Episode 365: Does Paleo cause heart disease?

(0:40) Welcome
Welcome back to The Paleo View listeners! Stacy is home and is so excited to jump into this week's very science-y topic!
Snuggling her pets and sleeping in her own bed, Stacy is so happy Stacy also shared an update on a family that she visited with while in Texas
Their daughter has alopecia and her hair is starting to grow back after following an AIP approach and working with her family to heal her body Sarah shared her feelings on how significant this is and what this specific case shows us about the autoimmune protocol
This week's show sponsor is Just Thrive probiotics
Both Stacy and Sarah's family uses this product Get 15% off with code PALEOVIEW15 Visit: https://thriveprobiotic.com/thepaleoview
(11:13) The Study that Sparked the Discussion
Recently, ahuman study was publishedlooking at how long-term adherence to a Paleo diet affects the gut microbiota and TMAO
Mainstream news picked it up the day it was published
Using headlines like, "Study linking Paleo diet to increased heart disease risk strengthens diet industry concerns"
There are a few physician-focused websites that publish news to keep doctors up to date on the medical literature
The headline was, "Paleo diet increases the risk for heart disease"
Sarah's inbox and The Paleo View's inbox was flooded with questions It is common in these situations for mainstream media to pick up on any anti-fad diet study
The standard response from our community is to find some reason why this study is irrelevant
TMAO is often linked with red meat consumption
It is thought to be one of the mechanisms behind the link between increased cancer risk and increased cardiovascular disease risk and high red meat consumption
The reason why Sarah wants to dedicate an entire episode to this study is that it was very well done
It has some results that we need to pay attention to Sarah doesn't see this study as a nail in the coffin on the Paleo diet Instead, Sarah sees this as a very serious warning about a very particular type of implementation of Paleo
We need to make sure we are incorporating all the key principles of Paleo, instead of combining Paleo with other dietary approaches
This study shows us that there are problems with the longterm implementation of a low carb Paleo diet
Really what it is telling us is that root vegetables and fruit are awesome
The study was performed in Australia and they took people who self-reported following the Paleo diet for over a year
The controls were following the national dietary recommendations of Australia
These are similar to the recommendations made by the USDA/MyPlate
Within the Paleo group, they further divided them into two subgroups
The people who followed Paleo very strictly were called strict Paleo The other group was called pseudo-Paleo
These people were consuming about one serving of grains or dairy per day
In the real world, most of us who have been following Paleo for a longtime fall closer to that pseudo-Paleo group Strict Paleo is often the challenge Paleo group or is utilized by those who are using it for therapeutic purposes
They had these people do a three-day weighed diet record
Measure and record everything they were eating They then did urine tests to measure nitrogen and the Goldberg cut point
If those urine tests didn't match the dietary records they were eliminated from the study
They eliminated anybody who had been on antibiotics, cholesterol medication, blood pressure-lowering medication, previously diagnosed with cardiovascular disease, anyone with any kind of GI disorder, or anyone who has had surgery on their GI tract
They were eliminating anyone who would predictively be an outlier
They then did a series of measurements (TMAO, blood work, stool analysis)
The two measurements that turned out to be different between the Paleo and pseudo-Paleo group was the amount of TMAO in their blood and what was happening in their gut microbiome
Sarah explained more about why TMAO was a focal point in this study
Studies that pool all of these studies together show that if you have higher TMAO in your blood you have a higher risk of cardiovascular disease
23% increased risk And 55% increased risk of all-cause mortality
Which is a general marker of health and longevity
The interesting thing that Sarah notes, is that there has also been a lot of research that fails to show a causal link
The majority of the science from the last few years makes this picture of TMAO as an indicator or a symptom as opposed to the direct link between high red meat consumption and heart disease
How we get TMAO:
Some we absorb directly from food Most of the TMAO is made by our gut bacteria when they metabolize choline, lecithin, and carnitine So it is a multi-step process
Sarah shared more on this process and how TMAO is created
Researchers have discovered over the last few years that how much TMAO is in your bloodstream is far more correlated to your gut microbiome than to how much carnitine you ingest There are certain bacteria that have been shown to be TMA producers There is now this really interesting picture being painted with all the scientific literature showing that TMAO is potentially, rather than a causal link between red meat consumption and cardiovascular disease and cancer, that it's an indicator of a gut microbiome that is conducive to disease development
As we start to look at TMAO it is probably less related to red meat consumption, so much as a dysbiosis in the gut
One of the best pieces of evidence for this is that fish is really really high in TMAO
People will get 300x more TMAO in their blood after eating fish than after eating beef, even if they have a microbiome that produces TMAO
And fish is uniformly beneficial and reduces the risk of heart disease
Sarah has seen in relation to this new scientific study is arguments that say, "TMAO probably doesn't cause heart disease, therefore Paleo causing high TMAO is nothing we need to worry about"
This isn't something Sarah agrees with
High TMAO, especially when it is not timed with TMAO rich foods, generally is an indicator of something going wrong with our gut bacteria that needs to be paid attention to The way that this study was designed to measure high TMAO food consumption is not taking into account seafood, which is something worth paying attention to
(27:40) Testosterone Deficiency
What is happening in this particular new study looking at strict Paleo and pseudo-Paleo adherence is not that TMAO is going up because the Paleo people are eating more fish
But rather that the TMAO is going up as a result of a shift in the gut microbiome
The study also took a deeper look into the gut microbiome
They found overall big trends However, the study did find that two particular genres of probiotic bacteria were really low in the Paleo and pseudo-Paleo groups
Bifidobacteria Roseburia bacteria
This is something really important to pay attention to Bifidobacteria are some of our main vitamin producers
They are important for inhibiting pathogen colonization in the gut They help to modulate our immune responses They modulate the gut barrier They can reduce inflammation They can improve glucose intolerance Low bifidobacteria is associated with a ton of different health problems
We get bifidobacteria from fermented dairy and sauerkraut
They love starch loving bacteria, especially fermented starch
There is a little less known about roseburia bacteria and fewer species
We do know that they are very important for maintaining gut barrier health
So if you have low roseburia you have a leakier gut
They are very important immune regulators, especially at reducing inflammation Low roseburia is also associated with many health conditions:
Cardiovascular disease Autoimmune disease IBS Neurological disease Allergies Asthma
They are really important members of a healthy gut microbiome
The levels of this bacteria were tanked in the study Another genus had taken their place, called Hungatella
This strain isn't as well studied as bifidobacteria or roseburia But hungatella are TMAO producers They are absolutely associated with TMAO
And this is probably why given that these people following Paleo were also consuming more red meat than the controls
So they were consuming the precursors at the same time as they were shifting their gut bacteria towards a TMAO producing bacteria type Their gut bacteria was making more TMAO We don't super understand if high hungatella might be linked with disease but we do know that the low roseburia and low bifidobacteria is potentially a problem
As this study looks at high TMAO and all these different measurements of what these people are eating and we have this shift in the gut bacteria
We have all of this really fascinating correlation analysis to try to understand what aspect it was of the study diet that was actually causing these shifts While TMAO itself was mostly aligned with red meat consumption, the shift in the gut microbiome that was driving TMAO production was actually most closely related to total carb consumption as well as resistant starch consumption In the control group, those people were mostly eating grains as their carb source In the Paleo and pseudo-Paleo group, they were mostly eating non-starchy vegetables
Hardly any roots and tubers Hardly any fruit So both groups were only consuming 90ish grams of carbs a day, but getting quite a bit of fiber
They were consuming 6 to 7 servings of vegetables a day As you dig into the details of what they were eating, they were not eating as much resistance starch
This indicates that this particular implementation of Paleo in this particular study is a low carb  Paleo template
Less than 100 grams of carbs a day Close to 30 grams of fiber
This is where the change in the gut microbiome is really predictable
Both roseburia and bifidobacteria thrive in starchy conditions and are very sensitive to the types of carbohydrates we consume Out gut bacteria have an amazing ability to digest carbohydrates
Sarah shared more on this process
If we don't feed our bifidobacteria the right type of food it can't survive
This is why this is such a sensitive species
There is this whole other fascinating to Sarah link with TMAO and what is happening in a low carb diet and the gut bacteria
This whole other life form is called Archaea
These are normal residents of the gut They are the main methane producers
These particular methane-producing Archaea use compounds like TMAO and TMA to produce methane
The diet factor that most strongly correlates with Archaea in the gut is carbohydrate consumption
We know that Archaea are fruit and starch lovers
Sarah dug deeper into the picture being painted by the results from this study
All of the things that would fix this gut microbiome and reduce TMAO production is to eat starchy roots and tubers and fruit
When you dig into these details this study makes a very strong case for high starchy vegetable consumption not being sufficient to support the gut microbiome
It is not enough to get fiber from non-starchy vegetables We need the type of fiber that is in fruit and resistance starch in root vegetables that is going to support a healthy gut microbiome that is going to reduce the risk of disease This study very cleverly used TMAO as a marker of those gut microbiome changes
It is the mainstream media that is then making the leap to it actually impacting cardiovascular disease risk
Stacy said that it is shocking to see another study supporting this idea that vegetables are good for you Sarah is really starting to see the evidence accumulate for problems associated with long-term low carb approaches
We need a diversity of fruits and vegetables and need to not be afraid of the carbohydrates in starchy vegetables Even if you can't do nightshades there are plenty of wonderful options We need to not be fruit-phobic The science is mounting up that we actually do best with moderate carbs, moderate fat, moderate protein
These approaches that are driving macronutrient extremes and even macronutrient imbalance have problems associated with them
Why have these diets lasted so long as weight loss approaches?
It is because it is a set of rules that result in ditching hyper-palatable foods and trick you into reducing your caloric intake
When we can formulate a much healthier option that embraces whole food sources of carbohydrates without demonizing them
It this uphill battle against the amount of misinformation that is out there on the internet that needs to be fixed Sarah's call to action (besides everyone going home and eating a sweet potato) is to contribute to this conversation of avoiding carb phobia
The manufactured food carbohydrates are clearly bad, but we don't need to lump these super nutrient-dense roots, tubers, starchy vegetables and fruit and demonize them with cupcakes
Stacy shared her thoughts on how we as humans are drawn to very dogmatic ideals
The truth of the matter is that not all carbs are the same
(49:42) Closing Thoughts
If you found this show fascinating, go back and check out the insulin showfor more on gut health and overall human health
It will help to make a lot of sense of the study
Stacy shared examples of cases when kids are put on extreme diets and does it make sense to put kids into these dogmatic bubbles?
If you answered no, then why does it make sense to put yourself into these bubbles? Is it just purely weight loss, or are you really thinking about health?
Studies like this always make Stacy go back to the mentality of, just focus on health
Colorful, rainbow foods exist for a reason There is so much science to support why it is healthy for you
Stacy reminds people that none of us are perfect
Making healthy choices every day is something we need to be mindful of, and that is hard It can be overwhelming, but there are things you can do to make it easier on yourself and to be excited
Take your kids with you to the grocery store and let them pick out vegetables and fruits that they love When you get home from the store cut them up and have them on hand in the fridge We as adults can do this to
This is the kind of thing where it is easy to get frustrated and overwhelmed with mixed messages  and not sure what to do and to feel like you can't win
And this isn't the case If good quality gluten-free oats agree with you and your family, enjoy them
Add some antioxidant-rich fruits, mix in some yogurt if that agrees with you because these things are feeding your gut in a good way It is about balance, and if we just relaxed into real food a little bit it would come easier and more natural to us
Sarah agrees with Stacy
Gluten-free oats are a gut microbiome superfood
These won't agree with everyone
 There are a list of foods that we define as not being Paleo, but they are great for the gut microbiome and when prepared correctly are nutrient-dense whole foods Sarah identifies with the label Paleo, but she thinks of Paleo as a diet that looks to Paleoanthropology in terms of understanding human biology and then confirms with contemporary studies with a biological systems approach
It has a rooted in science approach
This study is a really good illustration of the importance of taking this really thorough broad look at what foods do for us and don't do for us
And also understanding that one of the biggest problems that we have run into over the last 50 years is this idea that we have to just make a list of yes foods and no foods
We define all of these diets by what you cut out, not based on what you eat When people are troubleshooting they cut out more It isn't what you don't eat that makes a diet healthy, it is what you actually put in your face that makes your diet something that supports your body or not Sarah thinks it is important for this community to stop with the memes, the soundbites, and the lists and the rules
Start embracing a broader education around health topics that help us really understand what is in foods that help our bodies and what is in foods that may potentially undermine our health We need to start looking at the gray and not just the black and white so that we can start making informed choices Look at universal truths as opposed to arbitrary rules Dig in and understand
If you want to help your gut health, be sure to check out Stacy and Sarah's favorite probiotic
15% off with code PALEOVIEW15 Visit: https://thriveprobiotic.com/thepaleoview Stacy feels a difference when she remembers to take her probiotic every day
Thank you Sarah for taking the time to do all of this research Thanks for listening everyone! We will be back next week!