Decoding Popular Diets: The Paleo Diet

Last year, during my semi-annual teeth cleaning, my dentist asked my opinion on the Paleo Diet.  Mouth agape, I provided a brief and likely unintelligible response referencing the benefits of prioritizing whole foods and the potential risks of eliminating entire food groups.  Next visit, I'll simply direct him to this analysis, which will hopefully clear up any questions that you (and my dentist) have regarding the Paleo Diet. 


As a refresher from last week's post, here are the basics of the Paleo Diet:

The premise: Look to the past (back to what Paleolithic humans may have been eating) to guide our nutrition decisions today.  What to eat: Load up on fresh fruits + veggies, meat, seafood, eggs, healthy oils, nuts, + seeds.  What to avoid: Skip dairy, grains, legumes, potatoes, refined sugar, processed foods, and refined oils.  Grain-based alcohols are off-limits too!  Side note: There are a couple variations of the diet.  For example, sweet potatoes (but not white potatoes) are often included in moderation, and alcohol may be avoided completely (including wine).  

The analysis: There are two ways to analyze the Paleo Diet:  (1) from an evolutionary perspective (essentially, should we eat as cavemen did based on the health status of said cavemen, and if so, what does that look like in today's world?) and (2) from a nutritional perspective (are the included/excluded foods of the Paleo Diet backed by current nutrition research and if so, does that research support health improvements?).  As my expertise lies in nutrition, my analysis focuses on the latter perspective. 

The changes: When shifting from the typical Western diet to the Paleo Diet, the most obvious change is a decrease in overall carbs in exchange for an increase in protein and fat intake.  While calorie restriction isn't part of the diet, specific food group restriction is and those forbidden food groups contain a high percentage of carbohydrates.  Plant and animal based foods are both encouraged with a ratio of about 45:55 (plant:animal).  Since grains and legumes are avoided, fruits and vegetables will make up the majority of the plant-based foods. 

The good:  The Paleo Diet encourages an abundance of vegetables, preferably organic and local.  Fruit is also encouraged, although in smaller quantities than vegetables due to the higher sugar content.  Fruits and vegetables provide vitamins, minerals, antioxidants, and fiber - all things that we can and should increase in our diets!  Choosing organic and local options limits chemicals and transport time + resources and supports community growers.  When it comes to meat and fish, the Paleo Diet prioritizes quality sources, focusing on free-range + grass-fed meat along with wild-caught seafood.  Non-traditional meats also have a place in the Paleo Diet, including insects, which offer a sustainable source of protein. The diet advocates for monounsaturated oils (like olive oil) along with nuts and seeds, which all provide healthy fats.  Overall, what's included is mostly great stuff!  Additionally, avoiding processed foods and limiting alcohol should positively influence overall health and may even lead to weight loss.      

The questionable:  As a dietitian, I'm hesitant to remove entire food groups without a solid reason for doing so and a solid plan to make up for the nutrients found in those food groups.  To begin, there's the emotional issue of creating a forbidden foods list - will you feel deprived or begin to associate certain foods with guilt?  This is especially a concern if you have experienced disordered eating behaviors in the past or are opting into the Paleo Diet with the sole goal of losing weight.  While you can lose weight on the Paleo Diet (likely related to the removal of high-calorie, low-nutrient foods), I think you need to dig deeper than "I want to lose weight" to fully commit to and find success in the Paleo Diet as a lifestyle.  

Second, if you aren't experiencing gastrointestinal distress (stomach pain!) or another form of discomfort (foggy mind, inflammation, etc.) from eating certain foods, do they need to be strictly avoided?  While dairy, grains, and legumes can cause distress (especially for those with lactose-intolerance or Celiac Disease), they also offer a lot of benefits!  Dairy provides calcium, potassium, phosphorus, and vitamin D; grains (especially whole grains!) offer B vitamins and fiber; and both dairy and certain grains can be a good source of protein.  Legumes are also a valuable source of nutrients as they are high in fiber and serve as an affordable plant-based protein option.  Additionally, both grains and legumes contain folate, a B vitamin that is is influential in preventing neural tube defects and is therefore a key nutrient for women of childbearing age.  While the nutrients in dairy, grains, and legumes can be found in other foods, removing those food groups still requires an action plan to ensure adequate nutrient intake.  

Third, there's the issue of saturated fat.  With animal-based foods comprising 55% of the Paleo Diet, saturated fat intake may be higher than recommended.  Saturated fat has been in the news a lot lately (is it really bad for you?), but the overwhelming research shows a negative relationship between saturated fat and heart health.  As such, the American Heart Association recommends limiting saturated fat to 5-6% of your total calories (about 13 grams or 120 calories per day when consuming 2000 calories per day).  

The recommendations: I'm a big believer in working with individuals to find a way of eating that both fits their lifestyle and needs and optimizes their health.  The Paleo Diet is based in many sound nutrition guidelines that I fully support, but I also have a few recommendations to ensure adequate nutrient intake while following the diet.

1.  Work with a Registered Dietitian to help you discover what foods cause problems for YOU.  Determine if you can reduce the quantity of those foods or if complete elimination is the solution.  If elimination is key and the foods offer nutritional value, a Registered Dietitian can help you find alternatives (that you'll actually eat!) to provide those nutrients.  

2.  On a related note, as previously mentioned, you can find the nutrients in dairy, grains, and legumes in other foods, so eliminating them doesn't mean you're going to become nutrient deficient.  But without a realistic plan, you might be at risk.  Yes, fruits and veggies offer lots of vitamins, minerals, and fiber, but take a look at how much of those foods you currently consume and how much you plan to increase your consumption.  Remember that successfully following the Paleo Diet will likely require both the elimination and the addition of foods.    

3.  Learn about the bioavailability of nutrients (read: how well nutrients in certain foods are absorbed and utilized in the body) and what combinations of foods and/or nutrients will aid or inhibit nutrient absorption.  For example, calcium has been shown to inhibit iron absorption while vitamin C enhances it.  A Registered Dietitian can provide further guidance in this area as well.  

4.  To cut back on saturated fat intake when following the Paleo Diet, choose lean meat options as often as possible and choose oils rich in monounsaturated fats over animal fat (lard, duck fat).  

5.  Finally, whether or not you want to follow the Paleo Diet, most of us could benefit from two key parts of the plan: increasing our vegetable intake and reducing our highly processed food intake (think high calorie, low nutritional value items).  Making a few small changes to your diet can still have a big impact on your health and may feel more attainable and sustainable.      


Do you follow the Paleo Diet?  What's the biggest challenge you've encountered?  What do you enjoy the most?  Do you follow it strictly or allow for a few changes?  Let me know in the comments below!