palaeolithic diet versus Paleo Diet

Some of my friends and colleagues have tried to hard sell me on the paleo diet with what always sounded like junk science. Given the diversity of ecosystems at the time, it made no sense to me that all humans from that period (spanning tens of thousands of years) ate the same diet. The more I looked into it, the more the Paleo Diet felt classists and racist. I am a Paleo Diet sceptic.

I am here because my West African, Scottish, Dutch, French, Kalinago ancestors survived in their environment. My maternal grandmother was a pescatarian (a Western word not one she would have used to describe herself), ate a lot of fruit and greens, and lived into her 90's and my maternal grandfather was too. My paternal great grandmother ate meat but very little of it. She lived to be 93. So it seems to me, that a paleo style diet would most likely be detrimental to my health. I should eat my ancestral diet.

What does that look like?

  • Seafood - Mostly fish but really anything from the ocean including conch, whelks, lobster, whale and turtle.
  • Meat - lamb. I do not recall eating beef when I lived on the islands. Not even hamburgers. The chicken was imported and mostly grilled or used in pilau.
  • Greens - Kale is great but my grandparents never ate it. The most prevalent green on the island would be okra and the leaves of the dasheen plant, which is used to make calaloo. The tuber is also eaten.
  • Vegetables and ground provisions - Breadfruit, plantain (aka cooking banana), christophene, okra, dasheen, eddoe, sweet potato, cassava, squash, maize
  • Fruits - avocado, mangoes, prickly pear, guava, almond, cashew fruit, mamey sapote, sapodilla, custard apple, soursop, tamarind, papaya, coconut, plumrose, acerola cherry.

There are many more fruits and gound provisions that I can't remember. Notice that I did not list beef. I think my first taste of beef was when I moved to the United States. I didn't like it but since it seemed like the American thing to do, I ate my fair share of steak and burgers. A few years ago my eldest child said they did not like the taste of beef. But until earlier this year, my youngest relished her steak. I realised it was time. We no longer buy meat.

I am the process of evaluating my current diet with an eye toward a return to my ancestral diet which was rich in fish, ground provisions, and fruit.

Can a Low Carbohydrate Approach to Type 1 Diabetes Management Be Successful?

On the TuDiabetes T1 and LADA forums, Jessica Strickland, a woman with Type 1 diabetes, posted a question about low-carbohydrate diets.

I've been looking at diets lately. I've discovered Low Carb High Fat Diet (LCHF) and noticed that many people have had success with this way of eating. Have any of you Type One Diabetics ever tried it and had success? And was your Endocrinologist on board with it?

Thanks in advance, for your advice! Jessica Strickland

This question engenders heated debate and hurts feelings whenever the topic comes up. I wanted to post a response that was both informative and without emotion. I wanted to make sure that my answer did not cause any hurt feeling that their choices about how they manage diabetes were wrong. Here's the text of my answer.

My endocrinologist has always been on board with reducing carbohydrates in my diet. She has no particular recommendation on paleo, low-carb, south beach, diet etc. Together we define success or failure based on the numbers. Are my A1C, triglyceride, cholesterol, and frequency of hypoglycemic and hyperglycemic episodes within the normal range?

We don't discuss the emotional side of diabetes. We don't discuss whether I like eating only one slice of pizza or never eating cake or ice cream. We don't discuss what I've given up to help manage my diabetes long-term. From that perspective, trying to eat like ordinary people is irrelevant. It's a recipe for depression to focus on what has been lost instead of focusing on what is possible. I spoke with a friend who is a clinical social worker, and he helped me put "D" into perspective when I was at a low-point.

Whether or not your diet is low-carb or not is relative. There is no one definition.

According to the Institute of Medicine, the organization that sets the recommended daily intake of nutrients, adults and children over the age of 1 should eat 130 grams of carbs a day. ~ WebMD

Here's one very specific definition from a 2008 study.

Low-carb ketogenic diet (LCKD): less than 50g carbs and 10% calories daily of a 2000kcal diet Low-carb diet (LCD): 50-130g carbs daily and between 10-26% of calories of a 2000kcal diet Moderate-carb diet (MCD): 130-225g carbs daily and between 26-45% of calories of a 2000kcal diet ~ Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndromel

My current average daily carbohydrate intake is about 100 or less. My most recent A1C was 6.2 and has been as low as 5.5during a time when I tried eating about 70g carb per day and exercised).

Some people need more daily calories than others. A 165 cm tall man who sits in front of a computer most of his day and does not exercise needs fewer calories than a 165 cm tall man who hikes, jogs or runs every day. My advice is to reduce your carbohydrates and eat more fat and protein but design your diet. Call it the @Jessica_Strickland88 diet. If your diet helps you meet your diabetes management goal, whatever they are, then continue. If not, then adjust as needed.

As stated above, my diabetes management goal is simple. Do what I must in the present to reduce the risk of complications in the future. It's long-term versus short-term thinking. It's similar to retirement planning -- look at the numbers, adjust, and leave out the emotion.

I won't argue whether a low-carb, diabetic diet can be done. There are many sources of credible information on this topic. Do your research, make your own decision, and live with the consequences1 of your choices.

You may have to decide for yourself how low you want to go, depending on your meter readings and how you feel. ~ Low-Carb Diabetes: What You Need to Know

  1. The word consequence means: the effect, result, or outcome of something occurring earlier: Consequence is not a bad word. It's just often used in that context. The consequence of my going to graduate school is that I have skills that allow me sometimes to negotiate a higher income. The consequence of me eating a slice of cake at dinner is a sleepless night spent fighting hyperglycemia. ? 

"Liberation" has limits.

The idea that today people with diabetes can eat everything is supposed to be a liberating philosophy – and certainly, compared to the restricted diets of the past, it is. I’m grateful for faster acting insulins, blood glucose meters and continuous glucose monitoring systems. But unfortunately, this supposed liberation can only go so far: even today, every meal requires you to correctly guess how much insulin to take, and to monitor and check yourself multiple times afterwards to make sure that you’ve succeeded. As Dr Richard Bernstein has pointed out, the greater the number of carbohydrates in your math problem dinner, the more likely you are to get it wrong. Catherine Price via People With Diabetes Can Eat Everything, Really?.

Which is why I called Mike Norris an idiot for organizing an Ice Cream Social for people with diabetes. In his anger, he organized an event that surely the public saw as "diabetics fighting for the right to eat crap". It's tough enough for people with Type 1 to overcome the stigma that we caused our diabetes because of poor dietary choices.

Yes, I popcorn. No, I don't eat ice cream. Yes, I eat pizza1. No, I don't eat cookies. The things I eat that aren't nutritious, I eat in moderation. I eat them occasionally. They are not a regular part of my diet but I enjoy them when I eat them. But ... I would never advocate that eating them is part of a normal healthy diet. That's just stupid.

This, I realized, leads to a contradiction in supposed liberation: while part of me was grateful for the flexibility that today’s medications and technology allow, another part of me felt oppressed. Here’s why: if diabetes itself is supposedly no longer restricting me, if I supposedly have all the tools at hand to eat whatever I want, then any time I finish a meal with high blood sugar or a scary low, then I must have done something wrong. The problem, in other words, isn’t my diabetes, it’s me.

No Catherine; it's not you. It's the people who think there is something normal about eating four scoops of ice cream and washing it down with a soda. It's people who think eating an 1600 calorie dinner at The Cheese Cake Factory is "normal".

No one can eat like that and stay healthy. Not even people with diabetes.

  1. I had stopped eating pizza because of the roller coaster job it did on my blood glucose. I have started eating pizza again now that I have an insulin pump. But it's rare.