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Ancestral Health Symposium, LA, August 2011<br />Food and Western Disease<br />Staffan Lindeberg MD PhD<br />Center for Primary Health Care Research<br />Lund University, Sweden<br />
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Western diseases:<br />Cardiovascular diseases<br />diabetes <br />obesity<br />hypertension<br />dementia<br />cancers<br />osteoporosis<br />rickets<br />iron deficiency<br />autoimmune diseases<br />gastroesophageal reflux<br />irritable bowel syndrome<br />and many others<br />Lindeberg S. Food and Western Disease. Wiley-Blackwell 2010<br />
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The Trobriand Islands, Papua New Guinea<br />Striking absence of Western disease<br /><ul><li>myocardial infarction (Lindeberg S et al. J Intern Med 1993;233:269)</li></li></ul><li>The Trobriand Islands, Papua New Guinea<br />Striking absence of Western disease<br /><ul><li>myocardial infarction (Lindeberg S et al. J Intern Med 1993;233:269)
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consistent with earlier observations (Schiefenhövel, Jüptner)</li></li></ul><li>The Trobriand Islands, Papua New Guinea<br />Striking absence of Western disease<br /><ul><li>myocardial infarction (Lindeberg S et al. J Intern Med 1993;233:269)
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consistent with earlier observations (Schiefenhövel, Jüptner)
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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)
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consistent with studies in South America (Groom -71, Connor -78, Baruzzi -81)
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consistent with studies in the Arctic (Price -36, Kromann -80, Schaefer -81, Dyerberg -89)</li></li></ul><li>The Trobriand Islands, Papua New Guinea<br />Striking absence of Western disease<br /><ul><li>myocardial infarction (Lindeberg S et al. J Intern Med 1993;233:269)
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stroke (Lindeberg S et al. J Intern Med 1993;233:269)</li></li></ul><li>The Trobriand Islands, Papua New Guinea<br />Striking absence of Western disease<br /><ul><li>myocardial infarction (Lindeberg S et al. J Intern Med 1993;233:269)
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stroke (Lindeberg S et al. J Intern Med 1993;233:269)
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consistent with earlier observations (Schiefenhövel, Jüptner)</li></li></ul><li>The Trobriand Islands, Papua New Guinea<br />Striking absence of Western disease<br /><ul><li>myocardial infarction (Lindeberg S et al. J Intern Med 1993;233:269)
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stroke (Lindeberg S et al. J Intern Med 1993;233:269)
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consistent with earlier observations (Schiefenhövel, Jüptner)
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consistent with studies in East Africa (Trowell -81, Muwazi -44)</li></ul>Table. Incidence of stroke as proportion of acute neurologic disease in Kampala, Uganda.<br />
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The Trobriand Islands, Papua New Guinea<br />Striking absence of Western disease<br /><ul><li>myocardial infarction (Lindeberg S et al. J Intern Med 1993;233:269)
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stroke (Lindeberg S et al. J Intern Med 1993;233:269)
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consistent with earlier observations (Schiefenhövel, Jüptner)
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consistent with studies in East Africa (Trowell -81, Muwazi -44)
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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)</li></li></ul><li>Fig. Stroke incidence per 1000 person-years in the 1990s among selected westernized populations.<br />Feigin VI et al. Lancet Neurol 2003;2:43<br />
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The Trobriand Islands, Papua New Guinea<br />Striking absence of Western disease<br /><ul><li>myocardial infarction (Lindeberg S et al. J Intern Med 1993;233:269)
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stroke (Lindeberg S et al. J Intern Med 1993;233:269)
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diabetes type 2 (Lindeberg S et al. Metabolism 1999;48:1216)</li></ul>Fig. Fasting serum glucosein Kitava and Sweden.<br />
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The Trobriand Islands, Papua New Guinea<br />Striking absence of Western disease<br /><ul><li>myocardial infarction (Lindeberg S et al. J Intern Med 1993;233:269)
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stroke (Lindeberg S et al. J Intern Med 1993;233:269)
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diabetes type 2 (Lindeberg S et al. Metabolism 1999;48:1216)
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overweight (Lindeberg S et al. J Intern Med 1994;236:331)</li></li></ul><li>The Trobriand Islands, Papua New Guinea<br />Striking absence of Western disease<br /><ul><li>myocardial infarction (Lindeberg S et al. J Intern Med 1993;233:269)
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stroke (Lindeberg S et al. J Intern Med 1993;233:269)
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diabetes type 2 (Lindeberg S et al. Metabolism 1999;48:1216)
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overweight (Lindeberg S et al. J Intern Med 1994;236:331)
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hypertension (Lindeberg S et al. J Intern Med 1994;236:331)</li></ul>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).<br />
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The Trobriand Islands, Papua New Guinea<br />Striking absence of Western disease<br /><ul><li>myocardial infarction (Lindeberg S et al. J Intern Med 1993;233:269)
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stroke (Lindeberg S et al. J Intern Med 1993;233:269)
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diabetes type 2 (Lindeberg S et al. Metabolism 1999;48:1216)
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overweight (Lindeberg S et al. J Intern Med 1994;236:331)
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hypertension (Lindeberg S et al. J Intern Med 1994;236:331)</li></ul>Diastolic BP, mm Hg<br />Diastolic BP, mm Hg<br />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).<br />
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The Trobriand Islands, Papua New Guinea<br />Striking absence of Western disease<br /><ul><li>myocardial infarction (Lindeberg S et al. J Intern Med 1993;233:269)
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stroke (Lindeberg S et al. J Intern Med 1993;233:269)
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diabetes type 2 (Lindeberg S et al. Metabolism 1999;48:1216)
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overweight (Lindeberg S et al. J Intern Med 1994;236:331)
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hypertension (Lindeberg S et al. J Intern Med 1994;236:331)</li></ul>Systolic BP, mm Hg<br />Systolic BP, mm Hg<br />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).<br />
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BMI 24.5<br />BMI 20.3<br />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).<br />*standard score, number of standard deviations below or above Swedish means.<br />
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28<br />Westernization affects everyone<br />Blood pressure<br />Fasting plasma glucose<br />Cruickshank JK. Int J Epidemiol 2001;30:111<br />Poulter NR et al. Am J Hypertens 1988;1:143S<br />
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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)<br />(Lindeberg S. Eur Heart J 2005;26:2605-6)<br />
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Who wants to be normal?<br />Atherosclerosis is part of ’normal’ ageing in westernized populations<br />including japanese and chinese<br />Fig. 40-year old US woman with coronary atherosclerosis despite normal angiography(Nissen SE. Circulation 2001;103:604).<br />Fig. Percent of subjects with coronary atherosclerosis from birth to age 40 (Stary HC et al. AJCN 2000;72:1297S).<br />
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31<br />Atherosclerosis of left anterior descending coronary artery among 45-55 year-old men from four populations (Tejada -68)<br />
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Who wants to be normal?<br />Atherosclerosis is part of ’normal’ ageing in westernized populations<br />No atheromas in other free-living mammals<br />No atheromas in experimental animals without prior dietary manipulation<br />fat, casein, lactose, peanut lectin etc.<br />uncertain impact of cereal grains<br />
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Who wants to be normal?<br />Relative risk of Western disease<br />
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Who wants to be normal?<br />“Your blood pressure is normal.”<br />
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The Trobriand Islands, Papua New Guinea<br />Striking absence of Western disease despite<br /><ul><li>a fair amount of elderly
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6% between 60 and 95 years of age</li></li></ul><li>The Trobriand Islands, Papua New Guinea<br />Striking absence of Western disease despite<br /><ul><li>a fair amount of elderly
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age estimates based on historic events</li></li></ul><li>The Trobriand Islands, Papua New Guinea<br />Striking absence of Western disease despite<br /><ul><li>a fair amount of elderly
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no indications of genetic resistance</li></li></ul><li>The Trobriand Islands, Papua New Guinea<br />Striking absence of Western disease despite<br /><ul><li>a fair amount of elderly
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75% smokers</li></li></ul><li>The Trobriand Islands, Papua New Guinea<br />Striking absence of Western disease despite<br /><ul><li>a fair amount of elderly
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energy expenditure not extreme (but high)</li></li></ul><li>The Trobriand Islands, Papua New Guinea<br />Striking absence of Western disease despite<br /><ul><li>a fair amount of elderly
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low total fat intake (~20 E%)</li></li></ul><li>The Trobriand Islands, Papua New Guinea<br />Striking absence of Western disease despite<br /><ul><li>a fair amount of elderly
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Starch has not been shown to cause glucose intolerance</li></li></ul><li>The Trobriand Islands, Papua New Guinea<br />Striking absence of Western disease despite<br /><ul><li>a fair amount of elderly
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Grain-free, dairy-free diets in clinical practice<br />Fruit, roots, meat, organ meats, eggs, fish, shellfish, vegetables, nuts etc.<br />Beneficial effects in small clinical trials<br />Normalized glucose tolerance independent of weight loss in diabetes/IGT (Lindeberg S et al. Diabetologia 2007;50:1795)<br />Lower blood sugar, blood pressure, triglycerides and waist, and higher HDL, in diabetes type 2 (Jönsson T et al. Cardiovasc Diabetol 2009;8:35)<br />Lower LDL, triglycerides, fP-Insulin (by 68%), AUCInsulin (by 39%) and diastolic BP (Frassetto LA et al. Eur J Clin Nutr 2009;63:947)<br />
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A paleolithic-like diet improved glucose tolerance independently of weight loss or waist change<br /><ul><li>29 patients with ischemic heart disease and impaired glucose tolerance or diabetes; age 61±9 years
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randomized to one of two low-fat dietary models
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Consensus diet: whole grains, low-fat dairy products, vegetables, fruit and foods rich in omega-3 fatty acids (n=15)
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Paleolithic diet: lean meat, fish, vegetables and fruit (n=14; avoid cereals, dairy products, margarine, sugar, salt)
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25% lower reported energy intake in the Paleolithic group
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Much less grains and dairy foods and more fruit and nuts in the Paleolithic group
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No difference in reported intake of fat or fiber
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No difference in reported absolute intake of protein</li></ul>(Lindeberg S et al. Diabetologia 2007;50:1795)<br />
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A paleolithic-like diet improved glucose tolerance independently of weight loss or waist change<br />Paleolithic diet<br />Consensus diet<br />Before<br />Before<br />***<br />After<br />***<br />***<br />After<br />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.<br />(Lindeberg S et al. Diabetologia 2007;50:1795)<br />51<br />
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A paleolithic-like diet improved glucose tolerance independently of weight loss or waist change<br />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).<br />(Lindeberg S et al. Diabetologia 2007;50:1795)<br />52<br />
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A paleolithic-like diet improved glucose tolerance independently of weight loss or waist change<br />Table. Number of subjects with OGT plasma glucose above diabetes limits according to WHO diagnostic criteria (1999).<br />(Lindeberg S et al. Diabetologia 2007;50:1795)<br />
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A paleolithic-like diet was superior to ‘diabetes diet’ for patients with type 2 diabetes in a cross-over trial<br />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.<br />(Jönsson T et al. Cardiovasc Diabetol 2009;8:35)<br />
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Grain-free, dairy-free diets in clinical practice<br />Fruit, roots, meat, organ meats, eggs, fish, shellfish, vegetables, nuts etc.<br />Beneficial effects in small clinical trials<br />Lindeberg S et al. Diabetologia 2007;50:1795<br />Jönsson T et al. Cardiovasc Diabetol 2009;8:35<br />Frassetto LA et al. Eur J Clin Nutr 2009;63:947<br />LDL –22%, TG –35%, fP-Insulin –68%, AUC Insulin –39%, diastolic blood pressure –4%<br />
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Grain-free, dairy-free diets in clinical practice<br />Fruit, roots, meat, organ meats, eggs, fish, shellfish, vegetables, nuts etc.<br />Beneficial effects in small clinical trials<br />Many promising case reports<br />
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Grain-free, dairy-free diets in clinical practice<br />Fruit, roots, meat, organ meats, eggs, fish, shellfish, vegetables, nuts etc.<br />Beneficial effects in small clinical trials<br />Many promising case reports<br />No obvious risks for most people<br />
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Grain-free, dairy-free diets in clinical practice<br />Fruit, roots, meat, organ meats, eggs, fish, shellfish, vegetables, nuts etc.<br />Beneficial effects in small clinical trials<br />Many promising case reports<br />No obvious risks for most people<br />Uncertain effect of milk on bone strength<br />in children and adolescents (Winzenberg T et al. COCHRANE 2006; Lanou AJ et al. Pediatrics 2005;115:736)<br />in adults (Benetou V et al. EJCN 2011;65:132; Bischoff-Ferrari HA et al. J Bone Mineral Res 2011;DOI 10.1002)<br />
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Grain-free, dairy-free diets in clinical practice<br />Fruit, roots, meat, organ meats, eggs, fish, shellfish, vegetables, nuts etc.<br />Beneficial effects in small clinical trials<br />Many promising case reports<br />No obvious risks for most people<br />Uncertain effect of milk on bone strength<br />Uncertain iodine requirements in paleo perspective<br />
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Grain-free, dairy-free diets in clinical practice<br />Fruit, roots, meat, organ meats, eggs, fish, shellfish, vegetables, nuts etc.<br />Beneficial effects in small clinical trials<br />Many promising case reports<br />No obvious risks for most people<br />Possibly sustainable<br />Root vegetables, local production, no fertilizers, no dairy, sustainable meat, organ meats, involuntary calorie restriction<br />
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Everyone agrees: This is not healthy<br />61<br />
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Everyone agrees: This is healthy<br />62<br />
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Conclusions<br />Common foods may cause common health problems<br />Food choice may be more important than counting fat, carbohydrate or calories<br />Nearly all Westerners get atherosclerosis and we don’t know why<br />Conventional dietary advice is somewhat unfounded <br />Is endocrinology more important than nutritionism?<br />Many possibe endocrine disruptors in grains, seeds and beans<br />Tyrosine kinase agonists, autoantigen mimics, goitrogens, phytoestrogens etc. <br />www.staffanlindeberg.com<br />staffan.lindeberg@med.lu.se<br />