What is Paleo-Ayurveda?

Several weeks ago I was asked to do an interview on the subject of the “Paleo-Ayurveda” diet. I guess as one of the few in the Āyurveda community that utilizes the Paleolithic diet as a therapeutic tool, and also as someone who is outspoken on the issue of vegetarianism, it made sense in the interviewer’s mind to combine these modalities. Unfortunately, due to my busy schedule, I was never able to follow through on the interview, and so I will address my thoughts on this now.

For decades now I have been inspired by the teachings of Āyurveda. As a therapeutic tool there is no modality that speaks to me as clearly, but it is not the only modality that I employ in my practice. My background also includes training in Western and Chinese herbal medicine, as well as clinical nutrition. This diversity is reflected in my practice, in which I make use of a large range of medicines, from hand-made herbal pills (guṭikā and vaṭī) that I import from Nepal, to ethanol-based tinctures and percolations; from Chinese herbal granules, decoctions and syrups, to local, wildcrafted remedies that I make myself. Likewise, I am also trained in physiology, pathology, and clinical nutrition, and weave these elements into my practice as well, as do many of my respected colleagues.

Traditional herbal pills from Piyushabarshi Aushadhalaya, Nepal

While I do utilize Āyurveda as my primary modality, it may seem at first glance that I practice a kind of eclectic, syncretic approach to medicine. In all my studies and areas of research, however, I have made sure to understand each modality on its merits, and in its own context. I have thus avoided mixing and matching modalities, conflating a concept understood in one system, with a concept that forms the basis of another. Too often I see practitioners with only a smattering of training in one system, hook their newfound knowledge up to another modality they only partly understand, to create a syncretic approach that is often quite thin in substance. There is a long history of this in the West, for example, when ancient concepts such as yoga and the chakras were adopted by New Age enthusiasts, but without the benefit of really understanding the context or practice. A book such as the Energetics of Western Herbs is a good example of this, which isn’t rooted in any particular tradition, and lacks the necessary empiricism to make the text all that useful.

When I graduated from herb college all those years ago, the prevailing bias within my training was that a vegetarian diet was the best diet. It probably didn’t help that the dean of the college was an avowed vegan, but truth be told, there has long been a strong bias within the natural healing community that a vegetarian diet is better for you. Fortified with this bias, when I began to practice 20 years ago, I dutifully recommended to all my patients that they become vegetarian. And I continued this for at least a couple years, until it became very clear that a vegetarian diet wasn’t helping a large number of my patients, and in some cases – particularly for metabolic and autoimmune disease – was actually making them worse.

At this point, I began to investigate other dietary modalities to resolve the problems I was encountering. Being a vegetarian myself, and also seeing issues in my own health, I began to ask myself “what exactly am I supposed to eat”? The most logical place for me to start was an inquiry into the original human diet, and thus I embarked on a nutritional-anthropological journey that led to my discovery of a significant amount of research on what is proverbially called the “stone-age” or “paleolithic” diet.

Paleolithic cave paintings from Bhimbetka, Madhya Pradesh, India (c. 28,000 BCE)

In short, the Paleolithic diet reflects the original diet of our ancestors, before the first humans began to become dependent on agriculture some 9000 years ago. Scouring the literature, I came across clear evidence showing that the incidence and prevalence of chronic disease in agrarian populations was dramatically higher than in those few remaining groups that maintained this ancient diet. Bolstered by this research, I began to suggest to my patients that they cut out all agricultural staples, including cereal grains, legumes, and dairy products, as well as the “usual suspects” that characterize the Standard American Diet (SAD), such as refined sugar, fats, and salt.

Within 6-8 weeks I would uniformly note clinical improvement in patients suffering from metabolic issues including obesity and diabetes, as well as autoimmune disease such as ankylosing spondylitis and rheumatoid arthritis. Patients with cardiovascular problems, such as hypertension and hyperlipidemia, would also note that their condition tended to normalize and disappear within three months. I recall the case of one patient, who not only suffered from hypertension and hyperlipidemia, but had been recently diagnosed with glaucoma. Three months of dietary changes and treatment, and these conditions literally disappeared, much to the shock of the ophthalmologist. Of course, because I have always believed in the multi-factoral nature of disease, such changes were also accompanied by lifestyle measures, such as regular exercise (e.g. walking 45-60 min daily), the use of medicinal herbs, and key nutritional supplements. Nonetheless, without the dietary changes, as my previous experience demonstrates, sustainable therapeutic changes might not have been achieved.

I have been employing the Paleolithic diet in my clinical practice now since 1998, and have found it to be exceptionally useful in many cases. I have also followed this diet on a personal basis to one degree or another for most of this time since, and have also noted dramatic differences in my health when I do. Empirically, and on the basis of anthropological and medical research, I think that this diet makes a very strong case for itself, and it has been gratifying to see that more and more people are finding the same success in restoring their health, as I myself have experienced.

What has been less than gratifying is to see is the Paleolithic diet becoming a kind of fad, which like the Atkins diet or raw food veganism, is employed with very little understanding or experience. Partly this is because the Paleolithic diet challenges the dietary assumptions of the last 75 years within medicine, and thus vested interests cast aspersions upon it, leading to ignorance and confusion. But the primary issue, for me, have been the green-horned enthusiasts that have literally made a business out of the Paleolithic diet. Thus advocates with perhaps a better grasp of marketing than science, including celebrity chefs, have mis-framed and mischaracterized the benefits of the diet. The response has been increasing skepticism and acceptance of the Paleolithic diet within the mainstream, such that it now seems – like all passing fads – destined to fade away into the oblivion of history. But hopefully I speak too soon…

Oh well, back to the tried and true…?

Perhaps, tongue-in-cheek, I am envious that I didn’t cash in on the Paleolithic band-wagon. After all, I was using the diet some ten years before it began to become popular. But quite honestly, it never occurred to me, and I have no regrets. In good faith, I cannot unilaterally support join Team Paleolithic. This is because I know very well that the diet doesn’t work all the time, and that there are some people for whom this diet is not a good idea at all. And the reason I know this, is because I also employ Āyurveda.

According to its proponents, the Paleolithic diet should be good for everyone. After all, it is what we all used to eat, right? But very clearly, as I have seen in my practice, the Paleolithic diet doesn’t work for everyone, and can produce some major problems. But for what seems to be an irreconcilable contradiction among the paleo-proponents, because I also utilize a system like Āyurveda, I can see exactly how the Paleolithic diet causes problems. Stepping out of the paleo-paradigm allows me to see it more clearly, and this is useful: not only because it can inform how to modulate the diet in certain cases, but also because it provides guidance as to when this diet might be contraindicated. In light of this, the term “Paleo-Ayurveda” is a misnomer. It is term that demonstrates its own ignorance, that somehow we could take Āyurveda and blend it with the Paleolithic diet, and arrive at a syncretic system that is better than both. They are entirely distinct and separate considerations that must be understood on their own merits.

When it comes to comparing Āyurveda and the Paleolithic diet, it’s not like either approach is dealing with a fundamentally different object of concern. After all, food is food – no? Thus, there is obviously some overlap between these systems, and there is a way to also explain and harness the benefits of the Paleolithic diet within the context on Āyurveda. With its emphasis on animal fats and proteins, the Paleolithic diet maintains all the qualities of a vāta-reducing diet in Āyurveda. In this way, perhaps it is no surprise that the Paleolithic diet is beneficial in many different diseases characterized by the involvement of vāta, such as neurodegenerative disorders and autoimmune disease. According to the Caraka saṃhitā, almost 60{6921d8d6427042db5aa411e0d401cbd175b775e2ec65ab7940ca136572bc3362} of the diseases described in Āyurveda involve vāta as the primary etiological agent. Thus, it is easy to see why so many people find therapeutic benefit in this diet.

The problem not typically appreciated by paleo-proponents is that the Paleolithic diet can be very difficult to digest. Knowing this, measures can be taken to make the diet lighter, such as emphasizing soups and stews, rather than grilled, fried, or roasted meat. The amount of fat, meat and animal products too can be reduced, in favor of more vegetables – which by my measure – should account for at least 50-60{6921d8d6427042db5aa411e0d401cbd175b775e2ec65ab7940ca136572bc3362} of the total volume of food eaten everyday on this diet. Remember: Paleolithic peoples lived all over the globe, in a huge variety of environments, and thus there is a diverse range of foods and practices, and not all of these are based on animal products. The addition too of herbs and spices can also be very helpful to promote good digestion, but sometimes this is not enough.

If we regard what Āyurveda states, while 60{6921d8d6427042db5aa411e0d401cbd175b775e2ec65ab7940ca136572bc3362} of disease is linked to vāta, the remaining diseases are associated with pitta (inflammation) and kapha (congestion). As such, a vāta-reducing diet would make no sense for these conditions, and because the qualities of the Paleolithic diet directly antagonize pitta and kapha, it can actually make things much worse. This is apart from the fact that the Paleolithic diet is much harder to digest, which can affect anyone who suffers from weak digestion – regardless of the nature of the primary complaint. As anyone trained in Āyurveda knows, the role of digestion is fundamental to health, and improperly digested foods generate a by-product called ama. While this ama isn’t so much a material substance as an effect, it can be clearly identified, with symptoms such as a feeling of heaviness, mucus congestion, swelling, lethargy, and circulatory problems.

The 80 syndromes of vāta, Caraka saṃhitā, Sū 20:11

In such cases where āma can be seen, all fatty foods are removed from the diet, and the patient is given the easiest and simplest food to eat. The method to restore digestion and shed āma is called saṃsarjana krama in Āyurveda, also known as the graduated diet. This diet begins with the simplest foods to digest, such as a thin rice soup. Simple carbohydrate foods like rice soup are the easiest foods to assimilate, reflected in the composition of human breast milk, which contains mostly simple sugars that are easily digested by a newborn’s digestive system. Following rice soup are more complex foods, such as kitchari (rice and mung bean soup), and then finally a non-fatty meat broth called māṃsa rasa. At this point, the regimen is complete, and the patient can return to normal foods, slowing increasing the amount fat in the diet until it is being consumed at the optimal level (which is certainly much higher for almost everyone, than the low-fat diet recommendations of modern nutrition).

In summation, there is no such thing as Paleo-Ayurveda: it’s just an annoying marketing term formulated by people that have no idea what they are talking about. A lot of people do benefit from following a Paleolithic diet, and in consideration of the higher levels of fat found in this diet, we can also consider it a vāta-reducing diet. But if you have weak digestion, active inflammatory and congestive conditions, then you might want to approach this diet with some caution, or at the least, under the guidance of an expert.