Introduction the Paleo Diet

Over at Dave Munger's The Daily Monthly blog, he has been looking at ways to lose some weight in healthy and sustainable way for this month's topic.

Here is his introduction to this month's topic and an explanation of what he is looking for in this exploration:

Can you be fit and healthy without ruining your life?

Posted by Dave on April 1, 2010

I consider myself a relatively fit person. Of course, “relatively” is still relative. I try to watch what I eat. I usually exercise five days a week. Heck, I’ve even run a couple half-marathons. But the rest of my days are pretty much sedentary. I sit in a climate-controlled office staring at my computer screen. I make dinner in my highly automated kitchen. After dinner I sit in the living room sipping wine and watching TV or talking to Greta. Then I go to bed and start the process over again.

That’s not a whole lot of activity for a creature that evolved for endurance. Over a 50 mile course, a race between a man and a horse can be quite competitive. Millions of people all over the world do hard manual labor day in and day out. But millions of others don’t set aside any time for exercise. In my half-marathons, I’ve finished in the top half of competitors, so compared to a lot of people, I must be doing something right. Right? Or do my sedentary days outweigh my occasional bursts of activity? I exercise an average of 4 hours per week. That’s less than 4 percent of my total waking time. Is that really enough to stay fit?

There’s some evidence that a sedentary lifestyle increases mortality, even when exercise levels are taken into account.

I think a lot of people are in my position, living basically sedentary lives and adding in a few minutes here and there for exercise. That’s why, this month, I’m going to discuss fitness. What does it take to be a truly “fit” person? What’s the best way to maximize your health and live a long, active life?

Needless to say, there’s tons of research on the topic, often conflicting. I’ll try to negotiate through as much of it as I can while steering clear of fad diets and scams.

Meanwhile, over the course of the month I’m going to be keeping track of every calorie I consume and every moment of exercise. In fact, I’ve started up an account on a website that allows you to report your consumption to the world, so you can check up on me any time you like by following this link. The site also has an iPhone app, so in principle I should be able to keep track of this stuff wherever I go. I’ll provide updates here from time to time in case you don’t want to check a different site.

One interesting point about the MyFitnessPal site is that it assumes what you want to do is lose weight. You can’t even sign up without entering a weight-loss goal. For the most part, people feel that getting “fit” involves losing weight. I agree, I’d probably be a bit more “attractive” if I lost 20 pounds or so, but would that really make me healthier? There are places on the site to enter your weight, height, and measurements, but no spot to enter other health measures, like resting heart rate, cholesterol levels, and so on. Is this common among the many “fitness” tools out there? I may take some time this month to analyze the most popular fitness web sites and applications, to learn if any one is better than the others (I chose this one because its iPhone app is free and it received better reviews than most of the paid options).

The ultimate goal is to come up with a regimen that doesn’t sacrifice quality of life for health benefits. I’m not going to be eating spelt granola and wheatgrass, and I’m not going to work out for four hours a day. Is it possible to extend and improve your life while still actually living it? With any luck, by the end of this month, we’ll find out.

Since it is my job to do exactly this with my clients, I am very sympathetic to his project here. On the other hand, I know that need to make serious changes to our nutritional habits if we want to be healthy and maintain a healthy weight.

When Dave posted his week one update, he mentioned that we was using the guidelines from the MyFitnessPal site for his nutritional plan. That site gave his the following guidelines for weight loss:

55 percent of my calories should come from carbohydrates, 30 percent from fat, and 15 percent from protein.

My first thought was, "WOW, how out of date is that?" Forward thinking doctors have been recommending higher protein and very little to no grain diets for decades now, with The Adkins Diet, the Zone Diet, the Protein Power Diet, and the Paleo Diet being the most well-known approaches. For me, the Paleo Diet is probably the best overall approach, as long as we are not to strict and are willing to make a few modifications.

This was my comment on Dave's post:

That MyFitnessPal thing is going to make you a fat skinny guy (think Jared from the Subway commercials). You’re eating WAY too many carbs – aim for 30% protein, 40% carbs and 30% fats (only healthy fats), and when that stops working (and it will) drop to 30% carbs and go up to 35% protein and fats (the body does not need carbs to function).

Moreover, try to get most of your carbs from vegetables (higher in fiber, and so much more filling, as well as reducing blood sugar and cholesterol), berries, and starchy vegetables (pumpkin, sweet potatoes, squash) – eat whole grain breads/rice as a last resort.

Proteins should be lean: chicken, turkey, fish, and lean red meat, as well as eggs, and whey protein post-workout.

Fats should be seeds and nuts and nut-butters (walnuts, cashews, almonds, sunflower seeds, pumpkin seeds, flax seed), and olive oil or flax oil – almond oil and walnut oil are also good on salads and good for you.

If you do this with your diet, left weights a few days a week in hard, intense, but brief sessions (40-50 minutes, full-body), and get good sleep, the weight will come right off.

Dave asked for some references to look at my recommendations, and I applaud his willingness to look at other ideas about how to live and eat in a healthy way. Here is the comment I left in response:

My nutritional approach is based on Cordain’s “Paleo Diet” theory. But I am not nearly as strict as he is, recognizing that this is the 21st century and not everything we have invented is bad for us.

I also allow the occasional “cheat meal” after 2-3 weeks of initial adherence to the nutrition plan (depending on progress) – as a way to avoid “craving binges” and as a way to jump-start the metabolism, which slows down as calories are restricted (leptin is the main culprit).

One thing I didn’t mention in my approach is that once my clients reach or near their ideal weight (I’m a fitness trainer, nutritional coach), I advocate an 80/20 approach – do it right 80% of the time and the 20% of the time when you don’t is cool. That way we get to be healthy and still eat foods we like once in a while.

There are some modern conveniences that still work as part of this diet approach, so I am not a purist – 70% or more cocoa content organic dark chocolate (on oz. or so a day) is great for health, and it soothes cravings. Low-fat organic cottage cheese is a great source of non-meat protein.

In reality, however, we need to reprogram our brains to like healthier foods (lower fat and lower sugar). Evolution has programmed us to crave high energy density foods, but now that these foods are ubiquitous and not hard to come by, we have serious health issues as a result of having too much access to the foods and little emotional / cognitive control over eating them.

Peace,
Bill
________

A few studies, in no particular order:

Eric C Westman, Richard D Feinman, John C Mavropoulos, Mary C Vernon, Jeff S Volek, James A Wortman, William S Yancy and Stephen D Phinney. (2007). Low-carbohydrate nutrition and metabolism. American Journal of Clinical Nutrition, Vol. 86, No. 2, 276-284. PMID: 17684196

LA Frassetto, M Schloetter, M Mietus-Synder, RC Morris Jr and A Sebastian. (2009). Metabolic and physiologic improvements from consuming a paleolithic, hunter-gatherer type diet. European Journal of Clinical Nutrition; 1–9. doi:10.1038

Gabriela Radulian,Emilia Rusu, Andreea Dragomir, & Mihaela Posea. (2009). Metabolic effects of low glycaemic index diets. Nutr J. 2009; 8: 5. Published online 2009 January 29. doi: 10.1186/1475-2891-8-5.

Staffan Lindeberg, Loren Cordain, Boyd S. Eaton. (2003). Biological and Clinical Potential of a Palaeolithic Diet. Journal of Nutritional & Environmental Medicine, Volume 13, Issue 3 September 2003 , pages 149 – 160. DOI: 10.1080/13590840310001619397

Cordain L, Eaton SB, Sebastian A, Mann N, Lindeberg S, Watkins BA, et al. (2005). Origins and evolution of the Western diet: health implications for the 21st century. Am J Clin Nutr 81, 341–354.

Frassetto, Lynda A.; Krasnoff, Joanne B.; Mietus-Snyder, Michele; Duda, John; Painter, Patricia L. (2007). Medicine & Science in Sports & Exercise: May, Volume 39, Issue 5; p S286. doi: 10.1249/01.mss.0000274102.15465.3a (conference poster)

Alexander Leaf, and Peter C Weber. (1987). A new era for science in nutrition. Amer J Clin Nutr. 45: 1048-53.

A. Adam-Perrot, P. Clifton, F. Brouns. (2006). Low-carbohydrate diets: nutritional and physiological aspects. Obesity Reviews.
Volume 7, Issue 1 , P. 49 – 58.

Many of these articles (but now all) are available as Open Access, so if you are interested in reading them yourself you can just search for the title.

Again, Dave took my offerings seriously and reviewed some of the research in his most recent post, Glycemic What? His initial look at the material seems to confirm my point of view:

I asked Bill if he could provide any references to support his claims, and he did. So I decided to pick one of his sources at random and give it a read.

The article, led by Gabriela Radulian, reviews several studies on foods with low glycemic indexes. What’s a glycemic index? Wikipedia has a pretty good summary:

The glycemic index, glycaemic index, or GI is a measure of the effects of carbohydrates on blood sugar levels. Carbohydrates that break down quickly during digestion and release glucose rapidly into the bloodstream have a high GI; carbohydrates that break down more slowly, releasing glucose more gradually into the bloodstream, have a low GI. The concept was developed by Dr. David J. Jenkins and colleagues in 1980–1981 at the University of Toronto in their research to find out which foods were best for people with diabetes.

If carbohydrates break down more slowly, the theory goes, then you’re not hungry so quickly after you eat them. It makes some sense: If I eat a bag of potato chips (high GI), I’m hungry 15 minutes later. If I eat a bowl of oatmeal with the same number of calories, I can be satisfied for hours.

Radulian’s team, after reviewing dozens of studies, concluded that diets with low GIs can help with weight loss and also reduce blood pressure and inflammation that lead to heart disease, and also reduce insulin resistance and other factors leading to diabetes.

This particular study doesn’t discuss protein intake, another factor in the “paleo diet” Bill advocates, but another study does. I haven’t read it, but Yoni Freedhoff has. After studying hundreds of families with overweight or obesity problems, researchers found that the only diet that was successful in keeping weight off long-term was a high-protein diet. Low GIs didn’t help. So, at least for this population, GI isn’t a panacea, but Bill’s theory is holding up fairly well: Protein appears to be a key to weight loss, and low-GI foods have other benefits.

Dave concludes his post by speculating on the possible health impact of making the switch from the usual Western diet to the more healthy Paleo style diet. He raises a good point - we have no good longitudinal studies since the research into these diets is all relatively recent (for years, no one took these ideas seriously, but that is now changes).

Here are a couple of articles looking at the health benefits of eating a Paleo style style:

Metabolic and physiologic improvements from consuming a paleolithic, hunter-gatherer type diet

LA Frassetto, M Schloetter, M Mietus-Synder, RC Morris Jr and A Sebastian

Background: The contemporary American diet figures centrally in the pathogenesis of numerous chronic diseases—‘diseases of civilization’. We investigated in humans whether a diet similar to that consumed by our preagricultural hunter-gatherer ancestors (that is, a paleolithic type diet) confers health benefits.

Methods: We performed an outpatient, metabolically controlled study, in nine nonobese sedentary healthy volunteers, ensuring no weight loss by daily weight. We compared the findings when the participants consumed their usual diet with those when they consumed a paleolithic type diet. The participants consumed their usual diet for 3 days, three ramp-up diets of increasing potassium and fiber for 7 days, then a paleolithic type diet comprising lean meat, fruits, vegetables and nuts, and excluding nonpaleolithic type foods, such as cereal grains, dairy or legumes, for 10 days. Outcomes included arterial blood pressure (BP); 24-h urine sodium and potassium excretion; plasma glucose and insulin areas under the curve (AUC) during a 2 h oral glucose tolerance test (OGTT); insulin sensitivity; plasma lipid concentrations; and brachial artery reactivity in response to ischemia.

Results: Compared with the baseline (usual) diet, we observed (a) significant reductions in BP associated with improved arterial distensibility (-3.1±2.9, P=0.01 and + 0.19±0.23, P = .05); (b) significant reduction in plasma insulin vs time AUC, during the OGTT (P=0.006); and (c) large significant reductions in total cholesterol, low-density lipoproteins (LDL) and triglycerides (-0.8±0.6 (P = 0.007), -0.7±0.5 (P = 0.003) and -0.3±0.3 (P = 0.01) mmol/l respectively). In all these measured variables, either eight or all nine participants had identical directional responses when switched to paleolithic type diet, that is, near consistently improved status of circulatory, carbohydrate and lipid metabolism/physiology.

Conclusions: Even short-term consumption of a paleolithic type diet improves BP and glucose tolerance, decreases insulin secretion, increases insulin sensitivity and improves lipid profiles without weight loss in healthy sedentary humans.

European Journal of Clinical Nutrition advance online publication, 11 February 2009; doi:10.1038/ejcn.2009.4

Emphasis added in the results section - the benefits of even a short-term adoption of this nutritional approach are dramatic.

Here is another study looking at the health results. This is a review article presented as a plenary at a conference, so I am just posting one crucial idea about diet composition and what is means for health.

A new era for science in nutrition
Alexander Leaf MD, and Peter C Weber, MD

Human beings today, however, are confronted with diet-related health problems that were previously of minor importance and for which prior genetic adaptation has poorly prepared us. Chronic illness, affecting the older postreproductive persons primarily, could have had little selective influence during evolution, yet such conditions are now the major cause of morbidity and mortality in Western nations. As physicians and nutritionists we are increasingly convinced that the dietary habits adopted by Western societies over the past 100 years make an important etiologic contribution to coronary heart disease, hypertension, diabetes, and some types of cancer. These conditions have emerged as dominant health problems only in the past century and, as Eaton and Konner (5) point out, are virtually unknown among the few surviving hunter-gatherer populations whose way of life and eating habits most closely resemble those of preagricultural human beings (6). The longer life expectancy of people in industrialized countries is not the only reason that the chronic illnesses have assumed importance. The members of technologically primitive cultures who survive to the age of 60 years or more remain relatively free from these disorders, unlike their civilized counterparts (7-9).

Eaton and Konner (5) have estimated a proposed average daily macronutrient intake for late paleolithic human beings consuming a 3000 kcal diet containing 35% meat (788 g of game) and 65% vegetable (1464 g) foods with the composition shown in Table 1. Note that despite the very high animal protein intake, fat intake is low by our standards and contains a high proportion of polyunsaturated fatty acids. This important situation arises because game animals were lean and since they foraged for their food rather than being fattened with grains, as are present domesticated meat sources, little of the fat they contained was saturated and the plants they ate provided a relatively high proportion of polyunsaturated fatty acids. Furthermore-and probably highly significant-the fat of wild animals contains appreciable amounts of eicosapentaenoic acid (C20:5n-3), ‘ı-4% (5). Because the vegetable portion of the diet must also have contained appreciable amounts of n-3 polyunsaturated fatty acids including eicosapentaenoic acid (C20:5n-3), it becomes apparent that paleolithic man was ingesting an appreciable amount of these interesting n-3 fatty acids. In contemporary nutrition such quantities of n-3 fatty acids are present only in the diets of Eskimos and Japanese fishermen in whom the incidence of atherosclerosis and its most serious manifestation, coronary artery disease, is very much lower than among Western affluent societies (11, 12).

They raise a crucial point here that I have raised elsewhere - eating grass-fed beef and wild game is crucial to our health if we want to be healthy and still eat meat. The fat content makes a huge difference compared to what we get in feed-lot beef.

Finally, here is one last article that looks at higher protein diets in weight loss, which was Dave's original goal in this month's topic.

Comparison of high-fat and high-protein diets with a high-carbohydrate diet in insulin-resistant obese women.

McAuley KA, Hopkins CM, Smith KJ, McLay RT, Williams SM, Taylor RW, Mann JI.

Edgar National Centre for Diabetes Research, Medical and Surgical Sciences, University of Otago, PO Box 56, Dunedin, New Zealand. kirsten.mcauley@stonebow.otago.ac.nz

Erratum in:

• Diabetologia. 2005 May;48(5):1033.

Comment in:

• Diabetologia. 2005 Jul;48(7):1419; author reply 1422.
• Diabetologia. 2005 Jul;48(7):1420-1; author reply 1422.

Abstract

AIMS/HYPOTHESIS: A diet low in saturated fatty acids and rich in wholegrains, vegetables and fruit is recommended in order to reduce the risk of obesity, cardiovascular disease and type 2 diabetes mellitus. However there is widespread interest in high-fat ("Atkins Diet") and high-protein ("Zone Diet") alternatives to the conventional high-carbohydrate, high-fibre approach. We report on a randomised trial that compared these two alternative approaches with a conventional diet in overweight insulin-resistant women. METHODS: Ninety-six normoglycaemic, insulin-resistant women (BMI >27 kg/m(2)) were randomised to one of three dietary interventions: a high-carbohydrate, high-fibre (HC) diet, the high-fat (HF) Atkins Diet, or the high-protein (HP) Zone Diet. The experimental approach was designed to mimic what might be achieved in clinical practice: the recommendations involved advice concerning food choices and were not prescriptive in terms of total energy. There were supervised weight loss and weight maintenance phases (8 weeks each), but there was no contact between the research team and the participants during the final 8 weeks of the study. Outcome was assessed in terms of body composition and indicators of cardiovascular and diabetes risk. RESULTS: Body weight, waist circumference, triglycerides and insulin levels decreased with all three diets but, apart from insulin, the reductions were significantly greater in the HF and HP groups than in the HC group. These observations suggest that the popular diets reduced insulin resistance to a greater extent than the standard dietary advice did. When compared with the HC diet, the HF and HP diets were shown to produce significantly (p<0.01) p="0.02).">10% increase in LDL cholesterol, whereas this occurred in only 13% of subjects on the HC diet and 3% of those on the HP diet. CONCLUSIONS/INTERPRETATION: In routine practice a reduced-carbohydrate, higher protein diet may be the most appropriate overall approach to reducing the risk of cardiovascular disease and type 2 diabetes. To achieve similar benefits on a HC diet, it may be necessary to increase fibre-rich wholegrains, legumes, vegetables and fruits, and to reduce saturated fatty acids to a greater extent than appears to be achieved by implementing current guidelines. The HF approach appears successful for weight loss in the short term, but lipid levels should be monitored. The potential deleterious effects of the diet in the long term remain a concern.

PMID: 15616799 [PubMed - indexed for MEDLINE]

There you have it - a basic introduction to eating healthier with a Paleo style diet consisting of higher protein, healthy fats, fresh fruits and vegetables, and little to do no dairy or grains.

Tags: nutrition, health, fat loss, paleo diet, Dave Munger, The Daily Monthly, weight loss, high protein, low-carb, Adkins Diet, the Zone Diet, Protein Power, low grain diet, glycemic index