Food: Fiction, Facts and Fads Current Concepts in Sports Medicine Grant Morrison MD May 5, 2018 Disclosure • No relevant relationships to disclose. Objectives • Investigate origins for fad or novel diets • Improve comprehension of popular fad/novel diet knowledge

FOOD • SPORTS MEDICINE? • YOU ARE EATING WHAT??? • WHY?

• “The single most important decision you make about your health every day is what you eat” • Dr. Michael Greger, MD FAD DIETS – WHY? PALEO • Sarah Ballantyne, “The Paleo Approach” – a paleo diet consists of “meats, fish, eggs, , , nuts, and seeds.” • John Durant, “The Paleo Manifesto” – even seeds are suspect and should be avoided.

• (A genuinely Paleolithic diet, Durant concedes, probably ought to include human flesh; however, he does not advise this.) AGRICULTURE NEW • 10,000 years ago – wheat in Turkey • 9000 years ago – maize in Mexico • “The adoption of agriculture, supposedly our most decisive step toward a better life, was in many ways a catastrophe from which we have never recovered” – Jared Diamond: “The Worst Mistake in the History of the Human Race.” – Loss of height, loss of teeth • Daniel E. Lieberman: “farming ushered in an era of epidemics, including tuberculosis, leprosy, syphilis, plague, smallpox and influenza.”

PALEO CONTROVERSY • On the timescale of evolutionary history, it’s agriculture that’s the fad. • our chronic diseases stem from a disconnect between what our bodies evolved eating during the Stone Age during the last two million years, and what we’re eating today, – a hunter-gatherer type diet – AVOID REFINED CARBOHYDRATES, PROCESSED FOODS

• Durant blames “the vegetarian lobby.”

WHAT IS PALEO? DIET EVOLUTION? • Which “prehistoric past”? – 95% of evolution involved eating plants • Stone age = 2.5 million years, evolving over 25 million years

• EVOLUTION? – Most didn’t survive into old age; they didn’t live long enough to get heart attacks. EVOLVED TO EAT WHAT, WHEN? • EX: ATHEROSCLEROSIS • True carnivores never develop atherosclerosis – Dogs fed meat, + 100g cholesterol, + 120g • Rabbits (herbivores) fed cholesterol – Atherosclerosis in 2 months of a 2g cholesterol diet • For most of human evolution, cholesterol may have been virtually absent from the diet. • our body needs a certain amount of cholesterol, so our bodies didn’t just evolve to make cholesterol, but to preserve it, recycle it. • Our bodies evolved to hold onto cholesterol. – Far exceeds the bacon double cheeseburger era – Average Paleolithic life expectancy: 25 years • Old enough to reproduce • No need to avoid chronic disease

PALEO RESEARCH • Aborigine study – K O'Dea. Marked improvement in carbohydrate and lipid metabolism in diabetic Australian aborigines after temporary reversion to traditional lifestyle. Diabetes. 1984 Jun;33(6):596-603. – Dropped off in the outback, left to find their way back – Improved metabolic parameters – STARVING – Diet improved from refined carbs, soda, candy, beer, milk, cheap meat

PALEO PIG STUDY • 15 months • Less weight gain • Paleo group fed 20% fewer calories. • Improvement in insulin sensitivity in pigs – not reproduced in people – Benefits: improved glucose tolerance – Paleo group ate less dairy, , oil, and , and more and nuts, with no significant change in meat consumption. • Follow-up study also failed to find improved glucose tolerance over control, – Did show other risk factor benefits – Cutting out dairy and doughnuts, oil, sugar, candy, soda, beer, and salt POPULATION STUDIES • To, we don’t have to go back a million years. • Networks of missionary hospitals in rural Africa in the 20th century, – A population nearly free of chronic disease in old age – coronary artery disease virtually absent also but high blood pressure, stroke, diabetes, common cancers, and on down the list – a diet almost exclusively of foods

REVERSAL OF CHRONIC DISEASE • Research of Pritikin, Ornish, and Esselstyn • Plant-based diets can not only stop heart disease, but have been proven to reverse it in the majority of patients. • Perhaps because that’s what we ate through the vast majority of our evolution.

There's Probably Poop in Your Ground Beef 1/4/18, 7(55 PM

Published on Women's Health (https://www.womenshealthmag.com)

Home > There's Probably Poop in Your Ground Beef

PALEO CONCLUSIONS • Contaminants: – Meat Science, a review was published cataloging the laundry list: arsenic, mercury, lead, cadmium, polycyclic aromatic hydrocarbons, preservatives, and veterinary drugs, like the antibiotic residues. – Fish: “it would be impossible to follow the Paleolithic diet while avoiding the risks associated with consuming mercury in amounts in excess of the suggested EPA threshold.” • Paleo diet may be right about: – Restricting refined and processed “food” – but as an excuse to eat just loads of meat that bears little resemblance to the flesh of prehistoric wild animals (or the actual Stone Age diet). • TAshere’ s yet,nothing likeno bitin gdetectable into a big, juicy burger—u justificationnless you’re getting your beef that [1] with a siourde of na stbodiesy bacteria. evolved in such In a recent study by Consumer Reports [2], researchers analyzed 458 pounds of beef and found that all of it (yep, all of it) “contained baact wayeria that si asgnifie dto feca l beconta mibetternation.” Vom . able to deal with extra meat Nearly 20 percent of the beef also contained the bacteria C. perfringens, which causes food poisoning. And one percent was contaminated with– salmoEvolutionnella [3], a mislead ifavorsngly low-sou ntheding n uprimatember when you norm.consider the “billions of pounds of ground beef we eat every year,” researchers said.

So here’s the rub: You’re most at risk if you’re the type to order a burger undercooked (rare or medium-rare). That means the beef was cooked to temps less than 160 F, which is not hot enough to kill foodborne pathogens. “Up to 28 percent of Americans eat ground beef that’s raw or undercooked,” says Hannah Gould, Ph.D., an epidemiologist at the Centers for Disease Control and Prevention (CDC), in Consumer Reports.

RELATED: Going Veggie? 9 Ways to Ditch Your Burger Cravings for Good [4]

So why can you order a steak medium-rare and be fine? “Think of bacteria like pepper,” says Jonathan Campbell [5], Ph.D., meat extension specialist and assistant professor in animal science at Penn State University. “If you pepper the outside of a steak and sear it on the grill, you’ll kill the bacteria. If you grind that meat, you’ll mix the pepper throughout all of the meat,” he says. In other words, bacteria hang in all the nooks and crannies of your burger. Yum.

There are 48 million cases of foodborne illness annually, reports Foodsafety.gov [6]. While anyone can get food poisoning, certain groups (like pregnant ladies and older folks) are especially vulnerable, and are at risk for severe illness or hospitalization, according to the CDC [7]. If you’re healthy, eating an undercooked burger might not kill you, but it could leave you clutching the toilet for a couple days.

https://www.womenshealthmag.com/print/food/whats- in- ground- beef Page 1 of 3 Low inflammatory diets

Grain Brain

– David Perlmutter, MD, • Inflammation is source of neurology most chronic disease today – “Modern are silently destroying your brain,” he • “total elimination” of gluten to writes. “Basically, I am calling neurologic symptoms is what is arguably our most “amazing” beloved dietary staple a terrorist group.” • supplements and “detoxification” regimens — available for purchase on his various websites — are crucial to optimizing brain health

GRAIN BRAIN?

Brainmaker.com (2009) “Glutathione miracle” • “Meat and eggs are rich • “Incredible effectiveness for inflammation producing Parkinsons” fatty acids [sic]. It is this inflammation that leads to • But “We did not observe a the enhanced production of significant improvement in brain damaging free parkinsonian signs and radicals. The best diet is symptoms in the vegetarian with added fish.” glutathione group when compared with the placebo group.” “PLANT PARADOX”

LECTIN DANGER!

• Tomatoes, beans, whole grains • First lectin – RICIN – “a potent homicidal poison”

BLUE ZONES

• PLANT BASED DIET • EATING

THERE’S HOPE!

LECTIN BLOCKERS GUNDRYMD.COM

DIET Read more: http://stylecaster.com/beauty/what-are- nightshades/#ixzz5EOHR0sus

TB12 • should avoid sugary foods and other processed carbohydrates. • AVOID nightshade family, including tomatoes, strawberries, eggplants and potatoes, • nightshades, sometimes referred to as solanaceae, include tomatoes, • focus on foods high in alkalinity — bell peppers, paprika, cayenne such as artichokes, dandelion pepper, potatoes, eggplant, and also greens and escarole tobacco • cut back on foods that supposedly • Nightshades also contain lectins raise acid levels in our blood, like beef, salmon, butter and cheese. • “Lectins are not digested by the body and many say cause leaky gut, • Alex Guerrero, his close friend, or gaps in the lining of the gut business partner and “body coach.” increasing permeability and over time leading to food allergies and autoimmune diseases,” – sports nutritionist Marie Spano.

COULD THE BEST “DIET” BE…

NOT EATING? 2 PRIMARY FASTING CONCEPTS • METABOLIC: Tricking our bodies into believing we are in a famine mode, therefore, the body burns energy from stored fat in the body. • REGENERATIVE: Improved blood sugar levels, decreased risk of heart disease and cancer, – ward off neurogenerative diseases like Alzheimer's and Parkinson's FASTING MIMICKING DIET Valter Longo, PhD • a five-day program in which total caloric intake is limited to between 770 and 1,100 Director, USC calories per day. Longevity Institute • cells must consume all existing glycogen “IGF-1 is like an stores and begin consuming ketones accelerator that stored in fat, after the readily available promoted excess glucose has been depleted. activity of cells, even • After three to five days of ketosis, return when they don’t need to a normal range of calories again and the to be hyperactive. cells receive glucose to build back up Cellular hyperactivity is associated with • Key metabolic factors: decrease in IGF-1, oxidative stress and decrease in insulin, decrease in glucose, DNA damage.” increase in ketone bodies and IGFBP1

FASTING MIMICKING DIET

• 100 generally healthy participants from the United States randomized into two study groups to test the effects of a fasting- mimicking diet (FMD)—low in calories, sugars, and protein but high in unsaturated fats.

• subjects who followed 3 months of an unrestricted diet to subjects who consumed the FMD for 5 consecutive days per month for 3 months.

• Three FMD cycles reduced body weight, trunk, and total body fat; lowered blood pressure; and decreased insulin-like growth factor 1 (IGF-1). – No serious adverse effects were reported. – After 3 months, control diet subjects were crossed over to the FMD program, resulting in a total of 71 subjects completing three FMD cycles. – Both FMD arms showed that body mass index, blood pressure, fasting glucose, IGF-1, triglycerides, total and low-density lipoprotein cholesterol, and C-reactive protein were more beneficially affected in participants at risk for disease than in subjects who were not at risk 5:2 DIET Michelle Hervie, • calorie-restricted, low-carbohydrate diet for two consecutive days each PhD week. Research Dietitian, • Geared toward weight loss Nightingale Centre, University Hospital • Possible connection between weight South Manchester loss and chemotherapy, – calorie-restricted diet may be better Trust protected from the treatments’ toxic side “intermittent energy effects. restriction” or • Does not recommend the diet for “intermittent healthy people (because there isn’t fasting” data to support that recommendation). 5:2 Intermittent energy restricion • Randomized comparison of a 25% energy restriction as IER (~2266 kJ/day for 2 days/week) or CER (~6276 kJ/day for 7 days/week) in 107 overweight or obese premenopausal women over 6 months. • IER and CER are equally effective for weight loss • weight change for IER was −6.4 (−7.9 to −4.8) kg vs.−5.6 (−6.9 to −4.4) kg for CER • Both groups experienced comparable reductions in leptin, free androgen index, high sensitivity C-reactive protein, total and LDL cholesterol, triglycerides, blood pressure and increases in sex hormone binding globulin, IGF binding proteins 1 and 2. • Reductions in fasting insulin and insulin resistance were modest in both groups, but greater with IER than CER ALCOHOL