Dr. A. Arunkumar, M.B.B.S., M.D.(pediatrics)
The golden Paleolithic era
The Paleolithic (Old Stone Age) era began some 2.5 million years ago in Africa when the first crude stone tools were developed. It ended about 10,000 years ago in the Middle East, with the first ancient farms. We can trace the evidence showing the dominance of lean meat in human diets from our origins 2.5 million years ago until the beginnings of agriculture 10,000 years ago.
It’s been only 333 generations since this change—known as the “Agricultural Revolution”—happened, and yet we have almost completely lost track of the foods our ancient ancestors ate. The so-called new foods that agriculture gave us so completely displaced the old foods that most of us are unaware that these foods were ever new. Many people assume that cereals, millets, pulses, legumes, refined sugars have always been part of our diet. Not true! We need to rediscover the foods that brought our Paleolithic ancestors vibrant health, lean bodies, and freedom from chronic disease. The foods that agreed nicely with their genetic blueprints are the same foods that agree nicely with our genetic blueprints.
About 2.5 million years ago, our ancestors began trading in their big guts for bigger brains. Big protruding belly is characteristic of vegetarian animals (Apes, horses and cows). These animals need large, active guts to extract the nutrients from their fiber-filled, plant-based diet. Today our bellies are about 40 percent smaller than those of apes and our brains are about three times larger. The turning point came when our ancestors figured out that eating animal food (meat and organs) gave them much more energy. All the energy formerly needed by the gut was diverted to the brain, which doubled and then tripled in size. Meat and animal foods literally shaped our genome.
Our early ancestors could crack the skulls and bones and still find something to eat—brains and fatty marrow. Marrow fat was the main concentrated energy source that enabled the early human gut to shrink, while the scavenged brains contained a specific type of omega 3 fat called “docosahexaenoic acid” (DHA), which allowed the brain to expand. Docosahexaenoic acid is the building block of our brain tissue. Without a dietary source of DHA, the huge expansion of our brain capacity could never have happened.
Without meat, marrow, and brains, our human ancestors never would have been able to walk out of tropical Africa and colonize the colder areas of the world.
The Agricultural Revolution changed the world and allowed civilization—cities, culture, technological and medical achievements, and scientific knowledge—to develop. It all started in the Middle East about 10,000 years ago, when some enterprising people started to sow and harvest wild wheat seeds. Later, they domesticated barley and a few legumes and then livestock—sheep, goats, and pigs.
One physical ramification of the new diet was immediately obvious: early farmers were markedly shorter than their ancestors. They had more infectious diseases than their ancestors, more childhood mortality, and shorter life spans in general. They also had more osteoporosis, rickets, and other bone mineral disorders, thanks to the cereal-based diets. For the first time, humans were plagued with vitamin- and mineral-deficiency diseases—scurvy, beriberi, pellagra, vitamin A and zinc deficiencies, and iron-deficiency anemia. Instead of the well-formed, strong teeth their ancestors had, there were now cavities. Their jaws, which were formerly square and roomy, were suddenly too small for their teeth, which overlapped each other.
What had gone wrong? The new staples, cereals and starches, provided calories but not the vital nutrients of the old diet—lean meats, fruits, and vegetables. The result—ill health and disease. The health picture got worse with the introduction of refined cereals, sugars, alcohol, hydrogenated fats and oils, processed foods in the recent centuries.
Diet heart hypothesis
The vilification of fat had its roots in the 1960s. The key figure was prominent nutritionist Dr. Ancel Keys. In the post war years, there was increasing concern about the so called epidemic of coronary disease that seemed to be sweeping the United States. The cause of coronary artery disease is a ruptured atherosclerotic plaque. Pathologic studies clearly identified that there was cholesterol contained within these plaques.
Searching for a culprit, cholesterol was in the wrong place at the wrong time. This seemed to make some superficial sense. High cholesterol levels were believed to cause plaque buildup thereby blocking the artery causing heart attacks. If high blood cholesterol levels were bad, then eating cholesterol must be, too.
This ignored the fact that the overwhelming majority (80%) of the cholesterol in the blood is manufactured by our liver. Only 20% comes from our diet. From the bad rap it has gotten, you might believe that cholesterol is some harmful poisonous substance to be eliminated. Actually, nothing could be farther from the truth. Cholesterol is a key building block in the plasma membranes that surround all the cells in our body. In fact, it is so vital, that every cell in the body except the brain, which is too specialized, has the ability to make cholesterol. If you reduce cholesterol in your diet, your body will simply make more.
Dr. Keys doggedly pursued his hypothesis that increased dietary fat caused increased coronary disease. This led to the famous Seven Countries Study, an observational study that compared different rates of coronary disease and different diet and lifestyle factors. In 1970, at the 5-year point there were three main conclusions with regards to fats.
- Cholesterol levels predicted heart disease risk
- Amount of saturated fat in the diet predicted cholesterol levels
- Monounsaturated fat protected against heart disease
With the publication of Dr. Key’s Seven Country Study, the origins of the Diet-Heart Hypothesis were laid down. The major problem was that this was all observational data, and as such, was subject to severe interpretation. There were also some complaints from later analyses that Dr. Keys may have ‘cherry picked’ his countries to those that he knew would show the correlation.
Later many studies that followed such as MONICA study, MRFIT trial, DEBAKEY study, VETERANS CLINICAL TRIAL, PUERTO RICE HEART health study, HONOLULU heart program did not show direct correlation of dietary saturated fat / cholesterol intake and cardio vascular events.
Also it was proposed by many studies that replacing saturated fats with poly unsaturated fats containing vegetable oils such as sunflower, safflower, canola oils reduced blood cholesterol levels thereby reducing heart disease incidence and risk.
Then followed the era of statins where lipid lowering drugs were proposed as a means to reduce blood cholesterol and thereby reducing cardio vascular event risk. Trials and systematic reviews have supported the use of statins but large size holes in this area remain. Statins, even though appeared to reduce cardio vascular events to some extent, many studies over exaggerated the minimal benefits shown by statins by projecting the benefits in terms of relative risk. Also, majority of cardiovascular events continue to occur despite aggressive lowering of cholesterol levels.
This has led to re-analysis of trials and studies such as SYDNEY HEART STUDY and MINNESOTA CORONARY STUDY recently. These have found that reducing cholesterol levels by using poly unsaturated fatty acids increased the overall mortality rather than decreasing it. Also larger studies such as PURE STUDY have recently found out that saturated fatty acid and overall fat intake is not related to cardiovascular events. Rather, increased carbohydrate consumption and particularly refined carbs is mostly associated with increased cardio vascular and other related events.
All these have made us think what went wrong in the dietary pattern of ours which has increased the prevalence of lifestyle diseases like obesity, type 2 diabetes, hypertension, coronary heart disease, PCOS, non-alcoholic fatty liver disease, allergies, auto immune disorders to staggering numbers.
History of Paleo diet
The Paleo diet’s history goes all the way back to about forty thousand years ago, when humans began to hunt animals and gather fruits, vegetables, and nuts in order to survive. There is no “founder” of the Paleo diet per say; rather, modern fitness gurus and scientists specialize in Paleo research and studies. If we want to give credit to a group of people for discovering this diet and lifestyle, we have to look no further than our caveman ancestors.
In the early 1900s, a man named Joseph Knowles spent two months in the wilderness of Maine and became famous for his survival. He reported of his adventures by writing on tree bark with charcoal, and he wrote of how he ate berries before he learned to fish and hunt. Knowles even used tree bark to make his own clothes and shoes. At times he was even forced to eat bark and roots. Upon returning, Knowles’ health and digestion was declared to be perfect.
He even kept record of his vitals before and after his wilderness stint. Amazingly, Knowles lost more than ten pounds, and he even grew by .1 of an inch. His muscles got bigger and his lung capacity greatly improved. Knowles’ experiment proved that hunting and gathering food made him stronger and healthier.
The Paleo diet was first made popular in the 1970s by Walter L. Voegtlin, a gastroenterologist. He was one of the first advocates to state that the Paleo diet could actually improve people’s health and well-being. His dietary prescriptions were based on his own medical treatments of various digestive problems like IBS and indigestion.
In 1985, it was further developed by Stanley Boyd Eaton and Melvin Konner, and popularized by Loren Cordain in his 2002 book “The Paleo Diet”. He suggested a diet high in animal protein, omega 3 fats, monounsaturated fats, vitamins, minerals, phytochemicals, fiber and devoid of refined sugars, cereal grains, pulses, dairy products, vegetable oils and processed foods. The diet was low in carbohydrates and rich in fats, proteins, fiber and all micronutrients.
Since then innumerable research groups have worked on the benefits of paleo / low carb diet and hundreds of research papers have been published in leading medical journals regarding the benefits of paleo / low carb diet.
Arogyam & Nalvaazhvu group – Origin of Tamil Paleo diet
The tamil version of paleo / low carb diet was propagated by Mr. Neander Selvan. An economics professor by profession, he shun carbohydrates by the age of 40 for his medical conditions such as obesity, pre diabetes and switched over to a low carb paleo diet. Astonished by the results he achieved and improvement in his health, he started a facebook group called ஆரோக்கியம் & நல்வாழ்வு. Started as a modest 30-member group, the group started growing more and more by word of mouth spread. More people started benefitting by following this paleo type of lifestyle and got rid of lifestyle diseases like obesity, metabolic syndrome, type 2 diabetes, PCOS, allergic, autoimmune and related disorders. Mr. Sivaram Jagadeesan, type 1 diabetic himself, benefitted from this diet immensely and reduced his insulin dosages and achieved excellent glycemic control. He started a special group for diabetics. Immense number of people have benefitted from this diet and the group has grown to more than 5 lakh members. Medical doctors like us, initially skeptical about this diet, started this diet for our own problems and started experiencing the benefits. We have taken the job of research in this field of low carb diet and started applying greater insights into it. This medical conference is an earnest effort to reach out to the medical community and brainstorm regarding the mechanisms and wide applications of this revolutionary diet. To tell that it is a major dietary revolution in south India wouldn’t be an over statement.
Mechanism of diet
This diet works by 2 principles.
- Paleolithic principle – by stopping all the nonsense, junk and processed foods of current millennium and going back to the food plate similar to what Paleolithic ancestors ate, we are supplying our bodies with real whole foods close to our genes, hence getting rid of modern diseases.
- Low carb principle – this is the main principle by how the diseases part of metabolic syndrome are dealt with by cutting carbs and by tackling insulin resistance.
- Diseases like obesity, type 2 diabetes, hypertension, PCOS, NAFLD, atherogenic dyslipidemia are all part of metabolic syndrome. Insulin resistance is the hallmark of metabolic syndrome.
- We are trying to tackle metabolic syndrome by dietary modification.
- In paleo / LCHF diet, we are going to cut down all the starchy and sugary carbohydrates from our plates except those from vegetables and we are going to shift our energy dependency towards fats and proteins.
- In this way, by reducing carbohydrate load, we are reducing the circulating insulin levels. Since insulin is the main lipogenic hormone in our body, reducing insulin levels encourages fat burning and hence losing weight.
- Reducing insulin levels also reverses most of the diseases of metabolic syndrome group by settling hyperinsulinemia.
- This LCHF diet reverses diseases of metabolic syndrome independent of weight loss.
- More than simple LCHF, this Tamil Paleo diet stresses on cooking method, selection of food source, types of cooking oils, other lifestyle modifications such as sun bath, exercise, etc – a Paleolithic way of lifestyle. We don’t recommend any processed or packed food items. Hence by trying to take wholesome natural foods as far as possible, and trying to live a life as close as possible to our ancestors, we are taking this LCHF diet a step further.
Foods to be avoided:
All cereals and their derivatives (rice, wheat, oats, barley, rava, maida, corn)
All millets (ragi, etc)
All pulses and grams (peas, channa, black gram, green gram, Bengal gram, soya bean, sprouts, etc)
All snacks made from these cereals and pulses (bakery items, savories, biscuits, etc)
All sweets (sugar, jaggery, palm sugar, honey, carbonated beverages, juices, sweets, etc)
Majority of fruits except guava, avocado and cucumber.
Deep fried items, fast food items, processed meat products, alcohol, smoking.
Foods to be taken:
Fresh meat of any kind, (to avoid farm bred as far as possible),
Eggs, paneer, cheese, nuts (all except peanut)
All vegetables except tubers, legumes
Cooking oil:butter, ghee, cold pressed coconut oil, cold pressed sesame oil, extra virgin olive oil.
During initials days of paleo diet, one may experience symptoms like fatigue, tiredness, headache, vomiting, nausea, etc. these symptoms only last for 1-2 weeks. These are due to low carb adaptation. One need not fear about these symptoms as these will settle down soon.
Regular sun session (exposure to sun for atleast 20 mins a day) is necessary.
Regular physical activity is also essential. (mild to moderate cardio activities like brisk walking, jogging, etc.)
Disease specific diet plans:
People with diseases like diabetes, auto immune diseases, allergic disorders, thyroid disorders, people with preexisting dyslipidemia, renal, hepatic disorders, etc. need diets that are modified and customized according to their condition. Hence proper discussion with treating doctor and discussion of reports is a must before taking diet.
Innumerable people (more than 5 to 10 lakhs) have benefitted directly and indirectly from this tamil paleo diet.
Its main benefits include
- Secondary benefits include improvement in joint pains, OA, obstructive sleep apnea, snoring, etc.
- Excellent glycemic control with or without drugs based on disease condition. Most of the followers maintain HbA1C around 6%.
- Early nephropathy – microalbuminuria, early neuropathy, early retinopathy, non-healing ulcers have improved excellently
- PCOS improvement – excellent fertility rates in women with PCOS with paleo diet
- Excellent improvement of non-alcoholic fatty liver disease.
- Hdl increases, triglyceride decreases , ApoB decreases, hscrp decreases – hence decreasing atherogenic dyslipidemia.
- Allergic rhinitis and asthma improves excellently
- Auto immune disorders show good remission rates – particularly psoriasis, IBD (around 40 – 50%)
- Improvement in epilepsy, neurodegenerative disorders like Alzheimer.
There are many more unlisted benefits on which plenty of research is going on.
We give dietary advice in our group with following pre requisites.
Age, sex, weight, height, Diet preference.
Complete medical history – diseases and medication summary, past history of major illnesses or surgery, allergy, personal history including h/o smoking, alcohol, etc.
We also advice a blanket blood / urine investigation for following reasons.
- As a screening purpose to find out unknown / early diseases.
- To know associated alterations in major parameters.
- To know the state of preexisting disease.
Hence we advise following tests,
- Complete blood hemogram,
- Lipid profile, liver function test, renal function test
- Iron profile, vitamin D, B12 levels
- Cardiac risk markers including hscrp,
- Thyroid profile, HbA1C,
- Urine complete analysis.
We also advice other specific tests based on individual disease conditions.
Only after going though all these and after involvement of a doctor, diet advices are given for diseases.
We also advice regular follow up investigations every 3 months to look for improvement in preexisting disease conditions and alterations in other parameters.
Hence proper pre and post paleo investigations with regular follow-ups are a must for people with disease conditions following lchf / paleo diet.
Plenty of randomized controlled trials, 3 systematic reviews and many other studies have been published on this LCHF / paleo diet in most of the leading international peer reviewed journals like lancet, nature, bmj, ejcn, annals of medicine, Pediatrics, etc. Some of the studies are mentioned in forthcoming sections. Plenty of breath taking research is also going on throughout the world day by day in this field.
We too have started various studies on the beneficial effects of paleo diet and we are taking serious steps to publish the astonishing results in leading peer reviewed journals. We hope converting anecdotal evidence into evidence based medicine will benefit the humanity to the fullest.
Arunkumar, Deyanand et al.
100 people, 3 months, pre and post paleo diet analysis.
Paleo is not a diet. It is a way of living.
I hope, by the end of reading this, all the readers will be having a clear mind with a paradigm shift happening in the nutritional approach to most of the lifestyle disorders we face day to day.
And let that benefit be passed on to thy patients, family and friends.
Come, lets change the world, one step at a time!!!