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Thursday, April 21, 2016

Paleo meat meets modern reality

The Oldways Common Ground conference I was privileged to co-chair with Walter Willett last November had no shortage of riveting moments, as the recent posting of conference videos reminds me. But one really stood out.

Boyd Eaton is arguably the founding father of our modern understanding of, and preoccupation with, the Paleolithic diet. He shares credit with a very short list of others, among them his frequent co-author, Mel Konner. But there is no question that Boyd is on that short list. You can be confident that whoever provides you guidance on the Paleo diet concept gets their guidance from someone who gets their guidance from the work of Prof. Eaton. His work is all but universally recognized as part of the bedrock of our understanding.

What stood out, then, was Prof. Eaton's call for people to eat less meat. Not none, necessarily, although that's an option; but considerably less.

Let's be clear, Prof. Eaton is in no way “anti” meat. He readily acknowledges his own taste for it. He feels that all humans share that taste, whether they choose to indulge it or not, or even acknowledge it. And, he argues, rightly, that we are constitutionally, adaptationally, physiologically omnivorous.

But after allowing for all that, Prof. Eaton says, in essence: too bad! There are two basic reasons for his position, one the lesser, one the greater.

The lesser issue is the nature of the meat in question. That mammoth is no longer a choice is a given. Is modern meat like the meat our Stone Age ancestors ate?

The work of Prof. Eaton and his colleagues provides a very clear answer: not much. I have noted before that people routinely wave the “Paleo” banner as an excuse for eating pastrami, and that's baloney. Prof. Eaton agrees. For the rather dramatic nutritional and compositional differences between the modern meat that prevails, and the meat our Stone Age ancestors are thought to have eaten, I refer you to Dr. Eaton's original papers.

Those trying to have their side of beef and eat it, too, often talk about narrowing the gap between modern meat, and the kind of meat we “should” all eat. Pure meat. Ethically raised, free to range, well fed, organic, and all that. The trouble, of course, is that there simply isn't enough free range on the surface of the planet to raise enough animals that way to feed 8 billion quasi-carnivores. Mass production conspires against all of the very methods the “as long as it's pure” crowd espouses.

So, if you advise everyone to eat meat, but then add provisos about the purity of the meat, only one of two things can ensue. Either everyone ignores you, in which case your advice was rather pointless. Or people listen, in which case the demand for meat you've now fostered decimates the production methods you claim to favor. The production methods that supplant them give us meat nothing like that of our Stone Age ancestors.

The greater reason is, quite simply, the global human population and its impact on the planet. The Stone Age was home to scattered, isolated bands of Homo sapiens. There are now ever closer to 8 billion of us. Prof. Eaton states quite categorically that 8 billion Homo sapiens cannot have a meat-centric diet without ravaging the Earth; period.

This by no means makes our Paleolithic adaptations irrelevant; they still help define who we are, and inform what we need. Prof. Eaton's papers present estimated intake ranges for many nutrients, which may provide guidance toward optimal levels by clarifying native levels.

Dr. Eaton commented to me that the Paleo model advocates a higher protein diet than do many nutritionists, especially for children and teenagers, at least until full height is attained. There is lively debate in this area, in part because what was optimal for a physically demanding, 4-decade life span may or may not be so for a generally less strenuous but far longer life. Either way, Dr. Eaton goes on to say that we should get our protein, at whatever level, predominantly from plant sources now. (He noted in addition that the very well planned meals at the Oldways conference proved to him how delicious a plant-based, high protein meal could be.)

All too often, discourse on diet devolves into ideology when it should be bound to epidemiology. All too often, we approach dietary proclivities with nearly religious fervor, and fail to separate church and plate. All too often, some label like “Paleo” ignites fierce passions, and our imaginations, and we follow both into fantasy land. This is a reality check, from a uniquely qualified authority.

The modern reality is that we aren't in the Stone Age anymore. We can certainly learn from our Paleolithic experience, but we cannot replicate it in the 21st century, among our billions, and Tweet about it. When one of the world's foremost authorities speaks out on the implications of that, everyone waving the Paleo banner should set down their smartphone for a moment, and pause to listen.

This column was reviewed and approved by Dr. Eaton before publication. Both Dr. Eaton and Dr. Melvin Konner are members of the Council of Directors of the True Health Initiative.

David L. Katz, MD, FACP, MPH, FACPM, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care. He is a board certified specialist in both Internal Medicine, and Preventive Medicine/Public Health, and Associate Professor (adjunct) in Public Health Practice at the Yale University School of Medicine. He is the Director and founder (1998) of Yale University's Prevention Research Center; Director and founder of the Integrative Medicine Center at Griffin Hospital (2000) in Derby, Conn.; founder and president of the non-profit Turn the Tide Foundation; and formerly the Director of Medical Studies in Public Health at the Yale School of Medicine for eight years. This post originally appeared on his blog at The Huffington Post.

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Blog log

Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Auscultation
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

DrDialogue
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

FutureDocs
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

KevinMD
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

Prescriptions
David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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