The common sense, modified Paleo elimination diet

The common sense, modified Paleo elimination diet

Integrative, functional and holistic medicine all consider good nutrition to be a foundational, if not the keystone, therapeutic modality that supports optimal health and well being. Generally, the dietary approach most touted is one that is plant based and composed largely of whole foods.  Even when guided by these two fundamental principles it is still possible to be overwhelmed and confused by the variety of diets recommended by the experts, or self-proclaimed experts. Nearly everyone I engage with professionally wants to know what diet will support their health and longevity, improve energy, assist in weight loss/management, abolish chronic symptoms and/or eliminate disease. Is it Vegan, Vegetarian, Flexitarian, Pescartarian, Mediterranean, Macrobiotic, raw, gluten-free, low carbohydrate, low fat, low acid, calorie restricted, or some creative combination?

The diet I most frequently recommend, as an effective therapeutic tool, is one that I call a common sense, modified Paleo elimination diet.  It encompasses the basic tenets of a Paleo diet: whole foods, abundant plants, healthy fats, lean proteins, and no grains, dairy, legumes or processed, refined carbohydrates, including sources of simple sugars. To be more specific, this diet includes lots of vegetables, moderate intake of whole fruits, lean range fed meats, fish, eggs, nuts, seeds, nut/seed butters, other healthy fats–such as olive oil, coconut oil, avocado. Refined oils are not allowed. No legumes means no beans, peas, soy or peanuts, and yes, oats, rice, quinoa are included in the no grains prohibition. The diet does eliminate potatoes, but most advocates allow sweet potatoes. Salt should be greatly reduced. Finally–alcohol is a processed, refined carbohydrate and, therefore, should be significantly reduced, if not eliminated (see below for principles of elimination diet and reintroduction).

“Common sense” refers to my assessment that we do not know enough, yet, regarding the effects of red meat. Even organic, grass-fed and humanely raised beef contain significant amounts of heme (iron) and carnitine in their meat. There is concern that these natural attributes may possess some risk when consumed in large amounts. In addition, meat cooked at high temperatures, most notably with grilling, results in the production of cancer-causing heterocyclic amines and polycyclic aromatic hydrocarbons.  My recommendation is to not subscribe to the “cave-man” mentality exhibited by some enthusiasts who follow this diet, but rather, limit red meat intake to only a few times per month, or less.

“Modified” means that I want to make this diet work for anyone who is willing to give it a practice run. Perhaps baby steps are needed for implementation—adding one aspect of the diet at a time so it does not feel so foreign or overwhelming. Possibly understanding that occasionally diverting from the plan is not sinful, and may even provide insight into how certain foods affect one’s well being.  Or maybe someone discovers they cannot incorporate all of the principles of the diet. If they have developed an appreciation of the benefits of whole foods, plants, and the limitation of processed/refined carbohydrates (sugar), then that is a useful insight. The diet, though, is generally easily followed for at least the 4-8 week trial I recommend, especially since it enjoys an immense presence on the Internet. There are many websites and blogs devoted to the principles and practices of Paleo, along with an abundance of recipes sites. It is easy to modify a non-Paleo recipe; for example, just type in Paleo tabouli. When I did this I was greeted by at least six tempting recipes to consider. It is amazing how versatile cauliflower can be.  Of course, it is difficult, but not impossible, to be Vegetarian and Paleo. Again, the Internet can be a rich resource for attempting this lifestyle experiment.

“Modified” is also applied to the concept of using Paleo as an elimination diet. For individuals with health concerns it is usually worth addressing the possibility that some foods they are consuming may be contributing to their symptoms. An elimination diet helps to ferret out food intolerances, inflammatory load, and/or the inability to tolerate the burden presented by a frequently consumed food item. It also provides rest to a possibly stressed GI system. However, the traditional elimination diets can be onerous and unpleasant. The Paleo diet eliminates many of the major sources of food intolerances while allowing the individual to eat a balanced and varied diet. I suggest that the diet be followed for a minimum of 4-8 weeks, while keeping a symptom diary. If symptoms improve, but do not completely resolve, then the individual should pay attention to other foods in their diet that may be contributing to symptoms and eliminate them. At the end of the elimination trial, if the individual is missing a generally recognized-as-healthy food (e.g. quinoa, hummus), then it may be reintroduced—a moderate serving for two-three days (if tolerated), followed by removal of the food item for at least three days. No other new foods should be introduced during this time, and a careful recording of potential symptoms should be made. Also, attention should be paid to the quantity of the food item that is tolerated (burden), if it is added back into the diet.  If the individual wants to restore most or all of the whole foods eliminated from the Paleo diet, I do urge them to leave dairy, wheat and gluten to end of the trial. Even if an individual determines that they want to strictly adhere to the Paleo diet, it is useful to keep in mind these rules of food reintroduction, in case they run into a scenario in which consumption of a non-Paleo food is desired—such as at a restaurant or a friend’s home.

Many of us are already consuming Paleo meals, without labeling it as such. A piece of wild caught fish and two servings of vegetables, with a conscious effort to skip the bread or rice in order to reduce unnecessary calories; eggs or a breakfast smoothie with frozen fruit, almond milk, and now add some kale and nuts because your friend told you it was healthy; a large salad at lunch with cubes of left over chicken, avocado, walnuts and a balsamic vinaigrette; snacking on apple slices dipped in almond butter. I continue to be impressed by the number of people who derive benefit from this exploration in good eating–it may take some work, but it is well worth the effort. Be well.

The following is a basic recipe for Paleo bread that I found on the Internet. I have included my modifications as a way of illustrating the potential for exploring delicious variations on a theme.

Paleo Bread

1 ½ cups blanched almond flour

2 tablespoons coconut flour

¼ cup golden flaxmeal

¼ teaspoon celtic sea salt

1 ½ teaspoons baking soda

5 eggs

¼ cup coconut oil

1 tablespoon honey

1 tablespoon apple cider vinegar

Place almond flour, coconut flour, flax, salt and baking soda in a food processor

Pulse ingredients together

Pulse in eggs, oil, honey and vinegar

Pour batter into a greased 7.5 x 3.5 magic line loaf pan

Bake at 350° for 30 minutes

Cool and serve

I add a mashed banana, 2 TBSPs of hemp seed, coconut flakes, dried blueberries, cinnamon and nutmeg.

I also usually use coconut nectar in place of honey, and combine flax, sesame and chia seeds for my flaxseed meal.

I have also played with the flours–combinations of almond, cashew and hazelnut.

It needs to be a small loaf pan, and it will probably take longer to bake than 30 minutes. My loaf usually requires  around 45-50 minutes.

Ann Carey Tobin, M.D., FAAFP, is a board certified family physician. Her integrative medicine consultation practice, Partners in Healing, is located in Delmar. She can be reached at 518.506.6303, by e-mail at [email protected] or visit

Disclaimer: This information is provided for educational purposes only. Please consult a medical practitioner regarding the applicability of any opinions or recommendations with respect to your symptoms or medical conditions.

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