Know The Experts: Nora Gedgaudas, Page 151 & More

Updated slightly: 8/3/13.  Original publication date: 1/13/13.

While I have no inclination to vet every so-called expert in the community, every now and then one comes along that deserves closer scrutiny.  Scrutiny as to what their expertise really is in the areas in which they are giving so-called "expert" advice and information.  On a few occasions this past year, Nora Gedgaudas -- author of Primal Body - Primal Mind -- has weighed in on the "controversy" over so-called "safe starches".  While I've highlighted issues with her statements from time-to-time here, and Nora has been on my radar for a very long time, the fact that she seems to have such a prominent voice in paleo circles warrants this post.   I first heard of her from (who else) Jimmy Moore's podcast with her aired October 2009.

According to her website:

Nora Gedgaudas is one of the World’s leading experts on Paleolithic (Paleo) nutrition and author of the international best selling book “Primal Body, Primal Mind: Beyond The Paleo Diet For Total Health and a Longer Life”.

She is Board-certified in Holistic Nutrition® through the National Association of Nutritional Professionals (NANP) and is recognized by the Nutritional Therapy Association as a Certified Nutritional Therapist (CNT).

Huh?  World's leading expert ... on ANYTHING?   I'll get to her credentials later.  For now let's look into her great works as an international best selling author first, and we'll also look a bit on her website as well.

Poke about her website a bit and it is impossible to come to any other conclusion than that she is totally unqualified to discuss human physiology and metabolism.  Period.  Even a cursory review of the erroneous statements she has made on some very basic concepts should bring one and all to that same conclusion.  One of the first "red flag" things I read from Nora was the following on her website:  

Long chain saturates such as 18-carbon stearic acid (the most saturated fat in the body) is THE preferred fuel for the human heart. Stearates are commonly synthesized from glucose in the diet and are the primary storage form of saturated fat everyone wishes they had less of.

I interrupt this quote with minor quibbles.  First, by the most saturated fat I think she is referring to chain length and not degree of saturation.  All saturated fats are equally saturated.  They contain no multiple bonds.  But stearate/steric is the 18 carbon sat fat denoted 18:0.  One can see from here and here that this is not the primary storage form of saturated fats is 16:0 palmitate/palmitic acid representing 5-6X the amount of stearic.   Stearic is generally under 4% of the fatty acids, while palmitic is around 20% of the stored fatty acids.  Continuing on ...

If you don’t like it, eat less carbohydrate (the Textbook of Medical Physiology states “All body fat is made from glucose.”). All body fat can be potentially burned for fuel, assuming one has a well-adapted fat burning metabolism, low insulin levels and expends enough energy to do so.

The title of that book jumped off the page.  It is a highly regarded text used in medical programs, and it was the textbook for my advanced Anatomy & Physiology lab at RPI.  I recently unearthed my copy, the Sixth Edition authored by Guyton.  This text has undergone some revisions, subsequently adding Hall as an author (not that young biophysicist).  Gedgaudas lists the 1996 Ninth Edition in her "Miscellaneous Dietary Topics" section of references on p. 365 of 2009 PBPM.  The most recent version I own is an ebook of the Twelfth Edition.  

I was astonished to see such a glaringly erroneous statement attributed to this authoritative text.  So I emailed Nora to see if she'd made a mistake or could provide a more detailed citation in terms of edition and page number.  She emailed me back that she didn't have her copy handy but {paraphrasing her} "I didn't make it up!"    Well, that's the only way something like that makes it into print.  It is indisputable that the vast majority of fatty acids stored as body fat -- especially in humans -- come from dietary fatty acids, not glucose.  

Elsewhere on her website, she makes the same statement in an even more erroneous discussion of metabolic use of fats and glucose for fuel  (item 4):

Your body tries to take sugar from a meal out of the bloodstream as quickly as possible. The first order of business is to send glucose to your cells for immediate energy. If those cells are insulin resistant, then the sugar has to go somewhere (and energy cannot get into the cell). Your body sends some glucose to storage in the liver and muscle as glycogen. The rest of the glucose (i.e., most of it) goes to the liver to get converted into triglycerides so it can get sent to storage as body fat. Unless you have a very high rate of metabolism (not necessarily a good thing) you are likely to gain unwanted weight. This conversion to fat from sugar is a labor intensive process metabolically and takes a LOT of energy to accomplish. –It takes even more if a lot of fat was eaten at the same meal as the carbohydrates. Since burning the carbs off is priority #1 (and because it is impossible to burn fat AND sugar at the same time), whatever dietary fat is there also must be first converted to sugar before it can be re-converted to triglycerides and finally stored as body fat (“All body fat is made from glucose”—Basic medical Biochemistry).  This is a very energy INefficient process and takes an enormous amount of energy to do.

There is really so much wrong with the above paragraph, one does not even know where to begin.  Suffice it to say that this version of human metabolism will not be found in any reputable academic work.  Period.   The whole excess carbs converted to fat can be somewhat excused as an exaggeration of a real metabolic pathway (de novo lipogenesis), but the red highlighted passage above is made up or perhaps gleaned from the  pop-science "literature".

PAGE 151

The Trifecta Summary + Bonus:

• Grossly erroneous biochemistry attributed to big authoritative text, mis-cited
• Leptin science "lifted" from pop-sci mass media diet books
• Peer review research misrepresented.  "Prehistoric" diet not VLC

And now back to our regularly scheduled discussion ....

Interestingly, this altered citation -- Basic Medical Biochemistry instead of The Textbook of Medical Physiology , from Nora's blog -- is made on page 151 of PBPM (2009).  Here she states:

Ultimately, all body fat is made from glucose (Basic Medical Biochemistry).

With regard to Nora's book, either you are going to write a work of opinion, or based on experiential knowledge, or you are going to write a science-backed work that is thoroughly referenced. This does not mean the latter cannot include opinion or experiential knowledge, but that the lines should be clearly drawn as to which statements are supported by which references, and which are the statements made solely by the author.

It is not difficult to properly reference and distinguish one's own statements.  It may be slightly time consuming, but that's no excuse.  If one reads something on page 255 of Text 1, Author 1, and several studies confirm a similar statement, this could be referenced as follows:

In Text 1, Author 1 first identified confusiun is the hormone that causes blinkered belief in dogma (1)  This was studied by several research groups, and multiple studies have confirmed a strong correlation between heightened belief in dogma with high levels of confusiun in the blood. (2-5).  Therefore, this author believes the evidence is compelling to suggest confusiun levels are a good biomarker for susceptibility to dogma-based arguments in the population.  Reducing confusiun levels is a potential therapy to avoid this adverse state of mind.

1. Text 1, Author 1, JonQPublishers, 1935 , p 125.
2. Jones, et.al.  Confusiun associated with belief in dogma.  J. Dogma Res.  12:1322-1325.  1965.
3. Smith, et.al.  Review on the role of confusiun in dogma acceptance.  J. Pop Psy.  130:12-22.  1989.
4. Taubes, GT.  Confusiun made me do it.  Science Magazine.  999:999.  2012.
5. Bailor, J.  Meta-analysis on using confusiun supplements for fun and profit.  Private Communication.

This paragraph and referencing structure makes it unambiguous which statements go with which references. In fairly short order, one could go to each to check and read further if interested. Teachers used to randomly do just that to check for accuracy and possible plagiarism.   Even my hypothetical #5 is acceptable as it allows one to draw their own inferences on the strength of that reference, based on what the others say on the topic and perhaps even one's assessment on the credibility of the authors.  It is then made clear that the remainder of the paragraph is the author's own opinion and words.

To his credit, Taubes does provide page numbers for texts, but his footnoting placement is far from transparent.  His references are fairly "checkable" even if it takes a little more work than would be required were his books referenced more clearly as above.  Bailor is less forthcoming on page numbers in texts, an unacceptable practice repeated to far greater extent by Gedgaudas.  While Bailor only presents a smattering of texts in his references, Gedgaudas presents long lists of books -- mostly mass-media diet books, not academic works -- with no page references.  Ultimately she puts both of these guys to shame with her referencing shenanigans as they are not even numbered at all.  They are not in one alphabetical list by lead author., they are not even organized by chapter in some sort of chronological order.  No.  In PBPM, there are 30 pages of references organized by general topics, then sub-organized as books, articles and technical.  At least at this level things are alphabetical, but it is darned near impossible to trace a statement made in this book to the source.  As such, although she quotes and references Ron Rosedale several times, much of her book flirts dangerously with plagiarism (especially since much of his work is experiential and opinion).  I'm frankly surprised he hasn't made an issue of this ...

But here's a classic case where Nora's bad referencing obscures crucial errors.  On p. 151 -- same page as the presumable Guyton quotation -- she writes:

A fairly recent twelve-week study in Sweden compared the effects of a prehistoric (very low-carb) diet with what was termed a "Mediterranean diet" comprised of whole grain cereals, low-fat dairy product, fruit, vegetables and unsaturated fats.  After twelve weeks, participants' blood sugar peaks dropped 26% with the prehistoric diet, and only 7% with the Mediterranean diet.  (True Mediterranean diets actually look nothing like this.)

When I read this, I knew immediately she was talking about this study: A Palaeolithic diet improves glucose tolerance more than a Mediterranean-like diet in individuals with ischaemic heart disease, so I knew at least to look for the lead author Lindeberg.  I could be wrong, but I don't see this particular study in the references, though Lindeberg is cited, yet there can be no doubt this is the study she's referring to.  Why not reference this directly?   This is the oddest part of her referencing ... at random she provides inline references in the text -- from names only to a full reference -- why not consistently just reference them all??  In any case, for Paleo v. Med:   calories:  1344 v. 1755, protein:  90 v. 89 g,  fat:  42 v. 50 g (sat fat: 11.5 v. 16.8 g), and carbs: 134 vs. 231 g.  Since the caloric intake was substantially different, the percents are also relevant:

Protein/Fat/Carb      Paleo:  27/28/40 (alcohol 4%)     Mediterranean:  21/25/52 (alcohol 2%).  

BOTH of the diets studied were "low fat" diets, the Paleo diet was even lower fat than the Mediterranean diet in terms of absolute intake.   But more importantly, Gedgaudas misrepresented this study.  The "prehistoric" diet was lower carb, but at 134g carb and 40% of energy, it's hardly a low carb diet by many standards, certainly not very low carb.  Gedgaudas' focus throughout the book is on how our Ice Age ancestors led to our evolved physiologies to be fat burners.  Glucose is BAAAAAAAD.   This study in no way bears this out.

Before moving on from the references cited in the book to which Nora owes her status as "expert", I have to reiterate how many of her references are mass-media, pop culture diet & fitness books.  Let's hang out on page 151 a while longer here -- because she brings up leptin and insulin.  PBPM is heavily referenced with respect to leptin to the sorts of books I'm talking about.  The book, interviews and internet articles of one Ron Rosedale (L.Ron baybee!), along with Byron Richards' book thrown in for good measure, make up the endocrine section of this book and populate other reference sections.  It is disturbing how many times Mercola himself, or interviews with him are cited.  Given as she does cite some peer review literature in other areas, one has to wonder why not one -- just one, but preferably more -- from, say,  the "founder" of leptin, Dr. Jeffrey Friedman and other researchers?   Here's one that might be appropriate:  The Function of Leptin in Nutrition, Weight, and Physiology.   Rosedale's version of the leptin-insulin relationship, parroted in PBPM by Gedgaudas, is not found in any of Friedman's works, or any scholarly work that I've seen, especially through the mechanism of dietary carbohydrate spikes and surges these two subscribe to.  Why not at least a textbook here?

The Bonus:  In the original post I forgot to add this statement.  Yes, a fourth one on the same single page 151:

(a) The hormone glucagon is required for the mobilization of fat stores and allows them to be burned for energy.  (b) Glucagon does not operate in the presence of insulin.  (c) If one consumes enough carbohydrate to stimulate insulin secretion, glucagon cannot function, and body fat cannot be burned.

Addressed statement by statement:

(a)  The action of glucagon on adipocytes was controversial at the time of publication of PMPB.  Currently the evidence points to either no or a minor direct role for this hormone on adipocytes, but regardless the statement of "requirement" ranges from gross exaggeration to outright false.
(b)   If this were true then it makes no sense that protein stimulates secretion of both of these hormones.  It does this because in the absence of carbohydrate, insulin secreted to facilitate amino acid transport into cells may also stimulate glucose clearance and cause hypoglycemia.  Therefore glucagon stimulates glucose production in the liver.
(c)  Leaving aside the notion that glucagon cannot function, but in (a) Nora states a role for lipolysis of fat for glucagon.  Burning of body fat is oxidation, not lipolysis.

What of Gedgaudas' Credentials?   

She is:  Board-certified in Holistic Nutrition® through the National Association of Nutritional Professionals (NANP)

The NANP offers certificate programs at several colleges.  Don't be fooled.  You will not receive a degree (Associates, Bachelors, etc.) from that school, and the institution.  According to this PDF, the outlined requirements seem substantial, but this is mostly a listing of academic study/assessments the institution must submit for a person to sit for their "Board Exam".  If Nora Gedgaudas has completed substantial *for credit* classes at any of the institutions, one wonders why she does not sport an official degree.  Chances are these classes are specifically designed for this program and are not acceptable for credit (e.g. can be used as an elective for a degree program).  The college can exempt these classes from consideration for their various accreditations.  Happens all the time, quite often for specific continuation education programs for large employers.   I cannot imagine the Board Exam is very rigorous given Nora's misunderstanding of metabolic basics.

Bottom line, any group can conjur up a program and certification requirements and sound all official-like.  But it doesn't make it so.  Put otherwise, "board-certified" means only so much as the Board that is doing the certifying.   

How about:  Recognized by the Nutritional Therapy Association as a Certified Nutritional Therapist (CNT).

NTT Programs:   You must first and foremost pledge your  "allegiance to the teachings of such pioneering greats as Dr. Weston A. Price and Dr. Francis M. Pottenger, Jr. two of the greatest scientific minds ever to research nutrition, food and its’ effects on modern society. Their work is the basis for NTA’s core belief in properly prepared, nutrient dense whole foods."

We can be assured that Nora Gedgaudas participated in "in a rigorous course curriculum that includes anatomy and physiology, basic chemistry concepts, and the science of food and its’ nutritional components."  This must be where she got her keen understanding of human metabolism.

Look folks, I'm not bashing these programs or any who complete them.  I know nothing about them, though I'm not impressed.  EDIT:  On second thought, these programs rightly deserve bashing as they are NOT science based curricula.  Any relationship to a serious degree in nutrition, biochemistry or physiology is an illusion, and these programs seem nothing more than indoctrination into the fad diet beliefs of program developers. /EDIT   Seems to be a money-making scheme to me.  Pay fees to put letters after your name that qualify you to do nothing else.  You can't transfer the fruits of your labors to an accredited institution of higher learning should you decide to pursue further education.  Red flag to me, and I would suggest (just friendly advice) if you are into forging a career in alternative practice, get the "mainstream" degree, and then "specialize".  So, I am, however, pointing out the difference between these programs and those that are offered for the purpose of earning a degree from an accredited school.  Colleges and Universities routinely go through assessments to maintain some degree of academic integrity as to the content and skills that, say, a future employer or client or whatever would expect for one presenting "letters".  Either Nora Gedgaudas shames these organizations by sharing her self-appointed expertise of made up sheet, or she learned it from these programs.  I welcome input from any and all who have attended similar programs or are similarly certified to share their experiences in comments here.

But at least Nora can tell an emotionally stable keto-adapted voice in the wilderness of carb-addicted maniacs ranting about teh internet.  I dare not link to where this gem is located lest my rabid followers try to hunt down the keto goddess of serenity.  ;-)  Eh, just this once.  Be nice and don't "troll" a private diary blog, kay?    {EDIT:  Ms. Wooo has represented this linking as my urging readings to troll and harass her.  No.  I only link to this as an example of Nora's judgment regarding rational voices in this community.  Nothing more, nothing less.  Read and judge for yourselves. }