Paleo Diet and Diabetes: Improved Cardiovascular Risk Factors

Posted on September 26, 2011 | 2 comments

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Compared to a standard diabetic diet, a Paleolithic diet improves cardiovascular risk factors in type 2 diabetics, according to investigators at Lund University in Sweden.

Researchers compared the effects of a Paleo and a modern diabetic diet in 13 type 2 diabetic adults (10 men) with average hemoglobin A1c’s of 6.6% (under fairly good control, then).  Most were on diabetic pills; none were on insulin.  So this was a small, exploratory, pilot study.  Each of the diabetics followed both diets for three months.

How Did the Diets Differ?

Compared to the diabetic diet, the paleo diet was mainly lower in cereals and dairy products, higher in fruits and vegetables, meat, and eggs.  The paleo diet was lower in carbohydrates, glycemic load, and glycemic index.  Paleo vegetables were primarily leafy and cruciferous.  Cruciferous vegetables include broccoli, brussels sprouts, cauliflower, and cabbage.  Root vegetables were allowed; up to 1 medium potato daily.  The paleo diet also featured lean meats (why lean?), fish, eggs, and nuts, while forbidding refined fats, sugars, and beans.  Up to one glass of wine daily was allowed.

See the actual report for details of the diabetic diet, which seems to me to be similar to the diabetic diet recommended by most U.S. dietitians.

What Did the Researchers Find?

Compared to the diabetic diet, the paleo diet yielded lower hemoglobin A1c’s (0.4% lower—absolute difference), lower trigylcerides, lower diastolic blood pressure, lower weight, lower body mass index, lower waist circumference, lower total energy (caloric) intake, and higher HDL cholesterol (the good cholesterol).  Glucose tolerance was the same for both diets.  Fasting blood sugars tended to decrease more on the Paleo diet, but did not reach statistical significance (p=0.08, which is very close to significant).

So What?

The greater improvement in multiple cardiovascular risk factors seen here suggests that the paleo diet has potential to reduce the higher cardiovascular disease rates we see in diabetics.  This is just a pilot study.  Larger studies—more participants—are needed for confirmation.  Ultimately, we need data on hard clinical endpoints such as heart attacks, strokes, and death.

These diabetics had their blood sugars under fairly good control at baseline.  I wouldn’t be surprised if diabetics under poor control—hemoglobin A1c of 9%, for example—would see even greater improvements in risk factors as well as glucose levels while eating paleo.

There are so few women in this study as to be almost meaningless.

Results of this study may or may not apply to non-Swedes.

I see a fair amount of overlap between this version of the paleo diet and Dr. Bernstein’s Diabetes Solution diet and the Low-Carb Mediterranean Diet. 

Steve Parker, M.D.

Reference:  Jönsson, T., Granfeldt, Y., Ahrén, B., Branell, U., Pålsson, G., Hansson, A., Söderström, M., & Lindeberg, S.  Beneficial effects of a Paleolithic diet on cardiovascular risk factors in type 2 diabetes: a randomized cross-over pilot study.  Cardiovascular Diabetology, 8 (2009)  doi: 10.1186/1475-2840-8-35

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A Diabetes Specialist Contemplates the Paleo Diet

Posted on September 22, 2011 | 2 comments

In 2009, David Klonoff, M.D., reviewed the existing scientific literature on treatment of diabetes with a Paleolithic diet.  The majority of his comments refer to Jönsson’s 2009 research in Cardiovascular Diabetology, which involved only 13 patients.  Dr. Klonoff, by the way, is an endocrinologist and diabetes specialist in California.

Here are a few quotes from the Dr. Klonoff:

The main ingredient lacking in a Paleolithic diet is calcium, which must be supplemented to prevent bone mineral loss.  [No references cited.]

The Jönsson study was the first to assess the potential benefit of the Paleolithic diet compared to a diabetes diet for patients with T2DM [type 2 diabetes mellitus].

The implications of identifying a safer and more effective diet than what is currently being recommended for patients with obesity or T2DM are enormous.  The paleolithic diet is certainly not a new discorvery.  What is needed now is more clinical data with greater numbers of subjects and longer study durations so that more robust conclusions can be drawn.

Potential disadvantages of a Paleolithic diet might include deficient intake of vitamin D and calcium as well as exposure to environmental toxins from high intake of fish.

The Paleolithic diet might be the best antidote to the unhealthy Western diet.

Dr. Klonoff didn’t mention whether any of his patients had tried a paleo diet.  How about now, two years later?

Steve Parker, M.D. 

Reference: Klonoff, David.  The beneficial effects of a Paleolithic diet on type 2 diabetes and other risk factors for cardiovascular disease.  Journal of Diabetes Science and Technology, 3 (2009): 1,229-1,232.

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Is the Paleo Diet Low-Carb?

Posted on September 19, 2011 | 7 comments

Low-carb diet and paleo diet advocates often align themselves, even though S. Boyd Eaton’s 1988 version of the paleo diet doesn’t appear to be very low-carb at all: 46% of total calories from carbohydrate.  The standard American diet provides 50-55% of calories from carbohydrate.  Paleo proponents and low-carbers do share an affinity for natural, whole foods, and an aversion to grains, milk, and legumes. 

A 2010 article by Kuipers et al (reference below) sugggests 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 low-carb.  Modern Western percentages for protein, fat, and carb are 15%, 33%, and 50%, respectively.

Loren Cordain and associates in 2000 suggested that Paleolithic diets may have derived about a third—22 to 40%—of calories from carbohydrate, based on modern hunter-gatherer societies. 

You can make a good argument that these paleo concepts are healthy: high physical activity, nonsmoking, consumption of natural whole foods while minimizing simple sugars and refined starches.  The paleo community is convinced that grains and legumes are harmful; many others disagree.  Also debatable are the roles of dairy, polyunsaturated to saturated fat ratio, low sodium, and high potassium.  Modern diets tend to be high-sodium and low-potassium, which may predispose to high blood pressure and heart trouble—diseases of modern civilization.

It appears that the average paleo diet may have derived about a third of calories from carbohydrate: that qualifies as low-carb.

For more on the paleo diet and lifestyle, visit Robb Wolf’s website, Mark’s Daily Apple, and Archevore. 

Steve Parker, M.D.

References:

Kuipers, R., Luxwolda, M., Janneke Dijck-Brouwer, D., Eaton, S., Crawford, M., Cordain, L., & Muskiet, F. (2010). Estimated macronutrient and fatty acid intakes from an East African Paleolithic diet British Journal of Nutrition, 1-22 DOI: 10.1017/S0007114510002679.  Note that one of the authors is Loren Cordain.  Good discussion of various Paleolithic diets.

Eaton, S., Konner, M., & Shostak, M. (1988). Stone Agers in the fast lane: Chronic degenerative diseases in evolutionary perspective. The American Journal of Medicine, 84 (4), 739-749 DOI: 10.1016/0002-9343(88)90113-1

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.

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Paleo Diet Revival Story

Posted on September 16, 2011 | 8 comments

My superficial reading of the paleo diet literature led me to think Loren Cordain, Ph.D., was the modern originator of this trend, so I was surprised to find an article on the Stone Age diet and modern degenerative diseases in a 1988 American Journal of Medicine by S. Boyd Eaton, M.D., et al.  Dr. Cordain started writing about the paleo diet around 2000, I think.

What’s So Great About the Paleolithic Lifestyle?

In case you’re not familiar with paleo diet theory, here it is.  The modern human gene pool has changed little over the last 50,000 years or so, having been developed over the previous one or two million years.  Darwins’ concept of Natural Selection suggests that organisms tend to thrive if they adhere to conditions present during their evolutionary development.  In other words, an organism is adapted over time to thrive in certain environments, but not others.

The paleo diet as a healthy way to eat appeals to me.  It’s a lifestyle, really, including lots of physical activity, avoidance of toxins, adequate sleep, etc. 

The Agricultural Revolution (starting about 10,000 years ago) and the Industrial Revolution (onset a couple centuries ago) have produced an environment and food supply vastly different from that of our Paleolithic ancestors, different from what Homo sapiens were thriving in for hundreds of thousands of years.  That discordance leads to obesity, type 2 diabetes, atherosclerosis, high blood pressure, and some cancers.  Or so goes the theory.

What’s the Paleolithic Lifestyle?  (according to Eaton’s 1988 article)

  • Average life expectancy about half of what we see these days
  • No one universal subsistence diet
  • Food: wild game (lean meat) and uncultivated vegetables and fruits (no dairy or  grain)
  • Protein provided 34% of calories (compared to about 12% in U.S. in 1988)
  • Carbohydrate provided 46% of calories (only a  tad lower than what we eat today)
  • Fat provided 21% of calories (42% today)
  • Little alcohol, but perhaps some on special occasions (honey and wild fruits can undergo natural fermentation) , compared to 7-10% of calories in U.S. today [I didn’t know it was that high]
  • No tobacco
  • More polyunsaturated than saturated fats (we ate more saturated than polyunsaturated fat, at least in 1988)
  • Minimal simple sugar availability except when honey in season
  • Food generally was less calorically dense compared to modern refined, processed foods
  • 100-150 grams of dietary fiber daily, compared to 15-20 g today
  • Two or three times as much calcium as modern Americans
  • Under a gram of sodium daily, compared to our 3 to 7 grams.
  • Much more dietary potassium than we eat
  • High levels of physical fitness, with good strength and stamina characteristic of both sexes at all ages achieved through physical activity

[These points are all debatable, and we may have better data in 2011.]

The article authors point out that recent unacculturated native populations that move to a modern Western lifestyle (and diet) then see much higher rates of obesity, diabetes, atheroslcerosis, high blood pressure, and some cancers.  “Diseases of modern civilization,” they’re called.  Cleave and Yudkin wrote about this in the 1960s and ’70s, focusing more on the refined carbohydrates in industrial societies rather than the entire lifestyle. 

Paleo diet proponents agree that grains are not a Paleolithic food.  The word “grain” isn’t in Eaton’s article.  The authors don’t outline the sources of Paleolithic carbs: tubers and roots, fruits, nuts, and vegetables, I assume.  Legumes and milk are probably out of the question, too.

The Paleolithic Prescription: A Program of Diet and Exercise and a Design for Living was published in 1988 by Harper & Row (New York).  The authors are S. Boyd Eaton, M. Shostak, and M. Konner. 

Eaton and Konner are also the authors of “Paleolithic nutrition: A consideration of its nature and current implications.”  in New England Journal of Medicine, 312 (1985): 283-289.

Mat Lalonde, Ph.D., in an interview with Jimmy Moore suggested that Cordain would credit S. Boyd Eaton, M.D., with the recent trendiness of the paleo diet.

Paul Jaminet wrote at one of my other blogs: “In 1975 a gastroenterologist named Walter L. Voegtlin published a book called The Stone Age Diet arguing for a low-carb Paleo diet.  S. Boyd Eaton was second.  Not much happened for a time, then it picked up in the late 1990s and early 2000s.  Ray Audette with Neanderthin was first to market…Oh, and I forgot Jan Kwasniewski’s Optimal Diet, which was first published in Poland around 1970.  Not exactly a Paleo diet, but close.

If you have evidence that the “modern paleo” diet goes back further than this, please leave a comment.

Steve Parker, M.D.

References:

Kuipers, R., Luxwolda, M., Janneke Dijck-Brouwer, D., Eaton, S., Crawford, M., Cordain, L., & Muskiet, F. (2010). Estimated macronutrient and fatty acid intakes from an East African Paleolithic diet British Journal of Nutrition, 1-22 DOI: 10.1017/S0007114510002679.  Note that one of the authors is Loren Cordain.  Good discussion of various Paleolithic diets.

Eaton, S., Konner, M., & Shostak, M. (1988). Stone agers in the fast lane: Chronic degenerative diseases in evolutionary perspective The American Journal of Medicine, 84 (4), 739-749 DOI: 10.1016/0002-9343(88)90113-1

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.

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