https://www.finedininglovers.com/blog/food-drinks/what-is-the-paleo-diet/ Shannon Johnson, R.D., L.D., C.L.T. Paleo Objectives • Explain Paleo eating and its origins. • Describe foods that are included in the Paleo plan and those that are excluded. • Discuss how this type of eating style may or may not benefit our patients. Clip Art Basic Principles of the Paleo Lifestyle • • • • Eat whole foods. Avoid processed, refined foods. Eat for proper digestive functioning. Eat for good blood sugar regulation. Clip Art – Individualize the plan to meet health needs/goals. – This is not a “One size fits all” approach! Clip Art Paleolithic Diet Origins • Prior to Agriculture ~10,000 years ago – 333-400 generations ago – No grains, legumes, farmed-raised/grain-fed animals • We ate this way for 2.5 million years: – Lean game meat/poultry/fish + vegetables/fruit • Determined by – – – – Fossil Records Current Hunter-Gatherer Diets Chimpanzee diets (We share ~98% of the same DNA.) Nutrients in wild animals and plants Cordain, Loren. The Paleo Diet, revised edition. Houghton Mifflin Harcourt: Boston, NY; 2011. Clip Art Paleolithic Diet Origins • Discordance or Mismatch Hypothesis: The human genome evolved to adapt to conditions that no longer exist. Dietary changes have occurred faster than adequate genetic adaptation could respond. This mismatch between genome and diet has resulted in today’s chronic disease. Clip Art Konner M, Eaton SB. Paleolithic Nutrition: Twenty-Five Years Later. Nutrition in Clinical Practice. 2010; 25(6):594-602. Paleolithic Evidence – Hunter-gatherers of today do not suffer from modern diseases (DM, obesity, HTN, CVD, OA, high cholesterol). – Pima Indians in America vs in Mexico – Australian HGs with T2DM – improved health s/p return to former lifestyle/diet . Konner M, Eaton SB. Paleolithic Nutrition: Twenty-Five Years Later. Nutrition in Clinical Practice. 2010; 25(6):594-602. Diet Composition Clip Art DIET PROTEIN CARBOHYDRATE FAT Paleo 19-35% 22-40% 28-47% 30-35% 15-20% (Meat glycogen) 50% (↑ Omega-3) 15.5% 49% 34% 18-23% 4-26% 48-51% (Cordain L) Traditional Alaskan (3000 Kcal) Inuits/Eskimos (Ho KJ) US Diet (Cordain L) Low-Carb Fad Diets (Cordain L) !Kung in Africa 33% animal-based, 67% plant –based (1/2 wt = monongo nut) (Lee) Cordain, Loren. The Paleo Diet, revised edition. Houghton Mifflin Harcourt: Boston, NY; 2011. Ho KJ, Mikkelson B, Lewis LA, Feldman SA, Taylor CB. Alaskan Arctic Eskimos: responses to a customary high fat diet. Am J Clin Nutr1972;25:737– 45. Lee RB. What hunters do for a living, or how to make out on scarce resources. In: Lee RB, DeVore I, eds. Man the hunter. Chicago: Aldine Publishing Co, 1968:30–48. Small Clinical Studies 10-day Paleo Diet 9 non-obese, sedentary, healthy pts (uncontrolled) – Typical Diet: 3 days – 7 days of 3 “ramp-up” diets • (gradual increase of fiber/K+) – 10 days Paleo Results: *Modest, but significant decrease in BP *Improved arterial distension *↓ insulin secretion in 2-hr OGTT *↓insulin/glucose ratio *↓ 16% total cholesterol *↓ 22% LDL Frassetto LA, Schloetter M, Mietus-Synder M, et al. Metabolic and physiologic improvements from consuming a Paleolithic, hunter-gatherer type diet. Eur J Clin Nutr. 2009;63:947-955. Small Clinical Studies Mediterranean vs Paleo – Randomized controlled trial – 29 people with IHD + glucose intol. or T2DM – 12 weeks Glucose (OGTT) Results: ↓7% in Mediterranean Vs ↓ 26% in Paleo Lindeberg S, Jonsson T, Granfeldt Y, et al. A Palaeolithic diet improves glucose tolerance more than a Mediterranean-like diet in individuals with ischaemic heart disease. Diabetologia. 2007;50:1795-1807. Small Clinical Studies Diabetes ADA diet vs Paleo – Randomized, crossover pilot study – 13 people with T2DM – 3 months Results: Paleo diet group: ↓ HgA1c, TG, diastolic BP, wt, BMI, waist circ. ↑ HDL Jonsson T, Granfeldt Y, Ahren B, et al. Beneficial effects of a Paleolithic diet on cardiovascular risk factors in type 2 diabetes: a randomized cross-over pilot study. Cardiovasc Diabetol. 2009;8:35. The Paleo Plan Includes • • • • • Lean Animal-Based Protein Vegetables Fruit Natural, healthy oils Nuts Clip Art Cordain, Loren. The Paleo Diet, revised edition. Houghton Mifflin Harcourt: Boston, NY; 2011. http://blog.shadygrovefertility.com/wp-content/uploads/2013/11/paleo-for-pcos.jpg Paleo Exclusions • Processed Foods – – – – Reasons We Tend to Include High in sugar, fat (trans/saturated), and salt *Enjoyment, celebration Low nutrient-density, High caloric-density *Easy/Quick Oils when in high heat (deep fried) toxins *Cultural traditions Sugar, Salt, Vinegar, Alcohol • Grains – – – – Easily become excessive in diet If not used wt High in Lectins High in Phytates *Contributes to daily fiber *Contributes to B9, B1, B2, B3 *Inexpensive staple food *Cholesterol-lowering fiber • Legumes – High in Lectins Clip Art – High in Phytates – If not appropriately cooked toxins *Contributes to daily fiber *Cholesterol-lowering fiber *Inexpensive Protein • Dairy (including Butter) – USA: A1 or A2 Beta Casein – Lactose intolerance – Allergies *Major source of daily Ca & Vit D *Probiotics Lectins • Lectins = Phytohemagglutinins = Phytagglutinins – Glycoproteins that may serve in the following: • Recognition and binding of nitrogen-fixing bacteria to legume roots. • Defense mechanism of plant’s seed – Resistant to Proteolytic Digestion (wheatgerm, tomatoes, and navy beans) Antibodies • Known to agglutinate RBCs. • > 400,000 kidney bean lectin binding sites on surface of each RBC (phytohaemoglutinin). – Do not eat raw kidney bean sprouts! • Effects in Animals: Reduced growth rate, diarrhea, interference with nutrient absorption, GI ulcers http://www.ansci.cornell.edu/plants/toxicagents/lectins.html Lectins, Phytates, Enzyme Inhibitors in Legumes, Grains, & Nuts/Seeds • Differing Lectin Levels /Toxicity – Fungal infection/wounding of plant increases lectins. – Environment (weather, soil, location, season). – High levels in grains (wheat in particular) • Rinse/soak/rinse quinoa to help rid it of saponins – High levels in legumes (beans, lentils, soybeans, peanuts) • Peas and green beans are considered safe http://www.ansci.cornell.edu/plants/toxicagents/lectins.html Lectins • Certain seaweeds and mucilaginous vegetables have the ability to bind lectins in a way that makes them unavailable to the cells of the gut. • Lectins are resistant to dry heat, so using raw legume flours in baked goods should be done with caution. • The “Blood Type Diet” is based on how our blood cells react with lectins in foods. • Some experts hypothesize that it’s no coincidence the top 8 allergens also contain some of the highest amounts of lectins (including: dairy, egg, wheat, soy, peanuts, tree nuts, fish, shellfish). • Some experts theorize that lectins cause urinary tract infections. • Some experts theorize that the reason anemia is higher in developing countries is due to excessive levels of lectin consumption. Beneficial Lectins? Clip Art “Mushroom lectins are endowed with mitogenic, antiproliferative, antitumor, antiviral, and immune stimulating potential.” Singh RS, Bhari R, Kaur HP, et al. Mushroom lectins: current status and future perspectives. Crit Rev Biotechnol. 2010 Jun;30(2):99-126. ------------------------------------------------------------------------------------------------------ Phytates decrease mineral bioavailability. -bind Ca, Fe, Cu, Zn, Mg, blocking absorption Soaking and cooking significantly decreased phytic acid in 10 different varieties of legumes. Vadivel V, Biesalski HK. Effect of certain indigenous processing methods on the bioactive compounds of ten different wild type legume grains. Journal of Food Science and Technology. Dec 2012; 49.6:673-684. Soaking and Sprouting ↓Lectins/Phytates/Enzyme Inhibitors: Soaking, Sprouting, Fermenting, and Cooking http://www.ansci.cornell.edu/plants/toxicagents/lectins.html Who Does This? Natives of Central America and India, Squirrels, Your Ancestors! Soaking nuts, legumes, and grains in saltwater/acidic solution: • Neutralizes enzyme inhibitors • Decreases phytates • Decreases lectins Do not eat sprouted alfalfa seeds -Canavanine (metab. during growth) -inhibits immune system Nourishing Traditions by Sally Fallon http://apronstringz.wordpress.com/2012/04/13/mastering-sprouted-wheat-bread/ Soaking and Sprouting Two varieties of wheat after sprouting/drying significantly increased nutrient value. Nutrient Before Sprouting After Sprouting Alpha-Tocopherol 27 & 24 mg/kg 55 & 47 mg/kg % Omega 3 FA in Total FA 4.04 +/- 0.16 3.93 +/-0.12 16.08 +/-1.50 12.26 +/-1.36 Mg (mg/kg) 1792 +/- 101 1992 +/-188 3751 +/- 429 3271 +/-186 Ca (mg/kg) 313 +/- 18 277.8 +/- 26 756 +/- 49 602 +/- 60 Fe (mg/kg) 48 +/-3 41 +/-4 76 +/- 8 85 +/- 6 K+ (mg/kg) 8169 +/- 458 10,541 +/- 992 13,937 +/-1163 12,739 +/-1069 Ozturk K, Sagdic O, Hayta M, et al. Alteration in alpha-tocopherol, some minerals, and fatty acid contents of wheat through sprouting. Chemistry of Natural Compounds. Jan 2012;47(6): 876-879. Dairy Issues? • Lactose Clip Art – Intolerance……take lactaid or supplement with Ca + D – Tolerance • IgE-Based Allergy…….supplement with Ca + D – Whey – Casein • Non-IgE Sensitivity ……..supplement with Ca + D – Inflammatory mediators released from WBCs • Casein Variant and Human Health? – CVD/IHD, DM type 1 Dairy Issues? http://a2milk.com.au/beta-casein/beta-casein-milk-protein/ http://a2milk.com.au/beta-casein/beta-casein-milk-protein/ A2-Beta-Casein A2 beta casein = original beta casein gene. *Milk from cattle thousands of years ago, before largescale domestication = A2 Milk. A1 beta casein = from genetic mutation *Digestion of A1 beta casein can result in the production of bioactive beta casomorphin-7 (BCM-7). BCM-7: oxidizes LDL -Trials have shown A1 beta casein elicits biological effects in animals which lead to heart disease. Clip Art A1 Beta Casein BCM-7 Epidemiological studies in several developed countries show strong correlations between A1 beta casein and the following: -incidence of type 1 diabetes mellitus -heart disease mortality rates (oxidizes LDL) -aggravation of neurological disorders (autism and schizophrenia) Clip Art A1 Beta Casein/BCM-7 References Bell SJ, Gronchoski GT, Clarke AJ. Health implication of milk contaiing beta-casein with the A2 genetic variant. Crit Rev Food Sci Nutr. 2006;46(1):93-100. Birgisdottir, B. E., Hill, J. P., Harris, D. P., Thorsdotter. 2002. Variation in consumption of cow milk proteins and lower incidence of Type 1 diabetes in Iceland vs the other 4 Nordic countries. Diab.Nutr. Metab. 15:240-245. Clemens RA. Milk A1 and A2 peptides and diabetes. Nestle Nutr Workshop Ser Pediatr Program. 2011;67:187-95. Kaminski S, Cieslinska A, Kostyra E. Polymorphism of bovine beta-casein and its potential effect on human health. J Appl Genet. 2007;48(3):189-98. Laugessen, M. & Elliot, 2003. Ischaemic heart disease, Type 1 diabetes, and cow milk A1 β-casein. New Zealand Medical Journal 116(1168). Monetini L, Cavallo MG, Manfrini S, et al; IMDIAB Group. 2002. Antibodies to bovine beta-casein in diabetes and other autoimmune diseases. Horm Metab Res. 34(8):455-9. PCT/WO 02/19832/A1; Milk containing beta casein with proline at position 67 does not aggravate neurological disorders; Crawford RA, Boland MJ, Norris CS, Hill JP, Fenwick RM. Sun Z, Cade JR, Fregly MJ, Privette RM (1999); Beta casomorphin induces Fos-like immunoreactivity in discrete brain regions relevant to schizophrenia and autism; Autism 1999: vol. 3(1) 67-823. Sun Z and Cade JR (1999); A peptide found in schizophrenia and autism causes behavioural changes in rats; Autism 1999: Vol 3(1) 85-95. Tailford KA, Berry CL, Thomas AC, Campbell JH. 2003 A casein variant in cow's milk is atherogenic. Atherosclerosis. 170(1):13-9. Paleo Calcium + Vitamin D Sources • Sardines, Trout, Salmon, Perch • Swiss Chard, Kale, Broccoli, Turnips/Collard Greens, Okra, Bok Choy, Spinach, Seaweed, etc • Mushrooms • Egg Yolks • Almonds, Sesame Seeds • Beef liver • Dried Figs, Oranges • Sunshine!!! http://www.webmd.com/food-recipes/guide/calcium-vitamin-d-foods Clip Art ACID/BASE BALANCE - ↑ fruit/non-starchy veg Basic Maintenance of Stored Calcium - ↑ grain/starch/sugar/salt Acidic Calcium Depletion Clip Art Application to Our Patients? Clip Art • GI Complaints: May serve as a place to start for elimination diets. • Epilepsy: Low-carb Ketogenic diets decrease frequency of seizures. • Obesity/Overweight: Weight loss • Chronic Disease Improvement • Compliance may be difficult even with most motivated individuals. Clip Art – Not the most sustainable, ecological, or economical diet. Clip Art Basic Paleo Principles are in compliance with a healthy lifestyle • • • • • Eat whole foods. Avoid processed, refined foods. Eat for proper digestive functioning. Eat for good blood sugar regulation. Individualize to meet health needs and goals. – Consider Probiotics and Vitamin D supplements – Vegetarian: add back sprouted seeds – Add back A2 beta casein Dairy – Adjust Carbs to Meet Physical Activity Demands Questions? Clip Art Shannon Johnson, RD, LD, CLT [email protected] 612-273-4991 Thank You!