The Paleo Diet
Imagine a time before, cars, supermarkets, agriculture, heck, before houses existed. You’d spend the day roaming the planes of the land or the coast of the seaside in the endless pursuit to find food for yourself and your tribe. You’d gather anything edible you could find from plants and trees. This meant a lot of nuts, seeds, fruits and root vegetables. You’d also hunt and likely set traps for smaller animals to benefit from their nutrient rich meat. This approach was likely more frustrating but at least it was safe.
Every so often you’d score a big win and either scavenge or hunt bigger game for its meat or their eggs. A slightly more risky endeavour but the reward outweighed the risk.
If by the coast, you’d go fishing and reap the rewards oily and non oily fish offered. As time went by you’d get more and more big wins as hunting techniques advanced meaning a nutrient rich diet for you and your peers.
You had no where to call home. No fixed abode. You went where the climate and food took you. There was no breakfast, lunch and dinner. There was only eat and not eat.
This was the life of a hunter gatherer and one it can be argued our body’s evolved to endure.
The Palaeolithic diet or ‘paleo diet’, as it is more commonly known has grown tremendously in recent years. It’s a simple concept really. The diet rejects modern agricultural practices. It says we should eat like our ancestors prior to the agricultural revolution. This means following a diet similar to a hunter gatherer. This mainly relies upon, nuts, seeds, root vegetables, meat, fish and vegetables. This means foods like wheat, grains, bread, dairy, processed food, spreads and beans, pulses, lentils and other legumes are off the menu.
I’d say the paleo diet has outgrown what I’d call a diet. It has become more of a movement and a culture for some following it. One look through social media shows you countless people who identify themselves as ‘paleo’ in their profile. Much in the same way someone who is a vegetarian or vegan identifies themselves. Therefore, it’s an identity as much as it is a diet.
Though I’ve taken a break recently from writing I wanted to jump straight back in and write an article on whether the paleo diet is something you should be following.
A precursor to writing the article
I want to explain quickly how I and my colleagues judge diets. Health professionals use research to help inform our opinions. We do this by using evidence to prove or disprove concepts. Much in the same way a detective might build a case for a crime.
This isn’t always perfect and it certainly has it’s flaws. Yet a lot of what we know about health today comes directly from such evidence. For example, when you study smokers against non smokers you start to notice distinct health trends. Smoking increases cancer rates and declines lung function but this wasn’t always so obvious. We take this for granted now yet 100 years ago it was thought smoking was good for you. This was disproven by medical research. We replicate this in medicine and many other scientific endeavours.
When it comes to diet though we lose our way. Evidence is cherry picked to prove preconceived agendas. Highly biased literate is used and often the robust studies with hundreds of thousands of people are ignored.
You simply cannot do this. If you use medical research to prove one point you cannot ignore a larger and better designed study which suggests the opposite. Yet I see and hear this every single day.
So when I’m writing these blogs this is how I am approaching them. I’m not making this stuff up off the top of my head and I’m doing my due diligence. It’s not me just deciding which diet is good or bad. It is an informed opinion from thousands of nutritional studies over many years. I’m constantly weighing the good from the bad evidence and forming opinions. Not to mention 2 degrees on the subject and years of experience seeing patients every day.
Reasons to follow the paleo diet:
At the heart of it, I must admit, I quite like this concept. The rationale makes sense to me. Prior to having a supermarket on every corner, we only had limited options when it came to our diet. As opposed to other diets which live in the realms of pure pseudoscience I can see this approach has embraced a more common sense approach.
Like most diets a big plus point for paleo is it doesn’t allow junk food. No naughty treats or as keeping them as limited as possible. These foods obviously aren’t good for us and offer little nutritionally. Therefore, any diet that limits the intake of these foods will help your health, particularly in type 2 diabetes. Yet the paleo diet is not unique in this sense. No diet I’ve encountered is based around cake.
Paleo does not allow most starchy carbohydrates in the diet. This isn’t necessarily a good thing as I’ll discuss later. However, it does mean all processed refined starchy foods are avoided. Such foods have been shown to increase blood lipid levels, are associated with weight gain and are generally best substituted for wholegrain/wholemeal alternatives.
Some interpretations of the diet rely upon a large protein intake. Protein is known to be the most fulfilling macronutrient. This means high protein diets should keep you fuller for longer and more satisfied on the whole. If alongside this you take up resistance training protein will be utilised for building muscle. Muscle works like a furnace for the body because it is very metabolically active i.e. it burns up calories. Therefore, you will burn more calories each day if you have more muscle. It is for this reason many personal trainers and fitness plans rely on resistance training to build the furnace. However, there is much more to this concept than I can discuss here.
There is some thought in the medical evidence the inclusion of meat and fish helped fuel the development of our brain. This helped separate us from our ape compatriots. These nutrient dense protein foods helped us evolve into the intelligent species we our today.
It is theorised our ancestors had tremendous fibre intakes. The paleo diet can have very high fibre intakes too. Currently UK guidelines advise people to eat a minimum of 30g of fibre per day but we are way off that as a nation. During palaeolithic times fibre intakes were suspected to be as high as 100g per day. Fibre is good for us. There is a large body of evidence to support this. High fibre intakes are associated with less chance of developing type 2 diabetes. From an evolutionary perspective this makes sense. We evolve behaviours that benefit us. Therefore, our bodies benefiting from eating fibre is likely no coincidence. In other words we have evolved gastrointestinal traits to help extract appropriate nutrition from such foods. This anecdotally supports the paleo way of eating.
The closest we can come to studying Palaeolithic people is through modern tribal communities. Modern tribal communities develop much smaller rates of lifestyle diseases such as type 2 diabetes. Tribal people seem to live shorter lives on average but a greater proportion of this is spent in better health. If they had access to modern medicine it would be interesting to study their duration of life.
Reasons not to follow the paleo diet:
Most animals in the wild endure much hardship. Therefore, a diet prior to agriculture does not necessarily mean a healthy one. People could have been chronically malnourished in certain aspects.
Skeletal records easily show we are now bigger than our ancestors. Genetically we are exactly the same though. This indicates the difference is very likely nutritional. Therefore, we can see there may be advantages to how we eat today. Our diets appear more nutritionally complete. Modern nutrition may not be as unhealthy as we think if done correctly.
Debate remains over what the paleo diet actually looked like. Some think it was primarily a carnivore diet placing humans akin to big cats and meat eaters. However, the archaeological evidence strongly suggests we ate various diets. In fact, the idea we ate low carbohydrate diets are strongly challenged by living examples and fossil records. In reality we ate a variety of diets depending on the climate, land and availability of food.
One look at our anatomy also raises questions about this. When you compare us with other meat eating animals we are comparatively weak and slow. Prime for being eaten ourselves actually. Our teeth appear more suited to crushing plants rather than tearing chunks out of flesh. Our jaws are small and narrow. Again more likely suited to eating plants. Our ancestral lineage comes from the ape family, who are omnivores or plant eaters.
There’s no doubt meat and fish made up a component of our diet and as we became more advanced in our hunting methods I’m sure meat and fish featured more regularly. However, it is not proven the diet was entirely meat or fished based
Tribal communities of today may have lower rates of lifestyle related diseases. Don’t forget though, these communities do not have access to highly processed sugary and fatty foods. Cavemen weren’t fighting the temptation for a Saturday evening pick and mix. They also did not have to contend with things like alcohol, smoking, pollution and stressful jobs. Direct comparisons are therefore difficult to make. It seems today we live longer but in worse health. However, this isn’t unique to only caveman times. Obesity and lifestyle related diseases have only reached epidemic levels in the past 50-100 years. This appears to be down to westernisation, technology and reduced physical activity rather than agricultural practices. Dietary guidelines have never recommended eating processed food. Yet these foods make up a huge proportion of western diets. No wonder then, type 2 diabetes, CVD amongst many other diseases are on the increase.
One concept that escapes people is a diet is there to suit your purpose. For example, a marathon runner may rely upon an increased carbohydrate intake. A body builder will eat much more protein compared to the average Joe. Eating for health differs from eating specifically for weight loss. Palaeolithic humans did not have organised sports or gyms and so their diet was purely for survival. Eat what you can. To then extrapolate this diet to modern living may not be an ideal fit. Just because we found ways of mass producing food it doesn’t mean it is all unhealthy.
I suppose it’s like comparing chalk and cheese to some extent. Our ancestors had to exercise in order to find food and shelter. They had to eat what nature provided. Their whole set up was geared to living this way. By comparison we’re the first generation who need to actively exercise. We live in a remarkably obesegenic environment. So though I agree the concept is a nice one, I imagine it’s not for everyone.
Type 2 Diabetes Specific
The paleo diet is actually quite a low carbohydrate diet. If you’re able to stick to it your glucose control will likely improve. I also suspect if you haven’t been engaging with what you eat prior to starting the diet, you’ll also lose weight and reduce your blood lipids.
In this case, yes, it’s a good diet to follow. However, it isn’t the only diet that will yield results. I guess my take on it is I’m all for anything that helps people live healthier as long as it’s not positioned as the miracle cure – which many diets are.
Type 1 diabetes specific
There’s no evidence to suggest any diet helps improve type 1 outcomes. If you’re more engaged with your diet it should make it easier to carbohydrate count and manage your insulin. Also following a lower carbohydrate diet may reduce the margin of error when counting carbohydrates. That said, a low carbohydrate diet may leave you prone to hypo’s and therefore I’d always recommend speaking with your healthcare team and adjusting your insulin accordingly.
Lack of dairy
The paleo diet excludes dairy foods. Now this is a tricky one. I tried looking at populations where they typically have a low dairy intakes but couldn’t find much data. It would appear our ancestors did not consume dairy foods other than breast milk in infancy.
The need for milk to enhance skeletal development in childhood is well established. I suspect children remained breast fed for longer in palaeolithic times but I am speculating. So logically an argument could be made that if dairy did not feature in our diet for thousands of years why do we suddenly need it now?
I must admit, I didn’t know the answer to this argument. They have a point. So I took a look through the dietary literature. I looked at about 30-40 publications and every article except one found a beneficial effect on dairy consumption and bone mineral density in children and adults. This is a primary marker of bone health. Patients with osteoporosis have a low bone mineral density and are more prone to breaks and fractures. Despite this fact, the evidence for a reduction in fracture risk with increased dairy consumption has yet been established. However, it doesn’t seem a huge leap to connect the dots.
Therefore, if beneficial to bone health as it seems dairy foods are, a counter argument could be made that introducing dairy food has been a beneficial innovation. As a result, the exclusion of dairy foods, as seen in the paleo diet, may impact bone health across the lifespan. I suspect this topic is multifactorial. We know people develop weakened bones, particularly into older age but a causal link has yet to be pinpointed as there are many factors.
For now I think I will continue to recommend dairy foods as a good source of calcium because it is. However, if my patient doesn’t want to eat dairy, there are other foods which can provide calcium but in lesser quantities such as boney fish and leafy greens.
Evidence from modern day tribal communities shows they are healthier people with lower body weights on average. Evidence also suggests our ancestors could and did live into older age with archaeological findings supporting this. Therefore, we know these people were healthy.
Obesity was rare amongst hunter gatherers. However, supporters of the diet forget obesity was also rare in communities in periods after the agricultural revolution. Obesity appears to be very much a modern problem. Likely due to less physical activity and open access to both healthy and high calorie food 24/7.
As mentioned, the paleo diet doesn’t contain any processed food, refined sugar or alcohol. This is a great thing about the diet in it’s own little way because it doesn’t allow people to give in to temptation. On other hand, many people lose weight and get healthy following other approaches allowing a bit of what you like. I suppose this point is down to personal choice and what works for you.
As I said earlier though, no diet to my mind is based around cake. Therefore, the paleo diet is not unique in helping people lose weight. All diets work if you can stick to them.
As far as diets go I like this concept. Though, it’s not something I follow because for me it is too restrictive. I like a dash of milk in tea and a well portioned amount of carbohydrate on my plate. Though the concept is nice I can’t help thinking this diet unnecessarily limits your nutritional options.
There is a load of evidence to demonstrate wholegrains, diary, beans, pulses and lentils all have a beneficial effect on health. I agree the highly processed foods like white carbs, sugar and biscuits and cakes are not good for us. These should be minimised but this shouldn’t be extrapolated to all agricultural harvested foods.
Until the last 50-100 years there wasn’t an obesity problem per se. This means out of the estimated 250,000 years homo sapiens have been alive 249,900 have not experienced the same problem with health care we see today. I’m sure they had their own issues like infection, malnutrition, starvation but obesity and lifestyle related diseases amongst the masses were not major issues. Lifestyle related diseases therefore are not a result of agriculture, which happened around 10,000 years ago, but of modern life.
I think in conclusion, the paleo diet could help you with your weight, type 2 diabetes and many other health considerations. I don’t think this is paleo specific and if you started watching and engaging with what you eat you’d yield similar results. This has been shown over and over again in medical studies and in my own practice.
So i’ll leave it to you to make up your mind on this one and I hope this article has been useful.
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