Sunday, November 14, 2010

Book Review: The Paleo Solution by Rob Wolf

           Another regular feature of my Blog will be book reviews.  I’ll take a look at popular books on Diet, Exercise, Weight Loss and Health and let you know what I think.  I have only 2 criteria for reviewing a book.

1) It must be a Nutrition/Weight loss top 20 best seller on Amazon.  I want to review books that you all have heard of and may like to read.

2) The author must have credentials.  I need to see some level of education.  In other words, I need to see proof that the author has at least a peripheral understanding of nutrition science and research.  I am more than tired of celebrities who are selling diet and weight loss books without ever opening a book on the subject.

            The Paleo Solution by Robb Wolf meets both criteria nicely.   It is a best seller on in the category of weight loss and the author has a degree in biochemistry, a field closely correlated with nutrition.

            The book is based on the theory that the diet we ate during the Paleolithic or “hunter-gatherer” era of our evolution is the most health promoting.  The book is really well written and quite humorous at times.  The author and I have a lot in common.  In our youth we were both trying to be healthy and followed a low fat, high carb diet that made us sick.  We eventually learned about the right way to eat, fell in love with the field of nutrition and got a degree in the field.  The book spends a lot of time going over the biochemistry of digestion, presents a detailed 30 day meal plan and spends a good amount of time discussing exercise.   It’s a fairly long book (320 pages) but it reads quick because it is interesting and well written.

5 Things I really like about The Paleo Solution
1) The idea of studying human evolution to figure out what we should eat.  Anyone who has worked with me or read my book knows that my nutrition philosophy is heavily influenced by studying the original human diet.

2) The emphasis on the biochemistry of digestion.  The author does a great job explaining the hormonal consequences of eating different foods.  This is very important information if you want to truly understand the health effects of the foods we eat.

3) Emphasizes the importance of adequate sleep.  This is huge for both general health as well as weight loss.

4) Stresses that exercising too much is not good for you.  I like the moderate approach he takes to increasing physical activity.

5) Focuses on just 3 meals a day.  I totally agree with this philosophy.  With a stable blood sugar, there is no need to graze.

5 Things I disagreed with in The Paleo Solution
1) One thing that I found a bit tough to take is how the author kept blasting the nutritional research as quackery and non-scientific.   I feel that the research we do at Harvard is extremely relevant and our methods are tried and true.  There are a lot of problems with nutrition science for sure but to make such a blank statement was a bit rough.

2) The author believes that all grains are unhealthy.  I don’t agree with this.  There is very well designed research that points to the beneficial effects of whole grains on risk of heart disease, diabetes and even some cancers. 

3) The author also doesn’t differentiate cereal fiber from other forms of fiber.  He mentions that you get lots of fiber on his diet, which is true, but none of it is cereal fiber.  In our research at Harvard, cereal fiber had the most protective effects regarding disease risk reduction.

4) The meal plan was a little heavy on the red meat.  One of his sample days had red meat at all 3 meals and even for the snack.   This is not a good idea.

5) The nutrient composition of a sample day on his plan was: Fat 39%, Carb 23%, Protein 38% and cholesterol 461 mg.  This is a bit high on the protein.  I did a review paper on high protein diets and I feel this amount of protein may put a stress on the kidneys of sensitive individuals.  I’m also not crazy about the amount of cholesterol ingested on this day.

Is it worth reading?
        I think The Paleo Solution is definitely worth reading.  I learned a lot about how our early ancestors lived and ate and this is extremely relevant when asking questions about the lifestyle we were designed to live.   However, I think to follow the diet literally isn’t the best idea.   There is a lot of really good research out there that has improved our knowledge of the health effects of our food and that must be taken into account in addition to our native diet. 

        One last thought: Our early ancestors lived for only 30-35 years.  Who knows what long term health affects this native diet would have had on risk of heart disease, stroke, diabetes and cancer if they lived to their mid 70’s like we do?


Random Caveman said...

Robb does not have a PhD, but he has helped thousands of people improve their health through prescribing the Paleo Diet, so I believe he still meets your criteria and I'm glad to see a review of his book. I don't recon how you can endorse using evolution to understand nutrition and ignore that (grass fed) red meat has been #1 on the menu for millions of years while grains are newcomers that demonstrably spike blood sugar/insulin just like... sugar. What is often missed is that followers of the Paleo Diet typically eat more vegetables than vegetarians or vegans. I challenge you to try the diet for 30-60 days, take a blood panel before and after. If you work out often I have no doubt that you will be positively stunned with the results. I was.

Dr. Thomas Halton said...

Thanks for the comment Mike- When I saw that Robb was a research biochemist, a student of Dr. Loren Cordain and a Review Editor of the Journal of Nutrition and Metabolism, I assumed he did doctoral work, my apologies for this error. Here's the thing about red meat, while one can debate whether red meat increases risk of heart disease, there is strong evidence that it increases the risk of colon cancer, likely due to conversion of heterocyclic amines when cooked (see this reference: World Cancer Research Fund, American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR, 2007.). While I am not a huge advocate of whole grains, the benefits of including some in our diet are undeniable. In our Nurses' Health Study at Harvard, women who consumed 2-3 servings of whole grains per day were 30% less likely to have a heart attack or die from heart disease in the next 10 years compared to women who consumed less than one serving per week (Liu S, Stampfer MJ, Hu FB, et al. Whole-grain consumption and risk of coronary heart disease: results from the Nurses' Health Study. American Journal of Clinical Nutrition. 1999; 70:412-9.) There is also strong evidence that whole grains reduce risk of type 2 diabetes and certain cancers. I'd be happy to share the links for this research as well (shoot me an email). Small amounts of whole grains like steel cut oatmeal or brown rice, when mixed with adequate amount of protein and fat will not adversely effect serum blood sugar and insulin levels. So while I do use our original diet as the base of my nutrition philosophy and recommendations for my clients, I'd be negligent if I didn't also take into account the well designed research we've conducted at Harvard and other institutions in recent years.

Robb Wolf said...

Dr. Halton!
I'm honored you'd review the book and thank you for the kind words. Most of my focus on grains involves the autoimmune potential of grain lectins and similar compounds such as saponins in quinoa. Personally, I'm more worried about this issue than the carbohydrate load, although many folks have suffered enough oxidative damage to the pancreas to benefit from curtailed carb intake in general. This research may be of interest:

Of particular interest is the relative lack of improvement in Type 2 diabetics relative to the improvements seen in Type 2 diabetics on a paleo type diet. Not at the level of a metabolic ward, but interesting none the less.

Dr. Thomas Halton said...

Thanks for the link Robb,
That article is quite interesting, but on closer examination, I'm not sure it is a fair comparison. The "Consensus Mediterranean Diet" that was compared to the "Paleo Diet" included a good amount of white potatoes, very low nut consumption, low wine consumption, very little fish, a surprisingly small amount of olive oil, a huge amount of cereals and a high consumption of dairy, fruit juices, soda and sodium. I'm not sure this is consistent with a Mediterranean diet at all. In fact, the fat:protein:carb ratio is 25:20:52 and the glycemic load was quite high at 122. This diet would be better characterized as a low fat high, carb diet. This largely explains the results as a low fat diet is not the way to go to improve serum glucose and insulin levels. It would have been awesome to see a comparison of the Paleo diet to a true Mediterranean diet that is high in olive oil, nuts, red wine, fish, and lower in carbohdyrate, sweetened beverages and dairy products with an overall lower glycemic load. This is the way I have my clients eat and their blood sugars and insulin levels improve so much that their doctors can't believe it. Furthermore, the 2 diets were not isocaloric, the Med diet group ate ~450 more calories each day than the Paleo group. This could certainly confound the results as well.
Thanks again for the link and post and I wish you continued success with The Paleo Solution. I truly enjoyed reading it!

Unknown said...

Dr Halton as a physician myself who interests are in leptin signaling and the brain gut axis I think your stance on grains is what is off. The data on cereal fibers and heart disease diabetes and cancer is bad science published by editors and researchers with their hand in the cookie jars of the agracomplex. Your literature is rife with conflicts in funding for studies. Robb has said what he has said because the data is cooked. One of his best friends is Matt Lalonde a PhD at Harvard who is extremely well known and well read and fully supports Robb's beliefs and not the ones you do under Walter Willet. I have been advocating this style for eating over ten years and have thousands of success stories. We have ample evidence to see what refine sugars and grains have done to this countries health under the Walter Willets we have had to endure. I'll pass on this review. And I read your work too. Since you advocate inflammatory options in the diet, our immune system is only as strong as our weakest link. I can say your methods will require a substantial defense.

Dr. Thomas Halton said...

Thank you for taking the time to read my Blog and post a reply. I will address your points one at a time. #1) You say that the research on cereal fiber and disease is bad science with editors and researchers with their “hands in the cookie jar” and that my literature is rife with conflicts in funding. Accusing myself and my colleagues at Harvard of taking money from the food industry and altering our results for their benefit is a serious accusation that I take exception to. My research has been funded by National Institutes of Health Grants and not food industry funding. If you are going to accuse someone of such a serious offense and do so in public forum such as this, you should do a little more research and get your facts straight. #2) It is not just work from Harvard that has shown undeniable benefits of whole grains on risk of disease. Please take a look at these references from a variety of different cohorts, including the NIH-AARP cohort, The Iowa Women’s Health Study, The Nurses’ Health Study and a meta-analysis of 7 major studies (American Journal of Clinical Nutrition 1999 70:412, Nutr Metab Cardiovasc Dis 2008 18:283, PLoS Med 2007 4:e261, American Journal of Clinical Nutrition 2007 85:1353, American Journal of Clinical Nutrition 2007 85:1606). Despite your beliefs, these are extremely well designed, unbiased studies that show a real benefit of whole grains on risk of heart disease, type 2 diabetes, cancer and total mortality. #3) I too have done clinical work for over a decade and have had nothing but success with my nutritional recommendations. In fact, I have a stable of physicians here in Boston who send me out to see their patients, and let me tell you that both patient and physician are thrilled with the result endpoints, including weight loss, cardiovascular disease risk factor reduction and improvement in insulin sensitivity and risk of type 2 diabetes. #4) I’m not sure you know who Dr. Walter Willett is and what he stands for. Dr. Willett does not advocate refined grain consumption; he is strongly against refined grain and sugar intake. In fact, most of the research that bought to light the dangers of refined grains is Harvard research conducted under Dr. Willett. Furthermore, Dr. Willett has done more to improve the health of this nation than any other nutrition researcher I can think of. He spearheaded initiatives on folate which have dramatically reduced incidence of neural tube defect in developing fetuses, was a major player in lobbying to remove Trans fat from the food supply and is currently spearheading initiatives to reduce sodium in our food supply. I could go on and on. His work has saved the lives and improved the health of countless people around the world. It is my sincere hope that we have to “endure” his beneficial impact on our health for decades to come. #5) Lastly, you say that you have reviewed my work and feel that my recommendations need a substantial defense because they promote inflammation. My recommendations are based on solid research. Whole grains reduce inflammation, they don’t promote it. In fact, in the Iowa Women’s Health Study (American Journal of Clinical Nutrition 2007 85:1606), women who consumed 2 or more servings of whole grains per day had a 30% lower risk of inflammatory related death compared to women who rarely or never ate whole grains. Again, my recommendations are based on well designed, peer reviewed research and are flexible to change when well designed research tells us otherwise. I’d invite you to share your research on the dangers of whole grains and inflammation so we can all judge for ourselves. Sincerely, Dr. Thomas L Halton

Anonymous said...

Robb Wolf is a hack. He cares only to profit from gullible individuals. He pretends to be about helping people but he is only interested in one thing. Money. Just another salesman. Lookout for a lot more sponsors and other revenue streams to come in the near future!

Unknown said...

I have veered away from whole grains over the last few weeks due to trying to stick to the paleo diet but I have been wondering if totally cutting out whole grains is the best way to go or not?? I have just read all of these comments and still am feelings a little leery of totally cutting out whole grains. If I was to incorporate some whole grains back into my diet, what are the absolute best/healthiest ones to go with that wont effect my body in a negative way? And also, how often would I want them back into my diet to stay away from the negatively effecting my body? I am in my mid 20's and am very active in crossfit and do not have a weight issue in any way.

Random Caveman said...

I too felt leery about cutting out grains at first, because of how I grew up (in the 80s). I felt the same way about going back to butter, since we always ate margarine and were fed a line about butter.

My own analogy is like imagining I can fly high when doing fairly strict paleo. Eating white rice a few times per month does not really affect my altitude, but a weekend of binging on wheat = crash and burn, very hard to get back up in the air.

Experiment on your own, go one month on then one month off. You will find out for yourself how to soar.

Dr. Thomas Halton said...

Hey Brittany,
Thanks for the comment. I have my clients shoot for 1-2 servings of whole grains per day, focusing mainly on slow cooked oatmeal, brown rice, and quinoa. This amount will maximize the health benefits of whole grains and help to keep the overall glycemic load of the diet at an acceptable level.