Short Term Intervention Using the Paleolithic Diet to Prevent Progression from Prediabetes to Type 2 Diabetes in Those with HgA1c 5.7% or Higher

Saturday, 7 November 2015

Chrystyne Olivieri, BSN, FNP-BC, CDE
Department of PAANS Cardiology, Northshore LIJ Health System, Syosset, NY, USA

Background: Western metabolic diseases, especially, obesity, prediabetes, diabetes and cardiovascular diseases impose a great financial and quality of life burden on modern society. Chronic diseases are being identified as a health crisis in almost every country in the world today. These problems have continued to progress despite an alarming amount of modern pharmaceuticals. Many studies have identified lifestyle changes as the best to address these diseases. Human history reveals that prior to the advent of agriculture, humans were believed to be free of diseases such as cardiovascular disease and diabetes. Examination of anthropological remains have clearly identified that early humans, especially from the Paleolithic era of 50,000 to 10,000 years ago, did not die from the same diseases that plague modern man. During the end of the 1800’s through the 1900’s, anthropologists and biologists were particularly active in researching the lifestyles of indigenous, primitive cultures alive on the planet at that time. They found that those societies did not suffer any of the chronic diseases that are so prevalent in the modern world. The diets of these societies have been identified to be much lower in carbohydrates and higher in saturated fats than the Standard American Diet, regardless of where they lived on the planet. It was speculated that it was the diet that made the most profound difference in their health and longevity. Paleo eating patterns keeps a focus on naturally occurring foods like vegetables, fruit, large game, poultry, fish, eggs and nuts, with an eye on what was available during the Paleolithic era prior to the advent of agriculture and animal domestication. It also focuses on an avoidance of processed foods, sugars, grains, legumes, dairy, chemically altered fats and artificial sweeteners. This study attempts to employ Paleo eating patterns to mimic the diet of our ancestors as this may be a viable option to minimize the debilitating effects of metabolic diseases related to lifestyle.

Purpose: This study aims to explore to what extent a short term intervention utilizing the Paleolithic diet may affect weight, blood pressure and the specific biomarkers of metabolism in patients with HgA1c ≥ 5.7%. We will attempt to see how Paleo eating patterns may affect the prominent risk factors for many chronic diseases of the modern world.

Theoretical Framework: Change behavior is difficult for many people. Since diseases of lifestyle are often rooted in behavior, the psychological, social and cultural aspects of poor lifestyle choices must be considered if behavior modification is to be successful. A skilled provider can help patients to commit to change through the use of Brief Action Planning. This is a technique which allows patients to commit to making the changes in their lifestyle based on which behaviors they want to change rather than what the providers deems necessary to change. This patient centered approach respects patients autonomy by facilitating behavior modifications using the biopsychosocial model instead of the traditional biomedical model. Lifestyle modifications requires a broader approach if behavior change is the goal.

Review of Literature: For over twenty years, research has been conducted showing how diet and lifestyle interventions can reduce the morbidity and mortality associated with pre-diabetes and diabetes. Despite this, the prevalence of diabetes has risen. It wasn’t until 1985 that the first study of a specific ancestral diet was conducted in the United States by Eaton and Konner. It attempted to identify what would constitute the optimal human diet based on anthropological evidence. Since then, many researchers have also looked at the diets of indigenous cultures that had avoided contact with the modern world. Native cultures do not seem to experience the energy imbalance of food energy intake exceeding total energy expenditure, which is the basis of the Standard American Diet. Although many weight loss programs produce weight loss and improved glycemic control, the Paleolithic diet has been found to be superior for its effects on overall health. To date, there have been nine human studies conducted throughout the world evaluating the effectiveness of the Paleolithic diet in human health from 2007 to 2013. As a result, the evidence is well supported that the Paleo diet is a viable strategy to prevent or reverse the metabolic diseases so prevalent in our society. Humans have successfully evolved as a species eating a diet essentially void of high glycemic index carbohydrates, sugars, processed foods, artificial sweeteners and chemically altered oils and fats for hundreds of thousands of years. The evidence suggests that an ancestral diet can be employed to help treat and manage many chronic health problems associated with poor lifestyle choices.

Method: A convenience sample of men and women (N=34) that fit the inclusion criteria of HgA1c ≥ 5.7% were initially educated for 45 minutes in the essentials of the Paleolithic diet. Exclusion criteria were of patients using insulin or sulfonylureas, as they were more susceptible to hypoglycemia when removing high glycemic index carbohydrates from their diet. Bio-markers of metabolism included triglycerides, high-density lipoproteins, fasting glucose and fructosamine and these blood tests were resulted at baseline and repeated 3 weeks post-intervention. Blood pressure and weight were also taken at baseline and again at 3 weeks post-intervention. Differences were evaluated by T-test and analyzed with descriptive graphs to compare pre-intervention variables to post-intervention results.

Results: Results are pending. Preliminary data suggests that the Paleo diet is effective for weight loss and lowering triglycerides which are two major risk factor for chronic diseases like diabetes.

Potential Implications: Findings suggest that eating a low carbohydrate diet, such as the Paleo diet, has profound effects on risk factors for chronic disease in modern culture. Although it is necessary to exclude many foods and beverages commonly consumed in our modern culture, for those motivated to improve their health through lifestyle modifications, it may be a powerful tool in the prevention of metabolic diseases like diabetes.