Elite ancient Egyptians had heart disease

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Heart Disease Found in Egyptian Mummies:

“Atherosclerosis is ubiquitous among modern day humans and, despite differences in ancient and modern lifestyles, we found that it was rather common in ancient Egyptians of high socioeconomic status living as much as three millennia ago,” says UC Irvine clinical professor of cardiology Dr. Gregory Thomas, a co-principal investigator on the study. “The findings suggest that we may have to look beyond modern risk factors to fully understand the disease.”

“Every man a king” in these days indeed.

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49 Comments

  1. While the diet of any one mummy could not be determined, eating meat in the form of cattle, ducks and geese was not uncommon during these times. 
     
    lol, that’s why hunter-gatherers suffer from arthritis, heart disease, and dental decay. Forget Occam’s Razor by looking for a single dietary change — like one that would cause tooth decay (answer: not meat). Bunch of vegan queers. 
     
    The ancient Egyptian upper class were also obese: 
     
    http://www.proteinpower.com/drmike/uncategorized/obesity-in-ancient-egypt/ 
     
    Odd how we only observe that in agricultural populations. Maybe it’s those boatloads of carbs that they began chowing down on.

  2. agnostic beat me to it. 
     
    When all you have is a hammer, everything looks like a nail. And when all you have is a lipid hypothesis, everything looks like saturated fat.

  3. point taken, but to my knowledge hunter-gatherers don’t have leisure elites either. so that’s an alternate hypothesis.

  4. razib: 
     
    I guess I’m unclear as to what you mean to imply by saying that HG don’t have leisure elites. What exactly is the hypothesis there? 
     
    (I’m not being snarky, just looking for clarification.)

  5. charles, among HG’s everyone works and exerts. in ag societies a small minority can be sedentary because they extract surplus from the masses.

  6. @razib: okay, so you are saying the health issues could have come from the fact that they were sedentary. 
     
    Interesting hypothesis. I might also suggest that they were sedentary because of their health issues, which came from their diet, and thus the causation is turned around. Just as people aren’t fat because they eat too much, they eat too much because they’re fat. 
     
    I guess agnostic and I are just amazed at how much the “meat will kill you” hypothesis is stretched, even when there’s little evidence to support it. Many HGs ate a lot of meat, probably much more than the sedentary elites, and yet we don’t see the kind of health problems we see in these mummies for the most part. 
     
    So to immediately ascribe the problems to meat consumption, simply because they can’t bear to suggest that grain consumption might not be healthy, is kind of amusing.

  7. Does anyone happen to know whether the ancient Egyptian elite ate much fish?

  8. Y’all probably ran across this years before I did, but if not, here’s Jared Diamond calling agriculture the worst mistake humanity ever made: 
     
    http://www.awok.org/worst-mistake/

  9. You find these ailments even among hardworking, backbreaking people, though. Google “gary taubes lecture” and you should find a few video talks of his, half of which usually focuses on the biochem and the other half of which usually focuses on the history. 
     
    Chilean factory workers are noticeably overweight despite their daily toil. 
     
    Also, there’s a plausible mechanism for how carbs give you heart disease. They’re what drive up the concentration of the small, dense LDL particles, which are the ones associated with heart disease (the big, fluffy LDL particles aren’t; neither are HDL particles).

  10. The oldest man in the world: His diet secret was eating just two meals a day, a large breakfast and lunch. Elsewhere he has said that he never ate his fill but always left the table a little hungry. 
     
    Anecdatum, of course, but there’s a lot of evidence that from our point of view, lack of exercise and overeating, regardless of what it is that you eat, are the biggest problems. 
     
    From the point of view of most humans in history, not getting enough to eat has been the bigger problem, of course, sometimes along with overwork.

  11. I don’t think grains and sugars are necessarily the culprit. Plenty of people eat a lot of them and are perfectly healthy.  
     
    I would look to something else that ‘aided and abetted’ these pharaoh’s obesity. Alcohol was common, and is a drug that when combined with a lot of food will stop a metabolism dead in its tracks.  
     
    Those Chilean factories mentioned probably drank and smoked. 
     
    The French by and large are very healthy eating Baguettes. Usain Boldt, the fastest man alive, fueled his training with starchy yams, and his father even claimed that the yams are why his son won gold in Beijing.  
     
    I am a high fat proponent, I believe it is total horseshit that fat and cholesterol are supposedly bad for you. Since Americans started eating less butter, we have gained more weight and had more heart disease.  
     
    But I think that the anti-carb thing has gone too far too. It’s just another dogma. Over and over again I see evidence that it is possible to live a healthy life while eating carbs. 
     
    I certainly feel much better since I stopped trying to cut carbs from my diet. Now that I eat potatoes and have sugar in my coffee I am actually in better shape than when I tried to eat low carb. 
     
    Lastly, there are problems that can arise from eating too much meat. Too much iron in the diet, and not enough antioxidant rich fruits, can cause iron stress. Iron is very oxidizing. Similar with copper. Meat in general is very building as a food, but it can tax the system to digest it constantly. Starches like rice and fruits are easy to digest calorie sources. Look at the Thais. They eat a lot of rice, a lot of fruit, and they age really well.

  12. There isn’t any magic diet and there really isn’t any evil diet either. There’s a lot of evidence that eating too much is bad for you, though not as bad as eating too little. At the bottom end, you need minimum amounts of some vitamins and minerals a certain amount of balanced protein, and a certain number of calories. Those goals are rather easily attainable exept for desperately poor people and people relying entirely on a single crop or on heavily processed foods. 
     
    When people talk about sugar, fat, and meat as threats to health, I think that they’re talking almost entirely about the way these particular foods are conducive to overeating. They’re not poison, you shouldn’t feel guilty about eating them, but if you’re eating to much and exercising too little you’re not doing yourself any favors. Don’t try to fool yourself.  
     
    Americans are remarkably obese and this is one of our major health problems, after tobacco, and probably alcohol and murder. If you want to you can just say, “So what? What if I live until 75 instead of 80?” [or whatever the numbers are]. That’s basically what I’ve done — I’m at the overweight / obese borderline. 
     
    Overweight in America seems to me to be pretty strictly a lifestyle problem. A sedentary lifestyle, 24 hour availability of food, widespread boredom and depression, the flood of advertising, cheap food…. People talk about how hard it is to lose weight but that’s only because it’s hard to change all your habits and behavior patterns, which is what you have to do. 
    This thread seems to have been corrupted with American food politics, and I thought I’d step in.

  13. That’s basically what I’ve done — I’m at the overweight / obese borderline.  
     
    Well, use the “crazy” Seth Roberts diet then.

  14. i tend to be of john’s perspective. i’ve been in rural bangladesh, the poor farmers eat nothing but white rice (flavored with salt). but they’re wiry and thin. compared to these the chilean factory workers are kings of the earth. the idea that carbs necessarily lead to fat gets tiresome, since if you live a shitty enough life that’s obviously not true. now, that doesn’t mean that the mono-carb peasants of asia were healthy. but they weren’t fat.

  15. The French by and large are very healthy eating Baguettes. 
     
    Actually, there has been a sharp decrease in bread consumption over the century. 
     
    FWIW, I haven’t seen people getting thinner.

  16. FWIW, I lost 15 pounds using Seth Roberts’ Shangri-La diet (I used oil, not sugarwater), and I’ve kept the weight off since by eating a diet that I think of as Franco/Paleo/Primal — basically (thanks to my wife, who’s an excellent cook) good French food, minus the bread, the sweets, and the potatoes. I don’t obsess about carbs, let alone count them, but I’m sure I’m keeping them pretty low. 
     
    The Seth Roberts approach is certainly odd, but it definitely worked for me. What the oil did was act as an appetite suppresseant. You’re taking in a few hundred extra calories in the form of the oil, but your appetite generally subsides, so you wind up eating less overall. It’s funny when it kicks in — you simply find yourself not reaching out for seconds. It de-neuroticizes your relationship to food too, I found. No more crunching or gnawing just because you feel some crazy need to snack. You eat until you’re full, then you don’t think about food till your next meal. Very cool. You do have to be patient. I found that I lost about two pounds a month, no faster than that. But over a year … 
     
    I don’t lose weight eating Franco/Paleo/Primal, which is what I’m doing now. But I do find that I’m able to eat as much as I like of many rich and satisfying foods without putting weight on. Nice. My middle-aged friends, who are all fighting losing battles against their weight, stare at me in fury. 
     
    Wasn’t obese to start with, just a little heavier than I was comfortable being, by the way. 
     
    Incidentally, how many of y’all have read the Gary Taubes book, or at least looked at his online video lectures? He’s not a diet-and-exercise guru, he’s a science journalist exploring and evaluating the science. He spent five years doing what you guys sometimes do — he went thru all the studies and the literature, pulling them apart every which way, trying to figure out what they really demonstrate (or not). As far as I can tell, no one else has taken such a deep and long look at the science. Fun fact: he says that in his career as a science journalist he’d never run into such bad science and bad scientists as he did in obesity and nutrition. And this is a guy who covered cold fusion. 
     
    Me, I’d be hesitant about yakking with much confidence about eating and overweight without having tackled Taubes first.

  17. Ray: 
     
    Been there, done that. He’s full of crap. Cherry-picking, willful misinterpretations of anthropological and archeological data, etc. etc. etc. Not even getting into the dietary part, because I don’t feel knowledgeable enough in the basic science behind caloric metabolism to critique it from that end (though I would hazard a guess that neither do most of his supporters). Still the more I look into it, the more dubious I become. 
     
    That’s not to say his enemies or the mainstream wisdom are correct, but that his interpretation is full of crap as well. 
     
    I often find it funny that hbd types are going hogwild for this stuff in their little net subculture. The last few thousand years of human evolution has produced clear individual and group differences above the neck, but not in the gut? Please. 
     
    One gets to see the whole attachment to being intellectually contrary is much more important than being factually informed or even logically sound. 
     
    Again, that’s not to say it wouldn’t work for some people. If it works for you, great! I’m not aiming this at those who suggest it as a possibility. What I have issues with is it being made into a dietary panacea for all that ails the modern man. That just swaps hells, where vegetarians who believe they’re healthy when they’re actually anemic are replaced with paleos who believe they are healthy when their gallbladders are backing up. One shouldn’t replace one dietary orthopraxy with another. Even if brats are better than rice cakes.

  18. the idea that carbs necessarily lead to fat gets tiresome 
     
    Oh no one says that, though. They say that it’s necessary, not sufficient. Some of the army experiments that Taubes reviews are of men who are not overweight because they’re subsisting on a tiny number of calories, almost all of which are carbs. And we’re familiar with images of scrawny peasants who were eating only carbs. 
     
    But it’s rare to find really overweight people, let alone obese, where they consume few carbs. That’s a key and necessary step in the chain. 
     
    The last few thousand years of human evolution has produced clear individual and group differences above the neck, but not in the gut? 
     
    Yep, that’s right. The changes above the neck were dialing up something that already had been designed. Say, how much axon growth you have. Or sheer size of the brain. Etc. No one in HBD says that we evolved some completely new lobe in the past few thousand years. Some just have more of what was already there than others. 
     
    The gut story is totally different. It’s not true that humans were designed to eat grains or even that much vegetable matter — else we’d have more vegetarian guts. Our primate relatives don’t eat grains either. So thriving on grains would have to have been an entirely new design system. Can’t build it that quickly; everyone acknowledges that. 
     
    Read Cochran & Harpending’s book The 10,000 Year Explosion. They go over the distinction between tweaking the level of some really complicated existing system (say, turning down melanin production) vs. designing something new (like an eye). They emphasize that evolutionary change within the past 10,000 years must be of the tweaking kind due to time constraints. 
     
    Sickle-cell is another example: tweaks the shape of your red blood cell. The red blood cell itself took muuuuch longer than a few thousand years to fully evolve. The analogy with eating grains is correct: we aren’t adapted to eating grains any more than Africans are adapted to malaria. They’ve evolved a pitiful, slapdash defense against it, but it’s too new to have come up with an impressive design to master grains or malaria.

  19. Based on what I know, Americans are more obese than the great majority of its ancestor and sibling nations. It’s really a cultural and behavioral problem. Too many calories and not enough exercise is the reason. 
     
    A lot of obesity science is a spinoff of fad diets offering fake magic bullets. Eat more grapefruit, eat less gluten, on and on and on, forever and ever, amen. There must be a thousand of them. 
     
    One reason some diets work is that anything people do to eat deliberately rather than according to whim will tend to work, especially if the diet planner is counting calories. The diets are psychological tricks distracting people with shiny objects (the grapefruit diet) and sneaking in a rational diet of some kind or another. 
     
    Some have said that snacking all day long, instead of eating scheduled family meals, is a culprit. I don’t doubt it. If food’s always there in the fridge or on the street, it’s tempting to snack whenever you feel mildly bored or depressed. Alcohol and drugs work that way too. 
     
    Historically and in much of the world today, stunting and deficiency diseases were endemic. Historically, the greater availability of meat and animal fat coincided with the greater availabilty of carbs. Obesity is a pathology of freedom, success, and (relative) wealth. 
     
    In a lot of ways this issue is a type case of mistaken causal thinking, when you look for The Cause of a multi-causal effect. It’s like saying broken bones are the result of auto accidents. Statistically auto accidents might be the commonest single cause — probably not– but that would be a bad answer even if it was.  
     
    There’s always this idea that if there’s a problem, first science finds The Cause and then it finds The Cure. That’s the germ theory, and it worked for smallpox, but you can’t generalize from that.

  20. For the record, I Googled around and didn’t find a good source, but it seems that Austria, Czechia, New Zealand, Saudi Arabia, and maybe Finland are as obese as the US, and from other sources I know that the Pacific Island nations are worse.  
     
    Again, everything’s relative based on dosage. It’s stupid to fret about an ounce of butter here and there, but if you find yourself buying lard by the ten-pound tub, maybe you have a problem. I’ve been told that the Finns have switched away from the lard-based cuisine in recent decades, and that the beneficial health results are starting to appear.

  21. Spike — I’ve read Taubes’ book and followed the responses to it, and I haven’t run into much in the way of critiques that I could take seriously. He’s vulnerable on a few points here, a few points there, but the critiques haven’t added up to much. Where do you get your impression that he’s weak? And “cherrypicking” strikes me as way off-base — just as a practical fact, there has never been such a comprehensive review of the entire body of studies as Taubes did. If he was cherrypicking, then everyone else who has looked into the topic has been cherrypicking to the umpteenth degree. No doubt people will move beyond his book eventually, but for the moment “Good Calories, Bad Calories” seems to be the definitive word on the science of weight loss. If you’ve got a book or authority who’s better on the science, please volunteer a title, or a name, or a link. 
     
    Incidentally, Taubes isn’t a diet and fitness guru. What he does in the book (have you actually read it? or just read about it?) is demolish the body of health-and-weight advice that we’ve been given by the health establishment for the last 50 years. In a positive sense he isn’t advocating anything beyond taking the carbs-cause-overweight thesis seriously as a possible subject for research. Why? Because it’s been around forever as a folk thing, because there are some science-based indications that there’s something to it, and because it works for many people. But he doesn’t go beyond that. 
     
    John — Seriously, read Taubes, or watch the videos, or watch Tom Naughton’s documentary “Fat Head,” which does an amazingly good job of summarizing the Taubes-ian case. (Taubes did some coaching and advising for Naughton.) The “calories in/calories out” idea is simply mistaken — something he leaves in tatters. Sheer volume of calories clearly counts somewhat, but the kinds of calories people ingest is hugely important. And the idea that our slothfulness causes our obesity is clearly wrong, given that exercise (for all the good it does) doesn’t generally help people lose weight. The book is a real paradigm-shifter, as well as an excellent historical/journalistic look at the way science, health advice, and politics work, and can go awry. 
     
    If we’re all yakking about Cochran and Harpending, let’s be aware of the fact that in “The 10,000 Year Explosion” they take Loren Cordain seriously as a guide to what pre-agricultural people were living on. (FWIW, as far as I know, Cordain is Da Man where knowledge about pre-agricultural eating goes.) And what does Cordain — who, unlike Taubes, isn’t shy about pushing solutions — promote these days? Something he calls “The Paleo Diet” — no grains, no sweets, no dairy, and, yup, lowcarb.

  22. John — Stephan Guyenet, who’s very impressive, says you’re wrong about lard: 
     
    http://bit.ly/6e9DS 
     
    People eating a carefully balanced, unbelieavably high-fat diet do very well weight-wise: 
     
    http://bit.ly/7rU8lM 
     
    Start hanging around those two blogs and you’ll learn a lot.

  23. Agnostic, your claim that vegetable matter is new seems to be at variance with almost all other sources. So is your claim that game is “lean but not that lean.” Most sources typically say things like “extremely lean.” 
     
    One idea about obesity which I have heard hypothesized, though I know if there is any direct evidence for or against it, is low-grade exercise. People in 1950, like everyone prior to them including hunter-gatherers, walked a great deal but didnt necessarily often “work out” at high intensity as we understand it today. Evidence for this is simply that there were only 0.41 cars per person in the USA in 1960 (data from 1950 would actually be more interesting). I understand that there is limited evidence for sustained weight loss via “exercise” (jogging, playing tennis or team sports other than baseball, or otherwise “working out”).  
     
    Obviously the above might combine with an effect from carbs.

  24. Heres a much longer time curve for US cars per capita. It was 0.3 in 1950. Scroll down to the graph. 
     
    However, I’m not sure the automobile thing fits so great. This CDC graph makes it look like the epidemic is a creature of 1980-present. Or at least, prevalances were flat in the 60s and 70s though information from before is not given. 
     
    Naturally, cars per capita is not a perfect inverse index of miles walked, let alone all low-grade high-volume exercise. Many kinds of manufacturing jobs, for example, should be an important source of such exercise. Cooking would be too low-grade to count, I suppose, or at best marginal. Construction or painting would certainly count bigtime. One could do occupational epidemiology on this; one could even combine it with dietary epidemiology to look at lower-carbing, active people, in case there might be synergic effects.

  25. Guyenet says: In the last post, I reviewed some of the factors that I believe could have contributed to the epidemic of heart attacks that began in the 1920s and 1930s in the U.S. and U.K., and continues today. 
     
    This is misleading: Since 1950, age-adjusted death rates from cardiovascular disease (CVD) have declined 60%. When lard usage declined on Guyenet’s graph, so did heart attack, but in any case, substituting equal amounts of vegetable fat for animal fat isn’t what I’m talking about. Just a less greasy diet. 
     
    It’s probably true, though, that reduced smoking, cleaner air, and better treatment have more to do with the decline in heart disease than changes in diet. (We also seem to be dealing with a bifurcation, where some populations get thinner while others get fatter.)

  26. @Erik Johnson: 
     
    Low-grade exercise can’t have a lot to do with it. Taubes provides some great examples of native Americans. When they’re put on a reservation, and fed the government-issued refined carbohydrates as their primary calorie source, they get obese. And it’s not as if their life on the reservation is an easy or sedentary one, at least initially. 
     
    And a lot of recent research has demonstrated no correlation between lack of exercise and obesity, particularly in teenagers. 
     
    As Taubes points out, we keep trying to blame obesity on either gluttony or sloth (you eat too many calories or you don’t move around enough), but the research just doesn’t support either. 
     
    @John Emerson: I beleive it’s true that deaths from heart disease have declined, due to better care, but heart disease itself has not declined. 
     
    The declines in heart disease and stroke can be explained, in part, by improvements in long-term and emergency care. Decreased smoking accounts for some of the improvement, but only in recent years. Improved diets and exercise are unlikely to have had a major effect because obesity has been increasing in recent years while death rates from heart disease and stroke have improved. An often-overlooked factor in the improvement in cardiovascular health has been the general decline of infectious diseases, since heart disease can be brought on by rheumatic infections. The better health and nutrition of mothers and children in the 1920s and 1930s, reflected in higher birthweights during those years, may also have rendered those generations less susceptible to heart disease as adults. 
     
    http://www.prb.org/Articles/2002/USTrendsinHeartDiseaseCancerandStroke.aspx 
     
    So heart disease began to appear significantly in the first part of the 20th century, as argued by Stephen, corresponding to a rise in consumption of high-Omega 6 industrialized oils and away from saturated animal fats like lard. And mortality has decreased because we diagnose earlier and take care of people with heart disease better long-term.

  27. Look, are you guys really arguing that a lard diet and no exercise isn’t going to lead to problems? 
     
    As I said above, there isn’t going to be a single-factor explanation, and in any case I wasn’t talking about substituting equal amounts of vegetable fats for lard. I was talking about people who buy lard in bulk and cook absolutely everything in lard, which was customary in parts of Europe.  
     
    As far as “Studies Have Shown That Diets Don’t Work”, what they mostly show is that gimmick diets don’t work and that few people are willing to change their habits enough to lose weight. The whole diet idea is about trying to cheat and lose weight with only minimal changes. 
     
    And I started off saying, a bit of butter or meat here or there won’t kill you. And as far as dealing with tens of millions of people who are obese for dozens of overlapping reasons, it’s even more obvious that there isn’t going to be a single factor. (My link above only listed changes in diet fourth out of six possible causes for the improvement since 1950).

  28. > it’s even more obvious that there isn’t going to be a single factor 
     
    Strong evidence for this = ? This assertion comes up a lot in disease bio, without evidence. Its perfectly plausible of course, but so is the contrary.

  29. Does it seem more likely to you that obesity, like broken arms, is an broad effect that can be the result of a range of causes, or that it’s a specific disease with a single cause, like smallpox? Do we really need a double-blind study to answer this question? 
     
    To put it otherwise, we know the cause of obesity with certainty: eating more calories than are burned. But there are a very large number of reasons why people will either eat too many calories or not burn enough calories.

  30. Agnostic: 
     
    In regards to your assertion that the last few thousand years of human evolution has lead to essentially no great or revolutionary changes to group differences in human digestion I have two words: Lactose Tolerance. ‘Nuff said. 
     
    Ray: 
     
    I’m not saying the conventional wisdom is right.  
     
    I’m saying that Taubes, and much more pointedly those advocating that a certain diet not only will work for everyone but is healthy for everyone not much better than where we are at nowadays where a fat and sugar free diet is the panacea for everything. I’m more disturbed by the claims being made about traditional and hunter-gatherer diets that are on their head factually incorrect, as well as this stuff about metabolism which is an extraordinary claim that doesn’t have the extraordinary evidence backing it up.  
     
    I mean have you actually read the papers Taubes et al cites to see what their claims are, or are you taking his word on what it demonstrates? Just because someone has first-hand evidence a diet worked for them doesn’t mean that the science and claims made about it are sound. It all really strikes me as people projecting their anecdotal experience on a thin factual and logical framework which they really don’t have an deep understanding of to think critically about.  
     
    I’m not claiming I have a deep understanding of how human metabolism works, but when the advocates of it make historical and anthropological claims that I *know* are incorrect, I’m inclined to believe their claims about human metabolism also half-baked.

  31. John the calories in calories out hypothesis, simply doesn’t work because metabolism is flexible. How much nutrition we derive from food and what we do with those calories and building blocks is determined by hormonal response to food, bacterial activity in the gut, etc etc. 
     
    The body is generally good at maintaining homeostasis and many people are able to maintain body composition homeostatis despite wild variations in calorie intake and exercise. I have worked with athletes who have had to increase their calorie intake by 3000 calories before any weight gain. I have worked with severely overweight women eating less then 2000 calories a day who promptly lost weight when put higher calorie but more nutritious diets. The fact that increasingly large segments of the population are suffering a disease state of continual weight gain indicates there is something more going on here.  
     
    There some good evidence in the low carb camp, low carb dieting is definitely more effective and more sustainable I do not think it is entirely convincing though, the evidence that people can be perfectly healthy on very high carb diets is also strong. I am most intrigued currently by the evidence that differences in gut flora correlate strongly with obesity. http://mayoclinproc.highwire.org/content/83/4/460.full

  32. John: “To put it otherwise, we know the cause of obesity with certainty: eating more calories than are burned.” That’s a lot more disputable than you seem to think it is.

  33. Spike — Ah, so you haven’t actually read Taubes. Look, he isn’t a diet and exercise guru. He’s a science journalist taking a look at the studies — that’s all he claims to be doing, and all in fact he’s doing. His connection to the low-carb thing is this: he’s saying it’s worth researching. As of the early 2000s, when Taubes started his research, the health-tips establishment was so contemptuous of the low-carb approach that they hadn’t actually looked into it. It was off their radar screen. They were completely secure (in their own minds) in their advocacy of low-fat/high-carb approaches to weight control. Calories-in/calories-out, and “fat in the diet turns into fat in the bloodstream which turns into heart disease” — that was what their approach boiled down to. Both legs of that turn out to be exceedingly weak, if not downright wrong, if not downright dangerously wrong. The self-confidence of the eating-and-health-tips crowd is much less certain today than it was in 2000, and that’s partly due to Taubes. He (and others) has shown how weak and/or non-existent the so-called evidence for the low-fat/high-carb regime was. The studies were badly designed, and then often stupidly interpreted. Low-fat/high-carb eating has in fact probably made millions unhappy and sick, and may even have caused thousands of unnecessary death. 
     
    At the same time, many people have had luck with “avoiding the starch and sugar” type approaches — in other words, avoiding carbs.  
     
    It has gone so far that Harvard’s Walter Willett, one of the top establishment guys (and not a bad guy by any means) has made statements about how Atkins, though wrong on some counts, was a courageous guy who made very valuable contributions that clinicians need to wrestle with and open up to.  
     
    Taubes’ main point is that much of what the health-tips types claim to know is in fact wrong. 99% of what he talks about is how the conventional thing is wrong. 1% is suggesting that the low-carb approach is worth investigating. He makes no claims to being a clinician or medical researcher himself. He has just gone over the literature and pointed out its rather staggering flaws. He also points out what is clearly known about the role of refined carbs in being responsible for diabetes, heart disease and other ailments. 
     
    Here’s one essay where he asks, What do we really know about what makes us healthy? and answers, Not much. 
     
    http://www.nytimes.com/2007/09/16/magazine/16epidemiology-t.html?_r=2&ref=magazine 
     
    Wikipedia’s entry on Taubes is a good place to start investigating: 
     
    http://en.wikipedia.org/wiki/Gary_Taubes 
     
    What’s your complaint about the Paleo thing, by the way? Loren Cordain, who currently peddles The Paleo Diet, is, as far as I know, a genuinely respected guy where the diets of pre (or non) agricultural people go.  
     
    Incidentally, so far as my own eating goes I’m not interested in being dogmatic about any of this. On the other hand, I’m happy taking suggestions from smart people. Minimizing dumb carbs … Sticking to real foods and helping myself to loads of traditional fats … Opting for lots of color and spicing … Hey, it’s easy, and it makes for a delicious eating life. How nice that it seems to help me stay slim too.  
     
    Arthur De Vany, an economist and fitness guy who I’m betting we’ll all be hearing a lot more about in the next year, describes his own diet as “Paleo/Mediterranean/Californian,” and that isn’t a bad description of how my wife and I eat, though we enjoy more cheese than Art does — he avoids grains and dairy entirely.

  34. Cheap and easy: this lecture will give you a substantial sampling of what Taubes has to say —  
     
    http://bit.ly/xJth2

  35. A bad interviewer, but Taubes is thoughtful here: 
     
    http://bit.ly/7T8iBs

  36. Ray: 
     
    Did you miss the “more pointedly those advocating a certain diet?” and the “et al”? 
     
    Also the fact that I agreed that conventional wisdom about diet is crap?  
     
    Ain’t no “Aha, Gotcha!” moment here, dude.  
     
    While not in the book itself, Taubes aids those who would replace one junk science with another. There’s a difference between advocating questioning the common wisdom and silently letting people use your research to justify claims far beyond the merit of your original research. Far as I know, Taubes hasn’t said “Whoa, slow down boys” to the guys preaching that Paleo will save your waistlines and that everyone needs to go radically low carb. 
     
    If you want me to say it, then yes, I agree with him more than I disagree with him on his primary argument that the common wisdom about diet is crap, though I have my quibbles with his interpretation of how metabolism works and can shift (or not shift as it were). What I vehemently disagree with is his silent assent to those going overboard. 
     
    And yes, despite working with Cochran and Harpending and other great luminaries and iconoclasts of our modern times, contingent on what I know about pre-contact Polynesian, Micronesian and Melanesian diet and health and East Asian historical diet and physical anthropology, I’m saying what Loren Cordain states justifying Paleo diet is crap. And I will stand by that statement even if Greg Cochran himself shows up in this comment roll and takes the rhetorical birch branch to my impertinence.

  37. Spike — Taubes isn’t handing out diet and eating advice. He’s a science journalist, investigating and evaluating the science. If you check out the talks I linked to, he pointedly dodges all the chances he’s handed to play guru. If other guys come along and play guru using some of his findings, I’m not sure that’s really his business. (At least until someone gives him a contract to go write a book about the Paleo-eating world.) Anyway, so long as people struggle with weight and health probs, there are always going to be fitness-and-eating gurus.  
     
    Interested in hearing more about your beefs with Cordain et al. Seems to me that people like Hyperlipid and Whole Health Source are quite aware of the exceptions to the usual Paleo/low-carb rule — they looooovvvve trying to make some sense out of tribal people who stay slimmish while eating tons of carbs, for instance. Cordain … I dunno, I’d have to go back to his book, which I don’t have around any longer.

  38. > Does it seem more likely to you that obesity, like broken arms, is an broad effect that can be the result of a range of causes, or that it’s a specific disease with a single cause, like smallpox? Do we really need a double-blind study to answer this question? 
     
    Why is obesity necessarily more like bone breaks than it is like smallpox? It does *seem* that way, but why? Is that just superficial? Is it totally impossible that a single infectious cause could be at work in obesity, making it thus more like smallpox? Infectious disease doesnt have to be “classical”; it need not be communicable in the narrow sense at all. If everyone is infected with the agent, but it rarely causes the disease, then the disease may not be communicable at all. One type of herpes encephalitis is more or less caused by mutation in a certain immune system disease. Of course having that herpes virus is also a cause of this encephalitis, but practically everyone has it, so it *doesnt* at all cause the *difference* between the encephalitis patients and healthy normals. There are lots of examples like this, yet people still write in journals that Alzheimers, being non-communicable, could not possibly be caused by Chlamydia pneumoniae. 
     
    Also, perhaps we are really talking about the epidemic, not obesity proper. An epidemic of bone breaks, where their prevalence rose say 10x over a few decades, might have a single cause, even though there are several ways bones can be broken. For example, a dictator could come to power and force everyone to play full-contact football without pads, to be executed if they lose a game. Or a new or newly-virulent infection could arise which lowers the bone density of almost everyone.  
     
     
    > To put it otherwise, we know the cause of obesity with certainty: eating more calories than are burned. But there are a very large number of reasons why people will either eat too many calories or not burn enough calories. 
     
    The second sentence above is what I disagree with. How do you know? People get fatter on mean after marrying, at least according to common belief, but maybe the disorder is not fatness itself, but rather a *tendency* to have an imbalanced energy flux and get fat, a tendency which is somewhat suppressible. This tendency could be scientifically well-defined, because it could theoretically be measured by experiment at any time, if we take the person and marry them off, or do something else to them that makes them suppress their tendency less than before. A bad cold causes a tendency to be inactive, but I will still go to the store if I run out of food. Or marriage might cause an obesity-causing hormonal change which is the cause of all cases of obesity; thus marriage would be just one upstream cause that leads to the “true cause.” Anti-depressants that cause obesity might also be, in all cases, upstream of the same true cause.  
     
    Imbalanced energy budget might just be like the fact that the bone bends (before it breaks), thus overcoming the electrostatic affinities of its atoms. Though the bone does indeed bend, and it bends in every case, the more fundamental cause of the break is that great force was applied. Great force, too, applies in every case. This force caused the bending, and then the break. The most fundamental cause is that which is furthest upstream in the causal chain yet still applies to all cases, and still is a sine qua non for all cases.  
     
    We cant really say whether such a cause exists in obesity unless we know the full causal chain for every case. Denying that such a cause could exist, at this point, is putting the cart before the horse.

  39. I have been eating paleo for a while now. You definitely lose weight without too much pain. It kind of cuts down on your endurance though.  
     
    I read Taubes book; it seemed reasonable to me at the time but who knows. 
     
    I liked this Taubes article: 
     
    http://www.nytimes.com/2007/09/16/magazine/16epidemiology-t.html?ref=magazine

  40. Spike et al, you might be interested in one of my comments on this 2blow thread — it is the sixth comment. Tom Naughton replies to me in the last comment. 
     
    http://www.2blowhards.com/archives/2009/03/tom_naughton_an.html 
     
    I think you can see my point. If beef and white pasta (AKA normal pasta) provoke the same insulin secretion per kilocalorie — actually, white pasta provokes *less* — then why talk about insulin, or carbs? If you simply take out potatoes, then the “carb foods” in this paper are *less* insulinogenic than the “protein foods.” As wikipedia will tell you, protein too provokes insulin secretion.  
     
    Of course, one food group in that experiment *is* much more insulinogenic, and thats the sugar foods. But not the complex carb foods. 
     
    Is my paper just wrong? That could certainly be. I did scrutinize it’s methods and deductions, but I havent read any other papers on the subject. 
     
    You can see that Tom Naughton told me to look to *other* diet-responding hormones; he suggests that glucagon is more brought on by meats and has some anti-insulin sort of properties. But Taubes *does* focus on insulin quite a lot. I dont have his book but I have looked at one of the insulin-focused chapters online, and he does speak of it like its the real deal. But again, if this paper is right, I would lower my insulin by going from beef to white pasta, not vice versa. So if low carbs is really the thing (as opposed to low simple carbs, that is sugars), then there would seem to be no reason to mention insulin levels at all. 
     
    In brief at least one of these things must be true: 
     
    1. insulin doesnt matter for obesity 
    2. complex carbs dont matter for obesity, only sugars do 
    3. “my” paper is wrong

  41. I’m not sure if I remembered to paste my link — here it is: 
     
    http://www.2blowhards.com/archives/2009/03/tom_naughton_an.html

  42. Why is obesity necessarily more like bone breaks than it is like smallpox?  
     
    Nothing is necessarily anything, but I think that the burden of proof is heavily on anyone who thinks that there is an obesity germ or gene or diet that just happened to massively hit the US recently. 
     
    A lot of this kind of discussion seems to be driven by (besides the craving for an easy reducing diet) the scientific and/or personal inability to believe that anything has social or cultural cause or causes. Perhaps obesity is the natural state of anyone who’s idle and has access to all the food they can eat — a very rare state historically. Would that count as a single cause? 
     
    In a rough sense, we have identified the causes of both broken bones and of obesity. In the former case, various sorts of impact (and conditions weakening the bones, e.g. osteoporosis), and in the latter, too many calories. But neither one of these gives you a magic bullet.  
     
    I actually have nothing against any particular diet as such, paleo or any other, until it proves useless or harmful. But I do have a suspicion of all diets, foir reasons I’ve said.

  43. Well, I do spend more energy on biologic causes of things, because I think theyre underrated, just like non-PC beliefs. But it has to lead to some degree of bias; I believe that bias counteracts the biases of society, leading to a net bias of zero, but I could be wrong. The only way to be really objective is to spend equal effort reading both sides, otherwise you inevitably know how to “operate” the arguments of your side more skillfully even though you may be at least acquainted with all the arguments of the other side. Eventually I do hope to have more or less equal facility with both sides of all controversies on which I feel decided. 
     
    Always burden of proof comes up eventually in these sort of arguments. Plausibility, absent any direct evidence, more or less equals coherence and simplicity (both taken a priori), times precedentedness. All the ideas we discussed are rather coherent and rather well precedented. Do they differ in plausiblity *enough* that a burden of proof exists? I say no, you say yes. There are actually two variables in our disagreement, both of which we might disagree upon by subtle or not-so-subtle quantitative degrees. (The first can be altered or clarified empirically, and the second cant be.) First variable, just what is the prior probability (probability based on current knowledge) of your view being correct? Second variable, what probability of your view being correct, would suffice to lay a burden of proof on all other views? Neither of us will probably be willing to state a numerical value (or a distribution of numerical values) for either of these variables, yet we go on believing that we probably have different numerical values for these variables, which are not equally justifiable. 
     
    But I am still right about the whole thing, of course, despite my awareness of these nasty little niceties of epistemology — of course the values of those variables dont suffice to make your view “all but proved”, or suffice even to lay a “burden of proof” in the common sense. 
     
    One precedent for the germ view, which you might not know, is interesting because the absence of a germ can cause disease, and so can its presence. This is Helicobacter pylori; it was present in virtually all people primordially and we are probably adapted to its presence. Its absence increases the odds of esophageal cancer. Its presence (rarely) causes stomach cancer and of course most cases of duodenal ulcer. Everyone has it in poor nations but it is more like 50% in rich ones. I’m not sure if this is due to hygeine; probably not, though I dont know if its ever been studied. More likely it is due to accidental eradication by antibiotic use. (If you actually want to have a high chance of eradicating it you will need a short multi-drug therapy, but the more common single-antibiotic therapies might eradicate it 10 or 30% of the time.) 
     
    Of course, most antibiotics were invented in the 30s-50s, so this is not a particularly great theory for the obesity epidemic. But in principle the presence or absence of an infectious agent might still be the cause. 
     
    Personally I have a moderately bad belly but I am quite unfatted otherwise, an interesting example of hormones (probably) affecting adiposity.

  44. Ray: 
     
    Eric has covered quite a bit of some of it there. Still I’d like to add my two cents. Pre-contact and post contact Polynesian diet both had carbs as a main staple. Yet, around the mid 20th century Hawaiians started getting all the health problems derived from diet that plague native people much more than Old Worlders. The main thing? The switch from Taro, breadfruit and sweet potatos as the main carb staple to white rice and bread, and fresh fish and meat to processed fish and meat happened at that time. 
     
    Also to I’d like to mirror Razib’s comment in another way. The traditional Japanese peasant’s diet during the Tokugawa period was pretty much nothing but polished white rice supplemented with a small amount of seaweed, miso and fish. While this lead to a host of health problems from vitamin deficiencies that we can determine from examining skeletal remains, obesity definitely wasn’t one of them, if anything, quite the opposite. They were wiry as hell. 
     
    Still it’s interesting to note that when Hawaiians took up white rice, they started ballooning up, and as the Japanese diet becomes more westernized, they’re starting to gain weight. 
     
    I have a lot more ideas about this, but really I’m not motivated enough to do a large write up, look up sources and all that when diet is something people keep more as a religion than a rational set of beliefs. 
     
    In short my body feels best when I minimize grains, processed foods and dairy and eat traditional Hawaiian foods like bananas and raw fish. How my soul feels without Gnocchi and Red Wine is another matter altogether.

  45. Is there good evidence for the oft-circulated belief that medieval aristocrats were fat, rather than “overweight” or lean? Aristocrats from other societies? 
     
    How about evidence that obese people today are anhedonic compared to thin people, and/or have lower general impulse control as measured by lab psychology? Do they have markers of that, such as a higher rate of drug addiction?

  46. Eric, one of the points about multiple causes is that they all can be true. So switching from one kind of food to another could easily be a partial cause. Along with 24 hour access to food, a more sedentary lifestyle, and snacking versus family meals. And genetic and physiological differences between individuals can select who exactly becomes obese. With multiple causes (that’s 6 causes I named, but some of the six are whole categories of causes), there’s no need to select, but just quantify and draw decision trees. 
     
    The reason people want single causes so much is that they promise control. Sometimes you get that, sometimes not. Sometimes knowing the cause (e.g. diabetes) allows management but not sure; we can say that we know the cause (insulin problems) but not necessarily the cause of the cause. 
     
    I’m familiar with the ulcer example, but from what you said, finding the cause didn’t lead to control, and if the bacterium was pervasive at one time there must be a second cause of ulcers at least.

  47. John — You aren’t citing ANYTHING in the way of sources or studies. That’s unlike you. Tons of research has been done on diet, weight, and health, from anthropological to medical. It’s very scattershot, a lot of it has been of low quality, and a lot of it (according to Taubes and others) has been misinterpreted. But there’s tons of it to snoop around in. Why not take the plunge? You’ll enjoy Taubes for other reasons too. It’s a great look at how science, medicine, politics and public policy interact (and can go bad).  
     
    Spike — Yeah, the exceptions (or “exceptions”) are fun. I think you’ll find that some of these people are less dogmatic than you might expect. Hyperlipid and Whole Health Source love returning to the exceptions and trying to figure them out. If I recall right, Taubes doesn’t go too much into Polynesians, but he’s got a number of pages about the Japanese and many, many pages about American Indians. The diet docs and gurus are one thing — they’ve got something to sell (which is OK), so they often overplay their hands (which is also OK, as far as I’m concerned — it’s up to us to know how to take them). But the better researchers aren’t dogmatic. In fact, so far as researchers go, it’s the mainstream people who are the dogmatic ones. They interpret everything, literally everything, in the same way, and reach the same conclusions no matter what the evidence seems to say. Taubes has a good explanation for this. According to him, 1) many mainstream nutrition people are motivated by a do-gooding mentality (they’re teachers, they want to tell other people how to live) more than an interested-in-science one, and 2) many of the top nutrition people are activists, specifically of a Berkeley-vegetarian kind.  
     
    FWIW, my own hunch is that insulin is very (but probably not exclusively) important; that there are a number (but certainly not an infinite number) of eating-and-activity patterns that are or might be viable for a given person; that different populations have evolved different preferences, biochemistries, and general gestalts; that different families have too; that the age of a given individual counts for a lot (what works well for you at 20 might not work well for you at 70) … And that eating the Standard American Packaged-Food-and-Industrial-Oils Diet is probably disastrous for just about everyone. But what do I know, aside from what seems to work better and/or worse for me? But that’s part of the fun of all this. It’s messy, it has more to do with research and experience than it does with theory, it’s semi-predictive at best, there’s lot of variability, culture plays a role but seems to bleed into genetics (and vice versa) … Fun!

  48. On aristocrats, as I remember they were much taller than peasants, 6-12″ taller, and also stronger. They were professional soldiers in most cases up until 1800 or so, and while this doesn’t necessarily mean they were athletic, they often were.  
     
    A lot of our portrait of the aristocracy comes from middle-class and leftist sources which tend to be biased against them. By and large I think that they were more likely to be rough, bullying, and jockish than soft, effete, and fat. 
     
    But we’re talking about 1000-1800 AD over a dozen nations, so there’s a lot of variation.

  49. Hey, diet and dogmatism: 
     
    http://www.marksdailyapple.com/diet-dogma/

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