Dear Professor Cordain,
My husband and I have been reading your published books and research regarding the Paleo Diet, as well as watching interviews and documentaries on the subject and doing our own research as intensively as our free time allows us.
Only recently did we become familiar with the Paleo Diet, but it immediately struck a chord. My husband is 37 years old and was diagnosed with Multiple Sclerosis (relapsing remitting) 6 years ago. Although he is fortunate enough to have been relatively free of any serious relapses, the fear that it may escalate is always present. As you can imagine, we were quite excited when we came across your work on the subject and how the Paleo Diet can not only prevent the condition from evolving, but even revert it to some extent.
Curiously, a few months ago the MS treatment he was on (Gilenya, active ingredient Fingolimod) was no longer having the desired effects and the doctors suggested he started a new drug, Alemtuzumab. He was therefore required to stop taking any medication for a couple of months before he could be admitted to hospital to receive the new treatment. This happened to coincide with the time we started our strength training and weightlifting, and transitioning from our normal diet to Paleo (we had already eliminated sugar, legumes and most dairy and grains).
During those weeks, my husband’s energy levels and overall health improved remarkably, so did his athletic performance and even his mood. In fact, he was feeling so good he was even reluctant to go to hospital for the new MS treatment when the time came. He was actually concerned that all the good results would be undone. Naturally he did go and received the treatment but, in his own words, “couldn’t wait to get back home, enjoy proper food, go back to the gym and feel good again.”
As for me, I’ve been recovering from an eating disorder (Restrictive Anorexia Nervosa) for the past year. During that period, I’ve been following nutritional recommendations from well-intentioned nutritionists and doctors that are loaded with starches, “healthy” whole grains, porridge and even pudding.
Needless to say I put on weight (body fat) quite fast following the nutritionists’ recommendations (40 – 50% Carbohydrates and about 20% Fat, Protein being the rest). If I hadn’t taken up strength training in the meantime, an even greater percentage of the gains would have been body fat instead of most needed lean mass.
Coming from a low carb-diet, I could immediately feel the effects of the “recovery meal plan”: feeling bloated and sluggish, putting on fat on the abdominal area and thighs, being hungry within an hour after a meal. Naturally, replacing this with a Paleo approach not only felt intuitive but also the only rational path to follow, regardless of my condition.
We are currently reading The Paleo Answer, and also looking into Dr. Terry Wahls’ research, as well as the works of Robb Wolf, Gary Taubes and Dr. Boyd Eaton.
Although we are now living in Ireland, we are originally from the south of Portugal and already followed a diet that is not far from a true Paleo plan – we were fortunate enough to grow up in households where plenty of organ meats, fish, meats, vegetables and good fats were often on the menu. That doesn’t mean that we didn’t have that daily glass of warm milk and cookies before bed, sugary cereals for breakfast or, during most years of our adulthood, we didn’t fill a good part of our diet with fast, processed foods, sugar and takeaways. We are guilty as charged.
Nowadays we try as much as possible to eat organic, fresh produce, putting most of the emphasis on fresh fruit and vegetables, on good quality meats and fish, and eating little or no refined sugar or processed foods. Of course, as most people do, we thought whole grains and the so called “healthy carbs” were doing us a world of good.
It was only when I found myself in a rather delicate position regarding nutrition that a friend (a CrossFitter) suggested we had a look into the Paleo Diet. Both my husband and I are quite data driven people and the evidence behind the benefits of a Palaeolithic diet seemed irrefutable.
We therefore decided to make the transition from the current “common” diet to the one our bodies were designed to handle. I’m sure that you, better than anyone else, can understand how hard it is to “reprogram” our brain and reset a lifetime of unbalanced nutrition plans and bad habits, but I’m proud to say that, in a couple of weeks, we were able to eliminate all sugar, processed foods and legumes from our diet, and we dramatically reduced our intake of dairy products and grains (the odd slice of sourdough bread still tempts us from time to time, I must admit).
This is where I need guidance. Having reached a weight that is considered out of the underweight/danger zone and that I am happy with (I am 5’7 and 111.7 pounds), I have to reteach by body how to eat normally again, particularly following a Paleo diet.
Most Paleo followers are looking to lose body fat. On the contrary, I’m trying not to lose weight, maintain a healthy level and distribution of body fat and continue to get fitter following my strength training program.
M: What would be a correct macronutrient distribution? I am currently aiming for 25% Carbohydrates, 35% Protein and 40% Fat.
LC: Generally, on contemporary Paleo Diets, carbohydrates will be lower and protein higher than normal western diets, and fat generally will be higher. Typically, I don’t encourage people to weigh or measure their food intake, but rather to let your appetites govern how much and what type of food you eat. Nevertheless, the percentages of macronutrients (PRO, FAT, CHO) you have listed are reasonable, however 35 % protein approaches the physiological protein ceiling limit (35-40 %) of calories). Again, I recommend that you do not worry so much about macronutrient intake, but rather focus upon wholesome, living, natural foods at levels which satiate your natural appetite.
M: What is an appropriate portion size? For example, a typical fish meal for me is about 180g of grilled salmon, 100g of grilled asparagus (these are weighed after grilling), 1 tsp of olive oil and a tangerine, or a slice of watermelon, or 5 to 6 strawberries.
LC: These portion sizes are reasonable and in line with the amounts of foods many people consume while following contemporary Paleo Diets. I stress that you let your appetite govern your food intake. A rule of thumb is not to completely “stuff” yourself at every meal, but rather to leave each meal full and satisfied, but not over filled.
M: I tend to eat a lot of fruit during the day, almost at every meal (including snacks, and the same is true for my husband). Should we restrict the fructose?
LC: There is no doubt that modern contemporary fruits (apples, bananas and grapes) contain much more sugar than their wild counterparts. I have listed the sugar content of most modern domesticated fruits here.
Unless you are overweight or maintain one or more symptoms of the metabolic syndrome (hypertension, abnormal blood lipids, cardiovascular disease, etc.) you should not worry about limiting your fresh fruit intake. In my most recent book The Paleo Answer I’ve detailed why we need keep dried fruit intake fairly low, any fresh fruit should not be a problem.
M: I also snack on nuts or nut butters quite often and so does my husband, are nuts and nut butters something we should cut back? For example, a snack for me would be a diced apple with cinnamon and 30g of almond.
LC: In the amount you have described, nuts or nut butters will cause no adverse health effects. All nuts tend to be high in omega 6 fatty acids (particularly linoleic acid) which can be pro-inflammatory if consumed in excessive quantity, particularly if you don’t get enough long chain omega 3 fatty acids (EPA and DHA) as found in fatty fish (salmon, mackerel, herring, sardines etc.) butter.
M: Can you comment upon Calories In/Out vs. Satiety Levels? In your book you state that one should eat as much as one wants. Although the calories in/out theory has been proven to be misleading, should it be completely ignored?
In my specific case, I believe my body is clinging on to every single calorie after starvation and this is the reason why my weight won’t stabilize and my body fat keeps rising. I also have a hard time interpreting my satiety signals – some days it seems I could keep on eating at every meal, other days I’m not hungry at all. Therefore, I’m having difficulties in letting go of counting and measuring everything I eat.
LC: Protein has a greater satiety value than either fat or carbohydrate and most people eat fewer calories on a high protein diet (which is what the Paleo Diet is). Additionally, when people consume low glycemic index carbohydrates compared to high glycemic index carbohydrates, they also eat fewer calories. With the Paleo Diet, you will be obtaining almost all of your carbohydrate calories from low glycemic index vegetables, fruits and nuts, while you avoid high glycemic index carbs such as refined sugars and grains.
M: I cannot thank you enough for all your research and groundbreaking work, it has been life changing.
We are now considering writing a Paleo Cookbook, adapting the classics of the Portuguese cuisine and our own family recipes (such as pork heart, lungs and liver stew) to the Paleo approach. Most of the dishes are already compliant and the ones that are not will be adjusted according to your guidelines.
Thank you so much for your feedback, we are extremely grateful.
Marta and Jorge
LC: Thank you for your support and contributions!
(Pork Liver, Heart and Lungs Stew Traditional Recipe from the Alentejo Region, South of Portugal)
2. Add the minced garlic, spices and bay leaf to the meat and toss everything together.
3. Leave it to rest ideally for one hour, but if you’re short on time you can cook it straight away.
4. Put the pork lard and/or olive oil in a large pot (preferably a casserole or a ceramic pot) and sauté the onions until soft.
5. Add the meat and sear it for a few minutes until lightly cooked.
7. Let it simmer, covered, over a low heat for 45 min. At this point, test the meat with a fork the heart and lungs should be soft and tender (bear in mind that the liver has a firmer consistency). If not, allow to simmer for a while longer.
8. When the meat is nearly done, add a tbsp of vinegar to the blood you reserved earlier and stir it into the pot.
9. Still over low heat, bring it back to a boil and stir it for a while to thicken.
Serve with grilled zucchini (or oven baked sweet potato wedges for a post workout meal) and fresh spinach salad. Pair with a red wine from Alentejo, of course, Monte Velho Tinto from the Herdade do Esporão.
Recipe Courtesy of Marta and Jorge.