Does my reasoning "suffer"?

Cures for sick people aren't necessarily the basis of preventative treatment. So, what he sees work for sick people need not translate in advice for those who want to maintain rather than recover health.

My medical experience is 23 years of seeing -literally with the aid of advanced imaging- the effects of diseases of civilization, and how ineffective most standard medical therapy is for them. The ubiquity of the DOC and the inefficacy of standard medical care is what got me started reading about nutritional approaches to health 4 years ago.

When have I ever, even once, suggested a standard medical therapy for healthy people to employ in preventing disease?

I am in fact the one health blogger who does the exact opposite. I just wrote an entire post emphasizing how we should not assume the identity of "sick" as default. It's called "therapy versus life".

Have you even read the blog? I am very surprised that of all the pill and supplement pushing writers out there, you would name me as inappropriately applying therapy for the sick for prevention. I've never done any such thing. I am the only MD blogger I know of who recommends little to no laboratory testing. I OWNED a CT scanner and yet never recommended routine calcium scoring.

To push the envelope, why is his experience helping to diagnose the sick relevant to preventative medicine like proper nutrition?

Are you seriously asking how experience in diagnosing is relevant to preventive medicine? Would reading the same huge number of articles mined from pubmed but without medical training or experience make me less "biased" by not understanding what I'm reading about?

To further expand on my training - like most subspecialty trained radiologists, I spent at least half of my career doing general radiology, where you are responsible for knowledge of and diagnosis of literally every disease that can show up on a CT scan MRI or x-ray in patients of every age. This is a pretty broad grounding in human disease, and I would argue no specialty in medicine sees more of it.

If you think these insights are irrelevant to prevention, I would ask "how do you know what to prevent if you don't understand well what exists in the first place"?

I think Dr Harris could be biased somewhat about the prevalence or perniciousness of metabolic disorders due to the people he deals with in his practice. If you see NAFLD all the time, it's easy to have that bias your perception of the general population.

At the same time, however, I don't think his recommendations have much to do treating sick people. He's stated that he's "not a weight loss guy" and is more interested in helping people not hurt themselves than he is in healing them (something which he doesn't see as necessarily possible in all cases). His recommendations are deliberately generalized and when you read his blog you realize that in most cases what he's trying to get people to do is avoid excess fructose, seed oil and wheat - very general sorts of actions. He's not trying to preach to the sick with specific strategies to overcome various problems.

His relevant experience comes not from his professional career, but from his claimed reading of studies and literature relating to nutrition. If it turns out that he's been making all this up and never read anything, then he's a charlatan. So far, though, there's no reason to believe that. He seems genuine enough, and his claims are broadly in agreement with what you might find on your own.

As for Paleo and treating disease, it clearly depends on the disease. Switching to paleo will not fix tuberculosis, but it might help if you have a metabolic disorder or IBS. And since one of the foundational points of paleo is that eating correctly allows your body to function correctly, then the treatment is the same as the maintenance if it works; you just eat paleo and you're set. I don't see many people out there advocating severe diets for "treating" diseases and then different diets for "maintenance"; usually, if the "maintenance" diet doesn't work on the front end, it's not going to work at all.

Hi, Mike/mac389, it seems you are asking two questions, and then some other questions have spun out of those in the answers/comments. I'll talk about your two questions, and try to keep my responses distinct.

First, on your primary (and first) question, I'm surprised that no one has given what seems to be the obvious response: Dr. Harris might see a lot of people with metabolic syndrome and related issues, but we all see a lot of people with metabolic syndrome and related issues -- because it's everyone around us. So the fact that he's a doctor doesn't seem to change his perspective all that much. (If anything the more relevant selection bias / confirmation bias might be the one we all have as paleos, doctors and non-doctors alike: we all see metabolic syndrome everywhere since we're looking for it everywhere.)

Second, as a response to what I think is your second question, the question about the consequences that might come from a Berkson's bias, since preventative care may not be the same as reparative care: Sure, I think that pfw is right for the most part to say: if you're healthy eat paleo, and if you're sick eat paleo. But even within paleo/real-food approaches there are some differences. So, for example the last section of the Jaminets' book is a fascinating (although speculative) discussion of the different things you might do with your diet and lifestyle to address extracellular versus intracellular infection. Similarly you might think that a particular species of paleo diet might be best to deal with cancer (see some recent threads on PH). Or you might think that you need to change your diet radically to heal your digestive tract before returning to a more inclusive paleo way of eating.

Those are my answers to each of the questions.

An additional question might be how the two questions relate to each other. As a general statement we can say that there are selection biases (seeing an unhealthy population in your office) that lead to bad medical advice. But in most cases it seems like they don't. Like paleo dietary advice, for example. Although even there there are exceptions: like the ones I gave above. (Or perhaps that it would be bad to switch very suddenly to a high-fat paleo diet immediately after a heart attack, etc.)

From the OP

"In sum, I'd be interested in the community's thoughts on how Paleo approaches to treating disease differ from maintaining health. In particular, other than for parsimony's sake, why should we assume them to be the same, when evidence exists that they aren't?"

I believe there is a trend towards moderation in much of the paleo blogosphere. Many now recognize that, say, potatoes or even rice are fine for those with healthy metabolisms. There are several bloggers who (I'd say) aren't really concerned with "paleo" per se but more about diets informed by tradition (chris masterjohn, melissa mcewen, paul jamninet, stephen of whole health source (sp?), etc etc). Stephen from whole health source recently said he was fine with limited gluten, rather than strict gluten avoidance.

This trend of moderation seems to answer your question, at least partly. As bloggers have recovered their health, there is a move to diets that are simply about 'maintaining health'. there is some disagreement with the idea of a 'paleo solution' (referring to robb wolf's book here), i.e. a diet that should be given to celiacs, diabetics, and the overweight, which is then prescribed for everyone.

Personally, I think the final step of moving to a maintenance diet has been dropping the term 'paleo' from my vocabulary. I am more inspired now by traditional food practices and in simply limiting gluten. I see no problem with having a beer or two here and there, even if it contains gluten. The idea of a strictly limited 'paleo solution' or 'whole9 30 day paleo plan' is just unnecessary for me at this point.

Huh? Harris is a neuroradiologist by trade. Neuroradiology "is a subspecialty of radiology focusing on the diagnosis and characterization of abnormalities of the central and peripheral nervous system, spine, and head and neck." I infer therefore that his views on nutrition, exercise, and other subjects discussed here are not primarily and perhaps not significantly derived from his medical practice experience.

A dietary problem (the SAD) is best addressed with a restoration of a diet that is consistent with human evolutionary design. Though we may think of food as medicine, it's not that the fatty steak is a delicious magic pill, it's that it is standing in for what was a highly toxic meal, such as a plate of spaghetti. We aren't feeding ourselves medicine, we are removing toxins and feeding ourselves food.

i don't think kurt harris has asked for his positions not to be debated. in fact, i think he's asked for quite the opposite. he has said that he gives what he considers conservative recommendations and tries not to get too far ahead of the research. i have no degree in any of this stuff but i fail to see where kurt harris' drastically differs from robb wolf, chris kresser, mark sisson or any of the other paleo bloggers out there. so, why are we singling dr harris out?

Paleo is a very young and emerging field. One of the main confusions is the difference between paleo for sick people trying to get well, and paleo for healthy people trying to get healthier (or perhaps trying to remain that way). Paleo interventions in either case are going to be different, but we don't yet have a way of making the distinction. I think your question reflects this confusion.

If you are talking about degenerative diseases than it is really no different. Drugs usually treat symptoms of these degenerative diseases so drugs are not really a treatment.

If you are talking about some kind of infection such as cholera, I'll be the first one to ask for antibiotics.

It's not about strictly believing one person's opinion, no matter how scientifically informed. It's about looking for converging evidence from multiple sources. These can be bloggers, scientists, MDs, evolutionary theory, your own reading of the literature, etc.

Is there a known nutritional disease in which a type of eating cures disease but also causes it? I could see maybe a method of eating would cure one disease but maybe cause another. Touche on that one. Of course, if a lot of people switched to such a 'cure' It think you would then noticed a lot of this new prob taking it's place. Ane even if that were a danger, I think I'd still be interested in trying a cure for a disease that I might already have, even if it meant I MIGHT (but might not) get another one in the future. Because a disease I have now is probably more pressing than the chance of disease in the future.

Then again, paleo does not rest on just the theory that treatments might also make for good maintainance tactics, if if that is more probable than not. It also rests on understanding what we were designed to eat and always ate until recently, and it rests on what more healthful groups of people eat. And for everyone who has a problem, it also of course rests on treatment of those probs.

But my point is, paleo does not, or at least should not, rest on the ideas and assumptions of one person and one person's goals and concerns. Paleo is a process of taking in the whole milieu of data and considering it as fairly as possible. That may not be what always happens, but it's still a nice goal and one I like to think we do strive for.