Comparison with ancestral diets suggests dense acellular carbohydrates promote an inflammatory microbiota, and may be the primary dietary cause of leptin resistance and obesity

Figures & data

Table 1 Nutrition transition overview: obesity and “Western foods”

People	Diet	Macronutrient summary	Acellular foods or grains	Overweight or obesity	Other health markers	Reference
Kitava 1990s	Starchy root vegetables, fruit, some fish and meat, coconuts. Food abundance	~65% carbohydrate, high fibre, 17% saturated fat	−	0% overweight	No stroke, diabetes or heart disease. No increase in weight or blood pressure in middle age	^Citation3,Citation4,Citation6^–^Citation9
Machiguenga 1982	Mostly root vegetables, fruit and nuts, very small amount of meat and fish. Food abundance	High carbohydrate, high fibre	−	None reported	Healthy teeth and gums, good general health, except for parasites and infections	^Citation22
Masai 1971	Cow’s milk and blood, meat	66% fat, similar cholesterol intake to US	−	Lean	Atherosclerosis rare at autopsy	^Citation16
Kavirondo Kenyans 1929	Mostly meat	High protein, high fat	−	Lean	Aortic atheroma at autopsy rarer than in Westerners. No increase in blood pressure through middle age	^Citation20
!Kung 1972	~70% plant matter (mongongo nuts, fruits, roots, bulbs, leaves), some meat	Mongongo nuts: ~60% fat, 25% protein	−	Lean	No increase in blood pressure through middle age	^Citation29
Solomon Islanders 1974	Root vegetables, fruit, fish, limited meat, tinned fish	Varied	−/+	Lean (Western-influenced islands were heavier)	No hypertension or cardiovascular disease. Islands with Western influence showed increased blood pressure	^Citation26
Turkana 1980–83	Mostly milk, blood, meat, but by 1983 also some traded sorghum, maize, millet, and sugar	High protein, high fat	+	Lean (<5th percentile of Western weight)	No increase in weight in middle age	^Citation24,Citation25
Tarahumara 1978–79	90% from pinto beans and maize tortilla. Remainder from squash and other vegetables	High carbohydrate, high fibre, fat 12%, animal sources 6%, refined sugar 1%	++	5% BMI > 26	No hypertension, no rise in blood pressure with age	^Citation17,Citation19
Mexican Pima 2006	Beans, wheat-flour tortillas, corn tortillas, and potatoes	62% carbohydrate, 25% fat, high fibre	+++	Males: 7% obese Females: 20% obese	7% diabetes incidence	^Citation27
Arizona Pima 1996–2006	Refined Western diet, including fried breakfasts, processed meats, hamburgers, pork chops, beans, white bread, flour tortillas, fried or baked dough, cereals, canned foods, fruit juices	49% carbohydrate, 15% protein, 34% fat, >10% saturated fat	++++	Males: 64% obese Females: 75% obese	>30% diabetes	^Citation27,Citation28

Note: −, −/+, +,++, +++ and ++++: Approximate contribution of acellular foods or grains to diet, ranked from ‘absent’ (−), to ‘major component of diet’ (++++).

Figure 1 The carbohydrate densities of ancestral foods are distinctly lower than those of the Westernized diet. (A) The carbohydrate density (excluding fiber) of a broad selection of foods, in descending order of carbohydrate density (data from USDA).¹¹² Modern foods (gray bars) are those that have undergone refinement or desiccation, or are derived from grains. “Ancestral” foods (white bars) are unprocessed whole-foods from the categories of meats, eggs, fish, nuts, fruits, tubers, and leafy vegetables. (B) Carbohydrate density and caloric density of modern and ancestral foods. Some ancestral foods have caloric densities as high as modern foods, notably meats and nuts. (C) Carbohydrate density and glycemic index of modern and ancestral foods. Once again, there is no distinction between the two categories of food, and no correlation between the density of a carbohydrate and the nature of the blood glucose response it will elicit.

Figure 2 Schematic of the hypothesis.

Notes: The acellular dense carbohydrates of modern foods are proposed to produce an inflammatory microbiota from the mouth onwards, initially producing periodontal disease. The small bowel is exposed to lipopolysaccharide (LPS) and other pathogen-associated molecular patterns (PAMPs) from the oral microbiota, and proinflammatory modulation of its own small populations of bacteria by concentrated acellular carbohydrates. With systemic absorption enhanced by dietary fat, the inflammatory bacterial compounds induce leptin resistance and hyperphagia. The contents of the gray box represent the existing understanding of the effects of diet-induced obesity on energy homeostasis.
Abbreviations: CCK, cholecystokinin; PPY, peptide YY; CART, cocaine and amphetamine related transcript; CB1, cannabinoid receptor type 1; MCH, melanin concentrating hormone.

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