Did low fat diets cause the obesity epidemic in the US?

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The title of this post is a common theme repeated by the likes of Swedish diet doctor Andreas Eenfeldt - That somehow going low fat (thus high carb) has caused the obesity epidemic.  At best, by percentage only, the USofA has decreased fat consumption from 37% to 33% (or 36% to 33% for women) ... this 3-4% reduction in fat percentage has been accompanied by a 7% increase in carbs (42-to-49% men, 45-to-52% women).  As you can see in the graphs, absolute fat content is basically flatlined -- we didn't cut fat, women (who tended to "comply" on the fat recs moreso than men)  even added a small amount.  Any way you cut it, this relatively insignificant change would be insufficient to cause some sort of carb triggered, insulin-induced fat cell mutiny!  Confronted with such facts the insulin hypothesis, or what I call TWICHOO, is changed ever so slightly to focus on how carbs cause you to eat more -- to the tune of some 300-500 calories/day and gain weight.   (I would note that NuSI discounts any ineffectiveness of various LC diets that are not really LC and use 40% carbs -- If you don't see an effect there, you will do nothing to pin the obesity epidemic on the lowly carbohydrate.)

One of the things that Paul Jaminet mentions about his Perfect Health Diet, especially more recently, is that it is some sort of gourmet paleo diet, and resembles French and Thai cuisine.  So I was looking around for something about the Thai diet in particular and came across this paper:  The nutrition and health transition in Thailand.   This paper is a bit older (2002) and covers the period from 1960-1995, during which Thailand underwent an economic shift from an agricultural society to a more  industrial one.  During that period the diet changed significantly too.  Obesity is on the rise:

Thai staples and side dishes are being replaced by diets containing a higher proportion of fats and animal meat. A shift in the proportion of expenditure on food prepared at home and that expended on purchased, ready-to-eat food, in both rural and urban settings, gives another reflection of the change in food consumption of the Thai population. The prevalence of overweight and obesity among children and adolescents has increased dramatically during the past 20 years and is more pronounced in children from private schools and urban communities than in those from public schools or rural areas

The last sentence there is opposite of what we generally see here in the US, with overweight and obesity being more prevalent in lower socioeconomic classes.  As Thailand has "modernized" we find:

Among adults, results from two national surveys in 1991 and 1996 indicated that the problem of overweight and other risk factors for cardiovascular disease have increased significantly. In considering the overall causes of death among the Thai population, the leading causes are diet-related chronic degenerative diseases.  Diseases of the circulatory system have become the number one cause of death in Thailand and cancer has ranked as the number three cause of death since the late 1980s.

So what changes?  Have the Thai been shunning butter and beef in favor of cereal and canoli?  Nope.  

I suppose you could blame the problem on just about everything -- from fruits and even veggies, to eggs, to meat and poultry, to animal fats.  I suppose one could even fashion an anti-sugar meme from this data.  But do you see the one thing that has gone down?  That would be your starch -- rice, cereals (evil grains) and tubers -- consumption of this decreased progressively for a 31% decrease in 1995 vs. 1960.  The other thing you'll notice is that carbs were then and still are the major component of the diet.

The anti-CICO's will find a small nibble to nosh on here ... caloric intake went down slightly (70 cal/day, I would note that they cite a figure of 2290 cal/day for "the most recent" 1999 source).  But the rest is not looking so good for the TWICHOOB's!  

• Protein intake is fairly low but increased 18%.  
• The percentage of protein from animal sources increased from roughly 1/3rd to 1/2, an increase of 68% of 1960 levels.
• Fat intake more than doubled (2.5X) 
• Fat intake remains low by Western standards but began in single digit percent of calories (~9%) and has now increased to "low fat" (~22%)
• Carbs decreased from an uber insidiously fattening and insulin spiking  ~350g/day to a still insidious ~275g/day.  

Increase fat, decrease carbs and metabolic hell is beginning to break loose in Thailand.  It is noted in the paper that the more urban Bangkok carbohydrate intake is only about 50% with fat intake over 30% (sound familiar??!!).

What of these carbs?  Surely these are those "special" carbs we are used to hearing about like the sweet potatoes, those more fibrous legumes, or the unrecognizable as corn maize?  Nope.  Rice is described as the traditional major source of calories and protein.  From here:

Rice is so important to many Asian countries. In Thai, to have meal we say 'gin kow' which literally means 'eat rice'. In Thailand, rice is not a side dish, it is the central dish and all other things that you eat, support it. In a Thai meal, you generally eat more rice than anything else and it [rice] serves as the foundation for the food pyramid.

This recipe is for the fluffy white rice that you see with 90% of Thai dishes.

From Kindle PHD, location 1384

Now, aside from putting the kibosh on this nonsense of the low fat diet being fattening (if you're intellectually honest that is, there is no other way to view such information), this raises some serious questions as to the Perfect Health Diet.  Throughout the book, and in podcasts/presentations discussing his diet, Paul (and Shou Ching, but she doesn't do the public appearances other than the occcasional book signing)  routinely misrepresents both scientific literature and the diets of traditional cultures.   The PHD seems moderate coming from a VLC viewpoint, but when one looks closer the book is based on viewing all foods as toxic and envisioning some sort of perfect balance in that "U" or "J" curve (Paul uses an inverted U).

I submit that while seemingly more generous, Paul's 100-125g/day starch or roughly 20% calories ... this is unfounded.  This intake, he says, puts you on the top of that curve up there and as intake increases from there, you have declining health.  Clearly that is not the case for the Thai.  Their diet went from almost 80% carbohydrate to less than two-thirds of the diet.  As starch goes, the health or toxicity curve clearly doesn't resemble Paul's.  Meanwhile, the fat intake doesn't even begin to approach the ~60% most would eat on PHD.

For those not so inclined to read the linked article, I'll leave you with this description of traditional Thailand:

A new diet–health paradigm may be evolving that places more emphasis on the positive aspects of diet.  The paradigm goes beyond the role of food constituents as essential nutrients required for sustaining life and growth, to one of preventing or delaying the onset of chronic diseases later in life.  The food patterns, reported to confer longevity by promoting good health and prevent the premature onset of chronic disease later in life, are diets rich in cereals, legumes, vegetables and fruits, low in animal foods, and moderate in low-fat meats such as fish.  These are consistent with the traditional Thai eating pattern.  The origin of the Thai diet begins with the waterborne community. From information in King Ramkhamhaeng’s famous stone inscription in the early 13th century, it is clear that rice and fish were the major ingredients of Thai cuisine.  Aquatic animals, plants and herbs are still used a great deal in preparing meals; large pieces of meat are rarely used in any dish.  The common cooking methods still widely practised are stewing, grilling and baking; frying is an influence of Chinese cuisine.  Fresh spices and herbs are common, basic ingredients in most Thai dishes.  In a proper Thai meal, dishes are not served in courses; instead, they are served at the same time allowing the various dishes to complement and enhance each other.  All dishes are eaten with rice, which is a main staple for the Thai population.

A far cry from any version of paleo I've seen, even PHD itself.