Benefits 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

Otten, Julia; Stomby, Andreas; Waling, Maria; Isaksson, Anders; Tellström, Anna; Lundin-Olsson, Lillemor; Brage, Sören; Ryberg, Mats; Svensson, Michael; Olsson, Tommy

doi:10.1002/dmrr.2828

Cited by 122 publications

(122 citation statements)

References 49 publications

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“…The main results of the intervention have been previously published [25]. In the present substudy, we found no betweengroup differences in baseline characteristics except a higher fasting glucose in the PD-EX group (Table 1).…”

Section: Participant Characteristics and Intervention Validationsupporting

confidence: 71%

“…In addition, the participants were randomised to receive either supervised exercise training for 3 h per week (PD-EX group) or standard care exercise recommendations (PD group). The reduction of fat mass was the primary endpoint of this study and has been published previously [25]. The outcome measurements of this article are secondary endpoints (liver fat and peripheral and hepatic insulin sensitivity) and secondary analyses (IMCL).…”

Section: Methodsmentioning

confidence: 99%

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A heterogeneous response of liver and skeletal muscle fat to the combination of a Paleolithic diet and exercise in obese individuals with type 2 diabetes: a randomised controlled trial

et al. 2018

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Aims/hypothesis The aim of the study was to investigate ectopic fat deposition and insulin sensitivity, in a parallel single-blinded randomised controlled trial, comparing Paleolithic diet alone with the combination of Paleolithic diet and exercise in individuals with type 2 diabetes. Methods Thirty-two individuals with type 2 diabetes with BMI 25-40 kg/m 2 and 30-70 years of age followed a Paleolithic diet ad libitum for 12 weeks. In addition, study participants were randomised by computer program to either supervised combined exercise training (PD-EX group) or standard care exercise recommendations (PD group). Staff performing examinations and assessing outcomes were blinded to group assignment. Thirteen participants were analysed in each group: hepatic and peripheral insulin sensitivity were measured using the hyperinsulinaemic-euglycaemic clamp technique combined with [6, H 2 ]glucose infusion, and liver fat was assessed by proton magnetic resonance spectroscopy; both analyses were secondary endpoints. Intramyocellular lipid (IMCL) content was measured by magnetic resonance spectroscopy as a secondary analysis. All examinations were performed at Umeå University Hospital, Umeå, Sweden. Results Both study groups showed a median body weight loss of 7 kg. Fat mass decreased by 5.7 kg in the PD group and by 6.5 kg in the PD-EX group. Maximum oxygen uptake increased in the PD-EX group only. Liver fat showed a consistent reduction (74% decrease) in the PD group, while the response in the PD-EX group was heterogeneous (p < 0.05 for the difference between groups). IMCL content of the soleus muscle decreased by 40% in the PD group and by 22% in the PD-EX group (p < 0.05 for the difference between groups). Both groups improved their peripheral and adipose tissue insulin sensitivity, but not their hepatic insulin sensitivity. Plasma fetuin-A decreased by 11% in the PD group (p < 0.05) and remained unchanged in the PD-EX group. Liver fat changes during the intervention were correlated with changes in fetuin-A (r S = 0.63, p < 0.01). Participants did not report any important adverse events caused by the intervention. Conclusions/interpretation A Paleolithic diet reduced liver fat and IMCL content, while there was a tissue-specific heterogeneous response to added exercise training.

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Section: Participant Characteristics and Intervention Validationsupporting

confidence: 71%

Section: Methodsmentioning

confidence: 99%

A heterogeneous response of liver and skeletal muscle fat to the combination of a Paleolithic diet and exercise in obese individuals with type 2 diabetes: a randomised controlled trial

et al. 2018

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“…The PD causes a greater weight loss than a conventional diet according to Nordic Nutrition Recommendations among obese women without type 2 diabetes (21). Furthermore, the PD has been shown to improve insulin sensitivity and reduce hepatic lipid levels among patients with type 2 diabetes (22,23). In general, the PD excludes the intake of dairy products, salt, refined sugar and grains, while the intake of vegetables, lean meat, fish and nuts is increased (21,22).…”

Section: Introductionmentioning

confidence: 99%

Diet-induced weight loss alters hepatic glucocorticoid metabolism in type 2 diabetes mellitus

Stomby

Otten

Ryberg

et al. 2020

European Journal of Endocrinology

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Context Altered tissue-specific glucocorticoid metabolism has been described in uncomplicated obesity and type 2 diabetes. We hypothesized that weight loss induced by diet and exercise, which has previously been shown to reverse abnormal cortisol metabolism in uncomplicated obesity, also normalizes cortisol metabolism in patients with type 2 diabetes. Objective Test the effects of a diet intervention with added exercise on glucocorticoid metabolism. Design Two groups followed a Paleolithic diet (PD) for 12 weeks with added 180 min of structured aerobic and resistance exercise per week in one randomized group (PDEX). Setting Umeå University Hospital. Participants Men and women with type 2 diabetes treated with lifestyle modification ± metformin were included. Twenty-eight participants (PD, n = 15; PDEX, n = 13) completed measurements of glucocorticoid metabolism. Main outcome measures Changes in glucocorticoid metabolite levels in 24-h urine samples, expression of HSD11B1 mRNA in s.c. adipose tissue and conversion of orally administered cortisone to cortisol measured in plasma. Body composition and insulin sensitivity were measured using a hyperinsulinemic-euglycemic clamp, and liver fat was measured by magnetic resonance spectroscopy. Results Both groups lost weight and improved insulin sensitivity. Conversion of orally taken cortisone to plasma cortisol and the ratio of 5α-THF + 5β-THF/THE in urine increased in both groups. Conclusions These interventions caused weight loss and improved insulin sensitivity with concomitant increases in the conversion of cortisone to cortisol, which is an estimate of hepatic HSD11B1 activity. This suggests that dysregulation of liver glucocorticoid metabolism in these patients is a consequence rather than a cause of metabolic dysfunction.

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“…Mediterranean diet is one example that is in agreement with these requirements . In addition to that, Palaeolithic diet, which was shown to improve fat mass, insulin sensitivity, and HbA1c in patients with T2DM, adds more restriction to legumes, dairy products, and grains . Carbohydrate restriction is one of the dietary approach that does not in line with the American Diabetes Association's recommendation.…”

Section: Introductionmentioning

confidence: 99%

Effect of low‐carbohydrate diet on markers of renal function in patients with type 2 diabetes: A meta‐analysis

Suyoto

2018

Diabetes Metabolism Res

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Meta-analysis was conducted to clarify the effect of low-carbohydrate diet (LCD) on renal function in patients with type 2 diabetes. An extensive literature search was conducted on scientific databases including PubMed, Scopus, and Cochrane Library until September 2017. Only controlled trials on human subjects written in English were included in this meta-analysis. Several markers of renal function were compared between subjects who adopted an LCD or control diet, including estimated glomerular filtration rate, creatinine clearance, urinary albumin, serum creatinine, and serum uric acid. Random effect model was used in the analysis of each marker. In this meta-analysis, 12 controlled trials were selected, which involved 942 participants (500 received LCD and 442 received a control diet). The pooled standardized mean difference (SMD) of estimated glomerular filtration rate from LCD vs control diet was not different (pooled SMD: 0.26; 95% CI, -0.03 to 0.55; P = .08). Investigation on creatinine clearance also showed no significant difference (pooled SMD: 0.51; 95% CI, -0.38 to 1.40; P = .26). Other comparisons from urinary albumin (pooled SMD: -0.04; 95% CI, -0.75 to 0.67; P = .90), serum creatinine (pooled SMD: -0.57; 95% CI, -1.51 to 0.38; P = .24), and serum uric acid (pooled SMD: -0.86; 95% CI, -4.00 to 2.28; P = .59) also showed no significant difference in the results. In the present meta-analysis, no effect on markers of renal function was found after provision of a LCD compared with a control diet in patients with type 2 diabetes.

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Benefits 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

Abstract: Background Means to reduce future risk for cardiovascular disease in subjects with type 2 diabetes are urgently needed.

Cited by 122 publications

References 49 publications

A heterogeneous response of liver and skeletal muscle fat to the combination of a Paleolithic diet and exercise in obese individuals with type 2 diabetes: a randomised controlled trial

A heterogeneous response of liver and skeletal muscle fat to the combination of a Paleolithic diet and exercise in obese individuals with type 2 diabetes: a randomised controlled trial

Diet-induced weight loss alters hepatic glucocorticoid metabolism in type 2 diabetes mellitus

Effect of low‐carbohydrate diet on markers of renal function in patients with type 2 diabetes: A meta‐analysis

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