Category Archives: Paleo Diet

Paleo Diet Reduced Low-Grade Inflammation In Obese Postmenopausal Women

I haven’t read the entire article, so probably can’t answer any of your questions. When you read “android fat” below, think “belly fat,” which is linked to poor health outcomes compared to non-belly fat.

OBJECTIVE: Abdominal fat accumulation after menopause is associated with low-grade inflammation and increased risk of metabolic disorders. Effective long-term lifestyle treatment is therefore needed.

METHODS: Seventy healthy postmenopausal women (age 60 ± 5.6 years) with BMI 32.5 ± 5.5 were randomized to a Paleolithic-type diet (PD) or a prudent control diet (CD) for 24 months. Blood samples and fat biopsies were collected at baseline, 6 months, and 24 months to analyze inflammation-related parameters.

RESULTS: Android fat decreased significantly more in the PD group (P = 0.009) during the first 6 months with weight maintenance at 24 months in both groups. Long-term significant effects (P < 0.001) on adipose gene expression were found for toll-like receptor 4 (decreased at 24 months) and macrophage migration inhibitory factor (increased at 24 months) in both groups. Serum interleukin 6 (IL-6) and tumor necrosis factor α levels were decreased at 24 months in both groups (P < 0.001) with a significant diet-by-time interaction for serum IL-6 (P = 0.022). High-sensitivity C-reactive protein was decreased in the PD group at 24 months (P = 0.001).

CONCLUSIONS: A reduction of abdominal obesity in postmenopausal women is linked to specific changes in inflammation-related adipose gene expression.

Source: Attenuated Low-Grade Inflammation Following Long-Term Dietary Intervention in Postmenopausal Women with Obesity. – PubMed – NCBI

Do You Eat Food or Feed?

Future Feed

From Hawaiian Libertarian:

“Food is grown, raised, harvested and processed — and if not consumed while fresh — preserved in as natural and organic a state as possible to keep most of it’s nutritious and nourishing qualities intact.

Feed is mass produced by a few large multinational corporations line using bio-technological innovations to quickly and efficiently manufacture product units ready for global distribution and a near infinite shelf life. Its primary traits are using genetically modified grain products to create a marketable product that is usually adulterated with preservatives and flavor enhancements that give it a long shelf life in airtight packaging and designed in a laboratory to stimulate the taste buds to fool the human body into thinking it’s something good for you.

But above all, the primary difference between Food and Feed can be discerned by this: most real food requires little (if any) corporate mass media marketing campaigns to sell product and expand market shares and waistlines alike.”

Source: Hawaiian libertarian: FEED Inc. & The Corporate Campaign Dialectic

Dietitian Amy Kubal Answers, “Are Potatoes Paleo?”

Rosemary Chicken (garnished with pico de gallo) and Rosemary Potatoes

Rosemary Chicken (garnished with pico de gallo) and Rosemary Potatoes

“The whole “to spud or not to spud” issue is seriously ‘no small potatoes’ in the Paleosphere. It’s highly debated as to whether or not white potatoes are ‘safe’ or ‘allowed’, and if they are okay, the questions really start rolling in – Can I eat the skin? I should only eat the red ones, right? How should I prepare them? Do I need to only eat them cold? If I do eat them, does it mean I’m not ‘doing Paleo’? It’s exhausting and absolutely amazing how such an innocent looking food can create so much controversy. Seriously, people are VERY opinionated on the issue, and I’m sure my opinions will not go unopposed. Well, haters be damned, you’re going to get them anyway.”

RTWT.

Source: “Ask Amy The RD”: Are Those Spuds For You?? The “Paleoness” of Potatoes

paleo diet, Steve Parker MD

Sweet potatoes ready to pop in the oven

Grain-free paleolithic diet improves cholesterol levels better than traditional “heart healthy diet”

See modern man walking off that cliff?

See modern man walking off that cliff?

I haven’t read the full text of this new study, but here’s the abstract in case you’re interested:

“Recent research suggests that traditional grain-based heart-healthy diet recommendations, which replace dietary saturated fat with carbohydrate and reduce total fat intake, may result in unfavorable plasma lipid ratios, with reduced high-density lipoprotein (HDL) and an elevation of low-density lipoprotein (LDL) and triacylglycerols (TG). The current study tested the hypothesis that a grain-free Paleolithic diet would induce weight loss and improve plasma total cholesterol, HDL, LDL, and TG concentrations in nondiabetic adults with hyperlipidemia to a greater extent than a grain-based heart-healthy diet, based on the recommendations of the American Heart Association.

Twenty volunteers (10 male and 10 female) aged 40 to 62 years were selected based on diagnosis of hypercholesterolemia. Volunteers were not taking any cholesterol-lowering medications and adhered to a traditional heart-healthy diet for 4 months, followed by a Paleolithic diet for 4 months. Regression analysis was used to determine whether change in body weight contributed to observed changes in plasma lipid concentrations. Differences in dietary intakes and plasma lipid measures were assessed using repeated-measures analysis of variance.

Four months of Paleolithic nutrition significantly lowered (P < .001) mean total cholesterol, LDL, and TG and increased (P < .001) HDL, independent of changes in body weight, relative to both baseline and the traditional heart-healthy diet. Paleolithic nutrition offers promising potential for nutritional management of hyperlipidemia in adults whose lipid profiles have not improved after following more traditional heart-healthy dietary recommendations.”

 

Source: Paleolithic nutrition improves plasma lipid concentrations of hypercholesterolemic adults to a greater extent than traditional heart-healthy dietar… – PubMed – NCBI

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

President of Australian Diabetes Society On Paleo Diet for Diabetics: Don’t Do It

Really?

Really?

From SBS.com:

“People with type 2 diabetes should ditch the paleo diet until there’s substantial clinical evidence supporting its health benefits, warns the head of the Australian Diabetes Society.

It may be popular among celebrities but there’s little evidence to support the dozens of claims it can help manage the disease, says Associate Professor Sof Andrikopoulos.

“There have been only two trials worldwide of people with type 2 diabetes on what looks to be a paleo diet,” he said.

“Both studies had fewer than 20 participants, one had no control diet, and at 12 weeks or less, neither study lasted long enough for us to draw solid conclusions about the impact on weight or glycemic control.”

In a paper for the latest issue of the Australian Medical Journal, Andrikopoulos recommends people with type 2 diabetes seek advice from their GPs [general practitioners], registered dietitians and diabetes organizations.”

Source: Diabetics should put paleo on hold: expert | SBS News

I disagree with Prof. Andrikopoulos. We have adequate evidence to support a paleo-style diet for people with diabetes. I review it in 32 pages of my book. If you want to see the evidence right now, search this site for key words: O’Dea, Lindeberg, Jonsson, Frasetto, Ryberg, Mellberg, Boers, and Masharani.

If you seek diet advice from your general practitioner, endocrinologist, registered dietitian, and diabetes organizations, you’ll likely be told to eat too many carbohydrates, including processed man-made foods, which will wreck your glycemic control. The drug companies and medical-industrial complex will benefit at your expense.

Steve Parker, M.D.

No degludec up in here!

Front cover

Paleo Diet Pioneer Melvin Konner’s Latest Thoughts on Healthy Eating

Back in 1985, Melvin Konner and S. Boyd Eaton got the ball rolling on the current Paleolithic diet movement. Thirty years later, what would Konner say is a healthy way to eat?

Recent data on these issues make me more comfortable today saying what not to eat. Our ancestors had no refined carbs, which are killing us. We’d be wise to limit salt and saturated fat, which our ancestors’ prey had little of, and fiber and omega-three fatty acids seem to be good. Most humans have to avoid dairy; many must avoid wheat. Find out if you’re one of them. Exercise. That’s about it.

I’ve seen good data saying salt restriction is both harmful an helpful. So flip a coin or talk to your personal physician. If I were looking at starting a drug for hypertension, I’d certainly cut back on salt first and see if that cured me.

Recent clinical studies show that saturated fat isn’t harmful to most of us.

Steve Parker, M.D.

No link to suicide

Paleolithic Diet Improves Metabolic Syndrome

…according to an article at American Journal of Clinical Nutrition.

 

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“Metabolic syndrome” may be a new term for you. It’s a collection of clinical features that are associated with increased future risk of type 2 diabetes and atherosclerotic complications such as heart attack and stroke. One in six Americans has metabolic syndrome. Diagnosis requires at least three of the following five conditions:

  • high blood pressure (130/85 or higher, or using a high blood pressure medication)
  • low HDL cholesterol: under 40 mg/dl (1.03 mmol/l) in a man, under 50 mg/dl (1.28 mmol/l) in a women (or either sex taking a cholesterol-lowering drug)
  • triglycerides over 150 mg/dl (1.70 mmol/l) (or taking a cholesterol-lowering drug)
  • abdominal fat: waist circumference 40 inches (102 cm) or greater in a man, 35 inches (89 cm) or greater in a woman
    fasting blood glucose over 100 mg/dl (5.55 mmol/l)
  • fasting blood glucose over 100 mg/dl (5.55 mmol/l)

I don’t plan on reading the full text of the report because it’s a meta-analysis and I’ve likely reviewed the four component studies here already. Here are the results:

Four RCTs [randomized controlled trials] that involved 159 participants were included. The 4 control diets were based on distinct national nutrition guidelines but were broadly similar. Paleolithic nutrition resulted in greater short-term improvements than did the control diets (random-effects model) for waist circumference (mean difference: −2.38 cm; 95% CI: −4.73, −0.04 cm), triglycerides (−0.40 mmol/L; 95% CI: −0.76, −0.04 mmol/L), systolic blood pressure (−3.64 mm Hg; 95% CI: −7.36, 0.08 mm Hg), diastolic blood pressure (−2.48 mm Hg; 95% CI: −4.98, 0.02 mm Hg), HDL cholesterol (0.12 mmol/L; 95% CI: −0.03, 0.28 mmol/L), and fasting blood sugar (−0.16 mmol/L; 95% CI: −0.44, 0.11 mmol/L). The quality of the evidence for each of the 5 metabolic components was moderate. The home-delivery (n = 1) and dietary recommendation (n = 3) RCTs showed similar effects with the exception of greater improvements in triglycerides relative to the control with the home delivery. None of the RCTs evaluated an improvement in quality of life.

Ways to improve or cure metabolic syndrome include the paleo diet, Mediterranean diet, low-carb diets, ketogenic diets, and exercise. Losing excess fat weight with any reasonable diet would probably work. Enhance effectiveness with exercise.

Steve Parker, M.D.

Reference:Eric W Manheimer,  Esther J van Zuuren, Zbys Fedorowicz, and Hanno Pijl. Paleolithic nutrition for metabolic syndrome: systematic review and meta-analysis. AJCN. First published August 12, 2015, doi: 10.3945/​ajcn.115.113613

What Does the Paleolithic Diet Look Like?

Vegetables not in season

Vegetables not in season

It’s quite difficult to know exactly what early humans ate 100,000 years ago. Scientists use a variety of methods to investigate, including analysis of patterns of wear on teeth, searches of prehistoric dwellings, and analysis of carbon isotopes in organic matter.

Some of the best-preserved human prehistoric artifacts are found in caves, which protected them from environmental degradation. That’s why the paleo diet is sometimes called the caveman diet.

We have an inkling of what foods were available in specific climates and regions. We have some ideas about tools our ancestors had available to hunt, gather, and process foods. Perhaps most reliably, we have fairly good data on what modern hunter-gatherer groups eat (for those few still in existence) or ate (for those lately extinct or modernized).

The Paleolithic Versus Typical Modern Western Diet

Today we get most of our calories from grains, sugars, domesticated livestock, and dairy products. On the other hand, our pre-agricultural ancestors ate primarily wild game and naturally occurring plant foods. Their carbohydrates would have come from fruits and vegetables rather than cereal grains, diary products, and refined sugars. They ate no junk food, no industrial seed oils, and very few grains and dairy products. Compared to us, they ate more potassium, fiber, protein, and micronutrients, but less sodium and carbohydrate. They ate relatively more omega-3 fatty acids and less omega-6s. Paleo dieters today aim to consume natural whole foods while minimizing simple sugars and refined starches. The paleo community generally is convinced that grains and legumes are harmful, while others disagree. Dairy products are allowed in some versions of paleo, although purists would vote against. Now let’s dig into the details.

Paleo-compliant

Paleo-compliant

The Eaton and Konner Model

S. Boyd Eaton and Melvin Konner in 2010 looked carefully at the diet of pre-industrial hunter-gatherers and proposed a prototypical ancestral diet. Note that actual diet would vary with climate, latitude, altitude, water availability, etc. Eaton and Konner suggest our ancestral diet looked like this:

  • Carbohydrates: 35-40% of daily energy (calories)
  • Protein: 25-30% of daily energy
  • Fat: 20-35% of daily energy
  • Added sugar: 2% of daily energy
  • Fiber: over 70 g/day
  • EPA and DHA*: 0.7-6 g/day
  • Cholesterol: 500+ mg/day
  • Vitamin C: 500 mg/day
  • Vitamin D: 4,000 IU/day (sunlight)
  • Calcium: 1,000-1,500 mg/day
  • Sodium: under 1,000 mg/day
  • Potassium: 7,000 mg/day

*Eicosapentaenoic acid and docosahexaenoic acid (omega-3 fatty acids)

Their conception of a modern Paleolithic food pyramid is a base of high-fiber vegetables and fruits, the next tier up being meat/fish/low-fat dairy (all lean), then a possible tier for whole grain (admittedly very unusual), with a small peak of oils, fats, and refined carbohydrates. Their inclusion of dairy products and whole grains must be a concession to convenience and the reality that those items can be healthful for modern humans. Eaton and Konner note that hunter-gatherer groups had a high degree of dependence on plant foods, while obtaining 35 to 65% of diet (calories rather than weight, I assume) from animal flesh. They found some modern hunter-gatherer cultures deriving as much as 65% of calories from carbohydrate (mostly plants, then). It’s a mistake to assume that the typical Paleolithic diet is necessarily meat-based, as the popular press so often describes it.

Eaton and Konner make a few other distinctions that are worth mentioning now. Game animals have more mono- and polyunsaturated fatty acids than supermarket meat. The Paleolithic diet’s ratio of omega-6 to omega-3 fatty acids was about 2:1, in contrast to the modern Western ratio of 10:1 or even higher.

I’d like to share a few more tidbits from their 2010 article:

  • The transition from hunting/gathering to farming (about 10,000 year ago) saw a decrease in body size and robustness, plus evidence of nutritional stress.
  • Levels of muscular and aerobic fitness in ancestral groups are much higher than modern societies, with a concomittant higher level of calorie consumption.
  • Average life expectancies in pre-industrial hunter-gatherer (H-G) groups was only 30-35 years, but much of this low number simply reflects high infant and child death rates.
  • H-G deaths overwhelmingly reflect infectious diseases.
  • H-G groups had a high degree of dependence on plant foods.
  • Fish and shellfish are more important food sources than these authors thought 25 years earlier.
  • H-G diets are higher in fat and protein than they once thought. • Nearly all H-G carbs are from vegetables and fruits, which have more favorable glycemic responses (i.e., a lesser rise in blood sugar) than grains and concentrated sugars.
  • Uncultivated or wild fruits and vegetables have much more fiber than commercial ones (13 versus 4 g fiber per 100 g of food).

The Diet-Heart Hypothesis is the idea that dietary total and saturated fat, and cholesterol, cause or contribute to atherosclerosis (hardening of the arteries), leading to heart attacks and strokes. Konner and Eaton still believe (in 2010 at least) the theory is valid for fats, but not cholesterol. The latest evidence, however, is that even total and saturated fat are minimally or unrelated to atherosclerosis. They also believe total fat, due to its caloric load, is an important contributor to obesity and type 2 diabetes. I agree that may be true, especially if you eat a lot of carbohydrates with fat. To further imitate the Paleolithic lifestyle, Eaton and Konner also recommend high activity levels, including resistance exercise, flexibility, and aerobics, burning over 1,000 calories daily exclusive of resting metabolism. (Reference: Konner, Melvin and Eaton, S. Boyd. Paleolithic Nutrition: Twenty-Five Years Later. Nutrition in Clinical Practice, 25 (2010): 594-602. doi: 10.1177/0884533610385702) But let’s not put all our eggs in the Eaton and Konner basket.

That exposed skin makes vitamin D

That exposed skin makes vitamin D

The Kuipers Model

A 2010 scientific article by Kuipers et al suggests that the East African Paleolithic diet derived, on average, 25-29% of calories from protein, 30-39% from fat, and 39-40% from carbohydrate. That qualifies as mildly low-carb, and similar to Eaton and Konner’s macronutrient breakdown. Modern Western percentages for protein, fat, and carb are 15%, 33%, and 50%, respectively. Kuipers et al suggest that the evolution of our large brains in East Africa may have been possible by utilization of aquatic resources such as fish, lobster, crab, shrimp, sea urchins, squid, octopus, and amphibians. Rather than savannah, this was a land-water ecosytem. Diets here would have been rich in the omega-3 fatty acids (EPA and DHA) we find in fish oil. Kuipers believes roots and tubers were also part of the Paleolithic diet. (Reference: Kuipers, R., et al (L. Cordain and S. Eaton are co-authors) (2010). Estimated macronutrient and fatty acid intakes from an East African Paleolithic diet British Journal of Nutrition, 1-22 DOI: 10.1017/S0007114510002679)

The Cordain Model

Loren Cordain and associates in 2000 suggested that Paleolithic diets derived about a third—22 to 40%—of calories from carbohydrate, based on modern hunter-gatherer societies. The lower carb consumption compared to Western diets left more room for moderate to high amounts of protein and fat. Dr. Cordain is a co-author with Eaton and Konner on many paleo diet scientific articles, so they don’t have many differences. (Reference: Cordain, L., et al. Plant-animal subsistance ratios and macronutrient energy estimations in worldwide hunter-gatherer diets. American Journal of Clinical Nutrition, 71 (2000): 682-692.)

Dr. Cordain (Ph.D.) is probably the preeminent scientist who advocates the Paleolithic diet. He’s made a few modifications in his model diet over the years. From his website in 2014, the following are the seven pillars of his conception of the modern paleo diet compared to the typical Western diet. The paleo diet is:

  • higher in protein (25-30% of calories versus 15%)
  • lower in carbohydrates and glycemic index via nonstarchy fresh fruits and vegetables
  • higher in fiber
  • moderate to high fat content, especially monounsaturated fats and polyunsaturated fats (particularly omega-3 fatty acids)
  • higher in potassium and lower in sodium
  • higher dietary alkaline load relative to acid load (vegetables and fruit counteract the acid in meat and fish)
  • higher in many vitamins, minerals, antioxidants and plant phytochemicals

(Reference: http://thepaleodiet.com/the-paleo-diet-premise/)

Salmon is a great source of omega-3 fatty acids

Salmon is a great source of omega-3 fatty acids

Carbohydrate Content of the Paleo Diet

Since dietary carbohydrates are major contributors to blood sugar, the carbohydrates in the Paleolithic diet are important. It appears that the average paleo diet derived a little over a third of calories from carbohydrate: that qualifies as low-carb since the average Western diet provides half of calories as carbohydrate. The carbohydrates eaten by Paleolithic man were accompanied by lots of fiber, over four times as much as the average American diet (70+ grams versus 15 grams). The sources of carbohydrate were fruits, vegetables, and roots or tubers, with minimal and seasonal contribution from honey. Fiber is important since high consumption is linked in modern times to lower rates of type 2 diabetes, and fiber also slows and limits the rise in blood sugar after meals. Furthermore, the original Paleolithic carbohydrate sources generally would have been much less calorically dense than modern carbohydrates sources. For instance, one Frosted Strawberry Pop-Tart has the same amount of calories (200) as four cups of fresh strawberry halves, but the Pop-Tart has less than one gram of fiber compared to 12 gm in the raw berries.

We Can’t or Won’t Re-Create a True Paleolithic Diet

Because of our modification of edible plants and animals, it’s impossible for most of us to accurately recreate the diet of our Paleolithic ancestors. The closest you could come would be to live entirely off the land, catching or hunting wild animals and foraging for wild plants. That’s a heck of a lot of work, and wouldn’t sustain more than a tiny fraction of the planet’s current seven billion souls. If we’re going to construct a modern Paleolithic-style diet, now we’ve got some anchoring numbers.

Steve Parker, M.D.

Paleolithic Diet May Help Reduce Risk of Obesity

…according to a basic science study published in the British Journal of Nutrition. The mechanism for reducing obesity risk would be increased satiety. We’ve seen that before with the paleo diet as compared to a Mediterranean-style diet. Disappointingly, the researchers didn’t see any paleo diet benefits in these healthy study participants in terms of glucose and insulin metabolism.

I haven’t read the report, don’t have it, don’t know when I’ll read it.

Abstract

There is evidence for health benefits from ‘Palaeolithic’ diets; however, there are a few data on the acute effects of rationally designed Palaeolithic-type meals. In the present study, we used Palaeolithic diet principles to construct meals comprising readily available ingredients: fish and a variety of plants, selected to be rich in fibre and phyto-nutrients. We investigated the acute effects of two Palaeolithic-type meals (PAL 1 and PAL 2) and a reference meal based on WHO guidelines (REF), on blood glucose control, gut hormone responses and appetite regulation. Using a randomised cross-over trial design, healthy subjects were given three meals on separate occasions. PAL2 and REF were matched for energy, protein, fat and carbohydrates; PAL1 contained more protein and energy. Plasma glucose, insulin, glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic peptide (GIP) and peptide YY (PYY) concentrations were measured over a period of 180 min. Satiation was assessed using electronic visual analogue scale (EVAS) scores. GLP-1 and PYY concentrations were significantly increased across 180 min for both PAL1 (P= 0·001 and P< 0·001) and PAL2 (P= 0·011 and P= 0·003) compared with the REF. Concomitant EVAS scores showed increased satiety. By contrast, GIP concentration was significantly suppressed. Positive incremental AUC over 120 min for glucose and insulin did not differ between the meals. Consumption of meals based on Palaeolithic diet principles resulted in significant increases in incretin and anorectic gut hormones and increased perceived satiety. Surprisingly, this was independent of the energy or protein content of the meal and therefore suggests potential benefits for reduced risk of obesity.

Steve Parker, M.D.

Reference: Bligh H.F., et al. British J Nutr. 2015 Feb 28;113(4):574-84. doi: 10.1017/S0007114514004012. Epub 2015 Feb 9.
Plant-rich mixed meals based on Palaeolithic diet principles have a dramatic impact on incretin, peptide YY and satiety response, but show little effect on glucose and insulin homeostasis: an acute-effects randomised study.