Tag Archives: paleolithic diet

How About the Paleo Diet for Diabetes?

Not Dr. Frassetto

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:

  • what is the UCSF version of the paleo diet?
  • how many participants were in her study?
  • how long did her study last?
  • did she study only type 2 diabetics?
  • what exactly was the control diet?
  • how severe were the cases of diabetes studied?

For answers, we await publication of the formal report.

Steve Parker, M.D.

PS: I’m quite interested in the paleo diet as a treatment for diabetes.  I explore the concept at the Paleo Diabetic blog.

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My Paleo Diet Trial

For the last year, I’ve been pondering whether the paleo diet has anything to offer folks with diabetes or prediabetes.  The paleo diet, by the way, is also called the Paleolithic, Stone Age, Old Stone Age, hunter-gatherer, or caveman diet.  It definitely has some potential as a diabetes management approach.  I’ve been eating paleo-style for the last three months.

Why am I trying it?

  • Direct experience with implementation obstacles
  • Potential health benefits

My first Parker Paleo Diet meal: sautéed mixed veggies and pan-fried chicken breast

My current version of paleo is not designed for someone with diabetes or prediabetes.  That may come in the future.  By “current version,” I mean I’ll quite likely tweak it over the coming months.

Here’s what I’ve been eating (or not) on the Parker Paleo Diet:

FORBIDDEN FOODS: Grains (e.g., corn, wheat, rice), Dairy, Legumes (peanuts, beans, peas, green beans), Industrial Vegetable Oils (soybean, corn, safflower, etc.), Alcohol, Refined Sugars.

PROTEINS: Meat, fish/seafood, eggs, poultry, and wild game.  Bacon OK; minimize other processed meats.

NUTS & SEEDS: Especially walnuts, macadamia, cachews, almonds.  Limit to 1-2 oz/day.

FRUITS: Limit 2 pieces/day?

VEGETABLES:

Lower-Carb: Greens (lettuce, spinach, chard, collard, mustard geen, kale), radicchio, endive, bok choy, herbs, celery, radishes, mushrooms, cabbage, jicama, avocado, asparagus, okra, cucumbers, cauliflower, broccoli, peppers, summer squash, zucchini, Brussels sprouts, green onions, tomatoes, eggplant, tomatillos, eggplant, artichokes, turnips, rutabagas, spaghetti squash, carrots, onions, leeks, water chestnuts (small serving).  This list generally starts with the lower carb items and gradually increases to higher carb grams.  All these have 5 or fewer carbs per serving; most are  much less.

Starchy, Higher-Carb: Beets (6 g, GI 64), winter squashes (acorn, butternut), water chestnuts, parsnips (9 g, GI 97), potatoes (35 g, GI 87), sweet potatoes, (20 g, GI 61), cassava (37 g), taro (21 g), plantains.  Some categorize carrots as starchy.

HERBS & SPICES: Cilantro, parsley, basil, rosemary, thyme, etc.  Salt (minimal), pepper, vinegar.

OILS: Extra virgin olive, canola, flax, avocado.

CONDIMENTS: Olive oil vinaigrettes, mayonnaise from olive oil & egg yolk, and ?

LIQUIDS: H2O, coffee, tea

After two months of paleo eating, I summarized my experience at Paleo Diabetic.

By the way, I don’t have diabetes or prediabetes.  The paleo diet has some potential benefit for those conditions, particularly as compared to the standard American diet.  Ideally, I’d like to see more clinical studies before recommending it.  Dr. Frassetto and colleagues at the University of California-San Francisco should be publishing their results soon.

Steve Parker, M.D.

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Science in Support of the Paleo Diet

Stockholm Palace

Investigators at Karolinska Institutet in Sweden found diminished weight, body mass index, blood pressure, and waist circumference in 14 healthy medical students eating a paleo diet for three weeks.  

I reviewed this research report in my effort to determine if the paleo diet—aka Old Stone Age, caveman, ancestral, or Paleolithic diet—has anything to offer diabetics.

Published in 2008, this seems to be one of the seminal scientific studies of the paleo diet in modern Europeans.

Their version of the paleo diet:

  • Allowed ad lib: All fresh or frozen fruits, berries and vegetables except legumes, canned tomatoes w/o additives, fresh or frozen unsalted fish and seafood, fresh or frozen unsalted lean meats and minced meat, unsalted nuts (except peanuts – a legume), fresh squeezed lemon or lime juice (as dressing), flaxseed or rapeseed oil (as dressing), coffee and tea (w/o sugar, milk, honey, or cream), all salt-free spices.
  • Allowed but with major restrictions: dried fruit, salted seafood, fat meat, potatoes (two medium-sized per day), honey, cured meats
  • Prohibited: all milk and dairy products, all grain products (including corn and rice), all legumes, canned food except tomatoes, candy, ice cream, soft drinks, juices, syrups, alcohol, sugar, and salt

What Did They Find After Three Weeks?

  • Average weight dropped from 65.2 kg (144 lb) to 62.9 (139 lb)
  • Average body mass index fell from 22.2 to 21.4
  • Average waist circumference decreased from 74.3 cm (29.25″) to 72.6 cm (28.58″)
  • Average systolic blood pressure fell from 110 to 104 mmHg
  • plasminogen activator inhibitor-1 decreased from 5.0 kIE/l to 2.8 kIE/l
  • All of these changes were statistically significant

The researchers looked at a number of other blood tests and didn’t find any significant differences.

Five men and three women completed the study. Of the 20 who originally signed up, one could not fulfill the diet, three became ill (no details), two failed to show up.

So What?

That’s a remarkable weight loss over just three weeks for slender people eating ad lib.

The study authors concluded that these paleo diet-induced changes could reduce risk for cardiovascular disease. They called for a larger study with a control group. (If it’s been done, I haven’t found it yet.)

Sounds reasonable.

Steve Parker, M.D.

PS: You’d think they would have said more about the three participants who got sick, rather than leave us wondering if the diet made them ill.

Reference: Österdahl, M; Kocturk, T; Koochek, A;Wändell, PE. Effects of a short-term intervention with a paleolithic diet in healthy volunteers. European Journal of Clinical Nutrition, 62 (2008): 682-685.

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Filed under Heart Disease, Paleo diet, Weight Loss

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.

 

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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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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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Paleo Diet Revival Story

I had written recently of my ignorance regarding the modern version of the Paleolithic diet and lifestyle, thinking that Loren Cordain devised it around year 2000.  Then I found a medical journal article from 1988 outlining it, co-written by S. Boyd Eaton, M.D. 

Mat Lalonde, Ph.D., in an interview with Jimmy Moore instead suggested that Cordain would credit S. Boyd Eaton, M.D., with the trend.

The Paleolithic Prescription: A Program of Diet and Exercise and a Design for Living was published in 1988 by Harper & Row (New York).  The authors are S. Boyd Eaton, M. Shostak, and M. Konner. 

Eaton and Konner are also the authors of “Paleolithic nutrition: A consideration of its nature and current implications.”  in New England Journal of Medicine, 312 (1985): 283-289.

If you have evidence that the “modern paleo” diet goes back further than this, please leave a comment.

Steve Parker, M.D.

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