AHS Slides_Staffan Lindeberg

1. Ancestral Health Symposium, LA, August 2011Food and Western DiseaseStaffan Lindeberg MD PhDCenter for Primary Health Care ResearchLund University, Sweden

2. Western diseases:Cardiovascular diseasesdiabetes obesityhypertensiondementiacancersosteoporosisricketsiron deficiencyautoimmune diseasesgastroesophageal refluxirritable bowel syndromeand many othersLindeberg S. Food and Western Disease. Wiley-Blackwell 2010

3. The basis of nutritional advice

4. The basis of nutritional adviceStoriesS. GrahamA. LaneJ.H. KelloggD. BurkittBattle CreekM. Bircher-Benner

5. The basis of nutritional adviceStoriesA. Brillat-SavarinC. BernardW. BantingR. Atkins

6. The basis of nutritional adviceStories

7. MoneyThe basis of nutritional adviceStories

8. Money

9. Science

10. Epidemiology

11. Molecular biology

12. Clinical trialsPlacebo bread, real meatReal bread, placebo meat

13. The basis of nutritional adviceStories

14. Money

15. Science

16. Epidemiology

18. Clinical trials

19. Evolutionary medicineThe basis of nutritional adviceStories

20. Money

21. Science

22. Epidemiology

24. Clinical trials

25. Evolutionary medicineThe Trobriand Islands, Papua New Guinea

26. The Trobriand Islands, Papua New Guinea

27. The Trobriand Islands, Papua New GuineaKitavatropical island, 4 x 7 km

28. 2,300 inhabitants (in 1990); 6% 60-96 years

29. diet: cultivated tubers (yam, sweet potato, taro, tapioka), fruit, fish, nuts and leafy vegetables — no western food

30. regular physical activity: ~1.7 x BMR13Estimated amount of foods consumed by Kitavan adults in Nov-Dec 1990Daily intake Total Protein Fat CHO Energy(medians) (g) (g) (g) (g) (kJ)Tubers 1200 25 2 300 5600Fruit 400 3 <1 50 920Coconut 110 4 43 7 1865Fish 85Pork <1 - - - -Other meat <2 - - - -Other 200 5 <1 14 360Western food <1 0 <1 <1 20Total 2 000 54 50 370 9200Lindeberg S et al. AJCN 1997;66:845

31. The Trobriand Islands, Papua New GuineaStriking absence of Western diseasemyocardial infarction (Lindeberg S et al. J Intern Med 1993;233:269)The Trobriand Islands, Papua New GuineaStriking absence of Western diseasemyocardial infarction (Lindeberg S et al. J Intern Med 1993;233:269)

32. consistent with earlier observations (Schiefenhövel, Jüptner)The Trobriand Islands, Papua New GuineaStriking absence of Western diseasemyocardial infarction (Lindeberg S et al. J Intern Med 1993;233:269)

33. consistent with earlier observations (Schiefenhövel, Jüptner)

34. 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)

35. 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)

36. consistent with studies in South America (Groom -71, Connor -78, Baruzzi -81)

37. consistent with studies in the Arctic (Price -36, Kromann -80, Schaefer -81, Dyerberg -89)The Trobriand Islands, Papua New GuineaStriking absence of Western diseasemyocardial infarction (Lindeberg S et al. J Intern Med 1993;233:269)

38. stroke (Lindeberg S et al. J Intern Med 1993;233:269)The Trobriand Islands, Papua New GuineaStriking absence of Western diseasemyocardial infarction (Lindeberg S et al. J Intern Med 1993;233:269)

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

40. consistent with earlier observations (Schiefenhövel, Jüptner)The Trobriand Islands, Papua New GuineaStriking absence of Western diseasemyocardial infarction (Lindeberg S et al. J Intern Med 1993;233:269)

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

44. The Trobriand Islands, Papua New GuineaStriking absence of Western diseasemyocardial infarction (Lindeberg S et al. J Intern Med 1993;233:269)

47. consistent with studies in East Africa (Trowell -81, Muwazi -44)

48. 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

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

54. diabetes type 2 (Lindeberg S et al. Metabolism 1999;48:1216)

55. overweight (Lindeberg S et al. J Intern Med 1994;236:331)The Trobriand Islands, Papua New GuineaStriking absence of Western diseasemyocardial infarction (Lindeberg S et al. J Intern Med 1993;233:269)

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

59. 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).

64. hypertension (Lindeberg S et al. J Intern Med 1994;236:331)Diastolic BP, mm HgDiastolic BP, mm HgFig. 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).

69. hypertension (Lindeberg S et al. J Intern Med 1994;236:331)Systolic BP, mm HgSystolic BP, mm HgFig. 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).

70. BMI 24.5BMI 20.3Fig. 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.

71. 28Westernization affects everyoneBlood pressureFasting plasma glucoseCruickshank JK. Int J Epidemiol 2001;30:111Poulter NR et al. Am J Hypertens 1988;1:143S

72. 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)

73. Who wants to be normal?Atherosclerosis is part of ’normal’ ageing in westernized populationsincluding japanese and chineseFig. 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).

74. 31Atherosclerosis of left anterior descending coronary artery among 45-55 year-old men from four populations (Tejada -68)

75. Who wants to be normal?Atherosclerosis is part of ’normal’ ageing in westernized populationsNo atheromas in other free-living mammalsNo atheromas in experimental animals without prior dietary manipulationfat, casein, lactose, peanut lectin etc.uncertain impact of cereal grains

76. Who wants to be normal?Relative risk of Western disease

77. Who wants to be normal?“Your blood pressure is normal.”

78. The Trobriand Islands, Papua New GuineaStriking absence of Western disease despitea fair amount of elderly

79. 6% between 60 and 95 years of ageThe Trobriand Islands, Papua New GuineaStriking absence of Western disease despitea fair amount of elderly

80. 6% between 60 and 95 years of age

81. age estimates based on historic eventsThe Trobriand Islands, Papua New GuineaStriking absence of Western disease despitea fair amount of elderly

82. no indications of genetic resistanceThe Trobriand Islands, Papua New GuineaStriking absence of Western disease despitea fair amount of elderly

83. no indications of genetic resistance

84. 75% smokersThe Trobriand Islands, Papua New GuineaStriking absence of Western disease despitea fair amount of elderly

86. 75% smokers

87. energy expenditure not extreme (but high)The Trobriand Islands, Papua New GuineaStriking absence of Western disease despitea fair amount of elderly

89. 75% smokers

90. energy expenditure not extreme (but high)

91. high intake of saturated fat from coconut

92. low total fat intake (~20 E%)The Trobriand Islands, Papua New GuineaStriking absence of Western disease despitea fair amount of elderly

94. 75% smokers

97. high intake of starch from yam, sweet potato, taro etc

98. 65-70 % of energy from carbohydrate42Lindeberg S et al. AJCN 1997;66:845

99. 43Estimated dietary intakes for Kitavan adultsDaily intake Total Protein Fat CHO Energy(medians) (g) (g) (g) (g) (kJ) Tubers 1200 25 2 300 5600Fruit 400 3 <1 50 920Coconut 110 4 43 7 1865Fish 85 17 4 0 445Other 200 5 <1 14 360Western food <1 0 <1 <1 20Total 2 000 54 50 370 9200Lindeberg S et al. AJCN 1997;66:845

100. The Trobriand Islands, Papua New GuineaStriking absence of Western disease despitea fair amount of elderly

102. 75% smokers

106. 65-70 % of energy from carbohydrate

107. Starch has not been shown to cause glucose intoleranceThe Trobriand Islands, Papua New GuineaStriking absence of Western disease despitea fair amount of elderly

109. 75% smokers

113. 65-70 % of energy from carbohydrate

114. Starch has not been shown to cause glucose intolerance

115. Humans have a high capacity to digest starchCarbohydrate and fat – both to the left and to the right46

116. Is it time to shift focus?47

117. Part 2. Treatment of disease

118. Grain-free, dairy-free diets in clinical practiceFruit, roots, meat, organ meats, eggs, fish, shellfish, vegetables, nuts etc.Beneficial effects in small clinical trialsNormalized 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)

119. A paleolithic-like diet improved glucose tolerance independently of weight loss or waist change29 patients with ischemic heart disease and impaired glucose tolerance or diabetes; age 61±9 years

120. randomized to one of two low-fat dietary models

121. Consensus diet: whole grains, low-fat dairy products, vegetables, fruit and foods rich in omega-3 fatty acids (n=15)

122. Paleolithic diet: lean meat, fish, vegetables and fruit (n=14; avoid cereals, dairy products, margarine, sugar, salt)

123. 25% lower reported energy intake in the Paleolithic group

124. Much less grains and dairy foods and more fruit and nuts in the Paleolithic group

125. No difference in reported intake of fat or fiber

126. No difference in reported absolute intake of protein(Lindeberg S et al. Diabetologia 2007;50:1795)

127. A paleolithic-like diet improved glucose tolerance independently of weight loss or waist changePaleolithic dietConsensus dietBeforeBefore***After******AfterFig. 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.(Lindeberg S et al. Diabetologia 2007;50:1795)51

128. A paleolithic-like diet improved glucose tolerance independently of weight loss or waist changeFig. 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).(Lindeberg S et al. Diabetologia 2007;50:1795)52

129. A paleolithic-like diet improved glucose tolerance independently of weight loss or waist changeTable. Number of subjects with OGT plasma glucose above diabetes limits according to WHO diagnostic criteria (1999).(Lindeberg S et al. Diabetologia 2007;50:1795)

130. A paleolithic-like diet was superior to ‘diabetes diet’ for patients with type 2 diabetes in a cross-over trialFig. 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)

131. Grain-free, dairy-free diets in clinical practiceFruit, roots, meat, organ meats, eggs, fish, shellfish, vegetables, nuts etc.Beneficial effects in small clinical trialsLindeberg S et al. Diabetologia 2007;50:1795Jönsson T et al. Cardiovasc Diabetol 2009;8:35Frassetto LA et al. Eur J Clin Nutr 2009;63:947LDL –22%, TG –35%, fP-Insulin –68%, AUC Insulin –39%, diastolic blood pressure –4%

132. Grain-free, dairy-free diets in clinical practiceFruit, roots, meat, organ meats, eggs, fish, shellfish, vegetables, nuts etc.Beneficial effects in small clinical trialsMany promising case reports

133. Grain-free, dairy-free diets in clinical practiceFruit, roots, meat, organ meats, eggs, fish, shellfish, vegetables, nuts etc.Beneficial effects in small clinical trialsMany promising case reportsNo obvious risks for most people

134. Grain-free, dairy-free diets in clinical practiceFruit, roots, meat, organ meats, eggs, fish, shellfish, vegetables, nuts etc.Beneficial effects in small clinical trialsMany promising case reportsNo obvious risks for most peopleUncertain effect of milk on bone strengthin 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)

135. Grain-free, dairy-free diets in clinical practiceFruit, roots, meat, organ meats, eggs, fish, shellfish, vegetables, nuts etc.Beneficial effects in small clinical trialsMany promising case reportsNo obvious risks for most peopleUncertain effect of milk on bone strengthUncertain iodine requirements in paleo perspective

136. Grain-free, dairy-free diets in clinical practiceFruit, roots, meat, organ meats, eggs, fish, shellfish, vegetables, nuts etc.Beneficial effects in small clinical trialsMany promising case reportsNo obvious risks for most peoplePossibly sustainableRoot vegetables, local production, no fertilizers, no dairy, sustainable meat, organ meats, involuntary calorie restriction

137. Everyone agrees: This is not healthy61

138. Everyone agrees: This is healthy62

139. ConclusionsCommon foods may cause common health problemsFood choice may be more important than counting fat, carbohydrate or caloriesNearly all Westerners get atherosclerosis and we don’t know whyConventional dietary advice is somewhat unfounded Is endocrinology more important than nutritionism?Many possibe endocrine disruptors in grains, seeds and beansTyrosine kinase agonists, autoantigen mimics, goitrogens, phytoestrogens etc. www.staffanlindeberg.comstaffan.lindeberg@med.lu.se

AHS Slides_Staffan Lindeberg

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AHS Slides_Staffan Lindeberg