Which Diet Is Best?

Which Diet Is Best?

In answer to the question above: obviously it is the one which helps you lose the most weight in the shortest amount of time. Well, if that were the case then an extended fast would be the way to go. In fact, the longest fast on record was a man in 1971 who went 382 days taking in only water and occasional vitamin and mineral supplements. He went from a hefty 207 kg to 82 kg!.1

At the same time just about any diet will help you lose weight if it reduces calories and eliminates junk food. But if you are going to go back to eating the way you used to eat, then starting the diet is probably a waste of time because the weight will come straight back on.

In my opinion there must be some additional considerations besides weight-loss when choosing a diet for it to be truly effective. These are:

  1. Does the diet prevent you from feeling hungry?
  2. Does the food taste good?
  3. Is it a diet which you can maintain long-term?
  4. Does the diet reduce inflammation, food sensitivities and other immune reactions?
  5. Is the diet going to affect your other health markers positively? E.g. blood glucose, insulin, blood pressure
  6. Does your energy and concentration improve on the diet?

I don’t believe there is one specific diet which will work for everyone and at the end of the day any diet which satisfies the factors above is good in my opinion. If you haven’t found a diet which works for you I do think the paleo diet is a great template to start with.

What is the Paleo diet?

There is no one exact paleo diet out there which every paleo advocate agrees with. The basic premise is that Paleolithic man, existing in the period from 12 000 to 2 million years ago, as a hunter-gatherer would have had access only to foods he could kill or forage for hundreds of thousands of years, and hence would have been well adapted to eating those foods. Agriculture, existing meaningfully only in the last few thousand years, has produced foods we may not be so well adapted to eat, at least not in the large volumes consumed in modern times.

But Paleolithic man lived short lives and didn’t have time to develop the diseases of modern society, you may say. Well that’s probably not true according to this paper.

While it would be very difficult to eat like the cave-man of old, the paleo diet attempts to approximate the diet of the Paleolithic man as closely as possible with our modern day foods. This would look something like the following:

Foods to avoid:

  1. Grains
  2. Dairy
  3. Legumes
  4. Processed/refined food and sugars
  5. Margarines/seed oils

Foods to eat:

  1. Vegetables
  2. Fruits in moderation
  3. Meat, chicken, fish, eggs
  4. Nuts and seeds in moderation
  5. Healthy fats (butter, ghee, coconut oil, lard, olive oil)

Yes, pasta, pizza, sandwiches and burgers are out, at least in their traditional form. Fortunately there are ways to approximate these foods if you are desperate. If you really can’t do without these foods then the paleo diet may not be for you. In their place is nutrient dense food which your body needs for optimal health. Don’t worry, this is not necessarily a complete death sentence for takeaway-type food if you see the 80/20 rule.

All food is made up of 3 primary macronutrients: fat protein and carbohydrates. For the paleo diet it is usually recommended to go low carb, medium protein and high fat. What does this mean?

Carbohydrates

Low carb usually means under 100g of non-fibre carbs per day. If you are eating according to the list above this will happen almost naturally, especially if you reduce intake of things like potatoes, sweet potatoes and rice. Those trying to lose weight might want to go lower on the carbohydrates and power athletes might need a bit more of them.

Why go low carb? Because carbohydrates in excess are converted into fat in the body. A high carb diet is also more likely to produce blood sugar swings leading to hunger occurring more quickly and energy levels on a rollercoaster.

The body actually doesn’t require any carbohydrates in the diet to survive – it is not an essential nutrient. This is obvious from the 382 day fast example given in the introduction. The body can only store a few hour’s worth of glucose (carbohydrate) in muscles and the liver. Fortunately, glucose can be made by the body from fat and protein when needed. So when there are not enough carbs in the body for fuel the body starts to burn fat from its fat stores for energy: weight loss!

If you do not need to lose weight it is worth experimenting with the amount of carbs in your diet. Some people do very well on a very low carb diet (less than 50g) but others don’t. Some people do better having all their carbs later in the day or after a workout.

Protein

Moderate protein amounts to about approximately 1g/kg of ideal body weight per day.34 This might not sound like very much but remember steak and chicken are only about 20-30% protein. The average chicken breast has about 30g of protein while a 100g piece of beef steak is about 25g protein. Obviously body builders will require more protein but too high an intake of protein in people who don’t need it means the excess gets turned into fat.

Fat

In general you want to stick to consuming animal fats, although coconut oil and olive oil are excellent as well. But this means your saturated fat intake is going to markedly increase and saturated fat causes heart disease doesn’t it? Actually this is a lie we have been sold for decades. Several recent research papers have now shown there is no link between saturated fat and heart disease.2,3,4 And a new 2016 study displayed a smaller chance of a heart attack in those eating more saturated fat!5

So amazingly it turns out the highly processed and refined seed oils pushed on us for the last few decades are not as healthy for us as the fats we have been eating for hundreds of thousands of years.

One of the reasons for this is that seed oils are high in what are called omega-6 polyunsaturated fatty acids. These promote inflammation, turn rancid easily and are easily damaged by cooking. Animal fat (especially if the animal was grass fed and/or free range) is higher in the anti-inflammatory omega-3 fatty acids – especially high in fish. Several sources suggest we evolved with a 1 to 1 ratio of omega 6 to omega 3 in our diets whereas modern Western diets are now 15-16:1.6

Fat has a good satiating effect which lasts for a longer period than carbs by suppressing later food intake.11 This means if you increase the fat percentage of your diet you have less chance of feeling hungry for some time after the meal. Considering our brains are 60% fat and about 60% of breast milk calories are from fat (mostly saturated fat), it is obviously an important macronutrient for us.7

But won’t eating more fat make you fat? This does not appear to be the case and new research shows that a high fat diet may increase metabolism more than a low fat one. 8-10 So not all calories are created equal.

But aren’t grains the staple food of a healthy diet promoted by governments around the world?

How has having grains as the major component of our diets been working out for world health so far? There are several potential problems a diet high in grains could cause:

  1. Gluten sensitivity: there is some debate around whether this is a genuine condition (as opposed to Coeliac disease which is gluten allergy) but a new study seems to back up those who have been complaining of a myriad of symptoms from eating wheat. Gluten, the protein portion of the wheat seems to damage the lining of gut, allowing molecules to enter the blood stream which shouldn’t be there, causing subtle immune reactions from arthritis to headaches to skin rashes and many more.
  2. Glyphosate: this is the active ingredient in the herbicide used on many crops around the world, especially wheat, which might have similar effects to gluten.23
  3. FODMAPs: the acronym stands for Fermentable Oligo-, Di-, Monosaccharides and Polyols. This refers to certain types of carbohydrates which cause abdominal distress in certain people giving typical IBS symptoms. These FODMAPs are found in several plant http://www.ketogenic-diet-resource.com/daily-protein-requirement.html foods but in high amounts in grains (and dairy). A low FODMAP diet in susceptible people has been shown to reduce IBS symptoms.24
  4. Lectins: these are proteins in plants that protect them against pests, insects and microorganisms (and possibly us). A critical one found in wheat (especially whole wheat) is wheat germ agglutinin (WGA). In the light of the gluten hysteria, WGA has remained largely unnoticed but may cause numerous harmful effects in humans.25

Grains in general are not particularly nutrient dense, especially once refined, which is why breads and cereals are so often fortified with vitamins and minerals. They are also full of carbs and given the potential problems they may cause, detailed above, there is not much to lose by leaving them out (besides convenience perhaps).

Isn’t calcium intake too low on a paleo diet?

This is a common criticism of the paleo diet since dairy is generally excluded to a large degree. However, it is relatively easy to get your daily allowance in just by eating your greens, some sardines and almonds.28 If you have some concerns with low bone density, then try some yoghurt and cheese if it is well tolerated.

Just remember the fat soluble vitamins A, D and K are also important for bone health. Another good reason to eat more fat as these vitamins can’t be absorbed by the body without it.

One of the biggest drivers of osteoporosis may be general inflammation in the body, not lack of calcium.31 All the more reason to eat a diet which reduces inflammation.

Incidentally, there is evidence that taking calcium supplements does not prevent hip fractures due to osteoporosis and may even increase your risk of heart attack.26,27

What about high cholesterol?

For some people on the paleo diet their total cholesterol level will go down (usually HDL up and LDL and triglycerides down), while for others it will go up (HDL and LDL up, triglycerides down), at least initially for a few weeks. If you are concerned about high cholesterol levels this article can help you figure out where you stand. Usually there is not much to be concerned about because the effects are positive either way.

Do you get enough fibre on a paleo diet?

Since grains are removed where does the fibre come from? Vegetables, fruits, nuts and seeds provide plenty of fibre and remember the paleo diet is not a high meat diet. Eat as much plant food as you can.

There is also some good evidence that the high fibre recommendation by conventional nutrition may be overblown and even harmful in those with gut issues.32

So how does the paleo diet measure up in terms of the initial considerations of an effective diet:

  1. Does the diet prevent you from feeling hungry? The higher you go on the fat and lower on the carbs the greater this effect should be. See also the ketogenic diet for even greater effects on preventing hunger.21
  2. Does the food taste good? This is somewhat subjective but veggies slathered in butter and steak with a juicy fat rind or crispy chicken skin doesn’t turn many people off. And let’s not forget bacon…
  3. Is it a diet which you can maintain long-term? Since our ancestors managed to follow it for millennia and were pretty free from the chronic diseases of our time, your chances are good. Some of the latest research indicates a low carb diet is better for weight-loss in the long term.12
  4. Does the diet reduce inflammation, food sensitivities and other immune reactions? The most common foods to cause these kind of reactions are grains, dairy, vegetable oils, refined sugar and GMO’s which are all largely avoided on this diet.13,14
  5. Is the diet going to affect your other health markers positively? Several studies have shown improvements in blood glucose control and lowered blood pressure, LDL cholesterol and triglycerides even when compared to a Mediterranean diet.15-19
  6. Does your energy and concentration improve on the diet? This is again subjective and hasn’t really been measured, but many people do anecdotally report steadier, more consistent energy and less brain fog.

How do I start the diet?

First of all don’t start counting calories. Just eat from the Foods To Eat list above or for more detail see the green/orange/red list and cook your food in plenty of the approved fats. Some of the current paleo advocates, including myself, add tea and coffee, cheese, rice, full fat yoghurt and alcohol to this list, in moderation obviously. It is often best to set a baseline and stay off these for the first month and then add them in slowly and see how they affect you.

If you are trying to lose weight, reduce the starches (sweet potato, white potato, rice) and fruit as much as possible. If you are an athlete you may want to increase the starch component. However, especially endurance athletes may benefit from becoming a fat burner and trying the ketogenic/Banting diet. This diet is simply the paleo diet with the fat content dialed up to around 70-80% of calories and protein about 10-20%. The remaining 5-10% is given over to carbs. Those with significant weight to lose, diabetes or cancer can supercharge the paleo diet by trying the ketogenic or Banting diet. Your food choices are more limited though.

Food allergies/sensitivities

If you are having particular problems with food allergies/sensitivities or autoimmune diseases then you may want to try the autoimmune paleo diet which is a bit stricter on what foods you can eat. Nightshade vegetables, eggs, nuts, seeds and certain spices are to be avoided on this diet.

Another option is trying an elimination diet which is similar but starts you off on specific foods which shouldn’t cause a problem and then, after a period of 1 to 4 weeks, foods are are gradually added back in to see if there is any negative effect. Once offending foods have been identified, the paleo diet can then be better tailored to suit you.

Since an elimination diet, while free of charge, is time consuming and has some complexity to implement, another option is to test directly for specific food intolerances or sensitivities. This IgG testing is different from the typical IgE food allergy testing done with a blood or scratch test at your GP. In South Africa the IgG testing can be done here but is fairly costly.

Sample meal plan:

This meal plan is similar to what I will eat for the majority of the week. You are entitled to adapt it in any way appropriate.

 

Supplements

I am not a big fan of multivitamins if you are eating a decent diet. Most ingredients are nowhere near the therapeutic amounts required, the vitamins and minerals are often from sources which are not easily absorbed and assimilated by the body and there are additional fillers and constituents which may do more harm than good. I do however recommend the following:

  1. Omega-3: Due to their high omega 3 content it is worth having a portion or two of mackerel or sardines during the week and/or supplementing with an omega 3 fish oil.
  2. Probiotics: Our hyper-hygienic lifestyles have also reduced our exposure to the good bacteria which populate our guts and help digest our food, so adding in good sauces of probiotics like sauerkraut, homemade yoghurt, kefir, Kombucha and/or a probiotic supplement is wise.
  3. Vitamin D: this is best achieved through sun exposure. If you are not regularly exposing a good portion of your body to the sun then it is likely you are going to be low. Approximately 40-80% of US adults are deficient in vitamin D.29 Around 2000-8000 IU’s of vitamin D3 per dose is recommended but a blood test will tell you if this is required.
  4. Iodine: this is often low in the diet depending on the soil content in the area where the food is grown and is best supplemented by eating seaweed or dry kelp tablets. Too low a level of iodine affects the thyroid and can result in hypothyroidism exacerbating weight gain and diabetes.
  5. Magnesium: as with vitamin D most US adults are deficient in magnesium as it is often not in significant amounts in the diet.30 The best form I have found in South Africa is magnesium chelate (Dischem) up to 500-1000mg per day although it can also be obtained through an Epsom salts bath. Magnesium will also often help with relaxation, improving constipation and sleep.

How much salt is enough?

Another falsehood that has been promoted since the 1970’s is that salt intake should be kept as low as possible. This stemmed from a study that was done on rats in which high blood pressure was produced by feeding them the equivalent of 50 times as much salt as the average person currently eats.35

The low salt mantra has continued in the mainstream to the present day despite research showing a low salt diet makes stroke, heart attack and death more likely and could promote type 2 diabetes.36-38 There are certain conditions where a low salt intake is advisable like kidney failure or kidney stones.

So is this a licence to go wild on the salt intake? No, there does seem to be a Goldilocks area: not too much and not too little, where optimal health is found. This amounts to about 3-7 grams of sodium or about 1.5 to 3.5 teaspoons of salt a day.37 Generally on a whole, unprocessed food diet, sodium intake is low anyway, so adding salt to taste to your food in reasonable amounts will keep you in this zone. More salt is needed if you are exercising.

Which salt? Stay away from the refined table salt. Unrefined sea salts and other natural salts have been found to have a much higher trace mineral content.39 There are many out there so take your pick.

The 80/20 rule.

Many in the paleo community adhere to the 80/20 (or 90/10) rule: eat strictly paleo for 80% of the time and eat what you like for 20% of the time. If you are relatively healthy and aren’t the type to be completely derailed by this kind of policy, then it can be a good way to have 2 to 3 meals a week with family or friends who are not paleo-minded.

There is some evidence that, in the absence of a specific allergy or full blown sensitivity, small doses of the “non-paleo” foods may be a beneficial for the body, upregulating various immune processes.40 This kind of hormetic stress is the basis for the “what doesn’t kill you makes you stronger” meme; but the emphasis is on the small doses.

In Conclusion

If you are happy with your body shape, your energy is good and you have no significant illness and sleep well at night, then your current diet is probably working well for you, no need for change. If not, it can be worth trying the paleo diet for a month and see if things improve.

Don’t worry about counting calories or specific macronutrient ratios, especially initially. Stick to the recommended foods and make sure you eat enough so that you are not hungry for at least 3 hours after a meal. It is not necessary to eat at a specific time of the day and better to eat only when hungry. Many people on the paleo diet find themselves naturally skipping meals because they are not hungry and no, breakfast is not the most important meal of the day.

Please note, depending on how high your carb intake currently is, you may experience the “low carb flu” for a few days, or a week or two, as your body adjusts to become a fat-burning machine.

You may also not want to go cold turkey onto the diet and just slowly add bits here and there. Whatever works is best.

It can be worth having a medical exam and blood test with your relevant medical professional before going on the diet and then retest after a month or 3. If the various indicators are worse, then you may be one of the rare people for whom this diet is not right or you may need to adjust macronutrient ratios and look for food sensitivities. If things improve you are on the right track.

If weight loss is slower than you would like, reduce the fruit, starches, nuts and dairy. These are the biggest culprits in holding back weight loss. Intermittent fasting is another way to supercharge your weight loss.33

Don’t become a food nazi: what works for you might not work for someone else. Have fun with the diet and experiment to find what foods and ratios work best for you. The diet should be seen as a framework; you get to fill in the details.

References:

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2495396/pdf/postmedj00315-0056.pdf
  2. http://ajcn.nutrition.org/content/early/2010/01/13/ajcn.2009.27725.abstract
  3. http://annals.org/aim/article/1846638/association-dietary-circulating-supplement-fatty-acids-coronary-risk-systematic-review
  4. http://www.bmj.com/content/351/bmj.h3978
  5. https://www.ncbi.nlm.nih.gov/pubmed/26791181
  6. http://www.sciencedirect.com/science/article/pii/S0753332202002536
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3586783/
  8. http://www.thelancet.com/journals/landia/article/PIIS2213-8587(16)30085-7/abstract
  9. https://www.sciencedaily.com/releases/2012/09/120912084430.htm
  10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3564212/
  11. https://www.ncbi.nlm.nih.gov/books/NBK53550/
  12. http://www.thelancet.com/journals/landia/article/PIIS2213-8587(15)00367-8/abstract
  13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705319/
  14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2868080/
  15. https://www.ncbi.nlm.nih.gov/pubmed/17583796
  16. https://www.ncbi.nlm.nih.gov/pubmed/17522610
  17. https://www.ncbi.nlm.nih.gov/pubmed/19604407
  18. https://www.ncbi.nlm.nih.gov/pubmed/19209185
  19. https://www.ncbi.nlm.nih.gov/pubmed/23414424
  20. http://thepaleodiet.com/wp-content/uploads/2015/08/Evolutionary-Health-Promotion-Consideration-of-Common-Counter-Argument-The-Paleo-Diet.pdf
  21. https://www.ncbi.nlm.nih.gov/pubmed/18175736
  22. https://ultimatepaleoguide.com/autoimmune-protocol/
  23. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3945755/
  24. https://www.ncbi.nlm.nih.gov/pubmed/24076059
  25. http://www.greenmedinfo.com/page/opening-pandoras-bread-box-critical-role-wheat-lectin-human-disease
  26. http://www.health.harvard.edu/fhg/updates/Do-we-really-need-all-that-calcium.shtml
  27. http://www.bmj.com/content/341/bmj.c3691
  28. https://chriskresser.com/how-to-keep-your-bones-healthy-on-a-paleo-diet/
  29. https://www.ncbi.nlm.nih.gov/pubmed/21310306
  30. http://www.dumblittleman.com/2013/08/50-studies-suggest-that-magnesium.html
  31. Http://immunityageing.biomedcentral.com/articles/10.1186/1742-4933-2-14
  32. https://www.gutsense.org/fiber-menace/about-fiber-menace-book.html
  33. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3680567/
  34. http://www.ketogenic-diet-resource.com/daily-protein-requirement.html
  35. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2139217/
  36. http://jamanetwork.com/journals/jama/fullarticle/899663
  37. http://jamanetwork.com/journals/jama/fullarticle/1105553
  38. http://www.metabolismjournal.com/article/S0026-0495(10)00329-X/abstract
  39. http://onlinelibrary.wiley.com/doi/10.1111/j.1745-459X.2010.00317.x/abstract
  40. http://www.marksdailyapple.com/can-exposure-to-non-primal-foods-actually-help/#axzz42otpmLbJ

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