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Nutrition Past and Future

27 Ancestral Cholesterol 1 


Like Gary Taubes, Loren Cordain thinks he has found a paradox in diet-heart. Hunter gatherer diets are meaty, but they aren’t atherogenic. But is there really a paradox here? Or just his misunderstanding? I would have no problem with him saying he doesn’t understand something or that he can’t explain something. I’d be fine with it if he said, “Hey, check this out. My favorite meat-eating hunter gatherers seem to have had pretty low cholesterol. I thought that if you based your diet on animal products, that would give you high cholesterol. I can’t figure out what is going on with these hunter gatherers and their lipids.” No problem. It is a curiosity. But Cordain doesn’t say that. Instead, he pretends to have the explanation for this apparent paradox. They didn’t eat so much saturated fat. They ate plant foods that lower cholesterol and counteract inflammation. They were unstressed and they exercised. These are the reasons. Well, all those statements are fine but they aren’t the answer to his paradox. If they were, you would see Paleo followers with cholesterol in the 150 range and lower. You definitely do not. Moreover, Cordain has since abandoned his position on saturated fat.

He wrote: “The bottom line – dietary saturated fats have little effect upon morbidity or mortality from cardiovascular disease, cancer or other ubiquitous diseases of civilization.” But wait, I thought he had explained the low cholesterol of hunter gatherers! He said they had low saturated fat consumption, didn’t he? Doesn’t he know that saturated fat raises your cholesterol? Is he now saying his old paper about this hunter gatherer paradox was fundamentally misguided? Has he just decided that high cholesterol doesn’t matter, since he now says that saturated fat doesn’t matter and that raises cholesterol? Is he now rejecting the lipid hypothesis? And I thought he was giving us the wisdom of the ages with his Paleo diet. Does he mean to say he can just change his mind at will about what the historic human diet was? What else doesn’t he know? What else will he change his mind about? Why does he give a damn about what some recent crappy papers say about saturated fat when he told us he knew the single, original, species-specific diet for humans?

Remember, he strongly implied that saturated fat is a lethal fat in his book. What changed in the timeless and ideal human diet over the last few years? Did humans just recently change? Or is Loren Cordain just getting better at identifying his target market? Maybe he thinks this switch will help him make a few more bucks.

Cordain changed his mind because unlike the rest of the basic Paleo diet concept, which is fuzzy and imprecise and all about marketing, his position about animal foods and cholesterol was an aspect of his Paleo dream that could actually be proved wrong with objective data. Animal foods are naturally fatty and they will raise your cholesterol. He had not explained any paradox. His paper was just more Paleofantasy. Realizing that, he must have decided to make his life as a fad diet book peddler a bit easier by joining all the other fringe figures in that little club of cholesterol deniers, where they can all pat each other on their backs and keep selling their trashy little books to the obese, the ignorant, and the confused. Here is a screen capture from the Perfect Health Diet site. These are the actual cholesterol scores of people who were all claiming they were doing the low-carb, Paleo thing. Please pause this video and look closely. What you are looking at is not total cholesterol. Those are LDL scores. LDL should be around 70 or 75 if you listen to me and under 130 if you listen to government health agencies. If we are modeling ourselves on hunter gatherers, which is the whole premise of the Paleo fad, we should be shooting for around 75, just as I recommend, because that’s what we see in real hunter gatherers. But here you see frightening numbers like 261 and 396 and 433 among the chunky hunter gatherer poser class. This is just crazy! To me, this slide is a testament to the power of fantasy to completely blind people to their objective failure. A rational person should see numbers like this and say, “OK then, I tried Paleo. It turns out that if I try to eat like a hunter gatherer, I wind up with cholesterol numbers that are dangerous. Paleo is fun and all, but I should look for another fad diet that is less likely to kill me.”

If you are the sort of person who buys in on the Paleo fantasy, however, you are already self-selected as someone who has trouble thinking rationally about food. For such people, if there is a conflict between nice-sounding caveman stories and actual science, they will go with the simple story every time. They understand stories. This is the approach to nutrition that Loren Cordain took with every other idea he talks about, so it wasn’t too far for him to go to embrace saturated fat.

Here is a great example of the self-deluding personality of the Paleo dieter in action. Jimmy Moore has put himself out there for years as a low carber. He also put his cholesterol through the roof. He decided on his own that he eats the right way because he considers himself to be “Paleo” and so he doesn’t need to bother with cholesterol-lowering drugs. A cholesterol score of 326 is just fine, in his expert opinion. This is what denial looks like. This is not what a hunter gatherer looks like. I’ll bet you can tell the difference.

Never mind that statins have been shown over and over to work, Mr. Moore. They reduce mortality for those who have had heart attacks. I realize that this research isn’t Paleo and it does nothing for the fragile male ego.

Statins work in primary prevention as well. But the truth is that you shouldn’t need them, and you don’t need to take my word for that. Here is Mike Brown.

BROWN: The real news is that we shouldn’t really need these drugs, that for those of us who have normal genes, the reason why our blood is being filled up with cholesterol is because we are basically eating too much cholesterol and too much animal fat. And if you look at populations where the diet is lower in cholesterol and fat, they don’t need these statin drugs. They have low cholesterols in their blood and they have twenty times lower rate of heart attacks than we do in the United States.

“That’s all very nice, Dr Brown, but I didn’t hear the word “Paleo” in there and at no point did you assert my privileged place at the top of the food chain. You did nothing for my ego and you didn’t tell me a story. Therefore, I think I’ll just stick with the advice of my favorite bloggers and podcasters, thank you very much.” Isn’t that how the thinking goes?

Here is broscientist Robb Wolf writing about his understanding of evolution. He takes the reader on an extended fantasy in which he imagines himself strolling into a venerated bastion of mainstream nutrition science and confronting the assembled nerds there with his devastating Paleologic. Naturally, since this is his fantasy, they come off as fools while he is in full command of his special knowledge about hunter gatherers that would blow their minds if only they would listen. Before he imagines himself going to the nutrition researchers, though, he imagines that he first meets an anthropologist who uses an analogy that makes the deep wisdom of paleologic understandable for his scientifically illiterate readers. The fictional anthropologist says that if we picture the whole of human history as a football field, we only start getting into the time of agriculture and modern life in the last half-yard, and it is only in that small segment that we encounter newfangled evils like barley and lentils, the sources of all our problems. This passage in this book is a particularly vivid example of how someone can create a self-contained, self-validating personal reality. Find this in a bookstore and read this whole section and you will peer into the self-referencing, incurious Paleo mind. His fantasy is exactly the way he wants it to be, with no real experts intruding on his happy thoughts. Close your eyes and dream on, Mr. Wolf. You are truly the master of your domain. This is a nice little story that requires us to suspend disbelief and forget some basic facts about our evolutionary history. For one, our ancestors didn’t just appear out of thin air as modern humans at the other end of that football field. I’ll talk about that later. More important for this video, however, is something he left out, something that happened even closer to the near end of the football field. Maybe the last half-yard brought agriculture, but the last thousandth of a yard brought another big change: sanitation. Between sanitation, vaccinations, and the steady supply of abundant calories we get now, we are living in a very different world than that of the hunter gatherer, much less the farmer or the blacksmith of only a couple hundred years ago.

There are some rather huge clues that suggest the importance of these developments for those like Wolf who pretend to see the world through the eyes of evolutionary medicine. The most obvious clue is that the immune response to atherosclerosis is maladaptive. Inflammation actually makes heart disease worse. Normally, the cells of your innate immune system target and destroy invaders and do a great job of it. Your immune system has been refined over millions of years and it works incredibly well. However, high cholesterol doesn’t seem to be a condition that it has been trained over the millennia to address effectively. Macrophages eat excess cholesterol and become the foam cells that promote chronic inflammation.

Once the plaque forms and a heart attack happens, your immune system’s response doesn’t get any better. Like we saw with President Eisenhower, once that first heart attack happens the chances go up for another. The immune system makes things worse in that situation, too.

Plaques grow faster as the immune system steps up its attack even further. Your immune system doesn’t know it’s making things worse. It is just trying to destroy perceived invaders, the same as ever.

As you will see, hunter gatherers haven’t had this problem. They have very few risk factors for heart disease so they don’t wind up with thick and inflamed atherosclerotic plaque like us. Their immune systems are familiar with their circumstances. They have low cholesterol.

They also have a much greater exposure to pathogens. The pathogens that I’ll focus on here mostly are categorized as parasites.

If there is to be one image burned into your mind from the Primitive Nutrition channel, it should be this one. You are looking at the aortas of two different mice.  The one on the left ate a diet high in saturated fat. As you can see, the lumen, or the inside space of the aorta, has been drastically narrowed by plaque build-up. On the right you see a similar specimen from a mouse fed the same way, with a diet high in saturated fat, yet there is comparatively little plaque. What was the difference here? The mouse on the right carried parasites while it was eating its fatty diet.

I have shown my viewers this abstract in a past video. The authors of this study, led by Mike Doenhoff, helped us to understand the significance of this result. A parasitic infection might be able to counteract the effects of an atherogenic, high-fat diet. The parasites counterbalanced the fatty diet by lowering the cholesterol levels of the infected mice.

There you see the dramatic effect the parasites had on LDL. Please focus on my boxed highlight and the right two bars inside it. The highest one is for LDL without infection while eating high-fat. That was caused by feeding the mice cholesterol and lard. The bar to the right of that which is so much smaller is for the mice with the infection while being fed in the very same way. It’s a huge difference.

Doenhoff tells us that it is a good strategy for parasites to form a stable relationship with their host, and to do that it would make sense for them to provide some small benefit to that host. In this case, that service may be the control of host cholesterol levels. Whether you buy that rationale or not, you can’t really argue with the fact that we have coevolved with parasites, going all the way back to the beginning of Robb Wolf’s football field and then back a whole lot further. You also can’t argue with the fact that parasites tend to lower the cholesterol levels of their hosts. And lastly, you can’t argue with the fact that hunter gatherers mostly had pretty low cholesterol by our standards. These are the facts that doom the Paleo beliefs about cholesterol. Listen up, urban cavemen! You can’t be like your primitive ancestors and have high cholesterol.

It has been argued that one of the reasons we lost our body hair was through sexual selection based on parasite avoidance. Parasites would have had a harder time hitching a ride with less hair to hang onto. Less hairy mating prospects would have seemed a bit cleaner. I think it’s a good hypothesis. Parasites were ever-present for our ancestors so this makes a lot of sense.

Our hairier primate cousins certainly carry parasite loads in the wild. They have learned to self-medicate with the right plants to reduce their parasite burdens.

Hunter gatherers in Africa, which is where Robb Wolf’s football field would be geographically located, were found to carry around 20 worm and protozoa parasites in the tropics but only 1 to 9 in the deserts. I will show you in a later video why our roots are far more likely in the forest rather than the desert.

This paper goes through a range of parasites and describes the effects they have on cholesterol. I gave you some excerpts to give you an idea of how much we known about this. Schistosoma mansoni, like what the mice carried in the study we just saw, have LDL-receptors of their own for taking in the host’s cholesterol. Toxoplasma is similar this way. At the bottom left you see that by adding cholesterol to a parasite sample, we can cause them to multiply. To the right you see that other parasites have been shown to lower cholesterol levels in humans.

The same is true for malaria. This paper by Devendra Bansal goes on and on with examples like these.

Maybe you think that in the cold regions of an Ice Age or up in the Arctic with the Inuit that parasites would not have been a factor. You would be wrong. Here is a reference entirely devoted to this topic, and this one, too, goes on and on with examples of real human parasites. In Northern Russia it was reported that the prevalence of infections by one parasite were around 60%.

These helminth infections got up to around 50% prevalence in some areas.

The consumption of the raw brains of reindeers, no doubt a high-cholesterol, Weston Price Foundation-approved food , directly led to infection rates of up to 43% in one area.

Toxoplasma prevalence was as high as 53% among the Inuit. They would have gotten this infection from eating raw meat.

Even with those extremely high numbers, the authors point out that those rates are probably grossly underestimated.

Of course, the consumption of raw fish has led to high rates of infection in populations that resort to that as well.

It is for this reason that these researchers studying Paleolithic remains in the cold northern island of Japan remarked that the marine diets of ancient inhabitants there would have resulted in high parasitic loads. Whether we are thinking of primitive humans in the jungle or in the Arctic Circle, parasites would have accompanied the most Paleo of the Paleo, and they would have brought down their cholesterol levels. You can’t really be “Paleo” unless you are loaded with parasites, too.

Bacterial infection would have been a common fact of life for our ancestors as well, and this can also affect cholesterol levels. In this amazing study, six volunteers were injected with an endotoxin. This markedly lowered their cholesterol levels. Yet again we see an explanation for Loren Cordain’s paradox which he did not contemplate. Yes, Paleo dieters, ancient humans suffered bacterial infections.

You will see in my “How to Become Insulin Resistant” videos that high body iron stores, caused by the consumption of red meat loaded with heme iron, damage insulin sensitivity, increase inflammation, and make us more vulnerable to heart disease. Iron appears to act through LDL cholesterol to promote inflammation and plaque progression ...

Although I should mention that the subclinical development of plaques has been associated with iron stores even in the absence of increased inflammation. Excess iron is almost certainly a big problem for your arteries and your carbohydrate metabolism.

I argue now that these high iron stores are historically unprecedented, and this is also because of the effects of parasites, at least in part. This is a paper examining the very high prevalence of helminthic infections in rural Malaysia. The researchers noted that there was a strong association between iron deficiency anemia and parasitic infection.

Do you remember a previous slide in which I told you that for one parasite, an increase in cholesterol causes it to multiply?

A similar effect can be observed with increased iron stores. These researchers have shown us that increased iron stores would worsen the symptoms and severity of disease associated with Schistosoma.

Here again we have parasitologists proposing a good evolutionary rationale for their findings. They think that a diet lower in iron such as would have been the norm during the Neolithic would have provided a selective advantage against parasitic infection. Lower iron levels would have been adaptive, just like less body hair, because it would have minimized the burden of parasites. And yet modern gluttons consume plenty of heme-iron-laden red meat, without any parasites to compensate.

Today, it is believed that our high iron stores worsen the course of heart disease. Macrophages aren’t the only cells that start the maladaptive inflammatory process in atherosclerosis. Red blood cells filled with iron also attach to the vessel wall. Their iron then promotes oxidation and inflammation, the same issues that the low carbers and cholesterol deniers pretend they are really concerned about. The fact is that their diets, which are high in poorly regulated heme iron from meat, undermine all their stated goals. Eating meat only helps them with their true yet unstated purpose: to feel like they are members of a special hyper-masculine club.

Paleolithic remains have been found which give us an example of how iron deficiency anemia would have struck an old low carber. This hunter of 14,000 years ago ate a meat-rich diet. He was living the low-carb Paleo dream. You would think he got his share of iron from all his red meat. Maybe he did, but he also probably suffered from anemia, as he had a bone condition associated with iron deficiency.

Despite all this, in the imagination of a saturated fat promoter like Paul Jaminet, the man who claims to have identified a “perfect health diet,” we are now living in a more pathogen-and-toxin-rich environment than the Paleolithic. I learned of this quote through an anonymous yet much appreciated commenter from my channel. This is a classic truthy claim derived from paleologic that was never intended to be considered critically, but I just can’t help myself. I have questions for this guy. Hey, Mr. Physical Perfection, is your municipal water source treated with chlorine? Were you vaccinated against any diseases when you were a kid? How often do you wash your hands? Have you cooked your food lately? Have you eaten the raw flesh of a parasite-infested wild animal out of profound hunger and desperation recently?

Do you think our Paleolithic ancestors could get overnight shipping on a hair lice treatment for their kids from Amazon?

Do you know anything whatsoever about our historical relationship with parasites? Have you ever heard of the hygiene hypothesis?

Whenever I read a blog post from one of these characters about how good saturated fat and cholesterol are for the brain, I find very little evidence for that in the quality of their ideas. If this is how smart butter can make you, then count me out.

The belief in fairy tales is strong in these two. But words are cheap. I wonder if they would accept a challenge to demonstrate their confidence in their convictions. I have a dare for them in my next video. But before I get to that, I’ll give you some actual numbers to go with the concept of ancestral cholesterol.