The Paleo Diet
How was the Paleo Diet developed?
The ideas of the Paleo Diet were first documented in 1975 by Dr. Walter Voegtlin (1). It was further developed throughout the 1980s and became popular in the 2000s. Dr. Loren Cordain trademarked “The Paleo Diet” in 2002 and this is the form of the diet we know today (2). These researchers looked at how our ancestors ate and how our genes have evolved for thousands of years. They noticed that our ancestors did not suffer from many of the health conditions that are common today (3). Following a similar diet is thought to have similar health benefits since we are still genetically similar to our ancestors. It has since gained popularity with athletes, nutritionists and health advocates. We now have research supporting its health benefits as well.
What is the Paleo Diet?
The Paleo Diet is also known as the caveman diet, the hunter-gatherer diet or paleolithic diet. It is based on eating foods that our bodies are genetically designed to process (2). It removes foods that our ancestors wouldn’t have eaten before farming was available. This includes dairy products, cereals and grains, legumes, processed foods and sugars, starches and alcohols. It focuses on fruits and vegetables, lean meats, seafood, nuts and seeds, and healthy fats.
There have been many advances in food manufacturing in the past few decades. Food is more available in larger quantities and it lasts longer because of chemicals and preservatives. It is more convenient to prepare and tastes better due to added salts, sugars and artificial flavours. These advances have occurred much more quickly than our bodies and genes can keep up with (4). This is thought to contribute to chronic health concerns such as diabetes, heart disease, cancers and mental health concerns. A Paleo Diet is based on whole foods that our bodies are designed to process (2). It aims to provide a balance between modern technology and our genetics.
The Paleo Diet is a low sugar, high protein, high Omega-3, whole foods diet. It includes foods that are high in vitamins, minerals, plant compounds, fibre and water. It is low in salt, refined sugars, cereal grains, dairy products and processed foods. Civilizations that do not follow a standard Western diet are what the Paleo Diet is based on. These populations have low levels of obesity (2), heart disease (5), stroke (5), high blood pressure (5), diabetes (6), acne (4), cancer (4) and autoimmune disease (4). The idea is that we may be able to achieve their level of health if we can mimic their diet.
Who might benefit from the Paleo Diet?
The Paleo Diet may be helpful for those with chronic health conditions such as cardiovascular disease, diabetes and obesity. It may also help prevent these diseases as well as others such as cancer, acne and hormonal issues.
Others use the Paleo Diet as a guide for healthy eating to ensure their bodies are getting the proper nutrition it requires and feel their best. Research has shown that positive changes in weight and blood pressure can occur even when healthy people eat according to the Paleo Diet (7).
The Paleo Diet may improve several markers of cardiovascular disease. It has been shown to reduce blood pressure, total cholesterol, triglycerides, LDL cholesterol and insulin in as little as 10 days (8). It has also been shown to increase HDL independent of weight loss (9). These markers are linked to heart disease, stroke and other cardiovascular conditions.
How do cholesterol and triglycerides impact your health?
Cholesterol is a fat-like substance made by your liver. It is also found in foods you eat and is absorbed through your digestive system. It is packaged into particles called lipoproteins that carry cholesterol in the body. There are two types of lipoproteins, high-density lipoprotein (HDL) and low-density lipoprotein (LDL). LDL delivers cholesterol to the cells that use it to create hormones, bile and vitamin D. If your body has more LDL than it needs, it can build up in the walls of your blood vessels to form plaques. As this plaque builds up, the blood vessel becomes narrower which restricts blood flow. This is why LDL cholesterol is linked to heart disease and stroke, and why it is known as “the bad cholesterol”. HDL removes cholesterol from your cells and plaques that have formed and takes it back to the liver to be excreted. This is why HDL is known as “the good cholesterol” and benefits your cardiovascular system. Increasing HDL cholesterol while reducing LDL and total cholesterol can benefit your blood vessels. This can reduce your risk of heart attack and stroke.
Triglycerides are a type of fat molecule found in the blood. Fat is a very efficient form of storage for extra energy in the body. Your body converts extra calories and blood sugar into triglycerides to be stored as fat in your cells. When your blood sugar and energy stores are low, you can break down triglycerides for energy. High triglyceride levels may work with high cholesterol to form plaques in the arteries and cause hardening of the blood vessels. This is how triglycerides contribute to your risk of heart attack and stroke. High triglycerides are usually seen in conditions such as obesity, Type 2 diabetes, liver or kidney disease and metabolic syndrome.
The Paleo Diet is helpful for weight loss in terms of pounds lost and reduced waist circumference (10). This is likely due to less reliance on carbohydrates for fuel, less processed foods with high levels of sugar and salt and increased fullness between meals due to higher fat and protein content. In many studies, significant and sustainable weight loss was demonstrated with no change to the number of calories eaten (11, 12, 13, 14, 20). Calories may be reduced unintentionally due to the nature of the food included in the Paleo Diet however.
The Paleo Diet can help with fat loss around your organs too!
Many obese people also develop non-alcoholic fatty liver disease as a result of their excess fat stores. Your body stores fat very well. It usually stores it around your muscles where it can be used for energy if needed. When your body has lots of fat to store, it starts to store it around your organs. In simple fatty liver disease, fat becomes stored in the liver but there is little damage to the liver cells. This can progress to non-alcoholic steatohepatitis if excessive fat continues to be stored in the liver. This is when inflammation and liver cell damage occur along with the fat storage. This can lead to liver scar tissue called fibrosis. Cirrhosis occurs when these damaged liver cells die and this leads to low liver function. Liver cancer is also possible when these changes occur. The Paleo Diet has been shown to reduce liver fat content by as much as 49% in as little as 5 weeks (14). The largest benefit seems to be in those with the most fat content before starting the diet (14).
Diabetics can benefit from the Paleo Diet as well since it improves glucose tolerance and reduces HbA1c levels as a marker for long term blood sugar control (10). Fasting blood sugar and insulin levels can also be improved with the Paleo Diet (14).
How do grains affect blood sugar?
Carbohydrates are found in starches, grains and sugars such as bread, flour, rice, pasta, beans, potatoes, cereals, fruit and processed sugars. Our bodies break down carbs into glucose molecules that our cells can use for energy. Because we are good at processing carbs, we turn them into glucose very quickly. This causes a spike in blood sugar and this triggers the release of insulin from the pancreas. Insulin is a hormone that acts as a signaling messenger in the body. Insulin allows your cells to take in glucose from the bloodstream to use within the cell. We are also able to store extra glucose as glycogen in the liver and muscles, or as fat in the rest of the body. When insulin is released in large amounts over an extended period of time your cells can become resistant to the signal. This means your body needs a higher level of insulin to move glucose into its cells. At some point, your body cannot maintain these high levels of insulin so glucose builds up in the bloodstream. This is how insulin resistance is related to prediabetes, metabolic syndrome and Type 2 diabetes (15). Poor blood sugar control and obesity are related to many other chronic illnesses such as heart disease, stroke, cancer, high blood pressure and high cholesterol. It is becoming clear that grains and sugars can have a negative impact on our health.
The Paleo Diet has been shown to cause improvements in various aspects of Metabolic Syndrome in as little as 2 weeks (16)! Metabolic Syndrome is a combination of high blood pressure, high blood sugar, excess midsection fat and abnormal cholesterol or triglyceride levels. These conditions are often clustered together in overweight or obese individuals. This combination increases the risk of heart disease, stroke and diabetes. The Paleo Diet has been shown to improve waist circumference, triglycerides, blood pressure and blood sugar levels (17) which are all components of Metabolic Syndrome.
How are these conditions related?
Abdominal fat in particular has been linked to chronic diseases including heart disease (18), diabetes (19) and high blood pressure (19). Abdominal fat, or central obesity, also makes insulin resistance more likely.
Fat held in the abdomen is hormonally active and makes hormones called adipokines that are thought to reduce the body’s tolerance to glucose. Abdominal fat also releases hormones called resistins which further contribute to insulin resistance. The Paleo Diet helps control blood sugar levels and reduce abdominal fat which means it is likely helpful for Type 2 diabetes and other conditions related to abdominal obesity such as Metabolic Syndrome, heart disease and stroke.
What can you eat on the Paleo Diet?
The Paleo Diet mimics the diet of our ancestors who were hunter-gatherers. It is based on whole foods that our bodies can easily recognize and process.
Category |
Foods to Include |
Foods to Exclude |
Meat |
Beef, lamb, chicken, turkey, pork |
Processed and smoked meats (hot dogs, sausages, cold cuts) |
Fish and Seafood |
Salmon, trout, haddock, shrimp, shellfish |
Deep fried or battered fish products |
Eggs |
Free range if possible |
Processed egg products |
Fruits |
All fruits in their natural form |
Processed fruits with added sugar or preservatives, fruit juices |
Vegetables |
All vegetables in their natural form |
Creamed vegetables, canned vegetables with added sugar or preservatives |
Nuts and Seeds |
All seeds in their natural form including almonds, walnuts, hazelnuts, cashews, sunflower seeds, pumpkin seeds, sesame seeds, chia seeds |
Processed nut products with added sugar or preservatives |
Flavourings |
All herbs and spices in their natural form |
Sugar (high fructose corn syrup, soft drinks, fruit juices, table sugar, etc) and Artificial sweeteners (aspartame, sucralose, cyclamates, saccharin, dextrose) |
Dairy products |
Non-grain dairy substitutes (coconut milk, almond milk, non-dairy kefir) |
Milk, butter, cheese, ice cream, yogurt, cream cheese, cream |
Grains |
None |
Breads, pastas, corn, wheat, spelt, rye, barley, and legumes (beans, lentils) |
Fats and Oils |
Extra virgin olive oil, coconut oil, avocado oil |
Vegetable oils (soybean, sunflower, cottonseed, corn, grapeseed, safflower) and margarines |
Whenever possible, choose animal products that are wild raised/caught. The fat content of these animals is different from farm-raised animal products that are typically fed low quality grains. These products are also more likely to be organic with reduced levels of pesticides, antibiotics and hormones. They are more likely to be ethically raised as well. These products are typically more expensive than the grain-fed variety so work within your budget as much as you can.
Calorie restriction and portion control are not part of the Paleo Diet. Because most of the foods are plant-based, the number of calories you consume daily will likely be well controlled without you trying. You will also feel fuller longer because of the high in protein and good fats found in many of these foods. No one ever gained weight or became unhealthy eating too much healthy food!
The Paleo Diet is also not a low-carb diet. You are reducing your consumption of grain-based carbohydrates but complex carbs found in fruits and vegetables are increased. Protein and fat intake will naturally be increased by reducing reliance on carbs but it is not meant to be a high-protein or high-fat diet either. Eating whole foods with little processing is the focus and eating a variety of healthy foods is important.
What makes the Paleo Diet work?
The Paleo Diet focuses on whole foods with the building blocks your body needs to function well. Protein helps build muscle and bone and is also important for immune function and energy production. It may also be helpful for maintaining a healthy weight because it keeps you full after meals and slows your blood sugar spike after eating. Fruits and vegetables are full of vitamins, minerals, antioxidants, water, fibre and other nutrients. Healthy fats contain Omega-3s which decrease the inflammation linked to heart disease, stroke, diabetes, cancer and many other chronic conditions.
No Grains
The Paleo Diet eliminates most, if not all, grains from the diet. Grains are quickly processed by the body and turned into sugar. This sugar is then stored as fat and this is possibly the root of the obesity epidemics seen in Western cultures. Diets high in grains are also linked to unstable blood sugar which contributes to conditions like diabetes. These foods are not meant to be broken down by your body and have been linked to increased levels of inflammation. This inflammation is thought to be related to heart disease, arthritis, mental illness, digestive dysfunction, autoimmune disease and many other health conditions.
But didn’t our ancestors eat grains?
Wheat and other grains have been consumed for thousands of years, but industrialized farming has changed their properties and how they work in our bodies. Processing has allowed grains to be used in many different forms and store easily for long periods. This is why modern grains have become staples in Western diets. Manufacturing also removes many of the vitamins, minerals and nutrients that wheat and other grains are thought to contain. Ancient grains don’t seem to cause inflammation in the same way as modern wheat and other processed grains do. This is likely because modern grains are recognized as very different than the grains our bodies processed thousands of years ago.
Many modern grains are now exposed to fertilizers, pesticides and chemicals. When you eat grains, these toxins are consumed and can have a detrimental effect on the body. The agriculture industry has also manipulated the genetics of grains to yield larger crops that are resistant to drought, pests and disease. These genetic advances are too fast for our bodies to keep up with. The body is usually able to break them down but that doesn’t mean it should. Modern grain processing techniques also raise the gluten content in many grains, especially wheat.
What is gluten and why is it bad for us?
Gluten is a group of proteins found in grains such as wheat, rye, barley and spelt. Gluten is actually made up of 2 proteins; gliadin and glutenin. Gliadin is thought to be the more inflammatory component (21). Gluten is responsible for the stickiness of dough and the consistency of many grain products. When flour is mixed with water the gluten proteins give the dough elasticity. It also allows bread to rise when baked and gives it its fluffy texture (22).
Many people have adapted to tolerate gluten. Other people have various degrees of sensitivity to it. Celiac disease is a severe form of gluten intolerance and is actually an autoimmune reaction to the gluten proteins. When the body views gluten as an invader, the immune system attacks it as well as the lining of the intestines (23). This damage to the intestinal cells can cause nutrient deficiencies and many digestive issues (24) such as abdominal pain, bloating, diarrhea, weight loss and foul-smelling stools (8). Symptoms can also occur outside the digestive system including fatigue, skin conditions, mood disturbances or anemia (25).
Not everyone with a gluten sensitivity will test positive for Celiac disease. Many people have non-celiac gluten sensitivity. The symptoms are similar to Celiac disease but are typically less severe. This diagnosis is controversial since it relies on a patient’s report of their symptoms.
Celiac disease is diagnosed through laboratory tests. Blood tests that screen for the Tissue Transglutaminase (tTG) Antibody determine if antibodies to the gluten molecules exist in the body. If positive, this is usually followed by analyzing a biopsied sample of the small intestine. This looks for damage to the intestinal cells and can only be done if the patient is currently eating gluten. If you have an intolerance, eliminating gluten-containing grains from your diet will remove the inflammation gluten may be causing and your symptoms should improve.
What is inflammation?
Inflammation is your body’s natural response to some sort of injury. It is your body’s way of healing itself and is produced your immune system.
Chronic inflammation can occur over several months or years in response to damaged or dysfunctional cells. This creates a set of reactions called the inflammatory cascade. Inflammatory messengers called cytokines are released from the injured cells and call out to the immune system. The immune system sends white blood cells to remove damaged tissue. Your immune system also sends cells that help heal the damaged tissue and return you to normal function. This inflammatory cascade takes place as long as the signal from damaged cells is present. This long-term reaction has been linked to heart disease, cancer, autoimmune diseases, joint pain, fatigue and mental health concerns.
No sugar
The Paleo Diet eliminates all forms of artificial sugars. Many modern processed foods contain sugars, salts and artificial chemicals. These compounds are unnatural and were never meant to be processed by the body. Sugar creates inflammation in the body and the link to chronic health conditions is becoming much clearer (25, 26, 27). Sugar has been linked to inflammatory conditions such as obesity, diabetes, cancer, metabolic syndrome, autoimmune conditions and many others. Eliminating sugar reduces the blood sugar instability, fat storage and inflammation sugar consumption is known for.
Using natural sugars can provide flavour to your food without the inflammatory effects of sugar. Adding naturally sweet foods like raw honey, pure maple syrup, agave nectar, molasses, dates, bananas, applesauce and other fruits makes your food tasty and keeps you satisfied.
No dairy
Eliminating dairy is based on the idea that it’s not something we are meant to consume. No other animal drinks another animal’s milk. Dairy products are often contaminated by antibiotics, hormones and pesticides due to modern farming practices. They usually come from grain-fed animals as well. Dairy products also undergo lots of processing to make them safe for human consumption.
In addition, no other mammal drinks milk past infancy. Many people are intolerant to dairy as adults and find they feel better when they eliminate it from their diets. Lactose intolerance is estimated to affect about 75% of the world’s population (28). This is thought to be an adaptive response to not drinking breastmilk past infancy (28). Dairy contains lactose which is broken down by the enzyme lactase. Most people lose this enzyme as adults while others have adapted to keep producing it (29). People with lactose intolerance notice digestive symptoms when they consume dairy. Some people are intolerant to other proteins in dairy and experience similar inflammatory symptoms.
High-quality meats
Wild meats and animal products have been shown to have a different fat profile than farm-raised products. Farm-raised animals are typically fed low quality grains and this translates into poorer quality fat in their meats. Wild meats, fowl and fish are leaner, have lower levels of saturated fats and have higher amounts of Omega-3s (30). These are the meats that were eaten before modern agriculture and farming techniques.
How does the Paleo Diet compare to other diets?
The Paleo Diet has been compared to other diets in several studies looking at obesity and diabetes.
The Paleo Diet has been found to be more filling than the Mediterranean diet (11). This is likely due to its effect on levels of leptin, a hormone which is responsible for regulating appetite and bodyweight (11). This may make losing weight with the Paleo Diet more successful compared to other diets. It was also found that both diets improved blood glucose tolerance but they improved more for those on a Paleo Diet (12).
Compared to the “Diabetes Diet”, the Paleo diet showed more improvement in weight, waist size, blood pressure, HDL cholesterol, triglycerides and short- and long-term blood sugar levels (10).
The Paleo Diet has also been shown to reduce Metabolic Syndrome more the American Heart Association diet and conventional Western diets (13). It is thought to improve markers of cardiovascular health such as HDL, LDL, triglycerides and total cholesterol more than traditional heart-healthy diet recommendations as well (31).
The Paleo Diet has also been found to be more nutritionally dense than standard American diets (31), Mediterranean diet and vegan and vegetarian diets (31).
What are the risks of the Paleo Diet?
The Paleo Diet is typically well tolerated with no adverse effects reported (2). It is important to note that the Paleo Diet can be restrictive in nature which can be difficult to maintain long term. It may not be realistic to eliminate all foods completely based on what is commonly available to us in North America so results may vary. Paleo Diet foods are typically a bit more expensive than traditional grain-based foods, especially when buying organic, grass-fed, free range animal products. Eliminating processed foods will cut down on some of your other costs however, and the health benefits you’ll gain are worth even more!
But doesn’t milk build strong bones?
One of the criticisms of the Paleo Diet is low calcium intake. Dairy products and grains are said to be high in calcium and Vitamin D and both are important to bone health. In theory, eliminating these foods would have a negative impact on our bones and contribute to osteoporosis.
What is osteoporosis?
Our bones are constantly changing in a process called bone remodeling. Bones store calcium and they break down as needed to regulate calcium levels in the blood. Calcium is important for cell signaling, blood clotting, muscle contraction and nerve function. When blood levels of calcium drop, specialized cells called osteoclasts break down bone and the stored calcium gets released into the bloodstream. When there is extra calcium available, other cells called osteoblasts store this calcium in the bones and teeth. Osteoporosis occurs when osteoclasts break down more bone than osteoblasts rebuild. This is common as we age and can lead to higher fracture risk in older people, especially menopausal women. Vitamin D helps with calcium absorption from food to make sure there is calcium available to store. Osteomalacia is another cause of bone fractures and is caused by low Vitamin D levels. Osteoporosis is very common in Western cultures. It is estimated that 1 in 2 women and 1 in 4 men over 50 will break a bone due to osteoporosis (32) and fractures in the elderly may triple the risk of death (33).
So we should all eat lots of calcium, right?
Not necessarily. The daily recommended intake for calcium is controversial and ranges between 600-1300mg per day depending on the source (34, 35). We know calcium is important but too much isn’t good for you either. Excess calcium usually only comes from taking high-dose supplements but has been linked to kidney stone formation and heart disease. If you have lots of extra calcium, your body has to put it somewhere and your bones and teeth can only absorb so much!
Why do so many people have osteoporosis?
Inflammation is thought to contribute to poor bone health. Inflammatory cytokines and chronic inflammation have been linked to bone breakdown (36) and are considered risk factors in osteoporosis. We know diet and lifestyle have a huge impact on the levels of inflammation in the body. Inflammation is typically high in Western diets which may explain why osteoporosis rates are also high. High intake of grains and low intake of healthy fats, fruits and vegetables, and quality animal products increase the body’s resting levels of inflammation. This is why the Paleo Diet is thought to help prevent osteoporosis even though it eliminates dairy products.
There are arguments for and against dairy consumption in relation to osteoporosis. Dairy creates inflammation for some people but not for everyone. Some tolerate it just fine. Ultimately, if you are choosing to eat according to a Paleo Diet, dairy is out. Many non-dairy foods have lots of calcium including sesame seeds, bone-in fish, leafy greens like spinach, collard and turnip greens, and molasses. It is possible to achieve adequate calcium intake from non-dairy sources and reduce your resting levels of inflammation in the process.
Tips for Success on the Paleo Diet
Read ingredients labels – Many processed foods contain ingredients that should be eliminated but are not obvious. Read the ingredients labels of any processed foods you eat to find out exactly what is in it.
If it comes in a box or a bag don’t eat it – The easiest way to avoid additives is to eat a whole foods diet.
If your grandparents wouldn’t know what it is don’t eat it – Many foods have become so commonplace, we forget how new they really are to our bodies. If someone who wasn’t alive 100 years ago wouldn’t know what the food is, chances are your body isn’t meant to process it either.
Ensure sensible indulgences if necessary – You have to give yourself some wiggle room in order to make the Paleo Diet a sustainable, long-term lifestyle change. Foods such as wine, dark chocolate, tea and coffee contain healthy compounds and can be enjoyed occasionally.
Give it time – Eating according to the Paleo Diet is a difficult change for many people. Our diets are typically full of carbohydrates and processed foods so it will take time to adjust to this new way of eating. If you stick with it, it will become much easier as time goes on. Everyone is different, but most people notice a difference in some way after a few weeks.
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