Abstract
BackgroundWe have previously shown that a Palaeolithic diet consisting of the typical food groups that our ancestors ate during the Palaeolithic era, improves cardiovascular disease risk factors and glucose control compared to the currently recommended diabetes diet in patients with type 2 diabetes. To elucidate the mechanisms behind these effects, we evaluated fasting plasma concentrations of glucagon, insulin, incretins, ghrelin, C-peptide and adipokines from the same study.MethodsIn a randomised, open-label, cross-over study, 13 patients with type 2 diabetes were randomly assigned to eat a Palaeolithic diet based on lean meat, fish, fruits, vegetables, root vegetables, eggs and nuts, or a diabetes diet designed in accordance with current diabetes dietary guidelines during two consecutive 3-month periods. The patients were recruited from primary health-care units and included three women and 10 men [age (mean ± SD) 64 ± 6 years; BMI 30 ± 7 kg/m2; diabetes duration 8 ± 5 years; glycated haemoglobin 6.6 ± 0.6 % (57.3 ± 6 mmol/mol)] with unaltered diabetes treatment and stable body weight for 3 months prior to the start of the study. Outcome variables included fasting plasma concentrations of leptin, adiponectin, adipsin, visfatin, resistin, glucagon, insulin, C-peptide, glucose-dependent insulinotropic polypeptide, glucagon-like peptide-1 and ghrelin. Dietary intake was evaluated by use of 4-day weighed food records.ResultsSeven participants started with the Palaeolithic diet and six with the diabetes diet. The Palaeolithic diet resulted in a large effect size (Cohen’s d = −1.26) at lowering fasting plasma leptin levels compared to the diabetes diet [mean difference (95 % CI), −2.3 (−5.1 to 0.4) ng/ml, p = 0.023]. No statistically significant differences between the diets for the other variables, analysed in this study, were observed.ConclusionsOver a 3-month study period, a Palaeolithic diet resulted in reduced fasting plasma leptin levels, but did not change fasting levels of insulin, C-peptide, glucagon, incretins, ghrelin and adipokines compared to the currently recommended diabetes diet.Trial registration: ClinicalTrials.gov NCT00435240Electronic supplementary materialThe online version of this article (doi:10.1186/s12933-016-0398-1) contains supplementary material, which is available to authorized users.
Highlights
We have previously shown that a Palaeolithic diet consisting of the typical food groups that our ancestors ate during the Palaeolithic era, improves cardiovascular disease risk factors and glucose control compared to the currently rec‐ ommended diabetes diet in patients with type 2 diabetes
Leptin resistance is a possible player in the roadmap to the metabolic syndrome and type 2 diabetes [7], and it has been suggested that leptin can protect against lipotoxicity [7]
Four subjects were excluded for the following reasons: one starting with Paleolithic diet was wrongly included with ongoing warfarin treatment, one starting with Paleolithic diet was unwilling to continue due to abdominal pains and bloating, one starting with diabetes diet was excluded after developing leukemia, and one starting with diabetes diet was excluded after developing heart failure
Summary
We have previously shown that a Palaeolithic diet consisting of the typical food groups that our ancestors ate during the Palaeolithic era, improves cardiovascular disease risk factors and glucose control compared to the currently rec‐ ommended diabetes diet in patients with type 2 diabetes. Insulin resistance has been suggested to be a consequence and a protective mechanism against lipotoxicity [6,7,8,9,10]. Leptin resistance is a possible player in the roadmap to the metabolic syndrome and type 2 diabetes [7], and it has been suggested that leptin can protect against lipotoxicity [7]. In a previous publication from this trial, we reported significant improvements in glycated haemoglobin (HbA1c), blood lipids, blood pressure, weight and waist circumference [12] along with increased satiety [13] in patients with type 2 diabetes consuming a Palaeolithic diet, as compared to the officially recommended diet for patients with type 2 diabetes (diabetes diet) [14]
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