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• W2163709904 abstract "We appreciate Dr Hays’ interest in our recent review article,1O'Keefe Jr, JH Cordain L Cardiovascular disease resulting from a diet and lifestyle at odds with our Paleolithic genome: how to become a 21st-century hunter-gatherer.Mayo Clin Proc. 2004; 79: 101-108Abstract Full Text Full Text PDF PubMed Scopus (208) Google Scholar but several points he made require further clarification. His assertion that ancestral human (Homo sapiens) diets were dominated by animal foods is correct and is supported by both ethnographic2Cordain L Miller JB Eaton SB Mann N Holt SHA Speth JD Plant-animal subsistence ratios and macronutrient energy estimations in worldwide hunter-gatherer diets.Am J Clin Nutr. 2000; 71: 682-692PubMed Google Scholar and quantitative3Cordain L Eaton SB Miller JB Mann N Hill K The paradoxical nature of hunter-gatherer diets: meat-based, yet non-atherogenic.Eur J Clin Nutr. 2002; 56: S42-S52Crossref PubMed Scopus (259) Google Scholar studies of hunter-gatherer diets as well as by isotopic analyses of Upper Paleolithic human fossils.4Richards MP Hedges REM Gough's Cave and Sun Hole Cave human stable isotope values indicate a high animal protein diet in the British Upper Palaeolithic.J Archaeol Sci. 2000; 27: 1-3Crossref Scopus (64) Google Scholar However, it is erroneous to conclude that these animal food-based diets would have been high in saturated fatty acids (SFAs). Furthermore, little or no objective data support the assertions that dietary SFA is nonatherogenic under eucaloric conditions or that SFA represents an effective satiating macronutrient. From stone tool cut marks detected on the fossilized bones of animals that coexisted with humans during the Paleolithic era (approximately 2.6 million to 10,000 years ago), one can infer the species of animals that were consumed.5Bunn HT Kroll EM Systematic butchery by Plio/Pleistocene hominids at Olduvai Gorge, Tanzania.Curr Anthropol. 1986; 27: 431-451Crossref Google Scholar Many of the African animals eaten during the Paleolithic period still exist today. These include the wildebeest, hippopotamus, and zebra. Similar fossil evidence exists for mammals such as musk oxen and caribou that were hunted by hominids during glacial (ice age) periods in the Paleolithic era. Total body fat analyses of both caribou6Gerhart KL White RG Cameron RD Russell DE Body composition and nutrient reserves of arctic caribou.Can J Zool. 1996; 74: 136-146Crossref Scopus (72) Google Scholar and musk oxen7Adamczewski JZ Flood PF Gunn A Body composition of muskoxen (Ovibos moschatus) and its estimation from condition index and mass measurements.Can J Zool. 1995; 73: 2021-2034Crossref Scopus (27) Google Scholar show that fat mass varies seasonally in a cyclic, waxing-and-waning manner. Hence, maximal or peak body fat percentages are maintained only for a few months during the course of a year, even for mammals residing at tropical and southern latitudes.8Shackleton CM Granger JE Bone marrow fat index and kidney-fat index of several antelope species from Transkei.S Afr J Wildlife Res. 1989; 19: 129-134Google Scholar In most mammals, storage of excess food energy as fat occurs primarily as triacylglycerols in subcutaneous and abdominal fat depots. The dominant (>50% fat energy) fatty acids in the fat storage depots (adipocytes) of wild mammals are SFAs, whereas the dominant fatty acids in muscle and all other organ tissues are polyunsaturated fatty acids (PUFAs) and monounsaturated fatty acids (MUFAs).9Cordain L Watkins BA Florant GL Kelher M Rogers L Li Y Fatty acid analysis of wild ruminant tissues: evolutionary implications for reducing diet-related chronic disease.Eur J Clin Nutr. 2002; 56: 181-191Crossref PubMed Scopus (164) Google Scholar Since subcutaneous and abdominal body fat stores are depleted during most of the year in wild animals, PUFAs and MUFAs constitute the majority of the total carcass fat.9Cordain L Watkins BA Florant GL Kelher M Rogers L Li Y Fatty acid analysis of wild ruminant tissues: evolutionary implications for reducing diet-related chronic disease.Eur J Clin Nutr. 2002; 56: 181-191Crossref PubMed Scopus (164) Google Scholar Because of the seasonal cyclic depletion of SFAs and enrichment of PUFAs and MUFAs, a year-round dietary intake of high levels of SFA would not have been possible for preagricultural hominids preying on wild mammals. With the advent of agriculture and the domestication of wild animals, it became possible to attenuate or prevent the seasonal decline in SFAs by provisioning animals with stored fodder. Additionally, domesticated animals can be slaughtered at peak body fat percentages, whereas huntergatherers preying on wild animals were at the mercy of the seasons. In the United States, 99% of the beef we consume is produced in feed lots10Kidwell B All grass, no grain.Progressive Farmer [serial online]. October 2002; (Accessibility verified March 12, 2004.)Available at: http://www.progressivefarmer.com/farmer/magazine/article/0,14730,355103,00.htmlGoogle Scholar in which a characteristically obese (30% body fat11Wells RS Preston RL Effects of repeated urea dilution measurement on feedlot performance and consistency of estimated body composition in steers of different breed types.J Anim Sci. 1998; 76: 2799-2804PubMed Google Scholar) animal is always slaughtered at its peak fat mass regardless of the season. By employing known seasonal changes in the wholebody fat mass of caribou, the known fatty acid composition and mass of all edible tissues and organs, and third-order polynomial equations regressing carcass fat mass to carcass fat energy,2Cordain L Miller JB Eaton SB Mann N Holt SHA Speth JD Plant-animal subsistence ratios and macronutrient energy estimations in worldwide hunter-gatherer diets.Am J Clin Nutr. 2000; 71: 682-692PubMed Google Scholar it is possible to estimate total edible carcass SFA on a month-by-month basis. For a group of 3 caribou (mature bull, mature female, young bull),12Spiess AE Reindeer and Caribou Hunters: An Archaeological Study. Academic Press, New York, NY1979Google Scholar the yearly mean total edible carcass SFA content represents 11.1% of the total available calories, a value similar to that recommended by the American Heart Association for reducing the risk of cardiovascular disease (10% of total energy).13Krauss RM Eckel RH Howard B et al.AHA Dietary Guidelines: revision 2000: a statement for healthcare professionals from the Nutrition Committee of the American Heart Association.Circulation. 2000; 102: 2284-2299Crossref PubMed Scopus (1402) Google Scholar We do not recommend consuming a high-SFA diet because SFA down-regulates the low-density lipoprotein receptor,14Brown MS Goldstein JL How LDL receptors influence cholesterol and atherosclerosis.Sci Am. 1984; 251: 58-66Crossref PubMed Scopus (289) Google Scholar thereby elevating total plasma cholesterol and low-density lipoprotein cholesterol concentrations even in normal-weight individuals. Numerous epidemiological studies have shown that elevated plasma cholesterol concentrations increase the risk for coronary heart disease.15Stamler J Wentworth D Neaton JD Is relationship between serum cholesterol and risk of premature death from coronary heart disease continuous and graded? findings in 356,222 primary screenees of the Multiple Risk Factor Intervention Trial (MRFIT).JAMA. 1986; 256: 2823-2828Crossref PubMed Scopus (1780) Google Scholar, 16Stamler J Daviglus ML Garside DB Dyer AR Greenland P Neaton JD Relationship of baseline serum cholesterol levels in 3 large cohorts of younger men to long-term coronary, cardiovascular, and all-cause mortality and to longevity.JAMA. 2000; 284: 311-318Crossref PubMed Scopus (460) Google Scholar A necessary caveat to this statement is that dietary SFAs elicit this effect only under chronic hypercaloric or eucaloric conditions.17Phinney SD Bistrian BR Wolfe RR Blackburn GL The human metabolic response to chronic ketosis without caloric restriction: physical and biochemical adaptation.Metabolism. 1983; 32: 757-768Abstract Full Text PDF PubMed Scopus (129) Google Scholar Recent clinical trials of high-SFA diets such as the Atkins diet18Foster GD Wyatt HR Hill JO et al.A randomized trial of a low-carbohydrate diet for obesity.N Engl J Med. 2003; 348: 2082-2090Crossref PubMed Scopus (1406) Google Scholar, 19Samaha FF Iqbal N Seshadri P et al.A low-carbohydrate as compared with a low-fat diet in severe obesity.N Engl J Med. 2003; 348: 2074-2081Crossref PubMed Scopus (1032) Google Scholar, 20Hays JH DiSabatino A Gorman RT Vincent S Stillabower ME Effect of a high saturated fat and no-starch diet on serum lipid subfractions in patients with documented atherosclerotic cardiovascular disease.Mayo Clin Proc. 2003; 78: 1331-1336Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar have proved them to be effective in improving the blood lipid profile on a short-term basis (<1 year); however, these beneficial blood lipid changes occurred only under hypocaloric conditions. A final point is warranted. Ancestral hunter-gatherer diets would always have contained less carbohydrate and more protein in comparison to contemporary Western diets.2Cordain L Miller JB Eaton SB Mann N Holt SHA Speth JD Plant-animal subsistence ratios and macronutrient energy estimations in worldwide hunter-gatherer diets.Am J Clin Nutr. 2000; 71: 682-692PubMed Google Scholar This macronutrient composition (elevated protein at the expense of carbohydrate) was recently shown to be effective in both promoting21Skov AR Toubro S Ronn B Holm L Astrup A Randomized trial on protein vs carbohydrate in ad libitum fat reduced diet for the treatment of obesity.Int J Obes Relat Metab Disord. 1999; 23: 528-536Crossref PubMed Scopus (548) Google Scholar and maintaining22Westerterp-Plantenga MS Lejeune MP Nijs I van Ooijen M Kovacs EM High protein intake sustains weight maintenance after body weight loss in humans.Int J Obes Relat Metab Disord. 2004; 28: 57-64Crossref PubMed Scopus (252) Google Scholar weight loss because of the greater satiety and thermic effect of protein compared to either carbohydrate or fat.23Westerterp-Plantenga MS The significance of protein in food intake and body weight regulation.Curr Opin Clin Nutr Metab Care. 2003; 6: 635-638Crossref PubMed Scopus (121) Google Scholar Consequently, it is elevated protein that promotes satiety, not elevated SFA. The Hunter-Gatherer DietMayo Clinic ProceedingsVol. 79Issue 5PreviewTo the Editor: I read with interest the review article by O'Keefe and Cordain1 on cardiovascular disease resulting from a diet and lifestyle “at odds with our Paleolithic genome.” They make several important points, not the least of which was a failure of previous studies to link cardiovascular disease to the intake of meat, cholesterol, or total fat.2 Full-Text PDF" @default.
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