Tag Archives: Stone Age diet

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

Paleobetic Diet Book Now Available

Paleobetic Diet-FrontCover_300dpi_RGB_5.5x8.5

 

 

 

I started this blog four years ago as an exploration of the Paleolithic diet as a therapeutic option in diabetes and prediabetes. Scientific studies from Ryberg (2013), Mellberg (2014), Boers (2014), and Masharani (2015) have convinced me that the paleo diet indeed has true potential to improve these conditions.

A couple years ago I published a bare-bones preliminary version of the Paleobetic Diet. Here’s an outline. I just finished a comprehensive fleshed-out version in book format.

The central idea is to control blood sugars and eliminate or reduce diabetes drugs by working with Nature, not against her. This is the first-ever Paleolithic-style diet created specifically for people with diabetes and prediabetes.

Also known as the caveman, Stone Age, paleo, or ancestral diet, the Paleolithic diet provides the foods our bodies were originally designed to thrive on. You’ll not find the foods that cause modern diseases of civilization, such as concentrated refined sugars and grains, industrial seed oils, and over-processed Franken-foods. Our ancestors just five generations ago wouldn’t recognize many of the everyday foods that are harming us now. On the Paleolithic diet, you’ll enjoy a great variety of food, including nuts and seeds, vegetables, fruit, meat, seafood, and eggs.

In the book you’ll find 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 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.

 

Availability and Formats

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.

If you have diabetes or prediabetes, please give this program careful consideration. Help me spread the word if you know someone else who might benefit. Thank you.

Steve Parker, M.D.

Theoretical Support for the Healthfulness of the Paleo Diet

See modern man walking off that cliff?

See modern man walking off that cliff?

Aren’t people healthier now, thanks to the Agricultural and Industrial Revolutions?

As a marker for health, we can look at life span and longevity. Humans started to see dramatic increases in longevity probably around 30,000 years ago, before the revolutions. Nevertheless, Kuipers, Joordens, and Muskiet note that average life expectancy after the start of the Agricultural Revolution 10,000 years ago fell from about 40 to around 20 years.

Other researchers report that average height in the Nile River Valley at the time of the transition fell by 4 inches (10 cm). The Agricultural Revolution allowed for rapid expansion of human populations through more births, but those folks still didn’t live very long. As before the revolution, infections and high infant/child mortality rates were devastating killers, dragging down average life spans. If you survived childhood, you had a shot at hitting 50 or 60.

At the dawn of the Industrial Revolution, life expectancy at birth was only 35–40 years, even in then-sophisticated cultures like Switzerland. Consider Thomas Jefferson, the principal author of the U.S. Declaration of Independence and the third U.S. president, who lived between 1743 and 1826 (he died on July 4, Independence Day). He and his wife Martha had six children; only two survived to adulthood, and only one past the age of 25. Martha died at age 33. This mortality picture was typical for the times.

Since 1800, life expectancy has doubled in industrialized countries, but it’s mostly due to public health measures and economic prosperity. Other than smallpox vaccination, it wasn’t until the mid-20th century that medical care advances contributed in a major way to longevity.

Overview: Conflict Between Our Paleolithic Genes and Modern Life

A number of diseases or conditions may result from the mismatch of our Paleolithic genes and modern lifestyle. If not caused by the mismatch, they’re aggravated by it. These are the so-called “diseases of civilization”:

  • type 2 diabetes
  • high blood pressure
  • overweigh and obesity
  • dental caries (tooth decay or cavities)
  • osteoporosis
  • fertility problems (polycystic ovary syndrome)
  • pregnancy complications (pre-eclampsia, gestational diabetes)
  • some cancers (colon, breast, prostate)
  • heart disease (such as coronary artery disease)
  • major and postpartum depression
  • autism
  • schizophrenia
  • some neurodegenerative diseases (Parkinsons disease, Alzheimer’s disease)
  • constipation
  • hemorrhoids
  • diverticulosis
"I ate well over 70 grams of fiber daily!"

“I ate well over 70 grams of fiber daily!”

Overweight and Obesity

The Paleolithic diet is lower in total carbohydrate calories compared to the standard American diet: 30-35% versus 50-55% of calories. The higher consumption today, especially of highly processed refined carbohydrates, contributes to overweight and obesity, diabetes, gallbladder disease, heart disease, and possibly dementia. Ian Spreadbury hypothesizes that carbohydrate density of modern foods may be the cause of obesity. Refined sugars and grains—types of acellular carbohydrates—are particularly bad offenders. These acellular carbs may alter our gut microorganisms, leading to systemic inflammation and leptin resistance, etc. Our Paleolithic ancestors had little access to acellular carbohydrates. Here’s how Spreadbury explains acellular: “Tubers, fruits, or functional plant parts such as leaves and stems store their carbohydrates in organelles as part of fiber-walled living cells. These are thought to remain largely intact during cooking, which instead mostly breaks cell-to-cell adhesion. This cellular storage appears to mandate a maximum density of around 23% non-fibrous carbohydrate by mass, the bulk of the cellular weight being made up of water. The acellular carbohydrates of flour, sugar, and processed plant-starch products are considerably more dense. Grains themselves are also highly dense, dry stores of starch designed for rapid macroscopic enzymic mobilization during germination. Whereas foods with living cells will have their low carbohydrate density “locked in” until their cell walls are breached by digestive processes, the chyme produced after consumption of acellular flour and sugar-based foods is thus suggested to have a higher carbohydrate concentration than almost anything the microbiota of the upper GI tract from mouth to small bowel would have encountered during our coevolution.” (Reference: “Comparison with ancestral diets suggests dense acellular carbohydrates promote an inflammatory microbiota, and may be the primary dietary cause of leptin resistance and obesity,” in Diabetes, Metabolic Syndrome, and Obesity: Targets and Therapy. 2012; vol 5: 175–189. doi: 10.2147/DMSO.S33473 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3402009/)

Added sugar provides 17 % of total energy in modern societies, contributing to overweight, obesity, tooth decay, and diabetes. Modern diets provide 15–20% of calories from protein, compared to 25–30% in the Paleolithic diet. To the extent that high protein consumption is satiating, lower consumption may cause over-eating of carbohydrates and fats, then overweight and obesity and all their associated medical conditions.

Heart Disease

I written elsewhere on the blog that the much lower omega-6 to omega-3 fatty acid ratio in the Paleolithic diet. There’s some evidence that today’s high ratio may contribute to systemic inflammation and chronic disease, heart disease in particular. Today’s ratio is quite high due to our consumption of industrial seed oils, such as those derived from soybeans, peanuts, corn, and safflower. And we don’t eat enough cold-water fatty fish, which are major sources of omega-3 fatty acids. Two long-chain polyunsaturated fatty acids, EPA and DHA, are essential fatty acids. That means our bodies cannot make them. We have to get them from diet. DHA and EPA are also cardioprotective omega-3 fatty acids.

High Blood Pressure

Most modern diets have much more sodium and much less potassium than the Paleolithic diet, perhaps contributing to high blood pressure, which in turn contributes to heart attacks, strokes, and possibly premature death. The higher magnesium content of the paleo diet may also help prevent high blood pressure.

Gastrointestinal Problems

We eat much less fiber these days, contributing to constipation, hemorrhoids, and diverticulosis. Some experts believe low fiber consumption adversely effects development of palate bones, jaws, and tooth placement.

Osteoporosis

Our lower vitamin D levels these days may cause osteoporosis (thin fragile bones) and raise the risk of diabetes and cancer. Our prehistoric ancestors spent more time in the sun, allowing their bodies to make vitamin D.

Type 2 Diabetes

Robert Lustig and associates looked at sugar consumption and diabetes rates in 175 countries and found a strong link between sugar and type 2 diabetes. It’s not proof of causation, just suggestive. From the scientific article abstract: “Duration and degree of sugar exposure correlated significantly with diabetes prevalence in a dose-dependent manner, while declines in sugar exposure correlated with significant subsequent declines in diabetes rates independently of other socioeconomic, dietary and obesity prevalence changes. Differences in sugar availability statistically explain variations in diabetes prevalence rates at a population level that are not explained by physical activity, overweight or obesity.” (Reference: Basu S, Yoffe P, Hills N, Lustig RH (2013) The Relationship of Sugar to Population-Level Diabetes Prevalence: An Econometric Analysis of Repeated Cross-Sectional Data. PLoS ONE 8(2): e57873. doi:10.1371/journal.pone.0057873)

A major diet change from Stone Age to modern diets is a reduction in magnesium consumption. This could be one reason type 2 diabetes is a problem today. A 2013 article at Diabetes Care suggests that higher magnesium consumption in modern populations may protect against type 2 diabetes (Reference: http://care.diabetesjournals.org/content/early/2013/09/23/dc13-1397.abstract.html?papetoc).

Dental Problems

Dentist John Sorrentino wrote at his blog in 2012: “The truth is that tooth decay is a relatively new phenomenon. Until the rise of agriculture roughly 10,000 years ago, THERE WAS NO TOOTH DECAY IN HUMANS. Let that sink in for a moment. Humanity is 2,500,000 years old. For the first 2,490,000 years no one ever had a cavity. If we understand that tooth decay started when people started farming instead of hunting and gathering for a living clearly you realize that tooth decay is a disease or mismatch between what you are eating and what your body expects you to eat. If we examine the past as prologue it becomes clear that the path to proper health starts in the mouth and the answers are so simple that not only did a Cave Man do it. They perfected it.” (Reference: http://www.sorrentinodental.com/blog.html?entry=why-teeth-decay-i)

To be fair and balanced, a research report from 2014 found a very high incidence of caries (cavities) in a Stone Age population living in what is now Morocco. The authors attributed the cavities to heavy consumption of acorns, which are rich in carbohydrates and sticky, to boot.

Orthodontist Mike Mew, BDS, MSc, made a presentation at the 2012 Ancestral Health Symposium titled “Craniofacial Dystrophy—Modern Melting Faces.” Dr. Mew says 30% of folks in Western populations have crooked teeth and/or malocclusion, and the mainstream orthodontic community doesn’t know why. But they’ve got expensive treatment for it! Dr. Mew thinks he knows the cause and he shared it at the symposium. The simple cure is “Teeth together. Lips together. Tongue on the roof of your mouth.” And eat hard food that requires lots of chewing, like our ancestors did, ideally in childhood before age 9. Older people also benefit, he says.

NPR (National Public Radio) in February, 2013, ran an article called “Ancient Choppers Were Healthier Than Ours,” by Audrey Carlsen. An excerpt: “Hunter-gatherers had really good teeth,” says Alan Cooper, director of the Australian Centre for Ancient DNA. “[But] as soon as you get to farming populations, you see this massive change. Huge amounts of gum disease. And cavities start cropping up.” And thousands of years later, we’re still waging, and often losing, our war against oral disease. Our changing diets are largely to blame. In a study published in the Nature Genetics, Cooper and his research team looked at calcified plaque on ancient teeth from 34 prehistoric human skeletons. What they found was that as our diets changed over time — shifting from meat, vegetables and nuts to carbohydrates and sugar — so too did the composition of bacteria in our mouths. Not all oral bacteria are bad. In fact, many of these microbes help us by protecting against more dangerous pathogens. (Reference: http://www.npr.org/blogs/health/2013/02/24/172688806/ancient-chompers-were-healthier-than-ours)

Dentist Mark Burhenne wrote the following at Huffington Post – Canada: “It is generally well accepted that tooth decay, in the modern sense, is a relatively new phenomena. Until the rise of agriculture roughly 10,000 years ago, there was nearly no tooth decay in the human race. Cavities became endemic in the 17th century but became an epidemic in the middle of the 20th century (1950). If we understand that tooth decay started when people started farming, rather than hunting and gathering, it’s clear that tooth decay is the result of a mismatch between what we’re eating and what our bodies are expecting us to eat based on how they evolved….The recent changes in our lifestyle create a “mismatch” for the mouth, which evolved under vastly different environments than what our mouths are exposed to these days. Our mouths evolved to be chewing tough meats and fibrous vegetables. Sugar laden fruit was a rare and special treat for our paleolithic ancestors. Now, our diets are filled with heavily processed foods that take hardly any energy to chew — smoothies, coffees, and sodas high in sugar, white bread, and crackers to name just a few.” (Reference: http://www.huffingtonpost.ca/mark-burhenne/paleo-diet-oral-health_b_4041350.html)

Shrinking Brains

Since the end of the Stone Age, human brain size has been shrinking. That’s not good, is it? Anthropologist John Hawks has noted that over the past 20,000 years, the average volume of the human male brain has decreased from 1,500 cubic centimeters to 1,350 cc, losing a chunk the size of a lemon. The female brain has shrunk proportionately. Anthropologists don’t know why. Is it modern nutrition? The experts aren’t sure what it means for our future. As for me, I think the answer is in Mike Judge’s movie, “Idiocracy.”

His brain was bigger than yours

His brain was bigger than yours

Death By Sugar

Sugar-sweetened beverages kill almost 200,000 worldwide annually, according to a Gitanjali Singh, Ph.D., a postdoctoral research fellow at the Harvard School of Public Health. How could that be? Sugar-sweetened beverages contribute to obesity, which in turn leads to diabetes, cardiovascular disease, and some cancers. (Reference: Singh, GM, et al “Mortality due to sugar-sweetened beverage consumption: A global, regional, and national comparative risk assessment,” American Heart Association Epidemiology and Prevention/Nutrition, Physical Activity and Metabolism 2013 Scientific Sessions, Abstract EPI-13-A-879-AHA.) Reducing consumption of sugar-sweetened beverages was one of the major points in the American Heart Association’s 2010 guidelines for reducing heart disease.

Elderly Cognitive Impairment

Diets high in sugar and other carbohydrates raise the risk of elderly cognitive impairment, according to recent research by the Mayo Clinic. Mild cognitive impairment is often a precursor to incurable dementia. (Most authorities think dementia develops more often in people with diabetes, although some studies refute the linkage.) Researchers followed 940 patients with normal baseline cognitive functioning over the course of four years. Diet was assessed via questionnaire. Study participants were ages 70 to 89. As the years passed, 200 of them developed mild cognitive impairment. Compared with those eating the lowest amount of sugar, those eating the most sugar were 1.5 times more likely to develop cognitive impairment. Looking at total carbohydrate consumption, those eating at the highest levels of carbohydrate consumption were almost twice as likely to develop mild cognitive impairment. The scientists note that those eating lower on the carbohydrate continuum were eating more fats and proteins. (Reference: Mayo Clinic website, published October 16, 2012 http://www.mayoclinic.org/news2012-rst/7128.html)

Is a Paleolithic-Style Diet the Healthiest Way to Eat?

Certified paleo-compliant, plus high omega-3 fatty acids

Certified paleo-compliant, plus high omega-3 fatty acids

The jury’s still out on that one! My strong sense is that it’s definitely more healthful than the Standard American Diet. Maybe the traditional Mediterranean diet or DASH diet is even healthier. Don’t hold your breath waiting for the randomized controlled trials that would answer the question definitively.

If the paleo diet is the healthiest, which version is best? That’s a question for another day (or year).

The most healthful diet for you depends on your genetic make-up and any medical conditions you have.

Steve Parker, M.D.

Short-Term Paleo Diet Improves Glucose Control in Obese Type 2 Diabetes (the Masharani Study)

UCSF is here

UCSF is here

A three-week Paleolithic-style diet improved blood sugars and lipids in obese type 2 diabetics, according to researchers at the University of California—San Francisco. This is the Lynda Frassetto study I’ve been waiting over a year for. The first named author is U. Masharani, so I’ll refer to this work in the future as the Masharani study. Sorry, Lynda.

To understand the impact of this study, you need to know about a blood test called fructosamine, which reflects blood sugar levels over the preceding 2–3 weeks. You may already be familiar with a blood test called hemoglobin A1c: it tells us about blood sugars over the preceding three months. Blood glucose binds to proteins in our blood in a process called glycation. The higher the blood glucose, the more bonding. Glucose bound to hemoglobin molecules is measured in HgbA1c. Glucose bound to plasma proteins (predominantly albumin) is measured as fructosamine. It probably has nothing to do with fructose. Fructosamine is a generic name for plasma ketoamines.

If you’re doing a diabetic diet study over over 2–3 weeks, as in the report at hand, changes in glucose control will mostly be detected in fructosamine rather than HgbA1c levels.

How Was the Research Done?

Twenty-five obese diabetics in the San Francisco Bay area were randomly assigned to either a paleo-style diet or one based on American Diabetes Association (ADA) guidelines. They followed the diets for three weeks, with various measurements taken before and after intervention.

Participants were aged 50-69; you have to guess the sex breakdown. Average body mass index was 34. Over half (63%) were White/European American; there were three each of Asian, African American, and Hispanic ethnicity. They had normal blood pressures and diabetes was well controlled, with hemoglobin A1c’s around 7% and fructosamine levels close to normal. Four subjects were on no diabetes medications; 14 were taking metformin alone, five were on metformin and a sulfonylurea, one was on long-acting insulin and a sulfonylurea. No drug dosages were changed during the study.

Both intervention diets were designed for weight maintenance, i.e., avoidance of weight loss or gain. If participants lost weight, they were instructed to eat more. All food was prepared and provided for the participants. Three meals and three snacks were provided for daily consumption.

Fourteen subjects completed the paleo diet intervention. They ate lean meats, fruits, vegetables, tree nuts, poultry, eggs, canola oil, mayonnaise, and honey. No added salt. No cereal grains, dairy, legumes, or potatoes. Calorie percentages from protein, fat, and carbohydrate were 18%, 27%, and 58%, respectively. Compared to the ADA diet, the paleo diet was significantly lower in saturated fat, calcium, and sodium (under half as much), while higher in potassium (twice as much). These dieters eased into the full paleo diet over the first week, allowing bodies to adjust to higher fiber and potassium consumption. The paleo diet had about 40 grams of fiber, over twice as much as the ADA diet.

[I wonder why they chose canola over other oils.]

Ten subjects completed the ADA diet, which included moderate salt, low-fat dairy, whole grains, rice, bread, legumes, and pasta. Calorie percentages from protein, fat, and carbohydrate were 20%, 29%, and 54%, respectively (very similar to the paleo diet). I don’t have any additional description for you. I assume it included meat, poultry, eggs, and fruit.

Diet compliance was confirmed via urine measurements of sodium, potassium, pH, and calcium.

What Did the Researchers Find?

Both groups on average lost about 2 kg (4-5 lb).

Compared to their baseline values, the paleo group saw reductions in total cholesterol, HDL cholesterol, LDL cholesterol, HgbA1c (down 0.3% absolute reduction), and fructosamine. Fructosamine fell from 294 to 260 micromole/L. [The normal non-diabetic range for fructosamine is 190-270 micromole/L.]

Compared to their baseline values, the ADA diet group saw reductions in HDL cholesterol and HgbA1c (down 0.2% absolute reduction) but no change in fructosamine, total cholesterol, and LDL cholesterol.

Comparing the groups to each other, the difference in fructosamine change was right on the cusp of statistical significance at p = 0.06.

Within each group, insulin resistance trended down, but didn’t reach statistical significance. However, when they looked at the folks who were the most insulin resistant, only the paleo dieters improved their resistance. By the way, insulin resistance was measure via euglycemic hyperinsulinemic clamp instead of the short-cut HOMA-IR method.

Blood pressures didn’t change.

The authors don’t mention hypoglycemia at all, nor alcohol consumption.

They note that some of the paleo dieters complained about the volume of food they had to eat.

Errata

I found what I think are a couple misprints. Table 1 has incorrect numbers for the amount of sodium and potassium in the ADA diet. See the text for correct values. Table 2 give fructosamine values in mg/dl; they should be micromoles/L.

Final Thoughts

This particular version of the paleo diet indeed seems to have potential to help control diabetes in obese type 2’s, perhaps even better than an ADA diet, and despite the high carb content. Obviously, it’s a very small study and I’d like to see it tested in a larger population for several months, and in type 1 diabetics. But it will be years, if ever, before we see those research results. Diabetics alive today have to decide what they’ll eat tomorrow.

I wish the researchers had explained why they chose their paleo diet macronutrient breakdown: calorie percentages from protein, fat, and carbohydrate were 18%, 27%, and 58%, respectively. Perhaps they were trying to match the ratios of the ADA diet. But from what I’ve read, the average ancestral paleo diet carbohydrate energy percentage is 30-35%, not close to 60%. My experience is that reducing carb calorie consumption to 30% or less helps even more with glucose control. Reducing carbs that low in this study would have necessitated diabetes drug adjustments and increased the risk of hypoglycemia.

The authors wonder if the high fiber content of the paleo diet drove the lowered glucose levels.

High HDL cholesterol is thought to be protective against coronary artery disease and other types of atherosclerosis. Both diet groups here saw reductions in HDL. That’s something to keep an eye on.

The ADA diet group saw a drop in HgbA1c but not fructosamine. I can’t explain how HgbA1c goes down over three weeks without a change in fructosamine level.

You have to wonder if the paleo diet results would have been more impressive if the test subjects at baseline had been sicker, with poorly controlled blood pressures and HgbA1c’s of 9% or higher. And it sounds like some of these folks would have lost weight if not forced to eat more. The paleo diet is more satiating than some.

The article was well-written and a pleasure to read, in contrast to some I’ve suffered through recently.

Steve Parker, M.D.

Reference: Masharani, U., et al. Metabolic and physiologic effects from consuming a hunter-gatherer (Paleolithic)-type diet in type 2 diabetes. European Journal of Clinical Nutrition, advance online April 1, 2015. doi: 10.1038/ejcn.2015.39

Was It the Paleo Diet or Acorns or ? That Rotted These Teeth?

“Basically, nearly everybody in the population had caries,” or tooth decay, says Louise Humphrey, a paleo-anthropologist with the Natural History Museum in London.

Humphrey says 94 percent of the more than 50 people from the cave she studied had serious tooth decay. “I was quite surprised by that,” says Humphrey. “I haven’t seen that extent of caries in other ancient populations.”

Certainly, life was brutal and short for Stone Age folks, what with saber tooth cats, parasites, and not an aspirin to be found anywhere. But at least the paleo diet — meat, tubers, berries, maybe some primitive vegetables and very few carbs— was supposed to be good for the teeth. Carbohydrates can turn sugary in your mouth, then bacteria turn that into enamel-eating acid.

But apparently, these ancient people had a thing for acorns.

“Acorns,” says Humphrey, “are high in carbohydrates. They also have quite a sticky texture. So they would have adhered easily to the teeth.”

Read the whole thing.

Click to see the study abstract.

h/t Melissa McEwen

Free Online Paleo Recipes

Sirloin steak, salad, cantaloupe, 3 raspberries

Sirloin steak, salad, cantaloupe, raspberries (on the Paleobetic Diet)

Or paleo-ish anyway.

Most diabetics eating paleo-style need to know how may grams of digestible carbohydrate they’re eating. Their blood sugars will go too high if they eat too many carbs. “Too many” varies from one person to another. Additional nutrient numbers are just icing on the cake. (Oops! Not a good metaphor for a Stone Age diet website.) Other than this site, I’ve only found three other sites that divulge basic nutritional analysis of their free recipes. Several sites listed are primarily low-carb, so you have to see if the recipe you’re interested in fits your definition of paleo.

Before you go, I just want you to consider financially supporting the owners and writers at the following sites. Many of them have books or services for sale. Some have a Donate button. If they can’t bring home the bacon, the websites go down and the recipes go bye-bye.

Recipes With Nutritional Analysis

Catalyst Athletics

Linda’s Low-Carb Recipes

Hold the Toast (I bet Dana Carpender’s “500 Paleo Recipes” book provides basic nutrient analysis.)

Paleo Diabetic

More Recipes (You can do your own nutritional analysis at places like Fitday.)

The Clothes Make the Girl

NomNom Paleo

The Paleo Diet

Julianne’s Paleo & Zone Nutrition (see drop-down menu under Paleo Links, Recipes, and Meals tab)

Everyday Paleo (see drop-down menu under Food tab)

Paleo Food

Paleo Plan

Stalkerville

Perfect Health Diet

Diabetes Warrior

Whole Life Eating

Nell Stephenson

Paleo Diet Lifestyle

Happy hunting!

Steve Parker, M.D.

My Critique of the Joslin Critique of the Paleo Diet

paleo diet, Paleolithic diet, hunter-gatherer diet

Huaorani hunter in Ecuador

The Joslin Diabetes Blog yesterday reviewed the paleo diet as applied to both diabetes and the general public.  They weren’t very favorably impressed with it.  But in view of Joslin’s great reputation, we need to give serious consideration to their ideas.  (I don’t know who wrote the review other than “Joslin Communications.”)

These are the main criticisms:

  • diets omitting grains and dairy are deficient in calcium and possibly B vitamins
  • you could eat too much total and saturated fat, leading to insulin resistance (whether type 1 or 2 diabetes) and heart disease
  • it’s not very practical, partly because it goes against the grain of modern Western cultures
  • it may be expensive (citing the cost of meat, and I’d mention fresh fruit and vegetables, too)

Their conclusion:

There are certainly better diets out there, but if you are going to follow this one, do yourself a favor, take a calcium supplement and meet with a registered dietitian who is also a certified diabetes educator  to make sure it is nutritionally complete, isn’t raising your lipids and doesn’t cause you any low blood glucose incidences.

Expense and Practicality

These take a back seat to the health issues in my view.  Diabetes itself is expensive and impractical.  Expense and practicality are highly variable, idiosyncratic matters to be pondered and decided by the individual.  If there are real health benefits to the paleo diet, many folks will find work-arounds for any expense and impracticality.  If the paleo diet  allows use of fewer drugs and helps avoid medical complications, you save money in health care costs that you can put into food.  Not to mention quality of life issues (but I just did).

Calcium and B Vitamin Deficiencies

This is the first I’ve heard of possible B vitamin deficiencies on the paleo diet.  Perhaps I’m not as well-read as I thought.  I’ll keep my eyes open for confirmation.

The potential calcium deficiency, I’ve heard of before.  I’m still open-minded on it.  I am starting to wonder if we need as much dietary calcium as the experts tell us.  The main question is whether inadequate calcium intake causes osteoporosis, the bone-thinning condition linked to broken hips and wrists in old ladies.  This is a major problem for Western societies.  Nature hasn’t exerted much selection pressure against osteoporosis because we don’t see most of the fractures until after age 70.  I wouldn’t be surprised if we eventually find that life-long exercise and adequate vitamin D levels are much more important that calcium consumption.

With regards to calcium supplementation, you’ll find several recent scientific references questioning it.  For example, see this, and this, and this, and this, and this.  If you bother to click through and read the articles, you may well conclude there’s no good evidence for calcium supplementation for the general population.  If you’re not going to supplement, would high intake from foods be even more important?  Maybe so, maybe not.  I’m don’t know.

If you check, most of the professional osteoporosis organizations are going to recommend calcium supplements for postmenopausal women, unless dietary calcium intake is fairly high.

If I were a women wanting to avoid osteoporosis, I’d do regular life-long exercise that stressed my bones (weight-bearing and resistance training) and be sure I had adequate vitamin D levels.  And men, you’re not immune to osteoporosis, just less likely to suffer from it.

Insulin Resistance

Insulin resistance from a relatively high-fat diet is theoretically possible.  In reality, it’s not common.  I’ve read plenty of low-carb high-fat diet research reports in people with type 2 diabetes.  Insulin levels and blood glucose levels go down, on average.  That’s not what you’d see with new insulin resistance.  One caveat, however, is that these are nearly all short-term studies, 6-12 weeks long.

If you have diabetes and develop insulin resistance on a high-fat diet, you will see higher blood sugar levels and the need for higher insulin drug doses.  Watch for that if you try the paleo diet.

Are High Total and Saturated Fat Bad?

Regarding relatively high consumption of total and saturated fat as a cause of heart or other vascular disease: I don’t believe that any more.  Click to see why.  If you worry about that issue, choose meats that are leaner (lower in fat) and eat smaller portions.  You could also look at your protein foods—beef, chicken, fish, eggs, offal, etc.—and choose items lower in total and saturated fat.  Consult a dietitian or online resource.  Protein deficiency is rarely, if ever, a problem on paleo diets.

In Conclusion

I think the paleo diet has more healthful potential than realized by the Joslin blogger(s).  I’m sure they’d agree we need more clinical studies of it, involving both type 1 and 2 diabetics.  I appreciate the “heads up” regarding potential vitamin B deficiencies.  My sense is that the Joslin folks are willing to reassess their position based on scientific studies.

I bet some of our paleo-friendly registered dietitians have addressed the potential adverse health issues of the paleo diet.  Try Amy KubalFranziska Spritzler (more low-carb than paleo) or Aglaée Jacob.  I assume the leading paleo diet book authors have done it also.

If you’re worried about adverse blood lipid changes on the paleo diet, get them tested before you start, then after two months of dieting.

Steve Parker, M.D.

PS: The paleo diet is also referred to as the Stone Age diet, caveman diet, Paleolithic diet, hunter-gatherer diet, and ancestral diet.

Low-Carb Research Update

Grain-based high-carb Neolithic food

Grain-based high-carb Neolithic food

The paleo diet averages about 30% of total calories from carbohydrates, with a range of about 22 to 40%.  That 30% average is much lower than the standard 50–60% in the developed world.  Is that lower percentage healthy or not?  It depends on the quality of the carbs and the remainder of the diet.  It most certainly can be healthy.

As much as possible, I base my nutrition and medical recommendations on science-based research published in the medical literature.  In the early 2000s, a flurry of scientific reports demonstrated that very-low-carb eating (as in the style of Dr. Robert Atkins) was safe and effective for short-term weight management and control of diabetes.  Eighty hours of literature review in 2009 allowed me to embrace low-carbohydrate eating as a logical and viable option for many of my patients. The evidence convinced me that the relatively high fat content of many low-carb diets was nothing to worry about long-term.

I’d like to share with you some of the pertinent low-carb research findings of the last few years.

Low-Carb Diets

  • Low-carb diets reduce weight, reduce blood pressure, lower triglyceride levels (a healtlhy move), and raise HDL cholesterol (another good trend).  These improvements should help reduce your risk of heart disease.  (In the journal Obesity Reviews, 2012.)
  • Dietary fat, including saturated fat, is not a cause of vascular disease such as heart attacks and atherosclerosis (hardening of the arteries).  (Multiple research reports.)
  • If you’re overweight and replace two sugary drinks a day with diet soda or water, you’ll lose about four pounds over the next six months.  (American Journal of Clinical Nutrition, 2012.)
  • United States citizens obtain 40% of total calories from grains and added sugars.  Most developed countries are similar.  Dr. Stephan Guyenet notes that U.S. sugar consumption increased steadily “…from 6.3 pounds [2.9 kg] per person per year in 1822 to 107.7 pounds [50 kg] per person in 1999.  Wrap your brain around this: in 1822 we ate the amount of added sugar in one 12-ounce can of soda every five days, while today we eat that much sugar every seven hours.”
  • A very-low-carb diet improves the memory of those with age-related mild cognitive impairment. Mild cognitive impairment is a precursor to dementia.  (University of Cincinnati, 2012.)
  • High-carbohydrate and sugar-rich diets greatly raise the risk of mild cognitive impairment in the elderly. (Mayo Clinic study published in the Journal of Alzheimers’ Disease, 2012.)
  • Compared to obese low-fat dieters, low-carb dieters lose twice as much fat weight.  (University of Cincinnati, 2011.)
  • Diets low in sugar and refined starches are linked to lower risk of age-related macular degeneration in women.  Macular degeneration is a major cause of blindness.  (University of Wisconsin, 2011.)
  • A ketogenic (very-low-carb) Mediterranean diet cures metabolic syndrome (Journal of Medicinal Food, 2011.)
  • For type 2 diabetics, replacing a daily muffin (high-carb) with two ounces (60 g) of nuts (low-carb) improves blood sugar control and reduces LDL cholesterol (the “bad” cholesterol). (Diabetes Care, 2011.)
  • For those afflicted with fatty liver, a low-carb diet beats a low-fat diet for management. (American Journal of Clinical Nutrition, 2011.)
  • For weight loss, the American Diabetes Association has endorsed low-carb (under 130 g/day) and Mediterranean diets, for use up to two years. (Diabetes Care, 2011.)
  • High-carbohydrate eating doubles the risk of heart disease (coronary artery disease) in women.  (Archives of Internal Medicine, 2010.)
  • One criticism of low-carb diets is that they may be high in protein, which in turn may cause bone thinning (osteoporosis).  A 2010 study shows this is not a problem, at least in women.  Men were not studied.  (American Journal of Clinical Nutrition.)
  • High-carbohydrate eating increases the risk of developing type 2 diabetes (American Journal of Clinical Nutrition, 2010.)
  • Obesity in U.S. children tripled from 1980 to 2000, rising to 17% of all children.  A low-carb, high-protein diet is safe and effective for obese adolescents.  (American Journal of Clinical Nutrition, 2010.

Steve Parker, M.D.

PS:  The paleo diet is also referred to as the caveman diet, Paleolithic diet, hunter-gatherer diet, Stone Age diet, and ancestral 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