DietDoctor Shares More Practical Tips for Fasting 

This guy had long spans of time between meals, perhaps days

This guy had long spans of time between meals, perhaps days

Yet another good post from DietDoctor! Why fast? Among many reasons is that fasting turns on autophagy, which helps clear the debris of daily living out of your cells, probably leading to longer life.

Click here for P.D. Mangan’s post on fasting and autophagy.

Dr. Fung at DietDoctor also warns about the danger of hypoglycemia for certain folks with diabetes. Read that part carefully.

Anyway, here are Dr. Fung’s top eight tips:

“Drink water: Start each morning with a full eight-ounce glass of water.

Stay busy: It’ll keep your mind off food. It often helps to choose a busy day at work for a fast day.

Drink coffee: Coffee is a mild appetite suppressant. Green tea, black tea, and bone broth may also help.Ride the waves: Hunger comes in waves; it is not continuous. When it hits, slowly drink a glass of water or a hot cup of coffee. Often by the time you’ve finished, your hunger will have passed.

Don’t tell anybody you are fasting: Most people will try to discourage you, as they do not understand the benefits. A close-knit support group is often beneficial, but telling everybody you know is not a good idea.

Give yourself one month: It takes time for your body to get used to fasting. The first few times you fast may be difficult, so be prepared. Don’t be discouraged. It will get easier.

Follow a nutritious diet on non-fast days: Intermittent fasting is not an excuse to eat whatever you like. During non-fasting days, stick to a nutritious diet low in sugars and refined carbohydrates.

Don’t’ binge: After fasting, pretend it never happened. Eat normally, as if you had never fasted.”

Source: More Practical Tips for Fasting – Diet Doctor

Steve Parker, M.D.

PS: I don’t feature fasting in any of my books, but I’ve gradually come around to seeing the potential benefits.

Paleolithic and Mediterranean Diet Patterns Reduce Markers of Inflammation

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Many chronic medical conditions are though to be caused by chronic inflammation in our bodies. Sample conditions include high blood pressure, coronary artery disease (heart attacks), metabolic syndrome, type 2 diabetes, autoimmune diseases, and perhaps some cancers.

Taking the association further: could we prevent or alleviate these conditions by reducing inflammation? If so, diet is one way to do it.

Here’s an abstract from a scientific article I found:

Background: Chronic inflammation and oxidative balance are associated with poor diet quality and risk of cancer and other chronic diseases. A diet–inflammation/oxidative balance association may relate to evolutionary discordance.

“Objective: We investigated associations between 2 diet pattern scores, the Paleolithic and the Mediterranean, and circulating concentrations of 2 related biomarkers, high-sensitivity C-reactive protein (hsCRP), an acute inflammatory protein, and F2-isoprostane, a reliable marker of in vivo lipid peroxidation.

Methods: In a pooled cross-sectional study of 30- to 74-y-old men and women in an elective outpatient colonoscopy population (n = 646), we created diet scores from responses on Willett food-frequency questionnaires and measured plasma hsCRP and F2-isoprostane concentrations by ELISA and gas chromatography–mass spectrometry, respectively. Both diet scores were calculated and categorized into quintiles, and their associations with biomarker concentrations were estimated with the use of general linear models to calculate and compare adjusted geometric means, and via unconditional ordinal logistic regression.

Results: There were statistically significant trends for decreasing geometric mean plasma hsCRP and F2-isoprostane concentrations with increasing quintiles of the Paleolithic and Mediterranean diet scores. The multivariable-adjusted ORs comparing those in the highest with those in the lowest quintiles of the Paleolithic and Mediterranean diet scores were 0.61 (95% CI: 0.36, 1.05; P-trend = 0.06) and 0.71 (95% CI: 0.42, 1.20; P-trend = 0.01), respectively, for a higher hsCRP concentration, and 0.51 (95% CI: 0.27, 0.95; P-trend 0.01) and 0.39 (95% CI: 0.21, 0.73; P-trend = 0.01), respectively, for a higher F2-isoprostane concentration.

Conclusion: These findings suggest that diets that are more Paleolithic- or Mediterranean-like may be associated with lower levels of systemic inflammation and oxidative stress in humans.”

Source: Paleolithic and Mediterranean Diet Pattern Scores Are Inversely Associated with Biomarkers of Inflammation and Oxidative Balance in Adults

Which Costs More?: Mediterranean Diet, a Modified Paleo Diet, or Intermittent Fasting

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Click the link at bottom for details. From the study abstract:

“Background: Obesity, and resulting health problems, is a growing issue facing today’s society. Weight-loss diets are popular worldwide but have shown mixed health outcomes. Current research has shown that the Mediterranean (MED) and Paleolithic (Paleo) diets as well as Intermittent Fasting (IF) have positive health outcomes. However, there is very little research surrounding the cost of all three popular diets. One factor that may influence long- term adherence is the cost of the dietary regime.

Conclusion: Although these differences in costs were not significant, the analysis suggests the Paleo diet is a slightly more expensive plan, while the IF plan has emerged as a potentially cheaper weight-loss intervention. Small sample sizes in the Paleo diet plan limits the potential for comparison.”

Source: A Cost Analysis of Three Popular Diets: the Mediterranean Diet, a Modified Paleo Diet and Intermittent Fasting

Optimal Insulin Injection Guidelines from FITTER

Going in at a 45 degree angle with a 6 mm needle

Going in at a 45 degree angle with a 6 mm needle

“Many primary care professionals manage injection or infusion therapies in patients with diabetes. Few published guidelines have been available to help such professionals and their patients manage these therapies. Herein, we present new, practical, and comprehensive recommendations for diabetes injections and infusions. These recommendations were informed by a large international survey of current practice and were written and vetted by 183 diabetes experts from 54 countries at the Forum for Injection Technique and Therapy: Expert Recommendations (FITTER) workshop held in Rome, Italy, in 2015.”

Source: New Insulin Delivery Recommendations – Mayo Clinic Proceedings

Here are some bullet points that most insulin users need to know:

  • Average skin thickness is 2 to 2.5 mm, with 90% of people under 3.25 mm.
  • Use the shortest needles: 6 mm for syringes, 4 mm for pen injectors. The short needles help you avoid injections into muscle. Injection into muscle increases risk of hypoglycemia and wide blood glucose excursions.
  • Acceptable injection sites: abdomen, thighs, buttocks, upper arms (usually on the back of the arm).
  • If an arm site is chosen with a 6 mm needle, inject into a lifted skin fold (otherwise you might hit muscle).
  • When using the 6 mm needle, inject into a lifted skinfold if you are a child or normal-weight adult. Alternatively, insert the needle at a 45 degree angle.
  • The preferred site for regular insulin (soluble human insulin) is the abdomen, for faster absorption.
  • Use needles only once. (Admittedly, many get away with multiple uses without much trouble.)
  • Don’t inject into lipohypertrophy areas. Lipohypertrophy eventually is an issue in half of insulin users. It is a localized area of swelling or lumpiness at the site of prior injections. It’s often easier to feel than to see. Injection into these areas causes erratic absorption of insulin, with potential widely fluctuating and unpredictable blood sugar levels.
  • Rotate injection sites to avoid lipohypertrophy.
  • If using cloudy insulins (e.g., NPH and some pre-mixed insulins), gently roll and tip the vial or pen until the solution is milk white.

Click here to read about…

  • How to roll and tip a vial to make cloudy insulin milk white.
  • Proper needle disposal.
  • Insulin infusion sets for continuous subcutaneous insulin injection via pumps.

Steve Parker, M.D.

diaTribe Presents Expert Advice On Pregnancy and Diabetes From Dr. Lois Jovanovič 

Diabetes types 1 and 2 along with gestational diabetes are addressed in this diaTribe interview. For example:

“According to Dr. Jovanovič, it is important to make sure family members understand the importance of reducing carb intake for blood sugar management during pregnancy. She said that grandmas in particular “often think a pregnant lady needs to eat all the time and not only eat all the time, but eat tortillas and rice and pasta. The grandma often cooks and thickens food with starch, puts a lot of noodles in it, etc. Then of course the young woman doesn’t want to disappoint her grandma, and it can be a difficult situation.” Clear communication can help a supportive family provide medically sound support, in line with the mutually desired outcome – a healthy mom and baby!”

Source: Diabetes and Pregnancy: Expert Advice from Pregnancy Guru Dr. Lois Jovanovič | diaTribe

Impact of meat and Lower Palaeolithic food processing techniques on chewing in humans 

Gotcha!

Gotcha!

Catherine Zink and Daniel Lieberman have a research paper you science nerds might be interested in. A teaser:

“Yet Homo erectus differs from earlier hominins in having relatively smaller teeth, reduced chewing muscles, weaker maximum bite force capabilities, and a relatively smaller gut. This paradoxical combination of increased energy demands along with decreased masticatory and digestive capacities is hypothesized to have been made possible by adding meat to the diet, by mechanically processing food using stone tools, or by cooking. Cooking, however, was apparently uncommon until 500,000 years ago.

Source: Impact of meat and Lower Palaeolithic food processing techniques on chewing in humans : Nature : Nature Publishing Group

How to Pick a Church

Nativity Scene

I know most of you paleo dieters are godless heathens. But not all of you…

Let’s say you’re not happy with the ideology of your current church or you quit going to church years ago and are thinking about returning. Do you want a liberal or a conservative church? How would you find a church where you fit in?

One starting point would be to review a neat graphic put together by Tobin Grant. (Sorry, non-Americans, this is mostly about American churches. But there are data points for atheists and agnostics, too.)

Based on surveys of churchgoers, Mr. Grant classifies churches by where they stand on size of government and “protection of morality.” I’m not saying this is the best way to choose a church; it’s one way to get started.

Happy hunting!

Steve Parker, M.D.

Paleolithic Diet Beat Standard Healthy Diet in Overweight Australian Women

She doesn't need to lose weight

She doesn’t need to lose weight

By “beat the other diet,” I mean it in terms of weight loss. Over four weeks, the paleo dieters lost an extra 2 kg (4.4 lb) compared to the other group. Click the link at bottom for full text of the study. Here’s the abstract:

Background: The Paleolithic diet is popular in Australia, however, limited literature surrounds the dietary pattern. Our primary aim was to compare the Paleolithic diet with the Australian Guide to Healthy Eating (AGHE) in terms of anthropometric, metabolic and cardiovascular risk factors, with a secondary aim to examine the macro and micronutrient composition of both dietary patterns.

Methods: 39 healthy women (mean ± SD age 47 ± 13 years, BMI 27 ± 4 kg/m2) were randomised to either the Paleolithic (n = 22) or AGHE diet (n = 17) for four weeks. Three-day weighed food records, body composition and biochemistry data were collected pre and post intervention.

Results: Significantly greater weight loss occurred in the Paleolithic group (−1.99 kg, 95% CI −2.9, −1.0), p < 0.001). There were no differences in cardiovascular and metabolic markers between groups. The Paleolithic group had lower intakes of carbohydrate (−14.63% of energy (E), 95% CI −19.5, −9.7), sodium (−1055 mg/day, 95% CI −1593, −518), calcium (−292 mg/day 95% CI −486.0, −99.0) and iodine (−47.9 μg/day, 95% CI −79.2, −16.5) and higher intakes of fat (9.39% of E, 95% CI 3.7, 15.1) and β-carotene (6777 μg/day 95% CI 2144, 11410) (all p < 0.01).

Conclusions: The Paleolithic diet induced greater changes in body composition over the short-term intervention, however, larger studies are recommended to assess the impact of the Paleolithic vs. AGHE diets on metabolic and cardiovascular risk factors in healthy populations.

Source: Nutrients | Free Full-Text | Cardiovascular, Metabolic Effects and Dietary Composition of Ad-Libitum Paleolithic vs. Australian Guide to Healthy Eating Diets: A 4-Week Randomised Trial | HTML

Dr. Guyenet Asks: Do Blood Glucose Levels Affect Hunger and Satiety?

From the Whole Health Source blog:

“You’ve heard the story before: when you eat carbohydrate-rich foods that digest quickly, it sends your blood sugar and insulin levels soaring, then your blood sugar level comes crashing back down and you feel hungry and cranky.  You reach for more carbohydrate, perpetuating the cycle of crashes, overeating, and fat gain.

It sounds pretty reasonable– in fact, so reasonable that it’s commonly stated as fact in popular media and in casual conversation.  This idea is so deeply ingrained in the popular psyche that people often say “I have low blood sugar” instead of “I’m hungry” or “I’m tired”.  But this hypothesis has a big problem: despite extensive research, it hasn’t been clearly supported.  I’ve written about this issue before.

A new study offers a straightforward test of the hypothesis, and once again finds it lacking.”

Source: Whole Health Source: Do Blood Glucose Levels Affect Hunger and Satiety?

The study at hand involved 15 healthy young men. Results may not apply to overweight post-menopausal women with T2 diabetes, but I bet they do.

Steve Parker, M.D.

Jamie Scott On the New Zealand Heart Foundation Paleo Diet Trial

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Good thing she had a spear with her

“Do not adjust your set. And no, it isn’t April 1st.  The New Zealand Heart Foundation dietitians and nutritionists are giving Paleo a go.

It what sees me channeling the ghost of That Paleo Guy, I feel compelled to write a bit of a critique about their experiment, and their assumptions and starting points.  But to be clear before anything else, I do applaud the openness of the Heart Foundation to be giving this a go.

My first post to this blog outlined my reasons for largely divorcing myself from the term “Paleo” as a heuristic for how to navigate the very messy and confusing food environments we are faced with in our modern societies.  Subsequent posts have touched on why the paradigm made sense in the first place, and on some of the things we have taken issue with as the concept has grown in the public consciousness.”

Read the whole thing.