Red Meat and White Rice, Oh My!

This started as a note for an Around the Web, but has grown … so it will stand on its own.

The Red Meat Study

The Paleosphere has been abuzz about the red meat study from the Harvard School of Public Health. I don’t have much to say about it because the claimed effect is small and, at first glance, not enough data was presented to critique their analysis. There are plenty of confounding issues: (1) We know pork has problems that beef and lamb do not (see The Trouble With Pork, Part 3: Pathogens and earlier posts in that series), but all three meats were lumped together in a “red meat” category. (2) As Chris Masterjohn has pointed out, the data consisted of food frequency questionnaires given to health professionals, and most respondents understated their red meat consumption. Those who reported high meat consumption were “rebels” who smoked, drank, and did not exercise. (3) The analysis included multivariate adjustment for many factors, which can have large effects on assessed risk. Study authors can easily bias the results substantially in whatever direction they prefer. I’ve discussed that problem in The Case of the Killer Vitamins.

So it’s hard to judge the merits of the red meat study. However, another study from HSPH researchers came out at the same time that was outright misleading.

The White Rice and Diabetes Study

This study re-analyzed four studies from four countries – China, Japan, Australia, and the United States – to see how the incidence of diabetes diagnosis related to white rice consumption within each country.

Here was the main data:

The key thing to notice is that the y-axis of this plot is NOT incidence of type 2 diabetes. It is relative risk within each country for type 2 diabetes.

I looked up diabetes incidence and rice consumption in these four countries. Here is the scatter plot:

Here is the complete FAO database of 86 countries, with a linear fit to the data:

UPDATE: O Primitivo has data for 162 countries and a better chart. Here it is – click to enlarge:

If anything, diabetes incidence goes down as rice consumption increases. Countries with the highest white rice consumption, such as Thailand, the Philippines, Indonesia, and Bangladesh, have very low rates of diabetes. The outlier with 20% diabetes prevalence is the United Arab Emirates.

A plausible story is this:

  1. Something entirely unrelated to white rice causes metabolic syndrome. Possibly, the something which causes metabolic syndrome is dietary and is displaced from the diet by rice consumption, thus countries with higher rice consumption have lower incidence of metabolic syndrome.
  2. Fact: Diabetes is diagnosed as a fasting glucose that exceeds a fixed threshold of 126 mg/dl, and in those with metabolic syndrome (but not those without) higher carb consumption leads to higher fasting blood glucose.
  3. Therefore, the fraction of those with metabolic syndrome diagnosed as diabetic will increase as their carb consumption increases.
  4. In China and Japan, but not in the US and Australia, white rice consumption is a marker of carb consumption. So the fraction of those with metabolic syndrome diagnosed as diabetic will increase with white rice consumption in China and Japan, but will be uncorrelated with white rice consumption in the US and Australia.

Thus, diabetes incidence may be lower in China and Japan (due to lower incidence of metabolic syndrome on Asian diets), but higher among Chinese and Japanese eating the most rice (due to higher rates of diagnosis on the blood sugar criterion). This explains all of the data and is biologically sound.

What did the HSPH researchers conclude?

Higher consumption of white rice is associated with a significantly increased risk of type 2 diabetes, especially in Asian (Chinese and Japanese) populations.

No: Internationally, higher consumption of white rice is associated with a significantly reduced risk of type 2 diabetes, and the Chinese and Japanese experience is consistent with that. Carb consumption is associated with a higher rate of diabetes diagnosis within populations at otherwise similar risk for diabetes. White rice consumption is correlated to carb consumption especially strongly in Asian (Chinese and Japanese) populations.

Food Reward and “Eat Less, Move More” in Diabetes

Of course, the study authors knew that diabetes incidence is lower in countries that eat more white rice. How do they reconcile this with their claim that white rice increases diabetes risk?

The recent transition in nutrition characterised by dramatically decreased physical activity levels and much improved security and variety of food has led to increased prevalence of obesity and insulin resistance in Asian countries. Although rice has been a staple food in Asian populations for thousands of years, this transition may render Asian populations more susceptible to the adverse effects of high intakes of white rice …

In other words, rice-eating countries have higher physical activity and more boring food – just look at the notoriously tasteless cuisines of Thailand, China, and Japan – and their inability to eat high quantities of food has hitherto protected Thais, Chinese, Japanese, Filipinos, and Indonesians from diabetes.

However, once those rice eaters become office workers and learn how to spice their rice with more varied flavors, the deadly nature of rice may be revealed.

Stephan Guyenet writes that “Food Reward [is] Approaching a Scientific Consensus.” It certainly seems so; it is emerging as a catch-all explanation for everything, a perspective that can be trotted out in a few concluding sentences to reconcile a hypothesis (white rice causes diabetes) with data that contradict it.

Conclusion

To me, the HSPH white rice study doesn’t look like science. It looks like gaming of the grant process – generating surprising and disturbing results that seem to warrant further study, even if the researchers themselves know the results are most likely false.

Consensus or no – and consensus in science isn’t necessarily a sign of truth (hat tip: FrankG) – the food reward perspective seems to me an incomplete explanation for what is going on. It puts a lot of weight on a transition from highly palatable (Thai, Japanese, Chinese) food to “hyperpalatable” (American, junk) food as an explanation for obesity and diabetes. It seems to me that the lack of nutrients and abundance of toxins in the junk food may be just as important as its “hyperpalatability.” It’s the inability of the junk food to satisfy that is the problem, not its palatability.

I’m glad that the food reward perspective may start being tested against Asian experiences. That may shed a lot of light on these issues.

104 Comments.

  1. Hi Dr Andro:
    What are your dietary recommendations for inclusion of starch in the diet- do you agree or disagree with PHD recommendations on starch?
    Thanks,

  2. @Steve: I must admit that I have not read the book and everything I know is hearsay. What I can say is that I see no reason that starch is a general no-go. I also feel that the term “save starch” was not well chosen, because it suggests that the majority of starches in “unsave” – whatever that may be – and thusly only supports the carbophobia so many people are suffering from these days.

    Generally, I believe that the exclusion of all carbs (starch or no starch) is nothing but an allegedly very effective short-term intervention. That being said, I see “Atkins diets” as a proper (I don’t think the only) way to fight morbid obesity in the presence of full-blown insulin resistance. With every pound you shed and every additional step you hopefully take (meaning you become more active) your bodies ability to handle glucose will improve. Now, that alone would not be an argument to begin reincorporating carbs (if you discard social aspects), but the physiological consequences are.

    There is, I believe, a point where the pathological insulin resistance due to morbid obesity, hypertriglyceridemia and chronic inflammation turns into a “physiological” insulin resistance, which is NECESSARY for your body to survive on a no-carb diet. After all your muscles would suck away the little blood glucose you have in no time, if they were not insulin resistant. When this point of “physiological” insulin resistance is reached – the low-carb diet begins to show its nasty face. Weight loss stalls, thyroid hormone metabolism suffers, you name it…

    Now, just like Jimmy Moore, whom I could obviously not convince to try and re-incorporate carbohydrates into his diet, in the podcast which aired today, most low-carbers who have lost tons of fat with their way of eating fear regaining weight (weight most of them gained due to overeating NOT DUE TO CARBS)… and, in fact, they will probably gain some weight. The glycogen alone is good for a few kilos (although in many this is compensated by water loss), but when you go slowly even a sedentary person should be able to handle at least 100g of carbs per day (cf. my blogpost “Carbohydrate Shortage in Paleo Land”) / if you are working out you can easily make it 200g (at least on workout days) and could still lose weight easily, with the worst side effects being increased performance and well-being.
    With the restoration of muscle and liver glycogen (the role of the liver in the orchestrate of endocrine hormones is by the way largely underestimated, but that would be another post ;-) and the availability of TWO instead of ONE energy pathways, you signal your body that “the world is back in order” and he (or she ;-) can let go of more body fat… that does obviously require that you do NOT just eat the carbs in addition to the tons of fat you used to eat (assuming you have been low-carbing before), because it is simply false to assume that calories would not count at all.

    As far as carb sources are concerned, I would try to minimize all highly processed carbohydrate sources (anything that is made of flour is thusly on the “only occasionally” list / I hate those endless lists of “I cannot eat” – stay flexible!), rice is fine and personally I prefer basmati (=white) over brown rice, because for me taste is an issue, as well – moreover, I agree with Paul that the evidence that brown would be better than white is scarce; the science on anti-nutrients is inconclusive, as well, though ;-)

    I am also not sold on the idea that the small GI difference between basmati and brown rice does make a difference (if anything the glycemic load per meal is something you COULD / but do not have to / keep an eye on). I am also sure that “normal” potatoes are just as good (if you select the right type, don’t mash or overcook them, cf. the Potato manifesto @ http://suppversity.blogspot.com/2011/12/potato-manifesto-part-12-re-evaluation.html) as sweet potatoes and if you tell me something about Quinoa and all this **** I tell you that my grandpa would not have know what that is, got 89 years old and was in better shape than 90% of my students at the University when he died (on a side note: He ate regular potatoes at least 6x a week ;-)… overall most of those “you must not eats” are simply making your life miserable and don’t really make a difference for most people.

    I am also a huge fan of fruit (as in WHOLE fruit, never in powdered or juiced form) and I suggest that no one ever gets the idea to count carbs from veggies.

    that was my perspective on carbs :o) Any further questions?

  3. I’m half-Korean and lived in Korea, Taiwan and Hong Kong as a teenager and young adult, and also traveled throughout Asia. Let me add more anecdotal evidence to fuel the discussion. When I lived in urban Asia in the 70s, meat was still very expensive, and used sparingly to flavor soups and stews. No one was chowing down on all-you-can-eat Bulgogi or any kind of steaks or such, as is affordable today.

    I remember Asians being quite noodle-crazy. Noodles are eaten very often, if not daily for many people. Wheat noodles, mind you. I remember as a ten year old in Taiwan, our Ahma, or housekeeper, introduced me to instant ramen – just add hot water. I thought it was the bees knees! Come home from school and make myself a tasty bowl of ramen by myself. Everyone ate it. Steamed wheat buns, or Bao were also popular and available piping hot on any street corner shop. So you had all this consumption of basically empty calories from rice and refined wheat products like noodles on a daily basis, with little meat.

    Even fish was dried, salted stuff. I don’t know where all the fresh fish was being cooked, as it wasn’t all that available at reasonable prices in the cities. Koreans would typically prepare one small whole fish and that would be shared by the family at table, with soup, rice and assorted veg side dishes.

    What about the fact that Asians who immigrate to the US have American-born children who are quite a bit larger than the average person back home? Wouldn’t this indicate some lack of nutrition in their homeland diets? Southeast Asians from the poorest countries like Vietnam are particularly scrawny and small. Some might call that lean and healthy, but come on, it’s clearly malnourishment when the same scrawny people come here and you see them, and particularly their young children start to thrive physically. If you are an immigrant who grows 6 inches taller than your cousin back home, what does this mean?

    Of course you can’t paint all Asians with the same brush – there are poor, rich, urban, rural, people of different cultures. For all the drawbacks of the standard American diet, we really have eaten quite well compared to people around the world. A Russian immigrant friend who immigrated here in the 90s was awestruck when my husband and I took him to Tony Roma’s rib restaurant. He couldn’t believe each person got a plate full of meat, remarking that he had never eaten such meals back home in Moscow.

  4. Wayne D Johnson aka Prouddaddy

    @Adel: Hard to disagree with a single thing you’ve said — as usual!

  5. Sheep Counteress

    I agree completely with Hillside Gina’s observations. Thank you Gina!

    From some of the comments above, it seems people were fed very well as guests by grandparents or friends of family. We make it a point to be generous in our culture :)

    Definitely very few people in Taiwan in my parents’ generation (immediately post WW2, Revolution) starved, but it wasn’t a society where there was “all you can eat” anything. Meat was almost always pork. Fish occasionally. Chickens provided eggs, were killed for meat only on New Year’s. Beef was either taboo for Buddhists or for many who regarded cows as beasts of burden, and prohibitively expensive anyway. Fruits were wonderful but strictly seasonal, not like today where people can afford beautiful gift boxes of imported pears from Japan.

    I think people might lose sight of the fact that there are some strong values of frugality at play. In a US Chinese or Thai restaurant, rice is either complementary or it is 75cents a bowl, a totally trivial cost. Sure people in my parents’ generation could usually afford second helpings of rice, but it wasn’t trivial. And certainly not second helpings of meat. Second servings were almost always for heads of households/fathers or growing sons. ***Even today, servings of meat at home are what Americans would probably regard as paltry. Meat was and still is the condiment to rice or noodles.*** The portions you see in American Chinese restaurants are American portions, not what one person gets to eat every day at home.

    Of course people would be stuffed on both starch and meat on feast days like New Year’s, but New Year’s has such importance that people make a huge point of abundance. For sure the Chinese and Japanese saying that Paul has quoted is practiced: “Eat 8/10 full, walk 100 steps after the meal.”

  6. Sheep Counteress

    I would also add that there are more model-thin ladies in Taiwan than among Asians ladies in America, and more of what is described as “skinny fat” among men in Taiwan than among Asian men in the US. I’ve no doubt this is primarily due to less meat consumption, as well as almost total lack of practicing serious resistance exercise in Taiwan, except for competitive weightlifters and the sort.

    I’d say the height differences Hillside Gina describes are also still somewhat visible among Taiwanese today, more so among men. Wonder if that would also be due to different protein content of diet, since kids in Taiwan today do not have grossly deficient diets compared to their US peers?

  7. Hi Dr. Andro:
    Thanks for your detailed and well reasoned response. I could not agree with you more. As for my own diet, I think it would reflect your views: meat, fish,eggs,poultry,dairy(cheese/Greek yogurt), some fruit(berries) and fats consisting of coconut oil, olive oil or butter. Treats would be 85%+ dark chocolate or green tea ice cream should i visit a Japanese restaurant.
    Will a history of heart disease from grandfather on down, I note that NMR results show lots of small LDL if to many carbs are in the diet. Normal weight and BG so I think it might be genetics. If I go zero carb for a shot period of time, and restrict the carbs even from veggies the small LDL drops to nearly zero.
    My doc says I may be in the minority that needs statins. Looked over your blog: it is terrific!

  8. i would add that i eat potatoes and rice as well.
    Thank you

  9. @Dr. Andro

    The evidence is overwhelming that wheat and added sugars are “uniquely fattening” (to quote G. Taubes) – and they are both CARBS.

    You talk about 100 g carb per day for a sedentary person; I think this is fine, and may not even be enough for MOST people. However, most Americans are both sedentary and eating 400 g carb per day (or more); 100 or even 200 would be a huge reduction in carbs, and a huge improvement. So, your statement that most fat Americans got fat “due to overeating NOT DUE TO CARBS” is completely wrong; what they are overeating is wheat and sugar, which ARE carbs. Also, as I explained in my “Low-carb or Low-fat” post, MOST people need to get less than half their calories from carbs.

    So, I think that Paul’s use of the term “safe starches” – especially since he has always paired it with a recommendation for about 100 g carb per day – is entirely appropriate.

  10. Paul wrote:

    “….When people cooked at home every day, these culinary methods were probably common knowledge.

    Perhaps traditional diets didn’t get into the “hyperpalatable” space that you think causes obesity, but they certainly covered a wide range in palatability without inducing obesity…..”

    When I read this, I thought, of course traditional diets were palatable. To flip the question around, but what foods were present in traditional diets that might cause one to over consume those foods, or to cause someone to eat when not hungry?

    I’ve read Stephan’s articles on Food Reward and since then, I’ve noticed a lot of interesting things about my food choices.

    For one, I don’t have good instincts on what to eat. I ate 3 poached eggs, white rice cooked in broth, and some salsa for breakfast not because it was what I “felt” like eating but because I want to eat more nutrient dense foods to improve my health. Left to my own devices, I’m drawn to coffee and a chocolate croissant.

    I’ve been having a lot of the same things to eat. The egg/rice/salsa breakfast. Usually homemade yogurt and fruit. Then some cut of meat with veggies or meat over a salad. Sometimes homemade soup.

    It all tastes good, but I’ve found it’s….a bit boring. If I allowed myself to take more meals outside of the home, I’d certainly be susceptible to eating a diet that is more exciting, with more variety, and possibly a lot less healthy.

    Perhaps I’m one of those people who is more susceptible to food reward. I just find it remarkable that whether I’m hungry or not has a lot to do with what food is in front of me. We live in an age where we have the luxury to say “I don’t feel like eating that.”

    Since switching to eating many of the same basic foods over and over—not bland, just repetitive—and avoiding foods which make me want MORE (salted nuts, nut butter, fried potatoes with spices, tortilla chips…) I’ve found my appetite is down, and I’ve slowly been losing those last stubborn 15 pounds, no small feat for a relatively inactive 48 year old woman.

    • I was the same for a very long time, always fighting temptation to eat out whenever I could. I reigned in slowly, over the last couple of years so that now I actually don’t like eating outside of home. The exception is a Thai restaurant local to my place of work where the people there cook very much like they cook for themselves. Everything else, eg hamburgers, fries, cakes, etc are very much unappealing. I don’t know if it’s fear induced, or simply I have lost the desire to each SAD. I think most people go this way after eating well, just takes a little time.

  11. @Jeffrey: I did not criticize Paul, because I believe that his concept is flawed, but because the “added sugars” and the “wheat” are not macronutrients, but foods and if you read my comment carefully I said “no processed carbs” – I have not seen anyone eat unprocessed wheat yet and I also don’t know a food that is called “added sugar”

  12. Hi Michelle,

    It’s a great observation, and I think it covers the common ground I have with Stephan. Food reward does play a role, and healthy food eaten repeatedly over time does become boring and inhibit maintenance of excess weight, even if it is very tasty.

    A few of the differences:
    – I think the “healthy” qualifier is essential. Healthy food is very similar in nutrient composition to the human body components which are cannibalized during fasting. Thus, a marginal bite of food has essential zero impact on health in the short term. It is therefore easy for the brain to “not care” whether you eat it or not.
    – Contrariwise, non-nourishing food teaches the brain that it needs to upregulate appetite in order to get the nourishment the body needs.
    – Stephan emphasizes a spectrum of palatability culminating in “hyperpalatable” foods which drive obesity. I don’t think palatability has that much to do it, except that unhealthy foods must be palatable to induce people to eat non-nourishing foods and to trick the brain into continuing to expect them to be a source of nourishment. If foods are healthy, I don’t think palatability influences how much is eaten over long periods of time. Palatability may increase consumption in the short term, but that is due to novelty or to pre-existing nutrient deficiencies.
    – Stephan talks of “the food reward hypothesis” whereas I see many food reward hypotheses, protean in nature. Insofar as a consensus has been achieved, I think it is a very weak consensus (eg, I would fall within it).

    I agree with you and Stephan that in the modern world, with many unhealthy but superficially palatable food choices, we need to learn how to eat in a healthy way and to consciously direct ourselves to eat that way. Just eating food that looks tasty or excites hunger is no longer a sufficient guide to healthful eating, though it probably was in our evolutionary past.

    Best, Paul

  13. I suspect anyone that uses the term “scientific consensus” does not really understand science.

    Are they implying that if I get more scientists to agree with me than you do, I’m right? What if I have 49% and you have 51%, but mine have more relevant credentials – who’s consensus is more correct then?

    It’s beyond comprehension what the thought process behind that term is.

  14. Paul, what leads you to believe the brain or body has a mechanism for sensing the nutrient content of foods?

    If it does, wouldn’t it lead us to make better food choices, and not simply lead to up regulation of appetite?

    Why wouldn’t our bodies crave organ meats, and eggs?

    I find the whole topic curious! We discuss it quite a lot in our family, and I think we have all identified certain foods we will wolf down, regardless of hunger. And, why is it boring to eat the same old foods, even though they are packed with nutrients? Why would that make the body not want to eat?

    Thanks again for your contribution!

  15. Hi Michelle,

    I don’t think it senses the nutrient content of foods, that is why it can be fooled.

    Rather it senses certain things — eg fat, carbs, protein, salt, acids, bitter toxins — and estimates nutritional value from those cues.

    Junk foods evoke the cues of the evolved food reward system to pose as nourishing foods.

    I do think the brain senses the health of the body, and when the body’s health is suffering for lack of nutrition, it generates hunger.

    So, in this case, we would get pleasure out of organ meats and eggs — if we ate them.

    But I think we also have an “optimal foraging system” which has taught us how to obtain food with the least work. And this system often guides us away from liver and eggs toward cookies and soda.

    I think good foods are not boring, if we need them. They’re boring when we can do without them because we’re well nourished.

  16. Hi Paul, just thought I’d tell you how my thyroid recovery is going. I was so encouraged by the hair growth I got from following your suggestion to add carbs that I went overboard and tried refeeding (RRARF) for 11 days. Guess what, I gained 11 pounds! At a pound per day, the 50 pounds of fat it took me an entire year to fight off would have been right back on in only 7 weeks! My temps went down instead of up anyways, so there was no point. Oh well at least I had some fun eating Ben and Jerry’s coffee-toffee ice cream for breakfast!

    Your PHD book just arrived, and my mom is interested in doing your diet with me. She has had horrid GERD for 10 years, and now she only gets about 2 hours of sleep at night. She said it feels like having restless leg syndrome in your entire body all night long. She thinks it is menopause but I blame the Nexium, it keeps you from absorbing nutrients. I think she also has candida, since she once tried my (former) super-low carb diet for two weeks and all it did was make her stomach bigger. We are not giving up hope though, this morning she read out loud to me the part of your book which recommends to start the PHD without being too restrictive in meal portions. She loved that part, LOL.

  17. Hi Meli, thanks for the news! Carbs are great up to a point, but you can have too much of a good thing. My best wishes to your mom and please keep me posted!

  18. Hi Paul & everyone else ;-)

    I have to respectfully disagree as far as selenium toxicity from brazil nuts (and other foods) is concerned. I agree with you, Paul that it is neither necessary nor advisory to take >200mcg of supplemental selenium, but even the evidence for toxicity from (non-adulterated!) supplements is scarce and I have included a mini summary of the results of an investigation on the effects of the exorbitantly high selenium intake of the indigenous inhabitants of the Tapajós River delta in Brazil in a previous blogpost on the pro-fertility action of Se at the SuppVersity, cf. http://suppversity.blogspot.de/2012/01/selenium-fertility-mineral-organic-and.html

    Selenium intoxication from Brazil nuts? I don’t think so…

    That this practice is not going to result in selenium toxicity has, by the way, been shown only very recently in one of those studies that analyze traditional diets, which have become so in-vogue, as of late. Lemire et al., who analyzed blood (B-Se) and plasma (P-Se) samples from members of the communities which live along the Tapajós River in Brazil, did not only find that these people had selenium levels well beyond what is “considered toxic” in the US, they also state that their results “support the need to re-assess Se toxicity considering factors such as the chemical form of Se exposure, route of exposure (inhaled versus ingested), co-exposures to toxic elements such as mercury” and hint at “a possible association between high Se status and cardiometabolic health in this study population.” (Lemire. 2011) So, men or woman, fertile or infertile, fat or lean… you better make sure you get your share of brazil nuts, today ;-)

    Now there could be genetic or dietary co-factors playing a role here, but we are not only dealing with high intake, but also “toxic” (according to our standards) serum levels:

    “Although B-Se and P-Se surpassed concentrations considered toxic (B-Se: 1000 ?g/L (U.S. EPA, 2002)), no dermal or breath signs or symptoms of Se toxicity were associated with the biomarkers of Se status.”

    So that I would strongly support the researchers conclusion that

    Considering the current food transition towards a western diet in the Amazon, further studies should address the possible association between high Se status and cardiometabolic health in this study population.

    if you are interested in the FT, Paul, here is the link > http://www.ncbi.nlm.nih.gov/pubmed/21856002

  19. Paul,

    Thank you for another great article. I particularly liked the way in which science for the sake of money was shown to be prostituting itself.
    This article reminds me of a very nice piece written by Jon Barron of The Baseline of Health Foundation. in his February 27, 2012, article entitled “Unproven Medicine, Yet Again”, http://www.jonbarron.org/natural-health/unproven-conventional-medicine-newsletter, He plainly pulls down the curtain behind which the wizard of orthodox “Scientific Research” sits and reveals the bone-headed slop being foisted as science.

    Howard

  20. Michelle:

    “Paul, what leads you to believe the brain or body has a mechanism for sensing the nutrient content of foods?

    If it does, wouldn’t it lead us to make better food choices, and not simply lead to up regulation of appetite?”

    You’re touching on the very important difference between satiation and satiety! They’re synonyms in common usage — but they are distinct scientific terms describing two different real, measurable biochemical and neurological phenomena.

    Satiety is produced when our body absorbs the nutrients in food through the small intestine. However, this process can take several hours…far too long to be a useful signal to stop eating.

    In contrast, satiation is produced immediately by the sensory experience of eating food. Satiation is our estimate of future satiety based on our perception of what we’re eating…and, as such, it can be fooled in many different ways.

    The combination of satiety (our perception of our current nutritional state) and satiation (our perception of what we’ve just eaten) is what makes us stop eating.

    Based on the extensive existing science on the subject of hunger and reward, it’s clear that the idea that “food reward” is a unitary quantity directly related to “palatability” is oversimplified to the point of being factually incorrect. For more information on this fascinating subject, see (for instance) Benelam 2009 and Berridge 1996, and my series Why Are We Hungry? I enjoy presenting the science to my readers, and I look forward to presenting it in person at AHS 2012.

    JS

  21. Having read the views here on the Asian-Amercian susceptibility to Type 2 diabetes vs. Asians in Asia, I am slightly more confused than before.

    It seems plausible that the reduced-rice eating pattern of Asian-Americans, who have incorporated more wheat/junk-based foods into their diet, may have resulted in a higher incidence of diabetes than Asians in Asia with higher rice consumption/less wheat/other. But is this the case?

    I found Gina’s Korean anecdote interesting as well, since it implies that there is more wheat consumption going on in certain locations than we think.

    Also in urban areas where Western-style starchy foods are gaining in popularity, it would infer that Type 2 diabetes is on the rise.

  22. Hi Adel,

    It’s an interesting study, thanks for pointing it out.

    I’m not convinced there were no signs of selenosis in that population. 41% had abnormal nails and 23% had general irritation or mycosis on the body.

    However, it’s reassuring that the health harms weren’t severe. It looks like inorganic selenium (eg sodium selenite) may be much more toxic than the organic forms found in food.

    Best, Paul

  23. @JS

    Thanks, I’ll read your series.

  24. @Paul

    you are right, 1:0 Paul : Adel – a 100% Brazil nut diet is certainly not the “Perfect Health Diet”. I would yet still prefer 1-2 hands full of Brazil nuts per week over any selenium supplement (they also taste much better)

  25. What about those of us who are allergic to nuts and cannot eat Brazil nuts. Should we supplement with Selenium or just get it through diet?

  26. Hi Steve,

    firstly, I don’t believe that it is generally necessary for everyone to either eat Brazil nuts (only for their selenium content) or supplement with selenium.

    That being said the interaction of mercury (and other heavy metals) with selenium appears to increase the risk of deficiency, although a diet along the lines of “Paul’s” Perfect Health Diet should provide you with enough of all the micronutrients.

    Another confounding factor is gut (dys)biosis, and the bacteria in your gut competing with yourself for selenium esp. if overall intake is low (cf.http://www.ncbi.nlm.nih.gov/pubmed/18829286)

    I believe that (standard American diets aside) these are the main reasons why selenium supplementation can be indicated, which brings up the next questions:

    1) How much?
    2) In which form?

    Assuming that you do already get at least “some” Selenium from your diet, a prudent amount of supplemental Se, appears to be ~100mcg; the following trial appears to confirm that

    http://www.ncbi.nlm.nih.gov/pubmed/20181815
    To optimize the plasma selenoprotein P concentration in this study, 50 microg Se/d was required in addition to the habitual intake of approximately 55 microg/d.

    The supplement combination that was used in this study consisted of

    “Daily placebo or selenium-enriched yeast tablets containing 50, 100, or 200 microg Se ( approximately 60% selenomethionine), selenium-enriched onion meals ( approximately 66% gamma-glutamyl-methylselenocysteine, providing the equivalent of 50 microg Se/d)”

    Selenium yeast has as of late gotten some scientific attention and is hailed to be as bioavailable as dietary selenium (http://www.ncbi.nlm.nih.gov/pubmed/18193397) I am yet somewhat skeptical about the objectivity of respective trials, which were mostly conducted by the producers of pertinent products.
    I should clarify: I am skeptical, whether the yeast is the “best” form (safety up to 300mcg has been established, cf. http://www.ncbi.nlm.nih.gov/pubmed/15522125) or whether “normal” seleno-l-methionine does not have identical bioavailability (cf. http://www.ncbi.nlm.nih.gov/pubmed/16614127) – in the end, this is by the way, what the yeast contains, anyways. Sodium selenite, which is in many multis, on the other hand appears to be an inferior form.

    Hope that helps.

  27. What about pro oxidants in white rice or starch?

    ‘A new study published this month found that the consumption of 6-8 microwaved purple potatoes a day (they’re pretty small) resulted in a boost in antioxidant capacity of the blood (whereas the plain potato starch control acted as a pro-oxidant) and a drop in blood pressure in overweight individuals.’ from http://alturl.com/p9c9u

  28. For those interested in medieval diest Barbara Tuchman’s “A distant Mirror” would be a wonderful place to start. Game was restricted to the aristocracy in many places though in England at least there were Beasts of the chase and beasts of the warren the later being free to hunt. Roe deer (capreolus capreolus) were hunted to extinction in England after being placed in the second category.

  29. @Lance: Check out this study on the antioxidant activities of rice

    Pak J Biol Sci. 2010 Feb 15;13(4):170-4.
    Study on total phenolic contents and their antioxidant activities of Thai white, red and black rice bran extracts.
    Muntana N, Prasong S.
    Source

    The Center of Excellence for Innovation in Chemistry, Department of Chemistry, Faculty of Science, Mahasarakham University, Mahasarakham 44150, Thailand.
    Abstract

    In this study, different brans of Thai rice cultivars which were divided into 3 groups: white color (Hom mali 105, Supan, Saohai, Hom chaiya and Hom jun), red color (3256, GS 18003, 21606, 21699 and 5718) and black color (96041-20, 96051-37, 96004-49, 96023-35 and 96065-42) were investigated their Total Phenolic Content (TPC) and antioxidant activities. The rice brans were firstly extracted using methanol. The extracts were analyzed using Folin-Ciocalteau method for total phenolic content while thiocyanate method and 1,1-diphenyl-2-picrylhydrasyl (DPPH) free radical-scavenging assay were used for antioxidant activities determination. The results indicated that the total phenolic content of white, red and black rice bran extract were in the range of 0.8931-0.9884, 1.0103-1.0494 and 1.0810-1.2239 mg gallic acid equivalent (GAE mg(-1)), respectively. With thiocyanate method, percentage inhibition were in the range of 10.15-20.68, 30.64-38.80 and 25.52-26.28 for white, red and black rice bran extract, respectively. With DPPH radical-scavenging assay, methanolic extract of 5718 showed the highest (IC50=0.0057 mg mL(-1)) while Homchaiya showed the lowest (IC50=0.2582 mg mL(-1)) activities. All of extracts showed lower activity than BHA (IC50=0.0012 mg mL(-1)). However, the antioxidant activity of all rice bran extracts indicated high antioxidant efficiency in the following order: red>black>white color rice brans. It is a promising that Thai rice bran are potential antioxidant sources.

    PMID:
    20437683
    [PubMed – indexed for MEDLINE]

    I am actually somewhat fed up with of the “tuber-piming” and “rice-villification” all over the web. I mean yeah, you can easily eat 400g of carbs from rice in one sitting and that is probably not healthy, but part of the reason we do not see similar studies for the “wholy” sweet potatoes is that the same sick people who overeat on rice and get even sicker
    don’t eat sweet potatoes at all, and
    they (and even I) would have a hard time to down enough sweet potatoes in one sitting to achieve a similarly detrimental carb load as you get from the calorically much denser rice, anyways
    So are tubers bad? No! But rice isn’t devil’s excrement either *fullstop*

  30. sorry, my mistake, I am not yet fully awake. The above study is obviously not on “white rice” as the latter – at least in its by the way not very tasty mashy incarnation is devoid of the bran.

    my mistake, but in this regard the following studies come to mind

    Characterization of antioxidant compounds of red and white rice and changes in total antioxidant capacity during processing

    Abstract

    Although most rice cultivars have whitish kernel, some varieties have a red testa. Aim of this work was to compare the total antioxidant capacity (TAC) and the antioxidant chemical composition (namely tocols, ?-oryzanols, and polyphenols) of red and white rices. In addition, the effect of milling and cooking on antioxidants was investigated in both rices. Dehulled red rice showed a TAC more than three times greater than dehulled white rice and its high TAC was essentially characterized by the presence of proanthocyanidins (PA) and associated phenolics. Milling caused a significant loss of TAC, even if red rice maintained a higher TAC. Cooking caused a further loss of antioxidants, but when there was a full uptake of cooking water by the grains (“risotto”) this loss was limited. Thus, the consumption of whole or partially milled rice cooked as risotto would be preferred to preserve its nutritional properties.

    and this one

    Rice kernel phenolic content and its relationship with antiradical efficiency†‡

    Plant phenolics exert beneficial effects on human health and may also prevent oxidative deterioration of food. Two field experiments were carried out for characterising phenolics in rice. The first assay was conducted in 1999 and 2000 in Beaumont, TX and included five light-brown, two purple and 10 red pericarp coloured cultivars. ‘Bran colour’ was highly statistically significant for both bran phenolic concentration and antiradical efficiency (p < 0.001). ‘Year’ and its interaction with bran colour were not significant for the analysed traits, suggesting that seasonal differences and their interactions may not affect phenolic content or antiradical efficiency. The accessions ranged from 3.1 to 45.4 mg gallic acid equivalents (GAE) g?1 bran and from 10.0 to 345.3 µM trolox equivalents (TE) g?1 bran for total phenolic content and antiradical efficiency respectively. The light-brown bran genotypes exhibited the lowest values for phenolic content and antiradical efficiency, whereas red bran ones displayed ca 10 times higher total phenolic content and more than 50 times higher tannin content than light-brown ones. The two purple lines showed either low or high values for the studied traits. Antiradical efficiency of rice bran extracts was highly positively correlated with total phenolic content (r = 0.99***), suggesting that phenolics are the main compounds responsible for the free radical-scavenging activity in rice bran extracts. In the second field experiment (Stuttgart, AR, 2001 and Beaumont, TX, 2000), 133 coloured rice cultivars were analysed for total phenolic content in whole grain. The accessions showed a large variation for total phenolics, ranging from 0.69 to 2.74 mg GAE g?1 grain. The data confirmed previous results suggesting bran colour as the main factor affecting phenolic concentration in rice kernel and seasonal effects and their interactions as not significant. The results also confirm that within red and purple bran groups can be found the highest phenolic concentrations in rice kernel. Published in 2004 for SCI by John Wiley & Sons, Ltd.

    both suggesting that what is true for potatoes (and tubers), i.e. that color matters, is true for rice as well.

    On the other hand, there is still the issue of “what is an antioxidant”? Many of the beneficial health effects of polyphenols for example appear to be of hormetic nature, so that having no or little polyphenols, but this would be another discussion, I guess..

    sorry for the initial fauxpas, Lance. I still stick to the dose / response effect with rice vs. potatoes, but agree that the polyphenol count is an additional bonus white rice is probably missing (where is the study showing that it is a pro-oxidant, by the way, I mean aside from its effect on glycemia and downstream oxidation?)

  31. 400Grams of rice eaten in one sitting is two cooked cups. Seems like a lot to me. You must have a hearty appetite!

  32. actually, looking at nutritiondata.com, 1 cup of cooked white rice (weighing 158g to 186g depending of type of white rice) contains between 37g and 53g of carbs.

    So, 400 grams of carbohydrates from cooked rice would be between 7.5 cups and 10.8 cups of cooked white rice.

  33. Darrin,

    Yes on the rice carbs. The PHD book states that 3/4 of cup of cooked rice will provide 300-400 calories. Typo?

  34. I guess I must have been totally asleep still, on my previous posts *sorry Wrt to what exactly Paul writes in the PHD I would assume that this refers to uncooked rice… here is a pretty detailed overview over the energy content of rice

    http://calorielab.com/foods/rice/21

  35. @David,
    Not sure if you call it a typo in the book. It is definitely open to misinterpretation.
    A 3/4 cup (100 grams) measure of UNcooked rice will provide 300-400 calories.
    I’m guessing that when cooked it will still provide 300-400 calories? but of course the rice volume and weight will have increased a fair bit more than 3/4 cup and 100 grams (due to water absorption).

    & ps. this is 300-400 total calories, Not just carbohydrate calories. The carb calories from Cooked rice will be slightly less, around 90-92% of total calories (source nutritiondata.com).

  36. I cannot tell if this is a “typo”, but if it says that under “cooked foods” or “cooked rice” that it is a full-blown mistake, because this should obviously be the caloric value of 2/4 cup, which would be 3/4 * 186-187g (depending on what type of rice, you can press in 1-2 grams more or less into your stupid American cups ;-) ) and that would be ~140g or ~500kcal and 112g of carbs as per my calculation (and based on the data from the above source / I stopped using nutritiondata after identifiying a couple of mistakes back in the day)

  37. *lol* great: If what was a mistake, than my answer was a heap of typos *rofl*

  38. Hi everyone,

    Yes, the rice statement was a mistake in the book, it’s listed on our errata page (http://perfecthealthdiet.com/?page_id=1628, scroll down to p 104 errata).

    I looked up uncooked rice and meant to look up cooked rice.

  39. I have been really enjoying the informed posts here! I just happened on this site & have not yet read the PHD book so this comment may be a bit off-topic, but I’d like to see more consideration of the role of climate and season rather than a focus on what constitutes the “perfect diet”. Is the perfect diet in Saigon going to be the same as in Yellowknife? Does it make sense that we should strive for the same carbohydrate content in our diet both summer and winter (of course, with modern heating/ air conditioning many of us really live in the “sub-tropics” no matter where we are physically in the world)? From what I’ve read we are lacking in darkness & winter since we always crave light and summer. Our “dance of life” is all forward, with no back steps…perhaps we are stepping on Mother Natures toes.

  40. Hi Jeff,

    I think the perfect diet is more a matter of human biology than season. So there may be variability among persons, but for any individual the perfect diet will be same whether in Saigon or Yellowknife.

    Need for vitamin D supplementation might be different however!

  41. This winter I’ve begun to use light therapy. I bought a small unit and I sit every morning for 45 minutes with the light shining towards my eyes (obliquely) and from about the second week I started sleeping better, longer – and no longer felt like I wanted an afternoon nap. We had a long, grey winter here in Ontario and the sun hardly shined at all – bummer! So I recommend light therapy for those who get sleepy and “down” in the winter.

    As Paul says the diet we choose should reflect biology rather than season – but light therapy might help to even the playing field!

  42. So, I know this study about red meat might have some problems, but there’s lots of other studies that seem to show that red meat is bad at the levels you recommend in your book (the majority of meat coming from red meat). Do you still think red meat is okay at those levels?

    To be honest (and I want this observation to feel helpful), I’m a bit suspicious of you guys because you’ve already committed a bunch of resources to coming up with this diet, and you have a lot riding on it. I don’t completely trust your ability to change your mind in the face of contradictory evidence, because you’re always going to want the studies to come out in favor of what you already believe. Because if you were actually wrong, that would mean you might’ve shortened your life span (since you’ve been eating this way for awhile), so you’ll try desperately to explain away anything that doesn’t agree with you. Whereas, someone like me (who is only 21 and has just started looking for healthy longevity diets) is going to be a lot less reluctant to change their beliefs, because they haven’t committed to anything yet.

    But, so far, yours is the only diet I’ve liked out of the ones I’ve explored, and I’m hoping to not have to go do more tedious research to find nutrition writers who can actually change their minds, if it turns out that you guys aren’t working hard enough to avoid those potential sources of bias.

    So, I guess my questions are: Does the PHD account for the myriad of other red meat studies that seem to show that it’s bad? How could one modify the diet to start eating healthy levels of red meat? What are healthy levels of red meat on PHD?

    • Hi Kyle,

      A myriad of unconvincing studies is still unconvincing, especially because they don’t all point in the same direction.

      There’s no biology for harmful effects from red meat except (a) infections from pork which we’ve discussed, (b) potential excess iron which won’t happen when you eat 1/2 lb meat per day as we recommend, (c) Neu5Gc promotion of cancer.

      So you might avoid beef if you have cancer, and confine yourself to fish, but until there’s some reason to think beef might be harmful in healthy people, I’ll go with the studies that show it having beneficial effects.

  43. It seems whenever I eat rice a few days in a row, I have loose stools and upset stomach. I HATE this feeling and don’t experience with sourdough bread but seem to always with rice(white).

  44. UAE as an outlier is not surprising given the typical diet here.
    Lots of fast food, lots of white flour based products and loads of sugar.
    Fresh foods are expensive and low quality (everything is flown into the country), so heavy processed food culture now – far away from the traditional rice and meat diet pre rapid growth and industrialisation of the last 30 years

  45. I’m trying to, little by little, help all my family adopt this healthy way of eating. It helps that their Dominican and safe starches are a staple(as well as in other Caribbean countries) My uncle suffers from inflammation. I advised him to start lowering omega 6. He says he can’t tolerate beef though, that he feels horrible when ingesting it. What could this be?

    • Hi Hancy,

      Some people have beef allergies, the allergy is caused by a tick bite and is an allergy to certain glycoproteins carried by tick microbes but beef sugars can cross-react with the antibodies.

      Have him try fish and shellfish instead.

  46. I am confused about my own data.

    In India we have dish that is just white rice flour,baking powder and salt, spices boiled ,(papadinot lot. I ate with excess oil, way it is normal to eat in India.

    I tried this recently for evening dinner. Every time next morning my blood sugar was susbtantally lower.

    It sound counter intuitive but true I experimented severa; time. I wish someone who knows more about digetion will check this.
    Let me know at rajchicagoman@gmail.com

  47. Heartfelt thanks to you and Shou-Ching, Paul, for all your great work on these issues, and your clear and incisive commentary on the various research being done.

    Thought it worth linking to Gary Taubes’ takedown of the Red Meat study – it’s another good review of what constitutes bad science that I think this community will be interested in (if folks haven’t seen it yet).

    http://garytaubes.com/2012/03/science-pseudoscience-nutritional-epidemiology-and-meat/

  48. “Something entirely unrelated to white rice causes metabolic syndrome.” -that something is fat and sugar (fructose).

  49. Is White Rice Healthy or Not? - Wellness Mama - pingback on July 22, 2014 at 5:03 pm

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