Paleo-induced mineral periostitis (PiMP) is a recently recognized disease attributed to the so-called “paleo diet”. It most frequently involves the metacarpals and phalanges producing perpendicular periosteal projections (“spines”), an appearance that has lead to the alternative name of “cactus disease”. In severe cases the spines can tent the skin and present clinically, although the majority of cases are only detected radiographically after patients complain of hand pain, particularly when squeezing fruits (e.g. crushing goji berries).

Proponents of the paleo diet continue to deny that it causes PiMP, however a strong temporal association and correlation between length of diet and disease severity have proved scientifically robust; 2016 Cochrane Library metareview. Supportive archeological evidence from paleolithic human populations also exists including cave paintings in Argentina showing cactus hands 12,000 years ago (pictured above).

The European Society for Hand Models recently listed the paleo diet as a category 5 risk (alongside wood work, wicket keeping and thumb wrestling) after founding member Spike E. Hanzenfeat announced that his once "really really, ridiculously good looking hands" had been "internally shashlicked" within seven months of commencing the diet. A Broadway adaptation of his story entitled "The Stuff Fools Swallow" is expected in late 2017.

Know Your Risk
Individuals concerned about their dietary risk for cactus disease are advised to complete the PiMP online screening tool.