You may all lose faith in me and my abilities to write the book after I tell you this story. I spent over a month outlining the project. After about 5 failed attempts to ge the book going. I’m not used to organizing this much material and it’s tough to keep everything straight. So, I finally sat down and just focussed on outlining the project. I felt like I had a pretty solid outline, ran it by several folks, everyone felt it as solid so I dug in! I did the intro chapter, covered insulin, was workign my way through fats and realized I forgot a ton of important material in my outline. Important things like…oh…say…cardiovascular disease. You know, heart attacks and stroke…the most common killers of North Americans. Yea, I’m an idiot. I have worked on this paleo diet stuff for so long that the heart disease issue is completely passe. It is such a forgone conclusion that a low carb paleo diet will protect you from CVD that I forgot to include it in the damn book. Well, almost. So I sat down and outlined what I wanted to say about CVD and started collecting references and I ran across some goodies. They illustrate that I am not the only idiot apparently!
The basics of the diet-heart hypothesis go like this: High cholesterol leads to atherosclerotic plaques that precipitate a clot which can result in a heart attack or stroke. This whole notion grew from a disease called Familial Hypercholesterolemia and subsequent experiments that involved feeding rabbits (herbivores) oxidized cholesterol. These critters do not eat ANY cholesterol so the fact oxidized cholesterol caused problems is not surprising but also completely unhelpful when talking about people. Anyway, 50 years to failed dietary recommendations to lower cholesterol have done nothing to alleviate the CVD epidemic. In fact, the epidemic is rolling along bigger and badder than ever before. Well This Study was pretty interesting. It indicates that most people who suffer a heart attack have…low cholesterol! Now, everyone is in a fix to get folks on cholesterol lowering diets and statins to save them, but most heart attacks are in folks with…low cholesterol! Ok, doesn’t make any sense and it completely calls into question the notion that we need to reduce cholesterol levels…but why not give people statins and see how folks do on those. Well, interestingly, statins appear to decrease heart attack rates in people...with low cholesterol. The mechanism? Possibly a reduction in C-reactive protein (CRP), an indicator of systemic inflammation. Know what else reduces systemic inflammation? A paleo diet which controls insulin levels, removes gut irritating foods, balances omega-3/omega-6 fats. Add some vit-d and consistent good sleep and you have effectively turned off the type of inflammation underlying CVD, cancer and neurodegeneration.
Oh! Then there is the fact low cholesterol increases stroke rates!!
So, just to clarify:
1-Cholesterol supposedly causes CVD, But
2-Most heart attacks are actually occurring in people with low cholesterol, Yet
3-Doctors insist on cholesterol lowering protocols, including statins, Even though,
4-The benefit of statins has nothing to do with cholesterol, but rather it’s mild anti-inflammatory action, Which
5-Can be accomplished with simple dietary modifications and a few inexpensive supplements.
It would be funny if people were not dying from this stuff.
99 Comments
Hi Robb,
Completely different topic: endometriosis.
I have had a few clients currently with this. I have put them on Zone with paleo choices plus lots of omega 3, as it appears there that women with this are prone to autoimmune problems, and endo may have some immune dysfunction.
Have you had clients with this, and if so, how have they responded to paleo etc?
Do you have any other recommendations?
Robb…as always, thank you for all the information you put out there for us! Quick question about fish oil…would you recommend it for a diabetic and if so, how much?
Tristy-
Absolutely! the minimum dose would be about .5g/10lbs of body weight/day of EPA/DHA. This may SEEM like a lot but this is right in line with recommendations form Barry Sears, Poliquin and many others.
Julianne-
Low-carb paleo (using half the carb blocks recommended by the Zone, like in 42 ways to skin the zone) is a great way to go. Endometriosis is an insulin metabolism issue but it can have collateral problems including elevated cortisol AND depressed thyroid. We’ve seen a number of women benefit from 150mcg of iodine/day (this is actually a very modest dose, right at the RDA).
Sleep is critical. this is where someone with a Biosignature background can help get to the bottom of what is going on. Good blood work and an adrenal stress index (ASI) can slow be helpful.
Nikki!!!
Do you have any info on the Warfarin/N-3 interactions? We have a number of clients who are on Warfarin and, like you said, their docs are reticent to sign off on increased N-3’s. I have had in the back of my head a study that would demonstrate similar improvements on a coag-panel as asprin and warfarin but I have no idea if this work has been done.
I would not be surprised if the statins are working on different pathways in general. They are anti-inflammatory and decrease fibrinogen and modify calcium signaling, as you indicated. From the perspective of “First, do no harm” I think it’s an easy sell to use N-3 therapy in favor of most of our current tools.
THANK YOU for the input and great info.
Ron-
I just had dinner with Cordain about a month ago. There is no contradiction here,the paper you reference is indicative of MOST hunter gatherer populations studied, but not ALL. Prof. Cordain is quite clear that LDL is but a bit player in the whole CVD issue and it’s part is only made significant when other systemic inflammation markers are also elevated. This is his departure from something like a low-carb diet built around things like cheese. We have a net insulin load, altered acid/base balance, a shift in n-3/n-6 AND increased LDL count (and likely population distribution towards the small-dense-oxidizable LDL form).
Now, what I see in our clinical practice is folks emulating a low-ish carbs paleo diet and getting “good” blood lipid markers from nearly anyones perspective. A few folks end up with some slightly elevated LDL (but with a shit towards large variety), but we are seeing triglycerides, CRP, A1c all plummet. That net effect is all good.
I guess where I’m coming from is there are bigger fish to fry than LDL. Emulating a standard paleo diet fries those fish well!
Thanks so much Robb! I have recently met a Type 1 who has lost his health insurance and is struggling to afford all his meds. In the 2 weeks I have known him, I haven’t shut up about Paleo and the lifestyle changes he could make that would benefit him. So, he has agreed to give it a shot. I am so excited about this journey he is about to take! We are going to keep a daily journal, so we can track his progress. (If you’d like, I will document it all and pass it on to you) He has also suffered from depression most of his life, so I am excited to see the changes that happen on that side of things as well!
I know you hear, “Thank You” a lot, but it comes from the bottom of my heart. You have inspired me to live a healthier life and in turn, I am spreading your message to anyone who will listen! I have now converted both my roommates, my dad and stepmom have just started a 30 trial run, and countless On-Rampers and clients tell me their success stories daily!! I love seeing all these results! Thank you!!
wow! .5g/10 lbs bw of epa/dha! That is alot, but I guess I have read that Poliquin has his clients on 45g fish oil/day, which comes out to like 12g/day. Do you take that much Robb? I’m on 4.5g/day right now (175-180 lbs, 6-8% bf). Do you think doubling that would help insulin sensitivity? I’d like to lean up a bit more and add some strength….
Robb,
Huge hats off to you for your generosity in providing your time and knowledge on this stuff! It amazes me…seriously.
By the way, lost in the discussion of statins is the resulting reduction in CoQ10 levels.
Oh, and I would love to grab a beer with Dr Cordain and ask him about the need for supplements when paleo-ing (ok, not really a word). His books recommend them, but I question their bio-availability and large, single-dose forms. I guess I could marginally sign off on a Cal/Mag/Zinc supplement or perhaps even a B-complex, since Paleo doesn’t seem to afford much in the way of these. But vitamin C? Really?
Maybe Paleo Foods should come up with a vitamin-enriched Patron?!?!
Thanks again for all that you do, Robb.
Ian-
there is for sure an optimum dose for n-3’s and too much CAN buggar strength and performance gains. there are some subjective measures like your poop sinking or flaoting (or loose stools) but nothing really solid. this is something I’m looking for some better guidelines for folks.
tristy-
never hear enough thank you’s! Please do keep me psoted and let me know if I can help in any way.
Robb,
Thanks, I’ll do that.
Found this article on iodine which I thought, is a good overview.
http://www.hacres.com/diet/articles/Iodine.pdf
Great stuff Robb. Quick question. I have a client who complains of acne when dosing with Omega-3’s. Onset is in a few weeks after starting taking fish oi supplement. Any concerns or information on the topic. Cannot find too much reliable information on the topic.
Best regards,
Jesse
Jesse-
Yes, we have seen this in one client. I’m not sure exactly what is going on here. I forgot to ask Scotty Hagnass, OPT and IDO about this…those guys know fracking EVERYTHING. I’ll ping them and see what they think. Undoubtedly there is an overproduction of EGF (epithelial growth factor) but we usually only see this in high insulin states. These folks MIGHT need some GLA from primrose or borage oil to balance things out. This is where my understanding on the clinical side breaks down and without blood work I do not know of a good way to figure out what is happening.
Julianne!
SWEET! thanks Amiga!
A few questions raised by this post and the ensuing comments:
A little context for my questions: I eat meat and fruits and vegetables strictly about 6 days a week. Meat sources are typically grocery store bought grain-fed beef, chicken, and pork with eggs and/ or fish for breakfast and lunch meat for snacks. I’ve had good results athletically with these choices, but I have concerns about my long term health, especially related to my meat choices. I know that grass-fed, hormone free, etc is best but my wallet won’t allow for that. I wonder how much long term damage I’m doing with fatty salty meats if I’m balancing it with fruits and veggies, fish oil, and vitamin D.
1. My concern about sodium is because I eat alot of lunch meat and use some salt on my food at meals. Correct me if I’m wrong, but in Good Calories, Bad Calories Taubes makes the point that high sodium does not cause hypertension like everyone thinks it does and that the body will regulate its mineral levels fairly easily with no permanent damage. Cordain seems to be anti-sodium mostly due to acid overload. Any other reasons to avoid sodium long term? What about additional sodium for athletes, especially sweaty beasts like me? What are some signs of too much sodium intake?
2. I understand the acid/alkaline balance idea of the paleo diet and how it relates to calcium. If you’ve removed dairy from your diet, I understand that you can get calcium from several vegetable sources, but unless you are eating collard greens and spinach in huge amounts each day, it’s pretty hard to get anywhere close to the amount of calcium in dairy. How much calcium does the body need to function optimally (is the number different from the USDA prescribed 1000mg/day) ? With the relatively low amounts of calcium in a dairy-less diet, how does one ensure that they are not leaching bone calcium just to keep blood levels maintained, especially if they are eating large amounts of meat, salted or not? In an earlier post I saw you advise against calcium supplementation. I’d like to avoid supplementation beyond a Centrum as well, but I am concerned about my long term bone health and short term athletic performance as it relates to calcium.
3. In this post you’ve covered cholesterol in the body and how it is not a good indicator for heart disease. If one is supplementing with fish oil to balance the Omega-6s in fatty grain fed beef, are there still dangers in eating large amounts of fatty, grain fed meats from the saturated fats?
Sorry to write a book here, I understand that each of these topics might be better suited to a message board post, but I thought they might each be relevant to the post and comments.
Re fish oil and pimples.
I found that the type of fish oil supplement seems to make a difference.
When I switched from standard purified oil (which increased my spots) to Sears high concentrate omegaRx the pimples reduced.
May be something to do with other oils that are removed during the concentration process.
Not sure.
Thanks so much Robb. Let me know if there is anything more that you find out. It would be greatly appreciated. You have been my number one reference for any nutritional information. Thanks for the amazing site!
Jesse
Robb,
Here is a follow up with my client about the fish oil. This may have some implications.
“Here’s an interesting fact to consider about that… As I told you I have PTSD (Post Traumatic Stress Disorder) – and General Anxiety Disorder. At Duke University Medical Center, I went through a battery of tests & such when it was first diagnosed. Blood work, psychologocal analysis, TONS of questionaires & etc. I was fortunate enough to get to work with the director of the program at Duke – he was just incredible (Dr. Jonathon Davidson). All of that to say… One of the things I learned about anxiety disorder is that most people (who have general anxiety disorder) produce more sebacious fluids in general. It’s like your body’s always on high alert, or overdrive. I think that’s why I’m so sensitive to a lot of odd things. Will tell you more if you’re interested. BTW,I just had a great workout!
Julie”
Hey Robb, as you most likely know, correlation is not causation. When the study shows that most people who have heart attacks have low cholesterol, is their cholesterol low due to the drugs or is it normally low in those people? Really great article, I love these articles revealing the truths nutrition and health!
Hugh-
Great point and i do not know. As you notice in the comments, there may be some kind of physiological shift that happens before/during/after the MI which makes the LDL appear artificially low. I raises many interesting questions and has honestly re-ignited an interest on my part with regards to the CVD side of all this.
Jesse-
the advice I got back from OPT and Scotty hagnass was to reduce fish oil to 1g/day, hopefully seeing no acne, then slowly increasing up to about 4g/day for maintenance. That buildup should be about .5g/day for week each time to evaluate.
Given what you just shared, I’d say she has some obvious cortisol overproduction. THIS by itself can push things towards insulin resistance and shifts the whole system towards the pro-inflammatory side. If I were her, I’d track down a doc well versed in cortisol management. I have a link to Garret Smith in my recent training update, he may be able to help remotely or you may know a naturopath/MD who is savvy to this stuff.
I haven’t looked at the actual original studies, but this headline and article could be of interest:
“Low total cholesterol levels could be sign of cancer”
http://www.nbr.co.nz/node/114468
Hey Robb, in an ironic twist to the comments the other Jesse made, I started taking fish oil about a month and a half ago, and the reductions in inflammation have gotten rid of the last bit of appreciable acne that I’ve had nagging me for years. It also reduces the size of bug bites I’ve gotten to approximately a quarter of their size. I used to swell up horribly from even mosquitoes, but now it’s no big deal.
Thanks and keep up the awesome work!
I am skimming through the article posted by Julianne above. Um…
“Dr. Flechas has seen that iodine reverses polycystic ovarian syndrome”
DING! Robb, I have PCOS and you previously told me that some women see beneficial results from taking iodine. I cannot, for the life of me find it anywhere. They don’t sell iodine pills at nutrition supplement stores, health stores, grocery stores. I have searched for iodine online and only found it in pill form along with a multitude of other “thyroid enhancing vitamins”, which I don’t really know are necessary. Any input on a good iodine supplement I can take, and where to find it?
Amy-
you shouldnbe able to find something through like Solaray or a similAr company. Let me know if you track that down.
Robb,
If you can send me an email address, I can email you some of the relevant articles (pdfs) I have on hand re oral anticoagulant therapy and n-3 supplementation. Some of them are recently published so you may or not be able to see the full articles online depending on whether you have institutional access.
You can find a fairly comprehensive, although dated (2004), NIH doc on the subject of n-3 treatment openly available at :
http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=hserta&part=A137995.
NikkiT
Amy
I am taking a product called Terry Naturally Tri-Iodine.
Here is a link for the product:
http://www.nourishingfoods.com/terry-naturally-tri-iodine-90-capsules.html
Dr ralph cinque, who has posted on Robbs board in the past, made comments about the Finnish study that Julianne posted a link to in his health newsletter blog today. I agree with Dr Cinque, here is what he had to say
“Dr. Cinque’s comments: For years, those who have disputed the cholesterol hypothesis have pointed to the troubling statistic linking low cholesterol with cancer as proof that demonizing cholesterol is altogether wrong. And those who have advocated low-cholesterol or no-cholesterol diets, such as Nathan Pritiking, Neal Barnard, and John Mcdougall, haven’t addressed the issue- that I know of. Perhaps they have, but I am not aware of it. And it’s amusing that the medical establishment tries to debunk the idea that low cholesterol could cause cancer- but not because they’re championing starch-based diets but rather because they are hawking cholesterol-lowering drugs. What good would it be to take something to prevent heart disease if it also causes cancer? And, animal research with statins has indeed shown a troubling rise in cancer incidence among animals getting statins, and some human studies have also found the same. Is it because statins are carcinogenic in themselves or is it simply that they are very effective at lowering cholesterol, which (theoretically) protects against cancer? I can’t answer all the questions being raised, but I will say that I think it’s unlikely that low cholesterol achieved through diet causes cancer. All bets are off when it comes to the drugs. Note that even cancer patients who eat a standard American diet (and that includes most cancer patients in the US) tend to have lower cholesterol. When you have cancer, your liver doesn’t work as well, so it doesn’t make as much cholesterol, and your digestive system doesn’t work as well, and so it doesn’t absorb as much cholesterol. Plus, cancer patients, being very sick, tend to lose their appetite and eat less food, and eating less food tends to lower cholesterol. And that, collectively, is why cancer patients tend to have lower cholesterol.”
[Just in case this board doesn't allow quotes, I am re posting my comment with the link.]
Dr ralph cinque, who has posted on Robbs board in the past, made comments about the Finnish study that Julianne posted a link to in his health newsletter blog today. I agree with Dr Cinque, that it’s unlikely that low cholesterol achieved through diet causes cancer.
Here is what he had to say.
http://www.1to1vitamins.com/news/2009/artl7746.html
Ron-
Good stuff. Here is a paper you might find interesting
Of particular interest is the section on saturated fat which indicates weak, if any association with CVD.
Zach-
I’ll try to tackle this in the podcast…tough to answer all this in one crack amigo!
Hey Robb,
While I know it’s not true Paleo and one would be better off not chancing it but do you think sprouted grain products (yup, we’re talking Ezekial bread here) are a decent choice? I would think that it’s better than gluten free stuff.
Also I’d be curious to know if you have ever read any of Matt Stone’s stuff at http://180degreehealth.blogspot.com/ His position is basically eating enough of the right foods (mostly Paleo, he includes dairy, rice, potatoes and some sprouted grains) to repair the metabolism. Once the metabolism is repaired, the body will regulate to where it should be. Makes sense to me as he is a big believer in that proper digestion is the origin of health.
Thanks as Always,
Mark
Mark-
Call me a paleo extremist but sprouting grains is an attempt to take a food that is bad for us and make it slightly less so. Considering things like yams, sweet potatoes and fruit offer non of the gut irritation of grains I’m not really in a position to recommend them other than occasionally and even then I;d stick with corn/rice options for the most part. But, it;s always open for experimentation. I just don;t see many folks go back to a grain based diet once they have really given paleo a shot.
Thanks Robb. If I may ask a follow-up, is there something structurally that make sweet potatoes/yams ok to eat but not white potatoes? Or is there not much of a difference? I want to say it has something to do saponins, just a shot in the dark there.
Above Robb posted a link in answer to one of my comments, it didn’t work. here is the correct link. It was about dietary fat and CVD
http://www.thepaleodiet.com/articles/Dietary%20Fat%20Quality%20%20CHD%20August%202009.pdf
I will read it later.
Mark-
White potatoes have some gut irritation issues.
Thanks again Robb.
Steve,
Thanks for the link!!! I will give that a shot
RE sprouted grains:
Here is an answer from Loren Cordain on his new paleo diet blog
http://thepaleodiet.blogspot.com/2009/11/paleo-diet-q-111009.html
“Yes, sprouted grains and beans are a much healthier option. When we ’sprout grains’ we are allowing the seed to germinate and a shoot will emerge from the seed. This is the part that is cut off and eaten. Therefore, the seed itself is not actually consumed (as is the case with whole grains and wheat flours where the seed proteins and starches are milled and eaten). Since lectins are packaged along with the seed to protect against predation, once the seed sprouts, the lectin concentration diminishes within a couple days. In a week’s time the sprouts should have no residual lectins.
Gliadin and glutenin are the dominate proteins located in the endosperm of the seed. The starchy endosperm is located alongside the embryo (germ) within the seed, and provides nutrients the embryo needs as it is sprouting and growing. Therefore, there should be no gliadin or glutenin proteins in the sprout, but rather primarily non-digestible cellulous (dietary fiber). One can consume sprouted grains and beans without fear of anti-nutrients. However, keep in mind that these are still nutritionally poor in terms of micronutrients. Leafy greens and other vegetables contribute high fiber AND a higher concentration of nutrients-grains are still ‘nutritional lightweights’.
I would like to amend my earlier statement: We can consume GRAIN sprouts without fear of anti-nutrients. However, legume sprouts still appear to contain considerable concentrations of saponins–the secondary compounds responsible for increasing gut permeability. Alfalfa sprouts (which are actually in the pea family) have an especially high concentration.”
This discussion on CVD and cholesterol is adding confussion to my life.
Joined CF one year ago and took the (8 week) Paleo Challenge in June. That was an incredible success for me, good stuff. One side effect was a loss of 15lbs plus, which was not necessarily a goal.
The problem, my cholesterol soared from 225 to 300. My Triglicerids were excellent and my hdl (75) good and ldl (215) bad. How can it be said that high cholesterol is safe? Every doctor I have met “freaked” at those numbers – want to put me statins. I refuse.
One question I have is eggs. I was eating 3 per day. I was also eating bacon once or twice a week. Otherwise I worked hard to comply. I don’t understand what, in the Paleo Diet, could cause this problem. To abandon the diet would mean cheese, grains – along with hypo-glycimia and legumes.
The doctor wants no meat, skim milk and some grains. “There is no such thing as ‘good’ fat” according to the doc. But other than the numbers, the benifits from eating Paleo have been tremendous for me. Any thoughts would be helpful.
Rather Ripped-
I’d recommend reading Uffe Ravnskov’s book the cholesterol myths:
http://www.ravnskov.nu/cholesterol.htm
You likely have some other genetic factors at play here but like you pointed out, our other dietary options are not going to improve the situation.
Robb is that Night Calm the same as Nature Calm? I purchased it from Amazon over the weekend, started dosing last night.
Jc-
yep! I always botch that.
Robb,
I have been taking Cod Liver Oil for some time now (will change to reg fish since hearing podcast 2?) My wife noticed a nice oil slick in the john with my urine. I am 6′2″ 220# and taking maybe 1- 2 tablespoons of the Nordic Naturals a day. I just saw the rainbow shine myself last night….cause for concern? Just got blood work back as well low TG 53, 216 total cholesterol, VLDL 11, LDL 141, HDL 64, and 3.4 CHOL/HDL ratio. My wife is a bit worried but after reading a bunch here and the first 3 podcasts i am thinking commit a bit more to the paleo ie. leaner meats and I am doing alright. I will ask the doc about that LDL ratio and the TG.
Thank You for this amazing resource!
Ryan-
We would have soem REALLY wacky stuff going on if you are peeing out fats! Any other supps?
No other supps really, multi vitamin thats about it. Occasional protein powder. One abnormal kidney number as well, not very off, getting it retested though.
Robb,
I was fortunate enough to attend your CF Nutrition Cert at BTB Atlanta last November. At the time, you mentioned that you planned to “re-check” the Costco Kirklands brand fish oil to make sure it was still up to par – quality wise. Have you done this yet? If so, what did you find? I’ve been using this brand since it seems to be the most economical I’ve seen so far.
On another note, my wife & I went totally Paleo 1-1-10 and are seeing a BIG difference. We had been on the Zone…lost weight, but didn’t have the increase in energy that we are experiencing with Paleo. Plus, your comments about “quality over quantity” just make more sense. And I’d rather look like you than Barry Sears any day. We’ve made use of the recipes on http://www.everydaypaleo.com site that your trainer setup…so tell her thanks.
Thanks again for all that you do on this and other sites…you’ve helped me “see the light” when it comes to nutrition. Please finish the book!!!Thanks!!
Brian
Hey Brian!
I have not followed up on this. Someone else posted a comment that the Kirkland brand had to change the label claims due to variables stemming from the fish used. That makes sense but I have not followed it up. I still see people benefitting from the Kirkland brand, it’s inexpensive…so I tend to run with that.
I’m stoked you have seen benefit from a qualitative shift in your chow. Pseudo-science wins again!!
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