Mark and Toni’s 2019 Learning Odyssey 2019. Week 3. Food for Thought – Le Teeth, Dordogne, Le Paradox, Sat Fat, Cavemen, Hunter-Gatherers and all that.

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Le Dordogne, the very name ironically evokes our past, be it hunter-gathering paleolithic’s, early farming neolithic’s, troglodyte medievalists or, of course, the present and we modernists. When you step into this vast area of central France you are wrapped, like a warm cloth, in a rich variety of culture, history, nutirtion, nature and more besides.  We had made the long trip north by car via the Longuedoc and the Lot Valley to Salignac, approximately 5pm from the centre of Perigueux. The countryside was immense, the trees were mainly European Oak and a huge variety of nut trees too, Hazelnut, Walnut and Chestnut, either in orchards or randomly sown. This was probably the first indication of the food culture to come. The Dordogne is also the historic centre of the European hunter gatherer with caves displaying the art of our ancestral past, food, especially animals being centre stage. These are World heritage sites and are a welcome indication of what they hunted for and valued as food.

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The little village of Salignac was a short 30 minute walk from the campsite and we took very little time in our pigeon French to ask the local natives directions. Through the wildwood we traversed and found it in no time. It is really  a Bourg, not a village, something a little bigger. There were the cafe’s of course, the supermarket was on the fringes of the town, kept just out of sight but more in its gentle centre was the Grower’s market Shop, a treasure trove of what the region offers open everyday. The town centre, a small but significant affair was the venue to twice weekly markets, on Saturday morning and Thursday evenings. The later was also a time to commune, abide and take food cooked from the market and sit with the locals, or your neighbours, and eat what you smell and see cooking. A band played and the food and drink flowed.

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We decided not to travel too far, we being unlikely tourists, we did need to feed, and consequently and earnestly we found the right places to shop for food in the local produce market in Sarlat – la – Caneda and the Grower’s Shop in Salignac. They displayed locally grown foods like nuts, nut oils, foie gras, pate, duck and truffles, of course. The additional staples like breads, vegetables and salad were also in seasonal abundance.

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However, cooking ourselves was one thing and a total delight but getting a real food experience led us down the proverbial lane. We went to two places, one a Relais or Inn and a Ferme Auberge, a farm guesthouse come eatery. The later was the pick of the bunch and I’ll come back to that later. A bigger quest lurks in the shadows, and one that has spawned controversy and still does to this day. That being “Fat” and poor health outcomes, especially heart disease and weight gain. In the Dordogne the history surround fat, especially saturated fat is everywhere, but also other kinds of fat too, mono and polyunsaturated fats from locally caught fish and nuts pressed into oils or just plain raw. Saturated fats are an enigma it seems, a paradox even to some. Why are the French supposedly statistically healthier? As are the Swiss? The French go about their lives with a reverence for (quality) saturated fats, its in their blood culturally and physically. There is talk about a paradox, fat making them healthier in combination with wine, especially red, and living longer. This has been said to be similar overall to the UK in terms of mortality with a time line adjustment, reading the statistical data correcting and accounting for a difference in post-mortem reporting. I’m not so sure of that reading the report and references. I still think there is more to it than quantitative measuring, surely the lifestyle of the French, testing their sleep and movement history, stress levels, full dietary habits, community and value systems, especially in the rural areas accounts for some of the mismatch in data.

So what is the skinny on fat?

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Replacing saturated fat with polyunsaturated oils for preventing heart disease has been a source of continued argument and discourse, but current evidence ( RCT’s, systematic reviews, etc) doesn’t clearly support this. However, consumption of fructose sweetened, high fructose corn syrup or sucrose sweetened beverages ( and pure fruit juices ) is more strongly associated with poor heart health and now cancer risk. More research, it always seems, is required, particularly in this case, whole grains (starches) and complex carbohydrates as well as the quality of saturated fats. Added sugar, especially early in life is associated with obesity and diabetes.
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The gut microbiome ( our second brain ) alters too with highly processed fat and sugar diets, as seen in mouse studies, the oral microbiome as we have discovered as well, alters less beneficially too. The consumption of foods rich in Omega 3’s and 6’s, especially in balance (The Paleo Ratio) results in lower heart disease risk compared to saturated fats and sugars, however differences can exist between individuals. Foods like dairy, yoghurt, cheeses are associated with reduced risk but again, more research is required for clarification among specific sat fat and sat fat containing foods.
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A few studies might reveal answers to this historic debate. Cordain et al (2002) reviewed the evidence of hunter-gatherer diets, meat based yet non-atherogenic and found from 13 known quantitative dietary studies that animal food provided the dominant energy source (65%) while gathered plant foods comprised the remaining 35%. The paradoxical nature of this in terms of a modern Western diet associated with increasing risk for cardiovascular disease (CVD) mortality is evident, when not so present in hunter-gatherer communities. Fat energy intake from the diet equated to 28-58% of energy, more than from protein or carbohydrates, is similar to or higher than that found in Western diets.  Hunter-gatherer diets also have higher levels of mono and polyunsaturated fatty acids and a lower omega 6 to 3 ratio. This would serve to reduce the development of CVD. Other factors like foods rich in fibre, antioxidants, vitamins and phytochemicals along with low salt intake may operate synergistically with lifestyle behaviours. No smoking or alcohol, less stress and more exercise further deters heart disease.
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Further to this, Cordain et al (2005) discuss the origins and evolution of the Western diet and its health implications for the 21st Century. They propose that changes in the food and lifestyle environment began with agricultural and animal husbandry approximately 10,000 years ago. The so-called diseases of modern civilisation started with the discordance of our ancient, genetically determined biology with the nutritional, cultural and activity patterns of contemporary Western populations. Crucially 7 nutritional characteristics have changed from ancestral hominin diets; 1. Glycemic load 2. Fatty acid composition 3. Macronutrient compostion 4. Micronutrient density 5. Acid-based balance 6. Sodium-potassium ratio and 7. Fibre content.
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A study undertaken in Switzerland with dental students in 2009 (Baumgartner S, et al) tried to ascertain the impact of the stone age diet on gingival (gum) conditions in the absence of oral hygiene on the oral microbiome. This small-sized study saw 10 subjects living in an environment replicating stone age living for 4 weeks. Baseline assessment included bleeding on probing, gingival and plaque indices and probing depth.  The outcomes demonstrated after 4 weeks decreases in bleeding (34.8% – 12.6%), gingival scoring up from 0.38 to 12.6% (not significant), mean plaque scores increased from 0.68 to 1.47 and probing depths decreasing significantly. Bacterial counts at week 4 were also higher for 24 of 74 species. Overall a positive outcome with less bleeding and probing depths despite plaque growth was observed. The absence of refined sugars demonstrated gum health benefits despite the lack of oral hygiene. However diseased teeth, or decay, maybe not be so straight forward.
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The transition between hunter-gathers and neolithic farmers regarding diseased teeth is contentious, research done with modern Hadza tribes of Tanzania indicates decay is similar to modern societies, especially in women and young boys. Evidence from skulls from several thousands before the neolithic lifestyle changes  in Morocco found decay in half the remaining teeth. Only 3 of the 52 skulls showed no disease at all with evidence at the cave sites showing pine and acorn nuts being processed into a porridge like state. Interestingly, it appears that they ate diets high in plants and not animals.
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Stone age dentistry is in evidence too. Hunter-gatherer teeth found recently in the north of Italy dating over 10,000 years show signs of cavity preparation and filling with bitumen, an ancient tar like substance used primarily for attaching axe heads and spear tips to shafts with a woven material and wood. A pointed stone tool had been used  in this process too. This preceeds the neolithic period and again challenges the perception that hunter-gatherers had less decay.
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The subject of saturated fats verses carbohydrate rich diets poses a dilemma for us all professionally. Evidently quality saturated fat food appears to be better than carbohydrate rich diets in dental health. Refined, processed and ultra processed sugars are implicated in both gum and tooth disease whereas fats in particular don’t elevate oral pH or alter pathologically the oral microbiome, even in the absence of oral hygiene methods. Hunter gatherers suffered from poor dental health regarding their teeth only in certain areas and attempted to heal their ailing teeth with “pre dentistry”. How do I explain this to my clients? The fat, carbohydrate debate needs an inter professional dimension so all concerned sing from one song sheet aloud and inform our clients of the benefits of good quality fat as part of a whole food approach to nutritional health. I, for one, am tired of the broken record  that all carbohydrates are better for you than satiating, tasty, delicious, quality fat.
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Quality carbs need to meet quality fat and protein and the reduction of refined and processed sugars needs to be a matter of international agreement and action. I won’t hold my breath but will celebrate the Dordogne for giving me such filling and tasty morsels of food, I won’t forget how they made me full and feel, for quite some time.

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