Dear Dr. Cordain and Dr. Fontes Villalba,
I read with great interest your paper entitled: “Carrera-Bastos, P., Fontes-Villalba, M., O’Keefe, J. H., Lindeberg, S. and Cordain, L. (2011). The western diet and lifestyle and diseases of civilization. Research Reports in Clinical Cardiology 2011: 15-35.”
The demonstration is quite logical, but I would like to get your opinion on the following issue:
*If the paleolithic diet suits well human genetics and does not lead to chronic diseases – which is true -, and if grain products are not so good for human health, the world has changed with at least 1 billion people living in huge towns worldwide: they cannot realistically have a paleolithic diet going outside to hunt and collect berries! There is a compromise to find between the best and reality of our modern world. In that way, grain cereals and legumes appear as promising foods being cheap, easy to store, with a huge health potential, satiating, etc. Maybe humans before 10,000 years consume grains, but to a lesser extent?*
So, what do you think is the best diet today, in a world with more than 7 billions people and huge cities?
I will be very happy to have your opinion about this issue,
Available I remain,
Anthony FARDET, Ph.D.
Chargé de Recherches (Research scientist)
Human Nutrition Research Center, Auvergne
Clermont-Ferrand/Theix Research Center
Maelán Fontes Villalba’s Response:
Hello Dr. FARDET,
Today almost all health authorities and nutritionists believe that cereal grains are healthy for so-called diseases of civilization. This information is derived from epidemiological studies that can not establish cause-effect. Consistently, epidemiological studies show an inverse association between the consumption of cereal grains and western disease, which is not demonstrated by randomized controlled trials. In the women’s health initiative (+48,000 postmenopausal women) those women allocated to the intervention group (eat more than 6 servings/day of wholegrain cereals, 5 servings of fruit/vegetable and <20%en from fat) of whom had a CV event at baseline significantly increased their risk of CV event by 26%. In the DART trial, those men allocated to increase the intake of fiber from wholegrain cereals, increased the risk of death compared to the group who wasn’t advised to increase the intake of fiber.
Some systematic reviews make it clear that we don’t have enough evidence to recommend the intake of cereal grains for the prevention and treatment of cardiovascular disease (Kelly, Cochrane Database of Systematic Reviews, 2007), obesity, (FESNAD-SEEDO, Revista Española De Obesidad, 2011) or diabetes (Priebe, Cochrane Database of Systematic Reviews, 2008). Therefore, I don’t agree with you in that “they have a huge health potential.”
The short-term clinical trials published by my group (Lindeberg, Diabtologia, 2007; Jönsson, Cardiovascular Diabetology, 2009) have shown that a Paleolithic Diet is superior to the Mediterranean and American Diabetes Association diets, respectively.
From an evolutionary standpoint it is very unlikely that we have completed adapted to cereal grains in just 10,000 years (even knowing that human evolution has accelerated since the adoption of agriculture and living in huge cities, probably by pathogens rather than foods). So, there is no body of evidence that demonstrates we have adapted. This information is necessary before performing human experiments showing we are feeding individuals with a food meant for granivorous animals (birds, rodents, etc). And, while “everybody” may think we are adapted, it is very unlikely. The proof simply isn’t there. If we eat the kind of foods we ate during human evolution (>99.9% of our evolution), is there any obvious risk? Not that we are aware of. Are there potential health risk of consuming cereal grains? Yes there are. So, I would stay in the safe side.
Regarding you question about sustainability, I think you can adapt the Standard American Diet to one more suitable for our genetic legacy and improve health. Furthermore, if the world population would eat a diet in accordance with our physiology then the expense in health would be dramatically cut. I am not an expert in this field but I think that famine in the third world is more so a political problem than a problem with food choice itself.
You are right, however, regarding the DART study, the increased risk (18%) was non-significant, but in a Eur J Clin Nutr 2002 Ness, and after statistical adjustment, there was a significant increase of mortality in the first two years, but not the following years.
Many studies are conducted in ill people with high risk of CVD. If an intervention reduces the risk to that of “normal” westerners, then we could say there was a positive effect, but who wants to be normal? Not me! (see European Heart Journal 2005 Lindeberg). I prefer to have a low risk of western disease.
I agree that the Mediterranean Diet (for example) is better than the Standard American Diet, but is there a better diet? What if we reduce cereal grains in a Mediterranean Diet and increase fruits, tubers and vegetables? Do you improve a diet based on vegetables, fruits, tubers, lean meat, fish, eggs and nut if you include grains?
Dr. Cordain has explained in many lectures that cereals grains are not edible unless you process them. But there are many other reasons (bioactive compounds like exorphins, lectins, saponins, binding to endocrine receptors; antinutrients; protease and amylase inhibitors, etc), why cereal grains can be a problem for most people, besides non-celiac gluten sensitivity (and potential same effect of thousands of proteins in grains).
I am unfamiliar with any study where it has been shown that cereal grains, per se, are protective. As I previously mentioned, there are some studies (with numerous limitations like the PREDIMED study where the control group received much less support and followed a diet similar to that in WHI, where the risk of CVD was reduced, but you cannot say it was because of the intake of cereal grains. On the other hand, the studies comparing healthy diets with and without cereal grains have shown very interesting results. Should we look to the other side, or focus on those interesting data? Well, many people just turn their head to the other way, while we are interested in exploring what happened in those studies (Lindeberg, 2007; Jönsson, 20009; Mellberg, 2014).
The statement that our ancestor lived only until the age of 30 is false. See Kaplan, 2007–>modal age at death is >70 years old in hunter-gatherers. Of course, they are not people from the Paleolithic era but there is no reason to think that it was different then. See also Eaton, 2002 where Dr. Cordain is a co-author (Evolutionary Health Promotion: A Consideration of Common Counterarguments: Preventive Medicine 2002 Eaton).
Regarding meat, it is not true that Paleolithic Diets must necessarily be high in meat. Some hunter-gatherers consume high amounts plants, with carbohydrate being almost 70%en (see the Kitava study).
Dr. Cordain’s Response:
Dear Dr. FARDET,
Many thanks for your inquiry. Maelán Fontes has done a good job of summarizing potential health issues with cereal grains in his reply to you. In my paper, “Cereal Grains: Humanity’s Double Edged Sword,” I delve into greater detail on the topic with 55 pages of dialogue and 342 references.
Further, in our paper, “Origins and Evolution of the Western Diet: Health Implications for the 21st Century,” we show how humans have no nutritional requirement for whole grain cereals. In fact, when whole grains are added to the diet they significantly reduce the 13 nutrients most lacking in the US diet.
Further, in our paper “The Nutritional Characteristics of a Contemporary Diet Based upon Paleolithic Food Groups,” you can see how a modern Paleo diet based upon lean meats, fish, seafood, fresh fruits and vegetables and nuts (and devoid of whole grain cereals, dairy products and processed foods) are much more nutrient dense than either the current USDA recommended My Plate diet, or the Mediterrean Diet. The reason for this phenomenon is that the aforementioned foods are more trace nutrient dense than whole grains, dairy products or processed foods for the 13 nutrients most lacking in western diets.
Cheers, I hope these papers provide new learning to further educating yourself on the topic.
Loren Cordain, Ph.D., Professor Emeritus