Random Thoughts On Paleo Eating for People With Diabetes

Not really pertinent, but I like buffalo

I was interviewed a couple months ago by Amy Stockwell Mercer, author of Smart Woman’s Guide to Diabetes. All I knew beforehand was that she was interested in my thoughts on the paleo diet as applied to diabetes.  I think she had run across my PaleoDiabetic blog.

In preparation, I collected some random thoughts and did a little research.

What’s the paleo diet?

Fresh, minimally processed food. Meat (lean or not? supermarket vs yuppiefied?), poultry, eggs, fish, leafy greens and other vegetables, nuts, berries, fruit, and probably tubers.

Non-paleo: highly processed, grains, refined sugars, industrial plant/seed oils, legumes, milk, cheese, yogurt.

The paleo diet is also called Old Stone Age, caveman, ancestral, hunter-gatherer, and Paleolithic diet.

Is the paleo diet deficient in any nutrients?

A quick scan of Loren Cordain’s website found mention of possible calcium and vitamin D deficits. Paleoistas will get vitamin D via sun exposure and fish (especially cold-water fatty fish). Obtain calcium from broccoli, kale, sardines, almonds, collards. (I wonder if the Recommended Dietary Allowance for calcium is set too high.)

What About Carbohydrates and Diabetes and the Paleo Diet?

Diabetes is a disorder of carbohydrate metabolism. In a way, it’s an intolerance of carbohydrates. In type 1 diabetes, there’s a total or near-total lack of insulin production on an autoimmune basis. In type 2 diabetes, the body’s insulin just isn’t working adequately; insulin production can be high, normal or low. In both cases, ingested carboydrates can’t be processed in a normal healthy way, so they stack up in the bloodstream as high blood sugars. If not addressed adequately, high blood glucose levels sooner or later will poison body tissues . Sooner in type 1, later in type 2. (Yes, this is a gross over-simplification.)

Gluten-rich Neolithic food

If you’re intolerant of lactose or gluten, you avoid those. If you’re intolerant of carbohydrates, you could avoid eating them, or take drugs to help you overcome your intolerance. Type 1 diabetics must take insulin. Insulin’s more optional for type 2’s. We have 11 classes of drugs to treat type 2 diabetes; we don’t know the potential adverse effects of most of these drugs. Already, three diabetes drugs have been taken off the U.S. market or severely restricted due to unacceptable toxicity: phenformin, troglitazone, and rosiglitazone.

Humans need two “essential fatty acids” and nine “essential” amino acids derived from proteins. “Essential” means we can’t be healthy and live long without them. Our bodies can’t synthesize them. On the other hand, there are no essential carbohydrates. Our bodies can make all the carbohydrate (mainly glucose) we need.

Since there are no essential carbohydrates, and we know little about the long-term adverse side effects of many of the diabetes drugs, I favor carbohydrate restriction for people with carboydrate intolerance. (To be clear, insulin is safe, indeed life-saving, for those with type 1 diabetes.)

That being said, let’s think about the Standard American Diet (SAD) eaten by an adult. It provides an average of 2673 calories a day. Added sugars provide 459 of those calories, or 17% o the total. Grains provide 625 calories, or 23% of the total. And most of those sugars and grains are in processed, commercial foods. So added sugars and grains provide 40% of the total calories in the SAD. (Figures are from an April 5, 2011, infographic at Civil Eats.)

Anyone going from the SAD to pure Paleo eating will be drastically reducing intake of added sugars and grains, our current major sources of carbohydrate. Question is, what will they replace those calories with?

That’s why I gave a thumbnail sketch of the paleo diet above. Take a gander and you’ll see lots of low-carb and no-carb options, along with some carb options. For folks with carbohydrate intolerance, I’d favor lower-carb veggies and judicious amounts of fruits, berries, and higher-carb veggies and

Will these cause bladder cancer? Pancreatitis?

tubers. “Judicious” depends on the individual, considering factors such as degree of residual insulin production, insulin sensitivity, the need to lose excess weight, and desire to avoid diabetes drugs.

Compared to the standard “diabetic diet” (what’s that?) and the Standard American Diet, switching to paleo should lower the glycemic index and glycemic load of the diet. Theoretically, that should help with blood sugar control.

A well-designed low-carb paleo diet would likely have at least twice as much fiber as the typical American diet, which would also tend to limit high blood sugar excursions.

In general, I favor a carbohydrate-restricted paleo diet for those with diabetes who have already decided to “go paleo.” I’m not endorsing any paleo diet for anyone with diabetes at this point—I’m still doing my research. But if you’re going to do it, I’d keep it lower-carb.  E.g., under 100 g of digestible carb daily. It has a lot of potential.

Are There Any Immediate Dangers for a Person With Diabetes Switching to the Paleo Diet?

It depends on three things: 1) current diet, and 2) current drug therapy, and 3) the particular version of paleo diet followed.

Remember, the Standard American Diet provides 40% of total calories as added sugars and grains (nearly all highly refined). Switching from SAD to a low-carb paleo diet will cut carb intake and glycemic load substantially, raising the risk of hypoglycemia if the person is taking certain drugs.

Drugs with potential to cause hypoglycemia include insulin, sulfonylureas, meglitinides, pramlintide, and perhaps thiazolidinediones.

Who knows about carb content of the standard “diabetic diet”? Contrary to poplular belief, there is no monolithic “diabetic diet.” There is no ADA diet (American Diabetes Association). My impression, however, is that the ADA favors relatively high carbohydrate consumption, perhaps 45-60% of total calories. Switching to low-carb paleo could definitely cause hypoglycemia in those taking the aforementioned drugs.

One way to avoid diet-induced hypoglycemia is to reduce the diabetic drug dose.

A type 2 overweight diabetic eating a Standard American Diet—and I know there are many out there—would tend to see lower glucose levels by switching to probably any of the popular paleo diets. Be ready for hypoglycemia if you take those drugs.

Paleo diets are not necessarily low-carb. Konner and Eaton estimate that ancestral hunter-gatherers obtained 35 to 40% of total calories from carbohydrates. I’ve seen other estimates as low as 22%. Reality likely falls between 22 and 65%. When pressed for a brief answer as to how many carbohydrate calories are in the paleo diet, I say “about a third of the total.” By comparison, the typical U.S. diet provides 50% of calories from carbohydrate.

Someone could end up with a high-carb paleo diet easily, by emphasizing tubers (e.g., potatoes), higher-carb vegetables, fruits, berries, and nuts (especially cashews). Compared with the SAD, this could cause higher or lower blood sugars, or no net change.

A diabetic on a Bernstein-style diet or Ketogenic Mediterranean Diet (both very-low-carb) but switching to paleo or low-carb paleo (50-150 g?) would see elevated blood sugars. Perhaps dangerously high glucoses.

Any person with diabetes making a change in diet should do it in consultation with a personal physician or other qualified healthcare professional familiar with their case.

Steve Parker, M.D.

Fun Facts!

  • A typical carbonated soda contain the equivalent of 10 tsp (50 ml) of sugar.
  • The typical U.S. adult eats 30 tsp (150 ml) daily of added sweeteners and sugars.
  • U.S total grain product consumption was at record lows in the 1970s, at 138 pounds per person. By 2000, grain consumption was up by 45%, to 200 pounds per person.
  • Total caloric sweetener consumption (by dry weight) was 110 pounds per person in the 1950s. By 2000, it was up 39% to 150 pounds.
  • Between 1970 and 2003, consumption of added fats and oils rose by 63%, from 53 to 85 pounds. [How tasty would that be without starches and sugars? Not very.]
  • In 2008, “added fat” calories in the U.S. adult diet were 641 (24% of total calories).

Fun Facts provided by the U.S. Department of Agriculture.

 

5 Comments

Filed under Carbohydrate, Dairy Products, Drugs for Diabetes, Fat in Diet, Glycemic Index and Load, Grains, Paleo diet

Time to Update Your Strength Training Regimen?

Not Chris Highcock

Strength training, also called resistance training, is an important method for controlling blood sugars without drugs in folks with diabetes.

A few months ago I read Hillfit: Stength, an ebook  by Chris Highcock of Conditioning Research.  It’s about  improvement of hiking skills and enjoyment via strength training with without having to join a gym or buy lots of equipment.  I’ve been on Chris’s program for the last five weeks.

One of the scientific review articles he cites in support of his recommendations is an eye-opener.  Evidence-Based Resistance Training Recommendations is available free online.  It’s published in Medicina Sportiva, which I’m not familiar with.  I’ll confess I’ve read little of the hard-core literature on the science of strength training.  It’s one of my more recent interests.

An excerpt:

We recommend that appreciably the same muscular strength and endurance adaptations can be attained by performing a single set of ~8-12 repetitions to momentary muscular failure, at a repetition duration that maintains muscular tension throughout the entire range of motion, for most major muscle groups once or twice each week. All resistance types (e.g. free-weights, resistance machines, bodyweight, etc.) show potential for increases in strength, with no significant difference between them, although resistance machines appear to pose a lower risk of injury.

The article has got me questioning some of my long-held notions, such as how often to work out, number of reps moving a weight, speed of moving a weight, and whether I should stick with the free weights I tend to prefer.  Why not see if your dogma is supported?  Worth a look.

Steve Parker, M.D.

Fisher, James, et al.  Evidence-based resistance training recommendations.  Medicina Sportiva, 15 (2011): 147-162.

2 Comments

Filed under Exercise

Quote of the Day

The sovereign invigorator of the body is exercise, and of all the exercises walking is the best.

Thomas Jefferson

Comments Off on Quote of the Day

Filed under Exercise

Does Cutting Out Sugary Drinks Help With Weight Loss?

Are you obese, love sugary drinks, and want to easily lose four pounds (1.8 kg) over the next six months? Simply cut a couple of sugary drinks out of your daily diet, replace them with water or diet soa, and you may lose the pounds.  Or so say University of North Carolina researchers.
Down 4 pounds in 6 months. I’ll take it!

In the U.S., our consumption of calories from sugar-sweetened beverages (SSBs) almost doubled between 1965 and 2002, now comprising 21% of our total calories.  (I’ve seen lower estimates, too, such as all added sugars accounting for 17% of total calories.)  Remember that our overweight and obesity rates started rising around 1970.  Any connection there?

Some have speculated that cutting back on SSB consumption would lead to loss of some excess weight.  But it’s never really been tested until now.

By the way, your typical sugary carbonated beverage has 145 calories of pure carbohydrate, most often high fructose corn syrup.  That’s equivalent to 10 tsp (50 ml) of table sugar.  Soft drinks are liquid candy.

Methodology

UNC investigators recruited  about 300 overweight and obese folks (average BMI 36, average weight 100 kg (220 lb), 84% female, 54% black) who drank at least 280 calories daily of caloric beverages (sugar-sweetened beverages, juice, juice drinks, sweetened coffee and tea, sweetened milk, sports drinks, and alcohol).  In other words, they all drank at least two soft drinks or the equivalent daily.  Participants agreed to make a dietary substitution for six months.

The participants were randomly assigned to one of three study groups with a hundred participants per group. For the next six months…

  • Group WA substituted at least two of their SSBs daily with water (WA), any type as long as it was calorie-free.  Bottled water was provided.  This reduced sugary drink calories by 230/day.
  • Group DB substituted at least two of their SSBs daily with calorie-free diet beverages (DB).  Beverages were provided.  This reduced sugary drink calories by 230/day.
  • Group AC (attention controls) made no changes in baseline beverage consumption.  Investigators made a point not to talk to them about beverages.

All three groups had monthly group meetings.  WA and DB group meetings were focused on adherence to the beverage substitution guidelines.
The AC group meetings will involved a weigh-in and general weight loss information (e.g., read food labels, increase vegetable consumption, portion control, and increase physical exercise).

“All … groups had access to a group-specific …website, where they recorded the beverages (water and DB only) they consumed, reported their weekly weight, received feedback on progress, viewed tips, and linked to group-specific resources.”

Results

All three groups lost statistically significant amounts of weight, but there was no difference in amount of weight lost among the groups.  In other words, the folks who substituted water or diet beverages for  sweet drinks didn’t do any better than the AC (attentive control) group.

Average amounts of weight lost were in the range of 1.8 to 2.5% of total body weight.  For example, if you weigh 200 lb (91 kg) and lose 2% of your weight, that’s a 4-lb loss (1.8 kg).

Compared to the AC group, the WA group showed a statistically significant decrease in fasting blood sugar (down 3 mg/dl).  BTW, none of the participants were diabetic.

Sugar cane

Take-Home Points

Would the substituters have lost weight if they had simply cut out two sugary drinks a day, skipping the monthy meetings and website?  Don’t know.  But I bet that’s how the mainstream press will spin this.

If I were obese and had a sugary drink habit, I’d start substituting water.  Yesterday.

Substituting water for a couple sugary drinks a day could reduce risk of developing diabetes.

I was hoping to see a significantly greater weight loss in the water and diet drink substituters compared to the AC (Attention Control) group.  Presumably all of these AC folks would have stayed at their baseline weights if they hadn’t done any of this.  The substitution groups apparently didn’t receive the general weight-loss information given to the AC group.

One caveat: All groups had monthly meetings for six months.  What were the substitution groups  talking about other than adherence to the protocol?  Your guess is as good as mine since the researchers don’t say.  Perhaps something about those meetings led to the weight loss, not the act of substituting water or diet drinks for sugar.

So they lost an average of 4–5 lb (2 kg).  Big deal, right?  But remember this was just a six-month study.  Could that 4 lb turn into 12 lb (5.5 kg) over 18 months?  Maybe, but we don’t know.

Here’s the thing about averages.  Some of these people I’m sure lost closer to 5% of body weight, and some didn’t lose any, or gained.  Which group would you be in?  Only one way to find out.

Remember that many medical conditions linked to overweight and obesity improve with loss of just 5% of body weight.

The substituters cut out 230 calories a day of sugary drinks.  All other things being equal, they should have lost 12 lb (5.5 kg).  Problem is, all other things aren’t equal.  Numerous other factors are at play, such as activity levels, replacement of sugary drink calories with other calories, measurement errors, reporting errors, etc.

This was a female-heavy study.  Would this strategy work for men?  Even better in men?  We don’t know.  Why not try it yourself?

Steve Parker, M.D.

PS: I did a sugar-free and wheat-free experiment on myself earlier this year.  Lost some weight, too.

Reference: Tate, Deborah, et al.  Replacing caloric beverages with water or diet beverages for weight loss in adults: main results of the Choose Healthy Options Conscioulsly Everday (CHOICE) randomized clinical trialAmerican Journal of Clinical Nutrition, February 1, 2012, Epub ahead of print.  doi: 10.3945/ajcn.111.026278

Comments Off on Does Cutting Out Sugary Drinks Help With Weight Loss?

Filed under Carbohydrate, Overweight and Obesity, Sugar, Weight Loss

How Has the U.S. Diet Changed Over the Last Century?

U.S. obesity rate over last 40 years

 Beth Mazur over at Weight Maven has posted a lecture by Dr. Stephan Guyenet in which he outlines the changes in American diet over the last 100 years.  It’s only 16 minutes long.  You may  find an explanation for our excess weight problem.

On a related note, Civil Eats posted a cool info graphic showing the sources of calories in the U.S. diet and how those sources have evolved over the last four decades.

Steve Parker, M.D.

1 Comment

Filed under Uncategorized

Who’s Ray Audette?

Ray Audette hunted with hawks

I ran across a 1995 well-researched online article about Ray Audette, author of NeanderThin and one of the modern paleo movement pioneers.  It’s in Dallas Observer News: http://www.dallasobserver.com/1995-07-06/news/neander-guy/

Audette apparently self-published his book in 1995.  (Publishing by a “vanity press” is probably more accurate for the mid-90s.)  The 2000 edition of the book from St. Martin’s Paperbacks has a foreword by Dr. Michael Eades, who is also quoted liberally in the aforementioned article.

Mr. Audette credited his diet for curing both his diabetes and rheumatoid arthritis.  I’ve been pondering whether paleo-style eating  is generally a good thing for people with diabetes.  There are plenty of anecdotal reports of benefit.  Wish we had more scientific research.

1995 was only 17 years ago.  It seems like ancient history to me.

Steve Parker, M.D.

PS: The paleo diet is also referred to as the Old Stone Age, caveman, or Paleolithic diet.

3 Comments

Filed under Paleo diet

Quote of the Day

The second day of a diet is always easier than the first. By the second day you’re off it.

                                                     —Jackie Gleason

Comments Off on Quote of the Day

Filed under Quote of the Day

Right Diet Preserves Brain Function and Size

mp9004223691.jpg  Neurology last year reported that the proper diet seems to help prevent age-related brain shrinkage and cognitive decline.

From the press release:

People with diets high in several vitamins or in omega 3 fatty acids are less likely to have the brain shrinkage associated with Alzheimer’s disease than people whose diets are not high in those nutrients, according to a new study published in the December 28, 2011, online issue of Neurology, the medical journal of the American Academy of Neurology.

Those with diets high in omega 3 fatty acids and in vitamins C, D, E and the B vitamins also had higher scores on mental thinking tests than people with diets low in those nutrients. These omega 3 fatty acids and vitamin D are primarily found in fish. The B vitamins and antioxidants C and E are primarily found in fruits and vegetables.

So the dietary pattern linked to preservation of brain size and function in this study is: high omega-3 fatty acids and vitamins B, C, D, and E. I don’t know if study participants were getting these nutrients from supplements or from food or a combination. (I haven’t read the full article.)

Note that the time-honored Mediterranean diet is also associated with lower rates of dementia and slower rate of age-related mental decline.

I previously reported that a supplement cocktail of three B vitamins slowed the rate of brain shrinkage

Steve Parker, M.D.

Reference: Bowman, G.L., et al. Nutrient biomarker patterns, cognitive function, and MRI measures of brain aging. Neurology. doi: 10.1212/WNL.0b013e3182436598

h/t to Randall Parker at FuturePundit

3 Comments

Filed under Dementia, Health Benefits, Mediterranean Diet

Do We Need Supplements Because Our Soils are Depleted?

In my recent review of The Blood Sugar Solution, I noted the numerous supplements recommended by Dr. Mark Hyman: between 11 and 16 supplements.  And one of those supplements is a multivitamin/multimineral supplement that has 20 or so different components.

One reason we need the supplements, according to Dr. Hyman, is because the soils in which we grow food over the years has been depleted of minerals and other basic plant building blocks.

I know one doctor who told his patients the same thing while selling them over-priced supplements straight from his office.  According to the reviews of Dr. Hyman’s book at Amazon.com, Dr. Hyman sells supplements at his website.  The guy’s got an impressive marketing machine!

So is there any truth to the “soil depletion” argument for supplements?

Not much, if any, according to Monica Reinagel.  She reviewed the topic in 2010 at her Nutrition Diva blog: http://nutritiondiva.quickanddirtytips.com/are-fruits-and-vegetables-getting-less-nutritious.aspx.  I trust Monica.  In the same article, you’ll find links to her opinion on whether organic vegetables are healthier and worth the cost.

I’ve not done a comprehensive review of the soil depletion issue myself.   It’s quite a difficult area to research; try it and you’ll see.  The Soil Science Society of America, founded in 1936, sounds like a great place to find the answer.  No such luck.

The U.S. is a huge country with lots of different soil types and usage histories.   Soils in one field may be depleted in certain components whereas the field across the road may be quite rich.  Soils are not static.  Farmers are always making amendments to the soil, either with fertilizers or other additives, or by rotating crops.

Wouldn’t you think farmers, whether small family units or huge corporate enterprises, would do what’s necessary to keep their soils productive?

Another way to look at soil depletion would be to look at the nutrient content of the plants and animals that depend on soil for life.  The U.S. Department of Agriculture did that in its 2004 publication, “Nutrient Content of the U.S. Food Suppy, 1909-2000.”  This paper includes 10 vitamins and nine minerals.  For the boring details, see   http://www.cnpp.usda.gov/publications/foodsupply/foodsupply1909-2000.pdf.   Some excerpts:

Levels for most vitamins and minerals were higher in 2000 than in 1909.

Levels for vitamin B12 and potassium were lower in 2000 than in 1909, but over the series, met or exceeded current recommendations for a healthy diet….

The authors attibute lower potassium availability to lower consumption of plant foods, especially fresh potatoes.  I’m increasingly interested in the possibilty that low potassium consumption may contribute to heart disease and premature death.  But that’s a topic for another day.

I’m skeptical about claims of widespread soil depletion in the U.S. as a cause of food supply degradation.  Supplement sellers are sure to disagree.  To be sure you’re getting the nutrients you need, eat a wide variety of foods.

Steve Parker, M.D.

PS: The American Council on Science and Health has a brief article on whether everybody needs a multivitamin/multimineral supplement.

New research is questioning the benefits of taking supplemental vitamins and minerals, suggesting that, for the general population, such supplements may actually pose more risks than benefits.

Click for the full article: http://www.acsh.org/factsfears/newsid.3067/news_detail.asp

PPS:  Oregon State University’s Linus Pauling Institute published a long article on the multivitamin/multimineral supplement issue.  It seems fairly balanced to me.  The Institute notes the 2006 National Institutes of Health assessment that we have insufficient evidence to recommend either for  or against such supplementation (Annals of Internal Medicine, 145(5), 2006: 364-371).  Nevertheless, the Linus Pauling Institute recommends supplementation as “insurance.”  You know, just in case.

3 Comments

Filed under Supplements

Chronic Alcohol May Impair Vision in Diabetics

MedPage Today reported that long-term consumption of alcohol may impair vision in diabetics.  Drinkers performed less well on vision chart tests than non-drinkers. It’s not a diabetic retinopathy issue.

Beer and distilled spirits were riskier than wine.

The MedPage Today article didn’t comment on the potential health benefits of alcohol consumption. You can bet I’ll keep an eye on this.  (Did you get the pun?)

Steve Parker, M.D.

Comments Off on Chronic Alcohol May Impair Vision in Diabetics

Filed under Alcohol, Diabetes Complications