Farewell To "Paleo"

I have experimented with eating a so-called “paleo” diet for at least 14 years.  Although I had confidence enough in the concept to invest in self-publishing a book on putting it into practice, over this time I have endured increasing cognitive dissonance because the currently popular concept of paleo diet—animal-based, relatively high in protein and fat and relatively low in carbohydrate—conflicts with empirical nutrition knowledge accumulated over the course of 5 thousand years in both Asian and Western medicine, including a rather large body of clinical and laboratory data accumulated since the 19^th century, all pointing toward humans being more adapted to a plant-dominated, high-carbohydrate diet supplying significantly less than 30% of energy from fat. 

In addition, over this time period I have experienced myself, and seen in others, mostly gradual and sometimes sudden development of disorders that seem to occur regularly in people attempting to consume a high fat, excessive protein diet.   I have made this connection because of my previous nutrition and health history combined with my formal training in both Western nutrition and Oriental medicine.  To summarize, these unwanted changes have occurred:

1)  General dry skin, and return of inflamed skin lesions in locations previously healed during my years eating a low-fat, plant-based diet, plus emergence of lesions in new locations.  When I restrict total dietary fat to no more than 20% of energy and avoid red meat and  saturated fats, I watch my skin heal, and conversely, when I eat more fat, saturated fats, poultry, and red meat I watch it worsen.  By elimination and reintroduction, I have found that eating 6-8 ounces of grass-finished beef will within 24 hours noticeably increase skin itching.

[Update 3/20/12:  For references, see my post on arachidonic acid provided by all types of meat, discussing the evidence that excess dietary AA promotes inflammation including skin inflammation found in typical skin disorders like eczema and psoriasis, here.  Also my post discussing the evidence that heme iron found only in meat promotes inflammation, here.]

In general, it is standard practice in Chinese medicine to recommend elimination of red meat and poultry from the diet of people with inflammatory skin conditions because long empirical experience as well as Chinese theory indicate that these foods create inflammation (we say that they create heat).  Despite my training in both Chinese medicine and Western nutrition, I tested the paleo hypothesis that these problems are caused by grains.  My experience confirms the Chinese medical view that inflammatory skin conditions arise, not from eating benign gluten-free grains and starches, but from general blood inflammation, toxicity, and stagnation, promoted by heating, congesting, i.e. inflammatory foods such as meat and fats rich in arachidonic acid (for references see here). 

From a Western nutrition perspective, excess dietary protein loads the blood with unnecessary acid, ammonia, and urea, and increased dietary fat causes increased coagulability of the blood, which reduces the rate of blood flow, particularly through the fine capillaries, impairing delivery of nutrients and oxygen to and removal of wastes from the skin cells as well as reducing the rate of blood filtration by the liver and kidneys; resulting in chronic low level toxemia.  (3/20/12 Update: For references documenting the effects of fats on blood coagulation and flow, see this , and this.)

2) Gradual return of disabling seasonal allergies and sinus congestion and inflammation, along with chronic congestion of ear canals.  Reduction of dietary fat and protein quickly reduced the symptoms and thinned the secretions.  Prolonged high fat and protein intake appears to increase the thickness and hence stickiness of mucous in the respiratory tract, trapping dust, pollen, and other irritants that stimulate immune and inflammatory responses.

3)  Intermittent bouts of severe abdominal distress clearly caused by high fat intake, from which I could get relief only by fasting followed by reduced fat intake for several days.

4) Irregular bowel movement and, when eating very low fiber, constipation with small, dry, difficult to eliminate stools.  Tracy had the most problem with this.  High fat intake slows intestinal peristalsis, reducing the reliability and frequency of elimination.  (By the way, I have eaten 1.5 to 2.0 pounds of fruits and vegetables daily, providing 50 to 100 grams of fiber,  most of the time I have eaten 'paleo,' which I reported in detail in my book, The Garden of Eating.  Tracy ate similar or greater volumes of plants, so her severe irregularity was NOT caused by too little fiber.  Tracy only got relief by cutting the fat.)

[Update 3/20/12:  I neglected to provide the reference:  Whitney and Rolfes, Understanding Nutrition, 10th Edition, p. 91:  "When fat is present, intestinal motility slows to allow time for its digestion."]

5) [Update 3/20/12] Small yellowish lipomas, also called xanthomas, which have arisen twice during the 14 year paleo stint. Xanthomas occur particularly in people with high blood lipids, which I had for years while eating paleo (total cholesterol of well over 200).

Xanthoma:  Source: Medline Plus.

 The first time they appeared, I eliminated them by eating a very low fat grain-based diet for one period of about 6 months, then returned to eating a 40-60% fat diet rich in red meat.  After another five years or so they returned again.  Xanthomas include xanthelasmas, an accumulation of cholesterol under the skin of the eyelids.  Oriental medicine considers these xanthomas external signs of internal lipid accumulation (e.g. in the arteries), and research confirms that xanthelasmas are indicative of increased risk of cardiovascular disease.  

Xanthelasmas.  Source: TheHeart.org

6) Increasing muscular stiffness in mornings after sleep, along with severe cramps in lower legs occurring regularly at night, especially with very low carbohydrate intake.  The chronic morning stiffness quickly markedly reduced (about 3-4 weeks) after adopting a low fat intake.  I attribute the stiffness to sluggish blood circulation due to increased blood coagulability impairing nutrient and oxygen delivery and waste removal from tissues at night. 

7) Anxiety attacks, which I never experienced before, when eating low (20-25% energy) carbohydrate and high (50-60%) fat.  The attacks occurred consistently after large fatty meals. I attribute this to poor circulation to the brain along with neurotransmitter imbalance caused by inadequate intake of dietary carbohydrate.[Update 3/21/12:  This study found that people on a low carbohydrate diet for 52 weeks scored higher on scales of anger-hostility, confusion-bewilderment, and depression-dejection than people on a low fat diet for the same length of time.]

8) Chronic tension in the shoulders and neck, which decreases when eating less fat and more carbohydrate.  Oriental medicine explains this as an effect of excess dietary fat on liver and gallbladder functions, affecting the circulation in the gallbladder channel which traverses the neck and shoulders.

[Update 3/20/12:  I guess I should have documented that excess dietary fat can impair liver and gallbladder function.  Try searching PubMed with "high fat diet and NAFLD" or "high fat diet and NASH"and you will find plenty of evidence that high fat diets can induce fatty liver disease, like this, and this, or this, and fatty liver disease promotes gallbladder disease

I will give more details about my more than 30 years search for health through nutrition and natural medicine in another blog.

My wife Tracy, who now blogs at The Food Way, had the following distressing developments over the course of just 12 months eating in a low- to moderate-carbohydrate, grain-free paleo/primal fashion:

1) Progressive gain of body fat, due to a positive fat/calorie balance.  Simply, it was easy for her to overconsume calories when eating high fat foods. 

2) Headaches and tension that increased in intensity over the 12 months.

3)  Increasingly persistent right hypochondrial discomfort (discomfort under the ribs), a clinical indicator of stress to the liver.

4) Constipation of increasing severity over the course of the 12 months, due to dietary fat impairing intestinal peristalsis. (Reference given above.)

5) General and increasing sense of fatigue and morning sluggishness with increasing craving for morning coffee, an effect predictable from Chinese yin-yang theory applied to food.  Briefly, a high-fat diet contributes to congestion and stagnation, and coffee's bitter constituents break up the congestion and drain out the stagnation, so people eating high fat diets can find the effects of coffee very attractive or even essential to get things opened up and moving. 

6) Gradually increasing premenstrual breast tenderness and fibrocystic changes.  This was the most alarming symptom to me, because it indicates increasing endocrine imbalance and is unacceptable within Chinese medical gynecology, which recognizes it as an early warning sign for potential breast tumors.

[Update 3/20/12:  This study showed that women with cystic breast disease and breast pain have abnormally elevated levels of prolactin when on a high fat diet, but when they switch to a low (20%) fat diet this abnormality disappears.]

7)  Persistent muscular and joint aches and pains, due to impaired blood flow.

8)  Increasing vasomotor disturbances resulting in hot flashes and night sweats, another sign of endocrine imbalance.  This disorder is also unacceptable to Chinese gynecology and Western scientific research has found that the occurrence of vasomotor disturbance in perimenopausal women is related to fat content of the diet, with high fat diets promoting and low fat diets reducing the occurrence.

9)  Towards the end of the 12 months, she developed regular bloating after our high fat, meat-based meals, a sign of growing fat intolerance.

Since greatly reducing the fat and protein content of her diet, Tracy has had significant amelioration of all of the above symptoms.  You can read more of her account on her blog, The Food Way.

As a result of these experiences I have abandoned meat-based “paleo” dieting as popularly conceived, and realized that all my difficulties were predicted by Chinese medical nutrition theory, which has a few thousand years head start on recent "paleo" diet theory.  I have returned to eating a whole food, high-starch, gluten-free, low-fat (≤20% energy as fat) plant-based diet with much smaller amounts of animal products, primarily fish and shellfish.   Although this accords with both traditional Chinese medical knowledge and modern Western nutrition research, it does not fit with the claim that “paleo diet” consists of a meat-dominated, low-to-moderate carbohydrate, grain-free diet.

[Update 3/20/12:  So many people attack me for my supposedly stupid belief that a paleo diet is meat-based and low in carbohydrates.  I don't get it.  Loren Cordain has gone to great pains to provide evidence that both recent hunter-gatherer and ancient paleolithic era diets were low in carbohydrates.  His books and those of Art DeVany and Robb Wolf all present paleo diet as reduced carbohydrate diets with limited starches. 

The folks at the Journal of Evolution and Health recently got all excited by this 2011 paper by Ben-Dor et al which argues that man is an evolved fat hunter and includes the following claims

"modern hunter-gatherer (HG) groups, despite having access to fire and metal tools, also seem to have a strong preference for carnivorous foods over vegetal foods ([53]:682), a notion also supported by a recent study [75] that emphasizes limited consumption of carbohydrates by present day HG groups."
 
"an analysis of nine HG groups for which detailed dietary information exists ([76]:166) shows that five groups, located in an area abundant in vegetation, consumed only a meager amount of plant foods (17% of calories on average)."  

I see no indication that scientists promoting paleo diet are endorsing high carb, low fat, low meat diets.  I don't base my idea of paleo diet on what bloggers write, I base it on what the advocates of it have written in peer-reviewed science journals.]

Although I now believe that reverse engineering from presently observable human biochemistry and physiology suggests that modern humans are adapted to a high-carbohydrate, low-fat diet with relatively low or intermittent intake of animal foods (by current Western and especially "paleo diet" standards), mostly of fish and shellfish,  I doubt that my input will change the now entrenched idea that human evolutionary “paleo” diets were meat- and fat- rich and plant-food poor.   Therefore, I will not even attempt to call what I do or advocate a “paleo” or “primal” diet, although I think it appropriate to do so.  

But for now I won’t be changing the name of my blog. From the beginning I defined “Primal Wisdom” as the innate intelligence of the bodymind, written in its various nutritional and other requirements, as well as in all the movements of Nature, which inform the Chinese scientific principle of yin-yang complementary opposition.  Apparently the Nobel Prize winning physicist Niels Bohr understood the importance of this scientific principle, since he chose the yin-yang symbol for the his coat of arms. 

Coat-of-arms of Niels Bohr.  Source: Wikipedia

In future posts,  I think I will further discuss how we apply this and other Chinese medical principles to nutrition in such a way that makes sense out of the confusing mass of nutrition information available both within scientific research and in practical experience. 

 Hence, my farewell to popularized paleo.   I hope all “paleo,” “primal,” and “hunter-gatherer” dieters fare well in their quest for health.    So long as what you do continues to work for you, keep doing it.  I hope that you have the knowledge, clarity of mind, and subtlety of awareness to notice the early signs of malfunction before you succumb to something serious and beyond repair.  I have a series of blogs forthcoming on this topic, outlining the Oriental medical understanding of the progression of disease from minor to major, which Chinese physicians have used for millenia to help people reverse and prevent diet-related diseases.