An article by Lawrence Strauss on the Red Lady of El Mirón has reminded me of a cartoon in the New Yorker magazine and how little research there is on the “Paleo Diet.”

Dr. Strauss form the University of New Mexico leads the archaeologists who have spent the last 19 years excavating the El Miron cave in northern Spain, once home to a group of people in the Paleolithic Era. These people appear to have been anatomically similar to us, they wore clothes, and probably spoke a language.  In 2010, the remains of a woman were found in a side chamber to the main cave. While just a scattering of bones, this is the only burial site archaeologists have ever found from this period.  From pollen found at the site, archaeologists believe that grave site had been covered with small yellow flowers.  Her body was first painted with a bright red pigment before burial, hence her nickname, the Red Lady, and her grave was marked with a carved tombstone.  Given the time period of her death, some 18,700 years ago, this was an auspicious arrangement. [1]

“You can’t get away from the conclusion that this person, [out of] the hundreds and perhaps thousands of Magdalenians who once existed for several thousand years in Iberia, was given some kind of special treatment,” says Straus. “God only knows why.”[2]

Archaeologists have examined the isotopes in the tooth enamel of the Red Lady and can provide a fairly accurate description of her diet.   Meat from hoofed animals made up 80% of her diet.[3]    Her remaining calories came from fish, mushrooms, seeds and some starchy plant materials, though in relatively small amounts. The Red Lady would appear to have followed what modern nutritionists call the Paleo Diet.

Credit for the idea that a ‘Paleo Diet’ is healthy goes to Walter L Voegtlin  who advocated for a high fat, high protein diet in his book, The Stone Age Diet, published back in 1975. He argued that humans are carnivores and suggested that eating like our Paleolithic ancestors could make us modern humans healthier. Returning to the diet of our forebears, might, according to Voegtlin, reduce incidences of Crohn’s disease, diabetes, obesity and indigestion.  The diet is, as in the case of the Red Lady, mainly meats and fish and plant matter that would have been gathered, including nuts, seeds, vegetables and fruits. Most of our readers are likely familiar with the basic premises and precepts of the Paleo Diet as advocates tend to be somewhat evangelical about it. All grains and processed flours are avoided. Dairy products are off-limits—early man didn’t raise animals for meat or milk. Honey is the only sugar that’s allowed.   Salt intake is limited, meat is supposed to be grass fed, as they more closely resembles the natural diet of roaming animals.[4]

Elizabeth Kolbert writing in the July 24, 2014 issue of The New Yorker summed up the Paleo Diet rather well: “There are, of course, lots of ways to resist progress. People take up knitting or quilting or calligraphy. They bake their own bread or brew their own beer or sew their own clothes using felt they have fashioned out of wet wool and dish soap. But, both in the scale of its ambition and in the scope of its anachronism, paleo eating takes things to a whole new level. Our Stone Age ancestors left behind no menus or cookbooks. To figure out what they ate, we have to dig up their bones and study the wear patterns on their teeth. Or comb through their refuse and analyze their prehistoric poop. And paleo eating is just the tip of the spear, so to speak. There are passionate advocates for paleo fitness, which starts with tossing out your sneakers.”[5]

Whether or not most Paleo peoples actually ate the way modern proponents think they did remains question.  Early human diets likely varied by location and only rare populations would have had access to all the meat and fish they wanted.  Even in the case of the Red Lady, one can’t be certain that her diet was representative of her time, or whether she possessed a degree of social status that afforded her a special diet.  Certainly her burial was unique. It is clear that she didn’t have access to processed ‘paleo-protein bars’ and for sure not in the flavors these are offered in. http://www.julianbakery.com/paleo-protein-bars/

The real controversy though is whether it is a healthy to follow these Paleo guidelines?  Were prehistoric people really any healthier than our modern peers?  So far there is no strong evidence to that effect.

PubMed lists just over half a dozen clinical trials currently related to the Paleo Diet.

The most recent paper, one from this past February 2015 by Frances Bligh et al, reports that following Paleo principles increased satiety after eating but did not change insulin or blood glucose levels. [6,7]

Last October Inge Boers et al reported that following a Paleo diet had favorable effects on people with metabolic syndrome.  In their short two-week experiment, 18 of 32 individuals with some symptoms of metabolic syndrome followed a Paleo Diet.

This was probably the first trial to investigate whether the Paleo diet impacts metabolic syndrome and it appears as if it may help.  Blood pressures decreased, lipid profiles improved and there was a trend (nonsignificant) toward greater insulin sensitivity.  Those following the diet experienced significant weight loss though, and though this would be nothing to complain about for these patients, this effect may have confounded the other results. [8]

Back in January 2014, Rini Bisht et al reported that ten patients with multiple sclerosis who followed a Paleo Diet, took supplements and had physical therapy for a year, experienced less severe fatigue at study’s end. [9]

Tommy Jonsson et al had 13 type 2 diabetics try either a Paleo Diet or a standard diabetic diet for a three-month period and then switch to the other diet for an additional three-month period.  When results were published in July 2013, participants reported they felt greater satiety on the Paleo Diet.[10]

In an earlier 2009 publication, Tommy Jonsson appears to have reported that in the same study of 13 patients that following the Paleo Diet had improved glycemic control and was associated with a 0.4% decrease in A1c readings.[11]

It is not particularly surprising to read that going on a no sugar, almost no carbohydrate diet improves blood sugar control in diabetics.  One just has to imagine what the opposite of a Paleo Diet, that is a high sugar high carbohydrate diet, might do.

What is missing in the scientific literature on the Paleo Diet are data on the impact on morbidity and mortality on general populations that follow this diet.  That is whether or not following this diet reduces disease incidence or increases lifespan.

We certainly have some hints.  We know that high animal protein diets increase levels of insulin-like-growth factor-1 (IGF-1).  Higher levels of IGF-1 in middle age are associated with higher cancer and higher overall mortality. [12]

Though life isn’t this simple.  IGF-1 is one factor.  Insulin is another to consider.  Elevated insulin, as it ‘crosstalks’ with some of the same receptor sites as IGF-1 does, may also play a co-role in contributing to disease.  Thus the Paleo Diet, while it does increase IGF-1 may balance this action out by lowering insulin production. [13]    What the bottom line is remains unclear.  Because no large population of people follows a Paleo Diet, epidemiologic data are unavailable.

What is clear though is that Lawrence Strauss et all report that the Red Lady was only 35 to 40 years old when she died.

Which brings us to the cartoon in The New Yorker:  In it two cavemen are sitting by a fire deep in conversation.  One states, “Something’s just not right—- our air is clean, our water is pure, we all get plenty of exercise, everything we eat is organic and free-range, and yet nobody lives past thirty.”

http://www.condenaststore.com/-sp/Something-s-just-not-right-our-air-is-clean-our-water-is-pure-we-all-ge-Prints_i8545559_.htm

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1. Lawrence Guy Straus Manuel R. González Morales, with the assistance of David Cuenca Solanab, The Magdalenian human burial of El Mirón Cave (Ramales de la Victoria, Cantabria, Spain): introduction, background, discovery and context

Journal of Archaeological Science. Feb 2015.

http://www.sciencedirect.com/science/article/pii/S0305440315000564

2. Penny Sarche t “Red Lady cave burial reveals Stone Age secrets” 18 March 2015  New Scientist: http://www.newscientist.com/article/mg22530134.200-red-lady-cave-burial-reveals-stone-age-secrets.html#.VTPs7mRDv0Y

3. “The Red Lady of El Mirón”. Lower Magdalenian life and death in Oldest Dryas Cantabrian Spain: an overview. Lawrence G. Strausa, Manuel R. González Moralesb, Jose Miguel Carretero, Ana Belen Marín-Arroyo. Journal of Archaeological Science. March 2015. [http://www.sciencedirect.com/science/article/pii/S0305440315000801]

4. http://www.history.com/news/hungry-history/going-paleo-what-prehistoric-man-actually-ate

5. Elizabeth Kolbert: Stone Soup: How the Paleolithic life style got trendy. The New Yorker. July 28, 2014. http://www.newyorker.com/magazine/2014/07/28/stone-soup

6.  Plant-rich mixed meals based on Palaeolithic diet principles have a dramatic impact on incretin, peptide YY and satiety response, but show little effect on glucose and insulin homeostasis: an acute-effects randomised study.

Bligh HF, Godsland IF, Frost G, Hunter KJ, Murray P, MacAulay K, Hyliands D, Talbot DC, Casey J, Mulder TP, Berry MJ.

7.  Br J Nutr. 2015 Feb 28;113(4):574-84. doi: 10.1017/S0007114514004012. Epub 2015 Feb 9.Plant-rich mixed meals based on Palaeolithic diet principles have a dramatic impact on incretin, peptide YY and satiety response, but show little effect on glucose and insulin homeostasis: an acute-effects randomised study. Bligh HF1, Godsland IF2, Frost G3, Hunter KJ1, Murray P1, MacAulay K1, Hyliands D1, Talbot DC1, Casey J1, Mulder TP4, Berry MJ1.

8.  Favourable effects of consuming a Palaeolithic-type diet on characteristics of the metabolic syndrome: a randomized controlled pilot-study.

Boers I, Muskiet FA, Berkelaar E, Schut E, Penders R, Hoenderdos K, Wichers HJ, Jong MC. Lipids Health Dis. 2014 Oct 11;13:160.

9. J Altern Complement Med. 2014 May;20(5):347-55. doi: 10.1089/acm.2013.0188. Epub 2014 Jan 29. A multimodal intervention for patients with secondary progressive multiple sclerosis: feasibility and effect on fatigue.Bisht B1, Darling WG, Grossmann RE, Shivapour ET, Lutgendorf SK, Snetselaar LG, Hall MJ, Zimmerman MB, Wahls TL.

10.   Nutr J. 2013 Jul 29;12:105. doi: 10.1186/1475-2891-12-105.

Subjective satiety and other experiences of a Paleolithic diet compared to a diabetes diet in patients with type 2 diabetes.

Jönsson T1, Granfeldt Y, Lindeberg S, Hallberg AC.

11.  Cardiovasc Diabetol. 2009 Jul 16;8:35. doi: 10.1186/1475-2840-8-35.

Beneficial effects of a Paleolithic diet on cardiovascular risk factors in type 2 diabetes: a randomized cross-over pilot study.

Jönsson T1, Granfeldt Y, Ahrén B, Branell UC, Pålsson G, Hansson A, Söderström M,

12.  Low protein intake is associated with a major reduction in IGF-1, cancer, and overall mortality in the 65 and younger but not older population.

Levine ME, Suarez JA, Brandhorst S, Balasubramanian P, Cheng CW, Madia F, Fontana L, Mirisola MG, Guevara-Aguirre J, Wan J, Passarino G, Kennedy BK, Wei M, Cohen P, Crimmins EM, Longo VD.

Cell Metab. 2014 Mar 4;19(3):407-17

13.  Nutr Metab (Lond). 2011 Jun 24;8:41. doi: 10.1186/1743-7075-8-41.

Over-stimulation of insulin/IGF-1 signaling by western diet may promote diseases of civilization: lessons learnt from laron syndrome.

Melnik BC1, John SM, Schmitz G.

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