Heart Foundation Goes Paleo

Do not adjust your set. And no, it isn’t April 1st.  The New Zealand Heart Foundation dietitians and nutritionists are giving Paleo a go.

It what sees me channeling the ghost of That Paleo Guy, I feel compelled to write a bit of a critique about their experiment, their assumptions, and starting points.  But to be clear before anything else, I do genuinely applaud the openness of the Heart Foundation to be giving this a go.

My first post to this website outlined my reasons for largely divorcing myself from the term “Paleo” as a heuristic for how to navigate the very messy and often confusing food environments we are faced with in our modern societies.  Subsequent posts have touched on why the paradigm made sense in the first place, and on some of the things we have taken issue with as the concept has grown in the public consciousness.

In that first post I did make a reference to the Heart Foundation as a highly conservative “laggard” (rather than leading) organisation.

Bel Curve

That they are such an organisation isn’t necessarily a bad thing.  All of us are laggards in some capacity on variety of issues.  I’m a laggard when it comes to Facebook, Pokemon, and SnapChat, for examples.  We need laggards to place some drag on those who are over zealous. We’d be in one hell of a mess without them (though laggards can also be too much of a drag on good progression at times).

A potential benefit of being so late to the party is that you can perhaps have more certainty on a topic, including who your best sources of information are going to be.  Using the Diffusion of Innovation curve above, it becomes apparent that the more mainstream an idea or innovation becomes, the more sources of information (good and bad) you will have for the practical application of these ideas.

An organisation like the Heart Foundation experimenting with the likes of Paleo has a couple of options as to their approach.  They could test the broader market to see how easy/hard/confusing it all is; are there lots of rules, exceptions, etc?  This approach would be fair enough, and I could save them a lot of bother and tell them that the whole Paleo/Low Carb/Keto/Fasting/Bulletproof scene is a mess.

But then this holds true for just about any common and popular dietary paradigm…

So what value is there is proving that when an idea or innovation begins to be adopted by the mainstream, it tends to get distorted in such a way as to make it fit the lives of the majority, yet allow them to be seen to be doing the thing with the least amount of change possible? Almost none.

An alternative approach would be to evaluate the best and most pragmatic variants of such diets.  For example, if you were to evaluate whether a vegan diet is safe, easy, and practical to do, you’d pick a very sensible version of such a diet rather than test a 50-bananas-a-day version with any real view that this is what you might expect the general public to try.  Equally, you wouldn’t test the Mediterranean Diet by eating Mediterranean pizza three meals a day.  You hopefully see my point.

In March 2015, the Heart Foundation published their take on the Paleo diet.  Cue obligatory photo of meat (in this case, sausages), as well as typical references to cave-men.  As it is now 2016, the Heart Foundation might want to practice a bit of gender equality, so please feel free to use the image below of a cave woman medical doctor (with perfect cholesterol, I might add) about to chow down on a raw lamb chop (ticks all the Paleoesque hunter gatherer memes, but in such a 21st century, equal society kind of way).

cave-girl

There are a couple of tedious and tiresome points made by the Heart Foundation that I must address.

Supposedly a diet based on human evolution, paleo prescribes a list of ‘what to eat’ and ‘what not to eat’.

An interesting choice of words above.  “Supposedly” for the obvious cynicism, but also “based on”, as in, approximates.  So in this context, modern foods which approximate the foods that have featured the longest in our evolution.

Let me reposition the above with an example that might hold a bit more relevance to those in the Heart Foundation.

Supposedly a diet based on that eaten in the Mediterranean region, the Mediterranean Diet prescribes a list of ‘what to eat’ and ‘what not to eat’.

With reference to my point above, here is how a conversation with a Heart Foundation dietitian (HFD) might go:

HFD: “The whole concept seems a bit far-fetched, as our modern food supply and way of life is completely different to that of the caveman days.”

Me: “No more far-fetched than you telling me I should replicate the diet and lifestyle of subsistence farmers of Crete and Corfu.”

HFD: “Well, no.  You aren’t actually supposed to replicate the exact diet and lifestyle of the Mediterranean – you live in the South Pacific.  But you can certainly approximate the core foundations of such a diet and lifestyle and translate those to a modern Western society such as New Zealand.”

Me: Oh really?

Resolution of the conflict between environment and our ancient genome might be the only effective manner for “healthy aging,” and to achieve this we might have to return to the lifestyle of the Paleolithic era as translated to the 21st century culture.

Source

real-food

Mediterranean or Paleo?

In 2016, given the megabytes of writing on the subject, it really is a very weak argument from the Heart Foundation (and anyone else making it) that we aren’t cavepeople and therefore can’t replicate our Paleolithic past.  Time to move on, folks.

To qualify as a caveman, you may consume meat, poultry, fish, vegetables, fruits, nuts and seeds, but are banned from eating whole grains, legumes, dairy, coffee and alcohol.

Banned?

Is Paleo the diet of the Democratic People’s Republic of North Korea?

Because the Heart Foundation have been a little bit lax on their research with this one, they have missed the point that the vast majority of the main players and purveyors of a Paleolithic or Primal diet suggest that you eliminate what are potentially problematic foods and add them back in later to test how you look, feel, and perform with them in your diet, perhaps testing biomarkers of health and disease.

Robb Wolf will be the first to recommend that you experiment constantly, to find out what works best for you. Everybody is different and will respond to diets differently, so the most important thing is that you not get religious about the diet you choose, but that you remain open-minded about ways that you could improve what you’re eating to get better health and energy results.

Source

These same Paleo proponents also say coffee and alcohol is fine – unless you have obvious intolerances or other health/medical reasons for limiting or abstaining from these.  Likewise dairy. Ditto legumes.  Refined “acellular” grains are probably best kept away from, while intact or cellular starches are probably okay in the right context (again, as long as you have tested these on yourself).

wholegrains

By taking a “system restore” approach, eliminating some potentially problematic foods and challenging my system with them again, I was able to confirm that I have both coeliac disease and a reaction to dairy proteins that has been a longstanding source of blocked sinuses for me.  I don’t do milk, nor gluten grains, but I’ll eat all the kumara and yams every damn day, and between my protein intake, nutrient dense, high vegetable diet, resistance exercise, and time in the sun, there are no issues with my bone density. But I digress.

From the Heart Foundation Paleo experiment:

The definition of Paleo that I choose to work from involves excluding dairy, grains and legumes. It includes a strong focus on whole and less processed foods. For the record, the first three exclusions I’m personally and professionally opposed to, unless there is a good medical reason to do so.

See my experience above re: good medical reasons for exclusion. I am sure between the likes of myself, Mikki Williden, and Julianne Taylor, we can provide umpteen case studies where using a Paleo-type elimination-challenge diet, we’ve found both undiagnosed conditions, or have been able to provide some degree of dietary therapy for known existing conditions.

At the time of writing, only one day of the Heart Foundation’s Paleo experiment has been posted.  But it seems to give some indication of the direction being taken with the meal selection, and more specifically, the likely reasons it will be given a failing mark.

I’m a very simplistic guy at heart.  My approach to food reflects this.  I eat three meals per day, most days of the week.  Each one of those meals is typically anchored by some form of animal protein, yielding, generally, a minimum of around 25-30g in total protein.  For example, 4 eggs, scrambled, would be a standard protein anchor at breakfast.

To each of these protein anchors, the rest of the plate will be filled with a mix of seasonal vegetables, fruits, and nuts, and at the main meal post any intense activity for the day, seriously large servings of starchy tubers like kumara, taro, or yams.  Any added fats are either in the form of olive oil, avocado oil, coconut oil, or butter (as much as my sinuses will let me away with).

On occasion, particularly on a Saturday if we are out to a martial arts class or biking, we’ll skip breakfast and have a similarly constructed lunch as the first meal.  Very rarely, we will have one main meal in a day, but we would likely have been snacking all day on a hike somewhere for that to occur (normally on cold meats, nuts, fruits, and dates).

As I do the vast majority of the shopping and cooking, and I am Scottish in ancestry, I prefer cheap (or at least, I don’t like spending lots of money on something flash when there are better, lower-priced options around).  On average, a full meal, similar to the one pictured above, will come in between $5 and $7 per serving.  If we have splashed out for two large salmon steaks, then maybe closer to $10, but this wouldn’t be often.  So I would eat 3 very large, high-protein, real food meals a day, made at home, for most definitely under $20 a day on most days.

My simple man status also likes it easy when it comes to meal prep.  I will typically make salads in bulk and use these across several meals, or vegetables will be mixed in with my two-tick breakfast mince for a solid one-pan winter meal (typically made such that there will be plenty of left overs).  Currently, I have pork chops and kumara in the oven, which I’ll serve with some broccoli. A Sheppard’s Pie is commonly made, while scrambled eggs are the likely backbone of most breakfasts, taking less than 5 minutes to make.

What I would never advise is the approach seemingly taken by the Heart Foundation in their little experiment.

Next step is to do the shopping for the week ahead. I look down at the shopping trolley and it looks good – lots of fresh fruits and vegetables, nuts and seeds, and a top-up bottle of extra virgin olive oil. Replacements for milk and yoghurt are also needed. The coconut yoghurt I’ve seen posted on various social media feeds looks interesting and could be a good breakfast option. I find it in the yoghurt section but am taken aback by the cost – $10.99 for a 500g jar. Next is a trip to the spreads aisle for a peanut butter replacement. The almond butter is also expensive at $19.99 for a 375g jar – this is nuts! I have immediate concerns about how much this is all going to cost.

A lot. It is going to cost you a lot because you have spent on one jar each of yoghurt and nut butter what I would spend on 5-6 dozen eggs in a week, that would more than do us for 6-7 breakfasts and the occasional pre-training snacks.

This person is also trying to make a Paleo muesli type thing, which will invariably cost vast sums of money to make anything near enough (and still won’t be), and will take vast sums of time and energy to prepare.  They have dived into it the hard way, and I can already see the objections – costs too much & takes too much time (parenthetically – this is a diet only for the money and time rich).

After what sounds like a very small breakfast (from what I gather, this experiment is being done by a male), we get to lunch…

Lunch consists of roasted vegetables – beetroot, carrots, parsnip, pumpkin, capsicum – with salad greens, balsamic vinegar and olive oil, topped with some nuts and seeds. It tastes and looks great but I find more protein is required to get me through the afternoon. Snacks through the day are fruit which are my usual snacking staple. There are some strange rumblings in my tummy during late afternoon. I can’t work out whether it’s the increased nut and fibre content or I’m hungry.

Hungry. This person will be hungry. Had they not blown their budget on nut butter and coconut yoghurt, they could have bought a pork shoulder or leg of lamb and slow cooked it for the lunch meat that week (as we do here).  Or purchased more tins of sardines than is normally socially acceptable to eat at a workplace.

Arriving home…

Arriving home after picking up the kids, I have to resist the urge to reach for a rice cracker or eat the odd bit of pasta leftover from their dinner.

Yep, hungry.

Consistently, eating three solid meals a day with an amount of protein that puts me in the 1.6-2.0g/kg range, keeps me on an even energy keel all day, and avoids me adopting a killface even if a meal is delayed or missed.  Those who under eat on protein need to keep snacking and grazing on everything else to fill the void.  See, protein leverage hypothesis.

Adults’ dinner is twice cooked harissa pork fried with onions and garlic, avocado, tomato, capsicum and coriander, all wrapped in lettuce leaves. I eat three but feel like I could eat eight. Although I’ve just eaten, my mind seems to be telling me that something is missing or that I’ve been short-changed.

See also, protein leverage hypothesis.

This person has gone so light on good solid food for much of the day, that the only way to be sated at night is to… well, eat a big dose of protein.  Thus we can see the next criticism – that it isn’t a particularly satisfying way to eat and it leads to cravings and over-eating, especially in the evening.

Time and time again, working with individuals, if you get a good protein anchor at each meal, hunger is rarely an issue.  It generally only becomes an issue on days that they are under on protein energy.  Eat good levels of protein consistently and evenly distributed across the day, and you find that you actually don’t need the massive serves of meat that go with the overplayed Paleo caveman meme.

Overall, impressions from day one were a lift in the nutrient value of the food I was eating with a much stronger focus on vegetables and whole foods. There was also a realisation that carbohydrate foods can dominate my typical dietary pattern. While more effort is needed in planning and preparation, the challenge of trying new dishes is exciting. My goals for the coming week include making paleo bread…

“There was the realisation that carbohydrate foods can dominate my typical dietary pattern… My goals for the coming week include making paleo bread…”

iwkad22

Look, this is a valiant effort by this individual, and I really do applaud the Heart Foundation for giving this a go.  But there is all the usual misconceptions and misinformation coming out of this, not to mention that the person doing this has sent a strong signal after one day that Paleo will be written off as expensive and time-consuming. Eating “Paleo” foods will be seen to leave you feeling unsatisfied and that something is missing, and will reinforce to the late majority that the Heart Foundation protects that this isn’t something they need to be concerned with.

I really do hope that they come to their own realisation that they have set this thing up to fail from the start. The whole experiment could easily have been set up much better by reaching out to someone with experience in this area instead of wasting time second guessing all the usual rubbish and getting information from social media

If the person doing this experiment reads this, my suggestion to you is to start again and do the basics really well. Eat three meals a day with some form of highly available protein that is about the size of your hand.  Fill your plate with all the seasonal vegetables, fruits, and root tubers you want (including legumes!) – it is a plant-based diet after all.  See how you go with that for a month.

Postscript-1: The Heart Foundation have been very good sports about this and have taken on board some of my suggestions, resulting in this tweet…

Postscript-2: For all those who consider themselves Paleo, and who run various social media channels where they spruik over-priced “Paleo” rubbish, recommend a handful of Paleo birdseed for breakfast, and reinforce all the caveman replication rules and memes, you are as much to blame for everything written above as the person undertaking this experiment is for not doing their homework properly.