The Caveman in the Mirror: Masculinity and Paleofantasy

To assess the feasibility and efficacy of a novel 16-week exercise and diet program for important clinical outcomes in obstructive sleep apnea (OSA). Cohort study assessing sleep disordered breathing, cardiovascular risk factors, and neurobehavioral function prior to and following completion of the 16-week program. The program used a proprietary very low energy diet (Optifast, Novartis), and subjects participated in a supervised exercise schedule, which included both aerobic and resistance training. Follow-up contact was made at 12 months after program exit. Consecutive patients with newly diagnosed sleep apnea were approached who had an apnea-hypopnea index (AHI) of 10 to 50, a body mass index (BMI) of greater than 30 kg/m2, no significant comorbidities, and able to exercise. All data are presented as mean [SD]. Of 21 patients with OSA who were approached, 12 middle-aged (42.3 [10.4] years old), obese (BMI 36.1 [4.3] kg/m2), and predominantly female (75%) subjects with mild to moderate OSA were enrolled (AHI 24.6 [12.0]). Weight loss was significant (12.3 [9.6] kg, p <0.001), and 5 of the 10 who completed the program were able to independently maintain good weight loss at 12 months. At the 16-week assessment, there was a small nonsignificant fall in the AHI. Six of the 10 subjects had a reduction in sleep disordered breathing, and the AHI was less than 10 in 3 patients. There were significant improvements in neurobehavioral and cardiometabolic outcomes. Snoring improved in most subjects, but the improvement was clinically important (a score of < 2) in only 7. A supportive diet and exercise program may be of benefit to obese patients with mild to moderate sleep apnea. The results of this feasibility study showed significant weight loss and improvement in clinically important neurobehavioral and cardiometabolic outcomes but no significant change in sleep disordered breathing. These promising preliminary results need confirmation with a larger randomized trial.

BackgroundOur aim was to compare the effects of a Paleolithic ('Old Stone Age') diet and a diabetes diet as generally recommended on risk factors for cardiovascular disease in patients with type 2 diabetes not treated with insulin.MethodsIn a randomized cross-over study, 13 patients with type 2 diabetes, 3 women and 10 men, were instructed to eat a Paleolithic diet based on lean meat, fish, fruits, vegetables, root vegetables, eggs and nuts; and a Diabetes diet designed in accordance with dietary guidelines during two consecutive 3-month periods. Outcome variables included changes in weight, waist circumference, serum lipids, C-reactive protein, blood pressure, glycated haemoglobin (HbA1c), and areas under the curve for plasma glucose and plasma insulin in the 75 g oral glucose tolerance test. Dietary intake was evaluated by use of 4-day weighed food records.ResultsStudy participants had on average a diabetes duration of 9 years, a mean HbA1c of 6,6% units by Mono-S standard and were usually treated with metformin alone (3 subjects) or metformin in combination with a sulfonylurea (3 subjects) or a thiazolidinedione (3 subjects). Mean average dose of metformin was 1031 mg per day. Compared to the diabetes diet, the Paleolithic diet resulted in lower mean values of HbA1c (-0.4% units, p = 0.01), triacylglycerol (-0.4 mmol/L, p = 0.003), diastolic blood pressure (-4 mmHg, p = 0.03), weight (-3 kg, p = 0.01), BMI (-1 kg/m2, p = 0.04) and waist circumference (-4 cm, p = 0.02), and higher mean values of high density lipoprotein cholesterol (+0.08 mmol/L, p = 0.03). The Paleolithic diet was mainly lower in cereals and dairy products, and higher in fruits, vegetables, meat and eggs, as compared with the Diabetes diet. Further, the Paleolithic diet was lower in total energy, energy density, carbohydrate, dietary glycemic load, saturated fatty acids and calcium, and higher in unsaturated fatty acids, dietary cholesterol and several vitamins. Dietary GI was slightly lower in the Paleolithic diet (GI = 50) than in the Diabetic diet (GI = 55).ConclusionOver 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.Trial registrationClinicalTrials.gov NCT00435240.

The Movement movement

Websites of note.

Most studies of diet in glucose intolerance and type 2 diabetes have focused on intakes of fat, carbohydrate, fibre, fruits and vegetables. Instead, we aimed to compare diets that were available during human evolution with more recently introduced ones. Twenty-nine patients with ischaemic heart disease plus either glucose intolerance or type 2 diabetes were randomised to receive (1) a Palaeolithic ('Old Stone Age') diet (n = 14), based on lean meat, fish, fruits, vegetables, root vegetables, eggs and nuts; or (2) a Consensus (Mediterranean-like) diet (n = 15), based on whole grains, low-fat dairy products, vegetables, fruits, fish, oils and margarines. Primary outcome variables were changes in weight, waist circumference and plasma glucose AUC (AUC Glucose(0-120)) and plasma insulin AUC (AUC Insulin(0-120)) in OGTTs. Over 12 weeks, there was a 26% decrease of AUC Glucose(0-120) (p = 0.0001) in the Palaeolithic group and a 7% decrease (p = 0.08) in the Consensus group. The larger (p = 0.001) improvement in the Palaeolithic group was independent (p = 0.0008) of change in waist circumference (-5.6 cm in the Palaeolithic group, -2.9 cm in the Consensus group; p = 0.03). In the study population as a whole, there was no relationship between change in AUC Glucose(0-120) and changes in weight (r = -0.06, p = 0.9) or waist circumference (r = 0.01, p = 1.0). There was a tendency for a larger decrease of AUC Insulin(0-120) in the Palaeolithic group, but because of the strong association between change in AUC Insulin(0-120) and change in waist circumference (r = 0.64, p = 0.0003), this did not remain after multivariate analysis. A Palaeolithic diet may improve glucose tolerance independently of decreased waist circumference.

To investigate the influence of a trial lifestyle intervention on participants' preferences for a range of exercise and diet programmes and whether these differ between successful and unsuccessful participants. Hypothetical scenarios that describe attributes of diet and exercise programmes were developed using an experimental design. Participants completed an online questionnaire at baseline, 16 weeks and 12 months where they chose their most preferred of three programmes in each of sixteen scenarios. Discrete choice modelling was used to identify which attributes participants emphasised at each time point. Fifty-five individuals who exhibited symptoms of metabolic syndrome and who participated in a 16-week trial lifestyle intervention. There was a clear shift in programme preferences from structure to flexibility over the intervention. At baseline, emphasis was on individually designed and supervised exercise, structured diets and high levels of support, with Gainers focusing almost exclusively on support and supervision. Losers tended to consider a wider range of programme attributes. After 16 weeks preferences shifted towards self-directed rather than organised/supervised exercise and support was less important (this depended on the type of participant and whether they were in the follow-up group). Cost became significant for Gainers following the end of the primary intervention. The stated preference method could be a useful tool in identifying potential for success and specific needs. Gainers' relinquishment of responsibility for lifestyle change to programme staff may be a factor in their failure and in their greater cost sensitivity, since they focus on external rather than internal resources.

Introduction: The interest in minimalist and barefoot running is growing continuously. However, there is no data on how many runners drop out during this process. Objective: To describe the adhesion and dropout rates of a six-month instructed training program based on barefoot and minimalist footwear running. Methods: Thirty-four recreational runners participated in the study: 20 runners started the race training barefoot, while 14 runners were involved in training with minimalist footwear. Adhesion to intervention programs was evaluated through training spreadsheets and recording attendance at training sessions, while dropouts were evaluated at the end of training. A questionnaire was sent to participants who dropped out of the training, to obtain information related on why they had abandoned it. Results: Considering all participants (n=34), 41.2% of the runners completed six months with reduced plantar protection; 70% of all dropouts occurred in barefoot training; the main reasons for leaving the training were injury/pain (40%) and lack of time/suitable place for training (40%); and the majority of dropouts (50%) occurred in the first month of training. Barefoot training (n=20) showed 70% dropouts, 57.1% of them due to lack of time/suitable place for training; and 71.4% of the dropouts occurred in the first month of the intervention. The training with minimalist footwear (n=14) had fewer dropouts (42.9%) than the barefoot training, all of them due to injury/pain; 50% of them occurred in the third month of intervention. Conclusion: Dropouts usually occur at the beginning of training. Training involving barefoot running has more dropouts than training with minimalist footwear. Intervention programs lasting six months based on minimalist footwear/barefoot seems to have similar adhesion to other supervised exercise programs. The main reasons for dropping out are injury/pain and lack of time/suitable place to run.

Scalable knee osteoarthritis programs are needed to deliver recommended education, exercise, and weight loss interventions. To evaluate two 6-month, telehealth-delivered exercise programs, 1 with and 1 without dietary intervention. 3-group, parallel randomized (5:5:2) trial. (Australian New Zealand Clinical Trials Registry: ACTRN12618000930280). Australian private health insurance members. 415 persons with symptomatic knee osteoarthritis and a body mass index between 28 and 40 kg/m2 who were aged 45 to 80 years. All groups received access to electronic osteoarthritis information (control). The exercise program comprised 6 physiotherapist consultations via videoconference for exercise, self-management advice, and behavioral counseling, plus exercise equipment and resources. The diet and exercise program included an additional 6 dietitian consultations for a ketogenic very-low-calorie diet (2 formulated meal replacements and a low-carbohydrate meal daily) followed by a transition to healthy eating, as well as nutrition and behavioral resources. Primary outcomes were changes in knee pain (numerical rating scale [NRS] of 0 to 10, higher indicating worse) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]; scale, 0 to 68, higher indicating worse) at 6 months (primary time point) and 12 months. Secondary outcomes were weight, physical activity, quality of life, mental health, global change, satisfaction, willingness to have surgery, orthopedic appointments, and knee surgery. A total of 379 participants (91%) provided 6-month primary outcomes, and 372 (90%) provided 12-month primary outcomes. At 6 months, both programs were superior to control for pain (between-group mean difference in change on NRS: diet and exercise, -1.5 [95% CI, -2.1 to -0.8]; exercise, -0.8 [CI, -1.5 to -0.2]) and function (between-group mean difference in change on WOMAC: diet and exercise, -9.8 [CI, -12.5 to -7.0]; exercise, -7.0 [CI, -9.7 to -4.2]). The diet and exercise program was superior to exercise (pain, -0.6 [CI, -1.1 to -0.2]; function, -2.8 [CI, -4.7 to -0.8]). Findings were similar at 12 months. Participants and clinicians were unblinded. Telehealth-delivered exercise and diet programs improved pain and function in people with knee osteoarthritis and overweight or obesity. A dietary intervention conferred modest additional pain and function benefits over exercise. Medibank, the Medibank Better Health Foundation Research Fund, and a National Health and Medical Research Council Centre of Research Excellence.

Consumption, Wellness, and the Far Right

A popular diet in Sweden today is the palaeolithic diet, where lean meat, fish, vegetables, fruit, roots and nuts are dietary staples, while cereals, dairy products, salt and processed fat and sugar are avoided. The underlying rationale is that foods that were available during the evolution of primates, up to the emergence of fully modern humans, are healthier than recently introduced ones (dairy products, cereals, beans, refined fat, sugar, etc.), since our digestive and metabolic systems were not designed for the latter group of foods. Variation in plant foods, another principle based on evolutionary biology, is recommended to avoid high intakes of potentially harmful bioactive substances. It is not known whether palaeolithic diets are more, or less, effective than other diets in weight reduction. Keywords: evolutionary medicine; metabolic syndrome; overweight; popular diets; Western disease

The archaeological remains found in the Mumba rock-shelter in northern Tanzania – where continuous deposits span from the Middle Stone Age (MSA) to the historical period – provide a unique opportunity to study trends in technology and behavioural change of early humans. Developments in symbolic thought may be evident in the production and use of ochre pigments, beads and rock art. At this site, beads and other symbolic artefacts are represented in varying quantities through the late MSA, the Later Stone Age (LSA), Neolithic, and post Stone Age cultures. Such beaded ornaments were made from various raw materials including ostrich eggshells, stone pebbles, and arthropod shells. Ancient beading technologies, discovered at Mumba and other MSA sites across the East African region, contribute to clarifying the origin and development of representational cognition in the distant past. These artefacts also reveal components of personal identity and creative expression, whose recorded remains are patchy and infrequently discussed in Sub-Saharan Africa. From a Darwinian perspective, these archaeological finds demonstrate the empirical issue of environmentally selected human responses to local stimuli. They are remnants of the synergistic adaptation that led more generally to the broader technological innovations and behavioural changes occurring through the late Middle Stone Age and later flourishing universally during the Late Stone Age culture.

The role of activity in the therapeutic management of back pain. Report of the International Paris Task Force on Back Pain.

Bioethics: a memoir

On their way from the Stone Age via the Agricultural Revolution to current high-tech conditions, humans lost their primal foraging behavior. Today, energy expenditure is not necessary anymore for gathering nor hunting, and metabolic diseases are epidemically arising wherever our original Paleolithic lifestyle is turning into a modern sedentary lifestyle. In this pilot study, we followed through the concept that a radical change towards a Paleolithic hunter-gatherer lifestyle could serve as therapy against any metaflammatory disease, even in the short term. Thirteen healthy adult volunteers were transferred to the DELUX National Park (Germany and Luxembourg) for four days and three nights, where Stone Age conditions where mimicked. Thirty-eight biochemical and bioelectrical parameters were measured from participants before and after this relocation. Body weight (-3,9%), body fat (-7,5%), body mass index (-3,8%), visceral fat area (-14,4%) and metaflammation-related parameters (fasting glucose = -18,2%; fasting insulin = -50,1%; HOMA = -57,8%) decreased significantly. C-reactive protein, as the main indicator for low-grade inflammation, increased up to an average of 169,6 %. Our data show that returning to our Paleolithic roots may have positive effects on risk factors commonly associated with metabolic disorders, such as obesity and type 2 diabetes. These findings may lead the way to further research to answer the question whether the already existing metabolic conditions and/or autoimmune and neuroinflammatory diseases could be influenced by a Paleolithic lifestyle.

Paleo diets have been characterized as having foods that we “were born to eat,” and the justification for their healthful nature is based upon the assumption that they reflect the foods our Stone Age ancestors ate: low in sugar and cereals and high in meat and “healthy fats.” Here we critique this assumption by drawing on direct evidence of hominin diet from the bioarchaeological record (isotope and microfossil data) that shows that there was no such ubiquitous Stone Age diet. These data also demonstrate that plant foods, including cereals, were consumed by our ancestors many millennia before the Paleo diet proponents would have us believe and well before the agricultural revolution. We also probe our Eurocentric views of the genetic basis of metabolic syndrome-related diseases by reviewing the burden of these diseases, the possible skeletal evidence for this, from Oceania. This Oceanic case study underscores the diversity of our species, its histories, its ecologies, its genetics, and its diets. These differences extend over tens of thousands of years and demonstrate that there simply was not and is no signature one-size-fits-all diet from humankind’s past that is universally healthful.