Pros and Cons of the Paleo Diet

The paleo diet is designed to take your meals back to the caveman days. You’ll fill your plate with lots of meat, seafood, vegetables, nuts, and fruit – while skipping over any grains, dairy, or legumes.

Shifting from a Western diet high in packaged convenience foods to a paleo diet grounded in home cooking and unprocessed foods has several benefits. You may lose weight and improve your heart health.

However, the elimination of many food groups may not be a nutritious choice for all people. The diet is also costly and time intensive. Those factors can make the paleo diet challenging to follow long term.

Pros

Rich in Nutrient-Dense Foods

It's only natural that when less-nutritious foods are restricted, you'll turn to healthier options to fill your belly. The paleo diet emphasizes many nutrient-dense foods like:

• Vegetables - provide fiber, vitamins, and minerals
• Fruits - act as a naturally sweet treat and packed with phytochemicals
• Nuts - fill you up with healthy, satiating fats
• Seafood - packed with protein and omega-3 fatty acids

Weight Management

The paleo diet can certainly lead to weight loss if there is an overall calorie deficit, similar to any other type of diet. Indeed, evidence suggests that implementing a paleo diet leads to reduced body weight, waist circumference, and BMI.

Interestingly, an observational study published in 2019 found those following a paleo diet actually tended to have a higher BMI and rates of obesity compared to other people. These differences are likely due to the type of study.

In randomized controlled trials, those who are placed on specific paleo diet guidelines may experience weight loss. They are given specific rules for short term periods of time.

In observational studies, on the other hand, people are simply implementing their perception of the diet on their own without guidance. These folks may practice a less-than-ideal paleo meal plan, which might explain the differences in weight.

For example, just a quick glance at Pinterest displays endless recipes for paleo-friendly brownies, cakes, cookies, and more. Though they are made with nut-based flours and honey instead of all-purpose flour and sugar, merely adapting Western-style indulgences to paleo-friendly treats is not likely to result in weight loss if these are consumed in excess.

Cardiovascular Health

A 2019 meta-analysis in Advances in Nutrition linked the paleo diet to lower blood pressure, LDL cholesterol, and triglycerides. However, the authors warned that this is based on a small number of studies and that a few studies may have skewed results – so this should be interpreted with caution.

Longevity

In 2017, when researchers compared people whose diets most closely matched the attributes of a Paleo diet to those whose diets least matched, they found a lower risk of all cause mortality, cancer mortality, and cardiovascular disease mortality.

Keep in mind, this could easily be explained by a higher overall diet quality between the groups. Certainly, a group that eats more vegetables and less processed foods will likely experience better health outcomes – regardless of if they follow a Paleo diet or not - compared to a group with minimal produce and high processed food intake.

Possible Benefits for Patients with Multiple Sclerosis?

A modified Paleo diet has been widely promoted for patients with multiple sclerosis. The modified version follows many tenants of paleo, such as the elimination of most grains and dairy. However, this version adds an emphasis on eating nine servings of fruits and vegetables daily and calls for a somewhat lower intake of meat and fish.

A 2014 study examining this modified diet in conjunction with supplementation, muscle stimulation, exercise, and self-massage found a reduction in fatigue and an increase in quality of life among those with progressive MS.

However, there are many limitations to this research – the study did not include a control group, it was only completed by 6 people, and multiple interventions (diet, exercise, etc) were conducted at once making it impossible to tease out the role of the diet.

A study in 2017 looked solely at the effects of a modified Paleo diet on individuals with relapsing-remitting MS. Though the study was small, they did find improvements in fatigue and quality of life in the Paleo group compared to the control group.

This data is certainly limited and should be interpreted with caution - we can't draw conclusions based on two small studies, and of course, a restrictive diet always also carries some risk. Hopefully, though, future studies will further investigate if there are true benefits to a modified Paleo diet among people with MS.

Cons

Eliminates Food Groups

The paleo diet eliminates major food groups like grains and dairy, and cuts out other nutritious foods like beans, lentils, and peanuts. Though it’s still possible for you to meet your nutritional needs without these foods, it’s more challenging to do so. For example, you’ll need to prioritize other sources of calcium when you cut dairy from your diet.

In addition to this, unless you have a medical reason to remove these foods (like a food intolerance) – there’s no scientific evidence that suggests eliminating them benefits your health.

Unclear Impact on Gut Microbiome

The species and amounts of good bacteria in your digestive system – otherwise known as your gut microbiome – can be changed by altering your diet. Traditional hunter-gathers like the Hadza tribe were shown in research to have a greater microbial diversity compared to standard diet controls. Theoretically, this seems like a win for paleo proponents. 

However, this group is thought to consume upwards of 100 grams of fiber a day – far less than those on the paleo diet consume in our society today. By eliminating whole grains from on a paleo diet, it can actually be more challenging for people to meet the current minimal fiber intake of 25 grams per day for women and 38 grams per day for men.

Indeed, research in 2019 showed that shifting to a gluten-free diet – one pillar of the paleo diet – actually reduced healthy gut bacteria and increased unhealthy strains. Eliminating fiber and polysaccharides in grains may hurt, rather than help, our gut microbiome.

Small Risk of Iodine Deficiency

Though somewhat rare in the US, an iodine deficiency can lead to alterations in thyroid hormones and can cause the formation of a goiter.

Table salt has been iodized to prevent these issues since the 1920's - however, some paleo proponents advocate that people use alternatives like pink Himalayan salt, which contains less iodine. The paleo diet also eliminates one of the largest sources of iodine in the diet – dairy products.

Extremely stringent paleo followers may risk inadequate iodine intake, though this can be mitigated by eating lots of fish, shellfish, and sea vegetables.

Costly and Time Intensive

Because this diet eliminates processed foods, you’re going to need to make most meals from scratch. While that’s a healthy habit, it does take extra time. Meal planning and prepping can help with this.

In addition, cutting out inexpensive staples like whole grains and beans means your grocery bill might rise. Similarly, following the stricter guidelines for meat and fish (i.e. grass-fed beef; wild-caught fish) can be far pricier than conventional counterparts. Indeed, studies comparing Paleo diets to standard nutrition recommendations have found a greater cost to sustain this diet.

Difficult To Follow Long Term

Just like any other diet that eliminates major categories of food, the paleo diet can be difficult to sustain long-term. Do you really want to skip out on cake on your birthday, or miss your Grandma’s famous mashed potatoes at Thanksgiving?

Instead, you can always consider following a modified version of this diet, where you embrace the healthy tenants – like eating more produce and limiting added sugar – but also allow yourself some grace to sometimes stray from stringent eliminations. This may be more feasible (and enjoyable) to follow for life.