A Body Sculpted by History

 
 
Caveman Doctor was recently eating some liver that he acquired in a hunt.  Ok, he bought it from a local farmer whose cows roam the land eating grass, and he avoids the use of pesticides and antibiotics, but close enough.  During the feast with his fellow caveman, Roger, they were discussing the diet of modern hunter-gatherers and were wondering if some quality data (whatever data is) existed for the societies, as it would be very insightful regarding which foods we can eat and perform well on a daily basis.  Luckily, this data actually does exist.   
 
 
Massaikidney CD 300x199 A Body Sculpted by History
 

The Foods that Sculpted Our Body to Avoid the Diseases of Civilization

 

Humans have been roaming the earth for roughly 2.5 million years.  During this long period of time, our diet has likely changed significantly.  Our diet was dependent on the time in history (cooling or warming periods), location (tropical vs. frigid vs. seasonal), season, and based on the food sources that were available at that time.  While these factors vary throughout, one thing is certain: only a minute slice of this time involved a diet that included sugar or processed oils and even grains.
 
Enough about what we didn’t eat.  What about the foods that we actually did eat the majority of the time and what foods are/were found in those societies that avoid diseases of civilization?  Addressing this issue through an ancestral approach by examining modern and recent hunter gatherers gives us a glimpse into the past.  Many anthropologists have dedicated their careers to such an endeavor, and we have them to thank for the plethora of data in which they have provided us.
 
One such group has looked at 9 hunter-gatherer societies, providing a remarkable amount of dietary data on these groups1.  Looking at a moderate amount of macronutrient composition data of these hunter gatherer societies helps us to paint a picture as to what foods allow our body to function under high demands, avoid diseases, and are likely similar to those foods we have been eating for several million years.  In other words, it shows us which foods help sculpt our body to function to the best of its ability.  The table below (click to enlarge) charts the daily food intake of these modern hunter-gatherer groups.

 
 
Modern Hunter Gatherers 300x164 A Body Sculpted by History
 
 

The Diet of Modern Cavemen

Interestingly, meat and invertebrates, including snails, crabs, worms, and insects, on average compose well over half of the cumulative hunter gatherer diet at 65%, with 5 societies consuming 78% or above.  While we don’t know exactly how much of this food is fat versus protein, the consumption of organ meats by these traditional people and the composition of most animals (most of the animal is consumed with the organ and fatty parts being the prized portions), it is safe to assume a large majority of this is fat.  Other societies not discussed in this data prized the fatty portions of animals as well, including the Plains Indians, who made pemmican (a block of mostly fat with dried buffalo meat), and other tribes along the Pacific Coast who made boxed oolican grease.  They clearly consumed large proportions of dietary fat, but exactly quantifying these amounts remains a daunting and nearly impossible task.
 
Of even more interest, from looking at the table above, only the !Kung and Gwi did not get the majority of their calories from animal sources.  That being said, data on the !Kung is inconsistent, and while they may not have eaten as much meat as some of the other groups, some meat was replaced by seeds or nuts, which are mostly fat sources.  They also ate plenty of the fatty mongongo fruit2, leaving their dietary composition of largely fat, much like the other groups.
 
Plant foods varied significantly, with roots (i.e. tubers like sweet potatoes) composing the majority of non-animal foods and fruit even lesser so (except for the Nukak – see below).  Tubers may have been more protected from insects and animals, allowing them to be consumed more often or left in the ground as fallback food, a strategy frequently employed by the Hadza.3  Fruits must be consumed in an appropriate amount of time by humans, or they will lose out to animals and more often, insects.  One advantage for humans is that they can then consume the animals that ate their fruit, therefore obtaining these nutrients secondhand.
 
In terms of carbohydrate consumption, most of these groups ingest under one-fourth of food intake as carbohydrates, with the Hadza, Gwi, and Nukak consuming more plant sources.  However, the Nukak in Columbia consume a large amount of palm fruit4.  Even more than the mongongo, palm fruit is nearly all fat, and 50% saturated.  Therefore, while a significant portion of their diet was fruit based, it remained consistent with most of the other diets with fat as the primary source of sustenance.  As a result, the Gwi and Hadza were the only two hunter-gatherers to eat a relatively high amount of carbohydrates.
 
One group that was not analyzed was the Inuit (Eskimo) population in Northern Canada.  During his time as the treating physician, J.A. Urquhart describes a diet of nearly 100% fat with small amounts of protein5.  An extreme example certainly, though it is rather interesting to note that during his seven years living among Inuit members of all ages with access to all the diagnostic equipment available at that time (including x-ray imaging and surgical evaluation), he had not seen a single case of cancer.
 
 

Important Factors to Consider from this Data:

  1. Exact macronutrient makeup varies between hunter-gatherer societies.
  2. None consume sugar, processed oils or grains, as these foods were not part of hunter-gatherer diets, or substantial in any diet from 10,000 years ago to the beginning of time.
  3. The clear overriding theme is that animal products (i.e. mostly fat and lesser so protein) make up the vast majority of food intake within these societies.

 

Hunter-Gatherer Food Pyramid

Contrast this with the USDA’s dietary guidelines, which recommend an increase in whole grains and processed oils (which play no part in the diets listed above), with a restriction in solid fats and saturated fat (the near vast majority above)6These are absolutely not the foods with which our bodies were sculpted to process and play no part in the diets of those who have avoided diseases of civilization.  When our bodies reject such modern franken foods, it is no surprise when they lead to obesity, diabetes, heart disease, and cancer.  This also includes basing an entire diet on carbohydrate sources, which only one of these groups did.
 
 

Nutrient and Calorie Dense Foods: The Basis of Health

Regardless of which society we view, one dietary aspect persists – food consumption revolves around eating the most nutrient and calorie-dense foods.  When one considers hunter-gatherer societies, where the goal is to acquire food in order to survive, it only follows that eating the foods with the highest concentrations of calories and nutrients would provide the largest benefit physiologically for the body and brain.  From a cost/benefit function (energy spent acquiring food to energy derived from the food), it is irrational to dedicate large amounts of energy to acquire foods with little nutrient return on the investment.  Unfortunately, this is the backbone of the US dietary paradigm.
 
 

Food for Our Gut:

However, this is not the only explanation as to why humans have consumed energy and nutrient-dense foods for the vast majority of their existence.  Several explanations account for the vast amount of nutrient-dense foods that humans consumed, including meat and even some starches versus low-nutrient plants and fruit by comparison.  As Kaplan’s group explains1, humans have consumed rarer and harder to acquire nutrient-dense foods while apes consumed their low-nutrient counterparts, which explains the difference between our gut anatomy, physiology, and brain size.  More specifically, chimpanzees can rapidly absorb nutrients from foods that quickly pass through the gut, like fruit, while humans can meet the nutrient requirements more easily through the consumption of slower passing foods, like meat, and such differences may be represented by the vastly larger human small intestine, where most digestion occurs, versus the colon, which dominates in size in apes7,8.
 
In fact, over half of the length of the digestive tract in humans is made up of small intestine.  Interestingly, while many carbohydrates go undigested, only to be handled by bacteria in the large intestine, fats are degraded and absorbed within the small intestine9,10, as are most of the nutrients present within our food11.  This alone may give humans the edge over apes by providing them with the ability to derive sustenance from nutrient-dense foods by using their much larger small intestines.  Is it a coincidence that the human diet has involved heavy fat and animal sources over millions of years and the largest organ of our digestive tract is that which is meant to digest and absorb fats?  The issue here is less whether the fat in the diet lead to the larger small intestine or whether it was there all along, but rather the fact that our bodies have been manufactured to process a majority of nutrient-dense fats within the diet.  It is also no surprise that fat within the intestine is the regulator of appetite which stimulates signals, like the hormone Cholecystokinin (CCK), which tell the body that it know that it no longer needs to be hungry and should instead focus on digesting the nutrient and calorie-dense food within the small intestine.12  This is one reason why those consuming a low-fat diet have a steeper road ahead of them as they often experience hunger that is difficult to fight.  Adding to the problem is the fluctuations of their insulin and blood sugar which cause further hunger.  The cycle repeats when they turn to similar low-fat foods to quench their hunger.

 
 

Food for our Brain:

While our gut is designed to digest and absorb energy-dense fatty foods, it is no surprise that the fat absorbed by our gut is the major fuel for our brain (another factor separating man from ape), which is 60% lipid13.  In fact, human breast milk provides newborns with a 60% fat solution which is highly necessary for brain development and function.14  Finally, keep in mind that these hunter-gather cultures work together to hunt and acquire food15.  This executive functioning and cooperation are additional factors which we can attribute to brain function, thanks to fat consumption, which has increased human intelligence and allowed us to migrate to the top of the food chain.
 
Big Small Intestine = Big Fat Consumption = Big Brain
 
 

There are several reasons that our diets consisted primarily of animals and animal fat:

  1. Such energy and nutrient dense foods helped to fuel our brain
  2. Such foods are generally more difficult to acquire, which is why more intelligent humans are capable of acquiring them.  Compare this with chimpanzees, which eat a small fraction of meat16.  You need a bigger brain to be able to catch a prey or dig up buried roots.  Subsequently, those harder to hunt animals provide your brain with a rich source of fatty acids to function properly.
  3. Our bodies are meant to process these foods after 2.5 million years of consuming them and we have the machinery to digest and absorb such foods.

 

SAD: Standard American Diet:

Contrast this to the standard American diet, which consists of a much reduced 32% fat, 16% protein, and 49% carbohydrates17.  While these numbers dominate the amount of carbohydrates consumed by hunter-gatherers, our dietary recommendations suggest an even higher amount of carbohydrates and lower fat6.  These misguided recommendations also mention avoiding calorie-dense foods, which also happen to be nutrient-dense, as these recommendations follow the weight loss advice of “exercising more and eating less.”  Massive increases in the rate of obesity have followed since employing this strategy.18
 
 

In Conclusion:

Mirroring modern day hunter-gatherer societies likely involves eating the same foods our ancestors consumed for millions of years.  These high fat foods are the same sources of sustenance that our bodies are designed to process, and these foods likely help us to avoid the diseases of civilization, including diabetes, obesity, and even cancer.  This does not mean to eliminate all fruit or vegetables, as we can clearly derive benefit from these foods, as modern hunter-gatherers do and we have done in the past.  However, it is clearly efficient for our body, brains, and appetites (and therefore sanity) to consume the same energy and nutrient-dense foods that our intestines are designed to process and absorb, resulting in energy in which our brain is designed to use.
 
Once again, the pathway to health is deep rooted in our history, and Nature was kind enough to provide plenty of modern examples of what happens when we eat the foods we were meant to process. 
 
SIGNATURE2 A Body Sculpted by History
 
 

References:

1.            Kaplan H, Hill K, Lancaster J, et al: A theory of human life history evolution: Diet, intelligence, and longevity. Evolutionary Anthropology: Issues, News, and Reviews 9:156-185, 2000, http://dx.doi.org/10.1002/1520-6505(2000)9:4<156::AID-EVAN5>3.0.CO;2-7

2.            Belovsky GE: Hunter-Gatherer Foragirig: A Linear Programming Approach. Journal of Anthropological Archaeology 6:29-76http://deepblue.lib.umich.edu/bitstream/2027.42/26778/1/0000334.pdf

3.            Marlowe FW, Berbesque JC: Tubers as fallback foods and their impact on Hadza hunter-gatherers. American journal of physical anthropology 140:751-8, 2009, http://www.ncbi.nlm.nih.gov/pubmed/19350623

4.            Macía M, Armesilla P, Cámara-Leret R, et al: Palm Uses in Northwestern South America: A Quantitative Review. The Botanical Review 77:462-570, 2011, http://dx.doi.org/10.1007/s12229-011-9086-8

5.            Urquhart JA: The most northerly practice in Canada. 1935. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne 147:1193-6, 1992, http://www.ncbi.nlm.nih.gov/pubmed/1393934

6.            USDA: Dietary Guidelines for Americans,

7.            Milton K: A hypothesis to explain the role of meat-eating in human evolution. Evolutionary Anthropology: Issues, News, and Reviews 8:11-21, 1999, http://dx.doi.org/10.1002/(SICI)1520-6505(1999)8:1<11::AID-EVAN6>3.0.CO;2-M

8.            Milton K, Demment MW: Digestion and passage kinetics of chimpanzees fed high and low fiber diets and comparison with human data. The Journal of nutrition 118:1082-8, 1988, http://www.ncbi.nlm.nih.gov/pubmed/2843616

9.            Hubscher G: Transport of lipid across the small intestine. The Biochemical journal 114:46P-47P, 1969, http://www.ncbi.nlm.nih.gov/pubmed/5343743

10.          Spencer RP: Spatial Distribution of Intestinal Activities. The Yale journal of biology and medicine 36:279-94, 1964, http://www.ncbi.nlm.nih.gov/pubmed/14120286

11.          Thomson A, Drozdowski L, Iordache C, et al: REVIEW: Small Bowel Review: Normal Physiology, Part 1. Digestive Diseases and Sciences 48:1546-1564, 2003, http://dx.doi.org/10.1023/A:1024719925058

12.          Beglinger C, Degen L: Fat in the intestine as a regulator of appetite—role of CCK. Physiology &amp; Behavior 83:617-621, 2004, http://www.sciencedirect.com/science/article/pii/S0031938404004160

13.          Crawford MA: The Role of Dietary Fatty Acids in Biology: Their Place in the Evolution of the Human Brain. Nutrition Reviews 50:3-11, 1992, http://dx.doi.org/10.1111/j.1753-4887.1992.tb01283.x

14.          Crawford MA, Hassam AG, Stevens PA: Essential fatty acid requirements in pregnancy and lactation with special reference to brain development. Progress in Lipid Research 20:31-40, 1981, http://www.sciencedirect.com/science/article/pii/0163782781900114

15.          Henrich J: Social science: Hunter-gatherer cooperation. Nature 481:449-450, 2012, http://dx.doi.org/10.1038/481449a

16.          Wrangham R, van Zinnicq Bergmann Riss E: Rates of predation on mammals by gombe chimpanzees, 1972–1975. Primates 31:157-170, 1990, http://dx.doi.org/10.1007/BF02380938

17.          CDC: Trends in Intake of Energy and Macronutrients — United States, 1971–2000, 2004

18.          Cite Centers for Disease Control and Prevention, The Obesity Epidemic. Available at: < http://www.cdc.gov/cdctv/ObesityEpidemic/>. Accessed July 27, 2011

 

 
© Caveman Doctor 2012. All Rights Reserved.

Comments
23 Responses to “A Body Sculpted by History”
  1. brian says:

    Love the article. Would be interested in your thoughts on your recommended types of animal protein. Fish/Fowl/Red Meat – and details therein. I know I eat tons if grass fed beef but not as much fish as I would like.

  2. Laura Davies says:

    Hi Dr Champ,

    A colleague posed the following questions to me (re:this article) and I was curious what your thoughts were on his comments:

    “What was the average life expectancy of a hunter gatherer? Didn’t most of them die before they could run into any of the common vascular diseases or cancers? Also, no one is going to get fat, regardless of dietary composition, when living on a subsistence diet. Lastly, those figures are crazy – the daily caloric intakes range from 1000-4000 between groups!”

    • Hi,

      I’m not Doctor Champ but I have a degree in Anthropology and was an archaeologist before I had kids. I think sometimes we are tainted by our western culture belief that we are progressing forward and getting better as time goes on but that isn’t actually true. Hunter gatherers lived longer than their agricultural counter parts and they were generally taller too. Check out these articles, it might give you help you answer your friends questions…

      Jared Diamond, “The Worst Mistake in the History of the Human Race,” Discover Magazine, May 1987, pp. 64-66.
      http://www.ditext.com/diamond/mistake.html

      OR

      You might want to check out this article by Mark Sisson from Mark’s Daily Apple…
      http://www.marksdailyapple.com/life-expectancy-hunter-gatherer/#axzz2CDbL5C95

      I have read a good article by Phil Maffetone about longevity but I can’t find it. If you want to watch a good movie about survival and living off the land check out Rabbit-Proof Fence….In 1931, three aboriginal girls escape after being plucked from their homes to be trained as domestic staff and set off on a trek across the Outback..

      Hope the info helps:)

      • cavemandoctor says:

        Stephanie,

        Thanks for the great comments. I definitely agree with you. Also, that Diamond article is one of my favorite. I wrote a post on it, but decided not to release it as it was too controversial. I will definitely check out that movie – thanks for the recommendation.

        Thanks!
        CC

    • cavemandoctor says:

      Hi Laura,

      Great question. Some data point to around 50′s if one lived past childhood, though this may be generous. Missionary data from the turn of the century ranged from 50s to 60s (off the top of my head). However, even if they died in their 40s, they died without diabetes, obesity, and cancer, so they were doing something right. The Inuit were examined by modern doctors and no cancer was found. Breast and other superficial cancers would have been easily diagnosed. A 30 year old (or even younger) with breast cancer is no longer a rare occurrence. An overweight child is the norm these days. Combine those health aspects, with modern medicine, surgery, antibiotics, and safety from predators, and I think we have something to work with.

      The key is really the composition of the diets. Just like they don’t nowadays, calories didn’t matter then either.

      Thanks!
      CC

      • Paul N says:

        There is evidence from groups like the Inuit, and the Australian aborigines, that some lived for quite a while. There are stories of older aborigines being able to outrun their children.
        And they had a special word and class for “elders” – that wouldn’t exist if there weren’t any.

        As for the calorie intakes, it would be easy for active H/G people to go through 4000 cal/day, as do many modern athletes and fitness enthusiasts.

        While it is hard to quantify the calorie intakes, it is much easier to qualify what food types the calories came from – the take-away being the prominent position of animal foods in all the groups bar one.

        Weston Price, in his travels in the 30′s had identified that the most successful groups, that had best health, teeth, “effortless” chilldbirth etc, ate at least one of these four groups of animal foods;
        - fish/seafood
        - large game
        -dairy
        -small animals (incl birds) and insects

        When you consider that animal fats are where vits A,D, K2 come from, and animal foods are the *only* source of B12, its not hard to see why the successful populations included animal foods.

        When you look at the incidence of vegan women running into fertility/breastfeeding problems it is also no wonder that Price never found a vegan society, nor is there any evidence there has ever been one – they would have had too much trouble reproducing themselves!

        • cavemandoctor says:

          Paul,

          Thanks for the great comments. I agree and have heard this as well. People love to ask the “but how long did they live?” rebuttal, regardless if they were dying from other issues. Thanks for bringing up Weston Price – for the reader out there I highly suggest reading his book.

          Thanks,
          CC

  3. LP Johnson says:

    I recently got a traditional Scandinavian cookbook. It is my new favorite. Tons of offal, game & fish recipes. They preferred eggs to fowl (raw yolks used a lot), everything is cooked in animal fats, desserts are nut & berry based. All veggies are rutabaga, beet, parsnip, cabbages (in the form of kraut only) & greens. There are recipes that include rye & potatoes, but the author points out that these were unavailable until the 19th century! The main reason I love this cookbook is because it basically uses only ingredients that I have personally deemed to be sustainable for my family. Root veggies, cabbage, & Swiss chard I am really good at growing on my city lot, along with eggs from our hens, & Hubby is out hunting deer this morning. I don’t believe that getting back to this diet is as difficult as people make it (and my grocery bills are tiny compared to when I was buying bread & pasta).
    Sorry for the long-winded note, I just don’t want the Scandinavians to be forgotten (they might be in your fabulous article, however, I am not familiar with tribe names). I know many people picture “savages” when thinking of hunter/gatherers and Paleo. A lot of us Midwesterners are descended from Northern Europeans, and we aren’t as far removed from this diet as we think.

    • cavemandoctor says:

      LP thanks for the comments. It sounds like a great cookbook incorporating most of the foods that most of my readers and I eat.

      What is the title?

      Thanks!
      CC

  4. ReneeAnn says:

    Excellent post, as always. I love that you reference your articles so well. I just caught up on your podcasts. They are great. Keep it up! :)

    By the way, I learned from this article

    http://syontix.com/small-intestinal-bacterial-overgrowth-part-six-dietary-causes-of-impaired-intestinal-movement-and-inflammation/

    that constipation can be a symptom of gluten intolerance. I have never heard that before, but I can see the connection in my own history, now that I am aware of it. So, here is the sad conclusion that I have also come to…. I eliminated coffee about 2.5 years ago, just because I was so sick that I couldn’t eat much of anything but meat and broth. Through that illness, I found paleo and discovered many food sensitivities through careful use of the elimination diet. This last July, I found myself feeling so wonderful. By this point, I went from feeling good to feeling great. So, I decided to try coffee again. I experimented with it through the end of October. I *love* coffee, so I was trying to delude myself into overlooking bad health symptoms. The main thing that I was concentrating on was drinking a small enough dose, early enough in the morning, so that it did not disturb my sleep. I finally concluded that no dose would allow me to have deep sleep. Then, I heard about the coffee/gluten cross-reaction possibility. I really didn’t think that was the case for me, because at the time that I decided that I needed to get off gluten, my digestive system was the usual gluten reaction of sending me to the bathroom. But, now I’m thinking that is only because I was still pretty sick at the time.

    This is the very strange thing. The longer I drank coffee, the more constipated I became. Then, I read the article that I listed above and realized that this must have been my literally life-long symptom of gluten intolerance, since early childhood. I went off the coffee and in about two or three weeks, my gut was back to normal healthy functioning.

    I do hate that I know I can’t drink coffee again, but I know now that I must stay off of it. I have replaced it with a very delicious coconut oil cocoa, though. So, that is the good news. :)

    • Paul N says:

      ReneeAnn,

      if you want to give coffee one more shot, I highly recommend Bulletproof Coffee (with either cream/butter or coconut oil)

      It is the first coffee that my partner (and she is a coffee aficionado) and I have found does not leave us feeling dehydrated.

      • ReneeAnn says:

        I went through about 5 pounds of Bulletproof coffee during this experiment. I also tried other brands, but made sure that they were single estate, high elevation sources. I also chose light roast, except with the Bulletproof coffee, which is medium. Light roast leaves more anti-oxidants in tact. The rest of the day I drink water and lots of it. I eat a very clean auto-immune version of paleo. I always blended my coffee, and now my cocoa, with melted coconut oil. I can’t tolerate dairy at all. Not even ghee. This *was* my second shot on coffee. As much as I want it to be for me, it’s not. I really knew it within a couple of weeks and lived in denial the rest of the four month experiment. I even tried using only four ounces of coffee per morning. I not a fan of tea, so I am very glad that I thought of “Bulletproof” cocoa. :)

        I actually react strongly to the other gluten cross-reactive foods, as found here:

        http://alternativethyroidtherapy.com/wp-content/uploads/2011/07/Gluten-cross-reactive-foods.pdf

        So, I guess it shouldn’t have surprised me so much. I found myself acting like a wheat addict that refuses to seriously consider the consequences. hee, hee

    • cavemandoctor says:

      Interesting ReneeAnn,

      I drink coffee daily, but I do have mixed feelings about it. I have yet to try Bulletproof coffee, Paul, but I do hear good things about it. I read about the cross-reactivity of gluten as well, though this data sounds like it’s in the infancy stages. If one has gluten intolerance, I could potentially see it being an issue.

      Thanks!
      CC

    • Sharon says:

      ReneeAnn, I’m with you. I am not a coffee drinker and I have been using raw cacao for many years. I hope that is not a no no on the Paleo diet. I use about 1 tbsp with hot water. I add vanilla stevia, sometimes cinnamon, some butter, sometimes coconut butter and top it off with coconut milk. It tastes very lovely to me but when I give it to people who are used to commercial hot cocoa, they don’t enjoy it. I guess that’s a good sign.

      • ReneeAnn says:

        The one obstacle that I have with the hot cocoa is how to sweeten it. To me, stevia is just too bitter paired with cocoa. I haven’t tried vanilla stevia, but I rarely buy anything that has more than one ingredient, so it doesn’t sound like I would like the ingredient list. Right now, I am using one teaspoon of birch xylitol (more will send me to the bathroom… sorry if tmi) and one teaspoon of honey. I’d rather not use the honey, but have not found a way around it and still have a good tasting drink. I drank coffee easily and enjoyed it with no sweetener, but cocoa is too bitter.

  5. girl interrupted says:

    Dr Champ,
    I know this is random and has little or nothing to do with this article but since you are a cancer specialist i like to ask you are we any closer to finding a cure for cancer? i’ve seen too many people died of this horrible disease

    • cavemandoctor says:

      Hi,
      Unfortunately not. There is good research coming out so hopefully we can get closer. Prevention is key!
      CC

    • Kyle says:

      How far have we come on cancer research? Is a cure even a possibility? 6 months ago, I lost a good friend to liver cancer. He was only 28.

  6. cn says:

    school food service manager uses locally grown foods & grass fed beef for students meals at Keene School!

    http://www.aft.org/difference/aftmembers/holbrook.cfm

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