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PALEOLITHIC HEALTH
Randall F. Moore, M.D., J.D.
Department of Psychiatry
Scott and White
Texas A & M College of Medicine
OUTLINE
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Most important themes to remember
Definitions
Theory
Hunter-gatherer diets
Hunter-gatherer activities
Hunter-gatherer outcomes
Modern studies
Recommendations
Themes revisited
Comments and questions
MOST IMPORTANT THEMES
TO REMEMBER
• Organisms thrive best in the milieu and on the
diet to which they are evolutionarily adapted
• Various lines of evidence describe the way our
ancestors lived
• Paleolithic diet and exercise patterns improve
health
DEFINITIONS
• Discordance hypothesis
– The hypothesis that many of the diseases of
modern humans occur in significant part because
of discordance between our diet and lifestyle and
the diet and lifestyle of our ancestors
DEFINITIONS
• Hunter-gatherer
– A person who makes a living by hunting and gathering
and who not does not rely on agriculture
• Paleolithic period
– Human history from the invention of the first stone
tools 2.6 million years ago until the development of
agriculture 10,000 years ago
• 100,000 generations of human hunter-gatherers
• 500 generations of agriculturalists
• 10 generations in industrial age
THEORY
• Organisms thrive best in the milieu and on the
diet to which they are evolutionarily adapted
(genetically selected)
– Human lifestyles have changed rapidly in the last
10,000 years
– Human genome has changed 0.01% since advent
of agriculture
HOW WOULD A POLAR BEAR DO IN
THE JUNGLE?
HUNTER-GATHERER DIETS
WHAT OUR ANCESTORS DID NOT EAT:
GRAIN
• 24% of modern U.S. diet by Calories
• Humans cannot digest raw wheat, brown rice
or corn
• Cell walls must be mechanically disrupted by
milling
– First stone milling tools appear in the
archeological record 13,000 years ago
• Grain starches must be cooked to be made
digestible
MORE ON GRAIN
• Refining grain eliminates most vitamins and
minerals
– Refined grains are junk food
• Whole grains contain phytic acid
• Phytic acid binds calcium, iron, magnesium and zinc and
significantly limits their absorption from the gut
• Grains acidify the body
– The body releases calcium salts from bones and
nitrogen (in glutamine) from muscles to neutralize the
acidity
– Grains make your bones and muscles weaker
GRAIN AND BODY FAT
• Whole and refined grains have high glycemic
indices compared to fruits and vegetables
• Grains strongly raise serum glucose and thus
insulin levels
• Insulin causes fat storage
WHAT OUT ANCESTORS DID NOT EAT:
DAIRY
• 11% of modern U.S. diet
by Calories
• Hunter-gatherers did
not keep dairy animals
• Predecessors of modern
cattle (aurochs) not
domesticated until
7,000-10,000 years ago
• Cave painting: auroch
with horses
MORE ON DAIRY
• High insulin response
• Many dairy products have high levels of
saturated fats
• Cheeses are strongly acidifying
– Glutamine from muscles and calcium salts from
bone used to neutralize acids
– Dairy may cause net calcium loss from body
WHAT OUR ANCESTORS DID NOT EAT:
LEGUMES
• Beans
– Phytic acid
• Peanuts
– Peanuts very atherogenic in animals, maybe
because of peanut oil lectin
– Peanuts are fed to lab animals to produce
atherogenesis
WHAT OUR ANCESTORS DID NOT EAT:
HUGE AMOUNTS OF SUGAR
• Modern diet
– 18.6% of diet by Calories
– 152 pounds a year (including high fructose corn
syrup)
• Sugar strongly raises LDL
• Hunter-gatherers consumed honey only
seasonally
– 2% of diet by Calories
WHAT OUR ANCESTORS ATE:
PLANTS VERSUS ANIMALS
(LINES OF EVIDENCE)
• Pre-mammalian and early mammalian
ancestors
• Studies of modern non-human primates
• Archeology
• Ethnographic studies
• Biochemical analyses
Important Principle
• Evolution is conservative
• Many of our biochemical mechanisms are
hundreds of millions of years old
PRE-MAMMALIAN, EARLY
MAMMALIAN ANCESTORS
• Therapsids (mammallike reptiles)
– 200 million years ago
– Primarily insectivorous
• Early mammals
– Primarily insectivorous
• Insects nutritionally
very similar to wild
game
Therapsid
MODERN NON-HUMAN PRIMATES
• Chimps
– During dry season meat
may account for 25% of
energy consumed by
males
GUTS VERSUS BRAINS
• Overall chimps eat much more plant food than
meat
• Much of the plant food is quite fibrous and hard
to digest
• Therefore, chimp’s gut is much bigger than
human’s
• Human brain is 3X chimp’s size and needs a lot of
energy
• That amount of energy requires more animal
foods to ensure enough Calories and nutrients
GUTS, BRAINS AND TOOLS
• Archeological and fossil record
– 2.6 million years ago primates first used tools to
butcher animals
– Shortly thereafter brain size began to increase
• Meat, marrow and organs, especially brains,
allowed the hominid brain to grow
• A vegan expending 3,000 Calories per day would
have to eat enormous amounts of food to
consume enough energy
– 30 pounds of tomatoes or 18 pounds of cantaloupe or
6 pounds of potatoes
ARCHEOLOGY: FOSSILS
• Calcium verus strontium
ratios and nitrogen 15
isotope studies of early
hominid bones imply
consumption of
significant quantities of
meat
• Isotope studies of
Neanderthal bones imply
those people were “top
level carnivores”
• Neanderthal child
ANIMAL FOSSILS
• Some archeological
sites contain the bones
of literally thousands of
butchered animals
• Pre-agricultural human
encampments usually
near game migration
routes
• Mammoth bones in
modern Czech Republic
Prehistoric Art
• Prehistoric art often
glorified hunting
• Lascaux Cave, France:
Bison and hunter
HUNTING BIG, FAT ANIMALS
• Hunters preferred big
animals
– Much more fat than
small animals
• Protein must be mixed
with fat or carbohydrate
• Diet with >40% Calories
• San (Bushman) art from
from protein leads to
southern Africa
sickness
– “Rabbit starvation”
RABBIT STARVATION
• Diet with > 40% Calories
from protein leads to
sickness
• Liver cannot metabolize
protein fast enough and
kidneys cannot excrete urea
fast enough
• Ammonia and urea become
toxic
• Symptoms: diarrhea,
headache, fatigue,
hypotension, bradycardia,
hunger relieved only by fat
or carbohydrate
ETHONOGRAPHIC STUDIES
• Ethnographic Atlas
– Statistics on world’s cultures
• 229 Hunter gatherer societies surveyed
– 65% Calories from animals, 35% from plants
• Only studies with explicit quantification of
food
– 11 excluding Innuit (no plant food available)
– 2/3 of Calories from animal foods
BIOCHEMICAL ANALYSES
• Taurine
– Essential amino acid
– Not found in any plant food
– Cows can synthesize, cats can’t
– Humans have limited capacity to synthesize
– Vegans have low serum levels
BIOCHEMICAL ANALYSES
• 2O carbon fatty acids
– Required to synthesize eicosanoids, which include
prostaglandins and leukotrienes
• Involved in inflammatory control and central nervous system
signaling
– Herbivores can synthesize from 18 carbon fatty acids
– Carnivores have very limited capacity to synthesize
– Humans convert 18 carbon to 20 carbon fatty acids
inefficiently
WHAT OUR ANCESTORS DRANK
• Water
• Soda is second most
consumed beverage in U.S.
• Americans average
consuming 44 gallons of
soft drinks per year
– Lots of sugar, lots of diabetes!
– Lots of phosphorous, lots of
bone loss!
• All the sugar, twice the
caffeine and no biologically
redeeming value!
WHAT OUR ANCESTORS ATE
• Wild animals
– Meat
– Marrow and organs, including brains
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Fish
Shellfish
Fruits
Vegetables
Nuts
Seeds
Eggs
MACRONUTRIENT PROPORTIONS
Hunter-gatherer
Modern
Carbs 35%
Carbs 48%
Fat 35%
Fat 34%
Prot 30%
Prot 15%
ETOH 3%
CARBOHYDRATES
• Hunter-gatherer
– Low glycemic index fruits
and vegetables
– Honey: 2% of Calories
• Modern
– High glycemic index
grains
• 85% refined
– Sugar: 19%
FAT
• Hunter-gatherer
– Poly/Mono/Saturated
ratio = 7/8/5
– 25% of fat is saturated
– Omega 6/Omega 3 = 2/1
• Modern
– Poly/Mono/Saturated
ratio = 7/9/16
– 50% of fat is saturated
– Omega 6/Omega 3 =
10/1
– 18% of total Calories
from refined vegetable
oils
OMEGAS
• Omega 6 fatty acids
pro-inflammatory
– Common in processed
vegetable oils
• Omega 3 fatty acids
anti-inflammatory
– = aspirin
• Docosahexaenoic acid
(Omega 3)
JUNK IN YOUR TRUNK
• 71% of modern diet
consists of grains,
refined sugars, refined
vegetable oils and dairy
• 0% of hunter-gatherer
diet
CHOLESTEROL
• Modern average intake
= 266 mg/day
• Hunter-gatherer = 500
mg/day
• Serum cholesterol
driven more by
saturated fat and
refined sugars and less
by dietary cholesterol
intake
• Cholesterol
PROTEIN
• Excluding water, protein
comprises 50% of body
weight
DRIVE IT HOME…
…YOU NEED PROTEIN TO BE HEALTHY
• Excluding water, protein
comprises 50% of of body
mass
• 86 year-old bodybuilder
• Woman with anorexia
nervosa
PROTEIN
• Modern
– Ground beef
– 15% fat by weight
– 63% fat by Calories
• High saturated fat
• Omega 6/Omega 3 = 25/1
– 35% protein by Calories
• Hunter-gatherer
– Bison roast
– 2.4% fat by weight
– 16% fat by Calories
• Low saturated fat
• Omega 6/Omega 3 = 6/1
– 84% protein by Calories
• Red on yellow kills a fellow
MICRONUTRIENTS
• Hunter-gatherer
– Sodium < 1 gram
• Yanomamö: 250 mg/day
– Potassium 7 grams
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Yanomamö men hunting
• Modern
– Sodium 3.5 grams
• 10 grams NaCl
– Potassium 2.6 grams
FIBER
• Hunter-gatherer
– 70 grams/day
• Modern
– 15 grams/day
HUNTER-GATHERER
ACTIVITIES
ARCHEOLOGICAL EVIDENCE
• Early human bones similar to those of modern athletes
who perform exercises requiring high peak efforts
• Tendon insertion sites suggest great strength
• Torsional strength of human femur
– 25% higher in early Homo species compared to modern
humans
– Suggests greater repetitive use
• Cross sections of tibia near knee
– Anterior-posterior diameter greater than lateral diameter
in early human males
– Consistent with much long-distance running
PHYSIOLOGY
• Humans sweat (few
animals do)
• Humans have little body
hair
• These features suggest
adaptation to prolonged
activities generating a
lot of heat
HISTORICAL DESCRIPTIONS
• Lewis and Clark
– Native -Americans stampeded bison into ravine 8
feet deep
– Bull bison > 1 ton each
– 5 hunters pulled bison out of ravine and
butchered them in one day
HISTORICAL DESCRIPTIONS
• Nootka natives of Vancouver Island
– 16 men in 2 small boats rowed harpooned whales
to shore
• British colonialists in Tasmania
– Recorded Tasmania Aboriginals throwing 15 foot
spears 250 feet
PLANES, TRAINS, AUTOMOBILES …
… POWER TOOLS, TV AND VIDEO GAMES
• Modern Americans are
the weakest people to
have ever walked the
earth
ETHNOGRAPHIC DATA:
MODERN HUNTER-GATHERERS
• Cross train to hunt and gather
– Light, medium, hard cardio
– Sprinting and jumping
– Throwing and lifting
• Alternate hard and easy days
• Exercise is outdoors, in nature
– Sunlight => Vitamin D
– Nature => Lower stress
• Dancing at night for hours is common
ETHNOGRAPHIC DATA:
BELIEVE IT OR NOT
• In addition to the energy expended by a
modern office worker, the modern huntergatherer expends enough energy to walk 12
miles a day (≈ 1,000 Calories/day)
– Modern hunter-gatherers do live on more
marginal lands than most of our ancestors did
• More foot travel required to hunt and gather
HUNTER GATHERER
OUTCOMES
ARCHEOLOGY
• Our ancestors
– Strong bones
• Osteoporosis: very rare
– Height
• 1.6 million years ago:
Homo erectus as tall as
modern people; built like
middle distance runner
• Early agriculturalists 4
inches shorter than first
Homo sapiens sapiens of
30,000 years ago
• Cro-Magnon 25,000 years
ago: men = 70 inches,
women = 66 inches
• Modern U.S.
– Osteoporosis: 26% of
women
Caries
• Late Paleolithic
– 2% of tooth fossils show
caries (usually small)
• Modern U.S.
– 92% of U.S. adults have
had caries in permanent
teeth
DIVERTICULOSIS
• Traditional Africans
– Minimal incidence
– Probably secondary to
high fiber diet
• Modern U.S.
– 50% of those over 50
CAVE PAINTINGS
DEPICTED LEAN PEOPLE
Lascaux Cave, France
RECENT HISTORICAL DESCRIPTIONS OF
HUNTER-GATHERERS
• Cabeza de Vaca: Native Americans in Florida in
1527
– “Wonderfully built, spare, very strong and very
swift”
• Rene de Laudonniere: Native Americans in
1564
– “Women … can swim over great rivers, bearing
their children upon one of their arms”
RECENT HISTORICAL DESCRIPTIONS
• Captain Cook: the Maori in 1772
– “ … nor among the numbers that we have seen naked
did we perceive the slightest eruption upon the skin”
– “ … great number of old men … none of them were
decrepit”
• Henry Savage Landor: Borono Amazonians 1913
– “ … powerful chests … beautiful bronze torsi … arms
were powerful, exquisitely chiseled … legs
marvelously modeled, without an ounce of extra
flesh”
Body Composition
• Hunter-gatherers
– Minimal lean body tissue
loss into old age,
essentially no fat gain
• Modern U.S.
– Adults: 36% obese, 33%
overweight
– Children: 17% obese,
15% overweight
• 60 year-old Waorani
DIABETES AND CHOLESTEROL
• Hunter-gatherers
– Diabetes 1.1%
– Cholesterol
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Aborigines: 139
Hadza: 110
Innuit: 141
San: 120
Mbuti: 106
Yanomamö: 133
• Modern U.S.
– Diabetes 8.3%
– Cholesterol: 210
BLOOD PRESSURE
• Yanomamö aged 50+
– Women: 106/64
– Men 100/64
• Modern U.S.
– Age 55-64: 54% have
blood pressure >140/90
ATHEROSCLEROSIS
• Kikuyu
– Early 1900s
– > 1,000 autopsies
– No significant
atherosclerosis
• Modern U.S.
– Healthy Korean War KIA
– Average age 22
– Coronary atherosclerosis
in 75%
• Atherosclerotic
coronary
VO2 MAX
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Innuit: 56
Lapps: 53
Lufas: 67
Masai: 59
San: 47
Tarahumara: 63
Warao: 51
Western men: 41
Tarahumara
ACNE
• Common in western
world
– High glycemic load
carbohydrates and
insulinotropic dairy drive
IGF-1
– IGF-1 stimulates
sebaceous lipogenesis
• Very uncommon in
hunter-gatherers
MODERN STUDIES
7 WEEK ABORIGINAL TRIAL
• Urban-dwelling
Australian Aborigines
with DM2
• Return to bush in
phases
• Inland phase: 64% of
Calories from animals
• Weight lost: 17.6
pounds
• Fasting glucose down
43%
• Fasting insulin down
48%
• VLDL down 90%
2007 DIET TRIAL
• 12 weeks Paleolithic
versus Mediterranean
(self-policed after
education)
• Men with ischemic heart
disease and DM2 or
glucose intolerance
• Same weight of food
consumed—25% less
Calories in Paleolithic
group
• Glycemic load 47% lower
in Paleolithic group
• Fasting plasma glucose
– Paleo down 25%
– Med down 13%
• Fasting plasma insulin
– Paleo down 16%
– Med down 18%
• OGTT AUC insulin
– Paleo down 30%
– Med down 13%
• Waist circumference
– Paleo down 5.3%
– Med down 2.7%
2009 DIET TRIAL
• 7 days ramp up, then 10
days controlled Paleolithic
diet
• Healthy, obese adults
• Designed to not cause
weight loss
Fasting glucose down 5%
Fasting insulin down 68%
TG down 35%
Total cholesterol down
16%
• LDL down 22%
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– Compare: statins lower LDL
25-50% over 3 months
EXERCISE AND THE BRAIN
• ↑ dopamine,
norepinephrine,
serotonin
• ↑ BDNF → neurogenesis,
synaptogenesis
• ↑ Fibroblast GF → longterm potentiation,
neurogenesis, vascular
genesis
• ↑IGF1 → ↑ serotonin,
BDNF receptors
• ↑ Vascular endothelial
GF → vascular genesis
• Target HR → atrial
natriuretic peptide →
dampens NE (↓ anxiety)
and ↓ CRH → ↓ cortisol
→ ↓ hippocampal
damage
• Anaerobic → ↑ ↑ BDNF
and GH → neurogenesis
and ↑ IGF1
HUNTER-GATHERER SOCIAL LIFE
• Prolonged breast feeding (IgA and macrophages
enhance immunity)
• Respond to infant cries quickly
• Patient indulgence of young children
• Self-reliance and flexibility encouraged in children
more than obedience
• Multi-age play groups
• Gender egalitarianism
• Leaders build consensus more than they impose
answers
RECOMMENDATIONS
DIET
• Whole, natural, unprocessed foods as much as possible
• Fruits, vegetables, berries, nuts, seeds
– Walnuts, macadamia nuts, ground flax seeds for omega 3s
• Lean meat
– Bison, turkey, elk, deer, fish, shellfish
• Northern white fish for omega 3s
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Eggs
Cook with olive oil
Drink water
Don’t add salt
EXERCISE
• Cross train
• Do light, moderate and hard cardio
– Peak effort once or twice a week
– Maximum brain benefit: hard cardio requiring mental and motor
coordination
• Vigorous strength training
• Alternate hard and easy days
• For sustained body fat loss expend:
– 3,000 Calories per week for men
– 2,600 Calories per week for women
• Source: National Weight Control Registry
• Exercise outside as much as possible
– More reinforcing
– Better lowers stress
READING
• The Paleolithic Prescription
– S. Boyd Eaton M.D.
– Marjorie Shostak
– Melvin Konner, M.D., Ph.D.
• The Paleo Diet
– Loren Cordain, Ph.D.
THEMES REVISITED
• Organisms thrive best in the milieu and on the
diet to which they are evolutionarily adapted
• Various lines of evidence describe the way our
ancestors lived
• Paleolithic diet and exercise patterns improve
health
COMMENTS AND QUESTIONS
and
THANK YOU!