In the paleo/primal community, the messages about how to eat have recently become more confusing. As people move towards eating for better health, more questions seem to arise. Should I go low carb? Or maybe even ketogenic? What about if I have autoimmune disease? Or a thyroid problem? Or irritable bowel syndrome?
Everybody’s optimal diet will be slightly different based on their genetics, medical history, and what they can easily and affordably maintain.
Everybody’s optimal diet will be slightly different based on their genetics, medical history, and what they can easily and affordably maintain. The good news is that we will reap the greatest rewards just by beginning to eat in a more ancestral way.
In all honesty, the huge volume of data that we have tried to collect in order to figure out how to eat to prevent disease is incredibly confusing. However, one thing is almost certainly clear: the more we have messed with our food, the sicker we have become. The best way to eat is not actually a diet at all. It’s just a matter of eating real food.
Wherever you look, be it the traditional diets of previous or currently healthy cultures, or more recent clinical trials, the switch from processed foods to real food has a dramatic effect on health. Though we often worry about whether we should eat paleo or primal, or maybe follow an Atkins or a “Mediterranean” diet, all of these have shown various benefits. Although the details of these diets can often look quite different, what they have in common is a move away from processed foods and towards eating more nutrient-dense and fresh foods. For most people, this is all they need to do. Cut out the take away, sweets, cakes, bread, and fried things. Instead, learn to cook some basic fish, meat, and vegetable recipes, and make salads. Then make double and take it to work for lunch the next day.
The combination of vegetable oils (often used at high temperatures for frying) and processed carbohydrates is the defining feature of the Western diet.
By switching back to real food made from fresh ingredients, a number of things instantly happen:
- Intake of processed carbohydrates and vegetable oils drops
- Intake of protein and nutrients increases
The combination of vegetable oils (often used at high temperatures for frying) and processed carbohydrates is the defining feature of the Western diet. These ingredients are also linked to everything from heart disease to obesity, diabetes, and cancer. Our relative protein intake has also dropped, and protein is essential for a number of processes, particularly in maintaining a good metabolism, as well as bone strength. The issue of nutrient dense foods is also increasingly important, because we have stripped the soil of nutrients from decades of intensive farming. Compared to 100 years ago, we need to eat more food to get the same amounts of the vitamins and minerals we need to be healthy. This means we just can’t afford to eat refined foods at the expense of fresh produce.
For the average person trying to eat to stay healthy for as long as possible, the single best thing they can do is to reduce their intake of refined and processed foods, and go back to eating real food.
However, there are more specific diets out there that might fit your needs better, depending on any current health issues. These are all grounded on the same ideas, and can be tailored to specific needs. Though the list could be much longer, below is an overview of where people can think about starting.
Eat meat and vegetables, nuts and seeds, some fruit, little starch and no sugar. These are the basic paleo guidelines, and include the strict avoidance of all processed foods, grains, beans, peas, and dairy. Our best estimates suggest that up to 10% of people have some kind of gluten sensitivity, and these people should almost certainly avoid all grains. Though it will depend on genetics, many people will also benefit from removing dairy. Paleo is a great place to start for people with established metabolic disease (heart disease, type 2 diabetes, obesity, polycystic ovary syndrome) because of a spontaneous reduction in carbohydrate intake and moderate increase in protein. For the rest of us, however, the original paleo guidelines are probably stricter than we need.
Originally, the main difference between paleo and primal was a move away from restriction of saturated fat in the original paleo diet outline. A primal diet also encourages the intake of occasional high-quality (grass-fed, raw if possible, and often fermented) high-fat dairy, which can be an incredible source of nutrition. This has now become more common in the later versions of paleo, as has the inclusion of some other starches such as potatoes and rice. Some people are also including some beans or lentils, as these have been eaten for hundreds of thousands of years, and overall the data suggest that they can be beneficial additions to the diet, if tolerated. This approach is slightly less restrictive, so may be easier to follow. The important thing here is to remember that with an increase in the “allowed” foods, carbohydrate intake should still be tailored to health and activity levels.
Autoimmune Paleo (AIP) has real therapeutic potential in those with certain diseases. It includes the avoidance of eggs, nuts, seeds, and nightshades (potatoes, tomatoes, eggplants, peppers etc). A key aim is to minimise and reverse any gut permeability, which is associated with almost every autoimmune disease. I would also recommend AIP as a starting point for anybody with neurological diseases such as multiple sclerosis. This is because gut permeability, as well as antibodies that react with dairy and grains, can increase inflammation within the brain, and exacerbate symptoms.
For those with established metabolic diseases such heart disease, obesity, or type 2 diabetes, lowering carbohydrate intake to less than 15-20% of calories appears to be the best way to lose weight, re-establish metabolic health, and reduce future disease risk. Much of this comes through a reduction in insulin, and an improvement in insulin resistance. A low carb approach can easily fit into any of the diets above. However, those struggling with more complex autoimmune, adrenal, or neurological diseases should focus on maximising health through a nutrient-dense AIP approach, for example, before restricting carbohydrate intake.
Nutritional ketosis has huge potential benefit in certain contexts, but people will respond very differently based on their health and genetics. Ketogenic diets have been used for decades as a treatment for difficult cases of epilepsy, and are currently being investigated in human trials as an add-on treatment for certain cancers, and for brain injury such as strokes. Ketogenic diets also have benefit for metabolic diseases. However, most of this benefit appears to come from lowering carbohydrate intake, and there is some suggestion that strict ketosis may not be better than low carb for those with type 2 diabetes or obesity. The biochemistry of ketosis is both cool and complicated. For instance, ketosis boosts mitochondria and antioxidant levels, but there’s a risk of becoming deficient in certain minerals (such as sodium, potassium, magnesium, calcium, and selenium), as these are less well retained during ketosis. It is worth mentioning that we don’t have a large amount of strong scientific data on ketosis lasting longer than a few months, and we’re still teasing out all the mechanisms that explain both the potential positive and negative effects of long-term ketosis.
Some other diets worth considering are the Gut and Psychology Syndrome (GAPS) diet, the low FODMAPs (fermentable oligo- di- and monosaccharides and polyols) diet, and the specific carbohydrate diet (SCD). These largely focus on gut health, which is incredibly important for those with both mental health issues as well as things like irritable bowel syndrome. After a period of an exclusion diet, GAPS is largely similar to paleo, and will have similar benefits. Both low FODMAPs and SCD have been shown to improve symptoms in those with IBS, and some small studies suggest that the SCD may be a potential treatment for Crohn’s disease.
So, how should I eat?
The important thing to take away is that there is a huge amount of overlap across all these approaches – they focus on the importance of getting nourishment from food rather than just calories. It’s all about the overall pattern of your diet, so for most people, occasional pasta and milk won’t be a problem as long as they’re eating fresh real food.
Don’t eat food with lists of ingredients. Just eat ingredients.
If you need to move on from there, a few key ideas can help guide you:
- A more primal approach will often be more sustainable, and maximise the nutrient-density of the diet through greater variety.
- Those with chronic metabolic problems will benefit from lowering carbohydrate intake.
- Those with autoimmune or neurological disease should consider AIP.
- For those with specific gut issues, low FODMAPs and SCD can be helpful. Some people may even benefit from removing all fibre from the diet.
- Ketosis has a number of potential benefits, but we’re still waiting for robust long-term data in many contexts.
Importantly, it’s worth making sure you’ve given your current approach time and thought before trying something else. Also avoid complicating things by trying too many diets at the same time (like a low carb and low FODMAPs version of AIP). Be honest with what you’re looking for, and create a sustainable plan – returning to health will take time, but is completely worth it!
Finally, don’t worry about it too much – the stress of worrying about what you eat can undo much of the potential benefit. No matter how you end up eating, food should still be fun!
For further information on other diets please visit the following: