Paleo Diet Q & A - Lichen Sclerosis, Stevia

Lichen Sclerosis

Q: Hi there - I have been following a Paleo Diet for a few weeks now and there is no doubt that I feel much better for it. I did not need to lose weight and I always regarded myself as pretty fit and healthy. However, a little while back I developed a troublesome skin condition called Lichen Sclerosis. Have you ever been asked about this condition and suggested dietary changes? I think part of the problem is that the etiology is not fully understood but many doctors seem to think it has an autoimmune component though I have read recent research that suggests oxidative damage plays a part and that antioxidant therapy may be useful in treatment. This condition is supposedly incurable (though manageable with potent steroids) but I'm sure it would give a great many people some comfort if simple dietary changes could help. Would be really great to hear your thoughts.

Simon

A: Dear Simon,

The available evidence indicates that an autoimmune component likely occurs with Lichen Sclerosis (LS). With all autoimmune diseases, an autoantigen (self protein) exists and represents the target protein being attacked by the immune system. About 75 % of LS patients maintain an IgG autoantibody to Extra Cellular Matrix Protein 1 (ECM1)¹. Acceleration of ECM1 deposition in dermal (skin) blood vessels may underlie the disease symptoms ^{2, 3}. So the question now arises, what causes an accelerated deposition of ECMI in dermal blood vessels in LS patients? The available evidence indicates that increased concentrations of a ubiquitous enzyme in the body called tissue transglutaminase (TG2) is primarily responsible for excessive ECM1 accumulation³. In medical terms, an increase in a concentration of a substance in the bloodstream by another substance is called "upregulation".

So, in LS patients, an upregulation of TG2 causes an upregulation and increased deposition of ECMI in the skin blood vessels in the affected area of the body. The next question to be posed is, what event or events trigger an upregulation of TG2? When we answer this question, then dietary recommendations advocated by the Paleo Diet will make sense. A storage protein called gliadin which is fournd in wheat, rye, barley and oats is known to upregulate TG2 ^4-7. Hence grain free diets may prove to be therapeutic for LS patients, although no current randomized controlled trials of this intervention strategy have yet been conducted.

Cordially,
Loren Cordain, Ph.D., Professor

References:

1. Chan I, Oyama N, Neill SM, Wojnarowska F, Black MM, McGrath JA. Characterization of IgG autoantibodies to extracellular matrix protein 1 in lichen sclerosus. Clin Exp Dermatol. 2004 Sep;29(5):499-504.
2. Kowalewski C, Kozłowska A, Chan I, Górska M, Woźniak K, Jabłońska S, McGrath JA.Three-dimensional imaging reveals major changes in skin microvasculature in lipoid proteinosis and lichen sclerosus. J Dermatol Sci. 2005 Jun;38(3):215-24. Epub 2005 Mar 3.
3. Fisher M, Jones RA, Huang L, Haylor JL, El Nahas M, Griffin M, Johnson TS. Modulation of tissue transglutaminase in tubular epithelial cells alters extracellular matrix levels: a potential mechanism of tissue scarring. Matrix Biol. 2009 Jan;28(1):20-31. Epub 2008 Nov 5.
4. Michaelsson, G., Ahs, S., Hammarstrom, I., Lundin, I. P., & Hagforsen, E. Gluten-free diet in psoriasis patients with antibodies to gliadin results in decreased expression of tissue transglutaminase and fewer ki67+ cells in the dermis. Acta Dermato-Venereologica, 2003; 83(6):425-429.
5. Biagi F, Campanella J, Laforenza U, Gastaldi G, Tritto S, Grazioli M, Villanacci V, Corazza GR. Transglutaminase 2 in the enterocytes is celiac specific and gluten dependent. Dig Liver Dis. 2006 Sep;38(9):652-8.
6. Gorgun J, Portyanko A, Marakhouski Y, Cherstvoy E. Tissue transglutaminase expression in celiac mucosa: an immunohistochemical study. Virchows Arch. 2009 Oct;455(4):363-73.
7. Villanacci V, Not T, Sblattero D, Gaiotto T, Chirdo F, Galletti A, Bassotti G. Mucosal tissue transglutaminase expression in celiac disease. J Cell Mol Med. 2009 Feb;13(2):334-40.

---

Stevia

Q: Is Stevia Paleo? I have attempted to find an answer for this and the information I've found is conflicting at best. Please advise!!
Jeff

A: Dear Jeff,

There's some scientific evidence to support the notion that Stevia is safe, even in type 2 diabetes patients^{1, 2}. Furthermore, it has been demonstrated to have antihypertensive properties, as shown by Chan et al.³ and a long-term study⁴. Having said this, I am not aware of any study examining the potential antinutrient (lectins or saponins) content of the plant, hence we do not know the possible adverse effect of consuming this plant on a daily basis. Hunterh-gatherers used to consume a wide range of plants, thereby minimizing the amount of a single bioactive compound ingested and its toxicity. It is known that rotating the kind of plants is a good strategy in order to decrease food allergy and intolerance.

From an evolutionary standpoint we should look at nutrition as "whole food" rather than nutrients per se. The bottom line is that Stevia seems to be safe, but we need more research to rule out possible side effects.

I hope this is helpful,
Maelán

References

1. Gregersen S, Jeppesen PB, Holst JJ, Hermansen K. Antihyperglycemic effects of stevioside in type 2 diabetic subjects. Metabolism. 2004 Jan;53(1):73-6.
2. Barriocanal LA, Palacios M, Benitez G, Benitez S, Jimenez JT, Jimenez N, Rojas V. Apparent lack of pharmacological effect of steviol glycosides used as sweeteners in humans. A pilot study of repeated exposures in some normotensive and hypotensive individuals and in Type 1 and Type 2 diabetics. Regul Toxicol Pharmacol. 2008 Jun;51(1):37-41. Epub 2008 Mar 5.
3. Chan P, Tomlinson B, Chen YJ, Liu JC, Hsieh MH, Cheng JT. A double-blind placebo-controlled study of the effectiveness and tolerability of oral stevioside in human hypertension. Br J Clin Pharmacol. 2000 Sep;50(3):215-20.
4. Hsieh MH, Chan P, Sue YM, Liu JC, Liang TH, Huang TY, Tomlinson B, Chow MS, Kao PF, Chen YJ. Clin Ther. 2003 Nov;25(11):2797-808. Efficacy and tolerability of oral stevioside in patients with mild essential hypertension: a two-year, randomized, placebo-controlled study.

Answers to Questions Posted by Blog Readers - 11.23.09

Dear Readers,

Thank you for your comments and questions! Our team is working to review your Paleo Diet-related questions and provide you with answers. We read all comments, and we are very interested in hearing your thoughts, learning about your experiences, and understanding what questions you have.

The Paleo Diet Team

---

Blog Q: Ok, so I am just starting the diet and have just a few questions. I know processed grain/rice is a no but what about wild rice? I'm from Minnesota and my dad and I harvest our own rice from wild patches that grow in lakes. The rice is just then shaken and boiled and not processed so would this be an acceptable food?

Second question: my friend is the one who started me on this diet and she said that the only cheese that is OK is goat cheese. I know goat cheese is still dairy so I just wanted to confirm that it's a no-go and also if there are any cheese or cheese like substitutes.

A: Virtually all grains contain harmful substances namely lectins, alkylresorcinols, alpha-amylase inhibitors and protease inhibitors, independent of whether or not they are refined or whole grains. However, we believe that rice is probably the less harmful grain and wheat, barley, rye and maize the worst ones.

Regarding your second question, goat cheese is still a dairy product. Cow milk proteins are well studied and have been consistently demonstrated to be harmful to humans, but there's not enough literature to scientifically demonstrate that dairy products derived from goats have the same deleterious health effects. We think that because goat milk contain proteins from a different species it may have immunity stimulating proteins, and may therefore increase the risk of allergies or autoimmune diseases.

---

Blog Q: I have been doing the paleo diet for a few months now, prior to this I followed
the Zone diet for 12 years. I have a mild autoimmune condition (lupus) ANA positive 1:64 speckled pattern. I used to get swollen knees, and a sore neck, but not any more using paleo foods combined with zone balance and added Omega 3 and vitamin D.

Other problems that are completely resolved are PMS (breast pain, but no more now), Severe menstrual pain (virtually none now with paleo, exercise and omega 3), Constipation (none now with paleo).

A couple of months ago I had blood tests and found a few problems. Thyroid: TSH slightly high 5.1, T4 okay. Also borderline low B12 and folic acid. Both of which I get plenty of in food and a supplement. I also have Raynauds (not very severe though).

Dr thinks they are all related to the auto immune problems. I would like to resolve the B12 and thyroid problem. I was using a little soy milk, but I've cut that out 6 weeks ago. I've started
taking iodine tabs (Kelp) and had to have a vitamin B12 injection. I would like to know what factors might be causing me not to absorb B12 and folic acid. Also how can I improve thyroid function.

No other health problems, I'm at my ideal weight, do CrossFit for exercise. I'm 50.

Julianne

A: Your thyroid problems might be caused by an autoimmune reaction. Many Celiac Disease patients also suffer from Autoimmune Thyroid Disease and the former disease is triggered by grains containing gluten such as wheat, rye and barley. Hence, avoiding foods containing gluten may decrease the risk of an autoimmune reaction against your thyroid gland.

Legumes, cereal grains, eggs, tomatoes, potatoes, chili peppers, quinoa, amaranth, and root beer are foods containing lectins and saponins. Lectins and saponins, along with gluten, increase intestinal permeability, allowing the increased passage of bacterial, viral or food antigens into peripheral circulation. Some of these antigens may have molecular similarity (molecular mimicry) with certain self antigens, like thyroglobulin, and therefore can trigger an autoimmune reaction of T-Lymphocytes against our own tissues.

Iodine supplementation is a good intervention since it is needed for T3 production. Selenium supplements can also help because it is needed for T3 (the active form of thyroxin) production. Selenium deficiency is common because the soil where vegetables are grown nowadays are empty of selenium.

Regarding B12, a substance known as Intrinsic Factor is needed in order to absorb B12. Intrinsic Factor is produced in a healthy GIT, hence a Paleo Diet devoid of saponins, lectins and gluten can improve the production of Intrinsic Factor and therefore B12 absorption.

---

Blog Q: What is Dr. Cordain’s current recommendation regarding supplements? His books indicate supplementing certain vitamins (E, D, C, etc.) along with Selenium but I’m concerned that advice might be outdated. Recent literature (my apologies for not referencing them) along with some mainstream Dr’s--such as Dr. Dean Adel--indicate recent studies suggest supplements may be dangerous and to remove them all from your diet. Any comments or recent recommendations?

Similar Blog Q: In regards to the question on seafood, doesn't the recommendation to take supplements conflict with a recent newsletter that said vitamins aren't necessary? And that the human body wasn't meant to receive vitamins/antioxidants in pure form?

A: Dr. Cordain's current recommendations regarding supplements are based on the fact that our genome evolved in a diet rich in vitamins, mineral and phytochemicals compared to the typical western diet. In his scientific paper titled "The Nutritional Characteristics of a Contemporary Diet Based Upon Paleolithic Food Groups" he demonstrates that by eating a diet similar to what our ancestors did during 2.6 million years ago the amount of vitamins and minerals is much higher when compared to a typical western diet. This means that our "machinery", shaped by our ancient genome, needs high amount of vitamins, minerals and several other substances--not the ones recommended by current nutritional boards based on observations made in western populations. Hence, if you eat a Paleolithic diet you won't need to take supplements except for vitamin D, which is produced by the action of the sun in our skin. So, unless you have adequate exposure to sunlight (depending on season, latitude, skin color, etc.) you'll probably need to take vitamin D supplements.

In summary, if you've been eating a typical western diet, you are probably deficient in almost all vitamins and minerals, and will need to supplement them at least during a few months and cut them if you eat a Paleolithic diet most of the time. The ideal vitamins should be in their pure form.

---

Blog Q: In the newsletter v5 #24, you recommend breastfeeding until at least 1-1.5 years.

Is there a chance that auto-antibodies can be passed on to the child through mothers milk so that the child has greater risk in developing autoimmune disease? If that is the case, is it better to stop breastfeeding and start giving solid paleo food earlier?

Do you know if auto-antibodies pass on to the child during pregnancy?

Sincerely, Ohana

A: Dear Ohana,

Mother's milk provides the breast-fed baby with what is called passive immunity, this means that the mothers antibodies pass through to the infant in order to protect it against infections. Hence, the infant is protected against the same bacteria or virus as the mother is. However, our team is not aware of any research demonstrating that this mechanism increases the risk of autoimmune diseases. What has been shown is that food peptides from the mother's gut can pass on to the breast milk and therefore to the breast-fed baby. This might increase the risk of autoimmune or allergy diseases.

The bottom line is to eat as Paleo as possible in order to not increase the risk of these possible mechanisms of disease.

Regarding your last question, yes, auto-antibodies pass on to the child during pregnancy.

Paleo Diet Q & A - 11.18.09

Dear Readers,

Here's today's edition of Q & A from the Paleo Diet community. Thanks to those of you who've left questions and comments in reply to these posts. Our team is currently reviewing all outstanding questions and will have answers to post soon.

---

Q: My question is regarding the consumption of milk. There are a great number of coaches around the country who advocate at least moderate, if not generous, amounts of milk in their athletes' diets. Does it not provide a good source of protein and carbohydrate balance, not to mention the calcium content? What is the paleo stance on milk and why?

A: There are several reasons why not to consume dairy products:

Hominids evolved during 2.6 million years behaving as hunter-gatherers.

Although there wasn’t a single diet, and diet rather varied by latitude, season, climate, culture, etc., all ancestral diets shared key characteristics. Food sources were limited to unprocessed foraged plants, and unprocessed land and marine animals hunted from the proximate environment. As such, human diets consisted of combinations of wild animal carcasses (including brains, bone marrow, and organs), shellfish, fish, fruits, leafy vegetables, mushrooms, insects, larvae, nuts, seasonal honey, and eggs.

Ten thousand years ago, major changes in the environment happened, including the human diet. New foods, such as cereal grains, legumes, dairy, vegetable oils, refined sugars, fatty domesticated meats and salt, were introduced.

Since that time, there is strong evidence that our genome has remained essentially unchanged over the past 10,000 years. Evolutionary medicine predicts that these environmental changes may have caused adverse effects.

Indeed, it is believed that this mismatch between our ancient genome and the modern environment (including our modern diet) is at the root of the so-called diseases of western civilization, such as type 2 diabetes, obesity, dislipidemia, hypertension, certain types of cancer, acne, autoimmune diseases, myopia, polycystic ovary syndrome and more.

Regarding dairy, we know that this food group was not available for human intake prior to the onset of animal husbandry--roughly 9,000 years ago in the Middle East, and 7,000 years ago in Northern Europe. So dairy is a relatively new food on an evolutionary time scale, which explains why it may produce the following adverse effects, through different mechanisms:

• Milk is a source of estrogens and dihydrotestosterone precursors, which can increase the risk of certain cancers and acne.
• Milk increases IGF-1, and the IGF-1/IGFBP-3 ratio, and this increases the risk of certain cancers and acne--among other diseases--as explained by Dr. Cordain in his 2003 paper “Hyperinsulinemic diseases of civilization: more than just syndrome X” (http://www.thepaleodiet.com/articles/Hyperinsulinemic%20Diseases%20Final.pdf)
• Milk contains insulin, and bovine insulin differs in only 3 amino acids from human insulin. This feature can increase the risk of Type 1 diabetes in genetically susceptible persons.
• Betacellulin: is a hormone belonging to the EGF family of hormones. If it is confirmed that Betacellulin is able to enter circulation, then there is a very good possibility that it may increase the susceptibility of certain epithelial cancers.
• Milk elevates insulin as much as white bread. Constantly elevating plasma insulin levels may lead to insulin resistance, which is at the root of several metabolic diseases such as obesity, type 2 diabetes or hypertension.
• High calcium intake adversely affects zinc absorption, a key mineral in more than 300 enzymatic reactions.
• Milk contains several allergenic proteins.
• Dairy products, especially hard cheeses, yield a very high net acidic load which might lead to calcium and muscle loss and decrease growth hormone.

In sports nutrition BCAA intake is crucial for muscle recovery. Lean meat is the biggest sources of BCAA (33 grs/1000Kcal). Dairy contains much less BCAA (12 grs/1000Kcal), so if you replace lean meats with dairy you are taking much less BCAA which is crucial in muscle recovery.

---

Q: I was diagnosed with ulcerative colitis about 3 years ago. It started off as a very mild case but recently progressed to the point where my doctor was discussing having my colon removed if a new medication (Remicade) did not work. Being on Remicade has helped, and I was able to put 20 pounds back on. However, I do not believe in medication alone. I believe that diet is a key component to living a healthy life. I follow the Paleo Diet which has helped tremendously. I know that there are certain foods like night shade vegetables, which are part of the Paleo Diet, that I should avoid. Is there any other foods on the Paleo Diet that I should eliminate?

A: Yes, autoimmune patients should make some changes regarding The Paleo Diet:

• Nightshade (potatoes, eggplants, peppers and tomatoes) should be removed from your diet as they contain harmful lectins and saponins.
• Egg white is a source of a membranolytic (breaks cell membranes) protein--namely Lisozyme--and therefore should also be removed from your diet.
• Remember that soy beans derived products, as well as peanuts, are legumes. They should be removed from your diet.
• Another harmful nutrients are quinoa, amaranth and root beer.

You can find more info in our "How to Treat MS with Diet" program, which is available from our website: http://www.thepaleodiet.com/store.shtml.