Paleo, It's Time for a Name Change Please

As the Paleo diet movement seems to continue to grow and grow, the dogma continues to irk me. It, like any other diet, isn't good or bad by name - it depends upon execution. I have minor concerns related to some certain nutrients, like calcium and fiber/potassium (depending on how meat based the diet is), and concerns over the severe lack of long term data on the diet, that makes it difficult to say if it has any effect on cancer/CVD/osteoporosis risk. There's a lot of theory suggesting it's superiority - see here-, that lacks any strong clinical basis, which makes it hard for any evidence-based clinician to recommend long-term to anyone, or to know who could benefit most from these theoretical benefits.

Clinical concerns aside, the evolutionary 'science' of Paleo just irks the hell out of me- I've talked about it some before here. My undergraduate degree is in biological anthropology and I focused on understanding how metabolism/nutrients/foods may have acted as selective pressures throughout human evolution. So when someone says things to me like "We shouldn't eat 'x' because our ancestors didn't", I always make sure to remind them of a few things:
1. We ate for fertility, not longevity. Evolutionary forces act on factors that convey survival benefits, allowing one to reach the age of reproduction and pass along our genes. Thinking of food in an evolutionary light is inherently discussing whether it helped us reach the age of reproduction or not - it's not discussing longevity or deterring age-related disease.
2. You'll never know how much they ate - Anthropological data on the topic of diet doesn't allow you to determine specific caloric contributions of foods, or macronutrient distributions from Paleolithic data - I can maybe tell you about folic acid intake from skeletons with spina bifida (1), and I can tell you that nitrogen isotope analyses show that ancient hominids did eat meat, but I can't tell you how much - their diet could've been Mammoths, leaves and honey, and the latter two wouldn't show up in this analysis (2). It's quite difficult to tell you how much of certain plant foods they ate, as plants don't leave behind fossils; recent coprolite data suggesting Neanderthals ate plant foods (3) can alternatively be viewed as Neanderthals eating the stomachs/intestines of other animals who ate those foods (4). Even residues of plants on pots and found in teeth tell us nothing about frequency or quantity consumed of these foods. Egg shells found at a dig site could have been used for food or could be background noise - you don't know. If you're curious about all of the ways anthropologists can reconstruct the human diet, see an older post of mine here - these are all limited in their ability to tell us anything about consistent macronutrient distributions of the diet. You can build a picture, but its hazy. Scientists don't settle for hazy when giving dietary recommendations. And again, just because they ate it, doesn't tell us much of anything about longevity or disease risk.
3.Domestication vs Wild - Let's suspend reality and science for a second, and say we should be eating exactly like our ancestors. In that reality, we still could not eat like them. The foods that they ate were so 'wildly' different from our domesticated counterparts, that it's truly impossible to eat Paleo in modern society. Concern over eating 'evolutionarily' more novel sources of calories, focusing only on grains or dairy, is misplaced, as domestication has produced a food supply that is entirely 'evolutionarily novel' (5). This isn't to say grains or dairy are free from any nutritional scrutiny - it means that we should scrutinize all foods, and that you can't infer harmful food components from evolutionary theorizing.

I think when I first got into the biological anthropology/nutrition scene, I was like many in Paleo, really hoping to find "the perfect diet". What I quickly came to discover is that humans are able to persist in many different environments (more on this here), utilizing many different types of food sources, that were processed in a number of different ways. There is no strong evidence to suggest that Paleolithic ancestors ate to promote longevity, and deter age-related disease (see (4) to discuss Neanderthals and Medicinal Food use). If you want to know the most optimal diet, you'll have to wait until the field of nutrigenomics progresses further.

There's a lot of issues with the foundation of the Paleo diet. But the irony gets even better. I consistently see Paleo diet members hating on epidemiological and observational data. See this lovely Robb Wolf video here where he attacks the entire field of nutritional epidemiology. Ive mentioned to Paleo acquaintances that vegetarianism can be a healthy and beneficial lifestyle, because we have data from 7th Day Adventists (6) showing that vegetarians have lower rates of all-cause mortality and cause-specific mortality; I was dismissed because I was citing only observational data, as if it being observational somehow negates the clear effect that vegetarianism didn't kill them/send them into a nutrient deficient state. We can't isolate what factors led to this (is it the lack of meat intake or is it higher plant food intake? maybe other modifying lifestyle factors?). I can show Paleo'ers epidemiological data (7) that consistently shows an increase in colon cancer risk from consuming large amounts (more than 18oz/wk) of red meat; again, dismissed because it's observational, even when potential mechanistic data is available (8). I'm definitely not saying epidemiology data is by any means perfect, able to identify mechanisms or should be the basis of recommendations (individuals in the field have also critiqued the red meat/colon cancer link (9)).The overwhelming irony here, that I have a hard time even processing, is that the Paleo diet, and trying to eat like any human ancestors (i'm looking at you ancestral health community), is based on what members of this community consider bad data. Paleo, in and of itself, is inferred data, with absolutely no hard endpoints and really small sample size. You just can't critique dietary guidelines for being based off too soft of science, while the foundation of your diet is based off even softer science. If you go to Paleo forums, they constantly ask "did our Paleolithic ancestors do this?" This is the foundation of the diet, that then selectively picks and chooses current science to support it. We can't observe our Paleolithic ancestors. At best, we can infer from several highly limited lines of data what kinds of foods our ancestors ate - not how much, not in what proportions. If we are critiquing data and not giving diet recommendations off of studies that take diet records on modern individuals who are quite genetically similar to ourselves, why in the world is it suddenly sound advice to base your diet off of the inferred dietary intake/frequency data, from individuals who are significantly more genetically distinct from us? At least with modern epidemiology, we can link flawed diet intake/frequency data with a health outcome - you certainly can't do that with Paleolithic diet data. It relies on the assumption that Paleo'ers had perfect health, were impervious to chronic disease, and that if we just ate like them (or what we think they ate), we'll be eating for our 'Primal Blueprint'. It absolutely blows my mind that you can dismiss one line of evidence and then re-apply a less robust version of it later.

I don't say this because I think the Paleo diet has zero potential benefits - I just want a name change. You can surely start commenting with poorly matched trials employing Paleo-ish diets (-ish because they often contain foods that our ancestors would have never had access to) that show they are effective for weight loss and improve lipid profiles. The reality remains that we have no long term data on the diet, and the safety of heavily meat based diets is, at least, questionable, and even more arguably not great for the environment. If you want to do it, go for it. Nutrition and eating are personal choices. But for the love of Darwin, please stop the attack on science and misconstruing evolutionary biology to suit your dietary paradigm. If you like evolution, educate yourself on the 4 forces of evolution. Educate yourself on our primates/hominid ancestors and their diets. Educate yourself on how population genetics/evolutionary genomics can help us determine SNPs/ haplotypes that alter dietary needs, and confer susceptibility to diet related diseases. The more you do, the more you will hopefully see that asking yourself "does this make sense in an evolutionary light?" tells us very little about nutritional sciences, nutrient needs, and dietary guidelines. Pushing the notion that what we evolved to do is what we should do is a smack in the face at technology and human ingenuity - this kind of thinking breeds naturalistic fallacies. Even more so, the lack of significant genetic adaptations to diet in the human genome suggests that humans turned to technology when looking for food source, not waiting for biology and selection. Technology is an amazing component of the modern diet, and we should demand that it be used responsibly, not run from it.

You're not eating the diet of your Paleolithic ancestors. It's indisputable fact. It's also fact that what can be inferred about what our ancestors ate cannot tell us what we should be eating today - you are genetically distinct, with distinct dietary needs, and the food you're eating is, in itself, genetically distinct from what was eaten in the past. If you don't eat grains/legumes/dairy, just say it - stop misguiding people in how to think about evolution.  Anthropologists are tired of it - see here. I'm tired of it. There's no need to proselytize. The beauty of science is that it's not religion - we base our knowledge off of the best data available. Not inferred observational data with no outcome variables.

In my honest opinion, removing the name Paleo will at least make people take your concerns about grains/dairy/legumes more seriously. If you're going to critique the dietary guidelines, do so in a scientific manner, that lays out clear evidence, identifies what needs to be further researched, and lose the bias. Saying dietary guidelines are wrong and that we need to eat like our ancestors just gets translated to "PhD/RD/MDs are wrong and we should follow what we can infer about diets from cavemen". You should also acknowledge that those dietary guidelines you don't like, no one follows them anyway.

1.http://www.ncbi.nlm.nih.gov/pubmed/20949487
2. http://www.pnas.org/content/106/38/16034.full
3. http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0101045
4. http://www.sciencedirect.com/science/article/pii/S0277379113003399
5. https://www.youtube.com/watch?v=BMOjVYgYaG8
6. http://www.ncbi.nlm.nih.gov/pubmed/23836264
7. http://preventcancer.aicr.org/site/PageServer?pagename=recommendations_05_red_meat
8. http://cancerpreventionresearch.aacrjournals.org/content/4/2/177.long
9.http://www.ncbi.nlm.nih.gov/pubmed/20663065