Avoid Drug Toxicity By Eschewing Drugs

David Mendosa over at Diabetes Developments writes about avoiding diabetes drug toxicity with low-carb eating.  Amen, brother.

Steve Parker, M.D.

Natural Selection

Paleo diets (aka Stone Age, Paleolithic, or caveman diets) have been increasingly popular over the last few years.  The idea is that, for optimal health, we should be eating the things that we are evolutionarily adapted to eat.  Those foods pre-date the onset of large-scale agriculture 10-12,000 years ago.  So grains, dairy products, and industial seed oils play little or no role in someone who has “gone paleo.”

My recollection from college courses years ago is that average lifespan in paleolithic times was perhaps 25-30 years, or less.  If you’re going to die at 25, it may not matter if you eat a lot of  wooly mammath, berries, insects, cholesterol, saturated fats, Doritos, Ding Dongs, or Cheetos.  The diseases of civilization we worry about today—coronary heart disease, high blood pressure, cancer, dementia, type 2 diabetes, etc.—don’t usually appear until after age 30.  Paleolithic Man worried more about starvation, infection, and predation.

More recently, I’ve read that average lifespans of Paleolithic man were so low due to high infant and childhood mortality.  If you survived early childhood, you had a much better chance to hit 50 or better.

But now we live to be 80, long enough for diet-related diseases to appear. We have cancer, heart attacks, and strokes that paleo man rarely saw because he died of trauma or infection or starvation. We even see the expression of genes that were not subjected to survival or selection pressure: Alzheimers disease, Huntingtons chorea, and some breast cancers, for example.  People with genes for these diseases reproduce before the genes do their damage.

In other words, we carry genes that don’t matter if you die at age 30. If you live longer, they express themselves, and I believe we can modify their expression through diet and lifestyle. 

Jenny Ruhl, at her Diabetes Update blog, takes a critical look at the paleo diet concept.  I’m not saying I agree or disagree with her.  Newbies should look at all sides.  

Steve Parker, M.D. 

Extra credit: 

For purposes of discussion, let’s assume that human evolution actually occurred over millions, or at least hundreds of thousands, of years.  In other words, assume that God didn’t make Adam and Eve in human form in one day.

The theory of evolution proposes that genes that allow an animal to live and reproduce more vigorously in a particular environment will be passed on to the animal’s offspring.  Nature will select those genes to spread through the animal population over time, assuming the environment doesn’t change.  The offspring with those genes will be able to compete with other animals more successfully for food, shelter, and mates.  Factors that promote the persistence and inheritance of specific genes are called “selection pressure.”

Here’s an example of selection pressure.  Remember when you were in grade school on the playground, some people could naturally run faster than others?  Were you one of the fast ones?  If you’ve never seen it for yourself, take my word for it: Some people are naturally gifted with athletic genes.

Let’s say you and I are outside collecting berries and nuts in paleolithic times.  A saber-toothed tiger spots us and charges, hungry for a meal.  You don’t have to outrun the tiger: you just have to outrun me.  I’m slower than you, and get eaten.  I can no longer pass on my slow-running genes to the next generation.  You live another day and pass on your fast-running genes to your children. 

Viola!  Natural selection, via selection pressure, has promoted your genes over mine.

The tiger also passes on her genes since she was fast and smart enough to catch me, preventing starvation of her and her offspring.

[I’m 99% sure I wrote the preceeding few paragraphs originally a couple years ago.  My notes, however, hint that they may have been written by Dr. J., a regular contributor at CalorieLab.  Dr. J., let me know if I’ve plagiarized you and I’ll give you full credit and delete my writing.]

Self-Experimentation: Paleo Diet and Type 1 Diabetes

Feed the whole tribe with this baby!

 

 

Dave Wendel shares his experience treating type 1 diabetes with a paleo approach at Robb Wolf’s blog:

http://robbwolf.com/2011/10/17/type-1-diabetes-the-numbers-dont-lie/

Steve Parker, M.D.

Caveman Mark Trying Paleo Lifestyle for Type 1 Diabetes

Paleobetic is a new blog by a 30-year-old man, Mark, with type 1 diabetes.  At the start of November, 2011, he started the paleo lifestyle and diet, probably in the fashion of Robb Wolf.  He’s starting CrossFit, too.  It’s an open-ended N=1 experiment.

Since I’m in the U.S., I think of blood sugar in mg/dl rather than mmol/l.  Thankfully, Mark often includes his blood sugars in both values.  He’s on an insulin pump and does basal/bolus dosing of insulin.

You may want to follow Mark’s progress.

Steve Parker, M.D.

UCSF Investigating Paleolithic Diet for Diabetics

A May, 2010, press release from University of California San Francisco outlines the university’s research into use of the Paleolithic diet (aka Stone Age or caveman diet) for people with type 2 diabetes.  From the press release:

The initial research findings are striking. Without losing weight, participants in a preliminary study improved blood sugar control, blood pressure control and blood vessel elasticity. They lowered levels of blood fats such as cholesterol. And most amazingly, participants achieved these results in less than three weeks — simply by switching to a Paleolithic diet.

The lead researchers are nephrologist Lynda Frassetto and endocrinologist Umesh Masharani.  Frassetto and team had previously looked at metabolic improvements linked to the paleo diet.

We await publication of their current findings in a peer-reviewed scientific journal.

Steve Parker, M.D.

Paleo Diabetic Theory

In other words, is the paleo diet good for diabetics?

A few others have weighed in on this question in an organized fashion.  Steve Cooksey at Diabetes-Warrior.net immediately comes to mind.  Gary Rea, too (see Links at right).  Many others (hundreds or thousands?) with diabetes have been conducting paleo lifestyle experiments on themselves.

N=1 experiments (self-experimentation) are particularly helpful in the absence of randomized controlled clinical trials, the usual gold-standard study in medical science.  But N=1 experiments aren’t necessarily safe, especially for  a diabetic taking drugs that can cause hypoglycemia.

I’ve already figured out there’s not  much published scientific research on the application of paleo lifestyle choices as therapy for diabetes.  I plan to review the published literature over the coming year.  Coming up with some preliminary answers will also require some inductive reasoning and empiricism.

In thinking about the paleo lifestyle and diabetes, here are some of the issues and questions I need to address over the coming year:

Non-Diet Items 

  • exercise
  • rest
  • play
  • sun exposure
  • sleep
  • social interaction
  • diabetes prevention
  • effect on diabetic complications such as kidney disease, eye disease, nerve impairment, atherosclerosis (hardening of the arteries), heart disease, and stroke
  • spirituality (?)
  • individual genetic variation
  • safety
  • type 1 versus type 2 diabetes
  • drugs for diabetes

Diet-Related

  • what is the paleo diet
  • glycemic index
  • effect on blood sugar
  • diabetes prevention
  • effect of individual paleo diet components on diabetes
  • effect on diabetic complications such as kidney disease, eye disease, nerve impairment, atherosclerosis (hardening of the arteries), heart disease, stroke
  • type 1 versus type 2 diabetes

Imagine a diabetic asking his physician or dietitian, “What about the paleo diet? Can I try it?”  The typical professional is going to answer, “I don’t know.”  How many will have the time or interest to look into it?  Not many. 

Am I missing anything?  Do you know anybody else doing this in a public forum?

Steve Parker, M.D.

PS: A few diabetics don’t like to be called “diabetic.”  I mean no offense by the term.  It’s just typical medical short-hand for “people with diabetes” or “person with diabetes.”  Some blogs even use the acronym PWD.  Similarly, an asthmatic is a person with asthma, and an alcoholic is a person with alcholism.

Quote of the Day

The deviation of man from the state in which he was originally placed by nature seems to have proved to him a prolific source of diseases.

—Edward Jenner (1749-1823), of smallpox vaccination fame

Masai men in Tanzania. Modern hunter-gatherers?

Metabolic Improvements From a Paleolithic Diet in San Francisco

A Paleolithic diet improved metabolic status with respect to cardiovascular and carbohydrate physiology, according to a 2009 study at the University of California San Francisco.

Here are the specific changes, all statistically significant unless otherwise noted:

  • total cholesterol decreased by 16%
  • LDL cholesterol (“bad cholesterol”) decreased by 22% (no change in HDL)
  • triglycerides decreased by 35%
  • strong trend toward reduced fasting insulin (P=0.07)
  • average diastolic blood pressure down by 3 mmHg (no change in systolic pressure)
  • improved insulin sensitivity and reduced insulin resistance; i.e., improved glucose tolerance

Methodology

This was a small, preliminary study: only 11 participants (six male, three female, all healthy (non-diabetic), average age 38, average BMI 28, sedentary, mixed Black/Caucasian/Asian).

Baseline diet characteristics were determined by dietitians, then all participants were placed on a paleo diet, starting with a 7-day ramp-up (increasing fiber and potassium gradually), then a 10-day paleo diet.

The paleo diet: meat, fish, poultry, eggs, fruits, vegetables, tree nuts, canola oil, mayonnaise, and honey.  No dairy legumes, cereals, grains, potatoes.  Alcohol not mentioned ever.  Caloric intake was adjusted to avoid weight change during the study, and participants were told to remain sedentary.  They ate one meal daily at the research center and were sent home with the other meals and snacks pre-packed.

Compared with baseline diets, the paleo diet reduced salt consumption by half while doubling potassium and magnesium intake.  Baseline diet macronutrient calories were 17% from protein, 44% carbohydrate, 38% fat.  Paleo diet macronutrients were 30% protein, 38% carb, 32% fat.  Fiber content wasn’t reported. 

I’m guessing there were no adverse effects.

Comments

This study sounds like fun, easy, basic science: “Hey, let’s do this and see what happens!”

I don’t know a lot about canola oil, but it’s considered one of the healthy oils by folks like Walter Willett.  It sounds more appealing than rapeseed, from whence it comes.

I agree with the investigators that this tiny preliminary study is promising; the paleo diet (aka Stone Age or caveman diet) has potential benefits for prevention and treatment for metabolic syndrome, diabetes, and cardiovascular disease such as heart attack and stroke.

The researchers mentioned their plans to study the paleo diet in patients with type 2 diabetes.  Any results yet?

Are you working with a physician on a medical issue that may improve or resolve with the paleo diet?  Most doctors don’t know much about the paleo diet yet.  You may convince yours to be open-minded by trying the diet yourself—not always a safe way to go—and showing her your improved clinical results.  Or show her studies such as this.

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.

Reference:  Frassetto, L.A., et al.  Metabolic and physiologic improvements from consuming a paleolithic, hunter-gatherer type diet.  European Journal of Clinical Nutrition, advance online publication, February 11, 2009.   doi: 10.1038/ejcn.2009.4

Free Online Paleoanthropology “Textbook”: John Hawks Blog

I’ve never seriously studied anthropology, paleontology, or paleoanthropology.  When I read someone who seems or claims to be an expert on paleoanthropology or certain aspects of evolution, it requires a degree of trust on my part. 

(I have a stronger background in evolution, thanks to a B.S. degree in Zoology.  I was thoroughly indoctrinated in the mid-1970s.)

It was a slow day at work, so I just spent a couple hours perusing the blog of an actual paleoanthropologist named John Hawks.  It’s a massive database that may be the equivalent of a paleoanthropology textbook.  Naturally, it will reflect the biases of the author, if any (and we all have some, don’t we?) . 

Some interesting things you’ll find there:

Regarding the pace of human evolution in the Neolithic period, Artemis P. Simopoulos (with The Center for Genetics, Nutrition and Health in 2009) has a different view:

The spontaneous mutation rate for nuclear DNA is estimated at 0.5% per million years.  Therefore, over the past 10,000 years there has been time for very little change in our genes, perhaps 0.005%.  In fact, our genes today are very similar to the genes of our ancestors during the Paleolithic period 40,000 years ago, at which time our genetic profile was established.

I dunno; you decide.

Steve Parker, M.D.

Reference:  Simopoulos, Artemis P.  Evolutionary aspects of the dietary omega-6:omega-3 fatty acid ratio: medical implications.  World Review of Nutrition and Dietetics, 100 (2009): 1-21. Epub August 17, 2009.

LADA Awareness Week

 

“Who can tell us about LADA?”

This is the first ever LADA Awareness Week, organized by Diabetes Hands Foundation and dLife.  LADA stands for Latent Autoimmune Diabetes in Adults.  I think of it as type 1 diabetes that starts in adulthood, although there are some differences from typical juvenile-onset type 1 diabetes.

Seven-and-a-half to 10% of apparent type 2 adult diabetics have LADA.  It’s caused by the body attacking its own pancreas beta cells and thereby impairing insulin production; in other words, it’s an autoimmune thing.

Here are some generalities (with exceptions, of course) about LADA, compared to typical type 2 diabetes:

  • lower body mass index, often under 25
  • age at onset under 50
  • poorer response to dietary management
  • poorer response to oral diabetic medications
  • acute symptoms at time of diagnosis (e.g., weight loss, thirst, frequent urination, ketoacidosis, malaise, etc.)
  • higher risk of developing diabetic ketoacidosis
  • much more likely to need insulin

How Is LADA Diagnosed?

First of all, the doctor has to consider the possibility, based on the clinical factors above.  The autoimmune nature of the disease is reflected in islet-cell antiobodies (ICA) and antibodies to glutamic acid decarboxylase (anti-GAD).  These are testable in the blood.  One of the two may be enough.  If the disease is far enough along, blood levels of C-peptide will be low.  C-peptide reflects the body’s production of insulin.

For more information on LADA, talk to your doctor or see this page at dLife.

Steve Parker, M.D.