In this post, I'll review three cultures with different degrees of malocclusion over time, and try to explain how the factors I've discussed may have played a role.
The Xavante of Simoes Lopes
In 1966, Dr. Jerry D. Niswander published a paper titled "The Oral Status of the Xavantes of Simoes Lopes", describing the dental health and occlusion of 166 Brazilian hunter-gatherers from the Xavante tribe (free full text). This tribe was living predominantly according to tradition, although they had begun trading with the post at Simoes Lopes for some foods. They made little effort to clean their teeth. They were mostly but not entirely free of dental cavities:
Approximately 33% of the Xavantes at Simoes Lopes were caries free. Neel et al. (1964) noted almost complete absence of dental caries in the Xavante village at Sao Domingos. The difference in the two villages may at least in part be accounted for by the fact that, for some five years, the Simoes Lopes Xavante have had access to sugar cane, whereas none was grown at Sao Domingos. It would appear that, although these Xavantes still enjoy relative freedom from dental caries, this advantage is disappearing after only six years of permanent contact with a post of the Indian Protective Service.The most striking thing about these data is the occlusion of the Xavante. 95 percent had ideal occlusion. The remaining 5 percent had nothing more than a mild crowding of the incisors (front teeth). Niswander didn't observe a single case of underbite or overbite. This would have been truly exceptional in an industrial population. Niswander continues:
Characteristically, the Xavante adults exhibited broad dental arches, almost perfectly aligned teeth, end-to-end bite, and extensive dental attrition. At 18-20 years of age, the teeth were so worn as to almost totally obliterate the cusp patterns, leaving flat chewing surfaces.The Xavante were clearly hard on their teeth, and their predominantly hunter-gatherer lifestyle demanded it. They practiced a bit of "rudimentary agriculture" of corn, beans and squash, which would sustain them for a short period of the year devoted to ceremonies. Dr. James V. Neel describes their diet (free full text):
Despite a rudimentary agriculture, the Xavante depend very heavily on the wild products which they gather. They eat numerous varieties of roots in large quantities, which provide a nourishing, if starchy, diet. These roots are available all year but are particularly important in the Xavante diet from April to June in the first half of the dry season when there are no more fruits. The maize harvest does not last long and is usually saved for a period of ceremonies. Until the second harvest of beans and pumpkins, the Xavante subsist largely on roots and palmito (Chamacrops sp.), their year-round staples.The Xavante are an example of humans living an ancestral lifestyle, and their occlusion shows it. They have the best occlusion of any living population I've encountered so far. Here's why I think that's the case:
From late August until mid-February, there are also plenty of nuts and fruits available. The earliest and most important in their diet is the carob or ceretona (Ceretona sp.), sometimes known as St. John's bread. Later come the fruits of the buriti palm (Mauritia sp.) and the piqui (Caryocar sp.). These are the basis of the food supply throughout the rainy season. Other fruits, such as mangoes, genipapo (Genipa americana), and a number of still unidentified varieties are also available.
The casual observer could easily be misled into thinking that the Xavante "live on meat." Certainly they talk a great deal about meat, which is the most highly esteemed food among them, in some respects the only commodity which they really consider "food" at all... They do not eat meat every day and may go without meat for several days at a stretch, but the gathered products of the region are always available for consumption in the community.
Recently, the Xavante have begun to eat large quantities of fish.
- A nutrient-rich, whole foods diet, presumably including organs.
- On-demand breast feeding for two or more years.
- No bottle-feeding or modern pacifiers.
- Tough foods on a regular basis.
Severe abrasion was not apparent among the Bakairi, and the dental arches did not appear as broad and massive as in the Xavantes. Dental caries and malocclusion were strikingly more prevalent; and, although not recorded systematically, the Bakairi also showed considerably more periodontal disease. If it can be assumed that the Bakairi once enjoyed a freedom from dental disease and malocclusion equal to that now exhibited by the Xavantes, the available data suggest that the changes in occlusal patterns as well as caries and periodontal disease have been too rapid to be accounted for by an hypothesis involving relaxed [genetic] selection.The Masai of Kenya
The Masai are traditionally a pastoral people who live almost exclusively from their cattle. In 1945, and again in 1952, Dr. J. Schwartz examined the teeth of 408 and 273 Masai, respectively (#1 free full text; #2 ref). In the first study, he found that 8 percent of Masai showed some form of malocclusion, while in the second study, only 0.4 percent of Masai were maloccluded. Although we don't know what his precise criteria were for diagnosing malocclusion, these are still very low numbers.
In both studies, 4 percent of Masai had cavities. Between the two studies, Schwartz found 67 cavities in 21,792 teeth, or 0.3 percent of teeth affected. This is almost exactly what Dr. Weston Price found when he visited them in 1935. From Nutrition and Physical Degeneration, page 138:
In the Masai tribe, a study of 2,516 teeth in eighty-eight individuals distributed through several widely separated manyatas showed only four individuals with caries. These had a total of ten carious teeth, or only 0.4 per cent of the teeth attacked by tooth decay.Dr. Schwartz describes their diet:
The principal food of the Masai is milk, meat and blood, the latter obtained by bleeding their cattle... The Masai have ample means with which to get maize meal and fresh vegetables but these foodstuffs are known only to those who work in town. It is impossible to induce a Masai to plant their own maize or vegetables near their huts.This is essentially the same description Price gave during his visit. The Masai were not hunter-gatherers, but their traditional lifestyle was close enough to allow good occlusion. Here's why I think the Masai had good occlusion:
- A nutrient-dense diet rich in protein and fat-soluble vitamins from pastured dairy.
- On-demand breast feeding for two or more years.
- No bottle feeding or modern pacifiers.
Sadly, the lifestyle and occlusion of the Masai has changed in the intervening decades. A paper from 1992 described their modern diet:
The main articles of diet were white maize, [presumably heavily sweetened] tea, milk, [white] rice, and beans. Traditional items were rarely eaten... Milk... was not mentioned by 30% of mothers.A paper from 1993 described the occlusion of 235 young Masai attending rural and peri-urban schools. Nearly all showed some degree of malocclusion, with open bite alone affecting 18 percent.
Rural Caucasians in Kentucky
It's always difficult to find examples of Caucasian populations living traditional lifestyles, because most Caucasian populations adopted the industrial lifestyle long ago. That's why I was grateful to find a study by Dr. Robert S. Corruccini, published in 1981, titled "Occlusal Variation in a Rural Kentucky Community" (ref).
This study examined a group of isolated Caucasians living in the Mammoth Cave region of Kentucky, USA. Corruccini arrived during a time of transition between traditional and modern foodways. He describes the traditional lifestyle as follows:
Much of the traditional way of life of these people (all white) has been maintained, but two major changes have been the movement of industry and mechanized farming into the area in the last 25 years. Traditionally, tobacco (the only cash crop), gardens, and orchards were grown by each family. Apples, pears, cherries, plums, peaches, potatoes, corn, green beans, peas, squash, peppers, cucumbers, and onions were grown for consumption, and fruits and nuts, grapes, and teas were gathered by individuals. In the diet of these people, dried pork and fried [presumably in lard], thick-crust cornbread (which were important winter staples) provided consistently stressful chewing. Hunting is still very common in the area.Although it isn't mentioned in the paper, this group, like nearly all traditionally-living populations, probably did not waste the organs or bones of the animals it ate. Altogether, it appears to be an excellent and varied diet, based on whole foods, and containing all the elements necessary for good occlusion and overall health.
The older generation of this population has the best occlusion of any Caucasian population I've ever seen, rivaling some hunter-gatherer groups. This shows that Caucasians are not genetically doomed to malocclusion. The younger generation, living on more modern foods, shows very poor occlusion, among the worst I've seen. They also show narrowed arches, a characteristic feature of deteriorating occlusion. One generation is all it takes. Corruccini found that a higher malocclusion score was associated with softer, more industrial foods.
Here are the reasons I believe this group of Caucasians in Kentucky had good occlusion:
- A nutrient-rich, whole foods diet, presumably including organs.
- Prolonged breast feeding.
- No bottle-feeding or modern pacifiers.
- Tough foods on a regular basis.
I hope you can see that populations with excellent teeth do certain things in common, and that straying from those principles puts the next generation at a high risk of malocclusion. Malocclusion is a serious problem that has major implications for health, well-being and finances. In the next post, I'll give a simplified summary of everything I've covered in this series. Then it's back to our regularly scheduled programming.
Many thanks for another fascinating and thought provoking post.
You are a star. (-:
The traditional Kentucky diet includes grains and legumes (I don't think you included dairy in the description), 2 big no-nos from the paleo diet perspective. I think it's interesting that they had good teeth despite phytates in the diet. I get the feeling that a paleo-inspired diet ought to work to achieve optimum health, but it doesn't appear to be strictly necessary. The Masai drank a lot of milk.
Do you have any other health data on the Kentucky folk?
I loved reading Cold Mountain by Charles Frazier a few years ago, primarily for it's well-researched and detailed description of Appalachian life. Three characters and their experiences of struggle illustrate white well how to live off the land, whether by cultivation, hunting and foraging, or while traveling a long journey. It was so clear to me that good animal fat with some protein was crucial to long-term survival and seasonal variation.
While the story is set Civil War-era North Carolina, there are probably many similarities to traditional life in isolated communities along the Appalachian Mountain range in eastern Kentucky & Tennessee, Western NC & VA, & Northern GA, and probably north into PA, etc. The farm in the story very much mirrors the Central PA farm where my great grandmother (1895-1980) lived nearly her entire life.
The movie, of course, did not convey the same depth and rich detail about rural Appalachian survival and existence. I imagine an audio recording of the book would be very good, though. I highly recommend the book.
This is all very interesting. What were the tough elements of the Xavante diet? If the roots, did they eat them raw? If the nuts, did they crack the shells with their teeth? Did they use their teeth as tools a lot?
Did the flattening of their molars in early adulthood have any bad effects in old age?
On the rare occasion that I've resorted to using my teeth as a tool, I've wondered if I were doing harm to myself. Now I realize it's good exercise.
Yes, a number of cultures have successfully incorporated neolithic foods into a healthy diet. Some neolithic foods are more problematic than others, and the preparation methods matter as well. But honestly, all I can say about these people is that they had nice teeth. I don't have any other data on their health.
Phytate is only a concern if there is enough of it in the diet to prevent mineral absorption. I don't know how much corn they were eating, or how they were preparing it, so I can't say how much phytate they were eating.
Game meat is typically tough. Raw vegetables and fruit are tough enough in many cases to stimulate bone growth. I don't know enough about the nuts they ate.
Careful not to overdo it if you're going to use your teeth as tools! I don't want to get an angry e-mail from your dentist, haha. I think they used their teeth to chew leather and hold ropes, etc, rather than crack open nuts and hard bones. They had rocks for that.
Good commentary Ed,
Now you know why Weston A. Price and other observers (Cleave, McCarrison, Burkitt) never noticed a link between consumption of phytate rich foods, and even glutinous foods, and relative health. There was no apparent correlation because such items in the diet of impeccably well-nourished peoples was insignificant. Minutiae. Note that these were all agriculturalists. None were hunter gatherers. Agriculture is not the cause of modern man's decline. The Paleo mindset has no basis in reality. The belief that agricultural staples like whole grains and corn are inherently toxic is easy to disprove - whether fermented, sprouted, or simply ground up fresh and cooked for a couple of minutes.
From the things I read, I don't think I agree with your conclusion.
Removing glutinous foods seems to have a substantial positive impact on people, in particular those with auto-immune diseases.
I do not think that our bodies are as simple as, "eat glutinous foods, become unhealthy." There are clearly examples where this does not come true. However, there are a number of examples of "remove glutinous foods, become healthier." So there is a relationship, just not a simple one.
I'm not ready to completely jettison the paleo concept, as far as a positive prescription it seems to be very effective. What I feel is in contention are the warnings they give, which basically amount to "if you don't eat this way, you will get very sick." I think exploring this border area is very interesting. Some people do get sick on neolithic foods, some people don't, and "neolithic" is a rather broad category of not just foodstuff but proportions and quantities, and preparation methods as well.
I still believe in the paleo concept. I think it's the safest way to go. But we have to acknowledge that there are cultures that have made neolithic foods work, when using them in the right context.
You know we disagree on this. Every culture I've become familiar with that relies heavily on grains treats them to reduce phytic acid. McCarrison's Sikhs are not necessarily a counterexample. Mellanby showed that freshly ground whole wheat breaks down its own PA rapidly. If they let the batter sit around for as little as an hour, most of it would have been gone.
McCarrison's animal experiments aren't relevant here. Different animals have different abilities to break down PA during digestion. Humans and dogs break don little or none of it in the small intestine, whereas rats are pretty good at breaking it down.
Traditionally living Bantu children, in places where grains are heavily used, often have rickets. If you live in Africa, and thus you get plenty of vitamin D, there's only one reason you get rickets: severe mineral deficiency.
Interesting: "Traditionally living Bantu children, in places where grains are heavily used, often have rickets. If you live in Africa, and thus you get plenty of vitamin D, there's only one reason you get rickets: severe mineral deficiency."
Or, could it be that the grain-based diet creates greater demands for vitamin D? (I am not sure how this works, but think I read it here.) Dark-skinned people require more sunlight to make vitamin D than light-skinned people. The Bantus' skin pigment may reflect an earlier adaptation to living in sunny Africa *sans grains.* Europeans' lighter skin pigments may reflect an adaptation not only latitude and cloud-cover, but also a grain-based diet, all reasons to need to synthesize more vitamin D.
(Note that northern peoples who eat a lot of oily fish (and fish livers) often have a darker skin tone. And yes, another reason may be that they started living there more recently.)
I also wonder if this has something to do with African Americans' greater susceptibility to cancer and heart disease in the United States. Of course, disparities in income, food access (the "food desert" phenomenon in urban areas), and health care, as well as the stress of racism, all play a role, but northern and largely indoor living combined with a vitamin-D-deficiency-promoting diet (the SAD), combined with darker skin, probably has a lot to do with this.
Matt, in reading your comments about the Sikhs on 180 Degree Health, I wondered if their excellent health had to due with the freshly-ground-ness of the wheat. Stephan's observation makes sense to me here.
In your last post you said:
"Growth continues until about age 17, when the last skull sutures cease growing and slowly fuse. One of these sutures runs along the center of the maxillary arch (the arch in the upper jaw), and contributes to the widening of the upper arch"
Could metal braces contribute to malocclusion? Braces are often fitted in early teens and apply a lot of inward pressure on growing bone. Isn't this like foot binding? If you have a smaller dental arch as a result aren't you likely to have malocclusion even with the removal of teeth?
Interesting, I hadn't thought about it. Maybe.
It barely takes any vitamin D to prevent rickets. Rickets happens when your serum vitamin D approaches zero. I just can't believe that their vitamin D levels, in a traditional African society spending half the day outdoors, were so depleted that it gave them rickets.
Yeah, that makes sense, or we'd all have rickets around here (USA).
Your response to Matt addresses the phytic acid issue. But what about gluten? How could the Sikhs eat gluten as a staple and be so healthy? What is your explanation for McCarrison's findings in this regard?
Gluten only causes problems if the gliadin peptide in it gets past the intestinal wall as a peptide. If it gets broken down to amino acids first, it's harmless.
Something other than gluten causes breakdown of the intensitial biofilm-muscus-intestinal wall-blood barrier, IMO. I suspect it's fructose, since it's a metabolite and would logically change the composition of gut flora, but I am guessing.
The Fall 2009 issue of Wise Traditions, the journal of the Weston A. Price Foundation, had an interesting article about George Catlin, a 19th century "renaissance" (my description) writer and artist who spent considerable time living with various Native American tribes, as he recognized that their traditional way of life was quickly fading.
The book Catlin wrote and kept in print until his death, Shut Your Mouth and Save Your Life, is available on google books to read and download. It's full of interesting observations that pertain to Stephan's excellent series on malocclusion.
Is there any evidence these people were actually healthy, besides anecdotes?
I have evidence that North Indians eating whole wheat and dairy had fewer heart attacks than South Indians eating practically nothing but white rice and beans with no added fat. That's the only solid evidence I've come across, and I don't know how much it tells us about the health effects of wheat specifically.
If you have more evidence, please pass it along.
Thanks for passing that along.
Robert Mcleod said
"Gluten only causes problems if the gliadin peptide in it gets past the intestinal wall as a peptide. If it gets broken down to amino acids first, it's harmless.
Thank you for that.
So the rising rates of gluten intolerance are a reflection of the permeability of the gut wall.
Lots of things cause degradation of the gut wall, including lack of vitamin D, and an Omega 3 6 imbalance.
Thanks for the response. No, I have no other evidence other than what Matt said McCarrison said.
Do you consider McCarrison's evidence to be less anectdotal than Price's?
Price gave us numbers for tooth decay, that line up nicely with the findings of other investigators. He also did experiments in animals and humans to back up his theories.
Price's observations on malocclusion, thumb sucking, general health, etc, I consider anecdotes, because he didn't record anything systematically. But they gain strength when they're backed up by modern research, which they often but not always are.
The North Indian/South Indian paper is not rock solid--it neglects coconut which is South Indian staple. They eat it everyday.
The paper seeks to show the superiority of high-fibre whole-wheat based diet. But maybe the only effect is lack of Vitamin A and K2 in the South Indian diet.
Is anybody aware of evidence indicating that wheat gluten is an inherently harmful substance?
I suspect the following: nutritional deficiency leads to weak intestinal integrity which leads to gluten being a harmful substance. Healthy, nutritionally-sound individuals (i.e. traditional peoples) may not have any problem with wheat, while a deficient person might.
Either way, I avoid the stuff!
I have a few references.
"Gluten-induced mucosal changes in subjects without overt small-bowel disease. Lancet. 1981 Mar 7;1(8219):517-20."
They fed subjects 50g gluten per day (high dose), who were either normal or relatives of celiac patients. Both groups saw inflammatory changes in the gut lining and changes in absorption.
"Gliadin, zonulin and gut permeability: Effects on celiac and non-celiac intestinal
mucosa and intestinal cell lines. Scandinavian Journal of Gastroenterology,41:4,408 — 419"
They found that gliadin increases intestinal permeability in biopsies of CD patients, and to a lesser extent, normal controls.
"Gliadin Induces an Increase in Intestinal Permeability and Zonulin
Release by Binding to the Chemokine Receptor CXCR3. Gastroenterology. 2008 July ; 135(1): 194–204"
Gliadin increased intestinal permeability in mice through inflammatory signaling.
"Is gliadin really safe for non-coeliac individuals? Production of interleukin 15 in biopsy culture from non-coeliac individuals challenged with gliadin peptides. Gut 2007;56:889-890"
They found that gliadin causes inflammatory changes in celiac and non-celiac gut biopsies.
Yes Ryan, that is exactly the logic that I've followed. If healthy peoples tolerated grains, or carbs, or meats, or fruit, or dairy, or whatever a person's bent is - and many modern people are sickened by it, do we blame the grain or do we blame the people who can't tolerate it due to other factors. I think the answer is quite clear.
Grains without substantial amounts of "accessory food factors" such as ample fat soluble vitamins, is a harmful overall diet.
A paleo diet is a healthy diet and a safe bet assuming that it isn't too low in carbohdyrates - which is often counterproductive to modern man and his notoriously low metabolism and shot adrenals.
But the paleo craze has all kinds of flawed assumptions, like Mark Sisson's belief that paleo guy was uber lean and looked like a "decathlete." The aborigine on page 167 of Nutrition and Physical Degeneration doesn't look much like Sisson to me. In fact, they would have thought, by his leanness, that Sisson was one sick mofo if he had wandered through the village.
Anyway, I'm just saddened by the departure from Price and other astute scholars of the 20th century with modern-day abominations like Nora Gedgaudas's Primal Body-Primal Mind. No one who witnessed the change from healthy to sick with the introduction of refined foods had anything but great things to say about agricultural staples like corn, oats, and wheat. They certainly didn't abolish carbohydrates as many Paleos do, which is absolutely laughable. And I can't stand by it, especially after lowering my own fasting and postprandial blood glucose readings by 15%+ over the past month breaking nearly every one of the Paleo rules of Gedgaudas and company.
I'm gonna go off on Gedgaudas in my December ezine. She parades around like a Weston A. Price evangelist while completely turning her back on his work. I just don't want to see anyone round these here parts fall into the same black hole.
Your argument rests on the idea that "healthy people tolerate grains."
First off, "tolerate" is a very low bar, I don't think that's very meaningful.
Secondly, you seem to be heading towards circular logic -- if someone doesn't tolerate grains, then they were unhealthy to begin with? Correct me if I'm misunderstanding you.
If your goal is optimum health, I think there is ample evidence that eliminating grains will help you reach that goal.
Everyone has their own angle on things, and I think the anti-grain bias (which I share) can cause someone to become anti-carb (since so much of our carbs are grain based), and to the casual observer they are easy to confuse anyway.
I don't think you're any kind of authority so I don't care if you "go off" on someone, Gedgaudas or Sisson or whoever. This blog isn't about self-righteous attacks on other writers, it's about thoughtful and continuous learning. I would rather see you demonstrating your authority with quality logic, writing, references, and an ability to concede points to others.
I have just found this paper that has some useful info.
Live probiotic Bifidobacterium lactis bacteria inhibit the toxic effects induced by wheat gliadin in epithelial cell culture
K Lindfors,* T Blomqvist,* K Juuti-Uusitalo,* S Stenman,* J Venäläinen,† M Mäki,* and K Kaukinen‡
Maybe some are just less susceptible because of digestive and dietary factors.
It appears at least in the test tube that gliadins do affect gut permeability.
"The toxicity of gliadin and gliadin peptides as well as the mechanism by which they function can be studied in cell culture. It is known that intestinal epithelial cell lines Caco-2 and T84 respond to gluten/gliadin treatment in a specific manner. When Caco-2 cells are exposed to a peptic-tryptic digest of gliadin (PT-gliadin), there is a significant increase in the permeability of the epithelial layer, measured as increased transepithelial resistance (TER), presumably because of decreased expression of several tight junctional proteins . Furthermore, both cells types react to gliadin treatment by reorganizing their actin cytoskeleton [19,20]. This rearrangement in Caco-2 cells can be detected by large membrane ruffles at the edges of cell islets when grown in medium containing gliadin ."
Seems to me that the grains question would make a very good research topic for your blog. I have stopped eating grains and am very suspicious of them.
There are some that think that grains that are prepared in a healthfull way like soaking, spouting etc. will remove the problems with grains. But just removing some of the antinutrients doesn't address some of the other problems. Some of the problems are, a high GI index,large Omega 6 to Omega 3 ratio, potential to cause autoimune problems, possibility of raising small LDL(wheat) and Acid forming.
If you look it the whole picture, it seems that an excess of grains in one's diet could be very bad indeed.
I'm taking a middle way on grains. Not a lot, and sprouted, soaked, or fermented when I do.
Eating sprouted or sourdough bread is a really different experience for me than regular bread, cereal or pasta. I looked up fermentation's effects on wheat and if the fermentation is long enough it can break down almost all of the gliadin and a lot of the fructose, too, for what it's worth.
One thing I couldn't find any info about was fermentation's effect, if any, on wheat germ agglutinin, another suspected bad guy.
I am curious as to what it is about wheat that is suspected to cause an increase in vLDL. Is it just the carb load it contains, since a carb-heavy diet does the same thing? If so, can this be ameliorated by sticking to whole grains (slowing absorption among other possible factors), or by combining it with other things in one's diet, and simply not overdoing it?
A while ago I looked up wheat germ agglutinin and vLDL on PubMed, and the only information I could find were studies concluding that wheat germ agglutinin and/or wheat bran *lowered* vLDL (while leaving other lipids unaffected). If anyone is interested I'll try to find it again.
For me, I believe I am somewhat gluten intolerant, and went wheat-free for several years. It wasn't a health revolution for me, although it helped some things. I feel healthier now, eating some wheat, but making sure it's real sourdough bread. If it's not, gastric distress quickly ensues, and who knows what else.
Thanks for all the work Stephan.
Just as an aside, I have a friend whose great grandfather just died at 109 in west virginia. Diet consisted mainly of vegetables from his garden in large quantity, grass fed beef, pastured eggs and chicken meat, and wild game he shot. He also ate toast every morning (store bought bread).
Malocclusions are corrected primarily for aesthetic and psychologic reasons. However, in some cases, treatment may increase resistance to caries, to anterior tooth fracture, and, possibly, to periodontal disease or stripping of the gingiva on the palate. Treatment may improve speech and mastication as well.
Thomas E. Skelton, DDS, MS
Post a Comment