Perfect Health Diet Macronutrient Ratios ~ Part I: Breast Milk

If this post seems a bit out of the blue, it's because it was written a while ago and I'm currently going through the draft bin attempting to publish up some of that mostly done stuff.

First, it is important to note that there are actually three versions of The Perfect Health Diet book (perhaps four, I am unsure if the Kindle version was updated from the first print version, but I'll refer to the self-published Kindle version as v.2).  I mention this because the first ebook was published in 2010 as was the self-published paperback and the latest version was completed late in 2012.  While there are some minor changes, the core of the basis for the PHD has not changed much, if at all and if there were major changes I would expect Paul to highlight them in his various appearances.  So, in v.1 and v.2  the rationale behind the macronutrient content was put forth in a very straightforward manner in a section entitled:

Four Reasons to Believe in a 20-65-15 Macronutrient Ratio (Carb-Fat-Protein)
  1. This was the composition of the Paleolithic Diet
  2. This is the composition of breast milk (adjusted for adult brain size) 
  3. This is the composition of the human body - Eat what you are.
  4. Omnivorous animals prefer to eat this diet
Later in the text these ratios were relaxed a bit to 20% carb, 60-65% fat and 15-20% protein.  In all versions, rationale #4 is the weakest.  Which macronutrients lab mice prefer when given a choice is hardly convincing, and I've known field mice to get into both bars of soap and birdseed so I'm not going to conclude anything from that anytime soon!  This will probably be the first and last time I refer to that rationale, but anything can happen.   Also, point #1 has been discussed here quite a bit of late so I am not going to go into that again.  Suffice it to say that he cites Cordain here, and there's a real problem with his interpretation -- or rather one might say super cherry picking of the sort to make Gary Taubes proud!  This component of the argument is blurred somewhat in v.3 ... to fit the diet?   Although not numbered in the same fashion, all of these points persisted in the most recent version of the book.  
The basic structure of cells— a protein-rich intracellular compartment surrounded by fatty membranes— hasn’t changed in billions of years. The need for cells to be able to obtain energy by cannibalizing themselves hasn’t changed in that time either. So it should come as no surprise that all mammals have similar macronutrient needs. Mammals do need different foods— some are obligate herbivores, some obligate carnivores— but this is because they have different digestive tracts, not because their bodies have different nutrient needs. All mammalian diets point to the same basic macronutrient ratio: a macronutrient ratio that is majority fat, minority carbs and protein. The typical mammalian diet is about 10 percent carbs, 20 percent protein, 65 percent saturated and monounsaturated fat, and 5 percent polyunsaturated fat. Adjusting for our larger brain size, this suggests an optimal ratio for humans around 20 to 30 percent carbs, 15 percent protein, 50 to 60 percent saturated and monounsaturated fat, and 5 percent polyunsaturated fat. Which is strikingly close to the Paleolithic diet, the cannibal diet of fasting, and the composition of breast milk adjusted for brain size!  (Kindle Locations 994-1004)
As you can see,  there's a bit of hide-the-total-fat going on here with the breakout  of the PUFA.  Still there is a shift worth noting:  20-30% carb, 15% protein, and 55-65% fat.  I would be remiss if I didn't point out that carb-fat issue aside, no, Paul, the Paleolithic diet is described in none of the common publications to this community as only 15% protein.   

The remainder of this post will focus on Point 2, the breast milk issue,.  I'll do a followup on what he refers to as some sort of universal mammalian diet or the "cannibal diet" which is related to Point 3, as time permits.

The Breast Milk Argument for PHD

Why now?  Well I got side tracked yet again ;-)  I was sorting through papers and stuff the other day and listening to podcasts in the background.  Paul Jaminet did two new ones ... nothing new in the content really ... but a comment popped up in my reader challenging Paul Jaminet on this topic:
Tom wrote:  You mention in the interview that the composition of milk across different species are fairly constant. This does not fit my reading, see for example:  [link] . According to this website Antelope and Kengaroo would have 50% of energy from protein, horse milk 70% carbohydrates, reindeer 70% fats, some marine animals as much as 80-90% fats etc. ....
Now since  the link is from the Lactation Biology website for a class in the Animal Sciences Department at The University of Illinois, I'm going to take the information to be accurate to the best of the creator's knowledge.  Thankfully it was a mere C&P into Excel, a few columns of formulas later and I had the percentages by calories for the macronutrients to play around with.  I knew most of the diets off hand but did a quick search to fill in the gaps there as to which species are herbivores, carnivores or omnivores (please let me know if I made any error there.)

Regardless of what he claimed in the podcast, in PHD Paul states twice, perhaps more, that breast milk composition is similar in all mammals:
By calories, and excluding the contribution from milk oligosaccharides, human milk has a macronutrient profile of 54 percent fat, 39 percent carbs, and 7 percent protein.
Note the order:

• Fat provides the majority of milk’s calories.

• Carbohydrate is the second largest calorie source.

• Protein provides the fewest calories.
This order holds in the milk of EVERY mammalian species, not just humans. For instance, milk from cows is 52 percent fat, 29 percent carbohydrate, and 19 percent protein. (Kindle locations 636-643, emphasis mine)
But it is telling that most strains of wild-type mice chose to get a majority of calories from fat, a minority from carbs and protein— the same pattern we’ve seen repeatedly in other mammals, in humans, and in breast milk of all mammalian species. (Kindle Locations 895-897, emphasis mine)
This is quite a definitive statement and has persevered through the editions.  I find that quite odd because I know that Paul had been challenged on this rationale in general, so I'm surprised he never double checked it.  In his response to Tom's comment, it would appear his analysis was very limited to begin with:
Very interesting points. I’ve only looked at a restrictive set of species, and in those simple scaling laws, eg,
- Protein scales with body mass
- Fat+carb calories scale with energy expenditure (which depends on size [surface area: volume], ambient temperature, activity levels, and brain size)
- Fatty acid composition scales with brain size
- Fat:carb ratio is related to total energy expenditure : resting energy expenditure ratio
I have inquired if this scaling analysis is available and will link to it if Paul responds (update:  no response) . Still, this is not what was stated in PHD.    So here are a few bar graphs of the macro contents (by calorie %) of the various mammalian milks (human milk is shown in darker colors):

Milks sorted by FAT content, note humans near the middle of the pack and fat content ranging from 22 to 90%
Milk sorted according to CARB content.  Note humans are near the top of the list here with carb content across species varying from essentially zero to 62%.
Milk sorted according to PROTEIN content.  Note humans are at the bottom of the pack at 6% with the range up to 52%.
Lastly, I thought it would be interesting to see if there were any patterns that emerged for mammals based on the nature of the natural adult diet.  The image below is sorted by carnivores at the bottom (up through seal), herbivores (antelope through elephant) and omnivores (monkey on up) 

Milk by DIET type and secondarily on FAT consumption.  There does not appear to be much of a pattern here either.  
I think it is safe to say that the composition of mammalian breast milk varies widely between species, even within the classes of these species based on their adult diets.

Human Breast Milk vs. Adult Human Diet 

I have to be honest here, when I first read PHD mostly in short skimming sessions in various waiting rooms, often interrupted sometimes by days, this argument really stuck out to me as being rather illogical.  Infants of all species have different needs than the adults.  No difference can be more stark than that of the herbivore, as all mammals by definition eat an all "animal based" diet until they are weaned.  The explanation of conversion of nutrients -- the subject of the next post -- does not explain this difference fully, but I find that argument illogical as well.  There is no reason to believe that the needs of an infant would match those of an adult.  Further, the development of each animal and relative times of maturation vary quite widely.  A foal gets up and walks within a couple of hours while it takes many months for a human baby to stand hanging onto something for support.  Growth of brain vs. body differs widely, time to reproduction age, etc.  I see no reason to even try to extrapolate infant food, macronutrient or otherwise, to adult diets.  

Further, the main sugar in milk is lactose -- which isn't even paleo!!  So if we're talking evolution, there's a long way for humans from infancy to reproductive age + time until offspring are independent  (the important part for survival of the species)  and they would not have had access to lactose.  

But leaving this aside, Paul seeks to reconcile the various means by which he arrived at the macros in PHD -- it's story telling with quite a bit of stretching to go along with.  The macros don't really converge between what the paleo diet is (forget fat/carb, the protein content claimed is far lower than reported in the sources he cites) , and while the jump from the 54% he cites for human milk to 65% sounds nominal (smaller still when you hedge to 60%), this is rather difficult to attain with a "normal" diet that pretty much any humans have eaten, even the Inuit.  He tries to go about this task of bringing milk in line with the paleo macros by mathematically adapting the infant macros to the adult brain.  Since the infant brain is growing, it needs more carbs for total body weight.  The very low protein content makes sense because skeletal muscle and all that is not required as much for the infant as is brain development.  However, Paul focuses only on the carbs and surmises that the adult needs about half what the infant needs, and partitions the other 20% between protein and fat.  This appears arbitrary, if not biased to preserving the preconceived optimal fat level,  and largely to bring protein within range of what human adults generally consume.   

The prevalence of ketosis in human babies is a phenomenon ripe for the exploitation of diet gurus.  We are born fat burners Mark Sisson has exclaimed!   Nora Gedgaudas likes to evoke the ketotic infant quite a bit too.  But ketosis is prevalent in certain species early in life for specific reasons.  We are used to thinking of ketones as being glucose sparing.  In other words, they reduce the need for glucose by providing an alternate energy source for the obligate cells like those in the brain.    But here's an interesting paper:  Survival of the fattest: fat babies were the key to evolution of the large human brain  (a related work by Cunnane is cited in PHD).
... an brain was a product of having first evolved fat babies. Hence, the fattest (infants) became, mentally, the fittest adults. Human babies have brains and body fat each contributing to 11–14% of body weight, a situation which appears to be unique amongst terrestrial animals. Body fat in human babies provides three forms of insurance for brain development that are not available to other land-based species:  (1) a large fuel store in the form of fatty acids in triglycerides; (2) the fatty acid precursors to ketone bodies which are key substrates for brain lipid synthesis; and (3) a store of long chain polyunsaturated fatty acids, particularly docosahexaenoic acid, needed for normal brain development. ...
Emphasis is mine.  Taken in conjunction with the "high" fat content of human milk (including those MCTs), ketones are of clear importance early in life.  I don't want to turn this into a discussion of the role of ketones in adults, so I won't, but as per the bolded statement, ketones are probably more important as building blocks for lipids than they are for energy (though no doubt they play a role there as well).  So ... who is to say what fraction of the fats in breast milk are there specifically for this purpose of brain growth ... and when said growth tapers off early in life, it would seem logical that  fat requirements are reduced substantially.  Indeed, the statement in another paper by the same author that "ketones are important brain lipid precursors and their role in this regard is supported by glucose which generates the necessary NADPH for de novo lipogenesis" would argue strongly that in this context, glucose is still primary fuel, and thus humans with the bigger brains and needs for brain growth should have relatively high carbohydrate content in breast milk.  Yep ... right near the top while fats are modestly in the middle.    One might argue that adults are merely suppressing this preferred metabolism, but in my opinion (and that of many others) the fact that true ketosis is so difficult to attain and maintain argues against this.

Halving carbohydrate intake on a percentage basis is based on the following:  The weight of the newborn brain is 11% of body weight yet uses 75% of the baby's enery, and the adult brain is only 2% of body weight yet uses 23% of energy (these values are referenced to this paper in PHD, but are also in the Cunnane paper).  Yeah, and?  On a %E/%W basis, the infant brain ratio is 5.5 while the adult ratio is 11.5.  Here is where he gets the idea to halve the glucose needs from the diet.  OK, I see the math ... sort of ... But this is based on various assumptions such as (1) All of the energy used by the infant brain is from carbohydrate, and (2) the adult brain is the only organ that uses energy from carbohydrate.We know this not to be true. 

When published, this section will contain live links to:
Part II:  Nutrient conversion & Eat what you are
Part III:  Paleo macros


charles grashow said…
"Four Reasons to Believe in a 20-65-15 Macronutrient Ratio (Carb-Fat-Protein)
This was the composition of the Paleolithic Diet"

"Whenever and wherever it was ecologically possible, hunter-gatherers would have consumed high amounts (45–65% of total energy) of animal food. Most (73%) hunter-gatherer societies worldwide derived > 50% (≥56–65%) of their subsistence from animal foods, whereas only 13.5% of these societies derived more than half (≥56–65%) of their subsistence from gathered plant foods. In turn, this high reliance on animal-based foods
coupled with the relatively low carbohydrate content of wild plant foods produces universally characteristic macronutrient consumption ratios in which protein intakes are greater at the expense of carbohydrate.

NOTICE - "universally characteristic macronutrient consumption ratios in which protein intakes are greater at the expense of carbohydrate."

What sayeth Paul?
John Smith said…
The best diet is one that emulates the breast milk of a marsupial.
billy the k said…
The journal article cited by Jaminet that provides the underpinning for his advice re the optimal carb intake is: Nair, KS, et. al,: "Leucine, glucose and energy metabolism after 3 days of fasting in healthy subjects" (AJCN 1987; 46: 557-62) Jaminet (p87) says this study gives us the basis for the body's natural carb intake: "a fasting person's daily glucose production has been measured at 8 µmol/kg/minute, which for typical adults gives 120 to 160g/day." BUT! the trouble here is that the period after a person's last meal is not one state but rather a steady catabolic adaptation as the body transitions from the immediate
postabsorptive state to the fasted state to early starvation to prolonged starvation. And the glucose production and utilization rates are markedly different depending on what point you look at in this "postabsorptive-fasting-starvation" state. Jaminet chose to look at the glucose production rate after 3 days of fasting. In Nair's article we see that the measured fasting glucose production rate--after an OVERNIGHT fast--is 61% greater at ~13.55µmol/kg/minute than the day 3 rate of ~8.4µmol/kg/minute; that makes the 24hr rate not at 120g-160g/24hr but 193g-257g/24hr. E.A. Newsholme (Regulation in Metabolism;1973, Oxford UP) regards 3-4 days of zero food intake not as "fasting" but rather as the first few days of starvation. The glucose production and utilization rate will be greater before Jaminet's day 3, and decreased in the days after day 3. George Cahill (Physiology of Insulin in Man. [Diabetes; 1971:20 (12): 785-98]) says: "In the fasted state, liver glucose production is about 125-150mg/min, or 180-220gm/24hr." If Jaminet had used these measured overnight fasting glucose production rates from the world's expert on fasting and starvation (Cahill) we'd have his PHD carbs at 180-220g/day, or at 36% -44% of a 2000kcal/day diet. A further confounder is that a person's fasting glucose production and utilization rate depends on whether or not he or she has been eating a "previously well-fed diet." This term was used by past researchers to indicate that a person has been regularly eating enough carbohydrate to avoid what Cahill referred to as "a functional atrophy of the glucose-using enzyme inside the cell", and avoid the need for gluconeogenesis (Cahill put this amount at ~200g/day). Interestingly, this figure of 200g/day of carbohydrate matches the conclusion that Himsworth came to in his classic study (The Dietetic Factor Determining the Glucose Tolerance and Sensitivity to Insulin in Healthy Men. [Clinical Sci; 1935: (2) 67-94]): "It will be seen from the insulin sensitivity determination curve...that as the dietary carbohydrate is increased from 50g to 200g marked increase in insulin sensitivity, and consequently of the ability of the body to dispose of carbohydrate occurs; with increase from 200g to 350g little increase in sensitivity results and the sugar tolerance improves but slightly; and with increase from 350g to 450g a further but less marked improvement appears. It therefore appears that in the case of the diabetic balanced with insulin, increase in the carbohydrate of the diet from 50g to 200g will necessitate little or no increase in insulin dosage; that increase of dietary carbohydrate from 200g to 350g will produce such little improvement in insulin sensitivity that proportionate increase of the dose of insulin will be required;...This suggests that the maximum disposal of dietary carbohydrate by each unit of insulin will be obtained when a diet containing 200g of carbohydrate is given. FOR AMOUNTS BOTH ABOVE AND BELOW THIS FIGURE MORE INSULIN WILL BE REQUIRED FOR EACH GRAM OF CARBOHYDRATE." [italics mine]
carbsane said…
Likely to involve the liver in regulating glucose concentrations that are more critical for the brain building needs of the human infant. I think the role of ketones is misunderstood as an energy source when it seems to be more as a substrate for DNL of fatty acids for the brain.
carbsane said…
This paper is in contrast to other papers both before and after .. which is odd.

I>Takeaway: The Diet of the Paleolithic The Paleolithic diet was a fat-predominant, low-carbohydrate diet. Calories came mainly from fat-bearing animal foods, but plant foods were an essential part of the diet and comprised most of the weight. Typically:

• Carbohydrates made up 15 to 20 percent of calories, with excursions toward 50 percent depending on food availability. Most calories came from fatty animal foods. • Plant foods consisted predominantly of starchy in-ground carbohydrate sources such as roots, rhizomes, tubers, and corms plus above-ground fat sources such as coconuts, palm fruit, and mongongo nuts. Sweet fruits were rarely a major part of the diet. It was on a majority-fat, low-carb diet mainly composed of animal foods and in-ground plants that our ancestors evolved from a regional population of small-brained African apes numbering (probably) in the tens of thousands to a highly intelligent species at the top of the food chain and a global population in the millions. As our Paleolithic ancestors who dominated the globe were characterized by tall stature and healthy teeth and bones and their health deteriorated as soon as their diet was altered, we think it’s safe to say that such a low-carb, high-plant, starch-meat-and-fat-based diet is a healthful human diet.

Jaminet, Paul; Jaminet, Shou-Ching (2012-12-11). Perfect Health Diet (Kindle Locations 474-485). Simon & Schuster, Inc.. Kindle Edition.
George said…
Ketones are substrates for myelin-type lipids, and there's a lot of myelination going on. As shown by movements becoming more co-ordinated. Related to coconut oil and ketosis as a cure for brain diseases, I'm sure.
Bris Vegas said…
It isn't just the macro ratios that vary. The energy content is also radically different between species. Seal milk is basically double cream (50% fat by weight). Breast milk is very low energy (4.2% fat by weight).
Bris Vegas said…
The galactose is probably there as a prebiotic to encourage the growth of the dominant bifidibacteria and latobacilli gut bacteria essential to the immune system of babies. Adults have few of these bacteria.
Allison said…
Your breakdown by diet is kinda misleading as the macronutrient ratio can vary greatly within the herbivore or carnivore group. It would be interesting to compare to the actual macronutriant ratio of their adult diet but I dont know if that would be too much research. I would alternately be interested in seeing the animals re-ordered by some other qualifiers such as: arough estimate of optimal body fat as an adult (i noticed that the breast milks with the most fat are predominately cold weather animals that are carry alot of body fat) or growth rate from birth to weaning (not sure what that would show regarding the whole optimal diet thing but could be interesting)
carbsane said…
Hi Allison, I think it is enough to point out that the macros of obligate infant food are widely disparate to adult diets. I have neither the time, nor frankly the desire, to track down the dietary compositions of each of these species ... it would add little to the discussion IMO.

If we take just the cow, their infants consume a lot of lactose -- something that is neither part of the adult diet, nor produced later on via transformation of actually dietary content later on. Wow ... I think I should edit this observation into the post!

There's a lot of information out there regarding common industrial milk producers (mostly cow, goat, sheep) along with the metabolic state of the lactating mother. I personally have zero interest in this, but if someone is in the business it may well be. Bottom line, I think we really need to go into speculative gray areas too vast to divine a "perfect diet" for any adult based on infant nutrition.
carbsane said…
WOW -- how have I never seen that Cahill paper?

Thanks for these references. I've been trying to track down that Himsworth paper for ages. I don't suppose you have a copy?
charles grashow said…
eulerandothers said…
' the world's expert on fasting and starvation (Cahill)'

Not to split hairs here, but... Cahill died just last year. His reputation seems to center on glucose metabolism, according to Wikipedia:

'Especially the human glucose metabolism in diabetic or normal condition was in the center of his work. He was also interested in the effect of hunger and fasting on metabolic pathways and ketose processes.'

This paper, 'Starvation and Survival' has an interesting discussion at the end, with Dr. Cahill (the paper's from 1968).
eulerandothers said…

'Dietetic factors influencing the glucose tolerance and activity of insulin' H.P. Himsworth, J Physiology, 1934.

Is there any similarity to the paper cited (The Dietetic Factor Determining the Glucose Tolerance and Sensitivity to Insulin in Healthy Men.)?
carbsane said…
I have a friend that found the paper text today -- 30 pages! -- and took some snapshots of it and some other stuff in the same journal by him. I'll compare. Thanks!!
billy the k said…
Yes: both studies investigated insulin action and glucose tolerance.
And both were authored by Himsworth. Otherwise, the 1934 study you refer to involved rabbits, not humans.
billy the k said…
Ancel Keys certainly made contributions to the investigation of starvation. But the shoddiness he employed in the data cherry-picking for his Seven Countries study in an attempt to "prove" his cholesterol hypothesis (and get his face back on the cover of Time magazine) proved only that he was not above using fraud for self-promotion. Scientific "expert"? I don't think so. More like charlatan. Definitely lacking in the "empirical rigor" department.
(However, to his credit, my ol' man did appreciate those K rations in
carbsane said…
I've always been struck by that though. When you put the other countries in there, there is still a correlation. Not defending the study and all that, but the "cherry picking" to fit a curve seems to be the main issue folks have. The scatter in all the countries is far less than some of the studies I've seen.
It's interesting how Denise Minger is their Anti-China Study Messiah, but when she actually brings up some rather sobering realities regarding Ancel Keys and those studies, crickets start to chirp with no end to the 'Keys scammed and doomed us all' memes running ad nauseam.
carbsane said…

Yes, this post of hers got little buzz.
eulerandothers said…
This subject has me reading a book now about Ancel Keys' Starvation experiment. :

After the uninteresting few personal facts about Key, the actual experiment is the subject of the book and truly interesting! Keys may always have controversy surrounding his Seven Countries study, and the Mediterranean diet may be his legacy (at least judging from his obituary!) However, calling him a fraud seems a bit much!

Reading the discussion included in one of the papers by Cahill, 'Starvation and Body Nitrogen,' I had to laugh out loud at the language. Dr. Herbert G. Langford starts the discussion by saying, 'Those of us who occasionally starve the fatties think that after several days their ravenous appetite disappears.'

Wow! Those were the days....
billy the k said…
A person commits fraud when he knowingly deceives or commits an act of misrepresentation. Even before the Seven Countries study, Keys was convinced as to what the preventative measures should be to prevent heart attacks. According to Keys, high-fat food was the culprit:
"In 1953 he published a diagram (Journal of Mount Sinai Hospital.1953; 20:118-139) which showed a close correlation between the total intake of fat and the death rates from coronary heart disease in six countries. The points of the diagram lay almost perfectly on the upward curve of CHD deaths, so perfectly that the curve he drew looked more like the result of an experiment in physics than biology. If you extend the curve to the left it intersects the origin ( the intersection of the x- and y-axes), thus suggesting that if you completely avoid high-fat food, you will never have a heart attack...But why did Dr. Keys limit his data to a mere six countries? At that time information was available from 22 countries. The reason is that if all the countries were included, the association became rather weak. The death rate in Finland, for instance, was almost seven times that of Mexico, although fat consumption in the two countries was almost the same." [Uffe Ravnskov: The Cholesterol Myths, 2000. p16]
It's also interesting to check out his "How to Eat Well and Stay Well the Mediterranean Way" (1975). Ancel (and co-author wife Margaret) no doubt experienced some cognitive dissonance over some features of actual Mediterranean eating which didn't quite "fit the theory": "The average French diet is much higher in butter than the American diet. In the Mediterranean area of France, the per capita use of butter is less than half that of France as a whole, BUT IT IS STILL HIGHER THAN THE U.S. FIGURE." [emphasis mine].

"All over the Mediterranean both pan and FRENCH FRIED potatoes are extremely popular. A deep fat fryer is standard equipment in many households, especially in France and Spain, and it is common to use it at least several times a week for potatoes. Boiled and mashed potatoes are also used, but probably close to half of all the potatoes eaten in the Mediterranean are fried."

"Frozen desserts based on rich milk and cream are popular in all of the Mediterranean countries, but they are eaten as between-meal snacks, seldom at the end of a meal as dessert...The Mediterranean women--who aren't afraid of getting overweight--often enjoy a bowl of ice cream in late afternoon."

[So then: butter your breakfast toast, have a side of fries at lunch, take an afternoon break with a nice bowl of Haagen-Dazs and presumably get a thumbs-up from Mr. Anti-Sat Fat. (because it's "Mediterranean", see...) [Who'd have thunk it?]
billy the k said…
Methinks you may be shooting the messenger. I merely reported some quotes from Ancel's own book. Of COURSE it doesn't sound "Mediterranean." You may think Ancel was mistaken regarding those quoted observations. You lived in Italy. But remember that Ancel did too (retired at 68, at least half each year at his villa south of Naples). And just because he fudged the facts and thereby tarnished his scientific creds, that doesn't mean that Mediterranean foods aren't good to eat. I mean, come on: Greek salads, lasagne, minestrone, spaghetti--what's not to like?!! (And I can't leave out that most explosively delicious magnificent Italian cabernet--Sassicaia).
eulerandothers said…
The quotes you've used don't jibe with what is known as the Mediterranean diet. There's no relationship between those quotes and fact-fudging either! You seem to think he lacks credibility and yet the Mediterranean Diet thrives - and Keys is given credit for the general outline of the diet, including the prescription to minimize saturated fat. If you disagree with that proscription, then you have a problem with the Mediterranean diet. Without reading Ravnskov, I'm guessing HE has a problem with it.

The quote about frozen desserts is the most puzzling. Yes, there are creamy gelatos (but also Italian 'ices') and they may be popular in the sense that people enjoy them occasionally, especially in a warm region. In smaller portions. (Now, Ben and Jerry's have franchises in Europe and I wonder if they manage to keep portion sizes small...). And not so frequently - because casual snacking is more American than Mediterranean. But then, and this is also important: 'Mediterranean' becomes a nebulous term when describing countries and their regions and culinary habits.

What first captured Keys' attention was the lack of CVD in Naples, Italy. What he noticed about diet there got him started gathering the epidemiological data that led to generalizing about diet. It was easy to 'drill down' to saturated fats. And the saturated fat- heart disease link was nothing novel or unique to Keys.

So, cherry-picking here is all about your quotes. Keys wasn't pushing French Fries as part of the Mediterranean diet, was he? Or was picked that quote. What did you leave out about the Mediterranean diet - what was not said that would clarify the meaning of those quotes?

Continue to say that he 'fudged the facts': repeating something multiple times will not make it true.

Here's that Denise Minger blog entry:
billy the k said…
Ancel wasn't "pushing" french-fries. He noted that there was a Mediterranean fondness for eating potatoes, when they did eat potatoes, pan-fried or deep-fried. And this didn't concern him because "the standard oil used is olive oil, but nowadays seed oil is used a lot'...[and although]..."this definitely adds fat to the diet, but that fat is not the saturated type." For Ancel, such fried potatoes were much better to eat than a baked potato "served with a great lump of butter."

Actually, what first captured Ancel's attention in Naples wasn't the lack of CVD but the general good health, physical vigor, and the warmth, kindness and generosity of the Italians there. And may I say that in reading between the lines, I could not help thinking that it was just this aspect of those slim and vigorous pasta-eating Italians as contrasted to what he saw as the overweight, smug businessmen-Babbits of the upper Midwest--who'd come home at night to a Porterhouse steak, baked potato dripping with butter followed by a pint of ice-cream for dessert. He didn't like such people. He didn't like what they ate. It was almost as if they somehow "deserved" to have their rich foods do them in as a sort of natural justice for being such self-satisfied boors. Much the same way that Nathan Pritikin would lecture groups of doctors and tell them that if they wished to keep their health, they had better stop their all-American rich foods and start eating "like peasants."

I suspect that anything I may add now will only aggravate you. I assure you this is not my intention. As for fudging facts, there are Ancel Keys supporters and non-supporters. I became a non-supporter because I found Ravnskov's review and analysis of the whole business to be a persusive and devastating blow to the Diet-Heart Hypothesis, of which Keys' work played a big role.

I suppose others might find Ravnskov to be the fact-fudger. Opinion divides.
eulerandothers said…
I'm afraid I exaggerated when I stated that Keys saw no CVD in Naples. I've been reading 'The Mediterranean Presciption' (written by an Italian American doctor who prescribes the diet to his patients...). In the book, the author introduces the background to the diet:

'In reading about Keys' studies, I learned that his first destination, back in 1952, was the Southern Italian town of Naples. He was drawn there because of the reports he'd heard that heart disease barely existed among Neapolitans. As it turned out, area doctors confirmed that their hospitals rarely had coronary patients; the only cases were seen at private clinics for the well-to-do. The men of the working class- who couldn't afford the meats and dairy the upper classes could - had remarkably low cholesterol and almost no heart trouble.'

The ordinary food that Neapolitans had daily was described by Keys and the fries and cream mentioned in your examples - are simply not in that description. Always fresh fruit for dessert. Starches were pasta, beans, macaroni, fresh whole grain bread without any kind of spread or butter. A modest portion of meat or fish maybe twice a week.

'When Keys was asked years later to formulate a diet that might serve as a preventive against coronary heart disease, he could come up with nothing more suited for this purpose than the traditional working-class diet of early 1950s Naples.' (from 'The Mediterranean Prescription')

Now, what stands out to me here is that the private clinics WOULD be the place to find the people who could spend more money on expensive foodstuffs - eating more fatty meat, for example - and so doesn't that skew what Ancel noticed? Yes. But unless obesity was a problem, too, which would naturally become a category in itself, then he saw people who weren't particulary obese but had more CVD.

Keys had a keen appreciation of calories from his experiments. Earlier, when he had to give the results of the Starvation Study to people who were sent to rehabilitate starved people, he told them to skip the various mixtures and IVs they thought they needed to start 'refeeding' the starvation victims in famine and areas hit by war or disaster. He said, 'It's calories they need!' This was welcome news because it meant traveling without all that appartus. (The Great Starvation Experiment)

'...overweight, smug businessmen-Babbits of the upper Midwest--who'd come home at night to a Porterhouse steak, baked potato dripping with butter followed by a pint of ice-cream for dessert.'

I think you've just described 'meat and potatoes,' a theme which is not Mediterranean but is very Midwestern and American. And why not? Don't we have the space for millions of cattle? Don't huge herds provide meat and dairy in abundance? It's no accident that the Japanese, for example, eat more fish - they are surrounded by water, being an island nation. Geography explains a lot.

I know it's easy to love fun-loving emotional Southern Italians, but more than anything, the South of Italy is the poorer part of the country. I love to think that living in the rural South of Italy confers some healthful benefit because of the 'dolce far niente' (slower pace of life), but I think it's eating fewer calories, eating fresh food, and working hard that confers the benefits.
billy the k said…
Yes indeed: avoiding overeating appears to be pretty much the main deal (i.e., "CICO" as Carbsane puts it). And another reason I disagree with Keys re sat fat & cholesterol. This was brought home to me in a review by Donald J. McNamara (Nutrition and Cholesterol Metabolism. in: Nutrition and Heart Disease. 1987. CRC Press; v1:29-44). McNamara examined the evidence with respect to 9 dietary factors and their impact on 5 aspects of cholesterol metabolism (absorption, synthesis, catabolism, excretion, tissue flux). The 9 dietary factors: calories
SPE (sucrose polyester [!])
vegetable protein
ethyl alcohol
He summarized: "What dietary factor has the greatest impact on whole body cholesterol metabolism? The evidence indicates that total calories and body weight have the largest single effect on cholesterol synthesis, pool size, and biliary secretion, in addition to an increased incidence of hyperlipidemia. OBESITY AND A HYPERCALORIC INTAKE EXERT MORE INFLUENCE ON CHOLESTEROL POOL SIZE THAN ANY SINGLE, OR COMBINATION, OF DIETARY CONSTITUENTS, AND AS SUCH REPRESENT THE MAJOR DETERMINANTS OF STEROL METABOLISM IN THE MAJORITY OF INDIVIDUALS." [emphasis mine]

Ancel, I do believe, was wrong. Dietary saturated fat PER SE is not the culprit. While it's no doubt one helluva lot easier to overeat when foods are "rich" (and delicious) it is not their richness PER SE that is the culprit. It's the portion. The excess. The overall too-muchness.
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