Paleo Diet Q & A - 30 December 2009

Dear Readers,

Here's today's edition of Paleo Diet Q & A.

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Q: I happen to be Hyperthyroidic patient with plenty of Methimazole to take. My T4 is 15.5 and TSH .006 currently. I do kind of enjoy dairy foods like pot cheese/farmer's cheese, Raisin Bran with organic milk and some shredded wheat cereal. I can give that up. It tastes like horse food hay. My mom loves the Shoprite supermarket baguette Italian bread with plenty of artificial substances in it. I am trying to eat less and less of that. I have given up chocolate and I don't eat green tomatoes generally but the milk has vitamin D and I don't want to overindulge in supplements. My weight has been stable at around 188. I am 6 ft 3in. I weighed 147 early in 2009. I am 38 tomorrow. Now I can't substitute milk/vitamin D or can I? I do enjoy Soy. What else should I take or eat?

Lon

A: Dear Lon,

Hyperthyroidism could be the initial step in Hashimoto's Thyroiditis Disease. This happens to be an autoimmune disease where immune cells, namely T-Lymphocytes) attack cells of the thyroid gland, although a more comprehensive analysis is needed in order to do a diagnosis in your case. Another autoimmune disease called Celiac Disease carries an increased risk for other autoimmune diseases including HT. Celiac Disease is an autoimmune disease where the immune system mounts an attack against the epithelial cells lining the gut, triggered by gluten containing grains such as wheat, barley and rye. Hence, we believe that gluten containing grains may increase the risk for thyroiditis (remember that sometimes starts with hyperthyroidism and them moves to hypothyroidism). All grains and legumes (including soya and peanuts) contain harmful substances namely Lectins which increase intestinal permeability and this is associated to an increased susceptibility to autoimmune diseases.

Regarding dairy, they have several immunogenic (activate the immune system) proteins that may pass through the intestinal barrier if intestinal permeability is increased. Therefore, dairy are not the best choice to eat calcium, but rather green vegetables, such as kale, cauliflower, broccoli, etc.

Vitamin D is a crucial substance in terms of immune regulation. We suggest to measure blood levels of vitamin D and ensure they are in the 50-70ng/ml range.

The bottom line is to eat a diet based on lean meats, seafood, fresh vegetables, fresh fruits, nuts and olive oil. This will also provide you with big amounts of nutrients and antioxidants which may help to your overall health.

We hope this helps.
Maelán

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Q: From the reading your studies in The Paleo Diet Update, Volume 2 Issue 2, it appears that the investigators failed as do many others to consider that when the consumption of fruits and vegetables increased, that something else had to have been omitted--or else calorie intake would have increased. Hence, just as well have the omission rather than the inclusion that effected the outcome. Please pass along to Loren for his consideration.

Thanks, Van

A: Thank you for your comment. Indeed, when we add something to a diet in order to maintain a stable caloric intake something has to be removed. As you said, we can't be 100% sure that the positive effect was due to increasing fruits and vegetables. In one of the studies Dr. Cordain mentioned, they didn’t just reduce or increase fruit and vegetables, they also manipulated the variable cereal grains. This would not only have a net acid load and displaced net base yielding fruits & vegetables, but may also adversely affect bone health and calcium balance through other mechanisms.

In science, isolating variables is a frequent practice and this is one of the reasons why the evolutionary template can shed light into difficult nutrition questions. Instead of focusing on only one specific variable, we defend that optimal health can only be achieved if we mimic most of the ancient lifestyle (sun exposure, exercise, sleep, avoiding chronic stress and pollutants) and a pre-agricultural diet (not just a net base yielding diet), which is what we propose with The Paleo Diet.

Nevertheless, it should be mentioned that more and more evidence suggests that the diet’s acid load is important in terms of optimal health.

Cordially,
Pedro

Paleo Diet Food Pyramid

Dear Readers,

Recently we received a question from a member of the Paleo Diet community asking whether there was a Paleo Diet food pyramid. Dr. Cordain published what he dubbed Humanity's Evolutionary Food Pyramid (aka The Paleo Diet Food Pyramid) in the inaugural edition of The Paleo Diet Update (Volume 1, Issue 1), originally published in February, 2005. The USDA food pyramid is also included in this post for reference.

The key recommendations Dr. Cordain suggested in his article from Volume 1, Issue 1 are:

• Avoid the several ounces of grains per day the USDA Dietary Guidelines recommend.
• Don’t buy into the diary industry’s well-financed and politically connected campaign to convince you that you need to drink milk.
• Increase your intake of omega 3 fatty acids.
• Eat more protein and less high glycemic load carbohydrates than are recommended by the USDA Dietary Guidelines.

More on this subject coming soon.

Paleo Diet Q & A - 11.5.09

Dear Readers,

More Q & A from the Paleo Diet community:

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Q: I believe in the Paleo Diet and want to introduce it into my lifestyle but I have a chronic renal condition (IgA nephropathy) which is still mild. Can I still follow this diet but eating moderate protein instead of high? Or do you have any other suggestions to how I can go about it? The doctors never advised me to restrict my protein intake but I have read many articles that says that restricting protein intake benefits renal disease sufferers.

A: Circumstantial data from the Inuit people, before westernization, suggests that they ate high protein diets for a lifetime, and likely had normal kidney function. The available human data suggests that the kidney responds to a higher protein diet by increasing the glomerular filtration rate (GFR). This response is not pathological, but rather a healthful response as the effective GFR remains constant as kidney mass increases. The analogy is like a muscle that responds to lifting more weight - it hypertrophies (gets larger) to adapt to the increased load.

Yes, people with pre-existing kidney disease will worsen on a higher protein diet. My recommendation for these people would be to reduce the glycemic load of their diet (e.g. get rid of most processed food) first and carefully monitor kidney function until it begins to improve. Ironically, it is likely a high glycemic load diet that worsens kidney function in the first place.

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Q: I am not yet on the Paleo diet, though I would really like to be. I do not doubt the validity of the science or the biology that leads to the Paleolithic diet being so successful. However, living in the Western world means that just about everything has dairy and grains in it, along with unhealthy refined carbohydrates and trans fatty acids, therefore the most logical and reliable way to get a healthy Paleo diet is to buy the basic organic ingredients and make meals from them oneself.

Unfortunately, I don't know what the correct proportions of the food groups for a well-balanced Paleo diet are; i.e. how much fruit and vegetables compared with lean meat compared with nuts and seeds compared with fish, etc?

I also wanted to ask about the sorts of foods that should be eaten instead of grains and dairy. Although I am aware that calcium uptake is based on many factors besides just calcium intake, what is the source of calcium in the diet? Fish bones and the like? For grains, what should we eat instead for those meals: I know it has been said that vegetables of some kind (or fruit) should be eaten with every meal, but what does that make breakfast and lunch besides a pile of vegetables?

What else do we eat with them?

With this increase in fruit and veg consumption (about how many portions per day do you recommend?), how do we prevent ourselves getting massive diarrhoea? I personally had one point in my life where I was eating over 30 portions of fruit and five portions of veg per day. Is this too much, perhaps even to the point of being unhealthy?

Furthermore, with this increase in meat and seafood consumption, even with the reduction in grain and dairy production, will not an increased percentage of Paleo dieters hasten the trends of soil erosion and landscape damage due to the increase quantity of land required for farming to feed people?

Finally, with increased individual meat consumption, would not the risk of things like gout increase? Would it not at least potentially be risking the same health problems and complications of the Atkin's Diet?

Thank you for your help.

A: Regarding the optimal proportion of fruits, vegetables, lean meats and seafood there's not a consensus. Some studies made by Dr. Cordain et al. have shown plant to animal ratio ranges from 35:65 to 65:35 percent. This depends on latitude, season, climate, culture, etc. However, all ancestral diets shared key characteristics. Food sources were limited to unprocessed plants for ages, and unprocessed land and marine animals hunted from the proximate environment. We believe that the most common pattern was 30-35% protein (40% is the toxic ceiling), 30% fats and 40% carbohidrates. This means that lunch and dinner are based on lean meats or seafood and vegetables. Breakfast could be an opportunity to eat fruits, nuts, eggs or even vegetables and protein (turkey breast), see our newsletter v5_#39. Fruits and nuts are good options for snacks.

Grains and dairy are nutritionally poor when compared to fruits, vegetables, seafood and lean meats. So, grains and dairy have no natural substitute. Milk and grains are usually eaten with breakfast, and I've provided some ideas for breakfast. In our published research section on our website you can download Dr. Cordain's scientific paper regarding grains titled: Cereal grains: humanity's double edged sword.

Broccoli, cauliflower, kale and all green leaves are good calcium sources without the problematic issues that dairy has: they increase metabolic acidity which leads to bone calcium loss.

Yes, too much fruit consumption is not the healthiest choice. High fructose intake is related to many metabolic diseases, especially obesity. Diarrhea is usually associated to fructose intolerance.

So, one doesn't have to precisely count caloric intake from protein, fats and carbohydrates as long as you combine seafood and lean meats with vegetables in meals and use fruits and nuts as breakfast and snack options.

Regarding gout: gout is considered part of a metabolic syndrome and insulin resistance is at the root of gout illness. Along these lines, gout is rare among pre-agricultural populations (Hunter-gatherers). Serum uric acid levels depends on the amount entering the bloodstream and the amount leaving the bloodstream. The amount of uric acid entering the bloodstream depends on the amount of it produced by the liver (1/3 from diet and 2/3 from body turn-over of cells). The amount of uric acid leaving the bloodstream depends on the kidneys' excretion capacity. The metabolic syndrome and insulin resistance induce kidney underexcretion of uric acid. On the other hand, when the kidney is faced with high protein purine-containing foods, serum uric acid levels decrease because the kidney increases uric acid excretion (this is an evolutionary trade-off).

So, the real problem is increased liver production of uric acid and kidney uric acid underexcretion. High glycemic load foods (as found in the typical Western diet and not in The Paleo Diet), and subsequent hyperinsulinemia halts the kidney capacity to excrete uric acid. Regarding liver production of uric acid: fructose--and particularly High Fructose Corn Syrup (HFCS)--decreases inorganic phosphate in the liver, and this increases the production of uric acid from purines.

The Paleo Diet helps to fight gout as it is based on low-glycemic load foods, high protein, and no HCFS foods.

We hope this helps.