Saturday, February 4, 2012

An Interview with Dr. C. Vicky Beer, Paleo-friendly MD

As I was preparing my recent article on the Paleo diet (1), I interviewed a local Paleo-friendly MD named C. Vicky Beer.  I was only able to include a snippet of the interview in the article, but I thought WHS readers would be interested to read the rest of the interview with Dr. Beer:


1.  What drew you to the Paleo diet as a therapeutic approach?

I have been interested in the notion of the “ideal” or “optimal” diet for over 25 years, ever since I was majoring in Nutritional Sciences at Cornell University, and have studied and explored many diets over the years.   I have been intrigued by the notion of what humans are “meant” to eat, and what type of diet is optimal for health, wellness and disease prevention as it relates to my medical practice as well as my own life.  It was actually through Crossfit training that I first became exposed to the Paleolithic approach to diet.  I was impressed from the dramatic results I saw in fellow “crossfitters” in terms of not only their weight loss (in those who had weight to lose) but also from the benefits they seemed to be attaining in terms of their own endurance and athletic performance.  From the moment I heard about the Paleo, it made sense to me as a scientist.  The concept of Paleolithic diets makes sense to me as I do believe there is an ideal diet, one that is far different than the diet we think of as “American” which is heavily influenced by industrialization, agriculture, advertising and addiction.  The majority of the problems I see in my patients are related to diet and lifestyle.  Paleolithic type diets are dietary solutions to many of these problems.

2.  Under what circumstances do you recommend it?

We are dealing with an epidemic of diabetes in this country, which is an area of particular and focus and interest to me.  Here are some facts that I feel are astounding and frightening:

Data from the 2011 National Diabetes Fact Sheet (released Jan. 26, 2011) 

Total prevalence of diabetes
Total: 25.8 million children and adults in the United States—8.3% of the population—have diabetes.
Diagnosed: 18.8 million people
Undiagnosed: 7.0 million people
Prediabetes: 79 million people*
New Cases: 1.9 million new cases of diabetes are diagnosed in people aged 20 years and older in 2010.
Under 20 years of age
•    215,000, or 0.26% of all people in this age group have diabetes
•    About 1 in every 400 children and adolescents has diabetes
Age 20 years or older
•    25.6 million, or 11.3% of all people in this age group have diabetes
Age 65 years or older
•    10.9 million, or 26.9% of all people in this age group have diabetes
Men
•    13.0 million, or 11.8% of all men aged 20 years or older have diabetes
Women
12.6 million, or 10.8% of all women aged 20 years or older have diabetes

As you can see from these statistics, this is a huge problem, and I feel a direct result of many years in ones life of a diet and lifestyle that promotes glucose intolerance and ultimately diabetes. Diabetes is years in the making in each person.  By the time someone is actually diagnosed, their metabolic problems have been going on for many years.  My job as their physician is to try to reverse the process and get their blood sugars lower, and to try to shift their metabolism towards a healthier state.

Diet is a very personal thing and is influenced by finances, emotions, preferences, habits, culture, religion and attitude. It takes a great deal of motivation to make significant and even radical changes to someone’s diet.  For those who are truly motivated, I recommend the Paleo diet.  For those who are perhaps overwhelmed with diet change, or whose diet is so radically different than a Paleo type diet, I recommend smaller, incremental changes, or perhaps will focus on one particular aspect of Paleo eating, most commonly grains.  I believe our grain and corn heavy diet is at the root to many problems I see, and so I often work on this aspect first as I feel great benefit can occur.

Obesity in general is the culprit in many health problems, not just diabetes (and not all diabetics are obese per se).  Other problems I commonly see in my practice related to weight, and thus diet, are arthritis and hypertension.  Hyperlipidemia is also heavily affected by diet.  There is a tendency to think of high blood cholesterol as related to how much fat and cholesterol one eats.  I believe that is not the full story.  We know that meats from grass fed animals (and eggs from chickens that are not purely grain fed) are different in their fat composition and so I think it is not accurate to blame meat and eggs per se, but perhaps the types of meat.  I also believe that just as the fats in an animal fed grains are different than a grass fed animal (i.e. more pro inflammatory omega 6s, less omega 3s in the grain fed), I believe that humans are similarly influenced.  We know that heart disease is not just a problem of cholesterol but one of inflammation as well.  Here is a link to an excellent summary by Dr Andrew Weil on this topic.

The Paleo diet is inherently higher in omega 3s. 

Here is another link on the subject that I think summarizes the issue.

The Paleo diet I feel is also good for people with irritable bowel syndrome, since it is free of gluten and dairy which are often major culprits in this condition.

3.  What kinds of results have you seen?

So, to be clear, I don’t always recommend the “Paleo” diet to people by name.  There is so much resistance to change in people (that is our nature) that it is not frequent that I truly recommend the “Paleo diet.”  This is due to a number of factors.  Cost is one issue.  Another is religion (I have patients who do not necessarily believe in evolution and to therefore emphasize a diet that is based on an evoluationary concept would not work for them).  Another issue is culture.  Rice is such an integral part of so many Asian cultures that sometimes suggesting that someone eliminate rice from their diet is akin to suggesting they eliminate water.  I find that my patients are often more open to simple, clear suggestions, like “ try reducing the wheat, rice, corn and dairy” in the diet to get things started.

There are those people who are however intrigued by the concept of Paleolithic eating and for those people, they may be more motivated to make significant changes to their diet.

Regardless of what you call it, the results are the same.  People who significantly increase the amount of vegetables, fish, nuts, lean meats and fresh fruits in their diet, and who reduce their grain, dairy, and legume intake have lower blood sugars, usually lose weight, and usually have more energy.

4.  How has it compared to other therapeutic dietary approaches in your experience?  

I think there is difficulty for many people to accept the Paleo concepts since there is such an emphasis on grains in our diet and that they are healthy.  It is also not a mainstream diet, so there is less information readily available to people.

The good news I think is that more popular, known diets like the South Beach diet or Zone diet I believe are based in Paleolithic theory.  So by following those diets, which might be easier for people due to industry support of these diets as well as more of a mass media presence, people are likely to experience the same or similar health benefits.

5.  Have you encountered any drawbacks or contraindications to the approach?

As above – this diet can be difficult for people financially.  It can also be such a radically different way of eating than someone has eaten their entire lives that it can be a real challenge and often very small incremental changes are necessary.

However, many people come to me feeling poorly for years and are often ready to make changes in order to feel better.  Education about diet and how it impacts our health and well being does not usually fit well into the typical 15 minute office visit.  Time (appointment time limits )is therefore a challenge as well. 

As with any diet approach, balance and variety are necessary.  People have so many constraints on them – time, financial for example that make change difficult.  Many people are also dependent on the diet of their household/family members.  And as I mentioned, our culture, and the typical American diet, is so far removed from the Paleolithic diet that it is hard enough to work with one person. But usually that person is a member of a household with their own preferences, restrictions and believes which needs to be incorporated as well 

6.  Do you eat a Paleo diet?

Yes, about 80% of the time.  From my reading and personal experience, I feel that if I eat this way about 80% of the time I feel well, do well in my physical activities and have a stable mood, all benefits I believe of this diet.  I personally don’t feel nor believe that any diet needs to be followed 100% of the time (with rare exceptions, for example the need for someone with celiac disease to avoid gluten 100% of the time or in the case of food allergies).  Overall though, I think there needs to be flexibility in how one approaches diet and food in order to be able to live within certain guidelines.  So I eat Paleo about 80% of the time, but do enjoy a weekly cheeseburger, cream in my coffee, the occasional cocktail or glass of wine,  and very rarely bread with butter when I go out to eat.  None of these things are found within the “true” Paleo diet, but I think there is a way to attain balance and enjoy life and feel well.  I admit that if I go beyond that 80% I don’t feel well, so there is for me a continued motivation to adhere to the diet concepts.   For my patients who have been able to make significant changes to their diet, they too usually notice the impact of deviating from the diet in how they feel, their blood sugars, mood, well being, etc.  Once someone feels well, they have an important point of reference.  If I can help people reach that well being point of reference, then I feel like I have done my job.  It then becomes up to them to decide if they want to continue to work and strive to maintain that state of being.

In two later messages, Dr. Beer added this:

I realize that I didn't mention enough about success with Paleo and diabetes.  Every patient I have ever had with diabetes who has adhered to the paleo diet for most of the time has experienced dramatic results.  Every one of them has been able to reduce their blood sugars and reduce their medications significantly, and in some instances, stop their medicine altogether.  This is not unlike other more known popular diets such as South Beach or Zone, which are actually quite similar to the Paleo diet in composition.  Of course, to achieve dramatic results requires a commitment to exercise as well, but the impact of diet is often profound.

Anecdotally, I saw a patient just yesterday who was able to raise his HDL cholesterol by 20 points with the Paleo diet.  He has been an avid runner and cyclist for years, but always struggled with a low HDL.  We discussed Paleo a year ago at his physical, and when I saw him yesterday, one year later, his HDL and lipid ratio had dramatically improved!

Dr. C. Vicky Beer practices internal medicine at Virginia Mason hospital in Lynnwood, Washington.

13 comments:

David L said...

What are your thoughts on dairy in the Paleo diet? I know you have written about the value of milk, whole milk in particular, and (I believe) raw milk.

If one has the European genes for dairy, I think that it has resulted in positive effects through genetic selection. And cultured milk is generally well-tolerated. And a fair amount of lactose intolerance is really an allergy to certain breeds of cattle.

gunther gatherer said...

Hi Stephan, what is your rationale for corn avoidance? I understand that many indigenous people North and Central America thrived on it.

Or are you mainly talking about refined corn derivates like oil and sugar?

jaguarjordan88 said...

@gunther

sources that say they thrived? i recall always reading the exact opposite in comparison with non-agricultural indigenous peoples

Jenny said...

Actually it requires no commitment to exercise at ALL to lower diabetic blood sugars by cutting out carbohydrates. I know plenty of people who have achieved normal blood sugars without exercise, including me during the long periods when my severely damaged back made exercise impossible. During the years when I've done exercise, I haven't seen any improvement in my blood sugars. In fact, too much aerobic exercise can burn off what's left of my glycogen and ruin the rest of my day, energy-wise.

There is also some research evidence that a subset of people with diabetes have a genetic variant of damaged mitochondria that deprives them of any benefits of exercise. Ditto those who take large doses of vitamin antioxidants.

But everyone has been so brainwashed about the supposed benefits of exercise, I'm not surprised a doctor would say this.

Dave Martindale said...

Hi Dr. Beer, thanks for sharing your experience. I'd caution you to revisit your assumption that there isn't much information on the paleo diet and that it isn't mainstream. The diet's enormous therapeutic success is steadily propelling it into the mainstream.

While I understand first hand the magnitude of the necessary dietary changes for many people and agree that an incremental approach may improve adherence, the paleo diet (with individual modifications and allowing for addition of some neolithic foods) is truly the Human Diet and its days as a little known 'fad' diet have passed. This google trends page compares the relative search frequency of 'zone diet', 'paleo diet', and 'south beach diet' for January 2012:

http://www.google.ca/trends/?q=paleo+diet,+south+beach+diet,+zone+diet&ctab=0&geo=all&date=2012-1&sort=0 (Paleo diet FTW!)

You don't need to refer to the diet you recommend as 'Paleo', but a lot 'information' has been written about the Zone and South beach diets that simply isn't true.

Again, thanks for your input on Stephan's blog and for everything you're doing for your patients.

Naxossa said...

Here is another guy who helped reduce obesity Think it is too expensive? Maybe it is too expensive not to change things.
http://www.youtube.com/watch?v=lcSL2yN39JM&feature=player_embedded

gunther gatherer said...

Sorry Stephan, I meant "do you agree with Dr. Beer on the corn and grain avoidance thing?" Thanks.

Nigel Kinbrum said...

@Jenny: Would you agree that, for most people, exercise (especially high-intensity exercise) is beneficial in terms of increasing muscular insulin sensitivity and shifting nutrient partitioning towards muscle mass and away from fat mass?

johnmask said...

Hey!
its good to listen this interview..
There is also some research evidence that a subset of people with diabetes have a genetic variant of damaged mitochondria that deprives them of any benefits of exercise. Ditto those who take large doses of vitamin antioxidants.
lose weight fast

Thanks!!

Bog said...

I think the whole rationale behind the "Fred Flinstone Cavemen" diets have been exceptionally well elaborated in the primitive nutrition videoserie.

Grandious language and whole lot of pseudoscientific BS is what these appeal-to-nature diet advocates are made of. If you (still) think the Inuits and Masai make up an epitome of good health you might want to watch some of the videos.

I recommend that people follow the whole thing in a chronological order. The rock & roll starts from the video number 2. Enjoy. Grains are covered in four video segments "The thing gruel of grains" (videos 22-23) and Phytophobia (videos 17-18)

Loren Cordain
http://www.youtube.com/watch?v=VQGo8gc8028&feature=plcp&context=C3e80575UDOEgsToPDskLOPxpER1jwxcXX8QcwPo4i

naturalweightlosstruth said...
This comment has been removed by the author.
Dr. Mike Tremba said...

Hello, Dr.'s Beer and Guyenet,
Thank you to both of you for putting together a great interview.
Something I reference frequently (right along side the statistics that Dr. Beer thoroughly cited), is the dramatic increase of grain consumption thanks to the subsidies of the government. These artificially low grain prices (unfortunately) are large contributors to obesity, diabetes, etc... (Realize I'm preaching to the choir here). I have to believe however, that the more educated we become, the more we'll demand from our suppliers, healthy food choices.
Thanks again.

subtle magnetism said...

I'd consider the paleo diet the most mainstream diet and lifestyle being pushed right now. Information (good and bad) is everywhere you turn: blogs, magazines, news reports, celebrity interviews - paleo is the new fad diet and has been for at least the last couple of years. Harkens back to Atkins, The Zone, etc. in terms of mainstream media communication and book deals, cookbooks and the like.

I'm always curious when people consider their own diet and lifestyle to be so misunderstood, hidden or so cutting edge they assume they are among a small, select group of practitioners, when Oprah is already endorsing it and you can find cookbooks supporting it already cycled into the B&N clearance rack.