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.

Ad-Libitum Paleo Diet W/ a Handful of Simple Rules Cuts 5-7 kg of Body Fat in 12 Weeks - Plus: Paleo Research Overview | more.

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’."

Ad-Libitum Paleo Diet W/ a Handful of Simple Rules Cuts 5-7 kg of Body Fat in 12 Weeks - Plus: Paleo Research Overview

Ad-Libitum Paleo Diet W/ a Handful of Simple Rules Cuts 5-7 kg of Body Fat in 12 Weeks - Plus: Paleo Research Overview

dieting health insulin resistance lean mass lose fat lose weight muscle loss paleo paleolithic eating whole foods

Yes, these foods were "allowed" - Even nuts, albeit in limited amounts.

Ok, I have to admit that I have repeatedly made fun of "paleo" in the past. Its "cultish", sometimes even "sectarian" appeal is and will remain as hilarious in my eyes as the (for some people life-or-death-)question whether certain foods "are paleo" or not (who cares, as long as they are healthy?). If you happen to have seen my presentation at the Paleo Convention in Berlin, last year, you will know that, despite my apathy against the quasi-religious sides of "paleo", I do appreciate a certain set of "rules" or "principles" (or whatever you may call them) all iterations of "paleo" have in common.

These principles work! And they have just been shown to help middle-aged type II diabetics (age 59±8 years) shed a quite impressive 6.7 kg of body fat (w/out exercise "only 5.7kg) in 12 weeks - without dieting as in not eating, although you're hungry (Otten. 2016).

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As the headline already tells you, the subjects, individuals diagnosed with type 2 diabetes within the past 10 years, who had a BMI of 25–40 kg/m2 and were weight stable (i.e. <5% weight loss) for 6 months (that's important, because otherwise the data on the energy deficit in Figure 1, which was calculated as baseline vs. study intake would be inaccurate) were allowed to eat "as-libitum", which practically means "as much as they wanted", as long, as they adhered to (a) "paleo foods", i.e. lean meat, fish, seafood, eggs, vegetables, fruits, berries, and nuts, but no cereals, dairy products, legumes, refined fats, refined sugars, and (extra) salt (canned fish and cold cuts like ham were allowed) and (b) followed the following simple food-specific rules:

• 

  Paleo Goes "Real Science" - First Meta-Analysis of Available RCTs Shows Improvements in Health + Body Composition | learn more

  eggs - maximally 1–2/day, and no more than 5/week,
• potatoes - only 1 medium sized potato per day
• dried fruit - 130 g/day, not more,
• nuts - 60 g/day, so no snacking on almonds 24/7
• rapeseed or olive oil - maximum 15 g/day
• honey and vinegar - only small amounts as flavoring in cooking
• coffee & tea - max 300 ml/day (each, I assume)
• red wine - only one glass per week

Since the participants were also instructed to drink mainly still water, you will probably not be surprised that all subjects, irrespective of whether they had been randomly assigned to the no exercise or exercise group ended up in a significant energy deficit - in spite of being allowed to eat "ad-libitum" (see Figure 1 for the most relevant information about their diet(s)).

Figure 1: Energy and macronutrient intake; differences, rel. + abs. above bars (Otten. 2016).

It is also not surprising that the extra-exercise (1h of exercise, 3x per week | details see blue box below) that was done on top of the (at least) 30 min of moderate intensity exercise like brisk walking all patients had been prescribed as part of their regular T2DM treatment, almost doubled the energy deficit of the subjects in the paleo + exercise, i.e. the PD-EX group (remember: the subjects were allowed to eat more, as long as they stuck to the previously presented rules - since the intake of foods like steak or chicken breast was not limited, they would have been able - within certain limits - to significantly increase their energy intake and still did not fully compensate the energy expended during the workouts; this should remind you of previous articles of mine outlining that "exercise does not just make you hungry" | learn more)

What about compli-ance? Both groups increased their relative intake of protein and their intake of monounsatu-rated and polyunsatu-rated fatty acids. Both groups lowered their intake of carbohydrates and saturated fatty acids. The reduction of sodium intake was only significant in the PD-EX group. Nine of the 14 participants in the PD-EX group completed the 36 exercise sessions according to the study protocol. The remaining five participants completed between 27 and 35 workouts during the study period. The participants in the PD-EX group increased the cumulative weight load (weight × repetitions × sets) with the leg press during one exercise session from 1350 kg (900−1800) to 3000 kg (2700−4000) after 12 weeks.

What did the 1h workouts look like? The PD-EX group underwent a program comprising a combination of aerobic exercise and resistance training in 1-h sessions three times weekly at the Sports Medicine unit at Umeå University. The exercise sessions were performed on weekdays, with at least 1 day of rest between sessions. They were supervised by experienced personal trainers with bachelor’s degrees in Sports Medicine.

All exercise sessions started with aerobic exercise. The first session of each week consisted of low-intensity aerobic training at 70% of the maximum heart rate on a crosstrainer (Monark Prime, XT 50, Vansbro, Sweden). The second session of the week consisted of ten high-intensity sprint intervals at 100% of the maximal workload on a cycle-ergometer (Monark, Ergomedic 839E, Vansbro, Sweden), with low-intensity cycling between the sprints. The third session of each week comprised six moderate-intensity 5-min intervals between 45 and 60% of maximal workload on a cycle-ergometer. The duration/workload of the intervals increased every other week. When necessary, the intensity of the aerobic exercise sessions was adjusted in accordance with the participant’s performance.

After the aerobic exercise, the sessions progressed to resistance training with both upper and lower body exercises, including leg presses, seated leg extensions, leg curls, hip raises, flat and incline bench presses, seated rows, dumbbell rows, lat pull-downs, shoulder raises, back extensions, burpees, sit-ups, step-ups, and wall ball shots. At each training session, the participant performed 3–5 of the aforementioned resistance exercises, with 10–15 repetitions and 2–4 sets. Once participants could complete all repetitions, the workload was increased for the following session.

Still, the main advantage of exercise was not, as you may now falsely expect due to the ~100% increase in energy deficit, a significantly increased loss of body fat (the latter did not double and that must not surprise you!). Neither was it a powerful increase in insulin sensitivity (HOMA-IR), which increased in both groups similarly (45% | p<0.001). Yeah, and even the extra 0.2% decrease in HbA1c, the sugar coating on the subjects' red blood cells  (-0.9% in diet only, -1.1% in diet + exercise), is not the main reason you must not miss your workouts while dieting (paleo-style or not ;-).

Figure 2: Fat mass (a), insulin sensitivity (b), and cardiovascular fitness (c and d) during 12 weeks following either a Paleolithic diet with a supervised exercise program (PD-EX) or a Paleolithic diet combined with general exercise recommendations (PD). Boxes represent medians and IQRs, whiskers represent the most extreme values besides outliers, and filled circles represent outliers (>1.5 IQR); **p<0 .01="" 2016="" p="" td="" tten.="">

So why are workouts important, then? It's the increased fitness, as evidenced by the PD-EX exclusive increase in maximum oxygen uptake (0.2 L/min) and the conservation of lean mass, which reached statistical significance (1.2kg in PD-EX vs. 2.6 kg in PD) only in the male subjects (p<0.05 for the difference between intervention groups), however (it is well possible that this is due to a lack of protein in the women's diet, cf. bottom line), that made / makes exercise (esp. resistance training) so valuable while dieting... this and another thing, the abstract of the study does not appreciate, because it did not reach statistical significance: The increase in relative resting energy expenditure (REE), the scientists observed in the PD-EX group (this adds to the extra energy expenditure during workouts, by the way!). While the relative REE didn't change in the PD group, it increased by a(n over the long-term) potentially relevant (but statistically non-significant) 3% in the PD-EX group - an effect that more than countered the nasty reduction in REE scientists still hold responsible for the yoyo-effect most "biggest losers" experience after successfully losing weight.

Is this the first paleo study? Even though, the number is still low, this is not the first one. In 2009, already, Jönssen et al. reported that "a 3-month study period, a paleolithic diet improved glycemic control and several cardiovascular risk factors compared to a diabetes diet in patients with type 2 diabetes" (Jönssen. 2009). In 2013, the same authors found that a "Paleolithic diet is more satiating per calorie than a diabetes diet in patients with type 2 dia-betes [and that t]he Paleolithic diet was seen as instrumental in weight loss, albeit it was difficult to adhere to" (Jönssen. 2013) - a result they had previously observed in patients with heart disease, too, when they compared a paleo to a Mediterranean diet (Jönssen. 2010), which also improve glucose tolerance less effectively than the paleo diet in said subject group (Lindeberg. 2007). Furthermore, studies in healthy individiuals Frassetto et al. (2015) like Österdahl et al. report that even "a short-term intervention showed some favourable effects by the diet" (Österdahl. 2008) such as weight loss, waist reductions and an improved quality of the diet and improved "BP [blood pressure] and glucose tolerance, decreases insulin secretion, increases insulin sensitivity and improves lipid profiles without weight loss" (Frassetto. 2015). In view of the fact that the less than a handful of long-term (>1 year), studies similar benefits when comparing paleo to other recommended diets, such as the Nordic Nutrition Recommendations in Mellbert et al. (2014) also show "greater beneficial effects" (e.g. fat mass, abdominal obesity and triglyceride levels just as they were observed by Ryberg, et al. in 2013) for the paleo diet(s), one could argue that the evidence in favor of paleo dieting in health and disease is slowly accumulating.

Eventually, diet is king, ... and that, just like the fact that doubling the energy deficit you have on paper won't double the loss of fat mass, shouldn't be news to you. That doesn't mean that dieting with exercise would not increase the loss of fat mass, but what is more important is that it helped the subjects - at least the male ones - maintain significantly more lean mass (=muscle and organ mass, which also affects you REE!).

Whether the failure of the workout to produce significant lean mass maintenance in the women was due to their sex, their hormonal status (the females included in the study were postmenopausal) or the fact that they gravitated to eat less protein (this is speculative, since the study does not provides sex-specific intakes) cannot be said. Even in the men, the lean mass loss is yet large enough to speculate that we'd have seen sign. less muscle loss with higher protein intakes. After all, the 79g the subjects in the PED-EX group consumed on a daily basis amount to only 0,84g protein per kg of body weight. This has repeatedly been shown to be too little for older individuals - even if they were not dieting. A follow up to the study which includes (a) simply more protein or (b) an extra protein shake after the workouts that would bump the subjects' total protein intake into the ~1.6-2.0g/kg region would thus be something I'd like to see in the (not so distant) future.

As long as said study will not have been done, though (something tells me that it won't ;-), you can still reference Otten's study as evidence that you can effectively lose weight without cereals, dairy products, and legumes... I have to admit, though, that I suspect that especially the latter two of these "forbidden" foods would rather have augmented, not messed with the improvements in body composition Otten et al. observed in the study at hand | Comment!

References:

• Frassetto, Lynda A., et al. "Metabolic and physiologic improvements from consuming a paleolithic, hunter-gatherer type diet." European journal of clinical nutrition 63.8 (2009): 947-955.
• Jönsson, Tommy, et al. "Beneficial effects of a Paleolithic diet on cardiovascular risk factors in type 2 diabetes: a randomized cross-over pilot study." Cardiovasc Diabetol 8.35 (2009): 1-14.
• Jönsson, Tommy, et al. "A paleolithic diet is more satiating per calorie than a mediterranean-like diet in individuals with ischemic heart disease." Nutrition & metabolism 7.1 (2010): 1.
• Jönsson, Tommy, et al. "Subjective satiety and other experiences of a Paleolithic diet compared to a diabetes diet in patients with type 2 diabetes." Nutrition journal 12.1 (2013): 1.
• Mellberg, Caroline, et al. "Long-term effects of a palaeolithic-type diet in obese postmenopausal women: a two-year randomized trial." European journal of clinical nutrition 68.3 (2014): 350.
• Lindeberg, Staffan, et al. "A Palaeolithic diet improves glucose tolerance more than a Mediterranean-like diet in individuals with ischaemic heart disease." Diabetologia 50.9 (2007): 1795-1807.
• Österdahl, M., et al. "Effects of a short-term intervention with a paleolithic diet in healthy volunteers." European journal of clinical nutrition 62.5 (2008): 682-685.
• Otten, J, et al. "Effects of a Paleolithic diet with and without supervised exercise on fat mass, insulin sensitivity, and glycemic control: a randomized controlled trial in individuals with type 2 diabetes." Diabetes/Metabolism Research and Reviews (2016 |Accepted Article). doi: 10.1002/dmrr.2828
• Ryberg, Mats, et al. "A Palaeolithic‐type diet causes strong tissue‐specific effects on ectopic fat deposition in obese postmenopausal women." Journal of Internal medicine 274.1 (2013): 67-76.