Why are we continuing to compare our current dietary requirements with those of pre-modern era people? We're a very different people now, we also live longer. I'm not sure how relevant or useful the pre-modern era diet is to us.
Of course, the general jist of the "paleo" diet is fair - eat proper food.
Our physiology isn't really any different, except for the artificial alterations thereof. Human is human. Dietary needs may vary based on region, but not time period.
Also, we don't necessarily "live longer" now either - it depends entirely on a host of conditions, including sanitation, access to food, disease control, lifestyle, sociopolitical factors, and the like; all that varies from one culture to the next. There are some pre-modern cultures that may have lived longer than some modern cultures, and there are certainly some that lived proportionally as long or longer, once you factor in death causes that have nothing to do with health. (Consider also how many health problems are modern, first-world phenomenons.)
Thus, "we're healthier now than before" is more of a blanket statement that fails to account for thousands of factors. It's difficult to do a complete comparison straight across the board (e.g. we don't have to fear attacks by warring Mongols that cut our life expectancy short), so we look at individual topics without drawing artificial correlations between them. We don't have a life expectancy of 70-80 years because of our diet and lifestyle - we have one of the most nutritionally devoid diets in history, and we tend to be dangerously sedentary - we live long because of healthcare. When we make comparisons in history, we can't just look at "when did they die;" we MUST look at "WHY did they die?" A population dying of smallpox means we can't make the claim "they died young because of poor diet," because their diet may in fact have been quite good (or bad). This is why forensic anthropology is a thing.
As always, those who fail to learn from history are doomed to repeat it.
(Note, I've said nothing herein about the breakfast vs. no-breakfast topic; there are some interesting and valid points on both sides that warrant further inquiry. History has examples of both.)
Agreed, I think there are issues with modern food that make folks more likely to be in poor shape.* But some diets strike me as going too far in reacting to that by appealing to nature.
With paleo, legumes are prohibited because of phytates, but spinach and chard, and are cooked lightly (if at all) compared to beans, aren't, despite their oxalic acid content.
IMO for people who are overweight by, say, 20 lbs or more, calorie reduction will have the largest impact. To the point where recommendations based on meal timing & micronutrients (or even macros, to a certain extent) are only useful in that they might help with compliance.
(Which might still make them very useful. Good compliance is 100% necessary for success. But what works for compliance varies from person to person.)
As one gets closer to the ideal weight range, some fine-tuning might be in order, but I think it's important not to let such things take priority over plain old energy balance.
* Without getting too deep into it, I think hyperpalatability is the big issue -- the practice of adding synthetic flavoring to foods has done a number on our collective palate, and made high-calorie, low-nutrient foods more appealing than they'd be otherwise. The same techniques used to used to fatten up livestock are used to drive food sales, with predictable results.
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