Copyright © 2009
by Daniel Matthew Korn

All Rights Reserved

People have lost weight, sometimes very large amounts of weight, following many different types of diets. Recently, a two-year study was published in The New England Journal of Medicine that looked at the efficacy of a low fat/high carbohydrate diet, a high fat/low carbohydrate diet, and a balanced diet. All three types of diets resulted in weight loss.¹ This is more proof that neither fats nor carbohydrates cause weight gain; if they did, at least one group in the study should have gained weight rather than lost it. So why did people in all three groups lose weight?

The common feature of the three diets was that they encouraged consumption of fruits, vegetables, and sometimes whole grains while discouraging consumption of refined carbohydrates, processed foods, and refined sugars. Weight loss was achieved in all the groups because they all ate a more nutritious diet. Low carbohydrate diets have some similarities to the high carbohydrate Thai diet, in that they include large amounts of certain types of foods which are present to a far lesser extent in the typical Western diet. Red meat from animals raised with commercial feeds is high in cholesterol, but it is higher in nutrients than many of the refined sugars and grains that comprise much of the modern diet.

Earlier we noted that in the 1950s the rural Thai got about 80% of their calories from white rice and the majority of the remainder from fruits and vegetables. They also ate a small amount of chicken eggs and meat. This diet high in refined carbohydrates did not result in obesity, and one explanation for this is high consumption of fruits and vegetables. By volume, the diet was much more than 20% fruits and vegetables.

Fruits and vegetables differ from refined carbohydrates in that they contain significantly higher amounts of dietary fiber, vitamins, minerals, and other nutrients. Dietary fiber has been commonly believed to be the component of whole grains that prevents them from causing weight gain and that lowers cholesterol. However, recent experiments have shown that defatted rice bran, which still contains all of its fiber, has no effect on cholesterol.² Similar experiments with defatted wheat bran, which is also high in fiber, have shown that wheat bran by itself has no effect on body weight. Thus, it does not appear that dietary fiber is the component of unrefined carbohydrates that lowers cholesterol or body weight. Rather, something in their fat is responsible for at least some of these effects,³ as is something in the germ of the grain.

While weight gain is frequently thought to be associated with grains, the body seems to be able to handle grains in certain diets. We have just mentioned rice consumption by the rural Thai, who experienced no obesity at the time of the study discussed. Another example is bread, which has been part of the human diet since before written language existed in its current form. From Egyptian hieroglyphics, we know that the workers who built the pyramids ate a diet that included significant amounts of beer and a type of bread which was made from a whole grain and was high in nutrients. We can see from the mummified remains of pharaohs that obesity was extremely rare even among the ruling class, who presumably had access to a better diet and more alcohol. It should be noted that the beer in ancient Egypt was unfiltered and nutritionally different from that which is common in modern times.

There are many examples of bread consumption before obesity became a common health problem. We are, of course, familiar with the name of the city of Bethlehem. In Hebrew, Bethlehem literally means “house of bread,” and it was both a city name and a description. The first recorded mention of Bethlehem is in the Bible’s Book of Genesis, and it is “On her way from Bethel to the south she died in giving birth to her second son Benjamin and was buried on the way to Ephrath, which is Bethlehem.” Bethlehem (בית לחם‎) in this context is a Hebrew description of Ephrath, and it is likely that it was a description before it became a city name. The text is stating that Ephrath is the place, an appropriate usage of house in Hebrew, where bread was being produced.

We know from the name Bethlehem and other written sources that bread was plentiful in Israel in biblical times, and we know from archaeological evidence that it was consumed during the late Stone Age. Writings in classical Europe also describe the many types of bread available. In addition to these very ancient examples of bread consumption not leading to obesity, the early history of the United States gives a more modern one. Bread was a staple of the American diet from colonial times. It is notable that the “amber waves of grain” mentioned in “America the Beautiful” were largely used for creating bread.

Despite thousands of years of bread consumption, obesity was very rare until the twentieth century. Thus, the idea that all breads cause weight gain is incorrect. One of the differences between the stone ground bread of earlier eras and the highly refined bread of today is their dietary fiber content, but it is not the only difference. Our processing techniques allow us to make flours that have the wheat germ and bran removed, have a longer shelf life, and are easier to handle. However, the development of this longer shelf life has come at the cost of disruption to the body’s ability to regulate blood sugar and hunger. Even much of what we call “whole wheat bread” is significantly lower in nutrients than what was once commonplace. The shelf life is increased through chemical additives. It is extremely difficult to find bread that is made from 100% whole wheat and does not contain refined sugars, oils and additives. It is no wonder so many popular diets recommend avoiding all bread.

One of the reasons for the partial success of low carbohydrate diets is, ironically, that they encourage the consumption of carbohydrates such as fruits and vegetables. Fruits and vegetables are considered desirable in low carbohydrate diets because of their stabilizing effect on blood sugar. This is usually attributed to dietary fiber. However, research has shown that dietary fiber cannot be the only reason that fruit and vegetable consumption results in lower body weight. In studies comparing weight loss in groups that consume fruits and vegetables and groups eating food with fiber equivalent to that in fruit and vegetables, the people in the fruit and vegetable groups have experienced greater weight loss.⁴

A study published in Diabetes Care, a journal of the American Diabetes Association, showed no effect on body weight when defatted wheat bran, which contains a significant portion of the wheat kernel’s fiber, was eaten. The study concluded that another part of the grain kernel was responsible for the effect of whole grains on body weight.⁵ Something other than fiber in fruits and vegetables appears to be contributing to weight loss as well. The prime suspect is the nutrient content.

Replacing refined sugars and carbohydrates in the modern diet with fruits and vegetables does something very important in addition to increasing fiber consumption and stabilizing blood sugar. It raises the vitamin, mineral, amino acid, and phytochemical content of our diet. Sufficient consumption of certain nutrients has been associated with lower body weight, decreased cortisol production, an increased feeling of fullness after meals, and increased use of stored body fat.

If part of the reason fruits and vegetables cause weight loss is due to their vitamin content, we would assume that vitamin supplements would have an effect on body weight as well. Such an effect was discovered during a study completed in 2004 at the Fred Hutchinson Cancer Research Center in Seattle. Scientists at the center found that long-term consumption of supplements of vitamins B6 and B12, the minerals chromium and magnesium, and multivitamins were associated with slightly lower body weight.⁶

A criticism of studies that look at the effects of taking vitamins is that people who take them tend to be more health conscious, and other factors could be responsible for their lower weight. However, this study looked at the effects of taking fourteen different supplements, and many of them were not associated with lower body weight. This suggests that it was taking specific supplements that resulted in lower body weight, not being health conscious in general. Multivitamins, which were associated with lower body weight, tend to contain vitamins B6 and B12, chromium, and magnesium.⁷ They also contain vitamin C, which was not examined individually but which is involved in both lowering cortisol levels and increasing fat oxidation. Consumption of adequate levels of vitamin C has been associated with lower body fat levels.⁸ Vitamin E, which is not absorbed well from supplements, has been shown to decrease insulin resistance, leading to a greater feeling of fullness after meals.

Researchers knew that there were multiple factors involved in cell metabolism even before identifying them individually, and they referred to these factors as a group, which they termed the B-Complex. As different vitamins were discovered that were involved in cell metabolism, they were named vitamin B1, vitamin B2, and so on. Even though vitamin C helps increase fat oxidation, it was not included in the B vitamins because its effect is indirect. All of the B-Complex vitamins are directly involved in the reactions that either break down or assemble energy molecules in our cells.⁹

The levels of the B-Complex vitamins that are considered adequate today are much lower than those which were normally consumed before the end of the nineteenth century. The B-Complex vitamins were discovered in the 1930s, long after their presence in our bodies had started to fall. Mild deficiencies in vitamin B6, even based on today’s standard, are common in the United States¹⁰ and are associated with sleep deprivation and stress.¹¹ Deficiencies in B-Complex vitamins have also been linked to obesity,¹² and this is where the connection between caffeine and nutrition becomes apparent. Many of the B-Complex vitamins, which we are already consuming in historically low amounts, are depleted by caffeine, as is vitamin C.^{13, 14, 15} This may explain why caffeine has been implicated in weight gain today while not in the past; our diet today is much less nutritious than it was in the past.

The recommended dietary allowances (RDA), also known as recommended daily allowances, for vitamins and minerals were originally published in the 1940s as part of the work of a committee formed to investigate the nutrition requirements for the armed forces in World War II.¹⁶ These guidelines were based on vitamin and mineral levels in the food supply at that time, but those may not have been optimal levels. DDT was already widely employed as a pesticide and its use would have lowered the nutrient content of the food supply.¹⁷ In addition, many vitamin-destroying food processing techniques had been introduced before World War II.¹⁸ The levels of vitamins which scientists would have measured in the food supply and in people’s bodies would already have fallen. In fact, vitamin levels would have decreased before most vitamins were discovered. There would have been no way of knowing this then, nor would there have been awareness that the change in nutrient levels was linked to the rising prevalence of obesity.

Currently, many doctors want to raise the recommended intake of various individual vitamins. For example, the RDA of vitamin C for adults is 60 mg and is based on the amount needed to ward off scurvy. However, researchers have found that taking 1,000 mg of vitamin C daily lowers stress, cortisol production, and blood pressure. Looking at archaeological evidence, some researchers believe daily vitamin C consumption may have been as high as 1,000 mg during prehistoric times, and they would like the RDA for vitamin C to be raised.¹⁹

However, it does not appear that vitamin supplements are the answer for treating obesity and disease. The largest study of multivitamins ever done, involving over 161,800 patients and taking eight years, found that supplements do not significantly lower rates of heart disease or cancer.²⁰ On the other hand, research consistently shows that foods high in vitamins and minerals do lower rates of these diseases.

So why do multivitamins have no such effect? It appears there are two reasons. First, some nutrients cannot be absorbed well in pill form. In fact, the vitamin E found in supplements is treated as a foreign compound when it is not absorbed by fat in the stomach. The body needs to use a different type of vitamin E to get rid of it. Second, vitamins and minerals may not be the main nutrients which are deficient in our diet. Later in the book we will see an anti-inflammatory compound which the body creates from three amino acids, a vitamin, and a mineral that may reduce the risk of heart disease and cancer. Foods rich in vitamins and minerals generally have amino acids and other nutrients like phytochemicals and sterols, but vitamin supplements do not. This may explain why vitamin supplements do not improve our health in the same way as nutritionally rich food does.

Fast food and processed food are now everywhere. While there have been efforts to control the fat and calories contained in restaurant food, there has been very little discussion of their nutrient content. A significant portion of the food energy in fast food comes from vegetable oils and refined sugar, which have extremely low levels of nutrients.

Much has been made of the effect that processed wheat has on blood sugar, but there has been less discussion of the effect of processing on nutrient content. Wheat contains many vitamins that are used in fat oxidation and can reduce hunger, yet these are in the parts removed by our modern processing techniques. Removing the natural oils, which is done in creating most breads and pastas, extends their shelf life. These oils remain only in products labeled 100% whole wheat. Unfortunately, this has caused us to lose nutrients we cannot absorb well from supplements. In their natural form, some of these vitamins have almost pharmaceutical-like effects on cholesterol and inflammation.

In animals fed an extract of rice bran oil high in vitamin E and plant sterols, a 62% reduction in LDL cholesterol has been achieved.²¹ A similar effect is not seen in human studies that use synthetic vitamin E supplements. Vitamin E has been shown to increase insulin sensitivity, which is the opposite of insulin resistance. When we eat vitamin E in its natural form, food has a greater ability to make us feel full because of this increase in insulin sensitivity.

The oil found in unprocessed rice but removed during refining is considered one of the world’s richest sources of vitamins, antioxidants, and other nutrients.²² Wheat germ oil is also a very rich source of these nutrients. By removing oil from rice and wheat during processing, it is possible we are also losing health effects that have not been identified. The nutrient content of these oils is very similar to that of fruits and vegetables.

The trouble with eating refined carbohydrates, sugars, and processed oils is not these products in themselves, for they are components of foods that have been eaten throughout history. They all come from plants that in their natural forms would be healthful. The issue is not just the effects on blood sugar of a lack of fiber. If refined carbohydrates were the only problem, we would have expected all of the low carbohydrate diets to work. Of the remaining possible causes of impaired fat oxidation and weight gain, one plausible explanation is a deficiency of vitamins, minerals, and other phytochemicals caused by refined food products displacing nutrient-rich foods in our diets. To add insult to injury, the use of chemical pesticides has lowered the vitamin and mineral content of the remaining fruits and vegetables in our diets. Substantially higher levels of vitamins and minerals are found in organically grown produce than in that grown using chemical pesticides.

Stress has been shown to cause vitamin C and mineral depletion, including depletion of the minerals chromium and magnesium. These were the minerals we looked at earlier that, when taken in supplement form, were associated with lower body weight. Levels of these minerals measured in our blood fell by 33% in the twenty years between 1986 and 2006, despite what should have been an adequate level of consumption.²³

There are several factors contributing to our lowered mineral intake. Currently, most commercially produced fruits and vegetables are grown with pesticides and chemical fertilizer. Organic fruits and vegetables have an average of 78% more chromium than typical crops. Magnesium in organic vegetables is more than twice as high as in those grown conventionally.²⁴

Various cooking techniques as well as using pesticides can lead to losses of B-Complex vitamins and vitamin C.^{25, 26} Vegetables that are frozen for a year can lose more than 75% of their vitamin C content. Levels of other vitamins and minerals in our diet have been falling due to additional causes as well.

During the refining process, wheat loses an average of 66% of its B-Complex vitamins, as well as 70% of its minerals.²⁷ In over 90% of the wheat products sold in the United States (those which are not 100% whole wheat), processing techniques remove almost 90% of a form of vitamin E called alpha-tocopherol and 43% of a form called beta-tocopherol.²⁸ Wheat also loses phytosterols, a compound in fruits, vegetables, and whole grains which has been shown to reduce cortisol production,²⁹ cholesterol, and abdominal fat.³⁰ Like vitamin E, phytosterols cannot be absorbed well from supplements.

Vitamin E is of particular interest to obesity researchers because it lowers insulin resistance, the condition associated with obesity in which food becomes less filling and fat is increasingly deposited around the stomach. By removing the oils from grains to extend their shelf life, we are almost certainly losing phytosterols and additional nutrients with health effects that have not been identified. The parts of the grain kernel which are removed are the ones that are nutritionally similar to fruits and vegetables.

Exposure to industrial chemicals also increases our need for vitamins. Bacteria—and our bodies are filled with healthful bacteria—employ vitamins to break down industrial chemicals. Certain vitamins and minerals, including members of the B-Complex, are added to sludge pools that are used to break down industrial chemicals. One of these chemicals, nonylphenol ethoxylate, is still an ingredient in cleaning solutions in the United States, despite being banned in the European Union and Japan.³¹

Nutrient deficiency as a cause of weight gain explains why diets that focus on increasing consumption of fruits, vegetables, and whole grains are partially successful, even if we have not yet determined which nutrients are responsible. Increasing our consumption of these foods has some ability to lower hunger and restore the vitamins and minerals that are depleted by caffeine consumption, exposure to pollutants,³² and modern agricultural practices and food preparation techniques. Interestingly, Israel is an example of a country whose children have a low rate of caffeine consumption combined with higher vitamin and mineral intake.

The prevalence of obesity in Israel is less than half that in the United States, although adult obesity rates are only moderately lower.³³ The real difference is in the obesity rates of children and young adults. While the childhood obesity rate is 16% in the United States, obesity is rare among children in Israel, particularly in Jerusalem. Young people are even thinner than what is considered normal in the United States. Anecdotally, on a flight out of Tel Aviv, I sat next to a young Israeli soldier. Her waist was so small that she had trouble adjusting the seat belt so it was tight enough. There was extra room around her hips. She was not particularly thin for an Israeli woman her age, but the seats were not designed for someone with her waist size.

As discussed previously, soda is the number one source of caffeine for children in the United States. American children drink so much soda that it is their primary source of sugar. However, in Israel soda is not as readily available as it is in the United States. While almost all restaurants in the United States have soda fountains, almost no restaurants in Israel have them. Soda is sold by the can or the bottle, which can cost two or three dollars per serving with no free refills. The few establishments like McDonald’s and movie theaters that have soda fountains sell much smaller servings than are sold in the United States. However, this is not the only factor lowering soda consumption among Israeli youth.

My first summer in Israel was spent in Jerusalem, where summers are hot and dry. On many days the temperature reaches over 100 degrees. One of the first things foreign students are told is to always carry a large bottle of water. They are also advised to avoid drinking caffeine because it causes dehydration. In the hot dry summers of Jerusalem, dehydration is a serious threat for young people and tourists who spend most of their time outdoors. Stories of tourists hospitalized because of dehydration are not uncommon. Because of the high cost of soda, lack of availability, and concern over dehydration among people who spend their days outdoors, soda consumption among Israeli children is much less than among American children.

Fruit and vegetable consumption is much higher in Israel than in the United States. Small shops selling fruits and vegetables are everywhere, and in certain sections of Israeli towns you can easily pass five such shops in a ten-minute walk. While walking in Jerusalem one day, I was startled to see a small SUV with a large banana plant sticking out of its back pull up to a produce stand in front of me. From the SUV stepped a farmer, his clothes still covered in the dirt of his fields. He took a knife and started cutting bunches of bananas off the plant and into a basket at the stand. I grew up eating bananas that had been shipped to a supermarket, with a sticker indicating their country of origin. These bananas had ripened on the plant and had just been cut off in front of me, so I had to try them. The taste was shockingly good and nothing like that of the imported bananas I had eaten in the United States.

There are two possible explanations for the taste difference. The first is that bananas, along with most other produce in Israel, is locally grown and not imported. Because of this, the fruit can ripen before being picked. The second is lowered use of chemical pesticides. Since 1983 the government of Israel has funded a program to replace chemical pesticides with owls and kestrels, which are a type of falcon, to eat crop damaging rodents and insects. There are at least one thousand barn owl nest boxes and many thousands of owls and kestrels eating pests on Israeli farms. This is equivalent to several birds of prey for every square kilometer of land cultivated in Israel. A family of owls can eat three thousand rodents in a nesting season.³⁴ In addition to eating rodents, the kestrels also eat insects. The program has been so successful that it is now being exported internationally.³⁵

The lower use of chemical pesticides means that Israeli produce has a higher nutrient content. It also means Israelis are using fewer antioxidants to remove pesticides from their bodies. In one study of twenty thousand Americans with serious allergies, the majority of subjects had a higher level of pollutants, including several pesticides, in their bodies than did the general population, as well as deficiencies of numerous vitamins.³⁶ Exposure to pesticides and other synthetic chemicals has also been linked to various autoimmune disorders, in addition to allergies.

It is likely that low consumption of soda and high consumption of fruits and vegetables with superior vitamin and mineral content contribute to the low rate of childhood obesity in Israel. Among Israelis who are older and more likely to have air conditioned cars and office jobs, dehydration is not a concern. Coffee and tea are quite popular among Israeli adults, although soda consumption is much lower than among Americans. Fruit and vegetable consumption is certainly higher among Israelis of all ages. Another possible reason for the low rate of obesity in Israel is the relative absence of processed food and chemical flavorings. Foods in Israel are still largely flavored with herbs and spices rather than with artificial chemicals. The theory that soda consumption and nutrient deficiency are causes of weight gain appears to explain why, while obesity is much rarer among children in Israel than among those in the United States, the gap between adult obesity rates in the two countries is much lower.

However, if the factors we have discussed so far were sufficient to explain the symptoms associated with obesity, including sleep difficulties, we would expect that Israeli children would have the sleep patterns of earlier times, but this is not the case. A walk through one of Jerusalem’s parks early on a weekend morning does not reveal large numbers of children playing soccer and other games. The residential areas of Jerusalem are just as quiet on the weekends as are those in America. More importantly, Israel does not have much lower rates of heart disease, cancer, or diabetes than in the United States. As in the United States, these diseases become more prevalent as meat and fat consumption increases. This is troubling because we saw that the Inuit were able to avoid the diseases associated with obesity despite even higher consumption of meats and fats. So either obesity is occurring because the meats and fats in the modern world are different from those consumed historically or because of something associated with meat consumption in the modern world.

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