Doctor's Review: Medicine on the Move

March 30, 2017
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Are we really what we eat?

From Paleo to the Fertile Crescent to Grain Brain and back

The media frequently associates atherosclerosis with our overindulgent eating habits. It’s an idea that’s made the authors of countless diet books very rich. It’s also twisted government nutritionists into knots trying to come up with a food pyramid that, if followed, would keep citizens’ blood flowing smoothly and so save health care systems billions.

Yet the Egyptian builders of the original pyramids also suffered from “hardening” of the arteries. Native people living on the high plains before the invention of the bow and arrow suffered from atherosclerosis. So did the Unangan-speaking hunter-gatherers of the Aleutian Islands.

Science tells us that a high percentage of people who lived more than 4000 years ago had heart disease. CAT scans of mummies in locations across the globe have found blocked arteries in as much as 60 percent of the population. Experts estimate that most of our ancient ancestors' children died before age 15 and life after 40 was rare.

Still, we struggle to give up the idealized vision of an “original” human diet that might provide a magical solution to all our ills. In addition to not being terribly healthy, however, our predecessors ate whatever was at hand — and that varied tremendously depending on where they lived.

Hippocrates for thought

In warm, dry regions people were thought to mostly eat plants, augmented by occasional animal protein to come from hunting. In contrast, people in artic areas ate little but meat, consuming all parts of the animal to ensure that they got their necessary doses of the nutrients found in fruits and vegetables, seeds and nuts.

That said, contrary to what modern paleos contend, meat is no panacea. Around 400 BCE, Hippocrates, ahead of his time as always, was onto this. In the Greece of his day, obesity was on the rise and he thought he knew why. Foie gras, referred to in Homer's Odyssey, was a favoured delicacy and he fingered it as the culprit. His solution? Exercise and a moderate, heavily plant-based diet, much like the current strategies for curbing expanding waistlines.

What to eat was his primary guide to patient health. Millet and lentils, and pumpkin and chard were some of his prescribed favourites. He also suggested melikreton, a mixture of water and honey. To build his patients up he prescribed raw, whole milk and buttermilk, and even treated fevers with infusions and fasting.

Even earlier, moderation, with certain vegetables, was implied in the first recorded dietary advice. A stone tablet carved in Babylon around 2500 BCE suggests abstaining from onions for three days when suffering from internal pains.

The China Study

A conservative use of meat is a familiar part of the Chinese diet to this day. Small quantities used to flavour large vegetable dishes are still common. The ancient Chinese were probably the first to develop a food system. As early as the 6th century BCE, they developed the concept of Qi or "wind," the vitality of which was kept in check by taking in the correct balance of "hot" and "cold" foods. Traditional Chinese medicine (TCM) continues to practice this basic concept. Meat, blood, ginger and spices are considered "hot," while green vegetables and other plant foods form the cool end of the spectrum. The use of herbs in teas and soups was also an early practice, one still followed by many contemporary Chinese who approach illness first and foremost by adding and eliminating foods and herbs. They consider Western medicine "too strong," to be used only as a last resort.

China's scant use of meat, especially in rural populations, was highlighted in the 2005 publication of The China Study, a 20-year research project that examined the relationship between eating animal products and chronic illnesses. The researchers came to an emphatic and radical conclusion: moderate consumption of animal products, including eggs and dairy, is better than high consumption, but eliminating them altogether is best. The study claimed with no small certainty that eating animal products in any quantity, however small, reduces lifespan. The study sparked interest in vegan diets which continue to win adherents. Former US president Bill Clinton took the study to heart. He became a vegan and quickly dropped 11 kilos to return to his college weight.

Wheat is king

When we think of China, we think rice, not wheat. Legend has it that rice was domesticated around 3000 BCE, but genetic evidence puts the crop's domestication between 8200 and 13,500 years ago in the country’s Pearl River Delta region. The use of wheat is far from new, having reached China from Western lands around 2000 BCE. While Chinese southerners grow and eat rice, northerners still consume more wheat. In fact, China is the second highest producer of wheat worldwide. In 2013, the 121.7 million metric tonnes it produced put it just behind the EU’s 143.3 million tonnes. Canada was a distant seventh at 37.5 million tonnes.

Wheat is famous for jump-starting agrarian civilization and, to this day, grain remains the number-one global source of vegetable protein in human foods. Emmer, the forerunner of wheat, grew in the Fertile Crescent about 11,500 years ago. Large-scale cultivation and ease of long-term storage made it a key factor in the establishment of city-based cultures. Wheat’s popularity can also be attributed to its high protein content, which surpasses that of both corn and rice.

In medieval times, wheat became the basic staple for much of the world’s population spreading northward with the rise of Christianity. Christians of the day emphasized the specialness of wheat by likening its harvesting process to the life of Christ. St. Augustine sermonized: "This bread retells your history… You were brought to the threshing floor of the Lord and were threshed… While awaiting catechism, you were like a grain kept in the granary... At the baptismal font you were kneaded into a single dough. In the oven of the Holy Ghost you were baked into God's true bread."

Let them eat gruel

While the holy and the poor subsisted on wheat gruel, the rich fancied extravagant feasts so over the top that sumptuary laws were passed in an effort to curb gross overindulgence. Roe deer, wild boars, kid goats, rabbits, hares, capons, goslings and herons graced the banquet tables of the wealthy. Coloured jellies of gilded swans, peacocks and pheasants adorned with their feathers formed the centerpieces. Complex soups became de rigueur with aristocrats, and the richer the flavour and the more expensive the ingredients the better. They were often served five or six at a sitting sprinkled with saffron, rose water and pomegranate seeds, and were enjoyed in the place of sweets.

The church insisted that Christians eat fish on Fridays, not always a popular edict. Many got around the rules by stretching the definition of "fish" to include whales, barnacle geese, puffins and even beavers. Benedictine monasteries were known to out do even the lavishness of noble tables with 16-course meals.

During the renaissance, cooks learned to prepare a barrage of strange and wonderful foods from the New World including potatoes, corn, carrots, tomatoes, asparagus and coffee. Those at table were advised to approach these new foods with caution, consuming small amounts at first.

Sugar devil

Sugar cane originated in Southeast Asia. The process of granulated crystallization was discovered in India around 350 AD, and spread quickly to China and the Middle East. Crusaders brought the "sweet salt" home with them. William of Tyre, a crusade chronicler, described sugar as "a most precious product, very necessary for the use and health of mankind." After 1500, plantations in the New World made it a popular commodity.

Sugar had its shadow side, right from the start. Tooth decay aside, it was a highly labour-intensive crop to grow and harvest. The solution: slaves. By 1540, sugar plantations were being set up in Surinam, Brazil, Cuba and the Caribbean. Of the nearly four million slaves sent to the British West Indies, only 400,000 survived.

White flour, another a labour-intensive process, could only be afforded by the rich until after the invention of the roller mill and large-scale production. Refined sugar and white flour are now regarded as the two greatest evils of the modern diet.

The grain drain

In his recent best-selling book, Grain Brain, paleo-diet advocate Dr David Perlmutter says that it's not just wheat, but all grains that are to be avoided. He argues they cause a spike in blood sugar levels, which leads to inflammation and disease. He ascribes dementia and all other neurological disorders to the gluten in wheat, rye, barley and oats, which he calls a "modern poison." His paleo diet is only one of the most recent ideas of how to achieve optimum health. Opponents point out that healthy groups like the Okinawans and the Kitava of the South Sea who dine largely on starchy tubers and honey are a remarkably lean and robust people.

A March 2014 study entitled Low Protein Intake is Associated with a Major Reduction in IGF-1, Cancer and Overall Mortality in the 65 and Younger but Not Older Population published in Cell Metabolism examines the effects of animal protein. Lead by Morgan E. Levine and a host of other researchers, the title sums up the gist of it. Meat and other animal products were shown to cause disease in younger people, but to actually prevent disease in older people. Clearly, we’ve not heard the end of diet discussions which have gone on since humans first questioned what they put in their mouths.

There seems to be only one thing that we can agree on these days: green leafy vegetables are good for you and so is exercise. So if you're feeling lost and confused, go for a run or a game of tennis. When you get home, refuel with some lightly steamed kale or a side of bacon. Pick your poison.

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