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AHS Slides_Staffan Lindeberg
1. Ancestral Health Symposium, LA, August 2011 Food and Western Disease Staffan Lindeberg MD PhD Center for Primary Health Care Research Lund University, Sweden
2. Western diseases: Cardiovascular diseases diabetes obesity hypertension dementia cancers osteoporosis rickets iron deficiency autoimmune diseases gastroesophageal reflux irritable bowel syndrome and many others Lindeberg S. Food and Western Disease. Wiley-Blackwell 2010
43. consistent with studies in East Africa (Trowell -81, Muwazi -44)Table. Incidence of stroke as proportion of acute neurologic disease in Kampala, Uganda.
59. hypertension (Lindeberg S et al. J Intern Med 1994;236:331)Table. Blood pressure at age 40-60 years among hunter-gatherers, in Kitava and in Sweden (mm Hg, mean ± standard deviation)(modified from Lindeberg S et al. J Intern Med 1994;236:331).
64. hypertension (Lindeberg S et al. J Intern Med 1994;236:331)Diastolic BP, mm Hg Diastolic BP, mm Hg Fig. Diastolic blood pressure among males (left) and females (right) from Sweden (grey) and Kitava (black) (modified from Lindeberg S et al. J Intern Med 1994;236:331).
69. hypertension (Lindeberg S et al. J Intern Med 1994;236:331)Systolic BP, mm Hg Systolic BP, mm Hg Fig. Systolic blood pressure among males (left) and females (right) from Sweden (grey) and Kitava (black) (modified from Lindeberg S et al. J Intern Med 1994;236:331).
70. BMI 24.5 BMI 20.3 Fig. Z scores* of observed versus predicted mean cardiovascular risk factors in Kitavan males (left) and females (right) aged 40-65 years (after variable transformation when necessary). *standard score, number of standard deviations below or above Swedish means.
71. 28 Westernization affects everyone Blood pressure Fasting plasma glucose Cruickshank JK. Int J Epidemiol 2001;30:111 Poulter NR et al. Am J Hypertens 1988;1:143S
72. Ten-year risk of fatal cardiovascular disease in ’low-risk’ European populations. Chart based on total cholesterol (Conroy RM et al. Eur Heart J. 2003;24:987) (Lindeberg S. Eur Heart J 2005;26:2605-6)
73. Who wants to be normal? Atherosclerosis is part of ’normal’ ageing in westernized populations including japanese and chinese Fig. 40-year old US woman with coronary atherosclerosis despite normal angiography(Nissen SE. Circulation 2001;103:604). Fig. Percent of subjects with coronary atherosclerosis from birth to age 40 (Stary HC et al. AJCN 2000;72:1297S).
74. 31 Atherosclerosis of left anterior descending coronary artery among 45-55 year-old men from four populations (Tejada -68)
75. Who wants to be normal? Atherosclerosis is part of ’normal’ ageing in westernized populations No atheromas in other free-living mammals No atheromas in experimental animals without prior dietary manipulation fat, casein, lactose, peanut lectin etc. uncertain impact of cereal grains
76. Who wants to be normal? Relative risk of Western disease
77. Who wants to be normal? “Your blood pressure is normal.”
118. Grain-free, dairy-free diets in clinical practice Fruit, roots, meat, organ meats, eggs, fish, shellfish, vegetables, nuts etc. Beneficial effects in small clinical trials Normalized glucose tolerance independent of weight loss in diabetes/IGT (Lindeberg S et al. Diabetologia 2007;50:1795) Lower blood sugar, blood pressure, triglycerides and waist, and higher HDL, in diabetes type 2 (Jönsson T et al. Cardiovasc Diabetol 2009;8:35) Lower LDL, triglycerides, fP-Insulin (by 68%), AUCInsulin (by 39%) and diastolic BP (Frassetto LA et al. Eur J Clin Nutr 2009;63:947)
126. No difference in reported absolute intake of protein(Lindeberg S et al. Diabetologia 2007;50:1795)
127. A paleolithic-like diet improved glucose tolerance independently of weight loss or waist change Paleolithic diet Consensus diet Before Before *** After *** *** After Fig. Plasma glucose during the oral glucose tolerance test (OGT) at baseline and after 12 weeks of a Paleolithic diet (left) and a Consensus diet (right). Values are means (SE). ***p <0.001; absence of asterisk denotes p >0.05. (Lindeberg S et al. Diabetologia 2007;50:1795) 51
128. A paleolithic-like diet improved glucose tolerance independently of weight loss or waist change Fig. Change in glucose tolerance (left) and waist circumference (right) after 6 and 12 weeks of a Consensus diet (whole grains, lean dairy products, fruit, vegetables, foods high in omega-3 fatty acids; n=15) or a Paleolithic diet (n=14). (Lindeberg S et al. Diabetologia 2007;50:1795) 52
129. A paleolithic-like diet improved glucose tolerance independently of weight loss or waist change Table. Number of subjects with OGT plasma glucose above diabetes limits according to WHO diagnostic criteria (1999). (Lindeberg S et al. Diabetologia 2007;50:1795)
130. A paleolithic-like diet was superior to ‘diabetes diet’ for patients with type 2 diabetes in a cross-over trial Fig. HbA1c, HDL cholesterol, triglycerides, diastolic blood pressure, weight and waist circumference after 3 months with a ’diabetes diet’ (black) or a paleolithic diet (white) in 13 patients with diabetes type 2. (Jönsson T et al. Cardiovasc Diabetol 2009;8:35)
131. Grain-free, dairy-free diets in clinical practice Fruit, roots, meat, organ meats, eggs, fish, shellfish, vegetables, nuts etc. Beneficial effects in small clinical trials Lindeberg S et al. Diabetologia 2007;50:1795 Jönsson T et al. Cardiovasc Diabetol 2009;8:35 Frassetto LA et al. Eur J Clin Nutr 2009;63:947 LDL –22%, TG –35%, fP-Insulin –68%, AUC Insulin –39%, diastolic blood pressure –4%
132. Grain-free, dairy-free diets in clinical practice Fruit, roots, meat, organ meats, eggs, fish, shellfish, vegetables, nuts etc. Beneficial effects in small clinical trials Many promising case reports
133. Grain-free, dairy-free diets in clinical practice Fruit, roots, meat, organ meats, eggs, fish, shellfish, vegetables, nuts etc. Beneficial effects in small clinical trials Many promising case reports No obvious risks for most people
134. Grain-free, dairy-free diets in clinical practice Fruit, roots, meat, organ meats, eggs, fish, shellfish, vegetables, nuts etc. Beneficial effects in small clinical trials Many promising case reports No obvious risks for most people Uncertain effect of milk on bone strength in children and adolescents (Winzenberg T et al. COCHRANE 2006; Lanou AJ et al. Pediatrics 2005;115:736) in adults (Benetou V et al. EJCN 2011;65:132; Bischoff-Ferrari HA et al. J Bone Mineral Res 2011;DOI 10.1002)
135. Grain-free, dairy-free diets in clinical practice Fruit, roots, meat, organ meats, eggs, fish, shellfish, vegetables, nuts etc. Beneficial effects in small clinical trials Many promising case reports No obvious risks for most people Uncertain effect of milk on bone strength Uncertain iodine requirements in paleo perspective
136. Grain-free, dairy-free diets in clinical practice Fruit, roots, meat, organ meats, eggs, fish, shellfish, vegetables, nuts etc. Beneficial effects in small clinical trials Many promising case reports No obvious risks for most people Possibly sustainable Root vegetables, local production, no fertilizers, no dairy, sustainable meat, organ meats, involuntary calorie restriction
139. Conclusions Common foods may cause common health problems Food choice may be more important than counting fat, carbohydrate or calories Nearly all Westerners get atherosclerosis and we don’t know why Conventional dietary advice is somewhat unfounded Is endocrinology more important than nutritionism? Many possibe endocrine disruptors in grains, seeds and beans Tyrosine kinase agonists, autoantigen mimics, goitrogens, phytoestrogens etc. www.staffanlindeberg.com staffan.lindeberg@med.lu.se