Ancestral Diet Dishonesty -- Hawaiian Edition

Forget the paleo diet for a moment here. Let's face it, nothing in the modern interpretations ever really came close to whatever that was anyway.

Forget hunter gatherers for a moment here.  Let's face it, these cultures are isolated and generally irrelevant in every way to the "modern" agricultural world.

Let's even forget the diets of cultures around the globe from 300 or so years ago on back.  Most corners of the world were "contaminated" by trade and transplantation of foodstuffs, livestock and plant species not indigenous to various regions.   

No ... I'm talking about traditional regional diets that persisted in practice from the relatively recent past -- within a few hundred years -- through to a few generations ago.  

image link

How about such diets in cultures that occupied regions that we now call the United States of America?  One of the most disgusting (IMO) things about the so-called "ancestral" health advocates is their exploitation of traditional cultures to drive their agenda.  That would be bad enough, but they don't just exploit them, they routinely misrepresent the nature of the diets consumed and then fashion their own dietary recommendations that bear little resemblance to the true diets.  Oh but their diets were inspired by such and such!




So next week there will be an online summit -- Reversing Diabetes World Summit -- co-hosted by none other than Jimmy Moore!  (don't get me started there ...)  There have been a couple of free sneak peeks including this one by an Asylum fave, Dr. Cate Shanahan.

The interviewer goes through her usual bio with the "she studied ethnobotany and her healthiest patients' culinary habits in Hawaii" schtick.   At about the 1m:30s mark here are my quick notes (not official transcript):

• When she relocated to Hawaii, state with the longest lifespan in US realized she was immersed in culture of healthy people who could teach her the secrets "genetic wealth"
• Strong joints, fertility, no gray to 50 yrs, strong nails, limbs proportioned according to "golden ratio", long nose, high cheek bones, full lips, strong jaw 
• Reminds me (interviewer?) of hunter gatherer cultures around the world where people eat traditional diet and maintain health
• Her patients were employed in resorts, women in their 50's and 60's worked all day long, lifting, bending, scrubbing, reaching who would then go home and keep on working, make dinner for family and chase grandkids
• These women had beautiful skin, supple joints, few if any grays
• Each one had been raised in a rural area, raised as their parents and grandparents had been, on home grown fresh foods, prepared using simple traditional recipes

There is a very strange obsession with beauty and ratios of measurements and bone structure and all that with this woman, and she and her husband dedicate quite a bit of ink to that in Deep Nutrition.  Whether or not there is anything to this and some correlation between beauty and health, I think we can all agree that at this point there's nothing short of surgery any of us can do about most of that stuff.   Genetic wealth??   We have whatever jackpot we were going to have at conception.  So I don't really know what this has to do with diet and health in the present, but ....

Dr. Cate was practicing medicine in rural Hawaii?  Treating healthy middle aged women who wouldn't have needed her doctoring anyway .... Ummm ....

Later in the interview she goes into her low carb, moderate protein, high fat diet schtick.  Fat is where it's at for Cate, 50% or more the better!  She sneaks fermented foods and bone broth in there too.   Only athletes should consume more than 25% carb or protein in their diets.  Sugar is sugar, so once it's in you, your body can't tell if it came from a Twinkie or a potato.  Processing does stuff to proteins and enzymes and ... Oh I can't bother.  Her biochemistry and nutrition is so backwards it is beyond words, and yet she is teaming with Mark Sisson to do metabolic counseling!   Maybe they can get a Laker to do promos.  But I digress.  Anyone who reads her book and still considers her a reputable source of information discredits themselves.  Yes ... it is that bad!

So first, let's get some facts straight.  Hawaii does indeed have the longest average life expectancy in the US (oddly enough Latinos residing there have the lowest life expectancy for any state where itemized, Asians have higher life expectancies in all states where reported but not so much in Hawaii).    I can't get the full text for these but, I think the abstracts give enough information to realize that the Native Hawaiians fare relatively poorly in the longevity department where statistics Shanahan is citing are concerned.

Life tables by ethnic group for Hawaii, 1980:  "Results show that: 1) female life expectancy at birth is 81 1/2 years; 2) male life expectancy is 75 years; and 3) life expectancy by ethnic group shows Chinese and Japanese rank the highest, Filipinos next highest, Caucasians and others have the next highest, and Hawaiians and part Hawaiians have the lowest. It is clear that marked mortality differentials remain between ethnic groups and between the sexes in Hawaii."

Life and death in Hawaii: ethnic variations in life expectancy and mortality, 1980 and 1990: "Life expectancy in Hawaii is among the highest in the nation. Past research, however, found significant ethnic differences in longevity. This study presents life expectancy estimations for 1980 and 1990, along with ethnic differences in mortality rates for specific causes of death. The findings suggest that ethnic differences continue, with Chinese and Japanese having the longest life expectancy and Native Hawaiians having the shortest."

No doubt some degree of Westernizing of their diet factors in here, but let's put another oft-misrepresented traditional culture twist on this tale.  Do you suppose the migration of Okinawans to Hawaii might factor in on this slightly?  

Aaaanywaaaay.  Let us presume that native Hawaiians consuming their native diet would be healthy and all else being equal fare well in Hawaii to this day (or at least until Cate returned to the mainland).  What was their diet?  High fat?  Lotsa butter, broth and 'bucha?  Oh of course not silly.  

Obesity and cardiovascular risk intervention through the ad libitum feeding of traditional Hawaiian diet

The Waianae Diet Program is a community-based intervention strategy designed to be culturally appropriate by using a pre-Western-contact Hawaiian diet to reduce chronic disease risk factors in Native Hawaiians.  This paper describes a trial of the traditional Hawaiian diet fed ad libiturn to Native Hawaiians with multiple risk factors for cardiovascular disease to assess its effect on obesity and cardiovascular risk factors.  Twenty Native Hawaiians were placed on a pre-Western-contact Hawaiian diet for 21 d. The diet was low in fat (7%), high in complex carbohydrates (78%), and moderate in protein (15%).  Participants were encouraged to eat to satiety.  Average energy intake decreased from 10.86 Mi (2594 kcal)/d to 6.57 MJ (1569 kcal)/d.   Average weight loss was 7.8 kg and average serum cholesterol decreased 0.81 mmol/L from 5.76 to 4.95 mmol/L. Blood pressure decreased an average of 11.5 mm Hg systolic and 8.9 mm Hg diastolic.

Someone alert Sally Fallon Morell or Stephanie Seneff.  There has GOT to be a saturated fat deficiency thing going on here!!

The selection of food for the program consisted of foods available in Hawaii before Western contact, such as taro (a starchy root-like potatoes), poi (a mashed form of taro), sweet potato, yams, breadfruit, greens (fern shoots and leaves of taro, sweet potato, and yams), fruit, seaweed, fish, and chicken.  All foods were served either raw or steamed in a manner that approximated ancient styles of cooking.

But surely these poor folks were starving on less than 1600 cal/day!  Nope ...

Unlimited quantities of foods except fish and chicken were made available. To approximate the diet of the ancient Hawaiians, which was estimated to contain less than 10% fat, the amounts of fish and chicken were limited to a total of 142-198 g/d. The participants were required to come to the meal site twice a day.  In the morning breakfast was eaten as a group. Lunch and snacks were distributed at this time. In the evening everyone met for a cultural or health-education session during dinner.  Each day these participants were asked if they were hungry by use of a hunger-satiety scale described by Haber; if they were not satisfied, they were encouraged to eat more and to take enough snacks so that they would be fully satisfied.

As to carbs and diabetes?

Interestingly, in just 3 weeks, these subjects lost 17 lbs and saw improvements in everything ... despite consuming over 300 g carb both before and after the intervention, and although cutting around 20g carb went from roughly 50% to almost 80% of their diet.  Since Shanahan mentions fasting glucose over 90 as an early sign of trouble (Doc heal thy host ;-) ) the average in this study dropped from 8.99 mmol/L (162 mg/dL) to 6.86 mmol/L (123 mg/dL) ... ahem paging Fred Hahn!   I will be blogging on the rather exceptional results of this study in a separate post.  

If the Hawaiian women Shanahan came in contact with while doctoring there were healthy, etc. due to consuming a traditional diet, it was not anything resembling her version of WAPF-paleo-deep-in-the-woo-woods nutrition.   Remember, she was studying the culinary habits of her healthiest patients.  Ethnobotany!

So Shanahan takes her place to the right of Gary Taubes for misrepresenting her  pet culture.  I don't know, haven't seen much new or watched it from Taubes.  Does he still trot out poor "Fat Louisa" and misrepresent the Pima?    While I'm on this topic, I'm not sure exactly where to seat Paul Jaminet and claims he makes about Perfect Health Diet and traditional cultures.   In Chapter 25 the headline quote is:

The Perfect Health Diet closely resembles traditional diets of the Pacific Islands, whose inhabitants were noted for their exceptional health and beauty.

Of the Hawaiian diet he writes:

The traditional diet of the native Hawaiian consisted of taro (often prepared as poi), sweet potatoes, breadfruit, coconut, fish, squid, shellfish, pork, fowl including chicken, taro leaves, seaweed and limu (algae), and a few sweet fruits.

A famous festival hosted by King Kamehameha III in 1847 served “271 hogs, 482 large calabashes of poi, 602 chickens, 3 whole oxen, 2 barrels salt pork, 2 barrels biscuit, 3,125 salt fish, 1,820 fresh fish, 12 barrels lu’au and cabbages, 4 barrels onions, 80 bunches bananas , 55 pineapples, 10 barrels potatoes, 55 ducks, 82 turkeys, 2,245 coconuts, 4,000 heads of taro, 180 squid, oranges, limes, grapes and various fruits.” (8)   Except for the biscuits— hardly a food that would have been available seventy years earlier— these are all foods we can highly recommend. As this menu suggests, most calories came from meat, fish, taro, and coconut.  (Perfect Health Diet - Kindle Locations 4521-4528)

The edicts in PHD are very specific as regards carbohydrates, as well as his carefully laid out (though flawed on both logical and evidenciary bases) rationale for high (60+%) fat content.    While Paul recommends 100g starch per day, he cautions against too much more than that -- a caution for which he unfortunately fails to provide any evidence.  Not only does he misrepresent the Thai diet in the book, but he makes no effort to reference the usual dietary patterns of Hawaii.  A famous festival?  I mean on Christmas Eve we eat 12 dishes, all vegetarian but for two fish selections.  On Thanksgiving I serve potatoes, wild rice, sweet potatoes and stuffing, turkey and either lamb, ham or a beef roast of some sort, and at least two types of pies are served for dessert.  What does that have to do with what we actually eat on a regular basis?    I would add that this comes after a discussion of the Okinawan diet which he selectively references as being described as greasy!  (I have an interesting paper on this to blog on in the future as well.  Their diet is not meat-based low carb.)  After all of this, the section is tied up with:

Takeaway 

We did not know when we began writing that we would be recommending the foods traditionally eaten by Pacific Islanders. We are reassured that the Perfect Health Diet, which we arrived at from our study of the scientific literature, is very similar to traditional diets known to produce superb health.

Too bad that study of the literature didn't include more on the usual traditional diets or go past the types of foods to how much of each.  I may well have missed it as well, but one simply cannot make rice based dishes on the PHD and I've yet to see much (not saying there isn't any, but much) in the way of meals involving taro or WHOLE coconut.  Has there been a paleo that eats coconuts by the way?  Or do they just save those for the chickens?  Nowadays you can get fresh coconuts year round at economical prices.   I never see a few chunks on the pages of the cook books in actual dishes!

In Conclusion ....

I just had to rant a little because I am sick of this being repeated over and over to where people parrot it about the internet as truth.  If you are going to point to an ancestral diet for guidance, then point to it accurately and fully.   You don't get to use parts of the diet (like specific foods that might be consumed) and rearrange the proportions or preparations to suit promoting your diet or guidelines.

I'm also sick of so-called experts in diabetes furthering the misinformation that carbohydrates cause diabetes and low carb is the one and only way to go with that.  Carbohydrates -- to the tune of 70-80% -- did not cause diabetes in the traditional Pima nor the native Hawaiians.  These two groups just happen to be "poster cultures" for modern diets gone wrong suffering high rates of diabetes and obesity as Western influence has changed their diets.  These cultures simply did NOT get fat and sick by trading a traditional high fat diet off for a high carb one.  

If folks like Shanahan and Cate, and all the rest of those enthralled by "ancestral" populations, believe in evolution and adaptation and turning on and off genes and whatnot, they would not be recommending their LCHF diets for these populations or anyone else.