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Diabetologia: The Carnivore Connection: Dietary Carbohydrate in The Evolution of NIDDM
Diabetologia: The Carnivore Connection: Dietary Carbohydrate in The Evolution of NIDDM
Diabetologia
9 Springer-Verlag1994
For debate
Summary We postulate a critical role for the quantity therefore result in a high proportion of people with
and quality of dietary carbohydrate in the patho- genetically-determined insulin resistance. Other fac-
genesis of non-insulin-dependent diabetes mellitus tors, such as geographic isolation, have contributed
(NIDDM). Our primate ancestors ate a high-carbo- to further increases in the prevalence of the geno-
hydrate diet and the brain and reproductive tissues type in some population groups. Europeans may
evolved a specific requirement for glucose as a have a low incidence of diabetes because they were
source of fuel. But the Ice Ages which dominated among the first to adopt agriculture and their diet
the last two million years of human evolution has been high in carbohydrate for 10,000 years. The
brought a low-carbohydrate, high-protein diet. Cer- selection pressure for insulin resistance (!. e., a low-
tain metabolic adaptations were therefore necessary carbohydrate diet) was therefore relaxed much soon-
to accommodate the low glucose intake. Studies in er in Caucasians than in other populations. Hence the
both humans and experimental animals indicate that prevalence of genes producing insulin resistance
the adaptive (phenotypic) response to low-carbohy- should be lower in the European population and any
drate intake is insulin resistance. This provides the other group exposed to high-carbohydrate intake for
clue that insulin resistance is the mechanism for cop- a sufficiently long period of time. [Diabetologia
ing with a shortage of dietary glucose. We propose (1994) 37: 1280-1286]
that the low-carbohydrate carnivorous diet would
have disadvantaged reproduction in insulin-sensitive Key words Diet, diabetes, carbohydrate, protein, evo-
individuals and positively selected for individuals lution.
with insulin resistance. Natural selection would
Geographic isolation
J Long exposure
in the European population and any other group ex-
posed to high carbohydrate intake for a sufficiently
and/or to long period of time. The hypothesis is summarised in
Starvation Agriculture
and/or
Figure 1.
Short exposure to agriculture High CHOdiet
Our hypothesis hinges on four lines of evidence.
I
Intensification
of selection
I
Relaxation
of selection
1. that during the last two million years of evolution,
humans were primarily carnivorous, i.e., flesh-eating
pressure pressure hunters consuming a low-carbohydrate, high-protein
diet
2. that a low-carbohydrate, high-protein diet requires
~ fro'fquency frequency profound insulin resistance to maintain glucose
of
R gene(s) IR gene homeostasis, particularly during reproduction
3. that genetic differences in insulin resistance and
] I
industrial
revolution
predisposition to N I D D M can be explained by differ-
ences in exposure to carbohydrate during the past
Westernization
t 10,000 years
4. that changes in the quality of carbohydrate can ex-
I High CHOdiet High Clio diet
with high glycaemicindex with high glycaemicindex plain the recent epidemic of N I D D M in susceptible
populations.
The agricultural revolution brought a sharp increase Changes in the quantity and quality of carbohydrate
in the quantity of carbohydrate consumed. When the are clearly evident across time and space and present
industrial revolution occurred in the 17th century, a plausible explanation for differences in the predis-
J. C. Brand Miller and S. Colagiuri: The carnivore connection 1285
position to N I D D M . T h e high-protein, l o w - c a r b o h y - 13. Flood J (1992) Archaeology of the dreamtime. Angus and
d r a t e diet was the nutritional b a c k d r o p for the last Robertson, Sydney
14. O'Dea K (1991) Westernisation, insulin resistance and
two million years of h u m a n evolution. It w o u l d b e
diabetes in Australian Aborigines. Med J Aust 155: 258-
surprising t h e r e f o r e if o u r g e n o t y p e did n o t change 264
in i m p o r t a n t ways to a c c o m m o d a t e this diet. Finally, 15. Mann GV, Scott EM, Hursch LM et al. (1962) The health
we are not the first to suggest that an insulin-resis- and nutritional status of Alaskan Eskimos. A survey of the
tant g e n o t y p e w o u l d h a v e o f f e r e d a survival advan- Interdepartmental Committee on Nutrition for National
tage to specific p o p u l a t i o n s c o n s u m i n g a low-carbo- Defence, 1958. Am J Clin Nutr 11:31-39
h y d r a t e , h i g h - p r o t e i n diet. O ' D e a [14] and W e n d o r f 16. Szathmary EJE, Ritenbaugh C, Goodby CM (1987) Di-
etary change and plasma glucose levels in an Amerindian
and G o l d f i n e [21] m a d e similar observations for the population undergoing cultural transition. Soc Sci Med 24:
Australian A b o r i g i n e s and the Plains Indians of 791-804
N o r t h A m e r i c a , respectively. O u r h y p o t h e s i s differs 17. Kliks M (1978) Paleodietetics: a review of the role of di-
f r o m theirs in that it recognises that m o s t h u m a n etary fiber in preagricultural human diets. In: Spiller GA,
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Acknowledgements. We thank the following people for their J Med 312:283-289
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Drs. G. Denyer, S. Lillioja, J. Miller, G. Nabhan, L. Storlein and Nabhan GR Brand Miller JC (eds) Parallels in the evolu-
N. White. tion of Australian Aborigines and Pima Indians: diet, life-
style and diabetes. University of Arizona Press, Tucson, in
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