The food business is a strange blend of commerce, fads, media hype, multinationals, advertising, book publishing, research articles, supplements.. the list goes on. While I admit that some of these people have the best interests of your health at heart, many if not most, are in it for the buck. You could be buying a pair of shoes or a new suit for all they care as long as they get your consumer dollar. The nice thing about a pair of shoes that don't fit or a suit that just doesn't cut it is that you know pretty quickly. Either the blisters on your feet tell you or a kind friend lets you know the suit you thought was a deal would look better hanging on that skinny guy in the cornfield. Food intake is different. What tastes and feels so good going down can have gradual deleterious effects on your body that go unnoticed for years until something breaks down. Worse yet are the ever changing and conflicting messages we are bombarded with regarding what is "healthy" for us.

Who do you believe? In answer to that I would say believe yourself. Read everything with an open mind. Consider the source, the evidence, seek out the references if possible and ask yourself, "Does this make sense?" The latter question is one I try to ask myself all the time with respect to the deluge of nutritional advice we see or hear almost every day.

Diet Evolution

When we use the term diet in this article we are referring to general food intake and not reduced or restricted food intake as in dieting. There have been many articles recently that make reference to anthropological diets with the assumption that since our ancient ancestors never experienced disease they must have had a far healthier diet than the one we now consume. This could be true and we'll discuss this later but certainly they had a more active lifestyle and probably had a better balanced caloric budget than we do. Their level of activity in obtaining food was balanced by the food calories obtained and as such they stayed fit and healthy. At times when excess calories were available they most likely gained some weight but that would be in anticipation of hard times when food was scarce and they would have to rely on their body's reserves. For most people in developed countries the annual cycles of food scarcity never happen. There are endless calories, which when combined with poor judgement or weak wills lead to rates of obesity unheard of in human history.

There is an interesting aside here in terms of the prevalence of type 2 diabetes. It is hypothesized that in the past individuals with a genetic predisposition to rapid fat storage would have had an evolutionary advantage when confronted with a period of food shortage. This makes sense given that many of our ancestors certainly would have had to confront periods of near starvation and rapidly storing fat calories when food was abundant would be a survival advantage during difficult times. That genetic advantage turns out to be a disadvantage in our society since food is rarely scarce. In those individuals with a predisposition to rapid fat storage and available endless calories there is excess and un-required fat storage, progression to increased insulin resistance and eventually type 2 diabetes. It is important to note here that this genetic predisposition represents a potential for fat storage but typically type 2 diabetes will only present itself when there is excessive caloric intake in the absence of balanced energy-burning activities.

Efforts to generalize a single anthropological diet really make no sense since the geographical location often dictated the diet. 'Eat locally, think globally' was probably their slogan out of necessity rather than environmental concerns. In fact there would have been Paleolithic diets composed entirely of plants, others entirely of animals and a range of combinations, largely dictated by what was available. This simple fact emphasizes one thing: Humans are phenomenally adaptable in their ability to meet caloric and nutritional needs with any variety of foods.

Some of you who have read this newsletter for a while may recall the article I wrote regarding the findings of the heart protection study where cholesterol lowering medications were used in a large study population and demonstrated a significant reduction in heart attacks and strokes (Vol.3 No.4). One of the key messages behind this study was that lowering the LDL (the low density lipoprotein, 'bad cholesterol') with the medication Zocor (a statin) could help to reduce hospitalization and surgeries and ultimately save the health care system significant amounts of money. Keep in mind that this pharmaceutical intervention (Zocor 40 mg once per day) would come with it's own hefty price tag if applied to the 10-15% of the population at risk. In addition, the Zocor intervention did nothing for nutritional wellness.

There was an interesting study that appeared not long after that which was done in a smaller group of people and showed that an 'ape diet' was just as effective as a statin (in this case Lovastatin) at lowering the bad cholesterol. This was a Canadian study headed by Dr. David Jenkins at the University of Toronto and published in the prestigious Journal of the American Medical Association. This study randomized 46 men and women to one of three groups: a. A low-fat diet, b. A low-fat diet plus 20 mg lovastatin (Mevacor) and c. An ape diet. The latter consisted of an easy to prepare menu including such foods as oat bran bread and cereal, soy drinks, fruit and soy deli slices. They list a typical dinner as consisting of tofu bake with eggplant, onions and sweet peppers, pearl barley and vegetables. This really is a diet rich in nuts, fibrous grains and vegetable proteins. This was intended to be like an anthropological diet. It was unfortunate that this work didn't get as much exposure as the results of the heart protection study since the message is quite powerful. Diet can make a difference. Many advocates of statin therapy have argued that diet could not achieve the significant reductions in LDL observed with statin use. In this study however, the ape diet reduced the LDL by almost 29% compared to the 30.9% reduction observed in the statin treatment arm. It's all a matter of compliance, whether you're popping a pill or consistently embracing healthy food choices. The diet also lowered the C-reactive protein, a blood protein used as a risk marker for heart disease. An interesting comment from the author with respect to dieting and being hungry. Dr. Jenkins stated "the trouble was that the dieters were too full. We had to force feed people to get them not to lose weight. So that is a problem. The diets are very filling. So for those people who don't want to lose any weight, this diet is very filling and they may have trouble maintaining weight ". My response to this comment is that the majority of individuals with elevated cholesterol requiring some intervention are overweight and some weight loss may actually be beneficial as long it is done slowly and with adequate nutrition.