The Paleolithic Diet “Fat Loss & Heart Healthy Diet— So Easy A Cave Man Could Do It!”
by Dan Gwartney, MD

As a matter of full disclosure, I do watch the GEICO Insurance commercials and laugh at nearly every version. In fact, the one with Talia Shire (Rocky Balboa’s wife from the “Rocky” movies) playing a therapist represents the apex of commercial comedy in my opinion. The punch line, “So easy a caveman could do it,” suggests that the act of saving money on car insurance requires no more brainpower than discovering fire or inventing the wheel. After all, anything accomplished by the cranially challenged Neanderthal should be simple for modern man. Of course, as any blue-collar worker will gladly discuss over a draft beer, book smarts don’t get much work done. Mankind has evolved from his cave-dwelling days (whether he got there by being a hairless ape or a divinely sparked lump of clay is outside the scope of this article), graduating from taming fire to splitting the atom. Yet, despite all the knowledge and wisdom gained by walking upright for millennia, in some matters, modern man could learn a few things from his primordial ancestors.

Take for example the simple choices of what to eat. Caveman Ug and his hairy-backed clan avoided long lines at the grocery by hunting and foraging for their food, eating a healthy variety of nonprocessed foods that allowed them to live relatively free of chronic disease. Of course, they didn’t live as long as we do now, but little issues like saber tooth tigers and the Ice Age interfered with their longevity. Yet, modern man can little afford to express intellectual snobbery, as the cardinal sins of gluttony and sloth have combined to plague our generations with early death from chronic diseases and obesity.

Experts abound telling the public what to eat to be healthy or lose weight. Yet, for every low-fat expert, there is a low-carbohydrate expert. Sometimes very similar diets are called by several different names depending upon who has released a new book. Information overload may have as much to do with America’s weight problem as calorie overload.

Wisely, some experts looked at the dietary trends of healthy cultures to see what food choices were associated with a low prevalence of cardiovascular disease, diabetes or cancer. Traditional diets of Okinawa, Japan and the Mediterranean coast have long been held as examples of healthy diets. In Okinawa, a poor prefecture of Japan, the residents are known to live much longer than citizens of the United States. While a high intake of Soy and green tea consumption may play a part in the longevity demonstrated in those areas of Japan, it is likely that a lifetime of calorie deficit plays a greater role.1

The diet of the Mediterranean coast has attracted more interest, in part because it is more acceptable to the demands of Americans for flavor, satiety and food choices.2,3 The Mediterranean diet consists of whole-grain cereals, low-fat dairy products, legumes, vegetables, fruits, fatty fish, refined fats and oils rich in monounsaturated fatty acids and alpha-linolenic acid, as well as the moderate consumption of fermented alcohol.4,5 The value of the Mediterranean diet to health and weight control was a topic of discussion for scholars before three wise men rode, following a star, into Bethlehem and research continues to this day.6

Compared to the traditional Western diet, which is high in processed foods, starches and meat with high levels of saturated fat, the Mediterranean diet is associated with a much lower incidence of cardiovascular disease, obesity, diabetes and certain cancers.2,3 However, the Mediterranean diet is fairly regional and does not reflect the dietary practices of more primitive cultures that depended upon foraging and hunting rather than cultivated agriculture and domesticated stock animals.

Species adapt to their environments over generations, their structure and physiology adapting to survive the ambient conditions and food supply. Charles Darwin noted this in birds and tortoises during his time aboard the H.M.S. Beagle, which lead him to write the controversial book On The Origin Of Species By Means Of Natural Selection— this book is pivotal to explaining the theory of natural selection and supportive of evolution.7 While changes might be easily noted in fruit flies or mice, since they have such short life spans, similar changes would be difficult to record in longer living species such as man. Thus, it is unlikely that modern man’s physiology is much different from cave dwellers. Of course, in a few thousand years, that is less likely to be the case as man moves farther and farther from “natural” living due to advances in technology and a further limitation of resources as the growing population threatens to overwhelm the available food supply.

A group of researchers in Sweden sought to examine if a diet closely modeled after the diets of primitive man and aboriginal cultures would provide any health benefits to people suffering from severe cardiovascular disease.8 The subjects in this study had poor blood sugar control and abdominal obesity, several having recently survived heart attacks. The people were divided into two groups. The first received a Mediterranean diet and were given counseling about the documented health benefits associated with the diet. The second group was given a diet consisting of food choices reflecting those of primitive or aboriginal cultures (the Paleolithic diet) and taught the concept of evolutionary health promotion.9 The Paleolithic diet consists of lean meats, fish, fruits and vegetables and avoids dairy products, rice and cereals, beans, sugar, bakery products (breads and cakes), soft drinks and beer; also, the following food restrictions were advised— limit eggs (one or fewer per day), nuts (walnuts preferred), potatoes (two or fewer per day) and olive oil (one tablespoon or less per day).8,10
No limits were placed on the amount of food the subjects ate and they were allowed to choose within the respective diets however they wished. A variety of measures were taken at the beginning of the diets and after six and 12 weeks.

Both groups experienced benefits in weight loss, with a resulting reduction of waistline.8 The Mediterranean diet provided an average weight loss of 8 1/2 pounds and took a little more than 1 inch off the waist. The Paleolithic diet provided greater average benefits— 11 pounds lost in 12 weeks and more than 2 inches off the waist. Again, these changes happened without purposefully cutting calories.

The difference in weight loss was not significant between the two diets, but the Paleolithic had a significantly greater effect on waist reduction, suggesting it was particularly effective in reducing abdominal fat. Abdominal fat, particularly visceral fat, is strongly associated with insulin resistance and poor blood sugar control, making it likely that the Paleolithic diet would have a greater effect on measures of glucose tolerance and insulin sensitivity.11 In fact, when the data was analyzed, that is exactly what the researchers discovered. The Paleolithic diet, representing the foods available to primitive man during his evolutionary progress to modern man, resulted in better health and a correction of impaired glucose control in people with severe cardiovascular disease.8 The Paleolithic group experienced a significant drop in fasting glucose (blood sugar in the starved state), better handling of a large sugar load (oral glucose tolerance test) and may have improved insulin sensitivity.

In trying to ascertain if the changes in sugar control were a result of the components of the Paleolithic diet or due to the greater weight loss and decrease in waistline (which are known to be associated with better sugar control), the researchers dove deeper into the data. They discovered that the Paleolithic group ate significantly fewer calories, without being directed to or consciously dieting and that the majority of the calorie difference came from eating fewer carbohydrates.8 The Paleolithic diet ended up having a much lower glycemic load, despite a having a higher intake of fruits, much of the difference was the result of restricting cereals and dairy products.

The two diets provided almost the exact same quantity of food by weight, but the glycemic load of the Mediterranean diet was nearly twice that of the Paleolithic diet and provided approximately 400 more calories daily. Even after correcting for these dramatic differences between the diets, the effect of the Paleolithic diet on sugar control was still significantly greater than the Mediterranean diet. This suggests that the human body experiences a correction of a disrupted physiologic balance when provided with a diet closer to that which was present during the course of natural selection. Even the known health benefits of the Mediterranean diet were improved upon in this limited study. It remains to be seen if these results are confirmed in a larger study. Also, it would be interesting to see if certain elements of the Mediterranean diet could be added to the Paleolithic diet to provide greater or additional benefits, such as the inclusion of monounsaturated fats (olive oil) or limited amounts of dairy products such as yogurt.12-14 Mankind has left the shadows of the caves and now travels amongst the clouds and stars. Yet, in the rush for advancement, certain lessons have been left in the past. This study should stimulate further research in the concept of evolutionary health promotion and encourage people looking to improve health, bring in the belt line or possibly improve their body composition through better blood sugar control to adopt the dietary practices of our primitive ancestors. This does not mean that all progress should be ignored. The invention of soap and deodorant are good things. Also, please save the tiger-skin loincloths for private moments at home.

1. Willcox DC, Willcox BJ, et al. Caloric restriction and human longevity: what can we learn from the Okinawans? Biogerontology, 2006;7:173-7.

2. Ordovas JM, Kaput J, et al. Nutrition in the genomics era: Cardiovascular disease risk and the Mediterranean diet. Mol Nutr Food Res, 2007;51:1293-9.

3. Serra-Majem L, Roman B, et al. Scientific evidence of interventions using the Mediterranean diet: a systematic review. Nutr Rev, 2006;64(2 Pt 2):S27-47.

4. Ortega RM. Importance of functional foods in the Mediterranean diet. Public Health Nutr, 2006;9:1136-40.

5. Simopoulos AP. The Mediterranean diets: What is so special about the diet of Greece? The scientific evidence. J Nutr, 2001;131:3065S-73S.

6. Papavramidou N, Christopoulou-Aletra H. Greco-Roman and Byzantine views on obesity. Obes Surg, 2007;17:112-6.

7. Darwin C. On The Origin Of Species By Means Of Natural Selection. John Murray, London, 1859.

8. Lindeberg S, Jonsson T, et al. A Paleolithic diet improves glucose tolerance more than a Mediterranean-like diet to individuals with ischaemic heart disease. Diabetologia, 2007;50:1795-807.

9. Eaton SB, Strassman BI, et al. Evolutionary Health Promotion. Prev Med, 2002;34:109-18.

10. Eaton S, Konner M. Paleolithic nutrition. A consideration of its nature and current implications. N Engl J Med, 1985;312:283-9.

11. Fox CS, Massaro JM, et al. Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study. Circulation, 2007;116:39-48.

12. Fito M, de la Torre R, et al. Olive oil and oxidative stress. Mol Nutr Food Res, 2007;51:1215-24.

13. Carluccio MA, Massaro M, et al. Vasculoprotective potential of olive oil components. Mol Nutr Food Res, 2007;51:1225-34.

14. Kiessling G, Schneider J, et al. Long-term consumption of fermented dairy products over six months increases HDL cholesterol. Eur J Clin Nutr, 2002;56:843-9.