Is a Diet High in Carbohydrate Appropriate for Humans?

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Introduction

This post comes out of some recent lively discussion on social media where I was challenged to reconsider my position that a low-carbohydrate or keto diet can put people into remission of type 2 diabetes (T2D), but does not reverse it, and is not a cure. The discussion centred around whether metabolic diseases may result from a diet that humans have not evolved to see, and whether eating a species-appropriate diet could be viewed as “curative.”

Back in 2018, I argued that if blood sugar is only normal while eating a therapeutic diet or taking medication, then this is not a reversal of the disease process, but remission of symptoms. The American Diabetes Association (ADA) defines partial remission, complete remission, and prolonged remission based on HbA1C levels and the discontinuation of medication for specific timeframes [1].

Defining Remission of Type 2 Diabetes

There are three primary ways currently known for people to achieve remission of type 2 diabetes symptoms:

  1. A low-calorie energy-deficient (calorie-restricted) diet [1,3,4]
  2. Bariatric surgery (especially the Roux-en-Y procedure) [5,6]
  3. A ketogenic diet [2,7]

However, a challenge was raised: it assumes that the diet causing the disease is somehow natural. If the high-carbohydrate diet causing the disease is unnatural for humans, then returning to a “species-appropriate” diet could indeed be viewed as a cure.

Human’s Evolutionary Diet

The innovation of human agriculture, roughly 10,000 to 12,000 years ago, moved humans from a hunter-gatherer species to an agricultural one. This shift resulted in an estimated 50%—70% of calories coming from starch (carbohydrates) [12]. According to Dr. Donald Layman, looking at evolutionary history, the appearance of a diet centered around carbohydrates is very recent [13].

Cereal grains, legumes, and refined sugars were non-existent in the human evolutionary diet. Even domesticated fruits today contain significantly more carbohydrates than wild fruits found by our ancestors. Dr. Layman stresses that the human body responds to dietary carbohydrate as if it were highly toxic, rapidly clearing it to maintain blood sugar within a narrow range of 3.3-5.5 mmol/L (60-100 mg/dl).

Grains and Weight Gain: Verbatim from Harvard

Even Dr. Walter Willett of Harvard, an advocate for plant-based diets, noted in a 2012 lecture that fat in the diet is not a determinant of body weight. He stated: “farmers have known for thousands of years if you want to fatten an animal a lot, what you feed them is grains, high carbohydrate diets… it is easier for many people to get fat on a low-fat high carbohydrate diet.”

America: A Nation with Underlying Health Conditions

A 2018 study reported that 88% of Americans are metabolically unhealthy [11]. Only 12% of adults meet the markers for metabolic health, defined by waist circumference, blood pressure, glucose, HbA1c, triglycerides, and HDL cholesterol. The amount of refined carbohydrates and seed oils (canola, soybean) we consume in huge quantities today was simply not part of our evolutionary history.

Final Thoughts

Perhaps the logic of “remission” is flawed because it assumes our current diet is the baseline for “natural.” If metabolic disease is the result of eating a diet humans did not evolve to eat, then consuming a diet humans did evolve to eat—which reverses the symptoms—could indeed be viewed as “curative.”

More Info?

If you would like more information about the different types of low-carb or ketogenic diets I teach, learn about me and the Comprehensive Dietary Package that I offer.

To your good health!

Joy

You can follow me on:

Twitter: https://twitter.com/jyerdile
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References

  1. Lean ME, Leslie WS, Barnes AC, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet. 2018 Feb 10;391(10120):541-551. [https://pubmed.ncbi.nlm.nih.gov/29221645/]
  2. Athinarayanan SJ, Adams RN, Hallberg SJ, et al. Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes: A 2-year Non-randomized Clinical Trial. Front Endocrinol. 2019;10:348. [https://doi.org/10.3389/fendo.2019.00348]
  3. Lim EL, Hollingsworth KG, Aribisala BS, et al. Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia. 2011;54:2506-14. [https://doi.org/10.1007/s00125-011-2204-7]
  4. Steven S, Hollingsworth KG, Al-Mrabeh A, et al. Very low-calorie diet and 6 months of weight stability in type 2 diabetes: pathophysiological changes in responders and nonresponders. Diabetes Care. 2016;39:808-15. [https://doi.org/10.2337/dc15-1942]
  5. Cummings DE, Rubino F. Metabolic surgery for the treatment of type 2 diabetes in obese individuals. Diabetologia. 2018;61(2):257—264. [https://doi.org/10.1007/s00125-017-4513-y]
  6. Madsen LR, Baggesen LM, Richelsen B, et al. Effect of Roux-en-Y gastric bypass surgery on diabetes remission and complications in individuals with type 2 diabetes. Diabetologia. 2019;62:611. [https://doi.org/10.1007/s00125-019-4816-2]
  7. Evert AB, Dennison M, Gardner CD, et al. Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report. Diabetes Care. 2019 May;42(5):731-754. [https://doi.org/10.2337/dci19-0014]
  8. Luca F, Perry GH, Di Rienzo A. Evolutionary Adaptations to Dietary Changes. Annu Rev Nutr. 2010;30:291-314. [https://doi.org/10.1146/annurev-nutr-080508-141048]
  9. Goren-Inbar N, Alperson N, Kislev ME, et al. Evidence of hominin control of fire at Gesher Benot Ya’aqov, Israel. Science. 2004;304:725—727. [https://doi.org/10.1126/science.1095443]
  10. Layman DK. The Evolving Role of Dietary Protein in Adult Health. Nutrition Forum lecture. 2013. [https://youtu.be/4KlLmxPDTuQ]
  11. Araújo J, Cai J, Stevens J. Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition Examination Survey 2009–2016. Metab Syndr Relat Disord. 2019 Feb;17(1):46-52. [https://doi.org/10.1089/met.2018.0105]
 
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