Paleolithic Diet

Diet Series Paleolithic Diet Written by: Consultant Dietitian Current Western diets have led to the emergence of more chronic diseases, including obesity, cardiovascular disease, type 2 diabetes, and non-alcoholic fatty liver disease, which negatively affect life expectancy. These diets are characterized by high calorie intake, high fat content, high glycemic load, increased meat consumption, and elevated fructose intake [5]. There has been an increase in the consumption of processed products with added additives, such as preservatives, colorants, emulsifiers, and flavor enhancers, which are commonly used in the food industry [10]. The reason for adopting the Paleo diet stems from modern farming practices that are genetically incompatible with the human body [2]. Our ancestors were lean, fit, and generally free from heart disease and other ailments. Their genes were well-adapted to foods that were hunted, gathered, or fished from the natural environment, a diet that no longer exists as people began farming and raising domestic livestock after civilization. The Paleolithic diet, or Paleo diet, also known as the Caveman or Stone-Age diet, reflects the dietary practices of the Paleolithic era, which lasted from 2.5 million to 10,000 years B.C. This diet was based on wild food consumption, including meat, insects, green vegetables, roots, organ meats, seasonal fruits, and nuts [1, 5]. It became popular among those looking to improve their body shape by avoiding processed foods [3]. It is also widely practiced by athletes and young adults [3, 4]. So, what is included in the Paleo diet? The Paleo diet is low in carbohydrates (24.5%), high in protein (29.6%), and contains polyunsaturated fatty acids (15.3%) and cholesterol (835 mg/day) [1]. Paleolithic people did not consume dairy, as milking wild animals was not feasible. They also rarely ate cereal grains, avoided salting their food, and consumed refined sugar only in the form of honey. The diet is protein-rich due to the dominance of wild, lean animal foods, and lower in carbohydrates. Non-starchy wild fruits and vegetables were their primary carbohydrate sources, resulting in a higher fiber intake compared to modern diets [6]. To summarize the foods to include and avoid, refer to the table below. Allowed Not Allowed Lean red meat (sirloin steak, tenderloin) , game meats (venison, rabbit, wild boar) , organ meats (liver, kidney, heart from animals such as cows, chickens, or lambs) Grains (cereals = barley, corn, oats, rice, rye and wheat) Poultry Beans (soy milk, tofu) Fish, Seafood Legumes (edamame, hummus) Eggs Dairy products (milk, yogurt, cheese, ice cream) Leafy, cruciferous vegetables Salt Root vegetables Refined sugars (jam, syrup, candy, cakes, cookies) Mushrooms Refined fats Fruits Canned or processed meat Nuts (almonds, walnuts, cashews, pecans, pistachios) *no peanuts Fatty meats Raw honey Bacon Seeds (pumpkin, sunflower) Soda and fruit juices The Paleo diet is often followed for weight loss, diabetes management, and general health. Studies support its benefits, including improved glucose tolerance and significant weight loss. Lindeberg S, et al. (2007) compared Mediterranean and Paleo diets in heart disease patients, finding the Paleo group had better glucose removal and greater waist reduction (5.6 cm vs. 2.9 cm) [7]. Boers I, et al. (2014) noted its impact on lowering lipids, blood pressure, and weight, though long-term evidence remains limited due to short study durations and small samples [8]. The Paleo diet can have side effects, as it eliminates many carbohydrates and dairy products. Initially, your body might struggle to adjust from a high-carb to a low-carb diet, leading to symptoms like fatigue, irritability, or digestive discomfort. These effects may resolve within a few days but can last 2–4 weeks in more severe cases [11]. Headache Fatigue Lack of energy Nausea Dizziness Body aches Cold sweats Constipation and/or diarrhea Another downside of the Paleo diet is the exclusion of dairy products, which may result in a lack of calcium necessary for healthy bones and teeth. Vegetarians might find it challenging to follow since beans, a vital protein source, are restricted. Additionally, the diet’s restriction on grains, which provide insoluble fiber, raises questions about its impact on gut health. If you’re considering the Paleo diet or any other dietary approach, consult a registered dietitian nutritionist to ensure your choices meet your nutritional needs effectively. Reference List Cambeses-Franco C, González-García S, Feijoo G, Moreira MT. Is the Paleo diet safe for health and the environment? Sci Total Environ [Internet]. 2021;781(146717):146717. Available from: http://dx.doi.org/10.1016/j.scitotenv.2021.146717 Turner BL, Thompson AL. Beyond the Paleolithic prescription: incorporating diversity and flexibility in the study of human diet evolution. Nutrition reviews. 2013 Aug 1;71(8):501-10. Stanton R. Popular diets and over-the-counter dietary aids and their effectiveness in managing obesity. Managing and Preventing Obesity: Behavioural Factors and Dietary Interventions. Waltham, MA; 2014. Patel S, Suleria HA. Ethnic and paleolithic diet: Where do they stand in inflammation alleviation? A discussion. Journal of Ethnic Foods. 2017 Dec 1;4(4):236-41. Tarantino G, Citro V, Finelli C. Hype or reality: should patients with metabolic syndrome-related NAFLD be on the hunter-gatherer (Paleo) diet to decrease morbidity. J Gastrointestin Liver Dis. 2015 Sep 1;24(3):359-68. Cordain L. AARP The paleo diet revised: Lose weight and get healthy by eating the foods you were designed to eat. John Wiley & Sons; 2012 May 7. Lindeberg S, Jönsson T, Granfeldt Y, Borgstrand E, Soffman J, Sjöström K, et al. A Palaeolithic diet improves glucose tolerance more than a Mediterranean-like diet in individuals with ischaemic heart disease. Diabetologia [Internet]. 2007;50(9):1795–807. Available from: http://dx.doi.org/10.1007/s00125-007-0716-y Boers I, Muskiet FA, Berkelaar E, Schut E, Penders R, Hoenderdos K, et al. Favourable effects of consuming a Palaeolithic-type diet on characteristics of the metabolic syndrome: a randomized controlled pilot-study. Lipids Health Dis [Internet]. 2014;13(1):160. Available from: http://dx.doi.org/10.1186/1476-511X-13-160 Andrikopoulos S. The Paleo diet and diabetes. Med J Aust [Internet]. 2016 [cited 2022 Apr 1];205(4):151–2. Available from: https://www.mja.com.au/journal/2016/205/4/paleo-diet-and-diabetes Zopf Y, Reljic D, Dieterich W. Dietary effects on Microbiota-new trends with gluten-free or Paleo diet. Med Sci (Basel) [Internet]. 2018 [cited 2022 Apr 1];6(4):92. Available from: https://www.mdpi.com/2076-3271/6/4/92 Usman M, Davidson J. Paleo Diet – Side Effects. Mendon Cottage Books, editor. North Charleston, SC: Createspace Independent Publishing Platform; 2015.

Childhood Obesity

Let’s Talk About Childhood Obesity Written by: Apprentice Dietitian Chia Hui Ying Childhood obesity is one of the most pressing global challenges in the 21st century. In Malaysia, up to 30% of children are classified as overweight or obese. [1] According to the World Health Organization (WHO), obesity involves abnormal or excessive fat accumulation that increases health risks, including mortality. [2] Body Mass Index (BMI) is commonly used to classify weight status in children. Based on CDC growth charts, children at or above the 85th percentile are overweight, the 95th percentile obese, and the 99th percentile classified as having severe obesity. [3] Childhood obesity can be categorized as exogenous or endogenous. Exogenous obesity results from external factors, like an imbalance between energy intake and expenditure, while endogenous obesity arises from genetic, syndromic, or endocrine causes. [4] While genetics influence body fatness, environmental factors like diet and activity levels play a larger role. Modern diets often feature energy-dense, nutrient-poor foods, alongside reduced physical activity due to urbanization and sedentary habits. [2] Children who are overweight or obese are more likely to continue being overweight into adulthood, increasing their risk of developing non-communicable diseases like: Type 2 diabetes mellitus – Children as young as 8 years old might be at risk of getting type 2 diabetes mellitus. Children with obesity might consume high calories and sugar-rich foods, thus increasing T2DM risk. High blood pressure – As obesity becomes more severe, the risk of high blood pressure rises. Long-term high blood pressure puts stress on the heart. Liver diseases – Fatty liver disease (nonalcoholic steatohepatitis or NASH) is common among children with obesity and this can lead to liver failure. Heart diseases – Atherosclerosis (narrowing of blood vessels), is a common heart disease that people with obesity might suffer from. Childhood obesity and related non-communicable diseases are largely preventable. Prevention is widely recognized as the most practical approach to addressing the pediatric obesity crisis, as current treatments mainly manage symptoms rather than offer long-term solutions. Achieving and maintaining energy balance throughout life is key. To prevent childhood obesity, encourage healthy eating habits, promote physical activity, reduce sedentary behaviors, and foster a supportive environment that enables children to make healthier lifestyle choices. [1] Engaging in regular physical activity—at least an hour daily—helps children maintain a healthy weight, reduce obesity-related health risks, and strengthen their bones and muscles. Encourage a variety of enjoyable activities like team sports, swimming, yoga, biking, dance classes, or evening walks. A balanced fitness regimen should include stretching for flexibility and strength training for muscle growth. Outdoor activities, particularly for preschool-aged children, are highly beneficial for their physical and mental development. Encourage children to eat at least five servings of fruits and vegetables daily. Create appealing, colorful meals using ingredients like tomatoes, broccoli, corn, carrots, and green peas. Replace juices with fresh whole fruits such as oranges, starfruit, or watermelon. For picky eaters, incorporate vegetables into meals by blending them into meat patties or meatballs to ensure they receive essential nutrients. Reduce sedentary activities, such as watching videos, playing video games, or using the internet, to no more than two hours daily. Encourage simple habits like taking the stairs instead of elevators at malls or schools to increase physical activity levels. Parents should actively support and participate in their child’s activities. Set achievable goals based on the child’s interests and abilities. Track progress using a chart and celebrate milestones with positive reinforcement. Lead by example by making exercise a family activity to encourage healthy habits. Healthier Food Swaps Small, easy food swaps can significantly reduce sugar, salt, and fat intake for children. Even incorporating just one or two changes daily can lead to a healthier diet. The more adjustments made, the greater the benefits for overall health. Instead of Swap to Milk chocolate Dark chocolate Cordial drinks with added sugar Fresh fruit juices Sweetened / Flavored yogurt Natural yogurt with added fresh fruits Chips Nuts (almonds, walnuts) and seeds (sunflower seeds, pumpkin seeds) Fat cut of poultry / meat Lean cut of poultry / meat Reference List Childhood Obesity [Internet]. PORTAL MyHEALTH. 2013 [cited 2023 Jan 25]. Available from: http://www.myhealth.gov.my/en/childhood-obesity/ Noncommunicable diseases: Childhood overweight and obesity [Internet]. [cited 2023 Jan 25]. Available from: https://www.who.int/news-room/questions-and-answers/item/noncommunicable-diseases-childhood-overweight-and-obesity Calculate Your BMI – Standard BMI Calculator [Internet]. [cited 2023 Jan 25]. Available from: https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm Aggarwal B, Jain V. Obesity in Children: Definition, Etiology and Approach. Indian J Pediatr. 2018 Jun;85(6):463–71. Lee YS. Consequences of Childhood Obesity. 2009;38(1).

Kidney Stone Disease (Nephrolithiasis)

Let’s Talk About Kidney Stone Disease (Nephrolithiasis)​ Written by: Apprentice Dietitian Chang Chiao Wei What is a kidney stone? A kidney stone is a hard deposit formed in the kidneys when certain minerals, like calcium, oxalate, and uric acid, bind together and crystallize due to high concentration in the urine. These stones can vary in size, from tiny grains to larger stones that block the urinary tract, causing severe pain. Types and Prevalence Kidney stones are categorized into four main types: Calcium Oxalate & Calcium Phosphate (70-80%) – The most common type. Uric Acid Stones (10%) – Formed due to excessive uric acid. Struvite Stones (10%) – Linked to urinary tract infections (UTIs). Cystine Stones (<1%) – Caused by a genetic disorder. Historically, kidney stones were more common in men, but the gender gap is narrowing as more women are being diagnosed. Prevalence rates vary across regions, with 10-20% in Asia and 15-18% in Western countries. Signs and Symptoms Common symptoms include: Severe pain in the back, side, lower abdomen, or groin. Burning or painful urination. Cloudy, foul-smelling, pink, red, or brown-colored urine. Nausea, vomiting, fever, or chills (in severe cases). Small kidney stones may pass on their own, causing mild or no symptoms, but larger stones may block the urinary tract and require medical attention. Pain relievers or surgery may be necessary depending on the size and location of the stone. Dietary Management Diet plays a crucial role in preventing and managing kidney stones. Here’s a breakdown of essential nutrients and guidelines: Nutrient Recommended Intake Sodium Less than 2,300 mg/day Calcium 800 – 1200 mg/day Oxalate 40 – 50 mg/day Protein 0.8 – 1.4 g/kg of body weight Fluids More than 2.5 L/day Vitamin C Less than 1000 mg/day Dietary Tips for Prevention 1. Reduce Sodium Intake Limit salt intake to less than 1 teaspoon (6g) daily. Replace salt with herbs and spices (e.g., garlic, ginger, cumin, turmeric). Avoid high-sodium foods like canned foods, fast food, sausages, and processed meats. 2. Control Oxalate Intake Limit consumption of oxalate-rich foods like spinach, sweet potatoes, beetroot, rhubarb, nuts, chocolate, and soy. Pair oxalate-rich foods with calcium-rich foods (e.g., chocolate + milk or peanuts + yogurt) to reduce oxalate absorption. 3. Get Adequate Calcium Intake Contrary to popular belief, reducing calcium does not prevent kidney stones. In fact, adequate calcium intake helps bind oxalate in the intestines, preventing its absorption. Include both dairy (milk, cheese, yogurt) and non-dairy (chia seeds, kale, broccoli) sources of calcium in your diet. Choose calcium-rich foods with low sodium or added sugar. 4. Moderate Protein Intake Limit animal proteins (red meat, organ meat, seafood) as they increase uric acid production, making urine more acidic, which promotes kidney stone formation. Opt for plant-based proteins (lentils, beans, peas) to avoid acidic urine. 5. Increase Fluid Intake Aim to drink at least 2.5L of water daily to dilute urine and prevent stone formation. Add lemon juice to water as citric acid may prevent stone formation. Avoid sugary drinks and sodas. 6. Avoid Excessive Vitamin C High doses of vitamin C supplements can increase oxalate production, raising the risk of stones. It’s better to consume vitamin C from fruits and vegetables rather than high-dose supplements. Dietary Tips for Other Types of Kidney Stones Calcium Stones: Reduce sodium, oxalate, and excessive vitamin C; maintain adequate calcium intake, moderate protein, and sufficient hydration. Uric Acid Stones: Limit purine-rich foods (red meat, organ meat, seafood) and alcohol; stay hydrated. Struvite Stones: Typically caused by UTIs and require medical or surgical intervention. Cystine Stones: Caused by a genetic disorder and also require medical treatment. Take-Home Message Dietary changes, such as reducing sodium, controlling oxalate, and ensuring adequate hydration, can help prevent kidney stones. While dietary changes can manage calcium and uric acid stones, struvite and cystine stones may require medical treatment. Caring for kidney health is essential, as the kidneys play a vital role in filtering blood and removing waste. Reference List Han, H., Segal, A. M., Seifter, J. L., & Dwyer, J. T. (2015, July). Nutritional management of kidney stones (nephrolithiasis). Clinical nutrition research. Retrieved February 8, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4525130/   U.S. Department of Health and Human Services. (n.d.). Definition & Facts for Kidney Stones. National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved February 8, 2023, from https://www.niddk.nih.gov/health-information/urologic-diseases/kidney-stones/definition-facts Gillams, K., Juliebø-Jones, P., Juliebø, S. Ø., & Somani, B. K. (2021, October 8). Gender differences in kidney stone disease (KSD): Findings from a systematic review. Current urology reports. Retrieved February 8, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8497339/ Dottie. (2016, April 7). Urinary stones. PORTAL MyHEALTH. Retrieved February 8, 2023, from http://www.myhealth.gov.my/en/urinary-stones/  Kidney stones: Diet plan and prevention. National Kidney Foundation. (2022, November 4). Retrieved February 8, 2023, from https://www.kidney.org/atoz/content/diet#:~:text=To%20prevent%20uric%20acid%20stones,and%20low%2Dfat%20dairy%20products  Mitchell, T., Kumar, P., Reddy, T., Wood, K. D., Knight, J., Assimos, D. G., & Holmes, R. P. (2019, March 1). Dietary oxalate and Kidney Stone Formation. American journal of physiology. Renal physiology. Retrieved February 8, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6459305/  Diet and Kidney Stones – Queensland Health. (n.d.). Retrieved February 24, 2023, from https://www.health.qld.gov.au/__data/assets/pdf_file/0024/151863/renal_kdnystones.pdf   NHS. (n.d.). Prevention of Kidney Stones. NHS choices. Retrieved February 8, 2023, from https://www.nhs.uk/conditions/kidney-stones/prevention/#:~:text=The%20best%20way%20to%20prevent,throughout%20the%20day%2C%20every%20day.    Pearle MS;Goldfarb DS;Assimos DG;Curhan G;Denu-Ciocca CJ;Matlaga BR;Monga M;Penniston KL;Preminger GM;Turk TM;White JR; ; (n.d.). Medical Management of Kidney Stones: AUA guideline. The Journal of urology. Retrieved February 8, 2023, from https://pubmed.ncbi.nlm.nih.gov/24857648/  Gul, Z., & Monga, M. (2014, November 28). Medical and dietary therapy for Kidney Stone Prevention. Korean Journal of Urology. Retrieved February 8, 2023, from https://synapse.koreamed.org/articles/1006212