- Sarah’s new book and bringing scientific validity to the Paleo movement and
- Feeling empowered to experiment; a diet shouldn’t be a set of rules
- Learning to listen to your body and how it reacts to certain foods
- Where is all the research for Functional Medicine and the Paleo diet
- Fact checking and pseudoscience; not all articles published are fact!
- Why all diets (including Paleo) have a tendency to fall short in certain nutrients
- Food is not the only input to health
- Paleo Principles: The Science Behind the Paleo Template, Step-by-Step Guides, Meal Plans, and 200+ Healthy & Delicious Recipes for Real Life, by Sarah Ballantyne
- Why coaches are critical
- What a health coach does (and doesn’t do)
- How to know if this career is a fit for you
- The critical skills every health coach needs
- How to make a living as a coach
- What new opportunities exist for coaches
Sarah’s new book and bringing scientific validity to the Paleo movement
Sarah: You have to get used to eating a hamburger without the bun, and that's just too big of an ask for people, right? Chris: Right, right, absolutely. Sarah: I believe that was literally in the write-up last year, and I cannot tell you how many times I rolled my eyes. [laughter] Chris: Yeah. Yeah, and it's really interesting. It's so-called "science journalists," I'm doing air quotes now ... [laughter] Sarah: Yes.Empower your food choices with knowledge—Sarah Ballantyne shows us howChris: Don't even bother to spend one second looking in the scientific literature to determine if there is actually any support for the Paleo type of diet. Now, fortunately, we have people who have done that, such as yourself, and your new book, Paleo Principles, is a really deep dive into the science that supports nutrient-dense Paleo type of diet. Of course, both of us have written a lot about this over time, but was that your motivation for doing this book? Tell me a little bit more about that. Sarah: It was 100 percent. So I pitched this book to my publisher, and you've seen it, so I wasn't just pitching, I wanted to write the heaviest Paleo book; that wasn't what I actually set out to do. Chris: That wasn't a cookbook. Sarah: I didn't go, "Hey, publisher, I would like to write the heaviest." What I said is, "I wanted to write the book that brings scientific validity to the entire Paleo movement," which is an ambitious statement, but I was so frustrated reading these various critiques of Paleo, some of which have such a distorted understanding of the main tenets of Paleo to begin with, so they're criticizing a diet that doesn't even resemble how most of us eat, so that's frustrating in a different way. But then reading over and over again these articles that equate Paleo to zero-carbohydrate diets, all-meat diets, ketogenic diets, it's not the same thing, and there's some overlap in the approaches, and you can combine approaches, but Paleo, by itself, is not those things. And then you got the ... There's no science to support, there's only a handful of small clinical trials, and you can't put any stock in that, or there's the lack of evidence, the ... I almost feel like there's more than one group of people that I feel like I'm constantly talking into, like, "Can we just have this conversation about nutrient density and nutrient sufficiency? Number one, can we talk about compounds in foods that are inherently anti-inflammatory versus compounds in foods that are inherently inflammatory?" And I feel like I'm butting up against plant-based diet people, and then this very, very stuck in, “You have to eat foods from all the food groups,” and this ... Chris: That "We'll die if we don't eat whole grains" argument of nutritionists, dietitians.
Feeling empowered to experiment; a diet shouldn’t be a set of rules
Sarah: And so, I feel like when I'm talking to those groups of people, the only way to break through their very set opinions is to present a really robust scientific argument. And so that's one of the reasons why you and I have gotten along so well [chuckle] for so long because I know you do the same thing. But it's one of the reasons why the articles on my website are always thoroughly researched with citations and always present ... It's really important to me to present the current state of evidence in science, which is different than saying, "This is the way it is." Because we don't actually know everything. We're still researching various topics. And there's aspects of Paleo for which the evidence is really, really strong, and there's aspects of Paleo where it's a little bit more nuanced, and there's a more detailed conversation to have surrounding those particular foods. And I really feel that it's very important to present that to not just naysayers, but also people who are trying to use Paleo to reach their health goals, because I think that it's really important to empower people with knowledge and to admit the current bounds of human knowledge. Because that's the only way that we can continue to adapt and refine is if we can say, "Now," admit upfront. [chuckle] Traditionally prepared lentils is kind of a gray area. There might be some real benefits to this food for a lot of people. Maybe we shouldn't demonize it with soy. I think it's really important to have those more detailed conversations upfront so that it allows us to adapt as we learn more but also empower people to experiment with themselves as individuals and really understand their own optimal diet. Chris: Right. I so agree, 100 percent. And there's so many things came to mind there, I was jotting a couple of them down. [laughter] There's so many directions we could go. One is, I think just expanding the conversation around diet to move away from this idea that there's one diet that is great for everybody. And I think legumes are a perfect example of that because, certainly, you know and I know from my work that for some people, legumes are a really bad idea and are gonna cause a lot of problems. And people that come to mind, there are people with GI issues, FODMAP intolerance, autoimmune issues, in some cases. Whereas for other people, lentils and particularly the fermentable fiber that they contain might be really perfectly fine in the context of an overall nutrient-dense diet. So, I feel like that's something that is changing but needs to continue to change because if you look at even the concept of having the top diet, a list of top diets [chuckle] that US News & World Report publishes, implies that we can just find one diet that's gonna be best for everybody. Sarah: Well, and that's one of the reasons why I try very much in all of my writing, and I've tried very much in Paleo Principles, was to get away from trying to distill the Paleo diet or any other variation of the Paleo diet into a set of rules. And I really feel like that's one of the things that all of these other [chuckle] diets do. Right? They give you your "Eat this, don't eat this" rules, "measure this, count this" whatever it is. And I feel like that sets us up for two problems: One is that many human beings are sort of inherently rule breakers rather than rule followers, and I like to draw the comparison of speeding limits [chuckle] because I think there's a large percentage of the population that doesn't always drive the speeding limit. And maybe you're only going five miles an hour over, or 10 miles an hour over, and you're staying a belief in that threshold that would get you a ticket if you drove past a speed trap, but you're still pushing that rule, right? You're still trying to figure out your way around it. And I think we approach diet in very much the same way. When you just say, "This is what I'm supposed to eat and this is what I'm not supposed to eat," it sort of sets us up for rebellion, for trying to find the wiggle room, the cheat meals, whatever it is, and I think that does us a disservice because when you don't really understand the reason behind the rules, it makes it a lot harder to respect those rules. And I think you could make the same argument for a really windy road with a low speed limit, and you say, "Well, look, these corners are so tight that if you take it beyond the speed limit, you can go over the edge of the cliff," and all of a sudden people are driving the speed limit on that road. So, I think that if you can provide a broader education behind the rules and get into, rather than a dogmatic, rule-based approach, start talking about an educational foundation that informs choices and allows people to really understand, "Okay, so if I choose this food instead of this food, this is the impact it's going to have on my body." And that's separate than being perfect. It doesn't mean that we're gonna make the best choice every time, but it empowers our choices with knowledge, so that we have this deeper reasoning for doing something rather than just, "I know I'm supposed to," or "I know I'm not supposed to." I think that really is key to being able to effect a change in the chronic illness landscape right now because I think so many of us ... If you don't really understand why pizza and ice cream are not supporting your health, but you know they taste really good, you know you're not supposed to eat three meals of pizza and ice cream a day, but why not? Because, hey ... If you don't really understand what that's doing to your body, I think it's a lot easier to make the easy tasty choice as opposed to when you do understand what's going on. And then that translates to exactly what you're talking about, the getting away from one diet because you start to say, "Well, look, here's the main ideas that mean that this food is a better food than this food." It's nutrient density versus presence of compounds that might undermine your health in some way. And the thing is, is not all foods are black and white. There's these awesome foods that have tons of nutrients and nothing problematic in them, and then there's foods that have almost no inherent nutritional value and tons of problematic compounds, but most foods fall somewhere in the spectrum in between. So, where do you draw the line? And if you have this detailed understanding of what's in that food that is going to hurt you or harm you, then you can figure out where the line is for yourself. And then you can experiment on yourself and figure out, "Well, are the saponins and glutenins that are not completely deactivated by soaking and cooking in lentils, is that enough to be too much of a problem for me personally with my health history, and with my particular health challenges and health goals, compared to the incredible fiber density of lentils, and also the mineral density of lentils?" If I put this on a scale of pros and cons, that scale has to be informed by my personal health, everything. So then I'm gonna be able to decide, "Does this make it into my diet or not?" Because I really understand the decision in this detailed way, and it's one of the reasons why I've tried to really steer clear of even defining Paleo as we eat all these things and not these things.Learning to listen to your body and how it reacts to certain foods
Chris: Right. That is part of what we're struggling against as practitioners is we live in a culture where that kind of awareness of how things we put into our body impacts us is not cultivated or encouraged, and in some ways is discouraged. So many people don't ... They're not taught that or they're not helped to develop that as a kid, and then when they're adults, that software [chuckle] has not really been installed. And so, sometimes I've found that even if I say something like, "Pay attention to how that affects you," sometimes they get a blank stare like, "What do you mean?" And then I have to actually spell it out like, "Okay, so you're looking for any new symptoms, you're looking for an exacerbation of your current symptoms, you're looking for uncomfortable sensations in your body." It all sounds pretty elementary, but so many of us have not been supported in developing that kind of awareness. So I think that's one obstacle and one reason why people just want to be told what to eat and not to eat. The other thing is, it's much easier in some ways to just follow a prescription than it is to pay attention and determine what's happening based on what you're eating, and that's not always easy too. You and I both know if you eat something for breakfast and then you feel worse after lunch, was it because of what you ate for lunch or what you ate for breakfast? Sarah: Or what you ate four days ago. [chuckle] Chris: Exactly. Sarah: Right. Chris: So the food journals and stuff can be helpful, but it's not just that most of us haven't been supported to develop this awareness, it's that it's actually quite hard to do. So I think those were some of the obstacles. Sarah: There's so many ... There's so much signal interference from refined and manufactured foods as well, which I think makes the ... I come from a history of morbid obesity and binge eating disorder, so I'm very familiar [chuckle] with the complete ineffectual aspect of listening to your body. My body says to eat all this ice cream. I don't understand what your body says. [chuckle] Chris: Right. "What are you talking about?" Sarah: This is what my body says! And so, part of my personal health journey has been in part getting better in tune with what my body is actually telling me, but it's also been detoxing from those foods that were clouding out the signals from my body. And then in some ways, letting my brain override some of those signals. So, I still ... Even six-and-a-half years into Paleo from ... Binge eating disorder is a mental health problem, and so I will still sometimes have compulsion-to-eat-type sensations, and I have to think my way through it. It's not strong, like it's not ... It's something that in the olden days I wouldn't have been able to resist, when that compulsion to eat would come, that would be a main driver of my behavior. And now it's something that I can acknowledge and find a healthy something to satisfy that compulsion that's not going to derail me. But it's still something that will hit me from time to time, and I have to use my brain to go, "No, I'm not actually hungry right now." I know I feel like eating, but it's not ... Like this is the brain part, not the rest of my body talking. And that's been a really hard part of my personal health journey because it's required so much consistency in order to get to a place where I have a better relationship with food and a better understanding of my body's signals and what signals are real and which ones can just easily be ignored. Chris: Yes. This is a subject probably for a whole other podcast. So I'm gonna pause here, and I wanna actually move back a little bit to research, given that it's been such a big focus for both of us. When I was writing my book, my most recent book, Unconventional Medicine, and I was talking about Functional Medicine, one of the biggest critiques of Functional Medicine, just like Paleo, is that it's not evidence-based, or there's no research for it.Where is all the research for Functional Medicine and the Paleo diet?
Sarah: Again, I'm rolling my eyes. Chris: Yeah, again, eye roll, of course. But one of the reasons for that is if you go to PubMed and you search, which is, for people who are not familiar, it's a database of studies that have been published. And if you type “functional medicine” into PubMed, you get nothing. You're not gonna see a list of papers all supporting Functional Medicine. Does that mean that there's no research on Functional Medicine? Absolutely not. Functional Medicine is a paradigm. It's a framework. It's a way of looking at things. And so if you use an example like irritable bowel syndrome, a Functional Medicine approach to irritable bowel syndrome involves looking at the underlying causes like SIBO or parasites or disrupted gut microbiome or gut–brain axis dysfunction, things like that, instead of just looking at how effective is using drugs to suppress the symptoms. So if we wanna go into PubMed and search for Functional Medicine evidence for irritable bowel syndrome, you look for a connection between SIBO and IBS, you look for a connection between disrupted gut microbiome and IBS, you look for a connection between nutrient deficiencies and IBS, and every one of those studies that you find, which you will find many of, support Functional Medicine, but none of them are gonna have the term “functional medicine” in them. Sarah: Well, and much of the research that I draw on to support the Paleo diet, it's a very analogous situation ... Chris: That's what I thought. Sarah: Because it's not ... These are randomized, controlled [chuckle] cross-over, triple-blinded clinical trials with 10,000 participants of “these people go grain-free and these don't.” I mean, you just can't do that in a blinded fashion, period. But it's more the studies, and it's not even always human studies, although those are always wonderfully informative when we can get them, but it might be a cell culture model study that looks at gliadin fragments that we know are predictably formed in our digestive tract because the gliadin fraction of gluten is not very compatible with our digestive enzymes, so it's broken apart in very predictable locations and it creates these very predictable peptides of gliadin that have biological activity in everybody. And so it's a study that looks at some type of epithelial cell in a cell culture system, puts gliadin on the surface of that cell, and then measures how much gets to the other side, and then maybe does some really cool imaging looking at tight junction formation. And then you can say, "Oh, wow, look at this amazing study that showed that this particular gliadin peptide actually signals through calcium mobilization inside the cell and unraveling of the tight junction, which increases the permeability of this epithelial cell layer in a cell culture system." And, yeah, you still need to take that mechanistic information and go, "Okay, so in a live digestive tract, is the same magnitude of an effect seen compared to a mono-layer of epithelial cells in a cell culture system?" But that type of mechanistic data is what supports animal studies, which is then what supports human studies, and you can draw a really amazingly detailed and complete picture drawing on tens of thousands of studies that each look at these little tiny pieces of the problem. And then when you ... You put that all together and you say, "Well, look, I take this completely contemporary biology approach to Paleo." So I think evolutionary biology is fascinating, but all of my arguments for what to eat and what not to eat come from really understanding the impact at the cellular and molecular level of compounds in foods. And you can create this exact same picture, it comes out to pretty much Paleo by just taking that approach going through the scientific literature. And then it's supported with this now quite impressive growing collection of clinical trials where they take people and put them on a Paleo diet and measure improvements and various markers of health over time. So I think that it's going to be great to be able to add to this clinical trial evidence, but there's so much evidence there now. And it just takes a... I mean, it takes a person who loves spending hours upon hours in PubMed. [chuckle] But it takes somebody to take all those pieces of the puzzle and put them together for people. And that's not really a job that exists out there right now. It's not like there's a group of scientists whose job it is is to look at everybody else's science and make the big picture and then give that to the science writers. That's not currently a thing. So we feel so dissociated as average people from the medical literature just because of that lack of big-picture communication. Chris: Yeah, and that's why people have turned to bloggers because ... I mean, one of the consequences of the new media, internet, social media over the last several years ... We often forget, like Facebook's only what, 10, not even 10 ... Is it 10 years old? Nine years old or something? [chuckle] It's like ... Sarah: I think it's like 11 now, because I think I started in 2007.Fact checking and pseudoscience; not all published articles are facts!
Chris: Yeah, so it's like life after Facebook and life before Facebook ... I don't personally use Facebook, but it's had a profound impact, and not just Facebook but media and blogs and everything. And so newspapers ... It's kind of amazing that there still are newspapers in some way because it's so fragmented now. And one of the consequences is that newspapers had to really downsize, and traditional media outlets had to really downsize in order to survive. And the first thing that they downsized was investigative reporting and reporting by people with the deeper kind of reporting that would happen with true science journalism. So what you have now is people who are not trained in science filling the role of science journalists, and they just take stuff off of the wire, and there is no analysis at all to determine if it's legitimate. There's no critical thought process to go through the process that you just took us through in terms of thinking about a study and the specifics of it and how that can be related to a nutritional approach. And so we just get like a really glossy, superficial, and sometimes just outright wrong interpretation of what's happening in the scientific literature. Sarah: Well, it's one of things that I find so frustrating because there's a lot of different steps. So if you look at a website that does more science-based articles, they're typically getting their articles from press releases or they're getting their articles from bloggers, other websites that have already written something. And I get very, very frustrated when science is misrepresented, especially when it's misrepresented just to get a headline. That to me is just so, so frustrating. But it also ... The combination of that misrepresented science in what would be more sort of considered mainstream media, and the combination between that and the ... I mean, I love the internet, it's an amazing thing, but there's zero quality control. And so there's also this collection of people who write articles, the pseudo-science. So the, "I'm gonna write this in a very technical way, so you think I'm smart, and I'll throw a bunch of scientific citations at the bottom," but meanwhile it's actually just complete nonsense in those articles. And it makes it so that the consumer of information has to be so well-educated to be able to do their own quality control. They have to be able to read through these things and go, "Well, this person is reputable and always does great work. This person is just trying to get my dollar. And this article based on this paper is well representative of the work and this one isn't." It's tough for an average person. Like for me, I can get into the technical language really quickly and I can dive into the medical literature really easily, that's my background, and it can still be time-consuming, but it's not a super effort for me because it's a language that I speak so fluently. But for most people, it's really tough to be able to discern good information versus bad, which means that those of us who put so much effort into producing good information, sometimes our messages can get diluted with just the volume of stuff out there on the internet. Chris: Yeah, that's a huge pet peeve of mine too. I would say, right up there is just the laziness. Like I said before, it just drives me nuts when people don't take one second to go to PubMed and do a search. I mean, I'm not talking about general public, I'm talking about journalists, so-called science journalists. I don't expect the average person to go to PubMed and search. Sarah: But even health bloggers, if you're going to be contributing to this field and writing articles that maybe a media outlet is gonna pick up, the fact-checking is a great thing to do. Chris: Absolutely. So I mean, an example of that would be, if you say there's no research supporting the Paleolithic diet, why not ... Independent of everything we've said already that's like, you can't just look for studies that have the words "Paleolithic diet" in them because you're gonna miss nine-tenths of what's out there or more, actually probably more like 98 percent of what's out there. Sarah: Yeah.Why all diets (including Paleo) have a tendency to fall short in certain nutrients
Chris: But can you at least go and search for “Paleolithic diet”? [chuckle] I mean, that doesn't take long. And if I do that right now, I'd see that there's 198 search results. So not all of those necessarily are favorable, but the vast majority of them are, actually. There aren't many studies in that group if you scroll through the list, and even if you just read the abstracts that are showing harm from Paleo or no outcomes, no benefit. Sarah: Yeah, I mean there's zero studies showing harm from Paleo. There's a couple of studies showing ... Chris: There's one. Sarah: Oh! Is there one? Chris: Iodine deficiency over two years of people on a Paleo diet, but there's also ... Sarah: Oh, I'm gonna have to look at that one. Chris: Also iodine deficiency in the general population. So it's hard to say if that's specific to Paleo. And it's also quite easy to resolve. I've always recommended people consuming some sea vegetables and fish, and other types of foods that have iodine, but ... So if that's the only thing, you're doing pretty well. Sarah: Right. Well, and I think the other aspect of that is within every dietary framework, there are certain nutrients that tend to fall short. And of course, the Standard American Diet, it's like 90 percent of nutrients tend to fall short. And Paleo basically outperforms every other diet in terms of nutrient sufficiency, but there are still a handful of nutrients that if you're following a standard Paleo diet of meat and vegetables and some coconut oil, [chuckle] you have a higher likelihood of missing out, and it's not just iodine; we can fall short on calcium, we can fall short on biotin, we can fall short on magnesium, there's a collection of nutrients. And as soon as you combine Paleo with what I call a nutrient-density focus, so incorporating more seafood and sea vegetables, eating a very high vegetable content, so I recommend eight servings or more a day of vegetables as part of ... That's how I define the Paleo diet, is that it's a vegetable-rich diet, incorporating some organ meat. As soon as you start to think about these nutrient powerhouse foods as the basis even of the Paleo diet and rounding out with the filler foods, like fruit, [chuckle] round out with those things, then you very, very quickly nullify any potential arguments against Paleo for not supplying sufficient nutrients. Meanwhile, even if you don't have that amazing focus on nutrient-dense foods, you still outperform every other dietary framework [chuckle] in terms of nutrient sufficiency.Food is not the only input to health
Chris: And anti-inflammatory ... The facts and just avoiding most of the foods that we know are responsible for the chronic disease epidemic, really. [chuckle] It's so much about what's not there, too. There's ... When we look at traditional Paleo diets, I know you're not necessarily covering the evolutionary perspective in the book, but what's so notable about it, to me, is there were a lot of differences depending on geography and food availability and things like that, but there were common threads in all of those cases of what they weren't eating, and I think that makes a big difference, too. Sarah: And I think there's common threads, not just so ... I mean there's common threads in terms of inflammatory foods that are not part of their diet. There's common threads in terms of nutrient sufficiency. But there's also common threads in terms of the lifestyle aspects, and that's one of the things that is so powerful about Paleo, especially now that it's no longer just a diet or a diet plus CrossFit. Right? It's now a template for living. It's a framework that informs your food choices, but then it's also a focus on stress management and a focus on adequate sleep and active lifestyle and community. And these things have become so ingrained in how we define Paleo that I think it's really powerful because we know that food is not the only input to health. It's not the only factor. And so if we can combine these other really important aspects of healthy lifestyle, I think we've got an even more powerful argument that's an evidence-based argument in favor of this approach. Chris: Absolutely. So I want to thank you personally for doing this book. I am ... It's a much-needed resource, and I'm just going to ... If anyone ever says there's no science to support this approach, I'm just going to send them a link. [laughter] That will be my solo comment. Sarah: And all 1,400 references. [chuckle] Chris: I'm just saying, "Okay, read this, then if you want to have a conversation, we can have a conversation. But until you have educated yourself and you're speaking from a place of knowledge and understanding, then it's not even worth going there." Sarah: Well, thanks. [chuckle] Chris: So the book is Paleo Principles, by Sarah Ballantyne. It's on Amazon. All five-star reviews, which doesn't surprise me at all. And, yeah, what are you working on next? I know you've always got something cooking. Sarah: Yeah, I do. I'm actually working on another book. Chris: No, no way. [chuckle] Sarah: I am. Well, to be fair, I started this book two books ago and I got distracted by two books. This is one that I started a few years ago and I feel like I owe it to my publisher to finish it. So it is a gut health-focused book that is penciled to come out probably in the fall this year, if I can stay healthy and motivated [chuckle] to keep working on it. And then I'm definitely planning on a book break because they're quite draining projects to work on. But yeah, I always have ... I'm one of those people who always has way too many ideas and not enough time to see them all to fruition, so I'm definitely not bored. Chris: Yeah, I wouldn't expect you to be at this point. [laughter] Chris: Well, thanks for coming on, Sarah. It's always a pleasure to talk to you. And everybody, go check out ... Get yourself a copy of Paleo Principles. It's an amazing resource. If we were doing video, you could see it on my bookshelf here behind me. Very few books are in a place on that shelf because it's ... There's a limited amount of space, and I want to make sure that what's there is [chuckle] pulling its weight in terms of its reference value, so ... Sarah: Aw, thank you again. Chris: It's great to have quick, easy reference. I've got many of those studies somewhere in my files, but again, I want to thank you for putting those all together in one place. It's such a valuable service to the community. Sarah: Thank you, Chris. That means a lot to me. Chris: Okay, everybody, thanks for listening. Send in your questions to chriskresser.com/podcastquestion, and we'll talk to you next time.from Chris Kresser https://chriskresser.com/debunking-paleo-diet-myths-with-sarah-ballantyne/
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