+ Essay

Carbohydrate Addiction is Real – And It’s Killing Us
Adrian Hyland reports from the frontlines of the fat wars.

Otahuhu, Auckland
“It didn’t used to be like this.” Walter

Prince scans the road ahead as we cruise the South Auckland suburb of Otahuhu. The red and white hoardings of a Kentucky Fried Chicken outlet are coming up on our right. I look in my wing mirror for the one we passed a minute ago. Walter smiles and keeps his eyes on the road. “When I was growing up there was no McDonald’s or KFC, you had a takeaway bar. If you went to Uncle’s or Bilbo’s or any of those places they made decent burgers. There was lettuce, beetroot, tomato, onion. Fast food back then was better.” We glide past another popular contemporary food outlet: a petrol station. “See the sign? They’re selling cheap white bread, for a dollar, if you buy petrol. With an offer like that it’s hard to say no.” Walter, who was born in 1957, has lived the story of South Auckland. His mother arrived from Samoa in the late 1940s, part of a great influx from the Pacific Islands that eventually included each of her six siblings. All went on to marry Samoan partners and rear children in New Zealand. She was descended from the Chinese who emigrated to Samoa in the early 20th century to work as market gardeners. This lineage brought with it culinary privileges for her children. “Mum used to cook things like chow mein, chop suey, noodles. And seafood was cheap in those days. She’d bring home a crayfish, or we’d cut up some paua, and eat them raw with a bit of salt.” Walter turns to me. “Not that I eat paua or crayfish these days, that’s way out of my price league.” He is thin like a whippet. He works all over Auckland as a professional nurse in the elder healthcare sector. His mainly retired patients are lucky in one respect: they are from a generation that predated the Type-2 diabetes epidemic. “Diabetes is not
adrian malloch

adrian hyland is a north & south contributing writer. photographY by adrian malloch.
NORTH & SOUTH | SEPTEMBER 2013 | 55

54 | NORTH & SOUTH | SEPTEMBER 2013

Above: South Aucklander Walter Prince. “When I was growing up there was no McDonald’s or KFC, you had a takeaway bar. If you went to Uncle’s or Bilbo’s or any of those places they made decent burgers. There was lettuce, beetroot, tomato, onion. Fast food back then was better.”

a huge problem for my patients, because they spent a large portion of their life when things were different. A lot of them don’t have the problem because obesity just wasn’t prevalent when they were young.” Driving around South Auckland with him, it’s hard to see how obesity could be any more prevalent than it is right here, right now. Rates of Type-2 diabetes among Pacific Island males here run at 15 per cent, compared to the national rate of five per cent. Obesity in this part of New Zealand is now deeply ingrained – a cultural norm. Walter Prince has fought against these prevailing trends for most of his adult life. But if he is an outlier, it’s not just because

he’s a health-conscious South Aucklander. It’s because he remembers what life was like before the homogenisation that now characterises the area began, insidiously, to take over. “It was in the 1970s. We started to see the two-litre plastic bottles come in, and the price was getting quite cheap. I guess people make choices, and I think a lot of people made choices based on convenience and affordability.” We turn another South Auckland corner and roll past three bakeries in a row. Walter shakes his head. “See, back in the 60s, bread was really good quality. We used to have rye loafs – thick dense Reizenstein... good bread was cheap! Rye bread used to be a staple, you’d

buy Reizenstein in the dairy.” He pauses for a moment, thinking. “You’d have to go to a health-food store to buy bread like that now.” I remember Reizenstein, too. It disappeared in the 1980s. And I’m not seeing any health food stores on the streets of South Auckland.

The Diseases of Civilisation
“I have heard it mentioned in New Zealand that one of the greatest misfortunes which can occur to the inhabitants of an unknown island in the Southern Ocean is its discovery by some civilised navigator. This painful reflection entirely refers to the misery the people suffer from the introduction of bad habits and new diseases.” (T.R.H. Thomson, English explorer, 1854)

O
56 | NORTH & SOUTH | SEPTEMBER 2013

ut in the middle of the South Pacific Ocean, about 500km north of Western Samoa, three coralline volcanic peaks push 4km upwards from the ocean floor and break the surface as tiny barrier reefs, each protecting a central lagoon with a barrier of sand and coral rubble that never rises more than five metres above sea level. This is the landscape of Tokelau, population 1400. The three islands, whose land area totals around 12 square kilometres, have been the administrative property of New Zealand since 1925. Early visitors to Tokelau found

a people who existed on a traditional diet dictated to them by the extreme isolation of their homeland – a diet of coconut, breadfruit and fish. In 1923, a young Londoner named William Burrows, having spent several weeks as district officer in what was still at that stage pre-European Tokelau, wrote: “The natives do not seem to ‘run to fat’. It is a rare thing to see either an old man or old woman who has become ungainly, and the women especially keep their figures to an advanced age... They appear to be a healthy race.” As contact with the outside world increased in the late 1950s, and the islanders found themselves entering a trade economy that included other Pacific Islands like Samoa and New Zealand, ships bearing food imports began to arrive in the deep water outside the atolls. The freighters dropped anchor, supplies were lowered down the sides into aluminium dinghies, and intrepid couriers sped off to run the reef at high tide. The wail of the outboard motor began to echo around the coral walls of the lagoons of Tokelau, as bags of flour and sugar were whisked across the translucent pale-blue water to be offloaded with a crunch onto the shells that litter the white sand of the atolls. The Western diet had arrived, and in the second half of the 20th century an irresistible wave of social and environmental change swept over the ocean walls of this tiny society. In 1967, a young epidemiologist from New Zealand by the name of Ian Prior arrived in Tokelau. He believed that, by comparing the people who lived there with those who migrated to New Zealand, he might find some answers as to the causes of chronic “modern” diseases like diabetes and heart disease. For the next 25 years, the social and dietary patterns of the Tokelauans were scrupulously monitored by Prior and his team, with the results being finally published in 1992 by Oxford University Press. Migration and Health in a Small Society: The Case of Tokelau is more than a landmark work in the field of global epidemiology – it’s the document that predicted the global obesity epidemic, 20 years ago. The number of obese people in the world is now greater than the number of those who are starving. By zooming in on a tiny fragment of humanity, the Tokelau study paints a convincing picture of how this happened – how changing dietary patterns within Western society compromised our collective health and created an epidemic. An epidemic with a corollary – Type-2 diabetes – that is the global public health problem of the early 21st century.

A woman in Tahiti drinking coconut milk while her friend breaks open a coconut on a piece of driftwood, circa 1950.

The number of obese people in the world is now greater than the number of those who are starving. By zooming in on a tiny fragment of humanity, the Tokelau study paints a convincing picture of how this happened.

NORTH & SOUTH | SEPTEMBER 2013 | 57

getty

aground on a reef south of Fiji. For five months Tokelau had to do without the Western diet. As the New Zealand Herald reported on June 11, 1979: “There was no sugar, flour, tobacco and starch foods… and the atoll hospitals reported a shortage of business during the enforced isolation. It was reported that the Tokelauans had been very healthy during that time and had returned to the pre-European diet of coconut and fish. Many people lost weight and felt very much better, including some of the diabetics.”

A Global Epidemic

T
getty

Salmon and coconut pieces, cooked in a traditional roasting pit, are ready for a Hawaiian feast.

The data in Prior’s study shows that, in 1961, 7lb of sugar per person was imported into Tokelau. By 1980, that figure was 69lb per person. Over the same period, flour imports increased from 12lb per person in 1961 to 60lb in 1980. The household surveys in the study show that in the space of 15 years Tokelauans gradually altered the composition of their diet: carbohydrate consumption per person per day rose from 166g in 1961 to 202g in 1982. Meanwhile, fat consumption over the same period dropped, from 119g per person per day to 92g. This reversal was borne out in the percentages – in 1968, Tokelauans got 53 per cent of their energy from fat and 35 per cent from carbohydrates. By 1982, carbohydrate had taken over, and was at 45 per cent, with fat dropping to 43 per cent. These figures pale into insignificance, however, when put next to the statistics for those who left the islands, migrated to New Zealand, and were fully subsumed into the orthodoxies of Western life. Tokelauan migrants were already, as early as 1974-75, consuming 50g more carbohydrate per person per day (251g) than those based in Tokelau. The migrants were also consuming almost 20 per cent more total energy per day, and
58 | NORTH & SOUTH | SEPTEMBER 2013

three times as much cholesterol per day (340mg compared with 112mg). The consequences of 30 years of increased flour and sugar consumption? Prior and his team’s study produced conclusions that will be unsurprising to anyone familiar with the Pacific Island communities of New Zealand: “Exceptionally high incidence of diabetes, gout, and osteoarthritis among migrants is associated with the strong tendency toward higher weight gain. If one were to identify a single factor associated with the increased liability of the migrants to chronic disease, it would be weight gain.” The idea that weight gain can be attributed to a sedentary lifestyle is, in this case study, a myth: “Evidence suggests that, as a group, the Tokelauans in New Zealand may currently be more active in both their work and leisure than those in Tokelau, where energy expenditure is now more episodic.” The most extraordinary story out of Tokelau, and the one that crystallises the findings of Prior and his team to such an extent that it leaves some scientists scratching their heads, is the tale of the Cenpac Rounder, a cargo ship out of Samoa carrying imports bound for Tokelau. In January 1979 it found itself at the mercy of Cyclone Meli, and ran

here are two forms of diabetes – Type-1, which has a strong genetic component, and Type2, which is responsible for 90 per cent of all cases of diabetes in adults worldwide, and is linked to obesity. In the mid-1990s, the word “epidemic” began to be used about the disease, known in medical circles as the “silent killer”. Now in 2013 the epidemic is regularly described as the “climate change of healthcare”. Ninety million people in China live with the disease. In 2011, 1.3 million Chinese and 980,000 Indians died from related causes. In India, Type-2 diabetes rates are skyrocketing: 62.4 million people in 2011, compared with 50.8 million the year before. That’s an increase of 20 per cent in one year. According to the medical journal Nature, “The resulting healthcare costs and depletion of productivity are threatening to undo recent economic development in India.” In the UK, the National Health Service spent £10 billion in 2011 on keeping its rates down at around five per cent. In the US, $200 billion is spent on diabetes patients every year. New Zealand, a nation with a population of 4.5 million, is on what has been described as a collision course, with diabetes rates outstripping population growth. The direct health costs of diabetes alone were more than $600 million in 2011. The estimate for 2021 is three times that: $1.77 billion. The highest diabetes rates in the world, however, are in the Middle East. There, the accelerated economic development of the past 20 years has resulted in a headfirst plunge into the Western lifestyle and its accompanying diet. Qatar leads the world: one in four of its citizens is diabetic. Saudi Arabia is not far behind at 24 per cent, and in the United Arab Emirates one in five people has the disease.

Left: Foot x-ray of a 53-year-old diabetic man who developed poor circulation, ulcers and a foot infection requiring amputation of toes. Above: The temptations of sugary carbs are everywhere.

The pathological link between diabetes and rapid economic development is reinforced by a closer look at India’s problem. Nationwide prevalence in India is at nine per cent; that doubles to 20 per cent in its more prosperous southern cities. None of this data fully conveys the scale of the global epidemic – huge numbers of people are unaware they have the disease and are yet to be diagnosed.

The Silent Killer

U

p on a hill overlooking the central business district of New Zealand’s largest city, the sloping lawns of the University of Auckland campus are lit by a fierce Pacific sun. I’m sitting in inky-black shade on the patio of the old Government House with Kerry Loomes, who lectures at the School of Biological Sciences. In recent years, Loomes has spent much of his time following the patterns of the Type-2 diabetes epidemic. I ask him, is it a disease of civilisation? “I would tend to say so, yes. The most recent numbers out of the Middle East are just huge, and there seems to be a real trend towards Westernisation in these societies.” Loomes speaks quietly, in the measured, equivocal tones of an academic. This man of science, though, has the triangular upperbody shape of someone who looks after himself. It turns out his research into the path­

ology of obesity has taken him inside the discipline of bodybuilding – he entered his first competition last year. Does he think our sedentary ways have created the obesity epidemic? “It’s a minor factor, but there’s no doubt that diet is the predominant factor. The studies that have come out seem to suggest that on a carbohydrate-heavy diet people just eat more. There is an exercise component, but 60 or 70 per cent of it is diet. Exercise just makes you hungry and you eat more.” Another factor in the Type-2 diabetes equation appears to be complacency, or a lack of fear about what the disease really is and what it does. It’s just not an emotive issue. Perhaps we don’t know enough to be scared? Loomes spells out the dangers: “It’s about the ability of your body to store excess energy. We all have energy stores that need replenishing, and so, when we eat, our body converts the glucose in food into glycogen for us to store. But when that store is full it will just convert the rest, and turn it into fat. No one sees that happening inside you. “If this happens over and over then the capacity of the body to store fat becomes impaired, the fat spills over into muscle, and that’s when you get insulin resistance and high blood sugar.” High blood sugar means living with poor circulation, ulcers, possible nerve disease, and in some cases limb amputation. (Approximately half of all amputations in New Zealand are due to diabetes.) In recent

years, scientists have taken to describing the drawn-out process of physical deterioration that characterises Type-2 diabetes as “accelerated ageing”. Non-scientists might simply call it “slow dying”. This disease can get you quickly, though. Loomes: “One of the things that high blood sugar does, if you have it persistently, is it spontaneously attaches itself to proteins, which creates the whole atherosclerosis thing. If you have diabetes, your risk of having a heart attack is two to four times that of someone without diabetes. Basically, if your body isn’t storing energy efficiently, that’s when you’ll get downstream effects like clogged arteries.” Are these the same clogged arteries that we’ve been told for the past 40 years are the result of eating too much fat?

The Fad Diet that Lasted 40 Years

I

was born in 1973. Avoiding fat has been the central tenet of mainstream nutrition, the axis around which the entire food industry revolves, for the duration of my life. Somewhat surprising, then, to find out there has never been any clinical evidence to support the theory. Studies may have revealed the higher calorie count, per gram, of fat compared to carbohydrate, but recent research has shown that calories of fat, protein and carbohydrate all act differently once inside the
NORTH & SOUTH | SEPTEMBER 2013 | 59

body, making “calorie counts” irrelevant. The conspicuous paucity of hard evidence in support of the low-fat diet suggests that what has been influencing our eating habits for the last 40 years is largely a faith-based phenomenon. A quasi-religious doctrine, complete with false prophets, and multinational beneficiaries. To get any kind of rational perspective on this economic and cultural maelstrom, it’s necessary, then, to assume the position of an agnostic – to zoom out and look with a detached eye at the big picture. When you do that, the arguments line up against the low-fat diet in incriminating fashion. If we take a historical approach, a 2000year timeline of mankind’s dietary habits will reveal two things: firstly that the “lowfat period”, the first of its kind in history, is so tiny it barely registers on the timeline. Far more striking, though, is the fact when it does occur, the obesity epidemic immediately follows. If you take an epidemiological approach, you may find yourself asking how the preEuropean people of Tokelau managed to completely avoid obesity, chronic disease, and high cholesterol while living on a diet that, thanks to their coconut intake, was higher in saturated fat than any in recorded human history? Ian Prior’s migration study confirmed the islanders were less physically active than their migrant counterparts, so what kept them so healthy? The ocean breeze? You could adopt a “sports science” angle. Japanese sumo wrestlers, in their bid to pile on body fat in the weeks before a bout, do so by adopting a high-carbohydrate, low-fat diet. Sumo wrestlers will certainly vouch for the low-fat diet – it gets their body fat right up there. Of course, you could just look at the science, which on the subject of heart disease is increasingly unequivocal. In March 2010, the American Journal of Clinical Nutrition concluded that, from a meta-analysis of its 21 separate studies spanning 23 years and comprising 347,747 subjects, there was “no association between saturated fat consumption and the risk of heart disease”. That’s a study of almost 350,000 people. The paradigm shift away from the low-fat diet has been happening for a while now, especially in the US, where the most highprofile recent public health initiatives have been all about the dangers of sugar. But it may take a while yet for the hegemony of “lipophobia” – fear of fat – to disappear completely. The idea that “eating fat makes you fat” and its accompanying deterrent –
60 | NORTH & SOUTH | SEPTEMBER 2013

the heart-attack-associated image of the clogged artery – have both been welcomed into mainstream consciousness with such facility, and are so simple to comprehend, that to suggest an alternative to what has become an all-weather cultural touchstone is, in many people’s minds, just wacky.

Seventy Days of Boil-up

It’s very unfortunate that body ‘fat’ shares the same word as the ‘fat’ we eat because they are two completely different things. If people are visualising fat in their arteries, they’re really not getting it.” Ben Warren’s Essex-boy accent rings incongruously down the line from his home on an organic farm in Hawke’s Bay. “We need fats. They’re not just used for energy – they also get used for rebuilding your cellular structure, they’re precursors to your hormones, and they get burnt by your fat cells to maintain your body temperature.” Warren, an Englishman who describes himself as a souvenir from his Kiwi wife’s OE, is a nutritionist, and an expert in the growing field of “ancestral eating”. In 2010, he was approached by former All Black captain Taine Randell, who had recently returned home to his small Hawke’s Bay community of Flaxmere after living in the UK for 10 years. Randell, a Maori of Ngati Kahungunu descent, wanted to offer leadership in diet and exercise programmes, and address the obesity issues that are endemic to lowsocio-economic parts of New Zealand. “Taine came to one of my weekend seminars on nutrition, and he was really blown away by the information he was presented with. He saw an opportunity to help his community and his marae.” Randell and Warren set up a pilot study that attempted to mirror the macronutrients of what would have been a native Maori diet in the mid-1800s. For a 10-week period, 28 subjects consumed fat- and proteinheavy, traditional Maori dishes like “boilup” – off-cuts of meat with vegetables and kumara – and were denied sugary drinks and other processed carbohydrates. “I was getting worried during the programme, because they were really loving the saturated fats,” says Warren. “But we let them do their thing. It was about educating them so they’d listen to their bodies” After 70 days, the results of all this wackiness were emphatic: an average weight loss of 8.27kg per person, a statistical reduction

in the triglycerides that measure cholesterol and, most important, a significant reduction in HBA1C – the measure of how much damage has been done to blood cells by sugar, and a marker for Type-2 diabetes. The eating programme devised by Warren and Randell was similar to that undergone by Tokelauans in 1979, when the stranding of the Cenpac Rounder freighter had forced the islanders to go without flour and sugar for five months. In the case of Flaxmere, a Maori community where high blood sugar would be a default setting for many of its inhabitants, the positive health outcomes happened even more quickly, and were carefully monitored and documented. It was an intervention that produced, in just 10 weeks, findings that strongly support the prescription of a traditional – you could say pre-agricultural – diet for those with obesity-related conditions.

Ancestral Eating

A

ncestral eating, evolutionary health, paleo diet... despite the names, this is no more a “diet” than the Mediterranean diet or the Western diet. It’s an eating model, and the central idea is this: if civilisation, in the form of mass agriculture, has created new diseases, then to avoid those diseases wouldn’t it make sense to eat a pre-agricultural diet? It’s a concept that was explored in North & South’s July issue (Why Cave Girls Didn’t Get Fat), which looked at the scientific debate around potential benefits of the paleo diet. Even those advocating the principles of ancestral eating promote different versions, with the most stringent recommending we consume only what a caveman could have hunted down or fished or gathered with his hands. This leaves a surprisingly long list of foods, but excludes things like grains, dairy products, legumes and all alcohol. Some paleo practitioners even avoid fruit. At the other end of the spectrum is a man called Mark Sisson, an American former triathlete whose book The Primal Blueprint and website Mark’s Daily Apple have placed him at the forefront of the movement. The diet he advocates is a less challenging proposition – he too avoids the paleo pariahs of grains and processed carbohydrates completely, but he seems to have no real issues with dairy products, and drinks a glass of

ancestral eating diets: the most stringent would have us eating only what a caveman could have hunted down or fished or gathered with his hands.
red wine every evening. Sisson certainly puts himself out there: he could be lying on the beach in front of his Malibu home but instead he’s on his laptop answering the questions I’ve sent him out of the blue. Usually the first objection raised in any paleo conversation is the short lifespan of your typical caveman – a claim he’s quick to counter. “A study of various contemporary huntergatherer groups around the world found that their average lifespan was 72 years, which is not far off modern, industrialised countries. It’s the ‘acculturated’ huntergatherers – the ones who maintain their traditional lifestyles while having access to

modern medicine – who live the longest. That’s just like us who follow this primal lifestyle.” The hunter-gatherer outlined in The Primal Blueprint is a 21st-century creature, accustomed to modern distractions and compromises, and Sisson has equipped him with additional tools, the most attractive of which is the concept of 80/20 – one day in every five, you can toss your paleo principles out the window and eat whatever you want. “We live in a world full of temptation and insanely effective science-based marketing, and peer groups who are probably going to actively try to get you to eat the cake, or the cookies,” Sisson says. “We have to live in this world, and we have to be realistic about our situation. That’s where the 80/20 concept comes in.” Sisson is a populist, and in his book he avoids dwelling for too long on what could be perceived as dry areas of the debate – speculation over what paleolithic man really ate or didn’t eat, and the academic interests in the time periods in question. He addresses these issues, but for the most part focuses instead on the two goals common to all the different gradients of the ancestral diet: redressing the imbalance in

the modern Western diet he believes has been caused by over-consumption of carbohydrates, and overturning 40 years of institutionalised and media-driven fear of dietary fat. The Primal Blueprint repeatedly emphasises the importance of jettisoning the selfdenial and negativity that can accompany healthy eating and, unusually for a diet book, there’s no attempt to instil fear – the relentlessly positive Sisson argues that the stress involved in reading scare stories about heart attacks may well be more dangerous than anything we might eat. That claim might be open to question, but where Sisson seems to really be on firm ground is in the area of “satiety”. It is here that the debate around the ancestral diet moves beyond lifestyle magazines and into the arena of science. “On a per-calorie basis, the food we eat is nutrient-sparse. We’re getting fat because we are no longer sated by the food we eat, so our bodies are telling us to eat [more] because they’re trying to gather nutrients. It’s pretty messed up.” Let’s face it: we all know what it’s like to polish off a pizza, despite already feeling full after a couple of slices. Slowly but surely, clinical evidence that seems to explain this phenomenon is starting to arrive. Protein and fats are satiating, while carbohydrates, according to the new evidence, are not. (This is why “calories per gram” counts are now considered largely irrelevant.) While there’s little longitudinal data on the benefits of a paleo diet, a major study published this April in the New England Journal of Medicine found a significant reduction in heart attacks and strokes among those at high cardiovascular risk who followed a Mediterranean diet (high intake of olive oil, fruit, nuts, vegetables, and cereals; low intake of dairy products and red meat, plus wine in moderation) versus those advised to lower their dietary fat intake. Research so far into the paleo diet includes a small 2010 study by the department of clinical science at the University of Lund, Sweden, of 29 subjects with high blood sugar. They were split into two groups. The first lived on a paleo diet of meat, fish, fruit, vegetables, eggs and nuts, while the second dined on a Mediterranean diet of whole grains, low-fat dairy products, vegetables, fruit, fish, oils and margarine. The study’s conclusion, after 12 weeks: “A Paleolithic diet is more satiating per calorie
continu e s on pa g e 1 1 8 NORTH & SOUTH | SEPTEMBER 2013 | 61

continu e d from pa g e 6 1

We all know what it’s like to finish off a pizza when we’re already full after two slices. Slowly but surely, clinical evidence that seems to explain this phenomenon is starting to arrive.

than a Mediterranean diet.” The implications of that sentence won’t be immediately apparent to those of us who aren’t scientists. It takes a bit of further reading, in the part of the paper with a heading marked “Research Implications”, to get an idea why the scientific community is starting to take the idea of the paleo diet so seriously: “There may be a challenge to implement and adopt the Paleolithic diet on a worldwide scale in subjects with Type-2 diabetes.”

Obesity Frontline

A

nyone who wants to see Type2 diabetes in all its glory needs to take a trip to South Auckland’s Middle­­more Hospital. There’s no need to enter the building – the huge figures who shuffle around outside the entrance clutching bottles of Fanta and Coke tell the story. Most of these people aren’t even patients; they’re probably visiting family members, yet they’re exhibiting all the signs of Type-2 diabetes: the extra weight, the stiffness of movement, the lack of mobility, the addiction to easily consumed processed carbohydrates. This is the frontline of the war on obesity – and the predominantly Pacific Island communities of Counties Manukau is a Type-2 diabetes hotspot. No one knows more about the frustrating realities of trying to devise and implement public health programmes here than Dr Brandon Orr-Walker, clinical director of Counties Manukau District Health
118 | NORTH & SOUTH | SEPTEMBER 2013

Board, who sees parallels with tobacco. “The ‘evidence of harm’ for tobacco has been present for a long time, but the attempts of sovereign states to restrict the ability of tobacco companies to market continues even now to be challenging. So with large public health issues you have to take a multi-prong approach to get anything done, and in the case of obesity there’s a lack of very, very good evidence about true prevention.” We know the tipping point has already happened with smoking – the new, smokefree norm took shape with such lightning speed that it’s now a struggle to find anyone who will publicly disagree with current anti-smoking legislation. In the case of obesity, many anti-sugar campaigners in the US feel the scientific basis for such a tipping point – a game-changer to pave the way for public health warnings or possibly taxation – would be the discovery that not only are processed carbohydrates not satiating, they are, in fact, addictive. The term “carbohydrate addiction” was first coined in 1963 by Dr Robert Kemp, a British clinician who worked as a biochemist at Yale University. His work around a condition known as hyperinsulinemia led him to the conclusion that subjects in his trials, when consuming carbohydrates, were experiencing much the same internal cravings as those of cocaine or nicotine addicts. In 1995, the Department of Brain and Cognitive Sciences at the Massachusetts Institute of Technology published a study titled “Brain serotonin, carbohydrate-craving, obesity and depression”. It found: “Carbohydrate con-

sumption increases serotonin release; protein intake lacks this effect. Many patients learn to overeat carbohydrates to make themselves feel better. This tendency to use certain foods as though they were drugs is a frequent cause of weight gain.” And in June 2013, the American Journal of Clinical Nutrition published the results of a study that showed processed carbohydrates such as white bread, and food and drink with high levels of sugar, can stimulate parts of the brain involved in hunger, craving and reward. “Are carbohydrates addictive?” I ask OrrWalker. “Well, the best evidence of that would be if there was a physiologic level of withdrawal or dependency. We know if you stop a person smoking they will feel like ratshit. With an alcoholic, after two weeks they’re highly vulnerable. That’s some evidence they’re missing something, as opposed to just a preference. Addiction does force you into these strong cravings.” What does he think about the paleo diet? ‘Scientifically we can learn from it. The most interesting thing from my point of view is the idea the composition, the make-up of our diet can affect the amount we want to eat. And in a time of calorie excess, a diet that’s healthy in composition and which encourages satiety has got to be a starter.”

Mangere Bridge

C

ycling over the Manukau Harbour on the old Mangere Bridge that connects Central Auckland to South Auckland, it feels like I’m crossing some kind of divide. I know I’m not going to see Lycra-clad 30-something mums in fluoro jogging shoes and golf visors taking their prams for a run on this side of the harbour. That kind of ostentation would be frowned upon, laughed at even, south of the Manukau. South Aucklanders generally have a sense of communal pride, and it’s justified: few would argue against the idea that Manukau City is culturally the most fecund 10 square kilometres in New Zealand. Polynesian style is everywhere in Kiwi life, and it starts on the streets of Mangere, Otahuhu, Papatoetoe and Otara. White kids in the eastern suburbs try their hardest to appropriate the hip-hop panache that comes naturally to these PI kids. These boroughs ooze sporting talent. At any given time, three or four of the best rugby players in the world are from South Auckland. Jonah Lomu was born and grew

up here. Sir John Kirwan is the son of a Mangere butcher. Olympic champion Valerie Adams went to school here. Sir Edmund Hillary was from Tuakau. David Lange, born in Otahuhu, was a member of Parliament for Mangere for 23 years. He was elected New Zealand’s youngest prime minister in 1984. Lange suffered from obesity all his life, and at one point weighed 165kg. As a result of complications from Type-2 diabetes, he had his lower right leg amputated. He died of renal failure in Middlemore Hospital, aged 63. The potential for greatness in South Auckland, as it is within any multi-cultural cauldron, is limitless. So is the opportunity for self-destruction. David Lange was able to fulfil his potential. For many of his community, the obstacles presented by their lives will be too great to overcome. By the time I get off on the south side of the old Mangere Bridge, I’m hungry after half an hour on the bike. I stop at the first dairy I see. Somehow I’m not surprised when it turns out to be the convenience store equivalent of the house Hansel and Gretel discovered in the middle of the forest. I’m looking for a muesli bar, but there are none on sale here. This isn’t a convenience store, it’s a confectionery store. Its shelves are populated only by gift-wrapped offcuts from the tennis-court-sized slabs of sugar that shuttle around on conveyor belts in the world’s largest processing plants. If the government brought in a law tomorrow banning foods that contain more than 30 per cent sugar, this shop would be empty. There are two racks displaying bread, but only one kind is on sale at a discounted price: mass-produced, sliced white with all the nutritional value of an ice cream and none of the flavour. I park the bike in Walter Prince’s garage, and we set off for our drive around the South Auckland suburbs. Sitting in the passenger seat, I see a landscape that’s uniform: long, straight, wide, empty suburban streets, devoid of pedestrians, leading inexorably to a generic carbohydrate-loading hub. Here, there’s easy access to all of the globe’s most ubiquitous fast-food franchises. This is where the people are, and the people, thanks to ruthlessly effective advertising campaigns, are predominantly children. Undeveloped minds, unequipped to resist the marketing strategies of a global fast-food franchise. These kids are cannon fodder – ambling their way towards obesity, with a bag of processed carbohydrates in one hand and a bottle of processed carbohydrates in the other.

Walter, 56, has seen it happen before his eyes. He may have won his own personal battle and raised two healthy sons, both now in their 20s, but I can sense his sadness about what has happened to his wider community. “I remember when I was at school, there were only one or two big kids. I suspect they may have had problems with their thyroid or something, not so much a dietary thing. But now...” he tails off, into resignation. “Now, even just looking around here, or going to the marketplace on Saturday morning, there are a lot of kids carrying too much weight.”

An Anecdote
“Since it has been proved that fatty congestion is simply due to flour and starch, it may be inferred that a more or less strict abstinence from all floury or starchy foods leads to a diminution of flesh.”
Jean Anthelme Brillat-Savarin, The Physiology of Taste (1825).

A

ncestral eating has been around for a long time, in one form or another. I decide to find out what all the preagricultural fuss is about. As Kerry Loomes puts it: “If you go to the super­ market with the intention of buying healthy food, people without noting it lean towards the paleo diet anyway. It’s a common-sense diet.” And so it begins. On a damp Friday in May, I start on a regime basically consisting of fruit for breakfast, omelettes for lunch, and

meat and vegetables for dinner. In between, there are plenty of nuts and berries. There is no bread, no sugar, no potatoes, no rice, and certainly nothing processed. On the fifth day, in keeping with Sisson’s 80/20 concept, I go for some ice cream – something that I would never be able to remove from my diet. But I don’t feel like eating muffins or bagels so I don’t. Remaining within The Primal Blueprint parameters is proving surprisingly easy, and there’s no doubt about one thing: cooking with butter makes everything taste better. My main difficulty is in locating the whereabouts of some of the more exotic ingredients on Sisson’s list – sauerkraut, for example. After a week, I’m still unconvinced about the merits – or the taste – of this eastern European staple. I am, however, starting to notice something. I’m not getting hungry any more, at least not in the way I’m accustomed to getting hungry. There are no cravings. And I’m eating less. After two weeks, during which I have discovered almonds, dark chocolate and how good bacon tastes when you don’t remove the fat, I get on the scales. I’m unsurprised to find I have lost five kilograms, because I’ve seen it happening in the mirror all week. I actually feel lighter. There’s also a slightly disconcerting calmness – I’m vaguely aware of being in the same mood, the same state of mind, all day long. Then, the following Tuesday in the supermarket, it happens. Having just finished my paleo shopping, I put the bags down on a bench and reach for a drink of water. Gradually, as the people stream slowly through the checkouts, a feeling rises within me. A surge of emptiness that describes itself in my head with words: Is this it? No hunger, no highs and lows? Just water? Almonds? I’m aware of it when it’s happening – it lasts about five minutes, and it feels like a depressive episode of some kind. It shakes me up. By the time I get home it’s gone, but over the next few days I think about what Orr-Walker told me, about the scientific view of what constitutes addiction. It occurs to me that what I was experiencing were mild withdrawal symptoms. It’s only anecdotal evidence, but because it’s my anecdote I’ll make my own conclusions. Yes, I lost weight on the paleo diet and yes, it curbed my hunger. What I learnt from it, though, was far more challenging: that perhaps I had, to some degree, been unknowingly addicted to the processed carbohydrates most of us unthinkingly put into our body on a daily basis. +
NORTH & SOUTH | SEPTEMBER 2012 | 119

Sign up to vote on this title
UsefulNot useful