Asian Paradox’ by advocates and followers of carbohydrate restricted Low-Carb, Paleo and Primal type diets who hypothesize that such a dietary pattern promotes weight gain. Mark Sisson, a prominent Paleo diet advocate recently explained that the so-called ‘Asian Paradox’ is not a paradox because he believes that Asians have traditionally conformed to a lifestyle and diet that is comparable with his recommendations. The fact that the populations of many parts of Eastern and Southeast Asia have traditionally been slim while consuming a high carbohydrate diet, typically rich in white rice is often considered as a ‘’ by advocates and followers of carbohydrate restrictedandtype diets who hypothesize that such a dietary pattern promotes weight gain. Mark Sisson, a prominent Paleo diet advocate recently explained that the so-called ‘’ is not a paradox because he believes that Asians have traditionally conformed to a lifestyle and diet that is comparable with his recommendations. 1









Meat as a Staple in Asian Diets

Traditional Kirghiz nomadic pastoralists The evidence that Sisson provides to suggest that traditional Asian diets were rich in meat and offal is based on his observations of Chinese, Japanese, Korean, Thai and Vietnamese restaurants and Asian supermarkets in modern day United States. However, the food balance sheets from the United Nations for the early 1960s for these nations that Sisson makes special reference to, suggest that total animal food intake only amounted to between 2.5% and 10% of total caloric intake, with offal intake being almost non-existent.89 The evidence that Sisson provides to suggest that traditional Asian diets were rich in meat and offal is based on his observations of Chinese, Japanese, Korean, Thai and Vietnamese restaurants and Asian supermarkets in modern day United States. However, the food balance sheets from the United Nations for the early 1960s for these nations that Sisson makes special reference to, suggest that total animal food intake only amounted to between 2.5% and 10% of total caloric intake, with offal intake being almost non-existent. 87 As earlier dietary surveys, especially prior to World War II suggest that intake of animal foods was even lower, this casts significant doubt on Sisson's suggestion that animal foods traditionally contributed to a large portion of these populations diets. 88





91 Perhaps if Sisson would only visit a Mongolian Barbeque restaurant he would observe a meaty diet that is not only largely comparable with his recommendations, but also with the traditional diet of the nomadic pastoralists of Mongolia, Central Asia and northern China. It has been observed however that many of these nomadic populations who subsist largely on pasture raised animal foods have high rates of obesity and cardiovascular disease, and this has been frequently associated with their meaty diets. 90 92 Some of these observations were made at least as far back as ninety years ago.









It was observed that in the 1960s the rates of coronary heart disease of the nomads from Xinjiang in northern China who largely subsisted on pasture raised animal foods was more than 7 times higher than that of other populations both within Xinjiang and throughout China which had a much lower intake of animal fat.

...arteriosclerosis and degeneration of the myocardium are quite common conditions among the Inuit, in particular considering the low mean age of the population. It is clear that these populations who traditionally subsisted predominantly on large amounts of naturally raised animal foods that the Low-Carb and Paleo proponents such as Sisson promote are not a good role model of health. In the 1920s, it was observed that the nomadic pastoralists of the Kirghiz and Dzungarian Steppes in Central Asia and northern China subsisted almost exclusively on enormous amounts of fermented mare’s milk and meat from pasture raised animals. Not only was a high rate of obesity observed, but also high rates of premature extensive atherosclerosis, contracted kidney, apoplexy, arcus senilis, and gout. These pastoralists were often observed to suffer from complications related to cardiovascular disease even in their early thirties. In contrast, their urban counterparts who based their diet on soup, bread, pickles, and potatoes with very little meat were observed to be slim, free of cardiovascular disease and had very good health, even into their seventies when they were still sexually active.It was observed that in the 1960s the rates of coronary heart disease of the nomads from Xinjiang in northern China who largely subsisted on pasture raised animal foods was more than 7 times higher than that of other populations both within Xinjiang and throughout China which had a much lower intake of animal fat. 93 These findings from non-industrialized populations in Asia are compatible with the observations of a high rate of cardiovascular disease among the Inuit populations whose staple is marine animals. 94 In 1940, based on decades of clinical practice and his review of reports of medical officers dating all the way back to 1838, Bertelsen , who is considered the father of Greenland epidemiology stated in regards to the mortality patterns among the Greenland Inuit that:It is clear that these populations who traditionally subsisted predominantly on large amounts of naturally raised animal foods that the Low-Carb and Paleo proponents such as Sisson promote are not a good role model of health.







Wheat as a Staple in Asian Diets

Unleavened bread, the traditional Bedouins

predominant source of food There had been a considerable amount of research carried out in regards to diet and the health of populations within the greater Asia region that consumed a semi-vegetarian diet based largely on wheat. Examples include the Arab Bedouins and Yemenite Jews, both of which traditionally consumed on average more than 500 grams of bread per day. There had been a considerable amount of research carried out in regards to diet and the health of populations within the greater Asia region that consumed a semi-vegetarian diet based largely on wheat. Examples include the Arab Bedouins and Yemenite Jews, both of which traditionally consumed on average more than 500 grams of bread per day. 95 These populations are known for their exceptionally low rates of coronary heart disease and obesity when following their traditional wheat based diet. Perhaps the largest consumers of wheat that there is considerable data available for are the Bedouins from southern Israel. The great majority of the dietary intake of the traditional Bedouins comes from wheat, typically in the form of full-grain bread, which is especially the case for the poor who eat very little else. It was estimated that the Bedouins traditionally consumed on average 750 gm, or the equivalent of 25 slices of full-grain bread per day. 95





diseases of civilization’, including diabetes and coronary heart disease. For example sugar intake was observed to be modestly high, a trait comparable to that of the populations in Colombia, Cuba and Venezuela who have traditionally had among the highest rates of per capita sugar consumption in the world and low rates of coronary heart disease mortality. The traditional Bedouins had many dietary traits besides an extremely high intake of whole-grain wheat that are considered by advocates of Low-Carb and Paleo diets as being primary causes of obesity and the so-called ‘’, including diabetes and coronary heart disease. For example sugar intake was observed to be modestly high, a trait comparable to that of the populations in Colombia, Cuba and Venezuela who have traditionally had among the highest rates of per capita sugar consumption in the world and low rates of coronary heart disease mortality. 96 97 It was estimated that dietary cholesterol intake was only 53 mg/day and saturated fat was less than 3% of caloric intake, suggesting that animal foods as a whole contributed very little to the Bedouins diet. Meat was consumed only about once per month, and virtually never eaten by the poor. Similarly egg and especially fish intake was very infrequent, although animal milk is frequently consumed. Fat intake only contributed to about 11% of total caloric intake, with a relatively low intake of omega-3 fat and a high ratio of omega-6/omega-3 fat. Vitamin A intake was very low, and for the many women who virtually never exposed their skin outside, blood concentrations of vitamin D would have likely been on the low side. 96





It has been documented that diabetes and heart attacks were all but entirely absent in the traditional living Bedouins which had an average serum cholesterol of 4 mmol/l (155 mg/dl), and that the great majority of the population were exceptionally lean by western standards, both in terms of weight and skin thickness. 96 98 The rates of inflammatory bowel disease were also considered to be very low. 99 The few Bedouins that were observed to be obese were exclusively the wealthier elderly who rarely even walked. Being a semi-nomadic population that largely relied on walking as a means of transport, exercise has been suggested as one explanation for their exceptional low rates of obesity. However, many of the women were forced to stay inside their tents all day allowing for little exercise, yet these women with almost no exceptions were slim and free of vascular disease. 96





Researchers believe that it is the Bedouins small appetite that partly contributed to their exceptional leanness.102



Researchers believe that it is the Bedouins small appetite that partly contributed to their exceptional leanness. 96 Considering that about 90% of caloric intake was derived from full-grain wheat suggests that the wheat consumed was not a low satiety food, nor was it fattening. This hypothesis is consistent with the findings from a recent review of 38 epidemiological studies that found suggestive evidence that whole-grain bread intake favorably influences body weight. 100 Similarly, a number of controlled experiments found suggestive evidence that wheat bread assists with satiety and weight loss in low-calorie diets. 101 103 In addition, a recent large systematic review found that whole-grain cereals and bread are associated with a significantly decreased risk of colorectal cancer, type 2 diabetes and cardiovascular disease. 104

One clear downside of the Bedouins traditional diet was a very low intake of fruits and vegetables. Although an increased intake of fruits and vegetables would likely have helped to prevent a number of potential vitamin deficiencies and improved overall health, it is clear that the traditional Bedouins were very slim and had very low rates of diabetes and heart disease despite consuming a diet that Sisson considers as a primary cause of diseases of civilization.









Sisson referred to an article from a blogger, Ned Kock who analyzed the data from the China Study II with minimal control for confounding factors and found a positive association between wheat flour intake and cardiovascular disease mortality. However, Michel Blomgren, a statistics enthusiast who conducted a much more comprehensive analysis found that intake of wheat and a number of other staple grains were associated with a decreased risk of ischemic heart disease mortality. 105 The opposite was found for animal protein and both animal and vegetable fat (Fig. 2).

Figure 2. Various foods and nutrients and risk of ischemic heart disease in a multivariate regression analysis in the China Study II, ages 35-69





In the 109



Although it is clear that a small portion of the population, such as those with celiac disease will benefit from eliminating wheat from their diet, there is no need to resort to making up nonsense as Low-Carb and Paleo diet advocates such as Sisson and Wheat Belly author William Davis have done about whole-grain wheat being a primary cause of obesity and diseases of civilization.110







Although these findings may contrast the more simple analyses produced by people like Ned Kock and Denise Minger , the greater consistency with other ecological studies , as well as other lines of evidence described previously does provide some confidence for the validity of these findings. 106 107 This is not to say that this analysis is without its limitations, nor to say that an analysis with a similar degree of control examining all causes of cardiovascular disease mortality would not be more informative. However, when considered together with all other lines of evidence, this suggests that a modest intake of whole-grain wheat can be part of a health promoting diet for most people. These contrasting findings may not be considered to be all that surprising when considering that animal food intake was very strongly associated with favorable socioeconomic factors, with household income explaining up to 80% of the variance of intake between counties. Such favorable socioeconomic factors were not typically enjoyed in those counties with higher intakes of wheat, which would inevitably have had an unfavorable influence on cardiovascular disease mortality. 108 In the China Study , a higher wheat intake can probably be considered as a marker of a higher concentration of certain ethnic groups, such as those from Central Asia living in northern China. Without specific data on the ethnic breakdown of each county, this makes it difficult to determine how ethnicity may have impacted these findings. However, a number of studies examining people within some of the major ethnic groups living in northern China have investigated the association between dietary factors and obesity and other cardiovascular risk factors. For example, a study found that within several ethnic groups living in Xinjiang, the region with the highest average BMI in the China Study and home to a number of nomadic populations, meat intake was associated with an increased risk of obesity, consistent with studies carried out in other regions of northern China. 90 Although it is clear that a small portion of the population, such as those with celiac disease will benefit from eliminating wheat from their diet, there is no need to resort to making up nonsense as Low-Carb and Paleo diet advocates such as Sisson and Wheat Belly author William Davis have done about whole-grain wheat being a primary cause of obesity and 111 The idea that whole-grain wheat should be replaced with fatty meats and eggs is clearly a step in the wrong direction, and there are certainly better alternatives for people who cannot tolerate wheat.

What is the evidence?



The assertion that the populations of Eastern and Southeast Asia were traditionally slim and healthy while consuming a high carbohydrate diet is somehow a paradox suggests that populations in other parts world have not thrived on a high carbohydrate diet. Such a suggestion ignores the evidence from



The assertion that the populations of Eastern and Southeast Asia were traditionally slim and healthy while consuming a high carbohydrate diet is somehow a paradox suggests that populations in other parts world have not thrived on a high carbohydrate diet. Such a suggestion ignores the evidence from healthy populations all throughout the world