In general, we recommend that grains (particularly wheat) be consumed in moderation. This is because wheat/grains are generally more complex, require more digestive energy, interact with the intestinal bacteria more, tend to be inflammatory, can exacerbate gastrointestinal dysfunction, and in some cases, represent a food source to which people can be immunologically sensitive. In some cases, however, it may be necessary to not only avoid grains, but to completely eliminate them from the diet. These cases often involve significant gastrointestinal dysfunction (perhaps that does not respond to other therapeutic options) or significant immunological dysfunction (i.e., autoimmune disease). Additionally, we would classify dairy in a similar manner: we recommend that it be consumed generally in moderation, but in these circumstances, may require complete elimination. (Exception: a small amount of hard/aged cheese [low in lactose] may be consumed if tolerated).

The elimination of grains and dairy from the diet (in addition to processed seed oils) in favor of meat, vegetables, fruits, and tubers begins to look very similar to what is referred in the nutrition community as a “Paleolithic” (Paleo) diet. But the problem with the Paleo diet is that while it is not defined by this property, it more often than not ends up being a low-carbohydrate diet due to the elimination of grains. Low carbohydrate diets are antithetical to the bioenergetic perspective because low-carbohydrate diets cause secondary hypothyroidism, stress activation, and long-term metabolic dysfunction. And this is often what we see in clinical practice, patients feel better on a Paleo (or even “Carnivore” diet) in the short-term from the perspective of gastrointestinal and/or immunologic function, but develop long-term energy and hormonal problems due to the low-carbohydrate aspect. (Additionally, Paleo diets typically allow for seeds and nuts, which we discourage).

So how do we reconcile this? Answer: aggressive intake of healthy, non-grain, non-artificial carbohydrates (fruits, roots, and honey) to make the total carbohydrate intake normal (i.e., normal-carb Paleo). The key to doing this, however, is to supersede what one would generally consider a “normal” amount of these healthy carbohydrates. For example, one might consume 4-5 pieces of fruit, 3 x 10-ounce glasses of healthy fruit juice (no added/artificial sugar), and potatoes to obtain a normal carbohydrate intake. The amount of fruit and fruit juice in particular might seem abnormally high to some people, but remember that we are purposefully being aggressive with the fruits and roots to make up for the elimination of grains.

Consider the following example:

  • Breakfast: 3 medium eggs, 1 tbsp grass-fed butter, 1 medium banana, 10 oz orange juice, 8 oz coffee, 2 tbsp honey
  • Lunch: 1 medium chicken breast, 1 large baked potato, 1 tbsp grass-fed butter, 1 cup cooked broccoli, 1 tbsp olive oil, 10 oz apple cider, 25 grapes
  • Snack: 1 medium pear
  • Dinner: 5 oz beef steak, 0.5 cup of cooked cassava, 2 cups tossed salad, 1 tbsp olive oil, 1 tbsp apple cider vinegar, 10 oz apple cider, 2 cups cantaloupe

Note how we are able to achieve the target macronutrient ratios without addition of any grains or dairy. Recall that our recommended macronutrient ratios are: Protein: 15-25%, Net Carbs 50-60%, and Fat 20-30%. Again, we understand that this amount of fruit and fruit juice may seem “crazy” to some, however, remember that intake of these healthy carbohydrates will not causes significant elevation of the blood sugar, but rather improve thyroid, hormone, and metabolic function in the long-term. It should also be clearly stated that if you are transitioning from any type of low-carbohydrate to a more bioenergetic, normal-carb diet, this needs to be done slowly. For example, we might recommend that the relative carbohydrate intake increase by 5% per week until at goal. The gradual re-introduction of carbohydrates is necessary to prevent dramatic swings in the gastrointestinal microbiome environment as well as to prevent weight gain.