Agrarian diet and diseases of affluence--do evolutionary novel dietary lectins cause leptin resistance?

Wheat Germ Agglutinin (WGA): Its Nature, Biological Role, Significance in Human Nutrition, and Possibility to Be Used as Marker of Whole-Grain Status in Wheat-Based Foods

The growing scientific evidence on the health benefits of whole-grain food consumption has promoted the manufacturing of a great number of products differing in quality and content of whole-grain components. This is particularly true for commercial wheat-based products where it is not always clear how much whole wheat is present considering that in many cases, they are manufactured from reconstituted mill streams and that there is not a standardised globally accepted definition and metrics to objectively evaluate whole-grain status. Attempts have been made to assess the level of "wholegraininess" in wheat products by measuring specific constituents that correlate with different wheat tissues, especially those that are expected to be found in a true whole-grain wheat product. Wheat germ agglutinin (WGA), a small lectin protein present exclusively in the wheat-germ tissues, has been indicated by several scientists as one of these constituents and after founding that its level changes depending on the amount of germ found in a wheat flour, it has been indicated as a biomarker of whole-grain status for wheat products. In this review, the biochemistry of WGA, its methods of detection, and current knowledge on its possibility to be practically utilized as a reliable marker are critically discussed.

Dietary Protein Source Matters for Changes in Inflammation Measured by Urinary C-Reactive Protein in Rural Polish Women

Objectives

Multiple macronutrients have been shown to affect systemic inflammation, a well-known predictor of chronic disease. Less often, varying sources of these macronutrients are examined. Different subsistence environments lead to varying access to protein sources which, combined with physical activity patterns, may lead to different relationships than among more typically studied sedentary, industrialized populations. This study hypothesizes an association between dietary protein intake and urinary C-Reactive Protein (CRP) concentration in women from a rural, agrarian Polish community.

Materials and Methods

We assessed protein intake and their sources for 80 nonsmoking, premenopausal Polish women who were not pregnant, nursing, or on hormonal birth control during the study or within the previous six months. Each participant completed multiple 24-hour dietary recalls during one menstrual cycle. Participants collected morning void urinary samples daily over one menstrual cycle for urinary CRP analysis. We analyzed relationships between plant and animal protein intake and CRP over the menstrual cycle by multiple linear regression.

Results

Plant protein in cereal foods was significantly positively associated with cycle-average urinary CRP concentrations (p<0.05) after controlling for body fat percent, total energy intake, and dietary fiber. Foods containing animal protein were not significantly associated with CRP.

Discussion

Contents of this population's main plant and animal protein sources differ from those of more commonly studied industrialized populations. Within the context of a population's typical diet, more emphasis may need to be placed on particular source of protein consumed, beyond plant versus animal, in order to understand relationships with CRP.

Obesity and Leptin Resistance in the Regulation of the Type I Interferon Early Response and the Increased Risk for Severe COVID-19

Obesity, and obesity-associated conditions such as hypertension, chronic kidney disease, type 2 diabetes, and cardiovascular disease, are important risk factors for severe Coronavirus disease-2019 (COVID-19). The common denominator is metaflammation, a portmanteau of metabolism and inflammation, which is characterized by chronically elevated levels of leptin and pro-inflammatory cytokines. These induce the “Suppressor Of Cytokine Signaling 1 and 3” (SOCS1/3), which deactivates the leptin receptor and also other SOCS1/3 sensitive cytokine receptors in immune cells, impairing the type I and III interferon early responses. By also upregulating SOCS1/3, Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV)-2 adds a significant boost to this. The ensuing consequence is a delayed but over-reactive immune response, characterized by high-grade inflammation (e.g., cytokine storm), endothelial damage, and hypercoagulation, thus leading to severe COVID-19. Superimposing an acute disturbance, such as a SARS-CoV-2 infection, on metaflammation severely tests resilience. In the long run, metaflammation causes the “typical western” conditions associated with metabolic syndrome. Severe COVID-19 and other serious infectious diseases can be added to the list of its short-term consequences. Therefore, preventive measures should include not only vaccination and the well-established actions intended to avoid infection, but also dietary and lifestyle interventions aimed at improving body composition and preventing or reversing metaflammation.

Gluten consumption may contribute to worldwide obesity prevalence

Gluten consumption has been controversially associated with obesity in previous studies. We sought to examine this association at the worldwide level.

Country specific data were obtained from 168 countries. Scatter plots, bivariate, partial correlation and multiple linear regression models were used to explore and compare the coincidence between obesity prevalence and consumption of gluten, non-gluten cereal protein and total cereal protein respectively. The established risk factors of obesity: caloric intake, sedentary lifestyle, urbanization, socioeconomic status, meat protein intake and sugar consumption were included in analyses as potential confounders. The 168 countries were also stratified into developing and developed country groupings for further examination of the relationships.

Worldwide, bivariate correlation analyses revealed that the strength and direction of correlations between all variables (independent, dependent and potential confounders) were at similar levels. Obesity prevalence was positively correlated to gluten consumption but was negatively correlated to consumption of non-gluten cereal protein, and was in almost nil correlation to total cereal protein consumption. These relationships were similar across all countries (n= 168), developed country grouping (N=44) and developing country grouping (n=124). When caloric intake, Gross Domestic Product at Purchasing Power Parity, sedentary lifestyle and urbanization were kept statistically constant in the partial correlation analysis, obesity was significantly correlated to gluten consumption in all countries, developed country grouping and developing country grouping, and was significantly but inversely and weakly correlated to non-gluten cereal protein in all countries and developing countries, and was in almost nil correlation to total cereal protein in all country groupings. Globally, stepwise multiple regression analysis, when all the independent variables and potential confounding factors were included, selected consumption of sugar as the variable having the greatest influence on obesity with R2 = 0.510, while gluten was placed second increasing R2 to 0.596. Gluten consumption may have been emerging as an inconspicuous, but significant cause of obesity. While Westernization has driven the diet patterns worldwide to incorporate more gluten crops, obesity prevalence projection methods may estimate future obesity rates poorly if gluten consumption is not considered.

Dietary Polyphenols-Important Non-Nutrients in the Prevention of Chronic Noncommunicable Diseases. A Systematic Review

The improvement of the social and economic conditions of society has eliminated the threat of death from the majority of infectious diseases. However, the rapid progress of civilization has created new possibilities for the appearance of factors with adverse effects for the health of society. This has led to increased morbidity from certain diseases, the presence of which had not been observed several centuries ago. Chronic noncommunicable diseases (e.g., cancers, cardio-vascular disorders, diabetes, obesity, neurodegenerative diseases) result from an inappropriate relationship between people and their environment. The common characteristic for all chronic diseases is a “new” form of inflammation, very often called metaflammation, which is considered as a subclinical, permanent inflammation. As a result, metabolic cascade, including cellular oxidative stress, atherosclerotic process, and insulin resistance, occurs, which slowly generates significant deterioration in the organism. Polyphenols are the major group of non-nutrients, considering their diversity, food occurrence, and biological properties. The current review aims to present a wide spectrum of literature data, including the molecular mechanism of their activity and experimental model used, and summarize the recent findings on the multitude of physiological effects of dietary polyphenols towards the prevention of several chronic diseases. However, despite several studies, the estimation of their dietary intake is troublesome and inconclusive, which will be also discussed.

Possible Prevention of Diabetes with a Gluten-Free Diet

Gluten seems a potentially important determinant in type 1 diabetes (T1D) and type 2 diabetes (T2D). Intake of gluten, a major component of wheat, rye, and barley, affects the microbiota and increases the intestinal permeability. Moreover, studies have demonstrated that gluten peptides, after crossing the intestinal barrier, lead to a more inflammatory milieu. Gluten peptides enter the pancreas where they affect the morphology and might induce beta-cell stress by enhancing glucose- and palmitate-stimulated insulin secretion. Interestingly, animal studies and a human study have demonstrated that a gluten-free (GF) diet during pregnancy reduces the risk of T1D. Evidence regarding the role of a GF diet in T2D is less clear. Some studies have linked intake of a GF diet to reduced obesity and T2D and suggested a role in reducing leptin- and insulin-resistance and increasing beta-cell volume. The current knowledge indicates that gluten, among many environmental factors, may be an aetiopathogenic factors for development of T1D and T2D. However, human intervention trials are needed to confirm this and the proposed mechanisms.

The Effect of Gluten Free Diet on Components of Metabolic Syndrome: A Randomized Clinical Trial

Background:

This study aimed to assess the effects of Gluten free diet (GFD) on components of metabolic syndrome (MES).

Materials and Methods:

In this randomized clinical trial, 50 subjects diagnosed with MES were randomly divided into two groups (n=25). The first group received a GFD and the second group continued their regular diet. Biochemical markers of MES and blood pressure were measured before and after 8-week intervention.

Results:

Forty five subjects completed the study. A post-hoc comparison of the groups showed no effects of the GFD and control diet on LDL cholesterol, total cholesterol, fasting insulin, HOMA-IR, systolic and diastolic blood pressure levels. The GFD reduced fasting blood glucose, waist circumference (WC) and serum triglyceride concentration significantly compared with the control diet (p<0.05).

Conclusion:

Short-term GFD reduced WC and improved glycemic control and Triglyceride level in subjects with the metabolic syndrome.

Cereal Crops Are not Created Equal: Wheat Consumption Associated with Obesity Prevalence Globally and Regionally

BACKGROUND

Cereals have been extensively advocated as the beneficial food group in terms of body weight management, but each staple cereal crop may contribute in different ways. Studies of the association between wheat availability and risk of obesity are controversial. This study aimed to test the global and regional association between wheat availability as reported by FAO and obesity prevalence at a population level. FAO does not distinguish between whole grain wheat and refined wheat.

METHODS

Population-specific data from 170 countries on prevalence of obesity, availabilities of mixed cereals, wheat, rice, maize, meat, sugar, fat, soy and calories and GDP are obtained from the UN agencies. All variables were measured as per capita per day (or per year). Each country is treated as an individual subject. SPSS v. 22 is used to analyse these data for all the 170 countries and official country groupings (regions) using non parametric and parametric correlations, including partial correlation analysis.

RESULTS

Pearson's correlation coefficient analysis showed that obesity prevalence is positively associated with wheat availability (r = 0.500, p < 0.001), but is inversely associated with availabilities of total cereals (r = -0.132, p = 0.087), rice (r = -0.405, p < 0.001) and maize (r = -0.227, p = 0.004). These associations remain in partial correlation model when we keep availabilities of meat, fat, sugar, soy, caloric intake and GDP statistically constant. Overall, positive associations between wheat availability and obesity prevalence remain in different regions. Maize and mixed cereal availabilities do not show independent associations with the obesity prevalence.

CONCLUSIONS

Our study suggests that wheat availability is an independent predictor of the obesity prevalence both worldwide and with special regard to the regions of Africa, Americas and Asia. Future studies should distinguish between possible influence of whole grain and ultra-processed refined wheat products.

Digested wheat gluten inhibits binding between leptin and its receptor

Background

Leptin resistance is considered a primary risk factor for obesity. It has been hypothesized that dietary cereal grain protein could cause leptin resistance by preventing leptin from binding to its receptor. Non-degraded dietary wheat protein has been found in human serum at a mean level of 41 ng/mL. Here, we report our findings from testing whether enzymatically digested gluten from wheat prevents leptin from binding to the leptin receptor in vitro.

Gluten from wheat was digested with pepsin and trypsin under physiological conditions. Pepsin and trypsin activity was removed from the gluten digest with a 10 kDa spin-filter or by heat treatment at 100°C for 30 min. Binding to the leptin receptor of leptin mixed with gluten digest at a series of concentrations was measured using surface plasmon resonance technology.

Results

Binding of the gluten digest to the leptin receptor was not detected. Spin-filtered gluten digest inhibited binding of leptin to the leptin receptor, with 50% inhibition at a gluten digest concentration of ~10 ng/mL. Heat-treated gluten digest did not inhibit leptin binding.

Conclusions

Digested wheat gluten inhibits binding of leptin to the leptin receptor, with half-maximal inhibition at 10 ng/mL. The inhibition is significant at clinically relevant concentrations and could therefore serve as a novel pathway to investigate to understand the molecular basis of leptin resistance, obesity and associated disorders.

Plant as a plenteous reserve of lectin

Lectins are clusters of glycoproteins of nonimmune foundation that combine specifically and reversibly to carbohydrates, mainly the sugar moiety of glycoconjugates, resulting in cell agglutination and precipitation of glycoconjugates. They are universally distributed in nature, being established in plants, fungi, viruses, bacteria, crustacea, insects, and animals, but leguminacae plants are rich source of lectins. The present review reveals the structure, biological properties, and application of plant lectins.

Paleolithic diets as a model for prevention and treatment of Western disease

OBJECTIVES

To explore the possibility that a paleolithic-like diet can be used in the prevention of age-related degenerative Western disease.

METHODS

Literature review of African Paleolithic foods in relation to recent evidence of healthy nutrition.

RESULTS AND DISCUSSION

Available evidence lends weak support in favor and little against the notion that lean meat, fish, vegetables, tubers, and fruit can be effective in the prevention and treatment of common Western diseases. There are no obvious risks with avoiding dairy products, margarine, oils, refined sugar, and cereal grains, which provide 70% or more of the dietary intake in northern European populations. If stroke, coronary heart disease, type 2 diabetes, and cancer are preventable by dietary changes, an ancestral-like diet may provide an appropriate template.

Comparison with ancestral diets suggests dense acellular carbohydrates promote an inflammatory microbiota, and may be the primary dietary cause of leptin resistance and obesity

A novel hypothesis of obesity is suggested by consideration of diet-related inflammation and evolutionary medicine. The obese homeostatically guard their elevated weight. In rodent models of high-fat diet-induced obesity, leptin resistance is seen initially at vagal afferents, blunting the actions of satiety mediators, then centrally, with gastrointestinal bacterial-triggered SOCS3 signaling implicated. In humans, dietary fat and fructose elevate systemic lipopolysaccharide, while dietary glucose also strongly activates SOCS3 signaling. Crucially however, in humans, low-carbohydrate diets spontaneously decrease weight in a way that low-fat diets do not. Furthermore, nutrition transition patterns and the health of those still eating diverse ancestral diets with abundant food suggest that neither glycemic index, altered fat, nor carbohydrate intake can be intrinsic causes of obesity, and that human energy homeostasis functions well without Westernized foods containing flours, sugar, and refined fats. Due to being made up of cells, virtually all "ancestral foods" have markedly lower carbohydrate densities than flour- and sugar-containing foods, a property quite independent of glycemic index. Thus the "forgotten organ" of the gastrointestinal microbiota is a prime candidate to be influenced by evolutionarily unprecedented postprandial luminal carbohydrate concentrations. The present hypothesis suggests that in parallel with the bacterial effects of sugars on dental and periodontal health, acellular flours, sugars, and processed foods produce an inflammatory microbiota via the upper gastrointestinal tract, with fat able to effect a "double hit" by increasing systemic absorption of lipopolysaccharide. This model is consistent with a broad spectrum of reported dietary phenomena. A diet of grain-free whole foods with carbohydrate from cellular tubers, leaves, and fruits may produce a gastrointestinal microbiota consistent with our evolutionary condition, potentially explaining the exceptional macronutrient-independent metabolic health of non-Westernized populations, and the apparent efficacy of the modern "Paleolithic" diet on satiety and metabolism.

Diets of modern hunter-gatherers vary substantially in their carbohydrate content depending on ecoenvironments: results from an ethnographic analysis

In the past, attempts have been made to estimate the carbohydrate contents of preagricultural human diets. Those estimations have primarily been based on interpretations of ethnographic data of modern hunter-gatherers. In this study, it was hypothesized that diets of modern hunter-gatherers vary in their carbohydrate content depending on ecoenvironments. Thus, using data of plant-to-animal subsistence ratios, we calculated the carbohydrate intake (percentage of the total energy) in 229 hunter-gatherer diets throughout the world and determined how differences in ecological environments altered carbohydrate intake. We found a wide range of carbohydrate intake (≈3%-50% of the total energy intake; median and mode, 16%-22% of the total energy). Hunter-gatherer diets were characterized by an identical carbohydrate intake (30%-35% of the total energy) over a wide range of latitude intervals (11°-40° north or south of the equator). However, with increasing latitude intervals from 41° to greater than 60°, carbohydrate intake decreased markedly from approximately equal to 20% to 9% or less of the total energy. Hunter-gatherers living in desert and tropical grasslands consumed the most carbohydrates (≈29%-34% of the total energy). Diets of hunter-gatherers living in northern areas (tundra and northern coniferous forest) contained a very low carbohydrate content (≤15% of the total energy). In conclusion, diets of hunter-gatherers showed substantial variation in their carbohydrate content. Independent of the local environment, however, the range of energy intake from carbohydrates in the diets of most hunter-gatherer societies was markedly different (lower) from the amounts currently recommended for healthy humans.

A paleolithic diet is more satiating per calorie than a mediterranean-like diet in individuals with ischemic heart disease

Background

We found marked improvement of glucose tolerance and lower dietary energy intake in ischemic heart disease (IHD) patients after advice to follow a Paleolithic diet, as compared to a Mediterranean-like diet. We now report findings on subjective ratings of satiety at meals and data on the satiety hormone leptin and the soluble leptin receptor from the same study.

Methods

Twenty-nine male IHD patients with impaired glucose tolerance or diabetes type 2, and waist circumference > 94 cm, were randomized to ad libitum consumption of a Paleolithic diet (n = 14) based on lean meat, fish, fruit, vegetables, root vegetables, eggs, and nuts, or a Mediterranean-like diet (n = 15) based on whole grains, low-fat dairy products, vegetables, fruit, fish, and oils and margarines during 12 weeks. In parallel with a four day weighed food record the participants recorded their subjective rating of satiety. Satiety Quotients were calculated, as the intra-meal quotient of change in satiety during meal and consumed energy or weight of food and drink for that specific meal. Leptin and leptin receptor was measured at baseline and after 6 and 12 weeks. Free leptin index was calculated as the ratio leptin/leptin receptor.

Results

The Paleolithic group were as satiated as the Mediterranean group but consumed less energy per day (5.8 MJ/day vs. 7.6 MJ/day, Paleolithic vs. Mediterranean, p = 0.04). Consequently, the quotients of mean change in satiety during meal and mean consumed energy from food and drink were higher in the Paleolithic group (p = 0.03). Also, there was a strong trend for greater Satiety Quotient for energy in the Paleolithic group (p = 0.057). Leptin decreased by 31% in the Paleolithic group and by 18% in the Mediterranean group with a trend for greater relative decrease of leptin in the Paleolithic group. Relative changes in leptin and changes in weight and waist circumference correlated significantly in the Paleolithic group (p < 0.001) but not in the Mediterranean group. Changes in leptin receptor and free leptin index were not significant.

Conclusions

A Paleolithic diet is more satiating per calorie than a Mediterranean-like diet.

Trial registration

ClinicalTrials.gov NCT00419497

Latitude, local ecology, and hunter-gatherer dietary acid load: implications from evolutionary ecology

BACKGROUND

Past estimations of the net base-producing nature of the Paleolithic "Diet of Evolutionary Adaptedness" derived primarily from interpretations of ethnographic data of modern historically studied hunter-gatherers. In our recent ethnographic analyses, we observed large variations in diet-dependent net endogenous acid production (NEAP) among hunter-gatherer diets.

OBJECTIVE

We proposed to determine whether differences in ecologic environments influence estimations of NEAP.

DESIGN

By using ethnographic data of plant-to-animal subsistence ratios and mathematical models established previously, we computed frequency distributions of estimated NEAP in relation to latitude in 229 worldwide modern hunter-gatherer societies. Four different models of animal fat density were used: models A (3%), B (10%), C (15%), and D (20%). In addition, we estimated NEAP by primary ecologic environments in those hunter-gatherer societies (n = 63) for which data were documented.

RESULTS

With increasing latitude intervals, 0°-10° to >60°, NEAP increased in all 4 models. For models A, B, and C, the diets tend to be net acid-producing at >40° latitude and net base-producing at <40°; the same held for model D (>50° and <50°, respectively). For models A, B, and C, the diets of hunter-gatherers living in northern areas (tundra and coniforest) and in temperate grassland and tropical rainforests are net acid-producing. In all other ecologic niches, hunter-gatherers seem to consume a neutral or net base-producing diet.

CONCLUSIONS

Latitude and ecologic environments codetermine the NEAP values observed in modern hunter-gatherers. The data support the hypothesis that the diet of Homo sapiens' East African ancestors was predominantly net base-producing.

[Insulin resistance as a mechanism of adaptation during human evolution]

The recent application of concepts of evolution to human disease is proving useful to understand certain pathophysiological mechanisms of different entities that span genomic alterations of immunity, respiratory and hormone function, and the circulatory and neural systems. However, effort has concentrated on explaining the keys to adaptation that define human metabolism and, since the early 1960s, several theories have been developed. This article reviews some of the hypotheses postulated in recent years on the potential benefit of insulin resistance and discusses the most recent knowledge. The concept of the thrifty gene seems to have been definitively refuted by current knowledge. The current paradigm describes an interaction between the metabolic and the immune systems resulting from their coevolution, promoted by evolutionary pressures triggered by fasting, infection and intake of different foods. The activation and regulation of these ancient mechanisms in integrated and interdependent areas defines insulin resistance as a survival strategy that is critical during fasting and in the fight against infection. The relationship with some components of the diet and, particularly, with the symbiotic intestinal microflora points to new paradigms in understanding the pathophysiology of obesity, metabolic syndrome and type 2 diabetes mellitus.

Estimation of the diet-dependent net acid load in 229 worldwide historically studied hunter-gatherer societies

BACKGROUND

Nutrition scientists are showing growing interest in the diet patterns of preagricultural (hunter-gatherer) humans. Retrojected preagricultural diets are reportedly predominantly net base producing in contrast to the net acid-producing modern Western diets.

OBJECTIVE

We examined the dietary net acid load [net endogenous acid production (NEAP)] for 229 worldwide historically studied hunter-gatherer societies to determine how differences in plant-to-animal (P:A) dietary subsistence patterns and differences in the percentage of body fat in prey animals affect the NEAP.

DESIGN

With the use of 1) ethnographic data of dietary P:A ratios of hunter-gatherer populations, 2) established computational methods, and 3) knowledge that fat densities of animal foods consumed by hunter-gatherers varied between 3% and 20%, we computed the NEAP for the diets of 229 populations in 4 different models of animal fat densities (model A, 3%; model B, 10%; model C, 15%; model D, 20%).

RESULTS

As P:A ratios decreased from 85:15 to 5:95, the NEAP increased from -178 to +181 mEq/d (model A) and from -185 to +120 mEq/d (models B and C). Approximately 50% of the diets consumed by the 229 worldwide hunter-gatherer populations were net acid producing (models B and C). In model D, 40% of the diets were net acid producing.

CONCLUSIONS

Our data confirm that the NEAP of hunter-gatherer diets becomes progressively more positive as P:A ratios decline. The high reliance on animal-based foods of a worldwide sample of historically studied hunter-gatherer populations renders their diets net acid producing in approximately 40-60% of subgroups of P:A ratios. Only further investigations can show the implications of these findings in determining the NEAP of human ancestral diets.

Beneficial effects of a Paleolithic diet on cardiovascular risk factors in type 2 diabetes: a randomized cross-over pilot study

BACKGROUND

Our aim was to compare the effects of a Paleolithic ('Old Stone Age') diet and a diabetes diet as generally recommended on risk factors for cardiovascular disease in patients with type 2 diabetes not treated with insulin.

METHODS

In a randomized cross-over study, 13 patients with type 2 diabetes, 3 women and 10 men, were instructed to eat a Paleolithic diet based on lean meat, fish, fruits, vegetables, root vegetables, eggs and nuts; and a Diabetes diet designed in accordance with dietary guidelines during two consecutive 3-month periods. Outcome variables included changes in weight, waist circumference, serum lipids, C-reactive protein, blood pressure, glycated haemoglobin (HbA1c), and areas under the curve for plasma glucose and plasma insulin in the 75 g oral glucose tolerance test. Dietary intake was evaluated by use of 4-day weighed food records.

RESULTS

Study participants had on average a diabetes duration of 9 years, a mean HbA1c of 6,6% units by Mono-S standard and were usually treated with metformin alone (3 subjects) or metformin in combination with a sulfonylurea (3 subjects) or a thiazolidinedione (3 subjects). Mean average dose of metformin was 1031 mg per day. Compared to the diabetes diet, the Paleolithic diet resulted in lower mean values of HbA1c (-0.4% units, p = 0.01), triacylglycerol (-0.4 mmol/L, p = 0.003), diastolic blood pressure (-4 mmHg, p = 0.03), weight (-3 kg, p = 0.01), BMI (-1 kg/m2, p = 0.04) and waist circumference (-4 cm, p = 0.02), and higher mean values of high density lipoprotein cholesterol (+0.08 mmol/L, p = 0.03). The Paleolithic diet was mainly lower in cereals and dairy products, and higher in fruits, vegetables, meat and eggs, as compared with the Diabetes diet. Further, the Paleolithic diet was lower in total energy, energy density, carbohydrate, dietary glycemic load, saturated fatty acids and calcium, and higher in unsaturated fatty acids, dietary cholesterol and several vitamins. Dietary GI was slightly lower in the Paleolithic diet (GI = 50) than in the Diabetic diet (GI = 55).

CONCLUSION

Over a 3-month study period, a Paleolithic diet improved glycemic control and several cardiovascular risk factors compared to a Diabetes diet in patients with type 2 diabetes.

A Paleolithic diet confers higher insulin sensitivity, lower C-reactive protein and lower blood pressure than a cereal-based diet in domestic pigs

Background

A Paleolithic diet has been suggested to be more in concordance with human evolutionary legacy than a cereal based diet. This might explain the lower incidence among hunter-gatherers of diseases of affluence such as type 2 diabetes, obesity and cardiovascular disease. The aim of this study was to experimentally study the long-term effect of a Paleolithic diet on risk factors for these diseases in domestic pigs. We examined glucose tolerance, post-challenge insulin response, plasma C-reactive protein and blood pressure after 15 months on Paleolithic diet in comparison with a cereal based swine feed.

Methods

Upon weaning twenty-four piglets were randomly allocated either to cereal based swine feed (Cereal group) or cereal free Paleolithic diet consisting of vegetables, fruit, meat and a small amount of tubers (Paleolithic group). At 17 months of age an intravenous glucose tolerance test was performed and pancreas specimens were collected for immunohistochemistry. Group comparisons of continuous variables were made by use of the t-test. P < 0.05 was chosen for statistical significance. Simple and multivariate correlations were evaluated by use of linear regression analysis.

Results

At the end of the study the Paleolithic group weighed 22% less and had 43% lower subcutaneous fat thickness at mid sternum. No significant difference was seen in fasting glucose between groups. Dynamic insulin sensitivity was significantly higher (p = 0.004) and the insulin response was significantly lower in the Paleolithic group (p = 0.001). The geometric mean of C-reactive protein was 82% lower (p = 0.0007) and intra-arterial diastolic blood pressure was 13% lower in the Paleolithic group (p = 0.007). In evaluations of multivariate correlations, diet emerged as the strongest explanatory variable for the variations in dynamic insulin sensitivity, insulin response, C-reactive protein and diastolic blood pressure when compared to other relevant variables such as weight and subcutaneous fat thickness at mid sternum. There was no obvious immunohistochemical difference in pancreatic islets between the groups, but leukocytes were clearly more frequent in sampled pancreas from the Cereal group.

Conclusion

This study in domestic pigs suggests that a Paleolithic diet conferred higher insulin sensitivity, lower C-reactive protein and lower blood pressure when compared to a cereal based diet.

Leptin and incident type 2 diabetes: risk or protection?

AIMS/HYPOTHESIS

The aim of this study was to investigate the association of leptin levels with incident diabetes in middle-aged adults, taking into account factors purportedly related to leptin resistance.

SUBJECTS AND METHODS

We conducted a case-cohort study (570 incident diabetes cases and 530 non-cases) representing the 9-year experience of 10,275 participants of the Atherosclerosis Risk in Communities Study. Plasma leptin was measured by direct sandwich ELISA.

RESULTS

In proportional hazards models adjusting for age, study centre, ethnicity and sex, high leptin levels (defined by sex-specific cut-off points) predicted an increased risk of diabetes, with a hazard ratio (HR) comparing the upper with the lower quartile of 3.9 (95% CI 2.6-5.6). However, after further adjusting additionally for obesity indices, fasting insulin, inflammation score, hypertension, triglycerides and adiponectin, high leptin predicted a lower diabetes risk (HR=0.40, 95% CI 0.23-0.67). Additional inclusion of fasting glucose attenuated this protective association (HR=0.59, 95% CI 0.32-1.08, p<0.03 for linear trend across quartiles). In similar models, protective associations were generally seen across subgroups of sex, race, nutritional status and smoking, though not among those with lower inflammation scores or impaired fasting glucose (interaction p=0.03 for both).

CONCLUSIONS/INTERPRETATION

High leptin levels, probably reflecting leptin resistance, predict an increased risk of diabetes. Adjusting for factors purportedly related to leptin resistance unveils a protective association, independent of adiponectin and consistent with some of leptin's described protective effects against diabetes.