April 18, 2012

Nutritional biochemistry

How do some cultures stay lean while still consuming high amounts of carbohydrates?

Read Time 8 minutes

Many of you have asked this question over the past few months, and I’m sure many more of you have at least contemplated this question at some point.  I know I did.

For the sake of this discussion, let’s ignore the fact that the “historically” lean countries (e.g., France, Italy, Japan) are catching up to our levels of obesity and metabolic syndrome, especially in certain affluent subsets.  After all, we did get a 40 year head start on how to eat poorly.   So, let’s ask the question this way:

How does the average person living in, say, Japan stay leaner and healthier than the average American while still consuming >70% of their caloric intake in the form of carbohydrates?  

I don’t claim to know the answer this question, but I’ve got a few ideas.

Before getting to this question I want to mention that I have reorganized a page on the blog, Media, which now has a lot of videos and interviews.  A lot of the questions I get asked are addressed in these videos and interviews (both of me and others), so please check there for answers to your questions. Last week I was interviewed by Ben Greenfield. Ben asked a lot of great questions which many of you have also asked over the past few months. Take a look here and see the questions Ben posed.  If you’re interested in hearing my thoughts, listen to the audio clip from the interview.

Back to the question at hand

These data are a bit dated, but you can see the point: the United States is leading the way in the obesity race, while other countries (including those eating at least as high a total percent of their intake from carbohydrates) are not.  How is this possible if insulin – stimulated by carbohydrate intake – is an important hormone in the body’s drive to accumulate fat?  

This problem has many layers to it, but for the purpose of simplicity (always a danger when aspiring to explain complex phenomena) I’ll limit the discussion to three main points – think of them as the “higher order terms” – in their order of importance.

  1. Lower consumption of sugar
  2. Lower absolute consumption of carbohydrates
  3. More favorable consumption of polyunsaturated fatty acids (PUFA)

These reasons are not independent.  In other words, they are highly correlated and linked to each other, which actually amplifies their effects.

One other point to keep in mind: There is no definitive experiment I will point to that can prove my assertion beyond a reasonable doubt – for that I would need a prospective, well-controlled experiment comparing the eating habits of these countries over decades.  Many things I’m discussing are observational in nature, so you’ll have to really scrutinize my thesis on your own.


Reason #1 — Sugar intake

There is a great disparity between U.S. sugar consumption and the sugar consumption of countries like France, Italy, and Japan (and most countries, actually).  When I say “sugar,” of course, I mean sucrose, high fructose corn syrup, beet sugar, cane sugar, and liquid fructose (e.g., fruit juice) to name just a few forms.  Why does this matter?  If you’re not currently up on the why-sugar-is-bad-for-you data, it’s worth reading this post, and watching the lecture by Dr. Lustig.  For a quicker answer, watch this video from 60 Minutes.

Think of sugar as a “metabolic bully” or the proverbial Trojan Horse of metabolic syndrome – you let sugar in, and before you know it, you have diabetes, heart disease, and cancer.  Consumption of sugar makes us metabolically inflexible as part of a vicious cycle I’ve diagrammed below.  The more sugar you eat, the more insulin resistant you become.  The more resistant you are to the effects of insulin, the more insulin your pancreas needs to secrete in response to all carbohydrates, including the not-so-bad “non-sugar” ones. The more insulin your pancreas needs to secrete to manage your glycemic load, the higher your average insulin levels, which is manifested by higher levels of circulating insulin at all times – fed and not fed. Higher levels of insulin lead to less fat oxidation and more fat storage (from both ingested fats AND ingested carbohydrates – de novo lipogenesis).  This, not surprisingly, leads to greater insulin resistance, and so the cycle continues.  There is a reason “vicious cycles” are called “vicious.”

Vicious cycle



Reason #2 — Total glycemic load

It’s important to keep in mind that the percent of carbohydrate consumed is nowhere near as important as the absolute amount of carbohydrate consumed. Failure to understand this point may be one of the most significant reasons for the calories-are-everything-argument.  Recall my post on why Weight Watchers and most commercial diets are actually low-carb dietsVirtually any diet that reduces caloric intake also reduces glycemic load.  Worth repeating: Virtually any diet that reduces caloric intake also reduces glycemic load. That is, cutting calories almost always means cutting carbohydrates, cutting insulin, and cutting fat storage.  So what does this have to do with folks in Japan eating rice?  While these cultures may consume a higher percentage of their intake from carbohydrates, their actual glycemic load is lower. In other words, they actually consume fewer total carbohydrates in most cases than a typical Westerner (and in the presence of much less sugar!).  Contrast “typical” carbohydrates consumed by these “high” carbohydrate societies:

Photo by plusstory1 (http://plusstory1.tistory.com/28) [CC BY 4.0], via Wikimedia Commons
Photo by Liene Vitamante on Unsplash


Photo by Jonathan Pielmayer on Unsplash

Sure, they eat rice and bread and pasta.  But how much at one time?  And what are they eating it with?

Compare the figure above with that below, showing “typical” American carbohydrate consumptive patterns:


American eating

Are we eating the same amount of pasta per meal as the folks in Italy?  Perhaps, though I don’t think so.  Furthermore, while they make their own pasta sauce out of home-grown tomatoes, garlic, and olive oil, we dump a pound of Prego on ours (the second or third ingredient is nearly always sugar).  While the French are eating baguettes, we’re eating sugar-filled bread.  While the Japanese are eating a small bowl of rice, we’re stuffing our face with a plate of fries and breaded onion rings.

Why does consuming more glucose matter, notwithstanding the point that the glucose we consume is virtually always linked to sugar?  The human body can only store a finite amount glycogen, so any excess glucose we ingest actually does 2 harmful things:

  1. Continues to raise insulin levels, which inhibits fat mobilization,  and
  2. Gets stored as fatty acid, and ultimately ends up as triglyceride in fat cells.  Remember, this is a one-way metabolic street.  When your body turns glucose into fat (technically, we turn acetyl-CoA into malonyl-CoA into palmitate), you can’t turn that fat back into glycogen.

More absolute glucose, regardless of the relative percent, still leads to more fat accumulation.


Reason #3 — Inflammation

While insulin is certainly near the top of the list of pro-inflammatory factors in our bodies, it’s important to keep in mind the role of some other factors whose balance plays a role in inflammation such as eicosapentaenic acid (EPA), docosahexaenoic acid (DHA), and arachidonic acid (AA) to name a few.  I will, in a separate dedicated post, compose a thorough discussion on the metabolism of omega-3 and omega-6 fatty acids. To be clear, the science around this is not fully worked out, and much of what we speculate is based on indirect cause-and-effect inference, coupled with “sound” mechanistic reasoning and, of course, strong observation.  In other words, this is not close to bulletproof logic.

What is known is that diets high in omega-6 polyunsaturated fatty acid (PUFA) (e.g., mostly plant oils like sunflower, canola, safflower, and corn oil) relative to omega-3 PUFA (e.g., fish and fish oils) create a disproportionate ratio of AA to EPA and DHA. When I go through the biochemistry of this (which is super-cool!) it will be obvious why this is true: Eat a huge excess of omega-6 PUFA relative to omega-3 PUFA and your blood and tissues will show a lot of AA relative to EPA and DHA.  Same logic holds in reverse.

What does this mean?

Here’s where the story goes from being “clear” to “less clear,” at least to me. There is reasonable evidence that too little EPA and DHA (omega-3) predisposes us to certain diseases, in particular, cardiovascular disease.  There is some evidence that the relative amounts of EPA to AA and DHA to AA matter, too (i.e., what happens when you eat too much omega-6 PUFA relative to omega-3 PUFA).  What is not clear is if too much AA relative to EPA and DHA (i.e., much more omega-6 than omega-3) leads to clinically significant inflammation in the body that fosters other disease states.  In fact, a case can be made that high amounts of omega-3 PUFA are outright protective from many diseases including the disease spectrum of metabolic syndrome (e.g., diabetes, heart disease, cancer, Alzheimer’s disease), independent of omega-6 PUFA intake.

Observationally, this seems “clear” – societies whose ratio of omega-6 to omega-3 consumption are lowest (e.g., 3-to-1 or better) have far less disease than societies whose ratio is much higher in favor of omega-6 (e.g., 30-to-1).  Of course, this does not prove anything, since uncontrolled observations are just that.  This is how folks like Ancel Keys and Colin Campbell have caused so much trouble and confusion in the field of nutrition.  It is possible that some other factor, beyond this, is resulting in the differential disease pattern.   In other words, it is not clear if this observation is correct because of the relative amounts of omega-3 and omega-6, OR if it is true because of the absolute amount of omega-3, OR if it is true for some other reason? I don’t know (yet), but will continue to work on this.

That said, there is some indirect evidence linking differential consumption of PUFA (i.e., relative differences in omega-3 versus omega-6) with actual disease states.  A paper published in 1993 in the New England Journal of Medicine showed that patients with more EPA/DHA precursors than AA precursors in cell membranes had greater insulin sensitivity and less heart disease (though, obviously, these are linked).  I will review this in much greater detail in a dedicated omega-3/omega-6 post, but I want to point out that there is some evidence beyond just the observational data suggesting more omega-3 and less omega-6 in your diet leads to better insulin sensitivity:

Eating more omega-3 and less omega-6 may lead to more EPA/DHA precursors in cell membranes than AA precursors, which is correlated [not causally linked] with less insulin resistance.

Hence, Western diets, where we don’t consume much omega-3 PUFA, and it is very difficult to avoid omega-6 PUFA (they show up in virtually every processed and packaged food we touch, not to mention all sauces and dressing, and even our grain-fed meat), may predispose us to greater insulin resistance and inflammation.  As you can see in the figure below, a (historically) typical Japanese diet was nearly equal in omega-6 to omega-3, while our diets are typically much higher in omega-6 than omega-3 – BOTH because we don’t eat much omega-3 AND because we eat much more omega-6.  The same is true of a traditional Mediterranean diet.

Let me reiterate: I do not know if the relevant issue is the denominator (i.e., absolute amount of omega-3 consumed) or the ratio (i.e., relative amount of omega-6 to omega-3).

[Personal note: Pending resolution, I do both: I maximize my omega-3 intake and minimize my omega-6 intake to a ratio of about 1:1 with lots of EPA and DHA and little omega-6.  What is not clear to me yet from current data is if I should be minimizing my omega-6 intake.]

Omega-3 vs. Omega-6



What can we learn from this?

I alluded to how multifactorial this issue was, but I hope it’s clearer to you now.  Let me try to summarize why some cultures have historically been able to consume rice and pasta and baguettes but stay leaner and healthier than Americans:

  1. They consume a fraction of the sugar we do.  More sugar consumption leads to greater insulin resistance, more fat creation, less fat breakdown, and more fat accumulation.
  2. They consume less total glucose, AND the glucose they consume is accompanied by less sugar (and less omega-6 PUFA, if it matters).
  3. They consume a ratio of omega-6 to omega-3 PUFA that is much lower than we do.  This may further reduce any insulin resistance brought on by the glucose they do consume (in smaller doses and with less sugar).

Let me close with one personal and anecdote.  When I began my nutritional journey, for over 18 months I still consumed a modest amount of carbohydrate, probably on the order of what a typical person in Japan would consume.  The biggest elimination in my diet was sucrose, HFCS, and “junk” carbohydrates. The results were impressive.  I went from being about 200 pounds at 25% body fat to being 177 pounds at 10% body fat while still consuming some carbohydrates (by that point I was down to maybe 100-150 gm per day).   However, I was able to get leaner (170 pounds, 7.5% body fat) and further improve my risk profile for disease by going below 50 gm per day (i.e., entering nutritional ketosis).  Was this last step of nutritional ketosis necessary? Of course not, but it was a nice way to experience the full spectrum of carbohydrate restriction.  Will I ever go back to eating 100-150 gm per day of the “right” carbohydrates at some point? Probably, provided I don’t go back to eating sugar and stuffing my face with carbohydrates.  It will depend on what I’m optimizing for.

My point is this: Just modifying your diet by the 3 factors I mention in this post — elimination of sugar, less total glucose load, and improved omega-3/omega-6 profile — even if you are not genetically programmed to be lean, will probably deliver 80% of the value in terms of disease risk and body composition.

Photo by Jorge Zapata on Unsplash

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  1. Hi Peter,

    I am eagerly awaiting your blog post on Omega 3 and Omega 6 fatty acids (I love your site and have found it to be possibly the most useful nutrition related site on the internet). I’m curious if you limit yourself to grass-fed meat. Presently I have all but eliminated carbohydrates, outside of vegetables, from my diet and don’t consume vegetable oil (although mayo and canola oil have begun to creep back in). I’m curious if you know how much Omega 6 one would be getting per ounce of conventionally farmed meat?


    • Mark, whenever given the choice, I prefer grass-fed, but I’m not super-strict about. I do supplement n-3 (EPA and DHA) to a very specific levels of about 8.5 to 9% by RBC level, and my n-6 intake is pretty much confined to nuts and meat. I don’t really consume veg oils, largely because I think they taste like toilet water compared to a good olive oil. I don’t know the answer to your question, but I’m sure someone has done this calculation.

    • With no n-3 supplementation, just eating normal portions of fatty fish twice a week or so and avoiding vegetable oils, my RBC n-3 level is 10.9%. Some would suggest that’s too high, but I’m banking on the idea that if it results from real food in reasonable portions it’s probably OK.

      I heard Dr. Lustig state in an interview recently that if you consume farm-raised salmon fed grain-based pellets you might as well eat chicken since the n-3/n-6 ratio will be bad. My n=1 here would seem to contradict that, since (unfortunately) the great majority of the fish I consume is farmed.

  2. From my own experience I find it easier to maintain my 6 to 8% bodyfat on a highcarb diet. Everything from fruit to starchy and very simple sugars. When I actually cut to 5% I would do a big carbload once a week. Carbs have a better effect on leptin levels. I tried a keto diet. I lost a lot of muscle. Felt lethargic and my hormones were out of whack. It was hard to sleep and hard to focus. The moment I changed my macros to carb my training sessions were again intense. I could sleep again and felt happier. From serving in the navy and being stationed in countries that consume a lot of carbs like Japan, you definitely notice a higher NEAT. A lot of people moving around more. Which without carbs would be impossible to pull off. We’re more of a sedentary convenient society. Plus, maybe this is only ancedotal, but in my experience when I overconsume carbs I’m more more active the next day. A professor once told me that storing carbs as fat is a very costly process from an energy standpoint, but will stop the body from oxidizing lipids. My point is we live in a very lazy society that praises convenience. I’m not a genetic freak by any means. I was obese for most of my life. The last five years I’ve been able to maintain low bodyfat levels, plus compete in bodybuilding shows. Fat is burned in the fire of carbohydrates.

  3. I think everyone focuses on the macro-nutrients too much and ignores the micro-nutrients. I think the “paradox” of high carb cultures that don’t have the same problems of western civilizations can be explained in three ways:
    1. PUFA. The only major thing that has change in diet worldwide. And there ARE studies that show this causes or helps cause the metabolic issues the western world has… Or try this thought experiment: How did farmers make pigs fat before the advent of grain based feeds?
    2. Look at grains for a moment compared to other sources of carbs such as squash and potatoes. Grains are about three times more calorically dense. It is just plain easier to overeat. Now white rice… high caloric density, but it IS low in anti-nutrients, so less damaging than other grains. Wheat is the worst of all the grains, the genially modified are even worst as they have more anti-nutrients to act as natural pesticides. They help strip out required nutrients, which cause the body to require more intake of food to get those nutrients, but when the food is wheat, the vicious cycle continues.
    3. Liver function. Long story short, the liver needs certain dietary intakes to function properly. namely choline or the precursors. The best sources of these? Eggs, milk, and liver. (Any one of which is sufficient qualities solve the issue.) How much of those are eaten in the SAD? How much of these are eaten on the typical VLC diet?

    I think the low carb diets address most of these concerns on accident, but also induce other problems due to a glucose deficiency. That is why most people feel a lot better with a little more carbs. The paleo group also is almost there… but they still eat a lot of PUFA’s in the form of nuts. BTW, that was the answer to how farmers use to make pigs fat… they would feed them nuts in the fall. Specifically acorns and chestnuts.

  4. As someone in their early forties who is battling type 2 diabetes, I would like to point out something no one ever talks about: the brainwashing and mindgames American’s have to deal with in order to eat better and improve their health. Personally, it makes me incredibly depressed to hear what I now have to eat to feel & look better. All my life I was barraged with ads telling me to eat high-sugar cereals & sweet breads for breakfast. To drink soda instead of water. To eat delicious fast food. And that’s exactly what I did. My point is..why isn’t anyone addressing the mental issue beyond hunger? Why is everyone expecting American’s to just wake up one day after decades of brainwashing and being told the wrong things to eat and drink and just start eating low carb and avoid sugar? Don’t forget that when you raise an animal to eat and drink a certain type of food or liquid, that this then becomes ingrained in that animal, and will always be considered the “norm”, no matter what else is introduced in the future. And that’s exactly what many people like myself are now dealing with. Yes, I do everything I can to eat & stay healthy. I avoid sugar & carbs as much as possible, eat plenty of veggies & moderate fruit, take supplements, take my medication, and occasionally exercise if I have the time (I’m being honest here). But am I happy eating this way? Do I look forward to meals like I used to? At the end of the day do I feel satisfied and pat my belly because I ate good? No..not even close. As a matter of fact..I’m frickin’ miserable. And depressed. I miss Coca-Cola like a crackho who can’t afford another hit. I miss my mexican sweet breads with my loaded-up sweet coffee & cream. I miss being able to just pour me a big bowl of sweet cereal..instead of eating this healthy omelette with mushrooms. Food is now just sustenance..it doesn’t give me pleasure anymore. And when your brought up to believe food isn’t just food..but is happiness..well..that really affects your quality of life. So I can’t wait until researchers start developing ways to counteract all these years of brainwashing my generation had. Maybe create some therapies to counteract that and brainwash us into believing this veggie burger & carrot fries meal tastes as good as one made with angus beef and potatoes. But I think the chance of that happening in my lifetime is as good as science being able to create a “holodeck” like on Star Trek -in other words..fat chance.

    • PJ
      You are not alone in what you have described. Since I was small (quite awhile ago) I saw all sorts of food ads for sugary foods which my parents brought home. Plus treats galore that were touted as being healthy. Casseroles and other similar foods that were cheap, filling and crowded out more healthy food. Now I try to eat better with all I know and I can’t get past the ‘wanting’ of the foods that filled my younger days. I’ve done the 21 days or more routines in the hope the cravings would go away as others have claimed happened to them. Never happened to me. I always relapse like an ‘addict’. I’m looking forward to Peter addressing this as it is a major issue for many of us.

  5. …………………………..

    A couple of things………..

    Peter’s Ted Med Talk
    Peters taik has been online since day one – session 4 ——–1:14 into the video———— all the 2013 sessions are here and I watched them all- at —
    Kroger’s/Smith’s grocery stores
    They sell low carb yogurt – 4 carbs per container – $00.40 cents a container – these are the only places I’ve seen low carb yogurt sold

    Winco Stores
    They have an encredible bulk section – cinnamon $2.00 per pound and many other herbs as well

    Neighbor Lady Next Door
    This lady had diabetes – a rotting foot – they wanted to cut it off – she killed herself instead as she didn’t want to walk around with one foot – can’t say I blame her –

    As Peter Seller’s say’s in the movie “Only Two Can Play’ ———————- The Price is just too High——————-

  6. I have just discovered your awesome website (through the Diet Doctor’s website generously mentioning you). What an awesome site. I myself follow Dr. Rob Thompson’s Low Glycemic Load Diet, and am now reading his Sugar Blockers Diet book. The difference in my health has been amazing since loweriing the glycemic load in my diet (and I still eat lots of veg and fresh fruit!)… Thanks for such a wonderful website and great information.

    Please write a book for us. Can you tell I like to read? Thank you.

  7. Author Roger Mason states “the best source in the world” for DHA and EPA is flaxseed. He further says “fish oil has dangerous arachidonic acid”. This seems to contradict what I have learned from your website and other places. Please help resolve my confusion.

    • Scott, I don’t know Roger Mason. I do know, from speaking with the experts on this topic and reading their work (e.g., Bill Lands, Bill Harris), that conversion of ALA to EPA is about 1-2%, and virtually 0% to DHA. So while it’s true that flax high in omega-3 (ALA), this statement about it being the best source of DHA and EPA is incorrect. The issue of AA is also misleading, if not outright incorrect. Don’t take my word for it, though. See the work of folks like Lands and Harris.

  8. I feel very confused. Have read Dr. Dean Ornish and others who promote heart healthy eating through restricting junk food AND restricting/eliminating meats and full fat dairy. Have also read THE CHINA STUDY by Prof. Campbell.

    I know that Dr. Ornish has documented reversal of heart disease….and I’ve heard other docs on Public Television pushing vegan style diets. Then I read you and feel confused!

    Can you clarify?

    • Simone, the question we need to be asking is what is about these diets that may promote health? If you have the patience to read this blog in its entirety, I think you’ll have a better answer. I’m sorry that I can’t address this quickly in a short response.

    • Hi Simone,

      Jack Kruse, Mat Lalonde etc. have to some degree debunked Dr. Ornish’s studies supporting his diet and contributes it to some to other factors such as quit smoking and starting to exercise.

      I’m not saying that low carb/ketosis is the universal answer to all of our problems just that there is more to it than the diet guidelines advocated by Dr. Ornish.

  9. I’ve been reading “The Fat Switch” and some of what Dr. Richard Johnson has published, and I think he may have found some common threads in the diets that “work”. I started a low uric acid diet because I was getting gout symptoms … Like my Dad did. He controlled his gout with diet, and when he did … he got skinny . The “low gout” foods seem to cause weight loss. It seems uric acid might be the trigger for fat storage.

    Now in my case, the foods aren’t connected by much else, except that “gout sufferers” recommend them.

    1. Drink vinegar-water. Vinegar lowers uric acid levels, for some reason.
    2. Avoid fructose. Fructose raises uric acid levels.
    3. Avoid certain meats and seafoods.
    4. Avoid beer (I drink wine though).

    Anyway, it’s working. Joints stopped hurting, and I have been losing weight.

    • Very interesting, Heather. I’ll be meeting Dr. Johnson in September and look forward to discussing all of the implications of the fructokinase in great detail. I’m reading his book now.

  10. What are your thoughts on reasons why, even though Icelandic, Nordic and Japanese people eat a high amount of fish and have greatly reduced rates of heart attacks compared to US, they have a much higher rate of hemorrhagic strokes? I read somewhere that the high rate of strokes is not due to the omega 3 but rather due to the mercury and other pollutants found in fish. Is this correct? If so, what amount and what kind of fish is safe to eat per week?

    • High levels of EPA and DHA significantly thin the blood. If too high, this results in easy bleeding. So while, while this would protective from embolic stroke or atherosclerosis, it would increase the risk for anything hemorrhagic, including stoke.

  11. Peter, I tweeted you a few days back but I realise that twitter is probably not the best platform to discuss such big issues with their tiny word limits. I saw your talk on TEDMED 2013 and I thought it was intriguing but I have some questions on insulin resistance, diabetes, obesity and how they relate to one another. I apologise for any ignorance but your blog is massive and I didn’t really know where to start, despite trying your “start here” post which didn’t point me in any obvious directions to find the answer.

    I understand that your claim is that obesity and diabetes are both a result of insulin resistance, but I find this to be confusing. Insulin resistance, you say (as does most everyone else), is the reduction in sensitivity of cells to the effects of insulin. So what are the effects of insulin? Primarily, as you have noted, it is an increased uptake of blood glucose by muscle cells and fat cells, probably mediated by increased expression of some glucose transporters of some sort in the cell membrane. (Glut-4?) Thus, a reduction in this sensitivity should lead to a reduced ability of muscle/ fat cells to take up glucose for storage, whether in the form of glycogen (for muscle/ liver tissue) or lipids (via lipogenesis in fat cells). Doesn’t this mean that insulin resistance should actually lead to impaired fat accumulation rather than enhanced fat accumulation?

    Apologies if I have left my comments on an inappropriate post, once again I had difficulty trying to navigate to a relevant post dealing with this issue. Looking forward to hearing from you I enjoyed your TED although I wish you had explained your theory in greater detail.

    • DNL is a very minor part of the adiposity (see post on fat flux), so IR leads to more circulating insulin. Fig 1 in that post should make it more apparent why hyperinsulinemia increases adiposity.

  12. Thanks for the excellent article. Your judgements are spot on IMO. Perhaps I can throw a little light on your question about the amount of omega 6 required.

    “Traditional diets contain nearly equal amounts of omega-6 and omega-3 essential fatty acids.” Weston A. Price Foundation

    “To reach optimal health, the ratio of omega 3s to omega 6s should be close to 1:1. When omega-6 fats predominate in your diet, as is common in the United States, this encourages the production of inflammation in your body. Since so many diseases have now been linked to chronic inflammation, this really is one of the most important nutrition concerns to get right. Many scientists believe that one major reason for today’s high incidence of heart disease, hypertension, diabetes, obesity, premature aging, and some forms of cancer is the profound imbalance between your intake of omega-6 and omega-3 fats.” Doctor Joseph Mercola

    “Health practitioners often suggest you use no additional parent omega-6 and that instead you use supplements exclusively with parent omega-3. This is incorrect because the omega-6 we do consume in our foods is highly processed, harmful and often loaded with cancer-causing transfats. You need the additional pure parent omega-6 to compensate for this. Because the parent EFAs are so much more effective than EFA derivatives, you need a much lower total quantity than other formulations.” Doctor Brian Peskin PhD, Note parent omega 6 is unprocessed food high in omega 6. In addition to ingesting GOOD omega 6s we need to ELIMINATE the denatured omega 6s

    “Recognizing the unique benefits of EPA and DHA and the serious consequences of a deficiency the US National Institutes of Health recently published Recommended Daily Intakes of essential fatty acids. They recommend a total daily intake of 650 mg of EPA and DHA, 2.22 g/day of Omega 3 EFA and 4.44 g/day of Omega 6 EFA.” Note IMO this is LOW I try to get between 5 and 10 grams/day of each omega 3 and 6 on average

    Avocados are my favorite omega 6 source. When I think I have found the end of its benefits a day or two later I find more.


  13. Although things are changing, I’d like to add that many Asians don’t eat as much meat as Americans. Usually, on special occasions, like going out to restaurant or birthdays, holidays; maybe they eat meat once a week or once a month. Some will go months without it. If you’re not getting protein, then you need energy from other sources. This is also a common thing I’ve seen among vegetarians: they’re all very thin, it seems. I live in a place where there are a lot of vegetarians.

    Other sources of protein I’ve seen consumed include: soy-tofu, silk worms, crickets, scorpions, and then basic meats and fish.

    So basically, what if it’s a metabolism thing? What if their bodies are wired to burn carbs first? If you’re not getting protein energy, then that’s gotta leave carbs. Rice and noodles are cheap, and easy to make.

    Also, as you said, they eat a lot of veggies, and not as much sugar; definitely smaller portion sizes than others. Although, again, things are changing. When I was in Seoul, I saw people eating fried chicken with chopsticks. People love western food there. I fear for their health, lol.

  14. Brian Peskin has been advocating discontinuing fish oil supplementation in favor of a biologically appropriate ratio of Omega-6 to Omega-3 for years.He has spent many years in the wilderness making his argument in print and at medical conferences around the world. Successfully withstanding continual attacks by those blindly defending the status quo, he is happy to report the changing of the status quo as it relates to fish oil and heart health.
    Remember, May 2013 as the time when the medical establishment embraced one of Brian Peskin’s fundamental discoveries. Specifically, the discarding of fish oil for heart health. First reported in the New England Journal of Medicine, a very large well-done study in Italy showed that fish oil was completely ineffective in preventing heart disease for a very large group of high risk patients. Soon after, Dr. Eric Topol, renowned cardiologist from Scripps Health (La Jolla, California) and editor-in-chief of Medscape, recommended discontinuing all fish oil supplementation for the prevention of heart disease. It doesn’t get any more main stream than Dr. Topol, so I gladly accept the designation of an advocate for a rational, now mainstream approach for combating heart disease. For more info re: Parent Omega 6 and 3 go to Brian Peskin.com.

    • This is a very interesting debate, Darlene, and not one I know the answer for. I do suspect the reality is somewhere in the middle. VERY low EPA/DHA = “bad” VERY high EPA/DHA (i.e., uber supplementation) = “bad” also.

  15. Having reread this essay prior to a recent bike trip and vacation in France, I was alert to your theory that the “French Paradox” is explained by the lesser overall consumption of carbs and sugar by the French (compared with Americans.) I was convinced you were right.
    This is written long after you posted this blog and and I am not sure you check for current comments, but I feel compelled to report that I now think your theory is not fully correct.
    Most of the French I observed were indeed thin to just mildly overweight. The many Chinese tourists looked soft but not heavy. There was the occasional bulky Brit or German. But, yes, the truly big –bulging!– people were invariably American (further identified by their universally abysmal standard of dress.)
    Yet, yet, yet… never have I seen as many French fries (frites) served and consumed as I did in France, by locals. Even 40-Euro steak dinners in high-class restaurants came with mounds of frites. Asked for a salad substitute, French waiters seemed horrified — what, substitute rabbit food for a delicacy? I watched an American vegetarian ask for vegan cuisine … utterly stumping the waiter until with a sudden smile he left and then returned with a huge metal bowl filled with…. frites! Yes, there were vegetarian-friendly cafes scattered here and there but not many. Further, Parisian cafe tables groan under the weight of baguettes (whole or chopped) served at every meal! And don’t even start on the constant flow of desserts. Or the espresso sipped through cubes of sugar.
    Yes, I saw plenty of salads — usually arugula and lettuce– but otherwise, green vegetables were limited to the occasional dish of green beans, usually in fancier places. I never saw spinach or broccoli — except the latter, once, on a pizza at the next table.
    Speaking of pizza, Paris and Bordeaux seem to have more pizza places per square kilometer than I have ever seen in the States. At a cafe I watched two perfectly thin Parisians consume 14-inch pizzas — each! — for lunch.
    So what could account for the “French Paradox”? Red wine? Maybe. The higher quality of ingredients and preparation? Perhaps. But here are a couple other things to consider:
    At any given moment, it seemed half the city residents were on the sidewalks. Each side of Champs-Elysees was filled with pedestrians, seemingly 24/7. So were side streets. Merely by emulating the French, I soon found myself averaging nine miles per day. (My smartphone app credited 500 to 600 calories burned this way each day.) In public buildings (other than hotels) going to higher floors almost invariably meant climbing staircases rather than taking elevators or escalators.
    And another, less positive, factor: smoking. It looked to me like slim and fashionable young women nearly all smoked, and nearly constantly. Empty cigarette packages (even Camels!) and butts were the main component of debris at curbside.
    Despite the reported popularity of the “Dr. Dukan” diet in France, (a low-carb variant), no waiter I mentioned it to had any idea of what I was talking about. The French do not seem to share Americans’ obsession with “health food” (and generally don’t appear to need it, judging strictly by appearances) but their relative slimness, I suspect, is explained more than just by their food choices. Partly –perhaps — but not all.

  16. You questioned whether the apparent observed benefit came from improved Omega-6 to Omega-3 ratio or simply from increased Omega-3. Logically, you left something out. What about the benefit coming directly from REDUCED OMEGA-6?

    I happen to believe this to be the case and read about a study in India which seemed to bear it out. Just a population study and no “proof” of course, but pretty compelling.

    I don’t believe that humans need large amounts of Omega-3s, period. I DO believe that the vast majority of people walking around today, after decades if intense Omega-6 poisoning could probably benefit from it. However, I remain convinced that reducing Omega-6 addresses the real problem more effectively and directly. J

    ust curious how you left out one glaring logical possibility, while discussing the others in some detail.

  17. I have lived for 19 years in Italy and, to me, the most important difference between the Italian and the ‘Western’ diet I am experiencing in the UK is that (traditionally) Italians cook their food from scratch, even takeaways are what we call a ‘gastronomia’ ie homemade food sold to the public. Still, weight is not the only issue here and in the last few years, despite remaining comparatively lean, Italians have started to develop all the conditions linked to methabolic syndrom. Moreover, society is changing, more women work (true for all the 3 countries considered here) and ready-meals are becoming increasingly popular, hence the ‘westernification’ of our diet.

  18. Hi Dr. Pete, great blog. I love this post. It was well written and totally comprehensible. The people taking part are very knowledgeable too and I got some great info here (BTW I’m new to your site). I’ll be checking in more often. Thanks and keep up the great work.

  19. Great line of inquiry here. One thing that has not been mentioned is that the idea that just b/c the folks in Japan eating all that rice look thin, that they’re healthy. While I worked in HI I worked with a HUGE population of Japanese and other Asians who tended to eat rice for breakfast lunch and dinner. Many of them had diabetes in spite of normal BMI. (I did not have a body comp scale.) Cutting rice dramatically improved their numbers. So I don’t see any evidence that this population of people tolerates higher amounts of carbs any better than the rest of us, all else being equal.

    • Excellent point, and one that causes great confusion. Today, the prevalence of T2D in China is reported at about 11.5% — higher than even the U.S. How is this possible when their prevalence of obesity (according to BMI > 30) was reported in 2010 to be even lower?! Well, the answer almost certainly lies in your point, which is yet another example of the point I tied to make in my talk at TEDMED.

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