title: Palaeolithic diet decreases fasting plasma leptin concentrations more than a diabetes diet in patients with type 2 diabetes: a randomised cross-over trial.
abstract: BACKGROUND
  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 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.
  
  
  METHODS
  In 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/m(2); 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.
  
  
  RESULTS
  Seven 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.
  
  
  CONCLUSIONS
  Over 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.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00435240.
authors.affiliation: Clinical Research Centre, Faculty of Medicine, Center for Primary Health Care Research, Lund University, Malmö, Sweden. maelan.fontes_villalba@med.lu.se.|, Calle José Betancort, 15, 35530, Teguise-Lanzarote, Spain. maelan.fontes_villalba@med.lu.se.
authors.forename: Maelán
authors.initials: M
authors.lastname: Fontes-Villalba
authors.affiliation: Clinical Research Centre, Faculty of Medicine, Center for Primary Health Care Research, Lund University, Malmö, Sweden.
authors.forename: Staffan
authors.initials: S
authors.lastname: Lindeberg
authors.affiliation: Department of Food Technology, Engineering and Nutrition, Lund University, Lund, Sweden.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Granfeldt
authors.affiliation: Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
authors.forename: Filip K
authors.initials: FK
authors.lastname: Knop
authors.affiliation: Clinical Research Centre, Faculty of Medicine, Center for Primary Health Care Research, Lund University, Malmö, Sweden.
authors.forename: Ashfaque A
authors.initials: AA
authors.lastname: Memon
authors.affiliation: Clinical Research Centre, Faculty of Medicine, Center for Primary Health Care Research, Lund University, Malmö, Sweden.
authors.forename: Pedro
authors.initials: P
authors.lastname: Carrera-Bastos
authors.affiliation: NutriScience-Education and Consulting, Lda, Lisbon, Portugal.
authors.forename: Óscar
authors.initials: Ó
authors.lastname: Picazo
authors.affiliation: Independent researcher, London, UK.
authors.forename: Madhvi
authors.initials: M
authors.lastname: Chanrai
authors.affiliation: Clinical Research Centre, Faculty of Medicine, Center for Primary Health Care Research, Lund University, Malmö, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Sunquist
authors.affiliation: Clinical Research Centre, Faculty of Medicine, Center for Primary Health Care Research, Lund University, Malmö, Sweden.
authors.forename: Kristina
authors.initials: K
authors.lastname: Sundquist
authors.affiliation: Clinical Research Centre, Faculty of Medicine, Center for Primary Health Care Research, Lund University, Malmö, Sweden.
authors.forename: Tommy
authors.initials: T
authors.lastname: Jönsson
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D001835:Body Weight / Q000502:physiology; D002096:C-Peptide / Q000097:blood; D018592:Cross-Over Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000178:diet therapy*; D004032:Diet; D005215:Fasting; D005260:Female; D005749:Gastric Inhibitory Polypeptide / Q000097:blood; D005934:Glucagon / Q000097:blood; D006801:Humans; D007328:Insulin / Q000097:blood; D020738:Leptin / Q000097:blood*; D008297:Male; D008875:Middle Aged
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D007328:Insulin; D020738:Leptin; D005749:Gastric Inhibitory Polypeptide; D005934:Glucagon
keywords: Adiposopathy; Evolution; Glucagon; Leptin; Lipotoxicity; Palaeolithic diet; Type 2 diabetes