Vitamin D deficiency, seasonal depression, and diseases of civilization

George Hamilton admits that he has been addicted to sunbathing for much of his life. The photo below (from: phoenix.fanster.com), shows him at the age of about 70. In spite of possibly too much sun exposure, he looks young for his age, in remarkably good health, and free from skin cancer. How come? Maybe his secret is vitamin D.

Vitamin D is a fat-soluble pro-hormone; not actually a vitamin, technically speaking. That is, it is a substance that is a precursor to hormones, which are known as calcipherol hormones (calcidiol and calcitriols). The hormones synthesized by the human body from vitamin D have a number of functions. One of these functions is the regulation of calcium in the bloodstream via the parathyroid glands.

The biological design of humans suggests that we are meant to obtain most of our vitamin D from sunlight exposure. Vitamin D is produced from cholesterol as the skin is exposed to sunlight. This is one of the many reasons (see here for more) why cholesterol is very important for human health.

Seasonal depression is a sign of vitamin D deficiency. This often occurs during the winter, when sun exposure is significantly decreased, a phenomenon known as seasonal affective disorder (SAD). This alone is a cause of many other health problems, as depression (even if it is seasonal) may lead to obesity, injury due to accidents, and even suicide.

For most individuals, as little as 10 minutes of sunlight exposure generates many times the recommended daily value of vitamin D (400 IU), whereas a typical westernized diet yields about 100 IU. The recommended 400 IU (1 IU = 25 ng) is believed by many researchers to be too low, and levels of 1,000 IU or more to be advisable. The upper limit for optimal health seems to be around 10,000 IU. It is unlikely that this upper limit can be exceeded due to sunlight exposure, as noted below.

Cod liver oil is a good source of vitamin D, with one tablespoon providing approximately 1,360 IU. Certain oily fish species are also good sources; examples are herring, salmon and sardines. For optimal vitamin and mineral intake and absorption, it is a good idea to eat these fish whole. (See here for a post on eating sardines whole.)

Periodic sun exposure (e.g., every few days) has a similar effect to daily exposure, because vitamin D has a half-life of about 25 days. That is, without any use by the body, it would take approximately 25 days for vitamin D levels to fall to half of their maximum levels.

The body responds to vitamin D intake in a "battery-like" manner, fully replenishing the battery over a certain amount of time. This could be achieved by moderate (pre-sunburn) and regular sunlight exposure over a period of 1 to 2 months for most people. Like most fat-soluble vitamins, vitamin D is stored in fat tissue, and slowly used by the body.

Whenever sun exposure is limited or sunlight scarce for long periods of time, supplementation may be needed. Excessive supplementation of vitamin D (i.e., significantly more than 10,000 IU per day) can cause serious problems, as the relationship between vitamin D levels and health complications follows a U curve pattern. These problems can be acute or chronic. In other words, too little vitamin D is bad for our health, and too much is also bad.

The figure below (click on it to enlarge), from Tuohimaa et al. (2009), shows two mice. The one on the left has a genetic mutation that leads to high levels of vitamin D-derived hormones in the blood. Both mice have about the same age, 8 months, but the mutant mouse shows marked signs of premature aging.

It is important to note that the skin wrinkles of the mice on the left have nothing to do with sun exposure; they are associated with excessive vitamin D-derived hormone levels in the body (hypervitaminosis D) and related effects. They are a sign of accelerated aging.

Production of vitamin D and related hormones based on sunlight exposure is tightly regulated by various physiological and biochemical mechanisms. Because of that, it seems to be impossible for someone to develop hypervitaminosis D due to sunlight exposure. This does NOT seem to be the case with vitamin D supplementation, which can cause hypervitaminosis D.

In addition to winter depression, chronic vitamin D deficiency is associated with an increased risk of the following chronic diseases: osteoporosis, cancer, diabetes, autoimmune disorders, hypertension, and atherosclerosis.

The fact that these diseases are also known as the diseases of civilization should not be surprising to anyone. Industrialization has led to a significant decrease in sunlight exposure. In cold weather, our Paleolithic ancestors would probably seek sunlight. That would be one of their main sources of warmth. In fact, one does not have to go back that far in time (100 years should be enough) to find much higher average levels of sunlight exposure than today.

Modern humans, particularly in urban environments, have artificial heating, artificial lighting, and warm clothes. There is little or no incentive for them to try to increase their skin's sunlight exposure in cold weather.

References:

W. Hoogendijk, A. Beekman, D. Deeg, P. Lips, B. Penninx. Depression is associated with decreased 25-hydroxyvitamin-D and increased parathyroid hormone levels in old age. European Psychiatry, Volume 24, Supplement 1, 2009, Page S317.

P. Tuohimaa, T. Keisala, A. Minasyan, J. Cachat, A. Kalueff. Vitamin D, nervous system and aging. Psychoneuroendocrinology, Volume 34, Supplement 1, December 2009, Pages S278-S286.

Cancer patterns in Inuit populations: 1950-1997

Some types of cancer have traditionally been higher among the Inuit than in other populations, at least according to data from the 1950s, when a certain degree of westernization had already occurred. The incidence of the following types of cancer among the Inuit has been particularly high: nasopharynx, salivary gland, and oesophageal.

The high incidence of these “traditional” types of cancer among the Inuit is hypothesized to have a strong genetic basis. Nevertheless some also believe these cancers to be associated with practices that were arguably not common among the ancestral Inuit, such as preservation of fish and meat with salt.

Genetic markers in the present Inuit population show a shared Asian heritage, which is consistent with the higher incidence of similar types of cancer among Asians, particularly those consuming large amounts of salt-preserved foods. (The Inuit are believed to originate from East Asia, having crossed the Bering Strait about 5,000 years ago.)

The incidence of nasopharynx, salivary gland, and oesophageal cancer has been relatively stable among the Inuit from the 1950s on. More modern lifestyle-related cancers, on the other hand, have increased dramatically. Examples are cancers of the lung, colon, rectum, and female breast.

The figure below (click on it to enlarge), from Friborg & Melbye (2008), shows the incidence of more traditional and modern lifestyle-related cancers among Inuit males (top) and females (bottom).

Two main lifestyle changes are associated with this significant increase in modern lifestyle-related cancers. One is increased consumption of tobacco. The other, you guessed it, is a shift to refined carbohydrates, from animal protein and fat, as the main source of energy.

Reference:

Friborg, J.T., & Melbye, M. (2008). Cancer patterns in Inuit populations. The Lancet Oncology, 9(9), 892-900.

How to break a coconut

The coconut is often presented as a healthy food choice, which it is, as long as you are not allergic to it. Coconut meat has a lot of saturated fat, which is very good for the vast majority of us.

(I posted about this issue elsewhere on this blog: my own experience and research suggest that saturated fat is very healthy for most people as long as it is NOT consumed together with refined carbs and sugars from industrialized food products.)

Coconut water is a good source of essential minerals, particularly magnesium and potassium. So is coconut meat, which is rich in iron, copper, manganese, and selenium. Coconut meat is also an good source of folate and an excellent source of dietary fiber.

If you are buying coconuts at a supermarket, I suggest choosing coconuts that have a lot of water in them. They seem to be the ones that taste the best. Just pick a coconut up and shake it. If it feels heavy and full of water, that’s the one.

First you need to make some holes on the coconut shell to extract the water. I recommend using a hammer and screwdriver. The screwdriver should be used only for this purpose, so you can keep it clean. Nails can be too thin. Place the coconut over a mitten or towel, and make holes on the dark spots (usually three) using the hammer and screwdriver.

Once you puncture the coconut, move the screwdriver a bit to enlarge each hole. Then place the coconut on a cup or thermos, with the holes pointing downwards, and let the water flow out of it. Normally I use a thermos, so that I can keep the coconut water fresh for later consumption.

As soon as all the coconut water is out, hold the coconut with a mitten in one hand, and strike it with the hammer with the other hand. The key here is to hold the coconut with your hand. You need to strike it hard. It is a good idea to do this inside or right above a kitchen sink so that the shell pieces fall into it.

Do not place the coconut against a hard surface (e.g., ceramic tiles), otherwise you can either break that surface or send pieces of the coconut flying all over the pace. Strike different areas of the coconut until it breaks into 5 to 7 pieces.

Finally, remove the meat of the coconut with a butter knife. The hand that holds the knife should be protected with a mitten, because you will have to apply pressure with it.

Store the coconut water in a sealed thermos, and the coconut meat pieces in a sealed container, both in the refrigerator, to preserve their freshness.

Coconut water and meat have a slightly sweet taste because of their sugar content, which is small and packed in with a lot of fiber. 100 g of coconut meat has about 15 g of carbs, of which 9 g is dietary fiber; that is, 100 g of coconut meat has only 6 g of net carbs.

The low modern potassium-to-sodium ratio: Big problem or much ado about nothing?

It has been argued that the diets of our Paleolithic ancestors had on average a much higher potassium-to-sodium ratio than modern diets (see, e.g., Cordain, 2002).

This much lower modern ratio is believed by some to be the cause of a number of health problems, including: high blood pressure, stroke, heart disease, memory decline, osteoporosis, asthma, ulcers, stomach cancer, kidney stones, and cataracts.

But, is this really the case?

The potassium-to-sodium ratio in ancient and modern times

According to some estimates, our Paleolithic ancestors’ daily consumption was on average about 11,000 mg of potassium and about 700 mg of sodium (salt). That yields a potassium-to-sodium ratio of about 16. Today’s ratio in industrialized countries is estimated to be around 0.6.

Just for the sake of illustration, let us compare a healthy Paleolithic diet food, walnuts, with a modern industrialized food that many believe to be quite healthy, whole-wheat bread. The table below (click on it to enlarge) compares these two foods in terms of protein, carbohydrate, fat, vitamin, and mineral content.

Walnuts have a potassium-to-sodium ratio of about 205. The whole-wheat bread’s ratio is about 0.5; much lower, and close to the overall ratio estimated for industrialized countries mentioned above.

At the same time, walnuts provide a better nutritional value than whole-wheat bread, including a good amount of omega-3 fatty acids (2.5 g; of α-linolenic acid, or ALA). However, walnuts have a fairly high omega-6 fat content.

Also, many diabetics experience elevated blood glucose levels in response to whole-wheat bread, in spite of its glycemic index being supposedly lower than that of white bread. Walnuts do not seem to cause this type of problem, even though several people are allergic to walnuts (and other tree nuts).

Health effects of the potassium-to-sodium ratio

So, the potassium-to-sodium ratio appears to have been much higher among our Paleolithic ancestors than today. It is important to stress that, even though this is a possibility, we do not know this for sure. Animals go to great lengths to find salt licks, and then consume plenty of sodium in them. Our ancestors could have done that too. Also, we know that sodium deficiency can be deadly to both animals and humans.

As for the many negative health effects of a low potassium-to-sodium ratio in modern humans, we have reasons to be somewhat skeptical. One has to wonder if the studies that are out there do not conflate the effects of this ratio with those of other factors, such as smoking, heavy alcohol consumption, or consumption of industrialized high carb foods (e.g., cereals, pasta, refined sugars).

Another possible confounding factor is potassium deficiency, not the potassium-to-sodium ratio. Potassium deficiency, like other deficiencies of essential minerals, including sodium deficiency, is associated with serious health problems.

If potassium is deficient in one’s diet, it is also likely that the potassium-to-sodium ratio will be low, unless the diet is also equally deficient in sodium.

Let us take a look at a study by Ikeda et al. (1986), which included data from 49 regions in Japan, a country known for high consumption of sodium.

This study found a significant association between the potassium-to-sodium ratio and overall mortality and heart disease, but only among men, and not among women.

One wonders, based on this, whether another uncontrolled factor, or factors, might have biased the results. Examples are smoking and heavy alcohol consumption, which could have been higher among men than women. Another is chronic stress, which could also have been higher among men than women.

The researchers report that they found no association between the potassium-to-sodium ratio and mortality due to diabetes, liver disease, or tuberculosis. This ameliorates the problem somewhat, but does not rule out the biasing effect of other factors.

It would have been better if the researchers had controlled for the combined effect of covariates (such as smoking, alcohol consumption etc.) in their analysis; which they did not.

Moreover, the study found no association between the potassium-to-sodium ratio and blood pressure. This is a red flag, because many of the diseases said to be caused by a low potassium-to-sodium ratio are assumed to be mediated by or at least associated with high blood pressure.

Regarding the possible confounding effect of industrialized high carb foods consumption, it seems that many of these foods have a low potassium-to-sodium ratio, as the example of whole-wheat bread above shows. Thus, some of the health problems assigned to the low potassium-to-sodium ratio may have actually been caused by heavy consumption of industrialized high carb foods.

It is also possible that the problem is with the combination of a low potassium-to-sodium ratio and industrialized high carb foods consumption.

At the time the study was conducted, Japan was somewhat westernized, which is why industrialized high carb foods consumption might have been a factor. The US strongly influenced the Japanese after World War II, as it helped rebuild Japan’s economy.

In conclusion, the jury is still out there regarding whether the low modern potassium-to-sodium ratio is a big problem or much ado about nothing.

References:

Cordain, L. (2002). The Paleo Diet: Lose weight and get healthy by eating the food you were designed to eat. New York, NY: Wiley.

Ikeda, M., Kasahara, M., Koizumi, A., and Watanabe, T. (1986). Correlation of cerebrovascular disease standardized mortality ratios with dietary sodium and the sodium/potassium ratio among the Japanese population. Preventive Medicine, 15(1), 46-59.

Who is really behind these posts?

Acknowledgement: In addition to the references provided at the end of several posts, I would like to acknowledge that I also regularly consult with the most interesting man in the world, especially in connection with complex scientific matters. (YouTube link below, if you must know the identity of this incredibly modest and low-key person.)

http://www.youtube.com/watch?v=PVwG1t-NVAA

No need to refer to him as The Most Interesting Man in the World (i.e., capitalized), because, as he notes: "There is only one most interesting man in the world."

Go see your doctor, often

As I blog about health issues, and talk with people about them, I often notice that there is a growing contempt for the medical profession.

This comes in part from the fact that many MDs are still providing advice based on the mainstream assumption that saturated fat is the enemy. Much recent (and even some old) research suggests that among the main real enemies of good health are: chronic stress, refined carbs, refined sugars, industrial trans-fats, and an omega-6/omega-3 imbalance caused by consumption of industrial vegetable oils rich in omega-6 fats.

Because of this disconnect, some people stop seeing their doctors regularly; others avoid doctors completely. Many rely exclusively on Internet advice, from health-related blogs (like this) and other sources. In my opinion, this is a BIG mistake.

A good MD has something that no blogger who is not an MD (like me) can have. He or she has direct access to a much larger group of people, and to confidential information that can clarify things that would look mysterious to non-MDs. They cannot share that information with others, but they know.

For example, often I hear from people that they did this and that, in terms of diet a lifestyle, and that their lab tests were such and such. Later I find out that what they told me was partially, or completely, wrong. That is, they distorted the truth, maybe subconsciously.

I have never met an MD who completely ignored hard facts, such as results of lab tests and common health-related measurements. I have never met an MD who tried to force me to do anything either; although I have to admit that some tend to be a bit pushy.

I see a doctor who does not agree with me; e.g., he wanted me to take statins. No problem; that is the way I like it. If my doctor will agree 100% with all I say, do I need to see that doctor?

My doctor does not question lab results though, and maybe I am changing a bit the way he thinks. He wanted me to take statins, but once I told him that I wanted to try a few other things first, he said: no problem. When the results came, he had that look on this face - maybe u wuz royt eh!?

Many, many patients are under the mistaken assumption that they need to please their doctors. A subconscious assumption for most, no doubt. I guess this is part of human nature, but I don’t think it is helpful to doctors or patients.

Patients actually need to work together with their doctors, see them often, do their own research, ask questions, and do those things that lead to health improvements – ideally measurable ones.

The evolution of costly traits: A challenge to a strict paleo diet orientation

A fundamental principle that some associate with the paleo diet movement is that we should model our diet on the diet of our ancestors. In other words, for optimal health, our diet should be as close to the diet of our ancestors as possible. Following this principle generally makes sense, but there are a number of problems with trying to follow it too strictly.

Some of those problems are discussed in other posts. Examples are: our limited knowledge about what our ancestors really ate (some say: lean meat; others say: fatty meat); the fact that evolution can happen fast under certain circumstances (a few thousand years, not millions of years, thus recent and divergent adaptations are a possibility); the fact that among our ancestors some, like Homo erectus, were big meat eaters, but others, like Australopithecus afarensis, were vegetarians … Just to name a few problems.

The focus of this post is on traits that evolved in spite of being survival handicaps. These counterintuitive traits are often called costly traits, or Zahavian traits (in animal signalling contexts), in honor of the evolutionary biologist Amotz Zahavi (Zahavi & Zahavi, 1997). The implication for dieting is that our ancestors might have evolved some eating habits that are bad for human survival, and moved away from others that are good for survival. And I am not only talking about survival among modern humans; I am talking about survival among our human ancestors too.

Here is the most interesting aspect of these types of traits. Our ancestors may have acquired them through genetic mutation and selection (as opposed to genetic drift, which may lead some traits to evolve by chance). That is, they emerged not in spite, but because of evolutionary pressures.

The simple reason is that evolution maximizes reproductive success, not survival. If that were not the case, mice species, as well as other species that specialize in fast reproduction within relatively short lifespans, would never have evolved.

In fact, excessive longevity is akin to quasi-cloning through asexual reproduction, from an evolutionary perspective. It may be bad, in terms of the continuity of a species, because species in general need genetic diversity to exist in a constantly changing environment, and genetic diversity is significantly increased by sexual reproduction; the more, the better. Without significant mortality to match that, overpopulation would ensue.

In a sense, a high degree of mortality (acting in the selection of a trait), is one of evolution’s main "allies".

Genes code for the expression of phenotypic traits, such as behavioral (e.g., aggressiveness) and morphological (e.g., opposing thumbs) traits. Costly traits are phenotypic traits that evolved in spite of imposing a fitness cost, often in the form of a survival handicap.

In non-human animals, the classic example of costly trait is the peacock’s train, used by males to signal good health to females. This trait is usually referred to, wrongly, as the male peacock’s tail. Both males and females have tails, but only the males have the large trains, which are actually tail appendages.

What about humans?

One example is the evolution of testosterone markers in human males. Testosterone markers (facial masculinity) have been hypothesized to be handicaps evolved in part by human males to signal to females that they are healthy, essentially because testosterone suppresses the immune system. This intriguing idea, which has been supported by evidence, is known as the immunocompetence-handicap hypothesis (Rhodes et al., 2003).

This idea will sound bizarre to some, because of the notion that testosterone helps build muscle mass (which it does, together with other hormones, such as insulin), and arguably muscle mass helped our ancestors hunt and fight off predators. Yet, consider the following questions: If muscularity was so useful for hunting and fighting, why are humans generally weak compared with other animals of similar size? Why is it so hard to gain muscle mass, compared to fat mass?

Another example is the evolution of oral speech in humans. The evolution of oral speech is one of the most important landmarks in the evolution of the human species, having happened relatively recently in our evolutionary history. However, the new larynx design required for oral speech also significantly increased our ancestors’ chances of death by choking during ingestion of food and liquids, and of suffering from various aerodigestive tract diseases such as gastroesophageal reflux, among other survival-related problems.

Yet, oral speech may have evolved because it enhanced overall reproductive success, in part by enabling knowledge communication (Kock, 2009), and possibly also due to sexual selection (Miller, 2000). As Miller put it in his book The Mating Mind, ancestral women and men could gauge their mates' overall health by their ability to speak intelligently, in addition to other traits.

Now let us look at the connection with strict paleo dieting.

Paleolithic ancestors may have consumed certain types of food associated with handicaps that increased reproductive success. As far as evolution is concerned, this is fine – the genes are selfish, so to speak (Burt & Trivers, 2006; Dawkins, 1990). But that is where too much of a focus on a paleo diet may be a problem.

There are at least three hominid species in the Paleolithic period that differed significantly from each other: Homo sapiens, Homo erectus, and Homo habilis. If you go back in time a little further, we encounter other hominid species, such Australopithecus afarensis and Australopithecus africanus, who were mostly, if not strictly, vegetarians.

Evolution is very useful as a unifying principle to help us understand what is healthy today and what is not. But it cannot completely replace empirical research on nutrition. Some of that research will undoubtedly uncover nutrition habits that increase longevity and improve health today, even though they were not practiced by our paleo ancestors.

We know that highly refined carbs (e.g., white bread with no fiber) and sugars (e.g., table sugar) are too recent an addition to the human diet for us to have evolved to use them optimally for nutrition. So their association with the metabolic syndrome makes sense, from an evolutionary perspective. But there are many gray areas, where it may not be optimal to try to follow a diet that is as close to the diet of our ancestors.

References:

Burt, A. & Trivers, R. (2006). Genes in conflict: The biology of selfish genetic elements. Cambridge, MA: Harvard University Press.

Dawkins, R. (1990). The selfish gene. Oxford, UK: Oxford University Press.

Kock, N. (2009). The evolution of costly traits through selection and the importance of oral speech in e-collaboration. Electronic Markets, 19(4), 221-232.

Miller, G.F. (2000). The mating mind: How sexual choice shaped the evolution of human nature. New York, NY: Doubleday.

Rhodes, G., Chan, J., Zebrowitz, L.A., & Simmons, L.W. (2003). Does sexual dimorphism in human faces signal health? Proceedings of the Royal Society of London: Biology Letters, 270(S1), S93-S95.

Zahavi, A. & Zahavi, A. (1997). The Handicap Principle: A missing piece of Darwin’s puzzle. Oxford, England: Oxford University Press.

Ischemic heart disease among Greenland Inuit: Data from 1962 to 1964

This post has been revised and re-published. The original comments are preserved below.

Okinawa: The island of pork

The original inhabitants of the Ryūkyū Islands, of which the island of Okinawa is the largest, are believed to have the highest life expectancy in the world.

One of the staples of their diet is sweet potatoes. The carbohydrate percentage of a sweet potato is about 20; that is, each 100 g of sweet potato mass has about 20 g of carbohydrates. Sweet potatoes have a medium-high glycemic index, and are often avoided by those with impaired insulin sensitivity, and certainly by diabetics.

The other main staple of their diet is pork, as you may have inferred from the title of this post. The quote below is from the first of the three links provided below the quote.

Pork appears so frequently in the Okinawan diet that to say "meat" is really to say "pork." [...] It is no exaggeration to say that the present-day Okinawan diet begins and ends with pork.

        http://www.wonder-okinawa.jp/026/e/pork.html

        http://www.okinawaindex.com/index/?tid=2&cid=250&id=2

        http://ci.nii.ac.jp/naid/110000220190/en

So, what is the secret of the Okinawans’ longevity? Maybe it is the diet. Maybe it is the lifestyle. Maybe it is the fact that their mothers and fathers are Okinawans (the heritability of longevity has been estimated to be about 33%, and to be higher among females than males). Here are some interesting points that are worth noting:

- Their diet is not only of meat, but includes plenty of it.

- Their diet is not particularly low in saturated fat, and maybe it is high in it.

- Their diet is not particularly low in dietary cholesterol, and maybe high in it, since they eat the pig whole, including the parts (e.g., organs) rich in dietary cholesterol.

- Their diet is not a no carb diet, not even a typical low carb diet, but it seems to be very low in refined carbs and sugars.

Eating fish whole: Smelts

Since different parts of a fish have different types of nutrients that are important for our health, it makes sense to consume the fish whole. This is easier to do with small than big fish.

One of my favorite types of small fish is the smelt; the photo below shows a batch of smelts that I prepared using the recipe below. Another small fish favorite is the sardine. Small fish are usually low in the food chain, and thus have very low concentrations of metals that can be toxic to humans.

Many people dislike the taste of smelts, but will eat them if they are well seasoned and their texture is somewhat hard. Here is a recipe that will get you that.

- Steam cook the smelts for 30 minutes to 1 hour (less time = harder texture).
- Spread the steam cooked smelts on a sheet pan covered with aluminum foil; use light olive oil to prevent the fish from sticking to the foil.
- Preheat oven to 350 degrees Fahrenheit.
- Season the steam cooked smelts to taste; I suggest using salt, chili powder, garlic powder, and herbs.
- Bake the smelts for 30 minutes, turn the oven off, and leave them there for 1 hour.

There is no need to clean, or gut, the smelts for the recipe above. Since they feed primarily on plant matter, and have a very small digestive tract, there is not much to be “cleaned” off of them anyway.

They will be ready to store or eat cold. There are several variations of this recipe. For example, you can bake them for 40 minutes, and then serve them hot.

Saturated fat intake not associated with heart disease – Dr. Cordain’s article

I would like to comment on a recent article co-authored by Dr. Loren Cordain, and published in the journal Current Treatment Options in Cardiovascular Medicine, in 2009. Dr. Cordain is probably the leading expert today on the diet of our Stone Age ancestors.

The importance of this article comes from the fact that in the past Dr. Cordain has argued that our Stone Age ancestors have not consumed large amounts of saturated fat, because of the relatively low percentage of fat in the flesh of wild animals. This led, according to Dr. Cordain, to an evolved body design that is not well adapted to the consumption of significant amounts of saturated fat.

Yet, many other researchers have argued that saturated fats are beneficial to our health, with ample empirical evidence to back up their statements. The researchers at the Weston A. Price Foundation have been particularly prominent voices in favor of saturate fats.

Now, this acknowledgement that saturated fats (or saturated fatty acids) are not detrimental to health, particularly heart health, was made with qualifications. And, Dr. Cordain is not the first author of the article. Page 293 of the article states that:

Replacement of SFAs, especially palmitate, with MUFAs may provide moderate cardiometabolic benefits, and is unlikely to do harm. However, SFA reduction does not appear to be the most important dietary modification for CHD risk reduction.

(Notes: SFA=saturated fatty acids=saturated fat, think greasy steak and egg yolk; MUFAs=monounsaturated fatty acids, think olive oil and lard; CHD=coronary heart disease.)

Palmitate refers to palmitic acid, of which meat, butter, eggs, and dark chocolate are all good sources. Even salmon is a good source of palmitic acid, although it is also an excellent source of DHA and EPA omega-3 fat acids. EPA is eicosapentaenoic acid, and DHA is docosahexaenoic acid; both of which are found in fish.

So, the caution in the statement above does not make much sense given the mounting evidence that palmitic acid (especially when consumed with a low carb. diet, in my view), may have cardio-protective effects.

Nevertheless, this is a major shift from Dr. Cordain’s previous position that saturated fats cannot be part of a healthy diet because they do not fit well with what we currently know about the diet of our Stone Age ancestors.

Maybe those ancestors ate a lot of saturated fat after all, and that consumption led to adaptations that make saturated fat consumption healthy; again, in my view, as long as it is not accompanied by high consumption of refined carbs. and sugars.

Saturated fat was probably the most readily available type of fat to those ancestors, a rich source of calories, and virtually impossible to avoid given the main component of those ancestors’ diet – meat.

Intermittent fasting and reduced inflammation

A recent post on the Primal Wisdom blog led me to do go back to some of the research on an approach to dieting that I tried myself, with some positive results. The approach is known as intermittent fasting (IF). I also found an excellent blog post by Dr. Michael Eades on IF (see here).

Typically IF involves fasting every other day. On the non-fasting days, food and water consumption is not restricted in any way. On fasting days, only water is consumed. Variations of this approach usually involve replacing water with juice, and having an eating window of only a few hours within longer periods – e.g., fasting 19 hours and then eating during a window of 5 hours, for each period of 24 hours.

IF is different from calorie restriction (CR), in that in the latter total daily calorie intake is restricted to a somewhat fixed amount, below one’s basal metabolic rate (the number of calories needed to maintain one’s current weight). In CR the calorie restriction is not normally achieved through fasting, but through careful portion size control and selection of foods based on calorie content. Having said that, some prominent CR practitioners also practice IF.

One interesting aspect of IF studies is that often they do not involve any calorie reduction in the participants' diet; that is, individuals consume the same amount of calories that they would if they were not fasting at all. In other words, they consume 2X outside their fasting window; where X would be their normal caloric consumption without fasting.

Yet, the benefits of IF are still achieved. For example, during Ramadan, the levels of inflammation markers and factors, such as C-reactive protein (CRP) and homocysteine, go down, and remain low for several weeks after IF is interrupted. These inflammation markers and factors are known to be strongly associated with heart disease.

In fact, animal studies suggest that virtually identical benefits can be obtained through IF in terms of increased lifespan and disease resistance, as those normally associated with CR. Again, this is somewhat surprising because often IF does not involve any reduction in calories consumed.

Fasting promotes increased levels of growth hormone in humans. A decline in growth hormone levels is associated with aging. Thus, increased circulating growth hormones may be one of the mechanisms by which IF may affect lifespan.

There have been some reports of IF being associated with negative effects on health, but I suspect that they are associated with gorging on refined carbohydrates and sugars during the eating window. Refined carbohydrates and sugars promote inflammation, and IF reduces inflammation. It is conceivable that a very high consumption of refined carbohydrates and sugars during the eating window may completely negate the benefits of IF, particularly if one is doing a half-hearted version of IF to start with.

A combination of IF and a diet low in refined carbohydrates and sugars probably makes sense in terms of our evolved physiology. Our Stone Age ancestors had to fast on a regular basis, based on the availability of food – there were no refrigerators or grocery stores during the vast majority of our evolutionary history as a species. When food was available, it was consumed to satiety. In other words, our Stone Age ancestors practiced IF, against their will. Because of that, this is the state in which our body evolved to operate optimally.

If you watch enough episodes of the TV show Survivorman, you will probably notice that it is very unlikely that our Stone Age ancestors had access to enough calories to survive on plant foods only, assuming that they faced problems similar to those in the show.

Our digestive tract has evolved over millions of years from a mostly vegetarian diet, practiced by our Australopithecine ancestors, to a primarily carnivorous diet, adopted by human ancestors as far back as Homo erectus, and probably Homo habilis. Given that, only the recent invention of refined carbohydrates and sugars has given us access to enough dense carbohydrate sources of calories.

So, a combination of IF and a diet low in (or devoid of) refined carbohydrates and sugars makes evolutionary sense, and is probably why so many people who adopt Paleolithic diets see so many improvements in health markers such as inflammation markers, blood pressure, and HDL cholesterol.