Tag Archives: Stone Age diet

What Do Mainstream Dietitians Think of the Paleo Diet?

Australian Aborigine in Swamp Darwin

I’m curious to know what mainstream dietitians think about the Paleolithic diet, so I read an article entitled “Are diets from Paleolithic times relevant today?”  This one-page article is in the August, 2012, issue of the Journal of the American Academy of Nutrition and Dietetics. The author is Eleese Cunningham, RD, of the Academy of Nutrition and Dietetics Knowledge Center Team.

The Academy of Nutrition and Dietetics is the new name of the American Dietetics Association, “the world’s largest organization of food and nutrition professionals.”

Ms. Cunningham notes that “diet books for modern humans are extremely popular, and the Paleolithic diet, sometimes called the “Caveman Diet” or the “Stone Age Diet,” is one of the latest trends.”  You’d think the author would mention one of the popular paleo diet books, such as Loren Cordain’s, Robb Wolf’s, or Mark Sisson’s.  Think again.  She brings up only another dietitian’s review of Richard Nikoley’s paleo diet book, pointing out his lack of professional health credentials and his advocacy of raw milk consumption.  But milk isn’t even considered a component of most paleo diets.  Ms. Cunningham justifiably points out the infectious risks, however small, linked to raw milk consumption.  (I’ve not read Nikoley’s book, Free the Animal.)

(If you click the link to see the review of Nikoley’s book, scroll to page 30.  Sample: “Based more on science fiction than science fact, Nikoley’s recommendations are misguided and reckless…”)

Ms. Cunningham likes the fact that the paleo diet reduces consumption of salt and added sugars, while promoting fruit and vegetables.  However, she immediately notes thereafter that, “a striking counter to the meat-based Paleolithic diet is the evidence that supports the healthfulness of a vegetarian diet and the benefits it may have in the prevention and treatment of certain diseases.  Another review of this approach . . . questions the exclusion of nutrient-rich grains, beans, and low-fat dairy and the potential nutrient shortfalls associated with the Paleolithic diet restrictions.”

This article appears to be in a regular feature of the journal called, “From the Academy: Question of the Month.”  Are diets from Paleolithic times relevant today?  She never answers directly.  I suspect the average dietitian reading this article will conclude that Ms. Cunningham and the Academy are not in favor of the paleo diet.

Steve Parker, M.D.

Reference: Cunningham, Eleese.  Are diets from Paleolithic times relevant today?  Journal of the Academy of Nutrition and Dietetics, 2012 (vol. 112, issue 8): p. 1296.  doi: 10.1016/j.jand.2012.06.019

Position of the American Dietetic Association: Vegetarian diets.  Journal of the American Dietetic Association, 2009 (109): 1266-1282.

Day 1 of My Paleo Diet

Why do it?

  • Direct experience with implementation obstacles
  • Potential health benefits

My first Parker Paleo Diet meal: sautéed mixed veggies and pan-fried chicken breast

I’m not doing this to lose weight, although I wouldn’t mind losing 10 lb (4.5 kg).  I weigh 171 lb (77.7 kg, BMI 23.4).  Regarding health benefits, I’m just going to monitor how I feel.  No blood work.  My blood pressure’s normal already.

My current version of paleo is not designed for someone with diabetes or prediabetes.  That may come in the future (Dr. Frassetto, when can we see your latest research results?).  By “current version,” I mean I’ll quite likely tweak it over the coming months.  One of my major issues is whether to keep or delete potatoes.

Here’s what I’ll eat (or not) on the Parker Paleo Diet:

FORBIDDEN FOODS: Grains (e.g., corn, wheat, rice), Dairy, Legumes (peanuts, beans, peas, green beans), Industrial Vegetable Oils (soybean, corn, safflower, etc.), Alcohol, Refined Sugars.

PROTEINS: Meat, fish/seafood, eggs, poultry, and wild game.  Bacon OK; minimize other processed meats.

NUTS & SEEDS: Especially walnuts, macadamia, cachews, almonds.  Limit to 1-2 oz/day.

FRUITS: Limit 2 pieces/day?

VEGETABLES:

Lower-Carb: Greens (lettuce, spinach, chard, collard, mustard geen, kale), radicchio, endive, bok choy, herbs, celery, radishes, mushrooms, cabbage, jicama, avocado, asparagus, okra, cucumbers, cauliflower, broccoli, peppers, summer squash, zucchini, Brussels sprouts, green onions, tomatoes, eggplant, tomatillos, eggplant, artichokes, turnips, rutabagas, spaghetti squash, carrots, onions, leeks, water chestnuts (small serving).  This list generally starts with the lower carb items and gradually increases to higher carb grams.  All these have 5 or fewer carbs per serving; most are  much less.

Starchy, Higher-Carb: Beets (6 g, GI 64), winter squashes (acorn, butternut), water chestnuts, parsnips (9 g, GI 97), potatoes (35 g, GI 87), sweet potatoes, (20 g, GI 61), cassava (37 g), taro (21 g), plantains.  Some categorize carrots as starchy.

HERBS & SPICES: Cilantro, parsley, basil, rosemary, thyme, etc.  Salt (minimal), pepper, vinegar.

OILS: Extra virgin olive, canola, flax, avocado.

CONDIMENTS: Olive oil vinaigrettes, mayonnaise from olive oil & egg yolk, and ?

LIQUIDS: H2O, coffee, tea

I’m not counting calories, fat grams, or carb grams.  I’ll eat until full or satisfied, not stuffed.  This is a two-month trial, excluding 24 hours around Thanksgiving.

Steve Parker, M.D.

What Exactly Is the Paleo Diet?

Pure paleo

Let’s be realistic: There’s no way to eat a Stone Age diet these days unless you live off the land, hunting, fishing, and gathering from what’s naturally available in the wild.  Few can do that, although it’s not impossible.  I’m going to specify my version of the paleo diet because I’m starting a paleo diet trial soon—a first for me.

How long has man had fire?  Biological anthropologist Richard Wrangham estimates hominins tamed fire and started cooking with it 1.8 million years ago.  So I’m cooking my paleo foods if I wish.

As with my beloved Mediterranean diet, definitions of the paleo diet vary.  The following guidelines are influenced by my review of blogs or websites by Loren Cordain, Julianne Taylor, Robb Wolf, and Kurt Harris.  The first three are closely affiliated with each other, so expect lots of overlap.  It’s simplest to define paleo by what’s not allowed.

What’s NOT Paleo?

Industrial vegetable oils (e.g., soybean, corn,safflower), legumes, dairy, refined sugars, grains, alcohol, and high salt consumption.

What Is Paleo? 

The focus is on minimally processed, in-season, locally available foods.  Many favor pastured, grass-fed beef, free-range chickens, “organic,” and the like.  I guess that’s fine if you can afford it; I choose to spend my money elsewhere.

Proteins

Meat, fish/seafood, eggs, poultry, and wild game.  Most paleo proponents favor lean meats over fatty ones; it’s debatable. Undoubtedly, our domesticated feedlot animals are fattier than wild game, generally.  Processed meats such as bacon would not be pure paleo, but many paleo advocates allow it.

Nuts and Seeds

Favor those with the best omega-6/omega-3 ratio (2 or 3:1), such as walnuts, almonds, macadamia, and cashews.  Modern humans eat way more omega-6 fatty acids compared to ancient hunter-gatherers.

Fruits and Vegetables

It’s probably best to favor those with lower glycemic index.  Examples are berries, melons, cauliflower, tomatoes, onions, and broccoli.  Most modern fruits and veggies  have been bred for large size and good looks.  Ancient fruits and veggies were smaller and had much more fiber per serving.

Tubers, Roots, Bulbs

These are OK per Cordain, and I agree.  Examples include potatoes, cassava, taro root, onions.  Some paleo proponents exclude potatoes.

Oils

Cordain favors oils such as canola, flax, olive. Others mention avocado oil.  Aim for a good omega-6/omega-3 ratio.  Lard is probably OK although obviously processed.

Herbs and Spices

Many of our favorites should be OK.  Wolf says balsamic vinegar is allowed, although processed, like all vinegars.  Vinegar is “natural,” as you might have noticed if you ever walked through an apple orchard with rotting fruit on the ground; you can smell the vinegar.

Condiments

Undecided.  Note that you can make mayonnaise from olive oil and egg yolk.

Miscellaneous

Olives?  They’re processed, but I’m inclined to keep them in the mix.  Coffee?  Not paleo, but I ain’t givin’ it up.  Consider limiting nuts to one ounce daily since most of them are high in omega-6 fatty acids.  Fresh foods are more purely paleo than canned or frozen, but I’ll not exclude canned and frozen.  Limit fruit?  Probably: in most environments, they’re available only seasonally.  Diet sodas?  Clearly not paleo, but I enjoy one now and then and don’t see any drawbacks to low consumption.

Steve Parker, M.D.

Update October 8, 2012

I learned today that my version of paleo, by coincidence, is similar to the Hartwigs’s Whole30 plan.  But they allow clarified butter or ghee, green beans, and snow peas.  I include potatoes, but Whole30 doesn’t.

Does the Paleo Diet Cause Kidney Stones?

MedPage Today in May, 2012, reported a substantial increase (70%) in the prevalence of kidney stones in the U.S. over the last two decades. Stone prevalence rose from 5.2% to 8.8% of the population.  Prevalence was based on the periodic National Health and Nutrition Examination Survey, which asked participants, “Have you ever had kidney stones?”

Starting a hundred-yard DASH

Stone prevalence began rising even earlier.  Again according to the third NHANES, prevalence increased from 3.8 percent in the period 1976 to 1980 to 5.2 percent in the years 1988 to 1994.

Older studies estimated that one in 10 men and one of every 20 women will have at least one painful stone by the age of 70.

What are kidney stones make of?  

Three out of four patients with kidney stones form calcium stones, most of which are composed primarily of calcium oxalate or, less often, calcium phosphate.  Pure uric acid stones are less than 10 percent of all stones.

Why the increased stone prevalence?  Does diet count?

Unfortunately, the article doesn’t offer any reasons or even speculation as to why kidney stones are more prevalent.  Kidney stones have a genetic component, but our genes have changed very little over just two decades.  I have to wonder if diet plays a role.

UpToDate.com reviewed diet as a risk factor for kidney stones.  Some quotes:

There are several dietary factors that may play an important role in many patients: fluid, calcium, oxalate, potassium, sodium, animal protein, phytate, sucrose, fructose, and vitamin C intake. Lower intake of fluid, calcium, potassium, and phytate and higher intake of sodium, animal protein, sucrose, fructose, and vitamin C are associated with an increased risk for calcium stone formation. The type of beverage may also influence the risk. The effect of calcium intake is paradoxical, with a decreased risk with increased dietary calcium and an increased or no change in risk with calcium supplements.

The combination of dietary factors may also have a significant impact upon stone risk. As an example, the Dietary Approaches to Stop Hypertension (DASH) diet is high in fruits and vegetables, moderate in low-fat dairy products, and low in animal protein. Based upon an analysis of three large cohorts, adherence to a DASH-style diet lowered the risk for kidney stones among men, older women, younger women, high body mass index (BMI) individuals, and low BMI individuals. Thus, the DASH diet is a reasonable option in the attempt to reduce the risk of stone recurrence.

Higher sucrose [table sugar] intake is associated with an increased risk of stone formation in younger and older women.
The statements above link both low sucrose and high sucrose consumption to kidney stones, so I’m going to ignore sucrose.  The paleo diet, of course, does’t supply much sucrose.
I thought I read somewhere that the paleo diet is potentially deficient in calcium, but I can’t find the reference.  Dr. Cordain at his website suggests that the formal recommended dietary allowance is set too high in any case.  If the diet’s low in calcium, it could predispose to stones. On the other hand, most paleo diet versions are low in sodium and rich in potassium, which may protect against stones.
In Cordain’s 2002 Paleo Diet book, he writes:
In virtually every dietary permutation [of the paleo diet] the levels of vitamins and minerals exceed governmental recommended RDAs.
So does the paleo diet cause kidney stones?  Sorry, but I don’t know.  I tend to doubt it.  I’m not aware of any scientific studies comparing the prevalence of kidney stones in those eating paleo-style with an otherwise similar population.
What about stone prevalence in modern hunter-gatherer cultures?  I bet those data exist, but searching “urolithiasis AND hunter-gatherer” got me nothing at PubMed.  Comparing those cultures with modern Western ones is probably a fool’s errand anyway: too many other uncontrolled variables besides diet.
Standard advice to prevent initial and recurrent kidney stones is to avoid low urine output.  Do that by drinking plenty of fluid.
Although I pay $400 a year for access to UpToDate, they offer free public access to some of the website.  Here’s the UpToDate poop sheet on kidney stones.
Extra credit:  Medical conditions that predispose to kidney stones include primary hyperparathyroidism, obesity, gout, diabetes, and medullary sponge kidney.
For SEO: The paleo diet is also called Stone Age, Old Stone Age, Paleolithic, caveman, and hunter-gatherer, and ancestral diet.

Melanie Gores a Few Oxen

Australian Aborigine

Dietitian Melanie Thomassian at Dietriffic offers some iconoclastic ideas in her critique of the paleo diet (aka Paleolithic, Old Stone Age, caveman, or hunter-gatherer diet).  Some quotes:

I’ll be the first to admit the diet recommended by most mainstream nutritionists, dietitians, and doctors is pretty terrible, and believe it or not, I do understand why people look elsewhere for their dietary advice.

 

The philosophy and reasoning behind the whole Paleo diet, however, isn’t something I can reconcile myself to.

Melanie addresses legumes, dairy, grains, and the problem of determining prehistoric diets.

-Steve

Frustration

I just realized I started this blog six months ago with the idea that I’d “…share my investigation into whether the paleo diet and lifestyle are potentially therapeutic for people with diabetes.”

I’m frustrated that I haven’t made more progress.

Only a few clinical studies have looked at use of the paleo diet in diabetics.  And only type 2’s at that.  The Swedes (Steffan Lindeberg/Tommy Jonsson group) and Californians (Team Frassetto) own this field, at this point.

Loren Cordain is at Colorado State University.  Don’t they have a research department?

Are S. Boyd Eaton and Melvin Konner still in academia?

Namesake of the Cabbage Soup Diet

I found an article from 1984 looking at return of diabetic Australian aborigines to their traditional lifestyle.  I’ll report here after I analyze it.

Dr. Jay Wortman has done work with aboriginal peoples of Canada.  They have lots of diabetes, like the Pima in my neck of the woods.  I’ll look for his results.

If the paleo diet is ever going to be more than a fad, we need clinical studies that support it.  Shoot, even the cabbage soup diet has glowing anecdotal reports from individuals, but it hasn’t stood the test of time.

Am I missing any clinical studies?

Steve Parker, M.D.

PS: I still expect a flurry of paleo diet studies to be published in the next 5-10 years, involving several types of human participants (diabetics, overweight and obese, heart patients, hypertensives, etc.).  Then again, maybe I’m wrong.

PPS: Instead of “paleo diet,” you may prefer Old Stone Age diet, Stone Age diet, caveman diet, hunter-gatherere diet, Paleolithic diet, or Ancestral diet

Random Thoughts On Paleo Eating For People With Diabetes

Not really pertinent, but I like buffalo

I was interviewed  yesterday by Amy Stockwell Mercer, author of Smart Woman’s Guide to Diabetes.  All I knew beforehand was that she was interested in my thoughts on the paleo diet as applied to diabetes.

In preparation, I collected some random thoughts and did a little research.

What’s the paleo diet?

Fresh, minimally processed food.  Meat (lean or not? supermarket vs yuppiefied?), poultry, eggs, fish, leafy greens and other vegetables, nuts, berries, fruit, and probably tubers.

Non-paleo: highly processed, grains, refined sugars, industrial plant/seed oils, legumes, milk, cheese, yogurt, salt, alcohol.

Is the paleo diet deficient in any nutrients?

A quick scan of Loren Cordain’s website found mention of possible calcium and vitamin D deficits.  Paleoistas will get vitamin D via sun exposure and fish (especially cold-water fatty fish).  Obtain calcium from broccoli, kale, sardines, almonds, collards.  (I wonder if the Recommended Dietary Allowance for calcium is set too high.)

What About Carbohydrates and Diabetes and the Paleo Diet?

Diabetes is a disorder of carbohydrate metabolism.  In a way, it’s an intolerance of carbohydrates.  In type 1 diabetes, there’s a total or near-total lack of insulin production on an autoimmune basis.  In type 2 diabetes, the body’s insulin just isn’t working adequately; insulin production can be high, normal or low.  In both cases, ingested carbohydrates can’t be processed in a normal healthy way, so they stack up in the bloodstream as high blood sugars.  If not addressed adequately, high blood glucose levels sooner or later will poison body tissues .  Sooner in type 1, later in type 2.  (Yes, this is a gross over-simplification.) 

Gluten-rich Neolithic food

If you’re intolerant of lactose or gluten, you avoid those.  If you’re intolerant of carbohydrates, you could avoid eating them, or take drugs to help you overcome your intolerance.  Type 1 diabetics must take insulin.  Insulin’s more optional for type 2’s.  We have 11 classes of drugs to treat type 2 diabetes; we don’t know the potential adverse effects of most of these drugs.  Already, three diabetes drugs have been taken off the U.S. market or severely restricted due to unacceptable toxicity: phenformin, troglitazone, and rosiglitazone. 

Humans need two “essential fatty acids” and nine “essential” amino acids derived from proteins.  “Essential” means we can’t be healthy and live long without them.   Our bodies can’t synthesize them.  On the other hand, there are no essential carbohydrates.  Our bodies can make all the carbohydrate (mainly glucose) we need.

Since there are no essential carbohydrates, and we know little about the long-term adverse side effects of many of the diabetes drugs, I favor carbohydrate restriction for people with carbohydrate intolerance.  (To be clear, insulin is safe, indeed life-saving, for those with type 1 diabetes.)

That being said, let’s think about the Standard American Diet (SAD) eaten by an adult.  It provides an average of 2673 calories a day (not accounting for wastage of calories in restaurants; 2250 cals/day is probably a more accurate figure for actual consumption).  Added sugars provide 459 of those calories, or 17% of the total.  Grains provide 625 calories, or 23% of the total.  Most of those sugars and grains are in processed, commercial foods.  So added sugars and grains provide 40% of the total calories in the SAD.  Remember, we need good insulin action to process these carbs, which is a problem for diabetics.  (Figures are from an April 5, 2011, infographic at Civil Eats.)

Anyone going from the SAD to pure Paleo eating will be drastically reducing intake of added sugars and grains, our current major sources of carbohydrate.  Question is, what will they replace those calories with? 

That’s why I gave a thumbnail sketch of the paleo diet above. Take a gander and you’ll see lots of low-carb and no-carb options, along with some carb options. For folks with carbohydrate intolerance, I’d favor lower-carb veggies and judicious amounts of fruits, berries, and higher-carb veggies and

Will these cause bladder cancer? Pancreatitis?

tubers.  “Judicious” depends on the individual, considering factors such as degree of residual insulin production, insulin sensitivity, the need to lose excess weight, and desire to avoid diabetes drugs.

Compared to the standard “diabetic diet” (what’s that?) and the Standard American Diet, switching to paleo should lower the glycemic index and glycemic load of the diet.  theoretically, that should help with blood sugar control.

A well-designed low-carb paleo diet would likely have at least twice as much fiber as the typical American diet, which would also tend to limit high blood sugar excursions.

In general, I favor a carbohydrate-restricted paleo diet for those with diabetes who have already decided to “go paleo.”  I’m not endorsing any paleo diet for anyone with diabetes at this point—I’m still doing my research.  But if you’re going to do it, I’d keep it lower-carb.  It has a lot of potential.

Are There Any Immediate Dangers for a Person With Diabetes Switching to the Paleo Diet?

It depends on three things: 1) current diet, and 2) current drug therapy, and 3) the particular version of paleo diet followed. 

Remember, the Standard American Diet provides 40% of total calories as added sugars and grains (nearly all highly refined).  Switching from SAD to a low-carb paleo diet will cut carb intake  and glycemic load substantially, raising the risk of hypoglycemia if the person is taking certain drugs.

Drugs with potential to cause hypoglycemia include insulin, sulfonylureas, meglitinides, pramlintide, and perhaps thiazolidinediones.

Who knows about carb content of the standard “diabetic diet”?  Contrary to popular belief, there is no monolithic “diabetic diet.”  There is no ADA diet (American Diabetes Association).  My impression, however, is that the ADA favors relatively high carbohydrate consumption, perhaps 45-60% of total calories.  Switching to low-carb paleo could definitely cause hypoglycemia in those taking the aforementioned drugs.

One way to avoid diet-induced hypoglycemia is to reduce the diabetic drug dose.

A type 2 overweight diabetic eating a Standard American Diet—and I know there are many out there—would tend to see lower glucose levels by switching to probably any of the popular paleo diets.  Be ready for hypoglycemia if you take those drugs.

Paleo diets are not necessarily low-carb.  Konner and Eaton estimate that ancestral hunter-gatherers obtained 35 to 40% of total calories from carbohydrates.  I’ve seen other estimates as low as 22%.  Reality likely falls between 22 and 65%.  When pressed for a brief answer as to how many carbohydrate calories are in the paleo diet, I say “about a third of the total.”  By comparison, the typical U.S. diet provides 50% of calories from carbohydrate.

Someone could end up with a high-carb paleo diet easily, by emphasizing tubers (e.g., potatoes), higher-carb vegetables, fruits, berries, and nuts (especially cashews). Compared with the SAD, this could cause higher or lower blood sugars, or no net change.

A diabetic on a Bernstein-style diet or Ketogenic Mediterranean Diet (both very-low-carb) but switching to paleo or low-carb paleo (50-150 g?) would see elevated blood sugars.  Perhaps very high glucoses.

Any person with diabetes making a change in diet should do it in consultation with a personal physician or other qualified healthcare professional familiar with their case.

Steve Parker, M.D.

Fun Facts!

  • A typical carbonated soda contain the equivalent of 10 tsp (50 ml) of sugar.
  • The typical U.S. adult eats 30 tsp  (150 ml) daily of added sweeteners and sugars.
  • U.S total grain product consumption was at record lows in the 1970s, at 138 pounds per person.  By 2000, grain consumption was up by 45%, to 200 pounds per person.
  • Total caloric sweetener consumption (by dry weight) was 110 pounds per person in the  1950s.  By 2000, it was up 39% to 150 pounds.
  • Between 1970 and 2003, consumption of added fats and oils rose by 63%, from 53 to 85 pounds.  [How tasty would that be without starches and sugars?  Not very.]
  • In 2008, “added fat” calories in the U.S. adult diet were 641 (24% of total calories).

Fun Facts provided by the U.S. Department of Agriculture. 

(The paleo diet is also referred to as the Paleolithic, Old Stone Age, Stone Age, Ancestral, Hunter-Gatherer, or Caveman diet.)

Washington Internist Sees Good Results in Diabetics Eating Paleo-Style

Dr. Stephan Guyenet recently interviewed Dr. C. Vicky Beer about her experience with the paleo diet in her patients, diabetic or not.  Dr. Beer commented about people with diabetes specifically:

Every patient I have ever had with diabetes who has adhered to the paleo diet for most of the time has experienced dramatic results.  Every one of them has been able to reduce their blood sugars and reduce their medications significantly, and in some instances, stop their medicine altogether.  This is not unlike other more known popular diets such as South Beach or Zone, which are actually quite similar to the Paleo diet in composition.

Just thought you might like to know.

Steve Parker, M.D.

PS: When I write “paleo diet,” you could substitute Old Stone Age, Stone Age, or caveman diet.

Evidence for Human Grain Consumption 100,000 Years Ago

ScienceDaily December 17 reported findings of a Canadian archeological team who found evidence of systematic grain consumption by ancient humans in Africa:

The consumption of wild cereals among prehistoric hunters and gatherers appears to be far more ancient than previously thought, according to a University of Calgary archaeologist who has found the oldest example of extensive reliance on cereal and root staples in the diet of early Homo sapiens more than 100,000 years ago.

 

Neolithic technology

In case you’re new to the paleo diet, grains are considered verboten by most adherents.  (Paleo diet is also known as the Stone Age diet, caveman diet, and Paleolithic diet.)  The cereal grain mentioned in the ScienceDaily article is wild sorghum.

Many in the paleosphere believe that such ancient humans didn’t have the technical skills to transform wild grains into something edible on a regular basis.  I haven’t read the source material, nor do I have an opinion on whether the archeologists are correct.  I’m just sayin’…

Steve Parker, M.D.

Reference: Mercader, Julio,  et al.  Mozambican grass seed consumption during the Middle Stone Age. Science, December 18, 2009.

Chronic Systemic Disease and Dental Problems: A Carbohydrate Connection?

Dentists are considering a return to an old theory that dietary carbohydrates first cause dental diseases, then certain systemic chronic diseases, according to a review in the June 1, 2009, Journal of Dental Research

Neither Moore nor Sorrentino, but a nice set of choppers

Jimmy Moore has a recent podcast interview with Dr. John Sorrentino, a dentist who advocates a carbohydrate-restricted paleo diet for prevention and treatment of certain common dental problems.  By coincidence, Sorrentino is an old dental school classmate of Dr. Jack KruseDr. Sorrentino has a brand new dental blog.

We’ve known for years that some dental and systemic diseases are associated with each other, both for individuals and populations.  For example, gingivitis and periodontal disease are associated with type 2 diabetes and coronary heart disease.  The exact nature of that association is not clear.  In the 1990s it seemed that infections—chlamydia, for example—might be the unifying link, but this hasn’t been supported by subsequent research.     

The aforementioned article is written by Dr. Philippe P. Hujoel, who has been active in dental research for decades and is affiliated with the University of Washington (Seattle).  He’s no bomb-throwing, crazed, radical. 

That's more like it

The “old theory” to which I referred is the Cleave-Yudkin idea from the 1960s and ’70s that excessive intake of fermentable carbohydrates, in the absence of good dental care, leads both to certain dental diseases—caries (cavities), periodontal disease, certain oral cancers, and leukoplakia—and to some common systemic chronic non-communicable diseases such as coronary heart disease, type 2 diabetes, some cancers, and dementia.  In other words, dietary carbohydrates cause both dental and systemic diseases—not all cases of those diseases, of course, but some.   

Dr. Hujoel doesn’t define “fermentable” carbohydrates in the article.  My American Heritage Dictionary defines fermentation as:

  1. the anaerobic conversion of sugar to carbon dioxide and alcohol by yeast
  2. any of a group of chemical reactions induced by living or nonliving ferments that split complex organic compunds into relatively simple substances

As reported in David Mendosa’s blog at MyDiabetesCentral.com, Dr. Hujoel said, “Non-fermentable carbohydrates are fibers.”  Dr. Hujoel also shared some personal tidbits there. 

In the context of excessive carbohydrate intake, the article frequently mentions sugar, refined carbs, and high-glycemic-index carbs.  Dental effects of excessive carb intake can appear within weeks or months, whereas the systemic effects may take decades. 

Hujoel compares and contrasts Ancel Keys’ Diet-Heart/Lipid Hypothesis with the Cleave-Yudkin Carbohydrate Theory.  In Dr. Hujoel’s view, the latest research data favor the Carbohydrate Theory as an explanation of many cases of the aforementioned dental and systemic chronic diseases.  If correct, the theory has important implications for prevention of dental and systemic diseases: namely, dietary carbohydrate restriction.

Juvenile male Homo sapiens on Neolithic diet

Adherents of low-carb diets will love this article; it supports their choices.  The standard American diet provides 55% of energy in the form of carbohydrates.  Stone Age diets on average provided 35 to 40% of energy as carbs, but rarely as the simple sugars and refined starches that characterize modern Western diets.

I agree with Dr. Hujoel that we need a long-term prospective trial of serious low-carb eating versus the standard American high-carb diet.  Take 20,000 people, randomize them to one of the two diets, follow their dental and systemic health over 15-30 years, then compare the two groups.  Problem is, I’m not sure it can be done.  It’s hard enough for most people to follow a low-carb or paleo diet for four months.  And I’m asking for 30 years?!   

Dr. Hujoel writes:

Possibly, when it comes to fermentable carbohydrates, teeth would then become to the medical and dental professionals what they have always been for paleoanthropologists: “extremely informative about age, sex, diet, health.”

Dr. Hujoel mentioned a review of six studies that showed a 30% reduction in gingivitis score by following a diet moderately reduced in carbs.  He mentions the aphorism: “no carbohydrates, no caries.”  Anyone prone to dental caries or ongoing periodontal disease should do further research to see if switching to low-carb eating might improve the situation. 

Don’t be surprised if your dentist isn’t very familiar with the concept.  Has he ever mentioned it to you?

Steve Parker, M.D.

Reference:  Hujoel, P.  Dietary carbohydrates and dental-systemic diseasesJournal of Dental Research, 88 (2009): 490-502.

Mendosa, David.  Our dental alarm bell.  MyDiabetesCentral.com, July 12, 2009.