A few years ago the author of these pages was sitting in a Chinese tea shop in Malaysia sipping fermented pu’er and discussing the woes of the world with a bright young Russian man. It was the Russian’s view that the single greatest problem civilization faces is not ‘climate change’ or rising sea levels or rogue meteorites or even pandemics from wetmarkets in China, or any of those fashionable doomsday scenarios, but rather a silent, pervasive disease that is already in epidemic proportions but is hardly acknowledged let alone addressed. He had a vested interest in this, and was in Malaysia on related business.
He ran a company, he explained, that fitted prosthetic limbs to amputees, and then explained that Malaysia was one place where business was booming. There were two reasons for this. Firstly, Malaysians, like South East Asians in general, are completely reckless on their motorcycles, and every year the number of road fatalities and maimings is rising expedentially. Malaysian motorcyclists lose arms and legs at an alarming rate.
But the second reason is far more dramatic. Diabetes. Type Two. The incidence of the disease, especially among ethnic Malays, was, he said, rapidly approaching catastrophic levels. That was the word he used – “catastrophic”. He expected the number of amputations from diabetes to double in Malaysia every few years. The disease was spiraling out of control and there was, he noted, almost no coherent official response to the problem at all. He had all the statistics at hand; frightening, but in terms of his business model, fantastically lucrative.
But diabetes, he further explained, is just the half of it. The true disease is much broader and diabetes is only one instance of it. He was an expert on all this. It was his business to be fully apprised about all this. The ailment, he explained, is usually called ‘metabolic syndrome’ and has wide manifestations with obesity, diabetes, heart disease, inflammatory diseases and cognitive diseases such as Alzheimer’s all part of the same spectrum. It is rampant. Over half of Americans are somewhere on that spectrum with chronic metabolic disorders. The human and economic costs, both currently and projected, are truly astronomical. All modern societies are prone to it, newly modernized societies like Malaysia included, or even especially. It is THE disease, said the Russian, of industrialized modernity.
Although,
not always so. He knew the history. It is a new plague, in fact, he said. It really
only started reaching plague proportions after the Second World War. Incidence
of obesity, diabetes, heart disease and cognitive decline were relatively
uncommon prior to that. It was the same in Russia, he said. People died younger
in the old days, certainly, but of different things and for different reasons. He cited the long medical records kept by many prisons in the USA. In the 1890s only 2% of the prison population in Texas was clinically obese. In 1990 it was 36%.
By his definition ‘metabolic syndrome’ was a chronic disruption of the metabolic system and especially the hormones that run the whole thing. It’s a problem with the body's fuel system. Metabolism is all about how the body uses fuel. In diabetes, he explained, the body can no longer supply fuel to the extremities, the hands and feet, fingers and toes. The only option, in the end, is to chop them off before they go gangrenous. Before that, a broken fuel system is going to have dire consequences throughout the body, heart and brain included.
Evidence of metabolic dysfunction – such as irregular insulin levels – can often be seen in young adults or even teenagers or children. It is the beginning of a life long malady that has diabolical consequences.
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The rise of ‘metabolic syndrome’ is perfectly evident in the changing physique of people over the last century. It is striking in old photographs, is it not, how lean and slim everybody appears? Consider the abundant depictions of all manner of people in extant Edwardian photography, for example. For sure, there are older folk who are plump and jolly, but on the whole people appear to carry little weight.
More than that, though, if we look closely, their bodies are quite a different shape. Flesh and fat and musculature has an entirely different distribution over the body which makes us see the skelketal structures of the body quite differently. They almost look like different creatures. This is part of the nostalgic aura of photographs from that period, a hundred years ago. They were not only different times with different fashions; it is almost like they were populated by a different type of human being.
This is markedly true – and can be measured - in photographs of places like Japan in its early modernity, because the people populating those photographs are notably shorter than in contemporary Japanese society. People have grown taller - on average over six inches (over eight inches in Korea.) The rapid shift from the feudal to the industrial mode dramatically changed the physical structure of people. The whole morphology, the distribution of flesh and fat and muscle has changed. It is not just a matter of weight and height. It is a matter of shape. This is markedly so in Europeans and Americans. There have been dramatic changes in actual morphology.
Even slim people today tend to be slim in a different way and have a different physique to the slim people of the past. Even among the lean and healthy today you simply do not encounter the Edwardian physique. This is not just a matter of different cuts and lines in garments either. We can see it very plainly in the abundant nude photography of the period as much as in the clothed.
Most often these changes are attributed to changes in diet. Some people want to draw attention to other factors, but the evidence points to diet being the key. The physiology and morphology of people changed post-War due to changes in diet, in the main. While malnutrition, starvation and famine became less common, the rise of metabolic disorders at the same time - industrial diseases - would seem to have the same roots.
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The exact cause of metabolic syndrome however, is a matter of vexed debate. Indeed, in many forms it is one of the great debates of our time. The scope of the problem is poorly understood, and its causes and cures are a matter of contention, beyond a consensus that diet is the key. In part, it is surely a matter of quantity. People eat more. They are not subject to the pre-modern plight of having an unreliable food supply. Thus they grow taller and fuller. And if they eat in excess, they grow fat. Simple. The problem is abundance. This is the calorie theory of modern nutrition. Industrial agriculture and mass production has been too successful. There is something to be said for this as an outlook. Prosperity is a curse, or at least it is bittersweet. There’s always a worm in paradise. You conquer famine, but you create an epidemic of diabetes.
However, the ingredients, proportions and combinations of foods in the post-War diet have changed markedly as well. The noble but quantity-driven quest to feed the starving masses and eliminate famines inadvertently filled the modern diet with processed industrial foods and denatured pseudo-foods rather than fresh and unprocessed ones. This is where many want to lay most of the blame. But even then, where precisely? Vitamin depletion? Salt? Preservatives? Pesticides? Genetic modification? What part of the industrial process is the problem?
These
sorts of questions grow in urgency as the scourge of ‘metabolic syndrome’
advances. The approach to it, alas, is piecemeal and chaotic. For a start, we
tend to treat obesity, diabetes, heart disease and all the rest as separate
diseases rather than as a spectrum. Metabolic syndrome is a slow-moving train
wreck. And part of the problem, surely, is the appallingly inadequate state of
the science of human nutrition. As someone complained, “They can put a man on
the moon, but they can’t tell me if coconut oil is a superfood or a heart
poison.” That, actually, is the case. One study says butter is good; another says it will kill you. The nutritional sciences are in a quite shameful state of profound confusion.
Consequently, there is a growing crisis of confidence in the established nutritional models and, even further, many of the most basic assumptions of those models. Indeed, the crisis in confidence provoked by this epidemic is well-nigh civilizational in scale. Hence the Russian’s calculation of “catastrophic”. This epidemic has set people to question the very foundations of civilization itself, notably agriculture and the domestication of grains. It is no small crisis. It extends to the heart of things. It provides the context for many significant and especially corrosive and disruptive trends in the contemporary world. It is an agent of revolution and disruption on a fundamental scale.
It is certainly true that the so-called SAD diet (Standard American Diet), with guidelines and parameters set by an establishment of scientific experts (such as the American FDA), coincides chronologically with the explosion of these metabolic disorders. There is no escaping the fact that the post-War dietary models have correlated exactly with an epidemic of metabolic diseases. But you know what they say about correlation and causation. Is the paradigm the problem, or is it that people are a bit tardy in following the government’s nutritional guidelines and neglect to eat enough fiber?
Particular criticism in recent times has drawn attention to the low-fat fetish that has characterized the standard model since at least the late 1950s. How is it that people in previous eras ate bacon and butter and lard and ice cream but were slim with low incidence of metabolic problems? Fat is fuel. If metabolic disorders are fuel problems, one notable change is that one type of human fuel, fat, has been systematically demonized and often eliminated from foods. Belatedly, there is recognition now that there may be ‘good fats’ and that they may perhaps be important.
And perhaps it is significant that a whole new range of fats in the form of cooking oils have become ubiquitous? Blended vegetable oil – an industrial confection – has replaced butter and other traditional fats. It must now be fifty or sixty years since commercial cakes and pies and confections and other prepared foods were made with butter. Soy oil. Canola. Sunflower oil. These are new. They leaked through the whole food chain while the medical and public health authorities demonized the fats our ancestors ate. There is a growing body of opinion suspecting that this was a colossal mistake.
The connection between dietary fats and obesity, however, remains a stubborn orthodoxy. Yet, on the evidence, the war on fat has been as ineffective and as counter-productive as the war on drugs throughout much the same period. The war on fat, we should remember, was not aimed at reducing obesity. It is unfortunate that the word ‘fat’ is used for a macronutrient and as a synonym for being overweight. There was no obesity epidemic at the time the war on fat began. It was a plank of the cholesterol theory that took hold after President Eisenhower had a heart attack in 1955. People grew fat after low-fat became the norm.
Fuels being the issue, this has led some people – in fact a whole subculture of people – to reexamine the entire question of human nutritional fuels, which is to say the relationship between fats and carbohydrates. A heterodoxy has emerged. This proposes that – exactly contrary the standard model – the problem is not fats; rather the problem is carbohydrates, and the root cause of metabolic syndrome are the modern patterns of carbohydrate consumption. Low-fat led to high sugar. Certainly, by definition, diabetes is a disease of compromised carbohydrate metabolism. That is exactly what it is. It is like the body has become allergic to carbohydrates.
Yet the human body is very good at using carbohydrates as fuel. We have a very good system for turning starches into fuels. We could never have survived or thrived as a species without it. Indeed, civilization itself has only been possible because of the domestication of grains and starches which have provided the staples necessary to sustain larger populations and more complex societies. It is a serious problem if, for some reason, something is compromising our capacity to use such a basic and fundamental food source.
The official line is that we do not know what causes type 2 diabetes. The plainest explanation – good enough for a layman – is that the body’s carbohydrate mechanism becomes worn out, or broken, or compromised, by continual misuse. The most likely pattern of misuse is a combination of persistent snacking on sugary or high-starch foods, along with sedentary habits. A sure recipe for type 2 diabetes is a high-carb diet of relentless snacking and not much exercise. In Malaysia, the Malays left their traditional life in the kampungs and within barely two generations took up a sedentary urban life snacking on white rice and sugar ten times a day. The human body’s wonderful mechanism for using carbs – the very adaptation allowing us to be grain eaters - is broken. In a very real sense, a man who cannot eat carbs is estranged from the foundations of civilization.
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The counter views in this often reach for radical conclusions. This underpins a entire swathe of cultural, political and philosophical manifestations swirling amidst the chaos of our times. It is now influencing our entire culture. The crazed quest for ‘healthy alternatives’ and the rapid turnover of fad diets, for example, are symptoms of the chaos. Your soy latte with stevia is an artifact of the contemporary metabolic syndrome epidemic and responses to it.
So too are radicalized perspectives that propose, for example, that the whole of human civilization has been one huge disaster. In such a view, agriculture was a crime against nature. Society was a crime of man against man, and more especially woman. And the domestication of grains was violence against human biology, the beginning of the end – an end that is presently upon us. This is the post-humanist mindset: for most of human history we have been fundamentally wrong, if indeed we are not fundamentally and inescapably vermin upon the face of the long-suffering Earth. There is a tidal wave of metabolical disorders approaching and these are the types of ideas that will thrive in that context.
The
low-carb alternative is the inevitable outcome of these issues.
Contra-orthodoxy, it has occurred to some people that, while the body typically
runs on carbohydrates, it need not. It can run on fats. If starches and sugars
are in short supply, the body can use fats as its principle fuel. We have two
fuel systems. If one fails, we can switch to the other. This is the strategy of
the so-called ‘ketogenic’ approach, and often the so-called ‘paleo’ and 'carnivore' approach as
well. The body can turn fats into “ketones” and use them as fuel instead of
glucose. In fact, as adherents will tell you, there are some biological
advantages to doing so, and it was arguably the ‘normal’ fuel regime of human
beings as hunter gatherers, prior to the domestication of grains. Our ancestors sought out nutrient-dense foods. Why carry a bag of rice when you can carry an egg? For Australian aborigines the most prized part of the kangaroo was the fat in the tail. The low-fat orthodoxy has divorced us from all of these ancestral habits.
Again, we should note that these trends are best viewed as part of a bigger picture. The romanticization of hunter-gatherers is the inverse side of civilizational self-loathing. This is everywhere nowadays, not least throughout our educational institutions. In this narrative, people once lived in rosy health in harmony with themselves and nature; then civilization destroyed it all. Everything from permaculture to paleo is driven by this posture: mankind took a wrong turn somewhere around 12,000 BC, (for the raw food enthusiasts it was even earlier – we ruined everything when we domesticated fire!) and the only solution to the ills of modernity is a radical primitivism.
The truth of it, though, is that – grains or tubers – human beings like carbohydrates and have actively preferred them throughout history. The only natural low-carb high-fat diets are in high altitude or high latitude communities. Eskimos eat fat. It is all they have. People who live on the Tibetan plateau eat fat. It is the perfect – and only possible – fuel system they have. And it works well, and it has certain benefits. The cognitive benefits are notable. When the brain is fueled by ketones rather than glucose there is a marked increase in mental clarity. The brain likes the steadiness of ketones. Muscles, on the other hand, prefer the quick and volatile carbohydrates. A high altitude life built on rancid yak butter might be good for quiet contemplation but life down on the grain-growing plains requires a fuel system that is better suited to the biological energy needs of the builders of cities.
That, in fact, is what “going keto” is all about. Having trashed our carbohydrate metabolism to a whimper by living in decadent sugar-laden prosperity down on the plains, some people decide to go on a retreat up into the mountains for a while, and live on fat and berries, and there are others who resettle there for good. You can simulate this high-altitude experience by restricting carbohydrates to about five per cent of your daily fuel intake, either by food selection or by fasting. This pushes the body into ketosis. It will run happily on fats instead. Ketosis is a drastic but effective strategy at any stage in the progression of metabolic syndrome, and it allows the over-taxed carb-system time to mend, but it amounts – in a sense - to opting out of all the established dietary norms and other allegiances of human civilization.
Diabetic cookery, 1922. Prior to the invention of synthetic insulin and the standard diabetes drug Metformin (synthesized from the plant Galega officinalis), the standard diet for diabetics was low in carbohydrates and high in fats - more or less identical to the contemporary "ketogenic" diet (but the exact opposite to what medical orthodoxy continues to recommend.) The ketogenic strategy to arrest metabolic syndrome is really a return to practices prior to the intervention of modern pharmaceutical therapies. Old cookbooks invariably had a chapter on diabetic cookery and reveal the history of competing models of human nutrition and competing models of how to treat the illness.
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Taoism is interesting. China and rice are synonymous, and grains were domesticated there at a very early stage. Yet the ancient and indigenous spirituality of the land, Taoism, regards grains as a necessary evil. Grains “feed the three worms” that lead to human corruption. Instead, Taoism valorizes an earlier and more natural order before grain-eating became the norm. In Taoist asceticism, a retreat into nature and natural places – mountain tops especially – to adopt a life without grains is foundational. It is sometimes presented as a journey to the land of the pole star too. It represents a return to the primordial state. Much of Taoist spirituality – extended into Chinese medicine - in fact consists in the prolongation of that state.
In
this perspective, though, we are all weaklings now. We hide it with our mighty machines. Very few are up for the
low-carb monkish life in the mountains, while down on the plains mankind’s
great carbohydrate adventure becomes more problematic and compromised and
starts to come unraveled. Modernity lets slip all the traditional safeguards,
checks and balances. Science fumbles from one theory to another. A great epoch was built on grains, but the enormous
vitality of that move could not last forever. Grain-eating was always a
precarious undertaking, and could only be done with prudence. But men aren’t
prudent for long. Whatever other correlations we suspect might be causes, modern "dis- ease" (let's include depression and anxiety in this spectrum) correspond with modernity's neglect of and contempt for all the traditional wisdom that sustained us in the past. We pay the price for that hubris.
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The
upshot of this is that there are very few things as crucial to us as our
capacity to use carbohydrates as fuels; but that is exactly what has been
compromised. It represents a crisis of extraordinary proportions. Industrial
patterns of carbohydrate consummation are undermining our very capacity to use
carbohydrates as our primary fuel. The consequences of that are historic and unfathomable.
Harper McAlpine Black
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