In part one of this blog, I discussed how both paleo and vegan camps cherry pick research to substantiate their beliefs, and how the truth oftentimes lies between the lines. Looking beyond this confusion, what's an eater to do?
I vote for being a pegan or paleo-vegan, which is what I have chosen for myself and recommend for most of my patients. Keep in mind that most of us need to personalize the approach depending on our health conditions, preferences and needs.
What is a pegan? Well since I just made it up, I guess it's up to me to define.
Let's focus first on what is in common between paleo and vegan (healthy vegan), because there is more that intelligent eating has in common than there are differences. They both focus on real, whole, fresh food that is sustainably raised.
Here are the characteristics of a healthy diet everyone agrees on:
- Very low glycemic load -- low in sugar, flour and refined carbohydrates of all kinds.
- High in vegetables and fruits. The deeper the colors, the more variety, the better. This provides a high phytonutrient content protective against most diseases. (Although the paleo camp recommends lower glycemic fruit such as berries.)
- Low in pesticides, antibiotics and hormones and probably no- or low-GMO foods.
- No chemicals, additives, preservatives, dyes, MSG, artificial sweeteners and other "Franken Chemicals" that you would never have in your pantry.
- Higher in good quality fats -- omega-3 fats for all. And most camps advise good quality fats from olive oil, nuts, seeds and avocados. Although some, such as Drs. Esselstyn and Ornish, still advise very low fat diets for heart disease reversal.
- Adequate protein for appetite control and muscle synthesis, especially in the elderly.
- Ideally organic, local and fresh foods should be the majority of your diet.
- If animal products are consumed they should be sustainably-raised or grass-fed.
- If you are eating fish you should choose low mercury and low toxin-containing fish such as sardines, herring and anchovies or other small fish and avoid tuna, swordfish and Chilean sea bass because of the high mercury load.
Now comes the areas of more controversy.
- Dairy -- Both the paleo and vegan camps shun dairy and for good reason. See my blog on Got Proof about the problems with dairy in our diet. While some can tolerate it, for most it contributes to obesity, diabetes (due to lactose, which is sugar), acne, and may increase (not decrease) the risk of bone fractures, among other problems.
- Grains -- For millions of Americans gluten creates inflammation, autoimmunity, digestive disorders and even obesity. But do all grains cause a problem? Even though we started consuming grains recently in our evolutionary history, they can be part of a healthy diet, but not in unlimited amounts.
Any grains can increase your blood sugar. And if you eat any flours made from grains, you might as well be drinking a soda.
Stick with small portions (1/2 cup at a meal) of low glycemic grains like black rice or quinoa.
That said, for Type 2 diabetics wanting to get off insulin and reverse their diabetes and those with autoimmune disease, a grain- and bean-free diet could be a good experiment for a month or two to see how it impacts health.
- Beans -- Beans are a great source of fiber, protein and minerals. But they do cause digestive problems for some, and if you are diabetic, a mostly bean diet can trigger spikes in blood sugar. Again, moderate amounts are okay -- meaning about up to 1 cup a day. Some are concerned that beans contain lectins that create inflammation or phytates that impair mineral absorption. Among their other problems, studies show lectins bind to insulin receptors and potentially create leptin resistance.
- Meat -- Here's the sticky point. All meat is not created equally. Is it feed lot beef that has more palmitic and myristic acid that raises cholesterol and increases inflammation, or is it grass-fed beef that has more cholesterol neutral stearic acid and contains protective omega-3 fats and vitamins A and D that raises glutathione and other antioxidants? Some studies show meat increases heart disease and death rates, but others show the opposite. In truth it depends on the quality of the study, but the evidence in my mind is trending toward meat not being linked to death or heart attacks for the reasons I explained earlier -- there may have been other reasons excluded from the analysis in the meat eaters -- such as they were higher sugar consumers, they were more sedentary and they were more likely to smoke and drink. Eating sustainably-raised, clean meat, poultry and lamb and other esoteric meats such as ostrich, bison or venison as part a healthy diet is not likely harmful and can be very helpful in reducing triglycerides, raising HDL (or good cholesterol), lowering blood sugar, reducing belly fat, reducing appetite, raising testosterone and increasing muscle mass. A Clemson University study found grass-fed beef richer in more desirable fatty acids and antioxidants, with twice the amount of the anti-carcinogen conjugated linoleic acid. On the other hand, eating a lot of meat puts pressure on the planet -- more water use, more climate change, and more energy inputs. Eat meat as a side dish or condiment, and only consume grass fed and sustainably-raised.
- Eggs -- For years we were taught that cholesterol is bad, that eggs contain cholesterol so they must be bad, so we all suffered through years of egg white omelets, leaving the vitamins, nutrients and brain fats like choline in the garbage. Now, eggs have been exonerated and don't have any impact on cholesterol and are not associated with increased risk of heart disease. They are a great low-cost source of vital nutrients and protein.
- Fish -- If you are worried about mercury in fish (and you should be), then choose small, omega-3 fat rich fish such as sardines or wild salmon. If you are a vegan and don't want to eat anything with a mother for moral or religious reasons, then that perfectly ok. But it's critical to get omega-3 fats, and not just ALA (or alpha linolenic acid) found in plants. You need pre-formed DHA which is what most of your brain is made from. The good news -- you can get it from algae.
- Everyone needs Vitamin D3 (unless you are a lifeguard or run around naked south of Atlanta for at least 20 minutes a day, all year long). Studies link vitamin D deficiencies with numerous problems including autoimmune disease and hypertension. And omega-3 fats are hard to get for most. A Harvard University study found omega-3 deficiencies cause 96,000 deaths every year, making these deficiencies the sixth leading killer of Americans. Supplements (or a regular sardine diet) are essential. And for vegans, Vitamin B12 is also critical.
So what's an eater to do? Become a pegan or paleo vegan. Don't worry about focusing on how much you eat, if you focus on what you eat, your body's natural appetite control systems kick into gear and you eat less.
Here's what that looks like.
- Focus on the glycemic load of your diet. This can be done on a vegan or paleo diet, but harder on a vegan diet. Focus on more protein and fats. Nuts (not peanuts), seeds (flax, chia, hemp, sesame, pumpkin), coconut, avocados, sardines, olive oil.
- Eat the right fats. Stay away from most vegetable oils such as canola, sunflower, corn, and especially soybean oil, which now comprises about 10 percent of our calories. Focus instead on omega-3 fats, nuts, coconut, avocados and yes, even saturated fat from grass fed or sustainably raised animals.
- Eat mostly plants -- lots of low glycemic vegetables and fruits. This should be 75 percent of your diet and your plate. I usually make 2 to 3 vegetable dishes per meal.
- Focus on nuts and seeds. They are full of protein, minerals, and good fats and they lower the risk of heart disease and diabetes.
- Avoid dairy -- it is for growing calves into cows, not for humans. Try goat or sheep products and only as a treat. And always organic.
- Avoid gluten -- Most is from Franken Wheat, so look for heirloom wheat (Einkorn); if you are not gluten sensitive, then consider it an occasional treat.
- Eat gluten-free whole grains sparingly -- they still raise blood sugar and can trigger autoimmunity.
- Eat beans sparingly -- lentils are best. Stay away from big starchy beans.
- Eat meat or animal products as a condiment, not a main course. Read The Third Plate by Dan Barber to understand how shifts in our eating habits could save the environment and ourselves. Vegetables should take center stage and meat should be a side dish.
- Think of sugar as an occasional treat -- in all its various forms (i.e., use occasionally and sparingly).
This way of eating makes the most sense for our health and the health of our planet. It is sustainable and kinder to animals. I have addressed the topic of sugar and its dangers in my books The Blood Sugar Solution and The Blood Sugar Solution 10-Day Detox Diet, and am now working on a book about fat and meat.
This is a complicated story with many characters, opinions and beliefs -- all arguing their points with a mix of studies showing a variety of conclusions. My goal is to focus on biology -- how food affects us through human and animal experimental studies which prove cause and effect -- and not rely solely on studies of population habits which can often mislead and confuse because we can't draw cause and effect conclusions from them. Stay tuned for the real story on fat and animal food.
In the meantime, we can try to focus on what we know and customize it based on our preferences and beliefs. But we should leave religion out of nutrition while respecting individual choices and yes -- vegans and paleo folks can be friends!
How do I eat? After researching nutrition for 30 years and analyzing thousands of scientific papers and treating tens of thousands of patients with food, I vote for being a pegan!
Wishing you health and happiness,
Mark Hyman, M.D.
Mark Hyman, MD, believes that we all deserve a life of vitality -- and that we have the potential to create it for ourselves. That's why he is dedicated to tackling the root causes of chronic disease by harnessing the power of Functional Medicine to transform health care. Dr. Hyman and his team work every day to empower people, organizations, and communities to heal their bodies and minds, and improve our social and economic resilience.