Traditional village life still exists somewhere in the world – Anetytum, Vanuatu
I’ve been lucky enough to contract to the World Health Organization in the South and North Pacific to take on work in the daunting area of non-communicable disease (NCD) prevention (obesity, diabetes, heart disease, etc). It’s been a privilege, but a task which has no easy solution. Here’s a tale of paradise and paradise lost. The two extremes of what I’ve seen in the Pacific.
The happiest place in the world?
Aneityum is a small island in Southern Vanuatu. It has several villages, each with its own chief and leadership structure. There are no roads, no cars and no electricity. Almost all of the food is grown locally or caught in the sea. There is a growing, but very small, local tourism operation; some cruise ships stop by for a visit, but they are confined to a smaller island, which the locals have given the tourist-friendly name of Mystery Island. So their sole income is from a small amount of tourism. Money is really only needed for education purposes, i.e. for children going to high school on Tanna, the biggest nearby island. There are both English and French schools on the island. Money is also needed for a small amount of clothing. Everyone has moved on from grass skirts and the like and wears Western-style shorts and T-shirts. One of the first things I saw when I arrived was an All Blacks hat. I’m not sure the guy who was wearing it had heard of the All Blacks, though!
The staple diet on Aneityum comprises fruits, vegetables, water, fish, coconut everything and an occasional small amount of imported rice. In terms of exercise, their system of community subsistence agriculture keeps them active all day. We walked four hours to the next village and back in a single day. Here, this is normal activity.
Do they suffer from lifestyle diseases? Very, very little! They’re primarily concerned with other health care, though they are pretty well organised with this, with a dispensary led by a local who is trained in nursing and other aspects of practical health care.
This is paradise found. Real food, real people, and real happiness. These are the happiest people I have ever met. Do they have problems? Yes, of course. Are they healthy specimens? Pretty much. Do they feel they are missing out on something in life? Absolutely not. Would they eat takeaways and sugary drinks if they could get their hands on them? You bet.
Do these people get diabetes easily when exposed to the industrial food diet? Yes, Port Villa, Vanuatu’s capital, is just starting to see the rise of the pandemic there. I just hope and pray that these guys stay as they are.
Happy, healthy kids. Two French speaking little boys give us the thumbs up!
A catch of flying fish and sea salmon. Just paddle your canoe out at night. Put your lantern on and the fish all leap into the boat. When it’s full, paddle in. Simple as that!
Time bomb: Kiribati
The sad state of Kiribati. Under-nourished kids play on the rubbish in front of a polluted lagoon. Underweight kids and obese adults with diabetes. If it’s calories in/calories out then are the adults too greedy and eating all the food? I don’t think so. This is why “the experts” need to travel and see this stuff for themselves.
Tarawa is the main island in the Republic of Kiribati (formerly the Gilbert Islands). It is right on the equator, about three hours flight north of Fiji, and is famous for the Battle of Tarawa in World War II, in which the US and Japanese smacked it out with huge losses on both sides. You can still see some of the wreckage. A coral atoll, with a maximum height above sea level of 2 m, the island may well cease to exist in a few decades because of global warming. It’s hard to grow food on a coral atoll, and local food supply is a massive issue for the 42,000 people who live on Tarawa, which measures just 40 km long and 300 m wide. Fishing is good (offshore at least), although the influx of foreign aid has meant that a lot of people no longer fish. In any case, the main lagoon is polluted to the extent that there is no inshore fishing or swimming possible.
This is pretty much the opposite of Southern Vanuatu. Staple foods are cheap imported products such as soft drinks, white rice, flour, sugar, tinned fish and instant noodles. We saw diabetes running at 60 per cent, the highest I have ever heard of. Out of hundreds of people that I measured, I think only one or two were not obese. There is a road that runs the length of the island and everyone rides in a car or minibus. Habitual walking and manual work have decreased.
The net result in Tarawa is paradise lost. Rubbish everywhere, NCDs out of control, with no solutions in sight. I measured the blood-sugar levels of everyone in my local health team. They all had diabetes. Fasting blood glucose was over 10 mmol/L for everyone. Remember normal is under 5.
The physiotherapy department at the hospital only deals with amputees from diabetes complications. That’s running between 5 and 15 a month.
Two islands in the beautiful Pacific. One on real food and a traditional lifestyle, the other on the cheapest energy available: processed carbohydrates. If you ever wanted evidence that processed carbohydrates damage humans, you should go to Kiribati and have a look for yourself.
Here we have the perverse and real situation that there are obese adults and undernourished kids in the same family. That’s what you get on a high simple carb diet. Its wrong and it’s not the fault of these guys. what do you think is happening here? Are the parents eating all the food and starving the kids? Of course not. It’s metabolic dysfunction from the carbs running riot.
I wrote this post because it was a turning point for me in understanding that it was nothing to do with calories in and calories out. It is metabolic and hormonal control. It’s fairly clear to me.
More pictures to give you a flavour of what we saw in the “Happiest place in the world”. The only dodgy thing in these places are the toilets, especially at night.
Sunset on Aniwa in Southern Vanuatu
The island’s health committee shows off their health monitoring techniques
Sunday village lunch after church at Futuna Island. Health checks conducted after service but before lunch. Real food is all you can get here!
I wanted to have a caption saying “Grant Schofield picking up a chick!”
No caption needed
A day’s physical activity on the island
Where else in the world can you walk up to the edge of an active volcano and breathe in poisonous gases. dodge flying lava, and all this with no health and safety regulations?! Tana Island
This was, no kidding, someone’s carry on baggage on a local flight! You slip your fingers under the gills to hold it as you walk on.
Lean, strong, and healthy in Vanuatu
Grant Schofield has a chat to a village pig about the pig’s future. The pig listens carefully.
Thanks to everyone who has started following this blog. Frankly, while I find this stuff interesting and important, I had no idea that it was shared by so many other people. An academic’s real-life exposure to social media is an eye opener and fun. 3000 hits in a little over a week!
So the main question I have had from people so far is “what do you eat?” and “what about kids?” I think I can talk about both of those, in this and the next post. After all I am me, and I am the father of three boys.
I have been active and relatively fit my whole life, including a stint as a professional triathlete. One observation and my main excuse for not being a long lasting and super duper fast professional triathlete, was that I could never get my weight under 85-86 kg. In fact, when I did my fastest time in Ironman NZ 2001, I was officially entered in the heavy weight “clydesdale” division, where I was 94 kg at weigh in. To be fair, that was at the conclusion of the pre-race pasta party. My time of 9:04 was (I claimed at least), at the time, a clydesdale world record. I’m not sure there is such a record but it gave me mileage at the time – “world’s fastest fat guy over the Ironman triathlon distance”.
What bugged me though was why I couldn’t get fully race lean. I was eating low fat, high carb. It was exactly what the experts said I should do. I could hardly exercise any more. I was training up to 25 hours a week! In fact, I noticed the same thing when I watched the Ironman in Taupo New Zealand this year. Roughly one third of the field is overweight or obese in my judgement. How can they stay fat doing so much exercise? Maybe they are LESS fat than when they started? Or maybe their high carb diet and chronically raised insulin fails to allow fat burning?
Anyway, post triathlon retirement and children arriving I was up over 102 kg. I was still exercising everyday, eating “healthily” and still fatter than ever and it was getting out of control. Why was I always hungry? Why did my energy always “fall of a cliff” after lunch? I was trying really hard to NOT be a fat bastard. You can imagine, I do physical activity, nutrition, and obesity research. You lose street cred when you are fat.
My Solution: Take up marathon running and starve myself. This method got the weight off. It also made me sick and injured. I was especially prone to colds and flu with several every year. I hate flu.
I finally got consistently injured enough to flag the running and take up age group triathlon again. Same results: weight creeping, always creeping. When it crept past an acceptable point, I’d starve myself and exercise like crazy. I’d get sick.
Surely there has to be a better way? Enter, LCHF.
Now: I’m down to my lightest weight since mid-high school. 79 kg, lean, full of energy, and all the injury and illness has gone. I’m eating until full, as much as I like. It’s Awesome. I wouldn’t have believed this was possible. But it is.
I started reading all the literature and science in nutrition, which has been part of my broader field for a while. I have read enough now and experienced enough case work to change my starting hypothesis.
That’s partly why this blog is here. That’s why I have changed my research and practice direction in physical activity, nutrition and obesity, as well as the broader area of well being. I am now up with the science and we need to do it better.
So what do I eat?
I don’t always eat three meals a day now. I often try intermittent fasting which usually isn’t planned but happens naturally* according to hunger, food availability, work pressures and convenience. For this to be possible is a revelation to me. I have spent almost all of my life being pretty much hungry the whole time. If I didn’t eat every few hours I would fall off a glucose cliff and basically become 50% functional. This is hardly convenient and hardly optimal for a high performance life. My new way of eating also allows me to easily create calorie deficits to manage my weight if I feel I need to.
*The fact that I can quite often end up fasting accidentally for relatively long periods, while staying mentally sharp and full of physical energy, is an amazement to me. I’ve spent my whole life doing exactly the opposite. It’s sort of like the “user manual” for being me has been found. I am fat adapted and can oxidize fat as a primary fuel source. I can use ketones as a fuel for my brain. I don’t fall off the glucose “cliff” every few hours. This is a great place to be in. It also means you lose the cravings for the sweet food, especially sugar. This is the main benefit most people I know who have moved into this style of eating report. The constant energy and loss of ridiculous hunger every few hours.
I also have the occasional off day or meal when I just do whatever I feel like. We are all human after all. I used to plan these for a while and really looked forward to them. Frankly, now, I can do this if I want but I feel so crappy after eating simple carbs, especially wheat products, that I just don’t bother much. Again, this is a revelation as my self control in the face of high sugar high carb foods in the past has been completely non-existent!
Here are some typical meals for me:
- Scrambled eggs with whipping cream and streaky farm bacon from the butcher fried in coconut oil
- Smoothie made with coconut cream or milk, whipping cream, coco powder and or fresh berries
- Salmon, avocado and tomato
- Omelette with cheese and veggies (meat added when I feel like it).
- Massive salad with lettuce, tomato, capsicum, cucumber, cheese, meat of some sort – fish, chicken, bacon whatever is around, avocado, almonds. Mix up and add copious amounts of dressing which is home made olive oil and vinegar or mayo. The dressings have to be made by you, because almost all commercial dressings use hydrogenated vegetable fats – yuck – and are often high in sugar
- That’s my “go-to” lunch above. I lack imagination for lunch according to my family, but that’s the way it goes! I do have eggs and smoothies for lunch sometimes or something from the dinner/lunch list below.
- Some sort of meat or fish. Heaps of veggies (green and red veggies as a rule, cauliflower is also good, avoid starchy ones). I like pork with crackling. This is the time to really appreciate the flavors of fat.
- Wine, although I am trying an alcohol free month right now because it was getting out of hand!
- Berries and cream for dessert
- Low carb cheese cake is a favorite
Other tips and traps
- Don’t trim fat. Healthy fats are monounsaturated olive and other nut oils, Omega 3 fish oils, and healthy meat fats (unprocessed red and white meats including beef pork, fish and chicken), as well as dairy fats. Coconut oil is great. Avoid hydrogenated and polyunsaturated fats, especially in cooking.
- Just to reiterate, you have to replace carb and protein calories with something. The only macronutrient left is fat. Our ancestors likely coveted fat. Fat, at least as far as insulin and leptin goes, is metabolically benign. Carbs are not, especially when they are rapidly absorbed.
- Coffee is OK, I use whipping cream not milk. I tend to avoid dairy except cheese of all sorts (yum!) and cream. Milk can be high in lactose (a carbohydrate). Those who are more carbohydrate tolerant (have an ability to eat carbs without weight gain) can go for full fat milk and a fuller range of dairy. Most kids are in this category.
- Alcohol is a tricky question. Alcohol is certainly not metabolically benign. I recommend abstinence during the adaptation period into LCHF. Have a look at this link to explore more about keto/low carb adaptation. Then what you want is a low carb drink if you enjoy alcohol. I certainly don’t drink alcohol for physical health reasons but I do drink it for social and marital health reasons! My wife Louise and I spend lots of time sitting on our deck drinking wine and talking. Great fun! The active alcohol is called ethanol and is processed in the liver without much effect on insulin, at least not directly. It in fact follows a similar and dangerous path to the liver and beyond. It’s metabolically active in an inflammatory and insulin resistance-promoting kind of way. However, that said, we all have our vices, the actual insulin raising carbs in a glass of wine are between 3 and 6 g, depending on the wine and the size of glass (we have big glasses in our house!) so a glass or two is fine. Beers have way more carbs (12-20 g) per bottle and contain wheat that may result in other metabolic effects for some people. You can get low carb beers of course. I don’t really care for spirits, as a result of bad youth experiences I think, but if you do use them then it’s crucial to leave out the sugar based mixers.
That’s my wrap. I’m not perfect and as a normal human fall off the wagon too. I’m on the 18/21 plan. If there are 21 meals in a week, try for at least 18 good ones, hopefully better. Let me know your favorite meals and we can post them up.
OK here it is for real at last. We’ve been talking about it for a long time long. The whole airline business comes down to dollars and sense. It’s competitive, and every extra kilo costs extra fuel and aircraft wear and maintenance. Business is business, someone has to pay, and it really comes down to the customer in the end. If you are fat, you should pay more. You’ve eaten too much and moved too little. You gluttonous sloth, you should have tried harder.
Samoa Air now charges by the kilo. You’re an undernourished kid, cool – its very cheap. You’re an obese adult with a bit of luggage. Get you credit card ready. Hopefully it won’t be declined. Hopefully you haven’t put on any weight when they check/weigh you in.
On first pass, as a lean member of society, I agree with Samoa Air. I want to pay less because I weigh less. Why should I subsidise some 200 kg super beast?
And, Samoan Air isn’t really the first to do this. The reality for many morbidly obese people is that there is no way they can travel on a conventional commercial aircraft in a single seat. They end up having to pay double to fit themselves in. It’s simple physics right? No way to fit an incompressible mass into the volume of that seat.
OK, so what this really comes down to is what I want to spend the next few blogs and more on. What is obesity? Why does it happen? Why has it spiraled out of control everywhere? Who should be responsible for fixing this problem? How do we fix it? Is it even possible to fix it?
Back to Samoa Air. Their CEO describes it as a positive health promotion strategy. “This is the fairest way of travelling,” he told ABC Radio. “There are no extra fees in terms of excess baggage or anything – it is just a kilo is a kilo.
“When you get into the Pacific standard weight is substantially higher [than in south-east Asia] but it can be quite diverse. People generally are becoming much more weight conscious. That’s a health issue in some areas. It has raised the awareness of weight.”
Really? A health promotion strategy? Seriously? If only they knew that weight was an issue then they’d be thinner? I doubt there is anyone who wakes up and wants to remain obese. Has anyone seriously ever woken up and said to themselves “today is another day to get fat, bring it on!”
The debate centers on whether people are fat because they eat too much and move to little. This is conventional obesity wisdom, that a calorie is a calorie, and the only way to become obese is to eat too much. By definition, you cannot defeat the laws of thermodynamics. Therefore obesity is caused by gluttony and sloth. The cure therefore is obvious, raise awareness, tell people to get off their arse (move more) and eat less. Problem solved.
This is what drives most of public health effort around obesity, as well as the commercial and ethical response.
Except, we’ve already thought of that in public health, and it doesn’t work.
It doesn’t work, because it’s wrong. Straight wrong. The real problem is more complex and deserves your attention. It deserves your attention because no matter how lean you are, you too will at some point in your life have trouble controlling your weight. You will almost certainly have your life affected because others close to you struggle with their weight and the chronic disease being obese brings with it.
Let’s put out the alternative hypothesis. Obesity is a disease of excess fat accumulation. It’s a metabolic disorder, or at least metabolic dysfunction. Sure, gluttony and sloth are there. But they are symptoms, not causes. This metabolic dysfunction is caused by hormones. Those hormones are complex, but primarily relate to insulin and leptin.
Put simply, when insulin is raised by excessive loads of simple, refined carbohydrates you turn off fat burning and promote fat storage. Insulin blocks leptin – the off switch in the brain. Insulin down-regulates dopamine, the pleasure neurotransmitter in another part of the brain. You think you are starving, you crave more, and you move less. Gluttony and sloth symptoms, not causes. All extra energy is stored as fat. You can’t burn fat. You feel lethargic and tired. Your body goes into storage mode. It’s a great mode if you are harvesting late summer and have a winter or famine to survive.
We are coming back to this mechanism in way more detail in later blogs, don’t fret!
So here’s my bottom line. Obesity isn’t the fault of the individual. It’s the fault of the food supply. It’s the fault of bogus dietary guidelines that promote low fat, high carb diets. It’s the fault of society as a whole and we need to deal with it with science that hits the mark.
Science to date in nutrition hasn’t hit the mark. More to come on that too.
So that’s the debate. How do we deal with obesity? Samoa, one of the fattest countries in the world has started by putting some of the burden on the victims, not the perpetrators.
Am I right? What do others think? Here’s a reaction from a good friend of mine today. He’s very well educated and a great thinker.
MC “I am not so sure there is anything weird in this. Now days, user pays underlies almost every aspect of our lives – and certainly every aspect of discretionary private spending (with limited exceptions such as where it is economically rational for a company to charge customers on the basis of a cross-subsidisation methodology). With any air transport, weight is everything – the more something weighs, the more fuel gets burnt, the more it costs. We accept that in the context of cargo. Why not people? Because it is “unfair”? Really? Airlines work out fares based on average weight. Any given passenger is either above the line or below it. If you are below it, you are subsidising those who are above it; if above it, you are being subsidised. It makes no sense to say that big people are being punished or treated unfairly if they are charged a fare that reflects the greater cost to the airline to transport them. What is unfair is that those passengers who are below the line have to pay more to travel than they otherwise would have to because there are fat people who also want to travel.”
From the NZ Herald
“Absolutely, but as long as you get the equivalent seating space to go with the cost. You pay more, you get more.”
“Being attacked by an obesity expert and community leaders as insensitive and lame……
if people want to use those word’s ‘insensitive and lame’ they are just enabling obese people to think that being overweight is ok, and it’s not, it’s unhealthy… it’s nothing else but just plain unhealthy.
You go Samoa airlines you rock. It is a good thing to pay by weight….. you have to if you are posting a parcel don’t you? BTW I am a few kilos overweight.”
I had trouble finding anyone except the “lame obesity experts” sticking up for the fatties. Look, obesity is a massive issue (pun intended). It’s something we haven’t been able to sort. The science is becoming increasingly obvious, but the practice of helping people isn’t doing the business. It’s time for a new approach. Let’s see what actually works.
Stay with the blog and we’ll find some solutions that help us be the best we can be.
This is a great TED talk by presentation guru Nancy Duarte. Her ideas about speaking are what you get given when you are invited to do a TED talk. It’s a really powerful and simple analysis of great speeches in history including Martin Luther King’s I have a dream speech and Steve Job’s IPhone launch speech in 2007.
Great communication is of course essential to changing the world. It is essential to any good idea. Without great communication, great ideas are lost. Mediocre ideas can flourish because of great communication. That’s such a shame on both counts. The good news is that this is totally learnable. I did it myself in my TED talk which I’m pretty proud of.
The basic idea is that great speeches all have the same structure – a shape which describes how the world is, and then switches back to how it could be. It always ends with the “new bliss”. It pulls the audience between what is and what could be – the powerful idea you have of “the new bliss”.
Enjoy the video.