Graphs

Recently Adele Hite wrote a blog post entitled Just Asking the Question.  In it she posits:

So wouldn’t it be cool if we could ask folks on the street what they think caused the obesity crisis, and then show them this and ask them again?

The implication, of course, is that the misguided USDA Dietary Guidelines obviously caused the obesity epidemic.

The next image was part of a compilation put together by PaleolithicMD Ernie Garcia.    Note: his caption was:

Carb Consumption/Obesity DIRECTLY Proportional 

WOW ... this looks pretty damning for the carbohydrate, a poster to replace Farrah Fawcett on a teenage Gary Taubes' wall!!  I'll come back to this one later in the post.

Currently a version of Adele's image welcomes people to the website of the organization she heads: For a Healthy Nation.  FHN has a noble mission:  Transparency in the formulation processes of governmental nutritional recommendations and, it would appear separation of the guidelines from the USDA.  I'd be full bore behind FHN in this regard, but I'm not swayed by the graph above.  How many such graphs have we seen over the years correlating all manner of things with the obesity epidemic?  How many more could we construct?   It seems to me that the group at FHN believes strongly that Americans took to heart the USDA recommendations for a low fat high carbohydrate diet, and that this is what is making us fat.  We've heard this same meme a lot from low carbers, like that Swedish diet doctor with a penchant for snapping photos of fat Americans at frozen yogurt stands in airports.   But there's little evidence that Americans have actually followed the recommendations.  To claim that the SAD responsible for our obesity epidemic is a low fat diet -- even by percentage -- is to lie.  Sorry, that's a strong word, but it's applicable here.  Especially when put into context of the traditional diets of many cultures.  In particular I'm talking about those Arizona Pima again, who ate a much lower fat, much higher carbohydrate diet before settlers came around.

One of the most offensive ideas (not put forth by Adele TTBOMK) out there is that Americans started drinking Big Gulps because Coke & Pepsi, etc. are all low fat.  That sugar was given a free pass!  Gary Taubes mentioned this in his Big Fat Lie NYTimes piece.  I've heard Jimmy Moore say it, fibbin' through his teeth because he knows when he lost 170 lbs in 1999 on a very low fat diet, he portioned low fat sweets like marshmallows (ahem ... carbs or cals?).  The bottom line is that sugar in all it's glorious forms has always been a targeted culprit for weight gain and obesity.  Vegetarians and vegans are not counseled to live on chocolate and Pixie Stix.   

There are two main culprits of extra calories in the American diet are sugar sweetened beverages and added fats.   Lots of information in:  U.S. Per Capita Food Supply Trends: More Calories, Refined Carbohydrates, and Fats.   Yet these occupy the very top -- as in use sparingly -- of the former food pyramid.  Are all of these headless obese people we see in footage toting large sodas, or sitting down to a meal at McD's following USDA guidelines?  I think to answer yes would be laughable, and yet this is the basis of many arguments.  I recently did the egg survey -- that I'll write up later this week -- because this notion permeates not just the LC community, but much of the paleo community as well.  There's this romanticizing that somehow before our government messed up everything we were all eating these animal protein rich high fat diets and remaining slim and trim through all stages of life.  Below is a screenshot from that PDF comparing the food supply to the recs in 2000.  Notice anythingg?



OK ... let's get back to PaleoMD's graphic shall we?  Firstly, I tend to question it outright.  This notion that on average we consume 500g carb/day is off somehow.  The numbers just don't add up. 500g = 2000 calories which would be more than 100% for many women, and 67% for someone consuming 3000 calories/day.  Yet time and again, when intake is carefully monitored, or even ad libitum human junk foods are fed to rats, the SAD comes out to be more along the lines of 10-15% protein, high30's-mid40's % fat and 40-50% carbs (this blog post discusses the CAF rat and a human study commonly cited by Westman et.al.)

But let's presume the data is correct.  Where did it come from?  Gotta love tineye.com, for tracing this image -- Garcia merely attributes to Google Images -- to the following study:  Increased consumption of refined carbohydrates and the epidemic of type 2 diabetes in the United States: an ecologic assessment (free full text).  Let's look at all of the figures from that paper, shall we?  First, below we have the carb intake over a longer timeframe -- Garcia's graph comes from the part of that shown in yellow.  Do I need to comment?  Where's all the concern over the turn of the 20th century carb-induced obesity epidemic??  Memo to Mark Sisson:  Note how for most of the century if these data are to be believed, Americans ate 3X the threshold of carbs you still claim will result in insidious weight gain.  (FWIW my gut feeling is that intakes are/were quite a bit lower, but the relative consumptions are likely still instructive)

They looked at the quality of the carbs in terms of whole grains vs. corn syrup (?)  -- the top figure shows that wholegrain consumption went down as a percentage of carbs while corn syrup remained fairly flatlined until about 1950-5 where it takes off a bit, mirrored by continued decline of wholegrains.  One could make a case for a slight uptick of whole grains circa 1970, but it is not significant, and does not appear to go up much if any following the 1980 USDA Guidelines.  Yep ... Americans listened so well they went out and ate up a bunch of corn syrup when our government told us not to!!    I think the bottom Figure 3 is quite telling as well.  Those who want to tie diabetes incidence to corn syrup (presumably HFCS?) will have a hard time explaining the uptick in diabetes (bars) that precedes the marked uptick in corn syrup consumption.  If there's any mismatch in the correlation, since diabetes doesn't develop for several years, the diabetes should lag the corn syrup, not the other way around.  

Then we have Figure 4 showing total carb intake vs. diabetes incidence.  Pardon the slight incongruence in the horizontal time scale where I've modified the figure to show extended data on the left back to 1908.  You will note that the 1935 and 1955 bars for diabetes incidence come from the above plot.  In 1935, diabetes incidence was under 5 persons per 1000 (less than 1/2 a percent!)

I'd say this is rather compelling evidence that carbohydrate intake does not cause diabetes.  Looking back to Figure 1, we see that fiber was more prevalent in the carb sources prior to 1950.  IMO, the big farce about whole grains is that they are not a particularly good source of fiber.  Add in that most wholegrain products made from flour are rarely even 100% whole grain, and pulverizing grain to dust makes absorption more rapid.  Most wholegrain products differ very little compared with more refined products in terms of glycemic load, etc.

I'd like to see the recommendation of grains as being an essential part of one's diet, or major source of carbohydrates, sidelined.  They simply aren't particularly good staples in their modern forms where we're mostly talking mass manufactured wheat dust made into relatively high calorie/low nutrient breads and cereals.  But let's not forget that grains (and what's the distinction really, when you have people arguing so-called pseudograins, and equating corn with wheat with rice with oats with barley with buckwheat with etc.etc.) have been staples of various metabolically healthy societies throughout the millenia.

I don't think this message is going to go anywhere so long as ardent low carbers (paleo, posers or proud consumers of LC crap) are spearheading the movement.  I just don't see it.  Especially when Hite's organization boasts Adam "you can join me so long as you reject calories" Kosloff as it's Chair of Outreach and Dr.  Robert "Carbs Can Kill" Su on its advisory board.   This notion that we need to somehow reconnect with this fictional low carb high fat eating past is just that ... fiction.  Now whole, real foods we can rally around, but that includes many carbohydrates, and the bulk of innumerable traditional diets.  To be fair, Adele and I had a short exchange in the comments here, and I believe she's sincere in advocating for bioindividuality -- that there is no one diet for each person.  I agree with that, and I'd like to see guidelines -- if they are going to be issued from on high at all -- to focus on meeting minimums (already the supposed underpinning) of essential nutrients and how best to meet those and additional needs with real whole foods.  After that, so long as people are aprised as to what's in their foods, remaining decisions should be made by adults for themselves and for their own children.

But I do think my graphs are food for further thought.  What say you?