Tuesday, August 23, 2011

My Ancestral Health Symposium Presentation


"Ancestral nutrition: An alternative approach" by Don Matesz, MA, MS from Ancestry on Vimeo.


You may need to attach speakers or earphones to your computer to hear the audio.

Due to time constraints, I was not able to go into details explaining how each of the items I pointed to as adaptations to a plant-based diet could prove maladaptive for a diet providing a major proportion of energy from meat or fat.   I will expand on one example here and leave the others for others to think through.

Humans as well as other primates have uric acid levels higher than other mammals due to knock-out of the uricase-coding gene at least 15 million years ago. [1] This appears to have occurred as an adaptation to several environmental factors including 1) high dietary vitamin C (which lowers uric acid),  2) low sodium intake, and 3) low dietary fat combined with high fructose intake. 

Elevated uric acid appears to have at least two adaptive functions in such a context:  1) It raises blood pressure in the face of very low sodium and very high potassium intake, and 2) it facilitates the conversion of fructose into fat for adipose storage when vitamin C intake declines (in autumn, when fruits contain more fructose and less vitamin C).

This human/primate feature has positive effects in the context of a diet low in sodium and dietary fat, but high in potassium and fructose. 

However, it is potentially maladaptive when dietary sodium, fructose, or meat increase, and dietary potassium and vitamin C decrease.

Meat typically has a K:Na ratio of ~5:1 or lower, whereas fruits (the presumed main foods of the common ancestor of humans and chimps) have so little sodium, that the ratio is 100:1 or more.   Therefore, simply switching from plant-based to meat-based, without any addition of granular salt, automatically results in a relatively high sodium intake, for an animal adapted to the reverse, a low sodium, high potassium diet.

In addition, meat provides purines, which feed into the production of uric acid.  Elevated serum uric acid can produce overt gout, but before it does that, it can promote general inflammation [2], and elevated uric acid has been linked to chronic heart failure and increased cardiovascular risk [3, 4], metabolic syndrome [5], and elevated blood pressure [6, 7].  It also appears that uric acid increases the storage of body fat [1]:

Specifically, uric acid causes mitochondrial dysfunction with specific effects to increase fat accumulation by both increasing fat synthesis and by blocking fat oxidation (Sánchez Lozada LG et al, manuscript in preparation). Indeed, acutely raising serum uric acid with a uricase inhibitor in rats will result in fat accumulation in the liver within 24 hours, and this is not observed if the rise in uric acid is prevented. Other studies have suggested effects of uric acid on blood pressure, insulin resistance, and adipocyte activation (28, 29). Indeed, Cheung et al recently reported that mice that cannot produce uric acid (XOR knockout mice) have a central defect in adipogenesis and fail to get fat (30).

Vitamin C reduces uric acid concentrations [8].  Therefore, low intake of vegetables and fruits rich in vitamin C, combined with high intake of meat and fat, may promote abnormal elevated uric acid levels and all of the disorders above.

Fructose also feeds the production of uric acid, and vitamin C blocks the undesirable effects of fructose (which explains why eating fruits has a different metabolic effect than eating refined sugars) [9].  In the ancient environment, when our ancestors had diets low in fat but high in fruit, the pathway that converts fructose to fat when vitamin C concentrations are low was adaptive.  In the fall, when wild fruits had an increase in fructose content and a decrease in vitamin C content, the liver converted a higher proportion of the fructose into fat to be stored as adipose, as a combination of insulation against colder weather and a supply of energy to draw on when food supplies declined through the winter.  In the modern environment with a high ratio of fructose to vitamin C, the same system is maladaptive, resulting in increased uric acid levels, body fat accumulation, inflammation, and metabolic syndrome.

So, human uric acid metabolism remains adapted to a diet with a high ratio of potassium to sodium, and a high ratio of vitamin C to fructose.  In the context of a high dietary ratio of animal protein and fat reducing vitamin C intake and the K:Na ratio and providing purines, this system will likely prove maladaptive for at least some individuals.  The imbalance can manifest in variety of ways: inflammation effects, metabolic changes, hypertension, increased cardiovascular disease risk, increased fat storage, gout, etc..

This then provides one example where the effect of meat consumption depends on the quantity and dietary context, as well as individual variation in uric acid metabolism.   The higher our ratio of meat and fat to vegetables and fruits, the lower our vitamin C intake and K:Na ratio, and the more purines we have feeding the production of uric acid.  Higher intakes of vegetables and fruits rich in vitamin C and potassium will tend to counter the effects of the purines and sodium, which will delay the appearance of symptoms and reduce their severity. 

If someone eats a diet containing a high proportion of animal protein but also includes a fairly large amount of vegetables and fruits, he or she may not see any adverse symptoms related to excess serum uric acid appear for a long period of time.  The context (high intake of fruits and vegetables) modifies the effect of the high meat intake.  Further, the body's ability to adapt to any stressor (e.g. excess serum uric acid) declines as exposure continues for a longer period of time.  The adverse effects creep in slowly, at a rate as noticable as hair growth, or become more noticable after she or he reduces produce intake, or some other factor (e.g. stress) reduces the body's ability to deal with the excessive uric acid, or, simply, the body's ability to deal with the excess uric acid declines due to long exposure to the overload.  As things change, the person naturally gravitates toward non-nutritive ingestive behaviors that tend to reduce the symptoms. 

For example, she has a premenstrual headache.  She doesn't immediately think, "Oh, this is due to the long accumulation of congesting effects of my diet."  Instead, she takes a nap, or an aspirin, gets relief, and goes on her way.  If another person notices a little extra inflammation in a chronic skin condition that naturally fluctuates anyway, he doesn't immediately think that his food caused this, instead he puts some soothing balm on it, or takes an anti-inflammatory, which reduces the discomfort enough that he loses interest in exploring it further.  The use of non-nutritive ingestive behaviors is evolved and hence the natural approach to discomfort:  We "take something for it"  because our species evolved to use non-nutritive ingestion as an integral part of dietary adaptation.  People start looking deeper only when the non-nutritive ingestive behaviors no longer control the discomfort adequately.  So small things so gradually turn into large things that we often don't figure things out until they have gotten very persistent and distracting of our attention.


15 comments:

Ezer said...

Very nice post.

So, do you think that, if I eat a plant-based diet, high in folate (to address homocysteine produced from methionine) and high in vitamin C (to address uric acid produced from purines), I can avoid problems from a moderate to high intake of meat?

Do you see any problems with moderate to high intake of saturated fat in the context of a diet containing plenty of vitamin C?

Anand Srivastava said...

I understand how the Vitamin C to Fructose ratio works. In this case Vitamin C can be discarded but the ability of the body to convert fructose is limited. So if you consume too much fructose without enough Vitamin C there is going to be a problem. It would make sense to supplement Vitamin C ala Linus Pauling.

But how does it work for Potassium and Sodium, both can be discarded by the kidney. So the body can maintain a proper level, without any reference to the actual intake. Having too little of either can be a problem. And changing the consumption pattern can create a short term problem. So I can see where not eating enough vegetables can be a problem, but how can eating lots of salt be a problem, unless there is a kidney issue involved.

I think the real problem is too much fructose consumption and not enough vegetable consumption. This will exacerbate for susceptible people.

Anand Srivastava said...

I understand how the Vitamin C to Fructose ratio works. In this case Vitamin C can be discarded but the ability of the body to convert fructose is limited. So if you consume too much fructose without enough Vitamin C there is going to be a problem. It would make sense to supplement Vitamin C ala Linus Pauling.

But how does it work for Potassium and Sodium, both can be discarded by the kidney. So the body can maintain a proper level, without any reference to the actual intake. Having too little of either can be a problem. And changing the consumption pattern can create a short term problem. So I can see where not eating enough vegetables can be a problem, but how can eating lots of salt be a problem, unless there is a kidney issue involved.

I think the real problem is too much fructose consumption and not enough vegetable consumption. This will exacerbate for susceptible people.

Scartaris said...

I'm very fascinated with this new path that you've found yourself on.

Don how do you feel since you've switched from a high meat paleo type diet to one that your on now?

What other positive changes have you noticed?

David said...

Hey, really interesting ideas, and very brave to go against the grain in the paleo community!

From time to time you mention skin conditions. Do you have any idea about the influence of diet on acne and hair loss (male pattern baldness). And what does chinese medicine says about this?

greetings!

Matt said...

Don, what do you think of Dr. Richard Johnson's work? He goes into great depth on uric acid and fructose. Here is a lecture he gave recently. http://www.youtube.com/watch?v=OOJ3SiRj4AQ

malpaz said...

i learned a lot from this. It makes sense to me now and i 'get' the balance thing :)

Invisible Jungle said...

It may be true that the kidneys can remove excess sodium, but it's also possible that excess sodium can have deleterious effects in the interim, before it's excreted.

A similar example could be excess B-vitamins. The B-vitamins are water-soluble, so many people say that there's no danger in taking large amounts. "The body will simply excrete what isn't used." However, if one were to ingest 10 pounds of Vitamin B12, it would likely have some harmful effects before eventually being released from the body.

Sanjeev said...

I enjoyed that, Don ... thanks.

Is blood uric acid known to be causative of fat deposition or is high UA a side effect of some kind?

Next time I see my MD I'm going to ask to see my records from when I was obese but I believe he told me at my last visit that my UA is considerably higher now (170 pounds, ~15% bodyfat, diet's high starch and high to moderate protein and getting quite low in fat) than when I was obese on high fat.

Don said...

Ezer,

I think that you have the right idea regarding the balancing of produce and meat...but everyone is individual so you have to stay alert to changes and correct from there.

Saturated fat is a different issue, to my knowledge vitamin C doesn't influence metabolism of dietary fat. But other components of plants do influence how saturated fat affects us. For example, vegetables provide salacin, which has an anticoagulant activity, whereas saturated fat appears to have a pro-coagulant activity.

Don said...

Anand,

The human kidney avidly retains sodium, but avidly excretes potassium. So, as K intake declines and Na intake increases, we tend to accumulate Na in the body, which may elevate blood pressure, and a growing body of evidence indicates that excess body sodium may affect many cellular functions, creating metabolic disorders and possibly promoting problems like dementia, cancer, and others.

Don said...

Scartaris,

Basically, I find myself tending to a diet high in vegetables (including sweet potatoes and potatoes) and fruits, and relatively large amounts of nuts (up to a cup or so daily), still containing meat, fish, poultry, or eggs, about 70% of energy from plants, 30% from animal, but this varies and I try to follow my inner guidance, so it may change from time to time. Most of my fats now come from whole nuts, avocadoes, and olives, small amounts of olive oil, and whatever naturally occurs in lean meats and eggs, no more added animal fats.

I have reduced inflammation, I feel a little calmer/less driven, I have much more frequent bowel elimination. Over the last few months Tracy lost ~10 pounds, has more regular bowel movements, and no longer has pre-menstrual breast tenderness. We'll see what else happens. We know that we change from day to day and these changes may make it necessary to change diet to adapt. We don't know that we have come to a 'conclusion' because we're realizing how climate, activity, and many other factors influence our day to day needs.

Don said...

David,

Acne: This is uncommon in both primitive cultures, both those eating apparently meat-based (e.g. ) and starch-based (e.g. Kitavans) so I don't think low-carb/high protein is required.

In Chinese medicine, acne diagnosis is a little complicated. Cases vary. I have a little about it on my website:http://www.barefoot-acupuncture.com/acne.html

Male-pattern baldness: This is very interesting. There is some evidence that high calorie, high fat diets low in plant products promote this condition. For example, in Japan, it was rare before westernization, but now is more common. Plants contain compounds that modify the metabolism of testosterone, reducing its conversion to DHT, the promoter of male hair loss.

Since acne clearly responds to herbal medicines, and it rarely occurs in H-Gs or horticulturalists, I think it might be one of those conditions that happens because our body is adapted to intake of some 'draining' plant chemicals, so when we aren't eating them, we get excess inflammation, immune activity, and hyperproliferation of skin. This may also apply to male pattern baldness, since, like acne, it involves excess levels of DHT.

Don said...

Sanjeev,

From the post, part of one of the quotes:

"uric acid causes mitochondrial dysfunction with specific effects to increase fat accumulation by both increasing fat synthesis and by blocking fat oxidation"

It appears causal, since blocking the rise in UA blocks the fat formation.

Matt,

Thanks for that link. I'm not sure when I'll have a chance to watch it. Fructose certainly feeds uric acid production if not countered by adequate vitamin C, and there are other plant compounds that also counter it.

For example, cherries and other fruits and vegetables contain anti-inflammatory anthocyanins, and clinical studies show that eating about 20 cherries daily may reduce gout flares by 50%.

http://arthritis.webmd.com/news/20101110/cherries-may-cut-risk-of-gout-flare-ups

This provides another example of how quality and context affects outcome. Cherries contain fructose, but also vitamin C and anthocyanins. They reduce the risk of inflammation from eating excess purines. We have to keep in mind that fruit is not just fructose, it also contains 100s of other compounds not found in refined sugar.

mkedst said...

Hi Don,

I like the idea you mentioned in the presentation about eating fats as they naturally occur in foods, as opposed to adding separate fats, like oils.

Thanks,
Mark