Tag Archives: cholesterol

US Government Poised to Drop Cholesterol Warnings? | The Paleo DietCholesterol – is there a more controversial topic in the world of nutrition? For years, we were told that cholesterol is one of the most important biomarkers of health, particularly cardiovascular health. Prominent government- and health-related institutions have traditionally recommended upper limits on dietary cholesterol of 300 mg/day (effectively limiting egg consumption to 1 egg per day.) A recommendation based on the theory that dietary cholesterol – the cholesterol contained in food – negatively impacts cholesterol found in the blood, called serum cholesterol.

With the emergence of more and more scientific evidence, however, this theory has become increasingly untenable, causing many scientists to change their views on cholesterol. The counter theory – that dietary cholesterol has little impact on serum cholesterol – is actually nothing new. Even the progenitor of the misguided lipid theory of heart disease, Ancel Keys, acknowledged back in 1953 that dietary cholesterol doesn’t significantly impact serum cholesterol.1

Unfortunately, cholesterol came to be demonized due to its association with saturated fat and for decades both were thought to be unhealthy. New studies in the past several years have challenged this orthodox view of cholesterol.

The new research has also challenged traditional beliefs about eggs. Rather than limiting egg consumption, the available evidence suggests that eggs are actually cardio-protective.

In March 2017, for example, The Journal of Nutrition published a new study about egg consumption and its positive effects on both HDL function and plasma antioxidant levels.2 Previous studies had shown similar benefits, but those studies were largely conducted on unhealthy populations.3,4,5

The authors of this new study, therefore, decided to test how eating one, two, or three eggs daily would affect healthy young adults. This study was the latest in a series of scientific papers showing that foods rich in dietary cholesterol can actually decrease one’s risk for heart disease – a complete turnaround from the institutional forebodings of decades past.


Important, But Not Essential

Cholesterol is not an essential nutrient. This means that although your body requires cholesterol, you’re not dependent on food to obtain it. In fact, your liver produces 90% of the cholesterol needed by your body. Some people use this fact to advance the hypothesis that dietary cholesterol is unnecessary or even unhealthy. This hypothesis is flawed for several reasons, including:

  1. The foods that contain significant amounts of cholesterol also contain many other important nutrients, particularly iron, and vitamin B12.
  2. Nearly all foods that contain bioavailable forms of high-quality protein also contain cholesterol.


The Origins of the Theory

So where does the idea that dietary cholesterol is unhealthy come from? Surprisingly, the early studies that inspired this idea were actually conducted on rabbits. While this may seem reasonable, it’s important to remember that rabbits are herbivores. And since their natural diets don’t contain cholesterol, it’s no surprise that it impacts them negatively.

Nikolay Anichkov was the scientist who originally conducted these rabbit studies back in the early 20th century. Interestingly, he fed rabbits a purified form of cholesterol.6 Obtaining cholesterol this way is completely different from obtaining cholesterol from healthy foods. In fact, most of Anichkov’s peers questioned the relevance to human health of his cholesterol experiments performed on rabbits.

Nearly 40 years later, John Gofman became the next major researcher to show interest in the topic. Gofman reported that higher levels of LDL were associated with an increased risk for coronary heart disease (CHD), whereas higher levels of HDL appeared to protect against CHD.7

After Gofman, Ancel Keys became the most prominent heart disease researcher. Through a series of experiments, Keys concluded that saturated fat consumption has the biggest impact on serum cholesterol levels. However, regarding dietary cholesterol, as mentioned above, Keys reported, “repeated careful dietary surveys on large numbers of persons in whom blood cholesterol was measured consistently fail to disclose a relationship between the cholesterol in the diet and in the serum.”8

Keys became known as the father of the lipid hypothesis – the theory that fat consumption, particularly saturated fat, drives heart disease. During the past 15 years or so, the lipid hypothesis has faced serious challenges. One of its core tenets is that saturated fat increase LDL cholesterol, which does in fact correlate with heart disease. However, LDL varies by particle size – small or large.


Small versus Large

Small particle LDL is more prone to oxidation and to the formation of subsequent arterial lesions and arterial plaque.9 Large particle LDL is less susceptible to such modifications and therefore carries little, if any, cardiovascular risk. In fact, a study that tracked women for 11 years found no significant association between large particle LDL and cardiovascular disease risk (CVD).10

So how does all this relate to eggs and their relatively high amounts of dietary cholesterol? Some interesting findings emerged from the recent Journal of Nutrition study.2 For example, as egg consumption increased, small LDL decreased and large LDL increased – a win-win with respect to reducing CVD risk. Additionally, concentrations of HDL and the antioxidants lutein and zeaxanthin also increased as daily egg consumption went up.2

One great benefit of HDL is its ability to remove cholesterol from macrophages. This is one of the key aspects of preventing the build-up of cholesterol inside the blood vessels. Additionally, this is one reason why low HDL is related to increased CVD risk.11



Eggs have gotten a bad rap, mostly due their high levels of cholesterol and due to our imprecise, yet ever-evolving, views on the relationship between cholesterol-rich foods and blood cholesterol levels.

Unfortunately, the nutrition establishment is still struggling to acknowledge the obvious – that eggs and other cholesterol-rich foods are healthy. Back in 2015, the USDA was in the process of updating its official Dietary Guidelines for Americans. In its Preliminary Report, published in February 2015, the group’s Advisory Committee recommended dropping the decades old 300 mg/day limit on dietary cholesterol. The available evidence, they reported, “shows no appreciable relationship between consumption of dietary cholesterol and serum cholesterol.”12 Accordingly the committee concluded, “cholesterol is not a nutrient of concern for over-consumption.”

Unfortunately, as soon as the clouds of bad conclusions dissipated, they quickly reemerged, again blocking the light of reason and evidence. For in their final report, published in January 2016, the USDA backed away from the Preliminary Report’s encouraging conclusions. Instead, they settled on “individuals should eat as little dietary cholesterol as possible while consuming a healthy eating pattern.”13

So we’re back to square one. The usual suspects are still warning against dietary cholesterol, whereas the scientific evidence draws other conclusions. Egg-white omelets are still served in many restaurants, whereas the nutrient-rich yolks are often discarded. Are eggs healthy? The science says yes, but you can decide.


[1] Keys, A. (1953). Prediction and Possible Prevention of Coronary Disease. Am J Public Health Nations Health., 43(11). Retrieved from (link).

[2] DiMarco DM, et al. (2017). Intake of up to 3 Eggs per Day Is Associated with Changes in HDL Function and Increased Plasma Antioxidants in Healthy, Young Adults. Journal of Nutrition, 147(3). Retrieved from (link).

[3] Herron KL, et al. (2004). High intake of cholesterol results in less atherogenic low-density lipoprotein particles in men and women independent of response classification. Metabolism, 53(6). Retrieved from (link).

[4] Mutungi G, et al. (2008). Dietary Cholesterol from Eggs Increases Plasma HDL Cholesterol in Overweight Men Consuming a Carbohydrate-Restricted Diet. Journal of Nutrition, 138(2). Retrieved from (link).

[5] Blesso CN, et al. (2013). Whole egg consumption improves lipoprotein profiles and insulin sensitivity to a greater extent than yolk-free egg substitute in individuals with metabolic syndrome. Metabolism, 62(3). Retrieved from (link).

[6] Finking G, et al. (1997). Nikolaj Nikolajewitsch Anitschkow (1885-1964) established the cholesterol-fed rabbit as a model for atherosclerosis research. Atherosclerosis, 135(1). Retrieved from (link).

[7] Gotto AM, et al. (2011). Jeremiah Metzger Lecture: Cholesterol, Inflammation and Atherosclerotic Cardiovascular Disease: Is It All LDL? Trans Am Clin Climatol Assoc., 122. Retrieved from (link).

[8] Keys, A. (1953). Prediction and Possible Prevention of Coronary Disease. Am J Public Health Nations Health., 43(11). Retrieved from (link).

[9] Ross R. (1999). Atherosclerosis – an inflammatory disease. New England Journal of Medicine, 340(2). Retrieved from (link).

[10] Mora S, et al. (Feb 2009). Lipoprotein particle profiles by nuclear magnetic resonance compared with standard lipids and apolipoproteins in predicting incident cardiovascular disease in women. Circulation, 119(7). Retrieved from (link).

[11] Assmann G, et al. (1996). High-density lipoprotein cholesterol as a predictor of coronary heart disease risk. The PROCAM experience and pathophysiological implications for reverse cholesterol transport. Atherosclerosis, 124. Retrieved from (link).

[12] 2015 Dietary Guidelines Advisory Committee. (Feb 2015). Scientific Report of the 2015 Dietary Guidelines Advisory Committee. US Department of Health and Human Services and US Department of Agriculture. Retrieved from (link).

[13] USDA. (2016). Dietary Guidelines for Americans, Final Report. Retrieved from (link).

Eliminate Food Groups | The Paleo Diet
Do you believe that “our modern lifestyles, including nutrition, are the cause of current health problems?” If so, you could be susceptible to “fad diets,” according to the United Dairy Industry of Michigan (UDIM). Last week, the organization’s Technical Advisor for Nutrition, Lois McBean, wrote that those who follow the Paleo diet “are likely setting themselves up for nutritional deficiencies by eliminating entire food groups such as dairy, grains, and legumes.”1

McBean went on to observe, “Such restrictive diets are not consistent with current dietary recommendations including USDA’s MyPlate or the 2010 Dietary Guidelines for Americans.” It’s interesting that she invokes the 2010 Guidelines, considering that earlier this year, the Dietary Guidelines Advisory Committee (DGAC) acknowledged that the 2010 and previous Guidelines contain a glaring error.

In the DGAC’s own words, “Previously, the Dietary Guidelines for Americans recommended that cholesterol intake be limited to no more than 300 mg/day. The 2015 DGAC will not bring forward this recommendation because available evidence shows no appreciable relationship between consumption of dietary cholesterol and serum cholesterol.”2

The 2010 and previous Guidelines were wrong about cholesterol, a mistake that likely persuaded millions of people to avoid eggs, shrimp, and other healthy, cholesterol-rich foods. Is it conceivable that the Guidelines could also be wrong about dairy, cereals, and legumes? We’ll address this question, but first let’s examine the idea of “eliminating entire food groups.”

Eliminating Entire Food Groups

Paleo critics like McBean seem to think the USDA’s MyPlate is inclusive of all food groups, but surprisingly, it excludes the most nutrient dense food group of them all – organ meat. The Paleo diet, on the other hand, excludes dairy, cereals, and legumes because, despite the nutrients they contain, they also contain antinutrients and promote various adverse health effects. But what possible reason could the USDA and Paleo critics have for excluding organ meat?

In the US, organ meat fell out of favor decades ago, but in most other countries it’s embraced and recognized for its remarkably high nutrient levels. Those who worry about nutrient deficiencies should be questioning the exclusion of organ meat (an entire food group) before criticizing those who, for valid reasons, exclude dairy, cereals, and legumes.

Nutrient Deficiencies

McBean lauds dairy foods as “important sources of multiple essential nutrients, including calcium, vitamin D, and potassium,” while implying that the Paleo diet falls short on these nutrients. This is an interesting comment for three reasons:

1. Dairy is not a rich source of potassium

The charts below show potassium, vitamin D, and calcium levels for 100g portions of common foods. Paleo foods are highlighted in orange, non-Paleo foods in purple. All values are for uncooked foods; note that 100g doesn’t necessarily represent a serving size. For example, beans are richest in potassium, but once cooked, potassium is significantly diluted because the beans absorb so much water. As shown, Paleo foods, including vegetables, seeds, nuts, mushrooms, fruit, fish, and meat, provide plenty of potassium.

How much potassium is enough? The National Academy of Sciences (NAS) sets the Daily Recommended Intake (DRI) for all nutrients. For potassium, however, instead of a DRI they set an Adequate Intake (AI) level of 4.7g per day. The NAS notes, “dietary intake of potassium by all groups in the United States and Canada is considerably lower than the AI.”3 With so many potassium-rich foods to choose from (note: the chart is not comprehensive), the Paleo diet emerges as the solution for potassium deficiency, not the cause.

Potassium | The Paleo Diet

2. Most of dairy’s vitamin D comes through fortification

Vitamin D | The Paleo Diet[/one_half]

Dairy fat does contain a small amount of natural vitamin D, but non-fat and low-fat dairy have almost none. As shown in the chart, the foods highest in vitamin D are Paleo foods, namely fish, shrimp, eggs, and to a lesser degree organ meat and mushrooms. Even fortified dairy doesn’t provide spectacular amounts.

Furthermore, if you want to go the fortification route, you’re much better off with vitamin D supplements, in which case you could avoid the negative effects of dairy. Note that the DRI for vitamin D is 600 IU/day.

3. Dairy is indeed high in calcium, but the calcium story is nuanced

As Dr. Cordain has explained extensively, net calcium balance (NCB) is far more important than calcium intake. NCB equals calcium intake minus calcium excretion. Calcium excretion is largely a function of acid/alkaline balance. For diets with net acid loads, the body’s calcium salts, which are stored within the bones, are excreted to maintain balance. For diets with net alkaline loads, endogenous calcium stores are unaffected.

Calcium | The Paleo DietThe only alkalizing foods are vegetables and fruit. The Paleo diet is more alkaline than MyPlate because of its emphasis on vegetables and its exclusion of dairy, cereals, and legumes. As shown in the chart, calcium in the Paleo diet comes from seeds, nuts, bones, vegetables, and from the fact that proportionally less calcium is excreted, due to the diet’s alkalinity. Note that the DRI for calcium is 1,000 mg/day.

Despite its calcium levels, dairy causes more problems than it solves. According to the US National Library of Medicine, an estimated 65% of the global population is lactose intolerant.4 Additionally, drinking 3 cups of milk per day, as McBean and the UDIM recommend, is associated with an increased risk of bone fractures as well as increased overall mortality, according to a cohort study published by the British Medical Journal.5 This study was observational, so it cannot prove causation, but it underscores the net acid load problem and other problems associated with dairy.

Far from promoting nutrient deficiencies, a careful examination of the evidence shows the Paleo diet reverses nutrient deficiencies caused by junk food and other imbalanced diets. This is accomplished by eliminating problematic food groups, including dairy, cereals, and legumes, while embracing the healthiest food groups, including meat, fish, organ meat, vegetables, nuts/seeds, and fruit.


1. McBean, L. (November 4, 2015). Fad Diets: Be Careful What You Wish For. United Dairy Industry of Michigan.

2. Dietary Guidelines Advisory Committee. (February 2015). Scientific Report of the 2105 Dietary Guidelines Advisory Committee. USDA and Department of Health and Human Services.

3. National Academy of Sciences. Institute of Medicine. Food and Nutrition Board. (2004). Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate.

4. Genetics Home Reference. (May 2010). “Lactose Intolerance.” U.S. National Library of Medicine.

5. Michaëlsson, K., et al. (October 2014). Milk intake and risk of mortality and fractures in women and men: cohort studies. The British Medical Journal, 349.

6. Schmid, A and Walther, B. (July 2013). Natural Vitamin D Content in Animal Products. Advances in Nutrition, 4(453-462).

Paleo Budget | The Paleo Diet

For a nutritional concept to gain traction and remain relevant, nothing matters more than its ability to generate cold, hard cash. In the past, this usually meant governments (and their allied health institutions) would promote certain theories (e.g. the low-fat theory of cardiovascular disease), thereby creating consumer demand, and food manufacturers would respond, formulating products to meet that demand. Whether or not the theories were scientifically sound was relatively unimportant.

In the future, this demand creation model will reverse. Consumers will access scientifically sound nutrition advice, either directly through scientific journals or via independent health advocates, educators, and journalists. This will create demand, which suppliers will meet. Whether or not governments align themselves with scientifically sound nutrition will be somewhat inconsequential.

A monumental new study supports the above prediction while implying the future of Paleo is secure, at least for the next 15 years. Last week, the market research wing of Switzerland’s second largest bank, Credit Suisse, published an impactful analysis called, “Fat: The New Health Paradigm,” in which they project global macronutrient consumption trends for the next 15 years. Specifically, they expect saturated fat and total fat consumption to increase, omega-6 consumption to decrease, and carbohydrate consumption to decrease.[1]

In other words, consumers’ attitudes toward core aspects of the Paleo diet will solidify, thereby creating demand for healthy, high-fat, Paleo-oriented products. According to Stefano Natella, Global Head of Equity Research at Credit Suisse and an author of the study, savvy investors should be lining up behind businesses that understand these forthcoming trends.

“We believe that consumers are at a turning point and this has distinct implications for investors. The report’s conclusion is simple – natural unprocessed fats are healthy and are integral to transforming our society into one that focuses on developing and maintaining healthy individuals.”[2]

Key findings of the study include the following (note: all changes are per capita):

  • Globally, fat consumption will increase from its current per capita average of 26% of total calories to 31% by 2030.
  • In the US, fat consumption will increase from its current 40% of total calories to 47%.
  • Globally, saturated fat will increase from 9.4% of total calories to 12.7%.
  • Omega-6 consumption will decrease from 6% of total calories to 5.4%.
  • Carbohydrates will decrease from 60% to 55%.
  • Red meat consumption will increase 23% by 2030.
  • Egg consumption will increase 4% per year and by 2030, the average person will consume nearly 300 eggs per year (or 350 per year in the US, compared to the current 235).

During the past century, dietary guidelines restrictive of saturated fat and dietary cholesterol were issued to 220 million US citizens in 1977 and 56 million UK citizens in 1983. According to a systematic review and meta-analysis of research available during those years, neither the US nor the UK guidelines were supported by randomized controlled trials.[3] During the ensuing decades, food companies got rich selling low-fat foods, but only because consumers genuinely believed the low-fat dogma their government’s were propagating.

What if consumers had widespread access to information showing the guidelines were (and continue to be) wrong? Would they change their behavior? Would they alter their demands? Would food companies respond? According to the Credit Suisse report, yes. Consumers are becoming more educated about nutrition and food manufacturers are keenly watching. A lucrative new market is in the works. For the future, the smart money is on Paleo and otherwise healthy food.


[1] Credit Suisse AG. (September 17, 2015). “Fat: The New Health Paradigm.”

[2] Press release. (September 17, 2015). “Credit Suisse Publishes Report on Evolving Consumer Perceptions about Fat,” PR Newswire.

[3] Zoe Harcombe, et al. (Feb. 2015). “Evidence from randomised controlled trials did not support the introduction of dietary fat guidelines in 1977 and 1983: a systematic review and meta-analysis,” Open Heart, 2(1).

A Brief History of the Contemporary Paleo Diet Movement | The Paleo Diet


In order to appreciate any concept, including the Paleo Diet, it is important to recognize its history and how it came to be. Most of you are aware that Paleo and particularly Paleo diets have recently become very hot, on trend topics.

These ideas have become household words in the past few years; however it hasn’t always been this way. Below is a graph from Google Trends for the words “ the Paleo diet” (Figure 1).  It’s fairly clear from Figure 1 that, except for the past four years, the Paleo diet was virtually unknown to all but dedicated fans. Fortunately, I’ve been in the middle of this worldwide movement from nearly its very beginnings. So, I can personally tell you how it all began and my involvement in it.

Google Trends | The Paleo Diet Over Time

Figure 1. Google Trends. 25 June 2015.

Last October, I approached my 64th birthday with just a little trepidation because I was part of the 60’s generation whose mantra was not to trust anyone over 30, and now I’m twice that age.  As I look back over my life, I can pinpoint a few key events which led me to discover and appreciate what is now almost universally known as the Paleo diet.

I came of age as a track and field athlete at the University of Nevada, Reno in the late 60s and early 70s, and as such was always interested in diet, fitness and athletic performance. Later as a lifeguard at Lake Tahoe, my friends and I read all of the now classic vegetarian diet/health books such as Francis Moore Lappe’s Diet for a Small Planet, Paivo Airola’s Are You Confused? and Dick Gregory’s Natural Diet for Folks Who Eat among others. I even attended a Dick Gregory lecture in Seattle and got to shake this famous comedian’s hand.

My lifeguard friends and I experimented with vegan diets, fasting, and all kinds of vitamins and supplements. Almost everyone seemed to own a juicer. Each summer, instead of shying away from the sun and using sunscreens, we all tried to get the deepest tans possible. We swam in Tahoe’s icy, invigorating, non-chlorinated waters, and decades before Vibram Five Fingers and Nike Frees were the rage, we ran barefoot in the sand along Sand Harbor’s pristine shoreline.

Those 20 memorable summers as a lifeguard at Tahoe heightened my awareness of the outdoor, natural world, sunshine, health, fitness and diet. As my lifeguarding days drew to a close in 1991, Lorrie and I had just begun to eat Paleo. Here’s how it began.


I completed my Ph.D. in exercise physiology at the University of Utah in the spring of 1981 and promptly hired as a young assistant professor in the Department of Health and Exercise Science at Colorado State University. For the first 5-10 years of my career, my research focused mainly upon how diet and exercise affected fitness and athletic performance. I still hadn’t discovered Paleo, but read widely and had a considerable interest in anthropology.

In the spring of 1987, I happened upon Boyd Eaton’s (M.D.) now classic scientific paper Paleolithic Nutrition: a Consideration of its Nature and Current Implications which was published two years earlier in the prestigious New England Journal of Medicine.7 This article made a lasting impression upon me and was the single factor which caused me to focus my research interests upon ancestral human diets from that point forward.

For me, one of the surprising points that Dr. Eaton made in a subsequent paper was that cereal grains were rarely or never consumed by pre-agricultural hunter-gatherers.6  In the days and months after reading Boyd’s groundbreaking paper,7 I became absolutely engrossed in studying ancestral human diets and voraciously read everything I could about the topic. At first, I simply filed all of these scientific papers and documents into a single file folder I labeled “Paleolithic Nutrition.” Early on I realized that this strategy wouldn’t work because of the enormous volume and diversity of topics that materialized.

As I read more and more, patterns began to emerge. Stone Age people did not drink milk or consume dairy products. So, I created a file folder labeled “Dairy.” They also didn’t eat cereal grains, so I created a single file folder called “Cereal Grains.” However, just like the single folder I had originally created for “Paleolithic Nutrition,” it soon became apparent that the topic of cereal grains and their potential for adversely affecting health was an enormous topic that ultimately would require a huge number of file folders.

Over the course of the next seven or eight years, I collected more than 25,000 scientific papers and filled five large filing cabinets – each with hundreds of categories dealing with all aspects of Paleo diet and Paleo lifestyle. In 1994, I eventually mustered enough courage to telephone (no one used email then) the man who was responsible for my collection of articles on anything and everything related to Paleo. Dr. Eaton is a true gentleman and scholar in every sense of the word.  We spoke for almost an hour on that very first telephone call, and he gave me one of the greatest compliments of my life at the end of the conversation when he said, “It sounds to me like you know more about this than I do.”

Boyd and I eventually met in 1995, and two years later he invited me to speak with him at an international conference on fitness and diet organized by Dr. Artemis Simopoulos in Athens, Greece. Artemis was a wonderful hostess for the conference, and during my two week stay in Greece we had many conversations about diet and health. I mentioned that I had written a partially completed manuscript on the nutritional shortcomings of cereal grains. About a year later she asked me if I could complete the paper and submit it for publication in a scientific journal she edited.  I did, and that paper, Cereal Grains: Humanity’s Double Edged Sword, published in 199934 launched my published career in Paleo diets.

The Paleo Diet concept is now taken seriously in the scientific world thanks in part to Boyd Eaton’s pioneering work. There is no doubt in my mind that without Dr. Eaton’s influential 1985 New England Journal of Medicine paper,7 Paleo would continue to be an obscure word known mainly to anthropologists and would not have become the household term now recognized by millions. The Paleo Diet and Paleo lifestyle are clearly much larger than either my writings or Boyd Eaton’s. Hundreds if not thousands of scientists, physicians and people from all walks of life are responsible for creating this incredibly powerful idea that can be used to bring order and wisdom to dietary and lifestyle questions and issues.

Some of the key players who came before Dr. Eaton in the Paleo diet and lifestyle world require no introductions. Charles Darwin’s Origins of the Species was published in 1859 and started it all. It still amazes me that the most powerful idea in all of biology (evolution via natural selection) generally had not been applied to nutritional thought until 126 years later with Dr. Eaton’s classic paper.7  Theodosius Dobzhansky, a well-known Ukranian evolutionary biologist said, “Nothing in biology makes sense, except under the light of evolution.” Indeed, his statement could easily be reworked to “Nothing in nutrition makes sense, except under the light of evolution.5 A similar quote could also be applied to a multitude of lifestyle issues.

One way in which we can look at how and where the Paleo diet and Paleo lifestyle concepts arose would be to examine the contributions of a few of the key players who came both before and after Dr. Eaton’s landmark paper. Obviously, Charles Darwin started it all, but a number of noteworthy people had already recognized the value of ancestral dietary patterns decades before the publication of Boyd’s article.

Perhaps the very first book to achieve notoriety about non-western diets and disease was Weston Price’s Nutrition and Physical Degeneration, A Comparison of Primitive and Modern Diets and Their Effects, first published in 1939.23 Dr. Price, a U.S. dentist, extensively traveled the world in the 1920s and 30s and made detailed observations about diet and health in numerous non-westernized populations including Amazon Indians, Alaskan Eskimos, Australian Aborigines, Canadian Indians, Polynesians and African tribal populations among many others. This book is a real treasure and contains hundreds of photographs of non-westernized people in exquisite health taken in an era when modern processed foods were not universally available. Dr. Price noted that wherever and whenever modern diets were adopted by non-westernized cultures, their health declined. His statement was just as true then as it is today.

An intriguing aspect of early books like Dr. Price’s is that frequently the diet/health observations were correct but the underlying mechanisms about how diet and lifestyle specifically affected health were either unknown or poorly understood.  In the early part of the 20th century before population wide vaccination programs existed, tuberculosis remained a major public health problem responsible for millions of deaths worldwide.  In his book,23 Dr. Price noted that in Europe, heliotherapy (sunbathing) was being effectively used to treat tuberculosis. At the time and even decades later, these kinds of observations were commonly ridiculed by the “best medical minds” because they seemed ludicrous and had no known physiological basis. Let’s fast forward 65 years and put this 1930s observation under new light.

Discoveries made just in the past 5-7 years now show that sunlight exposure might be one of the best strategies to prevent or cure tuberculosis infections.10, 19, 27, 31, 35, 36  When you sunbathe, ultraviolet radiation from the sun causes vitamin D to be produced in your skin. The more sun you get, the more vitamin D is produced. Blood concentrations of vitamin D regulate the synthesis of a recently identified substance called cathelicidin which turns out to be one of the most potent antimicrobial (bacteria killing) peptides that our bodies produce. Cathelicidin shows specific killing activity against bacteria that cause tuberculosis,31, 35, 36 and epidemiological (population) studies confirm vitamin D insufficiency is a risk factor for tuberculosis.10, 19, 37  Most of us have been vaccinated against tuberculosis, so we really don’t need to worry about this disease.

Although Dr. Price’s book23 was advanced for its time, the evolutionary basis for optimal nutrition and healthy lifestyles still lay decades in the future. Other early popular books touching upon ancestral diets and health include:  Arnold DeVries’s Primitive Man and His Food (1952),4 Walter Voegtlin’s The Stone Age Diet (1975),30 Leon Chaitow’s, Stone Age Diet (1987),2 and Boyd Eaton’s The Paleolithic Prescription (1988).8

All of these books are long out of print and except for Boyd’s volume; these books simply fizzled and faded into obscurity because they didn’t have the bigger picture right. Without the evolutionary template correctly in place, these early books were incomplete and inconclusive.  At the time, scientists and the public at large still weren’t quite ready for Paleo diets and Paleo lifestyles.

Prior to the publication of Dr. Eaton’s 1985 paper,7 a few scientists had independently recognized the evolutionary underpinnings for healthful diets and lifestyle, but their work was published in obscure scientific journals that received little or no public notoriety.1, 25, 26, 28, 29, 32, 37 After publication of Boyd Eaton’s influential paper in the New England Journal of Medicine,7 a number of events ultimately set the stage for the worldwide recognition of the Paleo diet as well as the evolutionary basis for modern day Paleo lifestyles.


The basic foundation and logic for the Paleo diet concept lies in a recently recognized discipline called Darwinian Medicine. Following in the footsteps of Boyd’s landmark paper,7 came another revolutionary scientific publication in the Quarterly Review of Biology (1991) by Drs. George Williams and Randy Neese from the State University of New York at Stony Brook.33  The title of this paper was, “The Dawn of Darwinian Medicine.

As you can imagine from its title, it represented the very first scientific publication addressing how our ancestral evolutionary experience affects the manner in which we view and treat modern diseases. Although this paper is now more than 20 years old, its message is finally being filtered down to many physicians, their patients and the public at large.20

Here’s a quote from this paper that sums up Darwinian Medicine, “Human biology is designed for Stone Age conditions. Modern environments may cause many diseases.” Also, another enlightening quote that is totally relevant to this book: “it provides new insights into the causes of medical disorders.” For instance, cough, fever, vomiting, diarrhea, fatigue, pain, nausea and anxiety are widespread medical problems. Many orthodox physicians focus upon relieving short term distress by prescribing pharmaceuticals to block these responses. Darwinian Medicine would say these responses are not necessarily harmful, but rather signify the body’s effort to remedy a problem. In most situations coughing when you are sick is a natural and healthy response because it helps to purge disease causing microbes from your throat and lungs.

Similarly fever increases your body temperature which helps to destroy pathogens that have infected your body. Medications that suppress coughs and block fever may relieve symptoms but may actually prolong the illness. Obviously, certain extreme situations necessitate a balanced approach between our body’s evolutionary response to disease and modern medicine. For example, blocking fever can prevent febrile seizures and stopping vomiting can prevent severe dehydration.

The message is clear. We need to balance our hunter gatherer genetic legacy with the best technology of our modern world.


Having been a faculty member at a Division I Research University for 32 years, I can tell you that your personal experience with the Paleo diet and a dollar will buy you a single cup of coffee in the scientific community. In other words:  no matter how much weight you have dropped on the Paleo diet; no matter how much your blood chemistry has improved; nor how much better you feel, the medical and scientific community will, by and large, not listen to you. Your real world experiences have little or no traction in the academic community of science and medicine.   What they require is not your personal experience (anecdotal evidence), but rather experimental evidence based upon one of the following four scientific methods:  1) animal studies, 2) tissue or organ studies, 3) epidemiological [population] studies or 4) randomized controlled human trials.

When I first published The Paleo Diet in 2002 thousands of indirect experimental studies had supported its general principles in promoting weight loss, improving overall health and curing disease. For instance, a multitude of well controlled experimental studies had already confirmed beyond a shadow of a doubt that low glycemic load diets improved health and promoted weight loss. The Paleo diet is a low glycemic load diet.  Similarly, high protein diets were shown to be the most effective strategy to improve blood chemistry and help you lose weight. Yet again, the Paleo diet is a high protein diet.

Even in 2002, when The Paleo Diet first came into print, you would have been hard pressed to find a single nutritionist who would disagree with the notion that omega 3 fats improved health and well being in almost every conceivable way. Do I need to repeat myself? The Paleo diet is a diet rich in omega 3 fats.

By 2002 when my first book came into print, the thousands of scientific papers were independently verified that certain individual aspects of the Paleo diet normalized body weight and improved health and wellbeing. Nevertheless, at that time, not a single study had yet examined all of the combined nutritional characteristics of the Paleo diet.

Was a diet high in animal protein, omega 3 fats, monounsaturated fats, vitamins, minerals, phytochemicals, fiber and low in salt, refined sugars, cereal grains, dairy products, vegetable oils and processed foods healthy? Was it more healthful than the officially sanctioned USDA My Plate Diet or even the highly touted Mediterranean diet? The direct scientific answers to these questions had yet to be answered in 2002.

Fortunately, in the past eight years a number of scientists worldwide have dared to test contemporary versions of humanity’s original diet against supposed “healthful diets” as seen in Table 1 below.

One of the key figures behind this ground breaking research is my friend and colleague, Dr. Staffan Lindeberg (M.D., Ph.D.) from Lund University in Sweden. Staffan became interested in Paleo diets almost 25 years ago through his medical studies of the Kitavans,14-17 a non-westernized group of 2,250 people living on remote islands near Papua New Guinea. The Kitavans obtain virtually all of their food from either the land or the sea and have little contact with the modern world. Common western foods such as cereals, dairy, refined sugars, vegetable oils and processed foods are nearly absent from their diets.14-17 Predictably, these people represent the epitome of health compared to the average citizen living in the western world.  None of them are overweight, and heart disease and stroke are extremely rare. High blood pressure and type 2 diabetes are non-existent,14-17 and acne is not present among their children or teenagers.38 I doubt that you could round up a random group of 2,000 western people anywhere on the planet without encountering high rates of all of these diseases which are rare or not present in the Kitavans.

In the late 1990s I first began corresponding with Dr. Lindeberg on the then youthful internet.  We soon discovered that we had read almost all of the same scientific papers and were interested in almost all of the same diet/health topics. One study that stood out to both of us was an incredible experiment performed by Dr. Kerin O’Dea at the University of Melbourne and published in the Journal, Diabetes in 1984.21 In this study Dr. O’Dea gathered together 10 middle aged Australian Aborigines who had been born in the “Outback.” They had lived their early days primarily as hunter-gatherers until they had no choice but to finally settle into a rural community with access to western goods. Predictably, all 10 subjects eventually became overweight and developed type 2 diabetes as they adopted western sedentary lifestyles in the community of Mowwanjum in the northern Kimberley region of Western Australia.  However, inherent in their upbringing was the knowledge to live and survive in this seemingly desolate land without any of the trappings of the modern world.

Dr. O’Dea requested these 10 middle aged subjects to revert to their former lives as hunter-gatherers for a seven week period. All agreed and traveled back into the isolated land from which they originated. Their daily sustenance came only from native foods that could be foraged, hunted or gathered. Instead of white bread, corn, sugar, powdered milk and canned foods, they began to eat the traditional fresh foods of their ancestral past: kangaroos, birds, crocodiles, turtles, shellfish, yams, figs, yabbies (freshwater crayfish), freshwater bream and bush honey.   At the experiment’s conclusion, the results were spectacular, but not altogether unexpected given what was known about Paleo diets, even then. The average weight loss in the group was 16.5 lbs; blood cholesterol dropped by 12% and triglycerides were reduced by a whopping 72%. Insulin and glucose metabolism became normal, and their diabetes effectively disappeared.

Dr. Lindeberg and I both realized that this type of experiment would probably never be repeated simply because the hunter-gatherer lifestyle is nearly extinct, and very few contemporary people have the knowledge or skills to live entirely off the land. Back in those early days of our friendship, we both had the same vision. This experiment should be conducted in a slightly different manner but not with westernized, former hunter-gatherers. Why not take a group of typically unhealthy westerners and put them on commonly available contemporary foods that mimic the nutritional characteristics of hunter-gatherer diets? Wow, what a great idea! We both knew that this experiment was precisely what Dr. Eaton had in mind with his inspirational paper way back in 1985.7


It took nearly 22 years for Dr. Eaton’s dream of experimentally testing modern day Paleo diets to come true, but it finally happened with the publication of a paper by Dr. Lindeberg’s research group in 2007.18 Staffan followed this publication with two additional papers in 200911 and 2010.13 Good ideas catch on, and two other independent research groups around the world followed suit with similar results – the first in 2008 by Dr. Osterdahl and co-workers at the Karolinska Institute in Sweden22 and the next in 2009 by my friend and colleague Dr. Lynda Frasseto (M.D.) from the University of California San Francisco School of Medicine.9

Although science may move slowly, it eventually does move forward as old ideas are replaced with new and better thoughts and information. I can assure you that this fundamental diet and lifestyle concept based upon evolutionary biology is not a fad and will not fade away.

In his first study in 200718 Dr. Lindeberg and associates placed 29 patients with type 2 diabetes and heart disease on either a Paleo diet or a Mediterranean diet based upon whole grains, low-fat dairy products, vegetables, fruits, fish, oils, and margarines. Note the Paleo diet excludes grains, dairy products, and margarines while encouraging greater consumption of meat and fish. After 12 weeks on either diet blood glucose tolerance (a risk factor for heart disease) improved in both groups, but was better in the Paleo dieters.

In a 2010 follow-up publication,18 of this same experiment the Paleo diet was shown to be more satiating on a calorie by calorie basis than the Mediterranean diet because it caused greater changes in leptin, a hormone which regulates appetite and bodyweight.

In the second ever study (2008) of Paleo diets, Dr. Osterdahl and co-workers put 14 healthy subjects on a Paleo diet. After only three weeks the subjects lost weight, reduced their waist size and experienced significant reductions in blood pressure, and plasminogen activator inhibitor (a substance in blood which promotes clotting and accelerates artery clogging). Because no control group was employed in this study, some scientists would argue that the beneficial changes might not necessarily be due to the Paleo diet. However, as you shortly will see, a better controlled experiment showed similar results.

In 2009, Dr. Frasetto and co-workers put nine inactive subjects on a Paleo diet for just 10 days.9 In this experiment, the Paleo diet was exactly matched in calories with the subjects’ usual diet.  Almost anytime people eat diets that are calorically reduced, no matter what foods are involved, they exhibit beneficial health effects. So the beauty of this experiment was that any therapeutic changes in the subjects’ health could not be credited to reductions in calories, but rather to changes in the types of food eaten. While on the Paleo diet either eight or all nine participants  experienced improvements in blood pressure, arterial function, insulin, total cholesterol, LDL cholesterol and triglycerides. What is most amazing about this experiment is how rapidly so many markers of health improved, and that they occurred in every single patient.

In an even more convincing recent (2009) experiment, Dr. Lindeberg and colleagues compared the effects of a Paleo diet to a diabetes diet generally recommended for patients with type 2 diabetes.11 The diabetes diet was intended to reduce total fat by increasing whole grain bread and cereals, low fat dairy products, fruits and vegetables while restricting animal foods. In contrast, the Paleo diet was lower in cereals, dairy products, potatoes, beans, and bakery foods, but higher in fruits, vegetables, meat, and eggs compared to the diabetes diet. The strength of this experiment was its cross over design in which all 13 diabetes patients first ate one diet for three months and then crossed over and ate the other diet for three months. Compared to the diabetes diet, the Paleo diet resulted in improved weight loss, waist size, blood pressure, HDL cholesterol, triglycerides, blood glucose and hemoglobin A1c (a marker for long term blood glucose control).    From an experimental design perspective, this trial represents a powerful example of the Paleo diet’s effectiveness in treating people with serious health problems.

From 2007 until 2010 only five experimental studies tested contemporary “Paleo” diets in humans (Table 1).  However since then, interest in experimentally testing these diets has grown concurrently (Table 1) with the general public’s explosive awareness of the Paleo Diet concept (Figure 1). Except for a single study, human trials testing modern day Paleo Diets have shown them to be therapeutic and generally more effective in reducing body weight and ameliorating symptoms of the metabolic syndrome (Table 1) than conventional western diets, type 2 diabetic diets, the Mediterranean diet, and the American Heart Association (AHA) diet (Table 1).   Further, contemporary “Paleo diets” are nutritionally more dense in the 13 vitamins and minerals most lacking in the typical U.S. diet when contrasted to the USDA my Plate recommendations,39, 40 the Mediterranean diet, and vegan/vegetarian diets.

Table 1.  Paleo Diet References: Direct Human/Animal Experimental and Epidemiological Studies in chronological order (oldest to most recent).



  1. O’Dea K: Marked improvement in carbohydrate and lipid metabolism in diabetic Australian aborigines after temporary reversion to traditional lifestyle. Diabetes 1984, 33(6):596-603.


  1. Jonsson T, Ahren B, Pacini G, Sundler F, Wierup N, Steen S, Sjoberg T, Ugander M, Frostegard J, Goransson Lindeberg S: A Paleolithic diet confers higher insulin sensitivity, lower C-reactive protein and lower blood pressure than a cereal-based diet in domestic pigs. Nutr Metab (Lond) 2006, 3:39.


  1. Lindeberg S, Jonsson T, Granfeldt Y, Borgstrand E, Soffman J, Sjostrom K, Ahren B: A Palaeolithic diet improves glucose tolerance more than a Mediterranean-like diet in individuals with ischaemic heart disease. Diabetologia 2007, 50(9):1795-1807.


  1. Osterdahl M, Kocturk T, Koochek A, Wandell PE: Effects of a short-term intervention with a paleolithic diet in healthy volunteers. Eur J Clin Nutr 2008, 62(5):682-685.


  1. Jönsson T, Granfeldt Y, Ahrén B, Branell UC, Pålsson G, Hansson A, Söderström M, Lindeberg S. Beneficial effects of a Paleolithic diet on cardiovascular risk factors in type 2 diabetes: a randomized cross-over pilot study. Cardiovasc Diabetol. 2009;8:35
  2. Frassetto LA, Schloetter M, Mietus-Synder M, Morris RC, Jr., Sebastian A: Metabolic and physiologic improvements from consuming a paleolithic, hunter-gatherer type diet. Eur J Clin Nutr 2009.


  1. Jonsson T, Granfeldt Y, Erlanson-Albertsson C, Ahren B, Lindeberg S. A Paleolithic diet is more satiating per calorie than a Mediterranean-like diet in individuals with ischemic heart disease. Nutr Metab (Lond). 2010 Nov 30;7(1):85


  1. Carter P, Achana F, Troughton J, Gray LJ, Khunti K, Davies MJ. A Mediterranean diet improves HbA1c but not fasting blood glucose compared to alternative dietary strategies: a network meta-analysis. J Hum Nutr Diet. 2014 Jun;27(3):280-97
  2. Jönsson T, Granfeldt Y, Lindeberg S, Hallberg AC.Subjective satiety and other experiences of a Paleolithic diet compared to a diabetes diet in patients with type 2 diabetes. Nutr J. 2013 Jul 29;12:105. doi: 10.1186/1475-2891-12-105.
  3. Ryberg M, Sandberg S, Mellberg C, Stegle O, Lindahl B, Larsson C, Hauksson J, Olsson T. A Palaeolithic-type diet causes strong tissue-specific effects on ectopic fat deposition in obese postmenopausal women. J Intern Med. 2013 Jul;274(1):67-76
  4. Frassetto LA, Shi L, Schloetter M, Sebastian A, Remer T. Established dietary estimates of net acid production do not predict measured net acid excretion in patients with Type 2 diabetes on Paleolithic-Hunter-Gatherer-type diets. Eur J Clin Nutr. 2013 Sep;67(9):899-903


  1. Fontes-Villalba M, Jönsson T, Granfeldt Y, Frassetto LA, Sundquist J, Sundquist K, Carrera-Bastos P, Fika-Hernándo M, Picazo Ó, Lindeberg S. A healthy diet with and without cereal grains and dairy products in patients with type 2 diabetes: study protocol for a random-order cross-over pilot study–Alimentation and Diabetes in Lanzarote–ADILAN.Trials. 2014 Jan 2;15:2. doi: 10.1186/1745-6215-15-2.
  2. Bisht B, Darling WG, Grossmann RE, Shivapour ET, Lutgendorf SK, Snetselaar LG, Hall MJ, Zimmerman MB, Wahls TL. A multimodal intervention for patients with secondary progressive multiple sclerosis: Feasibility and effect on fatigue. J Altern Complement Med. 2014 Jan 29. [Epub ahead of print]
  3. Mellberg C, Sandberg S, Ryberg M, Eriksson M, Brage S, Larsson C, Olsson T, Lindahl B. Long-term effects of a Palaeolithic-type diet in obese postmenopausal women: a 2-year randomized trial. Eur J Clin Nutr. 2014 Mar;68(3):350-7.
  4. Smith, M, Trexler E, Sommer A, Starkoff B, Devor S.teven (2014) Unrestricted Paleolithic Diet is associated with unfavorable changes to blood lipids in healthy subjects. Int J Exer Sci 2014, 7(2) : 128-139.
  5. Talreja D, Buchanan H, Talreja R, Heiby L, Thomas B, Wetmore J, Pourfarzib R, Winegar D. Impact of a Paleolithic diet on modifiable CV risk factors. Journal of Clinical Lipidology, Volume 8, Issue3, Page 341, May 2014.
  6. Boers I, Muskiet FA, Berkelaar E, Schur E, Penders R, Hoenderdos K, Wichers HJ, Jong MC. Favourable effects of consuming a Palaeolithic-type diet on characteristics of the metabolic syndrom. A randomized controlled pilot-study. Lipids Health Dis. 2014 Oct 11;13:160. doi: 10.1186/1476-511X-13-160.
  7. Stomby A, Simonyte K, Mellberg C, Ryberg M, Stimson RH, Larsson C, Lindahl B, Andrew R, Walker BR, Olsson T. Diet-induced weight loss has chronic tissue-specific effects on glucocorticoid metabolism in overweight postmenopausal women. Int J Obes (Lond). 2014 Oct 28. doi: 10.1038/ijo.2014.188. [Epub ahead of print]
  8. Whalen KA, McCullough M, Flanders WD, Hartman TJ, Judd S, Bostick RM. Paleolithic and mediterranean diet pattern scores and risk of incident, sporadic colorectal adenomas. Am J Epidemiol. 2014 Dec 1;180(11):1088-97. doi: 10.1093/aje/kwu235. Epub 2014 Oct 17.
  9. Toth C, Clemens Z. Type 1 diabetes mellitus successfully managed with the Paleolithic ketogenic diet. Int J Case Pep Images. 2014 5(10):699-703.


  1. Talreja A, Talreja S, Talreja R,Talreja D. The VA Beach Diet Study: An investigation of  the effects  of plant-based, Mediterranean, Paleolithic, and Dash Diets on cardiovascular disease risk. J Am Coll Cardiol Intv. 2015;8(2_S):S41-S41.  doi:10.1016/j.jcin.2014.12.161
  2. Bligh HF, Godsland IF, Frost G, Hunter KJ, Murray P, MacAulay K, Hyliands D, Talbot DC, Casey J, Mulder TP, Berry MJ.Plant-rich mixed meals based on Palaeolithic diet principles have a dramatic impact on incretin, peptide YY and satiety response, but show little effect on glucose and insulin homeostasis: an acute-effects randomised study.Br J Nutr. 2015 Feb 28;113(4):574-84.
  3. London DS, Beezhold B. A phytochemical-rich diet may explain the absence of age-related decline in visual acuity of Amazonian hunter-gatherers in Ecuador. Nutr Res. 2015 Feb;35(2):107-17.
  4. Masharani U, Sherchan P, Schloetter M, Stratford S, Xiao A, Sebastian A, Nolte Kennedy M, Frassetto L. Metabolic and physiologic effects from consuming a hunter-gatherer (Paleolithic)-type diet in type 2 diabetes. Eur J Clin Nutr. 2015 Apr 1. doi: 10.1038/ejcn.2015.39. [Epub ahead of print]
  5. Tóth, C, and Zsófia, C. “Gilbert’s Syndrome successfully treated with the Paleolithic ketogenic diet.” Am J Med Case Reports. 2015 3(4). //pubs.sciepub.com/ajmcr/3/4/9/
  6. Pastore RL, Brooks JT, Carbone JW. Paleolithic nutrition improves plasma lipid concentrations of hypercholesterolemic adults to a greater extent than traditional heart-healthy dietary recommendations. Nutr Res. 2015; 35:474-479.





[1]Abrams, HL. The relevance of Paleolithic diet in determining contemporary nutritional needs. J Applied Nutr 1979;31: 43-59.

[2]Chaitow, L. Stone Age Diet. London, Macdonal & Co. (Publishers) Ltd., 1987.

[3]Cordain L, Lindeberg S, Hurtado M, Hill K, Eaton SB, Brand-Miller J. Acne vulgaris: a disease of Western civilization. Arch Dermatol. 2002 Dec;138(12):1584-90.

[4]DeVries, A. Primitive Man and His Food. Chicago, Chandler Book Company, 1952.

[5]Dobzhansky T. Am Biol Teacher. 1973 March; 35:125-129.

[6]Eaton SB, et al. Stone agers in the fast lane: chronic degenerative diseases in evolutionary perspective. Am J Med 1988;84:739-49.

[7]Eaton SB, Konner M. Paleolithic nutrition. A consideration of its nature and current implications. N Engl J Med 1985;312:283-9.

[8]Eaton SB, Shostak M, Konner M. The Paleolithic Prescription. New York, Harper & Row, 1988.

[9]Frassetto LA, Schloetter M, Mietus-Synder M, Morris RC, Jr., Sebastian A: Metabolic and physiologic improvements from consuming a paleolithic, hunter-gatherer type diet. Eur J Clin Nutr 2009.

[10]Ho-Pham LT, Nguyen ND, Nguyen TT, Nguyen DH, Bui PK, Nguyen VN, Nguyen TV. Association between vitamin D insufficiency and tuberculosis in a Vietnamese population. BMC Infect Dis. 2010 Oct 25;10:306.

[11]Jönsson T, Granfeldt Y, Ahrén B, Branell UC, Pålsson G, Hansson A, Söderström M, Lindeberg S. Beneficial effects of a Paleolithic diet on cardiovascular risk factors in type 2 diabetes: a randomized cross-over pilot study. Cardiovasc Diabetol. 2009;8:35

[12]Jonsson T, Ahren B, Pacini G, Sundler F, Wierup N, Steen S, Sjoberg T, Ugander M, Frostegard J, Goransson Lindeberg S: A Paleolithic diet confers higher insulin sensitivity, lower C-reactive protein and lower blood pressure than a cereal-based diet in domestic pigs. Nutr Metab (Lond) 2006, 3:39.

[13]Jonsson T, Granfeldt Y, Erlanson-Albertsson C, Ahren B, Lindeberg S. A Paleolithic diet is more satiating per calorie than a Mediterranean-like diet in individuals with ischemic heart disease. Nutr Metab (Lond). 2010 Nov 30;7(1):85

[14]Lindeberg S, Lundh B: Apparent absence of stroke and ischaemic heart disease in a traditional Melanesian island: a clinical study in Kitava. J Intern Med 1993, 233(3):269-275.

[15]Lindeberg S, Nilsson-Ehle P, Terént A, Vessby B, Scherstén B. Cardiovascular risk factors in a Melanesian population apparently free from stroke and ischaemic heart disease: the Kitava study. J Intern Med. 1994 Sep;236(3):331-40.

[16]Lindeberg S, Berntorp E, Carlsson R, Eliasson M, Marckmann P. Haemostatic variables in Pacific Islanders apparently free from stroke and ischaemic heart disease–the Kitava Study. Thromb Haemost. 1997 Jan;77(1):94-8.

[17]Lindeberg S, Eliasson M, Lindahl B, Ahrén B: Low serum insulin in traditional Pacific Islanders–the Kitava Study. Metabolism 1999, 48(10):1216-1219.

[18]Lindeberg S, Jonsson T, Granfeldt Y, Borgstrand E, Soffman J, Sjostrom K, Ahren B: A Palaeolithic diet improves glucose tolerance more than a Mediterranean-like diet in individuals with ischaemic heart disease. Diabetologia 2007, 50(9):1795-1807.

[19]Nnoaham KE, Clarke A. Low serum vitamin D levels and tuberculosis: a systematic review and meta-analysis. Int J Epidemiol. 2008 Feb;37(1):113-9.

[20]Nesse RM, Stearns SC, Omenn GS. Medicine needs evolution. Science 2006;311:1071.

[21]O’Dea K: Marked improvement in carbohydrate and lipid metabolism in diabetic Australian aborigines after temporary reversion to traditional lifestyle. Diabetes 1984, 33(6):596-603.

[22]Osterdahl M, Kocturk T, Koochek A, Wandell PE: Effects of a short-term intervention with a paleolithic diet in healthy volunteers. Eur J Clin Nutr 2008, 62(5):682-685.

[23]Price WA. Nutrition and physical degeneration; a comparison of primitive and modern diets and their effects. P.B. Hoeber, Inc., New York, 1939.

[24]Pritchard JK. How we are evolving. Sci Am. 2010 Oct;303(4):40-47.

[24]Shatin R. Man and his cultigens. Scientific Australian 1964;1:34-39

[26]Shatin R. The transition from food-gathering to food-production in evolution and disease. Vitalstoffe Zivilisationskrankheitein 1967;12:104-107.

[27]Talat N, Perry S, Parsonnet J, Dawood G, Hussain R. Vitamin d deficiency and tuberculosis progression. Emerg Infect Dis. 2010 May;16(5):853-5.

[28]Truswell AS. Diet and nutrition of hunter-gatherers. In: Health and disease in tribal societies. New York: Elsevier; 1977:213-21.

[29]Truswell AS. Human Nutritional Problems at Four Stages of Technical Development. Reprint. Queen Elizabeth College (University of London), Inaugural Lecture, May, 1972.

[30]Voegtlin, WL. The Stone Age Diet. New York, Vantage Press, 1975.

[31]Yamshchikov AV, Kurbatova EV, Kumari M, Blumberg HM, Ziegler TR, Ray SM, Tangpricha V. Vitamin D status and antimicrobial peptide cathelicidin (LL-37) concentrations in patients with active pulmonary tuberculosis. Am J Clin Nutr. 2010 Sep;92(3):603-11.

[32]Yudkin, J. Archaeology and the nutritionist. In: The Domestication and Exploitation of Plants and Animals, PJ Ucko, GW Dimbleby (Eds.), Chicago, Aldine Publishing Co, 1969, pp. 547-552.

[33]Williams GC, Nesse RM. The dawn of Darwinian medicine. Q Rev Biol. 1991 Mar;66(1):1-22.

[34]Cordain L. Cereal grains: humanity’s double edged sword. World Review of Nutrition and Dietetics. 1999;84:19-73.

[35]Afsal K, Harishankar M, Banurekha VV, Meenakshi N, Parthasarathy RT, Selvaraj P.Effect of 1,25-dihydroxy vitamin D3 on cathelicidin expression in patients with and without cavitary tuberculosis. Tuberculosis (Edinb). 2014 Dec;94(6):599-605.

[36]Selvaraj P. Vitamin D, vitamin D receptor, and cathelicidin in the treatment of tuberculosis. Vitam Horm. 2011;86:307-25.

[37]Abrams HL. A dischronic perview of wheat in hominid nutrition. J Appl Nutr 1978;30:41-43.

[38]Cordain L, Lindeberg S, Hurtado M, Hill K, Eaton SB, Brand-Miller J. Acne vulgaris: A disease of civilization. Arch Dermatol. 2002;138: 1584-90.

[39]Cordain L. The nutritional characteristics of a contemporary diet based upon Paleolithic food groups. J Am Neutraceut Assoc 2002; 5:15-24.

[40]Cordain L, Eaton SB, Sebastian A, Mann N, Lindeberg S, Watkins BA, O’Keefe JH, Brand-Miller J. Origins and evolution of the western diet: Health implications for the 21st century. Am J Clin Nutr 2005;81:341-54.

Ghee | Paleo Diet

Released from The Insider Vault: What’s the Skinny on Ghee?

I’m often asked is ghee Paleo? If you are not familiar with ghee, it comes from the Sanskrit word ghrita, meaning bright, and is clarified butter fat in which most of the water has been boiled off and the nonfat solids removed by continued heating, filtration, or decanting the remaining oil mixture.1 Traditional societies in India and elsewhere have produced and consumed ghee since at least 1500 BC.1


  1. Milk butter or desi method
  2. Direct cream method
  3. Cream butter method
  4. Pre-stratification method

All four commercial procedures to produce ghee rely upon heating at temperatures from 105° to 118° C to remove the water.1

Ghee typically contains milk fat (99 to 95%), water (< 0.5%) and protein (0.1%). The butter fat remaining in ghee after boiling and removal of nonfat solids contains saturated fatty acids (53.9 to 66.8%), polyunsaturated and monounsaturated fatty acids (22.8 to 38%), free fatty acids bound to albumin (1-3%), and cholesterol (0.15 to 0.30%).1, 2

In 1987, Jacobson first pointed out that ghee contained high concentrations (12.3%) of oxidized cholesterol, otherwise known as oxysterols.3 He suggested that consumption of ghee, with its high levels of oxidized cholesterol, by Indian immigrant population living in the UK likely represented an important dietary risk factor for atherosclerosis and heart disease.3 In subsequent years, it has been conclusively demonstrated in human, animal and epidemiological studies that dietary intake of oxidized cholesterol accelerates the rate of atherosclerosis or the hardening of the arteries, as well as increasing the size of the arterial plaque.4, 5, 6 Hence because of their atherogenic, cytotoxic and pro-inflammatory effects, oxidized cholesterol food products are almost universally recommended to be reduced or minimized in our diets.7, 8, 9

The final aspect of the ghee story that requires further scrutiny is the high concentration (12.3%) of oxidized cholesterol that Jacobson initially reported in
1987.3 This value has been questioned because of the analytical procedures that were used to measure the oxidized cholesterol.9 More recent studies suggest this
high value may have been incorrect.9, 10, 11

Fresh butter and cream samples contain barely detectable concentrations of oxidized cholesterol, whereas ghee manufactured at temperatures below 120°C contained 1.3% oxidized cholesterol.10, 11

Whether or not regular consumption of oxidized cholesterol at this lower concentration can still induce atherosclerosis in humans is currently unknown. However, part of the problem with ghee is that it is frequently used to fry food or is re-used many times in cooking foods. Both of these procedures are known to increase oxidized cholesterol to levels known to cause atherosclerosis in animal models.4 Foods fried in ghee may contain 7.1% oxidized cholesterol, whereas intermittently heated ghee contains 8.1 to 9.2% oxidized cholesterol.10

My advice is to skip ghee altogether and replace it with virgin olive oil for Paleo cooking and in salads.



1. Sserunjogi ML, Abrahamsen RK, Narvhus J. A review paper: Current knowledge of ghee and related products. Int Dairy J. 1998;8:677–88.

2. Sarojini JK, Ubhayasekera SJ, Kochhar SP, Dutta PC. Lipids and lipid oxidation with emphasis on cholesterol oxides in some Indian sweets available in London. Int J Food Sci Nutr. 2006 Nov-Dec;57(7-8):451-8.

3. Jacobson MS. Cholesterol oxides in Indian ghee: possible cause of unexplained high risk of atherosclerosis in Indian immigrant populations. Lancet. 1987 Sep 19;2(8560):656-8.

4. Soto-Rodríguez I, Campillo-Velázquez PJ, Alexander-Aguilera A, Rodríguez-Estrada MT, Lercker G, Garcia HS. Biochemical and histopathological effects of dietary oxidized cholesterol in rats. J Appl Toxicol. 2009 Nov;29(8):715-23

5. Staprans I, Pan XM, Rapp JH, Feingold KR. The role of dietary oxidized cholesterol and oxidized fatty acids in the development of atherosclerosis. Mol Nutr Food Res. 2005 Nov;49(11):1075-82.

6. Staprans I, Pan XM, Rapp JH, Moser AH, Feingold KR. Ezetimibe inhibits the incorporation of dietary oxidized cholesterol into lipoproteins. J Lipid Res. 2006 Nov;47(11):2575-80.

7. Otaegui-Arrazola A, Menéndez-Carreño M, Ansorena D, Astiasarán I.Oxysterols: A world to explore.Food Chem Toxicol. 2010 Dec;48(12):3289-303.

8. Hur SJ, Park, GB, Joo ST. Formation of cholesterol oxidation products (COPs) in animal products. Food Control 2007;18:939-947.

9. Sieber R. Oxidised cholesterol in milk and dairy products. Int Dairy J 2005;15:191-206.

10. Kumar, N. and Singhal, O. P. (1992), Effect of processing conditions on the oxidation of cholesterol in ghee. J. Sci. Food Agric., 58: 267–273.

11. Kumar MV, Sambaiah K, Lokesh BR. Effect of dietary ghee–the anhydrous milk fat, on blood and liver lipids in rats. J Nutr Biochem. 1999 Feb;10(2):96-104.


US Government Poised to Drop Cholesterol Warnings? | The Paleo Diet

The notion that dietary cholesterol, (cholesterol that occurs naturally within food), promotes cardiovascular disease has been a central tenet of the US government’s dietary recommendations for the past 50 years, including their Food Guide Pyramid (retired in 2005), MyPyramid (retired in 2011), and their current MyPlate configuration. Soon, however, the government may finally change its course, aligning itself with decades of scientific research showing that dietary cholesterol neither increases serum (blood) cholesterol levels nor increases risks for cardiovascular disease.

This surprising revelation broke when the Washington Times reported that the highly influential Dietary Guidelines Advisory Committee (DGAC), the group responsible for providing the scientific basis for official US dietary guidelines, is poised to reverse its longstanding warnings against eggs, shrimp, various animal fats, and other foods rich in dietary cholesterol.1

Such a reversal would be highly impactful and significant considering that official dietary guidelines affect school lunch programs and other institutional menu planning, while also directly influencing the eating habits of millions of Americans.

The DGAC convenes once every five years to update and adjust, if necessary, their recommendations. According to the Washington Post, at the panel’s final meeting in December, they decided to withdraw their dietary cholesterol warnings. “A person with direct knowledge of the proceedings,” the Post reports, “said the cholesterol finding would make it to the group’s final report, which is due within weeks.”2 In the current status and trend recap following December’s meeting the DGAC notes, “Cholesterol is not considered a nutrient of concern for overconsumption.” Read more here.

Members of the DGAC are not commenting publically until their report is published and submitted to the Department of Health and Human Services and the Department of Agriculture. Those agencies are not required to act upon the DGAC’s recommendations, but experts speaking with the Post report, “major deviations are not common.”

Let’s face it. The US government’s dietary recommendations have flown in the face of published nutritional science for far too long. It can’t, however, go on like this indefinitely. Eventually, the weight of the science coupled with shifts of thinking among scientists, nutrition experts, and consumers will nudge the government toward scientifically sound recommendations, as opposed to recommendations that serve the interests of food manufacturers and large agricultural conglomerates.

The campaign against dietary cholesterol dates back to 1961, when the American Heart Association (AHA) began warning against overconsumption. The AHA currently recommends no more than 300 mg daily. Eggs contain 185 mg of cholesterol, which means for decades past the AHA (and the US government by extension) has been taking the position that eating more than one daily egg is dangerous.

Even the infamous Dr. Ancel Keys, the progenitor of the lipid hypothesis of coronary heart disease, acknowledged as early as 1953 that dietary cholesterol doesn’t increase blood cholesterol and thus (according to his lipid hypothesis) doesn’t drive heart disease. Keys wrote in the American Journal of Public Health, “Repeated careful dietary surveys on large numbers of persons in whom blood cholesterol was measured consistently fail to disclose a relationship between the cholesterol in the diet and in the serum.”3

The Paleo Diet strongly encourages the DGAC to reverse its longstanding antagonism against healthy foods like eggs, beef, and shrimp, which contain relatively high amounts of dietary cholesterol. We further encourage the relevant governmental agencies to act upon the DGAC’s anticipated reversal, thereby definitively ending the ridiculous and entirely unscientific war against dietary cholesterol, an important and beneficial nutrient.

Christopher James Clark, B.B.A.

Nutritional Grail

Christopher James Clark | The Paleo Diet TeamChristopher James Clark, B.B.A. is an award-winning writer, consultant, and chef with specialized knowledge in nutritional science and healing cuisine. He has a Business Administration degree from the University of Michigan and formerly worked as a revenue management analyst for a Fortune 100 company. For the past decade-plus, he has been designing menus, recipes, and food concepts for restaurants and spas, coaching private clients, teaching cooking workshops worldwide, and managing the kitchen for a renowned Greek yoga resort. Clark is the author of the critically acclaimed, award-winning book, Nutritional Grail.



[1] Whoriskey, P. (February 10, 2015). The U.S. government is poised to withdraw longstanding warnings about cholesterol. The Washington Post. Retrieved from //www.washingtonpost.com/blogs/wonkblog/wp/2015/02/10/feds-poised-to-withdraw-longstanding-warnings-about-dietary-cholesterol/?tid=sm_fb

[2] Ibid.

[3] Keys, A. (November 1953). Prediction and Possible Prevention. American Journal of Public Health and the Nation’s Health, 43(11). Retrieved from //ajph.aphapublications.org/doi/abs/10.2105/AJPH.43.11.1399

Multi-Joint Exercise | The Paleo Diet

You sit at a desk all day. Relax on your couch while watching TV at night. Travel by car or public transit. What are the chances you could improve the physical demands being placed on your body to be more in line with how we were designed to live and move? Pretty good. We know activity was innate to hunter-gatherers to survive and sustain their lifestyle.1 And yet, while these instincts are still coded into our genes, western societies no longer demand the same physical activity.2

The majority of the time we are awake is spent in either sedentary behavior (58%) or light-intensity activity (39%), and only 3% in exercise time.3 The lack of movement in our society plays a significant role in an increased risk for obesity, poor physical fitness, depression, debility, and other disease. 4 Specifically, we are deficient in engaging in functional movements, positions that require more than one group of muscles and work from the core to the extremity. The three basic movements of squatting, lifting heavy objects, and carrying heavy things all require high ranges of joint motion.

In modern day, western society, the threat for survival is slim, comparatively. Nonetheless, these activities build overall strength, increase joint mobility, and can enhance our overall ability to perform essential daily activities as we age.5 6 Successful aging is measured by the physical, psychological, and social success with which adults are able to independently take care of themselves.7 In fact, the elderly in the Kung! hunter-gathers have been described as playful, vigorous and independent.8

Strong muscles help keep weak joints stable, comfortable, and protect them against further damage. The American College of Sports Medicine (ACSM) recommends that every exercise should be performed through a full range of motion when engaging in resistance training,9 which allows for strength adaptations to occur at every angle the joint moves through. These movements can potentially reduce injury and maintain flexibility for healthy joint integrity.10

Full range of motion exercises, like a deep squats, help maintain normal joint function by increasing and preserving joint mobility and flexibility.11 Passively sitting on chairs and couches, where we all spend a majority of our time whether at work or at home, completely turns off the functioning of the bones, muscles, and joints. This has biological consequences beyond reducing the strength of our muscles and the health of our joints.12 Physiologically, the loss of local contractile stimulation, induced through sitting, leads to both the suppression of skeletal muscle lipoprotein lipase (LPL) activity, which is necessary for triglyceride uptake and HDL-cholesterol production and reduces the uptake of glucose into the skeletal muscle.13 14

It is not uncommon in non-Western cultures for artificial hip and knee transplants to be rejected due to the resulting limited range of motion. Their daily living, compared to ours, involves many postures that require a much higher range of flexion at the joints.15 Even stair ascent and descent has been shown to be ergonomically demanding enough to work the joints of the ankle, knees and hips.16 Kneeling, squatting and sitting cross-legged on the floor are all basic movements we should be able to perform if our bodies are functioning at a healthy capacity.

Hunter-gatherers would not have been able to survive without being able to move completely, without restrictions, in a variety of positions. This same standard of being able to use our bodies to their fullest capacity should still be our goal today. Challenge yourself to break the norm of sitting in a chair throughout the day, and explore the possibilities of what you can do with your body. Get a standing desk, hang from a pull up bar in your door jam, squat, or even carry heavy items periodically throughout the day. Not only will you feel better, your body will thank you.


[1] Platek, Steven M., et al. “Walking the walk to teach the talk: implementing ancestral lifestyle strategies as the newest tool in evolutionary studies.” Evolution: Education and Outreach 4.1 (2011): 41-51.

[2] O’Keefe, James H., et al. “Exercise like a hunter-gatherer: a prescription for organic physical fitness.” Progress in cardiovascular diseases 53.6 (2011): 471-479.

[3] Centers for Disease Control and Prevention (CDC) National Health and Nutrition Examination Survey Data 2003-2004, 2005-2006. Atlanta, GA: Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS); 2009-2010. //www.cdc.gov/nchs/nhanes.htm Accessed November 5 2014.

[4] Eaton SB, Shostak M, Konner M: The first fitness formula. The paleolithic prescription. New York, NY: Harper & Row; 1988.

[5] Penninx, Brenda WJH, et al. “Physical exercise and the prevention of disability in activities of daily living in older persons with osteoarthritis.” Archives of Internal Medicine 161.19 (2001): 2309-2316.

[6] Ericsson, Y. B., L. E. Dahlberg, and E. M. Roos. “Effects of functional exercise training on performance and muscle strength after meniscectomy: a randomized trial.” Scandinavian journal of medicine & science in sports 19.2 (2009): 156-165.

[7] Dogra, Shilpa, and Liza Stathokostas. “Sedentary behavior and physical activity are independent predictors of successful aging in middle-aged and older adults.” Journal of aging research 2012 (2012).

[8] Biesele, Megan, and Nancy Howell. “The old people give you life”: Aging among! Kung hunter-gatherers.” Other ways of growing old (1981): 77-98.

 [9] Franklin, B.; Whaley, M.; Howley, E.; Balady, G. ACSM’s Guidelines for Exercise Testing and Prescription: Testing and Prescription. Lippincott Williams and Wilkins; 2000

[10] Cotter, Joshua A., et al. “Knee joint kinetics in relation to commonly prescribed squat loads and depths.” The Journal of Strength & Conditioning Research 27.7 (2013): 1765-1774.

[11] O’Shea, Pat. “Sports performance series: The parallel squat.” Strength & Conditioning Journal 7.1 (1985): 4-6.

[12] Dunstan, David W., Alicia A. Thorp, and Genevieve N. Healy. “Prolonged sitting: is it a distinct coronary heart disease risk factor?.” Current opinion in cardiology 26.5 (2011): 412-419.

[13] Bey L, Hamilton MT. Suppression of skeletal muscle lipoprotein lipase activity during physical inactivity: a molecular reason to maintain daily low-intensity activity. J Physiol. 2003;551(Pt 2):673–82.

[14] Hamilton MT, Hamilton DG, Zderic TW. Exercise physiology versus inactivity physiology: an essential concept for understanding lipoprotein lipase regulation. Exerc Sport Sci Rev. 2004;32(4):161–6.

[15] Hemmerich, A., et al. “Hip, knee, and ankle kinematics of high range of motion activities of daily living.” Journal of orthopaedic research 24.4 (2006): 770-781.

[16] Protopapadaki, Anastasia, et al. “Hip, knee, ankle kinematics and kinetics during stair ascent and descent in healthy young individuals.” Clinical Biomechanics 22.2 (2007): 203-210.

Red Meat and The Paleo Diet

Who doesn’t like a nice, rare filet mignon for dinner?  Or some flank steak, marinated in cumin, orange, lime and garlic, sautéed with peppers and onions and served with Bibb Lettuce warps and guacamole to create Paleo Fajitas?

It’s too bad we can’t eat this type of food that often. Or can we? We’ve all heard “Don’t eat red meat more than once per week” and “Always choose the leanest cuts of meat” from not only our doctors, but also from the media.

Unfortunately, the misconception that eating red meat, in and of itself, can cause certain types of cancers, high cholesterol and weight gain in the case of choosing fattier cuts, often serves as a deterrent for eating what is, in actuality, an outstanding source of protein, iron, zinc, B vitamins and fatty acids.

While we’d certainly want to avoid feed-lot, corn-fed beef, if we also ‘steer’ clear (pardon the pun) of 100% grass-fed beef, we’re actually doing ourselves a huge disservice.

To group the two together and present the nutritional value as one in the same would be akin to categorizing all proteins under one heading, where anything from hot dogs to wild salmon are suggested to be basically the same.

Not only does grass-fed beef come from a far more humane source, it’s also much higher in omega-3 fatty acids, conjugated linoleic acid (a potent source of antioxidants), Vitamin E and beta-carotene than grain-fed beef.

So how often can we eat it?  Isn’t more than once per week too much?

Eating it in balance, with a variety of other wild proteins, is the key.

Just as we wouldn’t want to eat only pastured chicken breast and wild salmon along with only broccoli and spinach, if we focus on incorporating some grass-fed meat, some wild fish, some pastured chicken, some eggs from pastured hens and some game meats, if accessible, we’ll reach a nicely balanced range of proteins, to accompany an equally varied array of fresh, local, in season veggies.

Now, what about choosing between a rib eye and a filet? Surely, the rib eye is a no-go, isn’t it? Not necessarily.

There’s room on a Paleo Diet for a fattier cut now and then, too.

So long as we stick with grass-fed, adding the more decadent cuts once in a while can often be what keeps us more likely to stay true to our Paleo lifestyle.

The satiating effect of the higher fat content, not to mention the flavor, can be the pièce de résistance of a special occasion meal, providing that beautiful balance so inherent to this healthy approach to eating and living.

Here is a great recipe to try; it’s my Paleoista version of Argentinean Flank Steak with Chimichurri.



Serves 2-3

  • 2 lbs grass fed flank steak
  • 4 cloves fresh garlic, smashed
  • 2 tbsp olive oil
  • 1/2 small lime, juiced
  • 1 tbsp dried oregano leaves
  • 1 tbsp dried basil leaves
  • 1 tbsp dried parsley flakes
  • Freshly ground black pepper, to taste
  • Dried crushed red pepper, optional, to taste
  • 1/2 cup fresh parsley
  • 1/2 cup fresh cilantro
  • 2 cloves garlic
  • 2 tbsp olive oil


1. Using a meat tenderizer tool, pound both sides of steak.

2. Place smashed garlic onto flesh of one side and pound into meat with tenderizer tool.

3. Rub thoroughly with olive oil and squeeze lime on top.

4. Combine all dry spices and press into meat.

5. Place in glass or ceramic dish and cover tightly; let marinate in refrigerator at least four hours.

6. Combine four remaining ingredients in mini prep food processor and whiz to combine. Tightly cover and refrigerate.

7. Preheat oven to broil (or light up the barbeque) and cook for roughly three minutes per side for rare, or longer for more done.

8. Remove from heat and let rest while you steam your favorite veggies.

9. Serve together with parsley combination on top.


Earlier this month, researchers from the University of Warwick published a study in Nutrition & Diabetes regarding the interaction of methylglyoxal (MG), a reactive glucose metabolite, and HDL cholesterol. HDL is universally known as “good cholesterol” and low HDL is an independent risk factor for cardiovascular disease.1 The study’s lead author, Dr. Naila Rabbani, claims “MG damage to HDL is a new and likely important cause of low and dysfunctional HDL, and could count for up to a 10% risk of heart disease.”2

Blood MG levels increase with short-term and persistent increases in blood glucose levels.3, 4 MG is particularly reactive, up to 40,000 times the reactivity of glucose, but is kept in check by an enzyme called glyoxalase 1 (Glo1).5 To address the problems of decreased HDL by way of decreased Glo1 and elevated MG, Rabbani suggests the creation of new food supplements and drugs: “By understanding how MG damages HDL we can now focus on developing drugs that reduce the concentration of MG in the blood.”6

While this recent study is an important contribution to scientific literature on “good” and “bad” cholesterol, it begs the question, can’t proper nutrition negate, or at least diminish, the need for proposed new supplements and drugs? According to a 2003 USDA publication, the average American eats an estimated 32 teaspoons of sugar daily.7

Sugar sweetened beverages may be uniquely dangerous with respect to decreased HDL levels. A 2012 study found that each additional teaspoon of added sugar per day consumed in beverage form results in a 0.12 mg/dL decrease in HDL.8 Since elevated blood glucose levels are associated with elevated MG levels, cutting drastically back on sugar is a logical first step toward establishing healthier MG levels.

The Paleo Diet, of course, eschews sugar, delivering only small amounts of glucose (and fructose) via fruits and vegetables, thereby promoting optimal MG and HDL levels. Other aspects of the Paleo Diet also promote increased HDL. For example, phenolic compounds in olive oil have been shown to increase HDL.9 DHA, a particular variety of omega-3 abundant in seafood, increases HDL.10 Saturated fat, which is embraced by the Paleo Diet, increases HDL.11

An unfortunate trajectory of medical research is the emphasis on developing products designed to address disease symptoms rather than addressing their underlying causes. If we are serious about getting healthy, we must make meaningful lifestyle changes. The diseases of modernity, including cancer, heart disease, and diabetes, are often referred to as lifestyle diseases because they are primarily caused by improper diet, smoking, and sedentary lifestyles.

Supplements and drugs are of little worth absent meaningful lifestyle changes. With respect to cholesterol, this means forgoing added sugar while eating a diet rich in animal foods and vegetables, with modest amounts of fruits, seeds, and nuts. In other words, the Paleo Diet promotes balanced cholesterol levels, making cholesterol-modifying supplements and drugs largely unnecessary.

Christopher James Clark, B.B.A.
Nutritional Grail

Christopher James Clark | The Paleo Diet TeamChristopher James Clark, B.B.A. is an award-winning writer, consultant, and chef with specialized knowledge in nutritional science and healing cuisine. He has a Business Administration degree from the University of Michigan and formerly worked as a revenue management analyst for a Fortune 100 company. For the past decade-plus, he has been designing menus, recipes, and food concepts for restaurants and spas, coaching private clients, teaching cooking workshops worldwide, and managing the kitchen for a renowned Greek yoga resort. Clark is the author of the critically acclaimed, award-winning book, Nutritional Grail.



1. Mahdy, AK, et al. (November 2012). Cardiovascular disease risk reduction by raising HDL cholesterol–current therapies and future opportunities. British Journal of Pharmacology, 167(6). Retrieved September 18, 2014.

2. University of Warwick. (September 1, 2014). Sugar substance ‘kills’ good HDL cholesterol. Retrieved September 18, 2014.

3. Beisswenger, PJ, et al. (April 2001). α-Dicarbonyls Increase in the Postprandial Period and Reflect the Degree of Hyperglycemia. Diabetes Care, 24(4). Retreived September 18, 2014.

4. McLellan, AC, et al. (July 1994). Glyoxalase system in clinical diabetes mellitus and correlation with diabetic .omplications. Clinical Science (London), 87(1). Retrieved September 18, 2014.

5. Thornalley, PJ. (December 2003). Glyoxalase I–structure, function and a critical role in the enzymatic defence against glycation. Biochemical Society Transactions, 31(6). Retrieved September 18, 2014.

6. Ibid, University of Warwick.

7. United States Department of Agriculture, Agriculture Fact Book 2001–2002, March 2003, Office of Communications. Retrieved September 18, 2014.

8. Welsh, JA, et al., (April 2012). The association between sugar intake and HDL levels varies by sugar type and source. The FASEB Journal, 26(Supplement). Retrieved September 18, 2014.

9. Covas, MI, et al., (September 2006). The Effect of Polyphenols in Olive Oil on Heart Disease Risk Factors. Annals of Internal Medicine, 145(5). Retrieved September 18, 2014.

10. Bernstein, AM, et al. (January 2012). A meta-analysis shows that docosahexaenoic acid from algal oil reduces serum triglycerides and increases HDL-cholesterol and LDL-cholesterol in persons without coronary heart disease. Journal of Nutrition, 142(1). Retrieved September 18, 2014.

11. Hayek, T, et al., (April 1993). Dietary fat increases high density lipoprotein (HDL) levels both by increasing the transport rates and decreasing the fractional catabolic rates of HDL cholesterol ester and apolipoprotein (Apo) A-I. Presentation of a new animal model and mechanistic studies in human Apo A-I transgenic and control mice. Journal of Clinical Investigation, 91(4). Retrieved September 18, 2014.

Mediterranean Diet | The Paleo Diet

Dr. Cordain,

Yours and Maelán Fontes Villalba’s position is both convincing and very interesting. But you agree that there are also studies showing protective effect of whole-grains?

I have another hypothesis – maybe complementary to yours: Perhaps it is before all drastic technological treatments applied to raw food edible materials that have rendered them deleterious for health via modified compounds not adapted to our genetics. Otherwise, our ancestors had a very low life expectancy: this an important point. And, if cereal grains were so bad, why are they edible? Don’t forget also that we have to consider wholegrains in the context of a whole diet. Finally, our ancestors seemed to eat lots of meat: maybe they were submitted to acidosis? And what do we know about diet-related chronic diseases at this ancient periods?

However, your genetic argument remains strong, I agree.

Friendly yours,

Anthony FARDET, Ph.D.
Chargé de Recherches (Research scientist)
Human Nutrition Research Center, Auvergne
Clermont-Ferrand/Theix Research Center

Dr. Cordain’s Response

Dear Dr. Fardet,

Thank you for keeping an open scientific mind — in regard to your comments, it is ironic that the range of diets to which our species has been conditioned to over the vast expanse of evolutionary experience is now beyond the reach of many of the world’s people.

France and French people have developed a cultural tradition of foods and eating/lifestyle habits which on the surface (in large population studies) appear to be healthier than in many parts of Europe and in the rest of the world. In France, on a population wide basis, French bread and other forms of wheat are consumed daily, as is wine, cultured cheese, and butter. Let’s not forget fresh veggies, fruit, fish, olives and olive oils — particularly in the South of France. Moreover, American style fast food is typically shunned by at least the older French population. Additionally, meals are consumed over long time periods with multiple dishes consumed in relaxed settings. These dietary patterns typically result in reduced total caloric intakes over a 24 hour period. This manner of meals pretty much describes the Mediterranean Diet which likely is healthier than the typical US Diet or the typical non-Mediterranean European Diet — both of which appear to accelerate all chronic diseases of western civilization.

Could the French or Mediterranean Diet be the healthiest way to stave off the chronic diseases which impact most western societies or is there a healthier alternative? Contrast the Mediterranean Diet and its associated morbidity and mortality rates for all causes combined to the Japanese Diet, or better yet to contemporary Paleo Diets. We now have preliminary data that the Paleo Diet is more nutritionally dense than the Mediterranean Diet and maintains multiple nutritional characteristics superior to the French, Mediterranean or Japanese Diets. The therapeutic data for contemporary Paleo Diets is now available. You can find these studies if you diligently look for them on MEDLINE.

Let me now address a few other concerns you have offered:

1. “Otherwise, our ancestors had a very low life expectancy: this an important point.”

Although this issue may represent an intuitive “flash point,” the best and most correct data would suggest otherwise. First, your characterization that, “our ancestors had a very low life expectancy” is not necessarily correct and is moreover misleading. Let me give you a simple example. If we have a population of 4 people (2 adults who die at age 80 and who give birth to 2 children who die in childbirth), then the average life expectancy of this population is quite low (160 years/4 = 40 years). Hence, “average lifespan” really only represents the average age at death. What is more important is to characterize the “average age” of the entire living population.

These statistics are calculated regularly by life insurance companies in the western world and are called Life Tables. Life Tables therefore reflect the living population and not those who have died only compared to the living. At least 4 life table studies of hunter gatherers show that a good percentage of the population survives into old age (>60 yrs.). These facts are rather surprising given that in their world, there was no modern medicine, sanitation or contemporary health practices, and that mortality comes not from chronic diseases (as in the western world) but rather from accidents, trauma, snake bikes, warfare and the stresses of living outdoors for an entire lifetime. Mortality and morbidity among hunter gatherers (even the elderly) do not show them sufferings the signs or symptoms of chronic disease found in western populations, and this should be the take home point. Let’s adopt the best of their worlds — leave the worst behind and take the best that the modern world has to offer.

2.”If cereal grains were so bad, why are they edible?”

Again, I encourage you to read my paper, “Cereal Grains: Humanity’s Double Edged Sword’ — Cordain, L. Cereal Grains: Humanity’s Double Edged Sword. World Rev Nutr Diet. Basel, Karger, 1999, vol 84, pp 19–73.

Cereal grains (whole wheat, rye, barley, oats, corn, maize, sorghum, millet, etc.) are not generally edible (or very poorly digestible) by humans (or almost any other primate) in their natural state without cooking. As a species, we have a poor/limited ability to hydrolyze raw grain starches into sugars and metabolize them and degrade their raw proteins into amino acids in our guts for absorption. Hence whole, uncooked grains consumed by humans and by virtually all primates (except for a single species of baboon [Gelada]) represent a food source which was rarely or never never consumed. See my paper cited above for the scientific references.

Accordingly, until humans developed fire, cereal grains would have never been a significant food source. More importantly, the ability to start fires “at will” is the crucial issue here. This technology likely developed in Europe (only) about 300,000 to 250,000 years ago, but occurred not “at will”, but more likely by collecting natural and lightning caused fires. To star a fire “at will” results from 4 or 5 technological advances which probably occurred only after the appearance of behaviorally modern humans (~200,000 ago or less).

More importantly, the cell walls of cereal grains must be broken down by mechanical means (milling) before fire and heating are effective to hydrolyze cereal grain starches and thereby make them available for human nutritional absorption. Important in this concept is that the first crude cereal milling stones do not appear in the archaeological record until about 15,000-25.000 years ago in the mid-east. The fossil, nutritional and physiological data indicate that cereal grains would have been rarely or never used as food sources by our species until very recently in human evolution, simply because they were indigestible.

3. “Don’t forget also that we have to consider whole-grains in the context of a whole diet.”

Consider reading these two papers:

1. Cordain L. The nutritional characteristics of a contemporary diet based upon Paleolithic food groups. J Am Neutraceut Assoc 2002; 5:15-24.

2. Cordain L, Eaton SB, Sebastian A, Mann N, Lindeberg S, Watkins BA, O’Keefe JH, Brand-Miller J. Origins and evolution of the western diet: Health implications for the 21st century. Am J Clin Nutr 2005;81:341-54

When cereal grains displace lean meats, fish, seafood, eggs, organ meats, fresh vegetables, and fresh fruits, they dilute the trace nutrient (vitamin, mineral, phytochemical) concentration of the 13 nutrients most lacking in the typical western diet. Hence, in the context of a whole diet, the inclusion of cereal grains makes all nutritional considerations worse.

4. “Finally, our ancestors seemed to eat lots of meat: maybe they were submitted to acidosis?”

The available archeaological evidence worldwide, spanning hundreds of thousands of years shows that osteological (bone mineral abnormalities) evidence cannot support your supposition. Rather, osteoporosis, cribra orbitalia and other bone mineral pathologies stemming from dietary induced acidosis only became commonplace following the agricultural revolution and the adoption of cereal grains and plant foods as staples. The physiological and archaeological mechanisms and arguments for these events are fully outlined in my paper, Cereal Grains: Humanity’s Double Edged Sword.

5. “And what do we know about diet-related chronic diseases at this ancient periods?”

As I have pointed out in prior blogs, it is difficult to deduce heart disease from the fossil/bone record. Further, except for bone cancers, the same be held true for cancers. Nevertheless, bone cancers are extremely rare or non-existent in the archaeological human record prior to agriculture. Studies of historically studied hunter gatherers show cardiovascular disease to be rare or non-existent.

Cordain L, Eaton SB, Brand Miller J, Mann N, Hill K. The paradoxical nature of hunter-gatherer diets: Meat based, yet non-atherogenic. Eur J Clin Nutr 2002;56 (suppl 1):S42-S52.


Loren Cordain, Ph.D., Professor Emeritus

Affiliates and Credentials