It’s funny, but in all the time that I’ve written on this paleo diet topic I’ve never really defined (in my terms) what I think constitutes a “paleo diet.” I laid out some general guidelines in the book and FAQ of course, but I’ve never done that for the blog. I think part of my neglect in this area is the fact this paleo diet concept is a moving target (as I’ll flesh out later) and the relevance of the message is audience specific:

Am I laying this out for academics, trying to create a robust epistemological framework from which to drive research, discussion and learning, or am I playing to folks new to this scene who just need some guidelines to lose weight, reverse disease and get healthy? I think I’ve mentioned this before, but Framework Matters! All that considered, I’m going to first lay out a general framework of what I feel the paleo diet (and lifeway) entails. This is for all the new folks coming to the blog so as to help them understand the basic concepts and get to the Doing. The second section will entail my best efforts to detail what I feel is the optimum human diet as viewed through the evolutionary lens. There may be some contradictions between the generalist idea and the more academic presentation, but keep in mind I’m presenting this to two different audiences. I try and try to cook up a one-size fits all approach but alas the world keeps presenting me with pesky nuances and individual circumstances that need addressing.

Paleo Diet 101

Before we delve into the paleo diet basics, one might ask, WHY? Why try to emulate an ancestral way of eating? We can answer this in three ways:

1-Archeological and anthropological data indicate our pre-agricultural ancestors were largely free from modern afflictions of Westernized cultures including obesity, cancer, cardiovascular and autoimmune diseases.

2-Modern molecular biology, immunology and endocrinology offer mechanisms that support the observational data we have obtained from the above.

3-Modern interventions with a paleo diet and ancestral lifeway (restoration of sleep, exercise and micronutrient patterns) have proven successful in resolving a host of diseases and improving both subjective and objective indices of health. This has occurred in both controlled clinical settings and in crowd sourced N=1 experiments (folks try a paleo diet, get better, share observations).

Those are three small points that represent staggering sums of research. For the uninitiated (of which most of our medical and academic community unfortunately belong), common counter points such as hunter-gatherer lifespan, acid base balance, micronutrient sufficiency and other concerns seem to present obstacles to the adoption or recommendation of an evolutionary biology based approach to eating and living. Well, like I said, the research exists to answer these issues, it’s just a matter of getting people to read it! The purpose of this blog, the ancestral Health Foundation and many other blogs is to answer these questions by offering basic education in the pertinent topics.

So, for now we’ll operate from the assumption that there might be something to this whole idea. If folks want support material you have to try NOT to find it at this point.

In simple terms the paleo diet is built from modern foods that (to the best of our ability) emulate the foods available to our pre-agricultural ancestors: Meat, fish, fowl, vegetables, fruits, roots, tubers and nuts. On the flip-side we see an omission of grains, legumes and dairy. As this is directed to folks new to the paleo diet idea we need to address the “What Abouts.” This is the seemingly endless list of ingredients that folks ask: “What about artificial sweeteners, agave nectar, red wine…” In simple terms, if it’s not meat, fish, fowl, vegetables, fruits, roots tubers or nuts…it’s a “no-go.” At least initially. I like to see people go after paleo strictly in the beginning so we get the best possible results, then folks can tinker from there. I’ve detailed all of this information in my FAQ shopping and food guide, and quick start guides. These are all available for free (you do not need to buy the book to get any of the information) and it details all of the special considerations of autoimmunity, fat loss, athletic performance and muscle gain.

In addition to food we like to consider things like sleep, stress and vit-d levels (for a short list) as a move away from ancestral norms appears to be very important when we are concerned about performance, health and longevity.

For a little overview of different “takes” on the paleo diet check out my good friend Dr. Dan Pardi who did a great, brief overview of 5 different paleo diet approaches.

Just as an aside: the reason I LIKE the ancestral model is it offers something people can relate to. Molecular biology, endocrinology and peer-reviewed studies are tough to identify with. The Ancestral model is observational, not scientific as held to the standards of physics or chemistry, but it’s a story that resonates with people. If we can get people to try this way of eating and living for 30 days we generally have long term buy-in due to the beneficial results of an ancestral lifeway.

Paleo Diet 201

For optimization I’d LOVE to throw out a magic macronutrient ratio that guarantees the best of all worlds to all people, be it 40-30-30 (carbs, protein, fat) or 60-20-20 (fat, protein, carbs) as two popular examples. As far as offering guidelines to get people going, these parameters are fine. Creating a solid scientific arguments based on static macronutrient ratios…I can’t do it. Use these as a tool, beware Magic Macros.

In years gone by I’d have staunchly recommended a low carb paleo diet as THE best intervention but I can’t in good faith recommend that anymore. Letting go of this is not easy as there are some interesting observations that might support this low-carb idea:

1-Low carb (ketogenic) diets show benefit in a host of disease states from traumatic brain injury to epilepsy.

2-Hysteresis paints transient ketosis as a beneficial state.

3-Depending upon how you define “optimum” (height and cranial capacity for instance) it would appear our species was at it’s height during the “Big Game Hunter” phase of evolution when stable isotope studies indicate we were nearly as carnivorous as the arctic fox (an obligate carnivore).

That’s all intriguing, but I’m not sure we can make first order recommendations on the above. We’ll see, perhaps I’m wrong.

What appears to be of immediate, absolute benefit is to avoid large amounts of toxicants and anti-nutrients like those we see in grains. Additionally, keeping an eye on lifestyle factors (sleep, stress, socialization, sunlight exposure) pays immediate, consistent dividends. But when we are talking “optimization” we need to define what it is we are trying to optimize. From a biological perspective, purely Darwinian in nature, agriculture was a huge boon to humanity as it appears to have increased reproductive potential (hunter-gatherer birth spacing was ~4 years, agriculturalist or modern birth spacing is little more than a year). Now if we manage to eat ourselves off this planet, or unleash an atomic event that takes us out of the running…perhaps agriculture was a really BAD idea! If we define Optimum as simply making the most of an organism then agriculture, or specifically the consumption of grains is a win. When we consider heart disease, neurodegenerative disease and the systemic inflammatory consequences of a grain based diet, things do not look so rosey. We have an early selective advantage (high birth rate) with later health problems that occur too late in life to affect reproductive potential. If we define Optimum as longevity we have interesting examples from the Kitavans, Okinawan’s, Amazonian Indians (the current oldest living person is a 120 year old woman from a hunter gatherer/horticulturalist tribe) and other locations such as Sardinia which make up the “Blue Zones” of longevity I think the Blue Zones folks are polishing the brass of the “low animal protein” crowd. I’d put low wheat consumption as a more powerful vector in that discussion, but that’s a topic for another post. I will say that we likely see some decreased mTOR signaling in these long-lived groups, but is this more importnat than the multi-generational extended families that offer enormous social support? Or, what if “Optimum” is defined as athletic performance? In this case we will see protein and carb intake that does us no favors with regards to oxidative stress and mTOR signaling, but if you want to climb to the heights of athletic performance, you WILL face some tradeoffs. This is my problem with the CrossFit model of Fitness involving “Increased work capacity across broad time & modal domains.” All that IWCABTAMD tells us is to “do more” and if you ask more of what the answer is “everything.” Biology does not work that way. Dose response curves exist and as with many things we see a “U” shaped curve with regards to activity level, health and longevity. At very low activity level we see a host of issues including muscle loss (sarcopenia), insulin resistance, and pathologic left ventricular hypertrophy. In active populations, the heart is “enlarged” (relative to sedentary “normal” individuals) yet we see non-pathologic heart enlargement in active folks. Frank Booth’s outstanding paper discusses this idea. It should be preposterous to assume a sedentary person is “normal” but again, that’s a topic for another day and part of the problem that occurs when medicine operates without an Evolutionary framework. What we do seem to understand from the literature and observation is a premium is placed on muscle mass and metabolic fitness when we are talking about longevity and that too much activity might be about as bad as too little .

So, what is an Optimum paleo diet for you? I don’t know. I do not know your specific needs or goals or what you are trying to Optimize. Personally, I like this model of striking a balance between Performance, Health and Longevity. I’m not willing to undergo severe calorie restriction to live to be 150. Low sex drive, constant cold due to low body temperature and no muscle mass seems like it would suck. Folks with illness have other concerns. If you have an autoimmune condition you will need to be tighter with your food and lifestyle if you want a fighting chance of reversing that condition. If you have suffered severe metabolic derangement with the associated pancreatic beta-cell damage we tend to see, you may ONLY be able to operate on a low carb approach. But your lifestyle will need to fit that! You will not get along well doing a lot of glycogen demanding exercise. I’m not even 100% sure of all that when we consider Prof. Lindeberg’s findings that a paleo diet, unrestricted in carbohydrate, which included ample fruits and tubers, dramatically reversed insulin resistance and improved glucose tolerance.

This “Kitavan” approach has however proven challenging with my clients as they manage to eat an ungodly amount of fruit. Or, perhaps they were metabolically broken to a degree that they do not handle many carbs at all. I’m not sure what is going on under the hood, but I do find a lower carb approach to be better for folks who are metabolically broken and have poor neuroregulation of appetite.

After we wade through all the nuances and details of “what is the Paleo Diet” what we have is a solid place to start, with a number of options for tweaking our approach based upon individual differences and goals. Don’t let this be overwhelming! When you are trying to figure things out ask yourself “Who” and “What.” Who are we talking about (athlete, diabetic, autoimmunity) and What are we trying to accomplish. With this framework it’s a simple matter to construct a reasonable palan…but we also need to remember that life is about trade-offs and compromises. Some goals may by necessity be antagonistic to other goals.