Monday, July 6, 2009

Unrefined vs. Refined Carbohydrates and Dental Cavities

There's a definite association between the consumption of refined carbohydrates and dental cavities. Dr. Weston Price pointed this out in a number of transitioning societies in his epic work Nutrition and Physical Degeneration. Many other anthropologists and dentists have observed the same thing.

I believe, based on a large body of anthropological and medical data, that it's not just an association-- sugar and flour cause cavities. But why? Is it that they lack micronutrients-- the explanation favored by Price-- or do they harm teeth by feeding the bacteria that participate in cavity formation? Or both?

I recently found an interesting article when I was perusing an old copy of the Journal of Dental Research: "A Comparison of Crude and Refined Sugar and Cereals in Their Ability to Produce in vitro Decalcification of Teeth", published in 1937 by Dr. T. W. B. Osborn et al. (free full text). I love old papers. They're so free of preconceptions, and they ask big questions. The authors begin with the observation that the South African Bantu, similar to certain cultures Dr. Price visited, had a low prevalence of tooth decay when eating their native diet high in unrefined carbohydrate foods. However, their decay rate increased rapidly as modern foods such as white flour and refined sugar became available.

To test whether refined carbohydrates have a unique ability to cause tooth decay, the investigators took pieces of teeth that had been extracted for reasons other than decay (for example, crowding), and incubated them with a mixture of human saliva and several different carbohydrate foods:
  • crude cane juice
  • refined cane sugar
  • whole wheat flour
  • white wheat flour
  • whole corn meal
  • refined corn meal
After incubating teeth in the solutions for 2-8 weeks at 37 C (human body temperature), they had trained dentists evaluate them for signs of decalcification. Decalcification is a loss of minerals that is part of the process of tooth decay. Teeth, like bones, are mineralized primarily with calcium and phosphorus, and there is a dynamic equilibrium between minerals leaching out of the teeth and minerals entering them.

The researchers used teeth incubated in saline solution as the reference. The dentists were "blinded", meaning they didn't know which solution each tooth came from. This is a method of reducing bias. Here are some of the results. Cane juice vs. refined sugar:

Unrefined cane juice was not very effective at causing decalcification, compared to refined sugar. This was a surprise to me. Here is the result for wheat:Note that the scale is different on this graph. Wheat, and particularly refined wheat, is very good at decalcifying teeth in vitro. Corn:

Refined corn is much more effective at decalcifying teeth than whole meal corn. Next, the investigators performed an experiment where they compared the three types of refined carbohydrate to one another:
As one would predict from the graphs above, refined wheat is worse than refined corn, is worse than refined sugar. This is really at odds with conventional wisdom.

It's important to keep in mind that these results are not necessarily directly applicable to a living human being, who wouldn't let a mouthful of wheat porridge sit in his mouth for five weeks. But it does show that refining carbohydrates may increase their ability to cause cavities due to a direct effect on the teeth (rather than by affecting whole-body nutritional status, which they do as well).

The authors tested the acidity of the different solutions, and found no consistent differences between them (they were all at pH 4-5 within 24 hours), so acid production by bacteria didn't account for the results. They speculated that the mineral content of the unrefined carbohydrates may have prevented the bacterial acids from leaching minerals out of the teeth. Fortunately for us, they went on to test that speculation in a series of further investigations.

In another paper, Dr. T. W. B. Osborn and his group showed that they could greatly curb the decalcification process by adding organic calcium and phosphorus salts to the solution. This again points to a dynamic equilibrium, where minerals are constantly leaving and entering the tooth structure. The amounts of calcium and phosphorus required to inhibit calcification were similar to the amounts found in unrefined cane sugar, wheat and corn. This suggests the straightforward explanation that refined sugar and grains cause decay at least in part because most of the minerals are removed during the refining process.

However, we're still left with the puzzling fact that wheat and corn flour decalcify teeth in vitro more effectively than cane juice. I suspect that has to do with the phytic acid content of the grains, which binds the minerals and makes them partially unavailable to diffusion into the teeth. Cane juice contains minerals, but no phytic acid, so it may have a higher mineral availability. This explanation may not be able to account for the fact that refined sugar was also less effective at decalcifying teeth than refined wheat and corn flour. Perhaps the residual phytic acid in the refined grains actually drew minerals out of the teeth?

No, I'm not saying you can eat sugar with impunity if it's unrefined. There isn't a lot of research on the effects of refined vs. unrefined sugar, but I suspect too much sugar in any form isn't good. But this does suggest that refined carbohydrates may be particularly effective at promoting cavities, due to a direct demineralizing effect on teeth subsequent to bacterial acid production. It also supports Dr. Price's contention that a food's micronutrient content is the primary determinant of its effect on dental health.

Reversing Tooth Decay
Preventing Tooth Decay
Dental Anecdotes

90 comments:

Bris said...

There is absolutely no mystery. Any dentist can tell you the answer. No sugars = no decay.

Streptococcus mutans the primary causative agent of caries can't metabolise complex polysaccharides such as starches. Simple sugars are needed to make the sticky biofilm which adhere the bacteria to the tooth. Without the biofilm the bacteria are quickly washed away by saliva.

The grain samples showed far less decay due to an absence of fermentable sugars. The amylase needed to convert starches to sugars would have quickly disappeared from the saliva in vitro.

I greatly doubt micronutrients or phytates had any significant role at all.

It is very well documented that a grain-based diet won't cause tooth decay as long as very basic oral hygiene is adhered too.

Caries was a disease of the affluent in western countries prior to about 1840. The poor invariably had good teeth due to a sugar-free diet. Once cheap sugar became available the incidence of caries exploded.

I had a friend who never ate any sugary foods but ate a huge amount of grain-based food and drank only water. He had perfect teeth. He sometimes went days without brushing his teeth but they always remained spotless.

I have an ultra low carbohydrate diet (<20g/day). My teeth are always "squeeky" clean despite no more than a very quick brushing twice a day to remove any food particles and tea stains.

Bris said...

I think the experiments were deeply flawed and had absolutely no connection with the real world scenarios.

In places where raw sugar cane was a once common snack, such as Cuba, tooth decay was absolutely rampant. In fact it was relatively common for these people to have lost most of their teeth to decay.

Brock Cusick said...

Overall I agree with Bris. This study is interesting, but not really that useful for studying dental health where the teeth remain in the mouth of a healthy, normal person.

At most this suggests and explanation for the slight differences in decay rate observed by Weston Price between the grain-eating tribes (such as the Swiss and Gaelics) and the more meat-only tribes (such as the Masai and Eskimo), but even then it's only suggestive.

I totally agree though about pre-1950's science. They were really scientists back them.

Coach Jeff said...

I don't know what it is, but your blog has a habit of putting out articles about a certain topic right about the time I'm personally researching that particular issue.

I recently have done in-depth research pertaining to the effect of starch on dental health. Including conversation with a very well informed dentist.

My conclusion is that starch is relatively harmless to teeth...UNLESS you leave it in mouth for a long time. Then of course the amylyase (spelling?) in your mouth will break the starch down into glucose. Thus teeth will be bathed in glucose. Not good.

The dentist I conversed with, told me he once had two twins come into his office. One with perfect teeth...the other with rotten ones. He could not figure out why two genetically identical people on the same diet (kids still eating Mom's cooking) had such drastically differing rates of decay.

Turned out the twin with bad teeth was fond of "bread balls" - would roll up a piece of bread into a ball and suck on it. In effect duplicating the old high-school experiment of leaving a cracker in your mouth long enough for it to taste sweet, due to it breaking down into glucose right in your mouth - given enough time.

The more research I do on starches, the more I'm convinced they are NOT the health menace many low-carbers portray them as.

Oh yeah...on more thing..xylitol gums interfere with tooth rotting bacteria's ability to wreck teeth. I chew Trident after all meals (it has xylitol) when I can't brush.

BTW - that dentist I conversed with has GREAT info about dental health. Not the usual generic info, by any stretch.

It's at:
http://www.doctorspiller.com/Tooth_Decay.htm#History

Anna said...

"The more research I do on starches, the more I'm convinced they are NOT the health menace many low-carbers portray them as. "

I'd add ...assuming glucose regulation is still intact.

If one's glucose regulation is dysfunctional, then starches indeed can play a significant role in creating damaging high BG levels and disease. Even if the control error is on the hypoglycemic side of the glucose dysfunction "coin", avoidance of starch can provide significant benefit in evening out the BG dips.

Perhaps people who gravitate to and do well on Low Carb diets to avoid lose and maintain weight generally already have some degree of dysfunctional glucose regulation (hyper and/or hypoglycemia). There are also some known (but not often tested for) genetic defects (such as MODY) that cause specific varieties of Type 2 DM, plus there is speculation that multiple environmental endocrine disrupters can and do wreak havoc on hormone regulation, health, and weight.

PaleoRD said...

"The more research I do on starches, the more I'm convinced they are NOT the health menace many low-carbers portray them as. "

I agree with that statement. I was on quite a low-carb kick after reading GCBC, but then after about a year I was having trouble sleeping and I looked tired. The problem? My adrenals were kicking in overtime to overcome the lack of dietary glucose for cellular energy.

Diana Schwarzbien writes some great books that really do a great job of explaining how the interaction of all of your hormones (although she mainly focuses on insulin, adrenaline and cortisol) control your metabolism and health. Some starch can do wonders in helping people with fatigued adrenals recover. According to her, the starch will raise blood sugar and that will reduce adrenaline, while the insulin release caused by eating the starch will have an anabolic action and help to repair the worn out glands.

Stephan Guyenet said...

Bris,

Starch can definitely contribute to cavities in the absence of sugar. The archaeological record shows that the adoption of agriculture was accompanied by rotten teeth. These people weren't sucking on lollipops all day, they probably had very limited access to simple sugars. I agree with you that simple sugars are not good for the teeth, but starch is not totally off the hook.

As for chewing cane causing cavities, Cuban cane chewers do indeed have a high prevalence of cavities. But you left out the data on Bantu cane chewers, who have a low prevalence of tooth decay and only a weakly significant increase over non-sugarcane field workers. That suggests that there may have been another factor at play in the Cuban cane chewers. I suspect susceptibility will depend heavily on the background diet.

You said "I greatly doubt micronutrients or phytates had any significant role at all." You should read the papers I linked to, I think you might change your mind. They tested the pH in each sample and it was the same, suggesting that bacterial acid production could not account for the difference in decalcification they observed. The only factor they identified that could account for it was mineral content.

Brock,

I agree that the experiments may only have limited applicability to a real human mouth, but they still identified a factor that may contribute to decay. If my phytic acid theory is correct, fermented grains such as the sourdough of the Loetschental valley swiss and African porridges should not cause cavities because they should contain plenty of available minerals. I think that fits well with the data.

PaleoRD,

I should read that book.

Charles R. said...

"No sugars = no decay"

I can't agree with this one, Bris. Growing up, I ate a ton of sugar. Heck, I used to eat it by the spoonful. And I hardly ever brushed my teeth (yeah, TMI). And I ate a lot of wheat products.

But I never had a cavity until I was in my 20s. (BTW my mother had terrible teeth problems all her life.)

I ascribe that to two things. One, I drank a LOT of milk until my 20s. Probably a half-gallon a day until I was 18.

And then when I was 19, I went on a macrobiotic diet for a few months and became severely malnourished.

Put those two factors together, and all of a sudden I had cavities.

I know the plural of anecdote ain't data, but my experience is at least suggestive, and tracks with Dr. Price's findings.

What I am curious about is whether we could reproduce the experiment with fermented grains, and whether that would make a difference.

toddhargrove said...

Paleo RD said:

"I agree [that starches are not a problem.] I was on quite a low-carb kick after reading GCBC, but then after about a year I was having trouble sleeping and I looked tired. The problem? My adrenals were kicking in overtime to overcome the lack of dietary glucose for cellular energy."

I had a similar experience after avoiding starches for a year, then adding them back ala Schwarzbein. My assumption was the same as yours - that lack of glucose overtaxed the adrenals. I find it interesting that a lot of the more starch phobic paleo types such as DeVany are big coffee drinkers.

Ann said...

PaleoRd, how were you able to trace your sleep problems and fatigue to your adrenal glands and low carb diet?

Did you need to up your carbs a great deal to get your energy back? What sort of balance of nutrients does Schwarzbein recommend? (My library no longer has her books.)

Thanks.

Stan (Heretic) said...

I totally disagree with the people who commented that sugar, not starch is the problem! Star IS the problem! Please re-read the article and the graphs: even refined cane sugar is less damaging for teeth than the whole wheat! That's also what I am seeing every time I read/research McDougall's forum, health issues section! Dental decay is one common theme among vegans. No, they do not eat junk carbs nor sweets!

They only consume very politically correct whole-natural-unprocessed everything - grains, vegetables and fruit.

That's what made me suspicious about starch. The phytic acid may be a factor but I suspect there might be something else as well.

PaleoRD said...

Ann:

I made the connection between overactive adrenals and low carb after reading Schwarzbein. Adrenaline is constantly secreted to help maintain blood sugar, most noticeably in the morning after a long night's fast. That is why those with fatigued adrenals have to drink coffee first thing in the morning! Adrenaline stimulates glycogen breakdown in the liver and gluconeogenesis as well as tissue breakdown to free up proteins for energy. After long term low carb, my glycogen stores must have gotten so low that my adrenals where having to overcompensate with excess adrenaline.

I actually have the opposite problem of fatigued adrenals, my adrenals are healthy so when I went low carb they really starting pumping out the adrenaline which would explain my poor sleep, dark eye circles and I could literally feel my heart beating very hard. I do not use any stimulants (such as coffee, tea, or nicotine), so I assume that my adrenals are healthy.

Schwarzbein's recommendations are pretty basic. Between 15 and 50 grams of carbs per meal depending on your degree of insulin resistance and activity level. Protein and fat are unlimited in her program, but she recommends limiting saturated fat if you have a lot of weight to lose. She recommends never going below 50 grams of carbs per day to avoid adrenal fatigue that can occur with long term carb restriction. She notes that our bodies really do not have a feedback mechanism for carb intake like we do for fat, so that is the only macronutrient that needs to be monitored.

My energy level was actually really high on low carb because of the adrenaline. I now try to eat a sensible portion (25 - 75 g) of carbs such as rice or potatoes with my last meal and I can again sleep like a baby!

Don said...

PaleoRD wrote:

"[Schwartzbein says that] Some starch can do wonders in helping people with fatigued adrenals recover. According to her, the starch will raise blood sugar and that will reduce adrenaline, while the insulin release caused by eating the starch will have an anabolic action and help to repair the worn out glands."

This is an interesting fantasy. If it was true, Inuit on their native diet would have all had "adrenal burnout".

You can check any physiology or endocrinology textbook to confirm the actions of insulin, and repairing adrenals (or any other organ) is not one of them. Its job is to clear toxic levels of glucose out of the blood, not repair vital organs. If you dispute me, please provide a reference, not to Schwarzbein (her books are full of flights of her fancy), but to a basic textbook.

Further, there is no evidence that eating a low carobhydrate diet "taxes the adrenals." Again, if it did, Inuit could not have thrived (as they did) on their native diet. Take a look at the pictures of Eskimos in Dr. Price's book....do they look tired? And don't give me the crap response suggesting that Eskimos are "specially adapted" to their diet but the rest of us are carbivores.

Stefansson proved that non-Eskimos do just as well on a carnivorous regime as any Eskimo.


Don

Don said...

Do cells require dietary glucose? No. Full stop. It is complete fantasy.

I have never seen any evidence that humans require starch in the diet for any purpose, much less to prevent adrenal burnout. There is no dietary requirement for glucose and a diet lacking glucose does not put any special strain on the adrenals.

Put in an evolutionary context, if the human body was so fragile that it had to have a specific amount of starch every day to prevent damage to a vital gland (adrenals) our species would never have survived the ice ages. And the Nenets would not be surviving in Siberia:

http://www.washingtonpost.com/wp-dyn/content/story/2008/05/13/ST2008051302252.html

Do you really think they all have insomnia from excessive adrenaline output?

Simply put, and from my own experience, people give up on low carbohydrate eating simply because they can't shake free from the belief that “some” carbohydrate is essential.

This belief has no physical basis, it is simply a reflection of your acculturation (you can be certain no traditional Eskimo held the belief). Going against it involves opposing years of indoctrination and associations created by parents and society, not to mention the pressure to conform to social norms.

Eventually most people create rationalizations to continue or resume eating the starches they grew up eating, including creating pseudo-scientific explanations such as Schwarzbein’s.

Stan is absolutely correct, the data here clearly shows starch is cariogenic. Dr. Price's work clearly showed the lowest rates of dental decay among the groups with diets low or absent starch and sugar (grain and fruit).

The idea that starch is "harmless" provided "good dental hygiene" is self-contradictory – like saying a poison is harmless as long as you take the antidote. If you have to brush your teeth to prevent tooth decay then you aren't eating the diet to which human teeth are adapted. No animal on its natural diet has tooth decay, despite no dentistry or dental hygiene.

The teeth of herbivores are completely different than those of carnivores, having very thick enamel and regenerating, to resist the effects of a diet composed primarily of carbohdyrate. Humans have a carnivore-type tooth structure with thin enamel, so most of us (at least 95%) get decay when we eat foods other than protein and fat. Teeth are absolutely necessary for survival, and if any species in the wild were to eat in such a way to lose teeth, it would spell death for the individual and the species. If humans were adapted to carbivory, we surely would have teeth that resist decay no matter how much carbohdyrate in the diet.

Every human characteristic including resistance to carbohydrate-fueled tooth decay varies across the population, with some few having high resistance, some very low resistance, and most with "average" resistance --distributed in a Bell curve fashion. Anyone who understands this expects that a few outliers (less than 5%) will manage to keep their teeth despite eating high carb diets, but would never conclude from this that carbohydrates don't cause havoc in most mouths.

In short, the fact that tooth decay incidence rises sharply with carbohydrate intake (as illustrated in Dr. Price's work), including starch intake, provides just one more proof that human dentition, hence the human body, is adapted to a low starch diet, the lowest being a strictly carnivorous diet. Which is what the archaeological evidence indicates our ancestors ate.

PaleoRD said...

A few possibilities:

If I had stuck to not eating starch for a longer period, my gluconeogenesis capability would have improved?

Insulin is an anabolic hormone. It pushes nutrients into cells, including adrenal cells. The hormone itself might not promote adrenal recovery, but the fact that it pushes aminos and sugars into cells may allow a faster recovery.

Glycogen in meat. As noted in the article you linked, the people ate "raw and frozen" meat and organs and bone broth. If an animal is killed in an unstressed state, there will not be a surge of adrenaline that triggers glycogen breakdown. Freezing and eating the meat raw will prevent further cell use of the remaining muscle glycogen. It is possible that for some parts of the year, Inuit consumed a quantity of glucose from the meat they ate, enough to prevent hyperadrenalism. If we are naturally carnivorous, would that mean that we evolved to eat more raw and fresh meat?

Just because we didn't evolve to eat something does not mean that thing is not beneficial. We would all agree that butter is healthy, but it is a processed product that involves a concentration of good nutrients. If our cells CAN use glucose as energy, is it bad to consume glucose?

Kurt G. Harris MD said...

Don said

"If you have to brush your teeth to prevent tooth decay then you aren't eating the diet to which human teeth are adapted. No animal on its natural diet has tooth decay, despite no dentistry or dental hygiene."

This is my view as well. My wife is a practicing dentist and sees plenty of vegans who avoid evil white sugar yet get plenty of decay from whole wheat breads and pastas. The only ones with more decay are the "dew heads" - every dentist knows the term - that chronically slurp mountain dew all day.

I also agree that "adrenal fatigue" due to lack of carbohydrates in the diet is fantasy.

Bris said...

Schwarzbein's theories are ludicrous. She is just another fringe-dwelling crackpot out to make money from a totally non-existent syndrome called "adrenal burnout".

The only tissues that need glucose (or ketones) are red blood cells, the cornea and retina in the eye and a small part of the brain. This requires only about 60g of glucose a day in total (2-3g/hr). This can be readily produced from protein via neoglucogenesis.

Cattle which are strict vegetarians get over 99% of their energy from amino acids and volatile fatty acids produced by gut fermentation not carbohydrates.

Unless you are engaged in continuous high intensity activity you are relying on fat for energy not glucose. You have about 500g (2000 Calories) of glycogen in reserve which easily provides provides enough energy for all but the most extreme endurance events.

Bris said...

PaleoRD said.

"Glycogen in meat. As noted in the article you linked, the people ate "raw and frozen" meat and organs and bone broth. If an animal is killed in an unstressed state, there will not be a surge of adrenaline that triggers glycogen breakdown."

Any traditional hunting method will always cause near total glycogen depletion from stress.

The only way to avoid stress in prey is a clean gunshot to the brain resulting in instant death. However post-mortem respiration of the muscle cells will still metabolise much of the glycogen.

sandra said...

I'm relatively new to the low carb thing...I have changed my diet, but am trying to remain skeptical and continue researching as I've fallen for fad diets before! I started on the low carb path because of a major health issue, so the stakes are high for me too. This blog is a great source of info- thank you!!

I generally feel great on resticted carbs, but have had cramping on exertion in my legs. A low-carber friend of mine told me this could be from too few carbs!

I've also had mixed results with my kids (I don't limit their carbs as much as mine). My oldest and youngest seem fine, but my middle child was losing weight (we're all lean already, so this is not the result I'm going for!). I guess this makes sense as low carb seem to be good for weight loss...although only one family member has had this result.

Maybe low carb is not good for everyone?? Do we have enough material in the archeological record to know for sure what our Paleo ancestors in all regions were eating? My middle son seems to tilt toward my gene stock while my other two resemble my husband more...

In any case, I've added back more bread for my son, but am questioning myself after reading all the anti-wheat info I've found here. I buy sprouted wheat bread that claims to be low glycemic... does sprouting remove the phytic acid? Would this kind of bread be unhealthy for other reasons (it does contain gluten)?

By the way, one fad diet I fell for was veganism... I can tell you that despite the lofty rhetoric, many vegans binge on sweets (when you're starving all the time it's very hard to resist)!

JohnN said...

ishoStephan,
The in-vitro experiment cannot account for the interaction between the bacteria in the mouth, the saliva (and its enzymes) and the starch. Once plaque is formed (starting from the gum line) no re-mineralization is possible regardless of the pH-level or the presence of phytic acid.

Regarding adrenal fatigue when limiting carbohydrates: Agree with Don and Kurt. I have not come across any study that substantiates this claim and not for lack of (L-C) detractors.
If you have sleep issues consider limiting protein intake while raising fat and carb (modestly) consumption.
The most common cause stems from depleted serotonin level in the brain (CNS); L-tryptophan (or 5-HTP) supplement should help. So does aerobic exercise which helps clear away amino acids that compete with L-tryptophan in getting through the blood-brain barrier.
John

Bris said...

"This is my view as well. My wife is a practicing dentist and sees plenty of vegans who avoid evil white sugar yet get plenty of decay from whole wheat breads and pastas."

Most vegans are very heavy fruit consumers. Fruit is both highly acidic and rich in sugars.

Bris said...

Don said:

"Do cells require dietary glucose? No. Full stop. It is complete fantasy."

All mammals evolved from insectivores. insects are animals.

Wild vegetarian mammals get almost no energy directly from carbohydrates. They rely on gut bacterial fermentations to turn cellulose and carbohydrates into protein and volatile fatty acids. The protein and VFAs then used to provide energy. Glucose is still produced overwhelmingly by gluconeogenesis in these animals.

Carbohydrate metabolism in mammals is a result of needing to metabolise carbohydrate-rich milk when young. Even strictly carnivorous domestic cats retain the ability to metabolise carbohydrates including starches into adulthood.

Bris said...

Nearly 30 years ago I went on a military survival exercise. Our group of nearly 100 males ate NOTHING for three days. None of us suffered any effects except severe hunger.

gallier2 said...

Barry Groves has a new article on the fat/carb ratio of different animals. Quite interesting to see that herbivores are also low-carbers...
http://barrygroves.blogspot.com/2009/07/i-wish-id-known.html

And here a link for people who like to see in what our ancestors were interested. I don't see lot of carrots and broccoli painted on the walls ;-)
http://www.lascaux.culture.fr/#/en/00.xml

Anand Srivastava said...

@PaleoRD

Your message got me thinking, why I sometimes have a bad nights sleep. It seems to me that it has happened since I started to restrict my carbs. But funnily it happens on the nights that I don't restrict my carbs.

So basically I get my bad sleep on days when I have more carbs, but somehow my low carb eating has increased the effect. Before my sleep used to be fine.

I also have a low blood pressure, that has been for a long time. I don't know what will solve it. Low carb has not done much to it. I believe this should solve my sleep problem as well. Somehow it seems to be affected by higher carb.

Chandler said...

Bris >> Wild vegetarian mammals get almost no energy directly from carbohydrates. They rely on gut bacterial fermentations to turn cellulose and carbohydrates into protein and volatile fatty acids.

Fascinating--your comment motivated me to do a search to verify this, and almost immediately I ran into the following link:

Digestive Physiology of Herbivores

I'd never thought to question my understanding of how herbivores derive their energy, and was surprised by the following fact:

Recall that in all animals the small intestine is the only site in the digestive tract where simple sugars and amino acids can be absorbed. Ruminants can utilize dietary starch, but very little of it is absorbed as glucose. Rather, starch and other soluble carbohydrates are fermented to volatile fatty acids in the forestomachs. What little starch enters the small intestine is poorly digested in that organ due to a relative deficiency in amylase.

(caveat that this quote references cow & sheep type herbivores, not the horse & rabbit variety)

So my (quick) reading reinforces that cows and their ilk derive energy mainly from fats & the protein of the microbes involved in the fermentation process. I'll need to read the full article in-depth later today...

Cynthia said...

In his excellent book "Trick and Treat", Barry Groves recounts a Swedish study where they measured the acidity levels in the mouth for a variety of starchy foods. Quotes Groves, "They found that, while sugary foods increased mouth acidity more than starches during the first 30 minutes, all three snack foods were worse than sugar after that time. This was because the starchy foods did not cause the eaters to produce so much saliva to clear the starch from the mouth. Cooked starches, particularly potato starch in products such as potato chips, cling longer to the teeth than many sugar foods."

Charles, it's interesting that you linked your heavy milk consumption to your healthy teeth. Groves also writes of a scientific review that "showed that milk and cheese could reduce the effects of metabolic acids, and could help restore the enamel that is lost during eating. In one study, cheese eaters experienced 71% less damage to their enamel over time."

Of course, we must also see how the body as a whole is involved in dental health. In "Sugar Blues", William Duffy cites research that links hormonal changes caused by a high sugar diet (and in his book, high sugar also includes high refined carbs) to altered internal activity of the teeth that leads to later decay. So tooth decay also occurs from the inside out.

Stephan Guyenet said...

John,

I agree, as do the study authors, that the results are not necessarily directly applicable to a live human mouth. But they do identify one mechanism that may contribute to decay, and show that there may be differences in the ability of refined and unrefined carbohydrates to cause it. It suggests that tooth decay isn't simply a matter of the carbohydrate content of foods.

Glenn said...

"Do we have enough material in the archeological record to know for sure what our Paleo ancestors in all regions were eating?"

I have the same question.

What is the evidence that Paleo HG's ate low carb?

Devils advocate: Couldn't they have eaten plenty of wild tubers and had a (natural/non-grain) carb intake of say 40% of calories or more?

How does anyone know they didn't?

Stephan Guyenet said...

Glenn,

I don't think it's clear that all our paleolithic ancestors ate low-carb. The only direct evidence we have is from bone isotope ratios and suggests a nearly carnivorous diet for paleolithic humans, but the data are extremely sparse and come only from Northern sites if I recall correctly.

Paleolithic humans seem to have relied at least partially on large game in most places, as judged by bones with butchering marks on them. But bones survive the rigors of time better than plant foods, so it's hard to say what the proportions were.

Modern hunter-gatherers survive on a diverse array of diets, not all of which are low in carbohydrate (ex, the Xavante foragers of Brazil and certain groups in Papua New Guinea). Although the average certainly seems to favor animal foods over plant foods.

There is some evidence that the modern spectrum of HG diets is more reliant on plant food and more diverse food resources than paleolithic HGs before the "broad-spectrum revolution" late in the paleolithic period. But I think it's premature to say that all or even most paleolithic hunter-gatherers ate a diet low in carbohydrate.

Kiwi said...

Off topic I know, but just in case it's not around for long, can someone watch this video clip and tell me what the hell is going on.
What's really in the test-tubes?
Thanks

http://tvnz.co.nz/world-news/some-food-thought-1-55-2834263/video

Anna said...

Kiwi,

That fat floating in the top of the test tubes is fat converted from carbohydrates in the liver. The blood becomes rich with fat very soon after every high carb meal, but that video portrays it as something abnormal. It's a sham portraying this as if the fat content in the meal is the main problem and those doctors should know better.

Dr. Mike Eades has a great post up yesterday about the misleading info in that video:

/www.proteinpower.com/drmike/saturated-fat/abcs-big-meal-propaganda/

That said, my memory of Appleby's food is simply awful and not just for the excess calories. The food is just low quality, highly processed, and bad, bad, bad. The only meal I can remember at an Appleby's (20 years ago?) was quite memorable for the incredibly awful fettucini sauce - as if it was from a can or jar - gluey fake processed cheese sauce without the orange coloring.

Coach Jeff said...

Several of you have brought up the fact vegans get plenty of tooth decay. This is true. Even vegans seem to admit as much.

And no, they tend not to eat refined sugars. So it must be the starch in their diet, right?

Well consider that the bacteria which rot your teeth do not know the difference between the sugar from candy vs. that from a banana.

Vegans eat loads of fruit. Fruit(especially modern, selectively bred fruits) have a fair amount of sugar. Dried fruits of course actually stick to the teeth, which is even worse. This is why "raw food" vegans have the absolute worst tooth decay.

I just do not see how starch could rot teeth, as it's sugar is chemically "bonded up" - unless you leave the starch in your mouth for a long time, so that the glucose breaks down and therefore becomes available to the bacteria in our mouth.

Also, regarding Weston Price...it's true that the only people with ZERO tooth decay were those who lived as near total carnivores.

But Price himself commented that the Dinkas, who ate starch and fish, were BETTER physical specimens than the carnivorous Masai.

Dental integrity is only part of the overall picture of total human health.

Although I lean somewhere between paleo and Weston Price in my dietary views, I do think the paleo crowd is a bit too anti-starch, and perhaps a bit too pro-fruit.

Kurt G. Harris MD said...

Some of this discussion is reminding me of the glycemic index bit where whole grain wheat bread is touted over white because it has a glycemic index of 50 instead of 75, and there is no discussion of the universe of animal products that have an index of zero. (not advocating GI, i'ts mostly useless)

Let's stipulate that sugar causes cavities the fastest, starches less than sugar but still significant (you doubt starches stick to your teeth and get into your sulci to be worked on by amylase?) but if you eat meat and whole cream you might not even need to brush.

I also know starch eaters who don't eat much sugar or fruit that get plenty of cavities. You don't have to eat simple sugars to get caries.

Senta said...

Another reason that vegans get a lot of cavities is likely that they are deficient in the fat-soluble vitamins A (pre-formed, not beta carotene), D and K2 which are critical to re-mineralizing teeth.

My husband eats the same way I do, Paleo/Weston A. Price, except he eats a lot more fruit. We both have excellent dental health and get comments from the hygienist about how we have no plaque or calculus. Before we change our diets, our teeth were not healthy.

I believe sugar and starch may contribute to tooth decay since the acids they cause demineralize teeth but if the rest of the diet favors remineralization, it could actually compensate and prevent cavities.

PaleoRD said...

Regarding the vegans who get tooth decay without eating sugar, could it be due to a lack of animal fat and protein in the diet?

What if it is possible to eat starch and sugar without getting caries as long as a good supply of animal foods is consumed?

There are many variables at play in vegans, such as vitamin B12 status, iron, vitamin A (vegans only get beta-carotene), sulfur containing amino acids and the greater mineral bioavailability from animal based foods.

PaleoRD said...

Sorry Senta, my comment is almost the same as yours. I guess yours was posted while I was typing mine :)

sandra said...

The authors did this study after noting that the Bantu had little tooth decay "when eating their native diet high in unrefined carbohydrate foods"...

How would cream or pulverized meat do in the petri dish test? I would think much better, but to be fair we'd need to try it...

Given that bone analysis can only tell us for sure what a certain individual ate, is it possible that some of our ancestors (depending on region) ate more carbs not only from tubers, but from grains as well?... could they have stored seasonal grains as we do today?

Kurt, I'm curious to know why you don't think GI is important. I worry about spiking insulin - is GI not really a good measure in your opinion?

Senta said...

No problem, PaleoRD! This a great topic with lots of good input, I appreciate all of it.

Kurt G. Harris MD said...

Hi Sandra

Oral flora don't thrive on fatty acids and protiens in vivo.

My point about GI is twofold:

The foods with the best glycemic index are not on the glycemic index charts because they don't have a glycemic index -eat the foods with no glycemic index to get the GI "low".

If you are comparing glycemic index foods that vary by 50:75 or some such ratio, there is simply no evidence that the lower glycemic carb laden foods are really healthier. In fact, if the GI is lower because of whole grains content, it has more lectins like WGA in it.

The best way to avoid insulin stimulation is to avoid carbohydrates, not eat more "healthy" ones.

Avoiding Fructose and Wheat (and seed oils) are probably the most important parts of that metabolically, and much more meaningful than the glycemic index. In fact, pure fructose has a low GI because your liver scoops it up on the first pass. Your blood sugar doesn't rise much in response, but it promotes insulin resistance and liver inflammation.

My advice, forget about the GI.

Stephan Guyenet said...

Senta and PaleoRD,

Price thought that the fat-soluble vitamins were important in protecting the teeth against decay due to carbohydrate foods, and I think you can make a good case for that based on his data and others.

Sandra,

There is evidence that hunter-gatherers ate grains in certain areas in the later paleolithic during the "broad spectrum revolution". It's not clear how widespread it was or what proportion of the diet it constituted. I think it's fair to say that grains consumption was probably rare before about 15,000 years ago, and didn't really become a widespread staple until after 10,000 years ago.

Kurt,

GI values of 50 and 75 for whole wheat bread and white bread are optimistic numbers. Most of the GI values I've seen for white vs. whole wheat bread are almost identical. I think digestion speed depends more on how fine the texture is than the fiber content, because really it's just a question of how fast the amylases can get to the starch and act on it.

Your point is well taken about the GI value of foods that don't contain carbohydrate. That never seems to enter into the discussion, I wonder why...

Nick said...

Stephan

You really seemed to split a nerve with this post - it certainly elicited many passionate and interesting comments.

I know it is a separate topic, but Dr. Schwarzbein is mentioned several times. I picked up her book awhile back and had a hard time believing what she has to say, as there were no references backing up many of her positions about how our metabolism works. Many NDs follow her protocol and prescribe a great deal of supplements. Many come from Thorne Research and are very expensive. I have searched for trials on some of the supps with little success, though it seems a controlled trial would be very simple to perform.

I would be very interested to hear your take on Schwarzbein's book(s) if you decide to read them. As the mind/body connection is so complicated, it is very hard to tell how much of what we experience is a result of the placebo effect.

On a different topic, I was speaking to someone yesterday who lived in Alaska for many years and remarked that many types of wild berries grew prolifically there during the summer months. I can't imagine the Eskimos would have avoided wild strawberries and blueberries if they were readily available.

Melchior Meijer said...

Hi Stephan and others,

This might be slightly off topic, since it is not directly related to caries. Someone I know well has always been plagued by terrible tartar. Just days after his clean up (2 per year) he already presents a visible layer of ‘cement’. He also suffers from periodontitis, despite his almost hysterical flossing, picking, brushing, etc. after every meal. At his latest visit, the dentist gave him the happy message that he needed surgery to remove the worst pockets, but that he was fighting a lost battle anyway. Bad genes, the dentist said. Somehow I succeeded to talk this hopeless guy into a modified paleo diet. Being the standard brainwashed athlete, he is convinced he will die eating low carb, but given his perspective he was willing to strictly avoid all gluten cereals (and all products containing them) for six months. He is getting his carb fix from potatoes, rice, rice crackers, quinoa and the occassional banana, date and fig. This experiment started in March. Fast forward to now: he has perfectly clean teeth, there is not a trace of tartar. For the first time in years his gums don’t bleed. I can’t wait to hear what his dentist and hygienist will say in September. The hygienist always books him in for 45 minutes of full time drilling.

This n=1 experiment so far seems to indicate that something else than starch and glucose is involved in dental heatlh/disease. Gluten again? And if so, how does it do it’s nasty job? Blocking mineral uptake? Triggering some auto-immune reaction? I am pondering full time.

Cheers from Holland, the country with the highest number of dieticians per capita in the world ;-).

Melchior.

Senta said...

Melchior,
Great example, wow! You may be on to something because my husband and I don't eat any wheat or other gluten grains at all and have no plaque or tartar any more. I wonder if it really could be gluten or something else in certain grains and not other sources of sugar/starch that causes tartar?

I found something disturbing about tartar-control toothpaste and wonder it this may provide clues as to what is in some grains that causes tartar so easily?

How does Tartar Control Toothpaste Work?

They actually call calcium phosphate, the substance needed to re-mineralize teeth, "destructive" because it causes tartar as well. So they block it completely by coating the teeth with a soluble form of phosphate so that calcium phosphate will just rinse off. To me that looks like they prevent tartar at the expense of re-mineralization!

So perhaps something in wheat deranges the re-mineralization process and calcium phosphate forms tartar on the surface of teeth instead of being incorporated into the teeth? That would also lead to weakened teeth and caries.

Stephan Guyenet said...

Nick,

Ah yes, I inflamed the whole-grains vs. no-grains controversy. Well that's OK, I find myself somewhere in between.

I'm sure the Inuit did eat some berries, but my impression from Stefansson's accounts is that it couldn't have been a major food source.

Melchior,

Awesome anecdote! It's rare that I hear about someone giving up gluten without cutting back on carbohydrate at the same time. It sounds like it's worked really well for him.

Senta,

That does sound like a strange way to protect teeth. I wonder if there are any studies to support its effectiveness?

Stephan Guyenet said...

Melchior,

By the way, a few studies have implicated inflammation as one mechanism of bone loss in celiac patients, so that could possibly contribute to dental problems as well.

dotslady said...

I thought nobody was going to mention the gluten factor! I have celiac and my teeth were troublesome from a young age (I ate lots of candy, not much soda, lots of grains and lots of milk). I have a lot of fillings, many root canals. I have retained baby teeth at the age of 48, and I hope to keep them as long as possible.

I was always bothered by my white spots, a few yellowed teeth, and damaged enamel on a few teeth. I was told from all my dentists that the white spots were from too much fluoride at some point while in utero, or during early dentition. We lived on a well, and I don't know the water's fluoride content. I wasn't a flosser until my late 20s - just wasn't educated. I became an ardent flosser after each dental exam's worsening gum dx (gingivitis).

It is well-known in the celiac community that tooth abnormalities are common. Go to a celiac support meeting and look around. My teeth were damaged from lack of calcium and vitamin D, K, etc. I'm trying to reverse my osteopenia.

The good news is after taking gf grains and sugars (Yoplait is gf - but what did I know before I started reading blogs like this?!) out of my diet, that my cleanings and dental bills have shrunk. I also had nagging tooth aches in my front teeth which I now attribute to low vitamin D.

I'm a bit of a WAPF, Paleo, and Schwarzbein dieter depending on the day... I read her book and was convinced it was healthy enough for me. But I'm not a scientist. I find it difficult to give up fruit. I watch my blood glucose. How do I know my liver is inflammed? My CBC's are great, but yes, my cholesterol (LDL) is high. But I'm changing subjects ... sorry.

Dr. Murray's article re: celiac:
http://tinyurl.com/m24vvn

" * Dental enamel defects. This is a problem when CD is otherwise silent in children during the time when their permanent teeth are developing. What happens is the enamel (the hard coating on your teeth) does not develop properly. With no enamel, your teeth wear down and you get cavities very quickly. Dr. Murray has seen terrible dental loss in 20-year-old celiacs, where they've lost an entire mouthful of teeth. This is not as much of a problem in the United States as it is in other countries, where dental care is not as frequent and aggressive. If dental enamel defects are detected, you can't really regrow it because it has never developed. But now there are new dental bonding techniques where they can put special films over the tooth to protect the defective area."

BTW, my mom had her upper teeth pulled at the strong suggestion of the Canadian dentist she saw back in the early 60s. She said this was common at the time. She loved potatoes and Pepsi. We're of Irish descent. How many Irish were impoverished, and at what cost to their teeth (they also have a higher than avg rate of celiac)? No one else in my family has been diagnosed celiac, nor do they care to be. :(

Ellen said...

"Schwarzbein's theories are ludicrous. She is just another fringe-dwelling crackpot out to make money from a totally non-existent syndrome called "adrenal burnout"."


I ASSURE you there is such a thing as adrenal burnout. That statement sounds similar to the MDs who say PMS isn't real.

dotslady said...

To complete my unscientific thoughts that are based on reading, you can bring up WAP or Masai, but as a whole, don't Africans have beautiful teeth (and they live w/plenty of vitamin D)? From what I can find most eat gluten-free grains if they aren't subsidized w/wheat and sugar. I also read in Chris Reading, MD's book "Trace Your Genes to Health" (http://bit.ly/4orfz) that it takes three generations to repair DNA (that's if you're mindful to do so). Lots of impoverished African-Americans still have beautiful teeth despite their likely grain-based diets. Maybe that's changing, I'd love to know.

IIILauraIII said...

Ellen said:

"I ASSURE you there is such a thing as adrenal burnout. That statement sounds similar to the MDs who say PMS isn't real."

You tell 'em Ellen!

Imagine just how under-diagnosed this problem is because most people will self-medicate with stimulants (coffee, tea, nicotine) and sugar, both of which are totally legal so no doctor's visit is required to obtain them.

Look at the popularity of soda, energy drinks and many coffee beverages, they combine both treatments and are available worldwide. Those don't help with tooth decay either.

Also, with the focus on insulin and insulin resistance, there is definitely some overlap of symptoms that people will attribute to being caused by insulin resistance and not adrenal fatigue.

sandra said...

I still wonder if there is a genetic factor. I was vegetarian for 8 years, 2 years vegan... lots of whole grains (but little sugar and none when I was vegan). This was in my 20's and I also didn't bother to go to the dentist for 5 years - when I finally did go, my dentist was expecting to find a mess because of my hiatus from regular check-ups. He was shocked to find my teeth in perfect condition. No caveties, no gum disease, nothing.

I know this is anecdotal, but so are other stories posted... Perhaps some of us are better adapted to grains and if our teeth don't suffer, maybe the rest of our bodies don't either? (although, I agree that veggie diets and esp. vegan diets are bad for other reasons!).

Perhaps I'm grasping at straws here as I'm freaking out about feeding a hungry family w/o bread and fruit... So I'm hoping that lots of good pastured meat, eggs and dairy with some grains is OK??

Kurt, thank you for the info. On the fructose issue, I did stop using agave and xylitol after reading GCBC (I did have feeling all along they were too good to be true!)... but again I'm kinda hoping getting some fructose in fruit wouldn't be bad (??). I've read that the body can absorb some fructose if it's not too much at a time. Also, does fruit have glucose too? If so, doesn't that help with absorption?

One more question on phytate... I'm sorry this is long. Since whole grains contain some minerals (though I realize not as much as meats) could they be simply cancelled out by the phytate content w/o actually robing minerals from the body or are the amounts very unequal?

Kurt G. Harris MD said...

Sandra

I have no doubt we are much more adapted to large boluses of starch than boluses of fructose. In nature, fructose comes 1:1 with glucose. either attached (as the disaccharade sucrose) or in honey, where there is sucrose and simple sugar forms of both glu and fru in roughly equal amounts.

I just read a paper from UC Davis that showed fructose empties from the stomach into the jejunum as a first order differential function - ie a cola drink with rush into your bowel much faster than a glucose sports drink -this may contribute to fructose malabsorption which is surprisingly common - malabsorption is not good - it leads to bacterial overgrowth, etc.

Fructose tastes good and in small amounts in a paleo diet is probably harmless. but it is otherwise completely unnecessary. In paleo times, it was a rare and inconsistent food source and many paleo peoples ate zero fructose.

The big hazard with eating fructose now is that it conditions you to sweets. In our fructose saturated food culture, that just makes it harder to stay on the path, IMO.

Calculate the cost of whole cream on a per calorie basis and you will see you can get 3200 calories for a few dollars. Compare that to $4.50 for 12 oz of sweetened breakfast cereal or event the cheapest HFCS soda pop.

Going for calorie density with fats is a reliable paleo principle and cost effective too.

With Whole cream, butter and eggs there is simply no economic argument for grains or cereals.

Connie's Place said...

to add my story to the gluten and teeth discussion...

I am sure that my two daughters (4yo and 20 months) are Celiac. I believe they get it from my husband, but now that the family is GF I'm beginning to wonder if it might be from both of us. I have actually stopped eating all grains because they seem to make me grumpy and tired and have my type II diabetic husband almost convinced to give them up completely as well. But the thing that made me sure that my daughters are Celiac is there teeth. My older daughter teeth came in with terrible enamel. The dentist said it probably was something that happening while I was pregnant (talk about mommy guilt) and that hopeful her permanent teeth would be okay. After my second daughter was born my husband eliminated gluten from his diet and I finally realized that my whole family was suffering from it and took it out of our diet. My second daughters teeth have one line of enamel issues that I think are from the small amount of time she was on a gluten diet. And my older daughters teeth are looking so much better now that she doesn't eat gluten. She actually eats tons of fruit.

My husband is Native Alaskan and Irish, and we are trying to convince his family members to give up gluten with no success. I live in Alaska and there are lots of berries here for about 2 months. There are a lot of edible plants as well, at least in this part of the state. Alaska is huge so my limited experience living in one part is certainly not enough to make me an expert.

Great post and discussion as always. I keep giving people the link to your blog but of course you have to be ready to have your entire nutritional education shatter to come.

Melchior Meijer said...

Senta,

That's an interesting link! Thanks.

Stephan,

Yes, this friend of mine offers an ideal opportunity to observe what happens if you just leave out gluten. As far as I know, this is the only intervention. He reports subjective health benefits as well, such as reduced anxiety, better exercise tolerance and an absence of 'cold sweaty shakes after a meal', which suggest normalisation of postprandial glucose and insulin excursions. Pitty we don't meassure things and pitty he's just an anecdote. On the other hand: small numbers and massive results often tell us something ;-).

Sandra,

I'm completely with you. I know lot's of wheat addicts with excellent dental health. We can't neither deny that many people live healthy lives well into their nineties on bread and 'gruel' (I assume these lucky folks were calorie restricted). But based on the research by Staffan Lindeberg et al (eloquently outlined by Stephan), I think that the toxins in grass seeds are able to produce an endless list of systemic disasters. Maybe genetics decide if you will end up with leptin resistance, periodontal disease and pancreatitis or with some nice kind of cardiomyopathy. Throw the massive amounts of fructose and linoleic acid we consume into the equation and it is a wonder that our life expectancy isn't a whole lot worse than it is.

Ed said...

Sandra and Kurt, search this blog for an earlier post titled something like "fructose index the new glycemic index" (something like that). In it, the recommendation is 20 grams of fructose/day.

Like omega 3s and 6s, I believe fructose impact is dose dependent and less is better than more, to a limit. Some daily fruit should be fine. Anyway, look for Stephans post, very educational about fructose.

Ed

TedHutchinson said...

Dietary Carbohydrates and Dental-Systemic DiseasesTwo contradictory hypotheses on the role of dietary carbohydrates in health and disease shape how dental-systemic associations are regarded.
On one side, Cleave and Yudkin postulated that excessive dietary fermentable carbohydrate intake led —in the absence of dental interventions such as fluorides—first to dental diseases and then to systemic diseases.
Under this hypothesis, dental and systemic diseases shared—as a common cause—a diet of excess fermentable carbohydrates.
Dental diseases were regarded as an alarm bell for future systemic diseases, and restricting carbohydrate intake prevented both dental and systemic diseases.
On the opposite side, Keys postulated the lipid hypothesis: that excessive dietary lipid intake caused systemic diseases. Keys advocated a diet high in fermentable carbohydrate for the benefit of general health, and dental diseases became regarded as local dietary side effects.
Because general health takes precedence over dental health when it comes to dietary recommendations, dental diseases became viewed as local infections; interventions such as fluorides, sealants, oral hygiene, antimicrobials, and dental fillings became synonymous with maintaining dental health, and carbohydrates were no longer considered as a common cause for dental-systemic diseases.
These opposing dietary hypotheses have increasingly been put to the test in clinical trials.
The emerging trial results favor Cleave-Yudkin’s hypothesis and may affect preventive approaches for dental and systemic diseases

TedHutchinson said...

I should have pointed out the full text of this paper is available FREE online at the link provided earlier.
The paper ends with the sentence
"This manuscript would not have been written were it not for Gary Taubes’ book, “Good Calories, Bad Calories.” So if you enjoyed reading GCBC, you will enjoy this.

sandra said...

Thanks Ed... I have been looking randomly at archives, but didn't notice the search button. Apologies to everyone for the repition!

Bris said...

Vitamin D metabolism in a frugivorous nocturnal mammal, the Egyptian fruit bat (Rousettus aegyptiacus).
http://www.ncbi.nlm.nih.gov/pubmed/12899852

This animal has no dietary or photobiogenic (sunlight) vitamin D source. It also has no detectable circulating vitamin D but is otherwise healthy.

I suspect that humans have an intremely inefficient vitamin D metabolism compared with most other mammals. We evolved as hairless tropical mammals so we would have naturally obtained massive UV exposure and produced extremely high levels of vitamin D. However many of us now get vastly less vitamin D than nature intended.

chasmyn said...

Wow. WOW. The original post is good, but the COMMENTS - what a wealth of information. Can I ask all of you brilliant folks who are reading this something?

My husband, at my urging, has just finished reading "The China Study" and is now decidedly vegan. Only he wants to get all of his "full feeling" from grains - granted we're talking about sprouted wheat Ezekiel bread and quinoa, but still...

And then I've also read Rami Nagel's "You Can Heal Your Child's Tooth Decay" and GAPS Guide, and am looking at both SCD and Body Ecology Diet with more raw foods added in.

My son's teeth have been crumbling since he was about 8 months old - his enamel is really soft and it crumbles away, leaving the dentin exposed. When he was 18 months old,he fell and broke one of his top front teeth - all four of which had exposed dentin at the time. I went to a local pediatric dentist who said pull them, and because it seemed like my only option, I allowed it.

He is now almost 4 and has lived without these teeth for a long time now, and of course, the surrounding teeth are suffering the same fate.

I am working to switch our diet from all organic everything to NO GRAINS or sugar, only...we LOVE fruit. We can live without wheat, we can live without refined sugars and such...but fruit? My son and I have the same love of fruit.

I have always thought it was a good thing because it's a raw, whole food. He will take in greens in the form of green smoothies with fruit, but not otherwise.

Is fruit really, really that bad? I'm happy to add in more bone broths and try to get fermented cod liver oil into him. I've got high vitamin butter oil...but telling him he cannot have fruit...telling either of us that...it feels very very threatening to me.

Has anyone read both The China Study AND WAP's work? Can you give me a quick comparison of the two? Ah, maybe i ask for too much - there is just so much information for me to distill, I feel as if this is a wonderful resource to help me do just that.

Thanks so much!

Bris said...

Hi Chasmyn. There is no need to eliminate fruit just keep it to 100g or less an day and no juices. Drink some water ASAP to wash away the acids.

After 12-18 months on a paleo diet most people find that sweet foods taste unpleasant.

Coach Jeff said...

Here's a link to an interesting article along these lines, entitled

"If A Diet Is Bad For The Teeth It Is Also Bad For The Body"

http://www.medicalnewstoday.com/articles/157105.php

Annette said...

A review by Chris Masterjohn of "The China Study" on WAP site: http://www.westonaprice.org/bookreviews/chinastudy.html

Personally, I must admit that the book seemed unrelated to any Chinese diet that I know of, though I am only really familiar with a small part of Guangdong. However, I felt it didn't ring true to mainstream Chinese life.

Bris said...

Annette:

The Committee for Responsible Physicians ins an extremist vegan organisation connected to PETA.

Senta said...
This comment has been removed by the author.
chasmyn said...

Thanks for the great links, everyone. I read them - all the Masterjohn stuff, the rebuttal, the response - all of it.

I have much to contemplate. Are there studies somewhere on fermented foods? I keep feeling like they are key - that I could do maybe not so much meat, higher fat, lots of fresh veggies, some fruit within reason, soaked nuts/seeds, bone broths, fermented CLO, and lots of good fermented foods.

I do a green juice every morning that I make myself and then green smoothies every day. Currently those green smoothies are the only way my almost four-year-old will allow greens into his diet. I am loathe to give those up just yet with him - perhaps what I am needing to do is just take little steps one at a time and make the shift that way. Giving up fruit almost entirely (some days we subsist almost on fruit alone, it seems) is way too daunting right now.

But enough about me - thank you so much for the continued information - it is all fascinating and gives me much to think about.

I'm going to re-read Nutrition and Physical Degeneration, too.

Bris said...

Chasym:

Children hate greens. The reason is simple - they are toxic to young children. Bitterness is a sure sign that a plant is poisonous.

In the 1920s paediatrician Clara M Davis found 15 unweaned children aged 6-11 months and let them choose freely from 33 foods. The children chose mostly high-fat, high-protein foods foods and fruit. They ate no greens and very little grain-based foods. None of the children suffered any health problems.

http://www.cmaj.ca/cgi/content/full/175/10/1199

chasmyn said...

bris: I've read that before somewhere about children choosing their own foods and being healthy.

I've also read that greens DO contain a miniscule amount of poison that will, over time, accumulate in the body and can cause issues, and this is why one needs to vary the greens one uses. From this same source I read that the reason we don't like greens per se is because we lack the ability to fully masticate them due to loss of wisdom teeth (generally used to properly masticate greens) and the fact that we never sit around long enough to properly chew our food (like gorillas?). SO when we DO try and eat a lot of greens, we will get sick because of not breaking them down properly before they reach the stomach.

This is why this particular source recommends green smoothies and the use of high-speed blenders to break down the food. And then "chewing" the smoothies to get the stomach acid needed in there to properly digest them. This has worked for me in getting bunches of greens in per day - I've had zero problems with digestibility using this method.

Aren't leafy greens important to kids' diets, though, too? I DO know that they need more of those good fats than we do as adults, for sure, and I pretty much let my son self-regulate in regards to food (within reason - no wheat or dairy or candy stuffs)...which is actually part of the why I am really torn about the fruit.

If he wants to eat nothing but raspberries (we picked the other day from the bush) and hard-boiled egg whites (I cannot get the good yolks into him when they're hard-boiled), like today, maybe there's something in those foods that is working for him? (He did also have part of a green smoothie and some veggie/beef stew).

I really appreciate you being willing to help me process all of this.

TedHutchinson said...

Dietary Carbohydrates and Dental-Systemic Diseases sorry the link I posted earlier returns the message not found, I hope this one stays working.

Bris said...

Why do people mention modern hunter-gatherers who eat high carbohydrate diets?

Modern HG diets are irrelevant. All modern HGs (except Inuits) live in extremely marginal environments almost devoid of large game.

The small slender physiques of almost all modern HGs are a sign of thousands of years of sub-optimal nutrition selecting for small size. An abundance of food would eventually select for large muscular physiques such as those of the Polynesians.

The only HG diet that matters is that of our ancestors in the Great Rift Valley 100,000 years ago. The only food that was available on the savannah in large quantities year-round was meat.

Bris said...

Chasmyn:

"I've also read that greens DO contain a miniscule amount of poison that will, over time, accumulate in the body and can cause issues, and this is why one needs to vary the greens one uses."

Children can't break down the plant toxins adequately.

"SO when we DO try and eat a lot of greens, we will get sick because of not breaking them down properly before they reach the stomach.'

We get sick because we are being poisoned.

"This is why this particular source recommends green smoothies and the use of high-speed blenders to break down the food. And then "chewing" the smoothies to get the stomach acid needed in there to properly digest them. "

Stomach acids are to digest protein not plant material.

"Aren't leafy greens important to kids' diets, though, too? "

Why? They contain almost no nutrients and humans can't digest cellulose. They mostly just pass through the body undigested and end up in the toilet.

PaleoRD said...

Bris: "The small slender physiques of almost all modern HGs are a sign of thousands of years of sub-optimal nutrition selecting for small size. An abundance of food would eventually select for large muscular physiques such as those of the Polynesians."

Price's photos were taken less than a century ago. They could be considered modern. Some of them have excellent physiques, and most of the photo's are of people's faces and fully clothed.

Look at these guys:
http://ryan-koch.blogspot.com/search?updated-max=2009-04-29T15%3A50%3A00-06%3A00&max-results=7

Definitely modern hunter gathers and they have excellent physiques.

Bris said...

"Definitely modern hunter gathers and they have excellent physiques."

They have very LEAN physiques with little muscle.

Australian Aborigines are generally quite short with exceptionally slender frames - like marathon runners.

The aborigines in the photo were perhaps 165-175cm tall and no heavier than 60kg.

PaleoRD said...

Bris

Please provide a description of the paleo physique. How can one obtain it? Who in the modern world most closely matches the ideal?

Stephan Guyenet said...

Sandra,

I think there is a strong genetic influence on the susceptibility to the effects of wheat, sugar, etc.

Grains are not inherently bad in my opinion, with the exception of wheat. But it depends on how they're prepared. You asked about minerals. It depends on the mineral. For example, phytic acid prevents zinc and iron absorption almost completely, but that may not be an issue if your consumption of them is modest and you eat sufficient animal foods.

Chasmyn,

I think eating fruit is not going to derail an otherwise good diet. The condition of your childrens' teeth is a clear sign that something in their diet isn't working for them. Vitamin D is also a critical factor for dental health.

Bris,

You said modern HG diets are irrelevant. I disagree. Modern HGs don't develop the "diseases of civilization". I prioritize avoiding diseases over being big and buff, personally.

Stephan Guyenet said...

Ted,

Thanks for posting that article, I've always thought what's good for the teeth is good for the rest of the body. I have a hard time believing the idea that there's no diet that is healthy for all body systems. But that's essentially what you're faced with if you believe animal foods are unhealthy.

chasmyn said...

Bris, I very much appreciate your responses, but this last one made me say, "what?" Leafy greens are FULL of vitamins and minerals - all of them are, to one degree or another. I'm stunned that anyone could think otherwise. There are many readily available resources for the vitamin and mineral content of leafy greens.

Stephen, Yes, Vitamin D. We live in the rainy, RAINY region of the Pacific Northwest. We are very lacking in Vitamin D for it, too.

Bris said...

Chasym:

"Bris, I very much appreciate your responses, but this last one made me say, "what?" Leafy greens are FULL of vitamins and minerals - all of them are, to one degree or another. I'm stunned that anyone could think otherwise. There are many readily available resources for the vitamin and mineral content of leafy greens."

I have been a food scientist and biochemist for 20 years. I will tell you unequivocally it is a *MYTH* that leafy greens are rich in vitamins and minerals. They are essentially just water and indigestible cellulose.

The total amounts of vitamins and minerals in greens is far lower than in animal foods. Animals concentrate vitamins and minerals in their bodies so the levels are much higher in their tissues than in the plants they eat.

The vitamin and mineral content of plant foods is determined by *CHEMICAL ANALYSIS*. This has absolutely no relationship to the availability of these nutrients when eaten.

In plants the cells have a rigid indigestible cellulose walls. These cells walls cannot be digested to release the nutrients. Greens also contain many antinutrients such as oxalic acid which prevent vitamin and mineral utilisation.

The forms of vitamins and minerals found in plants are generally poorly metabolised - vitamin A (retinol) from animal sources is 60x as effective as from plant sources (carotene). The heme form of iron found in meat is far more readily absorbed than iron from spinach.

As little as 1% of the nutrients in raw plant foods will actually be utilised when you eat them. The rest will simply pass undigested through the body and end up as feces.

In some cases eating greens will seriously *DEPLETE* the body of essential vitamins and minerals. The Australian explorers Burke and Wills eventually died in 1861 from eating nardoo fern shoots which prevented them from absorbing vitamin B6. The more they ate the faster they starved.

chasmyn said...

Whoa.

My head is spinning over that one.

Is there - so as not to take up this comment thread with my hunger for information, are there more resources for information on this I could read online? Or books?

And what about when the cellulose is broken down, say with a high-speed blender, so it is essentially pre-digested? Wouldn't that make a difference?

I have to say, the more I learn abut food and nutrition the less I feel I know. :-)

Bris said...

Chasym:

And what about when the cellulose is broken down, say with a high-speed blender, so it is essentially pre-digested? Wouldn't that make a difference?

A blender can't really break the cellulose down as the cells are microscopic and not damaged by the blades.

Cellulose is insoluble fibre which causes fermentation in the colon and encourages the overgrowth growth of pathogenic bacteria. Our gut physiology isn't able to handle large amounts of cellulose.

There is really no need to consume greens or juices. If a child won't eat a food just stop giving it to them. Lord Strathcona lived to age 93 in good health despite eating only soft-boiled eggs and milk.

If you are worried about vitamins and minerals just take a multivitamin and a vitamin C tablet daily.

I can't really recommend any books because my knowledge was obtained from textbooks and scientific papers. Unfortunately this approach is not very practical.

www.second-opinions.co.uk/

Is a great source of information. The author Barry Groves has a PhD in nutrition.

sandra said...

Bris:

"As little as 1% of the nutrients in raw plant foods will actually be utilised when you eat them. The rest will simply pass undigested through the body and end up as feces. "

You say "raw plant foods" - are nutrients more available if the veggies are cooked? Does this apply to fruit too?? Are the vitamins and antioxidants we're told to get from blueberries, etc. also locked away in cellulose?

Bris said...

You say "raw plant foods" - are nutrients more available if the veggies are cooked? Does this apply to fruit too?? Are the vitamins and antioxidants we're told to get from blueberries, etc. also locked away in cellulose?

The nutrients in vegetables are more readily available if they are cooked as this tends to rupture the cells.

Freezing helps release nutrients as the plant cells usually burst due to ice crystal forming inside. Freezing also preserves nutrients very well.

The nutrients are also locked away in berries. I buy frozen berries and thaw them as I need.

Nick said...

Bris

"I have been a food scientist and biochemist for 20 years. I will tell you unequivocally it is a *MYTH* that leafy greens are rich in vitamins and minerals. They are essentially just water and indigestible cellulose. "

Bris, you mentioned Barry Groves as a good source for nutrition. Although you didn't explicitly state that Barry agrees with you about leafy greens, I could find no references to leafy greens on his 'second opinions' website. I did find this from his October 25, 2008 post:

"If you want a long and healthy life, without diseases such as diabetes with its wide range of complications, you need to ensure stability in blood sugar and insulin levels. This means that foods such as meat, fish, eggs and green vegetables, which don't disrupt blood sugar (and therefore insulin) levels, are the ones you should eat."

Can you please provide references with regard to the nutrients provided by raw plant foods and leafy greens?

PaleoRD said...

A little late to add to this discussion, but here is a quote from Price, pg 263 of NAPD:

"Some of the current theories of the chemistry of tooth decay place the responsibility on the local condition of the mouth as affected by the contributing factors provided by starch and sugar which enhance the growth of acid producing organisms. A phase of this has been related to the slogan that a clean tooth cannot decay...Another difficulty is that the primitive races have smeared their teeth with starchy foods almost constantly and make no effort whatsoever to clean their teeth. In spite of this they have no tooth decay."

Stephan Guyenet said...

Love it.

Dr. David Cheng, DDS said...

One significant factor in the dental cavity-forming process is the "stickiness" of the sugar-containing food. The longer the food stays on the teeth, the more time bacteria have to metabolize the carbohydrates. So even foods that we don't normally associate with cavities has the ablility to form cavities if they are sticky.

Emergency dental

amalhator said...

I always believed raw vegetable were healthy since they have biophotons and the enzymes and nutrients are intact. Juicing them them energizes me I sleep a lot better. It is also claimed that a 70 year old woman who juiced for a long time looked as she was in her 40's.
http://articles.mercola.com/sites/articles/archive/2009/04/16/can-juicing-really-lead-to-happiness.aspx
http://articles.mercola.com/sites/articles/archive/2001/04/14/wrinkles-vegetables.aspx

Would raw leafy greens increase or decrease the chance of getting cavities, or have no effect?

Dr. Mercola recommends using Nutritional Typing which is a program that determines your optimal caloric ratio based on your genes ie. a diet beneficial to a person may actually be harmful to another person. This may explain why we get mixed results from diets.
http://nutritionaltyping.mercola.com/DailyTips.aspx

annie-lindley said...

I think the study should also have taken genetics into consideration. As one Sandra mentioned, she went 5 years without going to the dentist and there was nothing wrong with her teeth.

It might not always be what you eat, right? I just talked to a local dentist a while ago 877-639-0820 and he mentioned that sometimes it does happen, although of course he advised me to still visit twice a year even when I feel that my teeth are perfectly fine.

Gary Sharp said...

There is a dentist in Hamilton that was telling me that you can reverse tooth decay if you head it off fast enough. Is that true?

Ross Rubino said...

I could see why refined sugars do more decalcification since refining typically takes healthy bits OUT of the substance. Look at white rice and bread, it's more refined but has less nutrition. Refining is not always a good thing. As a Park Ridge dental office, we have seen this be true. Thanks for the post, Stephen.