He Said, She Said: The Paleo Diet

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Even if you have not tried to “go Paleo” yourself, you at least know someone who has.  Running neck and neck with gluten-free, the Paleo Diet seems to be one of the most popular diets these days.

The idea is to eat how some of our ancestors supposedly ate: inclusion of meat and seafood, fruits, vegetables, eggs, nuts, seeds, and some oils, and exclusion of grains, legumes, dairy, potatoes, refined sugar, salt, certain oils deemed unhealthy, and anything processed.

Should you go Paleo?  Here is what we think.

He Said

Last month while I was at a wedding, I asked a child psychiatrist seated next to me if any experiences from her own childhood inspired her choice of profession.  She smiled, leaned in, and asked me, “Oh, Jonah, do you have a week?”  Both the scope and depth of the topic were much too large to cover in the few minutes before the bride was due to walk down the aisle.  Similarly, how can I possibly do justice to all of my concerns with the Paleo Diet in this small space?  I can’t, so here are just a few of them.

  • No Legumes: Legumes are a staple of the Mediterranean diet, which has been shown in research to reduce the risk of strokes, heart attacks, and cardiovascular disease deaths.  One such study published this summer in the New England Journal of Medicine found the Mediterranean diet’s benefits to be so significant that the study was stopped early because it would have been unethical to delay publishing the findings.  Legumes are a great source of cost-effective and environmentally-friendly lean protein.  Their fiber keeps us satiated, regulates our bowel function, stabilizes our blood sugar, and lowers our cholesterol.
  • No Dairy: One can live perfectly fine without dairy, and many people around the world do just that.  We can get dairy’s nutrients, including calcium and vitamin D, from other sources.  However, anytime we cut out a food group, we have to pay that much more attention to making up for the nutrients it provides, or else we face the possibility of deficiencies.  Such deficiencies are real and do happen, even in our community.  A doctor recently referred an otherwise healthy young athlete to me because it took the woman nearly a year to heal from a simple fracture.  Her body was so deficient in nutrients after going gluten-free and dairy-free that her body was unable to heal itself until the deficiency was corrected.  When we include a wide variety of food groups, such deficiencies are less likely to occur, and we do not need to pay such close attention to the minutiae of our day-to-day eating.
  • Saturated Fat: The Paleo Diet is not necessarily high in saturated fat, as one could choose fat sources that are higher in polyunsaturated and monounsaturated fats, such as fish, nuts, seeds, and certain oils.  However, the potential for excess saturated fat exists if one overconsumes red meat or coconut oil.  One point that really bothers me though is the Paleo Diet’s notion that saturated fat is not actually detrimental to our health.  As I explained in one of my blog entries, it could come to pass that saturated fat is found not to be the concern that we currently think it is, but as of now, the overall body of research does not support that conclusion.  Experts around the world (literally) agree that we should keep our saturated fat intake low in order to protect our cardiovascular health.  To expose our bodies to high levels of saturated fat while banking on the hope that doing so is not detrimental to our health is to take a heck of a risk with our cardiovascular health.
  • Environmental Impact: Even if we were best off consuming animals as our only significant protein source, the planet cannot sustain it.  The United Nations tells us that we as a global society need to move towards a more plant-based dietary pattern for environmental reasons.  Recently, one of my colleagues attended a lecture given by a pro-Paleo author, and she asked him about the environmental impact of the diet.  “Not my problem,” was reportedly his answer.  But it is his problem.  It is all of our problem.  If the earth cannot handle its inhabitants eating a certain way, we have to adjust our ways.
  • Sustainability: As with any diet, the results are only as good as the changes are sustainable.  There are thousands of life events that can bring a diet to its end: the diet worked great, but then the holidays came around, or I started a new job, or someone brought leftover Halloween candy into the office, or I got sick, or I went on vacation, or I didn’t have the willpower to keep it up, and so on.  For reasons I can only hypothesize, when a diet is working, people praise the diet, but when the diet stops working, people blame themselves or some exterior event.  For a nutritional approach to be successful, it has to work for the long term, not just at first, and it has to be flexible enough to weather the challenges that life brings our way.  Ask yourself honestly whether the Paleo Diet meets these criteria.
  • Accuracy: According to archaeologists, the Paleo Diet does not even accurately reflect how our ancestors ate.  Not only did the diets of paleolithic man vary greatly depending on geography and season, but archaeologists also have evidence that their diets did include legumes and grains, two food groups excluded from the Paleo Diet.  Furthermore, virtually all (if not literally all) of our food supply has changed with agriculture, so our blueberries, carrots, lettuce, tomatoes, and bananas, for examples, barely resemble those that our ancestors ate.

Realize that people are much more likely to be vocal about their dietary successes than their disappointments.  For example, if a given diet works for 5% (which is actually a pretty typical success rate for most diets) of the 10,000 people who try it, 9,500 disappointed people will stay relatively silent about their experiences while 500 individuals rave about it online, at the gym, in the grocery store, at the office, over Thanksgiving dinner, etc.   Therefore, the impression we get of a given diet’s success is skewed and not reflective of reality.  If you have gone Paleo yourself and you feel great, it works in your life, and you are enjoying it, great, more power to you.  For most people though, the Paleo Diet is much too strict to integrate with their lifestyles in any sort of sustainable way. 

She Said

While the Paleo Diet might seem to be a relatively new eating style to many people, it has actually been around in one form or another for almost 40 years.  In 1975, a gastroenterologist named Walter L. Voegtlin published The Stone Age Diet: Based on In-Depth Studies of Human Ecology and the Diet of Man, in which he suggested that following a diet similar to that of our caveman ancestors from the Paleolithic Era would improve one’s health.  The diet, which consists of a higher protein, fiber, and fat intake and a lower carbohydrate intake, is said to minimize one’s risk of chronic disease as well as result in weight loss.

The diet recommends a high intake of fruits and vegetables, which in addition to supplying a plethora of vitamins and minerals, also provides fiber (which helps with GI function and blood sugar levels) and antioxidants (which help fight the trouble-causing free radicals that try to wreak havoc on our cells).  Fruits and veggies are also an excellent source of potassium, which helps regulate blood pressure.

There is some evidence that a Paleolithic diet can be beneficial for those with type 2 diabetes at risk for cardiovascular disease.  A 2009 study compared the Paleo Diet and the diabetes diet to see which was more successful at managing patients’ blood sugar, weight, cholesterol levels and other health factors.  Overall, the patients that followed the Paleo Diet for 3 months had better blood sugar management levels, increased levels of “good” HDL cholesterol, lower blood pressure measurements, and greater weight loss than those who followed the diabetes diet.  After looking at the patients’ food recalls, the investigators found that the patients who followed the Paleo Diet had a higher intake of fruits, vegetables, meat and eggs compared to the patients who followed the diabetes diet.  In addition, the Paleo group took in fewer total calories, carbohydrates, and saturated fat while having a higher intake of unsaturated fat and several vitamins than the diabetes diet group.  All of these results point to the Paleo Diet being a viable option for those looking to better control their type 2 diabetes and manage cardiovascular risk factors.

I am a fan of decreasing one’s intake of processed foods in general.  These foods are often made with large amounts of sugar and sodium, and some even contain trans fats to improve the food’s taste and/or make it more shelf-stable.  According to the Academy of Nutrition and Dietetics, about three-quarters of our sodium intake comes from processed foods.  High sodium intake is linked with high blood pressure, which is associated with a higher risk for stroke and heart attack.  Aside from increasing our calorie intake and possibly leading to weight gain, high sugar intake has been linked with the development of type 2 diabetes.  Trans fats, or manmade fats, raise our “bad” or LDL cholesterol while lowering our “good” or HDL cholesterol.

In general, I am not a fan of “diets,” that is, any eating plans that lay out a set of diet rules that one should follow in order to reach his or her health goals.  But, the Paleo Diet has some interesting principles and could be advantageous for certain individuals.