Tag Archives: paleo meals

FOOD-official-meatFor over a decade now, a debate has been raging within the nutrition science community. One side views saturated fat as generally unhealthy; they recommend replacing these fats, at least to some degree, with omega-6 polyunsaturated fats. The other side views saturated fat as health-supportive, or at least health-neutral; likewise, they regard omega-6 as somewhat unhealthy and typically recommend decreasing its consumption. So, who has it right? The truth seems to be grey and somewhere in between.

 

The Modern Diet

Americans have largely followed the US government’s dietary advice for the past 40 years. For example, following official dietary advice in the 80s to reduce fat in our diets, we decreased our fat consumption from 45 to 34% of calories, on average, while increasing our carbohydrate consumption from 39 to 51% of calories [i].

We made these changes because doing so – or so we were told – would decrease cardiovascular disease (CVD), which was and still remains the number one cause of death in the western world.

However, there are also different types of fats (see Figure 1) and both international and US government guidelines have made recommendations about the types of fats we should consume. Current recommendations suggest reducing saturated fat to a maximum of 10% of total calories while increasing omega-6 to somewhere between five and 10% of total calories  [ii], [iii].

Figure 1. The basic types of fat.

Different Types of Fats

 

As a population, we’re pretty much within these recommended zones. We get 11% of our calories from saturated fat and 8% from polyunsaturated fat (primarily the omega-6 variety)[iv], [v].

CVD mortality has declined since its peak in the 1950s, but CVD prevalence remains very high. For example, the total number of inpatient cardiovascular operations and procedures increased 28% between 2000 and 2010 (from 5.9 million to 7.6 million procedures) [vi]. Moreover, prevalence of metabolic syndrome, a precursor to CVD, has reached a staggering 34% of the population [vii].

If the advice to replace saturated fat with omega-6 was designed to reduce CVD, then what went wrong? Was the advice misguided? Let’s look at the evidence.

 

The Pro-PUFA Studies

Numerous recently published meta-analyses support the conclusion that replacing saturated fat with polyunsaturated fat (though not necessarily omega-6) leads to modest CVD risk reductions. For example:

 

  • Mozaffarian D, et al. (2010) pooled data from 8 randomized controlled trials (RCTs) encompassing 13,614 participants and 1,042 coronary heart disease (CHD) events. They determined that for every 5% caloric increase in polyunsaturated (PUFA) fat there is a corresponding 10% decrease in CHD risk [viii].

Study Limitations: PUFA consumption for this study included both omega-6 and omega-3. Therefore, it’s possible the positive results may have been primarily from omega-3; negative effects from omega-6 could have been masked.

 

  • Hooper L, et al. (2015) pooled data from 13 long-term RCTs encompassing 53,300 participants. They found “a small but potentially important reduction in cardiovascular risk when saturated fat intake was lowered,” particularly by replacing saturated fat with PUFAs, but not by replacing it with carbohydrates [ix]. However, the study found no clear effect of reducing saturated fat on total mortality.

Study Limitations: Among these RCTs, omega-6 and omega-3 PUFAs were grouped together. Therefore, analyzing the individual impact of either PUFA was not possible.

 

  • Farvid MS, et al. (2014) conducted a meta-analysis of 11 studies pertaining to omega-6 (LA) intake and CHD. They concluded “a 5% of energy increment in LA intake replacing energy from saturated fat intake was associated with a 9% lower risk of CHD events and a 13% lower risk of CHD deaths”.

Study Limitations: (1) Whereas this study did specifically measure omega-6, it didn’t account for the ratio of omega-6 to omega-3 (referred to as “n-6/n-3” hereafter), (2) the meta-analysis only included observational studies, not RCTs, and (3) the meta-analysis measured cardiovascular disease mortality, but not all-cause mortality.

 

  • Yanping Li, et al. (2015) conducted a meta-analysis of two observational studies, the first of which followed 85,000 women for 24 years and the second of which followed 43,000 men for 30 years. In total, 7,667 cases of CHD were documented. The authors concluded that replacing 5% of the energy intake from saturated fats with equal energy from PUFAs was associated with a 25% reduced risk of CHD [xi].

Study Limitations: (1) The study was observational (no RCTs were included), (2) the study didn’t account for the n-6/n-3 ratio, and (3) the data was derived from food frequency questionnaires.

 

  • Wu JH, et al. (2015) conducted a cohort study of 2,792 older US adults (mean age, 74). To avoid the problems associated with food frequency questionnaires, they analyzed circulating omega-6 (LA only) blood levels, an objective biomarker of LA consumption[xii]. Those within the highest quintile of circulating LA had 13% lower all-cause mortality than those in the lowest quintile. Interestingly, when the authors stratified subjects based on combined LA and omega-3 PUFA concentrations, those in the highest quintile had a 54% lower all-cause mortality risk compared to those in the lowest quintile.

Study Limitations: This study was designed better than most, but didn’t completely demonstrate how changes to the n-6/n-3 ratio affect mortality.

 

The Anti-PUFA Studies

Christopher Ramsden, MD is a clinical investigator for the National Institutes of Health. During the past decade, Ramsden has been among the most prominent scientists challenging the mainstream narrative that omega-6 should replace saturated fat. Through a series of studies, most of which were published by the British Medical Journal, Ramsden and his colleagues have put forth an important antithesis [xiii], [xiv], [xv]. Some of their conclusions include:

  • Increasing omega-3 relative to omega-6 significantly reduces the risk of heart disease.
  • Diets rich in omega-6 increase risks of all CHD endpoints, while increasing all-cause mortality risk.
  • Substituting dietary omega-6 LA in place of SFA increases all-cause mortality risk, as well as risks from coronary heart disease.
  • Benefits previously attributed to greater intake of total PUFAs may be specifically attributable to omega-3 and not to omega-6 LA.

Some of the problems with the studies used to justify increased omega-6 consumption, according to Ramsden and his colleagues, include:

  • Failure to distinguish between trials that selectively increased omega-6 and those that substantially increased omega-3
  • Failure to acknowledge that omega-6 and omega-3 replaced not only SFAs, but large amounts of trans-fats in many trials used in the pro-PUFA meta-analyses
  • Failure to provide the specific compositions of the diets (particularly with respect to omega-6 and trans-fat) used in the pro-PUFA meta-analyses
  • Failure to analyze the impact of n-6/n-3 ratios


The Middle Ground

As you can see, the consumption of saturated fat and omega-6 are controversial, partly because we lack rigorous studies specifically designed to test the optimal balance between saturated fat, omega-6, and omega-3. This was precisely the conclusion of a 2015 Cochran review by Al-Khudairy L, et. al. [xvi].

The authors sought RCT data demonstrating the effectiveness of increasing or decreasing omega-6 for the prevention of cardiovascular disease. Additionally, they wanted to assess the impact of total omega-3 consumption and the n-6/n-3 ratio.

Unfortunately, “very few trials were identified with a relatively small number of participants randomized.” They concluded, (1) there is currently insufficient evidence to recommend either increased or decreased omega-6 consumption, and (2) larger, better RCTs on this topic are needed.

 

Conclusion

In Part 1 of this article series, we’ve seen that many critical questions about optimal saturated- and polyunsaturated fat consumption levels haven’t yet been answered by science. While we wait for better RCTs to be conducted, we can gain deeper insights and a better understanding of this issue by examining the fat consumption patterns of our Paleo ancestors. Be sure to check out Part II of this series, where we’ll do just that.

 

References

[i] Cohen E, et al. (2015). Statistical review of US macronutrient consumption data,

1965–2011: Americans have been following dietary guidelines, coincident with the rise in obesity. Nutrition, 31. Retrieved from (link).

[ii] US Department of Health and Human Services and U.S. Department of Agriculture. (Dec 2015). 2015–2020 Dietary Guidelines for Americans. 8th Edition. Retrieved from (link).

[iii] FAO. (2010). Fats and fatty acids in human nutrition: Report of an expert consultation. Rome: Food and Agriculture Organization of the United Nations. Retrieved from (link).

[iv] Ervin RB, et al. Centers for Disease Control. (Nov 2004). Advanced Data from Vital Health Statistics. Retrieved from (link).

[v] Wright JD, et al. Centers for Disease Control. (Nov 2010). Trends in Intake of Energy and Macronutrients in Adults. From 1999–2000 Through 2007–2008. NCHS Data Brief, 49. Retrieved from (link).

[vi] Mozaffarian D, et al. (2015). Heart Disease and Stroke Statistics—2015 Update. Circulation, 131. Retrieved from (link).

[vii] Aguilar M, et al. (2015). Prevalence of the Metabolic Syndrome in the United States, 2003-2012. JAMA, 313(19). Retrieved from (link).

[viii] Mozaffarian D, et al. (2010) Effects on Coronary Heart Disease of Increasing Polyunsaturated Fat in Place of Saturated Fat: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS Med, 7(3). Retrieved from (link).

[ix] Hooper L, et al. (Jun 2015). Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev., 10(6). Retrieved from (link).

Farvid MS, et al. (Oct 2014). Dietary linoleic acid and risk of coronary heart disease: a systematic review and meta-analysis of prospective cohort studies. Circulation, 130(18). Retrieved from (link).

[xi] Yanping Li, et al. (Oct 2015). Saturated Fats Compared With Unsaturated Fats and Sources of Carbohydrates in Relation to Risk of Coronary Heart Disease. Journal of the American College of Cardiology, 66(14). Retrieved from (link).

[xii] Wu JH, et al. (Oct 2015). Circulating Omega-6 Polyunsaturated Fatty Acids and Total and Cause-Specific Mortality: The Cardiovascular Health Study. Circulation, 130(15). Retrieved from (link).

[xiii] Ramsden CE, et al. (2010). n-6 Fatty acid-specific and mixed polyunsaturate dietary interventions have different effects on CHD risk: a meta-analysis of randomised controlled trials. British Medical Journal, 104(11). Retrieved from (link).

[xiv] Ramsden CE, et al. (2013). Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: evaluation of recovered data from the Sydney Diet Heart Study and updated meta-analysis. British Medical Journal, 346. Retrieved from (link)

[xv] Ramsden CE, et al. (Apr 2016). Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968-73). British Medical Journal, 353. Retrieved from (link).

[xvi] Al-Khudairy L, et al. (2015). Omega 6 fatty acids for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev., 16(11). Retrieved from (link).

Paleo-Friendly One Pot Meals | The Paleo Diet

As winter nears and the days grow cold, a hearty, warming dinner begins to sound more and more inviting. Aren’t Paleo and hearty polar opposites? Substitutes for white potatoes and beans surely cannot compete with Paleo.

The key is to focus on the flavors and textures of the abundant seasonal produce and pair it with whichever wild proteins we can procure most easily. Then, we add our favorite herbs or spices, throw them into the slow cooker or Dutch Oven, and let time do its work.

By incorporating proteins, veggies and fats into one dish or pot, we save time and cleanup and end up with a meal for the whole family that is not only in keeping with True Paleo, but is also tasty and satiating, without filling you up so much you feel like you need to roll into bed.
How do wild game chili or pulled pastured pork sound? Slow cook one, and Dutch oven the other. Mix and match modalities, proteins, and veggies. Thankfully this fork in the road doesn’t have a “wrong way!”

WILD GAME CHILI

A lovely wild game chili meal, best made the day before serving to allow flavors a chance to develop.

Paleo-Friendly One Pot Meals | The Paleo Diet

Ingredients

  • 1 tbsp coconut oil
  • 1 lb free range venison boneless loin, cubed
  • 1 lb free range ground bison
  • 1 medium yellow onion, chopped
  • 4 garlic cloves, smashed
  • 1 jalapeno pepper, minced (omit seeds and pith for less heat)*
  • 2 cups homemade chicken or beef broth
  • 1 cup red wine*
  • 1 large, ripe tomato, crushed*
  • 1 tbsp ground cumin
  • 1 tbsp paprika*
  • 1 small bunch fresh cilantro and/or scallions, chopped finely, including stems
  • Lime wedges, for garnish
  • 4 cups wild mixed green lettuces of your choosing

Directions

1. Heat oil in Dutch oven over medium.

2. Add cubed loin and sear on each side until browned, then remove from pot.

3. Add ground bison and cook, stirring, until browned, and then remove from pot.

4. Add onion to pan and sauté until soft, about 5 minutes.

5. Add garlic and jalapeno and cook one more minute.

6. Add broth and wine and bring to boil, using wooden spoon to scrape any browned bits stuck to bottom.

7. Add tomato, and return both meats to pan.

8. Cover and reduce heat to low and simmer one hour, stirring occasionally.

9. Add cumin and paprika and simmer one hour longer.

10. Serve hot with cilantro or scallions and lime wedges on top, with greens placed in a mound on top of each bowl.

PINEAPPLE PASTURED PALEO PORK

A fattier cut from a naturally raised animal is perfectly paleo, not to mention delicious, from time-to-time. Make this at least a day ahead to experience the full decadence.

Paleo-Friendly One Pot Meals | The Paleo Diet

Ingredients

  • 2 tbsp coconut oil
  • 3 lbs pastured pork shoulder
  • 1 large sweet onion, chopped
  • ½ small pineapple, cored, peeled and cut into chunks
  • 2 large, ripe red tomatoes, halved*
  • 1 cup dry white wine*
  • 1 – 2 cups homemade chicken broth
  • 4 cups organic baby kale

Directions

1. Heat oil in Dutch Oven over med-high heat.

2. Place pork in oven and brown for two minutes on each side.

3. Remove pork from oven and place on plate, covered.

4. Add onion to oven and sauté five minutes.

5. Add pineapple, tomatoes and pork.

6. Pour in wine and broth (use more if you prefer more liquid, less if more of a stew).

7. Cover, bring to simmer, and let cook for two hours.

8. Remove from heat, let cool completely and refrigerate overnight.

9. The next day, place the oven over a medium flame and cook one more hour; pork will easily pull apart with two forks.

10. Shred all pork with two forks and serve on a bed of raw baby kale to enjoy the jus.

*For those following the Paleo Autoimmune protocol, the foods with an asterisk indicate which should be omitted.  Replace the tomatoes with other veggies and the wine with bone broth.

Danish Paleo Meals | The Paleo Diet

I would like to let you know how much I appreciate your book, recently translated into Danish. I have just read the book, and I have begun to adjust my daily meals to the Paleo diet – slowly but every day increasing the proportion of Danish Paleo food versus ordinary Danish food.

I have tried other diets, but none with a content so delicious, and which is so obviously natural to eat. One of the things that I have observed during the past weeks after I have begun to shift some of my meals to “Paleo,” is a tremendous reduction of my previous interest in “goodies,” cakes, bread, pasta, and rice. It seems like the craving is gone, and I can walk past any bakery shop without any feelings of loss.

Again, thanks for your book.

Lilli

Testimonial | The Paleo Diet

Dr. Cordain,

The reason for my writing is that I wanted to mention to you that I belong to a Paleo Diet ­Experimentation group. I like to think of it as a modern day’s book club for women. It is a core group of three women and we gather at someone’s home and the host is required to pick a Paleo meal that looks interesting and the rest of us figure out the techniques and prepare it. The host supplies all the ingredients, sets the table, and after the meal, all are required to clean up to leave the host with NO mess, as if nobody was there.

Since we have some experienced cooks and some novices, it makes it fun since the novices are excited to learn something new and the more seasoned cooks are excited to share their knowledge. Last week was Mediterranean and this week from the Paleo book, we are having Mexican. Husbands/boyfriends are invited, nobody is left out, it just all depends on people’s schedules. Paleo is not passive, here. We are practicing it and making it exciting! From meatballs, to ragouts, outstanding salad dressings, Indian, Italian, Middle Eastern… limitations only exist with one’s imagination.

Anonymous

Paleo Children | The Paleo Diet

Hello Dr. Cordain and Team,

I am a passionate Paleo follower and advocate this healthy way of eating to anyone who will listen. My question is in regards to my children aged 2 and a half and 3 and a half. Are there any special considerations that need to be made for small children?

My children love to eat meat, chicken, fish, and a large amount of fresh fruit and vegetables which is awesome. They eat small amounts of walnuts and pecans (cut up very small and eaten under supervision), I cook with extra virgin coconut oil, and they have a small cup of coconut water with dinner (only water other than that). We have not had wheat/gluten for 2 years, have stopped using gluten-free grains and use almond meal for special occasions. I have recently weaned my 2 and a half year old and have stopped giving my children organic milk after reading your book, though I occasionally use mozzarella and Parmesan when I make pizza for my husband and children. I want my children to have the best possible nutrition and I am a mum so I worry naturally, but any advice would be greatly appreciated.

Kind regards,

Georgia

Lorrie Cordain’s Response:

Dear Georgia,

Thanks so much for sharing Paleo with your friends and family. We are passionate about the numerous health benefits of The Paleo Diet and believe that it is people like you who are helping to spread the word, which in turn improves the health of so many people worldwide.

Your question is important, and one that we receive often from conscientious parents just like you, who are interested in making sure their children are getting all the nutritional requirements they need to begin and maintain a healthy lifestyle. Our recommendation is that the optimal time to begin introducing children to The Paleo Diet is at the time they are weaned and begin eating solid foods. When our 3 boys entered this stage of development, we used a blender or food processor to make a Paleo version of the organic, grass fed meats, and healthy fruits, and veggies we had cooked for our family meals. We found “baby food” very simple to prepare, and our children enjoyed these foods, developing their own personal tastes for a variety of dishes.

Once children reach the age of 2-3, like your children, they have grown enough teeth to be able to enjoy the same, delicious foods you prepare for the grown-ups in the family. Be sure that foods are well cooked and cut into very small pieces, as children this age can easily choke. Most pediatricians caution parents against feeding their children foods such as grapes and large pieces of meat, so use common sense when presenting foods that could cause problems. Bananas, peaches, mango, and avocado are good fresh foods that can be cut in to small pieces and eaten without cooking.

As children continue to grow, they are able to eat raw fruits, veggies and dense meats. Introduce new Paleo foods gradually and avoid forcing any foods that your child indicates he or she is not ready for. Parental attitudes about food are very important when raising healthy children. Food should never be presented as a reward or punishment and children should not be forced to continue eating when they are feeling full. We have been very mindful of this while raising our children and make consistent efforts to make our family meals a time of coming together to enjoy healthy foods. It is important to make every effort to gather daily as a family to share our lives over a delicious Paleo meal!

Over the years, many friends and family have asked us how to ensure that their children eat Paleo foods at all times, whether they are at school, visiting friends, or attending social functions. It may surprise you that we have never been quite this vigilant and strict with our children’s food choices. We feel that it is our responsibility to continually educate, provide, and model for our children the importance of eating a Paleo Diet. Equally important, we have shared the scientific principles that guide The Paleo Diet concepts and the positive impact this lifestyle will have on their health throughout their lives. We want our kids to make educated decisions and understand the implications for their choices. All of them have enjoyed the occasional pizza birthday party with friends, a fast food hamburger with fries, or a sweet snack. Because they have been given the information they need, each has made the personal decision to choose mainly healthy, Paleo foods as their dietary lifestyle of choice. Too many kids leave home for the first time and go overboard on the choice to eat all the forbidden foods which are suddenly unrestricted and readily available. Hence the infamous “Freshman 15!” With 2 children in college and one in high school, we find that guiding their food choices throughout their growing up years, and allowing the occasional treat has led them to make very healthy choices on their own. This is a gift you can give your children to take with them as they head down the road for a lifetime of health and longevity. Best of luck to you and your children!

All the best,

Lorrie Cordain, M.Ed.
The Paleo Diet Team

testimonial-the-paleo-diet

Hello Dr. Cordain,

I wanted to send you a note to connect and introduce myself.  Almost two years ago, I read your book, The Paleo Diet, and forever changed my life’s direction.

My culinary training is classical French with a twist of all that makes New American.  I ran a successful catering business in Atlanta for 7 years and in searching for a healthy way for my wife and I to eat, I read your book.  The smiles started from the first page when you gave tribute to S. Boyd Eaton. I catered a family BBQ for Boyd and Daphne a few years back! (They served corn by the way).

Reading on a flight back from London, I  found myself not able to put the book down, and not able to find flaw in anything you wrote. I said to myself this is it!  I proceeded to go in 100% and had amazing results.  Losing 35 lbs in 2.5 months, 10% BFI loss, increased muscle mass, just doesn’t happen when you are a chef.  My energy, and drive skyrocketed as I felt half my age.

I knew this was the direction not only for me, and my wife but my customers. I developed my product Pre-Made Paleo and never contracted another non-Paleo meal since.  Our meals are developed with classic technique using Paleo ingredients. My vision for my company is to change the way people eat. We now have a production kitchen focused completely on Pre-Made Paleo Meals and products that ship to all 50 states!

Thank you so much for your research, and shared knowledge.

All the best,

Chef Richard Bradford

Dr. Cordain’s Response:

Hi Richard,

Good to hear from you — congratulations upon your weight loss and health successes with the Paleo Diet.  I am also happy to know that I have such a well known culinary ally with the knowledge and abilities to bring the Paleo Diet to the cookery world.

Cordially,

Loren Cordain, Ph.D., Professor Emeritus

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