Tag Archives: heart disease

Introduction

        Unless you are involved in the culinary arts or the meat industry, you probably haven’t given much thought to the term, “Saint Louis Style Pork Ribs”.   Is this dish some kind of specially spiced, spare rib recipe from St. Louis, MO?  Did it originate in a colorful Saint Louis, 20th century restaurant, or maybe it was first served at a St. Louis Cardinal baseball game in the 1930s?   All three hypotheses seem to be plausible (1).

        Saint Louis Style Pork Ribs first and foremost represent a specific butchery cut of pork ribs recognized by the USDA (1).  Figures 1 and 2 below demonstrate exactly how “St. Louis Style Pork Ribs” are butchered from hogs.

Figures 1 and 2.   Butchery location of Saint Louis Style Pork Spare Ribs.

 

Because of their anatomical location slightly above pork bellies (the pork cut used for bacon manufacture), St. Louis Style Pork Spareribs represent the highest-fat, (combined muscle, bone and fat) cut in the entire pig.  O.K. what is the big deal about Saint Louis Style Pork Spareribs?

As many of our readers are aware, the official USDA position to prevent cardiovascular disease (CVD) is to eat less, not more saturated fat from fatty meats such as Saint Louis Pork Spareribs.  But, is there some nutritional factor present in unadulterated, fatty pork meat, such as found in Saint Louis Style Pork Spareribs that may not only prevent CVD, but may also prevent osteoporosis and be therapeutic for a wide variety of diseases which afflict the western world?

 

Dietary Menaquinones (Vitamin K2)

Saint Louis Style Pork Ribs have recently (2016) been discovered to be one of the richest dietary sources of menaquinones (2), also collectively known as vitamin K2.  Ingestion of menaquinones may reduce the risk of cardiovascular disease (CVD) (3-10), osteoporosis (11-16), multiple sclerosis and other autoimmune diseases (17-23) and cancer (24).  The optimal intake of the 10 dietary menaquinones (MK-4, MK-5, MK-6, MK-7, MK-8, MK-9, MK-10, MK-11, MK-12 and MK-13) is unknown (2, 25-27). Nevertheless, it is suspected that our current western diet is low or deficient in total menaquinones (MK-4 to MK-13) [2, 25-27].

If you relish fatty cuts of pork (back ribs, spare ribs and Saint Louis Style ribs), you are in luck, as the fattier the pork cuts, the more menaquinones they contain (2), which is a good thing for your bones (11-16), your heart (3-10) your immune system (17-23), and cancer prevention (24).  Table 1 demonstrates the concentrations of the 10 menaquinones (MK-4 to MK-13) in both processed pork products (Kielbasa, Pork sausage and Canadian bacon) and in fresh cuts of pork meat.

Table 1.  The menaquinone content (μg/100 g) of processed and fresh pork meats (2), ND = not detected.

Processed pork meats showed a strong correlation (r = 0.94) between total fat content of the various cuts and vitamin K content.  This robust relationship is not surprising as vitamin K is a fat soluble vitamin, and it’s hydrophobic (water avoiding) nature (30) explains why it is found in lower concentrations in leaner cuts of pork, which contain more water and less fat.  Accordingly, if you want to increase your dietary intake of menaquinones, you should eat fattier cuts of pork.

How about processed pork?  Should you consider eating huge quantities of Kielbasa, Pork sausage links and patties and Canadian bacon to obtain your menaquinones?  Probably not a good idea because all processed meats are highly salted. Table 2 below demonstrates the sodium (Na+) and potassium (K+) contents of the processed pork meats from study (2) and contrasts them to the fresh pork meats also tested in this study (2).

Despite being concentrated sources of menaquinones (Table 1), processed pork meat is also a concentrated source of Na+ with a 100 g serving averaging 1152 mg of Na+ and also exhibiting an unhealthy K+/Na+ ratio of 0.31.  For adults the daily recommended intake of Na+ is 2,300 mg and for hypertensives, 1,500 mg or less (28).  The Institute of Medicine (IOM) recommends a K+/Na+ ratio of 2.04, whereas contemporary Paleo diets maintain K+/Na+ ratios between 5.0 to 10.0 or higher (28, 29).  Hence, for our stone age ancestors, dietary K+/Na+ ratios below 1.0 (as present in processed pork meat) would have been impossible (28, 29).

In contrast, fresh cuts of fatty pork are not only rich sources of dietary menaquinones but also maintain healthful low Na+ concentrations together with high K+ concentrations (Table 2). Hence, fresh (unadulterated) pork, particularly fatty cuts represent excellent food choices to maintain high intakes of menaquinones while simultaneously keeping your Na+ intake low and K+ high.

Table 2.  The sodium (Na+) and potassium (K+) contents of processed and fresh pork meats, along with their (Ca2+) and magnesium (Mg2+) contents.

The Dietary Origin of Menaquinones

Vitamin K1, also known as phylloquinone is the most abundant form of vitamin K in our diet and is found in highest concentrations in leafy, green vegetables.  Our bodies have the capacity to convert K1 into menaquinones, but only into MK-4 (30). All other menaquinones (MK-5 to MK-13) are synthesized by bacteria and enter the human food chain either through dietary sources (particularly fermented foods) or from resident bacteria in our guts (25, 26, 30).

Recently (2018-17), accurate menaquinone measurements have been reported for fermented dairy products, particularly cheeses (31, 32).  Table 3 below shows the levels of menaquinones (MKs) in a variety of cheeses (31). As you can see from this table, a number of cheeses represent highly concentrated food sources of menaquinones, consumption of which would normally be a good thing from a nutritional perspective, as dietary menaquinones may reduce the risk of cardiovascular disease (CVD) (3-10), osteoporosis (11-16), multiple sclerosis and other autoimmune diseases (17-23) and cancer (24).

Unfortunately, as was the case with processed pork meats (Table 2), cheeses are almost universally high in salt, as can be seen from Table 4 below.  All cheeses shown maintain K+/Na+ ratios considerably below 1.00 which represent impossible values from an evolutionary perspective (28, 29).

In addition to the impossible evolutionary K+/Na+ dietary ratios present in cheeses; cheeses also maintain impossible Ca2+/Mg2+ ratios which could have never been consumed by ancestral humans before the advent of animal husbandry and dairy consumption (29, 33).   Recommended Ca2+/Mg2+ ratios are about 2.00 (34), meaning that you should ingest about twice the amount of calcium relative to magnesium you obtain from your diet.  Contrast this recommendation to the average Ca2+/Mg2+ ratio of 24.04 found in cheeses (Table 4) – meaning that cheeses contain ten times more calcium than magnesium, compared to recommended Ca2+/Mg2+ ratios (34).

Table 3. The menaquinone content (μg/100 g) of various cheeses (31), NM = not measured.

Table 4.   The sodium (Na+) and potassium (K+) content of various cheeses, along with their (Ca2+) and magnesium (Mg2+) content.

O.K. what are the health consequences of consuming enormous amounts of calcium relative to magnesium, even if you obtain the health promoting dietary menaquinones found in fermented cheeses?  And what are the adverse health consequences of consuming foods such as cheeses and processed meats loaded with salt and containing K+/Na+ ratios of less than 1.00?

High calcium intakes relative to low magnesium intakes, which frequently occur with high dairy consumption, are linked to an increased risk for cardiovascular disease (34-41) and osteoporosis (42-47).  High salt diets increase your risk for hypertension, stroke, cardiovascular disease (28), autoimmune disease (48-57), gastric ulcers (58-63), all cancers (64-83), and ocular cataracts (84-92).

Let’s now take a step backwards and show you the evolutionary basis for this seeming nutritional conundrum which requires us to obtain sufficient dietary menaquinones from high fat foods but advises us against consuming high fat salt laden cheeses and processed meats.

The Evolutionary Basis for Menaquinones in Our Diet

John Speth, Ph.D., a world renown anthropologist/archaeologist, has been my friend and scientific colleague for almost two decades.  He recently published a paper which provides the nutrition and anthropology communities with a powerful insight into the evolutionary basis for menaquinones in the human diet (93).  

Sir Arthur Conan Doyle stated, “There is nothing more deceptive than an obvious fact.”  Indeed, in his paper (93) John has eloquently pointed out an obvious nutritional fact:  Humans have been regularly consuming putrid, rotting and fermented foods since the Middle Paleolithic era and likely earlier. This obvious fact had been apparently unknown to most anthropologists and nutritional scientists, including myself, until the publication of Dr. Speth’s paper in 2017.

In nature, the fermentation of fish, meat, fruits and vegetables is haphazardly carried out by various bacterial species, particularly by lactic acid producing bacteria (LAB) associated with modern food production including the following 11 bacterial genera: Carnobacterium, Enterococcus, Lactococcus, Lactobacillus, Leuconostoc, Oenococcus, Pediococcus, Streptococcus, Tetragenococcus, Vagococcus and Weisella (94-96).  Many species within the LAB genera including Lactococcus lactis (sub species. Cremoris) and Leuconostoc lactis synthesize high amounts of long chain menaquinones (MK-8 to MK-10) (97).  Other bacterial species which ferment Emmental and Jarlsberg cheese such as Propionibacterium freudenreichii produce high amounts of MK-9 (4H) (98).  The bacteria (Bacillus subtilis) which ferments soybeans to make the Japanese food, natto produce unusually high concentrations of MK-7 (25).

All dietary menaquinones derived from the bacterial fermentation of various human foods, ultimately enrich our diet with long chain (MK-7 to MK-13) menaquinones, and have likely done so for millions of years (93).  Optimal dietary menaquinones intake has almost certainly been intimately linked to the consumption of fermented food since our genus, Homo’s, very beginnings more than 2 million years ago.  Accordingly, these bacterially derived menaquinones have played an important evolutionary role in determining contemporary human nutritional requirements.

Summary and Practical Implications

Fatty pork cuts such as Saint Louis Style Pork Ribs represent an excellent dietary choice for maximizing your intake of long chain (MK-7 to MK-13) menaquinones intake without increasing your salt intake or compromising your nutritional K+/Na+ ratio.  Consumption of long chain dietary menaquinones reduce your risk for cardiovascular disease (CVD) (3-10), osteoporosis (11-16), multiple sclerosis and other autoimmune diseases (17-23) and cancer (24).

In contrast, three other major sources of dietary menaquinones in the western diet (cheese, processed pork meats, fermented soy foods (soy sauce, miso, natto) contain excessive salt and calcium which yield evolutionarily impossible dietary K+/Na+ and Ca2+/Mg2+ ratios that increase the risk for CVD (34-41), osteoporosis (42-47), autoimmune disease (48-57), gastric ulcer (58-63) all cause cancer (64-83), ocular cataract (84-92).

The evolutionary basis for menaquinones in human nutrition comes not from recently introduced high salt processed meats, cheeses or soy products (all of which may be high in menaquinones), but rather from the evolutionary selective pressures derived from our species consumption of unadulterated bacterially fermented foods containing long chain menaquinones for millions of years.

Looking to the Future

Although all forms of vitamin K (K1, K2 and vitamin K precursors [menadione]) have therapeutic effects, the longer chain vitamin K2 (particularly MK-7 to MK-13) appear to be more effective in ameliorating chronic disease (99, 100) than vitamin K1 (phylloquinone).

An alternative dietary strategy to maximize your intake of long chain dietary menaquinones exists without increasing salt or calcium and unbalancing your K+/Na+ or Ca2+/Mg2+ dietary ratios.  This strategy has been unknowingly suggested to extend human lifespan and has shown to increase the lifespan of insects.

Stay Tuned – I will reveal this evidence in the next Paleo Blog.

REFERENCE

 

1. https://en.wikipedia.org/wiki/St._Louis-style_barbecue

2. Fu X, Shen X, Finnan EG, Haytowitz DB, Booth SL. Measurement of multiple vitamin k forms in processed and fresh-cut pork products in the U.S. food supply. J Agric Food Chem. 2016 Jun 8;64(22):4531-5.

3. Shea MK, Booth SL, Weiner DE, Brinkley TE, Kanaya AM, Murphy RA, Simonsick EM, Wassel CL, Vermeer C, Kritchevsky SB; Health ABC Study. Circulating Vitamin K is inversely associated with incident cardiovascular disease risk among those treated for hypertension in the health, aging, and body composition study (Health ABC). J Nutr. 2017 May;147(5):888-895

4. Shea MK, Booth SL, Miller ME, Burke GL, Chen H, Cushman M, Tracy RP, Kritchevsky SB. Association between circulating vitamin K1 and coronary calcium progression in community-dwelling adults: the Multi-Ethnic Study of Atherosclerosis. Am J Clin Nutr. 2013 Jul;98(1):197-208.

5. Shea MK, O’Donnell CJ, Hoffmann U, Dallal GE, Dawson-Hughes B, Ordovas JM, Price PA, Williamson MK, Booth SL. Vitamin K supplementation and progression of coronary artery calcium in older men and women. Am J Clin Nutr. 2009 Jun;89(6):1799-807

6. Gast GC, de Roos NM, Sluijs I, et al. A high menaquinone intake reduces the incidence of coronary heart disease. Nutr Metab Cardiovasc Dis. 2009 Sep;19(7):504-10.

7. Geleijnse JM, Vermeer C, Grobbee DE, Schurgers LJ, Knapen MH, van der Meer IM, Hofman A, Witteman JC. Dietary intake of menaquinone is associated with a reduced risk of coronary heart disease: the Rotterdam Study. J Nutr. 2004 Nov;134(11):3100-5.

8. Beulens JW, Bots ML, Atsma F, Bartelink ML, Prokop M, Geleijnse JM, Witteman JC, Grobbee DE, van der Schouw YT. High dietary menaquinone intake is associated with reduced coronary calcification. Atherosclerosis. 2009 Apr;203(2):489-93

9. Mayer O Jr, Seidlerová J, Vaněk J, Karnosová P, Bruthans J, Filipovský J, Wohlfahrt P, Cífková R, Windrichová J, Knapen MH, Drummen NE, Vermeer C. The abnormal status of uncarboxylated matrix Gla protein species represents an additional mortality risk in heart failure patients with vascular disease. Int J Cardiol. 2016 Jan 15;203: 916-22

10. Cundiff DK, Agutter PS. Cardiovascular disease death before age 65 in 168 countries correlated statistically with biometrics, socioeconomic status, tobacco, gender, exercise, macronutrients, and vitamin K. Cureus. 2016 Aug 24;8(8):e748. doi: 10.7759/cureus.748

11. Inaba N, Sato T, Yamashita T. Low-Dose daily intake of vitamin [C1] K (2) (menaquinone-7) improves osteocalcin γ-carboxylation: a double-blind, randomized controlled trials. J Nutr Sci Vitaminol (Tokyo). 2015;61(6):471-80

12. Shiraki M, Shiraki Y, Aoki C, Miura M. Vitamin K2 (menatetrenone) effectively prevents fractures and sustains lumbar bone mineral density in osteoporosis. J Bone Miner Res. 2000 Mar;15(3):515-21

13. Rønn SH, Harsløf T, Pedersen SB, Langdahl BL. Vitamin K2 (menaquinone-7) prevents age-related deterioration of trabecular bone microarchitecture at the tibia in postmenopausal women. Eur J Endocrinol. 2016 Dec;175(6):541-549

14. Knapen MH, Drummen NE, Smit E, Vermeer C & Theuwissen E. Three-year low-dose menaquinone-7 supplementation helps decrease bone loss in healthy postmenopausal women. Osteoporosis International 2013 24 2499–2507.

15. Kanellakis S, Moschonis G, Tenta R, Schaafsma A, van den Heuvel EG, Papaioannou N, Lyritis G & Manios Y. Changes in parameters of bone metabolism in postmenopausal women following a
12-month intervention period using dairy products enriched with calcium, vitamin D, and phylloquinone (vitamin K(1)) or menaquinone-7 (vitamin K (2)): the Postmenopausal Health Study II. Calcified Tissue International 2012 90 251–262.

16. Huang ZB, Wan SL, Lu YJ, Ning L, Liu C, Fan SW. Does vitamin K2 play a role in the prevention and treatment of osteoporosis for postmenopausal women: a meta-analysis of randomized controlled trials. Osteoporos Int. 2015 Mar;26(3):1175-86.

17. Riphagen IJ, Keyzer CA, Drummen NEA, de Borst MH, Beulens JWJ, Gansevoort RT, Geleijnse JM, Muskiet FAJ, Navis G, Visser ST, Vermeer C, Kema IP, Bakker SJL.
Prevalence and Effects of Functional Vitamin K Insufficiency: The PREVEND Study. Nutrients. 2017 Dec 8;9(12). pii: E1334. doi: 10.3390/nu9121334

18. Lasemi R1, Kundi M2, Moghadam NB3,4, Moshammer H1, Hainfellner JA5. Vitamin K2 in multiple sclerosis patients. Wien Klin Wochenschr. 2018 May;130(9-10):307-313.

19. Kusano J, Tanaka S, Matsuda H, et al. K1 and Vitamin K2 immunopharmacological effects on the peripheral lymphocytes of healthy subjects and dialysis patients, as estimated by the lymphocyte immunosuppressant sensitivity test. J Clin Pharm Ther. 2018 Jul 16. doi: 10.1111/jcpt.12747.

20. Myneni VD, Mezey E. Immunomodulatory effect of vitamin K2: Implications for bone health. Oral Dis. 2018 Mar;24(1-2):67-71.

21. Hatanaka H, Ishizawa H, Hirano T et al. Effects of vitamin K3 and K5 on proliferation, cytokine production, and regulatory T cell-frequency in human peripheral-blood mononuclear cells. Life Sci. 2014 Mar 18;99(1-2):61-8.

22. Meng K, Xu W, Hirano T et al. The effects of vitamin K1 and vitamin K2 on the proliferation, cytokine production and regulatory T-cell frequency in peripheral blood mononuclear cells of paediatric atopic dermatitis patients. Exp Dermatol. 2018 Apr 26. doi: 10.1111/exd.13671.

23. Wei FF, Thijs L, Zhang ZY et al. The risk of nephrolithiasis is causally related to inactive matrix Gla protein, a marker of vitamin K status: a Mendelian randomization study in a Flemish population. Nephrol Dial Transplant. 2018 Mar 1;33(3):514-522

24. Lamson DW, Plaza SM. The anticancer effects of vitamin K. Altern Med Rev. 2003 Aug;8(3):303-18

25. Walther B, Karl JP, Booth SL, Boyaval P. Menaquinones, bacteria, and the food supply: the relevance of dairy and fermented food products to vitamin K requirements. Adv Nutr. 2013 Jul 1;4(4):463-73

26. Beulens JW, Booth SL, van den Heuvel EG, Stoecklin E, Baka A, Vermeer C. The role of menaquinones (vitamin K₂) in human health. Br J Nutr. 2013 Oct;110(8):1357-68.

27. Shea MK, Booth SL. Concepts and controversies in evaluating vitamin k status in population-based studies. Nutrients. 2016 Jan 2;8(1). pii: E8. doi: 10.3390/nu8010008.

28. Sebastian A, Cordain L, Frassetto L, Banerjee T, Morris RC. Postulating the major environmental condition resulting in the expression of essential hypertension and its associated cardiovascular diseases: Dietary imprudence in daily selection of foods in respect of their potassium and sodium content resulting in oxidative stress-induced dysfunction of the vascular endothelium, vascular smooth muscle, and perivascular tissues. Med Hypotheses. 2018 Oct;119: 110-119

29. Cordain L. Nutritional characteristics of a contemporary diet based on Paleolithic food groups. J Am Nutraceutical Assoc 2002;5(3):15–24.

30. Shearer MJ, Okano T. key pathways and regulators of vitamin k function and intermediary metabolism. Annu Rev Nutr. 2018 Aug 21;38: 127-151

31. Vermeer C, Raes J, van ‘t Hoofd C, Knapen MHJ, Xanthoulea S. Menaquinone content of cheese. Nutrients. 2018 Apr 4;10(4). pii: E446. doi: 10.3390/nu10040446.

32. Fu X, Harshman SG, Shen X, Haytowitz DB, Karl JP, Wolfe BE, Booth SL. Multiple Vitamin K forms exist in dairy foods. Curr Dev Nutr. 2017 Jun 1;1(6):e000638. doi: 10.3945/cdn.117.000638.

33. Cordain L, Hickey MS, Kim K.  Malaria and rickets represent selective forces for the convergent evolution of adult lactase persistence. 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.

34. Rosanoff A, Dai Q, Shapses SA. Essential nutrient interactions: does low or suboptimal magnesium status interact with vitamin d and/or calcium status? Adv Nutr. 2016 Jan 15;7(1):25-43

35. Varo P. Mineral element balance and coronary heart disease.   Int J Vitam Nutr Res. 1974;44(2):267-73

36. Sato H, Takeuchi Y, Matsuda K, et al. Evaluation of the Predictive Value of the Serum Calcium-Magnesium Ratio for All-Cause and Cardiovascular Mortality in Incident Dialysis Patients. Cardiorenal Med. 2017 Dec;8(1):50-60

37. DiNicolantonio JJ, McCarty MF, O’Keefe JH. Decreased magnesium status may mediate the increased cardiovascular risk associated with calcium supplementation. Open Heart. 2017 May 22;4(1):e000617. doi: 10.1136/openhrt-2017-000617.

38. Park B, Kim MH, Cha CK, Lee YJ, Kim KC. High calcium-magnesium ratio in hair is associated with coronary artery calcification in middle-aged and elderly individuals. Biol Trace Elem Res. 2017 Sep;179(1):52-58

39. Kosch M, Hausberg M, Westermann G, et al. Alterations in calcium and magnesium content of red cell membranes in patients with primary hypertension. Am J Hypertens. 2001 Mar;14(3):254-8

40. Kisters K, Wessels F, Küper H, et al. Increased calcium and decreased magnesium concentrations and an increased calcium/magnesium ratio in spontaneously hypertensive rats versus Wistar-Kyoto rats: relation to arteriosclerosis. Am J Hypertens. 2004 Jan;17(1):59-62.

41. Resnick LM. Ionic basis of hypertension, insulin resistance, vascular disease, and related disorders. The mechanism of “syndrome X”. Am J Hypertens. 1993 Apr;6(4):123S-134S.

42. Tucker KL, Hannan MT, Chen H, Cupples LA, Wilson PW, Kiel DP. Potassium, magnesium, and fruit and vegetable intakes are associated with greater bone mineral density in elderly men and women. Am J Clin Nutr. 1999 Apr;69(4):727-36.

43. Ryder KM, Shorr RI, Bush AJ, Kritchevsky SB, Harris T, Stone K, Cauley J, Tylavsky FA. Magnesium intake from food and supplements is associated with bone mineral density in healthy older white subjects. J Am Geriatr Soc. 2005 Nov;53(11):1875-80

44. Stendig-Lindberg G1, Tepper R, Leichter I. Trabecular bone density in a two year controlled trial of peroral magnesium in osteoporosis. Magnes Res. 1993 Jun;6(2):155-63.

45. Rude RK, Singer FR, Gruber HE. Skeletal and hormonal effects of magnesium deficiency. J Am Coll Nutr. 2009 Apr;28(2):131-41

46. Sojka JE, Weaver CM. Magnesium supplementation and osteoporosis. Nutr Rev. 1995 Mar;53(3):71-4

47. New SA, Bolton-Smith C, Grubb DA, Reid DM. Nutritional influences on bone mineral density: a cross-sectional study in premenopausal women. Am J Clin Nutr. 1997 Jun;65(6):1831-9.

48. Wu C, Yosef N, Thalhamer T, Zhu C, Xiao S, Kishi Y, Regev A, Kuchroo VK. Induction of pathogenic TH17 cells by inducible salt-sensing kinase SGK1. Nature. 2013 Apr 25;496(7446):513-7.

49. Kleinewietfeld M, Manzel A, Titze J, Kvakan H, Yosef N, Linker RA, Muller DN, Hafler DA.  Sodium chloride drives autoimmune disease by the induction of pathogenic TH17 cells. Nature. 2013 Apr 25;496(7446):518-22

50. Hucke S, Eschborn M, Liebmann M, Herold M, Freise N, Engbers A, Ehling P, Meuth SG, Roth J, Kuhlmann T, Wiendl H, Klotz L. Sodium chloride promotes pro-inflammatory macrophage polarization thereby aggravating CNS autoimmunity. J Autoimmun. 2016 Feb;67:90-101.

51. Zostawa J, Adamczyk J, Sowa P, Adamczyk-Sowa M. The influence of sodium on pathophysiology of multiple sclerosis. Neurol Sci. 2017 Mar;38(3):389-398.

52. Schatz V, Neubert P, Schröder A, Binger K, Gebhard M, Müller DN, Luft FC, Titze J, Jantsch J. Elementary immunology: Na+ as a regulator of immunity. Pediatr Nephrol. 2017 Feb;32(2):201-210.

53. Hernandez AL, Kitz A, Wu C, Lowther DE, Rodriguez DM, Vudattu N, Deng S, Herold KC, Kuchroo VK, Kleinewietfeld M, Hafler DA. Sodium chloride inhibits the suppressive function of FOXP3+ regulatory T cells. J Clin Invest. 2015 Nov 2;125(11):4212-22.

54. Yi B, Titze J, Rykova M, Feuerecker M, Vassilieva G, Nichiporuk I, Schelling G, Morukov B, Choukèr A. Effects of dietary salt levels on monocytic cells and immune responses in healthy human subjects: a longitudinal study. Transl Res. 2015 Jul;166(1):103-10.

55. Zhou X, Zhang L, Ji WJ, Yuan F, Guo ZZ, Pang B, Luo T, Liu X, Zhang WC, Jiang TM, Zhang Z, Li YM. Variation in dietary salt intake induces coordinated dynamics of monocyte subsets and monocyte-platelet aggregates in humans: implications in end organ inflammation. PLoS One. 2013 Apr 4;8(4):e60332.

56. Zhou X, Yuan F, Ji WJ, Guo ZZ, Zhang L, Lu RY, Liu X, Liu HM, Zhang WC, Jiang TM, Zhang Z, Li YM. High-salt intake induced visceral adipose tissue hypoxia and its association with circulating monocyte subsets in humans. Obesity (Silver Spring). 2014 Jun;22(6):1470-6.

57. Min B, Fairchild RL. Over-salting ruins the balance of the immune menu.  J Clin Invest. 2015 Nov 2;125(11):4002-4.

58. Fox JG Dangler CA, Taylor NS, King A, Koh TJ, Wang TC. High-salt diet induces gastric epithelial hyperplasia and parietal cell loss, and enhances Helicobacter pylori colonization in C57BL/6 mice. Cancer Res. 1999 Oct 1;59(19):4823-8.

59. Shikata K, Kiyohara Y, Kubo M, Yonemoto K et al. A prospective study of dietary salt intake and gastric cancer incidence in a defined Japanese population: The Hisayama study. Int J Cancer. 2006 Jul 1;119(1):196-201.

60. Peleteiro B, Lopes C, Figueiredo C, Lunet N. Salt intake and gastric cancer risk according to Helicobacter pylori infection, smoking, tumour site and histological type. Br J Cancer. 2011 Jan 4;104(1):198-207.

61. Tsugane S. Salt, salted food intake, and risk of gastric cancer: epidemiologic evidence. Cancer Sci. 2005 Jan;96(1):1-6.

62. Wang XQ, Terry PD, Yan H. Review of salt consumption and stomach cancer risk: epidemiological and biological evidence. World J Gastroenterol. 2009 May 14;15(18):2204-13.

63. D’Elia L1, Galletti F, Strazzullo P. Dietary salt intake and risk of gastric cancer. Cancer Treat Res. 2014;159:83-95.

64. Amara S, Tiriveedhi V. Inflammatory role of high salt level in tumor microenvironment (Review).  Int J Oncol. 2017 May;50(5):1477-1481

65. Amara S, Alotaibi D, Tiriveedhi V. NFAT5/STAT3 interaction mediates synergism of high salt with IL-17 towards induction of VEGF-A expression in breast cancer cells. Oncol Lett. 2016 Aug;12(2):933-943

66. Amara S, Zheng M, Tiriveedhi V. Oleanolic acid inhibits high salt-induced exaggeration of warburg-like metabolism in breast cancer cells. Cell Biochem Biophys. 2016 Sep;74(3):427-34.

67. Amara S, Whalen M, Tiriveedhi V. High salt induces anti-inflammatory MΦ2-like phenotype in peripheral macrophages. Biochem Biophys Rep. 2016 Sep; 7:1-9

68. Amara S, Ivy MT, Myles EL, Tiriveedhi V. Sodium channel γENaC mediates IL-17 synergized high salt induced inflammatory stress in breast cancer cells. Cell Immunol. 2016 Apr; 302:1-10

69. Amara S, Majors C, Roy B, Hill S, Rose KL, Myles EL, Tiriveedhi. Critical role of SIK3 in mediating high salt and IL-17 synergy leading to breast cancer cell proliferation. PLoS One. 2017 Jun 28;12(6):e0180097. doi: 10.1371/journal.pone.0180097

70. Jansson B. Potassium, sodium, and cancer: a review. J Environ Pathol Toxicol Oncol. 1996;15(2-4):65-73

71. Jansson B. Dietary, total body, and intracellular potassium-to-sodium ratios and their influence on cancer. Cancer Detect Prev. 1990;14(5):563-5

72. Jansson B. Intracellular electrolytes and their role in cancer etiology.  In Thompson JR, Brown BW, eds. Cancer modeling. New York: Marcel Dekker 1987:1-59.

73. Jansson B. Geographic cancer risk and intracellular potassium/sodium ratios. Cancer Detect Prev. 1986;9(3-4):171-94

74. Jansson B, Jankovic J. Low cancer rates among patients with Parkinson’s disease. Ann Neurol. 1985 May;17(5):505-9

75. Newmark HL, Wargovich MJ, Bruce VR, Boynton AL, Kleine LP, Whitfield JF. Jansson B, Cameron IL. Ions and neoplastic development. In: Mastromarino AJ, Brattain MG, eds. Large bowel cancer. Clinical and basic science research. Cancer Research Monographs, Vol 3, New York: Praeger Publisher 1985:102-129.

76. Jansson B. Geographic mappings of colorectal cancer rates: a retrospect of studies, 1974-1984. Cancer Detect Prev. 1985;8(3):341-8

77. Jansson B. Seneca County, New York: an area with low cancer mortality rates. Cancer. 1981 Dec 1;48(11):2542-6

78. Jacobs MM, Pienta RJ.  Relationships between potassium and cancer.  In: Vitamins and Minerals in the Prevention and Treatment of Cancer (Jacobs MM [ed.]), 1991, CRC Press, Boston, Chapter 16, 227-245.

79. Davies RJ, Sandle GI, Thompson SM. Inhibition of the Na+,K(+)-ATPase pump during induction of experimental colon cancer. Cancer Biochem Biophys. 1991 Aug;12(2):81-94.

80. Thompson, Davies RJ.  A high potassium diet prevents transepithelial depolarization in experimental colon cancer. In: Vitamins and Minerals in the Prevention and Treatment of Cancer, (Maryce M. Jacobs, Ed.), CRC Press, Boston, 1991, p 263.

81. Fine BP, Hansen KA, Walters TR, Denny TN.  Dietary sodium deprivation inhibits cellular proliferation: evidence for circulating factor(s). In: Vitamins and Minerals in the Prevention and Treatment of Cancer, (Maryce M. Jacobs, Ed.), CRC Press, Boston, 1991, p 276.

82. Fine BP, Ponzio NM, Denny TN, Maher E, Walters TR. Restriction of tumor growth in mice by sodium-deficient diet. Cancer Res. 1988 Jun 15;48(12):3445-8.

83. Davies RJ, Daly JM. Potassium depletion and malignant transformation of villous adenomas of the colon and rectum. Cancer. 1984 Mar 15;53(6):1260-4.

84. CT Horng, YL Lee, HC Wu, HY et al. High salt diet induced the rapid myopic shift of cataract formation. Life Sci J, 2014;11:396-399.

85. Rodríguez-Sargent C, Cangiano JL, Berríos Cabán G, Marrero E, Martínez-Maldonado M. Cataracts and hypertension in salt-sensitive rats. A possible ion transport defect. Hypertension. 1987 Mar;9(3):304-8.

85. Donnelly CA, Seth J, Clayton RM, Phillips CI, Cuthbert J. Some plasma constituents correlate with human cataract location and nuclear colour. Ophthalmic Res. 1997;29(4):207-17.

86. Mathur G, Pai V. Comparison of serum sodium and potassium levels in patients with senile cataract and age-matched individuals without cataract. Indian J Ophthalmol. 2016 Jun;64(6):446-7.

87. Mirsamadi M, Nourmohammadi I, Imamian M. Comparative study of serum Na(+ )and K(+ ) levels in senile cataract patients and normal individuals. Int J Med Sci. 2004;1(3):165-169.

88. Bae JH, Shin DS, Lee SC, Hwang IC. Sodium intake and socioeconomic status as risk factors for development of age-related cataracts: The Korea National Health and Nutrition Examination Survey. PLoS One. 2015 Aug 19;10(8): e0136218. doi: 10.1371/journal.pone.0136218

89. Fossarello M, Orzalesi N, Corongiu FP, Biagini S, Casu M, Lai A.23Na NMR investigation of human lenses from patients with cataracts.FEBS Lett. 1985 May 20;184(2):245-8

90. Cumming RG, Mitchell P, Smith W. Dietary sodium intake and cataract: the Blue Mountains Eye Study. Am J Epidemiol. 2000 Mar 15;151(6):624-6

91. Rodríguez-Sargent C1, Berrios G, Irrizarry JE, Estapé ES, Cangiano JL, Martínez-Maldonado M. Prevention and reversal of cataracts in genetically hypertensive rats through sodium restriction. Invest Ophthalmol Vis Sci. 1989 Nov;30(11):2356-60.

92. Speth JD. Putrid meat and fish in the Eurasian Middle and Upper Paleolithic: Are we missing a key part of Neanderthal and Modern human diet? PaleoAnthropology 2017: 44−72. doi:10.4207/ PA.2017.ART 105

93. Mogensen G, Salminen S, O’Brien J.  Food microorganisms – Health benefits, safety evaluation and strains with documented history of use in foods.  Bull Int Dairy Fed, 2003;377:4-9.

94. De Vries MC, Vaughan EE, Kleerebezem M, Vos WM. Lactobacillus plantarum – survival, functional and potential probiotic properties in the human intestinal tract. Int Dairy J, 2006,16:1018-1028.

95. Azam M,  Mohsin M, Ijaz H, Tulain UR et al. Lactic acid bacteria in traditional fermented Asian foods. Pak J Pharm Sci, 2017, 5:1803-1814.

96. Morishita T, Tamura N, Makino T, Kudo S. Production of menaquinones by lactic acid bacteria. J Dairy Sci. 1999 Sep;82(9):1897-903

97. Hojo K, Watanabe R, Mori T, Taketomo N. Quantitative measurement of tetrahydromenaquinone-9 in cheese fermented by Propionibacteria. J Dairy Sci. 2007 Sep;90(9):4078-83.

98. Gast GC, de Roos NM, Sluijs I, Bots ML, Beulens JW, Geleijnse JM, Witteman JC, Grobbee DE, Peeters PH, van der Schouw YT. A high menaquinone intake reduces the incidence of coronary heart disease.  Nutr Metab Cardiovasc Dis. 2009 Sep;19(7):504-1

99. Cundiff DK, Agutter PS. Cardiovascular Disease Death Before Age 65 in 168 Countries Correlated Statistically with Biometrics, Socioeconomic Status, Tobacco, Gender, Exercise, Macronutrients, and Vitamin K.   Cureus. 2016 Aug 24;8(8):e748. doi: 10.7759/cureus.748.

[C1]

 

Fight Inflammation with a Paleo Diet

Most athletes are well aware of a fun little word called “inflammation”.1 Tough workouts are a common cause of inflammation. Acute inflammation (the only kind most people are aware of) is actually beneficial.2, 3 But – and this is a big BUT – chronic inflammation is a killer. Literally.4, 5, 6 The difference here is important, and very misunderstood. One of the biggest health benefits of consuming a Paleo diet comes from its anti-inflammatory nature.7, 8, 9 By fixing the Standard American Diet (SAD) ratio of high omega-6 to low omega-3, nearly everyone sees improvements.10, 11 But before we proceed further, let’s specify and define acute inflammation and chronic inflammation.

Fight Inflammation with a Paleo Diet

Imai, Yumi, Anca D. Dobrian, Margaret A. Morris, and Jerry L. Nadler. “Islet Inflammation: A Unifying Target for Diabetes Treatment?” Science Direct. Trends in Endocrinology & Metabolism, July 2013. Web. 25 Mar. 2015.

Fight Inflammation with a Paleo Diet

Heneka, Michael T., Markus P. Kummer, and Eicke Latz. “Innate Immune Activation in Neurodegenerative Disease.” Immunology Reviews. Nature, 25 June 2014. Web. 25 Mar. 2015.

Acute inflammation is what occurs when you get a bruise, cut, experience stress, or go through a hard workout.12 I used to practice Brazilian Jiu Jitsu and CrossFit on a near-daily basis, and I became very familiar with inflammation! However, this is the good kind of inflammation, remember. Without acute inflammation, you would never heal. Think about that for a minute. Chronic inflammation, by contrast, is problematic for two reasons. One, it is much less noticeable. You likely won’t have a bruise, cut, or any obvious symptoms. And two, it is the cause behind most serious diseases – whether it be cancer, heart disease or other conditions.13, 14, 15

With regard to diet, inflammation also plays a bigger role than most are aware of. Take acne, for example. This is an inflammatory condition. Some have even surmised that inflammation plays a role in acne at a subclinical level.16 This is one of the many reasons why dairy should be avoided when consuming a Paleo Diet. Perhaps surprisingly to some, coconut oil has been shown to have components which help protect against acne.17 The lauric acid found in coconut oil has anti-bacterial and anti-inflammatory properties, and would therefore also be beneficial after a tough workout.18 Win-win.

Vegetables are another key component of an anti-inflammatory diet, and unsurprisingly, a healthy Paleo diet is largely comprised of vegetables!19, 20 So what should athletes be eating? Coconut oil, protein and vegetables! Of course you’ll also want some anti-inflammatory fats, like the omega-3 fatty acids found in wild-caught seafood.21 From strictly a scientific perspective, it is quite clear athletes should stick to a diet based upon these foods to provide you with the best results.

Fight Inflammation with a Paleo Diet

Dantzer, Robert et al. “From Inflammation to Sickness and Depression: When the Immune System Subjugates the Brain.” Nature reviews. Neuroscience 9.1 (2008): 46–56. PMC. Web. 25 Mar. 2015.

Another aspect of inflammation which many are unaware of is that it can occur (and often does occur) in your brain!22 If the brain’s barrier is opened, your glial cells will likely be activated.23 These are the cells that deal with immunity. Once activated, an inflammatory response in your brain occurs.24 This is not good. To add to the fun, your brain now has trouble communicating with your gut, creating more issues, specifically serotonin biosynthesis problems.25 And, the delicate HPA (hypothalamus, pituitary, adrenal) axis will now likely be off-balance, as well.26

So, what is the best way to avoid inflammation, of all kinds (except beneficial, acute inflammation)? Quite simply: eat a Paleo diet. By avoiding gluten (a huge instigator of inflammation throughout the body and brain) you will be doing yourself a huge favor.27, 28 And when we replace problematic proteins like gluten, with nutrient-dense foods rich in protein, antioxidants and anti-inflammatory compounds, we procure better health for ourselves.29 Your mom was right: eat your vegetables for better health and less inflammation.30 Stay the course with a Paleo Diet and optimal health sans inflammation is within reach.

 

REFERENCES

[1] Pinto A, Di raimondo D, Tuttolomondo A, Buttà C, Milio G, Licata G. Effects of physical exercise on inflammatory markers of atherosclerosis. Curr Pharm Des. 2012;18(28):4326-49.

[2] Pedersen BK. The anti-inflammatory effect of exercise: its role in diabetes and cardiovascular disease control. Essays Biochem. 2006;42:105-17.

[3] You T, Arsenis NC, Disanzo BL, Lamonte MJ. Effects of exercise training on chronic inflammation in obesity : current evidence and potential mechanisms. Sports Med. 2013;43(4):243-56.

[4] Osiecki H. The role of chronic inflammation in cardiovascular disease and its regulation by nutrients. Altern Med Rev. 2004;9(1):32-53.

[5] Peev V, Nayer A, Contreras G. Dyslipidemia, malnutrition, inflammation, cardiovascular disease and mortality in chronic kidney disease. Curr Opin Lipidol. 2014;25(1):54-60.

[6] Kelly E, Owen CA, Pinto-plata V, Celli BR. The role of systemic inflammatory biomarkers to predict mortality in chronic obstructive pulmonary disease. Expert Rev Respir Med. 2013;7(1):57-64.

[7] De punder K, Pruimboom L. The dietary intake of wheat and other cereal grains and their role in inflammation. Nutrients. 2013;5(3):771-87.

[8] Soares FL, De oliveira matoso R, Teixeira LG, et al. Gluten-free diet reduces adiposity, inflammation and insulin resistance associated with the induction of PPAR-alpha and PPAR-gamma expression. J Nutr Biochem. 2013;24(6):1105-11.

[9] Nowlin SY, Hammer MJ, D’eramo melkus G. Diet, inflammation, and glycemic control in type 2 diabetes: an integrative review of the literature. J Nutr Metab. 2012;2012:542698.

[10] Kowalski LM, Bujko J. [Evaluation of biological and clinical potential of paleolithic diet]. Rocz Panstw Zakl Hig. 2012;63(1):9-15.

[11] 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;12:105.

[12] Ryan GB, Majno G. Acute inflammation. A review. Am J Pathol. 1977;86(1):183-276.

[13] Holmes C, Cunningham C, Zotova E, et al. Systemic inflammation and disease progression in Alzheimer disease. Neurology. 2009;73(10):768-74.

[14] Mcmillan DC, Elahi MM, Sattar N, Angerson WJ, Johnstone J, Mcardle CS. Measurement of the systemic inflammatory response predicts cancer-specific and non-cancer survival in patients with cancer. Nutr Cancer. 2001;41(1-2):64-9.

[15] Gomes de lima KV, Maio R. Nutritional status, systemic inflammation and prognosis of patients with gastrointestinal cancer. Nutr Hosp. 2012;27(3):707-14.

[16] Tanghetti EA. The role of inflammation in the pathology of acne. J Clin Aesthet Dermatol. 2013;6(9):27-35.

[17] Huang WC, Tsai TH, Chuang LT, Li YY, Zouboulis CC, Tsai PJ. Anti-bacterial and anti-inflammatory properties of capric acid against Propionibacterium acnes: a comparative study with lauric acid. J Dermatol Sci. 2014;73(3):232-40.

[18] Huang WC, Tsai TH, Chuang LT, Li YY, Zouboulis CC, Tsai PJ. Anti-bacterial and anti-inflammatory properties of capric acid against Propionibacterium acnes: a comparative study with lauric acid. J Dermatol Sci. 2014;73(3):232-40.

[19] Watzl B. Anti-inflammatory effects of plant-based foods and of their constituents. Int J Vitam Nutr Res. 2008;78(6):293-8.

[20] Galland L. Diet and inflammation. Nutr Clin Pract. 2010;25(6):634-40.

[21] Wall R, Ross RP, Fitzgerald GF, Stanton C. Fatty acids from fish: the anti-inflammatory potential of long-chain omega-3 fatty acids. Nutr Rev. 2010;68(5):280-9.

[22] Dantzer R, O’connor JC, Freund GG, Johnson RW, Kelley KW. From inflammation to sickness and depression: when the immune system subjugates the brain. Nat Rev Neurosci. 2008;9(1):46-56.

[23] Prat A, Biernacki K, Wosik K, Antel JP. Glial cell influence on the human blood-brain barrier. Glia. 2001;36(2):145-55.

[24] Skaper SD, Facci L, Giusti P. Mast cells, glia and neuroinflammation: partners in crime?. Immunology. 2014;141(3):314-27.

[25] Spiller R. Serotonin, inflammation, and IBS: fitting the jigsaw together?. J Pediatr Gastroenterol Nutr. 2007;45 Suppl 2:S115-9.

[26] Morand EF, Leech M. Hypothalamic-pituitary-adrenal axis regulation of inflammation in rheumatoid arthritis. Immunol Cell Biol. 2001;79(4):395-9.

[27] Hansen CH, Krych L, Buschard K, et al. A maternal gluten-free diet reduces inflammation and diabetes incidence in the offspring of NOD mice. Diabetes. 2014;63(8):2821-32.

[28] Antvorskov JC, Fundova P, Buschard K, Funda DP. Dietary gluten alters the balance of pro-inflammatory and anti-inflammatory cytokines in T cells of BALB/c mice. Immunology. 2013;138(1):23-33.

[29] Halliwell B. Antioxidants in human health and disease. Annu Rev Nutr. 1996;16:33-50.

[30] Holt EM, Steffen LM, Moran A, et al. Fruit and vegetable consumption and its relation to markers of inflammation and oxidative stress in adolescents. J Am Diet Assoc. 2009;109(3):414-21.

Vegetarian Diet | The Paleo Diet

Did you miss Vegetarian and Vegan Diets: Nutritional Disasters Part 1 or Part 2?
Read Part 1 HERE
Read Part 2 HERE

Vegetarian Diets: Other Nutritional Shortcomings

You don’t have to look any further than the ADA’s Position Statement28 or the USDA’s recommendations on vegetarian diets142 to discover additional nutrient shortcomings caused by plant based diets. The ADA matter of factly mentions that “…key nutrients for vegetarians include protein, n-3 fatty acids, iron, zinc, iodine, calcium, and vitamins D and B12..28 The USDA notes that “…vegetarians may need to focus on…iron, calcium, zinc, and vitamin B12.142 These subtle admissions of potential nutrient deficiency problems associated with vegetarian diets represent the tip of a nutritional nightmare. Just as was the case with vegetarian diets and vitamin B12 deficiency, there is little credible scientific evidence to show that people eating a lifelong plant based diet (without taking supplements or eating fortified foods) can achieve adequate dietary intakes of omega 3 fatty acids (EPA and DHA), iron, zinc, iodine, calcium, and vitamin D. To this list you can also add vitamin B6 and taurine, an amino acid.

Mineral Deficiencies and Vegetarian Diets

One of the major complications with the assessment of dietary nutrient adequacy in vegetarian diets, or for that matter, any diet has to do with whether or not the vitamins and minerals measured in certain foods actually get absorbed into our bodies. The bioavailability of vitamins and minerals in foods is just as important in how they impact our health as is the simple content of these nutrients in a food. By now you know that phytate is not a good thing because it prevents absorption of essential minerals. Whole grains and legumes are rich sources of phytate. Accordingly, our bodies have great difficulty extracting certain minerals from these foods because they are tightly bound to phytate. Phytate in whole grains impairs calcium absorption and may adversely affect bone health. Further, phytate also binds zinc, thereby interfering with its assimilation and incorporation into our cells. To this list you can add iron and magnesium. Because vegetarian diets are virtually impossible to follow without including lots of whole grains, beans, soy and legumes, they are inherently high in phytate. This is why it is difficult or impossible for vegetarians and vegans to maintain adequate body stores of calcium, zinc and iron.

Zinc Deficiencies in Vegetarian Diets

From the discussion above, you know that zinc is crucial for normal male reproductive function, but it is also required for good health and disease resistance in virtually every cell in our bodies, whether you are a man, woman or child.20, 41 Marginal zinc status impairs our immune system, slows wound healing, adversely affects glucose and insulin metabolism, and damages our body’s built in antioxidant system.16, 55 Without adequate dietary zinc we experience more upper respiratory illnesses that last longer. Zinc lozenges can slow or prevent common cold symptoms, and zinc oxide creams applied topically can speed healing. If you have ever experienced painful cracked heels or nose bleeds that just wouldn’t stop, try rubbing zinc oxide ointments on these wounds – you will be amazed at how rapidly zinc can heal these stubborn sores. How we got into this problem (marginal zinc status or deficiencies) in the first place originates directly from our diets. Anybody eating excessive whole grains and/or legumes and not eating meat, fish or animal products on a regular basis45, 59, 62 puts themselves at risk for all illnesses and health problems associated with borderline or deficient zinc intakes.

Iron Deficiencies in Vegetarian Diets

Your body stores of iron run hand in hand with zinc. The same types of diets that produce zinc deficiencies also create iron deficiencies. High phytate vegetarian diets based upon whole grains, beans, soy and other legumes invariably cause iron deficiencies5, 135 which are the most common nutrient deficit worldwide. In the U.S. 9% of all women between 12 and 49 years are iron deficient, while 4% of 3 to 5 year old children have insufficient stores of this crucial mineral.25 If you are pregnant, low iron status increases your risk of dying during childbirth, and frequently causes low birth weights and preterm deliveries. Even more disturbing is the potential for iron deficiencies to prevent normal mental development in our children and young adults.39, 90, 96 As a parent, I would never wish upon my child or for that matter anyone else’s, a diet causing nutritional deficiencies known to impair brain development and normal mental function. But this is just the case if you eat a vegetarian diet and impose it upon your children. Plant based diets not only increase the risk of impaired cognitive function in your children, but will hamper your own mental functioning. Numerous experimental studies show that inadequate iron stores in adults can slow or impair tasks requiring concentration and mental clarity.73

One of the most important outcomes of diets that cause iron deficiencies is that they make us fatigued and tired. If you are an athlete or have a demanding job requiring physical exertion, low iron stores will invariably reduce your performance. A recent (2009) experiment involving 219 female soldiers during military training showed that iron supplements improved blood iron stores, increased performance for a 2 mile run and enhanced mood.92 Similarly a study by Dr. Hinton and colleagues demonstrated that iron supplements in iron deficient male and female athletes improved endurance performance and efficiency.56 Whether you are an athlete, a laborer or even an office worker, your best nutritional strategy to improve iron stores, add vigor to your life and improve performance is to eliminate whole grains and legumes from your diet by adopting The Paleo Diet.

The burden of proof that vegetarian diets will not produce multiple vitamin and mineral deficiencies lies upon the governmental (USDA) and dietary organizations (ADA) that recommend these diets to us all and tell us that they are safe.28, 142 You might expect that the experimental evidence surrounding vegetarian diet recommendations would be convincing and overpowering. Nothing could be further from the truth, particularly when it comes to iron deficiencies and vegetarian diets.

As always the devil is in the details when it comes to getting correct answers to nutritional questions. Scientists who believe that vegetarian diets don’t adversely affect our iron stores often cite scientific papers showing no difference between blood iron concentrations in vegetarians and meat eaters. What they don’t tell us is how iron measurements were performed in the experiments they quote to support their viewpoint. This information is absolutely essential in knowing if iron deficiencies exist or not. Any study examining blood levels of iron in vegetarians using either measurements of hemoglobin (an iron carrying substance in red blood cells) or hematocrit (the concentration of red blood cells) are unreliable indicators of long term iron status. A much better marker is an iron carrying molecule called ferritin.75 Virtually all epidemiological (population) studies of vegans or ovo/lacto vegetarians show them to be either deficient or borderline iron deficient when blood ferritin levels are measured. Given this nearly unanimous finding from epidemiological studies, you might think that either the USDA or the ADA would become concerned and re-examine their endorsement of vegetarian diets. Unfortunately, we still live with governmental and institutional dietary recommendations that may do considerable harm to our health.

The most convincing type of experiments to reveal whether or not vegetarian diets may cause our iron stores to nosedive are called dietary interventions. Why not put a large group of non-vegetarians on a plant based diet for an extended period and see what happens to their blood iron levels? Wow what a great idea – unfortunately no such study has ever been conducted. The closest we have come to this experiment is a short term study (8 weeks) by Dr. Janet Hunt and co-workers at the Grand Forks Human Nutrition Research Center in North Dakota.63 The results of this experiment were anything but conclusive as the researchers made a fundamental blunder in the design of their experiment – they forgot to include a control group. Without a control group, it is impossible to interpret the outcome of this or any experiment.

Nevertheless, when women were placed on lacto/ovo vegetarian diets, their intestinal iron absorption was reduced by 70%; however, inexplicably, blood ferritin levels (a marker of their long-term iron status) did not decline for the group as a whole. It should be noted that nearly half of the subjects did experience drops in blood ferritin concentrations. Because the authors of this study failed to include a control group, then extraneous variables likely swayed the experiment’s outcome. You recall from earlier in this essay that vegetarian diets caused 7 out of 9 women to stop ovulating. With the cessation of menstrual periods, monthly blood loses also cease which in turn prevents monthly iron losses because blood is a rich source of iron. Hence, in any study evaluating blood iron stores in women, it is absolutely essential to know if their normal menstrual cycles were altered. Unfortunately, Dr. Hunt did not provide us with this information, thereby making the correct interpretation of her experiment difficult or impossible.

In order to once and for all know whether or not vegetarian diets cause iron deficiencies, we would need to perform Dr. Hunt’s experiment again, for at least a year with more subjects, a control group and monitor changes in menstrual periods. You would think that this kind of very basic experimental evidence would have already been in place before any governmental or institutional organization told us that vegetarian diets were safe and didn’t cause nutritional deficiencies. Unfortunately, these precautionary steps have never been taken, and millions of Americans who adhere to vegetarian diets with the mistaken belief that they will benefit health-wise will actually suffer.

Iodine Deficiencies in Vegetarian Diets

A number of studies have reported that vegetarian and vegan diets increase the risk for iodine deficiency.40, 77, 102, 153 One study from Europe demonstrated that 80% of vegans and 25% of ovo/lacto vegetarians suffered from iodine deficiency.77 Additionally, a dietary intervention by Dr. Remer and colleagues in 1999 confirmed this epidemiological evidence.102 After only five days on ovo/lacto vegetarian diets, iodine status and function became impaired in healthy adults.102 The primary reason why vegetarian diets cause iodine deficiencies is that plant foods (except for seaweed) are generally poor sources of iodine compared to meat, eggs, poultry and fish. Gross deficiencies of iodine cause our thyroid glands to swell producing a condition known as goiter, and in pregnant women result in severe birth defects called cretinism.141 Because salt is fortified with iodine, most people in the U.S. and Europe rarely develop gross iodine deficiencies.40, 140, 141 However moderate to mild iodine deficiencies appear in westernized countries, particularly among vegetarians and vegans.77, 102 Moderate iodine deficiency impairs normal growth in children and adversely affects mental development.140, 141, 152 A large meta analysis revealed that moderate childhood iodine deficiency lowered I.Q. by 12-13.5 points.153 Paleo Diets are not just good medicine for adults, but they also ensure normal physical and mental development in our children because of their high iodine content.

One of the problems with plant based diets is that they may put into play a vicious cycle that makes iodine deficiencies worse. When the thyroid glands iodine stores become depleted, as often happens with vegetarian diets, then certain antinutrients found in plant foods can gain a foot hold and further aggravate iodine shortages. Soy beans and soy products are frequently a mainstay in vegetarian diets and may promote inflammation.66 Unfortunately soy contains certain antinutrients (isoflavones) that impair iodine metabolism in the thyroid gland,43, 95 but only when our body stores of iodine are already depleted. Other plant foods (millet, cassava root, lima beans, sweet potatoes, and cruciferous vegetables [broccoli, cauliflower, turnips, kale, cabbage]) also contain a variety of antinutrients which hinder normal iodine metabolism. So, plant based diets put us at risk for developing iodine deficiencies in the first place, and when this happens our bodies become vulnerable to plant antinutrients that worsen the pre-existing deficiency. The important point here is that antinutritional compounds have virtually zero effect upon our thyroid gland when our body stores of iodine are normal and fully replete. Because meats, fish, eggs and poultry are rich sources of iodine, you will never have to worry about this nutrient when you eat Paleo style.

Vitamin D and Vitamin B6 Deficiencies in Vegetarian Diets

In my paper, Cereal Grains: Humanity’s Double Edged Sword, I have pointed out how excessive consumption of whole grains adversely affects vitamin D status in our bodies.148 Hence it goes without saying that vitamin D deficiencies run rampant in vegetarians worldwide because it is nearly impossible to become a full-fledged vegetarian without eating lots of grains. In the largest study of vegetarians ever undertaken (The Epic-Oxford Study), Dr. Crowe and fellow researchers reported that blood concentrations of vitamin D were highest in meat eaters and lowest in vegans and vegetarians.29 Nearly 8% of the vegans maintained clinical deficiencies of vitamin D. Vitamin D is not really a vitamin at all, but rather a crucial hormone that impacts virtually every cell in our bodies.

By now, you are starting to get a pretty good picture of what a nutritional nightmare vegetarian diets really are. When we let the data speak for itself, the number of nutrient deficiencies and adverse health effects associated with plant based diets are appalling and far outweigh any supposed health effects of this unnatural way of eating. One of the biggest kept secrets about vegan or vegetarian diets is that they frequently cause vitamin B6 deficiencies. If you recall, neither the ADA,28 nor the USDA142 has given us any warning that meatless diets increase our risk for vitamin B6 deficiencies.

On paper, it would appear that vegetarian diets generally meet daily recommended intakes for vitamin B6. This assumption comes primarily from population surveys examining the foods that vegans and vegetarians normally eat. In contrast, when blood samples are analyzed from people relying upon plant based diets, they unexpectedly reveal that long term vegetarians and vegans frequently are deficient vitamin B6. A recent study of 93 German vegans by Dr. Waldman and colleagues showed that 58% of these men and women suffered from vitamin B6 deficiencies despite seemingly adequate intakes of this essential nutrient.131 It turns out that the type of vitamin B-6 (pyridoxine glucoside) found in plant foods is poorly absorbed.47, 103 The presence of pyridoxine glucoside in plant foods along with fiber has been reported to reduce the bioavailability of vitamin B6 so that only 20 to 25% is absorbed and completely utilized.47 In contrast, vitamin B6 found in animal foods is easily assimilated, and an estimated 75 to 100% fully makes its way into our bloodstreams.47

Compelling evidence that vegetarian diets relying upon the plant form of vitamin B6 adversely affect our body’s overall vitamin B6 stores comes from Dr. Leklem’s laboratory at Oregon State University.47 Nine women were put on diets either high or low in the plant form of vitamin B6 (pyridoxine glucoside). After only 18 days, the high pyridoxine glucoside diets consistently lowered blood concentrations and other indices of vitamin B6 status. Deficiencies in this vitamin elevate blood homocysteine concentrations and increase our risk for cardiovascular disease similar to shortages of folate and vitamin B12. Further, vitamin B6 is an important factor in normal immune system functioning149 and shortfalls of this crucial nutrient have been identified in depression150 and colorectal cancer.151

Omega 3 Fatty Acid Deficiencies in Vegetarian Diets

A few years ago I was involved in a series of experiments here at Colorado State University in which we were interested in determining how high and low salt diets affected exercise-induced asthma. Our working hypothesis was that high salt diets would make measures of lung function worse, and low salt diets would improve things. One of our concerns with this experiment was to somehow make sure our subjects had fully complied with either the high or low salt diets. Completely removing salt from your diet is not an easy thing to do, and if some of our subjects had decided to sneak in a piece of pizza or some Doritos, it would mess up the experiment’s outcome. Fortunately, there was an easy way to figure out if our subjects had been compliant with the prescribed diets. All we had to do was to spot check their urine, because measurement of urinary salt levels is an accurate gauge of dietary salt consumption. High urinary salt levels universally reflect high salt consumption, whereas low urinary salt concentrations indicate low salt consumption. Short of major disease, there is virtually no other way high amounts of salt in the urine don’t indicate high amounts of salt in the diet.

In a similar manner, there are equivalent telltale indicators of omega 3 fatty acids in our bloodstreams that tell us beyond a shadow of a doubt whether or not we have regularly consumed fish, seafood or other good sources these healthful fats. The three main types of omega 3 fatty acids we need to concern ourselves with are EPA, DHA and ALA. EPA and DHA are called long chain omega 3 fatty acids and are only found in high amounts in fish, seafood, certain meats, and other foods of animal origin. Plant foods contain no EPA or DHA. On the other hand, ALA is called a short chain fatty acid and is found in both plant and animal foods. Both EPA and DHA in our red blood cells are markers of these important fatty acids in our diet. Without good dietary sources of EPA and DHA such as are found in fish, seafood and certain meats, our blood levels of EPA and DHA will decline. Just like salt in our urine was an indicator for dietary salt, EPA and DHA concentrations in our red blood cells are markers for our dietary intake of these long chain omega 3 fatty acids. It is virtually impossible to achieve high blood levels of EPA and DHA without regularly consuming fish, seafood and certain meats and organ meats (particularly grass produced meats and organ meats).

One of the major nutritional shortcomings in vegans is that they obtain absolutely no EPA or DHA from their diets.108, 110, 111 Consequently, they are totally dependent upon plant based ALA, supplements or fortified foods to obtain these healthful long chain omega 3 fatty acids. Without supplements or fortified foods, all vegans will become deficient in EPA and DHA because plant based ALA is inefficiently converted into these long chain fatty acids in our bodies. The liver converts less than 5% of ALA into EPA and less than 1% of ALA into DHA.15, 97 Virtually every epidemiological study that has ever been published shows that vegans, who do not supplement or consume long chain omega 3 fortified foods, to be deficient in both EPA and DHA76, 88, 108, 110, 111 Lacto/ovo vegetarians don’t fare much better because milk and egg based vegetarian diets simply do not supply sufficient DHA or EPA to maintain normal blood concentrations.88, 111

There is little doubt that vegan or vegetarian diets cause reductions in blood concentrations of DHA and EPA, which in turn represent a potent risk factor for many chronic diseases. Perhaps the single most important dietary recommendation to improve your health and prevent illness is to increase your dietary intake of EPA and DHA. Thousands of scientific papers covering an assortment of diseases clearly show the health benefits of these fatty acids. In randomized clinical trials in patients with pre-existing heart disease, omega-3 fatty acid supplements significantly reduced cardiovascular events (deaths, non-fatal heart attacks, and non-fatal strokes).19, 48, 138 Omega-3 fatty acids lessen the risk for heart disease through a number of means including a reduction in heart beat irregularities called arrhythmias, a decrease in blood clots, and reduced inflammation which is now known to be an chief factor causing atherosclerosis or artery clogging.

In addition to lowering the risk for heart disease, regular consumption of fish or supplemental omega-3 fatty acids may be useful in averting, treating, or improving a wide range of diseases and disorders, including virtually all inflammatory diseases (any disease ending with “itis”): rheumatoid arthritis,99 inflammatory bowel disorders (Crohn’s disease, ulcerative colitis), periodontal disease (gingivitis). Also mental disorders (autism, depression),3, 84 postpartum depression, bi-polar disorder, borderline personality disorder, impaired cognitive development in infants and children) may respond favorably to these beneficial fatty acids. Further, acne, asthma, exercise induced asthma, many types of cancers,120 macular degeneration, pre-term birth, psoriasis, insulin resistance, type 2 diabetes, cancer cachexia, intermittent claudication, skin damage from sunlight, IgA nephropathy, lupus erythematosus, type 1 diabetes, multiple sclerosis, and migraine headaches also improve with omega 3 fatty acids.

Taurine deficiencies in Vegetarian Diets

Although the number of nutrients which are frequently lacking in vegetarian and vegan diets may seem endless to you, we are now at the end of the list. Taurine is an amino acid (actually a sulfonic acid because it lacks a carboxyl group) in our bloodstreams that has multiple functions in every cell of our body. Unfortunately, this nutrient is not present in any plant food and is found in low concentrations in milk (6 mg per cup).80 In contrast, all flesh foods are excellent sources of taurine.80 For example, ¼ pound of dark meat from chicken provides 200mg of taurine. Shellfish are even richer still with over 800mg per quarter pound. The daily taurine intake in non-vegetarians is about 150mg, whereas lacto/ovo vegetarians take in about 17mg per day, and vegans get none. Although our livers can manufacture taurine from precursor molecules, our capacity to do so is limited – so much so that this amino acid is regularly fortified in infant formulas. As you might expect, studies of vegans show that their blood taurine levels are lower than meat eaters.81, 100 How depleted blood concentrations of taurine affect our overall health, is not entirely understood. Nevertheless, shortages of this amino acid and omega 3 fatty acids (EPA and DHA) may cause certain elements (platelets) in our blood to clot more rapidly which in turn increase our risk for cardiovascular disease.85, 91 Despite their meat free diets, vegetarians almost always exhibit abnormal platelets that excessively adhere to one another. In one dietary intervention, Dr. Mezzano and colleagues demonstrated that after eight weeks of EPA and DHA supplementation normal platelet function was restored in a group of 18 lacto/ovo vegetarians.85 Obviously, compromised taurine status will never become a problem in Paleo Diets, because meat, fish, poultry and animal products are consumed at nearly every meal.

In summary, if you have adopted, or are considering adopting a plant based diet for reasons of improving your health, make sure you reread this chapter and look up all of the references I have provided you. The evidence that vegetarian and vegan diets almost always cause a multitude of nutritional deficiencies is overwhelming and conclusive. Over the course of a lifetime, vegetarian diets will not reduce your risk of chronic disease and will not allow you to live longer. Rather, this abnormal way of eating will predispose you to a host of health problems and illnesses. Vegetarianism is an unnatural way of eating that has no evolutionary precedence in our species. No hunter-gatherer society ever consumed a meatless diet, nor should you. The ADA has labeled The Paleo Diet a fad diet because it eliminates “two entire food groups” (grains and dairy). Yet hypocritically, they exempt vegan diets from this characterization despite also eliminating two food groups (dairy, meats and fish). If The Paleo Diet is a fad diet, then it is the world’s oldest.

Cordially,

Loren Cordain, Ph.D., Professor Emeritus

References

1. Alexander D, Ball MJ, Mann J. Nutrient intake and haematological status of vegetarians and age-sex matched omnivores. Eur J Clin Nutr. 1994 Aug;48(8):538-46.

2. Appleby P, Roddam A, Allen N, Key T. Comparative fracture risk in vegetarians and nonvegetarians in EPIC-Oxford. Eur J Clin Nutr. 2007 Dec;61(12):1400-6.

3. Appleton KM, Rogers PJ, Ness AR. Updated systematic review and meta-analysis of the effects of n-3 long-chain polyunsaturated fatty acids on depressed mood. Am J Clin Nutr. 2010 Mar;91(3):757-70

4. Baines M, Kredan MB, Davison A, Higgins G, West C, Fraser WD, Ranganath LR. The association between cysteine, bone turnover, and low bone mass. Calcif Tissue Int. 2007 Dec;81(6):450-4

5. Baines S, Powers J, Brown WJ. How does the health and well-being of young Australian vegetarian and semi-vegetarian women compare with non-vegetarians? Public Health Nutr. 2007 May;10(5):436-42.

6. Bhushan S, Pandey RC, Singh SP, Pandey DN, Seth P. Some observations on human semen analysis. Indian J Physiol Pharmacol. 1978 Oct-Dec;22(4):393-6.

7. Bennett M. Vitamin B12 deficiency, infertility and recurrent fetal loss. J Reprod Med. 2001 Mar;46(3):209-12.

8. Berker B, Kaya C, Aytac R, Satiroglu H. Homocysteine concentrations in follicular fluid are associated with poor oocyte and embryo qualities in polycystic ovary syndrome patients undergoing assisted reproduction. Hum Reprod. 2009 Sep;24(9):2293-302

9. Bissoli L, Di Francesco V, Ballarin A, Mandragona R, Trespidi R, Brocco G, Caruso B, Bosello O, Zamboni M. Effect of vegetarian diet on homocysteine levels. Ann Nutr Metab. 2002;46(2):73-9.

10. Bocherens H, Drucker DG, Billiou D, Patou-Mathis M, Vandermeersch B. Isotopic evidence for diet and subsistence pattern of the Saint-Cesaire I Neanderthal: review and use of a multi-source mixing model. J Hum Evol. 2005 Jul;49(1):71-87

11. Boivin J, Bunting L, Collins JA, Nygren KG. International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care. Hum Reprod. 2007 Jun;22(6):1506-12.

12. Boxmeer JC, Smit M, Weber RF, Lindemans J, Romijn JC, Eijkemans MJ, Macklon NS, Steegers-Theunissen RP. Seminal plasma cobalamin significantly correlates with sperm concentration in men undergoing IVF or ICSI procedures. J Androl. 2007 Jul-Aug;28(4):521-7

13. Boxmeer JC, Brouns RM, Lindemans J, Steegers EA, Martini E, Macklon NS, Steegers-Theunissen RP. Preconception folic acid treatment affects the microenvironment of the maturing oocyte in humans. Fertil Steril. 2008 Jun;89(6):1766-70.

14. Boxmeer JC, Smit M, Utomo E, Romijn JC, Eijkemans MJ, Lindemans J, Laven JS, Macklon NS, Steegers EA, Steegers-Theunissen RP. Low folate in seminal plasma is associated with increased sperm DNA damage. Fertil Steril. 2009 Aug;92(2):548-56.

15. Brenna JT, Salem N Jr, Sinclair AJ, Cunnane SC. alpha-Linolenic acid supplementation and conversion to n-3 long-chain polyunsaturated fatty acids in humans. Prostaglandins Leukot Essent Fatty Acids. 2009 Feb-Mar;80(2-3):85-91.

16. Brown KH, Peerson JM, Baker SK, Hess SY. Preventive zinc supplementation among infants, preschoolers, and older prepubertal children. Food Nutr Bull. 2009 Mar;30(1 Suppl):S12-40.

17. Bucciarelli P, Martini G, Martinelli I, Ceccarelli E, Gennari L, Bader R, Valenti R, Franci B, Nuti R, Mannucci PM. The relationship between plasma homocysteine levels and bone mineral density in post-menopausal women. Eur J Intern Med. 2010 Aug;21(4):301-5

18. Bunn, HT, Kroll EM. Systematic butchery by Plio-Pleistocene hominids at Olduvai Gorge, Tanzania. Curr Anthropol 1986;20:365–398.

19. Calder PC, Yaqoob P. Omega-3 (n-3) fatty acids, cardiovascular disease and stability of atherosclerotic plaques. Cell Mol Biol (Noisy-le-grand). 2010 Feb 25;56(1):28-37.

20. Campbell-Brown M, Ward RJ, Haines AP, North WR, Abraham R, McFadyen IR, Turnlund JR, King JC. Zinc and copper in Asian pregnancies–is there evidence for a nutritional deficiency? Br J Obstet Gynaecol. 1985 Sep;92(9):875-85

21. Cappuccio FP, Bell R, Perry IJ, Gilg J, Ueland PM, Refsum H, Sagnella GA, Jeffery S, Cook DG. Homocysteine levels in men and women of different ethnic and cultural background living in England. Atherosclerosis. 2002 Sep;164(1):95-102.

22. Clarke R, Sherliker P, Hin H, Nexo E, Hvas AM, Schneede J, Birks J, Ueland PM, Emmens K, Scott JM, Molloy AM, Evans JG. Detection of vitamin B12 deficiency in older people by measuring vitamin B12 or the active fraction of vitamin B12, holotranscobalamin. Clin Chem. 2007 May;53(5):963-70

23. Clarke R. B-vitamins and prevention of dementia. Proc Nutr Soc. 2008 Feb;67(1):75-81.

24. Clarke R, Birks J, Nexo E, Ueland PM, Schneede J, Scott J, Molloy A, Evans JG. Low vitamin B-12 status and risk of cognitive decline in older adults. Am J Clin Nutr. 2007 Nov;86(5):1384-91.

25. Cogswell ME, Looker AC, Pfeiffer CM, Cook JD, Lacher DA, Beard JL, Lynch SR, Grummer-Strawn LM. Assessment of iron deficiency in US preschool children and nonpregnant females of childbearing age: National Health and Nutrition Examination Survey 2003-2006. Am J Clin Nutr. 2009 May;89(5):1334-42

26. Cordain L, Miller JB, Eaton SB, Mann N, Holt SH, Speth JD. Plant-animal subsistence ratios and macronutrient energy estimations in worldwide hunter-gatherer diets.Am J Clin Nutr. 2000 Mar;71(3):682-92.

27. Cordain L, Campbell TC. The protein debate. Catalyst Athletics, March 19, 2008. //www.cathletics.com/articles/article.php?articleID=50

28. Craig WJ, Mangels AR; American Dietetic Association. Position of the American Dietetic Association: vegetarian diets. J Am Diet Assoc. 2009 Jul;109(7):1266-82.

29. Crowe FL, Steur M, Allen NE, Appleby PN, Travis RC, Key TJ. Plasma concentrations of 25-hydroxyvitamin D in meat eaters, fish eaters, vegetarians and vegans: results from the EPIC-Oxford study. Public Health Nutr. 2011 Feb;14(2):340-6.

30. Dasarathy J, Gruca LL, Bennett C, Parimi PS, Duenas C, Marczewski S, Fierro JL, Kalhan SC. Methionine metabolism in human pregnancy. Am J Clin Nutr. 2010 Feb;91(2):357-65.

31. Davey GK, Spencer EA, Appleby PN, Allen NE, Knox KH, Key TJ. EPIC-Oxford: lifestyle characteristics and nutrient intakes in a cohort of 33 883 meat-eaters and 31 546 non meat-eaters in the UK. Public Health Nutr. 2003 May;6(3):259-69.

32. de Bortoli MC, Cozzolino SM. Zinc and selenium nutritional status in vegetarians. Biol Trace Elem Res. 2009 Mar;127(3):228-33.

33. de Heinzelin J, Clark JD, White T, Hart W, Renne P, WoldeGabriel G, Beyene Y, Vrba E. Environment and behavior of 2.5-million-year-old Bouri hominids. Science. 1999 Apr 23;284(5414):625-9

34. Dhonukshe-Rutten RA, van Dusseldorp M, Schneede J, de Groot LC, van Staveren WA. Low bone mineral density and bone mineral content are associated with low cobalamin status in adolescents. Eur J Nutr. 2005 Sep;44(6):341-7.

35. Dror DK, Allen LH. Effect of vitamin B12 deficiency on neurodevelopment in infants: current knowledge and possible mechanisms. Nutr Rev. 2008 May;66(5):250-5.

36. Ebisch IM, Peters WH, Thomas CM, Wetzels AM, Peer PG, Steegers-Theunissen RP. Homocysteine, glutathione and related thiols affect fertility parameters in the (sub)fertile couple. Hum Reprod. 2006 Jul;21(7):1725-33.

37. Ebisch IM, Pierik FH, DE Jong FH, Thomas CM, Steegers-Theunissen RP. Does folic acid and zinc sulphate intervention affect endocrine parameters and sperm characteristics in men? Int J Androl. 2006 Apr;29(2):339-45.

38. Elmadfa I, Singer I.Vitamin B-12 and homocysteine status among vegetarians: a global perspective. Am J Clin Nutr. 2009 May;89(5):1693S-1698S.

39. Falkingham M, Abdelhamid A, Curtis P, Fairweather-Tait S, Dye L, Hooper L.The effects of oral iron supplementation on cognition in older children and adults: a systematic review and meta-analysis. Nutr J. 2010 Jan 25;9:4.

40. Lightowler HJ, Davies GJ. Iodine intake and iodine deficiency in vegans as assessed by the duplicate-portion technique and urinary iodine excretion. Br J Nutr. 1998 Dec;80(6):529-35.

41. Fischer Walker CL, Ezzati M, Black RE. Global and regional child mortality and burden of disease attributable to zinc deficiency. Eur J Clin Nutr. 2009 May;63(5):591-7.

42. Food habits of a nation. In: The Hindu, August 14, 2006.
//www.hinduonnet.com/2006/08/14/stories/2006081403771200.htm

43. Fort P, Moses N, Fasano M, Goldberg T, Lifshitz F. Breast and soy-formula feedings in early infancy and the prevalence of autoimmune thyroid disease in children. J Am Coll Nutr. 1990 Apr;9(2):164-7.

44. Freeland-Graves JH, Ebangit ML, Hendrikson PJ. Alterations in zinc absorption and salivary sediment zinc after a lacto-ovo-vegetarian diet. Am J Clin Nutr. 1980 Aug;33(8):1757-66.

45. Freeland-Graves JH, Bodzy PW, Eppright MA. Zinc status of vegetarians. J Am Diet Assoc. 1980 Dec;77(6):655-61

46. Gilsing AM, Crowe FL, Lloyd-Wright Z, Sanders TA, Appleby PN, Allen NE, Key TJ. Serum concentrations of vitamin B12 and folate in British male omnivores, vegetarians and vegans: results from a cross-sectional analysis of the EPIC-Oxford cohort study. Eur J Clin Nutr. 2010 Sep;64(9):933-9

47. Hansen CM, Leklem JE, Miller LT. Vitamin B-6 status indicators decrease in women consuming a diet high in pyridoxine glucoside. J Nutr. 1996 Oct;126(10):2512-8

48. Harris WS, Kris-Etherton PM, Harris KA. Intakes of long-chain omega-3 fatty acid associated with reduced risk for death from coronary heart disease in healthy adults. Curr Atheroscler Rep. 2008 Dec;10(6):503-9.

49. Herbert V. Staging vitamin B-12 (cobalamin) status in vegetarians. Am J Clin Nutr. 1994 May;59(5 Suppl):1213S-1222S

50. Herrmann W, Obeid R, Schorr H, Geisel J. Functional vitamin B12 deficiency and determination of holotranscobalamin in populations at risk. Clin Chem Lab Med. 2003 Nov;41(11):1478-88.

51. Herrmann M, Widmann T, Colaianni G, Colucci S, Zallone A, Herrmann W. Increased osteoclast activity in the presence of increased homocysteine concentrations. Clin Chem. 2005 Dec;51(12):2348-53

52. Herrmann W, Schorr H, Obeid R, Geisel J. Vitamin B-12 status, particularly holotranscobalamin II and methylmalonic acid concentrations, and hyperhomocysteinemia in vegetarians. Am J Clin Nutr. 2003 Jul;78(1):131-6.

53. Herrmann M, Peter Schmidt J, Umanskaya N, Wagner A, Taban-Shomal O, Widmann T, Colaianni G, Wildemann B, Herrmann W. The role of hyperhomocysteinemia as well as folate, vitamin B(6) and B(12) deficiencies in osteoporosis: a systematic review. Clin Chem Lab Med. 2007;45(12):1621-32

54. Herrmann W, Obeid R, Schorr H, Hübner U, Geisel J, Sand-Hill M, Ali N, Herrmann M. Enhanced bone metabolism in vegetarians–the role of vitamin B12 deficiency. Clin Chem Lab Med. 2009;47(11):1381-7.

55. Heyland DK, Jones N, Cvijanovich NZ, Wong H. Zinc supplementation in critically ill patients: a key pharmaconutrient? JPEN J Parenter Enteral Nutr. 2008 Sep-Oct;32(5):509-19.

56. Hinton PS, Sinclair LM. Iron supplementation maintains ventilatory threshold and improves energetic efficiency in iron-deficient nonanemic athletes. Eur J Clin Nutr. 2007 Jan;61(1):30-9.

57. Hirwe R, Jathar VS, Desai S, Satoskar RS. Vitamin B12 and potential fertility in male lactovegetarians. J Biosoc Sci. 1976 Jul;8(3):221-7

58. Ho-Pham LT, Nguyen ND, Nguyen TV. Effect of vegetarian diets on bone mineral density: a Bayesian meta-analysis. Am J Clin Nutr. 2009 Oct;90(4):943-50.

59. Hotz C. Dietary indicators for assessing the adequacy of population zinc intakes. Food Nutr Bull. 2007 Sep;28(3 Suppl):S430-53.

60. Huang YC, Chang SJ, Chiu YT, Chang HH, Cheng CH. The status of plasma homocysteine and related B-vitamins in healthy young vegetarians and nonvegetarians. Eur J Nutr. 2003 Apr;42(2):84-90.

61. Humphrey LL, Fu R, Rogers K, Freeman M, Helfand M. Homocysteine level and coronary heart disease incidence: a systematic review and meta-analysis. Mayo Clin Proc. 2008 Nov;83(11):1203-12.

62. Hunt JR, Matthys LA, Johnson LK. Zinc absorption, mineral balance, and blood lipids in women consuming controlled lactoovovegetarian and omnivorous diets for 8 wk. Am J Clin Nutr. 1998 Mar;67(3):421-30.

63. Hunt JR, Roughead ZK. Nonheme-iron absorption, fecal ferritin excretion, and blood indexes of iron status in women consuming controlled lactoovovegetarian diets for 8 wk. Am J Clin Nutr. 1999 May;69(5):944-52

64. Hvas AM, Morkbak AL, Nexo E. Plasma holotranscobalamin compared with plasma cobalamins for assessment of vitamin B12 absorption; optimisation of a non-radioactive vitamin B12 absorption test (CobaSorb). Clin Chim Acta. 2007 Feb;376(1-2):150-4

65. Jathar VS, Hirwe R, Desai S, Satoskar RS. Dietetic habits and quality of semen in Indian subjects. Andrologia. 1976;8(4):355-8.

66. Jenkins DJ, Kendall CW, Connelly PW, Jackson CJ, Parker T, Faulkner D, Vidgen E. Effects of high- and low-isoflavone (phytoestrogen) soy foods on inflammatory biomarkers and proinflammatory cytokines in middle-aged men and women. Metabolism. 2002 Jul;51(7):919-24

67. Karabudak E, Kiziltan G, Cigerim N. A comparison of some of the cardiovascular risk factors in vegetarian and omnivorous Turkish females. J Hum Nutr Diet. 2008 Feb;21(1):13-22.

68. Katre P, Bhat D, Lubree H, Otiv S, Joshi S, Joglekar C, Rush E, Yajnik C. Vitamin B12 and folic acid supplementation and plasma total homocysteine concentrations in pregnant Indian women with low B12 and high folate status. Asia Pac J Clin Nutr. 2010;19(3):335-43.

69. Key TJ, Fraser GE, Thorogood M, Appleby PN, Beral V, Reeves G, Burr ML, Chang-Claude J, Frentzel-Beyme R, Kuzma JW, Mann J, McPherson K. Mortality in vegetarians and nonvegetarians: detailed findings from a collaborative analysis of 5 prospective studies. Am J Clin Nutr. 1999 Sep;70(3 Suppl):516S-524S.

70. Key TJ, Appleby PN, Rosell MS. Health effects of vegetarian and vegan diets. Proc Nutr Soc. 2006 Feb;65(1):35-41.

71. Key TJ, Appleby PN, Spencer EA, Travis RC, Roddam AW, Allen NE. Mortality in British vegetarians: results from the European Prospective Investigation into Cancer and Nutrition (EPIC-Oxford). Am J Clin Nutr. 2009 May;89(5):1613S-1619S

72. Key TJ, Appleby PN, Spencer EA, Travis RC, Roddam AW, Allen NE. Cancer incidence in vegetarians: results from the European Prospective Investigation into Cancer and Nutrition (EPIC-Oxford). Am J Clin Nutr. 2009 May;89(5):1620S-1626S

73. Khedr E, Hamed SA, Elbeih E, El-Shereef H, Ahmad Y, Ahmed S. Iron states and cognitive abilities in young adults: neuropsychological and neurophysiological assessment. Eur Arch Psychiatry Clin Neurosci. 2008 Dec;258(8):489-96. Epub 2008 Jun 20.

74. Koebnick C, Hoffmann I, Dagnelie PC, Heins UA, Wickramasinghe SN, Ratnayaka ID, Gruendel S, Lindemans J, Leitzmann C. Long-term ovo-lacto vegetarian diet impairs vitamin B-12 status in pregnant women. J Nutr. 2004 Dec;134(12):3319-26.

75. Knovich MA, Storey JA, Coffman LG, Torti SV, Torti FM. Ferritin for the clinician. Blood Rev. 2009 May;23(3):95-104

76. Kornsteiner M, Singer I, Elmadfa I. Very low n-3 long-chain polyunsaturated fatty acid status in Austrian vegetarians and vegans. Ann Nutr Metab. 2008;52(1):37-47

77. Krajcovicová-Kudlácková M, Bucková K, Klimes I, Seboková E. Iodine deficiency in vegetarians and vegans. Ann Nutr Metab. 2003;47(5):183-5.

78. Krivosíková Z, Krajcovicová-Kudlácková M, Spustová V, Stefíková K, Valachovicová M, Blazícek P, Nĕmcová T. The association between high plasma homocysteine levels and lower bone mineral density in Slovak women: the impact of vegetarian diet. Eur J Nutr. 2010 Apr;49(3):147-53

79. Kumar J, Garg G, Sundaramoorthy E, Prasad PV, Karthikeyan G, Ramakrishnan L, Ghosh S, Sengupta S. Vitamin B12 deficiency is associated with coronary artery disease in an Indian population. Clin Chem Lab Med. 2009;47(3):334-8.

80. Laidlaw SA, Grosvenor M, Kopple JD. The taurine content of common foodstuffs. JPEN J Parenter Enteral Nutr. 1990 Mar-Apr;14(2):183-8.

81. Laidlaw SA, Shultz TD, Cecchino JT, Kopple JD. Plasma and urine taurine levels in vegans. Am J Clin Nutr. 1988 Apr;47(4):660-3

82. Leboff MS, Narweker R, LaCroix A, Wu L, Jackson R, Lee J, Bauer DC, Cauley J, Kooperberg C, Lewis C, Thomas AM, Cummings S. Homocysteine levels and risk of hip fracture in postmenopausal women. J Clin Endocrinol Metab. 2009 Apr;94(4):1207-13

83. Lee-Thorp J, Thackeray JF, van der Merwe N. The hunters and the hunted revisited. J Hum Evol 2000; 39: 565–576.

84. Lin PY, Huang SY, Su KP. A meta-analytic review of polyunsaturated fatty acid compositions in patients with depression. Biol Psychiatry. 2010 Jul 15;68(2):140-7.

85. Mezzano D, Kosiel K, Martínez C, Cuevas A, Panes O, Aranda E, Strobel P, Pérez DD, Pereira J, Rozowski J, Leighton F. Cardiovascular risk factors in vegetarians. Normalization of hyperhomocysteinemia with vitamin B(12) and reduction of platelet aggregation with n-3 fatty acids. Thromb Res. 2000 Nov 1;100(3):153-60.

86. Molloy AM, Kirke PN, Brody LC, Scott JM, Mills JL. Effects of folate and vitamin B12 deficiencies during pregnancy on fetal, infant, and child development. Food Nutr Bull. 2008 Jun;29(2 Suppl):S101-11

87. Molloy AM, Kirke PN, Troendle JF, Burke H, Sutton M, Brody LC, Scott JM, Mills JL. Maternal vitamin B12 status and risk of neural tube defects in a population with high neural tube defect prevalence and no folic Acid fortification. Pediatrics. 2009 Mar;123(3):917-23.

88. Mann N, Pirotta Y, O’Connell S, Li D, Kelly F, Sinclair A. Fatty acid composition of habitual omnivore and vegetarian diets. Lipids. 2006 Jul;41(7):637-46

89. Mariani A, Chalies S, Jeziorski E, Ludwig C, Lalande M, Rodière M. [Consequences of exclusive breast-feeding in vegan mother newborn–case report]. Arch Pediatr. 2009 Nov;16(11):1461-3.

90. McCann JC, Ames BN. An overview of evidence for a causal relation between iron deficiency during development and deficits in cognitive or behavioral function. Am J Clin Nutr. 2007 Apr;85(4):931-45.

91. McCarty MF. Sub-optimal taurine status may promote platelet hyperaggregability in vegetarians.Med Hypotheses. 2004;63(3):426-33.

92. McClung JP, Karl JP, Cable SJ, Williams KW, Nindl BC, Young AJ, Lieberman HR. Randomized, double-blind, placebo-controlled trial of iron supplementation in female soldiers during military training: effects on iron status, physical performance, and mood. Am J Clin Nutr. 2009 Jul;90(1):124-31.

93. Michie CA, Chambers J, Abramsky L, Kooner JS. Folate deficiency, neural tube defects, and cardiac disease in UK Indians and Pakistanis. Lancet. 1998 Apr 11;351(9109):1105.

94. Misra A, Vikram NK, Pandey RM, Dwivedi M, Ahmad FU, Luthra K, Jain K, Khanna N, Devi JR, Sharma R, Guleria R. Hyperhomocysteinemia, and low intakes of folic acid and vitamin B12 in urban North India. Eur J Nutr. 2002 Apr;41(2):68-77.

95. Messina M, Redmond G. Effects of soy protein and soybean isoflavones on thyroid function in healthy adults and hypothyroid patients: a review of the relevant literature. Thyroid. 2006 Mar;16(3):249-58.

96. Osendarp SJ, Murray-Kolb LE, Black MM. Case study on iron in mental development–in memory of John Beard (1947-2009). Nutr Rev. 2010 Nov;68 Suppl 1:S48-52. doi: 10.1111/j.1753-4887.2010.00331.x.

97. Plourde M, Cunnane SC. Extremely limited synthesis of long chain polyunsaturates in adults: implications for their dietary essentiality and use as supplements. Appl Physiol Nutr Metab. 2007 Aug;32(4):619-34.

98. Pront R, Margalioth EJ, Green R, Eldar-Geva T, Maimoni Z, Zimran A, Elstein D. Prevalence of low serum cobalamin in infertile couples. Andrologia. 2009 Feb;41(1):46-50.

99. Proudman SM, Cleland LG, James MJ. Dietary omega-3 fats for treatment of inflammatory joint disease: efficacy and utility. Rheum Dis Clin North Am. 2008 May;34(2):469-79.

100. Rana SK, Sanders TA. Taurine concentrations in the diet, plasma, urine and breast milk of vegans compared with omnivores. Br J Nutr. 1986 Jul;56(1):17-27.

101. Refsum H, Yajnik CS, Gadkari M, Schneede J, Vollset SE, Orning L, Guttormsen AB, Joglekar A, Sayyad MG, Ulvik A, Ueland PM. Hyperhomocysteinemia and elevated methylmalonic acid indicate a high prevalence of cobalamin deficiency in Asian Indians. Am J Clin Nutr. 2001 Aug;74(2):233-41.

102. Remer T, Neubert A, Manz F. Increased risk of iodine deficiency with vegetarian nutrition. Br J Nutr. 1999 Jan;81(1):45-9.

103. Reynolds RD: Bioavailability of vitamin B-6 from plant foods. Am J Clin Nutr 1988;48:863-67.

104. Richards MP, Pettitt PB, Trinkaus E, Smith FH, Paunovic M, Karavanic, I. Neanderthal diet at Vindija and Neanderthal predation: The evidence from stable isotopes. Proc Natl Acad Sci 2000;97: 7663–7666.

105. Richards MP, Hedges REM, Jacobi R, Current, A, Stringer C. Focus: Gough’s Cave and Sun Hole Cave human stable isotope values indicate a high animal protein diet in the British Upper Palaeolithic. J Archaeol Sci 2000;27: 1–3.

106. Roe DA. History of promotion of vegetable cereal diets. J Nutr 1986;116:1355-1363.

107. Roed C, Skovby F, Lund AM. Severe vitamin B12 deficiency in infants breastfed by vegans]. Ugeskr Laeger. 2009 Oct 19;171(43):3099-101

108. Rosell MS, Lloyd-Wright Z, Appleby PN, Sanders TA, Allen NE, Key TJ. Long-chain n-3 polyunsaturated fatty acids in plasma in British meat-eating, vegetarian, and vegan men. Am J Clin Nutr. 2005 Aug;82(2):327-34.

109. Rush EC, Chhichhia P, Hinckson E, Nabiryo C. Dietary patterns and vitamin B(12) status of migrant Indian preadolescent girls. Eur J Clin Nutr. 2009 Apr;63(4):585-7. Epub 2007 Dec 19.

110. Sanders TA, Roshanai F. Platelet phospholipid fatty acid composition and function in vegans compared with age- and sex-matched omnivore controls. Eur J Clin Nutr. 1992 Nov;46(11):823-31.

111. Sanders TA. DHA status of vegetarians. Prostaglandins Leukot Essent Fatty Acids. 2009 Aug-Sep;81(2-3):137-41.

112. Sato Y, Honda Y, Iwamoto J, Kanoko T, Satoh K. Effect of folate and mecobalamin on hip fractures in patients with stroke: a randomized controlled trial. JAMA. 2005 Mar 2;293(9):1082-8.

113. Schneede J, Ueland PM. Novel and established markers of cobalamin deficiency: complementary or exclusive diagnostic strategies. Semin Vasc Med. 2005 May;5(2):140-55

114. Selhub J, Morris MS, Jacques PF. In vitamin B12 deficiency, higher serum folate is associated with increased total homocysteine and methylmalonic acid concentrations. Proc Natl Acad Sci U S A. 2007 Dec 11;104(50):19995-20000.

115. Shapin S. Vegetable love: the history of vegetarianism. New Yorker. 2007 Jan 22:80-4.

116. Singh K, Singh SK, Sah R, Singh I, Raman R. Mutation C677T in the methylenetetrahydrofolate reductase gene is associated with male infertility in an Indian population. Int J Androl. 2005 Apr;28(2):115-9.

117. Srikumar TS, Johansson GK, Ockerman PA, Gustafsson JA, Akesson B. Trace element status in healthy subjects switching from a mixed to a lactovegetarian diet for 12 mo. Am J Clin Nutr. 1992 Apr;55(4):885-90.

118. Stabler SP, Allen RH. Vitamin B12 deficiency as a worldwide problem. Annu Rev Nutr. 2004;24:299-326

119. Stephen EH, Chandra A. Declining estimates of infertility in the United States: 1982-2002. Fertil Steril. 2006 Sep;86(3):516-23.

120. Szymanski KM, Wheeler DC, Mucci LA. Fish consumption and prostate cancer risk: a review and meta-analysis. Am J Clin Nutr. 2010 Nov;92(5):1223-33.

121. Taneja S, Bhandari N, Strand TA, Sommerfelt H, Refsum H, Ueland PM, Schneede J, Bahl R, Bhan MK. Cobalamin and folate status in infants and young children in a low-to-middle income community in India. Am J Clin Nutr. 2007 Nov;86(5):1302-9.

122. te Velde E, Burdorf A, Nieschlag E, Eijkemans R, Kremer JA, Roeleveld N, Habbema D.
Is human fecundity declining in Western countries? Hum Reprod. 2010 Jun;25(6):1348-53.

123. Tikkiwal M, Ajmera RL, Mathur NK. Effect of zinc administration on seminal zinc and fertility of oligospermic males. Indian J Physiol Pharmacol. 1987 Jan-Mar;31(1):30-4.

124. van der Merwe NJ, Thackeray JF, Lee-Thorp JA, Luyt J. The carbon isotope ecology and diet of Australopithecus africanus at Sterkfontein, South Africa J Hum Evol 2003;44: 581–597.

125. van Meurs JB, Dhonukshe-Rutten RA, Pluijm SM, van der Klift M, de Jonge R, Lindemans J, de Groot LC, Hofman A, Witteman JC, van Leeuwen JP, Breteler MM, Lips P, Pols HA, Uitterlinden AG. Homocysteine levels and the risk of osteoporotic fracture. N Engl J Med. 2004 May 13;350(20):2033-41.

126. van Mil NH, Oosterbaan AM, Steegers-Theunissen RP. Teratogenicity and underlying mechanisms of homocysteine in animal models: a review. Reprod Toxicol. 2010 Dec;30(4):520-31.

127. Vegetarianism in American. Vegetarian Times Magazine, 2008. //www.vegetariantimes.com/features/archive_of_editorial/667

128. Verkleij-Hagoort AC, Verlinde M, Ursem NT, Lindemans J, Helbing WA, Ottenkamp J, Siebel FM, Gittenberger-de Groot AC, de Jonge R, Bartelings MM, Steegers EA, Steegers-Theunissen RP. Maternal hyperhomocysteinaemia is a risk factor for congenital heart disease. BJOG. 2006 Dec;113(12):1412-8.

129. Vogel T, Dali-Youcef N, Kaltenbach G, Andrès E. Homocysteine, vitamin B12, folate and cognitive functions: a systematic and critical review of the literature. Int J Clin Pract. 2009 Jul;63(7):1061-7

130. Wald DS, Law M, Morris JK. Homocysteine and cardiovascular disease: evidence on causality from a meta-analysis. BMJ. 2002 Nov 23;325(7374):1202.

131. Waldmann A, Dörr B, Koschizke JW, Leitzmann C, Hahn A. Dietary intake of vitamin B6 and concentration of vitamin B6 in blood samples of German vegans. Public Health Nutr. 2006 Sep;9(6):779-84.

132. Wang Q, Yu LG, Campbell BJ, Milton JD, Rhodes JM. Identification of intact peanut lectin in peripheral venous blood. Lancet. 1998;352:1831-2

133. Werder SF. Cobalamin deficiency, hyperhomocysteinemia, and dementia. Neuropsychiatr Dis Treat. 2010 May 6;6:159-95

134. Whorton JC. Historical development of vegetarianism. Am J Clin Nutr 1994;59 (suppl) 1103S-9S.

135. Wilson AK, Ball MJ. Nutrient intake and iron status of Australian male vegetarians. Eur J Clin Nutr. 1999 Mar;53(3):189-94.

136. Wong WY, Merkus HM, Thomas CM, Menkveld R, Zielhuis GA, Steegers-Theunissen RP. Effects of folic acid and zinc sulfate on male factor subfertility: a double-blind, randomized, placebo-controlled trial. Fertil Steril. 2002 Mar;77(3):491-8.

137. Xavier D, Pais P, Devereaux PJ, Xie C, Prabhakaran D, Reddy KS, Gupta R, Joshi P, Kerkar P, Thanikachalam S, Haridas KK, Jaison TM, Naik S, Maity AK, Yusuf S; CREATE registry investigators. Treatment and outcomes of acute coronary syndromes in India (CREATE): a prospective analysis of registry data. Lancet. 2008 Apr 26;371(9622):1435-42.

138. Zhao YT, Chen Q, Sun YX, Li XB, Zhang P, Xu Y, Guo JH. Prevention of sudden cardiac death with omega-3 fatty acids in patients with coronary heart disease: a meta-analysis of randomized controlled trials. Ann Med. 2009;41(4):301-10.

139. Zhao JH, Sun SJ, Horiguchi H, Arao Y, Kanamori N, Kikuchi A, Oguma E, Kayama F.
A soy diet accelerates renal damage in autoimmune MRL/Mp-lpr/lpr mice. Int Immunopharmacol. 2005 Oct;5(11):1601-10.

140. Zimmermann MB. Iodine deficiency. Endocr Rev. 2009 Jun;30(4):376-408

141. Zimmermann MB. The adverse effects of mild-to-moderate iodine deficiency during pregnancy and childhood: a review. Thyroid. 2007 Sep;17(9):829-35.

142. United States Department of Agriculture (USDA). Choose My Plate. gov. Tips for Vegetarians, //www.choosemyplate.gov/healthy-eating-tips/tips-for-vegetarian.html

143. Micha R, Mozaffarian D. Saturated fat and cardiometabolic risk factors, coronary heart disease, stroke, and diabetes: a fresh look at the evidence. Lipids. 2010 Oct;45(10):893-905.

144. Siri-Tarino PW1, Sun Q, Hu FB, Krauss RM. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr. 2010 Mar;91(3):535-46.

145. Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Saturated fatty acids and risk of coronary heart disease: modulation by replacement nutrients. Curr Atheroscler Rep. 2010 Nov;12(6):384-90.

146. Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Saturated fat, carbohydrate, and cardiovascular disease. Am J Clin Nutr. 2010 Mar;91(3):502-9

147. Pirke KM, Schweiger U, Laessle R, Dickhaut B, Schweiger M, Waechtler M. Dieting influences the menstrual cycle: vegetarian versus nonvegetarian diet. Fertil Steril. 1986 Dec;46(6):1083-8.

148. Cordain L. Cereal grains: humanity’s double-edged sword. World Rev Nutr Diet. 1999;84:19-73.

149. Rall LC, Meydani SN. Vitamin B6 and immune competence. Nutr Rev. 1993 Aug;51(8):217-25.

150. Folstein M, Liu T, Peter I, Buell J, Arsenault L, Scott T, Qiu WW.The homocysteine hypothesis of depression. Am J Psychiatry. 2007 Jun;164(6):861-7.

151. Zhang XH, Ma J, Smith-Warner SA, Lee JE, Giovannucci E. Vitamin B6 and colorectal cancer: current evidence and future directions. World J Gastroenterol. 2013 Feb 21;19(7):1005-10

152. Bougma K1, Aboud FE, Harding KB, Marquis GS. Iodine and mental development of children 5 years old and under: a systematic review and meta-analysis. Nutrients. 2013 Apr 22;5(4):1384-416.

153. Zimmermann MB. The effects of iodine deficiency in pregnancy and infancy. Paediatr Perinat Epidemiol. 2012 Jul;26 Suppl 1:108-17

Dr. Cordain's Interview With SPRY Magazine | The Paleo Diet

1) The Paleo Diet is based on a simple premise: stripping our diet down to the basics and mimicking the consumption habits of our caveman ancestors. Can you explain what this means from a food standpoint?

I wouldn’t necessarily agree that contemporary Paleo diets “strip our diets down”, but rather the opposite – they enrich our diets by reducing nutrient depleted foods that are ubiquitous in the typical western diet.  This lifelong plan of eating to maximize health  actually increases total micronutrient (vitamins, minerals, phytochemicals, fiber) density compared to the USDA My Plate recommendations, formerly the Food Pyramid as well as other so called healthful nutritional plans such as the Mediterranean Diet, The Dash Diet, Type 2 Diabetic Diets, vegetarian diets and others (1, 2).

Further, we shouldn’t be sexist and characterize this lifelong eating plan as being based upon “cavemen” diets only, rather it also includes the diet of hunter gatherer women.  And really it is not scientifically accurate to call it a “caveman” diet, but rather a “pre-agricultural” diet based upon the nutritional practices of our hunter gatherer ancestors (both men and women) who lived during the Paleolithic (old stone age) era and afterwards.

From a food standpoint, it means that we should try to mimic the food groups our hunter gatherer ancestors consumed with contemporary foods available in most supermarkets, farmers markets, co-ops and grocery stores.  These foods include fresh vegetables, fruits, fish, seafood, grass produced meat and poultry, nuts and certain healthful oils.  People consuming contemporary Paleo diets should try to avoid refined sugars, refined grains, trans fats, salt and almost all processed foods.  Our hunter gatherer ancestors rarely or never ate dairy products and cereal grains.

References:
1.    Cordain L, The nutritional characteristics of a contemporary diet based upon Paleolithic food groups. J Am Neutraceut Assoc 2002; 5:15-24.
//thepaleodiet.com/research-about-the-paleo-diet/#2002
2.    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.
//thepaleodiet.com/research-about-the-paleo-diet/#2005

2) From Atkins to the South Beach Diet, there is currently a variety of low-carb, high-protein diet plans on the market. In your opinion, what makes the Paleo Diet more effective than other diet plans out there?

As I mentioned earlier, the Paleo Diet is not a “diet” per se, but rather a lifetime plan of healthful eating which reduces the risk of the chronic “diseases of civilization” (obesity, type 2 diabetes, hypertension, high cholesterol, abnormal blood lipids, cancer, heart disease, etc.) which run rampant in the U.S. adult population.

Virtually all popular “diets” such as Atkins, South Beach and others were designed, engineered and created by fallible humans, and as such are rife with our human biases, misinformation and errors concerning the elements of optimal human nutrition.   Although, Boyd Eaton, myself and others have been credited with creating “The Paleo Diet”, this perception is incorrect.  The Paleo Diet is and always has been a biological force that shaped the human genome including our present day nutritional requirements.  It was created not by fallible human judgment but rather by the forces of evolution acting through natural selection over millions of years.  Together with anthropologists, physicians and scientists worldwide, Dr. Eaton and I simply uncovered that which was pre-existing.  The Paleo diet has always been the native diet of our species until the beginnings of the agricultural revolution 10,000 years ago (a mere 333 human generations).  Our hunter gatherer ancestors consumed a wide variety of fresh plant and animal food depending upon their geographic locale, time of season and food availability – hence there was no single “Paleo Diet” but rather numerous versions of these same two food elements: wild animal and plant foods.  Hunter gatherers ate no dairy foods, and rarely ate grains and except for seasonal honey ate no refined sugars.  Clearly they ate no modern processed foods.

Under these nutritional stipulations our ancestral diet was almost always high in protein and low in carbohydrate (3).  Hence, modern diets designed by diet doctors and fallible humans that are high in protein and low in carbs have at least got these two basic elements of our ancestral diet correct.  Nevertheless, it is almost axiomatic that the remainder of these fallible human dietary recommendations will be inconsistent with our ancestral diet and ultimately will result in nutritional shortcomings and health problems.

Case in point: The Atkins Diet.  This diet has been with us in various forms for at least 40 years and advocates reducing dietary carbohydrates to less than 100 grams per day or lower.  Few or no restrictions are placed upon the carbohydrate type, just the absolute amount.  So in effect, whole grains, refined grains and refined sugars would be  equivalent to fruits and vegetables as long as the total amount is restricted.  Additionally, fat types and sources are also undifferentiated, just as long as they don’t contain carbs that would exceed Atkins’  recommended values.  Cheese, butter, and cream are advised in lieu of excessive carbs from fresh vegetables and fruit.

The problem with these fallible human dietary recommendations was that Dr. Atkins was unaware of acid/base physiology.  Had he considered the evolutionary dietary template, he would have realized that a high protein/high fat diet that restricts carbohydrates from fresh vegetables and fruit  was inconsistent with our ancestral nutritional patterns and likely to cause health problems.  Further, he placed no limits upon cheese or even salted foods (net acid yielding foods) as long as they were low in carbohydrate. It is now known that diets with excessive acidity without accompanying base (alkalinity) from fruits and veggies adversely affects bone mineral health, blood pressure, kidney function and a variety of other factors (2, 4, 5).

In summary, unless high protein, low carbohydrate diets concocted by mortal humans don’t consider the evolutionary template they will invariably contain recommendations that are inconsistent with our ancestral diet and ultimately will result in sub-optimal health.

References:
3.    Cordain L, Brand Miller J, Eaton SB, Mann N, Holt SHA, Speth JD. Plant to animal subsistence ratios and macronutrient energy estimations in worldwide hunter-gatherer diets. American Journal of Clinical Nutrition, 2000, 71:682-92
4.    Sebastian A, Frassetto LA, Sellmeyer DE, Merriam RL, Morris RC Jr. Estimation of the net acid load of the diet of ancestral preagricultural Homo sapiens and their hominid ancestors. Am J Clin Nutr. 2002 Dec;76(6):1308-16
5.    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

3) What initially piqued your interest in studying the human diet of our Stone Age ancestors?

In 1987, I read Dr. Boyd Eaton’s seminal paper on the topic of “Paleolithic Nutrition” which appeared in the prestigious New England Journal of Medicine (6).  At the time, I thought this was about the best idea I had ever read on human nutrition, and have spent the past 25 years or so studying this concept.

References
6.    Eaton SB, Konner M. Paleolithic nutrition. A consideration of its nature and current implications. N Engl J Med. 1985 Jan 31;312(5):283-9

4) Dairy is one of the foods on the Paleo “do not eat” list. But by shunning dairy, don’t you run the risk of missing out on the many health benefits of dairy, including strong bones and digestive support?

The notion that calcium is the only and most important determinant of bone mineral health is incorrect, and in fact, numerous nutritional elements are involved in producing strong bones including acid base balance (adequate fruit and vegetable consumption) as mentioned above, sufficient high quality dietary protein, and a low dietary salt intake among others (7).  Do these nutritional factors sound familiar?  Which popular diet simultaneously maintains these characteristics?

Milk and dairy consumptions elicits insulin resistance in children (8) and represents a prominent risk factor for prostate, ovarian cancer, acne, multiple sclerosis and type 1 diabetes (7).

References:
7.    Cordain L.  Just say no to the milk mustache.  In: The Paleo Answer, John Wiley & Sons, New York, NY 2012.
8.    Hoppe C, Mølgaard C, Vaag A, Barkholt V, Michaelsen KF. High intakes of milk, but not meat, increase s-insulin and insulin resistance in 8-year-old boys. Eur J Clin Nutr. 2005 Mar;59(3):393-8

5) Do you think the Paleo Diet is too “strict” and inflexible? How can an individual maintain the Paleo Diet when dining out or in a situation where they are faced with limited food options, for example?

Built into The Paleo Diet is the 85:15 rule meaning that most people can obtain substantial health and weight loss benefits if they are at least 85 % compliant with the diet.  Three open meals per week correspond to 15 % non-compliance.  So if you want to go out and have pizza and beer with friends on a Saturday evening, it is permissible.  However, many people feel so bad after days and weeks of high compliance that it makes them think twice about doing it again.  People with serious health and obesity issues should try to maintain high compliance (95 % or greater).

6) In your book The Dietary Cure For Acne, you discuss the ways in which modern environmental factors (including diet) can trigger acne. What are some of the top foods for clearer, blemish-free skin?

The big issue here is the foods that shouldn’t be consumed,  These are the high glycemic load carbohydrates (9-11) and dairy products (12-14) which produce hormonal and cellular changes known to cause acne.  Again the evolutionary template with a diet consisting of a fresh foods (fresh, grass produced meats, poultry, sea food, fish, fresh vegetables and healthful oils) is the best medicine to produce clearer, blemish-free skin.

References:
9.    Cordain L, Lindeberg S, Hurtado M, Hill K, Eaton SB, Brand-Miller J. Acne vulgaris: a disease of Western civilization. Arch Dermatol. 2002 Dec;138(12):1584-90. //thepaleodiet.com/research-about-the-paleo-diet/#2002

10.       Cordain L, Eades MR, Eades MD. (2003). Hyperinsulinemic diseases of civilization: more than just syndrome X. Comp Biochem Physiol Part A:136:95-112. //thepaleodiet.com/research-about-the-paleo-diet/#2003
11.       Cordain, L. Implications for the role of diet in acne. Semin Cutan Med Surg 2005;24:84-91. //thepaleodiet.com/research-about-the-paleo-diet/#2005
12.   Cordain L. Dietary implications for the development of acne: a shifting paradigm. In: U.S. Dermatology Review II 2006, (Ed.,Bedlow, J). Touch Briefings Publications, London, 2006 //thepaleodiet.com/research-about-the-paleo-diet/#2006
13.   Melnik BC. Evidence for acne-promoting effects of milk and other insulinotropic dairy products. Nestle Nutr Workshop Ser Pediatr Program. 2011;67:131-45.
14.   Silverberg NB. Whey protein precipitating moderate to severe acne flares in 5 teenaged athletes. Cutis. 2012 Aug;90(2):70-2

Part II. (These can be very brief, 1-2 sentences).  

If you had to sum it up in a word or phrase, what is your health philosophy?
Emulate the activity and nutritional patterns or our hunter gatherer ancestors with all of the advantages of our modern world.

What is your favorite healthy weeknight dish to make?

I don’t distinguish between weekend or week nights.  Steamed king crab is a favorite

Do you have a favorite workout or fitness activity?
Exercise, play or any physical activity in the outdoors under the sun in a peaceful, natural setting.

What would you say is your “secret weapon” to staying healthy?
Adopting the beneficial aspects of our ancestral diet/lifestyle while leaving behind their hardships and taking advantages of the technological advances of our modern world.
If you’re ever faced with temptation, how do you keep yourself on track? Any tips?
Think about how well I will feel in the morning if I don’t fall to temptation.

Cordially,

Loren Cordain, Ph.D., Professor Emeritus

Affiliates and Credentials