RCT or Observational Study or Anecdote -- Define Paleo first!

Well, I might as well weigh in on the post of Robb's that got to me on several levels.

Evidence Based Medicine: Fraud, Double Standards And Ignorance

Robb seems upset that some unnamed Twitter adversary who probably got him riled up linking to a piece on Marlene Zuk's Paleo Fantasies book.  The response to this book has been interesting to watch but boils down to "she's all wrong, it's not about re-enactment".   Well blow me down isn't that exactly what the whole Grok thing is? I Caveman?  Some in paleo definitely take that schtick to a greater degree.  But what of the diet?

Can I ask yet again for a definition of what a paleo diet is?  The Paleo Diet (TM Cordain) used to include canola oil ....   Near as I can tell, paleo = grain free.  All else is negotiable.  Dairy?  Grok could have killed a lactating beast so ...  Eat meat morning, noon and night, or just night and by all means eat a lot of fat ... just make sure it's from a grass fed cow.  I mean come on, if there is stereotyping about what the paleo diet is, the paleo peeps have only themselves to blame.  And if there's laughing at their expense, it's only because it is utterly ridiculous to make paleo ice cream and consider putting a stick of butter in your coffee to enjoy with a brick of dark chocolate somehow righteous and evolutionary and really that much different than a home baked chocolate cake or, non-God forbid, a Twinkie. 

Click to enlarge
Macro and caloric content of
three paleo diet studies
But what gets me the most here, is that in the article Robb complains about how people just don't know there are scientific studies on the paleo diet.  Read his book!  I don't know who this guy on Twitter was, but I think one would be hard pressed not to have heard of that paleo vs. Med trial, whether or not the person knows that as the Lindeberg study: A Palaeolithic diet improves glucose tolerance more than a Mediterranean-like diet in individuals with ischaemic heart disease.  What most who cite that study don't know, is that it was a low calorie (under 1500/day) low fat (28%) and under 10% saturated fat.  It was not, as Nora Gedgaudas -- one of the world's self-proclaimed leading experts on paleo nutrition -- claims, a VLC diet (almost 40% carb!).  

After discussing a study on gun shot wounds and describing it as an observational study, Robb writes:  
Should this be dismissed as flippantly as Lindeberg’s Paleo vs. Mediterranean diet in Humans trial frequently is amongst the EBM crowd? How about just holding the same standards to all of this material instead of using one’s biases ?
Would this be anything like the low fat challenge from Larry Istrail?    I have certainly not been flippant about this study, I just don't find it supportive of the sort of paleo diet all of these bloggers are eating and selling.  So Robb's Twitter friend wrote 
“This is why I do not advocate Paleo, there is not science to back it up. Show me the science”
Personally, I'd like to see some science -- science, as in evolutionary biologists' takes on what paleolithic humans ate and whether or not they think we should be even attempting to mimic that.  Eh?  Were we ketotic carnivores?  This is what Nora tells us.  If we're talking double standards, have you read her book Robb?  Sisson's?  Where's the science behind the Primal Carbohydrate Curve?  Heck, can you please tell me how you and Chris Kresser settled on dried seaweed and kale and acai berry for your "paleo blend" .  

Normally I’d simply shoot the guy the Lindeberg paper, a Frasetto paper etc and theye MIGHT be surprised (as these people have never bothered to even look in pubmed for this material) but they will consistently default to the following positions:
-This is a small study, we cannot draw conclusions.
-It is largely observational
And on, and on.

Umm ... Yeah, it is a small study, Gary Taubes calls that "bad science" ... But please tell me who has dissed it because it is observational?  Robb seems confused that studies only come in two varieties:  RCT or Observational.   But what of Frasetto?  I blogged on that study here.  Frasetto is even less like the paleo diet we here so much about.  Her trial was not lower carb than baseline, quite high carb in fact, lower in fat than Lindeberg and relatively high sugar.  Oh, and very high protein.  Let us hope Diane Sanfilippo of 21 Day Sugar Detox fame hasn't ever referenced that one!

Look, I've tried to get Robb's take on what a paleo diet is, or what the diet is that is being studied.  I read his study on paleo in Reno PD and he basically said there are very general guidelines, that their diet was LC and he's trying to push it more Lindeberg. But I learned something new from the byline: Robb Wolf, Writer, The Performance Menu, and Editor The Journal of Nutrition and Metabolism, Reno, Nevada.  What?  Editor of the Journal of Nutrition & Metabolism? He was a review editor apparently, though he's not listed now.  But speaking of journals, Robb's post goes on to trash peer review and extol the virtues of PLoS.  What does that say of his work with JN&M?  Oh ... and science is rife with fraud.  All but those paleo studies I suppose?  And by the way, Paleologix are touted as "clinically proven" -- where's that science?  Is it observational?  ;-)    

Look, if there are double standards about the science here, the paleo and low carb communities are the ones demonstrating in spades.  Any observational study on sugar or carbs and diabetes, however remote, makes the rounds ... but one on meat or fat?  Repeat after me:  correlation is not causation, someone should tell these idiots that.  Somehow the flat out misrepresentation of scientific studies within his flock doesn't seem to bother Robb much.   

Now I'm not sure, but it seems like Robb is equating himself with Einstein because criticism of "Ancestral Health" is like criticizing "shallow thinkers" like Einstein.  Huh?   First, I realize paleo poses problems, but "ancestral health" is more than paleo or primal or whatever.  We have neolithic ancestors!!  Robb kept conflating the two.  And he threw in more knocks at modern medicine -- we've made great strides with antibiotics, but in treating diabetes and cancer, not so much.  The problem as Robb sees it is apparently that scientists do not view everything through a Darwinian monacle. 
In closing I’d like to issue a statement and a challenge to the Evidence Based Medicine crowd: If you are conducting research in the biological sciences (medicine is a sub-discipline of biology), and your research does not consider the implications of Evolution via Natural Selection, you are not yet practicing science. You are earnestly data collecting, but you have no overarching framework to know if your questions or interpretations have any merit. If you want to move the field of medicine towards an epistemology with the predictive power of Quantum Mechanics, you must conduct every bit of research, hypothesis generation, and data interpretation with the background music of “what are the evolutionary implications?” This transition will eventually happen; it’s just a question of if it will take a decade or a century.
What?  If scientists did what Robb proposes, it would set us back decades if not centuries.  This, frankly, is one of the more ridiculous things I've read coming from the IHC, and that's a pretty high bar.   Is this "What Would Darwin Think?"  C'mon!  What does natural selection have to do with anything if, as the paleo crowd claims, we haven't evolved.   How are diseases cured by applying Darwinism in the operating room?   I mean what do you even make of that paragraph?    

Here's what I'd like to see.  How about YOU and the rest of the paleos get together and have a summit and decide what this paleolithic diet is.   Begin with doing studies to look at the efficacy of THAT diet.     How about correct the record when science proves you wrong?  Concerned about fraud?  Look around you and tell me it is the scientific community that is the biggest problem in paleo.  Need I remind the audience that Robb Wolf will be headlining Jimmy Moore's LC Cruise this year, and he is fully apprised of that situation.  He is now selling supplements with the claim that they are clinically proven.  Show us the proof.  

In my last post I got a lot of "he's doing great things", kiss and make up and let's all sing kumbaya.  What great works?  He's trashing the modern medicines that are being used in his own Reno Law Enforcement "paleo" study, while apparently paleo is getting all the credit for the results.  This he is apparently doing for free.  Kudos.  Doesn't give him a pass on the rest of what he does which is done to earn his living (nothing wrong with that!).  In my experience, folks who routinely remind you of how much they do to help people with their free stuff are doing so to convince themselves.  He left science long ago, opened up a gym and wrote a diet book.  Oh ... and he had a hand in "bringing us" Jack Kruse and pointing fingers of blame.  I imagine he's still pissed at me for pointing out that he was linking to yet another quack with an interest in neuroscience a week or so ago. (Still debating publishing up a post on that episode). Rather than accuse people of having reading comprehension problems, how about you take little responsibility, Robb, for the reading material you are suggesting to them.  Is that really too much to ask?


ProudDaddy said…
In all fairness, define Mediterranean, Low Carb, ... It seems to me that most "diets" are just as ill-defined as Paleo. The versions used in RCTs seem to be all over the map!
CarbSane said…
I agree PD, and I point that out here frequently. If you're talking double standards, any time what is called LC "bests" the other diet, it is touted round the LC blogosphere. If it falls short, then it "wasn't really a LC diet". Paleo is "by default" LC because it is less than the mythical average of 500g carb/day SAD. There was one 6month study of VLC (still not Jimmy's NuttyK) and that's about it.

Hope all's well Wayne and you are enjoying your new little one!
CarbSane said…
Oops deleted a paragraph above. The problem for Robb & Co. is that he can't have it both ways. He can't bemoan the ignorance of those who don't know about the studies that have been done without holding those who do to some account when they misrepresent them. Frasetto and Lindeberg both demonstrated benefits of a low fat, low saturated fat diet -- in one case lower carb/calorie, in the other slightly higher calorie, same carb high protein.
Unknown said…
"“Other than simple curiosity about our ancestors, why do we care whether an adult from 4,000 years ago could drink milk without getting a stomachache? The answer is that these samples are revolutionizing our ideas about the speed at which our evolution has occurred, and this knowledge, in turn, has made us question the idea that we are stuck with ancient genes, and ancient bodies, in a modern environment. We can use this ancient DNA to show that we are not shackled by it.”

“In short, we have what the anthropologist Leslie Aiello, president of the renowned Wenner-Gren Foundation for Anthropological Research, called “paleofantasies.” She was referring to stories about human evolution based on limited fossil evidence, but the term applies just as well to the idea that our modern lives are out of touch with the way human beings evolved and that we need to redress the imbalance. Newspaper articles, morning TV, dozens of books, and self-help advocates promoting slow-food or no-cook diets, barefoot running, sleeping with our infants, and other measures large and small claim that it would be more natural, and healthier, to live more like our ancestors. A corollary to this notion is that we are good at things we had to do back in the Pleistocene, like keeping an eye out for cheaters in our small groups, and bad at things we didn’t, like negotiating with people we can’t see and have never met.”

“Grinding and cooking grain is a practice that goes back perhaps as far as 30,000 years. By contrast, brussel sprouts appear to be just a few hundred years old and until the 16th century Native American populations were the only people eating tomatoes or hot peppers. None of which is to say that adopting a paleo diet won’t “work.” Any sufficiently stringent, somewhat arbitrary set of dietary restrictions is likely to lead you to snack less and be more mindful of what you’re eating. But the paleo concept is a marketing gimmick that doesn’t have much basis.”

Unknown said…
“Four years ago, biology professor Marlene Zuk was attending a conference on evolution and diseases of modern environments. She sat in on a presentation by Loren Cordain, author of “The Paleo Diet” and a leading guru of the current craze for emulating the lifestyles of our Stone-Age ancestors. Cordain pronounced several foods (bread, rice, potatoes) to be the cause of a fatal condition in people carrying certain genes. Intrigued, Zuk stood up and asked Cordain why this genetic inability to digest so many common foods had persisted. “Surely it would have been selected out of the population,” she suggested.

Cordain, who has a Ph.D in exercise physiology, assured Zuk that human beings had not had time to adapt to foods that only became staples with the advent of agriculture. “It’s only been ten thousand years,” he explained. Zuk’s response: “Plenty of time.” He looked at her blankly, and she repeated: “Plenty of time.” Zuk goes on to write, “we never resolved our disagreement.””

” generalizations about the typical hunter-gatherer lifestyle are spurious; it doesn’t exist. With respect to what people ate (especially how much meat), the only safe assumption was “whatever they could get,” something that to this day varies greatly depending on where they live. Recently, researchers discovered evidence that people in Europe were grinding and cooking grain (a paleo-diet bugaboo) as far back as 30,000 years ago, even if they weren’t actually cultivating it. “A strong body of evidence,” Zuk writes, “points to many changes in our genome since humans spread across the planet and developed agriculture, making it difficult at best to point to a single way of eating to which we were, and remain, best suited.”

Social and family relationships, too, vary greatly. But to draw conclusions about ancestral hunter-gatherers by examining diverse forager communities existing now, as some anthropologists do, is dubious in itself. Tribal people, too, have had tens of thousands of years to evolve. And unlike paleolithic hunter-gatherers, they live on the margins of developed societies and are almost always affected by them in some way.

Furthermore, the fossil record of the Stone Age is so small and necessarily incomplete that its ability to tell us about paleolithic society is severely limited. Consider this: For all we know, the first tools were not stone implements but woven slings designed to allow a mother to carry an infant while foraging; it’s just that stone happens to survive longer than fibers.

Why are we so intent on establishing how paleolithic people ate, exercised, coupled up and raised their kids? That’s a question Zuk considers only in passing, but she hits the nail pretty solidly on the head: “We have a regrettable tendency to see what we want to see and rationalize what we already want to do. That often means that if we can think of a way in which a behavior, whether it is eating junk food or having an affair, might have been beneficial in an ancestral environment, we feel vindicated, or at least justified.” Even if we wanted to live like cavemen, Zuk points out (noting that the desire to do so somehow never seems to extend to moving into mud huts), we couldn’t. In reality, we don’t have their bodies, and don’t live in their world. Even the animals and plants we eat have changed beyond recognition from their paleolithic ancestors. It turns out we’re stuck being us.”
Unknown said…
Leslie became President of the Wenner-Gren Foundation of Anthropological Research in April 2005. The Foundation is the largest private foundation in existence devoted solely to the support of international anthropological research.

Leslie received her BA and MA in Anthropology from the University of California (Los Angeles) and her PhD in human evolution and anatomy from the University of London.

She spent the majority of her academic career (1976-2005) at University College London where she was Professor of Biological Anthropology from 1995. She was also Head of the UCL Anthropology Department from 1996-2002 and Head of the UCL Graduate School from 2002 to 2005. She served as the co-managing editor of the Journal of Human Evolution from 1993-1999, has been the primary supervisor for 23 PhD students, has published books (e.g. An Introduction to Human Evolutionary Anatomy. Academic Press: London. 1990 with Chris Dean) and a number of articles in academic journals and has been active with the media in the public dissemination of science and particularly human evolution. She has served as an officer for a number of anthropological and scientific societies and as a consultant and advisor to a number of international anthropological institutions and initiatives.

Most recently she received the 2006 Huxley Memorial Medal from the Royal Anthropological Institute, an Honorary Fellowship from University College London (2007) and the award of ‘2007 Musa Urania (Science) from the city of Florence, Italy.

Research Interests
Leslie is an evolutionary anthropologist with special interests in the evolution of human adaptation as well as in broader issues of evolutionary theory, life history and the evolution of the brain, diet, language and cognition.

Her most recent work has been on thermoregulation and climate adaptation in Palaeolithic hominins while earlier work focused on the relationship between energetics and evolution of locomotion, diet, and brain growth and maintenance.

In collaboration with Peter Wheeler, she developed the Expensive Tissue Hypothesis which posited an inverse relationship between brain size and gut size mediated through the adoption of a high quality animal-based diet. This work also provided the basis for a series of papers focusing on the relationship between energetics, growth and development and the evolution of cooperation in hominin evolution as well as on the evolution of the biological basis for human speech. Throughout her career in anthropology she has relied on the development and use of large palaeoclimate, archaeological, palaeontological, energetic, and skeletal databases without which much of her research would not have been possible."
Unknown said…


Low-carbohydrate diets were associated with a significantly higher risk of all-cause mortality and they were not significantly associated with a risk of CVD mortality and incidence. However, this analysis is based on limited observational studies and large-scale trials on the complex interactions between low-carbohydrate diets and long-term outcomes are needed.

George said…
All this silliness makes me glad I'm no longer a paleotard.

Now excuse me as my pancakes are ready.
Unknown said…
Take a look at this and tell me what a true human diet is

Libby said…
I simply don't understand the need for so many to vehemently attempt to ridicule or discredit the "Paleo" lifestyle. Whole foods, organic and grassfed when possible. How shocking! And really? Attempting to discredit it because cavemen didn't eat ice cream or something? That's silly. Anyone who understands Paleo realizes its an idea or template, even just a starting point to regain control over one's health, it's not about wearing loincloths and hunting mastodons after a good night's sleep in a cave. All this contention is a waste of time. The USDA, FDA, AHA, ADA....THAT is where contempt belongs, not towards anyone following a whole foods diet and spreading the good word about it. Why be hatin'?
BigWhiskey said…
This may be Grokism today: http://www.nationalhomeless.org/factsheets/health.html
Unknown said…
Whole foods, organic and grass fed when possible is not "paleo". People were eating this way 100 years ago - does that make them "paleo"?

Define exactly what you mean by the "paleo' lifestyle?
Travis Culp said…
Those pancakes better be made with almond flour and your copious tears or you'll be dead in a week.
Libby said…
After three years of daily (casual) reading and research, as well as following a "Paleo" diet myself, I understand that there is no hard and fast definition of the term. You probably know that it is generally meant as a whole foods diet including vegetables, fruits, meats, fish, nuts, seeds, preferably organic and/or grassfed as applicable. However, while I consider myself "Paleo" I eat raw dairy and occasionally potatoes and rice. I am also a fan of the GAPS diet and WAPF, both of which include grains and legumes in their definitions of healthful foods. I myself avoid grains because I suffer when I don't, but I can appreciate that there are definitions of healthy eating that go beyond Paleo for some, if not many people. WAPF probably most closely resides within your "100 years ago". It doesn't change the fact that for many, many people "Paleo" is a good place to start when one is attempting to clean up one's diet and health. You can't truly know whether wheat adversely affects you unless you try going without. For myself, I am no longer obese, no longer depressed. When I did return to grains (briefly), I immediately became depressed and bloated. The bottom line, you do your thing and I'll do mine. What's wrong with that? Meanwhile, there's lots of good info in the Paleosphere for many.
Nigel Kinbrum said…
How about "One with minimal manufactured food products in it"?

Tying a diet to a period in ancient history seems silly to me, as there was no one "Paleo Diet", as per Charles' link above. I think that a better (and harder to criticise) name is one that encapsulates what the diet is all about, in a short catchy name e.g. JERF (Just Eat Real Food). The name already exists, so why not use it instead of Paleo?
Libby said…
Charles, you probably also know that "Paleo" is regarded to be pre-agricultural, hence the no grains or legumes or dairy, since cattle weren't domesticated at that time. This doesn't mean that people didn't eat grains or legumes, even dairy I suppose...but that since there weren't great acres of grains but probably isolated wild stands of them, people ate a lot fewer of them. Unlike modern times (50-60 years ago or so), when companies started making all sorts of processed foods, most of which today make up the bulk of your average American's diet and all of which (nearly) include factory refined grains (wheat) and corn (HFCS).
Unknown said…
if no dairy then why do paleo advocates eat cheese and butter?
And if no processed food then why supplements eg, Paleologix ( Wolf / Kresser)? Primal range Sissons?
Travis Culp said…
Keeper: Obviously because the worship of false idols is more paleo than the consumption of processed food is not paleo.
Unknown said…
When women complain about "bloated" does that mean you fart a lot?

I've never heard a guy complain about bloating but I have heard them complain about farting like farm animals.

I think it might be the same ailment, and women just don't like to admit to farting like farm animals.
George said…
Yep, almond flour, coconut oil, an egg from the chickens in my garden, and elk blood instead of milk. :)
Steven Hamley said…
I said as much under a status update yesterday by a local Crossfit gym that was hawking fish oil supplements in assorted flavors. How is that unprocessed, natural, whole food that an ancestor would have eaten? I totally approve of whole foods and healthy proteins as the core of one's diet. I try to do that myself. But masses of fish oil and assorted supplements? And the "no tropical fruits" thing was part of it a couple years ago, to which I said, "Screw that," as I love mango and pineapple and papaya and assorted Caribbean fruits that Americans don't normally eat. I remember the push for lower carb in Paleo, and watch those fruits which are "nature's candy", and forget rice and corn and beans cause of the anti-nutrients. And forget dairy, unless it's ghee.

Now, if folks go easier on the rule and eat more tubers and add a bit of rice and dairy. Which is fine with me, cause I wasn't gonna give up cheese no how.

I think asking for the principals in the AH movement to make clear delineations of what IS and what is NOT their core non-negotiables in an Ancestral Diet is a good thing, because the edges of this are getting fuzzier and fuzzier since I first read Wolf and Cordain and Sisson and DeVany etc. I guess Paleo as a diet is evolving, too. Not necessarily bad. :D
Libby said…
See, it's you guys who are so hell-bent on "Paleo" being a literal term. Many Paleo followers, myself included, DO use dairy, potatoes, rice. WHO CARES? People supplement to compensate for years, decades of poor nutrition following the Standard American Diet. Paleo folks often transition to GAPS or WAPF. It's a starting point. It's not modern man running around trying to spear a mammoth. You guys should lighten up.
Unknown said…
I agree. I think it basically means a distended lower abdomen and generally the gas that is accorded. I have known guys who complain about bloat.
Travis Culp said…
I love fructose-bearing fruit. Had a huge mango and 3 apples so far today. The avoidance of nutritious whole foods as a result of misguided reductionism is paleo's biggest fault, in my opinion.
This brings us back to " First define paleo" If you are eating dairy and rice (grains) one would warrant that you are not eating paleo at all but a whole food or " real food " diet as put forward earlier by Nigel.
Travis has a good point here with the paleo aversion to fruit and fructose, probably the original ancestral food.
Unknown said…
If we are bloated we just let it rip and it cures the bloating problem, no need for a special diet.
shadow said…
@unknown. It "cures" nothing. Either be comfortable with gas or change something. So, yes, it requires tweaking what you shove down your throat.
Unknown said…
Just stop defining the way you eat as paleo. It doesn't exist.
What Libby commented is a generic statement you hear from all paleo followers.
Unknown said…
This comment has been removed by a blog administrator.
Unknown said…
Nothing gets shoved down my throat, never been to prison.
Unknown said…
@Sue - you said " "Paleo" is regarded to be pre-agricultural, hence the no grains or legumes or dairy, since cattle weren't domesticated at that time"

SO - haw can we eat beef if cattle weren't domesticated at that time??
Unknown said…
"If we are bloated we just let it rip and it cures the bloating problem, no need for a special diet."

Not really. One could be 'letting it rip' the entire day and the discomfort will remain as well as the bloat -- more gas is formed. One either has to take a break from eating, or swap to a lesser inconvenient form of calories. For some, even a measly serving of beans or lentils can create a lasting state of abdominal discomfort.
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