January 15, 2013
Primal Diet, Primarian Variants and Weight Maintenance 2013
by Barbara Berkeley, MD
As each year begins, I try to reclarify my own position on healthy diet. I encourage you to do the same.
We are all experts when it comes to our own bodies, yet we often cede responsibility to others: nutritionists, food bloggers, even doctors like me. The most important advice I can give you is to remind you that there is likely no one dietary truth. For those of us with an interest in how eating dovetails with health, learning is an ongoing process. We should read with curiosity and "try on" different ideas to see if they fit. What I believe may be diametrically opposed to what another "expert" espouses. Your choice of belief is up to you.
As 2013 begins, I am still firmly in the Primarian camp. For those of you who are new to this blog, let me briefly explain that Primarian diet (my particular take on a Primal eating style) is a slightly more permissive form of Paleo diet. It includes low fat dairy (if tolerated) and also advises the consumption of lean animal protein rather than fatty meats. Primarian eating, as laid out in my book Refuse to Regain, is a default diet that should be practiced 90% of the time. In not requiring or expecting perfection, I may be seen as less fervent than many Primal eating advocates.
I am not a dietary purist. There are three basic reasons for this.
1. All protestations to the contrary, no one knows for sure what constitutes the healthiest human diet. There may be many possible variants. I suggest that you look with suspicion on those who claim to have an absolute corner on the truth (that would include me in my more strident moments).
2. There are realities involved in eating in the modern world. While extremely devoted paleo practitioners may never deviate from plan, I have found the most people are unable to be so perfectly consistent. It seems far easier to become a vegetarian, which still allows the consumption of lots of carbs, then to become a Primal practitioner, giving up sugars, legumes, grains and milk.
3. We need to figure out what we want from a diet. No diet is able to deliver perfect health, a guarantee of longevity, or freedom from ever developing a cancer. So we should focus on what diet can do: keep weight stable, create healthy levels of cholesterol and lipids, reduce blood pressure and prevent high blood pressure. On a more global level,diet can make us feel healthy and give us a sense of well being.
Every human being is slightly different and what may work for one dietarily may be completely ineffective for another. Each of us will find that we are able to make tweaks around the outlines of the dietary worldview we choose, but we can only do this if we approach diet with a keen sense of self-observation and purpose. A complete failure to look at diet criticially is, in my view, responsible for many of the modern ills of the late 20th century.
So where do I, just one person...one voice, stand today? Here is where I am and why.
1. I believe in returning to largely unprocessed, more primal foods.
My reasons: It is probably true that humans can eat foods other than those in the original human diet. We may have become adapted to many new foods in the 10,000 or so years since we discovered agriculture. Nevertheless, we are going through a period where food and eating habits have begun to create disease. We can't be sure which elements are causing the problem. As a result, retreating to an approximation of the original human diet would seem to make sense. In practice, those I treat do better with weight loss and weight maintenance when they adapt more primal eating styles. I personally believe this is due to the elimination of the excessive carb burden in the SAD (standard Amercian diet). It may also be due to cutting back on fats, boosting protein intake, removing high fructose corn syrup and other additives, and/or increasing vegetable consumption.
2. I believe in diets that allow for compliance.
In my particular world, primal variants (Primarian diet) work well. I take note of the fact that a great many of the people on primal websites are young, athletic and highly motivated. It is not coincidental that Paleo diets have become associated with physical conditioning programs like Crossfit. It is appropriate and expected that young people lead the charge, introducing new ideas and practices. In the subculture of obesity medicine, however, we must deal with different realities. People who gain weight easily have generally been exposed to many highly restrictive diets. If they are to maintain weight permanently, it is crucial to identify a way of eating that can be practiced over the long term...among friends and family who will inevitably be eating quite differently. The additon of low fat dairy items, the acceptance of 90% compliance, and the advice to add back (with great caution!) small amounts of non-triggering carbohydrates, do not appear to adversely affect maintenance success. Indeed, these accommodations may make it more likely. And success, after all, is what we are about.
Having said all of this, I must reiterate that one of the major themes of my book, Refuse to Regain, is that maintainers should be "tough and not moderate". By this I mean that once someone has identified the diet that keeps them at optimal weight, staves off modern ills, and gives them a sense of general well-being, they should practice it religiously and defend it against all challenges. What is that diet for you? I suggest you start with a primal or paleo diet and work forward...slowly and deliberately. That is a project for 2013 and also for a lifetime.
To see more posts on Primal diet, select Primarian/Primal Diet under the "Categories" list in the bottom left margin of this page.
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