Category Archives: Paleo Diet

Is the Paleo Diet the Easiest to Stick With?

I’ve never eaten rabbit, but would try it. A patient in Florida cooked squirrel for me. Tastes like chicken, as I recall.

An article at Public Health Nutrition suggests that, yes, the paleo diet is one of the last to be abandoned. I’m not paying the $35 for access to the full article, so I don’t know which diets were considered. I assume all the popular ones.

Abstract

Objective: To use Internet search data to compare duration of compliance for various diets.

Design: Using a passive surveillance digital epidemiological approach, we estimated the average duration of diet compliance by examining monthly Internet searches for recipes related to popular diets. We fit a mathematical model to these data to estimate the time spent on a diet by new January dieters (NJD) and to estimate the percentage of dieters dropping out during the American winter holiday season between Thanksgiving and the end of December.

Setting: Internet searches in the USA for recipes related to popular diets over a 15-year period from 2004 to 2019.

Participants: Individuals in the USA performing Internet searches for recipes related to popular diets.

Results: All diets exhibited significant seasonality in recipe-related Internet searches, with sharp spikes every January followed by a decline in the number of searches and a further decline in the winter holiday season. The Paleo diet had the longest average compliance times among “new January dieters” (5.32 ± 0.68 weeks) and the lowest dropout during the winter holiday season (only 14 ± 3 % dropping out in December). The South Beach diet had the shortest compliance time among NJD (3.12 ± 0.64 weeks) and the highest dropout during the holiday season (33 ± 7 % dropping out in December).

Conclusions: The current study is the first of its kind to use passive surveillance data to compare the duration of adherence with different diets and underscores the potential usefulness of digital epidemiological approaches to understanding health behaviours.

Steve Parker, M.D.

Introducing the “Paleo Ratio” as an Assessment of Paleo Diet Compliance

The study at hand did not find an improvement in hemoglobin A1c in type 2 diabete after 12 weeks of intervention. I’m surprised. I haven’t read the whole report yet.

Abstract

This study is a secondary analysis of a randomized controlled trial using Paleolithic diet and exercise in individuals with type 2 diabetes. We hypothesized that increased adherence to the Paleolithic diet was associated with greater effects on blood pressure, blood lipids and HbA1c independent of weight loss. Participants were asked to follow a Paleolithic diet for 12 weeks and were randomized to supervised exercise or general exercise recommendations. Four-day food records were analyzed, and food items characterized as “Paleolithic” or “not Paleolithic”. Foods considered Paleolithic were lean meat, poultry, fish, seafood, fruits, nuts, berries, seeds, vegetables, and water to drink; “not Paleolithic” were legumes, cereals, sugar, salt, processed foods, and dairy products. A Paleo ratio was calculated by dividing the Paleolithic calorie intake by total calorie intake. A multiple regression model predicted the outcome at 12 weeks using the Paleo ratio, group affiliation, and outcome at baseline as predictors.

The Paleo ratio increased from 28% at baseline to 94% after the intervention. A higher Paleo ratio was associated with lower fat mass, BMI, waist circumference, systolic blood pressure, and serum triglycerides at 12 weeks, but not with lower HbA1c levels. The Paleo ratio predicted triglyceride levels independent of weight loss (p = 0.046). Moreover, an increased monounsaturated/saturated fatty acids ratio and an increased polyunsaturated/saturated fatty acids ratio was associated with lower triglyceride levels independent of weight loss. (p = 0.017 and p = 0.019 respectively).

We conclude that a higher degree of adherence to the Paleolithic diet recommendations improved fat quality and was associated with improved triglyceride levels independent of weight loss among individuals with type 2 diabetes.

Source: Using a Paleo Ratio to Assess Adherence to Paleolithic Dietary Recommendations in a Randomized Controlled Trial of Individuals with Type 2 Diabetes – PubMed

Steve Parker, M.D.

Meta-Analysis: Paleolithic diet effects on glucose metabolism and lipid profile among patients with metabolic disorders

See modern man walking off that cliff?

From mostly Iran-based researchers, published in Critical Reviews in Food Science and Nutrition:

Abstract

Objective:

Several randomized clinical trials (RCTs) have investigated the effects of the Paleolithic diet (PD) in adult patients suffering from metabolic disorders. However, the results of these RCTs are conflicting. Therefore, we conducted a systematic review and meta-analysis to assess the effects of the PD in patients with metabolic disorders.

Methods:

We searched the PubMed/Medline, Scopus, Cochrane Databases, Google Scholar, Web of Science, and Embase databases up to June, 2020. The data were pooled using a random-effects model. From the eligible publications, 10 articles were selected for inclusion in this systematic review and meta-analysis. The meta-analysis was performed using a random-effects model. The heterogeneity was determined using the I2 statistics and the Cochrane Q test.

Results:

The pooled results from the random-effects model showed a significant reduction of the homeostatic model assessment of insulin resistance (HOMA-IR) (weighted mean difference, WMD: -0.39, 95% CI: -0.70, -0.08), fasting insulin (WMD: -12.17 μU/mL, 95% CI: -24.26, -0.08), total cholesterol (WMD: -0.32 mmol/l, 95% CI: -0.49, -0.15), triglycerides (WMD: -0.29 mmol/L, 95% CI: -0.42, -0.16), low-density lipoprotein cholesterol (WMD: -0.35 mmol/L, 95% CI: -0.67, -0.03), blood pressure (BP)(WMD – 5.89 mmHg; 95% CI – 9.973 to – 1.86 for the systolic BP and WMD – 4.01 mmHg; 95% CI – 6.21 to – 1.80 for the diastolic BP values) and C-reactive protein (CRP) levels (WMD: -0.84, mg/L, 95% CI: -1.62, -0.06) in the PD group versus control group.

Conclusions:

Our findings provide better insights into the effect of the PD on the modulation of the glucose and lipid metabolism factors in patients with metabolic disorders, providing comprehensive information for the development of future RCTs with a high quality design.

Source: The effect of paleolithic diet on glucose metabolism and lipid profile among patients with metabolic disorders: a systematic review and meta-analysis of randomized controlled trials – PubMed

Proposal: A Second Paleolithic Diet Score

Not too many folks eat rabbit these days

Offhand, I don’t recall the first paleo diet score proposed several years ago.

From June 2020 in Nutrition Research Reviews:

In a PubMed searched up to December 2019, 14 different PaleoDiet definitions were found. We observed some common components of the PaleoDiet among these definitions although we also found high heterogeneity in the list of specific foods that should be encouraged or banned within the PaleoDiet. Most studies suggest that the PaleoDiet may have beneficial effects in the prevention of cardiometabolic diseases (type 2 diabetes, overweight/obesity, cardiovascular diseases and hyperlipidemias) but the level of evidence is still weak because of the limited number of studies with large sample size, hard outcomes instead of surrogate outcomes and long-term follow-up. Finally, we propose a new PaleoDiet score composed of 11 food items, based on a high consumption of fruits, nuts, vegetables, fish, eggs and meats; and a minimum content of dairy products, grains and cereals, and legumes and practical absence of processed (or ultra-processed) foods or culinary ingredients.

Source: Scoping Review of Paleolithic Dietary Patterns: A Definition Proposal – PubMed

Steve Parker, M.D.

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Nurse Practitioners May Advocate for Paleo Diet

The Nurse Practitioner has an article indicating that the paleo diet may prevent or treat prediabetes and diabetes:

Lifestyle changes that include adopting a healthy diet, such as the paleo diet, can help prevent prediabetes and T2DM [type 2 diabetes]. This article explores the potential benefits of replacing low-calorie diets with the paleo diet. As primary care providers, NPs [nurse practitioners] are positioned to help inform patients, particularly those with prediabetes and T2DM, about healthy lifestyle choices and provide them with resources to achieve weight loss success.

Source: Combating insulin resistance with the paleo diet : The Nurse Practitioner

I confess I haven’t read the entire article, just the abstract.

Steve Parker, M.D.

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Soybean Oil Not Healthy for Humans?

Soybean oil seems to be a real problem for male mice. We need more research in humans before outlawing it as dangerous toxin. If you’re eating the Standard American Diet, you’ll find it hard if not impossible to avoid. Of course, paleo diets should be naturally low in soybean oil.

From EurekAlert:

New UC Riverside research shows soybean oil not only leads to obesity and diabetes, but could also affect neurological conditions like autism, Alzheimer’s disease, anxiety, and depression.

Used for fast food frying, added to packaged foods, and fed to livestock, soybean oil is by far the most widely produced and consumed edible oil in the U.S., according to the U.S. Department of Agriculture. In all likelihood, it is not healthy for humans.

Source: America’s most widely consumed oil causes genetic changes in the brain | EurekAlert! Science News

Steve Parker, M.D.

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Does Calcium Consumption Help Prevent Brittle Bones in Older Women?

Waste of money and effort?

Due to a lack of milk products, paleo diets may not meet the Recommended Daily Intake of calcium. Your blood must have a certain amount of calcium, and if that level is too low, your bones donate calcium to the bloodstream.

Many physicians worry that inadequate calcium consumption causes or contributes to thin, brittle, easily breakable bones in postmenopausal women. A recent study suggests that calcium intake doesn’t matter.

Abstract

CONTEXT:

Calcium intakes are commonly lower than the recommended levels, and increasing calcium intake is often recommended for bone health.

OBJECTIVE:To determine the relationship between dietary calcium intake and rate of bone loss in older postmenopausal women.

PARTICIPANTS:

Analysis of observational data collected from a randomized controlled trial. Participants were osteopenic (hip T-scores between -1.0 and -2.5) women, aged >65 years, not receiving therapy for osteoporosis nor taking calcium supplements. Women from the total cohort (n = 1994) contributed data to the analysis of calcium intake and bone mineral density (BMD) at baseline, and women from the placebo group (n = 698) contributed data to the analysis of calcium intake and change in BMD. BMD and bone mineral content (BMC) of the spine, total hip, femoral neck, and total body were measured three times over 6 years.

RESULTS:

Mean calcium intake was 886 mg/day. Baseline BMDs were not related to quintile of calcium intake at any site, before or after adjustment for baseline age, height, weight, physical activity, alcohol intake, smoking status, and past hormone replacement use. There was no relationship between bone loss and quintile of calcium intake at any site, with or without adjustment for covariables. Total body bone balance (i.e., change in BMC) was unrelated to an individuals’ calcium intake (P = 0.99).

CONCLUSIONS:

Postmenopausal bone loss is unrelated to dietary calcium intake. This suggests that strategies to increase calcium intake are unlikely to impact the prevalence of and morbidity from postmenopausal osteoporosis.

Source: Dietary Calcium Intake and Bone Loss Over 6 Years in Osteopenic Postmenopausal Women. – PubMed – NCBI

Steve Parker, M.D.

PS: Elderly men get osteoporosis, too. But when the Emergency Department calls me to admit an older patient with a hip fracture, it’s a woman 9 out of 10 times.

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Were Early Homo Carnivorous?: The feeding behavior of early Homo at Olduvai Gorge, Tanzania

From the Journal of Human Evolution:

Abstract

The regular consumption of large mammal carcasses, as evidenced by butchery marks on fossils recovered from Early Stone Age archaeological sites, roughly coincides with the appearance of Homo habilis. However, the significance of this niche expansion cannot be appreciated without an understanding of hominin feeding behavior and their ecological interactions with mammalian carnivores. The Olduvai Geochronology and Archaeology Project (OGAP) has recovered a large and well-preserved fossil assemblage from the HWK EE site, which was deposited just prior to the first appearance of Acheulean technology at Olduvai Gorge and likely represents one of the last H. habilis sites at Olduvai. This taphonomic analysis of the larger mammal fossil assemblage excavated from HWK EE shows evidence of multiple occupations over a long period of time, suggesting the site offered resources that were attractive to hominins. There was a water source indicated by the presence of fish, crocodiles, and hippos, and there was possible tree cover in an otherwise open habitat. The site preserves several stratigraphic intervals with large fossil and artifact assemblages within two of these intervals. Feeding traces on bone surfaces suggest hominins at the site obtained substantial amounts of flesh and marrow, particularly from smaller size group 1-2 carcasses, and exploited a wide range of taxa, including megafauna. A strong carnivore signal suggests hominins scavenged much of their animal foods during the two main stratigraphic intervals. In the later interval, lower carnivore tooth mark and hammerstone percussion mark frequencies, in addition to high epiphyseal to shaft fragment ratios, suggest hominins and carnivores did not fully exploit bone marrow and grease, which may have been acquired from nutritionally-stressed animals that died during a dry period at Olduvai. The diversity of fauna that preserve evidence of butchery suggests that the HWK EE hominins were opportunistic in their acquisition of carcass foods.

Source: The carnivorous feeding behavior of early Homo at HWK EE, Bed II, Olduvai Gorge, Tanzania. – PubMed – NCBI

Steve Parker, M.D.

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Gut microbiome response to a modern Paleolithic diet

From PloS One:

Abstract

The modern Paleolithic diet (MPD), featured by the consumption of vegetables, fruit, nuts, seeds, eggs, fish and lean meat, while excluding grains, dairy products, salt and refined sugar, has gained substantial public attention in recent years because of its potential multiple health benefits. However, to date little is known about the actual impact of this dietary pattern on the gut microbiome (GM) and its implications for human health. In the current scenario where Western diets, low in fiber while rich in industrialized and processed foods, are considered one of the leading causes of maladaptive GM changes along human evolution, likely contributing to the increasing incidence of chronic non-communicable diseases, we hypothesize that the MPD could modulate the Western GM towards a more “ancestral” configuration. In an attempt to shed light on this, here we profiled the GM structure of urban Italian subjects adhering to the MPD, and compared data with other urban Italians following a Mediterranean Diet (MD), as well as worldwide traditional hunter-gatherer populations from previous publications. Notwithstanding a strong geography effect on the GM structure, our results show an unexpectedly high degree of biodiversity in MPD subjects, which well approximates that of traditional populations. The GM of MPD individuals also shows some peculiarities, including a high relative abundance of bile-tolerant and fat-loving microorganisms. The consumption of plant-based foods-albeit with the exclusion of grains and pulses-along with the minimization of the intake of processed foods, both hallmarks of the MPD, could therefore contribute to partially rewild the GM but caution should be taken in adhering to this dietary pattern in the long term.

Source: Gut microbiome response to a modern Paleolithic diet in a Western lifestyle context. – PubMed – NCBI

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Which Dietary Patterns Are Best for Type 1 Diabetes Control?

A mess of Bacon Bit Brussels Sprouts: 6 grams of fiber per serve

Dr. Muccioli over at Diabetes Daily posted a brief article on a recent research study. A snippet:

The authors found that a higher intake of fiber was associated with lower average blood glucose values. In contrast, a higher intake of carbohydrate, alcohol, and monounsaturated fat was negatively associated with glycemic control (these patients typically experienced more variability in their blood glucose levels). Finally, the analysis revealed that “substituting proteins for either carbohydrates, fats, or alcohol, or fats for carbohydrates, were all associated with lower variability in the measured blood glucose values.”

Source: Which Dietary Patterns Are Best for Type 1 Diabetes Control? – Diabetes Daily

Eaton and Konner figured the Paleolithic diet provided over 70 g/day of fiber. How much are we in the West eating now? Something like 15–20 grams.

Steve Parker, M.D.