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:
- nuts and seeds
- proteins (e.g., meat, fish, eggs)
A paleo diabetic diet could (should?) emphasize salads and low-carb colorful vegetables and only (?) low-carb or low-glycemic-index fruits.
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.
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.
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.
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.
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.
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.
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.