The Paleolithic Diet According to S.Boyd Eaton and Melvin Konner - Version 2010

S. Boyd Eaton, who along with Melvin Konner is generally considered one of the "Founding Fathers of Paleo", published  Paleolithic Nutrition:  A Consideration of its Nature and Current Implications (request doc share if link is broken)  in the New England Journal of Medicine in 1985.  In 1997, this duo (with SB Eaton III) published Paleolithic nutrition revisited: A twelve-year retrospective on its nature and implications  (request doc share if link is broken) in the European Journal of Clinical Nutrition.   As time progressed, these authors would collaborate with various others, including two with which most in the paleo community are well familiar:  Loren Cordain and Staffan Lindeberg.  These four were among the authors of the 2002 article in Preventative Medicine entitled Evolutionary Health Promotion, and a followup in the same journal authored by Eaton, Cordain and Lindeberg entitled Evolutionary Health Promotion: A Consideration of Common Counterarguments, in which the paleolithic diet was referenced to the 1997 paper from which the table above right comes.

In the intervening years, 2000 to be exact, probably the most "divergent" variation of the paleolithic diets was published:  Plant-animal subsistence ratios and macronutrient energy estimations in worldwide hunter-gatherer diets (request doc share if link is broken)   with Cordain and Eaton amongst the authors.  It is in this paper that the notion that paleo diets might be "high fat" can be traced.  

... high reliance on animal-based foods coupled with the relatively low carbohydrate content of wild plant foods produces universally characteristic macronutrient consumption ratios in which protein is elevated (19–35% of energy) at the expense of carbohydrates (22–40% of energy)

For worldwide hunter-gatherers, the most plausible (values not exceeding the mean MRUS) percentages of total energy from the macronutrients would be 19–35% for protein, 22–40% for carbohydrate, and 28–58% for fat ...

The more prominent message from that paper, to this reader anyway, was that hunter-gatherer diets varied widely around the globe and especially between N&S 40 latitude, and if there's any question where the "birthplace of man" is considered to be by the "founding fathers" of the movement, below is a screenshot from Eaton's AHS12 Talk

I include that so there is no confusion as to the "evolution" of thinking in this realm.  In 2005 Eaton addressed the Nutrition Society (lecture published 2006) with:  The ancestral human diet: what was it and should it be a paradigm for contemporary nutrition?   (request doc share if link is broken) 

Awareness of the ancestral human diet might advance traditional nutrition science.  The human genome has hardly changed since the emergence of behaviourally-modern humans in East Africa 100–50 · 103 years ago; genetically, man remains adapted for the foods consumed then.  The best available estimates suggest that those ancestors obtained about 35% of their dietary energy from fats, 35% from carbohydrates and 30% from protein.  Saturated fats contributed approximately 7.5% total energy and harmful trans-fatty acids contributed negligible amounts.  Polyunsaturated fat intake was high, with n-6:n-3 approaching 2:1 (v. 10:1 today). Cholesterol consumption was substantial, perhaps 480 mg/d.  Carbohydrate came from uncultivated fruits and vegetables, approximately 50% energy intake as compared with the present level of 16% energy intake for Americans.  High fruit and vegetable intake and minimal grain and dairy consumption made ancestral diets base-yielding, unlike today’s acid-producing pattern.  Honey comprised 2–3% energy intake as compared with the 15% added sugars contribute currently.  Fibre consumption was high, perhaps 100 g/d, but phytate content was minimal.  Vitamin, mineral and (probably) phytochemical intake was typically 1.5 to eight times that of today except for that of Na, generally < 1000 mg/d, i.e. much less than that of K. The field of nutrition science suffers from the absence of a unifying hypothesis on which to build a dietary strategy for prevention; there is no Kuhnian paradigm, which some researchers believe to be a prerequisite for progress in any scientific discipline. An understanding of human evolutionary experience and its relevance to contemporary nutritional requirements may address this critical deficiency.

To bring the peer review literature to as up to date as possible and show that not much has really changed, Eaton and Konner paired up once more in 2010 with:  Paleolithic Nutrition : Twenty-Five Years Later  (request doc share if link is broken).    The changes, attributed largely to higher animal food (including previously underrepresented aquatic animals) vs. plant food intake, include mainly an upward adjustment of total fat intake from low 20's to a range of 20-to-35% of calories.  Here's the section on Fat and Saturated Fat:

It was widely accepted by the late 1980s that saturated fat (SF) intake in the typical modern diet is far too high and that the C-14 and C-16 fatty acids are a major contributor to endemic atherosclerosis underlying most coronary artery disease and stroke, the first and third leading causes of death. Through energy load, total fat (TF) intake is an important contributor to endemic obesity and the growing epidemic of T2DM. Standard recommendations suggested that TF be reduced to no more than 30% of calories and that the ratio of SF to unsaturated fat be reduced markedly.  At the time, we estimated that in the HG diet, TF contributed about 20% of calories, including about 6% SF, a level of restriction deemed by most  authorities to be too difficult to achieve.   On the basis of new analyses of HG diets, we have raised the estimated range of their likely TF intake to 20%-35%.  Both low-fat (20%) and high-fat (40%) diets have been shown to aid in weight loss given appropriate caloric restriction and adherence,37 but it has also been shown that very low TF may not only prevent or retard atherosclerosis but, combined with other lifestyle changes, partly reverse established atherosclerotic plaques.38,39

However, TF is only part of the story. Game animals have more mono- and polyunsaturated fatty acids (MUFA and PUFA) than supermarket meat.10 It used to be recommended that SF intake be less than 10% of total energy, but according to the Institute of Medicine (IOM), any increase raises cardiac risk.40 

Suffice it to say that Eaton and Konner had moderated their take on fats slightly (a range that tops out at 35% and calling 40% "high fat" (40% is more like the SAD as implemented), but the general take on fats  has not really changed in the intervening decades, specifically where fat type is concerned.    Below are two nice summary tables from the 2010 paper:

I would note that the major difference between "Current" 2010 dietary recommendations and "Estimated Ancestral" a la Eaton & Konner is mostly a difference between swapping carbs for protein (not fat!) in the macronutrient department.   The rest, is a matter of types of foods, with the underlying themes of no grains or dairy preserved.  Ironically, here's what Eaton & Konner wrote in 1985 (emphasis mine):

Except for Eskimos and other high-latitude peoples, hunter-gatherers typically use many species of wild plants for food.  Roots, beans, nuts, tubers, and fruits are the most common major dietary consituents, but others, ranging from flowers to edible gums, are occasionally consumed.  Small cereal grains, which have been staples for "civilized" peoples since the Agricultural Revolution, make a surprisingly minor contribution overall; however, the wide range of vegetable foods eaten by foragers contrasts with the relatively narrow variety of crops produced by horticulturists and traditional agriculturists.

And at right is Eaton's AHS12 slide on antioxidants where he mentions beans as a good source of both antioxidants and soluble fiber.  He smiles a little bit when discussing this, and I get the feeling his "personal situation" makes room for some beans.  The 2010 paper goes on to cite the clinical literature -- studies by Lindeberg's group and Frassetto, as I've discussed here, for example in:  Two Paleo Diets from Lindeberg's Group and Is This Your Paleo Diet? -- conducted largely in accordance with Eaton and Konner's description of the paleo diet, a quarter century strong (though also eliminating legumes).

Now here was the slide I think many in attendance at AHS12 were pretty shocked by.  The "weak form" being acceptable for folks like himself in moderately good health with good biomarkers and all of that included whole grains and skim milk products.    Say what?  Wheat is murder!  Gluten is Satan's excrement!  Oatmeal is a blood sugar spiking bowl of battery acid!  Low fat dairy?  Doesn't he realize that's what has been making us all fat?   The #AHS12 hashtag went a bit viral on Twitter at this point with protestations on there being "agreement" over lean meats, and for crying out loud, where was the bacon and butter??!!  

I don't want to bombard you with any more screenshots, rather encourage you to listen to the talk, it is under a half hour and worth the watch.  He shows foods he's particularly fond of including skinless chicken, shellfish, lean meat (pork) and eggs.  Any fresh fruit (frozen OK) and fresh vegetables (frozen OK) are described as a "big part of our diet at home"  and  "how anyone can argue against carbohydrate in this form is hard for me to understand" ... while tubers are not pictured, the fruits include apples, grapes, peaches, pears, cherries, oranges and what looks to be a papaya, while veggies include broccoli, cauliflower, carrots and snap peas.  The blasphemous graphic of a spoon of shredded wheat and a glass of skim milk comes at the 7:50-ish mark.  

He goes on to discuss a strong form -- more pure -- of the diet that those with health issues and perhaps competitive athletes might consider.  Ditch the grains and dairy entirely and look at the alcohol and consider cutting it.  He doesn't mention increasing carbohydrate intake based on activity for athletes, which I find surprising, but this does not seem to be an oversight so I thought I'd mention it.    He goes on to discuss his activity which includes "cardio" about 3X/week and various strengthening exercises, primarily for the lower body, "somewhat against his prescription" daily.  

So ... 

What is the point of this post?  First, from this point forward, let it never be said that I didn't give enough "ink" to the original paleolithic diet as first put forth by the movement founders and leaders, S.Boyd Eaton and Melvin Konner.  I have been discussing this version of the diet increasingly for months now, and pretty much any time I do a post on whatever-the-heck the paleo diet is SUPPOSED to be.  Essentially the paleo diet of the background literature (what it was) is the same as the paleo diet of the clinical literature (what's been tested) -- a diet comprised of lean meats, vegetables, fruits, nuts, seeds, and eggs and devoid of grains, dairy and legumes.  I've been referring to this informally as Lindeberg-paleo, because it is Staffan Lindeberg's research group that first tested the diet.  Others have been similar in composition.  

Still, as you can see, Lindeberg is not inseparable from Eaton and Konner having co-authored papers together, and that other big name in paleo, who appeared on the Dr. Oz show recently, is right there in the mix as well:  Loren Cordain.    Here are the current "main points" Cordain makes on his website:

And a listing of his prescription on what to and not to eat

There are some minor differences here, but as regards the "official" paleolithic diet (that in the formal literature):

• Dairy is out.  All dairy, including butter, clarified or otherwise, raw or pasteurized and/or homogenized or otherwise, coming from grassfed animals or otherwise ... is out.   
• Fatty meats are never encouraged, thus no barbequed ribs or -- gasp! -- bacon, chocolate covered or otherwise.   Skin on your chicken?  Fuggettahboutit, let alone adding more fat to the mix!  
• Saturated fat consumption is not encouraged, coconut or otherwise (you'll note the nod above by Cordain, but not see mention in any paleo literature).  PUFA consumption is encouraged with the ratios of PUFA:SF in the clinical trials being close to 1 or above.
• Added fats are missing -- that's right, not just the seed oils (while Cordain did previously recommend canola on a fatty acid argument basis in conjunction with very lean meat), but there's no frying fatty ground beef in lard or spreading duck fat on turkey or tossing bacon drippings in your veggies.  
• Fruit is abundant in all paleo diets and there is little if any mention of limiting them.  There is also little mention of sticking to the "low sugar" berries either, as implemented by Frassetto.  
• Starch is less discussed, though it is included in modest amounts in the clinical trials while Cordain shuns potatoes on the website.  
• Legumes (beans) were included in the original original paleo diet, and Eaton gave special mention to them in his AHS12 talk, but they are also shunned in both the clinical trials and on Cordain's prescriptive.  

While practically nobody read it, I've been asking the question of whether the paleo diet was a VLC diet (or  basically even a low carb diet)  from close to the inception of this blog.   The only major paleo book (other than presumably Cordain's which I have not read) or blog that comes close to advocating anything resembling this paleo diet is Robb Wolf's The Paleo Solution ... the book.  However, his other works from podcasts to blog posts to social media and general commentary about the net bear little resemblance to the 30 days of low fat, low carb, high protein, low sat fat, relatively high PUFA, dairy free fare put forth in that book.  Nowhere in any of the literature is the notion of "fat burning beasts", of carnivory, of chronic and preferential ketosis, or fatty feasting discussed.   The paleo of the literature is simply not your guru's paleo, and it's not the paleo "practiced" by the vast majority of advocates and practitioners of the diet.  This is why the response to Eaton's talk at AHS12 went something like this reaction from Bobby Gill/UltraGrassFed:

The third and final day of the 2012 Ancestral Health Symposium started (for me) with a talk from the original caveman himself, Dr. Boyd Eaton.  His 1985 piece in the New England Journal of Medicine: “Paleolithic nutrition. A consideration of its nature and current implications” opened the gates for the movement we see here today.  Eaton himself has been eating and living a paleo lifestyle for 30 years now, so his talk focused on his own 30-year n=1 paleo “experiment”.  He appears to be in impressive health for a 75-y.o. man, and he presented some basic bloodwork and coronary CT scans that verified these assumptions.  Interestingly, Eaton’s take on “paleo” appears to have been formed in the 80′s and, unlike others in the community, he does not appear to have evolved his thinking since then.  For example, he views legumes and shredded wheat as reasonable foods for someone new to the diet because they lack sugar and salt.  This simplistic and seemingly uninformed viewpoint garnered much shock from an audience that focuses more on intestinal permeability, gut flora and hormonal regulation.  That said, even for a guy that eats lean meats and does isolation exercises, there is no doubt he is in phenomenal health, so even if Eaton’s paleo isn’t the same as Sisson’s, Wolf’s or anyone else’s, it is working from him so who are we to judge?   I give tremendous credit to Eaton for publishing his landmark paper in NEJM, and I commend him on his great health.  {note:  bolding is his, not mine}

Clearly, Eaton (and Konner) didn't stop looking at and thinking about the paleolithic diet for the past 30 years so it is somewhat of a slight, to use mild terminology, to imply his thinking is mired in the 80's  Gill offers up grudging compliments and acknowledgement of Eaton for his accomplishments and apparent fine health, *despite* his lack of  "evolution" to excuse the discordance between his version of "paleo" and what I call Paleo™ (to include the entirety of mass media diet book versions of paleo).  This comes off as excusing the outdated views of an old man whose ideas the movement has moved past with the inference that they are indeed outdated and have been improved upon.  The real question, however, should be explaining why it is that Sisson's or Wolf's or anyone else's version of paleo deviates from Eaton's.   When did bacon and chocolate and coffee and butter, sometimes all in one concoction, become synonymous with paleo while practitioners are warned off of fruit to some degree by almost all of the "paleo experts"?   There has been no peer review literature upon which this movement has sprung, rather the movement has been hijacked.  Hijacked away from its original formulation as well as the minor tweaks the underpinnings have undergone.   The questioning and judgment should be of Sisson, Wolf and anyone else whose version of "paleo" differs from Eaton's ... not the other way around.

What is truly odd is that Eaton's (and colleagues') work is cited by low carb (high fat) advocates in support of their diets and premises.  Everywhere.   It's in Good Calories, Bad Calories and The New Atkins.  It's in Perfect Health Diet and Primal Blueprint and Primal Body-Primal Mind .  It is misrepresented to varying degrees in one and all.   That is just plain deceptive and wrong, any way you look at it. 

In closing for today, I have this to say to my critics.  I am not anti-paleo.  The diet (and overall lifestyle for that matter) outlined by Eaton at AHS12 leaves little to be "against", and as pointed out in the 2010 paper, is not all that out of line with current recommendations.  I'd dare say that a case could be made that it's closer to MyPlate than most of the plates featured on paleo sites.  I will say this, however.  The major health issues that are seemingly spiraling out of control are not the fault of neolithic foods per se.  We quite simply have too many examples of traditional cultures thriving on grains and legumes and dairy to draw that conclusion.   They are instead a product of post-industrial affluence (and affluence is relative because compared to the rest of the world, most of the poor in this and other first world countries qualify as affluent) and technology assisted access.  While the paleolithic diet that Eaton and Konner characterized in 1985 would be beneficial to most to reverse current trends, there is ample evidence that we need not go back nearly that far.  We can know with high degrees of certainty exactly what various cultures ate 50, 100 or  more years ago, and to much greater certainty than the paleolithic era, we can know what humans consumed 1000 or 10,000 years ago.  When it comes to babies and bathwater, neolithic foods truly are babies we should be saving if the bathwater even needs to be thrown out at all, as opposed to just skimmed and filtered a bit.    So Eaton &amp Konner paleo is good but unnecessary in my book so I see no reason to become an outright advocate of that approach.

Paleo™ is another story.  I am against misusing science, diets based on bad science, dogmatic beliefs, nutritionism and diet as religion.  Mostly I'm against baseless restrictions that contribute to needless neurotic beliefs and behaviors concerning foods, real and naturally occurring foods in particular.  I'm thinking S. Boyd Eaton wouldn't ever be caught sporting most of the t-shirts sold on various blogs or worn by people to various paleo events.  In this regard he and I share more in common than he probably does with many who shamelessly proffer his works to substantiate theirs.  And lastly I will not give Paleo™ or its purveyors the benefit of the doubt just because they have helped some people and because some mistakenly believe their proselytizing can do no harm.  Especially when some of the advocates themselves have experienced serious detrimental health consequences as a result such as developing sensitivities to foods they were formerly able to enjoy without issue, biomarkers heading in the wrong direction often quite significantly, phantom adrenal fatigue, gut dysbioses that evade standard detection, plummeting energy levels, insomnia, worsening glucose metabolism, and weight gain or worse, binge eating and/or anorexia.  It would be one thing if that list applied to unknown and occasional outliers, that could probably be ignored ... but it does not.  There are prominent members of the community I could point to and it is a black eye on the whole community that such blind eyes are turned to these problems.  Heck, these folks are often rewarded for divulging how their diets are hurting them with accolades for bravery in coming forth, and encouragement to keep searching and find the strength to restrict even more.   If this were any other community, say Dr. Oz types, people would be outraged at the profit-making off of situations that Paleo™ often seems to itself create.  These same people are quick to blame their diets and lifestyles of years and sometimes decades ago for current problems but seem deliberately oblivious to where their current diets and lifestyles might be at fault.  Fellow sufferers are encouraged to seek treatments further and further from mainstream acceptance, which wouldn't be all that bad were so many of them so darned expensive and potentially harmful.  I cannot be a part of a movement that includes accepting woo woo wonks as criteria for membership.    I don't consider Eaton and Konner to be part of that either.

That's all for today.  Discuss ;-)