Paleolithic Diet, 4 - Antinutrients

I left off in my previous post talking about antinutrients. This is a broad and deep topic. It's a special person who can thrill in the minutia of toxicology. As much as I admit to those kinds of thrills, I'll also admit to feeling overwhelmed at times in class trying to grasp the sheer number of potential toxicants and the unbelievable array of impairments those chemicals can wrest from our bodies. Wow, just wow.

But to keep this short...

Cordain contends:

"There are components in raw cereal grains which wreak absolute havoc with human health and well-being." ... Besides phytates, "these antinutrients include protease inhibitors, alkylrescorcinols, alpha-amylase inhibitors, molecular-mimicking proteins, etc."

He adds that sophisticated processing technologies only partially mitigate the negative effect of grain consumption.

He lays out a convincing argument.

I have 2 concerns. When we choose not to eat grains, legumes, starchy tubers, and dairy foods, we're left with meat, seafood, fruit, vegetables, nuts, and a few other seeds - all foods promoted in the Paleo Diet.

Concern 1. Virtually ALL plant foods contain some amount of toxin or antinutrient, not just grains (which are seeds of grasses), legumes, and potatoes. Below is a table I swiped from Cornell University's GEO-PIE site.¹

If we are to apply the antinutrient argument to the selection of our meals, why not limit consumption of all plant foods? That leads me to my next concern.

Click for larger.
Concern 2. Animal tissue is also a source of toxins. Just as mercury bioaccumulates in fish (fish higher up the food chain contain more mercury), so chemicals, some toxic, can bioaccumulate in an ecosystem. Below is some text that accompanied the above table:

"Many of these compounds are known carcinogens. Some fat-soluble plant toxins even bioaccumulate - that is, when an animal eats the plant, the toxins collect in animal tissues and pass to humans when we eat the animal - and can be secreted in human and animal milk (for example, solanine from potatoes)."

And if it's grain we're trying to avoid, let us not look to our livestock, whose cells are packed with the imprint of the grain used to fatten them. In The Omnivore's Dilemma,Michael Pollen describes the journey of the unique carbon atoms found in corn as they travel up the food chain:²

"The higher the ratio of carbon 13 to carbon 12 in a person's flesh, the more corn has been in his diet - or in the diet of the animals he or she ate."

In fact, he says, when you compare the tissues of Mexicans, who eat more corn (outright) than North Americans, you find they still have a lower concentration of corn-based carbon 13 isotope in their bodies than we do. Our corn-fed cattle, and our consumption of same, are contributing to claims such as Todd Dawson, a Berkeley biologist made in reference to our corny tissues, "North Americans look like corn chips with legs."

Given the plethora of harmful compounds that Cordain describes reside in cereal grains, I shiver to think what amount of them may be accumulating in the flesh of our grain-fed livestock.

If we are to apply the antinutrient argument to the selection of our meals, why not limit consumption of animal foods as well as plant foods? (Let this be one more argument for pastured livestock.)

The Paleo Diet shows the potential of being the mother of all weight loss diets.

________¹ GEO-PIE: Genetically Engineered Organisms - Public Issues Education Project.
² Charming photograph of snake/frog/insect food chain via Biomes Blog.

Paleolithic Diet, 3 - Fire

Getting back to the diet that shuns grains, legumes, and potatoes...

There are so many points to consider here, pro and con, that I think I'll take them one at a time.

This post will be about fire.¹

(I'll try to hold my thinking to how these points might effect what we eat today, right now, for breakfast. Many of Cordain's contentions are so loaded that a meaty discussion of them is sure to elicit explosive tangents and "You're so full of s**t!"s - or to use Melinda's more cordial term, "academic infighting", when all I want to know is what to eat for breakfast.)

Cordain contends,

"Until the advent of regular fire use and control (as evidenced by hearths ~125,000 years ago) it would have been almost virtually energetically impossible for our species to consume cereal grains to supply the bulk of our daily caloric requirements."

Melinda counters that fire use may actually date to 1.42 million years ago, as evidenced by, among others, hearths uncovered at Oldowan sites in Africa. (She references a book, The Lost Civilizations of the Stone Age by Richard Rudgley, 2000 - a book I'll have to get my hands on).

The difference there, ~1.3 million years, is important since it might have allowed time for man's genes to evolve sufficiently to consume cooked grains.

Grains must be heated for them to be a viable foodstuff. Yet even when heated, according to Cordain, "cooked cereal grains wreak havoc on the primate gut because of [their] high antinutrient content."

Fast forward to breakfast. Here I have my fire-breathing hob and a bowl of dry, rolled or steel-cut² oats. According to the Paleo Diet, I am discouraged from cooking and eating my oats since my genes have not evolved in the time, anywhere from 1,420,000 to 125,000 years, that the forebears of my genes needed to make oats edible. Hm.
________
¹ Photograph is of an ancient living area with hearth as centerpiece. It's part of the Skara Brae Neolithic settlement in Scotland that was excavated in the early 1930s. Wikipedia notes the date of habitation from about 3100 BC, and says, "On average, the houses measure 40 square metres in size with a large square room containing a large hearth which would have been used for heating and cooking." Nice shelves.

² Thanks to Constance, I bought a box yesterday.

Vitamins Are Not Innocuous

The Sunday New York Times Magazine runs a feature called Diagnosis. The November 12th issue described a man who presented with a wound (an incision from a hernia operation) that would not heal ("The Healing Problem"). He also had too few red blood cells and too few white blood cells, especially neutrophils. He felt tired, achy and had a fever. He was admitted to the hospital and received weeks of intravenous antibiotics. The wound still did not heal.

The resident worked and studied and ran tests. Nothing. Then the man's wife showed up with a list of his vitamins. The diagnosis? A copper deficiency caused by ingestion of too much zinc.

The resident chimed, "We just don't think of vitamins as something that can be harmful."

This week an MD wrote in Letters, "The case serves to emphasize once more that "all natural" does not necessarily equate with "healthy" even with something as seemingly innocuous as vitamins."

Vitamins, "innocuous"? "all natural"? They're anything but. I'm talking about the kind you take from a bottle, not the kind found in our cells. The chemicals in a bottle can be helpful but they can also cause problems when taken in excess - from simple acne to bone loss.

I don't know why reviewing someone's supplement intake is considered novel or in this case worthy of praise. In my experience it's pretty routine. Every person who studies nutrition has to take a class in micronutrients and be able to recognize deficiency and toxicity states of every vitamin and essential mineral. Nutrition education wasn't a big part of the curriculum for the older docs I've worked with. But med students these days take nutrition classes. Well, some.

This man had gastric bypass surgery 4 years prior. He most certainly met with a provider who could assess his unique nutritional needs. Why was his later deficiency state a surprise? (For that matter, why wasn't the cause of his anemia investigated 6 months before he landed in the hospital? A review of his supplements then may have resolved the anemia and precluded his wound healing crisis.)

Got that off my chest :)

Paleolithic Diet, 2 - Overview

Cordain argues that since man has not evolved sufficiently in the approximately 10,000 years during which farming took hold - to be consuming products of farming: grains and legumes - his optimum diet, based on the bulk of his evolutionary past, would consist of the minimally processed, wild plant and animal foods of the pre-agricultural hunter-gatherer.

The hunter-gatherer, according to Cordain, did not eat the following:

Click for larger.
Table extracted from Cordain's 2005 article:
Cordain L, et al. Origins and evolution of the Western diet: health implications for the 21st century.Am J Clin Nutr,2005;81:341-54.

Says he:

"Although dairy products, cereals, refined sugars, refined vegetable oils, and alcohol make up 72.1% of the total daily energy consumed by all people in the United States, these types of foods would have contributed little or none of the energy in the typical preagricultural hominin diet."

There is merit is in many of his points. Who would disagree that our overly processed diet is contributing to modern day chronic diseases? I have a few concerns though that prevent me from recommending his food plan at the moment. I'll elaborate after I eat some not-so-wild turkey.

In the mean time, take a look at the above table and see if you can pick out one line that looks like it doesn't belong.

Giving Thanks 2006

To all my readers. Cheers.

~~~~~~Photo: Bix. But not of Bix.

Paleolithic Diet

Melinda sent a link to an essay by Dr. Loren Cordain, the author of The Paleo Diet. Dr. Cordain argues that grains and legumes are making modern man ill, in essence because the human gut hasn't evolved to digest and assimilate their nutrients.

He robustly defends his position. A critical mind can't help but question some of his assumptions though. See what you think:

The Late Role of Grains and Legumes in the Human Diet, and Biochemical Evidence of their Evolutionary Discordance

Wikipedia places the Paleolithic Period from between 2,500,000 to 11,000 years ago, ending with the introduction of agriculture.

Below is an illustration and caption from Australia's news site The Age.

1. HOMO HABILIS ~ NICKNAME: Handyman. LIVED: 2.4 to 1.6 million years ago. HABITAT: Tropical Africa. DIET: Omnivorous – nuts, seeds, tubers, fruits, some meat.
   
2. HOMO SAPIEN ~ NICKNAME: Human. LIVED: 200,000 years ago to present. HABITAT: All. DIET: Omnivorous - meat, vegetables, tubers, nuts, pizza, sushi.
   
3. HOMO FLORESIENSIS ~ NICKNAME: Hobbit. LIVED: 95,000 to 13,000 years ago. HABITAT: Flores, Indonesia (tropical). DIET: Omnivorous - meat included pygmy stegodon, giant rat.
   
4. HOMO ERECTUS ~ NICKNAME: Erectus. LIVED: 1.8 million years to 100,000 years ago. HABITAT: Tropical to temperate - Africa, Asia, Europe. DIET: Omnivorous - meat, tubers, fruits, nuts.
   
5. PARANTHROPUS BOISEI ~ NICKNAME: Nutcracker man. LIVED: 2.3 to 1.4 million years ago. HABITAT: Tropical Africa. DIET: Omnivorous - nuts, seeds, leaves, tubers, fruits, maybe some meat.
   
6. HOMO HEIDELBERGENSIS ~ NICKNAME: Goliath. LIVED: 700,000 to 300,000 years ago. HABITAT: Temperate and tropical, Africa and Europe. DIET: Omnivorous - meat, vegetables, tubers, nuts.
   
7. HOMO NEANDERTHALENSIS ~ NICKNAME: Neanderthal. LIVED: 250,000 to 30,000 years ago. HABITAT: Europe and Western Asia. DIET: Relied heavily on meat, such as bison, deer and musk ox.

Policosanol Update 2

Does policosanol lower cholesterol or doesn't it?

Thank you to Kharma Dave who provided an update on the policosanol story with this study that appeared in the November issue of the American Journal of Clinical Nutrition:

Lack of cholesterol-lowering efficacy of Cuban sugar cane policosanols in hypercholesterolemic persons

We would benefit from the insight of The Great Speculator as to why 50-odd studies, most originating in Cuba, reported an inverse (beneficial) and dose-dependant relationship between sugar cane policosanol and serum lipids, yet two recent studies support the null hypothesis, that is, intake of policosanol has no effect on serum lipids.

This most recent data point in the policosanol saga is hardly an exclamation point. The dose was small (10mg), the study group was small (n=21), the study length was short (28 days). In the world of studies, this one should have no impact on the accepted efficacy or sale of the product. It shouldn't. But it will. And that's a shame. (Note Kharma Dave's conclusion in the comments of this post.)

Why shouldn't it? Let's compare this recent policosanol study to the study of a mass-marketed pharmaceutical:

• If this was a study that found no advantage to taking a mass-marketed pharmaceutical (as opposed to a poorly-regulated supplement), it would have no impact on the accepted efficacy or sale of that pharmaceutical.
  
  
• If this was a study that found no advantage to taking a mass-marketed pharmaceutical (as opposed to a poorly-regulated supplement),
  and it included thousands of study participants who were observed over a number of months,
  it would still have no impact on the accepted efficacy or sale of that pharmaceutical.
  
  
• If this was a study that found no advantage to taking a mass-marketed pharmaceutical (as opposed to a poorly-regulated supplement),
  and it included thousands of study participants who were observed over a number of months,
  and it reported harmful, even life-threatening, side effects to taking the drug,
  it would still have no impact on the accepted efficacy or sale of that pharmaceutical.

I reach this conclusion because a popular mass-marketed pharmaceutical used to treat type 2 diabetes, Actos (pioglitazone), was recently reported to be just about useless in improving the quality of life or staving off early death in people with type 2 diabetes:¹

"Published studies of at least 24 weeks pioglitazone treatment in [approximately 6200] people with type 2 diabetes mellitus did not provide convincing evidence that patient-oriented outcomes like mortality, morbidity, adverse effects, costs and health-related quality of life are positively influenced by this compound."

And...

"The occurrence of oedema was significantly raised."
(Oedema, or edema, is fluid retention, which, according to Actos' website, "may lead to or worsen heart failure.")

But they conclude...

"Until new evidence becomes available the place of pioglitazone in the treatment of type 2 diabetes mellitus remains unclear."

Unclear. And the occurrence of a side effect which could lead to heart failure was significantly raised. Yet drug companies are still making and project to make big bucks from the sale of Actos:

"Actos generated $77.0 million of revenue for Lilly [in 3 months ending September 30, 2006], an increase of 20 percent compared with the third quarter of 2005."

Lilly only markets the drug. Its manufacturer, Japan's Takeda, does even better with sales topping $1.3 billion in the first half of 2006 - and foresees continued profits. News of the aforementioned and hardly upbeat study came out in October 2006, yet in November Bloomberg.com was reporting that the president of Takeda expected sales of Actos to "increase by at least 20 percent in the year ending March 2007."

What if we took this latest policosanol study, included it in a meta-analysis with those 50 positive studies, and I'll even throw in the negative German study from earlier this year. We could show policosanol good, nice and good, worthy of believed efficacy and increased sales, no harmful side effects - much better than Actos fared in its meta-analysis. Instead, we'll single out this little study and conclude "It does not work." (No offense to Kharma Dave. I think he summed up public impression perfectly.) Sigh. It's all so relative, and profit-based.

~~~~~~¹ The Cochrane Library, 2006, Pioglitazone for type 2 diabetes mellitus.

Glycemic Index, Glycemic Load

Great question from Melinda in the comments section that I thought I'd resurrect and discuss here ... because I get off on numbers:

Have been reading up on glycemic load. Understand the basic principle, but am confused by radically differing measurements in different tables of value from different sources. F'rinstance, the International table of GI & GL values linked to Mendosa's site lists the GL of an apple at an average of 6. I borrowed a book from library (hoping not to have to crank up the computer every time I want to check a value) titled Glycemic Load Diet by Rob Thompson, MD (2006). He lists the GL of an apple at 78 (and recommends keeping total daily GL below 500). An Australian website with a large table of values seems to be using yet another scale: an apple is listed w/ a GL of 684 (!) and you're recommended to keep your daily GL total at 3000 or less (http://optimalhealth.cia.com.au/GlycemicLoad.xls) . Online Harvard Health Publications lists an apple as having a GL of 6.

Needless to say, this is confusing. I know you recommend Mendosa's site, but if you use his GL listings, approx. what amount of GL total for a day would you be aiming at in order to lose a little weight & lower cholesterol and glucose blood levels?

Melinda,

I think that Mendosa's and the Australian site are in sync, except the latter does not divide by 100.

Basically, GL = GI x CHO(g)

That is, the glycemic load of a serving of food is equal to the glycemic index of that food multiplied by available carbohydrate. If you consider the GI as a percentage then the above result would be divided by 100.

To answer your question of how much GL in a day...
Say you planned on eating a 2000 calorie/day diet. Say you wanted about 55% of those calories to come from carbohydrate. At 4 calories per gram of CHO, you would end up eating 275g CHO. If you could possibly get all of your CHO to fall into a midrange GI of 60, you would end up eating a GL of 60x275/100, or 165. Since many people eat more than 275g carbohydrate in a day, and since those carbs are often of the processed variety (and thus have a higher GI) I can understand setting 300 as a daily GL limit.

Curiously, whenever I initiate a discussion of glycemic index and glycemic load, my conversation partner begins checking their watch. I've learned that statements like, "Try to eat fewer foods made from flour, especially wheat flour." or "Dilute your juices." condenses the message and gives the concept a working chance :)

Keeping a cap on glycemic load is one method of maintaining healthful blood sugars. This is another method.

~~~~~~
Re: Thompson. He seems to be out of sync with the others but that doesn't necessarily make him wrong.

I wasn't familiar with Dr. Thompson or his GL calculation. I went to his site and read his explanation.

I then played with the numbers (boy did I) and it looks like his system is somewhat comparable (although not identical) to the more established system, in that an apple leads to a lower blood sugar response than a slice of bread, a bagel a higher response than bread (because of its larger size), etc. Without a better explanation of his methodology that's all I can say.

I will say - None of these numbers are set in stone. Apples (and other foods) vary in the amount and types of sugars they contain, which would affect their GI. The best we can do is measure lots of apples (and other foods) and use a mean/average. When I consider the wiggle room in calculation of GI, serving size, calculation of CHO in serving size, lab error, etc., I can appreciate how tables of values might differ.

As if you don't have enough :) here's another good GI/GL table with explanation (scroll down a bit and select "View this table"):
International table of glycemic index and glycemic load values: 2002

Weight Loss by the Hour

I've come to the conclusion that the recent craze of grazing, that is, frequent snaking, is what's doing us in. Rather, it's doing our fat stores in ... letting them balloon to a size that's swelled the market for relaxed-fit jeans.

I don't say this lightly. And I say this reluctantly, being a fan of grazing from way back.

Working in the field of diabetes has put me on intimate terms with two states (of metabolism) that I'll use to support my position.

1. The postprandial state: the fed state, the 1 to 2 hours after food is consumed.
   
2. The postabsorptive state: the fasting state, begins when the last nutrient has been absorbed.

These two states call upon different types and levels of hormones - molecules that work hard to maintain the equilibrium we rely on to function.

You might think of the fed state as a building and storing state (anabolic).
You might think of the fasting state as a breaking-down and releasing state (catabolic).

In the fed state, we derive energy primarily from the carbohydrates we've just eaten.^{1, 2}
In the fasting state we derive energy primarily from stored fat.³

The transition period between the postprandial fed state and the postabsorptive fasting state occurs approximately between 2 hours after eating and 10 hours after eating. That's a period you'd want to shoot for if your goal was to mobilize a bit of flank fat. (Of course, if you're a bodybuilder, you'll want to avoid this period - it could encourage catabolism or disassembling of muscle tissue you spent hours at the gym assembling.)

What does this all boil down to? If you're in good health but trying to shed a few pounds, try not eating for stretches of 3 to 4 hours between meals. Try especially not to consume carbohydrates during that down time. Non-caloric beverages are fine, but one sugar-packed soda could send your body back to a pack-it-on postprandial state.

~~~~~~Below is an excerpt from Larry King's interview with Julia Child on December 28, 2000. I would give up snacking for a month to hear her say, "You don't have to shovel it in.":

KING: Does anyone in France diet?

CHILD: They don't have to because they don't eat these great big quantities. You know, we have our American Institute of Wine and Food and our motto is a very good one of: Small helpings, no seconds, a little bit of everything, no snacking, and have a good time. But if you follow that, you're perfectly fine.

KING: Can you really read Julia Child, go to restaurants, and lose weight or maintain good weight - low cholesterol? Look, can you eat in France and avoid sauces?

CHILD: Well, if - you don't have to avoid them. The thing is, I think as we started off saying small helpings and no seconds and no snacking and a little bit of everything. In other words, you should eat a little bit of everything. But if you're going to pack it in and overeat you're just going to be fat and unhealthy.

KING: So you think you can eat a cream sauce?

CHILD: Absolutely, but you don't have to eat big dollops of it; just have a taste of it. I think, if you have a wonderful dish, even if it's loaded with all kinds of calories and things, have a taste of it. Know what it's supposed to taste like. You don't have to shovel it in.

...

CHILD: But you can have just a little bite, Larry, you don't have to...
KING: Just a little bite.
CHILD: ... don't have to pack it in.
KING: The trouble is, when it tastes so good, can you eat one cashew?
CHILD: Yes, you have to do.
KING: You can eat one cashew?
CHILD: I can.
KING: You can eat one potato chip?
CHILD: That is hard, but I can.
KING: How about a dry roasted peanut? One.
CHILD: No, that I have to have two of. But chew it thoroughly.

~~~~~~¹ This statement does not precisely apply to a person with untreated diabetes (type 2), where insulin resistance can prevent post-meal glucose from entering cells and being oxidized for energy.

² This statement hinges on a variety of factors including the macronutrient content of the meal and the physiological condition of the eater, although it is generally applicable:

"Many high-carbohydrate foods common to Western diets produce a high glycemic response, promoting postprandial carbohydrate oxidation at the expense of fat oxidation, thus altering fuel partitioning in a way that may be conducive to body fat gain."
- Glycemic index and obesity, 2002.

" ... increased glucose oxidation limits oxidation of longchain fatty acids directly by inhibiting their transport into the mitochondria."
- Metabolic interactions between glucose and fatty acids in humans, 1998.

³ Shils ME, et al. Modern Nutrition in Health and Disease, 9th ed., 1999, p. 646.

Photograph of lemur compliments of Arkive.org

Non-prescription Xenical Stumbles On Its Way Across The Counter

There seems to be a holdup on marketing of GlaxoSmithKline's (GSK) new over-the-counter (OTC) weight-loss drug, Alli. In an 11 to 3 vote, an FDA advisory panel recommended approval of Alli, the OTC version of Xenical, on January 23 - over 9 months ago. GSK was thrilled and hoped to get the drug in stores before the end of this year, pending the FDA's final go-ahead. Since Alli would be the only FDA-approved weight-loss drug available without a prescription, GSK was salivating.

I wonder what's happening to all that drool.

Maybe it's going into their recent campaign to warn would-be consumers about the drug's untoward side effects (see bulleted list). The latest public rumble in GSK's struggle to get Alli on store shelves has been their outreach to pharmacists. Reuters is reporting that GSK met with pharmacists at Walgreens (the biggest US drugstore chain by revenue) in the beginning of October to, as one pharmacist described, "get them on board."

"If a patient experiences these unpleasant side effects, they will likely discontinue use."
- Jennifer McFee, Walgreens pharmacist

Can't have that.

Drugstore.com is selling a one-month supply of prescription Xenical, 90 capsules, for $204.40. Alli is expected to cost about a third of that price. However, Xenical is a 120 mg strength tablet, Alli is only 60 mg. Also, where Xenical may be covered by insurance, Alli will be an out-of-pocket expense.

Mechanism

The active ingredient in both Xenical and Alli works by interfering with the action of the enzyme lipase which is integral in the digestion and consequently absorption of fat. The pills are taken with meals that contain fat. About 20 to 30% of the fat in those meals goes out with the stool.

Stools that contain a substantial amount of fat can, well, be a nuisance. They create a feeling of urgency, and ... loss of control. They leak. They are fetid. They float, and so resist attempts to flush. Their movement is accompanied by copious quantities of gas. The fat they contain is not always fat you want to get rid of. Vitamins A (and beta-carotene), E, D, and K are fats. Alpha-linolenic acid (ALA) and linoleic acid (LA) are essential fats that we absolutely need and can only get in food. The famous, and justifiably so, EPA and DHA, are types of omega-3 fats that studies show keep our blood flowing and our mood glowing.

All those goods fats and more ... out the back door. For what? Less than 1 pound a month?¹ And a $70-a-month habit for life? Let me suggest a more nutritious, less annoying, and more economical therapy - walking.

~~~~~~¹ "Following one year of treatment, Xenical in combination with diet was shown to be more effective in reducing weight than diet alone. In most cases, weight loss was gradual. Patients treated with Xenical and a reduced-calorie diet for one year lost an average of 13.4 pounds while those on a reduced-calorie diet alone lost 5.8 pounds."
- Xenical product insert (pdf)

This post is for K, she of the iron intestines.