Beware the confirmation bias


Recently, while alone and unsupervised, I allowed myself to be goaded into an ill-advised Twitter debate. With someone who calls himself Ducks Dodger, no less. (For those of you who didn’t see it, you can go to my Twitter account, scroll back to April 8-9 and check out this tar baby I got caught up in.)

I soon realized the entire affair was an exercise in futility, so extracted myself from it. It was an exercise in futility because it was a blatant case of the confirmation bias writ large. But my aggravation hasn’t gone to waste because I’ve been waiting for an excuse to write a little essay on the confirmation bias that plagues us all. Who knew fate, in the guise of Ducks Dodger, would give me the prod I needed.

Taktu Cleaning Seal

Taktu cleaning fat from seal skin with an ulu
Cape Dorset (Kinngait), Nunavut, Canada,  August, 1960

In a bit, I’ll describe the details of this Twitter fiasco and how the confirmation bias reared its head. But first, let’s look at provoker-in-chief of the confirmation bias: cognitive dissonance.

Cognitive dissonance

Cognitive dissonance is the uncomfortable feeling we all get when trying to hold two opposing or clashing ideas in our brains at the same time.

For example, let’s say there exists a politician you hold in great esteem. You’ve actually met him, and he’s a warm, friendly charismatic guy, who embodies everything you and your party hold dear. Then a credible news report surfaces, fingering the guy as a pedophile.

If this accusation were made against a much-despised politician from the other party, you would have no trouble swallowing it whole. But since it is against your guy, you refuse to believe it. Even as more evidence stacks up, you just can’t bring yourself believe this wonderful person could do such a thing. The uncomfortable feeling you are experiencing is cognitive dissonance. You cannot hold the idea of this warm wonderful guy who exemplifies your beliefs dandling little boys.

The example above is a bit over the top, but similar, though less extreme, events happen constantly in politics and elsewhere. It is illuminating to see how they are dealt with. How those in power use the resolution of cognitive dissonance to get out of a jam.

Politicians seem to be incapable of staying out of trouble. Of course, they live under the magnifying glasses focused on them by the press and the opposing party, so there is little room for error. When one does screw up, a little drama unfolds that always follows the same script.

A news report pops up pointing out a political snafu. The opposing party and its news organs make hay. The offending party is rattled, confused, and lies low until it gets a few plausible talking points put together either denying or minimizing guilt. In rare cases – John Edwards’ impregnating his mistress while his wife, dying of breast cancer, was campaigning at his side springs to mind – the party will sacrifice one of its own. But most of the time, the creation of talking points is the common course of action.

The press and other politicians, of course, all see through this smoke screen. But the smoke screen wasn’t created for them – it was created for us, the great unwashed masses of voters.

When we hear of one of our own screwing up, we instantly are overwhelmed with cognitive dissonance. It’s an uncomfortable feeling. We like this guy, he is in our party, yet it appears he did bad. How can we hold those opposing thoughts in our brains? We cannot, at least not without considerable discomfort.

But, we don’t have to endure for long because our leaders’ talking points come to our rescue. Our cognitive dissonance dissolves in the solvent of these soothing words. We don’t have to think.  Our man is blameless after all. Life is once again good.

Confirmation bias

The confirmation bias is what allows us to uncritically accept these soothing words as the truth. We’re being told what we want to hear. And, thus, we believe it blindly, willingly, because it confirms whatever we already believed.

To show how the confirmation bias is built brick by brick, let us turn to politics once again.

Assuming we come to politics a tabula rasa (a major assumption because most of us follow in our parents footsteps or openly rebel against our parents), we start at zero.

Imagine yourself at the very top of the pyramid of knowledge and belief. Right at the apex, there is no knowledge or belief. You are a political newborn, so to speak.

At the base of the pyramid, the knowledge level is deep and wide. On the right side of the base is where all the conservative ideals, knowledge, and insights lie. On the left side live the liberal ones.

When you start at the top, you get tipped down one side or another. Maybe it’s a column you read, or a talking head on TV, or a parent, teacher, or friend. Doesn’t really matter, but somehow you get tipped to one side or the other and start rolling down that side of the pyramid, gathering ideology as you go.

You establish your rudimentary political views, and, as you start rolling down, you read more, you engage in discussion, you watch cable channels that mirror your views, and you, in general, become more entrenched in your ideology. All the way down you continue to confirm your ever-growing bias. Once you have reached the bottom, you have marinated so long in your particular political sauce that you can’t possibly understand how anyone could not believe the same way you do. In fact, you are certain that anyone who doesn’t is a completely misguided idiot.

It never occurs to you that others may have tipped and rolled down the other side of the pyramid. They, too, have reached their side of the bottom and are completely infused with the righteousness of their own beliefs and cannot imagine how someone could be so stupid as to believe any differently.

What is even worse is that many of us who have rolled down our own side of the pyramid refuse to even read anything written by one who has rolled down the other side. You don’t want to learn anything that might throw you into cognitive dissonance, so you renounce it as trash, unworthy of your reading, and move on. We’ve all done this at some time or other.

We work hard never to let opposing views penetrate our consciousness in an effort to avoid the unpleasant sensation of cognitive dissonance. The confirmation bias is the tool we use.

Conservatives don’t watch MSNBC; liberals don’t watch Fox. We always subscribe to magazines and newsletters that reflect our own underlying views. We read blogs that confirm our biases. If we stumble on one that doesn’t, we often leave snide comments and never return. The wide variety of material available on the internet and cable TV today is, in my view, why politics is so vicious. Not all that long ago, most of us had access to a daily newspaper or two and three TV channels, all of which were moderately liberal. People could argue with one another and drift toward the extremes, but were almost invariably brought back toward the middle by the staid mainstream media. Now people can indulge their confirmation biases 24/7, which doubtless leads to more edging toward the fringes and less trust of those on the other side of the debate.

Whenever someone comments for the first time on this blog and has a website (which can be discerned by their name being hyperlinked), I will often click on to take a look. If the commenter turns out to be a liberal, his/her website will be crawling with countless links to other liberal blogs, newsletters, articles, etc. Same if a commenter is conservative. I never find a blog – of a political nature (save one, see below) – that has links to both conservative and liberal sources.

You can test your own confirmation bias by going to one of my favorite sites, (RCP), the blog mentioned above that does link to both liberal and conservative sites. Go to the site and read down the list of hyperlinked articles. Some days it’s a little more conservative than liberal, and other days it is just the opposite. But on any given day, the site serves up a pretty even mix.

As you let your eye run down the list, notice which ones you want to open and read versus the ones you want to avoid. If you are a liberal, you will doubtless be drawn to those articles that confirm your liberal bias, and you will avoid opening and reading the obviously conservative ones. Same thing if you are a conservative.

And, God forbid, if you are a liberal (or conservative) and you happen to click on a link you think will confirm your bias only to discover it does not; chances are you will call BS and back out of that turkey in a heartbeat.

As an exercise in exorcizing my own political confirmation bias, I several years ago made the commitment that if I went to RCP, I would read every article. Not pick and choose. It has been quite enlightening.

We should all do this, not just with politics but with everything. Many aspects of life plunge us into cognitive dissonance, and our good friend and enabler, the confirmation bias,  always stands ready to help us out of it. It takes real work to hold the confirmation bias at bay and think critically. Critical thinking efforts are difficult and do not always provide us with the answer we want or sometimes even the correct answer, but they are, as Freud said of women, “the best thing of their kind that we have.”

The confirmation bias is everywhere

Sadly, our tendency to succumb to the confirmation bias is not limited to politics. Even scientists are all too prone to fall victim.

I would say at least half, if not three fourths, of papers published in academic journals are exercises in employment of the confirmation bias. It’s even worse with non-academicians, bloggers and the like, who truly (if sometimes mistakenly) believe they are practicing good science and indulging in heavy duty critical thinking.

I want to use my recent Twitter dustup with Ducks Dodger as an example of what I mean.

Here is the set up.

A blog post appeared, crediting Ducks Dodger for most of the content, stating in no uncertain terms that the Inuit were not in ketosis, and so therefore the Inuit didn’t really eat a high-fat, low-carb, ketogenic diet.

The basis for this unequivocal pronouncement were three old papers published between 40 and 85 years ago. The authors of these papers had not been able to find measurable ketones in their Inuit subjects under normal conditions. After a day or two of fasting, however, ketones were present just as they are in most of the rest of us. This finding set the authors to speculating as to why a group of people who ate primarily fatty meats would not be in ketosis all the time, because it just didn’t make sense that they wouldn’t be throwing off ketones like crazy.

One proffered solution to this conundrum was that the glycogen in the meat providing the bulk of the Inuit diet was providing enough carbohydrate to prevent their going into ketosis. It was known then that glycogen (the storage form of glucose) was present in muscle, and it made sense that there might be enough glycogen therein to prevent ketone formation.

There is about 6 grams of glycogen per pound of meat, so if the Inuit consumed from five to eight pounds of meat per day, as the articles claimed they did, the 30 to 48 grams of glycogen could conceivably halt ketone production. Especially if there were a bit of plant or vegetable matter thrown into the mix. That was the speculation at any rate.

The fly in the ointment here, however, is that glycogen rapidly degrades into lactic acid upon death. So unless this meat came from living animals that were still breathing while being eaten – highly unlikely – there wasn’t any glycogen to be had.

Scientists working today use liquid nitrogen ( ?320F) to flash freeze the livers and muscles of sacrificed lab animals immediately after death in order to determine the glycogen content before it degrades. Scientists working 80 years ago didn’t have this option, nor, apparently, did they understand how quickly glycogen degrades.

Glycogen degrades to lactic acid post mortem

What happens is this: when an animal meets a sudden end, it doesn’t die all at once. It’s kind of like a modern car. You pull it into the garage and turn off the key, but the lights stay on, the fan keeps running, the windows can still go up and down for a bit. The car is dead in that it has no way to actually run, but parts of it are still alive.

If, God forbid, you were to be shot in the heart with a high-powered rifle, you would doubtless be dead. But, like the car in the garage, parts of you would live on for a while. The muscles in your legs, for example, wouldn’t know you were really dead, and they would keep on keeping on.

In order for muscles, even relaxing muscles, to survive they need to burn fuel. Burning fuel requires oxygen. If your heart isn’t pumping because a bullet went through it, the muscles in your legs get no oxygen. When no oxygen is available, muscles do what muscles do when they exercise intensely and can’t keep up with the oxygen demand: they switch to anaerobic metabolism and go after the stored glycogen.

Burning the glycogen anaerobically results in a buildup of lactic acid. When your muscles are exercising, the blood washes away the lactic acid, but even then, if you exercise intensely enough, the lactic acid build up outpaces the blood’s ability to carry it away, leading to lactic acidosis. Your exercising muscles begin to burn and if you don’t slack off and let the accumulated lactic acid get washed away, your muscles will begin to cramp.

Same thing happens when you are dead. Since there is no blood pumping oxygen to the muscles, they burn glycogen anaerobically, producing lactic acid, which accumulates. Ultimately, the glycogen is depleted, the tissues are acidic, and no more ATP is produced. No more ATP means no power to run the calcium pumps, the cells lose calcium and the muscles begin to contract, leading to the condition called rigor mortis.

The upshot of all this is that when animals die, the glycogen in their muscles quickly degrades to lactic acid. The only way this process can be halted is to immediately flash freeze the tissue with liquid nitrogen to halt the glycogen to lactic acid conversion. Since that happens mainly in the lab and in special flash freezing facilities, any meat you purchase at the store or from your local farmer or that you kill yourself will not contain any glycogen to speak of.

The glycogen to lactic acid conversion upon death is all really basic science, not in dispute by anyone.

Keto adaptation

Then along comes the Duck claiming the glycogen survives death and is really there, which, he believes, is why the Inuit, under normal circumstances, don’t have measurable ketones. They’re eating all this meat, which is full of glycogen. What he fails to understand is that the Inuit are keto-adapted. Their lifelong diet of high-fat meat has gotten their ketone-producing-and-consuming systems working in precisely controlled fashion. Like, dare I say it, a well-oiled machine.

The Inuit burn ketones as they make them, so it stands to reason that they might not have measurable ketones under normal circumstances. During the time these old studies were done, the non-Inuit, white-bread-eating, white man was the standard. Feed a non-keto-adapted bread eater the Inuit diet, and he goes into ketosis in no time. Researchers back then figured the Inuit should do the same thing, and when they didn’t – because of keto-adaptation, which was not understood at the time – these scientist thought it worthy of publishing.

I gently pointed this out via Twitter and generated a barrage of Tweets from the Duck, consisting primarily of a series of links to obscure documents showing there was indeed glycogen in meat. Especially meat that had been quickly frozen. There were anecdotes about fish, having been jerked from holes in the ice and exposed to air, freezing instantly. I responded that it didn’t matter how cold it was at the Arctic Circle, it wasn’t ?320F, which is about the temp of the liquid nitrogen required to freeze tissue quickly enough to preserve glycogen.

Stefánsson makes an appearance

I proposed a reading of some of the works of the arctic explorer Vilhjálmur Stefánsson, who had lived among the Inuit for years and knew their ways well. He had described their eating habits in many of his books and articles. This suggestion inspired another over-the-top post, with content credited to the Duck, describing Stefánsson as a charlatan, a humbug, and a poltroon, who couldn’t be trusted to get anything right. (Stefánsson was involved in a couple of controversial events – the loss of the Karluk and the Wrangle Island expedition, both of which resulted in the loss of life. If Stefansson had fault in these, it arose from his overestimating the skills of those others involved. He, himself, was an intrepid Arctic explorer, who was never daunted by cold, barrenness or distance. And, as far as I know, no one ever doubted his observational ability in terms of the ways of the Inuit.)

I responded with a link to Stefánsson’s obituary appearing on the front page of the New York Times on August 27, 1962, which, though it did make reference to the Wrangle Island fiasco, made no mention of any skullduggery on his part.

I was then accused of not using science to argue my point, but resorting to nonscientific articles in “news rags” to bolster my case. I pointed out there was no science involved in repeating accusations of Stefánsson’s alleged humbuggery, and all I was doing was noting the most prestigious newspaper of the time, a newspaper never afraid to state the bad along with the good in an obit, ran a front page obituary without any mention of these accusations, leading me to believe they were not widespread and in common knowledge. Everyone in the public eye has detractors – for example, Christopher Hitchens wrote an entire book damning Mother Teresa. Had Stef been the vile lying swine the Duck was making him out to be, I doubt the NY Times would have treated him so kindly.

After a little back and forth, I withdrew from the debate, because it was becoming a bit harsh. Twitter is kind of the internet Wild West today, and many less restrained Twitterers were jumping into the fray, and the attacks were becoming too ad hominem for me.

Soon, the Duck bailed out, too, but not without recasting his views in a long farewell comment.

I thought the whole thing had come to its end, when someone wrote a comment attacking the Duck for attacking me. Duck responded by fisking his tormentor’s comment.

Parts of a couple of paragraphs provide a perfect example of what I mean by the confirmation bias and is emblematic of the way most people argue a point today:

I hope you realize that Dr. Eades isn’t an expert in everything. I did a lot of research and simply showed Dr. Eades numerous studies that showed he was mistaken. I don’t see what the big deal is. [Italics mine]

I put a lot of research into this article, citing over a dozen scientific studies to support my case. When he outright dismissed the article, I continued to show him real world evidence on Twitter and scientific data that explained why he was mistaken. Dr. Eades never once showed any scientific evidence to refute anything I put forward. [Italics mine]

I am absolutely certain the Duck put a lot of time in on his research, but he went about it in the wrong way, and the confirmation bias jumped up and bit him in his tail feathers.

I know this to be true from one of his Twitter links. Take a look at this screen shot:

Freezing stops glycogen

If you look at this link purporting to be real science bolstering the Duck’s case, you’ll see the Google search terms he used to track down this article were “freezing” “stops” “glycogen.” He wasn’t making a serious scientific inquiry – he had already gone public with his theories, now he was simply looking for anything to confirm them. The sad thing is, in Googling those three words, Google presented Duck many pages of material, most of which confirmed the basic science view of the degradation of glucose to lactic acid immediately post mortem, before he ever got to the page pictured above  confirming his bias. Try it yourself. Google those three words and see what you find.

That’s not how science works. In real science, which is, sadly, not practiced all that often, researchers attempt to discredit their hypotheses, not confirm them. Only after repeated efforts to prove their own theories incorrect, do true scientists start to consider that they may be on to something.

Most researchers, however, are like the Duck. They come up with an hypothesis, then construct an experiment designed to confirm what they think they know. And they usually do.

But let me end this interminable post on a conciliatory note. Let us grant the Duck the glycogen he swears the Inuit get from eating their five to eight pounds of raw meat per day. There is about 6 grams of glycogen per pound of raw meat, so if you want to eat five pounds of raw meat per day to get your 30 grams of carbs, go for it. I still say it is a ketogenic diet, and I’ll bet good money that until you become keto-adapted, you can eat all the carbs you’ll find in your daily ration of five to eight pounds of raw meat and still turn your ketostix purple most of the time.

If only this were the kind of ‘high-carb’ diet most people followed, we would have a lot less disease and a lot fewer victims of obesity.

If you would like to read more about cognitive dissonance and the confirmation bias, I can recommend two excellent books.  Mistakes Were Made and When Good Thinking Goes Bad.  Both are excellent.


Photo Credit: BiblioArchives / LibraryArchives via Compfight cc

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228 thoughts on “Beware the confirmation bias

  1. I witnessed that exchange and it was kind of the final straw for me. Many a blog now I simply don’t read anymore, FTA included. Resistant starch is interesting, but one can only take so much. Unfortunately one after the other LC blogger is heading in that direction. Fat Head’s the latest it seems, judging by Tom Naughton’s comment:

    “[…] I’m moving towards more of a Perfect Health Diet. I didn’t have the high fasting glucose issue that Richard wrote about, didn’t have the dry eyes, cold hands or thyroid issues that some people report on VLC, but his posts [Tim Tatertot’s] about RS and gut health convinced me it’s important to feed those gut bugs … and I’d rather start before I develop a problem.”

    I’m well aware of my own confirmation bias, but I simply accept that as part of life. Can’t really get around it. I fully accept that I may be wrong, but really, some of us do fine on LC – unlike the claim on FTA that 100% of low carbers will develop autoimmune issues. C’mon, 100%, that’s nuts.

    • I began following FTA to learn more about resistant starch and ultimately ended up confused about the food choices Richard was making. He would post his blood glucose numbers after eating rice and other carbs while on resistant starch; he would get what I felt to be poor numbers while he seemed to think they were great.

      I posed the question why was he using resistant starch as a “get out of jail free” card for making what I would consider to be poor food choices. Why eat foods we probably shouldn’t be eating (for a variety of reasons) when the blood glucose advantage still wasn’t that great? His response was rude and not at all helpful – I haven’t been back to his site.

      But I have added resistant starch to my diet just to see what it does. Just because Richard is a jerk doesn’t necessarily mean resistant starch might not have benefits.

      • I agree. Not necessarily about Richard’s being a jerk but about the notion that there may be some benefit of resistant starch. I just don’t like to jump headfirst into stuff until it gets sorted out a little better. When I first went into medicine, I was an early adopter. I gave patients all the new drugs that came along. Until there were a few bad outcomes, which made me a lot more conservative in my approach and got me off the early-adopter bandwagon, at least where treating patients was concerned.

        For this reason, it takes a while and a lot of data before I jump ship and plunge into the latest new and exciting remedy.

        • If we could all adopt such type of thinking! However, I believe that our egos and the fact that we want to be right all the time is what fuels these debates, if we can call them like that.

          It’s kind of difficult to have a hypothesis and try to prove it wrong. I mean it’s difficult for most “researchers” since as you said, most of them try to find the right arguments to make their hypothesis stand tall.

          I recall that some friend said that’s easy to do research today:
          1. develop a hypothesis
          2. go to pubmed or google scholar and search for data to prove it right…

          Damn, when are we gonna learn to think critically?

        • Well, anyone who has made too many potatoes or too much rice for dinner and eats it the next day, is eating “resistant starch” whatever that means. Putting a scientific schnozel on simple leftovers only creates a new bandwagon for everyone to jump on. After a galloping good ride, there will be a new one to climb on.

          The best dietary advice I was ever given was: If it wasn’t in your grandmother’s kitchen, don’t eat it.

          BTW, the Yiddish word I was looking for means “big nose.” Anyone help me out here?

  2. When invoking images of paedophiles to colour your prose, is it really appropriate to use descriptors such as “fingering” and “swallowing it”? It seems unnecessarily gratuitous..

    • lol If “fingering” and “swallowing it” bring images of pedophilia to mind, I think that may say more about YOU than Dr. Mike. While both could be taken in a sexual context, why that sexual context would be assumed to include children first speaks to your own mindset while reading.

  3. Great stuff Dr Eades, as usual. If ketogenic diet does not work for me or I don’t have a clue how to adapt properly it does not mean I should try very hard to make everyone else believe that there is no such thing as ketogenic diet.

  4. I was curious to know what these people were saying, so I went to a couple of the links. I soon gave up. Why? I hope it wasn’t just confirmation bias.

    The problem I found was that people don’t define their terms. For example, how was “ketosis” determined? By acetoacetate in the urine? By BHB in the blood? You can have the latter without having the former. But earlier researchers didn’t have ketone meters to enable measuring BHB in the field.

    So subjects might have lacked ketones in urine and conclusion was that they weren’t in ketosis. And these studies are cited as proof.

    Also, “eskimos” are not all the same. Coastal eskimos ate a lot of seafood; inland eskimos ate a lot of caribou. Diet varied during the year.

    Some people claim that “eskimos” got carbs from eating mossy contents of caribou stomachs and others say “eskimos” gave the stomachs to the dogs. Then there is the problem that Margaret Mead found, that subjects being studied often tell the researchers what they think they want to hear.

    Yet people will make blanket statements like “eskimos aren’t in ketosis” on the Internet, and this will be reposted and accepted as truth when it’s basically meaningless.

    It’s difficult enough to ferret out the truth, given all the variables, and it’s sad when time and space are devoted to supporting one dietary worldview on the basis of inadequate understanding and a lack of clarity about experimental conditions.

    Another variable is that we may have slightly different metabolisms for genetic, as well as dietary, reasons. For example, salivary amylase copy numbers. So if one blogger feels terrible on a LC diet, probably that individual should not follow a LC diet, but it doesn’t mean no one else should.

    I think a LC diet is the best place to start, especially for anyone with type 2 diabetes or a weight problem and metabolic syndrome (probably a high percentage of middle-aged Americans). If that doesn’t work for you, for whatever reason, then try something else.

    It’s good that the Internet has made so much science research available to everyone. It’s sad that so much of that research is misinterpreted and used as “proof” of preconceived ideas.

  5. Really excellent article, Michael.

    This in particular strikes a chord with me:

    That’s not how science works. In real science, which is, sadly, not practiced all that often, researchers attempt to discredit their hypotheses, not confirm them. Only after repeated efforts to prove their own theories incorrect, do true scientists start to consider that they may be on to something.

    Most researchers, however, are like the Duck. They come up with an hypothesis, then construct an experiment designed to confirm what they think they know. And they usually do.

    This kind of “science” has infected so many areas of interest. Climate science in particular (in addition to diet/nutrition as you’re well aware) is teeming with it, and it’s then being used to try to increase govt power and influence over us. It’s pernicious.

    • Made worse because there is now so little independent/government funding for true research. Those with the big money can buy the “science” they want to refute anything that would hurt their bottom line. And, because of these inbred biases people can for some time be led to ignore anything that don’t really want to hear.

  6. Duck isn’t the first amateur researcher claiming to be a “real scientist” (naming no names, here)…. the worst part of the problem, though, is that professional researchers are frequently just as bad. 🙁

  7. Some researchers (e.g. Dr Hugo Mercier, look him up on Google Scholar), argue that the confirmation bias isn’t a defect of human reasoning. In fact, the opposite is true – at least in social contexts, the confirmation bias is a positive feature.

    Here’s how it plays out in the real-world. We use our confirmation bias to generate an arguments (“RS is the bestest thing ever!!”). Indeed, we stubbornly stick to that argument and seek supporting evidence, never contradictory evidence. This is easier than reading all of PubMed to decide on the truth. We are not robot automatons.

    This seems like a misdirected route of finding the truth. But wait. We are social creatures. Evolution has us primed to to reason in social contexts, not alone. So what happens is, one’s peers and colleagues can critique your argument (which you generate via the confirmation bias). We are far better at critiquing the arguments of others’ than our own. This is why peer-review and open-criticism is so crucial in the scientific method. It is dangerous to reason alone; the (social) context matters. We are not objective towards our own arguments, but we do show profound cognitive vigilance towards the arguments of others.

    I hope that makes some sense. Anyone interested should read or listen to some of Hugo Mercier, as he understands human reasoning far better than I do. It just irks me when people say the confirmation bias is a defect of human reasoning. It isn’t.

    • Thanks for the heads up on Hugo Mercier. I wasn’t aware of him or his work. Thanks to Google Scholar, I found a few papers to pull, which I will dutifully read. I love his description of “our pig-headed core,” the older part of reasoning apparatus. I’ve always referred to it as the reptilian part of the brain.

      I haven’t read Mercier’s work yet, but I’m not entirely sure I totally agree it as per your description. I do think the confirmation bias plays a useful role sometimes. But I’m not so certain it’s a good thing in, say, peer review. In fact, I think it’s a real problem. What happens is this: A new paper gets submitted, and the editor of the journal sends it to peers to review. In deciding which peers to review the paper, the editor has two choices: he/she can send it to researchers who have written similar papers and understand the particular brand of science the paper represents, or he/she can send it to ‘peers’ who understand the science, but have written papers expressing opposing views. If the paper gets sent to the first group, it will get an easy pass because it fits with the bias of that group; if, however, it gets sent to the second group, it will likely be deemed unfit to publish and rejected because it flies in the face of the bias of the members of the second group, and they consider it bad science, unfit to see the light of publication. Which is why so many crappy or tepid articles get published. Either they fit with the bias of the reviewers or are innocuous enough not to ruffle any feathers. Of course, it doesn’t happen this way 100 percent of the time, but it does frequently enough.

      I think knowing about the confirmation bias is important. We all have it and, if we consider ourselves critical thinkers, should guard against its often pernicious effects.

      I love the little book I recommended at the end of the blog because it was written by a professor who teaches critical thinking and is full of references for further study. And, best of all, it describes a number of his battles with his own confirmation bias, showing how, once he made the decision to critically think instead of simply knee jerk react to something he ‘knew’ was true, he discovered how wrong he had been all along. Critical thinking is a difficult tool to learn to use, but once mastered (to the extent anyone can really master it), brings much enlightenment.

  8. Ok, please write on the hottest topic now! 🙂 Resistant Starch! It seems too good to be true! I, for one, love potato salad! 🙂

      • Beneficial beyond dark chocolate and onions/garlic and other non starchy veges that actually taste good?
        As an ex carbivore cold potato would have to be by far my least palatable option well excluding raw.

        And what benefits exactly compared to my current great health and lean body composition?

  9. This is true. I had a doctor who women thought was cute, but he dismissed me from the practice 2 days after alleging a HIPAA violation to the authorites (retaliation is illegal), missed complications after a surgery, sent me to a doctor that all of a sudden after I was dismissed, couldn’t find anything wrong but couldn’t diagnose me even with medical research given to him, gave me a “mental diagnosis” that didn’t match the DSM IV criteria for the disease, and then dismissed me when I said I couldn’t pay him for an office visit.

    Do you think any one believes the records, the medical research, phone logs, etc.? Oh he’s cute …

    You’re post is right on.

  10. Nice post (and great vocabulary), Dr. Eades.

    Do you think there is merit in contesting the claim that a diet containing five to eight pounds of raw meat daily is a ketogenic diet because of the amount of protein it contains?

    • Well, there is raw meat and there is raw meat. I doubt that anyone – the Inuit included – who eats five to eight pounds of raw lean meat per day. Lean meat contains about 7 grams of protein per ounce. Five pounds would give you about 560 grams of protein, which is a lot. The Inuit eat fatty cuts of meat, which provide more calories from fat and fewer from protein, so they don’t get anywhere near the protein intake they would were they eating lean meat.

      If you want to read some pretty good pieces on the protein/ketosis issues by a nutritional biochemist, check these out (here and here).

      • Thanks for the links, Dr. Eades.

        I would imagine that if you assumed that the Inuit are getting 1/2 the protein you estimated (cool aside: nutrition data is available for polar bears and bearded seals), Dr. Phinney (who was cited a couple of times in one of the links) would argue that a protein intake of > 3g/kg/d (280g protein for a 170 lb. individual) is not part of a well-formulated ketogenic diet. I’m not sure if he’s done the studies, or studies exist with protein intakes in the higher ranges (not sure what that means, but let’s say > 2g/kg/d), but would be interesting to see if it suppressed ketones.

        • I certainly wouldn’t personally clock measurable ketones eating several pounds of meat per day, either fatty or high protein. Whether this is a result of the protein or the lack of a calorie deficit I don’t know, but with three methods of measurement (blood B-OHB, urine AcAc, breath Acetone) that’s my n=1 experience.

          Glycogen in muscles does deteriorate fairly quickly after death which is why databases don’t report carbs in meat (especially those from outside the USA where carbs are actually *measured* rather than guessed by subtraction). On the TV last night it showed how electric shock is applied to recently killed carcasses to speed up the process by twitching the muscles.

  11. Wonderful post.

    I used to read FTA years back; now it’s just how I imagine asylums were before Haldol.

    And the relentless starch justifications sound a lot like, “It’s not enough that I eat Taco Bell; everyone else must line up behind me in the drive-through.”

  12. Dr.Eades, you discuss the style of argument, but I was hoping you would address the counterarguments that were made. You’ve repeated or clarified the points you made at the beginning and thank you for that, but those points were countered and I have not seen those counterarguments being addressed.

    If you get a chance, would you address these please? Because I’m sure I’m not the only reader now confused :

    1._The inuit were not in ketosis because the large amount of meat they ate has both some glycogen and a great deal of protein, upwards of 200gm. Also, the coastal groups had meat from marine mammals that contains large amounts of glycogen, while inland groups had meat ‘fermentation’ methods that increased carbohydrate content.

    However, even if the higher glycogen content weren’t true and they weren’t getting more than 50gm of glycogen from their meat, the high protein itself stops ketosis?

    The other points that I can see are minor compared to above since they only deal with details about glycogen :
    2. __the time it takes after death to deplete glycogen is at least several hours and can be a couple of days, as illustrated also by slaughter house and/or meat packing methods that aim to accelerate this process.
    3. __the temperature that Best preserves the original state of the meat or any biological sample (eg. preserves the most glycogen and for the longest time) may well be liquid nitrogen, but higher freezing temperatures are bound to preserve some too because the process scales with temperature, it’s not a switch that clicks at -196C.

    I’m trying to follow the debate and appreciate any help on this. Thank you.

    • If the Duck were arguing that the effects of gravity didn’t apply to the Inuit, would I be expected to counter those arguments? It’s all really basic biochemistry we’re talking about here. Not some new and exciting scientific discovery.

      Think about it, if there are 6 grams of glycogen in a pound of raw meat on the hoof, and only half of it degrades during the slaughter, butcher and refrigeration process, would that 3 grams per pound keep me out of ketosis? Have you ever eaten a pound of raw meat? I have, and it ain’t easy. Unless it’s steak tartare, which is chopped up into little pieces and mixed with spices.

      Take a look at these two posts by a very smart nutritional biochemist. (Click here and here) All of your questions should be answered.

      • Oh dear, I think biochemistry is quite safe. I did not see the Duck ever arguing whether it applies to the Inuit.

        The only question seems to be how much fat did the Inuit eat versus carbs-plus-protein, since that would allow at least an inference about ketosis.

        The only direct evidence, ketone measurements, is all against ketosis. There were no other direct measurements ever made that actually showed them in ketosis, were there?

        If not, there can’t be any confirmation bias regarding the direct evidence, ketone measurements.

        Therefore, it comes down to an argument about diet composition.

        Any research showing an Inuit diet composition favorable to ketosis would be indirect evidence and would have to be weighed against the evidence opposing it.
        At least though it would be evidence that is being discussed.

        About that diet composition :
        From the glycogen amounts that you quote, you seem to be saying that they did not eat organs or blubber or any additional sources of glycogen/glucose or sources of other carbs, only what’s found in muscle meat.
        There is evidence for this? If not in the Inuit, in other H-G groups?

        Are you also saying that even with all the extra protein they were getting from the large amounts of meat they ate, they would still be in ketosis?
        Isn’t a ketogenic diet designed around the ratio of fat : combined (protein+carbs) ?

        Biochemistry is grand, I’m rather partial to it myself and chose it for my minor in undergrad. My Ph.D. thesis was on organic materials.
        I also love steak tartare, more so with a raw egg on top! I don’t love politics or assorted biases.

        Thank you for getting back to me.

        • Based on my reading, the Inuit ate a diet high in fat and moderate in protein and lacking in carbohydrate. Such a diet is a ketogenic diet by the standards of the non-Inuit research subjects typically put on ketogenic diets for study purposes. As far as I know, we don’t have a plethora of study subjects who have been on such diets their entire lives, so we don’t know how they would react. We do have the papers quoted in the blog post I linked to showing that the Inuit, on the typical Inuit diet, aren’t in ketosis. We can interpret this info in several ways. We could say that the measuring techniques used at the time were not sophisticated enough to measure the low-level of ketones in the blood of people who are ketoadapted. We could also say that perhaps the Inuit, after a lifetime of ketoadaptation, have levels of ketones that aren’t measurable because they have a lifetime of adaptation. Or we could posit, as the Duck does, that there is enough glycogen in the high-fat, meaty diet the Inuit consume to prevent them from going into ketosis. In other words, they aren’t ketoadapted – they’re consuming a high-carb diet. Not a 300 gram per day high-carb diet, but a diet high enough in glycogen-derived carb that ketosis is prevented. Of the three scenarios above, I believe the last is the least likely.

          Why? Because when non-Inuit go on such a diet, they go into ketosis. Therefore there isn’t enough glycogen in the fatty meat the non-Inuit eat to prevent ketosis, so why would it prevent ketosis in the Inuit?

          • Thank you for laying that out, including the basic premise of the diet composition.
            I can see that if the diet was “high in fat and moderate in protein and lacking in carbohydrate”, then all the rest follows rationally.

            So really the issue is about that basic premise, about whether the diet was ketogenically high in fat compared to protein+carbs.

            I see that premise is what is used in the relative ‘weighing’ of the three scenarios, including against the direct ketone measurement evidence, which can then be discounted due to keto-adaptation.
            That adaption can be invoked if the basic premise for a ketogenic diet is true.

            Here’s my problem: the only direct documentation quoted has the Inuit eating 5 to 8 lbs of meat a day, as you’ve noted in your post.
            That’s too much protein for a ketogenic diet.
            Also, any kind of high meat consumption ruins keto ratios even more when added to the various small (but cumulatively substantial) sources of glycogen and other carbs that have been cited.

            What can fix the ratio of course is if there’s research documenting a High fat and Moderate protein diet (so, a much lower meat content?).

            Otherwise, to support a ketogenic conclusion I would have to say :
            _ I don’t believe the cumulative sources of glycogen and carbs (argue about indirect evidence)
            _and I don’t believe the Direct evidence of ketone measurements (ok., there’s a physiological argument against them, based on the diet composition premise)
            _and finally, I also don’t believe the Direct evidence (documentation) of high-meat diet composition.

            So, I would have to discount all the direct evidence on the Inuit diet and ketosis and that leaves just an argument about the relative amount of carbs ?!

            Unless, as I’ve noted, that’s Not all the direct evidence.
            However, I haven’t found any reference documenting anything other than high meat consumption.

            Do you have any references documenting moderate meat/protein consumption in the Inuit?
            Or is the diet composition premise an inference from synthesizing various indirect sources of information on their diet, environment etc?

            The nature of evidence would change the argument, wouldn’t it?
            Lightens idea of ‘confirmation bias’ maybe? 🙂

            Thanks again.

          • I don’t think the Inuit ate five to eight pounds of meat per day. And I’m not sure that the protein in a lot of fatty meat would interfere with ketosis. Why would it? The liver converts protein to glucose as the body needs it – it isn’t substrate driven. In other words, more protein doesn’t necessarily mean more glucose. Insulin controls gluconeogenesis, and it is known that protein stimulates the release of insulin. The insulin will inhibit gluconeogenesis.

          • “The liver converts protein to glucose as the body needs it – it isn’t substrate driven.”

            I was going to say that. It is a very salient point as many seem to be under the impression that it is substrate driven. I believe Amber wrote on that issue, too.

          • That’s the crux of it : why discount the documentation of high meat consumption?

            As for protein interfering with ketosis, I see there may be a biochemistry/physiology argument there?

            There’s a lot of anecdotal evidence, most famously I guess at LLVLC(!) , that too much protein won’t let you drop into ketosis and there’s the epilepsy/John Hopkins hospital diet prescriptions for ketogenic diets that lump protein+carbs together and focus the ratio on fat, eg. 4:1 F:(P+C).
            I thought such ratios derived from the hormone signaling, basically the glucagon/insulin ratio to drive gluconeogenesis vs. glycolysis.

            Also, on another level, it makes sense when considering that ketone production ramps-up in order to lower gluconeogenesis, saving muscle protein in starvation (I believe you mentioned that again just recently somewhere in these comments too). However, excess protein ingestion eliminates the need to get amino acids from muscle, so then there’s no need to lower gluconeogenesis and no increase in ketone production.

            Peeling away at this, I’m reexamining basics. I play devil’s advocate in order to be able to do that effectively, in fact, to avoid confirmation bias 🙂 . So thank you for engaging.

          • I’m not certain that high meat consumption is documented. Both Stefansson, who spent many years living with the Inuit in the early 1900s and John Murdoch, who reported on the expedition to Point Barrow in the late 1800s, state that the Inuit, although they consume (or did at those times) a primarily meat diet, don’t eat more fat than the average American of the time.

            This from Murdoch, who published it in the Ninth Annual Report of the Bureau of Ethnology in 1892, re the eating habits of the Eskimo:

            The food of these people consists almost entirely of animal substances.

            We saw nothing and heard nothing of … eating the half digested contents of the stomach of the reindeer… [caribou]

            As far as our observations go these people eat little, if any, more fat than civilized man, and, as a rule, not by itself. Fat may occasionally be eaten (they are fond of the fat on the inside of duck skins), but they do not habitually eat the great quantities of blubber spoken of in some other places or drink oil, as the Hudson Bay Eskimo are said to do by Hall, or use it as a sauce for dry food, like the natives of Norton Sound. It is usually supposed and generally stated in the popular accounts of the Eskimo that it is a physiological necessity for them to eat enormous quantities of blubber in order to obtain a sufficient amount of carbon to enable them to maintain their animal heat in the cold climate which they inhabit. A careful comparison, however, of the reports of actual observers shows that an excessive eating of fat is not the rule, and is perhaps confined to the territory near Boothia Felix.

            Eggs of all kinds, except, of course, the smallest, are eagerly sought for, but the smaller birds are seldom eaten…

            We saw this people eat no vegetable substances, though they informed us that the buds of the willow were sometimes eaten.

            This pretty much mirrors what Stefansson wrote about the Inuit diet based on his time with them. He observed their diet to be composed of 50 percent caribou, 30 percent fish, 10 percent seal meat, and the rest made up of polar bear, rabbits, birds and eggs.

          • Inland Inuit ate more caribou. Coastal Inuit ate more marine mammals. However, whale and seal meat are extremely lean. And Caribou meat is much leaner than beef or pork. Caribou is even leaner during the winter.

            So, if they weren’t eating a lot of blubber, that would mean that they were high protein and low fat. If they were high fat, I think it would have to be mainly from blubber.

          • Actually, it depends upon what part of the caribou you’re eating. According to Stefansson, the older animals were favored because they had more fat, and the slab of back fat can weight out at 50 lbs. Plus, the marrow is much favored along with the head. So, although the meat itself is lean, there is plenty of fat to go around from a caribou.

          • Right, but a male caribou gets up to 400 pounds, so overall it’s a pretty lean animal. And some of the caribou fat was used for their lamps from what I understand. Cows and swine are much fattier animals for sure, as they are bred to be fat. Very interesting!

            But I can see that whales and seals would definitely have yielded much more fat than a caribou.

          • Thank you for the clarification L.Amber, the nature of the measurement is part of the rational for discounting it, if there’s any reason to think that they were in ketosis from their diet composition.

  13. Your example of people dismissing the idea of their favorite politician being a pedophile reminds me of people who look to athletes and other celebrities as role models. There’s nothing wrong with admiring someone’s ability as an athlete or actor or politician, but none of that means they have a good character. Maybe admiring someone for one thing and loathing them for something else causes cognitive dissonance in some people.

    Information and a humble attitude are the main ways I avoid confirmation bias. Further information can show me where I’m wrong, and thinking about all the times I’ve been totally, completely wrong help me use that information.

  14. The problem with confirmation bias is that, once you start looking for it, you find it everywhere!

    Good article. Thanks.

  15. Everything is relative, what a mosaic of metabolic factors we all are. I wish Richard and friends would bring Dr Richard Bernstein into this. T2DM at 72 y/o, zero carbs and glibly says he hadn’t touched a piece of fruit in 30 years…and not a single diabetic complication. …must be doing something right for him, anyway. Of course, “they” say he is secretly treating all his patients for autoimmune disease. Where did they google that? Considering all of this, I do think the area of microbiota and RS is fascinating and long overdue. I am an 80 y/o cardiologist, still working full time, never catch a cold, and have been LC for 40 years…but now I am taking 2 TBL BRMPS BID, checking my finger stick often and having a hell of an interesting time. Let’s all stay tuned and see where it takes us.

    • Actually, Richard Bernstein, who is a friend of mine, is a Type 1 diabetic and has been so since he was 12 years old. A fascinating guy who knows pretty much everything there is to know about DM. He would no doubt give RS a try, all the while keeping a close watch on his own blood sugars.

      If you are 80 and still practicing cardiology, God bless you. You’re a better man than I am.

      Keep me posted on your self experimentation. I’m keenly interested.

      • I hope they don’t bring Dr. Bernstein into it; they will just fling feces at him.

        Their whole game is a blizzard of reference-spam, and if anyone doesn’t react with awe, they are then bullied in the nastiest possible aging-jock manner.

        It’s an open sewer. I can’t for the life of me figure out why anyone reads it. But I guess there are a lot of people who don’t recognize bullying for the sign of weakness that it is.

  16. Dr. Eades,

    You are right that Duck has confirmation bias. But, so do you!

    The problem is that you haven’t actually refuted any of Duck’s statements. You say that scientists flash freeze to -320, and while that may be true, he provided evidence of glycogen degradation stopping at -18ºC. You haven’t refuted that.

    He provided evidence of significant carbohydrates in blubber and marine mammals as well as glycogen in beef after many days. You haven’t refuted that either.

    You seem to have ignored those points.

        • The paper you linked is a nice one. Perhaps you should read it more closely. It describes well what goes on post mortem when muscle turns to meat.

          As I said before, if we grant that there is a couple of grams of glycogen left per pound of meat, so what? It’s not enough to keep someone following such a diet out of ketosis.

          • “…there is a couple of grams of glycogen left per pound of meat…”

            Indeed, so what?

            If you grant that low number, it’s still for muscle meat of land mammals.
            It doesn’t matter how little glycogen they may have had from land mammals if they were eating the much higher carb-containing marine mammals and blubber.

            Is there some rationale that says the rate of degradation is faster in these sources such that they’d still end up with just a couple of grams per pound? Would need to cite that info.

            That would be called an argument, btw, not ‘confirmation bias’.

            However, nothing about glycogen matters if their diet was so high in protein from pounds of meat per day that they couldn’t develop a ketone-based metabolism.

            Unless someone can show the Inuit didn’t eat blubber (!) and they didn’t eat pounds of meat per day, everything else is moot.

          • You wrote:

            If you grant that low number, it’s still for muscle meat of land mammals.
            It doesn’t matter how little glycogen they may have had from land mammals if they were eating the much higher carb-containing marine mammals and blubber.

            Doesn’t jibe with my sources. Stefansson, for example, writes that during the years he lived with the Inuit, about half their intake came from caribou meat, 30 percent from fish, 10 percent seal meat and the remaining 10 percent from polar bear, rabbits, birds and eggs. This was confirmed by the report of the Schwatka expedition from 1878-1880 and from a report from a Siberian trek in the mid 1860s. Not a lot of blubber in the Inuit diet.

            Stefansson writes in detail about the cuts of caribou prized by the Inuit. Mainly the fatty cuts. The head, to be specific,

            was considered the best part of the caribou – not just the tongue and brain, though both were relished, but the head as a whole. Among the best parts of it were were the fat behind the eye and the meat, a blend of lean and fat, inside the angle of the lower jaw.

            After the head come, in descending order of preference, brisket, ribs, pelvis and backbone. The principal applies that “the sweetest meat is nearest the bone”; excess outside meat is frequently peeled off from the backbone for dog feed, and sometimes from the ribs.

            In responses to previous comments, I’ve addressed the notion that the protein in meat prevent ketosis.

          • Thank you for the reference to Stefansson. So it’s back to which references to accept and which not.
            How is that confirmation bias?
            Only if one side is summarily dismissed or ignored is it any kind of bias.

            Please don’t get me wrong, I really appreciate the effort you put in your blog, in informing and educating and in responding to comments. I often learn something new here and I know many people have been helped.
            I thank you and I’m sure many have thanked you and for years!

            But I have to say, I just don’t understand why you would write a post summarily dismissing as ‘confirmation bias’ all references that do not support ketosis in the Inuit.

            You’ve been addressing some of those in the comments, I see. I’m really glad about that.

            Having the discussion, reexamining old information in light of new information, it helps everyone learn no matter what were their starting biases, don’t you think?

          • I think you may have completely missed the point of my post. The post wasn’t written as an argument about whether or not the Inuit are in ketosis. I didn’t write it to stimulate a debate on that issue either here in the comments section or via dueling blog posts. As you may recall, I wrote that I had been meaning to put up a post about the confirmation bias for a long time, and that the Duck’s activities prodded me into it.

            If you do as I suggested in the post and Google the words freezing stops glycogen as Duck did, you will find many pages of links to articles confirming the fact that glycogen degrades to lactic acid post mortem long before you ever get to the piece Duck used to confirm his bias. In other words, Duck passed over many articles refuting his own belief to get to the one confirming it, then accused me of not responding to the ‘science’ he had presented me with.

            Whether he’s right or I’m right doesn’t matter. What he did was what all too many people do. He simply pawed through the data, ignoring what refutes his theory and seizing on that confirming it. Which is what inspired me to write the post.

          • About high protein inhibiting ketosis, I see your answer to someone above and will study it.
            Meanwhile though, I thought the relative amount of glucagon-to-insulin drives metabolism towards gluconeogenesis or towards glycolysis.
            Gluconeogenesis first ramps up during fasting as blood glucose drops because the glycogen stores drop and after that it’s running on muscle protein so gluconeogenesis scales down to preserve muscle protein.The scaling down is enabled by increasing ketone production.

            With No fasting, gluconeogenesis will still ramp up enough to maintain blood glucose levels if there’s not enough from the diet, but after that where’s the drive to then lower gluconeogenesis if there’s no muscle break down, but rather, plenty of protein that can continue to fuel it?
            I thought therefore that in the end, fat is the key to ketosis. That’s why whether a diet is ketogenic is determined by the relative proportion of fat to the other macros.

          • The ratio of insulin to glucagon drives the system toward glycolysis or gluconeogenesis. During fasting, insulin falls and glucagon rises, driving the system toward gluconeogenesis. Dietary protein increases insulin and glucagon, keeping the system on the gluconeogenesis path, just not as intensely. And with the dietary protein, structural protein isn’t wasted.

            The key to ketosis is brain energy needs. If the brain needs energy and carbs aren’t available, then the liver breaks down as much fat – either dietary or body – as it needs to to provide the ketones to fill the gap.

          • I had read Stefansson’s work over 30 years ago and have much admired him. While LC or VLC is not for me, his hands on exploration and research are far more valuable than a mess of scientific papers.

            I remember him writing that one time in the Arctic, they ran out of seal oil and only had lean seal meat to eat. They immediately fell ill and were rescued barely in time by some Inuit who gave them copious quantities of blubber. From then on, he made sure he had plenty of fat with his meals and told everyone who would listen, he was on a high FAT diet, not high protein.

  17. Re: Inuit ketones,
    The explanation possibly lies here: (forget the T1D)
    Cold-adapted carnivores, e.g. dolphins. run “diabetic” BG on a “ketogenic” diet.
    They are really good at gluconeogenesis, but because low insulin, no harm is done – just cryoprotection.
    This might decrease ketones somewhat. Are there any BG readings from Inuit eating ketogenic diets?

  18. Thanks for this post. I am always interested in seeing another angle on how easily we delude ourselves. Readers may also enjoy David McRaney’s site, It’s also a book.

  19. Thank you for this post. Seems the FTA posse is out in force these days trying to intimidate and badger other bloggers that don’t agree with them. It has worked on some and I don’t read those blogs anymore. The guy that hides behind the moniker of ” duckdodger” will never answer questions regarding his credentials . He makes crazy claims and then ducks and dodges. If they really wanted to present information that could be of help to people their tatics leave something to be desired. Most of this is just an attempt to create hype for the upcoming book. It’s not the ” RS is great book”.
    It’s the” anti LC book

  20. Thomas Huxley put your eloquent post in this way:

    My business is to teach my aspirations to confirm themselves to fact, not to try and make facts harmonize with my aspirations.

    By the way, I like your metaphor of rolling down a pyramid, might be even more powerful it you started at a mountain top in winter, and you (a pebble) began rolling down one side or the other. Somewhere toward the bottom, an avalanche starts, and the pebble still in the center is swept out to one of two oceans (forgetting the Arctic for the moment).

    Duck belongs to a tribe of wing nuts, who are all too common these days. I agree that TV and the Internet have brought them out of the slime and woodwork.

    Thanks for spending your valuable time in elegantly dissing Duck. Great fun for the rest of us.

    I’ve a quick question too, I tend to get cramps most in my left leg. No one has mentioned a circulatory problem, but based on your description, is it possible I’m not getting enough blood to wash away the lactic acid? Oddly enough, I can ride a bike with no cramps, but running produces them, and they sometimes occur at nights.

    • Re the question. Difficult to tell given the small amount of info. Since you’re a reader of this blog, I assume you’re following a low-carb diet. If so, you might want to up your fluid intake and your sodium intake. And perhaps your potassium and magnesium intake. If all else fails, get your thyroid checked. Thyroid problems can sometimes result in bizarre musculoskeletal problems.

      Read the first two links in this post for some additional info.

  21. I’ve had back and forth comments with DuckDodgers myself, and he seems more concerned with wanting to be right, than actual truth. Everybody LC seems like an enemy to him, especially if they at all appear skeptical about RS.

    Though I’m personally trying RS, and think it’s beneficial, some in the RS crowd want to turn everybody that advocates any type of LC diet into an enemy.

  22. Dear Dr. Eades, thank you very much for the informative post. It’s not easy to do LC as there’s so much conflicting information floating around.

    You stated:

    “The Inuit burn ketones as they make them, so it stands to reason that they might not have measurable ketones under normal circumstances. ” 2 questions if you don’t mind, please:

    1. You mean one can be in ketosis and not have measurable serum ketone level?

    2. Drs. Phinney/Volek suggest optimal ketosis level of 1.5-3mM. What is your take on this?

    Thanks again.

    • I’m going to copy a response to a previous comment that I just posted, so it wasn’t there when you wrote this comment.

      Based on my reading, the Inuit ate a diet high in fat and moderate in protein and lacking in carbohydrate. Such a diet is a ketogenic diet by the standards of the non-Inuit research subjects typically put on ketogenic diets for study purposes. As far as I know, we don’t have a plethora of study subjects who have been on such diets their entire lives, so we don’t know how they would react. We do have the papers quoted in the blog post I linked to showing that the Inuit, on the typical Inuit diet, aren’t in ketosis. We can interpret this info in several ways. We could say that the measuring techniques used at the time were not sophisticated enough to measure the low-level of ketones in the blood of people who are ketoadapted. We could also say that perhaps the Inuit, after a lifetime of ketoadaptation, have levels of ketones that aren’t measurable because they have a lifetime of adaptation. Or we could posit, as the Duck does, that there is enough glycogen in the high-fat, meaty diet the Inuit consume to prevent them from going into ketosis. In other words, they aren’t ketoadapted – they’re consuming a high-carb diet. Not a 300 gram per day high-carb diet, but a diet high enough in glycogen-derived carb that ketosis is prevented. Of the three scenarios above, I believe the last is the least likely.

      Why? Because when non-Inuit go on such a diet, they go into ketosis. Therefore there isn’t enough glycogen in the fatty meat the non-Inuit eat to prevent ketosis, so why would it prevent ketosis in the Inuit?

        • I would say ketones at a level of 1.5-3mM would be fine. I’ve seen ketones up to almost 5mM without a problem. Phinney has done much of the work on ketosis and ketoadaptation, so I would tend to agree with him.

  23. There is something that I have a question about. You say that the Inuit were keto-adapted to a near perfect degree, so that in normal conditions they had no measurable ketones. That seems plausible. But just one to two days of fasting had them producing measurable ketones? Why would that be? Wouldn’t their ketone producing and consuming systems just continue on as before? Wouldn’t the feedback from the ketone consuming tissues and the ketone producing tissues stay the same and maintain the previous balance? Why a sudden surplus? It seems rather, well, rather odd that the white bread eaters and the Inuit would have the same physiological reaction to the same intervention (fasting). Again, after a lifetime of being keto adapted how could just two days of fasting cause a need for a surplus? I can see why in someone not keto adapted, but what would be the need in someone who was? If they’d been functioning perfectly for many years at a certain level of ketone production why would that production ramp up in such a short time from such a benign intervention unless the Inuit actually were like the white bread eaters going into the fast? Puzzling….uh, depending on which side of the bias you’re on.

    • I’m glad you asked this question. I was hoping someone would. I actually started to write about this in the post, but the thing had gotten so long, I cut it out. And hoped someone would bring it up here.

      When the Inuit consume their traditional diet composed of primarily fatty meat, they get a lot of fat and a moderate amount of protein. Their bodies use the fat for energy, with a bit being converted to ketones to replace some of the glucose required for glucose-dependent tissues. Assuming they are in equilibrium, their bodies should pretty much consume the ketones as they are produced.

      The protein in their diet does two things: it replaces worn out proteins, and it converts to glucose in the liver via gluconeogenesis. This glucose is used for the brain and the other tissues that are glucose dependent. Plenty of protein means the body isn’t in starvation mode, and glucose can be made as needed.

      During a prolonged fast, the brain derives a lot of its energy (~40 percent) from ketones, allowing the body to conserve muscle protein, which is the reservoir for glucose. At the start of the fast, the body breaks down muscle to make the glucose needed for glucose-dependent tissues. At the same time the body begins to rapidly breakdown body fat to get at the glycerol backbone of the stored fat to use for making glucose. Muscle is much more vital than fat, which is basically just stored energy, so the body makes the switch over as quickly as it can to minimize muscle breakdown.

      The energy needs of the brain drive this process, so when the Inuit, who were eating fatty meat and using the fat and protein for energy and sugar, start to fast, they switch over to burning more body fat to access the glycerol than they really need to burn. This excess fat makes a pass through the liver where it is converted to ketones, and so ketone levels in the blood rise to measurable levels.

      • The truth is out there. My search bubble revealed the following estimate of diet of the 1855 Eskimo –

        Protein (g) 282
        Carbohydrate (g) 54
        Fat (g) 135
        Calories (Cal.) 2640

        “It is, however, worth noting that according to the customary convention (Woodyatt, 1921 ; Shaffer, 1921) this diet is not
        ketogenic since the ratio of ketogenic(FA) to ketolytic (G) aliments is 1.09”

        From…. Sinclair Hm. The diet of Canadian Indians and Eskimos. Proc Nutr Soc 1953; 12: 69-82

        The key of course is to keep searching beyond the references provided to support one side of an argument.

  24. Confirmation bias is a rabbit hole that is very easy to fall into and really painful to get out of. Like you, I make it a point to force myself what blogs or news sites on the other side of the political spectrum are saying just to get a more balanced perspective on things.

  25. So – if I eat carbs at The Perfect Health Diet level and my last HA1C test was 5.2% – what would you say – that I’m a carb adapted human?

    • Nope. I might say you are a sort of carb-tolerant human, but that’s about as far as I would go. A 5.2% HgbA1c calculates to an average blood sugar of about 96, which I think is a little high. I would rather see HgbA1cs in the mid to high 4 range.

    • No, I don’t find many people with high ketone levels – most are in the lower ranges. But I wouldn’t go nuts if I saw a 5mM as long as glucose was normal.

      I like the HgbA1c for diabetic patients because it gives a rough approximation of what the average blood sugars are for the previous few months. It’s not a perfect measure by any means, but I like it because patients can’t game it. Before the HgbA1c measurement became readily available, diabetic patients and those with glucose intolerance of not yet diabetic levels could eat low-carb or even fast the day before their office visit and show up with normal looking blood sugar levels. The HgbA1c put an end to that because if they show up with a blood glucose of 85 mg/dl and a HgbA1c of 6.8, as a doc, you know what’s going on.

  26. Thank you so much for your kind response Dr Eades. I think I was unclear because the mid to high 4 range I was referring to was the HgbA1C test levels, not ketone levels. I wondered if you knew of how common it is for those following a ketogenic diet to get A1C levels to the mid to high 4 range without resorting to insulin.

      • I’d like to know for non-diabetics. I have been practicing low carb/paleo on and off for a while now and finally have converted solely to low carb (after realizing that I don’t need carbs for exercise and for other reasons), but I doubt I could ever get my hemoglobin A1C into the 4 range. I just had a blood test, so I’ll see what it says after about 4 months of low carb.

          • Well, the idiot doctor did not order a hemo A1C!! Fasting blood glucose was 103 (exactly the same as last year, when I was also low carbing for a while). I’ll need to get another blood test done. No vitamin D, either. I don’t know what she was thinking. Also, my TC was 179 and my HDL was 38. No matter what I do (exercise, fish oil, saturated fat, etc.), I can’t seem to get my HDL up. I’ve had around this level of TC and HDL since I’ve been 24 or so. My HDL was 42 last year, so it went down, but that’s probably within the range of accuracy of the measurement anyway.

  27. We are not tweeters, but we enjoy following those that Dr. Mike shares on his blog.

    When we suddenly came upon tweets about the Inuit and ketogenesis we wondered what this was all about. We first learned of the Inuit Eskimos and explorer Stefansson from the first edition of Protein Power many years ago. Intrigued by PP, we followed up on Stefansson and his studies, including specifics of the experiment at Bellevue Hospital in NYC. Details about Inuit nutrition, lifestyle, and health status are well documented, so why this fuss about whether they are in ketosis or not? (Many thanks for your clarification of the ketone lab findings in this “Beware the Confirmation Bias” post)

    We decided to go to the post of FTA to see if we could learn the “what and why” of the dispute. No luck on that score, but it did become apparent that FTA believes (or wants his readers to believe) that Dr. Mike does not know everything and that Dr. Mike does not respect him and his ‘science.’ FTA’s lack of logical argument about Inuit ketosis led us to believe that he really does not care about persuading Dr. Mike but rather just wants to 1. Put a few pockmarks on a sterling reputation or 2. Promote FTA and increase readership.

    We know you are not worried. PP speaks truth not opinion. Bless you and MD.

  28. I’m sorry I was unclear. I’m was wondering about non-diabetics and diabetics not taking exogenous insulin. But maybe it doesn’t really matter because as you explained, the real value in the A1C is to get a clearer picture of what’s been happening over the previous few months rather than rely merely on the fasting test. I have to smile at your description of how diabetics can game the fasting glucose test because that’s just what my father used to do. He’d “get religion” a few days before the test and meticulously count his alloted carb units (in those days low carb was the recommended diet for diabetics) and fast extra long before the blood draw. My father was a slender type 2 so docs were just content to see a decent fasting without further inquiry into what gastronomical hijinks could have been happening during the prior months.

  29. Okay, I struggled through your political metaphors and finally got to your point. I think.
    I have to say, as someone who has lived on all parts of the political spectrum, I would recommend you find a new favorite site.
    All of those links are crap. You won’t learn anything.
    I find google etc. to be fun. As soon as I see something that makes sense, I google the other side.
    Even your analysis of confirmation bias is pretty shallow, and oddly seems to be used to try to prove that your argument is better because you have less bias.(I am sure there is a logical fallacy in there) When in fact you have done little to support your argument.
    I don’t care. I will draw my own conclusions, and since I don’t have a blog to promote I don’t have to prove my lack of bias.
    However if your ignorance about what is a good source of information on politics/current events is any measure, then I don’t reckon you would be all that much better with science.
    By the way, I respect the work you have done, but this article comes off as childishness disguised as scholarship from over here.

  30. I find it odd that if the inuit were so carb dependant they had zero “atkins flu” when the carbs are removed via fasting or other intervention.

    Seems they have bodies experienced at running on ketones.

  31. In your article you provided a definition of a “real science”:

    “In real science, which is, sadly, not practiced all that often, researchers attempt to discredit their hypotheses, not confirm them. Only after repeated efforts to prove their own theories incorrect, do true scientists start to consider that they may be on to something.”

    Can you please show us, where in your article do you try to falsify, discredit, prove incorrect your hypothesis that Inuit are in ketosis?

    • I’m going to repeat to you what I wrote to another commenter yesterday:

      I think you may have completely missed the point of my post. The post wasn’t written as an argument about whether or not the Inuit are in ketosis. I didn’t write it to stimulate a debate on that issue either here in the comments section or via dueling blog posts. As you may recall, I wrote that I had been meaning to put up a post about the confirmation bias for a long time, and that the Duck’s activities prodded me into it.

      If you do as I suggested in the post and Google the words freezing stops glycogen as Duck did, you will find many pages of links to articles confirming the fact that glycogen degrades to lactic acid post mortem long before you ever get to the piece Duck used to confirm his bias. In other words, Duck passed over many articles refuting his own belief to get to the one confirming it, then accused me of not responding to the ‘science’ he had presented me with.

      Whether he’s right or I’m right doesn’t matter. What he did was what all too many people do. He simply pawed through the data, ignoring what refutes his theory and seizing on that confirming it. Which is what inspired me to write the post.

      • So if

        1) your hypothesis was that Duck Dogers has confirmation bias,
        2) your definition of real science is “researchers attempt to discredit their hypotheses, not confirm them. Only after repeated efforts to prove their own theories incorrect, do true scientists start to consider that they may be on to something”

        then where are your repeated attempts to prove false your hypothesis that Duck Dodgers has a confirmation bias?

        • I don’t have to because the simple pathway from glycogen to lactic acid has stood the test of time. All the enzymes involved are know, the reactions speeds are known, and how the whole process works from beginning to end has been elucidated and written up in countless papers and in every modern biochemistry text known. The process has gone from being an hypothesis to as close to a known fact as you can get.

          If Duck is trying to refute this fact, then does my pointing this out mean I suffer from the confirmation bias?

          If Duck were tell me that Inuit can flap their arms and fly, and I call BS on him, would you say I’m falling victim to the confirmation bias?

          Ridiculous as it seems, that’s just about what he’s doing.

          • So your approach is that if the actual real-world measurments of a complex system don’t match deductions from the theory then we should refrain from doing “real science” and assume primacy of deductions from theory over the real-world measurments of a complex system (like an animal organism)?

            Your deductions were based entirely on theories – “countless papers”, “biochemistry texts”.

            Duck Dodgers based his view on direct measurments of the thing the debate is about – done either by meat industry (glucose level in time) or by explorers measuring ketone levels in the Inuit. In what way do you think measurments are wrong?

            By the way – your analogy works against you. It’s not usual for humans to fly by flapping arms, but it is usual, the most common state, the default for humans not to be in ketosis. Thus it is normal to assume as a default position – just like most other humans, including other Asians closely related to them – are typically not in ketosis.

          • You’re claiming he’s making things up. But you’re ignoring the fact that he has been citing multiple sources that show otherwise, including sources from the beef industry that show a slow degradation process of glycogen at cold temperatures, as well as a stopping of glycogen degradation at slaughterhouse chill room temperatures to cause cold shortening. You seem to just dismiss the entire beef industry with a flip of the hand whether you realize it or not. That doesn’t seem right.

            If you truly make an effort to refute your own hypotheses, as you claim to, how can you ignore the actions of the entire beef industry that uses electrodes to speed up glycogen depletion before they freeze beef carcasses over the course of a few days? You say it’s all so rapid and not worth a look, but apparently it’s not rapid enough for slaughterhouses! If it was so rapid, they wouldn’t need electrodes.

            Glycogen depletion appears to be species-dependent and temperature dependent. And the marine mammals have large aerobic metabolisms that seem to delay glycogen depletion after death much longer than land mammals.

          • No, I didn’t say he was making things up. You’re putting words in my mouth. I said he was rooting through Google looking for anything that might substantiate his bias, which is that there is a lot of glycogen in meat. Enough glycogen, in fact, that it stops the Inuit who, on a traditional Inuit diet, eat primarily meat.

            Problem is, both he and you don’t really understand what cold shortening is all about. Or he doesn’t understand and you’re simply parroting him.

            But don’t feel bad. I, myself, didn’t know what cold shortening was until I looked it up. But, unlike Duck, I didn’t just look it up to try to prove my point and confirm my bias – I looked it up to learn something. And learn I did.

            As I described in my post, when an animal (including a human) dies, its muscles keep on trying to work. Since no blood is flowing bringing in fresh oxygen, the muscle converts to anaerobic metabolism, which means it has to use glucose. Glycogen, which is the storage form of glucose, degrades to lactic acid and harvests some ATP in the process. Since there is no blood to carry away the lactic acid, it accumulates and makes the tissues acidic. Ultimately, once the glycogen is used up, no more ATP can be formed. When this happens, the muscle cells begin to contract and rigor mortis sets in.

            Here’s how it works. The muscle cell requires calcium to contract. And it requires energy from ATP. The sarcoplasmic reticulum (SR), an organelle within the muscle cell, sequesters calcium. When the muscle needs to contract, the SR releases calcium into the inside of the cell and facilitates the contraction, which is driven by ATP. And it takes energy in the form of ATP to keep the calcium in the SR. So when the glycogen runs out, and no more ATP is being made, the SR can’t hold the calcium, which seeps out and causes the muscle to stiffen. This is called rigor mortis, the stiffness of death. Which I’ve known about since taking physiology in medical school.

            Cold shortening is something completely different, and I didn’t know anything about it till I looked it up and studied on it. A couple of conditions are required for cold shortening. First, the carcass has to be exposed to cold. Freezing temps will do it. Second, there needs to be some glycogen left in the meat when it is exposed to the cold. If there is no glycogen, there will be no cold shortening.

            Here is what happens. The cold exposure causes the SR to release calcium. In the process of degrading to lactic acid, the remaining glycogen generates ATP. The ATP in the muscle in combination with the calcium released by the cold-damaged SR causes an intense contraction of the muscle, shortening it by as much as a third. Since the muscle shortens as a consequence of exposure to cold, the phenomenon is called cold shortening. And the meat industry doesn’t like it because cold shortened meat is extremely tough.

            Meat processors can do a couple of things to prevent cold shortening. First, they can keep the slaughterhouses warmer so that the cold doesn’t drive the SR to release calcium. The other thing is to attach electrodes to the carcasses to stimulate the muscle to make it use up its glycogen so there is no ATP to drive the cold shortening process.

            Now, let’s compare the slaughterhouse to the traditional Inuit way of killing and dressing animals.

            I, obviously, wasn’t around when large numbers of Inuit following their traditional diets were roaming the Arctic, so all I have to go on are reports written by observers who did have boots on the ground then. But I do have pretty good info as to what happens in slaughterhouses since I have been in many. Before I went to medical school, I was an engineer. In one of my engineering jobs, the company I worked for designed waste water treatment facilities. Some of our biggest clients were slaughterhouses because they produce and have to deal with a lot of blood and feces, both of which play hell with the water supply.

            In my many hours in slaughterhouses, I was always amazed at how quickly – really, just a matter of minutes – a living, breathing, walking steer is converted to a carcass hanging in a cooler. The animals are stunned, lifted by a hind leg, their throats are cut and they start their path down the way. The first guy they come to skins them in a trice, and before you know it, they are a row of carcasses.

            In reading about cold shortening, I learned that if the skin is kept on the animal, the glycogen pretty much degrades quickly and cold shortening isn’t a problem. The skinning exposes the muscles to cold and causes the problem. But slaughterhouses don’t have the leisure to let the animal hang with their skins on, so they skin them, keep the slaughterhouse warm (they’re not really warm -they’re about 60F or so), and apply the electrodes if necessary.

            Now, a couple of things about the Inuit killing of animals. According to Stefansson, the Inuit froze their caribou (in the winter, of course) with the entrails removed and the hides on, so I doubt there was much glycogen left. He wrote that musk ox taint (by which I’m assuming he means spoil) if frozen with the hides on, but not caribou. So, if a musk ox were killed and skinned immediately in the winter, it might retain a little more glycogen, but we’re not talking much here.

            Also, one of the factors in the amount of glycogen left in the meat, is the stress condition of the animal prior to its death. If it is stressed, it burns up much of its glycogen pre mortem, allowing a much quicker onset of rigor mortis. In domestic animals slaughtered for food, this is a bad thing because it adversely affects the taste of the meat. Which is why slaughterhouses want to keep their animals calm right to the end. Makes the meat better.

            I suspect the animals killed by the Inuit were more stressed than the average stun-killed animals in a slaughterhouse. Especially if it was’t a clean kill and the animal takes a bit to die. Or runs and has to be chased down, a common occurrence, I would imagine. Once killed, the animal would never be converted to a carcass as quickly as in an assembly line meat packing plant, and so it’s coat would prevent the cold shortening and would allow the glycogen to degrade.

            So, I can’t see how animals killed by the Inuit contain much, if any, glycogen at all. At max, there is about 6 gm per pound, so it doesn’t require much degradation to get down to very little.

            As to seal meat and other forms of blubber, all my reading tells me that the Inuit didn’t eat a lot of it. Maybe 10 percent of the diet according to Stefansson.

            So there you have it. Make of it what you may. If you want to believe the Inuit were on a high-carb diet, far be it from me to stop you.

          • Fascinating Dr. Eades. Thanks for sharing.

            “At max, there is about 6 gm per pound”

            Well, marine mammals have considerably more glycogen than land-based mammals, so that “at max” figure you keep citing isn’t accurate, particularly since their glycogen seems to be concentrated in their skin and blubber. And it’s already been shown that marine mammals maintain postmortem aerobic metabolism much longer than land-based mammals. So, I don’t know why you’re focussing on beef so much.

            You keep referring to land-based mammals as an example in response to Duck Dodgers, but they wouldn’t apply for the coastal Inuit.

            Secondly, as it’s already been pointed out, seal meat and whale meat are extremely lean. If the Inuit weren’t consuming much blubber, as you say, then that would mean they were low fat, high protein. Caribou are very lean as well, with a few pockets of fat that were only maximized during the Summer and early Fall. So, you seem to be contradicting yourself when you claim that they were high fat but not explaining where they were getting all their fat from.

            If you say the Inuit were relying heavily on Caribou, then you must be referring only to the inland Inuit. Can you clarify your position?

          • Who cares whether the Inuit in question are coastal or inland? I’ve read multiple reports on both, and both eat a lot of caribou. What is the demographic breakdown? How many Inuit are coastal and how many are inland? What are the percentages of each, so we can determine the average Inuit? Then if we determine the average Inuit ate a little more glycogen in his meat than the inland Inuit and a little less than his coastal brethren, what does that tell us? This discussion is reaching the how-many-angels-can-dance-on-the-head-of-a-pin? status.

            I agree that whale meat is lean – I ate a bunch of it last summer in Norway, so I can comment first hand on that. Haven’t eaten seal though, so can’t comment on that first hand. But based on my reading, the Inuit used seal oil and whale blubber more for lighting (oil lamps) than they did for eating. Although they did use the oil for dipping their dried meat in from time to time. According to Stefansson, the inland Inuit traded with the coastal ones for the seal and whale oil, so even the inland ones got some of it.

            Also, as I’ve mentioned in these comments ad infinitum, caribou meat is lean, but, again, according to Stef, the Inuit gave most of the cuts we modern folk like to the dogs and went themselves for the fatty parts. We modern folk like younger animals for eating more than we like older animals because the muscle of the younger ones are more tender whereas those of the older are tougher. The Inuit we just the opposite. They preferred the older animals because, like with humans, older animals had more fat than younger ones, and, since they didn’t eat a lot of the muscle meat, they weren’t as concerned about the toughness.

            To quote Stefansson on page 27 of The Fat of the Land:

            Hunting man is a connoisseur of fats, and has a definite sequence of preferences in the different fats according to their origination in different parts of the body. The marrows are the best, and range in excellence from the hip and shoulder joints down – the further down the better. The marrow of humerus and femur is hard and tallowy at “room temperatures,” harder at the upper end. These bones are sometimes broken and the marrow eaten raw; but usually the bone, with what remains on it after the dog meat has been peeled off, is boiled and the cooked marrow is eaten warm.

            Passing down the leg the marrow is softer and softer, more and more like a particularly delicious cream in flavor, and is in each bone softer at the lower end than at the upper, so that if one is given a small piece in the dark he can tell, by the feel when he crushes it with his tongue against his palate, and by the taste, from which bone it is and from which end of that bone.

            He also wrote a couple of pages later in the same book re the caribou back fat:

            The slab of back fat is thickest a little in front of the roots of the tail and goes down about halfway to the hock joint, thinning rapidly. Forward it extends well out along the neck, thinning gradually from the hips forward. On the sides it goes a third of the way down over the ribs. When a caribou is killed and the back fat is peeled off and laid out on the grass or snow to harden. As Dr. Anderson says, it may run to fifty pounds on a bull that dresses 250-300 pounds. The slab is thinner the younger the animal, and for the same age is thinner with females than males.

            This is just to show there is more to caribou than the lean meat, which the Inuit didn’t particularly like. I am sure this back fat slab would be thrown away by today’s modern hunters and/or butchers and just the steaks eaten.

            If you want to argue that the coastal Inuit got a little more glycogen (which I don’t believe lasted all that long post mortem) than the inland ones, have at it. I just don’t think it makes any difference, and I don’t believe the either group of Inuit were on high-carb diets. There is simply too much evidence – both basic science and anthropological – to the contrary. Just don’t depend upon me to spoon feed it to you.

          • Dr. Eades, Interesting!

            I’ve really tried to follow this discussion closely and I could be wrong, but I don’t think anyone ever said the Inuits were on “high-carb diets.” The talk seems to be about whether the Inuits consumed more carbs than what was previously believed.

            I like your concise responses, but you seem to rely heavily on Stefensson’s observations here. His observations line up nicely with your position, but what are we to do with observations that conflict with Stefensson’s? I thought looking at the conflicting data is how we avoid confirmation bias?

            I’m sure you’ve noticed conflicting observations from other researchers. I certainly have. For instance, it’s pretty easy to find accounts of seals being the most important food for the Inuit, like this one


            “Seal is the primary, and most important, food of the Inuit, and they make use of the many seal varieties that live in the Arctic..The blubber and meat of the seals are eaten raw, while the intestines are either boiled or eaten raw.”

            And I see Caribou back fat is only available during the Summer months and early Fall if my sources are correct. But seals are the only animal they hunt year round. Maybe that’s why some researchers consider the seals to be the most important food?

            I appreciate you taking the time to address my questions. But it’s just that I see conflicting observations that don’t line up with Stefensson’s. Thanks again!

          • You wrote:

            I thought looking at the conflicting data is how we avoid confirmation bias?

            It is, but you’ve got to evaluate the conflicting data. The book you chose describes a more contemporary Inuit diet, not the ‘native’ Inuit diet. And the book appears to be sort of a compendium of cuisines throughout the world, not an anthropological text. I’m not sure it’s as valid and reliable a guide to the diet of the Inuit native diet as the observations of someone who lived with them for years.

            I rely on Stefansson a lot because he was a great writer, and because observations I find from other writers of the era provide confirming data but they don’t nearly as clearly and succinctly. Plus Stefansson is quoted extensively in the hardcore anthropological publications, which leads me to believe his observations are valid to those in that field.

            What are you trying to ferret out here? What difference does it make if some subgroup of Inuit ate more seal meat than another group? Stefansson writes about the Inuit eating seal and how they incorporate the seal fat with the lean when they eat. But he says the typical Inuit gets 10 percent of his calories overall from seal. If some other group of Inuit gets 30 percent of their calories from seal, what does that tell us? I can’t figure out what your getting at or really what difference it makes.

  32. Tempted by the promise of lower fasting BGs (as a Type 2 Diabetic) I did venture back onto FTA to read about Resistant Starch and found myself in the recent full-out ad hominem designed to somehow prove that long-term ketosis is dangerous because (apparently) Vilhjálmur Stefánsson was a scoundrel. I was very impolitely bullied out of the comments. This is not the way of convincing science.

    Even if what they (and by default I distrust anonymous bloggers.. especially those with cartoon names) claim about the glycogen stores in deep-diving marine animals, or even that the Inuit were not in ketosis; I’m not sure what that proves about he dangers of long-term ketosis?

    The ad hominem character-assassination of Vilhjálmur Stefánsson was totally unnecessary… unless this was not meant to be a science-based discussion. Given that I provided links to at least two of the research papers published after the year-long Bellevue trail; are we to assume that because Vilhjálmur Stefánsson was a ne’er-do-well, that by association so were all the Doctors who ran the trial?

    As Gretchen mentioned earlier: there was no single Inuit diet and even regionally there could be huge seasonal variability.

    As you point out Dr Eades: even if they were eating some carbs, it was certainly not at the level of SAD.

    What is the need for this “destructive science” where it seems that in order to prove your own pet theory, you must first destroy all others? On the contrary, I though the scientific method is underpinned by attempting to disprove your own theory and thereby rule-out alternate ways to interpret your observations?

    Confirmation Bias… sure I can relate and even recognise it in myself… it is human nature. But I attempt to hang onto a child-like curiosity and intend to keep asking “but why?” until the day I die.

    The internet has provided an overload of sources and I struggle with the idea that I should try to read “everything”. Starting from my normal default of trusting people, balanced by an healthy dose of skepticism, I am open to reading new blogs (for example) but once I realise that the blogger is not trustworthy, or honest, or even polite (who needs the hassle) I am out of there. I resist the charge that I am not “open minded” by not reading their site anymore… if the points they raise (invariably hidden deep in the mire of sarcasm or even vitriol) are worthwhile, then I am confident that will surface in a more reasonable and credible source.

    • I know what you mean. I find it really hard to believe I’m even in this debate because it is all such basic, basic biochemistry. It’s almost as if I’m trying to argue against the notion that gravitational forces don’t apply to the Inuit, and when I point out that they really do apply, I’m attacked for not providing the ‘real science’ to prove it. But it’s difficult to discuss biochemistry (or gravity, for that matter) with anyone who so obviously has very little knowledge of the subject.

      • Hard to believe? People still parrot CICO and eat less move more with no thought towards the effect of substrate type on the hormonal milieu.

        It would be entertaining but unethical to hook these morally superior naturally lean people up to a low level insulin drip. Low enough to not significantly impact circulating glucose but enough to halt HSL activity in adipocytes. Then see how good their will power really is.

    • Frank expresses my thoughts more eloquently than I could. I’m convinced of the importance of gut health, and that supplementing with RS might be beneficial on the low carb diet I’ve been on for 6 months; started reading FTA to learn more. This whole tempest in a teapot about the Inuits and ketosis — and the way in which some of the participants and their sycophants have carried themselves — has led me to stop reading them.

      I do believe there may be something there with the RS, based on my few weeks of using a few tablespoons of potato starch daily. Some objective evidence based upon my glucose meter (and my toilet — sorry if TMI), and perhaps some peripheral improvements that may be a placebo effect. I’ll credit Richard and Tim for their work in and continue to watch developments in this area as they surface in other sources.

  33. I admire your ability to dodge and weave around subjects that actually matter to people who are interested in health. It might maintain your ego but anyone reading this blog now has an amazing glimpse into conformational bias of a low carb guru.

  34. Hi Dr. Eades,

    I just wanted to say hello and wish you well and comment a bit.

    Astrophysicist and recognized intellectual , Paul Davies , points out that science is not an objective enterprise, in reality. All scientists, even the best of the best, had/have biases. Davies
    ( and Feynman) recognized this and tries his best to try to work around it. The easiest person to fool is ourselves. The idea of an unfeeling , unbiased , completely objective observer , in science, is a total myth. It’s an idealist’s fantasy. Nothing more.

    Davies ( and Feynman did too ) understands science better than these common Bloggers .These scientists themselves readily admitted to their biases and great ability./potential to fool themselves. It is unbelievable easy to do ! These scientists knew what it means to really know something…. the care and work involved. It is tremendous.

    I know you and Richard Nikoley are long time friends, however, I just want to give my fast assessment:

    Nikoley, CarbSane, Colpo et al- none of them – admit the very strong biases that they all have, while railing on everybody else in the Blogosphere. They themselves are very biased. It is evident in their writings. The acknowledgement of vast unknowns and uncertainty is not present. Feynman would have not been happy with this sloppy and self- delusion style of scientific inquiry. What they are engaging in is called “Cargo Cult Science”.

    In recent years, promotion of carb- rich diets and total bashing of low- carb diets is popular. That seems to be the “in vogue” thing to do these days. None of these Bloggers seems to realize they are very prone to fooling themselves. This was one of Feynman’s first scientific principles: “That we ourselves are the easiest person to fool by far.”

    I do not think the commentors over at Richard Nikoley’s blog understand this.

    Take care, Dr. Eades.


    • Thanks for the reference to Cargo Cult Science. I read Feynman’s book years ago, but I guess I had forgotten that part.

      What we have, though, is a serious lack of understanding of the most basic biochemistry. Difficult to debate when you don’t have at least something all sides can agree on and call a starting point, which, in this case is the simple enzymatic-driven cascade that degrades glycogen, in a step-wise fashion to lactic acid.

    • Today most information processing, including science, is done by computers, not humans. A single home computer has more computational power than the entire humanity.
      And the processing is done by general algorithms specialized (adpoted) for particular functionality, not a special, biased ones.

  35. Dr Eades – where does your version of Inuit get Vitamin C from? What are the amounts of Vitamin C they get from which source? The total daily amounts?

    • Where does my version of the Inuit…? What a bizarre sentence construction. Are there different versions of the Inuit out there running around? I always assumed Inuit were, well, Inuit.

      I’m assuming what you are asking is where the Inuit of a 100 years ago got their vitamin C? Or if they got vitamin C? Or why, if the Inuit ate primarily a meat-based diet, which the record is pretty clear they did, did they not get scurvy?

      That was one of the questions Stefánsson had, which is one of the reasons he wanted to live with the Inuit to see what they ate. His conclusion was that there is something in fresh meat that is anti-scorbutic. He published on it extensively, including a paper or two in the Journal of the American Medical Association. Now it’s well known that fresh meat prevents and even cures scurvy.

      • I see a lot of text with avoidance numbers. In your whole blogpost, including your comments.

        You shouldn’t be in doubt that my question was about numbers – I used words like “amount” and “total daily amoun” that clearly indicate a request for numbers not just text.

        The numbers in the question should relate to Vitamin C (usually given in grams, or grams per day), not to scurvy or “something int he fresh meat. And they are about sources of this vitamin text. So it’s basically about a table, with columns like:
        1) Source (eg. berries,eskimo potato etc.)
        2) Grams of vitamin c per day

        To complement Vitamin C intake you can also add a column with “carbohydrates”, and fill it for each row. You may discover some relations there.

        Of course I’m not demanding additional work from you – if you don’t know it, you can just say you don’t have a clue, or just don’t have time for that.

        • As far as I know, there is not much vitamin C in meat. But most people are concerned about vitamin C intake as it relates to prevention of scurvy, the real manifestation of a vitamin C deficiency. Stefansson discovered that there is indeed an anti scorbutic substance in fresh meat that prevents, and even treats, scurvy. Whether it is vitamin C in some for that’s unmeasurable or another substance altogether, I’m not sure.

          As to my tabulating the vitamin C levels by source in berries, vegetables, fruits, etc. You’ve got to be kidding.

          Google it.

          • Great paper! Thanks.

            According to Stefansson, Inuit avoided the livers of a number of game animals, but almost always ate seal livers when they had them. But, seal made up only about 10 percent of the Inuit diet and were eaten only at certain times of the year.

          • Hi Dr. Eades, thanks for the great convo. Late into the discussion but to further the data: Indigenous hunters, farmers only 30 yrs ago, traditional food based eaters today yet, etc…. Eat the whole animal (ruminants/herbivores, poultry, fish being predominant). The lean muscle meat is the least nutritious but generally more nutritious than any isolated veggie. Spleen & lungs are very high in vit C.(USDA data base) Liver & kidney, from herbivores & poultry, are also good sources & singularly – the MOST nutritious item a human could eat in reference to supplying essential micronutrients (USDA data base). Organ meats & marrow have always been the highest regarded & then the fatty cuts. Only recently have modern (particularly American) humans eschewed organs meat as inedible. If you consume all the organ meats (including the “guts”) you will have no problem getting all of the essential nutrients, generous fatty acids & collagen. To support a tribe of 10-30 individuals, it would take several animals/week = lots of organs to eat, lots of surplus muscle meat to dry or feed the dogs, plenty of fat.

            Most Americans have no clue what “food” really is. Much of our hard earned, traditional knowledge has been lost. The type of animal matters as to what one can eat safely. Most of our agricultural animals are herbivores/ruminants or poultry, not predators – for good reasons. Livers of carnivores (ie sled dogs, polar bears) contain dangerously high levels of vitamin A retinol (which led to the demise of several, stranded artic explorers). Seals are predators – not the most ideal food but would suffice as part of the diet.

            I too have felt Duck’s & FTA’s ire – I, mistakenly, entered the LC bash debate on Chris Kresser’s site… lots of “cherry picked ” data/articles and then the last resort to ridiculous ad hominem attacks. We all have our biases, and any good scientist/ researcher constantly questions their data & looks for the incongruencies/congruencies with the known science. The other concerning issue is that these discussions seem to be narrowly focused around macro nutrient balance (which IS critical) & caloric sourcing… However – Essential micronutrients clearly dictate the natural food source & it is not plant based, nor will muscle meat suffice. USDA data base has great info on nutrient levels of just about anything considered edible.

            Of interest – Based on the most recent DNA assays on ancient humans, it would appear that even in recent history (7000 kya) some of our H.sapiens ancestors lacked the ability to digest starches.
            That’s a lot closer to modern H.sapiens than a distant relative from a million yrs ago that ate tiger nuts.
            Vive Vida & good hunting!

          • If GTR were as widely and deeply read as he/she thinks then GTR would know about this from chapter 6 of Nutrition and Physical Degeneration regarding North American Indians:

            “Their knowledge of the use of different organs and tissues of the animals for providing a defense against certain of the affections of the body which we speak of as degenerative diseases was surprising. When I asked an old Indian, through an interpreter, why the Indians did not get scurvy he replied promptly that that was a white man’s disease. I asked whether it was possible for the Indians to get scurvy. He replied that it was, but said that the Indians know how to prevent it and the white man does not. When asked why he did not tell the white man how, his reply was that the white man knew too much to ask the Indian anything. I then asked him if he would tell me. He said he would if the chief said he might. He went to see the chief and returned in about an hour, saying that the chief said he could tell me because I was a friend of the Indians and had come to tell the Indians not to eat the food in the white man’s store. He took me by the hand and led me to a log where we both sat down. He then described how when the Indian kills a moose he opens it up and at the back of the moose just above the kidney there are what he described as two small balls in the fat. These he said the Indian would take and cut up into as many pieces as there were little and big Indians in the family and each one would eat his piece. They would eat also the walls of the second stomach. By eating these parts of the animal the Indians would keep free from scurvy, which is due to the lack of vitamin C. The Indians were getting vitamin C from the adrenal glands and organs. Modern science has very recently discovered that the adrenal glands are the richest sources of vitamin C in all animal or plant tissues.”

            And that’s just one animal source besides other vegetable sources such as pine needle tea. In short its the reason humans that lack the enzyme to make vitamin C eat the animals that can synthesize vitamin C as needed.

    • Getting Vitamin C exogenously isn’t particularly important to a meat eater. Read up about GLUT1, uric acid, etc.

      Or just google away on [ glut1 glucose receptors vitamin c ], there’s tons of info about how glucose in the diet can crowd out ascorbic acid and such, making Vit C important to people who live on bread etc.

  36. Dr.Eades,
    your commentators either genuflect or let you off easy and so you persist in the most supercilious manner imaginable, despite the fact that by now you must be aware that maybe, just maybe, you judged the matter wrongly.

    So yes, let’s talk biochemistry, shall we?

    Physics too, ironically, though it’s nothing as interesting as gravity that’s truly in dispute here.

    Instead, it’s the simple math of energy requirements that you are repeatedly trying to say does Not apply to the Inuit.

    I do so enjoy it when different fields of science each support the same conclusions.

    Scientists call that ‘independent confirmation’, or even “being consistent”.

    A philosopher might call it cognitive Consonance.

    Either way, a widely-read physician is likely to have come across it, here or there.

    It turns out that Canadian scientists and the government have been studying the Inuit for at least 150yrs.

    Sorry, but Stefansson and any travelogue-type accounts from the 1800s do not trump all the research or reviews that have been published on Inuit diet, health and lifestyle.

    Right on this continent. Rather close to home.

    Perhaps you never had occasion to dig into all that work before.

    However, now that you’ve been alerted to it, even had a lot of it apparently laid out for you with references, you declare your refusal to look at it.

    That is the very definition of Confirmation Bias.

    It’s not the side of a Pyramid that you’ve gone down yourself, it’s most of Luxor.

    However, Fine. Let’s ignore all of the published research and get down to ‘first principles’.

    After all, ‘basic science’ is why you claim to refuse to look at any of the actual research or the conclusions from any published review.

    Let’s start here : the Inuit did not eat much plant matter year-round.

    Fairly uncontroversial.

    That means the great majority of their energy needs were met through animal sources.

    So, fat and protein.

    Ah, but you claim they didn’t eat a significant amount of blubber.

    That means the great majority of their energy needs were met through land-based game.

    That would indicate several pounds of meat, as is indeed found in most studies and summarized in reviews.

    Oh, but you claim they Didn’t eat several pounds of meat a day.

    The math fails miserably at that point, so, it had to be ‘fatty’ meat.

    Despite the well-known fact that wild game is lean.

    Well, there must be some fat on it and Yes, there it is : in the head of the Caribou. Very fatty, true.

    Except, how big does that head have to be so that when split between several people, it shifts the macronutrient ratio of their diets to the ketogenic 80% Fat (if sedentary) or 70-75% if very active-to-active?

    Dinosaur Caribou?

    That all is just a problem with energy math.

    Here’s the biochemistry issue and it has Nothing to do with just how much glycogen is saved by freezing meat quickly after a kill :

    you state that you do not think large amounts of protein inhibits ketosis.

    Why is that?

    Because every ketogenic dieter has not discovered this for themselves?

    Because the Mayo Clinic and all hospitals that guide epileptics in how to design a ketogenic diet are Wrong?

    Because Phinney and Volk, Peter Attia, Peter Dobromylskyj and other scientists and doctors who study this, as well as current textbooks, all of them are Wrong?

    Yet, if there’s something you know, it’s biochemistry, by golly!

    Interesting enough, regarding the effect of large amounts of protein on ketogenesis, it’s not just biochemistry, it’s physiology.

    That really should be something on which you keep yourself current.

    Medice, cura te ipsum.

    • Why don’t you take a few deep breaths and calm down a bit. Maybe even have a glass of wine.

      Then write back in a more civil tone, and we’ll see what we’ve got we can discuss.

      Just for starters, the travelogues, as you describe them, are all we really have of the pre-contact Inuit before they began to be Westernized. And even those are sometimes too late.

      John Murdoch writing in the Ninth Annual Report of the Bureau of Ethnology (published in Washington, DC in 1892 about observations from an earlier expedition) reported:

      Of late years they [the Inuit] have acquired a fondness for many kinds of civilized food, especially bread of any kind, flour, sugar, and molasses…

      Shoot me the citations for some of these many papers by the Canadian scientists studying the Inuit. I would love to read them.

      BTW, what branch of the biological sciences is your Ph.D. in?

      • Excuse me Dr.Eades, I thought I was following the tone you set, both in the post and in your replies in comments.

        That tone is dismissive and very colorfully so, from making fun of the name Duck Dodgers to defying gravity.

        By the very fact that I have tried to engage your argument about basic science, I am at the very least not dismissive.

        Colorful? That I can do.
        I thought I detected that you enjoyed that type of debate, you’re rather good at it.
        Luxor was a nice touch, come on now:)

        In all seriousness, I see from some of the comments above that several people have tried, gently and with obvious respect, to understand your reasoning and others tried to redirect you to please pay attention to some of the very citations that now you graciously have said you’ll read.

        However, the point you have made repeatedly and with a joking scorn is that you don’t need to respond to the articles/citations because the arguments based on them violate basic principles.

        So we are ipso facto no longer talking about research or citations, is that not correct?

        I’ve laid out the argument from first principles in my comment.
        If I’ve missed something (really, this has been a ‘debate’ across so many locations that I well may) please correct me.

        Otherwise, it needs to be falsified, that is : let’s see if we can find a way to reconcile long-term keto-adaptation with the energy requirements and the biochemistry/ hormone signaling/ physiology?

        The basic principles argument against a significant degree of ketogenesis has been presented in my comment.

        To wit:
        – by knocking out carbs as a significant course of energy, we have protein and fat.
        – by knocking out blubber and sea mammals, we have land-based protein and fat.

        Given what’s known about game, including the fatty head (and all organs, including glycogen-rich liver, and gristle and blood), how would they get fat in their diet to the tune of 70-80% of their caloric requirements?

        So, either they need much less than the typical fat content for a ketogenic diet (therein would lie some science)


        we don’t knock out sea-mammals and blubber, which would allow more fat but also has significant carbs and defeats the physiological ‘reason’ (signal) for ketogenesis

        (by which, in the context of this argument, I always mean “enough ketogenesis to supply most of the brain requirement”, since of course there’s always some ketogenesis going on in the ‘post’ post-prandial, aka fasted, state)


        there’s something that’s being missed?

        Either way, it’s not trivial (though it may well turn out to be a simple solution – the best ones often are).

        That’s the reason I’m interested.

        The scientific method progresses by iterations, so trying to falsify the reasoning above from ‘basic science’ is something I’m actually trying to do and I would welcome your help.

        My Ph.D. is in biomolecular engineering.

        Please tell me it doesn’t matter, though?

        Arguments from basic principle by definition don’t rely on authority, I should never have signed that way in the context of this discussion.

        Though, knowing of a specialization in bio-science does perhaps permit the useful assumption that certain terms/language are understood?

        Still, I wish that’s what I was thinking, but in reality my only excuse is “it’s habit”:)

        • I’ll answer your question to the best of my ability in a bit, but first I want to reiterate that my post was not set up as a debate with Ducks Dodger. (Speaking of whom, the name is risible, so it should be made fun of. I know who everyone is in this debate except for whoever is hiding behind Ducks Dodger. Might be nice if he came out.)

          I wrote the post about the confirmation bias. As I stated, Ducks Dodger prompted me to write it because he so clearly fell victim to it himself in trying to dig up references to refute the points I made on Twitter, where the debate, such as it was, was held.

          Now I’ve got everyone coming out of the woodwork demanding that I make some kind of response to the ‘science’ Duck has come up with to refute the glycogen to lactic acid degradation that takes place upon death. And I say, if none of the glycogen degrades, you end up with about 6 gm of carb per pound of meat – if you think that is a high-carb diet, God bless you.

          As to your question, according to most of what I’ve read, the Inuit ate a diet made of about 50 percent caribou, 30 percent fish, 10 percent seal and 10 percent rabbit, polar bear, birds and eggs. These are the figures Stefansson quotes, but they are confirmed by others. Both Stefansson and Murdoch, who wrote the ethnology report for the government in the late 1800s (predating Stefansson) reported that the Inuit ate about the same amount of food, in terms of calories, as a standard American and ate the same amount of fat. I’m not sure I agree, but that’s what they reported. I would think they would have eaten more fat.

          Stefansson discusses how much the Inuit loved the heads of caribou and the marrow. And how they loved the slab of back fat, which could weight up to 50 pounds per animal. Both men remarked on how little vegetable matter the Inuit ate, so I can’t figure how they ate the same amount of fat as the typical American of the time. But perhaps they were correct. In the late 1800s/early 1900s maybe the average American ate a whole lot more fat than he does today, and I’m thinking in terms of today’s American.

          At any rate, I suspect it was a pretty high-fat diet the Inuit ate.

          I can tell you from many years of experience treating patients on low-carb diets that you don’t have to eat a 70-80% fat diet to go into ketosis. You can eat steak, chicken, lamb chops, virtually any kind of meat along with a salad and a green vegetable and get nicely into ketosis. And stay there for a good while. Ultimately, if you stick with such a diet, you end up ketoadapted and your level of measurable ketones fall.

          I suspect the Inuit were ketoadapted to the max since after weaning they were on an almost all-meat diet for the rest of their lives. I also suspect that had modern lab facilities existed back when one could still find an Inuit on a traditional diet, ketones might have been measurable. As it was, they were able to measure acetone only, which is the most elusive ketone. Had they been able to measure BHOB then, they may have found some, then we wouldn’t be having this debate.

          • Dr. Eades, Stefensson was observing the “Caribou Inuit” when he wrote those observations about high caribou consumption. They lived inland. Seals were by far the most important food source for the coastal inuit. And there is a lot of documentation confirming that.

            In your twitter comments, it seemed as though you were unfamiliar with the fermented seal carcasses. Could it be that all this time you’ve only familiarized yourself with the inland Inuit? It seems that they had different eating habits.

    • Jennifer,

      some commenters including me give up and do not comment any more as it would be like “knocking on a locked door”.

      Starting with the “the simple enzymatic-driven cascade that degrades glycogen”, as Dr. Eades puts it, discussing the Inuit diet composition and its supposed and never confirmed ketogenicity.

  37. Gemma, I actually answered above some time ago, but it’s in moderation I guess, which means that this note will appear even later.

    Still, thanks for the perspective. I don’t quite have the same one though and I hope really that I won’t.

    It’s just that I’ve dropped-in here on and off for years and I think Dr.Mike has a rather well-developed sense of humour, even self-deprecating at times (he could almost be Canadian, almost:)

    Which makes me think that the ‘noise’ due to different personalities’ communication styles (yes, that was excruciatingly polite) has been obscuring the substance.

    This includes, unfortunately, noise from some really nasty characters all over the ‘interwebz” and that I see even right here (which I never expected).

    What kind of person comments just to call others names and without addressing a single bit of substance?
    They are just looking for a platform to spout vitriol.
    No contribution as commentators at all.
    Would that there were a moderating filter for that!

    In any case, on further reflection and with input from knowledgeable, or at least sane, members of the community, it may be possible to reach some mutual understanding.

    Logic is usually a good place to start. With a bit of Socratic dead-earnest humour perhaps. For one thing I know, that I do not know.

    • Glad you wrote again. I’m not ignoring your previous comment, I’ve spent most of the morning reading papers I hadn’t before seen on the Inuit diet. I’ve got to do some real work for a while now, but rest assured I will answer your questions ASAP.

      Thanks for your patience.

      • Hi. Thanks for getting back to me, no problem, real work is like that:)
        I see your comment above and will go continue there.

  38. I don’t have thick enough skin for Twitter debates, and was consoled by this Tweet: Being popular on Twitter is like sitting at the cool table in the mental asylum cafe.

  39. Dr Eades

    You are a living, breathing example of confirmation bias. Your position as a climate change denialist proves that. Further conversations with you on any subject as useless.

    • Sorry you feel that way. I’ve spent a lot of time with you, Charles, answering, or at least trying to answer, various questions you have had on my views of the lipid hypothesis and statins. I even did the calculations for you on your own calcium score to try to help you get a better feel for what it really means.

      So, you, my friend, are going to be the recipient of the award for being the first person I’ve ever blocked from my blog. I would hate to have the responsibility of exposing you to any information that would be useless.

      And, BTW, I’m not a climate change denier; I’m a climate change agnostic. As is the great physicist Freeman Dyson, who knows vastly more about the subject than either you or I. So I’m in good company.

      I moved from being a sort of denier into the agnostic camp thanks to the little book on critical thinking I always recommend, which says, If you base your mindset upon only what you read in secondary sources and opinion pieces, then you are not informed. You’ve got to go to the primary sources. Which I haven’t done. Thus, I am an agnostic, not a denier.

      Now I’ve just got to figure out how to actually block someone.

      All the best

      • I’m standing up for Mike here.

        1. I have also blocked Charles. Several times, actually. And each time I tell him I don’t hold a grudge and let him back in, he goes and does the same thing. Shits on me.

        2. There is a difference between those who outright deny climate change, or even global warming, and those skeptical of the causes, i.e., anthropogenic.

        I’m pretty certain that neither Mike nor I deny that global climate changes, can get warmer and cooler, etc. It’s just that there exists now evidence to show climate shifts vastly more pronounced than what we see now, and man was not around, or merely a small part of the ecosystem.

        • Hey–

          Glad you commented on this. I was just getting ready to email you.

          I figured out how to block Charles from commenting, which I did, but can’t figure out how to block him from actually reading the blog.

          Is that possible? If so, how does it work?

          Also, is the ISP unique to the individual? In other words, if I block his ISP, will that block others’ as well? Sorry to be such a tech moron.


          • Mike:

            No, you can’t block anyone from reading. Well, you could but that would require a hack, and if he has dynamic IP, then as soon as he resets his modem, he’s back in.

            This is an issue in comment blocking as well, but since you have all moderation, no problem. I have what’s called 1st comment moderation. So, as soon as someone posts a legit comment and I approve, all subsequent comments go right through, and in my estimation, it’s a huge time saver.

            (I recall us talking about moderation stuff vis-a-vis Tim Ferriss during that coffee in the hotel lobby in Santa Barbara).

            What I’ve found is that there are very few trolls who don’t show it in the very first comment. They can’t help themselves. If you’re using wordpress, the setting is in the Discussion Settings and it’s the 2 boxes alongside “Before a comment appears.” Uncheck the 1st, check the 2nd. Works well for me and since you obviously publish comments that take you to task, probably worthy of a time saving experiment for you.

            In terms of moderation, though, just a ban doesn’t always work. What I do is go and make sure there’s “info” in the “Comment Moderation” section, like handles, email, etc.

          • Thanks. I guess I’ll just have to live with his comments going directly to spam. He can still read the blog at will and get his useless information. Though one wonders why he would.

          • Dick’s definition of a “troll”: anyone he disagrees with. For all his anarcho-bullshit and whatnot, his site is as locked-down and censored as the next fat low carber. Everyone, of course, is free to voice their opinion – unless it riles Richard up (in which case he will simply call them names and then block them. Truly heroic behavior. Very “Paleo” indeed).

    • There are basically no people who are “climate change denialists”. Basically everyone acknowleges climate is somehow changing; is not stationary over time.

      • The actual climate change “denialists” are the people who seem to think the climate should be the same, year after year.

  40. It saddens us to see the naysayers coming out of the woodwork, but we knew they would – they always do. There must be a need in some people to be contrary – independent of subject matter at issue.

    We have thought a great deal about this phenomenon and wondered if it might be due to the naysayer’s lack of ability to distinguish between fact and fiction. We decided to offer our thoughts because of our conviction that we are now at a crossroads; the future of humankind depends on selecting the path to valid, scientifically based nutritional science. The current state is an unacceptable and damaging mish mash of dribbles of truth in a milieu of pseudoscience.

    The following thoughts are our own and have not been tested in a public arena. As a start, it must be recognized that there are a few areas of knowledge that are not amenable to bias. For instance, are we biased if we believe that an apple will fall to the floor if it rolls off the table? In our universe, gravity is a natural law – a truth. There can be no bias when there are not two or more alternatives of belief. You may argue, as an early philosopher once did, that the apple might actually fly toward the ceiling if you performed the experiment a sufficient number of times. If you argued thusly, you would not be biased, you would be stupid.

    In nutritional science, as in physics, there are natural laws sufficiently general to accommodate the wide range of human biochemical variations. Thus, we have three macronutrients in the human pantry. Within this group of truths there are further natural law truths that govern the broad composition of the fuel that will provide optimum health for the human organism. The study of prehistoric man and his evolutionary diet (that PP introduced us to many years ago) provides scientists with the clues they need to investigate modern man’s nutritional needs.

    Decades of reproducible clinical experience combined with the science of biochemistry to explain why the clinical experience is reproducible gives us a means for revealing the truth that the broad requirement for optimal human nutrition is controlled carbohydrate intake combined with ample and appropriate protein and fat. Nutrition books that advocate low-carbohydrate nutrition are based on these nutritional truths

    Beyond the low-carbohydrate nutritional truth, a few more have been revealed. They are that the essential fatty acids must be in balance and that micronutrient requirements must be met. Beyond these, there are plenty of questionable data and pseudoscience in the current nutrition data bank to serve as ammunition for the naysayers.

    We all must accept the fact that our believing something is true does not make it true. What makes it true is reproducibility upon repetition plus “explainability” by biochemistry.

  41. Dr. Eades

    It has become a heartbreaking yet repeated exercise having to see such esteemed people like yourself spending the vast majority of their time “on the defensive”.

    There is an air in the blogosphere where it seems nearly mandatory to attack proven therapeutic interventions that low carb diet represents in order to carve out a niche for alternatives.

    At some point low carbohydrate diets will have enough acceptance and impact (such as they seem to enjoy in Sweeden) as they are accepted for the truly viable, healthy diet choice they are.

    There are a lot of troubling drama points that likely lead to your twitter exchange but the chain of events seems to be

    -Resistant starch is the new miracle cure
    -As its called a starch it must therefore prove we need starch
    -The Inuit have always been healthy without any concern for eating starch, thus those who insist carbs are required for health and who subscribe to the idea that glucose deficiency actually exists are left with a paradox they must explain away. Jaminet did this originally with his “speculation” that fresh arctic meat was loaded with glycogen. And new the resistant starch crowd are defending their own position with the same arguements.

    To me this falls apart on every single level

    Whether or not an Inuit populate spent any time in ketosis is not relevant at all to the therapeutic value of a low carb diet. Its about as relevant as the fact they didnt have vaccines and antibiotics. These are not ancestral, or Inuit, by nature yet both are of huge benefit.

    Whether or not fresh meat has more glycogen then not so fresh meat, equally irrelevant for the same reasons. When low carb and even ketosis is seen through the more sensible lense of a medical intervention, its “naturalness” or lack of “naturalness” is again rendered irrelevant.

    In terms of proving anything beyond what the Inuit may or may not have eaten, nothing discussed here seems to have the power to prove the value or lack of value, of ketosis. The two facts are largely unrelated as I have illustrated.

    At Primal North we embrace and support those who chose a ketogenic diet precisely because it does work for that group of people who chose to do it. None of them really care what the inuit eat, what they car about is that when in ketosis weight loss usually continues, weight gain usually halts, they feel more balanced and universally their medical lab results improve.

    It’s a shame so much mental energy needs to be taken away from helping those succeed with low carb in order to deal with those who cannot accept that the people we help get real benefits from it.

    And what is truly sad, at the very seed of this massively blooming tree of logical fallacy is the idea that you cannot benefit from low carb and resistant starch together. Considering the impact on blood sugar of potato starch is pretty much nill in the amounts prescribed, there seems to be no reason to discontinue a ketogenic diet in order to consume 40 grams of it a day if you chose to do so. I have checked with two PHDs who you are actually familiar with, and both indicated that some of this will be treated by the body as carbs but hardly likely to break ketosis.

    My whole view on this movement, and why I am entirely sick of it, is that its a possible complimentary therapy this is instead marketed as a “safe starch” in order to tie it to other diet niche markets and once again, peddle unjustified fear at ketogenic diets.

    Your interaction with the Duck strikes me as the the new normal. Right now in paleo the loudest and the most confirming comments and fans “win da science”.

    The idea of “alternatives that are effective” seems non-existant today and I truly miss the days when Paleo embraced low carb as a possibly complimentary treatment that it truly is.

    Its at the point now where experts such as yourself are engaged in order to “create the debate” that lends legitimacy to both sides. Its exasperating and exhausting for those who just want to forge ahead and make progress not page hits.

    Always a fan.


  42. Hmm, when I read about the Inuit not being in ketosis and the whole raw meat/glycogen thing, I did think perhaps it was true because my 16 year old diabetic cat gets higher blood sugar numbers after eating raw meat/bone/organs vs after eating canned food, low carb of course. Perhaps it is a coincidence. Great post.

  43. Here’s an very interesting editorial from the Journal Clinical Lactation that illustrates confirmation biases related to obesity.

    The Right, she suggests, sees greater obesity rates among blacks, and latinos as further proof of their inferiority and inability to care for themselves, while the Left sees it that phenomenon as the consequence of Big Food to fatten their wallets by fattening those most vulnerable to their franken-food formulations.

    Thought provoking

    • It is thought provoking, but the thoughts it provoked in me were a little different than this author’s.

      Plus, I always have a knee-jerk reaction to people who list all their merit badges beside their name.

      Kathleen Kendall-Tackett, Ph.D., IBCLC, RLC, FAPA, and God only knows what else. Please.

      • One of my professors used to say that one could learn a lot from checking the phone directory and see who’d list their Ph.D. and title – you know, prof dr so-and-so. This was in the Netherlands, I’m not sure if U.S. directories have these options.
        I checked, and it was very true. The optional use of such honorifics spoke volumes about the character of said persons as I knew them. Very amusing.

  44. It is amazing how trends go viral, it was IF-ing, then “safe starch”, now resistant starch.We can’t stay still for better or for worse. I wonder, what is next.

  45. Quite frankly, the whole Inuit debate is a distraction (to me) from the resistant starch topic. Anecdotally, it seems that RS ingestion does allow one to ingest more carbs, namely the so-called safe starches… it certainly does for me. RS alone, as we are finding out, is not a singular magic bullet in restoring/maintaining/repairing gut health. It is likely a necessary prerequisite, as it acts as a prebiotic & seems to generate a lot of benefits.. Low carbers & keto warriors ought not be dragged through the mud, nor should they flippantly dismiss the RS topic. Does it really matter how many carbs the Inuit consumed before their westernization? What really matters is putting the pieces to the puzzle together to discover the holy grail of optimal gut health. RS is one of those pieces. Those who choose to dismiss RS, so be it. It’s up to the individual to find out for his/herself. The true heroes are the self-experimenters who are paving the way for an honest pursuit of the truth. To date, there appears to be far more individuals experiencing positive benefits than not. The fewer distractions, the better, & this goes for both sides of the debate.

  46. Hi Dr. Eades

    Thanks for another great post! Skimming through the comments you have accomplished your goal of inciting that radical notion of critical thinking….whether those commenting are right or wrong , Black or White or in the shades of gray where a lot of the biological sciences truly lie it is good to see this sort of debate even if some of those “confirmational biases” rear their heads….

    Now I am a lowly empiricist (my wife is the researcher in our family with both Masters and PhD’s in Plant Pathology and Soil Science so I know my place), however, one who has consistently gotten athletes to successfully employ NK (nutritional ketosis) as the foundation of my OFM program (OFM=Optimized Fat Metabolism)….these athletes are quite literally exploring the outer edges of human endurance performance and our heretical fat-adapted approach is setting records and winning big races, most recently the USATF 100K National Championship by Zach Bitter and the Female Title at Marathon de Sables by Nikki Kimball. These are the latest in a string of victories and records so, observationally, something is working even though it counters the conventional carbohydrate-centric approach (for full disclosure OFM does allow “strategic” use of carbs once adapted for races and and OFM athlete appears to get a lot more from the carbs, using less). Jeff Volek is actually collecting data for his FASTER Study, and the data for the fat-adapted athletes is literally shattering what is thought possible for fat metabolism levels during exercise. Though an empiricist, something is working in the real world of endurance sports even if the experts say it is not possible. Germane to this post and comments, what I am consistently seeing in fat-adapted athletes is very similar to the Inuit….at rest their serum ketone levels are disappointingly low to undetectable and thus don’t jive with a lot of what is written on NK which is mostly for relatively sedentary people and people looking to lose some weight….what I have asked athletes who want to measure their ketones to do for re-assurance is measure their post exercise ketone levels and, sure enough, they get some pretty impressive levels in that post exercise hour (as long as they don’t ruin things with a “recovery” drink/meal of carbs)… I suspect the body become so efficient when fat adapted, physically active and weight stable ketones are consumed as needed when sedentary, but the liver can easily and rapidly increase production to meet demand when the added need of exercise arises and do so for hours upon hours compared to glycogen and gluconeogenesis.

    • She writes:

      Diabetes care is not a quick fix. You can’t take a pill for 10 days and be cured. It means working with a clinical team to control the disease month after month, year after year.

      Thing is, you can go on a low-carb diet and be ‘cured’ in under 10 days in the sense that your blood sugars can be normalized and many of the other symptoms lessened or eliminated. It doesn’t work for everyone in that not everyone has a complete normalizing of blood sugars in 10 days, but, based on my clinical experiences, a majority do.

      To bad this extremely efficacious treatment is ignored by so many very smart endocrinologists.

      • With diabetes, “remission” is a better word than “cure.” A person with type 2 that is caught in the early stages can often have fairly normal blood glucose levels on a LC diet, especially when the diet results in weight loss.

        But the diabetes genes are still there. If the person thinks he/she is cured and reverts to former habits, the symptoms will return. That’s why the word “cure” is dangerous.

        This blogpost is about confirmation bias and has wandered all over the map. I hate to add to the volume, but the word “cure” sets me off.

        • No problem. You are right. Remission is a much better word. For whatever reason, I couldn’t come up with it when I needed to. Thanks.

          It’s not really even in remission either, in the sense that cancer goes into remission never, one hopes, to return. The diabetic symptoms remain in remission or cure or whatever we want to call it as long as the low-carb regimen is maintained. If it’s back to the carbs, the symptoms will return.

          I always get annoyed when this happens because more often than not people will blame the diet they are no longer following for their return of symptoms. I’ve heard countless people say, Yeah, it worked for me for a while, but as soon as I went off, up went my blood sugar. Implying, of course, that the diet failed them.

          If they quit taking their blood pressure medicine and had their blood pressure go up, they wouldn’t think their blood pressure meds had failed them. But they do tend to blame their diet – even if they’re not following it. Strange.

          So we need a word that works for ‘cure’ or ‘remission’ that means it’s a cure only if one stays on the program. Any suggestions?

          • “So we need a word that works for ‘cure’ or ‘remission’ that means it’s a cure only if one stays on the program. Any suggestions?”

            “Control” works. “He controlled his diabetes, maintaining normal BG levels, with a LC diet.”

            If someone is very overweight and manages to lose the weight, sometimes they can continue to control even when eating carbs, at least for some years. We all wear out as time passes.

          • “Suppressed”, perhaps, or “held at bay.”

            But when Gretchen takes issue with your using the word “cured” above, she’s just badgering you, because you made a point of putting that word in scare-quotes. With the scare-quotes, you yourself were already drawing attention to the inappropriateness of the Yale researcher’s choice of words.

            Of course, if Gretchen acknowledged your scare-quotes, she’d miss out on another turn on her soapbox. Can’t have that!

            I’m getting so bored with the constant badgering of anyone associated with low-carb by the roving band of FTA losers. It’s absolute bullshit and these jerks should get a life.

          • Hey, now. Gretchen isn’t part of any “roving band of FTA losers.” She’s been an active commenter on this blog for a long time. Her views are always welcome.

          • Tom, No need to apologize to me. I thought it was funny. But I think this illustrates a weakness of the Internet. How can we find the truth if we won’t listen to people who don’t agree with us? Too many on the Net separate into factions and spend their time flaming each other.

            Way back in antedeluvian times when I was forced to read in the history of biology, I noticed that usually when you had two camps with opposite theories, it turned out that they were both wrong. The truth was something that was only determined when a new technology allowed people to see something they’d missed before.

            I think LC diets are the best thing we have today. But I’m open to the possibility that someone will discover something (a new hormone? a new pathway? a new way of measuring pathways in individuals?) that suggests that something else works better, at least for some individuals.

            So I try to read opposing views . . . up to a point.

          • As I’ve heard it said (the quote is attributed to multiple people): Keep an open mind, but not so open that your brains fall out.

          • I’m not into FTA, but being part of a roving band of losers sounds like fun. Where do I sign up?

          • Tom:

            Now I know that Grethchen and Mike already dealt with this.

            I was just posting to give you an open invite to be one of my losers. Don’t knock it until you’ve tried it.

            Cheers mate. You fessed up quick, and that’s always cool. Rare. So, cool.

        • The “remission versus cure” argument over lifestyle diseases always sets me off and I get tired of hearing, “There is no cure, only control/remission.” I call bullsh*t.

          Sure, some of us carry a greater potential to develop certain disease than others, but to paraphrase Gary Taubes– If we don’t live a lifestyle or eat a diet that triggers the genetic potential, does it even matter that we have it all?

          So OK, I ate a diet and lived a lifestyle that was conducive to triggering diabetes in me, and it did. Now, 8 years after changing that, I no longer have diabetes. My blood sugar and insulin response is normal, my A1C is low normal, my weight is steady and my lipid profile is enviable. I am CURED.

          Now you can certainly say with a degree of certainty that if I return to my old diet and lifestyle that I will develop diabetes again, but this doesn’t in any way suggest that I’m not cured now. Of course the factors that caused disease the first time around will cause it a second time as well… but if we’re to define this as “control” then mustn’t we view all HEALTHY people as diseased people who just don’t know it yet and who have their disease ‘under control’ as well?

          If some sort of environmental toxin was causing disease and that toxin was removed, a complete recovery would be a CURE. Can you imagine someone coming along and saying, “Well it’s not a cure because if you start consuming that toxin again, you’ll develop disease again.”?


          I had diabetes. It is CURED, it isn’t “being controlled” or “in remission”.

  47. I am in a mild ketosis most of the time initially to prevent migraines to happen too often and to last for too long. However, I get so many benefits unrelated to migraines from such metabolic state (for example never having any infection again or catching a seasonal flu, constant energy level and a good mood most of the time, and much more), that I think I would continue even if migraines were to disappear totally by some magic or due to me getting older. I noticed that many females reported the end of their migraines after their menstrual period stoped.

    When I was reading VS recollection of his life with Inuits, I noticed his remark that Inuit females were fat and grew old fast – not what I want to achieve for sure. During more that 6 years on a LC diet I have no complains about it affecting negatively my aging and appearance, quite the opposite. I understand that “primitive” people , especially females,had harder lives , but may be their ample meat consumption which was necessary to sustain their hard work, was also a contributing factor to the speed of their aging?

    I am happy not to be a part of a hunter-gatherers tribe, using modern appliances, color my hair, to have an option to call 911, not to be considered an old lady after turning 30 years old, not to have 10 living children and several dead ones, to be able to chat on my personal computer and to drive my car.

    • I haven’t gone back and looked, but as I recall re Stef’s writings on female Inuit, I don’t remember the fat part but I do remember the looking old part. Seems as if he attributed the premature aging of the skin to the constant smoke in the igloos or hide dwellings. Apparently the males were out all day hunting while the females stayed home and worked in the igloos where the smoke was often dense and oppressive. Seems to me as if it would age someone a little rapidly. And I do remember seeing photos of an autopsy on an Inuit woman whose lungs looked like those of a heavy, heavy smoker.

      • To my list of civilized things I appreciate I should have add not cooking on an open fire! Probably the health risks of a civilization started with the use of a fire – what brings us comfort, ability to live in a hostile environment, convenience may bring illnesses, however we often trade one set illnesses on another one. May be 2 – 3 millions years ago some old-school ancestors shacked their heads about hedonistic youngsters who started to rely on a dangerous fire to cook their food and to be kept warm.

        It is possible my recollection is not very accurate about Inuit females being exactly described as fat ones, may be another term was used. I also remember reading in many books than the native people on the North smoked as well (most probably a recent development because tobacco doesn’t grow in their climate).

  48. Dr. Mike, this article warms my heart. Your blog and books have impacted my health (mental and physical) positively, but it’s your turn of phrase for which I return. You’re one of my favorite writers and minds of our time. Many thanks for your work. Sally

  49. Hey Doc.

    Truly enjoyed that Grove’s Twitpic.

    When I looked at the back the small print had this:

    Groves of Academe; Sponsered by NIH & USDA.

    Next I Googled “Kitava Grove’s” & found a note which stated the Kitavans were too poor to afford it: they preferred tobacco. :))


  50. In ref. to your April 25 10:52 PM comment, what a coincidence. Did you visit a slaughterhouse in DesMoines in the 1970’s? I was a biochem student at iowa State U. I assisted for a time in a research project, led by Dr.James Thomas, that was part of the effort to map the many enzyme actions with glycogen. The experiment required repeated visits to a beef slaughterhouse in DesMoines to retrieve beef hearts. The hearts were harvested right on the killing floor as soon after slaughter as possible to capture the glucose response under stress, flash frozen in LN2 and transported to the labs. The hearts were ground/ liquified and samples ultra centrifuged to isolate glycogen synthetase and associated kinase fractions. Thousands of samples were assembled, tagged with RA P to track phosphorilation
    at specific locations on the peptide chain. It was tedious work that, along with the work of many others around the world, contributed in deciphering what is now in biochemistry and biology textbooks as the glycogen cycle. Maybe we crossed paths back then? Interestingly, the total body of knowledge in biochemistry has doubled every five years or so since those studies.

      • The article quotes over 20 different studies on the Inuit—spanning a century—including from a Nobel prize winning scientist August Krogh.

        You don’t seriously expect anyone to believe that all of those scientists don’t understand “basic biochemistry” do you?

          • Dr. Eades. Glycogen doesn’t appear to be the deciding factor in this discussion. More than 20 studies over 100 years say the Inuit were eating way too much protein to be ketogenic. According to one of the pro-ketosis studies quoted, from 2003:

            Ketones: Metabolism’s Ugly Duckling, by Theodore B. VanItallie, M.D., and Thomas H. Nufert, B.A (2003)

            A low-carbohydrate diet is not necessarily a ketogenic diet. This is particularly true of diets with unrestricted content of meat and other protein-rich foods. Heinbecker reported in 1928 that Baffin Island Eskimos subsisting on their usual diet of meat (virtually the only source of carbohydrate in their food was the glycogen in seal muscle) showed minimal ketonuria…It is unlikely that these very small amounts of glycogen could have accounted for the absence of appreciable ketonuria. A much more likely explanation is that the glucose derived from catabolism of ingested meat protein was sufficient to prevent ketosis. McClellan and DuBois fed two human volunteers “carbohydrate-free” diets high in meat content (an Eskimo-type diet) for many months in a metabolic ward setting. Their findings led them to conclude that, in persons subsisting on diets very low in carbohydrate, ketosis varies inversely with the quantity of protein eaten. This occurs because approximately 48 to 58% of the amino acids in most dietary proteins are glucogenic. For every 2 grams of protein consumed in a carbohydrate-free diet, somewhere between 1.0 and 1.2 grams are potentially convertible to glucose. Therefore, to obtain a degree of hyperketonemia (approximately 2-7 mM/L) believed to be therapeutically effective in certain important medical conditions such as epilepsy, patients must rigorously restrict protein as well as carbohydrate intake and, when possible, increase their level of physical activity.”

            Two things stand to me here.

            1) VanItallie and Nufert did not dismiss the notion of dietary glycogen as being outlandish or incompatible with “basic biochemistry.” They implied it was feasible, but believed it was too small to prevent ketosis.

            2) VanItallie and Nufert clearly state that the, “glucose derived from catabolism of ingested meat protein was sufficient to prevent ketosis.”

            Per Wikholm’s article in this month’s LCHF Maginsinet also supports #2, quoting from all the same literature showing high protein intake for the Inuit and debunking Stefansson’s claims for high fat with his own writing.

            The most popular LCHF bloggers in Sweden, Andreas Eenfeldt/Diet Doctor and Annika Dahlquist have agreed with Per’s findings—admitting that the Inuit were not ketogenic. So, I’m confused as to why you are still talking about glycogen when everyone else is focussing on the high protein, as VanItallie and Nufert have done.

          • This whole issue is like a vampire that refuses to die. It would be less aggravating if it were of any consequence, but in my view it isn’t.

            If you Google “Inuit diet” diet, you’ll get somewhere in the neighborhood of 22,000 hits. So someone went in there and cherry picked 20 papers showing there is substantial glycogen in the meat eaten by Inuits. This is exactly what I talked about in this post – going into some sort of database and picking only those papers that confirm your bias.

            Try Googling the following:

            post-mortem glygogenolysis

            Don’t go through what comes up searching for one that tells you there is substantial glycogen there. Just look at the first few on the list – those are the ones that index most highly. You’ll learn that glycogen rapidly (at lightning speed) degrades to lactic acid.

            As to the notion that protein prevents ketosis or that somehow protein mimics a high-carb diet, I’ve wanted to write a post debunking that for years but have never gotten around to it. Turns out that Bill Lagakos has already done it, so I don’t have to.

            Also, you’ve got to have an understanding of the basics of a) biochemistry, b) physiology, c) knowledge of how the publication of medical reports works, and it doesn’t hurt to have some d) actual hands on experience taking care of a lot of patients.

            Take this paper, for example:

            Alaskan Arctic Eskimo: responses to a customary high fat diet

            Now those who have a lack of understanding of a-d above, and who are hell bent on proving there is a lot of glycogen in dead meat, would seize on these words on upper right of page 738 (as some have already done):

            “Carbohydrates accounted for only 15 to 20% or their calories, largely in the form of glycogen from the meat they consumed.”

            Since the paper reported the Inuit were consuming an average of 3000 kcal/day, the above observation from the paper would seem to imply that the Inuit were therefore getting about 150 gm of carb in the form of glycogen per day. And the non-thinkers (or more accurately put, I suppose, the ignorant) would assume this proves their hypothesis that the Inuit are really on high-carb diets.

            But the reality is that the authors who wrote this paper didn’t measure the glycogen levels as it’s difficult to do because glycogen degrades so quickly. They simply picked the 15-20% glycogen from old papers in which the authors hadn’t measured but had assumed.

            What the authors of this paper did do, however, was to observe and study a group of Iniut and record what they ate. The goal of the study was to study the cholesterol levels of a group of people consuming a high-fat diet because in the 1970s fat was thought to drive cholesterol levels up.

            Their assumptions about glycogen providing 15-20% of calories skewed their calculations in the direction of less fat than what these people really ate.

            If you want to see a paper written way back when describing the difficulty in measuring glycogen, take a look at this one. You can see the trouble they took to try to measure glycogen in animals they had just killed and how elusive it was because it all converted to lactic acid at warp speed. Had earlier researchers read this paper published in 1927, they wouldn’t have made the mistake of reporting glycogen levels to be so high in dead animals. But you’ve got to remember that the scientific literature wasn’t as readily available back then as it is now in the era of the internet. Then it was vastly more difficult to do searches as the papers weren’t indexed.

            My view on the whole thing is that the Inuit on their traditional diet are ketone adapted and thus don’t throw off many ketone bodies when they eat what would be a ketogenic diet to most of us non-Inuit who haven’t spent the entirety of our lives eating low, low-carb.

          • Dear Dr. Eades,

            While I appreciate the sentiment of your “confirmation bias” post, there are a number of errors in this post that should be corrected.

            1) You cited John Murdoch incorrectly in your comments. His observations did not match up with Stefansson’s as Murdoch observed the Eskimo’s moderate fat intake (as stated in your quote). At Point Barrow he observed their blubber conservation for lamp fuel, low reindeer availability and consumption of seal as a “staple”.

            From: Ethnological Results of the Point Barrow Expedition, By John Murdoch (1892)

            Page 56: “The most important sea animal is the little rough seal, which is very abundant at all seasons. Its flesh is the great staple of food, while its blubber supplies the Eskimo lamps, and its skin serves countless useful purposes.”

            Page 268: “The flesh of the smaller seals forms such a staple of food, and their blubber and skin serve so many important purposes, that their capture is one of the most necessary pursuits at Point Barrow, and is carried on at all seasons of the year and in many different methods.”

            Page 264: “Reindeer are comparatively scarce within the radius of a day’s march from Point Barrow, though solitary animals and small parties are to be seen almost any day in the winter a few miles inland from the seacoast.”

            Murdoch even went out of his way to make this clear in another paper:

            From: On Some Popular Errors in Regard to the Eskimos, by John Murdoch (1887)

            “The enormous consumption of fat, supposed to be a physiological necessity to enable them to withstand the excessive cold, is probably the exception rather than the rule, to judge from the accounts of actual observers. It seems quite probable that the amount consumed in most cases is little, if any, greater than that eaten by civilized nations, when we consider that the people who eat the fat of the seal with the flesh and use oil for a sauce to their dried salmon, have no butter, cream, fat bacon, olive oil, or lard.

            We found, indeed, at Point Barrow, that comparatively little actual blubber either of the seal or whale was eaten, though the fat of birds and the reindeer was freely partaken of. Seal or whale blubber was too valuable,—for burning in the lamps, oiling leather, and many other purposes, especially for trade.”

            Murdoch’s observations clearly disagree with Stefansson’s. And even when they were able to find reindeer, even Stefansson admits that the reindeer are too lean to support ketosis.

            2) While it’s true that researchers use liquid nitrogen to eliminate errors in a warm lab environment, it’s been well established that glycogen degradation falls on a curve and is temperature-dependent. The colder the temperature, the slower the degradation. Rigor mortis, which is the process of exhausting glycogen in the muscle to lactic acid, takes hours to complete, and takes a particularly long time in colder temperatures. It’s odd that you don’t mention this.

            However, you seem to be unaware that diving marine mammals have even larger glycogen stores than had been previously assumed—particularly in their organs, blubber and skin [1][2][3][4]—and B) marine fish and marine mammals are unique in that they are unusually resistant to postmortem glycogen degradation and can even take days to degrade at 0°C (whales are particularly resistant even at 98°F).

            3)Simply pointing out that researchers use liquid nitrogen to freeze glycogen does not tell us what the freezing point of glycogen metabolism is. Studies have shown that fish glycogen degradation can be halted at -10°C, while bovine glycogen degradation can be completely halted for months at -18°C (0°F) according to a 1980 study. Interestingly, some fish don’t easily deplete their glycogen when they struggle. Did you really think that glycogen metabolism can only be stopped by liquid nitrogen? I hope you have evidence to support such a claim.

            Nevertheless, the slow degradation of marine-based glycogen has been known for a very long time.

            From: Observations On The Glycogen Content of Certain Invertebrates and Fishes, By L.G. Kilborn and J.J.R. MacLeod (1919)

            Until recently very little information existed concerning the presence of glycogen in the fishes. That some at least is present in the tissues of marine fish had been shown by Cl. Bernard, Pavy, Brücke, and others. It was stated by Bernard that this glycogen is unusually resistant to the influence of post-mortem changes, and that it does not readily disappear during hunger. During asphyxia, however, the glycogen rapidly disappears.

            And, while you are correct that most muscle glycogen degrades via ATP (making at least land-based muscles a poor source of glycogen), you neglected to mention postmortem glyocgenolysis, until now, which is the conversion of glycogen to sugar particularly in non-muscle organs, such as the liver. For instance, glycogen in the liver (which is obviously not a muscle) will degrade via glycogenolysis, converting nearly all of the glycogen into sugar.

            Interestingly, blood sugar will actually rise in the body of a dead animal, mainly due to postmortem glycogenolysis and bacterial breakdown of carbohydrates in the tissues and GI tract. When we consider that an average human liver has roughly 100g of glycogen in it, we can see that a liver has the potential to be very sugary. And in fact, universally, livers were eaten quickly and highly prized by hunters in virtually every culture—including the Inuit.

            If the Inuit were consuming dietary glycogen (which does happen with carnivores, by the way) they likely got much of it from non-muscle organs, such as skins, hearts, livers and glycogen pools. These happen to be in locations in an animal that do not “contract” in the way that muscles do. For instance, Muktuk (narwhale skin) is said to be rich in glycogen and tastes sweet, like hazelnuts.

            I’m unsure why you pointed us in the direction of “post-mortem glycogenolysis” since that was exactly my original point in that some glycogen degrades to sugar postmortem. And the very first study you asked us to look up when searching, “post-mortem glycogenolysis” says, “In all tissues glycogen was degraded rapidly and was accompanied by an increase in tissue glucose and lactate concentrations.” Even your own citations show us that you aren’t telling us the whole story when you say that, “the glycogen to lactic acid conversion upon death is all really basic science, not in dispute by anyone.” Well, actually, it’s clearly more complex than you are letting on. Granted I already pointed this out to you in the beef industry time tables, which you dismissed.

            4) You stated that early Inuit researchers didn’t know what keto-adaptation was or how to test for it, however Joslin, Heinbecker, Rabinowitch, DuBois, McClellan and others all wrote about keto-adaptation and used a half dozen approaches to rule it out, including urine testing of acetone, diacetic, and β-hydroxybutyric acid; acetone bodies in the breath; respiratory quotient; as well as documenting protein intake. Their tests were sensitive enough to detect keto-adaptation in the Bellevue Experiment as well as in the Inuit during starvation ketosis, which they even mention in their writing.

            5) In the comments, you claimed early 20th century researchers did not know about the speed of glycogen degradation. However, the rapid degradation of glycogen at room temperature was how Claude Bernard discovered glycogen in the first place.

            From: Claude Bernard and The Discovery of Glycogen

            Discovery of Glycogen
            At this time Bernard’s estimations of the sugar content of extract of liver tissue were made in duplicate by titration with copper reagent of Barreswil, a modified Fehling’s solution. He relates (Bernard, 1865, pp. 2291-295) how one day he was pressed for time and was unable to make his duplicate determinations simultaneously. He made one estimation immediately after the death of an animal and postponed the other until the following day. The second estimation gave a value very much higher than the first, and the difference was so great that Bernard investigated the reason for this discrepancy. Hitherto he had not ascribed significance to the length of time which elapsed between the death of an animal and the determination of the sugar content of the liver tissue. He now found that time was of great importance. Immediately after the death of an animal the liver was found to contain very little sugar, but within only a few minutes the amount of sugar had substantially increased, and at the end of two hours a large quantity had usually made its appearance.

            So, from day one, glycogen was known to degrade rapidly. However, it was also known early on that glycogen in marine life was observed to degrade more slowly.

            From: Observations On The Glycogen Content of Certain Invertebrates and Fishes (1920)

            Until recently very little information existed concerning the presence of glycogen in the fishes. That some at least is present in the tissues of marine fish had been shown by Cl. Bernard, Pavy, Brücke, and others. It was stated by Bernard that this glycogen is unusually resistant to the influence of post-mortem changes, and that it does not readily disappear during hunger. During asphyxia, however, the glycogen rapidly disappears.

            We can see that it is well known that glycogen in marine mammals was observed to degrade more slowly. So, perhaps it should not come at a surprise that, in 1952, Marsh found that whale glycogen depletion to rigor mortis took an exceptionally long time, even at 98°F!

            And in the Simpson & MacLeod study you referenced, it clearly says, “It is well known that sugar accumulates as glycogen disappears when liver is allowed to stand after death.” So, again, we can see that you are not giving us all the details when you focus on muscle glycogen at room temperature. The literature is very clear that liver glycogen degrades to sugar, via post-mortem glycogenolysis, and this is what contributes to post-mortem blood sugars rising.

            6) Their glycogen intake is probably not even worth scrutinizing given the well-documented very high protein and moderate fat consumption in every published study.

            7) An article by Per Wikholm was published in this month’s LCHF Magasinet, where Per demonstrates that the Inuit could not have been in ketosis given that the scientific literature is abundantly clear, over and over again, that the Inuit consumed too much protein and not enough fat. And more importantly, Per debunks Stefansson’s claims for high fat with writing from his own books—Stef admitted in the pemmican recipes that Arctic caribou was too lean to support ketosis. And as the literature shows, the Inuit were saving their blubber and fat for the long dark Winter to power their oil lamps and heat their igloos. Again and again, we see that in the literature, as even Stefansson admits this.

            As was stated above, the most popular LCHF bloggers in Sweden, Andreas Eenfeldt/Diet Doctor and Annika Dahlquist have reluctantly agreed with Per’s findings—admitting that the Inuit were likely not ketogenic from their diet.

            8) You referenced a post by Bill Lagakos, on how “relatively” high protein consumption can be ketogenic, however the post clearly says that “Negative energy balance promotes ketosis even with relatively high protein intake…It was, however, a rather severe caloric restriction…The point is that high protein won’t ‘knock you out of ketosis’ if you’re losing weight.” In the comments of that post, Bill clarifies, “You can easily maintain ketosis with 30% protein if it’s divided into a few meals, and especially if there is a mild energy deficit. That’s how most of the studies in this post were designed (except Phinney 1983 which had no energy deficit). The participants in Phinney 1980 were able to get 50% protein and still maintain ketosis because of a larger energy deficit.” Phinney’s 1983 subjects were eating 45% less protein than the Inuit and twice the levels of fat, according to detailed measurements from Krogh & Krogh (1914) and Rabinowitch (1936). So, unless you can show that the Inuit were chronically starving themselves every day, or at the very least obtaining most of their calories from fat, Bill’s post doesn’t show us anything that relates to the observed Eskimo diet.

            I already showed evidence that the Inuit went through times when food was scarce, and this is why even in the early 1930s the Inuit were only shown by Heinbecker to be adapted to starvation ketosis. If your argument is that the Inuit were only in ketosis while they were starving, I would agree.

            9) I should point out that NOBODY is saying that they Inuit were a high carb culture. I have no idea where you ever got that idea from. In fact, nobody (not even Ho, 1972) is saying that the Inuit obtained 15%-20% of their calories from glycogen. The Kroghs clarified in their 1914 paper that glycogen accounted for a little more than half of the 54g/d of carbs in the diet (the rest was from bread and sugar, which had been available since at least 1855). That’s what Ho meant when he said “largely.” So, the estimation of glycogen is actually fairly low. But as far as I know, you are the only scientist to dispute the idea of dietary glycogen. In fact, the main reason marine fish evolved amylase is to digest the glycogen in the tissues of their prey.

            From: Amylase activity of fingerlings of freshwater fish Labeo rohita fed on formulated feed, by M.P. Bhilave (2014)

            “In fish amylase is needed to digest glycogen, an energy source which is found in animal tissue.”

            10) And let’s be clear here. I did not go out of my way to pick 20+ studies from Google to confirm a bias. I honestly could not find any studies confirming ketosis from the traditional diet of the Inuit. And I honestly could not find any reliable evidence that the Inuit consumed a high fat diet beyond Stefansson’s contradictory statements or Schwatka’s sledging diet. Even when we look at a dietary survey of Inuit food preferences (Free Download), we still don’t see a preference for high fat! The idea that the Inuit were eating a lot of fat is nothing more than a myth that Stefansson perpetuated. I challenge you to find scientific evidence that concurs with Stefansson. Even McClellan and DuBois admitted in the published literature for the Bellevue Experiment that their Western ketogenic diet did not replicate the Eskimo diet.

            Frankly, I find your post and follow-up comments to be more than a little ironic. Here I’ve been unable to find any evidence that the Inuit were in ketosis from their traditional diet, or that they even consumed a high fat diet. And I’ve found a large body of evidence showing that they have never been observed in ketosis or consumed large quantities of fat, and all you’ve done is casually dismiss 150 years of research, while only referring to Stefansson’s flawed observations. If that’s not the very definition of confirmation bias, I don’t know what is.

            As to why you are reluctant to accept 150 years of detailed research on the Inuit diet—while only accepting the words of just one explorer who was well known to lie and exaggerate—only one reason comes to mind. It seems, to me at least, that rather than showing an interest in what the scientific literature actually says about the Inuit, you are hoping that Stefansson’s loose observations absolve you from having to show long term safety of a LCHF diet. The evidence suggests that LCHF is the modern invention of white polar explorers who needed to pack lightly while sledging. Shouldn’t the long term safety of a diet rise to higher standards than the word of a controversial polar explorer? I should certainly hope so.


          • Late to the party but Duck – bravo. Eades wrote a couple of thousand words, maybe 2 dozen were directly relevant to what you wrote.

            You taught me a lot. Thanks, if you are still reading.

            Eades never stops teaching me, well, other things.

  51. Dr. Eades,

    I would like to help.

    Most scientific ideas are wrong. Most experiments are wrong,too, the first time they are done. This is not taught often enough.

    Please let me take on both Richard AND Duck Dodgers as a favor. ALL science can EVER do is say what is plausible. What is more or less likely. At best, highly likely or highly unlikely. It can show us what is wrong. We can know we are wrong, but never that we are completely right.

    Newton’s laws for planetary motion were found incorrect about the orbit of Mercury. This was spotted a few hundred years later.

    Correlations, in science, do not mean anything UNLESS there is an underlying principle that deeply explains the correlation.

    Evidence alone does NOT determine theory choice as Albert Einstein new very well. This is a VERY important point.

    I talk to some of the best science educators in the world . I would love to correct most of the Blogsphere’s misinformation about “laws.” They remain always provisional and always perfectible. Physicists fully expect them to be modified with further advancements. “Immutability” is not even remotely a characteristic of a “law.”

    All of these Internet gurus are so easy to expose. I will happily show the Blogospherte Duck Dodgers have extremely poor understanding of of science.

    Duck Dodgers has A LOT to learn about the basics of science. I greatly look forward to educating both Richard and Duck Dodgers. They both banned me.

    Take care, Dr. Eades.

    Best wishes,

    • Razwell

      No, Duck Dodgers does not have ‘extremely poor understanding of science’. He is very good, in my opinion. I have been examining his work, and I have the greatest respect for it. Just as I have for CarbSane’s work, which you similarly rubbish.

      Jane Karlsson PhD