The Real Paleo Challenge Redux

The original title of my presentation for the Ancestral Health Symposium 2013 was:

But now I feel like it should be more like:

What’s going on in Paleoland? Well, you can see Melissa McEwan’s take on it here, or itsthewoo’s take on it here. My concerns about paleo are wrapped up in the presentation below, and going into AHS 2013 I was more than a little nervous about saying what it is I wanted to say. See, I don’t consider myself “paleo” (or “low carb” or “insert whatever diet therapy you think I adhere to here”); I consider myself a nutritionist, a public health professional, and work in progress. I do recognize the fact that a lot of people who do consider themselves “paleo” attend AHS–and I consider a lot of them my friends and colleagues. While I see promising things in the group of people who have chosen a paleo path, I also agree with a great deal of what both Melissa McEwan and itsthewoo have to say. (I admit to some sadness over the demise of Paleodrama. Other people binge-watch House of Cards. Me, after a long week of rhetorical theory and critical studies, I would grab a tumbler of sangria and binge-read Paleodrama. To each her own.) The presentation would, I hoped, put some of the “issues” that I see happening in Paleoland on the table, without throwing out the potential for paleo to grow into something more than itself. Well.

Without further ado, here’s the presentation as it was in August. Updates and commentary that did not appear in the original are in [brackets].

It is an honor to be here at AHS and I am delighted to be in such esteemed company. I hope that I can bring to our conversations this weekend a little something to offend everyone.

The primary misconception that I deal with in public health nutrition is that our current policy is the same thing as science. Conversely, a primary misconception regarding reforming this policy is the idea that “If only we could get the right information to the public and to policymakers, things would be different.” Having the evidence to support a movement’s agenda is important, but public perceptions and national policies are shaped as much by social, political, and cultural forces as by science.

As we have seen in other movements, cultural change drives policy change, which in turn drives cultural change. The current mainstream definition of what constitutes a “healthy” diet is an excellent example of this. At one point in the not-too-distant past, a low-fat, low-calorie, plant-based diet was considered a “fad” – just as the stereotypical paleo diet is today. But it was not science alone—or even primarily—that shifted the public’s perceptions.

In fact, the science supporting this dietary guidance has been and remains weak, but that didn’t stop it from becoming policy. George McGovern’s Senate Select Committee, a group of young white liberal men full of well-meaning social concern, wanted to create a plan to reduce chronic disease (a reasonable public health goal), as well as lengthen the lifespan of their committee. They did their work against a backdrop of post-World War 2 wealth, comfort, and suburban complacency that was rapidly crumbling in the face of social movements that would polarize the population: civil rights, women’s liberation, and anti-war protests. Television brought bombings, riots, assassinations, and Watergate, into middle class living rooms and shook middle class faith in government and social order. Middle class complacency was quickly turning into anxiety and cynicism.

Some of this anxiety took shape specifically around matters related to food and health. Ancel Keys taught the public his theories about heart disease–a “disease of success” brought on by too much animal fat. Rachel Carson raised awareness of environmental toxins. Ralph Nader and the Center for Science in the Public Interest raised the alarm about chemicals in our food supply put there by corporate greed—a force which also was accused of contributing to hunger in America. Many groups, from feminists to Beatles fans, picked up on these issues—along with ethical concerns about animal welfare—by turning towards vegetarian diets. McGovern’s committee—as they said back then—was hip to all of this.

This is clear in their choice of reference material for the Dietary Goals, which included—of all things—a cookbook called Diet for a Small Planet. As much vegetarian manifesto as a source for recipes, it proposed that a plant-based diet was the best way to feed the hungry, save the Earth, protect our health, and usher in the Age of Aquarius. [It still does.] This cookbook assured middle-class America that what was good for us was also good for the world. Its influence is felt throughout the 1977 Goals, which counseled Americans to reduce consumption of meat, eggs, butter, and full-fat dairy, and increase intake of grains, cereals and vegetables oils, recommendations that have changed very little in nearly 40 years.

McGovern’s committee wanted to return America to a more “natural” way of eating—and what could be wrong with that? This “back to nature” stance earned the Committee the nickname “the barefoot boys of nutrition.” This “back to nature” idea not only recalled the “physical culture movement” that had long been a part of American life, it resonated with Puritan ethics that suggested that self-discipline and a little suffering—which Americans were going to need for such a radical change in diet—were a mark of moral goodness. Barefoot and back to nature, fresh air, sunshine and a little suffering—does any of this sound familiar?

Those initial Dietary Goals did not embed themselves in American culture based on the strength of their science—to say the least. They grabbed the attention of the media and the middle class because they played on the existential anxieties that cultural turmoil creates. They substantiated a notion that by changing their diets, Americans could control some of the frightening things in the world—hunger, pollution, disease. We could demonstrate just how much we cared about these issues, and we could do it from the comfort and safety of our own dinner table. We are still trying to do that even now.

Our current calls for reform in the areas of food, nutrition, and health reflect the same set of complex social problems, the same inescapable environmental problems, the same threats to our food supply that the creators of the 1977 Goals faced—only compounded by time, technological advances, and a distinct turn for the worse in the country’s (and the world’s) health.

The paleo community emerged as a protest against dietary guidance that seems to many to be scientifically shoddy, shallow, limited, and ineffective. The attention to calorie balance as the only way to maintain health seems to be especially—and unnecessarily—restrictive and unhelpful. But “paleo” in its stereotyped form takes a shape that is little different from the one to which it stands in opposition.

Both of approaches to nutrition are stuck in the past in two primary aspects:

Both suggest a linear and mechanistic approach to the food-health relationship. “Eat this/don’t eat that and all will be well.”

Second, and more subtly, both approaches reflect the cultural values and social power of those doing the reforming, but may not reflect the realities of the most vulnerable in our population, the ones who might benefit most genuine changes to the system.

People have been burnt once already by a “nutrition revolution” – they are confused, skeptical, and wary. They don’t want to get fooled again. Right now, paleo is not offering much that is truly revolutionary in terms of a new way to approach to food and health. Unless and until we are ready to give up some of the same concepts that we criticize the mainstream approach for using–it’s really just “meet the new boss, same as the old boss.”

We can’t generate the outrage we need to change the public’s world view, because we have not decided what our own priorities are: Do we care only about our own food and health, or do we care about everyone’s food and health?

With regard to food, current nutrition policies are a barrier to the growth of local food systems.

Farmers have difficulty expanding the market for locally-produced animal products because of dietary guidance that limits saturated fat and cholesterol intake. Meanwhile the paleo community is in upheaval for days—weeks, months?—debating the worthiness of butter from cows that are only 90% and not 100% grass-fed. How can we support long-term sustainable growth in local systems when our own standards are incoherent and possibly unreasonable?

We want our meat, eggs, and butter to come from happy, healthy cows and chickens. But what attention are we willing to spare for the health and happiness of farm workers—or the workers up and down the food supply chain?

With regard to health, nutrition is a civil rights issue.

We don’t want our wellness determined by an arbitrary marker like LDL, but are we willing to go to bat for someone else whose wellness is determined by an arbitrary marker like BMI?

The paleo community spends its energy debating how various sugars and starches may or may not be paleo. This is fascinating, but will it help people with diabetes who are never offered an alternative to a low-fat diet—despite the science that demonstrates the benefits of a carbohydrate-reduction in treating this disease?

The current nutrition paradigm use moldy datasets normed on white female healthcare professionals born during the first half of the last century to inform the dietary health of dark-skinned young males all over America. But is suggesting they return to their caveman roots any more appropriate?

These are huge issues—wicked problems—and we can’t fix them by replacing the old rules with some new ones. In order to be a leading force in the kind of social movement that might create authentic change in the system, paleo is going to have to move beyond the limited perspective that perpetuates many of the mistakes of the current nutrition paradigm.

I propose that we consider the idea of ancestral health—as distinct from “paleo”–as a way of framing food and nutrition reform to address both the cultural and the scientific limitations of previous approaches.

In terms of science, anthropology and evolutionary biology have shown us that diet is idiosyncratic and variable within and between populations, but not chaotic; there are certain nutritional requirements, but there are many ways to meet them.

Research into the human microbiome has shown us that we are not alone; and that the health of the microbial communities within and around us is a critical aspect of our own health.

Epigenetics, genomics, and other aspects of systems biology have begun to reveal the complexity of interactions between our genetic material and our environment, with food being a primary, but by no means the only, environmental exposure.

All of these concepts can and should be part of the ancestral health framework.

But as I said at the beginning, science is not enough. There are three critical components that turn a protest into a movement.

1) Development of widely-shared cultural norms, the violation of which is perceived as injustice. In order to develop those norms, we’re going to have to do some GROWING UP.

2) Development of a repertoire of actions that demonstrate that conditions can be altered. In order to create the sense of agency and change that we want, we are going to have to start DIGGING IN.

3) Development of a dense social networks that can work collectively against a common target. In order to create these alliances, we are going to have to begin REACHING OUT.

Growing up for paleo—as for many things—will to need to start with a little makeover. Like all good makeovers, this doesn’t mean abandoning the paleo identity completely, but it means looking—and moving—beyond it. There are precedents for this from other nutrition reform arenas.

For many people, hearing the term “vegan” bring a knee-jerk—and negative—reaction; but the term “vegetarian” does not. People who promote a vegan diet know this and can frequently be found using the term “vegetarian” instead. So that’s a marketing strategy, and a fairly wise one.

Now, take the phrase “Atkins diet” which can also elicit a negative, knee-jerk reaction. But scientists who study such diets have learned to use the phrase “reduced-carbohydrate” not only for PR purposes, but because the phrase “Atkins diet” does not encompass the different approaches to carbohydrate reduction that scientists are interested in.

How about paleo? It also elicits a negative, knee-jerk reaction from many and calls up stereotypes of privileged white males eating big hunks of meat on a stick—even though, as Hamilton Stapell showed us, those stereotypes may be somewhat inaccurate. As such, the term “paleo” limits what we can expect to accomplish as a framing device for conversations about food, health, and lifestyle. From this point forward I will use the term “paleo” to refer to the stereotyped and limited perspective and “ancestral health” to refer to an expanded and comprehensive approach to food-health reform.

By shifting the shared norms of our community towards an ancestral health framework—rather than being limited to paleo—we can move beyond the outdated concepts that we share with the current approach to nutrition and the problems that they create. We can—if we choose to—use an ancestral health framework to challenge those assumptions in a truly radical way.

[What follows is what I call the Top Ten Reasons Paleo Pisses Me Off, but my hubby, ever the diplomat, said not to say that.]

[Reason 10:]  So let’s just get this out there: The first assumption we need to challenge is the one that equates body size with health, which is interesting since according to Dr. Stapell, both of these are primary reasons to become part of the paleo community.

Mainstream approaches indicate that overweight and obese Americans need to eat less and move more to achieve a healthy weight according to an arbitrary cut-off on a simplistic measuring tool.

The paleo approach suggests that maybe strong is the new skinny. Or maybe “strong” is just another superficial way of assessing another’s worth.

The problem is that attention to body size rather than health and functionality can lead to a moralizing and pathologizing perspective that doesn’t reflect reality. Not only can this approach foster disordered eating behaviors and judgment calls about food, character, and lifestyle choices, it tells us little about overall health. We have no way of knowing, looking at these two women (Brittany on the left and Jennifer on the right—no headless women here), who eats what kind of food, who is healthy now, or who is going to live a long and functional life.

Our challenge is to use the ancestral health framework to recognize that a multiplicity of body shapes can be healthy and functional, and to acknowledge that much of body shape and size is determined genetically and can be influenced by factors other than diet and exercise. De-emphasizing body shape/size brings our focus to health, and especially for women, inter-generational health.

Women can—and do—have bellies, butts, and bingo flaps. Sisters who rock the paleo hardbody look—more power to you. Sisters who are more the Venus of Willendorf type—more power to you too. We can all meet at the pool and compare muscles & bra sizes & bingo flaps—and just get over ourselves and any fear of somebody tweeting about our butts.

[Reason 9:] Growing up also means moving beyond the idea that food and nutrition are the same thing.

Typical nutrition guidance discusses food as if all food choices are based only on nutrition.

Yeah, we tend to do the exact same thing.

The Problem: People are concerned about a lot of other things besides nutrition. Usually cost, convenience, and taste come first–

–followed by a host of other considerations, only one of which is nutrition.

An ancestral approach to food can embrace all of the factors that impact our food choices because it can look at food in its cultural—as well as biological—context. It can highlight the role of environmental stressors in overall health–including economic and time pressures that also impact food choices. Acknowledgement of food communities allows us to explore the role food beliefs and preferences play in food choices; these too are part of an anthropological and evolutionary perspective on food-health relationships.

[Reason 8:]  We need to move past the idea that food is medicine.

Mainstream nutrition has promised that a low-saturated fat ,low-cholesterol, low-calorie, low-sodium, whole grain diet will prevent chronic illnesses like heart disease, cancer, and diabetes.

Us: Same promise, different food.

Now, I’m not going to say that the paleo paradigm doesn’t have some better biochemistry behind it; in many [but not all] respects, it does. The problem is that food is still not medicine.

A nutritionally-appropriate diet should be the foundation of good health, but it doesn’t guarantee it. Both groups are making promises they can’t keep & this leads to skepticism, cynicism, and disillusionment. Most importantly, this framework take a complex social construct and a biological necessity—food—and reduces it to a mechanistic and simplistic intervention–medicine.

Medicine is for sick people and food is for everyone. We may use food as part of a therapy to “heal” a particular condition at a particular point in time, but that is not the same thing as a public health paradigm. We put casts on broken legs, but we don’t recommend that everyone wear casts in order to prevent legs from breaking.

An ancestral health approach offers an opportunity to move away from the view of the human condition as one of potential “illness” to be “avoided” to one of wellness to be maintained.  By focusing first and foremost on essential nutrition—and the many appropriate ways that it can be acquired–the emphasis is on having health, not preventing chronic disease. The recognition of the complexities of what we know and don’t know about the relationships between food and health brings into the public health forum other important aspects of lifestyle—sleep, stress, play, activity—that can contribute to health and well being.

[Reason 7:] There is no small irony in the fact that both plant-based and paleo ideology emphasize a return to “a more natural way of eating.” How does that happen? Because the notion of “a more natural way of eating” is not something that is easy to define. [More generally, the emphasis on a more "natural" way of doing things is a rhetorical device that implies "goodness" and fails to evaluate the issue at hand on its own terms.]

Mainstream nutrition suggests that returning to a “more natural” diet means eating a lot foods that our ancestors DIDN’T eat—either in the near or distant past—like vegetable oils, and avoiding a lot of foods they DID eat, like butter, eggs, meat, and lard.

Paleo suggests that returning to a “more natural” diet means NOT eating a lot of foods that our ancestors DID eat—at least in the not too distant past—like bread, legumes, and dairy, [and eating a lot of foods they DIDN'T eat i.e. coconut milk, unless your ancestors were Thai].

The problem is that “natural” is term useful for marketing, but not much else. It isn’t a scientific concept, or even one that makes a lot of sense culturally. We don’t really have a lot of solid information about what was “natural” for our distant ancestors—and the gene/environment interactions that may have occurred since then may make that information less relevant than how our more-recent ancestors lived, ate, and worked.

Here’s our challenge: Ancestral health principles got their start by focusing on paleolithic times—and that perspective is a valuable one—but we don’t have to be limited to that. An ancestral health framework can also allow us to look to the near-past for clues about our health now, should we choose to. Here’s the beauty of this approach: It’s already been sanctioned by mainstream nutrition, and by two of the leaders in nutrition reform, Michael Pollan and Gary Taubes.

In his landmark 1985 article, Sick Individuals and Sick Populations, epidemiologist Geoffrey Rose called for “The restoration of biological normality by the removal of” among other things “recently-acquired dietary deviations.” Gary Taubes indicates that Weston A. Price’s work about the health impacts of introducing new foods into native diets as the “most influential” thing he read in researching Good Calories, Bad Calories. Michael Pollan suggestion that we eat the way our great-grandparents ate has become a rallying cry for many people interested in food reform.

[The pie chart above] is a pretty reasonable picture of an “ancestral diet” from 1955 America: we got about half of our calories from plant-based starches and sugars—only 10% of those as fruits and vegetables—and about half from mostly animal-based proteins and fats. I’m not saying this is a perfect diet, but it does seem to be the one we were eating before the rapid rise in obesity and diabetes.

An ancestral framework can help us analyze the differences between how this food environment may be similar to or different from our current one, without having to invoke a past that didn’t exist, as the plant-based folks must in light of this information—or a past that is so distant that it’s hard to say what we really know about it [as the paleo folks must]. On the other hand, the 1955 –style 50/50 diet looks remarkably familiar. It’s not that hard. Or is it?

[Reason 6:] Well, we make it hard by invoking food rules that don’t always make a lot of sense. Everyone’s current favorite, on all sides of the nutrition issue, is: Avoid processed foods.

Michael Pollan says avoid processed foods unless you are talking about vegetable oils.

Paleoista says avoid processed foods unless you are talking about hydrolyzed fish protein powder.

Problem: Food rules means splitting hairs, drawing lines in the sand, and creating arbitrary divisions—and they usually end up making the food rule makers look silly at best and hypocritical at worst. Food rules are the easiest things to dismiss, discount, or disprove. We’re already enmeshed in a set of arbitrary, unreasonable, and incoherent standards [called the Dietary Guidelines for Americans]; no one is interested in a new and different one.

Skip the food rules. What we need are guiding principles from an ancestral health perspective that can apply to individuals, industry, and policymaking processes. For instance, if we frame concerns around the “recently acquired dietary deviations” I just mentioned, we have a guiding principle—upon which Geoffrey Rose, Gary Taubes and Michael Pollan all agree—for looking at the current scientific literature and for conducting future investigations. We might go back a few generations or many generations; either way we can remain true to our generational perspective of health without limiting ourselves to a particular set of food rules.

[Reason 5:] The politics of responsibility are a no-win situation for the public.

Mainstream nutrition assures folks that, if the low-fat, low-calorie diet isn’t working for you, you’re not doing it right. Paleo people assure newbies that if the high-fat, no-calorie-counting paleo diet isn’t working for you, you’re not doing it right.

And when that logic doesn’t fly, both groups blame the “obesogenic” environment.

Problem: Both approaches assume that “If only that poor sick, fat person had the “right” food or the “right” information or the “right” environment, they’d stop being so fat and sick.” These approaches call for policy reforms that will force industry to make “the healthy choice the easy choice” for people apparently deemed too irresponsible or stupid to make the healthy choice otherwise. But industry is responsible to the public, not for the public. That’s the job of public health.

Challenge: An ancestral health approach recognizes that poor health may be as much an outcome of environmental impacts and generational health—especially prenatal health–as food choices and activity. This shifts the focus away from the politics of responsibility and puts the attention on food industry and policy reform where it belongs, not on a product—which the consumer may or may not choose—but on the processes over which consumers have little control: federal approval of food additives, food and farm workers rights, food safety and food waste, environmental impacts of our current agricultural practices, and many other food-related practices, program, and polices that have been ignored in favor of telling people what to eat and do and blaming them when it doesn’t work.

[Reason 4:]  This one is a real “I’m rubber, you’re glue” thing. We complain about all those mainstream nutrition articles making sweeping generalizations about how animal fats will kill you—then we turn around and make sweeping generalizations about how vegetable oils will kill you. The vast majority of these claims—on both sides of the table–are unproven and even untested; in many cases they are untestable. [The science for both claims is primarily observational; other science may be experimental, but based on animal models and cell cultures. The few randomized, controlled dietary trials that exist are just that, highly controlled. The populations may or may not be generalizable to larger populations; the methods may or may not translate to the "real world."]

Problem is, we don’t know what we think we know about the relationships between diet and health. Plus, there’s a really good chance we will never know what we think we need to know about the relationships between diet and health.

Science and medicine as they have been practiced in America for the past half a century (or more) have relied on a mechanistic approach to these relationships that is now rapidly giving way to more complex thinking. The mechanistic approach has served the industries of research, medicine, food and pharmaceuticals–because what is simplified can be controlled–but it hasn’t served the health of humans.

Ancestral health principles can help us think about science differently. Nutrition science as it is practiced now is backwards looking—especially nutrition epidemiology which relies upon ancient datasets gleaned from populations which are hardly representative of our current world. It ignores the complex relationships between ourselves, our environment, and our heredity that science has more recently uncovered. Despite its name, ancestral health represents a forward-looking framework. As an approach to public health, it can herald a shift to a more holistic, yet evidence-based focus that recognizes individual, community, environment, and generational impacts on health. Consider the ancestral health community’s active encouragement of n of 1 experimentation. It is a perspective that can go beyond Joe Paleo fiddling with his macronutrient ratios to a place of leveraging new biomedical technology, new ways of modeling complex relationships, and a new focus on patient-centered outcomes to create a revolution in how we approach the science of diet and health. This is not anti-science, but an embrace of science in all its complexity. Such an approach brings us to our biggest philosophical challenge:

[Reason 3:] Can we acknowledge that one diet will not be right for everybody?

Right now, mainstream nutrition asserts that everyone will benefit from eating a low-fat, low-calorie diet.

At the same time, the paleo community asserts that everyone will benefit from eating a paleo diet.

The problem with a top-down, unilateral imposition of one-size-fits-all dietary recommendations is the same as it was in 1977: Who asked you to come up with a diet for me that might or might not help prevent a condition that I may or may not be concerned about? Remember that a skeptical public doesn’t want to get fooled again. New arrivals to our country, who aren’t yet aware of the abysmal failure of our current nutrition system, are being greeted with admonitions to give up traditional foods like eggs and meat—but then paleo doesn’t have a much different message to offer, except that instead they should give up traditional foods like bread and beans.

Ancestral health principles embrace the notion of change. Ancestral health acknowledges complexity. It only makes sense that an ancestral health approach to public health would recognize diverse paths to acquiring appropriate nutrition, with a focus on foods high in nutrient value, and frame dietary information in terms of the diversity of individual, cultural, environmental, and generational contexts. But will it?

[Reason 2:]  Many of the assumptions I’ve mentioned are deeply embedded in our thinking, and reflect the concerns, values, and social power of the mostly white, well-educated, well-paid, predominantly female thirty-somethings that make up the paleo community. Not that there’s anything wrong with that—information from other datasets have shown that white, well-educated women are also the ones that most closely adhere to the Dietary Guidelines food pattern, so the presence of this demographic in paleo may reflect an overall concern not only for weight and appearance, but for family and health. This is a good thing. This particular demographic also has a long history of being the backbone of successful social reform movements—from child labor to drunk driving laws.

But ladies—and gentlemen—we are going to have to do more than vote with our forks or food dollars.

Both paleo and plant-based reform efforts seem to believe that your financial support of the food you’d like to see other people eating is the best way to change the food-health system. You can just munch your way to a better world without ever having to encounter anyone who doesn’t appreciate the change you’re creating for them.

For paleo eaters, increased demand may increase production, making some foods more affordable for some people. It may support some farmers—as long as they keep up with and adhere to all of the “appropriate” [and possibly contradictory, unrealistic, and/or absurd] paleo food rules—but it isn’t necessarily going to change the status quo for the most vulnerable in our population, the ones most subject to the effects of dietary policy as it stands now. Me buying my eggs locally doesn’t help the low-income mothers who would like to spend their federal assistance farmers market vouchers on local eggs too, which they are not allowed to do. Face it, in the “vote with your food dollar” approach, some folks have a lot more votes than others. Changing your diet is not enough to change the world. We are going to have to put down our forks and dig in.

One of the things any successful social change effort has is a story, where the victims of injustice can be rescued from evil by the heroes. A successful social change effort also has a way for everyone—from individuals to the government—to be a hero. This takes the form of a repertoire of actions for changing conditions. These concrete actions give a sense of agency and urgency to the cause; they say to the world: come join us, we are being the change we want to see.

Being a hero and acting from a place of our own food-health values, however, does not mean going out into the world and trying to impose those values on someone who hasn’t asked for our help. Instead, it means sharing the privilege of health we have in a useful way [and this is a privilege based much more on social class than diet], so that others may have the food and the health that they want—just as we wish to have the food and health that we want. How can we do that?

For example: An ancestral health framework recognizes the importance of protein as essential to a nutritionally-adequate diet. But protein is also the single most expensive food source to provide to the less fortunate. Because it is so expensive, it also means that protein is the food source most lacking in diets of those who are in most need.

The state of Illinois has established a program to encourage hunters and anglers to donate deer and Asian carp—which is an invasive species in the Great Lakes–for processing into healthy, ready-to-serve meals. I don’t know what their standards for that are, but if you work to build a similar program in your area—or maybe you’ll head up a protein food drive for a local shelter–you get to help set the standards, remembering that the goal is not necessarily following all the “right” food rules, but feeding the hungry essential nutrition.

[A number of states have programs--with various names, but often called "Hunters for the Hungry"--that bring hunters, processors, state inspectors, and hunger relief organizations together to help supply sources of all-important high-quality protein to those in need.]

Community level programs can ripple outward and upward – and if they are organized with an ancestral framework in mind, those ideas ripple outward and upward as well.

Farm to Family initiatives bring food from local farmers to local, low-income families at prices they can afford—an effort that supports local farmers as well as community members at risk for hunger and poor nutrition. These initiatives typically focus on fresh produce, but some include meat and eggs—and wouldn’t the world be a better place if even more of them did? College students with mad social networking skills can mobilize volunteers and connect resources to get the program off the ground. Local public health agencies and faith-based organizations can raise awareness so that families at highest risk can be reached—and so their wants and needs can be heard and honored. Individuals and families can donate time and money, while businesses can facilitate logistics with donations of materials or space. Feedback from the community can support policy change at local, state, and federal levels.

The ancestral health community has the sort of talent to pull an effort like this off, but it involves not just getting out of the house, but getting out of our comfort zones.

[Reason 1:] The lack of diversity that often comes with being part of a community of like-minded people presents both an epistemic challenge and a logistical one. It can lead not only to closed minds, but to closed doors. Being able to act from a place of ancestral health principles—rather than paleo rules—can make it easier to reach out to others–the final thing needed to build a social movement.

Confirmation bias has been a pervasive aspect of mainstream nutrition, and in opposition to it, paleo culture often seems to have adopted a similarly insular stance. It can be reinforced by influence and funding, but most often it is simply a way of not being challenged in our own beliefs.

In mainstream nutrition, the USDA and HHS write the Dietary Guidelines. They also finance the research and the experts that they later choose for their “evidence-based analysis” of these guidelines, so it’s no surprise that both the research and the experts support the status quo.

Paleo leaders also have a vested financial interest in being paleo leaders—books, speaking engagements, products, and other various funding streams—just as paleo followers have an interest in remaining comfortable in their chosen ideology. We support our leaders; they tell us what we want to hear.

This problem, also known as epistemic closure, echo chambers, or a circle jerk, is that these positive feedback loops end up welcoming only people that think exactly like the people already in the group. Sadly, the smarter you are, the better you are at confirming your own beliefs about things—and we have a lot of wicked smart people in the paleo community. Unfortunately, circle jerks quickly turn into cluster, let’s call them “efforts” – where the circle of closed thinking causes the very problems that the circle of closed thinking is unable to address exactly because of its closed nature. Which is sort of where we are now—both in mainstream nutrition and in paleo.

Much of mainstream nutrition has built-in alliances with academia, industry, advocacy groups, and policymakers. In order to make our voices heard, we will need to establish connections with other communities who will work with us on common issues. The general rule in building networks of alliances is that there are no permanent friends and no permanent enemies; everyone is a future ally. You work together on issues and projects as long as your goals align.

This may make for strange bedfellows at times, but if we want to be more than a passing fad, we are going to have to reach out of our comfort zone and connect with other communities with whom we may not feel an immediate kinship but with whom we share some core values.

For example, the Health at Every Size community. This community has a strong presence in academic circles that look at feminist and diversity issues. While an alliance based on paleo thinking might not make sense, the ancestral health framework would have much in common with these Health at Every Size principles.

The Invest in Healthy Food Project being promoted by the Union of Concerned Scientists uses MyPlate as its nutrition reference point. Icky, right? But a closer look shows a focus on policy change that is fully compatible with ancestral health principles. Specifically citing the need for changes to commodity crop policies and crop insurance that would benefit the local farmers that we support.

Other communities with whom we are likely to have some common objectives are: other alternative food movements–yes, including vegans; sustainable agriculture and permaculture communities; government accountability groups; and hunger groups. We don’t have to agree on everything, just our shared goals. We can learn from them and they can learn from us.

We can reach out to foundations, the media, professional organizations, and faith-based communities. And it doesn’t have to be on a national level. We can find influential allies in these groups in our own local communities.

And in fact, that’s where I would urge us to start. As a community, we exist both nowhere and everywhere—which can make us feel more at home at places like AHS than we do in our own towns. But, to quote Rick Ingrasci, if you want to create a new culture—throw a better party. One of the wonderful traditional things we do as humans is celebrate and build community with food—but it’s hard to celebrate if you are busy agonizing, analyzing, and criticizing your—or your neighbor’s—food. We have the opportunity to NOT be those nutrition reform people.

I’m going to end with a story about last year’s Food Day in Durham, NC. This is sponsored by the Center for Science in the Public Interest, which operates from a plants-are-better, saturated-fat-kills perspective. At an organizational meeting last year, a room full of young white women—and one white male—were busy wringing their hands over the lack of diversity at last year’s Food Day events. Now Durham is a very diverse little city. In Durham, we talk more about race than NASCAR fans talk about racing. But Food Day tends to be an almost all-white event involving mostly college kids from Duke rather than people from the community. Why oh why is that? these ladies (and one gentleman) wanted to know. I suggested that maybe it’s because no Food Day events serve meat—and there are lots of local meat, egg, and cheese producers that we could support by promoting their foods. These women looked at me as if I had just created a loud, legume-based bodily emission—and the topic was never mentioned again.

Well, we can throw a better party. We can appeal to a wider, more diverse, and inclusive community. It will mean growing up, digging in, and reaching out. But there are plenty of people out there who are hungry for a sense of identity, for connection, and for change. Ancestral health as a social movement can serve that purpose, as well as serve our communities—and we can serve it with a side of bacon.

The “thank you” slide is my shout-out to those who have helped me think about the issues I’ve raised.

Laura Schoenfeld @ Ancestralize Me!

Beth Mazur @ Weight Maven

Melissa McEwan @ Hunt Gather Love

Robert Patterson @ Michael Rose’s 55

Chris Masterjohn @ The Daily Lipid

Doug Imig – The Urban Child Institute

Andrew Abrahams – Long Dream Farm

Michael Ostrolenk – The Transpartisan Center

Postscript: At some point during the AHS 2013 weekend, I pulled Aaron Blaisdell aside and asked him what the deal was with paleo and AHS. Here’s his response as I remember it (and I hope he will correct me if I misrepresent him). He said something to effect of: AHS is about bringing an evolutionary perspective to health, including but not limited to matters relating to diet and nutrition. Darwin’s evolutionary perspective has been an incredibly powerful tool in other areas of biology for understanding why things are the way they are and for formulating hypotheses and testing them out, but it is often neglected when it comes to health particularly in matters of food and diet. AHS is about promoting that perspective, not about promoting a particular diet. [See Aaron's comments below for an expansion on this.  Note to self:  Drink that glass of wine after you ask Aaron Blaisell questions like that.]

I heaved a big sigh of relief. “Paleo” I can do without–just as I can do without all of those other conveniently-labeled approaches to diet and health with massive cognitive bias blind spots: vegan, vegetarian, low-carb, low-fat, “eating the food,” whatever, whatever (although I’m happy for the people who find that being part of those communities gets them on a path to health that works for them). So I guess this is my massive cognitive bias blind spot. I still love those AHS folks.

49 comments on “The Real Paleo Challenge Redux

  1. Ocean's Edge says:

    Thank you, for this. There is much food for thought here.

    There is little if anything I’d disagree with. However, that old cynic in me feels my back stiffen a little and my brain itches whenever we put a ‘name’ on it like ‘ancestral health’. I get the why, we do that. We need to set it apart from all the other things with names like vegan and paleo … but, by naming it we risk making it exactly the thing we don’t want it to be, a trend. We give it a name and the world asks ‘well what is ‘Ancestral Health’, and why do I care? You’ve done an admirable job of explaining it, but we’re talking about an ideology more defined by what is not than by what it is. I so get that, I’m a Canadian, we’ve made an entire cultural identity out of defining ourselves by what we’re not – but I also get the drawbacks to that. The minute you name it, someone wants you to define it, and if you’re defining it loosely (as it must be) by what it isn’t than what it is – that leaves a void or a gap that someone is going to try to fill with a definition and a parameter, and before ya know it those pesky rules start showing up. You want to build public policy on it, but policy makers want nice simple easy rules – they don’t really function well with the ‘this is what we won’t be’ and want clearly defined ‘this is what we will be’ rules. Policy unfortunately is built on rules not principles.

    Again, don’t get me wrong – there isn’t a single word here I’m not sort of cheering and going “YES!” to, but I really hope the ideology doesn’t become a ‘movement’ and get turned into something it was never really meant to be.

    • Adele Hite, MPH RD says:

      You make a very good point & one that I have some trepidation about myself. But I am comforted by the fact that there are already underway in other arenas similar movements with different names which would be fully compatible with the overall paradigm shift that “ancestral health” points to: evolutionary medicine; critical dietetics; critical nutrition; etc. The whole point of these lines of thinking is that a one-size-fits-all public health intervention for diet-chronic disease relationships is inappropriate. Policymakers might want rules rather than principles, but a primary principle at stake here is that general rules about diet & chronic disease can’t be applied to a population of people with diverse biological, ethnic, and cultural backgrounds.

      I feel like a broken record with this but our first hurdle to get over with regard to policy is that dietary guidance based on prevention of chronic disease is necessary at this time. We don’t have adequate scientific support for this type of guidance; such guidance has proven to be an immense failure so far; and there is no research that indicates that we would be worse off without it. This doesn’t mean that no guidance should be given. It remains important that everyone be given direction on how to get adequate essential nutrition, but there are many ways to go about this. A focus on adequate essential nutrition would give policymakers the “rules” they need w/o violating the principles of ancestral health or evolutionary medicine or anything else.

  2. Ms. T. says:

    I’m so glad I stopped by this blog through another link. This is a fantastic article! As a black women in the process of losing 200lbs, many things were said here that I wish could be screamed to the rooftops—starting with the fact that size does not equal health. I wish I could strike the phrase “unhealthy obese” from common vernacular. In the last year I have lost 30lbs. Yay. But what I’m much MUCH happier about is the fact that I have created a lifestyle that incorporate deliberate eating choices and consistent exercise. That is healthy.

    I tried Paleo. My body hated it. I need dairy products. I was surprised because I had bought into the idea that diary = bad. Come to find out my body thinks dairy = necessary.

    This journey is teaching me that my body is the only arbiter of what foods are healthy FOR ME. Zucchini is a super flexible food that can be eaten on almost every diet but my body says no. Ok. No Zucchini, no matter how awesome your zucchini spiral pasta looks.

    I also believe there is some truth in the idea of the “worrying” about food causing some of the problems with food. I don’t know if you saw this milkshake study: http://www.npr.org/blogs/health/2014/04/14/299179468/mind-over-milkshake-how-your-thoughts-fool-your-stomach

    but I hope this experiment is repeated to gain clarification about what exactly is happening there.

    In any case, great post!

    • Adele Hite, MPH RD says:

      Thanks for the kind words! And also thanks for the link–it kind of makes my point for me. Worrying about what is in your food is as likely to have an effect on your body as the stuff you’re worrying about. This doesn’t mean that everything in your food is benign; it means that, with the methods & knowledge we have now, the whole system is too complex to find some way to make decisive links between what is going on today to what diseases may develop 30 years from now. Best to take the approach you seem to have stumbled upon. Figure out what makes you feel right, right now. And focus on the preventive measures that we either know make a difference–smoking, alcohol consumption–or that make you feel better immediately–activity you enjoy, reducing stress.

      To me, rather than agonizing over the particulars about my food, it makes more sense to direct my attention to things about my food I think actually do make a difference: 1) adequate nutrition 2) current health & well-being 3) the food system as a whole.

      I wish you the best of luck on your journey. Thanks for stopping by.

    • Adele Hite, MPH RD says:

      I agree 100% that the conversation should ALWAYS be about health and not about bodyfat. Here’s the analogy I like: bodyfat is like a cough–sometimes it is a symptom of something serious; sometimes it is a symptom of something less serious; and sometimes–it’s just a cough. Tagging obesity as a disease not only signifies an erroneous assumption about a relationship (see Katherine Flegal’s work on the relationship between obesity and morbidity and mortality–it had Walter Willett spitting tacks), it opens the door to more of what Herndon is talking about: “You got diabetes because you are fat. You allowed yourself to get fat because you ate too much and didn’t move enough. You don’t deserve our consideration or care–or maybe your just don’t deserve the same insurance coverage as others.” And as far as I am concerned, the worst part about “fat blame” is self-blame. We’ve become so convincing regarding the locus and prevention of this disease, that when someone can’t lose weight by eating less and moving more (happens all the time despite what Marion Nestle says), that person will often blame him/herself. I know. I’ve not only been there, I’ve seen many patients trying to lose weight who have also blamed themselves (“I should not have eaten the other half of that granola bar for breakfast”). Enough already.

      • luanabee says:

        And yet if you display yourself in public with your bones showing, that’s glorified. Because skinny = healthy. The skinnier, the better. Only it’s not. The crazy, conflicting information and messages we get are making us the most eating-disordered nation on earth.

        I ran across a fascinating link (maybe here, I don’t know) to the story of a naturopath who, over time, figured out he was a quack. He coined the term “orthorexia,” to describe a disorder he saw where patients were obsessed with eating only healthy foods (with some bizarre notions of what’s healthy), not necessarily to lose weight. It led them to give up more and more “unhealthy” foods over time until they were surviving on, like, only carrot sticks. Or they’d come in looking for complicated regimens of vitamin supplements because they were convinced that the latest “miracle” nutrient would make them live forever.

        Here’s the link to his semi-autobiographical story. It was fascinating to see how alternative medicine helped perpetuate food myths and enable people’s eating disorders.

        http://www.orthorexia.com/hh/

      • Adele Hite, MPH RD says:

        I get that too. I lose weight when I’m stressed (unlike others who gain weight when stressed). At one of the most stressful times in my life, I got all kinds of compliments on how great I looked because I’d lost weight (dying on the inside, nobody noticed). I wonder sometimes if our national problem isn’t obesity, but some form of orthorexia–maybe orthorexia by proxy even? Classically (see Robert Crawford’s work on “healthism”), it is a middle-class, white people issue. We worry a lot about what we eat, but we might obsess even more about what others eat. At a recent presentation I tried to explain to an audience member that I don’t really have a “way of eating” or “food rules” that I apply, other than to get adequate nutrition. She, very honestly, said “I don’t know what to do with that, or how to think about you.”

      • luanabee says:

        Yes, Adele, isn’t that spontaneous stress weight loss what I call The Breakup Diet? Of course, everyone knows how healthy and sane we all are just after a relationship breakup. ;) It’s pretty sad that people you’re running into are confused about what to think of you if you don’t let a lot of food rules run your life.

        Orthorexia by proxy is a concept I can understand. I’ve seen it manifest itself in the self-righteousness of people who talk about the discovery of their funky food rules as “when they woke up” and make sure you know that they’ll “never go back” [you know, to eating normal food]. As if they are the healthy, enlightened ones; it’s a religion. I have a few friends like that and lord knows I carried around that attitude during my years as an unhealthy vegetarian. I’m finding out just how annoying I was.

      • Adele Hite, MPH RD says:

        Yeah, I’ve had to eat some crow in that regard–definitely NOT a vegetarian dish :)

  3. Great post, Adele! In particular, the concept of abandoning food rules really resonated with me. Why are we so insistent on creating rules that transform complex relationships into binary mandates? My only sense is that is easier for many (myself included) to follow rules than to have to really consider, on a case-by-case basis, whether to eat a food and how much of it to eat.

    In public health, we seem hell-bent on prescribing a way of eating for everyone, under the premise that issuing recommendations (from our ivory towers) and promulgating policies will yield the greatest good for the greatest number. But it strikes me, given the issues you pointed out, that this seems exactly opposite of what should actually be most impactful. Why can’t we consider that everyone comes from a different social, cultural, and genetic makeup which may require a unique way of eating? Our current approach not only neglects these nuances but it fails to consider feasibility. We issue recommendations that are so far from what most people can reasonably achieve within their own personal context, that many if not most don’t even bother to try (outside of the nutrition or paleo or any health food community, who are the exceptions). It’s just too difficult and too low a priority, given the myriad other real-life issues people must face on a daily basis. Also, I don’t know why we think it is appropriate to manipulate people’s values to achieve our own agenda. Trying to make people eat or not eat things that bring them pleasure or comfort seems a recipe for failure. Are you really going to tell folks in the South no more fried chicken and sweet tea, and expect that most will say, “OK, sounds good?” It’s the same thing with this whole local movement. Are we really going to expect low-income minorities to drop what they’re doing and head out to the suburban farmer’s market on Saturday, to pick fresh green beans with a bunch of cheerful yuppies? Instead, why not work within people’s social, financial, biological, and taste preferences and needs to help them achieve better health–as they define it and/or desire it?

    I dunno.

    Anyway, thanks for another thought provoking post!

    • Adele Hite, MPH RD says:

      Great questions. Thanks for the thought-provoking reply–I think it gets at what I was trying to say much more directly. I kind of want to put a note at the top of the post to just skip the preliminaries and read what you have to say :)

      I am especially intrigued by your thoughts on feasibility (the paper that demonstrated that you can’t meet sodium restrictions and still meet nutrition requirements comes to mind) and values (food is so central to our sense of who we are, but our dietary recommendations seem to disregard this completely).

      I still have no idea how were are going to get away from the top-down, one-size-fits-all mandates, from either the feds or from alternative nutrition communities that think THEY have the answer instead. On my end, I’ll keep working on trying to expose/explain the historical context of the whole conversation. Maybe if we realize that our “common sense” approach to nutrition (as it is now construed) is really an historical artifact and a relatively new one at that, we can begin to consider alternative universes? But mostly, I am convinced that asking the questions you’ve raised above (over and over again, in every context imaginable) is what will create change. Thanks again for joining the conversation!

      • Kenny says:

        Here’s how I think about it these days.

        We need to consider nutrition like we do exercise. With exercise it’s not one size fits everyone. Not everyone is suited to the same plan of exercise. We intuitively know this and tailor exercise plans to individual abilities and needs. Why don’t we do the same with nutrition and dietary guidelines?

        Dietary Guidelines need to be more like exercise plans. Choose your own plan, monitor your progress, see what works, what doesn’t, respond and change it up as needed as you go along. You change and grow as you continue an exercise plan, so you change what you do. It should be the same with nutrition and diet. Find the plan that works for you and customize it to make it work best for you. That’s what dietary guidelines should be like.

        We need to customize nutrition for each person. No one can do it for you, just like exercise. No one can tell you what’s exactly the right amount or things to do; you have to feel your way through it, stopping when things don’t feel right, and pushing harder when you feel up to it. In the same way, you need to learn to feel your way through your eating plan, how to feed your body for best results.

        Nutrition needs to be more like Exercise:
        * With Nutrition: experts tell you what to eat
        * With Exercise: you choose your own plan

      • Adele Hite, MPH RD says:

        All good points – but I’m afraid even exercise recommendations are become more–not less–prescriptive. We used to just tell people to exercise. Now we tell them for how long, how many days, and to what level of exertion. How do we turn these trends around?

      • luanabee says:

        We could model food and exercise only in terms of enjoyment, and perhaps help people get over the idea that these self-abusive food and exercise routines are keeping them healthy. When friends bring up their new crazy diet, I just smile, say I’m now on the “delicious food diet,” and describe the latest food I’ve rediscovered that I haven’t eaten in a long time. (Most recently maple syrup.) Who can argue with that?

        Same with the exercise. Constant, high-intensity exercise doesn’t solve people’s never-ending weight problem, and they stand a good chance of injuring themselves. The attitude I try to convey to people is, “Take it easy, be good to yourself.” IMO, exercise is a means of getting around to have a good time. Personally, I walk and bike around a lot to get somewhere or catch some fresh air. But you won’t catch me counting my steps or monitoring my heart rate to make sure I get the ultimate workout. What a drag THAT would be!

      • Adele Hite, MPH RD says:

        I love the “enjoyment” regime!

        I’d be happy if we could just treat food as if it is just food. I think life is too short for food not to be enjoyable, but then, every now & then, my mom cooks food & I eat it anyway–sorry mom :)

  4. It is interesting to see the increasing attention for the microbiome. I am waiting for the moment those libertarian paleo’s notice that that means we are all in it together healthwise.

    • Adele Hite, MPH RD says:

      Thanks for this Victor. Yes, we are all in together. It would be nice if we could start acting more like this is the case.

  5. Dana says:

    “…diet is idiosyncratic and variable within and between populations, but not chaotic; there are certain nutritional requirements, but there are many ways to meet them.”

    Aaand if you’ve gone Paleo, you can still have a variance from others in your nutritional requirements* and choose a different set of foods than they choose without deviating from what the modern Paleo movement (as opposed to ancestral dietary rules) suggests are the best categories of foods to eat.

    Indigenous red meat in Africa looks very different from indigenous red meat in Europe or North America.

    Fruits are different everywhere.

    Even tubers are different.

    The agricultural revolution screwed us, not only for the Neolithic foods it introduced (although dairy at least has some redeeming traits for some people, especially the fat), but for brainwashing us into believing that the world was empty of food unless we deliberately grow it here. It reduced our possible food choices in favor of letting the elites conquer all the food-plentiful land and then fence it off away from the rest of us.

    It’s not so much that Paleo has rules. EVERY traditional culture has rules about what you eat and what you don’t eat. Why? Because we’ve lost most of our instincts. That’s not a wrong thing for us to do, setting rules. The wrong thing comes when we make these rules because somebody got an idea and didn’t properly test it. Ancestral traditional food rules came from people testing foods over a long period of time and observing what effects they could observe. This is probably why liver has come to be considered an important food in nearly every pre-literate traditional culture across the globe. It certainly wasn’t due to an edict from Ancel Keys.

    —–
    *This is never an absolute variance. It always looks like a Venn diagram, one person’s requirements overlapping quite a bit over another’s with a little difference out at the edges on either side. I’m a little tired of people acting like we’re all becoming different species or something.

  6. Elizabeth says:

    Fantastic post. Especially this:

    Both paleo and plant-based reform efforts seem to believe that your financial support of the food you’d like to see other people eating is the best way to change the food-health system.

    I’ve been struggling with this so hard – I do all the right things (chat with the CSA lady who raises my kissed-by-angels animal products every Saturday at the market, spend hours researching ethical seafood choices, etc. etc.) but it’s becoming increasingly sterile and meaningless when I look out of my little grass-fed bubble into the rest of the world. There’s only so much fulfillment you can get by perfecting your own behavior; at a certain point, it just becomes unsatisfying and empty.

    My problem: I have no idea what else to do. I despair of the food system. I don’t think it CAN be fixed. I certainly can’t fix it; I have talents in other areas, but leadership and public policy are not among them. I see the industrial food system as deeply entrenched in our social, political, and economic structures: is it even reasonable to talk about changing our food system without changing EVERYTHING? The US food system is in many ways a consequence of US capitalism; what are we going to do, overthrow the economic regime?

    So ultimately I’m driven back on my own behavior as the only thing I have any control over – which of course is exactly where the industrial food system wants me, safely ascetic, isolated from everyone around me, and totally impotent as a force for political change because I’m too busy interrogating shrimp companies about their labor standards.

    Sorry for the rant – as you can see, you touched a nerve, and I mean that as praise! Your points are all very timely and worthwhile and I’ll be revisiting this to read it again, hopefully in a slightly less cynical mood.

    • Adele Hite, MPH RD says:

      Elizabeth, thank you so much for such a lovely, thoughtful reply. It has been on my mind all day. I think this is a key point: “So ultimately I’m driven back on my own behavior as the only thing I have any control over – which of course is exactly where the industrial food system wants me, safely ascetic, isolated from everyone around me, and totally impotent as a force for political change because I’m too busy interrogating shrimp companies about their labor standards.” You are right. That is how the system would have it. But you are not impotent. I don’t know what your talents are–writing? research?–you seem to do those things well! Whatever you have to share of your time and talents, share them in this effort. I don’t know enough about your circumstances to give you specific suggestions, but I would start specifically, with the real folks in your real home–not that the shrimp companies labor standards aren’t important, but maybe it is time to look around and see what you can do in the space nearby. When I gave this talk in Atlanta last summer, a young lady from Canada came up to me afterwards & said she’d been thinking about what she could do to make a difference & she said words similar to yours (not a policy person, leader, etc.). But then she said, “I decided I would see if I could collect donation of eggs from customers at my local farmers market and take them to a church in a low-income neighborhood nearby.” She figured it would help the farmers raising the chickens & benefit the families at the church who could use some extra help getting high-quality protein. I thought this was a lovely idea. You don’t have to start a foundation :) Just figure out where in your community that ever-expensive protein is needed (young moms, children, the elderly can especially use eggs and meat). Asking around at faith-based organizations is often a good idea. They know who in their community just had a baby or lost a job. Be creative about collecting protein foods. Rather than asking farmers for donations (they are typically operating on a pretty slim margin), ask customers–buy one dozen eggs for yourself & one for a local family. You don’t have to ask strangers, ask a few friends. Four dozen eggs a week can make a huge difference to a few families. That’s just one idea. Maybe some readers have some ideas too?

      So what would be the point of doing this? To say, I don’t just care about my food, I care about my community’s food. What the hell? Throw a party with your delicious CSA food & talk this up with your friends. Maybe as a group, you’d like to sponsor a CSA for a family that can use it? My local CSA has been taking a poll lately: Are we–the customers–willing to pay a little more for our CSAs in order to allow the farm to donate a CSA to a family in need? (The answers to the poll were all “yes”). Offer to take a similar poll for your local CSA to see if customers in your area would support such a thing.

      Will this change “the system”? “The system” is made up of many small actors, performing many small acts, that add up into something big. I just say we should do the same.

  7. Saara says:

    This, is a thorough and well thought out post. Ive been through so many fad diets and this article really put into words my feelings on all of them. I have learned a lot from the many different diets I’ve been able to narrow down the foods that cause the no digestive issues and do not trigger migraines or allergies.. The conclusion is that the best one for me is one that I get enough animal protein and everything else that i add on top of that is based on how it affects my health and satiety level.

    • Adele Hite, MPH RD says:

      Good for you! Your journey sounds similar to mine. Diets and dieting can sometimes provide very helpful information, as long as we don’t let the diet “dogma” get in the way of figuring out if it is really helping (which was my problem for a long time). I’m glad to hear you’ve found what works for you.

  8. As an aside, there’s a joke I heard long ago that there are two kinds of people in the world: people who divide people into two camps, and people who don’t. Seriously though, there do seem to be two camps here: one who wants to “appeal to a wider, more diverse, and inclusive community” and another camp (or camps) who, intentionally or not, wants to “create ‘responsible good eaters’ on one side, and ‘irresponsible Others’ on the other.”

    From what I’ve read (e.g., Peter Corning’s The Fair Society or John Cacioppo’s Loneliness) that this is part of the human condition (not just in the health community) and that it has to do with an evolutionary mismatch between us, our environment, and a safety need for feeling part of a community. If so, then it’s not clear that we can solve this problem purely (or primarily) through making a good case. I’m not sure what will.

    • Dana says:

      I think there are evolutionary reasons we’re xenophobic and go into us/them thinking. I don’t mean to excuse the modern incarnations of this behavior because they’re completely uncoupled from the evolutionary purposes they likely once served. And I really don’t think anyone wants to see the textwall if I try to explain what I mean. Just… it’s normal for a traditional culture to have food rules, there are all sorts of good reasons for that (OK, at least one or two good reasons), AND, it’s normal to expect newcomers to live like you. Now what we do with these impulses without allowing people to continue to act like jerks to well-meaning newcomers, I really have no idea, because some people are hellbent on believing that survival of the fittest means that a relatively weak primate with no sharp claws and no huge fangs can somehow get along in the world after his repulsive attitude and behavior have driven everyone else away.

      I *do* know we all, in this country, live in an environment which is profoundly inappropriate for us on a biological level, not only with our biochemistry but with our psychology too. I suppose it’s a given we’re going to act out in pathological ways, and it’s only a matter of time til something busts out. We seem to spend so much of our energy now just trying to rein ourselves in from going justifiably insane in an insane system. I don’t know how we do it. I guess we have enough toys to distract us or something.

    • Adele Hite, MPH RD says:

      There’s nothing wrong with food communities; there’s more of a problem with public health. I think institutionalized “food rules” hinder the development/maintenance of a food system that is adaptable and sustainable, because there is only one “right” way to do things. I grew up during a time when there was little talk of “healthy food,” although families certainly had their own food traditions that were quite different–no one way of eating was considered “better” than another.

      I know I can’t get in a time machine and make the 1977 Dietary Goals not happen, but if we realized that the judgments that we make about what ways of eating are “better” than others are typically based on the weakest of weak science–science that would get eliminated in the evolutionary gene pool if science worked that way–there would be less “us” and “them.”

  9. luanabee says:

    Thanks for the article, it triggered a lot of thoughts for me, as I seem to be on this same food journey.

    Yes! The key to organizing anything is to bring delicious food! Doubly good to ditch the agenda, nobody likes a scold. Let’s all just get together and celebrate over a feast. In my neck of the woods, there’s a home arts revival among 30-something women where these traditional food parties are starting to happen already. Not for any particular agenda, I think people are getting tired of the explosion of food rules and heading back to tasty meals.

    Almost all of my near ancestors were German, who ate all the meats and starches we’re told will kill us. The Germans still eat that way today; they’re doin’ fine. I’ve bought a few of the recipe books from my great-grandparents’ time, getting back to a place of seeing food as less about disease prevention and weight loss, and more about a delicious spot in a fulfilling life.

    • Adele Hite, MPH RD says:

      Yay! Couldn’t have said it better myself. I had a friend say yesterday (she is from France) that she thinks it is all the worry about food that is killing us.

      We spent 2 weeks in Germany a few summers ago. I have never seen so many active old people and by that I mean older than me :) Germans love walking & hiking & if you are not careful, you will get blown off a trail by a nonagenarian with a couple of alpenstocks. Is that how they manage to survive a steady diet of potato dumplings and weiner schnitzel? Who knows? But it sure beats Lean Cuisine & a treadmill :)

      • luanabee says:

        That must’ve been a great trip, I’d love to get there someday and am now learning the German language. Last night my German teacher was telling us about all the hiking and biking they do over there–starting with the daily trip to the markets to get their food for the day’s meals. What a way to start the day! Food is an important part of the socializing they do, and they get plenty of time off work to enjoy it. Sundays are still an almost mandatory day of rest. Could it be that low stress and laid-back attitude about food would keep us all healthier than focusing on the micronutrient du jour?

      • Adele Hite, MPH RD says:

        That sounds very much like what we experienced on our trip. My father-in-law and his lovely wife have a home in Munich & they love it for all of the reasons you’ve mentioned.

        “Could it be that low stress and laid-back attitude about food would keep us all healthier than focusing on the micronutrient du jour?” I was talking with my son about an hour ago, as I chauffeured him and his girlfriend home from hanging out at a bagel shop. They talk a lot about food. After we dropped her off, he asked me what I thought the biggest problem with Americans and food is and I said “We worry too f**kn much about it.” (And he said, “MOM. Language. Please.”) So yeah, that’s a possibility.

      • Dana says:

        French and Germans still eat a goodly amount of organ meats and animal fat. I have reason to believe that if you have your animal intake squared away and haven’t permanently damaged your metabolism yet (or other organs not directly related), you can get away with a certain amount of crap in your diet because you get enough of the nutrients that help you process the crap.

        This is why the French get away with bread and pastries and why the Germans get away with starch. And yet they still have fat unhealthy people in both countries. I’d be curious to see if these folks eat more junk and less organ than usual. My bet’s on “yes.” The modernizing people who are too cool to eat yucky old traditional ethnic foods are the first ones to suffer. See also Dr. Price.

        (It’s also happening in Japan. Their type 2 rate is rising at an alarming rate and I assure you they eat as much junk food as we do, though possibly with less wheat and definitely with stranger packaging.)

  10. Please read the blog post you’re referring to; you’ll see that I categorize the fish powder as an ‘in a pinch’ option; a grey area for those times you cannot find fresh foods and you have to make a choice between a few not so great options. Making a homemade smoothie using fish protein powder, fresh veggies, avocado and some fruit would be a far better option than opting for a pre-made protein shake with whey, casein, sorbitol, carageenan or sucralose.

    • Adele Hite, MPH RD says:

      A far better option for someone with a blender, a fridge, the time, resources & wherewithal to get the ingredients, not to mention $20+ bucks to shell out for fish protein powder.

      My point is that when we start drawing lines around what is “okay” and what is “not okay” to eat, we set up a whole lot of other unacknowledged barriers and assumptions that create “responsible good eaters” on one side, and “irresponsible Others” on the other side. “Shame on you for choosing a pre-made protein shake made out of all of those nasty ingredients!”

      I’m not picking on you (really). Communities in general are, by their very nature, full of rules; that’s how we know who is “in” and who is “out.” Food communities are no exception and my understanding is that you are a valued member of the paleo food community & your guidance is valued as well. My larger point is that this is not a way to approach public health.

      • luanabee says:

        OMG, you should have seen the online exchange I ran into on Facebook re: the dietary realities of poor single mothers with kids …

        Disturbing Fast Food Truth Not Exactly A Game-Changer For Impoverished Single Mom Of 3

        http://www.theonion.com/articles/disturbing-fast-food-truth-not-exactly-a-gamechang,35388/

        You can imagine the moralizing that ensued. I’ve been in her shoes. You get it from all sides. I appreciate that you included your thoughts on more accessible food options for poor people.

      • Well, if you cannot pick on the actual, orthodox bordering-on-outliers in a given community, who can you pick on? It’s these folks who make it a challenge to “appeal to a wider, more diverse, and inclusive community.” I agree though, Nell means well and it’s great that someone is concerned about keeping paleo from going over the “predominantly processed foods made with almond flour” cliff. She’s also certainly been trying to make paleo more accessible (ref the cheat meals on Dr. Oz).

        That said, I’m not sure which is a bigger stretch: advocating fish protein powder “in a pinch” or telling folks that they can’t have vinegar. Your mileage may vary, but I’m with the camp that thinks the acid-alkaline theory is not sufficiently supported by science.

      • Adele Hite, MPH RD says:

        :) Perhaps I was unclear. Not picking on her “personally” (I only pick on the humans I actually know in real life personally). But yes, picking on the orthodoxy of any given food community. You are dead right that orthodoxy is generally unhelpful to creating a more diverse coalition of people who are willing to work together on larger issues.

        Ye gads, the acid-alkaline theory. One of many diet-health theories, most (all?) of which are not sufficiently supported by science. Generally speaking, as long as you’re breathing, your body can pretty much take care of diet-induced acid-base fluctuations and if you’re not breathing, you’ll have other things to worry about.

    • Dana says:

      Whey protein doesn’t seem to bother me. I get the non-denatured stuff. It’s not much different than taking random tubers, drying them out and then grinding them to a powder, something Melissa McEwan was crowing about back when a helicopter caught some uncontacted Indians doing it down in South America.

      People process food. It comes down to what you can tolerate without destroying your body. That will vary from year to year, too, depending on lots of factors.

      Fish powder and fruit together sounds completely disgusting.

  11. As I said on FB earlier; Great read, and so insightful, as always. I think you paraphrased me quite accurately. But AHS expands beyond Darwinian thinking, and includes everything in the history and prehistory that affects where you are today: Phylogenetics, Epigenetics, Genetics, Development, evolutionary adaptation, cultural adaptation, cultural heritage, and your own personal life history. THAT is your entire ancestry. We must move beyond Kingdom, Phylum, Class, Order, Family, Genus, and Species, and include Race/ethnicity, culture/nation/local community, extended family, nuclear family and friends, you, you, and you…

    • Adele Hite, MPH RD says:

      I’m so glad you added these other layers of thinking and complexity to the picture. They truly illustrate why our current limited approaches to diet and health–whether mainstream or vegan or paleo–are inadequate.

    • Dana says:

      Why is that other stuff you said not at all related to “Darwinism”? Darwin was limited to the knowledge available in his time. I don’t think he did half bad, considering. People like throwing him around as a buzzword, same way they do “skepticism.” (I can’t hear that word anymore without my BS alarm going off. That’s how badly it’s abused.)

      I think the land you’re living on is more important than your race or ethnicity if your ancestors invaded the land you’re on. We can’t make little mini-Europes and mini-Asias and mini-Africas all over the world. Not feasible, not sustainable, not eco-friendly, blah blah blah. The germs here are important. The native foods are important. The watershed’s important. If we look out for the health of these, I think even those of us not ancestrally from here will eventually catch up. IF we’re willing to let ourselves evolve again instead of playing Nature.

      ‘course… “evolve” has become a buzzword too, so nobody really knows what it means either.

      • Adele Hite, MPH RD says:

        You’re right that Darwin was limited to the knowledge available at his time, but, to give one example that I actually know something about, epigenetics has actually been a challenge to strict evolutionary thinking. I think Aaron (and I agree) is simply arguing for a respect for the complexity & interconnectedness of humans, something that has been lost in modern approaches to diet-health.

  12. I had to look up bingo flaps…some things cannot be unlearned. ;)

    Adele, as usual, you’ve hit it out of the ballpark here. I LOVE it when someone understands the 3Dness of an issue, the nuance involved, and isn’t just going for the jugular of a straw man.

    As an observer of this whole maelstrom for over 3 years now, there are a few barriers to entry. “Paleo,” while trendy, is the best descriptor we have. It’s somewhat known in popular culture and is the quickest, most efficient way to express a certain dietary stance. I prefer “ancestral health” for the reasons you’ve cited, plus the fact that to me, science is vastly unsatisfying as an explanation of things. I feel like room has to be made for the knowledge of humans going back millenia. But when I say “ancestral health,” nobody knows what I’m talking about and they all think it has to do with genealogy or knowing whether BRCA genes run in the family. Which doesn’t mean that with more awareness that can’t be changed, just that that’s what we’re dealing with on the ground now.

    Just as I have issues with CrossFit’s programming, I have issues with Paleo and its messaging. And yet, CrossFit has singularly done more good for the exercise and fitness landscape in this country than any other method. And I believe this is also going to be the legacy of Paleo. Maybe not in any grander national policy scheme or widespread adoption, but I’m thrilled that it’s providing options for people who are suffering. I remember those days, not so far behind me. But I’m also thrilled to see it evolving (forgive the pun) and growing up, as you say. :) There are a lot of good people on the case. Like you.

    Thank you!

    • Adele Hite, MPH RD says:

      When I ride in the car with my kids and I stick my arm out the window, they happily provide the sound effects for bingo flaps flapping.

      Vegan/vegetarian approaches have called our attention to production practices regarding foods from animals that are important to the national conversation on food. Atkins & Gary Taubes have asked the public to question foundational assumptions regarding our national dietary recommendations and practices. You can appreciate these things without insisting that vegan or low-carb are the Best Diet Ever. Ditto all you’ve said about paleo & CrossFit. (I’ve yet to post my own personal experience with CrossFit entitled “Cross? Yes. Fit? Meh.”)

      Thanks for the kind words. I’m thrilled that there are more options out there for people who want to change the course of their own health, but there are still limited options for those who must rely on government programs and many larger systemic issues that can only be addressed if we can drop our factional politics and work together.

  13. Wow … thanks so much for posting this. It’s a really important read for most (all?) folks in this space. I’ve been reading Yoni Freedhoff’s new book recently and along with what David Katz has been railing against on his Linked In posts, I think there are some important common themes. It does occur to me that if we don’t get past where we are (what Katz refers to as the “vapid variety of pseudo-erudition”), it will get worse before it gets better … when all the aging Boomers (like moi) start really putting a dent into the US healthcare systems.

    Thanks too for the shout out … and back at ya!

    • Adele Hite, MPH RD says:

      Many more thanks to you. I’m not sure how I would keep up with what is going on in the world of nutrition without you.

      At some point, nutrition “experts” are going to have humbly acknowledge what we don’t know & can’t predict. Unfortunately, as much as I would like to agree with the “poet laureate of health,” Katz is part of the problem when he continues to insist that the reason our low-fat national dietary recommendations didn’t result in the expected improvements in health is that “The food industry exploited the advice and invented low-fat junk food to take advantage of it” as if, the advice itself, as federal nutrition policy, is otherwise completely unproblematic. It may be that “we never followed the advice we got” but that advice had never been proven to be worth following.

      Katz does an amazing rhetorical job of pretending to advocate for “no one diet to rule them all” while repeatedly disallowing low-carb diets to be acknowledged as healthy for some: “In general, such [low carb] diets are not admissible participants in the best-diet pageant.” How can he say in one breath “Do we know what diet is ‘best’? No we do not.” and then turn around and say, in essence, “Well, we know FOR SURE it isn’t a low-carb one.” If we don’t know, we don’t know. Period.

      Katz again: “The theme of healthful eating consistently emphasizes the same foods: vegetables, fruits, beans, legumes, nuts, seeds and whole grains. . . All banish highly processed foods delivering concentrated doses of refined starch, sugar, trans fat, certain saturated fats and/or salt to the realm of rare indulgence.” An important and recurrent element of mainstream nutrition rhetoric is to conflate “processed foods” with “saturated fat” and “salt” (the list used to include cholesterol, but that is beginning to disappear), when saturated fat and salt can and do exist in harmony with a diet of whole foods.

      Paleoland rhetoric does the same thing of course, conflating “processed foods” with “grains” and “legumes”. But grains and legumes can co-exist in a diet of whole foods too.

      And of course, this is what I’m whining about overall. Enough with the rhetoric on both sides.

      • I can’t decide if Katz’s perspective is changing or not. I do think that part of his rhetoric is reactive and that much of the anti-sentiment wrt low-carb diets is due to the dislike of its proponents. Mike Eades once pointed that out re Atkins … the science was dissed as much, if not more, because Atkins’ colleagues thought he was a dick.

        The other issue (IMO) is the range of what’s considered of a low-carb diet. I’d probably agree with Katz that a ‘best’ diet for the average Westerner is not going to involve a half-stick of Kerrygold on a steak. But I think a lot of folks might benefit from a lower carb diet, especially of refined carbs.

      • Adele Hite, MPH RD says:

        Beth, don’t you know Kerrygold butter is B-A-D, BAD? Only 90% grassfed :)

        I’m with you that this is likely part of the whole Atkins the man/Atkins the diet knee-jerk reaction. But we have to remember that one of the things that really pissed off mainstream nutrition folks is that Atkins said we should all be suing them for malpractice! Not because their diet was “wrong” per se, but because it was used as the “default” diet without consideration for individual variation. That still seems to be the case, unless your “individual variation” takes you in the vegatarian direction, which is OK.

      • Dana says:

        Then again, the dichotomy of processed foods vs whole foods is part of the problem. There’s foods you can home-prepare, and there’s industrial foods. If you must make the food in a factory before you can have it at all, it’s an industrial food and it’s probably not good for you. If you can make something like it in your kitchen, it becomes a matter of whether your body can tolerate it and will be nourished by it. Even some desserts can be nourishing.

        Grains and legumes are junk. They’re junk when they’re grown; that land would be better used as pasture or forest. They’re junk when you have to go through all those ridiculous steps just to make them edible. They’re junk because a lot of people who are sensitive to them don’t KNOW they are sensitive to them, and go around causing subtle damage for years before they finally clue in. And the nutritional value? Relatively speaking, it’s a joke. The stuff is poverty food, starvation food, meant to keep you alive til you succeed in a hunt again. We have the means now that we can entirely skip this step if we cared enough to make it happen.

        When we started eating this stuff on the evolutionary scale is somewhat important but even more so is the amount of B.S. we endure for so little return.

        If people are concerned about needing safe starches I don’t know why they don’t just make do with tubers. And you get more food for the amount of plant matter you grow.

      • Adele Hite, MPH RD says:

        Dismissing grains and legumes as junk dismisses the food traditions of cultures who have relied on them–and may tolerate & even enjoy them. Dietary shifts usually do involve a decreased reliance on plant proteins as a country/culture develops and an increased use of animal products–up to a point, then it levels off. So there does seem to be some historical acknowledgement of the nutritional inferiority of these foods. At the same time, this does necessarily mean that people from food cultures who tolerate and enjoy these foods would need to or want to eliminate them.

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