Wednesday, November 21, 2012

Essential Versus Optional in Paleo

By Diana Hsieh

When I developed my list of Modern Paleo Principles in early 2010, I'd hoped to be able to sort out the essential principles from the optional tweaks. So forgoing grains would be essential to eating paleo whereas intermittent fasting would be just an optional tweak that a person might never even try. Sounds reasonable, right? Perhaps so, but the attempt was a total non-starter.

Almost as soon as I sat down to write out my list of principles, I realized that I couldn't possibly separate them into "essential" and "optional," except in a few clear cases. Similarly, I couldn't rank its principles by priority except in a very rough way. Despite the core features of the diet captured in my definition -- avoiding grains, sugars, and modern vegetable oils in favor of high-quality meat, fish, eggs, and vegetables -- that just wasn't possible.

But... why not? Why can't we identify the essential versus optional principles of a paleo diet or rank its principles by priority? The answer is more interesting than I supposed at first. I see three major obstacles -- (1) the value of health, (2) individual differences, and (3) the science of nutrition. Let's examine each in turn.

Health Is Not Your Ultimate Value

Health is a major value, but it's not a person's proper ultimate value. Health is not all that matters in life.

A person's ultimate value is (or rather, ought to be) his own life. Consequently, people can make legitimate trade-offs with respect to health, in order to serve other, higher values. For example, a paleo-eater might choose to eat restaurant salads with canola oil dressing at business lunches because that's what best serves her career, even if that risks some harm to her health. Or a paleo-eater might enjoy the occasional "Mo's Bacon Bar," because the taste is just so worth the sugar hit. Such choices would be totally legitimate: optimizing health shouldn't be treated as an out-of-context duty.

What does that mean? It means that no principle of paleo can be treated as "essential" -- in the sense that if you violate it, then you're doing wrong, you've fallen off the wagon, you're no longer paleo. Paleo is not a religious dogma: it has no Ten Commandments -- nor even a "thou shalt." (That's for the vegans!)

Instead, paleo involves a set of principles to help guide the actions that impact our health, particularly diet. However, if a person is willing to pay the price for deviating occasionally from those principles -- if that's not a sacrifice for him but an enhancement of his life -- then he ought to deviate. That's the rational approach.

Your Health Depends on Individual Context

People are not merely fodder for the aggregate statistics of epidemiologists. They are individuals -- and each person's particular background, constitution, and circumstances matter to his choices about diet.

For example, one paleo-eater might be diabetic, another hypothyroid, and another in perfect health. One person might be disposed to heart disease, whereas another would be more likely to suffer from cancer or stroke. One person might suffer terrible effects from eating wheat, whereas sugar might be the downfall of another. A paleo-eater might be able to find a source of grass-fed beef that matches his budget -- or not. A person might have 200 pounds of fat to lose -- or 20 pounds of muscle to gain. One person might look, feel, and perform better eating starchy tubers while another does better avoiding them. One person might need to work hard to eliminate the soy from his diet, whereas another has none to remove. One person might live with a supportive spouse, while another lives with a hostile vegan roommate. One person might prepare all his meals at home, while another must eat in restaurants, while another must eat in the college dorm.

In short, people's backgrounds, constitutions, and circumstances are often hugely different in ways that will affect what they can and should eat. People will implement a paleo diet in very different ways, based on those differences. To claim, as a universal generalization, that certain paleo principles are essential while others are merely optional would be to run roughshod over those individual differences. Instead, each person needs to discover what's more essential versus more optional for him. Each person need to focus on his own life and values. The experiences of others are often useful guides or hints, but they don't determine what's essential versus optional for you.

The Science of Nutrition Is in Its Infancy

Ideally, with further development of science, we might be able to identify certain universal mid-level principles, such as "avoid foods that irritate your gut" or "avoid foods that promote the formation of small LDL." Then people could focus on those principles, rather than adapting the particular recommendations of paleo to their own cirucmstances. Those kinds of integrations would be useful, undoubtedly, but I see at least three problems with aiming for that.

First, the science of nutrition is not as advanced or definitive as we might like, except on a few issues. I'm routinely amazed by how much we still have left to learn -- on the value of tubers, on the different kinds of fats, on carbohydrate sources, and so on. So right now, we're not in a position to clearly define and defend such mid-level principles. The science needs to be more settled for that.

Second, such mid-level principles wouldn't be particularly helpful for guiding a person's everyday choices about what to eat -- unless he already knew, for example, what irritates guts in general and his gut in particular. So even if armed with a slew of solid mid-level principles, a person would still need to discover how to implement those principles well in his choices of what to eat for breakfast, lunch, and dinner.

Third, even if all that were known, individuals would still vary in their responses to foods, and they'd have to determine much of their own optimal diet by their own n=1 experiments. For example, people respond very differently to gluten. Personally, even small quantities of gluten give me migraines, but no digestive upset. Others have a different response -- or no response at all.

Conclusions

One important conclusions from these reflections on the value of health, individual differences, and the science of nutrition is that even though the various paleo diets have a common core, the principles of paleo cannot be designated "essential" versus "optional" nor ranked in order of importance.

Of course, we can define a paleo diet, because it means something definite. We can also identify the general principles of a paleo approach to health; that's what I hope that I've done with the Modern Paleo Principles. That's crucial for doing paleo well, I think.

Yet to think of some of these principles as universally "essential" versus universally "optional" would be a mistake. Instead, they should stand in our minds as "more or less important for me."

Of course, as an advocate of people, I'm interested to know what's more or less important for most people or for people with certain medical conditions. Still, the individual's mileage will always vary.

Also, a person often requires a few weeks or even months to learn how to implement the basic principles of paleo well in his own life, then even longer to tweak and optimize. For people really concerned to eat well -- and to be fully healthy -- that can be well worth the trouble!

Even with the broad range of paleo, we cannot hope to find a "one-size-fits-all" diet, except in a very broad way.

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