THE PALEO DIET INSIDERCROHN’S DISEASE & THE PALEO DIET

THE

Vol. 6, Issue 2

LICHEN SCLEROSIS

IS STEVIA PALEO?

PROS & CONS OF CHIA SEEDS

LOREN CORDAIN, PH.D.

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the immune system representing cellular mechanisms), chances are that a cross reaction between foreign antigens and self antigens (produced by T-cells) occur. This is termed molecular mimicry, and leads to self injury by the adaptive immune system.

Hence, decreasing intestinal permeability is one of the treatment targets. There are several nutrients known to increase intestinal permeability that you may want to avoid, at least until symptoms subside. Here is a list, with the noxious substances in parentheses:

• Cereal grains (lectins and gliadin)• Legumes, including soya and peanuts (lectins and saponins)

• Tomato (tomato lectin and alpha-tomatin)• Potato (lectins and saponins)• Chili (capsaicin)• Quillaja (foaming substance)• Quinoa (saponins)• Egg white (lysozyme)• Alfalfa sprouts (saponins)• Amaranth (saponins)• Alcohol

Moreover, some nutrients exert an adjuvant-like activity (they stimulate the immune system), which is something you don’t want to if you are suffering from an autoimmune disease. Nutrients containing adjuvants:

• Quillaja extract, found in root beer

• Tomato alpha-tomatine

Dairy products and vegetable oils also have deleterious effects upon your immune system. I hope this helps.

Maelán Fontes, MS Ph.D.

CROHN’S DISEASEQ: Can you comment on any reported results in curbing the symptoms of Crohn’s Disease with the Paleo Diet. As I am a sufferer, I would love to know.

Thank you,

Shannon

A: Dear Shannon,

Indeed, inflammatory bowel disease (Ulcerative Colitis & Crohn’s Disease) patients usually do very well with The Paleo Diet, as nutrients are one of the main environmental triggers of this condition. Crohn’s disease is an autoimmune disease where the immune system mounts an attack against its own tissues - in this case the cells lining the intestine.

For an autoimmune disease to occur we need a genetic predisposition and an environmental trigger. The genetic predisposition depends on genes coding for the Human Leukocyte Antigen (HLA) system. One of the environmental triggers may be nutrition, besides infections, geography (vitamin D deficiency), physical trauma or vaccination.

One of the key points in this process is increased intestinal permeability. This means that the gut barrier allows increased passage of bacterial or food proteins (antigens) into peripheral circulation, skipping a process known as oral tolerance. Once antigens come in contact with the immune system located in the gut associated lymphoid tissue, they may elicit a T-cell mediated immune response against those antigens.

If the molecular structure of the dietary or bacterial antigens is similar to that of the HLA system (part of

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LICHEN SCLEROSISQ: Hi there - I have been following a Paleo Diet for a few weeks now and there is no doubt that I feel much better for it. I did not need to lose weight and I always regarded myself as pretty fit and healthy. However, a little while back I developed a troublesome skin condition called Lichen Sclerosis. Have you ever been asked about this condition and suggested dietary changes? I think part of the problem is that the etiology is not fully understood but many doctors seem to think it has an autoimmune component though I have read recent research that suggests oxidative damage plays a part and that antioxidant therapy may be useful in treatment. This condition is supposedly incurable (though manageable with potent steroids) but I’m sure it would give a great many people some comfort if simple dietary changes could help. Would be really great to hear your thoughts.

Simon

A: Dear Simon,

The available evidence indicates that an autoimmune component likely occurs with Lichen Sclerosis (LS). With all autoimmune diseases, an autoantigen (self protein) exists and represents the target protein being attacked by the immune system. About 75 % of LS patients maintain an IgG autoantibody to Extra Cellular Matrix Protein 1 (ECM1).1 Acceleration of ECM1 deposition in dermal (skin) blood vessels may underlie the disease symptoms.2, 3 So the question now arises, what causes an accelerated deposition of ECMI in dermal blood vessels in LS patients? The available evidence indicates that increased concentrations of a ubiquitous enzyme in the body called tissue transglutaminase (TG2) is primarily responsible for excessive ECM1 accumulation3. In medical terms, an increase in a concentration of a substance in the bloodstream by another substance is called “upregulation”.

So, in LS patients, an upregulation of TG2 causes an upregulation and increased deposition of ECMI in the skin blood vessels in the affected area of the body. The next question to be posed is, what event or events trigger an upregulation of TG2? When we answer this

question, then dietary recommendations advocated by the Paleo Diet will make sense. A storage protein called gliadin which is fournd in wheat, rye, barley and oats is known to upregulate TG2.4-7 Hence grain free diets may prove to be therapeutic for LS patients, although no current randomized controlled trials of this intervention strategy have yet been conducted.

Cordially,

Loren Cordain, Ph.D., Professor Emeritus

For sources see References: Section I

STEVIAQ: Is Stevia Paleo? I have attempted to find an answer for this and the information I’ve found is conflicting at best. Please advise!!

Jeff

A: Dear Jeff,

There’s some scientific evidence to support the notion that Stevia is safe, even in type 2 diabetes patients.1,2 Furthermore, it has been demonstrated to have antihypertensive properties, as shown by Chan et al.3 and a long-term study.4 Having said this, I am not aware of any study examining the potential antinutrient (lectins or saponins) content of the plant, hence we do not know the possible adverse effect of consuming this plant on a daily basis. Hunter-gatherers

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used to consume a wide range of plants, thereby minimizing the amount of a single bioactive compound ingested and its toxicity. It is known that rotating the kind of plants consumed is a good strategy in order to decrease food allergy and intolerance.

From an evolutionary standpoint, we should look at nutrition as “whole food” rather than nutrients per se. The bottom line is that Stevia seems to be safe, but we need more research to rule out possible side effects.

I hope this is helpful,

Maelán Fontes, MS Ph.D.

For sources see References: Section II

CHIA SEEDSLoren Cordain, Ph.D., Professor Emeritus

Q: Are there any negative effects associated with chia seeds which would make them inappropriate in The Paleo Diet?

Thank you.

A: Good question. I would imagine that many of our readers have never even heard of chia seeds much less eaten them. Chia seeds (Salvia hispanica L.) are a member of the Labiatae plant family and are native to southern Mexico and northern Guatemala. The seeds are small, oval shaped; either black or white

colored and resemble sesame seeds.1 These seeds were cultivated as a food crop for thousands of years in this region by the Aztecs and other native cultures. Chia seeds can be consumed in a variety of ways including roasting and grinding the seeds into a flour known as Chianpinolli which can then become incorporated into tortillas, tamales, and various beverages.2 The roasted ground seeds were traditionally consumed as a semi-fluid mucilaginous gruel (Pinole) when water is added to the flour. In post-Columbian times the most popular

Nutrient Amount %DRI

Kilocalories 490 25 Protein 15.6 g 31 Carbohydrate 43.9 g 15 Fat 30.8 g 47 Saturated Fat 3.2 g 6 Monosaturated Fat 2.9 g na Polyunsaturated Fat 23.3 g na 18:1 oleic acid 2.0 g na 18:2n6 linoleic acid 5.8 g na 18:3n3 alpha 17.6 g na linolenic acid Fiber 37.7 g 151 Vitamin A 36 IU 1 Vitamin D na Vitamin E na Vitamin K na Vitamin B1 0.87 mg 58 Vitamin B2 0.17 mg 10 Vitamin B3 5.82 mg 29 Vitamin B6 0.69 mg 35 Vitamin B12 0 0 Folate 114 mcg 29 Pantothenic acid 0.94 mg 9 Biotin na Vitamin C 15.7 mg 26 Sodium 19 mg 1 Potassium 100 mg 5 Phosphorus 948 95 Calcium 631 mg 26 Copper 0.19 mg 9 Iron 10.0 56 Magnesium 770 mg 19 Manganese 2.17 mg 108 Zinc 3.5 mg 23

Table 1. Nutrient profile for chia seeds (Salvia hispanica L.), 100 gram portion.

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use of chia flour was to make a refreshing beverage in which the ratio of seeds to water is decreased, thereby resulting in a less gelatinous consistency to which lemon, sugar or fruit juice are added.2 The sticky consistency of chia seed Pinole or chia beverages comes from a clear mucilaginous, polysaccharide gel that remains tightly bound to the seeds.3 This sticky gel forms a physical barrier which may impair digestion and absorption of fat from the seed4 while also causing a low protein digestibility.5

In the past 20 years a revival of interest in chia seeds has occurred primarily because of their high fat content of about 25-39% by weight, of which 50-57% is the therapeutic omega 3 fatty acid and alpha linolenic acid (ALA).6, 7 In the past 10 years chia seeds have been used as a foodstuff for animals to enrich their eggs and meat with omega 3 fatty acids.8-11 So I wholeheartedly approve of feeding chia seeds to animals and then eating the omega 3 fatty acid enriched meat or eggs of these animals.

How about feeding chia seeds to humans – should we consume chia seeds because of their high omega 3 fatty acid (ALA) content? The Table below shows the entire nutrient profile of chia seeds. At least on paper, it would appear that chia seeds are a nutritious food that is not only high in ALA, but also is a good source of protein, fiber, certain B vitamins, calcium, iron and manganese.

Unfortunately, the devil is always in the details, and as is the case with many other plant seeds (e.g. cereal grains, legumes) a frequent evolutionary strategy to prevent predation by animals and microorganisms is the natural selection by the plant for toxic compounds known as antinutrients. As I previously mentioned, the thick mucilaginous gel which is tightly bound to chia seeds may impair fat absorption in animals4 which, along with their high fiber content, causes the available protein to be poorly absorbed.5 Another anti-nutrient found in chia seeds (~2,000 mg/100 g) is phytate or phytic acid, which impairs absorption of all divalent ions (calcium, iron, zinc, magnesium, manganese, etc) in a dose-dependent manner.12, 13 Meaning that once in your body (in vivo), the available calcium, iron, zinc, magnesium and manganese from chia seeds are poorly absorbed, hence making chia seeds a poor dietary source for these minerals. Although Table 1 suggests that chia seeds may be good sources of vitamin B6, the

bioavailability of B6 from plant foods tends to be low, whereas bioavailability of B6 from animal products is generally quite - high approaching 100%.14

A number of chia seed supplementation studies in rats and experimental animals have demonstrated certain favorable health effects including improvements in blood lipids, and insulin metabolism.9, 15, 16 However, these effects could not be replicated in a recent, well controlled study in humans, who consumed 50 grams of chia seeds per day for 12 weeks.19 In fact, despite an increase in blood ALA concentrations, overweight men and women experienced no changes in body weight, blood pressure, blood lipids or inflammatory blood markers.17 A recent review of all human chia supplementation studies concluded: “There is limited evidence supporting the efficacy of Salvia hispanica for any indication; thus far, only two clinical studies have examined the effects of Salvia hispanica on cardiovascular disease (CVD) risk factors (including body weight). One study showed some effects on some CVD risk factors, while the other did not. Neither study showed any effects of Salvia hispanica on weight loss.”

One of the outcomes of the Nieman et al. study17 that will require further scrutiny suggests that chia seed consumption may contain one or more antinutrients which may promote chronic low level inflammation – not a good thing. If you look at the data carefully, both men and women experienced increases in a blood inflammatory marker called interleukin 6 (IL-6). After 12 weeks of eating chia seeds the men’s

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blood levels of IL-6 increased 10.2% and the women’s increased 10.1%. Additionally another inflammatory marker called monocyte chemotactic protein (MCP) increased 6.9% in men, and 6.1% in women. Although the authors deemed these increases to be statistically insignificant, the large standard deviations for the measurements suggest that confounding extraneous factors may have influenced the results. In support of the notion that chia seed consumption may adversely affect the immune system and promote inflammation is a rat study showing that a one-month high-chia seed diet increased blood levels of IgE by 112.8%.18 IgE is an immunoglobulin that is a marker for allergenic food proteins that are processed through the gut.19

Just how chia seed consumption may promote chronic low-level systemic inflammation via their presence in the gastrointestinal tract is unclear. Although many species of Salvia have a high lectin content,20 which may adversely affect the gut by increasing intestinal permeability,21 Salvia hispanica or chia seeds do not contain any known lectins.22 Consequently, it is possible that other antinutrients found in chia seeds may adversely affect gut tissue, including saponins, which are frequently found in Salvia species,23 and which cause a “leaky gut”.24-27 To date, the saponin content of chia has not been measured. The thick mucilaginous gel which is tightly bound to chia seeds is a complex polysaccharide, and these types of polysaccharide gums are known to adversely alter small intestinal cell function - including increased

mucosal cell production,28 which could increase intestinal permeability.

When the gut becomes “leaky” it is not a good thing, as the gut contents may then have access to the immune system, which in turn becomes activated, and thereby causes chronic low-level systemic inflammation. In particular, a component of the cell walls of gut gram negative bacteria called lipopolysaccharide (LPS) is highly inflammatory. Any LPS which gets past the gut barrier is immediately engulfed by two types of immune system cells (macrophages and dendritic cells). Once engulfed by these cells, LPS binds to Toll Like Receptor 4, which in turn causes an immediate immune system response including increases in blood levels of IL-6 as shown in the Nieman et al study.17 Until further human studies are conducted, I would be cautious in recommending chia seeds for human consumption, particularly in people with food allergies or known autoimmune diseases.

For sources see References: Section III

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PRIMAL IN THE KITCHEN

PALEO TUNA NIÇOISE

4 4-oz tuna steaks 2 Tb. chopped fresh rosemary 1 garlic clove, crushed 2 Tb. red wine 2 Tb. extra virgin olive oil 4 cups mache (lamb’s lettuce) 2 hard boiled eggs, quartered 8 cherry tomatoes Freshly ground pepper, to taste

Place tuna in an oiled glass baking dish. Combine rosemary, garlic, red wine, and 1 tablespoon of the olive oil in a jar and shake well. Pour over tuna. Cover and refrigerate for thirty minutes.

Preheat oven to broil. Remove tuna from refrigerator. Broil for twenty minutes, turning at the halfway point. Remove from oven and set aside to cool for ten minutes.

Combine lettuce and remaining tablespoon of olive oil in a large bowl and toss well. Arrange lettuce with eggs and cherry tomatoes. Layer with tuna steaks and season with freshly ground black pepper.

Copyright © 2011. The Paleo Diet Cookbook. All Rights Reserved.

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2. Barriocanal LA, Palacios M, Benitez G, Benitez S, Jimenez JT, Jimenez N, Rojas V. Apparent lack of pharmacological effect of steviol glycosides used as sweeteners in humans. A pilot study of repeated exposures in some normotensive and hypotensive individuals and in Type 1 and Type 2 diabetics. Regul Toxicol Pharmacol. 2008 Jun;51(1):37-41. Epub 2008 Mar 5.

3. Chan P, Tomlinson B, Chen YJ, Liu JC, Hsieh MH, Cheng JT. A double-blind placebo-controlled study of the effectiveness and tolerability of oral stevioside in human hypertension. Br J Clin Pharmacol. 2000 Sep;50(3):215-20.

4. Hsieh MH, Chan P, Sue YM, Liu JC, Liang TH, Huang TY, Tomlinson B, Chow MS, Kao PF, Chen YJ. Clin Ther. 2003 Nov;25(11):2797-808. Efficacy and tolerability of oral stevioside in patients with mild essential hypertension: a two-year, randomized, placebo-controlled study.

REFERENCES: SECTION III1. Ixtainaa, VY, Nolascoa, SM, Tomás, MC. Physical properties of chia (Salvia hispanica L.) seeds. Industrial Crops and Products 2008;28:286-93.

2. Cahill, J.P. 2003. Ethnobotany of chia, Salvia hispanica L. (Lamiaceae). Economic Botany, 57(4):604-618.

3. Lin, K.Y., J.R. Daniel, and R.L. Whistler. 1994. Structure of chia seed polysaccharide exudate. Carbohydrate Polymers, 23:13-18.

4. Peiretti, P.B., G. Meineri. 2008. Effects on growth performance, carcass characteristics, and the fat and meat fatty acid profile of rabbits fed dietswith chia (Salvia hispanica L.) seed supplements. Meat Science, 80 (2008): 1116-1121.

5. Monroy-Torres, R., M.L. Mancilla-Escobar, J.C. Gallaga-Solorzano, S. Medina-Godoy, and E.J. Santiago-Garcia. 2008. Protein Digestibility of Chia Seed Salvia hispanica L. Revista Salud Publica y Nutricion, 9(1), Enero-Marzo 2008. Monterey, Mexico.

6. Ayerza, R. Oil content and fatty acid composition of Chia (Salvia hispanica L.) from five northwestern locations in Argentina. Journal of the American Oil Chemists Society 1995;72: 1079- 1081.

REFERENCES: SECTION I1. Chan I, Oyama N, Neill SM, Wojnarowska F, Black MM, McGrath JA. Characterization of IgG autoantibodies to extracellular matrix protein 1 in lichen sclerosus. Clin Exp Dermatol. 2004 Sep;29(5):499-504.

2. Kowalewski C, Kozłowska A, Chan I, Górska M, Woźniak K, Jabłońska S, McGrath JA.Three- dimensional imaging reveals major changes in skin microvasculature in lipoid proteinosis and lichen sclerosus. J Dermatol Sci. 2005 Jun;38(3):215-24. Epub 2005 Mar 3.

3. Fisher M, Jones RA, Huang L, Haylor JL, El Nahas M, Griffin M, Johnson TS. Modulation of tissue transglutaminase in tubular epithelial cells alters extracellular matrix levels: a potential mechanism of tissue scarring. Matrix Biol. 2009 Jan;28(1):20-31. Epub 2008 Nov 5.

4. Michaelsson, G., Ahs, S., Hammarstrom, I., Lundin, I. P., & Hagforsen, E. Gluten-free diet in psoriasis patients with antibodies to gliadin results in decreased expression of tissue transglutaminase and fewer ki67+ cells in the dermis. Acta Dermato-Venereologica, 2003; 83(6):425-429.

5. Biagi F, Campanella J, Laforenza U, Gastaldi G, Tritto S, Grazioli M, Villanacci V, Corazza GR. Transglutaminase 2 in the enterocytes is celiac specific and gluten dependent. Dig Liver Dis. 2006 Sep;38(9):652-8.

6. Gorgun J, Portyanko A, Marakhouski Y, Cherstvoy E. Tissue transglutaminase expression in celiac mucosa: an immunohistochemical study. Virchows Arch. 2009 Oct;455(4):363-73.

7. Villanacci V, Not T, Sblattero D, Gaiotto T, Chirdo F, Galletti A, Bassotti G. Mucosal tissue transglutaminase expression in celiac disease. J Cell Mol Med. 2009 Feb;13(2):334-40.

REFERENCES: SECTION II1. Gregersen S, Jeppesen PB, Holst JJ, Hermansen K. Antihyperglycemic effects of stevioside in type 2 diabetic subjects. Metabolism. 2004 Jan;53(1):73-6.

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7. Ting, I.P., J.H. Brown, H.H. Naqvi, J. Kumamoto, and M. Matsumura. 1990. Chia: a potential oil crop for arid zones. In: New Industrial Crops and Products, Proceedings of The First International Conference on New Industrial Crops and Products, edited by H.H. Naqvi, A. Estilai, and I.P. Ting. Association for the Advancement of Industrial Crops, Riverside, California, USA, pp. 197-202.

8. Ayerza R, Coates W. Dietary levels of chia: influence on hen weight, egg production and sensory quality, for two strains of hens.Br Poult Sci. 2002 May;43(2):283-90.

9. Ayerza R, Coates W, Lauria M. Chia seed (Salvia hispanica L.) as an omega-3 fatty acid source for broilers: influence on fatty acid composition, cholesterol and fat content of white and dark meats, growth performance, and sensory characteristics. Poult Sci. 2002 Jun;81(6):826-37.

10. Coates W, Ayerza R. Chia (Salvia hispanica L.) seed as an n-3 fatty acid source for finishing pigs: effects on fatty acid composition and fat stability of the meat and internal fat, growth performance, and meat sensory characteristics. J Anim Sci. 2009 Nov;87(11):3798-804.

11. Peiretti, P.B., G. Meineri. 2008. Effects on growth performance, carcass characteristics, and the fat and meat fatty acid profile of rabbits fed dietswith chia (Salvia hispanica L.) seed supplements. Meat Science, 80 (2008): 1116-1121.

12. Cordain L. Cereal grains: humanity’s double edged sword. World Rev Nutr Diet 1999; 84:19-73.

13. Torre M, Rodriguez AR, Saura-Calixto F: Effects of dietary fiber and phytic acid on mineral availability. Crit Rev Food Sci Nutr 1991;1:1-22.

14. Reynolds RD: Bioavailability of vitamin B-6 from plant foods. Am J Clin Nutr 1988;48:863-67.

15. Chicco, A.G., M. E. D’Alessandro, G.J. Hein, M.E. Oliva and Y.B. Lombardo. 2008. Dietary chia seed (Saliva hispanica L.) rich in α-linolenic acid improves adiposity and normalizes hypertriacylglycerolaemia and insulin resistance in dyslipaemic rats. British Journal of Nutrition, 101(2009): 41-50.

16. Ayerza R Jr, Coates W. Effect of dietary alpha-linolenic fatty acid derived from chia when fed as ground seed, whole seed and oil on lipid content and fatty acid composition of rat plasma. Ann Nutr Metab. 2007;51(1):27-34.

17. Nieman, D., C., E. J. Cayea, M. D. Austin, D. A. Henson, S. R. McAnulty, F. Jin. 2009. Chia seed does not promote weight loss or alter disease risk factors in overweight adults. Nutrition Research, 29(2009):414-418.

18. Fernandez, S., M. Vidueiros, R. Ayerza, W. Coates and A. Pallaro. 2008. Impact of chia (Salvia hispanica L) on the immune system: preliminary study. Proceedings of the Nutrition Soceity, Volume 67, Issue OCE, May 2008, E12.

19. Eigenmann PA. Mechanisms of food allergy. Pediatr Allergy Immuol 2009;20:5-11.

20. Perez G. Lectin prospecting in Colombian Labiatae. A systemic ecological approach – II. Caldasia 2006; 28(2):179-195.

21. Cordain L, Toohey L, Smith MJ, Hickey MS. Modulation of immune function by dietary lectins in rheumatoid arthritis. Br J Nutr. 2000 Mar;83(3):207-17.

22. Bird GW, Wingham J. More Salvia agglutinins. Vox Sang 1976;30:217-219.

23. Sabahi M, Ramezanian M, Jaffari GH, Heravi GH, Bahaeddini F. Survey of Iranian plants for saponins, alkaloids, flavonoids, and tannins. IV. The plants of Kerman Province. Int J Crude Drug Res 1985;23:165-175.

24. Keukens EA, de Vrije T, van den Boom C, de Waard P, Plasman HH, Thiel F, Chupin V, Jongen WM, de Kruijff B. Molecular basis of glycoalkaloid induced membrane disruption. Biochim Biophys Acta. 1995 Dec 13;1240(2):216-28.

25. Alvarez JR, Torres-Pinedo R. Interactions of soybean lectin, soyasaponins, and glycinin with rabbit jejunal mucosa in vitro. Pediatr Res. 1982 Sep;16(9):728-31.

26. Story JA, LePage SL, Petro MS, West LG, Cassidy MM, Lightfoot FG, Vahouny GV. Interactions of alfalfa plant and sprout saponins with cholesterol in vitro and in cholesterol-fed rats. Am J Clin Nutr. 1984 Jun;39(6):917-29.

27. Johnson IT, Gee JM, Price K, Curl C, Fenwick GR. Influence of saponins on gut permeability and active nutrient transport in vitro. J Nutr. 1986 Nov;116(11):2270-7.

28. Johnson IT, Gee JM. Gastrointestinal adaptation in response to soluble non-available polysaccharides in the rat. Br J Nutr. 1986 May;55(3):497-505.