Going back to go forward
In the 15 months or so since I started blogging and talking about health, I have tried to find a way to describe the overall approach I think we should take to maximise health and happiness. The more I’ve read, and the more I’ve interacted with people, especially those with different ideas to my own, the clearer this approach has become in my mind.
In my first ever blog article I warned of the upcoming zombie apocalypse:
“…streets full of moaning people, sick from their type II diabetes and demented from Alzheimer's, with nothing that "modern" medicine can offer them and no hospital beds to put them in. Half-blind from diabetic retinopathy, these zombies will stumble through the cities. Their oozing, infected, numb feet will slowly rot off because there won't be any antibiotics left that cover even the most "routine" infections. Doctors will be left to fight whatever fires they can. We'll just hose the streets down with statins, metformin and ACE inhibitors and see what sticks.”
Joking aside, this “vision” is part of the reason that I align myself with the increasingly maligned (but also increasingly popular) movement that is “Paleo”. In my mind, paleo is just a model for living well.
In short: we’re fat and sick because we’ve strayed too far from the sleep, activity, nutrition, community, and relaxation that we need in order to be as healthy as possible.
When we start arguing over the minutiae of diets - like exactly how many carbs we should eat, how many portions of vegetables we should eat, or whether or not we should cut the fat off our steak - we’ve completely missed the point. You could try to remember all the “rules” and things you’re supposed to be doing better, or you could just remember that we’ve stopped doing all the things that made us the awesome species that we are.
Let's keep it simple. Call it absolutely anything you like, but “Paleo” is just a format for a better way of looking after yourself, and others.
My journey to Paleo I first heard about the Paleo diet back when I was an undergraduate at Cambridge, but the real therapeutic potential of the paleo diet actually became apparent to me much later, in 2010. My stepbrother had recently been diagnosed with multiple sclerosis (MS), a disease where standard drug treatments have a poor safety record, and don’t prevent progression of the disease. Therefore, we started to look into all the potential causes of multiple sclerosis in order to pick out some additional treatment strategies. This involved digging into over 1,000 scientific papers and various case reports. Importantly, we assumed that anything could and would be relevant.
Though it’s not what we intended to look for, it rapidly became clear that diet could have a serious impact on MS disease progression. There’s good evidence that certain foods (particularly dairy and wheat proteins) can exacerbate the body erroneously attacking the brain, as happens in MS. At the same time, nutrients like vitamins D and B12, as well as iodine and the omega-3 fat DHA are incredibly important for normal neurological function and repair.
As a result, what shook out was very similar to a paleo diet. Since then, the MS patients I have worked with have seen some very promising improvements in their conditions from following an adapted paleo diet. Dr. Terry Wahls also found something very similar through her own struggle with MS, and is currently running clinical trials of this approach in patients. Find a detailed video on our work here.
This doesn’t mean I think that MS or autoimmune disease is caused solely by dietary factors, but it certainly appears that these can exacerbate the disease process, and prevent healing and repair.
Paleo is: real food The original description of the paleo diet can be summarised as: “meat and vegetables, nuts and seeds, some fruit, little starch and no sugar”. According to this definition, sugar, grains, pulses, processed foods, vegetable oils (sunflower, rape, soya etc), and dairy are all excluded. This is the ground on which much of the paleo warfare takes place, and most of it isn’t getting us anywhere.
I agree that the science on which some of the original paleo diet recommendations were based is not as robust as some might say. This is why the “diet” part of paleo has evolved to include beans and lentils as well as dairy, particularly full-fat and fermented dairy. Starchy foods like potatoes and rice have also come back into favour, particularly for those that are very active.
This backtracking has created some confusion, but in reality it’s just about eating real food. The main benefits of eating this way come from:
Removing processed food
Increasing healthy fats, protein and veggies
Excluding foods that you don't tolerate
Among paleoists there's also a huge drive to eat local, sustainable food, and focus on the environmental problemscaused by industrial farming (both grain and animal). And provenance is important, with a focus on grass-fed and wild animal products, because this can greatly improve the nutrient profile of the meat and the milk, and is associated with better animal welfare.
Removing processed foods In my personal experience, I’ve seen the biggest improvements in fat loss and blood sugar management in diabetics and overweight people just from removing processed sugar and flour (bread, pasta, cakes, biscuits), and starch-heavy foods like rice and potatoes. A high intake of (particularly processed) carbohydrates has been shown to increase your blood triglyceride levels, as well as certain types of cholesterol (like LDL-particle), which are much more important to your risk of heart disease than a basic cholesterol test.
Carbohydrates in general have become increasingly contentious. Some will say that carbs are the cause of all modern disease, and that as long as you control (or restrict) carbohydrate intake (and the insulin spike it causes), it doesn’t really matter what you eat. Consequently, paleo has been thought of as being a “high meat, high fat, low carb diet”. However, when Boyd Eaton and Melvin Konner first described paleolothic dietary patterns 30 years ago, they mentioned up to 65% plant foods, with a significant proportion of energy coming from carbohydrates. The difference is that this carbohydrate came from things like roots, tubers, and legumes (legumes were “banned” later on), rather than pizza, coke, and chocolate.
Eat more fat and protein! Eating more fat, including saturated fat, is incredibly important, particularly for vitamin D, and making hormones for normal sexual and reproductive function. However vegetable oils, which are often used for high temperature frying, can increase the risk of heart disease, because the damage caused to the oil by high-temperatures can then increase inflammation in the body.
Many people also don’t eat nearly enough protein. The combination of low protein intake and a sedentary lifestyle means our muscle mass is declining, even though we’re getting fatter. You also need more protein as you age to maintain the same muscle mass, and you need those muscles to stop you falling over and breaking a hip when you’re older.
Eating more meat, fish, and eggs will increase protein intake and fat intake, as well as provide a number of other nutrients. There is still some contention about meat, particularly red meat intake, especially from more traditionally trained dieticians. However, including red meat in the diet is associated with better health and nutrient status. This doesn’t mean that red meat is always a health food – if it is highly processed or cooked at a very high temperature, you can create some chemicals that are associated with worse cancer risk. I’ve covered this in more detail here. Summary: Don’t burn your steak, and don’t eat deep-fried things.
This means a paleo diet can easily be unhealthier – I often see people who eat lots of crispy bacon, nuts, and sweet potatoes, but not many vegetables or much seafood. As with any diet, big problems can arise when people only eat a lot of the same thing.
The benefit of vegetables Vegetables have everything from fibre, calcium, and magnesium, to various phytonutrients. Eating more fresh vegetables, from both a mineral and fibre perspective, has a huge benefit. Greater vegetable intake is associated with lower risk of pretty much every modern day disease we hear about. However, it’s probably much more complicated than that. Many of the minerals and vitamins in vegetables are poorly absorbed. You’d even be surprised by how little evidence there is to support the theory that we all need lots of fibre to stay regular and prevent heart disease and cancer. However, for most people struggling with their health and weight, increasing vegetable intake has two broad benefits:
They’re yummy, and a great vehicle for butter
They can help you feel full, and replace the processed nonsense that we’ve been calling food for the last couple of decades.
Excluding foods that don't agree with you Up to 20% of Caucasians and up to 80% of non-Caucasians are intolerant of lactose and dairy, and could benefit from taking those out. Additionally, up to 10% of us are potentially sensitive to gluten, or other similar proteins from grains. People often do better by starting with a paleo-style diet, and then adding foods back in. Many people might even have issues with dairy or wheat (eggs are another common allergen) without realising it.
However, some non-paleo foods have received a bad reputation, which they don’t deserve. The only studies showing that pulses are bad involve feeding uncooked or undercooked beans to rats or humans. All the other evidence suggests that beans, peas, and lentils can be very beneficial for health. Legumes, as well as things like whole grain barley and oats can improve both metabolism and gut health, particularly because they feed the “good” bacteria in the gut. Wheat probably isn’t an issue for most people, but the nutritional value of bread and pasta means that they’re just empty carbohydrates that are taking the place of vegetables, fish, or eggs.
Finally, high-fat and fermented dairy is a great source of protein, fats, and vitamins, and in those that can tolerate it, there is no reason to exclude it from the diet. The lactose content is greatly reduced in things like butter and cheese, so these may be OK in those that can’t drink milk.
Finding balance In my ideal “paleo” diet, grains, legumes, and dairy are all included. But this won't be right for everyone. Finding a personal balance takes some time.
I have included some examples of how this can be tailored to the individual at the end of this article. Importantly, I’m not going to tell you that we should all remove bread and milk from our diets, because I’m not sure it actually matters that much. Importantly, there is no one universal diet because:
We all evolved in different environments, eating different things
We all have different genetics, and different health problems
We are omnivores that have adapted to eat a wide range of foods
My personal diet involves eating plenty of protein, fat, vegetables, and the right amount of carbs to reflect my activity level. I eat high fat dairy products, I don’t worry if gluten crosses my plate occasionally, and I enjoy a legume now and again.
Most importantly, I am also really big on all the other stuff – sleep, stress, exercise, and fun. And squatting.
Paleo is: being human Though the modern diet is a huge part of the health issues that we’re currently seeing, it’s down to much more than just the food we eat.
We don’t sleep enough, we sit too much, and we have forgotten how to move. We eat nutritionally sparse comfort food, which gives the perfect combination of fat and carbohydrate to promote fat storage, and which gives few useful micronutrients. We don’t’ spend enough time with friends and family. We have swapped short-term stresses (like being sick or being hunted) for this long-term worry about things we probably can’t do much about, and which our hormones aren’t built to support.
The combination of dysregulated sex hormones and cortisol (chronic stress), with high levels of insulin (usually from over-ingestion of carbohydrates), sleep-deprivation (which promotes insulin and leptin resistance), and a sedentary lifestyle, is the perfect storm for weight gain and ill health. It seems to promote obesity, a number of cancers, as well as diabetes, and heart disease. Things like night shifts (eating at night and sleeping during the day) can also have a huge negative impact on health.
Are you sleeping enough? Do you hate your job? Do you have an unhealthy relationship with food from years of yo-yo dieting? Do you spend all your time hunched over a desk? The idea of paleo isn’t that we’re trying to be cavemen or accurately recreate anything from the past; we're just trying to find a sustainable way to fix these problems.
Paleo is: progressive One of the major problems we have with the science behind diet and lifestyle is that almost all of the data is “observational”. This includes one of the main observations used to support the ideas of paleo. Basically, when we switched from a hunter-gather lifestyle to an agricultural (and subsequently more sedentary and grain-dependent) lifestyle, our bones got weaker. We also got shorter, and our brains got smaller.
Fast-forward to modern nutritional science, where we look at how people eat, and follow them to see what diseases they get. However, most of these studies rely on people accurately remembering and recording what they’ve eaten over a period of time. Then we extrapolate, and assume that a) this is how they’re eating for years at a time; and b) that their later health problems are because of the foods they wrote down on a questionnaire 20 years ago. But we lie about what we eat, and we do other things that also affect our health, completely distorting the data that these large dietary studies rely upon. For instance, red meat is often discussed as a major risk factor for bowel cancer and heart disease, but people that eat more red meat also smoke more, exercise less, and drink more.
The statistics that scientists then choose to use to examine the huge volume of data they have can also completely change the result of the study. And in most cases, they do this to make the data support their own personal views, rather than give an objective summary of what they’ve found. But things will always change. And in reality, we don’t have much PROOF that grains caused our brains to shrink tens of thousands of years ago, or that red meat causes bowel cancer. All we can do is look at the data, and interpret it in the way that we think is most beneficial for most people.
Unlike the majority of similar schools of thought, paleo has evolved as science has progressed. The paleo community was a big part of the now widespread exoneration of the saturated fat. They also popularised the data on little-known nutrients such as vitamin K2, which is very important for calcium metabolism, improving bone health, and reducing heart disease risk. The evidence is also mounting that vitamin D from a pill can’t replace all the benefits of the vitamin D we make from being in the sunshine, and our need to be outdoors also makes more sense under the paleo framework.
The reason why paleo then makes sense to me is because it takes the modern science we do have, and fills in the gaps with some clues from the environments that we evolved through.
Paleo is: all the other stuff There are a number of societies around the world that thrive on hugely varied diets, most of which are not consistent with the original paleo “rules”. Some of these communities are known as the Blue Zones, and have been thoroughly studied because of their low risk of obesity, diabetes, and many cancers, as well as the fact that they have the greatest proportion of people that live to be over 80, 90, or 100 years old.
The Blue Zones provide very good evidence for why the dietary "rules" of the paleo diet shouldn’t be taken too seriously. For instance, the Nicoyans, Sicilians, Ikarians, and Okinawans eat a lot of legumes and grains, and not much meat. However, I believe the key here is how they live their lives:
They eat local, unprocessed food
They eat together, and they don’t overeat
They sleep enough
They have some form of stress-relief (meditation, napping, hiking outdoors)
They are active all day
They have well-established local communities and often large, social families
They also don’t have the love/hate relationship with food that we do, worrying about what we’re eating, or constantly trying to “diet”. If we all lived like this, I genuinely think that exactly what we eat would be less important.
Going forwards If you’ve skipped to the end, what I think paleo should really be telling us is how we can live as healthier and happier humans in the modern world.
As humans, we’re programmed to conserve energy (ie be lazy) and eat our fill when food is plentiful, because in the past we’d have spent the rest of the time cold, hungry, and hunting or foraging. Nowadays we’re only doing one half of that equation, with results that you can see wherever you look.
In my mind, optimal health can be achieved through some simple ideas:
Move more: Lift. Walk. Sprint. Jump. Climb.
Reduce stress: Meditate. Do yoga. Nap. Spend time outdoors.
Socialise: Put down the iPhone. Have fun with friends and family. Have sex.
Eat real food.
You can call it whatever you like. In fact, if you don’t like the term paleo, you can forget I ever mentioned it. But this is the stuff we’ve stopped doing, and we’re paying the price.
The good news is that it’s not actually that difficult to fix.
If you’re eager for more, I'm writing a book about all of this stuff with Chloe from Paleo Britain. It will be out in the first quarter of 2015. In the meantime you can check out our new website, and listen to our podcast.
References As with previous opinion pieces I have written, I have not collated an entire list of references. However, if anybody would like me to provide data or studies to back up any particular points, please let me know in the comments and I will gladly provide them.
Diet - the small print People will continue to argue over the dietary small print, and for some people that can be incredibly important. With that in mind, if you’re struggling with some kind of chronic disease, you need to bear in mind (a) what works for you; and (b) what today's science actually says about food.
Eat meat (nose to tail, especially offal)
Eat fish and eggs
Eat fresh vegetables
Eat some fruit, nuts and seeds
Eat some full fat dairy (butter and cheese)
Eat starchy vegetables and rice (tailored to your level of activity)
Eat legumes and unprocessed grains (if tolerated)
Eat fermented foods like sauerkraut and kefir
Variety is good
Worrying about exact ratios and calories is not good
Importantly, it’s not about counting calories or actively losing weight. The focus is on overall health, and long-term fat loss can only really happen as a result of better health.
People that are obese or have type 2 diabetes or cardiovascular disease do best when they remove carbohydrate-heavy foods. Conversely, active people or athletes will often need more carbs.
More extensive carbohydrate restriction (like a ketogenic diet) has therapeutic potential for some metabolic diseases (type 2 diabetes, polycystic ovary, obesity), neurological disorders (dementia, Parkinson’s, MS), and certain cancers. However, it is also unlikely to be a panacea, and depending on the condition, should include a discussion with your doctor.
As with multiple sclerosis, people with autoimmune diseases should consider removing all grains and dairy, and also some other things like the nightshade family (tomatoes, aubergine, potatoes etc), because they can increase the likelihood that the body will attack itself. This is also known as the Autoimmune Protocol. Even if the evidence behind this diet isn’t 100%, it’s a safe approach that may give benefit to people with potentially devastating, incurable diseases.
There are also several other similar diets, which can be implemented to address specific diseases and problems, particularly those with digestive issues. These include the Specific Carbohydrate Diet, the low FODMAPs diet, and the Gut and Psychology Syndrome (GAPS) diet. Those that have severe constipation or irritable bowel-type symptoms may even benefit from completely removing all fibre from the diet.
Healthy people don’t need to be as restrictive, but that doesn’t mean they’ll always be healthy, and this is something to be mindful of.
Prevention is always better than cure.