It is probably fair to say that the majority of my input into the That Paleo Guy blog has been based around reviewing various bits of scientific literature. As much as I enjoy reading this literature, I also learn a lot from working with and observing people, both in a “clinical” context of working with those who actively seek help, and in observing the actions, reactions, behaviours, and interactions of others who are just going about their day and trying to reconcile successes and failures with their health. You can learn a lot about human behaviour just by watching it. Tonight’s post sums up a week of observations.
Live Now, Pay Later – When the bill becomes due
From the time that I completed the bulk of my university studies until about 2008, the vast majority of my income came from working as a PT/Nutritionist inside a large Globo-Gym. I was never what I would call a ‘volume trainer’ – one that just pumped through large numbers of clients on a production line. I had a smaller client base, but was fortunate enough (or unfortunate when they were all on holiday), to have a handful of clients that hired my services for 3-4 sessions per week, each paying what was at the time a very high rate per session. These clients would be considered to be very wealthy (all millionaires, or very close to it), and were very successful business people in their own right. And they all had one thing in common… They had chosen to cash in their health to chase what they valued as success in their respective fields.
They had all come to a point in their lives where they were wanting to pull the brakes on a decline in their health that had begun to accelerate away on them. Their answer – throw money at the problem. Surely, if they just paid someone who would keep them accountable for 3 hours per week, they could carry on with their regular lives otherwise uninterrupted.
It would be easy for someone like me – someone who doesn’t own a house, doesn’t have much in the way of assets, savings, or investments – to feel that I wasn’t rich. But one thing I was reminded of then, and I am reminded of today when I look at other businessmen, was that for all my apparent lack of financial wealth (which may come back to haunt me one day), I had something they do not have and are seemingly unable to leave their investments long enough to attain (at least in their eyes) – good health.
These clients (and many of the people I interact with now), all spent a period of time cashing in their health (diet, physical activity, sleep, relaxation, relationships, etc), to chase the things that they felt held more value to them, be it money, influence, recognition, or whatever. Of course they didn’t make the conscious decision to give away their health. They just thought it either wouldn’t happen to them, or that once they had ‘made it’ (whatever ‘it’ is to them), they’d have time (and maybe money) to invest in their health.
There are a couple of flaws with this line of thinking, as I see it. Firstly, for those who are chasing recognition, influence, etc, I don’t believe that you ever get to a point where you have enough of these things. I have seen a couple of people who have retired early from high-level roles, where they received a lot of recognition, who have struggled with motivation for anything after leaving those roles. Invariably, both threw themselves back into similar projects, and neither invested any of their time or energy into rectifying their health issues. I think it is the exception rather than the rule when you see a person genuinely unplug from the values that once drove them and pursue what one might consider a healthful life.
Secondly, they are making the assumption that they can put their health on the back-burner for 5, 10, 15, 20 years, and still have the vast majority of it intact at the point they think they will then be able to dedicate resources to it. Their own optimism bias prevents them from ever believing that (within a 5-20 year time frame), their health will slip so much that they cannot ever get it back (or at least back to a point where they would like to have it). Indeed, 20 years of neglect is plenty of time in which a significant ill-health event can occur. Then what?
I was reminded of all of this on three occasions this week, when asked to review aspects of individual’s current health status. The question becomes one of “What can I do? Will the paleo diet help me now?”. While having every confidence that either actually starting eating in line with our evolutionary biology, or fine-tuning what they are eating will help, I also firmly believe that after many years of neglect, there is only so far you can wind the clock back… only so much a shift in lifestyle can do.
I don’t think anybody should have or sell the expectation that a paleo lifestyle will undo the damage from years of ignorance and neglect. And to be honest, for those who have flatly refused to listen, or who believe that they are some breed of special snowflake impervious to ill-health, I don’t really think this should even be an option presented to them.
I have no desire to save the human race from themselves with anything related to paleo. Increasingly I get twitter/email messages from people asking how they can explain some aspect of paleo to someone who just won’t listen. My answer is, you don’t. I don’t much see the point in diving in to save people who just want to drown you and themselves in the process. You help those who want to help themselves.
I’ve taken this stance with smokers. They know the risks. They know just how wrong it can go. So you don’t preach to them to change their ways. If I was emperor of New Zealand (Ming the Merciless?), and a smoker turned up in one of my hospitals with a smoking-related illness, it would be a case of “oh dear, that’s just too bad”. So why should it be any different for anyone who, knowing all the risks, still eats crap, doesn’t make time for physical activity, doesn’t prioritise sleep, doesn’t get out in the sun, doesn’t unplug long enough to relax, and who neglects their relationships and socialisation, and has their health head south on them? In my mind, it shouldn’t.
When a person chooses to live now and pay later, they should be made to pay the bill when it finally arrives, whatever it is. A paleo lifestyle shouldn’t be seen as a voucher that can be used to cover the full cost when the check finally arrives.
Inclusion versus Exclusion
Another observation from the week comes from how some people choose to apply certain strategies to their health. Mention that a paleo diet puts bacon and eggs, butter, and coconut cream on the menu, and many people become extremely enthusiastic about it. Including these foods into one’s diet is seemingly easy. Include some walking – doable. Spend some time in the sun – absolutely. But the difficulty arises with the exclusion side of the ledger.
In the first instance, people get the biggest gains, I believe, from what they exclude from their life, particularly the dietary exclusions of grains, sugar, and industrial oils. Whilst these exclusions offer the biggest payback, they are also some of the hardest things to do for some. It is asking someone to actually give something up. Unfortunately, however, we live in a world where many expect to have their cake and eat it to.
I have pondered this before. We are happy to add things… but subtraction is an equation we struggle with. Take something like some sort of inflammatory condition. We are encouraged to add fish oil capsules rather than subtract all the dietary ingredients causing the inflammatory reaction in the first place. We are conditioned to consuming something rather than not consuming; to take more rather than to have less.
Simply adding the aspects of a paleo life that you think are easy to add, and not subtracting the aspects that are inconsistent with that life, will simply not reap you the benefits you seek, and might even add to your problems. For example, there is a body of research suggesting that a diet rich in saturated fat is not a problem when consumed in the context of a relatively low carbohydrate diet. Keep that carb intake high, however, whilst adding more fat, and I think you might be asking for trouble.
When asked this week why someone’s blood lipid markers hadn’t shifted an inch despite the addition of more physical activity and more saturated fat, I was forced to tell them that until they change the things that actually change the numbers (grains and sugars in particular), then they can’t expect the numbers to change. Of course this means giving some things up. Again, live now – pay later…
The Safe Starch Debate
I’ve tended to stay well away from the time-sucking vortex that has become the “safe starches debate” (predominantly on Jimmy Moore’s blog). I see little point, to be honest, in having a debate around just what percentage or how many grams of carbohydrate should be included in a paleo-type diet. The debate seems to be focused on differences that have an individual context. That is, what works for and might be appropriate for me in terms of a certain carbohydrate intake (quantitative and qualitative), might be completely different for you. What might be deemed “safe” for each of us “depends”…
But once again, a debate seems to rage based around an aspect that has so many variables when it comes to nailing down a prescription – a prescription that could be completely different from one day to the next if any of those variables change, yet we tend to lose sight of the things on which we all agree. No matter what “flavour” paleo you are doing, there tends to be agreement that grains, sugars, and vegetable oils need to be heavily restricted, if not entirely eliminated. Everything else is seemingly up for fine-tuning based on individual context.
Now it wouldn’t be so bad, in my mind, having such a debate if we were in fact having an epidemic of people eating too much sweet potato, uncertain of how much is too much. But when I see people lurching from eating too little carbohydrate, believing extreme restriction to be some sort of magic bullet to their weight problems (anyone recall the extreme fat restriction from the 1990′s?), to having layers of gluten-free bread under their bacon and eggs, to dosing themselves with all manner of paleo candy, to not doing enough low-end aerobic work, to doing too much high-end work, to making some very poor choices of strength training, to not getting enough sleep, and so on, I just don’t think the prime issue is one of “safe starches” for the vast majority of people.
With the exception of comments from the likes of Melissa Hartwig, Mark Sisson, and a very thorough and level-headed response from Paul Jaminet, much of the debate seemed to descend into polarising personality clashes and egotism. I’ve said before that I like a good debate, and that it often throws a lot of information up into the light that might have taken significantly longer to come forth (and Jimmy Moore needs to be congratulated for kicking this particular debate off and pulling together the people he has). However (and this is an opinion shared by a few people I have discussed it with off-line), the egos and bitch-slapping that occurred in the comments turned the whole thing into a bit of a circus and train wreck.
For me, two commentors best summed up where I stand on the safe starches issue…
As we’ve been saying a lot lately, context matters. The context of the Perfect Health quotes pulled from the book matter a great deal, as does the context of an individual’s own metabolic and health status and the context of the very word “safe.”.
We think of those foods – white rice, white potato, tapioca – as “safe” starches from a GI perspective, as they don’t directly promote gut permeability or systemic inflammation. Whether they are a “safe” (translate: healthy) choice for people to include in their diets on a regular basis depends entirely on context, as a few of your panel responders here elegantly demonstrated.
I see an unnecessary trend towards differentiation in the ancestral/paleo/primal/lowcarb world. We are somehow trying to find all the ways we are different (which only confuses people) rather than identifying all the ways in which we are very alike and aligned, and then understanding the subtle differences that remain.
So those were the thoughts on my mind from this week. A slightly misanthropic post but I believe that if you aren’t trying to preach to and help everyone, then you’ll have enough energy to help those who really want it.