Saturday, June 2, 2012

It Starts With Food and Two Years of Evolutionary Psychiatry

I first met Dallas and Melissa Hartwig at AHS11 at UCLA. They are formidable, friendly, bubbly, beautiful, and very tall. I first heard of them several months earlier from Jamie Scott, and then remembered a spat back and forth between Kurt Harris and someone named Dallas over dairy in the comments of Kurt's blog (then named PaNu). Shortly after that, I received a comment or email from Dallas writing he was adding me to the "resources" list of the Whole9 website ("if you care" he said, which I thought was funny.)

I poked around the website and decided to do a Whole30 leading into the inaugural Ancestral Health Symposium. I didn't achieve a "perfect" 30 days due to a vacation to Santa Fe, but I did have some very positive effects which I wrote about in this post. In the mean time, Dallas and Melissa had become part of a group of paleo journal club buddies who pass around interesting papers and whatnot, and they supplied me with a copy of their Whole30 Success Guide. Since then I've also ordered a couple of their T-shirts (one for my sister-in-law who is a big fan), and while they let me buy the gift, they always gave me my shirts with the admonishment that I was not to buy them (I have a feeling they are fond of me, and maybe one day I can leverage that so they can teach me to snowboard or something :-).  We met again at PaleoFx and bonded over our shared relative certainty that the consumption of starch (GASP) was not going to lead us to an early grave (don't even get me started on that one).

All this exposition is my way of giving you full disclosure. And it is a bit fun to walk down memory lane. I started this blog almost two years ago exactly, the readership blooming within a few months thanks to links from Nephropal, Mark Sisson, and Kurt Harris, and later Stephan Guyenet. In the intervening years, I've had the opportunity to meet or correspond (sometimes at great length) with most of the major ancestral health figures, and Dallas and Melissa are among my favorites. It is no secret that Kurt Harris is another great favorite, but I have to say that in his N=1 exchange with Dallas above, I tend to side with Dallas, though a bias comes from me and my family having some issues with dairy. Kurt's arguments (as always) are extremely solid and reasonable. It's also funny how much has changed these past two years, how much online drama we've endured, and how my internet friendships have expanded to include so many people from all over the world. I haven't looked at my oldest blog posts in quite a long time, and I wonder how much I will cringe at my certainty, my style, and ignorance displayed in those first months.

I'm not yet marinated enough in this evolutionary medicine adventure to write a book.  Dallas and Melissa, however, have been working with their paleo-style food and lifestyle both personally and professionally since about 2006 or so, experimenting with their first Whole30 in 2009. I've known they were working a book for quite a while, and was honored when they asked me to review one of their final drafts and perhaps write a quote for the jacket. I was very pleased with It Starts With Food and ended up at the top of the back cover.


I loved the practicality and writing style of the Whole30 Success Guide, so it was no surprise to me that It Starts With Food is an easy and solid read with good narrative drive that takes you right through. It is not the slog of some nutrition books, comparable to the fun read of The Primal Blueprint.

There are two things about this book, however, that take it beyond the previous Paleo bestsellers. One is the terrific attention to the psychology of change and how modern food affects the way we think and crave. Another is the attention to science and how Dallas and Melissa are careful not to overreach. I know they vetted the manuscript with a number of folks, including the Kracken, hoping not to make the mistakes of Paleo past (such as strict prescriptions for carbohydrate grams or saying that legumes will kill you via the power of phytates and lectins.) Their Rx is orthodox Paleo (plus a helping of healthy fat) but they have good solid reasons why every step of the way. Their idea, like Robb Wolf's (and borrowed and attributed to Robb Wolf) is a "perfect" elimination diet, from which you learn a lot about yourself and add back in other likely healthy foods to figure out the balance of your best nutrition with your life.

The psychology piece is incredibly important. It is not easy to do a Whole30, even if you don't have many emotional issues with food, or even if you have weight to lose or are fighting a live threatening condition such as an autoimmune disease to give you plenty of motivation. Mark Sisson breezes past the psychology with his 80/20 rule (not a bad rule for many, though I find I need more like 95/5 to stay lean and sharp), and Robb Wolf in The Paleo Solution had a tough love approach "buck up buttercup" or something to that effect, which I found a bit cringe-worthy (sorry, Robb).  His blog is never like that.

It Starts With Food gives us tough love with extensive handholding, which I know through plenty of clinical experience with addiction and eating disorders is the most effective non-pharmacologic and non-locking-people-up-for-a-spell way to get people through the first rocky part of a major life change.  In addition, with the science and unknowns fully acknowledged, I can recommend this book to my patients and relatives without caveats, which is why I said in my quote:  "Here is the nutrition book we've been waiting for."

I also love how Dallas and Melissa address the so-called radical nature of the fad "Paleo diet" (bizarrely downtrodden by the conventional nutritionists, dieticians, and doctors in so many mainstream publications compared to such champions of processed food as SlimFast and WeightWatchers).
 "It's really not that radical--unless you consider eating nutrient-dense, unprocessed food radical.  Which, in today's microwave-dinner-fast-food-low-fat era, might very well be the case."
This book is Dallas' side of the argument with Kurt Harris.  It says, look, there may be some people who are perfectly healthy eating dairy, but it is worth eliminating it from your diet for a spell to see how you do. Some people, like me, will find fat mass, complexion, and GI tract all the better for it.  Others will not. Some will do very well with a bit of black beans (I do) whereas others will find it disturbs the intestines. And, again, there is nothing radical about a 30 day prescription of elimination. The real question is, what do you do for the rest of your life, and the transition to beyond the Whole30. Dallas and Melissa have plenty of answers for that as well, as does everyone else…let the debates begin.

18 comments:

  1. The thing is, even getting very positive results after a 30-day elimination does not necessarily prove that the eliminated food was "bad" or that it will continue to have the wrong effects, as it could just as easily be explained away as some form of "Reset" of the gut flora. Re-introduce moderately, perhaps accompanied by some pro-biotics and voila! I can have dairy again with impunity! maybe.

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  2. Hi Emily
    I had a similar reaction to the book. What made it worth six million stars in my book was also the emphasis on the psychological, something that is egregiously, really, so egregiously and erroneously, missing from conventional diet books.
    One of my readers, in response to my post, pointed out that tough love isn't sufficient for people with real problems. She argued that the reason she had liked my own writing so much was how much I emphasized forgiveness and being gentle with yourself with respect to your eating behaviors, and she found my love of Whole 9s book confusing. Maybe she was right.
    But maybe not.
    I believe that forgiveness is crucial (and Melissa and Dallas do, too), but the type of 'tough love' that Dallas and Melissa undertake I believe is meant to disarm the food and the Whole 30 undertaking, rather than the individual. They assert, for example, that their program is "not hard. Beating cancer is hard...drinking your coffee black is. not. hard." Perhaps they could have spoken with more sympathy for addicts and disordered eaters, but on the other hand, they may have done disordered eaters a service by presuming their ability to undertake this "easy" program.
    Or something. Perhaps.
    Thanks for the review. I thought Melissa and Dallas's book was both delightful and important, and I am so happy to see it's benefits being sung from corners other than my own.
    Stefani

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    1. Ah. Dallas was kind enough to point me towards their thoughts on this subject, which they had considered and aired a couple of months ago:

      http://whole9life.com/2012/04/sometimes-it-is-hard/

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  3. I would personally LOVE if you wrote a book. I'd buy five copies. I'm in my twenties and surrounded by people who suffer from depression, diagnosed and undiagnosed. I myself have a tendency towards but it stays away if I treat myself well. (protip: unrefined carbs are essential!)

    We have a huge problem with depression and suicide in this country (Ireland), we always have though it was either hidden or called something euphemistic like 'bad nerves'.

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  4. Emily,

    Thanks for your supportive words. After pouring our hearts into this book, it's encouraging to see that our intention and message have been adequately conveyed. I'll add in response to Stefani's comment (above) that we wrote specifically about modifications for people with eating disorders here: http://whole9life.com/2012/04/sometimes-it-is-hard/ Just like autoimmune conditions or nightshade sensitivity or whatever other personal idiosyncrasy, disordered eating requires some "special handling" above and beyond the eat-this-not-that approach. We sincerely hope we've struck that balance between Tough Love and compassion in our writing.

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    1. Dallas, I think you have, and that is part of why I enjoy the book so much. It really dials down on the psychological component and why we crave. In that Kessler book , "The End of Overeating," he had a prescription for food rehab at the end that I really didn't think would work. Your book comes much, much closer, and for many it will work (and already has). That said, some folks will need a lot more of a personalized approach, but no book by itself will be enough. There are some folks for which "moderation" really is the key, and 80/20 is the healthy balance :-)

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  5. I accidently deleted this comment in the email link on my phone, so I have to cut and paste it from the text of the email (sorry Kurt):

    Kurt G. Harris MD has left a new comment on your post "It Starts With Food and Two Years of Evolutionary ...":

    Well your review makes it sound a bit like someone wrote a book to carry on an argument with me about dairy from an 18 month old blog comment.

    Of course, context matters. What you haven't linked to is the entire exchange on Robb Wolf's blog where the issue was whether it made sense to warm people that dairy was bad because it was not "paleo" while not ever mentioning that many people have issues with totally "paleo" food items like shellfish, fish, beef, pork and totally normal food like tomatoes and potatoes and peaches and pears and apricots...

    A scientifically based elimination diet not based on Loren Cordain's mythology about milk would not eliminate dairy while ignoring beef (bovine serum albumin allergy is very common), and shellfish, to name just two very obvious example. And then we are not even addressing the overwhelming epidemiogic evidence in favor of dairy that does not even exist for all the "paleo" lean meats that are given a complete pass.

    But the issue we were actually addressing on my blog, which Dallas came to comment on, was how reliable was the subjective n=1 experience, and whether we should give equal weight to the mountain of success stories we hear with vegan, macrobiotic, 30 bananas a day. Macdougall, etc. As I recall, I said that n=1 subjectivity was not worthless, but should always take a back seat to objective data like fat mass, blood pressure, etc.

    " "It's really not that radical--unless you consider eating nutrient-dense, unprocessed food radical. Which, in today's microwave-dinner-fast-food-low-fat era, might very well be the case."
    This book is Dallas' side of the argument with Kurt Harris."

    Reading that quote, some might get the impression that I and Dallas are somehow on opposite sides of the whole foods argument. Nothing could be further from the case.

    Perhaps the entire book is an argument with me about the evils of "dairy" (whatever "dairy" means exactly) but that sounds like a boring read if so. I have not read it so I don't know.

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    1. Nah, I thought the old blog post with Dallas represented the tension between the orthodox paleo and the whole real foods folks. It Starts With Food has an ortho paleo prescription, but not because it is "paleo," they have lots of good reasoning behind it that is sensible enough (I recommend the book, it is a good read). I think the real question is yours from your blog post (linked above, so I hope that anyone who questions your argument and reasoning will simply click to see it)… is it harmful or silly to recommend avoiding, let's say, "dairy" or legumes (excepting peanuts), as those are perfectly good wholesome food groups with lots of nutrients and, if cooked or properly fermented, the antinutrients are mostly down for the count (compared to say, nuts). I think that's an interesting meta argument and the real question of what is good to eat and live on, though the argument per se is not explicit in the book.

      I hope no one gets the impression that you are anti whole foods, because that would be ridiculous.

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    2. And of course in a world where dehydrated yogurt bites and cereal puffs are considered healthy food for toddlers, maybe we should stop worrying about black beans and kefir.

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    3. We're pretty "meh" about black beans occasionally, and for some people, pretty stoked about kefir (context matters!). So... yeah. Bigger problems to address.

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  6. Emily, it's a little ironic that I came across this most recent series of comments while taking a break from updating our Dairy Manifesto (just as you make reference to some of your thoughts about your older work, we've found some of our older stuff sorely in need of some touching up). Maybe I'll fire the update off to Kurt when I'm done for his comments. :)

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  7. It was not obvious to me that you had whole foods vs orthodox paleo as a theme - that makes sense now that you've framed it that way but the post did not seem to elaborate on this, what I agree is a legitimate and interesting theme.

    There may be some missing context unless one reads the long exchange I had with Dallas on Robb's blog that was what prompted him to follow me to my blog and post after my n=1 mini-essay.

    Dallas had a guest post and a follow-on discussion thread on Robb Wolf's that frankly struck me as strident and a little condescending, although admittedly preaching to the choir over at Robb's. The gist of it was that one must be either dim or weak of will to not think it obvious that dairy is problematic. Having heard this kind of thing so many times, I piped up to point out that you never hear orthodox paleos warning about beef or eggs or shrimp or inplying that it is stupid or dangerous to eat them the way "dairy" is supposed to be.

    The thing which is even more apparent to me now, as I delve deeper into the the sea of immunoregulation and the old friends hypothesis, etc:

    The problems with dairy have nothing whatever to do with dairy "not being paleo" or humans not being "evolved" to eat dairy products. We are just as evolved to eat them as any other food that we can have food sensitivity or allergy to.

    The paleo conceit is that having an adverse reaction to a food is because we are not "adapted" to it, and THIS IS WRONG. we have reactions to precisely the foods we have the most exposure to, and it is no stupider or less natural to eat butter than it is to eat a peach, even though the former may give you acne and the latter may make your mouth itch because you have an allergy to birch pollen (this is incredibly common and is known as the oral allergy syndrome).

    Imagine Loren Cordain et al claiming we are not evolved to breathe air with ragweed or birch or timothy pollen in it and that is why we suffer hay fever.

    So call me a nit-picky carbsane window-breaker, but the reasons we eat this or that matter as much as whether it "works" to avoid or to eat this or that - or they should be if we are not to be politicians instead of scientists (e.g., i lost weight on low carb so the CIH must be true) And the moralistic tone of orthodox paleo rubs me the wrong way, I admit, even as I have been guilty of assuming such a tone myself from time to time.

    My issue was not in any way that dairy is not a problem or that it is useless to try eliminating it - far from it - it was trying to go the other way - to enlarge the method to entertain the idea that ANY food might not be tolerated, and to thereby remove the paleo puritanism - the judgement - that maintains that it is somehow "obvious" that dairy should be a problem because it is only something that may be "tolerated" - like cigarettes or something.

    I don't think being able to eat dairy is any more special or surprising than being able to eat beef, and the science is on my side from what I have read so far…

    But perhaps I'll check the book out. What works always matters to avowed pragmatists, and I count myself one.

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    1. I think the book shines pragmatically. But let's muse on the "allerginic reasoning," classically allergenic foods are wheat, dairy, egg whites, soy, shellfish, tropical fruits, peanuts and tree nuts. Any classic gold standard elimination diet will get rid of those (some "paleo" ingredients and some not). And of course we know that in cultures with much more rice consumption, rice allergies are more common. And certainly there are those sensitive to beef and pretty much anything (my mother is allergic to sesame seeds).

      So there's definitely the exposure piece, but also the foods that just seem to be more problematic in general (let's say shellfish or wheat). Just as there are pharmaceuticals that catch a lot more people with rashes (such as Bactrim or the antiepileptic medicines, some antibiotics), and some that very rarely cause rashes (lorazepam as an example).

      As a population, are we better off avoiding the hot ticket foods (hey, even shellfish??) for the most part and striving for a lot more diversity in what we eat to reduce exposure to any one thing? That I think is a big part of Michael Pollan's argument. Paleo celebrates diversity in organs and vegetables, but there are a lot fewer readily available safe proteins out there.

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  8. Certainly good thoughts. But the meta view that interests me most is to ask a more basic question than the immediately pragmatic one of what foods should we avoid to make us feel better or how do we best avoid them.

    The question that interests me is why are there whole foods that we need to avoid at all?

    Is it because of the kernel of paleo reasoning -that some of these foods are evolutionarily discordant?

    I used to think so, but I don't think so anymore. I think the reason we need to avoid any of the problematic foods is likely to be because of an environmental evolutionary discordance that is NOT dietary in the sense of what we are adapted to eat.

    I think it is all related to the old friends hypothesis. Missing portions of the gut biome cause the immune dysregulation that underlies some of these food intolerances, in addition to the epidemic of diseases of immune dysregulation that restrictive diets can admittedly be an effective bandaid for.

    **FWIW, I eat only pastured butter and fermented plain greek yogurt and no other dairy. My reasons for avoiding milk and cream have to do with eating a low reward diet that is low in liquid calories and avoids non-stoichiometic added fats rather than adverse reactions to dairy. I have tried dairy elimination and it has had no discernible effect.

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    1. In the book, Dallas and Melissa note that one of the things people miss and crave the most in the first part of a Whole30 is cheese. I remember missing it intensely the very first time I dialed down on paleo-style nutrition back in 2010, though I don't think I even ate that much cheese as I wasn't really raised on it. Interesting.

      Other thoughts--- peanuts and soy have lookalike antigens, as to chitins and tapeworms (as you told me), so overexposure and a bored immune system looking for action...

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  9. I guess everybody's got their something. My wife would be a cheese addict if she allowed herself and I am indifferent to it. I eat cheese mostly if it has been aged -which if one is concerned about casein at least one study suggests that there are no functional casomorphins in aged cheese.

    Also, it is a little know fact that cheese aged more than 6 months is almost all made from raw milk, even if not labeled that way. The govt does not require pasteurization for cheeses aged at least 6 months, so they usually are not pasteurized. My next door neighbor, who literally owns a cheese company (Bel Gioioso) is my source for this.

    There is one research group that believes that each of the 6 major families of proteins that account for most of the allergies in humans corresponds to a helminth protein. And we know that nematodes colonized the mammalian gut tens of millions of years before the entire IgE system (which only mammals have) evolved in response.

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  10. That should read "vertebrate gut"....

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  11. I've heard nothing but solid endorsements about this book. However, much of the praise is about the psychology and doing a 30 day trial. So my question is, what's in for someone who's been eating this way for 2 years (read a few books already) and has ZERO psychology issues -- cravings, lack of discipline, whatever -- to fight against?

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