Evidence for The Paleo Diet, and the Top 3 Myths

It’s no secret that there is an epidemic of chronic disease in the modern world.  Western nations continue to experience sharply rising rates of obesity and diabetes, while cardiovascular disease remains the leading cause of death (1, 2, 3, 4).  The public is looking for answers and many of them are looking to ancestral or ‘paleo’ diets as a way to improve their health.  However, ancestral diets are often dismissed by professional nutritionists as a ‘fad diet’ – leaving the public to turn to the internet, popular press, or lay nutritionists for advice.  Unfortunately, the guidance they find is often poor or even dangerous. 

This is a shame, considering that a well-designed, individualized ancestral diet can be an incredibly powerful healing tool.  As an example, Dr. Terry Wahls used her version of an ancestral diet to reverse her debilitating Multiple Sclerosis (10, 23).  I use ancestral diets with great success in my private practice, as a part of a broader functional and integrative approach.  Here I will share some of the research behind ancestral diets and will describe how they can be used professionally.

What are Paleo/Ancestral Diets?

For over 200,000 years, humans subsisted on a diet consisting mostly of meat, poultry, seafood, eggs, fruit, vegetables, nuts, seeds, herbs and spices.  Although there was some variation by area, there were obviously no processed foods.  Then, agriculture began around 11,000 years ago.  That is only 366 generations ago, or 0.5% of human history. (6)

The premise behind ancestral diets is that there has not been enough time or genetic pressure for humans to adapt to the foods that came with agriculture.  Examples of these ‘Neolithic’ foods include grains, industrial seed and vegetable oils, soy, processed sugar, and food additives (i.e. dyes, gums, and preservatives).  Dairy and legumes (beans) remain a grey area based on genetics, personal tolerance, and types/preparations of those foods. 

We now consume at least 70% of our energy from foods that were never consumed by our ancestors (14).  The idea behind ancestral diets is to return to eating the foods that our bodies are genetically programmed to expect.

Show Me the Data

The benefits of abandoning these Neolithic foods in favor of ancestral ones are no less than astounding.  Scientific studies have shown that ancestral diets:

  • Improve risk factors for metabolic syndrome.  Ancestral diets lower waist size, total cholesterol, LDL cholesterol, blood pressure, liver fat, and fasting blood glucose while increasing HDL.  This effect is found for a wide variety of test subjects – healthy controls, obese postmenopausal women, type II diabetics, and cardiovascular disease patients (9, 14, 16, 18)
  • Improve glucose tolerance and decrease waist size more powerfully than a Mediterranean Diet (15)
  •  Lower risk factors for cardiovascular disease – body weight, BMI, waist circumference, blood pressure, plasminogen activator inhibitor-1 (a marker of atherosclerosis) and CRP (a marker of inflammation) (12, 14, 24)
  • Improve blood glucose control and lower hemoglobin A1C in type II diabetics (12)

Amazingly, these impressive results were found in relatively short studies – 10 days to 3 months in duration. 

But I Heard that Paleo Diets….

Myth: They are overly-restrictive

Ancestral diets should be used like an elimination diet.  This is where a RD’s ability to provide individualized care is so essential.  The professional’s role is to decide if a trial may benefit the patient, then to design a personalized diet to be followed for a specific period of time.  Finally, they should guide the patient through reintroducing foods in a calculated way.  As an example of this, quality dairy foods are well-tolerated by many people of northern European ancestry.  I will often trial dairy foods of increasing lactose content after 30 days dairy-free.  The end goal is to get the patient to the broadest possible diet while maintaining their health improvements.

Also note that ancestral diets provide increased nutrient density.  The nutrient-rich foods that are added are just as (if not more) important than the foods that are removed.  Some of the original research of ancestral diets found that patients experienced remarkable health improvements just by adding traditional foods, even when they did not remove flour and refined sugar (17).  Keep in mind that to say that ancestral diets are nutrient-deficient is to say that humans went 99.5% of their history without sufficient nutrients.

 Myth: They contain way too much animal protein.

In fact, a well-balanced ancestral diet is composed of mostly plants, with a small to medium serving of high-quality meat, poultry, seafood, or eggs at most meals.  Interestingly, though, hunter-gatherers did consume 65% of their energy from animal sources on average and were relatively free from signs or symptoms of cardiovascular disease and diabetes (7, 13).  A well-planned ancestral diet usually does not increase animal protein, but does emphasize quality and nose-to-tail eating.  For example, liver is encouraged as a source of vitamins A and K, iron, copper, zinc, selenium, potassium, folate, and vitamin B-12.  Notably, these nutrients are often lacking in the modern diet (19).

Myth: They contain way too much fat and, thus, may increase risk of cardiovascular disease. 

Modern-day hunter gatherers eat fairly high-fat diets, at least as high as is currently consumed by western societies, with rare incidence of cardiovascular disease (7, 8, 13).  The amount of dietary cholesterol that they consume is similar or even higher to that of Americans (8).  It is important to understand, though, that dietary cholesterol has been shown not to have a major effect on serum cholesterol and risk of heart disease (13, 19).  In fact, dietary fat in general has been exonerated as being unhealthful for most individuals when it comes from appropriate sources and is part of an overall healthful diet (11, 22).

Hunter gatherers consumed much more omega-3 and less omega-6 fats, at a ratio of 1:2 instead of the modern ratio of 1:10 (8).  Omega-3 fats reduce inflammation, while excess intake of omega-6 fats (such as found in canola, corn, or vegetable oil) promotes inflammation and, thus, heart disease.  Traditional societies consumed only game animals, which have more mono and polyunsaturated fats and less saturated fat, as well as more omega-3 and less omega-6 fats (13). Hence, grass-fed and free range meat should be consumed if at all possible.

Traditional societies also consumed high amounts of plants, which are cardio protective.  They consumed no refined carbohydrates, which increase risk factors for cardiovascular disease (19).

Myth: They are really low in carbohydrate. 

Ancestral diets are agnostic with regard to carbohydrate, and there is massive variation among ancestral populations with regard to their carbohydrate intake.  Traditional societies remain lean with a large range of carbohydrate intake (6).  However, most ancestral populations consume high amounts of dietary fibre; some groups consume in excess of 100 grams per day (8).  On average, adults in the UK consume 18 grams per day (5).

Thus, an important feature of ancestral diets is that they support a healthy gut microbiota, which is protective against chronic disease (20). The fibre in ancestral carbohydrate sources nourish the microbiome, whereas refined grains/flour and sugar starve the microbiome and promote leptin resistance (20, 21).  Unfortunately, refined carbohydrates make up the vast majority of the carbohydrate consumption of modern societies (21).

Ancestral diet ‘beginners’ often unintentionally eat too few carbohydrates; they aren’t used to eating the amount of fruit and vegetables that is required.  Thus, professionals should ensure that carbohydrate intake is appropriate for that individual (accounting for their activity level, insulin sensitivity, gender, and age).

 Worth a Second Thought

Ancestral diets play an important role in a broader integrative and functional approach to nutrition.  They are, in fact, the original diet.  Overall, people are catching on to the fact that old paradigms do not protect them from chronic disease, and they are looking for health professionals who can help them find an effective approach.  I am happy to share more details and resources with colleagues.  You can contact me via my website: www.RealNutritionRX.com

Warm wishes, 

 

References:

1.     DiabetesInfo Facts and Figures about Diabetes. Available at: http://www.diabetes-info.co.uk/what-is-diabetes/facts-and-figures-about-diabetes.html (Accessed: 11 October 2016).

2.     Macmillan Cancer Support (2016a) Cancer statistics - evidence - Macmillan cancer support - Macmillan cancer support. Available at: http://www.macmillan.org.uk/about-us/what-we-do/evidence/cancer-statistics.html (Accessed: 11 October 2016).

3.     NHS Choices (2014) Latest obesity stats for England are alarming. Available at: http://www.nhs.uk/news/2013/02February/Pages/Latest-obesity-stats-for-England-are-alarming-reading.aspx (Accessed: 11 October 2016).

4.     NHS Choices (2016b) Coronary heart disease. Available at: http://www.nhs.uk/Conditions/Coronary-heart-disease/Pages/Introduction.aspx (Accessed: 11 October 2016).

5.     NHS Choices (2016c) Why is fibre important? Available at: http://www.nhs.uk/chq/pages/1141.aspx?categoryid=51 (Accessed: 11 October 2016).

6.     Carrera-Bastos, P. and Fontes (2011a) ‘The western diet and lifestyle and diseases of civilization’, Research Reports in Clinical Cardiology, p. 15. doi: 10.2147/rrcc.s16919.

7.     Cordain, L., Eaton, S.B., Miller, J.B., Mann, N. and Hill, K. (2002) ‘The paradoxical nature of hunter-gatherer diets: Meat-based, yet non-atherogenic’, European Journal of Clinical Nutrition, 56(s1), pp. S42–S52. doi: 10.1038/sj.ejcn.1601353.

8.     Eaton, S. (2006) ‘The ancestral human diet: What was it and should it be a paradigm for contemporary nutrition?’, The Proceedings of the Nutrition Society., 65(1), pp. 1–6.

9.     Frassetto, L.A., Schloetter, M., Mietus-Synder, M., Morris, R.C. and Sebastian, A. (2009) ‘Metabolic and physiologic improvements from consuming a paleolithic, hunter-gatherer type diet’, European Journal of Clinical Nutrition, 63(8), pp. 947–955. doi: 10.1038/ejcn.2009.4.

10.   Gnuechtel, A. (2016) Next event. Available at: http://functionalforum.com/september-2016-functional-forum/ (Accessed: 6 October 2016).

11.   Hyman, M. (2016) Eat fat, get thin: Why the fat we eat is the key to sustained weight loss and vibrant health. United States: Little, Brown & Company.

12.   Jönsson, T., Granfeldt, Y., Ahrén, B., Branell, U.-C., Pålsson, G., Hansson, A., Söderström, M. and Lindeberg, S. (2009) ‘Beneficial effects of a Paleolithic diet on cardiovascular risk factors in type 2 diabetes: A randomized cross-over pilot study’, Cardiovascular Diabetology, 8(1), p. 35. doi: 10.1186/1475-2840-8-35.

13.   Konner, M. and Eaton, S.B. (2010) ‘Paleolithic nutrition: Twenty-Five years later’, Nutrition in Clinical Practice, 25(6), pp. 594–602. doi: 10.1177/0884533610385702.

14.   Kowalski, L. and Bunko, J. (2012) ‘Evaluation of biological and clinical potential of paleolithic diet’, Rocz Panstw Zakl Hig, 63(1), pp. 9–15.

15.   Lindeberg, S., Jönsson, T., Granfeldt, Y., Borgstrand, E., Soffman, J., Sjöström, K. and Ahrén, B. (2007) ‘A Palaeolithic diet improves glucose tolerance more than a Mediterranean-like diet in individuals with ischaemic heart disease’, Diabetologia, 50(9), pp. 1795–1807. doi: 10.1007/s00125-007-0716-y.

16.   Manheimer, E.W., van Zuuren, E.J., Fedorowicz, Z. and Pijl, H. (2015) ‘Paleolithic nutrition for metabolic syndrome: Systematic review and meta-analysis’, American Journal of Clinical Nutrition, 102(4), pp. 922–932. doi: 10.3945/ajcn.115.113613.

17.   Price, W.A. (1939) Nutrition and Physical Degeneration: A Comparison of Primative and Modern Diets and Their Effects. PB Hoeber, Incorporated.

18.   Ryberg, M., Sandberg, S., Mellberg, C., Stegle, O., Lindahl, B., Larsson, C., Hauksson, J. and Olsson, T. (2013) ‘A Palaeolithic-type diet causes strong tissue-specific effects on ectopic fat deposition in obese postmenopausal women’, Journal of Internal Medicine, 274(1), pp. 67–76. doi: 10.1111/joim.12048.

19.   Scientific Report of the 2015 Dietary Guidelines Advisory Committee Part D. Ch 1: Food and nutrient Intakes (2015) Available at: http://health.gov/dietaryguidelines/2015-scientific-report/06-chapter-1/d1-2.asp (Accessed: 5 June 2016).

20.   Sonnenburg, J. and Sonnenburg, E. (2016) The good gut: Taking control of your weight, your mood, and your long-term health. United States: Penguin Books.

21.   Spreadbury, I. (2012) ‘Comparison with ancestral diets suggests dense acellular carbohydrates promote an inflammatory microbiota, and may be the primary dietary cause of leptin resistance and obesity’, Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, , p. 175. doi: 10.2147/dmso.s33473.

22.   Teicholz, N. (2014) The big fat surprise: Why butter, meat, and cheese belong in a healthy diet. United States: Simon & Schuster Children’s Publishing.

23.   Terry Wahls M.D. (2016) Available at: http://terrywahls.com/ (Accessed: 6 October 2016).

24.   Österdahl, M., Kocturk, T., Koochek, A. and Wändell, P.E. (2007) ‘Effects of a short-term intervention with a paleolithic diet in healthy volunteers’, European Journal of Clinical Nutrition, 62(5), pp. 682–685. doi: 10.1038/sj.ejcn.1602790.

Gestational Diabetes - A Diet and Meal Plan

Gestational Diabetes - A Diet and Meal Plan

Diagnosed with gestational diabetes?  Conventional wisdom is unlikely to resolve it.  Learn an evidence-based, ancestral approach that will improve your blood sugar control.   This article provides a specific, sane diet and meal plan. 

Read More

The What, Why, and How of Genetic Testing

genetic testing.jpg

Genetics is a topic that can be a little confusing and intimidating for people.  My aim here is to help you understand whether genetic testing can be helpful, what it can be helpful for, and what to look for in a genetic test.

What is Genetic Testing, Anyway?

First of all, nutrition-related genetic markers can be broken into two major categories – nutrigenomics and nutrigenetics.

Nutrigenetics is what you probably think of when you imagine genetic testing.  Your DNA gets tested for single-nucleotide polymorphisms (SNPs) that control the way your body functions.  For example, approximately 20% of the population has a version of the gene called TNF-alpha that is closely associated with chronic, low-grade inflammation, obesity, insulin resistance, and altered blood lipids.  In short, metabolic syndrome.  In these individuals, omega-3 fatty acids such as found in olive oil and fatty fish are ESPECIALLY important and helpful. 

In another example, some people have the E4 version of a gene called APOE.  This E4 SNP greatly increases risk of cardiovascular disease and Alzheimer’s Disease, and is highly sensitive to dietary changes.  While saturated fat is not something to worry about for most people, those with the E4 version of the APOE gene DO need to follow a low-saturated fat diet, and they are also highly sensitive to smoking and alcohol. 

It would be pretty good to know either of those examples applies to you, right?  But here’s where it gets pretty amazing.  Remember that nutrigentics addresses how genes change the body’s function.  On the other hand, NUTRIGENOMICS addresses how the environment changes the behavior of genes.  In order to explain that, let’s talk about the Human Genome Project. 

Why the Human Genome Project was a Disappointment

You may recall that the Human Genomic Project was a massive scientific undertaking that took 13 years, thousands of researchers, and billions of dollars of funding.  The goal was to sequence the human genome and the project was completed in 2003.  The project initially made enticing claims that it would lead to breakthroughs in the areas of cancer, heart disease, genetic diseases, diabetes, and mental health disorders.  Unfortunately, none of those promises came to fruition with the completion of the project.  This is because the scientists poorly understood an extremely important detail - epigenetics

It turns out that our environment has a major impact on the way our genes behave.  Imagine your genes forming a giant switch-board.  Environmental factors such as diet, stress, sleep, and exercise are what MOVE THE SWITCHES.  This is mainly accomplished by methylation, the addition or subtraction of a methyl group to DNA.  This turns the gene ‘on’ or ‘off’ or can even act like a dimmer, increasing or decreasing that gene’s action.

So, just knowing your genetic code doesn’t tell the whole story.  Epigenetics and nutrigenomics are the sciences of how environmental cues move our genetic switches.

I don’t mean at all that the Human Genome Project was worthless.  I just mean that our understanding of genetics has evolved – we now know that behavior and environment play much more of a significant role than previously believed.  This is GOOD news for us – your genes aren’t your destiny.  With the right data and plan we can literally hack our DNA. 

With the right data and plan we can literally hack our DNA

As an example of nutrigenomics, consider a compound called sulphoraphane that comes from cruciferous vegetables like broccoli, cabbage, and cauliflower.  Sulphoraphane literally switches on (upregulates) the genes responsible for eliminating toxins from the body.  This reduces cancer risk for everyone, but especially if you have the less active versions of those genes (if you have poor detoxification).  Wouldn’t you like to know if your detoxification genes are under-performers, so that you could know how much sulphoraphane you need to eat to reduce your cancer risk?  It’s pretty cool that you have that option. 

In a sense, the food you eat isn’t simply a compilation of nutrients – it’s information. 

But Watch Out…

Unfortunately, there’s a lot of noise in the genetic testing world.  The most common problem I see is that someone will pay for their 23&Me results.  This gets them a $200 string of meaningless data that they don’t know how to interpret.  So, they pay to put it through a filter such as Genetic Genie.  Unfortunately, they still don’t have something from the filter that gives them clear, actionable data.  So, they come looking for a real person to help them, but already $300 down the road with no results. 

So, yes, genetic testing can be helpful.  But you have to be careful.  There are a few really important things to look for when it comes to genetic testing:

  • The company keeps your genetic data private and secure (note: 23&Me sells your genetic data for research!)
  • They have a reputable scientific panel who can responsibly gauge what genetic SNPs have meaning, and what the true meaning is.  You should be getting on the order of 50 SNPs, not thousands.  There is not data to support clinically relevant recommendations for thousands of different genes, so that is a red flag.
  • Beware the single SNP.  One gene never tells the whole story.  Simply knowing your MTHFR or COMT gene result does NOT tell your whole methylation or clinical story.  Again, look for something on the order of 50 SNPs, not ONE and not THOUSANDS.
  • Watch out for third party interests.  Is the place where you’re getting genetic testing selling your data, or pushing dietary supplements based on the result?  Caution.  Some dietary supplements may be beneficial for some genetic results but selling supplements shouldn’t be a primary, up-front goal of the brand/company.  For example, not everyone with an MTHFR variation needs high-dose methylated B-vitamins.  In fact, that can be dangerous in some cases.  Which leads me to…
  • You should be getting professional counseling with your result.  A trained healthcare professional can help you translate your results into meaningful and effective diet and lifestyle recommendations.  They will consider your whole clinical picture within the context of your genetics.  Otherwise, you’re left with a bunch of meaningless code, or generic guidelines.  Try to work with someone who can incorporate food into your treatment plan.  Remember that food is information for your body!

So, Who Can Benefit?

One way to tell a bad genetic test is if you see promises that it will tell you everything about you and your health.  There are specific genes and SNPs that have good scientific data behind them, and others that don’t.  A good test will only report on the genes that have been shown by research to have a strong effect, and that are actionable with diet and/or lifestyle interventions. 

Fortunately, there is quite a bit that you can reliably know.  Genetic testing can tell you:

  • If you have increased risk of cardiovascular disease, dyslipidemia, inflammation, and obesity – and what to do about it
  • If your body is better adapted for a diet higher or lower in carbohydrates – and how to eat based on that result
  • If you are better adapted for a high or low-fat diet, and what types of fats you should consume
  • If you are a fast or slow metabolizer of caffeine and, thus, whether it is harmful for you
  • If you have robust or poor detoxification mechanisms, which contributes to cancer risk – and how to eat in response to that
  • The type of sports activity you are best suited for, and how to fuel for performance
  • The vitamins and minerals you metabolize less well and, thus, need to increase in your diet.  The most well-known example of this is your MTHFR and COMT genes and how they contribute to your methylation/utilization of the B vitamins folate and B-12. 
  • Your tolerance for dietary sodium
  • Your natural tendencies for cravings and snacks
  • If you have a genetic predisposition for intolerance to gluten and/or lactose/dairy

Where to Begin

Bottom-line, genetic testing is at a point where you can get useful information from it.  However, for good results, it is extremely important to work with a responsible lab and with the help of a trained professional.  I currently use several labs for genetic testing but in my opinion the best panel comes from Nutrigenomix.  You can get a sample test report from their website, or from me.  Some other reputable sources of genetic testing include Genova Labs, Great Plains Laboratories, and Spectracell. 

Who Should Do It

In my opinion, the best candidates for genetic testing are people who:

  • Have a family history of cancer or heart disease, or who have risk factors for them (i.e. obesity, insulin resistance, and/or dyslipidemia)
  • Have tried to improve on their health (lose weight, improve blood lipids, reverse insulin resistance, or decrease inflammation) without success
  • Have an interest in knowing their ideal diet: macronutrients (fats, carbs, and protein), and nutrients (vitamins/minerals) that require increased consumption and/or supplementation.

I hope this article helped to clarify the confusing and somewhat intimidating field of genetic testing.  This testing can fit into a functional medicine framework, but should be combined with your full, unique picture to make helpful, actionable recommendations for diet and lifestyle interventions.  If you have further questions or are interested in getting tested please feel free to contact me for details. 

Best wishes to you, and please feel free to share or comment using the below links.

The Paleo Plate

Hello, I'm super excited to share another eBook sneak peek with you today!  I call this the Paleo Plate.  It's a good starting point for following an ancestral diet.  Tons more helpful tips for making this easy will be included in the FREE eBook.  Make sure to join the newsletter to be the first to receive it! 

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