Dr. Cordain Interview for Academy of Nutrition and Dietetics

I was recently interviewed by a reporter representing “The Academy of Nutrition and Dietetics” which was formerly known as “The American Dietetic Association (ADA)” http://www.eatright.org/.

This organization certifies registered dietitian nutritionists in the United States. University level nutrition students must have met academic and professional requirements including an earned bachelor's degree with coursework approved by the Academy of Nutrition and Dietetics' Accreditation Council for Education in Nutrition and Dietetics (ACEND).

The official magazine of The Academy of Nutrition and Dietetics, is called “Food and Nutrition” https://foodandnutrition.org/ which reaches a readership of approximately 40,000 Registered Dieticians. Unfortunately, due to the length of my interview, the interview was not published in “Food and Nutrition” magazine. Below is that interview in its entirety.

Dr. Cordain responds to the reporter’s questions:

Obviously, your questions are good ones and are of interest to the Registered Dietitian (RD) Community and to all people concerned about diet/health and well-being. 

I have written extensively about the "Paleo Diet" concept in high quality, peer-reviewed nutritional and medical journals including: The American Journal of Clinical Nutrition, The British Journal of Nutrition, The European Journal of Clinical Nutrition, The World Review of Nutrition and Dietetics, The Journal of Applied Physiology, Acta Opthalmolgica, The Archives of Dermatology, The Scandinavian Journal of Clinical Laboratory Investigation, Mayo Clinic Proceedings, Preventive Medicine, Nutrition and Metabolism, Proceedings of the National Academy of Sciences, Open Heart (1-39) and many other high impact factor, peer-reviewed journals. Reprints of all of my scientific papers are available as free PDF downloads at my website: www.thepaleodiet.com.

Additionally, I have written six popular books and cookbooks on The Paleo Diet Concept including: The New York Times Bestseller, The Paleo Diet, (2002, revised 2010) (1), The Paleo Diets for Athletes (2005, revised 2012 and co-authored with Joe Friel) (41), The Paleo Diet Cookbook (2011) (42), The Paleo Answer (2012) (43), The Real Paleo Diet Cookbook (2015) (44), and Real Paleo Fast and Easy (2016) (45).

Questions

What are the advantages of following a Paleo Diet?
As I originally conceived this way of eating in 2002 in The Paleo Diet (1), my intent was to mimic the food groups that our pre-agricultural ancestors ate by using contemporary foods (fresh fruits, fresh vegetables, fish, shellfish, grass produced meats, organ meats and poultry, free-ranging eggs, nuts and certain healthful oils) commonly available at supermarkets. As I have pointed out in all of my writings, clearly it would be impractical or impossible for modern people to only eat wild plant and animal foods. Built into this diet was a behavioral crutch (the 85:15 rule) (1) which allowed people to occasionally “cheat” (1, 6, 41-45) but still obtain most of the nutritional and health advantages (1-3, 5, 8-31, 33, 35-39) of The Paleo Diet.

The nutritional advantages of following a diet comprised mainly of fresh fruits, fresh vegetables, fish, shellfish, grass produced meats and organ meats, free-ranging poultry, free-ranging eggs, nuts and certain healthful oils are readily apparent to any registered dietitian who has access to nutritional software. I use Nutritionist Pro (http://www.nutritionistpro.com/) to analyze the nutritional characteristics of contemporary diets based upon ancestral food groups (16, 23).

The typical plant to animal food subsistence ratio in hunter gatherer diets ranges from about 35 to 45 percent plant food with the balance from animal food (2, 16, 23, 31). Accordingly, when a modern, westernized person emulates the food groups in ancestral diets with contemporary foods, the diet becomes exceedingly rich in fresh fruits and vegetables (16, 23). A recent (2017) report (40) from the Centers for Disease Control and Prevention (CDC) showed that just 12 percent of Americans eat the minimum daily fruit recommendation (1 ½ - 2 cups/day), and only nine percent of Americans consume the minimum daily vegetable recommendation (2-3 cups/day). Hence, adoption of The Paleo Diet represents one of the best strategies to enrich the American diet with healthful fresh fruits and vegetables (1, 16, 23, 41-45).

The Paleo Diet avoids or eliminates processed foods containing refined sugars, refined grains, refined vegetable oils, trans fatty acids, salt and added chemicals. Because fresh fruits, fresh vegetables and nuts are consumed ad libitum as the carbohydrate source in lieu of refined sugars, refined grains and processed foods, The Paleo Diet is a low glycemic load diet (1, 16, 23) which promotes normalization of blood glucose, insulin and improvement in type 2 diabetes and the metabolic syndrome (46-55).

The Paleolithic diet is a low-salt diet because it avoids or eliminates the highest salt sources in the American diet (bread, baked goods, cheese, processed meats, sandwiches, pizza, tacos, chips, condiments, etc.), and replaces these processed foods with unsalted, unadulterated fresh foods (fresh fruits, fresh vegetables, fish, shellfish, grass produced meats and organ meats, free-ranging poultry, free-ranging eggs, nuts and certain healthful oils). The average U.S. diet (per day) contains 3,584 mg of sodium (Na+) and 2795 mg of potassium (K+) yielding a K+/Na+ ratio of 0.77 (56). Few natural, unsalted foods maintain K+/Na+ ratios less than 1.00. In fact, the K+/Na+ ratio in contemporary Paleo Diets ranges from 5.0 to 10.0 (16, 23, 30, 57, 58). The high average U.S. daily sodium intake (3,584 mg) and low potassium intake (2795 mg) increases the risk for hypertension, stroke, cardiovascular disease (CVD) and gastric cancer. By adopting a contemporary Paleo Diet, people will reduce their salt intake, increase their potassium intake (1, 41- 45) and reduce their risk for CVD, high blood pressure, stroke and stomach cancer.

In vivo (in the body) all foods are either net acid producing, net-base producing or neutral (59). The typical American diet is net acid producing because it contains high amounts of acid yielding cereal grains, salt, cheese, processed meats, processed foods and condiments (23, 57, 58), and low amounts of base yielding fruits and vegetables (40). A net acid yielding diet increases the risk for osteoporosis, kidney stones, stroke and hypertension (1, 43, 57) whereas a net alkaline yielding diet, high in fresh fruits and vegetables reduces the risk for these diseases (60-62). Hence, adoption of the contemporary Paleo Diet will result in a net base yielding diet and lessen the risk for osteoporosis, kidney stones, stroke and hypertension (1, 16, 23, 41-45).

What are the nutritional advantages of avoiding foods like dairy and legumes?
From an evolutionary perspective, the majority (65 to 70 percent) of the world’s adults are lactose intolerant (63, 64) and cannot drink milk without digestive discomfort because they lack the enzyme (lactase-phlorizin hydrolase) necessary to digest the sugar (lactose) present in the milk of mammals. From an evolutionary perspective, this information indicates that milk and dairy products could not have been a component of the original adult diet that shaped the human genome until very recent times, (64).

The human consumption of milk from a foreign species throughout our life is not without physiologic consequence, even if a person has inherited the gene (LCT) which codes for adult lactase persistence (64). Fresh cow milk contains the full complement of enzymes and hormones that are present in cow blood (65).

It had been assumed that these bioactive compounds in cow’s milk were degraded in the human gastrointestinal tract and that our immune systems ultimately prevented their entry into our bloodstreams. Unfortunately, this model has been shown to be incorrect, as cow milk apparently elevates a key human hormone (IFG) known to affect insulin and glucose metabolism and promote various cancers (35, 66). Other elements in cow’s milk are implicated in human cancer and disease including miRNAs (39) and stimulation of mTORC1-signaling (35). Further, recent studies implicate prediabetes and type 2 diabetes with dairy intake in adults (67) and children (68).

Legumes (beans, lentils, peanuts etc.) contain high concentrations of various antinutrients including phytate, lectins, saponins, tannins and isoflavones, protease inhibitors, raffinose oligosaccharides, cyanogenetic glycosides and favism glycosides (43). Without long term cooking or pressure cooking, these antinutrients remain active following ingestion by mammals and may disrupt gastrointestinal and immune function (43, 69, 70, 71). Because of their antinutrient content, particularly phytates, legumes are low quality foods that are deficient in multiple nutrients (zinc, iron, magnesium, calcium) unavailable for human absorption (43, 71). From an evolutionary perspective, until humanity was able to not only control fire, but to make fire at will (72), legumes would not have been a component of the diet that shaped our current genome until recent evolutionary times.

Why do you think there is such a strong following of this diet?
In this day and age of internet connectivity, people constantly correspond with their friends and neighbors about all things in their lives, including diet. Like a loophole in tax laws, when they discover something that works, the information is passed along, and passed along and passed along again.

The Paleo Diet works -- it works to help people become healthier; to lower blood cholesterol levels, to lower blood pressure; to reduce body weight; to have more energy throughout the day; and to improve health and well-being. This information has been substantiated in the scientific and medical literature for a decade (73-101)

Many athletes follow this diet and they do need carbs for fuel. What do you recommend for athletes in order to stay properly fueled?
All athletes do not compete in similar events. The metabolic requirements of a sprinter, an 800 meter runner, a miler or a 5 or 10 K and marathon runner are completely different from a high jumper, a pole vaulter or a shot putter. These athletes compete in events which have metabolic requirements that frequently overlap with team sports including soccer, basketball, football, baseball and tennis. Hence it is unfair to suggest that all athletes need carbs for fuel at all times.

Endurance athletes who have previously trained their beta oxidation (fat) metabolic pathways have been shown to outperform athletes who solely utilize high carb diets (102).

Coconut and cauliflower are two very popular Paleo foods, but aren’t necessarily connected to the Paleolithic era. How do those connect within the Paleo diet? Are they healthy choices in the Paleo diet?
Hmm. I disagree with you that coconut would not have been consumed by Paleolithic people (> 10,000 years ago). The archaeological evidence shows that our Paleolithic ancestors occupied coastal areas in Africa and Asia where coconut trees grew. There is no evidence to suggest otherwise that this plant food was exploited from the earliest of times.

Cauliflower on the other hand is a recent genetic permutation from broccoli which is a recent permutation from cabbage. These three plants (cauliflower, broccoli, cabbage) have similar nutritional characteristics which differ little from their inherent genetic species. Additionally, I never proclaimed that modern, domesticated versions of wild plant and animal foods should not be regular components of contemporary Paleo Diets.

Anything else you would like to relay to dietetic professionals?
Always let the data speak for itself, and do not permit charismatic individuals or political organizations to interpret the data outside of scientific norms.

How would you like to be quoted?
Always let the data speak for itself.

References:

1.Cordain L. The Paleo Diet, John Wiley & Sons, New York, NY, 2002 (revised 2010).

2.Cordain L, Brand Miller J, Eaton SB, Mann N, Holt SHA, Speth JD. Plant to animal subsistence ratios and macronutrient energy estimations in world wide hunter-gatherer diets. American Journal of Clinical Nutrition, 2000, 71:682-92.

3.Cordain L. (1999). Cereal grains: humanity’s double edged sword. World Review of Nutrition and Dietetics, 84: 19-73.

4.Cordain L, Miller J, Mann N. (1999). Scant evidence of periodic starvation among hunter-gatherers (letter). Diabetologia, 42: 383-84.

5.Mickleborough TD, Cordain L, Gotshall RW, Tucker A. A low sodium diet improves indices of pulmonary function in exercise-induced asthma. Journal of Exercise Physiology Online 2000;3(2): http://www.css.edu/users/tboone2/asep/April2000.html

6.Cordain L, Melby CL, Hamamoto AE, O’Neill S, Cornier M, Barakat HA, Israel RG, Hill JO. Influence of moderate chronic wine consumption on insulin sensitivity and other correlates of syndrome X in moderately obese women. Metabolism 2000;49:1473-78.

7.Gotshall RW, Mickleborough TD, Cordain L. Dietary salt restriction alters pulmonary function in exercise-induced asthmatics. Medicine and Science in Sports and Exercise, 2000;32:1815-19.

8.Cordain L, Watkins BA, Mann NJ. 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.

9.Mickleborough TD, Gotshall RW, Rhodes J, Tucker A, Cordain L. Elevating dietary salt exacerbates leukotrienes-dependent hyperpnea-induced airway obstruction in guinea pigs. J Appl Physiol 2001, 91:1061-66.

10.Mickleborough TD, Gotshall RW, Kluka E, Miller CW, Cordain L. Dietary chloride as a possible determinant of the severity of exercise-induced asthma. Eur J Appl Physiol 2001;85:450-56.

11.Eaton SB, Strassman BI, Nesse RM, Neel JV, Ewald PW, Williams GC, Weder AB, Eaton SB 3rd, Lindeberg S, Konner MJ, Mysterud I, Cordain L. Evolutionary health promotion. Prev Med 2002;34:109-118.

12.Eaton SB, Cordain L. Evolutionary Health Promotion. A consideration of common counter-arguments. Prev Med 2002;34:119-123.

13.Cordain L, Watkins BA, Florant GL, Kehler M, Rogers L, Li Y. Fatty acid analysis of wild ruminant tissues: Evolutionary implications for reducing diet-related chronic disease. Eur J Clin Nutr, 2002;56:181-191.

14.Cordain L, Eaton SB, Brand Miller J, Mann N, Hill K. The paradoxical nature of hunter-gatherer diets: Meat based, yet non-atherogenic. Eur J Clin Nutr 2002;56 (suppl 1):S42-S52.

15.Cordain L, Eaton SB, Brand Miller J, Lindeberg S, Jensen C. An evolutionary analysis of the etiology and pathogenesis of juvenile-onset myopia. Acta Opthalmolgica, 2002,80:125-135.

16.Cordain L. The nutritional characteristics of a contemporary diet based upon Paleolithic food groups. J Am Neutraceut Assoc 2002; 5:15-24.

17.Cordain L, Lindeberg S, Hurtado M, Hill K, Eaton SB, Brand-Miller J. (2002). Acne vulgaris: A disease of civilization. Archives of Dermatology,138: 1584-90.

18.Cordain L, Eades MR, Eades MD. (2003). Hyperinsulinemic diseases of civilization: more than just syndrome X. Comp Biochem Physiol Part A:136:95-112.

19.Lindeberg S, Ahren B, Cordain L, Nilsson-Ehle P, Vessby B, Nilsson A. Determinants of serum triglycerides and high-density lipoprotein cholesterol in traditional Trobriand Islanders – the Kitava Study. Scand J Clin Lab Invest 2003;63:175-180.

20.Lindeberg S, Cordain L, Eaton B. Biological and clinical potential of a Palaeolithic diet. J Nutr Environ Med 2003;13:149-160.

21.O’Keefe J.H., Cordain L. Cardiovascular disease as a result of a diet and lifestyle at odds with our Paleolithic genome: how to become a 21st century hunter-gatherer. Mayo Clin Proc 2004;79:101-108.

22.Lindeberg S, Ahren B, Cordain L, Rastam L. Serum uric acid in traditional Pacific Islanders and in Sweden. J Intern Med 2004; 255:373-378.

23.Cordain L, Eaton SB, Sebastian A, Mann N, Lindeberg S, Watkins BA, O'Keefe JH, Brand-Miller J. Origins and evolution of the western diet: Health implications for the 21st century. Am J Clin Nutr 2005;81:341-54.

24.Hoyt G, Hickey MS, Cordain L. Dissociation of the glycaemic and insulinaemic responses to whole and skimmed milk. Br J Nutr 2005;93:175-177.

25.Cordain, L. Implications for the role of diet in acne. Semin Cutan Med Surg 2005;24:84-91.

26.Cordain L., Hickey MS. Ultraviolet radiation represents an evolutionary selective pressure for the south-to-north gradient of the MTHFR 677TT genotype. Am J Clin Nutr 2006;84:1243.

27.Treloar V, Logan AC, Danby FW, Cordain L, Mann NJ. Comment on acne and glycemic index. J Am Acad Dermatol. 2008 Jan;58(1):175-7.

28.Ramsden CE, Faurot KR, Carrera-Bastos, P, Sperling LS, de Lorgeril M, Cordain L. Dietary fat quality and coronary heart disease prevention: a unified theory based on evolutionary, historical, global and modern perspectives. Curr Treat Options Cardiovasc Med; 2009;11:289-301.

29.Eaton SB, Cordain L, Sparling PB, Cantwell JD. Evolution, body composition and insulin resistance. Preventive Medicine, 2009;49:283-285.

30.Eaton SB, Konner MJ, Cordain L. Diet-dependent acid load, Paleolithic nutrition, and evolutionary health promotion. Am J Clin Nutr 2010;91:295-97.

31.Remko S. Kuipers1, Martine F. Luxwolda1, D.A. Janneke Dijck-Brouwer1, S. Boyd Eaton, Michael A. Crawford, Cordain L, and Frits A.J. Muskiet. Estimated macronutrient and fatty acid intakes from an East African Paleolithic diet. Brit J Nutr , 2010 Dec;104(11):1666-87.

32.O’Keefe JH, Vogel R, Lavie CJ, Cordain L. Organic Fitness: Physical Activity Patterns Compatible with our Hunter Gatherer Genetic Legacy. Physician and Sports Medicine 2010, 38 (4):11-18.

33.Carrera-Bastos P, Fontes Villalba M, O’Keefe JH, Lindeberg S, Cordain L. The western diet and lifestyle and diseases of civilization. Res Rep Clin Cardiol 2011; 2: 215-235.

34.O’Keefe JH, Vogel R, Lavie CJ, Cordain L. Exercise Like a Hunter Gatherer: A Prescription for Organic Physical Fitness. Prog Cardiovasc Dis. 2011;53:471-9.

35.Melnik BC, John SM, Carrera-Bastos P, Cordain L. The impact of cow's milk-mediated mTORC1-signaling in the initiation and progression of prostate cancer. Nutr Metab (Lond). 2012 Aug 14;9(1):74. doi: 10.1186/1743-7075-9-74

36.Fontes-Villalba M, Carrera-Bastos P, Cordain L. African hominin stable isotopic data do not necessarily indicate grass consumption. Proc Natl Acad Sci U S A. 2013 Oct 22;110(43):E4055. doi: 10.1073/pnas.1311461110. Epub 2013 Sep 23.

37.Melnik BC, Schmitz G, John S, Carrera-Bastos P, Lindeberg S, Cordain L. Metabolic effects of milk protein intake strongly depend on pre-existing metabolic and exercise status. Nutr Metab (Lond). 2013 Oct 2;10(1):60. doi: 10.1186/1743-7075-10-60.

38.O'Keefe JH, Bergman N, Carrera-Bastos P, Fontes-Villalba M, DiNicolantonio JJ, Cordain L. Nutritional strategies for skeletal and cardiovascular health: hard bones, soft arteries, rather than vice versa. Open Heart. 2016 Mar 22;3(1):e000325. doi: 10.1136/openhrt-2015-000325. eCollection 2016. Review.

39.Melnik BC, Kakulas F, Geddes DT, Hartmann PE, John SM, Carrera-Bastos P, Cordain L, Schmitz G. Milk miRNAs: simple nutrients or systemic functional regulators? Nutr Metab (Lond). 2016 Jun 21;13:42. doi: 10.1186/s12986-016-0101-2. eCollection 2016.

40.Lee-Kwan SH, Moore LV, Blanck HM, Harris DM, Galuska D. Disparities in State-Specific Adult Fruit and Vegetable Consumption — United States, 2015. MMWR Morb Mortal Wkly Rep 2017;66:1241–1247. DOI: http://dx.doi.org/10.15585/mmwr.mm6645a1

41.Cordain L, Friel J. The Paleo Diets for Athletes (2005, revised 2012), Rodale Inc., New York, NY.

42.Cordain L, Stephenson N, Cordain L. The Paleo Diet Cookbook (2011), John Wiley & Sons, New York, NY

43.Cordain L. The Paleo Answer (2012), John Wiley & Sons, New York, NY

44.Cordain L. The Real Paleo Diet Cookbook (2015), Houghton Mifflin Harcourt, New York, NY.

45.Cordain L. Real Paleo Fast and Easy (2016), Houghton Mifflin Harcourt, New York, NY

46.Lindeberg S, Jönsson T, Granfeldt Y, Borgstrand E, Soffman J, Sjöström K, Ahrén B. A Palaeolithic diet improves glucose tolerance more than a Mediterranean-like diet in individuals with ischaemic heart disease. Diabetologia 2007, 50(9):1795-1807.

47.Frassetto LA, Schloetter M, Mietus-Synder M, Morris RC Jr, Sebastian A. Metabolic and physiologic improvements from consuming a Paleolithic, hunter-gatherer type diet. Eur J Clin Nutr 2009. Aug;63(8):947-55

48. Jönsson T, Granfeldt Y, Ahrén B, Branell UC, Pålsson G, Hansson A, Söderström M, Lindeberg S. Beneficial effects of a Paleolithic diet on cardiovascular risk factors in type 2 diabetes: a randomized cross-over pilot study. Cardiovasc Diabetol. 2009;8:35 doi: 10.1186/1475-2840-8-35

49.Boers I, Muskiet FA, Berkelaar E, Schut E, Penders R, Hoenderdos K, Wichers HJ, Jong MC. Favourable effects of consuming a Palaeolithic-type diet on characteristics of the metabolic syndrom. A randomized controlled pilot-study. Lipids Health Dis. 2014 Oct 11;13:160. doi: 10.1186/1476-511X-13-160.

50.Mellberg C, Sandberg S, Ryberg M, Eriksson M, Brage S, Larsson C, Olsson T, Lindahl B. Long-term effects of a Palaeolithic-type diet in obese postmenopausal women: a 2-year randomized trial. Eur J Clin Nutr. 2014 Mar;68(3):350-7.

51.Manheimer EW, van Zuuren EJ, Fedorowicz Z, Pijl H. Paleolithic nutrition for metabolic syndrome: systematic review and meta-analysis. Am J Clin Nutr. 2015 Oct;102(4):922-32.

52.Pastore RL, Brooks JT1, Carbone JW2. et al. Paleolithic nutrition improves plasma lipid concentrations of hypercholesterolemic adults to a greater extent than traditional heart-healthy dietary recommendations. Nutr Res. 2015; 35:474-479.

53. Masharani U, Sherchan P, Schloetter M, Stratford S, Xiao A, Sebastian A, Nolte Kennedy M, Frassetto L. Metabolic and physiologic effects from consuming a hunter-gatherer (Paleolithic)-type diet in type 2 diabetes. Eur J Clin Nutr. 2015 Aug;69(8):944-8.

54.Fontes-Villalba M, Lindeberg S, Granfeldt Y, Knop FK, Memon AA, Carrera-Bastos P, Picazo Ó, Chanrai M, Sunquist J, Sundquist K, Jönsson T. Palaeolithic diet decreases fasting plasma leptin concentrations more than a diabetes diet in patients with type 2 diabetes: a randomised cross-over trial. Cardiovasc Diabetol. 2016 May 23;15(1):80. doi: 10.1186/s12933-016-0398-1.

55.Otten J, Stomby A, Waling M, Isaksson A, Tellström A, Lundin-Olsson L, Brage S, Ryberg M, Svensson M, Olsson T. Effects of a Paleolithic diet with and without supervised exercise on fat mass, insulin sensitivity, and glycemic control: a randomized controlled trial in individuals with type 2 diabetes. Diabetes Metab Res R ev. 2016 May 27. doi: 10.1002/dmrr.2828. [Epub ahead of print]

56.Bailey RL, Parker EA, Rhodes DG, Goldman JD, Clemens JC, Moshfegh AJ, Thuppal SV, Weaver CM. Estimating sodium and potassium intakes and their ratio in the american diet: data from the 2011-2012 NHANES. J Nutr. 2016 Mar 9. pii: jn221184. [Epub ahead of print]

57.Frassetto L, Morris RC Jr, Sellmeyer DE, Todd K, Sebastian A. Diet, evolution and aging--the pathophysiologic effects of the post-agricultural inversion of the potassium-to-sodium and base-to-chloride ratios in the human diet. Eur J Nutr. 2001 Oct;40(5):200-13

58.Sebastian A, Frassetto LA, Sellmeyer DE, Morris RC Jr. The evolution-informed optimal dietary potassium intake of human beings greatly exceeds current and recommended intakes. Semin Nephrol. 2006 Nov;26(6):447-53

59. Remer T, Manz F. Potential renal acid load of foods and its influence on urine pH. J Am Diet Assoc. 1995 Jul;95(7):791-7.

60.van Breda SGJ, de Kok TMCM. Smart Combinations of Bioactive Compounds in Fruits and Vegetables May Guide New Strategies for Personalized Prevention of Chronic Diseases. Mol Nutr Food Res. 2017 Nov 6. doi: 10.1002/mnfr.201700597. [Epub ahead of print]

61. Rodriguez-Casado A. The Health Potential of Fruits and Vegetables Phytochemicals: Notable Examples. Crit Rev Food Sci Nutr. 2016 May 18;56(7):1097-107.

62.Liu RH. Health-promoting components of fruits and vegetables in the diet. Adv Nutr. 2013 May 1;4(3):384S-92S.

63.Bayless TM,, Brown E, Paige DM. Lactase Non-persistence and Lactose Intolerance. Curr Gastroenterol Rep. 2017 May;19(5):23. doi: 10.1007/s11894-017-0558-9.

64.Cordain L, Hickey MS, and Kim K. Malaria and Rickets Represent Selective Forces for the Convergent Evolution of Adult Lactase Persistence. In: Biodiversity in Agriculture: Domestication, Evolution, and Sustainability, edited by P. Gepts, T.R. Famula, R.L. Bettinger et al. Published by Cambridge University Press. # Cambridge University Press 2012, pp 299-

65.Koldovský O. Hormones in milk. Vitam Horm. 1995;50:77-149.

66.Harrison S, Lennon R, Holly J3 Higgins JPT et al., Does milk intake promote prostate cancer initiation or progression via effects on insulin-like growth factors (IGFs)? A systematic review and meta-analysis. Cancer Causes Control. 2017 Jun;28(6):497-528.

67.Hruby A, Ma J, Rogers G, Meigs JB, Jacques PF. Associations of dairy intake with incident prediabeses or diabetes in middle-aged adults vary by both dairy type and glycemic status. J Nutr, Aug 2017, doi: 10.3945/jn.117.253401.

68.C Hoppe C, Molgaard C, Juul A & K F Michaelsen. High intakes of skimmed milk, but not meat, increase serum IGF-I and IGFBP-3 in eight-year-old boys. European Journal of Clinical Nutrition (2004) 58, 1211–1216 (2004)

69.Carbonaro M, Grant G, Cappelloni M, Pusztai A. Perspectives into Factors Limiting in Vivo Digestion of Legume Proteins:  Antinutritional Compounds or Storage Proteins? J. Agric. Food Chem., 2000, 48 (3), pp 742–749

70.Grant G, Dorward PM, Buchan WC, Armour JC, Pusztai A. Consumption of diets containing raw soya beans (Glycine max), kidney beans (Phaseolus vulgaris), cowpeas (Vigna unguiculata) or lupin seeds (Lupinus angustifolius) by rats for up to 700 days: effects on body composition and organ weights. Br J Nutr. 1995 Jan;73(1):17-29

71.Pusztai A, Clarke EM, King TP, Stewart JC. Nutritional evaluation of kidney beans (Phaseolus vulgaris): chemical composition, lectin content and nutritional value of selected cultivars. J Sci Food Agric. 1979 Sep;30(9):843-8

72.Cordain L. https://thepaleodiet.com/ancestral-fire-production-implications-contemporary-paleo-diets/

2007

73. Lindeberg S, Jönsson T, Granfeldt Y, Borgstrand E, Soffman J, Sjöström K, Ahrén B. A Palaeolithic diet improves glucose tolerance more than a Mediterranean-like diet in individuals with ischaemic heart disease. Diabetologia 2007, 50(9):1795-1807.

2008

74. Osterdahl M, Kocturk T, Koochek A, Wandell PE: Effects of a short-term intervention with a Paleolithic diet in healthy volunteers. Eur J Clin Nutr 2008, 62(5):682-685.

2009

75. Frassetto LA, Schloetter M, Mietus-Synder M, Morris RC Jr, Sebastian A. Metabolic and physiologic improvements from consuming a Paleolithic, hunter-gatherer type diet. Eur J Clin Nutr 2009. Aug;63(8):947-55
76. Jönsson T, Granfeldt Y, Ahrén B, Branell UC, Pålsson G, Hansson A, Söderström M, Lindeberg S. Beneficial effects of a Paleolithic diet on cardiovascular risk factors in type 2 diabetes: a randomized cross-over pilot study. Cardiovasc Diabetol. 2009;8:35 doi: 10.1186/1475-2840-8-35

2010

77. Jonsson T, Granfeldt Y, Erlanson-Albertsson C, Ahrén B, Lindeberg S. A Paleolithic diet is more satiating per calorie than a Mediterranean-like diet in individuals with ischemic heart disease. Nutr Metab (Lond). 2010 Nov 30;7(1):85 doi: 10.1186/1743-7075-7-85.

2013

78. Ryberg M, Sandberg S, Mellberg C, Stegle O, Lindahl B, Larsson C, Hauksson J, Olsson T. A Palaeolithic-type diet causes strong tissue-specific effects on ectopic fat deposition in obese postmenopausal women. J Intern Med. 2013 Jul;274(1):67-76

79.Clemens Z, Kelemen A, Fogarasi A, Tóth C. Childhood absence epilepsy successfully treated with the paleolithic ketogenic diet. Neurol Ther. 2013 Sep 21;2(1-2):71-6. doi: 10.1007/s40120-013-0013-2. eCollection 2013.

2014

80.Toth C, et al. Type 1 diabetes mellitus successfully managed with the Paleolithic ketogenic diet. Int J Case Pep Images. 2014 5(10):699-703.

81. Whalen KA, McCullough M, Flanders WD, Hartman TJ, Judd S, Bostick RM. Paleolithic and Mediterranean diet pattern scores and risk of incident, sporadic colorectal adenomas. Am J Epidemiol. 2014 Dec 1;180(11):1088-97.

82.Stomby A, Simonyte K, Mellberg C, Ryberg M, Stimson RH, Larsson C, Lindahl B, Andrew R, Walker BR, Olsson T. Diet-induced weight loss has chronic tissue-specific effects on glucocorticoid metabolism in overweight postmenopausal women. Int J Obes (Lond). 2014 May;39(5):814-9

83. Boers I, Muskiet FA, Berkelaar E, Schut E, Penders R, Hoenderdos K, Wichers HJ, Jong MC. Favourable effects of consuming a Palaeolithic-type diet on characteristics of the metabolic syndrom. A randomized controlled pilot-study. Lipids Health Dis. 2014 Oct 11;13:160. doi: 10.1186/1476-511X-13-160.
84. Carter P, Achana F, Troughton J, Gray LJ, Khunti K, Davies MJ. A Mediterranean diet improves HbA1c but not fasting blood glucose compared to alternative dietary strategies: a network meta-analysis. J Hum Nutr Diet. 2014 Jun;27(3):280-97
85. Talreja D, Buchanan H, Talreja R, Heiby L, Thomas B, Wetmore J, Pourfarzib R, Winegar D. Impact of a Paleolithic diet on modifiable CV risk factors. J Clin Lipid. 2014 May; 8(3): 341.
86. Mellberg C, Sandberg S, Ryberg M, Eriksson M, Brage S, Larsson C, Olsson T, Lindahl B. Long-term effects of a Palaeolithic-type diet in obese postmenopausal women: a 2-year randomized trial. Eur J Clin Nutr. 2014 Mar;68(3):350-7.
87. Jönsson T, Granfeldt Y, Lindeberg S, Hallberg AC. Subjective satiety and other experiences of a Paleolithic diet compared to a diabetes diet in patients with type 2 diabetes. Nutr J. 2013 Jul 29;12:105. doi: 10.1186/1475-2891-12-105.

2015

88. Manheimer EW, van Zuuren EJ, Fedorowicz Z, Pijl H. Paleolithic nutrition for metabolic syndrome: systematic review and meta-analysis. Am J Clin Nutr. 2015 Oct;102(4):922-32.
89. Pastore RL, Brooks JT1, Carbone JW2. et al. Paleolithic nutrition improves plasma lipid concentrations of hypercholesterolemic adults to a greater extent than traditional heart-healthy dietary recommendations. Nutr Res. 2015; 35:474-479.
90. Masharani U, Sherchan P, Schloetter M, Stratford S, Xiao A, Sebastian A, Nolte Kennedy M, Frassetto L. Metabolic and physiologic effects from consuming a hunter-gatherer (Paleolithic)-type diet in type 2 diabetes. Eur J Clin Nutr. 2015 Aug;69(8):944-8.
91. Bligh HF, Godsland IF, Frost G, Hunter KJ, Murray P, MacAulay K, Hyliands D, Talbot DC, Casey J, Mulder TP, Berry MJ. Plant-rich mixed meals based on Palaeolithic diet principles have a dramatic impact on incretin, peptide YY and satiety response, but show little effect on glucose and insulin homeostasis: an acute-effects randomised study.Br J Nutr. 2015 Feb 28;113(4):574-84.

2016

92.Talreja D, Talreja A, Talreja S, Choi H, Talreja R An Investigation of Plant-based, Mediterranean, Paleolithic, and Dash Diets. J Am Coll Cardiol Intv. 2016;9(4_S):S61-S61. doi:10.1016/j.jcin.2015.12.195

93.Whalen KA, McCullough ML, Flanders WD, Hartman TJ, Judd S, Bostick RM. Paleolithic and Mediterranean diet pattern scores are inversely associated with biomarkers of inflammation and oxidative balance in adults. J Nutr. 2016 Apr 20. pii: jn224048. [Epub ahead of print]

94.Fontes-Villalba M, Lindeberg S, Granfeldt Y, Knop FK, Memon AA, Carrera-Bastos P, Picazo Ó, Chanrai M, Sunquist J, Sundquist K, Jönsson T. Palaeolithic diet decreases fasting plasma leptin concentrations more than a diabetes diet in patients with type 2 diabetes: a randomised cross-over trial. Cardiovasc Diabetol. 2016 May 23;15(1):80. doi: 10.1186/s12933-016-0398-1.

95.Otten J, Stomby A, Waling M, Isaksson A, Tellström A, Lundin-Olsson L, Brage S, Ryberg M, Svensson M, Olsson T. Effects of a Paleolithic diet with and without supervised exercise on fat mass, insulin sensitivity, and glycemic control: a randomized controlled trial in individuals with type 2 diabetes. Diabetes Metab Res R ev. 2016 May 27. doi: 10.1002/dmrr.2828. [Epub ahead of print]

96.Dolan C, Carillo A, Davies N, Markofski M. Effects of an 8-week Paleo dietary intervention on inflammatory cytokines. 2016 American Physiological Society Conference, Inflammation, Immunity and Cardiovascular Disease, Westminster, CO, August 24-27, 2016, Poster Session II, 10.4, pp 40-41.

2017

97.Whalen KA, Judd S, McCullough ML, Flanders WD, Hartman TJ, Bostick RM. Paleolithic and Mediterranean Diet Pattern Scores Are Inversely Associated with All-Cause and Cause-Specific Mortality in Adults. J Nutr. 2017 Feb 8;:jn241919.

98.Blomquist C, Alvehus M, Burén J, Ryberg M, Larsson C, Lindahl B, Mellberg C, Söderström I, Chorell E, Olsson T. Attenuated Low-Grade Inflammation Following Long-Term Dietary Intervention in Postmenopausal Women with Obesity. Obesity (Silver Spring). 2017 May;25(5):892-900

99.Afifi L, Danesh MJ, Lee KM, Beroukhim K, Farahnik B, Ahn RS, Yan D, Singh RK, Nakamura M, Koo J, Liao W. Dietary Behaviors in Psoriasis: Patient-Reported Outcomes from a U.S. National Survey. Dermatol Ther (Heidelb). 2017 Jun;7(2):227-242

100.Manousou S, Stål M, Larsson C, Mellberg C, Lindahl B, Eggertsen R, Hulthén L, Olsson T, Ryberg M, Sandberg S, Nyström HF, A Paleolithic-type diet results in iodine deficiency: a 2-year randomized trial in postmenopausal obese women. Eur J Clin Nutr. 2017 Sep 13. doi: 10.1038/ejcn.2017.134. [Epub ahead of print]

101.Lee JE, Bisht B, Hall MJ, Rubenstein LM, Louison R, Klein DT, Wahls TL. A Multimodal, Nonpharmacologic Intervention Improves Mood and Cognitive Function in People with Multiple Sclerosis. J Am Coll Nutr. 2017 Mar-Apr;36(3):150-168.

102.Heatherly AJ, Killen LG, Smith AF, Waldman HS, Hollingsworth A, Seltmann CL, O'Neal EK. Effects of ad libitum Low Carbohydrate High-Fat Dieting in Middle-Age Male Runners. Med Sci Sports Exerc. 2017 Nov 6. doi: 10.1249/MSS.0000000000001477. [Epub ahead of print]