Western Diet vs Native Diets and Disease

Chapter summary

Populations living on coconut and fish develop “Western” diseases when they adopt sugar and flour: diabetes, gout, osteoarthritis and weight gain.
The Standard American Diet (SAD) is the likely driver of the global rise in metabolic syndrome and obesity.

Cleave and Campbell (1966) argued that heart disease, obesity, diabetes, ulcers and appendicitis share one cause: “refined-carbohydrate disease”.
The logic is simple. Westernisation added sugar, flour and white rice, and chronic disease followed soon after.
This fits groups who lived almost entirely on animal foods (Inuit, Masai, Samburu, Australian Aborigines, Plains Native Americans) and farming peoples (Hunza, Kikuyu).
Animal studies show added sugar causes these diseases. Humans live longer, so disease may take decades to appear. Removing sugar reduces weight and improves metabolism.

Epidemiologist Ian Prior tracked Tokelauans from 1967, both on the atolls and after migration to New Zealand.
On the islands, sugar use rose from 3kg per person a year in 1960 to 30kg by 1980. Flour rose from 5kg to 25kg.
Migrants to New Zealand changed more. Fat intake fell and carbohydrate rose from 202g a day to well over that.
Disease rose with the dietary shift.

Danish researchers followed Inuit health for over 100 years. “Traditional” cancers (nasopharynx, salivary gland, oesophagus) did not increase.
“Lifestyle” cancers (lung, colon, rectum, breast) rose.
Two changes match the rise: tobacco, and a move from animal protein and fat to refined carbohydrates.

In 2011, 1.3 million Chinese and 0.98 million Indians died from causes linked to type 2 diabetes.
Obesity is now a disease of civilisation, not only of the West.

Fat and cholesterol view: At the same time as Cleave and Campbell, US researchers argued heart disease came from dietary fat and cholesterol, and that chronic illness came from meat and fat. That view shaped official guidelines.
Refined carbohydrate view: Gary Taubes (The Diet Delusion) argues science was overridden by dogma and weak studies, and sugar and refined flour are the cause.
Sugar or flour? The author says refined carbohydrates have a clear impact, but it is hard to separate sugar from flour or rice because they arrive together.
Other factors: Salted preserved food and genes may play a part in some Inuit cancers.
Evidence limits: These are observational studies. Correlation is not causation, but changes across a whole population are a major concern.

Cleave, T. and Campbell, G. (1966) Diabetes, Coronary Thrombosis and the Saccharine Disease. Wright and Sons.
Taubes, G. (2008) Good Calories, Bad Calories (published in some editions as The Diet Delusion). Knopf.
Prior, I. (1981) Cholesterol, coconuts, and diet on Polynesian atolls: the Pukapuka and Tokelau island studies. Am J Clin Nutr 34(8):1552-61.
Hooper, A. et al. (1992) Migration and Health in a Small Society: The Case of Tokelau. Oxford University Press.
Friborg, J.T. and Melbye, M. (2008) Cancer patterns in Inuit populations. Lancet Oncology 9:892-900.