of Australia know what you think too: nationaloffice@daa.asn.au

If you are feeling particularly feisty, go to Jennifer’s blog and post your letter there too, to let her know you stand in solidarity with her.

I personally will be sending Minister Skinner a copy of this post 🙂

**And many thanks to Disco Stew who provided the authentic Australian translation of this conversation!

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Update:  In an appalling case of life-imitating-blog-imitating-life, Disco Stew sent me a link to this piece, written by Jane Feinmann, about type 2 diabetes and the continued use of a low-fat, carbohydrate-laden diet to “treat” it:

When I wrote about this dilemma in the Daily Mail recently, the piece triggered over 200 responses from readers caught in this invidious position.

Mary Megan from London was ‘stunned’ last year when her GP “recommended eating carbohydrates as part of a ‘healthy balanced diet’ when I know for a fact from having tested my blood sugar over the years that carbohydrates are the exact cause of my high blood sugar.”

Way to go, 21st century health care system. Sigh.

Where the Women Are, Nutrition Edition

I really try not to pout too much when I see lists like the one below from Jimmy Moore’s 2012 survey on “most trusted resources for the information you received about health”:

After pouring through a couple hundred names that people shared, here were the top 10 who made the list in 2012:

1. Mark Sisson (30%)
2. Robb Wolf (23%)
3. Gary Taubes (21%)
4. Chris Kresser (15%)
5. Sean Croxton (10%)
6. Dr. Mike Eades (9%)
7. Dr. Robert Atkins/Atkins.com (8%%)
8. Dr. William Davis (7%)
9. Tom Naughton (7%)
10. Diane Sanfilippo (6%)

But seriously?  ONE woman?  ONE?  That’s it?????? Good grief.

The reasons for this imbalance are another blog post.  Instead, I chose to channel my energies into introducing some women who are leading the way—in their own way—in the world of nutrition.  If there appears to be a  “bias” in that most of these women–in one way or another–suggest that the current “grains are great” approach to nutrition is an unsound approach to good health, you might ask yourself how much that has to do with the prevailing bias within our current, and highly unsuccessful, nutrition paradigm.  These women are leaders, not followers.

To me, they are the Chers, Madonnas  and Dolly Partons of the nutrition world, although with a few exceptions, you may not recognize their names (which I know is part of the problem). Most have them have been around the block a time or two, and they know how the game is played—and rigged. They’ve succeed by being entirely who they are—tough-minded broads, compassionate caretakers, and reluctant warriors in the cause for good health for all.

Some of these women I’ve met, some I know well, some I’ve only admired from a safe distance afar. I wouldn’t expect all of these women to agree with—or even like—each other, or me, for that matter. Some of them may be appalled to find themselves on this list at all. Oh well. I don’t agree with all that each of them has to say, but I embrace the diversity and the chance to recognize some women I think have shown us how to have the huevos we need for the work ahead of us.

So—without further ado, and in alphabetical order (why not?)—here they are.

Judy Barnes Baker brought us this useful meme.

Judy Barnes Baker came this close to getting the American Diabetes Association to publish and endorse her reduced-carb cookbook. When that arrangement fell through, she got her cookbook published anyway and went on to publish another. Like Dana Carpender (see below), she’s been making life easier for those folks who want a low-carb approach to life.

Dana Carpender is a force of nature. She’s been holding the toast since 1996, and with her technogeek husband, Eric, has been able to bring us that message over the web since the dawn of the internet. Her book and cookbooks have been a lifeline for many trying to figure out exactly how to put into practice a way of eating that makes them feel healthy and happy. And boy, does she ever have a mouth on her. Sometimes I think it would be fun to lock her in a padded room with Frank Sacks and see who makes it out intact. I know where my money would be.

Laurie Cagnassola

Laurie Cagnassola, dog-lover extrodinaire, was, until recently, the Director of Nutrition and Metabolism Society, a leading low-carb oriented organization. She managed to gracefully meld the work she did with NMS with her own stance as a vegetarian. While Richard Feinman lambasted the entrenched interests in science and government out front, she worked tirelessly behind the scenes to build the fledgling reduced-carbohydrate nutrition community into a full-grown movement.  I expect we’ll hear more from her in the future.

Laura Dolson’s beautiful Low-Carb Pyramid

Laura Dolson has been writing about the food, science, and politics of low-carb nutrition for over a decade.  As a person who “walks the walk,” her posts on about.com are an informative and realistic guide to carbohydrate reduction.

Mary Dan Eades MD is the beautiful half (okay, the beautiful half on the right, for all you women out there drooling over her husband) of the royal (protein) power-couple of the carb-reduction world, Drs. Mike and Mary Dan Eades. They are the authors of multiple diet and lifestyle books beginning with Protein Power, which helped me navigate my own personal path to health many years ago. She may prefer to focus on singing, traveling, and grandkids now, but her voice is what gave the brilliant biochem wonkiness of Protein Power its warmth, humanity, and accessibility.

Jackie Eberstein RN was Dr. Robert Atkins right-hand RN for many years. She’s soft-spoken, with a backbone of steel and a heart of gold. She thought Atkins was “a quack” when she interviewed for the job. Thirty years later, she was still marveling at the improvement people could make in their health following his diet. But she’s no extremist. She taught me the importance of making sure calorie levels on a low-carb diet were appropriate. She’s got her hands full with her husband, Conrad, a charmer who can seriously rock a bow tie.

Mary G. Enig PhD is co-founder with Sally Fallon Morrell of the Weston A. Price foundation. Her work on fats led her to be one of the first voices raised in warning about the dangers of trans fats—and she’s been battling the seed oil industries attempts to silence and marginalize her work ever since.

Mary Gannon PhD, has—along with her research partner, Frank Nuttall—been working quietly on the low-biologically-available-glucose (inelegantly known as the LoBAG) diet for a decade now, although her work stretches back into the 70s. She is persistent in her efforts to understand the benefits of reduced carbohydrate and increased protein in helping to reverse the symptoms of type 2 diabetes.

Zoe Harcombe has been researching obesity for a couple of decades now. A UK writer, researcher, and nutritionist, her book, The Obesity Epidemic, is giving readers on the other side of the pond a different perspective on nutrition.

hartke is online podcast

Kimberly Hartke puts the “life” in lifestyle changes as the publicist for the Weston A Price Foundation. She’s collected enough stories from being on the front lines of the nutrition revolution to write a book, which I am truly hoping she will do one day soon.

Weigh loss success story

Misty Humphrey’s warmth and humor permeate her writing and advice on diet and health.   If there was ever a way to screw up getting healthy Misty’s done it and she’s honest and funny as she tells her story and helps her readers avoid the same pitfalls.

Lierre Keith’s Vegetarian Myth is not just another story of someone who found that their favored way of eating didn’t work and—prestochango—transformed themselves and their health by discovering The Truth About Food. The power of her book lies in her examination of the beautiful myth that underlies vegetarian thinking—that we can somehow peacefully eat our way to personal and global health without any regard for ourselves as critters who—just like all other critters—must function within an ecosystem that is nothing but one expression of eat/be eaten after another. I like to put her book on the shelf next to Jonathan Safran Foer’s goofball Eating Animals, which amounts to little more than a literary snuggie for vegans (JSF considers the American Dietetic Association the very last word in science-based nutrition information <guffaw>). I expect The Vegetarian Myth to simply drain the ink off the pages of Eating Animals out of sheer proximity.

CarbSane’s Evelyn Kocur, shows us–and the rest of the world–what the focused energy of one cranky woman who thinks we’ve been fed a load of crap looks like. Although I’m not a fan of her style—after years of listening to my mother scream, even reading someone else’s raging makes me want to hide under the bed—I can nevertheless admire the no-holds-barred way she skips the warm fuzzies and goes straight for the jugular. I really wish–every now and then–that I could pull that off.  Even when she’s missed the target by a mile, I have to give her credit for sheer firepower.

Sally Fallon Morrell is the director and co-founder (along with Dr. Mary Enig) of the Weston A. Price Foundation. Sally Fallon Morrell is a mother of four and a force of nature who doesn’t mince words. She’s ticked off at least one person in the paleo movement with regard to her stance on saturated fat, but—as far as I can tell—he’s ended up changing his position on the subject; she hasn’t changed hers.

Patty Siri-Tarino, PhD, is lead author of the meta-analysis on the lack of association between saturated fat and heart disease that changed the nature of conversation about nutrition and prevention of chronic disease.

No pink fluffy weights for Krista Scott-Dixon

Krista Scott-Dixon is the first person I found on the internet who said lifting big heavy things is for women too. She taught me—and countless numbers of other women–how to squat and that feminist theory and nutrition do so go together. And she makes fart jokes. You could really just not bother reading anything else I write and just read her stuff. Case in point: a free e-book entitled, Fuck Calories. (As Krista says: Yes, this book has cuss words. Many of them. Deal with it. Hey, it’s free. You get what the fuck you pay for.) Could she get any cooler? She’s married to a rocket scientist.

Mary Vernon MD has been at the forefront of reduced-carbohydrate nutrition for many years as a leader at the American Society of Bariatric Physicians. This group has partnered with the Nutrition and Metabolism Society to encourage conversation within the scientific/academic/clinical setting about reduced-carbohydrate nutrition: its pros and cons; the science behind it; and its clinical application. When national nutrition policy eventually catches on, it will be due in no small part to the fact that Mary Vernon and ASBP have already been offering this nutrition option to patients for years.

Regina Wilshire is the inspiration for a folder on my desktop entitled, Regina Brilliance. She is full of common sense and uncommon smarts. Wife, mother, and tireless blogger, her Weight of the Evidence (now on facebook too) has been a resource for intelligent and insightful commentary on nutrition since 2005. In the midst of the PubMed duels we so often find ourselves wrapped up in, her posts on eating well on a food stamp budget bring a welcome reality check.

Daisy Zamora PhD fought battle after battle (a story she’s agreed to let me tell one day) to publish her groundbreaking research on why our one-size-fits-all diet may be especially devastating to the health of minorities. It is not difficult to imagine why the powers-that-be would not want this indictment of the failure of our dietary recommendations to be made public. But beyond being a quiet crusader for rethinking our current dietary paradigm, she recognizes the importance and centrality of food in our lives and health. You have no idea how rare it is in the world of academic nutrition experts to find someone who eats and cooks and talks about food—as opposed to nutrients in food—and, get this, appears to actually like the stuff!

Let me know who’s on your list, or who I should add.

Plus, if that’s not enough, I found that, in putting together this list, many of the women I admire in the field of nutrition are–gasp–Registered Dietitians. Since RDs catch so much crap from the rest of the alternative nutrition community about being mindless-Academy-of-Nutrition-and-Dietetics-robots, I thought I’d put together a list of RDs who have inspired me to continue to work towards better health for all, despite our own professional organization’s insistence on using USDA/HHS policy as if it is science and its wince-inducing reliance on both food and pharma funding.

Next up: Where the Women Are, RD edition.

Calories? Again? Already?

Are we not sick of this subject already?

There have been some excellent articles and lots of “food for thought” on this topic recently.

Robb Dunn did a guest post at Scientific American about “The Hidden Truths About Calories,” which—to summarize in a way that does no justice to the article at all—basically boils down to the fact that most of the hidden truths about calories are so hidden we simply don’t know much about them at all. (I second this: Why Calories Count Fo’ Shizzle.)

Go Kaleo has a great post on this topic called “Putting the (Calorie) Pieces Together.” 

And Regina Wilshire has a puzzle for us at Weight of the Evidence called “Working Through A Stall.” 

Sooooooo – do calories in general matter, or is only the “kinds” of calories (i.e. the “good” kind vs the “bad” kind) that matter?

I think Go Kaleo said it very well: “All that black and white thinking has got people believing a false dilemma: It’s EITHER ‘calories in vs. calories out’ OR ‘the kind of calories you eat’ that matters!” She’s right in saying that it is a false dichotomy.

Neither approach comes close to acknowledging the complex interplay of factors that is human metabolism. I’m down on the calories in/calories out paradigm because it is so limited in scope, but I am equally down on any paradigm that says they don’t matter at all.

There are far too many unknowns about how the energy content of the food we eat interacts with the energy needs of our bodies to insist upon a singular health-maintenance paradigm based on “calories in, calories out.” At the same time, there are far too many unknowns about insulin metabolism (we currently don’t even have agreed-upon ways to measure and discuss insulin dysregulation) to create a new singular health-maintenance paradigm based on “fat in, carbohydrates out.”

One thing that complicates the picture is that we equate the metabolic situation that causes fat gain with the metabolic situation that will induce fat loss. My understanding of the biochemistry is that there are two necessary aspects to weight gain: excess calories to store (although we seldom know how to measure or even estimate what we mean by “excess”) and the insulin signal that provides the mechanism for storage to take place. Remove one of these factors—again with the caveat that we have a limited understanding of what “excess calories” means—and you won’t have weight gain.

Weight loss may be a different matter entirely. For weight loss to take place, we have to figure out NOT ONLY how to not create a metabolic situation where these two factors are at play, we also have to figure out how to convince our body to reverse the fat-storage process. This may involve processes which go beyond just one eliminating insulin-stimulating carbohydrate foods because—unless someone has Type 1 diabetes—some basal levels of insulin (and we may or may not know what they are or if they are “normal” or how that matters) are always present. This may also involve processes which go beyond just eliminating “excess” calories because, as I hope I’ve made clear, we don’t really even know what that means.

Some people can reduce overall calorie intake and lose weight (this usually also involves a lowering of carbohydrate foods that stimulate insulin release) ; some people can just reduce their carbohydrate food intake  and lose weight (this usually also involves lowering calories available for storage); some people have to do both–deliberately and carefully—in order to lose weight. The trick is how to do this without

  1. inducing willpower-withering hunger pangs
  2. depriving the body of essential nutrition
  3. creating other metabolically-unfortunate side effects/consequences.

The answer will not be the same for everyone. Reducing the number of nutritionally-empty carbohydrates gets at both the calorie and the carbohydrate issue–so that’s sort of a no-brainer, but carbs and calories are not all that matter.

Like what?

Metabolism matters. Nourishment matters. Information signaling—provided by your body’s encounters with the environment, including food encounters–matters.

Do calories affect these things? YES!!! Do carbs affect these things? YES!!! Are there about a bazillion other things that affect these things? YES!!!

When the clinic doors at the Duke Lifestyle Medicine Clinic open, the first two patients through those doors were both very much alike and radically different.

Both were “obese” adult white males, but that’s about where the resemblance ended. One gentleman, who was almost as big around as he was tall, was actually pretty healthy. Most, if not all, of what we think of as meaningful or predictive health biomarkers (blood pressure, cholesterol, glucose, etc) were normal. His problems were primarily orthopedic; i.e. his weight was impacting his hip and knee joints.

The other gentleman was far less obese, but his weight (as you may guess) was concentrated in his abdomen, his predictive health biomarkers were in the toilet, and he had a bag of prescriptions meant to normalize those biomarkers to prove it.

I (now) think of the first gentleman as having “simple” obesity and the second gentleman as having “metabolic” obesity. Such fat patterning has also been referred to as gynoid obesity (“pear”) and android (“apple”) obesity, and the different health consequences of each have been recognized, but even these differences are over-simplified concepts.

Android obesity (Gentleman #2) has been associated with excess insulin and with more metabolic derangement than gynoid obesity. It has been fairly well explained at this point that, aside from its role as a fat storage mechanism, excess insulin causes other metabolic problems.*

Is gynoid obesity (Gentleman #1) primarily associated with “excess” calories or “excess” storage of calories, rather than insulin dysregulation? We don’t know. Can “excess” calories cause other problems besides those leading to fat storage? We don’t know that either. One of the problems with asking these questions is—again—how we define “excess.”

Either way, the next step is to recognize that how we address different types of obesity may also need to be different. One type of obesity may be best addressed by a focus on reducing carbohydrate intake. The other type could be addressed by a focus on decreasing calories in and increasing calories out—however you want to do that. (As above, either approach involves some aspects of the other.)

But even differentiating dietary approaches based on fat-patterning must acknowledge that if there is a spectrum—with simple obesity on one end and metabolic obesity on the other—that any individual can be located anywhere along that spectrum and thus a combination of approaches would have to be used to address the needs of the individual, which may need to go beyond both carbs and calories.

It is crucial to remember that our bodies not really designed to either “gain”or “lose” weight, but to respond to our environment by small shifts in– up-regulating and down-regulating—the production of proteins, enzymes, and other biomolecules to meet the pressures of the environment. We are adapted to adapt. Food is one of the primary signals our bodies get about our environment. Food lets the body know what the conditions are like “out there” so that we can make appropriate adjustments “in here.” These adjustments, we know now, can be passed on from one generation to the next, so that our offspring are also prepared for what is “out there.”

What the body is looking for—all the time, without exception—is essential nourishment and adequate energy (and again our definition of “adequate” is as problematic as our definition of “excess”).  Note to paleo-thinking readers:  the origins of the paleo diet emphasize acquiring essential nutrition, rather than forbidding non-essential foods. This point may be the most important aspect of ancestral nutrition. (And thanks to Katherine Morrison for calling this to my attention.)

An eating pattern that conveys to our body that the environment is lacking in either of these things is going to result in metabolic adjustments to this information. What the adjustment looks like is going to depend on genetic factors (What food environment were your ancestors adapted to?), and epigenetic factors (Did you have an adequately-nourished mom?), and previous adaptive adjustments (Does your body regularly have to respond to caloric highs or lows? to regular bouts of intense energy expenditure? to reduced nutrition?), in addition to those other bazillion things we don’t know about yet.

So what are we going to do about it? I am so glad you asked. I’ve been trying to work my way to a blog post about n of 1, or individualized nutrition, for weeks now. I think I’m about there.

*See the work of Gerald Reaven and Wenhong Cao, for example.