Without doubt, a primary benefit of the paleo diet is the elimination of grains (which contain inflammatory protein--gluten--and plant-defense toxins called lectins).

The high (good) fat aspect of the paleo diet also plays a big role in increasing HDL and lowering triglycerides. These good fats including animal fats, saturated fats (mistaken painted as bad-guy fats), omega-3's, omega-9's (like olive oil and avocado oil), while greatly reducing the inflammatory processed omega-6 oils (corn and soy oil, among numerous others).

The paleo diet also rules out any processed form of fructose:
http://www.thorne.com/altmedrev/.fulltext/10/4/294.pdf

i have eliminated wheat and all grains as you have suggested and my lipid profile from recent NMR has improved: HDL jumped from 40to 54; LDLC of 94 up from 93, and Trg dropped to 20 from 37 and large HDL-P increased from 3.3 to 14.8, particle number dropped from1795 to 1305, but they still remain all small particles.  LDL particle size unchanged at 19.7. So some good things from elimination of wheat and grains, but no change in particle size.  At 5'6" male and 145lbs, hard to lose weight.  Any suggestions on how to change particle size and lower number of particles further? diet is meat fish eggs poultry, whey powder, hard cheese, greek 2% yogurt and fruit and veggies, some red wine and dark(85%+ chocolate)  Vitamin D3 measures at 38(25oh). with family history, doc wants 20 mg Lipitor.  Excellent post in both cases. Perhpas Paleo not work for all, although Eades would say i should add more sat fat to diet

I love reading in more and more places that saturated fats are not evil!

The word is getting out, and one of these days, dietary researchers won't have to apologize about their results or come up with elaborate strategies to make sure that they can't be perceived as saying that saturated fat might be (gasp!) good for you.

Remember the Okinawans.  Previous generations of Okinawans are among the longest lived people on the planet.  Pork, fish, non-starchy vegetables (cooked in lard), and a little bit of rice make up almost all of their diet.

Dr. Davis, it wasn't that long ago that you were very cautious about fats and saturated fats, but I've seen a substantial shift in your comments over the past several months.  I salute your resolve to really understand what is good for our hearts and then going beyond that by doing your best to communicate what you've learned back to everyone who will listen/read.

This is the first time I have seen someone call out Gluten as the component of wheat that causes inflammation response.  Good to know as it is often a primary source of protein for vegetarians.

I don't see the fructose argument though.  This is a simple sugar that is broken down to glucose in the digestive tract like any other sugar eaten; according to high-school human biology......

Dr Davis,

Do low carb eaters need to be concerned about the aging effects of oxoaldehydes such as methylglyoxal?

I read recently that the concentration of such compounds increases during ketosis and that they are much more reactive than glucose, readily forming protein cross links which age the body.

-- Tom

Some people may be wondering how it was that eating wheat and other high fibre grains caused humans to become weaker, shorter and fatter.

This paper http://www.ncbi.nlm.nih.gov/pubmed/6299329 Reduced plasma half-life of radio-labelled 25-hydroxyvitamin D3 in subjects receiving a high-fibre diet.
unearthed by Stephan at Whole Health Source, provides one possible explanation as it shows a high-fibre diet reduces the half-life of 25(OH)D3 thus speeding up vitamin d deficiency.

Yes!  I thoroughly enjoyed Dr. Eades commentary on that study.  Although I do wish that study authors wouldn't obsess so much over saturated fat.

Steven from http://wholehealthsource.blogspot.com/ also did a bang up review.  His blog is also quite fantastic.  He did a series on Tokelau Island migrant studies that was very interesting.  They are a people that eat quite a lot of saturated fat, from coconut, and yet had virtually no heart disease.

I cut out wheat a long time ago but haven't had blood work recently.  If cholesterol has nothing to do with heart disease, why worry about it?  Why eliminate saturated fats if they're not contributing to atherosclerosis?

kevin

The wheat connection is interesting, it's far and away the worst grain for spiking my glucose levels, even wheat bran will do it.

My athlete cousin is already showing signs of the familial insulin resistance in her thirties and while she stuffs her body with far more carbs than I do she has noticed a marked improvement from avoiding wheat.

The horrible irony is that a diabetic colleague diagnosed my diabetes over twenty years ago and a friend who knew my diet suggested I might be wheat intolerant. My doctor wrote that I had "fanciful notions" and hypochondria. Now here I am. Meanwhile the GP died "unexpectedly" which was ironic

I wonder if wheat has always been this (comparatively) toxic or if it's the modern strains specifically. Originally it was a transgenic cross, kind of natural GM, with far more chromosomes than is good for it, but has been majorly tweaked over the years to provide current yields

It's odd to me how often folks state that there's no proof that saturated fat intake causes heart disease. I know the standard arguments, I've read Good Calories, Bad Calories and many of the websites dedicated to disproving the lipid hypothetesis.

But the fact is, there are quite a few studies that demonstrate that saturated fat intake IS associated with higher incidence of heart disease (not just cholesterol profiles).

A few examples:
http://content.nejm.org/cgi/content/abstract/337/21/1491

http://content.nejm.org/cgi/content/abstract/337/21/1491

http://www.ajcn.org/cgi/content/full/70/6/1001

The majority of the studies I've seen on low carbohydrate, high fat diets have all been pretty short-term and didn't actually measure heart disease. They just measured cholesterol and, occasionally, inflammation.

To Anonymous's question about fructose.  It's very important that you understand the metabolic pathway for fructose.

Fructose is carried by the blood from your gut directly to your liver.  Once detected, your liver stops everything else and converts fructose to triglycerides.  It does this because fructose is a highly reactive sugar and is treated as a dangerous substance by your body.  Triglycerides aren't nearly as bad (but if you've been reading this blog, you know that they're pretty bad, too).  

Most of the triglycerides are released into the blood (where they represent the wrong side of the HDL/triglycerides heart health ratio), while some small fraction remain trapped in the liver tissues.  If you keep hitting your liver with triglycerides (via fructose), and live long enough, those triglycerides get stored in the liver and you'll end up with fatty liver disease.

Fructose is all sorts of bad news for your health.  Sucrose, HFCS, honey, cane solids, corn syrup solids, etc: all contain significant quantities of fructose, and over time, all pose a risk to your heart, your liver, and via insulin resistance and glycation reactions, your entire body.

I am new to trying to understand the most healthy diet and just finished reading Dr. Eades book (who does not eschew whole grains in his meal plans).  I am reminded of Michael Pollan's comments that preface his book - 'In Defense of Food' in which he claims there is much ideology with regard to diet and nutrition.  

I understand many people have strong opinions, but I am hoping someone can provide insight into this website that includes whole wheat as one of the most important foods in our diet -- http://www.whfoods.com/genpage.php?tname=foodspice&dbid=141.

I am not asking this to be controversial, but would genuinely like to hear some factual counterpoints.

This is great news for the paleolithic community: the British Medical Association has just recognised the importance of paleolithic diets in this recent report (see pages 5/6): http://www.bma.org.uk/health_promotion_ethics/child_health/earlylifenutrition.jsp

This is truly a great read for me!! I love the quality information and news your blog provides Smile I have you bookmarked to show this to all!Thanks.


health

I have read your article Michael Eades on the Paleolithic diet' good article The diet consists of an inflexible meal plan. The diet does not allow forsubstitutions or deviations

Welcome to visit-

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This is the first time I have seen someone call out Gluten as the component of wheat that causes inflammation response. Good to know as it is often a primary source of protein for vegetarians.

This is very good - just mixed up a large glass full (minus the flaxseed).  And, that's my question, do you use finely ground flax seed?  I also tossed in a fist-full of blueberries - should be able to tolerate them well; I just had a very intense resistance training session

I'd love to see more recipes for some ideas.  I disagree with those who wrote in on the earlier post, characterizing smoothies as "not real food."  I'm a big fan for time-challenged mornings and post-workout nourishment.

Bill

I can't believe you passed up a perfectly good opportunity to embed a cheesy 80's Reese's commercial in this post.

http://www.youtube.com/watch?v=DJLDF6qZUX0

Anon--

Yes, I used a finely-ground flaxseed.

The berries are a great idea, provided quantity is small.

Just a cautionary note -

Sucralose/Splenda can have severe reactions.

I seem to respond/react to things severely.  Sucralose has caused both allergic reaction (swollen mucus membranes) and severe migraine for me.  In fact, as a frequent migraine sufferer (tho much less now that i've removed gluten and sulfites), the migraine i got from sucralose was by far the worst i've ever had.  

Personally, i am of the belief that if it effects me so strongly, it is probably not good for anyone, but the damage it does is much less pronounced in other people.

I stick to stevia for a no-calorie sweetener.

http://jstevens.wordpress.com/2008/02/20/how-sucralose-aka-splenda-is-made-and-why-you-want-to-avoid-it/

"How Sucralose (aka Splenda) Is Made And Why You Want To Avoid It

...I wanted to comment on Splenda.  Splenda, also known as sucralose, was created accidentally when some chemists were trying to produce an insecticide.  Here is the process by which they produce the formula sold in stores:

“1.  Sucrose is tritylated with trityl chloride in the presence of dimethylformamide and 4-methylmorpholine, and the tritylated sucrose is then acetylated with acetic anhydride.

2.  The resulting sucrose molecule TRISPA is chlorinated with hydrogen chlorine in the presence of tolulene.

3.  The resulting 4-PAS is heated in the presence of methyl isobutyl ketone and acetic acid.

4.  The resulting 6-PAS is chlorinated with thionyl chloride in the presence of toluene and benzyltriethylammonium chloride.

5.  The resulting TOSPA is treated with methanol in the presence of sodium methoxide to produce sucralose.”  (Note that methanol, wood alcohol aka paint remover,  is one of the questionable ingredients in aspartame.)

In addition, the bags and packets of Splenda commercially available are not pure sucralose.  They also contain bulking agents.  All artificial sweeteners use bulking agents.  Do you know what they use?  Sugar.  Dextrose, sucrose, and maltodextrin.  (Maltodextrin is corn syrup solids composed primarily from fructose and glucose in a starch form.)   All sweetener packets are at least 96 percent sugar.  Splenda is 99% sugar.

The packets are labelled calorie free as a result of manipulating a loophole in the food labeling laws.  The product can be described as sugar free if a serving contains less than 5 grams of sugar, and calorie free if a serving is less than 5 calories.  So they set the serving size on bags at .5 grams  and the packets contain a serving of 1 gram.  A one gram packet contains 4 calories.   This can be confirmed on the manufacturer’s website in the FAQ section:  â€œLike many no and low calorie sweeteners, each serving of SPLENDA® No Calorie Sweetener contains a very small amount of common food ingredients, e.g., dextrose and/or maltodextrin, for volume. Because the amount of these ingredients is so small, SPLENDA® No Calorie Sweetener still has an insignificant calorie value per serving and meets FDA’s standards for “no calorie” sweeteners. “

To make matters worse, when sucralose was shown to not raise blood sugars, it was the pure substance that was tested, not the mixture that is sold to the public.  Dextrose, sucrose, and/or maltodextrin are definitely going to raise a diabetic’s blood sugar.  There is also a great deal of evidence that artificial sweeteners actually cause an increase in appetite, causing people who consume them to take in more calories than they would otherwise.

Stevia, on the other hand, lowers blood sugar, making it a much better choice.  If you have tried stevia in the past and did not like the flavor, you might want to try another brand. ..."

If your looking for a more nutritious "sweetner" you should try adding half a cup of coconut water. Delicious!

Ps. I love your blog. Keep up the great work!

Tapioca starch in the almond milk, but not enough to hurt you.

I enjoy your blog. You have a good thread about the hazards of hyperglycemia.
However, this recipe is not one I would recommend to patients attempting to reverse metabolic syndrome, T2D, or IR.
Their main concern is the inflammation caused by the above listed disorders. The omega 6 content of the peanut butter, sunflower seed, and to an extent, almond butter would exacerbate the inflammation mitigated by the hyperglycemia.
In addition, sugar alcohols (xylitol, erythritol) tend to cause GI upset (gas, diarrhea). Also the hazards of Sucralose are intuitively obvious....it contains chlorine molecules....commonly found in many household cleaners, and of course used in WWI as a pulmonary choking agent.
I would only use macadamia nuts/nut butter, and Stevia to sweeten.
Dr. John

Thanks, Dr. John.

I hear you on the sucralose issue. I've actually been having positive experiences with stevia, xylitol, and erythritol. The important thing is that people have some good choices nowadays, unlike 20 years ago when we had saccharine . . . period.

There is no question that mannitol and sorbitol have greater potential for both GI distress (diarrhea) as well as increases in blood glucose, so these are clearly on the no-no list (unless you need a quick laxative).

Sucralose is not metabolized.  Most of it is excreted unchanged in the feces.  A small percentage is absorbed and excreted unchanged in urine.  

Sodium in food is more of a concern for a person who experiences migraine headaches.  Over-activity of muscles activated by the Trigeminal nerve due to airway resistance secondary to water retention is a greater concern.  Various factors are present both anatomically and physiologically in people who experience migraine.  The only way to determine if sucralose is actually the cause of a migraine is to consume sucralose on its own.

What concerns me is what happens to the sucralose in the environment.  The addition of a chlorine atom, (not a molecule, Dr. John) results in a molecule which cannot be metabolized by bacteria.  If environmental degradation is possible, then sucralose excreted by human beings is not an issue.  But if it persists in the environment, then it is a pollutant.

I am practically a fruitarian, so much of what I like would be off limits.
Is there an article here on what IS recommended?

Yes, atoms, not molecules...ie. precisely 3 atoms of chlorine/molecule of sucrose...

An interesting thing about this selective halogenation of sucrose, is the fact that sucralose (being 600 times as sweet as sucrose), increases the HbA1c numbers in my patients. This demonstrates a lessening of diabetic control. Thus, hemoglobin gets glycated and fasting blood sugar increases....with the attendant hyperglycemia issues as mentioned, and this excellent blog site.

For this reason I do not recommend sucralose for diabetics nor anyone wanting to keep blood sugar levels within normal limits. The current cost and future costs for diabetes will cripple our healthcare structure. Here are ADA numbers:

$174 billion: Total costs of diagnosed diabetes in the United States in 2007
$116 billion for direct medical costs
$58 billion for indirect costs (disability, work loss, premature mortality)

Dr. John

Dr. John, is it possible that other factors contribute to higher H1ac levels in your type 2 diabetic patients?  

Since sucrolose is not metabolically active and does not act as a laxative, then there could be other endocrinological and neurological reasons for higher glucose levels.

Here's an abstract on sucralose and Type 2 diabetes:

Grotz VL, Henry RR, McGill JB, Prince MJ, Shamoon H, Trout JR, Pi-Sunyer FX. Lack of effect of sucralose on glucose homeostasis in subjects with type 2 diabetes. J Am Diet Assoc. 2003 Dec;103(12):1607-12.

OBJECTIVE: To investigate the effect of 3-months' daily administration of high doses of sucralose, a non-nutritive sweetener, on glycemic control in subjects with type 2 diabetes. DESIGN: A multicenter, double-blind, placebo-controlled, randomized study, consisting of a 6-week screening phase, a 13-week test phase, and a 4-week follow-up phase. SUBJECTS/SETTING: Subjects with type 2 diabetes (age range 31 to 70 years) entered the test phase of this study; 128 subjects completed the study. The subjects were recruited from 5 medical centers across the United States and were, on average, obese. INTERVENTION: Subjects were randomly assigned to receive either placebo (cellulose) capsules (n=69) or 667 mg encapsulated sucralose (n=67) daily for the 13-week test phase. All subjects blindly received placebo capsules during the last 4 weeks of the screening phase and for the entire 4-week follow-up phase. MAIN OUTCOME MEASURES: Glycated hemoglobin (HbA1c), fasting plasma glucose, and fasting serum C-peptide were measured approximately every 2 weeks to evaluate blood glucose homeostasis. Data were analyzed by analysis of variance using repeated measures. RESULTS: There were no significant differences between the sucralose and placebo groups in HbA1c, fasting plasma glucose, or fasting serum C-peptide changes from baseline. There were no clinically meaningful differences between the groups in any safety measure. CONCLUSIONS: This study demonstrated that, similar to cellulose, sucralose consumption for 3 months at doses of 7.5 mg/kg/day, which is approximately three times the estimated maximum intake, had no effect on glucose homeostasis in individuals with type 2 diabetes. Additionally, this study showed that sucralose was as well-tolerated by the study subjects as was the placebo.

PMID: 14647086 [PubMed - indexed for MEDLINE]

Now, I can understand how sugar alcohols taken in large quantities might have some effect on blood sugar because they are laxative and increase gut motility and cause discofort or pain, both of which will spike blood sugar values. the liver dumps glucose into the bloodstream when the body is under stress like this.  And of course, the pancreas reacts very sluggishly to endogenous glucose.

I think type 2 diabetics should have routine sleep study screening to determine whether breathing issues during sleep may be upramping the sympathetic nervous system and causing high sugar levels during sleep. We can't just help these people improve their life quality by looking at only one parameter.

They need otolaryngological evaluation for anything from deviated nasal septa to chronic allergies, enlarged adenoids and tonsils.  The size of their jaws, how they function and tongue posture also factors in.

Not to mention, anyone with pulmonary issues would have increased effort on breathing...asthma, pulmonary hypertension etc.  The existance of chronic pain and anxiety conditions also influence how the body produces its own glucose.  

Patient's require a multi-disciplinary workup to determine the multiple factors that result in the development of type 2 diabetes.  It's not merely diet because these people have an awfully hard time changing their diets without having other problems addressed.

Excellent! Dr. Davis, you have had many posts of what not to eat but very few on what we should eat. Taking something out of our diet means we have to replace it with something. This post seems to be in the right spirit. I am going to try this soon. Now if only you can post a similar substitute for Keva Juice's Oreo Speedwagon smoothie! Yes, I know they are hazardous to your health but they are wickedly good!

-- Boris

I'm not totally convinced why sucralose, a chloro-carbon, similar to DDT and PCBs, would elevate the HgA1c levels. My guess would be a neurological response to an ingested poison. Sucralose does kill intestinal beneficial bacteria...lactobacillus, bifidobacteria, and bacteroides...of varying amounts of 37-67%...and the enteric nervous system would react by elevating cortisol/adrenaline/glucagon: while at the same time not delaying gastric emptying.
Body perception is stress....glycation of RBCs result, with CVD and sudden cardiac death.

Studies that use diabetic, and obese subjects in the assessment of A1c elevation are biased from the start. These individuals have already lost glycemic control and as a result would not have normal A1c levels to begin with...let alone studying their response 13 weeks later.

McNeil Nutritionals, maker of SPLENDA® Brand products, stated it has provided the American Diabetes Association (ADA) with a sponsorship to support the Association's efforts to fund research, information and advocacy programs on behalf of people with diabetes.
And McNeil Nuts. are owned by Johnson and Johnson, who are large contributors to the ADA...the journal of the previously listed biased study showing the sucralose doesn't affect A1c levels...in spite of the fact in clinical results showing the opposite.

Anything, sucrose or sucralose, that elevates A1c levels is cardio-lethal...and is best avoided.

Dr. D,
Do you use regular coconut milk or the lite? Does it make a difference, except calorically?

Thanks!

Jeanne

I am allergic to the artificial sweeteners. Thought I could tolerate sucralose but it just took a little time for a reaction. My mouth and throat became inflamed and I had sore bumps all over the inside of my throat and back of my mouth after about a week.

I don't like stevia or the other natural no calorie sweeteners either...they just don't taste sweet to me or have odd flavors.

But I found something.  It is not calorie free, but it has low glycemic index and tastes just like sugar.  It is "Organic Blue Agave". What are a few calories in exchange for some actual taste.

I bought it at Costco.

""Organic Blue Agave". What are a few calories in exchange for some actual taste."

High fructose corn syrup (HFCS) is about 55% fructose and cause inflammation, insulin resistance, and elevates triglycerides.  Agave syrup is often 70% or higher (possibly as high as 90%) fructose!  Marketing scam...