Constrained Carbohydrate Common Denominators

It has been clear for some time that the direct and indirect costs associated with diabetes and related metabolic disorders, heart disease, Alzheimer's, cancer, etc. are outstripping any conceivable economic growth and are a a truly systemic threat.   To many of us, reversing many of the misguided notions of nutrition, reinforced by the agricultural and pharma industries, that have dominated the past 30yrs is key if there is a hope to counteract this trend on a global scale.

But what is the right approach?  Decision support is always a tricky trade-off between complexity and adoption. People need tools to make decisions about their diet but the tools that are optimized and capture the most idiosyncratic variation may not be the ones that have the most broad impact.

If you look across the Primal/Paleo/Perfect-Health/Rosedale/Whole30/DeVany/Taubes/Eades etc. guidelines there is a lot of commonality but a significant amount of variation, mainly coinciding with incomplete empirical evidence or where the underlying processes are still unknown leading to multiple consistent interpretation of the same experiment.  In any case, the proponents and followers of these approaches are likely to be significantly more intrinsically curious, educated, economically successful,  and fascinated by the challenges of  n=1 experiment, analysis and interation than the average population.   Many people involved in these communities have experienced first-hand the acute effects of metabolic damage and were highly motivated and equipped to solve their personal problems.

All the frameworks start off seeming very straightforward as far as approximate macro-nutrient guidelines, approved and disapproved foods, supplementation, exercise and other behavioral guidelines.  But under closer examination and experience, all sorts of fine tuning becomes desirable.  Some of this is very natural as the needs of a severely metabolically challenged obese person, vs someone just trying to maintain weight at a  comfortable level are different.  But then the question of objective function becomes more and more prominent: is it weight loss, general health and disease avoidance, longevity, reproductive success?  And of course it is logical to think that one's personal history to date has a significant impact on what nutritional tweaks are most effective.

Although the cost issue has gotten a fair amount of attention and some debunking, it also seems unavoidable that the diets mentioned above are expensive to execute and maintain.  Whether it is dependence on grass-fed meat, supplementation, protein bars, access to organic vegetables, or simply the time to analyze and make good choices,  these are luxuries of the developed world and perhaps only the economic elite thereof.

So the question is, what are the broad messages that can be extracted from all the epidemiology and great analysis that have been done in response to the current crisis.  Fortunately we can hold up hope that more general and compelling principles/guidelines/explanations will emerge from the data in coming years as these movements intensify.   But change needs to be implemented immediately and thus we need to isolate a few principal components (in statistical terms) of our current state of knowledge and use these as the basis for a general message.  This will not be sufficiently precise, optimal or 'perfect' enough for sophisticated practitioners but are intended to maximize impact on mass behavior.  The most important success criteria is that the guidelines can be applied practically at the largest possible population.

There are many different ways of tackling the problem and we are deliberately ignoring the complicated interconnections and nuances of cause and effect.  The point is to get results. Should inflammation be the primary focus, or is it avoiding insulin resistance or leptin resistance ?  Are there acceptable protein and fat sources that can be produced at the necessary scale ?  Should we be looking for a macro-nutrient oriented food pyramid or a few simple 'don't eat this' (eg Fructose) rules.  Are there candidate diets that fit the bill.  As an example, consider the popular Zone diet?  The amount of carb allowed and the fat avoidance compared to most of the diets mentioned above may make it unappealing to some... but maybe it is more practical for most people to limit high glycemic load foods, and not try to navigate the delicate balance of maintaining satiety with the right fats while severely restricting carbs.

We would love to get comments and suggestions.