Ketogenic Diet

The Author, Richard Mackarness, was the doctor who ran Britain's first obesity and food allergy clinic. The book merges anecdotal observations from this clinic with a comprehensive review of all medical evidence throughout the world up to the mid-1970s. In the 1975 edition, this includes a historical analysis of diets from Harvey-Banting to Robert Atkins and Herman Taller, and features the work of Blake Donaldson, Vilhjalmur Stefansson and Alfred Pennington, who all promoted an Inuit-style meat-only diet. Mackarness extols the virtues of Pemmican, discusses food allergies, examines carbohydrate addiction and touches on related psychology.

Mackarness's philosophy has three main features:-

• A person's metabolism falls into one of two distinctive types, the constant-weight always-slim type, and the fatten-easily type.

• Weight gained by people in the latter group is due to an inability to break down carbohydrates fully because of a metabolic defect, and not as the public at large believe, because of weak-willed gluttony.

• Man's problems with obesity began 8,000 years ago, with the advent of cereal planting. For 4 million years before that, man was a hunter who survived by killing and eating meat, which has led to complete biological adaptation to a meat diet, but not to a cereal diet, because it is too recent.

Summary: Early nutrition research consistently showed that a properly nourished person is highly resistant to infection, whereas a malnourished one is highly susceptible. In this 1951 book, former U.S. naval surgeon Dr. Benjamin Sandler pokes holes in conventional ideas about polio and argues that the best way to have avoided the infectious disease was to eat a low-carbohydrate diet. He presents the evidence that led him to his conclusion and explains why, of all the countries in the world, the United States got hit hardest by the polio epidemic. He also details one of the most intriguing public health experiments in nutrition history, when in the summer of 1948 he convinced newspapers in the polio-ravaged state of North Carolina to publicize his low-carb diet as a means of prevention. Though the experiment was a success—the rate of polio in North Carolina changed from one of the highest in the country to one of the lowest—health officials categorically ignored Dr. Sandler’s work, and, shockingly, his book was later banned by the government. Like so much information suppressed in the early days of nutrition, Diet Prevents Polio holds great truths that merit a full examination in light of current biochemical knowledge. Published by the Lee Foundation for Nutritional Research, 1951.

One of the problems of modern living is the way in which we have departed from the things we did as we evolved. Diet is one of those things, and I believe that diet and the lack of the right exercise are the main reasons for the widespead prevalence of obesity, diabetes and heart disease.

I have always liked meat the best of all foods, and as a child I never wanted to eat my vegetables, other than the usual starchy things like bread and potatoes. As I grew out of my teens my weight suddenly shot up from 125 pounds to 186 in about six months. I was out on my own and trying to eat on the cheap, which naturally resulted in a rather carbohydrate-rich diet. (I once tried vegetarianism for about 6 months, but I felt like my body was dying, so I abandoned that trip). I was absolutely freaked at the sight of my stomach lying on the bed next to me. I went on restricted calories and lost weight down to about 150, but it was very difficult to get below that. When I became interested in ballet, and started to take classes, I found the extra weight a liability, but was unable to lose and still eat enough to have the energy for the strenuous exertions of ballet. I think that there are very few types of athletic activities with the demands of ballet training.

One day I picked up a magazine, since defunct, called Collier's, and there was an article about a way to control one's weight through diet, and the diet was one high in fat and low in carbs. The article was a review of a book titled Eat Fat and Grow Slim by an English physician, Dr. Richard Macarness. I was able to locate a copy of the book and found the theory sounded right, as I had always felt that veggies, which are almost entirely carbohydrates, weren't really food, at least not in the sense that meat was. As a kid I had the idea that we ate veggies because meat was expensive and rationed (which it was during the war).

Eat Fat and Grow Slim had as its basis the writings of an arctic explorer and anthropologist Vilhalmur Stefansson. Macarness was also familiar with the traditional "cure" for diabetes, which was to place the patient on a diet with virtually no carbohydrates. If there are no carbs in the diet, the body doesn't need the ability to make insulin, so the disease was no bother (other than the discomfort of the dietary discipline). Since we did not evolve eating carbs in the modern constant-intake fashion, our pancreas is subject to failure from over work, and perhaps it is sometimes destroyed by our own immune system due to the damage the constant flow of insulin does to the blood vessels. Remember the immune system is there to find and destroy the source of damage to our body. Diabetics, once the pancreas quits, suffer severe and rapid damage to their bodies from the high levels that injected insulin produces. Macarness also referred to a diet known as the "Blanding diet" used traditionally for the reduction in weight of very obese people. I went out and bought Stef's book and read it with growing excitement. The year was 1958....

The book by Stefansson was in its third edition in 1961, the date on the copy I now have, and this may have been the end of the publishing run, for I have not seen any copies later than this. The title is The Fat of the Land. An earlier version of the tale is called Not by Bread Alone. The Macmillan company has gone though a lot of changes since the time of the publication, and now no one at the firm seems to know anything about the book. Recently I have heard that there is a doctor in Hollywood who is putting entertainment people on this basic meat diet and getting phenomenal results in rapid weight reduction. The nice thing about this diet is that the human body does not seem to be able to store fat that is eaten in the food, so the fat you eat must be burned up. On the other hand, the body is totally unable to directly burn carbohydrates for energy, but must first convert them to fatty acids. (Guess where most of this fatty acid winds up!)

This information seems to have gotten lost in the translation, as many people think that carbs are "energy food". Nothing could be further from the truth, but since insulin is highly simulating, the insulin rush feels like "energy" to the person who has just taken in some sugar. Actually the insulin stimulates all the fat storage cells in your body as well as your brain and the little buggers start to work overtime to remove the excess glucose from the blood as quickly as they can. It is one of the ironies of life that glucose, required by the brain in small, but constant amounts, should be deadly poisonous at a higher level! (Diabetic coma).

The female hormones seem cause a strong craving for carbs, as the female body isn't fertile without a layer of fat. This makes this diet very hard for women to follow. Traditionally the women are the gatherers of fruits and (starchy) roots, while the men are the hunters. This is shown today in the different ways men and women go about buying things. The gals "shop" which is a trip through the entire store or mall in search of things to buy. They may not actually buy (gather) anything. The guys on the other hand know what they are after, and then seek it out (hunts it down) and buys it, usually then taking it home right away.

The meat diet in its purest form is similar to the diet of the stone age Eskimo, and contains no vegetables at all. That this is a healthy diet is not in dispute as the Eskimo, most of whom no longer are living the traditional life, never showed any signs of deficiencies. I have eaten this way for 39 years, perhaps not all those years as strictly as I should have, but my body is very much like it was when I was 30, about 2 inches thicker in the waist, but I don't have the kind of body that others my age have.

One of the things which we as hunters/carnivores have as a very real lifestyle requirement, is a high degree of physical activity. As hunters we had to be fit to chase and overcome our prey. Today many people do not continue a good exercise routine past teenage years. Almost all kids are almost excessively active, it is the natural thing to do, you must learn to be lazy, and I assure you the societal pressures are there to do just that. I was very active as a kid, and then when at 23 I started on with ballet, I found that the exercise was the only thing that kept my head clear. I later was into running and continued dance in various forms (good Ol' Grateful Dead!). Eventually I realized that it wasn't enough, that there had to be a more strenuous, challenging sort of physical activity in the mix, as I was losing strength and didn't like the way I looked. I was 55.

I don't think that the weight training was as hard to do at the beginning as the ballet was, but so much time had passed that I could be mistaken. Anyway the weights were HARD work at first, (and boy, were my joints and muscles sore!) but the results were fantastic. After the first few months had passed I felt great, better than I had in years. I had all sorts of people tell me things like: "you can't grow muscles after 40" (a doctor said this!). "Don't push yourself too hard, you're not a kid anymore." Then there were the guys who for some indecipherable reason were convinced that you couldn't possibly grow any muscles if you didn't eat a lot of carbs (they were fat, of course - well muscled, but fat). When I started to grow more muscles than I had ever in my life had, and pretty quickly at that, the voices were silent. I cannot understand why a muscle, which is almost purely protein, should need carbohydrates to grow, and in fact it doesn't. It does, however need fats, so if there isn't enough of them you are in trouble. Straight protein (no carbs, no fat) is not good for you, and in fact can prove quite toxic. I recommend no more than 5 grams a day of carbs, more than that seems to defeat the fat-burning stimulation of the diet.

At this point I should say something about fats. There are basically three types of fatty acids, saturated, which are the principle kind you have in your body; monounsaturated, like linoleic found in macadamia nut oil and olive oil; and the polyunsaturated kind, found in a lot of vegetable oils. These three types of fatty acids are combined (esterified) with glycerine in nature to form triglycerides, but the ones in your body fat will be the saturated kind, since that is what your body synthesizes. The best type for fuel is the saturated kind, it burns clean, not surprising since this is the kind that you are carrying around with you. There are some of the so-called Omega-3 fatty acids in all animal fat, not only in fish. The monos are good, in fact there are health benefits from having a certain amount of them in your diet. The dangerous ones are the polys. Polyunsaturated fatty acids have double bonds in the carbon chain which oxidize to form organic peroxides. These compounds are the most highly reactive of the so called "free radicals" which are associated with aging of the skin and other organs. The reason many people are taking high doses of vitamin C and E is to try to neutralize the free radicals. The joke is that they are probably creating the radicals faster than they can destroy them by consuming polyunsaturated oils in their diet.

There is a remarkable book by Uffe Ravnskov, a scientist-sceptic who has compiled a lot of information on the fat and cholestrol vs good health controversy. The books' title is "The Cholesterol Myths", and it is available through Amazon.com if not at your local bookseller. It is very enlightening, and unlike many of its genre, it has extensive references you can check. As you would guess from my mentioning it, he says fat is good for you and cholesterol has naught to do with heart disease.

There are still a lot of people who will tell you that you must "replenish" the glycogen in your muscles after exercise, even though the most rigorous experiments indicate that the glycogen levels in the muscles don't change during exercise. In fact the experiments show that the source of energy for muscular contractions is free fatty acids in a protein complex (acetylcarnitine), which is the energy source for the translation of the adenosine diphosphate back to triphosphate. The enzymes used in the muscles as they work don't originate there, but come from the liver, a good reason not to consume alcohol, which dramatically reduces the liver's ability to supply these enzymes. I have added nearly 30 pounds of muscles to my body in the last 7 years, no too bad for an old dog. You see most older guys in the gym using light weights, and they don't look so great. I didn't believe that I had to treat my self any differently at my age than anyone else. I found that I needed to have a longer period between workouts to recover, but the exercises needed to be done with the same intensity as everyone else. I currently take two days off between workouts and I try to hold the workouts down to around an hour each time (exclusive of the aerobic warm up, which is necessary to bring the liver online and provide cardiovascular health..

Obesity in the human has been widely studied by such authorities as Newburgh and Rony. It is generally accepted that fat in excess will be laid down only if food intake exceeds energy output. The treatment of obesity has generally followed this premise. Diets deficient in calories have been prescribed so that caloric intake does not exceed energy output. Weight loss should automatically follow when the instructions are faithfully followed. Indeed formulae have been devised to predict the loss in weight on a measured low caloric intake of a candidate of known height and weight. These low caloric diets are made up so as to be deficient in fat and carbohydrate and with protein at approximately 1 g. per kg. of body weight. It has been shown that weight loss can be achieved in this manner. The diet is followed and the desired results are obtained. Unfortunately, it is difficult for most patients seen in clinical practice to follow a low caloric diet. The literaturre is replete with instances of diet failure on such a regimen. The difficulty is in part due to inability to control appetite. Anorectic agents such as amphetamine, phenmetrazine hydrochloride and bulk substitutites have been utilized as a means of controlling appetite. These are of some value in the clinical mangement of an obese patient. Methods other than those of controlling appetite have also been applied. These include the administration of thyroid extract, the effect of regular exercise and psychotherapy administered both individually and in groups. However, in spite of all these methods, the long-term management of obesity presents many disappointments. Patients often lose weight only to regain it after a short interval. In many, weight loss is never achieved. 

Means other than the aforementioned have long been sought in the control of appetite. Appetite and satiety, i.e. the satisfaction of appetite, are complex problems. The latter, satiety, is dependent upon many variables. One of the chief factors is the production of body heat by the specific dynamic action of ingested food. Protein has much the highest index in this regard, while fat has the lowest." Rise in skin temperature and a resulting feeling of warmth are intimately correlated with the feeling of satiety. In fact, it has been suggested that the obese are slower in showing this rise, hence their desire for more food. Another theory relating to satiety is that of the arteriovenous (A-V) glucose difference and its regulation of glucoreceptors in the brain stem. Mayer feels that the glucoreceptors are the controlling centres of appetite and satiety. It is stated by others that satiety depends only on the body's caloric needs and the subsequent voluntary supply of calories. A most attractive hypothesis, well documented by physiological study, is that which proposes that satiety is experienced because the stomach is full. Nervous impulses are sent out to the brain when the stomach is filling or full and the sensation of satiety results. Satiety may then be related to many factors of the diet. If the bulk of food, its protein and its fat intake are increased, on the basis of some of these theories satiety may then more readily follow. Bulk, increased intake of fat and protein, and thus satiety, are not possible with the usual low caloric diet. 

As a diet for achieving satiety while effecting weight loss, the low carbohydrate diet of Pennington shows some promise. This diet allows as much bulk as desired. It is high in both fat and protein. Such a diet meets many of the requirements for achievement of satiety. It provides plenty of protein to be used for heat production by the body. Calories are supplied by the high fat intake and filling of the stomach is achieved by the usual bulky nature of the diet. Pennington claims that his patients have lost weight on this diet with a caloric intake of 3000 calories. Another consideration is that of a fat-mobilizing hormone which has been reported to be present in the urine of patients on this type of diet. Urine extracts from such fasting patients have been shiown to produce weight loss when injected into mice. Unfortunately, verification of this work has not as yet been reported by others. One may anticipate that with such a diet hunger may be avoided, appetite satisfied and a measurable weight loss achieved. The diet is not easy to follow. Its most important requirement is the strict necessity of restricting carbohydrate intake to less than 50 g. per day. One may consume as much fat and protein as desired to produce satiety. Of course diets high in fat and protein, and therefore meats, are somewhat expensive. These may be out of the reach of some economic classes. Other ethnic groups long accustomed to high carbohydrate intakes, such as Italians and Chinese, may find such a diet highly unpalatable. However, most well-motivated patients are prepared to follow such a diet. 

METHODS 

Forty-eight obese individuals were selected. These were patients attending a private practice, an industrial medical centre, or the outpatient clinic of a hospital. All expressed a desire to lose weight. A copy of the diet was given to each patient. The diet was made up to allow protein and fat ad libitunm. However, the carbohydrate component was carefully restricted to less than 50 g. per day. The object of the diet was to provide as much bulk as desired but at the same time to limit sharply the carbohydrate intake. These basic points were outlined to each patient. There were no other diet restrictions. Copies of the diet were mimeographed along with suggested menus for each meal. The patients were instructed regarding the approximate values of the usual daily foodstuffs. The high protein and high fat content foods were selected as being most useful for this type of diet. The whole regimen was reviewed with the patient after the diet had been followed for some weeks, so as to correct any misunderstanding that might have arisen. The patients at the outset found the concept of an ad libittum diet difficult to understand. However, with time they realized that the guiding principle of the extremely low carbohydrate intake (less than 50 g. daily) had first to be strictly maintained. They could then realize satiety by taking as much fat and protein as required. The patients' weights varied from 140 lb. in a young woman whose height was 58 in. to 274 lb. in an elderly woman 70 in. in height. The patients ranged in age from 16 to 62 years. They all fulfilled the true definition of obesity, being 20% more than the ideal (provided by the Metropolitan Life Insurance tables) weight for their height. Their weights were checked at monthly intervals for three months to one year. A small group, eight patients in all, were followed up for a two-year period. One patient was studied while in hospital and balance studies are available in this case (Fig. 1). The patients served as their own controls, since all had been on a low caloric diet without measurable success. At least half had used anorectic agents, seven patients had taken bulk substitutes, and eight had participated in group psychotherapy for a period of eight months. None of them showed a sustained loss of weight. 

RESULTS 

Forty-eight patients were seen initially. Of these, eight rapidly loist interest and did not wish to carry on with the diet after the first month. All of these patients complained, nonetheless, of the monotony of the diet, its constipating effect, the absence of taste and its failure to satisfy their desire for sweets. Of the remaining 40 patients, 12 felt that they were following instructions faithfully but did not lose weight. The remaining 28 patients achieved satisfactory weight loss during the period of at least six months in which the diet was followed. This loss varied from 10 to 40 lb., averaging 11/ lb. per week. Nine of the 28 patients who lost weight were able to reduce their weight to ideal chart indices.19 The others, although showing considerable weight losses during the period of study, did not reach this desired level. Results in the single case under balance study are shown in Fig. 1. The balance study was carried out on a woman (E.C.) who initially weighed 83 kg. (182 lb.). She was allowed a free diet, for the first seven days. It will be noted that the caloric intake was approximately 2800 calories and that little change in weight occurred. There was a substantial fall in weight from day 7 to day 15 when a low caloric diet of 1000 calories was taken. The high protein and fat diet of Pennington with only 50 g. of carbohydrate was followed for the final period from day 15 to day 24. The caloric value during this period was in the neighbourhood of 2000. There was a weight loss of at least 1 kg. (2.21 lb.) and, interesting to observe, a negative nitrogen balance and a positive sodium balance. The patients who did achieve weight loss showed a substantial fall as. illustrated by a representative case (Fig. 2). All patients, including those who dropped out of the study, expressed similar opinions regarding the diet. They agreed that it was monotonous and constipating. Many missed sweets and the oral satisfaction derived from sweets. However, none of the patients experienced hunger. since they were free to eat protein and fat at will. Hunger had been a factor to most of them on lowr caloric diets and they were quite familiar with this form of nagging discomfort. The new diet was preferred by them, if only for this reason. The eight patients followed up for two years maintained their weight loss w\hile following the diet. DIscussIoN The treatment of the obese patient has followxed a stereotyped pattern for the past 20 years. Prescribing a simple low caloric diet and sympathetic handling of the patient, the usual metlhod, had not been a rewarding form of clinical treatment. Usually, the patient was disturbed by a continual g,naving sense of hunger.0 Attempts to overcome the feeling of hlunger by the use of anorectic drugs and bulk substitutes have been found of value for limited periods.4 5 The use of food high in protein and fat in order to overcome hunger does not at first glance appear to be a likely treatment for obesity. However, such a diet, high in protein and fat but low in carbohydrate, has been suggested by Pennington, who has reported that weight loss can be achieved by such means.16 17 Pennington also has submitted the following theory in an attempt to show that fat and carbohydrate are metabolized in a different manner by obese as compared to normal subjects. A partial block in carbohydrate metabolism at the pyruvic acid level is postulated. Pyruvic acid becomes converted to fat. Glucose intake is increased in an attempt to overcome the block. Obesity results because of the increased intake and consequent fat deposition. By inhibiting glucose intake in the obese, Pennington feels that energy will be derived not from glucose but from fat (ketogenesis). Weight loss in the obese on such a diet is achieved through fat breakdown. The evidence for this theory is hardly complete. Our results do show that satisfactory weight loss may be accomplished by a full caloric, low carbohydrate diet. The patients ingested protein and fat as desired. Careful attention was paid to keeping carbohydrate intake to a minimum. It has been suggested that the diet was unpalatable and the caloric intake was unconsciouslv restricted for this reason, although the builk may have appeared to be sufficient. Another criticism might be that even if the total bulk and caloric intake were ingested, complete absorption may not have taken place. The answer to these points may be discussed in the light of the vork of Kekwick and Pawan,20 who have shown that obese patients will lose weight with diets of 1000 calories. Surprisingly, the rate of weight loss was increased when the composition of the diet was altered from the usual low caloric one to one predominantly made up of fat or protein. They also showed that more liberal diets, of approximately 2000 calories, sufficient to maintain an even weight in obese patients, would result in weight loss if this same caloric intake was altered to a high fat or high protein content of similar caloric value. Balance studies performed during the period showed that complete absorption occurred during the period of high fat or protein ingestion. They suggested that some aspects of metabolism are different in the obese as compared to the normal and that alteration in composition of food may alter energy output in the obese. Our results are compatible with these findings. The same studies have been extended by Pilkington,21 whose group has shown that obese patients on 1000 calorie diets consisting mainly of fat or protein, for long periods of time, lost weight at a constant rate. They found that after an initial rapid weight loss a steady state was achieved if the diet was continued for a sufficiently long period, usually months. The weight loss paralleled that seen in the usual isocaloric 1000 calorie diet consisting mainly of carbohydrate. One mtust bear in mind that these vere 1000 and not 2000 calorie diets. The detailed study on the single patient described in this report shows that weight loss occurred on a full caloric intake, consisting of high fat and protein and low carbohydrate content. The sodium balance was positive and the nitrogen balance negative during the periods of free diet and low caloric diet. However, while on the Pennington diet the sodium balance was negative and the nitrogen balance was positive. Although one is tempted to attempt it, it is not possible to interpret these findings decisively. Shifts in mineral balances are commonly observed phenomena in the obese when the caloric intake is manipulated. The patients who were successful in losing weight all did so on a liberal diet which prevented hunger and provided for satiety. All the other methods of weight reduction mentioned earlier have been utilized by the author in the past. The diet discussed was found to be the most satisfactory of all these methods in our hands. Weight reduction occurred dramatically with a rapid fall early and then proceeding slowly but surely. Only nine of the 28 were able to reach ideal weight indices.'9 The others did not do so well but did achieve significant weight losses. It is our feeling that the usual low isocaloric diet would be necessary to bring these remaining 18 subjects down to ideal weight indices, but this is not an established fact. As stated, the patients found this method of losing weight superior to others. They did not suffer from hunger, felt satisfied most 'of the time and were free to reach for food at any time. They found this to be of immeasurable comfort and thus they were able to lose weight to a greater degree and for a longer period of time than they had heretofore realized. The results reported indicated that a greater number of patients will follow such a diet for a long period with satisfactory achievement levels. 

SUMMARY Twenty-eight of 48 patients succeeded in losing weight on a liberal caloric diet high in protein and fat and low in carbohydrate, as proposed by Pennington. The results are discussed in the light of recent metabolic studies in obesity by Kekwick and Pawa.

Advice to Fat Men Is To 'Go Primitive'

Dr. Blake Donaldson insists that his weight reducing ideas are simultaneously 20 years ahead of the times and 8,000 years old. 

Donaldson, a trim 70 years old, is impressed by evidence that primitive man, for all his troubles, did not suffer from overweight. So Donaldson advises his patients to go primitive. Results, they shed a total of 4,000 pounds of fat per year. 

"The human animal " said Donaldson, while eating a big steak at a New York restaurant, "for millions of years lived just one way. He dwelled in forests and on the banks of streams. "He hunted and ate fat meat. His life was one of constant exercise. He had to be able to jump seven feet into a tree to escape a saber-toothed tiger. 

"We are fairly sure--from examining old German burial grounds and skulls found in the Arctic--that he had excellent vision, good teeth, no  arthritis or skin problems. Chances are he usually avoided the crippling and killing diseases aggravated by overweight." 

"People just refuse to believe that a ginger snap or a soda cracker is starch.

For the past four decades Donaldson has advised his overweight patients personally or through his book "Strong Medicine," to hold to the following regimen:

Do not retire before 10 p.m.; up by 6 a.m. Never sleep more than eight hours per day.

Before breakfast take a half-hour brisk walk. ("This is the most important medical advance in 8,000 years.")

For breakfast, lunch and dinner eat the same thing: one-half pound of fresh fat meat. A demitasse of black coffee three times daily is permissible.

Drink six glasses of water per day, none after 5 p.m.

Abstain from every other food, including seasoning. "It's so simple it's difficult," complained the good doctor.

"People just refuse to believe that a ginger snap or a soda cracker is starch. This is not an extreme diet. But if anybody is content to peel off three pounds of fat a week--and keep it off--my plan does it. 

"I don't object to smoking. People must have a few vices or they aren't worth talking to. They become plants.

"But I do object to flour addiction. This is a worse vice than heroin in terms of the physical damage it can do."

As Donaldson polished off his steak he confessed that being fat is not enough inducement to reduce. "It has to hurt you--either your pride or your body," he said. 

"And it's impossible to slim down some people. They simply do not obey orders. I don't think the devil himself could take fat off an opera singer."