I always get excited when I meet a fellow student in the medical world who has an interest in evolutionary and ancestral thinking. It doesn’t happen often, but I’ve twice run into students who, by subtle hints, have let on that they think our current thoughts on health and nutrition are seriously broken. The back-and-forth as we suss out whether we’re on the same team is like an ever-escalating dance. First someone drops the line “nutrient dense food”, then the other says something along the lines of “I don’t think saturated fats are evil”, and before you know it we’re lauding the benefits of egg yolks and liver.
In a culture that tends to focus on treating illness rather than preventing it, and in an environment where we’re frequently so busy trying to fix something that we don’t take the time to step back and wonder why it broke in the first place, it is refreshing to find people who like to think deeply about human evolution and ancestry when talking about health and disease. These people are rare in most clinical settings. When I find others who share these interests I generally wish I’d discovered our common interests earlier- I wish we’d had a secret handshake to tip each other off.
In just over a week I’m heading to Atlanta Georgia for the 2013 Ancestral Health Symposium. There, no secret handshake will be needed to ID those who are interested in evolutionary and ancestral health, as interest in this subject is a prerequisite for attending the symposium. I’m excited to catch up with old friends, meet new ones, and also to speak at this year’s symposium.
I’ve written before about alcoholic fatty liver disease (the subject of my PhD research), and I’m looking forward to talking about the role of dietary fats in fatty liver disease at this year’s symposium (though the time slot is shared with some other interesting talks, so I’m not sure I’ll garner much of an audience). I’m also hosting a panel of ancestrally minded physicians who will be talking about the successes and challenges of using evolutionary and ancestral thinking in their own clinical practice. They’ll be taking questions from the audience, so if you’re in attendance come prepared- it should be fun!
If you’ll be at the symposium, please say hello!
A good morning of Wilderness Medicine out in Canyonlands National Park,
Here’s the short abstract for my presentation:
Fatty liver disease is a growing epidemic in the developed world, with some estimating that over 40% of the US population have some amount of disease. The general recommendations for those with fatty liver disease include avoiding saturated fats, though research does not support this recommendation. In fact, saturated fats have been shown to be protective against fatty liver disease with some even having a therapeutic effect. Conversely, consumption of large amounts of polyunsaturated fats that have only recently become abundant in western diets plays a key role in disease development.
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Sorry for the slow rate of posts these days. I’m reaching the end of my final year or medical school (I actually graduate in December), and while fourth year clerkships aren’t nearly as arduous as those undertaken as a third year medical student, all the other loose ends of medical school are piling up on me at the moment. I take the Clinical Skills portion of the boards next week, the Clinical Knowledge portion of the boards at the beginning of September, and I have to get my residency applications ready to go in the near future (which, of course, includes figuring out WHERE I want to submit applications to!). Of course I also have a presentation to prepare and a trip to Atlanta to plan! I have a long list of things I want to write about, but at the moment other things are taking precedence. Thank you for your patience!
principleintopractice 
I wish I could be there, but have a family event the same weekend as the conference. Have a great presentation!
Beth, I really enjoyed meeting you last year. Sorry we won’t meet again this year!
Here are two more SFA vs fatty liver papers to help with your presentation!
The first is Sam French’s summary of his views on fats and ALD, a review/opinion piece written in response to one of Amin A. Nanji’s papers in 1995. I was mighty pleased to find this!
Click to access PII0016508595903542.pdf
The second is an animal trial – will a high-fat diet cause fatty liver in the hapless Wistar rat if the fats are saturated (butter or coconut oil)? No it won’t – but what happens around energy intake and output to the coconut oil rats is fascinating.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1805500/
Thank you! That second one is great- surprised I haven’t stumbled upon it before! I’ve been trying to catch up on some of the newer research that has come out since I defended my thesis and stepped away from the lab (and the primary papers). I knew about this one: http://www.ncbi.nlm.nih.gov/pubmed/23576797 which I was incredibly pleased to see when it was first published. Totally an “I told you so” moment when you see that MCTs have the same ameliorating effects for NAFLD as for AFLD.
I’ve thoroughly enjoyed a lot of the Nanji and French papers in the past- lots of good liver and lipid research from the pair of them! I hadn’t spotted the one you posted- thanks for sharing!
Yes, we’re definitely seeing a convergence between NAFLD and ALD. And also Hep C, such as it is. One thing paleo might not like so much is, that there is a role for dietary cholesterol in NASH. Not, mind you, serum cholesterol.
If you consider butyrate as SFA, then butyrate can join the list.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3656030/
And probiotics, and prebiotics, and choline, also, taurine ameliorates NASH – that might be by buffering the cholesterol.
So if we choose only those cholesterol-rich foods that are rich in choline, butyrate, taurine – i.e., not processed meats and cheeses – we might be OK.
There’s not much dietary research in this area (at least not that I’m aware of), but the research that looks at cell-signaling changes with fatty liver associated with protein-malnutrition suggests (to me) that there’s convergence there as well. It’s obviously a complex issue (involving cell signaling changes, changes in metabolism, inflammation, and issues that start in the gut), but there’s many similar themes that run through the various etiologies of fatty liver.
The probiotic stuff is interesting, and when you consider the small intestine bacterial overgrowth that can occur with alcohol consumption in combination with the gut-permeability issues that seem to arise with excess PUFA consumption it start to make sense that getting the right gut bacteria (or perhaps, just getting rid of the wrong ones), can seriously turn down the inflammatory picture.
As I’ve said- it’s not simple, but there’s a lot of research out there which can definitely help us put together a better understanding of whats going on.
There are more and more papers about SIBO involvement in ALD, NASH, hepatitis C coming out.
One simple scheme might go – fatty liver deranges cholesterol homeostasis, intrahepatic cholesterol accumulation sensitizes liver immune cells to LPS via TLR4, inflammation snowballs if SIBO, IBS etc are co-morbidities.
Grateful Dead keyboard player “Pigpen” McKernan died of cirrhosis at 27. Alcohol was a factor, but, so young? Pigpen suffered from colitis and a brother had Crohns according to wikipedia (which disputes the role alcohol and cirrhosis played in his death, but Pigpen’s declining liver function was well-known before he died, and the official cause of death, gastrointestinal hemorrhage, is consistent with cirrhosis).
Just introduce another factor – Vitamin D. Vitamin D receptors are a factor in gut permeability, and low vitamin D status is implicated in Hep C fibrosis and NASH.
e.g. “NASH progression is associated with VD depletion and elevated VDR expression in the liver. VD-treatment represses VDR and profibrotic/proinflammatory cytokine expression in HSC in vitro, which suggests a possible anti-fibrogenic therapy option for individuals with advanced NASH.” http://trs.scivee.tv/node/4155
Role of innate immunity and the microbiota in liver fibrosis: crosstalk between the liver and gut
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3379693/
OMG!
http://www.ncbi.nlm.nih.gov/pubmed/18093684
MCTS plus corn oil – worse than corn oil alone!
This is island diet today; fish packed in in soy oil plus coconut cream.
“Heavier reliance on animal protein and incorporation of Western foods in the diet-specifically, tinned fish and instant noodles-was significantly associated with increased obesity risk”
http://www.ncbi.nlm.nih.gov/pubmed/23505203
Gun, smoke…