Primal vs. Industrial Foods Cost Comparison

Richard Nikoley's post on Budget Paleo reminded me that about a year ago I created a table comparing the cost per calorie of common paleo or primal foods to that of some conventional processed foods.  Many people make the mistake of evaluating the cost of a food based on the cost per unit (e.g. per pound) rather than the cost per calorie or nutritional density.   Since we eat to satisfy our energy requirements, I find it more useful to evaluate based on the cost per calorie and nutrients, since I need a certain number of calories and a set of nutrients every day. 

To create these tables I used the lowest cost per unit I could find for the foods in question by shopping at local supermarkets in my area. 

• Trader Joe's: olive oil
• Food City:  Butter, conventional; pork roast or chops (on sale); beef top sirloin (on sale); eggs, conventional; sweet potatoes; white rice; Cheerios; tortilla chips; soda (generic); non-fat milk
• Sprouts: Butter, organic; walnuts; beef chuck roast; carrots; eggs, omega-3; beef with fat; oranges (in season); broccoli (in season, on sale); whole milk

Here's what I came up with for paleo or primal foods, purchased at common markets:

You can see that the fats have the lowest cost per calorie, followed by meats I found on sale, nuts, and conventional eggs.  Lard provides 1000 calories for 73 cents and olive oil for 75 cents.  Pork purchased on sale at Food City for $1.00 per pound (I've seen similar prices at Safeway, Fry's, and other markets) provides 1000 calories for 80 cents.  Thus, I could consume 3000 calories of pork, olive oil, and lard for a total cost of about $2.40 per day, or $72 per month (30 days).  If you needed only 2000 calories, you could eat for about $1.60 per day, or $48 per month.   For complete nutritional adequacy I would use some liver and cook some bones or inexpensive greens for minerals.

For some non-paleo foods, I came up with the following:

White rice is very low cost at 3 cent per calorie and 30 cents per 1000 calories, making it less than half the cost of olive oil, butter, or pork.  However, white rice fails to supply adequate quality or quantity of many essential micronutrients.  Further, eating white rice may increase the risk for developing type 2 diabetes (NIDDM).  Yes, it has a very low cost but I would rather see people invest in no-glycemic calories like olive oil, lard, or butter, or inexpensive meats like pork.

Perhaps to some surprise, Cheerios(TM) has a price tag as high as conventional butter when compared on a calorie for calorie basis, and so-called "cheap" junk foods like tortilla chips and soda actually cost more per calorie than olive oil, butter, and pork on sale.  These two junk foods also cost more per calorie than whole milk.

Whole milk is not paleo, but it is a matter of fact that humans can live in good health on a diet consisting almost exclusively of an adequate supply of whole milk, as shown by the Maasai, Fulani, and other pastoral societies.  In contrast, you can't live in good health on a diet consisting solely of Cheerios (TM).

A gallon of conventional whole milk supplies about 2400 calories and a wealth of protein, quality fat, vitamins, and minerals for only about $2.50.  A gallon of milk daily would cost $75 per month for one person.  Soda costs 30% more than milk on a calorie basis, and has NO essential nutrients.  While not paleo, a GOMAD (gallon of milk a day) diet would be nutrient dense on a mere $2.50 per day. 

Notice also that whole milk costs less than trendy whole wheat bread and non-fat milk. 

Any thoughts?

Practically Paleo Diet Reduces Markers of Aging In Humans

In my commentary on the Hungry Monkey Study, I suggested that reducing carbohydrate intake has similar metabolic effects to caloric restriction, without the restriction.

Just yesterday I learned that Ron Rosedale, Eric Westman, and John Konhilas published a retrospective clinical report in the January 2009 Journal of Applied Research entitled “Clinical Experience of a Diet Designed to Reduce Aging” (Full Text).

This article reports on the effects of a practically (i.e. almost) paleo diet on markers associated with aging, namely glucose, insulin, leptin, free T3 and serum triglycerides, all of which decline in response to caloric restriction and occur at lower levels in healthy centenarians than in people who do not live past 100 years.

The authors advised patients to consume a practically (i.e. almost) paleo diet with the following guidelines:

1. Eat unlimited fats
2. Restrict protein to 1-1.25g/kg lean body mass
3. Limit carbohydrate intake to non-starchy vegetables
4. Eat to satisfy hunger (no deliberate caloric restriction)

Patients receive instruction to obtain fats from raw nuts and seeds, avocados, olives and olive oil, flax oil and cod liver oil.

Based on lean body mass, most patients received instruction to consume 50-80g of protein per day from sardines, fish, eggs, tofu, chicken, turkey, wild meats, low-fat cheeses (cottage, ricotta, swiss), seafood, and veggie burgers. They recommended this relatively low protein intake in part because some of the benefits from caloric restriction appear to arise from protein restriction.

Obviously low-fat cheeses and veggie burgers don’t fit into my practically paleo scheme of things. Actually, it seems a bit odd that they recommended unlimited fat intake, and also use of low-fat cheeses and veggie burgers, also low in fat.

According to the report, the patients’ diet logs indicated that they averaged 20% of calories from protein, 20% from carbohydrate, and 60% from fat. Assuming an average 2000 kcalories per day, this would translate to 400 kcal from protein, 400 from carbohydrate, and 1200 from fat, which would come from 100g protein, 100g carbohydrate, and 133g fat.  This may indicate that people consumed up to twice as much protein as the authors recommended.

They also advised the patients to take the following supplements: L-carnitine 2000mg, alpha-lipoic acid 400mg, coenzyme Q10 100 mg, 1 tbsp cod liver oil, magnesium 300mg, potassium 300mg, vitamin C 1000mg, vitamin E 800mg daily, and a multivitamin consisting of all essential B vitamins and minerals.

Results

The table below shows the effects of this regimen on body weight, insulin, glucose, leptin, triglycerides, HDL, creatinine, free T3, thyroid stimulating hormone, and blood pressure:

Insulin declined by 40%, glucose by 8%, leptin by 48%, triglycerides by 28%, free T3 by 11%, and blood pressure by 10% systolic and 11% diastolic.

All of these declines also occur with caloric restriction. Of note, free T3, the secreted form of thyroid hormone thought to mediate most of thyroid actions, declined by 11%. About this the authors point out:

“Paralleling this reduction in circulating free T3, 9 patients of this study cohort that had basal body temperatures measured before and after intervention showed a significant decrease (p=0.004) in basal body temperature of 0.182 degrees C. Similar findings were reported in caloric restricted rodents, monkeys, humans, and centenarians (31-34). It has been suggested that the reduction in T3 and body temperature could alter the aging process by reflecting a reducing metabolic rate, oxidative stress, and systemic inflammation (35, 36).”

In other words, contrary to the claims of some bloggers, the declines of thyroid levels and body temperature brought about by either caloric or carbohydrate reduction appear associated with improved health and longevity, not “wrecked metabolism.” Keep in mind that so-called “normal” thyroid levels occur in a population rife with degenerative diseases and a relatively short lifespan. Adjusting your dietary intake to raise thyroid and body temperatures to “normal” may simply put you in the “normal” health/acclerated aging category.

Edit 5/5/2010:  Reading this last paragraph, I can see why some commenters got the idea that I was suggesting that hypothyroidism is a good thing.  I want to emphasize that the drops in free T3 and basal body temperature recorded in this study were quite small (11% and 0.182 degrees C, respectively) and did not place any of the participants in the hypothyroid category.   Such small reductions in metabolic rate appear associated with greater longevity and resistance to disease, whereas hypothyroidism reduces quality of life, increases risk of some diseases, and probably shortens lifespan.  End edit.

So, this study suggests that people who follow a diet similar to what I practice (20% protein, 20% carbohydrate, and 60% fat) may achieve the metabolic benefits of caloric restriction without the hunger associated with caloric restriction.

I dare say, long live practically paleo people!

Edit 3/27/2012:

I missed some of the most important, and suspicious aspects of this study.

The authors clearly state:  "The recommendation of a high fat, adequate protein, low carbohydrate diet resulted in a significant loss of body weight by 7.1 ± 0.8 lbs in this patient population."

That means this was a hypocaloric diet.  The results were produced by a caloric deficit and weight loss.  It does not follow that a eucaloric paleo diet producing weight maintenance will have the same results. 

Also of interest, they state their outcome measures as:  "Laboratory parameters included serum glucose, insulin, leptin, total cholesterol, LDL, HDL, triglycerides (TG), free T3 and thyroid stimulating hormone (TSH) following a 12 hour fast. "

But really interesting is they don't report total cholesterol or LDL in the Table 1B nor in the text.   The fact that they left out this data makes me very suspicious. I would guess this means that the subjects did not have favorable changes in total cholesterol or LDL.  If they did produce favorable changes in total cholesterol and LDL, they would have been sure to report those changes to support their case.

In the discussion they also state:

"Since this was a retrospective analysis of a clinical practice, there may be bias introduced in the patient sampling procedure. This study reflects the effect of recommending this diet in a clinical practice, so food intake was not directly measured. In addition, this sample population may reflect the results in highly motivated individuals. Though the metabolic improvements occurred in patients who had both high and low weight loss, the improvements in metabolic parameters may be all or partially due to the weight loss."

Thus, they even recognized themselves that 1) they probably used a biased sample, 2) they didn't adequately measure the food intake, and 3) the results might not have had anything to do with the dietary ratio.

Thus, this study failed to show any antiaging metabolic advantage of a calorically adequate low carbohydrate, high fat diet.


It doesn't show that paleo diet promotes longevity!


End of 3/27/2012 edit.

Practically Paleo: My Meals

Haven't had time to upload photos of my meals for a while.  Here you go:

Breakfast one day this week:  Smoked salmon bellies; stir-fried kale, scallions, and red pepper; and sweet potato with coconut oil.

I got the salmon bellies from Kenny and Brenna Aschbacher, the Fishhuggers.  I marinated about 3 pounds of salmon bellies with 2 T San-J soy sauce and 6 T Wright's Liquid Smoke overnight.  Then I broiled the belly strips with skin side up for about 3 minutes under high heat.  Tastes like bacon.

Breakfast 4/1/10

Grass-fed raw flank steak--I marinated it in olive oil and black pepper--with kim chi I get from a local Asian market.  At this meal I also had a sweet potato with coconut oil, and some fruit, but I don't remember what kind.  I got the steak from Kenny and Brenna Aschbacher, the Fishhuggers.

Breakfast 4/2/10

• Grass-fed ground beef chili made with beef bone broth, beef tallow, onion, marinade juices left from the smoked salmon (above), kelp, tomatoes, chili pepper, chili powder, cumin, garlic, and cilantro.  
• Steamed broccoli and red pepper tossed with olive oil and black pepper.
• Trader Joe's Wild Boreal blueberries with coconut milk topping.
• Mineola tangerine.

Lunch 4/2/10

Grass-fattened ground beef (seasoned but raw), same vegetables as for breakfast, an apple, and a mix of 1/2 cup walnuts, 1/4 cup almonds, and 1/4 cup raisins.

Nutrition Analysis 4/2/10

I wanted to see what kind of fatty acid profile I have when I eat nuts in the quantity (3/4 cup) I have in this day's menu.  The following provides the food list and macronutrient sums (click on image for larger version):

This slide gives the macronutrient ratio in tabular and graphic forms:

You can see that the day's meals provided 69% of energy as fat, 16% as carbohydrate, and 15% as protein.  Saturated fat provided 23% of energy, monounsaturated 27%, and polyunsaturated only 12%.

The following provides the micronutrient analysis:

The analysis shows this menu fell short in vitamin A, vitamin D, calcium, potassium, thiamin, and sodium.

Active Vitamin A (retinol) I get from sardines and liver on a weekly basis or so, in quantities that get stored in my liver to cover my requirements on days like this.  Vitamin D I get from sunlight and my daily supplement.

The calculated calcium content of this menu does not include the calcium-rich bone broth that I used in the chili.  That broth provides at least 100mg calcium per tablespoon, and I put enough in the chili so that each serving supplies 200mg calcium, bringing my total to 647mg for the day from foods.  As mentioned before, I take additional supplemental calcium on days like today when I know my food-source calcium intake falls below 750mg. 

This menu fell short of the recommended intake of potassium by about 20%, largely because I did not have a sweet potato in the menu.  When I don't get adequate potassium, I suffer nocturnal muscle cramps.  I find it a little challenging to consistently meet my potassium requirements while also keeping my carbohydrate intake below 20% of calories.

Although the software says this menu fell short of sodium requirements, it actually supplies more than the estimated requirement for sodium based on balance studies, i.e. 500mg.

I find that low carbohydrate menus tend to fall short of thiamine requirements if they don't include pork.  I find this a little disconcerting because I don't really enjoy conventional pork (an excellent thiamine source), nor do I eat organ meats rich in thiamine often, and although thiamine requirements decline somewhat with lower carbohydrate intake,  Hoyt has reported optic neuropathy due to thiamine deficiency in epilepsy patients following ketogenic diets and also in healthy individuals following low-carbohydrate diets for weight loss (abstract here and full text reproduced here).   Atkins, of course, recommended heavy vitamin supplementation to accompany his program.

For Fun: My Paleo Cats Hanging Out

I call the black beauty Angie, and the little tiger Sheba. 

Paleo Basics: How Much Sugar in Wild Fruits?

I frequently see the claim that wild fruits have less sugar than cultivated varieties.  It must sound reasonable to those who state it, but what does the evidence show?

In "Australian Aboriginal plant foods: a consideration of their nutritional composition and health implications" Brand-Miller and Holt discuss the carbohydrate contents of wild fruits consumed by Australian Aborigines and report:

"The average nutrient analysis of all the dried AA [Australian Aborigine] fruits in Table 1 (n = 7) shows that they are high in carbohydrate (59 %, v. 65 % in cultivated sultanas and raisins), and contain moderate amounts of protein (8 %) and fat (4 %) depending on the state of desiccation."

They also report:

"The average nutrient composition of all the fruit samples analysed (n = 334) is shown in Table 1 (macronutrients) and Table 2 (micronutrients). On first inspection they appear to be a little higher in protein (2 v. 1 %) and fat (1 v. 0 %) compared with the average of 17 types of cultivated western fruits. These small differences could be explained in large part by the lower water content of the wild foods (72 v. 85 % in cultivated foods). 

"Native fruits also appear to be twice as high in both carbohydrate (21 v. 9 %) and fibre (8 v. 3 %). However, because the methods used are not ideal (see above), the carbohydrate is probably an overestimate and the fibre an underestimate."

So analyses show that wild fruits have, in the first comparison, about the same sugar content as cultivated varieties, and in the second comparison, at least as much sugar, probably more, and up to twice as much, as cultivated.  Neither analysis showed them to have significantly less carbohydrate.

Paleo Basics: Fructose Fact Vs. Fiction

In response to my post on the Kitavan diet, which includes plenty of fruit and likely 36g of fructose daily, "gn" asked me if I think it plausible to suppose that human ethnic groups differ in ability to deal with fructose loads, so that daily fruit won't harm dark-skinned Kitavans living in tropical climate (constant summer) for hundreds of generations, but will harm people of European descent whose ancestors had fructose supply only in late summer and fall seasons.

From this question, which I will address below,  I get the impression that the Lustig lecture embedded above has led many to believe that daily ingestion of fructose in any quantity has toxic effects, such as non-alcoholic-fatty-liver-syndrome (NAFLS), particularly to people of European descent.

Unfortunately, Lustig's lecture contains misleading hyperbole or exaggeration (e.g. within the first five minutes he says "The Japanese diet is all carbs and no fat, and the Atkins diet is all fat and no carbs" and later he claims that Japanese eat no sugar, a falsehood) and doesn't give important details about research on fructose metabolism. The main problem lies in a failure to define the dose of fructose required to produce the adverse effects. Let's take a look at some of the research to see what people have missed.

Fructose Research

Le et al investigated the effect of fructose overconsumption on blood lipids and ectopic lipid deposition in healthy subjects with and without a family history of type 2 diabetes.   In this study they found that fructose overconsumption  "increased ectopic lipid deposition in liver and muscle and fasting VLDL-triacylglycerols and decreased hepatic insulin sensitivity" and the effect appeared greater in offspring of parents who had type 2 diabetes.

To get this effect, they used a hypercaloric high-fructose diet supplying 3.5g fructose per kg of fat free mass, amounting to more than 35% of energy intake.  For a lean individual like myself, that would require putting down more than 222g/888kcal of fructose daily while also consuming more calories than I expend.   This is an unrealistic intake of fructose for a person eating a whole foods diet.  It would require consuming more than 444g of table sugar, 12 non-diet sodas, or about 18 medium size apples or bananas.

For another example, Ackerman et al studied fructose-induced fatty liver disease in rats.  To induce FLD in the rats, they used a diet consisting of 60% fructose by weight, which supplied all the carbohydrate in the diet.  Humans do not typically consume diets in which fructose is the sole carbohydrate and the major macronutrient by weight.

Brown et al looked at the effect of fructose on blood pressure in young healthy people.  They had 15 volunteers drink a 500ml  beverage containing a single dose of 60g fructose or glucose.  Both sugars produced an increase in heart rate, and the fructose dose produced an elevation in blood pressure that persisted for at least 2 hours.  To get a single dose of 60g fructose from sucrose (table sugar) would required ingesting about 120g sugar in one sitting--or, 157g of high-fructose corn syrup, or more than 4 apples or 4 bananas.  This says nothing about the effects of consuming the more typical 15g fructose per serving found in a serving of soda, let alone eating whole fruits, which contain other components (e.g. potassium) that tend to reduce blood pressure.  For my n=1 experiment, I have routinely eaten 3-4 pieces or servings (cups) of fruit in a day for more than 10 years in a row and my blood pressure remains at 110/60.

Swarbrick et al claimed to show that consumption of fructose-sweetened beverages increases postprandial triglycerides and fasting apoB concentrations, and suggest that long-term consumption of diets high in fructose could lead to an increased risk of CVD.  To produce their results, they fed study subjects diets providing 25% of total energy as fructose.  For a 2000 kcalorie diet, that is 500 kcalories or 125g of fructose.  Again, this would require consuming a total of 250g of sugar from sucrose or high-fructose corn syrup, i.e. more than 6 non-diet sodas, or at least 10 pieces or cups of fruit in a day. 

As John White noted in the American Journal of Clinical Nutrition, in the typical U.S. diet, fructose contributes about 200–250 kcal/d, which amounts to about 7–8% of the current 2700-kcal/d per capita total calorie intake, a much smaller intake than used in these experiments, so they provide no evidence that typical intakes of fructose induce fatty liver disease.  He added:

"Although examples of pure fructose causing metabolic upset at high concentrations abound, especially when fed as the sole carbohydrate source, there is no evidence that the common fructose-glucose sweeteners do the same. Thus, studies using extreme carbohydrate diets may be useful for probing biochemical pathways, but they have no relevance to the human diet or to current consumption."

I could go on but instead I will refer you to an excellent critical review of Lustig's lecture by Alan Aragon:  The bitter truth about fructose alarmism.  After reviewing 19 papers on the effects of dietary fructose disputing some of the anti-fructose claims made by Lustig, and finding Lustig's presentation lacking, Alan comments:

"So, what’s the upper safe limit of fructose per day (all sources considered)? Again, this depends on a number of variables, not the least of which are an individual’s physical activity level and lean body mass.Currently in the literature is a liberal camp reporting that fructose intakes up to 90 grams per day have a beneficial effect on HbA(1c), and  no significant effects are seen for fasting triacylglycerol or body weight with intakes up to 100 grams per day in adults [15]. The conservative camp suggests that the safe range is much less than this; roughly 25-40 grams per day [19].  Figuring that both sides are biased, the middle figure between the two camps is roughly 50 grams for active adults."  

Back To The Original Question

As I noted above, "gn" asked me if I find it plausible that Europeans have less tolerance for fructose than Kitavans.  Short answer: No.  Long answer:  All of the above studies were done on people of European descent, illustrating that Europeans have a quite high tolerance for fructose.  Further, fructose tolerance developed millions of years ago in the African primate lineage from which we all hale, due to primate consumption of fruit as a dietary staple.  When humans moved out of Africa about 50 thousand years ago, they would have lost fructose tolerance only if maintaining it proved a disadvantage in northern climates.  In other words, they would have lost fructose tolerance only if maintaining it resulted in death before reproduction.

I can't imagine a scenario in which the environment would select against fructose tolerance, i.e. in which maintenance of fructose tolerance despite a fructose-poor environment, would cause a person to lose fertility or die before having a chance to reproduce.  I also can't imagine a scenario in which the environment (seasonal variations in supply of fructose) would select for fructose-intolerance, i.e. favor the reproduction of fructose-intolerant individuals.  On the contrary, seasonal supply of fructose would continue to select for those who could eat naturally large amounts of fructose (i.e. fruits) when seasonally available, because those people maintaining the deeply ingrained primate ability to metabolize fructose would even in the north have a greater total available food supply than fructose-intolerant individuals.

I routinely eat three to five servings of fruits daily, i.e. 30 to 50g of fructose, and have done so most days for the past 10 years that I have eaten a practically paleo diet.  My ethnic background consists of Hungarian, French, and German.   My last blood profile showed my total lipoproteins at 231 mg/dL, my HDL at 85, and my triglycerides at 47.  Using the Friedewald equation they calculated the LDL at 138, but since I have very low triglycerides, using the Iranian formula calculator I calculate my LDL equals 104.  Since I have nearly twice as much HDL as triglycerides, and low fasting glucose, I have extremely low heart disease risk.  My liver enzyme levels and bilirubin all fell in low normal values, indicating no liver dysfunction.





"

Paleo Diet Analysis: Kitavan Analogue Diet

This weekend I spent some time reading Stephan Guyenet's excellent series of posts on the Kitavans, along with parts of Staffan Lindeberg's website and book Food and Western Disease: An Evolutionary Perspective, which also contain information on the Kitavans.

The Kitavans display exceptional health and live well into their 90s without heart disease, cancer, diabetes, obesity, high blood pressure, or other diseases of civilization. They eat eat a diet composed primarily of tubers (sweet potatoes, cassava, yam, taro), coconut, fruit (bananas, guava, watermelon, pineapple), vegetables, and fish. Far from a low carbohydrate or high animal protein diet, this supplies 69% carb, 21% fat, 10% protein. They maintain immunity to modern diseases and have low insulin levels (almost half those of Swedes).

I decided to create a Kitavan diet analogue for analysis. They have an average caloric intake of 2200 kcal per day, so I aimed for that figure and incorporated the foods Lindeberg lists as their staples (above). The food list looks like this (click on images to enlarge for ease of reading):

The diet supplies 376g carbohydrate, 63g fat, and 64g protein.  The macronutrient analysis looks like this:

By energy, 66% carbohydrate, 24% fat, 10% protein, close enough to Lindeberg's reported 69:21:10 to serve as a valid measure.  It contains 52g saturated fat and supplies 20% of calories as saturated fat, again not significantly different from Lindeberg's reported 17% of calories from saturated fat.  Polyunsaturates and monounsaturates each contribute only 1% of calories.

Kitavans, photo source:  Staffan Lindeberg

The four fruits (one serving of each) supply about 72g of the total carbohydrate, which would mean an intake of about 36g of fructose.  Since the Kitavans have low insulin levels and don't have heart disease, cancer, diabetes, dementia, or any other disorder, they seem to provide evidence against the claim that more than 15g/d of fructose causes insulin resistance, etc.

The micronutrient analysis looks like this in tabular then graphic display:

The menu shows shortages in vitamin D and calcium.  Kitavans get plenty of sunshine so don't need dietary vitamin D.  My analysis assumed that they don't consume soft fish bones or make broth from fish bones, probably an incorrect assumption, and also does not account calcium they may get from drinking water (mineral waters can supply up to 500mg per liter), so their calcium intake probably exceeds the level in this menu.

 Kitavan fisherman, photo source:  Staffan Lindeberg 

One note about zinc:  Two thirds of the zinc supplied by this menu comes from one single oyster. Oysters supply 150mg of zinc per 100g serving, so a Kitavan needs only one oyster daily to bring the zinc level to well above recommended levels. 

In short, the Kitavan diet easily supplies all the essential nutrients at recommended levels, and affords a high immunity to modern diseases along with excellent longevity, without a high protein or low carbohydrate intake.

Practically Paleo Diet Supplementation: How Much Vitamin D?

About a year ago, one of my paleo-dieting, vitamin D-supplementing patients developed a salivary stone (sialolith), diagnosed by an oral surgeon.  A salivary stone consists of calcium phosphate blocking the salivary duct and saliva flow, resulting in swelling of the gland during meals when saliva production increases.

The patient refused the surgical treatment for this condition and consulted me for non-surgical treatment.   I began treating her with acupuncture and a Chinese herbal formula clinically proven effective for this condition.   Over the course of about 10 months of treatment consisting primarily of drinking an herbal tea every day, the stone dissolved, confirmed by the surgeon who diagnosed it.

In the meantime (several months into the treatment), she had her semi-annual vitamin D test which found a serum 25-hydroxyvitamin D level of 82ng/mL.   This came after six months of supplementing with 4000-5000 IU daily. When I saw this level I knew it fell in the range suggested as possibly optimum by Cannell at the Vitamin D Council (50-80ng/mL), but I advised her to reduce her vitamin D intake by half (from ~4000-5000 IU per day) and let it decline to 30- 50ng/mL.

Over the course of the next 7-8 months the patient had progressively less swelling during meals, and I could see the stone shrinking.   However, it shrank so much more slowly than I expected that I started to wonder if a high intake or elevated blood level of vitamin D counteracted the effect of the herbs, and contributed to the formation of this stone.  So I did a PubMed search to find out if anyone had ever investigated the relationship between vitamin D levels and formation of sialoliths.

I found one study  that looked for increased salivary stone formation in women taking vitamin D, calcium, and alendronate (PhosomaxÔ).  This study found no evidence of increased sialolithiasis in this group of women.  However, the abstract does not state the dose of vitamin D used, and I don’t want to pay to view the full text.  I feel pretty confident that this trial did not use a vitamin D dose greater than 2000 IU daily, whereas previous to her stone formation my patient was taking 4000-5000 IU.

Then I found the abstract of an experimental study by Westhofen et al: Calcium redistribution, calcification and stone formation in the parotid gland during experimental stimulation and hypercalcaemia.   In this study Westhofen et al induced hypercalcemia in rats by administration of dihydrotachysterol, a synthetic vitamin D analogue. They reported:

“During hypercalcaemia (induced by dihydrotachysterol), a calcium overloading of the cell membrane and intracellular buffer organelles without calcification was observed. Combined stimulation and hypercalcaemia induced an excessive calcium overloading of all intra-and extracellular calcium depots with excessive calcium release into the acinar lumina resulting in calcium phosphate aggregates and stone formation. Secretory stimulation and simultaneous hypercalcaemia exert potentiating effects on intracellular and intraluminal calcification proposing an importance for pathogenesis of human sialolithiasis.” [Emphasis added.]

Since vitamin D increases blood calcium by increasing both intestinal absorption and bone resorption, this suggested to me that excessive vitamin D could indeed increase the risk of forming salivary stones, particularly in people like my patient who form large deposits of calculus (thus have a tendency to high salivary calcium phosphate).

By the time I figured all this out, my patient’s stone had dissolved, confirmed by the same oral surgeon who diagnosed it.  By consuming vitamin D only intermittently, her vitamin D level fell to 39 ng/ML during the treatment period.

Then, in the process of working on my series on acid-base balance, I found that Eskimos probably had suboptimal intakes of magnesium.  I got a hold of a couple of studies looking at the effect of magnesium deficiency on bone health

Surveys since 1985 indicate that the typical U.S. individual does not ingest magnesium at amounts recommended by the RDA (1, 2) of 400mg for adult men and 310mg for adult women.  U.S. adults commonly consume 50% or less than recommended levels.  

Rude et al showed that restricting animals to magnesium intakes equivalent to just half of the adult human RDA resulted in “bone loss, decrease in osteoblasts, and an increase in osteoclasts by histomorphometry” (3).  Six months of low magnesium intake reduced trabecular bone volume significantly. 

They also found that low magnesium intake reduced levels of activated vitamin D, i.e. 1,25 dihydroxyvitamin D, aka calcitriol, by 50%!   This suggests that magnesium deficiency profoundly impairs activation of vitamin D.  This would mean that people who do not get adequate magnesium would show signs of vitamin D deficiency despite adequate sun exposure or vitamin D intake.  Conversely, people who consume more magnesium-rich foods, such as my paleo-dieting patient, require less vitamin D, and may more easily suffer from vitamin D excess. 

Finally, Rude et al also found that magnesium deficiency increased markers of bone inflammation (cytokines) and RANKL, also favoring bone resorption.

I exchanged a few emails with Dr. Stephan Guyenet (Whole Health Source) discussing this and he graciously shared a few other studies of interest here.

First, Batchelor and Compston studied the effects of cereal fiber on vitamin D pharmacokinetics in humans, following up on a study by Ford et al which “demonstrated biochemical improvement in ten patients with rickets or osteomalacia following the substitution of white leavened bread for chappattis in the diet”  (4).  They gave healthy volunteers bran supplying 20g of cereal fiber daily.   They demonstrated that the high intake of cereal fiber reduced the plasma half-life of 25-hydroxyvitamin D from 27.5 days to 19.2 days.  Since vitamin D appears in bile and cereal fibers may bind bile, Batchelor and Compston suggested that this may explain the loss of vitamin D in the cereal-fiber-supplemented individuals. 

This suggests conversely that people not consuming cereal fiber have a superior retention of vitamin D and would not require the same high doses as people consuming cereal-based diets.  Again, people on paleo diets would then have a greater susceptibility to adverse effects of high dose vitamin D.

Another study by Zanchi et al looked at bone metabolism in children suffering from celiac disease compared to controls (5).  Among the untreated celiacs, 40% had low blood calcium, 11% low blood magnesium, more than 50% had hyperparathyroidism, and 35% had blood 25(OH)vitamin D below 20ng/mL (frank deficiency).  The untreated celiacs had an average 25(OH)vitamin D less than half of healthy control subjects.  Ten of 20 patients who had at least two positive laboratory tests had osteopenia, which resolved after 6 months on a gluten-free diet.  Unfortunately, adults with late-diagnosed celiac do not have the same pattern of recovery of bone mineral density on gluten-free diets.

This shows that ingestion of gluten can reduce vitamin D levels in celiac patients.  Since at least two studies (6, 7) have shown that gliadin increases intestinal permeability of non-celiacs as well as celiacs, I suspect that gluten may affect vitamin D status in non-celiacs.  If so, a gluten-free paleo diet may increase the effectiveness of vitamin D, reducing the required dose and making paleo dieters more susceptible to vitamin D overdose.

By the way, Jorde et al gave 324 overweight or obese subjects either 40K IU or 20K IU weekly (5714 or 2857 IU daily) of vitamin D for a year.  They found no reduction in levels of markers of inflammation over that time, compared to unsupplemented subjects.

It could very well turn out that elevated vitamin D levels don’t themselves confer all the benefits linked to vitamin D status.  Higher vitamin D levels linked with lower risks of some chronic diseases (e.g. skeletal and autoimmune in particular) may turn out to only serve as a marker for the beneficial effects of outdoor activity, better micronutrient status (e.g. magnesium above), or lower intake of or susceptibility to the effects of gluten.

Urashima et al reported this month that school children given 1200 IU of vitamin D daily had nearly half the incidence of influenza and one-sixth the incidence of asthma found in unsupplemented children.  Thus, it appears that improved vitamin D status does improve innate immunity against infectious disease and reduce susceptibility to asthma.

For now I recommend keeping your serum vitamin D level between 40 and 60 ng/ml (edited 3/26/10) and not making an effort to obtain the higher levels (50-80ng/mL) recommended by the Vitamin D Council.  I still recommend using 10K IU for 1-3 days at the onset of symptoms of a cold or flu, to enhance the innate immune response and terminate the infection.    

In short, it seems likely that paleo dieters probably require less vitamin D supplementation than people on grain-based diets, and might have a higher risk of side effects from chronic high dose supplementation.  

1. Earl S. Ford and Ali H. Mokdad.  Dietary Magnesium Intake in a National Sample of U.S. Adults. J. Nutr. 133:2879-2882, September 2003

2. K. J. Morgan, G. L. Stampley, M. E. Zabik and D. R. Fischer. Magnesium and calcium dietary intakes of the U.S. population. Journal of the American College of Nutrition, Vol 4, Issue 2 195-206

3. Robert K. Rude, MD, Frederick R. Singer, MD and Helen E. Gruber, PhD. Skeletal and Hormonal Effects of Magnesium Deficiency. Journal of the American College of Nutrition, Vol. 28, No. 2, 131-141 (2009)

4. Batchelor and Compston.  Reduced plasma half-life of radio-labelled 25-hydroxyvitamin D, in

subjects receiving a high-fibre diet. Br. J. Nutr. (1983). 49, 213.

5. Zanchi et al.  Bone Metabolism in Celiac Disease. J Pediatr 2008;153:262-5.

6.  Drago et al. Gliadin, zonulin and gut permeability: Effects on celiac and non-celiac

intestinal mucosa and intestinal cell lines. Scandinavian Journal of Gastroenterology, 2006; 41: 408-419.

7. Bernardo et al. Is gliadin really safe for non-coeliac individuals? Production of interleukin 15 in biopsy culture from non-coeliac individuals challenged with gliadin peptides. Gut 2007;56;889-890.

8. Jorde et al. No effect of supplementation with cholecalciferol on cytokines and markers of inflammation in overweight and obese subjects.

9. Urashima et al. Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren. Am J Clin Nutr (March 10, 2010).

 

My Practically Paleo Meals 3/19/10

Today I decided to do a nutrition analysis of my meals in addition to posting photos.

Breakfast

Very rare beef rib steak, two soft boiled eggs, and a sauteed medley of onion, garlic, kale, and red pepper using olive oil.

About a cup of kabocha squash with coconut oil.

Frozen blueberries with Thai Kitchen coconut milk. When you put the coconut milk on top of the frozen fruit and stir them together a bit, the coconut milk freezes, creating a texture I enjoy.

Lunch

Same beef (larger portion), a whole avocado with salsa, same vegetables, an apple, and an orange.

Nutrition Analysis

I don't do this very often on my own meals.  Here's the breakfast food list and macronutrient totals:

This gives the macronutrient ratios for breakfast in pie chart form:

 This has the entire food list for the day:

This gives the pie chart representation of the macronutrient ratios along with fatty acid analysis (SFA, PUFA, MUFA), cholesterol content, and fiber content:

You can see that this menu supplied 59% of calories as fat, 26% as protein, and 16% as carbohydrate, with 35 grams of fiber.  This program calculated that saturated and monounsaturated fat each supplied 24% of calories (48% total), and polyunsaturated only 4%, but I suspect these may not be correct because the grass-fed meat and omega-3 eggs I used probably have proportions of fatty acids different from the items in the database.   On the days I eat walnuts instead of coconut it will vary with a higher proportion of polyunsaturated fats.

This gives the micronutrient analysis in tabular form with quantification:

This one depicts the nutrient contents in percents of the RDA in graphic form:

These meals fell slightly short of the 150g/d carbohydrate recommendation but this does not concern me since carbohydrate is not a required nutrient.  Vitamin D I get from sun and a supplement, and fish on the days I consume it, so it does not concern me either. 

Calcium fell short of the RDA about which we have a debate.  Recent research by USDA scientists indicates that that people may require only ~750mg of calcium daily (See Hunt and Johnson, full text here), rather than the 1000 mg RDA used by the FitDay calculator.  My food still fell short of that by about 300mg.  On the other hand, compared to other species on a pound for pound basis, we would predict humans requiring more like 2000mg daily; obviously these meals fell far short of that.

These meals also fell short of the RDA for magnesium by 30%, and 21% short of the RDA for thiamin.

I already knew that my meals do not typically meet the RDA for calcium or magnesium. Since I don't always eat fish bones or use bone broth daily, I currently take a calcium-magnesium supplement daily (in addition to vitamin D).  The thiamin level does not concern me because it fluctuates according to my food selections.

I might do another of these on a day that I eat less coconut and more walnuts to see what comes up.  

Practically Paleo: Storing Stock

To make eating grass-fed meat more economical, I buy it frozen in large quantities.  I just got about 100 pounds of grass-fattened beef and 50 pounds of wild Kodiak salmon from Kenny Aschbacher, the Fishhugger.

I have a chest deep freezer in one corner of my office:

 

Atop the contents I put this insulation to keep them very cold:

 

This box contains grass-fed ground beef:

This bag holds 50 pounds of wild salmon bellies in five pound packages:

Two more boxes of beef steaks and roasts:

One of the shrink-wrapped steaks; notice the yellow color of the grass-fed fat:

I had a couple of the steaks today.  I enjoy buying in bulk and saving myself money and shopping time.  I won't need to purchase meat for almost 6 months now.

Primal Diet On A Shoestring

Nutritionally Complete, Inexpensive Low Carbohydrate Meal Plan

Some of the questions I received on a previous post regarding nutrient, particularly folate, delivery of a diet containing no vegetation prompted me to run a nutritionalysis to see if I could create a nutritionally compete zero carbohydrate meal plan.

Alas, so far I could not do so, even when I included chicken liver in the daily diet to provide folate (chicken liver has about 400 mcg folate per 4 ounce serving). Although liver is very nutrient dense, without nuts (source of trace minerals not so well supplied by meat) and produce, I could not get adequate levels of vitamin C, vitamin E, magnesium, manganese, or potassium.

So, I changed my approach to create a diet with minimal carbohydrate, yet supplying all required nutrients, and I added the requirement that the daily diet cost would fall below the USDA allotments for Supplemental Nutrition Assistance Plan, otherwise known as food stamps.

I wanted to include the latter requirement because when I watched Food Inc a few weeks ago, I did not like the part where they created a sad story around a family that supposedly could not afford to purchase good food in a grocery store, so felt compelled to purchase $1 meals at fast food restaurants twice daily. I knew that story was a pile of corn grits, so I decided to prove it.

I succeeded in all respects. I came up with the following, tailored to my own nutritional requirements.

Cost of food and supplements

Food	Quantity	Grocery	Unit cost $	Cost $
Beef	8 ounces cooked	Food City	1.99/lb	1.00
Butter	8 tablespoons (112 g)	Food City	2.59/lb	0.63
Pork Chop	4 ounces cooked	Food City	.99/lb	0.50
Eggs	4 large	Food City	1.69/doz	0.56
Walnuts	1 ounce (14 halves)	Sprouts	4.99/lb	0.31
Turnip greens	4 cups raw (1/2 cup cooked) (220 g)	Food City	0.92/lb	0.45
Broccoli	2 cups raw (1 cup cooked) (182 g)	Sprouts	0.77/lb	0.31
Carrots	2 cups raw (1 cup cooked) (256 g)	Sprouts	0.59/lb	0.33
Peppers, red	1 cup cooked	Sprouts	0.77/each	0.77
Vitamin D3	2 x 1000 IU	Complementary Prescriptions	13.95/250,0.06/1000 IU	0.12
Vitamin K2	1.5 mg	Complementary Prescriptions	10.95/60, 0.18 ea	0.18
	TOTAL			$5.16

This menu provides 2442 calories, 191.0 g of fat, 63.7 g of carbohydrate (21 g as fiber; 42 g net carbohydrate), and 126.2 g of protein. That's 69% fat, 21% protein, and 10% carbohydrate. Saturated fat is 32% of energy, polyunsaturated 8%, and monounsaturated 22%.

It provides 524 mg folate (31% more than the RDA), and exceeded the RDA or AI for all nutrients measured on FitDay except VT-D, calcium, magnesium, and potassium.

Regarding calcium, metabolic studies indicate that the RDA overestimates calcium requirements. Current data indicates that people maintain calcium balance with an average intake of 741 mg per day [1]. This plan provides 782 mg of calcium. Also, adding 3 tablespoons of well-made bone broth (see The Garden of Eating for a recipe) to each daily meal will cost virtually nothing and add 300 mg calcium to bring total to over 1000 mg.

Regarding magnesium, metabolic studies indicate that the RDA overestimates magnesium requirements. Current data indicates that people maintain magnesium balance on an average intake of 165 mg per day [2]. This plan provides 285 mg, exceeding the 165 mg by 50%.

Regarding potassium, this plan provides 3608 mg, 77% of the "adequate intake" defined by the Institute of Medicine. Add some vegetable scraps to the pot while preparing the bone broth, and the broth will provide the necessary additional potassium. Alternatively, adding 1.5 cups of cantaloupe or similar fruit will bring the potassium to 4233 mg, 90% of the AI -- close enough -- while still keeping the total digestible carbohydrate at about 60 g/d, and increasing cost of the menu by only about thirty cents, to $5.46.

To cover vitamin D and vitamin K2, I included supplements: VT-D 2000 IU, VT-K 1.5 mg. I get them from Complementary Prescriptions.

According to the USDA’s Fact Sheet on Resources, Income, and Benefits for the Supplemental Nutrition Assistance Program (SNAP), a household of 4 qualifies for a maximum monthly allotment of food assistance in the amount of $668, or $167 per person, which comes to $5.57 per day. So you will have ten cents left over!

Someone with lower caloric requirements would just eat smaller portions and of course has lower nutrient requirements. They would spend even less.

So I have just shown that even people on food stamps can eat a highly nutrient dense, meat-based, low carbohydrate diet, shopping in conventional supermarkets.

So the Food Inc people got it wrong. That family doesn't need to eat at fast food joints. They could follow my plan, the whole family would lose body fat, the father would lose his diabetes, they would stop needing dental repairs, and they would then have the money he spent on medications for upgrading the quality of their food.

P.S.  If you like this post and want to see more like it, please consider making a small donation or a recurring subscription payment using the PayPal buttons in the right hand column.  Fighting fallacies is a full time job I love to do, but I need support to continue doing it.  Also consider sending a link to this post to all of your Facebook and other friends.  

Notes

1. Source: Hunt CD and Johnson LK. Calcium requirements: new estimations for men and women by cross-sectional statistical analyses of calcium balance data from metabolic studies. American Journal of Clinical Nutrition, Vol. 86, No. 4, 1054-1063, October 2007.

2. Source: Hunt CD and Johnson LK. Magnesium requirements: new estimations for men and women by cross-sectional statistical analyses of metabolic magnesium balance data. American Journal of Clinical Nutrition, Vol. 84, No. 4, 843-852, October 2006.