Some of you may know that I’ve designed a paleo diet for folks with diabetes. If interested, check out the Paleo Diabetic blog. Feedspot in February placed it on their Top 80 Paleo Diet Blogs and Websites list.
Steve Parker, M.D.
At Diabetes Warrior:
In this post I will be discussing my latest experiment. I am calling it “Diabetic Carnivore 2.0”. It’s 2.0 because I went ‘full-carnivore’ in 2017 for about three years, before tapering off earlier in 2020.
I’ll answer these questions in this post:
1) What is a carnivore in the context of this dietary experiment?
2) Why am I going ‘full-carnivore’ again?
* * *
Had we only grown lower carb, leafy green vegetables in our garden, I’d still be eating them probably … but we didn’t. We also grew higher carb vegetables and fruits like tomatoes, beets, turnips, onions and carrots.
We started out eating collards, chard and turnip green salads … all was well. Then I began easing turnips, carrots, beets, and tomatoes into our slaw. Small portions at first… but then the ‘carb creep’ happened. I would add more and more of the sugary, starchy veggies and fruits to the slaw, as well as eat more and more of them.
I only tracked my daily intake of carbs from the vegetables and fruits once. That one day, my carb totals were in the 70 gram range! Not a lot compared to ‘Standard American Diet’ but a lot compared to my typical ‘near zero carb’ meal plan.
Just like a previous high carb experiment (see this post, “Very Low Fat (and high carb) Experiment“), my body handled the sugar and starches from the vegetables pretty well at first but then the fasting blood sugars began to creep up.
Read on to see the connection to COVID-19.
Steve Parker, M.D.
The study at hand is an isolated case report, so we can’t get too excited about it. But it does suggest that a “paleolithic ketogenic diet” may be helpful in Crohn’s disease. “Carnivore diet” may be a better description of the treatment.
The problem with case reports is that an individual’s response to intervention may simply reflect placebo effect or spontaneous improvement of the underlying condition, rather than a true response to the treatment applied.
Crohn’s disease is one of two “inflammatory bowel diseases,” the other being ulcerative colitis. Both of these are felt to be autoimmune, meaning the body is attacking its own tissues as if they were foreign invaders, like germs. Crohn’s disease causes abdominal pain, diarrhea (sometimes bloody), bloating, nausea, malnutrition, and other effects. Ulcerative colitis is similar in presentation. I wrote many years ago about a paleo diet improving at least one case of ulcerative colitis.
Hungarian physicians (?) reported a case of a 16-year-old who was diagnosed with Crohn’s disease at age 14 and wasn’t doing well at all despite standard medical therapy. At one point, intestinal surgery was recommended but he (or his parents) declined.
On the paleolithic ketogenic diet, the patient went into remission within months, off medications, and has been in remission for 15 months. The patient’s BMI rose from 17.7 to 19.5.
So, what was this diet?
Why did this carnivore diet seem to work? The authors propose it improves the pathological intestinal permeability seen in Crohn’s disease. In short, excessive intestinal permeability allows bad things to enter the bloodstream and wreak havoc.
This is a radical diet compared to the Standard American Diet featuring dairy, grains, industrial seed oils, and ultra-processed foods. As usual, check with your personal physician before making any radical diet change. Odds are, however, your doctor doesn’t know much about this diet and won’t approve.
Steve Parker, M.D.
h/t P.D. Mangan
Yes...at least according to a tiny short-term study done in Germany. Only 10 experimental subjects.
Here’s their description of the food: “…low in carbohydrates, rich in Omega-3 fatty acids, and rich in vitamins C and D, antioxidants and fiber for four weeks.” How low in carbs? To a level “as far as possible to a level < 130 grams/day.” Click the link above for full diet details. It looks to me like a paleo diet.
The researchers note in the body of their report that they can’t tell for sure which components of the experimental diet were most helpful, but they suspect it’s 1) the carbohydrate restriction, 2) increased omega-3 fatty acids, and 3) reduced omega-6 consumption.
Those three factors are at play in the both the Paleobetic Diet and Low-Carb Mediterranean Diet.
Here’s the study’s abstract for you science nerds:
The aim of this pilot study was to investigate the effects of four weeks of an oral health optimized diet on periodontal clinical parameters in a randomized controlled trial.
The experimental group (n = 10) had to change to a diet low in carbohydrates, rich in Omega-3 fatty acids, and rich in vitamins C and D, antioxidants and fiber for four weeks. Participants of the control group (n = 5) did not change their dietary behavior. Plaque index, gingival bleeding, probing depths, and bleeding upon probing were assessed by a dentist with a pressure-sensitive periodontal probe. Measurements were performed after one and two weeks without a dietary change (baseline), followed by a two week transitional period, and finally performed weekly for four weeks.
Despite constant plaque values in both groups, all inflammatory parameters decreased in the experimental group to approximately half that of the baseline values (GI: 1.10 ± 0.51 to 0.54 ± 0.30; BOP: 53.57 to 24.17 %; PISA: 638 mm2 to 284 mm2). This reduction was significantly different compared to that of the control group.
A diet low in carbohydrates, rich in Omega-3 fatty acids, rich in vitamins C and D, and rich in fibers can significantly reduce gingival and periodontal inflammation.
Thanks to BioMed Central for making the entire report available for free.
An oral health optimized diet can reduce gingival and periodontal inflammation in humans – a randomized controlled pilot study
Published: 26 July 2016
A scientific study published 2017 compared a high-carb (at least 250 grams/day) to low-carb diet (50 grams or less) in 10 patients with type 1 diabetics. The low-carb diet yielded more time in the normal blood sugar range, less hypoglycemia, and less variability of glucose levels.
I assume the low-carb diet required less insulin, but I don’t know since I haven’t seen the full article. Let me know if you can confirm.
Here’s the abstract:
The aim of the present study was to assess the effects of a high carbohydrate diet (HCD) vs a low carbohydrate diet (LCD) on glycaemic variables and cardiovascular risk markers in patients with type 1 diabetes. Ten patients (4 women, insulin pump-treated, median ± standard deviation [s.d.] age 48 ± 10 years, glycated haemoglobin [HbA1c] 53 ± 6 mmol/mol [7.0% ± 0.6%]) followed an isocaloric HCD (≥250 g/d) for 1 week and an isocaloric LCD (≤50 g/d) for 1 week in random order. After each week, we downloaded pump and sensor data and collected fasting blood and urine samples. Diet adherence was high (225 ± 30 vs 47 ± 10 g carbohydrates/d; P < .0001). Mean sensor glucose levels were similar in the two diets (7.3 ± 1.1 vs 7.4 ± 0.6 mmol/L; P = .99). The LCD resulted in more time with glucose values in the range of 3.9 to 10.0 mmol/L (83% ± 9% vs 72% ± 11%; P = .02), less time with values ≤3.9 mmol/L (3.3% ± 2.8% vs 8.0% ± 6.3%; P = .03), and less glucose variability (s.d. 1.9 ± 0.4 vs 2.6 ± 0.4 mmol/L; P = .02) than the HCD. Cardiovascular markers were unaffected, while fasting glucagon, ketone and free fatty acid levels were higher at end of the LCD week than the HCD week. In conclusion, the LCD resulted in more time in euglycaemia, less time in hypoglycaemia and less glucose variability than the HCD, without altering mean glucose levels.
But that was way back in 2014…
To the uninitiated, the much talked about Paleo diet — a nutritional regimen centered around pasture-raised meat, eggs, fresh fruit and vegetables, and nuts, in the spirit of our cave-dwelling forebears — may seem like another low-carb fad, the South Beach diet dressed up in a mammoth hide. But the time has passed when it could be written off as a fringe movement of shaggy-haired Luddites with an outsize taste for wild boar meatloaf.
Lately, Paleo has charged toward the mainstream, not only as a hugely popular diet (it was most-searched diet of 2013, according to the Google Trends Zeitgeist list), but also as a cave-man-inspired lifestyle that has spawned a fast-growing industry.
If you’re interested in a paleo-style diet for diabetes, check out my Paleobetic diet.
Steve Parker, M.D.
A great thing about the macadamia nut is that it’s one of the few nuts with a good omega-6/omega-3 fatty acid ratio. In other words, it’s high in omega-3 and low in 6. This may have important cardiovascular health implications. Macadamias are one of the nuts I recommend in the Low-Carb Mediterranean Diet and Paleobetic Diet.
The first Australian macadamia plantation didn’t begin until the 1880s. And not until 1954 with the introduction of mechanised processing did commercial production became viable. Nowadays about 90 percent of the the world’s macadamia nut production comes from Hawaii, where it has become its third most important crop, according to The Wellness Encyclopedia of Food and Nutrition, University of California at Berkeley (1992).
Read the rest, where you’ll learn that macadamia nuts are the highest of all nuts in calories, gram for gram.
ABC Radio provides the audio and transcript of an interview with Dr. Troy Stapleton, who was diagnosed with type 1 diabetes at age 41. Dr. Stapleton lives in Queensland, Australia. At the time of his diagnosis…
I was advised to eat seven serves of bread and cereals, two to three serves dairy, fruit, starchy vegetables, and to balance that intake with insulin. If you add up all those serves, they were recommending a diet of up to about 240 grams of carbohydrates a day, and to balance it with insulin. I was going to be the best patient, and there has been some important trials that show that if you do control your blood glucose well then you can reduce your incidence of the complications.
Dr. Stapleton believes we evolved on a very low carbohydrate diet; the Agricultural Revolution led to our current high carb consumption. He was concerned about the risk of hypoglycemia with standard diabetic diets.
There was a different approach where essentially you went on a very low carbohydrate diet, this made a little bit of sense to me. Why would I eat carbohydrates and then have to balance it with insulin?
Here’s what the diabetes educators told him:
What they say is you need to estimate the amount of carbohydrate you’re going to eat, and then you need to match that carbohydrate dose essentially with an insulin dose. So you sort of look at your food and you go, okay, I’m having 30 grams of carbohydrate and I need one unit of insulin per 15 grams of carbohydrate, so two units. It sounds really quite straightforward, except that it’s very, very difficult to estimate accurately the amount of carbohydrate you’re eating. The information on the packets can be out by 20%. Most people say that your error rate can be around 50%.
And then of course it changes with what you’ve eaten. So if you eat carbohydrates with fat and then you get delayed absorption, then that glucose load will come in, and then the type of carbohydrates will alter how quickly it comes in to your bloodstream. And then of course your insulin dose will vary, your absorption rate will vary by about 30%. Once you think through all the variables, it’s just not possible. You will be able to bring your blood glucose under control, but a lot of the time what happens is you get a spike in your glucose level immediately after a meal, and that does damage to the endothelium of your blood vessels…
Norman Swan: The lining.
Troy Stapleton: That’s correct, it causes an oxidative stress to your endothelium, and that is the damage that diabetes does, that’s why you get accelerated atherosclerosis.
Here’s what happened after he started eating very low carb:
It’s been amazing, it’s been the most remarkable turnaround for me and I just cut out carbohydrates essentially completely, although I do get some in green leafy vegetables and those sorts of things. My blood sugar average on the meter has gone from 8.4 [151 mg/dl] down to 5.3 [95 mg/dl]. My HbA1c is now 5.3, which is in the normal range. My blood pressure has always been good but it dropped down to 115 over 75. My triglycerides improved, my HDL improved, so my blood lipid profile improved. And I would now have a hypoglycaemic episode probably about once a month after exercise. [He was having hypoglycemia weekly on his prior high carb diet with carb counting insulin adjustments.]
He was able to reduce his insulin from about 27 units a day down to 6 units at night only (long-acting insulin)! He admits his low insulin dose may just reflect the “honeymoon period” some type 1s get early on after diagnosis.
Norman Swan: So when you talk to your diabetes educator now, what does he or she say?
Troy Stapleton: Look, they’re interested, but they’ll tell me things and I’ll say, well, that’s actually not true. I’m quite a difficult patient, Norman.
He says he’s eating an Atkins-style diet. Combining the transcript and his notes in the comments section: 1) he doesn’t eat potatoes or other starchy vegetables or bread, 2) he eats meat, eggs, lots of starchy vegetable, some berries and tree nuts, olives, and cheese, 3) an occasional wine or low-carb beer, 4) coffee, and 5) he eats under 50 g/day of carbohydrate, probably under 30 g. This is a low-carb paleo diet except for the cheese, alcohol, and coffee. Cheese, alcohol and coffee are (or can be) low-carb, but they’re not pure paleo.
He notes that…
There is an adaption period to a very low carbohydrate diet which takes 4-6 weeks (ketoadaption). During this time symptoms include mild headaches, lethargy, cramps, carb cravings and occasional light headedness. These symptoms all pass.
Read or listen to the whole thing. Don’t forget the comments section. All the blood sugars you see there are in mmol/l; convert them to mg/dl (American!) by multiplying by 18.
Newly diagnosed type 2 diabetics have no need to avoid fruit …according to an article in Nutrition Journal. Fruit is a prominent component of the Mediterranean and paleo diets. It can be good for us, containing phytonutrients, fiber, etc. But fruit has the potential to increase blood sugars, too, which may be harmful over the long run. So whadda you do?
Researchers took newly diagnosed type 2 diabetics and split them into two groups. One group was told to eat at least two pieces of fruit daily, the other was told to eat no more than two pieces.
The researchers conclusions:
A recommendation to reduce fruit intake as part of standard medical nutrition therapy in overweight patients with newly diagnosed type 2 diabetes resulted in eating less fruit. It had however no effect on HbA1c, weight loss or waist circumference. We recommend that the intake of fruit should not be restricted in patients with type 2 diabetes.
PS: I haven’t read the full report yet.
Dr. Lynda Frassetto is a Professor of Medicine and Nephrology at the University of California San Francisco. She and her colleagues have completed a study of the Paleolithic diet as a treatment for diabetes (type 2, I think). As far as I know, details have not yet been published in the medical literature.
Dr. Frassetto spoke at the Ancestral Health Symposium-2012 earlier this year. You can view the 35-minute video here.
She is convinced that a paleo diet, compared to a Mediterranean-style diet, is better at controlling blood sugars and “reducing insulin” in diabetics (presumably type 2s). Insulin sensitivity is improved, particularly in those with insulin resistance to start with. The paleo diet group saw an average drop of fasting glucose by 23 mg/dl (1.3 mmol/l). One slide you’ll see in the video indicates the paleo diet reduced absolute hemoglobin A1c by 0.3%, compared to 0.2% with the “Mediterranean” diet. (Let me know if I got the numbers wrong.)
Color me underwhelmed so far.
Questions raised by the video include:
For answers, we await publication of the formal report.
PS: I’m quite interested in the paleo diet as a treatment for diabetes. I explore the concept at the Paleo Diabetic blog.