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Modern thoughts on the Paleo diet

Dear Dr. Roach • After a few months of stress eating, I have gained a lot of weight. People swear that the Paleo diet would help me lose weight and feel better. Do you recommend it? — H.C.

AnswerMost diets have good points and bad points, and work better or worse for different people. The Paleo diet is no exception. The theory behind Paleo is that humans are best adapted to the diet that Paleolithic man ate 10,000 or more years ago, which was high in meat, with relatively large amounts of fruits and vegetables, and no grains or dairy. I disagree with the theory on several points, especially that I think it is a fundamental misunderstanding of adaptation, in that there’s no guarantee that evolution produces a “best” adaptation, merely one that’s good enough. Paleolithic man ate what he had to survive, not necessarily what was optimal for his health.


The part about the Paleo diet that I do like is its recommendation against highly refined grains and other processed foods. I don’t agree with the usual recommendation to eat so much meat. It’s important to remember that the meat Paleolithic man ate, until just before being eaten, was busily running away from him and did not have remotely the fat content of today’s supermarket meat.

The nuts and vegetables available to modern man are vastly different from those available to Paleolithic man, according to a great talk from Christina Warriner. Finally, there is abundant evidence that preagricultural man, from many different societies, had atherosclerosis in the unlikely event he lived into his 40s.

Dear Dr. Roach • After having a body rash for five months, I finally was diagnosed as having subacute lupus. After searching on the Internet, I got very little understandable information. I am an 83-year-old very healthy woman. — J.B.

Answer • Lupus (literally “wolf,” as the classic rash of systemic lupus erythematosis was thought to resemble a wolf bite) is a complicated group of related diseases, including SLE (the “full-blown” syndrome, which can affect many organ systems, although itself highly variable), discoid lupus erythematosis (a skin condition that can exist by itself or as part of SLE) and subacute cutaneous lupus erythematosis, which I think you are referring to.

SCLE is a skin condition that starts as small, red, scaly raised bumps, which coalesce or form ring-like patterns on the trunk, shoulders, forearms and neck, but usually not the face. About a third of the time, SCLE is related to a medication. Many medications are associated with development of SCLE, including blood pressure medications, some statins, omeprazole and other anti-ulcer and GERD medications. About half the time, SCLE occurs in combination with systemic lupus.

Treatment of SCLE involves careful avoidance of direct sunlight, including the use of sunscreen and sun-protective clothing. Any drug commonly associated with SCLE should be stopped, if possible. Stopping smoking may improve the disease. Low vitamin D level is often associated with SCLE (possibly because people are avoiding sunlight), so supplementation may be necessary.

If medications are needed, topical steroids are probably the most effective treatment. Topical calcineurin inhibiters such as tacrolimus (Protopic) are (very) expensive alternatives.

So many people ask me to comment on dietary treatment that I will mention that although there is no data to prove it, I have anecdotally found that the “anti-inflammatory diet” of high fruits and vegetables, low saturated fat, low processed and high whole-grain products, and high omega-3 fatty acids such as fatty fish and walnuts, may improve symptoms of lupus, and is a generally healthy diet for most people.

I found two especially good websites for more information: lupus.org and mollysfund.org.

Dr. Keith Roach is a physician at Weill Cornell Medical College and New York Presbyterian Hospital.Readers may email questions to [email protected] or request an order form of available health newsletters at P.O. Box 536475, Orlando, Fla. 32853-6475

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