Paleo vs. the Plant-Based Diet

I recently went to a conference focusing on obesity prevention and food as medicine.  One of the speakers discussed the benefits of a plant-based diet.  A plant-based diet is, from what I understand, the same as being vegan- no meat, no dairy, no eggs.  I think the difference in name comes from the focus on plant-based whole foods.  In other words, you can call yourself vegan, but eat tons of French fries and sugar.  The plant-based diet recommends healthy grains like quinoa and whole grains, and avoiding sugar and excess fat.

As a physician, it was interesting to hear all of the research supporting the plant-based diet.  There is compelling evidence to show sustained weight loss, improvement in diabetes, and reduced cardiovascular disease (ie reversing or preventing clogged arteries).

I always thought I’d be hungry all the time if I were on that type of diet.  Apparently, because of the high fiber content, people feel full faster, and because of the lack of fat, their overall calorie intake is decreased.  And therefore they lose weight and keep it off.

The speaker talked about how in Okinawa, people live among the longest and healthiest in the world- many make it to 100.  Okinawa is an island of Japan, way south of the main islands.  Think Karate Kid 2.  Their traditional diet is heavy in sweet potatoes, and they also eat white and brown rice regularly, tofu, seaweed, fish and some meat.  But the meat is more limited.  This article has a nice breakdown in chart form:

While the Okinawans don’t maintain a fully plant-based diet, their consumption of animal products is low.

So what about the evidence on the Paleo diet?  Mark Sisson has previously posted on that topic:

There does appear to be research supporting the benefits of the Paleo diet.  And surely more underway.  I find it interesting that the healthcare organization that I work for has been promoting the plant-based diet, but there is no promotion of the Paleo diet.  For whatever reason, it still hasn’t gained respect in the medical community as far as I am aware.

As a physician who has been trained to practice medicine based on the available evidence, which is ever evolving, I’m left wondering what to believe.  There is apparently clear data on the benefits of the plant-based diet.  But based on personal experience backed by data, there are also benefits of a Paleo diet.

There is a lot of common ground- both diets stress eating whole foods, and avoiding processed foods and sugar.  Both diets focus on eating plenty of vegetables and fruit.  And the traditional Paleo diet advises avoidance of dairy, though with the Primal Blueprint version, some is ok.  Where they differ are regards to grains, legumes, and of course meat/eggs.

That’s where I start to wonder.  According to Mark Sisson, grains and legumes, even seemingly healthy ones like quinoa and soy, have inflammatory properties and therefore are best to be avoided.  The plant-based diet proponents talk about how dairy contains hormones, and both dairy and meat, particularly cheese, is high in saturated fat.

So what am I supposed to do?  The main thing that makes me suspicious of the plant-based diet is that it requires vitamin B12 supplementation.  If a diet is supposed to be complete, and what humans are meant to eat, then why would it cause a significant nutritional deficiency without the supplement?  On the other hand, since it’s impossible to eat all meat that is from grass-fed happy cows and the like, I do wonder about the effect of hormones and antibiotics from eating too much meat and dairy products.

And if dairy is so bad, I wonder about the effects on my son.  Now that he’s past the age of breastfeeding and formula, he drinks cow’s milk with every meal.  He has about a gallon a week.  We do get the pricier organic stuff, which shouldn’t have the antibiotics and such, but still.  If dairy is such a concern, could there be long-term effects of him drinking so much?  For now, we’ll keep giving him the milk per the pediatrics recommendations.  Maybe as he gets older, we can switch him to almond milk and such.

As for me, I love cheese, so the thought of giving that up is tough.  As for legumes- eating tofu seems like it shouldn’t be that bad on the spectrum of cheating on the Paleo diet.  I’ve been seeing a lot of pastas made from legumes lately.  One from Trader Joe’s made of black beans is ok.  The one I like better is from Costco, and it’s a spaghetti made from edamame (soybeans).  If I eat that stuff instead of the regular pasta, it can’t be that bad, right?

Now is there a happy medium?  I mean those Okinawan centenarians weren’t fully plant-based nor Paleo.  Well, turns out there’s a doctor out there who coined the term peganism, or Paleo-Vegan.  Dr. Hyman explains it well here:

He recommends eating mostly plants, avoiding gluten and eating other grains sparingly.  Avoid dairy.  Eat beans sparingly, and eat meat as a side dish, not a main dish.  And if you do eat meat, get the grass-fed/sustainably raised stuff.  Given what I know now about the plant-based diet and Paleo, maybe this pegan thing is worth a try.

The hard part, of course, regardless of what diet is best, is sticking to it.  Long workdays, stress eating, grabbing what’s convenient- the challenge is getting past those hurdles.