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THE PALEO DIET
THE
INSIDER
Vol. 3, Issue 5
THE DIETARY CURE
FOR ACNE
JOHN WILEY & SONS
INTERVIEW WITH
DR. CORDAIN
LECTIN BASED
FOOD
POISONING
CRITICISM
OF THE PALEO
DIET
LOREN CORDAIN,
PH.D.
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Vol. 3 ◆ Issue 5
Acne that first got you interested in this idea. Can you
describe that?
While our readers have known about the relationship
between diet and acne for quite some time, this
topic has gained more attention recently with the
publication of a clinical trial which showed significant
results in a group of teenagers following a diet similar
to that which we recommend. Though acne affects
mainly teenagers, millions of adults worldwide also
suffer from this condition. Understanding the impact
that diet has on this very visible disease can help us
better understand the effect of diet on a wide variety of
health conditions.
Dr. Cordain: Sure. Schaefer was a frontier physician
THE DIETARY CURE FOR ACNE
Editors note: John Wiley & Sons interview the New
York Times Bestselling author of The Paleo Diet;
Dr. Loren Cordain, Ph.D.
Wiley: Dr. Cordain, for years doctors have told the
patients that diet has nothing to do with acne and it
appears that some of the science may be proving them
wrong. What took so long?
Dr. Cordain: Boy, that’s a good question. You never
know what’s responsible for this but what I do know
is that the information that the notion that diet
didn’t cause acne was based on two flawed studies
that were published over 30 years ago. The problems
with those studies have been pointed out in the
scientific literature, but unfortunately, the dermatology
community hasn’t yet taken it to heart. They haven’t
changed the dogma in their textbooks. We now
have three good epidemiologic studies as well as one
dietary intervention that say otherwise, so there is
good credible evidence to suggest that diet indeed does
underlie acne.
who worked with the Inuit or Eskimo people as they
made the transition from essentially the Stone Age
to the space age. They were living in the far north
above the DEW line, or distant early warning line,
which was a line of radio stations that was built across
Canada in the 1950’s. Schaefer flew in on float planes to
Wiley: You described some anecdotal evidence
presented by Dr. Otto Schaefer in the Dietary Cure for
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these people and he wrote extensively in the scientific
literature in the 60’s, 70’s, and early 80’s about what he
had witnessed as these people made that transition. He
documented that in some of the best journals at the
time, and in one of the journals he suggested that acne
was absent in these people until they were exposed to
the Western diet and the Western way of living. And
that actually was the paper I read. It was in a journal
called “Nutrition Today”, published I believe in 1971
and that really kind of piqued my interest and we
pursued it.
known for a while. There are a couple of things that
happen and I think the first thing that one needs to
do is be familiar with the skin pore, also called the
pilosebaceous unit. The pilosebaceous unit consists
of a canal called the follicle, a hair, and a sebum
gland which produces oil. The follicle is lined with
skin cells called keratinocytes. The first step in the
blockage of the pore is that these keratinocytes become
overly adherent to one another and they don’t slough
off in the normal way. When this process, called
desquamation, is impaired, the keratinocytes, or the
skin cells lining the pore stay connected and they end
up blocking the pore.
Wiley: You just mentioned some of these
epidemiological studies that have recently been
published, and you actually published one of the first to
show a link between diet and acne back in 2002. Can
you describe that study and what you guys found?
The second factor that occurs is that the sebum glands
produce too much oil within the pore. They produce
too much oil because they are stimulated by circulating
male hormones, testosterone in the bloodstream;
both males and females produce testosterone, and that
excessive testosterone then causes too much sebum to
be produced.
Dr. Cordain: Sure. I would say that ours were the
first modern studies that pointed out that there might
be a link between diet and acne, but essentially what
we did is we studied two groups of people that were
living in non-Westernized ways. We looked at the
Kitavan islanders. This is a group of people that are
horticulturalists and fishermen and their island is
off the coast of Papua New Guinea. At the time we
studied them in the early to mid 1990s there were
about 3,000 of them living on the main island. They
didn’t have electricity and they had no Western goods.
Stefan Lindeberg from the University of Lund in
Sweden had studied these people for the last couple
of decades. They went in, looked at them on a crosssectional basis, and examined them for acne and found
that there wasn’t a single case of acne in the entire
population including a group of 300 adolescents. Then
we followed that study up with a longitudinal study
in which we went down to Paraguay and we studied
the Ache hunter-gatherers. My colleague Kim Hill
and his wife Magdalena Hurtado have been studying
this group of non-Westernized people for the last 30
years. We followed around a group of around 50 or 60
Ache over about a two-year period, including a fairly
substantial number of adolescents, and we didn’t find
a single acne lesion in the entire group. If we were to
look at a group of comparable Western adolescents, we
would find that acne has about a 90% incident rate.
This produces a climate that is ripe for infection of
the pore by bacteria that normally live on the outside
of the skin, and that are typically harmless. These are
anaerobic bacteria, meaning that they can function
without oxygen. So the oil-filled clogged pore is a
nice oxygen-free environment with a lot of food for
the bacteria. They get in there and multiply, causing
the painful red, swollen comedone, what the average
person calls a zit.
The final factor is an inflammatory process that causes
this whole thing to take off and get worse.
Wiley: The book is called the Dietary Cure for Acne,
which implies that diet may actually be causing acne.
Is there a scientific evidence to show a connection
between diet and these four mechanisms?
Dr. Cordain: I think we are just at the beginning
stages of understanding how diet causes acne and
our research group has proposed that high glycemic
foods are one of the major factors underlying the acne.
We’ve also proposed that dairy products underlie
acne because even though paradoxically they have
a low glycemic index, they spike the insulin levels
in a manner similar to high-glycemic foods. So we
believe that dairy products and high-glycemic load
carbohydrates like refined sugars, refined flours,
and processed foods are some of the primary factors
involved. Mechanistically, we’ve speculated on how
Wiley: In the book you talk about the four proximate
or immediate causes of acne. Can you go through
those?
Dr. Cordain: Sure. I think that this has been
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Vol. 3 ◆ Issue 5
these may or may not work, but to date there’s only
been one clinical trial which is Dr. Newman’s study
from the Royal Melbourne Institute of Technology
that was just recently published in two major
nutrition journals. And they were able to show that
reducing high-glycemic load foods and the glycemic
load will actually ameliorate acne symptoms.
beforehand cannot be cured with diet, but those who
don’t have permanent scarring can see significant
improvements in their skin within that window.
We believe that that window occurs because of the
turnover of keratinocytes. Keratinocytes are the cells
that ultimately plug the pores and they turnover in
about a 30-day period. However, there are comedones
that are closed and it takes longer for those to heal up,
so that’s why we take it out to a few more months, like
a three-month period.
Mechanistically, we’re not able to point out exactly
why it is, but we believe that it’s because when
insulin levels are elevated, the result is a hormonal
cascade that causes this improper desquamation
process. Elevated insulin also promotes elevated male
testosterone levels which in turn increase the sebum
production. Furthermore, in the typical Western
diet, we tend to have way too much omega-6 fats and
reduced levels of omega-3 which tends to promote the
inflammation process.
Wiley: Are there other health benefits that people
might see as a result of eating of this way?
Dr. Cordain: Yes, definitely. Even though it’s a diet
that can benefit and be therapeutic for acne patients,
this is not a diet per se. This is a lifetime way of eating.
This is a diet that will give most people more energy.
They won’t have that midmorning letdown. If they
have other health complaints, such as long-term,
chronic health problems, high blood pressure, elevated
blood cholesterol levels… it will benefit most of these
folks. People that are obese or overweight, they will
tend to normalize their weight. If they have type 2
diabetes, this can improve the insulin metabolism
and may get them completely free and clear of any
medication that they may be taking for type 2 diabetes.
It also can be beneficial for gout patients, for people
with auto-immune disease, and people with chronic
inflammatory disease can benefit from this type of a
diet.
Wiley: So who will this program work for?
Dr. Cordain: Well, I think that this will work for
most people. We clearly believe that it is genetic
susceptibility which predisposes some people to acne.
Some people can get by with eating these foods but
most can’t, given the notion that 90% of all teenagers
have acne. So, we believe that the vast majority of
people will improve significantly by adopting the diet
that we advocate. It is essentially a low-glycemic load
diet, high in protein, high in omega-3 fatty acids, and
low in lectincontaining foods like wheat. It is also
high in animal products which contain zinc, and we
know that zinc is a key element in helping to prevent
acne.
Wiley: And how quickly might somebody begin to
see results?
Wiley: We’ve been offering this book as an ebook for
about a while now, but even before the “Dietary Cure
for Acne” was written people were sending you some
feedback on their results. What have you been hearing
from your readers?
Dr. Cordain: Well, typically in the inflammatory
part of the disease we will actually see results within
days to a week and notice that they’re not getting
new zits or comedones. To completely clear their
skin, I think it can take anywhere from a month to
three months depending upon how bad they are.
Obviously, permanent scarring that has occurred
Dr. Cordain: We regularly hear from people who
have had acne for years and tried numerous remedies,
who have completely eliminated their acne following
this program. You know, this is what we refer to in
scientific literature as anecdotal evidence and these
are people that adopt this way of eating and they
experience improvement and for many people these
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case histories of individuals that have improvements
are very encouraging.
article Dr. Cordain suggested that specific substances
known as dietary lectins may be involved in both
the inflammation of the gut and in facilitating the
movement of bacteria from the gut into the blood
stream.
For scientists, we need randomized, controlled trials
like what we found with the Newman study to make
a strong case for the notion that diet is responsible for
acne, and that diet can ameliorate acne symptoms. We
now have three epidemiologic studies and one clinical
trial already supporting the role of diet in acne. We
still need to work out all the mechanism, but I think
that people don’t necessarily have to wait for all the
science to come in. They can go out there right now,
make some changes in their diet and monitor their
own symptoms, and hopefully see improvements
immediately. The cost-to-benefit ratio is very minimal.
Specific dietary lectins, found in wheat, grains, and
legumes, have been shown in animal models to
damage intestinal cell walls, leading to an inflamed
state. This inflammatory state allows passage of
bacteria and other foreign proteins into the blood
stream that simply should not be allowed there.
Additionally, dietary lectins have been shown to
facilitate the preferential growth of specific gut
bacteria often associated with RA symptoms. These
bacteria share a sequence of proteins very similar to
many of our own body’s protein sequences. Immune
cells ‘read’ the protein sequences on the bacteria and
may begin to associate similar self-proteins with these
foreign substances, thus attacking both the bacteria
and our own tissues.
Wiley: Thank you. Is there else that you would like to
add?
Dr. Cordain: You know, I just think that this is a
disease that many people in the world needlessly
suffer from, and it’s a disease that through behavioral
modification, i.e., changing parts of their diet, they
can experience significant improvements in their
symptoms. Many people have reported that they have
complete remission of their symptoms when they
follow this type of a diet, so they really have nothing to
lose but their poor complexions
Lectins themselves have been shown to be capable
of crossing a damaged gut membrane and entering
into the bloodstream in tact. It is not known whether
dietary lectins bind to synovial tissues in joints.
However, in animal models when lectins were injected
directly into joints the result was a massive immune
response followed by the destruction of joint tissue.
If lectins are indeed binding to synovial tissues, this
coupled movement of gut bacteria into the blood and
lectins’ own ability to cause an immune response may
be large factors influencing RA symptoms.
LECTINS AND AUTOIMMUNE
DISEASE
Rheumatoid Arthritis (RA) is a disease in which the
body’s own immune system begins to recognize bone,
cartilage, and tissues which serve as a cushion between
bones in joints as foreign bodies and will begin to
systematically destroy or degrade these tissues. This
leads to extreme pain, inflammation, stiffness, and
eventual immobility of certain joints. Though the
cause of RA is still largely unknown, it has long been
known that RA symptoms are highly correlated with
inflammation of gut. In this review of RA published in
2000, Dr. Cordain offered some interesting theories of
how specific dietary elements may be contributing to
both an inflamed gut and RA symptoms.
Knowing as we do that inflammatory guts and RA
are strongly correlated and that dietary lectins are
potential causers of inflamed guts it is to our benefit
to examine further the connection between the two
events and the dietary mechanisms through which
these events may be triggered.
Cordain L, Toohey L, Smith MJ, Hickey MS.
Modulation of immune function by dietary
lectins in rheumatoid arthritis. Brit J Nutr 2000,
83:207-217. http://www.thepaleodiet.com/
articles/Arthritis% 20PDF.pdf
Gut inflammation is known to increase intestinal
permeability, so that the gut becomes less capable of
limiting the substances that cross the gut barrier and
into the blood stream. Interestingly, 67% of all RA
sufferers also suffer from gut inflammation. In this
LECTIN-BASED FOOD POISONING
In The Dietary Cure for Acne Dr. Cordain discusses
how lectins can inhibit the activity of certain
zinc dependent enzymes necessary for the proper
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Vol. 3 ◆ Issue 5
breakdown and ‘sloughing off’ of skin cells; a process
known as exocytosis. Now research done by the
Medical College of Georgia has shown that specific
lectins are toxic to certain intestinal cells and can even
cause cell death. Similar to the acne story, the lectins
present on damaged intestinal cells were shown to
prevent the normal process of exocytosis of certain
mucus cells needed to keep intestinal cells healthy.
GI tract and colon cells were bathed in Wheat Germ
Agglutinin and then damaged. Dramatic decreases
in mucus secretion (mucus necessary for healing)
were observed in concurrence with abnormally large
amounts of cellular death in the area surrounding the
damage site. The scientists then concluded that lectins
are potent inhibitors of mucus secretion in GI epithelial
cells and are toxic and even deadly to damaged GI
epithelial cells with the likely mechanism being an
interruption in exocytosis of mucus from mucus
secreting GI and colon cells.
Gastro-intestinal (GI) epithelial cells are constantly
exposed to mechanical damage within our stomach
and intestines. Fortunately, they have a rapid repair
mechanism which typically seals the damaged cell
with mucus within seconds to prevent any unwanted
food-stuffs from entering our blood stream. However,
lectins may be delaying or completely inhibiting this
repair process. This is theorized to be the cause some
of the GI discomfort experienced with ingestion of
beans, or wheat germ agglutinin in those with celiac
disease.
Miyake K, Tanaka T, McNeil PL. Lectin-based
food poisoning: a new mechanism of protein
toxicity. PLoS ONE. 2007 Aug 1;2(1):e687.
http://www.ncbi.nlm.nih.gov/sites/entrez?
Db=pubmed&Cmd=ShowDetailView&TermToSea
rch=17668065&ordinalpos=1&itool=EntrezSyste
m2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pub
med_RVDocSum
Scientists at the Medical College of Georgia
introduced a variety of lectins to cultured rat’s
gastrointestinal (GI) epithelial cells to examine
lectins’ potential for binding these cells. Wheat Germ
Agglutinin was found to bind most readily. Next
scientists created ruptures in the GI epithelial cells
using both a laser and a syringe needle to mimic the
natural process of cell damage seen during digestion
of solid foods. Once damaged, scientists determined
the ability of the cells to repair themselves by
observing the influx of a dye present in the solution
that will not pass through an intact epithelial cell. The
GI epithelial cells coated with Wheat Germ Agglutin
were incapable of healing and dye leaked through the
damage site without restraint.
DIET AND ACNE
A recently performed dietary intervention published
in the Journal of American Academy of Dermatology
has examined whether one of two particular diets
prescribed to participants was to be more effective than
another at decreasing the severity of acne symptoms in
the participants.
The intervention recruited 43 male subjects between
the ages 15 and 25, all with mild to moderate acne
symptoms. Subjects were assigned randomly to either
a high Glycemic-load (HGL) diet or a low Glycemicload (LGL) diet. Details of subjects’ height, weight,
body fat percentage, body mass index, and, most
importantly, their visible acne lesion count, were
collected at 0, 4, 8, and 12-weeks on their prescribed
diet. Also investigated were the accompanying changes,
if any, observed in subjects’ fasting levels of insulin,
blood glucose, and other markers correlated with acne
severity.
You can imagine if this were an actual stomach cell
within the body being incapable of repairing itself
and the subsequent ‘leaking’ of stomach and intestinal
contents directly into the bloodstream.
Scientists went on to investigate lectins’ potential for
inhibiting the secretion of mucus necessary for GI
epithelial cell repair. A culture of mucus secreting
Subjects within the LGL experimental group were
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FEEDBACK FROM THE READERS
educated about the Glycemic index and on how
to replace high Glycemic-index foods with foods
containing higher protein content and with lower
Glycemic-indices (meats, whole grains, and fruits).
The control HGL group was not educated about
the Glycemic index and was instructed to include
carbohydrates regularly as a part of their diet.
Compliance was strictly monitored using several
control mechanisms.
Dear Dr. Cordain,
In Wikipedia (http://en.wikipedia.org/wiki/
Paleolithic_diet), there is an article on the
Paleo diet. In the “criticism section” for the diet
is the following:
“Ignorance of real Paleolithic diets: Archeological evidence and the study of modern-day
huntergather societies has shown that many
preagricultural peoples exploited wild grains,
legumes, and tubers. Often, they undergo
complex processing to make them edible (i.e.
bush bread). These are the same foods which
are vilified in the “Paleolithic” diet.
After twelve weeks the results of the intervention were
apparent to investigators. The LGL dieters experienced
a significantly greater reduction in acne lesion count
than did the HGL diet counterparts. In addition, LGL
dieters improved their weight, body fat percentages,
and waist circumferences significantly. Also of
interest were the changes observed in the LGL dieters’
insulin sensitivity levels and how it directly correlated
with their decreased acne lesion counts, indicating
a relationship between insulin sensitivity and acne
severity.
Ray Mears, Gordon C. Hillman (20 Sep 2007).
Wild Food. Hodder & Stoughton, 320. ISBN
0340827904.”
Are you aware of any peer-reviewed evidence
at all that may support this claim (even if you
believe it does not prove what is claimed)?
Smith, R.N., Mann, N.J., Braue, A., Makelainen, H.,
Varigos, G.A., The effect of a high-protein, low Glycemicload diet versus a conventional, high Glycemic-load diet
on biochemical parameters associated with acne vulgaris:
A randomized, investigator-masked, controlled trial.
Journal of American Academy of Dermatology 2007;
57:247256. http:// www.ncbi.nlm.nih.gov/sites/entrez?
Db=pubmed&Cmd=ShowDetailView&TermToSea
rch=17448569&ordinalpos=3&itool=EntrezSyste
m2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pub
med_RVDocSum
Thanks,
David
Hi David,
In 2000 we published a paper in the American Journal
of Clinical Nutrition (Plant to animal subsistence
ratios and macronutrient energy estimations in world
wide hunter-gatherer diets) in which we showed
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Vol. 3 ◆ Issue 5
that wild tubers would indeed have been a common
component in historically studied hunter-gatherer
diets, comprising 23.6% of all the plant food consumed
by the average hunter-gatherer. Our point was that
high glycemic load tubers (such as potatoes, which
were developed from intensive agricultural inbreeding
of wild types) would not have been part of preagricultural diets.
More importantly, for most of humanity’s existence
on the planet, up until the very end of the Paleolithic
period grains were never consumed. Grains are
virtually indigestible unless the cell walls are broken
via (grinding or milling) and the starch is gelatinized
by cooking. Hence the appearance of stone grinding
tools (mortar and pestle, saddle stones etc) heralds the
widespread use of grains in hunter-gatherer societies.
Most tubers and many underground plant structures
(corms, roots, etc) are inedible unless cooked. Cooking
serves to breakdown the cell walls and make the
starch available for absorption and it also inactivates
potentially toxic compounds. Hence, until hominins
could regularly control fire (~300,000 years ago), most
roots were inedible.
The first documented record of stone grinding
tools appearing in the fossil record occurs 22,500–
23,500 years ago in the near East (Piperno DR et
al. Processing of wild cereal grains in the Upper
Paleolithic revealed by starch grain analysis. Nature
2004;430:670-73), and the first hunter gatherer society
known to have made wide scale use of grains were
the Natufians who lived in the Levant ~13,000 years
ago. Hence, cereal grains have little or no evolutionary
precedent in hominin diet.
Historical and ethnographic studies of hunter
gatherers indicate that cereal grains were rarely
consumed. However, there are some notable
exceptions: Holocene hunter gatherers living in
marginal areas such as desert ate grains seasonally
such as the Great Basin Indians in the U.S. and
Australian Aborigines.
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PRIMAL IN THE KITCHEN
SHIITAKE MEAT LOAF
1 Tb. extra virgin olive oil
1/4 cup sliced shiitake
mushrooms
2 plum tomatoes, chopped
1 1/2 lbs ground grass-fed
beef or bison
1 omega 3 egg
1 Tb. freshly ground flaxseed
1/2 t. onion powder
1/2 t. garlic powder
1/4 cup red wine
Preheat oven to 350 degrees.
Heat oil in a cast iron skillet over medium
flame. Add mushrooms and cook for five
minutes. Toss in tomatoes and cook for an
additional five minutes. Remove from heat
and cool for five minutes. Puree in food
processor.
Combine meat, egg, flaxseed, onion powder,
garlic powder, and tomato mixture in a
medium bowl and mix thoroughly. Place
mixture in loaf pan. Drizzle with wine.
Bake meat loaf for one hour and fifteen
minutes. Remove from oven and cool for
five minutes.
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