Quote: More work for the primal / Paleo community

It is bad news. Twenty years ago, no state had an obesity rate above 15%. Now, 38 states have rates above 25%. It's a huge shift, and it's relentless.

James Marks, MD, MPH
Robert Wood Johnson Foundation

Conflicting results on salt intake and mortality

France, Vendée (85), île de noirmoutier, pure Salt. Pinpin 20:24, 19 September 2006 (UTC)By Dr. John

So, which is it, limit the salt or not? Several reports have appeared this week on the health effects of dietary salt. The one that seems to have caught the most attention was the study recently published in the American Journal of Hypertension. As reported by Scientific American on July 8, "a meta-analysis of seven studies involving a total of 6,250 subjects … found no strong evidence that cutting salt intake reduces the risk for heart attacks, strokes or death in people with normal or high blood pressure." This was viewed by many as absolving salt of any significant health impact. Indeed, the declarative title of the Scientific American article seemed to leave no doubt: It’s Time to End the War on Salt. However, medicine and science are rarely that easy.

On July 12, writing in the Forbes blog CARDIOBRIEF, Larry Husten reports on a study published in July 11 issue of the Archives of Internal Medicine which included twice as many subjects  - "12,267 adults participating in the 3rd National Health and Nutrition Examination Survey." This study found that the sodium-potassium ratio was the important factor and that “a high sodium intake, especially when combined with a low potassium intake, is associated with an increased risk of cardiovascular disease (CVD) and mortality.” Husten's post includes the AMA press release which concludes:

In summary, our findings indicate that higher sodium-potassium ratio is associated with significantly increased risk of CVD and all-cause mortality in the general US population,” write the authors. “Public health recommendations should emphasize simultaneous reduction in sodium intake and increase in potassium intake."

There is good news for modern Paleolithic nutrition which refrains from processed foods and includes plenty of fruits and vegetables:

The authors point out that salt is frequently added to processed foods, thereby increasing the sodium-potassium ratio, while fruits, vegetables and dairy products tend to have a lower ratio.

So, there you have it. Time for more studies or just eat your fruits and vegetables?!

Joseph finally quit grains to lower his bad cholesterol

Small, dense LDL is the type of cholesterol that gets under your vascular "skin", the thin lining that protects the inside of the vessel wall. These small, dense molecules are suspected to cause the first insult, which invites other factors to pile on and build a dangerous sludge in your artery called atherosclerosis. If you are a baby boomer like me, you were taught that cholesterol was bad. Then, no, no, HDL cholesterol is actually good; it was LDL cholesterol that was bad. Now we learn there are two types of LDL, large, buoyant LDL and the small, dense LDL. The small, dense version is the worst of the two. 

We also learned that the main cause of elevated cholesterol was fat. Well, yes, factory-made transfat is bad, but the biggest dietary cause of increased small dense LDL, is... carbohydrates! Dr. William Davis, author of The Heart Scan Blog, illustrates this in the case of Joseph, "a whip-smart corporate attorney" with high LDL cholesterol. Joseph's numbers before changing his diet were: LDL - 2620 nmol/L, and small LDL - 2331 nmol/L. Dr. Davis writes:

I advised him to eliminate wheat, cornstarch, and sugars, while limiting other carbohydrate sources, as well. Joseph didn't like this idea very much … (he) replaced all sugar and refined flour products with whole grains, but did not restrict his intake of grains. 

LDL decreased a small amount to 2451 nmol/L and small LDL to 1998 nmol/L. Dr. Davis:

I explained to Joseph that any grain, complex, refined, or simple--will, just like other sugars and carbohydrates, still provoke small LDL. Given the severity of his patterns, I suggested trying again, this time with full elimination of grains. 

Finally, LDL significantly decreased to 1320 nmol/L and small LDL to 646 nmol/L

This is typical of the LDL responses I see with elimination of wheat products on the background of an overall carbohydrate restriction. 

Take home point: Although genetics plays a role, the modern high carb diet with its refined sugars and grains raises your small, dense LDL, the really bad cholesterol. Unfortunately the test for small, dense LDL is expensive and not available in most medical offices. Talk to your doctor and find out what evaluation is right for you. 

(By the way, statin medications do not decrease small, dense LDL.)

Short Takes: "Silent" celiac disease, Pain on the brain, Anxiety in the gut

1. "Silent" celiac disease

Celiac disease is an insult of the modern diet occurring in at least 1% of the population. The reaction of the immune system to gluten protein in wheat and other grains sets off a "misguided attack" on the lining of the small intestine. As describe by ScienceNews:

The small intestine suffers from this misguided attack, and celiac patients can experience bloating, diarrhea, constipation, lethargy and poor nutrition as they lose some ability to absorb nutrients through the damaged walls of the small intestine.

However, others sensitive to gluten may not show these classic intestinal signs but instead suffer silently. As ScienceNews continues:

But many people don’t have such clear symptoms, said gastroenterologist Katri Kaukinen of the University of Tampere. Even undetected the disease can have health effects: It has been linked to poor educational achievement and failure to thrive in children, apparently due to nutrient loss. In adulthood, undetected celiac disease is associated with a risk of fractures, poor dental enamel, short stature, pregnancy difficulties and skin problems. 

Learn more from Nathan Seppa at ScienceNews or from Dr. Gerard Guillory in the previous post Gluten Sensitivity on the Rise.

2. Pain on the brain

Constant back pain wearing you down? Well, it does thin a portion of the frontal cortex of the brain. Fortunately, good pain control can allow the brain to recover. As reported by ScienceNews, scientist at McGill University in Montreal studied the brains of patients with low back pain and found the upper-outer edges of the frontal areas, specifically the dorsolateral prefrontal cortex (a region involved in pain modulation), were thinner than normal. Six months following successful treatment of the pain, repeat scans showed improvement in these areas. The greater the pain control, the greater the return to normal. Learn more from Laura Sanders at ScienceNews. 

3. Anxiety in the gut

Evidence is slowly growing that a number of "psychological" disorders such as depression may actually originate from poor nutrition. The latest study looks at the impact of gut bacteria on anxiety. As reported by ScienceDaily:

Working with healthy adult mice, the researchers showed that disrupting the normal bacterial content of the gut with antibiotics produced changes in behaviour; the mice became less cautious or anxious. This change was accompanied by an increase in brain-derived neurotrophic factor (BDNF), which has been linked to depression and anxiety.

When oral antibiotics were discontinued, bacteria in the gut returned to normal. "This was accompanied by restoration of normal behaviour and brain chemistry," Collins said.

One more reason to protect your gut bacteria by avoiding grains. 

Gluten Sensitivity on the Rise

Guest Post by Gerard Guillory, M.D.

Approximately 1% of persons in the US have celiac disease, an immune reaction to the gluten protein in wheat (above), barely, rye and sometimes oats. Many more may sensitive to this foreign protein.Gluten sensitivity is more common than medical experts once believed, affecting perhaps as much as 1 percent of the U.S. population. The symptoms of this condition, also referred to as celiac disease, can be widely varied and highly unpleasant. The good news is that celiac disease can be detected through a simple blood test and effectively managed through changes in diet.

Gluten is a protein found in wheat, barley and rye and food products such as breads and pastas that are derived from these grains. Gluten also is sometimes found in oats, which frequently are contaminated with gluten during processing and, as a result, also contain the protein.

In some people, the body’s immune system is triggered by the presence of gluten, causing a variety of problems. In children, these can include failure to thrive and short stature. Many gluten-sensitive adults experience chronic gastrointestinal problems, including diarrhea, flatulence and weight loss. Recent studies have indicated that many adults who are gluten-sensitive experience non-gastrointestinal problems as well, including iron-deficiency anemia and decreased bone density.

I became interested in gluten sensitivity in 1989, when I wrote my first book on irritable bowel syndrome (IBS). I had included a chapter on the so-called elimination diet. In those days, we didn’t have effective tests for many food allergies, so we recommended that patients eliminate various foods from their diet and then resume consumption of these, one by one. This would help identify the cause of IBS symptoms.

Through this method, we found that when some patients eliminated gluten from their diets, not only did IBS symptoms disappear, but so did other problems such as rheumatism, allergies and skin disorders.

Recent studies suggest that this isn’t a coincidence; in fact, there appears to be a direct link between gluten and auto-immune disorders. If you have an auto-immune disorder such as rheumatism, I recommend that you ask your physician about gluten sensitivity and consider getting a blood test. You also should consider testing if you are experiencing unexplained gastrointestinal problems such as chronic diarrhea or weight loss. Testing should be done before you attempt to eliminate gluten from your diet, so that the lab can determine whether gluten is triggering an immunological response.

If you test positive for celiac disease, your physician is likely to recommend that you work with a dietician to develop a gluten-free diet. Many people also join a support group, which helps them stay with the diet. Growing numbers of grocery stores and natural-foods stores sell gluten-free products, so the difficulties associated with the diet are perhaps not as onerous as they once were.

Gerard L. Guillory, M.D., is board-certified in internal medicine and has been practicing in Aurora, Colo., since July 1985. As an assistant clinical professor of medicine at the University of Colorado Health Sciences Center, Dr. Guillory is actively involved in teaching medical students, resident physicians, and nurse practitioner students. He has lectured extensively on the role of nutrition and disease. Over the years, he has fostered an interest in patient education and has authored three books on digestive troubles.

Originally posted at The Care Group, update Feb 7, 2011

Q&A: Will we get enough calcium on the Paleo diet?

In this and in subsequent entries, I will respond to some of the questions received following the lecture Paleolithic Nutrition: What is the Evidence? The lecture will also be given at noon on Friday, May 6 at The Medical Center of Aurora, North Campus.

Adults considering Paleolithic nutrition worry about getting enough calcium if the cut out dairy products. Their main concern is preventing osteoporosis, a thinning of the bone that can lead to fractures, disability, and in the elderly, even death. (Calcium metabolism in children is a separate issue and will not be considered in this entry. After all, Paleolithic young were likely breast fed for 5 or 6 years.)

The modern diet, also referred to as the Western diet, is not favorable to healthy calcium metabolism. As Staffan Lindberg notes in Food and Western Disease:

For the average Westerner, roughly one-fourth of their energy intake is provided by food that is lacking in calcium (primarily oil, margarine, and sugar). Cereals, which provide an additional 25%, contain relatively little calcium.  Hence, it should come as no surprise that the calcium intake among many hunter-gatherer societies is estimated to have been higher than among modern Westerners.

Fruits and vegetables, which form the base Paleolithic food pyramid, are important sources of calcium. As Loren Cordain states in The Paleo Diet:

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Doctor's elevated cholesterol drops quickly on Paleo diet

One doctor's remarkable response to the Paleolithic diet.

Dr. Lustig presents "Sugar: The Bitter Truth"

Robert H. Lustig, MD, Professor of Pediatrics in the Division of Endocrinology at the University of California, San Francisco, holds no punches during his lecture on "Sugar: The Bitter Truth." He takes a direct blow at sugar as the primary culprit for the obesity epidemic. The middle section on biochemistry is tedious, although it contains some pearls. If you want to jump through that section, pick back up at 1:08:29 on the time bar.

While he characterizes the Paleo foods as "raw" - not true of the Upper Paleolithic and maybe not since Homo erectus - he gets it right: the Paleo diet would prevent obesity and its many associated illness such as Type II diabetes.

Short Takes: Alzheimer's, PMS, Chronic Diseases

Does Alzheimer’s Disease start in the liver?

According to ScienceDaily, a recent study in The Journal of Neuroscience Research suggests the liver might be the source of beta amyloid found in the brain of patients with Alzheimer’s disease.

Unexpected results from a Scripps Research Institute and ModGene, LLC study could completely alter scientists' ideas about Alzheimer's disease -- pointing to the liver instead of the brain as the source of the "amyloid" that deposits as brain plaques associated with this devastating condition.

This unexpected finding holds promise for the development of new therapies to fight Alzheimer's."

(Maybe it also point the way to understading the cause. Is AD a dietary disease?)

Using a mouse model for Alzheimer's disease the investigators found “significant concentrations of beta amyloid might originate in the liver, circulate in the blood, and enter the brain. If true, blocking production of beta amyloid in the liver should protect the brain.”

Source
http://www.sciencedaily.com/releases/2011/03/110303134435.htm

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Gorillas regain health on original diet

John Durant at Hunter-Gatherer found a great video about gorillas fed mostly processed food for years improving their health when returned to an original diet. David A Gabel of ENN writes:

 After a 21 year old gorilla named Brooks died of heart failure at Cleveland Metroparks Zoo in 2005, a group of researchers decided to examine how the gorilla’s lifestyle affect their health.

For decades, zoos have fed gorillas bucket loads of high vitamin, high sugar, and high starch foods to make sure they got all their nutrients. At the Cleveland zoo, they have started feeding food such as romaine lettuce, dandelion greens, endives, alfalfa, green beans, flax seeds, and even tree branches which they strip of bark and leaves.

Watch these gentle giants and the progress they are making:

Jill Bolte Taylor's Stroke of Insight

A friend recently pointed me to a video of Jill Bolte Taylor, a neuroscientist, describing her stroke of insight. I previously commented on her book here. In video on TED, Dr. Taylor vividly describes the journey into her own mind and the different "personalities" of each brain hemisphere. 

An "Insight of the Decade": Chronic inflammation kills

Macrophages are "hallmarks of inflammation" and provide important immunological defense. However, they can also promote disease.Jonny Bowden, PhD, CNS, describes the Four Horsemen of Aging in his book The Most Effective Ways to Live Longer. Although not a paleo book per se, the discussion of the Four Horsemen - Free radicals, Inflammation, Glycation and Stress - is mostly on target.

Bowden quotes a number of specialists in the field:

Inflammation is one of the things that keeps us alive in a hostile world. … Without inflammation we would be sitting ducks in a very hostile world, with no way to repair the damage constantly being inflicted on us. Our internal inflammatory responses let us attack invaders, surround, them, and ultimately kill them before they kill us. (Barry Sears, PhD)

However, while we need acute inflammation to repair damage done by a cut, an infection, or other insult, chronic inflammation is another matter altogether. While not necessarily the starter switch, “chronic inflammation may be the engine that drives many of the most feared illnesses of middle and old age.” (Christine Gorman)

SAD is largely to blame:

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