PALEO? EFFECT OF PALEO DIET ON CVD By: Hannah Wolf and Sam Aldrich - - PowerPoint PPT Presentation

SHOULD YOU GO PALEO?

EFFECT OF PALEO DIET ON CVD

By: Hannah Wolf and Sam Aldrich

WHAT IS THE PALEO DIET?

• Also known as the “caveman diet” or

“stone age diet”

• A diet consisting of primarily meat, fish,

fruits, vegetables, and nuts based on the foods early humans consumed

• Most searched diet related term on

Google (2014)

References: Klonoff DC. The beneficial effects of a Paleolithic diet on type 2 diabetes Tarantino G, Citro V, Finelli C. Hype or reality Manheimer EW, Van Zuuren EJ, Fedorowicz Z, Pikl H. Paleolithic nutrition for metabolic syndrome

COMPONENTS OF THE PALEO DIET

INCL INCLUDED UDED

• Red meat, poultry,

fish

• Eggs
• Fruit
• Vegetables
• Nuts (except peanuts)

and seeds EX EXCL CLUDED UDED

• Grains
• Legumes
• Dairy products
• Processed foods
• Added sugar
• Coffee & alcohol

Reference: Aragon, A. The Paleo Diet: Claims Versus Evidence.

WHY DO PEOPLE GO PALEO?

• To mimic the way humans ate 2.5 million years
• Supporters believe our bodies have not adapted to our

current eating patterns

• The establishment of agriculture began ~10,000 years

ago

• Non-western populations that currently follow this

style of eating exhibit lower obesity rates and increased health benefits

• Lower consumption of processed foods and high GI

carbohydrates

References: Tarantino G, Citro V, Finelli C. Hype or reality Klonoff DC. The beneficial effects of a Paleolithic diet on type 2 diabetes Manheimer EW, Van Zuuren EJ, Fedorowicz Z, Pijl H. Paleolithic nutrition for metabolic syndrome

PALEO PROTESTORS

• Contradicts USDA’s 2015 Dietary Guidelines
• Critics believe our bodies have adapted to the

evolution of our diet over the last 10,000 years

• Today’s version of the Paleo diet does not necessarily

represent the type of diet consumed 2.5 million years ago

• Depended on climate and geographic location
• Health experts claim the Paleo diet lacks adequate

research (2015)

References: Tarantino G, Citro V, Finelli C. Hype or reality Manheimer EW, Van Zuuren EJ, Fedorowicz Z, Pijl H. Paleolithic nutrition for metabolic syndrome

RISK FACTORS FOR CVD

• LDL
• Optimal= <100 mg/dL
• Total cholesterol
• Optimal= <200 mg/dL
• HDL
• Optimal= ≥60 mg/dL

.

• Diabetes
• Hypertension
• BP ≥140/90
• Hyperlipidemia

Reference: Brown JE. Adult Nutrition: Conditions and Interventions. Nutrition Through the Life Cycle. 5th ed. Stamford, CT: Cengage Learning. 2014:438

SUPPORTIVE EVIDENCE

“Beneficial effects of a Paleolithic diet on cardiovascular risk factors in type 2 diabetes: a randomized cross-over pilot study” Jonsson et al. (2009)

• Randomized crossover trial
• 13 patients with type 2 diabetes (3 women, 10 men)
• Compare the effects of Paleolithic diet with a “typical”

diabetes diet on CVD risk factors

Reference: Jonsson T, Granfeldt Y, Ahren B, et al. Beneficial effects of a Paleolithic diet on cardiovascular risk factors in type 2 diabetes: a randomized cross-over pilot study.

METHODS

• Randomly assigned to follow a Paleolithic diet and a

Diabetes diet in line with dietary guidelines on two consecutive 3 month periods

• Biochemical and anthropometric measurements
• 4-day weighed food record on four consecutive

days, 6 weeks after initiating each diet

Paleolithic Diet Diabetes Diet

Total Energy (kcal) 1581±245 1878±379 Protein (g) 94±18 90±14 Fat (g) 68±11 72±20 Carbohydrate (g) 125±43 196±61 Fiber (g) 21±8 26±8

• Sat. Fat (g)

19±5 27±9 Monounsaturated Fat (g) 30±6 26±7 Polyunsaturated Fat (g) 14±4 12±4 Cholesterol (g) 577±107 365±88 Red indicates statistical significance (p= 0.05)

SIGNIFICANT DIET DIFFERENCES

PALEOLITHIC DIET

• Vegetables
• Fruit
• Meat
• Eggs

DIABETIC DIET

• Beans
• Cereals without

rice

• Milk/milk products
• Bakery items
• Potatoes

MAJOR RESULTS

Risk Factor Baseline Diabetes Paleolithic HbA1C (%) 6.6±0.6 5.9±0.9 5.5±0.7 DBP 83±10 83±9 79±6 Weight (kg) 87±17 84±15 81±13 BMI 30±7 29±6 28±5 Waist Circumference 103±14 98±11 94±9 HDL 23.04±3.96 22.68±4.14 24.12±5.4

MAJOR RESULTS

• Paleolithic diet resulted in:
• Lower HbA1c, triglycerides, diastolic blood

pressure

• Lower weight, BMI, and waist circumference
• Higher HDL
• Author’s conclusions: Paleolithic diet may lower

risk factors for CVD in comparison to a typical diabetes diet

LIMITATIONS

• Small sample size
• No blinding after randomization
• Possible carry-over effects of HbA1c levels
• Long-term study on broader populations is

needed

SUPPORTIVE EVIDENCE

“Metabolic and physiological improvements from consuming a Paleolithic, hunter-gatherer type diet” Frassetto et al. (2009)

• Outpatient, metabolically controlled study
• 9 non-obese, sedentary healthy individuals (6 male,

3 female)

• To assess potential health benefits of the Paleolithic

diet

Reference: Frassetto LA, Schloetter M, Mietus-Synder M, et al. Metabolic and physiologic improvements from consuming a Paleolithic, hunter-gatherer type diet.

METHODS

Usual Diet

Increased potassium and fiber Paleolithic

• type diet

3 Days 7 Days 10 Days

DIET COMPARISONS

NO SIGNIFICANT DIFFERENCE

• Kcals
• Carbohydrates
• Total fat
• Monounsaturated

fat

• Cholesterol
• Calcium

SIGNIFICANT DIFFERENCES éProtein êSaturated fat éPolyunsaturated fat êSodium éPotassium éPhosphate éMagnesium

MAJOR RESULTS

• Paleo diet was associated with reduced blood

pressure (-3.1+/-2.9 mm Hg), improved arterial distensibility (+0.19+/-0.23), and reduced plasma insulin

• Additionally: significant reductions in total

cholesterol (-0.8+/-0.6 mg/dL), LDL (-0.7+/-0.5 mg/ dL), and triglycerides (-0.3+/-0.3 mg/dL)

• Author’s conclusions: short-term Paleolithic-type

diet provides benefits, such as improved BP, insulin regulation, and lipid profiles

LIMITATIONS

• Small sample size
• Limited sample demographic
• No control group for comparison
• Short-term

SUPPORTIVE EVIDENCE

“Effects of a short-term intervention with a Paleolithic diet in healthy volunteers” Osterdahl et

• al. (2008)
• Pilot study
• 14 subjects (5 men, 9 women)
• Effect of a 3 week implementation of the Paleo diet
• n metabolic and anthropometric indicators

Reference: Osterdahl M, Kocturk T, Koochek A, Wandell PE. Effects of a short-term intervention with a Paleolithic diet in healthy volunteers.

MAJOR RESULTS

• Significant decrease in mean weight (-2.3 kg), BMI

(-0.8), waist circumference (-0.5 cm), systolic blood pressure (-3 mm Hg), and plasminogen activator inhibitor-1 (-72%)

• Diet components included increased potassium/

sodium ratio

• Important in prevention of hypertension
• Author’s conclusions: short-term intervention

proved favorable effects in CVD prevention

LIMITATIONS

• Small sample size
• Pilot study (preliminary)
• Dietary data only collected from 6 subjects
• Clinical significance?

SUPPORTIVE EVIDENCE

“Paleolithic nutrition improves plasma lipid concentrations on hypercholesterolemic adults to a greater extent than traditional heart-healthy dietary recommendations” Pastore et al. (2015)

• Prospective cohort
• 10 men, 10 women
• Four month AHA diet followed by four month

Paleolithic diet

Reference: Pastore RL, Brooks JT, Carbone JW. Paleolithic nutrition improves plasma lipid concentrations of hypercholesterolemic adults to a greater extent than traditional heart-healthy dietary recommendations.

MAJOR DISCUSSION POINTS

• Study design could be improved
• Exercise factor?
• Clinical significance?
• No washout phase
• Is it sustainable?
• Small sample size
• No assessment of inflammatory markers
• Cost

CONTRADICTING EVIDENCE

“Whole grain, cereal fiber, bran, and germ intake and the risks of all-cause and CVD-specific mortality among women with type 2 diabetes” He et al. (2010)

• Prospective cohort study
• 7,822 women with type 2 diabetes
• Whole grain consumption and all-cause and CVD-

specific mortality in patients with type 2 diabetes

Reference: He M, Dam RMV, Rimm E, Hu FB, Qi L. Whole grain, cereal fiber, bran, and germ intake and the risks of all-cause and CVD-specific mortality among women with type 2 diabetes.

METHODS

• Examined dietary intakes of women in the

Nurses’ Health Study (NHS)

• Using food frequency questionnaires, women

reported how often they consumed whole grains

• 26 years late, researchers recorded:
• 852 all-cause deaths
• 295 CVD-deaths

MAJOR RESULTS

Lower CVD- specific deaths

Whole grains intake Cereal fiber intake Bran intake

STRENGTHS

• Prospective cohort

study

• Provides valuable

information

• Minimizes bias
• Large sample size

WEAKNESSES

• Possible uncontrolled

covariates

• Does not prove cause

and effect

• More studies needed
• n additional

populations

CONTRADICTING EVIDENCE

“Association between dietary whole grain intake and risk of mortality: two large prospective studies in U.S. men and women” Wu et al. (2015)

• 2 large prospective cohort studies
• 74,341 women (Nurses’ Health Study)
• 43,744 men (Health Professionals Follow-Up Study)
• Assess the relationship between whole grain

consumption and mortality risk

Reference: Wu H, Flint AJ, Qi Q, et al. Association between dietary whole grain intake and risk of mortality: two large prospective studies in U.S. men and women.

METHODS

Food Frequency Questionnaires Mortality Rates Assessment of Covariates

MAJOR RESULTS

15,106 deaths 2,989 from CVD 5,964 from cancer 11,814 deaths 3,621 from CVD 3,921 from cancer

NHS Follow-Up HPFS Follow-Up

~20% ~30%

MAJOR RESULTS

• Each serving of whole grains (28g/day) was

correlated with 5 % decreased mortality and 9% decreased CVD mortality

• Intakes of bran (component of whole grains)

significantly associated with lower CVD-related deaths

STRENGTHS

• Large sample

sizes

• Includes men and

women

• Long-duration

WEAKNESSES

• Possible outside

factors

• Lack of diversity
• Cannot generalize

results

• Does not prove

cause and effect

CONTRADICTING EVIDENCE

“Whole-grain intake and insulin sensitivity: the insulin resistance atherosclerosis study” Liese et

• al. (2003)
• Prospective cohort study
• 978 subjects (both men and women, between 40-60

years old)

• Assess the relationship between whole-grain

consumption and insulin sensitivity

Reference: Liese AD, Roach AK, Sparks KC, Marquart L, D’Agostino Jr RB, Mayer-Davis EJ. Whole grain intake and insulin sensitivity: the insulin resistance atherosclerosis study.

MAJOR RESULTS

Increased insulin sensitivity and decreased fasting insulin Dark breads (wheat, rye, pumpernickel,

• ther high

fiber varieties)

High fiber cereals (bran, granola, shedded wheat)

LIMITATIONS

• Difficult to distinguish between types of grains
• Whole-grains vs. refined-grains
• Does not prove cause and effect
• Potential bias: Len Marquart (researcher)

employed by General Mills Cooperation

REASONS TO PROMOTE PALEO

• Less refined and processed carbohydrates
• Increased fruit and vegetable consumption
• Emphasis on unsaturated fatty acids
• May be associated with lower energy intake
• Encourages weight loss

PROBLEMS WITH PALEO

• Limited research
• Media/advertising influences public
• “Good foods” and “Bad foods” not

typically effective

• Cost

PALEO RESEARCH PROPOSALS

• Need more RCTs on larger sample sizes
• Have humans evolved along with our diet?
• Cost evaluation

THOUGHTS? QUESTIONS?

REFERENCES

• 1. Klonoff DC. The beneficial effects of a Paleolithic diet on type 2 diabetes and
• ther risk factors for cardiovascular disease. J Diabetes Sci Technol. 2009;

3(6):1229-1232. doi:10.1177/193229680900300601.

• 2. Tarantino G, Citro V, Finelli C. Hype or reality: should patients with metabolic

syndrome-related NAFLD be on the hunter-gatherer (paleo) diet to decrease morbidity? J Gastrointestin Liver Dis. 2015; 24(3):359-368. doi: 10.15403/ jgld.2014.1121,243.

• 3. Manheimer EW, Van Zuuren EJ, Fedorowicz Z, Pijl H. Paleolithic nutrition for

metabolic syndrome: systematic review and meta-analysis. Am J Clin Nutr. 2015; 102:922-932. doi:10.3945/ajcn.115.113613.

• 4. Aragon, A. The Paleo Diet: Claims Versus Evidence.

https://www.nsca.com/uploadedfiles/nsca/inactive_content/program_books/ ptc_2013_program_book/aragon.pdf. Accessed March 2, 2016.

• 5. Jonsson T, Granfeldt Y, Ahren B, et al. Beneficial effects of a Paleolithic diet
• n cardiovascular risk factors in type 2 diabetes: a randomized cross-over

pilot study. Cardiovasc Diabetol. 2009; 8: 35.

REFERENCES

• 6. Frasetto LA, Schloetter M, Mietus-Synder M, Morris Jr RC, Sebastian A.

Metabolic and physiologic improvements from consuming a Paleolithic, hunter- gatherer type diet. Eur J Clin Nutr. 2009; 63:947-955. doi:10.1038/ejcn.2009.4.

• 7. Osterdahl M, Kocturk T, Koochek A, Wandell PE. Effects of a short-term

intervention with a Paleolithic diet in healthy volunteers. Eur J Clin Nutr. 2008; 62:682-685. doi:10.1038/sj.ejcn.1602790.

• 8. Pastore RL, Brooks JT, Carbone JW. Paleolithic nutrition improves plasma lipid

concentrations of hypercholesterolemic adults to a greater extent than traditional heart-healthy dietary recommendations. Nutr Res. 2015 Jun;35(6):474-9. doi: 10.1016/j.nutres.2015.05.002.

• 9. He M, Dam RMV, Rimm E, Hu FB, Qi L. Whole grain, cereal fiber, bran, and

germ intake and the risks of all-cause and CVD-specific mortality among women with type 2 diabetes. Circulation 2010 May 25; 121(20): 2162–2168.

• 10. Wu H, Flint AJ, Qi Q, et al. Association between dietary whole grain intake and

risk of mortality: two large prospective studies in U.S. men and women. JAMA Intern Med. 2015 Mar; 175(3): 373–384.

• 11. Liese AD, Roach AK, Sparks KC, Marquart L, D’Agostino Jr RB, Mayer-Davis EJ.

Whole grain intake and insulin sensitivity: the insulin resistance atherosclerosis

• study. Am J Clin Nutr. 2003; 78(5):965-971.