New Ancestral Diet Review Paper

Pedro Carrera-Bastos and his colleagues Maelan Fontes-Villalba, James H. O'Keefe, Staffan Lindeberg and Loren Cordain have published an excellent new review article titled "The Western Diet and Lifestyle and Diseases of Civilization" (1). The paper reviews the health consequences of transitioning from a traditional to a modern Western diet and lifestyle. Pedro is a knowledgeable and tireless advocate of ancestral, primarily paleolithic-style nutrition, and it has been my privilege to correspond with him regularly. His new paper is the best review of the underlying causes of the "diseases of civilization" that I've encountered. Here's the abstract:

It is increasingly recognized that certain fundamental changes in diet and lifestyle that occurred after the Neolithic Revolution, and especially after the Industrial Revolution and the Modern Age, are too recent, on an evolutionary time scale, for the human genome to have completely adapted. This mismatch between our ancient physiology and the western diet and lifestyle underlies many so-called diseases of civilization, including coronary heart disease, obesity, hypertension, type 2 diabetes, epithelial cell cancers, autoimmune disease, and osteoporosis, which are rare or virtually absent in hunter–gatherers and other non-westernized populations. It is therefore proposed that the adoption of diet and lifestyle that mimic the beneficial characteristics of the preagricultural environment is an effective strategy to reduce the risk of chronic degenerative diseases.

At 343 references, the paper is an excellent resource for anyone with an academic interest in ancestral health, and in that sense it reminds me of Staffan Lindeberg's book Food and Western Disease. One of the things I like most about the paper is that it acknowledges the significant genetic adaptation to agriculture and pastoralism that has occurred in populations that have been practicing it for thousands of years. It hypothesizes that the main detrimental change was not the adoption of agriculture, but the more recent industrialization of the food system. I agree.

I gave Pedro my comments on the manuscript as he was editing it, and he was kind enough to include me in the acknowledgments.

In Search of Traditional Asian Diets

It's been difficult for me to find good information on Asian diets prior to modernization. Traditional Chinese, Taiwanese and Japanese diets are sometimes portrayed as consisting mostly of white rice, with vegetables and a bit of meat and soy, but I find that implausible. Rice doesn't grow everywhere, in part because it requires a tremendous amount of water. Removing all the bran was prohibitively labor-intensive before the introduction of modern machine milling. One hundred years ago, bran was partially removed by beating or grinding in a mortar and pestle, as it still is in parts of rural Asia today. Only the wealthy could afford true white rice.

Given the difficulty of growing rice in most places, and hand milling it, the modern widespread consumption of white rice in Asia must be a 20th century phenomenon, originating in the last 20-100 years depending on location. Therefore, white rice consumption does not predate the emergence of the "diseases of civilization" in Asia.

In the book Western Diseases: Their Emergence and Prevention, there are several accounts of traditional Asian diets I find interesting.

Taiwan in 1980

The staple constituent of the diet is polished white rice. Formerly in the poorer areas along the sea coast the staple diet was sweet potato, with small amounts of white rice added. Formerly in the mountains sweet potato, millet and taro were the staple foods. During the last 15 years, with the general economic development of the whole island, white polished rice has largely replaced other foods. There is almost universal disinclination to eat brown (unpolished) rice, because white rice is more palatable, it bears kudos, cooking is easier and quicker, and it can be stored for a much longer period.

Traditionally, coronary heart disease and high blood pressure were rare, but the prevalence is now increasing rapidly. Stroke is common. Diabetes was rare but is increasing gradually.

Mainland China

China is a diverse country, and the food culture varies by region.

Snapper (1965)… quoted an analysis by Guy and Yeh of Peiping (Peking) diets in 1938. There was a whole cereal/legume/vegetable diet for poorer people and a milled-cereal/meat/vegetable diet for the richer people.

Symptoms of vitamin A, C and D deficiency were common in the poor, although coronary heart disease and high blood pressure were rare. Diabetes occurred at a higher rate than in most traditionally-living populations.

Japan

On the Japanese island of Okinawa, the traditional staple is the sweet potato, with a smaller amount of rice eaten as well. Seafood, vegetables, pork and soy are also on the menu. In Akira Kurosawa’s movie Seven Samurai, set in 16th century mainland Japan, peasants ate home-processed millet and barley, while the wealthy ate white rice. Although a movie may not be the best source of information, I assume it has some basis in fact.

White Rice: a Traditional Asian Staple?

It depends on your perspective. How far back do you have to go before you can call a food traditional? Many peoples' grandparents ate white rice, but I doubt their great great grandparents ate it frequently. White rice may have been a staple for the wealthy for hundreds of years in some places. But for most of Asia, in the last few thousand years, it was probably a rare treat. The diet most likely resembled that of many non-industrial Africans: an assortment of traditionally prepared grains, root vegetables, legumes, vegetables and a little meat.

Please add any additional information you may have about traditional Asian diets to the comments section.

Acne: Disease of Civilization

I often focus on the bigger facets of the disease of civilization. Things like cardiovascular disease and cancer, which are major killers and the subject of intensive research. But the disease of civilization is a spectrum of disorders that affects the body in countless ways, large and small.

I recently read an interesting paper written by an all-star cast, including Loren Cordain, Staffan Lindeberg and Boyd Eaton. It's titled "Acne Vulgaris: A Disease of Western Civilization". The paper presents data from two different groups, the Kitavans of Papua New Guinea and the Ache hunter-gatherers of Paraguay. Both were systematically examined by doctors trained to diagnose acne. Out of 1,200 Kitavans and 115 Ache of all ages, not a single case of acne was observed. Hunter-gatherers and other healthy non-industrial cultures have nice skin. I dare you to find a pimple in Nutrition and Physical Degeneration.

In Western societies, acne is a fact of life. The paper states that 79 to 95% of modern adolescents suffer from some degree of acne, along with about 50% of young adults. That's an enormous difference.

The paper presents a very Cordain-esque hypothesis to explain the high incidence of acne in Western societies. In sum, they state that the Western diet causes hyperinsulinemia, which is thought to promote acne. This is due to insulin's effects on skin cell proliferation, its interference with the retinoid (vitamin A) signaling pathway, and its effect on sebum production.

They then proceed to point the finger at the glycemic index/load of the Western diet as the culprit behind hyperinsulinemia. It's an unsatisfying explanation because the Kitavans eat a diet that has a high glycemic load due to its high carbohydrate content, low fat content, and relatively high-glycemic index foods. I think the answer is more likely to reside in the specific types of carbohydrate (processed wheat) rather than their speed of digestion, with possible contributions from refined vegetable oil and an excessive sugar intake.