A Swede, a Kitavan, a Tsimane, and an Inuit Walk into a Restaurant…

Four friends get together for dinner at a restaurant.

Swedish Man: It’s great to see you guys!

Inuit Man: Yeah, it’s great to see you guys! And I’m glad we’re here. I’m very hungry.

Swedish Man: I already know what I’m gonna get; I’ve been thinking about it all day.

Tsimane Man: Let me guess: Steak and asparagus with tons of butter?

Swedish Man: What do you mean? Like low-carb or something?

Tsimane Man: Yeah, I know there was a big initiative in your country to get people to cut carbs. I thought all Swedes were low-carb.

Inuit Man: Seriously, we get together once a month, and we’re talking about Swedish government initiatives to cut carbohydrate intake.

Swedish Man (smiling): Yeah, bro, until you have something better to talk about. I won’t be holding my breath.

Tsimane Man: Ignore him. It’s true, right?

Swedish Man: Not exactly, but I know what you’re referring to. In 1985, there was a massive government initiative to get people to eat less fat and more carbohydrate. The recommendations were widely adopted. Then, starting in 2003 and lasting for several years, there was a widespread, equally successful (widely adopted) media campaign to get people to eat less carbohydrate and more fat. (1)

Tsimane Man: Got it.

Swedish Man: From 1986 to 2010, a group of researchers followed a bunch of us Swedes. I volunteered. There were more than 140,000 of us. For 25 years, they measured our food intake and a whole bunch of wellness outcomes. (1)

Kitavan Man: So, they followed you all during a period when cutting fat was popular and during a period when cutting carbohydrate was popular, right?

Swedish Man: That’s right. We’re talking about one of the largest and longest scientific studies of food intake and wellness ever conducted. (1)

Tsimane Man: What did they find?

Swedish Man: Over the 25 years the subjects were followed, they, um, we kept gaining weight. First, we went low-fat, then we went low-carb, and we kept gaining weight the whole way through. (1)

Inuit Man: What else happened?

Swedish Man: Of course, we can’t claim causation from a scientific study like this. All of the weight gain, we can’t say it was caused by the way the subjects ate. All we can say is that we gained weight during both the low-fat period and the low-carb period. Another interesting correlation occurred—with blood-cholesterol levels. There was a sharp bettering from 1986 through 2004. Then, they stayed about the same for a few years. And in 2007, there was a sharp worsening. Again, we can’t claim causation, but when the low-carb movement really took hold, blood-cholesterol levels got a lot worse. (1)

Tsimane Man: So that’s why you’re not low-carb?

Swedish Man (shaking his head): I’m not low-carb. I’m not low-fat. 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 silly games anymore. I just eat real food. No weird exclusion of entire food groups required.

[The server comes to the table.]

Server: It’s great to have you all back. Are you ready to 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. 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 fruit, all different kinds of tubers that are kind of like the sweet potatoes here, a lot of fish, and coconuts. (2,3,4)

Swedish Man: That sounds good!

Kitavan Man:  Oh, yeah! Island food is good! I’d love for you guys to come with me on my next trip.

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 came 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? Type-2 diabetes. Cardiovascular disease. Barely a trace. It’s almost impossible to find type-2 diabetes or cardiovascular disease in a Kitavan. (2,3,4)

Swedish Man: That’s amazing!

Tsimane Man: Fruit and tubers are both very high in carbs. Almost all carbs. Your people aren’t low-carb.

Kitavan Man: No, not at all. We eat a of fruit! And a lot of tubers! (2,3,4)

Tsimane Man: I never knew this about your people. What’s crazy is that a bunch of researchers came to study my people too. I don’t mean to brag… (smiling widely) Let me brag: They found us to be the people with the lowest amount of type-2 diabetes and 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.

Tsimane Man: Me too.

Kitavan Man: I’m ready.

Inuit Man (smiling widely): Thank goodness!

Swedish Man: What do your people eat?

Tsimane Man: We eat corn, manioc, plantains, and rice that we grow. Fruit and nuts that we gather. And meat we get from hunting, including fishing. (5)

Swedish Man: Like Kitavans, it sounds like a lot of carbs.

Tsimane Man: 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 the whole low-carb craze here. Both Kitivans and the Tsimane have almost no cardiovascular disease or obesity (2,3,4,5), and you’re all mostly eating carbohydrate (2,3,4,5). Here, everyone is doing that crazy keto diet with no carbs at all, and we’re sick as f** here. Something doesn’t add up.

Tsimane Man: Yeah, in the scientific paper about my people, they made an interesting comparison: The average 80-year-old Tsimane 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!

Tsimane Man: Right? There are all of these fancy schools here and all of these people with advanced degrees trying to “figure out the optimal diet”. They’re like a bunch of dogs chasing their tails.

Kitavan Man: They fly over to study us. They witness with their own eyes how well we are. They poke and prod us in a million ways, and they find out that we don’t get sick like their people do. But then they don’t even trust their 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 your people eat?

Inuit Man: Okay, I’ll play; this has actually gotten very interesting. We have one of the most unique ways of eating on the planet. My people live in one of the coldest climates on Earth. We can’t cultivate any plants. 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 up and up and up. Until you reach the Arctic Ocean. That’s where I’m from. How do people say it here? Cold as f***!

[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 low-carb, keto, and all of that, 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 type-2 diabetes, cardiovascular disease, obesity, and all of that. (7)

Tsimane Man: So you guys are basically on the keto diet that everyone around here 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 a ton of fat, a moderate amount of protein, and almost no carbohydrate. (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 guys ready to have your minds 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 way of eating. 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 think. 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: I’m getting there. (reaching 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 crazy interesting!

Inuit Man: This is from an editorial written by three physicians in 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 at all. That’s absolutely amazing!

Tsimane Man: Amazing!

Inuit Man: Isn’t that something? This is from the researchers who conducted one of the scientific studies those physicians are referring to. 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. These important metabolic effects of CPT1A provide the basis of our hypothesis that the c.1436C>T mutation might have conferred a metabolic advantage for the Northeast Siberian populations in dealing with their traditional high-fat diet.”

Kitavan Man: All of the advocates of the keto diet, they’re making ketosis and the production of ketone bodies out to be some sort of holy grail…

Tsimane Man (finishing the thought of the Kitavan man): …But the only people on Earth who naturally eat almost no carbohydrate don’t actually produce ketone bodies? Their bodies have developed a way to avoid going into ketosis altogether.

Inuit Man: (emulating the shrug emoji) That’s what the science says, 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 trick and hack and outdo 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): One quick thing 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, low-carb, you know, that sort of thing?

Server: Oh, yeah! I see it all. If there’s a fad diet, I see people jumping on it. Management even continually changes the menu to keep up with the latest fads.

Swedish Man: What do you think about the keto diet and everyone avoiding carbs these days?

Server (surprised and thrilled to be taking a shot at this one): You wanna know what I think? I see a lot of people come into and out of this place every week. 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 education. Junk art. It’s a mess. (pauses, looks down, then looks back at the others) With everything I’ve seen and with everything going on in this country, do you want to know what I think is making people sick and fat in the United States?

Swedish Man: What?

Server: Not butternut squash.

(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, 10.1186/1475-2891-11-40.
(2) Low Serum Insulin in Traditional Pacific Islanders—The Kitava Study. Metabolism, 1999, 10.1016/s0026-0495(99)90258-5.
(3) Age Relations of Cardiovascular Risk Factors in a Traditional Melanesian Society: The Kitava Study. The American Journal of Clinical Nutrition, 1997, 10.1093/ajcn/66.4.845.
(4) Apparent Absence of Stroke and Ischaemic Heart Disease in a Traditional Melanesian Island: A Clinical Study in Kitava. Journal of Internal Medicine, 1993, 10.1111/j.1365-2796.1993.tb00986.x.
(5) Coronary Atherosclerosis in Indigenous South American Tsimane: A Cross-Sectional Cohort Study. The Lancet, 2017, 10.1016/S0140-6736(17)30752-3.
(6) A Selective Sweep on a Deleterious Mutation in CPT1A in Arctic Populations. The American Journal of Human Genetics, 2014, 10.1016/j.ajhg.2014.09.016.
(7) The Ketogenic Diet for Obesity and Diabetes—Enthusiasm Outpaces Evidence. JAMA Internal Medicine, 2019, 10.1001/jamainternmed.2019.2633.

About Jason Gootman
Jason Gootman is a Mayo Clinic Certified Wellness Coach and National Board Certified Health and Wellness Coach as well as a certified nutritionist and certified exercise physiologist. Jason helps people reverse and prevent type-2 diabetes, cardiovascular disease, and other ailments with evidence-based approaches to nutrition, exercise, stress reduction, holistic wellness, and most importantly, lasting behavior improvement and positive habit formation. As part of this work, Jason often helps people lose weight and keep it off, in part by helping them overcome the common challenges of yo-yo dieting and emotional eating. Jason helps people go from knowing what to do and having good intentions to consistently taking great care of themselves in ways that help them add years to their lives and life to their years.