A special thanks to many readers who sent comments and questions about the article I wrote on the Paleo Diet. It is really rewarding to get feedback from our members as this type of dialogue helps the Museum to fulfill its mission and vision which includes both creating a “community of critical thinkers” and “inspiring curiosity.”
In writing the article I had to do a significant amount of research, and was lucky to have the advice of Dr. Melissa Wdowik, a registered dietician, as well as from Lance Holly who is an anthropologist. Here is a rundown of the sources I consulted and my thought process as I tried to get a handle on all the information out there. If you have recommendations to me about other sources I did not consider, please feel free to send me an email and let me know. I think the Paleo Diet is a fascinating lens through which we can look at human health and evolution and I hope to continue to learn more. Your thoughts are greatly appreciated!
WHERE I STARTED THIS JOURNEY
For overall nutrition, I started here:
And looked at this information:
Whole grains: http://www.choosemyplate.gov/food-groups/grains-why.html
I learned that the “Choose My Plate” info is based on the 2010 Dietary Guidelines for Americans:
Before diving into that 112 page document I looked at the Mayo Clinic as well to get an overview of the guidelines, “Boiling Down the Guidelines” is a good review: http://www.mayoclinic.com/health/dietary-guidelines/MY01594
THE REAL REFERNCES BEHIND THE DIETARY GUIDELINES
After reviewing the guidelines I went looking for the resources that helped inform them. The Dietary Guidelines are based on based on a review process for relevant dietary-related research and can be found here: http://www.nutritionevidencelibrary.com/default.cfm?library=DGAC
(This is a site that shows the data that is considered when compiling the Dietary Guidelines for Americans every five years. Click on the index to search topics. Within a certain topic, you can click on the review question that interests you most… bone health vs. weight loss will have different levels of support for example, then click on the evidence link to see all the references related to that topic. Each person will have a unique investment in the various health outcomes for each of the food groups listed below.)
OTHER PEER-REVIEWED ARTICLES AND REVIEWS
Access to Articles: note that the abstracts of these articles can be found online through http://www.ncbi.nlm.nih.gov/pubmed/, the full article may require a subscription, but one can request a copy of an article by visiting a public library, or can (usually) have immediate access to the article by visiting a university library which likely already has a subscription to the journal.
Impact of milk consumption and resistance training on body composition of female athletes. Josse & Phillips. 2012.
Putting the Whole Grain Puzzle Together: Health Benefits Associated with Whole Grains. Jonnalagadda et al. 2011.
Essentials of Healthy Eating: A Guide. Skerrett & Willett. 2010.
Increased Consumption of Dairy Foods and Protein during Diet- and Exercise-Induced Weight Loss Promotes Fat Mass Loss and Lean Mass Gain in Overweight and Obese Premenopausal Women. Josse et al. 2011.
Role of dairy beverages in the diet. Weaver. 2010.
Invited review: Dairy intake and bone health: a viewpoint from the state of the art. Caroli et al. 2011.
Major scientific advances with dairy foods in nutrition and health. Huth et al. 2006.
Cereal grains and legumes in the prevention of coronary heart disease and stroke: a review of the literature. Flight & Clifton. 2006.
Bone Mineral Density and Food-frequency in Korean Adults: The 2008 and 2009 Korea National Health and Nutrition Examination Survey. Yoon et al. 2012.
Dietary and training predictors of stress fractures in female runners. Wentz et al. 2012.
The gourmet ape: evolution and human food preferences. Krebs. 2009.
Phytochemicals for health, the role of pulses. Rochfort & Panozzo. 2007.
Nutritional quality of legumes, and their role in cardiometabolic risk prevention: a review. Bouchenak & Lamri-Senhadji. 2013.
Potential benefits of adherence to the Mediterranean diet on cognitive health. Féart et al. 2013.
Identification of the flavonoids in mungbean (Phaseolus radiatus L.) soup and their antioxidant activities. Li et al. 2012.
The role of geography in human adaptation. Coop et al. 2009.
Diabetes Mellitus: A “thrifty” genotype rendered detrimental by “progress”? Neel. 1962.
Worldwide spatial genetic structure of angiotensin-converting enzyme gene: a new evolutionary ecological evidence for the thrifty genotype hypothesis. Li et al. 2011.
Evolutionary Aspects of Diet: Old Genes, New Fuels. Eaton & Cordain. 1997.
Beneficial effects of a Paleolithic diet on cardiovascular risk factors in type 2 diabetes: a randomized cross-over pilot study. Jonsson et al. 2009.
The feasibility of a Paleolithic diet for low-income consumers. Metzgar et al. 2011.
A Palaeolithic-type diet causes strong tissue-specific effects on ectopic fat deposition in obese postmenopausal women. Ryberg et al. 2013.
A Palaeolithic diet improves glucose tolerance more than a Mediterranean-like diet in individuals with ischaemic heart disease. Lindeberg et al. 2007.
OUTSTANDING ISSUES NOT ADDRESSED
I also went back and read the FAQs on the Choose My Plate website, as there are many issues that aren’t really addressed in the guidelines, like celiac disease and lactose intolerance that can directly change the way that the guidelines are applicable to an individual. Here are some answers I found to these questions on this document: http://www.choosemyplate.gov/faqs.html
What is the difference between a food allergy and food intolerance?
For someone with a food allergy, proteins in certain foods trigger an abnormal immune response. Common food allergies include those to milk, eggs, fish, crustacean shellfish, tree nuts, wheat, peanuts, and soybeans. In comparison, food intolerances are due to the inability of the body to digest or metabolize a food component. For example, lactose intolerance is caused by a deficiency of the enzyme lactase that breaks down the sugar lactose in milk and milk products. Because food allergies and food intolerances can cause some of the same symptoms (stomach cramps, vomiting, and diarrhea) they are often mistaken for one another. Those who think they may have a food allergy or a food intolerance should be medically evaluated to avoid unnecessarily eliminating foods from their diet. Most people who have a food allergy need to completely eliminate the offending food and ingredients that contain the food's protein from their diet. However, for some food intolerances, like lactose intolerance, smaller portions (e.g., 4 ounces of milk) or a modified version of the offending food (e.g., lactose-reduced or lactose-free milk, yogurt, or cheese) may be well tolerated. More information about food allergies and intolerances can be found here.
What advice do you have for people who can't or don't drink milk?
For those who are lactose intolerant or sensitive to lactose, lower-lactose products are available. Hard cheeses and yogurt generally contain less lactose than milk and may be more easily tolerated. Some people may also try smaller portions of lactose-containing products (e.g., 4 ounces of milk) and/or combining the product with another food (e.g., having milk with cereal). Lactose-free milk is also widely available. Fortified soymilk (soy beverage), which has a similar nutrient profile to cow's milk, is another option within the Dairy Group. There are a number of calcium-rich, non-dairy foods for those who do not consume milk products for whatever reason (allergies, veganism, etc.). These foods include some green vegetables (collard greens, turnip greens, beet greens), white beans, canned fish (sardines and salmon with bones), and some soy products. However, consuming enough of these foods on a regular basis to meet calcium needs may be difficult for many. Calcium-fortified products such as juices, cereals, breads, almond drink, and rice drink can also be good sources of calcium. For more information on calcium sources, please see Appendix 14 of the 2010 Dietary Guidelines for Americans.
If I have diabetes, celiac sprue (gluten intolerance), food allergies, gastric bypass surgery, etc., how can I modify the USDA Food Patterns to fit my specific needs?
The USDA Food Patterns, based on The 2010 Dietary Guidelines for Americans, are applicable to healthy people over the age of two years. They do not take into account diseases or disorders that require therapeutic diets. For more information on a specific condition or therapeutic diet, please visit our Related Links page for government websites such as the National Heart, Lung, and Blood Institute (NHLBI) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
OTHER RESOURCES I USED
A recommended resource from ChooseMyPlate.gov was www.healthfinder.com. While it was more of the same in terms of reiterating the guidelines, I did think it had one really great tip- tracking your changing eating habits. This application is worthwhile in order to see what really works for you in an objective way- tracking and comparing what you are doing and what is helping you reach your health goals (weight loss, increased muscle mass, lower blood pressure etc.) http://www.healthfinder.gov/HealthTopics/Category/nutrition-and-physical-activity/nutrition/eat-healthy
Making small changes to your eating habits can make a big difference for your health. Keep a food diary to track this. Knowing what you eat now will help you make changes. Starting today, write down:
When you eat
What you eat
How much you eat
Where and with whom you eat
How you are feeling when you eat
If you have specific questions, it is a good idea to work with a dietician to make sure you can have concerns addressed and to make sure you are not excluding any nutrients inadvertently when you make changes to your diet. To find a registered dietician visit http://www.eatright.org/
I also like this approach called “Get the Facts” which basically reconfirms that personalized nutrition is complicated… http://www.eatright.org/Public/content.aspx?id=6641 last updated January 2013.
“Making the right food and nutrition choices is a necessary part of daily life—but finding the best and most accurate information can be confusing. However, it is possible to develop a plan for healthy eating, and plans that emphasize a balance of foods, like those based on the Dietary Guidelines for Americans, can promote positive lifestyle changes. An understanding of what is in the food we eat is essential for allowing all foods to fit into an eating plan—as long as they are consumed in moderation and combined with regular physical activity. Research studies and breaking news about food and nutrition appear in headlines almost every day. With so many changes, it can be difficult to tell which recommendations are based on strong scientific evidence, and which are simply marketing materials. Registered dietitians are food and nutrition experts, translating the science of nutrition into practical solutions for healthy living. Various tools are available to help meet the goal of a healthy weight. Among these is the Body Mass Index (BMI), which can be used as a screening tool to identify potential health problems.”
I read through the Questions & Answers document for the guidelines as well. And found this information useful http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/PolicyDoc/QandA.pdf
What are the major themes of the 2010 DGAC Report?
The DGAC considers the obesity epidemic to be the greatest threat to public health in this century. Each section of the Report was developed in a way that addressed the challenges of obesity. Another major theme was a focus on children throughout the Report. The Report included four major action steps for the American public:
Reduce the incidence and prevalence of overweight and obesity of the US population by reducing overall calorie intake and increasing physical activity.
Shift food intake patterns to a diet that emphasizes vegetables, cooked dry beans and peas, fruits, whole grains, nuts, and seeds. In addition, increase the intake of seafood and fat-free and low-fat milk and milk products and consume only moderate amounts of lean meats, poultry, and eggs.
Significantly reduce intake of foods containing added sugars and solid fats because these dietary components contribute excess calories and few, if any, nutrients. In addition, reduce sodium intake and lower intake of refined grains that are coupled with added sugar, solid fat, and sodium.
Meet the 2008 Physical Activity Guidelines for Americans.
Public comments address other issues and potential gaps in the Dietary Guidelines
This document may be a useful resource for others that have similar questions and places they may contact for more information.
For example, these comments address celiac disease and gluten:
Comment Number: 001364 “I was amazed that there is only a brief reference to Celiac Disease in the Guideline. The safety of foods for those required medically to follow a gluten free diet is not mentioned
as far as I could see. This is particularly important to those of us who need to follow this diet, especially as it relates to food manufacturing and food labeling. With the large
number of citizens who need to be assured of the safety of foods labeled "gluten free", shouldn't this be addressed in this report, rather than emphasizing only allergies? The
danger to those of us with Celiac Disease is the impact foods with proscribed grain sources has on the overall body for longer periods of time.”
Comment Number: 001371 “Gluten Sensitivity-- Have labels that ensure that things that have 'gluten free' are in fact 'gluten free' and also free from cross-contamination (e.g. cereals that say 'gluten free' that aren't produced in a dedicated assembly line. These products frequently make me sick, because of cross contamination. Perhaps a new ingredient 'contains gluten' being required for all foods that contain gluten of any kind (esp. modified food starch).”
Other resources on Celiac Disease
Did the public have an opportunity to give input on the DGA process?
A public comments database was accessible for providing written comments and submitting support material. A total of 765 written comments on the DGA process were posted between Oct 15, 2008, and April 29, 2010. A total of 1,159 comments on the DGAC Report were posted from June 15 to July 15, 2010. Oral testimony was heard at the 2nd DGAC meeting and at a public meeting on the DGAC Report in July 2010. A total of 51 organizations or individuals provided oral comments on the DGA process on January 29-30, 2009 (2nd DGAC meeting), and 50 organizations or individuals provided oral comments on the DGAC Report on July 8, 2010.
How was the DGAC deliberation process made transparent for the public?
The public was encouraged to submit comments and observe the first two DGAC meetings in person. They were encouraged to submit comments and view the remaining four meetings by webinar from 4 around the globe. A www.dietaryguidelines.gov website was developed to provide one-stop DGA information. Transcripts and meeting minutes for each DGAC meeting and archives of each webinar are available on the website. Outside speaker presentations and data charts were also posted to the website. In addition, all meeting announcements and details were posted online. All Committee decisions were discussed in the public forum.