Integrative, functional and holistic medicine all consider good nutrition to be a foundational, if not the keystone, therapeutic modality that supports optimal health and well being. Generally, the dietary approach most touted is one that is plant based and composed largely of whole foods. Even when guided by these two fundamental principles it is still possible to be overwhelmed and confused by the variety of diets recommended by the experts, or self-proclaimed experts. Nearly everyone I engage with professionally wants to know what diet will support their health and longevity, improve energy, assist in weight loss/management, abolish chronic symptoms and/or eliminate disease. Is it vegan, vegetarian, flexitarian, pescartarian, Mediterranean, macrobiotic, raw, gluten-free, low carbohydrate, low fat, low acid, alkaline, calorie restricted, or some creative combination?
The diet I most frequently recommend, as an effective therapeutic tool, is one that I call a common sense, modified paleo elimination diet. It encompasses the basic tenets of a paleo diet: whole foods, abundant plants, healthy fats, lean proteins, and no grains, dairy, legumes or processed, refined carbohydrates, including sources of simple sugars. To be more specific, this diet encourages plenty of vegetables, a moderate intake of whole fruits, lean range fed meats, fish, eggs, nuts, seeds, nut/seed butters, and other healthy fats–such as olive oil, coconut oil, and avocado. Refined oils are not allowed. No legumes means no beans, peas, soy or peanuts; and yes, oats, rice and quinoa are included in the no grains prohibition. The diet does eliminate potatoes, but many advocates allow sweet potatoes. Salt should be greatly reduced. Finally–alcohol is a processed, refined carbohydrate and, therefore, should be used judiciously.
The paleo diet, or Paleolithic diet, was first introduced in the 1975 book, The Stone Age Diet, and later popularized by Loren Cordain, PhD in his 2002 book (revised and updated in 2011), The Paleo Diet. This is a lifestyle diet that has steadily gained in popularity. Unlike many popular diet books, this one morphed into a movement; and, like many movements, it has generated various adulterated interpretations and some confusion regarding the intent of the original design. Dr. Cordain’s area of research is evolutionary medicine. He bases his principles for this diet on the premise that our pre-agricultural (more than 10,000 years ago) ancestors did not have access to dairy (how do you milk a wild animal?); they rarely consumed grains–considered “starvation food at best”; they did not salt their food; there were no refined sugars, although honey might be a rare treat; the diet was high in protein obtained from wild, lean animal foods; most of the carbohydrates consumed were non-starchy wild fruits and vegetables, resulting in a high fiber intake; and fats in the diet consisted mainly of monounsaturated and polyunsaturated fats—including the omega 3 essential fatty acids. Other researchers contend that the paleo proponents are off base with some of the principals in their gospel. This may be true, but in my experience, this does not negate the fact that a sensible approach to the paleo diet is a healthy diet that is well tolerated, and can serve as a useful therapeutic tool to improve health and combat illness. Albeit, one that can be a challenge for individuals invested in the standard American diet (SAD).
The first axiom is to avoid dairy. Milk from any species is designed to meet the needs of the young animal. It is filled with species-specific nutrients that help the mammalian infant to grow, prime the immune system, and ward off disease. Cow’s milk, meant to encourage rapid growth of the helpless calf, in the modern era is often spiked with extra hormones, antibiotics, and pesticides. It is also replete with natural, but concerning, bovine hormones, such as estrogen, insulin, insulin like growth factor 1, and betacellulin. In modern dairy farming the omega-3 rich diet of grass may be supplanted with the omega-6 heavy diet of corn and other grains, altering the nutritional profile. Evidence is mounting that dairy protein consumption is linked to several chronic diseases. Allergic and food sensitivity reactions to milk proteins, and lactose intolerance are among the most common food-related ailments. Avid consumption of dairy can usurp the healthier, more nutrient dense foods in a healthy diet, while also exposing the individual to the extra calories and increased saturated fats found in the high fat varieties. Yes, dairy is a source of calcium, but evidence does not support the contention that calcium from dairy serves to prevent osteoporosis. For all these reasons I find that a dairy-free trial can be an extremely profitable venture. There are individuals who enjoy dairy without experiencing adverse effects; and, others who successfully incorporate goat, sheep or organic raw cow’s milk into a balanced regimen. Hence, one of reasons to tailor the paleo diet to serve as an elimination diet for those who want to expand their food pallet at the end of the trial.
The admonishment to avoid all grains is rooted in concerns over the effects of specific proteins on the immune system, such as gluten and hybridized wheat proteins, and “anti-nutrients”, such as phytates and lectins. In addition, grains are a significant source of omega-6 essential fatty acids. The majority of grains in the modern SAD are refined and processed (e.g. bread, pasta, cereal, many snacks), resulting in less nutrient dense intake (including less fiber), and a negative impact on the glycemic load. Removal of all grains in an elimination diet will help determine if an individual suffers from a sensitivity to certain components in grains, possibly help to address an omega 6 to omega 3 imbalance, remove unnecessary low nutrient-dense calories, and hopefully redirect the individual to explore more beneficial whole food alternatives. The ingestion of legumes raises similar concerns for the paleo aficionado. In this case it is non-digestible lectin proteins that increase intestinal permeability and impair immune function. Balance is truly the key here, as whole grains and legumes in moderation may serve to support a healthy diet, if an individual determines these foods are well tolerated.
This article does not need to review the hazards of sugar intake. Research studies have thoroughly documented the pro-inflammatory and disease promoting effects of sugar. Sugar and the processed, refined carbohydrates that behave like refined sugar, play a major role in the development of insulin resistance, metabolic syndrome and associated diseases. Likewise, the negative role of excessive salt in the diet is well established. And, there is no doubt that including abundant fruits and vegetables in the human diet provides many benefits. For a paleo fan this food group will emphasize non-starchy varieties, full of phytonutrients and fiber, which will be digested and absorbed slowly. I tell my patients that I consider my rendition of the Paleo diet to be a plant-centered diet, where at least half the plate consists of a variety of plants, predominantly vegetables.
The remainder of the plate is composed of lean proteins, and healthy fats in moderation. A true paleo diet touts the benefits of obtaining lean protein from wild game, animals fed their natural diet, organ meats, wild caught fish, shellfish, and range fed eggs. It does not support the consumption of marbled steaks, bacon and other processed meats, which are high in palmitic acid, one of the saturated fats that will elevate cholesterol. The other is myristic fatty acid, which is paired with palmitic acid in high fat dairy products, including butter, cheese, cream, and whole milk products. In the modern era, it is also wise to limit animal fat as it harbors higher concentrations of antibiotics, hormones, and pesticides and herbicides found in the feed. Healthy polyunsaturated and monounsaturated fats found in nuts, seeds, avocado, olives, and oils from olives, avocado, walnuts, and flaxseed, round out that plate. My “common sense” approach refers to my assessment that we do not know enough, yet, regarding the effects of red meat. Even organic, grass-finished and humanely raised beef contain significant amounts of heme and carnitine in their meat. There is concern that these natural attributes may possess some risk when consumed in large amounts. In addition, meat cooked at high temperatures, most notably with grilling, results in the production of cancer-causing heterocyclic amines and polycyclic aromatic hydrocarbons. My recommendation is to not subscribe to the “cave-man” mentality exhibited by some enthusiasts who follow this diet, but rather, limit red meat intake to only a few times per month, or less.
A 2013-2014 survey of adults living in the United States found that the age-adjusted prevalence of obesity was 35.0% in men and 40.4% in women. It is essential that health care providers are equipped to confidently navigate the world of healthy eating to help patients achieve, and maintain, healthy body weight. Relevant literature and postings on the paleo diet are replete with glowing, although unscientific, testimonials. I can also attest to the fact that patients in my practice who follow this diet are satiated, and lose weight without counting calories. The paleo diet is not shy in its recommendation to consume more lean protein; and, one reason given for weight loss with this diet is the higher dietary-induced thermogenesis of protein versus fat and carbohydrates. In addition, protein satisfies hunger more effectively than carbohydrate or fat, reduces hunger between meals, and may improve insulin sensitivity. The added fiber of vegetables and fruits may also assist in satiety. Consuming adequate high quality calories prevents the body from reverting to starvation mode—a metabolically more efficient state in which the brain-body inadvertently sabatoges the dieter’s best efforts through metabolic slowdown. Be aware, though, that an individual will be at risk for falling short of his weight loss goal if he fails to fill his plate with nutrient dense vegetables, over consumes nuts and other healthy fats, and indulges in processed “paleo junk food.”
Many of us are already consuming paleo meals, without labeling it as such. Eggs or a breakfast smoothie with frozen fruit, almond milk, kale and nuts; a large salad at lunch with cubes of left over chicken, avocado, walnuts and a balsamic vinaigrette; a piece of wild caught fatty fish and two servings of vegetables, with a conscious effort to skip the bread or rice in order to reduce unnecessary calories; a snack of apple slices dipped in almond butter. Even if an individual discovers that he cannot incorporate all of the principles of the diet, he will hopefully develop an appreciation for the benefits of whole foods, plants, and the limitation of processed/refined carbohydrates (sugar). The diet, though, is generally easily followed for at least the 4-8 week trial I recommend; and, the individual choosing to explore this healthy approach to eating will have access to considerable public media support networks to promote a successful journey. Be well.
Ann Carey Tobin, M.D., FAAFP, is a board certified family physician, and certified Eden Energy Medicine practitioner. Her integrative medicine consultation practice, Partners in Healing, is located in Delmar. She can be reached at 518.506.6303, by e-mail at email@example.com or visit www.partnersinhealing.info.
Disclaimer: This information is provided for educational purposes only. Please consult a medical practitioner regarding the applicability of any opinions or recommendations with respect to your symptoms or medical conditions.