This is a clinical study from 1989
In 1989 in an intervention study, a native pre-Western contact diet was consumed by a group of Native Hawaiians with risk factors for heart disease. The programme was called the Waianae Diet Programme. Twenty people ate this diet for 21 days.
Native pure Hawaiians have a rate of obesity second only to Pima Indians, and their lifespan is the shortest in the USA. They have the highest mortality rates in the country from cardiovascular disease, stroke, diabetes, and cancer as compared to all other ethnic groups.
Historical evidence suggests that prior to Western contact native Hawaiians had little cardiovascular disease or obesity. Historical accounts describe pre-European Hawaiians “The common people are… of thin rather than full habit”.
The traditional native diet was high in fibre, high in complex carbohydrates, high in polyunsaturated fatty acids, low in saturated fats, and low in fat. It was estimated to contain, by calories, < 10% fat, 12 – 15 % protein, and 75 – 78% carbohydrate.
The study participants had obesity; average weight 120 kg and BMI 39.6.
The participants could eat as much as they wanted (ad-libitum) of foods that were only available before Western contact. Foods eaten included: taro, poi (a mashed form of taro) sweet potato, yams, breadfruit, seaweed, greens (fern shoots and leaves of taro, sweet potato, and yams), fruit, fish, and chicken. Foods were eaten raw or cooked similar to a traditional manner, i.e. steamed. Food was prepared for the participants. Fish and chicken were limited to 142 – 198 g/ day, fruit and vegetables were unlimited, and fat < 10% calories. Macronutrient ratios approximated native Hawaiian diets. Participants were encouraged to eat to satiety.
Gathering taro and taro leaves in Hawaii (source)
The traditional method of pounding Taro into poi (source)
Results:
Energy intake decreased by 41%, despite never being hungry, and reporting high levels of satiety.
One reason the participants could eat to satiety, yet decrease energy (calorie) intake this much, is because the traditional diet is a low-energy-dense diet. The energy density is 0.83 calories per gram, or 3.5kJ/g. Food volume actually increased from 1711g/ d to 1872 g/d.
It is also pertinent to note that carbohydrates decreased slightly, and fat decreased significantly. Ultra-processed foods are removed when one switches to ancestral diets. Ultra-processed foods are mainly comprised of highly refined carbohydrates (starches and sugar) and fat (typically highly refined seed oils and saturated fats). These foods are extremely energy dense and low in nutrients and fibre.
Weight loss: average of 7.8kg (range 2 – 15kg), and most cardiometabolic risk factors improved significantly as shown below:
Adherence to the diet was excellent in sharp contrast to other diet studies in this population; the reason suggested is that there was a high level of cultural pride and that the diet was culturally appropriate for this group.
Following this initial group, a further 120 people went through the 3-week programme. Their results were consistent with the first group:
Diabetes, blood sugar consistently improved. One participant who had been on 80 units of insulin no longer required any after 5 days, 2 others on 60 units day no longer required it after 3 weeks.
Fasting glucose: A large and consistent decrease.
Serum lipids: Total cholesterol decrease of 14%, and a reduction in total cholesterol/ LDL ratio. A significant reduction in triglycerides.
Blood pressure: both systolic (-7.8%) and diastolic (-11.5%) fell significantly.
Other health conditions also improved: Individuals reported improvement in arthritis, asthma, gastritis, fatigue, acne, headaches, and impotence.
Two participants with systemic lupus erythematosus (SLE) improved markedly
Note: The Waianae diet is a similar protocol as an autoimmune paleo (AIP) diet which excludes: eggs, nuts, seeds, dairy, nightshades, legumes and grains
Case 1: 38year old Japanese female
Symptoms:
- Fevers,
- weight loss,
- joint pain and polyarticular synovitis in the metacarpophalangeal joints and ankles
Diagnostic tests:
- Antinuclear ANA antibody titre of 1:80 with a speckled pattern,
- Erythrocyte sedimentation rate (ESR) of 53 mm/hr. (normal <20mm/h)
- Antibodies to ribonucleoprotein and SSA
Treatment:
- Prednisone, indomethacin for fevers, and then hydroxychloroquine.
Two years after diagnosis she went on the Hawaiian diet. Response to diet;
- ESR dropped from 70-90mm/hr to 39mm/hr.
- Elevated platelets normalised.
- She reported increased energy and was able to discontinue indomethacin and had no recurrence of fevers.
- Synovitis disappeared.
Normal diet was resumed after 3 months – the response:
- Within a month fatigue, rashes, fevers, and joint pain recurred.
Case 2: 44 year old female, mixed Hawaiian and European, presented with:
- Synovitis in the metacarpophalangeal and proximal interphalangeal joints
Diagnostic tests:
- ANA titre 1:126
- Antibody to DNA 217IU/ml (normal < 100IU/ml)
Treatment:
- Prednisone, hydroxychloroquine, ketophrofen, methotrexate
Response to Waianai diet, started 2 years after diagnosis:
- Within 2 months patient discontinued prednisone
- One month later she discontinued methotrexate
- The patient is free of pain and synovitis
The diet was discontinued and within one month pain and synovitis returned, and prednisone and methotrexate had to be restarted.
My view on this study
This study shows that a paleo or ancestral diet template works even if it is high in carbohydrates. This is likely to be a result of a number of factors:
- reducing overall calories, by changing energy dense foods for low energy density foods
- increasing the nutrient density of the diet,
- reducing the glycemic load by changing the type of carbohydrate consumed
- reducing the fat content (reduces harmful fats and excess calories)
- removing grains, sugars, unhealthy fats, and the numerous additives contained in a typical Western diet (ultra-processed food)
- changing the carbohydrate type from free starch found in grains (acellular) to starch contained in cells (cellular). Cellular starch has a different effect on gut microbiota to acellular starch. Dr Ian Spreadbury has written an excellent paper on this subject.
This diet challenges the belief that we need to eat a low carbohydrate paleo diet to reverse metabolic syndrome and lose weight. It may be (and other studies back this up) that simply eating cellular (starchy vegetables) in the place of refined grains and sugars, removing ultra-processed foods, and reducing energy density and therefore overall calories is what is needed to get results.
For those interested Dr Ian Spreadbury is spoke at the Ancestral Health Symposium in New Zealand October 2015
References:
Danao-Camara, T. C., & Shintani, T. T. (1999). The dietary treatment of inflammatory arthritis: case reports and review of the literature. Hawaii medical journal, 58(5), 126-131.
Shintani TT, Beckham S, Brown AC, O’Connor HK The Hawaii Diet: ad libitum high carbohydrate, low fat multi-cultural diet for the reduction of chronic disease risk factors: obesity, hypertension, hypercholesterolemia, and hyperglycemia. Hawaii Med J. 2001 Mar;60(3):69-73.
Shintani, T., Beckham, S., O’Connor, H. K., Hughes, C., & Sato, A. (1994). The Waianae Diet Program: a culturally sensitive, community-based obesity and clinical intervention program for the Native Hawaiian population. Hawaii medical journal, 53(5), 136-147.
Shintani, T., Beckham, S., Tang, J., O’Connor, H. K., & Hughes, C. (1999). Waianae Diet Program: long-term follow-up. Hawaii medical journal, 58(5), 117-122.
Shintani, T. T., Hughes, C. K., Beckham, S., & O’Connor, H. K. (1991). Obesity and cardiovascular risk intervention through the ad libitum feeding of traditional Hawaiian diet. The American journal of clinical nutrition, 53(6 Suppl), 1647S-1651S.
Further articles on this study
This intervention is essentially the McDougall plan (high starch, low fat) with a bit of fish and chicken added to the mix.
The Waianae diet came before McDougall. This is a high plant paleo diet. Paleo does not mean no starch, it means no modern food junk, just like this.
Indeed. McDougall based his “solution” on the diets of traditional Hawaiian eating patterns, but twisted it to be vegan.
A paleo diet seems to mean whatever the the person touting is wants it to mean, and paleo branded junk food is also modern. These are just my observation after reading a variety of paleo sites.
I don’t think talking about all PUFA together is informative enough.
As I see it the diet was a low omega-6 diet. Omega-6 excess is implicated in liver insulin resistance as commented by George Henderson. Dr. Kempner’s diet (precursor of Dr. McDougall’s one; via Denise Minger) included white rice and sugar but it was low in omega-6 too.
As I see it only either omega-6 excess or perhaps trans fatty acid presence (The government provided the Pima with subsidized “food”: white flour, sugar, partially hydrogenated lard, and canned goods, my bolds) is the common factor of every diet causing insulin resistance and diabesity from Pima to Hawaiian, including Maori. Not that you can’t gain weight without them if you endure the nausea as in the Massas’ case
Very high potassium content is the characteristics of these “paleo” carbs, and the diet above is very low in phosphorus and extremely high in potassium (probably 5000-10000 mg). In other words extremely alkaline.
An easy way of getting digestive problems (and all the other problems that follows from it, such as inflammation, weight gain, edema etc, even auto-immune diseases) is to ingest a lot of phosphorus rich foods, and stay away from the potassium rich ones.
Cheese for example is absent in potassium but high in phosphorus, while milk/yogurt has both. Meat is relatively high in phosphorus, but still low compared to whole grains. Eggs are also high in phosphorus. These foods would typically be constipating and cause a lot of gas if eaten in excess. Adding in whole grains and nuts may have a somewhat laxative effect, as the fiber will force out the content of the intestine quicker, but it will alternate with constipation, so it´s irritable bowel syndrome.
If we want to ingest grains, we should do as the Japanese or Italians: only eat refined grains, and combine them with plenty of vegetables. Then the overall composition will mimic that of fruits and root vegetables.
If we want to eat beans, we should reduce meat, egg and cheese consumption, and assure plenty of fruits and vegetables in the diet. Then the beans will not cause any gas and be an issue. Even a diet high in whole grains and beans may be okay if balanced with very large quantities of fruits and vegetables and with reduced intake of meat, cheese and eggs.
The article conjectured, “It may be (and other studies back this up) that simply eating cellular (starchy vegetables) in the place of refined grains and sugars will be what is needed to get results.”
It may just as well be the regular consumption of a fixed amount of good quality protein each day – as per the zone diet.
Their protein was actually quite low by Zone diet standards, I’d say it was more to do with removing grains and sugar and the high amount of fats