And she has type 1 diabetes, too. I look forward to some free time so I can peruse her site, Paleo Infused. Kelly’s twitter handle is @kellyOC.
And she has type 1 diabetes, too. I look forward to some free time so I can peruse her site, Paleo Infused. Kelly’s twitter handle is @kellyOC.
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:
For answers, we await publication of the formal report.
TV’s “The Biggest Loser” weight-loss program works great for overweight diabetics and prediabetics, according to an article May 30, 2012, in MedPage Today.
This isn’t directly related to the paleo diet or lifestyle, but I thought you might be interested.
For example, one man with a hemoglobin A1c (HbA1c) of 9.1, a body mass index (BMI) of 51, and who needed six insulin injections a day as well as other multiple prescriptions was off all medication by week 3, said Robert Huizenga, MD, the medical advisor for the TV show.
In addition, the mean percentage of weight loss of the 35 contestants in the study was 3.7% at week 1, 14.3% at week 5, and 31.9% at week 24…
The exercise regimen for those appearing on “The Biggest Loser” comprised about 4 hours of daily exercise: 1 hour of intense resistance training, 1 hour of intense aerobics, and 2 hours of moderate aerobics.
Caloric intake was at least 70% of the estimated resting daily energy expenditure, Huizenga said.
At the end of the program, participants are told to exercise for 90 minutes a day for the rest of their lives. Huizenga said he is often told by those listening to him that a daily 90-minute exercise regimen is impossible because everyone has such busy lives.
“I have a job and I work out from 90 to 100 minutes per day,” he said. “It’s about setting priorities. Time is not the issue; priorities are the issue.”
Of the 35 participants in this study, 12 had prediabetes and six had diabetes. This is a small pilot study, then. I bet the results would be reproducible on a larger scale IF all conditions of the TV program are in place. Of course, that’s not very realistic. A chance to win $250,000 (USD) is strong motivation for lifestyle change.
PS: Although not mentioned in the article, these must have been type 2 diabetics, not type 1.
I’m considering whether I should advise my patients with diabetes to pay careful attention to the protein content of their diet. It’s an important issue to Dr. Richard K. Bernstein, who definitely says it has to be taken into account.
Here are some of Dr. Bernstein’s ideas pulled from the current edition of Diabetes Solution:
Dr. Bernstein wrote:
In many respects—and going against the grain of a number of the medical establishment’s accepted notions about diabetics and protein—protein will become the most important part of our diet if you are going to control blood sugars just as it was for our hunter-gatherer ancestors.
I haven’t changed my thinking on this issue yet, but will let you know if and when I do. I don’t talk much about protein in Conquer Diabetes and Prediabetes in part because I wanted to keep the program simpler than Dr. Bernstein’s.
As with most aspects of diabetes, your mileage may vary. The effect of dietary protein on blood sugars will depend on type 1 versus type 2 diabetes, and will vary from one person to another. So it may be impossible to set rigid guidelines.
If interested, you can determine how much protein is in various foods at NutritionData.
Ketogenic diets don’t have anything to do with the paleo diet usually. However, I think they may play a legitimate role in weight loss for overweight type 2 diabetics. They could also be helpful in rapid control of blood sugars in out-of-control diabetics (excluding diabetic ketoacidosis).
Has anyone devised a ketogenic paleo diet yet? I don’t recall one off the top of my head.
Registered Dietitian Franziska Spritzler recently reviewed the concept of low-carb ketogenic diets. She thinks they are a valid approach to certain clinical situations. Among dietitians, this puts her in a small but growing minority.
I hesitate to mention this, but I will anyway. Many, if not most, dietitians too easily just go along with the standard party line on low-carb eating: it’s rarely necessary and quite possibly unhealthy. Going along is much easier than doing independent literature review and analysis. I see the same mindset among physicians.
Franziska breaks the mold.
Dr. Ernie Garcia is an internist in Louisiana treating some of his patients—particularly those with high blood pressure and diabetes—with the paleolithic lifestyle. (Mostly paleo diet, or other aspects of paleo lifestyle, too?)
Read more at PaleolithicMD.
Jimmy posted a recent interview with type 1 diabetic Dr. Keith R. Runyan, who is a nephrologist and internist.
Dr. Runyan is training for the Great Floridian Triathlon this coming October so he naturally has a great interest in high level athleticism as it intersects with diabetes. He fuels his workouts with dietary fats and proteins rather than the standard carbohydrates.
Dr. Runyan’s current carb consumption level didn’t come up specifically in the interview, but his website indicates he’s on a ketogenic diet heavily influenced by Dr. Richard Bernstein. I figure he’s eating under 50 grams of digestible carbohydrate daily. He also tried Loren Cordain’s paleo diet; my sense is that it didn’t help much with his diabetes, but perhaps some. My sense is that he incorporates at least a few paleo features into his current eating plan.
People with type 2 diabetes can probably tolerate a higher level of carbohydrates, compared to type 1’s, generally speaking. This didn’t come up in the podcast interview.
Overall, the interview strongly supports carbohydrate-restricted eating for folks with diabetes. Definitely worth a listen for anyone with diabetes who’s not sold on a very-low-carb diet. If you’re sitting on the fence, at least check out Dr. Runyan’s “About Me” page.
Elizabeth Woolley reviews most of them at her About.com column on type 2 diabetes. I don’t endorse everything there; just thought you might be interested.
I still see doctors at the hospital order “ADA diet” (American Diabetes Association) for their patients with diabetes.
There is no ADA diet.
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, salt, alcohol.
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 carbohydrates 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.)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 carbohydrate 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 (not accounting for wastage of calories in restaurants; 2250 cals/day is probably a more accurate figure for actual consumption). Added sugars provide 459 of those calories, or 17% of the total. Grains provide 625 calories, or 23% of the total. 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. Remember, we need good insulin action to process these carbs, which is a problem for diabetics. (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 andtubers. “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. 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.
Who knows about carb content of the standard “diabetic diet”? Contrary to popular 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 very 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.
Fun Facts provided by the U.S. Department of Agriculture.
(The paleo diet is also referred to as the Paleolithic, Old Stone Age, Stone Age, Ancestral, Hunter-Gatherer, or Caveman diet.)
Dr. Eenfeldt of DietDoctor.com gave a talk at the inaugural Ancestral Health Symposium in California, on the rationale of the current low-carb, high-fat diet (LCHF) so popular in his home country of Sweden. It’s very understandable to the general public and is a good introduction to low-carb eating. The entire YouTube video is 55 minutes; if you’re pressed for time, skip the 10-minute Q&A at the end.
He also discusses the benefits of LCHF eating for his patients with diabetes.
If you reduce carbohydrate, you’re going to replace it with either protein, fat, or both. Carbohydrate restriction, whether or not part of a Paleolithic eating pattern, generally improves blood sugar levels, especially in people with diabetes.