I would say it's all-or-nothing for the first few months. Your body needs to convert its metabolism from fat-burner to sugar-burner, and that won't happen if you do it half-ass. After you're adjusted, you can cheat a little 80/20. But you can never go "off" the diet totally or the ailments will come back.
5'0" female, 43 years old. Started Primal October 31, 2011, at a skinny fat 111.5 lbs. Low weight: 99.5 lb on a fast. Current weight: skinny-fat 106 lbs. Resetting with the 21-day challenge.
MY PRIMAL: I (try to) follow by-the-book primal as advocated by Mark Sisson, except for whey powder and a bit of cream. I aim for 80-90 g carb/day and advocate a two-month strict adjustment for newbies. But everybody is different and other need to tweak Primal to their own needs.