Category Archives: Paleo Diet

What’s the Difference Between White Potatoes and Sweet Potatoes?

Posted on April 11, 2013 | 2 Comments

The sweet taters have more vitamin A and, at least where I live, they’re more expensive. That’s all.

paleo diet, Steve Parker MD, diabetic diet

Sweet potato chunks brushed with olive oil, salt, pepper, rosemary

Oh, I forgot. Different colors, too.

AncestralChef has the details.

PS: I know a lot of nutrition bloggers and other health nuts use the nutrient database at NutritionData.com. That’s based version 21 of the U.S. Department of Agriculture’s Nutrient Database. The current version, however, is 25. About two years ago, the focus at NutritionData switched to referral of visitors to Self magazine. For my nutrient analysis, I’ve been using FitDay.com. Or you can go straight to the USDA.

paleo diet, Steve Parker MD

Ready to pop in the oven

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New Cochrane Review Supports Population-Wide Sodium Restriction

Posted on April 11, 2013 | 1 Comment

 

A pinch of salt helps reduce bitterness in coffee

A pinch of salt helps reduce bitterness in coffee

Details are at the British Medical Journal.

If you read it, note that the authors usually refer to salt in grams per day. In the U.S., we typically talk about dietary salt in terms of its sodium content, also in grams per day. Table salt, remember, is NaCl (sodium chloride).

The theory is that high salt intake raises blood pressure, which leads to premature death or disability from heart attacks, strokes, atherosclerosis, and aneurysms. Cut your salt consumption, and blood pressure comes down to a safer level.

You can find studies that don’t support the theory.

From the BMI article:

In the United States, it is recommended that sodium intake should be reduced to less than 2.3 g/day (equivalent to about 6 g/day salt) for most adults, with a further reduction to 1.5 g/day (4 g/d salt) for about half the population, including African Americans, all adults aged 51 and older, and individuals with hypertension, diabetes, or chronic kidney disease.

…

From the evidence above, it is clear that the recommendations to reduce salt from the current levels of about 9-12 g/day to 5-6 g/day will have a significant effect on blood pressure but are not ideal. A further reduction to 3 g/day will have a much greater effect on blood pressure, and we consider that this should become the long term target for population salt intake.

A pure paleo diet is a low-sodium diet.

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Is the Paleo Diet Truly Low-Carb After All?

Posted on April 6, 2013 | 3 Comments

Lifextension argues that very case in a recent blog post. If the paleo diet is low carb, then it’s going to be heavily animal-based. According to Lifextension:

Diachronic and comparative analysis of the skeletal data of human hunters and cultivators from across the globe has revealed that – prior to the onset of agriculture – carbohydrates must have comprised only a rare and occasional component of ancestral eating patterns. Furthermore, the impact of the introduction of carbohydrates to human diets was almost immediate in its deterioration of human health and biology.

…

However, paradoxically, many proponents of a ‘Paleo’ (i.e.: pre-agricultural) diet have promoted the use of tubers and other starches as – not only benign – but necessary health foods to consume for the correction of metabolic and endocrine disorders. Potatoes, rice, and other oxymoronically-labelled ‘safe’ starches, are being promoted in spite of the fact that they are exclusively Neolithic foods. Consequently, it is the conflation of starches, safe, and ancestral that I now wish to address, and hopefully correct.

Lifextension concludes:

The intake of plant foods by hominids was most plausibly and conceivably minimal. This is due to their limited, seasonal availability; the physiological ceiling on fibre and toxin intake; the biological evolution of early Homo physiology; along with the technological, spatial and temporal limitations of obligatory pre-consumption preparations. Consequently, evolutionary arguments for the consumption of what are quite blatantly Neolithic foods are rendered paradoxical and absurd. Starches are neither ‘Paleo’; nor does our evolutionary biology sanction them as ‘safe’.

Lifextension neither pulls punches nor takes prisoners. This could get interesting.

Read the rest.

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Seminal Article by Loren Cordain, Ph.D.

Posted on April 5, 2013 | 1 Comment

I have little to say about it. Just wanted it in my database:

“The Nutritional Characteristics of a Contemporary Diet Based Upon Paleolithic Food Groups” in Journal of the American Neutraceutical Association,  2002; 5:15-24.

The title of that journal doesn’t fill me with confidence, but it is what it is. Many of the ideas in the article are likely in his popular books.

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Anthropologist Debunks the Paleolithic Diet

Posted on March 25, 2013 | 3 Comments
paleo diet, paleolithic diet, caveman diet

Not Dr. Warinner

Christina Warinner has a new TEDx talk on the paleo diet.  Dr. Warinner has a Ph.D. in anthropology from Harvard, so I’ll call her an anthropologist. The written TEDx intro mentions she is a paleontologist, and she mentions “archeologist” in her talk.  Anyway, I’m sure she’s very bright and put much thought into her presentation.  She spoke at my old stomping grounds, the University of Oklahoma in Norman.

Click to view video.

Dr. Warinner is probably addressing the smarter half of the general population, who holds the idea, at least superficially, that the paleo diet is meat-based.  (The dumber half of the public isn’t watching TEDx videos.)  Dr. Warinner doesn’t define “meat-based.”  Is half the plate filled with meat, fish, or eggs?  75% of the plate?  Half of total calories?

I’m not familiar with all the popular modern versions of the paleo diet.  Perhaps some are in fact meat-centric, whatever that means.  But the ones I’m more familiar with, like Dr. Cordain’s and mine, prominently feature vegetables, fruits, and nuts.  You could easily fashion a plant-based paleo diet, filling 80 or even 90% of your plate with plants.  (A vegan paleo diet isn’t realistic.  Cultures not eating animals would die out from B12 deficiency.)

I’d swear I heard Dr. Warinner say “we’re not adapted to eat meat.”  Surely she mis-spoke.

She mostly debunks popular misconceptions of the paleo diet.  Most of us deeply familiar with the paleo diet would have little to disagree with her about.

Here are some of Dr. Warinner’s major points:

  • It’s nearly impossible for most of us to eat a true Paleolithic diet.  Selective breeding has altered nearly all our foods to the point of unrecognizability by cavemen.  Examples are bananas, broccoli, carrots, and tomatoes.
  • There is no single paleo diet.  It depends on regional geographic variations in rainfall, latitude, temperature, etc.  Local populations ate what was available, in season, and often migrated seasonally to find food.

Dr. Warinner suggests we all incorporate three concepts from the paleo diet:

  1. Eat a great variety of foods.
  2. For the highest nutrient content, eat fresh food when ripe, in season.
  3. Eat whole foods.

Steve Parker, M.D.

PS: Miki Ben-Dor, a Ph.D. candidate, had many more objections to Dr. Warinner’s speech.  Paul Jaminet made a few comments about it, too (see middle of his post, after the comments on Marlene Zuk’s PaleoFantasy).  Wendy Schwartz weighs in, too. Angelo Coppola does a good job countering most of Dr. Warriner’s criticisms.

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My Critique of the Joslin Critique of the Paleo Diet

Posted on March 16, 2013 | 3 Comments
paleo diet, Paleolithic diet, hunter-gatherer diet

Huaorani hunter in Ecuador

The Joslin Diabetes Blog yesterday reviewed the paleo diet as applied to both diabetes and the general public.  They weren’t very favorably impressed with it.  But in view of Joslin’s great reputation, we need to give serious consideration to their ideas.  (I don’t know who wrote the review other than “Joslin Communications.”)

These are the main criticisms:

  • diets omitting grains and dairy are deficient in calcium and possibly B vitamins
  • you could eat too much total and saturated fat, leading to insulin resistance (whether type 1 or 2 diabetes) and heart disease
  • it’s not very practical, partly because it goes against the grain of modern Western cultures
  • it may be expensive (citing the cost of meat, and I’d mention fresh fruit and vegetables, too)

Their conclusion:

There are certainly better diets out there, but if you are going to follow this one, do yourself a favor, take a calcium supplement and meet with a registered dietitian who is also a certified diabetes educator  to make sure it is nutritionally complete, isn’t raising your lipids and doesn’t cause you any low blood glucose incidences.

Expense and Practicality

These take a back seat to the health issues in my view.  Diabetes itself is expensive and impractical.  Expense and practicality are highly variable, idiosyncratic matters to be pondered and decided by the individual.  If there are real health benefits to the paleo diet, many folks will find work-arounds for any expense and impracticality.  If the paleo diet  allows use of fewer drugs and helps avoid medical complications, you save money in health care costs that you can put into food.  Not to mention quality of life issues (but I just did).

Calcium and B Vitamin Deficiencies

This is the first I’ve heard of possible B vitamin deficiencies on the paleo diet.  Perhaps I’m not as well-read as I thought.  I’ll keep my eyes open for confirmation.

The potential calcium deficiency, I’ve heard of before.  I’m still open-minded on it.  I am starting to wonder if we need as much dietary calcium as the experts tell us.  The main question is whether inadequate calcium intake causes osteoporosis, the bone-thinning condition linked to broken hips and wrists in old ladies.  This is a major problem for Western societies.  Nature hasn’t exerted much selection pressure against osteoporosis because we don’t see most of the fractures until after age 70.  I wouldn’t be surprised if we eventually find that life-long exercise and adequate vitamin D levels are much more important that calcium consumption.

With regards to calcium supplementation, you’ll find several recent scientific references questioning it.  For example, see this, and this, and this, and this, and this.  If you bother to click through and read the articles, you may well conclude there’s no good evidence for calcium supplementation for the general population.  If you’re not going to supplement, would high intake from foods be even more important?  Maybe so, maybe not.  I’m don’t know.

If you check, most of the professional osteoporosis organizations are going to recommend calcium supplements for postmenopausal women, unless dietary calcium intake is fairly high.

If I were a women wanting to avoid osteoporosis, I’d do regular life-long exercise that stressed my bones (weight-bearing and resistance training) and be sure I had adequate vitamin D levels.  And men, you’re not immune to osteoporosis, just less likely to suffer from it.

Insulin Resistance

Insulin resistance from a relatively high-fat diet is theoretically possible.  In reality, it’s not common.  I’ve read plenty of low-carb high-fat diet research reports in people with type 2 diabetes.  Insulin levels and blood glucose levels go down, on average.  That’s not what you’d see with new insulin resistance.  One caveat, however, is that these are nearly all short-term studies, 6-12 weeks long.

If you have diabetes and develop insulin resistance on a high-fat diet, you will see higher blood sugar levels and the need for higher insulin drug doses.  Watch for that if you try the paleo diet.

Are High Total and Saturated Fat Bad?

Regarding relatively high consumption of total and saturated fat as a cause of heart or other vascular disease: I don’t believe that any more.  Click to see why.  If you worry about that issue, choose meats that are leaner (lower in fat) and eat smaller portions.  You could also look at your protein foods—beef, chicken, fish, eggs, offal, etc.—and choose items lower in total and saturated fat.  Consult a dietitian or online resource.  Protein deficiency is rarely, if ever, a problem on paleo diets.

In Conclusion

I think the paleo diet has more healthful potential than realized by the Joslin blogger(s).  I’m sure they’d agree we need more clinical studies of it, involving both type 1 and 2 diabetics.  I appreciate the “heads up” regarding potential vitamin B deficiencies.  My sense is that the Joslin folks are willing to reassess their position based on scientific studies.

I bet some of our paleo-friendly registered dietitians have addressed the potential adverse health issues of the paleo diet.  Try Amy Kubal, Franziska Spritzler (more low-carb than paleo) or Aglaée Jacob.  I assume the leading paleo diet book authors have done it also.

If you’re worried about adverse blood lipid changes on the paleo diet, get them tested before you start, then after two months of dieting.

Steve Parker, M.D.

PS: The paleo diet is also referred to as the Stone Age diet, caveman diet, Paleolithic diet, hunter-gatherer diet, and ancestral diet.

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QOTD: Calcium and the Paleo Diet

Posted on March 5, 2013 | 1 Comment

“Low calcium intake, which is often considered as a potential disadvantage of the Paleolithic diet model, should be weighed against the low content of phytates and the low content of sodium chloride, as well as the high amount of net base yielding vegetables and fruits.”

—L.M. Kowalski and J. Bujko

Hamburger-Avocado Salad with tomatoes, cucumbers, lettuce, salt/pepper, and olive oil vinaigrette

Hamburger-Avocado Salad with tomatoes, cucumbers, lettuce, salt/pepper, and olive oil vinaigrette

PS: Low calcium consumption is thought to predispose to osteoporosis, a bone-thinning disease that causes fractures.  It affects women far more than men.  If you don’t live past 50 or 60, it’s not much of a problem.  Kowalski and Bujko imply that low phytate and sodium content, plus alkaline veggies and fruit, counteract any adverse bone effects of low calcium consumption.  I’m not sure because I don’t read Polish.  Loren Cordain’s paleo diet website talks about the diet being healthy for bones, citing the acid-base issue.

h/t Amy Kubal (Twitter: @AmykRd)

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Ideas For A Paleo Diabetic Diet

Posted on February 3, 2013 | 6 Comments
Sirloin steak, salad, cantaloupe, 3 raspberries

Sirloin steak, salad, cantaloupe, 3 raspberries

I’ve been thinking about a paleo-style diabetic diet for over a year.  Here are some miscellaneous ideas for your consideration.

A paleo diabetic diet will have the following major food groups:

  • vegetables
  • fruits
  • nuts and seeds
  • proteins (e.g., meat, fish, eggs)
  • condiments

A paleo diabetic diet could (should?) emphasize salads and low-carb colorful vegetables and only (?) low-carb or low-glycemic-index fruits.

Calories

Total calories?  Probably in the range of 1,800 to 3,000 calories daily with an average of 2,000.  Remember that 85% of type 2 diabetics are overweight or obese. Calorie restriction—regardless of macronutrient ratios (% carb, protein, fat)—tends to improve or normalize blood sugar levels.  Weight loss will likely entail some caloric restriction, whether consciously or not.

Type 1 Versus Type 2 Diabetes

Type 1 and type 2 diabetics have many pathophysiologic differences.  Could a single paleo diabetic diet serve both populations equally well?  That’s the goal.

Carbohydrates

Diabetics have trouble metabolizing carbohydrates, so a paleo diabetic diet should probably be lower-than-average in digestible carbs.  100 g/day?  30 g/day?  I’m leaning toward 60 g ± 25%, so 45–75 g.  Smaller, less active folks could eat 45 g/day; larger, more active guys eat closer to 75 g.

Is there a role for very-low-carb or ketogenic eating patterns?  For most folks, that’s less than 50 g of digestible carbohydrate daily.  Under 30 g for some.  Use that only for those needing to lose weight?  Start everybody at  very low carb levels then increase carbs as tolerated?  On the other hand, there’s a lot to be said for simplicity.  It might be best to avoid very-low-carb (ketogenic) eating entirely.  Anyone not losing the desired amount of fat weight could cut portion sizes, especially carbohydrates.

Fish

I encourage fish consumption twice a week, diabetes or no.  Cold-water fatty fish have more of the healthy omega-3 fatty acids than other fish.

Nuts

I’d encourage 1–2 ounces (28–56 g) of nuts or seeds daily.  Any more than that might crowd out other healthful nutrients.  Nuts are protective of the heart.

Proteins

Protein-rich foods can definitely raise insulin requirements and blood sugar levels, but not in an entirely predictable way, and not to the extent we see with carbohydrates.  Should insulin users dose insulin based on a protein gram sliding scale?  I’m leaning towards simply recommending the same amount of protein at each meal, perhaps 4–8 ounces (113–229 g).

Fruit and Starchy Vegetables

Could a paleo diabetic diet even be “paleo” without fruit?  The problem with classic fruits is that they spike blood sugars too high for many diabetics.  To prevent that, Dr. Richard Bernstein outlaws all classic fruits (and other starchy carbs), even limiting tomatoes and onions to small amounts.  E.g., a wedge of tomato in a salad.  He doesn’t allow carrots either, unless raw (lower glycemic index than when cooked).  A paleo diabetic diet eater may be able to get away with eating lower-carb, lower-GI (glycemic index) fruits such as cantaloupe, honeydew, strawberries and other berries.  Some paleo diabetic dieters will tolerate half an apple twice a day.

Different diabetics will have different blood sugar effects when eating starchy vegetables and higher-carb fruits.  Type 1 diabetics will tend to be more predictable than type 2s.  Both may just need to “eat to the meter”: try a serving and see what happens to blood sugar over the next hour or two.

Starchy vegetables—potatoes and carrots, for example—may well have to be limited.  Again, eat to the meter.

Gluten

This is looking to be gluten-free.  How trendy!  It’s a paleo celiac diet.

Use “natural” stevia as a sweetener?  If you read about how the product on your supermarket shelf  is made, it’s not at all natural.

Omega-6/Omega-3 Fatty Acids

A strict focus on omega-6/omega-3 fatty acid ratio will not appeal to many folks, even if it’s important from a health viewpoint.  Reserve this for advanced dieters who have mastered the basics?  Modern Western diets have an omega-6/omega-3 ratio around 10 or 15:1.  Paleolithic diets were closer to 2 or 3:1.  So we have an over-abundance of omega-6 fatty acid or deficiency of omega-3 that may be unhealthy.

Implementation

To get dieters started, I’d design a week of meals based on 2,000 to 2,200 calories.  If still hungry, eat more protein, fat, and low-carb vegetables (and fruits?).

What do you think?

Steve Parker, M.D.

Disclaimer:  All matters regarding your health require supervision by a personal physician or other appropriate health professional familiar with your current health status.  Always consult your personal physician before making any dietary or exercise changes.  

PS: See Dr. Bernstein’s “no-no” foods on page 151 of his Diabetes Solution book.

PPS: The paleo diet is also known as the Paleolithic diet, Stone Age diet, caveman diet, hunter-gatherer diet, and ancestral diet.

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The Traveling Sweet Potato

Posted on January 29, 2013 | Leave a comment

If you like sweet potatoes, ScienceNOW has an interesting article on the travels and domestication of the humble sweet potato.  An excerpt:

Humans domesticated the sweet potato in the Peruvian highlands about 8000 years ago, and previous generations of scholars believed that Spanish and Portuguese explorers introduced the crop to Southeast Asia and the Pacific beginning in the 16th century. But in recent years, archaeologists and linguists have accumulated evidence supporting another hypothesis: Premodern Polynesian sailors navigated their sophisticated ships all the way to the west coast of South America and brought the sweet potato back home with them. The oldest carbonized sample of the crop found by archaeologists in the Pacific dates to about 1000 C.E.—nearly 500 years before Columbus’s first voyage.

Some versions of the paleo diet don’t include white or sweet potatoes, probably because they originated in the New World (particularly Peru).  They wouldn’t have been eaten by our prehistoric ancestors in Africa.  I haven’t done the research yet, but I bet northeast Africa had a starchy tuber roughly equivalent to potatoes.

Steve Parker, M.D.

h/t Ivor Goodbody

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Paleo Pioneer S. Boyd Eaton’s Personal Lifestyle

Posted on January 14, 2013 | Leave a comment
African Savanna

African Savanna

Dr. Eaton (M.D.) spoke at the last Ancestral Health Symposium about his own diet and exercise program.  He’s 74-years-old and has been following his paleo lifestyle for 30 years.  In this video, Dr. Eaton looks quite fit and is obviously mentally sharp.

He talks about a “weak form” of the paleo diet that would include relatively small amounts of whole grains (e.g., shredded wheat) and dairy (e.g., skim milk).  He doesn’t proscribe beans.  He limits saturated fat, but enjoys red wine.

Dr. Eaton also discusses a “strong form” diet that would cut out the dairy, grains, and probably alcohol.  This is for those with certain diseases of modern civilization, such as high blood pressure, coronary artery disease, metabolic syndrome, adverse blood lipids, etc.  He didn’t mention diabetes specifically, but I bet he would include it in the list.

He has an impressive daily exercise program that probably takes at least an hour, with weight training on machines plus an aerobics (stationary bike and swimming).

Dr. Eaton supplments with a multivitamin/multimineral (showed a picture of Centrum), EPA/DHA, and fiber (especially soluble fiber).

The video is only 20 minutes long and well worth a look.

Steve Parker, M.D.

h/t Melissa McEwen. (Melissa has the impression the Eaton partakes of whole grains and dairy.  I didn’t hear that in the video but may have missed it.)

 

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