Easy and Not-So-Easy Weight-Loss Tips

 

Left, right, or straight ahead (the road less travelled)?

Left, right, or straight ahead (the road less travelled)?

Record-keeping is often the key to success. Depending on the weight loss program you choose, you might need to track: carbohydrate grams, calories, daily weight, all food consumption, blood sugars, etc. For example, I provide daily logs for all of my diets: Paleobetic Diet, Low-Carb Mediterranean Diet, Ketogenic Mediterranean Diet, and Advanced Mediterranean Diet.

Accountability is another key to success. Consider documenting your program and progress on a free website such as FitDay, SparkPeople, 3FatChicks, Calorie Count (http://caloriecount.about.com), or others. Consider blogging about your adventure on a free platform such as WordPress or Blogger. Such a public commitment may be just what you need to keep you motivated. Do you have a friend or spouse who wants to lose weight? Start the same program at the same time and support each other. That’s built-in accountability.

If you tend to over-eat, floss and brush your teeth after you’re full. You’ll be less likely to go back for more anytime soon.

Eat at least two or three meals daily. Skipping meals may lead to uncontrollable overeating later on. On the other hand, ignore the diet gurus who say you must eat every two or three hours. That’s BS.

Eat meals at a leisurely pace, chewing and enjoying each bite thoroughly before swallowing.

Savor every bite

Savor every bite

Plan to give yourself a specific reward for every 10 pounds (4.5 kg) of weight lost. You know what you like. Consider a weekend get-away, a trip to the beauty salon, jewelry, an evening at the theater, a professional massage, home entertainment equipment, new clothes, etc.

Carefully consider when would be a good time to start your new lifestyle. It should be a period of low or usual stress. Bad times would be Thanksgiving day, Christmas/New Years’ holiday, the first day of a Caribbean cruise, and during a divorce.

If you know you’ve eaten enough at a meal to satisfy your nutritional requirements yet you still feel hungry, drink a large glass of water and wait a while.

Limit television to a maximum of a few hours a day.

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Maintain a consistent eating pattern throughout the week and year.

Eat breakfast routinely.

Control emotional eating.

Weigh frequently: daily during active weight-loss efforts and during the first two months of your maintenance-of-weight-loss phase. After that, cut back to weekly weights if you want. Daily weights will remind you how hard you worked to achieve your goal.

Be aware that you might regain five or 10 pounds (2–4 kg) of fat now and then. You probably will. Don’t freak out. It’s human nature. You’re not a failure; you’re human. But draw the line and get back on the old weight-loss program for one or two months. Analyze and learn from the episode. Why did it happen? Slipping back into your old ways? Slacking off on exercise? Too many special occasion feasts or cheat days? Allowing junk food back into the house?

Learn which food item is your nemesis—the food that consistently torpedoes your resolve to eat right. For example, mine is anything sweet. Remember an old ad campaign for a potato chip: “Betcha can’t eat just one!”? Well, I can’t eat just one cookie. So I don’t get started. I might eat one if it’s the last one available. Or I satisfy my sweet craving with a diet soda, small piece of dark chocolate, or sugar-free gelatin. Just as a recovering alcoholic can’t drink any alcohol, perhaps you should totally abstain from…? You know your own personal gastronomic Achilles heel. Or heels. Experiment with various strategies for vanquishing your nemesis.

If you’re not losing excess weight as expected (about a pound or half a kilogram per week), you may benefit from eating just two meals a day. This will often turn on your cellular weight-loss machinery even when total calorie consumption doesn’t seem much less than usual. The two meals to eat would be breakfast and a mid-afternoon meal (call it what you wish). The key is to not eat within six hours of bedtime. Of course, this trick could cause dangerous hypoglycemia if you’re taking drugs with potential to cause low blood sugars, like insulin and sulfonylureas; talk to your dietitian or physician before instituting a semi-radical diet change like this.

One of the bloggers I follow is James Fell. He says, “If you want to lose weight you need to cook. Period.” James blogs at http://www.sixpackabs.com, with a focus on exercise and fitness.

Regular exercise is much more important for prevention of weight regain rather than for actually losing weight.

Steve Parker, M.D.

 

Which Diabetes Drugs Cause Hypoglycemia?

From 97 to 90 mg/dl

You shouldn’t notice low blood sugars unless under 65-70 mg/dl (3.7 mmol/l)

DRUGS THAT RARELY, IF EVER, CAUSE HYPOGLYCEMIA

Diabetics not being treated with pills or insulin rarely need to worry about hypoglycemia. That’s usually true also for prediabetics. Yes, some type 2 diabetics control their condition with diet and exercise alone, without drugs.

Similarly, diabetics treated only with diet, metformin, colesevalam, sodium-glucose co-transport 2 inhibitor (SGLT2 inhibitor), and/or an alpha-glucosidase inhibitor (acarbose, miglitol) should not have much, if any, trouble with hypoglycemia. The DPP4-inhibitors (sitagliptan and saxagliptin) do not seem to cause low glucose levels, whether used alone or combined with metformin or a thiazoladinedione. Thiazolidinediones by themselves cause hypoglycemia in only 1 to 3% of users, but might cause a higher percentage in people on a reduced calorie diet. Bromocriptine may slightly increase the risk of hypoglycemia. GLP-1 analogues rarely cause hypoglycemia, but they can.

DRUGS THAT CAUSE HYPOGLYCEMIA

Regardless of diet, diabetics are at risk for hypoglycemia if they use any of the following drug classes. Also listed are a few of the individual drugs in some classes:

  • insulins
  • sulfonylureas: glipizide, glyburide, glimiperide, chlorpropamide, acetohexamide, tolbutamide
  • meglitinides: repaglinide, nateglinide
  • pramlintide plus insulin
  • possibly GLP-1 analogues
  • GLP-1 analogues (exanatide, liragultide, albiglutide, dulaglutide) when used with insulin, sufonylureas, or meglitinides
  • possibly thiazolidinediones: pioglitazone, rosiglitazone
  • possibly bromocriptine

Click for a review of drugs for diabetes.

Steve Parker, M.D.

Do You Have Hypoglycemia Unawareness?

Steve Parker MD

Watch out for hypoglycemia particularly if you exercise vigorously and take drugs with the potential to cause hypoglycemia, like insulin and sulfonylureas

If you take drugs that can cause hypoglycemia, you need to know about “hypoglycemia unawareness.” (Click for a quick review of diabetes drugs.)

Some people with diabetes, particularly after having the condition for many years, lose the ability to detect hypoglycemia just by the way they feel. This hypoglycemia unawareness is obviously more dangerous than being able to detect and treat hypoglycemia early on. Blood sugar levels may continue to fall and reach a life-threatening degree.

Hypoglycemia unawareness can be caused by impairment of the nervous system (autonomic neuropathy) or by beta blocker drugs prescribed for high blood pressure or heart disease. It’s more common in folks who have had diabetes for many years. People with hypoglycemia unawareness need to check blood sugars more frequently, particularly if driving a car or operating dangerous machinery.

Steve Parker, M.D.

What Did Corn, Watermelon, and Peaches Look Like Thousands of Years Ago?

The answer is at an article at Vox. In brief, they didn’t look like anything you’d recognize today, thanks to selective breeding. That’s also why most of us today  can’t eat a true Paleolithic diet. Regarding corn:

As maize became domesticated in Mesoamerica, it was radically altered through selective breeding. Early farmers would examine their plants and save the seeds of those that were larger or tastier, or whose kernels were easier to grind. By 4000 BC, cobs were already an inch long. Within just a few thousand years, cobs had grown to many times that size. Later on, plant hybridization became an important breeding method to further cultivate certain traits.

Click through for well-done infographics.

 

Have You Heard About Dulaglutide for Diabetes?

I forgot to tell you about a new drug for diabetes that hit the market in the U.S. last fall. My preferred initial treatment approach to type 2 diabetes is diet and exercise in most cases, but in many cases that’s not enough.

If your blood sugar’s 400 mg/dl (22 mmol/l) and you’re fairly symptomatic from it, I’ll probably have to start you out on insulin while initiating dietary changes at the same time. Later we’ll try to get you off insulin, onto metformin, and perhaps off drugs entirely within a couple months. (Type 1 diabetics have to keep taking insulin shots, of course.)

Where this new drug fits into our armamentarium isn’t clear. Click here for links to professional association guidelines on diabetes drug prescribing.

In September, 2014, the Food and Drug Administration approved the fourth drug in the GLP-1 analogue class: dulaglutide. The granddaddy in the class is exenatide (Byetta). The new GLP-1 receptor agonist will be sold in the U.S. under the name of Trulicity. It’s a once-weekly injection.

This is only a summary and is liable to change. Get full information from your prescribing healthcare provider and pharmacist.

Resistance training helps control blood sugar

Resistance training helps control blood sugar

Uses

For adults with type 2 diabetes, in conjunction with diet and exercise. It’s not a first-line drug. It can be used by itself or in combination with metformin, pioglitazone, glimiperide (and presumably other sulfonylureas), and insulin lispro (e.g., Humalog, a rapid-acting insulin). The drug has not been tried with basal (long-acting) insulins.

Dose

Start with 0.75 mg subcutaneously every week. Can go up to 1.5 mg weekly if needed.

Adverse Effects

Hypoglycemia is rare, but possible, when GLP-1 analogues are used as the sole diabetes drug. When it happens, it’s rarely severe. But the risk increases substantially when dulaglutide is used along with insulin or insulin secretagogues such as sulfonylureas or meglitinides.

Common side effects are nausea, vomiting, diarrhea, abdominal pain, decreased appetite, dyspepsia, and fatigue.

It might cause thyroid tumors and pancreatitis.

Do Not Use If…

…you have a family or personal history of medullary thyroid cancer, or if you have Multiple Endocrine Neoplasia syndrome type 2 or pre-existing severe gastrointestinal disease. Those who are pregnant or nursing babies should probably not take it since we have no data on safety. Don’t use for diabetic ketoacidosis.

Use only with caution if you have a history of pancreatitis or known liver impairment.

Steve Parker, M.D.

Click for full prescribing information.

Theoretical Support for the Healthfulness of the Paleo Diet

See modern man walking off that cliff?

See modern man walking off that cliff?

Aren’t people healthier now, thanks to the Agricultural and Industrial Revolutions?

As a marker for health, we can look at life span and longevity. Humans started to see dramatic increases in longevity probably around 30,000 years ago, before the revolutions. Nevertheless, Kuipers, Joordens, and Muskiet note that average life expectancy after the start of the Agricultural Revolution 10,000 years ago fell from about 40 to around 20 years.

Other researchers report that average height in the Nile River Valley at the time of the transition fell by 4 inches (10 cm). The Agricultural Revolution allowed for rapid expansion of human populations through more births, but those folks still didn’t live very long. As before the revolution, infections and high infant/child mortality rates were devastating killers, dragging down average life spans. If you survived childhood, you had a shot at hitting 50 or 60.

At the dawn of the Industrial Revolution, life expectancy at birth was only 35–40 years, even in then-sophisticated cultures like Switzerland. Consider Thomas Jefferson, the principal author of the U.S. Declaration of Independence and the third U.S. president, who lived between 1743 and 1826 (he died on July 4, Independence Day). He and his wife Martha had six children; only two survived to adulthood, and only one past the age of 25. Martha died at age 33. This mortality picture was typical for the times.

Since 1800, life expectancy has doubled in industrialized countries, but it’s mostly due to public health measures and economic prosperity. Other than smallpox vaccination, it wasn’t until the mid-20th century that medical care advances contributed in a major way to longevity.

Overview: Conflict Between Our Paleolithic Genes and Modern Life

A number of diseases or conditions may result from the mismatch of our Paleolithic genes and modern lifestyle. If not caused by the mismatch, they’re aggravated by it. These are the so-called “diseases of civilization”:

  • type 2 diabetes
  • high blood pressure
  • overweigh and obesity
  • dental caries (tooth decay or cavities)
  • osteoporosis
  • fertility problems (polycystic ovary syndrome)
  • pregnancy complications (pre-eclampsia, gestational diabetes)
  • some cancers (colon, breast, prostate)
  • heart disease (such as coronary artery disease)
  • major and postpartum depression
  • autism
  • schizophrenia
  • some neurodegenerative diseases (Parkinsons disease, Alzheimer’s disease)
  • constipation
  • hemorrhoids
  • diverticulosis
"I ate well over 70 grams of fiber daily!"

“I ate well over 70 grams of fiber daily!”

Overweight and Obesity

The Paleolithic diet is lower in total carbohydrate calories compared to the standard American diet: 30-35% versus 50-55% of calories. The higher consumption today, especially of highly processed refined carbohydrates, contributes to overweight and obesity, diabetes, gallbladder disease, heart disease, and possibly dementia. Ian Spreadbury hypothesizes that carbohydrate density of modern foods may be the cause of obesity. Refined sugars and grains—types of acellular carbohydrates—are particularly bad offenders. These acellular carbs may alter our gut microorganisms, leading to systemic inflammation and leptin resistance, etc. Our Paleolithic ancestors had little access to acellular carbohydrates. Here’s how Spreadbury explains acellular: “Tubers, fruits, or functional plant parts such as leaves and stems store their carbohydrates in organelles as part of fiber-walled living cells. These are thought to remain largely intact during cooking, which instead mostly breaks cell-to-cell adhesion. This cellular storage appears to mandate a maximum density of around 23% non-fibrous carbohydrate by mass, the bulk of the cellular weight being made up of water. The acellular carbohydrates of flour, sugar, and processed plant-starch products are considerably more dense. Grains themselves are also highly dense, dry stores of starch designed for rapid macroscopic enzymic mobilization during germination. Whereas foods with living cells will have their low carbohydrate density “locked in” until their cell walls are breached by digestive processes, the chyme produced after consumption of acellular flour and sugar-based foods is thus suggested to have a higher carbohydrate concentration than almost anything the microbiota of the upper GI tract from mouth to small bowel would have encountered during our coevolution.” (Reference: “Comparison with ancestral diets suggests dense acellular carbohydrates promote an inflammatory microbiota, and may be the primary dietary cause of leptin resistance and obesity,” in Diabetes, Metabolic Syndrome, and Obesity: Targets and Therapy. 2012; vol 5: 175–189. doi: 10.2147/DMSO.S33473 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3402009/)

Added sugar provides 17 % of total energy in modern societies, contributing to overweight, obesity, tooth decay, and diabetes. Modern diets provide 15–20% of calories from protein, compared to 25–30% in the Paleolithic diet. To the extent that high protein consumption is satiating, lower consumption may cause over-eating of carbohydrates and fats, then overweight and obesity and all their associated medical conditions.

Heart Disease

I written elsewhere on the blog that the much lower omega-6 to omega-3 fatty acid ratio in the Paleolithic diet. There’s some evidence that today’s high ratio may contribute to systemic inflammation and chronic disease, heart disease in particular. Today’s ratio is quite high due to our consumption of industrial seed oils, such as those derived from soybeans, peanuts, corn, and safflower. And we don’t eat enough cold-water fatty fish, which are major sources of omega-3 fatty acids. Two long-chain polyunsaturated fatty acids, EPA and DHA, are essential fatty acids. That means our bodies cannot make them. We have to get them from diet. DHA and EPA are also cardioprotective omega-3 fatty acids.

High Blood Pressure

Most modern diets have much more sodium and much less potassium than the Paleolithic diet, perhaps contributing to high blood pressure, which in turn contributes to heart attacks, strokes, and possibly premature death. The higher magnesium content of the paleo diet may also help prevent high blood pressure.

Gastrointestinal Problems

We eat much less fiber these days, contributing to constipation, hemorrhoids, and diverticulosis. Some experts believe low fiber consumption adversely effects development of palate bones, jaws, and tooth placement.

Osteoporosis

Our lower vitamin D levels these days may cause osteoporosis (thin fragile bones) and raise the risk of diabetes and cancer. Our prehistoric ancestors spent more time in the sun, allowing their bodies to make vitamin D.

Type 2 Diabetes

Robert Lustig and associates looked at sugar consumption and diabetes rates in 175 countries and found a strong link between sugar and type 2 diabetes. It’s not proof of causation, just suggestive. From the scientific article abstract: “Duration and degree of sugar exposure correlated significantly with diabetes prevalence in a dose-dependent manner, while declines in sugar exposure correlated with significant subsequent declines in diabetes rates independently of other socioeconomic, dietary and obesity prevalence changes. Differences in sugar availability statistically explain variations in diabetes prevalence rates at a population level that are not explained by physical activity, overweight or obesity.” (Reference: Basu S, Yoffe P, Hills N, Lustig RH (2013) The Relationship of Sugar to Population-Level Diabetes Prevalence: An Econometric Analysis of Repeated Cross-Sectional Data. PLoS ONE 8(2): e57873. doi:10.1371/journal.pone.0057873)

A major diet change from Stone Age to modern diets is a reduction in magnesium consumption. This could be one reason type 2 diabetes is a problem today. A 2013 article at Diabetes Care suggests that higher magnesium consumption in modern populations may protect against type 2 diabetes (Reference: http://care.diabetesjournals.org/content/early/2013/09/23/dc13-1397.abstract.html?papetoc).

Dental Problems

Dentist John Sorrentino wrote at his blog in 2012: “The truth is that tooth decay is a relatively new phenomenon. Until the rise of agriculture roughly 10,000 years ago, THERE WAS NO TOOTH DECAY IN HUMANS. Let that sink in for a moment. Humanity is 2,500,000 years old. For the first 2,490,000 years no one ever had a cavity. If we understand that tooth decay started when people started farming instead of hunting and gathering for a living clearly you realize that tooth decay is a disease or mismatch between what you are eating and what your body expects you to eat. If we examine the past as prologue it becomes clear that the path to proper health starts in the mouth and the answers are so simple that not only did a Cave Man do it. They perfected it.” (Reference: http://www.sorrentinodental.com/blog.html?entry=why-teeth-decay-i)

To be fair and balanced, a research report from 2014 found a very high incidence of caries (cavities) in a Stone Age population living in what is now Morocco. The authors attributed the cavities to heavy consumption of acorns, which are rich in carbohydrates and sticky, to boot.

Orthodontist Mike Mew, BDS, MSc, made a presentation at the 2012 Ancestral Health Symposium titled “Craniofacial Dystrophy—Modern Melting Faces.” Dr. Mew says 30% of folks in Western populations have crooked teeth and/or malocclusion, and the mainstream orthodontic community doesn’t know why. But they’ve got expensive treatment for it! Dr. Mew thinks he knows the cause and he shared it at the symposium. The simple cure is “Teeth together. Lips together. Tongue on the roof of your mouth.” And eat hard food that requires lots of chewing, like our ancestors did, ideally in childhood before age 9. Older people also benefit, he says.

NPR (National Public Radio) in February, 2013, ran an article called “Ancient Choppers Were Healthier Than Ours,” by Audrey Carlsen. An excerpt: “Hunter-gatherers had really good teeth,” says Alan Cooper, director of the Australian Centre for Ancient DNA. “[But] as soon as you get to farming populations, you see this massive change. Huge amounts of gum disease. And cavities start cropping up.” And thousands of years later, we’re still waging, and often losing, our war against oral disease. Our changing diets are largely to blame. In a study published in the Nature Genetics, Cooper and his research team looked at calcified plaque on ancient teeth from 34 prehistoric human skeletons. What they found was that as our diets changed over time — shifting from meat, vegetables and nuts to carbohydrates and sugar — so too did the composition of bacteria in our mouths. Not all oral bacteria are bad. In fact, many of these microbes help us by protecting against more dangerous pathogens. (Reference: http://www.npr.org/blogs/health/2013/02/24/172688806/ancient-chompers-were-healthier-than-ours)

Dentist Mark Burhenne wrote the following at Huffington Post – Canada: “It is generally well accepted that tooth decay, in the modern sense, is a relatively new phenomena. Until the rise of agriculture roughly 10,000 years ago, there was nearly no tooth decay in the human race. Cavities became endemic in the 17th century but became an epidemic in the middle of the 20th century (1950). If we understand that tooth decay started when people started farming, rather than hunting and gathering, it’s clear that tooth decay is the result of a mismatch between what we’re eating and what our bodies are expecting us to eat based on how they evolved….The recent changes in our lifestyle create a “mismatch” for the mouth, which evolved under vastly different environments than what our mouths are exposed to these days. Our mouths evolved to be chewing tough meats and fibrous vegetables. Sugar laden fruit was a rare and special treat for our paleolithic ancestors. Now, our diets are filled with heavily processed foods that take hardly any energy to chew — smoothies, coffees, and sodas high in sugar, white bread, and crackers to name just a few.” (Reference: http://www.huffingtonpost.ca/mark-burhenne/paleo-diet-oral-health_b_4041350.html)

Shrinking Brains

Since the end of the Stone Age, human brain size has been shrinking. That’s not good, is it? Anthropologist John Hawks has noted that over the past 20,000 years, the average volume of the human male brain has decreased from 1,500 cubic centimeters to 1,350 cc, losing a chunk the size of a lemon. The female brain has shrunk proportionately. Anthropologists don’t know why. Is it modern nutrition? The experts aren’t sure what it means for our future. As for me, I think the answer is in Mike Judge’s movie, “Idiocracy.”

His brain was bigger than yours

His brain was bigger than yours

Death By Sugar

Sugar-sweetened beverages kill almost 200,000 worldwide annually, according to a Gitanjali Singh, Ph.D., a postdoctoral research fellow at the Harvard School of Public Health. How could that be? Sugar-sweetened beverages contribute to obesity, which in turn leads to diabetes, cardiovascular disease, and some cancers. (Reference: Singh, GM, et al “Mortality due to sugar-sweetened beverage consumption: A global, regional, and national comparative risk assessment,” American Heart Association Epidemiology and Prevention/Nutrition, Physical Activity and Metabolism 2013 Scientific Sessions, Abstract EPI-13-A-879-AHA.) Reducing consumption of sugar-sweetened beverages was one of the major points in the American Heart Association’s 2010 guidelines for reducing heart disease.

Elderly Cognitive Impairment

Diets high in sugar and other carbohydrates raise the risk of elderly cognitive impairment, according to recent research by the Mayo Clinic. Mild cognitive impairment is often a precursor to incurable dementia. (Most authorities think dementia develops more often in people with diabetes, although some studies refute the linkage.) Researchers followed 940 patients with normal baseline cognitive functioning over the course of four years. Diet was assessed via questionnaire. Study participants were ages 70 to 89. As the years passed, 200 of them developed mild cognitive impairment. Compared with those eating the lowest amount of sugar, those eating the most sugar were 1.5 times more likely to develop cognitive impairment. Looking at total carbohydrate consumption, those eating at the highest levels of carbohydrate consumption were almost twice as likely to develop mild cognitive impairment. The scientists note that those eating lower on the carbohydrate continuum were eating more fats and proteins. (Reference: Mayo Clinic website, published October 16, 2012 http://www.mayoclinic.org/news2012-rst/7128.html)

Is a Paleolithic-Style Diet the Healthiest Way to Eat?

Certified paleo-compliant, plus high omega-3 fatty acids

Certified paleo-compliant, plus high omega-3 fatty acids

The jury’s still out on that one! My strong sense is that it’s definitely more healthful than the Standard American Diet. Maybe the traditional Mediterranean diet or DASH diet is even healthier. Don’t hold your breath waiting for the randomized controlled trials that would answer the question definitively.

If the paleo diet is the healthiest, which version is best? That’s a question for another day (or year).

The most healthful diet for you depends on your genetic make-up and any medical conditions you have.

Steve Parker, M.D.

What Does the Paleolithic Diet Look Like?

Vegetables not in season

Vegetables not in season

It’s quite difficult to know exactly what early humans ate 100,000 years ago. Scientists use a variety of methods to investigate, including analysis of patterns of wear on teeth, searches of prehistoric dwellings, and analysis of carbon isotopes in organic matter.

Some of the best-preserved human prehistoric artifacts are found in caves, which protected them from environmental degradation. That’s why the paleo diet is sometimes called the caveman diet.

We have an inkling of what foods were available in specific climates and regions. We have some ideas about tools our ancestors had available to hunt, gather, and process foods. Perhaps most reliably, we have fairly good data on what modern hunter-gatherer groups eat (for those few still in existence) or ate (for those lately extinct or modernized).

The Paleolithic Versus Typical Modern Western Diet

Today we get most of our calories from grains, sugars, domesticated livestock, and dairy products. On the other hand, our pre-agricultural ancestors ate primarily wild game and naturally occurring plant foods. Their carbohydrates would have come from fruits and vegetables rather than cereal grains, diary products, and refined sugars. They ate no junk food, no industrial seed oils, and very few grains and dairy products. Compared to us, they ate more potassium, fiber, protein, and micronutrients, but less sodium and carbohydrate. They ate relatively more omega-3 fatty acids and less omega-6s. Paleo dieters today aim to consume natural whole foods while minimizing simple sugars and refined starches. The paleo community generally is convinced that grains and legumes are harmful, while others disagree. Dairy products are allowed in some versions of paleo, although purists would vote against. Now let’s dig into the details.

Paleo-compliant

Paleo-compliant

The Eaton and Konner Model

S. Boyd Eaton and Melvin Konner in 2010 looked carefully at the diet of pre-industrial hunter-gatherers and proposed a prototypical ancestral diet. Note that actual diet would vary with climate, latitude, altitude, water availability, etc. Eaton and Konner suggest our ancestral diet looked like this:

  • Carbohydrates: 35-40% of daily energy (calories)
  • Protein: 25-30% of daily energy
  • Fat: 20-35% of daily energy
  • Added sugar: 2% of daily energy
  • Fiber: over 70 g/day
  • EPA and DHA*: 0.7-6 g/day
  • Cholesterol: 500+ mg/day
  • Vitamin C: 500 mg/day
  • Vitamin D: 4,000 IU/day (sunlight)
  • Calcium: 1,000-1,500 mg/day
  • Sodium: under 1,000 mg/day
  • Potassium: 7,000 mg/day

*Eicosapentaenoic acid and docosahexaenoic acid (omega-3 fatty acids)

Their conception of a modern Paleolithic food pyramid is a base of high-fiber vegetables and fruits, the next tier up being meat/fish/low-fat dairy (all lean), then a possible tier for whole grain (admittedly very unusual), with a small peak of oils, fats, and refined carbohydrates. Their inclusion of dairy products and whole grains must be a concession to convenience and the reality that those items can be healthful for modern humans. Eaton and Konner note that hunter-gatherer groups had a high degree of dependence on plant foods, while obtaining 35 to 65% of diet (calories rather than weight, I assume) from animal flesh. They found some modern hunter-gatherer cultures deriving as much as 65% of calories from carbohydrate (mostly plants, then). It’s a mistake to assume that the typical Paleolithic diet is necessarily meat-based, as the popular press so often describes it.

Eaton and Konner make a few other distinctions that are worth mentioning now. Game animals have more mono- and polyunsaturated fatty acids than supermarket meat. The Paleolithic diet’s ratio of omega-6 to omega-3 fatty acids was about 2:1, in contrast to the modern Western ratio of 10:1 or even higher.

I’d like to share a few more tidbits from their 2010 article:

  • The transition from hunting/gathering to farming (about 10,000 year ago) saw a decrease in body size and robustness, plus evidence of nutritional stress.
  • Levels of muscular and aerobic fitness in ancestral groups are much higher than modern societies, with a concomittant higher level of calorie consumption.
  • Average life expectancies in pre-industrial hunter-gatherer (H-G) groups was only 30-35 years, but much of this low number simply reflects high infant and child death rates.
  • H-G deaths overwhelmingly reflect infectious diseases.
  • H-G groups had a high degree of dependence on plant foods.
  • Fish and shellfish are more important food sources than these authors thought 25 years earlier.
  • H-G diets are higher in fat and protein than they once thought. • Nearly all H-G carbs are from vegetables and fruits, which have more favorable glycemic responses (i.e., a lesser rise in blood sugar) than grains and concentrated sugars.
  • Uncultivated or wild fruits and vegetables have much more fiber than commercial ones (13 versus 4 g fiber per 100 g of food).

The Diet-Heart Hypothesis is the idea that dietary total and saturated fat, and cholesterol, cause or contribute to atherosclerosis (hardening of the arteries), leading to heart attacks and strokes. Konner and Eaton still believe (in 2010 at least) the theory is valid for fats, but not cholesterol. The latest evidence, however, is that even total and saturated fat are minimally or unrelated to atherosclerosis. They also believe total fat, due to its caloric load, is an important contributor to obesity and type 2 diabetes. I agree that may be true, especially if you eat a lot of carbohydrates with fat. To further imitate the Paleolithic lifestyle, Eaton and Konner also recommend high activity levels, including resistance exercise, flexibility, and aerobics, burning over 1,000 calories daily exclusive of resting metabolism. (Reference: Konner, Melvin and Eaton, S. Boyd. Paleolithic Nutrition: Twenty-Five Years Later. Nutrition in Clinical Practice, 25 (2010): 594-602. doi: 10.1177/0884533610385702) But let’s not put all our eggs in the Eaton and Konner basket.

That exposed skin makes vitamin D

That exposed skin makes vitamin D

The Kuipers Model

A 2010 scientific article by Kuipers et al suggests 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 mildly low-carb, and similar to Eaton and Konner’s macronutrient breakdown. Modern Western percentages for protein, fat, and carb are 15%, 33%, and 50%, respectively. Kuipers et al suggest that the evolution of our large brains in East Africa may have been possible by utilization of aquatic resources such as fish, lobster, crab, shrimp, sea urchins, squid, octopus, and amphibians. Rather than savannah, this was a land-water ecosytem. Diets here would have been rich in the omega-3 fatty acids (EPA and DHA) we find in fish oil. Kuipers believes roots and tubers were also part of the Paleolithic diet. (Reference: Kuipers, R., et al (L. Cordain and S. Eaton are co-authors) (2010). Estimated macronutrient and fatty acid intakes from an East African Paleolithic diet British Journal of Nutrition, 1-22 DOI: 10.1017/S0007114510002679)

The Cordain Model

Loren Cordain and associates in 2000 suggested that Paleolithic diets derived about a third—22 to 40%—of calories from carbohydrate, based on modern hunter-gatherer societies. The lower carb consumption compared to Western diets left more room for moderate to high amounts of protein and fat. Dr. Cordain is a co-author with Eaton and Konner on many paleo diet scientific articles, so they don’t have many differences. (Reference: 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.)

Dr. Cordain (Ph.D.) is probably the preeminent scientist who advocates the Paleolithic diet. He’s made a few modifications in his model diet over the years. From his website in 2014, the following are the seven pillars of his conception of the modern paleo diet compared to the typical Western diet. The paleo diet is:

  • higher in protein (25-30% of calories versus 15%)
  • lower in carbohydrates and glycemic index via nonstarchy fresh fruits and vegetables
  • higher in fiber
  • moderate to high fat content, especially monounsaturated fats and polyunsaturated fats (particularly omega-3 fatty acids)
  • higher in potassium and lower in sodium
  • higher dietary alkaline load relative to acid load (vegetables and fruit counteract the acid in meat and fish)
  • higher in many vitamins, minerals, antioxidants and plant phytochemicals

(Reference: http://thepaleodiet.com/the-paleo-diet-premise/)

Salmon is a great source of omega-3 fatty acids

Salmon is a great source of omega-3 fatty acids

Carbohydrate Content of the Paleo Diet

Since dietary carbohydrates are major contributors to blood sugar, the carbohydrates in the Paleolithic diet are important. It appears that the average paleo diet derived a little over a third of calories from carbohydrate: that qualifies as low-carb since the average Western diet provides half of calories as carbohydrate. The carbohydrates eaten by Paleolithic man were accompanied by lots of fiber, over four times as much as the average American diet (70+ grams versus 15 grams). The sources of carbohydrate were fruits, vegetables, and roots or tubers, with minimal and seasonal contribution from honey. Fiber is important since high consumption is linked in modern times to lower rates of type 2 diabetes, and fiber also slows and limits the rise in blood sugar after meals. Furthermore, the original Paleolithic carbohydrate sources generally would have been much less calorically dense than modern carbohydrates sources. For instance, one Frosted Strawberry Pop-Tart has the same amount of calories (200) as four cups of fresh strawberry halves, but the Pop-Tart has less than one gram of fiber compared to 12 gm in the raw berries.

We Can’t or Won’t Re-Create a True Paleolithic Diet

Because of our modification of edible plants and animals, it’s impossible for most of us to accurately recreate the diet of our Paleolithic ancestors. The closest you could come would be to live entirely off the land, catching or hunting wild animals and foraging for wild plants. That’s a heck of a lot of work, and wouldn’t sustain more than a tiny fraction of the planet’s current seven billion souls. If we’re going to construct a modern Paleolithic-style diet, now we’ve got some anchoring numbers.

Steve Parker, M.D.

Diet Implications of Human Origins and Migration

African Savanna

African Savanna

Until 10,000 to 12,000 or so years ago, humans and our hominin ancestors obtained food through a combination of hunting and foraging. We hunted small or large game and birds. At some point we learned how to catch fish and shellfish. We searched for and gathered up fruits, berries, leafy plants, nuts, seeds, mussels, clams, honey, eggs, and roots.

Young woman sitting at camp fire, holding fried sausage

 

The range of edible items expanded when we harnessed the power of fire for cooking, which was at least 230,000 years ago and may have been as long as a million years ago.Tools and weapons also expanded our possibilities from the very start of the Paleolithic.

 

Prior to 10,000 years ago, we weren’t farming or raising cattle and dairy cows. Available foods depended on local climatic conditions, soil, and water availability. Climate, in turn, is heavily dependent on latitude (how far away from the equator) and altitude. East Africa at the dawn of humanity is described as savanna: grass-filled plains with scattered patches of forest, and relatively dry. Plants and animals available there would be much different than the colder but wetter Europe 200,000 years ago.

Steve Parker MD, paleo diet, paleobetic

Nubian ibex in Israel

 

Humans in Northern Europe tended to eat more animal-based food and relatively less plant matter than savanna-dwellers, perhaps just because there were fewer edible plants growing in the cold climate. Many plants would have been highly seasonal, just as they are now.

Tribes of humans walked or migrated to nearby micro-climates as one plant went out of season and another came into season. Tribes followed prey animals as they also migrated in search of seasonal food.

Due to technological limitations, we wouldn’t have been able to utilize some potential food sources that required much processing, such as cereal grains and legumes. Since we weren’t yet pastoralists (raising sheep, cattle, etc.), we would have access to milk only if we killed a nursing prey animal. Have you ever tried to milk a wild water buffalo? Not advisable. Ability to digest milk beyond infancy was marginal. Even today, two-thirds of humans lose the ability to digest milk after infancy.

The experts debate actively debate how long we’ve been consuming significant amounts of cereal grains and roots. Canadian researchers working in Africa suggest we’ve enjoyed them for over 100,000 years (see Mercader, Julio, et al. Mozambican grass seed consumption during the Middle Stone Age. Science, December 18, 2009.)

Steve Parker, M.D.

How Fast Are Humans Evolving?

paleo diet, Steve Parker MD,calcium, osteoporosis

I’m guessing she’s northern European, perhaps Irish

Most paleo lifestyle proponents think that, genetically speaking, those of us living today are pretty much the same as our ancestors living 50,000 or even 200,000 thousand years ago. That may not be the case.

Conventional Wisdom

The traditional view of the rate of human evolution’s is articulated by Artemis P. Simopoulos, who was with The Center for Genetics, Nutrition and Health in 2009 when he wrote: “The spontaneous mutation rate for nuclear DNA is estimated at 0.5% per million years. Therefore, over the past 10,000 years there has been time for very little change in our genes, perhaps 0.005%. In fact, our genes today are very similar to the genes of our ancestors during the Paleolithic period 40,000 years ago, at which time our genetic profile was established.”

Evolving Thought

 

On the other hand, the experts are debating now whether the pace of human evolution has accelerated over the last 10,000 years. The iconoclasts say it has. For example, remember that most mammals lose the ability to digest milk after they’ve been weaned off the teat in early life: they lose the lactase enzyme that allowed them to digest milk sugar (lactose). That’s why lactose intolerance is so common among adult humans—only a third of us worldwide can digest milk. Five or 10,000 years ago, a genetic mutation occurred that allowed those possessing the gene to consume and digest milk. So a whole new source of food for adults opened up: dairy cattle. Would that have conferred a survival advantage? You bet. We have evidence that the milk-digesting mutation spread fairly quickly since its appearance. But it hasn’t spread across the globe uniformly. The ability to digest milk in adulthood—called lactase persistence—is less than 40% in Greece and Turkey, but higher than 90% in the UK and Scandinavia.

Another oft-cited example of rapid and recent human evolution is the appearance and spread of blue eyes starting six to 10,000 years ago. Everyone with blue eyes today apparently has a common ancestor that had a gene mutation back then, when everybody had brown eyes.

For more information on the “rapid evolution” idea, check out the writings of Gregory Cochran, Henry Harpending, and John Hawks. Also consider a new book by Nicholas Wade, “A Troublesome Inheritance: Genes, Race, and Human History.” Wade is a science writer for the New York Times.

Steve Parker, M.D.

If You Have Diabetes, You Need to Know About Glucagon

I couldn't find a pertinent picture

I couldn’t find a pertinent picture

Everybody knows that insulin is the key hormone gone haywire in diabetes, right? Did you know it’s not the only one out of whack? Roger Unger and Alan Cherrington in The Journal of Clinical Investigation point out that another hormone—glucagon—is also very important in regulation of blood sugar in both types of diabetes.

Insulin has a variety of actions the ultimately keep blood sugar levels from rising dangerously high. Glucagon, on the other hand, keeps blood sugar from dropping too low. For instance, when you stop eating food, as in an overnight or longer fast, glucagon stimulates glucose (sugar) production by your liver so you don’t go into a hypoglycemic coma and die. It does the same when you exercise, as your muscles soak up glucose from your blood stream.

Glucagon works so well to raise blood sugar that we inject it into diabetics who are hypoglycemic but comatose or otherwise unable to swallow carbohydrates.

Glucagon also has effects on fatty acid metabolism, ketone production, and liver protein metabolism, but this post is already complicated enough.

So where does glucagon come from? The islets of Langherhans, for one. You already know the healthy pancreas has beta cells that produce insulin. The pancreas has other cells—alpha or α cells—that produce glucagon. Furthermore, the stomach and duodenum (the first part of the small intestine) also have glucagon-producing alpha cells. The insulin and glucagon work together to keep blood sugar in an fairly narrow range. Insulin lowers blood sugar, glucagon raises it. It’s sort of like aiming for a hot bath by running a mix of cold and very hot water.

Update: I just licensed this from Shutterstock.com

Update: I just licensed this from Shutterstock.com

Ungar and Cherrington say that one reason it’s so hard to tightly control blood sugars in type 1 diabetes is because we don’t address the high levels of glucagon. The bath water’s not right because we’re fiddling with just one of the faucets. Maybe we’ll call this the Goldilocks Theory of Diabetes.

When you eat carbohydrates, your blood sugar starts to rise. Beta cells in the healthy pancreas start secreting insulin to keep a lid on the blood sugar rise. This is not the time you want uncontrolled release of glucagon from the alpha cells, which would work to raise blood sugars further. Within the pancreas, beta and alpha cells are in close proximity. Insulin from the beta cells directly affects the nearby alpha cells to suppress glucagon release. This localized hormone effect is referred to as “paracrine guidance” in the quote below, and it takes very little insulin to suppress glucagon.

From the Ungar and Cherrington article:

Here, we review evidence that the insulinocentric view of metabolic homeostasis is incomplete and that glucagon is indeed a key regulator of normal fuel metabolism, albeit under insulin’s paracrine guidance and control. Most importantly, we emphasize that, whenever paracrine control by insulin is lacking, as in T1DM, the resulting unbridled hyperglucagonemia is the proximal cause of the deadly consequences of uncontrolled diabetes and the glycemic volatility of even “well-controlled” patients.

*  *  *

All in all, it would seem that conventional monotherapy with insulin is incomplete because it can provide paracrine suppression of glucagon secretion only by seriously overdosing the extrapancreatic tissues.

So What?

Elucidation of diabetes’ disease mechanisms (pathophysiology) can lead to new drugs or other therapies that improve the lives of diabetics. A potential drug candidate is leptin, known to suppress glucagon hyper secretion in rodents with type 1 diabetes.

RTWT.

Steve Parker, M.D.

PS: Amylin is yet another hormone involved in blood sugar regulation, but I’ll save that for another day. If you can’t wait, read about it here in my review of pramlintide, a drug for type 1 diabetes.