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 EXCL EX CLUDED UDED INCLUDED INCL UDED • Red meat, poultry, • Grains fish • Legumes • Eggs • Dairy products • Fruit • Processed foods • Vegetables • Added sugar • Nuts (except peanuts) • Coffee & alcohol and seeds 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 • Diabetes • Optimal= <100 mg/dL • Hypertension • Total cholesterol • BP ≥ 140/90 • Optimal= <200 mg/dL • Hyperlipidemia • HDL • Optimal= ≥ 60 mg/dL . Reference: Brown JE. Adult Nutrition: Conditions and Interventions. Nutrition Through the Life Cycle . 5 th 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 30±6 26±7 Fat (g) Polyunsaturated Fat 14±4 12±4 (g) Cholesterol (g) 577±107 365±88 Red indicates statistical significance (p= 0.05)

SIGNIFICANT DIET DIFFERENCES DIABETIC DIET PALEOLITHIC DIET • Vegetables • Beans • Fruit • Cereals without rice • Meat • Milk/milk products • Eggs • 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 103 ± 14 98 ± 11 94 ± 9 Circumference 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 3 Days 7 Days 10 Days Increased Usual Paleolithic potassium Diet -type diet and fiber

DIET COMPARISONS SIGNIFICANT NO SIGNIFICANT DIFFERENCES DIFFERENCE • Kcals é Protein • Carbohydrates ê Saturated fat • Total fat é Polyunsaturated fat • Monounsaturated ê Sodium fat é Potassium • Cholesterol é Phosphate • Calcium é Magnesium

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 on 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 Cereal fiber intake Whole Bran intake grains intake Lower CVD- specific deaths

STRENGTHS WEAKNESSES • Prospective cohort • Possible uncontrolled study covariates • Provides valuable • Does not prove cause information and effect • Minimizes bias • More studies needed on additional • Large sample size 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.