It’s that time of year. Everyone is looking to make changes to their diet, and US News and World Report published its Best Diet Rankings for 2017. And once again, the Paleo Diet ranked very poorly and in last place was Whole30. In first place is the DASH diet, originally developed to prevent and lower high blood pressure. I figured I’d add to previous rebuttals here and here with a shiny new version of the same old argument.
I’m a dietitian and I love real food. I’ve seen people give up processed foods and it can change their life. It’s amazing to me that there is still so much bias against giving up processed foods. The reality is, not many people can moderate when it comes to hyper-palatable foods. I’m sure it’s pretty threatening to classically trained nutrition experts who still believe in low-fat dogma that the Whole30 book and Cookbook tops The New York Times Best Seller List. The Paleo Solution and blogs like Nom Nom Paleo are runaway successes. This is such a sharp departure from the norm. But maybe real food is what people need. And, given the great success of Paleo and Whole30, maybe it’s what people want because it works.
Never before have humans had to push away such an abundance of hyper-stimulating, highly processed, nutritionally void food-like products. These modern foods bypass our normal satiety cues, causing us to eat many more calories than we need for our sedentary lives. We’re overfed, obese, exhausted and malnourished all at the same time. Maybe we need to eat less fillers and more real food. I’d like to take a moment to provide some counterpoints to show how eating a nutrient-dense, real food diet, can actually be better than diets that completely avoid meat, require drinking 2 shakes a day containing high-fructose corn syrup, allow you to skip eating real food to save your “points” for alcohol, and ones that allow only 500 – 800 calories a day.
Enter Paleo and Whole30
The reason these diets work is because they force people to invest in a complete dietary transformation. One of the criticisms in the US News Report is that “most diabetes experts recommend a diet that includes whole grains, legumes and dairy products.” But if you stop to think for a second, aren’t many of those foods just adding more carbs with little other nutritional value? Also, aren’t we failing diabetics with our advice? We don’t need to drink orange juice and eat whole grain cereal with low-fat milk every morning. Beans are pretty difficult to digest and not a better source of protein than meat. Grains are not a better source of nutrients and fiber than roots and tubers. And while I see some benefit in high quality, full fat dairy in the form of yogurt or cheese, I also think it’s a great exercise to eliminate it for 30-days to see how it makes you feel. As far as milk goes, well milk is great at putting weight ON mammals, that’s what it’s for. With 75% of the world’s population lactose intolerant, and most of the nutritional benefits in milk coming from fat-soluble vitamins, it’s time to reconsider recommending 3 cups of low-fat or skim milk each day. There are no risks in avoiding sugar, grains and dairy and in fact, giving up these foods can help prevent disease.
The Difference Between Paleo and Whole30
Both diets focus on fresh meat and seafood, vegetables (including roots and tubers), fruit and healthy fats. Both diets avoid grains, sugar, legumes and dairy, plus industrially processed vegetable oils like soybean and canola. The Whole30 is intended to be a 30-day nutrition challenge that is based on the Paleo template, but further excludes honey, maple, and “Paleo treats.” The Whole30 is designed to reset your metabolism and taste buds, break your sugar addiction, and get folks back in the kitchen cooking real food instead of relying on convenient but unhealthy processed foods. The Paleo Diet is more of a template for an overall lifestyle that usually means a 30-day “squeaky-clean” intro (similar to the Whole30), then an 80/20 long term maintenance phase, meaning 80% Paleo and 20% healthy modern foods (some rice, cheese, yogurt, and the occasional treat) if tolerated. The Whole30 is not the Whole365. Most people who do a Whole30 end up also following a Paleo template of 80/20 after their 30-days.
Let’s do a quick rundown and rebuttal of the assumptions that USNWR and many other popular press critics have about paleo-style diets.
Assumption: Paleo Folks are Trying to Recreate Cave Man Days
Nobody is literally saying that domesticated cows were around during hunter gatherer times. Instead, these diet are simply looking back at what humans evolved to eat and focus on those foods as a template to for a more modern version of that diet. Yes, there is some evidence of a little grain consumption several tens of thousands of years ago, but generally humans evolved eating meat, roots and tubers and seasonal fruits, and that diet seems to work great for those who have tried it. Paleo is simply a template for eating a diet mimicking the hunter-gatherer way of eating.
I showed my cookbooks to my nutrition professor while completing my RD, and her exact words were, “Wow, you need to change the name of your book because this isn’t paleo, this is really healthy!” She admitted she had a bias against the word paleo, but once she understood that I was intelligent, very healthy, understood nutrient metabolism and also advocated for sustainability, her guard came down, and she was able to look at “Paleo” without cringing. Although she is a vegetarian for personal reasons, she said, “If I ate meat, this is exactly how I would eat.” So let’s please remove our stereotypes and keep an open mind, as real scientists do.
Assumption: We need to be eating grains to be healthy.
They are convenient, but not necessary at all. Nobody needs toast and pasta. Americans are not grain deficient. Let’s look at how sweet potatoes compare to whole wheat:
Sweet potatoes also have only 90mg of omega-6 per cup compared to the same amount of wheat cereal delivering 452mg. Grains are a big source of omega-6s, the kind of inflammatory fats that should be consumed less, not more. The foods with the highest omega 6’s are vegetable oils (margarine, commercial salad dressings) and another huge sources is grains, yes, even whole grains.
Type 2 diabetes is a disease of carbohydrate intolerance. Sugar is addictive. You would never tell an alcoholic to just self moderate and hope for the best, so why would you tell someone with metabolic disorder from overconsumption of carbohydrates to moderate? They need to give up the sugar. Instead, we’re telling them to eat less meat and more grains and legumes, and skim milk (more than 1/2 the calories from skim milk come from sugar.) In fact, the American Dietetics Association lists beans as the ideal source of protein.
From the Institutes of Medicine: “The lower limit of dietary carbohydrate compatible with life apparently is zero, provided that adequate amounts of protein and fat are consumed. However, the amount of dietary carbohydrate that provides for optimal health in humans is unknown. There are traditional populations that ingested a high fat, high protein diet containing only a minimal amount of carbohydrate for extended periods of time (Masai), and in some cases for a lifetime after infancy (Alaska and Greenland Natives, Inuits, and Pampas indigenous people) There was no apparent effect on health or longevity. Caucasians eating an essentially carbohydrate-free diet, resembling that of Greenland natives for a year tolerated the diet quite well. However, a detailed modern comparison with populations ingesting the majority of food energy as carbohydrate has never been done.”
The RDA for carbohydrate is only set at the arbitrary value of 130g/day in order to avoid ketosis, however they also say ketosis is not a danger (and this paper also backs that up). Ketosis is not ketoacidosis.
Now, the Paleo and Whole30 plans aren’t void of carbs, but people will naturally eat much less in the form of carbs if they’re not consuming breakfast cereals, bagels, breads, pasta, and cake. And it turns out, when you eliminate these foods from your plate, you end up replacing them with nutrient dense foods that are difficult to over consume because they’re not hyper-palatable. Nobody is going off the rails for sautéed spinach, roasted salmon and water, but they DO line up never-ending bowls of pasta, bread sticks and wine.
Let’s get rid of our bias of low-carb diets and instead, take an honest look at the research proving that a lower-carb diet can actually prevent or reverse type 2 diabetes. The carbohydrate choices for Paleo and Whole30 are completely reasonable, nutrient-dense, and delicious without overstimulating our appetites causing us to over consume. This is why most people with blood sugar disregulation do very well on Paleo and Whole30.
Assumption: Plant-Based Proteins are “Better” Than Animal Proteins
I challenge this on several levels. First of all, we need to be eating more protein and better protein. There’s an assumption that all we need to eat is 0.8g/kg per day. This is the absolute minimum to avoid disease, not the amount for optimal health. Also, this often gets translated to a baseline recommendation of 56 grams a day for men and 46 grams per day for women, numbers based on a “reference” man of 70kg (154lbs) and a “reference” woman at 57kg (125lbs). The average weights for Americans are much higher.
The Acceptable Macronutrient Distribution Range (AMDR) for protein is 10% – 35% of calories from protein. On a 2,000 calorie diet, this means 20% of calories from protein is actually 100g/day. That’s double the RDA. According to the Dietary Reference Intakes by the Institute of Medicine, “the current state of the literature does not permit any recommendation of the upper level for protein to be made on the basis of chronic disease risk.” This means there is no worry for people to consume more than the upper limit, though it would be pretty difficult to consume 35% of your calories from protein (the upper end of the AMDR.) That would be 175g of protein on a 2,000 diet.
Protein is the most satiating macronutrient. The more protein you consume, the more full you feel. Now, if you are trying to get more protein, here are the most efficient sources.
Let’s look at calories next. If we’re trying to eat more protein but fewer calories, which sources of protein are the best choices? Let’s look at how many calories you need to consume of these foods to get 30g of protein in a meal.
These two charts illustrate that animal protein is both the most efficient forms in terms of calories and grams of protein per serving. It should also be noted that plant-based proteins are not as easily digested and do not contain the full amino acid profile. Plus, beyond protein, animal flesh has a lot more vitamins and minerals than plant-based proteins, like heme-iron which is not available in plants.
So by “better,” I’m guessing that we’re talking about the misconception that all this red meat we’re eating is causing disease. Diabetes is not a disease of red meat intake. Cholesterol and saturated fat are “no longer nutrients of concern.” That said, are we really eating more red meat these days? Let’s look at our consumption patterns since 1970:
The assumption is that our “increase” in red meat is killing us, when in truth, Americans are eating less red meat than we did in 1970. But look at what we’re eating more of: poultry, vegetable oils, grains and sweeteners. Let’s also admit that epidemiology can only show associations, not cause. Correlations are interesting and can spark conversation, however they should not be presented as “evidence” that a particular food caused a particular outcome. Here’s an example of a correlation:
The reports that meat causes cancer are a little blown out of proportion. Comparing meat to cigarettes? In this review of 35 studies, the writers reported: “Collectively, associations between red meat consumption and colorectal cancer are generally weak in magnitude, with most relative risks below 1.50 and not statistically significant, and there is a lack of a clear dose–response trend.”
Additionally, relying on food frequency questionnaires can hardly drive policy, because it’s been proven that people lie when trying to recall what they ate. The truth is, when comparing someone on a vegetarian-type diet to a person on a Standard American Diet, you can’t simply call out red meat as the driver of disease. There are many other lifestyle factors that typical vegetarians do differently than a typical American, like generally taking more care of themselves by doing yoga and other movement, not smoking, drinking less, etc. In this study that compared those who shop at health food stores (so, accounting for lifestyle) there was no different in mortality, heart disease or stroke found between meat eaters and vegetarians. Eating lots of fresh vegetables and living a health conscious life are both important, something central to the most vegetarians, Paleo and Whole30 followers.
Red meat itself is not the villain, it’s more likely to be the fries, 72oz soda, and deep fried apple pie that was consumed with it.
The other reason why people call meat “bad” is the assumption that it’s better environmentally to eat only plants. Many parts of the world (such as much of Africa) are not well suited to cropping of wheat, corn, soy, and water-sucking plants like lettuce. Most of the world’s landmass is not suitable for growing vegetables and grains, and instead is much better used as grazing land for animals. I got into this much deeper in this post, but the summary is that we’re attacking meat as being an environmentally toxic and unhealthy way to get protein this is not necessarily the case. I do agree that we need to be eating fewer animals that eat grains (like CAFO chicken boneless skinless chicken breasts) but if we focus on animals that are converting grass (something we can not eat, on land that does not compete with humans for edible food) to flesh, then it’s pretty clear that eating these animals is quite efficient for human nutrition AND it can improve the soil and the climate, helping to sequester carbon.
I feel that most of the anti-meat energy comes from the guilt associated with killing an animal for our nourishment. Factory farming is not good for animal welfare or the environment, but to rule out all meat because of factory farming is like saying I’m not going to eat vegetables because I don’t believe in GMOs. Don’t hate the player, hate the game. It’s not that hard to find good meat. You can get grass-fed beef at Walmart now.
Assumption: There are Health Risks of the Paleo and Whole30 Diets
I’d like to first point out that in the US News critique of the vegan diet scores a 3.3 for “Nutrition”, although they also say how concerned they are about nutrient deficiencies. In fact, it’s been documented that the risks of a vegan diet outweigh any benefits. However, under Paleo and Whole30, there are huge red flags in the “Nutrition” category, saying you’ll miss calcium and vitamin D, plus those with IBS should consult their doctor before starting a Whole30, even though evidence is emerging that low FODMAP and the Specific Carbohydrate Diet (which are quite similar to Whole30 and Paleo) can be effective in treating IBS. There was also criticism from USNWR that the Whole30 is high in sodium, that saturated fat can lead to insulin resistance, and that the other diets are simply much healthier than Paleo and Whole30. I’ll tackle these each below:
Calcium and Vitamin D
Dairy is actually not the most efficient way to get calcium or vitamin D. US News actually has a post saying that you don’t need dairy to get calcium highlighting sardines, vegetables, and nuts and seeds, all foods approved for Paleo and Whole30. Cod liver oil and salmon are fantastic sources of vitamin D, foods that are not allowed on plant-based diets. Plus, milk is fortified with vitamin D, so it’s really no different from taking it in supplement form along with some calcium. So why attack the Whole30 as being deficient in these nutrients? Also, I’d like to point out that on the sample day breakdown of nutrients, USNWR scored the Whole30 diet as containing nearly 3 times the recommended intake of Vitamin D. I find it funny that there was no Vitamin D for the Paleo diet, considering that the two diets are nearly identical, yet the Vegan diet had B12 above the RDA listed in the USNWR. Was this in the form of a supplement? Without listing what foods were used to calculate the findings, it’s not very transparent and leaves a questioner like me puzzled.
Also, I found it interesting to read this comment, “Avoid diets that require a supplement … as this indicates the meal plan is lacking in nutritional value and the object of the diet creators is to use the diet for their own profit, one expert advised.” This is completely made up information. On the health and nutrition page of the USNWR, it was acknowledged that “A supplement isn’t required, but the Whole30 founders write in their book that they ‘believe many people would benefit’ from high-quality fish oil, vitamin D3, magnesium and ‘maybe some digestive help, like enzymes or probiotics.” This recommendation is completely reasonable, yet not a requirement of the diet. Vegans on the other hand absolutely require the supplementation of B12 to avoid serious neurological damage. Vegans also need to supplement with DHA. And, isn’t SlimFast based on supplements?
General Claims of Nutrient Deficiency on Paleo and Whole30
Here are a few more nutrition criticisms from USNWR, “While its focus on veggies and lean meat is admirable, experts couldn’t get past the fact that entire food groups, like dairy and grains, are excluded on the Paleo diet. “The risk of nutrient deficiency is real, unless the person takes a multivitamin,” one panelist commented. Here, its rating lagged behind most other diets.” And another, “Experts worried about dieters missing out on key nutrients on the Paleo diet, given that it shirks entire food groups. Its rating classifies it as “somewhat unsafe.” It was among the poorest performers in this category.” Again, what nutrients exactly can’t we get from meat, seafood, vegetables, fruit and nuts?
There’s Too Much Sodium on the Whole30
I’m completely perplexed by this one. In breakdown of nutrients on a Whole30 diet, the sodium was listed as 4,758 mg. Interestingly, the Paleo Diet came up as only having 726mcg. There was no place that I could find exactly which foods were used to compute the nutrition scores – a major flaw because there is no way I can verify the data. On a diet with no processed foods, how is it possible for someone who is basically cooking all their meals to have a sodium content of over TWO TEASPOONS of salt a day? Nobody adds this much salt to their roasted chicken and sautéed kale. On the “recipes” tab of the USNWR review, there’s a sample day listed and there is NO ADDED SALT at all. Now, humans need salt, and we all know that eating processed foods is where the majority of our sodium intake comes from, so on a diet void of processed food, the Whole30 and Paleo actually looks a whole lot like a “low sodium” diet to me – in fact the nutritional breakdown for Paleo shows it as having 1/2 the sodium (only 726mg) of the halo’d DASH diet (at 1507mg and 2101mg), one that allows margarine, fruit juices, white pasta, and includes (gasp) RED MEAT.
High Saturated Fat Leads to Insulin Resistance?
I took a look at the Atkins reviews as well. I don’t know how Atkins scored better than Paleo and Whole30, when they eliminate many more foods and include processed bars as part of the plan. I do appreciate the low-carb approach though, and I’ve seen many people do well on Atkins. Here’s a quote: “One panelist observed that the high level of saturated fat intake on the diet can hike the risk of insulin resistance, a hallmark of Type 2 diabetes.” How is this possible when going low-carb is fantastic at reducing insulin resistance, and has been shown to reduce glucose, insulin, triglyceride, ApoB and saturated fat (especially palmitoleic acid) concentrations, reducing small dense LDL particle numbers, glycated haemoglobin (HbA1c) levels, blood pressure and body weight while increasing low HDL-cholesterol concentrations and reversing non-alcoholic fatty liver disease (NAFLD)?
Diets that contain whole grains, low-fat dairy, legumes and sugar are healthier.
I took a look at the breakfasts listed for the various diets. The breakfast listed for the Paleo Diet is not really what paleo folks eat. This was taken from Loren Cordain’s book, who doesn’t “own” Paleo. Nobody owns Paleo. That’s the problem with people citing only his book as “THE” paleo book. His just happened to be the first book with that title. Most people on the Paleo Diet and Whole30 eat about 4-6oz protein per meal. So, I called the breakfast Whole30/Paleo, since the example for a Paleo breakfast in USNWR is unrealistic. The breakfast shown is quite similar to what I would eat for breakfast. I should note that prior to adopting a low carb/higher protein and fat diet, I ate very similar to DASH and was in metabolic syndrome but I was not overweight. I was a blood sugar mess though, and any of the other breakfasts listed here would certainly leave me starving by 9:30 and hypoglycemic.
Compared to the Whole30/Paleo breakfast, these other examples are low in fat, low in protein, and high in carbs. Eating this way in a fasting state (first thing in the morning) can set a person up for a blood sugar roller coaster. I was particularly unimpressed with the DASH diet (the #1 ranked diet.) Cereal, toast with margarine and orange juice? Who eats margarine still? I thought that left with the 1980’s. And we all know orange juice is just sugar. There are way better sources of vitamin C than orange juice. Did you see the Macrobiotic diet? It starts the day with NO FAT and NO PROTEIN. I really don’t understand how all of this skim milk and toast (with margarine) is more nutrient-dense than the breakfast shown for Whole30/Paleo.
For thorough review of nutrient density, I highly recommend this presentation:
Assumption: It’s Too Expensive to Eat Meat and Vegetables
People like to criticize both the Paleo and Whole30 plans as being expensive because “all that meat and produce can add up.” Yet, when you actually compare healthy food to processed foods, real food is cheaper. Let’s look at candy bars, which I don’t think anyone is complaining are so expensive. The average price I found in the US is $1.24 for a standard Snickers bar. That’s $0.66 per ounce.
Consumer Reports purchased 300 packages of ground beef in 103 stores in 26 cities across the United States in 2015. They paid an average of $4.95 per pound for conventional beef (which, I would argue is better than a snickers bar) and an average $7.83 per pound for grass-fed organic beef. That’s $0.39 and $0.49 per ounce, respectively. So, even grass-fed organic beef is $0.17 cheaper by weight than a snickers bar. Amazon sells a 6-pack of 5.5 ounce sliced Tofurky for $27.05, which equals a little over $13.00 per pound or $0.82 per ounce. Organic, grass-fed beef is $0.33 less per ounce than Tofurky. Organic vegetables like carrots, potatoes, and zucchini area all cheaper than candy bars and processed fake meat products.
Additionally, comparing the nutrition in fresh fruits, vegetables and nutrient-dense meat to processed food and meat-like products is definately not apples to apples. And the sustainability factor of these highly processed foods needs to be considered. If someone did a full life cycle assessment on Tofurky, looking at all of the inputs (water, fossil fuels, etc.) to make one floppy little piece of this fake meat, there’s no way that it’s more environmentally friendly than a cow that ate grass in a field.
Assumption: It’s Too Hard to Follow
Yes, it’s a lot easier to go through a drive through or purchase pre-made meals full of ingredients like this:
Jenny Craig ranked #10 and SlimFast is #20, way above Paleo and Whole30. On SlimFast, you drink 2 of these shakes a day, plus eat 2 bars with equally disturbing ingredients. The snacks listed are a banana and apple (on an empty stomach, hello sugar rush!) and then one “real” meal. And this is healthier than eating real food?
The goal of the Paleo diet and the Whole30 are to help people eat food that is closer to its real form, to reset tastebuds and to stop eating junk food. It’s not necessary to spend hours and hours in the kitchen either. A quick Paleo or Whole30 approved meal can be made by picking up a plain roasted chicken, grabbing a few carrots and hitting the salad bar. That’s pretty easy. Also, there is no weighing and measuring your food, because the idea is that if you eat real food, your body will self-regulate. Shouldn’t that be the goal of any weight loss program? Do we really want people reliant on bars and shakes as a long-term diet strategy?
Also, its super snarky to say that you can’t eat out unless you “eat in your neighbor’s cave“. Lots of restaurants offer a piece of salmon over a green salad, sautéed shrimp and vegetables, or a burger with no bun, baked potato and a side of fresh veggies. The reviewers really found that it’s more difficult to eat Whole30 and Paleo at a restaurant than it is to order a vegan dish? How easy is it to order a Slimfast shake at a diner? The attitude given to Paleo and Whole30 by the US News team has palpable bias. Here’s a quote from the Paleo review, “This diet should go back where it came from.” Nice one.
Assumption: There’s No Evidence
My final point of contention is the comments about how there haven’t been studies on a Paleo-type diet:
“Most of the other diets are better options for preventing or controlling diabetes, according to experts’ scores in this category. A lack of research showing its worth gave experts little option than to hand out poor scores.”
“Experts showed little confidence in the Paleo diet’s ability to prevent or manage cardiovascular disease. It was among the lowest-scoring diets in this category.”
Human evolution has taught us a thing or two about which foods we can thrive on. Before the agricultural revolution, humans who didn’t die from childbirth or accidents had remarkably good health. They didn’t need to measure and weigh their food. They didn’t need to drink two shakes and have two junky bars a day. They didn’t eliminate meat. They didn’t die of type 2 diabetes. They ate food closest to its natural form.
“Even short-term consumption of a Paleolithic-type diet improved glucose control and lipid profiles in people with type 2 diabetes compared with a conventional diet containing moderate salt intake, low-fat dairy, whole grains and legumes.” – Metabolic and physiologic effects from consuming a hunter-gatherer (Paleolithic)-type diet in type 2 diabetes.
Consumers are getting smart. They no longer trust nutrition advice, because what they’re being told doesn’t work. Cholesterol and saturated fat are no longer supposed to be “nutrients of concern,” so why the continued recommendations of low-fat milk? Why the fear of Paleo and Whole30? Why the cynical comments? People want results. They want to eat real food. They want to feel full and feel good, and say goodbye to their sugar tooth, expanding waistband, and exhaustion. Why not admit that grains and legumes don’t need to be part of a healthy diet? When 75% of the world’s population is lactose intolerant, maybe it’s time to stop recommending so much milk, which isn’t even the best source of calcium to begin with. Maybe people need to completely eliminate processed food for a period instead of drinking shakes and eating bars.
Countless people have found that when they eliminate grains, legumes, sugar and dairy for 30-days, it’s the beginning to a whole new way of relating to food. After their 30-day intro, they’re usually able to reincorporate a small amount of “modern” foods in moderation (like rice or full fat, plain yogurt, or the occasional treat or glass of wine) with no problem, while sticking to a general real food template as their base. Many people report that their blood sugar issues go away, food cravings disappear, acne improves, they sleep better, lose weight, perform better in the gym, and they just feel fantastic.
If we really knew so much about the right diets for everyone and how to get folks to stick to them, would we still have such a growing epidemic of diabetes and obesity today? Maybe it’s possible that we are still just learning. Nutrition is a new and evolving science, and it’s time to admit we’ve been wrong about things. Maybe it’s time to open our minds a bit to new ways of thinking and be a bit more humble about our “expertness”.