Paleo diet and stratospheric triglycerides

So, I'm diabetic. First diagnosed in 2002. Last June, my A1C was at 10.0.

I've done low-carb Paleo on and off for a few years, and I tried to get really serious with it recently. My A1C is now 8.5--- an improvement.

But my triglycerides are over 3000... yes, three-thousand.

My new doc is alarmed and worried about my risk of pancreatitis.

I've never had any problems with my blood pressure. Yesterday's office visit it was 106/64.

They drew blood during my visit, and the lab tech brought out my centrifuged blood and a "normal" sample to compare. My blood was like 30% white fat cells floating on top.

How do I do paleo in such a way that I manage type 2 diabetes, without getting fluffy fat flowing in my veins?

I know one friend who eats "paleo vegan ".
He is also controlling his sugars via diet. So his source of fats is primary nuts, with some avocados.

Other sources of good fats might be seafood or things like purslane.

Hello Kevin, I'm no expert, but I think you should find a paleo-friendly Registered Dietician and address what is the best diet for you. Then test and monitor those numbers down.

Are you testing your blood glucose daily+.

How much exercise do you get? *(cliche warning: "sitting is the new smoking")

In my 50's I've built up to walking (or bicycling) 6 miles a day to work. It feels good. A co-worker asked me if it's hard to walk home after a long 2nd shift in the ER. My answer is no, not anymore - it just feels like thinking. It clears my head and I observe things.

* I see omega 3 fish oil used for high triglycerides - maybe add more fish in diet.

Thanks for your responses.

Yes, as far as O-3 goes, I do include servings of small fish (sardines, mackerel) several times weekly, and I also eat high O-3 eggs. The doc wants to prescribe me this Rx fish oil supplement that is super-high in EPA/DHA, and is refined to remove toxins. I'm welcoming that intervention for the time-being.

As for exercise, I used to do a lot of walking, but not so much over this Winter. My wife and I live 1.6 miles from our respective work-places, and we can share our walk for about 1 mile of that. Now that the weather is improving in our area, we will be walking the 35 minutes to and from work 4 days per week. Plus, we like to get out of town and do some hiking on weekends for a more extended work-out. That's the plan, anyway!

I could never do vegan, or even vegetarian. I'll continue to eat the small fish (and occasional salmon). I do eat nuts and avocados, but I think I need to stop the bacon and large amounts of butter.

Keven, I was diagnosed as a diabetic in 2005 with an A1C that peaked at 7.9. I was on lots of diabetic meds for several years that got my A1C down into the high 6 range.

After a cardiac scare (ironically brought on by one of my diabetes meds) I tried a plant foods way of eating starting in 2011 that eliminated all animal products, primarily because of the saturated fats that are in them all. I also stopped eating anything with added refined oil of any kind as an ingredient. (I posted a bit more about my diet here if anybody is curious.) For reasons of weight control, I'm also careful with oil-rich plant foods like nuts and avocados, and try to eat them sparingly. I don't believe there is such a thing as "good fat" per se and if there is, there's enough of them in the whole grains and legumes that make up the bulk of my diet.

Eliminating all but a tiny fraction of the oils from my diet not only brought all of my lipids within the desired ranges, but it essentially cured my diabetes. When my A1C got to 5.0 in early 2013 and was still there three months later, I convinced my doctor to discontinue my last diabetes med. I'm still free of diabetes medication, and my A1C has stayed in a range from 5 to about 5.6.

My lipids numbers were never catastrophic like yours, but my triglycerides were pushing 300 before the plant foods. Now they hover between 150 and 170, although I do still take a statin which my doctor (but not me) credits more than the diet for my decent lipids numbers.

My conclusion from all of this has been that controlling dietary fats is the key to controlling diabetes and wayward lipids numbers. I don't know anything about paleo eating so perhaps William Bronson's "paleo vegan" friend is on to something that would work for you. But most regular vegans eat a ton of vegetable oils and highly-processed tofurkey stuff, so perhaps not, too. I just dunno.

I'm sorry I'm not knowledgeable enough about paleo eating requirements to assess whether what I've learned is useful in your situation. But since I've never personally met another diabetic who got off meds through diet, I feel like my experience of a working diet for doing that was worth mentioning anyway. Hope you find a solution that works for you!

Edited to add: This took a while to write and so I hadn't seen your most recent post when I posted this, Kevin. I see that my suggestions are even less helpful than I'd feared in your case. My apologies!

Dan, no worries... if it works for you, then do it... although I do question whether it's working for you to be on statins. The research is consistently coming back that statins are a "cure" that is worse than the disease these days. They recently linked statin drugs to Parkinson's.

While I'll never go vegetarian, I'm thinking that my Paleo dieting really should be more authentically paleolithic. Our paleo ancestors got 55-85% of their calories from gathered plant-based sources and the remainder from hunting/trapping, depending on seasons. Many also dried plant-based foods to survive through Winter.

I also don't care for raw foods, which is another craze. Evidence is that our Homo ancestors evolved from late hominid species, in part, through the development and use of fire to make foods more easily digestible. Raw foods do not sit well in my gut, causing acid indigestion, gas, bloating, and other discomforts. I'll steam my veggies at the very least.

I should do more crock-pot cooking. Soups and stews, with the bulk of the food being vegetable matter, and a bit of meat for flavor, sounds probably ideal. They say that high-water-content foods are the best, too.

Kevin EarthSoul wrote:Dan, no worries... if it works for you, then do it... although I do question whether it's working for you to be on statins. The research is consistently coming back that statins are a "cure" that is worse than the disease these days. They recently linked statin drugs to Parkinson's.

You're not the first to have said that. To avoid going too far off-topic, I'll just say that I don't intend for it to be permanent, and that it's an issue I'm paying careful attention to.

Kevin EarthSoul wrote:I should do more crock-pot cooking. Soups and stews, with the bulk of the food being vegetable matter, and a bit of meat for flavor, sounds probably ideal. They say that high-water-content foods are the best, too.

I always have a five-quart crock pot either cooking or in the fridge. Since I don't use meat for flavoring, I rely heavily on umami-rich ingredients like mushrooms (including a commercial mushroom powder from Taiwan and dried oyster mushrooms from my own trees) and soy sauce. I also use a lot of onions, garlic, and spices (and, increasingly as my gardening skills improve) dried herbage of various kinds.

Dan,your way of eating matches the recommendations from the"China Study"
My dad eats that way,and reading the book did change my own families consumption of dairy milk.

Hi Kevin,

Do you include fermented foods in your diet? Although raw, they are pre-digested by microorganisms and thus easier on the gut. Ferments have been around forever (even animals eat them) and they encourage good bacteria in your stomach that affects your whole body. There's lots of info on permies and online about it. My favorite diy site is Nourished Kitchen. Her Jalapeno sauerkraut and beet kvass are so tasty!

How many grams of carbs are you eating per day?

Kevin: If you are not familiar with this site, please check it out: MarksDailyApple.com. Click the "start here" tab at the top and be prepared to do some exploration. This site is "home base" for the Primal Blueprint, which is a version of Paleo, and incorporates lots of life-style stuff in addition to diet. I have had great results in my over all health picture following the advice found here, including lots of weight lost and improved blood profile (improved, but not "great")

The site has a very large user base, and the Forums are very active, lots of good information can be found there. I'm not sure if you can find anything that specifically addresses your Triglyceride issue, but there are a number of knowledgeable posters in the medical field who might give you some input.

Kevin,

This is likely due to some sort of genetic or familial issue. I hit all the 'perfect' ranges and at the time I was carrying around ghee for extra fat/calories.

Yep, it's a thing. Google: Familial hypertriglyceridemia

It will require some serious reading to figure out how bad it might be. They say it is bad for the pancreas, but what is the mechanism? Most of what is bad for the pancreas is carbohydrates and the resulting exhaustion from putting out massive doses of insulin all the time. Is there a mechanism via which triglycerides actually damage the pancreas directly? I know the pancreas has to come up with the enzymes for breaking down everything, so maybe you can give it a break with some lipase or pancreatin.

As far as changing your diet, well, you are a diabetic- the carbs will damage you for sure. I am less sure as to whether or not the fat will damage you. I suppose you could go a little leaner and eat a little more protein, but excess protein is turned into sugar, and really high protein will eventually cause it's own problems.

It would also be a good idea to get them to check how much insulin do you produce naturally. Your situation would make more sense if your pancreas wasn't producing any insulin. If that is the case, you aren't going to be able to solve it via diet alone. You'd have to take some insulin to give the body the signal to store that fat rather than let it hang out in the bloodstream.

Are you by chance overweight? AFAIK high triglycerides are typically caused by having excess body fat, which ultimately comes from a diet that is too high in carbohydrates as with diabetes. It's possible for fat intake to contribute to being overweight and/or having high triglycerides since it does have a high caloric value, although since it doesn't cause blood sugar spikes it doesn't have the same implications for diabetes as carbs do. Walking 35 minutes a day is probably not sufficient exercise in general. Fat burning only occurs after higher intensity aerobic workouts, such as running long distances or high intensity interval training.

Hi Kevin,

High triglyceride’s are generally caused from too high an intake of carbohydrates in your diet, although it could be other things too. If you are doing "paleo" then you should have really low triglyceride as paleo excludes all grains, potatoes etc and your carb intake would be mainly from green leafy vegg. It should be almost imposible to have your tri's so high from eating green leafy veg.

Can you write down what your typical meals look like in a day.

I work as a personal trainer and most of my clients are weight loss clients. 70% of weight loss is diet and so I have quite a bit of experience in this area.

Marc Troyka- You are right on the first part of your comment "high triglycerides are typically caused by having excess body fat, which ultimately comes from a diet that is too high in carbohydrates" but wrong about dietary fat being linked to high triglycerides due to excess calories.

Fat is stored as triglyceride’s, that is what body fat is, but fat that you eat travels through the blood as fatty acids. triglyceride’s are three fatty acid molecules combined with one glycerol molecule. A calorie isnt a calorie. your body react totally differently to say 1000 calories of carbs vs 1000 calories of fat vs 1000 calories of protein. eating mostly one or the other doesnt produce the same results, mainly because fat doesnt get turned into glucose and isnt readily stored as fat. infact your body will tell you when to stop eating fat (something that doesnt happen with carbs) and or upregulate your want to move and do exercise. i.e if you eat too much fat your body will make you move to burn off any extra calories. the opposite to eating mainly carbs.

Also, diet is much more important than exercise. If you are already quite overweight then it is doubtful that you will be able to make much(if any) of an impact on your weight if you don’t change your diet.

We have a saying in the PT world that says "you cant out train a bad diet" and its true, you cant. Especially if already overweight and out of shape.

Marc Troyka, what regulates if fat will be used as a fuel source or not (what most people call fat burning) is purely dependant on the release of insulin not exercise. That is why diabetics are generally overweight too.

When you eat carbs your body turns those carbs into glucose and then floods your blood with this glucose. glucose is toxic in high quantities so your body has to remove this glucose from your blood as fast as possible. It does this by excreting insulin which carries the glucose first to the muscles for storage, then to the liver. If both of these are "full" then your body stores the glucose as fat.

If you dont do much exercise and are sedentary then your glycogen levels in muscles and liver will generally be full meaning that all or most of the carbs that you eat will be stored immediately as fat. You can store anywhere up to 4000calories as glycogen in liver and muscles. If your body is dependant or "used" to using glucose(sugar/carbs) as a fuel source then it wont free up the fat you have stored untill you have almost depleted the 4000 calories of glycogen. good luck trying to do that with exercise if you are out of shape and overweight.

BUT if you go on a really low carb diet i.e a Ketogenic diet your body will shift from using glucose as its primary fuel source to using fatty acids (stored fat) and ketones as its main fuel source and will free up your body fat to be used as fuel.

your body will never use fat as a fuel source if you have insulin in your blood, as insulin is an indicator that there is glucose and glucose is toxic in certain quantities. So its very hard for diabetics to lose weight.

Here is some info on the ketogenic diet:
http://www.ketogenic-diet-resource.com/

The Paleo diet is a ketogenic diet when done properly.

give me a brief description of what you eat breakfast lunch and dinner and I can maybe see if your triglyceride are linked to that. could be other things though as well but normally high tri = high carb.

Hope that helps.

You only need to eat carbs (green veggies excluded) two maybe three times a week and if your overweight you dont actually need to eat carbs at all.

August Hurtel has given you some good info, the only thing I would ad is that fat shouldnt harm you. Eating higher fat will help you burn more fat. As August pointed out, you have to change the calories from carbs to calories from something and its cant be too much protein(too much being over 25% of calories) as your body can turn protein into glucose through gluconeogenesis.

Here is a great article for you to read up on about fat and how all the hype over low fat diets and the supposed link of fat and heart disease is little more than a myth.
http://chriskresser.com/the-diet-heart-myth-cholesterol-and-saturated-fat-are-not-the-enemy/

There is also a great book that explains all of this and is very interesting and easy to read:
http://garytaubes.com/works/books/why-we-get-fat/

he also has some great articles on his website.

very similar to paleo and ketogenic is eating under the guidelines of the wapf. Havent had a prescription in 3 years now guzzling grass fed raw milk, plowing down grass fed butter, coconut oil, olive oil, honey, pastured and game meats, organ meats properly prepared grains, organic fruits, sprouted nuts, whole food supplements, raw cheeses, and every conceivable organically grown vegetable, each having its own quirks for preparation including fermentation. Many of which involve smothering in butter. Also cod liver oil/high vitamin butter oil as a supplement. Ocean fish, sprouted/soaked beans, homemade broth, gelatin, quality yogurt, real iced cream, homebrewed and cultured beverages, smoothies. Holistic health care like chiro and acu when ill.

They have a stack of incredible cookbooks so the only reason for not eating well is lack of preparation and planning.

The list of modern American junk food I avoid is incredibly long, but once you see junk food for the empty impoverishing processed substance it is you end up with no interest in it. Velveeta margarine crispy crème donuts big macs pringles and mountain dew don't appeal to me, they are a bane and the sooner America wakes up and makes them go away the better off we all will be. This includes almost everything in the center aisles of a typical American grocery store (and even quite a few things on the perimeter). Also most of the dishes served at chain restaurants like fast food places.

Price, Pottenger and Lee were all brilliant doctors of nutrition and their work stands the test of time.

It has been four months since Kevin has posted. Perhaps we should send out a search party.