The Paleo Diet

1. The Paleo Diet Presented by Erin McLean

2. Overview • Paleo diet in a nutshell • Review of literature • Journal Club article • Methodology • Results • Discussion • Summary • Discussion questions • References

3. Paleo Diet…in a nutshell • Eat:

4. Paleo Diet…in a nutshell • Don’t Eat:

5. Review of LiteratureA 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 glucose-intolerance (Lindeberg et al., 2007, p. 1796)

6. Review of LiteratureA 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)

7. Review of LiteratureA 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)

8. Review of LiteratureA 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)

9. Review of LiteratureA 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

10. Review of LiteraturePaleo 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)

11. Review of LiteraturePaleo 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)

12. Review of LiteraturePaleo 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)

13. Review of LiteraturePaleo 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)

14. 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

15. 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)

16. 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)

17. 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)

18. 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)

19. 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)

20. 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)

21. 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)

22. Methodology: Design • Paleo Diet (10 days): ˗ Domestic meat, carrot juice, and mayonnaise included due to similarity of nutritional content to preagricultural foods. (Frassetto et al., 2009, p. 949)

23. 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)

24. 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)

25. Methodology:Outcome Measures • Outcome Measures: (Frassetto et al., 2009, p. 949-952)

26. 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)

27. 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)

28. 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)

29. 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)

30. 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)

31. 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)

32. 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)

33. 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)

34. 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)

35. 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)

36. Results • No significant change in: • Weight • Total body/intracellular water content • Mean creatinine clearance • Urine pH (Frassetto et al., 2009, p. 949-950)

37. Results • Strength of Evidence (EAL): • Evidence found in this research is given a Grade II (fair) status.

38. 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)

39. 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

40. Discussion Question #1 Paleo diet in standard clinical practice?

41. Discussion Question #2 Population that Paleo diet would appeal to?

42. Discussion Question #3 Credence to idea of following diet in line with human evolutionary biochemistry?

43. 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-paleo-diet/ 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, 2013, from http://www.chethstudios.net/2010/09/50-incredibly-creative-lego-creations.html Lego caveman 1 [Digital image]. (n.d.). Retrieved September 30, 2013, from http://hongkongcavalierdave.deviantart.com/art/Lego-Caveman-1-206782315

44. 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-legumes-cereals-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/2212-2672/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 http://coisasdemeninasvaidosas.blogspot.com/2013_06_01_archive.html Sears, K. (2013). [Table salt]. Retrieved September 30, 2013, from http://www.realsimple.com/home-organizing/cleaning/all-natural-cleaning-solutions-00000000011547/page10.html [Standing caveman]. (n.d.). Retrieved September 30, 2013, from http://lethereatclean.com/2013/06/10/why-i-love-to-hate-the-paleo-diet/