Swedish researchers reported recently that a Paleolithic diet was more satiating than a Mediterranean-style diet, when compared on a calorie-for-calorie basis in heart patients. Both groups of study subjects reported equal degrees of satiety, but the paleo dieters ended up eating 24% fewer calories over the 12-week study.
The main differences in the diets were that the paleo dieters had much lower consumption of cereals (grains) and dairy products, and more fruit and nuts. The paleos derived 40% of total calories from carbohydrate compared to 52% among the Mediterraneans.
Even though it wasn’t a weight-loss study, both groups lost weight. The paleo dieters lost a bit more than the Mediterraneans: 5 kg vs 3.8 kg (11 lb vs 8.4 lb). That’s fantastic weight loss for people not even trying. Average starting weight of these 29 ischemic heart patients was 93 kg (205 lb). Each intervention group had only 13 or 14 patients (I’ll let you figure out what happened to to the other two patients).
I blogged about this study population before. Participants supposedly had diabetes or prediabetes, although certainly very mild cases (average hemoglobin A1c of 4.7% and none were taking diabetic drugs)
As I slogged through the research report, I had to keep reminding myself that this is a very small, pilot study. So I’ll not bore you with all the details.
Bottom Line
This study suggests that the paleo diet may be particularly helpful for weight loss in heart patients. No one knows how results would compare a year or two after starting the diet. The typical weight-loss pattern is to start gaining the weight back at six months, with return to baseline at one or two years out.
Greek investigators found a link between the Mediterranean diet and better clinical outcomes in known ischemic heart disease patients. On the other hand, researchers at the Heart Institute of Spokane found the Mediterranean diet equivalent to a low-fat diet in heart patients, again in terms of clinical outcomes. U.S. investigators in 2007 found a positive link between the Mediterranean diet and lower rates of death from cardiovascular disease and cancer.
We don’t yet have these kinds of studies looking at the potential benefits of the paleo diet. I’m talking about hard clinical endpoints such as heart attacks, heart failure, cardiac deaths, and overall deaths. The paleo diet definitely shows some promise.
I also note the Swedish investigators didn’t point out that weight loss in overweight heart patients may be detrimental. This is the “obesity paradox,” called “reverse epidemiology” at Wikipedia. That’s a whole ‘nother can o’ worms.
Keep your eye on the paleo diet.
Reference: Jonsson, Tommy, et al. A paleolithic diet is more satiating per calorie than a mediterranean-like diet in individuals with ischemic heart disease. Nutrition and Metabolism, 2010, 7:85.
Diabetic Mediterranean Diet 
I’m curious if you would consider these diets representative of Paleo and Med?
http://www.nutritionandmetabolism.com/content/7/1/85/table/T2
Macro-wise they differed only slightly. Of note, carbs + protein = 66% for paleo, 67% for Med. There’s about a 6-7% swing in there with Paleo consuming more protein (27% v 20%) and fewer carbs (39% v 47%). The Med group consumed a lot of dairy it seems, although masses can be deceiving, 308g v 39g on average is considerably different. I always thought dairy was shunned on Med too.
Curious on your thoughts on this. Thanks!
Hi, CarbSane. Here’s my recollection of the food recommendations in the study at hand. The paleo diet was based on lean meat, fish, fruits, leafy and cruciferous vegetables, root vegetables (potatoes limited to two or fewer medium-sized per day), eggs, and nuts (no grains, rice, dairy products, salt, or refined fats and sugar). The Mediterranean-like diet focused on low-fat dairy, whole grains, vegetables, fruits, potatoes, fatty fish, oils and margarines rich in monounsaturated fatty acids and alpha-linolenic acid.
What we know as the healthy traditional Mediterranean diet is based on that of the mid-20th century, with heavy emphasis on southern Italy and Greece. Yogurt and cheeses were part of that diet, although not generally low-fat versions, which are a later invention. Nor would margarine be part of it. Amounts of yogurt and cheese would vary by region and individual.
Regarding carb content of the Paleolithic diet, you can find evidence for anything between 20 and 46% of total energy, in general.
-Steve
Personally I think a diet based on the paleo diet is probably the optimal human diet, but we do have some “non-paleo” food items that seem to have big health benefits, such as high-fat dairy.
Hi, Kris. You may well be right about paleo being optimal for the general population. Wish the researchers would get busy proving it. It won’t be long before someone devises a “paleo diet score” and applies it to the huge databases such as Nurses’ Health Study and Health Professional Follow-Up Study. Next we’ll need a prospective, interventional trial.
-Steve
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