Tag Archives: stone age diet

January 24, 2013 · 7:16 AM

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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January 4, 2013 · 12:29 AM

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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January 29, 2012 · 2:00 AM

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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January 15, 2012 · 4:39 AM

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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September 27, 2011 · 2:38 PM

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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November 3, 2010 · 2:00 AM

Paleo and Low-Carb Diets: Much In Common?

My superficial reading of the paleo diet literature led me to think Dr. Loren Cordain was the modern originator of this trend, so I was surprised to find an article on the Stone Age diet and modern degenerative diseases in a 1988 American Journal of Medicine.  Dr. Cordain started writing about the paleo diet around 2000, I think.

What’s So Great About the Paleolithic Lifestyle?

In case you’re not familiar with paleo diet theory, here it is.  The modern human gene pool has changed little over the last 50,000 years or so, having been developed over the previous one or two million years.  Darwins’ concept of Natural Selection suggests that organisms tend to thrive if they adhere to conditions present during their evolutionary development.  In other words, an organism is adapted over time to thrive in certain environments, but not others.

The paleo diet as a healthy way to eat appeals to me.  It’s a lifestyle, really, including lots of physical activity, avoidance of toxins, adequate sleep, etc. 

The Agricultural Revolution (starting about 10,000 years ago) and the Industrial Revolution (onset a couple centuries ago) have produced an environment vastly different from that of our Paleolithic ancestors, different from what Homo sapiens were thriving in for hundreds of thousands of years.  That discordance leads to obesity, type 2 diabetes, atherosclerosis, high blood pressure, and some cancers.  Or so goes the theory.

What’s the Paleolithic Lifestyle? (according to the article)

  • Average life expectancy about half of what we see these days
  • No one universal subsistence diet
  • Food: wild game (lean meat) and uncultivated vegetables and fruits (no dairy or  grain)
  • Protein provided 34% of calories (compared to about 12 in U.S. in 1988)
  • Carbohydrate provided 46% of calories (only a  tad lower than what we eat today)
  • Fat provided 21% of calories (42% today)
  • Little alcohol, but perhaps some on special occasions (honey and wild fruits can undergo natural fermentation) , compared to 7-10% of calories in U.S. today [I didn’t know it was that high]
  • No tobacco
  • More polyunsaturated than saturated fats (we ate more saturated than polyunsaturated fat, at least in 1988)
  • Minimal simple sugar availability except when honey in season
  • Food generally was less calorically dense compared to modern refined, processed foods
  • 100-150 grams of dietary fiber daily, compared to 15-20 g today
  • Two or three times as much calcium as modern Americans
  • Under a gram of sodium daily, compared to our 3 to 7 grams.
  • Much more dietary potassium than we eat
  • High levels of physical fitness, with good strength and stamina characteristic of both sexes at all ages achieved through physical activity

[These points are all debatable, and we may have better data in 2010.]

The article authors point out that recent unacculturated native populations that move to a modern Western lifestyle (and diet) then see much higher rates of obesity, diabetes, atheroslcerosis, high blood pressure, and some cancers.  “Diseases of modern civilization,” they’re called.  Cleave and Yudkin wrote about this in the 1960s and ’70s, focusing more on the refined carbohydrates in industrial societies rather than the entire lifestyle.  I expect Gary Taubes would blame the processed carbs, too. 

Paleo diet proponents agree that grains are not a Paleolithic food.  The word “grain” isn’t in this article.  The authors don’t outline the sources of Paleolithic carbs: tubers and roots, fruits, nuts, and vegetables, I assume.  Legumes and milk are probably out of the question, too.

Low-carb diet and paleo diet advocates often allign themselves, even though this version of the paleo diet doesn’t appear to be very low-carb.  The two share an affinity for natural, whole foods, and an aversion to grains, milk, and legumes.  Otherwise I don’t see much overlap.

ResearchBlogging.orgA 2010 article by Kuipers et al (reference below) sugggests that the East African Paleolithic diet derived, on average, 25-29% of calories from protein, 30-39% from fat, and 39-40% from carbohydrate.  That qualifies as low-carb.  Modern Western percentages for protein, fat, and carb are 15%, 33%, and 50%, respectively.

You can make a good argument that these paleo concepts are healthy: high physical activity, nonsmoking, consumption of natural whole foods while minimizing simple sugars and refined starches.  The paleo community is convinced that grains and legumes are harmful; many others disagree.  Also debatable are the role of dairy, polyunsaturated to saturated fat ratio, low sodium, and high potassium.  Modern diets tend to be high-sodium and low-potassium, which may predispose to high blood pressure and heart trouble—diseases of modern civilization.

For more on the paleo diet and lifestyle, visit Free the Animal, Mark’s Daily Apple, and PaNu. 

Steve Parker, M.D.

Update December 18, 2010:  I found a reference suggesting that Paleolithic diets may have derived about a third—22 to 40%—of calories from carbohydrate, based on modern hunter-gatherer societies.  See the Cordain reference I added below.

Reference:

Kuipers, R., Luxwolda, M., Janneke Dijck-Brouwer, D., Eaton, S., Crawford, M., Cordain, L., & Muskiet, F. (2010). Estimated macronutrient and fatty acid intakes from an East African Paleolithic diet British Journal of Nutrition, 1-22 DOI: 10.1017/S0007114510002679.  Note that one of the authors is Loren Cordain.  Good discussion of various Paleolithic diets.

Eaton, S., Konner, M., & Shostak, M. (1988). Stone agers in the fast lane: Chronic degenerative diseases in evolutionary perspective The American Journal of Medicine, 84 (4), 739-749 DOI: 10.1016/0002-9343(88)90113-1

Cordain, L., et al.  Plant-animal subsistance ratios and macronutrient energy estimations in worldwide hunter-gatherer diets.  American Journal of Clinical Nutrition, 71 (2000): 682-692.

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October 11, 2010 · 7:18 AM

Paleo Diet for Heart Patients With Diabetes and Prediabetes

A Paleolithic diet lowered blood sugar levels better than a control diet in coronary heart disease patients with elevated blood sugars, according to Swedish researchers reporting in 2007.

About half of patients with coronary heart disease have abnormal glucose (blood sugar) metabolism.  Lindeberg and associates wondered if a Paleolithic diet (aka “Old Stone Age,” “caveman,” or ancestral human diet) would lead to improved blood sugar levels in heart patients, compared to healthy, Mediterranean-style, Western diet.

Methodology

Investigators at the University of Lund found enrolled 38 male heart patients—average age 61—patients and randomized them to either a paleo diet or a “consensus” (Mediterranean-like) diet to be followed for 12 weeks.  Average weight was 94 kg.  Nine participants dropped out before completing the study, so results are based on 29 participants.  All subjects had either prediabetes or type 2 diabetes (the majority) but none were taking medications to lower blood sugar.  Baseline hemoglobin A1c’s were around 4.8%.  Average fasting blood sugar was 125 mg/dl (6.9 mmol/l); average sugar two hours after 75 g of oral glucose was 160 mg/dl (8.9 mmol/l).

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. 

Both groups were allowed up to one glass of wine daily.

No effort was made to restrict total caloric intake with a goal of weight loss.

Results

Absolute carbohydrate consumption was 43% lower in the paleo group (134 g versus 231 g), and 23% lower in terms of total calorie consumption (40% versus 52%).  Glycemic load was 47% lower in the paleo group (65 versus 122), mostly reflecting lack of cereal grains.

The paleo group ate significantly more nuts, fruit, and vegetables.  The Mediterranean group ate significantly more cereal grains,oil, margarine, and dairy products.

Glucose control improved by 26% in the paleo group compared to 7% in the consensus group.  The improvement was statisically significant only in the paleo group.  The researchers believe the improvement was independent of energy consumption, glycemic load, and dietary carb/protein/fat percentages.

High fruit consumption inthe paleo group (493 g versus 252 g daily) didn’t seem to impair glucose tolerance. 

Hemoglobin A1c’s did not change or differ significantly between the groups.

Neither group showed a change in insulin sensitivity (HOMA-IR method).

Comments

The authors’ bottom line:

In conclusion, we found marked improvement of glucose tolerance in ischemic heart disease patients with increased blood glucose or diabetes after advice to follow a Palaeolithic [sic] diet compared with a healthy Western diet.  The larger improvement of glucose tolerance in the Palaeolithic group was independent of energy intake and macronutrient composition, which suggests that avoiding Western foods is more important than counting calories, fat, carbohydrate or protein.  The study adds to the notion that healthy diets based on whole-grain cereals and low-fat dairy products are only the second best choice in the prevention and treatment of type 2 diabetes.

This was a small study; I consider it a promising pilot.  Results apply to men only, and perhaps only to Swedish men.  I have no reason to think they wouldn’t apply to women, too.  Who knows about other ethnic groups?

This study and the one I mention below are the only two studies I’ve seen that look at the paleo diet as applied to human diabetics.  If you know of others, please mention in the Comments section. 

The higher fruit consumption of the paleo group didn’t adversely affect glucose control, which is surprising.  Fruit is supposed to raise blood sugar.  At 493 grams a day, men in the paleo group ate almost seven times the average fruit intake of Swedish men (75 g/day).  Perhaps lack of adverse effect on glucose control here reflects that these diabetics and prediabetics were mild cases early in the course of the condition—diabetes tends to worsen over time.

ResearchBlogging.orgPresent day paleo and low-carb advocates share a degree of simpatico, mostly because of carbohydrate restriction—at least to some degree—by paleo dieters.  Both groups favor natural, relatively unprocessed foods.  Note that the average American eats 250-300 g of carbohydrates a day.  Total carb intake in the paleo group was 134 g (40% of calories) versus 231 g (55% of calories) in the Mediterranean-style diet.  Other versions of the paleo diet will yield different numbers, as will individual choices for various fruits and vegetables.  Forty percent of total energy consumption from carbs barely qualifies as low-carb. 

Study participants were mild, diet-controlled diabetics or prediabetics, not representative of the overall diabetic population, most of whom take drugs for it and have much higher hemoglobin A1c’s.

Lindeberg and associates in 2009 published results of a paleo diet versus standard diabetic diet trial in 13 diabetics.  Although a small trial (13 subjects, crossover design), it suggested advantages to the paleo diet in terms of heart disease risk factors and improved hemoglobin A1c.  Most participants were on glucose lowering drugs; none were on insulin.  Glucose levels were under fairly good control at the outset.  Compared to the standard diabetic diet, the Paleo diet yielded lower hemoglobin A1c’s (0.4% lower—absolute difference), lower trigylcerides, lower diastolic blood pressure, lower weight, lower body mass index, lower waist circumference, lower total energy (caloric) intake, and higher HDL cholesterol.  Glucose tolerance was the same for both diets.  Fasting blood sugars tended to decrease more on the Paleo diet, but did not reach statistical significance (p=0.08).

The paleo diet shows promise as a treatment or preventative for prediabetes and type 2 diabetes.  Only time will tell if it’s better than a low-carb Mediterranean diet or other low-carb diets. 

Steve Parker, M.D.

Reference: Lindeberg, S., Jönsson, T., Granfeldt, Y., Borgstrand, E., Soffman, J., Sjöström, K., & Ahrén, B. (2007). A Palaeolithic diet improves glucose tolerance more than a Mediterranean-like diet in individuals with ischaemic heart disease Diabetologia, 50 (9), 1795-1807 DOI: 10.1007/s00125-007-0716-y

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