Category Archives: Grains

Ancestral Diet May Improve Diabetes in Pima Indians

Saguaro cactus fruit is edible

I ran across a 1991 New York Times article by Jane Brody discussing the benefits to Pima Indians of returning to their ancestral diet.  The Pima have major problems with obesity and diabetes.  (I frequently treat Pima Indians in the hospital.)  Some quotes:

Studies strongly indicate that people who evolved in these arid lands are metabolically best suited to the feast-and-famine cycles of their forebears who survived on the desert’s unpredictable bounty, both wild and cultivated.

By contrast, the modern North American diet is making them sick. With rich food perpetually available, weights in the high 200’s and 300’s are not uncommon among these once-lean people. As many as half the Pima and Tohono O’odham (formerly Papago) Indians now develop diabetes by the age of 35, an incidence 15 times higher than for Americans as a whole. Yet before World War II, diabetes was rare in this population.

Pima Indians traditionally ate a diet of tepary beans, mesquite seeds, corn, grains, greens, and other high-fiber/low-fat foods.  The switch to a diet high in sugar, refined grains, and other highly processed convenience foods may well be responsible for the current high rates of obesity and diabetes.  Australian aborigines have the same problem.

Steve Parker, M.D.

The Carbohydrate and Chronic Disease Connection

Simple dinner roll, or a future HEART ATTACK?

Adherents of the paleo diet and low-carb diets will love this post; it supports their choices.

Dentists are considering a return to an old theory that dietary carbohydrates first cause dental diseases, then certain systemic chronic diseases, according to a review in the June 1, 2009, Journal of Dental Research.  It’s written by Dr. Philippe P. Hujoel, who has been active in dental research for decades and is affiliated with the University of Washington (Seattle). He is no bomb-throwing, crazed, radical.

We’ve known for years that some dental and systemic diseases are associated with each other, both for individuals and populations. For example, gingivitis and periodontal disease are associated with type 2 diabetes and coronary heart disease. The exact nature of that association is not clear. In the 1990s it seemed that infections – chlamydia, for example – might be the unifying link, but this has not been supported by subsequent research.

The “old theory” to which I referred earlier is the Cleave-Yudkin idea from the 1960s and ’70s that excessive intake of digestible carbohydrates, in the absence of good dental care, leads both to certain dental diseases – caries (cavities), periodontal disease, certain oral cancers, and leukoplakia – and to some common systemic chronic non-communicable diseases such as coronary heart disease, type 2 diabetes, some cancers, and dementia. In other words, dietary carbohydrates cause both dental and systemic diseases – not all cases of those diseases, of course, but some.

In the context of excessive carbohydrate intake, the article frequently mentions sugar, refined carbs, and high-glycemic-index carbs. Dental effects of excessive carb intake can appear within weeks or months, whereas the sysemtic effects may take decades.

Hujoel compares and contrasts Ancel Keys’ Diet-Heart/Lipid Hypothesis with the Cleave-Yudkin Carbohydrate Theory. In Dr. Hujoel’s view, the latest research data favor the Carbohydrate Theory as an explanation of many cases of the aforementioned dental and systemic chronic diseases. If correct, the theory has important implications for prevention of dental and systemic diseases: namely, dietary carbohydrate restriction.

I agree with Dr. Hujoel that we need a long-term prospective trial of serious low-carb eating versus the standard American high-carb diet. Take 20,000 people, randomize them to one of the two diets, follow their dental and systemic health over 15-30 years, then compare the two groups. Problem is, I’m not sure it can be done. It’s hard enough for most people to follow a low-carb diet for four months. And I’m asking for 30 years?!

Dr. Hujoel writes:

Possibly, when it comes to fermentable carbohydrates, teeth would then become to the medical and dental professionals what they have always been for paleoanthropologists: “extremely informative about age, sex, diet, health.”

Dr. Hujoel mentioned a review of six studies that showed a 30% reduction in gingivitis score by following a diet moderately reduced in carbs. He mentions the aphorism: “no carbohydrates, no caries.” Anyone prone to dental caries or ongoing periodontal disease should do further research to see if switching to low-carb eating might improve the situation.

Don’t be surprised if your dentist isn’t very familiar with the concept.

Steve Parker, M.D.

Reference: Hujoel, P. Dietary carbohydrates and dental-systemic diseasesJournal of Dental Research, 88 (2009): 490-502.

Mendosa, David. Our dental alarm bell. MyDiabetesCentral.com, July 12, 2009.

Jimmy Moore’s 2012 interview with Dr. Hujoel.

Sources of Calories in U.S. Diet Over Last Four Decades

Italian seaside totally unrelated to this post

Do you ever wonder how many of the total calories in the aveage U.S. diet come from added sugars? Grains? Dairy products? Added fats?

You’d have to do some detailed nutrient analysis to get your personal numbers, but if you’d like U.S. averages, see this cool infographic at Civil Eats.

The graph also shows how many calories are or were available for consumption per capita over time (without accounting for wastage in restaurants). It’s based on U.S. Department of Agriculture data.

A superficial glance suggests that U.S. per capita daily calorie consumption has increased by about 600 from the 1970s until now. But remember, these numbers don’t discount for restaurant wastage. Nor do I see an adjustment for children versus adults. I’ve seen other calculations of an extra daily 150 calories (women) to 300 calories (men). Even the lower numbers could explain our explosion of overweight and obesity.

Steve Parker, M.D.

Random Thoughts On Paleo Eating For People With Diabetes

Not really pertinent, but I like buffalo

I was interviewed  yesterday 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.

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.) 

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 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 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.  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 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.

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. 

(The paleo diet is also referred to as the Paleolithic, Old Stone Age, Stone Age, Ancestral, Hunter-Gatherer, or Caveman diet.)

Evidence for Human Grain Consumption 100,000 Years Ago

ScienceDaily December 17 reported findings of a Canadian archeological team who found evidence of systematic grain consumption by ancient humans in Africa:

The consumption of wild cereals among prehistoric hunters and gatherers appears to be far more ancient than previously thought, according to a University of Calgary archaeologist who has found the oldest example of extensive reliance on cereal and root staples in the diet of early Homo sapiens more than 100,000 years ago.

 

Neolithic technology

In case you’re new to the paleo diet, grains are considered verboten by most adherents.  (Paleo diet is also known as the Stone Age diet, caveman diet, and Paleolithic diet.)  The cereal grain mentioned in the ScienceDaily article is wild sorghum.

Many in the paleosphere believe that such ancient humans didn’t have the technical skills to transform wild grains into something edible on a regular basis.  I haven’t read the source material, nor do I have an opinion on whether the archeologists are correct.  I’m just sayin’…

Steve Parker, M.D.

Reference: Mercader, Julio,  et al.  Mozambican grass seed consumption during the Middle Stone Age. Science, December 18, 2009.