Tag Archives: Omega-3

We Need Fat in Our DietsHealthy Eating | The Paleo Diet 

Avoiding fat in our diet was all the craze in the 80s and 90s, but the fact is that eating fat is how our bodies get their essential fatty acids. These fatty acids help our bodies in many ways, and we can’t produce them alone. We need to eat fat.  

Our brains are 60% fatty acids, so some fat is necessary for ensuring healthy brain function. Fat gives our brain energy and helps fight off brain disease. Monounsaturated fats play a major role in improving our learning and memory. 

And fat protects us. It’s a major building block that helps make up the walls that support and protect our cells. Many of the vital organs, especially the kidneys, heart, and intestines are cushioned by fat that helps protect them from injury and hold them in place. 

Triglycerides and cholesterol are two essential fatty acids that our bodies can’t produce on their own, and they insulate us, protect our organs, and store energy needed for exercise and everyday activities. Triglycerides can hold twice as many calories as carbohydrates and proteins, and they can be found in a variety of foods, including fruit, pork, starchy vegetables, and oily fish. 

Since the important vitamins A, D, E, and K are fat-soluble vitamins, consuming them with fats we find in certain foods helps us to absorb these vitamins into the body.  

Vitamin A is good for your vision and skin, and it helps your body defend itself from illness and infection. Eggs, fish, milk, yogurt and cheese are all sources of Vitamin A. Vitamin E also helps maintain healthy skin and strengthens the immune system. You can find vitamin E in plant oils, nuts, and seeds.  

Vitamin D regulates nutrients that keep our bones, teeth, and muscles healthy. An insufficient amount of vitamin D in a person’s diet can lead to serious issues, such as osteomalacia, or softening of the bones. A good way to maintain healthy levels of vitamin D is to get plenty of sunlight. Vitamin D can also be found in fish, eggs, and red meat.  

 

Different Types of Fat 

When learning about fat, we should recognize the differences between the kinds of fat in the food we eat. The three most common in our diet are saturated fat monounsaturated fat, and polyunsaturated fat.  

According to the National Health Service, only 50 to 70 grams of fat should be consumed per day, and only 20 grams should be from saturated fat. 

And saturated fat may be the most common. We find it all throughout our diets—in beef, lamb, pork, poultry, sausage, salami, cheese, butter, cream, and many snack foods and deep-fried fast food favorites. 

Monounsaturated fatty acids improve blood cholesterol levels, decreasing your risk of heart disease. Monounsaturated fats are found often in foods such as olive oil, nuts, avocados and whole milk. 

Polyunsaturated fats include omega3 and omega6 fatty acids. 

Omega3 fatty acids are proven to regulate blood sugar levels. A study in 2014 showed that omega-3 fatty acids can help regulate how we metabolize glucose. That means it can help to mitigate some of the harmful effects of consuming glucose and other simple carbohydrates. Omega-3 fatty acids are great for your heart—they help reduce the risk of arrhythmia, slow the build-up of plaque in your arteries, and lower your blood pressure 

Omega-6 fatty acids can help control your blood sugar, reduce your risk of diabetes, and lower your blood pressure. Though there are also negative health effects of over-consuming omega-6 fatty acids, which is common on a Western Diet. It’s important to keep a high ratio of omega-3 to omega-6 fatty acids in the diet. 

Almost all trans fats are byproducts of industrial fat production. This type is extremely unhealthy and grant no health benefits, unlike the naturally occurring fats.  

Low-fat and especially nonfat diets have many risks, including hormone imbalance and decreased brain function and health. Make sure to educate yourself on the healthy levels of the different types of fats. We tend to look at fat as a bad thing, but it is positively necessary for proper brain and body health. 

 

Fish oil supplements remain one of the most popular ways to help maintain good health.[1] For years, the buzz has been that omega-3 fatty acids can help with a wide variety of conditions, ranging from preventing cognitive decline, to aiding with fat loss, and even to helping with brain and eye development.[2] And that’s just a few. There are a wide variety of other benefits to omega-3 fatty acids including good skin, aiding with sleep, and even helping with arthritis.[3]

 

What Are Omega-3 Fatty Acids?

Omega-3 supplements generally include two primary forms: EPA and DHA, which stand for eicosapentaenoic acid and docosahexaenoic acid respectively.[4] These are the two omega-3 fatty acids that have been studied the most, and seem to provide the most benefits.[5] Non-alcoholic fatty liver disease, for example, is the most common cause of liver disease, and both EPA and DHA can help reduce this liver fat, as well as aid with other chronic conditions.[6]

Both EPA and DHA are long chain polyunsaturated fatty acids, and appear to be crucial for reducing inflammation throughout the body.[7] The most commonly studied supplemental form is a blend of EPA to DHA, in a ratio of 18:12.[8] This is scientifically fascinating, as DHA is actually the more potent of the two omega-3 fatty acids.[9] DHA has been shown to be essential for the growth and development of our brains – which is why it’s added to almost every prenatal vitamin in the world.[10]

In fact, DHA is so important for our brain, that deficiencies have been associated with learning disabilities.[11] Similarly, cognitive decline has also been associated with a lack of DHA.[12] It’s interesting that brain deficiencies in infants – and degenerative brain diseases like Alzheimer’s – are linked by deficiencies in DHA.[13]

Biochemically, omega-3s are also interesting because they are an essential nutrient. Meaning, they are not made by the body. If you’re not eating enough wild-caught fish, or supplementing, you are likely deficient in omega-3’s.[14] Omega-3s are so crucial, that they even help build cell membranes. That’s right, our very own cells – the most basic building blocks of human life – require omega-3s.[15]

It is endlessly fascinating to me that omega-3s are not made by our body and must be obtained exogenously. For something so critical – usually our body would manufacture that sort of thing. Plant-based omega-3s come in a different form – alpha-linolenic acid – which the body has to change into DHA and EPA.[16] Because this is not a terribly efficient process, plant-based omega-3s are not recommended by me, to any of my clients.

 

Omega-3s Help with Weight Loss and Inflammatory Conditions

When it comes to body weight and obesity, omega-3 fatty acids play an important role. Among its benefits, omega-3s seem to play a role in appetite suppression. There are also the benefits of omega-3s in increasing lean body mass and aiding with better fatty acid oxidation.[17]

Surprisingly, in obesity research, omega-3 fatty acids do not actually appear to contribute to weight loss. But the research does show that omega-3s help keep weight off.[18] They are also critical to maintaining a healthy body weight, as well as a healthy BMI. This is important because research has also shown that about 50 percent of weight that is lost is regained after one year.[19] This means that long term weight loss remains out of reach for many and every little advantage can help.

To help reduce inflammation (another key component in reducing obesity,) omega-3s block inflammation pathways, which is also why omega-3s can be beneficial for those with arthritis, and other inflammatory conditions. Omega-3s can also help reduce the level of triglycerides found within the body – another key component in improving health and reducing obesity.[20]

Omega-3 fatty acids supplements may even help with depression since inflammation has been linked to depression,[21] though the research is still a bit mixed.

Alzheimer’s cannot be treated with just omega-3 fatty acids, but research has shown positive results for those who do not yet have a degenerative brain disease when supplementing with omega-3s.[22]

Since omega-3s are critical in building cell membranes – which literally protect our cells from harm – it’s easy to see how they also help protect us from other ailments.[23] Omega-3s are crucial for healthy functioning of our blood vessels, brain, lungs, eyes, heart, glands, sperm cells, and immune system.[24] Quite a laundry list of benefits – but also most critical for keeping obesity at bay.

 

Getting Enough Omega-3s in Your Diet

A Paleo Diet® will have a good amount of omega-3 fatty acids already present. Consuming wild-caught fish and other seafood, a key part of The Paleo Diet, will provide us with brain and heart healthy omega-3s.

However, I still recommend to clients that they take about 1000mg (or 1 g) per day, of DHA. This is because DHA has been shown to be able to retroactively convert to EPA.[25] Meaning you will get the benefits of both DHA and EPA just by taking DHA.

We know that omega-3s operate in a variety of ways to aid with obesity and the metabolic syndrome.[26] But it must be noted that nothing is a silver bullet, and a healthy diet and exercise plan remains the most critical piece of any healthy lifestyle. A Paleo Diet will provide a good amount of omega-3s, and the anti-inflammatory effects of vegetables in a Paleo approach will help aid with obesity even further.

As a final note, we cannot forget the benefits of protein, either. Protein revs up our metabolism, builds muscle, and lowers our hunger. A plain chicken breast, beats a protein powder, any day. But because omega-3s cannot be produced by our own bodies, we must eat them from food sources – and I still recommend that even the healthiest eater, supplements with around 1000mg (or 1g) of DHA.

 

References

[1] De magalhães JP, Müller M, Rainger GE, Steegenga W. Fish oil supplements, longevity and aging. Aging (Albany NY). 2016;8(8):1578-82.

[2] Harris WS. Fish oil supplementation: evidence for health benefits. Cleve Clin J Med. 2004;71(3):208-10, 212, 215-8 passim.

[3] Kremer JM, Lawrence DA, Petrillo GF, et al. Effects of high-dose fish oil on rheumatoid arthritis after stopping nonsteroidal antiinflammatory drugs. Clinical and immune correlates. Arthritis Rheum. 1995;38(8):1107-14.

[4] Swanson D, Block R, Mousa SA. Omega-3 fatty acids EPA and DHA: health benefits throughout life. Adv Nutr. 2012;3(1):1-7.

[5] Dyall SC. Long-chain omega-3 fatty acids and the brain: a review of the independent and shared effects of EPA, DPA and DHA. Front Aging Neurosci. 2015;7:52.

[6] Ochi E, Tsuchiya Y. Eicosapentaenoic Acid (EPA) and Docosahexaenoic Acid (DHA) in Muscle Damage and Function. Nutrients. 2018;10(5)

[7] Maroon JC, Bost JW. Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain. Surg Neurol. 2006;65(4):326-31.

[8] Ghasemi fard S, Wang F, Sinclair AJ, Elliott G, Turchini GM. How does high DHA fish oil affect health? A systematic review of evidence. Crit Rev Food Sci Nutr. 2018;:1-44.

[9] Grønn M, Christensen E, Hagve TA, Christophersen BO. Peroxisomal retroconversion of docosahexaenoic acid (22:6(n-3)) to eicosapentaenoic acid (20:5(n-3)) studied in isolated rat liver cells. Biochim Biophys Acta. 1991;1081(1):85-91.

[10] Lauritzen L, Brambilla P, Mazzocchi A, Harsløf LB, Ciappolino V, Agostoni C. DHA Effects in Brain Development and Function. Nutrients. 2016;8(1)

[11] Kuratko CN, Barrett EC, Nelson EB, Salem N. The relationship of docosahexaenoic acid (DHA) with learning and behavior in healthy children: a review. Nutrients. 2013;5(7):2777-810.

[12] Weiser MJ, Butt CM, Mohajeri MH. Docosahexaenoic Acid and Cognition throughout the Lifespan. Nutrients. 2016;8(2):99.

[13] Cederholm T, Salem N, Palmblad J. ω-3 fatty acids in the prevention of cognitive decline in humans. Adv Nutr. 2013;4(6):672-6.

[14] Weylandt KH, Serini S, Chen YQ, et al. Omega-3 Polyunsaturated Fatty Acids: The Way Forward in Times of Mixed Evidence. Biomed Res Int. 2015;2015:143109.

[15] Valentine RC, Valentine DL. Omega-3 fatty acids in cellular membranes: a unified concept. Prog Lipid Res. 2004;43(5):383-402.

[16] Gerster H. Can adults adequately convert alpha-linolenic acid (18:3n-3) to eicosapentaenoic acid (20:5n-3) and docosahexaenoic acid (22:6n-3)?. Int J Vitam Nutr Res. 1998;68(3):159-73.

[17] Smith GI. The Effects of Dietary Omega-3s on Muscle Composition and Quality in Older Adults. Curr Nutr Rep. 2016;5(2):99-105.

[18] Buckley JD, Howe PR. Long-chain omega-3 polyunsaturated fatty acids may be beneficial for reducing obesity-a review. Nutrients. 2010;2(12):1212-30.

[19] Blomain ES, Dirhan DA, Valentino MA, Kim GW, Waldman SA. Mechanisms of Weight Regain following Weight Loss. ISRN Obes. 2013;2013:210524.

[20] Shearer GC, Savinova OV, Harris WS. Fish oil — how does it reduce plasma triglycerides?. Biochim Biophys Acta. 2012;1821(5):843-51.

[21] Osher Y, Belmaker RH. Omega-3 fatty acids in depression: a review of three studies. CNS Neurosci Ther. 2009;15(2):128-33.

[22] Dyall SC. Long-chain omega-3 fatty acids and the brain: a review of the independent and shared effects of EPA, DPA and DHA. Front Aging Neurosci. 2015;7:52.

[23] Surette ME. The science behind dietary omega-3 fatty acids. CMAJ. 2008;178(2):177-80.

[24] Swanson D, Block R, Mousa SA. Omega-3 fatty acids EPA and DHA: health benefits throughout life. Adv Nutr. 2012;3(1):1-7.

[25] Grønn M, Christensen E, Hagve TA, Christophersen BO. Peroxisomal retroconversion of docosahexaenoic acid (22:6(n-3)) to eicosapentaenoic acid (20:5(n-3)) studied in isolated rat liver cells. Biochim Biophys Acta. 1991;1081(1):85-91.

[26] Lorente-cebrián S, Costa AG, Navas-carretero S, Zabala M, Martínez JA, Moreno-aliaga MJ. Role of omega-3 fatty acids in obesity, metabolic syndrome, and cardiovascular diseases: a review of the evidence. J Physiol Biochem. 2013;69(3):633-51.

Who says fishing for trout can only be done in the warmer months of the year?  In Colorado, home of The Paleo Diet®, there’s nothing better than a fresh catch at high altitude in the middle of winter! Check out the photo to the right of Kenny Cordain holding a 14.5-pound wild Mackinaw pulled up through two feet of ice from frozen alpine waters at 9000 feet. Worth all the effort for the high yield of multiple Omega-3 rich fillets to be enjoyed over the next few months.  Trout can be prepared and cooked using a variety of methods. One of our favorite recipes is so fast and easy, you can go from lake to table in record time.


Ingredients

  • 2-3 lbs trout fillets
  • 2 tablespoons extra virgin olive oil
  • 2 fresh lemons
  • 2 tablespoons unsalted lemon pepper
  • ¼ cup fresh cilantro

 

Directions

Rinse fillets in cold water and pat dry.  Heat olive oil in large fry pan over medium heat.  Place fillets in pan skin side down. Slice one of the lemons in half and squeeze juice evenly over fillets.  Slice the 2nd lemon into 1/8 inch slices, removing seeds.  Place lemon slices over fillets. Sprinkle with lemon pepper and cook until fillets are cooked ¾ through.  With large spatula, carefully turn fish and continue cooking. Once the fish has lost its pink color and flakes easily, remove from heat.  Sprinkle fresh cilantro over fillets before serving.

Serves 4.

 

In Part I of this series, we looked at the longstanding recommendations of many governmental health organizations to reduce dietary saturated fat and replace it with omega-6 fats. Doing so supposedly, these organizations claim, reduces cardiovascular disease (CVD) risk. As we saw in Part I, however, there is considerable controversy within the nutrition science community concerning this claim. There’s a case to be made for decreased saturated fat, but there’s also a case for decreased omega-6. Since the current science is far less black-and-white than the recommendations would lead you to believe, with Part II of this series, we’ll be looking at the debate from a paleolithic perspective, with the hope of gaining a broader and more balanced perspective on optimal consumption levels of both saturated and polyunsaturated fats.

 

Paleo PUFA Consumption

Although conclusive scientific studies are lacking, we can gain valuable insight by examining the diets of our Paleolithic ancestors. How much of these nutrients did they consume? How do current PUFA recommendations compare to PUFA consumption by our Paleolithic ancestors?

To know how much saturated fat and PUFAs they ate, we first must estimate how much total fat they ate. As always, Paleolithic diets varied based on geography and access to certain foods, but in general, our ancestors ate relatively more fat, more protein, and less carbohydrate, compared to contemporary diets. In 2000, Dr. Cordain and his colleagues estimated the following macronutrient ratios for Paleolithic diets:[1]

  • Fat: 28-58% of calories
  • Protein: 19-35% of calories
  • Carbohydrates: 22-40% of calories

They arrived at these estimates, in part, by analyzing the diets of 229 hunter-gather societies, assessing their specific foods, and measuring their ratios of plant to animal food consumption. The vast majority (73%) of these societies derived more than 50% of their calories from animal foods [2].

Next, we need to estimate how macronutrients are distributed within the specific foods our ancestors ate. Figures 1 and 2 below compare the meat of wild animals with the meat of commercially raised animals. Figure 1 shows the percentage of calories from protein, fat, and carbohydrate (note that carbs are negligible in animal meat) whereas Figure 2 shows each type of fat as a percentage of total fat. We can assume, with a reasonable degree of certainty, that wild animals today are similar to those hunted and consumed by our ancestors, with respect to body composition.

Macronutrient Calories in Animal Foods

Figure 1. Percent of calories from macronutrients (protein, fat and carbohydrate) in wild and commercial animal foods.

Proportion of Fatty Acids in Animal Foods

Figure 2. Proportions of fatty acids in wild and commercial animal foods.

 

Examining these figures, two dominant trends emerge:

1. Wild meat is proportionally higher in protein and lower in fat compared to commercially raised meat.
2. The fat portion of wild meat is proportionally higher in PUFAs – both omega-6 and omega-3 – compared to commercial meat.

Additionally, we can say that grass-fed beef is closer to wild meat than grain-fed beef, but both grass-fed beef and grain-fed beef poorly approximate wild meat.

The above observations are based on data from the USDA Nutrient Database and are substantiated by numerous studies comparing wild and domesticated animals [3], [4], [5], [6], [7].

Additionally, scientists have recently extracted frozen, Paleolithic-era animal carcasses from the Siberian tundra. Tissue analyses of these carcasses further highlight the similarities between Paleolithic meat and modern wild meat, particularly with respect to n-6/n-3 ratios [8], [9].

 

The Ever-Important Omega Ratio

As we saw in part I, many RCTs, observational studies, and meta-analyses addressing omega-6 consumption fail to properly account for omega-3 consumption (and the n-6/n-3 ratio). For our Paleolithic ancestors, this ratio was approximately 1/1 (and probably no higher than 3/1) [10]. Today, however, the ratio approaches 20/1 for people consuming typical Western diets [11].

This disparity is critical to the entire debate about saturated fat and its replacement with omega-6. Recent studies show saturated fat isn’t a health menace, as previously believed [12][13][14][15]. On the other hand, our reliance on commercially raised meat has probably skewed our fat consumption by over-representing saturated fat and under-representing PUFAs. We’ve compensated by consuming large quantities of vegetable oils, which are rich in omega-6, but omega-3 consumption has fallen by the wayside.

The consequences of our dramatically elevated n-6/n-3 ratios include the following:[16]

  • Increased inflammation
  • Increased leptin and insulin resistance
  • Increased risk for diabetes
  • Increased weight gain and risk for obesity

 

Keeping it Real

Just as previous generations shunned saturated fat, we would be foolish to shun omega-6 completely. After all, omega-6 is an essential fatty acid (EFA), meaning our body requires it and can only obtain it from food. That being said, some sources of are better than others.

It’s easy to get good quality omega-6 from olive oil, avocados, nuts, and from certain animal foods. By following the Paleo Diet template, you’ll get a good balance of omega-6 and omega-3, plus a good distribution of SFAs, MUFAs, and PUFAs.

With respect to omega-6, our best advice would be to eliminate all vegetable and seed oils from your diet. These include, among others:

  • Soybean oil
  • Corn oil
  • Safflower oil
  • Sunflower oil
  • Canola oil
  • Grapeseed oil

The problem with these oils is they contain very high amounts of omega-6. Consuming them increases your n-6/n-3 ratio, while also introduces potentially dangerous free radicals.

 

Unstable Seed Oils

The industrial processing of vegetable seed oils involves high-heat and the use of various chemical solvents – a guaranteed recipe for free radical oxidation and lipid peroxidation [17].

Cooking with PUFA-rich oils creates lipid oxidation products known as alkenals, some of which are toxic [18].

Olive oil, which contains some PUFAs, but is mostly comprised of MUFAs, has been shown to be more heat-stable and better for cooking compared to vegetable oils [19],[20]. It’s best to avoid high-heat cooking with any oils, but those containing higher amounts of SFAs and MUFAs are more stable than those with higher amounts of PUFAs.

 

Conclusion

Saturated fat isn’t unhealthy, but it needn’t be over represented in our diets. Many health authorities recommend replacing saturated fat with omega-6, and although some studies support this recommendation, most fail to differentiate between omega-6 and omega-3. Replacing some saturated fat with PUFAs could be beneficial, particularly if doing so lowered the n-6/n-3 ratio. For most people, this would mean eliminating all vegetable seed oils, while increasing oily fish (omega-3) consumption.

It’s also important to recognize that meat from game animals is better than commercially raised meat, but since obtaining wild meat is impractical for most people, pasture-raised meat (grass-fed, etc.) should always be favored.

Don’t over complicate things too much. You don’t need to meticulously track your fat consumption. By following The Paleo Diet template and listening to your body, you’ll get a healthy mix.

 

References

[1] Cordain L, et al. (2000). Plant-animal subsistence ratios and macronutrient energy estimations in worldwide hunter-gatherer diets. American Journal of Clinical Nutrition, 71(3). Retrieved from (link).

[2] Cordain L, et al. (2000). Plant-animal subsistence ratios and macronutrient energy estimations in worldwide hunter-gatherer diets. American Journal of Clinical Nutrition, 71(3). Retrieved from (link).

[3] Davidson B, et al. (Mar-Apr 2011). Meat lipid profiles: a comparison of meat from domesticated and wild Southern African animals. In Vivo, 25(2). Retrieved from (link).

[4] Rule DC, et al. (2002). Comparison of muscle fatty acid profiles and cholesterol concentrations of bison, beef cattle, elk, and chicken. J Anim Sci., 80(5). Retreived from (link).

[5] Cordain, et al. (Mar 2002). Fatty acid analysis of wild ruminant tissues: evolutionary implications for reducing diet-related chronic disease. Nature, 56(3). Retrieved from (link).

[6] Cordain, et al. (2001). Fatty acid composition and energy density of foods available to African hominids. Evolutionary implications for human brain development. World Rev Nutr Diet., 90. Retrieved from (link).

[7] Fine LB, et al. (2008). Comparison of lipid and fatty acid profiles of commercially raised pigs with laboratory pigs and wild-ranging warthogs. South African Journal of Science, 104. Retrieved from (link).

[8] Guil-Guerrero JL, et al. (2014). The Fat from Frozen Mammals Reveals Sources of Essential Fatty Acids Suitable for Palaeolithic and Neolithic Humans. PLoS One., 9(1). Retrieved from (link).

[9] Guil-Guerrero JL, et al. (2015). The PUFA-Enriched Fatty Acid Profiles of some Frozen Bison from the Early Holocene found in the Siberian Permafrost. Scientific Reports, 5. Retrieved from (link).

[10] Eaton SB, et al. (1998). Dietary intake of long-chain polyunsaturated fatty acids during the paleolithic. World Rev Nutr Diet., 83. Retrieved from (link).

[11] Simopoulos AP. (2016). An Increase in the Omega-6/Omega-3 Fatty Acid Ratio Increases the Risk for Obesity. Nutrients, 8(3). Retrieved from (link).

[12] Ruiz-Nunez, B., D.A.J. Dijck-Brouwer, and F.A.J. Muskiet, The relation of saturated fatty acids with low-grade inflammation and cardiovascular disease. Journal of Nutritional Biochemistry, 2016. 36: p. 1-20.

[13] Chowdhury, R., et al., Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk A Systematic Review and Meta-analysis. Annals of Internal Medicine, 2014. 160(6): p. 398-+.

[14] Astrup, A., et al., The role of reducing intakes of saturated fat in the prevention of cardiovascular disease: where does the evidence stand in 2010? American Journal of Clinical Nutrition, 2011. 93(4): p. 684-688.

[15] Hoenselaar, R., Saturated fat and cardiovascular disease: The discrepancy between the scientific literature and dietary advice. Nutrition, 2012. 28(2): p. 118-123.

[16] Simopoulos AP. (2016). An Increase in the Omega-6/Omega-3 Fatty Acid Ratio Increases the Risk for Obesity. Nutrients, 8(3). Retrieved from (link).

[17] Kanner J, et al. (2007). Dietary advanced lipid oxidation endproducts are risk factors to human health. Mol Nutr Food Res., 51(9). Retrieved from (link).

[18] Halvorsen BL, et al. (2011). Determination of lipid oxidation products in vegetable oils and marine omega-3 supplements. Food Nutr Res., 55. Retrieved from (link).

[19] Halvorsen BL, et al. (2011). Determination of lipid oxidation products in vegetable oils and marine omega-3 supplements. Food Nutr Res., 55. Retrieved from (link).

[20] Silva L, et al. (2010). Oxidative stability of olive oil after food processing and comparison with other vegetable oils. Food Chemistry, 121(4). Retrieved from (link).

FOOD-official-meatFor over a decade now, a debate has been raging within the nutrition science community. One side views saturated fat as generally unhealthy; they recommend replacing these fats, at least to some degree, with omega-6 polyunsaturated fats. The other side views saturated fat as health-supportive, or at least health-neutral; likewise, they regard omega-6 as somewhat unhealthy and typically recommend decreasing its consumption. So, who has it right? The truth seems to be grey and somewhere in between.

 

The Modern Diet

Americans have largely followed the US government’s dietary advice for the past 40 years. For example, following official dietary advice in the 80s to reduce fat in our diets, we decreased our fat consumption from 45 to 34% of calories, on average, while increasing our carbohydrate consumption from 39 to 51% of calories [i].

We made these changes because doing so – or so we were told – would decrease cardiovascular disease (CVD), which was and still remains the number one cause of death in the western world.

However, there are also different types of fats (see Figure 1) and both international and US government guidelines have made recommendations about the types of fats we should consume. Current recommendations suggest reducing saturated fat to a maximum of 10% of total calories while increasing omega-6 to somewhere between five and 10% of total calories  [ii], [iii].

Figure 1. The basic types of fat.

Different Types of Fats

 

As a population, we’re pretty much within these recommended zones. We get 11% of our calories from saturated fat and 8% from polyunsaturated fat (primarily the omega-6 variety)[iv], [v].

CVD mortality has declined since its peak in the 1950s, but CVD prevalence remains very high. For example, the total number of inpatient cardiovascular operations and procedures increased 28% between 2000 and 2010 (from 5.9 million to 7.6 million procedures) [vi]. Moreover, prevalence of metabolic syndrome, a precursor to CVD, has reached a staggering 34% of the population [vii].

If the advice to replace saturated fat with omega-6 was designed to reduce CVD, then what went wrong? Was the advice misguided? Let’s look at the evidence.

 

The Pro-PUFA Studies

Numerous recently published meta-analyses support the conclusion that replacing saturated fat with polyunsaturated fat (though not necessarily omega-6) leads to modest CVD risk reductions. For example:

 

  • Mozaffarian D, et al. (2010) pooled data from 8 randomized controlled trials (RCTs) encompassing 13,614 participants and 1,042 coronary heart disease (CHD) events. They determined that for every 5% caloric increase in polyunsaturated (PUFA) fat there is a corresponding 10% decrease in CHD risk [viii].

Study Limitations: PUFA consumption for this study included both omega-6 and omega-3. Therefore, it’s possible the positive results may have been primarily from omega-3; negative effects from omega-6 could have been masked.

 

  • Hooper L, et al. (2015) pooled data from 13 long-term RCTs encompassing 53,300 participants. They found “a small but potentially important reduction in cardiovascular risk when saturated fat intake was lowered,” particularly by replacing saturated fat with PUFAs, but not by replacing it with carbohydrates [ix]. However, the study found no clear effect of reducing saturated fat on total mortality.

Study Limitations: Among these RCTs, omega-6 and omega-3 PUFAs were grouped together. Therefore, analyzing the individual impact of either PUFA was not possible.

 

  • Farvid MS, et al. (2014) conducted a meta-analysis of 11 studies pertaining to omega-6 (LA) intake and CHD. They concluded “a 5% of energy increment in LA intake replacing energy from saturated fat intake was associated with a 9% lower risk of CHD events and a 13% lower risk of CHD deaths”.

Study Limitations: (1) Whereas this study did specifically measure omega-6, it didn’t account for the ratio of omega-6 to omega-3 (referred to as “n-6/n-3” hereafter), (2) the meta-analysis only included observational studies, not RCTs, and (3) the meta-analysis measured cardiovascular disease mortality, but not all-cause mortality.

 

  • Yanping Li, et al. (2015) conducted a meta-analysis of two observational studies, the first of which followed 85,000 women for 24 years and the second of which followed 43,000 men for 30 years. In total, 7,667 cases of CHD were documented. The authors concluded that replacing 5% of the energy intake from saturated fats with equal energy from PUFAs was associated with a 25% reduced risk of CHD [xi].

Study Limitations: (1) The study was observational (no RCTs were included), (2) the study didn’t account for the n-6/n-3 ratio, and (3) the data was derived from food frequency questionnaires.

 

  • Wu JH, et al. (2015) conducted a cohort study of 2,792 older US adults (mean age, 74). To avoid the problems associated with food frequency questionnaires, they analyzed circulating omega-6 (LA only) blood levels, an objective biomarker of LA consumption[xii]. Those within the highest quintile of circulating LA had 13% lower all-cause mortality than those in the lowest quintile. Interestingly, when the authors stratified subjects based on combined LA and omega-3 PUFA concentrations, those in the highest quintile had a 54% lower all-cause mortality risk compared to those in the lowest quintile.

Study Limitations: This study was designed better than most, but didn’t completely demonstrate how changes to the n-6/n-3 ratio affect mortality.

 

The Anti-PUFA Studies

Christopher Ramsden, MD is a clinical investigator for the National Institutes of Health. During the past decade, Ramsden has been among the most prominent scientists challenging the mainstream narrative that omega-6 should replace saturated fat. Through a series of studies, most of which were published by the British Medical Journal, Ramsden and his colleagues have put forth an important antithesis [xiii], [xiv], [xv]. Some of their conclusions include:

  • Increasing omega-3 relative to omega-6 significantly reduces the risk of heart disease.
  • Diets rich in omega-6 increase risks of all CHD endpoints, while increasing all-cause mortality risk.
  • Substituting dietary omega-6 LA in place of SFA increases all-cause mortality risk, as well as risks from coronary heart disease.
  • Benefits previously attributed to greater intake of total PUFAs may be specifically attributable to omega-3 and not to omega-6 LA.

Some of the problems with the studies used to justify increased omega-6 consumption, according to Ramsden and his colleagues, include:

  • Failure to distinguish between trials that selectively increased omega-6 and those that substantially increased omega-3
  • Failure to acknowledge that omega-6 and omega-3 replaced not only SFAs, but large amounts of trans-fats in many trials used in the pro-PUFA meta-analyses
  • Failure to provide the specific compositions of the diets (particularly with respect to omega-6 and trans-fat) used in the pro-PUFA meta-analyses
  • Failure to analyze the impact of n-6/n-3 ratios


The Middle Ground

As you can see, the consumption of saturated fat and omega-6 are controversial, partly because we lack rigorous studies specifically designed to test the optimal balance between saturated fat, omega-6, and omega-3. This was precisely the conclusion of a 2015 Cochran review by Al-Khudairy L, et. al. [xvi].

The authors sought RCT data demonstrating the effectiveness of increasing or decreasing omega-6 for the prevention of cardiovascular disease. Additionally, they wanted to assess the impact of total omega-3 consumption and the n-6/n-3 ratio.

Unfortunately, “very few trials were identified with a relatively small number of participants randomized.” They concluded, (1) there is currently insufficient evidence to recommend either increased or decreased omega-6 consumption, and (2) larger, better RCTs on this topic are needed.

 

Conclusion

In Part 1 of this article series, we’ve seen that many critical questions about optimal saturated- and polyunsaturated fat consumption levels haven’t yet been answered by science. While we wait for better RCTs to be conducted, we can gain deeper insights and a better understanding of this issue by examining the fat consumption patterns of our Paleo ancestors. Be sure to check out Part II of this series, where we’ll do just that.

 

References

[i] Cohen E, et al. (2015). Statistical review of US macronutrient consumption data,

1965–2011: Americans have been following dietary guidelines, coincident with the rise in obesity. Nutrition, 31. Retrieved from (link).

[ii] US Department of Health and Human Services and U.S. Department of Agriculture. (Dec 2015). 2015–2020 Dietary Guidelines for Americans. 8th Edition. Retrieved from (link).

[iii] FAO. (2010). Fats and fatty acids in human nutrition: Report of an expert consultation. Rome: Food and Agriculture Organization of the United Nations. Retrieved from (link).

[iv] Ervin RB, et al. Centers for Disease Control. (Nov 2004). Advanced Data from Vital Health Statistics. Retrieved from (link).

[v] Wright JD, et al. Centers for Disease Control. (Nov 2010). Trends in Intake of Energy and Macronutrients in Adults. From 1999–2000 Through 2007–2008. NCHS Data Brief, 49. Retrieved from (link).

[vi] Mozaffarian D, et al. (2015). Heart Disease and Stroke Statistics—2015 Update. Circulation, 131. Retrieved from (link).

[vii] Aguilar M, et al. (2015). Prevalence of the Metabolic Syndrome in the United States, 2003-2012. JAMA, 313(19). Retrieved from (link).

[viii] Mozaffarian D, et al. (2010) Effects on Coronary Heart Disease of Increasing Polyunsaturated Fat in Place of Saturated Fat: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS Med, 7(3). Retrieved from (link).

[ix] Hooper L, et al. (Jun 2015). Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev., 10(6). Retrieved from (link).

Farvid MS, et al. (Oct 2014). Dietary linoleic acid and risk of coronary heart disease: a systematic review and meta-analysis of prospective cohort studies. Circulation, 130(18). Retrieved from (link).

[xi] Yanping Li, et al. (Oct 2015). Saturated Fats Compared With Unsaturated Fats and Sources of Carbohydrates in Relation to Risk of Coronary Heart Disease. Journal of the American College of Cardiology, 66(14). Retrieved from (link).

[xii] Wu JH, et al. (Oct 2015). Circulating Omega-6 Polyunsaturated Fatty Acids and Total and Cause-Specific Mortality: The Cardiovascular Health Study. Circulation, 130(15). Retrieved from (link).

[xiii] Ramsden CE, et al. (2010). n-6 Fatty acid-specific and mixed polyunsaturate dietary interventions have different effects on CHD risk: a meta-analysis of randomised controlled trials. British Medical Journal, 104(11). Retrieved from (link).

[xiv] Ramsden CE, et al. (2013). Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: evaluation of recovered data from the Sydney Diet Heart Study and updated meta-analysis. British Medical Journal, 346. Retrieved from (link)

[xv] Ramsden CE, et al. (Apr 2016). Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968-73). British Medical Journal, 353. Retrieved from (link).

[xvi] Al-Khudairy L, et al. (2015). Omega 6 fatty acids for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev., 16(11). Retrieved from (link).

Healthy Eating | The Paleo Diet

Anyone who follows the U.S. nutritional guidelines has almost certainly been frustrated at some point or another by the conflicting advice and sometimes hopelessly outdated marketing material – think the Food Pyramid that still graces the walls of many elementary school classrooms.

The frustration has reached the point that cries of government corruption and inappropriate influence of big food industry lobbyists are frequently heard. Case in point, the February 2015 draft of the U.S. Dietary Guidelines,1 published every five years, prompted over 29,000 public comments compared to a couple thousand in 2010. The outcry has been so strong it has led to a Congressional review to start in October.

And just last week journalist Nina Teicholz published a scathing review of the guidelines in the high impact factor journal BMJ.2

Teicholz accused the Dietary Guidelines Advisory Committee (DGAC) of not listing their conflicts of interest, of using reviews from industry influenced professional associations, and of overall “weak scientific standards.” Which is scary considering the importance of the 2015 Dietary Guidelines can’t be understated.

According to Teicholz, “the guidelines have a big influence on diet in the U.S., determining nutrition education, food labeling, government research priorities at the National Institutes of Health (NIH) and public feeding programs.”

So what did the Committee recommend? The overall body of evidence examined by the 2015 DAC identifies that a healthy dietary pattern is higher in vegetables, fruits, whole grains, low- or non-fat dairy, seafood, legumes, and nuts; moderate in alcohol (among adults); lower in red and processed meats; and low in sugar-sweetened foods and drinks and refined grains.

Certainly not a win for the Paleo community, but also not anything we haven’t heard from these agencies for a long time.

Dr Barbara Millen, the Chair of the Committee, published an immediate response in BMJ claiming that “the procedures used to develop the DGAC scientific report are expansive, transparent, and thoughtful, with multiple opportunities for public input.”1

Millen pointed out that the committee was nominated by their peers and rigorously reviewed. She even fired back at Teicholz saying that she was just one individual with a clear bias herself having written the book The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet.

The biggest point of contention, however, was the methods for selecting the research the recommendations were based on.

In 2010, the US Department of Agriculture established the Nutrition Evidence Library (NEL) to help ensure the quality of nutritional recommendations by establishing standards for identifying and selecting research.3

Teicholz contends that the DGAC “did not use NEL reviews for more than 70 percent of the topics” and instead selected studies ad hoc often relying on reviews by external professional associations.

Millen defended the committee claiming that “you don’t simply answer these questions on the basis of the NEL. On topics where there were existing comprehensive guidelines, we didn’t do them.” Millen also contended that the bulk of their research came from the NIH and other federal agencies.

To her credit, the Guidelines detail four methods of research selection, most of which involved at the least consulting the NEL.

Ultimately, it is the recommendations themselves that will determine the integrity of the report and Teicholz had issues with several of them, all of which are highly relevant to those of us in the Paleo world:

THE CONTESTED RECOMMENDATIONS

Teicholz addressed the recommendation for lower dietary saturated fats first, pointing out that no NEL review of the research on saturated fat from the past five years was conducted. She claimed many conflicting studies were omitted, in particular a large controlled clinical trial known as the Women’s Health Initiative (WHI). No benefits of a lower saturated fat diet were observed in a cohort of 49,000 women over seven years.4

Millen responded that the report states “dietary advice should put the emphasis on optimizing the types of dietary fat and not reducing total fat.”

Next, Teicholz addressed the report’s failure to endorse a low carbohydrate diet claiming critical research was left out including a meta-analysis and a critical review demonstrating a benefit of low carb diets for type 2 diabetes.5, 6 Millen simply replied that there is limited evidence of the long-term health effects.

One of the biggest shifts in the new guidelines was a stronger emphasis on plant-based diets with the recommendation to reduce meat particularly red meat. The draft 2015 Guidelines added for the first time a “Healthy Vegetarian Pattern” to their three recommended diets that also include a “Healthy Mediterranean-Style Pattern” and a “Healthy U.S.-Style Pattern.”

Teicholz contends that there has been no review by the NEL of the health effects of red meat. While an NEL review of a vegetarian diet does exist and states that the evidence is limited for its disease fighting power.7 Yet, Teicholz holds that the report arbitrarily upgraded the rating of the evidence. She also claimed that the Guidelines left out three contradictory NIH studies including one from the WHI that found no significant advantage of a diet high in fruit, vegetables and grains for weight loss, diabetes, heart disease, or cancer.8-11 Even the Guideline’s sole diagram addressing red meat, according to Teicholz, showed that diets high in red meat were equivocal with diets lower in red meat.

Millen did not address the question of red meat in her response, but the report stated that the three recommended dietary patterns reaffirmed the 2010 DGAC recommendations and aligned with the American Institute for Cancer Research (AICR) and the American Health Association (AHA).1

A MORE MUNDANE EXPLANATION

A friend of mine, who by her own admission had a “cushy” well-paid job at a large government nutrition agency, once gave me her impression of government nutrition.

Her job was to follow the current research and take her findings to the higher-ups. She was quickly frustrated by the all-too-common response. They would thank her for bringing it to their attention, then tell her they already knew about it and they weren’t going to do anything. Did she experience, first hand, government corruption or industry influence at play?

My friend had a much more mundane answer. In a government nutrition agency, she said, there’s one unforgivable sin – to make a recommendation contrary to the decades old accepted cannon and end up being wrong. So was something this mundane going on with the DGAC?

The Report starts by asserting it was motivated by the current state of public health in the United States, a lot of which was a result of poor dietary patterns. Half of U.S. adults have a chronic disease and two-thirds are obese. It goes on to say these patterns “adversely affected the health of the U.S. public for decades and raise the urgency for immediate attention and bold action.”1

Yet that “bold action” consists of recommendations that by their own admission are consistent with past DGAC reports.

The few new recommendations they offer – replacing refined grain products with whole grain products and the reduction of refined sugar and sodium in the diet – are neither novel nor in any way controversial within the nutrition community.

Even in the Paleo world, while we would say to bypass the grains altogether, if you’re going to eat them, we’re still generally going to recommend whole grain products over refined empty-calorie snacks.

Perhaps Teicholz’s most poignant criticism of the report was her pointing out “a reluctance by the committee behind the report to consider any evidence that contradicts the last 35 years of nutritional advice.” She goes on to say that with the failure of existing intervention strategies, they should be welcoming new views.

Nowhere is the aging nature of the report potentially more obvious than in its handling of omega-3 fatty acids. As mentioned above, Millen responded to Teicholz by stating that the committee focused more on types of fats than absolute quantity. Which would imply that omega-3 fats were a focus.

Yet omega-3s are mentioned only three times in the 571-page report. Once in the context of wild vs farm raised fish. One paragraph under mental health where they briefly review the vast research showing the benefits of omega-3 for the brain and finally to point out the single study that found an association between nutrients in the diet and type 2 diabetes because it differentiated types of fats.12

The broad ranging health benefits of consuming omega-3 fatty acids, and the ratio of omega-3 to omega-6 fatty acids in the diet are some of the most heavily researched topics currently in nutrition.13 Yet the report made no recommendations about omega-3s. Instead it focused on a decades-old concept of “achieving better saturated fat to polyunsaturated fat ratios.”

IS MUNDANE ANY BETTER?

Teicholz herself concludes by admitting the mundane may be more at play than conflict of interest or industry pressure – “nearly all nutrition scientists accept funding from industry. Of far greater influence is likely to be bias in favor of institutionalized hypothesis.”

Nonetheless, does this really make the end result any better?

The report may very well answer that question itself. It has long been accepted that there is a big difference between refined sugar, refined grain products, and whole grain products despite all being grain-based. The report is careful and thorough in making this distinction and providing very different recommendations for each.

The report also admits to a difficulty in defining meat – “there was variability across the food groupings and this was particularly apparent in the meat group.” Red meats were clumped together with processed meat and chicken, fish was grouped with eggs and sausage.

Yet, after admitting to this issue, the report still stuck with traditional lines. Where it was careful to distinguish different categories of grains and plant foods it still ultimately lumped almost all meat together in its recommendation.

That is with the exception of a small footnote that ultimately contradicted its own recommendations:

As lean meats were not consistently defined or handled similarly between studies, they were not identified as a common characteristic across the reviews. However, as demonstrated in the food patterns modeling of the Healthy US-style and Healthy Mediterranean-style patterns, lean meats can be a part of a healthy dietary pattern.

Whether it was industry influence, conflict of interest, or simply mundane adherence to nutritional cannon, when it came to their final recommendations, they were unable to see the important implications of a distinction they themselves made.

REFERENCES

  1. United States. Department of Agriculture., Dietary Guidelines Advisory Committee. Scientific Report. v.
  1. Teicholz, N., The scientific report guiding the US dietary guidelines: is it scientific? BMJ, 2015. 351: p. h4962.
  1. Library, N.E., Frequently Asked Questions. 2015.
  1. Howard, B.V., et al., Low-fat dietary pattern and risk of cardiovascular disease: the Women’s Health Initiative Randomized Controlled Dietary Modification Trial. JAMA, 2006. 295(6): p. 655-66.
  1. Feinman, R.D., et al., Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base. Nutrition, 2015. 31(1): p. 1-13.
  1. Ajala, O., P. English, and J. Pinkney, Systematic review and meta-analysis of different dietary approaches to the management of type 2 diabetes. Am J Clin Nutr, 2013. 97(3): p. 505-16.
  1. Library, N.E., How do the health outcomes of a vegetarian diet compare to that of a diet which customarily includes animal products?
  1. Beresford, S.A., et al., Low-fat dietary pattern and risk of colorectal cancer: the Women’s Health Initiative Randomized Controlled Dietary Modification Trial. JAMA, 2006. 295(6): p. 643-54.
  1. Knopp, R.H., et al., Long-term cholesterol-lowering effects of 4 fat-restricted diets in hypercholesterolemic and combined hyperlipidemic men. The Dietary Alternatives Study. JAMA, 1997. 278(18): p. 1509-15.
  1. Prentice, R.L., et al., Low-fat dietary pattern and risk of invasive breast cancer: the Women’s Health Initiative Randomized Controlled Dietary Modification Trial. JAMA, 2006. 295(6): p. 629-42.
  1. Prentice, R.L., et al., Low-fat dietary pattern and cancer incidence in the Women’s Health Initiative Dietary Modification Randomized Controlled Trial. J Natl Cancer Inst, 2007. 99(20): p. 1534-43.
  1. Fung, T.T., et al., A prospective study of overall diet quality and risk of type 2 diabetes in women. Diabetes Care, 2007. 30(7): p. 1753-7.
  1. Gomez-Candela, C., et al., The Role of Omega-3 Fatty Acids in Diets. J Am Coll Nutr, 2015. 34 Suppl 1: p. 42-7.

Inuit | The Paleo Diet

The Inuit have long been used as a shining example that low carbohydrate approaches to diet can work.1 2 3 4 In fact, traditionally they consumed very little vegetables or any other typically Western foods, and subsisted mainly on fish, sea mammals, and land animals.5 And despite this diet (which would horrify most mainstream dieticians) the Inuit traditionally had very low rates of disease.6

By contrast, the traditional Western diet has been correlated with a plague of health issues.7 8 9 As a further example of just how nutritionally poor the Western diet can be, one third of all cancer deaths have been linked to continued intake of low quality foods – which are everyday staples of the Western diet.10

Interestingly, when consumed in a very low carbohydrate version, a Paleo Diet looks very similar – if not identical – to the traditional Inuit diet. Since this way of eating is higher in fat than most North American diets, it is commonly presumed (erroneously) that high fat diets must somehow be “bad.”11 12 What gets (purposely) left out of these arguments is the fact that the type of fat consumed is very important.13 14 15 16 17 Consuming omega-3 fatty acids is highly beneficial for health – while consuming industrial trans fat is pretty much the worst thing you can do for your health.18

To bring all this background knowledge to a head, new research published last week, showed that the Inuit have special mutations in genes involved in fat metabolism.19 These genetic mutations may allow them to thrive on their very low carbohydrate diet. This is thought provoking because these genetic mutations are found in nearly 100% of the Inuit. By contrast, only a mere 2% of Europeans exhibit the same mutations. This means that those of us from European ancestry may synthesize omega-3 polyunsaturated fatty acids differently than the Inuit.

While the initial buzz of this paper was high, in practice it really doesn’t change anything we know about consuming a healthy Paleo Diet. Omega-3 fatty acids, like those found in wild-caught fish, are still extremely beneficial for our health. In fact, researchers have found that omega-3 fatty acids have widely beneficial anti-inflammatory properties.20 This proves beneficial for inflammatory and autoimmune diseases, in addition to maintaining good health for those without specific health conditions. The advice to consume omega-3 fatty acids is great for mitigating coronary heart disease, depression, aging, and cancer.21

Beyond this, arthritis, Crohn’s disease, ulcerative colitis and lupus erythematosis are autoimmune diseases which may be helped by adequate omega-3 consumption.22 Of the omega-3 fatty acids available, DHA (docosahexaenoic acid) is the best, for a variety of reasons.23 24 Look for foods naturally high in DHA (such as wild-caught fish) and avoid inflammatory seed oils – like those commonly used by most major restaurants. This crucial step will help you stay healthy in the long term – no matter what genes and ancestry you may have.

REFERENCES

[1] Dewailly E, Mulvad G, Sloth pedersen H, Hansen JC, Behrendt N, Hart hansen JP. Inuit are protected against prostate cancer. Cancer Epidemiol Biomarkers Prev. 2003;12(9):926-7.

[2] Bjerregaard P, Dewailly E, Young TK, et al. Blood pressure among the Inuit (Eskimo) populations in the Arctic. Scand J Public Health. 2003;31(2):92-9.

[3] Mulvad G, Pedersen HS, Hansen JC, et al. The Inuit diet. Fatty acids and antioxidants, their role in ischemic heart disease, and exposure to organochlorines and heavy metals. An international study. Arctic Med Res. 1996;55 Suppl 1:20-4.

[4] O’keefe JH, Harris WS. From Inuit to implementation: omega-3 fatty acids come of age. Mayo Clin Proc. 2000;75(6):607-14.

[5] Kuhnlein HV. Nutrition of the Inuit: a brief overview. Arctic Med Res. 1991;Suppl:728-30.

[6] Stefansson V. The friendly arctic. The MacMillan Co, NY. 1921.

[7] Manzel A, Muller DN, Hafler DA, Erdman SE, Linker RA, Kleinewietfeld M. Role of “Western diet” in inflammatory autoimmune diseases. Curr Allergy Asthma Rep. 2014;14(1):404.

[8] Myles IA. Fast food fever: reviewing the impacts of the Western diet on immunity. Nutr J. 2014;13:61.

[9] Simopoulos AP. The importance of the ratio of omega-6/omega-3 essential fatty acids. Biomed Pharmacother. 2002;56(8):365-79.

[10] American Cancer Society. Cancer facts & figures 2004. Atlanta: American Cancer Society, 2004.

[11] Guldstrand MC, Simberg CL. High-fat diets: healthy or unhealthy?. Clin Sci. 2007;113(10):397-9.

[12] Schwingshackl L, Hoffmann G. Comparison of effects of long-term low-fat vs high-fat diets on blood lipid levels in overweight or obese patients: a systematic review and meta-analysis. J Acad Nutr Diet. 2013;113(12):1640-61.

[13] Abumrad NA, Piomelli D, Yurko-mauro K, Merrill A, Clandinin MT, Serhan CN. Moving beyond “good fat, bad fat”: the complex roles of dietary lipids in cellular function and health: session abstracts. Adv Nutr. 2012;3(1):60-8.

[14] Simopoulos AP. Omega-3 fatty acids in health and disease and in growth and development. Am J Clin Nutr. 1991;54(3):438-63.

[15] Daley CA, Abbott A, Doyle PS, Nader GA, Larson S. A review of fatty acid profiles and antioxidant content in grass-fed and grain-fed beef. Nutr J. 2010;9:10.

[16] Loef M, Walach H. The omega-6/omega-3 ratio and dementia or cognitive decline: a systematic review on human studies and biological evidence. J Nutr Gerontol Geriatr. 2013;32(1):1-23.

[17] Swanson D, Block R, Mousa SA. Omega-3 fatty acids EPA and DHA: health benefits throughout life. Adv Nutr. 2012;3(1):1-7.

[18] Ip C. Review of the effects of trans fatty acids, oleic acid, n-3 polyunsaturated fatty acids, and conjugated linoleic acid on mammary carcinogenesis in animals. Am J Clin Nutr. 1997;66(6 Suppl):1523S-1529S.

[19] Fumagalli M, Moltke I, Grarup N, et al. Greenlandic Inuit show genetic signatures of diet and climate adaptation. Science. 2015;349(6254):1343-7.

[20] 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.

[21] Harris WS, Dayspring TD, Moran TJ. Omega-3 fatty acids and cardiovascular disease: new developments and applications. Postgrad Med. 2013;125(6):100-13.

[22] Robinson DR, Knoell CT, Urakaze M, et al. Suppression of autoimmune disease by omega-3 fatty acids. Biochem Soc Trans. 1995;23(2):287-91.

[23] Horrocks LA, Yeo YK. Health benefits of docosahexaenoic acid (DHA). Pharmacol Res. 1999;40(3):211-25.

[24] Conquer JA, Holub BJ. Dietary docosahexaenoic acid as a source of eicosapentaenoic acid in vegetarians and omnivores. Lipids. 1997;32(3):341-5.

Vitamin D Omega 3 Supplements | The Paleo Diet

Choosing a Paleo diet and eating more in tune with how we’ve evolved provides the body with a robust amount of essential protein, healthy fats, gluten-free carbohydrates and nutrient dense veggies. An ancestral approach to eating also provides your body with key nutrients, vitamins and minerals the way nature intended. Does this mean that supplementation is unnecessary if you’re following a Paleo lifestyle? It’s a complicated question.

Most articles and blogs about supplements inevitably discuss the benefits or drawbacks of multi-vitamins. Research shows that if you eat a diet centered around the most nutrient dense foods – quality meats, veggies and fats – you’ll likely already be achieving a therapeutic dose for most vitamins and minerals. When intake is at a supra-physiological dose (that can never be found in nature), too many vitamins can actually put you at risk of chronic disease. Does this mean if you’re following a Paleo diet you don’t need any supplements?

Let’s look at the two most common instances where supplementation might still be a good idea, vitamin D and omega-3 fats. In both of these cases, although a Paleo diet is a great place to start, for many people this may not be enough.

SHOULD YOU SUPPLEMENT WITH VITAMIN D?

Vitamin D is classically known as an essential nutrient for bone health and immunity, however new research shows this fat-soluble vitamin has much more profound impacts on your health and well-being.

How important is vitamin D? Dr. Michael Holick, physician and vitamin D expert sums it up. “Imagine what would happen if a drug company came out with single pill that reduces the risk of cancer, heart attack, stroke, osteoporosis, PMS, depression and various autoimmune conditions? There would be a media frenzy the likes of which has never been seen before! Such a drug exists… it’s the sun.”1, 2, 3

Vitamin D is different than other vitamins because it’s created under your skin when ultraviolet light from the sun interacts with a specific enzyme to form cholecalciferol or vitamin D3. However, exposure to daily sunlight is no longer the norm as we are cooped up in cubicles all day and the deeply ingrained ancestral benefits of light exposure are overlooked.

It’s estimated that up to 70% of the American population is deficient in vitamin D (defined as blood levels below 20ng/mL or 50 nmol/L), or suffering from vitamin D insufficiency, a level above a diagnosed deficiency but still not sufficient for good health (measured as 20-32 ng/mL or 50-80nmol/L). 4

If you live in a northern climate with a true winter season, or north of the 49th parallel, it’s very difficult to achieve the required blood levels of vitamin D from food alone. While cold-water fatty fish, eggs and mushrooms are good foods sources of vitamin D, in the dead of winter they’re likely not enough. Adding a supplement can be highly beneficial.

The standard medical recommendation for vitamin D drops is 1,000-2,000 IU per day, however in the darkest winter months you may need a higher dose. Remember, always get your blood levels tested and work with a doctor if you’re thinking of supplementing with more than the recommended dose. The normal range is typically between 32-50ng/mL (80-125nmol/L) and for athletes new research suggests achieving levels greater than 40ng/mL (100nmol/L) to support superior performance and recovery.5 Be sure to take your vitamin D supplement with a meal that includes fat for optimal absorption.

SHOULD YOU SUPPLEMENT WITH FISH OILS?

Extra long-chain fats eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are the omega-3 ‘all-stars’ when it comes to supporting overall health and combating chronic disease. While most people know the benefits of omega-3 fats for cardiovascular health, many don’t realize they also help reduce the risk of diabetes and depression, protect against mental stress, and even support athletic performance by improving muscle protein synthesis and controlling excessive inflammation.

How important are omega-3 fats? In 2013, the Cardiovascular Healthy Study found that people with the highest omega-3 (e.g. EPA and DHA) levels in their blood had the lowest overall mortality rates.6 In short, the more omega-3 fats you consume, the less chance you have of dying from absolutely any cause. The good news is they are found in abundance in a Paleo diet (e.g. grass-fed meats, wild ocean fish, farm fresh eggs). However, modern day living and long, busy days might mean you’ll benefit from extra support.

If you’re prone to low mood or depression, or cope with regularly high stress levels fish oils could well be an important key to improving your brain health. A study in the Journal of Clinical Psychiatry found people experiencing depression had consistently lower levels of essential fatty acids in their blood. When subjects supplemented with fish oils they had significant improvements in their Hamilton Rating Scale, a recognized evaluation system for depression.7 The British Journal of Nutrition also discovered that supplementing with fish oils helps reduce the adrenal over-activation associated with high levels of mental stress.8

Rates of diabetes and pre-diabetes have never been higher, and constantly being on the go is just one factor that can lead to snacking on convenience foods that are high in processed carbs and sugars. A recent study of fish oil supplementation effects on blood sugar and insulin levels over a 3-week period found significant improvements in insulin function in those with elevated levels.9

Of course, it’s not enough just to increase your omega-3 intake. It’s far too easy to obtain excessive amounts of omega-6 type fats in today’s world, whether from processed foods, restaurant eating, or convenience snacks. The beauty of adopting a Paleo diet is that it often naturally restores this common imbalance. However, the impacts of modern living may still leave you short.

Unless you’re eating 1-2 pieces of cold, deep-water fatty fish daily, it’s best to add an omega-3 supplement rich in EPA/DHA. Fish oil is the richest in EPA and DHA, however krill oil, sea oil, and sea algae are all viable options as well. Aim to supplement with 1,000-1,500mg of combined EPA and DHA daily.

If you’re an athlete and training intensely fish oil supplementation can be a game changer. Supplementation can lead to an amazing 50% increase in the up-regulation of mTOR, the genetic signaling pathway that stimulates lean muscle growth, leading to significant increases in muscle protein synthesis and muscular hypertrophy.10  If you’re serious about your training, adding extra omega-3 fats to your sports nutrition arsenal is important.

A Paleo diet is a great way to cover all your bases on the nutrition front. However, depending on your genetics, where you live, how busy you are, and your lifestyle, diet may not be enough to correct low or insufficient levels of vitamin D and omega-3 fats. Adding these two supplements into your regime, particularly throughout the winter months, may be the fix you need to improve your health, productivity at work and performance in the gym.

REFERENCES

  1. Holick M.Vitamin D Deficiency:What A Pain It Is. Mayo Clin Proc 2003 78(12):1457-59
  1. Holick, M. Article Review: Vitamin D Deficiency. NEJM Medical Progress. 2007, 357:266-81.
  1. Holick, M. Shinning A Light On Vitamin D-Cancer Connection IARC Report. Dermato-Endocrinology, 2009 1(1):4-6
  1. Hanley D, Davison, K. Symposium: Vitamin D Insufficiency: A significant risk Factor in Chronic Disease and Potential Disease-Specific Biomarkers of Vitamin D Insufficiency: Vitamin D Insufficiency in North America. J Nutr 2005, 135:332-37.
  1. Koundourakis, N et al. Vitamin D and Exercise Performance in Professional Soccer Players. Plos One. 2014 Jul 3;9(7):e101659.
  1. Mozaffarian D, Lemaitre RN, King IB, et al. Plasma phospholipid long-chain omega-3 fatty acids and total and cause-specific mortality in older adults. A cohort study. Ann Intern Med 2013; 158:515-525.
  1. Su K, Huang S, Chiu C, Shen W. Omega-3 fatty acids in major depressive disorder. A preliminary double-blind, placebo-controlled trial. Eur Neuropsychopharmacol 2003;13(4):267-271.
  1. Delarue J et al. Fish oil attenuates adrenergic overactivity without altering glucose metabolism during an oral glucose load in haemodialysis patients. Br J Nutr. 2008 May;99(5):1041-7.
  1. Delarue J et al. Interaction of fish oil and a glucocorticoid on metabolic responses to an oral glucose load in healthy human subjects. Br J Nutr. 2006 Feb;95(2):267-72.
  1. Smith GI et al. Omega-3 polyunsaturated fatty acids augment the muscle protein anabolic response to hyperinsulinaemia-hyperaminoacidaemia in healthy young and middle-aged men and women. Clin Sci (Lond). 2011 Sep;121(6):267-78.

Boost Your Brain: Dopamine and Diet

There are many benefits of following a Paleo Diet.1, 2, 3, 4, 5, 6  The majority are aware of the physical effects of moving from a Western diet (full of processed foods, grains and sugar) to a Paleo Diet (rich with nutrients, anti-inflammatory fats, and healthy sources of carbohydrates).7, 8 However, most are likely unaware of the effects of diet on dopamine levels, and your brain.9, 10, 11, 12, 13 Numerous studies have examined the relationship, and all of the studies have fairly interesting results.14, 15, 16, 17, 18 One study showed mice fed a high fat diet during pregnancy had an increased preference for sucrose and fat.19 It must be noted, however, that what researchers refer to as a ‘high fat diet’ is instead a ‘high sugar and high fat diet.’20, 21, 22 On top of this, the diet consisted of poor sources of sugar and fat, not sweet potatoes and coconut oil.23

Boost Your Brain: Dopamine and Diet | The Paleo Diet

Wang, Gene-Jack et al. “Imaging of Brain Dopamine Pathways: Implications for Understanding Obesity.” Journal of addiction medicine 3.1 (2009): 8–18. PMC. Web. 6 Mar. 2015.

Boost Your Brain: Dopamine and Diet | The Paleo Diet

Volkow et al. “Overlapping Neuronal Circuits in Addiction and Obesity: Evidence of Systems Pathology.” Biological Sciences 363.1507 (2008): 3191.

More interesting, however, researchers ultimately found that diet actually altered the gene expression of dopamine and opioid-related genes.24 That is a pretty big find. Another study looked at the effect skipping breakfast had on dopamine levels.25 The authors of this study found breakfasts consumed with normal to higher amounts of protein, had increasingly positive effects on both dopamine secretion and reduced food cravings.

Boost Your Brain: Dopamine and Diet

Ahmad, S. Omar et al. “REDUCED NUMBERS OF DOPAMINE NEURONS IN THE SUBSTANTIA NIGRA PARS COMPACTA AND VENTRAL TEGMENTAL AREA OF RATS FED AN N-3 POLYUNSATURATED FATTY ACID-DEFICIENT DIET: A STEREOLOGICAL STUDY.” Neuroscience letters 438.3 (2008): 303–307. PMC. Web. 6 Mar. 2015.

If you’re having a hard time swallowing the idea that diet alters dopamine levels, this was only first “discovered” by researchers in 2003.26 Other researchers have stated that excessive intake of dietary fats leads to diminished brain dopaminergic function.27, 28, 29, 30 What must be noted here, again, is that they are not referring to healthier fats, but rather poor quality ones. By contrast, one can extrapolate that healthy fats (such as those included regularly in a Paleo Diet) will improve, or at the very least normalize, dopamine levels.31, 32, 33

As other researchers have also noted, sugar and fat bingeing have notable differences in addictive-like behavior.34 This, again, suggests we should avoid a Western diet at all costs, especially the unhealthiest versions, if you want to maximize dopaminergic function in the brain. Researchers have also found that the lack of opiate-like withdrawal signs after fat bingeing underscores the importance of opioid systems in differentiating sugars and fats and their subsequent effects on behavior.

While fat may not have the same effects on the brain as sugar,combining the two in one’s diet (especially in their worst forms) is akin to putting your brain in the freezer, or maybe even throwing it out in front of traffic.35, 36, 37 Healthy fats, like the omega-3 fatty acids found in abundance in a Paleo Diet, will help to maximize dopamine levels, as well as neuronal and physiologic functioning.38, 39, 40, 41, 42

Boost Your Brain: Dopamine and Diet

Teegarden, Sarah L., Eric J. Nestler, and Tracy L. Bale. “ΔFosB-Mediated Alterations in Dopamine Signaling Are Normalized by a Palatable High Fat Diet.” Biological psychiatry 64.11 (2008): 941–950. PMC. Web. 6 Mar. 2015.

In summary, proper dopamine levels are vital to leading a healthy life. A Paleo diet helps to optimize dopaminergic and neuronal health, meanwhile providing the multitude of healthful benefits. Check out the brand new The Real Paleo Diet Cookbook and check out over 250 delicious, healthy recipes that will help fuel your brain!

REFERENCES

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

[2] Konner M, Eaton SB. Paleolithic nutrition: twenty-five years later. Nutr Clin Pract. 2010;25(6):594-602.

[3] Frassetto LA, Schloetter M, Mietus-synder M, Morris RC, Sebastian A. Metabolic and physiologic improvements from consuming a paleolithic, hunter-gatherer type diet. Eur J Clin Nutr. 2009;63(8):947-55.

[4] 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.

[5] O’keefe JH, Cordain L. Cardiovascular disease resulting from a diet and lifestyle at odds with our Paleolithic genome: how to become a 21st-century hunter-gatherer. Mayo Clin Proc. 2004;79(1):101-8.

[6] Cordain L, Eaton SB, Sebastian A, et al. Origins and evolution of the Western diet: health implications for the 21st century. Am J Clin Nutr. 2005;81(2):341-54.

[7] Gutiérrez-fisac JL, Angel royo-bordonada M, Rodríguez-artalejo F. [Health-risks associated with Western diet and sedentariness: the obesity epidemia]. Gac Sanit. 2006;20 Suppl 1:48-54.

[8] Myles IA. Fast food fever: reviewing the impacts of the Western diet on immunity. Nutr J. 2014;13:61.

[9] Wang GJ, Volkow ND, Thanos PK, Fowler JS. Imaging of brain dopamine pathways: implications for understanding obesity. J Addict Med. 2009;3(1):8-18.

[10] Volkow ND, Wang GJ, Fowler JS, Telang F. Overlapping neuronal circuits in addiction and obesity: evidence of systems pathology. Philos Trans R Soc Lond, B, Biol Sci. 2008;363(1507):3191-200.

[11] Berthoud HR. Vagal and hormonal gut-brain communication: from satiation to satisfaction. Neurogastroenterol Motil. 2008;20 Suppl 1:64-72.

[12] Volkow ND, Wise RA. How can drug addiction help us understand obesity?. Nat Neurosci. 2005;8(5):555-60.

[13] Batterham RL, Ffytche DH, Rosenthal JM, et al. PYY modulation of cortical and hypothalamic brain areas predicts feeding behaviour in humans. Nature. 2007;450(7166):106-9.

[14] Dallman MF, Pecoraro N, Akana SF, et al. Chronic stress and obesity: a new view of “comfort food”. Proc Natl Acad Sci USA. 2003;100(20):11696-701.

[15] Adam TC, Epel ES. Stress, eating and the reward system. Physiol Behav. 2007;91(4):449-58.

[16] Rada P, Avena NM, Hoebel BG. Daily bingeing on sugar repeatedly releases dopamine in the accumbens shell. Neuroscience. 2005;134(3):737-44.

[17] Liang NC, Hajnal A, Norgren R. Sham feeding corn oil increases accumbens dopamine in the rat. Am J Physiol Regul Integr Comp Physiol. 2006;291(5):R1236-9.

[18] Avena NM, Rada P, Hoebel BG. Evidence for sugar addiction: behavioral and neurochemical effects of intermittent, excessive sugar intake. Neurosci Biobehav Rev. 2008;32(1):20-39.

[19] Vucetic Z, Kimmel J, Totoki K, Hollenbeck E, Reyes TM. Maternal high-fat diet alters methylation and gene expression of dopamine and opioid-related genes. Endocrinology. 2010;151(10):4756-64.

[20] Gibson SA. Are high-fat, high-sugar foods and diets conducive to obesity?. Int J Food Sci Nutr. 1996;47(5):405-15.

[21] Molteni R, Barnard RJ, Ying Z, Roberts CK, Gómez-pinilla F. A high-fat, refined sugar diet reduces hippocampal brain-derived neurotrophic factor, neuronal plasticity, and learning. Neuroscience. 2002;112(4):803-14.

[22] Kuo LE, Czarnecka M, Kitlinska JB, Tilan JU, Kvetnanský R, Zukowska Z. Chronic stress, combined with a high-fat/high-sugar diet, shifts sympathetic signaling toward neuropeptide Y and leads to obesity and the metabolic syndrome. Ann N Y Acad Sci. 2008;1148:232-7.

[23] Axen KV, Dikeakos A, Sclafani A. High dietary fat promotes syndrome X in nonobese rats. J Nutr. 2003;133(7):2244-9.

[24] High-fat diet alters the dopamine and opioid systems: effects across development. International Journal of Obesity Supplements. 2012;:S25.

[25] Hoertel HA, Will MJ, Leidy HJ. A randomized crossover, pilot study examining the effects of a normal protein vs. high protein breakfast on food cravings and reward signals in overweight/obese “breakfast skipping”, late-adolescent girls. Nutr J. 2014;13(1):80.

[26] Montgomery AJ, Mctavish SF, Cowen PJ, Grasby PM. Reduction of brain dopamine concentration with dietary tyrosine plus phenylalanine depletion: an [11C]raclopride PET study. Am J Psychiatry. 2003;160(10):1887-9.

[27] Tellez LA, Medina S, Han W, et al. A gut lipid messenger links excess dietary fat to dopamine deficiency. Science. 2013;341(6147):800-2.

[28] Volkow ND, Wang GJ, Telang F, et al. Low dopamine striatal D2 receptors are associated with prefrontal metabolism in obese subjects: possible contributing factors. Neuroimage. 2008;42(4):1537-43.

[29] Wang GJ, Volkow ND, Logan J, et al. Brain dopamine and obesity. Lancet. 2001;357(9253):354-7.

[30] Thanos PK, Michaelides M, Piyis YK, Wang GJ, Volkow ND. Food restriction markedly increases dopamine D2 receptor (D2R) in a rat model of obesity as assessed with in-vivo muPET imaging ([11C] raclopride) and in-vitro ([3H] spiperone) autoradiography. Synapse. 2008;62(1):50-61.

[31] Meguid MM, Fetissov SO, Varma M, et al. Hypothalamic dopamine and serotonin in the regulation of food intake. Nutrition. 2000;16(10):843-57.

[32] Carlin J, Hill-smith TE, Lucki I, Reyes TM. Reversal of dopamine system dysfunction in response to high-fat diet. Obesity (Silver Spring). 2013;21(12):2513-21.

[33] Chalon S, Delion-vancassel S, Belzung C, et al. Dietary fish oil affects monoaminergic neurotransmission and behavior in rats. J Nutr. 1998;128(12):2512-9.

[34] Avena NM, Rada P, Hoebel BG. Sugar and fat bingeing have notable differences in addictive-like behavior. J Nutr. 2009;139(3):623-8.

[35] Gómez-pinilla F. Brain foods: the effects of nutrients on brain function. Nat Rev Neurosci. 2008;9(7):568-78.

[36] Rosales FJ, Reznick JS, Zeisel SH. Understanding the role of nutrition in the brain and behavioral development of toddlers and preschool children: identifying and addressing methodological barriers. Nutr Neurosci. 2009;12(5):190-202.

[37] Black MM. Effects of vitamin B12 and folate deficiency on brain development in children. Food Nutr Bull. 2008;29(2 Suppl):S126-31.

[38] Parletta N, Milte CM, Meyer BJ. Nutritional modulation of cognitive function and mental health. J Nutr Biochem. 2013;24(5):725-43.

[39] Singh M. Essential fatty acids, DHA and human brain. Indian J Pediatr. 2005;72(3):239-42.

[40] Horrocks LA, Yeo YK. Health benefits of docosahexaenoic acid (DHA). Pharmacol Res. 1999;40(3):211-25.

[41] Kidd PM. Omega-3 DHA and EPA for cognition, behavior, and mood: clinical findings and structural-functional synergies with cell membrane phospholipids. Altern Med Rev. 2007;12(3):207-27.

[42] Enslen M, Milon H, Malnoë A. Effect of low intake of n-3 fatty acids during development on brain phospholipid fatty acid composition and exploratory behavior in rats. Lipids. 1991;26(3):203-8.

Balancing Migraine Pain with a Paleo Diet | The Paleo DIet

As a migraine sufferer, I was all too excited several years ago when the local hospital hosted an expert panel on migraine remedies which included diet. The 45 minute presentation covered the basic physiology, briefly mentioned chocolate and alcohol, and then spent the bulk of the time on medications – Aspirin, Excederin, Midrin, and Fioricet. During the Q&A I asked about omega-3 PUFAs since they are known to inhibit COX-2. One expert replied that she was unaware of any research on PUFAs or COX-2 for migraine. I appreciated her congenial reply, but sat down disappointed. Most of the medication identified did only one thing in the body – inhibit COX-2.

Let’s start at the beginning. Migraine is a complex condition with many subclasses including with aura (Classic,) without aura (Common,) chronic, retinal, and hemiplegic migraine.1-3

Whatever the name, for the 10-15% of Americans who suffer from them, migraines mean episodic, intense headaches, often with nausea and light and sound sensitivity. In all cases, it affects our quality of life and ability to work.4, 5

While medication remains the primary focus of migraine treatment, its use as the primary treatment has its own concerns. There’s now a class of chronic migraine called medication overuse headache (MOH) where overuse of pain medication can actually cause near daily headaches.6-8

This has led many to seek alternative treatments.

Diet may help. Migraineurs – a term that makes it sound like an exclusive club with a very low voluntary applicant pool – often cite dietary triggers for their migraines. The most common are alcohol, chocolate, cheese, caffeine, MSG and fasting.9 On the other side of the coin, dietary elements such as magnesium and omega-3 fatty acids may be therapeutic.10

Unsurprisingly, all of these dietary elements fit with a healthy, Paleo Diet lifestyle. So let’s take a look at the physiology of a few key elements of the Paleo Diet that can help you spend less time at the ”Migraineur Club House.”

MIGRAINE 101: DON’T GET HYPEREXCITED

There are many theories about the cause of migraines, but the most widely accepted is the neural hyperexcitability theory. Backed by recent MRI studies, it proposes neurons in the trigeminal-vascular region of the brain’s cortex become inappropriately activated, releasing a series of neurotransmitters that cause vasodilation, mast cell degranulation, increased permeability, platelet aggregation, inflammation, and ultimately pain.2, 9, 11-14 Recently, some suggest hyperexcitability is a result of a dysfunction in sodium-potassium transporters.15

For some, their migraine is preceded by a visual aura. This aura is caused by an initial depolarization of the neurons referred to as Cortical Spreading Depression.2, 15

That’s a very short summary of a very complex process. The take home message: an imbalance in excitation signals, neurotransmitters, and electrolytes may be at the root of your migraine pain. Dive in deeper with the references listed below.

POLYUNSATURATED FATTY ACIDS: MIND YOUR 3S AND 6S

While living out of the medicine cabinet may not be the best long term strategy, it’s important to point out that NSAIDs, such as ibuprofen, are very effective at reducing acute migraine pain.1, 4, 16 They do one thing – prevent the formation of molecules called prostaglandins by inhibiting a key enzyme called cyclooxygenase (COX).

So, it’s not surprising prostaglandins have been linked to migraine.1, 17-21 Simply injecting prostaglandin E2 (PGE2) into both healthy subjects and migraine sufferers was enough to cause migraine pain.22-25 The fact that  pain was immediate, indicates that PGE2 may actually be the direct cause of pain for sufferers.22

But how does this relate to diet?

Prostaglandins are created from the polyunsaturated fatty acids (PUFAs) we eat.1 Our bodies are not particular – they will use whatever type of PUFA is available. But we end up with very different prostaglandins depending on whether we consume more omega-3 or omega-6 PUFAs.26

The figure below shows the types of prostaglandins (and other eicosanoids) formed from arachidonic acid (omega-6) verses EPA (omega-3).26

Balancing Migraine Pain with a Paleo Diet | The Paleo Diet

PGE3 and PGI3 from omega-3 PUFAs may actually help prevent both the inflammation and electrolyte imbalance that causes migraines.15, 26, 27 In fact, they have anti-inflammatory benefits for many chronic illnesses including cancer and heart disease.28-32

By contrast PGE2 and PGI2 from Omega-6 PUFAs are pain-causing. Hence they are the targets of most over-the-counter pain killers. These prostaglandins and their precursor arachidonic acid are elevated during migraines and may sensitize of the trigeminal nerve which is the location of migraine pain.1, 15, 19, 20, 33, 34 In fact, the highest level of PGE2 receptors in the body are found in the trigeminal nucleus caudalis.22

Fortunately, when diets are high in omega-3 fatty acids such as EPA from fish oil, the good prostaglandins tend to supplant the bad.26

So, why then was it that studies of omega-3 supplementation have had mixed results for migraine?35-37

The potential answer gets at a key tenant of the Paleo Diet – just popping a few fish oil supplements and calling yourself healthy isn’t enough. It’s all about balance.

Due to the huge increase in vegetable oils and grain fed livestock in the western world, the ratio of omega-6 to omega-3 PUFAs in our diets have risen to 10:1 from an estimated 3:1 or even 2:1 in Paleolithic times.26, 38-40

To see if the ratio influenced migraines, a 2013 study by Ramsden et al, not only increased omega-3 in Migraineurs’ diets, but reduced the omega-6 content. The pain improved significantly. Interestingly, the investigators included a second group that only reduced omega-6 PUFAs in their diet. While not as dramatic, this group also improved.35

Issues with the high ratio of omega-6 to omega-3 fatty acids in the western diet go beyond migraines. The ratio has been associated with many chronic conditions including depression (due to its influence on serotonin), rheumatoid arthritis, inflammatory bowel disease, asthma, heart disease and chronic inflammation.26, 27, 38, 41

A Paleo Diet promotes a better omega-3 to omega-6 ratio. The best source of omega-3 PUFAs is EPA from fish, but other sources include walnuts, lean meats, and some vegetables such as broccoli and spinach.42 Just remember that the shift from omega-3s to omega-6 PUFAs in our bodies takes time – from 6 – 18 weeks.43

MAGNESIUM: THE PAINFULLY FORGOTTEN ELECTROLYTE

Magnesium is sometimes referred to as the “forgotten electrolyte” since it is frequently overshadowed by calcium in the research.44-46 Magnesium is involved in over 300 functions in our body, which means it is not a nutrient we want to forget about. Yet almost 48% of Americans eat less than the RDA.15, 44

Most magnesium is found in our bones and cells with less than 1% in our blood,45 which means that a blood test for magnesium isn’t very effective.47 Up to 14% of the population may be deficient and this deficiency has been associated with many chronic conditions including heart disease.48

Evidently, magnesium deficiency has been clearly linked to migraines.9, 47, 49, 50 In multiple studies, migraine sufferers had lowered levels of magnesium in their blood, saliva, and cerebrospinal fluid during attacks.51-56

Magnesium affects many processes linked to migraine including neurotransmitter release, serotonin receptors, inflammatory mediators, and the inhibition of platelet aggregation.56-63 It may even block some of the inflammatory effects of omega-6 PUFAs.44

Magnesium supplements help migraine sufferers.51, 56 Even more strikingly, people going to the emergency room with migraine pain are frequently treated with an infusion of magnesium sulfate which is more effective than the pharmaceutical treatments dexamethasone and metoclopramide.47, 57

Unsurprisingly with current migraine research pointing to electrolyte imbalances, the “forgotten electrolyte” may play a key role in migraine hyperexcitability.15

Sodium-potassium imbalance may trigger migraines, but overactive calcium channels could be the cause.2 High levels of calcium in the brain make neurons easily excitable.2, 44 Magnesium is a key regulator of calcium and might be able to control this calcium-induced hyperexcitability.44

In fact, in a review of migraine hyperexcitability, Welch proposed that the changes in magnesium levels during a migraine may be an attempt by the brain to restore electrolyte balance.2

Here again, migraines show why a properly balanced diet is far more important than just popping supplements.

With the concern over osteoporosis, daily calcium consumption has been increasing over the past four decades.44 This Western focus on calcium has led to one of the biggest criticisms of the Paleo Diet for its elimination of dairy. This is in spite of recent research questioning the benefits of high calcium intake and worse, linking it to heart disease.64-68

What may be more important than the absolute calcium level is the ratio of magnesium to calcium in the diet which has been decreasing.44 Not something to overlook considering increased magnesium consumption reduced all-cause mortality associated with high calcium intake.69

Worse yet, consuming too much calcium can exacerbate magnesium deficiency.70

The higher calcium-magnesium ratio of the Western diet may contribute to a variety of chronic conditions beyond migraine, including stress, metabolic syndrome, Type II Diabetes, hypertension and vascular disease.44

The Paleo Diet promotes a better calcium-magnesium ratio through the consumption of foods high in both including almonds, cashews, green leafy vegetables, and fish. While research is limited, it is believed that alcohol and sugary drinks can limit magnesium absorption.

ELIMINATING DIETARY PAIN

Food sensitivity remains one of the most common migraine triggers,71, 72 but the foods tend to be highly individual. A food diary is one way for migraine sufferers to identify their triggers. Though this can be difficult since foods interact and sometimes the migraine appears a day or more after eating the culprit foods.9

Fortunately, there may be another way to identify your triggers. Food that causes an IgG antibody response has been associated with migraines.9 Studies eliminating these foods have produced dramatic results with up to 93% of participants becoming headache free.71, 73, 74

Balancing Migraine Pain with a Paleo Diet | The Paleo DietWhile the point of an IgG-elimination diet is individualization, the table to the left shows the most common IgG-inducing food groups.71

This study found that an IgG-elimination diet also helped Irritable Bowel Disease, another condition affected by dietary imbalance.71, 75 Up to 50% of people with IBS suffer from migraines76 with neural hypersensitivity77 and mitochondrial DNA mutations75 linked to both.

We frequently recommend Paleo Dieters suffering from chronic conditions try an elimination diet. Seeing your allergist to help you identify IgG-provoking foods may be a shortcut to help you get past migraine pain.

Certainly PUFAs and magnesium have dominated the literature on diet and migraines – to the point that they were used as a proof of concept for literature research.78 But this doesn’t mean they are the only dietary factors. Both low fat79 and ketogenic diets80 improved migraine symptoms. Migraine hyperexcitability can be affected by the sodium-potassium balance in the diet and hydration status (with dehydration and hypohydration causing migraines).15

The underlying message is migraine pain may be a disease of imbalance. So, while I’ve reached for the Excedrin bottle more than a few times to get through my day, a balanced diet more attune with our evolutionary make-up may ultimately be what keeps us Migraineurs away from the medicine cabinet altogether.

Trevor Connor | The Paleo DietTrevor Connor is Dr. Cordain’s last mentored graduate student and will complete his M.S. in HES and Nutrition from the Colorado State University this year and later enter the Ph.D. program. Connor was the Principle Investigator in a large case study, approximately 100 subjects, in which he and Dr. Cordain examined autoimmune patients following The Paleo Diet or Paleo-like diets.

 

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21. Vardi, J., et al., Prostaglandin–E2 levels in the saliva of common migrainous women. Headache, 1983. 23(2): p. 59-61.

22. Antonova, M., et al., Prostaglandin E(2) induces immediate migraine-like attack in migraine patients without aura. Cephalalgia, 2012. 32(11): p. 822-33.

23. Sciberras, D.G., et al., Inflammatory responses to intradermal injection of platelet activating factor, histamine and prostaglandin E2 in healthy volunteers: a double blind investigation. Br J Clin Pharmacol, 1987. 24(6): p. 753-61.

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