Does the Paleo diet cure X?

http://www.examiner.com/article/jack-osbourne-high-fat-low-carb-ketogenic-paleo-diet-helps-multiple-sclerosis

The link above is one of many anecdotal pieces of evidence that has shown significant health improvements from a Paleo diet.  The health conditions that are purportedly improved by a Paleo diet range from inflammatory conditions such as Rheumatoid Arthritis, digestive problems such as Irritable Bowel Syndrome, neurological problems such as Multiple Sclerosis, and the number one killer in the United States: heart disease.  Are these pieces of evidence enough to state that the Paleo diet cures any of these conditions?  Absolutely not, we are eons away from a scientific consensus on what causes these problems, let alone what we can do to fix them.  Does this mean that the Paleo diet isn't the answer?  Nope.

Science is a wonderful thing, but not a necessity for something to be true.  Science is the process we use to come to a consensus on a topic such as this because it eliminates all alternative explanations.  Truths aren't made by science, they are identified with it.  It very well could be the case that many of our modern ills are directly attributable to the lifestyle we live.  Many of the problems that have plagued human civilization throughout history can be directly attributed to things we have determined to be "progress".  The formation of cities and towns is certainly progress, but that doesn't mean that communicable disease and the rapid spread of infection isn't a product of that progress.  As Lord Helmet told us many years ago, there is an up side and a down side to every Schwartz.

This is where the evolutionary approach to health enters the picture.  You've got X, will the Paleo diet help?  help maybe, but cure?  No.  Why?  The evolutionary approach to medicine isn't a diet.  There are many aspects of today's life that are quite novel to modern humans.  Never having to go hungry, never having to experience extremes in temperature, being able to sit on your butt all day long and still procure ample food, not having to succumb to bacterial infections due to antibiotics, and the onslaught of chronic stress we experience today.  The current food environment is certainly a drastic shift to our species, but it is one of many issues that may not jibe with our genetic code.

When you look at the epidemiological research, it is universally accepted that things like poor sleep, a diet high in processed food and calories, high levels of stress, long periods of inactivity, and infrequent intense physical activity are all aspects of modern life that are problematic to health.  When you look at modern day hunter gatherers who live a lifestyle that completely eliminates these traits, we see insignificant levels of the diseases that plague us such as Cardiovascular disease, Type 2 diabetes, Cancer, and even Depression.  Multiple studies are coming out showing what many of these poor lifestyle traits do to us at a genetic level, strengthening support that many of our issues are caused by our current lifestyle.  From a scientific perspective, this doesn't prove anything. Besides, let's say being born by C-section or having to take a dose of antibiotics to kill a bacterial infection do have some ramifications, is the alternative, aka death, a better prognosis than later obesity or IBS?  Probably not, but knowing how to take steps to prevent or reduce the potential symptoms from those potential outcomes likely lies within the evolutionary approach to health.

Many people can benefit from this information, and waiting for a scientific consensus is not going to benefit most people in this lifetime because it won't likely come in that time period.  Even if the scientific consensus comes, it won't show that the Paleo diet or an evolutionary approach to health cures these problems.  What it will show is that many of our current health problems may be caused by a modern lifestyle, but that doesn't mean doing some diet for 3 months will allow you to go back to business as usual.

Do Type 1 and Type 2 Diabetes share a common cause?

A new study recently published in the journal FASEB provides evidence that both Type 1 and Type 2 diabetes share a similar cause that differs only in the rate at which either disease occurs.  In the study, researchers found that human amylin, a hormone long associated with Type 2 diabetes, accumulates in toxic clumps that destroy the beta cells of the pancreas responsible for producing insulin.  This causes progressively worse pancreas function, leading to failure, that ultimately culminates in either form of diabetes(1).  Let's take a closer look at the findings.

When you eat a meal, insulin is secreted to help control the level of glucose in the blood by making cells in the body take in glucose.  At the same time, the hormone amylin is also secreted to help insulin regulate blood glucose by slowing gastric emptying, reducing digestive enzymes, and causing you to feel full.  When a person secretes more amylin than they can break down, clumps of the protein form on the pancreas negatively impacting beta cell function and causing cell death, thus decreasing insulin production.

In this study, researchers took mice and inserted copies of the human amylin gene, making them either homozygous or hemizygous.  Mice who were homozygous for human amylin received two copies of the gene while mice who were hemizygous only received one copy.  Mice who had two copies of the gene experienced higher levels of amylin, rapid destruction of the pancreas, high levels of insulin, a shortened stage of prediabetes, and juvenile-onset, or Type 1, diabetes.  The mice that had one copy of the gene experienced lower levels of amylin and a more prolonged period of prediabetes, which led to adult-onset, or Type 2, diabetes.

If we look at this in concert with the research on leptin resistance that shows it to precede insulin resistance, we get an interesting picture.  Leptin is another hormone that signals you to stop eating and is secreted by fat cells.  People with leptin resistance produce a lot of leptin, but the cells in the hypothalamus that help regulate food intake don't respond to it.  As a result, people with leptin resistance don't get the "full" signal and continue to eat when they don't need to.  At some point, this may cause them to overproduce amylin causing the toxic clumps associated with Diabetes.  Of course, this is an extreme simplification of a complex topic that needs further study, but it does paint a picture that both could be prevented or reversed. In addition, this study was done in mice so further studies in humans are needed.

Bonus nerd info:  Interestingly enough, amylin shares a common effect on cells with amyloid beta, the protein associated with Alzheimer's disease.  Both cause dysfunction of the mitochondria and an increase in free radical production due to interference in the activity of complex IV in the mitochondria.  The end result of high free radical production...cell death.  These mechanisms only differ in where the cells they affect are found, amyloid beta in the brain and amylin in the pancreas(2).

Paleo and remission from Multiple Sclerosis: Is there something there?

http://www.examiner.com/article/jack-osbourne-credits-low-carb-paleo-diet-for-70-lb-weight-loss-managing-ms

Chad Vaccarino of the music group A Great Big World and Jack Osbourne, son of Ozzy Osbourne, have both seen dramatic improvements in the symptoms they experience from Multiple Sclerosis.  In the video above, Chad discusses his history with treating the disease from taking pharmaceuticals that he felt made him sicker to his use of the Paleo Diet, which he claims has thrown him in to remission.  Chad's Paleo story began when he watched the widely viewed TED talk given by Dr. Terry Wahls, a physician who went from wheelchair-bound to perfectly ambulatory after researching and implementing what is now known as the Wahls' Protocol for Multiple Sclerosis.

While stories like this seem to be fairly common in the internet world, many people are rightfully skeptical.  As the physician in the video states, there is no evidence that diet will help with Multiple Sclerosis.  This is true from a purely scientific standpoint, but therein lies the rub.  There is no hard scientific evidence that the Paleo diet is effective for Multiple Sclerosis, yet here we have 2 people who have absolutely nothing to gain from telling you that it helped them saying that they are essentially symptom free.  As I have mentioned before, however, science doesn't make truths, it identifies them.  What I mean by this is that a lack of evidence doesn't mean something isn't true, it just means we haven't identified it as being true.  A great example of this is that at one point there was no evidence that the Earth was round, yet it has always been round.

This is where we run in to trouble.  Just like you are unlikely to find a treasure if you aren't looking for it, you are unlikely to identify scientific truths unless you search for them via research studies.  Upwards of 65% of biomedical research is funded by companies who are looking for something that they can patent and, therefore, profit from.  Since you can't patent a diet, there is no financial incentive to study the effect of diet on health.  Despite being incredibly beneficial to us as a society, research in this area is unlikely to be carried out via normal means.  While Dr. Wahls has sent numerous grant proposals to the NIH, she has yet to receive funding.  This is where crowd-sourced funding can be quite beneficial, and where you come in.  If 0.3% of the US population each donated $1 to Dr. Wahls' foundation, she would have enough funding to carry out a clinical trial.

The link below allows you to donate to Dr. Wahls' foundation to help fund her work.  If you would like to donate, that's awesome.  What may seem like an insignificant amount of money to you can be significant if enough people give.  Even if you don't wish to donate, please share this blog article with others so that they may donate to help fund research that is unlikely to be carried out otherwise.  If you donate, donate in Dr. Wahls' name and thank her for her work.  Use the mailing address in the right margin as her address.

http://terrywahls.com/resources/research/

If you are interested in learning more about the Wahls Protocol for Multiple Sclerosis. check out her book The Wahls Protocol.  Also, if you use Amazon to purchase stuff, you can use the smile program and they will donate a portion of your purchase to a charity of your choosing.  Just select The Wahls Foundation as your charity of choice.  This in no way impacts the cost of your purchases.

Some nutritional recommendations are Bolshevik

A recent article making the rounds in Australia and New Zealand attempts to expose the dangers of the Paleo Diet by pointing to scientific advice that just doesn't exist while at the same time pointing to the paucity of clinical trials supporting the diet.  The two primary faults of the article are inconsistent logic as well as utilizing scientific data in a way that it cannot be utilized, both of which combine to make a dizzying array of non-points that make it difficult for a layperson to differentiate fact from fiction.

At the heart of the story is the notion that there is no hard scientific studies showing the Paleo diet to be more effective than the standard diet recommended by most health authorities.  This is not to say there aren't many studies that show a Paleo diet to be more healthy than a Mediterranean Diet for several populations, there are several.  What it says is that these studies do not have enough participants to make a clear determination as to whether the diet is better than what health authorities currently recommend.

In my opinion, this is a valid point.  However, when these same health authorities point to the healthfulness of processed food products such as whole grains, they are using data that cannot be used to make that determination.  One of the inherent problems with nutrition research is that you have studies that are well controlled that can be used to say A causes B. Since these studies are well controlled they tend to have a very small number of participants because they restrict external influences that may affect the results.  Theses are the types of studies that are coveted by scientists, but they are extremely expensive and hard to do and, therefore, quite rare.

On the other side of the coin are studies that can have a huge number of participants but that aren't controlled at all.  No matter how many people you have in these studies, you can never say A causes B because you aren't testing whether A causes B, you are testing whether there is a relationship between the two.  This second type of study is where most, if not all, nutritional recommendations come from.  The problem is, using these studies to say eating X improves health is essentially lying because the studies do not say A causes B or B causes A, they say A and B share a relationship that deserves further testing in a well controlled experiment.

In the very few well controlled experiments that experts use to show whole grains to be healthy, whole grains are compared to refined grains as a control group.  In effect, these studies do not show whole grains to be a healthy part of a diet, it shows them to be healthier than refined grains, which we know to be fairly unhealthy.  Of course, it's difficult to identify which type of study the health authorities are using to refute the Paleo diet in these articles since they don't post any references. 

On the logical fallacy end of things is the point that our ancestors ate seeds of grasses, which is a fair point.  However, comparing a loaf of Pepperidge Farms bread to the types of grains eaten by our ancestors is hardly a scientific comparison.  For one, the traditional way to prepare grains is to soak them, which aids in digestion and cuts back on some of the toxic properties of grains.  Secondly, grinding grains with a mortar and pestle is hardly the same as the modern processing of grains in to bread by machine.

Another logical fallacy in these arguments is that grains are somehow necessary to a healthy diet.  While this is not directly stated in these articles, it is implied by the notion that cutting out grains or specific food groups is detrimental to health.  While the authors like to point out that the diet of our ancestors varied greatly, and many included seeds of grasses(grains), this notion does not in anyway imply that grains are necessary to health.  In fact, many modern hunter gatherer societies don't eat grains and do quite well.

While I agree with many points health authorities make against a Paleo Diet, particularly that a high meat/low carb/low diversity diet is a good idea, I feel these arguments are against the lunatic fringe of those implementing the diet.  A lot of this has to do with earlier iterations of the diet and the now increased availability of the books and sources that promoted it.  Over time, the message that Paleo diet proponents have crafted has become more refined and more scientifically sound.  A great reference for what I believe to be the future of the movement can be found here.  Rather than pointing the finger at macronutrients such as carbs or fat, the modern processing of food and it's effect on the microbiota of humans is implicated.

While I don't think this will quell the influx of experts who argue against the diet, it will certainly make it more scientifically valid.  None of this is to say that a rigid Paleo diet is absolutely necessary for health.  However, making better food choices a majority of the time based on principles identified by the science being generated from principles of evolutionary health can only be beneficial in the absence of hard scientific data that shows one way or another that processed grains, whether whole or refined, are something healthful to eat.  That data, despite the insistence by health authorities, does not exist.

Dietary resistant starch may reverse damage of a high meat diet

A recent study on the effect of resistant starch consumption on the risk for colorectal cancer found that consuming 40g of resistant starch with a diet high in red meat can reduce the risk of colorectal cancer associated with a diet high in red meat(1).  The researchers took 23 subjects and had them follow either a high meat diet or a high meat diet coupled with 40g of resistant starch for 4 weeks.  They then measured the expression of colorectal cancer promoting genes.  When the subjects consumed a high red meat diet, expression levels of the genes increased by 30%.  When the subjects consumed 40g of resistant starch with a high meat diet, expression levels of the genes went back to normal.

The researchers believe the improved effect of resistant starch is due to the presence of butyrate in the colons of people consuming resistant starch.  Resistant starch is a form of fiber that escapes human digestion and becomes available to bacteria in the colon.  Butyrate is a byproduct of the fermentation of resistant starch by resident bacteria.  While high consumption of meat increases expression of the genes associated with colorectal cancer, consuming resistant starch effectively reversed this expression, possibly by increasing levels of butyrate and other beneficial short chain fatty acids(SCFAs).

Good sources of resistant starch are under-ripe/green bananas and plantains, cooked and cooled potatoes(at least 24 hours), and chemically altered food products such as Hi-maize, a modified cornstarch currently used as a substitute for flour in home baking.  Bob's Red Mill Unmodified Potato Starch is also a good source of resistant starch at 8g/tablespoon.  While many have taken to huge servings of a single source, getting multiple types of fiber/resistant starch is likely a better option as different bacteria in different areas of the digestive tract ferment different types of fiber in to butyrate and other SCFAs.

Combining endurance exercise with resistance training

Over the course of the last 2 blogs, I've gone over the evidence that endurance exercise is something humans are uniquely adapted to and the science behind how we adapt to both forms of exercise.  In this blog I will go over the intricacies of combining both forms of exercise in a total fitness plan.  At the end, I'll go over why my personal program is laid out the way it is.

For the most part, combining resistance training with endurance training is fairly easy.  The first thing you need to do is determine your priorities.  Are you more interested in gaining muscle mass or are you interested in shedding some fat or participating in distance running competitions?  Making this determination will help you decide how much you should do of each and the order you should perform each in.  If you are trying to maintain strength, get stronger, or increase your muscle mass, you should place resistance training first during days you perform both. If you are trying to improve your performance in an endurance event you should perform your endurance exercise first.  From a fat loss perspective there really doesn't appear to be much of a difference, so if fat loss is your goal you should perform the one you like doing least first so you are less likely to skip it.

Keep in mind you don't have to perform both forms of exercise on the same day.  Assuming you plan on exercising Monday-Friday, you can perform each on alternating days.  If you are trying to get stronger or build muscle, you should perform resistance training on Mondays, Wednesdays, and Fridays and endurance training on Tuesdays and Thursdays.  Endurance exercise, when performed at a lower intensity, has the added benefit of promoting recovery from resistance training so this type of layout tends to work well for most.

If your goal is to become good at an endurance sport, chances are you will be performing that type of activity at least 5-6 times a week at varying levels of intensity.  This is because the adaptations that occur from endurance training are much more sensitive to taking long breaks and, therefore, require more training to attain and maintain.  In this case you will likely throw in 2 resistance training days on the days you are using lower intensity for your endurance training.

Another important concept to grasp is that adaptations to any mode of exercise are muscle specific.  In other words, endurance exercise that only uses the upper body leads to adaptations in the heart as well as the muscles of the upper body but no adaptation to the muscles of the lower body.  In the same way, resistance training of the upper body tends to only affect the muscles of the upper body unless the lower body is somehow involved in stabilizing the body moreso than it normally would by standing.  Taken further with regard to endurance training, while there will be some carryover between things like cycling and running, if you are trying to run a 10k you should stick to running and if you are trying to compete in cycling you should stick to that.

Finally, how hard you push yourself at each workout determines how much you adapt.  For the most part, if you don't push yourself further each time you train, you won't adapt further.  In other words, if you run 2 miles in 18 minutes and you never improve on that pace, don't expect to see a significant amount of adaptation over time.  It's actually a little more complex than that, and every now and again you have to throw in a lower intensity session or string of sessions to prevent overtraining, but the important part to note is that over time you should see improvements in the amount of time it takes you to complete endurance training and in the amount of weight you can lift for a given set of reps, or the amount of reps you can lift on a given amount of weight in resistance training.  Depending on how you structure your program, you may see more improvements from one form of training over the other, and you can adjust your program accordingly.

So what do I do for a program?  I do full body resistance training on Mondays, Wednesdays, and Fridays.  I do full body workouts because missing workouts is not that big of a deal and won't lead to me skipping out on body parts I don't want to do or on body parts that just happen to fall on Friday.  It also allows me to compress more work in to a given time by performing a leg exercise followed by an upper body exercise followed by a core exercise followed by a rest.  Each day I do an upper body pushing exercise, an upper body pulling exercise, a lower body hip dominant exercise, and a lower body knee dominant exercise and vary the reps of each from session to session and week to week.  I also perform core exercises to give myself a break between exercises.  After each resistance training session, I perform 15 minutes of rowing on a Concept 2 rower and keep track of how many meters I go each time.  The reason I chose rowing is because I want the beneficial effects of endurance training on the heart, but I want to maintain my leg strength and power.  Since I am not using my lower body as much during the endurance training, I'm using it just not as much as if I were running, I don't have to worry about an interference effect between distance running and resistance training of my legs.  Every now and again I will throw in some running on Tuesdays and Thursdays, I just keep the intensity of the runs low so that I am not forcing an adaptation that will conflict with my leg strength.  That's basically it, not too complex.

Author's note: My primary goals are longevity and to mitigate the trends associated with aging.  My goals are to remain lean, to maintain lean body mass, and to maintain cardiovascular function.

Complementary adaptations to resistance and endurance training

In my previous blog I introduced some of the anthropological evidence that humans are evolved for endurance running.  Many in the Paleo and Primal communities believe that most of what our ancestors did was sprint and lift heavy things and very little endurance activities were employed so they tend to avoid endurance exercise.  However, when you look at the adaptations that occur as a part of each exercise modality, there is the potential that combining the 2 is very beneficial through complementary adaptations.

Multiple systems are affected by resistance and endurance training.  While most people only think of the adaptations that occur within the musculoskeletal system, adaptations within the cardiovascular and nervous systems are also important.  Let's begin by taking a look at the adaptations to the musculoskeletal system.

As you can see, each exercise modality has differing effects on muscle cells within the body.  Each tends to improve the predominant energy system it uses, phosphagen and anaerobic systems in resistance training and the aerobic system in endurance training, by improving enzymatic activities in these systems.  This improves the capacity to use fat for endurance training while improving the capacity to use glucose in resistance training.  A couple of the adaptations found in endurance training, increased blood flow to the muscles and increased mitochondrial density, actually see a decrease in resistance training.

This is important because increased blood flow enhances oxygen delivery to the muscles and increased mitochondrial density provides more of the organelles responsible for the use of fat as energy in the cells.  Since fat requires oxygen to be burned, both are prerequisites for efficient fat burning and a decrease in either tends to hamper fat loss.  Of course, since some of these adaptations work against each other from a performance perspective, a person who is training for a sport that is heavily reliant on either modality will have to fine tune the proportion of each that they do for optimal results.

From within the cardiovascular system, many of the positive adaptations attributed to exercise come from endurance training.  One of these positive adaptations is a decrease in arterial stiffness which is one of the potential mechanisms that causes a decrease in blood pressure in people who regularly partake in endurance exercise(1).  In resistance training, studies have shown an increase in arterial stiffness which should result in an increase in blood pressure.  Interestingly enough, resistance training has also been shown to decrease blood pressure by amounts similar to endurance training, indicating that resistance training causes a decrease in blood pressure through a different mechanisms than endurance training(2).  This indicates combining the two could provide better results on blood pressure than one or the other.

Another aspect of health that improves with exercise and is worth noting is the effect of exercise on the brain.  Both resistance and endurance exercise have been shown to improve brain function, and studies have shown that these enhancements may be due to separate adaptations.  While endurance exercise tends to increase brain-derived neurotrophic factor(BDNF) and insulin-like growth factor-1(IGF-1) in the hippocampus, resistance exercise tends to increase brain levels of IGF-1 and cause increased expression of IGF-1 receptors in the hippocampus(3).  The hippocampus is a part of the brain integral to memory function and both BDNF and IGF-1 enhance it's function.  For more on how this works, the book Spark by Dr. John J. Ratey covers many of the positive adaptations of exercise on brain function.

Outside of these adaptations, the general consensus in medicine is that endurance exercise helps to maintain lung and heart function throughout life while resistance training tends to help maintain muscle mass and strength(4).  VO2max, a measure of cardiac output that increases with endurance training, has been shown to be a strong predictor of all-cause mortality.  In other words, people with a low VO2max have an increased risk of dying from any cause compared to people with a higher VO2max(5).  Muscle mass is also a strong predictor of all cause mortality; people with a higher muscle mass have a lower risk of dying from any cause than people with low muscle mass(5). 

Overall, both resistance training and endurance training have benefits that are separate from and potentially complementary to one another.  Adaptations to both, while sometimes conflicting, may prove to be either additive or synergistic when you combine both forms of exercise in your wellness program.  Studies show combining the 2 to be superior to one or the other as a therapeutic approach to both cardiovascular disease(6) and Type 2 Diabetes(7). Whether this holds true for healthy people looking to maintain their quality of life remains to be seen, but the mechanisms for at least an additive effect are there.

In my next blog we will go over how you can apply this information to your wellness program.