The Great Diet Smackdown (Part I)

It's time for a little, good ol' fashioned nutritional cage fighting.  May the best diet win.

There are three basic contenders in the nutritional olympics and, no, it ain't the high fat, high sugar diet that your Momma taught you.  It's between these three titans:

1)  The Paleolithic Diet (high protein, high fat, low carb with an emphasis on meats, vegetables and saturated fat and a complete rejection of grains)

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2) The Mediterranean Diet (low protein - except fish, high monounsaturated fats and medium carb with an emphasis on legumes/grains, red wine, olive oil, veges and fruit and a deemphasis of meat and saturated fat)

3) The Ornish Diet (low protein - except egg whites, low fat, high carbs with an emphasis on plant based foods and grains and a complete rejection of saturated fats, meats and fish)

For some of you this religious.  I can only ask that you lay down your weapons for a second and look at the summary of evidence below.  I will go through these one by one and examine them for how they stack up with handling mortality, cancer, hormones, erectile dysfunction and other concerns of us guys:

I. The Paleolithic Diet

This is the new kid on the block and is enormounsly popular with the American public at large. A trip to the neighborhood book store will show books promoting the Paleolithic Diet outnumbering other nutritional books ten to one.  And, in sales, I would guess the difference is even more pronounced. 

The arguments for the Paleolithic Diet are largely based on the "hunter-gatherer" concept.  The idea is that man, since he walked out of the jungles, hunted and - you guessed it - gathered.  In fact, they argue, this is how he flourished.  A corollary of this theory is that Grains are Evil.  Grains, paleo-enthusiasts assert correctly, are a recent development for mankind and a scourge having created the modern epidemics of Metabolic Syndrome and even tooth decay.  For those wishing a good dose of Paleolithic apologetics, simply do a search on the Westin A. Price Foundation or Anthony Colpo.

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So, since this is the most popular diet in American, can we assume that the Paleolithic Diet is backed by an abundance of studies showing its clear superiority?  Actually, quite the opposite is true.  Surprisingly, there are no studies showing improvements in mortality, cancer, heart disease or erectile dysfunction for those following a Paleolithic Diet.  This is even more perplexing when one considers that basic nutritional profiles have been studied for decades and no evidence has surfaced that the diet of a hunter-gatherer leads to superior longevity or long term health.  Furthermore, it should immediately be a red flag that there are no researchers pushing the Paleolithic Diet.  Let's face it:  Americans love meat and cheese and eggs and there's always someone to tell you what you want to hear, eh?

What is interesting is that if you read the writings of the Pro-Paleolithic writers, you will find that they seem to be arguing not that their diet is better, but rather that it is just as good.  So where do they get the idea that the Paleo Diet is THE diet??

Well, their primary line of evidence, as far as I can figure out, is that a few cultures, including the Masai, the Pukapuka and the Tokelua, eat huge amounts of saturated fat and have virtually no heart disease. Now that is an amazing fact and seems to challenge many nutritional theories to their very foundations.  After all, if saturated fat is such a Great Satan, then why do these cultures actuallly enjoy some of the best cardiovascular health in the world? 

The answer is simple: if you live like the Masai, you will undoubtedly enjoy incredible cardiovascular health just as they do.  But that's the problem:  it is virtually impossible for a modern urban dweller to live like the Masai.  The Masai are, as you may remember, the very tall African tribe that follows their cattle and drinking its very blood for a quick pick-me-up snack.  In fact, cattle literally supply almost all their food needs:  they also drink its raw milk and eat its raw meat.  Again, I emphasize the "raw" in the above sentence:  that is a key to Prostate Health for the omnivore.

What modern urban dweller has access to range-fed beef that is cooked with low or no heat?  The minute that the modern meat-loving male cooks his beef at any kind of heat, his risk of prostate cancer goes up - that's especially true of beef by the way.  And modern grain fed beef is notoriously low on omega-3 fatty acids putting him further at risk for inflammation.  

Furthermore, this link on the Masai shows that they are incredibly active and have an average BMI of 20.7!  Obesity is correspondingly uncommon.  In addition, their blood pressure is excellent:  an average of 119/71.  And no wonder:  they follow their cattle on foot through various grazing areas and are extremely athletic and fit.   George Mann, a researcher in the 1960's, actually studied the cadavers of hundreds of Masai and found that they actually had as bad or worse arteriosclerosis than the typical Westerner. [1]  His conclusion was:  "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."

So George Mann discovered that the key to Masai cardiovascular health was essentially the "Training Effect", i.e. their arteries were larger (from exercise) and thus could handle a worse arteriosclerosis. In other words, this simply potentially may show little more than their active lifestyle protected them from the ravages of the Paleolithic Diet.  Remember also that saturated fat temporarily hardens the arteries and that researchers have found that one of the cures for this is exercise as I cover in this link.  Again, a vigorous, athletic outdoor life may have saved them from their diet for all we know.

So, if you are going to exercise intensely, keep your body weight extremely low and eat only slow-cooked beef that is range fed, you will probably be okay on the Paleolithic Diet.  But what modern city-dweller can do all of those things?

One more important point that is missed (or ignored) by proponents of the Paleolithic Diet:  the Masai have very low cholesterol.  Their total cholesterol is an impressive 152!  Contrast this with the typical American who has high blood pressure and total cholesterol in the 180-250 range. Again, this is a critical observation:  heart disease is very rare in socities or individuals with cholesterol of 150 or below. George Mann noted that the Masai had relatively few arterial lesions and this was due undoubtedly to their superb lipid profiles.  Remember that this will also be good for your sex life:  control heart disease and you will have greatly improved erectile dysfunction.  A happy heart is a happy penis!

Paleolithic Diet propenents will point out that mortality studies sometimes show that low cholesterol is associated with increased death rates.  They jump all over this and claim that low total cholesterol is therefore actually unhealthy.  Please don't fall for this:  study after study has shown that if one has low total cholesterol through much of his life, cardiovascular disease is almost non-existant.  The probable reason that the mortality studies show increased mortality with low cholesterol is because low and lowering cholesterol is a sign of many severe illnesses.  In other words, many individuals in our Western culture start out with medium or medium high levels of cholesterol that slowly fall into the low range due to various life threatening illnesses.  But this a completely different situation from rural third world Chinese peasants, for example, who have low total cholesterol and virtually no heart disease.

Again, study after study  has shown this.  One study [2] found that people with low cholesterol from prior to age 50 enjoyed improved mortality contrasted with those that had falling cholesterol levels after the age of 50. The researchers stated it this way:  "Under age 50 years these data suggest that having a very low cholesterol level improves longevity. After age 50 years the association of mortality with cholesterol values is confounded by people whose cholesterol levels are falling--perhaps due to diseases predisposing to death". [2] A 2003 study came to the same conclusion:  "The authors conclude that low levels of cholesterol may be potential warning signs of occult disease or rapidly declining health". [3] Other researchers actually identified the diseases for which falling cholesterol in the elderly is such a mortality risk:  "The key finding of this report is that spontaneously falling TC [Total Cholesterol] levels were associated with increased risk of nonmalignant liver disease, total cancer, and most noticeably, cancers of the esophagus, prostate, and hemopoietic systems. By contrast, after confounders were controlled for, a stable low TC level was not associated with significantly increased mortality risk, although some marginal risk existed owing to an association of very low TC with fatal hemorrhagic stroke." [4]

An examination of the Framington Health Study showed that individuals with total cholesterol less than 150 had very low rates of heart disease. [5]  Furthermore, rural residents of the third world typically have total cholesterol levels below 150, and they do not develop coronary artery disease.  Again, the Paleolithic apologists conveniently ignore the fact that in areas of the world where a plant-based diet of grains and fruit are eaten, there is almost no heart disease. Isn't it ironic that, because of their extreme poverty, these people completely avoid the #1 killer of our affluent societies so laden with techology?  We spend billions upon billions each year on bypasses, stints and angioplasties when the answer is sitting right before us on the other side of ocean.

So, again, think of the hypocrisy of the Paleolithic position.  Their argument is that cholesterol does not matter and yet their Paleolithic Posterchild, the Masai, is an example of extremely low cholesterol. Nor can they use cultures such as the Tokelua or Pukapuka because these cultures do not fit the traditional hunter gatherer stereotype.  Both the Tokeluans and Pukapukans regularly eat fish, a very heart healthy food. (The same can be said of the Eskimos by the way). 

Again, the modern urban dweller cannot afford this form of the Paleolithic Diet either:  eating fish every day would saturate his tissues with mercury and PCB's.  The Paleolithic Diet is an unrealistic ideal for all of us sitting here staring into a computer screen.  And the Paleo Pundits are not going to tell you this.  Instead, they make it sound as if it is okay to eat large quantities of modern beef, chicken, turkey, pork, eggs and fish and all will be well if you're just low carb. 

So how has the Atkins Diet, another name for the Paleolithic Diet, done in recent research?  The results show that the Paleolithic Diet is only good for a) people who eat almost no carbs to lose weight [7] and b) people with diabetes or the Metabolic Syndrome. [8] However, for all others simply maintainng their weight with a Paleolithic Diet, the results are not looking good at all:  one recent study in the prestigious journal Circulation showed increased bodily inflammation and LDL levels. [9] 

And that same study [9] found something else the Paleolithic Diet proponents are not likely to tell you:   "reduced endothelial vasoreactivity".  That means they found the same old curse of saturated fat:  it temporarily "hardens" your arteries.  Yes, that means less blood flow and, yes, that will limpify your erections.

Now contrast all of that with our old friend, the Mediterranean Diet, which is a proven cancer, heart disease and erectile dysfunction fighter and which is low on saturated fat and meat.  There is no equivalent body of research from the Paleoliths. 

Our advice:  stick with the pro-testosterone Mediterranean Diet. Your heart will thank you.  Your penis will thank you.  And maybe even the Little Woman will thank you...

SMACKDOWN RESULTS:

Mediterranean Diet:  1,   Paleolithic Diet:  0

REFERENCES:

1) Am J Epidemiol,1972,95:26–37fact that individ2) JAMA,1987 Apr 24,257(16):2176-80

3) J Am Geriatr Soc,Jul 2003,51:991-6

4) Circulation,1995,92:2396-2403

5) Amer J of Cardiology,2001,88(4A):16F-20F

6) Clin Biochem,2004 Sep,37(9):830

7) J Nutr,Jun 2005,135:1339-1342

8) Nutr Metab (Lond),Nov 16 2005,2:31

9) Circulation,2007;116:II_819