Nonalcoholic Fatty Liver Disease
Posted on April 1, 2011 by Christopher Masterjohn • 13 Comments

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A Silent Epidemic of Nutritional Imbalance

Over seventy million Americans may have nonalcoholic fatty liver disease.1 The disease begins with the accumulation of fat within the cells of the liver, but can progress to inflammation, the development of scar tissue, and in some cases death from liver failure or cancer.2-4 Simple accumulation of fat within the liver generally proceeds without producing any overt symptoms, but it is not necessarily harmless. The liver regulates blood glucose and blood cholesterol levels, plays a critical role in burning fat for fuel, helps eliminate excess nitrogen, contributes to the metabolism of endocrine hormones, stores vitamin A, protects against infections, and detoxifies drugs and environmental toxins.

Any type of damage to the liver is thus likely to impact whole-body health. Indeed, fatty liver disease increases the risk of cardiovascular disease three-fold in men, fourteen-fold in women, and seven- to ten-fold in type-one diabetics.5-6 Fatty liver is thus a dangerous silent epidemic, and as we will see, it is likely caused by the overabundance of calorie-rich, nutrient-poor refined foods and the banishment of traditional sources of choline like liver and egg yolks from the modern American menu.
Relation to Obesity, Diabetes, and Insulin Resistance

Samuel Zelman, a medical doctor from Topeka, Kansas, published the first human case series connecting fatty liver disease to obesity in 1952.7 Zelman decided to examine a group of obese patients for fatty liver after observing the disease in a hospital aide who drank twenty or more bottles of Coca-Cola per day. This obscene amount of soda provided 1,600 calories of sugar and the caloric equivalent of a pint or more of whisky per day. Obese people were so hard to find at the time that it took Zelman a full year and a half to find twenty obese people who were not alcoholics. All of his subjects showed some degree of liver damage, and about half had a significant degree of fatty liver disease.

Zelman knew that fatty liver occurred in the earliest animal models of obesity involving genetics or surgical damage to the hypothalamus,8-9 and suggested that hypothalamic damage, biological inheritance, and “psychological factors” contributed to obesity in humans. He proposed that obesity increased the caloric requirement and led to cravings for energy-dense, nutrient-poor foods that increased the need for choline and B vitamins. These foods then overloaded the liver with energy but failed to provide the nutrients needed to process that energy, resulting in fatty liver.

Zelman’s obese subjects universally preferred a diet rich in carbohydrate and fat but poor in protein. The one exception was a man who “related a fantastic story of fondness for the ingestion of huge beefsteaks,” but Zelman distrusted his story because the man’s psychiatrist had accused him of being a pathological liar. Zelman prescribed a diet containing “as much protein as possible,” emphasizing beef liver, lean fish, and lowfat dairy products such as skim milk and cottage cheese, as well as extra B vitamins and choline.

Zelman was likely on the right track when he identified nutrient density as an important component of a therapeutic diet, but his opposition to both fat and carbohydrate likely contributed to his regimen’s ultimate lack of success. He reported “as much difficulty and discouragement in dealing with the craving for carbohydrate- and fat-rich foods manifested by the obese as with the craving for alcohol of the chronic alcoholic.” Only two of his twenty subjects lost weight. He retested them for fatty liver and found some improvement, but he never reported completely successful resolution of obesity in any of his patients and consequently failed to document the success of his program in treating fatty liver.

Although type-one diabetes is much less common than obesity, it had been connected to fatty liver disease as early as 178410 and the resolution of diabetic fatty liver was an early objective of insulin therapy.11 Physicians identified the connection between alcohol consumption and fatty liver disease in the 1830s,12 however, and in the middle of the twentieth century the connection to obesity and diabetes was lost from mainstream consciousness as alcohol came to be seen as the exclusive cause of the disease. At least as early as the 1970s, this exclusive association of fatty liver with alcoholism had become so ingrained that physicians simply accused their patients of lying if they presented with fatty liver but denied drinking alcohol.13

In 1980, Jurgen Ludwig and other physicians from the Mayo Clinic produced a report of twenty patients with nonalcoholic fatty liver disease.13 Ninety percent of the patients were obese, 35 percent had heart disease, 30 percent had gall bladder problems, and 25 percent had type-two diabetes. These physicians coined the term “nonalcoholic steatohepatitis,” to describe the disease and abbreviated it “NASH.” The creation of a specific term for the nonalcoholic manifestation of the disease promoted greater awareness of this form, facilitated the organization of an entire research field devoted to its study, prevented doctors from accusing patients of lying about their alcohol intake, and, in the words of the Mayo Clinic physicians themselves, spared doctors “the embarrassment (or worse) that may result from the ensuing verbal exchanges.”

Since the Ludwig group’s landmark paper, numerous studies have confirmed the relation between fatty liver, obesity and diabetes. Autopsy14-15 and ultrasound16-17 studies have shown that rates of fatty liver are five- to fifteen-fold greater in obese individuals than in lean individuals and that the disease is present in up to three quarters of obese people. Similar studies have shown that 45 percent of type-one diabetics and 70-85 percent of type-two diabetics have fatty liver.6, 18-19 Moreover, even in the absence of diabetes and obesity, those with the lowest insulin sensitivity have the highest accumulation of liver fat.20
SIDEBAR: THE FUNCTIONS OF THE LIVER
The liver is the largest gland in the human body, accounting for about 2.5 percent of total bodyweight; it plays a large number of roles in promoting the health of the entire body. The liver regulates blood glucose and cholesterol levels, contributes to fat-burning, helps eliminate excess nitrogen, filters pathogens and particulate matter that would otherwise enter the bloodstream, detoxifies drugs and environmental toxins, and promotes the elimination of toxic chemicals and metals from the body.The liver is divided into four lobes, which include the left and right lobes as well as two smaller lobes called the quadrate and caudate lobes. Just under the right lobe lies the gall bladder, which acts as a reservoir that holds up to two to three tablespoons of bile. The blood supply to the liver is unique in that it comes from two sources. Blood that is rich in nutrients but relatively poor in oxygen flows from the stomach and intestine to the liver through the portal vein. This constitutes 60 to 70 percent of the blood that reaches the liver. Oxygen-rich blood from the lungs flows to the liver through the hepatic artery, which constitutes the remainder. These vessels infuse the liver tissue with blood through a network of large, irregular capillaries called sinusoids, until the blood finally leaves the liver through the central vein.

Almost 95 percent of the cells in the liver are hepatocytes, which carry out the basic metabolic functions of the liver. The lining of the sinusoid itself is composed of sinusoidal endothelial cells, which are separated by small gaps that allow the passage of nutrients from the sinusoid to the hepatocytes. Several other cell types abide within the sinusoids, including stellate cells, Kupffer cells and a small number of pit cells. Stellate cells store vitamin A and lay down materials of the extracellular matrix such as collagen. Kupffer cells and pit cells are both members of the immune system. Kupffer cells are macrophages that function to remove bacteria and their byproducts, viruses, and undesirable particulate matter from the blood. Pit cells are natural killer cells that form a defense against viruses and tumors.

In the fasting state, or when eating a high-fat, low-carbohydrate diet, we derive much of our energy from fats. The liver is responsible for converting fats into ketones and sending them into the blood so that other tissues may use them for energy. The liver also processes amino acids into glucose and disposes of excess nitrogen left over from this process as ammonia. In the fed state, however, and especially when we have eaten carbohydrates, insulin causes our liver to stop making ketones and glucose and to synthesize triglycerides instead, package them into very low-density lipoproteins (VLDLs), and send them into the bloodstream. When humans become insulin resistant, however, these processes go awry. The liver continues to synthesize triglycerides in response to insulin, but stops suppressing the synthesis of glucose. As a result, blood glucose levels rise, and the pancreas must secrete extra insulin to keep them under control. This extra insulin causes the liver to make even more triglycerides. The end result is poor control of blood glucose and elevated blood triglycerides.

The liver closely ties together the regulation of blood lipids with the production of bile. Although the liver produces less than a sixth of the body’s cholesterol, it is the primary organ that expresses the LDL receptor, which takes up cholesterol-rich LDL particles from the blood. This not only lowers the cholesterol concentration in the blood, but also protects delicate components of the LDL particle from oxidation by ensuring that the particle is taken into cells before its stores of antioxidants run out. The liver then breaks down LDL particles and uses the cholesterol within them to synthesize bile acids, which promote the absorption of fat-soluble nutrients in the intestine. Thyroid hormone accelerates this process by signaling to the liver that the body is in a state of abundance and thus directing it to increase its expression of the LDL receptor, while many natural plant substances accelerate this process by causing the excretion of bile acids and causing the liver to divert more cholesterol into bile acid production.

Contrary to the popular misconception that the liver “stores toxins,” its actual function is to process toxins into forms that can be more easily excreted. It mixes these processed toxins into the bile, together with toxic metals, glutathione, and many other substances before sending the bile out into the intestine. Glutathione protects the intestines from oxidative damage and is efficiently reabsorbed. We excrete most toxins that are packaged into the bile through either the feces or urine, but there are some “poorly behaved toxins” that constitute exceptions. For example, methyl mercury and arsenic are efficiently reabsorbed and circulate through the body repeatedly. Diclofenac, a non-steroidal anti-inflammatory drug (NSAID), uses its excretion into the bile as an opportunity to cause intestinal damage. By and large, however, the excretion of toxic drugs, metals, and environmental chemicals into bile means their safe elimination from the body.

The liver plays many other important roles, including the metabolism of steroid hormones and the partial activation of vitamin D to 25-hydroxycholecalciferol or 25(OH)D. It should be clear from these many roles that damage to the liver of any form could potentially contribute to the development of many other diseases. Thus, ensuring proper liver function is imperative to supporting whole-body health.

REFERENCES: Luxon, BA. Anatomy and Physiology of the Liver and Biliary Tree. In: Bacon BR and Di Bisceglie AM, eds. Liver Disease: Diagnosis and Management. Philadelphia, PA: Churchill Livingstone (2000) pp. 3-15.; Jaeschke H. Toxic Responses of the Liver. In: Klaassen CD, ed. Cassarett and Doull’s Toxicology: The Basic Science of Poisons: 7th Edition. New York, NY: McGraw-Hill Proffessional (2008) pp. 557-582.

Since nonalcoholic fatty liver disease was rarely diagnosed before 198013 and since even today most people with fatty liver are probably not diagnosed,21 there is no way to track its prevalence over time. The prevalence of diagnosed diabetes in the United States, however, has increased from five to eight percent since 1988,22 and the prevalence of obesity has increased from about 15 percent to 35 percent since 1960.23 Given the high prevalence of fatty liver in obese and diabetic populations, we have likely experienced the emergence of a silent epidemic of fatty liver disease as the prevalence of obesity and diabetes has grown over the last few decades to reach epidemic proportions.
Diagnosing Fatty Liver Disease

Biopsy, ultrasound and magnetic resonance spectroscopy (MRS) are all legitimate methods of diagnosing fatty liver,6, 16-19, 21, 24-25 although ultrasound can sometimes fail to detect moderate cases of fat accumulation. Even though physicians often refer patients to biopsy when they have elevated liver enzymes,24 nearly 80 percent of patients with fatty liver have normal levels of these enzymes.21 In fact, in ten women who recently developed liver problems on an experimental diet low in choline, nine developed fatty liver but only one developed elevated liver enzymes.26 Fatty liver should therefore be suspected on the basis of obesity, diabetes and insulin resistance rather than elevated liver enzymes.
Fatty Liver As a Nutritional Imbalance

A well-functioning liver supports our health in many different ways (see sidebar). It is therefore deeply concerning that fatty liver is an independent risk factor for cardiovascular disease,5-6 as this would suggest that the disease may in fact compromise liver function and contribute to other degenerative diseases. Learning how to prevent and treat fatty liver, then, is critical.

In order to understand how our livers get fat, we must first realize that fatty liver disease occurs in two distinct stages (see sidebar for more detail). In the first, called simple steatosis, fat accumulates within the cells of the liver. In the second stage, inflammation, the proliferation of fibrous connective tissue (fibrosis), and eventually the formation of scar tissue (cirrhosis) ensue. In modern terminology, “nonalcoholic fatty liver disease (NAFLD)” refers to the full range of these disease states, while “NASH” refers only to the inflammatory stage.27

A number of experimental diets are currently used to study nonalcoholic fatty liver disease in laboratory animals, including diets high in fat, high in fructose, or deficient in choline and methionine. None of these models fully resembles the human situation, probably because they all emphasize single factors carried to extremes, whereas the human situation reflects a combination of several contributing factors (see sidebar).

The totality of the evidence suggests that the initial accumulation of fat in the liver is triggered by nutritional imbalance. As Zelman suggested in the 1950s, fatty liver seems to occur as a result of too much energy flowing through the liver without sufficient nutrients to process it. The accumulation of delicate fats, especially polyunsaturated fatty acids (PUFAs), increases the vulnerability of the liver to oxidative and inflammatory insults in the form of infections, toxins, or poor metabolism. These insults launch the progression from the first stage of simple fat accumulation to the second stage of inflammation.

The key culprits, then, are nutrient-poor refined foods, choline deficiency and polyunsaturated oils. The interaction between these factors can be seen by turning to the history of the development of animal models for fatty liver disease.
The Role of Refined Foods

In 1924, George Burr joined the laboratory of Herbert Evans, where Evans and Katherine Scott Bishop had recently discovered vitamin E.66 Evans and Bishop were having trouble reproducing their vitamin E-deficient diet, and Burr helped them develop a highly purified diet based deficiency that vitamin E could not cure, which Burr and his wife Mildred later identified as essential fatty acid (EFA) deficiency.67-68 Observing the fact that the annual per capita consumption of sugar in the United States had tripled over the preceding decades from 38 pounds to 115 pounds, Clarence Martin Jackson conducted a comprehensive analysis of the anatomy and tissue characteristics of rats fed Burr’s EFA-sufficient, 80 percent sucrose control diet.69 He compared them to rats fed 45 percent sucrose or 45 percent starch. Neither the 45 percent sucrose diet nor the 45 percent starch diet produced fatty liver, but the 80 percent sucrose diet produced moderate to severe cases of the disease. He noted that the liberal provision of cod liver oil, dried yeast and wheat germ satisfied the nutritional needs of the rats in all treatment groups, and that smaller amounts of sucrose may contribute to fatty liver in humans consuming nutritionally deficient diets. Indeed, dietary protein, methionine, and choline were later shown to protect against sucrose-induced fatty liver.12

In 1977, the American Institute of Nutrition (AIN), the principal professional organization for nutritional research scientists in the United States, developed standards for cereal-based, purified and chemically defined rodent diets.70 The purpose of the purified and chemically defined diets was to standardize diets between studies, so that toxicologists could easily make comparisons between one study and another. The days of cod liver oil, yeast and wheat germ were over. The days of purified vitamin and mineral mixes were now ushered in.

The AIN initially designated the purified diet as “AIN-76,” but they increased the vitamin K concentration ten-fold three years later in response to reports of excessive bleeding.71 They designated the new diet “AIN-76A.” Both of these diets were 50 percent sucrose and 15 percent starch, much lower in sucrose content than the diet that Jackson had used to induce fatty liver just a few decades earlier. Nevertheless, reports quickly began to surface of fatty liver developing spontaneously in rodents fed the AIN-76A diet.72 Reducing the concentration of sucrose from 50 percent to 20 percent resolved the fatty liver. Because of this and several other adverse metabolic effects of sucrose, the AIN released a new diet in 1993 and reduced the sucrose content to 10 percent, with the remainder of the carbohydrate supplied by cornstarch and a small amount of dextrinized cornstarch to aid in pelleting.73-74 As a result of many other problems that had surfaced with the diets, the AIN also increased the amount of vitamins E, K and B12, increased the calcium-to-phosphorus ratio, substituted soy oil for corn oil, and added various trace minerals not yet known to be essential.
SIDEBAR: The “Two-Hit ” Hypothesis of Nonalcoholic Fatty Liver Disease
The fact that some people who develop simple accumulation of fat in their livers, called steatosis, never develop the inflammatory form of fatty liver, called NASH,28 led to the “two-hit hypothesis.”29 This hypothesis considers steatosis to represent the results of a “first hit” that may itself be relatively benign, but nevertheless increases the vulnerability of the liver to a “second hit” in the form of oxidative or inflammatory insults that trigger the progression to NASH.This concept is supported by studies showing, for example, that genetically obese laboratory animals develop steatosis, but only develop strong evidence of NASH if they are treated with an inflammatory bacterial byproduct called endotoxin.30 Vitamin E, a fat-soluble antioxidant, is able to block this effect,31 showing the close relationship between inflammation and oxidative stress.

The “first hit” is likely caused by increased synthesis of fat from carbohydrate,32-33 increased release of free fatty acids from fat stores into the blood stream,34 decreased burning of fat for fuel,35 and impaired export of triglycerides from the liver.36 These all lead to the accumulation of fat in the liver. The “second hit” involves the oxidative destruction of this fat, called lipid peroxidation.31, 37 The mere accumulation of oxidizable fat within the liver itself may increase the risk of lipid peroxidation.38 Impairment of mitochondrial function,39-42 spillover of fatty acids from mitochondria to other sites of fat-burning that burn fat in a much “dirtier” way,43-44 and inflammation30 further contribute to the development of NASH. Although some studies have failed to document progression from steatosis to NASH,28 others have documented a high rate of progression.2 A study published last year tracked people with steatosis for three years.2 A little less than half either stayed the same or got better, but almost 40 percent developed borderline NASH and over 20 percent developed fullfledged NASH.

Simple steatosis may not be as benign as it appears. Among type-one diabetics in one study, those with steatosis were seven- to ten-fold more likely to have cardiovascular disease (CVD), and steatosis correlated with CVD independently of traditional risk factors.6 Another study tracked apparently healthy Japanese for five years.5 Those with steatosis at the beginning of the study were almost four times more likely than those without steatosis to develop CVD by the end of the study. When the researchers looked at the effect in men and women separately, the risk was increased three-fold in men and fourteen-fold in women. Remarkably, when they combined fatty liver into a statistical analysis with “metabolic syndrome”—a hodge-podge of symptoms including abdominal obesity, high blood pressure, elevated fasting glucose, elevated triglycerides, and low HDL-cholesterol—only fatty liver significantly predicted the risk of CVD. These studies do not prove cause and effect, but they do suggest the possibility that fatty liver deranges whole-body metabolism and contributes to negative health effects far beyond the boundaries of the liver itself.

Why did sucrose prove so much more harmful in the context of the purified AIN-76 diet than it did when Jackson provided it in combination with cod liver oil, yeast, and wheat germ? In all likelihood, the provision of these unrefined foods supplied a wide variety of interacting vitamins, minerals, and other nutritional substances that aided in the metabolism of the sugar, helping the liver to burn it for energy, store much of the excess as glycogen, and export any fat made from it into the bloodstream. We will never know the exact nutritional composition of Jackson’s diet. We do know from other studies, however, that supplying extra choline in the diet provides powerful protection against fatty liver, whether induced by sugar, alcohol, or fat.
The Role of Choline

The discovery that choline could prevent the accumulation of fat in the liver was a byproduct of the seminal animal research conducted during the 1920s and 1930s showing that type-one diabetes was a disease of insulin deficiency. Physiologists first identified the role of insulin deficiency in type-one diabetes by studying the disease in dogs. In 1889 they produced diabetes by simply taking out the whole pancreas from these dogs and, after scrambling for a couple decades to identify the active component, they cured the diabetes with insulin in the early 1920s.75
SIDEBAR: Animal Models of Fatty Liver Disease
Researchers use a number of experimental diets to induce fatty liver in animal models, but none of them perfectly replicates the disease as it occurs in humans.HIGH-FAT DIETS : Rats consuming about 45 percent fat from coconut oil or butter do not develop steatosis even after fourteen weeks.45 Diets composed of 60 percent fat made mostly from lard cause steatosis to develop within eight weeks, but produce little evidence of NASH.46 Diets containing 70 percent fat made mostly from corn oil administered by gavage,47 intragastrically,48-49 or in liquid form50 induce clear evidence of NASH. In fact, a corn oil-based liquid diet will induce NASH in as little as three weeks.50 It is difficult to directly compare these studies because of the obvious differences in study design, but they do seem to suggest that corn oil is particularly noxious. Indeed, in nutrient-deficient and alcoholic models of fatty liver, replacement of corn oil with beef fat, cocoa butter or medium-chain triglycerides proves protective.51-53 Substitution of palm oil for fish oil also proves protective in the alcoholic model.54 High-fat diet models of fatty liver disease resemble the human situation in that they induce obesity,46 insulin resistance,50 and the spillover of fatty acids from the mitochondria to other sites where the fatty acids burn much “dirtier.”50 Their emphasis on polyunsaturated oils, moreover, resembles the great increase in linoleic acid and slight decrease in saturated fat that has occurred in American diets as the epidemic of fatty liver has emerged55-56 and the higher intake of omega-6 fatty acids found in NASH patients.57 These diets, however, are so high in fat that they suppress the synthesis of fat from carbohydrate, which is actually elevated in humans with fatty liver disease.33

HIGH-FRUCTOSE DIETS : Diets containing 60 percent fructose cause increased blood triglycerides, insulin resistance, and steatosis in mice within five weeks.58 Over the course of 16 weeks, diets containing 30 percent glucose and 30 percent fructose will even induce mild inflammation.59 These models resemble the human situation in that synthesis of fat from carbohydrate is increased, and resemble the 30 percent increase in total fructose that has occurred since the introduction of high-fructose corn syrup60 as well as the statistical association between sweetened soft drinks and fatty liver.61-62 These diets, however, fail to induce obesity. They are very ineffective at inducing NASH, and what little inflammation does occur primarily occurs where blood enters through the portal vein,59 while in humans inflammation tends to occur where blood exits through the central vein.13

METHIONINE-AND CHOLINE-DEFICIENT (MCD) Diets : Severe deficiency of methionine and choline impairs the ability of the liver to export triglycerides into the blood stream, which also occurs in humans.36 The deficiencies are so severe, however, that they induce weight loss instead of obesity. Although they make the liver insulin resistant, they actually increase whole-body insulin sensitivity.63-64 Nevertheless, MCD diets are useful for demonstrating the combined effects of different models. MCD diets are not just deficient in methionine and choline. They are usually loaded with sugar and corn oil as well. Fructose, as a component of sucrose, is required for the development of steatosis,65 while corn oil is required for the progression to NASH.37 Unlike the model using fructose alone, the inflammation occurs in a pattern consistent with human fatty liver.37 The experimental model that would most closely resemble the human situation would be a combination of sugar, polyunsaturated fat, and a much more moderate form of choline deficiency.

Although cured of diabetes, the insulin-treated dogs nevertheless developed severe fatty liver degeneration and ultimately died of liver failure. Adding raw pancreas to their diet, which was composed of lean meat and sucrose, cured the problem. As researchers attempted to discover what it was in raw pancreas that cured the disease, they found in the early 1930s that egg yolk lecithin, which is abundant in choline, could cure it.76 Then they found that choline alone could cure it.77

It later turned out that the dogs became deficient in choline and methionine without a pancreas because they were not producing the digestive enzymes needed to free up those nutrients from the foods they were eating. Thus, simply providing them with the digestive enzyme trypsin could cure the fatty liver.78

In 1932 a group of researchers decided to replicate the fatty liver seen in the dogs in a nondiabetic rat model. What better way to stuff their livers with fat? Feed them fat! It seemed simple enough and it did indeed work. Although they had trouble reproducing the fatty liver with different colonies of rats or during the summer heat, they produced fatty liver in certain colonies of rats during the winter by replacing 40 percent of their ordinary cereal-based diet with beef drippings. Choline-rich lecithin derived from egg yolk or beef liver or simply choline itself cured the disease.79-80

Another group of researchers, however, tried to replicate this experiment in a group of rats who were consuming sufficient protein to maximize growth.81 They thus fed them 40 percent beef drippings but replaced another 20 percent of their cereal grains with the milk protein casein. This experiment failed miserably (Figure 1a). The researchers suspected that the casein might have been the problem, and they were indeed correct: on a choline-free, 40 percent beef dripping diet, reducing the casein from 20 to 5 percent doubled the level of fat in the liver (Figure 1b).82

We now know that choline is necessary to produce a phospholipid called phosphatidylcholine. This is a critical component of the VLDL particle, which we need to make in order to export fats from our livers. The amino acid methionine can act as a precursor to choline. Thus, the combined deficiency of choline and methionine will severely impair our abilities to package up the fats in our livers and to send them out into the bloodstream.83 This explains why casein was so effective at preventing fatty liver: it provided the rats with methionine that they could use to make choline.

Similarly, in 1949 a group of researchers showed that sucrose and ethanol had equal potential to cause fatty liver, and that increases in dietary protein, extra methionine and extra choline could each completely protect against this effect.12 Over fifty years later, in our own decade, researchers have shown that choline deficiency likewise causes fatty liver in humans.84 Thus, choline eventually proved capable of preventing fatty liver regardless of whether it was induced by feeding sugar, fat, or alcohol. These studies suggested that virtually any form of energy delivered to the liver can cause the accumulation of fat, so long as key nutrients needed to metabolize that energy—such as choline—were missing.
The Role of Polyunsaturated Oils

The initial experiments showing the protective effect of casein suggested that long-chain saturated fats might be more problematic than unsaturated fats or medium-chain fats (Figure 2a). As it turns out, saturated fats actually increase the need for choline slightly more than polyunsaturated fats (Figure 2b).85 Why this happens is unclear, but it may be that the body is quick to burn polyunsaturated fats for energy, since having them hang around is so dangerous. After all, if they hang around, they are likely to contribute to oxidative damage.

Spring2011_masterjohnfig1
Figure 1. A. When rats were fed 20 percent casein, none of the different fats tested brought the level of fat in the livers above normal. B. When the amount of casein was reduced, fatty liver ensued. From references 81 and 82.

There is some experimental evidence suggesting that polyunsaturated fats may impair the export of fats from the liver by facilitating oxidative damage of the proteins involved.86 This evidence comes from isolated cells and live animals injected with fatty acids. Substituting coconut oil for corn oil prevents steatosis in some,52 but not all,37 studies using choline-deficient diets. Polyunsaturated oils are probably most likely to contribute to the accumulation of liver fat when combined with other factors that favor oxidative stress such as alcohol abuse, iron overload, toxin exposure, and poor metabolism.

There is much stronger evidence that polyunsaturated oils are responsible for the progression from simple steatosis to NASH.37 Substitution of carbohydrate, coconut oil or beef tallow for corn oil all prevent the oxidative damage and inflammation that results from methionine and choline deficiency during this stage of the disease.37 High-fat diets, moreover, only cause overt NASH when they are based on corn oil (see sidebar). These effects may result from a high intake of total PUFA, or may result from a high ratio of omega-6 to omega-3 fatty acids. Both of these factors are likely to play a role.
A Combination of Factors

As nonalcoholic fatty liver disease has emerged over the last several decades, refined foods have become commonplace. Liver has virtually disappeared from the American menu, and eggs have fallen victim to the anti-cholesterol campaign. These foods are the principal sources of choline (see Table 1). Total fructose intake has increased 30 percent, and intakes of linoleic acid, the major omega-6 PUFA, have doubled.56, 60 It is likely that all these factors have conspired to produce the current epidemic.

Each of the experimental diets often used to induce fatty liver in laboratory animals—diets high in fat, high in fructose, or deficient in choline and methionine—fail to completely capture the picture of human fatty liver disease. When these factors are combined, however, the picture begins to emerge (see sidebar).

The requirement for choline and the propensity to develop fatty liver is influenced by a person’s genetics and background diet. Diets rich in fat or fructose will require more choline than diets rich in starch. Vitamin B6, folate, vitamin B12 and betaine (a nutrient found most abundantly in spinach and to a lesser extent in wheat and beets) all reduce the requirement for choline. A person’s ability to make choline out of the amino acid methionine depends on his genetics, and preliminary studies suggest that Asians are better able to make this conversion than Caucasians.87-91

Spring2011_masterjohnfig2
Figure 2. Left: Predominantly unsaturated or medium-chained fats produced less steatosis than predominantly long-chain saturated fats. Right: A diet containing 30 percent butter produced a choline requirement that was 30 percent higher than a diet containing 30 percent corn oil when fed to rats. From references 81 and 85.

Many other nutritional, metabolic, and lifestyle factors are likely to play a role in fatty liver as well, by influencing the liver’s ability to store carbohydrates as glycogen and to burn carbohydrates and fats for fuel. Thus, while there are special roles for including egg yolks, liver, other organ meats, and spinach in the diet, as well as avoiding polyunsaturated oils and refined foods—especially sugar—there is likely to be a wide range of different diets that can promote liver health. What they all have in common is that they are ancestral diets, rich in nutrient-dense foods that we are well-adapted to, rather than the displacing foods of modern commerce. The emergence of fatty liver as a silent epidemic in the modern era is a call to nourish our livers with age-old traditional wisdom as we pursue the vibrant health of our ancestors.

TABLE 1. Choline in Selected Foods
Data taken from the USDA Database for Choline Content of Common Foods. http://www.nal.usda.gov/fnic/foodcomp/Data/Choline/Choline.pdf
Food 	Choline (mg/100 g) 	Food 	Choline (mg/100 g)
			
Egg yolk, raw 	682 	Pistachios 	72
Beef liver, pan-fried 	418 	Chicken, roasted 	66
Chicken liver, pan-fried 	309 	Salmon, dry heat 	65
Whole egg, raw 	251 	Cashews 	61
Turkey Heart, simmered 	173 	Pine nuts 	56
Wheat germ 	152 	Almonds 	52
Bacon, pan-fried 	131 	Macadamia nuts 	45
Mutton, roasted 	100 	Brussels sprouts, boiled 	41
Turkey gizzard, simmered 	82 	Pecans 	41
Shrimp, canned 	81 	Broccoli, boiled 	40
Hamburger, broiled 	81 	Cauliflower, boiled 	39
Adventures in Macro-Nutrient Land
Posted on April 2, 2003 by Sally Fallon and Mary G. Enig, PhD • 0 Comments

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win02-macronutrient1When Alice fell down the rabbit hole, she found herself in a bewildering world where magic potions made her grow large or small, where school masters taught reeling and writhing and where tea parties lasted all day long.

Should Alice suddenly develop an interest in nutrition today and begin to read popular books on the subject, she would find herself in a bewildering world where small things are made large and large things small, where nutrition commentators engage in much reeling and writhing and where the academic tea party on macronutrient values never ends.

For in the academic world funded by the food processing industry, macronutrients (proteins, fats and carbohydrates) loom very large, food quality is pushed to the background and there is much reeling and writhing around the Mad Hatter notion that fats should be limited.

The first to attempt simple dietary guidelines were the dieticians, who came up with the Four Food Groups—meats, poultry, fish and beans; milk and cheeses; vegetables and fruits; and breads and cereals—an innocuous construct that offended no one and completely avoided making any judgements on dietary fats.1 Emphasis on macronutrient ratios came in with the USDA Food Guide Pyramid in 1992, which reflected the pro-grain conclusions of the McGovern Committee by giving prominence to carbohydrates and relegating animal foods to the smaller areas at the top of the pyramid. Fats and oils are mysteriously put with sweets (which are carbohydrates)—for reasons unknown except to government bureaucrats—and placed at the top of the pyramid with the admonition to “eat sparingly.”
Chasing the White Rabbit

Both the US government and the American Heart Association (AHA) preach fat restriction as the key to good health. Both recommend that less than 30 percent of dietary calories come from fat, with 15 percent from protein and the balance—up to 60 percent—from carbohydrates such as bread, pasta, rice, cereal, fruits and vegetables. (Milk products, nuts and beans are also sources of carbohydrates.)

To the average consumer, these guidelines might seem entirely reasonable. After all, if Alice fills her plate with meat, potatoes and vegetables, and then puts a generous pat of butter on the potatoes, it looks as though she is well within the guidelines—that pat of butter makes up far less than one-third of the volume of food on the plate.

But the diner’s claim to virtue fades away when the mathematics of caloric values are explained. Proteins and carbohydrates provide about 4 calories per gram (except for fiber, which is indigestible carbohydrate, which for humans provides 0 calories per gram). But fats provide about 9 calories per gram. So that pat of butter provides over twice the caloric value per weight than the proteins and carbohydrates in the meat and vegetables. Even so, at twice the caloric value, a pat of butter would still come in at under 30 percent of calories based on a visual assessment of the volume of food on the plate.

But it gets worse. Most of the volume of the meat and vegetables is made up of water, which has no calories at all, whereas fats contain very little water, if any. You need to eat about 300 grams of lean meat to obtain 50 grams of protein—the daily amount recommended by the USDA—because over 80 percent of the meat is water. (A serving of meat according to the Dietary Guidelines, by the way, is 100 grams, or about the size of a deck of cards.)

Compounding the problem is the fact that meat contains hidden fat. A 100-gram serving of lean beef brisket, for example, with no visible fat, still contains over 10 grams of fat, or 44 percent of total calories as fat, because the cell membranes of the meat are composed of fat. Even vegetables contain traces of fat, although usually less than 0.5 grams per 100 grams.

Thus, although Alice’s meal contains only about 8 percent of total weight as butter, it contains 58 percent of calories as fat—not a saintly diet at all, but one for the Sybarite! Twenty-eight percent of calories in this meal comes from protein and a mere 14 percent from carbohydrates, even though Alice consumed two carbohydrate foods. Total calories for the beef brisket, broccoli, mashed potatoes and butter is just under 500 (see Table 1).
Table 1: Calories in a Typical Dinner
Food Item
in grams
	
Moisture
%
	
Protein
	
Carbs
	
Fats
	
Calories
grams 	kCal 	%kCal 	grams 	kCal 	%kCal 	grams 	kCal 	%kCal
100g beef brisket (no visible fat) 	59.1 	29.7 	118.8 	56% 	0 	0 	0% 	10.5 	94.5 	44% 	213.3
100g mashed potatoes w/milk added 	82.8 	2.1 	8.4 	13% 	13.0 	52.0 	78% 	0.7 	6.3 	9% 	66.7
100g broccoli steamed 	91.3 	3.1 	12.4 	38% 	4.5 	18.0 	54% 	0.3 	2.7 	8% 	33.1
25g butter (less than 2 T) 	15.9 	0.2 	0.8 	1% 	0 	0 	0% 	20.3 	182.7 	99% 	183.5
Totals for 325g of food 	35.1 	140.4 	28% 	17.5 	70.0 	14% 	31.8 	286.2 	58% 	496.6

If Alice prefers rib eye steak to brisket, if her mashed potatoes are made with cream instead of milk, and if she puts a little butter on the broccoli, she doubles her caloric intake to just over 1000 of which 663 or about 66 percent are calories from fat. Should she treat herself to a dish of ice cream for dessert, she adds another 260 calories, including over 100 calories as fat, but her percentage of calories as fat drops 9 points to 57 percent because of the high levels of carbohydrate calories from the sugar in the ice cream. The grand total for her satisfying meal including dessert is 1367 calories with 57 percent as fat, 16 percent as protein and 27 percent as carbohydrate. Thus we can conclude that a good way to decrease your percentage of calories as fat is to eat ice cream!

Of course, this is not what the dieticians had in mind when they urged us to lower the fat content of our diets. Let’s see how we must manipulate Alice’s steak dinner to bring it into conformity with USDA guidelines. In order to lower the percentage of protein to a level near the magic 15 percent, while at the same time drastically reducing fat and raising carbohydrates, we must slash the portion of beef brisket to a measly 25 grams or less than 2 tablespoons, one-fourth of the original amount. We must reduce the butter to 1 teaspoon, triple the amount of mashed potatoes and add two slices of dry bread (see Table 2).
Table 2: Calories in a High-Carbohydrate Dinner
Food Item
in grams
	
Moisture
%
	
Protein
	
Carbs
	
Fats
	
Calories
grams 	kCal 	%kCal 	grams 	kCal 	%kCal 	grams 	kCal 	%kCal
25g beef brisket 	59.1 	7.3 	29.2 	55% 	0 	0 	0% 	2.7 	23.9 	45% 	53.1
300g mashed potatoes w/milk added 	82.8 	6.3 	25.2 	13% 	39 	156 	78% 	2.1 	18.9 	9% 	200.1
100g broccoli ,steamed 	91.3 	3.1 	12.4 	38% 	4.5 	18.0 	54% 	0.3 	2.7 	8% 	33.1
5g butter (1 tsp) 	15.9 	0 	0 	0% 	0 	0 	0% 	4.1 	36.9 	100% 	36.9
Roman Meal bread (2 slices) 	38.0 	12.6 	50.4 	16% 	54.8 	219.2 	71% 	4.6 	41.4 	13% 	311
Totals for 634.6 kCal 	29.3 	117.2 	18% 	98.3 	393.2 	62% 	13.8 	124.2 	20% 	634.2

win02-macronutrient2This protein-deficient, high-carb meal contains a total of 634.2 calories—140 calories more than the meal that contained a generous portion of butter—with 20 percent of calories as fat, 18 percent of calories as protein and 62 percent of calories as carbohydrates—the white stuff. And while the dieticians might be satisfied with these numbers, Alice most certainly will not. On the contrary, she is likely to feel stuffed and sleepy after all those carbs and then ravenously hungry two hours later when her blood sugar drops. Then Alice’s alter-ego will probably conclude that it’s time to visit the kitchen for a snack of chips or ice cream—to satisfy her craving for fat.
Down the Rabbit Hole

What’s clear from this exercise is that the only way to achieve the dietary guidelines with foods that Americans enjoy eating is to drastically reduce meat and fat and pile on the carbs. If we follow this argument down the rabbit hole to its logical conclusion, we are led to one of two choices—either add lots of sugar to standard American meals or cut way back on animal foods and eat heaps of beans and pasta.

The latter course is the one advocated by extremists like Dean Ornish and John McDougal (and backed by Dr. Neil Barnard of the Physicians’ Committee for Responsible Medicine). Using the Alice-in-Wonderland logic that if a little is good, then even less is better, Ornish and McDougal promote a diet containing only 10 percent of calories as fat, a proposal that makes normal eating impossible. Even nuts are taboo on such a diet. Since beans can contain up to 25 percent protein and have less than 5 percent fat, they are given as the ideal protein source. If you want the complete protein provided by animal foods, your only choices are skim milk, egg whites and shellfish. These diets were invented by academicians, not cooks, and are too unpalatable—not to mention deficient in nutrients—to be taken seriously.
The Cheshire Cat

Diets high in carbohydrates and low in fat don’t stick to the ribs. Unimpeded by fats, which have the effect of slowing down digestion, carbohydrate foods flood the bloodstream and quickly raise the blood sugar. Without adequate fat in the diet, the blood sugar is likely to tumble shortly thereafter, causing intense hunger and food cravings that are satisfied either by more high-carb foods—or by giving in to fats. Either way, the result is more calories. It’s no coincidence that as Americans have tried to avoid dietary fats, the rate of obesity has climbed. That’s because we’re eating too many calories, say the dieticians, wagging their fingers with disapproval. Unfortunately, only those with iron wills can eat high-carb and low-cal for any length of time. The weak-willed raid the cupboard or the refrigerator, bingeing and splurging on snack foods and sweets.

win02-macronutrient3The role of fats in curbing appetite was recognized as long ago as 1863, when William Banting first proposed a low-carbohydrate, high-fat diet for weight loss. Today this diet is promoted by the famous (or infamous) Dr. Atkins, who looms over the card-carrying dieticians like the Cheshire cat. Atkins’ guidelines of 55 percent or more of calories as fat, 25 percent as protein and less than 20 percent as carbohydrates is exactly what Alice achieves with her initial diet of brisket, broccoli and potatoes with butter. If she eliminates the potatoes and puts butter on her broccoli instead, she lowers her caloric intake by about 70 calories and raises the percentage of fat to 65 percent. To achieve a really high fat diet, one that would put her into a state of metabolic ketosis (where the body burns off stored fat), she would need to eat a rib eye steak instead of brisket. This would raise her total calories to 651 with a whopping 83 percent of calories as fat (see Table 3).
Table 3: Calories in a Low-Carbohydrate Dinner
Food Item
in grams
	
Moisture
%
	
Protein
	
Carbs
	
Fats
	
Calories
grams 	kCal 	%kCal 	grams 	kCal 	%kCal 	grams 	kCal 	%kCal
100g rib-eye steak 	40.0 	19.9 	79.6 	18% 	0 	0 	0% 	39.4 	354.6 	82% 	434.2
100g broccoli, steamed 	91.3 	3.1 	12.4 	38% 	4.5 	18.0 	54% 	0.3 	2.7 	8% 	33.1
25g butter (less than 2 T) 	15.9 	0.2 	0.8 	1% 	0 	0 	0% 	20.3 	182.7 	99% 	183.5
Totals for 225g of food 	23.2 	92.8 	14% 	4.5 	18.0 	3% 	60 	540 	83% 	650.8

Dr. Atkins has been vindicated in a study that was presented at the annual meeting of the American Dietetics Association (ADA) in October of this year.2 The study enrolled 53 women, ages 31-59. All women followed a low-calorie diet of about 1,200 to 1,500 calories per day. Half followed a lowfat approach while the other went on Dr. Atkins’ low-carb diet. The Atkins group lost on average 18.5 pounds compared to 9 pounds in the lowfat group. The ADA’s response to this news is the response that always pops up when study results contradict tightly held paradigms—”more studies are needed.”

But the Atkins diet does have its dangers. In order to “improve” on the diet, many are tempted to restrict not only carbohydrates but also fat, ending up with a diet that has a high percentage of calories from protein—the brisket dinner rather than the rib eye (see Table 4). Dieters often add protein powders to up the protein content without adding too many calories at the same time. The result can be a diet unnaturally high in protein, something that all primitive peoples avoided. Protein requires vitamin A for its metabolism and a diet too high in protein without adequate fat rapidly depletes vitamin A stores, leading to serious consequences—heart arrhythmias, kidney problems, autoimmune disease and thyroid disorders. Diets too high in protein also cause a negative calcium balance, where more calcium is lost compared to the amount taken in, a condition that can lead to bone loss and nervous system disorders.
Table 4: Calories in a Calorie-Restricted, Low-Carbohydrate Dinner
Food Item
in grams
	
Moisture
%
	
Protein
	
Carbs
	
Fats
	
Calories
grams 	kCal 	%kCal 	grams 	kCal 	%kCal 	grams 	kCal 	%kCal
100g beef brisket 	59.1 	29.7 	118.8 	56% 	0 	0 	0% 	10.5 	94.5 	44% 	213.3
100g broccoli, steamed 	91.3 	3.1 	12.4 	38% 	4.5 	18.0 	54% 	0.3 	2.7 	8% 	33.1
25g butter (less than 2 T) 	15.9 	0.2 	0.8 	1% 	0 	0 	0% 	20.3 	182.7 	99% 	183.5
Totals for 225g of food 	33 	132 	31% 	4.5 	18.0 	4% 	31.1 	279.9 	65% 	429.9

A clue to making the Atkins diet successful comes from studies of the diets of carnivores like dogs and lions. Weston Price reported that lions could not breed in captivity when fed on steak alone. When liver was added, they bred easily.3 When lions in Africa are fed exclusively on muscle meats, they become cripples due to spinal collapse. When they were given bones that they could crush, the problem resolved.4 Bones provide calcium and liver provides vitamin A—among many other nutrients—and they work synergistically with the protein in muscle meats. Those on the Atkins diet should eat liver at least once a week or take cod liver oil daily (or both) and use bone broths frequently.
In Wonderland

No diet has been accompanied with as much hype as the Zone Diet, invented and popularized by Barry Sears. This regime calls for a strict balance of 30 percent protein, 30 percent fat and 40 percent carbs—with these ratios, Sears promises, one enters the Zone, where “the mind is relaxed, yet alert and exquisitely focused. . . the body is fluid, strong and apparently indefatigable”.5

The 30/30/40 Zone Diet puts one in “a metabolic state in which the body works at peak efficiency. Outside the Zone, life is its normal self—sometimes rewarding, mostly frustrating, filled with perplexing problems, missed opportunities and illnesses great and small. But inside the Zone life becomes easier and better. In the Zone you’ll enjoy optimal body function: freedom from hunger, greater energy and physical performance, as well as improved mental focus and productivity.” Has any nostrum been huckstered with greater promises than these?

In response to Ornish and McDougal, who promise optimal health with very lowfat diets, Sears argues that the body actually does need fats. But some fats are bad, he says. We should avoid saturated fats and also too much arachidonic acid, found in nutritious foods like liver, eggs and butter. He recommends lean meat along with sources of monounsaturated fat such as avocados, almonds and olive oil.

Someone dipping into Sears book for the first time might think that at last he had come across a diet that was truly satisfying. After all, it contains lots of protein and, according to Sears, plenty of fat. But Sears comes up against the same mathematics that bedevils our dieticians. Fat contains 9 calories per gram, compared to 4 for proteins and carbohydrates, so you can’t add very much fat to meals before you surpass the magic 30 percent. In a meal composed of 6 ounces of white fish for protein and 2 cups steamed vegetables plus 1 piece of fruit for the carbohydrates, the added fat is—don’t laugh—4 teaspoons of slivered almonds! With 4 ounces of chicken breast (skinless of course, to avoid arachidonic acid6) you get a large salad mixed with 4 teaspoons of olive oil. A strange sounding meal consisting of 1 cup lowfat cottage cheese and 1 1/3 cups of cooked oatmeal gets four macadamia nuts. An “omelette” consisting of 6 egg whites and 1 ounce of nonfat cheese gets 1 1/3 teaspoons (that’s teaspoons, not tablespoons) added olive oil.7, 8

If you have trouble figuring out all these ratios, or if you need a between-meal snack (Sears recommends a carefully balanced snack at least two times per day), you can eat Sears’ BioZone meal replacement bars, which have the magical proportions of 30/30/40. The protein comes from soy and whey, the carbs from fructose syrup, and the fats from palm and palm kernel oils (the only two healthy ingredients in Zone bars). It’s easy to formulate a bar with exact ratios when you are using processed ingredients that are 100 percent protein, 100 percent fat and 100 percent carbohydrate, but when it comes to real food, things get tricky. We wonder whether Sears put his bars together first before turning his attention to food, and whether when he did so he was surprised at how little fat you could add to a meal before surpassing 30 percent. In any event, the result is unlike any traditional diet found on earth, is severely deficient in nutrients and carries the inherent danger of diets in which high levels of protein are not supported by adequate fats.

Similar to the Zone Diet is the Paleo Diet, proposed by Loren Cordain.9 Although Cordain notes in his own published papers that hunter-gathers “relished certain fatty portions of the carcass including brain, marrow and depot fat,”10 his own diet is much lower in fat than the typical Paleolithic diet (which can be as high as 80 percent of calories as fat).11 The diet is very high in protein with typical proportions of 33 percent protein, 25 percent carbohydrate and 42 percent fat. He promotes lean meat, shellfish and some organ meats over cheese, whole milk, sausage and fatty meats, because they have a high protein-to-fat ratio. Only six eggs are allowed per week, because the protein-to-fat ratio of eggs is low. The rest of the diet consists of fruits, vegetables and nuts but no grains or legumes. Salt is forbidden in the Paleo Diet.

Cordain’s analyses found a range of 59-66 percent of saturated in the depot fat that hunter-gatherers relished, but he advises his readers to cut all the fat off our meat and replace butter and lard with olive oil, flaxseed oil, walnut oil, canola oil, mustard seed oil or avocado oil, because these oils contain “heart-healthy” monounsaturated fatty acids. He recommends organ meats but they don’t show up very often in the recipes and the skin comes off in his chicken recipes, even though chicken fat is rich in monounsaturates. (We haven’t yet figured out why people who write diet books foster such a hatred for the part of the chicken children love the most—the crispy, succulent skin.)

Cordain admits that his diet contains virtually no vitamin D but he says that Paleolithic man got his vitamin D from the sun. (How he did that in cold northern climates is not explained.) There are no good sources of calcium in this diet either and the vitamin A it supplies is inadequate for all that protein. No sweets are allowed in Cordain’s diet, of course, but his logic breaks down when he recommends diet sodas instead.

The Paleo Diet ends up being lower in fat than almost all traditional diets. Moreover, it contains no sources of concentrated carbohydrates that the body could turn easily into the saturated fat it needs. And without grains or rice or potatoes to provide carbohydrate calories, you have to eat a lot of vegetables to get the carb proportion up to even 25 percent. Children and even grown men who hate vegetables might have trouble on this diet, and there are no high-fat or high-carb comfort foods that make mother’s cooking something they would want to come home to. Like the Zone Diet, the Paleo Diet is one created by professors rather than food providers faced with the challenge of putting satisfying meals on the table day in and day out—meals their families will actually eat.

Table 5: Fat Content in Common Foods
Coconut Milk 89%
Avocado 88%
Salad with Oil and Vinegar Dressing 86%
Rib Eye Steak 81%
Peanut Butter 77%
Cheddar Cheese 74%
Hamburger 68%
Eggs 65%
Potato Chips 63%
Mackarel 59%
Tuna Salad 56%
Caviar 52%
Whole Milk 50%
Ice Cream 47%
Lean Beef (brisket) 43%
Apple Pie 39%
Cookies 38%
Pepperoni Pizza 32%
Salmon 32%
Oysters 21%
Skim Milk 4%
Lima Beans 4%
The only protein foods that can be consumed without surpassing the USDA guidelines of 30 percent or less of calories as fat are shellfish, skim milk and legumes. The Alice-in-Wonderland logic of the US Dietary Guidelines means that apple pie and cookies are healthier than eggs, whole milk and cheese. Coconut milk, avocado, salad dressing, steak and peanut butter are off the charts and can’t be included in any diet that conforms to the Food Pyramid unless combined with foods very high in carbohydrate and low in fat such as bread and pasta.

The Reaven and the Writing Desk

The Reaven diet, named after Dr. Gerald Reaven, calls for 5 percent protein, 40 percent fat, 45 percent carbohydrates.12 Dr. Gerald Reaven spent many years researching Syndrome X, characterized by high blood cholesterol, obesity, insulin resistance and high blood pressure. There is no proof that this bizarre macronutrient balance will help cure Syndrome X. In fact, this ivory tower diet is typical of those invented at writing desks rather than by cooks working with real food. While the level of fat in this diet approaches that of diets in the real world, the amount of protein stipulated is far too low. Saturated fat is held to be bad because it raises cholesterol and since it’s hard to find animal proteins that don’t contain saturated fat and a “cholesterol burden,” the preferred protein in the Reaven diet is soy. The diet consists of soy foods like tofu and vegeburgers, monounsaturated vegetable oils, grains and legumes (sources of insoluble fiber) and lots of fruits and vegetables. Should Alice put her kids on this diet, she shouldn’t be surprised when they sneak out for a burger and fries.
You Are Old, Father William

win02-macronutrient5The latest salvo in Macro-Nutrient Land is the Calorie Restriction Diet, inspired by animal experiments in which mice, guppies, water fleas, yeast, spiders, Labrador retrievers, a microscopic water invertebrate called the rotifer, and rhesus monkeys are said to live longer on diets that restrict caloric intake.13 Researchers are encouraged by the longevity of a single monkey who has reached 38 years on a diet in which the portion of monkey chow—dried compressed pellets of wheat, corn, soybean, alfalfa, fish and brewer’s yeast—has been cut by 30 percent compared to controls. (Other rhesus monkeys for which records exist have lived to 36 and 39 years so far on normal diets. The life-span of rhesus monkeys in the wild is unknown.) Researchers describe C58, their long-lived calorie-restricted monkey, as “in excellent health,” even though he suffers from “a touch of arthritis and a cataract.” In his younger days, C58 was an aggressive “alpha male,” reaching out of his cage to grab passersby. But C58 has lost his pep on calorie-restriction. He now sits quietly in his cage “munching contentedly on a handful of chow and gazing out of his cage with mild curiosity.”

In humans, calorie-restriction translates to about 1500 calories per day, with the arbitrary stipulation of 18 percent of calories as fat, 32 percent as protein and 50 percent as carbohydrates. A typical calorie-restriction meal plan is given as 1 cup of quick oats, 2 tablespoons of toasted wheat germ, 1 cup skim milk and blueberries for breakfast and vegetables, fruit and a small portion of fish for dinner—in other words, two measly meals and no lunch at all. Obviously this diet will be severely deficient in nutrients, which the elderly need just as much as the young.

But volunteers are already testing the “Calorie Restriction with Optimal Nutrition (CRON)” plan. At least 800 of these “Cronies” participate in an on-line chat group in which they crow about the predicted outcome of starvation—weight loss, a drop in cholesterol values and lowered body temperature. Unfortunately, a common complaint is that many of the Cronies become irritable and snappish. Testosterone drops, causing some of them to lose interest in sex. Several have developed early signs of osteoporosis and one became severely anemic.

Nevertheless, the Cronies continue with the Spartan life-style on promises that they will add a few years to the human carcass. Many have been misled by claims that the diet on Okinawa—where there are 34 centenarians for every 100,000 people, more than triple the US rate—is a low-calorie, lowfat diet consisting of “soy, vegetables and small amounts of fish, meat and rice.” This is an example of dieticians “painting the white roses red” because the earliest article on the Okinawan diet described it as “greasy.”14 Lard was traditionally used in cooking on the island and although it may not be used as much today, the Okinawan centenarians were using lard most of their lives, lives that began long before the USDA decided to tell us all to eat canola oil.

The sad thing about the Cronies’ collective renunciation is that the calorie-restriction movement was precipitated by a complete misrepresentation of the original calorie-restriction experiments on rats. These were carried out by Morris Ross and his colleagues at the University of Pennsylvania starting in the late 1950s.

Studies have shown “that a lifetime regimen of restriction in total food or caloric intake resulted in a remarkable increase in the length of life and a reduction in incidence of several debilitating and life-shortening diseases,” reports Ross boldly.15 Unfortunately, the “benefits” of calorie-restriction only accrue when rats are given severely calorie-restricted diets immediately after weaning. Such a regimen actually results in stunting, impairment of structural, functional and behavioral development including reduced learning ability, and hormonal deficiencies that prevent the rats from going through puberty. When mature rats are given calorie-restricted diets, the length of life is either drastically curtailed or significantly lengthened depending upon the level of caloric restriction and the protein-calorie ratio of the diet. Surprisingly, the restricted diet imposed at maturity resulting in the longest survival was a diet of moderate restriction with a lower protein level. In older, heavier rats, the sudden imposition of calorie-restriction drastically curtailed the duration of life.

win02-macronutrient6In one experiment it was reported that rats on normal diets had more and larger tumors than those on a calorie-restricted diet. However, close examination of the data reveals that the calorie-restricted rats had more tumors per body area and the tumors were more malignant.16 Very high protein diets caused a dramatic increase in the incidence of renal, myocardial and prostatic diseases. The details of these studies should give pause to Sears, Cordain and others who advocate calorie-restricted diets with high relative levels of protein.

Stephen R. Spindler, professor of biochemistry at the University of California at Riverside is the current guru of calorie restriction. “Low-Calorie Diet Slows Aging in Mice in Study,” claimed a recent headline.17 According to the article, “Putting elderly mice on a very low-calorie diet for as little as four weeks reversed many of the changes in the activity of various genes that had occurred during normal aging. . .” The resesearchers were not looking at actual signs of disease, nor were they measuring lifespan, but instead focused on the analysis of 11,000 different genes using a method called microarray technology in which Spindler has large financial holdings.

Actually, none of these studies is particularly relevant to humans eating real food because the rat and mice chow used is a highly artificial concoction straight from Macro-Nutrient Land. The chow used in Ross’s rat studies consisted of 22 percent casein, 6 percent corn oil and 59 percent sucrose! Thus, calorie restriction in these studies means restriction of isolated protein (produced at high temperatures that produce carcinogens), vegetable oil (invariably rancid) and refined sugar (completely devoid of nutrients and a stress on any living system). If this research has anything to teach us, it is that the calories humans of every age should restrict are the empty calories of white flour and sugar in processed foods; instead we are being urged, over and over again, to cut back on fats.

A primary cause of aging is free radical damage.18 Therefore the equation for a longer life would include minimizing exposure to vegetable oils (the primary source of free radicals) and maximizing intake of protective nutrients such as vitamins A and D (found exclusively in animal fats), vitamin E (found in butter, egg yolks and olive oil), vitamin C and key trace minerals like calcium, selenium and zinc. Digestion becomes more difficult as we age so it is important for the elderly to consume foods prepared in such a way as to maximize assimilation. Raw dairy products, bone broths and soups based on broth, and lacto-fermented foods are important elements in a diet for those would-be centenarians who wish to do more than sit in the corner “munching contentedly” on their chow.
Which Way?

In order to find our way out of the confusion of Macro-Nutrient Land, we turn to Dr. Weston Price. What he found in his studies of healthy primitive populations was great variety in macronutrient ratios. All groups had a certain amount of animal foods, but the levels of fat and carbohydrates varied widely—from almost no carbs in northern climates to lots of carbs in tropical regions. The carbohydrates were supplied by grains, legumes, tubers, honey and fruits like bananas. But even in the tropical regions there were good sources of fat, from meat, fish, milk, insects and palm and coconut oils.

Virtually no traditional diet falls within the USDA dietary guidelines of 30 percent or less of calories as fat except when there is an actual shortage of food. If meat or dairy products are consumed, the percentage of calories from fat will be well over 30 percent. Olive oil used in the Mediterranean, palm oil used in Africa, coconut oil used in the tropics all add to the modern dieticians’ collective nightmare.

The exception to the rule is Japan. The largest source of calories in the Japanese diet is fish, with consumption averaging almost half a pound per day.19 If the average fish contains 3 grams of fat per ounce (and many contain more), then the diet will contain about 200 calories or 10 percent of fat from fish. Other fats such as lard, tallow, sesame oil, perilla oil, whale oil, meat and egg yolk (all used in the traditional Japanese diet), and even from milk products (used in fairly large quantities today) will raise fat calories to something like 20-30 percent of the total. The fats that the Japanese do eat, however, are rich in fat-soluble activators A and D—fish heads, traditionally consumed at breakfast, are a particularly rich source of vitamin A—and white rice in the diet is easily converted to fat.

What is consistent throughout the world, during periods of both plenty and scarcity, is that protein rarely exceeds 20 percent of total calories. Dietary surveys conducted 100 years ago—when Americans were eating real food and not inhibited by any strictures on fats or carbohydrates—recorded a range of 10-21 percent protein, with a surprisingly narrow range of 10-15 percent for American diets (see Table 6).20 The American diets were also surprisingly high in calories, ranging from 3400 to over 6600 calories, so the low percentage of protein was not due to economic hardship. In fact, 14 percent of calories in a 3500-calorie diet translates to 123 grams of protein per day, or well over 1 1/2 pounds of meat—far higher than the current USDA recommendation of 50 protein grams.

Fat content in the American diet of 100 years ago ranged between 34 and 48 percent. In a diet of 3500 calories per day, 40 percent of calories as fat translates to 155 grams of fat. Assuming that half that fat comes from meat and the balance from dairy products, the daily intake of butterfat would be almost 3 ounces, equivalent to 3/4 stick of butter per day.
Table 6: Macronutrient Ratios
in America and Other Nations in 1902 	Protein 	Carbohydrates 	Fats 	Total
	grams 	kCal 	%kCal 	grams 	kCal 	%kCal 	grams 	kCal 	%kCal 	kCal
Football team in CT and CA 	226 	904 	14% 	634 	2536 	38% 	354 	3186 	48% 	6626
Farm Families in eastern US 	97 	388 	11% 	47 	1868 	55% 	130 	1170 	35% 	3426
Laborer families in US 	120 	480 	12% 	534 	2136 	54% 	147 	1323 	36% 	3939
African Americans in AL and VA 	86 	344 	10% 	440 	1760 	52% 	145 	1305 	38% 	3409
US Army Rations 	120 	480 	13% 	451 	1804 	48% 	161 	1449 	39% 	3733
Lawyers, teachers in US 	104 	416 	13% 	423 	1692 	52% 	125 	1125 	35% 	3233
Italian families in Chicago 	103 	412 	14% 	391 	1564 	52% 	111 	999 	34% 	2975
French Canadians in Chicago 	118 	472 	15% 	345 	1380 	42% 	158 	1422 	43% 	3274
Poor families in New York City 	93 	372 	13% 	407 	1628 	57% 	95 	855 	30% 	2855
Swedish mechanics 	189 	756 	16% 	714 	2856 	62% 	110 	990 	22% 	4602
Russian peasants 	129 	516 	16% 	589 	2356 	75% 	33 	297 	9% 	3169
Japanese professor 	123 	492 	21% 	416 	1664 	71% 	21 	189 	8% 	2345
German laborer 	52 	208 	13% 	287 	1148 	69% 	32 	288 	18% 	1644
Note that for all but one of the diets, protein consumption greatly exceeds the USDA recommended amount of 50 grams. Protein consumption varies from 10 to 21 percent of calories, with an average of about 16 percent. Only one of the American diets falls within the guidelines of 30 percent or less of calories as fat, and that is for poor families in New York City. The values for the non-US diets—more in line with USDA guidelines—actually reflect difficult economic conditions in these parts of the world, including actual famine. All but two of the diets would be considered very high in calories by today’s standards. These high-calorie diets contain very high levels of carbohydrates. If the carbohydrate content were lowered to reduce caloric intake, percentage of calories as fat would be much higher. Adopted from W.O. Atwater, PhD. Principles of Nutrition and Nutritive Value of Food. Farmers’ Bulletin No 142, US Department of Agriculture, 1902.
Waking Up

The notion that all of us should consume lowfat diets with the same ratios of macronutrients comes from wonderland. If you suffer from hypoglycemia or diabetes, or are prone to seizures, you will need more fat in your diet to keep blood sugar levels stable. If you want to lose weight, you will need to cut back on total calories. This will be easier to do if you eliminate a large portion of the carbohydrates and keep the fat percentage relatively high. If you are an athlete, farmer or laborer burning up large amounts of energy, you can eat more carbohydrates than the rest of us without gaining weight.

If you are eliminating most carbohydrate foods from your diet, then it is important to consume plenty of fat. Several researchers have reported that a diet of lean meat leads to nausea in three days, symptoms of starvation and ketosis in 7-10 days, severe debilitation in 12 days and possibly death in a few weeks.21 Vilhjalmur Stefansson lived for many years among the Eskimos and thrived in a diet that was 20 percent protein and 80 percent fat.22 When he and his colleagues tried to eat lean meat, they quickly developed diarrhea and a lack of energy.

Dr. Price did not focus on macronutrient values but on micronutrients—vitamins and minerals. He win02-macronutrient7pointed out that when the foods are dense in nutrients, fewer calories are needed to maintain optimum health. Humans are not designed to exist on purified macronutrients, but need a wide variety of nutrients found in the proteins, carbohydrates and fats in real foods. In fact, Price believed that the nutrients in animal fats were the most important of all.

The current dietary guidelines make a mockery of Price’s discoveries. We analyzed a diet of real food based on the USDA dietary guidelines (see Table 7). Levels of most nutrients met the stingy amounts called for in the Recommended Daily Allowance (RDA), but these amounts are much lower than the levels of nutrients Price found in the diets of healthy primitives. If you find a politically correct diet of real food unpalatable—actually only a masochist could stay on such a diet for any length of time—then you can still stay within the USDA guidelines and get your RDA of vitamins and minerals by eating processed foods with synthetic vitamins added—which is the whole point of the exercise.

Dieticians are trained to dispense processed foods and what the focus on macronutrients does is turn us away from the real foods that nourished our ancestors. Whole milk, eggs, cheese, organ meats, sausage, bacon, hamburgers, roast chicken with crispy skin, gravy, butter and even nuts simply don’t qualify under the US dietary guidelines, but dry breakfast cereals, pasta, lowfat dairy and veggieburgers certainly do. Only when we recognize the dietary guidelines and their spinoffs (Ornish, McDougall, Sears, etc.) for what they are—nothing but a pack of cards—can we wake up and enjoy real food again.
TABLE 7: EATING ACCORDING TO USDA GUIDELINES Breakfast: 1 poached egg, 1 slice dry toast, 1 cup skim milk, 1/2 grapefruit, 1 large wedge of melonLunch: 1 ounce Swiss cheese, 1 baked potato with skin, 1 cup skim milk, 1/2 cup sliced raw cucumber, 1 medium apple, 2 slices dry breadDinner: 1 cup salad greens (no dressing), 3 ounces lean beef, 3 cups cooked spaghetti, 1 cup cooked broccoli, 3/4 cup tomato juice, 2 slices dry bread

Total Calories: 2101
Protein: 110 grams or 440 calories = 21%
Carbohydrates: 314 grams or 1256 calories = 60%
Fat: 45 grams or 405 calories = 19%

SIDEBARS
Meat and Wapatos—Was the Paleolithic Diet Actually Low in Carbohydrates?

In a most interesting thesis, anthropologist Melissa Darby postulates that in the Northern hemisphere as the ice sheet was retreating, there were considerable wetlands that supported Sagittaria latifolia, an emergent wetland plant spread by waterfowl and known as a pioneering plant because it was one of the first to colonize these areas. It grows as a monoculture and can take over a wetland. On the lower Columbia River and in the Mississippi delta there are places where there is no other plant except S. latifolia for hundreds of acres. The Chinook Indians called these tubers wapatos. Darby suggests that S. latifolia was widespread in 10,000 BC in the shallow lakes, ponds, streamsides and wetlands that were draining the water from the ice sheet (PhD Thesis 1996, Portland State University).

S. latifolia produces a tuber that tastes like a potato, cooks as fast or faster than a potato and does not need to be processed with stone tools. It can be baked in hot ashes so it is hard to find in the archaeological record. It is available and harvestable from early fall to mid-spring when plant foods are generally considered to be scarce, and was very cost effective to harvest. It dries well and can be stored for long periods of time. It has been recovered in Paleolithic sites in Poland and in the caves in the Great Basin.

This does not mean that the Paleolithic diet was high in carbohydrates in the same way that modern diets are high in carbohydrates (mostly refined carbohydrates), but it does indicate that the diets of primitive man contained some high-carbohydrate foods.
The Optimal Diet

Taking Dr. Atkins one step further is Polish doctor Jan Kwasniewski, who recommends an extremely high-fat, low-carb diet in his book Optimal Diet. His rationale is the claim that mother’s milk contains the proportions of 1:3.5:0.3 of protein to fat to carbohydrates. Actually, the proportions of mother’s milk are more like 1:7:5. Human milk contains only 6 percent of calories as protein, with 54 percent of calories as fat and 40 percent as carbohydrates—proportions that definitely exclude human milk from USDA recommended foods! While Kwasniewski is mistaken about the composition of mother’s milk, his adherents claim relief from many ailments. Kwasniewski forbids all refined carbohydrates and recommends consumption of plenty of saturated fat and bone broth, both of which supply nutrients sadly lacking in modern western diets.
Can Low-Protein, High-Carbohydrate Diets Be Healthy?

Although most of the diets described by Dr. Weston Price contained generous amounts of animal foods, a few were characterized by low levels of animal foods and a high carbohydrate intake. Several African groups consumed insects, small dried fish and shrimp, and small amounts of shrimp paste as their chief animal foods, with large amounts carbohydrates from tubers, grains, fruits like bananas, and vegetables. Natives of the high Andes consumed small amounts of animal foods in the form of Guinea pigs and dried seafood, particularly dried fish eggs, with large amounts of carbohydrates from potatoes and grains. Even the Swiss diet was relatively low in protein (milk has 2 percent of calories as protein, Swiss cheese has 23 percent of calories as protein) and high in carbohydrates from bread and milk. Protein intake may have been less than 10 percent in these diets, and carbohydrate intake in the range of 60 percent, yet these groups had excellent dental health and a high level of overall good health.

These healthy high-carbohydrate, low-protein diets have several factors in common. One is that the animal foods were of exceptional quality. Insects, dried fish, shrimp, fish eggs and butter from pasture-fed cows are all excellent sources of the fat-soluble activators. Secondly, the carbohydrate foods were usually fermented, a process that greatly increases nutrient values and makes minerals more available. Finally, these diets contained no refined or devitalized foods.

A low-protein, high carbohydrate diet is risky for those living in the industrialized world, where nutrient-dense animal foods like insects and fish eggs are avoided, where carbohydrate foods are not usually fermented, and where it is difficult to completely avoid refined and devitalized foods. Higher levels of animal foods in conjunction with quality animal fats supplying ample amounts of vitamins A and D, provide an extra measure of protection in western diets.
The following letter was received in April 2006 from a member in Poland: Dear WAPF Team, Further to your comment may I point out to you that it is not Dr Kwasniewski who is mistaken in his calculations. It is your analysis, which mistook calories for grams. Dr K gives his proportions in grams, as this is the practical way to control food intake. However, in energy terms, he clearly says in his writings that in human milk, depending on mother’s diets, well over 70% comes from fats. Plus, the baby’s body converts 90% of the lactose into TGL & fats, too, so a baby’s body runs mostly on fats, protein and the remaining 10% of lactose – for the building purposes. Best regards and thank you for your wonderful work, especially that you are doing it in the U.S., the land of the profit above all.–Izabela Niewiadomska (Poland)
The Rosedale Diet: Turn Off Your Hunger Switch!
By Ron Rosedale, M.D. and Carol Colman
Harper Collins, 2004

Ron Rosedale enjoys a popular reputation as a leading authority in metabolic and nutritional medicine, with a keen interest in longevity research. He has founded Rosedale Metabolic Medicine and co-founded the Colorado Center for Metabolic Medicine, both in Denver, Colorado.

Rosedale has treated thousands of patients for obesity, as well as diabetes, cardiovascular disease and other so-called “diseases of aging” primarily via his dietary and nutritional approach that seeks to control the hormones insulin and leptin. He was one of the first to herald the dangers of insulin—particularly insulin resistance— and its role in causing or exacerbating many degenerative diseases, along with its ability to prompt the body to store fat as well as resist burning it.

Leptin (from the Greek, leptos, meaning thin) is a newly discovered hormone that is produced by our fat cells and is now understood to be a powerful determinant of metabolism and hunger signaling. Leptin directly affects the hypothalamus, and controls such vital functions as reproduction, body temperature, blood circulation, and bone and tissue repair. Blood levels of leptin and insulin have much to say about the state of our general health as well as our prospects for long life.

Critical to those who wish to lose excess body fat, leptin is the hormone that signals the body when hunger has been satisfied, when enough fat has been stored for fuel, and when that fat is to be burned. For the body to properly “hear” these messages from leptin, communication must be clear between the hormones and the cells in our brains and other tissues. Unfortunately, the same modern dietary conditions that have caused insulin resistance to become epidemic have also caused a concomitant “leptin resistance” or “deafness” in the body’s response to leptin’s messages. Rafts of starchy carbohydrates and a flood of damaged and dangerous oils and fats in the modern Western diet have altered human metabolism for the worse.

Humans are best suited for burning fat as fuel for all normal metabolic functions except in occasional short-lived emergencies when sugar metabolism allows for lightning-fast reactions— when we can run or lift enormous weight with almost superhuman powers. However, as a result of the sea of sugar and starchy carbohydrates in the standard modern diet, most of us have “learned” to become solely sugar burners. When sugar is burned almost exclusively as fuel, the body simply stores dietary fat. Excess weight on the body is a sign of the body’s insensitivity to leptin and its inability to burn fat as fuel. Other, more ominous health problems are engendered by excessive leptin (and insulin) levels as well.

High carbohydrate diets have become a major stressor in our lives, since sugar burning is associated with stressful situations in which we need to react quickly to avoid danger. Such diets constantly provoke the sympathetic nervous system, “revving” up metabolism, including blood pressure and the adrenal glands, and steadily wearing out the body. Further, being a constant sugar burner means that even when asleep the body will seek to burn sugar. When glycogen stores in the liver have been exhausted, the body will turn to protein from muscle and even bone to break down and burn as sugar for fuel—one reason that high leptin levels are associated with osteoporosis.

According to Rosedale, when our bodies are accustomed to burning sugar, even a meal composed of healthy protein and fat will largely be converted to stored fat (and not burned as fuel) if we also consume non-fibrous carbohydrates in the same meal. The body will preferentially start burning the sugar in the carbohydrates as fuel, storing a finite amount of it as glycogen in the liver, and the rest as fat on the body. Some of the protein in the meal will be used for repair and maintenance, but the excess will also be metabolized as sugar, and stored as fat. And since the body’s cells are replete from the sugar metabolism of carbohydrate, the fat in the meal is also stored as fat on the body. Even with plenty of good fat available for combustion, Rosedale contends, a body in the habit of sugar burning will “ignore” the fat and look to burn sugar—either by making us hungry for more carbohydrates or by breaking down muscle once the liver’s limited glycogen stores have been emptied. This is why someone who is a sugar burner and tries to lose weight—that is, lose fat—with an exercise program will either fail, or only lose muscle fiber while remaining flabby. A very sorry situation any way you look at it.

Enter the Rosedale diet. Rosedale promotes his meal plan as a “leptin sensitizing” regime that will train the body’s metabolism to become proficient at burning fat. The aim is not only to lose weight, but to reverse the unhealthy and harmful cascade of metabolic disorders influenced by leptin resistance that cause not only obesity, but cardiovascular disease, arthritis, diabetes and other modern diseases of aging.

Rosedale’s regime is a cold-turkey, full-abstinence diet from all sources of starchy carbohydrates. All grains in all forms—the obvious offenders— are excluded forever. For the introductory first three weeks, while the body is in a sort of “boot camp,” only modest amounts of protein from approved sources are allowed—largely fish and seafood, game such as buffalo, venison and ostrich, and skinless chicken and turkey. Rosedale requires his dieters to keep close tabs on protein consumption. “Adequate” protein levels must not be exceeded lest the sugar-burning body convert that excess protein into sugars and sabotage fat burning. For most people, protein is restricted to 50-75 grams per day, spread out over all meals and snacks. By comparison, an egg has about eight grams of protein; a piece of meat two by three inches has about fifteen. These amounts seem abstemious, to say the least, but Rosedale insists that too much protein is counterproductive both to his diet and to any ambitions we might have for longevity. You will be eating a lot of salads with this diet, and a fair amount of nuts, olives, and avocados. Rosedale also recommends a lot of water—eight to ten glasses a day. That will certainly fill you up!

Vegetables and fruits are restricted to a list even more severe than, say, the GAPS diet allows: along with predictably proscribed potatoes, parsnips and yams are also beets, carrots, pumpkin, tomato and most legumes such as green peas, lima beans and peanuts. Fruits such as bananas, oranges, apples, pineapple, grapes, and all melons are permanently verboten, as are virtually all dried fruit. In fact, the approved fruits for the three-week trial literally number only two: avocados and olives. After this trial period berries and lemons and limes are allowed. No sweeteners of any kind are allowed, but stevia powder is acceptable; the artificial sweetener sucralose (Splenda) is allowed “if you must.” Raw or plain, home-roasted nuts appear often as snacks to assuage hunger and sugar urges—seven to ten are allowed at a time. “High omega-3” eggs are allowed, and only goat cheese and non-fat or lowfat soft and hard cheeses. The only fats allowed in the introductory period are actually oils: avocado, olive and almond. Cod liver oil is highly recommended as a daily supplement.

Low-carb “veggie” burgers are allowed, as are various whey protein products, and rare portions of “high fiber” breads, typically made with oat bran and soy flour.

Rosedale insists that followers of his diet will never be hungry, and boasts that the percentage of calories from fat on his regime ranges from fifty to even higher. While scoffing at other health “experts” who foolishly promote “fat phobia” among their patients, and coming down squarely against damaged vegetable oils and trans fats, Rosedale seems nevertheless ambivalent about the role of saturated fats in the diet and for human health—much of the time he mirrors the mainstream condemnation of “bad” saturated fat, but then will follow with qualifying comments, as though he is not quite sure what he really thinks. “Saturated fat is much harder to burn off than good fat (until you become a good fat burner),” he writes, “so if you eat high amounts of saturated fat, you will interfere with your body’s ability to burn fat. A diet high in saturated fat promotes insulin resistance, and may increase the risk of heart disease . . . If you are trying to become a proficient fat burner, I recommend that you eliminate all beef, lamb, and pork from your diet, at least for the first three weeks you are on the meal plan (unless it is not grain-fed). . . It doesn’t make much sense to eat what you’re trying to get rid of.”

Later, however, in his discussion of recommended meats, Rosedale praises grass-fed livestock (and game) for their much healthier nutrient and fat profile compared to feedlot animals, and suggests readers work at finding such grass-fed meats. It seems that he does distinguish between fats from these differently raised livestock, (“Not all beef is the same”) but the good news must be teased out of his recommendations. I suspect the average reader might not even notice the import of his murmured parenthetical remarks and subordinate clauses.

Rosedale doesn’t help to clarify matters by constantly contrasting saturated fat (such as chicken skin) with “good” fat (such as avocado), especially since chicken skin contains more monounsaturated than saturated fat! Just once I would like to open a diet book and read, “Yes, on our diet you’ll be able to enjoy olives and avocados! They actually contain the same heart-healthy monounsaturated fat found in chicken skin and lard.”

The Rosedale Diet was first published in 2004, and since six years have passed it only seemed fair to discover whether he has updated anything about saturated fats on his website devoted to his meal plan. A visit to www.drrosedale.com pulled up this current take: “Yes, the major portion of your diet should be composed of healthy fats. The important distinction between good and bad fats lies not in whether they’re saturated or unsaturated, but whether they are omega-3 or omega-6. Omega 3 fatty acids, such as those found in fish and flax oils are tremendously healthy and will provide you a great deal of benefit. Omega-6’s such as are found in peanut, soybean and sunflower oils (among others) are almost the opposite. You do need a small amount, but you will get them naturally. The more you willfully eliminate, the better you will be. Saturated fats are generally (but not always) slightly harder to burn (a big exception being coconut oil, which is very healthy for you) but as your body becomes better and better at it by practicing on easy unsaturated fats, you are welcome to consume more advanced fats with the confidence that your body will know what to do with it. People do not become fat because they eat fat. They become fat because they cannot burn it. Through this eating plan, you can.”

Now it appears that saturated fat is sometimes only “slightly” harder to burn than unsaturated fats (and these days Rosedale embraces coconut oil) so the reader and/or diet adherent is still left to his own powers of discrimination regarding the reputation of saturated fat. It is amusing that Rosedale considers saturated fats more “advanced” than unsaturated fats, and that the latter are merely training wheels for wobbly novice fat burners. Saturated fat burning, on the other hand, is apparently like reaching the metabolic Olympics level. Why would the 18-carbon saturated fats be any harder to digest than the 18-carbon monounsaturated fats that he recommends? Seems like he is just making this up. And doesn’t he know that it is the monounsaturated fatty acids that tend to build up in the fatty tissue of those who gain weight?

Rosedale includes ghee on his list of approved fats and oils. Sweet (uncultured) milk and almost all commercial yogurt and cottage cheeses contain a fair amount of sugar in the form of lactose and added ingredients (and even sweet butter is only about 80-84 percent butterfat)—and should obviously be avoided during the “training” phase of Rosedale’s diet. Ghee (or clarified butter), on the other hand, is pure butterfat. Also, if you absolutely can’t live without that single cup of morning coffee, only add heavy cream, not milk, he advises. (Can’t argue with that.)

The short list of allowed dairy products contains only lowfat versions of cottage cheese, cream cheese and a few hard cheeses. Tiny portions of full-fat cheeses are allowed after the three-week training period, but clearly dairy products are given short shrift overall. Rosedale professes to be “no fan” of dairy, and argues that for us to drink the milk of other mammals is wholly unnatural—the great pastoralist cultures of the world, full of tall slender people, notwithstanding. It goes without saying that home-cultured raw dairy products from direct farm-to-consumer relationships is far outside the context of Rosedale’s diet and his perception of his audience’s ingenuity. Rosedale reminds us that cheese and other dairy products are loaded with saturated fat, and most readers will be numbed by the incessant repetition—both from Rosedale and the medicalized media—to accept the blanket condemnation.

It came as a surprise to find that fistfuls of supplements are strongly recommended as part of the Rosedale diet. (“No matter how healthy you eat, there are important vitamins that you simply cannot get out of your diet.”) Rosedale sells his own line of supplements.

Suggested recipes and menus are largely appetizing, mostly featuring honest cuts of seafood, eggs and meat. Olive oil and occasionally ghee and butter are the main additional fats used in simple cooking preparations. In a truly bizarre spasm of karmic fat comeuppance, however, the last recipe in the section, for French Silk Pie (mille pardons to the French!) calls for four cups butter (an error; one pound butter is the weight), one and one-third cups Splenda, two cups egg whites, chocolate, and one cup whipping cream!

The Rosedale Diet gives a valuable introduction to the role diet plays in our general health and especially to the diet’s effects on the key metabolic hormones insulin and leptin. These hormones in turn powerfully influence our risk for numerous degenerative diseases that bring misery and shorten life. However, the actual diet can in fact be very dangerous—much like the South Beach diet, it is devoid of carbohydrates, and unless the reader can thread through the subtleties of his discussion on fats, it is likely to be low if not completely lacking in saturated fats. When we avoid saturated fats, the body goes to Plan B and makes them from carbohydrates. Where are his dieters going to get the saturated fats the body needs so much?

The book provides many testimonials, but nothing in the way of long-term assessment. How did his clients do over the years, assuming they could actually stay on the diet and didn’t give in to the temptation of French Silk Pie?
Why We Need Carbs
Posted on October 18, 2016 by Christopher Masterjohn • 1 Comment

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One of the lessons that comes across most clearly from the studies that Weston Price documented in Nutrition and Physical Degeneration is that, although traditional diets all emphasized nutrient-dense foods, the specific mix of animal and plant foods was widely variable. Since it is primarily plant foods that provide carbohydrate, the carbohydrate content of traditional diets was also widely variable. In groups that lived in the Arctic, it was very low; in groups that lived close to the equator or that relied on grains, it was much higher.

This observation implies that humans can thrive on a wide range of carbohydrate intakes, but it does not imply that anyone in any circumstance can live on a diet that is virtually free of carbohydrate, and it does not imply that carbohydrate is not important. In fact, carbohydrate is essential to our physiology. In this article, I will discuss the essential roles of carbohydrate in the body,1 and then derive some practical conclusions about how we can manage our own carbohydrate intake.

STRUCTURAL ROLES OF CARBOHYDRATE
Carbohydrates play a variety of essential structural roles in our cells. Each repeating unit of DNA and RNA contains the sugars deoxyribose or ribose, which we make from glucose. These sugars are also essential structural components of the energy carriers we derive from niacin (vitamin B3), riboflavin (vitamin B2), and pantothenic acid (vitamin B5), which we use throughout every aspect of energy metabolism. They are also an essential structural component of ATP, the main energy currency of the cell.

Our tissues are composed of cells that reside within an infrastructure known as the extracellular matrix. All extracellular matrices are built largely from proteoglycans, which consist of a core protein that binds to glycosaminoglycans. In less technical terms, these are combinations of carbohydrate and protein that heavily favor carbohydrate. They are typically 95 percent carbohydrate and 5 percent protein. Popular supplements to support joint health typically contain the predominant glycosaminoglycans in joint fluid, chondroitin sulfate and glucosamine sulfate.

Glycoproteins are another way in which carbohydrates and proteins can be combined. Compared to proteoglycans, they tend to have less carbohydrate and more protein. Nevertheless, the carbohydrate content is widely variable. Antibodies such as IgG are glycoproteins, and contain as little as 4 percent carbohydrate, whereas mucin, the main constituent of mucus, is a glycoprotein that contains 80 percent carbohydrate. Cells are often coated in a glycoprotein structure known as the glycocalyx that allows cells to recognize one another, and to communicate and interact with one another.

The health value of these roles is obviously vast: without them, energy metabolism would fail, and with it, the vast array of energy-dependent processes within the body; without them, our ability to read our own genetic information or to pass it on to our offspring would fail; without them, immunity and digestion would suffer. We could expand the list of such negative health consequences endlessly. Most of the carbohydrate we take in each day is used for energy, and the role of carbohydrate in energy metabolism is a more productive area of focus if we are trying to understand the potential consequences of consuming too little of it.

CARBOHYDRATE AND ENERGY METABOLISM
Like proteins and fats, we break carbohydrates down into two-carbon units known as acetyl groups that then enter the pathways we use to break them down fully into the carbon dioxide that we exhale and the hydrogen ions and high-energy electrons that we use to synthesize ATP.

Since carbohydrate is richer in oxygen than fat, its metabolism requires 25 percent less water and generates 50 percent more carbon dioxide. Protein is intermediate. The more carbon dioxide we make, the more we need to breathe. A low-carbohydrate, high-fat diet is a useful way to decrease the stress on the lungs in patients requiring artificial ventilation. Outside of that context, however, carbon dioxide plays valuable roles. For example, it facilitates the delivery of oxygen to our tissues, and it activates vitamin K-dependent proteins. It is possible, then, that dietary carbohydrate could assist oxygenation of tissues for such purposes as healing from injury or enhancement of athletic performance, and it is possible that dietary carbohydrate could be an important synergist with vitamin K.

In the presence of oxygen, there is little difference between fully breaking down carbohydrate for energy and fully breaking down fat for energy. They each have an advantage over protein in that their breakdown does not require us to manage the disposal of leftover nitrogen, but this is just as true of fat as it is of carbohydrate.

Carbohydrates, however, have a unique advantage over the other macronutrients in that we can break them down for energy even in the absence of oxygen. We do this by splitting glucose in half and converting it to two molecules of lactate, which is known as anaerobic glycolysis.

Anaerobic glycolysis only generates a small amount of energy compared to fully oxidizing glucose to carbon dioxide. However, tissues that use anaerobic glycolysis can utilize the Cori cycle to greatly amplify the energy produced. In the Cori cycle, a lactate-producing tissue sends the lactate to the liver; the liver uses energy to convert the lactate back to glucose, and sends the glucose back to the lactate-producing tissue. The net result is that energy is transferred from the liver to the lactate-producing tissue and that the lactate-producing tissue meets its energy needs even in a relative absence of oxygen.

There are a few cases where anaerobic glycolysis is especially useful. Red blood cells lack mitochondria and are thus completely unable to fully break down macronutrients for energy using oxygen. This requires them to rely exclusively on anaerobic glycolysis. A small collection of other tissues rely substantially on anaerobic glycolysis simply because they do not take up enough oxygen from the blood, and these include the lens and cornea of the eye, the kidney medulla and the testes. In acute stress and high-intensity exercise our demand for energy temporarily exceeds the oxygen supply, and the deficit is made up with anaerobic glycolysis.

The brain uses oxygen to produce about 90 percent of its ATP and uses anaerobic glycolysis for the other 10 percent.2 Cells known as astrocytes perform most of the anaerobic glycolysis. Rather than delivering the lactate to the liver, however, they deliver it to neurons. Neurons burn the lactate for energy and that helps them conserve glucose for antioxidant defense.

ANTIOXIDANT DEFENSE AND NUTRIENT RECYCLING
In addition to anaerobic glycolysis, there is a second pathway that has an absolute demand for glucose known as the pentose phosphate pathway. In this pathway, instead of using the energy from glucose to make ATP, we use it for the synthesis of larger molecules, for antioxidant defense, and for nutrient recycling.

With the help of thiamin (vitamin B1), niacin (vitamin B3), and riboflavin (vitamin B2), this pathway takes energy from glucose and uses it for the following processes: the synthesis of fatty acids, cholesterol, neurotransmitters and nucleotides; the recycling of glutathione, the master antioxidant and detoxifier of the cell; and the recycling of vitamin K and folate.

GLUCONEOGENESIS, CORTISOL AND THYROID
Since we have an absolute need for glucose to support anaerobic glycolysis and the pentose phosphate pathway, we have a very robust system for ensuring we always have enough glucose even under conditions of dietary carbohydrate deprivation: gluconeogenesis. This is the production of glucose from non-carbohydrate precursors. Gluconeogenesis is primarily supported by protein but is also supported to a minor degree by fat.

While it is conceivable that someone on an extremely low-carbohydrate intake could suffer from a deficiency of total glucose, particularly if subsisting on a diet that is also very low in protein and deficient in nutrients needed for gluconeogenesis, this is likely to be very rare. When we chronically restrict carbohydrate, our bodies will naturally do everything in their power to conserve glucose, and in most cases gluconeogenesis will be sufficient to meet these lower needs.

The potential downside to chronic carbohydrate restriction is in the set of compensations we make to prevent a deficiency of glucose. Gluconeogenesis is primarily stimulated by the adrenal hormone cortisol. Cortisol antagonizes thyroid hormone and, when chronically elevated, impairs immunity. As we move away from burning glucose and toward greater reliance on fat, free fatty acids elevate. Cortisol augments this rise even further by causing us to release free fatty acids from adipose tissue. High levels of free fatty acids can impair thyroid hormone’s ability to carry out its physiological functions within our cells even if blood levels of thyroid hormones remain normal.

Interpreting blood, saliva, and urinary hormone testing is complicated and should be done under the supervision of a qualified practitioner. Nevertheless, we can note a few useful guidelines here.

Elevated cortisol could be a sign of inadequate carbohydrate intake. However, prolonged chronic elevation of cortisol can ultimately lead to long-term changes that bring cortisol to normal or low levels. Additionally, the rise in cortisol may occur at times that are difficult to detect. For example, if carbohydrate stores are inadequate to maintain stable blood sugar through the night, cortisol could spike in the early morning hours to stimulate gluconeogenesis. Cortisol normally spikes once you wake up and are exposed to light, and you cannot measure your cortisol when you are asleep, so it would be difficult to detect an early pre-waking rise in cortisol in this context.

If blood levels of thyroid hormone are affected, low T3 is the most likely result.3 However, T3 can be normal and elevated free fatty acids could still be impairing its cellular function.

If thyroid hormone activity is low, whether from low T3 or from interference with its activity by elevated cortisol and free fatty acids, one of the likely consequences is high LDL-cholesterol with low sex hormones. I consider the combined pattern of total cholesterol in substantial excess of 220 mg/dL, a high total-to-HDL-cholesterol ratio in substantial excess of 3.0, and total or free sex hormones toward the lower ends of the reference ranges to be a potential sign of low thyroid activity regardless of blood levels of thyroid hormones.3

HOW MUCH CARBOHYDRATE SHOULD WE EAT?
Carbohydrate demand is going to vary from person to person and is going to depend on physical activity level, but we can derive some general guidelines. The liver stores about 90 grams of carbohydrate, skeletal muscle stores 300 grams, and bodily fluids contain 30 grams.5 A completely sedentary person will primarily be tapping into the liver’s glycogen stores in order to stabilize blood sugar between meals. In the absence of physical activity, then, it makes sense to use about 100 grams per day as an initial target.

Someone whose physical activity is no more intense than walking is unlikely to begin tapping into their muscular glycogen supply. Greater intensities, however, such as running or weight lifting, will do so. It is almost impossible for someone to more than guestimate how much muscular glycogen they would burn through with any particular physical activity pattern, but it is reasonable to say that a very active person could add another 300 grams of carbohydrate on top of the initial 100 grams. In fact, the primary metabolic consequence of consuming 500 grams of carbohydrate in an otherwise healthy person, regardless of physical activity, is to shift that person’s metabolism almost entirely toward burning carbohydrate for energy.

These numbers should not provide more than an initial guideline. If someone wishes to restrict carbohydrates to less than 100 grams per day for a specific purpose, a prudent approach to safety would be to monitor stress, thyroid, and sex hormones, to ensure they all remain in optimal range. Physically active people should be aware that they may need considerably more than 100 grams to prevent these hormones from going out of range.

TRADITIONAL DIETS
We may be left wondering, but what about the Inuit? Didn’t they eat far less than 100 grams of carbohydrate per day?

When we look at traditional diets, we have to be careful of emulating the tails of the distribution. Most traditional diets contained plenty of carbohydrate. Diets traditional to the Arctic are the exception, and they are adaptations to that specific environment. The inhabitants of the Arctic most likely adapted to that environment with a suite of genetic and cultural adaptations that may have to work in concert to produce optimal health.

Consider what Price himself wrote of the reproductive diets in the Arctic:

For the Indians of the far North [reinforcement of fertility] was accomplished by supplying special feedings of organs of animals. Among the Indians in the moose country near the Arctic circle, a larger percentage of the children were born in June than in any other month. This was accomplished, I was told, by both parents eating liberally of the thyroid glands of the male moose as they came down from the high mountain areas for the mating season, at which time the large protuberances carrying the thyroids under the throat were greatly enlarged.

It could well have been that consumption of moose thyroid was an important means of maintaining fertility in the face of the level of carbohydrate restriction that the Arctic environment forced on its inhabitants.

We know that there are genetic variations in fat metabolism common to Arctic populations that likely lead their fat metabolism to be different than other populations,6,7 but it is too early to fit these into a coherent explanation of how these populations adapted to the specific demands of the Arctic environment.

It is safer ground to emulate the preponderance of traditional diets that contained plenty of carbohydrate than to emulate the lower tail of the carbohydrate distribution found in the Arctic because we don’t fully understand how the particular suite of genetic and cultural adaptations allowed Arctic populations to thrive on such a low carbohydrate intake.

Nevertheless, we do as humans contain a remarkable degree of metabolic flexibility. It makes the most sense to emphasize nutrient density above macronutrient composition, but to also be conscious of the need for carbohydrate to minimize hormonal dysregulation and support athletic performance. This will allow us to gravitate intuitively toward the amount of carbohydrate that works best for us, and to modify our carbohydrate intake as needed to best support our health.

ATHLETIC PERFORMANCE
For athletes,4 the potential downside of chronic excessive carbohydrate restriction is impaired performance or impaired performance gains for activities that require anaerobic glycolysis.

There are three energy systems that fuel activity during exercise: creatine phosphate, anaerobic glycolysis and oxidative phosphorylation. Oxidative phosphorylation refers to the complete oxidation of carbohydrates, fats or proteins.

During a bout of continuous high-intensity physical activity, we fuel the first fifteen to thirty seconds with energy from creatine phosphate. The period from thirty to ninety seconds is dominated by anaerobic glycolysis. Anaerobic glycolysis remains significant through the first thirty minutes, but diminishes in importance after ninety seconds when oxidative phosphorylation begins to take over. Oxidative phosphorylation becomes the overwhelming factor after thirty minutes.

Chronically restricting carbohydrate will shift the body toward using fatty acids and ketones (small, water-soluble derivatives of fatty acids) for fuel. This can shift the post-ninety-second demand for fuel from the oxidation of carbohydrate to the oxidation of fat, but it cannot reduce the demand for glucose in the thirty to ninety-second mark. We rely on anaerobic glycolysis during this period because our demand for energy temporarily exceeds the delivery of oxygen to our tissues, and eating a high-fat diet is not going to increase the speed at which we can suddenly drive oxygen to our muscles during the acute onset of intense activity.

Athletic training itself could reduce the demand for glucose in the thirty-to-ninety-second mark by making us more effective at oxygenating our tissues and more efficient in our use of energy. But all athletes train, so no athlete can rely on this alone for a competitive edge. Even after ninety seconds, glucose will be the limiting factor for maximum intensity simply because any intensity above and beyond what the supply of oxygen can accommodate can only be met through anaerobic glycolysis.

Many athletes supplement with creatine in order to boost the amount of energy available in the first thirty seconds or extend the creatine supply somewhat beyond thirty seconds. This is especially valuable for weight training, where a set often lasts thirty to sixty seconds. Consuming a large amount of creatine from meat or supplements might reduce the demand for anaerobic glycolysis by extending the use of creatine beyond the thirty-second mark. Nevertheless, it is not going to extend the dominance of the creatine phosphate system through ninety seconds or provide the edge needed for maximal intensity thereafter.

Sprinting, track-and-field events, gymnastics and most team sports rely on short bursts of energy that depend on anaerobic glycolysis. There is currently a paucity of controlled studies investigating the degree to which these sports can maximally adapt to fat-burning on carbohydrate-restricted diets.

It is important to realize, however, that the primary variables at risk are maximal performance and stress hormone adaptation. Maximal performance is primarily important in a competitive context, where a marginal increase in speed in a particular instant could make the difference of winning or losing. Stress hormone adaptation is relevant to everyone regardless of athletic status, but since athletes have a greater need for carbohydrate, they would be more likely to experience negative adaptations than someone enduring a similar level of carbohydrate restriction but living a sedentary lifestyle.

REFERENCES
1. Unless otherwise cited, information in this article comes from Ferrier, DA. Lippincott’s Illustrated Reviews: Biochemistry. 6th Edition. Lippincott Williams and Wilkins (Philadelphia) 2014.
2. Schoenfeld P, Reiser G. Why does brain metabolism not favor burning of fatty acids to provide energy? Reflections on disadvantages of the use of free fatty acids as fuel for brain. J Cereb Blood Flow Metab. 2013;33(10):1493-9.
3. Masterjohn C. The Daily Lipid Podcast Episode 11: Paleof(x) Grab Bag: Carbs Sex Hormones, Diabetes, and More. http://chrismasterjohnphd.com/2016/06/02/the-daily-lipid-podcastepisode-11_2/ Published June 2, 2016. Accessed September 7, 2016.
4. Hunter, GR. “Physical Activity, Fitness, and Health.” In Ross AC, et al., Eds. Modern Nutrition in Health and Disease: Eleventh Edition. Lippincott Williams and Wilkins (Philadelphia) 2014.
5. Keim NL, et al. “Carbohydrates.” In Ross AC, et al., Eds. Modern Nutrition in Health and Disease: Eleventh Edition. Lippincott Williams and Wilkins (Philadelphia) 2014.
6. Greenberg CR. The paradox of the carnitine palmitoyltransferase type Ia P479L variant in Canadian Aboriginal populations. Mol Genet Metab. 2009;96(4):201-7.
7. Zhang, JY. Desaturase and elongase-limiting endogenous long-chain polyunsaturated fatty acid biosynthesis. Curt Opin Clin Nutr Metab Care. 2016; 19(2):103-10.
The Good Scots Diet
Posted on May 1, 2009 by Katherine Czapp • 7 Comments

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The healthy Scots diet of two hundred years or so ago consisted of a fairly limited bill of fare composed of local foods: oats as chief cereal grain; root vegetables such as turnips and potatoes; leeks, cabbage and kale supplemented by wild vegetables such as nettles, sorrel and garlic; butter, cheese and other dairy products; fish, shellfish and seaweed; some meat and game; and numerous varieties of wild berries in summer.

The emphasis in this diet on fish livers and fish liver oils, shellfish, organ meats, blood, and healthy fats like lard—and the resulting robust health of the traditional Scots—helps dispel the modern myth that vitamin A is toxic and the modern notion that we cannot obtain sufficient vitamin D from food.

The mistress of the Scots kitchen turned these honest, simple ingredients into a nourishing assortment of dishes which are quite distinct from those represented by the bulk of other British Isle cuisines. This distinction in some part recalls the days of the Auld Alliance—Scotland’s political consolidation with France against the English from the thirteenth century until the end of the sixteenth—which left a bright and lasting influence on Scottish cuisine both in its style and its lexicon.

The foods, menus, history and folklore of Scottish domestic culture are celebrated with a robust affection and pride that are delightfully infectious in Florence Marian McNeill’s The Scots Kitchen: Its Lore and Recipes. McNeill first published The Scots Kitchen in 1929, with the aim of commemorating and extolling the Scots national tradition as expressed in its regional gastronomical heritages that she, even by the start of the last century, feared might be lost forever “in this age of standardization.”

McNeill was born in 1885 in Orkney, the archipelago of islands just north of Scotland, at a time when the previous century of Agrarian and Industrial Revolutions had wrought their stark and sometimes brutal dislocations and disruption of the ancient Scots traditions in social and domestic life. Her early years on the islands helped to shape her life-long fascination and pride in Scottish history and cultural traditions. Later in her life she produced a four-volume history of Scottish customs, folklore and ancient festivals called The Silver Bough, today considered an essential source by historians in the field.

The Scots Kitchen evokes the era before the forced pace of social change brought about by industrialization, and conjures the image of the self-sufficient farmstead, and within, the capable mistress at the helm of her bubbling cauldrons and sizzling “girdles” over the peat fire. McNeill generously interlards the many old recipes with historical, literary and contemporary commentaries that animate the period, as well as provide a constant social context for the heritage of the recipes and menus.

Speaking of the period pre-dating the Agrarian Revolution (which spanned roughly 1750 to 1850) McNeill paints the scene of the early Scot amid the gifts of his homeland: “In olden times, when the population was small and sparse—by the beginning of the sixteenth century it did not exceed half a million—the means of sustenance were on the whole plentiful. The moors and forests abounded with game; elsewhere ‘herds of kye nocht tame’ with flesh ‘of a marvelous sweetness, of a wonderful tenderness, and excellent delicateness of taste’ ranged the hills. Rivers, lochs, and seas teemed with fish. Sheep were valued mainly for their wool, cows for their milk. Butter and cheese were in use in the earliest times and the oat and barley crops have always provided the staple bread.”

By the end of the seventeenth century, however, the Scottish peasantry suffered a period of great scarcity of food and even famine that lasted intermittently into the first fifty years of the next century. Partially a result of civil and religious wars, as well as the continuous struggles with England, and partially a result of failing farming techniques, the life of the rural poor was one of grinding poverty and want. Gradual improvements in the raising of crops as the eighteenth century drew near brought dietary improvements to most rural dwellers, and to the gentry, a gradual development from a plain to a more sophisticated daily menu.
Mairzy Doats and Scots Eat Oats

“Look at the Scotch, with their oatmeal porridge, as robust a set of men as ever lived. A Highlander will scale mountains all day upon a diet of oatmeal stirred in water fresh from a gurgling spring with his finger, in a leather cup.”1

Oats “were hardly known on the continent . . . but were raised in Scotland to the highest perfection. One gathers, indeed, that in early times abroad oats were regarded as a weed.”2

Oats thrive in the cool, damp Scottish climate, even though the soil is sometimes thin and poor. The ancient custom of composting the oat straw thatch of their cottages—replaced each year when saturated with the residues of constant peat smoke oozing through—has likely been one secret to their oats’ vigor.

Weston Price conducted his own experiments in the 1930s to prove the efficacy of smoked roof thatch to fertilize oats, which permitted them to produce heavily in the short and cool northern season. McNeill simply asserts that something in the good earth made them “the flower of our Scottish soil, and through that magic cauldron, the porridge pot, Scottish oatmeal has been transmuted through the centuries into Scottish brains and brawn. (Alas for the deterioration wrought in our cities by the abandonment of the ‘halesome farin’ of rural Scotland for cheap imported food stuffs!)”

“There is one kind of food,” the distinguished doctor, Sir James Crichton-Browne, writes in 1901 in Stray Leaves from a Physician’s Portfolio, “that is helpful to the brain and to the whole body, throughout childhood and adolescence, and that is oatmeal. Oats are the most nutritious of cereals, being richer than any other in fats, organic phosphorus and lecithins. . . . At one time it was the mainstay of the Scottish peasants’ diet and produced a big-boned, well-developed and mentally energetic race, but it is so no longer, having given way to less useful and economic foods, and in the case of children in the large towns. . . to tea and [wheat] bread with dripping, margarine or jam.”

The sting of Samuel Johnson’s oft-repeated witticism scorning the Scot’s preference for horse-fodder is mitigated by another of his own admiring observations during a visit to Scotland about the oat-heavy diet. “Such food makes men strong like horses, and purges the brain of pedantry.”

Spr09-FisherFolk  Hearty Scotish fisherfolk. Note the size of the upper arms on the fisherman

McNeill marks the progression of grain preferences among the Scots in the last several centuries wherein ancient barley gave way to the supremacy of oats, which in its turn, during the most recent hundred years is “threatened by wheaten flour, the victory of which would be regarded by many as a national disaster.”

“Up until the middle of the last [nineteenth] century,” lamented Lord Boyd Orr, director of the Rowett Nutrition Institute at Aberdeen in the early 1920s, “the people of Scotland were eating natural foodstuffs. With the introduction of machinery, this has been changed. . . . Natural foods have been changed into artificial foodstuffs, with the very best substances purified away that the Almighty put there to keep us in perfect health.”

As these comments reveal, the Scots themselves were well aware of the detrimental changes that modern agriculture and food processing were wreaking on their long-venerated primary foodstuff. McNeill often turns to the details of careful oat milling and preparation that she fears will one day be utterly abandoned: “A good miller knows just what samples of grain to select, just how long the process of drying in the kiln requires, just how to set the stones for the correct shelling and grinding of the cleaned and dried oats. The method of kilndrying is somewhat more arduous than the modern method of mechanical drying, but it is to the kiln that we owe the delectable flavor of the best oatmeal.”

At one time, water-driven oat mills with stone grinders dotted the Scottish landscape at intervals of about every eight miles. McNeill continues, “In meal from the local mills, as in château wines, there are constant minor differences in taste, due in part to the quality and age of the grain, and in part to the temperature and time taken in the kiln. Country folk with a natural palate always appreciated the fact that the age-old primitive structure of the local mills provided an agreeable variation in the flavour of the meal. Far too much of the meal in the market today [1920s] is mass-milled by a process which affects adversely both its flavour and nutritive qualities. That is why so many children do not enjoy the porridge as their parents did. . .”

“The best oatmeal is well-ripened on the stalk, dried by sunshine and, if necessary, in the gentle warmth of a small kiln, and ground between two honest mill-stones. Some sort of virtue disappears with rapid drying, while high-speed milling between opposed surfaces of steel may possibly add a trace of iron to our diet, but cannot achieve the effect of a little fine sandstone dust.”3

Before, during and after the advent of the water-driven mill, with which the Scots had experimented perhaps as early as 700 AD, farmwives milled their oats by hand with the use of a quern, “a hand-mill composed of two circular stones with a hole in the centre of the upper one, through which it is fed corn [grain], and a wooden handle. The meal falls from all sides on to a wide tray, and by means of a wooden spindle can be ground coarse or fine at will…” The ancient quern worked so efficiently that it had continued in common use through the nineteenth century and even well into the twentieth.

Farmers who grew their own oats but sent them to the local mill to be threshed, winnowed and ground into meal also received in return a bag of “sids”—the inner husks of the oats to which some of the nutritious kernel would adhere. From these sids an ancient Celtic dish called sowans”(or sowens) was made.

The sids were soaked in water for approximately one week (or even more) until they were well soured. The liquid was then poured off and reserved, the sids squeezed to extract the last bits of goodness, and then discarded. The reserved liquid would sit another two days, collecting as sediment at the bottom of the vessel. McNeill comments that this sediment “contains practically all the nutritious properties of the oatmeal in its most easily digested form. When required for use, pour off all of the clear liquid (swats) and put some of the sediment (sowans) into a saucepan, allowing a gill [five ounces] for each person, with two gills of water and salt to taste. Bring to the boil, stirring continuously, and cook gently for ten minutes or longer, until thick and creamy. Serve like porridge, in wooden bowls or deep plates, with cream or rich milk.”

In his 1904 work Scottish Life and Character, William Sanderson quotes an Englishman’s impression of sowans to his friends after his return south: “The lady of the house boiled some dirty water, and by the blessing of God it came out a fine pudding.”

Ubiquitous oats were prepared in many ways, and many of them deceptively simple. “The ancient way of dressing corn [grain],” writes Martin Martin circa 1695 in A Description of the Western Isles of Scotland, “which is yet used in several Isles is called Graddan, from the Irish word Grad, which signifies quick. . . . A Woman sitting down, takes a handful of Corn [sheaf of grain, in this case oats], holding it by the Stalks in her left hand, and then sets fire to the Ears, which are presently in flame; she has a Stick in her right hand, which she manages very dexterously, beating off the Grain at the very Instant, when the Husk is quite burnt, for if she miss of that, she must use the Kiln, but experience taught them this Art to perfection. The Corn may be so dressed, winnowed, ground and baked within an Hour after reaping from the Ground. The Oatbread dressed as above is Loosening, and that dressed in the Kiln is Astringent, and of greater strength for laborers: but they love the Graddan, as being more agreeable to their taste.”
The Kail Yard

“As oats and barley were the staple grains,” McNeill explains, “so kail [kale] was long the staple vegetable. His kail-yard was, in fact, to the old Scots crofter what his potato plot was to the Irish peasant. There he planted cabbages for summer and green kail for winter use, in addition, of course, to potatoes. . . . The vogue of kail, however, was originally confined to the Lowlands. The Highlander preferred the common nettle in his broth, and appears to have regarded the use of kail as a symptom of effeminacy.”

Kail was so ubiquitous a vegetable that it lent its name to the vegetable garden in general (the kail-yard) as well as to the evening meal, regardless of what else might be served (“Will you come and tak’ your kail wi’ me?”), and, by extension, the general term for broth or soup.

The potato traveled to Scotland via Ireland, and its first recorded appearance there is in 1701. In his Domestic Annals of Scotland, published in 1885, Robert Chambers tells us that “About 1773 it was beginning to be cultivated in gardens, but still with a hesitation about its moral character, for no reader of Shakespeare requires to be told that some of the more uncontrollable passions of human nature were supposed to be favoured by its use…”

Turnips were introduced at about the same time. Carrots, summer cabbages and other “coleworts” provided welcome variety in the diet.
Fish and Seafood

The Scots have traditionally eaten more fish than their carnivorous neighbors in England. McNeill describes the vast bounty of fish and sea food available to the Scots: “The great salmon-rivers and innumerable lochs and trout streams, together with the wide sea-track that skirts our shores from Stornoway to Eyemouth—the immemorial route of the annual migration of our herring shoals—provide us with a wealth of fish of high quality. The most important of our white fish are haddock, cod, plaice and hake; others are whiting, halibut, turbot, lemon-sole and ling; and in our herring (as in our oats) we possess a foodstuff of the highest nutritional value and of a quality unexcelled in any other part of the world.”

A diet high in fish and sea foods, including sea weeds, was observed to bestow particular vigor and lustiness to seaside inhabitants. Martin Martin in A Description of the Western Isles tell us “It is a general Observation on all such as live on the Sea Coast, that they are much more prolific than any other people whatsoever.”

And McNeill remarks in a footnote that “Aphrodite was born of the sea, and was commonly held to exercise her influence through certain products of the sea, notably (in the Scottish tradition) trout, skate, shell-fish and salt. Skate-bree (the liquor in which skate has been boiled) is a famous old Scottish love-potion.”

Shellfish was also very important as a staple of the diet—of these, oysters reigned supreme throughout the seventeenth and eighteenth centuries, with Scottish oysters shipped by the thousands of barrels all through the British Isles.

In The Good Scots Diet: What Happened to It? author Maisie Steven emphasizes the fact that fresh fish would have made a significant contribution to the diet of inland dwellers to such a degree that they actually became tired of it—a startling thought to us nowadays when such bounty would be relished as the highest luxury.

In The Scottish Gael (1831), James Logan writes, “In Aberdeenshire the servants, during the summer, had so much salmon that they refused to eat of it oftener than twice a week.” “But on the West Coast,” comments Maisie Steven, “the fish which added most to the frugal diet of the common people was unquestionably the herring. . . . Because of the herrings’ well-known habit of arriving periodically in great shoals, it is easy to understand how some technology for preserving surpluses came to be devised, and how this led eventually not only to each cottage having its own barrel of salt herrings as a bulwark against want, but also to the emergence of that succulent item so beloved of gourmets everywhere, the Scots kipper. It is of interest, however, that in earlier times the term ‘kipper’ frequently refers to salmon rather than the herring. . . . The traditional cereal-based diet being short in vitamins A and D meant that herrings, richly endowed with these, could provide an excellent supplement.”

McNeill provides at least a dozen recipes for fish liver dishes, attesting to their popularity, and remarking that “The livers, which must be perfectly fresh, make a rich and nourishing stuffing. (Cod liver is richest in oil.) In Shetland, where they are much used, a special utensil called a pannabrad (panna, kettle and brad, melting) is used for melting fish livers, and the oil obtained is stored for winter use.”

The Cook and Housewife’s Manual of 1826, allegedly written by Mistress Meg Dods, the dauntless landlady of the inn in Sir Walter Scott’s novel St. Ronan’s Well, was actually penned by Mrs. Isobel Christian Johnson, wife of an Edinburgh publisher and herself the editor of Tait’s Magazine. McNeill shares many of Meg Dods’s recipes in order to exemplify the Anglo-Gallic style of cooking that Mrs. Dods/Mrs. Johnson considered the greatest the world had ever known. McNeill feels that the work, filled with practical culinary advice as well as sound gastronomic philosophy, is “not unworthy to be placed alongside its French contemporary, Brillat Savarin’s Physiologie du Goût.”

The Manual’s simple but refined method of vegetable preparation would be appreciated today: tender vegetables are steamed—never boiled to death in water—and served with complementary fresh herbs and butter; potatoes are to be fried in goose fat; sorrel is cooked in butter. Luscious soups, such as oyster, are thickened with egg yolks and cream, and again with the addition of simple, but fresh and complementary herbs.
Breakfast in Scotland

McNeill readily admits that it is not dinner, but breakfast, that is the meal upon which the Scots particularly pride themselves. In Scotland, she gently but wryly comments, dinners are generally “more distinctive than distinguished.”

“In the breakfast,” asserts Dr. Johnson, “the Scots, whether of the Lowlands or the mountains, must be confessed to excel us. . . . If an epicure could remove by a wish in quest of sensual gratification, wherever he supped, he would breakfast in Scotland.”

Neither tea nor coffee—fashionable amendments to wealthy tables which made their way to Scotland via France and England in the early eighteenth century—appears on the Highland breakfast-table described by Tobias Smollett in Humphrey Clinker:

“One kit of boiled eggs; a second, full of butter; a third, full of cream; an entire cheese made of goat’s milk; a large earthen pot, full of honey; the best part of a ham; a cold venison pasty; a bushel of oatmeal, made into thin cakes and bannocks; with a small wheaten loaf in the middle, for the strangers; a stone bottle full of whiskey; another of brandy, and a kilderkin [half a barrel] of ale.”

No less than dinner, the first meal of the day was a social occasion in which guests, extended family and travelers alike were regaled with the best the gentry household had to offer.

McNeill recounts another bounteous breakfast spread enjoyed by a French visitor: “In 1784, at the house of Maclean of Torloisk, on the island of Mull, Faujas de St. Fond found the breakfast table ‘elegantly covered with the following articles: Plates of smoked beef, cheese of the country and English cheese, fresh eggs, salted herrings, butter, milk and cream; a sort of bouillie of oatmeal and water [clearly porridge was a novelty to the Frenchman!], in eating which, each spoonful is plunged into a basin of cream; milk worked up with the yolks of eggs, sugar, and rum; currant jelly, conserve of myrtle, a wild fruit that grows among the heath; tea, coffee, three kinds of bread (sea biscuits, oatmeal cakes, and very thin and fine barley cakes); and Jamaica rum.’”

“The breakfast!” exclaims Dr. Redgill in Susan Ferrier’s Marriage, after vigorously abusing the Scottish dinner, “that’s what redeems the land—and every county has its peculiar excellence. In Argyllshire you have the Lochfyne herring, fat, luscious, and delicious, just out of the water, falling to pieces of its own richness . . . . In Aberdeenshire you have the Finnan haddo’ with a flavour all its own, vastly relishing. . . . In Perthshire there is the Tay salmon, kippered, crisp and juicy—a very magnificent morsel. . .”

In My Schools and School-masters, Hugh Miller, describing the “genuine Highland breakfasts” he enjoyed on his visits to an aunt in Sutherland, writes: “On more than one occasion I shared in a not unpalatable sort of blood-pudding, enriched with butter, and well seasoned with pepper and salt, the main ingredient of which was derived from the yeld [young] cattle of the farm. The practice was an ancient and by no means unphilosophic one. . .”

Another contemporary writer also recalls collecting vitamin D-rich blood from living animals: “Some of the stronger cattle were bled in the spring by an expert. The blood was carefully prepared, salted in a tub, and set aside for use. We called it black pudding.”

Blood sausages, or blood puddings, were made from ox, pig’s, sheep’s and goose blood. The blood was often thickened with oatmeal or barley meal, enriched with suet, lard or other fat, and seasoned with onions, pepper, salt and other spices. Tripe skins were used as casings, except in the case of goose blood sausages, for which the skin of the goose’s neck served this purpose.

Although never great meat-eaters, the Scots raised beef and mutton of excellent quality; in fact, the famous roast beef of Olde England, according to McNeill “at its best is Scots beef, which always fetches a higher price in the London market.”
Dairy Products

Milk from cows, sheep, and goats has been an important cornerstone of the Scots diet, and especially to help eke out the times when the diet was largely cereal-based. Fresh milk, buttermilk and whey were primary beverages for a very long time, along with supplemental ale brewed from barley and oats.

Whey was drunk fresh, or fermented further to create a sparkle, and was a favorite thirst-quencher. Of interesting historical note, McNeill explains that “Whig, (Old Scots quhig) is the acetous liquid that subsides from sour cream, and is the origin of the political term, which was first applied by Scottish Episcopalians (who were almost invariably Tories) to Presbyterians, and by Presbyterians of the Established Church to those of the dissenting bodies.”

Buttermilk was also in great demand in the summertime, both among the rural people and city dwellers. McNeill notes it “was valued as both food and drink, and was held to cool the stomach in fever and to aid the cure of dysentery and other ailments.” J. Jamieson in the Book of the Old Edinburgh Club recounts the popularity of buttermilk in the city: “In old Edinburgh, throughout the summer months, one might witness daily the picturesque sight of milkmaids on horseback riding into town with soordook [buttermilk] barrels strapped across the saddle behind them. . . . It has been estimated that at the end of the eighteenth century a thousand pounds a year was paid in Edinburgh during the months of June, July, August, and September for this very inexpensive beverage, which was sold for a penny the Scots pint (i.e. two Imperial quarts).”

Yet one more romantic evocation of the era from Alexander Carmichael’s Carmina Gadelica paints an irresistible bucolic scene:

“The milking-songs of the people are numerous and varied. They are sung to pretty airs, to please the cows and induce them to give their milk. The cows become accustomed to these lilts and will not give their milk without them. This fondness of the Highland cows for music induces owners of large herds to secure milkmaids possessed of good voice and some ‘go.’ It is interesting and animating to see three or four comely girls among a fold of sixty, eighty or a hundred picturesque Highland cows on meadow or mountain slope. The moaning and heaving of the sea afar, the swish of the wave on the shore, the caroling of the lark in the sky, the unbroken song of the mavis on the rock, the broken melody of the merle in the break, the lowing of kine without, the answering of calves within the fold, the singing of the milkmaids in unison with the movement of their hands, and of the soft sound of the snowy milk falling into the pail, the gilding of hill and dale, the glowing of the distant ocean beyond, as the sun sinks into the sea of golden glory, constitute a scene which the observer would not, if he could, forget.”

McNeill adds that well into the twentieth century, the milkmaids in many parts of Scotland would call their cows with “Proochey, leddy, proochey moo!” [Approchez moi!]
How to Hunt a Haggis

Haggis is simply the apotheosis of the sausage. Poet Robert Burns regaled it as the “great chieftain o’ the puddin’ [sausage] race,” and further honored it with a long, mock-heroic poem, “Address to a Haggis,” that in recent times is ritually recited before serving forth the haggis during Burns Night suppers, held each January 25 on the anniversary of Burns’s birth. (This year he celebrated his 250th.)

The origin of the name haggis is sometimes attributed to the French hacher—from which we derive the terms “hash” and “hatchet” in English— but it is more likely that it simply came from the Scots verb hag, meaning to hack or chop. Similar stuffed concoctions were prepared by many peoples since antiquity, but only the Scots seem to have preserved the custom to the present day. McNeill semi-humorously rails against the modern prejudice suffered by haggis: “Why everybody except the Scots stopped stuffing the paunch whilst they went on stuffing the intestines, the annals of gastronomy do not reveal. And why so many people furth of Scotland regard the haggis as an uncivilized dish and sausage as a civilized one is another mystery.

“The choice of haggis as the supreme national dish of Scotland is very fitting. It is a testimony to the national gift of making the most of small means; for in the haggis we have concocted from humble, even despised ingredients a veritable plat de gourmets. It contains a proportion of oatmeal, for centuries the national staple grain, whilst the savoury and wholesome blending of the cereal with onion and suet. . . is typically Scottish. Further, it is a thoroughly democratic dish, equally available and equally honoured in castle, farm and croft. Finally, the use of the paunch of the animal as the receptacle of the ingredients gives that touch of romantic barbarism so dear to the Scottish heart.”

George Saintsbury, perhaps the most influential English historian of the early twentieth century, Professor of English at the University of Edinburgh, and a “distinguished critic of food and wine as well as letters” writes: “Generally speaking, Scotch ideas on food are sound. The people who regard haggis and sheep’s head as things that the lips should not allow to enter them, and the tongue should refuse to mention, are, begging their pardons, fools.”
The Scots Tradition Today

In 1985, Maisie Steven published The Good Scots Diet: What Happened to It? The cry of distress in her title reflects recent alarming trends in the modern Scots diet that one sees, to greater or lesser degree, in all parts of the industrialized world. Steven noted that health workers recorded a decline in the quality of the diet in certain areas in Scotland in the 1920s, but the health of children in some agricultural districts was still quite sound as revealed in the findings of the Medical Research Council’s Report No. 101:

“The town children appeared to be poorly developed, often pale, and in Glasgow frequently rachitic, thus forming a striking contrast to the country children, who were sturdy, well-developed and rosy-cheeked, and in whom rickets was almost non-existent.”

Their food, Steven notes, “consisted of soups, stews, porridge, milk, oatcakes and scones, the cottage gardens contributed a limited variety of vegetables and some soft fruit. [The researchers] noted the fact that although the parents were in general very poorly paid, they did at least have rent-free houses and received some extras such as meal, potatoes and milk; fresh air and exercise were also duly acknowledged as having contributed to the altogether superior physique of the country children.”

In the 1960s, rickets made a disturbing reappearance among children in Glasgow, and many of the elderly were found to be suffering from anemia and osteomalacia, while middle-aged citizens were commonly plagued with overweight, hypertension, and heart disease. Typical modern Scots foods were flour and sugar products of numerous kinds, tinned meats and soups, pasta, syrups, buns, cakes and biscuits. Stevens relates the habitual daily menu for children as consisting of a packet or two of crisps (potato chips) for breakfast—or no breakfast at all—followed by pastry or rolls for lunch (a West Scotland “specialty” was a white roll stuffed with crisps) and for supper a meat pasty or sausage roll, followed by pie or trifle or ice cream.

Could there be an alternative to this dietary wasteland? Stevens relates an interesting story: “A few years ago a Dane, Paul Stemann, wrote a most interesting account of his trek across the Highlands with a pack pony. While he greatly appreciated the people and the superb scenery, his comments on the food were less than complimentary. He missed nothing—the tired vegetables in the shops, the general lack of well-cultivated gardens on the West coast—but especially he wondered why it was that fresh food seemed to play such a small part in the daily menus. ‘All through the Highlands,’ he writes, ‘there were venison, salmon, lobster, crab, wild raspberries, rowanberries, chanterelles—all the most delectable foods. It was all around, but never put in front of you.’”

Steven was still able to find living persons who could indeed remember alternatives: “An elderly lady from the Outer Hebrides who kindly cast her mind back for the benefit of this study to the food of her childhood early this century, recalled that main meals in those days frequently centred around fish of one kind or another—salted herring or mackerel, dried salt fish, shellfish—although mutton, fowls and rabbits were also regular fare. Potatoes still formed a basic part of the food—not infrequently twice in the day—other vegetables apart from turnips being comparatively rare except in broth. Oats, Indian (maize) meal and flour, along with dairy produce, formed the basis of the other meals; puddings were almost exclusively rice and carrageen (purple seaweed); fruit remained as scarce as it had ever been.

“She recollected: ‘The “piece” we carried to school consisted of oatcakes or sometimes scones, with crowdie [curd with butter], treacle or jam. And well I remember how ravenous we always were by the time we had walked the long miles home! A bottle of seal oil always stood on the mantelpiece and we seemed to be given a dose for every kind of ailment.’”

The industrial standardization of food that F. Marian McNeill feared would overtake Scottish cooking spells the death not only of culinary culture, but eventually of the people who once were sustained by their native dietary culture. McNeill refuses to consider defeat, however: “We may rest confident that out of the domestic travail through which our women folk are now passing there will emerge a new delight in the home, and, not least, in the kitchen.

“Lean gu dlùth ri cliù do shinnsre,” says the Gaelic proverb: “Let us follow in the brave path of our ancestors.”

SIDEBARS
Porridge

The following instructions for “the one and only” oat porridge, from The Scots Kitchen, are wonderful to contemplate if only for the theatricality of the ritual!

“The halesome parritch, chief o’ Scotia’s food.” –Robert Burns

(The One and Only Method)

Oatmeal, salt, water

“It is advisable to keep a goblet [cast iron cooking pot] exclusively for porridge.

Allow for each person one breakfastcupful of water, a handful of oatmeal (about an ounce and a quarter), and a small saltspoon of salt. Use fresh spring water and be particular about the quality of the oatmeal. Midlothian oats are reputed to be unsurpassed, but the small Highland oats are very sweet.

Bring the water to the boil and as soon as it reaches boiling-point add the oatmeal, letting it fall in a steady rain from the left hand and stirring it briskly the while with the right, sunwise, or the right-hand turn for luck—and convenience. A porridge-stick, called a spurtle, and in some parts a theevil, or, as in Shetland, a gruel-tree, is used for this purpose. Be careful to avoid lumps, unless the children clamour for them. When the porridge is boiling steadily, draw the mixture to the side and put on the lid. Let it cook for from twenty to thirty minutes according to the quality of the oatmeal, and do not add the salt, which has a tendency to harden the meal and prevent its swelling, until it has cooked for at least ten minutes. On the other hand, never cook porridge without salt. Ladle straight into cold porringers or soup-plates and serve with individual bowls of cream, or milk, or buttermilk. Each spoonful of porridge, which should be very hot, is dipped in the cream or milk, which should be quite cold, before it is conveyed to the mouth.”

The traditional Scots seasoning for porridge is only salt; sugar, as used by the English, was early on considered “deplorable.”
Traditions in Porridge Preparation

The old Scottish preparation of sowans resembles almost precisely the ancient Russian dish called oat kissel (pronounced “kee-SYELL”)—made from whole oats, which also produced a smooth, soured gel that was understood to be easily digested and especially nourishing for children, the elderly and convalescents. This complex method of preparation was certainly a means to address all of the components in grain that have been a challenge for the human digestive anatomy.

Oats contain more phytates than almost any other grain—in fact their high phosphorus content is largely bound up in their phytates. At the same time, oats possess relatively small amounts of phytase, the enzyme needed to neutralize phytate. The usual means to reduce phytate content in wheat or rye—by soaking for eight to twelve hours in a warm, slightly acid medium—is far less effective with oats. Germination and/or fermentation are the means to best convert phytate in oats. The old, traditional harvest methods provided natural opportunities for the oats to start and stop germination after harvest in their ripening and storage out doors, when in contact with light applications of dew or rain. The scythed sheaves first stood in the fields for days or even weeks until the crop was fully harvested. The sheaves were then collected and expertly piled in large, twenty-foot tall stacks and lashed down with ropes against wind, rain and snow. Of course it would be a disaster if the oats were actually to sprout fully before they were needed, but it seems likely that natural conditions allowed for some conversion of phytates while in storage. Drying in the kiln removed excess moisture and allowed for better milling and removal of the outer hull. The “sids” that the miller returned to the Scots farmer would contain most of the phytate still present in the oat groat—as it is contained in greatest concentration in the bran. The very long souring process—a week or more on average—would give the sids the time they needed to ferment, while also converting the gluten, starches and sugars into a nearly pre-digested form.

Another common preparation of oat porridge in the Scottish kitchen included the farm wife cooking a large pot of porridge early in the week that would be poured into the drawer of the kitchen cupboard and left to cool and congeal. All week, family members would cut a slice to take with them to the fields and eat cold under its new name, calders. Certainly the calders soured pleasantly as the days went by. Slices were also fried in butter to accompany fish or eggs.

“Whey-whullions,” according to The Scots Kitchen, was “formerly a common dish among the peasantry of Scotland, consisting of the porridge left at breakfast, which was beaten down among fresh whey, with an additional quantity of oatmeal.”

Although one finds numerous references to the old tradition of soaking the oatmeal overnight before making breakfast porridge, there are just as numerous old methods that do not employ a pre-soaking stage. In particular, the preparation of brose is a very early version of “quick oats” if there ever was one: “Put into a bowl two handfuls of oatmeal. Add salt and a piece of butter. Pour in boiling water to cover the oatmeal and stir it up with the shank of a horn spoon, allowing it to form knots. [The oatmeal inside the knots is raw.] Sup with soor dook [buttermilk] or sweet milk, and you have a dish that has been the backbone of many a sturdy Scotsman.”

Milk brose is made similarly, except with boiling milk instead of water, and sometimes the liquid left from boiling kail was used to prepare kail-brose. At one time servants in straitened circumstances had to make do with plain brose three times a day, with perhaps pease-meal brose or turnip brose on a Sunday and not much else. A skin ailment called Scotch fiddle was also common at this time, so called because of the constant itching between the fingers of the sufferer. Whether this was a kind of dermatitis or eczema brought about by an excessive near-raw oat diet, or a deficiency symptom because of a general lack of nutrients, or even scabies mites from cramped and abject living quarters is now difficult to tell. At the time, the cure was to stop eating oats and subsist on pease porridge until the skin cleared.
NETTLE KAIL [BROTH]

“If they would eat nettles in March
And drink mugwort in May,
So many fine maidens
Would not go to the clay.”
Funeral song for a Scottish mermaid.

“This simple but delicious soup is associated especially with the month of March, when nettles are young and fresh and the black March cockerel [young rooster] is exactly a year old, with young and tender flesh . . . . In the old days, March time was tonic time, and it was believed that nettle kail—taken three times during the month, sometimes on three consecutive days—purified the blood, cleared the complexion, and in general, ensured good health for the ensuing year.

A year-old cockerel, young nettles, oat or barley meal, butter, salt, pepper, wild garlic or onion, water.

Gather a sufficient quantity of young nettles—it is advisable to wear gloves. Strip off the young, tender leaves at the top, discarding the coarser ones, and wash in several changes of salted water. Dry in a clean cloth and chop finely, unless the leaves are very small. Put the dressed and stuffed bird (see below) into the kail-pot with two quarts of cold water. Bring slowly to the boil, and add the nettles—about three-quarters of a pint—and a handful of oat or barley meal, stirring well. Add salt to taste, a good pat of butter, and a little wild garlic or onion. Simmer until the bird is tender, then season the kail to taste.

For the stuffing, rub a piece of butter into twice its weight in oatmeal or barley meal, or substitute finely chopped suet for the butter. Season with salt, pepper and a little wild garlic. Mix the ingredients well and stuff the bird. Insert a skewer in the opening.

Nettles make an excellent substitute for spinach in early spring.”
Common Fish Dishes from The Scots Kitchen
To Fry Herring in the Scots Fashion

Wha’ll buy my caller [fresh] herrin’?
They’re bonnie fish and dainty fairin’
Wha’ll buy my caller herrin’
New drawn frae the Forth?
—Lady Nairne: Caller Herrin’

Fresh herring, oatmeal, pepper, salt, dripping

“Cleanse, dry and trim the herring. Score across slantwise in two or three places on each side. Sprinkle with pepper and salt and toss in coarse oatmeal on a sheet of kitchen paper until they are thoroughly coated. An ounce of oatmeal and the same quantity of dripping should be allowed for every two herring. Make the dripping smoking hot in a frying-pan and brown the herring nicely on both sides, allowing them from ten to fifteen minutes. Drain on paper and serve very hot. They may be garnished with parsley and cut lemon. In Buchan, vinegar and oatcakes are considered the perfect accompaniment to this dish.”
Crappit (Stuffed) Heids

Formerly a favorite supper dish all over Scotland.

Heads of haddock, forcemeat

“The original Scots farce was simply oatmeal, minced suet or butter, pepper, salt, and onions made into a coarse forcemeat for stuffing the heads of haddock and whiting. Modern crappit heads are farced with the fleshy parts of a boiled lobster or crab, minced, a boned anchovy, the chopped yolk of an egg, grated bread or pounded biscuit, white pepper, salt, cayenne, a large piece of butter broken down into bits, with beat eggs to bind, and a little oyster liquor. A plainer and perhaps as suitable stuffing may be made of the roe of haddock or cod parboiled, skinned and minced, mixed with double its bulk of pounded rusks or bread-crumbs, a good piece of butter, shred parsley, and seasonings, with an egg to cement the forcemeat. Place the crappit heads on end in the bottom of a buttered stew-pan, pour the fish-soup gently over them, cover and boil a half-hour.”
Crappit Heids from the Isle of Lewis

The heads and livers of fresh haddock, oatmeal, pepper, salt, milk

“Chop the livers, which must be perfectly fresh, mix them with an equal quantity of raw oatmeal, add pepper and salt, and bind with the milk. Stuff the heads with this mixture, and boil them with the fish. The liquor makes good stock for fish soup.

A similar stuffing is made with cods’ livers, but the body, not the head, is stuffed, through the gullet.”
High Fish

Mrs. Dods/Mrs. Johnson preferred her fish to be “ripened” for two days or more, as fresh fish was considered “harsh”—this last a Scots predilection of the time for slightly “high” fish dishes. Two descriptions follow.
Kiossed Heids

“These are fish heads rolled in a cloth and put into the crevice of a stone wall, where they are left until they acquire a gamey flavour. They are then cooked—usually roasted—and are eaten with butter and potatoes.”
Earth-Dried Skate

This description is attributed to the early twentieth-century English naturalist and author Harry Mortimer Batten: “Skate are placed on damp grass and covered with sods for a day or two. They are too tough if eaten fresh, but seasoned for just the right time they are the most excellent breakfast dish I know. And they make very good soup. . . . Skate must be fried or baked and served with the skin on, never boiled. . . . Skate are said not to take salt. They are frequently hung up unsalted and eaten ‘high’—an acquired taste—as in the Island of Lewis.”
Cheese in Scotland

The Scots have made cheeses since time immemorial, and although they never matched the inventiveness and variety of the French, their cheeses have been an important and loved food for generations. Here is a recipe for a fresh curd cheese that was often made especially for children.
Hatted Kit

(An old Highland Recipe)

Buttermilk, new milk, sugar, nutmeg, double cream

“Warm two quarts of buttermilk slightly at milking time. Carry the vessel to the side of a cow and milk into it a pint of milk. Stir well. At the next milking, add another pint and stir again. Let it stand till it firms and gathers a hat. Remove the curd, place it on a hair sieve, and press the whey through till the curd is stiff. Put into a mould and leave for half an hour. Turn out and strew with sugar and nutmeg, and serve with thick cream.”
Crowdie or Cruddy Butter

“Crowdie” is another common farmstead cheese product—”crowdie” derives from Old Gaelic for “curd.” In good times, oatcakes were adorned with thick coatings of crowdie.

“In Iverness and the Ross shires there is a rural breakfast article called crowdie, not the common composition, oatmeal and water or milk, but made thus: Take two parts fresh sweet-milk curd and one of fresh butter. Work them well together and press them in a basin or small shape and turn it out, when it will slice nicely. When whey is much used for drink in hot weather the curd may be usefully thus disposed of. It is eaten with bread and butter and keeps a long time, if goût is liked. This preparation, when the curd is well broken and blended with the butter, is sometimes made up in wooden moulds and kept for months, when it becomes very high flavoured though mellow.”
Haggis

(Traditional Cottage Recipe)

The large stomach bag of a sheep, the pluck (including heart, lungs and liver) beef suet, pin-head oatmeal, onions, black pepper, salt, stock

Brown and birstle (dry or toast) a breakfastcupful of oatmeal before the fire or in the oven. Clean the great bag thoroughly, washing it first in cold water and then, after turning it inside out, scalding and scraping it with a knife; then let it soak overnight in cold salted water. In the morning put it aside with the rough side turned out. Wash the pluck well and put on to boil covered with cold water, letting the windpipe hang over the side of the pot to let out any impurities.

Let it boil for an hour and a half, then take it out and cut away the pipes and any superfluities of gristle. Mince the heart and lungs and grate half the liver. (The rest of the liver is not required.) Put them in a basin with half a pound of minced suet, two medium-sized onions finely chopped, and the toasted oatmeal, and season highly with black pepper and salt. (A pinch of cayenne, say some housewives, ‘makes all the difference.’) Over the whole pour, preferably when cold, as much of the liquid in which the pluck was boiled (or, better still, good stock) as will make the mixture sappy.

Fill the stomach bag rather more than half full—say five-eighths—as it requires plenty of room to swell. Sew it up securely and place it on an enamel plate in a pot of boiling water (to which half a pint of milk is often added), or, better still, boil it in stock. As soon as it begins to swell, prick it all over with a large needle to prevent its bursting. Boil steadily, without the lid, for three hours, adding boiling water as required to keep the haggis covered. Serve very hot without any garnish.

The usual accompaniments are mashed potatoes and mashed turnips or, better still, the two mashed together with a good piece of dripping.
Traditional Meat Dishes from the Scots Kitchen
Potted Head

(Old Family Recipe)

Ox head, ox foot, salt, pepper, cayenne, mustard, bay leaf, mace, cloves or allspice or nutmeg, water

Soak half an ox head and a foot for a few hours. Break them up into several pieces. Remove from the foot as much of the fat and marrow as possible. Scald head and foot with boiling water and, when cool enough, scrape and clean them thoroughly. Put them into a large saucepan, plentifully covered with cold water, and add two tablespoons of salt. Bring this very slowly to the boil, skim carefully, and let it simmer for three hours. Take out the head and foot and remove all the best meat from them. Return the bones to the pan, adding more water if there is not enough to cover them. Add a bay leaf, a blade of mace, and a very few cloves, if liked. Let this simmer for two or three hours longer. Strain into a basin and put aside till it gets cold. There should be at least eight breakfast-cupfuls of liquid. Next day (or sooner) remove all the fat from the top of the stock, which should now be a jelly. Trim and chop the meat and put it into a clean saucepan with the stock. Let this simmer for fifteen or twenty minutes. Add half a teaspoon of mustard, the same of allspice or nutmeg if cloves have not been used, and season rather highly with pepper and cayenne. Pour into wetted moulds and put in a cool place to set. Turn out and serve with salad.
To Dress a Sheep’s Head

O Lord, when hunger pinches sore,
Do Thou stand us in stead
And send us, from Thy bounteous store,
A tup or wether head.
—Robert Burns: A Grace

The head, after singeing, should be boiled long and gently, as for Powsowdie (see below) along with the trotters. It is then split and laid flat on a large ashet [serving tray] with the trotters around it, the tongue sliced, and, if liked, balls of yolk of egg. The dish is garnished with sliced vegetables—carrots, turnips and onions—that have been cooked in the broth. Parsley or brain sauce may be served with it.
Powsowdie or Sheep’s Head Broth

(Pow = head; sowdie = sodden, or boiled)

Sheep’s head and trotters, mutton, barley, peas, carrots, turnips, onions, parsley, salt, pepper, water

Choose a large, fat, young head. When carefully singed by the blacksmith, soak it and the singed trotters for a night, if you please, in lukewarm water. Take out the glassy part of the eyes, scrape the head and trotters, and brush till perfectly clean and white; then split the head with a cleaver, and lay aside the brains, clean the nostrils and gristly parts, split also the trotters, and cut out the tendons. Wash the head and feet once more, and let them blanch till wanted for the pot.

Take a large cupful of barley, and about twice that quantity of soaked white (dried) or fresh green peas, with a gallon or rather more of water. Put to this the head, and from two to three pounds of scrag [bony parts of the neck] or trimmings of mutton, perfectly sweet, and some salt. Take off the scum very carefully as it rises and the broth will be limpid and white as any broth made of beef or mutton. When the head has boiled rather more than an hour, add sliced carrot and turnip, and afterwards some onions and parsley shred. A head or two of celery sliced is admired by some modern gourmands, though we would rather approve of the native flavour of this really excellent soup. The more slowly the head is boiled, the better both the meat and the broth be. From two to three hours’ boiling, according to the size of the head and the age of the animal, and an hour’s simmering by the side of the fire, will finish the soup. Many prefer the head of a ram [tup] to that of a wether [castrated sheep], but it requires longer boiling. In either case the trotters require less boiling than the head. Serve with the trotters and sliced carrots round the head.

McNeill supplies the following helpful home-preparation notes: “To singe the head at home, hold it over the fire, and as the wool singes scrub the burnt wool off with a knife; then hold the head over the fire and repeat until all the wool has been singed and rubbed off. Finally, go over the whole head carefully with a hot iron or poker until no trace of wool is left.” It is said that the reason why the head was so tender in the old days was that the blacksmith’s boys played football with it! “The decay of the smiddy [blacksmith’s shop] has sadly reduced the popularity of this excellent soup.”
Two Recipes for Fowls
Feather Fowlie

(A luncheon soup which may be a legacy of the Auld Alliance.)

Fowl, ham, celery, onion, thyme, parsley, mace, salt, eggs, cream.

Take a fresh fowl; joint and let the pieces soak for half an hour in cold water to which you have added a dessertspoonful of salt, then wash it well under the tap and put it into a stew-pan with a slice of ham, a stick of celery cut small, a sliced onion, thyme, parsley and a bit of mace. Cover with a quart of cold water, put the lid on, and bring it to the boil; then draw it to the side and let it cook gently for an hour and a half; strain, and immediately clear off all the grease with paper. Put it into another stew-pan and add a dessertspoonful of chopped parsley and a ladleful of first stock. Let it heat up for fifteen minutes and add the minced white meat of the fowl. Remove from the fire, stir in three strained yolks of egg and a dessertspoonful of warmed cream. Pour into a heated tureen.

MacNeill believes that “fowlie” is a corruption of volaille, and “feather” of velouté —”the more so as the soup bears a strong resemblance to the French velouté de volaille.”
Cock-A-Leekie

(Traditional Recipe)

A cock or plump fowl, leeks, prunes, Jamaica pepper, salt, veal or beef stock

Cut off the roots and part of the heads of two or three bunches of leeks and wash thoroughly. Truss the fowl and place in a large pot with three or four of the leeks, blanched and chopped, and two quarts of good stock. Bring to the boil and cook gently for two hours or longer, until the fowl is tender, when it should be removed. Clear off all the grease with paper. Add the remainder of the leeks, blanched, with more salt, if required, and Jamaica pepper to taste. Simmer very gently until the leeks are tender. Half an hour before serving, add a dozen or so of prunes, unbroken. Remove the skin and bones from the fowl and mince the white meat fine and place in a tureen with the soup.

(Note courtesy of Meg Dods: “The soup must be very thick of leeks, and the first part of these must be boiled down into the soup until it becomes a lubricious compound.”)

REFERENCES

    Robinson, Solon, How to Live, Saving or Wasting, or Domestic Economy Illustrated, 1860
    McClure, Victor, Scotland’s Inner Man, 1935.
    Gastrologue, The Scotsman Magazine, c. 1920.

This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly magazine of the Weston A. Price Foundation, Spring 2009.
Merrie Olde England
Posted on January 1, 2000 by Sally Fallon and Mary G. Enig, PhD • 0 Comments

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    Pullets; Boiled capon; Shoulder of mutton; Veal roast; Boiled chickens; Rabbits roast; Shoulder of mutton roast; Chine of beef roast; Pasty of venison; Turkey roast; Pig roast; Venison roast; Ducks boiled; Pullet; Red deer pye cold; Four capons roast; Poults [young chickens] roast; Pheasant; Herons; Mutton boiled; Wild boar pye; Jiggits of mutton boiled; Jiggits of mutton burred [buttered]; Gammon of bacon; Chicken pye; Burred [buttered] capon; Dried hog’s cheek; Umble pye; Tart; Made dish.

Thus read the menu for a Monday morning breakfast served in honor of King James I’s visit to the northern English town of Preston in August of 1607. Dinner the previous evening featured thirty dishes for the first course and twenty-seven in the second.

Travelers of less exalted station did not find such elaborate banquets at the end of their day’s journey but nevertheless expected a variety of meats for their evening meal. John Byng, a guest at the White Swan Inn at Middleham in 1792 made the following inscription in his dairy: “I now felt a haste for dinner, and this is a description of it: Cold ham; A boiled fowl; Yorkshire pudding; Gooseberry pye; Loyn of mutton roast; Cheesecake.”1

Animal foods of every description served as the basis of the English diet for all but the poorest during the Shakesperean period-from game for the aristocrat, including beaver and boar, pheasant and heron, to domestic animals for the less privileged-beef, veal, lamb, mutton, pork, rabbit, chicken, pigeon, turkey, goose and duck. The diet also included organ meats such as liver, kidneys, tongue, calf heads, sweetbreads, brains, heart, ears and feet. The English Housewife, written during the early part of the 17th century, contains recipes for “puddings of a calf’s mugget [entrails]” and “roast cow’s udder.”2 Umble pie, made from the entrails or umbles of deer, was regarded as peasant food-the nobleman keeping the musclemeats of the deer he hunted, while the umbles went to his huntsman and servants. Haggis, made from finely minced organ meats mixed with oats and aged or fermented in a sheep’s stomach, nourished the hardy yeoman, particularly in the more northern parts of the island and in Scotland. Tripe (cow’s stomach) formed an important part of the diet, especially among the poor. Organ meats began to go out of fashion, particularly among the upper classes, during the Victorian era, but even today tripe is still sold in special shops in some parts of the British Isles.

Various sorts of puddings-black pudding, kidney pudding, marrow pudding, blood pudding, suet pudding and so on-also supplied nutrient-dense organ meats and fat to the English diet. These puddings came to the British Isles from the Romans who made urpuddings by pouring meat or blood, salt, spices and other ingredients into a skin of animal’s intestines. Sometines these puddings were then smoked. At some unknown date, the animal intestines were replaced with a pudding cloth and puddings came to be distinguised from sausages, smaller versions still encased in animal intestines. Later sweet things like raisins began to be added to these puddings, resulting finally in the Christmas pudding, containing sugar, pastry, dried fruits and suet. In some parts of the British Isles, these Christmas puddings still contained meat as late as the early 1800’s.3

Seafood for fast days (which amounted to almost half the days of the year) included trout, turbot, sole, whitebait, carp, cod, mackerel, anchovies, cockles, mussels, oysters, eel and crab. Salmon was brought in fresh from the Northwest of England to the London markets. According to the novelist Daniel Defoe, “This is performed with horses, which changing often go night and day without intermission, and, as they say, very much outgo the post, so that the fish come very sweet and good to London.” Fresh shellfish were available in season in the largest towns, paticularly near the seacoast. However, inhabitants of inland smaller towns had to content themselves with preserved seafoods, such as pickled or salted oysters. Oysters, being cheap, were a favorite food of the poor. “Poverty and oysters always seem to go together,” observes Sam Weller in Pickwick.

Dairy products added to the richness of the diet and, unlike meat and fish, were available to those on the lowest rung of the social ladder. Most peasant families owned a cow, or a cow together with a goat. “Why, sir, alas, my cow is a commonwealth to me,” says a rustic character A Looking Glass for London and England, “for first, sir, she allows me, my wife and son, for to banquet ourselves withal: butter, cheese, whey, curds, cream, sod [boiled] milk, raw milk, sour milk, sweet milk and buttermilk.”4 Eggs were used liberally in omelets, puddings and pastries.

Without refrigeration and cookstoves, food storage and preparation presented challenges to the housewife and innkeeper alike. Fortunately, salt needed for preservation was plentiful in England. Cattle were brought into the market towns in September and October. The beef was salted and then hung up in smoke to preserve it. Pork was likewise both salted and smoked to make bacon and ham. For poorer families, these were practically the only meats eaten during the winter months. Fish such as cod was preserved by salting, or, in the case of salmon, by pickling in salt brine, and transported in tubs to the larger markets. Another preservation method was “potting” in which shrimp and smaller fish such as trout were placed in small containers and covered with butter or other fat, mixed with spices.5

Dinners in the houses of the gentry could be elaborate affairs, with roast meats and “made” dishes-elaborate concoctions featuring dozens of ingredients, including a variety of spices. Chefs for the great lords often used a “cullis,” which was a stock made from large quantities of meat and bone cooked in water over a long period to extract all the goodness, after which the meat and bones were discarded, leaving a rich broth that could be used for sauces and “made dishes.”6

But most English households lacked ovens and utensils necessary for complicated dishes. Food preparation was achieved by slow boiling in pots hung over the hearth fire-the Christmas turkey or goose had to be carried to the baker’s for roasting. This meant that soups formed the mainstay of peasant diet, prepared by boiling bones, meat and vegetables in a pot over the fire. Soups were known either as “running” or “standing” pottages. A running pottage, or broth, was a thin soup containing bits of meat, and vegetable and herbs that were in season. A standing pottage was thickened with breadcrumbs or rice until it was similar in consistency to a present-day mousse.7 Sausages could be cooked on a grill or in a skillet-or even speared with a stick and held over the fire. Preparation of pudding-purchased from the butcher-was a simple matter of seething it in a pot over the hearthfire, resulting is a dish that was satisfying, nutritious and easy to prepare-a kind of Shakesperean take-out.

As for grains, rye, barley and oats were staple crops, made into coarse gruels or cakes. Oats and other grains were prepared as porridges or “frumenty,” by soaking them in warm water for 24 hours. They were served with butter or cream and honey or sugar.8 A Welsh recipe for “Llymru” reads as follows: “Mix oatmeal with sufficient buttermilk and water to make a liquid consistency. Leave for 2 nights then rinse through a hair sieve. Let it stand and pour off the surface water. Simmer for 40 minutes and keep stirring. Serve with sweet milk.”9

Oats and barley were also made into cakes, often cooked on a griddle. Before baking soda made its appearance, in the middle of the 19th century, such cakes would have been prepared using a natural yeast, and allowed plenty of time to rise before they were baked. In the north, dough made from oats was “clapped and driven out as thin as paper on a round board, then transferred to a round iron plate of like size and baked over the coals.” Such “clapbread” was crisp and wafer thin, like modern day crackers, and was eaten with butter and cheese.

Wheat was used for breadmaking among the upper classes and in the large towns. White bread made from refined flour was available from medieval times and held in high prestige. While the lower classes ate dark coarse bread, usually made with rye and often with peas or other pulses mixed into the dough, the upper classes regarded black and brown breads with aversion.10 White flour was also used for making pastries of various sorts-both those that enclosed meat dishes such as umble pie or chicken pasties, and those that served as a basis for dessert tarts and pies. Pastry dough was prepared by mixing butter, lard or suet with “fine white flour.”

Grains were also fermented into various sorts of ales and lagers-either by the housewife or in alehouses that existed in almost every town. These beers were an excellent source of nutrients including B vitamins, minerals and enzymes. Small beer, which contained only a small amount of alcohol but large amounts of lactic acid and beneficial enzymes, was traditionally consumed in the morning, accompanying a heavy breakfast of fish or cold meat, bacon and eggs.11 Strong beers, with their high content of alcohol, were recognized as providing “comfort for the poor.” The poet John Taylor recorded a total of nine different ales served at the same meal, during a visit to Manchester in 1618. Eight of them were herbal ales, flavored with hyssop, wormwood, rosemary, betony and scurvygrass. Wines from France and Spain were imported to England and found their way to almost every region; but they were beyond the means of most.

Farm families drank milk, buttermilk or whey. Whey, in particular, was recognized as a digestive aid and beneficial to the skin.12 It was served at the spas or baths-frequented by the well-to-do for “cures”-often mixed with herbs, fruit or wine.

Cookbooks from the period attest to the availability of a wide variety of vegetables including those of the onion family-onions, leeks and garlic-plus root vegetables, spinach, asparagus and artichokes. These were used in soups and stews, rather than served plain. Most cookbooks list a salad made of lettuces and herbs. In general, the upper classes looked upon vegetables with disdain, as a lower class food, to be eaten by the farmers who grew them.13 Potatoes and tomatoes did not gain acceptance until the Victorian era. As with meats, preservation of vegetables was a problem and most recipes books of the period contain a number of recipes for pickled vegetables-French beans, cucumbers, onions, cabbages, artichokes, mushrooms, asparagus, beet root, cauliflower, radishes, herbs and even walnuts and grapes-prepared with a salt and vinegar brine, then protected from the air with a weighted cover or a layer of butter or tallow. A number of foodstuffs, including mushrooms, walnuts, cucumbers and oysters, were added to “catsup,” originally a pickled fish sauce made from anchovies or other small fish, something like Worcestershire sauce. Writing in 1730, Dean Swift mentions catsup as one of several fermented foods favored by the English: “And for our homebred British cheer, Botargo (fish roe relish), catsup and cabiar (caviar).”

The British considered raw fruits to be “unwholesome.” Medical books of the period warned that fresh fruits “filled the body with crude and waterish humours, that dispose the blood unto putrefaction.”14 Apples, pears, quinces and berries were stewed or made into tarts, pies and other “puddings.”

Not all foodstuffs in wide use were locally produced. Since the Crusades, a variety of spices and other exotic foods had been available to the upper classes and to townspeople. In the Winter’s Tale, Shakespeare’s Perdita instructs the Clown to obtain foods for the sheep-shearing feast. Her shopping list includes rice, saffron, mace, dates, nutmegs, ginger and sugar. Almonds were another imported food, widely used, often made into almond milk which served as a thickener for sauces on feast days when dairy products were forbidden.15 Sugar and spices were used liberally to make piquant sauces, served with the ubiquitous cold meats, and in “made dishes” for the tables of the well-to-do.

Inhabitants of the British Isles enjoyed sweet desserts, sometimes made with honey but more often with sugar, which was available since the time of the Crusades. In fact, it was the British demand for sugar, even more than spices, that fueled the era of exploration and colonization. The English Housewife, published in Shakespeare’s day, calls for sugar in almost every dish-salads, omelets, fritters, pancakes, broth, boiled meat, stewed fish, roast meats, meat pies and of course dessert pies, tarts and puddings.16 Later it became unfashionable to use too much sugar in sauces and meat dishes, but the consumption of sugared foods continued to grow with the advent of confectioners and pastry shops in every town, and the popularity of a new custom-taking tea with sweet cakes in the afternoon. The widespread use of sweet wines added to the amount of sugar in the diet-often sugar was added to wines to make them sweeter.17 Large quantities of sugar in the diet were the cause of the proverbial English bad teeth. A visitor to England in 1598 said of the sixty-four-year-old Queen Elizabeth that her “teeth [were] black, a defect the English seem subject to from their too great use of sugar.”18

Until the Victorian Age, the British diet contained many protective factors that offset the deleterious effects of sugar-most notably organ meats, eggs and butter rich in fat soluble vitamins. Bone broths and whole grain products, including hearty ales, provided minerals in abundance and fermented foods provided enzymes. During the 19th century, these homespun foodstuffs were gradually replaced by factory produced foods-canned and pasteurized. Organ meats fell out of favor and the hearty English breakfast was replaced by toast and tea. In fact, tea became the national drink, replacing buttermilk and whey at the morning meal. The disruption of industrialization left many in extreme poverty. A survey taken in the 1840’s revealed that most factory workers were limited in their choice of food to white bread (now become cheap and available to the poor), cheese, butter, sugar, tea, salt and potatoes, with a small amount of bacon or other meat used for flavoring.19 The decline in the use of traditional foods, accompanied by crowding and unsanitary conditions in the major cities, paralleled the great rise of disease in the 1800’s-cholera, TB, diphtheria, typhoid fever and typhus. Later in the century fresh meat, vegetables and fruit became more available but the trend towards the use of fabricated foods was exacerbated with the introduction of margarine, as a substitute for butter, and bouillon cubes, as a substitute for the rich broths of earlier days.

In recent years, the English have been beguiled by claims for the “Prudent Diet,” one in which vegetable oils are substituted for animal fats and the use of cholesterol-rich foods is minimized. The suet, lard, butter, eggs and shellfish of Shakespeare’s day are spurned as unhealthful. These are the very foods that Weston Price discovered to be so necessary for attractive development, good health and successful reproduction. The diet of Merrie Olde England may not have been perfect, but it nourished a race that was energetic, curious, lusty, capable and strong. “Prudence,” said the English poet William Blake, “is a rich, ugly old maid, courted by incapacity.”

References

    C. Anne Wilson, Traditional food east and west of the Pennines, Page Bros, Ltd, Norwich, England 1991, p 61.
    Gervase Markham, The English Housewife, McGill-Queen’s University Press, 1986
    Daniel Pool, What Jane Austen Ate and Charles Dickens Knew, Simon and Schuster, 1993, p 207
    Michael R Best, Introduction to The English Housewife, Mc-Gill-Queen’s University Press, 1986, p xlvi
    Wilson, op cit, p 49
    Michelle Berriedale-Johnson, Olde Englishe Recipes, Judy Piatkus (Publishers) Limited of Loughton, Essex, 1981, p 13
    Ibid, p 10
    Ibid, p 122
    Janet Douglas Pennant, More Llandegai Recipes, Sackville Printing Works, p 5
    Stephen Mennell, All Manners of Food, Illini Books edition, 1996, p 303
    Wilson, op cit, 59-60
    Virginia Holsinger, et al, “Whey Beverages: A Review,” Journal of Dairy Sciences, Vol 57, August 1974, pp 849-859
    Mennell, op cit, p 46
    Best, op cit, p xxv
    Constance B Heiatt, et al, Pleyn Delit: Medieval Cookery for Modern Cooks, University of Toronto Press, 1997, p xx
    Gervase, op cit
    Best, op cit, p xliii
    Ibid, p xxxvi
    Sally Mitchell, Daily Life in Victorian England, Greenwood Press, Westport, CT, 1996, p 122

Copyright: © 1999 Sally Fallon and Mary G. Enig, PhD. All Rights Reserved. First published in Price-Pottenger Nutrition Foundation Health Journal Vol 21, No 4. (619) 574-7763.
The Mediterranean Diet: Pasta or Pastrami?
Posted on June 30, 2000 by Sally Fallon and Mary G. Enig, PhD • 1 Comment

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The Mediterranean diet “is characterized by abundant plant foods (fruit, vegetables, breads, other forms of cereals, beans, nuts and seeds), fresh fruit as the typical daily dessert, olive oil as the principal source of fat, dairy products (principally cheese and yogurt) and fish and poultry consumed in low to moderate amounts, zero to four eggs consumed weekly, red meat consumed in low amounts, and wine consumed in low to moderate amounts, normally with meals. This diet is low in saturated fat (less than or equal to 7-8% of energy) with total fat ranging from less than 25% to greater than 35% of energy throughout the region.”1

This, according to the Diet Dictocrats, is the diet that we should adopt to protect ourselves from chronic disease, especially heart disease.

The author of this theory, and the first to describe the Mediterranean diet in these terms, was Ancel Keys, architect of the lipid hypothesis, namely that heart disease is caused by “the major dietary villain,” saturated fat from meat and dairy products.2 According to Keys, his introduction to the Mediterranean diet began in the early 1950s when he was a visiting professor at Oxford. In 1951, he chaired the first conference of the Food and Agriculture Organization of the United Nations at their headquarters in Rome.

“The conference talked only about nutritional deficiencies. When I asked about the diet and the new epidemic of coronary heart disease, Gino Bergami, Professor of Physiology at the University of Naples, said coronary heart disease was no problem in Naples.”

Dr. Keys returned to Oxford where, as an underpaid visiting professor, he and his wife endured an unheated house and got by on food rations. He then had the brilliant idea of visiting sunny Naples to check out Professor Bergami’s claim. Once there, he discovered the trotterias and dined on “simple pasta and plain pizza.” Keys says he discovered that heart attacks were indeed rare in Naples, “except among the small class of rich people whose diet differed from that of the general population-they ate meat every day instead of every week or two.” His wife amused herself by measuring serum cholesterol concentrations “and found them to be very low except among members of the Rotary Club.” After this exacting research, Keys was able to conclude that “there seemed to be an association between the diet, serum cholesterol and coronary heart disease.”

“The heart of what we now consider the Mediterranean diet is mainly vegetarian,” he reports. “Pasta in many forms, leaves sprinkled with olive oil, all kinds of vegetables in season, and often cheese, all finished off with fruit and frequently washed down with wine.”

At first, Dr. Keys’ found little support for his revolutionary theories. But he encountered a sympathetic listener in 1952 when he presented his views to a small audience in New York at Mt. Sinai Hospital. Fred Epstein was convinced by Keys’ data and began spreading the message “with great effect over Europe and America.”

Keys then published his Seven Countries Study3 in which he claimed a relationship between high rates of coronary heart disease and consumption of saturated fat in seven countries. He was able to do this by handpicking countries where both heart disease and consumption of saturated fats were high and by ignoring countries with the same kind of diet but where heart disease was low.4

Since Keys’ published his “research,” the Mediterranean diet-at least, what is perceived to be the Mediterranean diet-has become government policy. The USDA has immortalized Keys’ fond remembrance of trotteria fare from sunny Naples in the form of a food pyramid, based on lots of white bread and pasta topped with a generous layer of fruits and vegetables. This strangely shaped pizza then gets a splash of olive oil and cheese, an anchovy or two, a pinch of sugar and voila! the dietary solution to rampant chronic disease.

Chronic disease is still rampaging in spite of worldwide acceptance of the food pyramid but Keys, at least, has fared rather well. In 1993, after Fred Epstein gave the summary lecture at the international celebration of the Seven Countries Study in Fukuoka, Japan, and at the fourth annual Ancel Keys Lecture at the 1993 American Heart Association Convention, Keys’ was deluged with requests for interviews and advice. “In May 1993, a crew from an American magazine came to our home Minnelea in Minnesota, bringing a photographer from California to record the scene while I talked about the Mediterranean diet.”

Dr. Keys no longer has to winter in Minnesota but can escape to his second home in southern Italy. But his vacations to Naples include some sad moments as he observes unfortunate changes in the Mediterranean diet. “The restaurants are increasingly popular but the food they serve is commonly far from the Mediterranean pattern. . . Everything has to be loaded with butter or margarine and ground meat. Serving only fruit for dessert is not common; ice cream or pie is customary. Whereas Italian restaurants brag about the healthy Mediterranean diet, they serve a travesty of it.” Keys does not tell us whether his recent prosperity, which allows him to dine in white-table-cloth restaurants rather than sidewalk cafes, has caused him to abandon his monk-like regimen of “leaves sprinkled with olive oil” and fresh fruit. It must be distressing indeed to observe sophisticated Italians feasting on such travesties as pasta al Fredo, veal scallopini and prosciutto, especially to one who has taken the stringent vows of the diet priesthood.

But the life of the missionary is never easy. No, it is a lonesome road, filled with disappointment. Imagine the late-night soul-searching of Dr. Perez-Llamas and his colleagues who set out to study the consumption patterns of a group of adolescents in the region of Murcia, in southeastern Spain.5 Were these Mediterranean teenagers consuming a “balanced diet,” with plenty of vegetables and fruit? Not at all. The naughty youngsters consumed mostly sausage! “The results showed a very low consumption of vegetables, some deficiencies in the intake of the milk and fruits and an excessive intake of fats. . . while the intake of fish and pulses was insufficient in our study.”

Alas, lamented Dr. Perez-Llamas, “the study reveals that although Murcia is a typically Mediterranean region, the characteristics of the diet of Murcian adolescents are quite different in some respects from the typical alimentary habits of the Mediterranean diet.”

Dr. Perez-Llamas proposed to remedy these dietary sins with the modern version of the Spanish inquisition: “. . . nutritional advice was given to mothers and adolescents. The use of Spanish portions from the six basic food groups proved to be a very helpful method to popularize the principles of balanced diet in our population.”

Another group of diet-priests, headed by Dr. Alberti-Fidanza, made a pilgrimage in 1994 to study elderly Italians in the rural areas of Crevalcore and Montegiorgio, two of the districts Keys had included in the Seven Countries Study.6 But the older generation had fallen away! They no longer practiced the food Puritanism that Keys claimed he observed three decades earlier. “In both areas, but particularly in Montegiorgio, these subjects have been abandoning the traditional Mediterranean diet.”

The question that the believers haven’t asked themselves is this: Was the lean, so-called Mediterranean diet they observed after the war the true Mediterranean diet? Or were they observing the tail end of deprivation engendered by half a decade of conflict? Were the inhabitants of Crevalcore and Montegiorgio abandoning the traditional Mediterranean diet, or were they taking it up again? And did Keys miss the sight of Italians enjoying rich food in the early 1950s because Italians had never done such a shameful thing, or was the visiting professor too poor at the time to afford anything more than plain pizza in a sidewalk cafe?

Recipes of All Nations7 was published in 1935, almost two decades before the new diet religion was proclaimed to the suffering millions. Consider the description of food in Sardinia. Grains are certainly a part of their diet, consumed as bread, pasta or polenta, but in most interesting ways. “One of their favorite ways of cooking macaroni is to cook it in either lamb or pork fat . . . with small pieces of either lamb or pork, chopped tomatoes, chopped garlic and curd, mixed with a little water and salt and moistened with a little game stock, if this is obtainable.” Gnocchi is flavored with saffron and “served with a tomato sauce, or with gravy and cheese made from ewe’s milk.” Bland polenta is enlivened with “chopped salt pork, small pieces of sausages and grated cheese.” La Favata is made with “pieces of salt pork, cut in large chunks, ham bone, special homemade sausages, a handful of dried beans, wild fennel, and other herbs and a little water.”

Nothing lowfat so far. But perhaps Keys and his entourage were right when they said that meat is eaten sparingly in the Mediterranean region. Read on. “The Sardinians are great meat eaters, but their methods of cooking various kinds of meat are simple-almost primitive, in fact.” Like most Italians, the Sardinians prefer young animals-lamb, kid or suckling pig-usually roasted in front of a wood fire. “The meat is finally browned by constant basting with hot fat. . . ” The baby pigs “are so tender that even the skin, ears and all can be eaten.”

The diet of Corsica “has in no way been subjected to any outside influence. . .” No new catechism, no diet evangelists here. So Corsicans can enjoy the following without guilt: All manner of fish, including small lobster, cuttlefish and shellfish; anchovy paste made with the addition of figs; dried salt cod; beef browned in lard; strips of goat fillet, salted and sun dried; chestnuts mixed with polenta and cream and served with different kinds of meat or black pudding.

A beautiful new encyclopedia of traditional foods, You Eat What You Are,8 also gives a rather different view of Italian cuisine than the one proclaimed in the gospel according to Ancel Keys. Author Thelma Barer-Stein notes that butter is the cooking fat of choice in northern Italy, lard in the middle region and olive oil in the south. But pork is consumed throughout the entire peninsula, usually in the form of sausages-which anyone but an American visiting professor could discern are the sin qua non of Italian cuisine. Salami, bologna, mortadella and zamponi-there would be no Italian cuisine without these. Sausage is a way of making innards taste delicious-as in pezzante, an Italian speciality made from sinews, livers and lungs. Cooks use plenty of pancetta (Italian-style bacon) and children love crisp cracklings of pig skin called fritolli, rich in vitamin D.

Jews living in Italy made sausage and cold cuts, but they did not use pork. In her book The Classic Cuisine of the Italian Jews,9 author Edda Servi Machlin remembers her father’s carne secca (salt dried meat) and salsicce de minao (beef sausage.) “Both dishes were renowned and appreciated among the Jewish communities all over Italy.” These foods were made in late winter and hung in “an open north window” for four to six weeks to air dry. Other specialities included lingua salmistrata (pickled beef tongue), the aroma of which would “resuscitate the dead,” and salame d’oca (goose sausage). (See Food Feature, page 48.) These meats were all fermented-and eaten raw.

About eggs, Machlin reports: “Eggs have always been among the most inexpensive of the highly nutritious foods. For us, they were not only a staple, but also a universal remedy for most ailments, real or imaginary, much as vitamins are for many people today. In order to be fully effective, eggs had to be ingested raw and very fresh-in fact, warm, directly from the chicken nest. So, naturally, every family had a small poultry yard in their orchard.”

Italy produces as many kinds of cheese as France, including two of the very best: Parmesan and Gorgonzola, both full fat and creamy rich. Italian cheese garnishes more than pizza. It is used in turnovers, vegetable dishes, salads and sandwiches. A favorite is mozarella, cut into squares, dipped in batter and deep fried.

Italians are masters at preparing every kind of meat-from sweetbreads to knuckle bones. Lean meat gets a cream sauce or stuffing of ham and ricotta cheese.

Fish and shellfish of every variety are used in seafood platters, fish soups and fish stews. The Diet Dictocrats, flush with the success of their food pyramid, seem to have missed the ecstatic experience of calamari, dipped in batter, deep fried and served heaped up on platters-a healthy snack as long as traditional fats, not partially hydrogenated vegetable oils, are used in frying. In Naples, where Keys had heard that heart disease was rare, snacks of fresh seafood are as popular as pizzas and small containers of oysters can be eaten on the run.

Italians love their vegetables for sure and that’s because they know how to make them taste good. They know that salads taste better with a good dressing of aged vinegar and olive oil; and cooked vegetables blossom when anointed with butter, lard or cream.

Italians don’t generally start with day with eggs but they make up for it later on. Eggs are used in rich sauces and custards, like zabaglione. Soups are often served with poached egg.

And what about ice cream? Is this something new to the Italian diet-an American travesty? Not quite. “The first ice cream shops or gelateria opened in Tuscany in the 1500s, but the Southern Italians are believed to be responsible for the popularity of ice cream in North America.” And no one uses ice cream with greater inventiveness than the Italians, from the spumone of Naples to cassata, a decorative ice cream cake, to semifreddi, “a type of soft foamy ice cream that also comes in many flavors.” It is true, however, that Italians sometimes consume ice cream with fresh fruit.

As it’s clear to anyone who has traveled to Italy or eaten in an Italian restaurant, the backsliding Italians have reverted to the food paganism of their ancestors-if they ever left it. So orthodox nutritionists have recently enshrined the Greek diet as the most virtuous of politically correct Mediterranean cuisines, described as consisting principally of olive oil, bread and tomatoes.

Rosemary Barron ran a cooking school on Crete from 1980-1984 and has spent many months living there, as far back as 1963 when she participated in an archeological dig. In 1991 she published Flavors of Greece, which received an “Editor’s Choice” award in the New York Times Book Section.

It is true, she reports, that the Greeks eat lots of bread. In the countryside, family bread is still usually made with stone-ground flour in wood-burning ovens. White bread is found in the stores but there still is a long and strong tradition of all sorts of brown breads, including a fermented “shepherd’s” loaf made with wheat bran, oat bran and whole wheat flour. Much bread is “twice-baked” into rusks, which are normally consumed at breakfast.

Rosemary estimates that Cretans probably eat several pounds of cheese per week, providing about 600 calories of fat per day, or 25% of calories in a 2400-calorie diet, just from cheese alone. Since the fat in goat milk cheese is almost 70% saturated, one-half pound of cheese per day would supply about 18% of calories as saturated fat, more than twice as much of that “dietary villain” as sanctioned by the diet-priests.

Other sources of saturated fat include yoghurt, milk and small amounts of butter, used in pastries. Olive oil is the preferred fat for cooking and salads. It is used very generously, providing lots more fat calories, including some calories as saturated fat.

And there’s also plenty of saturated fat from meat in the Cretan diet. Lamb or kid is eaten in the spring and goat throughout the year. Pork is eaten frequently, either as chops or roast, and old hens and roosters are served up boiled. The most common meat of all is game in season-birds, rabbit and hare. Tiny birds grilled and wrapped in vine leaves are popular. Thin smoked sausages serve as appetizers and garnishes.

Egg consumption averages about ten per week, used as ingredients in omelets, cakes, savory dishes and avgolemono, an egg-lemon sauce. Rosemary remembers her surprise on cracking her first Cretan egg-the yolk was bright orange, so bright that the scrambled eggs she made with it were also orange.

Cretans love unusual foods like snails and organ meats-kidneys, liver and spleen. Fish roe is considered a delicacy and may be made into small cakes and fried in oil, or into taramosalata, a paste served as an appetizer.

Those who live near the coast eat fresh seafood every day-including shellfish, sea urchins, octopus, squid and cuttlefish. Until recently, the only transport was by donkey and there were no refrigerators. This meant that unless you lived by the sea, you rarely ate fresh seafood. Cretans had several methods for preserving fish by salting or smoking, and for creating odorous sauces from rotting fish. Smaller fish were placed in earthenware jars and covered with herbs and olive oil. Donkeys then carried these “fish up the path” to the interior.

All of these animal foods, including the orange egg yolks, are excellent sources of vitamins A and D, the fat-soluble vitamins Weston Price discovered to be vital for good looks and robust health. When foods rich in these fat-soluble activators are abandoned, subsequent generations have more narrow faces, more tooth decay and more disease. They are less attractive and less strong. The presence of adequate amounts of vitamins A and D in the Cretan diet is probably what protects populations throughout the Mediterranean from the high amount of bread or pasta and frequent use of sweets.

Cooking is simple on Crete and throughout most of Greece. Rather than make stock or broth, Cretans cook meat and fish with the bones. In fact, traditionally no meat or fish was sold without bones, as bones are a proof of freshness.

Even today most food on Crete is cooked in communal ovens. Thus the typical meal is prepared in a shallow casserole that can be carried to the ovens. Good fish and tender cuts of meat are cooked on outdoor grills.

Wonderful fresh vegetables, including artichokes and eggplant, luscious fruits, almonds, pistachios, lentils and chick-peas all contribute to this delicious Mediterranean cuisine. The preferred beverage is homemade wine.

The main meal in most of Greece is lunch, eaten at home and consisting of a main course, usually a stew or casserole containing meat, along with vegetables, salad, bread and cheese. Then everything shuts down until about 5 PM. Dinner is late by our standards, preceded by a few hours of mezedes (little nibbles) taken in a cafe, or at home with a drink. Mezedes might be bits of cucumber, tomato, cheese, olives, seafood or slices of sausage. In a typical village scene, the men sit in cafes for a couple of hours and the women sit outside their houses, chatting to each other. The men then come home to dinner about 10 PM. Desserts like ice cream and pastries are eaten in cafes during family outings and at home on feast days.

The European Union is a breeding ground for zealots of food Puritanism so the Greeks are being pressured to conform. No more long lunches and leisurely hors d’oeuvres. Greece has to follow the same hours as the rest of Europe-and eat the same foods, like standardized lowfat factory-made cheeses, white bread, lean meat packaged without the bone, commercial baked goods based on vegetable oils and soft drinks. These are the real travesty of the modern Mediterranean diet, not foods rich in animal fats, and this garbage is much easier to sell when doctors say that it’s better for your health than the traditional foods of your ancestors.

The people of Greece enjoy one of the longest life-spans in the world, but it may not last if they adopt the American professor’s version of the Mediterranean diet, which actually hastens the trend towards processed food.

“Unhappily,” writes Keys, “the current changes in Mediterranean countries tend to destroy the health virtues of the diet as we saw them forty years ago. Efforts are needed to reverse this change. Education is important. We should concentrate on the medical profession and the schools. It is not enough that doctors measure serum cholesterol and tell patients with high values to avoid butter and fatty meat. They also should emphasize prevention by targeting the general public.”

This means more seminars, in villages by the sea. The second annual meeting, Keys reports, was held in Pioppi, a village on the Mediterranean coast, “about four kilometers from our home in Italy.” Sponsored by the International Society and Federation of Cardiology, these retreats have attracted “some 800 doctors from 30 cities in 22 countries.” Oh, what sacrifices are made in the name of science!

And what does this College of Cardiologists eat when convened on their Italian retreat? Do the learned doctors confine themselves to plain pasta and lean meat? Do they nibble on lemons and leaves in the land of spumone?

The greatest of the seven deadly sins is not gluttony but pride, pride so blinding that it presumes to inflict one’s own pathology of renunciation upon a whole population, starting with the children. “In these seminars,” says Keys, ” we stress the Mediterranean type of diet and its helpful role in controlling the concentration of serum cholesterol and reducing the associated risk of coronary heart. . . I believe it is important to bring the diet message to school children. . . Our challenge is to figure out how to make children tell their parents that they should eat as Mediterraneans do. At least, we should help children get rid of some nonsense ideas and convince them that meat and rich dairy products will not makeEating by the Seasons in Russia
Posted on March 28, 2009 by Katherine Czapp • 4 Comments

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Like all great national cuisines, the Russian tradition developed as a unique response to its climate, geography and history. Over the centuries its culinary richness evolved as it absorbed and then transformed the influences brought by trade with Western Europe and the Orient, as well as through foreign invasion and its own territorial expansion. The highly sophisticated cuisine of the 17th and 18th centuries, with its elaborate courses, ornate table service, and exotic imported delicacies existed only for a rare few—the landed aristocracy and wealthiest city dwellers. The bulk of Russia’s population was scattered across a vast terrain in tiny villages, isolated by great distances, and feeding themselves from their own small farms and the forests, rivers and lakes nearby. Challenged by a harsh and often fickle northern climate, yet endowed with a creative native ingenuity, these peasants created a “cuisine of the people” out of simple ingredients that was nevertheless nourishing, appealing and enduring. With some additions and refinements, this peasant cuisine became the solid basis of Russian cooking up until the twentieth century.
Medieval Rus

The early Russian diet depended heavily on grain products, and especially those that could be grown during its short, cool growing season. Medieval records vividly depict in a few words the regular disasters and famine befalling both men and livestock in frequently undependable weather. These extracts describe a four-year span from The Chronicle of Novgorod, 1017-1471:

AD 1125…The same year there was a great storm with thunder and hail… it drowned droves of cattle in the Volkhov, and others they hardly saved alive.

AD 1127….And in the autumn the frost killed all the [grain] and the winter crop; and there was famine throughout the winter…

AD 1128…This year it was cruel; the people ate [linden] leaves, birch bark, pounded wood pulp mixed with husks and straw; some ate buttercups, moss, horse flesh; and thus many dropping down from hunger, their corpses were in the streets, in the market place, and on the roads, and everywhere. . . fathers and mothers would put their children into boats in gift to [foreign] merchants [to be slaves], or else put them to death.

When nature obliged, rye, spelt, millet, barley, oats and buckwheat were the primary grain crops, and provided the foundation of the diet in the form of bread, kasha, and grain product called kissel.

The Russians likely learned the art of sourleavening bread from the Scythians—Central Asian nomads who ruled southern Russia for three centuries from about 300 AD. Sourdough rye bread has been recorded as a staple in the diet since at least the 9th century. It has remained a favorite and respected mainstay for centuries; revered even as the very essence of life. In the typical peasant diet an adult would consume close to two pounds of this dense, sour bread per day.

Wheat flour was introduced as a trade item during the 15th century, but was not suitable for growing in the northern European portion of Russia. After Ivan IV (the Terrible) conquered Kazan and Astrakhan in the 16th century, Russia gained territory where wheat could be grown, and this was transported to the rest of the country. In this era, filled, leavened pies, such as pirogi, made from wheat flour were introduced into the cuisine. The peasants continued to rely upon rye as the source of their daily bread, however.

The great reliance on grains resulted in creative ways of preparing each one, both to provide variation in the diet and to maximize their nutritive value. Grain kissel, for instance, is a method of soaking, fermenting and cooking grain (and also dried peas) that produces a jelled liquid “concentrate” of the grain, and is usually eaten cool with sour cream or kvas. The procedure for oat kissel, for example, involves drying whole oats carefully on the floor of a warm brick oven, and then pounding the oats in a mortar to partially crush them. The oats are covered in hot water and left to sour in a warm place for a day and a half. The soured oats are then pushed through a sieve and the thick oat “milk” that is extruded is slowly cooked until it thickens further like a jelly. It is then poured into a wide plate and left to cool, becoming even more jelled. This oat “aspic,” served with sour cream or kvas, is considered especially good for children, the elderly and convalescents, as it is nutritious and very easy to digest. The soured oat remnants did not go to waste, but were stirred into flour, left for 24 hours to sour further, and then baked into flat breads called lepyoshki.

Kasha, or porridge, ascended to the status of a mass ritual dish between the 10th and 14th centuries. To mark great undertakings, such as the ground-breaking for a cathedral or fortress, a wedding, baptism, and so on, kasha was prepared to feed a large crowd. The word “kasha” became synonymous with “feast” and indeed there were many delicious ways to prepare it. The preferred grain for kasha was buckwheat, although barley, spelt and green rye were also made into kashas. The kasha was cooked in an oven in earthenware pots with a strong meat bouillon and any number of additions such as meat, mushrooms, and onions.
Shchi and Soups

Accompanying bread and grain was the other great mainstay of the traditional Russian peasant diet—soup, and in particular shchi. Shchi is a soup made from green cabbage in the summer and soured cabbage or sorrell in the winter. Depending upon the wealth of the household it could be very plain, made with just vegetables and herbs, or quite rich, made with a strong meat broth and cooked with a large piece of meat that was served alongside. Often a thick shchi might make up the entire meal. Its popularity transcended all economic classes and was regularly served on the tables of the rich and poor alike. In a climate that experienced six months of winter each year, hot soup was a comfort as well as a nourishing centerpiece in the diet, and Russian cuisine has never lost the requirement of a first course of soup in the daily menu.

Borshch and ukha are two other basic soups common to Russian cuisine, although borshch is actually of Ukrainian origin. There are literally hundreds of borshch recipes, some including sausages and other cuts of meat and even beans, some are vegetarian, but the primary and sole requirement is that it must contain beets. Borshch is traditionally enhanced with sour cream in the soup plate, and often the broth is spiced with pickle brine.

Ukha is made from fish, yet is not technically a fish soup. The simplest method was to poach a whole fish in water with herbs and seasonings and the entire fish (including softened bones) would be eaten with its broth. A more elaborate variation calls for several varieties of bony fish to first be cooked to produce a stronger broth. These fish are then discarded and whole pieces of better quality fish are poached in this broth.
Dairy Products

Peasants with a bit of land to support a few pigs, chickens and a cow or two greatly improved their diets with meat, eggs and dairy products for most of the year. Most milk products were eaten fresh, or soured, such as clabbered milk (prostokvasha) and sour cream (smetana). Cheese was traditionally the simple dry-curd pot cheese (tvorog) made from raw milk that soured naturally into curds and was then strained. Tvorog is eaten as is with sweet or sour cream or spread thickly on bread, and can also be used in baked dishes. Another ancient means of preparing milk was “baking” it in an earthenware jug at very low temperatures in the brick oven overnight or all day until a thick, honey-brown skin appeared on the milk and it soured slightly. This toplyonnoye moloko was an early delicacy, somewhat similar to custard.

Kefir was originally a product of the tribal peoples of the northern Caucasus region and became a popular Russian food later on. Cultured dairy products (never sweetened) have always been a permanent fixture in the Russian diet, and even today a wide variety of fermented dairy products is commercially available in Russia, including several varieties of kefir cultures and two varieties of “baked” fermented milk (varenets and ryazhenka) with special bacterial cultures added. Bifidok and Acidophilin contain kefir cultures with yet other beneficial lactic acid bacteria.

The Russians had known of and enjoyed the nutritive and medicinal benefits of fermented mare’s milk, kumyss, since earliest times. This was another food introduced many centuries before by the Scythians and in widespread use as noted in the oldest Russian chronicles. In the 17th century the Russian Orthodox Church proscribed the eating of horse flesh and drinking of mare’s milk as unclean, and kumyss dropped from the scene until appearing again in more recent times.
Kvas: Drink of the People

Kvas is a lightly fermented, slightly alcoholic beverage commonly made from rye bread sweetened with a bit of honey or fruit juices. Its widespread use among Russian peasantry has been recorded since at least 1000 AD. The sweetsour drink contains a good supply of B vitamins and active enzymes and was used, along with beet kvas, as a frequent addition to soups. Large pieces of meat were often oven-braised in kvas.

Besides kvas, early Russians enjoyed mead (medok, medovukha) and other forms of fermented honey, some mildly alcoholic and some much stronger. In the tenth century a form of mead was soured with hops and berry juices, and a method similar to wine making and requiring a five- to 35-year aging period produced a potent honey drink resembling Cognac. Earlier still, the Russians fermented birch sap into a sort of “beer.” Beer-making with grains did not develop until the end of the 13th century, and vodka made from rye grain appeared in Moscow somewhere in the mid to late 15th century. There was already a state monopoly on its production by the 16th century.
Mongol Influence

The Mongol invasion and conquest of Kievan Rus by Batu Khan occurred in 1237 and lasted until Ivan III terminated their “yoke” in 1480. For nearly 250 years the Russian people were subjected to waves of brutal sieges by the Golden Horde, as well as extortion exacted in the form of ransom tributes paid to forestall annihilation.

In spite of its destructive impact on Russian society, the Mongol presence also enriched the Russian diet in several important ways. With the reopening of the old Silk Road to China the Mongol invaders introduced spices such as saffron and cinnamon. Even more important than spices, however, the Mongols brought from China the art of fermenting cabbage. Although the Russians had long grown cabbage, they did not know how to preserve it in brine as sauerkraut. Once introduced, soured cabbage and other vegetables quickly became central in the Russian and Eastern European diet. In fact, it is nearly impossible to imagine Russian cooking without sauerkraut, pickled cucumbers and the many other brined vegetables and fruits, which greatly enlivened the table year round with much longed-for variety and important nutrients. Fresh vegetables and herbs included radishes, parsley, dill, chervil, green onions and garlic. Wild-growing chickory, nettles, sorrel and purslane were most often cooked in soups.
Russian Orthodoxy

In 988 Prince Vladimir of Novgorod converted to Christianity and established the Byzantine rite of Orthodox Christianity as the Russian national faith. Legend has it that Vladimir chose the Orthodox Church because he didn’t like the dietary restrictions of either Judaism or Islam, and rejected the western Catholic tradition of an unleavened Eucharist host. Russian Orthodoxy nevertheless exerted a strong influence on the national diet through the imposition of a strict regimen of fast days. Depending on the calendar year, there are about 250 fast days each year, including every Wednesday and Friday, and the Great Fast (or Lent) of 50 days.

Among a people inured to food scarcity and occasional famine it seems heartless to impose further dietary restrictions, but the Russian diet actually expanded after the adoption of Orthodoxy. The prohibition from eating meat during fast days led to a blossoming in the creativity of fish dishes. Russia’s many rivers, streams, ponds and lakes were stocked with an astonishing variety of fish and crayfish, and its inland population had regular recourse to this rich bounty. Mushroom dishes also abounded, aided in great part by the many prolific mushroom species native to Russian forests. Here are two menus from a 19th century fast day of a comfortable, but not aristocratic, household:

Mushroom and sturgeon marrow pirog
Sturgeon head soup
Potatoes with herring
Cranberry kissel

Plum soup with wine
Pike in yellow sauce
Potato cutlets with mushroom sauce
Stewed fruit compote
Feast Days

The Russian ecclesiastical calendar culminates in the spring with the progression of Butter Week, or Maslenitsa, through the Great Lenten Fast and finally the joyous feast of Easter (Paskha). Maslenitsa is an ancient holiday celebrated in mid winter that has been incorporated into Russian Orthodoxy, and in fact is so beloved it has been celebrated without interruption up to the present day. Originally a festival in honor of the coming spring, increasing sunshine and hoped-for fertility, the week-long holiday is one of a merry-making and carnival mood, with sleigh rides, dancing, and the eating of great quantities of blini drenched in butter and sour cream—two favorite foods that would be banned during the upcoming seven-week fast. Blini are themselves an ancient leavened pancake—thicker than crèpes, but not as thick as American breakfast pancakes. They were originally made of buckwheat flour and round in shape to remind one of the sun.

In rural Russia the long fast period also served to ensure that livestock would not be eaten but survive to fatten and reproduce in the spring. When the fast was broken with the great feast of Easter, celebrants of every ilk presented a holiday table as lavish as families could afford.

Several ritual foods are always required for the Easter table. Boiled eggs, usually decorated simply, are symbols of the fertility of spring and are presented in great quantity. Kulich, a very rich yeasted cake made with wheat flour, butter, eggs, and milk is only prepared for Easter. Its traditional accompaniment is paskha, a sweet cheese dish made from tvorog, sour cream, egg yolks, ground almonds, vanilla and sugar, shaped in a truncated pyramidal mold. A 19th century Easter table of a prosperous country family might look like this:

Paskha
Kulich
Babas
Mazurkas
Tortes
Decorated eggs
Butter sculpted in the shape of a lamb
Boar’s head
Baked ham
Stuffed turkey
Cold roast hare
Roast veal
Wood grouse
Cold roast antelope or venison
Roast elk
Roast marinated beef
Stuffed suckling pig
Bread, horseradish, mustard, vinegar, olive oil
Various vodkas and wines
The Russian Oven

Perhaps one of the most profound influences on Russian traditional cuisine is the Russian oven (russkaya pechka) around which all family life centered in rural Russia. Of colossal size and weighing a ton or two, the Russian oven was made of clay, stone or brick. The multi-purpose oven was built with an ingenious internal channel system that directed hot smoke through a series of chambers before it exited the hut (izba). A fire was built in the main chamber, and controlled via several flue dampers. The structure burned fuel very efficiently, and a single firing was enough in all but the coldest weather to prepare the oven both for cooking all meals and heating the izba for the entire day. When the fire had died down, and the oven was very hot, the coals and ashes would be swept out or pushed to the side and food could then be cooked or baked. The hottest temperatures were used to bake bread, and as the oven slowly cooled other foods would be placed inside to “stew.” Nooks and shelves built on the sides of the oven were perfect spots for souring foods at a steady warm temperature. The tops of the ovens were flat and provided a cozy spot for the old folks (and cats) to sleep.

The oven had no burners, so all food was cooked inside the oven by the experienced housewife. Most food was cooked in earthenware containers that had rounded sides to maximize heat exposure. A long-handled tool with a U-shaped end served to move the jars in and out of the oven. Other oven utensils were bread peels and wooden paddles for turning grain that was dried on the oven floor. Long, slow cooking in radiant heat characterizes most of early Russian dishes, such as kasha and even soup, which was “stewed” more than boiled. Meat stews, interestingly, were not typical Russian fare as the traditional method of preparing meat was baking it on trays in large pieces, or even, if possible, cooking the whole animal. Chopped meat dishes, pâtés, ground meat and pureéd soups were introduced to Russian cuisine from western, mostly French, sources. Western-style stoves—enclosed metal ranges with burners that could deliver high heat—were introduced toward the middle of the 19th century in Russia, mostly for city dwellers and the provincial gentry, although the Russian oven was preferred for most traditional cooking and processing of raw ingredients.
Enduring Traditions

The most novel refinements in Russian cuisine introduced in the 17th through the 19th centuries came largely from the west, and particularly from France. The influence turned out to be a mutual one, producing a grand Franco-Russian culinary style that featured hallmarks of both traditions, but was largely enjoyed only by the nobility and large landowners. Changes to the diet and daily lives of the peasants came much more slowly, due in good part to their deep suspicion of novelty. Potatoes, for example, were first introduced during the reign of Catherine the Great, yet took another 70 or 80 years before they were accepted and widely cultivated.

In some ways it could be said that Russia’s medieval period, as far as the bulk of the population was concerned, continued largely intact until it collided abruptly with the twentieth century. Upheaval in the shape of civil war, revolution and world war touched and forever altered every soul in the country. Collectivization ended the tradition of the peasant class, and also changed the face of agriculture for decades to come. A second world war and the long, hard recovery that followed, with chronic food shortages and deficits, made permanent because of Cold War military spending, ended only in the 1990s with the fall of the Soviet Union. Although consumer goods have since multiplied greatly, with many expensive foreign food imports, it will still take time for private ownership of the land to recreate a domestic food production economy to feed the people, although already there are some beginnings.

In the wake of such history, it is revealing to learn that during the period of perestroika, one of the first books to be reprinted after long neglect was an 1861 classic, Elena Molokhovets’ A Gift to Young Housewives. This beloved cook book had been continually in print and revised for 20 editions by its author until 1911. Written at a time that some consider the zenith of Russian cuisine, the book was condemned as decadent and bourgeois after the 1917 Revolution. Found only rarely at high prices in used book stores, the book recalled the culinary glory of a vanished age. The renewed popularity of Molokhovets’ masterpiece among modern ordinary people as well as restaurateurs speaks of the enduring pride in the cultural heritage of Russian traditional dishes and cooking methods.

Sidebar
A French View of 17th Century Muscovy

This excerpt is from the account of a French soldier of fortune, Jacques Margeret, who entered the services of Tsar Boris Godunov from 1600 to 1606. He returned home to France and in 1607 published his Estat de l’Empire de Russi et Gran de Duche de Muscouvie. His account provides a clear picture of the country’s possessions and natural resources, as well as the behaviors of its people, court officials and rulers. Margeret comments below on the general constitution of Muscovites and in particular their love of the banya, or sauna, as a health aid.

“’Tis almost a miracle to see how their bodies, accustomed to and hardened by cold, can endure so intense a heat, and how that, when they are not able to endure it any longer, they come out of the stoves, naked as the back of a man’s hand, both men and women, and go into the cold water…and in winter how they wallow in the snow….The Muscovites are of a healthy and strong constitution, long lived and seldom sick; which when they are, their ordinary remedies, even in burning fevers, are only garlic and strong waters…

“There are among the Russians many people aged 80, 100, to 120 years old. They are not subject to illness as in these parts. Except for the emperor and some principal lords, they do not know about physicians. They even consider to be unclean several things which one uses in medicine. Among other things, they do not take pills voluntarily. As for enemas, they abhor them…If the common people are sick, they usually take a good draught of aqua vitae, place in it…a peeled clove of garlic, stir this and drink it. Then they go immediately into a hot house which is so hot as to be almost unendurable, and remain there until they have sweated an hour or two. They do the same for all sorts of maladies….”

References

    Medieval Russia: A Source Book, 850-1700, Basil Dmytryshyn, Harcourt Brace, Third Edition, 1991.
    Classic Russian Cooking, Elena Molokhovets’ A Gift to Young Housewives, Joyce Toomre, Indiana University Press, 1992.
    The Art of Russian Cuisine, Anne Volokh with Mavis Manus, Collier Books, MacMillan Publishing Co., 1989.
    Russian Cooking, Helen and George Papashvili, Time Life Books, 1969.
    Кулинарный словарь, В.В. Похлебкин, Москва Центрограф, 1999.
    Обрядовая кулинария, Е. Й. Высоцкая, составитель, Мн.: Литература, 199

This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly magazine of the Westo the boys any stronger and the girls any prettier.”10