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Paleolithicdiet
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This article is about a modern nutritional approach. For information on the dietary practices of Paleolithic humans, see Paleolithic#Diet and nutrition. Themoderndietaryregimenknownasthe Paleolithic diet(abbreviatedpaleo dietor paleodiet),alsopopularlyreferredtoasthe caveman diet,Stone Age dietandhuntergatherer diet,isanutritionalplanbasedonthe presumedancientdietofwildplantsandanimals thatvarioushumanspecieshabituallyconsumed duringthePaleolithiceraaperiodofabout 2.5millionyearsdurationthatendedaround 10,000yearsagowiththedevelopmentof agriculture.Incommonusage,suchtermsasthe "Paleolithicdiet"alsorefertotheactualancestral Paleolithic-styledish:Seafoodstew [1][2]Centeredoncommonlyavailable humandiet. modernfoods,the"contemporary"Paleolithicdiet consistsmainlyofgrass-fedpastureraisedmeats,fish,vegetables,fruit,roots,andnuts,andexcludes grains,legumes,dairyproducts,salt,refinedsugar,andprocessedoils. [1][3][4] Firstpopularizedinthemid1970sbygastroenterologistWalterL.Voegtlin, [5][6]thisnutritionalconcepthas beenpromotedandadaptedbyanumberofauthorsandresearchersinseveralbooksandacademic
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Espaol Italiano Magyar Portugus SimpleEnglish Svenska

journals. [7]Acommonthemeinevolutionarymedicine,[8][9]Paleolithicnutritionisbasedonthepremisethat modernhumansaregeneticallyadaptedtothedietoftheirPaleolithicancestorsandthathumangenetics havescarcelychangedsincethedawnofagriculture,andthereforethatanidealdietforhumanhealthand well-beingisonethatresemblesthisancestraldiet. [4][10]Proponentsofthisdietarguethatmodernhuman populationssubsistingontraditionaldietsallegedlysimilartothoseofPaleolithichunter-gatherersare largelyfreeofdiseasesofaffluence,[11][12]andthattwosmallprospectivestudiesofthePaleolithicdietin humanshaveshownsomepositivehealthoutcomes. [13][14]Supporterspointtoseveralpotentially therapeuticnutritionalcharacteristicsofallegedlypreagriculturaldiets. [10][15] Thisdietaryapproachisacontroversialtopicamongstnutritionists [16][17]andanthropologists,[7][18]andan articleontheNationalHealthServiceofEnglandChoiceswebsitesuggeststhatitmaybeafaddiet.[19] Criticshavearguedthatifhuntergatherersocietiesfailedtosufferfrom"diseasesofcivilization",thiswas duetoalackofcaloriesintheirdiet,oravarietyofotherfactors,ratherthanbecauseofsomespecialdiet composition. [20]Someresearchershavetakenissuewiththeaccuracyofthediet'sunderlyingevolutionary logic, [20][21][22]andhavedisputedcertaindietaryrecommendationsandrestrictionsonthegroundsthat theyprovidenohealthbenefitsorposehealthrisks [20][21]andarenotlikelytoaccuratelyreflectthefeatures ofancientPaleolithicdiets. [22][23]A2011surveyofexpertsbyUSNews&WorldReportrankedthePaleo diettheworstofthe20dietsevaluated,remarkingthattherewaslittleevidencesupportingthediet's effectiveness.However,thiswasspecificallyamodernizedoffshoottothepaleodietinwhichverylow-carb isemphasized,thisdietspecificallycontainingonly23%carbohydrates. [24]Thisiscontrarytothedietsthe othergreatapesfavourwhichgenerallyeatsome70-90%plantfood. [25][26]Ageneralizedpaleodietwasnot apartofthisstudy.Indeed,inoneexpert'swords:"AtruePaleodietmightbeagreatoption:verylean, puremeats,lotsofwildplants.Themodernapproximationsarefarfromit." [27]
Contents[hide] 1History 2Practices 3Rationaleandevolutionaryassumptions 3.1Opposingviews 3.1.1Planttoanimalratio

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4Nutritionalfactorsandhealtheffects 4.1Macronutrientcomposition 4.1.1Proteinandcarbohydrates 4.1.2Fattyacids 4.2Energydensity 4.3Micronutrientdensity 4.4Fibercontentandglycemicload 4.5Sodium-potassiumratio 4.6Calciumandacid-basebalance 4.7Bioactivesubstancesandantinutrients 5Research 5.1Archeologicalrecord 5.2Observationalstudies 5.3Interventionstudies 6Sustainability 7Seealso 8References

History
GastroenterologistWalterL.Voegtlinwasoneofthefirsttosuggestthatfollowingadietsimilartothatof thePaleolithicerawouldimproveaperson'shealth. [6]In1975,hepublishedabook [5]inwhichheargued thathumansarecarnivorousanimalsandthattheancestralPaleolithicdietwasthatofacarnivorechiefly fatsandprotein,withonlysmallamountsofcarbohydrates. [28][29]Hisdietaryprescriptionswerebasedon hisownmedicaltreatmentsofvariousdigestiveproblems,namelycolitis,Crohn'sdisease,irritablebowel syndromeandindigestion.[5][30] In1985,S.BoydEatonandMelvinKonner,bothofEmoryUniversity,publishedakeypaperonPaleolithic nutritionintheNew England Journal of Medicine,[31]whichcausedtheconcepttogainmainstreammedical attention. [32]Threeyearslater,S.BoydEaton,MarjorieShostakandMelvinKonnerpublishedabookabout
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thisnutritionalapproach, [33]whichwasbasedonachievingthesameproportionsofnutrients(fat,protein, andcarbohydrates,aswellasvitaminsandminerals)aswerepresentinthedietsoflatePaleolithicpeople, notonexcludingfoodsthatwerenotavailablebeforethedevelopmentofagriculture.Assuch,thisnutritional approachincludedskimmedmilk,whole-grainbread,brownrice,andpotatoespreparedwithoutfat,onthe premisethatsuchfoodssupportedadietwiththesamemacronutrientcompositionasthePaleolithic diet.[28][34][35]In1989,theseauthorspublishedasecondbookonPaleolithicnutrition. [36][37] Startingin1989,SwedishmedicaldoctorandscientistStaffanLindeberg,nowassociateprofessoratLund University,Sweden,ledscientificsurveysofthenon-westernizedpopulationonKitava,oneoftheTrobriand IslandsofPapuaNewGuinea.Thesesurveys,collectivelyreferredtoastheKitavaStudy,foundthatthis populationapparentlydidnotsufferfromstroke,ischemicheartdisease,diabetes,obesityorhypertension. Startingwiththefirstpublicationin1993, [38]theKitavaStudyhassubsequentlygeneratedanumberof scientificpublicationsontherelationshipbetweendietandwesterndisease. [39]In2003,Lindeberg publishedaSwedishlanguagemedicaltextbookonthesubject. [40]In2010,thisbookwaswhollyrevised, updatedandpublishedforthefirsttimeinEnglish.The2010book [41]isgearedtowardsbothprofessionals andinterestedlaypeoplealike,citesmorethan2000references,andprovidesacomprehensiveresourcefor thescientificfoundationforthePaleolithicdietandtherelationshipbetweenwhathumanseatandwestern diseases. Sincetheendofthe1990s,anumberofmedicaldoctorsandnutritionists [42][43][44]haveadvocatedareturn toaso-calledPaleolithic(preagricultural)diet. [7]Proponentsofthisnutritionalapproachhavepublished books [30][45][46]andcreatedwebsites [47][48]topromotetheirdietaryprescriptions. [49][50][51][52][53]They havesynthesizeddietsfrommodernfoodsthatemulatenutritionalcharacteristicsoftheancientPaleolithic diet,someofwhichallowspecificfoodsthatwouldhavebeenunavailabletopre-agriculturalpeoples,such ascertainanimalproducts(i.e.dairy),processedoils,andbeverages. [30][54][55] AnothercontributorofthePaleoDietmovementisDr.LorenCordain.Heistheauthorofaseriesofbooks (ThePaleoDiet,ThePaleoDietforAthletes,andthePaleoDietCookbook)thathaveincreasedinterestin thebenefitsofamoderndietbasedevolutionaryprinciples.

Practices
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ThePaleolithicdietis amoderndietary regimenalsoknown astheBalfourdiet, thatseekstomimic thedietof preagriculturalhuntergatherers,onethat Paleolithic-styledish:Roastporkw ith correspondstowhat cookedandraw vegetablesandfruit. wasavailableinany Araw ,palaeolithic-styledish:A oftheecological sashimi(raw fish)dinnerset [1][4]Baseduponcommonly nichesofPaleolithichumans. availablemodernfoods,itincludescultivatedplantsand domesticatedanimalmeatasanalternativetothewildsourcesoftheoriginalpreagriculturaldiet. [1][3][56] Theancestralhumandietisinferredfromhistoricalandethnographicstudiesofmodern-dayhuntergatherersaswellasarchaeologicalfinds,anthropologicalevidenceandapplicationofoptimalforaging theory.[10][57][58][59][60] ThePaleolithicdietconsistsoffoodsthatcanbehuntedandfished,suchasmeat,offalandseafood,and canbegathered,suchaseggs,insects,fruit,nuts,seeds,vegetables,mushrooms,herbsandspices. [1][3] Somesourcesadviseeatingonlyleancutsofmeat,freeoffoodadditives,preferablywildgamemeatsand grass-fedbeefsincetheycontainhigherlevelsofomega-3fatscomparedwithgrain-produceddomestic meats.[1][3][56][61]Foodgroupsthatadvocatesclaimwererarelyorneverconsumedbyhumansbeforethe Neolithic(agricultural)revolutionareexcludedfromthediet,mainlygrains,legumes(e.g.beansand peanuts),dairyproducts,salt,refinedsugarandprocessedoils, [1][3]althoughsomeadvocatesconsiderthe useofoilswithlowomega-6/omega-3ratios,suchasoliveoilandcanolaoil,tobehealthyand advisable. [56]Practitionersarepermittedtodrinkmainlywater,andsomeadvocatesrecommendteaasa healthydrink, [56]butalcoholicandfermentedbeveragesarerestrictedfromthediet. [3][56]Furthermore, eatingawidevarietyofplantfoodsisrecommendedtoavoidhighintakesofpotentiallyharmfulbioactive substances,suchasgoitrogens,whicharepresentincertainroots,vegetablesandseeds. [1][57][62]Unlike
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rawfooddiets,allfoodsmaybecooked,withoutrestrictions. [1][63]However,therearealsoraw,paleolithic dieterswhobelievethathumanshavenotadaptedtocookedfoods,andsotheyeatonlyfoodswhichare bothrawandpaleolithic. [64][65] AccordingtocertainproponentsofthePaleolithicdiet,practitionersshouldderiveabout5665%oftheir foodenergyfromanimalfoodsand3645%fromplantfoods.Theyrecommendadiethighinprotein(19 35%energy)andrelativelylowincarbohydrates(2240%energy),withafatintake(2858%energy)similar toorhigherthanthatfoundinWesterndiets.[56][66][67]Furthermore,someproponentsexcludefromthediet foodswhichexhibithighglycemicindices,suchaspotatoes.[3]StaffanLindebergadvocatesaPaleolithic diet,butdoesnotrecommendanyparticularproportionsofplantsversusmeatormacronutrientratios.[1][57] AccordingtoLindeberg,calciumsupplementationmaybeconsideredwhentheintakeofgreenleafy vegetablesandotherdietarysourcesofcalciumislimited. [1]Moremoderately,Dr.KurtG.Harris recommendsavoidingfructose,linoleicacid,andglutengrainsastheprimaryneolithicagentsresponsible formoderndiseases,and"therestisjusttinkeringaroundtheedges." [68][69]

Rationaleandevolutionaryassumptions
AccordingtoS.BoydEaton,"wearetheheirsofinheritedcharacteristicsaccruedovermillionsofyears thevastmajorityofourbiochemistryandphysiologyaretunedtolifeconditionsthatexistedbeforethe adventofagriculturesome10,000yearsago.Geneticallyourbodiesarevirtuallythesameastheywereat theendofthePaleolithicerasome20,000yearsago." [70] Paleolithicnutritionhasitsrootsinevolutionarybiologyandisacommonthemeinevolutionary medicine.[8][9][71]Thereasoningunderlyingthisnutritionalapproachisthatnaturalselectionhadsufficient timetogeneticallyadaptthemetabolismandphysiologyofPaleolithichumanstothevaryingdietary conditionsofthatera.Butinthe10,000yearssincetheinventionofagricultureanditsconsequentmajor changeinthehumandiet,naturalselectionhashadtoolittletimetomaketheoptimalgeneticadaptations tothenewdiet. [1]Physiologicalandmetabolicmaladaptationsresultfromthesuboptimalgenetic adaptationstothecontemporaryhumandiet,whichinturncontributetomanyoftheso-calleddiseasesof civilization.[4] Morethan70%ofthetotaldailyenergyconsumedbyallpeopleintheUnitedStatescomesfromfoods
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suchasdairyproducts,cereals,refinedsugars,refinedvegetableoilsandalcohol,thatadvocatesofthe Paleolithicdietassertcontributedlittleornoneoftheenergyinthetypicalpreagriculturalhominindiet.[10] ProponentsofthisdietarguethatexcessiveconsumptionofthesenovelNeolithicandIndustrialerafoodsis responsibleforthecurrentepidemiclevelsofobesity,cardiovasculardisease,highbloodpressure,type2 diabetes,osteoporosisandcancerintheUSandothercontemporaryWesternpopulations. [10]

Opposing views
TheevolutionaryassumptionsunderlyingthePaleolithicdiethavebeendisputed. [18][21][22][34]Accordingto AlexanderStrhle,MaikeWoltersandAndreasHahn,withtheDepartmentofFoodScienceatthe UniversityofHanover,thestatementthatthehumangenomeevolvedduringthePleistocene(aperiodfrom 1,808,000to11,550yearsago)restsonaninadequate,butpopulargene-centeredviewofevolution.[22] TheyrelyonRussell(2001)[72]toarguethatevolutionoforganismscannotbereducedtothegeneticlevel withreferencetomutationandthatthereisnoone-to-onerelationshipbetweengenotypeandphenotype.[22] Theyfurtherquestionthenotionthat10,000yearsisaninsufficientperiodoftimetoensureanadequate adaptationtoagrariandiets.[22]Forexample,allelesconferringlactosetoleranceincreasedtohigh frequenciesinEuropejustafewthousandyearsafteranimalhusbandrywasinvented,andrecentincreases inthenumberofcopiesofthegeneforsalivaryamylase,whichdigestsstarch,appeartoberelatedto agriculture. [citation needed]ReferringtoWilson(1994), [73]Strhleetal.arguethat"thenumberofgenerations thataspeciesexistedintheoldenvironmentwasirrelevant,andthattheresponsetothechangeofthe environmentofaspecieswoulddependontheheritabilityofthetraits,theintensityofselectionandthe numberofgenerationsthatselectionacts." [74]TheystatethatifthedietofNeolithicagriculturalistshad beenindiscordancewiththeirphysiology,thenthiswouldhavecreatedaselectionpressureforevolutionary changeandmodernhumans,suchasEuropeans,whoseancestorshavesubsistedonagrariandietsfor 400500generationsshouldbesomehowadequatelyadaptedtoit.Inresponsetothisargument,Wolfgang Koppstatesthat"wehavetotakeintoaccountthatdeathfromatherosclerosisandcardiovasculardisease (CVD)occurslaterduringlife,asaruleafterthereproductionphase.EvenahighmortalityfromCVDafter thereproductionphasewillcreatelittleselectionpressure.Thus,itseemsthatadietcanbefunctional(it keepsusgoing)anddysfunctional(itcauseshealthproblems)atthesametime." [74]Moreover,S.Boyd Eatonandcolleagueshaveindicatedthat"comparativegeneticdataprovidecompellingevidenceagainstthe
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contentionthatlongexposuretoagriculturalandindustrialcircumstanceshasdistancedus,genetically, fromourStoneAgeancestors" [12]howevertheymentionexceptionssuchasincreasedlactoseandgluten tolerance,whichimproveabilitytodigestdairyandgrains,whileotherstudiesindicatethathumanadaptive evolutionhasacceleratedsincethePaleolithic. [75] ReferencingMahneretal.(2001)[76]andStrhleetal.(2006), [77]Strhleetal.statethat"whateveristhe fact,tothinkthatadietaryfactorisvaluable(functional)totheorganismonlywhentherewasgenetical adaptationandhenceanewdietaryfactorisdysfunctionalpersebecausetherewasnoevolutionary adaptationtoit,suchapanselectionistmisreadingofbiologicalevolutionseemstobeinspiredbyanaive adaptationisticviewoflife."[22] KatharineMilton,aprofessorofphysicalanthropologyattheUniversityofCalifornia,Berkeley,hasalso disputedtheevolutionarylogicuponwhichthePaleolithicdietisbased.Shequestionsthepremisethatthe metabolismofmodernhumansmustbegeneticallyadaptedtothedietaryconditionsofthePaleolithic. [18] Relyingonseveralofherpreviouspublications, [78][79][80][81]Miltonstatesthat"thereislittleevidenceto suggestthathumannutritionalrequirementsorhumandigestivephysiologyweresignificantlyaffectedby suchdietsatanypointinhumanevolution." [18] EvidencesuggeststhedietofStoneAgehumansdidinclude,insomeform,therefinedstarchesandgrains thatareexcludedfromthepaleolithicdiet.ThereisevidencethatPaleolithicsocietieswereprocessing cerealsforfooduseatleastasearlyas23,000[82][83]or30,000yearsago, [84]andpossiblyasearlyas 105,000[85]or200,000yearsago. [86]

Plant to animal ratio

ThespecificplanttoanimalfoodratiointhePaleolithicdietisalsoamatterofsomedispute.Themeandiet amongmodernhunter-gatherersocietiesisestimatedtoconsistof64-68%ofanimalcaloriesand32-36% ofplantcalories, [67][87]withanimalcaloriesfurtherdividedbetweenfishedandhuntedanimalsinvarying proportions(mosttypically,withhuntedanimalfoodcomprising26-35%oftheoveralldiet).Aspartofthe so-calledMantheHunterparadigm,thisratiowasusedasthebasisoftheearliestformsofthePaleolithic dietbyVoegtlin,Eatonandothers.Tothisday,manyadvocatesofthePaleolithicdietconsiderhigh percentageofanimalfleshtobeoneofthekeyfeaturesofthediet.
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However,greatdisparitiesdoexist,evenbetweendifferentmodernhunter-gatherersocieties.Theanimalderivedcaloriepercentagerangesfrom25%intheGwipeopleofsouthernAfrica,to99%inAlaskan Nunamiut.[88]Theanimal-derivedpercentagevalueisskewedupwardsbypolarhunter-gatherersocieties, whohavenochoicebuttoeatanimalfoodbecauseoftheinaccessibilityofplantfoods.Sincethose environmentswereonlypopulatedrelativelyrecently(forexample,paleo-IndianancestorsofNunamiutare thoughttohavearrivedtoAlaskanoearlierthan30,000yearsago),suchdietsrepresentrecentadaptations ratherthanconditionsthatshapedhumanevolutionduringmuchofthePaleolithic.Moregenerally,hunting andfishingtendtoprovideahigherpercentageofenergyinforagersocietieslivingathigherlatitudes. Excludingcold-climateandequestrianforagersresultsinadietstructureof52%plantcalories,26% huntingcalories,and22%fishingcalories. [87]Furthermore,thosenumbersmaystillnotberepresentativeof atypicalStoneAgediet,sincefishingdidnotbecomecommoninmanypartsoftheworlduntiltheUpper Paleolithicperiod35-40thousandyearsago, [89]andearlyhumans'huntingabilitieswererelatively limited[dubious discuss],comparedtomodernhunter-gatherers,aswell(theoldestincontrovertibleevidence fortheexistenceofbowsonlydatestoabout8000BCE, [90]andnetsandtrapswereinvented22,000to 29,000yearsago.) Anextremeversionofthislineofthoughtpositsthat,upuntiltheUpperPaleolithic,humanswerefrugivores (fruiteaters),whosupplementedtheirmealswithcarrion,eggs,andsmallpreysuchasbabybirdsand mussels,and,onlyonrareoccasions,managedtokillandconsumebiggamesuchasantelopes.[91]This viewissupportedbythestudiesofhigherapes,particularlychimpanzees.Chimpanzeesareclosestto humansgenetically,sharingmorethan98%oftheirDNAcodewithhumans,andtheirdigestivetractis functionallyverysimilartothatofhumans.Chimpanzeesareprimarilyfrugivores,buttheycouldandwould consumeanddigestanimalflesh,giventheopportunity.However,theiractualdietinthewildisabout95% plant-based,withtheremaining5%filledwithinsects,eggs,andbabyanimals. [92]Somecomparative studiesofhumanandhigherprimatedigestivetractsdosuggestthathumanshaveevolvedtoobtaingreater amountsofcaloriesfromhigh-qualitysourcessuchasanimalfoods,allowingthemtoshrinkthesizeofthe gastrointestinaltract,relativetobodymass,andtoincreasethebrainmassinstead. [80][93]Nevertheless, modernhumans'digestiveorgansandmechanisms,suchasdentition,stomachpH,andgutsize,remain muchclosertochimpanzeesthantoobligatecarnivoresortrueomnivoressuchasbearsand raccoons. [91][94]
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Adifficultywiththispointofviewisthathumansareestablishedtorequirecertainlong-chain polyunsaturatedfats(LCP),suchasAAandDHA.[95]HumanLCPrequirementsaremuchgreaterthan chimpanzees'becauseofhumans'largerbrainmass,andhumans'abilitiestosynthesizethemfromother nutrientsarepoor,suggestingreadilyavailableexternalsources. [96]ButLCP'sarenonexistentinplants, andDHAisalsoalmostnonexistentinmosttissuesofwarm-climateanimals.Pregnantandlactating femalesrequire100mgofDHAperday. [97]TheprimarysourceofDHAinthemodernhumandietisfish. Despitethegeneralshortageofevidenceforextensivefishing,thoughttorequirerelativelysophisticated toolswhichhavebecomeavailableonlyinthelast30-50thousandyears,it'sbeenarguedthatexploitation ofcoastalfaunasomehowprovidedhominidswithabundantLCP. [96]Alternatively,ithasbeenproposedthat earlyhominidsfrequentlyscavengedpredators'killsandconsumedpartswhichwereleftuntouchedby predators,mostcommonlythebrain,whichisveryhighinAAandDHA. [97]Just100gofscavengedAfrican ruminantbrainmatterprovidemoreDHAthanisconsumedbyatypicalmodernU.S.adultinthecourseofa week. [97][98]Otherauthorssuggestedthathumanabilitytoconvertalpha-LinolenicacidintoDHA,while poor,is,nevertheless,adequatetopreventDHAdeficiencyinaplant-baseddiet. [99]

Nutritionalfactorsandhealtheffects
SincetheendofthePaleolithicperiod,severalfoodsthat humansrarelyorneverconsumedduringpreviousstagesoftheir evolutionhavebeenintroducedasstaplesintheirdiet. [10]With theadventofagricultureandthebeginningofanimal domesticationroughly10,000yearsago,duringtheNeolithic Revolution,humansstartedconsuminglargeamountsofdairy products,beans,cereals,alcoholandsalt. [10]Inthelate18th andearly19thcenturies,theIndustrialrevolutionledtothelarge scaledevelopmentofmechanizedfoodprocessingtechniques andintensivelivestockfarmingmethods,thatenabledthe productionofrefinedcereals,refinedsugarsandrefined vegetableoils,aswellasfattierdomesticmeats,whichhave becomemajorcomponentsofWesterndiets.[10]
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Suchfoodstapleshavefundamentallyalteredseveralkey nutritionalcharacteristicsofthehumandietsincethePaleolithic era,includingglycemicload,fattyacidcomposition, macronutrientcomposition,micronutrientdensity,acid-base balance,sodium-potassiumratio,andfibercontent.[10] Thesedietarycompositionalchangeshavebeentheorizedas riskfactorsinthepathogenesisofmanyoftheso-called "diseasesofcivilization"andotherchronicillnessesthatare widelyprevalentinWesternsocieties, [4][10][100][101][102][103] includingobesity,[104][105][106]cardiovascular disease,[107][108][109]highbloodpressure,[110]type2 diabetes,[111][112]osteoporosis,[113][114]autoimmune diseases,[115]colorectalcancer,[116][117][118]myopia,[119] acne,[120][121][122][123]depression,[124]anddiseasesrelatedto vitaminandmineraldeficiencies.[115][125][126][127]

Fruitsandvegetables,richinvitamins, potassiumandfiber,representanimportant featureofhunter-gathererdiets.[10]

Macronutrient composition
Protein and carbohydrates

Fiber-richrootvegetables,suchas beets,rutabagas,carrots,celeriacand turnips,maintainnutrientproperties(low glycemicandinsulinresponses) characteristicoftraditionalhunter-gatherer plantfoods.[3]

"Theincreasedcontributionofcarbohydratefromgrainstothe humandietfollowingtheagriculturalrevolutionhaseffectivelydilutedtheproteincontentofthehuman diet."[128]Inmodernhunter-gathererdiets,dietaryproteinischaracteristicallyelevated(1935%ofenergy) attheexpenseofcarbohydrate(2240%ofenergy). [66][67][129]High-proteindietsmayhaveacardiovascular protectiveeffectandmayrepresentaneffectiveweightlossstrategyfortheoverweightorobese. [10] Furthermore,carbohydraterestrictionmayhelppreventobesityandtype2diabetes,[130][131]aswellas atherosclerosis.[109]Carbohydratedeprivationtothepointofketosishasbeenarguedbothtohave negative[132]andpositiveeffectsonhealth. [133][134] Thenotionthatpreagriculturalhunter-gathererswouldhavetypicallyconsumedadietrelativelylowin carbohydrateandhighinproteinhasbeenquestioned. [135]Criticsarguethatthereisinsufficientdatato
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identifytherelativeproportionsofplantandanimalfoodsconsumedonaveragebyPaleolithichumansin general, [7][18][23][77]andtheystresstherichvarietyofancientandmodernhunter-gathererdiets. [18][21][22] Furthermore,preagriculturalhunter-gatherersmayhavegenerallyconsumedlargequantitiesof carbohydratesintheformofcarbohydrate-richtubers(plantundergroundstorageorgans).[17][21][22] AccordingtoStaffanLindeberg,anadvocateofthePaleolithicdiet,aplant-baseddietrichincarbohydrates isconsistentwiththehumanevolutionarypast.[1][4] Ithasalsobeenarguedthatrelativefreedomfromdegenerativediseaseswas,andstillis,characteristicof allhunter-gatherersocietiesirrespectiveofthemacronutrientcharacteristicsoftheirdiets. [20][136][137] MarionNestle,aprofessorintheDepartmentofNutritionandFoodStudiesatNewYorkUniversity,judging fromresearchrelatingnutritionalfactorstochronicdiseaserisksandtoobservationsofexceptionallylow chronicdiseaseratesamongpeopleeatingvegetarian,MediterraneanandAsiandiets,hassuggestedthat plant-baseddietsmaybemostassociatedwithhealthandlongevity.[16][23]

Fatty acids
Hunter-gathererdietshavebeenarguedtomaintainrelativelyhighlevelsofmonounsaturatedand polyunsaturatedfats,moderatelevelsofsaturatedfats(1015%oftotalfoodenergy [138])aswellasalow omega-6:omega-3fattyacidratio.[10][67][139]Cowsfedagrass-baseddietproducesignificantamountsof omega-3fattyacidscomparedtograin-fedanimals,whileminimizingtransfatsandsaturatedfats.[140]The dietdoesincludeasignificantamountofcholesterolduetotheinclusionofleanmeat. [141]Thesenutritional factorsmayservetoinhibitthedevelopmentofcardiovasculardisease. [10]Thishighratioofpolyunsaturated tosaturatedfatshasbeenchallenged.Whilealowsaturatedfatintakewasarguedfor[67]ithasbeen arguedthathunter-gathererswouldselectivelyhuntfatteranimalsandutilisethefattiestpartsoftheanimals (suchasbonemarrow). [142]

Energy density
Thepaleolithicdiethaslowerenergydensitythanthetypicaldietconsumedbymodernhumans. [143]This isespeciallytrueinprimarilyplant-based/vegetarianversionsofthediet,butitstillholdsifsubstantial amountsofleanmeatareincludedincalculations.Forexample,mostfruitsandberriescontain0.4to0.8 caloriespergram,vegetablescanbeevenlowerthanthat(cucumberscontainonly0.16caloriesper
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gram). [144]Leangamemeat,suchascookedwildrabbit,ismoreenergy-dense(upto1.7caloriesper gram),butitdoesnotconstitutethebulkofthedietbymass/volumeattherecommendedplant/animal ratios,anditdoesnotreachthedensitiesofmanyprocessedfoodscommonlyconsumedbymodern humans:mostMcDonaldssandwichessuchastheBigMacaverage2.4to2.8calories/gram, [145]and sweetssuchascookiesandchocolatebarscommonlyexceed4calories/gram. Thereissubstantialevidencethatpeopleconsuminghighenergy-densitydietsarepronetoovereatingand theyareatagreaterriskofweightgain.Conversely,lowcaloricdensitydietstendtoprovideagreater satietyfeelingatthesameenergyintake,andtheyhavebeenshowneffectiveatachievingweightlossin overweightindividualswithoutexplicitcaloricrestrictions. [146][147][148]Evensomeauthorswhomay otherwiseappeartobecriticaloftheconceptofPaleolithicdiethavearguedthathighenergydensityof moderndiets,ascomparedtoancestral/primatediets,contributestotherateofdiseasesofaffluenceinthe industrialworld. [81]

Micronutrient density
Fruits,vegetables,leanmeats,andseafood,whicharestaplesof thehunter-gathererdiet,aremorenutrient-densethanrefined sugars,grains,vegetableoils,anddairyproducts.Consequently, thevitaminandmineralcontentofthedietisveryhighcompared withastandarddiet,inmanycasesamultipleoftheRDA.[3] Fishandseafoodrepresentaparticularlyrichsourceofomega-3 fattyacidsandothermicronutrients,suchasiodine,iron,zinc, copper,andselenium,thatarecrucialforproperbrainfunction anddevelopment. [125]Terrestrialanimalfoods,suchasmuscle, brain,bonemarrow,thyroidgland,andotherorgans,also representaprimarysourceofthesenutrients. [62]Calcium-poor grainsandlegumesareexcludedfromthediet. [149][150][151]Two notableexceptionsarecalcium(seebelow)andvitaminD,both ofwhichmaybepresentinthedietininadequatequantities. ModernhumansrequiremuchmorevitaminDthanhunteropen in browser PRO version
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Nutssuchasw alnuts(picturedabove) arerichsourcesofmicronutrientsand protein.

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gatherers,becausetheydon'tgetthesameamountofexposure tosun.Thisneediscommonlysatisfiedindevelopedcountries byartificiallyfortifyingdairyproductswiththevitamin.Inorderto avoiddeficiency,amodernhumanonahunter-gathererdiet wouldhavetotakeartificialsupplementsofthevitamin,ensure adequateintakeofcertainfattyfish, [152]orincreasetheamount ofexposuretosunlight(it'sbeenestimatedthat30minutesof exposuretomid-daysuntwiceaweekisadequateformost people.)[153]

Fishandseafood,suchassalmon (picturedabove),aresignificantsourcesof essentialmicronutrients.

Fiber content and glycemic load

Unrefinedwildplantfoodslikethoseavailabletocontemporaryhunter-gathererstypicallyexhibitlow glycemicindices.[154]Contemporarydietsdevoidofcerealgrains,dairyproducts,refinedoilsandsugars, andprocessedfoodshavebeenshowntocontainsignificantlymorefiber(~42.5g/d)thaneithercurrentor recommendedvalues. [3]Moreover,dairyproducts,suchasmilk,yogurt,andcottagecheese,havelow glycemicindices,butarehighlyinsulinotropic,withaninsulinindexsimilartothatofwhitebread. [155][156] Thesedietarycharacteristicsmaylowerriskofdiabetes,obesityandotherrelatedsyndromeXdiseasesby placinglessstressonthepancreastoproduceinsulin,andpreventinginsulininsensitivity.[157]

Sodium-potassium ratio
Sincenoprocessedfoodsoraddedsaltareincluded,thesodiumintake(~726mg)islowerthanaverage U.S.values(3,271mg)orrecommendedvalues(2,400mg).Further,sincepotassium-richfruitsand vegetablescompose~30%ofthedailyenergy,thepotassiumcontent(~9,062mg)isnearly3.5times greaterthanaveragevalues(2,620mg)intheU.S.diet. [3]Theinvertedratioofpotassiumtosodiuminthe U.S.dietadverselyaffectscardiovascularfunctionandcontributestohypertensionandstroke,compared withpreagriculturaldiets. [114][158]

Calcium and acid-base balance

Dietscontaininghighamountsofsaltorcerealsandotherfoodsthatinduceandsustainincreasedacidity
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ofbodyfluidmaycontributetothedevelopmentofosteoporosisandrenalstones,lossofmusclemass,and age-relatedrenalinsufficiencyduetothebody'suseofcalciumtobufferpH. [citation needed]Thepaleodiet maynotcontainthehighlevelsofcalciumrecommendedintheU.S.topreventtheseeffects. [141]However, becauseoftheabsenceofacidyieldingcerealsandenergy-dense,nutrient-poorfoodsinthehuntergathererdiet-foodsthatdisplacebase-yieldingfruitsandvegetables-thedietproducesanetbaseloadon thebody,asopposedtoanetacidload,whichmayreducecalciumexcretion. [113][dead link]
[159][not in citation given]

Bioactive substances and antinutrients

Furthermore,cerealgrains,legumesandmilkcontainbioactivesubstances,suchasglutenandcasein, whichhavebeenimplicatedinthedevelopmentofvarioushealthproblems. [4]Consumptionofgluten,a componentofcertaingrains,suchaswheat,ryeandbarley,isknowntohaveadversehealtheffectsin individualssufferingfromarangeofglutensensitivities,includingcoeliacdisease.SincethePaleolithicdiet isdevoidofcerealgrains,itisfreeofgluten.Thepaleodietisalsocasein-free.Caseinisaproteinfoundin milkanddairyproducts,whichmayimpairglucosetoleranceinhumans. [4] ComparedtoPaleolithicfoodgroups,cerealgrainsandlegumescontainhighamountsofantinutrients, includingalkylresorcinols,alpha-amylaseinhibitors,proteaseinhibitors,lectinsandphytates,substances knowntointerferewiththebody'sabsorptionofmanykeynutrients. [4][101][115]Molecular-mimicking proteins,whicharebasicallymadeupofstringsofaminoacidsthatcloselyresemblethoseofanother totallydifferentprotein,arealsofoundingrainsandlegumes,aswellasmilkanddairyproducts. [4][101][115] AdvocatesofthePaleolithicdiethavearguedthatthesecomponentsofagrariandietspromotevitaminand mineraldeficienciesandmayexplainthedevelopmentofthe"diseasesofcivilization"aswellasanumber ofautoimmune-relateddiseases.[4][101][115]

Research
Archeological record
OnelineofevidenceusedtosupporttheStoneAgedietisthedeclineinhumanhealthandbodymassthat occurredwiththeadoptionofagriculture,attheendofthePaleolithicera. [21][115]Associatedwiththe
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introductionofdomesticatedandprocessedplantfoods,suchascerealgrains,inthehumandiet,there was,inmanyareas,ageneraldecreaseinbodystatureanddentitionsize,andanincreaseincariesrates. Therewasalsoanassociatedgeneraldeclineinhealthinsomeareas. [7][160][161]

Observational studies
Basedonthesubsistencepatternsandbiomarkersofhunter-gatherersstudiedinthelastcentury, advocatesarguethatmodernhumansarewelladaptedtothedietoftheirPaleolithicancestor. [162]Thediet ofmodernhunter-gatherergroupsisbelievedtoberepresentativeofpatternsforhumansoffiftytotwentyfivethousandyearsago, [162]andindividualsfromtheseandothertechnologicallyprimitive societies, [163][164]includingthoseindividualswhoreachtheageof60orbeyond, [38][165]seemtobelargely freeofthesignsandsymptomsofchronicdisease(suchasobesity,highbloodpressure,nonobstructive coronaryatherosclerosis,andinsulinresistance)thatuniversallyafflicttheelderlyinwesternsocieties(with theexceptionofosteoarthritis,whichafflictsbothpopulations). [4][12][162]Moreover,whenthesepeopleadopt westerndiets,theirhealthdeclinesandtheybegintoexhibitsignsandsymptomsof"diseasesof civilization".[11][162]Inoneclinicalstudy,strokeandischaemicheartdiseaseappearedtobeabsentina populationlivingontheislandofKitava,inPapuaNewGuinea,whereasubsistencelifestyle,uninfluenced bywesterndietaryhabits,wasstillmaintained. [38][166] OneofthemostfrequentcriticismsofthePaleolithicdietisthatitisunlikelythatpreagriculturalhuntergathererssufferedfromthediseasesofmoderncivilizationsimplybecausetheydidnotlivelongenoughto developtheseillnesses,whicharetypicallyassociatedwitholdage. [12][17][167][168][169]AccordingtoS.Jay OlshanskyandBruceCarnes,"thereisneitherconvincingevidencenorscientificlogictosupporttheclaim thatadherencetoapaleolithicdietprovidesalongevitybenefit." [169]Inresponsetothisargument, advocatesofthepaleodietstatethatwhilePaleolithichunter-gatherersdidhaveashortaveragelife expectancy,modernhumanpopulationswithlifestylesresemblingthatofourpreagriculturalancestorshave littleornodiseasesofaffluence,despitesufficientnumbersofelderly. [12][170]Inhunter-gatherersocieties wheredemographicdataisavailable,theelderlyarepresent,buttheytendtohavehighmortalityratesand rarelysurvivepasttheageof80,withcausesofdeath(whenknown)rangingfrominjuriestomeaslesand tuberculosis. [171] Criticsfurthercontendthatfoodenergyexcess,ratherthantheconsumptionofspecificnovelfoods,such
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asgrainsanddairyproducts,underliesthediseasesofaffluence. [17][21][172]AccordingtoGeoffrey Cannon, [17]scienceandhealthpolicyadvisortotheWorldCancerResearchFund,humansaredesignedto workhardphysicallytoproducefoodforsubsistenceandtosurviveperiodsofacutefoodshortage,andare notadaptedtoadietrichinenergy-densefoods. [173]Similarly,WilliamR.Leonard,aprofessorof anthropologyatNorthwesternUniversity,statesthatthehealthproblemsfacingindustrialsocietiesstemnot fromdeviationsfromaspecificancestraldietbutfromanimbalancebetweencaloriesconsumedand caloriesburned,astateofenergyexcessuncharacteristicofancestrallifestyles. [172]

Intervention studies
ThefirstanimalexperimentonaPaleolithicdietsuggestedthatthisdiet,ascomparedwithacereal-based diet,conferredhigherinsulinsensitivity,lowerC-reactiveproteinandlowerbloodpressurein24domestic pigs. [174]Therewasnodifferenceinbasalserumglucose. [174]Thefirsthumanclinicalrandomized controlledtrialinvolved29peoplewithglucoseintoleranceandischemicheartdisease,anditfoundthat thoseonaPaleolithicdiethadagreaterimprovementinglucosetolerancecomparedtothoseona Mediterraneandiet.[13][175]Furthermore,thepaleolithicdietwasfoundtobemoresatiatingpercalorie comparedtotheMediterraneandiet. [176] Aclinical,randomized,controlledcross-overstudyintheprimarycaresettingcomparedthePaleolithicdiet withacommonlyprescribeddietfortype2diabetes.ThePaleolithicdietresultedinlowermeanvaluesof HbA1c,triacylglycerol,diastolicbloodpressure,bodymassindex,waistcircumferenceandhighervaluesof highdensitylipoproteinwhencomparedtotheDiabetesdiet.Also,glycemiccontrolandother cardiovascularfactorswereimprovedinbothdietswithoutsignificantdifferences.Itisalsoimportanttonote thatthePaleolithicdietwaslowerintotalenergy,energydensity,carbohydrate,dietaryglycemicloadand glycemicindex,saturatedfattyacidsandcalcium,buthigherinunsaturatedfattyacids,dietarycholesterol andsomevitamins. [177]TwoclinicaltrialsdesignedtotestvariousphysiologicaleffectsofthePaleolithic dietarecurrentlyunderway, [178][179]andtheresultsofonecompletedtrial [180]haveshownmetabolicand physiologicimprovements. [181]TheEuropeanJournalofClinicalNutritionpublishedastudy [182]ofatrialof thePaleolithicdietin20healthyvolunteers.Inthestudy,inthreeweekstherewasanaverageweight reductionof2.3kg,anaveragereductioninwaistcircumferenceof1.5cm(aboutone-halfinch),anaverage reductioninsystolicbloodpressureof3mmHg,anda72%reductioninplasminogenactivatorinhibitor-1
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(whichmighttranslateintoareducedriskofheartattackandstroke.)However,theNHSKnowledgeService pointedoutthatthisstudy,likemosthumandietstudies,reliedonobservationaldata.[183]

Sustainability
ThePaleolithicdiethasbeencriticizedonthegroundsthatitcannotbeimplementedonaworldwide scale. [184][185][186]AccordingtoLorenCordain,ifsuchadietwaswidelyadopted,itwouldcompromisethe foodsecurityofpopulationsdependentoncerealgrainsfortheirsubsistence.However,hesaysthatwhere cerealsarenotanecessity,asinmostwesterncountries,revertingtoagrain-freedietcanbehighly practicalintermsofcuttinglong-termhealthcarecosts.[187]BarryBogin,aprofessorofanthropologyatthe UniversityofMichigan,statesthatlessintensivefarmingtechniques,suchaspasture-grazedcattle,willnot producesufficientmeattofeedtheworldspopulation.[188]Adherentstothepaleolithicdietretortthatthe rootcauseofdiminishingfoodsecurityisoverpopulationratherthananyinherentunsustainabilityin paleolithicfoodmethods.Onanotherlevel,criticshavearguedthat"exclusiondiets"suchastheStoneAge diet"canbehighlyrestrictive,sociallydisruptive,andexpensive." [21][189]

Seealso
Alkalinediet Anopsology Bushfood Diabeticdiet Inuitdiet Lowsodiumdiet Low-carbohydratediet MarkSisson Naturalfoods Nutritionalgenomics Paleolithiclifestyle
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PeterUngar Prebiotics Prehistoricmedicine Proteinpoisoning Rawfeeding RayMears RogerMacDougall Sedentism VilhjalmurStefansson Wholefoods

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relatetodietinthepast" .InHublin,Jean-Jacques&Richards,MichaelP.The Evolution of Hominin Diets: Integrating Approaches to the Study of Palaeolithic Subsistence.Springer.ISBN9781402096983. 58. ^Cordain,Loren(2006)."ImplicationsofPlio-PleistoceneHomininDietsforModernHumans(PDF)" .In Ungar,PeterS..Evolution of the Human Diet: The Known, the Unknown, and the Unknowable.Oxford,USA: OxfordUniversityPress.pp.36383.ISBN0195183460. 59. ^http://darwinstable.wordpress.com/2009/01/03/optimal-foraging-theory-and-meat-consumption/ 60. ^http://paleodiet.com/definition.htm 61. ^CordainL,WatkinsBA,FlorantGL,KelherM,RogersL,LiY(March2002)."Fattyacidanalysisofwild ruminanttissues:evolutionaryimplicationsforreducingdiet-relatedchronicdisease" .European Journal of Clinical Nutrition56(3):18191.doi:10.1038/sj.ejcn.1601307 .PMID11960292 . 62. ^a bCordainL,EatonSB,SebastianA,MannN,LindebergS,WatkinsBA,O'KeefeJH,Brand-MillerJ(1 August2005)."ReplytoSCCunnane" (PDF).American Journal of Clinical Nutrition82(2):48384. PMID16087997 . 63. ^Eaton,S.Boyd(2006)."PreagriculturalDietsandEvolutionaryHealthPromotion" .InPeterUngar. Evolution of the Human Diet: The Known, the Unknown, and the Unknowable.Oxford,USA:OxfordUniversity Press.pp.400.ISBN0195183460. 64. ^http://www.rawpaleodiet.com/ 65. ^http://rawpaleodiet.vpinf.com/rvaf-overview.html 66. ^a bCordainL,MillerJB,EatonSB,MannN,HoltSH,SpethJD(1March2000)."Plant-animalsubsistence ratiosandmacronutrientenergyestimationsinworldwidehunter-gathererdiets" .American Journal of Clinical Nutrition71(3):68292.PMID10702160 . 67. ^a bc de CordainL,EatonSB,MillerJB,MannN,HillK(March2002)."Theparadoxicalnatureofhuntergathererdiets:meatbased,yetnon-atherogenic" (PDF).European Journal of Clinical Nutrition56(Suppl 1):S4252.doi:10.1038/sj.ejcn.1601353 .PMID11965522 . 68. ^http://www.paleonu.com/get-started/ 69. ^http://www.paleonu.com/panu-weblog/2009/11/27/health-and-evolutionary-reasoning-the-panumethod.html 70. ^EatonSB,EatonSB3rd,KonnerMJ(1997)."Paleolithicnutritionrevisited:atwelve-yearretrospectiveon itsnatureandimplications" (PDF).European Journal of Clinical Nutrition51(4):20716. doi:10.1038/sj.ejcn.1600389 .PMID9104571 . 71. ^EatonSB,CordainL,EatonSB(2001)."Anevolutionaryfoundationforhealthpromotion" Review of Nutrition and Dietetics90:512.doi:10.1159/000059815 .PMID11545045 . (PDF).World

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(25000yearsbp)".Antiquity81:845855. 84. ^Revedin,AnnaAranguren,BBecattini,RLongo,LMarconi,ELippi,MMSkakun,NSinitsyn,Aetal. (2010)."Thirtythousand-year-oldevidenceofplantfoodprocessing" .Proceedings of the National Academy of Sciences107(44):188159.Bibcode2010PNAS..10718815R . doi:10.1073/pnas.1006993107 .PMC2973873 .PMID20956317 . 85. ^JulioMercader(2009)'MozambicanGrassSeedConsumptionDuringtheMiddleStoneAge',Science,18 December2009. 86. ^Murphy,D(2007).People, Plants and Genes: The Story of Crops and Humanity.Oxford:OxfordUniversity Press.ISBN0199207135. 87. ^a bMarloweFW(2005)."Hunter-gatherersandhumanevolution" (PDF).Evolutionary Anthropology14 (2):15294.doi:10.1002/evan.20046 . 88. ^Kolbert,Elizabeth."FleshofYourFlesh" ,The New Yorker,November9,2009,accessedJanuary,27, 2011. 89. ^AfricanBoneToolsDisputeKeyIdeaAboutHumanEvolution NationalGeographicNewsarticle. 90. ^Collins,Desmond(1973).Background to archaeology: Britain in its European setting(Reviseded.). CambridgeUniversityPress.ISBN0521201551. 91. ^a bDonnaHart,RobertW.Sussman.Man the Hunted.ISBN0813339367. 92. ^"Chimphuntingandflesh-eating" . 93. ^LeslieC.Aiello,PeterWheeler(1995)."Theexpensive-tissuehypothesis" .Current Anthropology.

94. ^MiltonR.Mills,M.D."TheComparativeAnatomyofEating" . 95. ^Kris-Etherton,PMHarris,WSAppel,LJNutrition,Committee(2003)."FishConsumption,FishOil, Omega-3FattyAcids,andCardiovascularDisease" .Arteriosclerosis, thrombosis, and vascular biology23 (2):e2030.doi:10.1161/01.ATV.0000038493.65177.94 .PMID12588785 . 96. ^a bCrawfordMA.Evidence for the Unique Function of Docosahexaenoic Acid (DHA) During the Evolution of the Modern Hominid Brain . 97. ^a bc CordainL,WatkinsBA,MannNJ(2001)."Fattyacidcompositionandenergydensityoffoods availabletoAfricanhominids:evolutionaryimplicationsforhumanbraindevelopment" .World Rev Nutr Diet:144161. 98. ^"DietaryFats:TotalFatandFattyAcids" . 99. ^BryceA.CarlsonandJohnD.Kingston(2007).Docosahexaenoic Acid Biosynthesis and Dietary Contingency: Encephalization Without Aquatic Constraint . 100. ^Fairweather-Tait,SusanJ.(October29,2003)."Humannutritionandfoodresearch:opportunitiesand

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challengesinthepost-genomicera".Phil. Trans. R. Soc. Lond. B358(1438):170927. doi:10.1098/rstb.2003.1377 .PMC1693270 .PMID14561328 . 101. ^a bc dJnssonT,OlssonS,AhrnB,Bg-HansenTC,DoleA,LindebergS(2005)."Agrariandietand diseasesofaffluenceDoevolutionarynoveldietarylectinscauseleptinresistance?" .BMC Endocrine Disorders5:10.doi:10.1186/1472-6823-5-10 .PMC1326203 .PMID16336696 . 102. ^Leach,JeffD.(2007)."PrebioticsinAncientDiet" doi:10.1616/1476-2137.14801 . .Food Science and Technology Bulletin4(1):18.

103. ^Collins,Christopher(JanuaryMarch2007)."SaidAnotherWay:Stroke,Evolution,andtheRainforests:An AncientApproachtoModernHealthCare".Nursing Forum42(1):3944.doi:10.1111/j.17446198.2007.00064.x .PMID17257394 . 104. ^BellisariA.(March2008)."Evolutionaryoriginsofobesity".Obesity Reviews9(2):165180. doi:10.1111/j.1467-789X.2007.00392.x .PMID18257754 . 105. ^Strandvik,B.Eriksson,S.Garemo,M.Palsdottir,V.Samples,S.Pickova,J(March4,2008)."Isthe relativelylowintakeofomega-3fattyacidsinWesterndietcontributingtotheobesityepidemics?".Lipid Technology20(3):5759.doi:10.1002/lite.200800009 . 106. ^WoodLE(October2006)."Obesity,waisthipratioandhuntergatherers".BJOG: an International Journal of Obstetrics & Gynaecology113(10):111016.doi:10.1111/j.1471-0528.2006.01070.x . PMID16972857 . 107. ^O'KeefeJHJr,CordainL,HarrisWH,MoeRM,VogelR(June2004)."Optimallow-densitylipoproteinis50 to70mg/dl:lowerisbetterandphysiologicallynormal" .Journal of the American College of Cardiology (AmericanCollegeofCardiology)43(11):214246.doi:10.1016/j.jacc.2004.03.046 .PMID15172426 . 108. ^O'KeefeJHJr,CordainL,JonesPG,AbuissaH.(July2006)."CoronaryarterydiseaseprognosisandCreactiveproteinlevelsimproveinproportiontopercentloweringoflow-densitylipoprotein" .The American Journal of Cardiology98(1):13539.doi:10.1016/j.amjcard.2006.01.062 .PMID16784936 . 109. ^a bKopp,Wolfgang(May2006)."Theatherogenicpotentialofdietarycarbohydrate".Preventive Medicine 42(5):33642.doi:10.1016/j.ypmed.2006.02.003 .PMID16540158 . 110. ^Tekol,Yalcin(April2008)."Maternalandinfantiledietarysaltexposuremaycausehypertensionlaterin life".Birth Defects Research Part B: Developmental and Reproductive Toxicology83(2):7779. doi:10.1002/bdrb.20149 .PMID18330898 . 111. ^DedoussisGV,KalioraAC,PanagiotakosDB(Spring2007)."Genes,DietandType2DiabetesMellitus:A Review" .Review of Diabetic Studies4(1):1324.doi:10.1900/RDS.2007.4.13 .PMC1892523 . PMID17565412 .

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112. ^Haag,Marianne&Dippenaar,Nola(2005)."Dietaryfats,fattyacidsandinsulinresistance:shortreviewof amultifacetedconnection".Medical Science Monitor11(12):RA359367.PMID16319806 . 113. ^a bSebastianA,FrassettoLA,SellmeyerDE,MerriamRL,MorrisRCJr(1December2002)."Estimationof thenetacidloadofthedietofancestralpreagriculturalHomosapiensandtheirhominidancestors" . American Journal of Clinical Nutrition76(6):130816.PMID12450898 . 114. ^a bMorrisRCJr,SchmidlinO,FrassettoLA,SebastianA(June2006)."Relationshipandinteraction betweensodiumandpotassium" .Journal of the American College of Nutrition25(3):262S70S. PMID16772638 . 115. ^a bc de fCordain,Loren(1999)."Cerealgrains:humanity'sdouble-edgedsword" of nutrition and dietetics84:1973.doi:10.1159/000059677 .PMID10489816 . (PDF).World review

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125. ^a bCunnane,StephenC.(1August2005)."OriginsandevolutionoftheWesterndiet:implicationsof iodineandseafoodintakesforthehumanbrain" .American Journal of Clinical Nutrition82(2):483 authorreply4834.PMID16087997 . 126. ^Solomons,NoelW(2008)."Nationalfoodfortification:adialoguewithreferencetoAsia:balanced advocacy" (PDF).Asia Pacific Journal of Clinical Nutrition17(Suppl1):203.PMID18296293 . 127. ^Friis,Henrik(February2007)."Internationalnutritionandhealth" PMID17349228 .[dead link] .Danish Medical Bulletin54(1):557.

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138. ^Cordain,Loren(2006)."Saturatedfatconsumptioninancestralhumandiets:implicationsfor contemporaryintakes" .InMeskin,MarkS.Bidlack,WayneR.&Randolph,R.Keith.Phytochemicals: Nutrient-Gene Interactions.CRCPress.pp.11526.ISBN0849341809. 139. ^Simopoulos,ArtemisP.(2006)."Evolutionaryaspectsofdiet,theomega-6:omega-3ratio,andgene expression".InMeskin,MarkS.Bidlack,WayneR.&Randolph,R.Keith.Phytochemicals: Nutrient-Gene Interactions.CRCPress.pp.137160.ISBN0849341809. 140. ^Mann,NJPonnampalam,ENYep,YSinclair,AJ(2003)."Feedingregimesaffectfattyacidcomposition inAustralianbeefcattle".Asia Pacific journal of clinical nutrition12 Suppl:S38.PMID15023647 .edit 141. ^a bLonge,JacquelineL.(2007).The Gale Encyclopedia of Diets: A Guide to Health and Nutrition.Gale Cengage.ISBN1-4144-2991-6. 142. ^Strhle,A.Hahn,A.Sebastian,A.(2010)."Estimationofthediet-dependentnetacidloadin229 worldwidehistoricallystudiedhunter-gatherersocieties".The American journal of clinical nutrition91(2): 406412.doi:10.3945/ajcn.2009.28637 .PMID20042527 .edit 143. ^A.M.Prentice,S.A.Jebb(November2003)."Fastfoods,energydensityandobesity:apossible mechanisticlink".Obesity Reviews(4):187194. 144. ^Rolls,Barbara.The Volumetrics Eating Plan: Techniques and Recipes for Feeling Full on Fewer Calories. ISBN0060737301. 145. ^"McDonald'sUSANutritionFactsforPopularMenuItems" . 146. ^"Energydensityoffoodsaffectsenergyintakeinnormal-weightwomen" 147. ^"Theeconomicsofobesity:dietaryenergydensityandenergycost" . .

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ISBN0763776637. 154. ^Foster-PowellK,HoltSH,Brand-MillerJ(1July2002)."Internationaltableofglycemicindexandglycemic loadvalues:2002" .American Journal of Clinical Nutrition76(1):556.PMID12081815 . 155. ^LiljebergElmsthlH.&Bjrck,IngerME(2001)."Milkasasupplementtomixedmealsmayelevate postprandialinsulinaemia" (PDF).European journal of clinical nutrition55(11):99499. doi:10.1038/sj.ejcn.1601259 .PMID11641749 . 156. ^HoytG,HickeyMS,CordainL(2005)."Dissociationoftheglycaemicandinsulinaemicresponsesto wholeandskimmedmilk" .British Journal of Nutrition93(2):17577.doi:10.1079/BJN20041304 . PMID15788109 . 157. ^CordainL,EadesMR,EadesMD(2003)."Hyperinsulinemicdiseasesofcivilization:morethanjust SyndromeX" (PDF).Comparative Biochemistry and Physiology Part A: Molecular & Integrative Physiology136(1):95112.doi:10.1016/S1095-6433(03)00011-4 .PMID14527633 . 158. ^FrassettoLA,MorrisRCJr,SellmeyerDE,SebastianA(February2008)."Adverseeffectsofsodium chlorideonboneintheaginghumanpopulationresultingfromhabitualconsumptionoftypicalAmerican diets".Journal of Nutrition138(2):419S22S.PMID18203914 . 159. ^FrassettoLA,MorrisRCJr,SebastianA(2006)."Apracticalapproachtothebalancebetweenacid productionandrenalacidexcretioninhumans" .Journal of Nephrology.199(19):3340. PMID16736439 .[dead link] . 160. ^Larsen,ClarkSpencer(1November2003)."Animalsourcefoodsandhumanhealthduringevolution" Journal of Nutrition133(11,Suppl2):3893S3897S.PMID14672287 . 161. ^Hermanussen,MichaelPoustka,Fritz(JulySeptember2003)."StatureofearlyEuropeans" (Athens)2(3):1758.doi:10.1159/000079404 .PMID17003019 .

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