Tag Archives: paleo diet

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.

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UCSF Investigating Paleolithic Diet For Diabetics

  A May, 2010, press release from University of California San Francisco outlines the university’s research into use of the Paleolithic diet (aka Stone Age or caveman diet) for people with type 2 diabetes.  From the press release:

The initial research findings are striking. Without losing weight, participants in a preliminary study improved blood sugar control, blood pressure control and blood vessel elasticity. They lowered levels of blood fats such as cholesterol. And most amazingly, participants achieved these results in less than three weeks — simply by switching to a Paleolithic diet.

The lead researchers are nephrologist Lynda Frassetto and endocrinologist Umesh Masharani.  Frassetto and team had previously looked at metabolic improvements linked to the paleo diet.

We await publication of their current findings in a peer-reviewed scientific journal.  C’mon people, it’s 2012 already.  In the meantime, I prefer the Low-Carb Mediterranean Diet.

Steve Parker, M.D.

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Book Review: The Smarter Science of Slim

I  recently read The Smarter Science of Slim, by Jonathan Bailor and published in 2012.   Per Amazon.com’s rating system, I give it four stars (“I like it”).

♦   ♦   ♦

Mr. Bailor’s weight-management diet avoids grains, most dairy, oils, refined starches, added sugars, starchy veggies, corn, white potatoes.  You eat meat, chicken, eggs, some fruit, nuts, seeds, and copious low-starch vegetables.  No limit on food if you eat the right items.   

It’s high-fiber, high-protein, moderate-fat, moderate-carb (1/3 of calories from carbohydrate,  1/3 from protein, 1/3 from fat).  He considers it Paleo (Stone Age) eating even though he allows moderate legumes and dairy (fat-free or low-fat cottage cheese and plain Greek yogurt).

Will it lead to weight lose? Quite probably in a majority of followers, especially those eating the standard, low-quality American diet.  When it works, it’s because you’ve cut out the fattening carbohydrates so ubiquitous in Western societies.  The protein and fiber will help with satiety.  Is it a safe eating plan?  Yes.

For those with diabetes needing to lose weight, I prefer a lower carbohydrate content in the diet, something like Conquer Diabetes and Prediabetes: The Low-Carb Mediterranean Diet.

I don’t recall any recipes or specific meal plans.  You put your own meals together following his guidelines.

Our major points of agreement:
 – Exercise isn’t terribly helpful as a weight-loss technique for most folks.
 – We’re overweight because we eat too many starches and sweets.
 – Natural, minimally processed foods are healthier than man-made highly refined items.
 – No need to emphasize “organic” /grass-fed beef/free-range chicken.
 – We don’t do enough high-quality exercise.

I have a few problems with the book:
 – It says we’re eating less.  U.S. caloric consumption over the last several decades has increased by about 150 cals (630 kJ) a day for men and 300 cals (1260 kJ) for women.  The author seems to contradict himself at one point by favorably quoting Hilda Bruch’s writing that “…overeating is observed with great regularity” in the obese. 
 – Scary graphs showing increasing instances of heart disease and diabetes over time aren’t helpful because they ignore population growth.  The population-adjusted diabetes rate is indeed increasing whereas heart disease rates are decreasing.
 – It says the Calories In/Calories Out theory of overweight has been proven wrong.  This is by no means true.  It just hasn’t helped us much to reverse the overweight epidemic.  Sure, it’s often said that if you just cut a daily tablespoon of butter out of your diet, you’d lose 11 lb (5 kg) in a year, all other things being equal.  Problem is, all other things are never equal.  In reality, we replace the butter with something else, or we’re slightly less active.  So weight doesn’t change or we gain a little.
 – It says the “eat less, exercise more” mantra has been proven wrong as a weight loss method.  Not really.  See above.  And watch an episode of TV’s The Biggest Loser.  Exercise can burn off fat tissue.  The problem is that we tend to overeat within the next 12 hours, replacing the fat we just burned. I agree with the author that “eat less, exercise more” is extremely hard to do, which is the reason it so often fails over the long run.  As Mr. Bailor writes elsewhere: “Hard to do” plus “do not want to do” generally equals “it’s not happening.”  Mr. Bailor would say the reason it ultimately fails is because of a metabolic clog or dysregulation. 
 – He says there’s no relationship between energy (calorie) consumption and overweight.  Not true.  Need references?  Google these: PMID 15516193, PMID 17878287, PMID 14762332.  The author puts too much faith in self-reports of food intake, which are notoriously inaccurate.  And obese folks under-report consumption more than others (this is not to say they’re lying). 
 – Mr. Bailor’s assessments too often rely on rat and mice studies.
 – By page 59, I had found five text sentences that didn’t match up well with the numeric bibiographic references (e.g., pages 48, 50, 59).
 – S. Boyd Eaton is thrice referred to as S. Boyd.
 – How did he miss the research on high intensity interval training by Tabata and colleagues in 1996.  Gibala is mentioned often but he wasn’t the pioneer.
 – Several diagrams throughout the book didn’t print well (not the author’s fault, of course).
 – In several spots, the author implies that HIS specific eating and exercise program has been tested in research settings.  It hasn’t.

Mr. Bailor’s exercise prescription is the most exciting part of the book for me.  His review of the literature indicates you can gain the weight-management and health benefits of exercise with just 10 or 20 minutes a week.  NOT the hour a day recommended by so many public heath authorities.  And he tells you how to do the exercises without a gym membership or expensive equipment.  That 20 minutes is exhausting and not fun.  You have fun in all the hours you saved.  If this pans out, we’re on the cusp of a fitness revolution.  Gym owners won’t be happy.  Sounds too good to be true, doesn’t it?

One component of the exercise program is high intensity interval training (HIIT), which I’m convinced is better than hours per week of low-intensity “cardio” like jogging. Better in terms of both fitness and weight management.

The resistance training part of the program focuses on low repetitions with high resistance, especially eccentric slow muscle contraction.  This is probably similar to programs recommended by Doug McGuff. John Little, and Skyler Tanner.  I’m no authority on this but I’m trying to learn.  By this point in the book, I was tired of looking up his cited references (76 pages!).  I just don’t know if this resistance training style is the way to go or not.  I’ll probably have to just try it on myself.  What do you think?

I admire Mr. Bailor’s effort to digest and condense decades of nutrition and exercise research.  He succeeds to a large degree.

Steve Parker, M.D.
 

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Introducing Paleo Diabetic, a New Blog

A few of my patients have asked me if the paleo diet and lifestyle would be good for their diabetes.  I’m not sure.  A few pilot studies suggest it would be.  I expect much more published scientific research over the coming decade, in addition to self-experimentation reports by patients.  I’ll be looking into the matter at Paleo Diabetic.

The paleo diet in modern times began gathering steam in 2008.  It’s still not widely known or followed, but the trend is definitely upwards. 

The idea behind the paleo diet—also referred to as the Stone Age or caveman diet—is that optimal health depends on adherence to dietary and lifestyle factors to which we’re genetically adapted.  Our current mix of genes overwhelmingly reflects the Paleolithic era of human cultural development, starting anywhere from 750,000 to 2.5 million years ago, and ending around 10,000 years ago.  It’s also called the Stone Age.

The paleo diet pattern isn’t set in stone.  In general, it includes nuts, vegetables, fruits, fish, meat, and poultry.  It excludes or limits grains, dairy, legumes, sugars other than fruit or honey, industrial seed oils (e.g., from soybean and corn), and modern processed, highly refined foods.  Fresh, natural, and “organic” are preferred.

I’ve already got a few posts up and plan on new ones once or twice weekly.  If you’re interested, please join me at Paleo Diabetic.

Steve Parker, M.D.

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How Common Is Celiac Disease?

Celiac disease, aka gluten enteropathy, affects one of every 133 Americans, according to the National Digestive Diseases Information Clearinghouse.  That’s much more common than we thought a couple decades ago.  Read about celiac disease symptoms and physical signs at About.com or the NDDIC link.

I read a few paleo diet/lifestyle blogs regularly.  In case you didn’t know, paleo diet advocates shun wheat and other grains.  Recent paleo converts often report how this or that symptom or physical condition improved when the dieter “went paleo,” often attributing the improvement to cutting out wheat products.   Wheat contains a protein—gluten—that causes disease in people who have celiac disease.  Other sources of gluten are barley and rye.

Visit WebMD for details about celiac disease: http://www.webmd.com/digestive-disorders/celiac-disease/default.htm

Click to see one definition of the paleo diet: http://paleodiet.com/definition.htm

An article in the Wall Street Journal implies that star tennis player Novak Djokovic’s recent winning streak is attributable to a gluten-free (and low-carb) diet.  Click for details: http://online.wsj.com/article/SB10001424052748703509104576327624238594818.html 

Here are Dr. Barbara Berkeley’s thoughts on Djokovic: http://refusetoregain.com/refusetoregain/2011/08/novak-djokovic-the-diet-that-conquered-tennis.html

Or is Djokovic playing so well because of the CVAC pod?: http://online.wsj.com/article/SB10001424053111904787404576532854267519860.html

If cutting out wheat from your diet improves or resolves bothersome medical symptoms, it makes me wonder if you have celiac disease.  Other possible explanations include placebo effect and coincidence.  And if you switch from a standard American diet to paleo, you’re doing more than just eliminating gluten.

I reviewed several sources for the prevalence of celiac disease in the U.S.  The best figure is one of every 133 residents. 

Most countries have a prevalence of roughly one of every 350 citizens.  Prevalence varies by country and ancestry; celiac disease is at least twice as common in whites of northern European lineage.

Full-blown classic celiac disease is relatively easy for doctors to recognize, but that’s only the tip of the iceberg.  Adults more commonly have one or two milder, nonspecific manifestations such as fatigue, malaise, depression, malnutrition (especially low iron, folate, or vitamin D), neuropathy, belly pain, headaches, thin bones, diarrhea, or a rash.  I’m glad to see increasing physician and public awareness of gluten intolerance.  If it’s not considered as a cause of these symptoms, it’ll never be diagnosed and treated appropriately.

Celiac disease is being diagnosed more often because of the availability of blood tests that help us screen for it.  If you think you have celiac disease, consider getting one of two blood tests: IgA antibodies to tissue transglutaminase, or IgA endomysial antibodies.  If that test is positive and symptoms or physical signs suggest celiac disease, the next step is usually a small bowel biopsy.

Steve Parker, M.D.

Update August 31, 2011: Tom Naughton reviewed Dr. William Davis’ new book, Wheat Belly, yesterday.  In the book, Dr. Davis notes that modern wheat varieties are vastly different from their ancient ancestors, different even than wheat of 50 years ago.  The modern varieties apparently contain much more of the gluten proteins that trigger immunologic celiac symptoms. 

Update September 13, 2011: A recent study of adult type 1 diabetics at a U.K. teaching hospital found celiac disease in three of every hundred cases.

References: WebMD.com (about one in a hundred US residents affected), University of Chicago Celiac Disease Center (one in 133 Americans affected), and MedicineNet.com (one in 3000 (sic) North Americans affected), UpToDate.com (in most countries, one in 350 have celiac disease), National Digestive Diseases Information Clearinghouse (one in 133 in U.S.).

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Pilot Study: Paleo Diet Is More Satiating Than Mediterranean-Style

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.

Steve Parker, M.D.

Reference: Jonsson, Tommy, et al.  A paleolithic diet is more satiating per calorie than a mediterranean-like diet in individuals with ischemic heart diseaseNutrition and Metabolism, 2010, 7:85.

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Quote of the Day

Here’s one the paleo diet advocates will like.

The deviation of man from the state in which he was originally placed by nature seems to have proved to him a prolific source of diseases.

Edward Jenner (1749-1823), of smallpox vaccination fame

Masai men in Tanzania. Modern hunter-gatherers?

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