The Paleo Diet, otherwise known as the “Caveman Diet,” is hugely popular at the moment. And lots of folks want to know how it plays with diabetes...
The DiabetesMine Team has taken a deep dive here into what this eating plan entails, and what nutrition experts and research have to say about it.
What is Paleo?
The basic idea of the Paleo Diet is returning to our dietary roots. That is, the name is short for “Paleolithic” referring to the Stone Age, when humans had a very simple diet of whole, unprocessed foods. The theory here is that if we go back to eating that way, we’ll all be healthier and toxin-free.
This diet is super-trendy at the moment as almost a modern “cure-all,” but the premise is based on scientific evidence about what early humans ate.
Established by health scholar Loren Cordrain, Paleo assumes that humans were genetically and evolutionarily designed to eat foods that were available during the Paleolithic era, versus the agriculturally-based diet that was only developed in the last 10,000 years -- and even more so the processed and chemically-based diet of the last hundred years.
The diet consists of lean meats, vegetables, fruits, and nuts. What’s missing are all processed foods, grains, dairy, and legumes, along with simple sugars and artificial sweeteners. Because, you know... cavemen didn’t eat that stuff.
According experts, the Paleo Diet is high in protein, fiber and healthy fats; high in potassium salt intake and low in sodium salt (healthier option); and provides dietary acid and alkaline balance as well as high intake of vitamins, minerals, plant phytochemicals and antioxidants. It’s also quite low-carb -- a plus for those of us with diabetes, to be sure!
But for many people, it is difficult to make a long-term commitment to swear off ALL cereal, pasta, bread and rice, dairy foods, beans and peanuts, potatoes and processed foods.
Still, the Paleo Diet has a huge following, has inspired something called the Ancestral Health Movement, and now even has its own annual conference in Austin, TX: Paleo f(x), billed as “the world’s premier wellness event, covering health, nutrition, fitness, sustainability, and everything in between.“
Health Benefits of the Paleo Diet?
Paleo followers believe that eliminating certain foods in their diet will reduce inflammation in the body, and folks will enjoy health benefits like weight loss, reduced bloating, clearer skin, and more energy.
You may wonder why the Paleo Diet cuts out whole grains, dairy and legumes, when we’ve been told for decades that stuff is good for us?
The answer is that some health experts attribute the rise in heart disease, cancer, type 2 diabetes and other diseases to our 10,000-year-old "diet of agriculture." The fact is that most Americans consume far more carbohydrates than we really need on a daily basis, and our waistlines prove it. Many experts now believe that carbohydrates, especially processed foods but even grains, stimulate the appetite because the brain doesn't respond to the nutrients the same way it does to meats and vegetables. Think about it: how many of you can eat one tortilla chip after another without stopping? How many of you can say the same thing about chicken breast?
"Legumes and whole grains contain some of the highest concentrations of anti-nutrients in any foods," Paleo founder Cordrain writes. "These compounds frequently increase intestinal permeability and cause a condition known as "leaky gut," a necessary first step in almost all autoimmune diseases. Further, a leaky gut likely underlies chronic, low-grade inflammation, which underlies not only autoimmune diseases, but also heart disease and cancer."
However, there is also plenty of research showing that whole grains and legumes are good for you, but that simply overdoing it on the anti-nutrients will cause problems for your gut.
Some experts simply point out that grains have fewer benefits compared to fruit and veggies, therefore due to the potentially unsavory consequences, they think we should stick to a non-grain diet. In addition, many people also report seeing health improvements when going gluten-free.
Dairy is probably the most hotly debated area of the Paleo movement. The reason: dairy can actually be really good for you. But it can also be bad for you. Dairy that comes from hormone and antibiotic-infused cows living in incredibly close quarters should probably be avoided. High-fat, and even raw (if you can find it), dairy is recommended because it has a good mixture of protein, fat, and carbohydrates.
In addition, the dangers of saturated fat and cholesterol, which originally scared many people away from the ultra-low-carb Atkins diet, are now believed to have been overstated. Newer research indicates that dietary saturated fat and cholesterol does not raise the body's cholesterol. The foods that replaced them, like margarine, may have actually caused more disease than the foods the health authorities originally blamed. So enjoy those eggs!
While the health benefits of Paleo eating have been greatly hyped, many experts doubt whether it is any better than a Mediterranean, Ketogenic or Vegan diet that also focus on whole foods but are less restrictive.
The Paleo Diet and Diabetes
So is the Paleo Diet ideally suited to diabetes?
He points out the lack of hard scientific data on what is the best way of eating for people with diabetes (see Research section, below).
“When I started exploring the Paleolithic diet as an approach to diabetes several years ago, my first concern was whether it provided adequate basic nutrition. I.e., enough vitamins, minerals, essential fatty acids, fiber, protein, etc. I convinced myself it is indeed adequate,” Dr. Parker says.
On the question of whether he specifically recommends Paleo for PWDs (people with diabetes), he says: “As your readers are aware, each case of diabetes is unique... Whether type 1 or 2, PWDs have variable degrees of insulin resistance and sensitivity, which will affect food choices. The individual PWD may have to experiment with different diets to see which is best for (them), based on overall sense of well-being, glycemic control, other medical conditions present, age, cost, food preferences, etc.”
We posed the same question to a number of experts, and the consensus seemed to be that Paleo eating is basically “diabetes-neutral,” meaning it’s not inherently better or worse for people with diabetes than most other diets.
“Since the Paleo Diet completely eliminates the typical foods of indulgence -- desserts, pizza, French fries, sweetened beverages, etc. -- people who strictly follow the plan often have improved blood glucose levels, more healthful cholesterol levels, reduced triglyceride, more energy, better sleep and other improvements. They may even drop a few pounds. However, these gains are very likely the result of eating less (or no) highly processed, nutrient-poor and high-calorie foods and not so much the result of the specific Paleo plan,” says Jill Weisenberger, a Virginia-based registered dietitian nutritionist, certified diabetes educator (CDE) and certified health and wellness coach.
Susan Weiner, a registered dietitian nutritionist and CDE in New York who’s also a published author and was named AADE’s 2015 Certified Diabetes Educator of the Year, reminds us that animals and plants have evolved significantly since the days of our ancestors. Therefore, what we are eating now is not the same nutritionally as what our ancestors ate.
“It’s also important to point out that our ancestors simply had shorter life spans than we do, and therefore may not have developed many of the diseases that we have today,” Weiner says. “Additionally, the ‘Paleo’ friendly fruits and vegetables were vastly different than what is agriculturally available today. So it’s not as simple as making a one-on-one comparison to what our ancestors ate 10,000 years ago… our ancestors (cavemen) also did not just live in one place, they ate differently depending on their environments.”
Certain principles of the Paleo Diet, such as reducing consumption of processed food and limiting salt and sugar intake, can be beneficial to people with diabetes, Weiner says. “However, trying to completely eliminate all processed foods from your diet for the rest of your life is challenging (to say the least), and may put a lot of pressure on a person who has diabetes and other daily concerns around diabetes management.”
Weiner adds that completely cutting out beans, legumes and dairy may be too restrictive for some people who have diabetes and may have other health consequences such as reduced fiber intake. She notes two other drawbacks as well: overly restrictive diets may worsen disordered eating behaviors, and it can also be expensive to purchase organic foods suggested on this diet plan.
Christel Oerum, a longtime type 1 and diabetes advocate who is a certified personal trainer, bikini fitness champion and founder of TheFitBlog, looks at the Paleo Diet through the eyes of a knowledgeable patient and health coach. She says:
“I like many of the underlying ideas of the Paleo Diet, primarily the focus on eating ‘real’ unprocessed foods. I am also a fan of getting enough protein and not being afraid of healthy fats. But from a diabetes perspective, I do find the Paleo Diet’s approach to carbohydrates a little challenging. While it’s not a low-carb diet per se, it does restrict a large number of complex carbs (only sweet potato is allowed) while allowing more high glycemic carbohydrates like honey and dried / fresh fruit. I have nothing against high glycemic carbohydrates in small amounts and at the right time, but including them in high quantities will make good blood sugar management very challenging.”
Research On the Paleo Diet Says…
There are in fact precious few research studies done on effects of the Paleo Diet -- just a couple of short-term studies including a relatively small number of people, the experts tell us.
Weisenberger points out a “small but well-designed study” from 2009, in which 13 people with type 2 diabetes ate both a Paleo Diet and a non-Paleo Diet for three months each. On average, they had lower weight, A1C, triglyceride and diastolic blood pressure levels after consuming the Paleo Diet.
“However, this does not suggest to me that the Paleo Diet is superior to other diet plans. That’s because following the Paleo Diet resulted in the consumption of less carbohydrate (on average 71 g less daily), fewer calories (on average ~300 calories less daily) and less saturated fat (on average 8 g less daily), among other differences. These are very big differences. I suspect that if the calorie and carbohydrate contents of the diets were held identical, the results would be more similar. Changes in glucose tolerance did not differ between the two diet periods, by the way,”
Weiner highlights a similar UC San Francisco study from 2011 in which two small groups of people with type 2 diabetes ate either a Paleo or Mediterranean diet for several weeks running. Results showed that the Paleo group had improvement in blood pressure, blood sugar and cholesterol levels.
But she also has reservations about reading too much into those results. “The people in the study may not have been food shopping and preparing healthy meals prior to adopting healthier habits (in the study) such as eating less processed foods and more vegetables,” she says. “More research needs to be done to see if this type of eating plan has long lasting effects on blood sugar levels and diabetes.”
Note that in U.S. News and World Report’s 2014 ranking of Best Diets Overall (compiled with the help of top health and nutrition experts), Paleo tied for last in a group of 32 diets, with this comment: “Experts took issue with the diet on every measure. Regardless of the goal — weight loss, heart health, or finding a diet that’s easy to follow — most experts concluded that it would be better for dieters to look elsewhere.” No. 1? The government-developed DASH (Dietary Approaches to Stop Hypertension) diet.
Best and Worst Paleo Foods for Diabetes
Experts agree that lean meats, vegetables, and nuts are all great choices for PWDs, yet as Oerum notes, the Paleo emphasis on fruit (with all its natural sugar) definitely gives some people pause.
Interestingly, in the 2009 study, the participants assigned to the Paleo Diet who lowered their A1C levels had consumed less carbohydrates overall, but they consumed more fruit -- almost twice as much as the control group. “I know many PWDs who fear eating fruit because of its sugar content. This should help allay those worries,” Weisenberger says.
Many Paleo bloggers and their readers readily admit that “eating like a caveman” is more of a general principle, because there was no single caveman diet. It's kind of like telling someone today to eat like a human. The caveman diet likely ranged from primarily meats to primarily plants, depending on where the cave-folks lived. Plus, many Paleo followers now insert various ingredients to "paleo-ify" certain foods, such as kale chips, spaghetti bolognese made with spaghetti squash, and banana bread made with almond flour. Certainly not something a caveman would have dined on! But all good options for diabetes, actually.
For her part, Weiner says: “I believe in individualized nutrition choices for people with diabetes. Small and sustainable adjustments to your current meal plan is usually most effective to help positively influence your blood sugar levels. Try reducing your intake of processed food and adding in more fresh vegetables and lean protein. It doesn’t matter what you ‘name’ the meal plan that works best for you and your diabetes.”
What does she herself eat? Lots of vegetables, some fruits, nuts, fish, lowfat and nondairy items and all types of plant-based proteins, along with chicken, turkey, beef etc.
A Low-Carb Version of Paleo
Paleobetic author Dr. Parker sums it up this way: “Just as nature has designed each animal species to thrive on certain foods, we humans are healthiest eating particular nature-made foods, not man-made… The Paleo diet is a reasonable one for diabetes. A low-carb version should be even better.”
“Why do I favor carbohydrate restriction?” he writes to us. “For T2D, it allows minimization of diabetic drug usage. The problem with most of our diabetes drugs is that we don’t know the
long-term safety and side effects (metformin and insulin are exceptions). For example, it took us 15-20 years to figure out that metformin can cause vitamin B12 deficiency. Taking three or four high-dose diabetes drugs is an open-ended N=1 experiment with unknown outcome. For T1D, carb restriction allows minimization of insulin dose, which in many folks cuts down their episodes of hypoglycemia.
“Furthermore, many experts think high insulin levels (hyperinsulinemia) cause some of the complications of diabetes and aging, such as vascular disease and high blood pressure. A type 1 PWD who is overweight and using more than 70-80 units of insulin daily is probably insulin resistant and hyperinsulinemic. Why not reduce carbs and insulin dose?”
He adds that if he had diabetes himself, he would follow a diet limited to 30 to 100 grams a day of carbs, definitely on the lower end if he had type 1.
“These carbohydrate ranges are possible with a Bernstein diet, low-carb Mediterranean, low-carb Paleo, and perhaps even vegetarian,” he adds. “I doubt that the popular generic Paleo diet book diets reduce carbs below 100 grams. They usually don’t even provide carb counts, which I think are important. My personal choice at this stage would be low-carb Mediterranean simply because we have good long-term studies demonstrating (that) is healthful.”
A “Paleobetic” Experience
The Internet is full of testimonials from folks who have “gone paleo” and report a good experience. One example is T1D Lindsay Swanson, who wrote a guest post at the Joslin Diabetes
Center blog reporting that “living paleo has lessened that relentless burden tremendously through consistency and stability.”
When diabetes advocate and former DiabetesMine team member Allison Nimlos first experimented with the Paleo Diet back in 2013, she experienced some amazing results right off the bat. She reported:
1. My blood sugars started dropping right away. It only took a couple of days before I saw that my blood sugars were lower and steadier throughout the day. After a few more days, I started having a fair share of low blood sugars!
2. My basal insulin is impacted by my diet more than my bolus ratios. When I first started dropping frequently — a 3-4 low blood sugars a day — I thought I need to cut everything. Turns out, I did need to drop my Lantus by 10%, but I didn't need to do anything to my bolus ratios. (Yet.)
3. I have the best control in recent memory, but it's not perfect. Like anything that involves tweaking and adjustments, the Paleo Diet is hardly a cure. Now that I'm taking less insulin, there are fewer chances for me to go low, and more chances for me to go high. You can never expect anything -- not a diet, not a medication, not an insulin pump -- to run the show for you.
4. If you eat low-carb, you have to bolus for protein. This was the biggest shock for me. After querying my friends, I discovered that bolusing for approximately half the protein is what I need to do to prevent a post-meal spike. Gary Scheiner, author and CDE at Integrated Diabetes Services, explained, "Since your Central Nervous System needs glucose to function, if your diet is lacking in carbs, the liver will convert some dietary protein into glucose. So it is usually necessary to bolus for some of your protein whenever you have a meal that is very low in carbs." For me, a low-carb meal is anything under 30 grams of carbs.
5. My skin and energy levels improved. Not really diabetes-related, but certainly benefits!
Allison ended up straying from the Paleo Diet after just 7 months because she found it too hard to sustain. “But I do appreciate what I learned from my experience... and the exposure to different types of recipes,” she writes. “I’ve learned to appreciate different cuts of meats, the kinds of substitutions you can do with vegetables (try spaghetti squash instead of pasta!) and the magic of spices.”
And she reminds us not to get too hung up on the “history” or “legitimacy” of the “caveman diet.”
“Almost everyone who actually follows the Paleo Diet recognizes that it’s not historically accurate. It’s not meant to duplicate any kind of historical diet that our ancestors ate. What it is trying to do is get us to eat clean, natural and unprocessed healthy foods. There are a variety of reasons why (enthusiasts) advocate a no-grain, no-legume, no-dairy diet — all of which you can read about in the book “It Starts with Food” or by searching the Internet — but in the end they just want people to eat foods that are healthy and won’t cause any digestive harm.”
Excellent point. It seems the core value of the Paleo Diet and others like it is in getting people to become conscious consumers of as much clean, unprocessed food as possible. And that’s a win for diabetes care, without a doubt.