Response to Michael Pollan

Michael Pollan, the celebrated food writer whose opinions are widely respected and whose pithy comments are widely quoted (he’s particularly known for saying “Eat food, not too much, mostly plants,) is someone with whom I generally agree. We share many platforms, including the benefits of returning to whole food, real food, a high volume of plant food, and a return to cooking. However, he recently criticized the modern Paleo diet (http://www.motherjones.com/environment/2014/01/michael-pollan-paleo-diet-inquiring-minds), and with this, I must take issue. I don’t think he has taken the time to understand the Paleo diet, which is quite common among those who are critical of Paleo eating. I would like, therefore, to take this opportunity to discuss his comments and explain why his criticisms are misplaced.

First of all, he argues (as many do) that there is no single Paleolithic diet. This is true. The original hunter-gatherers ate over 200 different plants and animals over a year’s time. How many different species does the average westerner eat in a year these days? Probably less than 30. What’s more, the foodstuffs our ancestors consumed were highly adapted to the specific regions they lived in and each local society learned over hundreds of generations which plants and animals were associated with providing vitality for or bringing sickness to the clan.

Also, studies have shown that traditional diets are radically different between societies. For example, the arctic hunter-gatherers ate a pure animal product diet 10 months out of the year. The Amazonian rain forest dwellers and the African hunter-gatherer ate more insects, amphibians, and lizards, and hundreds of different plants. The Native Americans ate a mix of fish, meat, and hundreds of different plants and animals unique to their environment over the course of the year. All these diets were extremely local and seasonal, and people generally thrived on all of them.  There are likely many thousands of diets created by humans that maximize their vitamin, mineral, essential fat, and antioxidant intake per calorie based on the food available. Humans are amazingly omnivorous creatures. We can thrive on a wide variety of just about anything nature provides.

However, all these diets have some commonalities, and this is the notion which the modern Paleo diet works with. Traditional diets are all packed with many more vitamins, minerals, and essential fatty acids because they rely on natural whole foods. The typical westernized diet is filled with processed foods, like white flour, high fructose corn syrup, and other refined sugars. It contains minimal vegetables and fruits, as well as far fewer vitamins and minerals in comparison ^1-5. It is not a “natural diet” because most of the foods in it have been processed and are no longer in whole-food form. Many critics of Paleo-style diets miss this point. Modern Paleo diets are not meant to replicate ancient diets. They are meant to emulate ancient diets, and this is a critical difference—it is what takes the Paleo diet from the realm of theory into a practice in reality.  The Paleo diet emulates as closely as possible in our contemporary world the foodstuffs and manner of eating practiced by our Paleolithic ancestors, and this in itself, apart from quibbling about how accurate it may or may not be, is a great improvement over what most people are doing now. Accuracy is not the point. Health is the point.

Another argument against the Paleo diet is that our world has changed and no food we currently eat resembles any of the foods our Paleolithic ancestors ate. It’s true that many of the foods we eat today have been altered through intensive plant breeding into foods that are much sweeter and richer in carbohydrates than they once were (not to mention more disease-resistant, weather-resistant, herbicide-resistant, and therefore more generally suitable to the conditions necessary for industrial farming). Also, even natural, organic foods cannot escape containing some level of toxins because the world is now so polluted. Our soil is also widely depleted of the nutrients it once contained, and selective breeding and genetic modification aimed at a higher number of bushels per acre (not at improving vitamin or mineral content per bushel) have certainly resulted in plants that are less nutrient-dense than they once were. We can never go back to a planet as pure as it was in the Paleolithic era, but that doesn’t mean we can’t or shouldn’t eat the best foods available to us. It only means we may need to eat even more vegetables and fruits, to compensate for diminished nutrient levels (this is a crucial aspect of the Wahls™ diet).

Another popular criticism of the Paleo diet is that eliminating grains and dairy eliminate important sources of nutrition. Pollan implies this when he says that people in some cultures have depended on bread for survival. However, not only is the bread widely available in the United States as far removed from the whole grain fermented bread our European ancestors ate as an ear of sweet corn or a stalk of wheat is from its ancient form, but it is simply untrue that grains and dairy are necessary for health. Many cultures over many centuries have survived without (or with only minimal, nutritionally insignificant) grain and certainly without dairy products. You can easily get all the nutrients you need without eating grains, dairy, or legumes, and in addition you will be free from the toxic effects of these modern foods. A hunter-gatherer-style diet packed with natural plant foods and natural meats (grass-fed and/or game meat, wild-caught fish) contains all the nutrients you need to thrive.

Finally, another common criticism is that people didn’t live very long in the Paleolithic era. This is also true, but shortened lifespans of our ancient ancestors had nothing to do with their diets. In the Paleolithic era, the mean age of death was somewhere in the mid-30s, but this is because there was a 38% to 45% mortality rate for those under the age of 15. Those who survived childhood actually did quite well. Gurven and Kaplan studied this question extensively and published their findings in 2007. The results might surprise you. Hunter-gathers historically (and now in the current hunter-gatherer societies that have not yet adopted western lifestyles) often lived past 60 years of age⁶. These people were and are physically and mentally fit without medication, and many thrive into their 70s and even 80s. The transition from hunter-gatherer societies was associated with loss of height, increased risk for degenerative arthritis of the spine, and tuberculosis. Fertility increased, leading to an increase in population, but it was a less healthy one^7;8.

Those populations who converted to western diets continued to do worse as “progress” marched on. The next major transition came with the industrial revolution in 1850 with the wide availability of sugar, white flour, and a steady decline in breast feeding.  This was associated with another decline in health and an increase in chronic diseases, including heart disease, diabetes, and obesity⁹. Now, as societies move from developing economies to developed economies, the early mortality due to infectious disease has been replaced by chronic diseases related to lifestyle, that is diabetes, obesity, and heart disease⁹. Sweetener consumption has risen from an average of less than 10 pounds of sugar per person per year in 1900 to over 100 pounds plus per person per year in 2000. In addition, modern populations have steadily grown in size. According to the Centers for Disease Control, in 2010, 69% of Americans were overweight or obese¹⁰.

Put more simply, the extension in the average age of life from the Paleolithic era to the current era has occurred because of the decrease in infectious causes of death, lower childhood mortality, and increased use of medical technology, not because we as a society are enjoying more vitality and vigor related to any sort of dietary improvement. Quite the contrary, in fact.

All these criticisms overlook a simple fact: The modern Paleolithic diet concept is not meant to exactly replicate what our ancestors ate. Instead, it is meant to take the general concepts and apply them to our modern food supply as well as we can, in an effort to restore human health and reverse the epidemic of chronic diseases that have plagued humans since the agricultural revolution.  Michael Pollan seeks the same goal, with only a slightly different approach—but for those with autoimmune disease and other chronic conditions, those slight differences spell the difference between just surviving and actually improving and restoring health.

Let’s look at those differences a little more closely. Pollan recommends whole foods and cooking. Excellent. But he does not advocate the elimination of grains, legumes, and dairy products. Any logical person knows that just because humans didn’t do something in early history doesn’t mean we shouldn’t do it now. Maybe the relatively recent addition of huge amounts of grain and dairy into the human diet are just fine for us? Let’s consider. There has been a lot of research into the modern incarnation of a hunter-gatherer type of diet, and the conclusions of that research are generally that the diet isn’t just good in theory.  For example, in one study, when healthy volunteers adopted a hunter-gatherer diet, rich in animal protein, non-starchy vegetables, and berries, there was a significant improvement in multiple biological markers of health status with subjects experiencing improvements in blood pressure, blood cholesterol values, and improved sensitivity to insulin^11;12. In another randomized crossover trial, subjects were given a standard diabetic diet or a hunter-gatherer diet for three months and then switched to the other diet. Again, scientists found that the hunter-gatherer diet was associated with better blood sugar control, better blood pressure, better cholesterol values, and more weight loss than the standard diabetic diet¹³.

In an effort to compare the modern Paleo diet with the standard American diet, Dr. Jayson and Mira Calton did a micronutrient analysis of several current diets including Diane Sanfillipo’s Practical Paleo Diet and Mark Sisson’s Primal Diet for their book, Naked Calories, Revised Edition, and discovered that those diets were much more nutrient dense than the standard American diet and were among the most nutrient dense diets that they analyzed. Great news! However, both the Paleo and primal diets were still only meeting the RDA for 15 of 27 micronutrients and would have required more than 14,000 calories to meet the all the RDAs (still far better than the standard American diet, which would have required more than 27,000 calories ¹⁶ to meet the RDA for all micronutrients!).  These Paleo-style dies are obviously far superior to the standard American diet, but without specific guidance to maximize the micronutrient content, anyone following these diets is still at risk for missing key brain and key mitochondrial vitamins, minerals, essential fatty acids and antioxidants. If you have chronic health issues, this is a critical factor to consider. The Wahls™  Diet is specifically designed to hit the RDA targets and exceed them in every category.

And what each level of the Wahls™  Diet plans seeks to replicate, in an attempt to avoid or repair these detrimental processes, is the original human diet. I do it in a very structured way, so you can fill your plate with foods that will ensure you get the maximum nutrition possible using agriculturally available products. Few of us actually hunt and gather our food from the wild, nor do we have the exact knowledge our ancestors had about how to get the most nutrition from the foods growing in our locale. However, if you eat a diet heavy in leafy greens, non-starchy vegetables, and berries, as well as animal protein (without including any of those more recent troublesome dietary additions, like gluten grains or dairy products), you have the best possible chance at optimizing your health.

Let me conclude with my personal experience. I had been dependent upon a tilt recline wheelchair for four years due to secondary progressive MS. I am a physician scientist, and based upon on my review of the latest research on the nutritional needs of the brain and traditional societies, I created a diet and lifestyle program to try and slow my decline. The results stunned everyone, including my physicians. One year after adjusting my diet and lifestyle, I was walking easily throughout the hospital and even able to bike 18 miles with my family.  It changed how I view the world of disease and health. It changed how I practice medicine. And it changed the focus of my research, which now tests the power of a modified, specifically nutrient-dense Paleo-style diet to treat multiple sclerosis and other chronic diseases. I teach the public and the medical community and have written a book, The Wahls Protocol: How I Beat Progressive MS Using Paleo Principles and Functional Medicine, that describes in detail the diet and lifestyle changes that I used to heal myself and that I am studying in our clinical research.

Paleo may seem like a fad right now, but the reason it has become such a popular way of eating is because for many of us, grains, legumes, and dairies have a detrimental effect, and intensive nutrition based on natural plant foods, meat, and fish makes us feel better than we ever have before. Energy soars, brain fog clears, and in many cases, declines in mobility reverse. We have so much more health and vitality by excluding grain and dairy and severely restricting legumes, eating vegetables, berries, and meat instead.  It is the nutrient density combined with the elimination of detrimental foods that determines whether the diet is health promoting.  The diet we use in our clinical trial, a structured Paleo diet that we call the Wahls™  Diet, has 1.5 to 8 times the levels of vitamins, minerals and essential fatty acids in it as compared to the standard American diet. In the end, I believe the only real measure of the worth of a diet is nutrient density and the elimination of detrimental components. Held up to that standard, the modern version of the Paleo diet is among the most health-promoting diets available to humans today.

Bio

Dr. Terry Wahls is a clinical professor of medicine at the University of Iowa where she teaches internal medicine residents in their primary care continuity of care clinics, sees patients in a traumatic brain injury clinic and conducts clinical trials.   She is also a patient with a chronic progressive neurological disorder, secondary progressive multiple sclerosis, which confined her to a tilt-recline wheelchair for four years.  But thanks to the power of Paleo Principles and Functional Medicine, Dr. Wahls restored her health and now pedals her bike five miles to work each day. She is the author of The Wahls Protocol: How I Beat Progressive MS Using Paleo Principles and Functional Medicine (due out March 13, Avery an imprint of Penguin).

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