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Nutrition Past and Future

34 An Evolved Fuel System 2

In my video 51 from The Primitive Nutrition Series, I talked about this trial led by Neal Barnard that demonstrated the potential of a low-fat, high-carb vegan diet to improve the wellness of diabetics. Hemoglobin A1c dropped. LDL dropped. Weight dropped. I mentioned that, as surprising as this study might seem to some, he was simply reviving and improving upon a diet strategy that had helped diabetics in the past.

Of course, diabetes is a disorder of carbohydrate metabolism, so for the great majority of physicians, the obvious thing to do seems to be to limit carbohydrates. As you can tell from this JAMA article from 1958, this thinking has been around awhile. Hardly any doctors back then would even consider cutting back on meat. Fat’s place at the diabetic’s dinner table was unquestioned as well. Few would dare consider that an excess of fat and protein might have set the stage for diabetes in the first place.

I was surprised to learn from Barnard’s book that doctors in the past had successfully moved diabetics to higher-carbohydrate diets, so I decided to investigate that history and share what I've found with you. It’s been fascinating for me to read the old papers reporting case studies and trials which presaged the modern research on low-fat and plant-based diets. Now, I would love to tell you that vegan diets were championed by a few progressive doctors like Barnard in the old days. However, it is clear to me that such diets have only been examined seriously in recent times. In my opinion, today’s mainstreaming of vegan diets is truly an indicator of our modernity. It’s an innovation that could only have occurred once our species rose to a certain stage of intellectual and ethical development. The downside of this is that I can’t harken back to a romanticized and embellished past the way the Paleo diet promoters do. Veganism is mostly a modern idea. There is nothing retrograde about it.

There were, however, a few glimmers that foreshadowed what I believe is our plant-based future, and my Primitive Nutrition project is here to bring them to you.

Before I move through these studies, here is a disclaimer for any diabetics watching this. YouTube videos are no substitute for a doctor. This quick sequence is just to give you a brief look at a forgotten storyline in the history of diabetes treatment. Assume the diabetics in these papers were using insulin unless I state otherwise. These are simply the published accounts of doctors reporting that they had happier and better managed patients on diets that were relatively high in carbs.

With that out of the way, our first paper is from 1926. You can see its summary here and you can tell that these doctors were very pleased to share their results. More carbs, more energy, more happiness.

These doctors had successfully added substantial amounts of carbs to the diets of patients previously treated with high-fat diets. This is what their diets looked like. As you can tell, despite that title this is not what we would call a high-carb diet today, as there was still plenty of meat and fat on the menu.

In 1929, Russell Richardson reported more contented patients on a higher-carb diet as well. They had experienced discomfort while eating high-fat diets. Once again, this paper was not about an even remotely high-carb diet, but it, too, indicated some willingness to question the high-fat dogma.

In 1931, James Short predicted that higher-carb diets would become increasingly common in the management of diabetes.

The following year E.P. Poulton reported that with what he called a high-carb, low-fat diet, it became possible to reduce insulin for some patients. He found this approach quite preferable to the low-carb diets he had previously advised for his patients.

In 1934 James Short’s prediction about the increased popularity of higher-carb diets was believed to be coming true by this doctor named Himsworth. This article brings us to a genuine milestone, an early flickering of insight. I think Himsworth was the first doctor who seemed to have a handle on what carbs could really do for the insulin resistant. It was his belief that higher-carb diets allowed insulin to act more effectively in regulating blood sugar. He shared his experiences from treating patients in this paper.

Here you see the visuals he provided to contrast the performance of a high-fat diet with a high-carb diet. It is worth your effort to hit pause now so you can study this. As you can see, glycemic control was much better after both oral and intravenous challenges on his higher carb diet. The high-fat diet failed quite spectacularly. Unfortunately, Himsworth does not state the specifics of the diets used in this comparison.

He was observing increased insulin sensitivity, but he did not know if that was a result of the reduction of fat in his patients’ diets or if their added carbs were enhancing insulin efficiency.  "Insulin efficiency" was a phrase he favored and I think it is quite apt.

Here at the end, he proposed that diabetes could be the result of insulin resistance.

A doctor named Rabinowitch was one of the best known advocates of high-carb diets for diabetics in the 1930s. In 1935, he reported on the long term results of this strategy. He stated that in 24% of his cases, insulin could be discontinued entirely. He went further in his language than Himsworth and categorically stated that fats impaired insulin sensitivity. He, too, found that his patients felt better eating more carbs.

Most interesting is his remark to the right that he was sure that his dietary treatment was also proving successful in slowing the development of heart disease. Of course, he was very right about that. Rabinowitch was amazingly ahead of his time. Most of the world still hasn't caught up.

With Rabinowitch, we are at last beginning to see the use of diets that could fairly be considered moderately low-fat. Just as a higher-carb approach appeared poised to enter the mainstream, the idea was apparently practically forgotten.

After the 1930s it seems there were few published reports of the use of high-carb diets with diabetics. Why was this approach disregarded after such promising evidence appeared? I'm sorry to say that I could not find an answer to that. It seems that the work of Rabinowitch and Himsworth was simply too ahead of its time. We now skip way ahead to 1971 as John Brunzell and his team tested the effectiveness of an 85% carbohydrate diet with mildly diabetic patients. Fasting glucose and insulin fell. Oral glucose tolerance improved. He reported that peripheral insulin sensitivity may be improved with a high-carb diet. Here at last we see a true high-carb, low-fat approach being recognized for what it could do, over thirty-five years after Himsworth, and thirty-five years before Barnard.

Brunzell was aware of the work of Himsworth, so he certainly saw those dramatic graphs of his that you just saw only moments ago. He tested Himsworth's observations using formula diets, including one that had practically no fat at all.

He was able to publish impressive graphs of his own. You are looking at insulin levels after an oral glucose tolerance test. The improvement from the high-carb approach was striking. Don’t expect to see a low-carb trial produce results like that.

Brunzell gave simultaneous calorie restriction some of the credit for this improvement.

In 1979, James Anderson and Kyleen Ward tried a high-carb, and crucially, a high-fiber approach with diabetics. They compared it to a moderately high-fat diet. Here again, we see that a high-carb diet allowed for the discontinuation of insulin for some patients. Please notice that after only 16 days on the high-carb, high-fiber diet, a dramatic reduction in cholesterol was measured.

Here you see the basics for both diets. While they didn’t use a whole food, vegan diet, their diet did provide their participants with a respectable quantity of fiber.

They did this because they understood that fiber could help diabetics control their triglycerides. They had a feel for the way our evolved fuel system works. They did note that in their experience, patients did not stick with healthy diets like this on their own. Since they were working with diabetics, it is more than likely that those patients had some poor eating habits to overcome. For the body to heal, the mind must change. I consider most diabetics to be in one big category of failed omnivores.

James Anderson published again on this topic in 1991. This time he compared his high-carb, high-fiber diet to a low-carb diet in a randomized crossover trial.

This study took place in a metabolic ward. The patients spent four weeks on both diets. Please note on the right that the diets were weight-maintaining, so there was no confounding effect of weight loss in this one and neither diet was disadvantaged by a higher caloric content.

You can see that total calories were quite close, while the two diets were quite different in quality. The high-carb, high-fiber diet was not vegan, so the differences achieved could have been made even greater.

At this point you should be able to predict the results they got. The high-carb diet allowed for lower insulin requirements than the low-carb diet. It also beat low-carb handily at lowering LDL. Once again, an improvement in peripheral insulin sensitivity was noted. Unfortunately, low expectations creep in at the end of this paper as the authors stated that their diet might be impractical for long-term use. Having worse diabetes symptoms long term seems to me to be even more impractical than maintaining a healthy diet. I guess your perspective depends on your standards.

And then there seems to be another hiatus in published research with this approach until we see Dr. Barnard’s paper. There has been a remarkable herd behavior in the dietary treatment of diabetics. Apparently, it took a vegan doctor to approach this subject a different way. I don’t think high-carb diets for diabetics will slip into obscurity again. With this video, this knowledge is out there now for everyone to see.

There has been plenty of other research using non-diabetic subjects which shows us how to properly fuel ourselves. This study from 1990 is just one example. This one looked at a weight-maintaining, high-carb diet that was also high-fiber. These subjects were non-obese and non-diabetic. Over several weeks, peripheral insulin sensitivity improved for these folks. Fasting glucose and insulin dropped. Cholesterol did, too.

By no coincidence, this successful dietary intervention relied on plant fibers and lots of them. It’s rare to see a diet trial with such good numbers for fiber.

So you see, carbs from whole foods like starches and fruits allow your fuel system to stay in balance without compromising insulin sensitivity or causing an unwanted excess of triglycerides.

There is no reason to demonize carbs the way Dr. Atkins did. Atkins called our natural craving for sweets, a craving that should be satisfied with beautiful whole fresh fruits, an addiction. He likened cravings for carbs to addictions to alcohol and cigarettes. He expected abstinence of us from the foods that taste best to us. This is not reasonable.

This is a newborn reacting to different tastes. The very contented face on the top right came immediately after this baby tasted something sweet. Dr. Atkins was speaking from the perspective of someone with a lengthy troubled, neurotic, failed relationship with food. We are not born with addictions. This baby does not have the same relationship to sweet tastes that a chain-smoker has to nicotine. How much more obvious can I make it than this? The low-carb belief system is an absurdity.

Atkins scared people into believing that sweet carbs would produce in them a state of high blood sugar and insulin resistance. In truth, as we have seen, healthy carbs aren’t responsible for insulin resistance. In truth, high-fat, high-protein diets like the one Atkins pushed are. “How To Become Insulin Resistant” is next.