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This post received some minor updates on Oct. 22, 2014 and Nov. 14, 2017. It addresses the Paleo diet specifically, not AIP (autoimmune protocol). To learn more about my stance about both the Paleo and AIP diets, read the chapter, “Why This is Not Another Paleo or AIP Cookbook” in my #1 best selling Essential Thyroid Cookbook: Over 100 Nourishing Recipes for Thriving with Hypothyroidism and Hashimoto’s.

As popularity in the Paleo (short for Paleolithic) diet has grown, so have questions from my clients about its merits. Many of my clients are nutritionally savvy – they’ve done a lot of their own research on hypothyroidism, Hashimoto’s, and adrenal dysfunction, and come to me to help them sort out the contradictions and confusion and give them a supportive program with which they can start putting one foot in front of the other. And there’s a lot of confusion about the benefits of going Paleo.

I’m not saying I have all the answers (who does?), and I’m not an expert on the pros and cons of the Paleo diet, but doing this work for a few years and seeing impressive results, not just for my clients, but also for myself, gives me a good sense of what’s hype and what’s real and effective and what can help people move the meter on their thyroid- and adrenal-related fatigue, brain fog, sleep issues, weight issues, hair loss, and moodiness. And other symptoms. And to put a damper on the autoimmunity that’s causing these symptoms in the first place.

When it comes to nutrition for low thyroid function, especially Hashimoto’s, you can’t throw a stick without hitting a blog or website about the importance of implementing a Paleo diet. It’s a craze, if you ask me, and I’m kind of tired of hearing about it.

As Sean Croxton said, “Let’s face it, going 100% Paleo isn’t for everyone. Even me. To the average person, despite its benefits, Paleo can seem intimidating, restrictive, and at times kinda annoying, to be honest.”

Prior to my “Paleo fatigue,” I watched with distance interest as the craze took hold. I’ll admit, that there was a part of me that felt like I should go Paleo. And I felt that perhaps I was doing my clients a disservice by not promoting it and educating them about it. I considered it, even though my horse sense was telling me there is nothing wrong with eating whole grains (gluten-free, of course).

Much to my delight, in May of this year, Experience Life magazine published a moderated debate of sorts – Paleo vs. Vegan. As of a few weeks ago, this piece was the most-read article on their site. (Interestingly, I found out last week that my recent Repair Your Thyroid article is currently the most-read. I’m so tickled.)

(If you don’t want to read this whole post, scroll down for my numbered list of reasons why I feel that the Paleo diet isn’t all it’s cracked up to be, especially for people with Hashimoto’s.)

I felt that this article kind of let me off the hook. Even some of my favorite health and wellness experts aren’t convinced that going Paleo is the end all be all, and although I’ll never go there, there is a lot of merit to veganism as well. It depends on who you ask, what you believe, and how you FEEL when you’re experimenting with different ways of eating.

So who’s right? No one. Because we’re all individuals. And as I learned in school, nutrition is the only science where opposing theories can be proven right.

With a Paleo diet, you’re only eating what’s believed to be the foods that our ancient ancestors ate, mostly foods you can forage for: meat (grass-based/pastured only), fish, vegetables, fruits, nuts, seeds, herbs, spices, eggs, unrefined coconut and olive oil, and animal fats like ghee (butter oil), lard, and tallow. Some followers say eat minimal fruits and some only support eating berries.

I’m all for all of these foods. There isn’t a darned thing here that I don’t eat regularly, with the exception of lard and tallow, even though I think they’re fine to consume.

Where I start to glaze over is when Paleo enthusiasts proselytize about the dangers of grains and legumes.

Update: Here are two posts written after this post was published: In Defense of Grains and In Defense of Legumes. You can find even more information on the benefits of grains and legumes in my Essential Thyroid Cookbook.

They consider the lectins in grains and legumes “poison” and to cause leaky gut and an immune response. Phytic acid, also found in grains and legumes, is said to bind to zinc, iron, calcium, and magnesium, causing us to be deficient in these nutrients.

Most Paleo eaters agree that seeds and nuts are fine, but there is evidence pointing to the fact that seeds and nuts actually contain more phytates. (Granted, many Paleo followers are soaking, fermenting, and sprouting their seeds and nuts, which removes most of the phytic acid.)

There are so many people who’ve eaten grains and legumes all their lives and thrived. And not all grain- and legume-eaters are deficient in zinc, iron, calcium, and magnesium. (It’s good to check your levels.)

The Paleo crowd also eschews soy (a legume that I’m not a fan of myself), dairy, sugar, caffeine, and oils derived from seeds and grains, which can be high in inflammation-promoting Omega 6 fatty acids. Some say no eggs. And no starchy vegetables because they can’t be eaten raw.

Sugar and sweeteners? Sure, we can live without them. Dairy? Sure, it’s yummy (can anyone say HARD CHEESE?), but many people are dairy-intolerant (including many with Hashimoto’s) and do well to eliminate it.

If you ask me, Paleo folks are really making best guesses here, as there’s a fair bit of controversy about what our ancestors did, in fact, eat. According to Dr. Andrew Weil, “…it is unlikely that we would find many of the actual foods they ate appealing.”

With the exception of starchy vegetables, which some Paleo followers accept, the Paleo diet smacks of the Atkins diet all over again. And we all know what happened with the Atkins diet – it came in like a lion and out like a lamb. For good reason, I feel.

I wholeheartedly agree that the Paleo diet has its strong points and I adhere to what I would consider to be a Paleo template. But not because I’m jumping on a bandwagon – I was eating this way before Paleo became the diet du jour. And it’s generally how I encourage my clients to eat.

I believe that clean protein and vegetables (starches included!) are what our diets should primarily consist of, with some true whole grains (not flour-based products) and legumes. And minimal fruits. And dairy, if you can tolerate it.

Below are my beefs with Paleo. Let’s start with the fact that Paleo is low-carb. Many Paleo folks will pound on their chests declaring that it’s not, but if you eschew grains, legumes, and starchy vegetables, you’re eating a low-carb diet. I know they generally don’t like the comparison to the Atkins diet, but there’s little distinction.

Below are my Paleo “issues.” Again, you can find even more information in my Essential Thyroid Cookbook.

1. Our bodies do not like carb restriction. The body views caloric restriction as a stressful response and it gets doubly concerned when carb intake drops. (Important: since the original writing of this post in 2012, many anti-carb promoters have gone “moderate carb” or even completely backpedaled on their anti-carb stance. Why? Read on…)
2. If you want to maintain optimal thyroid function, low-carb diets are not a wise idea. Low carb diets can lower T3, your active thyroid hormone, and increase Reverse T3, which acts against thyroid hormone production and is often associated with adrenal dysfunction.
3. Eating legumes is largely how vegetarians and vegans get their protein. Limited protein in the diet = limited T4/T3 conversion for those with hypothyroidism. (And what about vegetarians and vegans who believe in the benefits of being legume- and grain-free? What are they supposed to eat? Just vegetables? That’s not healthy or filling.)
4. Give your thyroid some love in the form of carbs, and it will return the favor in the form of improved cold tolerance and better overall body temperature regulation – which many people with low thyroid function struggle with. More stable body temperature = improved thyroid function and more stable adrenals.
5. Excess protein in the diet can cause brain fog and can leech calcium from the bones. One popular Paleo proponent writes, “And the fact that phytates are chelating calcium out of our bodies means that we have less access to that bone-building and nerve-transmitting mineral we’re all so fond of.” Um, excess protein leeches calcium too.
6. I realize that magnesium is derived from all kinds of foods, including nuts and seeds and most vegetables, but legumes and grains are also a fantastic source of this important mineral. Magnesium has been nicknamed “the miracle mineral” because of its incredible benefits. 
7. Again, Paleo proponents hate the Atkins comparison, but what made Atkins successful for weight loss is that it puts people in a state of ketosis. Sure, you’ll probably drop weight quick-like on the Paleo diet – because you’re eating a ketogenic diet, or close thereto. Ketosis occurs when metabolism shifts towards obtaining energy from fat stores vs. food. Ketones (waste products) make insulin levels fall so low that the muscles and tissues of the body burn body fat for energy, as during starvation. This is hard on the heart and kidneys – it can cause kidney stones – and ketones makes the blood acidic. And it can give you keto breath. Not sexy.
8. Carbs, and more specifically, the glucose in carbs (a form of sugar), are the primary fuel source for many of the body’s vital organs, including the brain. The brain is a glucose hog, and this is why many Atkins dieters complained of feeling tired, angry, depressed, spaced out, and tense. And it’s probably why some Paleo dieters don’t stick to the diet long. Research has shown that carb-restrictive dieters tend to become depressed about two weeks into their diet, about the time their serotonin levels (a neurotransmitter and feel-good brain chemical that elevates mood, suppresses appetite, and has a calming effect) have dropped due to decreased carb intake. Carbs trigger a release of insulin into the blood stream. Insulin goes about clearing all the amino acids out of the blood, with the exception of tryptophan, which is an amino acid that normally gets crowded out by other amino acids in its attempt to cross the blood-brain barrier. Yet when its competitors are out of the way, it enters the brain and is converted to serotonin. More serotonin = a sense of happiness and wellbeing.
9. A low-carb diet can cause hair loss. Not great for people already losing hair due to low thyroid function.
10. A low-carb diet is not a good idea for someone seeking pregnancy. Granted, clean, quality fats and proteins are super important for fertility, but eating these macronutrients with little to no carb balancing can thwart your ability to become pregnant.

* * *
Okay, back to the autoimmune thing. Some Paleo experts feel that eating a Paleo diet is important if you have autoimmunity (in the form of Hashimoto’s for the hypothyroid community). It’s not. And I’m living proof. And so are many of my clients.

Update: Since this post was written, the AIP diet has become popular for those with autoimmunity.

When I embarked on my drug-free autoimmune/Hashimoto’s-slaying journey in 2008, Paleo wasn’t a big deal yet. Yes, being 100% gluten free is non-negotiable if you have Hashimoto’s (or any autoimmunity), but non-gluten grains like amaranth, buckwheat, corn, and rice were a regular part of my diet as my thyroid antibodies plummeted and as I started to get relief from my hypothyroid symptoms and feel better.

One popular thyroid/Hashimoto’s doctor said, “People with autoimmunity can’t handle grains.” Really? How can you make this blanket statement? How can this be applicable for every.single.person with Hashimoto’s?

NOW…I will say that for people who have significant gut dysbiosis or leaky gut or SIBO (small intestine bacterial overgrowth) or IBS (irritable bowel syndrome), or any kind of intestinal imbalance, which is common for those with autoimmunity, it MAY be beneficial to remove grains and legumes from the diet for a period of time. A Paleo-ish diet can be a therapy for healing these imbalances and bringing integrity back to the intestinal lining and to the digestive system.

When it comes to healing the thyroid and taming autoimmunity, you always have to address gut function. But are grains and legumes always the culprit? And is eliminating grains and legumes the silver bullet for healing? I don’t think so. Staying on this diet forever? I don’t believe it’s necessary. Or sustainable.

According to Dr. Weil, “There’s no harm, and some potential benefit, in trying the Paleo diet, but I believe the diet is too restrictive for most people to stick with long term. I think success is more likely for the majority if they regard it as healthy direction, rather than as a strict set of guidelines from which one can never deviate.”

Here’s when I recommend eliminating grains and legumes: when a diet that helps determine foods sensitivities that in turn antagonizes the immune system (an Elimination/Provocation diet), along with gut-healing supplementation, has proven unsuccessful in healing the gut and taming autoimmunity. Most of us have a food sensitivity, and many have more than one. If you continue eating dairy on a grain-free diet (which I realize isn’t “Paleo”), you’ll still have problems.

Examples of how going Paleo without identifying food sensitivities won’t get you very far: Many people are sensitive to nightshades (potatoes, tomatoes, peppers, and eggplant), which aren’t often on lists of potential food offenders.

And of the three biggest offenders (wheat/gluten, dairy, and eggs), eggs are allowed by most Paleo folks. Simply put, eating foods you’re intolerant of is a huge impediment to healing and identifying these rascals is more important than going Paleo.

Identifying food sensitivities will go a long way in helping you heal and in getting a handle on autoimmunity. And for those who still struggling with gut issues, I recommend eliminating grains and legumes – as a therapeutic diet, not a lifelong commitment. Heal the gut, and many of the previous “irritants” can be eaten in moderation.

I’ve known a few Paleo adherents who did well on the diet for a while, only to hit a wall. Maybe they saw some of their autoimmunity flare up, or they didn’t feel as vibrant as they did the first year or so. And they scrambled for answers, only to eliminate even more foods from their diet (??), finding themselves emotionally miserable, confused, and not feeling any better.

The stress and distress of this type of situation only serves to cause more damage to the gut lining and to up the ante on autoimmunity.

I’ve also known people who’ve tried going Paleo and felt ill. A common response from the Paleo community is often, “You did it wrong.” And thus the proselytizing ensues. But I’m not a fan of the, “I’m going to make you wrong to prove me right” position. 

It bugs me to no end when diet becomes a religion. And when diet fanatics find out that you don’t pray at the Paleo or vegan or raw food altar, you’re seen as “wrong.” Nevermind that diet is an individual choice and that it’s really not anyone’s business how you or I eat.

I feel sorry for anyone who has excommunicated themselves from the church of Paleo. Paleo proponents can be pretty dogmatic, to say the least. Again, I eat a “Paleo template,” so I’m not saying that the principles of the diet are wholeheartedly faulty. I just don’t like the rigidity. 

And again, while I don’t have all the answers, I feel that some of you will be let off the hook – maybe that gremlin on your shoulder who’s been telling you you “should” go Paleo will be quieted. (Remember, don’t “should” on yourself.)

According to Ann Marie Michaels, author of the hilarious and engaging blog, Cheeseslave, “The Paleo diet is fundamentally flawed. It’s a diet based on misinformation about the past and the present. Paleo adherents believe that the hunter-gatherer lifestyle is somehow superior to that of the sedentary agriculturalist. It is a romantic ideal based on fantasy, not reality. The reality is that living as a hunter-gatherer is not an easy life, and it was not a lifestyle people chose because they thought it was cool or better.”

It’s all about experimentation. It’s fine to explore different ways of eating. Try a Paleo diet, if you feel inclined. And if you FEEL great, fantastic. I’m all for that. But once you’ve moved through the therapeutic phase and things don’t seem to be working as well, don’t beat your head against a wall trying to fit a square peg in a round hole.

As Dr. Frank Lipman says, “When it comes to crafting your own eating plan, listen to your body. I think we are all biochemically unique, and there is no one right diet that works well for everyone.”

Conclusion: I ba-leeeeeve (from-the-pulpit reference there) in many of the principles of the Paleo diet. I love the idea of a Paleo template. It’s how I eat. But given that we don’t really know what our ancestors ate, and that a restrictive diet isn’t sustainable long-term for most people – and can be stress-inducing – I’m not singing in the choir.