Wednesday, July 30, 2008

Fat Boy

My family, some friends and I were at a restaurant last night. We ordered coffee after dinner. I poured a (very) generous amount of cream into my decaf. One of my friends gave me the nickname "fat boy" because I eat so much fat. The reason it's funny and not insulting is that I have a low bodyfat percentage. Paradox? I don't think so.

My family was also wide-eyed when I had three eggs for breakfast this morning, fried in butter. Sounds decadent, but it only adds up to 300 calories, or roughly 10% of my daily caloric intake.

Saturday, July 26, 2008

The Inuit: Lessons from the Arctic

The Inuit (also called Eskimo) are a group of hunter-gatherer cultures who inhabit the arctic regions of Alaska, Canada and Greenland. They are a true testament to the toughness, adaptability and ingenuity of the human species. Their unique lifestyle has a lot of information to offer us about the boundaries of the human ecological niche. Weston Price was fascinated by their excellent teeth, good nature and overall robust health. Here's an excerpt from Nutrition and Physical Degeneration:
"In his primitive state he has provided an example of physical excellence and dental perfection such as has seldom been excelled by any race in the past or present...we are also deeply concerned to know the formula of his nutrition in order that we may learn from it the secrets that will not only aid in the unfortunate modern or so-called civilized races, but will also, if possible, provide means for assisting in their preservation."
The Inuit are cold-hardy hunters whose traditional diet consists of a variety of sea mammals, fish, land mammals and birds. They invented some very sophisticated tools, including the kayak, whose basic design has remained essentially unchanged to this day. Most groups ate virtually no plant food. Their calories came primarily from fat, up to 75%, with almost no calories coming from carbohydrate. Children were breast-fed for about three years, and had solid food in their diet almost from birth. As with most hunter-gatherer groups, they were free from chronic disease while living a traditional lifestyle, even in old age. Here's a quote from Observations on the Western Eskimo and the Country they Inhabit; from Notes taken During two Years [1852-54] at Point Barrow, by Dr. John Simpson:
These people [the Inuit] are robust, muscular and active, inclining rather to spareness [leanness] than corpulence [overweight], presenting a markedly healthy appearance. The expression of the countenance is one of habitual good humor. The physical constitution of both sexes is strong. Extreme longevity is probably not unknown among them; but as they take no heed to number the years as they pass they can form no guess of their own ages.
One of the common counterpoints I hear to the idea that high-fat hunter-gatherer diets are healthy, is that exercise protects them from the ravages of fat. The Inuit can help us get to the bottom of this debate. Here's a quote from Cancer, Disease of Civilization (1960, Vilhjalmur Stefansson):
"They are large eaters, some of them, especially the women, eating all the time..." ...during the winter the Barrow women stirred around very little, did little heavy work, and yet "inclined more to be sparse than corpulent" [quotes are the anthropologist Dr. John Murdoch, reproduced by Stefansson].
Another argument I sometimes hear is that the Inuit are genetically adapted to their high-fat diet, and the same food would kill a European. This appears not to be the case. The anthropologist and arctic explorer Vilhjalmur Stefansson spent several years living with the Inuit in the early 20th century. He and his fellow Europeans and Americans thrived on the Inuit diet. American doctors were so incredulous that they defied him and a fellow explorer to live on a diet of fatty meat only for one year, under the supervision of the American Medical Association. To the doctors' dismay, they remained healthy, showing no signs of scurvy or any other deficiency (JAMA 1929;93:20–2).

Yet another amazing thing about the Inuit was their social structure. Here's Dr. John Murdoch again (quoted from Cancer, Disease of Civilization):
The women appear to stand on a footing of perfect equality with the men, both in the family and the community. The wife is the constant and trusted companion of the man in everything except the hunt, and her opinion is sought in every bargain or other important undertaking... The affection of parents for their children is extreme, and the children seem to be thoroughly worthy of it. They show hardly a trace of fretfulness or petulance so common among civilized children, and though indulged to an extreme extent are remarkably obedient. Corporal punishment appears to be absolutely unknown, and children are rarely chided or punished in any way.
Unfortunately, those days are long gone. Since adopting a modern processed-food diet, the health and social structure of the Inuit has deteriorated dramatically. This had already happened to most groups by Weston Price's time, and is virtually complete today. Here's Price:
In the various groups in the lower Kuskokwim seventy-two individuals who were living exclusively on native foods had in their 2,138 teeth only two teeth or 0.09 per cent that had ever been attacked by tooth decay. In this district eighty-one individuals were studied who had been living in part or in considerable part on modern foods, and of their 2, 254 teeth 394 or 13 per cent had been attacked by dental caries. This represents an increase in dental caries of 144 fold.... When these adult Eskimos exchange their foods for our modern foods..., they often have very extensive tooth decay and suffer severely.... Their plight often becomes tragic since there are no dentists in these districts.
Modern Inuit also suffer from very high rates of diabetes and overweight. This has been linked to changes in diet, particularly the use of white flour, sugar and processed oils.

Overall, the unique lifestyle and diet of the Inuit have a lot to teach us. First, that humans are capable of being healthy as carnivores. Second, that we are able to thrive on a high-fat diet. Third, that we are capable of living well in extremely harsh and diverse environments. Fourth, that the shift from natural foods to processed foods, rather than changes in macronutrient composition, is the true cause of the diseases of civilization.

Monday, July 21, 2008

Book Review: "The Human Diet: Its Origins and Evolution"

I recently read this book after discovering it on another health site. It's a compilation of chapters written by several researchers in the fields of comparative biology, paleontology, archaeology and zoology. It's sometimes used as a textbook.

I've learned some interesting things, but overall it was pretty disappointing. The format is disjointed, with no logical flow between chapters. I also would not call it comprehensive, which is one of the things I look for in a textbook.
Here are some of the interesting points:
  • Humans in industrial societies are the only mammals to commonly develop hypertension, and are the only free-living primates to become overweight.
  • The adoption of grains as a primary source of calories correlated with a major decrease in stature, decrease in oral health, decrease in bone density, and other problems. This is true for wheat, rice, corn and other grains.
  • Cranial capacity has also declined 11% since the late paleolithic, correlating with a decrease in the consumption of animal foods and an increase in grains.
  • According to carbon isotope ratios of teeth, corn did not play a major role in the diet of native Americans until 800 AD. Over 15% of the teeth of post-corn South American cultures showed tooth decay, compared with less than 5% for pre-corn cultures (many of which were already agricultural, just not eating corn).
  • Childhood mortality seems to be similar among hunter-gatherers and non-industrial agriculturists and pastoralists.
  • Women may have played a key role in food procurement through foraging. This is illustrated by a group of modern hunter-gatherers called the Hadza. While men most often hunt, which supplies important nutrients intermittently, women provide a steady stream of calories by foraging for tubers.
  • We have probably been eating starchy tubers for between 1.5 and 2 million years, which precedes our species. Around that time, digging tools, (controversial) evidence of controlled fire and changes in digestive anatomy all point to use of tubers and cooked food in general. Tubers make sense because they are a source of calories that is much more easily exploited than wild grains in most places.
  • Our trajectory as a species has been to consume a diet with more calories per unit fiber. As compared to chimps, who eat leaves and fruit all day and thus eat a lot of fiber to get enough calories, our species and its recent ancestors ate a diet much lower in fiber.
  • Homo sapiens has always eaten meat.
The downside is that some chapters have a distinct low-fat slant. One chapter attempted to determine the optimal diet for humans by comparing ours to the diets of wild chimps and other primates. Of course, we eat more fat than a chimp, but I don't think that gets us anywhere. Especially since one of our closest relatives, the neanderthal, was practically a carnivore.
They consider the diet composition of modern hunter-gatherers that eat low-fat diets, but don't include data on others with high-fat diets like the Inuit.

There's some good information in the book, if you're willing to dig through a lot of esoteric data on the isotope ratios of extinct hominids and that sort of thing.

Thursday, July 17, 2008

New Low-carb Study

I know you’ve all heard the news about the new low-carb study in the New England Journal of Medicine by now, but I have to chime in. I‘m going to try to offer you a different perspective of the study that you may not have found elsewhere. First of all, this is a Rolls Royce of a study. It was large, well-controlled, and two years long. It was partly funded by the Atkins foundation, but it's a peer-reviewed study in a good journal and if anything the study design is slanted against the low-carbohydrate diet.

The study compared the weights and various health parameters of 322 overweight subjects put on one of three diets: a “low-fat diet”, a Mediterranean diet and a “low-carbohydrate diet”. The first two were calorie-restricted while the low-carb diet was not. First of all, the “low-fat” diet was not particularly low in fat. It was 30% fat by calories, only a few percent short of the US average. What they call low-fat in the study is actually a calorie-restricted version of the American Heart Association diet recommendation, which suggests:

“…30% of calories from fat, 10% calories from saturated fat, and an intake of 300 mg of cholesterol per day. The Participants were counseled to consume low-fat grains, vegetables, fruits, and legumes and to limit their consumption of additional fats, sweets and high-fat snacks.”

So henceforth, I’ll refer to it as the AHA diet rather than the low-fat diet.

The “low-carb” diet wasn’t particularly low in carbohydrate either. The low-carb group was only getting 10% fewer calories from carbohydrate than the low-fat or Mediterranean diet groups. Despite these problems, the low-carbohydrate diet was the most effective overall. It caused a weight loss of 5.5 kg (12 lb), compared to 4.6 kg (10 lb) and 3.3 kg (7.4 lb) for the Mediterranean and AHA diets, respectively.

One of the most amazing aspects of the study is that the low-carb diet was the only one that wasn’t calorie-restricted, yet it caused the most weight loss. People in the low-carb group naturally reduced their calorie intake over the course of the study, ending up with an intake similar to the AHA group.

The low-carb diet also came out on top in most of the markers of health they examined. It caused the largest drop in HbA1c, a measure of average blood glucose level. It caused the largest drop in C-reactive protein, a measure of inflammation (the Mediterranean diet also did well). And finally, it caused the biggest improvement in the triglyceride:HDL ratio. This ratio is the best blood lipid predictor of heart disease risk I’m aware of in modern Western populations. The lower, the better. They didn't calculate it in the study so I had to do it myself. Here's a graph of the change in trig:HDL ratio for each group over the course of the study:

Other interesting findings: despite the calorie restriction, diabetic participants on the AHA group actually saw a significant increase in fasting blood glucose.

I've speculated before that wheat and sugar may cause hyperphagia, or excessive eating. We can see from these results that reducing carbohydrate (and probably wheat) reduces overall caloric intake quite significantly. This squares with the findings of the recent Chinese study that showed an increase in calorie intake and weight, correlating with the replacement of rice with wheat as the primary carbohydrate. It also squares with diet trends in the US, where wheat consumption has risen alongside calorie intake and weight.

I'd love to know what the results would have looked like if they had gone on a true low-carbohydrate diet, or even simply eliminated grains and sugar.

Wednesday, July 16, 2008

Sunscreen and Melanoma

Melanoma is the most deadly type of skin cancer, accounting for most skin cancer deaths in the US. As Ross pointed out in the comments section of the last post, there is an association between severe sunburn at a young age and later development of melanoma. Darker-skinned people are also more resistant to melanoma. The association isn't complete, however, since melanoma sometimes occurs on the soles of the feet and even in the intestine. This may be due to the fact that there are several types of melanoma, potentially with different causes.

Another thing that associates with melanoma is the use of sunscreen above a latitude of 40 degrees from the equator. In the Northern hemisphere, 40 degrees draws a line between New York city and Beijing. A recent
meta-analysis found consistently that sunscreen users above 40 degrees are at a higher risk of melanoma than people who don't use sunscreen, even when differences in skin color are taken into account. Wearing sunscreen decreased melanoma risk in studies closer to the equator. It sounds confusing, but it makes sense once you know a little bit more about UV rays, sunscreen and the biology of melanoma.

The UV light that reaches the Earth's surface is composed of UVA (longer) and UVB (shorter) wavelengths. UVB causes sunburn, while they both cause tanning. Sunscreen blocks UVB, preventing burns, but most brands only weakly block UVA. Sunscreen allows a person to spend more time in the sun than they would otherwise, and attenuates tanning. Tanning is a protective response (among several) by the skin that protects it against both UVA and UVB. Burning is a protective response that tells you to get out of the sun. The result of diminishing both is that sunblock tends to increase a person's exposure to UVA rays.

It turns out that UVA rays are more
closely associated with melanoma than UVB rays, and typical sunscreen fails to prevent melanoma in laboratory animals. It's also worth mentioning that sunscreen does prevent more common (and less lethal) types of skin cancer.

Modern tanning beds produce a lot of UVA and not much UVB, in an attempt to deliver the maximum tan without causing a burn. Putting on sunscreen essentially does the same thing: gives you a large dose of UVA without much UVB.

The authors of the meta-analysis suggest an explanation for the fact that the association changes at 40 degrees of latitude: populations further from the equator tend to have lighter skin. Melanin blocks UVA very effectively, and the pre-tan melanin of someone with olive skin is enough to block most of the UVA that sunscreen lets through. The fair-skinned among us don't have that luxury, so our melanocytes get bombarded by UVA, leading to melanoma. This may explain the incredible rise in melanoma incidence in the US in the last 35 years, as people have also increased the use of sunscreen. It may also have to do with tanning beds, since melanoma incidence has risen particularly in women.

In my opinion, the best way to treat your skin is to tan gradually, without burning. Use clothing and a wide-brimmed hat if you think you'll be in the sun past your burn threshold. If you want to use sunscreen, make sure it blocks UVA effectively. Don't rely on the manufacturer's word; look at the ingredients list. It should contain at least one of the following: titanium dioxide, zinc oxide, avobenzone (Parsol 1789), Mexoryl SX (Tinosorb). It's best if it's also paraben-free.

Fortunately, as an external cancer, melanoma is easy to diagnose. If caught early, it can be removed without any trouble. If caught a bit later, surgeons may have to remove lymph nodes, which makes your face look like John McCain's. Later than that and you're probably a goner. If you have any questions about a growth, especially one with irregular borders that's getting larger, ask your doctor about it immediately!

Monday, July 14, 2008

How to Cause a Cancer Epidemic

A report came out recently showing that melanoma incidence has increased dramatically in the US since 1973, particularly among women. The authors suggested the rise could be due to increasing sun exposure, which I am highly skeptical of. The data he cites to support that idea are quite weak. I think the prevalence of vitamin D deficiency in this country suggests otherwise.

Melanoma is the most deadly form of skin cancer, and the only type that is commonly life-threatening. Its link to sun exposure is tenuous at best. For example, it often occurs on the least sun-exposed parts of the body, and its incidence is lower in outdoor workers.

What is the solution to rising melanoma incidence? Sunblock! Slather it on, ladies and gentlemen! No matter that we evolved outdoors! No matter that it may do nothing for melanoma incidence or mortality! No matter that you'll be vitamin D deficient! No matter that it contains known carcinogens! 30+ SPF, the more the better. Don't let one single deadly UV photon through.

The irony of all this is that if you believe the data on vitamin D, avoiding the sun would cause many more cancers than it would prevent, even if all melanoma were due to sun exposure.

Sunday, July 13, 2008

Fish Oil and Asthma Weirdness

I read an interesting study today on fish oil and asthma. It's the result of a randomized controlled trial, the kind that can actually tell us about cause and effect.

In 1990, researchers assembled a group of 533 pregnant women and divided them into three groups. One group received 4g/day fish oil in capsules, one group got 4g/day of olive oil in capsules, and the third group got no oil. They were told to take the capsules from gestational week 30 until delivery. The 16 year-old children of women who took fish oil capsules during pregnancy had a 63% lower rate of asthma than the olive oil group, and an 87% lower rate of allergic asthma. Pretty straightforward.

Now for the weirdness. The no oil group actually did better than the other two groups, with a 71% lower asthma rate than the olive oil group, and no cases of allergic asthma whatsoever! The result was not statistically different from the fish oil group however. So we have just gone from a result that suggests fish oil is protective, to one that suggests fish oil is neutral and olive oil is detrimental!

The result is really hard to believe, especially since Mediterranean countries with high olive oil intakes don't have elevated rates of asthma. It was also hard for the authors to believe, so they invoked a concept called "contamination bias". In this case, what that means is that the no oil group may have been eating more fish than the olive oil group.

could have happened because they had been informed of the study's hypothesis (this was required by the Danish Scientific Ethical Committee System). They knew they weren't getting fish oil, they knew there was preliminary evidence that fish oil protects against preterm birth and heart disease (in the Inuit, incidentally), so the authors speculate that they went out and started eating fish. This didn't happen in the olive oil group because according to a questionnaire, half of them thought they were getting fish oil already!

I will say, in favor of this hypothesis, that the no oil group looks remarkably like the fish oil group in terms of the rate and age of onset of asthma.
I think the result needs to be replicated before we can really say what happened. It's unfortunate, because it was a large, well-designed study. In the meantime, keep on eating fish.

Thanks to snowriderguy for the CC photo

Thursday, July 10, 2008

Grains and Human Evolution

You've heard me say that I believe grains aren't an ideal food for humans. Part of the reason rests on the assertion that we have not been eating grains for long enough to have adapted to them. In this post, I'll go over what I know about the human diet before and after agriculture, and the timeline of our shift to a grain-based diet. I'm not an archaeologist so I won't claim that all these numbers are exact, but I think they are close enough to make my point.

As hunter-gatherers, we ate some combination of the following: land mammals (including organs, fat and marrow), cooked tubers, seafood (fish, mammals, shellfish, seaweed), eggs, nuts, fruit, honey, "vegetables" (stems, leaves, etc.), mushrooms, assorted land animals, birds and insects. The proportion of each food varied widely between groups and even seasons. This is pretty much what we've been living on since we evolved as a species, and even before, for a total of 1.5 million years or so (this number is controversial but is supported by multiple lines of evidence). There are minor exceptions, including the use of wild grains in a few areas, but for the most part, that's it.

The first evidence of a calorically important domesticated crop I'm aware of was about 11,500 years ago in the fertile crescent. They were cultivating an early ancestor of wheat called emmer. Other grains popped up independently in what is now China (rice; ~10,000 years ago), and central America (corn; ~9,000 years ago). That's why people say humans have been eating grains for about 10,000 years.

The story is more complicated than the dates suggest, however. Although wheat had its origin 11,500 years ago, it didn't become widespread in Western Europe for another 4,500 years. So if you're of European descent, your ancestors have been eating grains for roughly 7,000 years. Corn was domesticated 9,000 years ago, but according to the carbon ratios of human teeth, it didn't become a major source of calories until about 1,200 years ago! Many American groups did not adopt a grain-based diet until 100-300 years ago, and in a few cases they still have not. If you are of African descent, your ancestors have been eating grains for 9,000 to 0 years, depending on your heritage. The change to grains was accompanied by a marked decrease in dental health that shows up clearly in the archaeological record.

Practically every plant food contains some kind of toxin, but grains produce a number of nasty ones that humans are not well adapted to. Grains contain a large amount of phytic acid for example, which strongly inhibits the absorption of a number of important minerals. Tubers, which were our main carbohydrate source for about 1.5 million years before agriculture, contain less of it. This may have been a major reason why stature decreased when humans adopted grain-based agriculture. There are a number of toxins that occur in grains but not in tubers, such as certain heat-resistant lectins.

Non-industrial cultures often treated their seeds, including grains, differently than we do today. They used soaking, sprouting and long fermentation to decrease the amount of toxins found in grains, making them more nutritious and digestible. Most grain staples are not treated in this way today, and so we bear the brunt of their toxins even more than our ancestors did.

From an evolutionary standpoint, even 11,500 years is the blink of an eye. Add to that the fact that many people descend from groups that have been eating grains for far less time than that, and you begin to see the problem. There is no doubt that we have begun adapting genetically to grains. All you have to do to understand this is look back at the archaeological record, to see the severe selective pressure (read: disease) that grains placed on its early adopters. But the question is, have we had time to adapt sufficiently to make it a healthy food? I would argue the answer is no.

There are a few genetic adaptations I'm aware of that might pertain to grains: the duplication of the salivary amylase gene, and polymorphisms in the angiotensin-converting enzyme (ACE) and apolipoprotein B genes. Some groups duplicated a gene that secretes the enzyme amylase into the saliva, increasing its production. Amylase breaks down starch, indicating a possible increase in its consumption. The problem is that we were getting starch from tubers before we got it from grains, so it doesn't really argue for either side in my opinion. The ACE and apolipoprotein B genes may be more pertinent, because they relate to blood pressure and LDL cholesterol. Blood pressure and blood cholesterol are both factors that respond well to low-carbohydrate (and thus low-grain) diets, suggesting that the polymorphisms may be a protective adaptation against the cardiovascular effects of grains.

The fact that up to 1% of people of European descent may have full-blown celiac disease attests to the fact that 7,000 years have not been enough time to fully adapt to wheat on a population level. Add to that the fact that nearly half of genetic Europeans carry genes that are associated with celiac, and you can see that we haven't been weeded out thoroughly enough to tolerate wheat, the oldest grain!

Based on my reading, discussions and observations, I believe that rice is the least problematic grain, wheat is the worst, and everything else is somewhere in between. If you want to eat grains, it's best to soak, sprout or ferment them. This activates enzymes that break down most of the toxins. You can soak rice, barley and other grains overnight before cooking them. Sourdough bread is better than normal white bread. Unfermented, unsprouted whole wheat bread may actually be the worst of all.

Wednesday, July 9, 2008

Another China Tidbit

A final note about the Chinese study in the previous post: the overweight vegetable-eaters (read: wheat eaters) exercised more than their non-vegetable-eating, thin neighbors. So although their average calorie intake was a bit higher, their expenditure was as well. So much for 'calories in, calories out'...

Although I speculated in the last post that affluent people might be eating more wheat and fresh vegetables, the data don't support that. Participants with the highest income level actually adhered to the wheat and vegetable-rich pattern the least, while low-income participants were most likely to eat this way.

Interestingly, education showed a (weaker) trend in the opposite direction. More educated participants were more likely to eat the wheat-vegetable pattern, while the opposite was true of less educated participants. Thus, it looks like wheat makes people more educated. Just kidding, that's exactly the logic we have to avoid when interpreting this type of study!

Tuesday, July 8, 2008

Wheat in China

Dr. Michael Eades linked to an interesting study yesterday on his Health and Nutrition blog. It's entitled "Vegetable-Rich Food Pattern is Related to Obesity in China."

It's one of these epidemiological studies where they try to divide subjects into different categories of eating patterns and see how health problems associate with each one. They identified four patterns: the 'macho' diet high in meat and alcohol; the 'traditional' diet high in rice and vegetables; the 'sweet tooth' pattern high in cake, dairy and various drinks; and the 'vegetable rich' diet high in wheat, vegetables, fruit and tofu. The only pattern that associated with obesity was the vegetable-rich diet. The 25% of people eating closest to the vegetable-rich pattern were more than twice as likely to be obese as the 25% adhering the least.

The authors of the paper try to blame the increased obesity on a higher intake of vegetable oil from stir-frying the vegetables, but that explanation is juvenile and misleading. A cursory glance at table 3 reveals that the vegetable-eaters weren't eating any more fat than their thinner neighbors. Dr. Eades suggests that their higher carbohydrate intake (+10%) and higher calorie intake (+120 kcal/day) are responsible for the weight gain, but I wasn't satisfied with that explanation so I took a closer look.

One of the most striking elements of the 'vegetable-rich' food pattern is its replacement of rice with wheat flour. The 25% of the study population that adhered the least to the vegetable-rich food pattern ate 7.3 times more rice than wheat, whereas the 25% sticking most closely to the vegetable-rich pattern ate 1.2 times more wheat than rice! In other words, wheat flour had replaced rice as their single largest source of calories. This association was much stronger than the increase in vegetable consumption itself!

All of a sudden, the data make perfect sense. Wheat seems to destroy the metabolism of cultures wherever it goes. I think the reason we don't see the same type of association in American epidemiological studies is that everyone eats wheat. Only in a culture that has a true diversity of diet can you find a robust association like this. The replacement of rice with wheat may have caused the increase in calorie intake as well, subsequent to metabolic dysfunction. Clinical trials of low-carbohydrate diets as well as 'paleolithic diets' have shown good metabolic outcomes from wheat avoidance, although one can't be sure that wheat is the only culprit from those data.

I don't think the vegetables had anything to do with the weight gain, they were just incidentally associated with wheat consumption. But I do think these data argue against the commonly-held idea that vegetables protect against overweight.

Monday, July 7, 2008

Cancer in Other Non-Industrialized Cultures

In Cancer, Disease of Civilization (1960), Wilhjalmur Stefansson mentions a few cultures besides the Inuit in which large-scale searches never turned up cancer. Dr. Albert Schweitzer examined over 10,000 traditionally-living natives in Gabon (West Africa) in 1913 and did not find cancer. Later, it became common in the same population as they began "living more and more after the manner of the whites."

In Cancer, its Nature, Cause and Cure (1957), Dr. Alexander Berglas describes the search for cancer among natives in Brazil and Ecuador by Dr. Eugene Payne. He examined approximately 60,000 people over 25 years and found no evidence of cancer.

Sir Robert McCarrison conducted a seven year medical survey among the Hunza, in what is now Northern Pakistan. Among 11,000 people, he did not find a single case of cancer. Their diet consisted of soaked and sprouted grains and beans, fruit, vegetables, grass-fed dairy and a small amount of meat (including organs of course).

I no longer think of cancer as an inevitable risk of getting old, but as another facet of the disease of civilization.

Saturday, July 5, 2008

Mortality and Lifespan of the Inuit

One of the classic counter-arguments that's used to discredit accounts of healthy hunter-gatherers is the fallacy that they were short-lived, and thus did not have time to develop diseases of old age like cancer. While the life expectancy of hunter-gatherers was not as high as ours today, most groups had a significant number of elderly individuals, who sometimes lived to 80 years and beyond. Mortality came mostly from accidents, warfare and infectious disease rather than chronic disease.

I found a a mortality table from the records of a Russian mission in Alaska (compiled by Veniaminov, taken from Cancer, Disease of Civilization), which recorded the ages of death of a traditionally-living Inuit population during the years 1822 to 1836. Here's a plot of the raw data:

Here's the data re-plotted in another way. I changed the "bin size" of the bars to 10 year spans each (rather than the bins above, which vary from 3 to 20 years). This allows us to get a better picture of the number of deaths over time. I took some liberties with the data to do this, breaking up a large bin equally into two smaller bins. I also left out the infant mortality data, which are interesting but not relevant to this post:

Excluding infant mortality, about 25% of their population lived past 60. Based on these data, the approximate life expectancy (excluding infant mortality) of this Inuit population was 43.5 years. It's possible that life expectancy would have been higher before contact with the Russians, since they introduced a number of nasty diseases to which the Inuit were not resistant. Keep in mind that the Westerners who were developing cancer alongside them probably had a similar life expectancy at the time. Here's the data plotted in yet another way, showing the number of individuals surviving at each age, out of the total deaths recorded:

It's remarkably linear. Here's the percent chance of death at each age:

In the next post, I'll briefly summarize cancer data from several traditionally-living cultures other than the Inuit.

Friday, July 4, 2008

Cancer Among the Inuit

I remember coming across a table in the book Eat, Drink and Be Healthy (by Dr. Walter Willett-- you can skip it) a few years back. Included were data taken from Dr. Ancel Keys' "Seven Countries Study". It showed the cancer rates for three industrialized nations: the US, Greece and Japan. Although specific cancers differed, the overall rate was remarkably similar for all three: about 90 cancers per 100,000 people per year. Life expectancy was also similar, with Greece leading the pack by 4 years (the data are from the 60s).

The conclusion I drew at the time was that lifestyle did not affect the likelihood of developing cancer. It was easy to see from the same table that heart disease was largely preventable, since the US had a rate of 189 per 100,000 per year, compared to Japan's 34. Especially since I also knew that Japanese-Americans who eat an American diet get heart disease just like European-Americans.

I fell prey to the same logic that is so pervasive today: the idea that you will eventually die of cancer if no other disease gets you first. It's easy to believe, since the epidemiology seems to tell us that lifestyle doesn't affect overall cancer rates very much. There's only one little glitch... those epidemiological studies compare the sick to the sicker.

Here's the critical fact that modern medicine seems to have forgotten: hunter-gatherers and numerous non-industrial populations throughout the world have vanishingly small cancer rates. This fact was widely accepted in the 19th century and the early 20th, but has somehow managed to fade into obscurity. I know it sounds unbelievable, but allow me to explain.

I recently read Cancer, Disease of Civilization by Vilhjalmur Stefansson (thanks Peter). It really opened my eyes. Stefansson was an anthropologist and arctic explorer who participated in the search for cancer among the Canadian and Alaskan Inuit. Traditionally, most Inuit groups were strictly carnivorous, eating a diet of raw and cooked meat and fish almost exclusively. Their calories came primarily from fat, roughly 80%. They alternated between seasons of low and high physical activity, and typically enjoyed an abundant food supply.

Field physicians in the arctic noted that the Inuit were a remarkably healthy people. While they suffered from a tragic susceptibility to European communicable diseases, they did not develop the chronic diseases we now view as part of being human: tooth decay, overweight, heart attacks, appendicitis, constipation, diabetes and cancer. When word reached American and European physicians that the Inuit did not develop cancer, a number of them decided to mount an active search for it. This search began in the 1850s and tapered off in the 1920s, as traditionally-living Inuit became difficult to find.

One of these physicians was captain George B. Leavitt. He actively searched for cancer among the traditionally-living Inuit from 1885 to 1907. Along with his staff, he performed 50,000 examinations a year for the first 15 years, and 25,000 a year thereafter. He did not find a single case of cancer. At the same time, he was regularly diagnosing cancers among the crews of whaling ships and other Westernized populations. It's important to note two relevant facts about Inuit culture: first, their habit of going shirtless indoors. This would make visual inspection for external cancers very easy. Second, the Inuit generally had great faith in Western doctors and would consult them even for minor problems. Therefore, doctors in the arctic had ample opportunity to inspect them for cancer.

A study was published in 1934 by F.S. Fellows in the U.S Treasury's Public Health Reports entitled "Mortality in the Native Races of the Territory of Alaska, With Special Reference to Tuberculosis". It contained a table of cancer mortality deaths for several Alaskan regions, all of them Westernized to some degree. However, some were more Westernized than others. In descending order of Westernization, the percent of deaths from cancer were as follows:

Keep in mind that all four of the Inuit populations in this table were somewhat Westernized. It's clear that cancer incidence tracks well with Westernization. By "Westernization", what I mean mostly is the adoption of European food habits, including wheat flour, sugar, canned goods and vegetable oil. Later, most groups also adopted Western-style houses, which incidentally were not at all suited to their harsh climate.

In the next post, I'll address the classic counter-argument that hunter-gatherers were free of cancer because they didn't live long enough to develop it.

Thursday, July 3, 2008

Cancer and the Immune System

My understanding of cancer has changed radically over the past few months. I used to think of it as an inevitable consequence of aging, a stochastic certainty. The human body is made of about 50 trillion cells, many of which replicate their DNA and divide regularly. It's only a matter of time until one of those cells randomly accumulates the wrong set of mutations, and loses the molecular brakes that restrict uncontrolled growth.

Strictly speaking, the idea is correct. That is how cancer begins. However, there's another check in place that operates outside the cancer cell itself: the immune system. A properly functioning immune system can recognize and destroy cancerous cells before they become dangerous to the organism. In fact, your immune system has probably already controlled or destroyed a number of them in your lifetime.

I recently read a fascinating account of some preliminary findings from the lab of Dr. Zheng Cui at Wake Forest university. His group took blood samples from 100 people and purified a type of immune cell called the granulocyte. They then evaluated the granulocytes' ability to kill cervical cancer cells in a cell culture dish. They found that it varied dramatically from one individual to another. One person's granulocytes killed 97% of the cancer cells in 24 hours, while another person's killed 2%.

They found some important trends. Granulocytes from people over 50 years old had a reduced ability to kill cancer cells, as did granulocytes from people with cancer. This raises the possibility that cancer is not simply the result of getting too old, but a very specific weakening of the immune system.

The most important finding, however, was that the granulocytes' kung-fu grip declined dramatically during the winter months. Here's Dr. Cui:
Nobody seems to have any cancer-killing ability during the
winter months from November to April.

Hmm, I wonder why that could be?? Vitamin D anyone??

In the next post, I'll talk about cancer in non-industrialized cultures.