Literature Review

A multidisciplinary reconstruction of Palaeolithic nutrition that holds promise for the prevention and treatment of diseases of civilisation

Article· Literature Review (PDF Available)inNutrition Research Reviews 25(1):96-129 · June 2012with 1,019 Reads
DOI: 10.1017/S0954422412000017 · Source: PubMed
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Abstract
Evolutionary medicine acknowledges that many chronic degenerative diseases result from conflicts between our rapidly changing environment, our dietary habits included, and our genome, which has remained virtually unchanged since the Palaeolithic era. Reconstruction of the diet before the Agricultural and Industrial Revolutions is therefore indicated, but hampered by the ongoing debate on our ancestors' ecological niche. Arguments and their counterarguments regarding evolutionary medicine are updated and the evidence for the long-reigning hypothesis of human evolution on the arid savanna is weighed against the hypothesis that man evolved in the proximity of water. Evidence from various disciplines is discussed, including the study of palaeo-environments, comparative anatomy, biogeochemistry, archaeology, anthropology, (patho)physiology and epidemiology. Although our ancestors had much lower life expectancies, the current evidence does neither support the misconception that during the Palaeolithic there were no elderly nor that they had poor health. Rather than rejecting the possibility of 'healthy ageing', the default assumption should be that healthy ageing posed an evolutionary advantage for human survival. There is ample evidence that our ancestors lived in a land-water ecosystem and extracted a substantial part of their diets from both terrestrial and aquatic resources. Rather than rejecting this possibility by lack of evidence, the default assumption should be that hominins, living in coastal ecosystems with catchable aquatic resources, consumed these resources. Finally, the composition and merits of so-called 'Palaeolithic diets', based on different hominin niche-reconstructions, are evaluated. The benefits of these diets illustrate that it is time to incorporate this knowledge into dietary recommendations.
A multidisciplinary reconstruction of Palaeolithic nutrition that holds promise
for the prevention and treatment of diseases of civilisation
Remko S. Kuipers
1
, Josephine C. A. Joordens
2
and Frits A. J. Muskiet
1
*
1
Laboratory Medicine, University Medical Center Groningen (UMCG), Groningen, The Netherlands
2
Human Origins Group, Faculty of Archaeology, Leiden University, Leiden, The Netherlands
Abstract
Evolutionary medicine acknowledges that many chronic degenerative diseases result from conflicts between our rapidly changing environ-
ment, our dietary habits included, and our genome, which has remained virtually unchanged since the Palaeolithic era. Reconstruction of
the diet before the Agricultural and Industrial Revolutions is therefore indicated, but hampered by the ongoing debate on our ancestors’
ecological niche. Arguments and their counterarguments regarding evolutionary medicine are updated and the evidence for the long-
reigning hypothesis of human evolution on the arid savanna is weighed against the hypothesis that man evolved in the proximity of
water. Evidence from various disciplines is discussed, including the study of palaeo-environments, comparative anatomy, biogeochemistry,
archaeology, anthropology, (patho)physiology and epidemiology. Although our ancestors had much lower life expectancies, the current
evidence does neither support the misconception that during the Palaeolithic there were no elderly nor that they had poor health. Rather
than rejecting the possibility of ‘healthy ageing’, the default assumption should be that healthy ageing posed an evolutionary advantage for
human survival. There is ample evidence that our ancestors lived in a land water ecosystem and extracted a substantial part of their diets
from both terrestrial and aquatic resources. Rather than rejecting this possibility by lack of evidence, the default assumption should be that
hominins, living in coastal ecosystems with catchable aquatic resources, consumed these resources. Finally, the composition and merits of
so-called ‘Palaeolithic diets’, based on different hominin niche-reconstructions, are evaluated. The benefits of these diets illustrate that it is
time to incorporate this knowledge into dietary recommendations.
Key words: Palaeolithic nutrition: Disease prevention: Disease treatment: Dietary recommendations: Evolutionary medicine:
Healthy ageing
Introduction
In the Origin of Species
(1)
, Darwin recognised that there
are two forces of evolution, i.e. natural selection and the
conditions of existence, where the latter was considered
the most powerful
(2)
. For example, important steps in evo-
lution are the origin of eukaryotic life approximately
1·6–2·7 billion years ago
(3,4)
and the appearance of photo-
synthetic cyanobacteria that began to oxygenate the
atmosphere about 2400 million years ago (Mya)
(5)
. However,
there was relatively little alteration in the design of life
forms before the Cambrian explosion about 600 Mya. Only
when the oxygen tension in the atmosphere rose above the
Pasteur point did aerobic metabolism become thermo-
dynamically possible
(6)
, resulting in an explosion from
simple prokaryotics to a diversity of eukaryotic life forms
(7)
.
During the past millions of years of evolution, with rela-
tively little alteration in life forms and environmental circum-
stances, the human genome has become optimally adapted
to its local environment
(8 – 11)
. In other words, our genome
may have reached a state of homeostasis, defined as the
‘optimal interaction between environment and genome’ or
‘nature in balance with nurture’, to support optimal survival
for reproductive success. The aetiologies of many typically
Western diseases, also known as diseases of affluence or
civilisation, have been attributed to the disturbance of this
delicate balance, secondary to the rapid changes in the con-
ditions of existence, while our genome has remained basi-
cally unchanged since the beginning of the Palaeolithic
era. The former include changes in physical activity, stress,
sleep duration, environmental pollution and others
(12,13)
,
*Corresponding author: Dr Frits A. J. Muskiet, fax þ31 50 361 2290, email f.a.j.muskiet@umcg.nl
Abbreviations: AA, arachidonic acid; ALA, a-linolenic acid; en%, percentage energy; EQ, encephalisation quotient; Kya, thousand years ago; LA, linoleic
acid; MCSFA, medium-chain SFA; Mya, million years ago; RAR, retinoic acid receptor; RXR, retinoid X receptor; TR, thyroid hormone receptor; VDR,
vitamin D receptor.
Nutrition Research Reviews (2012), 25, 96–129 doi:10.1017/S0954422412000017
qThe Authors 2012
Nutrition Research Reviews
but one of the most rapidly changing conditions of existence
has been the human diet.
Since the onset of the Agricultural Revolution, some 10
thousand years ago (Kya), and notably in the last 200
years following the start of the Industrial Revolution,
humans have markedly changed their dietary habits. Con-
sequently, it has been advocated that the current pandemic
of diseases of civilisation results in part from the mismatch
between the current diet and our Palaeolithic genome. In
other words, ‘we are what we eat, but we should be
what we ate’
(14,15)
. The ensuing poorly adapted phenotype
may find its origin as early as in the fetal period
(16,17)
and
possibly as far back as in the maternal grandmother’s
womb
(18)
. This phenotype might be laid down in, inher-
ently labile, epigenetic marks that are meant for the
short- and intermediate-term adaptation of a phenotype
to the conditions of existence. With clear evolutionary
advantages they may become transmitted to the next
generations as a memory of the environmental conditions
that can be expected after birth
(19)
. They thereby give
rise to a seemingly high contribution of genetics in some
of the associated ‘typically Western’ degenerative diseases,
which are in fact complex diseases that by definition do
not inherit by Mendel’s law, illustrating that epigenetic
marks can also become erased.
From a pathophysiological point of view, the poorly
adapted phenotype in Western countries, ensuing from
the conflict between the changing lifestyle and our Palaeo-
lithic genome, centres on chronic low-grade inflammation
and the metabolic syndrome (also named the insulin resist-
ance syndrome), which are risk factors for many of the dis-
eases and conditions typical for affluent countries, such as
CVD, type 2 diabetes mellitus, osteoporosis, certain types
of cancer (notably colon, breast, prostate), fertility pro-
blems (polycystic ovary syndrome), pregnancy compli-
cations (gestational diabetes, pre-eclampsia), some
psychiatric diseases (major and postpartum depression,
schizophrenia, autism) and neurodegenerative diseases
(Alzheimer’s disease, Parkinson’s disease)
(20 – 22)
. The
genetically determined flexibility to adapt to a changing
environment appears to have been exceeded and the
genetically most vulnerable have become sick first, but ulti-
mately all individuals will become sick with increasing
dose and exposure time.
Environment, nutrients and their interaction with the
genome
Adjustment of the DNA base sequence is a slow process
that in an individual cannot support adaptation to environ-
mental changes occurring at intermediate or rapid pace.
Flexibility for rapid adaptation is provided by genetically
encoded mechanisms that allow adjustment of phenotype
by epigenetics and by the interaction of the environment
with sensors, such as those of the sensory organs, but
also by the many that remain unnoticed
(23 – 25)
. The role
of nutrients in (epi)genetics and their direct interaction
with the genome have become increasingly acknow-
ledged
(26)
. Examples of such nutrients are iodine, Se,
vitamins A and D, and n-3-fatty acids, which are direct or
indirect ligands of the thyroid hormone receptor (TR),
retinoid X receptor (RXR), retinoic acid receptor (RAR),
vitamin D receptor (VDR) and PPAR. Homodimerisation
and heterodimerisation of these receptors facilitate gene
transcription and thereby keep our phenotype optimally
adapted to the reigning conditions of existence. The roles
of these nutrients, their respective receptors and the
interaction between their receptors are indicative of the
importance of their dietary presence and of a certain
balance between their dietary intakes to arrive at optimal
interaction with the genome. Lessons for this optimal
interaction, and hence for the development of randomised
controlled trials aiming at the study of diet or lifestyle,
rather than single nutrients, might derive from knowledge
on human evolution and the conditions of existence to
which our ancestors have been exposed. These lessons
might provide us with valuable information on what we
should genuinely define as a ‘healthy diet’.
Evolutionary medicine
The concept that a thorough understanding of evolution
is important in the prevention and treatment of (human)
diseases has long been recognised. For example, in the
early 1960s it was stated that ‘nothing in biology makes
sense except in the light of evolution’
(27)
, while in ethol-
ogy, a distinction was made between proximate and ulti-
mate (also named evolutionary) causes
(28)
. Proximate
explanations provide a direct mechanism for certain beha-
viour in an individual organism. They explain how biomo-
lecules induce certain behaviour or, for example, an
allergic reaction. Proximate explanations, however, pro-
vide insufficient information to answer the question why
this behaviour or this allergic reaction occurred. Ultimate
explanations provide answers explaining why things
happen from an evolutionary point of view. Many, if not
all, diseases can become explained by both proximate
and ultimate explanations. The science searching for the
latter explanations has become known as ‘evolutionary
medicine’. Unfortunately, modern medicine deals mostly
with proximate explanations
(29,30)
, while ultimate expla-
nations seem more prudent targets for long-time disease
prevention
(29)
.
The term ‘evolutionary medicine’ (also named Darwinian
medicine) was launched by Randolph M. Nesse and George
C. Williams
(31,32)
. They provided evolutionary answers
for the understanding of human diseases. Many diseases
do not result from a single biological, anatomical or phy-
siological abnormality, but rather from a complex web
of interactions. They often reflect the collateral damage
of the survival and reproduction strategies of our genes
and the genes of other organisms in our environment.
Palaeolithic nutrition for disease prevention 97
Nutrition Research Reviews
The resulting disease manifestations include the outcomes
of human defence mechanisms to clear foreign pathogens
and the collateral damage of conflicts and trade-offs
between humans and foreign invaders. Examples often
overlooked are coincidence, in which diseases may result
from imperfections of human evolution, and exaptation, in
which a feature is not acquired in the context of any function
to which it might eventually be put
(33)
. For example, the
equilibrium between the not yet full-grown, but yet relatively
large, brain of a newborn and the small birth canal in its
turn is constrained by an upright posture and provides
an example of a trade-off in human evolution. The location
of the birth canal in its turn provides an example of an
evolutionary coincidence that urges to deal with an, in
retrospect, imperfect evolutionary design. These examples
illustrate that evolution builds on the past: it is not possible
to start a completely new design from scratch, which
argues against ‘intelligent design’. The most important
example of an evolutionary explanation for human disease,
however, comes from the mismatch between our slowly
adapting genome and the rapidly changing environment,
notably our diet.
Evolutionary medicine argues that the chronic degenera-
tive diseases causing most morbidity and mortality in afflu-
ent countries occur because of the current mismatch
between the rapidly changing conditions of existence
and our Palaeolithic genome
(34)
. These mismatches will
persist, notably in the light of our long generation time.
The genetic adjustments needed to adapt to the new
environment are also unlikely to occur, since the mismatch
exerts little selection pressure. That is, they do not cause
death before reproductive age, but rather reduce the num-
bers of years in health at the end of the life cycle
(35)
. Con-
sequently, evolutionary medicine acknowledges a return to
the lifestyle before the onset of the Agricultural Revolution
as translated to the culture of the 21th century and as
popularised by the expression: ‘how to become a 21th cen-
tury hunter–gatherer’
(36)
. Skeptics of evolutionary medi-
cine often raise the intuitive criticism that the human
ancestor had a very short life expectancy compared with
contemporary individuals
(35)
. Consequently, they argue,
there was no selection pressure on longevity or ‘healthy
ageing’, since there were virtually no old people, while
the few individuals reaching old (for example, postmeno-
pausal) age provided no evolutionary benefit to younger
individuals who were still able to reproduce. The counter-
argument is multilevelled.
Arguments and counterarguments in evolutionary health
promotion
It needs to be emphasised that evolutionary medicine pre-
dicts no further increase in life expectancy, but rather a
decrease in the numbers in deteriorating health at the
end of the life cycle. It has been estimated that the com-
plete elimination of nine leading risk factors in chronic
degenerative diseases would increase life expectancy at
birth by only 4 years, since these diseases only affect
late-life mortality
(37)
. Second, the increased life expectancy
at present originates mostly from the greatly diminished
influence of some unfavourable conditions of existence,
including (childhood) infections, famine, homicide and
tribal wars
(34,38)
secondary to the high levels of medical
sciences and continuing civilisation. Thus, to achieve the
average life expectancy of 40 years in a present-day
hunter–gatherer society, for every child that does not sur-
vive beyond 1 year of age, another should reach the age of
80 years. In fact, about 20 % of modern hunter – gatherers
reach at least the age of 60 years
(39 – 41)
. In other words,
the popular argument that very few individuals in these
societies live past 50 years
(35)
is unsupported by ethno-
graphic data. The third, often raised, argument is that
due to the higher life expectancy in present-day humans,
it is invalid to compare the mortality figures for cancer
and degenerative disease of present-day huntergatherers
(with low life expectancies) with those of Western popu-
lations (with a life expectancy of 80 years). However,
early biomarkers of degenerative diseases such as obesity,
high blood pressure, atherosclerosis and insulin resistance
are also less common in younger, age-matched, members
of present huntergatherer compared with members of
affluent societies
(9,42)
, while measurements indicative for
‘good health’ such as muscular strength and aerobic
power are more favourable in the former
(43)
. Moreover,
even the oldest individuals in huntergatherer societies
appear virtually free from chronic degenerative dis-
eases
(44 – 46)
. A fourth counterargument against the assump-
tion that our human ancestors before the Agricultural
Revolution died at a young age derives from archaeological
records. After the transition from hunting and gathering to
farming about 10 Kya, life expectancy dropped from about
40 years (as it is in recently studied hunter gatherers,
but also was among students of the Harvard College
Class born in 1880
(47)
) to about 20 years
(48 – 50)
. This see-
mingly evolutionary disadvantage, secondary to a decrease
in nutritional quality, is substantiated by a decrease in gen-
eral health that has become noticeable from a decrease
in final height, while skeletal markers of infection and
nutritional stress became more common in archaeological
finds
(49 – 52)
. These setbacks were eliminated by a net
increase in population growth, secondary to an increased
productivity per land area that resulted in more energy
intake per capita. Life expectancy remained stable through-
out the Neolithic until the late 18th century, seldom
exceeding 25 years in ‘civilised’ nations
(35)
. From this
time, improvements in hygiene, food production and
manufacturing, energy generation, per capita income,
shelter, transportation, clothing and energy intakes sub-
stantiated an increase to and beyond the life expectancy
that prevailed before the onset of the Agricultural Revo-
lution. Greater energy availability enhanced, for example,
the energy requirements of the immune system and for
R. S. Kuipers et al.98
Nutrition Research Reviews
reproduction, both improving longevity
(35,53)
. Importantly,
it was concluded that medical treatments had little impact
on mortality reduction, while public health achievements
(sanitation, food and water hygiene, quarantine and
immunisations) have critically improved life expectancy.
The fifth counterargument is that old people do provide
an evolutionary benefit to the younger generations.
Male fertility remains largely intact and male provisioning
might help in the problem of high female reproductive
costs, although the latter is contested
(54,55)
. The benefits
of older females have been put forward in the grand-
mother hypothesis. This hypothesis, in which the presence
of older females within a certain group benefits the
reproductive success of their offspring, is supported by
studies in human huntergatherer
(56 – 62)
and primate
societies
(56,60,63)
. Interestingly, the fitness benefits of
grandmothering proved insufficient to fully explain the
evolution of increased longevity
(62)
, suggesting that other
evolutionary benefits, such as grandfathering, might also
be involved in the long reproductive and non-reproduc-
tive lifespan of Homo sapiens. A recent analysis supports
such benefits for both older males and females, since
the presence of post-reproductive women increased the
numbers of newborns by 2·7 %, while 18·4 % of the infants
in a polygamous society in rural Africa were sired by
males aged 50 years and above
(64)
. In support of the state-
ment that ‘nothing in biology makes sense except in the
light of evolution’ we therefore conclude that, unless
proven otherwise, the presence of a substantial pro-
portion of older males and postmenopausal females in
hunter–gatherer, in contrast to primate societies, should
be considered as proof for the evolutionary benefit
that these individuals are to their progeny. Finally, we
propose that this assumption would only be convincible
if these individuals were reasonably fit, thereby support-
ing the concept of healthy ageing. Hence, healthy
ageing seems both supported by ethnographic data and
its benefit to huntergatherer societies. Other commonly
raised arguments against the genomeenvironment mis-
match hypothesis are the potential genetic changes since
the Agricultural Revolution, the heterogeneity of ancestral
environments and innate human adaptabilty
(35)
. Counter-
arguments to these critics have been discussed in great
detail elsewhere
(35)
.
In the present review, a multidisciplinary approach is
used, including palaeo-environmental reconstruction, com-
parative anatomy, biogeochemistry, archaeology, anthro-
pology, (patho)physiology and epidemiology, to assess
the characteristics of the ecosystem that supported
human evolution. Based on this assessment, an approxi-
mation is made of the dietary composition that derives
from this ecosystem. Finally, the potential benefit of a
return to this ‘Palaeolithic diet’ is discussed and an
update is provided for the evidence for the positive
health effects of these diets.
Human evolution
Hominins are defined as members of the taxon Hominini,
which comprises modern Homo sapiens and its extinct
relatives over the past about 7 million years. The oldest-
known hominins (Fig. 1) are Sahelanthropus tchadensis
from Chad (about 7 Mya
(65)
) and Orrorin tugenensis
from Kenya (about 65·7 Mya
(66)
). The next oldest are
Ardipithecus kadabba (Ethiopia, about 5·8 Mya
(67)
)and
A. ramidus (Ethiopia, about 4·4 Mya
(68)
), Australopithecus
anamensis (Kenya, about 4·1–3·9 Mya
(69)
), Au. afarensis
(Ethiopia, Tanzania and maybe Kenya, 3·6–3·0
Mya
(70,71)
), Au. bahrelghazali (Chad, about 3·5 Mya
(72)
),
Kenyanthropus platyops (Kenya, about 3·5 Mya
(73)
),
Au. garhi (Ethiopia, about 2·5 Mya
(74)
) and Au. africanus
(South Africa, about 2·9–2·0 Mya
(75)
). From these earliest
hominins evolved the genera Paranthropus (three known
subspecies) and Homo. The earliest species that have
been designated Homo are Homo rudolfensis,Homo
habilis and Homo erectus sensu lato including H. ergaster
(Eastern Africa, about 21.8 Mya): these in turn are the
presumed ancestors of Asian H. erectus,H. heidelbergensis
(Africa, Eurasia 0·6–0·3 Mya), H. neanderthalensis
(Eurasia, 0·4–0·03 Mya) and H. sapiens (from about 0·2
Mya onwards)
(76 – 78)
. The recently discovered H.floresien-
sis (0·095–0·013 Mya
(79)
) and the previously unknown
hominins from Denisova Cave (about 0·05– 0·03 Mya
(80)
)
show that in the recent past several different hominin
lines co-existed with modern humans.
Africa is now generally accepted as the ancestral home-
land of Homo sapiens
(77,81,82)
. In several subsequent out-
of-Africa waves
(83)
, hominins of the genus Homo colonised
Asia, Australia, Europe and finally the Americas (Fig. 2).
Archaic Homo species reached as far as the island of Flores
in South-East Asia, East China and Southern Europe
(Spain). Homo heidelbergensis remains were found in
Africa, Europe and Eastern Asia, while Homo neandertha-
lensis was restricted to Europe, Western Asia and the
Levant. At last, in the later out-of-Africa diaspora starting
about 100 Kya, Homo sapiens finally reached Australia and
the Americas, while probably replacing earlier hominins
in Africa, Europe and Asia that had left during the earlier
out-of-Africa waves. However, there remains some
debate
(82,84 – 86)
whether or not the gene pool of archaic
hominins contributed to that of modern humans. In the
replacement theory, archaic hominins make no contribution
to the gene pool of modern man, whereas in the hybridis-
ation theories (either through assimilation or gene flow),
newly arriving hominins from the later out-of-Africa wave
mixed with archaic predecessors. Current evidence from
DNA analyses supports the concept that the gene pool of
archaic hominins, notably Neanderthals
(87)
, but also Deniso-
vans
(80)
contributed to the gene pool of Homo sapiens.
The African cradle of humankind is supported by
micro-satellite studies
(88)
that reveal that within popu-
lations the genetic variation decreases in the following
Palaeolithic nutrition for disease prevention 99
Nutrition Research Reviews
7
6
5
4
3
2
1
0
7
6
5
4
3
2
1
0
Mya Mya
H. neanderthalensis
H. sapiens
H. heidelbergensis
H. floresiensis
H. erectus
H. mauritanicus/antecessor
H. habilis
Au. sediba
H. rudolfensis
Au. africanus Au. garhi
Au. afarensis
K. platyops
Au. anamensis
O. tugenensis
S. tchadensis
Ar. kadabba
Ar. ramidus
Au. bahrelghazali
P. aethiopicus
P. boisei
P. robustus
H. ergaster
Fig. 1. Scheme of the possible phylogenetic relationships within the family Hominidae. Note that at many time points of evolution, several different hominin species
coexisted. Mya, million years ago; H.,Homo;Au.,Australopithecus;K.,Kenyanthropus;P.,Paranthropus;Ar.,Ardipithecus;O.,Orrorin;S.,Sahelanthropus.q
Ian Tattersall, with permission
(76)
.
R. S. Kuipers et al.100
Nutrition Research Reviews
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    The current Western diet figures centrally in the pathogenesis of several chronic diseases such as obesity, type 2 diabetes, cardiovascular disease and the emerging major health problem nonalcoholic fatty liver disease, all of them negatively impacting on life expectancy. This type of diet is represented by a high calorie uptake, high glycemic load, high fat and meat intake, as well as increased consumption of fructose. On the contrary, a simplified way of eating healthily by excluding highly-processed foods, is presumed to be the Paleolithic diet (a diet based on vegetables, fruits, nuts, roots, meat, organ meats) which improves insulin resistance, ameliorates dyslipidemia, reduces hypertension and may reduce the risk of age-related diseases. The diet is the foundation of the treatment of obesity- and type 2 diabetes-related nonalcoholic fatty liver disease and a diet similar to those of pre-agricultural societies may be an effective option. To lend sufficient credence to this type of diet, well-designed studies are needed. © 2015, Romanian Journal of Gastroenterology. All rights reserved.
  • Chapter
    When a mother gives birth to a child naturally, in addition to life and love, she gives her baby a third gift which is often ignored: immunity. When the baby passes through the vaginal canal, it comes into contact with a series of “good” bacteria that offer it the first form of adaptation to the surrounding environment. Selected by the adaptive dynamics that are established between the mother and her ecological niche—her relationship with the environment, food, infectious agents and various allergens—they colonize the intestinal tract of the baby, who will inherit a strain of bacteria that are already well adapted to the environment where it will live. Made up of 100 trillion cells with a gene pool that is 100 times greater than the human one, this set of bacteria, known as the intestinal microbiome (the bacterial flora)—today considered like a real organ—has essential functions for human health, such as exploiting the energy of components that are difficult to assimilate, producing useful vitamins, keeping the immune system efficient and above all, competing with pathogenic bacteria and defending us from the aggression of microorganisms. Recent studies have shown that children who are born by caesarean section develop in the first years of life, and often later as well, some complications linked to the malfunctioning of their immune system, not only because they do not have the beneficial maternal “contagion” of useful bacteria but also because they can be damaged by infections due to the pathogenic bacteria present on the skin and in the hospital environment (Dominguez-Bello et al. 2010). In particular, babies born by caesarean section have a greater rate of asthma, allergic reactions, anaphylactic shock (atopic syndromes) and colitic disorders (Gronlund et al. 1999; Salminen et al. 2004; Negele et al. 2004; Debley et al. 2005; Biasucci et al. 2008; Neu and Rushing 2011).
  • Article
    De evolutionaire geneeskunde, ook wel darwinistische geneeskunde, maakt gebruik van kennis van de paleolithische omgeving, genetica, vergelijkende anatomie, bio-geochemie, archeologie, antropologie, (patho)fysiologie en epidemiologie. Het betreft een nog jonge discipline die ziekte en gezondheid tracht te verklaren vanuit onze evolutionaire achtergrond. Deze kennis is belangrijk voor de identificatie van factoren die een rol spelen in onze huidige ongezonde leefstijl. De discipline komt niet zelden in conflict met heersende wetenschappelijke paradigma’s. In de paleolithische tijd (2,5 miljoen tot 10.000 jaar geleden) is ons brein gegroeid van ongeveer 400 naar 1.300–1.400 mL. Deze groei kon slechts plaatsvinden in het land-water ecosysteem, waar overvloedige hoeveelheden ‘hersen-selectieve nutriënten’ samenkomen. Ze omvatten jodium, selenium, ijzer, vitamines A, D en B12, en de visolievetzuren EPA en DHA. Wereldwijd behoren hun tekorten momenteel tot de meest voorkomende deficiënties. Onze uniek grote verhouding tussen hersen- en totaal lichaamsgewicht heeft ons gevoelig gemaakt voor glucosetekorten. Deze dreigen vooral bij hongeren, zwangerschap en infectie. Hiertoe passen we ons energiemetabolisme aan, onder andere door het veroorzaken van insulineresistentie. Onze huidige ongezonde leefstijl wordt gekenmerkt door chronische stress, chronisch slaapgebrek, wanvoeding, onvoldoende fysieke activiteit, abnormale microbiële flora en milieuverontreiniging. Ze brengen ons in een chronische toestand van lage-graad inflammatie, hetgeen leidt tot metabole aanpassingen. Op lange termijn veroorzaken deze aanpassingen het metabool syndroom en de typische welvaartsziekten, zoals diabetes mellitus type 2, hart- en vaatziekten en bepaalde vormen van kanker. Terugkeer naar de paleolithische tijd met behoud van de cultuur van de 21e eeuw is de enige natuurlijke manier om gezond oud te worden.
  • Article
    Full-text available
    Acne vulgaris, an epidemic inflammatory skin disease of adolescence, is closely related to Western diet. Three major food classes that promote acne are: 1) hyperglycemic carbohydrates, 2) milk and dairy products, 3) saturated fats including trans-fats and deficient ω-3 polyunsaturated fatty acids (PUFAs). Diet-induced insulin/insulin-like growth factor (IGF-1)-signaling is superimposed on elevated IGF-1 levels during puberty, thereby unmasking the impact of aberrant nutrigenomics on sebaceous gland homeostasis. Western diet provides abundant branched-chain amino acids (BCAAs), glutamine, and palmitic acid. Insulin and IGF-1 suppress the activity of the metabolic transcription factor forkhead box O1 (FoxO1). Insulin, IGF-1, BCAAs, glutamine, and palmitate activate the nutrient-sensitive kinase mechanistic target of rapamycin complex 1 (mTORC1), the key regulator of anabolism and lipogenesis. FoxO1 is a negative coregulator of androgen receptor, peroxisome proliferator-activated receptor-γ (PPARγ), liver X receptor-α, and sterol response element binding protein-1c (SREBP-1c), crucial transcription factors of sebaceous lipogenesis. mTORC1 stimulates the expression of PPARγ and SREBP-1c, promoting sebum production. SREBP-1c upregulates stearoyl-CoA- and Δ6-desaturase, enhancing the proportion of monounsaturated fatty acids in sebum triglycerides. Diet-mediated aberrations in sebum quantity (hyperseborrhea) and composition (dysseborrhea) promote Propionibacterium acnes overgrowth and biofilm formation with overexpression of the virulence factor triglyceride lipase increasing follicular levels of free palmitate and oleate. Free palmitate functions as a "danger signal," stimulating toll-like receptor-2-mediated inflammasome activation with interleukin-1β release, Th17 differentiation, and interleukin-17-mediated keratinocyte proliferation. Oleate stimulates P. acnes adhesion, keratinocyte proliferation, and comedogenesis via interleukin-1α release. Thus, diet-induced metabolomic alterations promote the visible sebofollicular inflammasomopathy acne vulgaris. Nutrition therapy of acne has to increase FoxO1 and to attenuate mTORC1/SREBP-1c signaling. Patients should balance total calorie uptake and restrict refined carbohydrates, milk, dairy protein supplements, saturated fats, and trans-fats. A paleolithic-like diet enriched in vegetables and fish is recommended. Plant-derived mTORC1 inhibitors and ω-3-PUFAs are promising dietary supplements supporting nutrition therapy of acne vulgaris.
Literature Review
  • Article
    Vitamin D deficiency is now recognized as a pandemic. The major cause of vitamin D deficiency is the lack of appreciation that sun exposure in moderation is the major source of vitamin D for most humans. Very few foods naturally contain vitamin D, and foods that are fortified with vitamin D are often inadequate to satisfy either a child's or an adult's vitamin D requirement. Vitamin D deficiency causes rickets in children and will precipitate and exacerbate osteopenia, osteoporosis, and fractures in adults. Vitamin D deficiency has been associated with increased risk of common cancers, autoimmune diseases, hypertension, and infectious diseases. A circulating level of 25-hydroxyvitamin D of >75 nmol/L, or 30 ng/mL, is required to maximize vitamin D's beneficial effects for health. In the absence of adequate sun exposure, at least 800–1000 IU vitamin D3/d may be needed to achieve this in children and adults. Vitamin D2 may be equally effective for maintaining circulating concentrations of 25-hydroxyvitamin D when given in physiologic concentrations.
  • Book
    This volume 2 and its companion volume 1 present the results of new investigations into the geology, paleontology and paleoecology of the early hominin site of Laetoli in northern Tanzania. The site is one of the most important paleontological and paleoanthropological sites in Africa, worldrenowned for the discovery of fossils of the early hominin Australopithecus afarensis, as well as remarkable trails of its footprints. The first volume provides new evidence on the geology, geochronology, ecology, ecomorphology and taphonomy of the site. The second volume describes newly discovered fossil hominins from Laetoli, belonging to Australopithecus afarensis and Paranthropus aethiopicus, and presents detailed information on the systematics and paleobiology of the diverse associated fauna. Together, these contributions provide one of the most comprehensive accounts of a fossil hominin site, and they offer important new insights into the early stages of human evolution and its context.
  • Article
    Mann, G. V. (Vanderbilt Univ. School of Medicine, Nashville, Tenn. 37203), A. Spoerry, M. Gray, and D. Jarashow. Atherosclerosis in the Masai. Am J Epidemiol 95: 26–37, 1972.–The hearts and aortae of 50 Masai men were collected at autopsy. These pastoral people are exceptionally active and fit and they consume diets of milk and meat. The intake of animal fat exceeds that of American men. Measurements of the aorta showed extensive atherosclerosis with lipid infiltration and fibrous changes but very few complicated lesions. The coronary arteries showed intimal thickening by atherosclerosis which equaled that of old U.S. men. The Masai vessels enlarge with age to more than compensate for this disease. It is speculated that the Masai are protected from their atherosclerosis by physical fitness which causes their coronary vessels to be capacious.
  • Article
    Full-text available
    The extent to which women of reproductive age are able to convert the n-3 fatty acid alpha-linolenic acid (ALNA) to eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA) and docosahexaenoic acid (DHA) was investigated in vivo by measuring the concentrations of labelled fatty acids in plasma for 21 d following the ingestion of [U-13C]ALNA (700 mg). [13C]ALNA excursion was greatest in cholesteryl ester (CE) (224 (sem 70) micromol/l over 21 d) compared with triacylglycerol (9-fold), non-esterified fatty acids (37-fold) and phosphatidylcholine (PC, 7-fold). EPA excursion was similar in both PC (42 (sem 8) micromol/l) and CE (42 (sem 9) micromol/l) over 21 d. In contrast both [13C]DPA and [13C]DHA were detected predominately in PC (18 (sem 4) and 27 (sem 7) micromol/l over 21 d, respectively). Estimated net fractional ALNA inter-conversion was EPA 21 %, DPA 6 % and DHA 9 %. Approximately 22 % of administered [13C]ALNA was recovered as 13CO2 on breath over the first 24 h of the study. These results suggest differential partitioning of ALNA, EPA and DHA between plasma lipid classes, which may facilitate targeting of individual n-3 fatty acids to specific tissues. Comparison with previous studies suggests that women may possess a greater capacity for ALNA conversion than men. Such metabolic capacity may be important for meeting the demands of the fetus and neonate for DHA during pregnancy and lactation. Differences in DHA status between women both in the non-pregnant state and in pregnancy may reflect variations in metabolic capacity for DHA synthesis.
  • Conference Paper
    Animal source foods (ASF) have always been a constituent of human diets. Their pattern of use, however, changed in dramatic ways over the course of human evolution. Before 2 million years ago (mya), meat in particular was acquired opportunistically via hunting of small or young animals and scavenging of animals killed by other species. At some point after that time, humans began to hunt cooperatively, making possible the acquisition of meat from large game. The marked increase in human heights between 2.0 and 1.7 mya may be linked to more efficient means of acquiring meat, namely through hunting. The final pattern of meat (and other ASF) use before the modern era is associated with the shift from hunting and gathering beginning similar to10,000 y ago. This fundamental dietary change resulted in a narrowing of diet, reduced consumption of meat and increased focus on domesticated grains. The study of archaeological human remains from around the world reveals that this period in human dietary history saw a decline in health, including increased evidence of morbidity (poorer dental health, increased occlusal abnormalities, increased iron deficiency anemia, increased infection and bone loss). Human populations living in developing and developed settings today rely on meats with lipid compositions that when eaten in excess promote cardiovascular disease. As humans become more sedentary and eat more high fat foods, we can expect to see increases in heart disease, osteoporosis and other diseases of "civilization.".