Paleolithic diet

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Paleolithic-style dish: Seafood stew

The modern dietary regimen known as the Paleolithic diet (abbreviated paleo diet or paleodiet), also popularly referred to as the caveman diet, Stone Age diet and hunter-gatherer diet, is a nutritional plan based on the presumed ancient diet of wild plants and animals that various human species habitually consumed during the Paleolithic—a period of about 2.5 million years duration that ended around 10,000 years ago with the development of agriculture. In common usage, such terms as the "Paleolithic diet" also refer to the actual ancestral human diet.[1][2] Centered around commonly available modern foods, the "contemporary" Paleolithic diet consists mainly of lean meat, fish, vegetables, fruit, roots, and nuts; and excludes grains, legumes, dairy products, salt, refined sugar, and processed oils.[1][3][4]

First popularized in the mid 1970s by a gastroenterologist named Walter L. Voegtlin,[5][6] this nutritional concept has been promoted and adapted by a number of authors and researchers in several books and academic journals.[7] A common theme in evolutionary medicine,[8][9] Paleolithic nutrition is based on the premise that modern humans are genetically adapted to the diet of their Paleolithic ancestors and that human genetics have scarcely changed since the dawn of agriculture, and therefore that an ideal diet for human health and well-being is one that resembles this ancestral diet.[4][10] Proponents of this diet argue that modern human populations subsisting on traditional diets allegedly similar to those of Paleolithic hunter-gatherers are largely free of diseases of affluence,[11][12] and that two small prospective studies of the Paleolithic diet in humans have shown some positive health outcomes.[13][14] Supporters point to several potentially therapeutic nutritional characteristics of allegedly preagricultural diets.[10][15]

This dietary approach is a controversial topic amongst nutritionists[16][17] and anthropologists,[7][18] and it has been qualified as a fad diet by the National Health Service of England and American Dietetic Association.[19][20] Critics have argued that if hunter gatherer societies failed to suffer from "diseases of civilization", this was due to a lack of calories in their diet, or a variety of other factors, rather than because of some special diet composition.[21] Some researchers have taken issue with the accuracy of the diet's underlying evolutionary logic,[22][21][23] and have disputed certain dietary recommendations and restrictions on the grounds that they provide no health benefits or pose health risks[22][21] and are not likely to accurately reflect the features of ancient Paleolithic diets.[23][24] It has also been argued that such diets are not a realistic alternative for everyone.[25][26]


[edit] History

Gastroenterologist Walter L. Voegtlin was one of the first to suggest that following a diet similar to that of the Paleolithic era would improve a person's health.[6] In 1975, he published a book[5] in which he argued that humans are carnivorous animals and that the ancestral Paleolithic diet was that of a carnivore—chiefly fats and protein, with only small amounts of carbohydrates.[27][28] His dietary prescriptions were based on his own medical treatments of various digestive problems, namely colitis, Crohn's disease, irritable bowel syndrome and indigestion.[5][29]

In 1985, Melvin Konner and S. Boyd Eaton, an associate clinical professor of radiology and an adjunct associate professor of anthropology at Emory University, published a key paper on Paleolithic nutrition in the New England Journal of Medicine,[30] which allowed the dietary concept to gain mainstream medical recognition.[31] Three years later, S. Boyd Eaton, Marjorie Shostak and Melvin Konner published a book about this nutritional approach,[32] which was based on achieving the same proportions of nutrients (fat, protein, and carbohydrates, as well as vitamins and minerals) as were present in the diets of late Paleolithic people, not on excluding foods that were not available before the development of agriculture. As such, this nutritional approach included skimmed milk, whole-grain bread, brown rice, and potatoes prepared without fat, on the premise that such foods have the same nutritional properties as Paleolithic foods.[27][33][34] In 1989, these authors published a second book on Paleolithic nutrition.[35][36]

Since the end of the 1990s, a number of medical doctors and nutritionists[37][38][39] have advocated a return to a so-called Paleolithic (preagricultural) diet.[7] Proponents of this nutritional approach have published books[29][40][41][42] and created websites[43][44] to promote their dietary prescriptions.[45][46][47][48][49] They have synthesized diets from commonly available modern foods that would emulate the nutritional characteristics of the ancient Paleolithic diet, some allowing specific foods that would have been unavailable to preagricultural peoples, such as certain processed oils and beverages.[29][50][51]

[edit] Practices

Paleolithic-style dish: Roast pork with cooked and raw vegetables and fruit.
Raw Paleolithic-style dish: A raw tomato sauce with olives, celery, spinach and walnuts on courgette 'pasta' noodles.

The Paleolithic diet is a modern dietary regimen that seeks to mimic the diet of preagricultural hunter-gatherers, one that corresponds to what was available in any of the ecological niches of Paleolithic humans.[1][4] Based upon commonly available modern foods, it includes cultivated plants and domesticated animal meat as an alternative to the wild sources of the original preagricultural diet.[1][3][52] The ancestral human diet is inferred from historical and ethnographic studies of modern-day hunter-gatherers as well as archaeological finds and anthropological evidence.[10][53][54]

The Paleolithic diet consists of foods that can be hunted and fished, such as meat, offal and seafood, and that can be gathered, such as eggs, insects, fruit, nuts, seeds, vegetables, mushrooms, herbs and spices.[1][3] Practitioners are advised to eat only the leanest cuts of meat, free of food additives, preferably wild game meats and grass-fed beef since they contain high levels of omega-3 fats compared with grain-produced domestic meats.[1][3][52][55] Food groups that advocates claim were rarely or never consumed by humans before the Neolithic (agricultural) revolution are excluded from the diet, mainly grains, legumes (e.g. peanuts), dairy products, salt, refined sugar and processed oils,[1][3] although some advocates consider the use of oils with low omega-6/omega-3 ratios, such as olive oil and canola oil, to be healthy and advisable.[52] Practitioners are permitted to drink mainly water, and some advocates recommend tea as a healthy drink,[52] but alcoholic and fermented beverages are restricted from the diet.[3][52] Furthermore, eating a wide variety of plant foods is recommended to avoid high intakes of potentially harmful bioactive substances, such as goitrogens, which are present in certain roots, vegetables and seeds.[1][53][56] Unlike raw food diets, all foods may be cooked, without restrictions.[1][57] Cooking is widely accepted to have been practiced 250,000 years ago in the Middle Paleolithic, and possibly as long ago as 500,000 years ago.[58]

According to certain proponents of the Paleolithic diet, practitioners should derive about 56–65% of their food energy from animal foods and 36–45% from plant foods. They recommend a diet high in protein (19–35% energy) and relatively low in carbohydrates (22–40% energy), with a fat intake (28–58% energy) similar to or higher than that found in Western diets.[52][59][60] Furthermore, some proponents exclude from the diet foods which exhibit high glycemic indices, such as potatoes.[3] Staffan Lindeberg, an associate professor in the Department of Medicine at the University of Lund, advocates a Paleolithic diet, but does not recommend any particular proportions of plants versus meat or macronutrient ratios.[1][53] According to Lindeberg, calcium supplementation may be considered when the intake of green leafy vegetables and other dietary sources of calcium is limited.[1]

[edit] Rationale and evolutionary assumptions

Food guide pyramid showing the relative proportions of food recommended by the United States Department of Agriculture. Grains and cereals, which are excluded from the Paleolithic diet, form the base of the pyramid.

According to S. Boyd Eaton, "we are the heirs of inherited characteristics accrued over millions of years; the vast majority of our biochemistry and physiology are tuned to life conditions that existed prior to the advent of agriculture some 10,000 years ago. Genetically our bodies are virtually the same as they were at the end of the Paleolithic era some 20,000 years ago."[61]

Paleolithic nutrition has its roots in evolutionary biology and is a common theme in evolutionary medicine.[8][9][62] The reasoning underlying this nutritional approach is that natural selection had sufficient time to genetically adapt the metabolism and physiology of Paleolithic humans to the varying dietary conditions of that era. But in the 10,000 years since the invention of agriculture and its consequent major change in the human diet, natural selection has had too little time to make the optimal genetic adaptations to the new diet.[1] Physiological and metabolic maladaptations result from the suboptimal genetic adaptations to the contemporary human diet, which in turn contribute to many of the so-called diseases of civilization.[4]

More than 70% of the total daily energy consumed by all people in the United States comes from foods, such as dairy products, cereals, refined sugars, refined vegetable oils and alcohol, that advocates of the Paleolithic diet assert contributed little or none of the energy in the typical preagricultural hominin diet.[10] Proponents of this diet argue that excessive consumption of these novel Neolithic and Industrial era foods is responsible for the current epidemic levels of obesity, cardiovascular disease, high blood pressure, type 2 diabetes, osteoporosis and cancer in the US and other contemporary Western populations.[10] This is despite evidence that Paleolithic societies were processing cereals for food use at least as early as 23,000 years ago[63][64] and perhaps as early as 200,000 years ago.[65]

[edit] Opposing views on human evolution

The evolutionary assumptions underlying the Paleolithic diet have been disputed.[18][22][23][33] According to Alexander Ströhle, Maike Wolters and Andreas Hahn, with the Department of Food Science at the University of Hannover, the statement that the human genome evolved during the Pleistocene (a period from 1,808,000 to 11,550 years ago) rests on an inadequate, but popular gene-centered view of evolution.[23] They rely on Russell (2001)[66] to argue that evolution of organisms cannot be reduced to the genetic level with reference to mutation and that there is no one-to-one relationship between genotype and phenotype.[23]

They further question the notion that 10,000 years since the dawn of agriculture is a period not nearly sufficient to ensure an adequate adaptation to agrarian diets.[23] Referring to Wilson (1994),[67] Ströhle et al. argue that "the number of generations that a species existed in the old environment was irrelevant, and that the response to the change of the environment of a species would depend on the hereditability of the traits, the intensity of selection and the number of generations that selection acts."[68] They state that if the diet of Neolithic agriculturalists had been in discordance with their physiology, then this would have created a selection pressure for evolutionary change and modern humans, such as Europeans, whose ancestors have subsisted on agrarian diets for 400–500 generations should be somehow adequately adapted to it. In response to this argument, Wolfgang Kopp states that "we have to take into account that death from atherosclerosis and cardiovascular disease (CVD) occurs later during life, as a rule after the reproduction phase. Even a high mortality from CVD after the reproduction phase will create little selection pressure. Thus, it seems that a diet can be functional (it keeps us going) and dysfunctional (it causes health problems) at the same time."[68] Moreover, S. Boyd Eaton and colleagues have indicated that "comparative genetic data provide compelling evidence against the contention that long exposure to agricultural and industrial circumstances has distanced us, genetically, from our Stone Age ancestors."[12]

Referencing Mahner et al. (2001)[69] and Ströhle et al. (2006),[70] Ströhle et al. state that "whatever is the fact, to think that a dietary factor is valuable (functional) to the organism only when there was ‘genetical adaptation’ and hence a new dietary factor is dysfunctional per se because there was no evolutionary adaptation to it, such a panselectionist misreading of biological evolution seems to be inspired by a naive adaptationistic view of life."[23]

Katharine Milton, a professor of physical anthropology at the University of California, has also disputed the evolutionary logic upon which the Paleolithic diet is based. She questions the premise that the metabolism of modern humans must be genetically adapted to the dietary conditions of the Paleolithic.[18] Relying on several of her previous publications,[71][72][73][74] Milton states that "there is little evidence to suggest that human nutritional requirements or human digestive physiology were significantly affected by such diets at any point in human evolution."[18]

[edit] Nutritional factors and health effects

Fruits and vegetables, rich in vitamins, potassium and fiber, represent an important feature of hunter-gatherer diets.[10]
Fiber-rich root vegetables, such as beets, rutabagas, carrots, celeriac and turnips, maintain nutrient properties (low glycemic and insulin responses) characteristic of traditional hunter-gatherer plant foods.[3]

Since the end of the Paleolithic period, several foods that humans rarely or never consumed during previous stages of their evolution have been introduced as staples in their diet.[10] With the advent of agriculture and the beginning of animal domestication roughly 10,000 years ago, during the Neolithic Revolution, humans started consuming large amounts of dairy products, beans, cereals, alcohol, salt and fatty domestic meats.[10] In the late 18th and early 19th centuries, the Industrial revolution led to the large scale development of mechanized food processing techniques and intensive livestock farming methods, that enabled the production of refined cereals, refined sugars and refined vegetable oils, as well as fattier domestic meats, which have become major components of Western diets.[10]

Such food staples have fundamentally altered several key nutritional characteristics of the human diet since the Paleolithic era, including glycemic load, fatty acid composition, macronutrient composition, micronutrient density, acid-base balance, sodium-potassium ratio, and fiber content.[10]

These dietary compositional changes have been theorized as risk factors in the pathogenesis of many of the so-called "diseases of civilization" and other chronic illnesses that are widely prevalent in Western societies,[4][10][75][76][77][78] including obesity,[79][80][81] cardiovascular disease,[82][83][84] high blood pressure,[85] type 2 diabetes,[86][87] osteoporosis,[88][89] autoimmune diseases,[90] colorectal cancer,[91][92][93] myopia,[94] acne,[95][96][97][98] depression,[99] and diseases related to vitamin and mineral deficiencies.[90][100][101][102]

[edit] Macronutrient composition

[edit] Protein and carbohydrates

"The increased contribution of carbohydrate from grains to the human diet following the agricultural revolution has effectively diluted the protein content of the human diet."[103] In modern hunter-gatherer diets, dietary protein is characteristically elevated (19–35% of energy) at the expense of carbohydrate (22–40% of energy).[59][60][104] High protein diets may have a cardiovascular protective effect and may represent an effective weight loss strategy for the overweight or obese.[10] Furthermore, carbohydrate restriction may help prevent obesity and type 2 diabetes,[105][106] as well as atherosclerosis.[84] Carbohydrate deprivation to the point of ketosis may, however, cause adverse health effects.[107]

The notion that preagricultural hunter-gatherers would have typically consumed a diet relatively low in carbohydrate and high in protein has been questioned.[108] Critics argue that there is insufficient data to identify the relative proportions of plant and animal foods consumed on average by Paleolithic humans in general,[7][18][24][70] and they stress the rich variety of ancient and modern hunter-gatherer diets.[18][22][23] Furthermore, preagricultural hunter-gatherers may have generally consumed large quantities of carbohydrates in the form of carbohydrate-rich tubers (plant underground storage organs).[22][23][17] According to Staffan Lindeberg, an advocate of the Paleolithic diet, a plant-based diet rich in carbohydrates is consistent with the human evolutionary past.[1][4]

It has also been argued that relative freedom from degenerative diseases was, and still is, characteristic of all hunter-gatherer societies irrespective of the macronutrient characteristics of their diets.[21][109][110] According to Marion Nestle, a professor in the Department of Nutrition and Food Studies at New York University, judging from research relating nutritional factors to chronic disease risks and to observations of exceptionally low chronic disease rates among people eating vegetarian, Mediterranean and Asian diets, it seems clear that plant-based diets are most associated with health and longevity.[16][24]

[edit] Fatty acids

Hunter-gatherer diets generally maintain relatively high levels of monounsaturated and polyunsaturated fats, moderate levels of saturated fats (10–15% of total food energy[111]) as well as a low omega-6:omega-3 fatty acid ratio.[10][112] Moreover, they are devoid of artificial trans fat.[10] These nutritional factors may serve to inhibit the development of cardiovascular disease.[10] The Gale Encyclopedia of Diets recommends a low intake of red meat because it contains high levels of cholesterol, which may present health risks when consumed in excess.[113]

[edit] Micronutrient density

Nuts such as walnuts (pictured above) are rich sources of micronutrients and protein.
Fish and seafood, such as salmon (pictured above), are significant sources of essential micronutrients.

Fruits, vegetables, lean meats, and seafood, which are staples of the hunter-gatherer diet, are more nutrient-dense than refined sugars, grains, vegetable oils, and dairy products. Consequently, the vitamin and mineral content of the diet is very high compared with a standard diet, in many cases a multiple of the RDA.[3] Fish and seafood represent a particularly rich source of omega-3 fatty acids and other micronutrients, such as iodine, iron, zinc, copper, and selenium, that are crucial for proper brain function and development.[100] Terrestrial animal foods, such as muscle, brain, bone marrow, thyroid gland, and other organs, also represent a primary source of these nutrients.[56] Calcium-poor grains and legumes are excluded from the diet.[114][115][116] The Gale Encyclopedia of Diets indicates that the Paleolithic diet is low in calcium.[113]

[edit] Fiber content and glycemic load

Unrefined wild plant foods like those available to contemporary hunter-gatherers typically exhibit low glycemic indices.[117] Contemporary diets devoid of cereal grains, dairy products, refined oils and sugars, and processed foods have been shown to contain significantly more fiber (~42.5 g/d) than either current or recommended values.[3] Moreover, dairy products, such as milk, yoghurt, and cottage cheese, have low glycemic indices, but are highly insulinotropic, with an insulin index similar to that of white bread.[118][119] These dietary characteristics may lower risk of diabetes, obesity and other related syndrome X diseases by placing less stress on the pancreas to produce insulin, and preventing insulin insensitivity.[120]

[edit] Sodium-potassium ratio and acid-base balance

Since no processed foods or added salt are included the sodium intake (~726 mg) is lower than average U.S. values (3,271 mg) or recommended values (2,400 mg). Further, since potassium-rich fruits and vegetables comprise ~30% of the daily energy, the potassium content (~9,062 mg) is nearly 3.5 times greater than average values (2,620 mg) in the U.S. diet.[3] The inverted ratio of potassium to sodium in the U.S. diet compared with preagricultural diets adversely affects cardiovascular function and contributes to hypertension and stroke.[89][121]

Moreover, diets containing high amounts of salt induce and sustain increased acidity of body fluid, and net acid producing diets may contribute to the development of osteoporosis and renal stones, loss of muscle mass, and age-related renal insufficiency. Because of the absence of cereals and energy-dense, nutrient-poor foods, in the hunter-gatherer diet, foods that displace base-yielding fruits and vegetables, the diet produces a net base load on the body, as opposed to a net acid load.[88][122]

[edit] Bioactive substances and antinutrients

Furthermore, cereal grains, legumes and milk contain bioactive substances, such as gluten and casein, which have been implicated in the development of various health problems.[4][13] Consumption of gluten, a component of certain grains, such as wheat, rye and barley, is known to have adverse health effects in individuals suffering from a range of gluten sensitivities, including coeliac disease. Since the Paleolithic diet is devoid of cereal grains, it is free of gluten. The paleodiet is also casein-free. Casein is a protein found in milk and dairy products, which may impair glucose tolerance in humans.[4][13]

Compared to Paleolithic food groups, cereal grains and legumes contain high amounts of antinutrients, including alkylresorcinols, alpha-amylase inhibitors, protease inhibitors, lectins and phytates, substances known to interfere with the body's absorption of many key nutrients.[4][76][90] Molecular-mimicking proteins, which are basically made up of strings of amino acids that closely resemble those of another totally different protein, are also found in grains and legumes, as well as milk and dairy products.[4][76][90] Advocates of the Paleolithic diet have argued that these components of agrarian diets promote vitamin and mineral deficiencies and may explain the development of the "diseases of civilization" as well as a number of autoimmune-related diseases.[4][76][90]

[edit] Research

[edit] Archeological record

One line of evidence used to support the Stone Age diet is the decline in human health and body mass that occurred with the adoption of agriculture, at the end of the Paleolithic era.[22][90] Associated with the introduction of domesticated and processed plant foods, such as cereal grains, in the human diet, there was, in many areas, a general decrease in body stature and dentition size, and an increase in caries rates. There was also an associated general decline in health in some areas.[7][123][124]

[edit] Observational studies

Based on the subsistence patterns and biomarkers of hunter-gatherers studied in the last century, advocates argue that modern humans are well adapted to the diet of their Paleolithic ancestor.[125] The diet of modern hunter-gatherer groups is believed to be representative of patterns for humans of 50 to 25 thousand years ago,[125] and individuals from these and other technologically primitive societies,[126][127] including those individuals who reach the age of 60 or beyond,[128][129] seem to be largely free of the signs and symptoms of chronic disease (such as obesity, high blood pressure, nonobstructive coronary atherosclerosis, and insulin resistance) that universally afflict the elderly in western societies (with the exception of osteoarthritis, which afflicts both populations).[4][12][125] Moreover, when these people adopt western diets, their health declines and they begin to exhibit signs and symptoms of "diseases of civilization".[11][125] In one clinical study, stroke and ischaemic heart disease appeared to be absent in a population living on the island of Kitava, in Papua New Guinea, where a subsistence lifestyle, uninfluenced by western dietary habits, was still maintained.[128][130]

One of the most frequent criticisms of the Paleolithic diet is that it is unlikely that preagricultural hunter-gatherers suffered from the diseases of modern civilization simply because they did not live long enough to develop these illnesses, which are typically associated with old age.[17][12][131][132][133] According to S. Jay Olshansky and Bruce Carnes, "there is neither convincing evidence nor scientific logic to support the claim that adherence to a paleolithic diet provides a longevity benefit."[133] In response to this argument, advocates of the paleodiet state that while Paleolithic hunter-gatherers did have a short average life expectancy, modern human populations with lifestyles resembling that of our preagricultural ancestors have little or no diseases of affluence, despite sufficient numbers of elderly.[12][134]

Critics further contend that food energy excess, rather than the consumption of specific novel foods, such as grains and dairy products, underlies the diseases of affluence.[17][22][135] According to Geoffrey Cannon,[17] science and health policy advisor to the World Cancer Research Fund, humans are designed to work physically hard to produce food for subsistence and to survive periods of acute food shortage, and are not adapted to a diet rich in energy-dense foods.[136] Similarly, William R. Leonard, a professor of anthropology at Northwestern University, states that the health problems facing industrial societies stem not from deviations from a specific ancestral diet but from an imbalance between calories consumed and calories burned, a state of energy excess uncharacteristic of ancestral lifestyles.[135]

[edit] Intervention studies

The first animal experiment on a Paleolithic diet suggested that this diet, as compared with a cereal-based diet, conferred higher insulin sensitivity, lower C-reactive protein and lower blood pressure in 24 domestic pigs.[137] There was no difference in basal serum glucose.[137] The first controlled human trial involved 29 people with glucose intolerance and it found that those on a Paleolithic diet had a greater improvement in glucose tolerance compared to those on a Mediterranean diet.[138][13][139] Subsequently, a 3 week trial with the diet, in 20 healthy volunteers of which 6 dropped out and only 6 of the remaining had complete dietary information available, showed variable results. During the trial calorie consumption decreased 36% leading to significant weight loss. However adverse changes in serum calcium were observed.[140] The NHS Knowledge Service states that there are several limitations to the study and that "readers should not draw too many conclusions from it."[141] The Halford Watch refers to the study as "bad science".[142] Two clinical trials designed to test various physiological effects of the Paleolithic diet are currently underway,[143][144][145] and the results of two completed trials have not yet been reported.[146][147]

[edit] Sustainability

The Paleolithic diet has been criticized on the grounds that it cannot be implemented on a worldwide scale.[25][26][148] According to Loren Cordain, if such a diet was widely adopted, it would compromise the food security of populations dependent on cereal grains for their subsistence. However, he says that where cereals are not a necessity, as in most western countries, reverting to a grain-free diet can be highly practical in terms of cutting long-term healthcare costs.[149] Barry Bogin, a professor of anthropology at the University of Michigan, states that less intensive farming techniques, such as pasture-grazed cattle, will not produce sufficient meat to feed the world’s population.[150] On another level, critics have argued that exclusion diets such as the Stone Age diet "can be highly restrictive, socially disruptive, and expensive."[151][22]

[edit] See also

[edit] References

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