Tag Archives: The Paleo Diet

When it comes to brain fuel – glucose is king.[1] Glucose is the brain’s primary source of fuel and it is quite narrowly regulated inside our body as a result. This is referred to as glucose homeostasis.[2] There are two key players in this process – insulin and glucagon.[3] These two hormones are kept in balance so that our blood sugar remains stable. When we eat, the ratio of insulin to glucagon is high – which helps to facilitate many postprandial (after meal) processes in the body.[4]

The standard American diet is very high in glucose – meaning it’s high in carbohydrates like bread, pasta, baked goods, and juices.[5] While glucose is the king of brain (and body) fuel, we do also have the ability to fuel our brains with ketone bodies, which is part of why low carb diets are currently exploding in popularity.[6] Heck, even I got in on the action, and wrote a low carb cookbook. (Note that while the Paleo Diet is lower carbohydrate than the standard American diet, at www.thepaleodiet.com, Dr. Loren Cordain and the Editorial Board do not support extreme low-carbohydrate diets like the Ketogenic diet.)


How the Body Manages Glucose

The nuts and bolts of how our brain handles glucose is actually very fascinating. To easily explain a very complex situation, it is best to start by describing the various different metabolic states which bring about different activity in the body and brain. For example, when we lack carbohydrates, our liver glycogen stores are rapidly used and fatty acids are then shuttled (from stored fat,) to provide energy via a process called oxidation.[7] These changes rapidly makes the body less reliant on glucose as it addresses the shortage.

Fatty acid oxidation allows the limited supply of glucose to be conserved for the brain – likely a mechanism developed to prevent starvation in our ancestors, during times of food scarcity.[8]

Think of this as a backup fuel system. Our body knows when one fuel is running low or not available, and switches to another energy supply. Taken to an extreme, when carbohydrates are low enough, for long enough, we go into ketosis.[9] The ‘keto flu’ – where we don’t feel very good after removing carbohydrates from our diet – is directly related to this switch in fuel systems.

On the flip side, if we have plenty of carbohydrates, our bodies will choose to store fat and rely on glucose for fuel since our ability to store carbohydrates is limited. This is also why marathon runners carb-load. They want to maximize this limited store and make sure more glucose is available for their bodies to draw upon as they step outside of a normal human activity range. Glycogen stores can be increased temporarily this way, but if you do this repeatedly – without burning the energy – you are very likely to gain weight instead.[10]

But when we really get into the details; how exactly does our brain sense glucose? and why is this important?

Essentially, there are neurons which detect the presence of glucose, and send signals to our brain, alerting the brain to its presence.[11] Since our brain controls our energy balance (as well as our hunger and satiety signaling processes) – the neurons which detect glucose are critically important.[12] But interestingly, these neurons are located outside the blood-brain barrier – not where you might expect.


What Happens to the Brain when Glucose Balance is Disrupted?

When glucose gets out of balance, diseases, obesity, and other conditions develop. But how does this happen, if we have glucose sensing neurons? In some cases, cells such as these neurons, can die and this is tightly related to brain disorders and degenerative brain conditions.[13] Also, neurotransmitter synthesis requires glucose, and our brain will simply have extreme issues if glucose levels (or regulation of glucose sensing) is disrupted.[14]

Glucose is actually shuttled from the blood to the brain through GLUT1 transporters on the surface of the brain which allows glucose to cross the blood-brain barrier.[15] This transport is carefully regulated and can be disrupted if the glucose-sensing neurons aren’t functioning appropriately. This can lead to serious issues.

Most glucose in the brain is used for ‘thinking’ and ‘processing’. These are broad terms, but essentially mean that without enough glucose in the brain, we can’t think properly, or process information. This disruption is similar to what is seen when alcohol is consumed, for example.

These processes (and glucose) are very critical for both learning and memory, and one can quickly see how glucose disruption and cell malfunction or cell death can greatly impair our brain’s critical processes.[16]

Glucose is in fact even more critical for other functions. For example, glucose can be used to synthesize glutamate, glycine, aspartate, and other important compounds. This is critical, as these compounds normally cannot easily gain entry directly into the brain, without glucose being used to synthesize them.[17] Another example of the importance of glucose, is autophagy. Autophagy is a greatly important process that “cleans out” dying or misfunctioning cells. It can be disrupted by poor glucose metabolism. In the simplest terms, think of it as recycling – but for the body.[18] Just as we recycle to provide better results for the earth – our body has internal mechanisms of recycling, for our own well-being. Glucose is also critical for metabolic coupling – where compounds made in one cell, can be used by a neighboring cell.[19] Think of it as similar to your neighbor borrowing a cup of sugar from you (though hopefully as a Paleo Dieter, you’re not keeping big bags of sugar in your kitchen.)

About 50 percent of all glucose in the body is used by the brain – which helps explain the ‘hangry’ state that we all experience.[20] If there isn’t glucose in the brain – neurotransmitters are not produced. This means neurons can’t talk to each other and helps explain our confusion and foul mood when our blood sugar gets very low.

Interestingly, research has also shown a direct link between too much sugar (specifically fructose) – and premature aging. Other studies have shown that too much glucose can be linked to cognitive decline and memory issues.[21] This research is the most frequently cited when articles claim that ‘sugar can kill us’, or ‘sugar can cause Alzheimer’s’. Type 2 diabetes is of course known as the disease where our bodies simply become resistant to insulin – truly scary.

Glucose sensing in the brain is critically important, and a Paleo Diet® will keep glucose levels at normal, healthy levels – leading to much better brain health and a healthier life overall.



  1. Mergenthaler P, Lindauer U, Dienel GA, Meisel A. Sugar for the brain: the role of glucose in physiological and pathological brain function. Trends Neurosci. 2013;36(10):587-97.
  2. Tups A, Benzler J, Sergi D, Ladyman SR, Williams LM. Central Regulation of Glucose Homeostasis. Compr Physiol. 2017;7(2):741-764.
  3. Kalra S, Gupta Y. The Insulin:Glucagon Ratio and the Choice of Glucose-Lowering Drugs. Diabetes Ther. 2016;7(1):1-9.
  4. Kalra S, Gupta Y. The Insulin:Glucagon Ratio and the Choice of Glucose-Lowering Drugs. Diabetes Ther. 2016;7(1):1-9.
  5. Sartorius K, Sartorius B, Madiba TE, Stefan C. Does high-carbohydrate intake lead to increased risk of obesity? A systematic review and meta-analysis. BMJ Open. 2018;8(2):e018449.
  6. Laffel L. Ketone bodies: a review of physiology, pathophysiology and application of monitoring to diabetes. Diabetes Metab Res Rev. 1999;15(6):412-26.
  7. Purdom T, Kravitz L, Dokladny K, Mermier C. Understanding the factors that effect maximal fat oxidation. J Int Soc Sports Nutr. 2018;15:3.
  8. Houten SM, Wanders RJ. A general introduction to the biochemistry of mitochondrial fatty acid β-oxidation. J Inherit Metab Dis. 2010;33(5):469-77.
  9. Miller VJ, Villamena FA, Volek JS. Nutritional Ketosis and Mitohormesis: Potential Implications for Mitochondrial Function and Human Health. J Nutr Metab. 2018;2018:5157645.
  10. Ma Y, Olendzki B, Chiriboga D, et al. Association between dietary carbohydrates and body weight. Am J Epidemiol. 2005;161(4):359-67.
  11. Burdakov D, Luckman SM, Verkhratsky A. Glucose-sensing neurons of the hypothalamus. Philos Trans R Soc Lond, B, Biol Sci. 2005;360(1464):2227-35.
  12. Routh VH. Glucose sensing neurons in the ventromedial hypothalamus. Sensors (Basel). 2010;10(10):9002-25.
  13. Hotchkiss RS, Strasser A, Mcdunn JE, Swanson PE. Cell death. N Engl J Med. 2009;361(16):1570-83.
  14. Bak LK, Schousboe A, Sonnewald U, Waagepetersen HS. Glucose is necessary to maintain neurotransmitter homeostasis during synaptic activity in cultured glutamatergic neurons. J Cereb Blood Flow Metab. 2006;26(10):1285-97.
  15. Morgello S, Uson RR, Schwartz EJ, Haber RS. The human blood-brain barrier glucose transporter (GLUT1) is a glucose transporter of gray matter astrocytes. Glia. 1995;14(1):43-54.
  16. Mergenthaler P, Lindauer U, Dienel GA, Meisel A. Sugar for the brain: the role of glucose in physiological and pathological brain function. Trends Neurosci. 2013;36(10):587-97.
  17. Hertz L, Rothman DL. Glucose, Lactate, β-Hydroxybutyrate, Acetate, GABA, and Succinate as Substrates for Synthesis of Glutamate and GABA in the Glutamine-Glutamate/GABA Cycle. Adv Neurobiol. 2016;13:9-42.
  18. Glick D, Barth S, Macleod KF. Autophagy: cellular and molecular mechanisms. J Pathol. 2010;221(1):3-12.
  19. Steinman MQ, Gao V, Alberini CM. The Role of Lactate-Mediated Metabolic Coupling between Astrocytes and Neurons in Long-Term Memory Formation. Front Integr Neurosci. 2016;10:10.
  20. Mergenthaler P, Lindauer U, Dienel GA, Meisel A. Sugar for the brain: the role of glucose in physiological and pathological brain function. Trends Neurosci. 2013;36(10):587-97.
  21. Calsolaro V, Edison P. Alterations in Glucose Metabolism in Alzheimer’s Disease. Recent Pat Endocr Metab Immune Drug Discov. 2016;10(1):31-39.

At the heart of the scientific process is debate. Debate is critical because everything in science is a theory and theories can only be improved by constantly challenging and refining them.

In nutritional science the debate often gets heated and even that can be a good thing. Scientists debating the merits of various diets often cite vastly different and contradictory studies. Sometimes they can even doggedly argue polar opposite interpretations of the same study.

But as long as you can back it up with research, almost anything is fair game.

Almost anything.

One thing you cannot do is create your own definition of a theory and then debate the merits of that definition.

For example, if we were going to debate the merits of the Paleo Diet vs the Mediterranean Diet, we couldn’t argue that the Mediterranean is unhealthy because people on the diet eat a pound of Oreos every day. They don’t. That’s not part of the definition.

In fact, we recently wrote an article comparing the nutrient density of the Paleo Diet to the Mediterranean Diet. To make this comparison we used the gold-standard Mediterranean sample menu as defined in the literature.[1] It took me hours to find the most acknowledged version, but it was time well spent because we wanted to debate the Mediterranean Diet and that meant debating the accepted definition.

Unfortunately, not everyone shares our standards and right now there’s a study making the rounds in the media that broke this important rule.

The study by Genoni et al has made claims about serious health concerns with the Paleo Diet. The authors found that people on a Paleo Diet have significantly higher levels of serum trimethylamine-N-oxide (TMAO) which has been associated with heart disease.[2]

Not only was the definition of a “Strict Paleo Diet” in their study not Paleo, but it matched up almost perfectly with fad low-carbohydrate diets which advocates of the Paleo Diet have stated clearly are neither Paleo, nor healthy.[2, 3]


Comparing the Diets: Why It Wasn’t Paleo

The study focused on a group that the authors referred to as the “Strict Paleolithic group” Their primary finding was that “consumption of a long-term Paleolithic diet was associated with markedly higher serum TMAO concentrations, but only in those who adhered to the diet strictly.”

So just how Paleo was this strict Paleo group?

In the Revised Edition of The Paleo Diet – the original Paleo Diet book and still recognized as the book that defines the diet – Dr Loren Cordain dedicated the first chapter not to defining the diet, but to warning readers against confusing fad low-carbohydrate diets with the Paleo Diet. In fact, this first chapter is titled “Not Just Another Low Carb Diet.”[3]

On page 24, the book breaks down a standard Paleo Diet next to a fad low-carb diet and shows what makes them different.

In Table 1 below, we have reproduced that comparison and placed next to them the breakdown of the three diets in the TMAO study by Genoni et. al.. We also included the breakdown of two sample Paleo Diet menus created by Dr. Cordain. One is from page 29 of his book and the other is from a 2002 study Dr Cordain published in the Journal of the American Neutraceutical Association (JANA) showing the nutrient composition of a sample Paleo Diet.[4]

Table 1. Comparison of the compositions of the three diets in the Genoni et. al. to two sample Paleo Diet menus and compositions of a proper Paleo Diet and Fad Low-Carbohydrate Diet as defined in the Revised Edition of The Paleo Diet.[2, 3]

* taken from the 2011 Revised Edition of The Paleo Diet, the first and still considered the definite definition of the Paleo Diet
** taken from a 2002 study by Dr Cordain published in JAMA containing one of the first analyses of a sample Paleo Diet menu
***6.7g of the polyunsatured fats (32%) were in the form of Omega-3s compared to 1.0g in a typical Western diet

What is most striking is that the “Strict Paleo Diet” group in the study by Genoni et. al. lines up almost perfectly with the definition of a fad low-carbohydrate diet and does not line up at all with the Standard Paleo Diet (highlighted in pink.)

In fact, strictly by the breakdown in the table, the Control group, which was defined as “consuming a diet typical of national recommendations,” lined up better with the Standard Paleo Diet than the Strict Paleo Diet group in the study.

What’s equally striking is how easy it is to see these contradictions. Anyone can recreate this table simply by looking at page 24 of The Paleo Diet and the diet chart in the TMAO study. You don’t need a degree in statistics nor do you need a Ph.D.

However, a Ph.D. leading a major research study should know better.

The fact is, the authors did not work with the accepted definition of the Paleo Diet. Instead, they worked with their own definition. Literally. In their Introduction they claim, “The Paleolithic diet can be classed as a low carbohydrate diet [5}.” That sole references is to a study by the same lead author – Genoni.[5] In other words, they referenced themselves for their definition of the diet.

And unfortunately, the criteria in their definition were woefully inadequate. Subjects only needed to eat minimal grains and dairy. That is not a sufficient definition of the Paleo Diet and as the study unfortunately proved, does not differentiate between a fad low-carb diet and a true Paleo Diet.

The two Paleo groups in this study were actually following a fad low-carb diet and the inability of Genoni et al to make this differentiation brings into question the primary conclusions of their study:


The Paleo Diet is Not Another Low Carbohydrate Diet

In a recent Newsweek article, lead author Genoni pointed to the low carbohydrate nature of the Paleo Diet as one of the major concerns. “We also found that populations of beneficial bacterial species were lower in the Paleolithic groups, associated with the reduced carbohydrate intake.”

It’s worth pointing out that their healthy control group fits within the carbohydrate range for a standard Paleo Diet. And while the sample Paleo Diets in table 1 are lower in carbohydrates than this control group, the two Paleo groups in the study clearly do not fit within the Paleo Diet carbohydrate definition.

We actually share the author’s concerns with very low-carbohydrate diets and have written about it.


Can She Blame Low Fiber Consumption?

In another interview with Paleo Magazine, Genoni said that elevated TMAO from consuming fish is not a concern because it is transient. Her concern was chronic TMAO elevation on a Paleo Diet due to the low-fiber in the diet. However, not only is the Paleo Diet not low in fiber, the breakdown of the two sample Paleo Diet menus in Table 1 have a higher fiber content than any of the diets in the study at 42.5g and 47g respectively. The control diet in the study only averaged 29.7g.


Or Fats?

“Conversely the direction of the shift in microbiota composition associated with fat consumption was in the opposite direction and suggests a more deleterious profile.” That’s a heavy quote. But it was a lead in to a substantial portion of the conclusions where the authors explained that the high-fat and particularly high-saturated fat content of the Paleo Diet may cause unwanted changes in our gut bacteria.

While the fad low-carbohydrate diets in the study are very high in fats, the two sample Paleo Diets published by Dr Cordain are comparable to the study’s control diet in total fat. In fact, the sample Paleo diets are actually lower than all of the study’s diets in saturated fat at 18g and 21g respectively. Even the study’s control diet averaged 27.3g of saturated fat.


In a Good Scientific Debate, You Come Armed with Scientific References

As we already pointed out, the sole reference the researchers had for claiming a Paleo Diet is low carbohydrate was one of their own studies. But that wasn’t the only place Genoni et al made strong claims with little backing.

The very first line of the study states that “The Paleolithic diet is promoted worldwide for improved gut health. However, there is little evidence available to support this claim.” Their sole reference for this prominent line in the study is a 2016 Australian cookbook.[6]

If you’re going to reference books instead of studies, what about all the books that actually popularized the Paleo Diet internationally. Better yet, what about referencing actual research about gut health. To start with, what about all the respected scientists who spent years living with and studying still existent hunter-gatherer societies. Their large body of research has consistently reported a robust microbiome, remarkable gut health, and nearly non-existent heart disease in these societies despite the fact that they’ve never eaten a single whole grain. [7-14]

We recommend starting with The Diverse Microbiome of the Hunter-Gatherer published in Nature – one of the most respected journals in the world. Scientifically, it certainly has more to say than an Australian cookbook.


We’re Ready to Debate… When You Are

To the authors of this study, we welcome a debate with you. We will give you full credit that the statistical analysis in your study was high quality, and you found concerning trends in plasma TMAO related to diet.

However, we have real concerns with the design of your study. Not the least of which is the fact that you did not study the Paleo Diet. The diet in your study was a fad low-carbohydrate diet that we have already stated is not Paleo and agree is not healthy.

So, before we engage in a debate with you, we ask two favors:

First, please make sure you stick to the rules of debate and learn the definition of the Paleo Diet before you show up. The one thing you do not get to do is create your own flawed definition of the diet and then attack those flaws.

Frankly, we’re sure your study was very expensive. It seems like it would have been prudent, before investing that sort of time and money, to have done your background research and learned what the Paleo Diet is. You know… read the first 30 pages of the New York Times bestseller that defined the Paleo Diet.

The truth is that we know you have done that. And what baffles us is that you seem to have completely forgotten the definition. You did conduct an earlier group of studies in 2016 where you had subjects read The Paleo Diet by Dr Loren Cordain and follow it’s guidelines. Those subjects did not see a rise in TMAO levels and actually saw health improvements including significant weight loss.[5, 15] How exactly did you forget the definition of the diet over those three years?

Second, until you understand the definition – or perhaps stop conveniently forgetting it – please stop using the term “Paleo Diet” or making claims about it. The fact is, your current research doesn’t study it.


Click Here to read a response to this study by fellow member of the Paleo Diet Editorial Board, Dr Mark J. Smith. Mark dived into the politics of this research and the Dieticians of Australia Association’s long standing debate with the Paleo Diet. Mark dives deeper into the fact that this was not actually the first study Genoni et al conducted of the Paleo Diet. In their first study, they gave subjects copies of “The Paleo Diet” by Dr Loren Cordain and instructed them to follow the books guidelines. That study found benefits to the Paleo Diet.



1. Ryan, M.C., et al., The Mediterranean diet improves hepatic steatosis and insulin sensitivity in individuals with non-alcoholic fatty liver disease. J Hepatol, 2013. 59(1): p. 138-43.

2. Genoni, A., et al., Long-term Paleolithic diet is associated with lower resistant starch intake, different gut microbiota composition and increased serum TMAO concentrations. Eur J Nutr, 2019.

3. Cordain, L., The Paleo diet : lose weight and get healthy by eating the foods you were designed to eat. Rev. ed. 2011, Hoboken, N.J.: Wiley. xv, 266 p.

4. Cordain, L., The nutritional characteristics of a contemporary diet based upon Paleolithic food groups. Journal of the American Nutraceutical Association, 2002. 5(5): p. 15-24.

5. Genoni, A., et al., Cardiovascular, Metabolic Effects and Dietary Composition of Ad-Libitum Paleolithic vs. Australian Guide to Healthy Eating Diets: A 4-Week Randomised Trial. Nutrients, 2016. 8(5).

6. Evans, P., The complete gut health cookbook. 2016, Sydney: Pan Macmillan Australia Pty Ltd.

7. Schnorr, S.L., The diverse microbiome of the hunter-gatherer. Nature, 2015. 518(7540): p. S14-5.

8. Fragiadakis, G.K., et al., Links between environment, diet, and the hunter-gatherer microbiome. Gut Microbes, 2019. 10(2): p. 216-227.

9. Mancabelli, L., et al., Meta-analysis of the human gut microbiome from urbanized and pre-agricultural populations. Environ Microbiol, 2017. 19(4): p. 1379-1390.

10. Rampelli, S., et al., Metagenome Sequencing of the Hadza Hunter-Gatherer Gut Microbiota. Curr Biol, 2015. 25(13): p. 1682-93.

11. Crittenden, A.N. and S.L. Schnorr, Current views on hunter-gatherer nutrition and the evolution of the human diet. Am J Phys Anthropol, 2017. 162 Suppl 63: p. 84-109.

12. London, D. and D. Hruschka, Helminths and human ancestral immune ecology: What is the evidence for high helminth loads among foragers? Am J Hum Biol, 2014. 26(2): p. 124-9.

13. Cockburn, T.A., Infectious diseases in ancient populations. Curr Anthropol, 1971. 12: p. 45-62.

14. Davis, E.W. and J.A. Yost, The ethnomedicine of the Waorani of Amazonian Ecuador. J Ethnopharmacol, 1983. 9(2-3): p. 273-97.

15. Genoni, A., et al., Compliance, Palatability and Feasibility of PALEOLITHIC and Australian Guide to Healthy Eating Diets in Healthy Women: A 4-Week Dietary Intervention. Nutrients, 2016. 8(8).


The Paleo Diet and VegetablesWhen you have been a proponent of Paleolithic nutrition for nearly 30 years, have read the research on its health benefits, and have knowledge of thousands of individuals that have benefited by its adoption, you receive negative research1 with a healthy dose of skepticism.  That being said, one still has to examine the research and make an objective assessment to either include it in the database of relevant studies, move it into the “more research needed” column, or confidently challenge it as yet another biased attempt to discredit an important area of nutritional research.

I say this because we’ve been here before.  In fact, last time we felt the research/reporting was so poor and biased, that three of us from The Paleo Diet® Team wrote articles addressing the issue.  This previous research came out of Australia, as does this new research paper published by Genoni et al. claiming the Paleolithic Diet raises serum trimethylamine-N-oxide (TMAO), a potential biomarker of cardiovascular disease (CVD).  In fact, the few negative studies published about the Paleo Diet all appear to come from Australia. So, it might be worth starting by taking a quick look at some of the nutritional politics down under.

The Dietitians Association of Australia (DAA) presents itself as “the peak body for dietetic and nutrition professionals, representing more than 7,000 members around Australia and overseas.”  Further, the DAA states that, “we recommend looking for the Accredited Practising Dietitian (APD) credential when choosing a dietitian.”  The DAA, of course, is responsible for bestowing that title on any nutritionist wanting the same.  That also means anyone coming along with something successful that they don’t own, or control, would obviously be competition and in theory could result in their member number decreasing.

So, when Australian celebrity chef, Pete Evans embraced the Paleo Diet® and simply used his skills as a chef to create recipes to share with his followers, the DAA made it a cause to discredit him at every opportunity.  They have chosen to frequently attack him as unqualified and create the impression that he came up with the concept of Paleolithic nutrition, rather than address in detail the enormous body of peer-reviewed literature that supports the Paleolithic nutritional template.

You can see that the DAA doesn’t have a particularly favorable opinion of Paleolithic nutrition by viewing their assessment of the diet on their website.  In their opening remarks, they state, “There is debate whether the Paleo Diet is truly healthy or not.  Higher-protein diets have been examined in research and a local version has been promoted by the Commonwealth Scientific and Industrial Research Organisation (CSIRO), called the Total Wellbeing Diet[i].  However, compared to the Paleo Diet, the CSIRO Total Wellbeing Diet has been extensively studied in a variety of groups.”  This is a remarkable statement as it is a complete misrepresentation of the facts.  As the screen shots below show, a search on the US National Library of Medicine’s website (aka PubMed.gov), for (Paleolithic[Title]) AND Diet[Title] returns 46 results, while a search for (CSIRO[Title]) AND diet[Title] returns only 2!


Screenshot #1


Screenshot #2


The DAA wants their audience to think that the Paleolithic diet is a crazy celebrity fad with little to no research.  They do attempt to address a few research papers in their assessment, but the interpretation leaves much to be desired and of course they conveniently ignore the vast body of research that exists today supporting Paleolithic nutrition.

From what I’ve seen, the DAA are doing everything they can to discredit the Paleo Diet® and protect their brand irrespective of the vast majority of the research, showing a benefit of following the Paleolithic dietary template.  Which is actually a great shame, as I think the DAA is missing out on a wonderful opportunity to help the Australian populace.

As will be discussed, what the current study does highlight is that there is clearly confusion as to what actually constitutes a modern Paleolithic diet.  One of the major downsides of Dr. Loren Cordain’s research going viral and the subsequent creation of the Paleo diet movement, was the simultaneous creation of many self-determined experts.  They have in turn, created their own versions of a Paleolithic diet that, and unlike the template created by Dr. Cordain, have not been supported by the peer-reviewed process.  So, it would make sense for the DAA to include the science and practical implementation of a modern Paleolithic Diet within their APD program to help with this confusion.


What does all this have to do with the newest research paper on the Paleo Diet from Australia?

Well, first, the research was conducted at Edith Cowan University which has a dietetics education program accredited by the DAA.  On its own, that shouldn’t be a red flag, however, there are a number of other issues that need to be considered.  First, the research paper, to me, was not written with the impartial tone that one is used to seeing in research papers.  The very opening statement in the abstract appeared unusual.  It stated, “The Paleolithic diet is promoted worldwide for improved gut health.”  This statement stood out because while I am certainly aware of the benefits both clinically and from the research, it is a rather specific point given the relatively limited research related to the adoption of a Paleolithic diet and its effect on gut health.

If you conduct an advanced search at PubMed.gov using Paleolithic AND Diet AND Gut AND Health, as of this writing, you will be presented with just 13 studies that match this search criteria.  One of which is this current study, leaving 12 studies that match the search.  One could argue that seven of these studies could be related to the adoption of a Paleolithic diet and gut health, which again, seems limited to justify such a statement.

So, I was interested in seeing why this study used that statement about the Paleolithic Diet being promoted worldwide for gut health.  It was cited, so I quickly turned the pages to see the source of this front and center statement, and was shocked to see that the hypothesis of this research paper was citing a 2016 book, entitled “The complete gut health cookbook” written by Pete Evans.2  Yes, that’s correct, the same celebrity chef that I referred to above that the DAA has made a common target.

Now, with no disrespect to Pete Evans, finding a book with that title does not justify a scientific research group stating that the Paleolithic diet is being promoted worldwide for improved gut health.  But again, on its own, it also doesn’t mean that the research isn’t a valid topic to be investigated, I think looking at how Paleolithic nutrition can influence gut health is a great idea, and there is a significant body of research that shows that the microbiome of hunter gatherers is far more diverse than industrialized populations and correlates to the health of the host.3-33

However, it did make me think we need to dig a little deeper here as to any potential conflicts of interest.  In doing so I found it very interesting to learn that Edith Cowan University banned high fat proponent and Bring Back the Fat author, Christine Cronau from speaking at the University, saying it did not align with the institute’s “evidence-based approach”.

Following the reference to Pete Evan’s “The complete gut health cookbook” was the statement, referring to the Paleolithic diet, “However, it excludes grains and dairy, food groups that form part of the evidence-based national Australian and international dietary guidelines.”  “Evidence-based”, suggesting that excluding grains and dairy is not evidence-based.

Well let’s examine this statement a little further.  As I have previously stated in other articles, Dr. Cordain’s book “The Paleo Answer” references over 900 sources, with only a handful not coming from peer-reviewed journal articles34.  There’s also Dr. Cordain’s large body of published peer-review research, each with hundreds of references.  So I would say that’s pretty much evidence-based!  But how about the Australian and international dietary guidelines, are they really evidence-based?  Well that’s another story, but thankfully there is an eye-opening paper published in 2015 in the British Medical Journal by Nina Teicholz, that tackles that very question.35  I highly recommend you take the time to read it.

Further, while it is correct that the Paleolithic diet excludes grains and dairy, it also excludes legumes and all processed foods.  It is interesting to see how many people represent these exclusions as a negative, but when one appreciates the benefit to detriment ration of consuming these foods, one quickly understands the net benefit of elimination.

So before getting into the details of this particular study, let’s take a quick look at the database of published research on the effects of adopting a Paleolithic diet.  We’ve been keeping track of this since, somewhat ironically, the landmark aboriginal study by O’Dea that demonstrated a marked improvement in carbohydrate and lipid metabolism after a temporary reversion to a traditional lifestyle36.  The list of published studies can be seen at our website here.


Earlier Research By the Same Authors Actually Finds Benefits to the Paleo Diet

Of the now nearly 50 published papers looking at Paleolithic nutrition, only a few, report any negative consequences (one study’s title indicated a negative result, but the data actually revealed a positive outcome!).  Dr. Angela Genoni is responsible for three publications reporting negative findings.  However, her first published study37 demonstrated beneficial outcomes of adopting a Paleolithic diet but subsequent results have been negative, or perhaps better stated, they have been presented as negative findings.  Consequently, I think it prudent to examine these publications ahead of her most recent paper.  To clarify, in her earlier research only one study was actually conducted, and the data was presented in three separate publications.37,38,39

The opening line in the abstract of the first published paper, while certainly open for interpretation, seems grossly inaccurate, at least to me.  The paper states that “limited literature surrounds the dietary pattern” and referenced three published papers despite there being over 30 studies at the time of publication (see, again, our chronological publication list).  This just supports my concern that the research was not being conducted with impartiality as it is very easy to use PubMed.org and obtain these studies.  And this of course does not even include the many studies that support the negative consequences of consuming grains, legumes, dairy and processed food, foods not included in the Paleo Diet®, listed in Dr. Cordain’s book, The Paleo Answer.34

In Dr. Genoni’s first study, the dietary intervention is described as follows: “Those in the Paleolithic group were provided with meal ideas obtained from “The Paleo Diet” book [Cordain, L. The Paleo Diet; JohnWiley & Sons, Inc.: Hoboken, NJ, USA, 2011.] and advised to consume lean meats, fish, eggs, nuts, fruits and vegetables, and small amounts of olive or coconut oils.  Grains, cereals and dairy products were not permitted.  Dairy products were replaced with unsweetened almond milk.  Sugarless black coffee and tea were allowed.  All vegetables were permitted on the diet, except for corn, white potatoes and legumes.  To ensure adequate carbohydrate, additional fruit was recommended.  Dried fruit was limited to one tablespoon per day.”  I’d say this is a good recommendation to implement a modern Paleo Diet®, although one should point out that corn, potatoes and legumes are not vegetables, and there should be no need to recommend additional fruit.

The study concluded that in healthy females, the Paleolithic diet induced a more favorable effect on body composition over the short-term intervention period.  The full paper can be accessed here.

The second study, published just a few months after the first publication, was titled “Compliance, Palatability and Feasibility of PALEOLITHIC and Australian Guide to Healthy Eating Diets in Healthy Women: A 4-Week Dietary Intervention”.38  As already stated, this research was part of the first study examining the cardiovascular and metabolic impacts of the diets.  If you are interested in reading about the findings, you can get access to the full article here.

I would only like to make one important point.  In the discussion, the authors state, “While both groups viewed the diets as healthy, a greater proportion of the Paleolithic group felt that the diet did not fit with the belief of a ‘healthy’ diet.  This may reflect participant belief that the while the Paleolithic diet is high in ‘healthy foods’ such as fruits, vegetables, eggs, meats and nuts, the elimination of grains and dairy products makes the dietary pattern less healthy or unhealthy.”  Well is this really that surprising given that the DAA is shouting from the rooftops, that the elimination of dairy and grains is a really, bad idea!

The third publication presented data on the dietary intake of resistant starch (RS), a dietary component that has similar physiological effects as dietary fiber and potentially related to bowel health, and the serum concentrations of TMAO, a potential biomarker of CVD.39  The full paper is also available on-line and can be accessed here.  The data showed a significant reduction in RS for the Paleolithic diet but did not show a significant difference in TMAO between the two diets.

The authors speculated that the inability to see a difference in TMAO, may have been due to a small sample size and the low total energy of the diet.  However, it should be emphasized that this data is from the same study that did show the Paleolithic diet to significantly improve body composition.  With respect to RS, increasing RS in typical western diets may well confer a benefit, because of the low fiber intake, however, when total dietary fiber intake is high, which it is on a Paleolithic diet (confirmed by the groups own research37), increasing RS likely has little benefit.


The Most Recent Study by This Group Fundamentally Changes Their Study Design

Because the initial study only examined the effect of a Paleolithic diet over a short-term, 4-week intervention, the current study was designed to see if long-term adherence to a Paleolithic diet, compared to controls, would also see a significant reduction in RS and an increase in TMAO.  Recruitment for the study was done via online advertisements.

Unlike the initial research where no increase in TMAO was seen, the data from this study did show an increase, as well as a reduction in RS.  However, TMAO is a complicated topic and we will be addressing this in a detailed follow-up article in the coming weeks.  But suffice to say, one cannot state that increased TMAO concentrations is causative of CVD, rather there has only been shown a correlation between high TMAO levels and CVD.

While the current study has shown an increase in TMAO, this does not match the findings of many previous studies already referenced that have shown a Paleolithic Diet to decrease markers of CVD.  And correlation is not causation.  Further there is a difference between exogenous TMAO from foods, primarily fish and red meat, and endogenous TMAO produced by microorganisms in the gut.  To highlight this point, fish is one of the greatest dietary sources of TMAO40 and yet, fish has been well established as being cardio-protective.41  So, while fish can elevate TMAO but not be the cause of CVD, CVD could certainly be responsible for increasing TMAO, two very different physiological outcomes.

But of major concern with the current study is its design.  The authors categorized Strict Paleolithic (SP) as subjects that consumed <1 serving of grains and dairy per day and Pseudo-Paleolithic (PP) as subjects that consumed >1 serving of grains and dairy per day.  I think a more appropriate categorization would be SP as having <1-2 servings of grains and dairy per week and PP having <1 serving of grains and dairy per day, and even that might be a stretch (no data was presented with respect to legume consumption in the present study, although the first study did, and consumption was minimal).

So, the big question to ask here\ is: did the subjects assigned to the respective Paleolithic diets even consume a Paleolithic diet?  My colleague on the Paleo Diet® Team, Trevor Connor, has also written an article about this study and shared the same concern with me regarding this question.  So Trevor compared the reported dietary data and shows it in a table in his article.  What it confirms is that the current study did not examine a Paleolithic diet compared to the template developed by Dr. Cordain, particularly when one compares the dietary fiber.  Interestingly, when one looks at the fiber content of their initial study, as a percentage of caloric intake, the fiber content matches up very closely to the Paleolithic diet presented by Dr. Cordain in his 2002 paper.42  And this initial study showed the Paleolithic diet to improve body composition while not increasing TMAO.

So, in summary, since the current research paper didn’t actually examine a Paleolithic diet, the conclusion cannot be made that the Paleolithic diet raises serum TMAO.  However, earlier research conducted by Genoni et al., when an appropriate Paleolithic diet was administered, did demonstrate a Paleolithic diet to improve body composition in a 4-week intervention, without increasing TMAO.  Perhaps the most important finding of this study, is that there are many people thinking they are following a Paleolithic diet when they are not doing so, which highlights the importance of from where individuals are obtaining their information!



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2. Evans, P., The complete gut health cookbook. 2016, Sydney: Pan Macmillan Australia Pty Ltd.

3. Cockburn, T.A., Infectious diseases in ancient populations. Curr Anthropol, 1971. 12: p. 45-62.

4. Nasidze, I., et al., High Diversity of the Saliva Microbiome in Batwa Pygmies. PLoS One. 2011;6(8):e23352. doi: 10.1371/journal.pone.0023352. Epub 2011 Aug 16.

5. Bengmark, S. Nutrition of the Critically Ill—A 21st-Century Perspective Nutrients. 2013 Jan 14;5(1):162-207. doi: 10.3390/nu5010162.

6. Bengmark, S. Nutrition of the critically ill – emphasis on liver and pancreas. Hepatobiliary Surg Nutr. 2012 Dec;1(1):25-52. doi: 10.3978/j.issn.2304-3881.2012.10.14. Review.

7. Adler, C.J., et al., Sequencing ancient calcified dental plaque shows changes in oral microbiota with dietary shifts of the Neolithic and Industrial revolutions. Nat Genet. 2013 Apr;45(4):450-5, 455e1. doi: 10.1038/ng.2536. Epub 2013 Feb 17.

7. London, D. and Hruschka, D., Helminths and human ancestral immune ecology: What is the evidence for high helminth loads among foragers? Am J Hum Biol, 2014. 26(2): p. 124-9.

8. Martinez, F.D., The Human Microbiome Early Life Determinant of Health Outcomes Ann Am Thorac Soc. 2014 Jan;11 Suppl 1:S7-12. doi: 10.1513/AnnalsATS.201306-186MG.

9. Quercia, S., et al., From lifetime to evolution: timescales of human gut microbiota adaptation. Front Microbiol. 2014 Nov 4;5:587. doi: 10.3389/fmicb.2014.00587. eCollection 2014.

10. Rook, G.A., Microbial ‘old friends’, immunoregulation and socioeconomic status Clin Exp Immunol. 2014 Jul;177(1):1-12. doi: 10.1111/cei.12269. Review.

11. Schnorr, S.L., Gut microbiome of the Hadza hunter-gatherers. Nat Commun. 2014 Apr 15;5:3654. doi: 10.1038/ncomms4654.

12. Bligh, H.F., 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. doi: 10.1017/S0007114514004012. Epub 2015 Feb 9.

13. Logan, A.C., et al., Natural environments, ancestral diets, andmicrobial ecology: is there a modern “paleo-deficit disorder”? Part I J Physiol Anthropol. 2015 Jan 31;34:1. doi: 10.1186/s40101-015-0041-y. Review.

14. Logan, A.C., et al., Natural environments, ancestral diets, andmicrobial ecology: is there a modern “paleo-deficit disorder”? Part I J Physiol Anthropol. 2015 Mar 10;34:9. doi: 10.1186/s40101-014-0040-4. Review.

15. Obregon-Tito, A.J., et al., Subsistence strategies in traditional societies distinguish gut microbiomes. Nat Commun. 2015 Mar 25;6:6505. doi: 10.1038/ncomms7505.

16. Rampelli, S., et al., Metagenome Sequencing of the Hadza Hunter-Gatherer Gut Microbiota. Curr Biol, 2015. 25(13): p. 1682-93.

17. Segata, N., Gut Microbiome: Westernization and the Disappearance of Intestinal Diversity. Curr Biol. 2015 Jul 20;25(14):R611-3. doi: 10.1016/j.cub.2015.05.040.

18. Gomez, A., et al., Gut Microbiome of Coexisting BaAka Pygmies and Bantu Reflects Gradients of Traditional Subsistence Patterns. Cell Rep. 2016 Mar 8;14(9):2142-2153. doi: 10.1016/j.celrep.2016.02.013. Epub 2016 Feb 25.

19. Turroni, S., et al., Fecal metabolome of the Hadza hunter-gatherers: a hostmicrobiome integrative view. Sci Rep. 2016 Sep 14;6:32826. doi: 10.1038/srep32826.

20. Turroni, S., et al., Enterocyte-Associated Microbiome of the Hadza Hunter-Gatherers. Front Microbiol. 2016 Jun 6;7:865. doi: 10.3389/fmicb.2016.00865. eCollection 2016.

21. Crittenden, A.N. and S.L. Schnorr, Current views on hunter-gatherer nutrition and the evolution of the human diet. Am J Phys Anthropol, 2017. 162 Suppl 63: p. 84-109.

22. Gupta, V.K., et al., Geography, Ethnicity or Subsistence-Specific Variations in Human Microbiome Composition and Diversity. Front Microbiol. 2017 Jun 23;8:1162. doi:10.3389/fmicb.2017.01162. eCollection 2017.

23. Konijeti, G.G., et al., Efficacy of the Autoimmune Protocol Diet for Inflammatory Bowel Disease. Inflamm Bowel Dis. 2017 Nov;23(11):2054-2060.

24. Mancabelli, L., et al., Meta-analysis of the human gut microbiome from urbanized and pre-agricultural populations. Environ Microbiol, 2017. 19(4): p. 1379-1390.

25. Rampelli, S., et al., Characterization of the human DNA gut virome across populations with different subsistence strategies and geographical origin. Environ Microbiol. 2017, Nov; 19(11): 4728-4735.

26. Smits, S.A., et al., Seasonal Cycling in the Gut Microbiome of the Hadza Hunter-Gatherers of Tanzania. Science. 2017 Aug 25;357(6353):802-806. doi: 10.1126/science.aan4834.

27. Gentile C.L. and Weir T.L., The gut microbiota at the intersection of diet and human health. Science. 2018 Nov 16;362(6416):776-780. doi: 10.1126/science.aau5812. Review.

28. Jha, A.R., et al., Gut microbiome transition across a lifestyle gradient in Himalaya. PLoS Biol. 2018 Nov 15;16(11):e2005396. doi: 10.1371/journal.pbio.2005396. eCollection 2018 Nov.

29. Lassalle, F., et al., Oral microbiomes from hunter-gatherers and traditional farmers reveal shifts in commensal balance and pathogen load linked to diet. Mol Ecol. 2018 Jan;27(1):182-195.

30. Valle Gottlieb, M.G., et al., Impact of human aging and modern lifestyle on gut microbiota. Crit Rev Food Sci Nutr. 2018 Jun 13;58(9):1557-1564.

31. Ganguli, S., et al., Gut microbial dataset of a foraging tribe from rural West Bengal – insights into unadulterated and transitional microbial abundance. Data Brief. 2019 May 24;25:103963. doi: 10.1016/j.dib.2019.103963. eCollection 2019 Aug.

32. Hansem, M.E.B., et al., Population structure of human gut bacteria in a diverse cohort from rural Tanzania and Botswana. Genome Biol. 2019 Jan 22;20(1):16. doi: 10.1186/s13059-018-1616-9.

33. Fragiadakis, G.K., et al., Links between environment, diet, and the hunter-gatherer microbiome. Gut Microbes, 2019. 10(2): p. 216-227.

34. Cordain, L., The Paleo Answer. 2012, Hoboken, N.J.: Wiley.

35. Teicholz, N., The scientific report guiding the US dietary guidelines: is it scientific? BMJ 2015;351:h4962 doi: 10.1136/bmj.h4962 (Published 23 September 2015).

36. 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.

37. Genoni, A. et al., Cardiovascular, Metabolic Effects and Dietary Composition of Ad-Libitum Paleolithic vs. Australian Guide to Healthy Eating Diets: A 4-Week Randomised Trial. Nutrients 2016, 8, 314; doi:10.3390/nu8050314.

38. Genoni, A. et al., Compliance, Palatability and Feasibility of PALEOLITHIC and Australian Guide to Healthy Eating Diets in Healthy Women: A 4-Week Dietary Intervention. Nutrients. 2016 Aug 6;8(8).

39. Genoni, A. et al., A Paleolithic diet lowers resistant starch intake but does not affect serum trimethylamine-N-oxide concentrations in healthy women. Br J Nutr. 2019 Feb;121(3):322-329.

40. Kruger et al., Associations of current diet with plasma and urine TMAO in the KarMeN study: direct and indirect contributions. Mol. Nutr. Food Res. 2017 Nov;61(11).

41. Kwok, C.S., et al., Dietary components and risk of cardiovascular disease and all-cause mortality: a review of evidence from meta-analyses. Eur J Prev Cardiol. 2019 Apr 11:2047487319843667. doi: 10.1177/2047487319843667. [Epub ahead of print]

42. Cordain, L., The nutritional characteristics of a contemporary diet based upon Paleolithic food groups. Journal of the American Nutraceutical Association, 2002. 5(5): p. 15-24.

If you’re following the Paleo Diet®, your grocery list is largely made up of fresh vegetables, grass-fed or pasture-raised meat, and free-range eggs. While your body benefits from this way of eating, your wallet might be hurting – these high-quality foods can have a high price tag! It can also be a challenge to find good sources for locally-grown produce and grass-fed meat. The offerings at your local grocery store might not cut it and there may not be a convenient farmers market in your area.

Community Supported Agriculture (CSA) could be a great solution for making your Paleo lifestyle work. While CSA models vary, the general principle is that customers support a specific farm or group of farms by buying “shares” of their products. In exchange for paying at least part of the season’s cost up front, customers usually receive a slight discount off the equivalent retail costs, or they receive special items not available in regular retail outlets.

CSA started as a model primarily for vegetable sales, but now all kinds of farms are getting in on the action. In some areas, farms have formed cooperative CSAs that offer a wider variety of products. By joining a CSA run by a local farm or cooperative, you can ensure you’re getting the freshest produce and properly raised meat at a reasonable cost.


How does it work?

How it works varies with each CSA, but most will ask for some sort of commitment at the beginning of each season. You might be asked to pay for the entire CSA share up front or make a deposit. However, some CSAs will offer weekly or monthly payment options.

Your farm will tell you how to pick up your CSA share – some farms only offer onsite pickup, while others deliver to several locations in the area or even offer home delivery. Pickups will usually be on a set schedule: Just keep in mind that CSAs aren’t quite like Fresh Direct or other grocery delivery services and depends on the farm’s harvest schedule.

Your farm should give you plenty of information about what to expect in your share. Many CSAs offer little to no choice; the farmer plans out the shares based on how the harvest is going. But many farms respond to customer demand and let CSA members have some say about what they want in their shares. Meat and eggs are often available as an add-on to a vegetable share, although some meat producers have their own CSAs.


How can I find one?

There are a number of websites that can help you find the right CSA in your area. A few good places to start include:

Sometimes areas with a lot of farms have CSA fairs where you can meet the farmers and learn more about the CSA options available to you.

If you’re strictly following the Paleo Diet, make sure to ask the farmer how often they plan to give you items like potatoes or green beans in the vegetable share, and what your options are for swapping those out for more Paleo-friendly ingredients. Some CSAs might let you make the switch in advance, and some have a “swap box” where members can deposit produce they don’t want and select something else.

The bottom line is that if you’re committed to the Paleo lifestyle, you might want to try committing to a local farm too. Joining a CSA might introduce you to new vegetables or cuts of meat that could expand your palette, and you’ll save some money while getting high-quality local food.

If you’ve joined a CSA and are looking for some good recipes for all that fresh food, check out our collection of Paleo Diet recipes.

Beef Thai SaladWhile we would love to say we traveled all the way to Thailand for this recipe, it’s surely the next best thing with these all-natural, fresh ingredients straight from our local grocer. This Paleo Diet® salad makes an ideal Summer meal with a perfect balance of nutrients to satisfy your appetite and cool you off on a hot night. We especially love the spicy dressing that gives the greens a little extra flavour kick to delight those of us who love to wake our taste buds up now and then.



  • 1-pound sirloin steak
  • Black pepper to taste
  • 2 small seedless English cucumbers, thinly sliced
  • 1 shallot, thinly sliced
  • ½ cup fresh cilantro, roughly chopped
  • 2 cups mixed greens
  • 1 tsp coconut oil


The Dressing
  • 3 cloves small garlic, minced
  • 1 red chili pepper, seeded and chopped into small pieces
  • 2 T salt-free chicken stock
  • 2 tsp salt free red pepper sauce
  • 2-3 T fresh lime juice



Season the steak with black pepper. Heat 1 tsp coconut oil in a grilling pan over medium heat. Grill the steak for about 2-3 minutes per side or until desired doneness is achieved. Remove steak from pan and set aside.

Mix all ingredients listed under “dressing” together with the exception of the lime juice.

Heat a small saucepan over medium-high heat. Add dressing and stir gently with wooden spoon until warm, but not bubbling. Stir in fresh lime juice. Remove from heat and set aside.

Prepare salad just before serving. In a large salad bowl, toss chopped cucumber, cilantro, shallots, and mixed greens. Slowly drizzle dressing over salad and toss gently. Thinly slice the beef against the grain and arrange on top of salad.

Serves 4.

Beef Thai Salad Ingredients

Beef Thai Salad

There’s nothing like fresh peaches to sweeten up the end of summer! At The Paleo Diet®, we count the days until this incredible treat begins showing up at our local farmer’s markets and grocery stores. The taste difference between peaches that have been sitting in cold storage waiting to be ripened and the just-picked ripe and ready fruits makes the waiting and anticipation well worth it. Once fresh peaches arrive, it’s important to eat them within a day or two. Our team loves to top off our dinner menu with this delectable treat. The best part is that it’s fast and easy to prepare, so no long hours sweating away in the kitchen.



For the Filling:

  • 6 fresh and ripe peaches
  • 2 tablespoon coconut oil, melted
  • 1 teaspoon cinnamon
  • 2 teaspoons unsweetened, organic apple juice concentrate
  • 1 teaspoon arrowroot starch
  • 1 teaspoon vanilla extract

For the Crust:

  • ¾ cup pecans
  • 2 tablespoons coconut oil, melted
  • 1/3 cup almond flour
  • ½ teaspoon cinnamon
  • 1-2 tablespoons unsweetened, organic apple juice concentrate
  • ¼ cup unsweetened, shredded coconut
  • 2 tablespoons ground flax



Preheat oven to 350 degrees F.

Wash and slice peaches into ½ inch slices. Place in large bowl and add remaining filling ingredients. Gently combine all ingredients until peach slices are evenly coated. Pour filling mixture into 9-10 inch skillet or 8×8 baking dish.

Prepare crust by pulsing pecans in food processor for 10-20 seconds. Add remaining crust ingredients and pulse again until well blended. Pour crust over the top of the filling, distributing evenly.

Bake for 40 minutes until topping is golden brown and crispy. Enjoy!

Serves 6-8.




Paleo Peach Cobbler Ready To Eat

Introduction and Historical Perspective

Almost all of us are familiar with hot sauces – who among us hasn’t encountered a bottle of Tabasco, Cholula, Crystal, Tapatío or Sriracha hot sauces at our favorite Mexican Restaurant? Hot sauces represent condiments which are almost universally offered at Mexican and fast food restaurants in the U.S. and elsewhere. Later, I will get into the specific formulations of popular hot sauces, but for now, let it be known that most are mixtures of hot chili peppers, salt and vinegar among other ingredients.

Obviously, the most important component of fiery hot sauces is their chili peppers. All worldwide farmed chili peppers were first grown from wild seeds indigenous to present day Mexico and dated to about 7,000 to 8,500 years before present (B.P.) (1-4). These chili pepper plants were eventually domesticated by about 900 BC (2). Hence, chili peppers were never consumed by humans until our species migrated from Asia to the Americas roughly 15,000 years B.P. Consequently, chili peppers represent a very recent dietary addition for our genus (Homo), which originated at least 2.0 million years ago in Africa. Clearly, numerous North and South American plant foods also represent unique dietary additions for humans as we migrated from Asia to the western hemisphere. So, at least upon initial glance, chili peppers characterize just one of hundreds of novel plant foods that humans encountered as our species made our way into North and South America about 15,000 years B.P.

Nevertheless, chili peppers are nutritionally unique because they are the only plant species in the world which produce capsaicinoids (5, 6). Capsaicinoids are the molecular compounds which give chili peppers their pungent taste and burning sensation when consumed – the higher the capsaicinoids concentration, the greater we perceive the feeling of “heat”. Two major biochemical forms of capsaicinoids exist: capsaicin (trans-8-methyl-N-vanillyl-6-nonenamide) and dihydrocapsaicin (8-methyl-N-vanillynonanamide) which represent about 77-98 percent of the capsaicinoids present in chili peppers (7). Other minor capsaicinoids within chili peppers include nordihydrocapsaicin, homocapsaicin, homodihydrocapsaicin and nonivamide among more than 20 similar compounds (7).

All five domesticated species of chili peppers (Capsicum annuum, Capsicum frutenscens, Capsicum chinense, Capsicum pubescens and Capsicum baccatum) originated in the Americas (1-4). On the 15th of January, 1493, during Columbus’ first voyage back to Spain from the new world, he recorded in his diary that large quantities of chili peppers (which he called “axi, ques su piiento”) were harvested on Hispaniola (now the islands of Haiti and the Dominican Republic) by the native Americans (2). Shortly, after his return to Spain from Hispaniola (on the 3d of April, 1493), Columbus presented chili peppers to King Ferdinand and Queen Isabella of Spain who commented that “axi” burned their tongues (2). Diego Alvarez Chanca, a physician on Columbus’ second voyage to the West Indies in 1493-1496 also brought chili peppers back to Spain (8). In the ensuing 200 years, hot chili peppers then rapidly made their way to India, East Asia, and Southeast Asia (2) where they have become integral parts of the cuisines of these regions.

Although only five species of domesticated chili peppers are commonly consumed, numerous cultivars of these species are frequently eaten, and each cultivar maintains widely varying concentrations of capsaicinoids. The “heat” or relative pungency of any species or cultivars of chili peppers is measured by the concentration of capsaicinoids which it contains. These concentrations are most accurately determined by high performance liquid chromatography (HPLC) procedures (9), but most frequently are measured using Scoville Heat Units (SHU), a subjective human measurement of “heat” or spiciness (9). For instance, the cultivar we all know as “green bell peppers” are a member of Capsicum annuum and maintain a Scoville Heat Unit of “0 -100”; meaning that this pepper has little or no perception of spiciness or “heat” (10-39). On the other hand, jalapeno peppers which also belong to the same species, Capsicum annuum, are considerably hotter than green bell peppers and have SHU ratings between 2,500 to 8,000 (10-39). The hottest of all peppers belong to the species, Capsicum chinense (the cultivars of this species are also known as ghost, habanero, datil, Scotch bonnet, naga, fatalli and bhut jolokia among other peppers) and maintain SHU rating between 272,897 and 1,037,305 (10-39). Intermediate to Capsicum annuum and Capsicum chinense chilies are members of the pepper species, Capsicum frutescens, which includes Tabasco, Thai, Piri Piri, Malagueta and Malawian Kambuzi peppers with SHU values ranging from 109,508 to 487,619 (10-39).

The race to produce a “hotter” hot sauce with the highest SHU rating of course makes for an interesting story on the internet, social media, and daily newspapers (40). As hotter hot sauces burn your tongue and make you sweat, few of us consider the health implications of regular capsaicinoid ingestion.


Fiery Hot Sauces: The Good

Table 1 below shows the sodium content, the Scoville Heat Units (SCU), the caloric density, the price and type of peppers found in 33 widely available hot sauces. Note that several hot sauces are manufactured without any added salt, and many brands contain very little sodium (< 35 mg/tsp) including the bestselling McIIhenny’s Tabasco (Original Red) Sauce. Because most hot sauces primarily contain salt, water, vinegar and chili peppers; they are uniformly low in calories (0-10 kcal per teaspoon; Table 1). Accordingly, these two nutritional characteristics (low sodium, low calories) can be viewed as “Good” from a health perspective. The USDA recommended sodium intake is 2,300 mg per day for adults and 1,500 mg per day for people with high blood pressure. Hence, a few hot sauces commonly available at grocery stores (Cholula, Tapatio, Crystal, Franks Red Hot Original and Louisiana Hot Sauce) represent condiments with higher concentrations of salt and therefore should be consumed cautiously for people wanting to reduce their sodium intake.

Table 1. The sodium (Na+) content, Scoville Heat Units, energy (kcal), price and type of chili peppers in 33 brands of hot sauces (10-39).



Many people are unaware that most hot chili pepper sauces are fermented foods. For instance, one of the original hot sauces, McIllhenny’s Tabasco Sauce (Original Red) is produced by grinding fresh peppers into a mash and then soaking the mash in a salt solution inside covered white oak barrels for up to three years (41). The mash is then strained of skins and seeds and mixed with vinegar for a month to produce the final sauce (41). This process (soaking in salt and then vinegar under anerobic [without oxygen] conditions) promotes growth of anaerobic bacteria which allow the food (mashed chili peppers) to ferment but not to spoil and putrefy. Salt encourages the growth of halophilic (salt loving) anaerobic bacteria. Vinegar increases the environmental acidity (lowering the pH) of the mixture which also boosts anaerobic, fermentive, bacterial growth.

Accordingly, the use of salt, vinegar, and covered containers epitomizes a universal and traditional formula to ferment food, thereby preventing its spoilage (42). Hence, fermented plant food contained within covered containers along with salt and vinegar produces a powerful anti-pathogenic effect causing the rapid disappearance of putrefying and disease producing bacteria in the fermented concoction including: Staphylococcus aureus; Salmonella typhymurium; Listeria monocytogenes; Escherichia coli; Clostridium perfringens and Vibrio parahaemolyticus (42, 43).

The anaerobic bacteria and other microorganisms causing the fermentation of vegetables including chili peppers produce metabolic byproducts which are released into the fermented vegetable mixture. Bacteria which ferment plant foods including sauerkraut (fermented cabbage,) pickles (fermented cucumbers,) kimchi (all Korean fermented plant food including cabbage, radishes, cucumbers, chili peppers, mustard leaves, and Welsh onion leaves) (42) encourage further growth of anaerobic bacteria (42, 44). Olives also are fruits produced by their fermentation in salt and vinegar. A less appreciated fermented food is chocolate (the fermented fruit of Theobroma cacao; the South American chocolate tree) which does not require either salt or vinegar for its fermentation.

Many fermented foods contain similar anaerobic bacteria and microorganisms, hence the fermented foods we regularly consume (cheeses, salami, sauerkraut, pickles, olives, kimchi, chili peppers, and chocolate) maintain similar bacterial nutrients derived from the microorganisms and bacteria responsible for their fermentation.

The bacterial compounds infused into fermented foods have seldom been recognized as therapeutic nutritional agents. In part, because nutritionists have not specifically measured these bacterially produced nutrients in fermented foods. For instance, pork has only recently (2016) been demonstrated to be a rich source of short (MK-4) and long chain menaquinones (MK-9 to MK-11) or vitamin K2 (45). Long-chain menaquinones can only enter the human food chain through bacterial contamination (spoilage/fermentation) of the normal fresh food which we eat.

Swine are notorious consumers of rotten, putrid and fermented food (46). Hence it is not surprising that pig tissues should represent a concentrated source of the bacterial nutrients which they consume such as the fat-soluble menaquinones (MK4, MK-9 to MK-11) or vitamin K2. Specifically, long-chain bacterially derived menaquinones are concentrated in the fat tissues of swine (45). A long-term evolutionary function of menaquinones (vitamin K2) is to act as lipid soluble antioxidants for anaerobic bacterial species (47-49).

A wide range of bacterial species have been found with the spontaneous fermentation of Jalapeno chili peppers in a saline environment including the anaerobic lactic acid bacteria (LAB) Lactobacillus plantarum, Leuconostoc citreum, Weissella cibaria and Lactobacillus paraplantarum (50). Further, these same genera (Leuconostoc, Lactobacillus, Weissella) and others Lactococcus and Pediococcus are key players in kimchi fermentation (51).

The crucial point here is not to become overly engaged in the microbiology of specific bacterial species which cause fermentation of chili peppers and other vegetables and fruits, but to realize that common bacterial species are associated with the fermentation of almost all plant foods. These common anaerobic LAB bacterial species, during the fermentation process, synthesize nutrients which have the capacity to serve as lipid soluble antioxidants capable of defusing the toxic ROS produced by the mitochondria in aerobic cells.

Currently, the menaquinone concentrations in bacterial species of LAB are either unknown or obscure; further these lipid soluble antioxidants have rarely or never been measured in fermented chili peppers or other fermented foods except soybeans. Other bacterially produced, important lipid soluble antioxidants which have been shown to improve health such as melatonin (52), pyrroloquinoline quinone (PQQ) (53) and CoQ10 (54) and CoQ9 have not or have barely been measured in fermented foods such as spicy hot sauces, despite the knowledge that fermented peppers and fermented vegetables may contain bacterial species capable of producing these lipid soluble antioxidant compounds.

Numerous studies have suggested that capsaicinoid containing foods may have positive and therapeutic health promoting effects (55-65). In humans, the biological receptor for capsaicin is called the transient receptor potential vanilloid subtype 1 (TRPV1) which is widely expressed in brain, sensory nerves, bladder, gut and blood vessels. TRPV1 is activated by multiple environmental stimuli including exogenous chili pepper capsaicin ingestion, heat, low pH (<5.9) and certain endogenous lipid molecules (63). TRPV1 plays essential roles in inflammation, oxidative stress, and pain sensation (66). Accordingly, capsaicinoids derived from the consumption of hot chili peppers and fiery hot sauces likely have therapeutic functions in the prevention of cardiovascular disease (62-64), diabetes (62, 64), pain (62, 66) and certain autoimmune diseases (65).

Nevertheless, an infrequently recognized downside to consumption of chili peppers is their ability to disrupt the intestinal barrier function (67-78).


Summary (The Good, The Bad)

So, to summarize. Fiery hot sauces are low in calories, frequently (but not always) low in sodium and often contain mashes of chili peppers with bacterially fermented by products and their residues that may have therapeutic health effects together with the beneficial effects of the capsaicinoids present in chili themselves.


Fiery Hot Sauces: The Ugly

Exogenous dietary capsaicinoids from chili peppers represent unique biochemical compounds which the human genome did not encounter until very recently from an evolutionary perspective. As previously demonstrated, Columbus and his crew brought chili peppers to Europe in 1493, and they then spread worldwide in the ensuing 200 years. Accordingly, our species has had little or no time to evolve genetic adaptations to an exogenous plant substance (capsaicinoids) which fundamentally interact with our physiologies via the TRPV1 receptor and other cellular mechanisms.

One of the unexpected health consequences of worldwide chili pepper consumption is its adverse effect upon the human gut, particularly with chili pepper species and cultivars which maintain higher capsaicinoid concentrations and hence higher SHU values. The notion that chili pepper consumption could increase intestinal permeability was unknown until 1994 when Hashimoto and colleagues (67) demonstrated that a vegetable extract only found in sweet peppers (of 32 vegetables analyzed) impaired the intercellular tight junction (TJ) barrier through the paracellular pathway. The authors noted that these changes would, “bring about an invasion of allergenic molecules from the intestinal lumen to the serosal region, which may cause food allergy.” In their 1997 follow-up study (68), Hashimoto and co-workers identified that the active substances in the purified sweet pepper extract which increased intestinal permeability were capsianosides (capsaicins). The authors suggested that, “capsianosides would be useful to enhance the permeability for drugs or other biologically important hydrophilic substances across the intestinal mucosa.”

One year later in 1998 Jensen-Jarolim and colleagues (69) demonstrated that paprika and cayenne pepper spices increased intestinal macromolecular permeability. The authors noted that this event might be of pathophysiological importance, particularly with respect to food allergy and intolerance.

One mechanism underlying capsaicin’s ability to increases intestinal permeability was further examined by Isoda, Han, and colleagues in a series of papers (69-71). These investigators demonstrated that capsaicin’s intestinal permeability impairment resulted partially from capsaicin’s ability to bind the TRPV1 receptor in the gut which directly altered tight junction opening characteristics partially via increasing calcium influx in intestinal cells (70, 71).

One of the implications about capsaicin ingestion from chili peppers is this compound’s ability to promote drug (71), macromolecule and intestinal luminal content (allergens) movement across the intestinal barrier (67-69). A molecule of potential interest from capsaicin’s increase in gut permeability is LPS, a pro-inflammatory residue from gut bacteria. Current studies suggest that capsaicin induces an anti-inflammatory profile that inhibits LPS-induced IL-1β, IL-6 and TNF-α production in a time- and dose-dependent manner (79) that sensitizes the TRPV1 receptor activation (80).

Given this information and the prior data suggesting that capsaicin does not promote autoimmune disease (65), which clearly has an increased gut permeability element, it appears that capsaicin’s ability to increase gut permeability may not be associated with increased inflammation (79) or autoimmunity (65). An important caveat to the autoimmune data associated with capsaicin consumption is a recent study suggesting that hot chili pepper consumption may cause the cellular events leading to disease symptoms in IgA nephropathy patients (81).



Regular consumption of hot chili peppers may have numerous health promoting effects, and its pungent taste adds to the cuisine of worldwide cultures. People trying to lower their sodium intake can choose fiery pepper sauces with lower salt formulations. People with food allergies and certain autoimmune diseases may benefit by limiting pepper sauce consumption or ingesting sauces and chili peppers with lower capsaicin concentrations.



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Most baby boomers haven’t saved enough to live even a modest, middle-income lifestyle after work ends [1,2]. Unexpected post-retirement expenses can quickly overwhelm resources – especially medical expenses.

“Maintenance” medication expenses often take retirees by surprise as they transition to Medicare. Many don’t realize that Medicare has its own costs and, unlike private insurance, it has NO caps on most out of pocket expense. Even with supplementary insurance, some medical expenses never really go way – especially for drugs.

Typical maintenance medications are designed to treat diseases of lifestyle – illnesses that are heavily associated with the nutritional and exercise choices we make earlier in life. Baby boomers (including this writer) grew up in a pro-obesity, pro-diabetes, pro-cancer, pro-dementia, pro-atherosclerotic haze of misinformation and heavily processed food.

The consequences can be huge.

A Georgetown University study showed that 75 percent of adults ages 50-64 fill an average 13 prescriptions per year, rising to 20 per year for ages 65-79. Chronic disease patients fill a lot more (examples, across all age groups, include 34 prescriptions for diabetes and 30 for heart disease) [21].

The same study also showed that we pay more prescription costs out of pocket as we age – adults ages 65-79 pay 56 percent on their own costs and this rises to 67 percent by age 80.

And those percentages assume Medicare drug benefits are in force. The dollars alone strongly argue for diet and lifestyle changes.

Medicare Wasn’t Meant to Cover Everything

Whole books have been written about Medicare. Websites like Medicare.gov and CMS.gov (Centers for Medicare and Medicaid) have thousands of pages of information that is beyond the scope of this post. I’m just going to touch on some highlights which are current for 2019.

While Medicare is a valuable public program assisting millions, it is only partial coverage. There are startling out-of-pocket leftovers.

Some examples:

Medicare Part A (hospital)
$1341 deductible, per illness. $341 copay per day after 60 days, then $682 per day after 90 days [3].

Medicare Part B (outpatient)
After your annual deductible you pay 20% of all costs…forever. There is no cap [4].

Medicare Part D (drugs)
This is the hardest to nail down since most benefits are dictated by the private insurer you select.

The maximum annual deductible is $415 [5], but then cost sharing can vary [6]. Once your plan has paid $3,820 in benefits you enter the “coverage gap” and can pay:

  • Generic copay: 37% (no cap)
  • Brand name copay: 25% (no cap)

Catastrophic level: These coverage gaps are in place until you’ve paid $5,100 [7]. AFTER $5,100.00 of “eligible expenses” are paid in the plan year, coverage reverts to low copay but, again, without any cap [8].

Then there’s the question of whether your drug is on the plan formulary (list of approved drugs)? If so, does it get favorable “low tier” reimbursement? Some drugs don’t get full coverage, or any coverage.

The coverage gap is supposed to “close” in 2020 – but the current legislative trend is not pro-retiree, or even pro-consumer. Scheduled Medicare changes in the Affordable Care Act, designed to help retirees could be modified, delayed or even reversed by the current administration.

Will drug costs delay your retirement?

This glimpse of Medicare’s out of pocket expenses can be quite sobering the first (or even the 100th) time you see the big picture – especially if you retire on a modest budget while taking several prescriptions.

If you’re currently still working, you may be on generous group or individual health insurance through your job and not really notice your drug costs. But at some point, most of us lose our pre-retirement insurance plans and have to scramble for some combination of Medicare and supplementary coverage.

There is no guarantee that your medication(s) – or other medical treatment – will be covered the same way as before retirement.

Will you be part of the group that simply can’t retire due to drug costs? A 2018 Consumer Reports survey reviewed during a Senate Special Committee hearing on Aging in 2019, showed 12 percent of respondents delayed retirement specifically due to prescription costs [9].

Another survey showed that many older adults, especially in median income households, either delay or simply choose not to receive needed medical care due to cost [10].

Not surprisingly, unanticipated medical expenses are a leading cause of bankruptcy, especially for retirees [11].

There’s even a case of a retiree who robbed banks to pay for his medications [20]!

But are your medications (or your nursing home stay) really necessary?

Conservative financial advice recommends saving $275,000 to $500,000 just for out of pocket medical expenses in retirement. Yet, a large percentage of baby boomers haven’t even saved that much to live on.

These households simply can’t pay high medical costs on top of normal living expenses. This is especially true of long-term facility care, which is not covered beyond 60 days by Medicare or any Medicare supplementary insurance.

Absent from most “conservative financial advice” is the idea that many of us can make lifestyle changes that could minimize or prevent future medical expenses.

Please reread that sentence.

The widespread availability of inexpensive, unhealthy food has led to a current “global pandemic of obesity and chronic diseases” that afflict many retirees including metabolic syndrome, diabetes, atherosclerosis, cancer, Alzheimer’s and other dementia [12]. These conditions account for a large percentage of medication use (and drug-intensive nursing home admissions.)

Our lifetime of “harmless” habits (including pancakes, donuts, bagels, PBJ, chips, cookies, crackers, toast, breakfast cereal, fried or processed food, sugar, corn syrup, questionable food additives, and pesticides) is closely linked to numerous chronic diseases—and related treatment costs [13,14,15].

While pre-retirees might find it inconvenient or challenging to make significant dietary changes, modest-to-median income households may wish they had done so much earlier.

Saying NO to Permanent Patient status

A naturally low-carbohydrate, nutrient-dense, whole food diet—like the Paleo Diet®—is an important step in the journey away from “lifestyle” chronic disease. Many Paleo adherents, including this writer, report improved health as well as weight loss and improved energy. All of which can reduce medication usage.

Some examples include:

Diabetes: in one study, a Paleo Diet dramatically outperformed the recommended American Diabetes Association diet with respect to glucose control and lipid profiles [16].

Heart health: numerous studies, including this one, demonstrate that Paleo dieting offers strong control of hyperlipidemia compared to “traditional grain-based, heart-healthy diet recommendations” [17].

Alzheimer’s: a growing body of research shows that Paleo- (or even ketogenic-) style dieting can arrest or even reverse cognitive decline. [18].

Coupled with regular exercise [19], a dedicated Paleo Diet can strongly massage health outcomes in your favor.

To understand what this can mean in potential medical cost savings, here’s one example. Alzheimer’s patients survive, on average, 3-11 years after diagnosis [22]. Full-blown care in a nursing facility, based on 2018 figures, averages $100,380 per year [23]. This means that healthy lifestyle changes have the potential to save $301,140 to $1,104,180. Only some of which would have been covered by Medicare. 

While no diet alone can guarantee you’ll never get sick, responsible lifestyle choices now – even if you’re already retired and on maintenance medications – can improve your well-being and protect your bank account.


  1. Backman, Maurie. “Baby Boomers Are Overwhelmingly at Risk of Falling Short in Retirement -.” The Motley Fool, 30 Dec. 2018, https://www.fool.com/retirement/2018/12/30/baby-boomers-are-overwhelmingly-at-risk-of-falling.aspx.
  2. Nova, Annie. One-Third of Baby Boomers Had Nothing Saved for Retirement at Age 58. 7 Nov. 2018, https://www.cnbc.com/2018/11/07/one-third-of-baby-boomers-had-nothing-saved-for-retirement-at-age-58-.html
  3. Inpatient Hospital Care Coverage. https://www.medicare.gov/coverage/inpatient-hospital-care.
  4. Part B Costs | Medicare. https://www.medicare.gov/your-medicare-costs/part-b-costs.
  5. Yearly Deductible for Drug Plans | Medicare. https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/yearly-deductible-for-drug-plans.
  6. Copayment/Coinsurance in Drug Plans | Medicare. https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/copaymentcoinsurance-in-drug-plans.
  7. Costs in the Coverage Gap | Medicare. https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/costs-in-the-coverage-gap.
  8. “2019 Changes to Medicare Part D Coverage | Simplefill Prescription Assistance.” Simple Fill | Prescription Assistance, RX Assistance, Astrazeneca Patient Assistance – Portland, OR, 9 Oct. 2018, https://simplefill.com/heres-need-know-2019-changes-medicare-part-d-coverage/.
  9. Bowers, Lois. “Survey Finds That 12% Delay Retirement Due to Drug Costs, Senate Aging Committee Hears – News.” McKnight’s Senior Living, 8 Mar. 2019, https://www.mcknightsseniorliving.com/home/news/survey-finds-that-12-delay-retirement-due-to-drug-costs-senate-aging-committee-hears/.
  10. Bowers, Lois. “Healthcare Costs Worry Older Adults across Income Levels – News.” McKnight’s Senior Living, 3 Apr. 2019, https://www.mcknightsseniorliving.com/home/news/healthcare-costs-worry-older-adults-across-income-levels/.
  11. Brockman, Katie. “More Retirees Than Ever Are Filing for Bankruptcy — Here’s Why -.” The Motley Fool, 16 Dec. 2017, https://www.fool.com/retirement/2017/12/16/more-retirees-than-ever-are-filing-for-bankruptcy.aspx.
  12. Mozaffarian, Dariush, et al. “Role of Government Policy in Nutrition—Barriers to and Opportunities for Healthier Eating.” BMJ, vol. 361, June 2018, p. k2426. www.bmj.com, doi:10.1136/bmj.k2426.
  13. Thorn , Eric, M. D. “Carbohydrates Are Killing Us.” The Washington Times, https://www.washingtontimes.com/news/2018/jul/8/fatty-foods-dont-cause-heart-disease-bread-and-pas/. Accessed 4 Apr. 2019.
  14. Livesey, Geoffrey, and Helen Livesey. “Coronary Heart Disease and Dietary Carbohydrate, Glycemic Index, and Glycemic Load: Dose-Response Meta-Analyses of Prospective Cohort Studies.” Mayo Clinic Proceedings: Innovations, Quality & Outcomes, vol. 3, no. 1, Feb. 2019, pp. 52–69. PubMed Central, doi:10.1016/j.mayocpiqo.2018.12.007.
  15. Khazan, Olga. “The Startling Link Between Sugar and Alzheimer’s.” The Atlantic, 26 Jan. 2018, https://www.theatlantic.com/health/archive/2018/01/the-startling-link-between-sugar-and-alzheimers/551528/.
  16. Masharani, U., et al. “Metabolic and Physiologic Effects from Consuming a Hunter-Gatherer (Paleolithic)-Type Diet in Type 2 Diabetes.” European Journal of Clinical Nutrition, vol. 69, no. 8, Aug. 2015, pp. 944–48. www.nature.com, doi:10.1038/ejcn.2015.39.
  17. Pastore, Robert L., et al. “Paleolithic Nutrition Improves Plasma Lipid Concentrations of Hypercholesterolemic Adults to a Greater Extent than Traditional Heart-Healthy Dietary Recommendations.” Nutrition Research (New York, N.Y.), vol. 35, no. 6, June 2015, pp. 474–79. PubMed, doi:10.1016/j.nutres.2015.05.002.
  18. Bredesen, Dale E. “Reversal of Cognitive Decline: A Novel Therapeutic Program.” Aging, vol. 6, no. 9, Sept. 2014, pp. 707–17. PubMed, doi:10.18632/aging.100690.
  19. Booth, Frank W., et al. “Lack of Exercise Is a Major Cause of Chronic Diseases.” Comprehensive Physiology, vol. 2, no. 2, Apr. 2012, pp. 1143–211. PubMed Central, doi:10.1002/cphy.c110025
  20. EndPlay. “Utah Man Robbed Bank Because He Could Not Afford Medications, Police Say.” WSOC, 8 June 2019, https://www.wsoctv.com/news/trending-now/utah-man-robbed-bank-because-he-could-not-afford-medications-police-say/956430486.
  21. “Prescription Drugs.” Health Policy Institute, https://hpi.georgetown.edu/rxdrugs/
  22. “What to Know about the Stages of Alzheimer’s.” Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/alzheimers-stages/art-20048448.
  23. Cost of Long Term Care by State | 2018 Cost of Care Report | Genworth. https://www.genworth.com/aging-and-you/finances/cost-of-care.html.


Fire up the barbecue and prepare for a classic summertime meal with these Paleo Diet® skewers. What makes these skewers so appealing in the summer? There’s no sweating it out in a hot kitchen with this one. The preparation is fast and easy, and the cleanup is minimal. But that doesn’t make it any less healthy. The chicken and vegetables are packed with nutrients in this delicious combination. Better make extra!



  • 1 lb boneless chicken breast
  • 3 fresh limes
  • 4 cloves minced garlic
  • 1-inch piece of fresh ginger, peeled and grated with micro plane
  • ¼ cup coconut oil
  • 1 red onion, halved and halved again
  • 2 bell peppers orange and yellow, large chunks
  • 1 large zucchini, halved and cut into large chunks



Cut chicken breasts into 1-inch chunks and place in a glass container.

Prepare the limes by first zesting, then juicing each into a medium bowl. Add the minced garlic, ginger, and coconut oil. Pour over the chicken and stir to combine. Cover the chicken and refrigerate for a minimum of 2 hours.

Skewer chicken and vegetables alternating each until skewer is filled. Grill the kebabs over direct medium heat, keeping the lid closed as much as possible, until the chicken is firm to the touch and no longer pink in the center, 8 to 10 minutes total, turning once or twice during cooking. Take care not to overcook.

Serve with your favorite fresh, seasonal fruit for a complete Paleo meal.

Serves 4.



When I began my career in fisheries science 43 years ago, I had no idea a major debate over where we get our fish from would be as contentious as it has become.  

Admittedly, I was drawn to the important questions of our future food supplies and the role fish would play in that future. 

So, I ask here the burning question.  Should we buy fish sourced from the wild or from farms—also known as aquacultured fish?  Facts and science can lead us to an answer. 

If I know only one thing, I know this: the best way to analyze this question is objectively, using facts and science as the basis for that analysis.  Throughout my career, I have used objectivity and facts to guide my decisions.  This approach has served me well.  There are times to set aside dogma (otherwise known as “religion,” or, as I’m using it here, belief in something based purely on faith,) prejudicepreconceived notions, and tightly held beliefs when the facts—scientific facts—strongly suggest otherwise. 

If you consider yourself an environmentalist (however you may define the word,) I applaud you.  I am one of them and we need more of them in the world.  However, environmentalists are just as prone to misconceptions as anyone.  This is a human trait where we accept or reject a notion based on a mental construct we devise and build over time.  Indeed, that construct becomes more rigid as we get older, and tends to be reinforced by items of information that fit into or conform to that construct, while at the same time we tend to reject the items that do not fit the construct or are contrary to it.  In short, we believe what we want to believe.  History is full of examples (e.g., the earth is flat, we are at the center of the solar system and universe, alchemists can turn lead into gold, on and on). 

The belief that wild fish are “better for you than farmed fish—more wholesome and nutritious, more natural, better for the environment, live a better lifeis just one more example without a real basis in facts.  It’s religion. 

I know for some of you, I have just blasphemed!  How can I dare say cultured fish are superior to wild fish?  I apologize, but please, hear me out and read on!  Read what I am about to say and then form your own opinion.  I promise to be as objective and fact-based as possible.  Dogma, religion, and bias have no place in this discussion. 


The Science and Facts of Farm and Wild Fish – The Seas are Limited 

Here’s the predicament with which we are faced.  According to the UN Food and Agriculture Organization, the overall demand and supply today in the world for fish and seafood is about 175 million metric tons per year (yes, that’s 385 billion pounds), and is growing at a rate of about 3 percent per year1.  The reasons for this rapid growth are numerous, but steady increases in world population and the rise of the large Chinese middle class (with more disposable income and an aspiration for higher-quality protein) are near the top of the list. 

Of the 175 million metric tons of supply, 90 to 95 million metric tons come from the wild.  The remaining 80 to 85 million metric tons come from aquaculture—fish farms—with a value that exceeds $231 billion.  The issue is that the seas have reached their production limits and did so more than 25 years ago.  Indeed, many wild fisheries are overfished and are threatened with collapse1. 

By the way, there is an additional 30 million metric tons per year of aquatics plants (mostly macroalgae) that are produced on aquatic farms in addition to finfish and shellfish. [1] 

Bottom line: wild supplies are finite!  So, we cannot expect any more production from the wild.  More wild fish will not miraculously appear, and we don’t want to slaughter every one of them.  That’s what would happen without aquaculture.  We would eat every remaining fish on the planet, and then a few days later we would be hungry again.  End of story.  It’s that simple. 


18 Reasons We Should Look to Aquaculture 

As the saying goes, every cloud has a silver lining.  This cloud is no different.  The issue is the misconceptions and dogma. Many lump fish farms in with large-scale cattle and chicken feedlot farms with all the same health and environmental concerns. But that’s just not the case. 

So, bear with me as I explain, in an objective and fact-based way, why we should look to aquaculture as a solution to our predicament. 

1. Supplies from farms are not finite. This means that aquaculture will continue to grow rapidly (about 5 percent per year), and over time supplies from the wild will essentially fade into the backgroundthough not disappear entirely—as a percentage of total supply.   

2. True environmentalists are pro-aquaculture.  Aquaculture takeshuman supply pressure off wild stocks and puts it where it should be—on production from farms.  Aquaculture is agriculture.  Hunting and gathering must end in the seas as it ended on land 10,000 years ago at the dawn of terrestrial agriculture. 

3. Farmed fish are not abused! The notion of abuse is completely counterproductive to the best interests of the fish farmer and counterintuitive to their goals, which are fast-growing and healthy fish.  Water quality, fish densities, and nutrition are optimized to reduce stress and create a healthy production environment.  They are treated with the respect they need and   Happy fish create high rates of survival, smaller feed bills, and healthy profits for producers.  Humane treatment is simply good business. 

4. Aquaculture products are fully traceable, from feed to hatchery,to grow-out, to processing, to distribution, to endpoint of sale. [2]  We know exactly what went into their production and their exposure.  Traceability simply is not possible with wild finfish and shellfish!  We don’t know what they have eaten or what they have been exposed to (toxins, medical waste, plastics, heavy metals, etc.). 

5. Water use and discharge from many indoor facilities is limited by use of recirculating aquaculture system (RAS) technology.  This approach uses filters that reuse water again and again, filtering out wastes and replenishing oxygen.  This is a very frugal approach that uses minimal amounts of water as compared to other conventional technologies such as raceways, ponds, and ocean net-pens.

6. More and more fish farm operators use a technique called integrated multi-trophic aquaculture (IMTA).This is where the “wastes” from the fish facility are used as raw materials for production of other products such as shellfish and saleable plants. [3,4]  These secondary crops act as natural filters, turning potential liabilities (i.e., fish wastes) into raw material assets.  Operators literally make money from wastes.  Additionally, solid wastes can be used as high-quality material for composting and application to farmers’ fields. 

7. Aquaponics (i.e., integrated aquaculture and hydroponics) is one form of IMTA. This is a very popular land-based form of IMTA, usually with the fish in tanks in an insulated building and the plants in an adjacent, attached   This approach is highly scalablevery small and costing only a few dollars (and fits on a kitchen countertop), to very large systems capitalized with tens of millions of dollars. 

8. Discharge water is high quality when RAS and IMTA systems are used. The discharge water (what of it there is—only small amounts) is high quality or higher than the intake water. 

9. Indoor facilities can operate year-round. In good and bad weather and employ people who otherwise may not be able to find work.

10. The excessive use of chemicals and antibiotics in aquaculture is a myth in North America,Europe, and many parts of Asia.  In fact, as aquaculture is such a fledgling industry, the controlling government departments have made the use of these compounds more difficult than most other forms of agriculture.  In the USA, the FDA highly regulates use of most chemicals and antibiotics. [5]  They are only allowed after the demonstration of need through a clinical examination and/or under the guidance of a veterinarian. 

11. Aquaculture producers avoid the use of all therapeutants (i.e., antibiotics,sterilants, vaccines, etc.) whenever possible.  They are expensive and diminish profitability.  Instead, producers are turning to probiotics, superior management techniques and equipment, and other benign forms of health maintenance.  Farmed finfish and shellfish are health food—wholesome and nutritious.

12. Third-party certification programs are now the norm in aquacultureand in all parts of the worldMuch like the Good Housekeeping Seal of Approval or Underwriters Laboratories UL.  They guarantee fish welfare, sustainability, environmental sensitivity, sanitation, freedom from chemical residues, and wholesomeness. 

13. Fish have a much better feed conversion ratiothan any other agriculture species. The weight of feed to weight of fish is usually at or below 1.5:1.  By comparison, swine and cattle convert at rates as high as 8:1 or more, and poultry at 2-3:1. [6]  Because fish are cold-blooded (poikilothermic), little or no food energy goes into producing heat, so much more of it is directed toward growth.  Growth is regulated by the water temperature in which the fish live.  With proper species selection and/or supplying appropriate conditions, growth rates can be optimized.  Low feed conversion ratios mean more sellable production for each unit of food consumed. 

14. Aquaculturistscan easily adjust the nutritional qualities of their fish for consumers – by simple manipulations of their feed, including eliminating contaminants. [7]  Cultured fish are as nutritious or often more nutritious than their wild-caught counterparts. [8] 

15. Fish farms canactually use less water per unit of production than cattle ranches and feed lots.  And they are virtually odorless. 

16. Aquaculture in general offers a much more efficient use of space.  Aquaculture can produce a greater amount of product in a given area by virtue of production in a three-dimensional culture environment. [9]

17. Fish farms can be the envy of the nearby conventional and regional farmers as they become models of sustainability and environmental stewardship.  Their neighbors and other customers will be proud to buy products from these facilities. 

18.  If you want to be part of the solution and not part of the problem, then support aquaculture and eat farmed products.  Avoid fish from the wild. 


Buy Farm Raised Fish 

Aquaculture is not perfect (again, aquaculture is not perfect!).  No one claims it is, and aquaculture is not a panacea Translation: my eyes and mind are wide open!  But improvements are implemented every day and every year, such as alternative and sustainable aquaculture (actually, this is true for all livestock including fish) and feed ingredients (e.g., insect- and algal-based proteins and oils) which are coming on strong.  I see it all the time.  Indeed, as a consultant, I can help fix what is wrong. 

Let’s allow the wild fish to live out their lives in peace and help them to contribute to the overall health of the natural aquatic ecosystems in which they reside, as they should.  When you buy fish, buy farmed products and rest comfortably that you are doing the best for yourself and the world.  



1. FAO.  2018.  FAO yearbook.  Fishery and aquaculture statistics 2016.  Food and Agriculture Organization of the United Nations.  http://www.fao.org/3/i9942t/I9942T.pdf 

2. FDA.  1999.  Guidance for industry: questions and answers for guidance to facilitate the implementation of a HACCP system in seafood processing.  U.S. Food and Drug Administration.  https://www.fda.gov/regulatory-information/search-fda-guidance-documents/guidance-industry-questions-and-answers-guidance-facilitate-implementation-haccp-system-seafood 

3. Anonymous.  2019.  Integrated multi-trophic aquaculture.  Wikipedia.  https://en.wikipedia.org/wiki/Integrated_multi-trophic_aquaculture 

4. Boxman, S.E., A. Kruglick, B. McCarthy, N.P. Brennan, M. Nystrom, S.J. Ergas, T. Hanson, K.L. Main, and M.A. Trotz.  2015.  Performance evaluation of a commercial land-based integrated multi-trophic aquaculture system using constructed wetlands and geotextile bags for solids treatment.  Aquacultural Engineering 69:23-36. 

5. FWS.  2015.  Approved drugs for use in aquaculture.  U.S. Fish and Wildlife Service.  https://www.fws.gov/fisheries/aadap/PDF/2nd-Edition-FINAL.pdf 

6. Anonymous.  2018.  Feed conversion ratio.  Wikipedia.  https://en.wikipedia.org/wiki/Feed_conversion_ratio#Beef_cattle 

7. Hardy, R.W.  2005.  Contaminants in salmon: a follow-up.  Aquaculture Magazine 31(2):43-45. 

8. Hardy, R.W.  2003.  Farmed fish and omega-3 fatty acids.  Aquaculture Magazine 29(2):63-65. 

9. Despommier, D.  2010.  Vertical farming.  Thomas Dunne Books.  New York.  305pp. 

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