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.)

16 responses to “Random Thoughts On Paleo Eating For People With Diabetes

  1. Paleo, smelleo … labeling can confuse things a bit given the parameters you may seek. While I started off with “low carb Mediterranean” I realised I was drifting into the “paleo” zone. The issue of tension was animal fats. Having cooked “Mediterranean’ for nigh on 40 years I don’t see how the Mediterraneans consciously deleted body fats and grizzle from their consumption. It doesn’t work like that: people eat what they can get. In contrast “paleo” doesn’t seem to be nuanced — is a grab bag lifestyle — but where it makes especial sense is that it promotes a particular approach to movement and exercise which cannot be separated from cell biology and insulin resistance, metabolism, etc. So while I ate similar to the way the traditional Cretans may eat, albeit low carb. — and lost 10 kgm — what really changed for me was when I started High Intensity Interval Training. I’ve been a Long Slow Distance kind of bloke for so long, habits died hard. But Interval Training — micro tearing the muscles; developing real burn; 3 times per week full on — has taken me to another somatic level altogether. So where “paleo’ and the “paleo community” are ahead is that it is holistically obsessed. “Diet” is one aspect — which in effect is high protein/low carbs.: eschew the grains…and whatever else you want to boogify — but you need to engineer a change in you activities as well. Whether the Paleo/ Neolithic cuisine hypothesis is correct is not something that has not necessarily been proven. It seems some what Utopian and sentimental to me: eating au naturel . Nonetheless, where it registers direct hits is in debunking some of the Preconceived Wisdom of the dietary assumptions that bear down on us.

    • Hi, Dave.
      I, too, have gotten into HIIT over the last year: interval training on a treadmill. A pure paleoista would do it outdoors on a trail. That’s after jogging 20 miles a week between ages 20 and 40, and two marathons. I don’t miss the long runs! And my knees are happier.

  2. Pingback: Paleo Diet and Diabetes « re-Defining Diabetes

  3. Nice summary. Why do you emphasize cashews in your post?

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  5. great post! Ive been eating paleo for a few years now. I’m a type 1 diabetic and this diet has helped me a lot!

    hey, check out http://www.1happydiabetic.com
    We’d love to hear from you on the site!

  6. Hello Steve, I’m a lifelong type 1 diabetic and I’ve just become interested in the Paleo lifestyle a few weeks ago. With the Paleo diet being a ketogenic diet, is safe for me to use it, as long as I monitor my keytones carefully? I know that ketoacidosis only occurs with both ketones and high blood sugar. I’ve read though that ketones make your heart more effecient, and I also have had bypass, so making my heart more efficient is important to me. In addition, with increased protein in the Paleo diet, do I need to worry about my kidneys?

    • Hi, Richard.
      The paleo diet is not a ketogenic diet.
      People with diabetes who have existing kidney disease should probably be concerned about the amount of protein in a paleo diet. Konner and Eaton suggest that an ancestral diet provides an average of 25-30% of calories from protein, compared to a modern diet’s 15-18%. So a paleo diet could represent a larger protein and acid load for the kidneys to handle. In the absence of existing kidney disease, the protein load is probably not a concern.
      I admit I’ve not studied this the protein issue in detail yet.


  7. Hi Steve, I’m new on this journey and after struggling for years with my diet and the complications of diabetes I’m ready to really commit to this. As I’m allergic to tree nuts and this seems like a large part of this diet, what would you recommend as a replacement?
    Thanks so much!

    • Hello and welcome, Riccardo!
      How about legumes (e.g., peanuts, and not too many) and seeds? Or just don’t worry about the lack of tree nuts. I’m absolutely convince one can have a long, healthy life without tree nuts.


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    I alwas like the ketogenic diet because it can tone down body fats because it forces the body to burn down fats faster. *”.*”

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  9. body fats must be kept to a minimum as much as possible to avoid further health problems in the future. ..

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