To Reiterate, Just In Case You Missed It: No Elevated Ketone Levels in the Inuit

Sorry Low Carb dieters: the Inuit just aren’t that into you

Since this post the other day and subsequent exchanging of some emails and comments here & there with those I’d generally consider advocates of very low carb dieting—to include those advocating near perpetual states of ketosis—I’ve been met with surprise bordering on disbelief that indeed no, the Inuit are no more a “ketogenic society” than anyone else across the planet Earth.

And if not, then there is literally not a shred of any basis that chronic ketosis is a healthy state to be in (and so sorry, but I’m just guessing it’s not “nutritional,” either).

Let’s dive into the three old papers cited in that other post: 1928, 1936, and 1972, all with identical findings.

~ STUDIES ON THE METABOLISM OF ESKIMOS. Peter Heinbecker. Departments of Biological Chemistry and Physiology, Washington University School of Medicine, St. Louis. July 9, 1928.

The main objects of the experiments were to learn whether detectable ketosis exists among Eskimos under natural dietary conditions; the extent to which ketosis develops in fasting and the rate at which it disappears on glucose ingestion; the “carbohydrate tolerance” as indicated by blood sugar curves; and to determine the respiratory metabolism during and after a ketosis-producing fast. […]

It may be said at once that the Eskimo on his usual dietary shows no ketosis and has high tolerance to ingested glucose. […]

Eskimos show a remarkable power to oxidize fats completely, as evidenced by the small amount of acetone bodies excreted in the urine in fasting.

[emphasis added; note also that “acetone bodies” and/or acetoacetic acid are what are commonly referred to today as “ketone bodies.”]

The paper explains why they’re not in ketosis. Two reasons.

1. Very high protein intake (av. 280 grams/day; fat only 135 grams)
2. Low carbohydrate, but not very low carbohydrate (“54 gm. of carbohydrate of which the bulk is derived from the glycogen of the meat eaten.”)

Accordingly, with super sufficient protein to make glucose from dietary protein, combined with the meat carbs (liver and muscle glycogen) they get from eating raw, fresh kills, they maintain good glucose tolerance and insulin sensitivity.

In order to produce deep ketosis, which the paper explains they were very resistant to, they fasted the subjects for 82 hours. Guess what happened to their glucose tolerance? Shot to hell would be an understatement! This should be a sobering picture for anyone experimenting with prolonged ketosis (starvation).

Wow, they must be DEB3ATEEZ! No, they were put into starvation, and in order to spare essential glucose for the brain, the metabolism no longer gave a runny shit about cellular sensitivity to insulin. Yea, really healthy and “nutritional,” that chronic ketosis thing.

Now, tell me again how “there’s no such thing as an essential carbohydrate.”

Now I understand exactly what happened when months ago, thinking ‘hmm, maybe there’s something to this,’ I began eating 4-6 oz. portions of protein rather than 8, 12, 16 or more. Upped the fat, stayed lowish carb, and then when I did have a carby meal, glucose tolerance was shot to hell and I’d see 160-180, even 194 once. I also now understand perfectly why upping my carbs to 100-200 of starch daily restored my tolerance to normal human.

Moving on.

~ A STUDY OF THE BLOOD LIPOIDS AND BLOOD PROTEIN IN CANADIAN EASTERN ARCTIC ESKIMOS. Arthur Curtis Corcoran and Israel Mordecai Rabinowitch. Department of Metabolism, The Montreal General Hospital, Montreal. December 13, 1936.

Both lived at Dundas Harbour, on Devon Island (lat. 74deg 35′), and had had practically no carbohydrate food other than the glycogen of animals for about 10 months before the tests. In each case, the test was commenced in the fasting state and the concentrations of the different plasma lipoids were determined before and again 1, 2 and 3 hours after administration of the oil. […]

Also suggestive of an unusual mechanism for the utilization of fat is the absence of ketosis in these natives, whereas the urines of both of Tolstoi’s subjects contained acetone. The explanation of this absence of ketosis is not entirely clear. As shown previously [Rabinowitch & Smith, 1936], though the small amount of carbohydrates in the diets may be more than balanced by the potential sugar production from the large amount of protein to keep the ratio of fatty acid to glucose below the generally accepted level of ketogenesis, the respiratory quotient data suggest another mechanism also. That the Eskimo possesses a very active fat metabolism is suggested from some of the data. [emphasis added]

I can hear the VLC/Keto “nutritionists” now: “SEE, LC MAKES UZ A FATZ BUR3RZ!” Yea, but they’re not in [“nutritional”] ketosis. They’re eating their meat fresh and raw, lots and lots of it (high protein), getting glycogen from it, and it’s also plenty enough to ensure robust gluconeogenesis from dietary intake.

They are not putting themselves into a “nutritional” state of starvation by restricting protein along with carbohydrate, in order to consume more micronutrient bankrupt fat, without even resistant, fermentable fibers to ensure vitamin-synthesis by gut microbes—just to ensure keto-hocus-pocus long term. The Inuit are not doing anything like it, have never done anything like it, and would avoid it like the plague if they had ever even conceived of such a harebrained idea.

A final note on this one, because some are surely going to purposely misread the study so they can lie. First of all, as the paper makes clear, this was a study about blood lipids and the differences between different populations, i.e., those eating a “civilized diet,” vs. those further north eating predominately their natural diet, except for at most 2 months of the year (remember that number).

In order to determine the efects, if any, of the dietary habits of these natives, the data, as stated, were divided into two groups, namely, (a) those obtained in Hudson Bay and Strait amongst natives who live, to an appreciable extent, upon mixed diets, and (b) those obtained in Baffin and Devon Islands amongst natives whose diets, except for about 2 months in the year, consist of the natural foods of their environment (seal, whale, narwhal, walrus, etc.). A summary of this division of the data is recorded in Table III in which are also recorded, for comparative purposes, the average values found with the same technique amongst civilized peoples. It will be noted that the average concentrations of total lipoids, neutral fat, total fatty acids and phospholipins and the average ratio of phospholipins to total cholesterol were higher amongst the meat-eaters than amongst those whose diets, in addition to meats, consisted also of appreciable quantities of carbohydrates (flour etc.). [emphasis added]

Now, recall what I quoted above:

Both lived at Dundas Harbour, on Devon Island (lat. 740deg 35′), and had had practically no carbohydrate food other than the glycogen of animals for about 10 months before the tests. […]

…the absence of ketosis in these natives. [emphasis added; plus, 10 + 2 = 12]

…Just so you can keep your liars straight.

~ ALASKAN ARCTIC ESKIMO: RESPONSES TO A CUSTOMARY HIGH FAT DIET. Kang-Jey Ho, M.D., Ph.D., Belma Mikkelson, B.S., Lena A. Lewis, Ph.D., Sheldon A. Feldman, M.D., and C. Bruce Taylor, M.D. The American Journal of Clinical Nutrition. August 25, 1972.

Grain products and simple carbohydrates are virtually absent from the diet, as they must be imported from a great distance at considerable cost.

The marine mammals and the herds of caribou, upon which the Eskimos depend, tend to be migratory, and famines occur occasionally, especially during the long dark winters (5, 6). In the summertime, their diet is usually plethoric. In general, they have no fixed time for meals and eat as they please, but they usually do have one good meal toward the end of each day. Much of their food is eaten uncooked, partly from preference and especially from necessity, because fuel is scarce. […]

Average total daily caloric intake was approximately 3,000 kcal per person, ranging from 2,300 to 4,500 kcal. Approximately 50% of the calories were derived from fat and 30 to 35% from protein [260 grams on average]. Carbohydrate accounted for only 15 to 20% of their calories, largely in the form of glycogen from the meat they consumed. Grain products were scarce and although sucrose was not unknown, the average adult ingested less than 3 g/day, primarily for sweetening tea or coffee.

Are you noticing a pattern here in the composition of diet in all three studies, and that the the VLC, Ketogenic and Zero Carb folks have it conveniently wrong? How many times have you heard over the years that “Atkins is not a high protein diet, it’s a high fat diet?” Well, Atkins may indeed be high fat, low to moderate protein, but it certainly doesn’t have the Inuit as a healthful population as an example, to justify such tomfoolery—as its proponents seem to do endlessly; nor does it have any other population I’m aware of, either. Moreover, much of that protein was fresh and raw, thus providing significant glycogen (carbohydrate) from meat, another aspect that in no way supports a VLC, Ketogenic, or ZC diet. The entire very low carb phenomenon is in part a charade when it uses these Inuit and other populations to justify doing something so unnatural, so unprecedented!

And sorry, but in all cases in all three studies, protein is 250 grams and upward, on average. Ever tried to ingest that much protein without drinking it? Well, I have: 280g on workout days and 230g on rest days, while doing LeanGains for months. It’s high protein. Trust me. I hated that part the most, especially when it had to be combined with lower fat on the workout days, in order to accommodate far higher carbohydrate and stay within total caloric bounds because for Martin Berkhan, it’s count calories or go home. So this is another thing Atkins and other VLCers get wrong if in any way thinking they are modeling some natural, proven healthy diet by claiming it’s not and should not be very high protein. It’s not even close. And by the way, Atkins isn’t even a ketogenic diet beyond induction and as I recall, one was supposed to find the level of carbohydrate that would keep him out of ketosis. So, this whole “nutritional ketosis” (an enormous contradiction in terms, incidentally) thing is even a vast departure from Atkins, all the while Atkins is likely too low in protein for many practitioners. What a mess.

Well, no need to delay further, you already know the punchline.

Each Eskimo’s serum was tested for the presence of ketone bodies by the strip paper technique (18), which is sensitive to concentrations of 1 mg/ 100 ml or greater and all serums were negative. This does not preclude an increase in ketone body production during this time; usually these substances do not attain noxious concentrations until after fasting periods longer than 50 hr. [emphasis added]

So there you have it. Three studies separated by 44 years, from the West of Alaska to the Hudson Bay, all on Inuit with just about the same high protein dietary ratios, all on their natural diets, and not a single subject in ketosis, ever; and it was more difficult to get them into ketosis than for normal subjects, requiring them to be starved for more than two days straight.

So, what are the lies of commission and omission by advocates of very low carb, ketogenic and zero carb diets we’ve exposed so far, over the last few weeks?

1. The poster child Inuit do indeed get carbohydrate, above 50g per day on average, from “meat sugar” (liver and muscle glycogen that’s only available in appreciable amounts when fresh and raw). See more here.
2. The poster child Inuit do indeed get fiber, from meat (glycans in the raw blood, raw meat, raw grisly bits and raw connective tissues that resist enzymatic digestion and the gut microbes take over). See more here. Here too.
3. The poster child Inuit are never in ketosis unless in a severely fasted state.
4. The poster child Inuit indeed eat as high protein as possible, in oder to have adequate glucose available, both from the aforementioned glycogen, as well as in sufficient quantity for gluconeogenesis without wasting lean tissue.

In other words, I can’t think of a single thing I can recall from VLCers, Ketosis fans, or Zero-Carb zealots about the Inuit that’s true and accurate—at least in the context of what their diet actually is and how their metabolism responds to it.

Do you believe this is all an innocent mistake? After all, even the oldest paper, from 1928, seemed to take it as an matter of course that carbs from meat (glycogen) was obvious and well known, and all three papers mention that matter-of-factly.

Accordingly, I think you’ve been conveniently lied to by some people. Why, would be up to you to form an opinion.

So, what are my closing thoughts, suggestions? It’s simple. In order to do LC healthfully, based upon the lowest carbohydrate intake of any population we know about, you:

1. Get that protein high, and unless I’m not mistaken, this has always been Dr. Mike “Protein Power” Eades’ take on LC. Good for him.
2. Unless you’re a hunter out eating your kills fresh and raw, including the offal, then you need to get at least 50g of carbohydrate daily. I’d suggest safe starches (rice, potatoes, traditionally prepared legumes).
3. Get over the notion that fat is particularly healthful or nutritious. 50% of calories ought to be about the upper limit.
4. Scroll up and look at the 2nd chart again and get over the notion that a state of prolonged ketosis (starvation) is in any way healthful and does anything but mess up your glucose tolerance and insulin sensitivity royally. Inuit have excellent glucose tolerance when eating their natural diet. You don’t, if you’re keeping yourself in ketosis.
5. Get over the notion that when in ketosis, eat a piece of birthday cake, and see your BG spike to 200 that “you can’t tolerate any carbohydrate.” No, you’re just confirming a bias based on bullshit information. You’ve fucked up your tolerance and insulin sensitivity by following shitty, wrong advice. Your fault. Your metabolism is probably fine if you follow the above steps. Expect to have high readings for a few days until you adjust. Toss your meter for a while, so you don’t freak yourself out.
6. Exercise ketosis intermittently. It’s called a fast. 1-2 days, once every while. Likely healthful in terms of hormesis and autophagy.
7. Get resistant fermentable fibers like resistant starch in your diet so that your gut bugs have the substrates by which to synthesize vitamin nutrients. And in order to ensure that you’re not feeding empty cages, such as after lifelong occasional rounds of carpet bombing antibiotics, or years of VLC dieting that has starved some of them to extinction, get on some rounds of soil-based probiotics.
8. Stop being such idiots about all of this.

Alright then. Does that about cover it?