AHS Slides_Staffan Lindeberg

Ancestral Health Symposium, LA, August 2011
Food and Western Disease
Staffan Lindeberg MD PhD
Center for Primary Health Care Research
Lund University, Sweden

Western diseases:
Cardiovascular diseases
diabetes
obesity
hypertension
dementia
cancers
osteoporosis
rickets
iron deficiency
autoimmune diseases
gastroesophageal reflux
irritable bowel syndrome
and many others
Lindeberg S. Food and Western Disease. Wiley-Blackwell 2010

The basis of nutritional advice

Stories
S. Graham
A. Lane
J.H. Kellogg
D. Burkitt
Battle Creek
M. Bircher-Benner

Stories
A. Brillat-Savarin
C. Bernard
W. Banting
R. Atkins

Stories
Money

Stories
Money
Science
Epidemiology
Molecular biology
Clinical trials
Placebo bread,
real meat
Real bread,
placebo meat

Stories
Money
Science
Epidemiology
Molecular biology
Clinical trials
Evolutionary medicine

The Trobriand Islands, Papua New Guinea

Kitava
tropical island, 4 x 7 km
2,300 inhabitants (in 1990); 6% 60-96 years
diet: cultivated tubers (yam, sweet potato, taro, tapioka), fruit, fish, nuts and leafy vegetables — no western food
regular physical activity: ~1.7 x BMR

13
Estimated amount of foods consumed by Kitavan
adults in Nov-Dec 1990
Daily intake Total Protein Fat CHO Energy
(medians) (g) (g) (g) (g) (kJ)
Tubers 1200 25 2 300 5600
Fruit 400 3 <1 50 920
Coconut 110 4 43 7 1865
Fish 85
Pork <1 - - - -
Other meat <2 - - - -
Other 200 5 <1 14 360
Western food <1 0 <1 <1 20
Total 2 000 54 50 370 9200
Lindeberg S et al. AJCN 1997;66:845

Striking absence of Western disease
myocardial infarction (Lindeberg S et al. J Intern Med 1993;233:269)

consistent with earlier observations (Schiefenhövel, Jüptner)

consistent with studies in Melanesia(Breinl -15, Clements -36, Devine -46, Backhouse -58, Whyte -58, Barnes -61, Campbell and Arthur -64, Dewdney -65, Kariks -67, Vines -70, Aiken -74, Hornabrook -74, Mathews -74, Page -74, Somers -74, Sinnett -77, Korner -80, Palmer -82, Ree -82)
consistent with studies in Africa(Donnison -29, Vint -37, Muwazi -44, Davies -48, Thomas -60, Trowell -60, Reef -62, Seftel -63, Tejada -68, Dodu -72, Edginton -72, Okuwobi -72, Shaper -72, Walker -75, Truswell -76, Isaacson -77, Trowell -81)
consistent with studies in South America (Groom -71, Connor -78, Baruzzi -81)
consistent with studies in the Arctic (Price -36, Kromann -80, Schaefer -81, Dyerberg -89)

stroke (Lindeberg S et al. J Intern Med 1993;233:269)

consistent with studies in East Africa (Trowell -81, Muwazi -44)
Table. Incidence of stroke as proportion of acute neurologic disease in Kampala, Uganda.

consistent with studies in East Africa (Trowell -81, Muwazi -44)
consistent with studies in Papua New Guinea (Breinl -15, Clements -36, Backhouse -58, Campbell -64, Dewdney -65, Stanhope -69, Vines -70, Sinnett -73, Hornabrook -74, Hornabrook -75, Nagurney -75, Sinnett, PF -77, Palmer -82, Ree -82)

Fig. Stroke incidence per 1000 person-years in the 1990s among selected westernized populations.
Feigin VI et al. Lancet Neurol 2003;2:43

diabetes type 2 (Lindeberg S et al. Metabolism 1999;48:1216)
Fig. Fasting serum glucosein Kitava and Sweden.

overweight (Lindeberg S et al. J Intern Med 1994;236:331)

hypertension (Lindeberg S et al. J Intern Med 1994;236:331)
Table. Blood pressure at age 40-60 years among hunter-gatherers, in Kitava and in Sweden (mm Hg, mean ± standard deviation)(modified from Lindeberg S et al. J Intern Med 1994;236:331).

Diastolic BP, mm Hg
Diastolic BP, mm Hg
Fig. Diastolic blood pressure among males (left) and females (right) from Sweden (grey) and Kitava (black) (modified from Lindeberg S et al. J Intern Med 1994;236:331).

Systolic BP, mm Hg
Systolic BP, mm Hg
Fig. Systolic blood pressure among males (left) and females (right) from Sweden (grey) and Kitava (black) (modified from Lindeberg S et al. J Intern Med 1994;236:331).

BMI 24.5
BMI 20.3
Fig. Z scores* of observed versus predicted mean cardiovascular risk factors in Kitavan males (left) and females (right) aged 40-65 years (after variable transformation when necessary).
*standard score, number of standard deviations below or above Swedish means.

28
Westernization affects everyone
Blood pressure
Fasting plasma glucose
Cruickshank JK. Int J Epidemiol 2001;30:111
Poulter NR et al. Am J Hypertens 1988;1:143S

Ten-year risk of fatal cardiovascular disease in ’low-risk’ European populations. Chart based on total cholesterol (Conroy RM et al. Eur Heart J. 2003;24:987)
(Lindeberg S. Eur Heart J 2005;26:2605-6)

Who wants to be normal?
Atherosclerosis is part of ’normal’ ageing in westernized populations
including japanese and chinese
Fig. 40-year old US woman with coronary atherosclerosis despite normal angiography(Nissen SE. Circulation 2001;103:604).
Fig. Percent of subjects with coronary atherosclerosis from birth to age 40 (Stary HC et al. AJCN 2000;72:1297S).

31
Atherosclerosis of left anterior descending coronary artery among 45-55 year-old men from four populations (Tejada -68)

Atherosclerosis is part of ’normal’ ageing in westernized populations
No atheromas in other free-living mammals
No atheromas in experimental animals without prior dietary manipulation
fat, casein, lactose, peanut lectin etc.
uncertain impact of cereal grains

Relative risk of Western disease

“Your blood pressure is normal.”

Striking absence of Western disease despite
a fair amount of elderly
6% between 60 and 95 years of age

6% between 60 and 95 years of age
age estimates based on historic events

no indications of genetic resistance

75% smokers

75% smokers
energy expenditure not extreme (but high)

75% smokers
high intake of saturated fat from coconut
low total fat intake (~20 E%)

75% smokers
high intake of starch from yam, sweet potato, taro etc
65-70 % of energy from carbohydrate

42

43
Estimated dietary intakes for Kitavan adults
Daily intake Total Protein Fat CHO Energy
(medians) (g) (g) (g) (g) (kJ)
Tubers 1200 25 2 300 5600
Fruit 400 3 <1 50 920
Coconut 110 4 43 7 1865
Fish 85 17 4 0 445
Other 200 5 <1 14 360
Western food <1 0 <1 <1 20
Total 2 000 54 50 370 9200

75% smokers
Starch has not been shown to cause glucose intolerance

75% smokers
Starch has not been shown to cause glucose intolerance
Humans have a high capacity to digest starch

Carbohydrate and fat – both to the left and to the right
46

Is it time to shift focus?
47

Part 2. Treatment of disease

Grain-free, dairy-free diets in clinical practice
Fruit, roots, meat, organ meats, eggs, fish, shellfish, vegetables, nuts etc.
Beneficial effects in small clinical trials
Normalized glucose tolerance independent of weight loss in diabetes/IGT (Lindeberg S et al. Diabetologia 2007;50:1795)
Lower blood sugar, blood pressure, triglycerides and waist, and higher HDL, in diabetes type 2 (Jönsson T et al. Cardiovasc Diabetol 2009;8:35)
Lower LDL, triglycerides, fP-Insulin (by 68%), AUCInsulin (by 39%) and diastolic BP (Frassetto LA et al. Eur J Clin Nutr 2009;63:947)

A paleolithic-like diet improved glucose tolerance independently of weight loss or waist change
29 patients with ischemic heart disease and impaired glucose tolerance or diabetes; age 61±9 years
randomized to one of two low-fat dietary models
Consensus diet: whole grains, low-fat dairy products, vegetables, fruit and foods rich in omega-3 fatty acids (n=15)
Paleolithic diet: lean meat, fish, vegetables and fruit (n=14; avoid cereals, dairy products, margarine, sugar, salt)
25% lower reported energy intake in the Paleolithic group
Much less grains and dairy foods and more fruit and nuts in the Paleolithic group
No difference in reported intake of fat or fiber
No difference in reported absolute intake of protein
(Lindeberg S et al. Diabetologia 2007;50:1795)

Paleolithic diet
Consensus diet
Before
Before
***
After
***
***
After
Fig. Plasma glucose during the oral glucose tolerance test (OGT) at baseline and after 12 weeks of a Paleolithic diet (left) and a Consensus diet (right). Values are means (SE). ***p <0.001; absence of asterisk denotes p >0.05.
51

Fig. Change in glucose tolerance (left) and waist circumference (right) after 6 and 12 weeks of a Consensus diet (whole grains, lean dairy products, fruit, vegetables, foods high in omega-3 fatty acids; n=15) or a Paleolithic diet (n=14).
52

Table. Number of subjects with OGT plasma glucose above diabetes limits according to WHO diagnostic criteria (1999).

A paleolithic-like diet was superior to ‘diabetes diet’ for patients with type 2 diabetes in a cross-over trial
Fig. HbA1c, HDL cholesterol, triglycerides, diastolic blood pressure, weight and waist circumference after 3 months with a ’diabetes diet’ (black) or a paleolithic diet (white) in 13 patients with diabetes type 2.
(Jönsson T et al. Cardiovasc Diabetol 2009;8:35)

Lindeberg S et al. Diabetologia 2007;50:1795
Jönsson T et al. Cardiovasc Diabetol 2009;8:35
Frassetto LA et al. Eur J Clin Nutr 2009;63:947
LDL –22%, TG –35%, fP-Insulin –68%, AUC Insulin –39%, diastolic blood pressure –4%

Many promising case reports

No obvious risks for most people

Uncertain effect of milk on bone strength
in children and adolescents (Winzenberg T et al. COCHRANE 2006; Lanou AJ et al. Pediatrics 2005;115:736)
in adults (Benetou V et al. EJCN 2011;65:132; Bischoff-Ferrari HA et al. J Bone Mineral Res 2011;DOI 10.1002)

Uncertain effect of milk on bone strength
Uncertain iodine requirements in paleo perspective

Possibly sustainable
Root vegetables, local production, no fertilizers, no dairy, sustainable meat, organ meats, involuntary calorie restriction

Everyone agrees: This is not healthy
61

Everyone agrees: This is healthy
62

Conclusions
Common foods may cause common health problems
Food choice may be more important than counting fat, carbohydrate or calories
Nearly all Westerners get atherosclerosis and we don’t know why
Conventional dietary advice is somewhat unfounded
Is endocrinology more important than nutritionism?
Many possibe endocrine disruptors in grains, seeds and beans
Tyrosine kinase agonists, autoantigen mimics, goitrogens, phytoestrogens etc.
www.staffanlindeberg.com
staffan.lindeberg@med.lu.se

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