Tag Archives: caveman diet

Ideas For A Paleo Diabetic Diet

Sirloin steak, salad, cantaloupe, 3 raspberries

Sirloin steak, salad, cantaloupe, 3 raspberries

I’ve been thinking about a paleo-style diabetic diet for over a year.  Here are some miscellaneous ideas for your consideration.

A paleo diabetic diet will have the following major food groups:

  • vegetables
  • fruits
  • nuts and seeds
  • proteins (e.g., meat, fish, eggs)
  • condiments

A paleo diabetic diet could (should?) emphasize salads and low-carb colorful vegetables and only (?) low-carb or low-glycemic-index fruits.

Calories

Total calories?  Probably in the range of 1,800 to 3,000 calories daily with an average of 2,000.  Remember that 85% of type 2 diabetics are overweight or obese. Calorie restriction—regardless of macronutrient ratios (% carb, protein, fat)—tends to improve or normalize blood sugar levels.  Weight loss will likely entail some caloric restriction, whether consciously or not.

Type 1 Versus Type 2 Diabetes

Type 1 and type 2 diabetics have many pathophysiologic differences.  Could a single paleo diabetic diet serve both populations equally well?  That’s the goal.

Carbohydrates

Diabetics have trouble metabolizing carbohydrates, so a paleo diabetic diet should probably be lower-than-average in digestible carbs.  100 g/day?  30 g/day?  I’m leaning toward 60 g ± 25%, so 45–75 g.  Smaller, less active folks could eat 45 g/day; larger, more active guys eat closer to 75 g.

Is there a role for very-low-carb or ketogenic eating patterns?  For most folks, that’s less than 50 g of digestible carbohydrate daily.  Under 30 g for some.  Use that only for those needing to lose weight?  Start everybody at  very low carb levels then increase carbs as tolerated?  On the other hand, there’s a lot to be said for simplicity.  It might be best to avoid very-low-carb (ketogenic) eating entirely.  Anyone not losing the desired amount of fat weight could cut portion sizes, especially carbohydrates.

Fish

I encourage fish consumption twice a week, diabetes or no.  Cold-water fatty fish have more of the healthy omega-3 fatty acids than other fish.

Nuts

I’d encourage 1–2 ounces (28–56 g) of nuts or seeds daily.  Any more than that might crowd out other healthful nutrients.  Nuts are protective of the heart.

Proteins

Protein-rich foods can definitely raise insulin requirements and blood sugar levels, but not in an entirely predictable way, and not to the extent we see with carbohydrates.  Should insulin users dose insulin based on a protein gram sliding scale?  I’m leaning towards simply recommending the same amount of protein at each meal, perhaps 4–8 ounces (113–229 g).

Fruit and Starchy Vegetables

Could a paleo diabetic diet even be “paleo” without fruit?  The problem with classic fruits is that they spike blood sugars too high for many diabetics.  To prevent that, Dr. Richard Bernstein outlaws all classic fruits (and other starchy carbs), even limiting tomatoes and onions to small amounts.  E.g., a wedge of tomato in a salad.  He doesn’t allow carrots either, unless raw (lower glycemic index than when cooked).  A paleo diabetic diet eater may be able to get away with eating lower-carb, lower-GI (glycemic index) fruits such as cantaloupe, honeydew, strawberries and other berries.  Some paleo diabetic dieters will tolerate half an apple twice a day.

Different diabetics will have different blood sugar effects when eating starchy vegetables and higher-carb fruits.  Type 1 diabetics will tend to be more predictable than type 2s.  Both may just need to “eat to the meter”: try a serving and see what happens to blood sugar over the next hour or two.

Starchy vegetables—potatoes and carrots, for example—may well have to be limited.  Again, eat to the meter.

Gluten

This is looking to be gluten-free.  How trendy!  It’s a paleo celiac diet.

Use “natural” stevia as a sweetener?  If you read about how the product on your supermarket shelf  is made, it’s not at all natural.

Omega-6/Omega-3 Fatty Acids

A strict focus on omega-6/omega-3 fatty acid ratio will not appeal to many folks, even if it’s important from a health viewpoint.  Reserve this for advanced dieters who have mastered the basics?  Modern Western diets have an omega-6/omega-3 ratio around 10 or 15:1.  Paleolithic diets were closer to 2 or 3:1.  So we have an over-abundance of omega-6 fatty acid or deficiency of omega-3 that may be unhealthy.

Implementation

To get dieters started, I’d design a week of meals based on 2,000 to 2,200 calories.  If still hungry, eat more protein, fat, and low-carb vegetables (and fruits?).

What do you think?

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.  

PS: See Dr. Bernstein’s “no-no” foods on page 151 of his Diabetes Solution book.

PPS: The paleo diet is also known as the Paleolithic diet, Stone Age diet, caveman diet, hunter-gatherer diet, and ancestral diet.

Two Month Recap of the Parker Paleo Diet Trial

soup, home-made, potato, chicken, paleo diet, meal, Stone Age diet, recipe

Potato chicken soup

I’ve completed my two-month paleo diet trial.  I’m proud to say I’ve been fairly compliant with it, although certainly not 100%.  Perhaps 95%.

My major transgressions have been:

  • three diet sodas
  • a bottle of wine around Thanksgiving holiday
  • two or three pies around Thanksgiving (I couldn’t stand throwing them out)
  • other grain and refined sugar products around Thanksgiving
  • four servings of salad dressing made with industrial seed oils when I had no good alternative
  • a Blizzard (thick milk shake) from Dairy Queen
  • on 10–15 days I’ve exceeded my 2-ounce (60 g) limit on nuts

Results and Overall Impressions of Paleo Eating

It’s fairly easy, even when dining out or away from home.  Nevertheless, it requires some discipline and willpower.

My sense is that my meat, poultry, egg, and nut consumption stayed about the same as my baseline, pre-paleo levels.  I eliminated cheese and didn’t miss it much.  I ate more vegetables and fruit.

paleo diet, paleo meal, recipe, stone age diet, paleo food, hunter-gatherer food

I took my lunch meals to the hospital

My wife says paleo eating is at least a little more expensive than my prior eating habits, mostly related to fresh vegetables and fruit.  Grain products like bread, pasta, and rice are cheaper calories.  On the other hand, we saved money by not buying wine even though I don’t drink expensive wine.

I don’t miss grain products much at all.  I had already cut back on them over the last couple years as part of my experimentation with low-carb eating.  I do enjoy whole grain breads but could live a happy life without them if necessary.

I miss sweet items like cinnamon rolls, other pastries, cake, pie, ice cream, diet soda, and candy bars.  I don’t care for sugary soda pop and fruit juices.

I didn’t do this to lose weight, yet went from 171 lb (77.7 kg) down to 164 lb (74.5 kg).  So an unexpected loss of 7 lb (3.2 kg).  I hovered between 162 and 166 lb for the last few weeks so I don’t think I’ll keep losing weight if I stay with the program.

Do I feel any different eating this way?  No.  I’m blessed with good health, so wasn’t looking for any upgrades.  I have noticed more sweetness in a few foods, such as nuts and carrots.

I take nothing away from those who report more energy, better sleep, improved digestion, increased strength, less joint pain, etc., from paleo-style eating.  Undoubtedly, some of those apparent improvements are placebo effect, some are coincidental, and some are bona fide results of the paleo lifestyle.

Steve Parker, M.D.

PS: The paleo diet is also called the Paleolithic diet, hunter-gatherer diet, Stone Age diet, caveman diet, or ancestral diet.

Update December 16, 2012:  I wondered if lack of alcohol for the last two months had any effect on my weight loss.  For the last week I ate my usual paleo diet but added 3 fl oz (90 ml) of whiskey daily.  Weight today 163 lb (73.9 kg), so no real change over the short run.  That’s enough whiskey for a while.

Update December 27:  After three days of unrestrained Holiday eating, my weight is up 8 lb to 171 lb (77.7 kg).  Mostly thanks to pie, cookies, and candy.  I’m sure some of that extra weigh is glycogen, water, and intestinal contents, rather than fat.  Back on the paleo diet today, a low-carb version.

Update December 29:  Weight is down 5 lb to 166 lb (75.5 kg).  Amazing.

Pace salsa, paleo diet, Parker paleo diet

The contents of this salsa jar are all paleo-compliant

paleo diet, Parker paleo diet, canned pumpkin

Pure paleo contents unless there’s BPA in the can liner

pumpkin pie, paleo diet, Parker paleo diet

Definitely non-paleo pumpkin pie

wine bottle, red wine, paleo diet, meal,

Wine is not “paleo” by most definitions

paleo diet, paleo food, hunter-gatherer diet, macadamia nuts

L. Cordain likes the low omega-6/omega-3 ratio of macadamia nuts

What Do Mainstream Dietitians Think of the Paleo Diet?

Australian Aborigine in Swamp Darwin

I’m curious to know what mainstream dietitians think about the Paleolithic diet, so I read an article entitled “Are diets from Paleolithic times relevant today?”  This one-page article is in the August, 2012, issue of the Journal of the American Academy of Nutrition and Dietetics. The author is Eleese Cunningham, RD, of the Academy of Nutrition and Dietetics Knowledge Center Team.

The Academy of Nutrition and Dietetics is the new name of the American Dietetics Association, “the world’s largest organization of food and nutrition professionals.”

Ms. Cunningham notes that “diet books for modern humans are extremely popular, and the Paleolithic diet, sometimes called the “Caveman Diet” or the “Stone Age Diet,” is one of the latest trends.”  You’d think the author would mention one of the popular paleo diet books, such as Loren Cordain’s, Robb Wolf’s, or Mark Sisson’s.  Think again.  She brings up only another dietitian’s review of Richard Nikoley’s paleo diet book, pointing out his lack of professional health credentials and his advocacy of raw milk consumption.  But milk isn’t even considered a component of most paleo diets.  Ms. Cunningham justifiably points out the infectious risks, however small, linked to raw milk consumption.  (I’ve not read Nikoley’s book, Free the Animal.)

(If you click the link to see the review of Nikoley’s book, scroll to page 30.  Sample: “Based more on science fiction than science fact, Nikoley’s recommendations are misguided and reckless…”)

Ms. Cunningham likes the fact that the paleo diet reduces consumption of salt and added sugars, while promoting fruit and vegetables.  However, she immediately notes thereafter that, “a striking counter to the meat-based Paleolithic diet is the evidence that supports the healthfulness of a vegetarian diet and the benefits it may have in the prevention and treatment of certain diseases.  Another review of this approach . . . questions the exclusion of nutrient-rich grains, beans, and low-fat dairy and the potential nutrient shortfalls associated with the Paleolithic diet restrictions.”

This article appears to be in a regular feature of the journal called, “From the Academy: Question of the Month.”  Are diets from Paleolithic times relevant today?  She never answers directly.  I suspect the average dietitian reading this article will conclude that Ms. Cunningham and the Academy are not in favor of the paleo diet.

Steve Parker, M.D.

Reference: Cunningham, Eleese.  Are diets from Paleolithic times relevant today?  Journal of the Academy of Nutrition and Dietetics, 2012 (vol. 112, issue 8): p. 1296.  doi: 10.1016/j.jand.2012.06.019

Position of the American Dietetic Association: Vegetarian diets.  Journal of the American Dietetic Association, 2009 (109): 1266-1282.

Day 1 of My Paleo Diet

Why do it?

  • Direct experience with implementation obstacles
  • Potential health benefits

My first Parker Paleo Diet meal: sautéed mixed veggies and pan-fried chicken breast

I’m not doing this to lose weight, although I wouldn’t mind losing 10 lb (4.5 kg).  I weigh 171 lb (77.7 kg, BMI 23.4).  Regarding health benefits, I’m just going to monitor how I feel.  No blood work.  My blood pressure’s normal already.

My current version of paleo is not designed for someone with diabetes or prediabetes.  That may come in the future (Dr. Frassetto, when can we see your latest research results?).  By “current version,” I mean I’ll quite likely tweak it over the coming months.  One of my major issues is whether to keep or delete potatoes.

Here’s what I’ll eat (or not) on the Parker Paleo Diet:

FORBIDDEN FOODS: Grains (e.g., corn, wheat, rice), Dairy, Legumes (peanuts, beans, peas, green beans), Industrial Vegetable Oils (soybean, corn, safflower, etc.), Alcohol, Refined Sugars.

PROTEINS: Meat, fish/seafood, eggs, poultry, and wild game.  Bacon OK; minimize other processed meats.

NUTS & SEEDS: Especially walnuts, macadamia, cachews, almonds.  Limit to 1-2 oz/day.

FRUITS: Limit 2 pieces/day?

VEGETABLES:

Lower-Carb: Greens (lettuce, spinach, chard, collard, mustard geen, kale), radicchio, endive, bok choy, herbs, celery, radishes, mushrooms, cabbage, jicama, avocado, asparagus, okra, cucumbers, cauliflower, broccoli, peppers, summer squash, zucchini, Brussels sprouts, green onions, tomatoes, eggplant, tomatillos, eggplant, artichokes, turnips, rutabagas, spaghetti squash, carrots, onions, leeks, water chestnuts (small serving).  This list generally starts with the lower carb items and gradually increases to higher carb grams.  All these have 5 or fewer carbs per serving; most are  much less.

Starchy, Higher-Carb: Beets (6 g, GI 64), winter squashes (acorn, butternut), water chestnuts, parsnips (9 g, GI 97), potatoes (35 g, GI 87), sweet potatoes, (20 g, GI 61), cassava (37 g), taro (21 g), plantains.  Some categorize carrots as starchy.

HERBS & SPICES: Cilantro, parsley, basil, rosemary, thyme, etc.  Salt (minimal), pepper, vinegar.

OILS: Extra virgin olive, canola, flax, avocado.

CONDIMENTS: Olive oil vinaigrettes, mayonnaise from olive oil & egg yolk, and ?

LIQUIDS: H2O, coffee, tea

I’m not counting calories, fat grams, or carb grams.  I’ll eat until full or satisfied, not stuffed.  This is a two-month trial, excluding 24 hours around Thanksgiving.

Steve Parker, M.D.

What Exactly Is the Paleo Diet?

Pure paleo

Let’s be realistic: There’s no way to eat a Stone Age diet these days unless you live off the land, hunting, fishing, and gathering from what’s naturally available in the wild.  Few can do that, although it’s not impossible.  I’m going to specify my version of the paleo diet because I’m starting a paleo diet trial soon—a first for me.

How long has man had fire?  Biological anthropologist Richard Wrangham estimates hominins tamed fire and started cooking with it 1.8 million years ago.  So I’m cooking my paleo foods if I wish.

As with my beloved Mediterranean diet, definitions of the paleo diet vary.  The following guidelines are influenced by my review of blogs or websites by Loren Cordain, Julianne Taylor, Robb Wolf, and Kurt Harris.  The first three are closely affiliated with each other, so expect lots of overlap.  It’s simplest to define paleo by what’s not allowed.

What’s NOT Paleo?

Industrial vegetable oils (e.g., soybean, corn,safflower), legumes, dairy, refined sugars, grains, alcohol, and high salt consumption.

What Is Paleo? 

The focus is on minimally processed, in-season, locally available foods.  Many favor pastured, grass-fed beef, free-range chickens, “organic,” and the like.  I guess that’s fine if you can afford it; I choose to spend my money elsewhere.

Proteins

Meat, fish/seafood, eggs, poultry, and wild game.  Most paleo proponents favor lean meats over fatty ones; it’s debatable. Undoubtedly, our domesticated feedlot animals are fattier than wild game, generally.  Processed meats such as bacon would not be pure paleo, but many paleo advocates allow it.

Nuts and Seeds

Favor those with the best omega-6/omega-3 ratio (2 or 3:1), such as walnuts, almonds, macadamia, and cashews.  Modern humans eat way more omega-6 fatty acids compared to ancient hunter-gatherers.

Fruits and Vegetables

It’s probably best to favor those with lower glycemic index.  Examples are berries, melons, cauliflower, tomatoes, onions, and broccoli.  Most modern fruits and veggies  have been bred for large size and good looks.  Ancient fruits and veggies were smaller and had much more fiber per serving.

Tubers, Roots, Bulbs

These are OK per Cordain, and I agree.  Examples include potatoes, cassava, taro root, onions.  Some paleo proponents exclude potatoes.

Oils

Cordain favors oils such as canola, flax, olive. Others mention avocado oil.  Aim for a good omega-6/omega-3 ratio.  Lard is probably OK although obviously processed.

Herbs and Spices

Many of our favorites should be OK.  Wolf says balsamic vinegar is allowed, although processed, like all vinegars.  Vinegar is “natural,” as you might have noticed if you ever walked through an apple orchard with rotting fruit on the ground; you can smell the vinegar.

Condiments

Undecided.  Note that you can make mayonnaise from olive oil and egg yolk.

Miscellaneous

Olives?  They’re processed, but I’m inclined to keep them in the mix.  Coffee?  Not paleo, but I ain’t givin’ it up.  Consider limiting nuts to one ounce daily since most of them are high in omega-6 fatty acids.  Fresh foods are more purely paleo than canned or frozen, but I’ll not exclude canned and frozen.  Limit fruit?  Probably: in most environments, they’re available only seasonally.  Diet sodas?  Clearly not paleo, but I enjoy one now and then and don’t see any drawbacks to low consumption.

Steve Parker, M.D.

Update October 8, 2012

I learned today that my version of paleo, by coincidence, is similar to the Hartwigs’s Whole30 plan.  But they allow clarified butter or ghee, green beans, and snow peas.  I include potatoes, but Whole30 doesn’t.

Can A Christian Be A Paleo Advocate?

If you’re squeamish about discussions of religion and God, read no further! What follows is controversial and much of it not subject to scientific investigation.

In case you’re wondering, I’m a Christian.  This simply means I believe I was given life by God, that His son Jesus became a man and died for my sins, and that I will have everlasting life in heaven for believing on this.  I strive to live the way God would want me to live, as written in the Holy Bible.  I was brought up in the Catholic faith, even attending parochial school in grades 1-8, but I’m Protestant now.  I went through an agnostic period between the ages of 19 to about 38—I’m glad I made it through that alive!

I’ve been learning more about paleo eating over the last year since it overlaps a fair amount with low-carb eating. (Paleo-style eating is also referred to as ancestral, Old Stone Age, hunter-gatherer, or the caveman diet.) The Paleolithic Era covers about 1.5 to 2 million years of human evolution, admitting that there probably hasn’t been much genetic change over the last 50,000 years (debatable). The cornerstone of paleo eating is that we should eat the things we are evolutionarily adapted to eat. We’ll be healthier that way. We didn’t have corn chips, soda pop, and candy bars 20,000 years ago, so we shouldn’t be eating them now.

Sounds reasonable, doesn’t it? Various species of animals thrive on certain foods and not others. My horses eat three meals a day – all hay; you and I couldn’t survive on that.

I have a college degree in Zoology, so I was thoroughly indoctrinated in Charles Darwin‘s evolutionary theory, at least the version current in the mid-1970s. Darwin’s theory requires no God, or didn’t include a role for God or gods. How Darwinians answer the question of Creation, I don’t know.

Many proponents of evolutionary theory seem to be atheist or agnostic. Natural selection determines who lives or dies, not the hand of God. Some brands of Christianity, but not all, reject the idea of human evolution in its entirety. They believe God created us just as we are about 6,000 years ago. So can a Christian be a paleo diet advocate?

(I don’t know where Judaism, Islam, and other major religions stand on evolution.)

Human evolution is central to paleo diet theory. A religious person may reject the idea of human evolution; can he nevertheless participate in the modern “paleo community”?

I believe God made us and the universe. There’s no proof – it’s a matter of faith. I don’t know if He made us 6,000 years ago or two million.  The bulk of the science speaks clearly against 6,000 years ago.

Our bodies are made to thrive on certain foods and not others.  That’s true for all animals.  If you find an injured bird in your yard and hope to nurse it back to health,  you better find out what it eats naturally and provide it, or you’ll fail.  The range of foods humans can thrive on is pretty broad. Whether the optimal way of eating is determined by godless evolutionary processes or by the intelligent design of a Creator doesn’t matter so much if you’re looking at it from a purely nutritional viewpoint.

From an “everlasting life” viewpoint, it matters.  Big time.

The paleo guys might be right about the best way to eat. Science continues to accumulate evidence one way or the other.

Christianity and paleo diet theory are not mutually exclusive. A Christian can ignore the possiblity of a million years of evolution, believing instead that God made our bodies in such a way that we’d be healthier eating certain foods and not others. Those foods may be the components of the paleo diet, whatever that is.

Steve Parker, M.D.

Further reading:

Carl Drews has written extensively on Christianity and Evolution, including his essay on Theistic Evolution.

Phil Porvaznik’s article on theistic evolution and the Roman Catholic Church.

Wikipedia: Catholic Church and Evolution.

Can a Christian follow a paleo low-carb diet? at Jimmy Moore’s Livin’ La Vida Low-Carb blog.

A few questions for the atheists.  Where did the universe come from?  Was it created? By whom or what?  What if God exists, and he made us for a reason and wants us to live a certain way?

Consider this excerpt from Walter Isaacson’s book, “Einstein: His Life and Universe”:

One evening in Berlin, [Albert] Einstein and his wife were at a dinner party when a guest expressed a belief in astrology. Einstein ridiculed the notion as pure superstition. Another guest stepped in and similarly disparaged religion. Belief in God, he insisted, was likewise a superstition.

At this point the host tried to silence him by invoking the fact that even Einstein harbored religious beliefs.

“It isn’t possible!” the skeptical guest said, turning to ask Einstein if he was, in fact, religious.

“Yes, you can call it that,” Einstein replied calmly. “Try and penetrate with our limited means the secrets of nature and you will find that, behind all the discernible laws and connections, there remains something subtle, intangible and inexplicable. Veneration for this force beyond anything we can comprehend is my religion. To that extent, I am, in fact, religious.”

Random Thoughts On Paleo Eating For People With Diabetes

Not really pertinent, but I like buffalo

I was interviewed  yesterday by Amy Stockwell Mercer, author of Smart Woman’s Guide to Diabetes.  All I knew beforehand was that she was interested in my thoughts on the paleo diet as applied to diabetes.

In preparation, I collected some random thoughts and did a little research.

What’s the paleo diet?

Fresh, minimally processed food.  Meat (lean or not? supermarket vs yuppiefied?), poultry, eggs, fish, leafy greens and other vegetables, nuts, berries, fruit, and probably tubers.

Non-paleo: highly processed, grains, refined sugars, industrial plant/seed oils, legumes, milk, cheese, yogurt, salt, alcohol.

Is the paleo diet deficient in any nutrients?

A quick scan of Loren Cordain’s website found mention of possible calcium and vitamin D deficits.  Paleoistas will get vitamin D via sun exposure and fish (especially cold-water fatty fish).  Obtain calcium from broccoli, kale, sardines, almonds, collards.  (I wonder if the Recommended Dietary Allowance for calcium is set too high.)

What About Carbohydrates and Diabetes and the Paleo Diet?

Diabetes is a disorder of carbohydrate metabolism.  In a way, it’s an intolerance of carbohydrates.  In type 1 diabetes, there’s a total or near-total lack of insulin production on an autoimmune basis.  In type 2 diabetes, the body’s insulin just isn’t working adequately; insulin production can be high, normal or low.  In both cases, ingested carbohydrates can’t be processed in a normal healthy way, so they stack up in the bloodstream as high blood sugars.  If not addressed adequately, high blood glucose levels sooner or later will poison body tissues .  Sooner in type 1, later in type 2.  (Yes, this is a gross over-simplification.) 

Gluten-rich Neolithic food

If you’re intolerant of lactose or gluten, you avoid those.  If you’re intolerant of carbohydrates, you could avoid eating them, or take drugs to help you overcome your intolerance.  Type 1 diabetics must take insulin.  Insulin’s more optional for type 2’s.  We have 11 classes of drugs to treat type 2 diabetes; we don’t know the potential adverse effects of most of these drugs.  Already, three diabetes drugs have been taken off the U.S. market or severely restricted due to unacceptable toxicity: phenformin, troglitazone, and rosiglitazone. 

Humans need two “essential fatty acids” and nine “essential” amino acids derived from proteins.  “Essential” means we can’t be healthy and live long without them.   Our bodies can’t synthesize them.  On the other hand, there are no essential carbohydrates.  Our bodies can make all the carbohydrate (mainly glucose) we need.

Since there are no essential carbohydrates, and we know little about the long-term adverse side effects of many of the diabetes drugs, I favor carbohydrate restriction for people with carbohydrate intolerance.  (To be clear, insulin is safe, indeed life-saving, for those with type 1 diabetes.)

That being said, let’s think about the Standard American Diet (SAD) eaten by an adult.  It provides an average of 2673 calories a day (not accounting for wastage of calories in restaurants; 2250 cals/day is probably a more accurate figure for actual consumption).  Added sugars provide 459 of those calories, or 17% of the total.  Grains provide 625 calories, or 23% of the total.  Most of those sugars and grains are in processed, commercial foods.  So added sugars and grains provide 40% of the total calories in the SAD.  Remember, we need good insulin action to process these carbs, which is a problem for diabetics.  (Figures are from an April 5, 2011, infographic at Civil Eats.)

Anyone going from the SAD to pure Paleo eating will be drastically reducing intake of added sugars and grains, our current major sources of carbohydrate.  Question is, what will they replace those calories with? 

That’s why I gave a thumbnail sketch of the paleo diet above. Take a gander and you’ll see lots of low-carb and no-carb options, along with some carb options. For folks with carbohydrate intolerance, I’d favor lower-carb veggies and judicious amounts of fruits, berries, and higher-carb veggies and

Will these cause bladder cancer? Pancreatitis?

tubers.  “Judicious” depends on the individual, considering factors such as degree of residual insulin production, insulin sensitivity, the need to lose excess weight, and desire to avoid diabetes drugs.

Compared to the standard “diabetic diet” (what’s that?) and the Standard American Diet, switching to paleo should lower the glycemic index and glycemic load of the diet.  theoretically, that should help with blood sugar control.

A well-designed low-carb paleo diet would likely have at least twice as much fiber as the typical American diet, which would also tend to limit high blood sugar excursions.

In general, I favor a carbohydrate-restricted paleo diet for those with diabetes who have already decided to “go paleo.”  I’m not endorsing any paleo diet for anyone with diabetes at this point—I’m still doing my research.  But if you’re going to do it, I’d keep it lower-carb.  It has a lot of potential.

Are There Any Immediate Dangers for a Person With Diabetes Switching to the Paleo Diet?

It depends on three things: 1) current diet, and 2) current drug therapy, and 3) the particular version of paleo diet followed. 

Remember, the Standard American Diet provides 40% of total calories as added sugars and grains (nearly all highly refined).  Switching from SAD to a low-carb paleo diet will cut carb intake  and glycemic load substantially, raising the risk of hypoglycemia if the person is taking certain drugs.

Drugs with potential to cause hypoglycemia include insulin, sulfonylureas, meglitinides, pramlintide, and perhaps thiazolidinediones.

Who knows about carb content of the standard “diabetic diet”?  Contrary to popular belief, there is no monolithic “diabetic diet.”  There is no ADA diet (American Diabetes Association).  My impression, however, is that the ADA favors relatively high carbohydrate consumption, perhaps 45-60% of total calories.  Switching to low-carb paleo could definitely cause hypoglycemia in those taking the aforementioned drugs.

One way to avoid diet-induced hypoglycemia is to reduce the diabetic drug dose.

A type 2 overweight diabetic eating a Standard American Diet—and I know there are many out there—would tend to see lower glucose levels by switching to probably any of the popular paleo diets.  Be ready for hypoglycemia if you take those drugs.

Paleo diets are not necessarily low-carb.  Konner and Eaton estimate that ancestral hunter-gatherers obtained 35 to 40% of total calories from carbohydrates.  I’ve seen other estimates as low as 22%.  Reality likely falls between 22 and 65%.  When pressed for a brief answer as to how many carbohydrate calories are in the paleo diet, I say “about a third of the total.”  By comparison, the typical U.S. diet provides 50% of calories from carbohydrate.

Someone could end up with a high-carb paleo diet easily, by emphasizing tubers (e.g., potatoes), higher-carb vegetables, fruits, berries, and nuts (especially cashews). Compared with the SAD, this could cause higher or lower blood sugars, or no net change.

A diabetic on a Bernstein-style diet or Ketogenic Mediterranean Diet (both very-low-carb) but switching to paleo or low-carb paleo (50-150 g?) would see elevated blood sugars.  Perhaps very high glucoses.

Any person with diabetes making a change in diet should do it in consultation with a personal physician or other qualified healthcare professional familiar with their case.

Steve Parker, M.D.

Fun Facts!

  • A typical carbonated soda contain the equivalent of 10 tsp (50 ml) of sugar.
  • The typical U.S. adult eats 30 tsp  (150 ml) daily of added sweeteners and sugars.
  • U.S total grain product consumption was at record lows in the 1970s, at 138 pounds per person.  By 2000, grain consumption was up by 45%, to 200 pounds per person.
  • Total caloric sweetener consumption (by dry weight) was 110 pounds per person in the  1950s.  By 2000, it was up 39% to 150 pounds.
  • Between 1970 and 2003, consumption of added fats and oils rose by 63%, from 53 to 85 pounds.  [How tasty would that be without starches and sugars?  Not very.]
  • In 2008, “added fat” calories in the U.S. adult diet were 641 (24% of total calories).

Fun Facts provided by the U.S. Department of Agriculture. 

(The paleo diet is also referred to as the Paleolithic, Old Stone Age, Stone Age, Ancestral, Hunter-Gatherer, or Caveman diet.)

Washington Internist Sees Good Results in Diabetics Eating Paleo-Style

Dr. Stephan Guyenet recently interviewed Dr. C. Vicky Beer about her experience with the paleo diet in her patients, diabetic or not.  Dr. Beer commented about people with diabetes specifically:

Every patient I have ever had with diabetes who has adhered to the paleo diet for most of the time has experienced dramatic results.  Every one of them has been able to reduce their blood sugars and reduce their medications significantly, and in some instances, stop their medicine altogether.  This is not unlike other more known popular diets such as South Beach or Zone, which are actually quite similar to the Paleo diet in composition.

Just thought you might like to know.

Steve Parker, M.D.

PS: When I write “paleo diet,” you could substitute Old Stone Age, Stone Age, or caveman diet.

Evidence for Human Grain Consumption 100,000 Years Ago

ScienceDaily December 17 reported findings of a Canadian archeological team who found evidence of systematic grain consumption by ancient humans in Africa:

The consumption of wild cereals among prehistoric hunters and gatherers appears to be far more ancient than previously thought, according to a University of Calgary archaeologist who has found the oldest example of extensive reliance on cereal and root staples in the diet of early Homo sapiens more than 100,000 years ago.

 

Neolithic technology

In case you’re new to the paleo diet, grains are considered verboten by most adherents.  (Paleo diet is also known as the Stone Age diet, caveman diet, and Paleolithic diet.)  The cereal grain mentioned in the ScienceDaily article is wild sorghum.

Many in the paleosphere believe that such ancient humans didn’t have the technical skills to transform wild grains into something edible on a regular basis.  I haven’t read the source material, nor do I have an opinion on whether the archeologists are correct.  I’m just sayin’…

Steve Parker, M.D.

Reference: Mercader, Julio,  et al.  Mozambican grass seed consumption during the Middle Stone Age. Science, December 18, 2009.

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.