Paleo: the right food for the wrong reasons.
Meat, fish, eggs, vegetables, fruit, nuts. No grains, no dairy, no beans, no processed food. The plate is mostly fine. The caveman story behind it is mostly fiction.
The short version
- What it is
- Eat what a Stone Age hunter-gatherer could have eaten. Cut grains, dairy, legumes, sugar and processed food.
- Good for
- Kicking out junk food. Some weight and waist loss in small, short trials.
- Bad at
- History, fibre, calcium, iodine, and your grocery bill.
- Evidence
- Weak. A handful of small trials.
- Our take
- Steal the "real food only" part. Keep the beans, oats and yoghurt.
What the paleo diet actually is
The paleo diet is built on one idea: our bodies evolved over millions of years in the Palaeolithic, the Old Stone Age, and farming arrived only about 10,000 years ago. Too recent, the theory goes, for our genes to cope with bread, milk and lentils. So you eat like a hunter-gatherer.
In practice that means meat, fish, seafood, eggs, vegetables, fruit, nuts, seeds and "natural" fats like olive oil, avocado and coconut. Out go all grains (yes, oats and brown rice too), dairy, beans and lentils, peanuts, soy, refined sugar, refined vegetable oils and anything that comes out of a factory.
Primal is the softer cousin. Same base, but full-fat dairy like butter, cheese and yoghurt is usually allowed, and the rules are treated more as guidelines than commandments.
How it works in your body
There's no special Stone Age metabolism switching on. What happens is simpler. You cut out ultra-processed food, sugar, sweets, crisps and soft drinks in one go. Your carbs drop because bread, pasta and rice are gone. Protein goes up because meat, fish and eggs fill the gap. Protein and fibre-rich vegetables keep you full, so most people end up eating less without counting anything.
Paleo works mainly because of what it throws out, not because of what cavemen did. The catch is that it also throws out some of the best-studied foods in nutrition: whole grains, beans and lentils, and dairy.
What you eat, what you don't
Eat
- Meat, poultry, fish and seafood
- Eggs
- Vegetables of every kind, including sweet potato
- Fruit and berries
- Nuts and seeds (not peanuts)
- Olive oil, avocado, coconut
- Herbs, spices, water, black coffee, tea
Forget it
- All grains: wheat, rice, oats, corn, barley
- Milk, cheese, yoghurt (primal keeps some)
- Beans, lentils, chickpeas, peanuts, soy
- Sugar, sweets, soft drinks
- Refined seed oils, margarine
- Processed and packaged food
Alcohol on paleo
OK, now and then
- A glass of dry red or white wine
- Clear spirits like tequila or vodka, neat or with soda water and lime
- Hard cider with no added sugar, if your version of paleo allows it
Not paleo
- Beer (it's made from grain)
- Grain whiskies, for strict followers
- Cocktails, liqueurs, sweet mixers
- Alcopops and anything with cola or juice
50 Club: one glass of dry wine with a meal.
No caveman ever drank a Pinot Grigio, so this is where the theory gets creative. Fewer drinks is the honest paleo answer. The World Health Organization says no safe level of alcohol has been shown.7 All the details are in our alcohol guide.
What it's good for, with proof
Some weight and waist off, in the short term
A 2019 meta-analysis pooled 11 randomised trials in people with chronic diseases. Compared with diets based on official guidelines, paleo groups lost about 3.5 kg more on average, with smaller waists and lower BMI.1 The authors were careful: the studies were small and short, and they called for bigger, longer trials.
Better metabolic numbers, in a few small trials
An earlier review of four small randomised trials found that paleo improved waist size, blood pressure, blood fats and blood sugar a bit more than guideline diets, at least in the short term.2 Four trials, roughly 160 people in total. Promising. Not proof.
Belly fat early on, then the gap closes
The longest trial ran two years in 70 women with obesity after menopause. The paleo group lost more fat and waist than the group on standard Nordic recommendations at six months, but by two years the difference in body measurements had mostly disappeared.3 Sound familiar? Almost every diet looks better at six months than at two years.
The uncomfortable truth
"Cavemen didn't eat grains." Some did. Starch grains found on 30,000-year-old grinding stones from Italy, Russia and the Czech Republic suggest Stone Age Europeans were already grinding plants, and possibly making flour.4 There was also never one "paleo diet". People ate whatever their region offered, from seal fat to tubers.
"Paleo is how humans are meant to eat." Which humans? Arctic hunters, tropical foragers and Stone Age Europeans ate completely different things. And a bacon-and-coconut-oil breakfast isn't something any hunter-gatherer ate either. Paleo food is modern food with a costume on.
The risks
- Iodine. In the two-year Swedish trial, the paleo group developed mild iodine deficiency, because dairy and iodised table salt were out.5 Iodine matters for your thyroid, and badly in pregnancy.
- Gut and fibre. Long-term paleo eaters had less resistant starch (the fibre your gut bacteria love) and higher blood levels of TMAO, a compound linked with heart disease, than people eating normally. Strict followers who ate no whole grains had the highest levels.6 It's an observational study, so it can't prove cause, but it's a warning sign.
- Calcium. No dairy means you have to find calcium elsewhere: leafy greens, tinned fish with bones, almonds, fortified alternatives. Many people don't.
- Saturated fat creep. "Paleo" bacon, butter and coconut oil everywhere turns a vegetable-heavy diet into a meat-and-fat diet. That isn't what the trials tested.
- Cost and social life. Grass-fed everything is expensive, and you can't eat the rice at every hawker stall or the bread at every dinner. Most people quit.
Allergies: watch the staples
Paleo accidentally removes several allergens (gluten, milk, peanuts, soy, lupin). It leans hard on the others.
| Paleo staple | Allergen (EU list of 14)8 | Swap |
|---|---|---|
| Eggs, paleo mayo, paleo baking | Eggs | Fish, meat; flax "eggs" for baking |
| Almond flour, cashews, walnuts | Tree nuts | Pumpkin and sunflower seeds, coconut flour |
| Salmon, sardines, tuna | Fish | Poultry, eggs, meat |
| Prawns, crab, mussels, squid | Crustaceans, molluscs | Fish, chicken |
| Tahini, sesame seeds | Sesame | Sunflower seed butter |
| Bone broth, soups, stews | Celery | Fennel, carrot, leek |
| Paleo dressings and mustard rubs | Mustard | Olive oil, lemon, herbs |
| Dried fruit, wine | Sulphur dioxide and sulphites | Fresh fruit |
Don't do paleo if you…
- are pregnant or breastfeeding (iodine and calcium matter too much to gamble with)
- have kidney disease, because of the high protein load
- have high LDL cholesterol and plan to eat it the bacon-and-butter way
- have ever had an eating disorder: long lists of forbidden foods are a bad idea
- are under 18
Healthen me asks about all of these and gives you a different plan if any apply.
How we use paleo in your plan
We don't. Paleo is an information article for us, not part of the engine, because the evidence is thin and it cuts foods with strong evidence behind them.
What we do borrow is the spirit: real food, nothing from a factory, protein and vegetables on every plate. Our plan does that already, built on the Mediterranean diet and low-carb meals after your fast. Beans, oats, yoghurt and wholegrain rye stay on the menu, because the evidence says they should. If you want a paleo-style 30-day reset, the plant-friendlier version is the pegan diet, and the strict one is Whole30.
This article is general information, not medical advice. If you have a medical condition or take medication, talk to your doctor before changing how you eat.
Sources
- de Menezes EVA et al. Influence of Paleolithic diet on anthropometric markers in chronic diseases: systematic review and meta-analysis. Nutrition Journal 2019;18:41. doi.org/10.1186/s12937-019-0457-z
- Manheimer EW et al. Paleolithic nutrition for metabolic syndrome: systematic review and meta-analysis. American Journal of Clinical Nutrition 2015;102(4):922–932. doi.org/10.3945/ajcn.115.113613
- Mellberg C et al. Long-term effects of a Palaeolithic-type diet in obese postmenopausal women: a 2-year randomized trial. European Journal of Clinical Nutrition 2014;68:350–357. pubmed.ncbi.nlm.nih.gov/24473459
- Revedin A et al. Thirty thousand-year-old evidence of plant food processing. PNAS 2010;107(44):18815–18819. doi.org/10.1073/pnas.1006993107
- Manousou S et al. A Paleolithic-type diet results in iodine deficiency: a 2-year randomized trial in postmenopausal obese women. European Journal of Clinical Nutrition 2018;72(1):124–129. doi.org/10.1038/ejcn.2017.134
- Genoni A et al. Long-term Paleolithic diet is associated with lower resistant starch intake, different gut microbiota composition and increased serum TMAO concentrations. European Journal of Nutrition 2020;59(5):1845–1858. doi.org/10.1007/s00394-019-02036-y
- WHO Regional Office for Europe. No level of alcohol consumption is safe for our health. News release, 4 January 2023. who.int/europe/news/item/04-01-2023-no-level-of-alcohol-consumption-is-safe-for-our-health
- Regulation (EU) No 1169/2011 on food information to consumers, Annex II (the 14 allergens). eur-lex.europa.eu/eli/reg/2011/1169/oj