The Management of Type 2 Diabetes: The Mom Experiment of 2012

Disclaimers: The content and view expressed in the following post are solely mine and do not reflect the opinions of my employer or any of my affiliated research centers. My interest and subsequent remarks regarding the benefits of the Paleolithic diet are solely mine and are based on my independent research as a health consumer and should be taken as such. They are intended for educational purposes only.

Perhaps not surprising to those who know me, I tend to get enamored with the emerging research on Paleolithic nutrition (Paleo). I believe solid peer reviewed research is critically important for building the credible evidence base necessary for moving Paleo from a theoretical novelty to widespread acceptance within the larger health professional community. As much as I love research, I firmly believe the ultimate value of Paleo lies in the ability to translate these concepts into the everyday lives of those who need a nutritional overhaul. At the end of the day the motivation for most of us is seeing our family and friends adopt a sound nutritional plan and gain control of health and well-being.

Everyone can benefit from a Paleo; however, I believe individuals living with obesity related metabolic disorders like Type 2 Diabetes (T2D) have the most to gain. Most people have a general understanding that diabetes is not a good thing but I don’t think most have a full appreciation for just how serious this condition can be. Advances in pharmacological intervention have made it possible to delay the onset of more serious complications allowing individuals to live longer, more productive lives than in years past. However it’s also made it much easier to lose sight of the fact that over time T2D can cause serious complications that include blindness, kidney failure/dialysis, limb amputations and premature death from heart disease and stroke. What is even scarier is the fact national projections estimate 1 of every 3 individuals born after the year 2000 will have diabetes at some point in their life, 1 of every 2 minorities. I’ll refrain from commenting on why I believe excessive carbohydrate consumption and food quality are driving these trends for now, but I think it goes without saying this is an important issue that warrants some serious discussion.

Undoubtedly, having a solid nutritional foundation is critical for managing type 2 diabetes and minimizing the long term impact on health and functioning. A well balanced Paleo diet serves this purpose. Paleo is a whole food diet consisting of meat, vegetables, fruit, nuts, seeds, roots/tubers that forces individuals to consume smart carbohydrates that are friendly on blood sugars. This is absolutely critical for those living with T2D. Paleo is often portrayed as a low carbohydrate diet and to some degree this is true. However, I would argue it’s more of a smart carbohydrate diet that can be adjusted up or down depending on the varying needs or goals of individuals. Rather, the focus on the absolute amount of carbohydrates is much less important than the focus on the quality of the carbohydrates. A solid Paleo coupled with a sensible exercise regimen can do more to manage this condition and delay the onset of more serious complications than any medical or pharmaceutical intervention available, seriously.

Taking a brief detour, this is exactly what much of the existing Paleo research in the medical literature has focused on. I’m working on an additional post that outlines in more detail the current medical literature on Paleolithic nutrition, but there are a few points worth making (since I know most of you will be dying to read the post reviewing the literature review). One of the first and probably most notable experiments was conducted by Lindeburg and colleagues in Sweden and published in 2007 among metabolically challenged adults. This study compared a Paleo diet to a Mediterranean type diet, which is by all intensive purposes considered among the most healthy by contemporary standards. Interestingly, differences in macronutrient intake between the two groups were pretty marginal (Protein 27% vs. 20%; Fat 27% vs. 25%: Carbohydrate 40% vs. 52%). The Paleo group still consumed 40% of calories from carbohydrates which is not terribly restrictive. The primary difference in the composition of the diets between the two groups related directly back to the choice of carbohydrates. The Mediterranean group consumed cereals grains/dairy and the Paleo group did not. Carbohydrates in the Paleo group came primarily from vegetables and fruit. As would be expected, the overall glycemic load of the diet was much lower in the Paleo group. So what happened? The study found a marked improvement in glucose tolerance among the Paleo group whereas those following the Mediterranean diet showed no appreciable improvement in glucose tolerance despite weight loss in both groups. In other words both groups lost weight; however, only individuals following Paleo diet experienced better glycemic control suggesting specific foods choices are important when trying to control blood glucose.

It’s one thing to read about studies from Sweden, but how does this translate to the everyday lives of those living with T2D? That’s a tough one for me; it’s not something that’s affected me directly. I’m relatively young and I’m in pretty darn good shape (at least I think so) and until recently I have had no first hand knowledge on how to use Paleo for the management of T2D. Recently however, the stars aligned and I was fortunate enough to do something I’ve wanted to do for a long time, help a loved one with T2D adopt a Paleo type diet and track the results.

A Little Background

If there was ever someone who could benefit from eating Paleo, it’s my mom. I don’t want to divulge her entire medical history but let’s just say it includes pleasant things like type 2 diabetes, autoimmune disease, and breast cancer. As a loving and caring son with a particular interest in the connection between nutrition and health, it’s very hard to sit back and watch these things unfold getting progressively worse year after year. There’s a fine line between offering advice out of loving concern and being belligerent, condescending, and/or judgmental. The line is even thinner then when you consider the fact she gave birth to me and changed my diapers. Recently my mom came to visit and spent about 10 days with us following the birth of my 3rd child. Despite my hesitancy, Mom and I had a heart to heart about her health and what she could do about it. The nature of the conversation is personal, but in the end I convinced her to eat Paleo for the last 7 days of her visit. If she didn’t feel better and see an improvement in her blood sugars then she could just go back to doing what she was doing before. It was a pretty good deal; she didn’t have to do anything except eat what I put in front of her and listen when I explained what we were doing and why.

In case you are wondering, I did not neglect my other family duties and this did not take away from bonding with the new addition. I pulled double duty as dad and chef for 7 days.

The Intervention

I didn’t really intend to turn this into an experiment, it just kind of happened. I knew she was having trouble with controlling her blood glucose levels. In fact, two weeks before her visit her physician increased her insulin dosage to get her blood sugars under control. I simply suggested she check her sugars on a regular basis for the 7 days and we’ll just see what happens relative to the past month or so. Determining what approach to Paleo we should take was a little tricky. As I mentioned earlier in addition to T2D she also suffers from autoimmune disease. She could certainly benefit from the autoimmune protocol; however, it’s pretty restrictive and I was concerned about compliance once she left. In the end, we decided controlling her blood sugars was the immediate priority and we could work on the rest later. My primary objective was for her to learn the basics of Paleo and to have early success to reinforce the behavior change. So, what did we eat?

The Menu

Our primary objective was controlling her blood sugars; however, we still consumed a pretty liberal version of Paleo. We had sweet potatoes a couple times and I didn’t really restrict her fruit intake for the most part. We also had a couple Paleo treats throughout the week that are not particularly friendly on blood sugars. We also had a freebie meal that included some black beans and dairy. We tried to get into a rhythm of cooking breakfast, dinner, and eating left-overs for lunch. This approach has worked well for me and it is something she can incorporate at home.

Sunday – Dinner: Spaghetti w/ ground turkey and spaghetti squash
Monday – Breakfast: Chicken-apple hash, sausage links (3 small links)/ Lunch: Left-over spaghetti / Dinner: Paleo meatloaf (Everyday Paleo), steamed veggies
Tuesday – Breakfast: Spinach omelet w/ sliced avocado / Lunch: Left-over Paleo meatloaf, steamed veggies / Dinner: Baked Chicken Tenders (Paleo breading on tenders), baked sweet potato fries, steamed veggies / Paleo Treat: Chocolate chip cookies
Wednesday – Breakfast: Paleo pancakes (banana, egg, almond butter), scrambled eggs / Lunch: Let-over chicken tenders w/ side salad (olive oil and salt for dressing) / Dinner: Pork chops, zucchini cakes, green beans
Thursday – Breakfast: Vegetable and sausage stir-fry / Lunch: Left-over zucchini cakes, walnuts / Dinner: Baked salmon, asparagus, small sweet potato
Friday – Breakfast: Banana and walnuts / Lunch: Skipped / Dinner: Taco salad w/ homemade tortillas (allowed black beans, cheese)
Saturday – Breakfast: Spinach quiche, bacon (3 slices) / Lunch: Grilled chicken salad (Zaxby’s), w/ olive oil and salt for dressing / Dinner: Returned home

As a side note, she actually consumed more calories daily during the 6.5 days eating Paleo than she was on daily basis at home. Keep that in mind when contemplating the results.

Results

Even with a liberal interpretation of Paleo, the results were pretty astonishing. I pulled the blood glucose readings from her Glucometer and created a run chart of all her blood sugars for the past 2 months. Being the nerd that I am I calculated daily blood sugar averages, put the results in a linear regression model with time as a covariate reflecting three periods: 1) her baseline with poorly controlled sugars, 2) the 2 weeks following the MD increasing her insulin, and 3) when she started Paleo at my house. The results:

Glucose	Coef.	Std. Err.      t	P>t	[95%Conf.	Interval]
Time
1	Reference
2	-54.46	19.69    -2.77	0.009	-94.26	-14.65
3	-112.31	18.71    -5.41	0.000	-139.13	-63.49

I won’t divulge her baseline level, but as you can see from the results above, her daily average blood glucose levels fell by 54 points after her MD increased her baseline insulin dosage and prescribed fast acting insulin (Time 2). That’s both good and bad. It’s good in the sense she was able to get her blood sugars back under control (but still high) by increasing her insulin. However, it’s bad in the sense that the more insulin she has to take, the more fat her body will store, which further exacerbates the insulin resistance problem. It’s a perpetuating negative feedback system. Eventually, continuing insulin resistance coupled with over-worked pancreatic beta cells cause the pancreas to stop working. Then you are really in a hot mess, which is what we are trying to avoid.

Now to the exciting part. After 6.5 days of eating Paleo, her daily blood sugars dropped by 112 points compared to the baseline (Time 3), ~50 points more than the medical intervention of increased insulin. Here is the kicker, by the end of the first week, she stopped all her fast acting insulin and lowered her baseline insulin intake back to where it was before it was increased by her physician. Think about that for a minute. Even a loose interpretation of Paleo lowered daily blood sugars lowered by 112 points and significantly reduced insulin intake…..in 6.5 days. She also lost 15 pounds. Yes, I know, it’s impressive. That’s the power of the n=1 experiment. Sometimes you just have to do it and see what happens. You are usually not disappointed.

A Few Observations

Insulin intake when restricting carbohydrates is one issue to be acutely aware of when making the transition. We really had to stay on top of her insulin dosing. She didn’t anticipate the marked drop in blood sugar when making the initial transition and didn’t adjust her insulin dosing accordingly. This led to some pretty low blood sugars at night. She had to get up and eat a banana once or twice, but we got it squared away after a couple days.

As a side note there’s a funny story about low blood sugars at night. She knew we were starting the new diet on Sunday, so Saturday she came home from the store with a bag of Reeses Cups Minis to have on hand in case her blood sugars dropped too low. Not so fast my friend. I had a mole on the inside who told me of the hidden bag of candy. I wanted to give her a chance to do the right thing before I confiscated the candy so Sunday I informed her if she had low blood sugars she was to eat a banana or some dates. A few minutes later she came downstairs with the candy and voluntarily handed it over. At that point I knew she was serious and wasn’t just humoring me.

She moped around like I stole her lunch money for a day or two. However, she seemed to perk up after a couple days. We were cooking together, she was asking questions, we were enjoying the new baby, and it was great. She made a couple comments about feeling more alert and energetic, like she’s coming out of a fog or something. I would say this story sums it up. The night before she left she was up running around playing hide and seek with my two older kids. That may not sound like a big deal to most of you but I can honestly say I’ve never seen her up and playing with any of her grand kids. She plays with them, but it’s usually sitting down or holding them in a chair. As a son, that made the experiment worth every bit of the effort.

The Aftermath

So you might be wondering what happened when she left the confines of my house and returned home? I’m happy to report that 2 months (actually closer to 3 months now) later she’s still eating Paleo and doing a pretty darn good job. Yes, it’s taken me that long to get this post out. Her blood sugars have stayed under control and she’s lost about 25 pounds so far. Is she 100% Paleo? No, she has had her moments and fair share of struggles (as do most of us). The past month has been particularly hard as our family has experienced some pretty significant life stressors that make progress difficult. However, we are all moving forward. She’s learning, trying, and making progress. My Dad is also on board now. In the end, that’s really all I can ask for.

So, now that you are ready to give it a shot for yourself check out the Paleo-Jitsu: Black Belt Nutrition post below. That should give you enough information to get going. Eat black belt foods everyday, purple belt foods every now and then if you want, and avoid white belt foods (they will make you sick).

Paleo-Jitsu Psychological Hurdles: Fat Is Not The Enemy

In talking with individuals about eating Paleo, by far the most common psychological hurdle I come across is the notion that a diet rich in fat (particularly saturated fat) will increase your risk of obesity, wreak havoc on your blood lipids, and send you to an early grave. I must confess this was the most significant psychological hurdle I had to overcome when contemplating Paleo. I have high cholesterol and it’s been that way since I was a child (familial hypercholesterolemia). Luckily I have the heterozygote type (inherited from 1 parent) so I’m still here to write this blog. I tell you that just to say this……I’ve really, really looked into this issue of saturated fat, cholesterol, and heart disease. It’s personal. I have no intention of leaving my beautiful wife and children so I’m not going to follow a diet that increases that risk. I love them too much.

I’ve been shocked, and somewhat bewildered at what I’ve found in looking at the current medical literature on the subject. It’s actually a little embarrassing that I have a terminal public health degree and have been so wrong for so many years, but nonetheless. As with most people, I operated from the same paradigm governing our current dietary recommendations of eating less fat and replacing those calories with carbohydrates. Surely these recommendations reflect years of scientific evidence and the various federal and non-profit agencies making these recommendations are on top of it. I trusted prevailing wisdom and never really looked into it further with any type of rigor. We all know this by now but the current recommendations call for reducing fat consumption to less than 30% of total calories (<10% if you are at risk of heart disease) and replacing these calories with carbohydrates, which should comprise 50%-60% of your calories. Eating more vegetables/fruits is also recommended, which is pretty much universally accepted and no one takes exception with. This sounds reasonable enough, so what’s the problem?

The problem is since the current recommendations gained widespread acceptance in the 1970’s, the waistlines of Americans have continued to grow accordingly. Between 1980 and 2008 the rate of obesity in the US has more than doubled increasing from 15% in 1980 to 35% in 2008. I examined published data from the National Health and Nutrition Examination Survey (NHANES) to look at macronutrient intake (fat, carbohydrate, protein) during this same time period. I was surprised to find the percent of total calories from fat and saturated fat in the average American diet has actually decreased by 9% and 17%, respectively. Perhaps you will find it more interesting to know that carbohydrate consumption as a percent of total calories increased by 12% in the average American diet. Based on this data it would appear we have indeed followed these recommendations by reducing fat consumption and replacing it with carbohydrates. Now, these are precisely the type of ecological data you should be very weary of and these numbers should not be taken to imply causal inference. These data do not distinguish between the types of carbohydrate consumed and likely reflects increases in sugar sweetened beverages and other cheap, readily available forms of empty calories. However, it is interesting to note aggregate changes in consumption of macronutrients seem to reflect historical nutritional recommendations; yet, rates of obesity are moving in the opposite direction. The obvious question is what’s up with that?

Choose your Paradigm Carefully

A good friend of mine suggested I read a book published by Thomas Khun titled “The Structure of Scientific Revolutions.” This is an older book I would not recommend to anyone unless you have insomnia and need a non-medicinal alternative to get some sleep; or, unless you are a researcher/nerd who gets into this stuff. Either way the take home point of this book is a poignant one and provides a nice illustration for discussing how these things came to be. The book focuses on paradigms or sets of assumptions, concepts, values, and practices that constitutes a way of viewing reality. It examines how paradigms become a reality and more importantly how they change. The interesting thing about science is once a specific paradigm takes root and gains widespread acceptance, it spawns a flurry of scientific activity continually building from the original paradigm. This in and of itself is not a bad thing and can yield tremendous advances in knowledge and science rapidly. Periodically, new paradigms come along challenging the conventional wisdom of the prevailing paradigm. New paradigms are often met with skepticism and bear the burden of proof. However, if they stand up to the rigorous backlash they can become a paradigm shifter. As a paradigm shifts the body of work built on the original paradigm comes into question and must be seriously examined in the context of the new paradigm.

Perhaps it might be easier to visualize scientific progress as a Jenga puzzle. Once a paradigm (base) has been established researchers add pieces creating a very large, complex puzzle. What happens when the pieces building the tower get pulled out in the context of an emerging paradigm? Better yet, what happens to the mountain of pieces if the corner piece of the base is removed? If the original paradigm turns out to be wrong then the mountain of research built on the paradigm is severely compromised and is called into question. This is not an affront on the quality of research completed that built the original puzzle; rather, the problem is with the original paradigm itself. Perhaps the more important question is what happens when a shaky paradigm finds its way into public policy? Unfortunately a faulty paradigm translating to public policy is the case with our current nutritional recommendations.

The Science

Let’s quickly visit the fat consumption, high cholesterol, heart disease paradigm most of us have been working from. The science driving this paradigm dates back to research completed from the 1960’s through the 1980’s, before the sub-typing cholesterol by HDL (good) and LDL (bad). Early research did find that saturated fat intake increased cholesterol; therefore, must increase the risk of heart disease. Although fat consumption does generally increase total cholesterol there is a differential effect of fat on good/bad cholesterol. Most scientists would agree the Total/HDL (good) cholesterol ratio is the more important predictor of heart disease than total cholesterol. More recent data has indicated the HDL /Triglyceride (circulating fat in the blood) ratio is an even more important predictor than LDL (bad) cholesterol levels. It turns out saturated fat consumption (depending on the specific type of saturated fat) can increase LDL (bad) levels; however, it also raises HDL (good) levels proportionally higher than LDL (bad) levels and decreases triglyceride levels. So, the net risk/benefit of saturated fat consumption tilts in your favor. This is the basis for much of the more current research that continues to exonerate saturated fat from sweeping indictments in the current recommendations (pulling pieces from the original paradigm Jenga puzzle).

Don’t just take my word for it. Let me give you an excerpt from a section in an Exercise Physiology Sports Nutrition and Energy Metabolism textbook published in 2008 (Wolinsky and Driskell).

“There has been much controversy about both the health and effectiveness of lower carbohydrate diets. New studies from leading institutions including Duke and Harvard Universities have shown low carbohydrate diets are safe, healthy, and lead to more permanent fat and weight loss, and have shown improvements in the dieters blood lipid and cholesterol levels.

Several studies have shown that low carbohydrate diets are more effective for weight and fat loss than high carbohydrate diets. The results of a study published in 2002 showed that long-term use of a low carbohydrate diet resulted in increased weight and fat loss, and dramatic improvement in blood lipid profiles (decreased cholesterol, triglycerides, and LDL, and increased HDL levels). Two studies published in 2003 in the New England Journal of Medicine found that people on high protein, high fat, and low carbohydrate diets lost twice as much weight over 6 months as those on a standard low fat diet recommended by most major health organizations. In both studies, the low carbohydrate dieters generally had better levels of “good” cholesterol and triglycerides, or fats in the blood. There was no difference in “bad” cholesterol or blood pressure………….

In the latest study, researchers from the Harvard School of Public Health, after analyzing data collected over 20 years from more than 82,000 women participating in the Nurses Health Study, concluded that low carbohydrate diets do not seem to be linked to higher risk of heart disease in women.”

The effect of high fat/protein and low carbohydrate diets on weight loss and blood lipid is one thing, but what about the longer term effect of saturated fat consumption and adverse cardiovascular events? Loren Cordain outlines some of this in his most recent book “The Paleo Answers.” I pulled the reference articles he discusses in the book and took a look for myself. It’s not that I don’t trust what I’m reading, but we all should make it a habit of not blindly following what someone tells us without looking into it further (so feel free to check up after me).

So, the most recent evidence is outlined in a paper published in 2010 in Lipids, by Micha and Mozaffarian. This study reviewed the most recent studies to date specifically examining the association between saturated fat consumption and various cardiovascular events. I was surprised to find the mountain of evidence on saturated fat consumption and cardiovascular events only included 11 prospective studies (studies that follow people over time) and 8 randomized controlled trials (the gold standard for research). This in and of itself should raise some red flags about the supposed mountain of evidence. The limited number of studies in this area raises serious concerns of publication bias; rather, there are many more studies that showed no significant findings that were not published. Nonetheless, this review of published studies showed no effect of saturated fat consumption on cardiovascular events. What’s interesting is this particular study also examined these relationships in the context of other macronutrient substitution. So, if you replaced saturated fat consumption with other types of fats (monounsaturated, polyunsaturated) or carbohydrates what happens? The review found replacing saturated fat with carbohydrates actually increased the risk of cardiovascular events. Review of the 8 randomized controlled trials showed similar results, no significant affect of saturated fat consumption and cardiovascular events.

Let me pause and make a public confession. I used to be a low carbohydrate hater. Yes it’s true and boy do I feel stupid. I was wrong and feel I should issue a public apology. I remember spouting off relentlessly when someone even breathed the word “Atkins Diet” in my presence. Now I don’t advocate for the Atkins Diet for various reasons, but I am a believer in a low/smart carbohydrate approach to eating.

Now that my public apology is over, let’s get back to the point. If the most current review of the medical literature available indicates no association between saturated fat intake, blood lipid levels, and cardiovascular events, why do the current dietary recommendations say we should reduce fat intake and eat more carbohydrates? Excellent question that directs us back to the issue of paradigms.

Public Policy

The original paradigm guiding the current recommendations can be traced back to a gentleman named Ancel Keys and the Seven Countries Heart Study published in the late 1960’s. In many regards this study was ahead of it’s time and was probably the best that could be done with the resources available. This was before things like SAS, STATA, SPSS and various other statistical software packages were available making it way too easy for anyone (including myself) to do statistical analysis. Anyway, this study found a perfect linear correlation between fat consumption and coronary heart disease using seven countries as data points. Although an ecological study, the results seemed pretty darn convincing. The results of this study became the guiding paradigm reflected in our current nutritional recommendations. There’s only one problem, there were actually 22 countries included in the original study (not 7). I do not want to beat up on Dr. Keys or question the gentleman’s scientific integrity, but it does seem like a classic case of data cherry picking. When examining these same relationships including all 22 countries available, it turns out there was no detectable correlation between fat consumption and coronary heart disease. In fact, you can easily show the exact opposite correlation if you select seven different countries. This issue has been documented in several places so I don’t want to belabor the point. You can look this stuff up for yourself. If you want more information on the data with 22 countries you can find it here http://high-fat-nutrition.blogspot.com/2009/02/cholesterol-presentation-between.html or look up Gary Taubes. This has been well documented.

Shortly after Keys released his study, the McGovern Committee on Nutrition and Human Needs released their dietary recommendations for the country (1977). Acutely aware of Dr. Key’s work, to no surprise the committee recommended avoiding saturated fat and increasing carbohydrate consumption. Again, I don’t want to beat up on the McGovern Committee; this group did a tremendous amount of excellent work on poverty, food insecurity, and malnutrition. However, the fact remains this committee promulgated the same faulty paradigm institutionalizing the low fat/high carbohydrate message into the medical community and general populous. After the recommendations were met with significant opposition from various industries and others in the scientific community, the responsibility for providing nutritional recommendations were handed over to the United States Department of Agriculture (USDA) and the Department of Health and Human Services (DHHS) in 1980. The results were no different, the continued promulgation of a faulty paradigm. What’s interesting to me is the fact these recommendations have been met with opposition from other scientists from day one. The science behind the paradigm was never overwhelming or indisputable.

To make a bad situation worse mix in the Nixon administration, farm subsidies, and the proliferation of cheap grains into the food supply and you have yourself a nice little perfect storm of poor nutrition policy. For various reasons that are beyond the scope of this post, the Nixon administration was met with rising inflation and food prices heading into an election year. In an effort to stabilize food prices, in 1973 the administration altered the structure of farm subsidies to grain farmers, flooded the market with inventory driving down prices for grains (wheat, corn, soy). This made the production of things like high fructose corn syrup (sugar sweetened beverages) and various other low fat, high carbohydrate rich foods very cheap, easy to produce, and readily available for consumers. The affect of these polices spilled over into other areas as grains for cattle feed became much cheaper artificially lowering the price and quality of meat from cattle farms. Ironically, the subsidies available making grain prices artificially low are not readily available for fruit, vegetable, and range cattle farmers.

What’s the point?

The point is this, much of the historical basis for our current nutritional recommendations stemmed from a study that turns out to be very misleading. This is compounded by the fact governmental food policies have made calorically dense/nutrient deficient carbohydrates readily available for consumption (see paragraph 3). The science supporting a high carbohydrate/low fat diet is shaky at best and I would argue there’s more evidence to the contrary. Referring to our previous analogy, current evidence continues to pull the corner piece from the Jenga puzzle; the prevailing paradigm guiding nutritional policy for the past 30 years is crumbling. So why doesn’t the puzzle fall? At least from my perspective it’s because the paradigm found its way into public policy rather quickly and once something becomes public policy it’s darn near impossible to weed it out. It requires politicians to admit they were wrong and those financially benefiting from these recommendations to let it go. When’s the last time that happened? The final point is you are really on your own when it comes to figuring out what type of approach to eating you should take. We have all received bad advice for the past 30 years. Thankfully, solid science is emerging and we can now educate ourselves and adjust accordingly. 

What does this mean to you…

High fat/protein, low carbohydrate diets are not some fringe, gimmicky diet. They are legitimate and the most current research available indicates they actually perform better than high carbohydrate/low fat diets for weight loss and blood lipid control. From my perspective a Paleo approach to eating is by far the most well balanced, practical approach to eating I’ve come across that has the science to back it up. Eating lean meats, vegetables, fruits, nuts, seeds, roots, and tubers by default keeps carbohydrate consumption smart/low, controlling blood sugar swings and insulin responses. Moreover, this approach to eating makes your body an efficient fat burner which is great for increased energy and performance.

Should you consume copious amounts of saturated fat eating Paleo? Not necessarily, but you shouldn’t be scared of it. If you recall from above, substitution of saturated fat with carbohydrates was associated with an increase in adverse cardiovascular events; however, substitution with monounsaturated fats and to some degree polyunsaturated fats of the fish variety is associated with a decrease in cardiovascular events. Eating a well-balanced Paleo diet should provide a good mix of quality saturated, monounsaturated, and polyunsaturated fat. Regular consumption of Paleo staples such as coconut oil, avocados, olive oil, nuts, and omega-3 rich meats/fish, vegetables and fruits while limiting intake of grain based carbohydrates should put you in pretty good shape.

Let me be explicitly clear. The absolute worse thing you can do is consume a diet rich in saturated fat and high in carbohydrates, I would call this the biscuits and gravy approach to eating. You get the short end of both sticks and a ticket to early departure. You are left with two options. You can choose to continue following the current recommendations of the past 30 years, starve to death, and continue to be frustrated with the results. Or, you can join me in eating Paleo , not be hungry, have plenty of energy, and look better naked.

To get started on Paleo, check out my July post Paleo-Jitsu: Black Belt Nutrition

Paleo-Jitsu: Black Belt Nutrition

I’ve found getting this blog up and going to be a little challenging. Given my occupation the last thing I want to do is perpetuate subjective opinion, bad science, and the alternative agendas of people trying to sell useless alternative health products. Perhaps that’s why I feel the need to launch into a long drawn out explanation of my independent investigation into the science behind Paleo and my conclusions. Recommending a specific diet is not something I take lightly, particularly when the diet flies in the face of conventional wisdom. Despite my impulses to turn this blog into a position paper on why I think Paleo is a nutritional paradigm shifter, I think it’s more important to provide practical advice on how to get started. I’ll address the various psychological hurdles many may face (like why fat is not bad) in future posts.

Paleo

Eating Paleo consists of eating meats, vegetables, fruit, seeds, nuts, roots (sweet potatoes), and tubers (yams). These foods are nutritional powerhouses, natural, and should serve as the cornerstone of a Paleo diet. Noticeably absent from the list of Paleo recommended foods are sugar, sugar’s drunk Uncle Bob high fructose corn syrup, cereal grains (wheat, rice, corn, oats, barley, etc), dairy, and legumes (beans). There are several reasons why these foods are on the no-fly list. The general argument, in the most primitive sense, is these foods were not around until ~10,000 years ago following the agricultural revolution and our bodies are not well adapted to them so they are not considered Paleo. I think there are more compelling arguments as to why these foods should be avoided I will discuss below.

Palo-Jitsu

Recently there has been some discussion of what it actually means to be Paleo. The salient theme of the discussion centers around the notion Paleo should be used as a template or starting point for making dietary choices. I tend to agree with this concept of Paleo. I’ve started thinking of Paleo more of a continuum of food choices with flexibility to slide to the left or right depending on individual needs and tolerances (with some caveats). To help illustrate this concept, I’ve formulated my own Paleo continuum of food choices to help my family and friends get started.

I’ve presented my Paleo continuum in the context of another paradigm shifter, Gracie Jiu-Jitsu. Similar to Paleo, Gracie Jiu-Jitsu also turned conventional wisdom upside down and ushered in a new paradigm for martial arts. This is my way of combining my two passions (outside of my wife and beautiful girls) into one. As a point of reference I have been training Jiu-jitsu for 10 years so I’m well aware there two more belts (brown and blue) not included in my continuum. However, for simplicity sake, I kept the Paleo-Jitsu food continuum to the three levels illustrated below.

Black Belt Foods	Purple Belt Foods	White Belt Foods
Meats(preferably grass fed)	White Potatoes	Sugar
Fish, chicken, beef, pork, turkey	Fermented Dairy	High Fructose Corn Syrup
Vegetables	Butter, yogurt, cheese	Cereal Grains (gluten)
Fruits	Pseudo grains (quinoa)	Wheat, oats, barley, soy
Eggs	Beans/legumes	Industrial seed oils
Fats	Cereal Grains (non-gluten)	Canola, soy, corn, etc
Avocados, nuts, coconut/olive oil	Rice (white)/corn
Sweet Potatoes/yams	Alcohol (gluten free)
Fatty meats (bacon, sausage)	Red wine/hard ciders
Sweeteners
Honey/maple syrup/cocoa (>70%)

Paleo-Jitsu Explained

If you want to eat Paleo you really need to roll with black belt foods. These should represent the overwhelming majority of your food choices. The Paleo black belt foods I have listed are in a hierarchy of importance. Meat, vegetables, fruits, good fats, and smart carbohydrates (sweet potatoes) should form the bulk of your diet. The additional foods in italics are those that are technically Paleo, but I suggest consuming in relative moderation. They are fine but you probably don’t want to be eating these on a daily basis. I tend to think of these more as black belt treats.

One of my favorite aspects of Paleo is the fact you don’t have to weigh, measure, count, or do any other annoying administrative activities associated with dieting. Just eat Paleo black belt foods; eat when you are hungry and stop when you are full. I’m trying really hard to resist the temptation to go into detail on what changes are going on in your body. The most important things you need to know are:

·        Paleo black belt foods control insulin levels/swings

·        Paleo black belt foods remove gut irritants from the diet, reducing systemic inflammation

·        Paleo black belt foods allow you to switch your primary source of energy from carbohydrates to fat (very important concept)

Let me pause briefly and address bullet number three as I think it’s pretty important and interesting. One thing you will notice after a few days/weeks on Paleo is your energy levels will be much better. Although I also noticed an increase in my energy levels, I wanted to verify the science behind this statement. I checked out an exercise physiology sports nutrition and energy metabolism book published in 2008 from the University Library. This is not a Paleo book; it’s an academic text book. In a chapter on protein metabolism, the book actually goes into detail on how your body adapts to conserve protein in a lower carbohydrate environment. Basically, your body down regulates enzymes that promote carbohydrate metabolism and up regulates enzymes that control the level of fatty acids and amino acids in energy metabolism. It also discusses the fact that fat is a more efficient fuel source and yields more ATP (body’s usable energy) per capita when metabolized than carbohydrates. Your body has an endless supply of fat but a limited supply of carbohydrates that can be used for fuel, so the premise makes sense. Fat is a more efficient fuel source and your body can switch from carbohydrate to fat metabolism. The carbohydrates you do need for vital organs that only run on glucose (such as the brain) can come from fruits/vegetables and your body can actually make them through a process called gluconeogenesis.

Back to the main show…..Purple belt foods are a little more difficult to articulate, mostly because these tend to be gray areas. They are not Paleo by fundamentalist standards and in their natural state, contain certain anti-nutrient properties that can cause some problems if ingested. However, recent studies/commentary suggests fermented, soaking, heating, or cooking can neutralize many of the anti-nutrient properties to some degree. This is where the sliding left and right based on individual needs and tolerances comes into play. The bottom line is if you consume Paleo purple belt foods from time to time it’s not going to be particularly problematic provided you tolerate them well; but here’s my argument against these foods. In raw form they have natural defense mechanisms that are designed to make predators sick if consumed. If you have to take heroic measures to neutralize recognized anti-nutrient properties so they are OK to eat, do you really want to when there are perfectly nutritious alternatives available? From my perspective consistently substituting purple belt foods for vegetables/fruits reduces the nutrient density of your meals and undermines your progress towards optimal health and well being. These foods simply do not pack the nutritional punch of Paleo black belt foods. Perhaps I should put it another way, Paleo black belt foods tap out purple belt foods every time, do you want to be a black belt or a purple belt?

White belt foods are only good for beating up on, just like Jiu-Jitsu white belts (just kidding). These foods serve no purpose and should be avoided. There’s no gray area on white belt foods, they are not good for you even in moderation. The worst offenders are sugar, high fructose corn syrup, gluten containing cereal grains (wheat, oats, barley), and industrial seed oils (soybean oil, canola oil, corn oil, etc). With that said do I have white belt foods from time to time? Absolutely, and I don’t feel bad about it either. These are exceptions, not part of my primary diet. I usually save these for special occasions that require social interaction, things like birthday/holiday parties.

Tying It Together 

There are different recommendations on how to get started. Rob Wolf (The Paleo Solution) recommends 30 days of strict Paleo to get started, Loren Cordain (The Paleo Diet, The Paleo Answers) recommends an 85/15 split (eating Paleo 85% of your meals), and others recommend 80/20. Honestly, I’m less concerned with which one you follow as long as you start eating Paleo. When I first started I stayed around at 85/15 and it worked fine for me. I felt so good after a few weeks I really didn’t want to eat non-Paleo so now I’m probably 95/5.

The difficult part is the initial start up, so I suggest you formulate a plan of attack for the first week or two. The first book I read (The Paleo Solution) has a 30 day meal plan. I also ordered a couple other Paleo cookbooks (Everyday Paleo by Sara Fragoso and a kid’s book “Eat Like a Dinosaur” by the Paleo Parents). Both of these are great and there are cool recipes in the books, but I found them to be a little intimidating. Many of the dishes were pretty involved for a novice cook and included foods, spices, cooking methods I was not familiar with. The thought of buying all the ingredients and trying to cook such a variety of meals was a bit overwhelming.

What helped me tremendously was to take foods/meals I already ate and make them Paleo. I don’t need a lot of variety so I came up with a 2-3 go-to breakfast options and 3-5 for dinner and rotated. I wanted to see if the diet was legit so I was less concerned with developing my inner Bobby Flay and more concerned about observing the results. I found simple things like substituting sweet potatoes for white potatoes or skipping the rice for a double serving of vegetables worked well. Meat and vegetable stir-fry’s are a good, simple option when you first get started. A couple times a week I picked a new recipe form one of the books and gave it a shot. Some were keepers others were not. Eventually you build more variety (although I still have my 2-3 go-to breakfasts). Also, there’s an endless supply of Paleo recipes online if you are feeling froggy.

Sometimes it can be helpful to see a real example, so here is what I have eaten the past 5 days (including July 4^th):

Day 1- Breakfast: spinach omelet w/sliced avocado (spinach sautéed in coconut oil); Lunch: apples w/ almond butter; Dinner: baked chicken leg quarter, broccoli, sweet baked sweet potatoes fries (olive oil and cinnamon)

Day 2- Breakfast: Paleo cakes (2 mashed up bananas, 1 egg, 2 tablespoons of almond butter cooked in coconut oil on the griddle), strawberries; Lunch: left over chick leg quarter, salad (spinach, red bell pepper, cucumber, green onion, tomatoes, olive oil and balsamic vinegar), handful of walnuts; Dinner: spaghetti (my wife’s spaghetti sauce with beef), spaghetti squash as noodles; Treat: Paleo cookies (almond butter, apple, pumpkin, banana, coconut milk, coconut flour, walnuts, and cinnamon)  

Day 3- Breakfast: leftover Paleo cookies (yes, cookies for breakfast); Lunch: left over spaghetti, cashews Dinner: sweet potato cakes, eggs, avocado, and bacon

Day 4- Breakfast: Paleo cakes; Lunch: left over sweet potato cakes, pistachios; Dinner: tilapia, assortment of steamed veggies, green beans (technically a legume, but has vegetable properties)

Day 5- Breakfast: spinach omelet; Lunch: Chick-Fil-A grilled chicken salad w/ 2 fruit cup sides; Afternoon Snack: carrot juice, left over tilapia (needed to replenish glycogen stores after an ill advised workout in 100 degree heat) Dinner: grilled burgers (no bun) topped with guacamole, baked sweet potato fries, Paleo cookies and a Woodchuck Cider (c’mon, it’s the 4^th of July)

For any other nutrition nerds reading, I did a quick macronutrient breakdown of the past 5 days in general 45-50% of my calories are coming from fat (13-15% saturated), 25-30% from carbohydrates and 20-25% from protein. This is probably a little carbohydrate heavy if you goal is weight loss, but I’m pretty active so it works well for me. I normally wouldn’t make two batches of Paleo cookies is such a short period of time, but it was the 4^th of July. That probably bumped my carbohydrate intake up. 

I’m generally good to go with breakfast and dinner. Lunch tends to give me the most trouble. Often I eat a pretty big breakfast that carries me through the day so I only need a snack for lunch which generally consists of fruit and nuts. Of course I can make a salad but that get’s a little old. What I’ve started doing lately that seems to be working well is making extra meat/protein for dinner and eating that for lunch with some additional fruit/veggies/nuts. That’s helped me get some additional calories in to offset my energy expenditures. The fact that I’m to the point of trying to add calories even though I’m not really hungry should give you an indication of how well Paleo works.

Summing Up

All that’s left to do is give it a shot. I promise you will not be disappointed. If you don’t have more energy, trim up, and feel better than you have in a long time I’ll refund your money for the free advice (sit on that one for a minute). So…..

·        Eat mostly Paleo black belt foods

·        Be vary cautious when contemplating purple belt foods

·        Stay away from white belt foods except to beat them up

Some of my go-to sources of information:

Rob Wolf ( http://robbwolf.com/ )

Mark Sisson ( www.marksdailyapple.com )

Chris Kresser ( http://chriskresser.com/beyondpaleo )

A special thanks to my beautiful wife for proofreading this post. Despite having a terminal degree, I still seem to have trouble with spelling and punctuation. I would love to hear how you are doing. My email address is nathan.l.hale@gmail.com

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