Palaeolithic diet-induced weight loss extends benefits to sleep apnoea in women

High adherence to the palaeolithic diet helps reduce sleep apnoea in menopausal women who are overweight, with the benefit linked to weight loss, according to a secondary analysis of a trial comparing a 2-year intervention of a palaeolithic diet with a low-fat control diet according to the Nordic Nutritional Recommendations.

The analysis included 70 healthy, nonsmoking women (mean age 60 years, mean body mass index [BMI] 33 kg/m²). Two years of palaeolithic diet intervention led to greater weight loss compared with the control diet (mean, 7.2 kg, 95 percent confidence interval [CI], 5.3–9.2 vs 3.9 kg, 95 percent CI, 1.9–5.9; p<0.021). [Int J Obesity 2022;46:1833-1839]

Weight loss translated to a reduction in the apnoea-hypopnoea index (AHI) in the palaeolithic diet group (p=0.034) but not in the control group (p=0.69). BMI changes also showed a significant correlation with AHI changes in the palaeolithic diet group only (p=0.03 and p=0.70).

After 2 years, AHI improved in women who lost weight by >8 kg, regardless of the diet group. About 40 percent of women in the palaeolithic diet group and 20 percent in the control group had lost >8 kg at follow-up.

The present data support “the finding that the more weight that is lost, the greater the reduction in the AHI found in previous trials,” according to the investigators. [BMJ 2009;339:b4609; Am J Respir Crit Care Med 2009;179:320-327; Arch Intern Med 2009;169:1619-1626; JAMA 2012;308:1142-1149]

Caveman diet

Palaeolithic diet typically includes meat, fish, eggs, fruits and vegetables, seeds, and nuts, along with healthy fats and oils. It is the modern interpretation of the diet that humans ate during the Palaeolithic or "Old Stone Age" era and centres on the idea that eating like them can promote good health. [Eur J Endocrinol 2019;180:417-427; Adv Nutr 2019;10:634-646; Obes Rev 2019;20:1132-1147]

How palaeolithic diet can help with weight loss and sleep apnoea may be related to the previously reported improvements in components of the metabolic syndrome, notably waist circumference and triglyceride levels, that the diet induces, with close relationships having been established between the metabolic syndrome and the AHI. [Am J Clin Nutr 2015;102:922-932; Sleep Med 2011;12:329-334]

“A palaeolithic diet can therefore be recommended to women who are overweight after menopause, with the understanding that it will only affect the severity of sleep apnoea if weight is reduced by more than 8 kg,” the investigators said.

However, they stressed that the diet had no effect on excessive daytime sleepiness, which is suggested as the most important symptom of sleep apnoea.

“It is … possible that daytime sleepiness in women with overweight after menopause is primarily due to factors other than sleep apnoea. This may explain why no effect was found between weight reduction and daytime sleepiness in the present trial,” the investigators explained.

“Further studies with large sample sizes are needed before a palaeolithic diet can be recommended to people with obstructive sleep apnoea,” they added.