Four friends get together for dinner at a restaurant.
Swedish Man: It’s really good to see you guys!
Inuit Man: Yes, it’s great to see you guys! And I’m glad we’re here. I’m really hungry.
Swedish Man: I already know what I’m gonna get; I’ve been thinking about it all day.
Tsimané Man: Let me guess: Steak and asparagus with lots of butter?
Swedish Man: What do you mean? Like low-carb or something?
Tsimané Man: Yeah, I know there was a big initiative in your country to get people to cut carbs. I thought all Swedes were on the low-carb diet.
Inuit Man: Seriously, we get together once a month and we’re talking about Swedish government initiatives and cutting carbs?
Swedish Man (with a smile): Yeah, we are, bro, until you have something better to talk about. I won’t be holding my breath.
Tsimané Man: Ignore him. It’s true, right?
Swedish Man: Not exactly, but I know what you’re referring to. In response to the fact that Swedish people had among the highest prevalence of cardiovascular disease in our world at the time, in 1985, there was a massive government initiative to get people to cut fat and add carbs. It was very successful, in the sense that the recommendations were widely adopted. Then, starting around 2003, and lasting for several years, there was a widespread, equally successful media campaign to get people to cut carbs and add fat. (1)
Tsimané Man: Oh, got it.
Swedish Man: From 1986 to 2010, some researchers followed a bunch of us Swedes. I volunteered. There were over 140,000 of us. For 25 years, they measured our food intake, our body weight, our blood-cholesterol levels, and more. (1)
Kitavan Man: So they followed you all during a period when the low-fat diet was widespread and during a period when the low-carb diet was widespread, right?
Swedish Man: That’s right. And this is one of the largest studies of food intake and wellness ever conducted, both in terms of number of subjects and length of follow-through. (1)
Tsimané Man: What did they find?
Swedish Man: First, over the 25 years, body weight of Swedes kept rising. First, we went low-fat, then we went low-carb, and we kept gaining weight the whole way through. On both diets, over time, we gained weight. (1)
Inuit Man: How about blood-cholesterol levels?
Swedish Man: First, let me say that we can’t claim causation from a study like this. All that weight gain, we can’t say it was caused by eating low-fat or low-carb. All we can say is that people just kept gaining weight during the periods of time when those diets were widely followed. With blood-cholesterol levels, there was a sharp bettering from 1986 until 2004, then they stayed about the same, then, in 2007, there was a sharp worsening. Again, we can’t claim causation, but as the low-carb movement really took hold, blood-cholesterol levels got a lot worse. (1)
Tsimané Man: So that’s why you’re not low-carb?
Swedish Man: I’m not low-fat. I’m not low-carb. I’m not low-anything. Well, I am low-dogma. No, at this point in my life, I’m firmly no-dogma.
The other men all smile.
Swedish Man: I don’t play those games anymore. Now just I eat real food and I really enjoy it. No weird exclusion of entire classes of foods required.
The server comes to the table.
Server: It’s great to have you all back. Are you ready do order?
Kitavan Man: We need a few more minutes. We’ve been talking.
Inuit Man (pointing to the Swedish man and teasing): He’s been talking.
Server (smiling): I’ll come back in a bit. Take your time, gentleman.
Kitavan Man: I just eat real food too. I grew up that way so it comes easy to me. I grew up on lots of fruit, all different kinds of tubers that are kind of like the sweet potatoes here, lots of fish, and coconuts. (2,3,4)
Swedish Man: Sounds good!
Kitavan Man: Oh, yes. Island food is good, men! I’d love for you guys to come with me on my next trip back home.
Swedish Man: You don’t have to ask me twice.
Kitivan Man: My people are super well too. When I was a teenager, a bunch of researchers come to the island to study us because we’re so well. (2,3,4)
Swedish Man: What did they find?
Kitivan Man: Do you want to know what they didn’t find? Cardiovascular disease. Barely a trace. It’s almost impossible to find cardiovascular disease in a Kitavan. (2,3,4)
Swedish Man: That’s amazing.
Tsimané Man: Fruit and tubers are both really high in carbs. You all definitely aren’t on the low-carb diet.
Kitavan Man: No, not at all. Lots of fruit! Lots of tubers! (2,3,4)
Tsimané Man: I never knew all this about you. What’s crazy is that scientists came to study my people too. I don’t mean to brag, while yeah I do. (pauses an smiles widely) Let me brag: They found us to be the people with the lowest amount of cardiovascular disease ever observed, even less than you Kitavans. (5)
Inuit Man (pretending to be annoyed): Are you guys going to be ready to order soon?
Swedish Man: I’m ready.
Tsimané Man: Me too.
Kitavan Man: I’m ready.
Inuit Man (smiling widely): Thank goodness!
Swedish Man: What do the Tsimané eat?
Tsimané Man: We eat corn, manioc, plantains, and rice that we grow along with fruit and nuts we gather and meat we get from hunting (including fishing). (5)
Swedish Man: Like the Kitavans, it sounds like lots of carbs?
TsimanéMan: Oh yeah! About 72 percent of our energy comes from carbohydrate, 14 percent from fat, and 14 percent from protein. (5)
Swedish Man: Wow! Something is way off with this whole low-carb craze here in the United States. Both the Kitivans and the Tsimané have virtually no cardiovascular disease or obesity (2,3,4,5) and you’re all eating mostly carbs (2,3,4,5). Here, everyone is doing that crazy keto diet with no carbs at all and we’re sick as fuck here. Something doesn’t add up.
Tsimané Man: Yeah, in the study of my people, they did a direct comparison. The average 80-year old Tsimané had the heart of the average 55-year-old in the United States. (5) We’re doing just fine with our corn, manioc, plantains, and rice, thank you very much.
Inuit Man: Okay, that’s interesting!
Tsimané Man: Right? There are all these fancy schools here and all these people with advanced degrees trying to “figure out the optimal diet”. They’re like a bunch of dogs chasing their tails.
Kitavan Man: Then some of them fly over to study us. They witness with their own eyes how well we are. They do elaborate testing on us and they find out that we don’t get sick like their people do. But then they don’t even trust their own data, for crying out loud.
Inuit Man: They don’t trust themselves. They don’t trust nature. They live in great fear. My people, we’re one with nature. We don’t use nature. We don’t fight nature. We’re one with nature. We are nature. We never separated.
Swedish Man: What do the Inuit eat back home?
Inuit Man: Okay, I’ll play; this has actually gotten really interesting. And we have one of the most unique ways of eating on the planet, so you guys are going to find this fascinating. My people live in one of the coldest climates on Earth. We can’t cultivate any plants, so even to this day, we don’t do any farming. We hunt, mostly for seals, and for some inland animals too. And we gather a very small amount of plant foods when they’re available which is very rare. (7) You think the summer is short here in Maine? Go up to Canada. Then keep going up. And going. Until you reach the Arctic Ocean. That’s where I’m from. How do people say it here? Cold as fuck!
The other men all smile.
Swedish Man: Wait, so the Inuit don’t eat much carbohydrate at all then?
Inuit Man: Almost none. Carbohydrate-rich food just isn’t there. (7) If you want to study the effect of the low-carb diet and the keto diet, you want to study my people. We’ve been eating that way for a long time. We don’t have any weird artificially tanned people promoting it as a diet, we just eat that way because that’s what’s available for us to eat.
Swedish Man: And are your people well?
Inuit Man: Yes, we largely avoid cardiovascular disease, obesity, and the other chronic ailments common in the West. (7)
Tsimané Man: So you guys are basically eating like you’re on the keto diet that everyone around here in the States is doing?
Kitavan Man: Yeah, that’s what it seems like. I mean, your people must eat a lot of fat?
Inuit Man: We eat tons of fat, a moderate amount of protein, and almost no carbs. (7) Just like the keto diet.
Swedish Man: Well, then, maybe the keto diet works too. I mean, it seems to work well for the Inuit.
Inuit Man: Are you ready to have your mind blown?
Swedish Man: Oh, I can tell this is gonna be good.
Inuit Man: The whole premise of the keto diet is you eliminate virtually all carbohydrate from your diet. You do this to force your body into a state of ketosis characterized by the formation of ketone bodies. Advocates of the keto diet claim all kinds of benefits come from being in ketosis and the formation of ketone bodies.
Swedish Man: Wow, so the Inuit must be in like super ketosis or something! That must be why they’re so well!
Inuit Man: That’s what many people here believe. Many people make a big mistake and use the well-being of the Inuit to support the notion that getting into ketosis comes with all kinds of benefits.
Swedish Man: Wait, I’m confused.
Inuit Man: Hang tight; I’m getting there. (reaches for his phone) In 2013, a group of geneticists discovered that the Inuit have a widespread genetic mutation that prevents most of us from ever going into ketosis at all. (6) Hold on, I have it right here.
Swedish Man: This is really interesting!
Inuit Man: This is from an editorial written by three physicians recently in the medical journal JAMA Internal Medicine (7):
“The risks posed by the ketogenic diet may explain why the majority of, if not all, populations consume enough carbohydrates to avoid chronic ketosis. Despite popular misconception, even the circumpolar Inuit, who historically have subsisted on a diet of minimal carbohydrates, have a widely prevalent genetic mutation to circumvent the production of ketones. Although the reason for the genetic mutation is not known, it may have conferred a survival advantage, by minimizing ketone production.”
Swedish Man: Wow!
Kitavan Man: It’s as if their bodies know better. The Inuit eat in a way that would force chronic ketosis in everyone else on Earth and their bodies have adapted in a way that they don’t produce ketone bodies. That’s absolutely amazing!
Tsimané Man: Yes, that’s amazing!
Inuit Man: Isn’t that something? This is from the geneticists who did the original research those physicians were referring too. This is from the American Journal of Human Genetics (6):
“Moreover, the large amounts of n-3 polyenoic fatty acids in the traditional diet of these aboriginal peoples are known to increase the activity of CPT1A. In this context, the CPT1A-activity decrease due to the c.1436C>T mutation could be protective against overproduction of ketone bodies.”
Kitavan Man: So all these advocates of the keto diet, they’re making production of ketone bodies out to be some sort of holy grail…
Tsimané Man (finishing the thought of the Kitavan man): …But the only people on Earth who natural eat virtually no carbohydrate don’t actually produce ketone bodies? Their bodies have developed a way to avoid going into ketosis altogether?
Inuit Man: That’s what the science shows, my friends. (6,7)
Swedish Man: Wow, nature is wicked smart and seems to have a sense of humor at the same time!
Inuit Man: We are nature, men. The sooner we embrace interbeing and live as one with nature, the better off we’ll be. We need to stop trying to trick and hack and outsmart nature. That’s what these crazy fad diets are all about. They’re people trying to outdo and hack nature. That never goes well. Trust me.
The server comes over to the table.
Server: All right, is everyone ready to order?
Inuit Man: Yes! I’m so hungry.
Swedish Man (addressing the server): Before we get to that, have you seen a change in how people eat in the restaurant over the years? Have you seen people eating low-fat, eating low-carb, you know, that sort of thing?
Server: Oh yeah, I’ve seen it all. If there’s a fad diet, I see people jumping on it. Management even changes our menu to keep up with the latest fad diets.
Swedish Man (addressing the server): So what do you think of the keto diet and everyone avoiding carbs these days?
Server (surprised and thrilled to taking a shot at this one): You wanna know what I think? I see a lot of people come in and out of this place every day. It’s a little slice of Americana. I’ve seen it all. And I can tell you this. Our society is certainly very sick. We have broken families. Broken communities. We have junk food. Junk media. Junk art. Junk education. It’s a truly sick society. (pauses, looks down, then looks back at the others) With everything I’ve seen, and with everything going in in this country, do you want to know what I think is making people sick and fat in the United States?
Swedish Man (addressing the server): What?
Server: Not squash.

With the citations for this article, I’ve added bonus information for you: quotes from the scientists, researchers, and physicians who conducted these studies. Don’t be duped by a fast-talking, fancy-talking bully selling a fad diet. Empower yourself with science. With truth.
Of course, there are a plethora of scientific studies showing the benefits of the low-carb diet and the keto diet. There are just as many showing the benefits of the low-fat diet. These are almost all short-term studies.
Any real scientific exploration considers all of the available knowledge. Choosing not to look at the other knowledge isn’t intellectually rigorous or honest.
“Stupidity is overlooking or dismissing conspicuously crucial information.”
—Adam Robinson
It’s easy to say, “There’s science to support the low-carb and keto diets,” but stopping there ignores what Robinson brilliantly refers to as “conspicuously crucial information”.
All of this knowledge is available:
- There’s lots of data from short-term clinical studies showing benefits of the low-carb diet and the keto diet.
- There’s lots of data from short-term clinical studies showing the benefits of the low-fat diet (which is high in carbohydrate).
- There’s data from one of the largest studies ever conducted on the relationship between ways of eating and wellness (the one on the Swedes I described in this article).
- There’s data from studies of the Kitavans and the Tsimané I described in this article.
- There’s the knowledge of a widespread genetic mutation in the Inuit, a people who naturally eat almost no carbohydrate, that prevents them from going into ketosis. We don’t know why this genetic mutation exists. But the powerful implication is that chronic ketosis created by chronic carbohydrate deprivation is so dangerous that a genetic mutation has emerged in the Inuit to prevent it.
Something besides carbohydrate-rich food is making people sick and fat in the United States. Acorn squash, blueberries, sweet potatoes, and pineapple aren’t the problem. The low-carb and keto diets aren’t a holy grail.
Here are the references and quotes straight from the scientists, researchers, and physicians who conducted these studies that I promised:
(1) Associations Among 25-Year Trends in Diet, Cholesterol and BMI from 140,000 Observations in Men and Women in Northern Sweden. Nutrition Journal, 2012, 11(1), 1-13.
“In the 1970s, men in northern Sweden had among the highest prevalences of cardiovascular diseases (CVD) worldwide. An intervention program combining population- and individual-oriented activities was initiated in 1985. Concurrently, collection of information on medical risk factors, lifestyle and anthropometry started. Today, these data make up one of the largest databases in the world on diet intake in a population-based sample, both in terms of sample size and follow-up period. The study examines trends in food and nutrient intake, serum [a component of blood] cholesterol and body mass index (BMI) from 1986 to 2010 in northern Sweden.”
“Reported intake of fat exhibited two significant trend breaks in both sexes: a decrease between 1986 and 1992 and an increase from 2002 (women) or 2004 (men). A reverse trend was noted for carbohydrates, whereas protein intake remained unchanged during the 25-year period. Significant trend breaks in intake of foods contributing to total fat intake were seen. Reported intake of wine increased sharply for both sexes (more so for women) and export beer increased for men. BMI [body-mass index] increased continuously for both sexes, whereas serum [a component of blood] cholesterol levels decreased during 1986 – 2004, remained unchanged until 2007 and then began to rise. The increase in serum [a component of blood] cholesterol coincided with the increase in fat intake, especially with intake of saturated fat and fats for spreading on bread and cooking.”
“Men and women in northern Sweden decreased their reported fat intake in the first 7 years (1986 – 1992) of an intervention program. After 2004 fat intake increased sharply for both genders, which coincided with introduction of a positive media support for low carbohydrate-high-fat (LCHF) diet. The decrease and following increase in cholesterol levels occurred simultaneously with the time trends in food selection, whereas a constant increase in BMI [body-mass index] remained unaltered. These changes in risk factors may have important effects on primary and secondary prevention of cardiovascular disease (CVD).”
(2) Low Serum Insulin in Traditional Pacific Islanders—The Kitava Study. Metabolism, 1999, 48(10), 1,216-1,219.
“In Kitava, the intake of Western food is negligible and stroke and ischemic heart disease are absent or rare.”
“Low serum insulin may partly explain the low prevalence of cardiovascular disease in Kitavans and probably relates to their marked leanness.”
(3) Age Relations of Cardiovascular Risk Factors in a Traditional Melanesian Society: The Kitava Study. The American Journal of Clinical Nutrition, 1997, 66(4), 845-852.
“The population is characterized by extreme leanness (despite food abundance), low blood pressure, low plasma plasminogen activator inhibitor 1 activity [a marker of thrombosis related to the development of the metabolic syndrome (the cluster of cardiovascular disease, type-2 diabetes, obesity, and related diseases) and cancer], and rarity of cardiovascular disease. Tubers, fruit, fish, and coconut are dietary staples whereas dairy products, refined fat and sugar, cereals, and alcohol are absent and salt intake is low.”
(4) Apparent Absence of Stroke and Ischaemic Heart Disease in a Traditional Melanesian Island: A Clinical Study in Kitava. Journal of Internal Medicine, 1993, 233(3), 269-275.
“On the island of Kitava, Trobriand Islands, Papua New Guinea, a subsistence lifestyle, uninfluenced by western dietary habits, is still maintained. Tubers, fruit, fish and coconut are dietary staples. Of the total population, 1816 subjects were estimated to be older than 3 years and 125 to be 60-96 years old. The frequencies of spontaneous sudden death, exertion-related chest pain, hemiparesis, aphasia and sudden imbalance were assessed by semi-structured interviews in 213 adults aged 20-96. Resting electrocardiograms (ECG’s) were recorded in 119 males and 52 females. No case corresponding to stroke, sudden death or angina pectoris was described by the interviewed subjects. Minnesota Code (MC) items 1-5 occurred in 14 ECG’s with no significant relation to age, gender or smoking. ST items [a measure of heart function] (MC [Minnesota Code] 4.2 and 4.3) were found in two females and Q items [a measure of heart function] (MC [Minnesota Code] 1.1.2, 1.3.2 and 1.3.3) in three males. Stroke and ischaemic heart disease appear to be absent in this population.”
(5) Coronary Atherosclerosis in Indigenous South American Tsimane: A Cross-Sectional Cohort Study. The Lancet, 2017, 389(10,080), 1,730-1,739.
“Despite a high infectious inflammatory burden, the Tsimane, a forager-horticulturalist population of the Bolivian Amazon with few coronary artery disease risk factors, have the lowest reported levels of coronary artery disease of any population recorded to date.”
“The Tsimane live a traditional forager-horticultural lifestyle, in huts of thatched roofs, typically in villages of roughly 60-200 people. An estimated 14% of their average caloric diet is protein, 14% is fat, and 72% is carbohydrate. Meat protein and fat are acquired by hunting with guns and bow and arrow, or fresh water fishing with arrows, hook and line, or nets. Non-processed carbohydrates are grown in the form of rice, plantain, manioc, and corn via slash-and-burn horticulture, and the Tsimane also gather wild nuts and fruits.”
“In this population-based study of the indigenous Tsimane population of Bolivia, we observed a very low prevalence of coronary atherosclerosis, as measured by CAC [coronary-artery calcification] scoring. The low prevalence of atherosclerosis extends to the older ages wherein up to 31 (65%) Tsimane octogenarians were free from atherosclerosis; only four (8%) of octogenarians showed moderately elevated CAC [coronary-artery calcification] scores. This makes the Tsimane the population with the least reported coronary atherosclerosis. This contrasts starkly with the US MESA population in which only 14% of the MESA [Multi-Ethnic Study of Atherosclerosis] population had no CAC [coronary-artery calcification], and more than 50% exhibited CAC [coronary-artery calcification] scores of at least 100 Agatston units. These findings translate to a 24-year lag before Tsimane reach a CAC [coronary-artery calcification] score of above 0 and a 28-year lag before they reach a CAC [coronary-artery calcification] score of at least 100 compared with an unselected US population. By these findings, an 80-year old Tsimane possesses the ‘vascular age’ of an American individual in their mid fifties. These findings of apparent protection from coronary atherosclerosis in the Tsimane extend to old age.”
(6) A Selective Sweep on a Deleterious Mutation in CPT1A in Arctic Populations. The American Journal of Human Genetics, 2014, 95(5), 1-6.
“Moreover, the large amounts of n-3 polyenoic fatty acids in the traditional diet of these aboriginal peoples are known to increase the activity of CPT1A. In this context, the CPT1A-activity decrease due to the c.1436C>T mutation could be protective against overproduction of ketone bodies.”
(7) The Ketogenic Diet for Obesity and Diabetes—Enthusiasm Outpaces Evidence. JAMA Internal Medicine, 2019, published online on July 15, 2019, DOI: 10.1001/jamainternmed.2019.2633.
“The risks posed by the ketogenic diet may explain why the majority of, if not all, populations consume enough carbohydrates to avoid chronic ketosis. Despite popular misconception, even the circumpolar Inuit, who historically have subsisted on a diet of minimal carbohydrates, have a widely prevalent genetic mutation to circumvent the production of ketones. Although the reason for the genetic mutation is not known, it may have conferred a survival advantage, by minimizing ketone production.”
“Although the ketogenic diet has garnered much attention for the dietary treatment of chronic diseases such as obesity and type 2 diabetes, the evidence supporting its use is currently limited and the diet’s potential risks are real. Physicians and patients should continue to judiciously appraise the benefits and risks of the ketogenic diet in accordance with the evidence, not the hype.”
Remember your mantra for today: NOURISHING MOVEMENT, NOURISHING FOOD, NOURISHING LIFE.
There’s a place below to share your feelings on this article if you’d like. I’d love to hear from you.