Paleo: Where we part ways

It was with a deep breath that I dove into this post. If I’m being honest, even choosing a title for this was something of a challenge. “Where we part ways” hopefully implies that I think there are great aspects of this diet. The emphasis on whole foods and eating close to nature is awesome… and that’s about as far as we go, together.

Here’s a brief story about my introduction to this diet:

I co-teach an ACE personal training certification class for college students during the summers. Last year, after a class on basic nutrition, I was escorted to my car by two students who were fervent paleo-ers… 4 city blocks out of their way. I was given an exhaustive run-down of the entire diet and then my credentials and ethics were questioned when I made the fateful mistake of calling Paleo a ‘fad diet’. What disturbed me wasn’t their unshakable allegiance to their diet (which seemed to allow no room for debate) … what disturbed me was their self disclosure of never going to bars with their friends, deliberately staying out of the house if their roomies ordered pizza, and proclamation that it’s better to avoid or to fast during traditional family holidays because of the food being served. It made me sad! ..and it sounded eerily similar to some of my other patients who battle with disordered eating. Ultimately, while there are many facets of Paleo that I really appreciate – I don’t support rigid dietary behaviors that socially isolate us from our friends and loved ones (with the obvious exception of food allergies).

Not Here To Debate Evolution

One of the hotly debated issues among Paleo proponents and skeptics is the question of whether we’ve evolved to digest grains, dairy, legumes, processed sugar and oils, and certain fruits. Do we still have the same gut function as our caveman ancestors? And if so, what are the implications of our rapidly changing and evolving food system on our health (and weight)? 7d99f941c23009abdb69391f9c2d2601 I don’t have answers to these questions.  I am not an anthropologist, biologist, research biochemist, evolutionist or … an aerospace engineer (like author Gary Taubes of “Good Calories, Bad Calories” fame). I’m a registered dietitian, pure and simple. I write about what I do know: nutrition’s role in disease prevention, developing a healthy self image, and prevention & recovery from eating disorders. This post is not going to debate the evolutionary theory of what we’ve evolved to tolerate. You can easily Google the different sides of this debate and make your own assessment.

You might check out these videos:

Paleo – It works! (Robb Wolf)
Debunking the Paleo Diet Christina Warinner at TEDxOU
The Protein Debate – with T. Colin Campbell PhD vs. Eric C Westman

Probably not surprising to you, dear reader, is that my professional role models and mentors quite disagree that we should eliminate these foods. And they encourage the consumption of whole, unprocessed grains, fruits, beans, legumes, and dairy – if tolerated. To view some of their statements, see:

You ask I answer: Paleolithic Diet (Andy Bellatti, RD).
Is the Paleo Diet Really Healthy? see comments by Marion Nestle.
Warning: Dieting Causes Weight gain (Evelyn Tribole)

Paleo: Where We Align (and part ways)

Paleo and I intersect on a few important health & nutrition recommendations (see the center overlap). Many aspects of Paleo fit in nicely with what I prescribe as a dietitian and with the HAES principles: Paleo where we part ways Interestingly, someone could follow my guidelines (on the right) and still be Paleo… For example, let’s pretend that ‘Sally’ learns that her body doesn’t tolerate grains or gluten very well. And in fact, she feels pretty wonderful on a low grain, high fat, moderate protein diet. And she learned this because she was paying attention to how foods affect her energy, digestion, sleep, and mood. Rather than diet or fast, she trusts her body to tell her when she is hungry. Rather than deem foods “bad” or “off limits” or “cheat foods” – she intuitively understands how certain foods make her feel, and has the freedom to choose. Sally’s food choices are not fear-based or rigid. She eats foods that make her feel great so she can live a healthy and active life. Sally can’t always find exactly what she wants to eat a family gatherings, restaurants, or convenience stores. But that’s okay, because she is a flexible eater, too. She knows that she can trust her body to make up for her nutritional mistakes.

Paradoxically, I would argue that most people cannot adhere to strict Paleo principals and also be intuitive, competent eaters. Nearly anytime external rules govern our intake, we remove ourselves from the drivers seat. The basic premise of a diet is “you can’t trust yourself to make the right food choices.” I argue that you can, and my nutrition counseling is geared towards empowering people to trust themselves with food. Dieting is one of the most dis-empowering things you can do. Now, yes a certain amount of guidance might be necessary to help someone adopt healthful behaviors, but this guidance should be personal, flexible, joy-based, with some focus on health and disease prevention.

Where Paleo (and any diet) can go wrong:

Here are a couple of examples that I see every day in my practice:

♦ ‘Frank’ is someone who does tolerate grains, and actually functions quite well with a high whole-grain diet. He is a competitive distance runner, and loves to take long weekend bike rides with his buddies. Frank is Jewish and attends weekly “bagels & schmear’ gatherings with his Jewish friends. Food is a rich and significant piece of his religion, social/family life, and nutrition. Frank tries Paleo and feels horrible: deprived, hungry, fatigued during workouts and socially isolated.

♦ ‘Rich’ is somewhat sensitive to gluten. He is also in recovery from binge eating disorder. He needs to be careful to eat foods in moderation, not get too hungry, and resist the urge to diet. He knows that certain behaviors are likely to trigger a binge: restricting major food groups, feeling deprived, categorizing food in to “good” & “bad” categories, and alone-time. He has tried Paleo in the past (because of his gluten sensitivity) and found that he was feeling great for about two weeks! High energy, clear headed, sleeping well… But gradually he began to miss some of his favorite “bad foods”. He strained to stick to the diet, but inevitably would binge eat the “bad foods” and feel incredible self-loathing + horrible gut ache. Eating all foods in moderation (even gluten) has helped Rich stay in remission from a devastating eating disorder.

♦ ‘Alison’ goes on the Paleo diet to lose weight. Deep, toxic body image concerns are behind her drive to diet; however, she is already at an optimum healthy ‘set point’ weight for herself.  In the first two weeks, she loses a remarkable 11-lbs. She feels like she’s found the dieting holy grail. Friends and family compliment her; she relishes the attention. The scale keeps going down, only her progress is slower and slower each week. One week, she notices she has actually gained a few pounds back! She panics, and resolves to cut out all carbs. When this doesn’t make a difference, she cuts out all the high fat meats and does exercise videos in her room at night. Thoughts about food and body consume her. Her menstrual cycle has ceased for a few months, now. She is in the beginning stages of osteopenia, has developed iron deficiency anemia, and the behaviors of a restrictive eating disorder.

Persons like Alison might go on to develop and eating disorder, or they might go through the roller-coaster of the dieting cycle (eventually giving up on the diet, regaining the weight + more, and beginning another diet). Diets draw in folks susceptible to disordered eating, and become means to foster and grow the disorder. As an example of this, here is a heartbreaking disclosure from Paleo Dietitian Amy on using Paleo as a restrictive behavior in her Anorexia.

Dieting + Eating Disorder Development

Research consistently demonstrates that people who adhere to strict diet programs increase their risk of developing an eating disorder. Some interesting statistics taken directly from ANAD, NEDA, and NIMH:

♦  35% of “normal dieters” progress to pathological dieting. Of those, 20-25% progress to partial or full-syndrome eating disorders.

♦  A study of 14-15 year old adolescent girls who engaged in strict dieting behaviors were 18 times more likely than their non-dieting peers to develop and eating disorder within six months.

♦  Girls who diet frequently are 12 times as likely to binge as girls who don’t diet (Neumark-Sztainer, 2005)

♦  In judged sports – sports that score participants – prevalence of eating disorders is 13% (compared with 3% in refereed sports) … {cough, cough CrossFit…ahem}

♦  A comparison of the psychological profiles of athletes and those with anorexia found these factors in common: perfectionism, high self-expectations, competitiveness, hyperactivity, repetitive exercise routines, compulsiveness, drive, tendency toward depression, body image distortion, preoccupation with dieting and weight.

♦  95% of dieters regain the lost weight in 1-5 years. Of those dieters, 2/3rd regain more weight than was originally lost.

Studies show that dieting precedes the onset of binge eating disorder (among other forms of EDs)… but, dieting does not intrinsically cause eating disorders. ED onset can be triggered by multiple factors (trauma, psychological disorders, genetics) as discussed in other posts. However, it’s important that we are aware of this correlation between dieting & ED onset, and modify our recommendations accordingly.

Evolution Aside

It’s so easy to get caught up in debating the particulars of a diet like Paleo: can we/can’t we tolerate grains? Aren’t processed oils “bad”!? Do we have caveman digestive systems or not? Are beans and legumes to blame for the increase in our waistlines (slight sarcasm)? ….But really.

That debate certainly has a place elsewhere – but not in this post. My goal with this post was to take a gobal view; look at the big picture. Here are a few things I’ve learned as a dietitian who has worked with hundreds of people at various points on the disordered eating spectrum:

(1) Every BODY is different, and no one eating style is best for everyone

(2) It’s not the diet that’s disordered (paleo, vegan, raw-food and otherwise), it’s the reasons behind it

(3) Diets inevitably fail 95% of us, and they can be harmful to the body, mind, and soul.

(4) With a little nutrition information and a lot of mindfulness, we can learn which foods we tolerate (and don’t) and make empowered decisions accordingly.

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