May 9, 2023

Were Paleo People Really Healthier Than Us?


The popular Paleo Diet encourages adherents to eat lean meat, vegetation, some dairy products, and fish, while avoiding processed foods and food derived from grains. Does this work? To date there are no definitive studies on whether the Paleo diet is actually effective for weight loss or healthier than other meal plans. Like any diet, the proof is not short term weight loss, but rather long term health benefits, including weight loss. At first glance, the rationale behind the Paleo plan seems reasonably sound, but the idea that we could, or as some proponents suggest, “we should” adopt the lifestyle of our post ice-age ancestors is just silly. Which begs the question. Were humans of the late Paleolithic era really happy, hard working, health conscious naturalists? Unlikely, but we suspect that not a single one died from obesity.

During the Paleolithic period, which ended approximately 10,000 BC, our ancestors had formed small interdependent societies that survived by hunting, fishing, scavenging and gathering edible vegetation. Because food was scarce, they ate whatever they could pick, dig up, kill, drag home and throw on the grill– and frankly, we don’t know if they were healthy or not. In fact most did not live long enough to die from the things that kill us, such as diabetes or coronary artery disease. On the contrary, most died from exposure, starvation or trauma.

In contrast, modern Americans hunt and gather in super markets, convenience stores and drive-through windows. Not only is our modern diet categorically unhealthy, we expend almost no energy to attain it. As a result, the critically important energy balance equation is now tilted far beyond the tipping point. Whereas our ancestors hunted, gathered and scavenged in hope of finding and consuming enough nutrients and energy to survive for another day, perhaps two. Today we eat because good tasting food is everywhere and truthfully most of us cannot recall a time when we ate because we were nutrient deficient or in need of calories to maintain our body temperature. Nope, we eat because we are bored, busy, curious, stressed, relaxed, hurried, happy, sad, etc…and finding tasty meal requires minimal expenditure of caloric energy. As a result of our collective over eating and sedentary living, obesity, not starvation is now the number one preventable cause of death in the modern civilized world. How bad is it? Data from The National Health and Nutrition Examination Survey (NHANES) 2011–2012 survey show that two out of three U.S. adults are overweight or obese. It gets worse. The highly touted and statistically successful Interactive Dialogue to Educate and Activate (IDEA) clinical trial could not be replicated in the community setting. In other words, individuals who are at risk for diabetes and cardiovascular disease did well (lost weight and improved glycemic control) while in a structured clinical trial, but failed miserably when left to fend for themselves. So changing ones diet and lifestyle is essential for improved health. But as the data reveals, this is truly the hard part.

Our friend and colleague, Dr Louis Aronne, an internationally recognized obesity expert and director of the Comprehensive Weight Control Program at Cornell University understands the energy balance conundrum that obese persons face. His research suggests that biology, not willpower, plays the most significant role in overeating and obesity. The biology of which he speaks, is a highly complicated feedback system involving body fat, important energy regulating hormones. All of which are mediated by the paraventricular nucleus of the hypothalamus. As humans evolved from hunting and gathering to our modern sedentary lifestyle, our internal weight-regulating system, which is biased towards calorie conservation and diminished satiety, tells us to eat more that we actually need. This is also known as hypothalamic disregulation. When food is overwhelmingly sugar or fructose filled or constructed to “hijack” the brain and cause loss of control, we often advise boring the brain to submission through eating the same food again and again for a period of time. Most effective treatments psychoeducational and even medical treatments for obesity is focused on re-calibrating the weight regulating system to restore energy balance—and optimal health. Dr Aronne’s research revealed that lowering insulin levels through calorie reduction, managing carbohydrate intake and moderate exercise, nudges the brain to re-calibrate and burn energy and store calories more efficiently. Interestingly, these are also some of the benefits of the high protein Paleo diet.

We wholeheartedly agree with Dr Aronne, and have worked to build this into our work with patients in the office, rehab, or camp.  When the brain recalibrates, eating healthier and eating less becomes the new normal, and optimal body weight is more easily sustained.

So yes our ancestors were hard working hunters, scavengers and fisherman and in all probability, burned and stored calories efficiently–but this was not a lifestyle choice—it was simple survival. But the principle is sound. Restoring energy balance through better nutrition and increased energy expenditure is a simple and straightforward approach to achieving, and more importantly, sustaining optimal health. So when our obese patients ask which diet or exercise program is best–our answer is always the same. Are you willing to invest the time and energy to find out.




by: Mark S. Gold, MD , Eliza Kingsford, MA , Drew W. Edwards, EdD, MS


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