A couple of days ago the New York Times featured a front page article entitled So Big and Healthy Grandpa Wouldn’t Even Know You about how today’s people are so much larger and healthier than their predecessors from several generations back.
The piece describes research showing how most people from the Civil War era were much less healthy and much smaller than their descendants alive today. Researchers looked at a sample of about 50,000 Union Army veterans using not just the death certificates of the men involved, but

…the daily military history of each regiment in which each veteran served, which showed who was sick and for how long; census manuscripts; public health records; pension records; doctors’ certificates showing the results of periodic examinations of the pensioners…

and compared them to men of the same ages but living today. As you might imagine, those living today are considerably larger, but that’s not the only difference.
They discovered that almost everyone of the Civil War generation was plagued by life-sapping illnesses, suffering for decades. And these were not some unusual subset of American men — 65 percent of the male population ages 18 to 25 signed up to serve in the Union Army. “They presumably thought they were fit enough to serve,” Dr. Fogel [the primary researcher] said.

Even teenagers were ill. Eighty percent of the male population ages 16 to 19 tried to sign up for the Union Army in 1861, but one out of six was rejected because he was deemed disabled.

After the war ended, as the veterans entered middle age, they were rarely spared chronic ailments.

“In the pension records there were descriptions of hernias as big as grapefruits,” Dr. Costa said. “They were held in by a truss. These guys were continuing to work although they clearly were in a lot of pain. They just had to cope.”

Eighty percent had heart disease by the time they were 60, compared with less than 50 percent today. By ages 65 to 74, 55 percent of the Union Army veterans had back problems. The comparable figure today is 35 percent.

A series of charts published with the article shows the remarkable difference in size and longevity between men of that era and those alive now.
Click here to view image
A few weeks back I posted on the difference between the size of Revolutionary War re-enactors and actual Revolutionary War soldiers and was taken to task by at least one commenter for my lack of taste and/or sensitivity in posting a picture of an obese man and calling him obese. This time the New York Times and the subject himself (“we’ve ballooned up,” said he) do the dirty deed so that I can be held blameless.
NYT obesity then and now.bmp
Why this huge disparity in health and size? According to the article much has to do with early sickness and state of nutrition. There are a number of researchers today looking at the idea of fetal programming, i.e., what happens to the fetus as a function of the mothers diet, smoking and health status. Based on a considerable amount of research it’s looking like the mother’s diet during pregnancy has a whole lot to do with what happens to the fetus long after birth and even into middle and old age. Babies who are malnourished (or inappropriately nourished) during their time as a growing fetus end up developing problems with obesity and heart disease later in life. According to my reading on the subject the optimal dietary steps a pregnant woman should take are to reduce consumption of refined carbohydrates during the first trimester and increase protein intake significantly during the last trimester. Why? The first trimester is when the fetus is forming many of its organs, including its pancreas. The volatile blood sugar and consequent insulin swings refined carbohydrate intake occasions in the mother are transmitted to the fetus, who then develops a pancreas filled with beta cells that are less sensitive. In other words, the fetus develops a pancreas that is prone to insulin resistance even prior to birth. The rapid growth of the fetus in the last trimester demands a lot of protein. If the protein is provided in the diet, then the fetus gets plenty for normal growth and doesn’t have to rob from the mother creating a situation where both may be damaged.
It’s my guess that many of the problems these Civil War veterans experienced were a consequence of fetal malnutrition compounded with adult malnutrition. In going back through some of my reference books on early diet I came across the first rigorous study of the English diet performed back in 1862-1863. This study, performed by a Dr. Edward Smith, proves to be extremely enlightening and deserving of a post all of its own, which it will get in due course. Although a comparison of the diet in England is not a direct apples to apples comparison to the American diet of the same time, it’s probably pretty close. And since England was further down the Industrial Revolution road than America at the time, the English diet, if anything, was probably a little better than the American diet.
Dr. Smith took a detailed dietary history of a number of English families whose members worked either indoors or outdoors, with the outdoor workers being, presumably, those doing the most physical labor. He broke the diets down into a number of specific food types, which gives a pretty good indication of dietary quality.
It turns out that bread was the principal food for all groups, with the average being somewhere between 12 to 16 ounces per day and contributing approximately 40 percent of calories. Most of the bread consumed was purchased, not home baked.
Apart from the wheat in bread, no other cereal grains were eaten in any significant quantities.
Potatoes were considered ‘dear food,’ were difficult to come by, and were consumed in extremely small quantities and not very often. Cabbage, another major vegetable in the diet of the time, were eaten even less frequently than potatoes. Onions were ‘used very extensively and give a savoury relish when bread is the chief article of which the meal is composed.’
The average consumption of milk was just under a quarter pint per day, with the indoor workers getting only about half that amount.
Most people ate meat only a couple of times per week giving an average daily consumption of 2 to 3 ounces.
On average, under a half ounce of cheese was eaten per day and one egg was eaten every two or three days.
About an ounce of sugar per day, or about 6 teaspoons, was the average consumption.
And total fat, excluding that found on meat or in cheese, was about three quarters of an ounce per day and was typically fat saved from cooking meat and only very occasionally butter.
Dr. Smith describes a typical Sunday meal:

Universally, the dinner on Sunday is better than that on other days, because, in many instances, in addition to other reasons, it is the only dinner at which all the members of the family can assemble.

The meat or the bacon, when the whole quantity is small, as 2 lb. to 4 lb., [for the entire family] is commonly cooked for this dinner, and all partake of it. What is left is reserved for the husband, who either takes a little portion with him for his dinner daily, or eats it at home; and it is remarkable that this is not only acquiesced in by the wife, but felt by her to be right, and even necessary for the maintenance of the family. The remark was constantly made to me , ‘that the husband wins the bread, and must have the best food.’ If the family be thrifty, the husband will have a morsel of meat or bacon daily throughout the week, but in other instances the whole is consumed in the first two, three or four days. The important practical fact is however well established, that the labourer eats meat or bacon almost daily, whilst his wife and children may eat it but once a week, and that both himself and his household believe that course to be necessary, to enable him to perform his labour.

It’s pretty easy to see that with this kind of diet most people would be be small. The pregnant mothers aren’t going to be able to provide the necessary nutrients for optimally healthy babies. The babies born were fetally programed to develop heart disease and obesity, but couldn’t become obese because they never got enough to eat. And it’s easy to see that adults who were malnourished as fetuses and continued to be malnourished through childhood and adulthood would be more sickly and be prey for every bacteria and virus that came down the path.
Paleolithic man, who ate plenty of meat, was large and robust with a greater bone cortical thickness than we have today. It’s only been in the last generation that we have caught up size-wise to our ancestors of a hundred thousand years ago. Why? Because for the first time since the advent of agriculture meat has become relatively cheap and plentiful. During the time of Dr. Smith’s study the average family spent somewhere in the range of 50 to 60 percent of income on food, and you’ve seen what they got for their money. According to government statistics we today spend on average about 14 percent of our household income on food. And look at what we get for our 14 percent compared to their 50 percent. It’s no wonder were fat and comparatively healthy while they were thin and sickly.
We’ve got two extremes. They were suffering from undernutrition; we are suffering from overnutrition. If you’ve got the choice, take overnutrition, especially coupled with antibiotics and all the other marvels of modern medicine.
But just because overnutrition makes you bigger and stronger and allows you to live longer than chronic starvation, it isn’t optimal nutrition. Optimal nutrition, in my view anyway, is plenty of good quality protein, plenty of good quality fat, and easy on the carbs. Remember, the human body requires protein and it requires fat; it requires no, zero, nada carbohydrate. As I’ve said at least ten thousand times, it makes no sense to me to load up on what we don’t need at the expense of what we do need.
Our Civil War era ancestors were on a high-carb, low-protein, low-fat, low-calorie diet and it didn’t do them a lot of good. Don’t make the same mistake when you can afford to do a whole lot better.


  1. I just listened to a lecture by Dr. Ken Fine, from Enterolab.com, talking about how something close to 30% of us have the antibodies to gliadin in our intestines. I wonder how much of the malnutrition back then was due to eating so much bread, and causing subsequent damage to the small intestine. Although, I must say, their diet sounded pretty awful.
    Hi Nancy–
    I’m quite sure that a lot of it came from their large consumption of bread. Their diet sounded awful, indeed.

  2. Dr. Mike, Please run some photos of scantily clad women eating meat — just make sure they are fit and trim so they won’t be embarrassed by a photo appearing on the web for all the world to see. And to be on the safe side, you should probably say nice things about them too. Maybe you could mention how nice it is to see that they’ve had such good returns on their high protein diet. I’m sure that will put a stop to any more comments about your lack of taste and sensitivity.
    Hi James–
    I already posted one. See the first photo in the Eades/Cordain picnic blog. Right in the middle is a scantily clad woman eating meat. And you’re right; I’ve had no comments about my lack of taste and sensitivity since. Maybe you’re on to something.

  3. Thank you for reinforcing my gut instinct to follow PP while pregnant. I ate plenty of protein and good fats, very little carbs. I do the same now that I am nursing. I have a very healthy 3 month old little boy. I wish I had found PP before my other 2 children were born.
    Now, I think I’ll go eat a steak..
    Hi Jenny–
    One thing I would change about PP during pregnancy would be to add more colorful fruits and vegetables to the regimen of meat and good fats.
    Thanks for writing.

  4. I look forward to the full post about Dr. Smith’s findings–so much for the belief that the British ate three things, beef, bread, and beer. More like bread, bread and bread.
    Not to jump the subject track, one thing I’ve always been curious about is that Paleolithic man is always touted as being big and strong due to the high-protein diet, but didn’t he also die young? I remember in my anthropology classes in college life expectancy 100,000 years ago was late twenties or early thirties. Was this a falsehood or were their other factors involved? Low-carb has worked swimmingly for me but I have a friend who’s terrified that if she eats like a cave person she’ll be dead in five years.
    Hi Patricia–
    Actually the Brits in Dr. Smith’s study did drink some beer, but not nearly as much as would be expected.
    The idea that Paleolithic man died early is a misconception. In fact, it’s such a misconception that I’ll probably blog about it in detail in due course. Studies of the lifespan of early man have shown that some individuals lived as long as we do today. The overall shortness of mean lifespan came as a result of their extremely hostile environment as compared to ours today. An early 20th epidemiologist studying the differences in aging between whites and Native Americans who lived in the same area found that their were about 20 Native American centenarians to every white centenarian. At the time the Native Americans were still living a Paleolithic lifestyle (or at least the centenarians had been for most of their lives). So, in brief, the old argument that it doesn’t matter what was healthy for Paleolithic man because he died young doesn’t really hold water.

  5. Sir any thoughts on thinning hair and insulin as it seems to be implicated from what i’ve read ?
    Thankee kindly
    Hi Simon–
    There is indeed evidence that hyperinsulinemia causes apical (on the crown of the head) baldness. I don’t know that anyone knows the mechanism.

  6. “Eighty percent had heart disease by the time they were 60, compared with less than 50 percent today”.
    The following is from �The Skinny on Fats� from Mary Enig, PhD, and Sally Fallon on The Weston A. Price Website.
    Before 1920 coronary heart disease was rare in America; so rare that when a young internist named Paul Dudley White introduced the German electrocardiograph to his colleagues at Harvard University, they advised him to concentrate on a more profitable branch of medicine. The new machine revealed the presence of arterial blockages, thus permitting early diagnosis of coronary heart disease. But in those days clogged arteries were a medical rarity, and White had to search for patients who could benefit from his new technology. During the next forty years, however, the incidence of coronary heart disease rose dramatically, so much so that by the mid fifties heart disease was the leading cause of death among Americans. Today heart disease causes at least 40% of all US deaths.
    So which is it? Was heart disease rare due to early death from infectious diseases or was it not noticed due to poor statistical reporting or is Dr. Fogel incorrect in his statistics? Another possibility is the extreme stress of war, especially the Civil War, also contributed to heart disease. My readings on the subject indicated that foot soldiers in the civil war lived in very poor conditions and thus may not be suitable subjects as a typical American male of the 19th Century.
    As always thanks for the time and space.
    P.S. There’s a discussion of the limitations of statistical reporting on the Cholesterol Skeptics website at http://www.thincs.org/discuss.April02.htm.
    Hi Mark–
    A couple of things. First, there is a fair amount of controversy over whether or not heart disease was common in the late 19th/early 20th century. Heart disease (we’re talking myocardial infarction, i.e., heart attack) is typically a disease of older people. When lifespans are short due to infectious diseases and trauma–as they were in those days–many people die before they are able to have a heart attack. As people start living longer–thanks to antibiotics and good trauma care–they live into the ages where they do have heart attacks. Also, there is some speculation that, since the first symptom of an acute heart attack is sudden death in a third of the cases, deaths from heart attack were undiagnosed and underreported. In fact, I’ve heard some of my ancient relatives–before they passed on–talk about how so and so took such and such medicine and fell over dead. I’m sure in many cases like these that so and so was feeling some measure of discomfort from the early stages of an MI, took a dose of something for it, and succumbed to sudden death. I don’t really have an opinion on whether or not heart disease was as rampant 100 years ago as it is today because I haven’t looked into it in depth and so don’t have a firm opinion. I am pretty sure that the famous Scottish surgeon John Hunter died of a heart attack in 1793 at the age of 65. He had experience several years of classic angina, crushing substernal chest pain, whenever he became agitated, leading to his famous remark: “I’m at the mercy of any rogue who chooses to provoke me.” He ultimately had the big one.
    I should have mentioned it in my post, but I believe the heart disease most of the post-Civil War subjects of this study had was probably congestive heart failure or so-called dropsy, which can also occur with protein malnutrition. I doubt that they had myocardial infarction type heart disease.
    Also, the men that were the subjects of this study fought in the Civil War but were studied using their medical information from then along with their medical information throughout their lives. Presumably, after the war their living conditions improved considerably. If my living conditions now were the same as they were when I was in college, God only knows what kinds of health problems I would have.

  7. The picture used to show the difference between what someone would look like now compared to then is a bit unfair.
    The original Civil War man was around 20 years old when the picture was supposedly taken whereas the current soldier is 55 years old.
    Many 20 year olds when they reach the age of 55 will look like the current soldier.
    Hi Ron–
    That’s a valid point. The article pointed out that the 55 year old man was larger in every dimension, not just in belly size. Pictures of average people back then–even at age 55–show most of them to be non-obese, even slim.

  8. Although the civil war vet was small, was he lean? I’m guessing not. I know a person who is small, yet when he takes off his shirt, he has a gut, and looks like his bodyfat is high. He is on statins, eats the low fat/high carb diet, and believes he is eating right. His doctor and dietitian tell him what to eat, I can’t convince him otherwise. I also can’t get him to weight train either. My wife and I call this group the “skinny-fat guys”.
    Hi Audley–
    Given the diet the Civil War soldiers followed, I would imagine that the guy pictured was mainly skin and bones.
    I’ve seen many people like your friend, and ‘skinny-fat guys’ is a good name for them. The old saying that you can lead a horse to water but you can’t make him drink certainly applies to these people.

  9. I also hear the argument about the short lifespan of Paleolithics. Your reply makes sense to me but it is not the conventional wisdom. To shore up my defense of my “wacky new diet” as well as satisfy my own curiosity, I would like to read more on the Paleolithic human diet and physical development. Any books or published research you could recommend that would help fill in the gaps? Much obliged!
    Hi Jeff–
    As far as aging and Paleolithic man goes, take a look at the book Why We Age by Steven N. Austad. It is an excellent book on aging and, I think, deals with the aging of early man. I say I think because I’m in the middle of rearranging my books right now and can’t lay my hands on my copy to check specifically. If it’s not in the book, then it’s in one of his many papers. Even if it is not in the book, the book is by far the best book I’ve ever read on aging.
    To read a ton of stuff on Paleolithic man take a look at the following website:
    This website contains a wealth of information on all aspects of the Paleolithic diet. But, beware, it is, like virtually everything on the web, subject to double checking.
    Have fun–

  10. “An early 20th epidemiologist studying the differences in aging between whites and Native Americans who lived in the same area found that their were about 20 Native American centenarians to every white centenarian. At the time the Native Americans were still living a Paleolithic lifestyle (or at least the centenarians had been for most of their lives). So, in brief, the old argument that it doesn’t matter what was healthy for Paleolithic man because he died young doesn’t really hold water.”
    would you provide this reference? this is a great stat.
    thanks much…
    I don’t have the reference. If anyone does, I would love to see it. If someone has the citation, let me know, and I’ll be able to retrieve it and make it available to all.

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