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Food and nutrition

On the African savannah, lions eat zebras, and zebras eat grass. What would happen if you fed raw meat to zebras and grass to lions? You’d probably have a lot of hungry and unhappy animals on your hands. Over millions of years, lions and zebras have evolved to eat certain diets. The digestive system of a lion is simply not designed to eat plants. Just like lions and zebras, humans have evolved to eat a particular diet. In the Paleolithic period about 2.6 million years ago, our earliest human ancestors were hunter-gatherers who caught fish and wild meat, and gathered fruits and vegetables1. For millions of years, this was the human diet, and our bodies and digestive systems evolved accordingly.
 
Then agriculture was invented about 11,000 years ago. Suddenly, the main part of our diet consisted of simple carbohydrates such as wheat, rice, pasta, flour, potatoes, and other starchy foods. About 6,000 years ago, dairy foods such as milk and cheese were introduced into our diet. Refined sugar was even more recent, appearing in northern India around 500 BC. The first vegetable oils were rendered and pressed about 6,000 years ago, while the process of hydrogenating vegetable oils was only invented in 1897.

Paleolithic Diet
We are Stone Age people eating a Space Age diet. Fettuccine Alfredo may taste good, but pasta and cheese are not good for your body. In the typical Western diet, over 70 percent of the daily energy intake comes from foods which were unavailable to early humans. The table below shows the percentage of daily energy from these foreign food groups.

FOOD GROUP PERCENTAGE OF DAILY ENERGY
Cereal grains 24%
Refined sugars 19%
Refined vegetable oils 18%
Dairy products 11%
Alcohol 1%
TOTAL 73%

It’s true that our genes are continually evolving. But 11,000 years is too short a time for our genetics to adapt to a new diet of bread, milk, fat, and sugar2. For example, 90 percent of Asians, 70 percent of blacks and Native Americans, and 50 percent of Hispanics will develop lactose intolerance at some point during their lifetimes3. Stomach pain, bloating, and gas are the body’s way of telling us that we shouldn’t eat dairy products. Milk and dairy haven’t been available to humans long enough for our digestive systems to adapt. Just like it’s natural for lions to eat zebras, it’s natural for humans to eat a Paleolithic diet of lean protein, and fresh fruits and vegetables. We’re asking for trouble when we eat a non-Paleolithic diet. For example, your risk of heart disease is much higher if you eat a lot of saturated4 or trans fats5.

Fast food is especially bad. Scientists have found that a single serving of McDonald’s French fries in New York City contains about 6 grams of trans fats6. One serving of chicken McNuggets contains about 4 grams. This is frightening when you consider that the recommended intake of trans fat is 0 grams. In the documentary Super Size Me, Morgan Spurlock eats nothing but McDonald’s fast food for 30 days. His health deteriorates rapidly—he gains 25 pounds and suffers from mood swings, sexual dysfunction, and liver damage. Our modern diet is a health hazard7. The tragedy is that most people don’t know it.

Food Diary
How healthy is your diet? Find out by keeping a food diary.
  1. For one full day, write down everything that you eat or drink.
  2. Count the number of foods that contain dairy, sugar, grains, refined carbohydrates, vegetable oil, saturated or trans fats.
  3. How does this number compare with the amount of lean protein, and fresh fruits and vegetables that you eat?

Paleolithic Health
With their Paleolithic diet, hunter-gatherers were much healthier than farmers8. Archeological evidence from hunter-gatherers in Turkey and Greece shows that the average height was 5’9 for men and 5’5 for women. By 3,000 BC, the average height shrank to 5’3 for men and 5’0 for women because of the shift to an agriculture-based diet. This diet also led to vitamin- and mineral-deficiency diseases such as scurvy, beriberi, pellagra, vitamin A deficiency, zinc deficiency, and iron-deficiency anemia. In turn, child mortality was higher, and people’s lifespans were shorter. Archeologists have found that the teeth of pre-agricultural people were almost free of cavities, even though they never brushed or flossed. Cavity-producing bacteria require sugar or starch to produce the acid that eats away enamel. No sugar, no starch, no cavities.

Healthy Teeth and Gums
In our modern diets, it’s difficult to avoid sugar and starch completely. So what should you do for healthy teeth and gums? The American Dental Association recommends brushing twice a day with toothpaste, and flossing once a day. For brushing, there are two types of toothbrushes: manual and electric-powered. Manual toothbrushing is proven to reduce gingivitis9. But electric-powered brushes are even better. They’re also just as safe as manual brushes.

The best electric-powered brushes use “rotation-oscillation” to turn the brush head in one direction and then the other at very high speeds. In a review of over 40 clinical trials, researchers found that rotation-oscillation brushes reduced plaque by an extra 11 percent, and gingivitis by 17 percent, when compared with manual brushes over a 3-month period10. In a study from Amsterdam’s Academic Center for Dentistry, 90 volunteers had their teeth cleaned by a dental hygienist using either an electric toothbrush, or a traditional polish session11. Two minutes with an electric toothbrush removed the same amount of plaque as 10 minutes of professional polishing. Give your teeth a treat—buy a rotating-oscillating toothbrush.

Four Steps to a Healthy Smile
  1. Buy a rotating-oscillating electric toothbrush (e.g., Braun Oral-B AdvancePower Series).
  2. Brush your teeth twice a day: after breakfast, and before bedtime.
  3. Clean slowly around each tooth, and pay special attention to the base of the teeth where they meet the gums.
  4. Floss once a day before bedtime.

Optimal Nutrition
Loren Cordain is a professor of exercise physiology at Colorado State University, and an expert in the study of Paleolithic nutrition. In his book The Paleo Diet, Cordain summarizes the key components of our ancestral diet:
  • Wild, lean animal protein was the biggest part of the Paleolithic diet.
  • Almost all carbohydrates were from non-starchy wild fruits and vegetables.
  • Paleolithic people ate no dairy food.
  • They hardly ever ate cereal grains.
  • They did not salt their food.
  • The only refined sugar was an occasional bit of honey.
  • Most of their dietary fats were monounsaturated, polyunsaturated, and omega-3 fats.
Millions of years of evolution have adapted our bodies to perform best on a diet of lean protein, and fresh fruits and vegetables. Let’s take a look at these two food groups in more detail.

Protein
Chimpanzees are our closest living relatives, but they have big bellies like cows, horses, and other plant-eating animals. In contrast, human bellies are about 40 percent smaller than chimps, and our brains are about three times larger8. These differences evolved because our Paleolithic ancestors switched from eating mainly fruits and vegetables, to eating mainly meat.

For early humans, the first sources of meat were bones and carcasses left behind by larger predators. Our ancestors used stone tools to crack open the skulls and bones to get at the fatty brains and marrow. These tissues are very rich in a type of omega-3 fat called docosahexaenoic acid (DHA). By scavenging skulls and bones, our ancestors gained access to a plentiful source of DHA. Pound for pound, DHA provides much more energy than fruits or vegetables. This extra energy enabled the human brain to grow larger than when it was on a vegetarian diet.

After our Paleolithic ancestors learned to hunt, they supplemented their scavenging with a regular supply of wild meat. Analysis of ancient human remains from Gough’s Cave12 in Britain and Vindija Cave13 in Croatia has shown that wild meat was the main source of food in the Paleolithic diet.

Lean Meat
Early humans ate more meat than modern humans, and the meat they ate was wild rather than domesticated. This is an important distinction because wild meat is higher in protein and lower in fat than domesticated meat. For example, wild meat contains about 15–20 percent of its calories as fat, whereas a lean cut of farm-raised beef is about 35–40 percent fat. Farm-raised meats such as lamb chops may be up to 75 percent fat.

In modern-day hunter-gatherer societies, wild meat makes up about 65 percent of the traditional diet, with the remaining 35 percent coming from wild plant foods. About 40 percent of the daily energy intake comes from fat. Most health organizations recommend that fat should make up a maximum of 30 percent of the daily energy intake to lower the risk of heart disease. But hunter-gatherers are generally free of heart disease. The reason is because wild meat is high in healthy monounsaturated and polyunsaturated fats, and low in unhealthy saturated fat. In fact, the “gamey” flavor of wild meat comes from the omega-3 fats and wild plants in the animal’s diet.
 
In a study comparing the diets of traditional Greenland Inuit with Danish city-dwellers, researchers found that the Inuit ate about twice as much protein and the same amount of fat, but had almost no heart disease14. The credit goes to the heart-healthy fats in wild meat, and the absence of refined carbohydrates in the traditional Inuit diet. The type of fat you eat is more important than the amount of fat. Omega-3 and unsaturated fats are healthy, whereas saturated and trans fats are unhealthy.

Although wild and free-range meats are becoming more popular, many supermarkets don’t carry them yet. So what should you buy? The table below lists some examples of lean protein that are good for your health8. When you compare the percentage of fat and protein in lean and fatty meats, you can see why lean protein is so much healthier for you.

 LEAN PROTEIN  PERCENTAGE PROTEIN  PERCENTAGE FAT
 Skinless turkey breasts  94%  5%
 Boiled shrimp  90%  10%
 Boiled lobster  89%  5%
 Pork tenderloin  72%  28%
 Sirloin beef steak  65%  35%
 Skinless chicken breasts  63%  37%
 Broiled salmon  62%  38%

FATTY PROTEIN
PERCENTAGE PROTEIN PERCENTAGE FAT
T-bone steak 36% 64%
Chicken thigh/leg 36% 63%
Pork ribs 27% 73%
Beef ribs 26% 74%
Bacon 21% 78%
Bologna 15% 81%
Hot dog 14% 83%
       
Fish
Fish is a great source of lean protein and healthy omega-3 fats. But what about contaminants such as mercury and organochlorine? Walter Willett is a professor of epidemiology and nutrition at the Harvard School of Public Health. After analyzing the health risks of organochlorine compounds in farmed salmon, he estimated that the lifetime risk of harm was about 1 in 10,00015,16,17. In contrast, the benefits of eating salmon are “likely to be at least 100-fold greater than the estimates of harm, which may not exist at all.”

According to the U.S. Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA), nearly all fish and shellfish contain traces of mercury. But the levels are unlikely to cause any harm, except in pregnant women or young children. The official recommendation is up to two meals a week of low-mercury fish and shellfish for women who may become pregnant, pregnant women, nursing mothers, and young children. Everyone else can eat as much as they want.

The Republic of Seychelles is an archipelago in the Indian Ocean, where 85 percent of the population eats fish daily. In a study of over 700 mother-child pairs, researchers found that the average mercury level in the mothers’ hair was 6.8 ppm, and the average children’s level was 6.5 ppm19. Even though these levels are 10–20 times higher than in Americans, no negative developmental effects were observed. Instead, children with higher mercury levels achieved slightly higher test scores, most likely because of the beneficial effects of omega-3 fat on brain development. The health risks of mercury in fish are likely small or nonexistent. Still, it makes sense to eat low-mercury fish if you have the choice.

Mercury Levels
The EPA maintains a database of local fish consumption advisories for the states and territories in the United States, and the provinces and territories in Canada. You can search through the EPA’s database at http://epa.gov/waterscience/fish/advisories/index.html.
The table below lists examples of fish and shellfish with low and high mercury levels.

LOW-MERCURY FISH & SHELLFISH Abalone (farmed), Anchovies, Butterfish, Calamari (squid), Catfish, Caviar (farmed), Clams, Crab (king), Crawfish/crayfish, Flounder, Haddock, Hake, Herring, Lobster (spiny/rock), Mackerel (Atlantic), Mussels (farmed), Oysters, Perch (ocean), Pollock, Salmon (wild or farmed), Sardines, Scallops, Shad, Shrimp, Sole, Sturgeon (farmed), Tilapia, Trout, Whitefish
MEDIUM-MERCURY FISH & SHELLFISH Carp, Cod, Crab (Dungeness), Crab (blue), Crab (snow), Mahi Mahi, Monkfish, Perch (freshwater), Skate, Snapper, Tuna (canned, chunk light)
HIGH-MERCURY FISH & SHELLFISH Grouper, Mackerel (king), Marlin, Orange Roughy, Shark, Swordfish, Tilefish, Bluefish, Croaker, Halibut, Lobster (American/Maine), Rockfish, Sea Bass, Sea Trout (Weakfish), Tuna (canned, white albacore), Tuna (fresh)

Protein Limit
We’ve evolved to eat a lot of lean protein. Is it possible to eat too much? Early pioneers and frontiersmen suffered from an illness known as “rabbit starvation” when they ate too much protein20. Small animals such as rabbits and squirrels are mostly protein with very little fat. For example, a squirrel is about 83 percent protein and 17 percent fat, whereas a mule deer is 40 percent protein and 60 percent fat. The symptoms of rabbit starvation are nausea and diarrhea.

When protein is digested, it releases nitrogen, which is processed by the liver into a substance known as urea. Urea is then excreted by the kidneys in your urine. But the liver has a limit on the amount of urea it can produce. For the average person, this limit is about 200–300 grams of protein per day, or the equivalent of three 12-ounce steaks21. Rabbit starvation is a reminder that the healthiest diet is a balance of lean protein, unsaturated fat, and fresh fruits and vegetables.
 
Vegetarian Diets
If too much protein is unhealthy, is the same true for fruits and vegetables? In the United States, almost 3 percent of adults are vegetarians22. They don’t eat any meat or animal products. Many vegetarians believe that their diet is the healthiest. Are they right?

In a study from the University of Padova, Italian researchers studied two groups of Bantu villagers in Tanzania23. One group lived on a lakeshore and consumed large amounts of fish. The second group lived in the nearby hills and ate a vegetarian diet. Except for the fish, the diet, lifestyles, and gene pools were similar between the two groups. But it turned out that the fish-eating group had lower blood pressure, lower levels of unhealthy fats such as triglycerides and cholesterol, and higher levels of healthy omega-3 fats.

The problem with vegetarian diets is that they’re low in lean protein and omega-3 fats. Also, some vegetarians eat refined carbohydrates such as rice, bread, and sugary foods, which lead to weight gain and cavities. Your body is designed to eat lean animal protein—it’s a mistake to cut it out of your diet.

Glycemic Index
Fruits, vegetables, bread, and rice are all examples of carbohydrates. But fruits and vegetables are complex carbohydrates, whereas bread and rice are refined carbohydrates. The difference is that complex carbohydrates have not been processed by milling, grinding, or polishing. This means they contain more nutrients and fiber. Also, they have a lower Glycemic Index (GI). GI is a measure of how quickly carbohydrates are digested into sugar and released in your bloodstream. For example, white rice has a GI of 126 and a baked potato has a GI of 121. Compare this to a GI of 62 for an orange and 52 for an apple.

High-GI foods give you a sugar rush. Your body responds by releasing insulin to lower your blood sugar. But because there’s so much sugar, your body overcompensates and releases too much insulin. This leads to a sugar crash. That’s why you feel tired and sluggish after a big meal of pasta. Over time, the yo-yo spikes in your blood sugar take their toll on your health. Scientists have found that a diet high in sugary foods and refined carbohydrates is associated with obesity, diabetes, and heart disease24,25. In contrast, low-glycemic foods release sugar gradually into your bloodstream. This gives your body time to adjust the amount of insulin and keep your blood sugar steady26. Until 11,000 years ago, no one ate bread, rice, pasta, sugar, or other refined carbohydrates. Stop eating these killer carbs and reclaim your health.

Healthy Foods
A Paleolithic diet is the best for your health. There are six simple rules to follow:
  1. All the lean meats, fish, and seafood you can eat
  2. All the fruits and non-starchy vegetables you can eat
  3. No grains or cereals
  4. No legumes
  5. No dairy products
  6. No processed foods
You may find it surprising that the healthiest diet consists only of lean protein, and fresh fruits and vegetables. After all, the Food Pyramid from the U.S. Department of Agriculture (USDA) recommends grains and dairy products. Unfortunately, farm lobbyists and special interest groups have seen to it that the Food Pyramid is based more on Washington politics than good science.

Humans lived as hunter-gatherers for millions of years before the Food Pyramid was ever dreamed up. That’s why your body functions best on a Paleolithic diet. That being said, it’s hard to say goodbye to all the unhealthy foods right away. To make things easier, I’ve compiled a list of common foods and divided them into three categories8. Eat regularly from the first category, eat in moderation from the second category, and avoid the third category altogether. Over time, adjust your diet so that you’re eating mainly from the first category.

What a strange machine man is. You fill him with bread, wine, fish, and radishes, and out come sighs, laughter and dreams.
-Nikos Kazantzakis

Category 1: Eat Regularly
Try to eat lean protein, and fresh fruits and vegetables at every meal. The reason you can eat as much as you want without getting fat is because the fiber from fruits and vegetables make you feel full quickly, and the protein helps you stay full over time. If you can’t find a food on this list, ask yourself whether a caveman would have eaten it.

Lean poultry (white meat, skin removed)
• chicken breast, turkey breast, game hen breasts

Lean pork (trimmed of visible fat)
• pork loin, pork chops
• any other lean cut

Lean beef (trimmed of visible fat)
• flank steak, top sirloin steak, extra-lean ground beef, London broil, chuck steak
• lean veal
• any other lean cut

Other meats
• rabbit meat (any cut)
• goat meat (any cut)

Organ meats
• beef, lamb, pork, and chicken livers
• beef, pork, and lamb tongues
• beef, lamb, and pork marrow
• beef, lamb, and pork “sweetbreads”

Wild meat
• alligator, bear, bison (buffalo), caribou, elk, emu, goose, kangaroo, Muscovy duck, New Zealand cervena deer, ostrich, pheasant, quail, rattlesnake, reindeer, squab, turtle, venison, wild boar, wild turkey, and other wild meats

Fish
• bass, bluefish, cod, drum, eel, flatfish, grouper, haddock, halibut, herring, mackerel, monkfish, mullet, northern pike, orange roughy, perch, red snapper, rockfish, salmon, scrod, shark, striped bass, sunfish, tilapia, trout, tuna, turbot, walleye, fish oil capsules, and other fish

Shellfish
• abalone, clams, crab, crayfish, lobster, mussels, oysters, scallops, shrimp

Fruits
• apple, apricot, banana, blackberries, blueberries, boysenberries, cantaloupe, carambola, cassava melon, cherimoya, cherries, cranberries, figs, gooseberries, grapefruit, grapes, guava, honeydew melon, kiwi, lemon, lime, lychee, mango, nectarine, orange, papaya, passion fruit, peaches, pears, persimmon, pineapple, plums, pomegranate, raspberries, rhubarb, star fruit, strawberries, tangerine, watermelon, and other fruits

Vegetables
• artichoke, asparagus, beet greens, beets, bell peppers, broccoli, Brussels sprouts, cabbage, carrots, cauliflower, celery, collards, cucumber, dandelion, eggplant, endive, green onions, kale, kohlrabi, lettuce, mushrooms, mustard greens, onions, parsley, parsnip, peppers (all kinds), pumpkin, purslane, radish, rutabaga, seaweed, spinach, squash (all kinds), Swiss chard, tomatillos, tomato, turnip greens, turnips, watercress, and other non-starchy vegetables

Spices
• garlic, powdered onion, lemon juice, lime juice, lemon crystals, lemon pepper free of salt, cayenne pepper, chili power, black pepper, cumin, turmeric, ground cloves, oregano, ground allspice, celery seeds, coriander seeds, ground cardamom seeds, and other non-salty seasonings
• cinnamon, nutmeg, mint leaves, ginger, vanilla, and other non-sugary, non-salty spices

Beverages
• water, mineral water

Recipes on Demand
  1. Not sure what to cook? Go to http://allrecipes.com/Search/Ingredients.aspx and enter in the ingredients you have on hand.
  2. The website will give you a list of recipes that contain those ingredients. Happy cooking!

Category 2: Eat in Moderation

Fish
• unsalted canned fish (tuna, salmon)

Eggs
• chicken (regular or omega-3), duck, goose

Fruits
• Dried fruits

Vegetables
• avocado, cassava root, corn, manioc, sweet potatoes, yams

Oils
• flaxseed, canola, olive, mustard seed, walnut

Nuts
• almonds, brazil nuts, cashews, chestnuts, hazelnuts, macadamia nuts, pecans, pine nuts, pistachios, pumpkin seeds, sesame seeds, sunflower seeds, walnuts

Legumes
• all beans (adzuki beans, black beans, broad beans, fava beans, field beans, garbanzo beans, horse beans, kidney beans, lima beans, mung beans, navy beans, pinto beans, red beans, string beans, white beans), black-eyed peas, chickpeas, lentils, peas, miso, peanut butter, peanuts, snowpeas, sugar snap peas, soybeans and other soybean products such as tofu
 
Grains
• amaranth, barley, buckwheat, millet, oats, quinoa, rice (brown rice, white rice, wild rice, basmati rice), whole wheat (bread, rolls, noodles, pasta, spaghetti, lasagna, pita bread, flat bread), whole grains

Dairy
• skim milk, low-fat yogurt

Beverages
• coffee, tea, wine, beer, spirits, skim milk, unsweetened soya milk, unsweetened fruit juices

Category 3: Foods to Avoid
A good rule of thumb is to avoid all prepared, processed, and packaged foods.

Fatty meats
• bacon, beef ribs, chicken and turkey legs, chicken and turkey skin, chicken and turkey thighs and wings, fatty beef roasts, fatty cuts of beef, fatty ground beef, fatty pork chops, fatty pork roasts, lamb chops, lamb roasts, leg of lamb, pork ribs, pork sausage, t-bone steaks

Starchy vegetables
• processed foods with potatoes (French fries, potato chips, mashed potatoes)
• tapioca pudding

Dairy foods
• butter, cheese, cream, dairy spreads, frozen yogurt, ice cream, ice milk, nonfat dairy creamer, powdered milk, whole milk
• processed foods made with dairy products

Cereal grains
• processed foods with barley
• processed foods with corn (corn tortillas, corn chips, cornstarch, corn syrup)
• processed foods with oats
• processed foods with rice (top ramen, rice noodles, rice cakes, rice flour)
• processed foods with rye (rye bread, rye crackers)
• processed foods with wheat or wheat flour (bread, rolls, muffins, noodles, crackers, cookies, cake, doughnuts, pancakes, waffles, pasta, spaghetti, lasagna, wheat tortillas, pizza, pita bread, flat bread)

Salty foods
• commercial salad dressings and condiments, bacon, cheese, deli meats, frankfurters, ham, hot dogs, ketchup, olives, pickled foods, pork rinds, processed meats, salami, salted nuts, salted spices, sausages, smoked/dried/salted fish and meat, canned meats and fish

Sweets
• candy, honey, chocolate bars
• sugary snacks

Oils
• almond, apricot, coconut, corn, cottonseed, grapeseed, hazelnut, oat, palm, peanut, rice bran, safflower, sesame, soybean, sunflower, tomato seed, wheat germ oils
• vegetable oils
• butter, margarine, shortening, lard
• food with trans fats

Spices
• salt, soya sauce, cooking wine
• spices containing salt

Beverages
• soft drinks, including diet pop
• sweetened drinks, including fruit drinks

Planning for Healthy Eating
It’s easier to eat healthy if you plan ahead. I like to plan my meals for the week on Saturday. I make one big trip to the grocery store, and stock up on lean protein, and fresh fruits and vegetables. On Sunday, I usually make a big pot of chili, and freeze it in individual lunches for the week. I also cut up fruits and vegetables and put them in Ziploc baggies or Tupperware.

For snacks, I buy fruits such as oranges, bananas, pears, and apples because they’re easy to wash and eat on the go. I also keep bags of nuts and dried fruit in my desk so that I’m not tempted to eat junk food. Fruits and vegetables move through your digestive system quickly, so the key to staying full is eating protein with every meal.

Healthy Meals
There are lots of healthy meals that taste good and are easy to cook. Here are 2 days of meals that I eat all the time. Notice there’s no rice, bread, pasta, or other refined carbohydrates.

DAY ONE

Breakfast
• Oatmeal with raisins and blueberries
• Banana
• Soya milk

Lunch
• Home-style chili
• Baby spinach salad with tomatoes, red peppers, and Italian dressing
• Green tea

Dinner
• Chicken breast stir fry with bok choy, green onions, and olive oil
• Water

Snacks
• Trail mix
• Oranges
• Strawberries

DAY TWO

Breakfast
• Poached egg
• Low-fat yogurt
• Soya milk

Lunch
• Beef stir fry with red peppers, green peppers, olive oil, and pepper flakes
• Watermelon slices
• Green tea

Dinner
• Baked salmon on a bed of baby spinach
• Glass of white wine

Snacks
• Unsalted cashews and almonds
• Cantaloupe
• Honeydew

References
  1. Cordain L et al. (2005). Origins and evolution of the Western diet: health implications for the 21st century. Am J Clin Nutr. 81:341–54.
  2. Voight BF et al. (2006). A map of recent positive selection in the human genome. PLoS Biol. 4(3):446–458 (e72).
  3. Harvard School of Public Health. Calcium and milk. http://www.hsph.harvard.edu/nutritionsource/calcium.html
  4. German JB, Dillard CJ. (2004). Saturated fats: what dietary intake? Am J Clin Nutr. 80:550–559.
  5. Mozaffarian D et al. (2006). Trans fatty acids and cardiovascular disease. N Engl J Med. 354:1601–13.
  6. Stender S, Dyerberg J, Astrup A. (2006). High levels of industrially produced trans fat in popular fast foods. N Engl J Med. 354(15):1650–1652.
  7. Lieberman LS. (2003). Dietary, evolutionary, and modernizing influences on the prevalence of Type 2 diabetes. Annu Rev Nutr. 23:345–77.
  8. Cordain L. (2002). The Paleo diet: lose weight and get healthy by eating the food you were designed to eat. John Wiley & Sons.
  9. Robinson PG et al. (2006). Manual versus powered toothbrushing for oral health. The Cochrane Database of Systematic Reviews. Issue 1.
  10. Mantokoudis D et al. (2001). Comparison of the clinical effects and gingival abrasion aspects of manual and electric toothbrushes. J Clin Periodontol. 28:65–72.
  11. Van der Weijden GA et al. (2004). Plaque removal by professional electric toothbrushing compared with professional polishing. J Clin Periodontol. 31:903–907.
  12. Richards MP, Hedges RE. (2000). Gough’s Cave and Sun Hole Cave human stable isotope values indicate a high animal protein diet in the British Upper Palaeolithic. Journal of Archaeological Science. 27:1–3.
  13. Richards MP et al. (2000). Neanderthal diet at Vindija and Neanderthal predation: The evidence from stable isotopes. Proc Natl Acad Sci USA. 97(13):7663–7666.
  14. Cordain L et al. (2002). The paradoxical nature of hunter-gatherer diets: meat-based, yet non-atherogenic. European Journal of Clinical Nutrition. 56(Suppl 1):S42–S52.
  15. Willett WC. (2005). Fish: Balancing health risks and benefits. Am J Prev Med. 29(4):320–321.
  16. Cohen JT et al. (2005). A quantitative risk–benefit analysis of changes in population fish consumption. Am J Prev Med. 29(4):325–334.
  17. Foran JA et al. (2005). Quantitative analysis of the benefits and risks of consuming farmed and wild salmon. J Nutr. 135:2639–2643.
  18. Hites RA et al. (2004). Global assessment of organic contaminants in farmed salmon. Science. 303:226–229.
  19. Davidson PW et al. (1998). Effects of prenatal and postnatal methylmercury exposure from fish consumption on neurodevelopment. JAMA. 280:701–707.
  20. Cordain L et al. (2000). Plant-animal subsistence ratios and macronutrient energy estimations in worldwide hunter-gatherer diets. Am J Clin Nutr. 71:682–92.
  21. Rudman D et al. (1973). Maximal rates of excretion and synthesis of urea in normal and cirrhotic subjects. J Clin Invest. 52:2241–2249.
  22. American Dietetic Association. (2003). Position of the American Dietetic Association and Dietitians of Canada: vegetarian diets. J Am Diet Assoc. 103(6):748–765.
  23. Pauletto P et al. (1996). Blood pressure and atherogenic lipoprotein profiles of fish-diet and vegetarian villagers in Tanzania: the Lugalawa study. Lancet. 348:784–88.
  24. Roberts SB. (2000). High-glycemic index foods, hunger, and obesity: is there a connection? Nutrition Reviews. 58(6):163–169.
  25. McKeown NM et al. (2004). Carbohydrate nutrition, insulin resistance, and the prevalence of the metabolic syndrome in the Framingham Offspring Cohort. Diabetes Care. 27:538–546.
  26. Bouche C et al. (2002). Five-week, low–glycemic index diet decreases total fat mass and improves plasma lipid profile in moderately overweight nondiabetic men. Diabetes Care. 25:822–828.

Copyright © 2009 by Paul Lem, M.D.
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