Tuesday, March 30, 2010

Paleo Diet pH: Does It Matter, part VII

Some people appear to believe that Stefansson's 12 month trial of an all meat diet published in JAMA proved that an all meat diet provides adequate skeletal nutrition for prevention of osteoporosis.

According to the JAMA report on the all meat experiment, Stefansson consumed ends of bones supplying about 100mg calcium daily (less than by Inuit). The report on the experiment states:

"The increased amount of tartar on Stefansson's teeth and the lack of evidence of lowered blood calcium offers an interesting field for speculation. There was no decreased density in roentgenograms of the hands at the end of the experiment when compared with the hand of a man on a general diet."

Testing only the hands with X-ray does not tell us whether he lost vertebral or trochanter bone; and X-rays don't have the ability to detect the small amount of bone density lost in one year.

In fact, the National Institute of Arthritis, Musculoskeletal, and Skin Diseases (NIAMS) has this to say about X-ray tests for bone density:

"X-Ray Tests

If you have back pain, your doctor may order an x ray of your spine to determine whether you have had a fracture. An x ray also may be appropriate if you have experienced a loss of height or a change in posture. However, because an x ray can detect bone loss only after 30 percent of the skeleton has been depleted, the presence of osteoporosis may be missed."

So the test used to evaluate effects of an all meat diet on Stefansson's bone density would only have detected loss of bone if he had lost 30 percent of his bone mass. Simply put, at the time of the experiment, they did not have a technology capable of detecting smaller yet significant changes in his bone mass.

Further, they don't report before and after X-rays of Stefansson, they report comparing Stefansson's hands to those of a man "on a general diet." Which can't tell us whether the diet had any impact on Stefansson's bones.

The failure of Stefansson's blood calcium to decline is not surprising, since body can prevent drops in blood calcium by extracting calcium from the bones and tissues. Low calcium in blood causes PTH release, which extracts calcium from bone to raise blood calcium to normal levels. Thus, on a calcium deficient diet, blood calcium will not go below normal until bone stores of calcium have been exhausted.

Stefansson reportedly had increased dental tartar, which indicates increased salivary calcium and phosphorus. What makes this happen?

This study showed that administration of PTH increases calcium and phosphorus in saliva: http://www.ncbi.nlm.nih.gov/pubmed/404157

Thus, we can surmise that Stefansson probably had increased PTH, which was probably resorbing bone to maintain normal blood calcium, simultaneously raising the calcium content of his saliva, producing increase in tartar. The calcium and phosphorus should stay in bones, not be deposited on the outside of teeth.

I also want to note that Stefansson consumed organ meats that supply vitamin C (brains, liver, etc). To that extent Stefansson did replicate an Inuit diet. He in fact made it very clear that to live on an all-meat diet requires replicating the Inuit diet in several important respects, including eating far more fat than protein, eating organs, etc.

As an experiment, I ate an all meat diet for more than one month. I ate ends of bones, but not every day, and liver once weekly. Within a few weeks, I developed severe muscle cramps indicative of mineral (primarily potassium) deficiencies. When I added vegetables and fruits back to my diet, the cramps diminished. This tells me that an all meat diet does not adequately provide me with potassium, for which I have to eat plants.


Anonymous said...

Woah, your blog design is...different than before. Will it stay that way or what's up with that?

Don said...


Just trying it out...what do you think?

undertow said...

I think the new colors are a keeper.

Anonymous said...

Hi, undertow, you're here too? Nice!

@Don: Actually I like dthe old one way better. Super simplisctic and super nice. Whatever, if you wish, I could even do a little redesign for you^^. I just recently done a redesign for a blogger page and people were quite satisfied. ^^

Paul Bergner said...

Nice experiment. I am wondering the quality of meat that you ate on your experiment (I'm not advocating for all-meat). From data on Fitday it seems that meat from wild game has a much higher potassium-to-sodium ratio than modern farmed meats. In a selection here:
The average ratio for wild game was 5.8 and for farmed meats (with one outlier removed) was 1.43. The amounts are in only 1 pound of meat, and many groups ate more than that, and seem to have obtained high amounts of K and very low Na by modern standards.

I also wonder about getting adequate magnesium from an all-meat diet, and in my own and my patients diets on paleo-type plans, it is difficult to put together on paper a diet that has 500 mg of magnesium in it, and harder to actually consume one.

Don said...


When you consult fitday or USDA database, make sure you compare RAW meats. Most of the cooked meat figures include salt added in cooking. FitDay shows raw ground beef containing 4 times as much potassium as sodium. Conventional raw beef sirloin, 1 lb. has 2843mg K and 556mg Na, a 5:1 ratio. The 4-5:1 K:Na ratio is required in all mammals. I think you got mislead by using cooked for modern meat and raw for wild.

In my experiment I used a mix of grass-fed and market beef, adding no sodium. I have the same effect even when eating only grass-fed. I also find Mg commonly short when CHO severely restricted. Nuts can fill gap for some people.

Paul Bergner said...

Thanks for the tip on cooked vs raw. We need more data for sure, its fairly scarce on wild and grass fed.

John Paul said...

Dear Don,

I like to first thank you for sacrificing time and effort in creating this informative blog. I keep coming back to your blog to educate myself.

Your series on Eskimos and osteoporosis is of importance to me. You see I am thinking of adopting the Primal Diet by Aajonus Vonderplanitz. I start digging around criticisms against the eating lifestyle and the strongest attack on it is in regards with osteoporosis and Eskimos. I like to know what is your expert opinion on the Primal diet.

Speaking of all meat diet and osteoporosis, Don have you check out the Mongolian diet? The Mongolians is famous for being carnivorous but I do notice that they are heavy drinkers of milk. The milk I am referring to is Mare's milk which I think is a goat. The Mongolian diet I think for now has the potential to be an all meat diet without the osteoporosis drawback due to the fact they have access to milk hence calcium compare to the Eskimos. I am leaning towards adopting the Mongolian diet just because of the fact that their greatest example is none other than Genghis Khan. Genghis Khan and his army is considered to be the best in history and a lot of credit goes to their diet. I love to read history and every time I read about Genghis Khan, the Mongolian diet is always mention as one of their success secrets. I figure out that if it works for Genghis Khan then it can work for me.

Don said...

John Paul,

Mare's milk is from horses (female horse=mare).

The Mongolian diet including milk would make it similar to the Masai diet, which to my knowledge has no osteoporosis risk. However, I'm not sure how deeply physicians have studied the Masai.

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