5

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Survivor Bias or For Whom Does the Paleo Diet Fail

Answered on August 19, 2014
Created January 25, 2011 at 3:31 PM

Hi All,

Do we overestimate how good adopting a paleolithic lifestyle is because it has worked for us?

Prior posts provided anecdotal evidence of 'paleo failures'. However, has it been systematically studied so we better know under what circumstances a paleo lifestyle, inasmuch as it can be narrowly defined, fails? I ask this because if the contention is that adopting a paleo lifestyle leads to better health for those without severe ailments (slippery definition, I know) such as hereditary genetic defects like hemophilia or retinoblastoma, then someone should look for sound couter-evidence.

I would think the standard paleo detractors would fund research that could accidentally answer this question, but I've never found a trial identifying a group of people (or conditions) for which the paleo approach has been demonstrated to fail.

Thanks in advance for your thoughts, Mike

EDIT for Clarification: Thanks everyone for the comments that illustrate how inclusive (despite being about what not to eat) the paleo approach is. Although there are many paleo approaches, shouldn't we be able to test when the physiological effects they all have in common are insufficient to combat some pathology? As an example to give this question focus, what if adopting a well-defined paleo approach increased the risk of some cancers but decreased the risk of others? One could then study the origin of this differential effect.

I push this in part because I feel that paleo is in danger of being written off as 'another diet' whose effectiveness stems from the prolonged calorie restriction that not eating a type of food and finding a supportive community enables. Inasmuch as the paleo lifestyle gives a window into nutrition, it could provide a much-needed change of direction in nutrition research. But, to really change the SAD (thinking public health here) there is a preponderance of evidence one needs to accumulate...

068ab14851955abf08cb9d905e630808

(0)

on June 12, 2014
at 12:58 PM

We are highly adaptable and since natural selection is not about 'survival of the fittest' but, rather, the 'survival of the fittest to breed' we can actually be rewarded for practices that support better breeding but not better quality of life or longevity. In other words, our genes probably 'like' diary products even if, long term, our bodies don't, because they trigger earlier fertility and, therefore, more babies.

89e238284ccb95b439edcff9e123671e

(10299)

on May 09, 2011
at 06:56 AM

Verena, good for you. Note that I use the words 'could' and 'for you'. While I definitely eat more fats than CW would want, I'm not very high in fats too...

8a8129d053df7365c6529b0c2ac95efb

(284)

on May 07, 2011
at 09:38 PM

i don't a gree that low fat paleo doesn't work...i am a living example that it does! :)

0e395acc856e3353f3f5892e6b09b0e7

(1227)

on January 25, 2011
at 09:53 PM

Eva, I'm glad you really didn't intend the big bold letters. They made the hair on my head stand up and shoot back from my head. Like a cartoon character in a big wind. I totally agree with what you are saying, however.

61b801de5dc345b557cd4623d4a4f26b

(2682)

on January 25, 2011
at 09:48 PM

I'm with sherpamelissa - My main reason for sticking with paleo is I believe it's the best for my health. On the other hand, my husband hasn't seen any major changes in me (besides weight loss) so he's not convinced it's different than any other way of "healthy" eating.

Medium avatar

(39831)

on January 25, 2011
at 09:02 PM

Oh yeah, I mean your points are well-taken, I just don't think there is any money in such studies, and as such, they will most likely never be conducted. I've noticed this strong desire for empirical, double-blind, scientific method kind of info with regard to paleo, but I'll take an anecdote with a well-reasoned argument in lieu of that any day.

4e40d2b9e1a762949a25b958762aa10d

(762)

on January 25, 2011
at 08:25 PM

@Travis: I also think this is unlikely. However, while I don't doubt the empirical (even if sometimes anecdotal) proof that paleo approaches work, I often find the science lacking. (Not that the science behind the SAD is anything to write home about.) So, to further our understanding of just what is going on when we eat something I thought, motivated by the food as the best medicine concept, to ask when the Paleo approach is bad or ineffective medicine.

4e40d2b9e1a762949a25b958762aa10d

(762)

on January 25, 2011
at 08:22 PM

To explain my choice of terminology, I used 'survivor bias' in its meaning as a statistical term. Quoth wikipedia: "Survivorship bias is the logical error of concentrating on the people or things that "survived" some process and inadvertently overlooking those that didn't because of their lack of visibility. This can lead to false conclusions in several different ways. The survivors may literally be people, as in a medical study, or could be companies or research subjects or applicants for a job, or anything that must make it past some selection process to be considered further."

4e40d2b9e1a762949a25b958762aa10d

(762)

on January 25, 2011
at 08:20 PM

@Heather: That's a great idea for an "ecological" or "cross-sectional study (to use 2 public health terms)- whether some groups are more likely to go Paleo than others.

9722850c9a1c47b79edf7c4233040248

(1276)

on January 25, 2011
at 06:53 PM

I totally get that. I'm just saying that it *might* take a lot more fortitude, depending on the individual, to stay with it "because research shows it's good for me," rather than "because it hurts when I don't!" I'm somewhat in-between, and I think that for the average person, results speak louder than words.

7e746be2f0e550a8cd7df881322ae705

(18701)

on January 25, 2011
at 05:50 PM

Well, I am a Paleo "Survivor" that had nothing wrong with me to start. I've seen no real benefits health-wise other than making it slightly easier to lose body fat, but I know I could have done that on my previous diet also. The reason I'm staying with it is because during my research Paleo eating I truly believe it is more healthy for my body.

D67e7b481854b02110d5a5b21d6789b1

(4101)

on January 25, 2011
at 04:37 PM

"Essentially, you would have to demonstrate someone's health is dependent on dairy, grains, legumes, or sugar." Great answer!

62ed65f3596aa2f62fa1d58a0c09f8c3

(20807)

on January 25, 2011
at 04:33 PM

Oh weird, adding numbers to sentences apparently also make them appear in bold letters for some reason.

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7 Answers

13
154d799847153f5589f99496a9bdbb71

on January 25, 2011
at 04:32 PM

Paleo is mainly about what not to eat. To say someone can't succeed on paleo means they can't survive (or do well) without neolithic foods. Essentially, you would have to demonstrate someone's health is dependent on dairy, grains, legumes, or sugar.

I have never seen evidence suggesting people do better on wheat vs no wheat, milk vs no milk, or soda vs no soda. Quite the opposite.

If on the other hand, someone wants to claim that a particular approach to paleo failed (low fat, low carb, raw, lots of nuts, high in nightshades, etc.) then they need to modify the diet to suit their needs. Not blame the concept of eating an ancestral diet.

D67e7b481854b02110d5a5b21d6789b1

(4101)

on January 25, 2011
at 04:37 PM

"Essentially, you would have to demonstrate someone's health is dependent on dairy, grains, legumes, or sugar." Great answer!

6
525ceb06bc8862932d853a033411e3b7

(350)

on January 25, 2011
at 09:58 PM

The implication is that, if one is regularly eating Neolithic foods, one is not thriving. Yet there are thousands of athletes around the world setting records eating wheat, dairy, sugar etc. Further, millions of people around the world seem to subsist and even (depending on one's definition0 thrive on diets that include, or are even based on, wheat, rice, dairy etc. While the experience of many Paleos is that eliminating these foods can also eliminate the problems they cause for those who suffer from gluten-related issues (or dairy allergies etc) seems sound, it strikes me as a stretch to apply this logic to everyone in the world, particularly those with no health issues.

The original post suggested that the onus is on the non-Paleos to prove the superiority of a diet that includes neolithic foods. I disagree, the onus is clearly on the Paleo diet to prove its utility to those who do not have any manifest diet-related health issues with dairy, grains and legumes (even those issues they are unaware of). I say this as someone who has completed a 30 day induction and had no change in health, BP, blood work, recovery, etc. I later reintroduced milk with no problem and from time to time I eat grains and some sugar. I'm basically 80% compliant still, but I see no need (socially or health-wise) to go 100%.

068ab14851955abf08cb9d905e630808

(0)

on June 12, 2014
at 12:58 PM

We are highly adaptable and since natural selection is not about 'survival of the fittest' but, rather, the 'survival of the fittest to breed' we can actually be rewarded for practices that support better breeding but not better quality of life or longevity. In other words, our genes probably 'like' diary products even if, long term, our bodies don't, because they trigger earlier fertility and, therefore, more babies.

6
4145b36f1488224964edac6258b75aff

(7821)

on January 25, 2011
at 03:43 PM

I very much like the idea behind this question. Attempting to falsify belief and recognizing bias is important.

The main problem is that there haven't been many studies (at least that I know of) which have tested a "paleo" diet. To top it off, "Paleo" is more of a philosophy than a specific diet, more of a food first principle than something like Atkins or Ornish, so you'd have a tough time defining things well enough that some paleo group wouldn't say, "Well yeah but that's not how I eat".

Also, "paleo" often converges with many other food philosophies when you get down to basic implementation, so you end up with labeling issues. Am I eating real food or am I eating paleo? What's the difference?

So I guess you'd probably have a hard time finding a group of people for whom paleo would fail, since at the end of the day paleo boils down to "eat real food, minus grains". If you managed to falsify the idea that "Eat real food, minus grains" is healthy, it would be a revolution in human nutrition with ramifications well beyond the paleosphere.

3
9722850c9a1c47b79edf7c4233040248

(1276)

on January 25, 2011
at 05:44 PM

I think that people are most likely to keep up with paleo (and be more strict about their personal definition of it) if they had health problems that clear up with paleo, and come back with trigger foods. Knowing in theory what is optimal for you is psychologically different from knowing through X Food = Major Pain. I recently came across a traditional foods/paleo forum where I least expected to find it. I was pleasantly surprised until I realized that all the posts were titled things like "I really want to stay Paleo, but I'm addicted to grains!" Or "Maybe I'll go WAPF instead so I can have grains!" Perusing these, it quickly became clear that they hadn't experienced major health benefits from paleo. Maybe a slight increase in energy and clearing of mental fog, but not "my knee doesn't ache anymore, but it swells up so badly I can barely walk when I accidentally stray" like for me.

So, maybe paleo "survivors" were sicker in general? A study would be fascinating.

7e746be2f0e550a8cd7df881322ae705

(18701)

on January 25, 2011
at 05:50 PM

Well, I am a Paleo "Survivor" that had nothing wrong with me to start. I've seen no real benefits health-wise other than making it slightly easier to lose body fat, but I know I could have done that on my previous diet also. The reason I'm staying with it is because during my research Paleo eating I truly believe it is more healthy for my body.

9722850c9a1c47b79edf7c4233040248

(1276)

on January 25, 2011
at 06:53 PM

I totally get that. I'm just saying that it *might* take a lot more fortitude, depending on the individual, to stay with it "because research shows it's good for me," rather than "because it hurts when I don't!" I'm somewhat in-between, and I think that for the average person, results speak louder than words.

4e40d2b9e1a762949a25b958762aa10d

(762)

on January 25, 2011
at 08:20 PM

@Heather: That's a great idea for an "ecological" or "cross-sectional study (to use 2 public health terms)- whether some groups are more likely to go Paleo than others.

61b801de5dc345b557cd4623d4a4f26b

(2682)

on January 25, 2011
at 09:48 PM

I'm with sherpamelissa - My main reason for sticking with paleo is I believe it's the best for my health. On the other hand, my husband hasn't seen any major changes in me (besides weight loss) so he's not convinced it's different than any other way of "healthy" eating.

3
62ed65f3596aa2f62fa1d58a0c09f8c3

(20807)

on January 25, 2011
at 04:32 PM

From anecdotal reports, the main problems seeme to be:

1 Induction flu and/or withdrawal symptoms. Many people need a period of adaptation.
2 Some people needing more carb than others-gotta work out ideal carb intake.
3 Allergies to one or some of the paleo foods
4 Some people choosing a list of foods that do not fully meet nutritional needs (magnesium, etc)
5 Paleo eating not solving every problem the person has by itself.

These issues are only 'failures' if the problem is not solved and only the first two issues are more paleo specific. The others can happen on any loosely organized diet. Part of the problem is that paleo is not a set prescribed diet plan. There is actually a huge variation in the way some paleo people eat compared to others. Mix that with epigenetics and it's not a surprise that results can vary greatly as well. In some ways, several of the tenants of paleo are even at crosshairs with eachother. You can't really have a diet that is not really a diet but just a list of thousands of choices, and then expect a similar and controlled response by everyone on that 'diet.' Paleo eating is really less of a diet and more of a theory that many of us think is correct. This theory shapes our eating and lifestyle plan, but each of us interpret it differently and our eating plans are actually very individual from another. There is no just one paleo 'diet' plan.

62ed65f3596aa2f62fa1d58a0c09f8c3

(20807)

on January 25, 2011
at 04:33 PM

Oh weird, adding numbers to sentences apparently also make them appear in bold letters for some reason.

0e395acc856e3353f3f5892e6b09b0e7

(1227)

on January 25, 2011
at 09:53 PM

Eva, I'm glad you really didn't intend the big bold letters. They made the hair on my head stand up and shoot back from my head. Like a cartoon character in a big wind. I totally agree with what you are saying, however.

2
89e238284ccb95b439edcff9e123671e

(10299)

on January 25, 2011
at 04:23 PM

I think the major reason why people fail is psychosocial. You have to be able go against the flow. That's not easy!

I'm lucky, my wife and I work at home. We can rather easily control our dietary environment. We're both physical therapists, so we don't sit still all day long. We control our own agenda (more or less).

Other reasons could be finding 'your' paleo approach. I think Melissa McEwen talks about a 'faileo-diet'. You should check her blog for this post. Eating low fat paleo could not be your optimal diet. Although I'm convinced that in principle and for most, a paleo diet is easy, for some the basic paleo concept could need a little tweeking and adjusting. These little things could make a big difference in result.

89e238284ccb95b439edcff9e123671e

(10299)

on May 09, 2011
at 06:56 AM

Verena, good for you. Note that I use the words 'could' and 'for you'. While I definitely eat more fats than CW would want, I'm not very high in fats too...

8a8129d053df7365c6529b0c2ac95efb

(284)

on May 07, 2011
at 09:38 PM

i don't a gree that low fat paleo doesn't work...i am a living example that it does! :)

0
Medium avatar

on January 25, 2011
at 07:34 PM

A failure of the paleo diet is actually a victory for neolithic food addictions. I just can't fathom someone feeling better or being healthier eating these "food" aberrations.

4e40d2b9e1a762949a25b958762aa10d

(762)

on January 25, 2011
at 08:25 PM

@Travis: I also think this is unlikely. However, while I don't doubt the empirical (even if sometimes anecdotal) proof that paleo approaches work, I often find the science lacking. (Not that the science behind the SAD is anything to write home about.) So, to further our understanding of just what is going on when we eat something I thought, motivated by the food as the best medicine concept, to ask when the Paleo approach is bad or ineffective medicine.

Medium avatar

(39831)

on January 25, 2011
at 09:02 PM

Oh yeah, I mean your points are well-taken, I just don't think there is any money in such studies, and as such, they will most likely never be conducted. I've noticed this strong desire for empirical, double-blind, scientific method kind of info with regard to paleo, but I'll take an anecdote with a well-reasoned argument in lieu of that any day.

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