Control Diabetes and Prediabetes With Paleolithic Eating (Outline Version)
Copyright © 2013 by Steve Parker, M.D.
The ideas and suggestions in this document are provided as general educational information only and should not be construed as medical advice or care. All matters regarding your health require supervision by a personal physician of other appropriate health professional familiar with your current health status. Always consult your personal physician before making any dietary, medication, or exercise changes. Consult your dietitian before making dietary changes. The publisher and author disclaim any liability or warranties of any kind arising directly or indirectly from the use of this document. If any problems develop, always consult your personal physician. Only your physician can provide you medical advice.
- Nuts & seeds
- Condiments & oils
- 1–2 oz nuts (primarily) or seeds.
- Protein 3–8 oz per meal, or unlimited but consistent from day to day and meal to meal. Three meals daily. Fish at least twice weekly.
- Two servings of low-carb vegetables (serving = 7 oz or 200 g) plus 1 or 2 servings of fruits (serving size below), starchy vegetables (serving size below), or more low-carb vegetables (serving = 7 oz or 200 g).
- Condiments and oils as needed for flavor and cooking.
NUTS AND SEEDS
Focus on walnuts, pecans, macadamia, cashews, almonds.
Meat, fish/seafood, eggs, poultry, offal, and wild game. Bacon OK, but minimize it and other processed meats.
(Group A) Raw salad vegetables: lettuce, mushrooms, radishes, spinach, cucumber, tomato, scallions, parsley, jicama, arugula, kale, endive, radicchio, chard, sweet peppers, avocado, olives (pickled green or ripe black), pickles (dill or sour, not sweet or “bread and butter”), bok choy, escarole. Average digestible carbohydrate per 7 oz serving (200 g) is 5 g. The highest digestible carb counts are in scallions and jicama (8 g), and sweet peppers (7g).
(Group B) Solid or leafy vegetables, often cooked: artichoke hearts, broccoli, summer squash, zucchini, spaghetti squash, tomato, onion, cauliflower, eggplant, Brussels sprouts, asparagus, bamboo shoots, okra, sauerkraut (canned), collard greens, beet greens, turnips, turnip greens, mustard greens, kale, chard, daikon radish, celeriac, kohlrabi, rhubarb, bok choy. These average 8 g of digestible carbohydrate per 7 oz serving (200 g). Celeriac and onion are highest at 16 and 14 g, respectively. Weigh Group B veggies before cooking.
(Each serving has 7.5 grams of digestible carbohydrate.)
- apple, a third of medium-sized one (54 g)
- banana, one third (39 g)
- peach, one half of medium (75 g)
- strawberry halves, two thirds of a cup (75 g)
- blueberries, one half cup (75 g)
- raspberries, 1 cup (123 g)
- blackberries, 1 cup (144 g)
- cantaloupe, one half cup cubes (80 g)
- honeydew, 1 cup of cubes (85 g)
- date, medjool, one half date (12 g)
- orange, navel, one half (70 g)
- pear, a third of medium-sized one (60 g)
- pomegranate, one fourth of 4″ (10 cm) diameter fruit (70g)
- tangerine, one half (44 g)
- grapefruit, one half (61 g)
- cherries, sweet, raw, a third of a cup (45 g)
- grapes, a third of a cup (50 g)
- raisins, seedless, 20 (9 g)
- nectarine, medium, one half (70 g)
- mango, slices, a third of a cup (55 g)
- pineapple, raw chunks, a third of a cup (55g)
- lime/lemon juice, raw, 2 limes or lemons (88 g)
- watermelon, diced, two thirds of a cup (100 g)
- plantain, raw, 1 oz or 28 g
(Each serving has 7.5 grams of digestible carbohydrate.)
- potato, white, raw, flesh and skin, one fourth of medium potato (53 g)
- carrots, raw, strips or slices, three quarters of a cup (92 g)
- sweet potato, raw, a third of 5 inch-long (13 cm) tater (45 g)
- beets, canned, drained solids, three fourths of a cup slices (130 g)
- cassava, raw, 3/4 oz or 21 g)
- taro, raw, 1 oz or 28 g
- parsnip, raw, 2 oz or 60 g
- winter squash (e.g., acorn, butternut), raw, 1 cup of cubes (115 g)
CONDIMENTS AND OILS
Mustard, home-made vinaigrette, home-made mayo (olive oil and egg yolk), cilantro, parsley, basil, rosemary, thyme, etc. Salt (minimal), pepper, vinegar. Oils: extra virgin olive, flax, avocado.
If you take certain diabetes drugs, the Paleobetic Diet could put you at major risk for serious—even life-threatening—hypoglycemia (low blood sugar). Once again, consult your physician, certified diabetes educator, and dietitian regarding this and other issues before starting the diet.
Including scattered carbohydrates in condiments etc., this diet would total roughly 60 g of digestible carbohydrates daily.
Try to limit breakfast digestible carbs to 10 g; limit lunch and dinner carbs to 20 g each.
To determine carbohydrate content of foods, use the USDA National Nutrient Database for Standard Reference at http://ndb.nal.usda.gov.
You’ll need a kitchen scale.
To minimize effect on blood sugar, eat starchy veggies and fruits with meals that include a protein or nuts. Compared to raw carrots, cooked carrots have more effect on blood sugar. Fruits may have less adverse effect on blood sugar if eaten at lunch or dinner.
If you must have between-meal snacks, eat nuts/seeds, protein, or low-carb veggies.
Still hungry? Eat a protein food.
Larger or more active folks who feel deprived and don’t need to lose weight: eat more protein and/or increase other components by 25%.
Smaller or less active folks who aren’t losing excess weight or are gaining unwanted weight: eliminate fruits and starchy veggies, or reduce all components by 25%.
Having trouble losing excess weight? Minimize or eliminate fruits and starchy vegetables.
Compared with other common low-carb vegetables, onions and tomatoes may be more likely to spike your blood sugar.
Note: This diet is gluten-free!
Advanced dieters can focus on omega-6/omega-3 fatty acid ratio: eat less omega-6 and more omega-3.
Liquids: water, coffee, tea, maximum of 2 diet sodas per day if necessary.
Sweeteners: stevia, (honey has 6 g of carb per tsp or 5 ml, so best to avoid).
FORBIDDEN FOODS: Grains (e.g., corn, wheat, rice), dairy, legumes (peanuts, beans, peas, green beans), industrial vegetable or seed oils (soybean, corn, safflower, etc.), alcohol, refined sugars.
Click here (Print Documents) for a Daily Log and Shopping List that will help you adhere to the diet.
Update: August 27, 2015
A comprehensive version of the Paleobetic Diet is now available in paper book or ebook versions. Dr. Parker and his co-author wife provide one week of meal plans to get you started, plus additional special recipes. Meals are quick and easy to prepare with common ingredients. You’ll find detailed nutritional analysis of each meal, including carbohydrate grams.
All measurements in the book are given in both U.S. customary and metric units. Blood glucose values are provided as both mmol/l and mg/dl. Also included is information and advice on exercise, weight loss, all 12 classes of diabetes drugs, management of hypoglycemia, and recommended drug dose adjustments. All recipes are gluten-free.
You’ll find Paleobetic Diet at all major online bookstores. For example, Amazon (290-page paperback book in U.S.), Kindle ebook, and multiple ebook formats at Smashwords.
I haven’t gone through all the blog entries, so my apologies if my question has been answered in a blog entry (if so, please let me know which one). My question is “Why no dairy or alcohol?” If I read this page correctly, you have oil, cured meat and diet sodas – all of which our “paleo” ancestors would likely not have eaten (at least I know that there were no diet sodas 10,000 or so years ago), but you have no dairy.
The only time Paleolithic humans would have come across dairy products would have been milk inside a nursing animal, such as an ungulate, that they just killed. I figure that would have been highly seasonal and probably not all that common. I do imagine they would have tried drinking the milk at least once. If it tasted good, they’d do it again. It’s somewhat speculative on my part to say that such milk would have been a very small proportion of their overall diet. I’ve not run across any opinion from an expert on this.
We know that even modern moose (mooses?), reindeer, and birds can get drunk by eating fruit that has fermented into alcohol in the field. I can imagine Paleolithic man doing the same, but I’m not aware of any proof. This type of alcohol, like milk, would have been seasonal, perhaps just two weeks out of the year. I can’t imagine our ancient ancestors drinking nearly as much alcohol as modern man.
That being said, milk and judicious amounts of alcohol can contribute to a healthy diet, in general. Just not much to a pure paleo diet.
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Thank you so much for this article! I was told to go Paleo and just sent to the net to research it. Now I have some actual guidelines!
Thanks for visiting, Carrie. By the way, I’ll be posting some more recipes here over the next few months unless my other job as a hospitalist interferes.
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According to research, Cavemen existed in large part by eating Tiger Nuts, and you may well be asking what the heck are Tiger Nuts.
You can find out at http://www.tigernutsusa.com
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Good diets for t1d are poorly documented on the internet. Paleo/Keto have been the ONLY diets I have had success with. One thing I would add is to occasionally skip a meal and perform light daily aerobic exercise to keep glycogen levels down. Stored up glycogen, when dumped into the bloodstream, can be a very confusing experience as it can happen even during the most rigorously monitored diet!
Thanks for your contribution. Regarding fasting (skipping meals now and then), PD Mangan thinks it may improve longevity.
[Anyone planning on skipping a meal may need to adjust insulin or other diabetic meds to prevent hypoglycemia.]
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I like to put fruits and vegetables in their proper categories. For example, avocados, tomatoes, olives, pumpkin, squash and peppers are all fruits.
As I said earlier, I discovered through observation in the early 80’s that diabetics could not eat fruit by itself, though fruit was always recommended as a stand-alone snack by the Am. Diabetic (and Dietetic) Assoc. You recommended that starchy vegs/fruits should be eaten with a protein or nuts, which is so invaluable to people, in general, diabetic or not.
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Thank God I’m not a Paleo man as many of the foods recommended would spike my BGs. I’ll stick to my low carb diet as it works for me.
Hi, Frank. The Paleobetic Diet provides around 45-80 grams of digestible carbohydrate daily. That’s quite a bit lower than the 250 grams eaten by the average Westerner. I’m glad your current diet is working for you!
Yes I can see it would be useful for many people. I wanted to flag up that some people have to go lower than 45g carbs per day.
Dr. Richard Bernstein, a T2 diabetic, recommends 30 grams/day. Few can go lower than that long-term.
I am pre-diab and no meds, dropped sugar and soda, work on walking 20 min. daily and dropped 14 lbs., down to 6.0 A1C in 4 months. but diet is hard for low income single 67 year old. Dr. says 30 carbs count per meal-3 times a day. carb count =15grms per 1 count, so what does that mean in terms or what you state for daily carbs.
Congratulations on your success thus far!
I don’t use the term “carbs count” so I don’t know what your doctor means.
I ask my patients to focus on total daily digestible carbohydrate (or “carb”) grams. Instead of “digestible,” many use the term “net carbs.” For a prediabetic, it usually doesn’t matter if the majority of carb grams are eaten at one meal or spread throughout the day; it’s personal preference.
For folks taking drugs that can cause hypoglycemia, the distribution of carb grams throughout the day is important.
About tomatoes- I test my blood sugar levels with my food diary and cherry tomatoes raise my blood sugar high and fast and I wonder what chemical reactions do this? Dr. Bernstein is right. Something oher than CI and carb amounts.
If I recall correctly, Bernstein also says you have to watch out for onions, too.
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I’m really glad I found your site! I experimented with paleo a couple of years back to try and shift some weight (I’m pretty obese – around 260lb). I dropped around 30lb and really enjoyed the diet (it’s extremely palatable!), but confess to having really done it a bit wrong – I probably went a bit too low with my carbs which seemed to cause me to dehydrate frequently (esp. in the mornings – I was always waking up parched!), plus I ate quite a large amount of almonds (more than recommended amounts anyway), dark chocolate and drank loads of black tea, all of which probably combined to cause me to end up in the A&E dept with a bad case of kidney stones! Anyway, I fell off the caveman bandwagon big style and just went back to my old bad eating habits, with the result that now, a couple of years later, I’ve put all the weight back on that I lost (and some), and have just had a blood test at the doc’s for suspected diabetes (I’ve recently been experiencing increasingly severe thirst, aches in my legs and feet, and frequent brain fog, lethargy etc) What finally prompted me to make the appt was when I tried testing my blood sugar with a spare monitor belonging to my uncle who’s a diabetic (I have T2D on both sides of my family), and my post-prandial glusose was up to 13mmols (?240mg/dl in US), which is apparently higher than it should be – perhaps not “big money” compared to bg levels some have to contend with, but maybe enough to cause my more recent symptoms.
I immediately went back on the paleo diet, only this time with less of the foods I knew to be high in oxalates, scaling back a bit on the protein too (I was eating huge portions of it when I did paleo before!), and have kept some full-fat dairy in my diet to keep my calcium levels up ( as per my doc’s advice, to bind oxalates in my gut and stop them entering my kidneys. I also take some lime or lemon juice in my water bottle to boost citrate levels in my blood which apparently helps too.) I’ve been experimenting with “safe starches” to see how they affect my blood glucose. Suffice it to say that on my new anti-lithiogenic (? that’s a correct term) adapted paleo diet I can keep my blood sugar levels on an even keel and within normal limits, even when including some potatoes, bananas etc in my daily diet, and it’s pretty effortless! It’s been a bit tricky to calibrate things so that my carbs are not so low that I get too thirsty (which is of course a danger for stone-formers like me), and they’re not so high that they push my blood sugar up (which has also probably been causing me excessive thirst!) However, I’ll learn over time to get the balance right (I was having fun testing effects of different foods on my bg with the glucose monitor, then I ran out of the test strips lol!) It seems pretty hard really to eat too many carbs on this diet, because there’s not all the grain-based or sugary products to contend with (though i suppose you could still have too much dried fruit etc, which I know pushes my bg up beyond normal limits so I avoid it.)
Anyway, I should get results back from my blood test tomorrow, and I’m keeping my fingers crossed that I’m just prediabetic and haven’t got full blown T2D yet! Even if I am T2D, I’m going to ask my doc if I can try to manage it with diet before going on any meds. I feel confident that I’m getting to know how my bg works and how to manage the levels – going paleo again makes it a lot easier! (plus it’s the tastiest, easiest diet to stick to ever!!)
Lara, thanks for sharing your story.
You’re very welcome! Here’s an update – my hbA1c came back as prediabetic level (I didn’t find out the exact figure, but I’d already been eating a primal-style paleo diet for a couple of weeks when I had the test, which I’m not sure might have lowered the final results somewhat.) Anyway, since then I’ve been experimenting with my diet and have found a great benefit of going full paleo and ditching dairy – my asthma has pretty much disappeared and peak flows have increased dramatically! I still make sure to keep my calcium levels up with oily fish with bones in a few times a week, and plenty of low oxalate greens every day. I’ve also been able to go lower with carbs without the thirst I used to feel before at very low levels (? I adapted to it?) I’m losing weight so that people notice every time they see me, which is great encouragement! Also, I seem to be growing hair back around my hairline which had become very thin – guess I’m getting more nutrients or something (or ? my thyroid is functioning better). Also, my doc had diagnosed fatty liver because my liver enzymes were up. and so I’ve been eating beef liver etc to raise my choline (which I read on Chris Masterjohn’s site can help reverse this condition.) I’ve got loads of energy and am finding that I actually want to get up and move around and do stuff, whereas before I was just more or less vegetating in a chair when I wasn’t at work!
I’m guessing you’ll have heard loads of these success stories by now – it is an amazing diet, and the natural appetite regulation factor has been a huge plus point for me – in the past I just felt I had no control over my appetite at all. It was like being swept away in a whirlwind of cravings and hunger! Now my blood glucose is down and my insulin probably on an even keel, I can go for hours without even thinking about food!
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