Tuesday, May 31, 2016

Paleolithic Diet Trials: Otten et al


* The paper is behind a pay wall.  I have access, but if you don’t some of the data is in a supplementary document that you can access here (just remember that the data is in median, interquartile range)

Methods

32 older people with a BMI 25-40 and type 2 diabetes were randomly allocated to follow either a Paleo diet or a Paleo diet + an exercise program for 12 weeks

“The diet was based on consuming lean meat, fish, seafood, eggs, vegetables, fruits, berries, and nuts. Cereals, dairy products, legumes, refined fats, refined sugars, and salt were excluded with the exception of canned fish and cold cuts like ham. The diet was consumed ad libitum, with restrictions of the following: eggs (1–2/day but a maximum of 5/week), potatoes (1 medium sized/day), dried fruit (130 g/day), and nuts (60 g/day). Rapeseed or olive oil (maximum 15 g/day) and small amounts of honey and vinegar were allowed as flavoring in cooking. Participants were instructed to drink mainly still water. Coffee and tea were restricted to a maximum of 300 g/day, and red wine to a maximum of one glass/week”

“…all study participants were advised to perform moderate exercise (e.g. brisk walking) for at least 30 min every day. The PD-EX group underwent a program comprising a combination of aerobic exercise and resistance training in 1-h sessions three times weekly”

Results

The reported energy intakes at baseline are a lot lower than the baseline energy expenditure (2995 and 2960 kcal), suggesting some serious underreporting is going on.  See table 3 for more results, bold indicates a significant difference


Paleo
Paleo + Exercise
Baseline
12 weeks
Baseline
12 weeks
Energy
2022
1731
1595
1065
Protein
83 (17%)
96 (24%)
77 (18%)
79 (26%)
Fat
88 (39%)
71 (42%)
67 (34%)
61 (45%)
Carbohydrate
200 (41%)
127 (31%)
169 (42%)
77 (27%)
Fibre
21
23
20
14

Both groups experienced significant weight loss and improvements in many metabolic markers.  Despite decreasing SFA and increasing MUFA and PUFA, LDL-C wasn’t altered by the diet or exercise, which might be due to high statin use (6/15 and 8/14) and the already low LDL-C

The Paleo + exercise group had identical weight loss with minimal differences in body composition vs. the Paleo group.  The exercise group had a non-significant larger reduction in fasting glucose, but started significantly higher, and slightly larger reduction in HbA1c, but 0.2% is not that exciting. As Adel Moussa points out, the real benefit to the exercise intervention is an increase in fitness (VO2 max and heart rate), which can become quite important for the day-to-day functioning of these older participants.  But a possible explanation as to why the exercise intervention didn’t have more effect is that the physical activity energy expenditure (measured from accelerometer and heart rate monitor over a 7 day period) didn’t change in the Paleo + exercise group (-18 (-368, 340) kcal), so perhaps there was some compensation as a result of the intervention.  See table 2 for more results, bold indicates a significant difference


Paleo
Paleo + Exercise
Baseline
Change
Baseline
Change
Weight (kg)
90.0
-7.1
97.3
-7.1
Body fat (%)
37.8
-3.5
37.7
-4.1
Lean mass (kg)
56.5
-1.4
61.0
-1.2
WC (cm)
111
-9
108
-8
HbA1c (%)
7.1
-0.9
7.3
-1.1
Fasting glucose (mmol/l)
8.0
-0.9
8.9
-2.0
Fasting insulin (mIU/l)
23
-8
16
-4
VO2 max
23.4
1.9
22.5
3.3
Resting heart rate
70
-3
72
-11
Systolic blood pressure
135
-17
132
-11
Diastolic blood pressure
86
-9
82
-10
Total-C (mmol/l)
4.2
-0.3
4.3
-0.6
HDL-C (mmol/l)
0.85
-0.01
1.09
0.01
LDL-C (mmol/l)
2.1
-0.1
2.4
-0.1
Triglycerides (mmol/l)
2.1
-0.6
1.7
-0.5
hsCRP (mg/l)
1.2
-0.4
1.5
-0.4

Also, check out Adel Moussa’s article on this study at SuppVersity

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