Clinicians working with Paleo Clients

I had a soon-to-be-RD friend of mine ask me to write up a brief article on how clinicians can respond to clients who would like to go, or are, Paleo.

1. No diet is perfect by name - it's all about the nutrients you intake. Most dietary mantras (Mediterranean, Veg*n, Paleo, etc) can be healthful assuming you get adequate amounts of all your nutrients, but many have their drawbacks - Paleo is no exception. When it comes to Paleo, there's a few nutrients to keep in mind:

• Iodine: eschewing dairy and choosing sea salt can potentially cut large sources of iodine in the diet. Advise individuals to consume seaweed, incorporate some iodized salt, or take a Kelp extract supplement (be careful not to overdue with the supplements if it gets to that point, many contain 2-3x the RDA). 
• Manganese: It's not a mineral we hear talked about a lot, but the major sources of it are grains, especially brown rice. If the individual is just concerned about gluten, brown rice can be a great option. Spinach contains manganese as well - though many Paleo followers avoid this due to its phytic acid content. Pineapple and pumpkin seeds are more Paleo friendly sources. Deficiencies are very rare but data from animal models show negative impacts on bone density and mitochondrial function (Mn is a component of the mitochondrial manganese superoxide dismutase)
• Vitamin E: oils and nuts/seeds are excellent sources of Vitamin E. However, due to their phytic acid content and the Paleo communities focus on this 'antinutrient', i've seen major Paleo icons (Chris Kresser) arguing against consumption of nuts. Dark leafy greens are okay sources of vitamin E , though individuals would need to be consuming 4-5 servings a day to hit the RDA. This is a nutrient that NHANES shows many don't get enough of, let alone people who cut out the major sources of it. Animal products are generally not a good source of vitamin E, even if the feed has been supplemented.
• Calcium: Paleo'ers don't consume dairy, for the most part (some consume raw milk).  Make sure that patients/clients are consuming several servings of low-oxalate (Brassica family: kale, collards, broccoli) dark leafy greens. I've seen some forums talking about things like sesame and chia seeds being great sources of calcium, but these are largely not bioavailable.

2. Most Paleo'ers, or potential Paleo'ers, are physically active. Some variations of the Paleo diet border on being very low carbohydrate. Encourage clients to consume starchier vegetables and tubers, like squash, zucchini, and sweet potatoes, to recover and restore glycogen after a workout. Remind them that carbohydratess are not the devil, and individuals who exercise are much more insulin sensitive.

3. Grass-fed meats - grass fed meats contain more omega 3's and less omega 6's. Paleo focuses a lot on these products, even though they contain very small amounts of Omega 3's compared to fish, and Conjugated Linoleic Acid at levels that are irrelevant compared to those used in controlled studies (which already produce mixed data). A lot of internet nutrition focuses on reducing omega 6 content of the diet - it's one thing to reduce added oils (good++), but it's another to reduce your consumption of nuts and seeds. Fish + flax/chia/hemp should be the focus for obtaining omega 3's. If individuals can afford grass-fed, go for it. But clients who struggle to afford fruits and vegetables should spend their money there as opposed to grass fed meats.

4. Educate yourself on gluten sensitivity, celiacs, plant lectins, fructose, and phytic acid. These are some major topics that the Paleo movement pushes. With the popularity and success of Crossfit, it doesn't appear Paleo will be going away anytime soon, and the education will be worth your while - it's part of nutrition, and if RDs are going to be the nutrition professionals, they need to know about it. I have several posts that can help get you started (1, 2, 3, 4, 5)

Paleo can definitely be healthy - but to date, there are no truly scientifically backed claims that make Paleo a better option than other well planned diets that include grains and dairy (several studies have been done, but they have been poorly matched to their controls). I would be very careful about how you approach this topic with clients reading Paleo forums, because many rely on discrediting the 'mainstream' medical professionals like RDs. Focus less on attacking the diet, and more on working with them to achieve their goals, while ensuring that they can still maintain a healthy nutritional status.