Tag Archives: paleolithic diet

QOTD: Calcium and the Paleo Diet

“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)

Diabetic Hypoglycemia and the Paleo Diet: Recognition and Management

Healthy non-diabetics making the switch to the paleo diet rarely, if ever, experience hypoglycemia.  That’s not true for diabetics, especially if they’re on certain medications.

hypoglycemia, woman, rock-climbing

Hypoglycemia now would be a tad inconvenient

Hypoglycemia means an abnormally low blood sugar (under 60–70 mg/dl or 3.33–3.89 mmol/l) associated with symptoms such as weakness, malaise, anxiety, irritability, shaking, sweating, hunger, fast heart rate, blurry vision, difficulty concentrating, or dizziness. Symptoms often start suddenly and without obvious explanation. If not recognized and treated, hypoglycemia can lead to incoordination, altered mental status (fuzzy thinking, disorientation, confusion, odd behavior, lethargy), loss of consciousness, seizures, and even death (rare).

You can imagine the consequences if you develop fuzzy thinking or lose consciousness while driving a car, operating dangerous machinery, or scuba diving.

Do not assume your sugar is low every time you feel a little hungry, weak, or anxious. Use your home glucose monitor for confirmation when able.

Why Would the Paleo Diet Cause Hypoglycemia?

Carbohydrates are the the primary source of blood glucose (blood sugar).  Paleo diets typically derive anywhere from 20 to 40% of total calories from carbohydrate, with 30% being about average.  This compares with 50-60% of calories coming from carbs in the usual American diet.  Additionally, the overall glycemic index of paleo diet carbs is likely to be lower than an average American diet since there are no refined starches and sugars.  A lower glycemic index tends to limit blood sugar spikes in response to a meal.  So any diabetic switching to a paleo diet could see significant drops in blood sugar,  including hypoglycemia.

How Is Hypoglycemia Treated?

If you have diabetes, your personal physician and other healthcare team members should teach you how to recognize and manage hypoglycemia. Immediate early stage treatment involves ingestion of glucose as the preferred treatment—15 to 20 grams. You can get glucose tablets or paste at your local pharmacy without a prescription. Other carbohydrates will also work: six fl oz (180 ml) sweetened fruit juice, 12 fl oz (360 ml) milk, four tsp (20 ml) table sugar mixed in water, four fl oz (120 ml) soda pop, candy, etc. Fifteen to 30 grams of glucose or other carbohydrate should do the trick. Hypoglycemic symptoms respond within 20 minutes.

hypoglycemia, candy

Lady, fruit juice would raise your blood sugar much quicker

If level of consciousness is diminished such that the person cannot safely swallow, he’ll need a glucagon injection. Non-medical people can be trained to give the injection under the skin or into a muscle. Ask your doctor if you’re at risk for severe hypoglycemia. If so, ask him for a prescription so you can get an emergency glucagon kit from a pharmacy.

Hypoglycemia Unawareness

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. People with hypoglycemia unawareness need to check blood sugars more frequently, particularly if driving a car or operating dangerous machinery.

OK, the Acute Crisis Is Over — What Next?

If you do experience hypoglycemia, discuss management options with your doctor: downward medication adjustment, shifting meal quantities or times, adjustment of exercise routine, eating more carbohydrates, etc. If you’re trying to lose weight or control high blood sugars, reducing certain diabetic drugs makes more sense than eating more carbs. Eating at regular intervals three or four times daily may help prevent hypoglycemia. Spreading carbohydrate consumption evenly throughout the day may help. Someone most active during daylight hours as opposed to nighttime will generally do better eating carbs at breakfast and lunch rather than concentrating them at bedtime.

DRUG  ADJUSTMENTS  TO  AVOID  HYPOGLYCEMIA

Hypoglycemia is a great risk for diabetics taking certain diabetic drugs while on a low-carb paleo diet. This is dangerous territory.

Remember, drugs have both generic and brand names. The names vary from country to country, as well as by manufacturer. You’ve got to know what class of drug you’re taking.  If you have any doubt about whether your diabetic drug has the potential to cause hypoglycemia, ask your physician or pharmacist.

hypoglycemia, fruit juice, orange juice

That’s the ticket

DRUGS THAT CAUSE HYPOGLYCEMIA

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

  • insulin
  • sulfonylureas: glipizide, glyburide, glimiperide, chlorpropamide, acetohexamide, tolbutamide
  • meglitinides: repaglinide, nateglinide
  • pramlintide plus insulin
  • exenatide plus sulfonylurea
  • possibly thiazolidinediones: pioglitazone, rosiglitazone
  • possibly bromocriptine

DRUGS THAT RARELY, IF EVER, CAUSE HYPOGLYCEMIA

Diabetics not being treated with pills or insulin rarely need to worry about hypoglycemia.  That’s true also for prediabetics.

Similarly, diabetics treated only with diet, metformin, colesevalam, 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.

DRUG ADJUSTMENTS TO AVOID HYPOGLYCEMIA

Diabetics considering or following a carbohydrate-restricted diet must work closely with their personal physician, dietitian, or certified diabetes educator, especially to avoid hypoglycemia caused by the aforementioned classes of diabetic drugs.

Clinical experience with thousands of patients has led to generally accepted guidelines that help avoid hypoglycemia in diabetics on medications.

Common strategies for diabetics on hypoglycemia-inducing drugs and starting a low-carb diet include:

  • reduce the insulin dose by a quarter or half
  • change short-acting insulin to long-acting (such as glargine)
  • stop the sulfonylurea, or reduce dose by a quarter or half
  • reduce the thiazolidinedione by up to a half
  • stop the meglitinide, or reduce the dose by up to a half
  • monitor blood sugars frequently, such as four times daily, at least until a stable pattern is established
  • spread carbohydrate consumption evenly throughout the day

Management also includes frequent monitoring of glucose levels with a home glucose monitor, often four to six times daily. Common measurement times are before meals and at bedtime. It may be helpful to occasionally wake at 3 AM and check a sugar level. To see the effect of a particular food or meal on glucose level, check it one or two hours after eating. Keep a record. When eating patterns are stable, and blood sugar levels are reasonable and stable, monitoring can be done less often. When food consumption or exercise habits change significantly, check sugar levels more often.

No One Cares About Your Health As Much As You

I recommend you become the expert on the diabetic drugs you take. Don’t depend solely on your physician. Do research at reliable sources and keep written notes. With a little effort, you could quickly surpass your doctor’s knowledge of your specific drugs. What are the side effects? How common are they? How soon do they work? Any interactions with other drugs? What’s the right dose, and how often can it be changed? Do you need blood tests to monitor for toxicity? How often? Who absolutely should not take this drug? Along with everything else your doctor has to keep up with, he prescribes about a hundred drugs on a regular basis. You only have to learn about two or three. It could save your life.

If you’re thinking that many diabetics on low-carb diets use fewer diabetic medications, you’re right. That’s probably a good thing since the long-term side effects of many of the drugs we use are unknown. Remember Rezulin (troglitazone)? Introduced in 1997, it was pulled off the U.S. market in 2001 because of fatal liver toxicity.  In 2010, rosiglitazone was heavily restricted in the U.S. out of concern for heart toxicity.

Steve Parker, M.D.

Once Again, There Is No “Paleo Diet”

David Despain, reports on “The Evolution of Human Nutrition” meeting of December, 2012.  Example:

Want to eat a diet that mimics that of our Paleolithic ancestors? It might be a little more complicated than what the popular books say.

The fact is, there was never one Paleo Diet; it’s more likely there were hundreds of them and that they were continually changing and broadening over evolutionary time.

That was the overarching message of an impressive lineup of experts on ancient human diets at a symposium entitled “The Evolution of Human Nutrition” organized by the Center of Academic Research and Training in Anthropogeny (CARTA) at UC San Diego on December 7, 2012.

Read the rest.  David has embedded some videos made at the symposium.

Attack Acne and More With mTORC1 Modulation

Was Hippocrates the dude that said something about “make food your medicine”?

Bodo Melnik has an article in DermatoEndocrinology regarding the dietary causes of acne.  He also comments on the role of Western foods in obesity, cancer, diabetes, high blood pressure, and neurodegenerative disorders.  These are our old friends, the “diseases of civilization.”  Melnik mentions the Paleolithic diet favorably.

Melnik says it’s all tied in with mTORC1: mammalian target of rapamycin complex 1.

A snippet:

These new insights into Western diet-mediated mTORC1-hyperactivity provide a rational basis for dietary intervention in acne by attenuating mTORC1 signaling by reducing (1) total energy intake, (2) hyperglycemic carbohydrates, (3) insulinotropic dairy proteins and (4) leucine-rich meat and dairy proteins. The necessary dietary changes are opposed to the evolution of industrialized food and fast food distribution of Westernized countries. An attenuation of mTORC1 signaling is only possible by increasing the consumption of vegetables and fruit, the major components of vegan or Paleolithic diets. The dermatologist bears a tremendous responsibility for his young acne patients who should be advised to modify their dietary habits in order to reduce activating stimuli of mTORC1, not only to improve acne but to prevent the harmful and expensive march to other mTORC1-related chronic diseases later in life.

You sciencey types can read the rest.  Our new friend mTOR also seems to be involved with growth of muscle induced by resistance exercise.

h/t Mangan

Low-Carb Research Update

Grain-based high-carb Neolithic food

Grain-based high-carb Neolithic food

The paleo diet averages about 30% of total calories from carbohydrates, with a range of about 22 to 40%.  That 30% average is much lower than the standard 50–60% in the developed world.  Is that lower percentage healthy or not?  It depends on the quality of the carbs and the remainder of the diet.  It most certainly can be healthy.

As much as possible, I base my nutrition and medical recommendations on science-based research published in the medical literature.  In the early 2000s, a flurry of scientific reports demonstrated that very-low-carb eating (as in the style of Dr. Robert Atkins) was safe and effective for short-term weight management and control of diabetes.  Eighty hours of literature review in 2009 allowed me to embrace low-carbohydrate eating as a logical and viable option for many of my patients. The evidence convinced me that the relatively high fat content of many low-carb diets was nothing to worry about long-term.

I’d like to share with you some of the pertinent low-carb research findings of the last few years.

Low-Carb Diets

  • Low-carb diets reduce weight, reduce blood pressure, lower triglyceride levels (a healtlhy move), and raise HDL cholesterol (another good trend).  These improvements should help reduce your risk of heart disease.  (In the journal Obesity Reviews, 2012.)
  • Dietary fat, including saturated fat, is not a cause of vascular disease such as heart attacks and atherosclerosis (hardening of the arteries).  (Multiple research reports.)
  • If you’re overweight and replace two sugary drinks a day with diet soda or water, you’ll lose about four pounds over the next six months.  (American Journal of Clinical Nutrition, 2012.)
  • United States citizens obtain 40% of total calories from grains and added sugars.  Most developed countries are similar.  Dr. Stephan Guyenet notes that U.S. sugar consumption increased steadily “…from 6.3 pounds [2.9 kg] per person per year in 1822 to 107.7 pounds [50 kg] per person in 1999.  Wrap your brain around this: in 1822 we ate the amount of added sugar in one 12-ounce can of soda every five days, while today we eat that much sugar every seven hours.”
  • A very-low-carb diet improves the memory of those with age-related mild cognitive impairment. Mild cognitive impairment is a precursor to dementia.  (University of Cincinnati, 2012.)
  • High-carbohydrate and sugar-rich diets greatly raise the risk of mild cognitive impairment in the elderly. (Mayo Clinic study published in the Journal of Alzheimers’ Disease, 2012.)
  • Compared to obese low-fat dieters, low-carb dieters lose twice as much fat weight.  (University of Cincinnati, 2011.)
  • Diets low in sugar and refined starches are linked to lower risk of age-related macular degeneration in women.  Macular degeneration is a major cause of blindness.  (University of Wisconsin, 2011.)
  • A ketogenic (very-low-carb) Mediterranean diet cures metabolic syndrome (Journal of Medicinal Food, 2011.)
  • For type 2 diabetics, replacing a daily muffin (high-carb) with two ounces (60 g) of nuts (low-carb) improves blood sugar control and reduces LDL cholesterol (the “bad” cholesterol). (Diabetes Care, 2011.)
  • For those afflicted with fatty liver, a low-carb diet beats a low-fat diet for management. (American Journal of Clinical Nutrition, 2011.)
  • For weight loss, the American Diabetes Association has endorsed low-carb (under 130 g/day) and Mediterranean diets, for use up to two years. (Diabetes Care, 2011.)
  • High-carbohydrate eating doubles the risk of heart disease (coronary artery disease) in women.  (Archives of Internal Medicine, 2010.)
  • One criticism of low-carb diets is that they may be high in protein, which in turn may cause bone thinning (osteoporosis).  A 2010 study shows this is not a problem, at least in women.  Men were not studied.  (American Journal of Clinical Nutrition.)
  • High-carbohydrate eating increases the risk of developing type 2 diabetes (American Journal of Clinical Nutrition, 2010.)
  • Obesity in U.S. children tripled from 1980 to 2000, rising to 17% of all children.  A low-carb, high-protein diet is safe and effective for obese adolescents.  (American Journal of Clinical Nutrition, 2010.

Steve Parker, M.D.

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

Denmark’s Paleolithic Diet

ScienceNordic has an article about the diet of Paleolithic humans who lived in what is now Denmark.  It’s brief and written for the general public.  The author mistakenly characterizes the “modern paleo” diet as no- or very-low-carb.  It’s lower in carb content than the standard American diet, but by no means no-carb.

—Steve

Could Acellular Carbohydrates Be the Cause of Obesity?

Ivor Goodbody in a recent tweet reminded me of an interesting nutrition science article.  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.

Harvesting acellular carbs

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.

Read more about it in “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, pp. 175-189.

To reverse our modern obesity epidemic, we need better understanding of the underlying pathophysiology.

—Steve

PS:  For Spreadbury’s formal definition of acellular carbohydrates, see my long comment below.

Dr. Frassetto Discusses Paleo Diet and Diabetes

Not Dr. Frassetto

Dr. Lynda Frassetto is a Professor of Medicine and Nephrology at the University of California San Francisco.  She and her colleagues have completed a study of the Paleolithic diet as a treatment for diabetes (type 2, I think).  As far as I know, details have not yet been published in the medical literature.

Dr. Frassetto spoke at the Ancestral Health Symposium-2012 earlier this year.  You can view the 35-minute video here.

She is convinced that a paleo diet, compared to a Mediterranean-style diet, is better at controlling blood sugars and “reducing insulin” in diabetics (presumably type 2s).  Insulin sensitivity is improved, particularly in those with insulin resistance to start with.  The paleo diet group saw an average drop of fasting glucose by 23 mg/dl (1.3 mmol/l).  One slide you’ll see in the video indicates the paleo diet reduced absolute hemoglobin A1c by 0.3%, compared to 0.2% with the “Mediterranean” diet.  (Let me know if I got the numbers wrong.)

Color me underwhelmed so far.

Questions raised by the video include:

  • what is the UCSF version of the paleo diet?
  • how many participants were in her study?
  • how long did her study last?
  • did she study only type 2 diabetics?
  • what exactly was the control diet?
  • how severe were the cases of diabetes studied?

For answers, we await publication of the formal report.

Steve Parker, M.D.

What Do Mainstream Dietitians Think of the Paleo Diet?

Australian Aborigine in Swamp Darwin

I’m curious to know what mainstream dietitians think about the Paleolithic diet, so I read an article entitled “Are diets from Paleolithic times relevant today?”  This one-page article is in the August, 2012, issue of the Journal of the American Academy of Nutrition and Dietetics. The author is Eleese Cunningham, RD, of the Academy of Nutrition and Dietetics Knowledge Center Team.

The Academy of Nutrition and Dietetics is the new name of the American Dietetics Association, “the world’s largest organization of food and nutrition professionals.”

Ms. Cunningham notes that “diet books for modern humans are extremely popular, and the Paleolithic diet, sometimes called the “Caveman Diet” or the “Stone Age Diet,” is one of the latest trends.”  You’d think the author would mention one of the popular paleo diet books, such as Loren Cordain’s, Robb Wolf’s, or Mark Sisson’s.  Think again.  She brings up only another dietitian’s review of Richard Nikoley’s paleo diet book, pointing out his lack of professional health credentials and his advocacy of raw milk consumption.  But milk isn’t even considered a component of most paleo diets.  Ms. Cunningham justifiably points out the infectious risks, however small, linked to raw milk consumption.  (I’ve not read Nikoley’s book, Free the Animal.)

(If you click the link to see the review of Nikoley’s book, scroll to page 30.  Sample: “Based more on science fiction than science fact, Nikoley’s recommendations are misguided and reckless…”)

Ms. Cunningham likes the fact that the paleo diet reduces consumption of salt and added sugars, while promoting fruit and vegetables.  However, she immediately notes thereafter that, “a striking counter to the meat-based Paleolithic diet is the evidence that supports the healthfulness of a vegetarian diet and the benefits it may have in the prevention and treatment of certain diseases.  Another review of this approach . . . questions the exclusion of nutrient-rich grains, beans, and low-fat dairy and the potential nutrient shortfalls associated with the Paleolithic diet restrictions.”

This article appears to be in a regular feature of the journal called, “From the Academy: Question of the Month.”  Are diets from Paleolithic times relevant today?  She never answers directly.  I suspect the average dietitian reading this article will conclude that Ms. Cunningham and the Academy are not in favor of the paleo diet.

Steve Parker, M.D.

Reference: Cunningham, Eleese.  Are diets from Paleolithic times relevant today?  Journal of the Academy of Nutrition and Dietetics, 2012 (vol. 112, issue 8): p. 1296.  doi: 10.1016/j.jand.2012.06.019

Position of the American Dietetic Association: Vegetarian diets.  Journal of the American Dietetic Association, 2009 (109): 1266-1282.

Melanie Gores a Few Oxen

Australian Aborigine

Dietitian Melanie Thomassian at Dietriffic offers some iconoclastic ideas in her critique of the paleo diet (aka Paleolithic, Old Stone Age, caveman, or hunter-gatherer diet).  Some quotes:

I’ll be the first to admit the diet recommended by most mainstream nutritionists, dietitians, and doctors is pretty terrible, and believe it or not, I do understand why people look elsewhere for their dietary advice.

 

The philosophy and reasoning behind the whole Paleo diet, however, isn’t something I can reconcile myself to.

Melanie addresses legumes, dairy, grains, and the problem of determining prehistoric diets.

-Steve