J Ethn Foods 4 (2017) 236e241

Contents lists available at ScienceDirect

Journal of Ethnic Foods

journal homepage: http://journalofethnicfoods.net

Review Article

Ethnic and paleolithic diet: Where do they stand in inflammation

alleviation? A discussion
Seema Patel a, *, Hafiz A.R. Suleria b, c
a
Bioinformatics and Medical Informatics Research Center, San Diego State University, San Diego, CA, USA
b
UQ Diamantina Institute, Translational Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
c
Department of Food, Nutrition, Dietetics & Health, Kansas State University, Manhattan, KS, USA

a r t i c l e i n f o a b s t r a c t

Article history: The current food options, especially in the Western countries, are acidogenic, which reduce extracellular
Received 26 July 2017 pH and perturb ionic homeostasis. The acidity-activated enzymes mediate a large panel of chronic and
Received in revised form acute diseases.
10 October 2017
To quell the morbidities and mortalities associated with the metabolic syndromes, nonpharmacologic
Accepted 11 October 2017
Available online 16 October 2017
approaches are preferred. Dietary interventions are critical in this regard. Among the array of dietary
patterns, paleo diet has garnered much attention in the last decade. This diet rich in phytochemicals and
unsaturated fatty acids is deemed wholesome for the body. Several studies have proven this claim, yet
Keywords:
Homeostasis their nutritional adequacy for all age groups is contentious. The popularity of ethnic foods is rising; but
Inflammation their nutrition and safety position can vary. Although some of them are close to paleo food, some are
Metabolic acidosis unhealthy. This review explores the mechanism by which paleo diet restores homeostasis of the body
Paleo diet and how its inherent nutritional deficiency can be amended with conventional diet, by the formulation
Western diet of personalized diet. This compilation is expected to be insightful for dietary optimization.
© 2017 Korea Food Research Institute. Published by Elsevier B.V. This is an open access article under the
CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Introduction civilization, food paradigms changed drastically. With

Paleolithic diet or paleo diet, the food habits of humans during
the Paleolithic Era (45,000e40,000 to 10,000 BC) has got immense
popularity in recent times, in keeping with the rising instances of
inflammatory diseases, autoimmune pathologies, and cancers. A
paleo diet is a modern dietary regimen based on foods presumably
eaten regularly during the Paleolithic Era, which includes lean
meat, fish, shellfish, fruits, vegetables, roots, eggs, and nuts, but not
grains, dairy products, salt, or refined fats and sugar [1], which
became staple food long after the appearance of fully modern
humans [2]. While some believe that paleo diet is indeed health
promoting, some dismiss it as “hype” or “fad” [3]. However, current
evaluations have supported that this diet is compatible for health,
and it should be made a staple in food platter. The explanation is
that the human body has evolved to its current state because of
nourishment by fruits, tubers, nuts, etc. [4]. Paleolithic diet was
alkalogenic; therefore, it kept human extracellular fluid pH neutral,
a requisite for homeostasis. However, with the progress of
* Corresponding author. Bioinformatics and Medical Informatics Research Center,
San Diego State University, 5500 Campanile Dr, San Diego, CA 92182, USA.
E-mail address: seemabiotech83@gmail.com (S. Patel).
agriculture and animal domestication (Neolithic Revolution), diet
was dominated by grains and dairy products. It tilted the extra-
cellular fluid neutrality towards acidity [5]. But, industrialization
(Industrial Revolution) and the emergence of processed food
crossed the tipping point [5]. Increment in the consumption of
processed foods, together with a reduction in fruit and vegetable
intake, has dramatically changed the pattern [6]. The processed,
high-carbohydrate, and high-fat diet increased the extracellular
acidity, activated the zymogens, and inflamed the system [7]. No
wonder, in current times, metabolic, autoimmune, endocrine, and
neural diseases abound in mankind, especially in the developed
regions of the world [8]. Ignorance of this culprit, combined with
easy accessibility of drugs, is imposing further oxidative stress on
the body [9,10] and skewing the pH toward more acidic. The
phenotype of the modern human might have become refined
today, but the genome is almost the same since the Paleolithic Era
[11,12]. While the genome is static, the food habit has undergone
radical change, which is taking toll on the mankind.
In realization of the adverse effects of changed food habits, there
is a revival in interest for ethnic foods. Cajun cuisine which includes
dish such as gumbo, jambalaya, and boiled crawfish are popular
across the United States [13]. In Bedouin Arab minority

https://doi.org/10.1016/j.jef.2017.10.004
2352-6181/© 2017 Korea Food Research Institute. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/
licenses/by-nc-nd/4.0/).
 S. Patel, H.A.R. Suleria / Paleolithic diet to prevent inflammation and acidosis
communities, ethnic foods include za'atar, leafy dark green vege-
tables, and camel milk [14]. Japanese ethnic dishes include fish and
seaweed. Corn and flour tortillas, beans, tomatoes, chili peppers,
lard, and beef tallow are cooking mainstays of Mexican foods.
Medical nutrition therapy is considered for the management of
pathologies like end-stage kidney disease [15]. Diet therapy is the
cornerstone of gestational diabetes mellitus.
At the same time, the question of how ethnic dietary preference
may be influencing diseases is coming forth. Not all ethnic foods are
healthy in terms of their ingredients or processing technique.
Polyunsaturated and monounsaturated fatty acids were found
higher in most ethnic foods consumed in Italy and Spain compared
with ethnic foods of other countries [16]. Ethnic and cultural factors
determine dietary preferences. As globalization spreads across the
world, societies are becoming multicultural and people are
showing keen interest to taste the ethnic foods from different
cultures. However, it might be difficult on the metabolism, as the
genetics has evolved differently due to distinct dietary patterns.
Salt-loaded seafood might be metabolized in a Japanese person but
might cause hypertension in an Indian person. An European person
might develop allergy to peanuts, while the nut can be a common
ingredient in Chinese cuisine. Therefore, it is better to stick to one's
own diet. Even one's own ethnic food should be consumed in
moderation, as taste is not the reflection of the nutritional profile or
antinutrients in the food. Cassava (Manihot esculenta Crantz) root is
used as a food source in certain cultures [17]. It contains neurotoxic
cyanogenic glycosides linamarin and lotaustralin, which can cause
cyanide poisoning [17]. An excitatory amino acid L-ODAP (b-N-
oxalyl-L-a, b-diaminopropionic acid) in Lathyrus sativus (grass pea
or khesari dal), when ingested regularly, can cause paralysis [18,19].
An ethnic community, the Chamorro people of Guam, is often
afflicted with neurodegenerative disease clusters of Alzheimer's,
Parkinson's, and amyotrophic lateral sclerosis, because of their
consumption of cycad (Cycas micronesica) seeds, which contains
neurotoxins beta-N-methylamino-L-alanine [20]. The Japanese
traditional puffer fish (fugu or blowfish) contains tetrodotoxin,
which if consumed can be fatal [21]. Japanese people have learned
to ferment the fish to reduce its toxicity. A bamboo species Phyl-
lostachys edulis, used as food, contains a-amylase inhibitors such as
orientin, isoorientin, vitexin, and isovitexin. The leaves are soaked,
heat inactivated, and cooked to eliminate the inhibitors. Ethnic
foods have their origin in the availability of the ingredients.
Fig. 1. Some ethnic foods from different countries. (A) Injera. (B) Kabob. (C) Fried banana. (D) Poke. (E) Biryani. (F) Noodle soup. Some of these ethnic foods are of high calorie, high
protein, and high fat, while some are nutrition poor.
237
Whatever was abundant or easily obtained dominated as ethnic
food. Food scarcity has led to the invention of different strategies to
deal with antinutrients and to make the most of the available
materials. Before agriculture succeeded and globalization improved
the food scenario, people in different countries had to deal with
drought and famine, which often compelled them to integrate odd
things to their food platter. Therefore, what may come across as
delicious for a particular culture might appear gross to the other.
“Huitlacoche,” the Ustilago maydis e caused fungal gall on corn cobs
(Zea mays L.), was a delicacy in Aztec cuisine and is relished in Latin
America [22]. Obesity or a particular disease is pervasive in a cul-
ture because of the dominance of particular ingredients in the
cuisine. Native American tribes living in harsh conditions subsisted
on various plant and animal products, for their nutritional needs.
Kutzadika people in Mono Lake region consumed alkali fly (Ephydra
hians) pupae; Paiute Indians consumed Pandora moth (Coloradia
pandora) larvae; the Maidu people consumed carpenter ants
(Camponotus spp.); some tribes used secretions of mealy plum
aphid (Hyalopterus pruni) as sugar. People in the Midwest of the
United States used the katydid (Anabrus simplex) as food. In Oriental
countries such as Thailand, Vietnam, and Cambodia, people eat
grasshoppers, crickets, spiders, scorpions, ants, and weevil
larvae. Chapulines, the grasshoppers (Sphenarium sp.), are eaten in
Mexico and Central America [23]. In Japanese culture, wasp, silk
moth, cicada, and grasshopper preparations are served in restau-
rants [24]. Casu Marzu, a putrid cheese made from sheep milk has
maggots of cheese fly (Piophila casei) [25]. The consumption of bats,
frogs, bird egg fetus, and swiftlet bird's nest is prevalent in different
parts of the world. Tibetans are a high-altitude community, and
they thrive with limited food resources because of their genes that
adapt to particular low-temperatures (HIF2A/EPAS1 and EGLN1)
[26]. Other people exposed to these meager food settings may
develop nutritional deficiencies. The Maasai, tribe of Tanzania, are
seminomadic people, and their pastoralist way of living exposes
them to severe food insecurity, though meat, milk, and ugali (a thick
maize-based porridge) constitute their primary food [27].
In current times, people are showing interest for exotic ethnic
foods. Japan's sushi, Italy's pasta, El Salvador's fried plantains,
Afghanistan's kabob, India's curry, Ireland's fish and chips, Ethiopia's
injera, Vietnam's noodle soup, Hawaii's poke (raw fish salad), and
Mexico's burrito, which were once ethnic food of a particular region
of country are now global fare. Fig. 1 presents some ethnic foods
238 J Ethn Foods 2017; 4: 236e241
from different countries. Even, they are showing interest for such
bizarre preparations as part of food tourism and for the sake of
tasting exotic foods. However, the risks are not considered. Snake
wine, alcohol steeped with venomous snake, is sold in China,
consumption of which had led to cases of coagulopathy [28]. Ar-
thropods have chitin and tropomyosin which can cause allergy and
anaphylaxis [29]. Food professionals suspect the hygienic
practice and labeling of the ethnic food preparations. Mycotoxins
such as trichothecenes and ochratoxin A are present in chili pow-
der, curry powder, and ginger [30]. Kidney bean, which is a staple in
Hispanic cuisine, is known to cause allergic incidents in people with
different genotypes. This review analyses the pros and cons of the
paleo diet. Further, the overlap between ethnic foods and paleo
foods has been discussed.
Paleolithic diet
In a 3-month-long randomized crossover study, a paleo diet
ingestion improved the glycemic control and several cardiovascular
risk factors in type 2 diabetes patients [1]. In an observational
study, paleo diet reduced the risk of a number of metabolic syn-
dromes, as determined from the decline in weight, C-reactive
protein, glycated hemoglobin, improved blood pressure, glucose
tolerance, insulin level, and lipid profiles [5]. Frassetto et al also
found that 10 days of a paleo diet improved the diastolic blood
pressure, insulin sensitivity, and lipid parameters [31]. Paleolithic
diet is associated with lower levels of systemic inflammation and
oxidative stress in humans, as determined from the low-plasma
high-sensitivity C-reactive protein and F2-isoprostane level
(Whalen et al, 2016). F2-isoprostane is a specific prostaglandin F2-
like compound, derived from the nonenzymatic peroxidation of
arachidonic acid. A paleo diet improves fat mass and metabolic
balance, including insulin sensitivity, glycemic control, and leptin in
patients with type 2 diabetes [32]. A randomized controlled study
involving 2 weeks of paleo diet intake could ameliorate metabolic
syndrome, especially cardiovascular risk factors [33]. A systematic
review based on four randomized controlled trials resulted in
short-term improvements in metabolic syndrome components
following paleo diet [34]. A 4-month consumption of a paleo diet
improved glucose control and lipid profiles in people with type 2
diabetes, compared with conventional diet (comprising moderate
salt intake, low-fat dairy, whole grains, and legumes) [35]. Con-
sumption of paleo diet increased incretin and anorectic gut hor-
mones (glucagon-like peptide-1 and peptide YY), which improved
satiety[36]. Paleo diet is rich in Kþ. Deficiency of this ion has been
implicated in cardiovascular diseases, kidney stones, and osteopo-
rosis. Therefore, a Kþ-rich paleo diet might have enough of this
mineral to prevent the need of drugs or supplements [37]. A
comparative study between the Western diet and paleo diet reveals
that the latter can inhibit mammalian target of rapamycin complex
1 signaling, thus exerting effect on cell growth, proliferation, and
angiogenesis [38]. In a case study, a female in her sixth decade,
when subsisted on paleo-pattern food, her glycemic load and blood
pressure issues were resolved [39].
Western diet
The Western diet is the reverse of paleo diet, which is dominated
by high glucose, dairy protein, saturated fats, and trans fats [40,41].
Furthermore, this diet is brimming with sugar, salt, lipid, and ad-
ditives. Preservatives like sulfites, nitrites, benzoic acid, emulsifier
agents (polysorbate-80), and colors are being added liberally to the
food for the augmentation of shelf-life and esthetic appeal. Such diet
includes cheese, pizza, pasta, french fries, chocolates, mayonnaise,
soft drinks, processed meat, and frozen foods [42,43]. Dairy
products have hormones like prolactin, estrogen, progesterone,
androgen, insulin-like growth factor-1, and prostaglandins [44].
Apart from those, other estrogenic, thyrostatic, and beta-adrenergic
compounds are added to these foods, despite regulations [45].
Spectrometric analyses have identified trace amounts of pesticides
like alachlor, atrazine, butachlor, isoproturon, malaoxon, methyl
paraoxon, monocrotophos, phorate sulfone, phorate sulfoxide, 2,4-
D, phorate, etc. in popular soft drinks [46]. Unfortunately, the cur-
rent generation is under the grip of these acidogenic and pesticide-
laced foods [47]. These types of foods are known to be acidogenic, for
they tilt the acidebase balance in favor of acidity [48]. A majority of
morbidities afflicting mankind today are attributed to the Western
diet. Inflammatory ailments from the acne vulgaris to diabetes,
tumorigenesis, sepsis, celiac disease, Crohn's disease, inflammatory
bowel disease, obesity, nonalcoholic fatty liver disease, cardiovas-
cular disease, chronic obstructive pulmonary disease, chronic kid-
ney disease, faster bone resorption, brain ischemia, etc. have been
linked to the unhealthy constituents of the Western acidogenic diet
[38,47,49,50].
Mechanisms of amelioration
The healthy aspect of paleo diet stems from its buffer-like effect
on the body pH. Ions and electrolyte balance in the body is para-
mount for survival. None of the living organisms can escape the
fluctuation in pH. The shift in pH ushers in a deluge of undesirable
consequences. Acidic milieu acts as stressors due to the abundance
of reactive oxygen species, reactive nitrogen species, etc. [51]. The
stressors favor the activation of a range of enzymes which ought to
be dormant [52,53]. Proteases (matrix metalloproteases and ca-
thepsins), nitric oxide synthase, adenosine triphosphate synthase,
glycosidases, urease (Ni2þ-containing hydrolase), phospholipase D,
cyclooxygenase-2, and aromatase are some of the aberrantly acti-
vated enzymes which initiate pathologic cascades [54e62]. Acidosis
induces mitogen-activated protein kinase phosphorylation, a
requisite for pathologies [63]. Extracellular acidity activates proton-
sensing proteins which prevent the actin polymerization (F-actin)/
depolymerization (G-actin) process, which impedes cellular func-
tions [64,65]. Together, they affect vesicular trafficking, autophagy,
innate immunity, angiogenesis, proliferation, metastasis, apoptosis,
etc. [58,66e68]. Drug resistanceemediating efflux protein, the P-
glycoprotein, activity is increased by low intracellular calcium
levels and high acidic pH [69e72]. Cancer-associated receptor
proteins, the G proteinecoupled receptors such as ovarian cancer G
protein-coupled receptor 1, G protein-coupled receptor 4, and T-cell
death-associated gene 8 act as proton sensors [73,74]. Subsequently,
ion channels such as the proton-gated sodium channels are
manipulated, and this ionic perturbation leads to pain [75e77].
Paleo diets are dominated by plant products and are not pro-
cessed. Therefore, the polyphenolic phytochemicals quench reac-
tive oxygen species and lower acidity [47,78e80]. Fig. 2 illustrates
the mechanism of the Western diet and paleo diet mediating
pathogenesis and restoring homeostasis, respectively.
Discussion
Owing to the inappropriate diet, by the time the individuals
reach their forties, inflammatory diseases affect them. To get rid of
the pathology, people seek sugar-free, fat-free, gluten-free, and
probiotics-enriched diets. Awareness and moderation in food
habits can go a long way in health retention. Inflammatory food
consumption should be minimized to achieve optimal physiological
pH of the body [81]. The inclusion of alkalogenic foods such as
citrate, etc. in diet should be increased [42]. In fact, the Mediter-
ranean food comprising whole grains, fruits, nuts, vegetable, seeds,
 S. Patel, H.A.R. Suleria / Paleolithic diet to prevent inflammation and acidosis
Glycemic control
Fruits
Normalize blood pressure
Vegetables Modulate lipid profile
Decline in weight
Tubers
Nuts Decline C-reactive protein
Drop in glycated haemoglobin (HbAlc)
Lean meat
Paleo diet
Type II diabetes
Acne
Metabolic
acidosis Tumor
Oxidative stress Sepsis
Inflammation Crohn’s disease
Obesity
High glucose Non-alcoholic fatty liver disease
Dairy protein Cardiovascular disease
Saturated fats Chronic kidney disease
Trans fats
Faster bone resorption
Western diet Additives Brain ischemia
Fig. 2. The mechanism of the Western diet and paleo diet mediating pathogenesis and
restoring homeostasis, respectively. Western diet causes oxidative stress and inflam-
mation. It leads to metabolic acidosis and other pathologies. Paleo diet, dominated by
fruits and vegetables, ameliorates blood parameters.
legumes, potatoes, and herbs is regarded the healthiest because of
its alkalogenic ingredients [82e85].
Paleo diet is much ancient than diverse repertoire of ethnic di-
ets. Thousand years of evolution, geographical relocations, and
cultural practices led to the emergence of ethnic diet, from the
paleo diet. Ethnic diets vary in their nutritional values, while some
of them might be better than modern diet, some may not be. Biryani
and burrito are heavy in spice and oils, whereas injera is made of
humble ingredients; poke and sushi are minimally processed.
Furthermore, the ingredients used in the preparation of these
ethnic foods need consideration while determining the food safety.
Raw foods like might contain Norovirus [86], while the health ef-
fects of soy, sesame, etc., are debatable due to the role of phy-
toestrogens (isoflavone and lignan) present in them [87e89].
The current generation is focused mostly on weight loss and
muscle development. Therefore, they do not hesitate to take ste-
roids or supplements. These ingredients might be showing instant
effect but in a long run they are not beneficial for the body. Whey
protein [90], branched-chain amino acids (leucine, isoleucine, and
valine), carnosine, L-arginine, glutamine, carnitine, ZMA (blend of
zinc, magnesium aspartate, and vitamin B6), high molecular-
weight carbohydrates, and beta-ecdysterone are nourishing for
the musculoskeletal system, but these components are also neu-
rotransmitters; therefore, they lead to other health problems.
Questions arise if paleo diet can meet the nutritional require-
ment of humans? Plant-based foods are low in calcium and vitamin
D, the components essential for skeletal system health [1]. In that
case, modern dietary ingredients should be used in moderation.
However, it is important to understand the links. In diseases like
osteoporosis, calcium is lost by bone demineralization. That does
not mean one should take high doses of calcium supplements, as it
will put strain on the kidneys [91]. Calcium is lost from bone, when
the body fluid becomes acidic. It can be hypothesized that as paleo
diet is not likely to raise acidity, calcium loss should not be an issue.
Another publication also supports this hypothesis reporting that
paleo diet has low phytates and sodium chloride content; therefore,
it is less likely to increase acidosis [5].
The arguments that can be made against the inefficacy of paleo
food have been outlined below. Dairy products like cheese and
butter are acidogenic and insulinotropic, but they provide vitamin
239
D, which is needed for health [5,92]. Also, the hunteregatherer era
involved raw consumption of food or probably limited fire usage.
Therefore, the food is likely to contain gliadin, lectins, and saponins.
These components are known to evoke immune response and to
cause intestinal porosity [5,93,94]. A study hypothesizes that
cooked foods required less energy for digestion, which led to the
enhancement in brain size [95]. It challenges the benefit claims of
paleo diet. These hypotheses are worthy of testing.
Also, modern diet with high protein may be harmful for adults,
but not for adolescents. Furthermore, thousand years of evolution
has generated diverse genotypes. Therefore, a “one-size-fits-all”
dietary pattern is not going to help. Therefore, adherence to
personalized diet is important [96]. Apart from that, depending on
age, health status, and co-morbidity, the food habits need to be
revised. In an inflammatory condition, an individual who used to
digest animal proteinebased foods might develop skin rashes
while someone who used to metabolize dairy products might show
intolerance.
Finally, it is important to realize that apart from diet, other
factors are causal of inflammation. These nondiet factors include
infections (virus, bacteria, protozoa, nematode, and fungi), aller-
gens (plant pollen, arthropod chitins, metal, etc.), and occupational
exposures [97e99]. The all-pervasive pollution, reckless usage of
drugs, and chemical toiletries are other cardinal inflammatory
agents [100e103]. Therefore, before attributing paleo diets as
antiinflammatory, effects of these agents ought to be verified. If an
individual's lifestyle includes above inflammatory agents, the best
of nutritious diet, be that paleo or ethnic origin, cannot help alle-
viate a health condition. For systemic well-being, a holistic and
disciplined life is of paramount importance.
Conclusion
Acidogenic foods lead to drop in body pH, which initiate a
cascade of enzyme activation, inflammation, and tumors. In this
regard, dietary correction by adoption of paleo diet appears to be a
holistic solution toward good health. Several clinical cases and
cohort studies have proven that paleo diet is capable of preventing
metabolic syndrome, but the consumers' age, gender, and health
status are critical parameters in its efficacy.
Conflicts of interest
The authors have no conflicts of interest to declare.
Compliance with ethical standards
This work does not involve human participants or animal
models.
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