I’ve just spent an afternoon disappeared down the rabbit hole that is PubMed.
It started with a paper I spotted documenting the health changes that took place among Alaskan Inuit during the mid 20th century — an unusual topic to see in the British Medical Journal — but one which immediately struck a chord with my knowledge of the work of Weston A Price.
The importance of this kind of research is that it helps us understand what direction our own diets might take to better improve our own health.
Background: Weston A Price
(Skip over this bit if you already know about Price’s work)
In the 1930’s a dentist named Weston A Price travelled the world observing traditional societies transitioning from their traditional diets to western foods.
He made meticulous studies of their dentition and general health, observing that those eating their traditional foods almost never had caries, crowding or other dental malformation, even where they showed extreme wear or chipping due to grit in the diet and using their teeth as tools (for example to soften leather). On the other hand those who had started eating recently-introduced shop food had high rates of dental caries, and gave birth to babies with narrow jaws and crowded teeth.
His travels and observations are detailed in his excellent book Nutrition and Physical Degeneration which is essential reading for anyone trying to understand the origins of the modern diseases epidemics of obesity, diabetes and heart disease. His work has been highly influential on the modern Ancestral Health movement (led by The Weston A Price Foundation) and to a lesser extent on the Paleo Diet movement.
Below are photos he took of Alaskan Inuit during his visits in the 1930s. On the left are natives who were still eating their traditional diet, whilst on the right and those who had started eating modern shop foods.
The question then is what precisely caused the changes he observed? Was it the inclusion of processed food? or the reduction in traditional foods? or both? What part did change in activity levels or socioeconomic status play? And can we apply some of this knowledge to our own diets and lives today?
Price was not the only person to document such changes, as many of the first clinics and physicians stationed at the frontiers of the expanding Western empires witnessed these changes first hand. A plethora of records from the era still exist, tucked away in museums around the world which represent a great historical archive documenting the last major transition of humanity from traditional to modern lifestyles.
The author Gary Taubes presents dozens of well researched examples in his books Why We Get Fat and Good Calories, Bad Calories (aka The Diet Delusion – UK). I highly recommend these books which contain many fascinating stories from around the world. In the meantime, here are some you can read straight away…
Two recent articles
Despite being well-known amongst alternative nutritionists and ancestral health bloggers, the likes of Price and Taubes rarely have their theses taken up in the orthodox literature, where instead they are either attacked or ignored (the latter being the preferred and more effective approach).
So I was pleased to see that the increasingly open-minded British Medical Journal Open Heart have published at least two articles on this theme.
In fact, one of the joint authors of the papers below, James J DiNicolantonio – a cardiovascular researcher from Saint Luke’s Mid America Heart Institute at the University of Missouri-Kansas City – is Associate Editor of BMJ Openheart. His joint author James O’Keefe, is a researcher in the Department of Internal Medicine at the same University, with interest in Hypertension, Atherosclerosis,Diabetes, Lipid Metabolism, Cardiovascular and Coronary Artery Disease and Statins, who cropped up again later in my research (see further down this post).
The titles of the two papers make their historical investigation quite clear:
- Markedly increased intake of refined carbohydrates and sugar is associated with the rise of coronary heart disease and diabetes among the Alaskan Inuit (2017, Full text here)
- The introduction of refined carbohydrates in the Alaskan Inland Inuit diet may have led to an increase in dental caries, hypertension and atherosclerosis (2018, Full Text here)
Both are easy to read articles, not too technical, give them a go.
Like the work of Price and Taubes, these papers document the change in diet from traditional to modern foods along with the corresponding worsening of metabolic and dental health.
Here are some selected quotes:
From paper 1
Alaskan natives who had previously had just 1/18th the rate of death due to ischaemic heart disease in the mid-1950s had an identical rate of heart disease mortality by the mid-1980s compared with the USA. Importantly, one of the major dietary changes that occurred in the mid-1950s in Alaskan Inuit was an increase in the intake of carbohydrates and simple sugars.
In the 1950s, only five diagnoses of diabetes had been made from eight hospitals serving Alaskan Inuit, ‘Five hospitals had never seen diabetes mellitus in an Eskimo’.More importantly, ‘Vital statistics reports showed 35 deaths due to diabetes in Alaska in the years 1919–1951, but none of these were in Eskimos’. In other words, prior to 1950, diabetes was virtually non-existent in the Alaskan Inuit. Scott and Griffith in 1957 wrote, ‘Diabetes mellitus was not detected in the 869 Eskimo National Guardsmen tested’. Thus, diabetes was apparently absent in Alaskan Inuit even up to 1957. Interestingly, the intake of carbohydrates among Alaskan Inuit increased by around 50% from 1957 to 1965, and by the early 1970s, the rate of diabetes in Alaskan natives had tripled.13This suggests that the increase in the intake of refined carbohydrates in the Alaskan Inuit may have contributed to their rise in diabetes.
From paper 2
With westernisation however came an increase in the intake of refined carbohydrates and sugar in the Alaskan Inuit. Indeed, compared with the Inuit of Point Hope, the Inuit living in a boarding high school consumed more carbohydrates (48% vs 10% of total calories), less fat (39% vs 55% of total calories) and less protein (14% vs 35% of total calories).
In summary, based on X-ray exams, older Alaskan natives had about one-half to one-third the rate of atherosclerosis compared with 14 other more westernised populations on autopsy. Autopsy studies in the mid-to-late 1950s in Alaskan Inuit showed around one-fifth the rate of death from cardiovascular disease (5.8%) as compared with those in the USA (30.6%) during the same time period, and based on autopsy studies, the rate of death from ischaemic heart disease in Alaskan Inuit was around 1/18th that of the USA (1% vs 18.44%)
Contemporary application of the traditional Inuit diet
Whilst it is fascinating to read about the historical changes in diet as reported by Price, Taubes, DiNicolantonio and O’Keefe, the real test of the hypothesis is to see if there is any contemporary evidence about the benefits of traditional foods in the Inuit diet. Fortunately, there is quite a lot, and indeed the research does show that even small amounts of native foods in the diet can lead to significant improvements in diet quality.
Here’s a selection of what I found:
Traditional food patterns are associated with better diet quality and improved dietary adequacy in Aboriginal peoples in the Northwest Territories, Canada. (Sheehy, 2015)
“The diet of nontraditional eaters contained, on average, a lower density of protein, niacin, vitamin B12 , iron, selenium, zinc, omega-3 fatty acids (P ≤ 0.0001), vitamin B6 , potassium, thiamin, pantothenic acid (P ≤ 0.001), riboflavin and magnesium (P ≤ 0.05). Inadequate nutrient intake was more common among nontraditional eaters for calcium, folate, vitamin C, zinc, thiamin, pantothenic acid, vitamin K, magnesium, potassium and sodium. Non-nutrient-dense foods (i.e. high fat and high sugar foods) contributed to energy intake in both groups, more so among nontraditional eaters (45% versus 33%). Traditional foods accounted for 3.3% and 20.7% of total energy intake among nontraditional and traditional eaters, respectively.
Diet quality and dietary adequacy were better among Inuvialuit who consumed more traditional foods. The promotion of traditional foods should be incorporated in dietary interventions for this population.”
Traditional food consumption is associated with higher nutrient intakes in Inuit children attending childcare centres in Nunavik. (Gagné, 2012)
“Although traditional food was not eaten much [by the children in this study], it contributed significantly to the nutrient intakes of children. Consumption of traditional food should be encouraged as it provides many nutritional, economic, and sociocultural benefits.”
Dietary adequacy of vitamin D and calcium among Inuit and Inuvialuit women of child-bearing age in Arctic Canada: a growing concern. (Kolahdooz, 2013)
“Inadequate dietary vitamin D intake is evident among Inuit and Inuvialuit women of child-bearing age in Arctic Canada. Promotion of nutrient-rich sources of traditionalfoods, supplementation protocols and/or expanded food fortification should be considered to address this nutrition concern.”
The calcium question
This last paper reveals a dilemma for modern nutritionists: they have to acknowledge that traditional diets are healthier – in this case contributing to vitamin D status – but, when it comes to calcium they find that both modern and traditional diets are only adequate because they are both consuming dairy products.
Table 3 in the paper shows calcium contributions from different foods, and all of the traditional foods are low in calcium. So how exactly were the traditional Inuit getting sufficient calcium when they didn’t have any dairy products? Are our RDAs incorrect? Do calcium needs decrease on a diet high in animal foods / protein? Or where the Inuit eating more bones and bone broth?
That last point has been investigated by – well look at that – one of our BMJ authors James O’Keefe and father of the paleo diet Loren Cordain in the following paper, in which they question reliance on dairy products for calcium, instead considering other strategies, including the consumption of bone broth and bone meal on.
Nutritional strategies for skeletal and cardiovascular health: hard bones, soft arteries, rather than vice versa (James O’Keefe, 2016)
In short, they point out that bones need vitamin D, K1 and K2, protein, magnesium and potassium. When these are present in adequate amounts in the diet calcium needs may be lower. Traditional diets are replete in all of these nutrients so may have led to a reduced calcium requirement.
They argue that the primary source of calcium would have come from eating bones:
Theoretically, including animal bones (sardines, salmon, soft chicken bones, bone broths, etc) may be an effective dietary strategy to ensure adequate calcium intake and to optimise long-term bone health.
As evidence they point to studies using calcium supplements in the form of microcrystalline hydroxyapatite (the form of calcium found in bone). Which they say “produces less of an acute spike in blood calcium levels compared to soluble calcium salts typically used in standard supplements, and thus may be less likely to increase vascular calcification and coronary risk.”
They also point to a study that found calcium hydroxyapatite supplements increased bone thickness more than standard calcium supplements:
Personally I’m not convinced that this provides a sufficient explanation for how the traditional Inuit were able to maintain bone development on a low calcium diet. I suspect that there are other factors at work.
The recent explosion in interest in a purely carnivore diet has thrown up some interesting, albeit anecdotal, evidence from among its adherents. It would appear from online forums that there are thousands of people pursuing a meat-only diet. Many of them appear to have been eating this way for decades, and some have given birth to several healthy children who they have also raised meat only. They report that neither they nor their children have had any problem with bone health.
That’s interesting and suggests that either there is something bone-protective in meat, or that something in a standard diet makes us need more calcium. Such an observation has been put forward before: A study in Scotland — Meat consumption reduces the risk of nutritional rickets and osteomalacia (Hibbeln et al, 2005) — found that vegetarian diets were associated with increased risk of bone disorders like rickets, whereas meat eating was protective independent of sun exposure.
Another possibility is that the Inuit and other ancient Northern populations have adapted to lower vitamin D requirements via natural selection, (Frost P, 2012). But that doesn’t explain how come they have strong bones on a low calcium diet.
Of course it may turn out that the carnivore dieters all end up with early onset osteoporosis despite their being little evidence thus far. If that turns out to be the case, then we still are none the wiser as to how come the bones of Inuit and other hunter-gatherers living on their traditional diet didn’t crumble away.
Exercise vs diet
One of the problems of placing all of the emphasis on diet is that one can miss other factors. Westernised lifestyles tend to be more sedentary. What health changes might be down to a less active lifestyle?
In the following paper, two groups of physically active Greenland Inuit were compared: the first eating a largely traditional diet and the second relying on more Westernised foods. Although the Western diet group had more risk factors for heart disease, blood glucose control — and therefore Diabetes risk — was the same.
Metabolic profile in two physically active Inuit groups consuming either a western or a traditional Inuit diet. (Munch-Andersen, 2012)
“Diabetes or impaired glucose tolerance was not found in the Inuit consuming either the western or the traditional diet, and this could, at least partly, be due to the high amount of regular daily physical activity. However, when considering the total cardio vascular risk profile the Inuit consuming a western diet had a less healthy profile than the Inuit consuming a traditional diet.”
- We can learn much about health from understanding the changes that take place among peoples transitioning from a traditional to a modern lifestyle.
- Modern processed foods and refined carbohydrates appear to be driving many modern diseases.
- Adding even small amounts of traditional foods into the diet is likely to be beneficial.
- For most Westerners such foods might include nuts, berries, eggs, full-fat dairy, game meats and seafood.
- Physical activity may be important in some modern diseases
- We don’t understand how traditional diets lead to good bone health