Isn't it Genetics?

I received the following comment from Aaron and it’s an important point I’ve been meaning to make. As biotech makes it’s way into our lives there is a growing tendency to attribute EVERYTHING to genetics. Thousands of times I’ve heard the fatalistic refrain: “Well, my parents had diabetes (or heart disease or you pick the issues) and I’m just PRONE to the problem…”

The part that people are focusing on is the disease process and not this “prone” issue. In this situation it means a certain likelihood of developing a given condition. Check out Aaron’s comment:


I also have porphyria (EPP which is short for Erythropoietic Protoporphyria, to be specific). EPP is an autosomal dominant point mutation (located on Chromosome I think). Thus, it is technically not an autoimmune disease, but a metabolic disease (leaving those with EPP 50% deficient in production of ferrochelatase (sp?), one of the precursor steps to the production of Heme).

However, since going primal (I still drink raw milk, eat cheese and other fermented dairy and thus am not technically paleo), and supplementing with 4-6k vitamin D3 daily, and taking fermented high-vitamin cod liver oil and high vitamin butter oil (a la recommendations of Dr. Price himself), my EPP is basically in remission. I used to be sensitive to the sun and had to avoid it for the most part. Now I can go out for more than an hour at noon and not get any reaction at all. I actually have to be careful not to sunburn! I’ve never had to worry about sunburn because worrying about EPP never allowed that to happen. I have to train my self now as a 40 year old to not get sunburned! So, even non-autoimmune genetic disorders can be modulated by the environment.

By the way, you said you’ve seen people put porphyria into remission. Can you point me to your information on those sources?


First things first, Thanks Aaron for taking the time to post a comment, much appreciated. Second thing…is porphyria a Genetic Disease? Terms like “Autosomal Dominace” could make one think we have slid into some kind of BDSM site! Well, check out this paper. Of particular note is this section:

“EPP is normally inherited in an autosomal dominant pattern with low clinical penetrance…”

That bolded emphasis is mine. Now, what the frack does it mean? Well, it means that there are people running around with the GENES for the disease (Damn me and my faulty genetics!!), but who do not HAVE the disease. Later in the abstract, the writer postulates that it is necessary to have some OTHR genetic issues to bring the disease into full expression. I have two words for that: Bewll Sheeeet.

Let’s run through the facts here:

1-Aaron (and one of our clients, Paula) HAD porphyria. In Paula’s case for over 20 years. Presumably they had the autosomal dominant inheritance (received the main “bad” genes) and if you are like most of the folks researching porphyria, you must assume some other wacky combination of genotypes that actually manifest in the disease, because, most people WITH the main “genetic problem” never manifest the disease. Geneticists are mistakenly trying to attribute EVERYTHING to genes. Ya, still with me?

2-So then Aaron and Paula altered their environment (food being the main issue here) and went into REMISSION. But wait a second…it’s a “genetic disease” they had it one day, not the next day…hmmmm…did we change their genetics?! Uh, NO. We removed the environmental insult that was the actual precipitating agent in the whole disease, in this case gluten and related grain lectins. A little google search shows some interesting linkage between porphyria and transglutaminase…the auto-antigen in celiace disease. Folks, you will be hearing a bunch about tranglutaminase in the coming months, in a staggering number of diseases. So Aaron, yes, this IS an autoimmune issue.

With the exception of a few conditions like Down Syndrome and PKU, damn near every “genetic” disease plays out like this. The genes need some kind of environmental que to manifest. And you know what the que typically is? Some kind of food or activity that is completely at odds with our hunter gatherer ancestry. Breast cancer is another great example. We have now “discovered” several breast cancer genes: BRCA-1, BRCA-2. The problem is people WITHOUT these genes GET breast cancer. People WITH those genes DON’T get breast cancer. What gets left out is the ENVIRONMENTAL interaction in the disease process. Stuff like inadequate sleep, low vit-d, skewed n-3/n-6 fatty acid levels and hyperinsulinism. Did y’all know taking a little aspirin reduces risk of breast, colon and prostate cancer? But then again, so does eating, sleeping and living in synch with our genetics.

The point I’m trying to make here is this whole “genetics” thing is bullocks. One of my best friends, Charles, is half black, half Pilipino. I’m Swedish and Scotish. If Charles and I stand in the Northern California sun in July who gets sun-burned first? Obviously, my white, pasty self. If we went past 45* north or south latitude who gets rickets first, me or Charles? Charles’ darker skin produces less vitamin-d from uv radiation. This is the same concept as porphyria and a host of other disease. A set of genetic potentialities that need the right environmental trigger to bring them into a disease state.

Categories: Celiac and Gluten-Free, Healthcare, Paleo/Low Carb


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  1. Mark says

    Hey Robb,
    From your experience and knowledge, do you think that gluten causes problems only when one is chronically exposed (daily) or should someone be worried about some gluten a couple of times a week? I know this is probably is a sliding scale based on prior exposure but thought I’d get your opinion. Basically just wondering if living Paleo/Primal most of the time and going “modern/SAD” here and there (2 to 3 meals a week or even a weekend binge) is most likely ok?

    • says

      Gluten really keeps things irritated for a long time. Weekly exposure is about all it takes to keep the gut irritated. Everyone has the issues but it varies in severity from person to person. for me it;s a simple deal: Corn tortillas instead of flour. Dark chocolate covered almonds instead of a cookie, Tequila instead of normal beer. That’s my personal way to handle this, not saying it’s “THE” way but folks report remarkably good results and low difficulty in implementation.

  2. Christina says

    I have been diagnosed with high blood pressure at age 26 and have been following Paleo for about 2 months (since starting crossfit). How long does it take to see reversed results? Since following paleo pretty darn close and also adapting a raw paleo-type foods and consuming foods specifically to aid in the reduction blood pressure (low glycemic foods, etc.) My blood pressure hasn’t changed much since I stopped taking my blood pressure medication 2 months ago. I’m now back on my medication because my last reading was 158/89, with a resting heart rate of 51 and that’s after eating a lunch high in various vegetables, and 2.5 oz. lien meat. My father has high blood pressure which I was TOLD was genetic and I ended up getting. SO my question is, really….How long do you follow paleo before you can actually take yourself off these medications? AND, are these medications hurting me more than helping (i.e., diabetics on insulin shots)? Thanks a bunch!!! Great post.

    • says

      Generally blood pressure drops like a stone…how is your sleep? How many hours, what quality. Magnesium supplementation might be of assistance also (400mg/day mixed chelate).

      I can;t think of anything else other than I recall mercury toxicity can underlie some forms of stubborn hypertension…but this is really grasping at straws.

  3. says

    Thanks for the enlightening discussion. I basically agree with your assessment, though I’ve framed it in the Mendelian genetics tradition. Technically, then, I have a variant of an allele that interacts with dietary grains to produce a phenotype of sun sensitivity. Removing grains (my safeword, so to speak) has shifted my phenotype to that expressed by carriers of the other variant of the allele. Still, though, compared to many interactions, this one is quite simple (i.e., Mendelian-like). My mother’s father had the disease, my mother and her brother have it, my brother and I have it, and at least one of my daughters has it (the other one just turned one year old and we have yet to test her for the “disease”/phenotype). I’m trying to remove as many grains (especially wheat) from my older daughter’s diet as possible at this point (not an easy thing as she’s addicted to goldfish (the crackers not the real fish which would be quite paleo), cereal, pasta, rice, bread, etc. I’m making headway but it’s slow going (she’s a stubborn recalcitrant 4 year old for chrisake!).

    I have goaded my mom into getting more paleo and giving up bread and past as much as possible, but having had her gall bladder removed a few years ago she has trouble on a very low-starch diet. She is trying to replace the grain-based carbs with potatoes. She is so stunned by my ‘remission’ that she’s really trying to achieve some real progress with these changes, too. It’s quite difficult after 65 years of SAD.

    Thanks for dedicating an entire post to my comment!

    • says

      Yep, that’s how I see it. I suspect there might be a survival advantage for your genotype with some things like malaria but I have not found any indicatiosn fo this in the research. Will keep looking on that.

      One of our trainers (mother of: 3 kids, 2 chiuauas, one spastic crossfitting husband) finally took matters into her own hands: She gutted the house and there simple were no options besides meat, fruit and nuts. Where before the mom was the only healthy individual, now the whole house is. It did involve a 3 day “peasant uprising” on the parts of the kids. Then they got hungry…

      Your mom has undiagnosed gluten intolerance, likely celiac. I did a post on GB and celiac some time ago, might be worth tracking down. Your mom would likely benefit from a digestive enzyme like NowFoods:Super enzymes. 1-2 caps per meal, all meals MUST contain protein (meat, fish, fowl) and fat. I’ve only had perhaps 3 people who hadd progressed to the point of GB removal actually stick to a paleo diet. I honestly suspect some kind of nerve damage that makes these people virtually incapable of change. It’s WEIRD. Perhaps you can light a fire under her by saying I did not think she COULD do it!?

      Keep me posted and good luck.

  4. dan says

    relating to what mark said – how can we tell when gluten is irritating us enough to cause problems? should it be extremely obvious when it does or are is it more discreet? are there specific tests to actually determine whether or not we have gluten sensitivity? if i don’t have any overt problems with eating gluten then is it still detrimental to my health? sorry for the long list of questions … i’ve been trying to go paleo, but its hard to avoid eating the occasionally cookie or starchy food!

    • says

      Great questions but it’s damn simple: Remove all gluten (ideally all grains) from your diet for a month. Reintroduce. What happens.

      nothing beats personal experience.

  5. says

    Thanks for the advice. I’d initiate a peasant uprising immediately (and tried it earlier this year) but my wife would have to be on board, too. I’m not sure I want to lose a marriage over this. Still, I’ve been steadily serving a feast of nutritional research to my wife and it is sticking more and more firm with her every month. Hey, I’ve gotten her to switch to cooking ONLY with sweet potato noodles, so that’s a step in the right direction.

    • says

      that’s a damn good step. One day at a time, just feel things out. If it seems to be worth the trouble, good to go. If not, one can always go about things as before.

  6. Eric says


    What’s your take on high Vitamin D intake for people who don’t have any particular autoimmune or metabolic diseases? I’ve heard differing opinions on it–helps you get full use of fish oil, helps testosterone levels and muscle growth, etc, as well as people who say it’s worthless.

  7. says

    About gluten sensitivity. I really like the books written by Dr Rodney Ford, a pediatric gastroenterologist and allergy specialist. His testing shows that 1 in 10 people are gluten sensitive. Most gluten experts tout the common – 1 in 100. He says this is completely wrong and they are using very limited testing which only uncovers severe intolerance. He uses a range of different blood tests which he describes in his book and on his website.

    With regards to nerve damage and gluten sensitivity – that is exactly what he proposes is the problem, Gluten damages nerves and brain, and that is what leads to such a wide range of symptoms. I guess the longer one eats it the more permanent the damage.

    • says

      It appear gluten affects the enzyme transe glutamanase…which modifies virtually every protein in the body. this si why we see such amazingly wide ranges of disease. Good find on that stuff!

  8. Carl says

    re: blood pressure:

    Backing up what Robb said, when I started eating paleo, by blood pressure dropped within weeks. a decade ago, my BP was routinely about 125/75, and in the past year, every time someone checked it, it seemed to creep up a little. This year it got worrisome: 140/85 in March, and 148/92 in June. Though I zoned for a while last year, historically, my diet consistently contained a lot of wheat and rice. I went paleo in July, after attending a CrossFit nutrition cert, and when I saw my doc in September, my BP was 112/65. I made her check it again. I have had it checked several times in the past couple of weeks, and it has been consistently below 120/70, better than I can recall it ever being.

    What’s being stubborn for me is my lipid profile. My tris are down from 240 to 82, but everything else is still outside the “good” range”. My doc brought up cholesterol meds, but I told her I had no intention of going on them. She wants new bloodwork in 6 months and wants to see improvement or me on medication. In response to that (and having just read Lights Out) I am getting more sleep and upping my fish oil dose.

    Someone recommended Niacin supplementation to improve cholesterol. Has anyone had experience with that?

    • says

      cholesterol is far from the complete picture in CVD risk. Get your LDL particle size checked AND get your CRP (c reactive protien). I’d be willing to bet both of those look good which makes a marginally high cholesterol level mean…you have a marginally high cholesterol level! Check out this book and site:

  9. dan says

    sorry, i know this is not really related but, i noticed you posted on coach rut’s site about doing the wendler 5-3-1, which i had heard of before. i looked it up, and i noticed the similarities it had with the layout of MEBB program with the rep scheme and all, except that the wendler progresses with sub-maximal weights while in MEBB, its always a max-effort.

    would you mind commenting on sub-maximal progressions vs. max efforts for improving strength (which do you think is better?). and do you think the wendler 5-3-1 could be mixed with metcons similar to MEBB programming?

  10. Mike says

    Hey Robb

    Great article. It’s genetics 101 (environment+genes=phenotype), yet many adults/people in the medical profession still use “it’s just genes” as an excuse.

    On this, I’ve been eating strict paleo/gluten-free/no drinking, yet have repeatedly tested high for AST/ALT (low 50s for both). Food quality at college blows, and obviously stress and sleep are not exactly optimal/consistent. Not eating too much fruit at all either (maybe 1 apple/day). Supplementing with 5g fish oil EPA/DHA per day, 5k ius Vitamin D3 +sun exposure (my D3 was 47, so I am trying to get this up), and ZMA every night at around 8 (my sleep gets messed up when I take this too close to bed). Any suggestions? Could chronic stress really contribute this much?

  11. Eric says


    Tried posting this question before but think it got hung up in the filter–what are you thoughts on higher than recommended Vitamin D intake for people who don’t have any sort of diseases? I just saw a NY Times article that made it sound like a miracle drug that can help athletic performance, boost your immune system, and a bunch of other stuff I can’t remember, and I’ve also seen people who say it’s nothing special. If you think it’s useful, how many mg a day is a good amount?

  12. Ed says


    You’ve answered a question I’ve been posing to myself for a while now. Why do I hate Gattaca so much? It’s cos the WHOLE friggin movie is about genetics and predisposition.

    So muc truth here though Robb. Bullshit people get (Type 2) Diabetes due to genetics, the closest thing to a genetic factor is gestational diabetes. It’s too many fucking carbs. Now that you’ve got me all worked up, any good tips for controlling cortisol (non-supplementally) apart from decent sleep, low-carb, stress less?
    I’ve been doing cold showers recently but then I read in an older Question of Strength (Poliquin) that cryotherapies raise PWO cortisol and all-in-all do nothing for recovery.

    Robb I need your help, as ever gratefully,

  13. Liz says

    Hi Robb,
    I was at your Nutrition Seminar in Toronto on Saturday, and wanted to say THANK YOU. My parents are both on the Paleo bandwagon now after hearing about the connection between insulin and Alzheimer’s. My maternal grandmother had “diabetes of the brain” (very lean all her life, severe Alzheimer’s starting around age 70), so there was some fear of a genetic predisposition. Now I have to get to work on my sister and her IBS, and we’ll be golden. Again, thank you.

    Regarding Pregnancy-Induced Hypertension (precursor to Toxemia, aka in late pregnancy, requires that labor be induced): Are you aware of any info out there about reversing PIH once it occurs with a low-carb paleo approach? I’m thinking a lot of otherwise unnecessary pitocin inductions could be avoided.

    • says


      Thank you so much for attending! I’m not really aware of too many folks in which the PIH was then remedied with a paleo diet. It is simply rare to get someone to change food midstream. I can think of a few positive examples. I’m sure it would work, just not sure how to get folks to give it a shot.

  14. says

    For Christina:
    I had my BP checked at my last dental appt. It was 150/71. I have been strict paleo for 2+ yrs. I USED to have high BP when i ate 3 bagels at a sitting and ran 8 miles per day….but I havent’ had a problem for years.
    Mark Sisson had a good post on this a while back, so I followed his suggestions. I bought a higher quality home BP tester with a large cuff. I took my BP about 30 times a day throughout the day. My BP varied from 109/60 to 139/68. It totally varied, however, the one factor I could tie to my results was STRESS. If I just got done wrangling up the kids or trying to get them to clean up toys…it was high. The next day, same time of day, same food patterns…no kids, BP was 112/62. Stress = lack o’ sleep, too much exercise, kids, work, etc.
    My suggestion to you–try biofeedback. Robb suggested this to me at a Nutrition cert. Crazy concept, but it works.

  15. says

    I had my liver enzymes tested once and my ALT was 46, AST 60, a little high, googled it and found it can be linked with muscle damage (test these after a marathon and they can be very elevated). The week I had them done I had really sore muscles from a workout. 1 week later and without sore muscles the measurements were back to normal.

  16. Carl says


    Thanks for the book recommendation. It’s on its way from amazon. I’m reading Taubes’ Good Calories, Bad Calories now, and am becoming quite disinclined to pay any attention to my 220 cholesterol total, and instead focus on eating good food and getting a few good workouts in each week.

    Thanks for all the information you’ve armed me with.

  17. JD says


    In Cordain’s most recent newsletter he recommends “at least 2000 IU’s” of vitamin d3. You recommended 5k here. Can you clarify with some dosage guidelines? At the Monrovia cert you mentioned a forthcoming post on Vit D. I can wait if that’s in the works. 😉

  18. Becky says

    gallbladder removed and later on melanoma on back and lung. Do,you think some of this is gluten related?

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