By Mukaaila Kareem
As someone who had early life in rural Nigeria, I strongly believe that the diet debates are out of touch elite pastimes borne out of food glut in the western societies. For survival, all living things evolved and adapted to scarcity, and humans have been appropriately described as opportunistic omnivores who would eat whatever is available. How supposedly omnivorous humans turned out to be sharply divided into tribalistic die hard vegan, keto, Mediterranean, paleo and all other kinds of dieters is hard to wrap my brain around. No matter how much label you put on it, food is nothing more than stored chemical energy and my lived village experience and training tell me the absurdity of unending debates about the superiority of one diet over the other, especially when it all boils down to emotion and not much science.
It is absolutely true that over-consumption is the major cause of obesity, diabetes and heart diseases, which are the current major silent killers of mankind. However, the label placed on food, by way of one’s preferred diet is not as significant as the energy it stored and released into the bloodstream through digestion and absorption. To buttress the fact that less is better, and not an endorsement by any means, a Nashville man lost 58.5 pounds in 100 days on half portion of three McDonald’s meals a day. The buzz about the new wonder drug, Ozempic, is largely because it keeps the stomach full by delaying food emptying into the small intestines where most food absorption takes place and centrally blocks the brain’s hunger signals. In other words, the weight not gained are the nutrients not eaten or absorbed, which is exactly the same principle of surgical gutting of the stomach via bariatric surgery.
Lately, I have been showing increased interest in the chemical energy of elements, and to give credence to the fact that nothing in nature is static, even a “stable” atom can transform from one element to another through 3 kinds of decay without violating the law of conservation of energy. Take for example, an isotope of oxygen may decay to form nitrogen gas and the energy before and after the formation of nitrogen can still be accounted for. It is, therefore, a stretch to assume that food nutrients, made of atomic bond between carbon, oxygen, hydrogen, and nitrogen which can decay in their isolated forms and without violating the law of conservation of energy would somehow defy this law in their composition as food nutrients by some “metabolic abracadabra” as peddled by Hollywood celebrities, social media influencers and the so-called nutrition experts.
While it can be argued that the modern fondness for caveman’s paleo diet of fruit, seeds, vegetables, and animal protein is more imagined than real, the keto diet is entirely a different ballgame as there are no tangible harvest on a “keto farm” or “keto hunting/gathering” in the wild other than a reliance on an eating pattern that triggers intermediate metabolic molecules called “ketone bodies.” No doubt the keto diet has a surprising effectiveness in weight loss and diabetes reversal but no more so than any other fad diets or rationed junk meals as demonstrated by the Nashville man on McDonald’s half portion meals. Put bluntly, there are no civilisations that ever lived on ketogenic diets and the traditional high fat foods of the Arctic populations before the advent of Europeans were not ketogenic. The therapeutic effect of ketosis in seizure management has long been established but a chronic or perpetual state of nutritional ketosis does not reflect the history or lifestyle of any known civilization. While modern dieters romanticise keto, the truth of the matter is that ketosis is an unintentional fasting/starvation state in natural environments that may carry dire survival consequences in a prolonged absence of food. It is no wonder that modern hunting and gathering societies hardly go into ketosis. Furthermore, obligate carnivores and hibernating bears are not known to go into ketosis as no living things can perpetually survive on the edge of fasting and starvation in the natural world.
Glucose, fatty acids and amino acids on the “chopping block” for ATP energy extraction go through different metabolic pathways but they all end up with a common 2-carbon molecule called acetyl coa. During starvation or high-fat diets, most of the acetyl coa molecules come from fatty acids because of depletion of glucose. However, unlike glucose, fatty acids are not soluble and therefore cannot cross the blood brain barrier and thus create a situation that puts the energy supply to the brain under threat. Therefore, as a temporary substitute for glucose, the liver condenses 2 molecules of acetyl coa to produce soluble 4-carbon molecules called “ketone bodies” or mouthful chemical compounds called beta-hydroxybutyrate and acetoacetate, which can easily cross the blood brain barrier as temporary stopgap for the brain’s preferred glucose. To fuel the confusion and misinformation about keto diet, a big-time nutrition expert claimed that ketones “burn cleaner” than glucose in the brain which undoubtedly puts pressure on innocent keto dieters to obsessively check their blood ketone levels. This assertion belies the biochemical pathways of ketone bodies. In fact, ketone bodies are not used directly as fuel sources because they have to be reconverted to acetyl coa in the cell’s “powerhouse” before they are terminally burnt into carbon dioxide and water.
Every cell, including the unicellular organisms such as bacteria, has what I called “survival intelligence”. This is why bacteria evolve quickly to produce new strains that are resistant to certain antibiotics and for the same reason there are many variants of COVID-19. It turns out that humans have slowly evolved mechanisms over millennials to survive in their environments through appropriate gene mutations. While arctic dwellers, like intuit of Canada and Greenland, eat high fat and low carbohydrate diet, their physiology resists ketosis due to the genetic differences from tropical dwellers. They also have increased ability to generate glucose from their high protein consumption to compensate for lack of abundant tubers and fruits in the arctic regions. For instance, tropical dwellers can convert 18-carbon plant omega-3 fatty acid called alpha-linolenic acid (ALA) to useful 20- and 22-carbon omega- 3 fatty acids called eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) respectively through enzymes called FADS1 and FADS2. However, because the intuit have abundant source of EPA and DHA from consumption of fish, their FADS genes are silenced due to lack of consistent plant foods and according to a 2015 New York Times article, “despite eating so much fatty meat and fish, the Inuit didn’t have a lot of heart attacks. This led to the recommendation that Westerners eat more fish to help prevent heart disease and sent tens of millions scrambling for fish oil pills.” However, a 2018 Cochrane article concluded that “moderate‐ and high‐quality evidence suggests that increasing EPA and DHA has little or no effect on mortality or cardiovascular health” adding that “previous suggestions of benefits from EPA and DHA supplements appear to spring from trials with higher risk of bias.” Furthermore, the CPT1A gene found in the liver and kidney, has the dual responsibility for ketogenesis and regulating the import of long-chain fatty acids into mitochondria to help maintain energy. However, according to a 2018 article, the variants of CPT1A among intuit also known as “Artic mutation” show less activity for production of ketones and instead “increases heat in the body to stay warm in a cold climate by directing free fatty acids away from liver cells to brown fat”.
While consumption of carbohydrates or glucose is almost forbidden in low carb circles, the arctic dwellers intentionally seek out glucose. They obtain calories from carbohydrates mostly in the form of glycogen, otherwise called “animal starch” from consumption of raw meat and they practice a unique process of fermenting animal protein into carbohydrates. Finally, as if they realized that glucose is the preferred fuel for the picky brain, a 1928 article by Heinbecker stated that “intuit’s babies are wholly breast-fed until the end of the second year when meat is added to their diet [and] children often nurse irregularly until the age of 4 or 6.” For growing babies in the arctic environments, the only sure source of glucose is in the breast milk which is a disaccharide of galactose and the hated glucose by the low carbers. All diets work but to base the premise of a diet on carbohydrate hating is wrong. Broadly speaking, in all human fields of endeavors, the law of conservation of energy is never contested but we tend to suspend disbelief when it comes to diets as we doggedly assume that the presence or absence of a certain hormone will circumvent metabolism and “melt away the fat.” This is also wrong and unhelpful to innocent diet followers.
Mukaila Kareem, a doctor of physiotherapy and physical therapy advocate, writes from the USA and can be reached via makkareem5@gmail.com
