(First submitted January 24, 2013, modified today.)
Dear Editor of Acupuncture Today and Acupuncture Profession,
I read with interest and dismay Jake Paul Fratkin’s article “The Miracle Cure for Losing Weight.” I studied and implemented the so-called Paleo diet for about 15 years during which I came to understand the major flaws in its theory and practices. I also was the only Chinese medical presenter at the first (2011) Ancestral Health Symposium on the relevance of Paleolithic nutrition to modern humans, so I feel a responsibility to comment in detail.
While I agree that we have no miracle cure for weight loss, I disagree with the idea that a low starch Paleo diet based on meat, fish, and eggs with some fruits and vegetables accurately represents “the diet of our ancestors” and serves as a healthy approach to weight loss.
Prehistoric humans of the paleolithic period had no known control over their food supply and probably took every opportunity to eat the richest foods available to them. Ethnographic data indicates clearly that, due to seasonal fluctuations in wild food supplies, both non-human primates and non-agricultural people had a feast and famine lifestyle that allowed abundance during some seasons but enforced significant caloric restriction and weight loss in others. According to Chakravarthy and Booth, this pattern most likely affected paleolithic humans:
"Because the success of finding food in the hunter-gatherer society was never guaranteed (14), it was not unusual for our Late-Paleolithic (50,000-10,000 BC) ancestors to undergo periods of feast (during food abundance) intermixed with periods of famine (under drought conditions, an unsuccessful hunt, or inability to hunt due to physical inactivity or illness), thereby resulting in cycles of feast-famine as well as physical activity-rest." 1Consequently, any Paleolithic humans who engaged in nutritionally motivated hunting would have done so in order to increase their food energy intake in order to maintain or gain weight, not in order to achieve weight loss. Further, wild game flesh has substantially less fat and kcalories than the fattier animal flesh in modern supermarkets. In view of this, the "Paleo diet" theory that overfed sedentary modern humans who need to lose excess adipose should regularly eat the fatty flesh and eggs found in supermarkets because active, underfed, extremely lean prehistoric people who struggled to meet their basic kcaloric needs ate lean game flesh or eggs whenever possible lacks basic credibility.
|People wanting to get lean should emulate the food choices of people wanting to get fat? Source: Alerte Environnement|
The fossil record does not provide us with detailed diet diaries of prehistoric humans so most ideas of Paleo diet plant-animal ratios represent speculation. The modern human genome primarily developed in Africa. Modern African foragers (Ju/'Hoansi and Hadza) succeed in killing large but lean game animals only about once a month, only after large energy expenditure in hunting, so these hunter-gatherers, like other primates, rely primarily on fruit, vegetables, nuts, and seeds for sustenance. 2
Hawkes compared the energy delivery of hunting to gathering among the contemporary Hadza and found that hunting provided a lower energy return than gathering done by any but the youngest members of the tribe:
“The household share is a rough estimate of the hunter's contribution to family consumption when he hunts big game. The overall average acquisition rate for hunters is 4.89 kg/day (live weight; Hawkes et al. 1991). If we assume that the hunter's household keeps 10%, then his "take-home" rate is .49 kg/ day.3 Hadza men spend 4.13 hrs/day hunting on average, making their average take-home rate .12 kg/hr....It seems improbable that prehistoric humans, who had lesser technology (not even possessing the bow and arrow), had greater hunting success. In contrast, the average resident of a modern nation can procure as much meat as she wants with a credit card. Further, like other wild animals but unlike the average modern patient seeking weight loss, Paleolithic humans hosted cholesterol- and iron- depleting, antiatherogenic parasites [4, 5, 6, 7], which would have protected them from two harmful components of animal flesh. 8 I discussed problems involved in applying supposedly Paleolithic diets to modern populations in my 2011 Ancestral Health Symposium lecture in which I integrated principles of Chinese science with biomedical nutriton. 9
“The rates for large game can also be compared with gathering plant foods by converting kilograms of meat to calories. If large animals are estimated at 1500 Cal/kg live weight (following Lee 1979), a rate of .12 kg/hr (live weight) gives 180 Cal/hr. This rate is lower than all but the very youngest children earn gathering (Blurton Jones et al 1989; Hawkes, O'Connell, and Blurton Jones 1995). In the long run, big-game hunting is inferior to available alternative strategies for provisioning families.” 3
Fratkin identifies China and France as two cultures that “manage to stay thin.” Remarkably, neither of these cultures avoid all of the starchy “white” foods that Fratkin blames for obesity. However, while according to the UN OECD, the rate of obesity in France (9.4%) is less than a third of that in the U.S. (30.4%), their rate is still three times that of Japan or South Korea (each 3.2%). While the French eat substantial amounts of animal flesh and saturated fats (~40% of energy as fat 10), the Japanese diet in comparison supplies contains relatively little animal flesh, particularly from land animals, and supplies only 29% energy as fat  and about 60% energy as carbohydrate , mostly from white rice.
Further, the French have had their current high animal product and fat intake for only a relatively short period of time, which confounds claims that their diet doesn't promote obesity or heart disease [ 31] because evidence suggests the effect does not appear on a population level until the population has maintained their high fat intake for at least 25 to 35 years. A murine study indicates that high-fat diets produce a gradual enhancement of fat mass over four generations , which would amount to at least 80 years for humans.
The very lean Chinese eat a diet based on rice, noodles, and steamed bread. The Cornell-Oxford-China Health Project found that the average Chinese person gets less than one percent of his total kcalories from animal protein (Americans get an average of ten percent of energy from animal protein). The average Chinese diet supplies 70 to 80 percent of calories as carbohydrate, mostly from rice and noodles, but less than 15 percent of calories from fats (Americans get about 35 percent of calories from fats). Chinese remain lean despite consuming one-third more kcalories (per kg body mass) than Americans. 
|Eating rice makes people fat? Source: TheDailyKos|
In China and elsewhere, obesity increases with fat and animal flesh intake, and decreases when carbohydrate-rich plant foods such as rice and pasta replace fat and flesh. In the Adventist Health Study, only the vegans had an average BMI in the healthy range, whereas the average BMI of lacto-ovo vegetarians, pesco-vegetarians, semi-vegetarians, and nonvegetarians all indicated overweight or obese, and the prevalence of overweight or obesity and diabetes increased directly with the increased variety and amount of animal product in the diet.  In the EPIC-Oxford study, vegans had the slowest rate of weight gain.  In a Belgian population, people reporting a higher intake of animal protein and lower intake of plant protein had a higher body mass than those with lower intake of animal protein and higher intake of plant protein.  In the U.S., meat consumption associates positively with both obesity and central abdominal obesity. 
The whole idea that carbohydrate-rich foods—namely, plants–– uniquely cause obesity lacks scientific foundation. More than 50 years of scientific research has shown that almost all stored body fat comes from excess dietary fat  and that, because fat supplies more than twice as many calories per gram as either protein or carbohydrate, fat balance primarily determines energy balance. That is, dietary fat intake primarily determines the caloric content of the diet and body fatness. As stated by Swinburn and Ravussin:
“Under normal conditions, carbohydrate, protein, and alcohol are not converted to fat. Glycogen and protein stores are closely controlled, and increasing the intake of nonfat nutrients stimulates their oxidation rates proportionally. Thus, chronic imbalance between intake and oxidation of nonfat nutrients cannot lead to obesity."
Generally, animal flesh, dairy, and eggs provide more fats and have a higher caloric density than fruits, vegetables, grains, or legumes.
Fratkin advises avoidance of “Bread, pasta, cookies, cakes, pastries, cheese, yogurt, milk, ice cream, and all desserts.” Lean Chinese people eat steamed bread and pasta, but usually without adding much if any flesh, butter, cheese, mayo, or oils.
|Eating noodles sure made these Chinese chefs fat! Source: TravelChinaGuide.com|
Bread and pasta have little fat and low energy density when not loaded with fatty condiments or sauces. One study found that overweight young men assigned to eating 12 slices of white bread daily (without fatty toppings) lost 14 pounds in 8 weeks. The rest of the items on Fratkin's list ("...cookies, cakes, pastries, cheese, yogurt, milk, ice cream, and all desserts") supply 50 percent or more of their calories as fat or sugars. Someone wishing to lose body fat should eliminate those items from the diet, not because they are “white,” high in carbohydrates, or absent from Paleolithic diets, but because they are high in fat, refined sugars, and calories.
Besides promoting obesity, diets high in animal products provide excessive cholesterol and saturated fats. Based on more than 50 years of accumulated evidence establishing the causal relationship between dietary lipids and cardiovascular disease, the Food and Nutrition Board of the National Academy of Sciences states that any incremental intake of cholesterol or saturated fatty acids increases coronary heart disease risk. Humans do not require dietary cholesterol or saturated fats. All flesh foods (meat, fish, poultry) contain similar amounts of cholesterol (wt/wt) and eggs have the largest cholesterol content of commonly consumed foods. Animal foods also constitute the primary dietary sources of saturated fatty acids.
Prevention or reversal of cardiovascular disease requires total cholesterol below 150 mg/dL and LDL below 70 mg/dL , which constitute physiologically normal values in mammals . Levels above these constitute excess serum cholesterol. In rural Chinese counties where cardiovascular disease, cancer, and other diseases of affluence rarely occur, mean serum total cholesterol averages 127 mg/dL [25, 26].
Dietary animal protein, cholesterol and saturated fatty acid intake also show positive epidemiological links with diabetes, cancer, Parkinson’s disease, Alzheimer’s disease, and autoimmune diseases, we have identified plausible biological mechanisms by which dietary animal food intake may promote these diseases, and reduction or elimination of animal flesh, fat, and cholesterol have been shown in numerous clinical trials conducted over the course of 100 years to ameliorate or eliminate these diseases . Therefore, a meaty Paleo diet probably puts patients at an increased risk of cardiovascular, metabolic, neurological, and autoimmune diseases.
Recently, a panel of experts ranked the Paleo diet as the least desirable approach to general health or weight loss due to its nutritional imbalances and a lack of evidence for safety or efficacy.  John McDougall, M.D., a leader in lifestyle and nutritional medicine with more than four decades of experience using plant-based diets to reverse obesity and chronic disease, has written a thorough critique of the Paleo diet, citing evidence that prehistoric human diets included starchy foods. In fact, human saliva contains more of the starch-digesting enzyme amylase than any other species, clearly indicating that we have specific genetic adaptation to a starch-rich diet.
The Paleo diet lacks evidence of safety or efficacy and may put patients at well-known risk. Moreover, it contradicts the principles of traditional Asian nutrition and ethics (humanity and nonviolence).
"The honorable and upright man keeps well away from both the slaughterhouse and the kitchen. And he allows no knives on his table." ConfuciusIronically, more than 100 years of biomedical nutrition research indicates that plant-based diets similar to traditional rural Asian diets prevent and with modification may reverse cardiovascular, metabolic, and immune system diseases.
The eminent Chinese physician Sun Si Miao stated that, whenever applicable, the skilled doctor should advise dietary changes before implementing herbs or acupuncture. However, scientifically incorrect ideas about human nutrition limit our clinical abilities and endanger our patients.
Don Matesz, M.A., M.S., Dipl. OM, L.Ac.
Barefoot Acupuncture Clinic
1 Chakravarthy MV, Booth FW. Eating, exercise, and “Thrifty” genotypes: connecting the dots toward an evolutionary understanding of modern chronic diseases. J Appl Physiol 2004 January 1:96(1):3-10. http://jap.physiology.org/content/96/1/3.long#F1
2 Speth JD. The Paleoanthropology and Archaeology of Big-Game Hunting. Springer, New York, 2010.
3 Hawkes K. Hunting and the Evolution of Egalitarian Societies: Lessons from the Hadza. In: Diehl, M. W. (Ed.), Hierarchies in Action: Cui Bono? Occasional Paper 27. Southern Illinois University, Center for Archaeological Investigations, Carbondale, IL. 59–83. 65.
4 Sianto L, Chame M, Silva CS, et al. Animal helminths in human archaeological remains: a review of zoonoses in the past. Rev Inst Med Trop Sao Paulo. 2009 May-Jun;51(3):119-30. PMID: 19551285
5 Midzi N, Mtapuri-Zinyowera S, Mapingure MP, et al. Consequences of polyparasitism on anaemia among primary school children in Zimbabwe. Acta Trop. 2010 Jul-Aug;115(1-2):103-11. PMID: 20175980.
6 Bansal D, Bhatti HS, Sehgal R. Altered lipid parameters in patients infected with Entamoeba histolytica, Entamoeba dispar and Giardia lamblia. Br J Biomed Sci. 2005;62(2):63-5. PMID:
7 Stanley RG, Jackson CL, Griffiths K, Doenhoff MJ. Effects of Schistosoma mansoni worms and eggs on circulating cholesterol and liver lipids in mice. Atherosclerosis 2009 Nov;207(1):131-8. PMID: 19464685.
8 Kell DB. Iron behaving badly: inappropriate iron chelation as a major contributor to the aetiology of vascular and other progressive inflammatory and degenerative diseases. BMC Med Genomics. 2009 Jan 8;2:2. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2672098/
9 Posted on YouTube at http://www.youtube.com/watch?v=PIB6C5cy-KQ, and slides available at http://www.slideshare.net/ancestralhealth/ahs-slidesdon-matesz.
10 Razanamahefa L, et al. Dietary fat consumption of the French population and quality of the data on the composition of the major food groups. Bull Cancer 2005 Jul; 92(7):647-57. http://www.ncbi.nlm.nih.gov/pubmed/16123004
13 Campbell TC, Junshi C. Diet and chronic degenerative diseases: perspectives from China. Am J Clin Nutr. 1994 May;59(5 Suppl):1153S-1161S. PMID: 8172116
14 Campbell TC. The China Study. Benbella Books, 2006.
15 Tonstad S, Butler T, Yan R, and Fraser GE. Type of Vegetarian Diet, Body Weight, and Prevalence of Type 2 Diabetes. Diabetes Care. 2009 May; 32(5): 791–796. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2671114/
16 Rosell M, Appleby P, Spencer E, and Key T. Weight gain over 5 years in 21, 966 meat-eating, fish-eating, vegetarian, and vegan men and women in EPIC-Oxford. International Journal of Obesity (2006) 30, 1389–1396. http://www.nature.com/ijo/journal/v30/n9/full/0803305a.html
17 Lin Y, Bolca S, Vandevijvere S, et al. Plant and animal protein intake and its association with overweight and obesity among the Belgian population. British Journal of Nutrition (2011), 105, 1106-1116. http://journals.cambridge.org/action/displayFulltext?type=1&fid=8207505&jid=BJN&volumeId=105&issueId=07&aid=8207503&bodyId=&membershipNumber=&societyETOCSession=
18 Wang Y, Bevdoun MA. Meat consumption is associated with obesity and central obesity among US adults. Int J Obes (Lond). 2009 June; 33(6): 621–628. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2697260/.
19 Hellerstein MK. No common energy currency: de novo lipogenesis as the road less traveled.. Am J Clin Nutr 2001 Dec;74(6):707-708.
20 Swinburn B, Ravussin E. Energy balance or fat balance. Am J Clin Nutr 1993; 57(suppl):766S-71S. http://ajcn.nutrition.org/content/57/5/766S.full.pdf
21 Mickelsen O, et al. Effects of a high fiber bread diet on weight loss in college-age males. AJCN (1979) 32:1703-1709.
22 Food and Nutrition Board (FNB). Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients) (2005). National Academy of Sciences Press. Pages 422 and 542.
23 Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III Final Report) http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3full.pdf
24 O'Keefe JH Jr, Cordain L, Harris WH, Moe RM, Vogel R. Optimal low-density lipoprotein is 50 to 70 mg/dl: lower is better and physiologically normal. J Am Coll Cardiol. 2004 Jun 2;43(11):2142-6. PMID: 15172426
25 Campbell TC, Junshi C. Diet and chronic degenerative diseases: perspectives from China. Am J Clin Nutr. 1994 May;59(5 Suppl):1153S-1161S. PMID: 8172116
26 Campbell TC, Parpia B, Chen J. Diet, lifestyle, and the etiology of coronary artery disease: the Cornell China study. Am J Cardiol. 1998 Nov 26;82(10B):18T-21T. PMID: 9860369
27 Campbell TC. The China Study. Benbella Books, 2006.
28 US News. http://health.usnews.com/best-diet/best-overall-diets .
29 McDougall J. The Paleo Diet is Uncivilized (and Unhealthy and Untrue). The McDougall Newsletter, June 2012. http://www.drmcdougall.com/misc/2012nl/jun/paleo2.htm
30 "The honorable and upright man keeps well away from both the slaughterhouse and the kitchen. And he allows no knives on his table." Confucius