The Paleolithic diet presumes that foods eaten during the stone-age (Paleolithic era from 2.5 million years ago to 10 thousand years ago) are optimal foods for humans. The Paleolithic (Paleo) diet includes grass fed beef and other lean meats, fish, shellfish, fruits, vegetables,  eggs, nuts, but no grains, no dairy, no salt, no refined fats (butter or margarine) and no sugar or high fructose corn syrup.

Fanatical Diet (Lifestyle types)
There are three things one should never discuss in polite company, religion, politics, and diet. Getting into an argument with proponents of diets is like a democrat trying to convince a republican that Obama is ok. Each side will quote their own studies, statistics, and population studies. But the key to scientific study of the various diets is not what we presume from correlation, but from what we learn when that diet is placed into patients – in this case, the laboratory values of those who have the diet.

Diet proponents become fanatical about their diet (lifestyle) to the point of religious fervor. Seeking to prove that their diet is backed by science, proponents use population studies with associations that are only suggestive and not proof of causation. These associations become propaganda as the associations are repeated over and over, morphing from a suggestion to “proof.”

The Flaws of population studies or Correlation does not equal causation
The foundation of many diets are based on the correlation of what a population eats and what diseases they suffer from. In the Paleo diet the assumption about what they ate and the diseases they suffered from is a spurious correlation at best, and far from causation.

Population studies are flawed, as often we find that we don’t know as much about the population as the data might suggest. Take the Pima Indians of the Southwest. In 1990 a paper came out stating that the Pima Indians had a low incidence of fatal coronary heart attacks in spite of having a high rate of diabetes. The Pima Indians were called among the most studied populations, with an NIH post in Phoenix, and lots of studies showing the highest rate of diabetes in the world. When the population was examined more carefully, the Pima Indians had plenty of heart disease.

Step back from the most studied group in the United States with great statistics and physicians trained in modern medicine and then imagine making conclusions about what Chinese eat, or Mediterranean’s, or French. Those assumptions are more flawed, as are the statements about what diseases they do or do not have. Now step back further trying to determine what people of the Stone Age ate, what diseases they had, and we leave the tenuous role of suggestion and enter the role of outright guessing. Even if we have reasonable data (and often we don’t – even for the best studied people in the United States) the correlation between what people eat as a cause for what diseases they have is a fundamental flaw. Correlation does not equal causation.

The Best Diet or Lifestyle is?
When it comes to the best diet plan for a person – we just don’t know enough to say that one is better than another. There isn’t enough evidence to state that the Paleolithic (also called Paleo) diet is better than the Ornish, Southbeach, Pritiken, or pick one, or better than how you currently live your life.

We cannot broadly say that any given diet will prevent heart disease, cancer, arthritis, or even obesity. When someone tells you a diet can prevent such, they have gone from the realm of science to the realm of bs.

The Paleo Diet Premise:
The Paleo diet premise is that we should avoid certain foods because our body is not evolved to process those foods, and if it does process them it will lead to the chronic diseases of modern man – heart disease, strokes, cancer. Cavemen didn’t have those diseases, so we should eat like cave men. Of course, we don’t know about what diseases that cavemen had – especially when it comes to organ and soft tissue diseases, we just have a few fossils that we examine and look for evidence of known diseases. Would coronary artery disease show up in a fossil – nope? Would cancer show up in the fossil – bone cancer would (kind of a rare cancer) or cancer that went to the bone might – but it would be hard to tell if the fossil evidence.

We do know, from many hunter-gathering societies, that they live a short life, and not long enough to develop the diseases we associate with aging. All a person has to do to pass on their genes is make it into puberty, and to be effective to nurture the young, into the 30′s, and to see grandchildren and help child raising – into the early 40′s. That is what a simple civilization needs. After that, in any primitive society, the elderly become a burden – perhaps to be placed on an ice flow. People who live into their 40′s and 50′s may die of cancer, heart disease, or obesity- but they will have passed on their genetic code.

The Evolution of Homo Sapiens:
When Homo Erectus came out of Africa, they encountered a world that was much more varied in food sources than Africa. The brain of the human (H. sapiens) evolved, becoming much larger, and utilizing far more energy than the brains of the Australopithecus – about 10 percent more. More than any other species, humans evolved a brain that required more calories- and our brain metabolism accounts for up to 25% of our energy needs. Bigger brains and its increased requirements mean a richer diet- and modern hunter gathering species derive about half of the energy from animal foods – in contrast with other primates that have far fewer animal foods. While our ancestors the Australopithecus dined on plant foods, and had large mouths to grind up fibrous plants – humans are built, with smaller faces and jaws, to dine on energy rich animal foods.

The reconstructed skull of Lucy, Australopithecus- large jar and muscles for eating plants

The Human skull is larger, larger brain- and jaws for more energy rich foods

Humans were successful, as the fossil record shows, because they were “flexible” eaters, using a wide variety of dietary strategies. If there were a lot of Elk, then we ate elk- berries, we picked berries. To state that our digestive system evolved only to eat some few items found in the Stone Age – has been disproven on the face of it. Our ancestors in Africa didn’t encounter Arctic char, whales, seals, salmon – and yet when they moved from that warm climate to the frozen north, they adapted quite well to a very high fat diet of primarily animal based diet that was clearly not available in Africa. The findings of starch grains from wild plants in grinding tools from sites in Italy, Russia, and the Czech Republic from the mid-upper Paleolithic era suggest that the production of flour was present 30,000 years ago.

Contrary to what Paleo proponents state: people made flour 30,000 years ago

How to eat like a caveman
There are some things about the Paleo diet that people avoid:

Excess sugars including fructose
Excess Omega 6 oils – including soy
Processed wheat, grains, and gluten
Dairy

What is the scientific evidence for this? It’s the simple premise that modern man has lifestyle illness from altering food, taking in too many calories, and if we would return to our ancestors roots (pun intended) we would avoid these highly processed foods and not suffer from the holy trinity of diabetes, obesity, heart disease, and maybe even cancer. There is not a single shred of evidence to support the premise of this diet.

An entire dietary regimen has been formed with plenty of books and websites to guide you through this. It has become so popular that the question becomes not the flawed premise for the diet, but rather how the diet would compare to other diets. If you want to eat like a caveman, then shop on the outside of your grocery store.  Everything on the inside of your grocery store is generally processed foods, and everything on the periphery of the grocery store is generally not processed.  On the periphery you will find the vegetables, fruits, meat counter, fish counter – although you might get in trouble with dairy, and before you check out they might have a cookie or two – or there might be a bakery (a big no no among the non-Geico types). But lets be clear- whatever the caveman could get that they could eat- they would eat, and if a caveman were to be around today- wait, we have them – well, they eat Poptarts.

In one real scientific study patients with known heart disease who were randomized to either the Mediterranean-like diet (based on whole grains, low fat dairy products, fish, fruit, and vegetables) or the Paleolithic diet (no grains or dairy but plenty of lean meat, fish, fruits, vegetables, root vegetables, eggs, and nuts) and those who undertook the Paleolithic diet were satisfied with less food. There was also a decrease in leptin in the Paleolithic group by 31% and by 18% in the Mediterranean group.

There have been other studies that show that people who go with this diet have improved laboratory values – less triglycerides, lower blood pressure, some weight loss, that the diet has a better glycemic index (the food doesn’t increase blood glucose levels as much). This diet compared to a standard diabetic diet did better. Those studies are short term, with small numbers of individuals, and hints of laboratory values.

So before one assumes I am putting this diet plan into the trash bit along with Ornish- there is clearly some data here that shows good nutritional sense in the food.

While highly processed carbohydrates transiently increases blood glucose levels more than whole grains – it does not mean that bread is bad for a person. At least we don’t know enough about this to state that today. Clearly, people who eat a lot of flour based products can get fat quickly, and getting off the bread and bakery products will help reduce weight, decrease hemoglobin A1C levels, decrease triglycerides, and overall be healthy.  Some people need to be told to never eat them again – as some alcoholics must never drink again- and some people are able to moderate them so they do minimal damage to the body.

Only a few studies have examined the effects of the Paleolithic diet on laboratory values that we associate as increased risk for disease – but again, those were laboratory values, not a long-term follow up for disease.

The premise for the Paleo diet may be flawed, but here are the parts of the Paleo diet that most would agree with:

(a) Highly processed grains – white flour, rolled oats- do cause a rapid increase in blood glucose levels and the body responds to that by increasing triglycerides and ultimately fat.
(b) Fish – as long as it is not contaminated with mercury, is a protein source that is high in Omega 3 fatty acids, which have been shown to be beneficial. If you have some great fish three or four meals a week it works out well.
(c) Vegetables and fruits are the basis for most diets- thus a vegetarian could participate in a Paleo diet easily. Too many people do not eat enough fruits or vegetables or look to them as snacks.
(d) The trend away from cattle feedlots and desire to have grass fed rather than grain fed beef. Grain fed beef is fatter and more prone to being infected with Salmonella or E.Coli than grass fed beef.  There is a wider variety of taste with grass fed beef, and most who find grass fed beef end up preferring its flavor. Grass fed beef is best cooked with Sous Vide cooking.
(e) If you eat more calories than you burn you will gain weight. But it is more than just calories – it is also the types of calories. Eating high glycemic index foods mean you will spike glucose pushing it into cells, where it will be quickly transformed and stored as fat. Low glycemic index foods will be slowly burned  - thus, calorie for calorie with the Paleo diet plan you will tend to burn the fuel from the food as opposed to store it.
(f) If you eat a majority of your food with highly processed grains instead of whole grains you will have a faster rise in blood sugar. Some attribute this rise to increased obesity and an increased load on the pancreas.

Overall- this is not a bad diet program. Nothing in it would appear to cause nutrient deficiencies and there is some preliminary evidence that this diet keeps a person more satisfied with less food. It is a low-carbohydrate diet, and those diets, in comparison to other diets, tend to produce faster and longer weigh loss.

Here are a few scientific references- I’m sure we will add more as time goes on

Low incidence of fatal coronary heart disease in Pima Indians despite high prevalence of non-insulin-dependent diabetes. RG Nelson, ML Sievers, WC Knowler, BA Swinburn, DJ Pettitt, MF Saad, IM Liebow, BV Howard, and PH Bennett
Circulation. 1990;81:987-995

Food for Thought: Dietary change was a driving force in human evolution. Wm R Leonard. Scientific American. December 2002: 107-114.

A Paleolithic diet is more satiating per calorie than a Mediterranean-like diet in inviduals with ischemic heart disease. Jonsson, et. Al. Nutrition & Metabolism 2010, 7:85

Thirty thousand-year-old evidence of plant food processing. A Revedin, et al Proc. Nat. Acad. Sci, November 2010: 107:18815-18819

Heart disease happens when the arteries feeding the heart become infiltrated with plaques – and these plaques happen to contain fat, cholesterol, white blood cells. If the plaque builds up slowly the flow of blood to the heart diminishes and people develop chest pain or angina. If that plaque ruptures and causes the artery to close- that is a heart attack or myocardial infarction.

Plaque formation was thought to be because of a person’s diet – since the plaques had high levels of fat and cholesterol, it was thought that a diet that was low in fat and cholesterol would minimize a person’s risk of heart disease. Sometimes that is true- but not always- as the French have shown us- with a diet high in fat and cholesterol and one of the lowest levels of heart disease in the western world.

It turns out the instigator of plaque formation are the lipo-proteins that carry cholesterol and triglycerides. Think of LDL, HDL, VLDL, and IDL (low density lipoprotein, high density lipoprotein, very low density lipoprotein, and intermediate density lipoproteins) as boxcars that carry cholesterol and triglycerides. Those lipoproteins set off an inflammatory reaction in the blood vessel (they become oxidized) and that leads to plaque formation. The more of those proteins a person has, the higher the likelihood that they will develop heart disease.

Think of LDL as “lousy.” The HDL levels are associated with fewer tendencies for heart disease – but they still can cause inflammation of the artery, and a problem. Hence, artificially raising HDL levels causes more issues with heart disease (as was recently discovered in the niacin trials). HDL levels are seen in people who have more omega-3 fatty acids in their diets, but increasing their levels is still harmful.

The more lipoproteins your body makes the higher incidence of heart disease you will have.

It has only been recently that science has recognized that one must measure the lipoproteins directly. Not indirectly by measuring cholesterol – as the laboratories do today. In the recent article from the Journal of the American Medical Association, they measured LDL-cholesterol in people placed on diets rich in soy proteins, fiber, and walnuts – showing a decrease in the LDL-cholesterol – a classic mistake. LDL-cholesterol does not measure the total number of lipoproteins. The amount of lipoproteins one has depends on how much cholesterol and triglycerides the lipoproteins have to carry. If a person has a lot of cholesterol and/or triglycerides in the blood the body will make more lipoproteins. If you have too many, those lipoproteins will get into the wall of the artery and lay down their cholesterol and triglycerides (which are fats).

If you have a lot of triglycerides it will bump off the cholesterol and you will make more proteins to carry the triglycerides. Your cholesterol level will be low, but your number of lipoproteins will be high- and thus, even with low cholesterol you will have a high incidence of heart disease. This explains some of the seemingly contradictory data of people who had low LDL-cholesterol levels but a higher incidence of heart disease – when that blood was looked at later they were found to have a high level of the LDL proteins.

We still don’t understand everything about the biology of the formation of plaque but we do know this: genetics determines most of the level of cholesterol, and if your level is high reducing it with medication will reduce the incidence of heart attacks and strokes. If you have genetically high triglyceride levels, the same applies.

In terms of diet- dietary cholesterol has minimal impact on blood cholesterol. Triglyceride level can be greatly impacted by diet – however.

To reduce triglycerides in your diet, here are some suggestions:

* Eat fewer calories if you are overweight. Excess calories are converted into triglycerides and stored as fat.
* Avoid trans fats, found in some fried foods and commercial baked products.
* Replace saturated fat (found in animal fat and some tropical oils) for mono-unsaturated fat (found in olive/canola/peanut oils, etc.).
* Consume at least 2 servings of cold water fish each week, such as salmon, mackerel, tuna, lake trout, herring, and sardines (all of which are high in omega-3-fatty acid). *Include into your diet other foods high in omega-3 fatty acid, such as ground/milled flaxseed, walnuts, almonds, canola or soybean oil, etc.
* Avoid refined foods and foods that contain sugar (such as white flour, desserts, candy, juices, fruit drinks).
* Choose carbohydrates that have 2 grams fiber or more per serving, such as brown rice, whole wheat bread, and whole grain cereals.
* Consume at least 2-3 cups of vegetables and 1 cup of fruit each day.
* Follow your doctor’s advice regarding alcohol. Alcohol increases triglyceride levels for some individuals. If you have high triglycerides and do consume alcohol (such as red wine), it is recommended to limit intake to 5 ounces per day or limit it entirely.
* Exercise to burn excess calories, aiming for at least 30 minutes of physical activity on most days of the week.

Medications
People who have high triglycerides and low HDL or high LDL levels may require medications as well as diet modifications. Patients with triglycerides in the very high range (over 500 mg/dL) generally will require medications, because triglyceride levels this high may cause an acute inflammation of the pancreas.

Making changes in what you eat on a day-by-day basis can make a profound difference over time about how you eat. Here are a few examples of trading up for health:

Years ago I use to have a hamburger and French fries for lunch, almost every day. The first trade up was to get rid of the French Fries. That represented 600 calories a day. Over the course of 5 days that was 3000 calories – almost one pound of fat. In three months I lost five pounds. Eventually, the hamburger went, and was replaced with a home-made chicken salad, much healthier, because I was able to include items with increased micro-nutrients.

Another patient of mine struggled with weight loss and finally realized she was drinking wine every night: 3-4 glasses. First she dropped to no more than two glasses and over two months lost 6 pounds. This last year she changed her habit from having two glasses of wine a night. Here’s what she said:

“I would come home every night and want a glass to relax. Then you talked to me about smoothies, and making my own. So I started making a simple smoothie with berries, yogurt, some flax seed, and fiber. I noticed after I drank it I felt more refreshed, and was in a better place to make dinner. I had more energy – and best of all, I lost another 10 pounds in two months and have kept it off.”

She traded alcohol, and its calories, for berries rich in fiber, vitamins, antioxidants, and the flax seed with omega-3 fatty acids. It was also a way to get more fiber in her diet.

Trading up to better food, to better quality food, means that you can enjoy life more. It gives you a chance to incorporate some of the micro-nutrients that you might be missing. Ultimately you are empowering yourself for your own health.

Nothing tastes as good as healthy food, and nothing tastes as good as slender feels.

Smoothies make a great afternoon snack, too. Especially the time of day when you’ve just gotten home from work, you’re not ready for dinner, but your body needs a little “something.” Or an afternoon snack when you know you are not going to dinner for a while but want something that tastes pretty good.

I like making smoothies, because with them I know I can get into my body the things that I may not get in my daily diet. It allows me to pack in some healthy components, and here are a few things that I keep next to my blender that are important to my morning routine.

Fiber:

Fiber is material that the body does not digest in the guts. It helps keep people “regular” – and that means it will bulk things up. Fiber was once thought to prevent colon cancer, but that is not true. What it can prevent is diverticulosis (a disease of the colon where sometimes we have to perform a colostomy and remove part of the colon). Fiber can also prevent hemorrhoids (and if you have them it can help get rid of them).

The American Dietetic society recommends adults get 21 – 38 grams of fiber a day – and most get less than half of that amount. The best sources of fiber are vegetables, beans, fruits, and whole grains. Fiber adds bulk to the diet – and can make you feel satisfied for a long period of time.

I like adding fiber to supplement my diet, and there are a whole bunch of these products on the market. Some of them can cause gas – so I prefer those that do not – like Citrucel. Adding Citrucel to a smoothie gives me a boost of fiber and “keeps me going.” This type of fiber is called methyl-cellulose. It is found commonly in plants – and your body doesn’t digest it, but it acts as a broom to clean things out.

Flaxseed Grain:

Flaxseed is a grain that is high in Omega 3 fatty acids, that may help reduce the risk of heart disease. These are healthy fatty acids that help reduce total blood cholesterol and low-density lipoprotein (LDL, or “bad”) cholesterol. Think of your blood vessels like plumbing. Over time they get clogged with things like low-density lipoprotein (LDL). Think of Omega-3 fatty acids as the Drano for your plumbing. While you want to avoid putting things in that will clog those arteries, you also need some help getting rid of old bad habits. The whole grain is not always digested – so I prefer ground flaxseed. I typically add a tablespoon of this to the smoothie.

Whey Protein:

Protein isn’t always needed in a smoothie- especially if you are getting enough protein from your regular diet. But if you need some protein, a whey based protein is helpful. I use a product called Unjury. This is a medical protein that you can purchase online. We use that because it is the tastiest of the proteins out there (based on a taste test of my patients). It also has no added calories. Some of the flavored proteins also add a bit of different tastes to the smoothie, and the protein gives the smoothie a nice consistency and flavor.

Splenda:

Artificial sweeteners are either the saving grace of America, or the cause of evil. My basic take on sweeteners is that you should use natural food, and not artificial sweeteners. The first issue with artificial sweeteners came to light when cyclamates were found to cause cancer in rats. So in 1969 cyclamates were taken off the market. Saccharin was the next agent, but many didn’t like its after taste. Then came aspartame (Equal). This had no bitter after taste and became the favorite until someone started a rumor that aspartame killed ants, and was originally used as a rat poison. This is untrue on both counts. First, aspartame was developed as an artificial sweetener and second, it does not kill ants (I tried it, as have a lot of others – sadly it doesn’t work).

Splenda does contain calories (because of our FDA regulations it is allowed to be listed as “zero calories” but it is not). Splenda has 3.36 calories per packet (1 gram). It tastes like sugar- is made from sugar – and is generally easy to deal with. Two other sweeteners have joined the market in the United States. Stevia is a product of several plants and was recently approved as a food additive in the United States, and Truvia (a proprietary blend of Stevia made by Coca-Cola and Cargill the Pepsi produce it PureVia). These are essentially all the same. There are some other sugar-alcohols like Xylitol that work.

The issue with artificial sweeteners has been getting used to the sweet taste, and increase in appetite. In rats that are consuming artificial sweeteners, there is an increase in their body weight over time as they increase the amount of food they consume. Not that we are rats, but avoiding the sweet taste is important. And it’s no accident that while many of my weight loss patients consumes large quantities of “diet cola,” they still consume a lot of calories to go with the diet soda. It is also no accident that once our patients get off artificial sweeteners, they do much better.

Overall, avoid the artificial sweeteners. But when it comes to smoothies, you can add just a bit. Want to know what’s even better than Splenda (which I only use for very tart berries) ? BLUEBERRIES – a great natural sweetener.

Strawberry Smoothie

There is nothing like a smoothie to start the day, and sometimes when I first walk in the door from the office. Waking up after a night of sleep means you need some fluid – just like after a long day of work! So having a smoothie is quick and easy. The addition of some protein powder and fiber makes this a great start to the day (or end of the day).

1 ounce of Vanilla Whey (I use Unjury from unjury.com – it is a medical protein)

1 cup of frozen strawberries

4 ounces of plain Greek yogurt

1 tablespoon of sugar free Citrucel (fiber supplement)

1 cup of water

2 tablespoons of Splenda

Blend in a blender until smooth. It makes two servings

144 calories, 22 g protein, 0.1 g fat, 0 cholesterol, 4.15 gm of fiber

A word about blenders: There are lots of them on the market. Get a good one. Most professional chefs have a Vitamix in their kitchens at home and at work. They are expensive, but they are worth the extra money, and they have a wide range of things to do besides crush ice for the margarita.

For a while it seemed that everyone was talking about the importance of fiber,  and its role in preventing a variety of diseases.  After much speculation, we now have a few answers about  what fiber really does, and what makes it an  important component of good nutrition.

Fiber is simply things that humans cannot digest.  Many vegetables and fruit have methylcellulose – the stringy stuff– and we, as humans cannot digest it.  Cows can, horses can, deer can – but not humans.  This is why it is better to cook vegetables – because by breaking down some of the fiber our bodies can get to the nutrients that are locked into the vegetables.

What we do with it is simply pass the material through our body.  If you don’t have enough fiber you can become constipated – and develop things like hemorrhoids or diverticulosis.  Fiber is also good if you have chronically loose bowel movements – it will help bulk up the stools.

Years ago a group of people thought increased fiber would lead to less colon cancer – -with the theory that fiber acts as a broom to sweep out the colon and thus keep the colon from being in contact with toxic stool.  Well- that has been tested in a number of places and just isn’t the case.  Even people with high fiber diets have no lower incidence of colon cancer than those with an average fiber diet.

Some thought fiber would increase the metabolism – so by taking more fiber in you would be able to loose weight.  That was proved to be incorrect also.

What is known is that the more bulk fiber you have- from fruits and vegetables- with higher fiber — the longer the sense of feeling full is.

This is why we recommend to patients to increase green vegetables, or squash, or beans – to increase their fiber – and to keep them feeling full for a longer period of time.

So- if you want to lose weight- increase your fiber and decrease your processed food.  If you suffer from chronic hemorrhoids – see your doctor- but before then start on a high fiber diet (I recommend to my patients they take a scoop of fiber in 12 ounces of water followed by 12 more ounces of water).

Find yourself hungry mid-afternoon — consider a high fiber snack – like fruits.

So fiber has a lot of advantages – and the best source of fiber — vegetables

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