 All right. We've been talking a lot about paleolithic nutrition, evolutionary medicine. But what most of us do is they have blogs and they do theoretical research. Well, that's of course interesting. That's a generating hypothesis. But what actually what needs to be done is there needs to be done randomized clinical trials. And of course, there needs to be basic knowledge. Basic knowledge from where we come from. What do we know about paleolithic nutrition if we take a look at the place where we should take a look, where the paleolithic was and during the paleolithic, what was eaten? Well, as I told here, I'm also going to tell you a lot about what I did during my research, during my PhD. But I'm also going to do some myth-busting. There's a lot of myth I've heard these days, a lot of stories people told and things people were saying. Well, a lot of things I need that need some clarification. The first of this evolution is about reproduction. So after a successful reproduction life, it's useless. I've heard it several times during this symposium. But well, of course, we agree that reproduction is very important. And well, evolution is about reproduction. But there's more, because it's not about only reproduction. As I, well, I asked this question to Dawkins once and he was laughing. He said, no, of course not. It's about the amount of offspring you have. The second step is that offspring needs to reach reproductive age to have offspring itself. And at last, it needs to be fertile. Well, that's called the grandmother hypothesis, the grandfather hypothesis. It has been tested in several species of monkey, of apes. It had also been tested in humans. I know about one study in the Hazabee. But I also now know about a friend of mine. It's from Bodegom. He went to West Africa, and he did a similar study in several thousands of Africans. And he found that children who have a grandmother at the time of their birth have 2.7% more offspring. So that's an increase in offspring. That's an evolutionary advantage. Second, 80% of the children in this population were sired by a man over 50 years old. So that proves that after you have reproduced, you didn't reach the end of your life. You're not useless anymore. Even old people have their uses. They also bring evolutionary advantages to the rest of, well, their offspring. So let's get back to the, yeah, welcome. Tell that at home. And evolutionary medicine. Well, this is what we all know, of course. This is nothing new to you, everybody here. Of course, no, it's an equilibrium between our genes and our environment. And, well, diet is one of the examples of the environment which we shoot, well, which is in some kind of optimal equilibrium now with our ancient genome. Well, what do we want to know? We want to know what was the composition of our diet during the Paleolithic and before. So if we have knowledge on that, we can, well, give advices on what we should be eating now to make this equilibrium or restore this equilibrium again. Well, then first we have to answer the question. And I think Boyd Eaton was talking about it this morning. Where did evolution of the human species take place? Well, we know that our last common ancestor with the chimpanzee was about 6 million years ago. Well, that's 6 million years. That's a lot. Boyd Eaton was talking about 50,000 years ago. But he was, of course, talking about the Paleolithic and some ancestor which was living, well, 50,000 years ago he could be living everywhere, actually, because we had already left Africa. But I say we spent at least 6 million years of evolution in Africa. Well, that means since about 100,000 years ago we left Africa, 89% of evolution occurred in Africa. So if we want to say something useful about our Paleolithic nutrition, what we ate during the Paleolithic, we should go back to Africa and especially to East Africa, the cradle of mankind. Well, I'm not the first who was thinking about it. Of course, Boyd Eaton himself published about it in 1985. It was specific on this subject. He was talking about what were they eating in East Africa and co-ordained it the same. But actually, it was earlier already in 1968 when Richard Lee and Irvin DeVora they organized a famous symposium. It was called Man the Hunter. And he wrote some interesting things about it. What did he say? Well, you can read it here. The general view is that gathering of plants and shellfish should be the most productive for hunter-gatherers followed by fishing. And then, while the hunting of mammals is the least reliable source of food. Well, that's something else we have been hearing a lot here, especially some fitness talks were showing a lot of meat. Well, if that's the least reliable source of food, maybe, well, should we call ourselves Man the Hunter? Well, that was the story and the question this Richard Lee also wanted to answer. So what did he say in the end? He estimated from this atlas, that's on the previous slide. You saw the ethnographic atlas. That's an atlas containing, well, all the world populations, including the Dutch, all the different Indians in Northern America, but all every small population or small tribe on this world. They extracted only the people who were not dependent on agriculture from that atlas, and they were investigating what percentage of, yeah, what percentage in these people who only depended on either plant food, fishing, or hunting rely on hunting only. Well, he said 35% of the diet in worldwide hunter-gatherers society, societies derived from hunting. Well, that sounds plausible and that's still what's being used. However, and Cordain pointed this out, he said, because from 1968 on we said, okay, man the hunter, the myth has been busted. We were eating 65% plant foods, but yeah, probably if we're listening more clearly than most of the listeners at that time, I was talking about plant food, I was talking about fish food, and animal hunted food. So actually Cordain said, we should not be talking about 65% plant food because the other 35% is something else. And of course, well, I already told you that must be derived from fishing. So only 30% derives from plant food, 35% derives from hunting, and another 35 of subsistence derived from fish foods. Well, we published this in 2010. It was me together with Boyd Eaton, Michael Crawford from England, and Lord and Cordain and my professor for this mosquito. We published it in the British Journal of Nutrition in 2010, that it was like, it was also very important to include fishing in our thoughts about what was our Paleolithic diet. And then I wanted to add something else. Cordain also said the scores that were in the man the hunter book and in the ethnographic atlas were percentage of subsistence, mostly by weight. But as everybody in this audience knows, is that of course, if you eat meat and if you eat fat, that contains more energy percent. So actually the numbers, the real numbers might be a little different, but for general purposes also Cordain used these numbers, 30, 35, 35. So again, this is the picture that Boyd Eaton was showing to us this morning. And well, I was surprised that after he showed us a picture of the savanna, he showed us this, the shellfish. So I was wondering, where did he find these shellfish on this arid savanna? Well, I can tell you if whoever has been in Africa knows that it's not all dry grass and not all savanna. Well, this is actually a lot of places in Africa, beautiful places and especially of course in the Paleolithic long time ago when there were more dry and more moisture periods. A lot of times Africa looked like this and there was plenty of food and well actually there were also more human species around than there are now. So I think the myth man the hunter has now a little bit been busted. This is only something that happened with the more recent Homo sapiens like 50,000 years ago, maybe 200,000 years ago but like two million years ago most of the plant or most of the food was not hunted but it was for a large part derived from gathering plant foods and gathering fish or hunting fish. So we could better be talking about man the gatherer. This is actually a picture from Australian originals at the moment that the first explorers who were arriving there, men were collecting oysters and mussels and stuff like that on the beach. So there's additional evidence. The probability of a kill in a bushman is only 23%. So you could say hunting is very important for those people, yeah, that's true. They talk about it all the time. If you go to a campfire they will be talking about the hunting but that is because hunting is important for them and of course they like most the food that's deriving from hunting but it's not their primary source of food. The probability of a kill is only 22%. So a long period of the other time they're probably running for elephants instead of catching them. So in this case also, if the men are running for the animals it might be women the gatherer and you can also imagine. The arid savanna is much too dangerous for the woman and especially for a child especially for a pregnant woman. So a much easier place for a woman to collect their food is on the beach and that's what you see also if you go to Africa. Woman can collect both plants, stranded fish and shellfish and even with their children. So let's back to the case. We ate at least 35% food. That's what the ethnographic Atlas is telling us what actually man the hunter was already telling us but it was not interpreted right. So I was looking for additional evidence. Is there more evidence that we derived a significant proportion of our diet from fish? Is there archeological evidence? Is there isotopic evidence? And I will tell you about it more. Or is there more evidence from human physiology and epidemiology? Well first, archeology. Very difficult to interpret. Why? Because the sea level has risen over 150 meters in the last 17,000 years. So all the places where we live close to the sea, well you can go there but you have to wear diving stuff and you have to be 150 meters deep. People are actually doing this. They are trying to do archeological, find archeological stuff under the water. But yeah, it's very difficult. But there are some places for example caves which used to be very close to the water which are now, well they are under the water but somehow there are some caves which have gone up now and that's for example in South Africa. And they have been finding a lot of archeological evidence that people were using aquatic resources. Actually if you take, and that's the, well we are fortunate that of course a lot of lakes inside the water level has remained more constant. And what we see is that the oldest evidence for the exploitation of aquatic resources, resources dates from about two million years ago in Lake Turkana. Well I've written a review about it and you can see it on the right bottom corner. There's actually much, much more evidence for use of aquatic resources. There's a lot of fossil evidence. There's a lot of just shells. There are shell middens. A lot of bones from aquatic animals which have been used by humans. So the evidence is there. There's clear evidence. Even use of more sophisticated ways of hunting date from only 90,000 years ago. Zaire, they have been found harpoon points. They have been found fishing hooks. And if you go back to seafaring, they have found canoes that were dated 42,000 years ago. But there's also fossils from Flores, that's near Indonesia. They have found human fossils on Flores Island. Well the people who have been there, maybe not so many, but there's a very deep sea straight among the mainland and Flores Island. Which is about five kilometers wide and about five kilometers deep. And if all the water is getting through, it's very strong current. So it's impossible. It's like nobody has ever made that crossing swimming. So it's impossible to imagine how these people, those who are erectus actually it was. So they are like one million year old or several hundred, 800,000 years old they assume. How could he cross this sea street without, well, basic knowledge of how to navigate the sea? Well, they didn't find any evidence, but the evidence that that guy was living there is somehow evidence. So they're not yet, yeah, they didn't yet find out how he got there. But a two kilometer deep reef seems to be a very difficult obstacle you could only cross by navigating. Well, we know about out of Africa diasporas. Well, this is the out of Africa diaspora and you see that almost, well, almost all of the coasting out of Africa occurred along the coast. People were following the coast. They always used the water to move out of Africa. And that's not the coincidence in my opinion. Those people used the aquatic resources for basic life. Like I was telling you, hunting provided only a 23% success. So it was like, as has been told by other researchers, shellfish and fish were like their butter and bread. It was their basic food. They weren't even talking about it. I was in Africa and people told me we were eating vegetables. And when I was invited to their dinner, they gave me fish. And I said, this is not a vegetable. And they said, yeah, but it's basic food first. We call it a vegetable. It's so common. Well, imagine how it was happening that time. There was more. People were eating fish and shellfish all the time. It was their basic food. Hunting was of course more important for them. But it doesn't mean nutritionally more important in amounts. It was in their head and it was, yeah, it was not in the amounts that it was more important. Well, then isotopic evidence. Maybe if, well, most people here have probably read this article. It was in Science last year, written by Ungar and Matt Sponheimer from South Africa. And those guys do a lot of isotopic ratios on fossils. And by comparing these isotopic ratios, they try to find out what people were eating. Well, there's one isotopic ratio which is interesting in my opinion. It's the C3 and the C4. C3, well, it's something they measure the ratio between those two in bones. It's very difficult, but I can explain it shortly. C3 is typically from bushes, forests, trees, and stuff like that. Well, C4 is typical for savanna grasses. So because we were thinking we derived from a chimpanzee-like creature, we would be eating most C3 plants. That is because that's the fruits and that's all the leaves that you can find in the rainforest. But when they did the analysis, sorry, when they did the analysis, they saw that the values they found were somewhere in between for C3 and C4. So, well, that proved either that our ancestors were eating grass, C4 grass, or they were eating part of their diet from other animals that were eating C4 grasses. But, well, after some discussion, they said, well, that's quite difficult. How can those early hominins catch, for example, buffaloes and zebra on the savanna because these were the Homo erectus a few million years ago? Well, then they found another option and they said, maybe it's termites. Well, that is from what I have found is the latest option they have found for the outcomes of their research. But we did more extensive research on the same subject. This is the ratios you can find for our ancestors. And here you see the termites. So their isotopic ratio, it's called their isotopic footprint, is closest to termites. That's the only thing they said. They hypothesize it's close to termites. What they also said is, maybe we have been eating a mix of C3 herbivores. So that's herbivores in the forest and a mix of C4 herbivores. Where's the C4 here? So if you have a mix, you mix this one with this one, you might end up somewhere in between. Well, that's also a possibility. That's the possibilities they were giving us. But as you do a more extensive literature research, what we did, we did a review, you see, you also see that freshwater fish, marine mammal hunters, crustaceans, freshwater fish, fish agaterus, freshwater carnivores, all those fish eating animals are very close to the ratio we found in early homo. But for some reason, especially the archeologists, do not want to believe that we were possibly eating fish. Well, actually the ethnographic atlas showed us 33% was deriving from fish or 35. I don't know, well, nobody really knows why it's this way. I contacted Matt Sponheim and he said, well, we will take it under investigation and that was, well, a year ago. Well, there's more about epidemiology and pathophysiology. What does the aquatic environment provide us more? It's some very important nutrients. Ben Balzer had a poster presentation yesterday about iodine and brain development. How important it is for brain development to consume enough iodine? It's related to IQ. Well, iron, we've been hearing a lot about iron today. Iron is also very important. Selenium, well, I haven't heard a presentation about it, but it's also very important for us. Not to mention vitamins A and D, and of course, omega-3 fatty acids. Moreover, DHA is the most important fatty acids in the human brain. So, well, we had the discussion with Lord and Cordane and he had a paper about it some years ago and he said LCP for brain expansion because DHA is very abundant in the brain. It could also derive from a scavenged brain. Well, that's possible, of course, but as most of you know, well, you can imagine who needs most of the LCP for a developing brain. That's not the man scavenging on the savanna. That is the pregnant woman who is not scavenging at the savanna and who is waiting at her husband at home. And especially the infant who has his brain spurred just shortly after birth also needs a lot of DHA. So either they go on the savanna, which is unlikely, which has not been proven in present hunter-gatherers, or those men have to bring back those LCP. Well, that's a blubbery brain, all those kilometers from the place where they're scavenging an animal. Well, I have heard a story about a long-distance runner from Professor Lieberman, but I'm not sure if they were experienced in long distance running with a blubbery brain in their hands. Well, but what is the solution? Again, women can collect shellfish, can collect fish at seashores, at lakeshores, and those are also very rich sources of omega-3 in LCP. So what we did is, in the paper I was already talking about, we did in Crawford and Cordain, we made a model for what if we include 33% aquatic foods in a paleolithic diet. Well, we used some constraints for that model because, of course, well, it has been said before, 35% of protein is a maximum level linoleic acid. LA here means it's, there it is, there it should be at least 1% of energy. And well, we said it can only be locally available foods, so foods from the East African ecosystem. The plant animal ranges were ranged between 30 and 70, but the amount of fish and animal within that model could range from zero to 100%. So where did we end up with that? Well, actually it was quite the same, and maybe some of you have read the paper, it's the last assumption or the last estimation we made of a paleolithic diet with Cordain. It's about the same numbers for Missouri papers. The only thing is we now included long chain polysaturated fatty acids. And the interesting thing was in these diets they were consumed in gram amounts. Well, that's a little bit different from what we are advised by the nutritional boards nowadays. And the second thing is that linoleic acid was very low. So, well, the interesting result, and we wanted to prove this in Africa, was we had high LCP intakes and very low linoleic acid intakes. But what does the facts on the floor tell us? So we went to Africa. This is what I did. I drove my car all the way from Cape Town. Well, finally back to Amsterdam where we did a lot of stops. We were looking for hunter-gatherers. Well, these guys, of course. But yeah, I am mid-busting today, so I can tell you those guys are not here anymore. I found some and they said, I can redress for you if you pay me. Yeah, so probably his food wasn't that traditional either. So we continued. We went from South Africa where we, this is from Botswana, actually, where we met this guy, not this guys. We went further on to Tanzania. And in Tanzania, we had the same problem. The Hazabee, they were, well, they were living traditional, but they had every tribe had their own anthropologist and they had their own food supply from local tourists. And if it wasn't food, it was alcohol. So we had a lot of difficulty finding real traditional people. So in the end, we decided we'd try to find people who show parts of a traditional lifestyle. So for example, the pastoralists, some agricultureists, they practice agriculture, but they're still eating a lot of local fish from the local lakes. The same for hunter-gatherers. They also have some, well, natural traditions. For example, they walk around, well, half-naked, who has ever seen the Hazabee. So from these combination of tribes in Africa, we try to reconstruct our Paleolithic diet. Well, for example, we collected milk samples. We did two papers on that. And you can see that's a lot of people. For, this was for examination of the amount of fish. Like I told you, 35%, we wanted to prove that. So we used DHA as a proxy for fish consumption. And what we saw is that, I shall start with DHA. Indeed, in the populations where we sampled, we found very high contents of DHA in the milk, proving that they were eating a lot of fish. And also that's, well, it's physiologically possible to have very high concentration of DHA in the milk just by eating it. The other thing was in, and that were only a few tribes that were not yet using cooking oil for frying or for whatever. And those people indeed had very low concentrations of linoleic acid in their milk. So this is another myth. We saw that Paleolithic intakes of linoleic acid were very low, not only from the reconstruction, as I showed you before in the paper with Codain, but also proven by the milk of the people who were not yet eating vegetable oils. Well, nevertheless, the American Health Association is advising us to consume over 10% of linoleic acid. So, well, that's not really the same as a Paleolithic diet contained probably. Well, that's what I was talking about at a congress with a friend of mine, Chris Ramson. And he said, he did a meta analysis on the subject. And he said, do you know where the recommendation from the American Health Association derived from? He said, they derived from studies which have been performed with PUFA. That's a combination of alpha-linoleic and linoleic acid. And he excluded all the studies that contained both of these. And he showed that if you were just eating more alpha-linoleic acid, that's also a PUFA, then indeed you had a lower cardiovascular disease risk while you only took the linoleic acid trials, you actually had a borderline higher risk of cardiovascular disease. So these recommendations from the American Health Association are quite biased by using, well, the wrong studies to say something about linoleic acid while you actually use the combination of alpha-linoleic and linoleic acid. Well, that's an important difference. Well, as most of you know, also the present, high intakes of linoleic acid interfere with the chain elongation from alpha-linoleic acid to its long chain metabolites, EPA and DHA. So that's another disadvantage of eating these high amounts of linoleic acid. So this myth is also busted. Linoleic acid, for me, is not healthy. So what did we do further? We also collected more strong status parameters. Besides milk, we collected erythrocytes from these people from the different locations I was showing you. Well, that's what we did because we wanted to show the difference with the physiological pregnancy in Western countries. Well, what do we consider normal in a Western pregnancy? For everybody, well, most people probably won't know, but biomagnification means that if you take blood from the mother and her child at delivery, you will find that the infant has a higher erythrocyte DHA status compared to his mother. Well, in other words, the infant is more important during pregnancy. It attracts all the DHA, how do you say? It eats all the DHA from its mother. So the mother will deplete during pregnancy and actually during, it said, well, sorry, this is the infant. The infant, it should not be during pregnancy, it should be during lactation. So what I was saying is biomagnification is normal in a Western pregnancy. Well, the mother depletes her DHA stores during pregnancy and during subsequent lactation. What you also see is, despite the depletion of the mother, the infants in a Western pregnancy still deplete their DHA stores during lactation. Is that normal? Well, in Western countries, we consider that as normal. Well, we do a lot of supplementation studies, but they are based on, well, outcomes. They never based on depletion. If you look at the studies, they didn't look at what happens to the actual status. Well, we did that. And what we saw is that in those African people with the high intakes of fish, you saw a few differences. First of all, at delivery, the African woman with high fission takes had higher erythrocyte DHA status compared to the infant. So no biomagnification. The mother is still higher. While here, the mother is lower compared to the infant. Second, infant erythrocyte DHA status. That's a proxy for the DHA status in general. Increased after delivery, you can see it here. The infant goes up. Well, in Western pregnancies, the infant and the mother go down. And last of all, what we saw is that the decrease in the maternal erythrocyte status here, this is in almost vegetarian, well, semi malnutritioned African mothers, the DHA status increased a lot. Well, in Western pregnancies, it also decreased it, but less, but what you see is it gets even less. The decrease is still less in those African women with not even that high, but quite high intakes of DHA. So what we could calculate, and we pull up a stat in the Joan of Nutrition, is that if you, well, if you go any further, for example, you say if you eat more fish, what status should you have not as a mother not to decrease your DHA status? Well, that was eight. Well, remember the eight. Because DHA is associated with more diseases and more things such as post-imperial part of depression. It's connected to infant neurodevelopment. It's connected to psychiatric disorders. It's connected to fertility. For example, if you look at sperm, sperm has a long tail. That's why it swims so fast. I heard during lunch, some woman talking about, fertility is very important. So I was thinking, oh, I have to add this. Sperm is swimming more quickly when it contains more DHA. That's an interesting detail. And of course, cardiovascular disease, myocardial infarction, and antirhythmic effects of DHA are very well known. And last of all, inflammation with the metabolic syndrome. What is the role of DHA in inflammation? I will tell you shortly. First of all, cardiovascular disease. What did we see? This is a study by Harris. He's the same guy who did the American Health Association recommendation for Linnolake Acid. But whatever, he also did a study on DHA, which I do trust. And that's like, if you had a very low DHA status, that's the fish oil, you had a very hot, well, it was normalized to one. But as soon as your status increased, the risk of getting cardiovascular disease increased very, very significantly. This is about 25%, so from 1 to 0.25. That's a big decrease in cardiovascular disease risk. And even if they compared it to other risk factors, look here. This is HDL. This is LDL. This is CRP. The biggest risk reduction you receive by monitoring your DHA status. So why is everybody talking about CRP, inflammation, DHL, LDL, the ratio, even homocysteine? Well, the most important, well, in my opinion, a very useful risk marker for getting a vascular disease would also be monitoring your DHA status. It's very easy. Well, the method is not that easy. But it's a very good marker for evaluating your risk of cardiovascular disease. So the second thing, psychiatric disorder. Horabin wrote a book about it. Psychiatric disease closely connected to DHA. And they also saw the lowest incident of major depressive disorders and bipolar disorders from a DHA status of 7% like a little bit lower than the 8%, but still. And then inflammation. What did we see? We collected thousands of samples from African people. We collected thousands of samples from Dutch people, from Caribbean people. We collected a lot from malnutrition. Well, it was Pakistani and Israeli children. And what you saw is there was a parabolic, like a disshaped. What is it? The shape of curve between DHA and AA. Well, most of you will know. I lost my red thing here. DHA and AA. AA is known as pro-inflammatory. And DHA is known as anti-inflammatory. So what you saw in those women, because, well, in this example, we only collected a lot from women, you saw that their increasing DHA status decreased their concurrent AA status. So that might be the pro-inflammatory reaction was suppressed by the anti-inflammatory DHA, which was high in those women. Well, I will be quickly about this. We also collected, to say something about neurology, we collected brain from infants who were diseased during delivery. And we found in these children we found lower DHA status and higher AA status compared to Western woman well quite as children as expected. We made movies of those children. We made hundreds of movies just to observe the movement patterns in these children. We put them on the back, as you can see here. We made a movie about 15, 20 minutes. And we were, their movements were observed by a pediatrician who was experienced in this. And they found that the DHA status in these infants was collected with the complexity of their movement patterns. And well, there's another study which shows that especially in the pre-central cortex here, DHA status is very high. So DHA might be connected to motor complexity. So it makes sense what we found. Well, finally, vitamin D. We measured vitamin D in traditional people, because we are always talking about vitamin D. What should be the optimum levels? Well, nobody knows why, because we only measure in people who are sitting indoors all day. And even if you go to Africa, most people are dressed now. But as we will all agree, junior paleolithic people are either not wearing anything or just some, well, scars, animal cloth. Well, this is the people we were sampling. Hazabee, they are very black. But well, most of the day they walk around. Just they don't have houses or they don't have, well, there's some shelter. But well, they participated. And another group is the Maasai. We collected blood samples from these Maasai. And well, of course, it doesn't surprise you. But there wasn't hard evidence until yet. Nobody had done this study to simply measure vitamin D levels in traditional and togetherness. And well, well, this is the median. It's 120 and 110. It doesn't surprise you. But of course, the conservative societies in Europe were like, ooh, this is toxic. Well, I'm not sure. I only know that the Dutch Health Council advises 30 nanomole, so that's a lot lower, for women under 50 and men under 70. And well, above these age, it's only 15 nanomole. And well, actually, the IOM, the Institute of Medicine, says the same, 50 should be perfect. Well, that's a big difference with our ancestors. Is this improved that there's a problem with calcium? Well, from 80 already, there's no increase in calcium absorption, so it won't be too much. So the only problem is, how can we reach these ancestral levels? Well, in Holland, we have a problem, because we calculated that you need to have intakes. Well, our baseline levels in Holland, where there's not a lot of sun, especially in the winter, are between 20 and 40, according to our local health committee, is perfect. But if I would say my status is 20 or 30, and I want to increase it to 80, which I assume is better, I should eat a normal dose of 55 micrograms. Well, that's not allowed. In the Netherlands, our upper level advised by these health institutes is only 50 micrograms. Interesting, so we can't even eat enough to have ancient levels of vitamin D. So my conclusion is, our ancestors had high DHA status, high vitamin D status, and low linoleic acid status, compared to current Western societies. And I think that, while we saw a lot of risk factors here, which are, well, related to all kind of ingredients and nutrients and macronutrient compositions, why don't we include the omega-3 index? EPA plus DHA, it has been, well, like the figure I showed you, it has a very good correlation to cardiovascular disease. So I suggest we should include that. And I think that long-term intervention studies are needed to confirm the beneficial effects of the nutrients I'm talking about, DHA, vitamin D, and LA. But they need to be performed with a concurrent appreciation of other factors that have changed since the start of agricultural revolution, and not to be the industrial revolution. And what I mean is, if we do an intervention trial, you can give people DHA only or vitamin D only, but we have changed a lot. So like the vitamin A intervention studies, which showed increased cancer rates, well, that doesn't tell us that vitamin E is unhealthy. It does tell us that we never ate vitamin A only when we were eating. You eat a banana and you eat a fish. So actually, if you want to study the health effects of these nutrients, we should include the knowledge we have now, that vitamin D was high and DHA was high, in the advisement, like the studies that Stefan Linderberg is doing, to include all the ingredients we need to eat more in a study, and then look at the final outcomes. Thank you. Questions? We have time for about one question in case everybody has one. Well, you mentioned the omega-3 index, so that's a great thing. I can't hear you. All right, you mentioned the omega-3 index is a great predictor of cardiovascular disease rates. And that's connected both to how much you consume, but it's also easily destroyed by oxidative stress. A lot of negative health conditions you'll lose will respond to omega-3. So it may not be quite as easy to prepare that biomarker as just eating fish. But I think everything is about the patient consumption diet. I wonder if you have thought about it. If you have looked in this literature, and I think that diet very steps to improve it. To improve it? Yeah, well, I have looked. Yeah, the question is, have I looked into literature? If there's any way to improve your omega-3 index? Well, of course, there's eating fish, but most fish are not that rich in DHA, so you have to eat fatty fish. And well, the amounts that also depends on the person you are, because they have, well, actually, there seems to be a strong selection pressure on the ability to make omega-3 fatty acids. But further proves me that living in an aquatic environment and eating aquatic resources is important, because our genes are very well adapted. They have been selected to be able to convert alphanelic acid to longer chain metabolites. But there are big differences between individuals. So I could say to one person, you should eat two times of fish a week is enough for you to reach eight grand percent of DHA. But for others, they could have to eat it like daily. So well, at least two times fatty fish a week is what my society, also the International Society for Fatty Acid and Liberal Research, recommends to reach a status of, well, it's not really a status. They say 500 milligrams a day should be advised. That's the recommendation. So two times fatty fish a week. Great, everyone. Please thank Remco once again.