 It is my great pleasure to introduce Stefan Lindeberg, who is going to give a talk, Food and Western Disease. Please welcome, warm round of applause, Stefan. I'm delighted and truly honoured to stand at this historic event among so many paleo enthusiasts and follow two of the persons who are among those who have inspired me the most. I read Boyd Eaton's paper in 1985 and I had a neighbour who was a vegetarian in Chitome. Well, we have a gut of vegetarians. Oh yeah, I said and went to the library and then it's just been flying on its own wings since then. Lauren Cordain who has helped me to understand so many of these details. And one of the persons who have helped me to understand the importance of biologically active substances in foods, which at this point I think are more important than macro or micronutrients. So, as you will see during my speech, I'm no proponent of a low carb diet. And I think biologically active components of food are more important to understand why we have diseases that are absent in some populations. So, essentially all what I say is in a book I published last year, Wild and Blackwell, Food and Western Disease. I have a home page, also I'll show you in the end, stuffonlinderberg.com. Well, the basis, just a few words about the basis of nutritional advice. Unfortunately, stories are a big part of what we or any person believes is healthy food. And people like John Harvey Kellogg has had more influence on thinking about healthy diet than Darwin has. I see so many people here now, so I'm optimistic for the future. The story about low carb, I will come back to it every now and then in my talk. But essentially the idea that post-prandial, that is after a meal, post-prandial increasing glucose is the cause of Western disease. It's, well, you could call it a hypothesis or a story. Sometimes it's hard to differ between the two, but it's certainly not been proven that it's the main cause. Then another question is, if your glucose intolerant, then you cannot handle high loads of carbohydrate. But that's another issue. And of course money, I don't have to say anything about that. But it's obvious for anyone who goes into this kind of business from a scientific or any other point of view that money has a huge impact and has had. So we have science also and at this point epidemiology, observational studies have had more influence than clinical trials. Of course it's difficult to make clinical trials to have two groups who eat what they think is exactly the same type of hamburger. One group eats hamburger with real meat and the other group with placebo meat and one group with a vice versa for the bread. Of course it's impossible to do it at this point, maybe sometime in the future. But for most issues it's impossible to do a real good study. So we need to include evolutionary thinking as Boyd and Lauren has shown so brilliantly. For example, many people feel that it's good, they say it's natural. So sometimes when they use the word natural they mean it's evolutionary. It complies with evolutionary principles to breastfeed your babies that are giving it... Sorry I'm a bit jet lagged so I don't find the words... what do you call it? But sometimes natural can apply to what I call nature romanticism because sometimes it comes from nature then it's good. So some women give their babies formula based on soybeans because they feel that this is natural, it comes from nature. Then they forget that the soy plant wants to survive just like any other plant and maybe this is trivial stuff for you but I'll say it anyway the defense system among plants is a highly underestimated health hazard because the plant cannot run away so it protects its children in another way by producing high amounts of biologically active compounds such as guenstein and the phytoestrogens that are so highly praised because they come from nature but we should apply evolutionary principles on our thinking. So I'm more afraid of guenstein because it's deliberately directed towards herbivores while DDE the metabolite of DDT it just happens to be estrogenic it could be a health hazard from my understanding it's not proven as much as people think but anyway I'm more afraid of deliberate estrogens from nature than of those who happen to be estrogenic so this is the natural hormone, the stratium. Okay and closely attached to evolutionary medicine these days is observations among traditional populations with hopefully hundred gatherer lifestyles but sometimes you cannot find the populations with true hundred gatherer lifestyles and when we did the Kitava study these are the Kitavans a 50 year old man to the left and his 87 year old father. In 1990 we chose that particular population because they had enough elderly people and they were a large enough community with non-western food habits so we could not find under the circumstances we had available to study a hundred gatherer population but that would have been the best thing but anyway when you study very diverse populations like the Eskimos with a low carb diet and you study hundred gatherers sometimes with a high carbohydrate diet from root vegetables the main thing is that they don't eat western food the 70% that Lauren showed you is absent for both of them but the amount of carbohydrate or fat can be very very different and the ones we studied the Kitavans have a high carbohydrate intake but I would have been glad to study a low carb population so my issue is not that fat is bad I think it's not the main issue to understand why they don't have western disease so we have the Troven Islands north of Papua New Guinea and we chose Kitava Island because that was the part that had the least influence of western food habits so 0.5 dollars per year 50 cents per year on average was spent on imported food so it's negligible and it's a lot of yam, sweet potato, taro, tapioca there is some other foods around there's been a debate at least in Sweden they say that I did not see the pigs because I did not want to see them well please be more careful these people are in love with the low carb hypothesis so they tend to miscredit me but pork meat is eaten at occasions but it's almost negligible the striking thing then is that coronary heart disease, ischemic heart disease like myocardial infarction is apparently totally absent and they are very well aware of what happened two or three generations ago they were very keen to explain in detail and they knew exactly from village to village the name of the persons who had this or that disease and we can rely on it and also we are helped by two physicians two German physicians who have worked there for years and they both state that they have not seen cardiovascular disease and this complies with findings in many traditional populations so our populations are not hunter-gatherers they are primitive horticulturalists they use a wooden stick to dig and they cultivate yam and other tubers and they cultivate fruit and they fish and they get coconut so they have just as much saturated fat as in Sweden they get it from coconut stroke is absent as well and you sometimes forget stroke when you discuss cardiovascular disease so the Japanese have had a lot of stroke and some other low risk populations have had just as much stroke as others this is also consistent with findings for example in East Africa when the British came to Kenya and Uganda they found from 1920s and so on that stroke was absent among the indigenous population and then it became the most common neurologic disease parallel to a change in society changes in lifestyle and so forth now history repeats itself in Papua New Guinea so this 47 year old man has hemiparesis and aphasia he cannot speak, he cannot move half of his body it happened like this from one day to the other and of course when we asked in Kitaba about this they knew that they had never heard of sudden inability to speak or sudden paralysis in a conscious person it tells us something important many countries who have what we consider a healthy lifestyle in Bahrainian countries for example have a lot of stroke so we should not forget stroke when Japanese migrated to Hawaii stroke decreased and myocardial infarction increased and even more when they migrated further to the United States we measured a lot of variables related to western disease and their levels are brilliant and this has been shown in so many populations so it's almost trivial actually it's trivial to many people who do not accept the paleo concept but they cannot, well you know how defence mechanisms work and if there's a new way of thinking logic is not always working so fasting serum glucose is two standard deviations lower in the red Kitabans than in the yellow healthy Swedish population and about the same for body mass index if you have a 50 year old woman in Sweden on average she would weigh 22 kilos less if she had the same BMI as in Kitaba, German islands unfortunately the difference is even bigger because she has more fat I think the concept of sarcopenia the concept that Boyd was talking about that you have too little muscle mass is very important to elaborate on the corresponding figure for men is 19 kilos if they had the same BMI as in Kitaba blood pressure is low in traditional populations including the Kitabans I will go through some of this kind of trivial stuff of course it's not trivial it's certainly not trivial to my patients when I tell them that your blood pressure is normal which means normal Swedish blood pressure but if you want to have a real low good blood pressure you need to go paleo so I'll skip some of these slides because they just showed some details about and this one too it's better we have time at the end for questions so when traditional population migrates or becomes organized the whole population increases its blood pressure or blood sugar so 100% after migration have a higher blood pressure than they would have if they had not transitioned into a western lifestyle I was asked by the European Heart Journal a couple of years ago to comment on the fact that when you measure serum lipids or blood pressure in a random Norwegian population you find that after the age of 60-65 virtually everyone needs medication so most people feel we have a problem here and the problem is not that the studies are misinterpreted I think you gain something most people if you take these medicines but of course we have a problem why in the first place did we put ourselves in this position throughout decades of unhealthy lifestyle and this chart actually is a so-called low risk Mediterranean population so the Norwegians are worse off but not very much worse than the so-called low risk populations you should remember that atherosclerosis I don't know is there a popular term or does everyone understand atherosclerosis like hardening fattening of the arteries which is the basis of cardiovascular disease in many many cases this is a process that affects virtually everyone so this 40 year old US woman has a normal coronary angiography but when you study her with ultrasound you see that there is thickening on the artery there is compensatory enlargement of the artery so that blood flow remains normal but the process is going on and in autopsy studies up to age 40 you see that most people who die in car accidents or whatever have fairly advanced atherosclerosis so this is a if you like normal process but in South Africa in the 1950s it was noted in autopsy studies that black people black males, middle aged men in Durban South Africa 76% of them had no or virtually no atherosclerosis of the coronary artery of the heart versus 9% of white men in New Orleans and it's not genetic because blacks in the US for example have just the same amount so this is something with the modern life standard in animal experiments and animal observations it seems pretty clear that you cannot get atherosclerosis in animals without a wrong diet so diet is the outstanding cause of atherosclerosis in animal experiments virtually the only way to get regression to have it go back and yes, it's not only about fat there are also bioactive substances that seem to be important and the impact of serial grains is uncertain I hope some of you will be able to listen to Lauren Cordain talking about atherosclerosis because he knows a lot about everything especially this and autoimmunity and some other diseases so a low risk westerner is not the same as a non westerner and this physician says that your blood pressure is normal and the patient doesn't ask anymore but sometimes they do ask and my experience is that they are very interested to discuss where do we come from, what did we eat and so forth and also the physician tells this patient to lose 20 kilos and then please come back and tell me how on earth you succeeded it's not because of lack of elderly that these people don't have Western disease there are enough elderly this woman is 94, this man is 100 years old our age estimates were based on historic events so in 1912 a man from Australia came and settled in Kitaba this is his gravestone in Kitaba he stayed there until his death this is a Japanese sea wreck so we have some historic events which we could relate to we are pretty safe with our age estimates and it's not from genetic reasons this is a Trojan islander now living as a westernised businessman in the mainland he was the only one with a blood pressure above 90 the diastolic blood pressure the only one who was larger around his waist than around his hips and so forth actually they are more vulnerable Europeans, Anglo-Saxons and others are slightly less vulnerable when we eat a western diet 75% of smokers smoking in different studies suggests that this comes on top of atherosclerosis and other things energy expenditure is high but not extreme so an average construction worker in Sweden would have about the same level of physical activity but on retirement day he looks very different in every aspect their saturated fat intake is high from coconut their total fat intake is low but I don't make a big point of this I don't think you need to eat a low fat diet I think you need to stay away from western food so 65 to 70% of their energy comes from carbohydrate starch, mainly starch which as you probably know is the main villain for glucose intolerant people as long as there are glucose intolerant our studies suggest that you can improve your glucose tolerance immensely by reverting to a paleo diet I skip some of these slides now humans have a high capacity to digest starch we have a high capacity of salivary amylase we are still descendants of starch eating ancestors I don't say we need it but I say we can cope with it so carbohydrate and fat both to the left and to the right but very different types of food I think we should talk about food instead of macronutrients and things like that and when we talk about the big villains I think we need to be much more about bioactive substances in food so far for prevention and now treatment of disease there are very few studies you will hear Linda Fressetto later she and we and a few others are those who have done the few randomized controlled trials you could say that the critics are right when they say there is too little data well yes, I tend to agree there are small trials, there are not long term trials and so on but it's a start and we found that in patients with early diabetes or some of them had only impaired glucose tolerance that's pre-diabetes all of them reverted to normal glucose values on a paleo diet and in another study we found that in patients with more long standing type 2 diabetes paleolithic diet was more beneficial than what we normally tell our patients to eat and then Linda Fressetto's group has shown that healthy subjects lower their low density lipoprotein cholesterol, the bad cholesterol, triglycerides and fasting insulin very much and the area under the insulin curve when you drink glucose solution by a very high figure also so all these findings are very promising I think I skip these slides this is what I just said about our study so in addition to that we have many promising case reports I look forward to meet Ben Bolzer there might be many others I have not met so far who can tell about their experience as physicians I think we should start collecting data not only about the success stories but also about the failures because there are a couple of failures where I don't quite understand how to proceed but on the whole it's a very successful clinical experience that I have so far there are no obvious risks Pedro Bastos will tell you more about milk later today it's surprising how uncertain the effects for bone strength are that has been propagated for so many years now because there's money in it and other issues as well iodine is an interesting story I think the requirements of iodine as we see it as it is proposed it's not wrong but it's hard to see how could our ancestors maybe I think we can perhaps come back to that later but this is one of the issues we need to discuss more within the community because if they were not eating lots amounts of shellfish and marine fish on a daily basis they would have problems unless they knew that they need to take the thyroid of animals and split it in group or thyroid requirements during the Paleolithic were lower it could be that today they are increased due to substances in food that interfere with our thyroid system it could be sustainable if you eat more root vegetables if we find out that root vegetables are healthy then it's perhaps more easy for sustainability and more local production no fertilizers soon we are out of phosphate and what happens then there are many issues that are problematic no dairy is more sustainable than with dairy and sustainable meats, eating organ meats and you get involuntary calorie restriction in our experience and in our studies if you eat as much as you like but you just pick paleo food you get automatic calorie restriction so if we eat less it's more food for the planet everyone agrees this is unhealthy everyone agrees this is healthy the funny thing with this slide is that it's very different belief systems connected to each of the pictures so if you ask someone what do you believe in well I believe in the DASH diet now yeah it's this one the dietary approach is to stop hypertension diet but when you look at what is on the plate you see that well more or less paleo so common foods may cause common health problems and food choice may be more important than to count fat to count carbohydrate or calories nearly all of us get atherosclerosis and we don't know why I think nutritionism has been too much on the agenda this is a term from what's his name Scridini so something like that picked up by Michael Pullman thank you so much for the suggestion that reversals can be made in blood glucose etc by going grain and dairy free do you find that atherosclerosis can be reversed? well in animal trials it has been shown that it can be reversed in humans the few studies that have been made were with either extremely low fat diets suggesting that fat can have something to do with in some cases but we know too little there are too few studies but certainly the animal experiments show that it can be reversed yes even calcified plaques can be resolved so the option seems to be there can you make a comment on somebody who is pre-diabetic and if you continue to eat a lot of fruit do you look at certain fruits having more fructose do you take that into account? I suggest you follow your patients in my experience they can eat a lot of fruit in the first study I mentioned they were eating I think half a kilo of fruit a day there is much water in it it's not as much as it seems but in another study we made in more long standing diabetes that we did not publish it was kind of pilot study many years ago they were eating six fruits a day and nothing untoward happened I think the main issue is to get the patients to become more glucose tolerant meaning they can handle fruit better and I think paleo diet is better than any solution I am aware of well they eat pretty often they have three big meals a day and in between that they eat when they are hungry or they want to eat so they take a fruit or they take these young coconuts from the trees either they climb up themselves one 70 year old man he died when he fell from the coconut tree that's the side story but they eat fairly frequent nevertheless I think intermittent fasting is an interesting option I am glad you mentioned it so what would be your point in this area why did you ask they boil their food their tubers so it's a lot of carbohydrate from morning to dawn that's what steak was asking about the question you heard about people's metabolism being geared towards burning fats and ketones versus burning sugars on glucose and if the ketopins for example are eating a high carb diet the amount of carbs that are used to burn in the short term post-pandial is stored in liver glycogen to the extent that there must be others left over is that turned into fatty acids that are then stored and then released between meals during longer terms in which case it would be even though it's a high starch diet it somewhat becomes also a little more of a high fat diet is that a possible hypothesis certainly yes I don't know so much about those details but it certainly is as far as I'm aware yeah, thanks questions then why don't we put our hands together again we'll reconvene here in a couple of minutes at 10.55