Advanced Mediterranean Diet

A Paleolithic diet improved metabolic status with respect to cardiovascular and carbohydrate physiology, according to a 2009 study at the University of California San Francisco.

The Paleolithic diet is also referred to as the paleo diet, Stone Age diet, and caveman diet.

Here are the research specifics, all statistically significant unless otherwise noted:

• total cholesterol decreased by 16%
• LDL cholesterol (”bad cholesterol”) decreased by 22% (no change in HDL)
• triglycerides decreased by 35%
• strong trend toward reduced fasting insulin (P=0.07)
• average diastolic blood pressure down by 3 mmHg (no change in systolic pressure)
• improved insulin sensitivity and reduced insulin resistance; i.e., improved glucose tolerance

Methodology

This was a small, preliminary study: only 11 participants (six male, three female, all healthy (non-diabetic), average age 38, average BMI 28, sedentary, mixed Black/Caucasian/Asian).

Baseline diet characteristics were determined by dietitians, then all participants were placed on a paleo diet, starting with a 7-day ramp-up (increasing fiber and potassium gradually), then a 10-day paleo diet.

The paleo diet: meat, fish, poultry, eggs, fruits, vegetables, tree nuts, canola oil [?], mayonnaise [?], and honey.  No dairy legumes, cereals, grains, potatoes.  Caloric intake was adjusted to avoid weight change during the study, and participants were told to remain sedentary.  They ate one meal daily at the research center and were sent home with the other meals and snacks pre-packed.

Compared with baseline diets, the paleo diet reduced salt consumption by half while doubling potassium and magnesium intake.  Baseline diet macronutrient calories were 17% from protein, 44% carbohydrate, 38% fat.  Paleo diet macronutrients were 30% protein, 38% carb, 32% fat.  Fiber content wasn’t reported. 

I’m guessing there were no adverse effects.

Comments

This study sounds like fun, easy, basic science: “Hey, let’s do this and see what happens!”

I don’t know a lot about canola oil, but it’s considered one of the healthy oils by folks like Walter Willett.  It sounds nicer than rapeseed oil.

I agree with the investigators that this tiny preliminary study is promising; the paleo diet has potential benefits for prevention and treatment for metabolic syndrome, diabetes, and cardiovascular disease such as heart attack and stroke.

The researchers mentioned their plans to study the paleo diet in patients with type 2 diabetes.  Any results yet?

Are you working with a physician on a medical issue that may improve or resolve with the paleo diet?  Most doctors don’t know much about the paleo diet yet.  You may convince yours to be open-minded by trying the diet—not always a safe way to go—and showing her your improved clinical results.  Or show her studies such as this.

Steve Parker, M.D.

Reference:  Frassetto, L.A., et al.  Metabolic and physiologic improvements from consuming a paleolithic, hunter-gatherer type diet.  European Journal of Clinical Nutrition, advance online publication, February 11, 2009.   doi: 10.1038/ejcn.2009.4

Men eating low-carb diets featuring protein and fats from sources other than red and processed meats may reduce risk of developing type 2 diabetes later, compared to other types of low-carb diets.  The same Boston-based researchers previously looked for a similar association in women and found none.

The article in American Journal of Clinical Nutrition seems to me unusually complicated.  It was frustrating to read, searching for but not finding much useful for clinical practice.  How low-carb were these diets?  Thirty-seven to 43% of energy from carbs in the most dedicated dieters, compared to 50-60% in the standard American diet.

After wading through most of this article, I came away with the impression the authors were just data-mining a huge database, to add one more item to their CVs (curriculum vitae).  This article is a confusing mess, or maybe I’m just stupid. I regret wasting an hour on it.

Steve Parker, M.D.

Reference: De Konig, Lawrence, et al.  Low-carbohydrate diet scores and risk of type 2 diabetes in men.  Amercan Journal of Clinical Nutrition, 2011. doi: 10.3945/ajcn.110.004333

One of the very first users of insulin injections lived to be 73.  That amazes me since most of her life was lived before we could keep close track of blood sugar levels with home glucose monitoring.  She died of pneumonia in 1981.  She was a type 1 diabetic since age 11.

Insulin was discovered in Canada

Her name was Elizabeth Hughes, daughter of a New York governor.  She was started in insulin around 1922. 

I read about her in Nutrition Journal earlier this year.  Most of the article was about the use of starvation diets for diabetics in the pre-insulin era .  Ever heard of the Joslin Clinic, a preeminent U.S. diabetes center?  Elliott Joslin was once an advocate of these starvation diets.  Insulin changed that.

The article notes that before insulin therapy was available, the standard diabetic diet was low-carbohydrate, avoiding sugars and starches, sometimes called the “animal diet.”

I also learned that urine became easily testable for sugar in the early part of the 20th century, if not earlier.  Before this, many cases of diabetes (mostly type 2) were undetectable or misdiagnosed.

Even today, type 1 diabetes is a hard row to hoe.  Before 1922, it was even worse.  As bad as it can get.

Steve Parker, M.D.

I recently read Sugar Nation, by Jeff O’Connell, published in 2011.  Per Amazon.com’s rating system, I give it five stars (”I love it”). 

I have one copy of the book to give away to someone with a mailing address in the U.S.  If you’d like it, be the first to e-mail me with the name for “wisps of precipitation streaming from a cloud but evaporating before reaching the ground.”  Two syllables, starts with “v”.  My e-mail is steveparkermdATgmailDOTcom.

Update August 3, 2011: The book was won by John from Richardson, TX. The word is virga.

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With the U.S. Centers for Disease Control predicting that one of every three citizens born in 2000 will become diabetic, this book is “just what the doctor ordered.”  Already,  one in three of all adults has prediabetes.  The numbers are even scarier if we look at those over 65: HALF have prediabetes, while two in ten have diabetes.  I treat diabetes every day; trust me, you don’t want it.

I agree with O’Connell that over-consumption of sugar and refined starches often leads to type 2 diabetes and prediabetes, particularly when combined with obesity, a sedentary lifestlye, and genetic predisposition.  (Our bodies easily and quickly convert potatoes and refined starches like white flour and white rice into blood sugar.) Yearly sugar consumption in the U.S. was five pounds per person in the 1800s, but is now up to 160 pounds a year. 

O’Connell was motivated to write this because of his personal diagonosis of prediabetes in 2006.  Later he was also diagnosed with reactive hypoglycemia.  Furthermore, his father died of the ravages of type 2 diabetes.  O’Connell’s physician in 2006 didn’t offer much managmement advice, so the author did his own research and shares it with us here.  The author’s personal approach has been a fairly intense exercise program and major reduction in consumption of sugar and other carbohydrates, particularly ones that are quickly converted to blood sugar.  He eats 80 or less grams of carb daily, compared to the average American’s 275 grams.  I agree these management options can be extremely helpful for prediabetes and type 2 diabetes, particularly if applied early in the course of the condition.

O’Connell is critical of most physicians and the American Diabetes Association (ADA) for not knowing about carbohydrate restriction and for inadequately promoting exercise.  He accuses the pharmaceutical industry of having too much influence over physicians and the ADA.  While admitting that “…taking a pill [is] much easier than reengineering the way you lead your life,” he mostly lets patients off the hook in terms of taking control of diet and physical activity.  I can understand that to a degree; physicians should be leading the way.  I don’t see that happening soon.  Patients need to take charge now; many have already done so.  Compared to a five-minute lecture in a doctor’s office, this book will be a much more effective motivator for change.

(Patients taking drugs with the potential to cause hypoglycemia need their doctors’ help adjusting dosages while making these lifestyle changes.)

The author tells us that we in the U.S. spent $12.5 billion on drugs for diabetes in 2007, nearly double the amount spent in 2001.  It’s only going to get worse going forward.  We have 11 classes of drugs for diabetes now.  Surprisingly, we don’t know all of the potential adverse long-term side effects of most of these drugs.  Phenformin was pulled from the U.S. market years ago due to fatal lactic acid build-up.  Earlier this year, rosiglitazone prescribing was greatly restricted in view of adverse heart effects.  If we can effectively address diabetes and prediabetes with diet and exercise, why not?  (Clearly, diet and exercise don’t always work, and type 1 diabetics always need insulin.) 

For those who won’t or can’t exercise regularly, be aware that carb restriction alone is a powerful approach.

I heard more about reactive hypoglycemia a couple decades ago than I do now.  It could be a precursor to type 2 diabetes.  I think physicians lost interest in it because too many people were using it as a excuse for odd behavior when they really didn’t have hypogylcemia.  This book may spark a resurgence in interest.

O’Connell implies that the high revenues generated by diabetic drug manufacturers may not be justifiable.  In fairness, I must point out that the same companies spend hundreds of millions of dollars just to get a drug on the market, and millions more on research for drugs that fail and never see the light of day.

I was glad to see the author mention low-carb beers: Michelob Ultra and MGD 64.  I’ve had trouble finding carb counts on many beers.

O’Connell recommends supplements: leucine, cinnamon, protein powder, chromium, alpha lipoic acid, biotin, magnesium.  I’ve not done in-depth research on most of those.  What I’ve read in the science literature about cinnamon and chromium has not been very positive or definitive.

My favorite sentence: “Along with a low-carb eating plan, a gym memership is the most potent antidote to type 2 diabetes.”

This book was a pleasure to read; professional, well-organized, touching all the right bases in understandable terms.  I can well understand how he makes a living as a journalist. 

Steve Parker, M.D., author of Conquer Diabetes and Prediabetes: The Low-Carb  Mediterranean Diet   

Disclosure: I don’t know the author.  The publisher’s representative provided me with two free copies of the book, otherwise I recieved nothing of value in exchange for this review.  

Eating nuts improves blood sugar control and cholesterol levels in type 2 diabetics, according to a recent research report in Diabetes Care.

Canadian researchers randomized 117 type 2 diabetics to eat their usual types of food, but also to be sure to eat either

•  mixed nuts (about 2 ounces a day)
•  muffins (I figure one a day)
• or  half portions of each. 

They did this daily for three months.  Compared to the muffin group, the full nut group ate quite a bit more monounsaturated fatty acids.  (I don’t have full study details because I have access only to the article abstract.)

Results

Hemoglobin A1c, a reliable measure of blood sugar control, fell by 0.21% in the mixed nut group.  That’s a move in the right direction.  LDL cholesterol, the “bad cholesterol” linked to heart and vascular disease, also dropped significantly. 

So What?

The investigators suggest that replacement of certain carbohydrates with 2 ounces of daily mixed nuts is good for people with type 2 diabetes.

I must mention that nuts are  a mandatory component of the Ketogenic Mediterranean Diet  and the Low-Carb Mediterranean Diet, and a recommended option on the Advanced Mediterranean Diet. 

Steve Parker, M.D.

References:  Jenkins, David J.A., et al.  Nuts as a replacement for carbohydrates in the diabetic diet.  Diabetes Care, June 29, 2011.  doi: 10.2337/dc11-0338

PS: The lead author of this study is the same David Jenkins of glycemic index fame.

In 2009, Current Diabetes Reports published “The usefulness of a Mediterranean-based diet in individuals with type 2 diabetes,” by Catherine M. Champagne, Ph.D., R.D., L.D.N.  Unfortunately, the full article isn’t available to you at no cost.  But I read it.  Her article is a review of available scientific evidence related to the Mediterranean diet as applied to a diabetic population.  Dr. Champagne wrote:

This diet is a viable treatment option; advisors should stress not only adherence to a fairly traditional Mediterranean eating plan but also a lifestyle that includes sufficient physical activity.

I’ve been publishing my series on exercise here in dribs and drabs for the last several months.

Dr. Champagne was very favorably impressed with the DIRECT trial of Shai et al, which I covered extensively elsewhere.  DIRECT compared three diets over 24 months: Atkins, Mediterranean/calorie-restricted, and low-fat/calorie-restricted.  Mind you, it was a weight loss study, but a fair number of diabetics participated.  Mediterranean-style eating showed the most beneficial effects for diabetics. 

I think the Mediterranean diet could be even healthier for people with diabetes if it had fewer carbohydrates.  That’s why I composed the Low-Carb Mediterranean Diet.

Dr. Champagne also mentions evidence that a modified Mediterranean diet may help counteract the build-up of fat in the liver, seen in up to 70% of type 2 diabetics.  I wrote recently about how a very-low-carb diet beat the low-fat diet so often recommended for this condition (hepatic steatosis or non-alcoholic fatty liver disease).

If you want full online access to Champagne’s 6-page article, you can purchase it for $34 (USD) at SpringerLink.  I cite many of the same scientific sources and provide a whole lot more in my 216-page Conquer Diabetes and Prediabetes: The Low-Carb Mediterranean Diet, at Amazon.com for $16.95 or $9.99 (the Kindle edition) or in multiple ebook formats from Smashwords.

Steve Parker, M.D.

Reference: Champagne, Catherine (2009). The usefulness of a Mediterranean-based diet in individuals with type 2 diabetes. Current Diabetes Reports DOI: 10.1007/s11892-009-0060-3

I recently read Carbohydrates Can Kill, by Robert K. Su, M.D., written in 2009.  Per Amazon.com’s rating system, I give it four stars ( I like it).

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Many developed Western societies have a love affair with carbohydrates, particularly concentrated sugars and highly processed grains and starches.  The U.S. is a good example.  Our skyrocketing rates of overweight and obesity (68% of adults) are testament to that.  Obesity is strongly linked to cancer, high blood pressure, heart attacks, diabetes, strokes, and premature death.  It’s not too much of a stretch to blame carbohydrates for at least a portion of these diseases and others.  Dr. Robert Su thoroughly reviews these connections in Carbohydrates Can Kill.

Blissfully unaware of his prediabetes

Blocked heart arteries are the No.1 cause of death in developed countries.  A growing trend among the experts is to abandon the theory that total and saturated fats cause heart disease, pointing instead to excessive consumption of sugars and processed grains and other starches.  Dr. Su makes a fairly convincing case for the carbohydrate theory of heart disease.  He’s also convinced that carbs cause high blood pressure, dementia, many cancers, diabetes, overweight, perhaps even most diseases. 

This book addresses overweight, adverse health effects of obesity, nutrition and digestion in detail, and numerous scientific studies supporting his ideas.

One of the most interesting things to me was Dr. Su’s personal medical story.  At age 62, he found himself 40 pounds (18 kg) overweight, blood pressure 205/63, and having apparent reversible heart pains (angina) when stressed or exercising.  The combination of salt restriction and exercise didn’t help.  Reducing carbs to 60-70 g/day and continued exercise (walking and stair-climbing) did the trick, helping him lose 30 pounds and controlling angina and high blood pressure.  I expected him at any time to reveal he had a heart attack, stroke, or heart bypass surgery, but he dodged those bullets.  His problems at 62 were a wake-up call.  He didn’t want to end up prematurely dead or disabled, a burden to his family and unable to spend quality time with them.  So he undertook major lifestyle changes.  Very inspirational. 

In addition to a medical degree, Dr. Su has a degree in pharmacy.  He knew he’d be put on multiple drugs if he went to a doctor for treatment of his symptoms.  Like me, he’s wary of drug side effects and wanted to avoid them, opting for diet and exercise instead.  He gambled and won.  I’m sure at least a few others would not be so lucky.

Dr. Su cites evidence that high blood sugars cause inflammation, which can predispose to cancer.  Diabetics do indeed have a higher risk of certain cancers, yet he didn’t mention that diabetics have a lower risk of prostate cancer. 

Dr. Su is anti-alcohol.  The studies are mixed on the overall health effects of alcohol, but the bulk of the studies link low-to-moderate consumption of alcohol with less cardiovascular disease and longer lifespan.  Clearly, heavy drinking can be lethal.

Like all books, CCK isn’t perfect.  First, it could have used better editing to eliminate grammatical errors and wordiness.  Next, I suspect Dr. Su is getting a little ahead of the science when he states that “….most diseases, if not all, are directly or indirectly caused by too much blood sugar.”  If carbohydrates are so deadly (mediated via high blood sugar), why do the Kitavan’s of Melanesia have such low rates of heart attack, stroke, overweight, and diabetes, despite a diet deriving 69% of total calories from carbohydrates?  (Calories from carbohydrates in the U.S. are about 50% of the total.)  Granted, Kitavan’s carbs are mostly unrefined.  Could the Kitavans be genetically protected from carb toxicity? 

So, what do we do if carboydrates are so dangerous?  Dr. Su recommends limiting carb consumption to a maximum of 100 grams a day.  (By way of reference, average U.S. carb consumption is 250 grams a day.)  Simple sugars and highly processed grains and starches should be avoided.  Additionally, he recommends a yearly glucose tolerance test to determine fasting blood sugar, then blood sugar readings every 15-20 minutes after an unspecified meal for two or three hours.  I wonder if a single hemoglobin A1c blood test would suffice.  I agree with Dr. Su that fasting blood sugars should be under 110 mg/dl (6.1 mmol/l)—if not lower—and all blood sugars after meals under 150 mg/dl (8.3 mmol/l).

Dr. Su is a tireless advocate for carbohydrate-restricted eating.  Visit his website: carbohydratescankill.com.  If his diet and exercise ideas were widely adopted in the U.S., we’d be a healthier country.  This book is a worthy read for anyone with overweight, obesity, diabetes, prediabetes, or otherwise enamored of concentrated sugars and highly processed grains and other starches.  Note that one of every three U.S. adults has prediabetes, including half of all those over 65, and most of them are unaware.

Steve Parker, M.D.

I did a phone interview a couple weeks ago with Dr. Robert K. Su, author of Carbohydrates Can Kill.  It should be available in podcast form at Dr. Su’s website within the next three months.  Dr. Su is on a mission to educate the public on the dangers of excessive blood sugar levels, whether or not diabetes or prediabetes is present.  Visit Dr. Su’s website for a wealth of information on carbohydrates and their effects on blood sugar levels and health.

Steve Parker, M.D., author of Conquer Diabetes and Prediabetes: The Low-Carb Mediterranean Diet

In the U.S., 24 million people have diabetes, mostly type 2.  That’s one in 10 adults.  The number for those over 60 is two in 10. 

Fifty-seven million have prediabetes; that’s one of every three adults.  Most of them are unaware of it.

The American Diabetes Association offers an online diabetes and prediabetes risk assesment.  Why not check your odds?

Steve Parker, M.D., author of Conquer Diabetes and Prediabetes: The Low-Carb Mediterranean Diet

In January, the U.S. Centers for Disease Control and Prevention released the latest estimates for prevalence of diabetes and prediabetes.  The situation is worse than it was in 2008, the last figures available. 

• Nearly 27% of American adults age 65 or older have diabetes (overwhelmingly type 2)
• Half of Americans 65 and older have prediabetes
• 11% of U.S. adults (nearly 26 million) have diabetes (overwhelmingly type 2)
• 35% of adults (79 million) have prediabetes, and most of those affected don’t know it

The CDC estimates that one of every three U.S. adults could have diabetes by 2050 if present trends continue.

The press release from the CDC mentions that physical activity and avoidance of overweight will prevent some cases of diabetes.  I believe that  limiting consumption of refined carbohydrates like sugar and flour would also help.

Those who already have diabetes and prediabetes should consider carbohydrate-restricted Mediterranean-style eating, as in Conquer Diabetes and Prediabetes: The Low-Carb Mediterranean Diet.

Steve Parker, M.D.