Category Archives: Paleo Theory

I’ve Never Had Much Interest in the Kitavans…

…but maybe you have.

If so, click over to Science-Based Medicine for Dr. Harriet Hall’s thoughts on them and Staffan Lindeberg’s seminal nutrition study. This is her second recent post on ancestral diets (aka paleo). A snippet:

I am always suspicious of initial reports of unusually healthy or long-lived groups in remote areas, because I have so often seen such reports disconfirmed by subsequent investigations. Lindeberg’s studies were done in the early 90’s and have not been confirmed by other studies in the ensuing two decades. In the Kitava study, the ages of subjects were not objectively verifiable, but were estimated from whether or not they remembered significant historical events. The absence of heart disease and stroke was deduced by asking islanders if they had never known anyone who had the symptoms of either condition. This was reinforced by anecdotal reports from doctors who said that they didn’t see those diseases in islanders. EKGs were done on the Kitavans, but a normal EKG does not rule out atherosclerosis or cardiovascular disease. I’m not convinced that we have enough solid data to rule out the presence of cardiovascular disease or other so-called “diseases of civilization” in that population.

You can guess where this is going.

Dr. Stephan Guyenet chimes in with cogent comments.

Read the whole thing.

A Theoretical Framework For Evolutionary Medicine

paleo diet, Paleolithic diet, hunter-gatherer diet

Huaorani hunter in Ecuador

If you’re scientifically inclined, you’ll enjoy perusing the following article. Otherwise, quit now before it’s too late.

Lifestyle and nutritional imbalances associated with Western diseases: causes and consequences of chronic systemic low-grade inflammation in an evolutionary context,” by Begoña Ruiz-Núñez, Leo Pruimboom, D.A. Janneke Dijck-Brouwer, and Frits A.J. Muskiet. It’s in the Journal of Nutritional Biochemistry, vol. 24, issue 7, pp. 1183-1201. http://dx.doi.org/10.1016/j.jnutbio.2013.02.009,

Here’s the abstract:

In this review, we focus on lifestyle changes, especially dietary habits, that are at the basis of chronic systemic low grade inflammation, insulin resistance and Western diseases. Our sensitivity to develop insulin resistance traces back to our rapid brain growth in the past 2.5 million years. An inflammatory reaction jeopardizes the high glucose needs of our brain, causing various adaptations, including insulin resistance, functional reallocation of energy-rich nutrients and changing serum lipoprotein composition. The latter aims at redistribution of lipids, modulation of the immune reaction, and active inhibition of reverse cholesterol transport for damage repair. With the advent of the agricultural and industrial revolutions, we have introduced numerous false inflammatory triggers in our lifestyle, driving us to a state of chronic systemic low grade inflammation that eventually leads to typically Western diseases via an evolutionary conserved interaction between our immune system and metabolism. The underlying triggers are an abnormal dietary composition and microbial flora, insufficient physical activity and sleep, chronic stress and environmental pollution. The disturbance of our inflammatory/anti-inflammatory balance is illustrated by dietary fatty acids and antioxidants. The current decrease in years without chronic disease is rather due to “nurture” than “nature,” since less than 5% of the typically Western diseases are primary attributable to genetic factors. Resolution of the conflict between environment and our ancient genome might be the only effective manner for “healthy aging,” and to achieve this we might have to return to the lifestyle of the Paleolithic era as translated to the 21st century culture.

I encourage you to read the whole article if you’re interested in such things. I’ll only mention certain concepts in this post if I want to learn or remember them for my own purposes.

The authors stress our large brains’ constant need for energy from glucose. This is how they explain our propensity to develop insulin resistance:

A glucose deficit leads to competition between organs for the available glucose. As previously mentioned, this occurs during fasting [and starvation], but also during pregnancy and infection/inflammation. Fasting is characterized by a generalized shortage of glucose (and other macronutrients), but in case of pregnancy and inflammation we deal with active compartments competing with the brain for the available glucose, i.e., the growing child and the activated immune system, respectively. During competition between organs for glucose, we fulfill the high glucose needs of the brain by a reallocation of the energy-rich nutrients, and to that end, we need to become insulin resistant.

During starvation and times of infection or inflammation, we divert glucose to our brains or immune systems via insulin resistance in certain tissues. These tissues can then use less glucose and more fat for energy. “…the adipose tissue compartment will be encouraged to distribute free fatty acids, while the liver will be encouraged to produce glucose via gluconeogenesis and to distribute triglycerides via very low-density lipoprotein (VLDL).”

This reallocation of energy—the aim of the process above—and the compensatory hyperinsulinemia “are meant for short-term survival, and their persistence as a chronic state are at the basis of the ultimate changes that we recognize as the symptoms of the metabolic syndrome, including the changes in glucose and lipid homeostasis and and the increasing blood pressure. For example, the concomitant hypertension has been explained by a disbalance between the effects of insulin on renal sodium reabsorption and NO-mediated vasodilatation, in which the latter effect, but not the first, becomes compromised by insulin resistance, causing salt sensitivity and hypertension.”

I warned you to get out before it was too late!

Looks like a great place to hike

Looks like a great place to hike

I don’t ever recall reading how much energy our immune system uses. The authors write:

During infection/inflammation we deal with the metabolic needs of an activated immune system for acute survival. The inactive immune system consumes about 23% of our basal metabolism, of which as much as 69% derives from glucose (47%) and the glycogenic amino acid glutamine (22%). Upon activation, the energy requirement of our immune system may increase with about 9–30% of our basal metabolic rate. In multiple fractures, sepsis and extensive burns, we deal with increases up to 15–30, 50, and 100% of our basal metabolism, respectively.

The activated immune system, they say, functions mainly on glucose.

Summarizing thus far, we humans are extremely sensitive to glucose deficits, because our large brain functions mainly on glucose. During starvation, pregnancy and infection/inflammation, we become insulin resistant, along with many other adaptations. The goal is the reallocation of energy-rich substrates to spare glucose for the brain, the rapidly growing infant during the third trimester of pregnancy, and our activated immune system that also functions mainly on glucose. Under these conditions, the insulin resistant tissues are supplied with fatty acids. Other goals of the changes in the serum lipoprotein composition are their role in the modulation of the immune response by the clearance of LPS [lipopolysaccharides] during infection/inflammation and the redirection of cholesterol to tissues for local damage repair. The metabolic adaptations caused by inflammation illustrate the intimate relationship between our immune system and metabolism. This relation is designed for the short term. In a chronic state it eventually causes the metabolic syndrome and its sequelae. We are ourselves the cause of the chronicity. Our current Western lifestyle contains many false inflammatory triggers and is also characterized by a lack of inflammation suppressing factors.

The authors list many familiar components of the Western lifestyle that can cause chronic systemic low-grade inflammation, “which in turn leads to chronically compromised insulin sensitivity, compensatory hyperinsulinemia and, eventually, the diseases related to the metabolic syndrome”:

  • the consumption of saturated fatty acids and industrially produced trans fatty acids
  • a high ω6/ω3 fatty acid ratio
  • a low intake of long-chain polyunsaturated fatty acids (LCP) of the ω3 series (LCPω3) from fish (EPA and DHA are most important)
  • a low status of vitamin D and vitamin K and magnesium
  • the “endotoxemia” of a high-fat low-fiber diet
  • the consumption of carbohydrates with a high glycemic index and a diet with a high glycemic load
  • a disbalance between the many micronutrients that make up our antioxidant/pro-oxidant network
  • a low intake of fruit and vegetables
  • an abnormal composition of the bacterial flora in the mouth, gut, and gingivae
  • chronic stress
  • smoking, second-hand smoke, and environmental pollution
  • insufficient physical activity
  • insufficient sleep
  • excessive alcohol consumption
  • low fiber intake
  • meat from domesticated animals
  • obesity

“Homo sapiens emerged about 160,000 years ago in East-Africa.”

In contrast to some (e.g., John Hawks?) who believe we are rapidly evolving, these authors think that our genome, “with an average effective mutation rate of 0.5% per million years,” still overwhelmingly reflects the Paleolithic era.

They support their contentions with 334 references.

Steve Parker, M.D.

“Scientific American” Pooh-Pooh’s the Paleo Diet

Click through for details. The writer mentions our pals Marlene Zuk and Christine Warinner. A snippet:

The Paleo diet not only misunderstands how our own species, the organisms inside our bodies and the animals and plants we eat have evolved over the last 10,000 years, it also ignores much of the evidence about our ancestors’ health during their—often brief—individual life spans (even if a minority of our Paleo ancestors made it into their 40s or beyond, many children likely died before age 15). In contrast to Grok, neither Paleo hunter–gatherers nor our more recent predecessors were sculpted Adonises immune to all disease.

Were Hominins Eating Grains 3 Million Years Ago?

A guest blogger at Discover magazine tackles some recent evidence that our hominin ancestors ate more grain than we might think. Her conclusion:

So while there remains little doubt that many modern humans eat too much sugar and processed foods, these studies show that identifying a particular “paleo” diet is impossible. Researchers are just beginning to understand what ancient humans ate, and these recent studies show that grasses and grains have been part of the human diet for millions of years.

Read the rest. You may find the comments interesting.

Who Invented Clothes?

Archeologist Suzi Gage suggests the answer in an article at The Guardian:

Quite astonishingly, there is physical evidence that Neanderthals more than 100,000 years ago were tanning animal skins – a stone tool from the site of Neumark-Nord in Germany has preserved scraps of organic material stuck to it that were soaked in tannin, the substance in oak bark used to make leather. It was probably part of the tool handle that got wet while the hides were being worked.

DNA from lice indicate that our ancestors wore clothes as long as 170,000 years ago.

Read the rest.

Is the Paleo Diet Truly Low-Carb After All?

Lifextension argues that very case in a recent blog post. If the paleo diet is low carb, then it’s going to be heavily animal-based. According to Lifextension:

Diachronic and comparative analysis of the skeletal data of human hunters and cultivators from across the globe has revealed that – prior to the onset of agriculture – carbohydrates must have comprised only a rare and occasional component of ancestral eating patterns. Furthermore, the impact of the introduction of carbohydrates to human diets was almost immediate in its deterioration of human health and biology.

However, paradoxically, many proponents of a ‘Paleo’ (i.e.: pre-agricultural) diet have promoted the use of tubers and other starches as – not only benign – but necessary health foods to consume for the correction of metabolic and endocrine disorders. Potatoes, rice, and other oxymoronically-labelled ‘safe’ starches, are being promoted in spite of the fact that they are exclusively Neolithic foods. Consequently, it is the conflation of starches, safe, and ancestral that I now wish to address, and hopefully correct.

Lifextension concludes:

The intake of plant foods by hominids was most plausibly and conceivably minimal. This is due to their limited, seasonal availability; the physiological ceiling on fibre and toxin intake; the biological evolution of early Homo physiology; along with the technological, spatial and temporal limitations of obligatory pre-consumption preparations. Consequently, evolutionary arguments for the consumption of what are quite blatantly Neolithic foods are rendered paradoxical and absurd. Starches are neither ‘Paleo’; nor does our evolutionary biology sanction them as ‘safe’.

Lifextension neither pulls punches nor takes prisoners. This could get interesting.

Read the rest.

Seminal Article by Loren Cordain, Ph.D.

I have little to say about it. Just wanted it in my database:

The Nutritional Characteristics of a Contemporary Diet Based Upon Paleolithic Food Groupsin Journal of the American Neutraceutical Association,  2002; 5:15-24.

The title of that journal doesn’t fill me with confidence, but it is what it is. Many of the ideas in the article are likely in his popular books.

Anthropologist Debunks the Paleolithic Diet

paleo diet, paleolithic diet, caveman diet

Not Dr. Warinner

Christina Warinner has a new TEDx talk on the paleo diet.  Dr. Warinner has a Ph.D. in anthropology from Harvard, so I’ll call her an anthropologist. The written TEDx intro mentions she is a paleontologist, and she mentions “archeologist” in her talk.  Anyway, I’m sure she’s very bright and put much thought into her presentation.  She spoke at my old stomping grounds, the University of Oklahoma in Norman.

Click to view video.

Dr. Warinner is probably addressing the smarter half of the general population, who holds the idea, at least superficially, that the paleo diet is meat-based.  (The dumber half of the public isn’t watching TEDx videos.)  Dr. Warinner doesn’t define “meat-based.”  Is half the plate filled with meat, fish, or eggs?  75% of the plate?  Half of total calories?

I’m not familiar with all the popular modern versions of the paleo diet.  Perhaps some are in fact meat-centric, whatever that means.  But the ones I’m more familiar with, like Dr. Cordain’s and mine, prominently feature vegetables, fruits, and nuts.  You could easily fashion a plant-based paleo diet, filling 80 or even 90% of your plate with plants.  (A vegan paleo diet isn’t realistic.  Cultures not eating animals would die out from B12 deficiency.)

I’d swear I heard Dr. Warinner say “we’re not adapted to eat meat.”  Surely she mis-spoke.

She mostly debunks popular misconceptions of the paleo diet.  Most of us deeply familiar with the paleo diet would have little to disagree with her about.

Here are some of Dr. Warinner’s major points:

  • It’s nearly impossible for most of us to eat a true Paleolithic diet.  Selective breeding has altered nearly all our foods to the point of unrecognizability by cavemen.  Examples are bananas, broccoli, carrots, and tomatoes.
  • There is no single paleo diet.  It depends on regional geographic variations in rainfall, latitude, temperature, etc.  Local populations ate what was available, in season, and often migrated seasonally to find food.

Dr. Warinner suggests we all incorporate three concepts from the paleo diet:

  1. Eat a great variety of foods.
  2. For the highest nutrient content, eat fresh food when ripe, in season.
  3. Eat whole foods.

Steve Parker, M.D.

PS: Miki Ben-Dor, a Ph.D. candidate, had many more objections to Dr. Warinner’s speech.  Paul Jaminet made a few comments about it, too (see middle of his post, after the comments on Marlene Zuk’s PaleoFantasy).  Wendy Schwartz weighs in, too. Angelo Coppola does a good job countering most of Dr. Warriner’s criticisms.

My Critique of the Joslin Critique of the Paleo Diet

paleo diet, Paleolithic diet, hunter-gatherer diet

Huaorani hunter in Ecuador

The Joslin Diabetes Blog yesterday reviewed the paleo diet as applied to both diabetes and the general public.  They weren’t very favorably impressed with it.  But in view of Joslin’s great reputation, we need to give serious consideration to their ideas.  (I don’t know who wrote the review other than “Joslin Communications.”)

These are the main criticisms:

  • diets omitting grains and dairy are deficient in calcium and possibly B vitamins
  • you could eat too much total and saturated fat, leading to insulin resistance (whether type 1 or 2 diabetes) and heart disease
  • it’s not very practical, partly because it goes against the grain of modern Western cultures
  • it may be expensive (citing the cost of meat, and I’d mention fresh fruit and vegetables, too)

Their conclusion:

There are certainly better diets out there, but if you are going to follow this one, do yourself a favor, take a calcium supplement and meet with a registered dietitian who is also a certified diabetes educator  to make sure it is nutritionally complete, isn’t raising your lipids and doesn’t cause you any low blood glucose incidences.

Expense and Practicality

These take a back seat to the health issues in my view.  Diabetes itself is expensive and impractical.  Expense and practicality are highly variable, idiosyncratic matters to be pondered and decided by the individual.  If there are real health benefits to the paleo diet, many folks will find work-arounds for any expense and impracticality.  If the paleo diet  allows use of fewer drugs and helps avoid medical complications, you save money in health care costs that you can put into food.  Not to mention quality of life issues (but I just did).

Calcium and B Vitamin Deficiencies

This is the first I’ve heard of possible B vitamin deficiencies on the paleo diet.  Perhaps I’m not as well-read as I thought.  I’ll keep my eyes open for confirmation.

The potential calcium deficiency, I’ve heard of before.  I’m still open-minded on it.  I am starting to wonder if we need as much dietary calcium as the experts tell us.  The main question is whether inadequate calcium intake causes osteoporosis, the bone-thinning condition linked to broken hips and wrists in old ladies.  This is a major problem for Western societies.  Nature hasn’t exerted much selection pressure against osteoporosis because we don’t see most of the fractures until after age 70.  I wouldn’t be surprised if we eventually find that life-long exercise and adequate vitamin D levels are much more important that calcium consumption.

With regards to calcium supplementation, you’ll find several recent scientific references questioning it.  For example, see this, and this, and this, and this, and this.  If you bother to click through and read the articles, you may well conclude there’s no good evidence for calcium supplementation for the general population.  If you’re not going to supplement, would high intake from foods be even more important?  Maybe so, maybe not.  I’m don’t know.

If you check, most of the professional osteoporosis organizations are going to recommend calcium supplements for postmenopausal women, unless dietary calcium intake is fairly high.

If I were a women wanting to avoid osteoporosis, I’d do regular life-long exercise that stressed my bones (weight-bearing and resistance training) and be sure I had adequate vitamin D levels.  And men, you’re not immune to osteoporosis, just less likely to suffer from it.

Insulin Resistance

Insulin resistance from a relatively high-fat diet is theoretically possible.  In reality, it’s not common.  I’ve read plenty of low-carb high-fat diet research reports in people with type 2 diabetes.  Insulin levels and blood glucose levels go down, on average.  That’s not what you’d see with new insulin resistance.  One caveat, however, is that these are nearly all short-term studies, 6-12 weeks long.

If you have diabetes and develop insulin resistance on a high-fat diet, you will see higher blood sugar levels and the need for higher insulin drug doses.  Watch for that if you try the paleo diet.

Are High Total and Saturated Fat Bad?

Regarding relatively high consumption of total and saturated fat as a cause of heart or other vascular disease: I don’t believe that any more.  Click to see why.  If you worry about that issue, choose meats that are leaner (lower in fat) and eat smaller portions.  You could also look at your protein foods—beef, chicken, fish, eggs, offal, etc.—and choose items lower in total and saturated fat.  Consult a dietitian or online resource.  Protein deficiency is rarely, if ever, a problem on paleo diets.

In Conclusion

I think the paleo diet has more healthful potential than realized by the Joslin blogger(s).  I’m sure they’d agree we need more clinical studies of it, involving both type 1 and 2 diabetics.  I appreciate the “heads up” regarding potential vitamin B deficiencies.  My sense is that the Joslin folks are willing to reassess their position based on scientific studies.

I bet some of our paleo-friendly registered dietitians have addressed the potential adverse health issues of the paleo diet.  Try Amy KubalFranziska Spritzler (more low-carb than paleo) or Aglaée Jacob.  I assume the leading paleo diet book authors have done it also.

If you’re worried about adverse blood lipid changes on the paleo diet, get them tested before you start, then after two months of dieting.

Steve Parker, M.D.

PS: The paleo diet is also referred to as the Stone Age diet, caveman diet, Paleolithic diet, hunter-gatherer diet, and ancestral diet.

Matthew Yglesias Says “Paleo Diet Is Nonsense Science”

Here’s his brief article at Slate.  Mr. Yglesias was apparently influenced by Marlene Zuk.

Well, now that that’s settled, I can shut down this blog and start another hobby.

https://twitter.com/johndurant/status/311369697658564608