Mark Sisson's Blog, page 306

What Did Our Ancient Ancestors Actually Eat?

A few weeks ago, I made the point that even though we may not have access to our paleolithic ancestors’ (yes, all of them) food journals, and even though there were many different paleolithic diets depending on climate, latitude, topography and other environmental contexts, the ancestral eating paradigm remains viable, helpful, and relevant to contemporary interests. That almost goes without saying, right? It’s kind of why we’re all here, reading this and other blogs, and asking the butcher for lamb tongues and goat spleens with straight faces. This stuff works.

But make no mistake: we may not know the day-to-day eating habits of our ancestors, but we know some things. And we can use what we know, drawing on several lines of evidence, to make some educated estimates.

The best place to start is, well, the place where it all started: East Africa, the cradle of human evolution. More specifically, let’s look at the Lake Turkana, Rift Valley, Omo River part of Ethiopia and Tanzania, which is where the oldest known remains of modern homo sapiens – dating back 200,000 years – were found. It’s a beautiful place. I mean just look at it. No wonder we hunkered down there for thousands of years.

So, what’s good to eat there?

A landmark paper examined this very question, using the available data to construct a series of dietary patterns that might have characterized the typical intake ranges of the very first homo sapiens living in East Africa – the ancestors of us all. Their conclusions?

Average intakes of moderate-to-high protein (25-29% of calories with a range of 8-35%), moderate-to-high fat (30-39%, range of 20-72%) and moderate carbohydrates (39-40%, range of 19-48%).
Regarding fats, SFA was 11.4-12%, MUFA 5.6-18.5%, and PUFA 8.6-15.2% of total calories. Pretty balanced overall.
PUFA was far more varied and diverse than the kind of PUFA typically eaten in modern diets, with very little linoleic acid (just 2.3-3.6% of calories) and far more arachidonic acid (2.54-8.84%) and long-chain omega-3s (2.26-17%).

All that looks familiar. The ranges allow for varying levels of carbohydrate, fat, and protein depending on your activity levels and goals, but it sets some “ground rules” like “keep linoleic acid low” and “be sure to get plenty of omega-3s.” So far, so good.

What were the most important foods eaten by these early humans in East Africa, and what can we glean from it?

Fish and Shellfish

The Rift Valley hosts a number of freshwater lakes teeming with fish and shellfish rich in docosahexaenoic and arachidonic acids. These fats are necessary for fetal and early infant brain development. When modern local women eat fish from those same lakes, their breast milk becomes extremely rich in both DHA and AA; this leads to improved pregnancy and early infancy outcomes. The modern pelagic fish from the Rift Valley lakes are high in DHA, EPA, calcium, and other important nutrients. And that’s what matters: the nutrients.

They were also relatively easy to gather, requiring no special tools and very little caloric expenditure. Shellfish are especially easy to pick up.

Takeaway: The density of brain-and-baby-specific nutrients found in fish and shellfish made these foods perhaps the most important to the earliest humans. Don’t skimp on the long-chain PUFAs.

Land Animals

East African hominids have a long and storied history with the resident megafauna. As far back as 2 million years ago, we were hunting (not just scavenging) them. 500,000 years ago, we were wielding formidable thrusting spears. By at least 280,000 years ago, we had developed throwing spears to prey on the crocodiles, hippos, and other large delicious beasts roaming the Rift Valley. Clearly, we’ve always known how to obtain and consume animals (and yes, “always” is correct because we’ve been eating animals as long as we’ve been us), whether through scavenging, persistence hunting, or ambush predation.

Upon making (or stealing) a kill, the homo sapiens in East Africa wasted nothing. Markings on bones indicate expert butchery. Meat was completely removed. Bones were stripped of marrow and smashed to get every last drop. Heads were prized for the “fatty, nutrient-rich, energy-dense within-head food resources.” Adipose tissue and offal – all of it – was eaten. They weren’t just eating eland loin, in other words, but utilizing everything.

Takeaway: Eating the entire animal isn’t just economical, it’s the kind of “meat consumption” we’re strongly adapted to. Diverging from that may be problematic. Eating only muscle meat and eschewing the fat, bones, and offal is likely evolutionary discordant.

Tubers

Important parts of early human diets, tubers likely acted as fallback foods for when the hunt was poor or fish were scarce. It’s crucial to understand that these were wild, fibrous tubers, though – not the creamy, smooth russet potatoes that make the best darn mash you’ve ever tasted. An analysis of wild tubers currently present in this area and utilized by the Hadza (the modern hunter gatherers who live on the same ancestral Tanzanian lands) found that they contain only between 19 and 26 grams of starch per 100 grams of tuber, along with a ton of prebiotic fiber (PDF). Some of that starch was likely resistant as well, boosting the prebiotic count even higher and lowering the amount of digestible starch.

East African wild tubers therefore provide a moderate bolus of digestible starch with a sizable portion of prebiotic substrate, resulting in moderate glucose loads and improved glucose tolerance from the fermentation of prebiotic fiber.

Takeaway: Tubers were important foods for early humans, but not necessarily for the glucose they provided. The primary feature of wild East African tubers that set them apart from modern cultivated tubers was the indigestible portion, the prebiotic fiber and resistant starch that fed, nurtured, and cultivated the hugely crucial microbiome living inside our guts.

What’s the point of all this? Simple. To pay homage to the past. What went down hundreds of thousands of years ago in a far-off region in East Africa isn’t just “the past,” after all. It’s our past. It’s our story. Your story. And even though there were and are many more stories still to come from other places and times, those first humans squinting into the sun as it dipped down below the edge of the known world, turning toward the fire and the dance and the feast, slurping up some freshwater mollusk or sharing a split, roasted femur with a pal or lover – they made us who we are today. Their everyday habits, their dietary choices, their responses to the demands of the day all unwittingly paved our way, for better or for worse.

It’s good to acknowledge that.

Well, that’s it for today, folks. I hope you enjoyed today’s post. Be sure to let me know in the comment section!

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Are Antioxidant Supplements Effective?

If you pay attention to science journalism, you’ve probably heard tell that antioxidant supplements have mostly negative effects on health markers, ranging from impaired training adaptations in response to exercise, extreme hypoglycemia, and even cancer. At their best, these reports say, antioxidants are merely useless and totally ineffective.

So, is this true? Are antioxidants harmful? Are they effective?

Let’s examine some of the specific claims made about antioxidant supplements.

Do antioxidants erase the beneficial effects of exercise?

Sometimes they reduce them, sometimes they enhance them, and sometime they have a neutral effect. It depends on several factors.

It depends on your baseline oxidative stress status. Giving antioxidant supplements to heart disease patients on an exercise regimen did not reduce the benefits of exercise. CHD patients typically have elevated oxidative stress markers.

It depends on your age. In elderly exercisers, taking a green tea and vitamin E supplement actually enhanced the effects of exercise. They improved body composition, glucose tolerance, and oxidative stress load to a greater degree upon antioxidant supplementation, probably because older people are more susceptible to oxidative stress induced by exercise.

It depends on your body composition. One of the more recent “antioxidants cancel out exercise” studies actually suggests that obese people enjoy improved body fat loss when supplementing and exercising. And even though the healthy trainees who supplemented showed biomarkers that normally indicate impaired training adaptations, their V02 max and running performance compared favorably to those who did not supplement.

It depends on the nature of the exercise. The more antioxidants you take, the higher your tolerance for greater intensities. You’ll likely “need” more intensity. That may be why giving antioxidants to people engaged in high intensity interval training does not reduce the benefits.

Do antioxidants cause hypoglycemia?

Pick an antioxidant, any antioxidant, and you’ll find people online complaining about it causing low blood sugar. How can this be if antioxidants are “good for you”?

Many (and perhaps most) antioxidants are insulin-sensitizing agents. They increase the effects of insulin, a primary one of which is the removal of glucose from the blood, so you need less insulin to remove the same amount of glucose. Or put another way, the same amount of insulin removes even more glucose. If you’re lean, if you’re perfectly insulin sensitive, if you’re walking around with optimal blood glucose levels, consuming an insulin-sensitizing agent may be too much of a good thing. It may make you hypoglycemic.

What if you’re not healthy? If you’re a type 2 diabetic, if you’re completely sedentary, if you’re obese and insulin resistant, if you’re hyperglycemic, more insulin sensitivity will improve your health. Context matters. Always.

That’s why the same alpha lipoic acid that might cause hypoglycemia has also been shown to prevent the descent from glucose intolerance into full-blown type 2 diabetes and increase insulin sensitivity in type 2 diabetics. Or why the curcumin that may cause low blood sugar in healthy people can reduce the incidence of type 2 diabetes diagnoses in an at-risk cohort. In other words, it helps the people who need the help.

Do antioxidants increase cancer?

A headline like “Antioxidants Could Increase Cancer Rates” implies that supplements are increasing the incidence of cancer in the population. Looking at the study it draws upon, you realize that vitamin E and NAC “only” accelerated tumor growth in mice with pre-existing tumors rather than spurred the formation of new ones. That’s understandable, as cancer patients undergoing radiation or chemo therapy are usually told not to discontinue any antioxidant supplementation.

Meanwhile, other evidence shows that NAC is chemopreventive (inhibits cancer from starting), especially when combined with other antioxidants like green tea extract. It’s also safe to assume that the vitamin E used in this study was alpha tocopherol, whereas broad-spectrum vitamin E that includes tocotrienols tends to slow the progression of cancer.

Certain antioxidants may very well spur progression of (some) existing cancers, but that’s not the same as increasing the incidence of cancer.

Why do so many studies show that antioxidants don’t work?

They’re studying the wrong populations. Healthy people are not the same as unhealthy people. They respond differently to medications, foods, exercise regimens, and yes, antioxidants.

In healthy men, grape polyphenol extracts don’t improve vascular function. In men with metabolic syndrome, grape polyphenol extracts lower blood pressure and increase flow-mediated dilation. Similar differences have been observed with resveratrol, too. And despite that, antioxidants sometimes do work, even in generally healthy populations; a complex of quercetin, curcumin, catechins, and selenium improved cardiovascular disease markers after two months.

Notice a trend? Antioxidant supplements are generally beneficial for unhealthy people with high baseline levels of oxidative stress and systemic inflammation, while they can be unhelpful for people who are already healthy with low levels of oxidative stress and systemic inflammation. Unfortunately, most people fall into the former category.

Take me, for example.

Back when I first got started on the Primal road to better health, I was a mess. Overtraining, chronic stress, inflammation – the years of abusing my body in the pursuit of elite endurance performance had not been kind. I designed my antioxidant supplement (Damage Control Master Formula) to counter all that oxidative stress I was subjecting myself to. And, in concert with smarter (less) training, a better (more Primal) way of eating, and other lifestyle interventions (stress, sleep, play, etc.), it seemed to help. It was actually a very selfish endeavor – I just wanted to get healthier, faster, so I put together a spectrum of safe, natural compounds and extracts that satisfied my criteria:

Moderate doses that reflect the ongoing research.
Able to pass through the body if not needed.
Takes advantage of synergistic interactions between nutrients and antioxidant recycling (for example, since vitamin E alone as alpha tocopherol actetate becomes a pro-oxidant when it donates an electron, Master Formula has a spectrum of mixed tocopherols and tocotrienols and vitamin C to help recycle the various forms of E back to antioxidant state).

Nowadays, I’ve got my health dialed in. I eat right, move correctly, sleep well, and kinda-sorta handle stress adequately. I don’t need to take an antioxidant supplement on a daily basis, so I take it intermittently. One pill after breakfast one day, three the next day, and none for half a week. Then I’ll take it every other day at varying dosages, then back off for another half week. That’s just an example, not a prescription. I jump around, basically. What’s funny is that because I’m fairly healthy, taking Master Formula every day could conceivably offer diminishing, or even negative returns. The same negative effects you see bandied about. Taking it the way I do now has a hormetic effect, the phenomenon whereby a moderate stressor upregulates your own antioxidant mechanisms to make you healthier and more robust.

The bottom line of all this? Figure out where you stand.

A severely obese person might benefit from more regular usage. An extremely active, high-performing, daily-training athlete would probably benefit from semi-regular usage. A heart disease patient might look into supplementation. And I imagine a person working 15 hour days at a high-stress job could probably benefit from antioxidant supplementation. These are people who are inflamed, who are coming into the game with a hefty load of oxidative stress. They can probably use the extra help.

If you’re eating well, exercising intelligently, getting as much sleep as you need, and not suffering from any obvious maladies, you don’t “need” to take an antioxidant supplement. You might benefit from the occasional hormetic dose – as I believe I do – especially if you don’t eat enough phytonutrient-rich plant food, but you’ll be okay without it.

See how it works? Rather confusingly. There are no easy answers, only choices – often hard ones – we must make based on our personal situations.

Let’s hear from you guys. Do you take any antioxidants? Why or why not?

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Dear Mark: Bone Broth Nutrients and Alternatives to Agriculture

Today’s edition of Dear Mark is a two-parter. First, I dig a bit deeper into the nutrients found in bone broth. A reader’s come across some startling nutritional data that seems to call into question the legitimacy of our community’s collective love affair with hot bone water. Find out if we’ve been overselling the benefits. Then, I discuss humankind’s tendency to (try to) tame, quell, counteract, and otherwise improve on nature’s mysterious workings. Can we come up with a viable alternative to agriculture, often characterized as our most egregious offense?

Let’s go:

Mark,

I know in the primal/paleo world, bone broth is considered a superfood. I always have some in my fridge, and consume it almost daily. I investigated the nutrient content of beef bone broth, and was pretty disappointed. First, there are very few studies that break down the nutrient profile of bone broth. And second, the few that are out there paint a pretty dull picture of bone broth. A one-cup serving provides a measley 9% calcium, 3% magnesium, and on and on ad nauseum. I thought I would bring it up to see if you had other sources of info, and maybe consider doing a post about it sometime. No doubt, the entire MDA community would be interested! Thanx!

Marc

Good question, great name, interesting spelling.

I have taken a look at the (limited) research available on the nutrient contents of bone broth. One study in particular caught my eye where veal bones were sliced open to expose the marrow, placed in water with some acetic acid (vinegar), and boiled for nine hours. As you mention in your question, the mineral loss from bones into the broth was extremely unimpressive – just a few milligrams of calcium and magnesium. Gelatin was the only nutrient of note found. And in the most unexpected turn of events, bones that were placed in room temperature water for nine hours actually gave off more minerals than the boiled bones. Weird, huh?

I was certainly surprised when I first read it, but ultimately not dissuaded from my continual pursuit of delicious bone broth. Here’s why I don’t put much stock in these results.

Nine hours isn’t enough time to really break down ruminant bones like veal. When you get into 24-hour stock territory where the fork plunges into the femur bone or 36 hours where the knuckle crumbles in your hands and the resultant stock turns cloudy with dissolved bone solids, there’s got to be something more going on than just a few milligrams. Nine hours will get most of the exterior collagen, but that’s about it. Many of the best nutrients are locked within the bones themselves, including minerals and more collagen (used to make bones slightly elastic). Pressure cooking can significantly cut down the required time if you don’t want to have the stove going for two days.

Even if the study’s results do apply to pressure-cooked and long-simmered bones and “real” broth contains very few minerals, broth ultimately isn’t only about the minerals. Bones contain far more interesting compounds than just calcium, magnesium, and phosphorus (besides, we can get all that stuff from our food):

Gelatin – I won’t talk too much about gelatin because I do so on a regular basis. Rest assured, though: it’s probably the most important reason we should take the time to make bone broth. Yes, you can get your gelatin in powder form, but that won’t get you the following bone nutrients.

Hyaluronic acid - Synovial fluid, that slippery lubricant inhabiting our joint capsules and making them glide safely and smoothly together, is mostly hyaluronic acid. Race horses with bad osteoarthritis get intra-articular shots or IVs of synovial fluid to treat their condition, and studies on oral administration indicate that hyaluronic acid is the main player. You can also find hyaluronic acid in the bones and the connective tissue (usually attached to the bones). Seeing as how a high-hyaluronic acid extract of chicken combs (the fleshy red waddle that sits atop a chicken’s head) improved quality of life and reduced pain in patients with osteoarthritis, making and drinking broth from those parts (not necessarily the combs, although go for it if you have access to them) should also help.

Chondroitin sulfate - Chondroitin sulfate is a popular joint health supplement, often paired with glucosamine. Does it work? Many people will vociferously claim it’s bunk. I’ll just say that the humans participating in the study which found that six months of chondroitin sulfate supplementation reduced cartilage loss in patients with osteoarthritis probably have a different opinion. Except for the folks who got the placebo, that is. Seeing as how those supplements get the chondroitin sulfate directly from animal cartilage, why not just eat the cartilage, or a broth made with plenty of cartilaginous substrate? The stuff works and it’s delicious when you get it right from the bones. The keel cartilage of the chicken back bone is a particularly rich source of the stuff and highly water-soluble, according to one paper (PDF).

If only we could figure out a humane, sustainable way to tap the suprapatellar pouch of a live grass-fed steer and draw out the synovial fluid. You have to think that would make the ultimate joint supplement, right?

Hi Mark,

You often hear that agriculture was “humankind’s greatest mistake” in this community and I think I agree but what’s the solution now? We’re stuck with it and we have to feed all these people somehow. Are there any viable alternatives?

Thanks,

Marc

Another Marc, eh? Weird.

It does seem like we’re in a pickle, huh?

We humans think we’re pretty good at conquering nature. We “tame” it. We put up walls, raze forests, lay down roads and think we’ve figured it out. Only things don’t really work out so great. Unintended consequences always seem to arise.

We forgo the nomadic hunter-gatherer life to live in close quarters with each other and our livestock in order to keep death and malnutrition at bay – only to develop virulent infectious diseases that often originate in the livestock, spread from person to person due to cramped conditions, and continue to plague us to this day.

We sterilize things, manage to avoid the acute germs, keep our homes clean – but then end up with bad immune systems and imbalanced gut flora that lead to chronic autoimmune disease and allergies.

We convert vast reams of prairie teeming with wild grasses we cannot eat into cropland that produces billions of calories – but then end up with nutrient-sparse/energy-rich diets, rampant obesity, and a rapidly disappearing topsoil unfit to grow anything of worth.

We devise genetically modified organisms with immunity to herbicides so that we can blanket the crops with the herbicides in order to boost production and make up for the poor topsoil – only to create herbicide-resistant weeds that lower production and necessitate the use of more and even stronger herbicides.

Each one of our perfect solutions to the “nature problem” comes with baggage because nature is impossibly complex. It’s the result of billions of years of constant, unceasing refinement in response to billions of shifting variables. We’re discovering new genes, new bioactive plant compounds, new species, new roles for DNA we previously assumed to be “junk.” And really, it’s not that “we’re” discovering it. It’s this team of researchers in Beijing discovering that, that team in British Columbia stumbling upon this, this garage scientist in a Dutch suburb discovering that. It’s individuals, or groups of individuals. Yes, the Internet has made knowledge easier to share and more widely accessible, but the sheer breadth of it all is staggering and only getting more so. It’s hard to account for a bit of data when you’re unaware of its existence.

As far as the agriculture problem, I really don’t know. I am intrigued by the permaculture movement. Rather than start in the lab and force their findings on nature, they start with nature, observe its patterns and laws, and use the lab to enhance them. They rightly acknowledge that the “natural way” – whatever that is – of plants, animals, microbes, fungi, and other denizens of the soil all interacting is the most sustainable and perhaps even productive way to grow food. They also realize that rather than oppose nature, we can use science to enhance its processes. For example, decomposition of organic materials happens out in the wild but over a longer timescale. Compost piles do the same thing, only faster, without perverting or counteracting the original premise.

I can’t see the world switching over to a permaculture-based system anytime soon, but is that because of entrenched interests and inertia or a lack of viability? Throw in a little holistic livestock management a la Allan Savory and it seems like you’d have a solid system for producing food.

That’s it for me, folks. I’d like to hear what you guys have to say. Still going to make bone broth? How do you think we should handle food production? I suspect the former will be easier to answer than the latter!

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Weekend Link Love

My friends at EXO have completed their first production run of Cricket Protein bars and they taste fantastic! If I didn’t tell you the protein came from crickets, you’d swear it was whey protein. Order a box at EXO.co before they’re sold out (full disclosure: I am an investor in this company).

Anyone near Philly? Go check out the Primal Blueprint Transformation Seminar happening on March 20th!

Episode #10 of The Primal Blueprint Podcast is now live. This time, broadcasting straight from Primalcon Tulum, we’re joined by Darryl Edwards – the former computer programmer turned master of play. Darryl explains how you can make your workouts more successful by making them more fun, offering both practical fitness advice and a way to cultivate a playful attitude about life in general.

Dr. Ron recently sat down at the Paleo Runner Podcast to talk about his new book, The South Asian Health Solution, and explain the health crises currently facing South Asia.

Research of the Week

Both men and women are more attracted to the faces of the top cyclists in the 2012 Tour de France.

Males seem to respond better to sprinting than women, experiencing more mitochondrial biogenesis and muscle protein synthesis (although it’s still beneficial for both!).

Leaving poverty is complicated. A new study shows that boys who move from lower-class neighborhoods to higher-class neighborhoods experience far more depression and exhibit more misbehavior than girls who make the same move.

Interesting Blog Posts

“All animals play.” Is play the most fundamental foundation of physical reality?

Don’t worry, guys. The FDA says BPA is totally fine (hey, it could be, but I’m skeptical of the source).

Media, Schmedia

Dozens of Americans with extreme sensitivity to electromagnetic signaling have relocated to a small Virginia town where wifi is banned – and they claim to be feeling better than ever.

I am entirely unsurprised that the experts who recommend that more people be placed on statins are paid by the manufacturers of statins.

Everything Else

Even though it’s already surpassed its funding goal, the Kickstarter for monkii bars – a lightweight, portable suspension system that sets up in under a minute and lets you workout anywhere, anytime – is still accepting pledges. This is a great opportunity to become an early adopter for a big discount.

How pathogens shaped – and shape – human culture.

Is an elevated LDL particle count simply a marker of a tryptophan deficiency?

Joshua Weissman of the Slim Palate has released his awesome new cookbook, The Slim Palate Paleo Cookbook. Check out the promo video for his story and a taste (pun absolutely intended) of the kind of food and photography you can expect from the book.

I shudder to imagine the kinds of prebiotics we’d have to swallow if this electricity-consuming bacteria took up residence in our guts.

A shotgun shell that creates life (although I suppose at close enough range it might be able to kill something).

Antibiotics: the fat drug.

Recipe Corner

I would eat this pie. What about you?
This was my first time hearing of the “Irish boxty,” but now I really want to try it. And that full Irish breakfast? Man. Say what you will about food from the British Isles. They really know how to throw down at breakfast.

Time Capsule

One year ago (Mar 17 – Mar 23)

10 Full Body Workouts You Can Do in 10 Minutes Flat - Yes, friends. Ten minutes is plenty of time to get a good training session in.
Do Fear and Anxiety Define Your Health Journey? – Sometimes, anxiety is warranted. Usually? It’s an unnecessary burden to bear.

Comment of the Week

Paraphrasing Justice Potter Stewart:

I shall not today attempt further to define the kinds of material I understand to be embraced within that shorthand description ["lean tissue"]; and perhaps I could never succeed in intelligibly doing so. But I know it when I see it…

- Paleo Bon Rurgundy’s got the right idea.

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Swedish Meatballs

Swedish meatballs can be a main course, but their small size is ideal for an appetizer, ready to be stabbed with a toothpick or picked up by hungry fingers. But if you’re not planning a festive smorgasbord in the near future, then just stash these meaty morsels in the fridge for middle of the week snacking.

The allspice and nutmeg seasoning in these Swedish meatballs is subtle, but enough to be noticed, and makes the dish taste different from your average meatball. Swedish meatballs are usually made with a blend of beef and pork, which you could certainly do, but they’re also really delicious made with ground bison. The small size of Swedish meatballs means they don’t need to be cooked long, which is perfect for bison, a type of meat that is most tender and juicy when served medium rare.

Why use bison? Bison is a great source of protein, iron and omega-3 fatty acids. Bison aren’t mass-farmed and rarely treated with antibiotics and hormones. Ideally, buy bison that is labeled as 100% grass fed.

The cream sauce served with these meatballs is traditional (as is a dollop of lingonberry jam on the side) but not necessary if you don’t do dairy. There’s no question the sauce is delicious, but Swedish meatballs will disappear quickly without it too.

Servings: 22 small meatballs

Time in the Kitchen: 35 minutes

Ingredients:

2 tablespoons unsalted butter, divided (30 g)
1/4 of a yellow onion, finely chopped
1 pound ground meat (bison, or a mix of beef and pork) (450 g)
2 tablespoons water (30 ml)
1 egg, whisked
1/2 teaspoon kosher salt (2.5 ml)
1/4 teaspoon freshly ground black pepper (1.25 ml)
1/4 teaspoon freshly ground nutmeg (1.25 ml)
1/8 teaspoon allspice (a pinch)
1/2 cup beef stock (120 ml)
1/2 cup heavy cream (120 ml)
Finely chopped fresh dill for garnish

Instructions:

Melt 1 tablespoon of the butter in a large frying pan over medium heat. Add the onion and cook until softened, 4 to 6 minutes. Remove from heat and let cool slightly.

By hand, very gently mix together the cooled onion, meat, water, egg, salt, pepper, nutmeg and allspice. Don’t over-mix the meat (which can make it tough). The blend will be loose and quite damp.

Gently form small meatballs, using about a tablespoon of meat for each. The meatballs will not be firm; this is okay, and means you will have tender, juicy meatballs. If you find the meat too hard to work with, then refrigerate it for 30 minutes to an hour. Wetting your hands with water can help the meat stick to your hands less.

Melt the remaining tablespoon of butter in the same frying pan over medium heat. Add the meatballs and fry, turning after 4 minutes or when the bottom is browned and no longer sticking to the pan.

Cook for another 4 to 6 minutes.

If making the sauce, remove the meatballs from the pan. Add the stock and bring to a boil for 3 minutes, scraping up any bits of meat in the pan. If you want a smooth sauce, strain the stock then return it to the pan.

Add the cream to the stock and simmer gently until it reduces and thickens, about 3 minutes. Add the meatballs back to the pan for a few minutes before serving.

Garnish with dill.

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I Rediscovered Life Through the Primal Lifestyle

It’s Friday, everyone! And that means another Primal Blueprint Real Life Story from a Mark’s Daily Apple reader. If you have your own success story and would like to share it with me and the Mark’s Daily Apple community please contact me here. I’ll continue to publish these each Friday as long as they keep coming in. Thank you for reading!

When I was very little my sister and I were allergic to literally everything – meat, egg white, honey, nuts, etc. We were also constantly ill and I was really overweight for a child. My mother put us on a diet that we were eating, mainly fruits and vegetables because we were allergic to most other things. We started exercising and practicing the Buteyko breathing method which was the only thing that would calm our coughs. We got better and our allergies disappeared. We grew up and we slowly forgot about this healthier lifestyle that actually saved us.

I come from Bulgaria, a beautiful picturesque country that has one big fault – a complete obsession with being unhealthily skinny. Since the beginning of my teenage-hood I have been badly experimenting with my body through the constant change of my diet. I tried The Balanced Diet, which was not too bad but I had to measure my food to the gram for every meal and this made me paranoid about the sizes of portions. I have also tried The Protein Diet which allows only white meat the first week. After that vegetables such as cucumbers are included but fruits, nuts, fats are strongly forbidden. I even tried The Cabbage Soup Diet which literally made me sick because it was so awful. I also tried not eating anything while I was at school from 7am till the evening. After all that bouncing from diet to diet at the age of 18 I was suddenly less than 50 kg (110 lbs). I am 172cm tall (5′ 7.5″), had zero amount of energy and was constantly ill.

The summer after that I wanted to go back to normal eating but my body was so used to not eating properly that it refused to be fed anything. I spent the whole summer vomiting because my stomach did not accept anything I gave it. Slowly I got better and started eating again. However, one thing stayed with me forever due to all of these diets – constant stomach pain. At the age of 21 the pain got so bad that I had to do some tests and discovered that my gall-bladder was getting irritated by something and was jumping up into my stomach causing the pain. The doctors told me that it is caused by some kind of food that I can’t tolerate. They suggested to stop eating raw tomatoes and cut out the black pepper. This helped a bit but still the pain would come from time to time. I knew I had to change my life and find out what was causing all that stress to my gall-bladder.

I was 22 when I first discovered the real food lifestyle that eliminated all the artificial ingredients and tolerates only wholegrain products when it comes to grain products. I felt a bit better and had more energy than before. However, the pain was still there from time to time and I gained some weight because of all the wholegrain products that I thought were very good for me. I started noticing that my stomach hurt just after I had eaten something with grains in it, but I did not really do anything about it.

During a lunch break at university my sister told me about The Primal Blueprint. She stumbled upon the Mark’s Daily Apple website while she was researching if eating one apple a day was truly healthy or just a myth. She told me what the idea behind all of it is and how this is not a diet but a lifestyle. It was very important that everything on the website is scientifically based and not just the opinion of yet another diet guru. After all the diets I had tried, what did I have to lose? So I gave it a try.

I remember the day when I emptied all my kitchen cupboards and threw away every bit of grain I had. I felt alive! I had energy for everything, I was not falling asleep constantly anymore and the pain was completely gone. I reached 63 kg (138 lbs) and I have stayed like that ever since. This was the first time in my life that my weight was completely stable and not fluctuating all the time. I used to have problems with spots on my back before, but not anymore. I used to be ill and have colds every several weeks, but no more! It is incredible to feel great and who would have guessed that the path to healthy life was bacon! I know the Primal lifestyle works because when I occasionally decide to have something with wheat in it if I am on a holiday, all the problems come back even after one bad meal. I am happy I listened to my sister and now we both experience the advantages of gluten and grain-free eating. I do not miss anything and in fact I don’t even crave or like these products anymore – bread, pastry, cakes, they all taste bad now, unless I have made them myself at home using real, good products.

I have lived in UK for 5 years now and I have realized that many people have similar problems, but they either don’t know what to do about them or are just scared to change their whole life. I have a close friend who had problems with hair loss and constant hunger. After months and months of me telling her to try the Primal way she agreed, and now her hair is perfect. She doesn’t feel hunger and she feels happier and better than ever before. This is why I created a Primal website for the UK – Primal Yum (Facebook). I want to show people that food can be great and even much better when artificial ingredients and grains are omitted. Life can be good and we can be healthy. Why would you willingly choose to be ill?

Rositsa

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Harnessing the Power of Self-Identity

So often we talk about how to get beyond the limiting, even destructive identities we create for ourselves or have been imposed on us in our lives. The fact is, no one should feel beholden to a definition that hampers their self-actualization or undercuts their physical or emotional well-being. That said, what if we examined the flip side of this equation? We often assume a fixed identity is something that works against our greater good, but what if – under the right circumstances – it can be a positive, grounding influence that helps circumscribe our daily decisions in a healthy way? Consider reader Steve’s thought-provoking comment on a post from this past summer regarding “The Uses and Abuses of Guilt”:

As for guilt/shame, I feel them whenever I act (eat) in a way that is not consistent with my identity as a person. Goals may come and go, so I don’t use goals as a motivator, but identity is a constant. Along this line, I know we all have the freedom of choice, but for me, I choose to live as though I have ‘no choices,’ meaning my identity determines actions, and decisions almost make themselves.

While he later suggests this approach isn’t for everyone, I think he’s onto something here. Can we harness the powerful psychological sway of self-identity to train our own behavior toward healthy living?

The Power of Identity

I’ve been thinking a lot lately about the psychology of living well. Why does it seem to come fairly easily to some, while others continually struggle? While I believe we’re creatures of free will (at least in the colloquial sense), the consciousness that gets us there isn’t usually automatic. We have whole evolutionary schema to consider as well as decades of personal scripts that subtly steer our actions and reactions. This said, the more conscious we are of their influences, the more critically aware we can be of their role in our thinking – for better or for worse. Likewise, we make room to consider other information and cultivate the ability to more evenly weigh various perspectives. In other words, we consciously choose what we want to direct our decisions in any given situation.

Self-identity is perhaps the most formidable or at least confounding of these influences. Our basic animal natures might be the most inherently entrenched, but they’re relatively simple. When we have the humility to acknowledge them, we understand that they’re fairly straightforward. Self-identity, however, is richly layered, often unconsciously complex. And it’s much more powerful than we tend to give it credit for. How we identify ourselves (including those characteristics others perceive or impose that we accept into our self-definition consciously or unconsciously) can influence our assumptions about everything from our intelligence to our mental stability, our athletic ability to our general health and well-being. If we don’t identify ourselves as athletic, how likely is it that we’ll pursue athletic abilities on any level? If we accept that we’re sickly, how likely is it that we’ll ever believe we can truly thrive? If we believe that we don’t have much self-discipline, in how many areas of our lives will this “truth” play out?

Harnessing Self-Identity

Yet, as Steve suggests, we can take advantage of our own assumptions when the self-identity we’re working with supports good choices. If our self-identity was defined in such a way that we gravitated toward the things we wanted anyway, wouldn’t it free up an immense amount of mental energy and emotional bandwidth? We could, as he suggests, let our identity home in on what felt right or “true” to ourselves.

The power to harness here is our natural affinity toward congruence. We want our experience to match our assumptions – about the world and ourselves. In fact, we’ll often go to great lengths to unconsciously manipulate behavior or deny certain data in order to attain that secure sense of congruence. We crave certainty after all – confirmation that what we believe is true. We see it in the context of large groups, but it operates much the same in the space of our individual minds.

Some of us may be totally dumbfounded at the thought of someone losing 100 pounds but putting it back on because – perhaps at least in part – the new image in the mirror was too foreign to mentally assimilate. We may scratch our heads (or bang them against a wall) wondering why a smart person who knows better continually chooses the wrong relationships or unhealthy lifestyle options. Somewhere in their minds, there’s a pattern to fit, and come hell or high water something in their brain is going to make the pieces fit.

The yearning for congruence can be a neurotic, self-sabotaging undercurrent in our lives or a healthily gratifying, simplifying well-spring. If our self-concept, for example, includes a “sensitivity” to sugar, caffeine and artificial ingredients, we’re more likely to steer away from them. If we conceive of ourselves as an avid meat eater, guess what we’ll make sure we seek out at the buffet? If we believe we can’t live without movement or the outdoors, we’ll make time for them. If we’re convinced we’ve always loved sleep and need nine luxurious hours of it every night, you can imagine we’ll prioritize it.

There’s an enormous difference between reading that the human body functions optimally on an average of 8-9 hours of sleep and personally believing to the core of your identity that you need and love it. You might learn in middle school health class that 2-3 servings of meat the size of a deck of playing cards will give you adequate protein, but that can’t match the influence of your own individual identification with craving meat at each meal. Likewise, if your parents referred to you as the family’s veggie lover who always finished off whatever was on your plate and the serving bowl, this will likely stick with you as you grow older. In short, it’s the colossal distinction between “I should” and “I am.”

Revising Self-Identity

All of this raises the natural question, “What if my self-identity isn’t something that serves my good?” In other words, what if our self-identities are more likely to dictate eating too much sugar or working out when it’s convenient? Obviously, we can’t trade it in, but can we retool it? The answer appears to be yes. In the words of psychologist Mihaly Csikszentmihalyi, “The self is a fragile construction of the mind.” A recent Atlantic article, “Personal Identity Is (Mostly) Performance” quoted Csikszentmihalyi to support the idea that our outer environments must continually support existing identity constructs. Without them, the old assumptions and associations can lose their potency.

This is good news for those of us who could use a revamping. The more we rid our lives of the details and reminders that bolster what we want to let go of, the better able we are to make space for something new and healthier. That can mean clearing out our cupboards, switching out our cookbooks, changing our daily routines and shopping sources, socializing differently, overhauling our wardrobes, and revising our calendars. In other words, transform as many relevant externals as possible (giving special attention to the ones that have the most impact) and let the effects seep inward over time. Fake it ’til you make it.

Simultaneously, however, we can rewrite the internal summaries that define us. I truly mean that literally. Take the time to rewrite your identity with pen and paper (or keyboard). Do something visual in addition. This is who you are. Put up reminders all over the place – your car visor, your bathroom mirror, you sock drawer, your cubicle wall, your refrigerator, etc. The object isn’t to become someone else entirely. It’s to reframe those touchstones of self-identification and broaden the scope of your life to include possibilities you’ve never allowed yourself to consider even if there’s ample evidence that they fit the life you want.

If you struggle to re-envision a different identity other than a self-destructive one you’ve struggled against in the past, let me throw in a modest proposal here. Over the years and the course of several books, I’ve been intrigued by the resilience of the Primal/Grok model. When I first proposed it, I’ll admit I envisioned it as a convenient visual, a narrative centerpiece for the blog and a bit of entertainment. That said, regarding the primal side of my human heritage has entered my consciousness and identity in a unique way. There’s something to believing in an inherently health-seeking, richly intuitive dimension of yourself that’s in touch with the most basic rhythms of life. Anyone who knows me understands I live a very modern existence, but the Primal metaphor genuinely expanded my understanding of what I need to do to thrive in life. It’s also helped upend some lingering ambivalence at unexpected turns my life took from the original vision I had for it a few decades ago. I see myself and my life in a very different light as a result.

In a sense, the Primal narrative – understanding our evolutionary legacy as it lives within our genes – is an additional dimension to embrace in our identities that reaffirms physical needs and psychic layers the modern culture often tells us are expendable (e.g. time in nature, a deep more than broad social network, continual movement throughout the day, etc.) and offers physiological reasons why we may have struggled against physical ailments – a realization which may supplant old emotional messages that have distorted our self-identities. Whether or not the Primal message informs our identities, we gain from opening to the possibility of larger, deeper and older influences in our potential. In their light, we may have a different view of our own personal stories.

Thanks for reading, everyone. Let me know your thoughts on the role of self-identity and behavior.

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Are Bodyweight Exercises Alone Enough?

In my Primal Blueprint Fitness eBook, I promote a bodyweight training program. Though it can be modified with weight vests, at its core it is comprised entirely of exercises that use your own bodyweight as resistance – pushups, pullups, planks, rows, squats, and sprints. For the majority of people who try it, it works great because PBF is a basic program designed to appeal to people from every fitness background. People who’ve never lifted a weight in their lives can jump right in with the beginning progressions, move on up through the more difficult variants, and get quite fit in the process. It’s not the end all, be all of training – and I make that pretty clear in the eBook – but it’s a foundation for solid, all around fitness. Some choose to move beyond it or incorporate weighted movements, some are content.

Still, some people are skeptical about the efficacy of a bodyweight training program. Is it truly enough, or just “good enough”? Can you really get big and strong without slinging heavy weights around?

It depends on what you mean by “enough,” of course, but the answer is generally “yes.” Bodyweight training is a legitimate option for anyone interested in building an impressive physique, increasing their strength, improving their athletic performance, mobility, and flexibility, and establishing excellent mind-body-space awareness. Plus, the ability to bust out some ridiculous moves on the pullup bars at the local park has to count for something.

Don’t take my word for it, though. Check out some of the people getting and staying very, very strong using primarily bodyweight exercises:

Al Kavadlo

Beastskills

Gymnastics Bodies

Eat Move Improve

Hannibal

So yes, a smart bodyweight program can rival the best barbell training, but that doesn’t mean it’s easy. These guys aren’t just mindlessly doing progressively greater numbers of pushups, pullups, and air squats. If you want to get as strong as possible, just doing more reps won’t cut it. You need intelligent progression.

Progression isn’t just adding reps. Eventually, you have to make the exercises harder to keep getting stronger, either by adding weight, increasing the degree of stabilization required, or decreasing the amount of leverage you have. Normal dips too easy? Move onto ring dips, and then weighted ring dips. Doing twenty pullups in a row without much issue? Try wearing a weight vest or work your way toward a one arm pullup. Bodyweight rows with your feet up on blocks a cinch? Try taking one foot off, then both, then trying front levers.

And that’s part of the reason why most people opt for barbells over bodyweight training: it’s easier and far less humbling to add weights to a bar than remove leverage from a bodyweight movement. In many cases, to progress in bodyweight means learning an entirely new movement from scratch. Starting over from zero. It’s harder to quantify than weight training and easier to get stuck.

But that doesn’t mean it’s not effective. In fact, the degree of difficulty required to perform some of the more intermediate and advanced bodyweight exercises implies their effectiveness.

What kind of exercises qualify as “bodyweight training”?

There are three primary categories, and the most successful people draw on exercises from all three.

Calisthenics are the basic bodyweight exercises like pullups, pushups, squats, jumping jacks, lunges, dips, planks, and rows. They have the broadest appeal, attracting elderly Chinese ladies wearing windbreakers and impossibly muscled guys wearing jeans and Jordans.

Plyometrics consist of explosive bodyweight exercises, like depth jumps, box jumps, broad jumps, jump squats, Russian lunges, burpees, and jumping pushups.

Gymnastics describes the highly technical movements those amazingly compact, muscular people perform during every summer Olympics. Most people probably won’t ever reach that level, but they can still get really strong using the rings to work on the earlier progressions that precede the expert-level movements, like levers, planches, muscle-ups, rows, pullups, and dips.

How does bodyweight training measure up to weight training?

There’s not a ton of research, but it seemed to fare well in the one study I found. Athletes were placed on one of three training programs: traditional resistance training, “complex training” (an undulating mix of high and low intensity weight training), or plyometrics training. By the end of the study, all groups had experienced identical gains in back squat, Romanian deadlift, and calf raise strength.

There may be little research directly comparing bodyweight training to barbell training or other forms of strength and conditioning, but my intent is not to claim one is better than the other. They’re all different, and they’re all effective. We do have research showing the beneficial effects of bodyweight exercises on the same types of performance markers we traditionally target with weight training, however, and there may even be a few unique effects.

Bodyweight exercises require activation of more muscles.

Bodyweight exercises are closed kinetic chain movements; rather than moving an object toward or away from your body, you are moving your body toward or away from the ground. This requires cooperation between all the muscles that form the kinetic chain and provides an arguably more complete stimulus of the musculature. For instance, in a bench press, your core is supported by the bench; in a pushup, your core is supported by the core musculature.

Bodyweight exercises develop proprioceptive awareness.

Bodyweight training refers to moving your body through space, and this movement provides additional feedback to your body and brain when compared to lifting a weight with your arms. Neuromuscular activation is highest during exercises that move the body.

Bodyweight exercises can’t be replicated by weight training.

Many people avoid bodyweight exercises because they can’t figure out how to replicate some of their favorite barbell exercises, like overhead press (try handstand pushups), bench press (try ring pushups), or barbell rows (try tuck front lever rows), but what about the inability of barbell exercises to replace many bodyweight movements? You can’t replicate swinging on monkey bars, climbing a rope, doing a muscle-up, crawling on your hands, or performing an L-sit with weights, just to name a few. Even the weight training exercises that seem to replicate bodyweight exercises have different effects; compare your lat pulldown machine performance with your deadhang pullup performance for a perfect example.

A recent review spanning several decades of research summed up the effects of lower body plyometrics training on neuromuscular, performance, and health adaptations in healthy people:

Increased neuromuscular activation.
Increased strength and power.
Faster stretch-shortening cycle of muscles, leading to improved performance.
Improved coordination between muscles involved in the movements.
Enhancement of general athletic capability, including jumping, sprinting, agility, and endurance.
Reduced risk of lower body injuries in susceptible populations.
Increased bone mass.

The one area where bodyweight training probably falls short is the lower body. For the most part, our legs and glutes are just way too strong to reach their full potential through air squats – and most bodyweight proponents will agree. However, a program consisting of plyometrics (jumping lunges/squats, broad jumps, depth jumps), single leg squats, and sprinting, especially hill sprints, can produce a strong lower body. You may not get the same degree of hypertrophy without adding weights to your lower body work, but you can certainly get stronger.

Am I suggesting that everyone ditch the weights, cancel the gym membership, and invest in a set of Perfect Pushups? No. The two can coexist quite happily. In fact, if I’m designing the optimal program for strength and mass, I’m going with a fusion of bodyweight training (gymnastics, ring work, pullups, dips) for the upper body and weight training (lunges, squats, deadlifts) for the lower body.

My point is simple. If you have no access to quality gym equipment, if you live next door to a park with an awesome outdoor workout station, if you hate weight training, if you fear weight training, or even if just prefer bodyweight exercises, fear not: you can build an awesome body and get incredibly strong by emphasizing bodyweight training.

What about you? Do you prefer bodyweight exercises to weight training? What kind of results have you seen doing one or the other?

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Cholesterol, Culture, and Being Flexible!

This is a guest post from Dr. Ronesh Sinha (aka Dr. Ron). Dr. Ron is an internal medicine physician in Northern California. He specializes in helping patients from diverse ethnic backgrounds reduce heart disease risk factors through lifestyle changes. I’ve recently published Dr. Ron’s book The South Asian Health Solution . You can learn all about the book and the special offer that ends tomorrow here. Enter Dr. Ron…

I started off about a decade ago with an internal medicine practice in the heart of Silicon Valley. I learned from medical training that a typical heart attack patient is an overweight, old white guy who smokes and eats red meat. That would have been incredibly useful if I was put in a time capsule and sent back to the 1950s to practice medicine in the heart of Framingham, Massachusetts, which is where the outdated guidelines originate from. I was flooded with sedentary, mostly non-smoking, non-white, non-obese and often vegetarian patients who looked nothing like those case studies from medical training. Back then they were getting employer-based health screenings that only drew their total cholesterol level. Most of them had a total cholesterol of less than 200 and if these screenings happened to check LDL levels they often looked “good” also. These individuals were patted on their back, told they were doing great, and sent home. However, these same patients, mostly Asian Indian, were developing rampant diabetes and heart disease. One of my first heart attack cases was a 32-year-old, non-smoking Indian vegetarian. I started seeing similar cases and as I delved through the research back in those early days, I discovered that Asian Indians had one of the highest incidences of heart disease in the world. The part that puzzled me was when I looked at their cholesterol through my medically trained Framingham lens, their cholesterol numbers continued to look pretty normal…or so I thought! I went to big companies and lectured about cholesterol and feverishly preached the virtues of a low-fat, high fiber diet, one that I also practiced. However, something started happening. I never reached an overweight BMI, but my waistline did start expanding a bit and as I started checking my own numbers I noticed that my total cholesterol and LDL looked really “good,” but the other numbers on my cholesterol panel didn’t. Let’s take a look at my lipid timeline:

Look at my numbers from 7/2009. Total cholesterol of 154 mg/dL and an LDL cholesterol of 85 mg/dL. These are numbers that would make most conventionally trained physicians proud. Unfortunately, the majority of physicians ignore a far more important number, the Triglyceride-to-HDL (TG/HDL) ratio, a marker for insulin resistance, which you can see was a whopping 11.2 back then. I had developed metabolic syndrome, the dreaded insulin resistant condition that significantly increases heart attack and stroke risk. The goal is to get the TG/HDL ratio below 3.0 and the lower the better. I did do an LDL size profile as you can see from the results and it showed that I was carrying the more ominous, small dense pattern B LDL. Not necessarily ominous because of its size, but because pattern B is usually (not always) associated with greater LDL particle numbers, the real lipid risk marker for atherosclerotic plaque.

Now, as I transitioned to a more ancestrally-aligned lifestyle thanks to Mark’s Daily Apple, notice how my good cholesterol (HDL) goes up 19 points to 47, my triglycerides drop to 74 and my ratio drops to 1.6. To achieve this type of progress from the knowledge I gained from medical training I’d be taking enough of the prescription drug Niacin to make me flush and possibly raise my blood glucose, while throwing down a ton of fish oil capsules and still my results would not be as impressive. However, Dr. Framingham (not an actual doctor, but one who rigidly adheres to Framingham dogma) would cast a disapproving stare, pointing out that my total cholesterol went up 30 points to 184 and that the all-important LDL jumped 37 points. Surely that was due to all those artery-clogging egg yolks I was eating, right? Stop the eggs and here’s some Lipitor! However, notice that my LDL particle size transitioned to type A and if I had checked my LDL particle numbers back then, they would have gone down. If I’ve lost you on any of this, I use illustrations and my “6 Cholesterol Rules” in the cholesterol chapter of The South Asian Health Solution so patients and doctors clearly understand how to interpret lipid panels and when to order advanced lipid tests. In an ideal world all doctors would replace the currently outdated lipid test with an advanced test like the NMR LipoProfile, but it is still possible to make some pretty accurate risk assessments when you follow my cholesterol rules. If doctors wonder if this information is up to date, I also incorporate the 2013 cholesterol guidelines which in many ways actually supports this approach. I did a blog post on the new guidelines here. Just remember that in most cases when you reverse insulin resistance by improving your TG/HDL ratio your total cholesterol may go up thanks to a rise in your healthy HDL cholesterol and your LDL may go up too thanks to a shift from LDL subtype B to A, which means you have fewer large particles carrying more cholesterol. This phenomenon commonly elevates the LDL level on a standard lipid panel (aka “LDL-C”). I actually tell my patients and referring doctors in advance to expect a “healthy rise” in these numbers as we reduce their risk and improve their overall health. By the way, the good news is I have several doctors who refer patients to me and they are understanding and fully endorsing this approach after watching their patients reverse insulin resistance, shed excess body fat and often get off their drugs. I work in a group of over a thousand doctors and I also work with major health insurance plans who are starting to acknowledge that the current regimented, government-endorsed guidelines are failing miserably. I even have a growing panel of physicians, among whom obesity and insulin resistance are becoming a major problem, who have now become my patients since the very system they are working in is failing to give them effective risk-reducing lifestyle solutions. There’s a ton of work left to do, but I’m happy to see that there is a groundswell taking place within the medical community.

Now I want to make an important point here. I discussed how Dr. Framingham and my past self overly prescribed to regimented, outdated guidelines. When I made the transition to my current lifestyle I must admit that even my prescription of ancestral practices was initially over regimented. Although this was effective for some patients, for others it created more stress. As much as people say this way of eating is “easy,” it ain’t that easy for individuals like vegetarian Indians who come from cultures where legumes, flatbreads and rice are core staples. We also have to be careful using words like “safe starch” for rice. Yes, rice in moderation and timed appropriately can be a “safe starch” for someone who is or becomes insulin sensitive and metabolically flexible, but not for someone who is highly insulin resistant. I recently had a Chinese Google engineer come see me with advanced metabolic syndrome, telling me after his highly selective online research that he is continuing to pound large amounts of rice since it’s considered “safe.” I told him it’s not safe now, but we may be able to make it safe if he follows my plan.

Fortunately, plenty of my vegetarian Indians have been able to hang onto some of their legumes and controlled portions of rice and do just fine. I thank Mark and the Primal Blueprint Publishing team for allowing me to include this vital information in my book for vegetarians so they don’t feel excluded from this potentially life-saving approach due to rigid rules. Mark has been at the forefront of making this movement inclusive and flexible so all people can benefit, regardless of their level of motivation, instead of adopting an extreme mantra like “ditch the grains or die!” Forcing individuals to completely eliminate foods they consider integral to their culture only increases stress and possibly inflammation like this guy:

Notice how when his TG/HDL ratio was “optimal” in July 2013 at 1.8, his hsCRP was 3.6, slightly above the upper limit of 3.0. Yes he was satisfied, but not completely happy with his initial eating plan so I let him add back in some more legumes and rice. Unlike the Chinese Google engineer, this patient earned back his metabolic right to have some of these grains after he achieved insulin sensitivity through ancestral-aligned lifestyle changes. His TG/HDL ratio did go up a bit in October to 3.1, but notice how his hsCRP, a blood test marker for inflammation, dropped to an optimal level of 0.6. The hsCRP is a part of the “Metabolic 6-pack” tests I discuss in the book, which is a modification of the metabolic syndrome criteria. So this patient had a lower inflammation (hsCRP) despite his TG/HDL ratio being a touch higher, and as most of you already know, inflammation is the real underlying culprit for heart disease, chronic disease and premature aging. I see this pattern frequently enough to assume that making a diet too restrictive to adhere to rigid guidelines may be doing more harm than good. It’s not always elicited by checking a simple blood test like the hsCRP. Often you need to sit back and ask yourself if this way of living is making you happy? If the answer is a resounding no, you need to re-evaluate your choices and loosen the reins a bit. I initially may have gone from being “Dr. Rigid Framingham” to “Dr. Rigid Paleo,” but am now backing off if I sense that patients are persistently overwhelmed by my prescribed lifestyle plan. If you are killing yourself trying to achieve single digit body fat or a personal best in some endurance event, or if living in ketosis is not truly effortless due to other life obstacles or cultural constraints, you may need to back off and find a path that works and feels better for you. Stress and sleep trump everything and I focus on these in detail in my book, including devices and apps pulled from my TED talk and corporate wellness programs that have really helped struggling individuals achieve better life balance. Mark wrote up in a recent post that studies show the best exercise is the one you enjoy. This same philosophy can be applied to your diet and overall lifestyle plan. Fortunately there are a plethora of options with this style of living that can allow you to optimize health while maximizing enjoyment.

I want to end by saying thank you to Mark and the Primal team for publishing this book, and to the whole MDA community who helped guide me towards the right answers and have also served as a support community for my patients.

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Dear Mark: Is a High Protein Diet Really As Bad for You As Smoking?

It’s about that time, boys and girls. A new “protein kills” study has arrived to throw you into the pit of existential angst and self-doubt you recently managed to crawl out of from the last one. As you may know, I’ve just spent a week in Tulum, Mexico for PrimalCon (which was amazing, by the way, absolutely fantastic) where I managed to avoid most contact with my inbox. Oh, I took a couple glimpses here and there, enough to notice an endless stream of frenzied email subject lines, but I didn’t read the contents until the flight home. I still knew what was coming.

I finally have a little time to dig into this paper (which actually covers two studies) to see if there’s anything we can learn. Let’s jump right in…

Mark,

A co-worker informed me of a news clip she’d heard regarding an increased cancer risk for those who stick to a high animal protein-based diet. She said that smoking cigarettes is healthier than eating high fat/high protein diet. My first reaction was to chuckle (just another CW media attack against Paleo/Primal) and I did once I read the actual piece in Forbes. I wanted to get your thoughts on it as a lot of the article’s evidence once again seems inconclusive. Seems like there are a lot of caveats.

Emily

Right off the bat, we can read the paper and see an important part that the journalists conveniently left out:

Conversely, high protein intake was associated with reduced cancer and overall mortality in respondents over 65, but a 5-fold increase in diabetes mortality across all ages.

and:

Using Cox Proportional Hazard models, we found that high and moderate protein consumption were positively associated with diabetes-related mortality, but not associated with all-cause, CVD, or cancer mortality when subjects at all the ages above 50 were considered.

Huh. From age 50-65, protein modestly increases mortality, especially cancer- and diabetes-related mortality. In ages 50+, though, a high protein intake has no association with all-cause mortality (the most important endpoint), while in ages 65+, high protein is downright protective. The only consistent positive association across all ages is with diabetes mortality. How can this be?

It’s well known that seniors are less efficient at utilizing protein than younger people. Muscle protein synthesis is slightly impaired in the elderly, for example. As such, they need to eat more of it to get the same benefits as the rest of the population. It may be that they also have a higher upper threshold for protein until harm ensues – a higher “protein ceiling.”

Other populations also have higher ceilings. Runners, cyclists, dancers, swimmers, weight lifters (especially weight lifters) all need more protein than the sedentary, just like the seniors. Unfortunately, the authors did not control for exercise. Too bad, because it probably would have modified the relationship between protein intake and mortality in the other age groups.

I think if anything can be taken from this study, it’s that you should only eat as much protein as you require. We likely all have “safe protein ceilings” depending on various factors, like age and activity level. The ceiling is higher the older and more active you are.

Since the connection between diabetes-related mortality and protein persisted even among the older crowd, let’s look at that a little further. Does other research agree that protein is bad for diabetics?

Well, in the most recent meta-analysis dealing with diet and diabetes, researchers concluded that “low-carbohydrate, low-GI, Mediterranean, and high-protein diets are effective in improving various markers of cardiovascular risk in people with diabetes and should be considered in the overall strategy of diabetes management.” They looked at both epidemiology and clinical trials to reach that conclusion, so it’s not clear how protein is increasing diabetes mortality in the current study if the relationship is causal.

I’m not suggesting that you eat all the protein you want as long as you’re exercising or elderly. I’ve even softened my “high-protein” leanings over the years, advocating instead for a more moderate approach. One gram protein per pound of lean tissue is plenty for most active people, and many can get by on half that.

The Mouse Study

Okay, that’s one part of the paper. There was also a study that found both breast cancer and melanoma tumors grew more slowly in mice on a 4-7% protein diet than mice on an 18% protein diet. High protein mice also had higher levels of IGF-1, a growth promoter, and the rate of tumor growth was associated with the amount of IGF-1 secreted. The protein was entirely casein, with a touch of added methionine.

When I saw that they used casein, it reminded me of something from Chris Masterjohn’s analysis of the T. Colin Campbell casein/cancer studies. While high intakes of casein promoted the growth of existing tumors in those rodents, it was also protective against the mutagens that cause the initial appearance of tumors. Protein was protective against cancer until they had it, at which point it accelerated the cancer’s progression. Rodents on the low protein diet were more susceptible to getting cancer after aflatoxin exposure. Once the rodents already had cancer, low protein was protective against further growth.

Does this phenomenon apply to the most recent study? Impossible to tell. The mice were directly injected with melanoma and breast cancer cells, not exposed to a cancer-causing toxin or exposed to high levels of UV radiation. This usually isn’t how cancer develops in the real world, unless we’re talking about mistakenly receiving a cancerous organ transplant. We tend to develop cancer in response to mutagens in the environment.

That said, we can’t discount the results entirely. Getting your protein only from casein is unwise (and unfeasible when eating whole foods). Methionine (an amino acid common in muscle meat which does increase IGF-1) probably should be balanced with glycine (an amino acid common in connective tissue and gelatinous cuts of meat). I think glycine is especially important for a few reasons:

Glycine reduces the toxicity of a high-methionine diet in rats.
Glycine is essential for the activation of a tumor-suppressing gene active against breast cancer.
Glycine supplementation even mimics the life extending properties of methionine restriction.

Realize that the Primal eating plan doesn’t prescribe “eating lots of meat.” Instead, we “eat animals,” and animals have bones and gristle and organs and tendons and loins and ribs and shoulders and all kinds of edible bits and pieces with extremely varying amino acid profiles. Over the years, I’ve been emphasizing these “alternative” cuts more and more. The folks profiled in the study’s data sets probably weren’t eating whole animals. The mice definitely weren’t. We largely just eat meat, and I think that should probably change if we want to maintain optimal health and avoid some of the diseases the epidemiology keeps pointing at.

There are also untoward effects of ultra-low protein intakes to consider. While this paper was only concerned with the cancer endpoint, free-living, free-thinking, autonomous humans with hopes, desires, aspirations, and goals aren’t only worried about cancer. We’d certainly prefer not to have cancer, but what if the narrow pursuit of the ultimate anti-carcinogenic diet has unpleasant side effects that affect the enjoyment of our lives?

Consider that low protein diets:

Slow the metabolism, increase insulin resistance, and cause body fat gain.
Impair the immune system and make infections more severe.
Reduce muscle function, cellular mass (yes, the actual mass of the cell itself), and immune response in elderly women.
Impair nitrogen balance in athletes.
Increase the risk of osteoporosis.
Increase the risk of sarcopenia (muscle wasting).

In other words, starving yourself of protein (the mice in the study achieved the protective effects by eating just 4-7% of calories as protein, which qualifies as protein starvation in most books) may reduce tumor growth, but it might make you fatter and weaker, give you brittle bones, prevent you from taking care of yourself in the later years, and make you more susceptible to illness. Oh, and it may even make you more vulnerable to initially getting cancer (if the Campbell casein studies are applicable to people). But that’s all worth it if once you have cancer the tumors grow slightly more slowly, right?

Even IGF-1 isn’t evil. It promotes growth across the board – in muscles and in tumors. Tumors suck, but not everyone has tumors. Everyone does have muscles. IGF-1 secretion also promotes neural growth and resistance to neurological degeneration. In a study mentioned in yesterday’s Weekend Link Love, elderly women improved muscular and cognitive function by eating a diet high in protein derived from red meat and lifting heavy things. Another study found that increased IGF-1 was linked to improved memory and vigor in both middle-aged and elderly subjects. I don’t know about you, but “living long and dropping dead” is all about vigor for me.

Think about it. Vigor. Sure, it’s not exactly a traditional health biomarker, but who’s got it? What kind of older people display vigor?

The sassy centenarian who eats bacon for breakfast every single day.

The old guy with the vice-grip for a handshake.

That old dude surfing with all the guys a third his age.

The 85 year-old great grandmother who shoulders past you at the farmer’s market to get the best leeks.

The old lady who beats you at raquetball.

I will take vigor every single time even if it modestly increases the speed of tumor growth on the off chance I get cancer. That’s just me, though.

Summing Up

As I see it, there are some potential takeaways, keeping in mind that half the paper was based on epidemiology:

Don’t eat more protein than you actually need. Get extra calories from fat and, if activity warrants it, carbs.

Eat the whole animal. Don’t just eat muscle meat, but also bones, ligaments, shanks, cartilage, tails, and organs. Supplementary gelatin is a good idea if you don’t eat the aforementioned foods.

Don’t eat a diet of casein, methionine, soybean oil, corn starch, and sucrose, especially if you have cancer.

And some questions:

High IGF-1 levels are linked to bad things like cancer, but also good things like strong muscles and a sharp mind. How do we balance the two?

Were processed meat and fresh meat lumped together? Is pepperoni pizza “meat”?

What about people younger than 50? They weren’t addressed at all.

How valid is the dietary data? It was gathered by calling people on the phone and asking them what they’d eaten the previous day and whether that was typical of their normal diet. Seems awfully unreliable and prone to human error.

That’s my take. There are many others out there, but this is mine. What do you think?

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