Over the weekend I spent some time looking at the evidence in the area of ‘primal’ or ‘Paleolithic’ eating. I was aware, I think, of much of the evidence in this area (and I’ve even reported on relevant studies here and here), but it seems I missed a quite-important study that I am going to report here.
The study, published in 2009 in the journal Cardiovascular Diabetology [1]. In this study, 13 men and women with type 2 diabetes ate, on separate occasions, two different diets, each for three months. One diet was a typical ‘diabetes diet’, rich in carbobydrate. The other was a ‘primal’ or “Paleolithic’ diet based on foodstuff resembling those that humans ate prior to the introduction of agriculture and animal husbandry some 10,000 years ago. Here are the details of these diets:
Diabetes Diet
The information on the Diabetes diet stated that it should aim at evenly distributed meals with increased intake of vegetables, root vegetables, dietary fiber, whole-grain bread and other whole-grain cereal products, fruits and berries, and decreased intake of total fat with more unsaturated fat. The majority of dietary energy should come from carbohydrates from foods naturally rich in carbohydrate and dietary fiber. The concepts of glycemic index and varied meals through meal planning by the Plate Model were explained. Salt intake was recommended to be kept below 6 g per day.
Paleolithic Diet
The information on the Paleolithic diet stated that it should be based on lean meat, fish, fruit, leafy and cruciferous vegetables, root vegetables, eggs and nuts, while excluding dairy products, cereal grains, beans, refined fats, sugar, candy, soft drinks, beer and extra addition of salt. The following items were recommended in limited amounts for the Paleolithic diet: eggs (≤2 per day), nuts (preferentially walnuts), dried fruit, potatoes (≤1 medium-sized per day), rapeseed or olive oil (≤1 tablespoon per day), wine (≤1 glass per day). The intake of other foods was not restricted and no advice was given with regard to proportions of food categories (e.g. animal versus plant foods). The evolutionary rationale for a Paleolithic diet and potential benefits were explained.
Compared to the diabetes diet, the Paleolithic diet led to individuals eating an average of about 300 calories less each day. This likely reflects the ability of primal, lower-carb diets to sate the appetite more effectively than ‘healthy’ diets richer in carbohydrate. For more on this, see this recent post.
Overall, the Paleolithic diet brought improvements in a range of health measures and markers compared to the diabetes diet. Specifically:
- An additional 3 kg reduction in weight
- A reduction in triglyceride levels (high levels of triglyceride are linked with increased risk of cardiovascular disease)
- Reduced diastolic blood pressure (the lower of the two blood pressure readings)
- 4 cm reduction in waist circumference
- Lower levels of HbA1c (measure of blood sugar control over the preceding 3 months or so)
- Increased levels of HDL cholesterol (the form of cholesterol associated with reduced risk of cardiovascular disease)
In other words, the Paleolithic diet, compared to standard diatetic advice for diabetes, led to significant improvements in markers for diabetes and cardiovascular disease.
Some of these benefits might be related to the fact that, on the ‘Paleo’ diet, individuals ate less. But ate less of what? Daily consumption (in grams) of protein, carbohydrate and fat in the paleo diet and carbohydrate diet were:
Protein: 94 and 90
Carbohydrate: 125 and 196
Fat: 68 and 72
In other words, the Paleo diet contained a little more protein and a little less fat, but the major difference was a lot less carbohydrate.
There is a common notion that when individuals go ‘low-carb’, they end up eating a tonne of protein and fat. This study actually reflects what tends to happen in reality: individuals don’t end up doing that at all, they just eat less carbohydrate. And the typical results of this are, in this study, here for all to see.
References:
1. Jönsson T, et al. Beneficial effects of a Paleolithic diet on cardiovascular risk factors in type 2 diabetes: a randomized cross-over pilot study. Cardiovasc Diabetol. 2009;8:35.
That’s a very interesting study, haven’t seen it before.
I’m not surprised that the paleolithic diet had better results, in fact I think it is absolutely ridiculous that diabetics are actually advised to eat a high-carb diet.
The little biochemistry I’ve done in med school makes me fully capable of understanding how much madness it is to recommend high-carb for diabetics. It just doesn’t make any sense.
See also using the produce ELEOTIN to help reverse diabetes. It has shown great promise.
It is interesting to note that, until the 1970s, the typical diabetes diet was far from rich in carbohydrate. A member of my family was diagnosed type 2 diabetic in the 1960s, and the diet recommended was high fat, low carb, allowing one potato “no larger than a hen’s egg” per day. In the 70s the diet was changed to a low fat, high carb, restricted calorie diet, and the patient complied but complained of feeling hungry all the time. You have to ask what was the medical science justification for the about-face on a diet which had been used for the previous hundred years.
Hi, thanks for sharing, this supports what has happened with me. I was heading towards 17st morbidly obese, with pcos and subclincal hypothyroid. At the start of this year I started eating eggs in the morning, protein and leafy salad for lunch and fish or meat with veg for dinner, periodically I would have some extra carbs like rice, the difference in my weight, skin, energy and mood levels is amazing – I have lost 3st no energy slumps and feel much better, when I went back to eating the way I used to a couple of weeks ago to test how it made me feel, I was very tired, exhausted, had aches and pains, I only put on a few lbs but generally felt rubbish it amazes me how we are programmed to believe that a diet high in carbs is better, following this routine of eating is the only thing that has ever worked for me, traditional diets such as WW I seldom lose anything and end up getting very frustrated. My blood tests are good and my thyroid is now functioning normally.
I think you also need to udernline that it is a short term study and also they used hypocaloric approach (under 2000 kcal/d). I assume be4 those ppl ate far more than 2000 kcal/d. ALso very few studies looked at the long term effect on low carb high fat and protein diet.
I just read through the whole study and I think this study is a joke. First of all if you look at the figure, ppl on paleo diet were on 1580 kcal/d (if they not cheated as it is a common case), whilst on diebtic diet they ate 1878 kcal/ (300 kcal more so no wonder they loss more weigh on paleo diet. In addition at the baseline paleo group had a number of lower biomarkers, eg, weight, waist etc.
if you look at the basic macronutrient, fat and protein (average) was almost the same in both groups, except that diabetes diet group ate 70 g more carb. Which added those extra 300 kcal/d.
As I said I am very doubtfull if most ppl would sustain for a long time on 1580 kcal/d, and sooner or later they start binging, one junk food, like sweets , bread., chocolate, etc. And regain all the weight and more.
Andy
No limits were put on caloric intake. The ‘paleo’ diet led to about 300 calories less eaten a day than on the diabetes diet. Why? Probably because a paleo diet is more satisfying right? It’s amazing how dismissive some people are of this effect, but actually, it’s probably a major reason why this sort of diet ‘works’ for improved weight loss and health.
As regards the ‘short-term’ nature of the study, what evidence do you have the altnerative diets (e.g. low-fat/high-carb diet) are effective for weight loss or improved health, or that paleo diets are hazardous?
Your thoughts about resultant bingeing are, in my experience, way off the mark. I don’t see this at all in practice. I suspect neither would you if you had enough experience in the area.
When I was diagnosed with type 2 diabetes in the late 50s at the age of 15 (and thin as a rake) the regime I followed was really strict. It was low carb – everything was weighed, even the majority of fruits and vegetables. Meat, fish, eggs, dairy (but not milk) and some vegetables were unlimted.
It seems barmy to me that a body which can’t cope with carbohydrate is loaded up with it. For me it’s always gone against the grain (and against common sense) to eat a lot of carbs so I don’t, though I don’t weigh food anymore
Robbo, for a great book about why the medical establishment is so keen on low fat high carb advice, Gary Taubes new book Why We Get Fat is excellent.
http://www.amazon.co.uk/gp/aw/d/0307272702/ref=mp_s_a_1?qid=1305288965&sr=8-1
The diet you describe seems actually quite high in carbohydrate.
It even sounds very tasty to me! Yet, it would hardly pass muster for people who swear by the low-carb diet lifestyle. Fruits? All those vegetables and nuts?
Ok I,m impressed where can I get this diet
I just want to reiterate that most people, especially, male wont last long on 1580 kcal/d, and sooner or later will end up binging. And even during the studies it is well known that ppls cheat. I would say its is far more effective to eat a bit more and also exercise, which show to improve glycemic control and diabetes.
On thing why those low car diets is so attractive that ppl like hearing good things about their bad habits. And ppl just get impression that they eat low carb high fat and stay lean or cure their diabetes. I think thats an illusion. Again not saying that ppl should eat high sugar cereals or sweets etc. Nevertheless a number of doct also showed that low fat high carb diet can improve and even cure diabetes. Look at the Dr. McDougal, Dr. Bernard, Dr. Delgado. However, again most ppl so addicted to their dairy and other foods that they cannot drop their fat intake to 10%. And also ppl do not exercise. Again not saying that those low fat diets work for everyone, but most ppl do not follow them correctly and then say they dont work.
Andy
That statement right there indicates, in my opinion, just how little relevant experience you have in this area and/or how little you know about effective nutritional management of diabetes.
When the macro-nutrient composition of a food is declared in the nutrition box, and we take note of it, it can lead to a distorted impression.
Some food sources contain considerably more water and significantly more fibre than do others. Water and fibre are not energy sources for us. Yet when the %fat is declared is declared as % by weight. This distorts comparisons say between green leaves and cheese because green leaves are so much lower in energy density than cheese.
If the water and the fibre is factored out of the calculation and the % fat is calculated as a %age of the total energy supplied then the results look so different. As a %age of the energy supplied green leaves can be high in fat. For my mind this doesn’t indicate green leaves are unhealthy but it does contribute to denting the automacity in thinking that low fat is ‘good’, better, or best.
For a startling and eye-opening result do the calc for watercress.
Hi, I am very interested in eating a healthy diet and have done so for some years. Although, what is a healthy, balanced diet? I have changed my mind about this many times, but eating in a way we have done for 2m years or so makes sence, ie before the agricultural revolution.
However, when I do cut out, or reduce, grains I get extreamely hungry and bad tempered. Could it be withdrawal syndrome as a test said I was sensitive to wheat + dairy. Or that everyone has different dietary needs? I’m already a very slim and healthy 41 year old. What do you think about blood types? I’m a type B which was created after the agricultural revolution – presumably to cope with the diet changes that had occurred….?
By the way, always very interested in your work. Thx
Whilst I find the diet credible, surely we wouldn’t be where we are today without the development of agriculture and techniques like cheese to provide food which would keep. Presumably evolution didn’t stop a few thousand years ago? Some people have problems with dairy or wheat, but does that make them evil?
I am not completely against the low carb diet, if it works thats fine. Regarding my knowledge on diabetes management, I think I know a least as much as your average reader, if not more and I know both side, though not from the practical exprence, but rather theoretical. I am also about to get a degree in science, nevertheless I am much more open-minded that what I am taught, hence I read blogs like yours.
Ive read in various forums and also some scientific paper showing benefits of cutting off carbs, however, very few studies looked at the long term effect. But I would like to hear from ppl who done low carb diet without cheating long term, if they are able to sustain such a lifestyle. Also how you explain that ppl, cure their diabetes on low fat diet like Dr. McDougal’s or Dr. Nick Delgado or Dr. Berdard’s.
Finally myself Ive tried to cut carbs but I get bad body odours, armpits starts stinking, whilst on low fat high car diet, no body odour, even if i dont have a shower for a week. Whilst on low carb diet you can start getting body odour withing a day. I wonder if anyone else facing such a prob. Also how would you explain such fenomena, do you think bacteria on the skin thrive by some metabolites extreted by metabolising fat for energy. Or my body just unable metabolise high amounts of fat. BTW i havent used any deodorant in my life, so some of you might be masking you body odours and may even not be aware.
Dr Briffa,
The sample size is small – is that statistically significant?
Tom
Tom
I don’t understand your question. Could you expand please?
Of course.
“The study, published in 2009 in the journal Cardiovascular Diabetology [1]. In this study, 13 men and women with type 2 diabetes ate, on separate occasions, two different diets, each for three months.”
I wondered if you can draw meaningful conclusions from the data given that the study only looked at 13 subjects (if I read it correctly).
My question is, is it a reliable conclusion to draw with this number of patients, or should a larger cohort be looked at?
Thanks,
Tom
Tom
I see.
The main risk of using such a small sample size would be a type 2 error i.e. that a genuine difference between the diets exists that was not detected due to the small sample size. However, a genuine difference was detected.
In general terms, the smaller the difference/effect, the larger the sample required to detect it. Of course the other side of this is that if an effect is seen is a small sample size, the effect is usually large, right?
The science we have is supportive (some might say very supportive). Also, it utterly mirrors my experience in practice (hence, at least to some degree, my enthusiasm). Oh, and one more thing: it’s common sense of course.
I’d say we’ve got more than enough reason to advise diabetics to eat a Paleolithic diet over a standard ‘diabetes diet’ rich in foods that we know destabilise blood sugar levels. What you make of this, Tom, is of course entirely up to you.
To Andy on sticking to paleo diet:
In 2009, I went onto the following diet:
One bowl of Bran Flakes with milk every morning, constituting almost all carbohydrates for the day.
Lunch: Meat/fish and sallad and/or vegetables in unrestricted amounts.
Dinner: Like lunch, plus often cheese(s) as dessert. Haven’t counted calories since I eat so much; I guess it must be over 2500.
Never any fruit, rice or pasta. Never a feeling of eating less than I craved for. No sense of deprivation, on the contrary, eating all I want (although not anything I’d like, note the difference).
In a week, I lost 3kg. In a month 10kg cumulatively and in three months 12kg in total, to return – at the age of 40 – to my ideal weight of 79 kg that I weighed at 17. Feeling great. Never tired after a meal. No cholesterol issues or other nutritional issues. No problems keeping this diet. I eat as much as I like following that diet; yesterday for example it was three steaks and a huge bowl of salad. Occasionally I can deviate from the diet and treat myself with, say, a pizza or pasta or whatever. Perhaps once a month on average. But it does not set any cravings going at such intervals.
I have absolutely no doubts about the superiority of this dietary approach, based on my own experience, and the experiences extensively reported scientifically and anecdotally.
Prior to doing this, I tried enormous amounts of excercise, with no effects on weight. And I was always in good condition aerobically and strengthwise, so the excercise was hard; I pushed myself on the bicycle, trained for and ran marathon, worked out in the gym… This is not to say a bad thing about excercise, but for weight management and diabetes, it probably does little in itself. The Paleo diet, by contrast, does.
Sorry for typo; I wrote that I started in 2009 but I in fact started in 2008 (in June).
Kerstin, it could well be withdrawal from the morphine-like compounds, gluteo- and caso-morphines in gluten and dairy that makes you feel irritable and hungry. Withdraw grains gradually and/or look into enzymes which contain DPP IV, often used to help process those opiates out of the system more effectively.
It could also be the lowering of serotonin or B vits – make sure you are eating a good diet with nuts, seeds and organic chicken.Good luck.