Pondering Paleo? Learn More Before Committing

The newest edition of the US News and World Report issue on diet ratings is out.  Let’s face it, most overweight people, including many with diabetes, never go to see a dietitian.  If their doctor recommends they lose weight, they often look to what’s the next best thing being touted. Armed with the notion that lower carbohydrate is better they may be drawn to the Paleo diet.

Now it was one of the losers in the US News’s “competition”; it received only two out of five stars in each of the categories: short-term weight loss, long-term weight loss, easy to follow, nutrition, safety, for diabetes and for heart health. The experts rating these diets didn’t think much of it.

Let’s take a closer look at the diet, using the sample menu below written on a Paleo aficionado’s website to review its benefits and drawbacks both as a diet for the control of diabetes and as a weight loss diet.

The Paleolithic era started about 2 million years ago and ended about 10,000 years ago.  This was before the dawn of agriculture; so a men living during that time were eating only fruits, vegetables, nuts, seeds, meat, fish and poultry.  You won’t find dairy, legumes or grains on the plan.  The digestive systems of these pre-historic humans were primed to thrived on this diet, because it’s all they had access to. And the menu looks appealing, doesn’t it?  You can imagine your appetite being stimulated by the great array of colors and flavors on your plate.

The menu illustrates some very positive things about the diet for people with diabetes. Processed foods are out.  Once you have eliminated processing, your sodium intake is slashed dramatically.  That’s a plus; the Dietary Guidelines for Americans recommend that people with diabetes limit their sodium intake to 1500mg a day.   With all the fruits and vegetables you eat, your consumption of the blood pressure friendly mineral potassium is way up.  Most Americans don’t get anywhere near the 4,700mg recommended. You will on Paleo.

Meats are a big part of the Paleo diet. Good news for carnivores, bad news for saturated fats.

Total carb is down, also; it is usually less than 25% of total calories. That means fewer blood glucose spikes.   Of course, you have to control how many fruits you eat at a particular time.  And the carbs you do eat are low glycemic index and high fiber.  People with diabetes may suffer from constipation due to the complication of neuropathy, so your chances of regular bathroom habits certainly may improve on the Paleo diet.

In terms of weight loss, if the calorie level is low enough (as with any diet), you will lose weight. The high fiber and low glycemic index attributes of the diet may also contribute to a lower calorie intake.  However, if you eat enough high-fat, high-calorie red meat sources you could actually gain weight.

So what are the caveats?  Since grains and dairy are missing, the diet is deficient in calcium and may be deficient in B vitamins. Unless you watch your portions and choose only lean meats it can be very high in fat and saturated fat.  High fat meals can lead to insulin resistance, whether you have type 1 or type 2 diabetes, increasing the amount of medication you may need for a meal.  Saturated fat has been implicated in the development of heart disease.

Aside from the nutrient issues, it falls short in practicality. This isn’t an easy diet to follow in our society.  To make it as nutritionally complete as possible requires both a significant amount of planning and cooking.  If you need dinner on the table at six and you don’t want steamed broccoli, strawberries and a piece of plain broiled fish, you have to do some work.  It may also be expensive; you get almost all of your protein from meat, a high-ticket item in most grocery stores.

There are certainly better diets out there, but if you are going to follow this one, do yourself a favor, take a calcium supplement and meet with a registered dietitian who is also a certified diabetes educator  to make sure it is nutritionally complete, isn’t raising your lipids and doesn’t cause you any low blood glucose incidences.

To make an appointment with a Joslin dietitian visit us online or call (617) 732-2440

If you’re interested in finding out what the diet is like, go paleo for a day

Roasted Pepper & Sausage Omelet
1/2 cup sweet potatoes sautéed in coconut oil

4 oz. Cilantro Turkey Burger & 1/2 Avocado
2 cups spinach
1 cup cantaloupe

2 oz. homemade beef jerky
10 strawberries
1/2 cup blueberries

4 oz. Chez Lorraine’s Baked Salmon
1 cup Cauliflower Rice
1 1/2 cups steamed broccoli

Carrot Banana Muffin


  1. There have only been a few clinical trials of the paleo diet in people with diabetes. Lynda Frasetto and colleagues at the University of California San Francisco should have one published later this year.

    Regarding total and saturated fats as a cause of heart disease, I tend to doubt it. In 2009 I spent 80 hours reviewing the science behind the traditional diet-heart hypothesis, and didn’t find much to support it. I think I’ve got all the studies that speak against the diet-heart hypothesis (i.e., total and saturated fat cause atherosclerosis) listed here:


    • Dear Dr. Parker,
      I am so pleased the blog generated a bevy of comments. I really enjoyed reading your respone. The preponderance of studies including the Framingham Heart Study indicates that a high intake of saturated fat in suspectible individuals is a marker for high cholesterol levels. and high cholesterol levels is one marker (certainly not the only one) for heart disease risk. Whether the effects of saturated fat are adequately mitigated by a diet sufficiently high in fruits and vegetables and low in high glycemic carbohydrates is an interesting point. However most Americans do not eat this type of diet and a reduction of saturated fat in the context of current eating habits has been shown to lower cholesterol levels.

  2. This is a great article although I think that it is being advertised as more difficult than it actually is. I am a type 1 diabetic, college student, and i’m making it work. Since I began eating paleo my blood sugar levels have been so much more controlled. I do not spike after meals anymore. I would recommend paleo to any other diabetic because it has improved my quality of life drastically. I don’t quite understand the logic in this article behind having to take more insulin at each meal. I take LESS THAN HALF the insulin eating paleo than I did when eating conventionally and like I said my blood sugars are amazing. Hope this helps anyone interested in trying it out!

    • Dear Hannah,
      I am glad you liked the article. My comment on isulin had to do with increased needs for high fat independent of the carbohydrate content. The lower the carb content of the meal the less insulin you will use. But for the same amount of carb, regardless of how much that is, the higher the fat the more insulin is needed.

  3. Thank you for your approach in this article. I tend to expect articles to bash the paleo diet as opposed to taking the balanced approach that you did.

    I was introduced to “paleo eating” three years ago (2010) when my gym did a 60 day challenge. I became a type 2 diabetic in 1992. I was 23 years old and weighed 325 pounds. By the time 2010 came around, I was down to 210 pounds and had my blood sugar under good control through diet and Metformin (2000mg/day). 30 days into the challenge I was able to come off of Metformin completely, and have not looked back since. My A1C improved (I stay under 6). My endocrinologist says that she really doesn’t consider me a diabetic at this point, but to make sure I stay consistent and don’t slip back into old habits.

    I’m probably 85-90% paleo in my eating these days (I’m not a caveman after all!). This seems to work well for me. It’s not a prescription for everyone, but I’m convinced of it’s merits.

  4. In the mid 60’s I spent a week or so at Joslin. I’ve been a type 2 for 61 years, no meds ever for this condition. My A1c varies 5.6 – 6.1 and I follow an Atkins type diet. The glycemic index gives a useful guide for choosing carbs that are kind to a diabetic. I like fats, and take a daily gulp of cod liver oil for omega 3 balance. (My cholesterol is in the 170 range.)
    It has been outrageous that for 60 years or more starting in the 40’s trans fat loaded margarine was promoted by government agencies as “healthful” and coconut oil (and butter) demonized as “dangerous” when the opposite was the factual truth.

  5. The sample diet is not too paleo. Sausage and turkey burgers are highly processed foods. What’s the carrot banana muffin doing there?
    Lean meats are not so very expensive– a 8-12 oz of round steak cost what an individual pizza does. Meats do contain calcium… And as far as I understand it, there is nothing in the paleo diet that forbids vitamin supplements. I for one find that my digestive tract functions better without whole grains and gluten, or is this TMI?

  6. I just took some time to read this. Thanks all for an objective article and responses. People will try anything to lose wt fast fast. They are desperate to do something drastic that does not involve surgery. I am a registered dietitian and diabetes educator. I try to be opened minded. However I always go back to: moderation, portion control is the key. It works for me, for my clients, easy to remember….. and then others need a little extra help to stay motivated to practice moderation. Thanks again Joslin.

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