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Implementing The Paleo Diet:
The Synthesis & Nutrient
Characteristics of a
Contemporary
Diet Based Upon
Paleolithic Food Groups
Loren Cordain, Ph.D.
Department of Health &
Exercise Science
Colorado State University
Fort Collins, Co USA
Diet & Disease:
Genetic Discordance
How Do Zoo Keepers Determine
the Optimal Diet of Wild Animals?
v The closer zookeepers can
match, an animal’s captive
environment
v To its natural environment,
v The healthier the animal will
be and more likely to
reproduce
v This includes the exact type
of foods they would normally
eat in their wild state
v These are the foods to which
the animal species is
genetically adapted
Giraffes in The San Diego Zoo
Wild Animal Park
The Optimal Human Diet
v Humans are no
different than any
other wild animal
v We are genetically
well adapted to the
foods normally eaten
in our native
ecological niche
v What is the native
human ecological
niche?
v Hunter Gatherer
!Kung Hunter Gatherer
in East Africa
Circa - 1964
Eaton SB et al. Paleolithic nutrition. A consideration of its nature and
Current implications. N Engl J Med 1985 312 283-89.
Our Ancient
Hunter Gatherer Heritage
v Despite our cities, cars,
computers and modern
technology
v All Humans have only very
recently left the Stone Age
KNM ER 1470
(Homo habilis)
vSince the appearance of the human
genus (Homo habilis) 2.4 Million years ago
v Humans have occupied the Hunter-gatherer
niche until:
vThe Agricultural Revolution only 10,000 yrs
(500 generations) ago
Our Ancient Hunter Gatherer
Heritage
v Human nutritional needs
were established in the
remote pre-historic past
over eons of evolutionary
experience
v The selective pressures
of the hunter-gatherer
niche determined our
present day genetic
makeup including our
nutritional requirements
Generations (~30 yrs) in the
Evolution of Humanity
Generations
Homo habilis (1st Homo species )
76,667
Homo erectus (modern body size)
60,000
Modern Homo sapiens (cranial size)
6,666
Agricultural Revolution (cereals)
333
Advent of Dairying (milk, cheese etc)
200
Industrial Revolution (refined sugars,
7
refined cereals, oils, canned food)
Food Processing Industry (junk food)
4
% Total
100.0
78.2
8.7
0.4
0.26
0.009
0.005
Conclusion: 99.6% of all Homo generations had no
evolutionary experience with commonly consumed
modern foods introduced during the Neolithic!
Our Ancient Hunter
Gatherer Heritage
v Mitochondrial DNA +
single nucleotide
polymorphisms (SNPs)
evidence from diverse
ethnic groups world wide:
v Some, but relatively little
change in human genome
since the appearance of
behaviorally modern
humans (Homo sapiens)
40,000 yrs ago
Macaulay V et al. The emerging tree of Western Eurasian
mtDNAs a synthesis of control-region sequences and
RFLPs. Am J Hum Genet 1999 64 232-49.
Cordain L. et al. Fatty acid composition and energy density of foods
available to African hominids: evolutionary implications for human
brain development. World Review of Nutrition and Dietetics, 2001, 90:
144-161.
Voigth BF et al. A map of recent postive selection in the
Human genome. PLOS Biol 2006 4 0446-0458.
Our Ancient Hunter Gatherer
Heritage
Discordance Hypothesis
v The discordance between
modern foods and those
to which pre-agricultural
people were genetically
adapted
v Contributes to many diet
related health problems
of modern humans
v Modern Anatomy
Physiology &
v Hence, Nutritional
requirements
v Remain virtually
identical to those of
Stone Age Hunter
Gatherers
Cordain L. Cereal grains. Humanity’s double
Edged sword. World Rev Nutr Diet 1999 84
19-73
These foods comprise (>70% energy)
in typical Western Diets
But were virtually unknown in
Ancestral Human Diets
Breads, Cereals, Rice and Pasta
Dairy Products
Refined sugars, grains, vegetable oils and
dairy = 70.9% of energy in the U.S. food supply
Meats,
Fish
Added Salt
15.7
18.6
1.4 Eggs
Nuts, Seeds
3.1 Legumes
3.3 Fruits
Refined
Sugars
Refined
Vegetable Oils
Grains
Dairy
4.8 Vegetables
17.8
Refined Vegetable Oils
Refined Sugars
(except honey)
0.8 Miscellaneous
Fatty Meats
Alcohol
23.9
10.6
v Refined sugars, grains, vegetable oils and dairy represent
Neolithic & Industrial era foods that were not present in traditional
ancestral human diets
v By default, their inclusion displaces minimally processed, wild
plant and animal foods.
Cordain et al. Am J Clin Nutr 2000 71 682-92
Gerrior S, Bente I. 2002. Nutrient Content of the U.S. Food Supply, 1909-99: A Summary Report.
U.S.D.A, Center for Nutrition Policy and Promotion. Home Economics Research Report No. 55
The Synthesis & Nutrient Characteristics of
a Contemporary Diet Based Upon
Paleolithic Food Groups
Fish
Seafood
Lean
Meats
Food Components of
Typical Hunter-Gatherer Diet
Typical Macronutrient
Breakdown
(28-47 %)
Fat
(19-35 %)
Protein
(22-40 %)
Carbohydrate
Fresh Veggies
Nuts/Seeds
Fresh Fruits
Apportionment of daily energy to the five
food groups in a contemporary diet based
upon Paleolithic food groups
30
27.5
v 1.
v
v
v
v
v
v
v
v
Animal food energy = 55%
a. Hunted animal = 27.5%
b. Fished animal = 27.5%
c. No fatty or processed
meats
d. No dairy foods
2. Plant food energy = 45%
a. No cereal grains
b. Minimally processed
fresh fruits,
vegetables,
seeds & nuts
3. No Processed Foods
Cordain L et al. Am J Clin Nutr, 2000, 71: 682-692.
Modern Foods to Use:
Top 20 Most Commonly Consumed
Vegetables v 1. Potato
27.5
% Total Energy
25
20
15
15
15
15
10
5
0
Vegetables
Fruits
Nuts/seeds
Sea Food
Lean Meats
Cordain L et al. Am J Clin Nutr, 2000, 71: 682-692.
1. Sweet Corn is excluded because
it is a grain
2. Potatoes are excluded because they
maintain characteristics (high glycemic
index) not found in Paleolithic diets
v
v
v
v
v
v
v
v
v
v
v
v
v
v
v
v
v
v
v
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
Iceberg lettuce
Tomato
Onion
Carrot
Celery
Sweet Corn
Broccoli
Green cabbage
Cucumber
Bell pepper
Cauliflower
Leaf lettuce
Sweet potato
Mushroom
Green onion
Green bean
Radish
Summer squash
Asparagus
Modern Foods to Use:
Top 20 Most Commonly Consumed
Fruits
1. Dried fruits (raisins, dates etc. are
excluded because they
maintain characteristics (high glycemic
load) not found in Paleolithic diets
v
v
v
v
v
v
v
v
v
v
v
v
v
v
v
v
v
v
v
v
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
% Protein
80
60
67
75
68
19
26
89
40
ck
en
Ch
i
5
Tu
rk
ey
28
0
Po
rk
20
Be
ef
% total energy
100
v
v
v
v
v
v
v
v
v
v
v
v
v
v
v
v
v
v
v
Banana
Apple
Watermelon
Orange
Cantaloupe
Grape
Grapefruit
Strawberry
Peach
Pear
Nectarine
Honeydew melon
Plum
Avocado
Lemon
Pineapple
Tangerine
Sweet cherry
Kiwi fruit
Lime
Modern Foods to Use:
Top 4 Most Commonly Consumed
Lean Meat
% Fat
Modern Foods to Use:
Top 20 Most Commonly Consumed
Fish/Seafood v 1. Shrimp
v 1. Beef (Sirloin tip
roast trimmed of
visible fat)
v 2. Chicken (breasts
without skin &
trimmed of visible fat)
v 3. Pork (Loin roast
trimmed of visible fat)
v 4. Turkey (Breasts
without skin)
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
Cod
Pollock
Catfish
Scallop
Salmon
Flounder
Sole
Oyster
Orange Roughy
Mackerel
Ocean Perch
Rockfish
Whiting
Clam
Haddock
Blue Crab
Rainbow trout
Halibut
Lobster
Modern Foods to Use:
Top 10 Most Commonly Consumed
Nuts/Seeds
v
v
v
v
v
v
v
v
v
v
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Almonds
Walnuts
Pecans
Filberts
Brazil nuts
Pistachio nuts
Macadamia nuts
Coconut
Sunflower seeds
Pumpkin seeds
Sample 1-day Menu (25 yr female, 2200 kcal)
Breakfast
Cantaloupe
Atlantic salmon (broiled)
Lunch
Vegetable salad with walnuts
Shredded Romaine lettuce
Sliced carrot
Sliced cucumber
Quartered tomatoes
Lemon juice dressing
Walnuts
Broiled lean pork loin
Dinner
Vegetable avocado/almond salad
Shredded mixed greens
Tomato
Avocado
Slivered almonds
Sliced red onion
Lemon juice dressing
Steamed broccoli
Lean beef sirloin tip roast
Dessert – Strawberries
Snacks
Orange
Carrot sticks
Celery sticks
Food Quantity (g)
276
333
Energy (kcal)
97
605
68
61
78
246
31
11
86
10
26
10
52
8
70
205
112
123
85
45
29
31
468
235
130
16
26
150
260
11
8
131
400
39
66
81
90
30
35
14
My Pyramid:
Stated Dietary Goals
Shaw A et al. Using the Food Guide Pyramid:
A Resource for Nutrition Educators. USDA,
Food, Nutrition and Consumer Services.
v
v
v
v
v
v
v
v
v
v
v
v
v
A Diet Adequate in:
Protein (RDA)
Vitamins (RDA)
Minerals (RDA)
Fiber (no RDA): 20-35 g (ADA)
Without Excessive:
Calories
Fat (< 30 % energy)
Saturated Fat (< 10 % energy)
Cholesterol (< 300 mg)
Sodium (< 2,400 mg)
Added Sugars (<8.7 % energy)
Alcohol (<1-2 std drinks)
Nutrient Comparison:
USDA Recommended vs. Paleo Diet
USDA
Recommended
Shaw A et al. Using the Food Guide Pyramid:
A Resource for Nutrition Educators. USDA,
Food, Nutrition and Consumer Services.
5 Days Menus at 2,200 Calories
Modern Paleolithic Diet
Comparison:
Dietary Characteristics for all Individuals in U.S. Versus:
USDA Food Pyramid Recommendations
(Red Values = Do Not Meet Recommendations
Energy
Carbohydrate (% total energy)
Added sugars (% total energy)
Fiber
Total fat (% total energy)
Saturated fat (% total energy)
Saturated fat (% total fat energy)
Monounsaturated fat (% total fat energy)
Polyunsaturated fat (% total fat energy)
Omega 3 fat
Omega 6 fat
Trans fatty acids (% total fat energy)
Cholesterol
Protein (% total energy)
Total alcohol (% total energy)
Sodium
Potassium
Salt (NaCl)
Actual Pyramid
2002 kcal
51.8 %
16.1 %
15.1 g
32.8 %
11.3 %
37.4 %
41.4 %
21.2 %
2.3 g
13.0 g
7.9 %
256 mg
15.4 %
1.4 %
3271 mg
2620 mg
9.6 g
Recom
varies
none
8.7
20-35g
<30
<10
none
none
none
none
none
none
<300
(>9-11%)
(<10%)
<2400
none
Percentage of All Individuals (2 yrs & older) Not
Meeting 100% of 1989 RDAs in US (1994-96)
14 Nutrients Most
Lacking in U.S. Diet
v
v
v
v
v
v
v
v
v
v
v
v
v
Summary:
Differences in Actual Vs:
My Pyramid Recommended Nutrients
v
v
v
v
v
v
v
Zinc
= 73.3 %
Calcium
= 65.1 %
Magnesium = 61.6 %
Vitamin A = 56.2 %
Vitamin B6 = 53.6 %
Iron
= 39.1 %
Vitamin C = 37.5 %
Folate
= 33.2 %
Vitamin B1 = 30.2 %
Vitamin B2 = 30.0 %
Vitamin B3 = 25.9 %
Protein
= 20.5 %
Vitamin B 12 = 17.2 %
v
v
v
v
v
“Paleo Diet” Vs. Food Pyramid:
Nutrient Characteristics (25 yr female – 2,200 Kcal)
Protein (g)
Protein (% energy)
Carbohydrate (g)
Carbohydrate (% energy)
Total sugars (g)
Fiber (g)
Fat (g)
Fat (% total energy)
Saturated fat (g)
Saturated fat (% total energy)
Monounsaturated fat (g)
Polyunsaturated fat (g)
Omega 3 fat (g)
Omega 6 fat (g)
Cholesterol (mg)
Sodium (mg)
Potassium (mg)
Paleo Diet
217
38
129
23
76.5
42.5
100.3
39.0
18.0
6.4
44.3
26.7
9.6
14.2
461
726
9062
Food Pyramid
113
20
302
53
96.6
30.0
67.0
27.0
19.6
7.0
22.8
19.0
1.0
14.3
219
2626
3450
Nutrient
Values
Refined sugars
too high
Fiber
too low
Total fat
too high?
Saturated fat
too high
Sodium
too high
Trace Nutrients (majority of
population deficient):
Vitamin B6
too low
Vitamin A
too low
Magnesium
too low
Calcium
too low
Zinc
too low
“Paleo Diet” Vs. Food Pyramid:
Trace Nutrients: 25 yr. Female – 2,200 kcal
Vitamin A (RE)
Vitamin B1 (mg)
Vitamin B2 (mg)
Vitamin B3 (mg)
Vitamin B6 (mg)
Folate (μg)
Vitamin B12 (μg)
Vitamin C (mg)
Vitamin E (IU)
Calcium (mg)
Phosphorus (mg)
Magnesium (mg)
Iron (mg)
Zinc (mg)
PALEODIET
% RDA
6386 798
3.4
309
4.2
355
60
428
6.7
515
891
223
17.6
733
748
1247
19.5
244
691
69
2546 364
643
207
24.3
162
27.4
228
FOOD PYRAMID
% RDA
1,659 207
2.3
209
2.6
236
30
214
2.6
200
453
113
4.7
196
233
388
10
125
1215 122
1808 258
427
138
19
127
14
116
Food Group:
Nutrient Density Ranking (nutrient/ energy)
13 Most Frequently Deficient Nutrients
Nutrient Density for Food Groups (100 kcal samples)
Superscripts are rank scores (7=highest;1=lowest) for each nutrient
Whole
Whole
Grains
Milk
Fruits
Lean
Vitamin B12 (μg)
0.004
0.585
0.004
0.004
7.427
0.636
0.004
Vitamin B3 (mg)
1.124
0.141
0.893
2.735
3.196
4.737
0.352
Phosphorus (mg)
903
1525
331
1576
2197
1514
802
Vitamin B2 (mg)
0.052
0.266
0.093
0.337
0.094
0.145
0.041
Vitamin B1 (mg)
0.125
0.061
0.113
0.267
0.082
0.186
0.124
Folate (μg)
10.34
8.12
25.06
208.37
10.83
3.81
11.05
Vitamin C (mg)
0.01
1.54
74.26
93.67
1.95
0.12
0.43
Iron (mg)
0.904
0.081
0.692
2.597
2.076
1.105
0.863
Vitamin B6 (mg)
0.093
0.071
0.205
0.427
0.194
0.326
0.082
Vitamin A (RE)
22
505
946
6877
324
11
23
Magnesium (mg)
32.64
21.92
24.63
54.57
36.16
18.01
35.85
Calcium (mg)
7.62
194.37
43.04
116.86
43.15
6.11
17.53
Zinc (mg)
0.674
0.623
0.251
1.045
7.67
1.96
0.62
Sum Rank Score
42
43
47
82
66
51
39
Veggies Seafood
Meats
USDA
Recommended
Nuts/seeds
v
v
v
v
v
v
v
6 Oz
Daily
Dietary Acid/Base Balance
Potential Renal Acid Loads of Foods (100 g portion)
+ values = acid
-values = alkaline
Grains
Brown rice
Rolled oats
Whole wheat bread
Spaghetti
Cornflakes
White Rice
Dairy
Parmesan cheese
Processed cheese
Hard cheese
Cottage Cheese
Whole milk
Legumes
Peanuts
lentils
Peas
12.5
10.7
8.2
7.3
6.0
4.6
34.2
28.7
19.2
8.7
0.7
8.3
3.5
1.2
Meats, Fish, Eggs
Trout
10.8
Turkey
9.9
Chicken
8.7
Eggs
8.2
Beef
7.8
Cod
7.1
Fruits
Raisins
-21.0
Black currants
-6.5
Bananas
-5.5
Apricots
-4.8
Vegetables
Spinach
-14.0
Celery
-5.2
Carrots
-4.9
Lettuce
-2.5
Remer T, Manz F. Potential renal acid load of foods and its influence on urine pH.
J Am Diet Assoc 1995;95:791-97
Nutrient
Density Rankings
per Food Group
3 Cups
Daily
No. 1: Veggies (82)
No. 2: Seafood (66)
No. 3: Lean meats (51)
No. 4. Fruits (47)
No. 5. Whole Milk (43)
No. 6. Whole grains (42)
No. 7. Nuts/Seeds (39)
Conclusion
Displacement of vegetables,
seafood, lean meats and fruit by
whole milk reduces the overall
dietary trace nutrient density
U.S Diet:
Acid/Base Balance
v The average western diet produces a
slight chronic metabolic acidosis
v Net Acid Yielding:
v 1.
Cereal Grains = 23.9 % energy
v 2.
Meats, fish
= 15.7 % energy
v 3.
Dairy
= 10.6 % energy
v 4.
Nuts, legumes = 3.1 % energy
v 5.
Eggs
= 1.4 % energy
v 6.
Salt (NaCl)
= 9.6 g/day
v Net Alkaline Yielding:
v 1.
Vegetables
= 4.8 % energy
v 2.
Fruits
= 3.3 % energy
v Neutral (but displace alkaline foods):
v 1.
Refined sugars = 18.6 % energy
v 2.
Refined Oils
= 17.9 % energy
Kurtz I et al. Effect of diet on plasma acid-base
composition in normal humans. Kidney Int 1983 24 670-80
Potential Renal Acid Load (PRAL) in Example Diet
(PRAL Food Data from Remer & Manz, 1995)
Alkaline Yielding Foods
Cantaloupe
Lettuce
Carrot
Cucumber
Tomatoes
Lemon juice
Salad greens
Avocado
Almonds
Onion
Broccoli
Strawberries
Orange
Celery
Total
Acid Yielding Foods
Salmon
Pork
Beef
Walnuts
Total
Weight (g)
276
68
142
78
331
62
112
85
45
29
468
130
66
90
PRAL/100 g
-3.5
-2.5
-4.9
-0.8
-3.1
-2.5
-2.5
-3.5
-2.8
-1.5
-1.2
-2.2
-2.7
-5.2
Net PRAL
-9.7
-1.7
-7.0
-0.6
-10.3
-1.6
-2.8
-3.0
-1.3
-0.4
-5.6
-2.9
-1.8
-4.7
-53.2
333
86
235
11
7.9
7.9
7.8
6.8
26.3
6.8
18.3
0.7
51.4
Summary: Health Implications
Important Differences in Modern Paleo Diet Vs:
Food Pyramid Recommended Nutrients
v
v
v
v
v
v
v
v
v
v
v
v
v
v
v
Nutrient
Protein
Refined sugars
Glycemic load
Fiber
Saturated fat
MUFA
PUFA
omega 3 PUFA
Cholesterol
Sodium
Potassium
Calcium
Acid/Base
All other trace nutrients
Paleo
higher
lower
lower
higher
lower
higher
higher
higher
higher
lower
higher
lower
net alkaline
higher
Pyramid
lower
higher
higher
lower
higher
lower
lower
lower
lower
higher
lower
higher
net acidic
lower
Acid/Base Balance
v The displacement of fruits and
vegetables by cereal grains,
dairy products and processed
foods shifts diet to net acid
yielding
v Diseases promoted by a net
metabolic acidosis:
v 1. Osteoporosis
v 2. Hypertension
v 3. Kidney stones
v 4. Stroke
Sebastian A et al. Estimation of the net acid load of the diet of ancestral
preagricultural Homo sapiens and their hominid ancestors Am J Clin Nutr
2002 76 1308-16
Potential Nutritional Shortcomings:
The Paleo Diet vs. The Food Pyramid
v No vitamin D?
v Insufficient calcium?
v Excessive cholesterol?
v Excessive protein?
“Paleo Diet” Vs. Food Pyramid:
Calcium Intake:
25 yr. Female – 2,200 kcal
Calcium Homeostasis & Bone Mineral Status:
A Function of Calcium Balance
v Balance = (Calcium In - Calcium Out)
ACTUAL U.S. DIET
PALEODIET
% RDA
691
69
1215
122
v Calcium out:
v 1.
v
v
v 2.
v
v
Calcium Homeostasis & Bone Mineral Status:
A Function of Calcium Balance
Total dietary calcium ingested
Total dietary calcium absorbed from
GI tract
Calcium lost in urine
a.
Dietary calcium
b.
Body stores of calcium
Calcium lost in feces
a.
Dietary calcium
b.
Body stores of calcium
Calcium Density (mg/kcal)
in Food Groups:
0.455 mg/kcal = Minimum density needed to Achieve RDA
2.5
1.28
1.5
1
0.5
0.061
0.075
0.175
Seeds/nuts
0.32
0.43
0.455
Whole Milk
0
Veggies
v The RDA for calcium is 1000
mg for a 25 year old woman
consuming 2200 kcal
v Hence, the average calcium
density of any single food
needed to achieve the RDA is
(1000mg/2200 kcal) =
0.455mg/kcal
1.94
2
Whole
Grains
v Calcium in (ingested):
Lean
Meats
v Balance = (Calcium In - Calcium Out)
Minimum
70
v 1.
v 2.
% RDA
Fruits
701
% RDA
Legumes
Calcium (mg)
v Calcium in:
FOOD PYRAMID
Conclusion: Of all Paleo Food Groups, only vegetables have
a sufficient calcium density to meet the RDA for calcium
How Much Vegetable Food Only is Sufficient
to Achieve Calcium DRI (1000 mg)
25 yr Old Female, 2,200 kcal
v Mean Ca+ density for 20 Commonly consumed
vegetables in U.S. = (1.28 mg/kcal)
v 1000 mg Ca/1.28 mg = 781 kcal of vegetables
v 781 kcal/2200 kcal = 35.5 % energy
Calcium Homeostasis & Bone Mineral Status:
A Function of Calcium Balance
v Balance = (Calcium In - Calcium Out)
v Calcium out (urinary calcium):
v A primary determinant of urinary
calcium loss is acid/base balance
v A net acid diet increases urinary
calcium losses, a net alkaline diet
prevents urinary calcium losses
Sebastian A et al. Improved mineral balance and skeletal metabolism in postmenopausal
women treated with potassium bicarbonate. N Engl J Med 1994 330 1776-81.
Questions:
ƒ
How Do Hunter-Gatherers
Maintain Calcium Balance
& Healthy Bones Without
Dairy Foods?
v How Did Humanity
Maintain Calcium Balance
& Healthy
Bones Prior to
Agriculture?
U.S Diet:
Acid/Base Balance
v The average western diet produces a
slight chronic metabolic acidosis
v Net Acid Yielding:
v 1.
Cereal Grains = 23.9 % energy
v 2.
Meats, fish
= 15.7 % energy
v 3.
Dairy
= 10.6 % energy
v 4.
Nuts, legumes = 3.1 % energy
v 5.
Eggs
= 1.4 % energy
v 6.
Salt (NaCl)
= 9.6 g/day
v Net Alkaline Yielding:
v 1.
Vegetables
= 4.8 % energy
v 2.
Fruits
= 3.3 % energy
v Neutral (but displace alkaline foods):
v 1.
Refined sugars = 18.6 % energy
v 2.
Refined Oils
= 17.9 % energy
Kurtz I et al. Effect of diet on plasma acid-base
composition in normal humans. Kidney Int 1983 24 670-80
Potential Renal Acid Load (PRAL) in Example Diet
(PRAL Food Data from Remer & Manz, 1995)
Alkaline Yielding Foods
Cantaloupe
Lettuce
Carrot
Cucumber
Tomatoes
Lemon juice
Salad greens
Avocado
Almonds
Onion
Broccoli
Strawberries
Orange
Celery
Total
Acid Yielding Foods
Salmon
Pork
Beef
Walnuts
Total
Weight (g)
276
68
142
78
331
62
112
85
45
29
468
130
66
90
PRAL/100 g
-3.5
-2.5
-4.9
-0.8
-3.1
-2.5
-2.5
-3.5
-2.8
-1.5
-1.2
-2.2
-2.7
-5.2
Net PRAL
-9.7
-1.7
-7.0
-0.6
-10.3
-1.6
-2.8
-3.0
-1.3
-0.4
-5.6
-2.9
-1.8
-4.7
-53.2
333
86
235
11
7.9
7.9
7.8
6.8
26.3
6.8
18.3
0.7
51.4
Relation Between the Absorption Fraction of
Calcium and Daily Dietary Calcium Intake
% Calcium Absorbed
0.8
0.7
At the mean Ca intake (700 mg for 25 yr
old female), ~25% of dietary calcium is absorbed
0.6
0.5
0.4
0.3
0.2
0.1
0
0
0.2
0.4
0.6
0.8
1
1.2
1.4
Calcium Intake (g/day)
O’Brien K et al. Am J Clin Nutr 1996 63 579-83
1.6
1.8
2
Calcium Homeostasis & Bone Mineral Status:
A Function of Calcium Balance
v Balance = (Ca+ In - Ca+ Out)
v Calcium in (absorption):
v Hunter Gatherers spent most of
the day outdoors
v Increased sunshine exposure
increased vitamin D synthesis in
skin, thereby increasing intestinal
calcium absorption, effectively
reducing the calcium RDA
Conclusions:
v It is possible to achieve the
RDA for calcium on non-dairy
foods
v Calcium balance is more
important that RDA intake in
determining calcium
homeostasis
v When ingestion of alkaline
foods > acid foods, calcium
homeostasis can likely be
achieved at < RDA
v To achieve a net dietary
alkalosis total fruits + veggies
= (~35-40% of energy)
Except for Fortified Foods,
There are No Natural Foods Containing
Substantial Concentrations of Vitamin D
v Cod liver oil is the
only natural food
containing high
concentrations of
Vitamin D
v Starting in the
1950’s- 60’s
v Milk and margarine
was fortified with
Vitamin D
Cod liver oil was routinely
Fed to children in the1940s1950s to prevent rickets
“Paleo Diet” Vs. Food Pyramid:
Cholesterol Intake:
25 yr. Female – 2,200 kcal
Cholesterol (mg)
ACTUAL
U.S. DIET
PALEO
DIET
FOOD
PYRAMID
RECOMMENDED
INTAKE
256
491
219
300
Conclusions:
Copper Eskimos:
Circa 1913
v Hunter gatherers
would have acquired
virtually all body
vitamin D stores via
sunlight exposure
v Exception: Hunter
gatherers living in
polar regions eating
marine mammal and
fish organs
v Modern Paleo Diets
require either sunlight
exposure or vitamin D
supplement
Influence of Dietary Cholesterol Upon
Serum Cholesterol
Howell Equation:
Allows the prediction of changes in serum cholesterol
from changes (Δ) in dietary Polyunsaturated fat (PUFA),
Saturated fat (SFA) & Cholesterol (CHOL)
Δ serum CHOL (mg/dL) =
1.918 x ΔSFA – 0.900 x ΔPUFA + 0.0222 x ΔCHOL
Where:
SFA = % saturated fat energy
PUFA = % polyunsaturated fat energy
CHOL = dietary cholesterol (mg)
Howell WH et al. Am J Clin Nutr 1997 65 1747-64
Interaction of Dietary
(Polyunsaturated/Saturated) Ratio &
Cholesterol Upon Serum Cholesterol
491
500
400
300
256
300
219
200
100
0
Actual U.S. Diet
Paleo Diet
Food Pyramid
Recommended
Conclusions:
1. Dietary cholesterol has a minimal effect upon serum
cholesterol levels
2. When the dietary P/S > 0.8, additional dietary
cholesterol has no effect upon serum cholesterol
v The dietary P/S influences the
effect of dietary cholesterol
upon serum cholesterol
v Lower P/S = Higher Serum
CHOL
v Higher the P/S = Lower Serum
CHOL
v At P/S of > 0.80, the addition of
750 mg of dietary cholesterol
did not elevate serum LDL
cholesterol
2
Dietary P/S
v Lowering Dietary Cholesterol
from 491 mg to 300 mg drops
serum cholesterol by 4.5 mg/dl
v Lowering Dietary Cholesterol
from 491 mg to 219 mg drops
serum cholesterol by 6.0 mg/dL
v HIGH CHOL > 240 mg/dL
v BORDERLINE CHOL = 200-239
mg/dL
v DESIRABLE CHOL = < 200
mg/dL
v Cutting dietary cholesterol
from 491 to 219 would reduce a
high cholesterol (240 mg/dL) to
234 or 2.5%
Serum cholesterol
(mg/dL)
Dietary Cholesterol Has a Minimal
Influence Upon Serum Cholesterol
1.48
1.5
1
0.9
0.56
0.7
0.5
0
Actual U.S. Diet
Paleo Diet
Food Pyramid
Recommended
Schonfeld G et al. J Clin Invest 1982 69 1072-80
Excess Dietary Protein:
Can it lead to Kidney Disease?
v Brenner Hypothesis: Increased
Glomerular Filtration Rates
(GFR) induce hyper-filtration
causing glomerulosclerosis
v Glomerulosclerosis causes
elevated levels of albumin
(plasma protein) in urine
because of altered glomerular
permeability
v Reduced protein diets improve
kidney function (reduce GFR &
urinary albumin) in some, but
not all patients with pre-existing
kidney disease
Brenner BM et al. N Engl J Med 1982
307 652-59
Excess Dietary Protein:
Can it lead to Kidney Disease?
Excess Dietary Protein:
Can it lead to Kidney Disease?
v Almost all studies of acute (1-4
wks) high protein diets show them
to elevate GFR
v Observational studies of
vegetarians show them to have
lower GFR than non-vegetarians
v Does this evidence indicate that
high protein diets promote kidney
disease?
v Not necessarily so
v Why?
Skov AR et al. Int J Obes Metab Disord
1999 23 1170-77.
Skov AR et al. Int J Obes Metab Disord
1999 23 1170-77.
High Animal Protein Improves
Blood Lipids
v Wolfe BM et al. Potential role of
raising dietary protein for
reducing risk of atherosclerosis.
Can J Cardiol 1995 11:127G-31G
v Exchange of low fat,
animal protein for
carbohydrate:
1. reduced LDL (9%),
2. reduced total
chol/HDL (15%)
3. reduced triglycerides
by 23%
4. increased HDL by
12%
v The only long term trial of high
protein diets (25 % energy) showed
no deleterious kidney changes after
6 months
v NO changes in urinary albumin
(pre/post diet)
v GFR increased, but so did kidney
volume (measured via MRI)
v GFR expressed per kidney volume
did not change
v Conclusion: kidney adapts to high
protein diets in HEALTHY NORMALS
Bison Steaks:
84% Protein,
16% fat
High Protein Reduces the Risk
of Heart Disease
v Hu FB et al. Dietary protein and
risk of ischemic heart disease in
women. Am J Clin Nutr
1999 70 221-7
1. Nurses Health
Study: 80,082 women
followed since 1976
2. High protein
intake (both animal &
vegetable) were
associated with low
risk of coronary heart
disease
Alaskan King Crab Legs:
85% protein, 15% fat
High Protein Increases Metabolism
and Promotes Weight Loss
PROTEIN has 2.5 - 3.5X the
thermic effect (ability to increase
metabolism) of either FAT or CHO
ƒ PROTEIN exerts a
higher effect upon
both:
1) meal satiation and
2) post meal satiation
than HIGH FAT or
HIGH CARB food
Thermic Effect
PROTEIN
= 261 kJ
CARBOHYDRATE = 97 kJ
FAT
= 71 kJ
Crovetti R et al. The influence of
thermic effect of food on satiety.
Eur J Clin Nutr 1998 52 482-88.
High Protein Increases Satiation
and Promotes Weight Loss
Skinless Chicken Breast:
63% protein, 37% fat
High Protein Diet is More Effective than High
Carbohydrate Diet in Causing Weight Loss
“Replacement of some dietary
Porrini M et al. Weight, protein, fat and
timing of preloads affect food intake.
Physiol Behav 1997 62 563-70
Steamed Shrimp:
90% protein, 10% fat
High Protein is Associated with Reduced the
Risk of Hypertension & Stroke
Hypertension
v Obarzanek E et al. Dietary
protein and blood
pressure. JAMA
1996;275:1598-1603
carbohydrate by protein in
and ad libitum fat-reduced
diet, improves weight loss and
increases the proportion of
subjects achieving a clinically
relevant weight loss.”
Stroke
v Klag MJ et al. The decline
in stroke mortality. An
epidemiologic perspective.
Ann Epidemiol 1993;3:57175
Skov AR et al. Randomized trial on
protein vs carbohydrate in ad libitum fat
reduced diet for the treatment of obesity.
Int J Obes Relat Metab Disord
1999 23 528-36
Lean flank steak trimmed of visible fat:
62% protein, 38% fat
Broiled Salmon Steaks:
62% protein, 38% fat
High Protein Increases Survival Time
for Patients with Breast Cancer
Holmes MD et al. Dietary
factors and the survival of
women with breast cancer.
Cancer 1999;86:826-35.
“No survival advantage
was found for a low fat
diet after a diagnosis
of breast carcinoma.
However, increased
survival was observed
among women eating
more protein, but not
red meat”
Steamed Lobster Tail:
89% protein, 5% fat
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