Sunday, June 19, 2011

Gathering Wild Grains

From the book Lost Crops of Africa:  Volume 1: Grains published by the National Academies Press:

"Over large areas of Africa people once obtained their basic subsistence from wild grasses. In certain places the practice still continues—especially in drought years (see boxes, pages 258 and 264). One survey records more than 60 grass species known to be sources of food grains.2
Despite their widespread use and notable value for saving lives during times of distress, these wild cereals have been largely overlooked by both food scientists and plant scientists. They have been written off as ''obsolete"—doomed since hunting and gathering started giving way to agriculture thousands of years ago. Certainly there has been little or no thought of developing wild grains as modern foods.
This deserves reconsideration, however. Gathering grains from grasslands is among the most sustainable organized food production systems in the world. It was common in the Stone Age3 and has been important almost ever since, especially in Africa's drylands. For millennia people living in and about the Sahara, for instance, gathered grass seeds on a grand scale. And they continued to do so until quite recently. Early this century they were still harvesting not insignificant amounts of their food from native grasslands.
However, in previous centuries the grains of the deserts and savannas were harvested in enormous quantities. In the Sahel and Sahara, for example, a single household might collect a thousand kilos during the harvest season.4 The seeds were piled in warehouses by the ton and shipped out of the region by the caravan-load. It was a major enterprise and a substantial export from an area that now has no equivalent and is often destitute."
If possible in relatively recent centuries, why not during the stone age?

By the way, in prehistoric sites the evidence points to consumption of sorghum, a gluten-free grain, at about 100,000 years before present

If so, then what about leading up to that?  Evolutionary explanations generally involve gradual changes over long periods of time.  A species generally does not change its means of subsistence suddenly, or even over a few millennia.   Adaptation to a new niche (if truly new) generally takes a very long time.

The hypothesis that grains were hardly ever consumed before about ten thousand years ago suffers from lacking a plausible explanation for why and how a species never adapted or even interested in cereal grains would so suddenly (on an evolutionary time scale) adopt a totally new behavior and means of subsistence.

Supposedly gathering grains would be a poor time investment for a forager.  Put to the experimental test, this turns out to be untrue.  From Kislev et al, "Impetus for sowing and the beginning of agriculture: Ground collecting of wild cereals" [1 full text]:

"We found that hand gathering of wild barley and emmer spikelets from the ground in Korazim and Mount of Beatitudes (Israel) is simple and efficient. About 0.25–0.5 kg (0.337 kg on the average) of pure grain could be gathered per hour by a single person, which provides on the average between a half and a whole day of the nutritional requirements for an adult individual."
So, in one to two hours a forager could collect enough wild grain to feed himself for a day, just collecting it off the ground by the handful.  Eight hours of collecting could supply him with grain for a whole week.  A smart forager would quickly come up with ways to make the work easier and more efficient.  Kislev et al continue:

"Our results are in accordance with Harlan, who, after experimental hand stripping of pre-full-ripe ears of wild einkorn at Karacadag, southeast Turkey, claimed that in three weeks, a family group could gather more grain than it could possibly consume in an entire year (28)."
Three weeks investment for more food than you can eat in an entire year doesn't count as optimal foraging?  More from Kislev et al:

"The significance of recognizing the practicality of spikelet gathering from the ground is that the gathering of large-seeded cereals as a staple food is not restricted to early summer. Rather, it can continue throughout the summer into the autumn, July through October, when the first heavy rains arrive and the dispersed grains begin to sprout. In other words, the collecting of grains from the ground would supply hunter-gatherers with a ready source of vegetal food until October, when acorns, their second most important plant resource, matured (29). The availability of acorns in October enabled them to invest part of the harvested grains for sowing. Moreover, stored grains and acorns would have provided nourishment until the following summer. There would then have been no period of vegetal food shortage due to seasonality of the two major harvests that helped support human groups in Western Asia at least from the beginning of the Upper Palaeolithic."

Has the bubble burst yet?

Put this together with evidence that Paranthropus boisei, a human relative dating to 1.4 to 1.9 million years ago,  grazed on grass [2].  Paranthropus and humans both descended from Australopithecus, but the Paranthropus went extinct.  To several scientists working with this information, this new data on Paranthropus suggests a reinterpretation of previously collected data on Australopithecine diet, i.e. that Australopithecus may also have eaten grasses.

Perhaps we can start to put together a plausible path for the incorporation of cereal grains--grass seeds--into human diets.  Perhaps human ancestors used grasses as food more than 2 million years ago. Human evolution might look something like this: the grass-eaters went extinct, but the grass-seed eaters thrived.


Theo said...

When you really look at it, the research damning grains is pretty weak. Phytic acid is only detrimental in large quantities and easily dealt with. The various protein toxins appear to be readily dealt with by people with good digestive capacities. Remember that all plants (especially holy nuts) contain toxins just like grains. I'm not even convinced that gluten is bad unless you are sensitive. Add to that the number of incredibly healthy cultures observed by Weston A Price and Robert McCarrison thriving on grains and I think the evidence is unconvincing.

Theo said...

That being said, I also think that the evidence damning animal fat is pretty weak (even having read your recent posts). Why don't we all just eat real food and not get too extreme about anything?

Anonymous said...

Yeah, I never bought into the whole idea that primitive (pre-agricultural) people never consumed grains
(there's too much evidence that they did) - nor the idea that harvesting said grains was an inefficient use of resources. In fact I imagine that primitive man pretty much tried to eat anything he saw other critters eating. That said, I do think we've mucked things up in the modern age with the way we process grains and I don't think they're ideal for anyone with a wonky metabolism. Once that metabolism is *fixed* [ish] I don't have a serious issue with eating boiled rice or barley or even bread from hand-ground grains (if anyone has the patience for that). For my money our issues with gluten and peanuts and all the other Armageddon-come-lately allergens was probably self inflicted. The fact that it took us this long to develop them on such a grand scale implies that the issue is more likely with us than with the native ingredients.

Anonymous said...

ETA - by *hand ground grains* I don't necessarily man mortar and pestle so much as *freshly* ground grains (minimally processed and immediately used after grinding)

Ed said...

Interesting but also not interesting.

Surviving a famine is good. Doesn't mean you're in optimal health.

Curious about preparation measures. Curious about relative health, compared to other populations who perhaps ate less seeds and more not-seed. Curious about how widespread the seed-eating.

Exploitation of a new food source precedes adaptation. We have greater ability to digest starch, but no phytase. Do not conflate seeds with tubers despite similar high starch content.

I don't think it's in dispute that humans ate a wide variety of foods. This post offers lots of "could haves," not a lot of "did." What portion of diet was from seeds, in what order of preference, compared to other sources? I don't know, do you?

Don, perhaps you should try living a year on nothing but seeds, let us know how that goes :-)

If your point is not that seeds are optimal, but that they are legitimate potential food, shrug. I think they could serve as a staple, requiring very careful preparation and supplementation with animal products. You'd want pots, when were those invented? And, my guess is if you're raised from birth on such a diet, you're likely shorter and less physically robust. But I don't know that at all for a fact. Just my prejudices.

Asclepius said...

Kislev et al's experiment seems to be premised on a form of settled agriculture rather than foraging.

It seems to me that it was done under ideal conditions - ie there were no wild herbivores to compete for the grains in their experiment. How would this affect the dependability of the grains as a food source? Competition is a big game changer (unless you hunt the competition and eat it).

Michal said...

Nazis used grains to kill in a perverse way concentration camp prisoners they abandoned while escaping from approaching front. During the release the starving prisoners were given a pocket of grains and sent home. Many of them could not withstand the hunger and eaten the grains. Those people died. Those who didn't eat the grains survived.

Helen said...


"Why don't we all just eat real food and not get too extreme about anything?"

I kinda like that idea.


Did this have to do with grains specifically or with eating a tiny amount of food vs. none and how that would affect one's ability to adapt to starvation conditions? What if they'd had a tiny bit of cheese, raisins, candy, or jerky?

Does anyone know if it's a metabolic effect - ? Hopefully if there were other experiments on this phenomenon, they weren't done in this way.

nothing91 said...

LOL. Barely a year ago the guy who now eats more rice than anything else wrote this post:

Surely now we can trust you though.

Wonder what you'll be saying next year. :-)

Paul said...

What about all the toxins in the massive plant foods you consume?
Don, how much potatoes do you eat on average?

Anonymous said...


I agree!

It is okay when there is some sort of smooth transition (like for example Stephan) but a sudden U-turn was unexpected and came as a shock.

But anyways people are entitled to hold their own views. I visit this blog just to check out the interesting to and fro discussions.

R. K. said...

I wonder if you can explore the following, for I have been puzzled about it for years, ever since reading the passage in the book 'Master of Five Excellences'. (The book is about Professor Cheng Man-ch'ing.)

On page 115,

"For the past five thousand years, Chinese have believed that ch'i from grains is the best nutrition -- few truly understand this."

The book can be searched at Amazon for those who want to see the surrounding text.

noah said...

Grain-free, dairy-free, low Omega 6s, no added sugars. This diet has given me vibrant health and reversed some early degenerative joint issues. It wasn't until the grains were eliminated that I really achieved the superior results.

Josh Day said...

Grains. Nazis. Wow.

The idiotic, emotional comments are fascinating. For a second I thought I was on a vegan blog where the blogger had a paradigm shift and was simply sharing the truth as he perceived it through his own experiences and interpretations of research, and the radical crazy vegans brought out the pitch forks and torches when their comfortable dogma disappeared. Then I remembered it's paleo, but, oh shit, same results after all.

Anyway... Science! Sieg Heil!

In all seriousness, Don, I salute you for your honesty and courage. Personally I disagree with a number of your revelations, but at the end of the day it doesn't really matter because we all make our own decisions about our health and dietary lifestyles... at least those of us who aren't mouth breathing trolls.

Your blog continues to be very well thought-out and interesting. I came kinda late in the game so I need to catch up a bit, but I have read your farewell to paleo post and was intrigued.

Unlike some "paleo" practioners, I attempt to keep my emotional baggage checked at the door.

Fordley Boy said...

"Has the bubble burst yet?" Well mine hasn’t.

My issue is not that you have changed so radically and so suddenly, it is the strength of feeling against your previous position. For me the science is uncertain, determined as much by ideology as observation. All we can do is try to draw our own conclusions using n=1, critical research and anecdata.

I was diagnosed with ankylosing spondylitis about 7 years ago. This presented itself as sacroiliac inflammation, a couple of bouts of iritis and the gradual insidious degeneration of my physical self. Not life threatening but enough to impact on all aspects of my life (limping, poor sleep, insanely swollen Achilles). A forward thinking rheumatologist called Erbinger identified gut problems, the probable overgrowth of klebsiella pneumoniae bacteria that was feeding on undigested starch. The bacteria exits the gut due to intestinal permeability and the body (over) reacts by attacking the klebsiella pneumoniae and healthy tissue in a process known as molecular mimicry. In short, the bacteria’s molecular structure is similar to our own tissues. Viola! Classic auto immune inflammation soon follows.

Why am I in remission? I eliminated all starch, dairy and sugar from my diet. I can now eat fruit, dark chocolate, drink a couple of unpastuerised beers and play football, run and exist at about 95% of capacities (if I strictly follow a GAPS diet I can get close to 100%). Thanks to and the paleo community I was able to refine my diet to my specific, individual needs. Initially, starch, sugar and dairy elimination wasn’t enough for me. My progress was slow until I used the paleolithic auto immune protocol (no nuts, seeds, greens, legumes and nightshades).

The moral of the story reminds me of Socrates’ derision of the unexamined life. We are each responsible for our own pursuit of truth although our discourses are intimately connected to those around us. As you examine your’s Don I will examine mine. Our paths will continue to cross. However, whatever evidence we unearth there is always a counter position as we search for this elusive truth. I won’t renounce my previous position of veganism or vilify its followers. If it works for them and they have “truth” good for them. In the meantime I will abstain from starches (grains) enjoy good health and offer road maps to family,friends and acquaintances as they examine their own lives.

Great blogs Don. I now disagree with many of your conclusions but I will continue to read, learn and think. Keep up the good work. But be careful about those sudden U-turns. Those who need to follow you can quickly get lost!

nothing91 said...

"So there you have my perspective on rice. I do not recommend regular consumption of either brown or white rice." --Don Matesz

"Kids absolutely will thrive if you feed them meat and fat and limit their sugar intake. Feed people dangerous grains and they will have a lot of health problems. This all follows from our ancestral hunter heritage." --Don Matesz

"To clarify a point, when I say that humans are specifically adapted to a primarily carnivorous diet, I mean this: In evolution, speciation results from to specialization in exploitation of a particular ecological niche... Human ancestors chose to exploit a very different ecological niche which exerted natural selection pressures that resulted in modern humans having bodies specialized for a largely carnivorous diet. Basically, they chose a habitat in which plant foods were scarce and animal foods – starting with insects, worms, etc. – were more abundant. --Don Matesz

"I don’t deny that we have the ability to consume plant foods. I only emphasize that whereas other primates have specialized in eating vegetation, humans have specialized in eating meat. We have specialized to the extent that we can live on meat alone, and doing so can improve our health." --Don Matesz

Thomas said...

@Fordley Boy-

Nice post (good to hear you are doing well with the AS) and you make a very important point. One commenter, on another thread, remarked that the body is a moving target and this is a good example of that. Pathology often requires a different approach and is often where special diets and supplements fit in.

I've heard others remark that these leaky gut problems may be more a result of medications (ex. NSAID) that tend to harm the gut. They are so commonly used, it makes sense. Who can be sure, though.

Txomin said...

I wonder. It is indeed possible to gather huge amounts of anything... if it is persistently placed right in front of you by nature or chance. I have never come across such a thing in the wild. But maybe it did exist once, why not.

praga said...

@ nothing91 June 20, 2011 1:06 PM, who wrote, "Wonder what you'll be saying next year. :-)"

"When the facts change, I change my mind. What do you do, sir?" Keynes

nothing91 said...


Cute quote but irrelevant to the discussion.

The "facts" haven't changed. They've been there all along. What has changed is Don's beliefs. And Don's beliefs at any given time determine which "facts" he focuses on.

When Don believed that a meat-based diet was the way to go, he found facts to back it up. Now that he believes a grain-based diet is superior, he is magically able to find facts to back this up as well.

But what happened to all the facts about the superiority of meat? Did they disappear? Nope, they're still there -- Don just chooses to now ignore them. Just like he ignored all this new-found evidence about grain-based diets until very recently.

Jim Sutton said...

The only grains that I noticed being mentioned were emmer and einkorn, both of which are genetically quite different from today's frankenwheat.

A quick search on those names will yield interesting information. Just sayin'...

Thomas said...

Wheat-phobia is overblown, with exceptions, and grains as a food source has probably saved countless more lives than it has killed. Grains, particularly wheat, may not be the best food (especially very processed grains), but it's still food-which is good enough for some people living on this planet. This "optimal" diet idea is creation of people who have more than enough resources. We are lucky to be so choosy.

Thomas said...

Facts? This is not about facts. It's about the interpretation of facts and how they fit into the bigger picture-a picture which we don't understand fully and which keeps changing. Those who think they have this nutrition thing all figured out are kidding themselves.

trix said...

"Why don't we all just eat real food and not get too extreme about anything?"

I agree. I used to be amazed at what you ate, Don...the photos and descriptions of your meals...all seemed to have a big portion of meat...two or three times a day. I knew I couldn't do that. You seem to have gone from one extreme to another.

Balance....instead of extremes...just eat real foods and have variety in our diets.

noah said...

@Josh Day
Either the "idiotic, emotional,mouth breathing troll" comments got deleted or you have a very low threshold for disagreement.

Nobody likes a brown-noser. And Sieg Heil? Really? You lose

Malena said...


Food is persistently placed right in front of us today as well, but we don't know what it looks like.

Check out on Youtube "Harvesting Wild Rice with Daniel Vitalis and Arthur Haines". They harvest huge amounts of wild rice in Maine, mid Sept, in just a few hours.

Don said...

Those of you who have never made a mistake in your life, keep throwing stones.

Those of you who have never thought they were on the right track, only later to find they were not, keep mocking me.

Those of you who have never gotten enthusiastic about a perspective, only to find its flaws later after damage done, keep ridiculing me.

Those of you who have never made a U-Turn upon realizing that although you were certain you were going the right way, you were actually going the wrong way, continue to attack me.

As for me, when I finally really saw what a meat-based diet was doing to my wife, and how it clicked with research ignored by the low-carb and paleo communities, and my own profession, I saw we were going the wrong way. I could no longer ignore or rationalize the worsening of my own health.

And, I could no longer rationalize the failure of a meat-based carb-controlled diet as a treatment protocol in my clinic.

I've seen the meat-based diet fail miserably for too many people, especially women, to take a "gradual" approach to changing my opinion.

A sudden U-Turn was the only appropriate response, just as if I suddenly realized that I was going north when I really needed to go south.

I will admit when I have made a mistake and correct my course regardless of what others think.

The problem I discovered in paleo, and I contributed to it, is this: There isn't much evidence that a meat-based diet is superior for any aspect of human health or performance, but we've (including me in the past) gotten very creative at creating the illusion that it is so.

I got skilled at attacking studies that suggest that a meat-based diet might not produce optimal health, but I couldn't really find much research to back the claim that a meat-based high fat diet does produce optimal health or reverses major diseases.

I have a friend who does research on diet and prostate cancer. He has through research shown that a low-fat plant based diet dramatically reduces the doubling time of PSA in men with active prostate cancer, while also reducing body mass and fat, improving cardiovascular health, and having multiple systems' wide benefits.

We also have multiple trials showing that a very low-fat diet can reverse atherosclerosis.

We just don't have any equivalent research showing that eating a meat-based diet can reverse such diseases.

On top of that, regarding athletic performance, I don't know of any sports nutrition authority that recommends a high-fat, low-carb diet for optimum sports performance. The evidence that high carbohydrate diets promote superior performance is just too voluminous.

I just refused to continue with my head in the sand.

Txomin said...


Unfortunately, what you view as persistent is only anecdotal. Hunger remains a devastating issue still today. Food does not simply occur in unlimited amounts. The opposite is true, quite tragically.

Moreover, even accepting that there are indeed specific places where wild food is plentiful, there is still a need for transportation systems to distribute it elsewhere. I don't find evidence of sufficiently strong commerce until very late in the history of the human species.


Thank you for the time and effort you have put into this site.

This post (as your comment) contains contradictions. It is also uninterestingly aggressive in their absolute certainty.

For what is worth, I consider the Paleo diet to be an interesting hypothesis, no more. I accept it relies too much on "logic" and "guess work" but, as an academic, I am forced to acknowledge that nutrition research does not yet have The Answer (if it did, you wouldn't be doing 180's).

Ultimately, I find diet wars to be irrelevant.

Txomin said...

How sad, censorship.

Helen said...

Don -

I continue to read with interest. What you said before, and are saying now, I take with a grain of salt, which is one of the few things I've never eliminated from my diet.

I, too, have, far less publicly, tried and touted various dietary approaches to health problems and have gone down the garden path full of studies and web articles supporting my point of view. I, too, have, both purposely and accidentally found out that if not the opposite of what I thought was true, then very nearly so. It's a bit daunting to think that this may happen again - and again.

Especially when you're dealing with multiple health issues. For, instance, the high-soluble-fiber diet that seems to work well for my borderline diabetes does not make my GERD happy. Some of the foods that would be great for inflammatory issues and all-around nutrition seem to contain too much oxalic acid for my system. Maybe there is no perfect diet. Maybe there's just the best we can do. I agree with Thomas: "We are lucky to be so choosy."

One bit of progress: While I used to be a mouth-breather for much of every day, I'm now only one at night. And not even every night. Just most.

Don said...


Censorship? What are you talking about?

Absolute certainty? Look, I have experience with my own fucking health as well as that of people in my family. I have seen the results of eating low-fat plant-based and the results of eating high-fat, meat-based on my own health and that of my present wife and numerous other women. I have over the past 30 years watched health issues abate when eating low-fat plant-based and return when eating high fat animal based, in myself and in people close to me, and watched research show the same. In the past two months, I have watched a return to low-fat plant-based improve my health and that of my wife and patients. When I see something repeat over and over I get the significance. I won't call it "absolute" certainty, but I will call it knowledge of what works and what doesn't, gotten by trial and error...

Edison is said to have made several thousand useless prototypes before getting the light bulb right. But he did get it right because he wasn't deterred by mistakes. You might say he was "uninterestingly aggressive in his absolute certainty" that he finally did, in fact, create a light bulb. Whatever.


I completely agree with you that we are lucky to have choice. This is where I think all this debating is bullshit. People in rural Viet Nam, for example, aren't debating whether or not to eat rice because it isn't 'paleo.' This debate is for people living in luxury. Which luxury fantastically clouds our minds (mine included).

I just had a 20 something patient of Vietnamese ancestry come to my clinic last week. She told the story of how her 90 yr old grandmother is still fully functional and alert, taking care of a household, never had any degenerative disease. The grandmother has lived her entire life in Viet Nam, on the traditional diet...mostly rice with vegetables and very little animal foods. Her mother, on the other hand, emigrated to the U.S., adopted a high fat diet (compared to the Vietnamese diet) and here developed diabetes. When her mother returned to Viet Nam and the traditional diet, her diabetes disappeared. That would make her (and me) pretty certain that the Vietnamese diet prevents diabetes and the U.S. diet causes it.

Don said...


I don't have any idea why your post does not show up here. I can assure you that I did not 'censor' it. In fact I have a notice that it is posted in my email box. I don't even moderate comments on this blog.

So who removed your post? Wasn't me. Post it again if you like.

Fordley Boy said...

My experiences as a vegan were pretty positive. However, my AS was in its infancy. It is difficult to say if veganism is more effective than high fat, high protein to combat AS. Perhaps if I had stuck it out I would not have developed AS. However, has many vegetarians and vegans who suffer from AS. My suspicion is that AS and starches are mutually exclusive and AS sufferers may do better on high fat, high protein. The conclusion: each to their own through research and experimentation.

Don't take the criticism the wrong way Don. It's just if you state such an apparently certain position and suddenly change, people who accepted your primal wisdom will be upset, confused maybe even angry.

For example take this statement "adopted a high fat diet (compared to the Vietnamese diet) and here developed diabetes." It appears that you are implying that it is the high fat diet that made this lady ill. I have no doubt that a traditional diet without processed foods would improve her health but you just can't say that it was caused by high fat diets. Did she smoke? Drink alcohol? Eat lots of processed carbs? Drink soda? Work in a factory with noxious chemicals? Your conclusion is strikingly similar to that drawn from the China Study, that there were a number of possible factors responsible for ill health but it was animal products that were demonised.

If you position yourself as a spokesperson for "primal wisdom" but renounce primal diet you need to evolve a thicker skin. As I said earlier great blog, always interesting and I look forward to continuing to learn from your posts.

WoLong said...

Hi Don,

I grew up in China in a neighbourhood where numerous people lived close to or over 100 years. My own grandfather lived to 98 in pretty good health, both physically and mentally. He walked about 5 miles every day until 90 then cut it down to 3 miles everyday later. What did they eat? In volume: vegetables, white rice and meat. When I was growing up, meat was used as a condiment to elevate the flavours of vegetable dishes. Diabetes was non existant. There were some cardiovascular issues, but minor in most people. This is how I still eat now in Canada. This may not be the optimal diet, but I have seen it work well so this is what I do. Plus, it's easy and cheap.

Eric said...

I suspect a few people might be well serviced by reading "MISTAKES WERE MADE, but not by me"... An interesting read on the power of cognitive dissonance, seemingly quite prevalent in the "paleo" community where, at least at its roots and when I first encountered it in 2000, I would have hoped for more open-mindedness...

Josh Day said...

That's right, Noah. You totally owned me. So I guess I "lose."

You can take your virtual little blog points back to the cave and divide em up among your fellow anonymous trogs.

And for the record I share in a lot of the disagreement, which I've already stated but you clearly didn't read. The point of my post (which was to point out the absurdity of bringing nazis into this argument) is that the majority of disagreement is derisive in nature and immature and emotionally-based. Very vegan, if you will.

Go check out the comments on and after Don's post "Farewell to Paleo." Lot of rational, logical discussion with absolutely zero ad hominem attacks among those who disagree.

noah said...

@Josh Day
Indeed, I was wrong to toss the Nazi disqualifier at you. I see the post you were mocking now.

Chris Kresser best summarized my thoughts on the whole thing, particularly "The fact that you experienced health problems on the Paleo diet does not in any way prove that it's a suboptimal diet. "

I don't doubt that Don has gathered enough observational data to arrive at his current opinion. However, in my practice I have consistently seen the symptoms he developed while eating paleo resolve by implementing a paleo approach.

noah said...

My n=1 experience is that varying macronutrient ratios seasonally has been optimal and has felt natural. That is, higher carbohydrate (fruit/starch) in the summer, lower carbohydrate in the colder months. I don't understand why the carbohydrate choice would be grains however. Unless starvation was the alternative. They are simply low nutrient, high effort and often irritating.

noah said...

"We also have multiple trials showing that a very low-fat diet can reverse atherosclerosis.

We just don't have any equivalent research showing that eating a meat-based diet can reverse such diseases."

Except of course for Framingham
And this:
And many many others.

noah said...

@ Don

"We also have multiple trials showing that a very low-fat diet can reverse atherosclerosis."

reverse it or cause it?

Mikko Lahtinen said...


"reverse it or cause it?"

In my opinion that is not a very low-fat diet.

noah said...

But that's ok because you won't even remember you have heart disease

Thomas said...

From what I have heard, Dr. Ornish had great success reversing CVD with his diet. It's a tough diet to maintain, however. This is true for most people with all diets though-paleo and low carb included. Modern lifestyle and it's comforts, especially food comforts, is a very very difficult thing to manage long term.

noah said...

Dr Ornish never isolates his variables. I believe he does this intentionally to conflate results. Most dietary interventions are improvements over the SAD. Even Dr Ornish' unsustainable diet will show improvement short term.

Heart disease is cause by endothelial inflammation (think high blood glucose/ high insulin) and blood lipids that are prone to infiltrate the endothelium ( think oxidized lipoproteins). Both of which are exacerbated by a diet high in carbohydrate.

The paleo diet usually, although not universally, improves blood lipid and endothelial inflammation markers.

Thomas said...


"The paleo diet usually, although not universally, improves blood lipid and endothelial inflammation markers."

Again, compared to the SAD.

So a high carbohydrate diet causes (or at least contributes to) heart disease. Are you sure about this? The macronutrient ratios are important?

Anonymous said...

Avoiding toxins and eating nutrient (trace mineral) dense food is far more important that fretting over macro ratios. Humans have thrived on every ratio under the sun.

What we universally do not thrive on is insidious malnutrition (from empty calories), and the toxic by-products of industrial food production.

I would bet the vast majority of non-celiac people could eat Spelt, Einkorn,and Emmer breads if they were fermented and sprouted. This would take care of the majority of the supposed gluten and starch "intolerance". These processes and ingredients yield profoundly different foods than modern hybridized grains.

noah said...

We can thrive long term on a wide macronutrient range. Very high carbohydrate intake which is necessitated by very low fat diets are in my opinion problematic for most people. High activity levels offer some protection.

"I would bet the vast majority of non-celiac people could eat Spelt, Einkorn,and Emmer breads if they were fermented and sprouted."

But why bother making the sub-optimal, tolerable?

Today's lunch is grilled salmon, zucchini sauteed with onion and garlic, steamed carrots, green salad. Which of these foods should I displace with a pile of quinoa to improve my health?

noah said...

"So a high carbohydrate diet causes (or at least contributes to) heart disease. Are you sure about this?"

It appears to be an important factor.

"After a two-year investigation, Professors Kaushik Desai and Lily Wu have discovered diets high in carbohydrates are a probably mechanism for the skyrocketing rates of Type 2 diabetes."

"The work by Kaushik Desai and Lily Wu, professors in the U of S College of Medicine's Department of Pharmacology, focused on methylglyoxal (MG), which is produced naturally as the body metabolizes glucose consumed in carbohydrates."

Thomas said...


That's interesting, but it doesn't explain why traditional cultures who eat high carb see very little occurrences of diabetes. I highly doubt it's "carbohydrate", but may be the quality of carbohydrate as well as other macro nutrients. Other factors, such as physical activity, stress, etc. are also likely significant contributors. Blaming diabetes on high carb intake (and it's effects on insulin) is way too simplistic and I don't think is supported by the real world evidence, although it fits into many theoretical models that make sense (and are probably wrong).

noah said...

Right, the Kitavan diet of 70% carbs with an accompanying lack of heart disease. I don't find that very relevant. They also smoke heavily and don't have lung cancer.

Today's high carb diet doesn't consist almost exclusively of tubers and certainly quality matters. Maybe we should call todays carbohydrates transcarbs.

To use traditional cultures as a reference for safe carbohydrate intake then we're back to eliminating grains. Not for their anti-nutrients but to mimic traditional high carb diets.

Don said...

Wo Long,

Exactly what I am talking about. Non-gluten grains, vegetables, and small amts of animal food used like a condiment, just enough to prevent deficiencies but not enough to cause excesses.

Don said...


1) I have tried paleo in multiple variations, from high in produce to none, from just adequate protein to high, from moderate fat to high, from low carb to moderate. I did my experiments over the course of 14 years...I was dedicated. I did not find any variation satisfying for control or prevention of my symptoms. When I just reduce fats and animal protein and increase whole food carbs, I see consistent improvements.

2. That quote from Sally Fallon does not show that a meat-based diet reverses heart disease. Of course she fails to note that Framingham also found that no one with a cholesterol under 150 mg/dl had a heart attack, or that Castelli decided, based on his research, to advocate for a low fat diet, not the Sally Fallon diet.

The NEJM link you gave doesn't connect to any article.

3. I used to believe that Ornish confounded variables also. But where is the evidence that exercise or meditation can reverse atherosclerosis, stop angina, and prevent heart attacks without diet intervention? To my knowledge, none exists. The reversal of accumulation of arterial plaque requires creation of an internal environment that will breakdown and remove the plaque. I would put it this way, you need a negative plaque balance. This requires reducing dietary items that promote plaque formation. Ornishes study shows that his diet protocol creates an internal condition that reverses plaque formation. Even if "confounded" by meditation and exercise, the fact is it worked.

Practically speaking, if facing death, would you rather do only one thing that might help (diet), or include all things that we have reason to believe will help?

3. As Mikki stated, 25% fat is not necessarily 'low fat' since in some countries with low heart disease risk the fat intake is <20 or even<15% of calories. Further, they tested the diets for only 2 weeks. What if triglycerides go up on the low fat diet because a low fat diet allows the body to go into negative fat balance, releasing fat from storage to burn, and it takes more than 2 weeks to adapt to low-fat intake?

4. If low fat, high carb diets cause heart disease then why is heart disease less common in lower fat Japan than in higher fat U.S. or France?

5. Kitavans just aren't the only high carb culture with low heart disease risk, nor is high grain consumption associated with heart disease. Japan, China, Thailand, Viet Nam, rural Mexico, rural Africa, etc all have high grain, high carb diets and low heart disease risk. In the U.S., people with high intake of whole grains have lower risk of heart disease.

As Thomas points out, the theory that high carb (or grain) intake causes heart diseases or diabetes "makes sense" but so much evidence contradicts it that it is probably wrong.

Michael Novak said...

Howdy Don,

I'd like to say that I admire you willing to be as honest possible with your interpretation of your personal results and the state of research. Criticizing you for changing your mind is the very antithesis to what makes a good scientist - revising one's hypotheses in light of new data.

That said, you made a comment concerning a "meat-based diet" not being optimal for athletics as per the research. As you are aware, a good deal of this research is on endurance athletes. In regards to issues of body composition and anaerobic performance, there is a good bit of literature showing a comparative advantage to "high" protein diets. Not necessarily high FAT diets. It's certainly possible to have both a high protein and high carbohydrate diet - many bodybuilders take this approach, for example.

I was curious about your take on this, i.e. the role of protein intake on body composition etc. As per the research (or rather my understanding thereof), most of the advantages of low carbohydrate diets go away when both kcals and protein are matched in non low carb groups. I.e. it appears to be that the comparatively higher protein intake seems to accomplish a lot of the good of the "low carb" diet in terms of satiety, retention of lean mass etc.

Anyhoo, I was wondering what your official opinion is on the state of research in terms of body composition, strength athletes etc and protein intake. On an anecdotal, "it works" level, people have generally found comparatively higher protein diets vastly superior to lower protein intakes in these regards.

noah said...

@ Don
" I used to believe that Ornish confounded variables also. But where is the evidence that exercise or meditation can reverse atherosclerosis, stop angina, and prevent heart attacks without diet intervention? To my knowledge, none exists."

Significant data available.

Exercise and Heart Disease Reversal

Meditation and Heart Disease Risk Factors

"If low fat, high carb diets cause heart disease then why is heart disease less common in lower fat Japan than in higher fat U.S. or France?"

Likely because of the liberal consumption of this animal (fish) fat.

Brandon Berg said...

What if triglycerides go up on the low fat diet because a low fat diet allows the body to go into negative fat balance, releasing fat from storage to burn, and it takes more than 2 weeks to adapt to low-fat intake?

My knowledge of lipid metabolism is incomplete, but it's my understanding that triglycerides are broken down into free fatty acids before being released from fat cells, and that serum triglycerides are therefore always a sign of fat storage rather than of fat utilization.

Furthermore, longer-term studies comparing low-fat and low-carbohydrate diets have consistently shown that low-carbohydrate diets lead to greater reductions in fasting serum triglycerides.

And as I pointed out in my comments to your energy balance post, your idea that a low-fat diet has a unique ability to induce negative fat balance seems to be based on an untenable extrapolation from short-term trends (burning fat to conserve glucose for glycogen replenishment). Longer-term studies have not consistently borne this out, generally showing similar fat loss for isocaloric fat-based and carbohydrate-based diets.

By the way, you've cited several studies involving feeding a single-meal to support your claims about the dangers of a high-fat diet. Isn't it a bit inconsistent to object now that two weeks is not adequate time to adjust to a diet with a new macronutrient profile?

On that topic, here's a study finding improved peak flow-mediated dilation after 12 weeks on a fat-based diet relative to a carbohydrate-based diet, in contrast to an earlier study showing impaired FMD after a single high-fat meal.

Do you have any plans to go back and write rebuttals to any of your old posts advocating a high-fat diet? I mean, you're kind of doing that now in a very general sense, but I think that pointing out specifically where you think you were wrong would make for interestning reading.

Stancel said...

Some people say that they used grains for beer. The truth is, that beer was discovered precisely because they were consuming grains.

If we believe that seeds are paleo, then it's not much of a step to believe that consumption of grains (grass seeds) extends before the Neolithic. The difference between seeds and grains is grains have more carbs and less fat. But that doesn't change that people eventually, at some point, saw them as edible, and I don't believe that happened suddenly on Day 1 of the Neolithic period.

I believe the phytic acid issue is silly, simply because the paleo community will talk about phytic acid as if it was something exclusive to grains, when in fact it has been found that nuts and seeds can contain far more phytic acid than grains. Lectins, are also a favorite word to throw around, but only a few lectins are worth being concerned about, mainly phytohaemeglutinin, found in red kidney beans...basically...the bad lectins in beans, legumes and grains are minimized by cooking. Even Mark Sisson admits this.

But there is a "good" side to lectins as the bitter melon contains a lectin that is supposed to be beneficial for blood sugar control.

It seems that the paleo community has to get beyond promoting buzzwords and stick to convincing arguments.

Don said...


yes, you are right that use of fatty acids from adipose for fuel does not raise trigs, I made a mistake. You are also correct that some studies show increased trigs with high carb diets.

Elevations of trigs from high carbohydrate diets can occur in overweight individuals, but this probably is not from de novo lipogenesis. Minehira et al found:

"Whole body net DNL is not increased during carbohydrate overfeeding in overweight individuals. Stimulation of adipose lipogenic enzymes is also not higher in overweight subjects. Carbohydrate overfeeding does not stimulate whole body net DNL nor expression of lipogenic enzymes in adipose tissue to a larger extent in overweight than lean subjects."

Hellerstein also:

"It is concluded that DNL is not the pathway of first resort for added dietary CHO, in humans. Under most dietary conditions, the two major macronutrient energy sources (CHO and fat) are therefore not interconvertible currencies; CHO and fat have independent, though interacting, economies and independent regulation."

As a lean individual, I have had low trigs on both low fat and high fat diets. Japanese have low trigs and low coronary artery disease and MI risk. Same with Kitavans. Vegans have lower trigs than vegetarians:

If long term high carb low fat causes high trigs, why don't these populations show it, and why don't I have high trigs on low fat high carb?

Because the elevation of trigs is a result of the interaction between being overweight and eating carbohydrate. The real problem is excess body fat, not excess dietary carbohydrate. And where does that excess body fat come from?

Dietary fat. Astrup et al analyzed results of studies comparing low-fat ad libitum intervention diets with medium-fat ad libitum or usual ad libitum diets and found:

"Because weight loss was not the primary aim in 12 of the 16 studies, it is unlikely that voluntary energy restriction contributed to the weight loss....A reduction in dietary fat without restriction of total energy intake prevents weight gain in subjects of normal weight and produces a weight loss in overweight subjects, which is highly relevant for public health."

Forgetting about "studies", my wife was on high fat for ~12 months and continuously put on body fat. She has been on low fat high (60%) carb for only about 6 weeks and has lost fat without going hungry, sometimes consuming ~2000 kcal daily (large for for a woman not quite 5' tall and <110 pounds).

Don said...

Nordman et al reviewed trials of low-carb and low-fat diets comparing effects on weight loss and cardiovascular risk factors. They reported that at 6 months the low carbers showed greater weight loss, but at 12 months there was no difference in weight loss, thus the low carb diets led to more rapid initial loss but the rate of loss slowed or they regained compared to low-fat:

“Triglyceride and high-density lipoprotein cholesterol values changed more favorably in individuals assigned to low-carbohydrate diets (after 6 months, for triglycerides, weighted mean difference, -22.1 mg/dL [-0.25 mmol/L]; 95% CI, -38.1 to -5.3 mg/dL [-0.43 to -0.06 mmol/L]; and for high-density lipoprotein cholesterol, weighted mean difference, 4.6 mg/dL [0.12 mmol/L]; 95% CI, 1.5-8.1 mg/dL [0.04-0.21 mmol/L]), but total cholesterol and low-density lipoprotein cholesterol values changed more favorably in individuals assigned to low-fat diets (weighted mean difference in low-density lipoprotein cholesterol after 6 months, 5.4 mg/dL [0.14 mmol/L]; 95% CI, 1.2-10.1 mg/dL [0.03-0.26 mmol/L]).”

Nordman et al considered the two approaches a toss-up for cardiovascular risk factors:

“Low-carbohydrate, non-energy-restricted diets appear to be at least as effective as low-fat, energy-restricted diets in inducing weight loss for up to 1 year. However, potential favorable changes in triglyceride and high-density lipoprotein cholesterol values should be weighed against potential unfavorable changes in low-density lipoprotein cholesterol values when low-carbohydrate diets to induce weight loss are considered.”

Since in the Framingham research , in China, and among hunter-gatherers, immunity to myocardial infarction occurs in individuals with total cholesterol levels under 150, it would seem to me that it is more important to get total cholesterol levels down than to try to get “ideal” ratios of HDL and triglycerides in a context of higher total cholesterol. If so, the advantage goes to the low fat diet, not the low carb diet.

Don said...

The Nordmann reference:$=activity

Don said...


Improvement of dilation and reduction of risk factors do not equal reversal of plaque accumulation. Ornish and Esselstyn showed reversal of plaque accumulation. Yes, exercise and meditation can reduce the risk of infarction, but can they reduce arterial plaque, independent of diet changes? Glad to see any evidence that in absence of dietary changes, exercise or meditation can remove arterial plaque, but I won't hold my breath.

Japanese have a total average fat intake of 25% of energy. Their diet is low-fat (compared to France or the U.S.) and mostly polyunsaturated and marine. Have you seen evidence that you can just add marine fat to a typical U.S. diet and thereby produce a heart disease risk as low as the Japanese or Kitavan (also low-fat)? Also, Kitavans have a similar very low risk but no where near the same marine fat intake as the Japanese. You also find very low heart disease in rural Africa and rural China, and among Tarahumaras in Mexico, without high marine oil intake. These data points don't support the idea that high carb diets cause heart disease unless accompanied by high amounts of marine fats.

kyle said...

Ok this is just some thoughts I don't know of scientific references to support this but some things that I wonder about.

First, I've heard it said that if you wait until your thirsty to drink water your already dehydrated.

Second, I know my body craves carbs and actually tonight I cut back on the amount of meat that I normally eat because I was actually craving more vegetables and carbs over the meat.

What I was thinking, and Don you talked about it once before too, that hunger is a reliable gauge.

Well, sometimes I think why would our bodies wait until after we are dehydrated to make us thirsty for more water? Also, if carbs are so bad for us why do our bodies crave carbs? If our body wants to maintain homeostasis why would we crave things that would disrupt that. I don't know but I feel the reason that paleo works for most people is because they cut out processed foods that are actually high fat foods when switching to paleo. Its like people are switching to one form of high fat for another which is just a lesser of two evils and concluding that its the carbs that are bad. Also, some of these people that like to say what about mark sisson's abs. Well some people are genetically gifted and can eat any kind of diet and still do good. Also people say when switching to paleo and ditching chronic cardio that both of those are better than high carb and chronic cardio. Well maybe it was the chronic cardio that was bad not the high carbs. People like to say Don doesn't provide references and science well neither do paleo advocates. I've seen more references given by Don than Mark. Lastly, the body has to work with protein, fat, and carbs, its a system of multiple parts working together. People want to condemn this or that but they all have their place. Humans have been around for a long time without the notion of a "high fat" or "high carb" diet maybe we should do what they did and just eat whatever we crave or desire. If our bodies are products of millions of years of evolution shouldn't it be able to know better than we what it needs?

Tal said...


'Today's lunch is grilled salmon, zucchini sauteed with onion and garlic, steamed carrots, green salad. Which of these foods should I displace with a pile of quinoa to improve my health? "

So where do you obtain your bulk calories from? Surely not from green salads, zucchini and carrots?

noah said...

Not sure what you mean by "bulk" calories. If you mean fiber, I pay no attention to that.

72% of all MIs occur in people with LDL between 100-130. Higher LDL did not provide linear increase in risk and lower LDL did not provide a linear decrease. The cholesterol tree has been barked up, wrong tree.

noah said...

Re Ornish and plaque reduction. I don't doubt that critically reducing fat intake can cause a very, very small reduction in arterial plaque as he demonstrated. The brain will take fats from any organ or tissue to keep itself from being damaged. Preservation of brain tissue will take priority over repairing damaged endothelium. This does not extrapolate to healthy high fat diets causing plaque formation.

Tal said...


I meant from what source do you obtain the bulk of your non-fibre and non-protein calories. Butter? Sweet potatoes?

noah said...

Fats: coconut oil used in cooking, avocado, chicken fat from homemade stock, beef steaks and homemade stocks. Liver and heart in the form of pate. Tuna and other fish. Eggs. Small amount of nuts.

Carbohydrates: Plenty of fruits and vegetables. Yes, yams, sweet potatoes.

Don said...

Overnight I realized that I actually did not make a mistake regarding trigs and carbs.

If serum trigs go up, this means either 1) less fat is being stored (if the fats are in the blood, they are not being stored), or 2) less fat is being burned, or 3) both.

If increased carb intake increases your trigs, it means more fat is in the blood available for burning, less is being packed away in adipose or in vascular walls.

In other words, since as I noted DNL from dietary carbohydrate is negligible, the rise in trigs found in overweight people eating high carb low fat may be a sign that less of dietary fat is getting packed a way in adipose or vascular walls via action of lipoprotein lipase.

So by this line of reasoning the rise of trigs in overweight people on high carb diets may be a GOOD thing so long as it does not exceed normal limits i.e. 150 mg because it means they are storing less of dietary fats.

By the way, according to several researchers, compared to the evidence linking cholesterol to cardiovascular risk, the evidence to linking high triglycerides is weak and insufficient to support intervention to lower triglycerides at the expense of lowering total cholesterol:

'However, not all individuals with raised TG levels have increased risk of CHD.'

Anonymous said...

Don, I'm not sure I agree completely with everything you are saying but I am glad you have the stones to speak your mind. Even if you are wrong I am sure you going in a new direction will spur lots of interesting discussions and insights.

Don't let the haters get to you. As you write more articles the tolls will start to fall off and the remaining readers will be the ones who just want to live better, not people who want to browbeat others into thinking their way.

For what its worth. I went paleo lost 20 pounds, felt great, then started adding more foods back in. I added potatoes back thanks to your writings along with beans and
buckwheat. I haven't gained anymore weight and feel better.

My meals are basically red meat diluted with veggies plus some starch. Instead of breaking it down by carbs, fat, and protein; I break it down by appearance. My plate will basically be 50% veggies, 25% meat, 25% starch. On my starch and veggie serving I always add some olive oil/lemon dressing or some butter.

noah said...

You're obviously a smart, sincere health care practitioner. You and I have had opposite clinical and personal experience with a paleo approach spanning virtually the same time frame.

You have chosen to place weight in the data that supports your current position, I consider the research that supports my experience, more credible.

I wish you continued success.


Pete said...

Hey Don, I think it's great and might I add, a bit refreshing, to see someone argue in favor of higher carbohydrate diets. I was reading your recent post on micronutrient comparisons and it really opened my eyes, but I still have doubts whether or not a high carbohydrate would be beneficial in the long run, especially when you think about all the lectins and antinutrients contained in most legumes and grains.

I went from a typical high carb mexican diet, of tortillas, beans, dairy, avocados, and meat to a paleo diet to fix my gut issues, and although it has helped, it has made me feel toxic? Does that make sense? My gut feels better in terms of bloating and pain, but I feel heavier and very lethargic.

I hope you could release a couple posts sharing your opinion on anti-nutrients and legumes in most grains and how they affect the gut and autoimmunity.

Thanks Don.

Brandon Berg said...

Vegans have lower trigs than vegetarians.

It's worth noting that vegans actually ate less carbohydrate than vegetarians in that study. Less of everything, really. But you are correct that they did not have elevated triglycerides despite eating a primarly carbohdyrate-based diet.

That said, I did a PubMed search for '"low fat" "low carbohydrate" triglycerides', and every single study I looked at that compared LC and LF diets showed greater reduction of fasting TG levels in the LC group.

I'm not saying that the greater TG reduction in the LC group is protective, necessarily. My suspicion is that blood lipids are unreliable proxies for underlying conditions, and that we don't really understand this well enough to know when elevated or depressed levels of certain blood lipids are benign or pathological.

The real problem is excess body fat, not excess dietary carbohydrate. And where does that excess body fat come from? Dietary fat.

Agreed, but I have a different interpretation.

A low-fat diet still has more than enough dietary fat to support rapid weight gain with no DNL at all. If you're eating 2500 calories a day, 20% from fat, then you can store up to 55g of fat per day without any DNL at all.

And I think this is why we don't see DNL very much under normal circumstances, even on a hypercaloric diet. Given a hypercaloric mixture of fat and carbohydrate, the efficient thing to do is to burn the glucose for energy and store the fat directly, rather than burning the fat for energy and then wasting energy converting the carbohydrate to fat.

I suspect that we would see significant de novo lipogenesis when carbohydrate intake exceeds the body's total energy requirements and glycogen stores are full. Which Hellerstein alludes to in the abstract you linked: "Only when CHO energy intake exceeds TEE does DNL in liver or adipose tissue contribute significantly to the whole-body energy economy."

All of which is to say that the way to lose fat is to reduce total energy intake. Certain individuals may or may not find this easier to do on a low-fat or low-carbohydrate diet.

Brandon Berg said...

If serum trigs go up, this means either 1) less fat is being stored (if the fats are in the blood, they are not being stored), or 2) less fat is being burned, or 3) both.

If increased carb intake increases your trigs, it means more fat is in the blood available for burning, less is being packed away in adipose or in vascular walls.

Again, I'm not 100% certain, but this doesn't sound right to me. Here's the model I have of how this stuff works:

Serum triglycerides come in two forms: Chylomicrons and VLDL. Chylomicrons transport dietary triglycerides from the intestines to various other tissues, and VLDL transports triglycerides from the liver to muscle and fat cells for oxidation or storage.

Fasting triglycerides are mostly carried in VLDL, because after fasting for 12 hours, all the chylomicrons should have been cleared. Presence of chylomicrons in a fasting sample is pathological.

So in non-pathological cases, triglycerides in a fasting sample are all coming from the liver. This doesn't necessarily indicate DNL. The liver also collects unused dietary fat from the bloodstream.

Now, what you're saying, as far as I can tell, is that high-carbohydrate diets elevate triglycerides by preventing adipocytes from absorbing triglycerides from VLDL. That sounds pathological to me. Like diabetes, but for fat instead of sugar.

What I suspect is happening is that on a high-carbohydrate diet muscle cells will preferentially take up carbohydrate, leaving the liver to clear more of the dietary fat from the bloodstream. Then the liver will slowly release stored fat until the next meal.

That said, I agree that in lean individuals the effect is small and probably not pathological. I suspect that elevated triglycerides are only problematic insofar as they indicate either fat gain or an impaired ability to remove fat from the blood for oxidation or storage.

Also, here's Hellerstein saying more or less the same thing I said about DNL in my last comment.

They reported that at 6 months the low carbers showed greater weight loss, but at 12 months there was no difference in weight loss....

Well, yes, that's my point. The claims you've made in some of your recent posts would seem to imply that we should see substantially greater weight loss for the low-fat groups, and the research just doesn't show that. Neither do we see support for the bolder claims made by the advocates of low-carbohydrate diets.

Now, you can say that if we extrapolate from this trend, maybe we would see greater weight loss for the low-fat group at the two-year point. Maybe. Or maybe they just converge asymptotically. Until someone actually does the study, it's all speculation.

jaime said...

Don, but what about people with diabetes?, would they benefit with this macronutrient way of eating?, do you think is possible to reverse diabetes with a high whole carbs low fat way of eating?



Reid said...

Don said, "I just had a 20 something patient of Vietnamese ancestry come to my clinic last week. She told the story of how her 90 yr old grandmother is still fully functional and alert, taking care of a household, never had any degenerative disease. The grandmother has lived her entire life in Viet Nam, on the traditional diet...mostly rice with vegetables and very little animal foods. Her mother, on the other hand, emigrated to the U.S., adopted a high fat diet (compared to the Vietnamese diet) and here developed diabetes. When her mother returned to Viet Nam and the traditional diet, her diabetes disappeared. That would make her (and me) pretty certain that the Vietnamese diet prevents diabetes and the U.S. diet causes it."

I cannot believe I just read this. One patient that says their mother adopted a US high-fat diet make you "pretty certain" that a traditional Vietnamese diet prevents diabetes and the US diet causes it? If the mother was was eating a traditional US diet, I'm sure it was not even close to what the Paleo folks consider a proper diet. Also, how can you rely on some comments from your patient unless they were tracking the diet their mother was eating.

Don, I appreciate you changing your opinions when "the facts" change but maybe you should remember the lesson you learned when you thought the high-fat meat based diet was the right way to can never be certain of anything. Different people respond to different foods. I can't understand how you can vilify meat and fat when so many people have seen tremendous benefits from them via n=1 testing and published research.

Malena said...


Um, Reid, in case you haven't noticed Don has presented lots of scientific data and personal experiences in this post and in earlier posts. One anecdotal example does not undermine that. And, what really is an anecdotal example from one person (in this case patient) than actually - a personal experience. So, should we just sometimes count on personal experience and sometimes not?

I've been involved in testing skincare products and no matter how clever you design the study, there are thousands of aspects that the measuring devices or the survey questions or the dermatologist's inspection can never cover. Fortunately some of those aspects can be collected by us supervising the study. I would say the most interesting aspects of the products we have been tested have not been seen in the study material but in the anecdotal talks we have had with the subjects.

As skincare is sold to the end consumer, the end consumer must like the product and thus it is in our interest to really listen to the patient. Not so with pharmaceuticals or I suppose in many cases diet theories. There the surveys are primarily focused on getting some good results and as you know there are lies, damned lies and statistics. You can e.g. "forget" to mention the negative results and the patients' complaints that are not covered in the design protocol and market the positive aspects - although the negative aspects might be far worse than the positive effects could ever accomplish.

Negative effects that always seem to be neglected with HFLC diets are (especially in women, maybe because it is mostly men doing studies) depression, PMS, lethargy, edema and lack of essential vitamins. In fact, several books have been written (by women) regarding low serotonin levels, where the authors are often seeing the HFLC trend as being the cause. If anecdotal data had been more appreciated, I am sure that could have saved many women from lots of pain.

Reid said...

"Um, Reid, in case you haven't noticed Don has presented lots of scientific data and personal experiences in this post and in earlier posts. One anecdotal example does not undermine that. And, what really is an anecdotal example from one person (in this case patient) than actually - a personal experience. So, should we just sometimes count on personal experience and sometimes not?"

Fair point. I think my bigger issue is that Don writes like he is certain about all of this. He was certain "paleo" was right and now he is certain it isn't. As you mention, there are thousands of stories out there of people seeing improved health markers on a high-fat meat based diet. Are they wrong? Should we not consider their personal experiences? As Chris Kessler has said, different people respond to different things. We need to keep that in mind as we study these things. If I were a patient of Don's I would be very skeptical with his recent 180 degree turn.

Malena said...

To be honest, I believe the only correct answer is your own body. And I know for a fact every ones body is different.

I have an identical twin and already as kids (same genes, same environment) Annika's and my digestion differed. So apparently, neither genes, nor environment can give us the whole picture. As long as modern science skip this little sort of quite important detail, we will not come much further. Perhaps epigenetics will start to fill in this immense gap.

nothing91 said...

"I think my bigger issue is that Don writes like he is certain about all of this. He was certain "paleo" was right and now he is certain it isn't."

Yep, absolutely right.

Everything with Don is a certainty. And this is the primary reason why he's being criticized. (It's not, as he tries to portray it, simply because he changed his mind.)

Fordley Boy said...

Yes I agree. This area is so full of uncertainty, it is diificult to suddenly accept that soemthing else is now so certain!

Thomas said...

I agree about the uncertainty, but Don is no different than the vast majority of low carb and paleo devotees who are unapologetic in their certainty about those diets. To use that argument against Don is disingenuous if you are part of that crowd.