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LDL cholesterol lowered dramatically with psyllium / Metamucil supplement with each meal

By
Julianne
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17

High LDL cholesterol? Have you tried psyllium / Metamucil?

For a while now my LDL cholesterol has been higher that ideal (post menopause which is not uncommon). I’ve written about this before and how I have chosen to explore dietary options rather than medication (statin drugs).

In advance – please do not advise me that high LDL is benign and I shouldn’t give two hoots about it, because my HDL is high and triglycerides low. For a number of reasons I do not subscribe to that for myself. For example:

What I’ve discovered so far:

  • I’m sensitive to dietary saturated fats – dairy and coconut fats increase my LDL.
  • A very low carbohydrate diet increases my LDL

Changing dietary fats to predominantly monounsaturated fats – olive oil, avocado, nuts and their oils led to a decrease in my LDL. I cut out coconut cream in my coffee and replaced it with almond milk. I limit dairy fat, and eat leaner cuts of meat.

Eating more fibre rich carbohydrates and nuts and seeds decreases LDL; legumes, oatbran, vegetables, flax seed, etc. I eat a lot of root vegetables, sweet potatoes are my favourite. I feel my best on a moderate carb diet and it works better for my powerlifting. I eat a large mixed salad at least once a day.

As I’ve written previously – despite these changes my LDL is still high, and probably not helped by menopause and Hashimotos.

Always on the lookout for possible natural strategies to reduce is – this tweet appeared in my feed

Dr Nadolsky noted that both LDL cholesterol and LDL particle numbers reduced. Intriguing. I tweeted back that I would give this a go.

I bought a packet of organic psyllium hulls, and started with one teaspoon in a glass of water with each meal. Best to start slow when you add fibre your body is unfamiliar with. No problems here though – so I increased it to 2 teaspoons per meal. The trick is to take it with meals, not randomly once a day.

Five weeks on I had another lipid test. My LDL had decreased to 3 (from 5.4), my ratio was still similar in fact lower as well, 3.1 down from 3.8. (My HDL decreased from very high 2.2 to 1.7 and triglycerides remained low) Total cholesterol down from 8.3 to 5.2

This was a huge surprise. With all the talk of statin drugs being the only way to reduce cholesterol (by mainstream doctors) I’d never considered using this inexpensive option as a cholesterol lowering protocol.

As a result of my success, I took to PubMed to find out more. Could lowering your cholesterol be as simple as taking a cheap fibre supplement, without side effects of statin medications?

How does psyllium work to reduce LDL cholesterol?

This study investigated the mechanisms by which psyllium fiber works to reduce LDL in hamsters:

Mechanisms of LDL-cholesterol lowering action of psyllium hydrophillic mucilloid in the hamster

Hamsters were chosen as they have similarities to humans in cholesterol metabolism and they the kinetics of LDL production and degradation have been worked out in detail in this animal.

Hamsters were fed a normal hamster cereal based diet with added cholesterol and hydrogenated coconut oil to increase LDL. One group had added psyllium, the other added  microcrystalline cellulose (Avicel refined wood pulp) making up 7.5% of the  diet.

Results:

  • Psyllium decreased total (122.1 ± 4.1 vs. 399.4 ± 39.4 mg/dl) and LDL-cholesterol (46.0 ± 2.2 vs. 143.5 ± 12.0 mg/dl) compared to Avicel. The psyllium LDL measures were the same as the hamsters on a standard diet without the added fats.
  • Psyllium-fed animals had a 44% lower rate of LDL-cholesterol production (167.6 ± 8.1 vs. 300.2 ± 16.0 μg/h per 100 g bw), and a 2.2-fold higher rate of hepatic LDL clearance (50.1 ± 2.3 vs. 22.6 ± 2.1 μl/h per g). The psyllium fully prevented the increase in LDL production by the liver
  • Whole body LDL receptor activity was marginally higher in the hamsters given psyllium (55.9 ± 1.4%) than in those fed Avicel (47.5 ± 3.3%).

In hamsters it markedly stimulates the activity of cholesterol 7a-hydroxylase. Deficiency of this enzyme in humans increases the possibility of cholesterol gallstones, it plays a critical role in the control of bile acid and cholesterol homeostasis (reference).

Proposed mechanisms in humans:

Human studies adding psyllium to the diet:

Meta-analysis of 8 studies: Cholesterol-lowering effects of psyllium intake adjunctive to diet therapy in men and women with hypercholesterolemia: meta-analysis of 8 controlled trials.

Inclusion:

  • Study has a control group
  • Subjects consumes 10.2 psyllium for 8 weeks or more
  • Psyllium was used in conjunction with the American Heart Association Step I diet

Psyllium was given either twice a day (2×5.1g) or 3 times a day (3×3.4g) mixed with water. Placebo was microcrystalline cellulose.

Nine lipid profile measures were analyzed: serum total cholesterol, LDL cholesterol, HDL cholesterol, triacylglycerol, the ratio of LDL to HDL cholesterol, ratio of total to HDL cholesterol, apo A-I, apo B, and the ratio of apo B to apo A-I.

Results

  • Psyllium significantly reduced total and LDL-cholesterol concentrations over 8 wk of treatment compared with placebo and baseline values
  • In this meta-analysis, psyllium lowered serum total cholesterol concentrations an additional 4% and serum LDL-cholesterol concentrations an additional 7% relative to placebo in subjects consuming an AHA Step I diet.
  • Psyllium also significantly lowered serum ratios of apo B to apo A-I an additional 6% relative to placebo.
  • Psyllium did not significantly affect serum HDL-cholesterol or triacylglycerol concentrations.
  • Two individual studies included in this meta-analysis reported significant changes in serum apo concentrations. Bell et al (reference) noted a 6.8% decrease in apo B concentrations relative to placebo in subjects consuming psyllium. Sprecher et al (reference) noted a 6.4% increase from baseline in serum apo A-I concentrations in subjects consuming psyllium. The significant 6% decrease relative to placebo in serum ratios of apo B to apo A-I of subjects consuming psyllium in this meta-analysis is consistent with changes seen in individual studies. Apo B promotes atherogenesis, whereas apo A-I—the protective factor in HDL cholesterol—reduces atherogenesis
  • 5.1 g psyllium 2 times daily or 3.4 g psyllium 3 times daily was equally effective
  • The incidence of adverse events was similar between psyllium and placebo groups. Symptoms involving the digestive system (eg, flatulence, abdominal pain, diarrhea, constipation, dyspepsia, or nausea) and symptoms typical of upper respiratory tract infections were the most commonly reported symptoms for both the psyllium and placebo groups. the overall dropout rate due to adverse events was 3.2% for subjects treated with psyllium, which was comparable with the 2.6% rate for subjects treated with placebo.

Study: Psyllium given to men with high cholesterol eating a normal fat diet

26 men with cholesterol ranging from 4.86 to 8.12 mmol/L (188 to 314 mg/dL) in a double-blind, placebo-controlled parallel study. Following a two-week baseline period, subjects were treated for eight weeks with 3.4 g of psyllium or cellulose placebo at mealtimes (three doses per day). All subjects maintained their usual diets, which provided less than 300 mg of cholesterol per day and approximately 20% of energy from protein, 40% from carbohydrate, and 40% from fat.

  • Eight weeks of treatment with psyllium reduced serum total cholesterol levels by 14.8%, low-density lipoprotein (LDL) cholesterol by 20.2%, and the ratio of LDL cholesterol to high-density lipoprotein cholesterol by 14.8% relative to baseline values.
  • The reductions in total cholesterol and LDL cholesterol became progressively larger with time, and this trend appeared to be continuing at the eighth week.
  • Psyllium treatment did not affect body weight, blood pressure, or serum levels of high-density lipoprotein cholesterol, triglycerides, glucose, iron, or zinc. No significant changes in serum lipid levels, body weight, blood pressure, or other serum parameters were observed with placebo treatment.
  • Subject adherence to psyllium treatment was excellent, and no adverse effects were observed

Psyllium also reduces blood glucose when taken with meals

49 patients with type 2 diabetes 27 took psyllium twice a day half an hour before meals, and 22 placebo, 36 completed the study.

HbA1c decreased significantly in the psyllium group compared to placebo 10.5 (+ 0.73) to 8.9 (+ 0.23), as did fasting blood glucose.

LDL to HDL ratio improved significantly in the psyllium group, due to an increase in HDL

Does dose and time on psyllium affect results?

A meta-analysis of 21 studies, the dose and the time using psyllium affects both total cholesterol and LDL cholesterol. (Time- and dose-dependent effect of psyllium on serum lipids in mild-to-moderate hypercholesterolemia: a meta-analysis of controlled clinical trials)

  • There was a significant dose–response relationship between doses (3–20.4 g/day) and changes of serum total cholesterol or LDL cholesterol levels.
  • According to this calculations in the study, consumption of psyllium 5, 10 and 15 g/day could result in 5.6, 9.0 and 12.5% decrease of LDL cholesterol level respectively.
  • Taking psyllium has a cumulative effect with LDL levels continuing to decrease over weeks and months.

How to take psyllium

Psyllium can be bought as husks, powder, in capsules or mixed with flavour and sweetener (Metacucil). One teaspoon contains about 3 grams of psyllium. About 2 grams of this is fibre.

Start with 1 teaspoon with a large glass of water per day. If all goes well increase to 1 teaspoon per meal, gradually increasing to 2 – 3 teaspoons per meal. If you get any unpleasant symptoms decrease the dose to what you tolerate.

Interactions with medications

Psyllium may reduce absorption of some medications making them less effective, or in the case of blood glucose or cholesterol medications, enhancing their effect.

Here is further information:

Penn State Hershey Medical Centre; Possible Interactions with: Psyllium

Drugs.com: Psyllium drug interactions

 

Study – Ultra-processed food – more calories eaten and weight gain compared to unprocessed food

By
Julianne
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2

When I did the research for the TV series “Why are we fat?” presented by New Zealand Chef (and programme guinea pig) Simon Gault, the overwhelming reason experts around the world gave for the massive increase in our collective weight was the amount of ultra-processed food we now eat. In America the average diet is made up of around 60% ultra processed foods. These foods typically have high percentages of three primary ingredients: refined starch, sugar and refined seed oils.

Despite this connection – up until now – there has not been a randomised controlled diet study comparing a diet high in ultra-processed foods against a diet with unprocessed foods, and each diet’s effect on food intake and weight.

Ultra-processed diets cause excess calorie intake and weight gain: A one-month inpatient randomized controlled trial of ad libitum food intake

Dr Kevin Hall, a nutrition scientist has recently completed a study which shows that eating ultra-processed foods contributes to weight gain.

What is the definition of ultra-processed and unprocessed foods?

Ultra-processed foods:

“Ultra-processed foods are industrial food and drink formulations made mostly or entirely from substances derived from foods, together with additives. The ingredients, the various processing techniques and the sequences of stages used for the manufacture of ultraprocessed foods (hence ‘ultra-processed’) are designed to create durable, accessible, convenient, hyper-palatable, highly profitable ready-to-eat, ready-to-drink or ready-to-heat products liable to displace all other NOVA food groups – natural or minimally processed foods, processed culinary ingredients and processed foods – and the dishes and meals made with them. Examples of typical ultra-processed foods are soft drinks; sweet or savoury packaged snacks; confectionery, mass-produced packaged breads, buns, biscuits and cakes; hot dogs, poultry and fish ‘nuggets’ and other reconstituted meat products; ‘instant’ soups and noodles; industrialized desserts; and industrially pre-prepared pizzas, pies and other dishes and meals.” (reference)

Unprocessed or minimally processed foods:

“Group 1: Unprocessed or minimally processed foods, such as fresh, dry or frozen fruits and vegetables; packaged grains and pulses; grits, flakes or flours made from corn, wheat, rye; pasta, fresh or dry, made from flours and water; eggs; fresh or frozen meat and fish; fresh or pasteurized milk.” (reference)

How the study was carried out

Participants: 10 male and 10 females with stable weight.

Figure 1. Overview of the study design. Twenty adults were confined to metabolic wards where they were randomized to consumed either an ultra-processed or unprocessed diet for 2 consecutive weeks followed immediately by the alternate diet. Every week, subjects spent one day residing in a respiratory chamber to measure energy expenditure, respiratory quotient, and sleeping energy expenditure. Average energy expenditure during each diet period was measured by the doubly labeled water (DLW) method. Body composition was measured by dual-energy X-ray absorptiometry (DXA) and liver fat was measured by magnetic resonance imaging/spectroscopy (MRI/MRS).

 

The setting of study: The participants stayed in the Metabolic Clinical Research Unit (MCRU) for a continuous 28 day period.

Study structure: Subjects were randomly assigned to either the ultra-processed diet, or the unprocessed diet for 2 weeks, then immediately swapped to the other diet for the second 2 weeks.

Food: The diet food was prepared for the participants. Meals were matched for total calories, energy density, macronutrients, fiber, sugar, and sodium, but widely differed in the percentage of calories derived from ultra-processed versus unprocessed foods as defined according to the NOVA classification scheme (Monteiro et al., 2018). Snacks and water were freely available. The meals had twice the number of calories each participant needed to maintain their current weight. The reason for this was to allow each person to eat freely (ad libitum) in order to satisfy their appetitite.

The participants were allowed 60 minutes to eat a meal, and all food not eaten was removed and weighed. The length of time they spent eating was timed.

Here are examples of the different meals, there were 7 days of meals on rotation for the two weeks on each diet.

Examples of the meals provided, ultra-processed on the left and unprocessed on the right.

Assessments of satiety

All participants answered questions on hunger and fullness, on a scale of 0 to 100 (“not at all” to “extremely”), before a meal, and 30 – 60 minutes after meals for 2 to 3 hours.

Results

Differences in caloric intake:

Daily energy intake was 508±106 kcal/d greater during the ultra-processed diet (p=0.0001). Neither the order of the diet assignment (p=0.64) nor sex (p=0.28) had significant effects on the energy intake differences between the diets.

Specific increases in food: At breakfast and lunch, when the ultraprocessed diet was consumed – both carbohydrates and fats increased significantly. Protein intake was significantly lower at lunch when ultraprocessed food was eaten. Protein has an effect on hormones promoting satiety so this may be a factor in reduced calories also.

Why did the participants eat more food when they were given ultraprocessed meals?

Did the food taste better? No – none of the participants reported any difference in pleasantness.

The speed of eating: One interesting observation is that the meal eating rate was greater in terms of calories consumed per minute, and grams per minute – that is more calories were consumed in a shorter space of time when eating ultraprocessed food. This is a likely result of the refined nature of ultraprocessed food, making it easier to chew and swallow quickly.

Figure 2. Ad libitum food intake, appetite scores, and eating rate. A) Energy intake was consistently higher during the ultra-processed diet. B) Average energy intake was increased during the ultra-processed diet because of increased intake of carbohydrate and fat, but not protein. C) Energy consumed at breakfast and lunch was significantly greater during the ultra-processed diet, but energy consumed at dinner and snacks was not significantly different between the diets. D) Both diets were rated similarly on visual analogue scales (VAS) with respect to pleasantness and familiarity. E) Appetitive measures were not significantly different between the diets. F) Meal eating rate was significantly greater during the ultra-processed diet.

Body weight changes: Participants gained 800 grams on average during the ultraprocessed 2 weeks, and lost 1.1kg on average during the umprocessed diet phase.

Figure 3. Body weight and composition changes. A) The ultra-processed diet led to significantly increases in body weight and fat mass whereas the unprocessed diet led to significant losses of weight, fat-free mass, and fat mass. B) Differences in body weight change between the ultra-processed and unprocessed diets were highly correlated with the corresponding energy intake differences. C) Liver fat was not significantly changed by the diets.

Hormones that control appetite: The appetite suppressing hormone PYY increased during the unprocessed food diet compared to baseline and the ultraprocessed food diet. The hunger hormone grehlin was decreased in the unprocessed food diet.

Other measures:

A number of other measures were taken, continous glucose monitoring, lipids, energy expenditure, insulin sensitivity and others which you can see in the study, and changes between groups were not significant.

Blood glucose and insulin

Interestingly continuous glucose and insulin monitoring showed no difference between the groups, despite this, when eating unprocessed food participants lost weight.

Figure 4. Glucose tolerance and continuous glucose monitoring. A) Glucose concentrations following a 75g oral glucose tolerance test (OGTT) was not significantly different between the diets. B) Insulin concentrations following the OGTT were not significantly different between the diets. C) Continuous glucose monitoring throughout the study did not detect significant differences in average glucose concentrations or glycemic variability as measured by the coefficient of variation (CV) of glucose.

 

Symptoms and health conditions linked with non coeliac wheat and gluten sensitivity

By
Julianne
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0

In 2015 a group of experts came together to work out how to diagnose and test non coeliac wheat or gluten sensitivity.

Non-Coeliac Gluten Sensitivity (NCGS) is a syndrome characterized by intestinal (affecting the digestive tract) and extra-intestinal symptoms (affecting other areas of the body) related to the ingestion of gluten-containing food, in subjects that are not affected by either coeliac disease or wheat allergy.

Coeliac disease is a serious auto-immune disease that is triggered by gluten. Those with diagnosed coeliac disease must strictly avoid gluten for their lifetime. See my earlier post for an explanation of coeliac disease. Celiac disease: How gluten invades and sets up an auto-immune reaction.

Coeliac disease (CD) is diagnosed with specific tests which show antibodies are being made against deaminated gliadin peptides (a protein in gluten) and tissue transglutaminase (tissue transglutaminase is an enzyme that fixes damage in your body), as well as IgA endomysial antibody. A biopsy of the lining cells in the duodenum (part of the intestine) will confirm damaged cells typical of CD. People with coeliac disease have a specific genes that make them susceptible: over 99% of people affected possess either HLA DQ2, HLA DQ8, or parts of these genes.

Gluten is found in wheat, barley and rye, one in 5 people with coeliac also react to oat gluten called avenin. (Source)

A number of people notice they react to gluten containing grains, however when tested they do not have the specific coeliac disease antibodies. This condition is called non-coeliac gluten or wheat sensitivity (NCGS or NCWS)

In 2015 a group of experts met in Salerno, Italy and described the common and not so common symptoms reported by those with NCGS.

Symptoms to NCGS are different to FODMAP sensitivity, which are limited to gastrointestinal symptoms. The term FODMAP is an acronym, derived from “Fermentable Oligo-, Di-, Mono-saccharides And Polyols”. FODMAPs are short chain carbohydrates that are poorly absorbed in the small intestine, and many people with irritable bowel syndrome find they improve with a low FODMAP diet. People with NCGS will get a resolution of symptoms when they remove gluten grains, despite continuing to consume FODMAPs from other sources.

A range of signs and symptoms have been reported in association with NCGS. This table has been taken from the paper “Diagnosis of Non-Celiac Gluten Sensitivity (NCGS): The Salerno Experts’ Criteria”

The diagnosis of NCGS is made when the patient reported intestinal and extra-intestinal symptoms occurring after the ingestion of gluten, which improves or disappears when gluten was withdrawn from the diet, and recurs when gluten is reintroduced into the diet.

As you can see gluten has many effects in parts of the body outside the digestive tract. People’s symptoms typically surface in a few hours to 1 days after eating gluten.  In more than half of these patients (in this study), the symptoms occurred within 6 hours after gluten ingestion; in about 40%, between 6 and 24 hours after ingestion; and in less than 10%, more than 24 hours after ingestion.

An earlier Italian study identified 486 patients with NCGS, and found there was associated autoimmune disease detected in 14% of cases.

Here are 2 graphs from the study – the first shows the percentages of people reporting gastrointestinal symptoms, the second – symptoms outside the gastrointestinal tract.

Aphthous stomatitis is mouth ulcer, aerophagia is swallowing air.

Laboratory tests showed low levels of ferritin, folic acid, and vitamin D in 23%, 5%, and 11%, respectively, of patients with suspected NCGS. The most common anti-body tested was anti-gliadin antibodies (AGA) with 25% having an IgG postive test, although in other studies it is as high as 56% (Serological tests in gluten sensitivity (nonceliac gluten intolerance) Volta 2012).

This study has limitations in that although each person was seen by a specialist, the symptoms were reported by the patient, and a placebo effect of the gluten free diet cannot be ruled out for some.

(Reference: An Italian prospective multicenter survey on patients suspected of having non-celiac gluten sensitivity. Volta, 2014)

In a more recent narative review of extra-intestinal diseases associated with NSGS the authors found:

Increased autoimmune disease; 29% in those with NCGS compared to 4% in control group.

A positive anti-nucleus antibody (ANA), a well-known marker of autoimmune diseases, was present in the 46% of NCGS subjects, compared to the 2% of controls, and ANA correlated with DQ2/8 haplotypes.

In the study the most frequently reported NCGS-associated autoimmune disorder was Hashimoto thyroiditis (29 patients).  Psoriasis (4 cases), type 1 diabetes (4 cases), mixed connective tissue disease (1 case) and ankylosing spondylitis (1 case). (High Proportions of People With Nonceliac Wheat Sensitivity Have Autoimmune Disease or Antinuclear Antibodies.)

Neurological manifestations.

Headache is a very frequent finding in NCGS.

Depression has been shown in a double blind study (Randomised clinical trial: gluten may cause depression in subjects with non-coeliac gluten sensitivity – an exploratory clinical study)

Gluten ataxia (Gluten ataxia is better classified as non-celiac gluten sensitivity than as celiac disease: a comparative clinical study)

Gluten neuropathy (Neuropathy associated with gluten sensitivity)

Gluten encephalopathy; the most common symptom of this is migraine. It has been demonstrated that a gluten free diet improves the headaches and stops the progression of cerebral alterations detected at magnetic resonance imaging. (Migraine and coeliac disease). (Headache and CNS white matter abnormalities associated with gluten sensitivity)

Cases of Gluten Psychosis has been described: hallucinations, crying spells, relevant confusion, ataxia, severe anxiety and paranoid delirium occurred shortly after gluten ingestion and disappeared within one week of gluten free diet.(Gluten Psychosis: Confirmation of a New Clinical Entity.)

Psychiatric conditions including schizophrenia

Results are mixed, however gluten appears to play a role in many conditions. This reveiw is good; it covers anxiety, depression and mood disorders, ADHD, autism spectrum disorders, schizophrenia, epilepsy, and gluten ataxia. (Neurologic and Psychiatric Manifestations of Celiac Disease and Gluten Sensitivity)

Schizophrenia: In this review the authors state “Several studies presented evidence to suggest that symptoms associated with schizophrenia were minimized when gluten was excluded from patients’ diets.” (A review on the relationship between gluten and schizophrenia: Is gluten the cause?)

Skin conditions

The possibility of a skin involvement in 18% of NCGS has been reported. Dermatitis, rash and eczema were the most common skin manifestations in NCGS, psoriasis has also been mentioned. (Cutaneous Manifestations of Non-Celiac Gluten Sensitivity: Clinical Histological and Immunopathological Features)

Rheumatologolical manifestations (joints / arthritis)

Ankylosing spondylitis: in a group of 30 subjects with ankylosing spondylitis, 11 had AGA positivity, while no patient in a control group exhibited this, and only one of the 11 was confirmed as having Coeliac disease. (The significance of coeliac disease antibodies in patients with ankylosing spondylitis: a case-controlled study)

Four cases of axial spondyloarthritis (2 ankylosing spondylitis and 1 psoriatic spondyloarthritis), where CD was ruled out, went onto remission after several months on a gluten free diet. Accidental gluten exposure in 2 caused the return of joint inflammation. (Non-celiac Gluten Sensitivity and Rheumatic Diseases)

In the above study 5 other case studies which include polyarthritis of unknown cause, polyarthritis associated with ANA and with anti-cardiolipin antibodies, refractory rheumatoid arthritis, Raynauds disease, systemic sclerosis and mixed connective tissue disease all showed striking improvement to a gluten free diet.

Fibromyalgia

Fibromyalgia is a disease characterized by widespread pain, often accompanied by fatigue, memory problems, sleep disturbances, depression or irritable bowel syndrome. In many case series, several NCGS patients complain of chronic muscle or joint pain, leg numbness, fatigue and headache, therefore it is possible that an underlying undiagnosed fibromyalgia could be present. In a Spanish study of 246 fibromyalgia patients following gluten free diet, 90 showed clinical symptom improvement. (Fibromyalgia and non-celiac gluten sensitivity: a description with remission of fibromyalgia) In 20 of this group who followed a gluten free diet for 16 months, 75% experienced full remission for pain. A gluten challenge resulted in symptoms recurring.

Reproductive disorders

Endometriosis: In a 2012 study 217 patients with severe painful endometriosis-related symptoms were tested on a gluten free diet and for 12 months. At enrolment time, the baseline values of painful symptoms were assessed by Visual Analogue Scale (VAS) for dysmenorrhoea, non-menstrual pelvic pain, and dyspareunia. At the end of 12 months, 156 patients (75%) reported statistically significant change in painful symptoms (P<0.005), 51 patients (25%) reported not improvement of symptoms. No patients reported worsening of pain. A considerable increase of scores for all domains of physical functioning, general health perception, vitality, social functioning, and mental health was observed in all patients (P<0.005). (Gluten-free diet: a new strategy for management of painful endometriosis related symptoms? Marziali, 2012) A 2015 study using a gluten free diet for 150 women with endometriosis and chronic pelvic pain also showed statiscally signifcant reduction in pain at 6 months in the gluten free vs control group. (Role of Gluten-Free Diet in the Management of Chronic Pelvic Pain of Deep Infiltranting Endometriosis, Capozzolo 2015)

 

Testing your response to a gluten free diet if you suspect NCGS.

First – if you suspect you are sensitive to gluten, it is very important that before you embark on a gluten free diet you get tested for coeliac disease. Once you are gluten free the test will not show up any reaction, and you do need to know whether you have CD or NCGS.

The Salerno group came up with a checklist of most common symptoms and those to monitor when testing a gluten free diet in those with NCGS. (This is done with the help of a nutrition specialist)

Mark the following symptoms out of 10. Then follow a strict gluten free diet for a period of time, and mark your symptoms out of 10 again to see if there is a change. You can retest your response to gluten by adding gluten foods back into your diet to see if they affect you. (Ideally in a clinical setting the response to gluten should be done in a double blind study, i.e. tested with the addition of bread that may or may not contain gluten)

    • Abdominal pain or discomfort
    • Heartburn
    • Acid regurgitation
    • Bloating
    • Nausea and vomiting
    • Borborygmus (rumbling or gurgling in intestines)
    • Abdominal distension
    • Eructation (belch)
    • Increased flatus (gas in intestines, farting)
    • Decreased passage of stools
    • Increased passage of stools
    • Loose stools
    • Hard stools
    • Urgent need for defecation
    • Feeling of incomplete evacuation
    • Extra-intestinal symptoms:
    • Dermatitis
    • Headache
    • Foggy mind
    • Fatigue
    • Numbness of the limbs
    • Joint/muscle pains
    • Fainting
    • Oral/tongue lesions

Well that’s it for this post, feel free to comment or tell me about your own experience. In the next post I will write about other components of wheat that might be contibuting to NCGS

What My FitnessPal data tells us about satiety and overeating (from Optimising Nutrition)

By
Julianne
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1

Marty Kendall is an engineer and nutrition nerd. He uses his exceptional analytical skills and logic to discover really useful information about nutrition science, and what actually works for health and fat loss.

Once recent series I find exceptionally fascinating and useful is analysis into satiety and overeating from My Fitness Pal data.

Discovering the effect food had on satiety back in 1996, allowed me for the first time in my life to stop fearing eating. When I discovered the magic of satiety, appetite regulation, and blood sugar control and how food managed this – I had freedom from fear of putting on weight. I also gained freedom from hunger and freedom from reactive hypoglycemia and its unpleasant effects.

Due to my own experience I’ve taken a great interest in satiety and appetite regulation, and how food choices affect this.

Marty has taken a close look at data from MyFitnessPal and analysed the patterns that stop people from overconsuming calories. I hope there are more posts to come, however head over to Optimising Nutrition and read the full posts yourself.

Here is a very brief overview of the posts from this analysis:

How to you optimise your protein, fat, and carbohydrates to minimise hunger?

Looking at the My Fitness Pal (MFP) data:

  • Protein improves satiety
  • Unprocessed carbohydrates are beneficial
  • Satiety is worst with very high levels of fat, if on a low carb diet, satiety is best with carbs btween 20 – 30% calories and protein greater than 20% calories, and fat less than 60%.
  • Less fat reduces energy density so you get more food with less calories – this fills you up.
  • Satiety also improves with high levels of carbohydrates; 60% carbs, and protein above 20% calories
  • moderate fat combined with moderate carbohydrates together with low protein is where the most overeating happens (think about ultra-processed food – donuts, chips, etc – they are tasty and a carb/fat, low protein combo). this combination also has a high energy density – more calories in a small volume of food.

Read the details here: How to optimise your protein, fat and carbohydrates to minmise hunger.

For much more detail on the concept of weight gain with teh carbohydrate/ fat formula read this post: Don’t Eat for Winter!

 

How much protein do you need for breakfast for satiety? Is 30 grams as recommended by Tim Ferris enough? 

  • 11% of daily calories as protein looks to be optimal. The “typical female” would need to consume 45g of protein at breakfast to get the minimum effective dose for satiety while the “typical male” would need to consume 55g of protein for breakfast to reach their minimum effective dose of protein to optimise for maximum satiety.

Will Tim Ferriss’ 30g of protein at breakfast help you lose weight? 

What are the optimal macros for fat loss without hunger?

There is much debate about diets. Should I eat keto, low carb, high fat, low fat, high protein or high carb?  Consciously restricting calories is not easy, so if we can eat to satiety and restrict calories enough to lose fat and maintain that loss, life becomes so much easier.

Marty looked at all the ranges of macros in peoples diets in MyFitnessPal, and the associated calorie intake. What he found:

  • People following a low protein, high fat approach consistanly exceeded calorie target
  • Prioritising protein increases satiety

Optimising macros for fat loss with less hunger

Which leads to the next question? How much protein do you need to eat to reduce hunger for fat loss?

The data from MyFitnessPal shows that people who eat more protein tend to spontaneously eat less, and those that ate less protein tended to eat more and were less likely to achieve their goals.

  • The protein intake linked with greater satiety is 2.4g/kg lean body mass (LBM) per day. This corresponds to a 15% spontaneous reduction in calories.

You can calculate your LBM by taking the percentage of fat off your total body weight. E.g. if you weigh 80 kg and your body fat is 35%, your LBM will be 65% of 80kg which is 52kg.

How much protein do you need to reduce hunger for weight loss?

How many meals a day do you need to lose weight?

Will eating 6 times a day or twice a day give better results?

The MFP data shows:

  • Those who ate more than three meals a day were likely to consume more calories than average, around 220 calories more.
  • Limiting  meal numbers is linked with eating less food, 100 calories a day less for 3 meals, and 266 calories per day with 2 meals

For more detail and which meals per day were more effective – go to the original article: How many times should you eat a day to lose weight?

What about breakfast – do people eat more or less if they skip breakfast?

The data set shows breakfast skippers tend to eat more. If you eat more or your calories early in the day, you eat less over the entire day.

Why breakfast is the most important meal of a day

 

 

 

Paleo diet consistently outperforms healthy eating guidelines: 7 studies

By
Julianne
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0

The paleo diet compared to recommended healthy diets – which has the best results?

Many countries use experts to create healthy eating guidelines, here is a link to the information on how the US guidelines are created https://health.gov/dietaryguidelines/process.asp.

Some dietary guidelines have been designed specifically for people with cardiovascular disease or type 2 diabetes, such as the American Diabetes Association (ADA) guidelines.

Other healthy diets have been shown by epidemiological studies to reduce the risk of non-communicable diseases, for example, the Mediterranean diet pattern.

Over the last 12 years, a number of studies have tested a classic paleo protocol with a number of these healthy eating guidelines.

I’ve written about the paleo diet used in studies in a prior post: Paleo diet studies, weight loss and satiety, I also covered how a paleo diet achieved greater weight loss and satiety compared to other diet protocols.

In this post, I outline each study, the diet it was compared to and its results.

All studies apart from one were a maximum of 3 months on the intervention diet.

  1. Beneficial effects of a Paleolithic diet on cardiovascular risk factors in type 2 diabetes, a randomized cross-over pilot study. Jonsson et al., 2009 Pubmed, Full text

Study type and length: Randomised open label crossover, 3 months on Paleo diet (PD) and 3 months on current dietary guideline for diabetes (DD)

Participants: 13 total, 7 started PD first, 6 started with DD. Type 2 diabetes duration average 9 years

Study length: 6 months (3 months each diet)

Results: Paleo diet resulted in lower HbA1c, triglycerides, BP, Weight, Waist circumference, higher HDL, compared to Diabetes diet

This graph is from the study:

2. A Palaeolithic diet improves glucose tolerance more than a Mediterranean-like diet in individuals with ischaemic heart disease. Lindeberg et al., 2007 Pubmed Fulltext

Type of study and length: 12 weeks, Randomised controlled dietary intervention. Mediterranean like diet (MD) compared to paleo diet (PD)

Participants: 29 male with ischemic heart disease (IHD) and with impaired glucose tolerance or type 2 diabetes. Increased OGTT. Waist >94cm. PD n=14, MD n=15

Results: PD, 20% decrease in the oral glucose tolerance test (OGTT) during the first 6 weeks and an 8% decrease between weeks 6 and 12.  In the MD group, a 10% decrease of OGTT after the first 6 weeks with no further change at 12 weeks. After 12 weeks, all 14 subjects in the Palaeolithic group had normal 2-hour plasma glucose values, compared with 7 of 15 subjects.

Waist circumference decrease: PD 5.6cm, MD 2.9cm, Weight loss PD 5.1kg, MD 3.8kg

Here are graphs of oral glucose tolerance tests, (OGTT) and plasma insulin changes.

3. Cardiovascular, Metabolic Effects and Dietary Composition of Ad-Libitum Paleolithic vs. Australian Guide to Healthy Eating Diets. A 4-Week Randomised Trial. Genoni 2016 PubMed, Fulltext

Study design: Randomised, non blinded,  Australian guide to healthy eating (AGHE) n=17 compared to PD n=22. Primary aim to compare PD with AGHE health effects and nutritional adequacy.

Participants: 39 healthy overweight women, Age 47 + 13y, BMI 27 + 4,

Study length: 4 weeks

Results:

  • PD significantly greater weight loss; 3.2 vs 1.2kg,  decreased waist; 3.4 vs 1.6cm, fat loss, lowered systolic BP; 3.3 vs 0.7 mmHg.
  • There were no significant differences in fasting C-reactive protein, glucose, insulin, urinary sodium or creatinine.
  • Nutrients: PD had significantly lower calcium, iodine, thiamin and riboflavin.  PD had significanlty higher intakes of vitamin C and betacarotene.
  • Women on paleo had 76% less desire for sugar foods vs 56% on AGHE

4. Paleolithic nutrition improves plasma lipid concentrations of hypercholesterolemic adults to a greater extent than traditional heart-healthy dietary recommendations. Pastore, 2015 Pubmed,

Study type and length: 8 months, 2 phase intervention, own controls. AHA heart-healthy dietary guidelines for 4 months, (phase 1) followed by PD 4 months (phase 2). Variables measured at baseline to end AHA, then end PD phase.

Participants: 10 male, 10 female with hypercholesteremia

Results:

  • There were greater improvements in the PD phase compared to ADA phase in lipids, Total cholesterol -3% on AHA, -20% PD, LDL, -3% AHA, -36% PD, HDL AHA, no change, +35% PD.
  • Weight loss AHA 3.3kg, PD 10.4kg in men. AHA no change, PD 8.1kg

Lipid changes chart:

5. Metabolic and physiologic effects from consuming a hunter-gatherer (Paleolithic)-type diet in type 2 diabetes. Masharani, 2015 Pubmed

Study Type: Randomised, Non blinded. Outpatient, metabolically controlled study comparing Paleo diet (PD) with a standard diet based on nutrition recommendations of the American Diabetes Association (ADA diet).  Same calories and PFC ratio. Completed: PD n=14 ADA n=10

Study length: Baseline: 3 days, ramp up diet: 7 days, intervention: 14 days.

Participants: 24 participants, T2D, controlled 50-69yrs, BMI <40.

Results:

  • Fructosamine, which is a shorter-term marker of glycemic control, declined by 34μmol/l in the Paleo group (P=0.01) and only by 3μmol/l in the ADA group
  • Weight changes – similar both groups
  • There were statistically significant reductions in total cholesterol, HDL cholesterol and low-density lipoprotein (LDL) cholesterol on the Paleo diet.
  • Triglycerides trended downward to a greater degree on the Paleo diet than on the ADA diet.
  • No significant BP changes
  • Insulin sensitivity improved on paleo diet (see graph)

6. Favourable effects of consuming a Palaeolithic-type diet on characteristics of the metabolic syndrome, a randomized controlled pilot-study. Boers, 2014 PubMed, Full text

Study Type: Randomised controlled single-blinded pilot, stratified (men/women) PD n= 18, compared to isogenic healthy reference diet: n=16 (14 completed)  Dutch Health Council guidelines. Bodyweight kept stable throughout the intervention. 32 completed the study. All meals delivered, the goal to maintain weight so it was not a confounder

Study Length: 2 weeks

Participants: 34 subjects, with 2 characteristics of metabolic syndrome (Central obesity, elevated TG, Reduced HDL, raised BP, elevated plasma glucose). Mean age 53.5 (SD9.7), Male =9, Female = 25. BMI mean 31.8, Waist >102cm men, 88cm f, BP > 130/85, HDL <1, Fasting glucose >5.6

Results:

  • PD resulted in lower systolic BP -9.1mmHg, Dutch -5 mmHg, Total Cholesterol, triglycerides, higher HDL
  • Bodyweight reduced on PD, unintended
  • Tendency to larger decrease in AUC insulin in PD
  • Both groups: 3cm reduction in waist circumference
  • hsCRP and TNFa, cortisol, intestinal permeability did not change in either group
  • At end 89% PD and 64% Dutch group were motivated to continue

 

7. Long-term effects of a Palaeolithic-type diet in obese postmenopausal women, a 2-year randomized trial. Melberg et al,.2014 Pubmed, Full text

Type of study and intervention: Randomly assigned to paleo Nordic Nutrition Recommendations (NNR) or paleo diet (PD); 35 in each group

(This group has 10 published studies comparing a range of different measures)

Participants: 70 women (61 analysed) – post menopause, non-smoking, obese (BMI >27), mean age 60yrs, (range 49 – 71) mean BMI 33. at 24 months 27 in PD, 22 in NNR completed

Study length: 24 months, with measures at 6, 12, 18 and 24 months

Results – these are some results from several study publications, listed at the end:

  • Both the diet groups decreased their total fat mass: PD: -6.5 and NNR: -2.6kg at 6 months; and PD: -4.6 and NNR: -2.9kg at 24 months
  • Waist PD group at 6 months -11.1 vs NNR -5.8cm; P=0.001
  • Hip circumference decreased with a significant difference between the groups at 6 months (-6.8 with PD vs-2.7 cm with NNR at 6 months; P=0.001)
  • Triglyceride levels decreased significantly in the PD group over time with a 0.26 and 0.22mmol/l difference between the diet groups at 6 and 24 months (P=0.001 and P=0.004)
  • Memory performance improved significantly from 16.7 ± 3.3 correctly remembered face-name pair, out of maximum 24, at baseline to 18.5 ± 2.0 after the dietary interventions, F (1, 18) = 8.3; p = 0.010; without difference between the PD or standard diet according to NNR.
  • Liver fat decreased after 6 months by 64% (95% confidence interval: 54-74%) in the PD group and by 43% (27-59%) in the LFDAfter 24 months, liver fat decreased 50% (25-75%) in the PD group and 49% (27-71%) in the LFD group.
  • Blood lipids and blood pressure,Triglycerides, total cholesterol and LDL improved significantly more in the PD group duringthe first 6 months of the study
  • Android fat decreased significantly more in the PD group (P50.009) during the first 6 months
  • Serum interleukin 6 (IL-6) and tumor necrosis factor a levels were decreased at 24 months in both groups (P<0.001) with a significant diet by-time interaction for serum IL-6 (P50.022). High-sensitivity C-reactive protein was decreased in the PD group at 24 months (P50.001).
  • Markers of insulin sensitivity improved in the PD group compared to NNR

Further papers from this 24-month study, paleo diet compared to Nordic nutrition recommendations in 70 post menopausal women:

Diet-Induced Weight Loss Alters Functional Brain Responses during an Episodic Memory Task, Boraxbekk, 2015

Diet-induced weight loss has chronic tissue-specific effects on glucocorticoid metabolism in overweight postmenopausal women. Stomby A, 2015

Strong and persistent effect on liver fat with a Paleolithic diet during a two-year intervention. Otten J 2016

Left ventricular remodelling changes without concomitant loss of myocardial fat after long-term dietary intervention Andersson J 2016

Plasma metabolomic response to postmenopausal weight loss induced by different diets Chorell E 2016

Attenuated Low‐Grade Inflammation Following Long‐Term Dietary Intervention in Postmenopausal Women with Obesity Blomquist C, 2017

Decreased lipogenesis-promoting factors in adipose tissue in postmenopausal women with overweight on a Paleolithic-type diet. Blomquist C, 2017

A Paleolithic-type diet results in iodine deficiency: a 2-year randomized trial in postmenopausal obese women Manousou S, 2018

Paleo and Mediterranean diet patterns associated with less cardiovascular disease, inflammation, oxidative stress and colon cancer

By
Julianne
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1

In a large longitudinal study – a Paleolithic and a Mediterranean diet were investigated for their relationship to a number of diseases and deaths.

  • Colorectal adenoma which is a precursor lesion of the colorectal adenocarcinoma (colon cancer)
  • Biomarkers of inflammation – via high sensitivity C-Reative Protein (hsCRP)
  • Oxidative balance – via a measure of oxidative stress called F2-isoprostane concentrations
  • All cardiovascular disease mortality
  • All cancer mortality
  • All cause mortality

How the study was done:

This was prospective cohort study – which means a group of similar individuals (cohorts) are followed over time, to determine how certain factors affect rates different diseases. In this study 30,183 white and black adults predominantly from the Southeastern United States were followed. Of these 21,423 individuals filled in a food frequency questionnaire at the start of the study. Individuals were monitored for the above disease outcomes.

The following table shows how the different dietary patterns were scored. Individuals ended up in one of 5 quintiles depending on how closely or different their diet pattern was to either a paleolithic pattern of a Meditteranean pattern. The association of diseases to diet patterns was analysed.

Results:

During the 11 y of follow-up (median: 6.25 y), 2513 participants died. There were statistically significant trends for decreasing risk for all-cause mortality, colon cancer, cardiovascular diseases, inflammation and oxidative stress with increasing Paleolithic and Mediterranean diet scores.

 

You can see the studies in full here

Paleolithic and Mediterranean Diet Pattern Scores Are Inversely Associated with All-Cause and Cause-Specific Mortality in Adults

Abstract

Background: Poor diet quality is associated with a higher risk of many chronic diseases that are among the leading causes of death in the United States. It has been hypothesized that evolutionary discordance may account for some of the higher incidence and mortality from these diseases.

Objective: We investigated associations of 2 diet pattern scores, the Paleolithic and the Mediterranean, with all-cause and cause-specific mortality in the REGARDS (REasons for Geographic and Racial Differences in Stroke) study, a longitudinal cohort of black and white men and women ≥45 y of age.

Methods: Participants completed questionnaires, including a Block food-frequency questionnaire (FFQ), at baseline and were contacted every 6 mo to determine their health status. Of the analytic cohort (n = 21,423), a total of 2513 participants died during a median follow-up of 6.25 y. We created diet scores from FFQ responses and assessed their associations with mortality using multivariable Cox proportional hazards regression models adjusting for major risk factors.

Results: For those in the highest relative to the lowest quintiles of the Paleolithic and Mediterranean diet scores, the multivariable adjusted HRs for all-cause mortality were, respectively, 0.77 (95% CI: 0.67, 0.89; P-trend < 0.01) and 0.63 (95% CI: 0.54, 0.73; P-trend < 0.01). The corresponding HRs for all-cancer mortality were 0.72 (95% CI: 0.55, 0.95; P-trend = 0.03) and 0.64 (95% CI: 0.48, 0.84; P-trend = 0.01), and for all-cardiovascular disease mortality they were 0.78 (95% CI: 0.61, 1.00; P-trend = 0.06) and HR: 0.68 (95% CI: 0.53, 0.88; P-trend = 0.01).

Conclusions: Findings from this biracial prospective study suggest that diets closer to Paleolithic or Mediterranean diet patterns may be inversely associated with all-cause and cause-specific mortality.

Paleolithic and Mediterranean Diet Pattern Scores and Risk of Incident, Sporadic Colorectal Adenomas

Abstract

The Western dietary pattern is associated with higher risk of colorectal neoplasms. Evolutionary discordance could explain this association. We investigated associations of scores for 2 proposed diet patterns, the “Paleolithic” and the Mediterranean, with incident, sporadic colorectal adenomas in a case-control study of colorectal polyps conducted in Minnesota (1991–1994). Persons with no prior history of colorectal neoplasms completed comprehensive questionnaires prior to elective, outpatient endoscopy; of these individuals, 564 were identified as cases and 1,202 as endoscopy-negative controls. An additional group of community controls frequency-matched on age and sex (n = 535) was also recruited. Both diet scores were calculated for each participant and categorized into quintiles, and associations were estimated using unconditional logistic regression. The multivariable-adjusted odds ratios comparing persons in the highest quintiles of the Paleolithic and Mediterranean diet scores relative to the lowest quintiles were, respectively, 0.71 (95% confidence interval (CI): 0.50, 1.02; Ptrend = 0.02) and 0.74 (95% CI: 0.54, 1.03; Ptrend = 0.05) when comparing cases with endoscopy-negative controls and 0.84 (95% CI: 0.56, 1.26; Ptrend = 0.14) and 0.77 (95% CI: 0.53, 1.11; Ptrend = 0.13) when comparing cases with community controls. These findings suggest that greater adherence to the Paleolithic diet pattern and greater adherence to the Mediterranean diet pattern may be similarly associated with lower risk of incident, sporadic colorectal adenomas.

Paleolithic and Mediterranean Diet Pattern Scores Are Inversely Associated with Biomarkers of Inflammation and Oxidative Balance in Adults

Abstract

Background: Chronic inflammation and oxidative balance are associated with poor diet quality and risk of cancer and other chronic diseases. A diet–inflammation/oxidative balance association may relate to evolutionary discordance.

Objective: We investigated associations between 2 diet pattern scores, the Paleolithic and the Mediterranean, and circulating concentrations of 2 related biomarkers, high-sensitivity C-reactive protein (hsCRP), an acute inflammatory protein, and F2-isoprostane, a reliable marker of in vivo lipid peroxidation.

Methods: In a pooled cross-sectional study of 30- to 74-y-old men and women in an elective outpatient colonoscopy population (n = 646), we created diet scores from responses on Willett food-frequency questionnaires and measured plasma hsCRP and F2-isoprostane concentrations by ELISA and gas chromatography–mass spectrometry, respectively. Both diet scores were calculated and categorized into quintiles, and their associations with biomarker concentrations were estimated with the use of general linear models to calculate and compare adjusted geometric means, and via unconditional ordinal logistic regression.

Results: There were statistically significant trends for decreasing geometric mean plasma hsCRP and F2-isoprostane concentrations with increasing quintiles of the Paleolithic and Mediterranean diet scores. The multivariable-adjusted ORs comparing those in the highest with those in the lowest quintiles of the Paleolithic and Mediterranean diet scores were 0.61 (95% CI: 0.36, 1.05; P-trend = 0.06) and 0.71 (95% CI: 0.42, 1.20; P-trend = 0.01), respectively, for a higher hsCRP concentration, and 0.51 (95% CI: 0.27, 0.95; P-trend 0.01) and 0.39 (95% CI: 0.21, 0.73; P-trend = 0.01), respectively, for a higher F2-isoprostane concentration.

Conclusion: These findings suggest that diets that are more Paleolithic- or Mediterranean-like may be associated with lower levels of systemic inflammation and oxidative stress in humans

 

Paleo diets studies show increased satiety and decreased calorie intake

By
Julianne
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0

To date there are 16 paleo diet studies (with over 20 published papers), 14 on the classic paleo, and 2 using the stricter auto-immune paleo (AIP) diet. Here is a link to blog posts on the AIP for multiple sclerosis and inflammatory bowel disease.

The Paleo, short for Paleolithic diet continues to be controversial amongst health professionals. It is often touted in the media as being high in animal protein, high fat (especially saturated fat), low carbohydrate and unhealthy because it cuts out entire food groups (grains, dairy, legumes).

Posts such as this one which claim the paleo diet is high in red meat and saturated fat, cutting grains is dangerous, presumably because fibre (gut health) and B vitamins.

I’ve taken a close look at all published paleo diet intervention studies. In this post I focus on studies where the food changes are clearly documented. That is total energy, carbohydrates, fats and protein changes were documented and micronutrients and fat types analysed.

The first thing that stands out on reading these papers is the diet used in the studies is quite different from the perception of what people eat on a paleo diet, and the one in the media.

All these studies use a classic paleolithic diet as recommended by Loren Cordain. Here is an outline of the actual paleo diet used in studies. It is neither very low carbohydrate or high fat:

Foods excluded in all studies, i.e. not allowed on a paleo diet:

  • Cereal grains, including corn
  • Dairy products
  • Legumes, includng soy and peanuts
  • Refined fats
  • Refined sugars
  • Added salt
  • Beer
  • Soft drinks
  • Processed meat – some allowed limited cured meats
  • Processed foods in general

Foods allowed, unless stated there is no limit on the amount eaten:

  • Lean meat and poultry
  • Fish and seafood
  • Eggs (often restricted to 2 per day)
  • Fruit and berries
  • All vegetables including root vegetables
  • Some studies allowed one to 2 potatoes a day, others none
  • Nuts (40 – 60 grams a day) almonds and walnuts were often recommended
  • Avocado
  • Dried fruit in small amounts in some studies (1 tablespoon day to 130 grams a day)
  • Added oil: olive or rapeseed (canola) oil, 15 grams or 1 tablespoon a day
  • Small amounts of honey and vinegar for flavour
  • Red wine, from 1 glass a week to maximum of 2 glasses a day
  • Unsweetened almond milk
  • Salt free spices
  • Coffee and tea

Protein, carbohydrate and fat ratios by calories were controlled in some studies, and not others. They were controlled by providing meals, or meal plans. Those that had controlled macronutrient ratios tended to use this ratio:

Protein 30%, Carbohydrates 30%, Fat 40% by calories

Some studies supplied food, others did not. Even those that supplied food allowed participants to eat ad libitum – to appetite, they could add allowed foods if they were hungry.

How did the diets change from baseline or compared to the reference diet (non-paleo diet)?

  • Protein stayed the same or increased a little (around 15 grams a day)
  • Saturated fat decreased significantly and monounsaturated and polyunsaturated fat increased or stayed the same.
  • Total fat did not change much, in some studies it decreased.
  • Carbohydrates decreased by about half in most studies, however the lowest carbohydrate intake in the studies was 77 grams per day. The range was 77 to 164g/day. All bar one group were above 100 grams a day.
  • Fibre intake tended not to change from baseline
  • Food volume and weight stayed the same, even though energy intake reduced.
  • Calories decreased by about 25 – 30% (remember people are eating to satiety and not hungry)
  • Sodium decreased significantly and potassium increased in all paleo groups
  • Micronutrients: Calcium typically reduced, whereas many others increased including B6 and B12

Overall results worth a mention

Compared to baseline or other healthy diets, the paleo diet achieved better results in every singly study in all the following measures

  • Satiety and satiety hormones
  • Greater reduction in caloric intake without counting calories
  • Greater reduction in fat mass
  • Greater reduction in waist circumference
  • Greater improvements in insulin sensitivity and other markers of pre-diabetes and type 2 diabetes
  • Greater reduction in blood pressure
  • Greater improvements in blood lipids

Please note and I think it is worth mentioning – these results can only be applied to the type of paleo diet in the guidelines at the top, it does not apply to any other version of the paleo diet or a ketogenic, or other type of low carbohydrate diet.

The Studies

Study 1: Otten, J et al, 2017

Benefits of a Paleolithic diet with and without supervised exercise on fat mass, insulin sensitivity, and glycemic control: a randomized controlled trial in individuals with type 2 diabetes (PDF), Pubmed

Study type and intervention: Randomised to two groups: Paleo diet plus standard care exercise (PD, n=15) and PD plus supervised high intensity exercise, 3x week (PDEX n=14). Ad libitum diet.

Participants: 32 people with overweight with type 2 diabetes, BMI 25 – 40 kg/m2, 29 completed study. Plus an additional reference group of 9 with no intervention

Study length: 12 weeks

Results: Fat mass decreased in both groups: 5.7kg in PD group and 6.7kg in PDEX group. Waist circumference PD -7cm, PDEX -8cm,  and insulin sensitivity increased. Blood pressure decreased in both intervention groups without any group difference: systolic,13% in PD and 8% in PDEX; diastolic,10% in PD and 12% in PDEX

How did the diet change compare to baseline?

  • Total energy reduced: PD 2064 to 1446 kcal, PDEX 1728 to 1307
  • Protein slight increase PD: 83 to 96, PDEX: 77 to 79
  • Fat, total PD: 88 to 71g/day, PDEX: 67 to 61 g/day
  • MUFA and PUFA increased a little. Total SFA decreased: PD 34 to 15g per day, PDEX 27 to 14
  • Total carbohydrates decreased: PD 200 to 127, PDEX: 169 to 77g per day

 

Study 2: M Ryberg et al., 2013

A Palaeolithic-type diet causes strong tissue-specific effects on ectopic fat deposition in obese postmenopausal women. Pubmed (PDF)

Study type and intervention: Paleo diet ad libitum, pilot study. Women were their own controls, variables at baseline and end of the study were compared for changes.

Participants: 10 post-menopausal, non-smoking women, healthy, overweight with BMI > 27

Study length: 5 weeks

Results: Body weight reduced by 4.6kg; 86.4 to 81.8kg, Hepatic lipid content decreased by 49%. Blood pressure, waist circumference and leptin also reduced.

How did the diet change compared to baseline?

  • Energy intake decreased by 25% (2408 to 1888kcal)
  • Protein increased by 27%, 105 to 122g per day
  • Carbohydrates decreased by 58%, 281 to 118 g per day
  • Fats: total 33 to 43.5 g per day. SFA decreased by 57%, 39.2 to 16.7 g per day. PUFA Increased by 122%, 11.6 to 25.8g per day. MUFA 32.8 to 44.9g per day
  • Fibre 25 to 26.9g per day

 

Study 3: C Melberg et al., 2014

Long-term effects of a Palaeolithic-type diet in obese postmenopausal women, a 2-year randomized trial. pubmed

Type of study and intervention: Randomly assigned to paleo Nordic Nutrition Recommendations (NNR) or paleo diet (PD); 35 in each group.

Participants: 70 women (61 analysed) – post menopause, non-smoking, obese (BMI >27), mean age 60yrs, (range 49 – 71) mean BMI 33. at 24 months 27 in PD, 22 in NNR completed

Study length: 24 months, with measures at 6, 12, 18 and 24 months

Results: Both the diet groups decreased their total fat mass: -6.5 and -2.6kg at 6 months; and -4.6 and -2.9kg at 24 months for the PD and NNR group, respectively.

How did the diet change compared to baseline, 6 months and 24 months?

  • Total energy (kcal) PD: 2000, 1625, 1599. NNR: 2019, 1660, 1768 (The PD group had a 19% and 20% lower reported energy intake and the NNR group 18% and 12% lower reported energy intake at 6 and 24 months, respectively.)
  • Protein PD: 84.4, 93.7, 84.8, NNR: 85.2, 76.5, 76.4
  • Carbohydrate: PD; 224, 120, 137. NNR; 222, 181, 190
  • Fat: Decreased in NNR by 18g per day and 3.5g per day in PD at 6 months

 

Study 4: T Jönsson et al., 2009.

Beneficial effects of a Paleolithic diet on cardiovascular risk factors in type 2 diabetes, a randomized cross-over pilot study. (PDF) Pubmed full-text link

Study type and length: Randomised open label crossover, 3 months on Paleo diet (PD) and 3 months on current dietary guideline for diabetes (DD)

Participants: 13 total, 7 started PD first, 6 started with DD. Type 2 diabetes duration average 9 years

Study length: 6 months (3 months each diet)

Results: Paleo diet resulted in lower HbA1c, triglycerides, BP, Weight, Waist circumference, higher HDL, compared to Diabetes diet

Diet differences between PD and DD:

  • Paleo diet lower in total energy, 1456 kcal vs  1581 kcal, although it weighed the same. Paleo diet had lower energy density.  Mj per gram – PD; 4.7, DD; 5.6
  • Lower in carbohydrate, 125 vs 196g
  • Protein similar: PD 94 vs DD 90g
  • Fats: total PD 68g/day, DD 72g/day. PD higher in UFA. SFA, lower in PD; 19, vs DD 27g
  • Nutrients: PD slightly higher in many vitamins, except calcium; lower on PD 356, vs DD 698.
  • Glycemic Load: PD meals had a lower glycemic load. 63 vs 111

 

Study 5: Lindeberg, 2007.

A Paleolithic diet is more satiating per calorie than a Mediterranean-like diet in individuals with ischemic heart Disease. (full) PubMed

Type of study and length: 12 weeks, Randomised Controlled dietary intervention. Mediterranean like diet (MD) compared to paleo diet (PD)

Participants: 29 male with ischemic heart disease (IHD) and with impaired glucose tolerance or type 2 diabetes. Increased OGTT. Waist >94cm. PD n=14, MD n=15

Results: PD, 20% decrease in the oral glucose tolerance test (OGTT) during the first 6 weeks and an 8% decrease between weeks 6 and 12.  In the MD group, a 10% decrease of OGTT after the first 6 weeks with no further change at 12 week. After 12 weeks, all 14 subjects in the Palaeolithic group had normal 2 hour plasma glucose values, compared with 7 of 15 subjects.

Waist circumference decrease: PD 5.6cm, MD 2.9cm, Weight loss PD 5.1kg, MD 3.8kg

Diet difference between groups

  • Energy intake PD 25% lower.  PD5.6MJ, MD 7.5MJ, i.e. PD consumed less energy, for same satiety.
  • Protein intake identical,
  • Carb PD 43% decrease. PD 134g, MD 231g.
  • Total fat: PD 42g/day, MD 50g/day
  • GL 47% lower in PD, correlated strongly with cereal intake. PD 65, MD 122.  High fruit and lower cereal intake was associated with larger waist cm loss.
  • Satiety Quotient: strong trend for greater satiety quotient for energy in the Paleolithic group (2.7  RS/MJ vs. 1.8  RS/MJ, Paleolithic vs. Mediterranean,
  • Similar weight of food: PD 1493 ± 607 g/day vs. 1649 ± 273 g/day
  • Lower energy density of food in PD: 4.5 kJ/g vs. 5.4 kJ/g, Paleolithic vs. Mediterranean
  • Lower salt intake in PD 4.7g/d vs 7.2g/d

 

Study 6: A Genoni et al., 2016.

Cardiovascular, Metabolic Effects and Dietary Composition of Ad-Libitum Paleolithic vs. Australian Guide to Healthy Eating Diets. A 4-Week Randomised Trial. (PubMed full Text)

Study design: Randomised, non blinded,  Australian guide to healthy eating (AGHE) n=17 compared to PD n=22. Primary aim to compare PD with AGHE health effects and nutritional adequacy.

Participants: 39 healthy overweight women, Age 47 + 13y, BMI 27 + 4,

Study length: 4 weeks

Results: PD significantly greater weight loss; 3.2 vs 1.2kg,  decreased waist; 3.4 vs 1.6cm, fat loss, lowered systolic BP; 3.3 vs 0.7 mmHg. Nutrients: PD had significantly lower calcium, iodine, sodium, betacarotene, vitamins C, A & E, and red cell folate. Women on paleo had 76% less desire for sugar foods vs 56% on AGHE

Diet differences between AGHE and paleo diet, changes from baseline to intervention diets.

  • Total energy, PD from baseline, drop of 1883Kj, AGHA, 1432 Kj
  • Protein: Basline to PD +2g, AGHE, -11g/ day
  • Carbohydrate: baseline to PD 191 to 103 g/day, AGHE 188 to 163 g/day
  • Dietary fibre similar and no change, approx 25g/day
  • Total fat: Baseline to PD 71 to 65g/day, AGHE, 79 to 60
  • SFA: PD 27 to 19g/day, AGHE; 31 to 22g/day

 

Study 7: M Osterdahl et al., 2008.

Effects of a short-term intervention with a paleolithic diet in healthy volunteers. (PDF) PubMed

Study type: Pilot study. Aim: assess the effect of a paleolithic diet in a pilot study on healthy volunteers

Study length: 3 weeks

Participants: Healthy volunteers, 20 – 40 yrs, BMI<30. 10m, 10f started, 5m, 9 f completed

Results: Weight reduced by 2.3kg, Waist by 1.5cm, Systolic BP reduced by 3mmHg

Diet changes from normal diet:

  • Total energy: reduced by 36%, 2478  to 1584 kcal/day,
  • Protein:  increased slightly: 84 to 95 g/day
  • Carbohydrates: reduced by 53%, 335 to 158 g/day
  • Fibre: no change –  range 25 -35g per day
  • Fat: redcued 82 to 63g/day.  SFA 31 to 15g/day
  • Nutrients: Vitamin B6 +76%, Vit C +200%, Vitamin E +69%, Vitamin K +45%, sodium -62%, potassium +45%, calcium -53%,

 

Study 8. R Pastore et al., 2015.

Paleolithic nutrition improves plasma lipid concentrations of hypercholesterolemic adults to a greater extent than traditional heart-healthy dietary recommendations PubMed

Study type and length: 8 months, 2 phase intervention, own controls. AHA heart-healthy dietary guidelines for 4 months, (phase 1) followed by PD 4 months (phase 2)

Participants: 10 male, 10 female with hypercholesteremia

Results: Baseline to end AHA, then end PD phase. There were greater improvements in the PD phase compared to ADA phase in lipids, Total cholesterol -3% on AHA, -20% PD, LDL, -3% AHA, -36% PD, HDL AHA, no change, +35% PD. Weight loss AHA 3.3kg, PD 10.4kg in men. AHA no change, PD 8.1kg

Diet changes between phases

  • Same energy: 8700 kJ perday
  • Protein PD 123g compared to 91 g per day
  • Carbohydrates PD 164 vs 271g per day
  • Fat PD 94g, AHA 68g, SFA 24 vs 21, MUFA 44 vs 26.5, PUFA, 19vs 14.6, EPA+DHA 1580 vs 570mg.
  • Fibre PD 34, AHA 28
  • Sodium PD 2194 vs 2121, potassium PD 5859 vs 3932

 

This last study measured satiety hormones after single meals

Study 9: F Bligh et al., 2015.

Plant-rich mixed meals based on Palaeolithic diet principles have a dramatic impact on incretin, peptide YY and satiety response, but show little effect on glucose and insulin homeostasis: an acute-effects randomised study. (Full study link) PubMed

Study type: Three different meals were tested in 24 healthy male subjects, each subject tested each meal, randomised crossover. Meals: paleo diet meal 1(PD1) paleo principles modern foods with PCF ratios based on hunter-gatherer studies. PD2 same ingredients, but lower protein to match reference (ref)meal based on WHO guidelines. All 3 meals had 50g available carbohydrates. Carbohydrates in WHO meal was from rice, fruit, vegetables, in PD meals from vegetables, fruit, and mushrooms.

Results: Both PD1 and PD2 had a significant increase in GLP-1, and Peptide YY and improved satiety. The incretin hormone GIP was dramatically lower and showed a very different response curve for both PAL1 and PAL2 in comparison with the REF meal

 

 

“The Truth About Carbs” BBC documentary the diet rapidly reverses type 2 diabetes In Dr Unwin’s patients

By
Julianne
-
2

I’ve written about Dr. David Unwin in previous posts. He is an inspirational GP in the UK who is using a whole food, low carbohydrate diet to reverse type 2 diabetes and obesity and saves the NHS thousands of pounds in medication costs.

A UK doctor puts 18 patients with type 2 diabetes on a low carb diet with amazing results

UK doctor saves government £45K by using low carb diet to treat type 2 diabetes

This graph shows just how little his Norwood Surgery spends in drug costs compared to other practices.

A documentary has been shown in the UK recently which clearly outlines the problem with highly processed carbohydrates (the beige and white ones), and follows a group of people with type 2 diabetes and obesity as they change their diets to follow these prinicipals. What is fantastic is that none considered the change difficult, or restrictive.

Here is the documentary. Happy watching.

 

 

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Paleozone Nutrition
Nutrition stuff I find interesting with a Paleo Zone flavour by New Zealand nutritionist Julianne Taylor

Disclaimer - This information is provided for your interest only. I am not a Doctor, and so this is not meant to be medical advice

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