Transcript The Paleo Diet

The Paleo Diet
Presented by Erin McLean
Overview
• Paleo diet in a nutshell
• Review of literature
• Journal Club article
– Methodology
– Results
– Discussion
• Summary
• Discussion questions
• References
Paleo Diet…in a nutshell
• Eat:
Paleo Diet…in a nutshell
• Don’t Eat:
Review of Literature
A Palaeolithic diet improves glucose tolerance more than a
Mediterranean-like diet in individuals with ischaemic heart disease
• Purpose:
– To compare the effects of the Paleo diet to a
Mediterranean-like diet on glucose tolerance and
insulin response in IHD patients with glucoseintolerance
(Lindeberg et al., 2007, p. 1796)
Review of Literature
A Palaeolithic diet improves glucose tolerance more than a
Mediterranean-like diet in individuals with ischaemic heart disease
• Methods:
– 12-week controlled dietary intervention trial
– 29 male IHD patients with glucose intolerance and
waist circumference >94 cm recruited
– Subjects randomized to the Paleo diet (n=14) or
the Consensus diet (n=15)
– All subjects given written dietary advice and
recipes according to assigned diet
– Outcome measures included glucose AUC and
insulin AUC in OGTTs, weight change, and waist
circumference
(Lindeberg et al., 2007, p. 1795-1797)
Review of Literature
A Palaeolithic diet improves glucose tolerance more than a
Mediterranean-like diet in individuals with ischaemic heart disease
• Results:
– Glucose AUC ↓ 26% in Paleo group (P=0.0001) and 7% in
Consensus group (P=0.08)
• Glucose AUC improvement in Paleo group independent of
change in waist circumference
– Change in waist circumference ↓ 5.6 cm in Paleo group
(P=0.0008) and 2.9 cm in Consensus group (P=0.03)
– Trend toward larger ↓ in insulin AUC in Paleo group but
considered NS due to association between insulin AUC and
change in weight
(Lindeberg et al., 2007, p. 1795)
Review of Literature
A Palaeolithic diet improves glucose tolerance more than a
Mediterranean-like diet in individuals with ischaemic heart disease
• Conclusion:
– Glucose tolerance may be enhanced on the Paleo
diet independently of ↓ in waist circumference
(Lindeberg et al., 2007, p. 1796)
Review of Literature
A Palaeolithic diet improves glucose tolerance more than a
Mediterranean-like diet in individuals with ischaemic heart disease
• Evaluation of Article:
– Accurate summary of current body of knowledge
– Possible bias
– Conclusions appropriate
Review of Literature
Paleo diet versus modified Paleo diet: A randomized control trial
of weight loss and biochemical benefit
• Purpose:
– To compare physiological and metabolic
improvements in subjects consuming either a
Paleo or modified Paleo diet
(Martin et al., 2013, p. A-35)
Review of Literature
Paleo diet versus modified Paleo diet: A randomized control trial
of weight loss and biochemical benefit
• Methods:
– 5-week clinical dietary intervention study
– 20 subjects recruited and placed in Paleo diet or modified
Paleo diet group
– Each group given specific dietary instructions and required
to submit weekly diet compliance records
– Outcome measures included body composition and weight,
lipid profiles, insulin sensitivity, and BP
(Martin et al., 2013, p. A-35)
Review of Literature
Paleo diet versus modified Paleo diet: A randomized control trial
of weight loss and biochemical benefit
• Results:
– Both diet groups exhibited significant ↓(P<0.05)
in:
•
•
•
•
•
Weight (-3.3 ± 0.4 kg)
BMI (-1.2 ± 0.2 kg/m²)
FFM (-0.9 ± 0.3 kg)
Fat mass (-2.2 ± 0.3 kg)
% body fat (-1.6 ± 0.4%)
– Lipid profiles, insulin sensitivity, and BP measures
improved but no significant difference measured
between diet groups
(Martin et al., 2013, p. A-35)
Review of Literature
Paleo diet versus modified Paleo diet: A randomized control trial
of weight loss and biochemical benefit
• Conclusion:
– Following a modified Paleo diet may result in
physiological improvements similar to those
observed in the more restrictive Paleo diet
(Martin et al., 2013, p. A-35)
Journal Club Presents…
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
Purpose
• To compare the effects of a paleolithic-type
diet with that of a usual diet on metabolic and
physiological variables
(Frassetto et al., 2009, p. 948)
Methodology:
Subjects
• Subject Recruitment Criteria:
– Nonobese men and women
– 18 years of age or older
– No medical problems
– No medications
– Minimal regular physical activity
– Pass telephone screening
– Pass graded maximal exercise treadmill test
(Frassetto et al., 2009, p. 948)
Methodology: Subjects
• Recruited Subjects:
– 11 participants enrolled/9 participants completed
study
– 6 males/3 females
– Age: 38 ± 12 years
– BMI: 27.8 ± 2.4 kg/m²
(Frassetto et al., 2009, p. 949)
Methodology:
Design
• Design:
– Research type:
• Outpatient, metabolically controlled study
– Diets:
• Usual diet (days -2 to 0)
• Three ramp-up diets (7 days)
• Paleo diet (10 days)
(Frassetto et al., 2009, p. 947-948)
Methodology: Design
• Usual Diet (3 days):
– Participants ate usual diet
– Testing:
• Baseline 24-h urine collections for electrolyte profile
• Fasting blood samples for lipid, glucose, and insulin
profiles
• BP measurements
– Dietitian interview:
• Five-pass, 24-h diet recall of usual diet
(Frassetto et al., 2009, p. 948)
Methodology: Design
• Ramp-up Diets (7 days):
– Intervention phase
– Diets developed by research dietitians
– Diets utilized for adaptation purposes
• Fiber
• Potassium
(Frassetto et al., 2009, p. 948)
Methodology: Design
• Ramp-up Diets Con’t:
– Ramp 1 diet: 1 day, 125 mmol K
–Ramp 2 diet: 3 days, 180 mmol K
˗ Ramp 3 diet: 3 days, 259 mmol K
(Frassetto et al., 2009, p. 951)
Methodology: Design
• Paleo Diet (10 days):
Included Foods
Excluded Foods
Meat
Dairy products
Fish
Legumes
Poultry
Cereals
Eggs
Grains
Fruits
Potatoes
Vegetables
Products containing KCl
Tree nuts
Canola oil
Mayonnaise
Honey
(Frassetto et al., 2009, p. 949)
˗ Domestic meat, carrot
juice, and mayonnaise
included due to similarity
of nutritional content to
preagricultural foods.
Methodology: Design
• Paleo Diet Con’t:
– 3 meals/3 snacks
– Same diet consumed daily
– 1 meal/day consumed at research center
– All other meals packed for take-out
– 24-h urinary sodium and potassium excretion
utilized as dietary compliance marker
(Frassetto et al., 2009, p. 949)
Methodology: Design
• Paleo Diet Con’t:
– Maintenance energy needs calculated based on
participant weight and daily activity level
– Body weight measured daily to eliminate weight
loss
(Frassetto et al., 2009, p. 949)
Methodology: Outcome Measures
• Outcome Measures:
Main Outcome Measures
Outcome Measures
Electrolyte excretion
Usual vs. Paleo diet intakes
Lipid profile
Weight change
Glucose & insulin profiles
Total body/intracellular water
content
Blood pressure & vascular
reactivity
Creatinine clearance
Urinary calcium/creatinine
clearance
Urine pH
(Frassetto et al., 2009, p. 949-952)
Methodology: Procedures
• First 3 Days (Usual diet, days -2 to 0):
– Baseline 24-h urine collections for electrolyte profile
– Fasting blood samples for lipid, glucose, insulin
profiles
– BP and vascular reactivity
• Last 3 Days (Paleo diet, 15 to 17):
– All initial tests repeated
– Results from first 3 days averaged/results from last 3
days averaged
(Frassetto et al., 2009, p. 948-949)
Methodology: Procedures
• Electrolyte Profile:
– Data obtained from 24-h urine collection
– Averaged days -2 to 0 and 15 to 17 for each
participant
– Mean values compared before and after Paleo
diet
(Frassetto et al., 2009, p. 948-949)
Methodology: Procedures
• Lipid Profile:
– Data obtained from fasting blood samples
– Averaged days -2 to 0 and 15 to 17 for each
participant
– Mean values compared before and after Paleo
diet
(Frassetto et al., 2009, p. 948-949)
Methodology: Procedures
• Glucose & Insulin Profiles:
– Data obtained from fasting blood samples
– Blood samples obtained at 0 (fasting), 30, 60, and 120
min during 2-h OGTT
– Insulin AUC from 2-h OGTT calculated using
trapezoidal method
– Insulin sensitivity calculated using homeostatic
assessment model
– Mean values compared before and after Paleo diet
(Frassetto et al., 2009, p. 948-949)
Methodology: Procedures
• BP and Vascular Reactivity:
– BP measured after 10 min of sitting at 1 min
intervals for 3 min
– Mean values compared before and after Paleo
diet
– BAD and blood flow measured at baseline and
after cuff occlusion for 5 min
(Frassetto et al., 2009, p. 949)
Methodology: Data Analysis
• Data Analysis:
– Repeated measures analysis with post hoc paired
t-tests
– Regression analysis
– Range and medium data
– Measured consistency of directional changes in
outcome variables
– Statistics reported as mean ± s.d.
(Frassetto et al., 2009, p. 949)
Results
• Electrolyte Profile:
– Urinary Na content ↓ by 89 ± 73 mmol/d (P=0.007)
– Urinary Cl content ↓ by 76 ± 64 mmol/d (P=0.007)
– Urinary K content ↑ by 71 ± 54 mmol/d (P=0.004)
– Ratio of urinary K/Na excretion ↑ from 0.5 ± 0.1 to
2.2 ± 0.6 (P<0.001)
– Urinary Ca/creatinine excretion ↓ by 10 ± 5 mmol
Ca/88400 mmol Cr/d (P=0.001)
(Frassetto et al., 2009, p. 949-950)
Results
• Lipid Profile:
– Total cholesterol ↓ by 0.8 ± 0.6 mmol/l (16%; P=0.007)
– LDL cholesterol ↓ by 0.7 ± 0.5 mmol/l (22%; P=0.003)
– VLDL cholesterol ↓ by 0.2 ± 0.1 mmol/l (35%; P=0.01)
– Triglycerides ↓ by 0.3 ± 0.3 mmol/l (35%; P=0.01)
(Frassetto et al., 2009, p. 950)
Results
• Glucose & Insulin Profiles:
– Mean fasting glucose ↓ by 5% but NS
– Fasting insulin ↓ by 68% from baseline (P=0.07)
– Insulin AUC ↓ by 181 ± 132 pmol (P=0.006)
– Insulin/glucose AUC of usual vs. Paleo diet ↓ from
20 ± 10 to 12 ± 9 mg/M (P=0.005)
(Frassetto et al., 2009, p. 950)
Results
• BP and Vascular Reactivity:
– Mean diastolic BP ↓ by -3.4 ± 2.7 mmHg (P=0.006)
– Mean arterial pressure ↓ by -3 ± 3 mmHg (P=0.01)
– Trend toward ↓ in systolic BP but NS
– Baseline BAD NS before or on Paleo diet
– Peak BAD during hyperemia ↑ by 0.19 ± 0.23 mm
(P=0.05)
(Frassetto et al., 2009, p. 950, 952)
Results
• No significant change in:
– Weight
– Total body/intracellular water content
– Mean creatinine clearance
– Urine pH
(Frassetto et al., 2009, p. 949-950)
Results
• Strength of Evidence (EAL):
– Evidence found in this research is given a Grade II
(fair) status.
Strength of Evidence
Quality
Fair (II)
Consistency
Good (I)
Quantity
Limited (III)
Clinical Impact
Good (I)
Generalizability
Fair (II)
Discussion
• Subjects exhibited improved lipid profiles, insulin
secretion, and BP and vascular reactivity. This
occurred in a short period of time without:
• Losing weight
• Increasing physical activity levels
• Taking medications
• Further research needed to compare effects of
common intervention diets to Paleo diet in
determining relative health efficacy
(Frassetto et al., 2009, p. 952-954)
Summary
• Paleo diet theorized to be more conducive to
human digestive and metabolic systems
• Limited research on Paleo diet
• In featured article, improved circulatory,
carbohydrate and lipid metabolism/physiology
observed from consuming Paleo diet
Discussion Question #1
Paleo diet in standard clinical practice?
Discussion Question #2
Population that Paleo diet would appeal to?
Discussion Question #3
Credence to idea of following diet in line
with human evolutionary biochemistry?
References
[Caveman and woman]. (n.d.). Retrieved September 30, 2013, from
http://yaniblog.blogspot.com/2012/11/lego-minifig-troubles.html
[Caveman running]. (n.d.). Retrieved September 30, 2013, from
http://lego.wikia.com/wiki/Caveman
[Cavemen spearing elephant]. (n.d.). Retrieved September 30, 2013, from
http://www.nerdfitness.com/blog/2010/10/04/the-beginners-guide-to-the-paleodiet/
Comet, R. (2001, January 1). Potatoes [Digital image]. Retrieved September 30, 2013,
from http://visualsonline.cancer.gov/details.cfm?imageid=2653
[Dairy products]. (n.d.). Retrieved September 30, 2013, from http://www.wdpa.net/
Frassetto, L. A., Schloetter, M., Mietus-Synder, M., Morris Jr, R. C., & Sebastian, A.
(2009). Metabolic and physiologic improvements from consuming a paleolithic,
hunter-gatherer type diet. European Journal of Clinical Nutrition, 63, 947-955. doi:
10.1038/ejcn.2009.4
Kosoris, S. (2010, September 5). Caveman [Digital image]. Retrieved September 30,
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Lego caveman 1 [Digital image]. (n.d.). Retrieved September 30, 2013, from
http://hongkongcavalierdave.deviantart.com/art/Lego-Caveman-1-206782315
References
Lindeberg, S., Jönsson, T., Granfeldt, Y., Borgstrand, E., Soffman, J., Sjöström, K., &
Ahrén, B. (2007). A Palaeolithic diet improves glucose tolerance more than a
Mediterranean-like diet in individuals with ischaemic heart disease. Diabetologia,
50(9), 1795-1807. doi: 10.1007/s00125-007-0716-y
Manieri, L. (2008, March 7). Legumes and cereals [Digital image]. Retrieved September
30, 2013, from http://www.dreamstime.com/royalty-free-stock-images-legumescereals-image4527449
Martin, C. A., & Akers, J. (2013). Paleo diet versus modified paleo diet: A randomized
control trial of weight loss and biochemical benefit [Abstract]. Journal of the
Academy of Nutrition and Dietetics, 113(9), suppl 3, A-35. Retrieved September
30, 2013, from http://download.journals.elsevierhealth.com/pdfs/journals/22122672/PIIS2212267213007934.pdf
McCarthy, J. (n.d.). [Foods on Paleo diet]. Retrieved September 30, 2013, from
http://theotherpress.ca/paleo-diet-hot-trend-or-a-survival-guide/
[Oatmeal]. (n.d.). Retrieved September 30, 2013, from
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[Standing caveman]. (n.d.). Retrieved September 30, 2013, from
http://lethereatclean.com/2013/06/10/why-i-love-to-hate-the-paleo-diet/