Archive for the ‘PhDs’ Category

Dr.

Thursday, July 10th, 2008

Audio Interview

Part 1

Part 2

Part 3

Part 4

Dan
Hi Dr. Cordain this is Dan.

Dr. Cordain
Hi

Dan
Hi there. Thanks for talking to me again, I’ve been looking forward to it.

Dr. Cordain
No problem.

Dan
Thank you so much for your ongoing research into the diet and acne connection. I just can’t wait until we figure out a way to help most people through some sort of holistic method, whether that be diet or supplementation or what have you.

Dr. Cordain
Well I think you’re right Dan. I’ve spoken to many people in the dermatology community around the United States and all over the world and I think it’s high time we get to the bottom of what causes acne and the notion that we’ve stonewalled diet for 30 years on no good rationale or logic or even scientific studies is I think very much recognized now and there is an emerging group of scientists and dermatologists who now believe that diet is not only just a minor part of acne but it is the major underlying environmental factor.

Dan
It makes a lot of common sense, so I’m curious to see what comes out. Could you describe the Paleo Diet, if you had to distill it down into a 30-second bit? How would you describe the Paleo Diet?

Dr. Cordain
It’s real easy. It’s unlimited lean meats, seafood, fish, as much fruits and vegetables as you want to eat. That’s the diet in a nutshell, what you don’t want to eat is processed foods, refined sugars, salts, cereal grains or dairy products.

Dan
Great. So before I launch into my other questions I think it’s important that I present my bias at the top of my interviews.

Dr. Cordain
Absolutely.

Dan
My bias is that I actually tried the Paleo Diet as strictly as I possibly could. I was totally committed. I tried it for about two and a half months, six months to a year ago. I was extremely strict, except I did eat nuts on a daily basis. I had vinegar on my salads almost daily after about a month or so. I started cheating and had vinegar in my salads and I did not always slow-cook everything. I think I may have gone off of it just slightly here and there inadvertently, say if I ate out to a restaurant, I’d get steak and some vegetables and I don’t know if when they cook a steak they put a little sugar in there, I’m not positive. I was as strict as I could possibly be and what happened with me was I felt amazing. I’ve literally never felt better in my life. My energy was even, my emotional state was great, nice and even as well, and I was able to get off my Regimen, my topical anti-acne Regimen, for the first two months or so. I was very excited. I was convinced diet and acne were related and I was ready to tell everyone about it. Then I was posting my success online and there was a user on my message boards who kept saying to me, “The reason that your skin is clear is because you’re losing weight and taking in less calories. You’re going to see that as your weight levels out your skin will go back to how it was.” I didn’t believe him but he was very persistent, and sure enough after about two months–that was the point I stopped losing weight on the diet–my skin started going back to having minor problems. Then there was a period of about a week, week and a half, before Christmas where I just started eating more. I’m not sure why, I think I was just hungrier. And my skin was awful. I had a cyst on my chin, I had probably five or six other pretty bad comedomes on my face. It was the worst my face has been since I can remember, for at least a decade. So I immediately went back on the Regimen at that point. Can you explain why that may have happened to me?

Dr. Cordain
Well you know Dan, we’re at the very beginning of understanding how diet causes acne. We just completed the first clinical trial. There are two epidemiologic studies that were completed by the Harvard Group. As is the case with anything in science that is new, we don’t completely understand the underlying mechanisms and I would be not completely forthright if I did not say that to you. But we have mechanisms that we suspect, and I think you’re absolutely right, when you lose weight and you reduce your calories it immediately improves insulin sensitivity no matter what you’re eating. We believe one of the primary mechanisms that underlie the development of acne is insulin resistance. Why do I say that? I say that because adolescence is a time when virtually all people in the Western World experience some type of acne. Adolescence is a period of natural insulin resistance because insulin resistance is a physiologic state that allows for rapid growth. This is why adolescents become insulin resistant during those growth years, is that it facilitates growth. We believe that tacked on to the typical Western diet, which is a high glycemic low diet, which also exacerbates insulin resistance is one of the major underlying factors and with Neil Mann’s study, he was able to show that insulin resistance is linked to acne. Now, how does insulin resistance in and of itself can cause acne without lying those mechanisms. In a series of scientific papers that I’ve written, we believe that insulin is a master hormone and it causes a cascade of other hormones, which ultimately affect the pilosebaceous unit. The unit that actually causes it, a comedome or zit. I can go into more detail but for your listeners I don’t know if that kind of detail really matters.

Dan
I’m going to link to your website and they’ll be able to find your book and learn about all that stuff. It’s incredibly interesting stuff. I’m hoping to keep this as much as real plain English as possible.

Dr. Cordain
So that’s pretty much what we think is going on. That’s the mechanism. The Harvard Group has identified milk drinking as a liability factor and a number of dermatologists on the East Coast actually do that with teenage acne patients, they just have them stop drinking milk, and a good percentage have complete remission of symptoms or improvement. I have been in contact with Dr. Bill Danby and his group and Balory Traylor, they’re both MD dermatologists and use diet to affect it. They’re also publishing literature and got their own books out on it. We think milk drinking is also involved with acne besides the high glycemic load diet, and we think there are a number of factors in which milk may promote or exacerbate acne symptoms. In addition to getting rid of processed foods, sugary and so forth, we think that milk drinking and dairy products are not a good thing, for a number of reasons. As scientists we speculate what the mechanisms are but it will probably be a decade or more before we find out exactly what’s going on. What we’ve done now is we’ve really raised the bar and we’ve raised the eyebrow of the traditional dermatology community who forever and a decade stonewalled the idea that diet and acne were related. Now we have the first clinical trials showing that indeed a low glycemic load diet improves symptoms. So you’re actually right. There’s an interaction with calories that will take a while for us to figure out with more clinical trials.

Dan
You refer to that one clinical trial. That was one of my questions. How much clinical evidence do we have to back up the diet and acne connection and how conclusive is the evidence at this point?

Dr. Cordain
We have single study that came out of Neil Mann’s laboratory from the Royal Melbourne Institute of Technology. The design of the study was impeccable from the scientific perspective, but it’s a single study and science moves slowly, and one study does not change a discipline, so we need what are called replicate studies and these are in the offing right now. I know a number of groups around the world are in the process of, or have trials currently being conducted. I think that once we have a single trial, like with Neil’s study, then it’s going to promote interest in it. The way to do these studies is with government funding through NIH, National Institute of Health, through the various boards, and we have to get scientists that are interested and then get funding to do the study, because these studies are expensive where we involve humans. And science moves slowly. The Mann Study took two years to complete and another year and a half to two years to get into the scientific literature. So this is why I say it would be probably a decade or decades before the dogma is completely reversed.

Dan
Now you referred to the Harvard Group and a milk connection. Is that a study that the Harvard Group did?

Dr. Cordain
Yes. They published two papers on it and these are what is referred to as epidemiologic papers. The Mann Study was a controlled randomized clinical trial, in which we actually altered the diet of people and used the number of zits or comedomes as the outcome variable. With the Harvard School of Public Health they published their two studies in the epidemiologic literature, and what that is is they look at a large, large groups of people. The Nurses Health Study involves 80,000 women and they look at an association between diet and disease. And what they found, and there are different ways of looking at this, one was looking at a ‘retrospective cohort’, meaning that you look at people backwards in time and then they did a more powerful study called a ‘prospective cohort’, meaning that they follow people over time and they monitor their diet. And in both of these studies what they found was that milk drinking was associated with the development of acne.

Dan
One followup question on the milk studies. In your professional opinion, do you think we’re referring to milk here or any dairy product?

Dr. Cordain
I suspect it’s any dairy product and I suspect there may be degrees of how bad one dairy product affects things. We don’t know what element in milk is causing the association between milk drinking and acne. I was at a conference at Harvard where we talked about this last October. There’s a couple of lines of thought. The first is that there are hormones in milk that actually get past the gut in tact and enter human circulation. This, to my way of thinking, is somewhat unlikely in that most of the gut hormones are broken down by enzymes in the gut. Secondly, these large protein molecules cannot get past the gut barrier. However, there is one exception to this. It’s a hormone in milk called betacellulin. And betacellulin survives the gut enzymes and it also can get into circulation because there is a hormonal receptor in the gut which specifically binds this hormone and draws it into the body. So we believe that there is at least one cow hormone called betacellulin that can get into the circulation. Betacellulin, once it gets into the circulation, can bind other hormonal receptors in the pilosebaceous unit and the function of this hormone is to cause growth. And one of the problems with acne is that there is excessive growth of the cells lining the pilosebaceous unit. So we think that the betacellulin milk may be one of the factors. The other factor that we believe that may be responsible of why milk drinking is associated with acne is that milk paradoxically has a low glycemic index but has a high insulin index, meaning that it doesn’t spike your blood sugar but it makes your blood insulin levels go up. We believe that when blood insulin levels go up it causes this cascade of hormonal effects. It elevates IGF-1 and depresses another hormone called IGF-binding protein-3. And we believe that these hormonal changes cause an increase in the secretion of androgens, male hormones that both women and men secrete, that increase sebum secretion in pilocaebacious unit, which also underlies acne. There’s a variety of factors in milk that scientists suspect may underlie the association of milk drinking in acne. This is why chocolate, forever and a day, has been implicated in acne. When we think about milk chocolate candy, it’s made out of milk solids which contain the same hormones. It’s also made out of sugar which has a high glycemic load. So we believe this is why chocolate may be particularly effective at eliciting acne symptoms.

Dan
Interesting. Getting back to the Paleo Diet again for a moment if we can, I know that a lot of the listeners to this will probably want to try the diet. I noticed that it was incredibly hard for me to stick to the diet, and I was totally committed. You were nice enough to donate about 20-25 of your e-books, and I had a bunch of people on my website try the diet as well. No one really came close to following it as strictly as I did. Do you think it’s really possible for people in the 21st century to follow a caveman-type diet?

Dr. Cordain
Well this is actually how we came to the conclusion that diet and acne were related is that our first study that we published in 2002 were the result of almost a decade worth of research. We went down into very primitive places in the world where the Western culture is absent. We went to an island off the coast of Papua New Guinea called Kitaba and we studied about 3000 people there including almost 300 teenagers and in that entire group of 300 teenagers, we didn’t find a single case of acne, whereas the prevalence of acne in Western teenagers approaches 85-90%. So that kind of tipped us off that it probably is environmental and logically diet in nature. We did another study in which we went down to the jungles of Paraguay and we followed around a group of hunter/gatherers for a two year period, and this was a different approach. This was a longitudinal approach instead of just looking at them in a cross-section. We followed them over a two year period and once again we didn’t find any acne in the entire population. And even though these were two different ends of the world, there were universal characteristics of their diet that kind of stood out for us. One was that they were fairly high in protein and they had virtually no processed foods, and they had a low glycemic load. They obviously didn’t have any dairy products and they didn’t eat any grains either. So, those are the characteristics of the diet that we thought would be helpful and with the Mann study they actually just looked at two elements, the protein and the glycemic load. So to answer your question we’ve kinda been spoiled, the horse is out of the bag. We’ve grown up in the Western world with hamburgers and french fries and pizza and Coke and white bread and donuts and you name it and everything that most of us eat on a daily basis. And you’re absolutely right, I think that it is difficult for people, particularly adolescents and young people to follow this type of a diet. But people that are sick people, the original Paleo Diet wasn’t designed for acne patients, it was designed for people that have serious health problems, cardiovascular disease, type 2 diabetes, morbid obesity, and what we found was that when people are with their back to the wall and the alternative is death or serious illness, following this diet becomes second nature. I think that there is a lead in period that takes people probably six months or longer to be able to do it and during that period they kind of have ups and downs and in both our books we describe the little tricks or methods used to help do this. For some people, going cold turkey works, for others they need to go back and forth. My feeling is that you can get substantial health effects when you’re 85 percent compliant. We also believe that there are different genetic factors that may underlie acne. Your case is one of them, maybe you have a strong genetic susceptibility for these diseases of insulin resistance. We just don’t know. I haven’t seen your blood work up. Other people report dramatic effects when they’re roughly 80-90% compliant.

Dan
Can I ask about that? I had dramatic effects as well but they only lasted about two months while I was losing weight. When you hear these dramatic results from people, at what time period is it that you hear the results?

Dr. Cordain
I’ve reported them in my books, people write in and tell me how they’ve done. Wiley keeps track of these things. We’ve reported about 20 or 30 cases that people can read and each one of them slightly different. We have people of all ages, all walks of life, all genders that have reported success.

Dan
My question I guess is how long into the diet do they report success because if one of my theories is correct, anybody who goes on a calorie restricted diet is going to see an improvement in acne symptoms. And it may simply be that.

Dr. Cordain
I wouldn’t say that’s a theory. I would say that’s a pretty good supposition. We believe the same thing. Calorie-restricted diets, no matter what you eat, are going to improve insulin sensitivity because there’s an interaction between calories and insulin sensitivity and we haven’t untangled that interaction as I mentioned we’ve only got a single study, and that was a confounding factor of Neil’s study so we need to determine what the role of caloric restriction is versus glycemic load. That has yet to be worked out. I honestly do believe that no matter what they eat, if they calorically restrict will have an improvement in acne symptoms. If you have what’s called an isocaloric diet and your reduce the glycemic load, that will be the next experiment that needs to be conducted is to keep the calories constant and reduce the glycemic load and see if acne symptoms subside. We also suspect besides milk and the glycemic load and calories we also suspect that there are certain foods that may interact with the pilosebaceous unit, one of them is peanuts. Peanuts contain a substance called PNA or peanut agglutinin we believe that PNA binds the same gut recepter that betacellulin does. We know from studies in England that PNA gets right into the bloodstream and if it does, then it in all likelihood it is binding these keratinous sites, these cells that line the pilosebaceous unit, if it binds those, and it causes a hormonal effect, like when it binds its own receptor, then it will also increase proliferation. We think that this is why some of the anecdotal evidence suggests that peanuts also exacerbate acne symptoms.

Dan
Interesting. Would you be able to give a few suggestions on how everyday people could modify their diet to improve their acne symptoms?

Dr. Cordain
I think everyday people eat white bread or white flour almost every day of their life, also refined sugars every day of their life. The average American eats close to 160 pounds of sugars on a yearly basis. We eat about a quarter of our calories in white bread. We eat a substantial amount of potatoes. All three of those foods, sugars, potatoes, and white flours yield a high glycemic load so at every turn of the screw, whenever possible, try to avoid those foods. I would also try to avoid dairy products as well. I think that most people, those simple suggestions of reducing or avoiding those types of processed foods will experience significant improvement in their symptoms.

Dan
Would you include peanuts on that list?

Dr. Cordain
Once again, we have no experimental data. What we have is a theoretical basis for this. It’s kind of like putting the dots together. We know that when people eat peanuts, we have scientific evidence to show that a substance in peanuts immediately appears in the bloodstream and we know that it binds a receptor that is located in the pilosebaceous unit. We haven’t put all the dots together. We haven’t actually had people eat peanuts, measure it in their blood, then measure it in the pilosebaceous unit, measure the activity of the pilosebaceous unit and then measure acne symptoms. Those four dots have not been connected they are all isolated at this point. It’s kind of like putting together a detective story is that you see a footprint leading into a house, and then you don’t see it again until it’s in the bathroom and then you don’t see it again until it’s someplace else. And so, that’s what we’re looking at. We see these footprints, these suggestive mechanisms in the body, but we actually haven’t been there to witness the entire series of events and so that’s what future research will focus on is how all of these things work together. Clearly we don’t believe that acne evolves just from a single dietary element, nor do we think that these dietary elements affect all people in the same manner. We think that some people have a much greater genetic susceptibility to acne than others. It’s a moving target right now and that genetic susceptibility makes things tough and unfortunately, I wish you were one of those people who genetically would have right off the bat improved, like other anecdotal stories that have come in. Whether your story would have worked or not would’ve never made any difference in the scientific community. It would have for you, and maybe for your listeners, but it would have not changed one iota in the scientific community. What is required are empirical database studies. That’s a slow process, so what we’re seeing now if the beginning of that process. Unfortunately for you, and others who grew up at this period, you’ll say, “Geez, I wish the scientific community would have figured this out two decades earlier”. Part of it is dogma, and it’s hard to get around the dogma. Through my publications, most of the dermatology community realizes that there is not any good evidence to make the suggestion that diet doesn’t cause acne. We pointed that out. The most frequently cited studies, the Fulton study published in the Journal of the American Medical Association and another one in the Family Practitioner, we blew those out of the water. I teach a research design class at the University and we routinely show that there’s a hole big enough in both of those studies that you can drive a Mack truck through. They’re not good science.

Dan
That sounds like a really big step to me. At least we’ve realized that diet and acne may be related, but maybe the bottom line at this point is that more research is required.

Dr. Cordain
I’ve never suggested anything other than that. All I’ve suggested is that the dogma that diet doesn’t cause acne is not a good position for anyone to take or to believe.

Dan
I guess what confused me as far as what you’ve put out there is the name of the book is “The Dietary Cure for Acne” and so, from that title, I assumed that you were saying that there is a dietary cure for acne.

Dr. Cordain
I believe there is, but again, I’m a scientist and until the science definitively shows that, what I’m giving is my hypothesis and my hypothesis has not been shown to be wrong by the three studies that have come out. All three are in agreement with what we’re saying.

Dan
Okay, well thanks so much for your time. I really appreciate everything that you’re doing.

Dr. Cordain
Okay Dan, well you’re a real warrior and a spirit and hopefully your grassroots effort is going to make a difference.

Dr. Cordain’s web site