[Here’s one for the paleo diet advocates.]
The deviation of man from the state in which he was originally placed by nature seems to have proved to him a prolific source of diseases.
—Edward Jenner (1749-1823), of smallpox vaccination fame
Health care insurance doesn’t mean access to medical care any more than car insurance means you have access to a car.
-WhiteCoat’s Call Room, October 6, 2010
A Paleolithic diet lowered blood sugar levels better than a control diet in coronary heart disease patients with elevated blood sugars, according to Swedish researchers reporting in 2007.
About half of patients with coronary heart disease have abnormal glucose (blood sugar) metabolism. Lindeberg and associates wondered if a Paleolithic diet (aka “Old Stone Age,” “caveman,” or ancestral human diet) would lead to improved blood sugar levels in heart patients, compared to healthy, Mediterranean-style, Western diet.
Methodology
Investigators at the University of Lund found enrolled 38 male heart—average age 61—patients and randomized them to either a paleo diet or a “consensus” (Mediterranean-like) diet to be followed for 12 weeks. Average weight was 94 kg. Nine participants dropped out before completing the study, so results are based on 29 participants. All subjects had either prediabetes or type 2 diabetes (the majority) but none were taking medications to lower blood sugar. Baseline hemoglobin A1c’s were around 4.8%. Average fasting blood sugar was 125 mg/dl (6.9 mmol/l); average sugar two hours after 75 g of oral glucose was 160 mg/dl (8.9 mmol/l).
The paleo diet was based on lean meat, fish, fruits, leafy and cruciferous vegetables, root vegetables (potatoes limited to two or fewer medium-sized per day), eggs, and nuts (no grains, rice, dairy products, salt, or refined fats and sugar).
The Mediterranean-like diet focused on low-fat dairy, whole grains, vegetables, fruits, potatoes, fatty fish, oils and margarines rich in monounsaturated fatty acids and alpha-linolenic acid.
Both groups were allowed up to one glass of wine daily.
No effort was made to restrict total caloric intake with a goal of weight loss.
Results
Absolute carbohydrate consumption was 43% lower in the paleo group (134 g versus 231 g), and 23% lower in terms of total calorie consumption (40% versus 52%). Glycemic load was 47% lower in the paleo group (65 versus 122), mostly reflecting lack of cereal grains.
The paleo group ate significantly more nuts, fruit, and vegetables. The Mediterranean group ate significantly more cereal grains,oil, margarine, and dairy products.
Glucose control improved by 26% in the paleo group compared to 7% in the consensus group. The improvement was statisically significant only in the paleo group. The researchers believe the improvement was independent of energy consumption, glycemic load, and dietary carb/protein/fat percentages.
High fruit consumption inthe paleo group (493 g versus 252 g daily) didn’t seem to impair glucose tolerance.
Hemoglobin A1c’s did not change or differ significantly between the groups.
Neither group showed a change in insulin sensitivity (HOMA-IR method).
Comments
The authors’ bottom line:
In conclusion, we found marked improvement of glucose tolerance in ischemic heart disease patients with increased blood glucose or diabetes after advice to follow a Palaeolithic [sic] diet compared with a healthy Western diet. The larger improvement of glucose tolerance in the Palaeolithic group was independent of energy intake and macronutrient composition, which suggests that avoiding Western foods is more important than counting calories, fat, carbohydrate or protein. The study adds to the notion that healthy diets based on whole-grain cereals and low-fat dairy products are only the second best choice in the prevention and treatment of type 2 diabetes.
This was a small study; I consider it a promising pilot. Results apply to men only, and perhaps only to Swedish men. I have no reason to think they wouldn’t apply to women, too. Who knows about other ethnic groups?
This study and the one I mention below are the only two studies I’ve seen that look at the paleo diet as applied to human diabetics. If you know of others, please mention in the Comments section.
The higher fruit consumption of the paleo group didn’t adversely affect glucose control, which is surprising. Fruit is supposed to raise blood sugar. At 493 grams a day, men in the paleo group ate almost seven times the average fruit intake of Swedish men (75 g/day). Perhaps lack of adverse effect on glucose control here reflects that these diabetics and prediabetics were mild cases early in the course of the condition—diabetes tends to worsen over time.
Present day paleo and low-carb advocates share a degree of simpatico, mostly because of carbohydrate restriction—at least to some degree—by paleo dieters. Both groups favor natural, relatively unprocessed foods. Note that the average American eats 250-300 g of carbohydrates a day. Total carb intake in the paleo group was 134 g (40% of calories) versus 231 g (55% of calories) in the Mediterranean-style diet. Other versions of the paleo diet will yield different numbers, as will individual choices for various fruits and vegetables. Forty percent of total energy consumption from carbs barely qualifies as low-carb.
Study participants were mild, diet-controlled diabetics or prediabetics, not representative of the overall diabetic population, most of whom take drugs for it and have much higher hemoglobin A1c’s.
Lindeberg and associates in 2009 published results of a paleo diet versus standard diabetic diet trial in 13 diabetics. Although a small trial (13 subjects, crossover design), it suggested advantages to the paleo diet in terms of heart disease risk factors and improved hemoglobin A1c. Most participants were on glucose lowering drugs; none were on insulin. Glucose levels were under fairly good control at the outset. Compared to the standard diabetic diet, the Paleo diet yielded lower hemoglobin A1c’s (0.4% lower—absolute difference), lower trigylcerides, lower diastolic blood pressure, lower weight, lower body mass index, lower waist circumference, lower total energy (caloric) intake, and higher HDL cholesterol. Glucose tolerance was the same for both diets. Fasting blood sugars tended to decrease more on the Paleo diet, but did not reach statistical significance (p=0.08).
The paleo diet shows promise as a treatment or preventative for prediabetes and type 2 diabetes. Only time will tell if it’s better than a low-carb Mediterranean diet or other low-carb diets.
Reference: Lindeberg, S., et al. Palaeolithic diet improves glucose tolerance more than a Mediterranean -like diet in individuals with ischemic heart disease. Diabetologia, 50 (2007): 1,795-1,807. doi: 10.1007/s00125-007-0716-y
The Happy Hospitalist has a timely post about the safety of the infamous airport x-ray scanners.
Would you rather be dosed with radiation, have your private parts groped, or not fly at all?
Certainly, by the last decade of the [20th] century, some lessons had plainly been learned. But it was not yet clear whether the underlying evils which had made possible its catastrophic failures and tragedies—the rise of moral relativism, the decline of personal responsibility, the repudiation of Judeo-Christian values, not least the arrogant belief that men and women could solve all the mysteries of the universe by their own intellects—were in the process of being eradicated. On that would depend the chances of the twenty-first century becoming, by contrast, an age of hope for mankind.
-Paul Johnson in Modern Times (1991 revised edition)
Several mainstream media sources recently touted the Mediterranean diet as an effective method for prevention of the expected middle-age weight gain. Reuters is one source, for example. Men on the Mediterranean diet gained 2 lb (about a kilogram) less than other men over six years. Mediterranean-dieting women gained weight too, but a whole 0.77 lb (0.35 kg) less than others.
Big whoop.
The media attention was based on a Spanish study of over 10,000 men and women university graduates over the course of six years. Average baseline age was 38. A Mediterranean diet score was calculated based on a food frequency questionnaire given only at the start of the study. Adherence with a Mediterranean-style diet was judged for each individual as either low, medium, or high.
You’d think this research report would tell you how much weight these folks gained on average over six years, and how many pounds less if one followed the Mediterranean diet. Think again. No such luck, which reminds me of one of my favorite aphorisms: “eschew obfuscation.”
I had to do my own calculations based on Table 3. And I still don’t know how much the average person in this cohort gained over six years.
I am a die-hard Mediterranean diet advocate. It’s linked to myriad health benefits. I’d love to believe it prevents middle-age weight gain. But the results of this study are so modest as to be almost nonexistent.
Reference: Beunza, J., Toledo, E., Hu, F., Bes-Rastrollo, M., Serrano-Martinez, M., Sanchez-Villegas, A., Martinez, J., & Martinez-Gonzalez, M. (2010). Adherence to the Mediterranean diet, long-term weight change, and incident overweight or obesity: the Seguimiento Universidad de Navarra (SUN) cohort American Journal of Clinical Nutrition DOI: 10.3945/ajcn.2010.29764
The higher the consumption of saturated fat, the lower the risk of death from stroke, according to Japanese researchers in a recent American Journal of Clinical Nutrition.
Most physicians in the West would have predicted the opposite: saturated fats increase your risk of stroke. Western physicians tend to think most strokes and heart attacks are caused by the same process, atherosclerosis, and would be aggravated by saturated fat consumption. We’re learning that ain’t necessarily so.
Most strokes in the Western world are thought to be linked to atherosclerosis (hardening of the arteries) of relatively large arteries. In Japan, most strokes not caused by bleeding in the head are actually lacunar infarctions involving small arteries in the brain, not necessarily involving atherosclerosis.
Another major difference between East and West is that saturated fat consumption in Japan is far lower than in the West.
Are you confused yet?
It seems to me that comparing strokes in Japan versus the West is comparing apples to oranges. The take-away point to me is that we have to be quite wary of generalizing the research results applicable to one culture or ethnic group, to others.
Reference: Yamagishi, K., Iso, H., Yatsuya, H., Tanabe, N., Date, C., Kikuchi, S., Yamamoto, A., Inaba, Y., Tamakoshi, A., & , . (2010). Dietary intake of saturated fatty acids and mortality from cardiovascular disease in Japanese: the Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC) Study American Journal of Clinical Nutrition, 92 (4), 759-765 DOI: 10.3945/ajcn.2009.29146
Think of how stupid the average person is, and then realize that half of them are stupider than that.
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