The Sami paradox or how to dismiss a traditional low carb, high protein diet

 

This blog post concerns the Nordic, aboriginal Sami diet and health. The traditional Sami diet can be summarized as a mainly animal based, paleo diet with some fat reindeer milk added to it. I will focus on three recent documents, a dissertation/thesis on Sami diet and health, a document from the Sami Council on traditional Sami cooking and a recently conducted radioisotope analysis of a 500 year old skeleton of a Sami woman.

Recently a Swedish observational study made headlines throughout the world. It claimed that every bite of protein that replaced a carbohydrate bite would kill you off earlier compared to high carb eaters. Denise Minger has dissected that study here. http://rawfoodsos.com/2012/07/01/bad-science-strikes-again/

But here is the funny thing: The aboriginal Swedish Sami population has been eating a low carb and a very protein rich diets for millennia One estimate is about 20 E% carbs, 47 E% protein, 33 E% fat. Even if I consider this specific estimate overestimating the protein content compared to the fat content, the traditional Sami diet was no doubt a high protein diet. Samis have for centuries been renown for their good health, longevity and vitality and by the mid 20th century they had 50 % less frequency of cardiovascular disease/stroke compared to ethnic Swedes.

There are even earlier reports on the exceptional Sami health. This one is from S Rehn in 1671:

And as they are not known to be struck by serious diseases, thus they live to a high age, some to 70, 80, 90 or 100 or more and in their old age they are agile, quick to do their daily tasks and to travel and run in the woods and over land. They seldom get gray hair.”

Another report comes from one of the greatest scientist in Swedish history, Carl Linnaeus http://en.wikipedia.org/wiki/Carl_Linnaeus the inventor of Systema Naturae, the system for classifying different species and families of plants and animals, still used to day. In 1732 he made his six month long trip to Lapland in northern Sweden where he studied its biology and its people.

Picture: Linnaeus depicted on the Swedish 100 Crown bill)

 

 

Picture: A much younger Linnaeus on his travel to Lappland in a traditional Sami dress.

In the quote from Linnaeus, he uses the term “Lapp” to describe a Sami. That was the term used in his time and I have kept it in my translation even though the word “lapp” in modern Swedish is about as politically incorrect as describing African Americans with the n-word. Anyway this is what he had to say about Sami diet and health compared to an agriculturalist, South Swedish diet:

 “A Northern Lapp lives only of meat, fish and poultry and hence becomes small, thin, light, nimble. A farmer, however, in Sweden’s southern provinces of the Skåne plains, eating peas, very much buckwheat porridge, and whose diet consists mostly of vegetable flour dishes, becomes tall, well built, stiff, strong and then heavy [meaning overweight/obese] ”

 “The Northern Lapp does not eat bread but is an example of good health. I saw old men about 60 years of age running around in the mountains like children, even able to put their foot on their necks. My conclusion is that it is because the absence of bread. Everyone eating bread has an obstructed stomach.

 Now isn’t that just amazing? About two hundred years before anyone knew about carbohydrates and it’s effect on insulin and IGF-1, Linnaeus correctly observes a correlation between carbohydrates, height and obesity later in life. He also observes a correlation between bread, stiffness and problems with the gastro intestinal tract. I would really like to have Linnaeus with us today, discussing bread on a prime time TV-show together with Dr William Davis or posting on his Wheat Belly Blog. Linnaeus and Rehn described early what is the Sami paradox – a bread free, animal based, low carb diet leading to longevity and good health.

Recently a thorough analysis including isotope analysis was performed on a 500 year old Sami female skeleton from Gransjön, Jämtland. The reserchers conluded that she did not have any sign of dental karies in her teeth or show any signs of iron deficiency, both conditions that was very usual among people in the cities from the same time eating a high carb, grain based diet. The isotope analysis were also consitant with a quite low carb, animal based diet. It showed, by analysing teeth that form during different time in childhood and analysing the skeleton wich renews itself every 15 years, that her diet went more carnivorous as she aged. The findings were also in line with a diet of animal sorces from both land and sea.

So just like the conventional wisdom of dieting has had to deal with the French, the Swiss, the Massai and the Israeli paradox they had to face the Sami paradox – How can a population eating a low carb, high protein diet be so healthy? Well, the answer is of cause that you pick data from an observation study in the 21st century when practically no one is eating a true Sami diet any longer and reach the conclusion that the Sami diet had nothing to do with their good health.

Now before we get started on this subject, let me declare that I am not a proponent of a high protein diet. My current opinion is that people who are overweight or/and have metabolic syndrome/diabetes/pre-diabetes do better on a low carb, high fat diet (LCHF). I do however believe that a high protein diet based on whole foods can be a healthy diet for people without any metabolic condition (and without any condition that impairs kidney function).

Now let´s start. The original Sami diet, what was it? The Sami people are most renown for their reindeers but probably for most Samis, many of which did not keep reindeers at all, hunting and especially fishing, mainly trout and other fatty fish, made up the bulk of the diet. It is also worth noting that reindeer herding changed a lot during the 20th century from small scale focusing on keeping reindeers for milking them to larger herds geared toward meat production.

Reindeers produce small amounts of milk compared to cows but it is a lot fatter.

 

The Sami lives in an area called Sapmí in the North of Sweden, Norway, Finland and parts of the Kola peninsula in Russia.

Many still lives in the Northern part of Sweden but most of the Sami has adopted a western lifestyle and I have anecdotally been told that the Swedish municipality with the largest Sami population at present is Stockholm City, the capitol of Sweden. There is no way of knowing for sure since ethnic registration in public records was outlawed in Sweden after the second world war, for obvious reasons.

Anyway, the Sami people lived far up North in Sweden, from about the latitude of Anchorage, Alaska and further North, somewhat warmer than Alaska thanks to the warmth from the Gulf stream, without many edible vegetables or fruits. Among the few edeible vegetables were Angelica .

Both the green parts and the root were eaten. It was also used as a preservative for storing reindeer milk in buried containers to ferment in the chill mountain ground. The inner bark of the pine tree were processed and eaten as a vitamin C supplement. A lot of different herbs were used for medical purposes and for making tea.

Edible berries included blueberries, buckthorn (very rich in vitamin C), lingonberries (lingonberry jam might be found at your nearest IKEA store) and the amber colored cloud-berries (make sure to try it if you ever visit Sweden, Norway, Finland, Northern Russia, Canada or Alaska). Lingonberries and cloud-berries contains natural, acidic preservatives that makes them easy to store for quite a while.

 

Actually, there is an indigenous Sami word for grain flour so it is possible that some kind of wild grain have been harvested in small amounts even in ancient times. In more recent history Samis traded small amount of grain flour from the surrounding agriculturalist. From the flour they made unleavened bread and some blood dishes. Leavened breads only became popular quite late at the end of the 19th century.

Still, there were not that many carbs around. No Seven Eleven to stop by for a quick snack flushed down with a Big Gulp of sugary soda while herding your reindeers on the mountain. The traditional Sami diet was low carb by default with no need to send out food frequency questionnaires to confirm it.

 Now this lengthy post [Yes, You ain't seen nothing yet!] is mainly based on three documents:

1. “Sami lifestyle and health – epidemiological studies from northern Sweden”a recent dissertation by Lena Maria Nilsson, Umeå university, available in English full text here: http://umu.diva-portal.org/(The abstract is also available translated to Swedish and four Sami languages.)

 2. “Samisk mat” [Sami food], a document in Swedish published by the Swedish Sami Council at http://www.samer.se/3539 documenting traditional, animal based Sami food. Unfortunately it is only available in Swedish but I guess you could read similar descriptions of how the whole animal was used for food, clothes and shelter in documentation of native Americans and Canadians use of the bison and the caribou. Nothing was wasted. (Wikipedia has a page on modern Sami cuisine)

2. The isotope analysis of a 500 year old, female skeleton from Gransjön, Jämtland made by archaeologists Marcus Fjällström and Gunilla Eriksson It is also in Swedish and not online: http://su.diva-portal.org/smash/record.jsf?pid=diva2:503244

Any one interested in paleo and low carb diets should read the very informative first parts of Lena Maria Nilssons thesis that describes the background about Sami diet and health. I think she has done some really important job in interviewing a old Sami people about what the Sami diet was like in 1930-1950, information that would have otherwise been lost forever. One of the important findings is that fat fish played a far greater role in the Sami diet than has been assumed for long time. It was assumed to consist mainly of reindeer meat and offal. The rest of the thesis are about recently conducted observational studies that I think are quite meaningless, trying to link Sami dietary patterns to Viagra health in a time when there is almost no one eating a traditional Sami diet any longer.

During the 20th century the Samis were getting more and more integrated/assimilated into the society dominated by “ethnic Swedes”. Their diet gradually became more similar to the standard Swedish diet. Their children went to school and later kindergartens where Swedish high carb foods were served. Consumption of fat fish among the Samis declined as did consumption from offal from reindeer and hunted animals.

he expansion of hydroelectric power plants and dams in most of the major rivers in the north of Sweden probably contributed to making it harder to sustain a diet based on fat fish. The tradition of milking reindeers ended about the mid 20th century. The same changes in diet that happened to the “ethnic” Swedes in general also effected the Sami population. Sugar consumption increased dramatically and so did the quality of grain based products. Highly processed white wheat flour with a higher glycemic index and more starch, milled with steel rolls gradually replaced grains like rye, barley and oats milled with stone-rolls. Leavened bread replaced unleavened bred to a large extent.

Now here is where I think Nilssons thesis comes crashing down. She finds some dietary pattern that are still more frequent in the Sami population compared to other Swedes in general, such as a higher (but not as high as before) consumption of fatty fish and a lower intake of bread, fibre and vegetables (but not as low as before). From this she creates a Sami diet score system similar to the Mediterranean diet score. By the way this score also includes consumption of boiled coffee. For some reason the Samis got the taste for coffee when it was introduced in Sweden in the 18th century and begun consuming it in high quantities. Swedes in general drink brewed coffee but Samis are more likely to drink boiled coffee

But if we leave the coffee aside, the big problem is that you can’t investigate the health potential of a Sami diet when it no longer exists. Studies from the mid 20th century, while most Samis still had eaten a traditional diet for the better part of their lives showed a clear health benefit when it comes to western diseases like cardiovascular disease and most cancers.

More recent studies show that lifespan and health of Samis and “ethnic Swedes” has now converged. In her thesis Nilsson is quick to draw the following conclusion from that fact: “The relatively good health status of the Sami population is therefore probably not attributable to the studied aspects [diet] of the “traditional Sami” lifestyle…”

Here are my major objections to that conclusion. My hypothesis would rather be something like this: As long as the Samis stayed on a diet that could actually be described as a traditional Sami diet, they staid healthy, in fact a lot healthier than “ethnic” Swedes. As their diet deteriorated and became more like the standard Swedish diet with a lot of sugar and grains the Sami health started to deteriorate even faster then when “ethnic Swedes” ate a similar diet.

The thing is that Samis are aboriginal people with a long history of a hunter and gatherer diet kind of living. The scientific debate goes on and the jury is still out on this one, but today it seems more likely that the spread of agriculture to the Nordic countries was not only a spread of memes (ideas) but also a spread of genes… or to put it in another way, the invading agriculturalists from the south, the Fertile Crescent of the Middle East to a large extent replaced the hunter and gatherers that had lived in Northern Europe before.

 According to DNA research “ethnic Swedes” has, just like almost all people in Europe, substantial genetic traits that points to major influence from agriculturalist from the Fertile Crescent (one exception to this is the Finnish people who show relatively low genetic influence from agriculturalists and whose language is related to the different Sami languages). The Sami people does not show genetic influence from the early agriculturalists and DNA research suggest that they are decendents of hunters and gatherers.

The reasons this is important in this discussion is because there is some evidence that the early agriculturalists from the Fertile Crescent seems to have required some genetic adaptations to eating a grain based diet and still stay relatively healthy for most of their lives.

Aboriginal hunters and gatherers on the other hand seem to be less adapted to eating a grain based and sugary Western diet. They are much more prone to get Western diseases like diabetes, cardiovascular disease and cancers earlier in life when they eat a Western diet. Jennie C Brand-Miller, an Australian researcher famous for her research on glycemic index (GI) and glycemic load (GL) has put forward her carnivore connection hypothesis to explain this phenomena. The hypothesis postulates that insulin resistance might have provided an evolutionary advantage for hunter and gatherers eating a low carb diet, but today is detrimental to their heath when eating a Western diet.

So even if there still are some vague traces left from the traditional Sami diet in the modern Sami diet such as a somewhat higher consumption of fish and meat, the higher content of easily digestible carbs in the modern Sami diet might very well be more detrimental to Sami health, even though it is still somewhat lower in carbs than the standard Swedish diet. The modern Sami diet has simply hit its carb roof where it is equally detrimental to Sami health as the somewhat higher carb diet is to “etnic Swedes”. If you believe there is some relevance to Brand-Miller’s carnivore connection hypothesis then the Sami health may soon very well be worse than that of ethnic Swedes as traditional Sami food patterns give way for the standard Swedish diet.

The reason this has yet not happened might be that the reindeer herding Samis have had at least some protection in Swedish law making it somewhat easier for them to maintain a more traditional lifestyle and food pattern while many other aboriginal people in different parts of the World have been forced to abandon their traditional lifestyle and diets.

A nomadic, herding lifestyle clashes with the Western, capitalist concept of owning land. (Oops, did I just loose some GOP and libertarian readers there?). Even if the reindeer herding Samis have the basic right to herd their animals where reindeer herding has been practised since ancient times it is often difficult to prove when landowners refute it since the Samis has not kept public records dating back hundreds of years. The efforts to preserve the wolf population in Sweden also effects the reindeer herding.

In 1986 the North of Sweden was hit hard by the radioactive fallout from the Chernobyl nuclear plant accident in Ukraine. Most of the reindeer meat and berries were declared unsuitable for human consumption for many years. The government provided some basic economical compensation for this disaster but it was a hard blow to the reindeer. (Worth mentioning here is that native American/Canadian tribes in an act of solidarity sent emergency relief to the Samis consisting of meats and berries.)

 The traditional Sami diet and its effect on health deserves a more thorough investigation. We have enough historical records pointing to it beeing a more healthy diet than the currently recommended, grainbased My Plate diet. To simply dismiss the traditional Sami diet as having nothing to do with good health, based on uncertain, observational studies made in a time when practically no one eats it any longer, is both unwise and disrespectful.

The Sami diet deserves to be investigated in a conclusive interventional study. An small intevention study has been made in Australia where aboriginal people that were diabetic and obese was put back to their traditional hunter and gatherer diet. It showed that their health improved. A similar study has been made in Vancouver, Canada among native Canadians and it’s been described in the film ”My Big Fat Diet”.

Sadly Sweden has a long tradition of disrespect and full blown racism towards the Samis. In the Swedish encyclopedia ”Nordisk Familjebok”, present in every Swedish school during the early 20th century, Samis were discribed as greedy, stubborn, suspicious, hunched backed and walking in a silly, wagging way, having protruding ears, unpleasent squeaky voices, ugly, filthy and smelling bad.

So even if nazism never went big in Sweden and we were by pure luck not invaded by Hitler, we still have our share of a dark, racist past. In fact Sweden was the first country in the World to start a governmentally funded institute for racial biology in 1922. They went on to do measurements of head circumference of both living Samis and plundering some Sami graves while at the task of proving white, Caucasian superiority.

 But to finish this long blog post in a positive way, there is hope. The 500 year old female Sami skeleton was tuned back to the local Sami community to be reburied after the isotope analysis that learned us a lot about the traditiona Sami diet and health was concluded. In 2006 a Swedish museum finally decided it was time to return a totem pole stolen from the Haisla tribe in Canada and the Swedish NHL Hall of Fame ice hockey player Börje Salming, a long time player for Montreal Maple Leaves and of Sami decent was chosen as one of the people to return it.

The traditional Sami diet, as well as other aboriginal diets effect on health, deserves to be tested seriously in high quality, interventional, scientific studies head to head with the grain based diet that is today recommended throughout the world by authorities.

/Per Wikholm

PS. OMG… How could I forget I should have ended this post with this amazing cartoon by Jenny Holmlund?

Picture:  Sami mom: “Look children, an ethnic Swede!”

Sami boy: “Is it true you live in over leveraged houses?” [mortgages far over their real value]

Sami girl: “And that all your clothes are made by children on the other side of the Earth?”

Sami boy: “And that you only eat industrial processed foods?”

One thought on “The Sami paradox or how to dismiss a traditional low carb, high protein diet

  1. Strålande bra ;-) (som vanligt)
    Självklart måste kosten, och dess effekter, sättas i samband med om den faktiskt ingår i dagens menyer. Att kolla på samers matvanor idag ska inte blandas samman med hur samer åt för hundra år sedan, eller m.a.o. hur samer mår idag ska inte skyllas på hur samer åt för hundra år sedan.
    Jag tror även som du att ursprungsbefolkningar, samer, aboriginer m.fl. får betydligt större problem av västerländsk kost eftersom de haft kortare tid på sig att anpassas till denna.

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