10 Days of 'Paleo Life in the Wilderness' Will Strip up to 18 cm off Your Waist and Boost Your Insulin Sensitivity by 53%

10 Days of 'Paleo Life in the Wilderness' Will Strip up to 18 cm off Your Waist and Boost Your Insulin Sensitivity by 53%

diet health insulin insulin sensitivity lifestyle lose fat metabolic syndrome paleo paleo lifestyle physical activity

Even though it may have been funny, this is not exactly how the scientists simulated the "paleo lifestyle" in the study at hand. Eventually, however, it came down to eating healthier, being active and even being stressed (within the limits of natural "paleo stress", though).

No, this science website is not going to turn into a paleo blog, ... don't worry. It's mere coincidence that this is the 2nd "paleo" study in 2 weeks that is interesting enough to get its own SuppVersity article devoted to it (last one).

Moreover, said study, which was published in the peer-reviewed scientific journal BioMed Research International, recently (Pruimboom. 2016), doesn't even have the world "paleo" in title of full-text and could still be called "the true paleo" study. It does, after all, revolve around a 10-day mimic of a "hunter-gatherer lifestyle" and its favorable effects on anthropometrics and clinical chemical indices such as the reductions in insulin, triglycerides, HDL, elevated liver health markers and other indices that are usually far from being optimal in the average student, scientist, physician, and other health professionals who participated in the study at hand.

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As the researchers point all, all subjects (n=10, n=32 and n=11) "were interested to experience the impact of ancient lifestyle on their own health and well-being and therefore jointly decided to engage in this study" (Pruimboom). In that, the term "this study" refers to three separate 10-day trips through the Spanish Pyrenees during the summers of 2011 (𝑛 = 10), 2012 (𝑛 = 32), and 2013 (𝑛 = 11), on which ...

"[t]he participants lived outdoors and walked from one watersource to another. Food was provided by the organization and with help of forest-guards from official institutes of the Catalan county. Food intake was planned before the trip, based on the average daily food intake by the traditionally living Hadzabe people in Tanzania. The use of mobile phones or other electronic devices was not allowed" (Pruimboom. 2016)

It is obviously debatable, if "mayonnaise" is a paleo food (not sure if they made it themselves) and how "paleo" the rest of the subjects' diet which may have been designed to mimic the macros, but probably not the foods of the Hadzabe (see Figure 1, tabular overview on the left) actually was.

Figure 1: Exemplary food intake (left) and changes in anthroprometrics (right); stat. sign. w/ p < 0.001 was observed for the median changes, not the minimal and maximal changes, obviously (Pruimboom. 2016).

What is undebatable, though, is the statistical significance and health relevance of the reductions in weight and body fat you can deduce from the sign. reduction in the median subjects' waist circumference.

Mind the statistics: There's a reason why I plotted more than one value in Figure 1. While I cannot tell you the reason why, I can tell you that at least one subject did not see the expected improvements in waist circumference. Possibly, he or she ate too much mayonnaise ;-), ... Why's that relevant? Well, it obviously goes to show you that calories still count. While the median subjects (with the low number of participants the scientists didn't calculate averages) obviously was in a caloric deficit, this one person probably just wasn't caught feasting secretly on the supply.

It should be noted, though, that these changes were certainly not attributable solely to the diet. Rather than that it should be obvious that the significant reduction in body and most certainly belly fat was the consequence of (a) what and how much the subjects ate while (b) experiencing what the Dutch scientists call "ancient stress factors" they were facing during a 10-day trip that revolved around the following four principles:

• Walking and limited manual work- providing the exercise / general physical activity stimulus modern humans lack: There were daily walking trips from waterhole to waterhole, with an average walking distance of about 14 km/day, including altitude differences up to approximately 1,000 m. The participants carried their own backpacks with an average weight of 8 kg. The trip took place in the part of the Pre-Pyrenees with a maximum altitude of 1,900 meters above sea level. In addition, some manual work was done to clean mountain trails as agreed upon with the Catalan Government.
• Intermittent fasting - leaving room to actually experience hunger and all its beneficial hormonal correlates (e.g. AMPK increase => mitochondrial housekeeping, etc.): Participants consumed two meals daily. The first meal was provided by the organization halfway and the second meal prepared on arrival at the camping site. Animals, including ducks, chickens, turkeys, rabbits, and fish, were delivered alive and killed by the participants. Fish were caught with nets in the Noguera river. All foods were prepared on the spot by the participants.
• 100% exposure to the elements - resynchronizing the internal clock: The participants slept outside in sleeping bags on small inflatable mattresses. Outside temperatures varied from 22 to 42∘C during daylight, whereas night temperatures varied from 12 to 21∘C. One group experienced a day of snow in the middle of July, which prompted the organization to provide hotel accommodations for a single night.
• Cyclic water intake - experiencing thirst to benefit from the anti-inflammatory release of oxytocin (Krause. 2011): Bulk (intermittent) drinking behavior was recommended by drinking as much as possible (up to satiety) after reaching a waterhole. The waterholes contained nonchloritized drinking water (Note: I would not suggest using "dehydration" as a means to improve your health; while it may have done this in the study at hand, it's simply stupid - and that's in the literal sense, as you've read in my article "Hydrated or Dumb").

Only in conjunction, with these "stress factors" did the diet do its body fat reducing and, as the data in Figure 2 shows, glucose and blood lipid reducing effects:

Figure 2: Changes in glucose and lipid metabolism over (I repeat) only 10 days; worth mentioning: all but the effect on HDL were statistically highly sign. with p < 0.001 (Pruimboom. 2016).

Effects of which the scientists say that they were the result of acute stress, which promotes release of stress hormones, including adrenaline, noradrenaline, and cortisol, all of which are bad in excess, but will "give rise to recovery from the reigning state of chronic low-grade inflammation and the return to homeostasis" (Pruimboom. 2016), when the stressors are hit the sweet spot of hormesis as it occurred in response to / corollary with the elevation in AST, ALT and hs-CRP of which I've explained previously that all of them can be natural reactions to (especially unaccustomed) physical activity (learn more about ALT, AST and exercise induced inflammation that may be misunderstood as a health problem).

In the study at hand, said "recovery from the reigning state of chronic low-grade inflammation" was characterized by "profound metabolic and immunologic adaptations", of which the scientists highlight that they relate to three classic features of the metabolic syndrome, i.e. body mass, glucose homeostasis, and circulating lipids. The fourth, i.e. blood pressure was - unfortunately - not recorded.

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Bottom line: With the metabolic syndrome, also named the insulin resistance syndrome, being "a well-established risk factor for various diseases of affluence, including type 2 diabetes, cardiovascular disease, essential hypertension, polycystic ovary syndrome, nonalcoholic fattyliver disease, certain types of cancer (colon, breast, and pancreas), sleep apnea, and pregnancy complications, such as preeclampsia and gestational diabetes", the scientists are right to highlight in their conclusion that the subjects didn't just feel better subjectively (according to questionnaire), but returned from the "wilderness" in an objectively healthier state.

A state of which the scientists say that it has been promoted by the previously discussed consequences of the four pillars (see list) and related effects, such as the reduction of the postprandial inflammatory response (Holmer-Jensen. 2011; Klop. 2011; Peairs. 2011) and increased protection against pathogens (Fielding. 2000; MacEneaney. 2009) that occurs, when you are physically active before a meal. Even the presence of "cutaneous- and other body surface-directed danger signals" could, as Pruimboom et al. point out have been "hormetic triggers" | Comment!

References:

• Fielding, Roger A., et al. "Effects of prior exercise on eccentric exercise-induced neutrophilia and enzyme release." Medicine and science in sports and exercise 32.2 (2000): 359-364.
• Holmer-Jensen, Jens, et al. "Differential effects of dietary protein sources on postprandial low-grade inflammation after a single high fat meal in obese non-diabetic subjects." Nutrition journal 10.1 (2011): 1.
• Klop, Boudewijn, et al. "Understanding postprandial inflammation and its relationship to lifestyle behaviour and metabolic diseases." International journal of vascular medicine 2012 (2011).
• Krause, Eric G., et al. "Hydration state controls stress responsiveness and social behavior." The Journal of Neuroscience 31.14 (2011): 5470-5476.
• MacEneaney, Owen J., et al. "Effect of prior exercise on postprandial lipemia and markers of inflammation and endothelial activation in normal weight and overweight adolescent boys." European journal of applied physiology 106.5 (2009): 721-729.
• Peairs, Abigail D., Janet W. Rankin, and Yong Woo Lee. "Effects of acute ingestion of different fats on oxidative stress and inflammation in overweight and obese adults." Nutrition journal 10.1 (2011): 1.
• Pruimboom, Leo, et al. "Influence of a 10 days mimic of our ancient lifestyle on anthropometrics and parameters of metabolism and inflammation. The ‘Study of Origin’."

True or False? 'Low Fat' for the Lean, 'Low Carb' for the Obese and Insulin Resistant - Pilot Study Confirms Often Heard Dieting Advise on a Surface Level , However, ...

True or False? 'Low Fat' for the Lean, 'Low Carb' for the Obese and Insulin Resistant - Pilot Study Confirms Often Heard Dieting Advise on a Surface Level , However, ...

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Low carb, or fat? Left or right?  Which one should you chose and why? Shall you go by your body weight, your insulin sensitivity or your personal food preferences?

"Low Fat for the Lean, Low Carb for the Obese and Insulin Resistant," this quote from the headline sounds like a reasonable advise if you look at the existing evidence on low carbohydrate dieting, which appears to excel whenever the subjects are significantly overweight and insulin resistant. Studies that would do a head-to-head comparison of the two to confirm the accuracy of the hypothesis that "because they are insulin resistant, avoiding carbohydrates will aid people with (pre-)diabetes in losing weight" are non-existent... well, I should probably say they "were" nonexistent; a recent pilot study by Gardner et al does after all just that: compare the weight loss response of insulin sensitive vs. resistant individuals who consume either a low fat or a low carbohydrate diet over 6 months.

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The results of Gardner's study have recently been published ahead of print in the venerable scientific journal  Obesity; and they are... interesting, but as it was to be expected for a pilot study with "only" 61 participants in four groups, more research will be needed to make definite conclusions.

Figure 1: Weight loss (kg) after 6 months on the respective in insulin resistant and sensitive subjects (Gardner. 2015).

If you look at the main study outcome, i.e. the weight loss in Figure 1, for example, it would appear as if the previously cited statement from the headline of today's SuppVersity article was confirmed. Due to the large intra-group (=between individuals in one group) differences in all four diet groups (see error bars in Figure 1, they are about as long as the mean difference, we may speak of a trend or a tendency, that appears to confirm the previously stated hypothesis that an insulin resistant individual is better off avoiding carbs when dieting while an insulin sensitive one should stick to the mainstream low-fat recommendations (remember all subjects were overweight, none of the was athletic).

Figure 2: Proportions of carbohydrates, fats, and proteins for each diet at baseline, 3 months, and 6 months (Gardner. 2015).

This wouldn't be a SuppVersity article, though, if a brief glimpse at the main result was everything it had to offer. Let's first take a look at the reported energy- and macronutrient intakes (Figure 2) of the healthy, premenopausal women and men (age 18-50) with stable (>2 months) BMIs and an age between 28 years and 40 years (aside from the increased number of subjects with metabolic syndrome in the insulin resistant group, there were no noteworthy inter-group differences at baseline).

Limbo-Titrate-Quality: The dietary strategy that was used is quite interesting and actually something worth copying for yourself or your clients. There was the "Limbo" phase where the fat or carb intake had to be cut back drastically to 20 g/day of total fat or digestible carbohydrates. The goal of this phase was, as the scientists point out "to achieve the lowest level of fat or carbohydrate intake within the first 8 weeks" (Gardner. 2015). In the second stage, the scientists labeled as the "Titrate" phase the subjects slowly added fat or carbohydrate back to their diet - in increments of 5 g/day (e.g., from 20 to 25 g/day). With each increase, the intake had to be maintained stable for at least 1, maximally 5 weeks before adding another 5 g/day. The (good) idea was to allow each of the participants (in what the researchers call stage 3 of the intervention, although 2 + 3 appear to depend on each other) to find his or her specific level of fat or carbohydrate intake he / sheh "could be maintained long term, potentially for the rest of their lives" (ibid). The fourth and last stage eventually focused on diet quality. In the "Quality" phase the subjects had to maximize the nutrient density of their foods by selecting whole foods, buying organic, grass-fed, etc.

As you can see significant inter-group differences were observed only for the macronutrient composition; and even though these differences were significant, we are nor talking about a ketogenic vs. no-fat diet. Rather than that, both diets had a relatively balanced macronutrient profile, albeit with different main energy sources (carbs vs. fat). What did not differ for the groups, though was the total energy intake (Figure 2). This is interesting, because, in theory, the subjects were allowed ot eat as much as they wanted; and still, the data in Figure 2 tells you that they restricted their energy intake by noteworthy 30% on average (the ~600kcal-deficit also explains why the subjects even lost weight), with no difference between the subjects on the allegedly more satiating low carb vs. low fat diet.

Figure 3: Fiber, added sugar and saturated fat intake in g/1000kcal (Gardner. 2015).

Visible differences existed, obviously, for the intake of fiber, added sugars and saturated fats (Figure 3). These differences, which are characteristic of low fat vs. low carb diets, may also be the reason a recent study by Mansoor et al. (see red box below) found differences in the effects on triglycerides (increases with high CHO and even more so sugar intake), HDL and LDL (both increase w/ high saturated fat intakes) when they compiled the results of the contemporary low fat vs. low carb trials.

So, what's healthier, then? Low carb or low fat? To answer this question, researchers from the University of Oslo have recently conducted a meta-analysis that yielded quite interesting results, when the individual findings from the studies were pooled as weighted mean difference (WMD) using a random effect model: Compared with participants on LF diets, participants on LC diets experienced a greater reduction in body weight (WMD –2·17 kg; 95 % CI –3·36, –0·99) and triglicerides (WMD –0·26 mmol/l; 95 % CI –0·37, –0·15), as well as a greater increase in HDL-cholesterol (WMD 0·14 mmol/l; 95 % CI 0·09, 0·19) - that's good. Unfortunately, they also saw signficant increases in LDL-cholesterol. With 0·16 mmol/l, the mean difference in LDL was larger than the mean HDL increase, which could suggest an increase in CVD risk and has the authors conclude that their "findings suggest that the beneficial changes of LC diets must be weighed against the possible detrimental effects of increased LDL-cholesterol" (Mansoor. 2015). Personally, I would say, though, that for the mostly obese subjects in the studies, the weight loss and reduction in triglycerides (likewise a marker of CVD risk) are more important than the increase in LDL-C - future studies should try to elucidate if the particle size and LDL oxidation worsened as well and what the actual long-term (years, not months) effects are.

It is thus no wonder that the data from  blood analysis of the study at hand (Figure 4) mirrors the results of the studies Mansoor et al. (2015) analyzed for their meta-analysis that is about to be published in the British Journal of Nutrition (see red box):

Figure 4: Changes in LDL-C, HDL-C, Trigs and fasting glucose after 3 & 6 months (Gardner. 2015).

With the most significant differences being observed for triglycerides and LDL, the situation is very similar to the one the Mansoor et al. describe in their review. In this regard, it is also worth mentioning that the differences between the groups were reduced, when the subjects started to increase their fat or carbohydrate intake by 5g on a 1-4 week basis to eventually end up at their individual "that's how I could eat for the rest of my life"-level (compare the 3 months with the 6 months data).

This doesn't solve the dilemma we're in, though: without further data on particle sizes and oxidative status of the LDL molecules, etc. it is virtually impossible to make a reliable prediction which of the two diets is going to have the higher long-term health benefits. What may be even more important, though, is that we must not forget that it is not debatable that both diets triggered significant weight loss and measurable health improvements, especially in the subjects with pre-existing insulin resistance (blue and orange bars in Figure 4).

Figure 5: Changes in the prevalence of metabolic syndrome after 3 and 6 months (Gardner. 2015).

Bottom Line: So, it doesn't matter how you diet as long as you diet? Well, as previously pointed out, the absolute weight-loss values in Figure 1 appear to confirm the hypothesis that "low carb" is for the sick, while "low fat" for the healthy overweight individuals.

The significant intra-group differences, however, tell us that whether you are or aren't insulin resistant is not the only determinant of your response to the different diets. Especially for healthy individuals experimentation and finding what suits you, your lifestyle and sports best does therefore still appear to be the way to go.

In those with pre-existing metabolic syndrome (which is more than just insulin resistance, by the way), the generally higher relative reduction in MetSyn prevalence Gardner et al. observed in their study (Figure 5) do yet appear to confirm the general trend towards low-carbohydrate diets for people with serious metabolic issue; and maybe that's actually the main take-home message of a study that must be seen as a first attempt to identify one of the variables that determine whether an individual thrives on a low carb, a low fat or maybe just a completely balanced diet | Comment!

References:

• Gardner, et al. "Weight Loss on Low-Fat vs. Low-Carbohydrate Diets by Insulin Resistance Status Among Overweight Adults and Adults with Obesity: A Randomized Pilot Trial" Obesity (2015): Ahead of print.
• Mansoor, et al. "Effects of low-carbohydrate diets v. low-fat diets on body weight and cardiovascular risk factors: a meta-analysis of randomised controlled trials." British Journal of Nutrition (2015): First view article.