Appendix : Atkins and Paleo

I quite like having this section as the appendix, as I had my own removed as a result, I suspect, of eating too much animal protein. Anyway, I wanted to talk about about the Atkins/Paleo/High protein/Low carb diet, not least because I subscribed to it myself for a while. There's a lot about it that's very attractive. I thought I was so clever, eating tasty food and cocking a snook at the establishment. I knew something they didn't! Unfortunately, what I knew was a) what I wanted to hear and b) garbage.

I don't want to be too glib about it and in the interests of being fair, I may be over-simplifying the Atkins message. One the other hand, I'm sure that the explanations given were designed to sound simple, to be interpreted in a very simplistic way. The basic rationale that I inferred from the books I read went something like this.

Fat isn't the enemy. Sugar is the enemy. Sugar is the modern day curse - here's a graph showing sugar consumption vs chronic disease since 1900 ZOMG IT'S A LINE. Furthermore, when you eat starch (potatoes, pasta, bread etc.), do you know what happens to that starch in your digestive system? It's converted to sugar. THAT MAKES IT THE SAME. And what's diabetes? Too much sugar in the bloodstream! QED. Don't eat sugar, don't eat carbs, fat is fine and protein is even better.

Superficially, there's some truth in those points. Let's break them down one by one. Increase in sugar consumption does indeed correlate with the increase in chronic disease over the last 100 years. However, so do increases in fat consumption, animal protein consumption, meat consumption, dairy consumption and so on [1]. You could almost say consumption of everything (except fruit and vegetables). For most of this time, high sugar foods were also high fat foods [2]. Fast food, cookies, chocolate, ice cream and the rest. High sugar but also high in saturated fat. Correlation is not (necessarily) causation, when many other substances that have also seen increased consumption in this time.

Starch is indeed converted to sugar during digestion. But that's the key word, digestion. If you swallow a spoonful of sugar, or drink a Coca-Cola, that sugar goes into your bloodstream very quickly. This causes an insulin surge as the body tries to deal with this influx of sugar, with associated strain on the liver and potential for exacerbating diabetes or pre-diabetes, more of which below. When you eat a potato, however, it takes time to digest that starch, to disassociate it from the fibre. The sugar is released gradually into the bloodstream, and there's no surge that's difficult for the body to handle. Similarly with fruit, it contains sugar, but it's bound up with fibre that takes time to digest and there is a more controlled release of sugar into the bloodstream.

That sugar needs to be transferred to the muscles where it is converted to energy. Insulin plays a key role in this transfer process. When this process isn't working properly, sugar can't be transferred into the muscle cells, the body tries to produces more insulin to lower the blood sugar levels, but it doesn't work - basically this is Type 2 Diabetes. When you have Type 2 Diabetes, you have to be very careful about eating sugar because your body can't send it where it needs to go.

However, we now know that high sugar levels don't CAUSE Type 2 Diabetes. The problem is caused when fat is absorbed into the muscle cells. This interferes with the process of extracting the sugar from the blood (it starts to get complicated here) but the upshot is that excess FAT consumption causes the problem. Once the problem is there, you can manage it by not eating sugar, but excess sugar accumulating in the bloodstream makes the symptoms much worse. It is complicated and I hope I have made that point without over-simplifying too much, but the thrust is that too much saturated fat essentially causes initiation of Type 2 Diabetes, not sugar. See Dr Barnard's presentation, which also convincingly argues that reduction of fat intake can reverse the disease.

So the main points of the Atkins argument, as I interpreted them anyway, were based on over-simplifications and half-truths. However, most people would find that Atkins brought short-term results. After all, cutting out sugary processed foods is definitely a plus. In addition, when starved of carbohydrates, the body burns its own carbohydrate stores, which are bound up with water. When the stored carbs are burned off and the water is passed, there's an associated initial weight loss. Weight loss though, while it's a very good bio-marker, it still only a marker. Studies cited by Atkins diet proponents were able to show short-term weight loss but could give no information on medium or long term effects on health. Indeed, many had to admit that there were short-term adverse health effects, constipation being common.

In fact, the diet isn't sustainable in the long or even medium term. Diets based on calorie restriction (see below) never are. Carbohydrates are your body's most natural energy source. Provided you're not going full Man Versus Food, your body can burn off excess carbs as body heat or simple nervous twitching, like that restless leg thing people do when they're sitting down (as anyone ever seated next to me at a poker table can confirm). Fat is stored most efficiently as, guess what, fat. Converting that fat to energy is something that your body can do, but it's an inefficient process. Keto diets are supposed to work this way, sending the body into ketosis by depriving it of all carbohydrates and forcing fat to be converted to energy. This is an emergency mechanism for the body, not a normal mode of operation, and as I said fat -> energy is an inefficient process. It's far more efficient to simply eat carbs for energy and cut down on fat because we don't need the fat store any more.

When you're consuming calorie dense food like meat and dairy, it's very easy to overeat. A full stomach three times a day equates to far more calories than you need. So you have to calorie restrict, and physiologically you often feel hungry for the simple reason that your stomach isn't full. On top of that, your body is craving carbs for an efficient energy source. So, inevitably, most people give in and eat some chips or bread. When my attempts at the diet didn't work, I blamed it on the carbs I ate in those "moments of weakness", which were in fact my body demanding what it needed.

That's the long way round but I did want to cover it. Paleo is really just Atkins rebranded, based on an idealistic and naive idea of what our ancestors actually ate. Now we're better at analysing small particles of food remains from archaeological sites, we've found that our ancestors used to eat more grains and starches and less meat than we previously thought. Even though we didn't have agriculture, we still ate the grains and root vegetables that we could find. Meat was more of an occasional luxury, and as I mentioned in the section on evolution, something we devoured for its high caloric density and saturated fat content. We weren't eating 180 pounds of meat a year though [3]

In the end, the Atkins diet was a failure of reductionist thinking, and also to some degree a way of extracting money from people. Dr.Atkins himself died in an accident, but the coroner's report noted that he had a history of heart attacks, congestive heart failure and high blood pressure. He was 6 feet tall (the same height as me) and weighed 258 pounds (91 pounds more than I do). It was (and still is) also remarkable how many expensive supplements you were supposed to take with this "great diet". Fat good carbs bad was far too simple, and also wrong :) but if I said carbs good fat bad that would be an oversimplification too. It was telling people good news about their bad habits, and that's always a big seller.

[1] As specific examples, US per capita chicken consumption has increased 6x since 1909, and cheese consumption 8x.

[2] Recently, processed food has reached the point where the two are often separated. As a good rule of thumb, anything marked "Low Fat" is loaded with sugar, and anything marked "Low Sugar" is loaded with fat.

[3] Average US adult consumption, and bear in mind that's average, many people are well north of that.

Further Watching :

Milton Mills : What's Wrong With The Paleo Diet?

A New Nutritional Approach to Type 2 Diabetes – Dr Neal Barnard

The Starch Solution – John McDougall MD

Low Carb Keto Diet – Debunking 7 Misleading Statements