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).
