Serum Cholesterol Among the Eskimos and Inuit

Posted by on July 1, 2011 18 comments

We’re investigating the surprising claim, set forth by S. Boyd Eaton, Melvin Konner, and Marjorie Shostak 1988 [1] and reiterated by Loren Cordain and collaborators in 2004 [2] and Boyd and Konner 2010 [3], that hunter-gatherers had total serum cholesterol below 135-140 mg/dl (3.49-3.62 mmol/l), and that this was healthy. A summary of their claims can be found in Tuesday’s post (Did Hunter-Gatherers Have Low Serum Cholesterol?).

The original Eaton et al paper [1] listed Hadza, Kalahari San (Bushmen), Congo Pygmies, Canadian Eskimos, and Australian Aborigines as hunter-gatherer populations with low cholesterol. So I’m going to survey cholesterol levels in those groups, and maybe a few others.

I had intended to cover all groups in one post, but I found that doing the topic justice requires more elaborate discussion. Therefore, I’ll give each group its own blog post, starting with the Eskimos and Inuit.

A word of caution: Please do not jump to conclusions until the series is complete. I will withhold most of my analysis until the end of the series. For now I am just presenting data, assessing its quality, and including relevant facts about the health of the study population.

Summary of the Data

Searches on “Eskimo cholesterol” and “Inuit cholesterol” turned up a lot of papers. I didn’t look at all of them but I looked at most of the pre-1988 papers (which Eaton et al could have cited) and a sampling of recent ones.

Here is a table summarizing what I found. Papers are ordered from oldest to newest:

Cholesterol Levels of Eskimo & Inuit Populations 

Paper [ref] Mean TC Notes
Corcoran & Rabinowitch 1935 [9] 141 mg/dl Stale samples, obsolete technique, small sample size; tuberculosis common
Wilber & Levine 1950 [11] 218 mg/dl
Rodahl 1955 [13] 215 mg/dl
Pett & Lupien 1958 [10] 204 mg/dl
Scott et al 1958 [12] 214 mg/dl
Davies & Hanson 1965 [8] 182 mg/dl Diseased (tuberculosis), life expectancy 32 years
Ho et al 1972 [7] 221 mg/dl
Dyerberg et al 1975 [6] 216 mg/dl
Young et al 1993 [15] 205 mg/dl Average of 4 age and gender cohorts
Howard et al 2010 [14] 211 mg/dl TC calculated from LDL 125, HDL 62, triglycerides 118
Makhoul et al 2010 [5] 223 mg/dl

Results are remarkably consistent. Nine of the eleven papers reported mean total cholesterol (TC) between 204 mg/dl and 223 mg/dl. Let’s look more closely.

Studies that Reported Low Serum Cholesterol

The TC of 141 mg/dl reported by Corcoran & Rabinowitch 1937 [9] among Hudson Bay and Baffin and Devon Island Eskimos is precisely the number quoted for Canadian Eskimos by Eaton, Konner and Shostak [1]. Presumably this was their source for that number.

How solid is the number? Corcoran & Rabinowitch acquired samples from only 27 non-fasting Eskimo men. The measurement method was archaic and the samples were not fresh:

None of the tests was completed during the voyage. The work then was confined to collection of the blood samples and their necessary treatment to preserve the different constituents to be examined. All analyses were made on oxalated plasma. [9]

Corcoran & Rabinowitch note the unreliability of lipid measurements from the 1930s:

A survey of the literature shows wide variations of the different lipoid constituents of blood, both in fasting experiments and following ingestion of food, in animals and in man, and whether the analyses were made upon whole blood, red blood cells, plasma or serum. Correlation of these data is difficult because of the variety of technical methods with which they were obtained. [9]

Possible evidence for deterioration of the samples is the fact that, although twenty of the twenty-seven Eskimos were eating zero-carb diets, no ketones were found in any sample:

Also suggestive of an unusual mechanism for the utilization of fat is the absence of ketosis in these natives, whereas the urines of both [Stefansson and Andersen during the Bellevue All-Meat Trial] contained acetone. The explanation of this absence of ketosis is not entirely clear. [9]

My guess is the ketones had evaporated before measurement, or were otherwise degraded.

I might add that in 1935, when the Corcoran & Rabinowitch samples were collected, the Eskimo had already begun to deviate from the hunter-gatherer lifestyle. Rabinowitch 1936 [16] reports:

These Eskimos are employed by the Police, and live in huts for a great part of the year. Their food and clothing are also to some extent the products of civilization … The food supplied by the Police must be supplemented by the natural foods of their environment- seal, etc. These Eskimos still spend much time hunting. [16]

Rabinowitch observed flour in about half the Eskimo tents he visited, and was told at Lake Harbour, which may have had the lowest flour consumption of the sites he visited, that the average annual flour consumption was 130 pounds for a family of three Eskimos. [16]

Infectious disease, notably tuberculosis, was common:

Tuberculosis was common in the Straits and Bay. At Chesterfield Inlet, of 62 persons examined 22 had some respiratory disturbance; and of these 12 had coughs with no detectable adventitious sounds in the lungs; 2 had what appeared to be bronchitis only; and 8 had active pulmonary tuberculosis. In addition to these 8 cases, active glandular tuberculosis (cervical) was found in 4 children. At Port Burwell, of 31 natives examined 8 had coughs with no detectable adventitious sounds; 2 had what appeared to be bronchitis; and 5 adults had active pulmonary tuberculosis. Two children had masses of confluent glands in the neck. There was one case of tuberculosis of bone (phalanx); there was no reason to suspect lues in this case. At Coral Harbour there was a child with tuberculosis of a knee joint. Two cases of active pulmonary tuberculosis were found at Lake Harbour. At Wolstenholme one child was found with a mass of confluent glands in the neck. [16]

They also had parasites and worms:

From reports of the Institute of Parasitology of McGill University by Drs. TWM Cameron and IW Parnell it is obvious that the Eskimo is exposed to a variety of parasitic infections. These authors have found that at least three-quarters of all the animals examined, birds, duck, geese, etc., harboured parasites. The polar bear, walrus, and weasel were found free, but most of the seals were infected with Ascarides and intestinal flukes. The Eskimo lives in intimate contact with his dogs, and carcasses and feces of these animals are heavily parasitized with hookworm, Ascarides, flukes, and tape worms. Ascarides, taenia and hookworm were found as far north as Craig Harbour, and hares from Ellesmere Island were heavily infected with worms. Nail scrapings of Eskimos were found high in content of Oxyuris vermicularis…. Our pathologist, Dr LJ Rhea, in his search for parasites found 6 cases of eosinophilia amongst 34 blood smears. [16]

The other paper showing a mean population TC below 200 mg/dl was Davies & Hanson 1965 [8], who found a mean TC of 182 mg/dl. I liked this paper because it gave a lot of textual background concerning the health and diet of the 727 Canadian Northwest Passage Eskimos studied. Some quotes from this study:

[Seventy to ninety percent] live at sealing or fishing camps and visit the trading posts twice yearly or more often, depending on distance.

Ten to 25% of their food is obtained from trading posts …

[L]ife expectancy of the Eskimo is about 32 years … [8]

Health was poor, as you’d expect from the short life expectancy. Infectious disease was a serious problem. Many had had tuberculosis or brucellosis; chronic coughs were common. Many had abnormal blood cell counts, such as eosinophilia, neutrophilia, and lymphocytosis. Some had diabetes, despite low-carb diets; I suspect the combination of alcohol and omega-3 fats (also low vitamin D) to have been the culprit. However, iodine status was excellent and hypothyroidism was extremely rare.

My guess is that these Eskimos were bringing a lot of tobacco, alcohol, and infectious disease back from those trading posts.

Considering that 75% to 90% of their food was acquired in the traditional way, a life expectancy of 32 years is not exactly a ringing endorsement of the healthfulness of the Eskimo/Inuit diet. The poor health of this group of Eskimos may have contributed to their relatively low TC of 182 mg/dl.

Studies that Reported High Serum Cholesterol

The other nine studies reported mean serum TC between 204 and 223 mg/dl. These levels fall in the minimum mortality region of O Primitivo’s database and are suggestive of good health.

I particularly like one recent paper, Makhoul et al 2010 [5], because it sampled Yup’ik Eskimo eating the traditional diet, and included scatter plots showing each individual’s cholesterol numbers. They write:

Because of their traditional diet, which is based largely on fish and other marine foods (20), Yup’ik Eskimos have a mean intake of EPA and DHA that is >20 times the current mean intake of the general US population (3.7 compared with 0.14 g/d in men and 2.4 compared with 0.09 g/d in women) (21). Studies of Yup’ik Eskimos offer a unique opportunity to examine how a broad range of EPA and DHA intakes (22) affect chronic disease biomarkers. [5]

Some Eskimos in their sample got as much as 15% of calories from EPA+DHA. Their cholesterol levels:

TC is mostly between 200 and 240 mg/dl, LDL between 100 and 160, and HDL between 50 and 70. Cholesterol increased as fish oil intake increased – evidence that cholesterol gets higher as the diet becomes more traditional.

Other studies also found that the more traditional the Eskimo diet, the higher were total cholesterol levels. Here is the discussion in Ho et al 1977 [7], who found mean total cholesterol of 221 mg/dl in Arctic Eskimos:

This value was in general agreement with that obtained from other mass samplings of Arctic Eskimos (8-11) but was slightly higher than those values obtained from the Eskimos living on the Pacific Coast of Alaska, as reported by Scott et al. (9). [PJ: Scott et al, my reference [12], found mean TC of 214 mg/dl.] A generalization was made by Scott and co-workers from their study on 842 Eskimos that northern Alaskan Eskimos have higher serum cholesterol levels than southern Eskimos. The reason for this difference might well be related to the differences in their diets, as the main staple of northern Eskimos is marine mammals, whereas that of the southern Eskimos includes some vegetables and fish (12). [7]

In general, the studies reporting mean TC over 200 mg/dl all reported that their study population were eating a diet resembling the traditional hunter-gatherer diet. In Arctic populations, this diet featured high intake of marine mammals and low intake of carbohydrates.

Conclusion

The vast majority of studies show that Eskimo and Inuit populations have mean serum cholesterol over 200 mg/dl. The only studies showing mean serum cholesterol below 200 mg/dl sampled tuberculosis-ridden populations with short life expectancy. The study showing the lowest mean serum cholesterol used obsolete sample preparation and measurement techniques on stale samples.

The most parsimonious explanation of the data is that TC of 200-230 mg/dl is normal for Eskimos and Inuit, that lower TCs indicate the presence of infectious diseases such as tuberculosis, and that the very low TC of Corcoran & Rabinowitch 1937 may have suffered from sample degradation during the two-and-a-half-month voyage (July 13-Sept 29) before samples could be measured in Montreal.

It would be difficult to attribute the low TC in Corcoran & Rabinowitch 1937 to diet, as the subjects ate flour and other government-provided foods and did not obviously eat a more traditional diet than the Eskimo of later studies. The most salient difference between the Corcoran & Rabinowitch subjects and those of later studies was the high incidence of tuberculosis in 1935. Perhaps the low TC in Corcoran & Rabinowitch was due to tuberculosis, but Davies and Hanson found a mean TC of 182 mg/dl in another tuberculosis-ridden Eskimo population.

The Corcoran & Rabinowitch 1937 paper will be useful to us because it gives us an indication what may happen to measured TC levels when an older measurement method, that of Abell, is applied to stale samples. It appears that such measurements may under-report TC by as much as 1/3 (210 mg/dl to 141 mg/dl).

Related Posts

The posts in this series are:

References

[1] Eaton SB, Konner M, Shostak M. Stone agers in the fast lane: chronic degenerative diseases in evolutionary perspective. Am J Med. 1988 Apr;84(4):739-49. http://pmid.us/3135745. Full text: http://www.direct-ms.org/pdf/EvolutionPaleolithic/EatonStone%20Agers%20Fast%20Lane.pdf

[2] O’Keefe JH Jr, Cordain L, Harris WH, Moe RM, Vogel R. Optimal low-density lipoprotein is 50 to 70 mg/dl: lower is better and physiologically normal. J Am Coll Cardiol. 2004 Jun 2;43(11):2142-6. http://pmid.us/15172426.

[3] Konner M, Eaton SB. Paleolithic nutrition: twenty-five years later. Nutr Clin Pract. 2010 Dec;25(6):594-602. http://pmid.us/21139123. Full text: http://ncp.sagepub.com/content/25/6/594.full.

[5] Makhoul Z et al. Associations of very high intakes of eicosapentaenoic and docosahexaenoic acids with biomarkers of chronic disease risk among Yup’ik Eskimos. Am J Clin Nutr. 2010 Mar;91(3):777-85. http://pmid.us/20089728.

[6] Dyerberg J et al. Fatty acid composition of the plasma lipids in Greenland Eskimos. Am J Clin Nutr. 1975 Sep;28(9):958-66. http://pmid.us/1163480.

[7] Ho KJ et al. Alaskan Arctic Eskimo: responses to a customary high fat diet. Am J Clin Nutr. 1972 Aug;25(8):737-45. http://pmid.us/5046723.

[8] Davies LE, Hanson S. THE ESKIMOS OF THE NORTHWEST PASSAGE: A SURVEY OF DIETARY COMPOSITION AND VARIOUS BLOOD AND METABOLIC MEASUREMENTS. Can Med Assoc J. 1965 Jan 30;92:205-16. http://pmid.us/14246293.

[9] Corcoran AC, Rabinowitch IM. A study of the blood lipoids and blood protein in Canadian Eastern Arctic Eskimos. Biochem J. 1937 Mar;31(3):343-8. http://pmid.us/16746345.

[10] Pett LB, Lupien PJ. Cholesterol levels of Canadian Eskimos. Federation Proc. 17(1958): 488, 1958.

[11] Wilber CG, Levine VE. Fat metabolism in Alaskan Eskimos. Exp Med Surg. 1950 May-Nov;8(2-4):422-5. http://pmid.us/15427668.

[12] Scott EM et al. Serum cholesterol levels and blood pressure of Alaskan Eskimo men. Lancet. 1958 Sep 27;2(7048):667-8. http://pmid.us/13588965.

[13] Rodahl K. Diet and cardiovascular disease in the Eskimos. Trans Am Coll Cardiol. 1955 Apr;4:192-7. http://pmid.us/14373771.

[14] Howard BV et al. Cardiovascular disease prevalence and its relation to risk factors in Alaska Eskimos. Nutr Metab Cardiovasc Dis. 2010 Jun;20(5):350-8. http://pmid.us/19800772.

[15] Young TK et al. Cardiovascular diseases in a Canadian Arctic population. Am J Public Health. 1993 Jun;83(6):881-7. http://pmid.us/8498628.

[16] Rabinowitch IM. Clinical and Other Observations on Canadian Eskimos in the Eastern Arctic. Can Med Assoc J. 1936 May;34(5):487-501. http://pmid.us/20320248. Full text: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1561651/pdf/canmedaj00512-0065.pdf.

Did Hunter-Gatherers Have Low Serum Cholesterol?

Posted by on June 28, 2011 25 comments

Emily raised a great question in response to last Tuesday’s post:

[W]hat of the reports of hunter gatherers having low cholesterol. Is it the product of fringe environments, or low infectious burden, or what?

Let’s look into this. Do hunter-gatherers in fact have low cholesterol? If so, why?

The Claim

As far as I know, this idea originated with and was promoted by the fathers of Paleo dieting, S. Boyd Eaton and Loren Cordain, and their collaborators.

Its first appearance, to my knowledge, was in a 1988 paper by S. Boyd Eaton, Melvin Konner, and Marjorie Shostak called “Stone agers in the fast lane: chronic degenerative diseases in evolutionary perspective” [1]. Here’s their data:

The footnote to Table IV reads as follows:

The published paper has 101 references and takes 11 pages in the journal, yet no supporting references for the cholesterol data were included.

Here is a graph from a 2004 paper by Loren Cordain, William Harris, and some pro-statin medical doctors [2] (thanks Stabby!):

The caption states that total cholesterol (TC) ranges between 70 and 140 mg/dl in hunter-gatherers, and LDL cholesterol (LDL-C) between 35 and 70 mg/dl. However, this claim is unsourced. The paper provides references for assertions that LDL tends to be around half TC, and that modern Americans have TC around 208 and LDL-C around 130, but there are no references for hunter-gatherer cholesterol levels.

The data in this graph seem to be drawn from the Eaton, Konner, and Shostak paper [1]. The Hadza number is the same as the 109.5 mg/dl (2.83 mmol/l) average of the male and female Hadza in [1]; Inuit at 141 mg/dl (3.65 mmol/l) is the same as “Canadian Eskimos” in [1]; !Kung and San (probably the same people) are both listed very close to the 119.5 mg/dl (3.09 mmol/l) average of “Kalahari San (Bushmen)” in [1]; Pygmy looks identical to the 106 mg/dl average of male and female “Congo Pygmies” in [1]. It looks like they just copied from Eaton et al but deleted the Australian Aborigines who in [1] had a male-female average TC of 139 mg/dl (3.59 mmol/l).

Eaton and Konner were sticking to the low hunter-gatherer cholesterol claim in 2010 [3]; they cited only their original 1988 paper [1] when they wrote:

Our review of various health measures in HG and other nonindustrial populations showed that average HG serum total cholesterol was always below 135 mg/dL … [3]

So over 23 years, to judge by these papers, Eaton et al and Cordain et al have yet to cite a peer-reviewed article in support of the proposition that hunter-gatherers had low cholesterol. Where did this idea come from? And is it true?

The Evidence Is Worth Looking Into

The claim that healthy hunter-gatherers had serum cholesterol below 140 mg/dl is quite surprising, given that contemporary populations are healthiest when their serum cholesterol is over 200 mg/dl, and mortality rises and life expectancy falls sharply as serum cholesterol falls below 180 mg/dl. (See Blood Lipids and Infectious Disease, Part I, Jun 21, 2011.)

Are hunter-gatherers – either their diets or their genetics – so different from modern populations? Or is the claim that healthy hunter-gatherers have low serum cholesterol a mistake?

I think this is an interesting question, with implications both for the design of Paleo diets and for our interpretation of serum lipid results. When we discussed HDL, I argued that some dietary methods to raise HDL might benefit us by enhancing immunity (see HDL and Immunity, April 12, 2011; HDL: Higher is Good, But is Highest Best?, April 14, 2011; How to Raise HDL, April 20, 2011). Might a similar strategy for dietary manipulation of LDL be desirable too?

Next Steps

I’ll examine the issue in 3 parts:

  • On Thursday I’ll survey the literature on hunter-gatherer cholesterol. What are their numbers really?
  • Next week I’ll continue the Blood Lipids and Infectious Disease series by looking at the immune functions of LDL cholesterol. What happens to LDL when people get infections? Is there an optimal LDL level?
  • In conclusion of the series I’ll return to the issue of human populations – whether hunter-gatherer, horticultural, pastoral, or modern – and what their cholesterol levels tell us about their health. Why do some populations have low serum cholesterol and other populations have much higher cholesterol?

This might lead us into issues such as: Has there been recent human evolution toward higher cholesterol levels? Are there biological differences in optimal cholesterol levels among different human populations – for instance, Africans and Eurasians, or aboriginal populations and descendants of Neolithic farmers?

Should be fun!

Related Posts

The posts in this series are:

References

[1] Eaton SB, Konner M, Shostak M. Stone agers in the fast lane: chronic degenerative diseases in evolutionary perspective. Am J Med. 1988 Apr;84(4):739-49. http://pmid.us/3135745. Full text: http://www.direct-ms.org/pdf/EvolutionPaleolithic/EatonStone%20Agers%20Fast%20Lane.pdf

[2] O’Keefe JH Jr, Cordain L, Harris WH, Moe RM, Vogel R. Optimal low-density lipoprotein is 50 to 70 mg/dl: lower is better and physiologically normal. J Am Coll Cardiol. 2004 Jun 2;43(11):2142-6. http://pmid.us/15172426.

[3] Konner M, Eaton SB. Paleolithic nutrition: twenty-five years later. Nutr Clin Pract. 2010 Dec;25(6):594-602. http://pmid.us/21139123. Full text: http://ncp.sagepub.com/content/25/6/594.full.

Homemade Kimchi

Posted by on June 26, 2011 41 comments

After our post on Kimchi (May 15, 2011) we decided to start making our own fermented vegetables. Foods are always healthier when made at home, and you can adjust the ingredients to fit your taste.

I’m happy to say it’s been a big success. Our kimchi is tastier than store-bought kimchi, probably much healthier, and we’re eating more of it.

We’re making a number of different varieties, including white radish kimchi and cucumber and carrot kimchi. The methods are essentially the same, so we’ll just show you the traditional Korean cabbage kimchi.

Preparing the cabbage

We used about 5 pounds (2.3 kg) Napa cabbage, about 1½ heads. A head looks like this:

The outer layer usually is dirty or has some damage, so we discard that. We also cut out the stem.

In the traditional methods, when kimchi was made at harvest and was meant to store vegetables through the winter, the head of cabbage would be kept whole. However, for household use it’s best to cut it immediately into bite-size pieces. We do that by cutting the head in half and then cutting cross-wise:

The next step is to salt and dehydrate the cabbage. The salt helps draw water out of the cabbage, preventing the kimchi from becoming watery or soupy, and also helps sterilize the cabbage for a more consistent fermentation.

You’ll need a large bowl; stainless steel is good. Put a layer of cabbage – a handful is a good amount – and then sprinkle salt generously over it:

Continue layering in this way until all the cabbage is in:

It will take about an hour for the salt to draw the water out of the cabbage. As that happens, water will begin collecting in the bowl, which you can drain. In the last half hour, periodically grab handfuls of the cabbage and squeeze them to drive out the water. When you’re done the volume of cabbage will be much reduced:

At this point you can wash the cabbage to remove any remaining salt and water:

Preparing the marinade

For our marinade we used green onions, garlic, ginger, coarsely ground cayenne pepper (sold in Korean stores as “red pepper powder”), and fish sauce.

We recommend about a ¼ cup of both fish sauce and red pepper in 5 pounds cabbage for a moderately spicy kimchi. The amount of fish sauce and of pepper is probably the biggest determinant of the kimchi’s taste.

Mince the ingredients and put them in a mixing bowl large enough to hold the cabbage:

Add the cabbage a handful at a time and squeeze it to eliminate as much water as possible before adding it to the mix:

Mix all the ingredients thoroughly by hand until it looks something like this:

At this point you can taste the mixture and decide if it needs more salt or other spices. When you like the taste, it’s ready to begin fermenting.

Fermentation process

The most important tool you need is a suitable pickling or fermenting jar. It should be glass or ceramic and sealable. We chose a ceramic jar which is fairly inexpensive at Pier 1 Imports. It has an indentation in the lid which allows them to be stacked:

It also has ribbed plastic in the lid which makes a sort of seal, but we also seal it further with plastic wrap and a rubber band:

Keeping oxygen out helps assure that the bacterial species which develop are better suited to the anaerobic environment of the gut, creating a more probiotic mix of flora and preventing the kimchi from going bad as quickly.

The jar should be clean and dry (sterile) before the kimchi mix is put in. It then looks like this:

To accelerate the fermentation, you can leave it out at room temperature overnight, or for two nights. After that, it should be kept refrigerated.

Our kimchi seems to last considerably longer than store-bought kimchi. Ours has still been good after 2 weeks.

Eating the kimchi

We just pull out some at each meal:

The whole process is very easy – basically, just mix the ingredients and let nature take its course.

Kimchi goes best as a complement to fatty foods. Try a piece with each bite of ribeye steak https://perfecthealthdiet.com/?p=2775; or eat it with Cambridge Fried Rice.

Around the Web; Back from Vacation Edition

Posted by on June 25, 2011 23 comments

A lot has happened since we last did a round-up. Here is a sampling of things we’ve found interesting:

[1] Interesting posts: Jamie Scott channeled his inner Staffan Lindeberg and performed the Vanuatu Study: “The Diet and Lifestyle of the People of Vanuatu: Paleo in Paradise”. It has a lot of pictures and descriptions of the Kitava-like Paleo diet and attractive good health of the natives. Unfortunately, fewer Melanesians are eating traditional diets, and we may not be able to observe traditional diets in native populations much longer.

Chris Masterjohn helps us understand Weston A. Price. He also did a fascinating podcast with Chris Kresser on LDL cholesterol: The Healthy Skeptic Podcast Episode 11. Speaking of cholesterol, Ned Kock reported that alcohol increases LDL cholesterol in people with the ApoE e4 allele, but decreases LDL cholesterol in people with the ApoE e2 allele.

In another post, Ned notes that a 6-foot man can be strong and healthy at 145 pounds. The moral: Be yourself; don’t think your body needs to look like someone else’s.

The opportunity to reverse Type 2 diabetes by diet was in the news, because of a UK study (Pubmed, Full text) in which 11 patients experienced normalization of beta cell function and reversal of Type 2 diabetes on a diet of 600 calories per day: 280 carb calories, 200 protein calories, and 120 fat calories per day (plus considerable fat released from adipose tissue). This is a starvation diet, below our safe minimum of 600 carb+protein calories and undoubtedly deficient in micronutrients and complex biological compounds, since it’s almost impossible to be well nourished on less than 1200 calories per day of real food. Indeed, people on the diet felt they were starving:

“It was very tough. I was hungry all the time. It was a starvation diet and food was on your mind all the time,” he said.

Many bloggers commented, including Peter Dobromylskyj, Jenny Ruhl, and Pål Jåbekk.

Melissa McEwen cured a skin condition by getting more vitamin A. Matt Stone offered a Paleo failure story, and linked to some pictures of hypothyroid faces. CarbSane found that selenium cured her insomnia; in the comments Mario argues that selenium may be protecting against metal and halogen toxicity.

Keith Woodford links to research showing that opioid peptides from cow’s milk drank by the mother can enter babies via breast milk and argues “the implications are huge”. Dr. Briffa notes that the artificial sweetener aspartame is converted to formaldehyde, a potent carcinogen, in the body. Chris Kresser discusses why it’s possible to have trouble with coconut milk. In the comments Tony Mach says the biggest BPA exposure comes from handling cash register receipts.

At Angelo Coppola’s “Latest in Paleo” blog, breastfeeding advice from a recovered boob nazi. (I may discuss this post a bit in an upcoming blog post.)

Via The Telegraph, many dishwashers are infected with fungi and deposit potentially dangerous fungal pathogens on plates and utensils. Via Craig Newmark, Top Ten Myths About Introverts.

Tom Naughton reveals that the government issued health warnings against cholesterol in the 1960s at the direction of Lyndon Johnson – who wanted to reduce the price of eggs to improve the inflation statistics!

NBA player Robert Horry leaves a poignant letter to his daughter, who died from a genetic disease.

Finally, for our academic readers, the oldest known journal rejection letter, written to Ptolemaeus in regard to his method for measuring the circumference of the earth.

[2] Don’t sleep on the sofa darling: Thursday’s post called to mind Petula Clark’s great hit:

In this video, recorded live in 2003 in Paris, Petula is 70 years old and looks great. At 78 she’s still performing. I wonder what diet she eats?

(The 1967 studio version can be heard here.)

[3] It’s safe to come out:

[4] Thank you, Pål – and thank you, readers: While we were on vacation, Pål Jåbekk of Ramblings of a Carnivore posted a very nice review of our book: “The As Good Health As Possible Diet”:

I would like there to be one diet book. One book that is constantly updated with new research. It would be The Diet Book. The book that made all other diet books superfluous. The go to place for everyone interested in achieving good health. The only book we would need….

The one book I’ve found that comes closest to being the diet book to end all other diet books is Perfect Health Diet. Had it replaced the official dietary guidelines we might actually be getting somewhere. The Perfect Health Diet book is not a perfect book, nor should it be. I think that some of the composition could be improved as well as the lay out and I would’ve liked to see some statements moderated, but content wise and information wise, Perfect Health Diet appears as a good first draft of a book with the potential to end the need for any more diet books.

I am excitedly looking forward to the second edition.

Pål is one of our favorite bloggers and a perspicacious writer on health, so this is high praise. As he says, our book is a work in progress. We are still learning, and that is why blogging is so much fun. The growth of knowledge is a cooperative process, and we continue to learn from other bloggers and from our readers.

We believe that diet should be a primary therapy for all diseases, and that with a good diet and appropriate antimicrobial therapies nearly all diseases can be cured. It’s exciting therefore to hear from readers, especially sick readers, who apply our ideas. We are grateful to readers who share their experiences with us, whether good or bad. Both successes and failures are educational.

Like Pål, we look forward to a second edition. We aim for the perfect diet, but we know that we have not yet written the perfect book. To achieve excellence, an evolutionary process is usually required. We’re most grateful to all those who apply our ideas and help us refine them.

[5] Another migraine success story: Speaking of reader feedback, it was great to hear from Rebecca Lachance on Facebook:

Just a note of thanks for helping me control migraines/headaches. Ketogenic diet has made an enormous difference in my life. Down from 24 days of headaches in February to only 4 days in June! My M.D. is suffering cognitive dissonance – thrilled with the decrease of headaches, but “suggests” a minimal dose of statins to prevent atherosclerosis – despite an HDL of 99 and TRG of 52. Obviously, I won’t be taking statins!… Thanks again.

We believe that ketogenic diets are probably therapeutic for nearly all neurological diseases, so we hope more people with brain or nerve disorders will try our version of the ketogenic diet.

[6] Don’t rush to your funeral: A Russian woman, wrongly declared dead, woke up at her own funeral and had a heart attack when she realized she was about to be buried alive.

[7] It’s good to supplement magnesium: A study in AJCN found that women in the highest quartile of dietary magnesium had a 37% lower risk of sudden cardiac death, and in the highest quartile of serum magnesium had a 77% lower risk of sudden cardiac death, than women in the top quartiles. In the same issue, a clinical trial found that supplementation of 500 mg/day magnesium was beneficial for obese people.

We recommend supplementing magnesium at 200 mg to 400 mg per day. 500 mg/day is more likely to produce an observable effect in a 4-week trial, but is more than we would recommend for long-term supplementation.

[8] My interview with Cary Nosler’s Wide World of Health: The podcast is available for download here.

[9] Getting Real at Whole Foods: This has been making the rounds, but it’s good enough for one more showing:

Via Melissa McEwen.

[10] O Primitivo on LDL, meat, and mortality: Ricardo (“O Primitivo”) of Canibais e Reis (“Cannibals and Kings” in Portuguese; inspired by Marvin Harris’s book), who was the source of the data discussed in Tuesday’s post, tried to leave a comment there but it had too many links for our spam filter and was lost. Fortunately, he emailed me with some fascinating information.

First, he has compiled a database specifically correlating LDL cholesterol levels to various health conditions. This is a very valuable database and I hope he’ll blog about it before long. LDL levels are highly correlated with total cholesterol, so the results are similar to those in his total cholesterol database, but still interesting.

O Primitivo also sent links to some of his blog posts:

Plus a number of links to recent papers which I’ll leave for him to blog about.

Since he has so much good material, and many people will lack time to explore it all, let me give you one highlight. From his document on animal-vegetable ratios, the fraction of food intake from animals versus mortality:

Take that, vegetarians!

Thank you, Ricardo, for all the great information. You have a fantastic blog.

[11] The cat who didn’t bark:

[12] Quote of the week: From a comment by Chris Friederich on Chris Masterjohn’s blog:

“If people let government decide what foods they eat and what medicines they take, their bodies will soon be in as sorry a state as the souls of those who live under tyranny.” – Thomas Jefferson

[13] Who eats better, lab mice or humans?: Paleo bloggers frequently mock scientists for the “Western” diet fed to lab mice: usually some mix of sucrose, casein, and soybean oil. After watching this video, what strikes me about the ingredient lists is that the scientists are right. “Western” humans are eating an awful lot of artificially-colored animal chow:

[14] Race to the bottom continues: Via Bix at Fanatic Cook, a Japanese food scientist has learned how to make “turd burgers” – fake meat made of protein derived from bacteria in sewage, and “improved” by the addition of soy protein:

[15] Shou-Ching’s photo art: Belated Father’s Day edition:

[16] Weekly video: The United States has been losing family farms. One reason is aggressive enforcement of counter-intuitive and health-damaging farm regulations. The new movie “Farmageddon” documents how difficult it is for family farms to produce healthy food. Here is the trailer:

Farmageddon – Movie Trailer from Kristin Canty on Vimeo.

Via Scott Kustes.