Paleo Diets May Negate Benefits of Exercise

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Paleo Diet May Undermine Benefit of CrossFit Exercise

Much of the low-carb and paleo reasoning revolves around insulin. To quote a paleo blogger, “carbohydrates increase insulin, the root of all evil when it comes to dieting and health.” So, the logic follows that because carbs increase insulin, we should stick mostly to meat, which is fat and protein with no carbs; so, no increase in insulin, right?


We’ve known for half a century that if you give someone just a steak: no carbs, no sugar, no starch; their insulin goes up. Carbs make our insulin go up, but so does protein.

In 1997, an insulin index of foods was published, ranking 38 foods to determine which stimulates higher insulin levels. Researchers compared a large apple and all its sugar, a cup of oatmeal packed with carbs, a cup and a half of white flour pasta, a big bun-less burger with no carbs at all, to half of a salmon fillet. As you can see in the graph in my video Paleo Diets May Negate Benefits of Exercise, the meat produced the highest insulin levels.

Researchers only looked at beef and fish, but subsequent data showed that that there’s no significant difference between the insulin spike from beef, chicken, or pork—they’re all just as high. Thus, protein and fat rich foods may induce substantial insulin secretion. In fact, meat protein causes as much insulin release as pure sugar.

So, based on the insulin logic, if low-carbers and paleo folks really believed insulin to be the root of all evil, then they would be eating big bowls of spaghetti day in and day out before they would ever consume meat.

They are correct in believing that having hyperinsulinemia, high levels of insulin in the blood like type 2 diabetics have, is not a good thing, and may increase cancer risk. But if low-carb and paleo dieters stuck to their own insulin theory, then they would be out telling everyone to start eating plant-based. Vegetarians have significantly lower insulin levels even at the same weight as omnivores. This is true for ovo-lacto-vegetarians, lacto-vegetarians, and vegans. Meat-eaters have up to 50% higher insulin levels.

Researchers from the University of Memphis put a variety of people on a vegan diet (men, women, younger folks, older folks, skinny and fat) and their insulin levels dropped significantly within just three weeks. And then, just by adding egg whites back to their diet, their insulin production rose 60% within four days.

In a study out of MIT, researchers doubled participants’ carbohydrate intake, and their insulin levels went down. Why? Because the researchers weren’t feeding people jellybeans and sugar cookies; they were feeding people whole, plant foods, lots of whole grains, beans, fruits, and vegetables.

What if we put someone on a very-low carb diet, like an Atkins diet? Low carb advocates, such as Dr. Westman, assumed that it would lower insulin levels. Dr. Westman is the author of the new Atkins books,  after Dr. Atkins died obese with, according to the medical examiner, a history of heart attack, congestive heart failure, and hypertension. But, Dr. Westman was wrong in his assumption. There is no significant drop in insulin levels on very low-carb diets. Instead, there is a significant rise in LDL cholesterol levels, the number one risk factor for our number one killer, heart disease.

Atkins is an easy target though. No matter how many “new” Atkins diets that come out, it’s still old news. What about the paleo diet? The paleo movement gets a lot of things right. They tell people to ditch dairy and doughnuts, eat lots of fruits, nuts, and vegetables, and cut out a lot of processed junk food. But a new study published in the International Journal of Exercise Science is pretty concerning. Researchers took young healthy people, put them on a Paleolithic diet along with a CrossFit-based, high-intensity circuit training exercise program.

If you lose enough weight exercising, you can temporarily drop your cholesterol levels no matter what you eat. You can see that with stomach stapling surgery, tuberculosis, chemotherapy, a cocaine habit, etc. Just losing weight by any means can lower cholesterol, which makes the results of the Paleo/Crossfit study all the more troubling. After ten weeks of hardcore workouts and weight loss, the participants’ LDL cholesterol still went up. And it was even worse for those who started out the healthiest. Those starting out with excellent LDL’s (under 70), had a 20% elevation in LDL cholesterol, and their HDL dropped. Exercise is supposed to boost our good cholesterol, not lower it.

The paleo diet’s deleterious impact on blood fats was not only significant, but substantial enough to counteract the improvements commonly seen with improved fitness and body composition. Exercise is supposed to make things better.

On the other hand, if we put people instead on a plant-based diet and a modest exercise program, mostly just walking-based, within three weeks their bad cholesterol can drop 20% and their insulin levels 30%, despite a 75-80% carbohydrate diet, whereas the paleo diets appeared to “negate the positive effects of exercise.”

I touched on paleo diets before in Paleolithic Lessons, and I featured a guest blog on the subject: Will The Real Paleo Diet Please Stand Up?

But my favorite paleo videos are probably The Problem With the Paleo Diet Argument and Lose Two Pounds in One Sitting: Taking the Mioscenic Route.

I wrote a book on low carb diets in general (now available free full-text online) and touched on them in Atkins Diet: Trouble Keeping It Up and Low Carb Diets and Coronary Blood Flow.

And if you’re thinking, but what about the size of the cholesterol, small and dense versus large and fluffy? Please see my video Does Cholesterol Size Matter?

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations—2013: Uprooting the Leading Causes of DeathMore Than an Apple a Day2014: From Table to Able: Combating Disabling Diseases with Food, 2015: Food as Medicine: Preventing and Treating the Most Dreaded Diseases with Diet, and my latest, 2016: How Not To Die: The Role of Diet in Preventing, Arresting, and Reversing Our Top 15 Killers.


Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.

168 responses to “Paleo Diet May Undermine Benefit of CrossFit Exercise

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  1. What about for vegans who struggle with producing enough insulin to get the sugars/nutrients into the cells for energy? Might they (me!) benefit from higher insulin? Some of us actually can benefit from more insulin, right? Might this be why the addition of minimal (but at least some) animal protein can benefit some people?

    I find it interesting that insects our consumed in rather significant amounts by grazing cattle, rabbits, etc. (plant eaters). Might the meat protein from these insects, worms lingering on produce help create insulin to then facilitate energy into the body? Seems very natural. Vegans in nature have this synergy.

      1. I’m another vegan with insufficient insulin, and I’m part of a group of five insulin-deficient people who follow Dr. Greger (we all met through this site). Ironically, we’ve all found that a high-fat vegan diet (Eco-Atkins) is the only thing that holds our glucose down to reasonably normal levels. Lots of nut and seed butters, hemp, flax, etc. Belinda, let me know if you’d like to join us.

          1. Pre-diabetes actually. All of us are extremely thin, very fit with absolutely no insulin resistance, but simply don’t produce sufficient insulin for a variety of reasons. We’re always perplexed that Dr. Greger forgets to include us in his categories because it is clear that a high carb diet would destroy our remaining insulin production.

        1. Russell, I would like to find out more about your group. (I’m Howard L. Silverman, PhD, DC, – my email is working but my website is temporarily down)

          I’m also a person who requires a high fat, carb limited diet to manually keep my blood glucose level under good control. In addition, my protein intake, while more than sufficient, needs to be kept low enough to maintain adequate pH levels that don’t stress my kidneys. As a result of some dietary restrictions that I’ve come up with, I can get away with up to 50 grams of carbs at a meal, providing I am very strict about maintaining a carb to protein ratio of just a hair over 3.6 to 1. Even with this carb-protein ratio maintained, above 50 total grams of carbs, for a meal, my blood glucose spikes.

          I am not overweight though I was borderline obese many years ago. Most of my life I’ve been very thin. I’m officially a type-2 diabetic but as a result of my dietary restrictions I don’t require medication. I was tested and do not have pancreatic antibodies either. It is very similar to being a type-1.5 diabetic but without having any pancreatic destroying antibodies.

          A friend, who I believe to be pre-diabetic, can only tolerate 35 grams of carbs at a meal before blood glucose instability sets in, and if the carb-protein ratio in our diets are not controlled, our carb limits are even lower. Going below the 3.6 to 1 ratio appears to be associated with cognitive problems for both of us that seem to be associated with protein induced blood insulin instability. I suspect that this situation is a lot more prevalent than anyone is aware of. I’ve found that in virtually all areas of science, if a phenomena can’t be easily explained within the currently accepted model of the day, the information is not discussed, often not even at the higher levels of academia.

          Plant based omega fat balance also needs to be maintained in order to minimize systemic chronic inflammation. Without this balance, brain function seems to get fuzzy. The 18 carbon chain omega-3 and omega-6 fats are found in both plants and the animals who eat the plants. The omega-6 fats are out of balance in grasses, and even more out of balance in most nuts, avocados, virtually all vegetable oils and almost all GMO vegetable oils. Consider eating these with lots of chia or flax seeds. Coconut oil appears to be the best all around food preparation fat.

          All of the above appears to be true whether the specific dietary regime is vegan, ovo-lacto vegetarian, or carnivorous. However, following a whole foods vegan diet, as Dr. Greger suggests, appears by far to be the least restrictive for balancing and the safest to follow. Unfortunately, I can only follow a vegan regime part of the time, as I run into an iron deficiency problem, and since I don’t want to have to take iron supplements any longer than necessary, I’m not always a strict vegetarian, though I am more and more of the time.

          1. Howard, the issues you raise are well beyond my level of nutritional understanding and I can’t comment on them. But since you asked about our little group, yes, we have five people and are in regular correspondence. All of us follow a vegan diet using high total fats, low saturated fats, moderate to high protein, and ultra low carbs. We’re all able to keep our LDLs in the low ranges that Dr. Greger recommends, and we’ve succeeded in keeping our A1cs in the low 5 range as a result of limiting carbs. This has helped to prevent progression of our pre-diabetes.

        2. Russell, may I join too? I can’t believe I have finally found people like me. I have had two Drs. and an Endocrinologist specializing in diabetes tell me my condition doesn’t exist!! Do you guys suffer from insomnia too if you eat grains, flour, etc?

          1. No insomnia problems, as far as I know, when eating grains and flour. But there’s tons of people with low insulin production, sometimes autoimmune-related, sometimes other stuff. Do you have low insulin production? Has it been tested?

      1. Partially, but like most things, environment as well. In my case, I have antibodies that are attacking my pancreas (they also attack the thyroid — Graves disease). But others in our group have insulin insufficiency for different reasons than mine.

    1. .
      Hi Belinda,

      Since I do not know your specific situation, I can only make general comments. You are correct that it is insulin’s job to bring glucose (sugar) to your cells to use as energy. Insulin is like a “key” that opens the “door” to the cell to let the glucose inside. Insulin resistance is the term that is used to describe when insulin the cells are not getting the glucose they need, and it is instead staying in the bloodstream. This is because the cells are resistant to the insulin – meaning the insulin “key” is trying to open the “door” but the cells are resistant. It is likely because the “locks” are gunked up with fat. Even though you said you’re vegan, please make sure you’re keeping oils and other fatty foods to a minimum and exercising regularly. Fatty plant foods and animal foods plus lack of exercise increase insulin resistance. I hope that answers your question. If you are hungry for more info, check out Also, the book Dr. Neal Barnard’s Program For Reversing Diabetes is a good source of info on this topic.

      1. Belinda, I’d like to add an important caveat to Stephanie’s comment. If you are already thin and do not have insulin resistance (similar to me, and others in our Greger-originated group), then carbs are going to exacerbate your pancreatic insufficiency and fat is exactly what you need. If you haven’t already, read Dr. Richard Bernstein’s work. After being a Type 1 for 70 years with terrible lipids, his lipids today are that of an Olympic athlete — trigs in the 40s, LDL at 53, and HDL at 123, and his coronary calcium score is a 1, almost perfect. Unlike us, he is a carnivore, but has based his diet on having virtually zero carbs and high fat only. He’s now in his early 80s, and is still counseling patients. He’s a Professor Emeritus at Albert Einstein.

          1. A GAD-65 antibody test will tell you if your pancreas is being attacked by antibodies. If so, this is known as LADA, for late-onset diabetes. My test turned up positive at age 58 (despite being vegan for 35 years!), and I’ve been trying to control it since then with a high-fat, Eco-Atkins, with some success.

  2. The fact that excess protein and fat require more insulin has been illustrated over and over with my daughter. Being a type 1 diabetic has one advantage–you can see how various foods affect your insulin needs. Eating WFPB, my daughter uses 16 units of insulin for food/day; if she adds just 10 grams of dairy fat, insulin needs double, and she’ll require 32 units of insulin for food/day. Recently at a restaurant she ate a large serving of fish; her blood sugars stayed high for over 24 hours, requiring lots of extra insulin.

    Actually when she came home from college this weekend, we discussed the challenges of eating out and eating a balanced diet each day. I asked if she was interested in learning about Dr. Greger’s Daily Dozen. After going over the guidelines she exclaimed, “This looks like an easy vegan diet to follow!” and proceeded to download the Daily Dozen App. I’m hoping it will help her make good food choices on her journey through life.

      1. Just do a search for the app on Google Play, ( on your phone). I don’t know what the search tool is for I phones – Apple search? Anyone? Install it and you’re off and running. I recommend it to my clients too.

  3. What a Paleo diet is varies quite a bit by who is talking. From most I know who eat that way it includes a LOT of complex carbs, just no beans or grains so abundance of sweet potatoes and winter squash…

    1. That may be true for almost any diet, including WFPB, making me think the Daily Dozen is a major innovation. Too many vegans eat junk food, too many espousing WFPB diets get their B12 from soy milk or fortified packaged cereals… but this puts the kibosh to Atkins, which I’d found half-plausible from Stefansson’s old books. (Also Atkins had ties to Carlton Fredericks, whose New York radio broadcasts were once the only nutrition data aimed at the public.)

  4. I’ve posted here once before. I started the Westman low carb diet in April of 2015. I’ve lost over 50 pounds since starting the low carb diet. Three months before going low carb my total cholesterol was right around 269. I’ve had blood taken twice since going low carb. My total cholesterol as of three weeks ago is now 191. My LDL has gone down, not up. My C-reactive protein level was high before low carb but is now normal. I think we need more large scale studies. The fact is, I’ve lost weight and my total cholesterol, LDL and blood pressure have all improved since going low carb. I think one thing people miss is that most who are following a low carb diet (myself included) eat a lot of vegetables.

    1. Greg: Eating your veggies is great. But note that veggies have a lot of carbohydrates. If you are attributing your good health to the veggies, it’s not the low carbohydrates that are the benefit.
      Also note that any time you lose weight, your cholesterol levels will go down. That’s a given. But you can lose weight all sorts of ways, including unhealthy ways. So, the question is, will a diet that is high in fat and animal products be healthy long term? According to the body of scientific evidence as presented here on NutritionFacts, the answer is likely “no”. Though there are always people who do risky behaviors and luck out. Consider those rare people who smoke all their lives and still live to be 100…
      I’m glad you lost weight. I hope you have good health going into the future.

      1. Thea, I strongly disagree. I have two salads a day as main courses. My net carbs for each one is between 8-12 grams of carbs. Yes, veggies have carbs but unless you eat starchy ones like potatoes, a veggie low carb diet is actually quite natural. Based on my experience, Greg is correct. Reducing carbs can quickly reduce LDL as well as weight.

        1. Russell: You are a special case with a particular condition/malfunction – like a ketogenic diet can help a child with epilepsy. That doesn’t mean that ketogenic diets are healthy for the majority of humans. The science does not support ketogenic diets. I’m pretty sure that Tom Goff has a post or two showing all the evidence against high fat diets for long term health / showing increased mortality. I could try to find one of those posts or maybe Tom Goff will kindly bring it up again himself. And the evidence supporting “high” (I would classify as human-normal) carbohydrate diets is overwhelming. There is nothing “natural” about a low carb diet for humans if natural means healthy long term for the general population.
          I’m glad you are able to make your diet work for your special circumstance, but the evidence suggests that such diets are unhealthy long term for the general population.

          1. Thea, the Eco-Atkins study suggests that all vegetarians can benefit from a low-carb diet, not just me. Please take a closer look at the study:

            METHOD: A total of 47 overweight hyperlipidemic men and women consumed either (1) a low-carbohydrate (26% of total calories), high-vegetable protein (31% from gluten, soy, nuts, fruit, vegetables, and cereals), and vegetable oil (43%) plant-based diet or (2) a high-carbohydrate lacto-ovo vegetarian diet (58% carbohydrate, 16% protein, and 25% fat) for 4 weeks each in a parallel study design. The study food was provided at 60% of calorie requirements.

            RESULTS: Of the 47 subjects, 44 (94%) (test, n = 22 [92%]; control, n = 22 [96%]) completed the study. Weight loss was similar for both diets (approximately 4.0 kg). However, reductions in LDL-C concentration and total cholesterol-HDL-C and apolipoprotein B-apolipoprotein AI ratios were greater for the low-carbohydrate compared with the high-carbohydrate diet (-8.1% [P = .002], -8.7% [P = .004], and -9.6% [P = .001], respectively). Reductions in systolic and diastolic blood pressure were also seen (-1.9% [P = .052] and -2.4% [P = .02], respectively).

            1. Russell: Given the information you provided, it looks to me like the study is comparing people who eat all plants to people who eat a combination of plants and animals (lacto-ovo means that they eat eggs and dairy). We know that animal products are bad for you. It’s no surprise that the animal group did not do as well. I don’t think the study you cite answers the question about whether eating a high fat diet is good for the general population long term.
              You will note how few people were in the study. Also note that the subjects apparently needed to lose weight. So, not starting with a healthy set of people. Do you know how long term the study was?
              Also of interest to me is this statement: “The study food was provided at 60% of calorie requirements.” Does that mean that people were only eating 60% of their calorie needs? Or were the people expected to fill in 40% themselves according to the group they were put in?

              1. Yes, it compares vegetarians who may consume eggs and cheese to high-fat (44% of diet), low-carb vegans. Ideally it would compare low-carb vegans to high-carb vegans but there is little data on that yet. Nonetheless the study shows that from a number of standpoints (lipids including LDL, C-Reactive Protein, and calculated CHD risk using Framingham), high-fat, low-carb diets are far better than a lacto-ovo vegetarian diet that uses skim milk and egg substitutes to control saturated fat intake.

                Here’s a more recent study by Jenkins that extended the study another six months:

                Dr. Jenkins: “We killed two birds with one stone — or, rather, with one diet,” said Dr. David Jenkins, lead researcher and director of the Clinical Nutrition and Risk Modification Centre at the hospital, in a statement. “We designed a diet that combined both vegan and low-carb elements to get the weight loss and cholesterol-lowering benefits of both.”

                His comment from this article:

                It seems clear that if high levels of vegetable fats were harmful, they wouldn’t have been so successful at improving all the risk factors of the study group more quickly and further than the vegetarian group.

                The 60% comment refers to the fact that they ate only 60% of their former caloric intake.

                1. I’m not finding the information compelling, not compared to other studies and information. But it sounds like you find the information compelling and that is good given the diet you are eating. I hope it works.

                  1. Okay, please share those studies, if you have any! I’m unaware of any studies suggesting that low-fat, high carb vegan diets are healthier than high-fat, low carb vegan diets. But I’ve noted a number of recent studies are pointing towards the strong benefits of significant quantities of nuts and other plant-based fats, so clearly it’s important to keep an open mind on this issue.

                    On a related note, there is an tendency to conflate all plant fats together, but this is a scientific oversimplification. Someone who eats a lot of macadamia nuts, olive oil, and avocados is consuming a high level of saturated fats. But someone who eats a lot of almond butter, hemp, chia, and flax will have a far superior lipid profile and much lower LDL, VLDL, etc. due to the much lower level of saturated fats in their diet. I’ve personally tested this. A higher saturated fat vegan diet raises my LDL to the mid-120 range, and VLDLs above 20. When I switch to lower saturated fats but same overall fat intake, my LDL drops to the low 80s, and VLDL to just 8. This is with two vegan diets with almost exactly the same amount of total fat content.

                    1. Russell: What I’m talking about is the only studies showing actual reversal of heart disease (opening up of arteries) being low fat whole plant food based diets. See for example Esselstyn’s diet. Consider also the large number of studies on this site showing how healthful intact grains and legumes are. They are associated with long life. If I recall, you have said that you feel your pancreas was hurt eating lots of grains, but you also mentioned white flour products and white rice, etc.–not the kind of whole plant foods I have been talking about as part of a healthy diet.
                      You mentioned olive oil. I don’t know of any olive oil associated with long life except that maybe if it replaces saturated fat, it may lower risk of heart disease–but not remove risk to my knowledge. There are videos on this site showing how olive oil itself is bad for us, including hurting the lining of our blood vessels, increasing heart disease risk.
                      I’ll also stress again that I’m sure that short term studies can show some improvements in markers when someone is eating certain kinds of high fat diets, but the concern I’ve been bringing up is the long term impact of very high fat diets on overall health. What we know is that one of the longest lived, healthy populations in the world are traditional Okinawans and that diet is 6% fat. I’m not aware of any populations eating high fat diets in the range you are talking about who live long (100+ years), healthy lives. The short term evidence you presented seems incredibly weak to me. (I respect if you find it compelling. I’m just saying I do not.)
                      I don’t know of any studies pitting a truly high fat vegan diet with a truly low fat WPFB diet. But I think the evidence I am discussing here is compelling enough to say that the body of evidence does not support advocating high fat diets (even if vegan) to the general population. Maybe your diet will be proven fine for the general population in the future. I don’t know. What I do know is that the experience of a few people with a serious health problem does not outweigh all the evidence I listed above.
                      This is some of the evidence and thinking I had in the back of my head when I did my posts above. I have listened carefully to your story in the past, and I have learned something from it. I’m happy when you share your experience here on NutritionFacts as I imagine others who share your particular circumstance might benefit. That said, I can’t imagine taking that experience (yours or mine) and applying it to someone who is or has been overweight, still has high cholesterol, and shows no reason to believe has a malfunctioning pancreas. That’s why I have been disagreeing with you.

                    2. Thea, we agree on a lot more than we disagree on. Yes to vegan diets; to keeping saturated fats at reasonable levels (even plant-based saturated fats); to keeping the cardiovascular system clean. No to excessive use of olive oil, coconut oil, palm oil, and things like macadamia nuts. But my comments were not focused on heart disease though I agree that some followers of this site who have that problem should follow the best science and go with an Esselstyn-type diet.

                      Where we disagree is on what constitutes a healthy vegan diet for people without heart disease. Because of our group’s conditions with pancreatic insufficiency, we’ve done quite a bit of dietary experimenting using lab work to back us up. And what we’ve learned, to our great relief, is that one can maintain an excellent lipid profile at or very close to Dr. Greger’s ideal lipid recommendations despite getting 60-70% of total caloric intake from plant fats.

                      And that’s the disconnect throughout the nutrition establishment — and even on this site. Nutritionists as well as Dr. Greger won’t even entertain the concept, despite that we are doing, and proving this every day.

                      Here’s why it matters: if one can achieve virtually perfect LDLs, VLDLs, HDLs, and triglycerides on a high fat vegan diet, while maintaining very low inflammatory markers (CRP, homocysteine, etc.) this strongly suggests that cardiovascular issues are not an issue. And there’s even an argument that this approach may be healthier than a high-whole-carb vegan diet, in that triglycerides are likely much lower. No science to back it up yet, just sayin’.

                      So, I’m afraid I don’t have the background (or time) to take this much further. But our little group would be so appreciative if Dr. Greger stopped conflating people getting high levels of fat from animal-based vegetarian and meat-based diets with high-fat, low-carb vegans who very carefully maintain their lipids in near-perfect shape.

                      We agree on so much, but it would be good to see what we consider “our people” have a more open attitude about it.

                      One final point: everything about diabetes in the literature today suggests that insulin resistance is the real culprit, and that a low-fat diet will help to overcome this. But such a diet would have sent us all into full-blown diabetes already, something we’ve so far managed to avoid (all of us). So high-fat, low-carb is working, at least for those of us with insulin insufficiency issues. The one-size-fits-all approach is clearly wrong, at least for us, and so we’d appreciate a more nuanced approach on this, too.

                      Thanks for engaging and listening!

                    3. Russell: I judge from your answer that you are tired of the conversation and that is fine. I totally get that. Feel free to ignore the rest of this post.
                      If you are still with me, I have two responses to your post: First is that I am confused when you say, “…my comments were not focused on heart disease…” and then still spend a great deal of time talking about good lipid profiles and LDL. Those are usually markers we talk about because bad numbers are related to heart disease. Except for how those markers indicate risk of heart attacks, no one cares about the numbers. Since you focused on your lipid profile, that was why I addressed heart disease as one of the first points in my post. Plus heart disease is our number one killer. So, addressing heart disease seems relevant to talking about diet and long term health.
                      My second response is about the end of your post. At the end you talk about diabetes, but I think are confusing type 1 and 2 in your words. (Not that you are confused about them. I know you know the difference.) You say that “…everything about diabetes on this site and by nutritionists today suggests that insulin resistance is the real culprit…” With type 2 diabetes, the type that most people have, insulin resistance *is* diabetes. Insulin resistance is caused by a high fat diet. The low fat whole plant food diet is a proven method for dealing with the cause of insulin resistance.
                      You don’t have insulin resistance. I remember you saying that you were tested, so you know this for a fact. This means that you don’t have the problem this site is dealing with when it talks about diabetes. Most people who have diabetes do have the type of problem that is caused by a high fat diet. That’s one reason why it makes sense for this site to focus on that.
                      I know that some definitions of type 2 include the pancreas not producing enough insulin, but that definition is madness and just confuses matters. The problem you have is related to type 1, but instead of a completely dead pancreas, your pancreas is partially working. Others have posted on this site that when they or someone they know who has type 1 and follows a whole plant food diet, they are able to lower their insulin needs. Those are anecdotes which seem to run counterpoint to your anecdotes. ??? Maybe. I’m not sure about that.
                      I think it is fine to say, “I and a few other people in the minority have condition X. I wish Dr. Greger would address it.” Cool. You are not alone in wishing Dr. Greger would address X or Y or Z. But as I see it, this site is generally about trying to address the main problems affecting the general population. The place to bring up the stories and theories to try to deal with less common situations is here in the forum when we don’t have enough science to go on to address those nuances in the video. (That’s just my opinion.) That’s another reason why it makes sense for this site to focus on type 2 diabetes. It’s about all we can say.
                      To address the caveat with more detail: Even when more rare conditions are addressed here on NutritionFacts, those conditions are only addressed when there is some good science to allow Dr. Greger to say something about it. That’s key. At the moment, the body of evidence (at least as determined by Dr. Greger and others) says that approximately 1/2 starch-y/high-carbohydrate foods — say the Daily Dozen — is the best diet for the general population. If there are some good studies to back up your diet for long term health, I hope that Dr. Greger will address those studies too. If he feels the studies are compelling, I think he would adjust his Daily Dozen and wouldn’t hesitate to change his views on this site. He has changed his views on various points historically as the science evolves.
                      I agree that everyone is different–to a degree. That’s why it was interesting for me to learn about your situation and how you have dealt with it. Also, it saddens me to see you write, “…it would be good to see what we consider ‘our people’ have a more open attitude about it.” I know my own attitudes have changed on the matter as they apply to you and your friends. I just wouldn’t apply the lesson learned to the original poster, which was who I was replying to when you commented in reply to me. If you will recall, I even brought up your situation and solution on a previous page on NutritionFacts and directed people to talk to you. I am trying to be nuanced about what I share with people based on their situation. :-) I’m glad you have found people to talk to who share your dietary needs and views. I’m sorry you don’t feel included enough on the site.

                    4. Thea, thanks for your quick reply. Actually, I didn’t say I was tired of replying, only that I don’t have either time or sufficient expertise to go much further. The time factor is trying to work and also stay on top of my hyperactive 10 year old son. :)

                      Re heart disease, if someone has it, they should follow Esselstyn and try to reverse. Zero saturated fats, agree. But if not, then follow Greger and shoot for a value of perhaps LDL 70. That’s what I was trying to say. Big difference between having proven coronary artery disease and having clear arteries. I even recall Esselsytn saying that if you don’t have the disease, avocados are okay.

                      Putting Type 1s and Type 1.5s together, that represents 20% of the total population of diabetics:

                      They all need accurate dietary advice. So far, Bernstein has been the leader in providing a great dietary regimen for them that allows them to live into their 70s, 80s, and 90s. Ironically, it is a carnivorous diet with 35% fat, but I believe he is mistaken and that a high-fat vegan diet can do even better. But that’s an argument for another day on another site. :)

                      Yes, a WFPBD will help reduce insulin needs vs. a SAD diet, but that diet may still be detrimental over the long run for a Type 1 as it requires more insulin than necessary. And it may cause a Type 1.5 to turn into a Type 1 faster than they should.

                      Yes, thanks for bringing up my comments on the site a while back; that was very kind and hopefully helpful to someone. Re the original poster, she did not mention whether she was thin or overweight, but everyone just assumed that the answer would be to increase carbs and cut out fat, which is ridiculous since we don’t know the cause of her high glucose. And that’s part of what I’m talking about. We must be careful to not confuse the 80% or so who may be insulin resistant with the 20% who are experiencing insulin deficiency.

                    5. Russell: Nice answer. I don’t agree with all the details of your reply, but I think you made some good points and I think that pretty much winds up the conversation.
                      The only response I have this time is: I know the post you are talking about re “original poster”, but that is not the person I was conversing with. *This* particular thread that you and I are on now was started by a man who said that he lost 50 pounds and has a total cholesterol of 191. That was the person that I responded to and then you responded to me. This is a person who thinks that because he lost 50 pounds on a low carb diet, and thus had his cholesterol level go down, his Westman diet is healthy for him long term.

                    6. Russell: I’ll also add that I did not reply to the female poster you are talking about (at least not that I remember) precisely because of what I have learned from you. If I had, hopefully you would have been more happy with the response I would have given. :-)

                    7. Russell: Thanks for the link, but I don’t consider newspaper/media articles to be good sources of nutrition information. Remember the big Times article titled “Eat Butter, Scientists Labeled Fat The Enemy. Why They Were Wrong”. It was an article filled with a ton of verifiable falsehoods. But someone who is not familiar with the science would not know it. You can read more about the whole situation in the following link if you are not familiar with what I’m talking about:
                      The media is interested in promoting controversy and something new. That doesn’t mean it is actually representing the science. I’ll be interested to hear what Tom says if he decides to investigate and comment.

                    8. Yes, I’ve worked with the media a lot in my career and I agree with you. Their claim regarding lowering the need for insulin and losing weight however, is not at all unreasonable. Bernstein’s patients, for example, would probably all attest to this. The controversy is whether such a diet may reduce or increase CVD risk and all-cause mortality despite the reduced diabetes issues. I’ll also look forward to seeing if Tom has further thoughts on this.

                      Regarding a LCHFPBD, I also wanted to note that not all plant fats are equal, and they should not be lumped together. Macadamia or cottonseed vs. flax and chia, for example. This is a bigger difference than between whole and refined grains, which we are very careful to describe correctly.

                    9. You are all overlooking the elephant in the room! It may well be that the imbalance of omega-6 and omega-3 fats needs to be factored into the equation before any of the research findings can have any real meaning. I might be wrong, but it was only after I corrected this imbalance in my diet that my blood work indicated that my chronic inflammatory markers had all dropped way down, and I’ve tried everything I could think of for years to curb the inflammatory markers. Think about it!

                      By the way the body uses animal omega fats considerably differently than it uses the 18 chain carbon essential fatty acid chains. They are not equivalent in terms of how the body processes and utilizes them, even though the media and some doctors seem to treat them as if they are. Also note that the majority of the green vegetables have at least a little more omega3 fatty acids than they have omega-6, even if the difference is only 10 mg for the meal though it can be as high as several hundred mg. It is not the omega-6 to omega-3 ratio that is important, it is the quantity of each that I suspect needs to be examined from a practical point of view and whether they are consumed together at a meal or spread out and ingested at different times. The body appears to react to them differently under these differing circumstances and the literature is often examining everything at a microscopic individual level without examining the overall functionality and how it is holistically influenced.

                    10. Dr. Howard: I’m not seeing how your focus on omega 3s and 6s is relevant to the discussion. In other words, I don’t see how omega 3 and 6 has to do with missing any elephants.

                      My understanding is that all whole plant foods contain various amounts of fats. All whole fats contain various ratios of saturated, poly unsaturated, and mono unsaturated fats. Within the poly category, there will be some omega 3s and some omega 6s in various amounts and ratios.

                      I’m aware that greens have a good amount of omega 3s. Luckily intact grains have a good amount of omega 6s. Good balance in my opinion.

                      As I see it, the discussion at hand was: People who fall under the category of eating a whole plant food based (WPFB) diet can still be eating a wide range of macro nutrient percentages: For example, some WFPB eaters might be eating more foods higher in fat compared to other WFPB eaters.

                      Some people seem to be eating an extremely high amount of fat while also eating a very low amount of carbs. If they are still WFPB eaters, is this pattern of macro nutrients healthy? Healthy long term? Healthier than the diets recommended by say Greger and Esselstyn and McDougall and Barnard? Is there good evidence to back up the healthfulness of eating such a high fat WPFB diet if someone is not a type 1.5 diabetic? Those are the questions I believe we were discussing. Were you answering those questions? (You could have an I just missed it.)

                      I saw that you are going to join Russell’s group. That sounds like a good idea as you might be able to connect with people of a similar situation and extend the knowledge of the group. I hope that works out.

          2. Hi Thea

            Another problem with these studies is that they are short term. Most diets offer short term benefits if theyalso deliver weight loss. Longer term though, what are the effects? Low carb diets are associated with increased mortality.

            Vegetable fats may well be less unhealthy than animal fats. There si evidence for that but I have not seen any evidence that they are superior to WFPB diets.

            Fats and oils also have unfortunate effects on cardiovascular health that underline the argument for remaining cautious about high fat diets of all kinds eg

            1. Tom, in case you missed this in the NY Times, which suggests that many lives may be saved on a high-fat diet for those with diabetes.


              Your first study cited also suggests that high-fat, low carb vegan diets do not have elevated CVD risks, which is quite reassuring.

              As for WFPBD vs. high-fat, low carb vegan diets, there’s no actually any evidence either way, so we’re simply taking our best guesses. But my guess is that a HFLCPBD will equal or beat any other diet, so long as one maintains LDL at modest levels (say 70 or 80).

              Time will prove this out, one way or the other.

              Thanks for the citations.

              1. Thanks Russel. I did catch that NY Times article but did not find it convincing. There are no long term studies showing that such diets are safe let alone effective. Dr Garth Davis wrote a critical review of the article which is worth a read.

                I am also not sure that your assessment of the implications of the first study – “that high-fat, low carb vegan diets do not have elevated CVD risks,” – is correct. It seems a bit of a leap to me especially since the study is primarily about low carb, high protein diets and the authors themselves conclude that “The associations of low carbohydrate, high protein, and low carbohydrate-high protein scores with cardiovascular outcomes were not, in general, statistically significantly different between women whose protein intake was mainly of animal origin and those whose protein intake was mainly of plant origin.”

                My interpretation of the available evidence suggests that all low-carb diets carry some degree of risk. Consequently, I just can’t share your views on this matter or endorse your guesses.

                However, I wish you good health and good fortune.

                1. Tom, in the first study, I was focused on these phrases:

                  “When the results were examined with the animal or plant origin of the diet taken into account, a statistically significant positive association was seen with low carbohydrate diets of mainly animal origin, but a statistically significant inverse association was seen with low carbohydrate diets of mainly vegetable origin.”

                  But admittedly, the jury is out until we have more long-term studies.

                  However, you may have missed a comment of mine regarding good plant fats vs. bad plant fats. I’d suggest that the difference is greater than the difference between whole grains and refined grains in terms of overall health impacts. After all, a diet including macadamias and palm oil vegan ice cream (very popular in Germany at the moment — NPR story on it today) may drive LDL to some very high levels. But a lot saturated fat vegan diet may allow LDL to remain low at 70 or 80. I would expect far higher CVD with the former than the latter, wouldn’t you?

                  If so, wouldn’t it be advisable for vegans to begin discussing the difference between high and low levels of saturated fat? I haven’t seen much on this. And so, high carb whole food vegans and low carb whole food vegans are considered to be on equivalent diets in these studies, but that may not be appropriate or accurate from a nutritional/scientific standpoint.

                  1. Thanks Russell.

                    I did see your comments about different fats. I think that it is generally accepted that there are different health effects from consuming different types of fats. Dr G has already discussed this on a number of occasions eg

                    This is also the current conventional wisdom

                    However, there is also evidence that all fats – when consumed as isolated concentrated foodstuffs (oils, lard, butter etc) – have adverse effects. I mentioned some of the relevant studies in a previous post.

                    The evidence that a WFPB diet is the healthiest option for most people is however substantial and discussed extensively on this site. You are in a very special position and what may be the healthiest dietary option for you will not be optimum for most people.

                    1. Tom, all great links, thank you! I also appreciate the Harvard analysis, as well as the quote from Dr. Greger here, from your second link:

                      “Now look, if you’re eating so healthy that your LDL cholesterol is under 60 or 70, then I don’t see coconut oil as a problem.” So he sees plant-based sat fat as okay, so long as LDL is kept in check. I may have missed it, but does he ever suggest that mono or polyunsaturated fats are a concern (so long as LDL levels are down at 60 or 70?). Hard to figure out a theory why high-fat plant diets would be harmful if LDL is low…

                      Yes, it is true that Blue Zone diets have carbs as their primary staple, but one could also make the argument that their modest fish consumption of 5% of their diets is a significant factor for their longevity as well (or their naps, long walks, low body weight, or social interactions).

                    2. I cannot speak for Dr G but my impression, from all that I have seen and read, is that he does not regard any fats per se as necessarily bad and to be avoided at all costs (with the possible exception of trans fats). After all, even broccoli contains saturated fat and he is all in favour of our eating that.

                      What he appears to be concerned about in this particular area are the processed food stuffs that we call fats and oils – ie foodstuffs such as edible oils, lard, tallow, butter, cheese etc Vegetable foods that are high in fats like olives, avocados, nuts etc deliver a large variety of other nutrients which may moderate, counterbalance or otherwise affect the consequences of eating high fat In the “fats and oils”, most of these protective factors have been removed.

                      Also, I think that he is OK with people using small amounts of oil or animal foods in the context of a WFPB especially if those people do not have cholesterol, obesity, lipid or other problems. He does not think it is optimal but rather a way of capturing the great majority of benefits of an entirely whole food plant diet accompanied by appropriate supplements. His view here appears to be that half a loaf is better than none.

                      Yes, it would be possible to argue that it is fish or exercise or whatever (rather than whole plant foods) that is responsible for Blue Zones longevity. Well, it would be if we did not have other evidence in addition to simple observational studies of long-lived populations. And if we did not understand that all these factors can impact health and longevity.

                      For example, there have been experimental studies like the Esselstyn and Ornish programs which have demonstrated reversal of heart disease in a majority of compliant patients. No other dietary intervention had done that.Less well-known is a short term McDpugal study which found that a short term vegan diet improved a range of biomarkers in study subjects.

                      Then of course there are all the mechanisms by which whole plant foods benefit health and animal foods and highly processed plant foods damage it This site is full of discussions of the multitude of studies that illustrate these points.

                      It is not just vegetarians like Dr G saying that people need to eat this way. Most mainstream health and nutrition scientific reports assess the evidence and conclude that people need to eat more fruit and vegetables. The 2016 report of the US Dietary Guidelines Advisory Committee recommends that more vegetables, fruit and whole grains should be consumed. The World Cancer Research Fund expert report advises that we should “eat mostly food of plant origin”. The World Health Organization also concludes that people
                      “not eat enough fruit, vegetables and dietary fibre such as whole grains.” This broad conclusion is based on reviews of all the evidence by scientific panels of genuine experts. And none of them were vegetarians to my knowledge. I am not aware of any of these expert panels concluding that we should be eating more oils or meat.

                      do not eat enough fruit, vegetables and dietary fibre such as whole grains.

                      Just to conclude, it is not just the effect on cholesterol that is the concern with fats and oils. They have a range of effects on the endothelium, on systemic inflammation, insulin resistance and other issues.

                    3. Tom, it’s refreshing read your comprehensive and open-minded views of the science, including your thoughts on both saturated and unsaturated fats. Agreed that added oils, cheeses, etc. are potentially harmful beyond just LDL.

                      From a vegan health standpoint, I think a more relevant theoretical question may be what the tradeoffs are between higher sources of mono/poly fats from avocados, olives, nuts, seeds vs. higher levels of carbs from whole grains. The former may elevate LDL/VLDL, while the latter elevates triglycerides, which are also a risk factor for CVD. Perhaps the tradeoff should be framed primarily in terms of lipid values because as we know, triglycerides above 150 are considered a risk factor and may be problematic at even lower levels, while LDL above 100, or even 70 as Greger suggests, may be problematic. Fyi, cardiologist Dr. Sigurdsson from Doc’s Opinion frames trigs as a concern only if the Trigs/HDL ratio exceeds 2:1 He says:

                      “The authors pointed out that fat-induced increase in TG following a meal is a postprandial phenomenon (we all have high TG for a few hours following a fatty meal) caused by chylomicrons is different from the carbohydrate-induced rise in TG (later found to be caused by elevation of VLDL).

                      These findings have been confirmed in several more recent studies. Despite this, low fat, high carbohydrate diets are still being recommended as a primary option to reduce the risk of heart disease.

                      Although low-fat diets may help lowering LDL-C, low carbohydrate diets are more effective in improving the TG/HDL-C ratio.

                      This suggests that solely selecting LDL-C as a target in cardiovascular prevention is an oversimplification, and may have lead to wrong conclusions regarding the relationship between diet and heart disease.”


                    4. Thanks, Russell, you are very kind.

                      There are problems with the views of people like Dr Sigurdsson. One is that they tend to concentrate on individual biochemical processes and test results while ignoring hard clinical endpoints. For example, whole grain consumption is associated with reduced mortality and morbidity contrary to the impression he tries to convey.

                      Ditto for his views on saturated fat.

                      The evidence for the effectiveness of low fat diets in improving cardiovascular health is still relatively weak.

                      However, much depends on what type of low fat diet is followed. Esselstyn and Ornish (and Pritikin before them) have demonstrated that whole food plant based diets which are very low in fat have reversed heart disease and decreased mortality. I am not aware of any high fat diets that have done this – although replacing saturated fat in the diet with PUFAs has been shown to reduce the rate of CVD events.

                      As for his other arguments, he also ignores the fact that cholesterol lowering has been shown in study after study to reduce adverse events whatever his theoretical arguments tell us should happen. Further, he is a bit vague about whether these measures (TGL, HDL etc) are modifiable risk factors or just markers). Recent trials to increase HDL for example did not deliver clinical benefits and we now know that not all types of HDL are beneficial.

                      Some of his comments and observations are valid of course. However, that brings me to another problem which appears typical of people with his views. The information he offers is often correct as far as it goes but is incomplete and consequently can be quite misleading.

                      With TGL, for example, he states baldly that carbohydrates raise TGL. This is correct, The macronutrient carbohydrate does raise triglycerides. He forgets to add that not all foods that are commonly called “carbs” raise triglycerides
                      “A diet high in refined carbohydrates increases triglyceride levels, while fiber-rich food choices such as whole grain breads and cereals help to reduce it.”

                      To be fair, I do not think whole grains lower TGL much if at all but the evidence indicates that they certainly do not not raise it – unlike refined grains. However, you got the impression from his article that all foods commonly called carbs raise triglycerides. This just isn’t correct. He must know this but seems quite willing to accept that his article implies that they do.

                    5. Thanks Tom, lots of good and fair-minded point here, which I appreciate. Not everyone on this site is as open-minded as you in examining the literature and coming to objective conclusions. There is, in my view, a bias among certain commentators on this site that a low-fat PBD is the only option for optimal health and longevity, but that does not seem to be backed up either by Greger’s own comments or the studies. Failing to distinguish between types of fat is problematic. I agree that for someone with proven heart disease, an Essystyn-style diet would be the odd-on favorite for reversal, but w/o that condition, there’s no proof that a high-fat but low saturated fat diet is at all harmful.

                      Btw, I loved this line from the first link you sent:

                      “The relative risks for morality were 0.85 (0.80 to 0.91…”

                      Lol, I think morality is a marker of veganism, rather than the other way around. Hate it when researches conflate markers with causes… :)

                    6. I think that it is certainly possible to make a respectable case that a high fat (low sat fat) WFPB diet is healthy. The Cretan diet reported in Ancel Keys’ Seven Countries study was reportedly up to 40% fat, primarily from olives/olive oil. The Cretans apparently had the highest longevity of all those cohorts studied.

                      Also, if I remember correctly, the most recent report of the US Dietary Guidelines Advsory Committee states that the quantity of fat consumed is not as important as the quality of the fats consumed

                      However observational studies like the Seven Countries are subject to confounding. And I am also convinced that the effects of fat consumption on things like endothelial function and inflammation seen in experimental studies, indicate that a low fat WFPB diet is preferable for most people.

                      Yes, it is a great typo isn’t it? Of course, I make gresat numbers of typos but they aren’t usually as funny.

                    7. Thank again Tom. Great links. I just figured out that I have less than half the saturated fat intake that Cretans did, about 3% of my energy intake (about 6 grams/day, despite 120 g/mono/poly fat), so that bodes well.

                      I also thought this was interesting — it was towards the bottom (highlights mine):

                      Professor Willet:
                      ” … the total percentage of calories from fat in the diet probably does not make too much difference… We really have to recognise it’s not that carbohydrates are good and fats are all bad, there’s good and bad in both of them”.

                      According to Prof Frank Sacks of Harvard University, both cultural models result in low blood cholesterol (LDL cholesterol) levels. Both a low fat and a high fat diet, low in saturates, can reduce LDL cholesterol by 17%. However, low fat high carbohydrate diets reduce the ‘good’ blood cholesterol (or HDL cholesterol) by 18%, relative to the Mediterranean model.

                      To relate this HDL effect to coronary incidence, the low fat diet would predict a 16% increase in coronary incidence in men and even more in women. On the Mediterranean model there would be less change. In the short-term at least, low fat diets also increase serum triglycerides of the order of 25%. This would predict an increase in coronary incidence of 16% in women and 6% in men. Replacing one type of fat with another does not affect triglyceride levels. On the low fat diet the benefits of the decrease in LDL are nearly completely offset by the negative impact of reduced HDL and increased triglycerides, particularly in women, and this actually predicts an increase in coronary incidence. These effects on blood lipids may explain why the Greeks in the 7 countries study had much lower death rates from CHD than the Japanese.

                    8. Thanks Russell, you are doing a good job in keeping your saturated fat intake. Even olive oil is about 13-14% saturated fat.

                      Sacks’ remarks are generalisations. Certainly in the West, when people replace fats with carbs, the carbs tend to be chips, crisps, white bread, pasta, white rice etc etc. Such refined carbs will drive up up triglycerides and depress HDL. No argument there.

                      However, as shown by the studies referenced in my previous post, whole grains and complex carbs like eg sweet potato do not depress triglycerides and they actually increase HDL cholesterol.

                      Similar comments apply to his remarks concerning the comparison with the Japanese and Cretan cohorts in the Seven Countries study. The Japanese were eating white rice. The Cretans were eating whole grain bread. The type of carbs makes a huge difference. The Cretans were also scampering up and down mountains which raises HDL. I understand that they also ate a lot of wild harvested herbs and other plants which would also have affected their lipid profile.

                      Consequently, I am still of the view that whole plant foods are the healthiest option for most people. In your case however, you have to go high fat. However, it would still probably be helpful if you could include some whole grains and beans in your regimen – tempeh (soy beans) is about 47% fat for example.

                      Anyway, gotta go to the airport – off to Australia later today. Good luck.

                    9. Yes, agree with your analysis. As for beans, I get my hit from tofu every day, which is about zero in saturated fat, and not much total fat either.

                      Have a good flight! I’ll be on that same flight in June.

              2. Look at the omega-3 omega-6 levels for these fats. Also note that from an omega point of view the omega-3 are so high in both flax and chia in absolute terms that they can potentially be harmful if used with a low fat vegan diet. In simple terms omega-6 fat is eventually converted to arachidonic acid that is essentially used create inflammatory prostaglandins to start and maintain an inflammatory process that the body uses to help cleanup damaged cells, and the omega-3 fats are then used to cut off the inflammation so that new tissue can be formed. Too much inflammation is not good, and too much anti-inflammation also isn’t good. Either extreme makes it difficulty for the body to do what it needs to do. Macadamia nuts have very little omega-6 fats compared to other nuts. I suspect that these may be one of the healthiest nuts to eat when balanced with certain fruits like strawberries. It is questionable whether any additional omega-3 fats are even needed. Ingesting other nuts without accompanied chia or flax seeds is a lot more questionable from an omega-6 omega-3 perspective. Cottonseed oil is usually GMO and certainly to be avoided. Is it possible that apples and oranges are being compared. It’s like lumping CLA fats with other trans fats! Talking about saturated fats as bad is like saying that all trans fats are bad. Neither are a true statement. It might be useful to substitute the word “most” for the word :all” when having these discussions.

    2. Greg And Everyone Interested In Paleo Diets: Wow, *just* after I posted my reply to you, I got a ‘breaking medical news’ e-mail from PCRM (Physician’s Committee for Responsible Medicine). It specifically addresses the point I was trying to make. Check this out!:

      Veggies Won’t Undo the Risks of Eating Meat

      High fruit and vegetable intake will not counterbalance the increased risk for heart disease caused by eating meat, according to a study published in the American Journal of Clinical Nutrition. Researchers followed 74,645 participants from the Swedish Mammography Cohort and the Cohort of Swedish Men studies and monitored diet and mortality due to heart disease. Those who consumed the highest amounts of red meat increased their risk of dying from heart disease by 29 percent when compared to those who consumed the least. The risks remained consistent when coupled with various fruit and vegetable intakes. High fruit and vegetable intake could not prevent meat-related deaths.

      Bellavia A, Stilling F, Wolk A. High red meat intake and all-cause cardiovascular and cancer mortality: is the risk modified by fruit and vegetable intake? Am J Clin Nutr. Published online August 24, 2016.

      You got yourself to a better/good weight. Maybe now it is time to start thinking about eating healthy?

    3. I concur with Thea. I had a friend last fall who said his Dr. recommended the Paleo diet for weight loss and maintenance. He did not want to discuss further after I told him that the Paleo diet was ultimately a dangerous diet, ( what good is low weight if your arteries are scarred with plaque?), and, that the large majority of Drs had very little to NO training in nutrition.
      I just heard from a mutual friend that about two months ago he had a stroke. Very sad indeed. While this is anecdotal evidence, my educated guess is that if he changed to a WFPB last fall the stroke risk would have been much lower and it may not have happened at all!

    4. When you eat veggies you have a number of nutrients working to let you absorb what you need to create energy: you have carb and lipids and proteins with vitamins and minerals. In France we designed a burning fat soup to improve cardiac surgery procedure for overweight patients, it is just vegetables. I help American people to lose 20-100 lb with it . People who try it are amazed how they have energy when losing weight. Burning fat is just biochemistry.
      We can make very sophisticated customized nutrition plan for any individual that is easy to follow, and simple with the knowledge we have now. Organic food is a part to be healthy. The processed food is creating new intolerances, allergies, and chronic diseases. It is easier to be healthy when we know what individually , we can eat.

  5. My understanding is that the paleo clan focuses on raising HDL and thinks there’s zero connection between lipid levels and heart disease. I was told once by a paleo guru that my cholesterol is “too low.” (TC=100, LDL=45, HDL=40) And I have diagnosed severe heart disease. If I’m correct about the paleos and cholesterol, they’d care not about the CrossFit study’s results with respect to lipids.

    1. I’ve read the same, only time LDL is mentioned is when it’s used to describe the big bouncy type they get…even though they are a potential problem too.

      1. Thanks for the opportunity to clarify. I was diagnosed via conventional angiogram Aug 2012. I had/have seven separate stenoses distributed among all three major coronary arteries ranging from 40% to 95% blockage, with most 80%+. I began Dr. Esselstyn’s WFPB diet roughly the same time. When I began the diet (and I was on no medications at the time), TC=214, LDL=148, HDL=47. I’ve posted my current lipid numbers above, plus I now take 10 mg of atorvastatin (a quite small dose; some people take 80 mg). Based on my reading about the average effect of the dose of the statin I’m taking, of the ~100-pt drop in my LDL, I attribute roughly 40% of drop to statin and 60% to WFPB diet. Probably more than you wanted to know, sorry. :)

          1. Yeah, I’ve suggested that, or at least going to 5 mg. Doc says he’s concerned I’d lose the “other benefits” of the statin, by which I presume he means anti-inflammatory. Given my diet, I think I don’t need that benefit either–we’re still “negotiating.”

            1. In that case I would seek a second opinion and maybe even a third opinion. At this point it seems like the statins may do more harm than good.

            2. Kurt: I would like to second Aaron Coleman’s opinion. I’m not an expert, but I do know that statins come with serious, dangerous, potentially permanent harms for some people. Saying you should stay on statins for “other benefits” without saying what those other benefits are or having a serious discussion weighing the potential benefits with the potential costs is really offensive to me, and I don’t know either of you. How is that even ethical? Especially when you have gone through the effort of changing your diet to an anti-inflammatory diet? And is your doctor saying that everyone should be on statins regardless of their cholesterol levels because statins are anti-inflammatory? Is that ethical?
              Of course you have to do what makes sense to you. I wasn’t going to say anything, but Aaron said something and then I couldn’t help jumping in. Whatever you decide, I hope it works out well for you! You should be proud of the progress you have made. Best of luck.

            3. I would not be quick to discount your physician/s assessment.

              Yes, statins carry some risks but for somebody with established serious heart disease, these may well be significantly outweighed by the potential benefits. eg this from earlier today

              and this from Harvard a few years ago

              In my view (not that that is worth anything), your physician’s recommendations are fully in accordance with the scientific evidence. Unlike the paleo cranks’ opinions.

              1. Tom Goff: I looked at your first link. I am not able to evaluate the validity of that study or article. But even if the following quote from the page is true: “Their own analysis, the team wrote, showed that statins prevented many more heart attacks and strokes than they caused muscle problems or diabetes.” They are not saying that there is *no* risk. Just that in their opinion, the benefits outweigh the risks. But the benefits occur only because the pills are given to someone who eats an unhealthy diet. Eating an unhealthy diet is how they got the heart disease in the first place. And add to that that you have to treat something like 2,000 people with statins before you prevent even one heart attack (if I remember correctly), and the benefits of statins seem way overblown to me.

                If someone is eating a diet proven to open up arteries and is sticking with it very well, why would it make sense to prescribe a drug with potential serious harms? It may be relevant to give statins to someone who refuses to change their diet. Or to someone who changes their diet and still struggles to get their cholesterol under control. But that’s not who we are talking about here. I’m obviously not an expert either, but I don’t see how it makes sense in this case for someone to continue to take a drug that could dissolve their muscles.
                More general discussion on the point of the article on South China Morning Post: On one hand, I believe in being honest with people so that they can make educated decisions. On the other hand, it seems that scaring people about statins seems like a good thing to me when there is a safer and cheaper alternative. Sometimes facing a scare is the only way to get people to change. For me, it is a conundrum.

                1. Possibly but they can be complementary. If I recall correctly, both Esselstyn and Ornish (and McDougall for that matter) use statins in conjunction with WFPB diets in appropriate clinical circumstances. This seems to indicate that it is not always either/or. Certainly, both the UK and US guidelines are clear that the benefits of statins do not solely consist of cholesterol lowering and the effects thereof. I think that is true of the European guidelines also but a new version came out recently and I haven’t had time to read them

                  I was on statins years ago but stopped because of liver damage. It was that which set me on the road to improving health through a WFPB diet. Consequently, I am personally no fan of statins but the evidence is what it is. I find it convincing. Increased risks for muscle damage and T2D are one thing but they have to be compared to an even bigger risk of heart attack and stroke in people identified at particular risk in the guidelines.

                  The first article is from the UK National Health Service website. It has high credibilty. In fact, its credibility is enhanced by the fact that the UK NHS heavily subsidises prescription drug purchases. It therefore has a strong financial interest in reducing unnecessary drug use. Its advice is based on a very thorough analysis of the costs and benefits of statin use, issued just a few years ago.

                  Yes, the best course is to avoid problems in the first place by adopting a WFPB diet early. However, if you have significant established heart disease then statins and diet may both be required. As I wrote earlier, Esselstyn, Ornish and McDougall all seem to concur with this view. And of course it is a view shared by the UK and US guidelines.

                  I am no clinician and am not familiar with this case but, from what has been written, I think the doctor is quite right here. It is riskier to stop the statins than it is to keep taking them

                  1. Tom Goff: It has been a while since I read Esselstyn’s book, but I seem to remember that he only prescribes statins as needed to lower cholesterol. And after that, the person could get off the drugs if they could maintain the lower cholesterol numbers. I think we will have to agree to disagree on this one. I don’t think the evidence is compelling to keep someone on statins who has already lowered their total cholesterol to 100 and is sticking to a healthy diet that is proven to reverse heart disease (what the studies you are referencing don’t likely cover) and is also anti-inflammatory.
                    Maybe the deciding factor should not be the cholesterol levels, but a test to show how clear the vessels are. If the vessels are clear and elastic and I was a doctor, I’d insist the patient get off the statins. :-)

                    1. Fair enough bit I do not think that there is actually any evidence that, in cases of established heart disease , a WFPB diet is superior to a WFPB diet plus statins. Whereas there is evidence that people with established heart disease (as specified in the various guidelines) do benefit from statins.

                    2. “Whereas there is evidence that people with established heart disease (as specified in the various guidelines) do benefit from statins.” If I’m not mistaken this evidence applies to people that continue on with unhealthy diets so of course they do benefit from statins? Unless Kurt has a doctor that believes in a WFPB, I feel as though the doctor will keep him on the statin no matter what, out of fear of a medical malpractice lawsuit if he doesn’t follow the status quo of prescribing statins to recovering heart disease patients. This is where the second or third opinion comes in by finding a doctor that believes in the diet and is not afraid of taking patients off of their medication.

                    3. “If I’m not mistaken this evidence applies to people that continue on with unhealthy diets so of course they do benefit from statins?”

                      No. My understanding is that it applies to all patients with established significant heart disease. All the relevant studies/evidence are described and referenced in the relevant guidelines if you wish to double check.

                      I do not think that the doctor recommends that Kurt continues with statins because of malpractice issues. It seems apparent to me that he/she is doing it because that is what the evidence shows will best benefit the patient. The guidelines do not make recommendation based on the “status quo”, whims or prejudice, and they set out the evidence and reasoning behind the recommendations.

                      In any case, why seek any medical opinion at all if all one intends to do in any event is discontinue statins? Why not save the trouble and expense and just discontinue the statins based on one’s own opinions?

                    4. Tom Goff: You wrote, “In any case, why seek any medical opinion at all if all one intends to do in any event is discontinue stains?” I think this is a great question and brings up a topic that is important to me. I approach these relationships with the firm belief that any medical professional I interact with is on *my* team. They are not the team captain. I am. So, for any medical problem I have, I want to know all of the various opinions and approaches the professional believes is applicable. And I want to have contact with someone who has the legal authority to prescribe drugs and do physical interventions (set a broken bone for example) as needed.
                      However, a wise person will keep in mind the strengths and weaknesses of the people on their team. For example, when it comes to doctors, I would keep in mind that it is likely my doctor knows less about nutrition and how nutrition affects health than I do. And it is also likely my doctor is not aware of all the research and probably does not have the training or time to really dive into studies and evaluate their validity. So, I will listen to my doctor’s opinion carefully and take it seriously, but I will never turn over my responsibility and my right for taking charge of my own health and making my own health decisions, especially when it comes to an area that is likely one of my doctor’s weaknesses.
                      Suppose I was in a position similar to Kurts and after careful review of the studies and listening to the opinion of a couple of doctors, I want my doctor to work with me on weaning myself off the statins and evaluating how it goes. That’s worth the trouble and expense of going to the doctor even if I don’t agree with the doctor’s first recommendation about the drug. Another benefit of seeing the doctor is that there are plenty of other aspects of the situation that I may want help with and agree with the doctor on. In the end, the doctor is my advisor. Not my parent or dictator. And he/she can be very helpful to me even if I decide he/she is wrong on one aspect of my care.
                      One of my favorite testimonials on NutritionFacts, and what we get here a lot, are the stories about how people took their own health into their own hands and got better for it.
                      I love this topic and am super passionate about it. I think it is so important that doctors are respected, but also acknowledged as being human. In the end, a lot of health decisions are gambles based on knowledge, values and risk tolerances. It is the doctor’s role to give me the knowledge I need to make decisions. It is also the doctor’s role to share her/his opinion based on her/his experience. I need a doctor for that. But it is not fair to put the burden of making the final decision on the doctor when it is my health that is on the line and my values and risk tolerances that matter. In the end, it is the doctor’s responsibility to respect my decision.

                    5. I fully agree. The decision is one’s own and nobody cares more about your health than you do. The doctor is merely an adviser albeit a highly expert one.

                      My point really was that, unlike you and Aaron, I believe that the recommendation made by Kurt’s physician is the correct one based on the available evidence. Statins have been demonstrated to provide significant net benefits to people with established heart disease, over and above simple cholesterol lowering.

                      As far as I understand it, your and Aaron’s view is that they are unnecessary once cholesterol has been reduced to a safe level in people on WFPB diets. You may be correct but I am not aware of any evidence demonstrating this.

                    6. Tom Goff: I think the evidence does support my view. That’s where we are disagreeing. I’m looking at the same evidence you are and coming to a different conclusion. I totally respect your opinion and thinking ability. I’m often blown away with the quality of your posts on this site. I just happen to think you are getting it wrong in this case. I still respect you. :-)
                      To reframe a bit: As strongly as I’m presenting my opinion, I don’t think this is a black and white issue at all. I think this is one of those unsettled areas that needs more research. I think your opinion on this topic is perfectly valid even if I don’t agree with it.

                    7. Thanks Thea. I agree that more research is needed to clarify this issue.

                      In the meantime, I think the evidence demonstrates that both WFPB diets and statin therapy improve outcomes for people with established heart disease. So why not use both therapies?

                    8. Tom Goff: There is clear evidence that people on WFPB diets will not benefit from statins. I can understand saying that you put different emphasis on the evidence. But claiming there is no evidence is mind blowing to me. Just in case I haven’t been clear enough in my posts, here is the evidence laid out in bullet form:
                      > people with heart disease of the type we are talking about (ie, I’m not talking about some kind of congenital heart defect) have blocked arteries and lots of fatty stuff floating around in their blood
                      > those blockages are caused by plaque build-up
                      > that plaque comes from (or is made up of?) high cholesterol. Or at least I know I can say that without high cholesterol (high meaning above human-normal) in the blood, no one gets the plaque build up
                      > it is fully proven and uncontested to my knowledge that people on a specific WFPB diet can clear their blocked arteries on a WFPB diet.
                      > I don’t think it is possible to have a heart attack of the type we are talking about when your arteries are clear.
                      > it is also fully proven that people on a specific WFPB diet can permanently lower their cholesterol levels to human normal levels, there by preventing future plaque build up
                      > while the amount of harm from statins may be contested, the fact that there is potential for serious harm is not contested. If I understood correctly, it sounds like you have personal experience with the harms of stains. Surely you do not contest that serious harm is possible? (This bullet alone is reason enough for someone to say that there is evidence to not take the statins. As I said and you said you agreed, a final medical decision is about values, not just numbers.)
                      > The studies you find so compelling that say, “the evidence suggests that taking statins does more good than harm” are saying that even though it takes thousands of people taking statins before a single heart attack is prevented, the harm done by statins is even less than that. So, on average, you could say that the benefit outweighs the harm. But there are clear winners and losers in this game. I say that when you factor in the cost and hassle of the statins and the low percentage of getting a benefit, a reasonable person might conclude that for them, the harms outweigh the benefits. This is not just a numbers decisions. Deciding benefit is also a values decision. The opinions of a few researchers are not a black and white fact of 2 + 2.
                      > Also, the studies you find compelling *may* include some tiny number of people on WFPB diet, but we know that there are not that many people who follow a true Esselstyn-type diet. So, if those studies included a decent number of people to come to their conclusion that statin use provides on average more benefit than harm, they were not basing that conclusion on people who have cleared their arteries. There is no reason to believe that the conclusions of those studies even apply to the case we are talking about.
                      So, on one hand, you have people who essentially don’t have heart disease any more and their chances of getting heart attacks are nill to extremely small. On the other hand, you have the potential (however small) of serious health harms from statins, the monetary cost of the drug, the daily hassle of taking the drug, the cost of doctor visits to monitor you while you are on the drug, etc. I can fully understand someone looking at the evidence and weighing their values and agreeing with you. But it is also perfectly legitimate to look at that evidence and say that taking statins does not make sense. My interpretation of the evidence is different than yours. That doesn’t mean that there is no evidence to back up my position. We just have different opinions on what is relevant.
                      If I had a doctor who is not aware of that evidence or is unwilling to work with me in light of the evidence to even lower the amount of the statin use, then it would be time for me to get that second opinion. It is not shopping around (as you claimed in the post to Aaron) to get a second opinion. No doctor is infallible. In matters of great importance, it is highly recommended by everyone (including doctors) to get a second or third opinion. I think the evidence fully supports getting a second opinion in this case. As I said above, I might not base my decision on just my cholesterol levels. I might also look into how clear my arteries are now. I need a doctor who is willing to be good team member to figure it out and then respect my decision.

                    9. “My point really was that, unlike you and Aaron, I believe that the recommendation made by Kurt’s physician is the correct one based on the available evidence.” Are you a cardiovascular doctor? I’m curious if you are stating this opinion while having 0 experience dealing with heart disease patients, especially those on a WFPB diet.

                    10. Are you a cardiovascular doctor? I’m curious if you are stating your opinion while having 0 experience dealing with heart disease patients, especially those on a WFPB diet.

                    11. Aaron Coleman: Thank you. I’m convinced that our medical system would work a lot better if more patients and doctors adopted this paradigm.

                    12. Lets be honest here. There is zero evidence that statins will benefit a patient on a WFPB diet that has a total cholesterol around 100. Correct me if I am wrong. This is a very unique case so to take the guidelines as gospel is unprofessional. If you go back and read earlier comments, I specifically stated seeking a 2nd or 3rd opinion. Obviously from a medical doctor especially if you can find a doctor that has experience with a WFPB diet and/or getting patients off of their statin medication. The goal isnt to just get off statins. The goal is to make sure you arent wasting money on medication that is is doing more harm than good.

                    13. Yes, let’s be honest here. The evidence clearly shows that statins benefit people with established heart disease. You do not want to acknowledge this.

                      You also seem to believe that doctors should not follow evidence-based guidelines because you think people with low cholesterol on WFPB diets are a special case. You may right but there is no evidence that this is so

                      Are you saying it is unprofessional to follow evidence-based guidelines in this case and professional to ignore them based on (no evidence but) a strong belief? Sorry, but I do not accept this argument.

                    14. Please show me where I said I do not accept the fact that evidence shows that statins benefit those established heart disease. Then show me where i said doctors should ignore the guidelines. I simply said there is no evidence based guidelines on heart disease patients on a WFPB diet. What dont you understand? Are you against seeking a second or third opinion because of these guidelines?

                    15. I said “acknowledge” not “accept” and this is the first time you have acknowledged it
                      There is no evidence that people on WFPB diets with established heart disease will not benefit from statin therapy. Why do you assume they will not?
                      You do not appear to be advocating a second or third opinion as such. You appear to be advocating “doctor shopping” until Kurt finds one who will agree to discontinuing statin therapy contrary to the evidence based guidelines.

                    16. With the acknowledge statement and everything else you
                      have said shows you had every intent at implying I do not agree with the
                      guidelines. Which is a false assumption #1.

                      Are you against getting a second opinion? Do you think
                      doctors are Gods and know everything? All doctors have different
                      experiences with difference patients. If you are trying to lose weight,
                      your doctor or dietitian will likely recommend food on “My Plate”
                      which recommends dairy consumption. So what you do is get a second opinion from someone experienced in a WFPB diet whom may be able to better assist you not because they are simply against any guidelines but because they have professional experience dealing with a WFPB patient. There are no guidelines recommending a WFPB diet for health or weight loss but there are doctors whom have experience that a WFPB diet works best for their patients.

                      “There is no evidence that people on WFPB diets with
                      established heart disease will not benefit from statin therapy” There is also
                      no evidence that people on WFPB diet with established heart disease will
                      benefit from statin therapy. I am clearly not assuming they will not benefit. I
                      clearly said there is no evidence that they will, just like there is no evidence
                      that they wont. False assumption #2

                      Now you think I am advocating shopping until Kurt
                      finds a doctor to get him off the statins contrary to the guidelines. You are
                      just going in circles. False assumption #3. You and I both have no idea if a
                      doctor with experience dealing with a WFPB diet will recommend Kurt off statins
                      completely, lower his dosage, increase his dosage or give him a different
                      medication. If you weren’t hell bent on making false assumptions to boost your
                      argument then you would have clearly understood my point. If you are against
                      Kurt seeking the best help possible then that’s just crazy. 2 doctors is always
                      better than 1. 3 is better than 2. They may all agree with his current doctor or
                      they may disagree.

                    17. Thank you Tom for representing a position here in discussion that I rarely see on NF forums. As a person with diagnosed heart disease and a survivor of bypass surgery, ALL my doctors told me statins have benefit over and above cholesterol lowering, and even if I could lower my LDL further from 100 to 70 say, they would want me to stay on them. Niacin does NOT have the same benefit and they refuse to prescribe it.

                      I am on wfpb no-oil, no junk food vegan diet, always been slim (bmi 19) , always been fit…. hs-crp less than 0.5

                      The other point is that people frequently make the remark that arteries heal on wfpb diet as if that spinach is going to sweep it all out and make you like new. I beg to differ. After being hard core perfect I have no doubt that tiny , miniscule improvements happen in the arteries, but even dr mcdougall is certain that the plaque in his own arteries remain from his younger years, albeit stable and unlikely to cause harm.

                      I feel people reading this site can get the impression that eating wfpb is akin to waking on the other side of the rainbow, and while many issues may indeed be resolved, I feel it is misleading to insinuate that you can return to the cardio status of a child. just sayin’

                    18. Thanks.

                      Yes, it is fashionable to denigrate physicians and the various guidelines they follow but evidence based medicine has its strengths. Perhaps it is not a bad thing that your doctors refuse to prescribe niacin. While modern studies generally find niacin safe and to reduce mortality, Nathan Pritikin referred (p87) to preliminary results from the Coronary Drug Project (1966-75) which showed that there were more sudden deaths and more CHD deaths in a group treated with nicotinic acid (niacin).

                      This may have just been a statistical fluke because the final results from the CDP study revealed an 11% benefit (after long term follow-up and discontinuation of the drug).

                      Nevertheless, statins appear more effective (and may be safer).

                      Given that studies keep demonstrating survival benefits from statin use (eg this below from 4 days ago), if I had heart disease, I’d be loath to gamble my life and health on a WFPB diet alone being a better option than a WFPB diet plus statin use.

                  2. Tom Goff: This is going back to a conversation we had previously dropped. I have one new bit to share. I just finished listening to an interview with Dr. Ornish that changes something we were both thinking.
                    You wrote above, ” If I recall correctly, both Esselstyn and Ornish (and McDougall for that matter) use statins in conjunction with WFPB diets in appropriate clinical circumstances.”
                    I thought that was true too, (though I thought that the people were weaned off the drugs after their disease reversed). In the interview I just heard, Dr. Ornish said that one of his “definitive” studies, done in 1990, did not use any drugs in the experimental group. Only the control group (about half of the control group) used drugs. The experimental group was able to reverse their heart disease with diet, a little exercise, and some stress relief opportunities. The heart disease progressed in the control group.
                    I don’t expect this information to change your larger opinion in the discussion we were having. I’m not presenting it as new information to sway your opinion. I just thought you would be as interested as I was to hear this.
                    I don’t have more of a reference for that study than what I wrote here. But if anyone is interested in hearing a very interesting interview with Dr. Ornish, it will be available for free for a short time more only (maybe through this weekend?). It is part of the Plant Pure Summit which is going on now and is free to sign up. Here’s a link to the video: You probably have to sign up and log in before you can watch the video/interview.

                    1. Thanks Thea. I will try to catch the video although I am getting ready to travel to Australia tomorrow.

                      As I wrote before, you may be right on this issue but there is no evidence demonstrating that a WFPB diet is equivalent to or superior to a WFPB diet with statins. The opposite is also true of course but it seems a reasonable supposition that applying two demonstrated-successful therapies would be better than simply relying on one.

                      I know you disagree and set out a list of reasons/evidence supporting your opinion. However, from my perspective, that evidence you offered may be suggestive but it does not actually demonstrate that WFPB is superior to WFPB plus statins. To demonstrate that, there would have to be a head-to-head test comparing the two approaches.

                      That is why I made the point that the recommendations of Kurt’s doctor are fully in accordance with both US and international guidelines, and the available evidence.

                      However, i thought it best to withdraw from the discussion at that point because I would just have been repeating myself. Also, I thought Aaron’s posts were becoming somewhat … surreal.

  6. So my problem cooking for my husband is this; he has a history of kidney stones. He was having them every 6 months.
    I am trying to stay on a low OXALATE diet, but most of the veggies are high oxalates.
    It seems most of the good things are high in oxalates. Can you please speak into this?

    1. Dr Greger has some recommendations for that. Also, years ago I talked to my doctor about kidney stones because I was at risk for them and several people in my immediate family had them. My doctor to me that kidney stone aren’t caused just by eating oxalates. He said, it also takes calcium and the conditions also have to be right. He said it’s like having all the ingredients to make a cake. But if the combination isn’t right, including oven temp, etc, then you’re not going to get a cake. I’ll also mention that my friend who had had several kidney stones went whole-food plant-based diet using nutritionfacts info as his guide. He hasn’t had a kidney stone since.

      There might be other blog posts and videos on this site. I’m not sure. Maybe others can help out.
      Good luck to you and your husband.

      Mark G.

    2. As mbglife comments, oxalates are only one possible cause. There are other factors eg

      “Eating, Diet, and Nutrition
      People can help prevent kidney stones by making changes in their fluid intake. Depending on the type of kidney stone a person has, changes in the amounts of sodium, animal protein, calcium, and oxalate consumed can also help.

      Drinking enough fluids each day is the best way to help prevent most types of kidney stones. Health care providers recommend that a person drink 2 to 3 liters of fluid a day. People with cystine stones may need to drink even more. Though water is best, other fluids may also help prevent kidney stones, such as orange juice or lemonade. Talk with your health care provider if you can’t drink the recommended amount due to other health problems, such as urinary incontinence, urinary frequency, or kidney failure.

      Recommendations based on the specific type of kidney stone include the following:

      Calcium Oxalate Stones
      reducing sodium
      reducing animal protein, such as meat, eggs, and fish
      getting enough calcium from food or taking calcium supplements with food
      avoiding foods high in oxalate, such as spinach, rhubarb, nuts, and wheat bran
      Calcium Phosphate Stones
      reducing sodium
      reducing animal protein
      getting enough calcium from food or taking calcium supplements with food
      Uric Acid Stones
      limiting animal protein
      More information about how changes in diet affect kidney stone formation is provided in the NIDDK health topic, Diet for Kidney Stone Prevention.”

      Hope this helps.

  7. A friend of mine has a child with epilepsy and a ketogenic diet is recommended by a neurologist at John Hopkins:

    Also Dr. Mark Hyman, head of functional medicine at the Cleveland Clinic, recommends ketogenic diets for brain health: – his latest book is entitled “Eat Fat, Get Thin: Why the Fat We Eat Is the Key to Sustained Weight Loss and Vibrant Health”

    Dr. Mercola writes “Ketogenic Diet Can Benefit Many Chronic Health Problems” and “How Ketogenic Diet May Promote Longevity and Increased Muscle Mass”

    Dr. Terry Wahls, in her book “The Wahls Protocol”, claims to have reversed her MS and recommends a ketogenic diet (over 68% from healthy fats).

    In the book “Primal Endurance”, written for triathalon and marathon athletes, it recommends a ketogenic diet.

    I have an autoimmune demyelinating disease, CIDP, and I am confused on whether a ketogenic diet, composed of healthy fats, is best or not.

    A ketogenic diet could also be vegan with lots of raw organic avocadoes, nuts, and seeds.

    Dr. Greger and Dr. Fuhrman recommends minimizing animal products.

    Dr. Amy Myers, in her book, “The Autoimmune Solution”, and Dr. Peter Osborne, in his book “No Grain, No Pain” both recommend paleo diets.

    Any guidance on sorting out these conflicting dietary viewpoints would be greatly appreciated. Thanks.

    1. I wouldn’t pay attention to ANYTHING Dr. Hyman says. Watch this you tube video about how he deliberately misstates the outcome of a study to the exact opposite conclusion, For brain health, I always recommend my clients to the Physician’s Committee for Responsible Medicine’s, ( president Dr. Barnard’s book – “Power Food’s for the Brain” – what’s good for the heart is good for the brain – and it ain’t FAT!

      1. misinformation goes on and on , Dr Oz had Rachael Ray on yesterday touting the health benefits of kale and cauliflower , she used tons of cheese with both . It was a heart stopping moment !

    2. William. Don’t listen to them. Many years ago I had an auto-immune issue that caused me to lose my hearing. I had surgery to replace both eardrums and unfortunately that only helped for a short time. It wasn’t until I changed my diet that I was able to end the inflammation in my ears.

      Go WFPB.

    3. Years ago I got interested in Hyman’s recommendations because a few things he said made sense. But the more I looked into what he was saying the more I came to the conclusion that he’s a quack.

        1. Dr. Hyman calls himself a Paleo-Vegan, his diet sounds nothing like Dr. Greger’s high grain diet recommendations. Dr. Hyman also promotes some animal food.

        2. If I’m not mistaken, Hyman is funded but the animal food industry. No other explanation to publish a book that promotes eating fat to get thin. insane

          1. Hyman works at the Cleveland Clinic in a functional medicine role, a form of lifestyle medicine. He is not the only doctor who now, based on the evidence, advocates eating more fat than he did 15 years ago. I would guess that the majority of nutritionally oriented doctors now advocate this. Neal Barnard and Daniel Amen advocate more fat consumption that they used to. I think the key is being very careful about what kind of fat. Many vegan doctors think we need to eat more avocado, olives, hemp, chia, and flax seeds and nuts. That’s what they mean by healthy fat.

    4. Ketogenic diets are a recognised treatment for children with serious, intractable epilepsy but are associated with some risks. Such risks are a good reason for individuals without intractable epilepsy or specific clinical problems to avoid ketogenic diets,

      As for Hyman, my opinions follow those of mbglife and vegcoach. People selling sensational books about nutrition and health, even if they are MDs etc, tend not to be the most reliable sources of information.

  8. Who says paleo is low fat, high protein diet? That study should say low fat, high protein diets are were studied, not Paleo. Everyone I know, read, and follow in the ancestral health circle already know the dangers of low fat high protein diets. That is why the recommendation is usually high fat, low carb, MODERATE protein.

    1. Well, Cordain the self-proclaimed father of the paleo movement seems to recommend high protein diets
      “The typical hunter-gatherer protein intake would have fallen between 19 and 35% of total energy, 14 values which would be labeled either “high” or “very high” protein diets when compared to current U.S. values (15%). ……. The evolutionary template would then suggest that when dietary protein intakes are restored to levels that our species is genetically accustomed, good health will prevail.”

      Incidentally, high fat low carb diets seem like another high road to increased mortality and morbidity, according to available evidence.

      1. More trendy diets: Yes, the Banting diet! I see that professor Tim Noakes has fallen into this. Also Phil Maffetone “Maffetone Method” being popularized by journalist Christopher McDougall in his best seller”Natural Born Heroes”.

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  10. I think we are mixing dietary fat and dietary protein as a cause of increasing insulin. It is known that two much protein can induce insulin rise.
    Is there a study that shows dietary fat casing rise of insulin level? I haven’t read one yet.

    1. There are many eg
      “Dietary fat has been implicated in the development of insulin resistance in both animals and humans. Most, although not all, studies suggest that higher levels of total fat in the diet result in greater whole-body insulin resistance. Although, in practice, obesity may complicate the relationship between fat intake and insulin resistance, clinical trials demonstrate that high levels of dietary fat can impair insulin sensitivity independent of body weight changes. In addition, it appears that different types of fat have different effects on insulin action. Saturated and certain monounsaturated fats have been implicated in causing insulin resistance, whereas polyunsaturated and omega-3 fatty acids largely do not appear to have adverse effects on insulin action.”

      etc etc

      See also

      1. Thanks, Tom. I could not read in details of the first reference you listed.

        However, almost all of the studies in fat and diabetes did not quantify dietary protein intake. In Western diet, high intake of fat has always been associated with high intake of proteins. It cannot be concluded that dietary fat caused diabetes.

        Since trans fat was banned in 2013, many studies so far mixed trans-fat with saturated fat.

        One more thing, there are many natural doctors successfully treating and curing autism, diabetes and cancers employing high fat schemes (80% calories from fat). This anecdotal evidence contradicts those studies that associating diabetes with high intake of fat.

        1. Well, clearly you and the scientific community disagree on this point.

          If by ‘natural doctors”, you mean naturopaths then I would suggest that you treat all their claims and assertions with a great deal of caution. They do not have a scientific (or to my mind a fully rational) approach to health and nutrition matters. They still employ discredited and magical approaches such as homeopathy.

          Anecdotal evidence is a very weak form of evidence.You can find anecdotal evidence to support virtually any proposition no matter how absurd. n That is why carefully designed and executed experimental and observational studies are preferred.

          “Anecdotal evidence (also proof by selected instances, or, more pejoratively, anecdata) is use of one or more anecdotes (specific instances of an event; stories) to either support or refute a claim. The use of anecdotal evidence to draw a conclusion is like using the NBA all-star teams to estimate the average height of Americans.
          Whereas anecdotal evidence is sometimes the starting point of a proper scientific investigation, it is all too often the ending point and every point of a pseudoscientific investigation. In the world of pseudoscience, an anecdote is the equivalent of a peer-reviewed, double-blind, repeatable scientific experiment with consistent results. In other words, the true believers accept that just because something once seemed to work for someone then it will work for everyone, everywhere, every time!
          Anecdotal evidence is often used in politics, journalism, blogs and many other contexts to make or imply generalisations based on very limited and cherry-picked examples, rather than reliable statistical studies. A classic instance was Ronald Reagan’s story of a “welfare queen” who was abusing the system, who Reagan attempted to portray as indicative of the average welfare recipient. It turned out she didn’t even exist when some reporters finally decided to look for her.
          Anecdotal evidence is especially vulnerable to confabulation or outright deceit.
          Remember: the plural of “anecdote” is not “data”.[note 1]”

            1. Hi Jason

              To be honest, I can’t keep up with the serious literature on health and nutrition let alone what is said in the blogosphere, especially the wackier end inhabited by the likes of the Weston Price Foundation.

              The point about the Masterjohn article that leaps out at me is that it ignores the rest of the evidence base concerning fat and T2D in humans. That evidence consists of much, much more than a couple of mouse studies. It consists of experimental studies, observational studies and the identification of mechanisms by which dietary (saturated) fat damages the endocrine system. Of course other factors impact T2D risk such as obesity/BMI which can modulate the effects of dietary fat. but ,taken in toto, it indicates a key role for dietary saturated fat

              “In the past couple of decades, evidence from prospective observational studies and clinical trials has converged to support the importance of individual nutrients, foods, and dietary patterns in the prevention and management of type 2 diabetes. The quality of dietary fats and carbohydrates consumed is more crucial than is the quantity of these macronutrients. Diets rich in wholegrains, fruits, vegetables, legumes, and nuts; moderate in alcohol consumption; and lower in refined grains, red or processed meats, and sugar-sweetened beverages have been shown to reduce the risk of diabetes and improve glycaemic control and blood lipids in patients with diabetes. ”

              “A high-fat, low-carbohydrate intake reduces the ability of insulin to suppress endogenous glucose production and alters the relation between oxidative and nonoxidative glucose disposal in a way that favors storage of glucose. ”

              You might want to look at some of the professional literature on this rather than higher tendentious blogs by agenda driven individuals writing for fringe websites. A few places to start are below:


              Of course, Dr G has a number of videos on this topic which describe the evidence much better than I can, eg:


      1. if it was immediately mediated by glucagon then how would we even know that animal protein increases insulin secretion in the first place?

  11. I am not going to waste my time watching videos of fad diets like Paleo. Until there is scientific evidence that there is something better than a whole plant-based diet I see no reason to continue finding fault with other diets. Yes, there is a whole world out there with heart disease and diabetes but most of them are not going to change regardless of the evidence…

  12. This does not hold up with my clinical experience with clients nor with my own personal story or that of my family’s. In fact, a carb rich plant based diet lead myself and many of my clients to end up gaining weight and losing health. I don’t believe in a one size fits all diet but I do know that low fat and whole grains do not work well for everyone long term. I especially see profound benefits in children’s cognition and behavior as well as their athletic ability when they move to a more Paleo like nutritional template as their framework. I don’t like the dogma about a Paleo diet. It can be plant based and carb rich with the use of starchy tubers if needed to support higher energy needs such as those that do Crossfit (I often see those folks eating too low carb). I personally eat more plants than meat and encourage my clients to do the same. Not everyone can tolerate a ton of plants though, sometimes a short term dietary intervention is needed to support healing digestive function. Bioindividuality – it’s about what works for you.

    1. I don’t see that in the scientific literature at all. However, since your stories are anecdotal and cannot be verified I guess you can safely make any claim you want without being afraid of someone proving you wrong.

    2. How can you have clinical experience with clients if you don’t have any recognizable certifications? What foods are you referring to when you say carb rich and was carb rich accompanied by low fat or was it a high carb/high fat diet? Also do you test athletic ability when you meet with clients or just going by what they tell you?

  13. This is a great article. I would like to add, though, that there is a proportion of people (those with digestive issues like IBS, SIBO, most autoimmune diseases) who won’t be able to tolerate a diet with such a high proportion of carbs. These people remain more asymptomatic on diets like the autoimmune Paleo/autoimmune protocol. In extreme cases, diets like the specific carbohydrate diet or even the low-FODMAPs diet could be used.

  14. I’m sorry, but the basis of your argument is so very wrong. Excess protein glucosifies and thus causes insulin spikes. The low-carb/paleo ethos doesn’t promote an excess of protein. The low-carb high fat ethos, or ketogenic diet promotes a low-carb diet with a moderate intake of protein but a high intake of fat. The high fat intake in key, and that’s what you’re missing here. You’re branding a low-carb diet ineffective when you’re comparing a high-carb diet with a high-protein diet, instead of a low-carb high fat diet. Low-carb does not equate to a high-protein diet.

    1. The largest paleo promoters advocate high-protein diets. It’s not like high-fat diets would be so much better but for different reasons.

    2. How can you have high fat without high protein? Unless they are eating a ton of avocados. High fat animal products go hand in hand with high protein.

      1. Easily…full fat dairy, oils. The standard macros for a Low Carb High Fat diet is 70% fat, 20% protein, 10% carb. I’m hitting this more or less every day with very little effort. Breakfast would be full fat greek yogurt with nuts/seeds/berries/shredded coconut, lunch would be a salad with salmon, olive oil dressing, dinner could be steak with garlic butter, or an omlette with cheese and bacon…It’s really not that hard to get to 70% fat.

        1. You mentioned nuts, seeds, cheese, bacon and steak. All high fat/high protein foods. On a 2,000 calorie diet, your 20% protein would equal 100 grams which is alot unless you are very active. 171 grams of fat and 24 grams of carbs. That is a high fat, high protein, low carb diet.

            1. lol Sara so if you are not in this so called Nutri-babble-sphere then I guess you don’t study nutrition. Whether the 20% of calories from protein is high or not depends on the persons weight, total calorie intake and lifestyle among other things. 20% may not be high to an athlete, bodybuilder or active individual but for someone who is sedentary or does not have much muscle mass may be overconsuming. (most people)

    3. There is very little evidence that high fat low carb diets are harmless let alone healthy. Claims to the contrary seem to be mostly assertions of faith based on specious reasoning.

      Studies showing increased mortality is associated with low carb diets do not distinguish between high fat and high protein diets. Claiming that only high protein low carb diets are problematic does not seem to have much solid science behind it. Full fat dairy is of course high in saturated fat. All credible health authorities recognise that high saturated fat consumption is dangerous eg

      Definitions of high and low are relative and to a degree subjective. However, 20% protein is certainly higher than the US average. Also, a diet delivering 20% of calories from protein is fairly widely regarded as a high protein diet.

      The WHO recommends 10-15% of calories should come from protein and fat should not exceed 3)%

      “The Expert Report’s specific recommendations on diet include limiting fat to between 15 and 30 percent of total daily energy intake and saturated fats to less than 10 percent of this total.

      Carbohydrates, the report suggests, should provide the bulk of energy requirements – between 55 and 75 percent of daily intake and free sugars should remain beneath 10 percent. Protein should make up a further 10-15 percent of calorie intake and salt should be restricted to less than 5 grams a day. Intake of fruit and vegetables should be plumped up to reach at least 400 grams a day.”

      So you may be deceiving yourself if you think that you are eating and advocatting a low protein diet.

      1. Tom Goff: M reaction upon seeing that someone was eating 20% protein, primarily from animal sources, was to remember Campbell’s work and how animal protein above 10% promotes cancer growth. I struggle with how to define high and low for macronutrients, but most of the time I think the number have to be in relationship to known healthy and unhealthy amounts. The authorities you site must know something of the research to come to the conclusions they did.

    4. “Dietary fat has been implicated in the development of insulin resistance in both animals and humans. Most, although not all, studies suggest that higher levels of total fat in the diet result in greater whole-body insulin resistance. Although, in practice, obesity may complicate the relationship between fat intake and insulin resistance, clinical trials demonstrate that high levels of dietary fat can impair insulin sensitivity independent of body weight changes. In addition, it appears that different types of fat have different effects on insulin action. Saturated and certain monounsaturated fats have been implicated in causing insulin resistance, whereas polyunsaturated and omega-3 fatty acids largely do not appear to have adverse effects on insulin action.”

  15. You list a few studies but have no references to back it up. How many participants, what was the control, how did they test, etc. You give no details. Interesting but incomplete.

    1. Ben: Are you referring to the blog /article from Dr. Greger? If so, look for the words in green. At least, that is how it appears on my screen. Those words in green are links to the studies so that you can answer those questions if you want.

      1. Hi Thea – I’d like to offer up a suggestion. Regarding the “words in green” which are links to additional information that Dr. G. references. You are somewhat helping me to make my point – I find it very difficult to see the words in green and the links that they are . I would like to suggest that whatever “words in green” that Dr. G. chooses to use (for our benefit of course) that he consider putting them in all caps or perhaps a brighter (yellow? red?) color that is easier to see. I’ve had a difficult time seeing the links.
        Thanks alot!!

        1. Guest: As a volunteer moderator, I don’t have any influence over these decisions. However, I’ve been told that the great techy people who operate this site read the comments precisely for suggestions such as yours. I think it is a very good idea personally. Hopefully the staff will see your request and take some action. Fingers crossed.

  16. What a stupid article and written my a doctor no less … It may as well be written by registered dietician. I eat only raw meat and raw eggs with lots of butter. And I plan on eating this way for the rest of my life. I used to be a raw food vegan and fruitarian and I lost all my upper teeth. I have dentures to prove that being a plant eater is not good for your health.

    1. Amazing that people will walk right by a century of peer reviewed nutritional research in order to embrace the diet of an obese mortician who changed his diet from truly hideous to merely appalling. As is so often said, people love to hear good news about their bad habits. And who wouldn’t want to be able to eat at least some of their favorite bad foods and lose weight! Sounds good. The trouble is that while they are aiming to reach a goal, they are aiming at the wrong goal. They labor under the mistaken idea that weight is the cause of ill health, and so they only need to lose weight in order to be healthy.

      Sure any reduction from a BMI of 32 to 25 (as Banting did) will improve ones health. But completely lost on the low carbers is whether they are as healthy as they could be at their lower weight. Did they not just reduce their blood pressure, but get it under 110/65, which is what it is in population without heart disease? Did they eliminate their insulin resistance and reverse their diabetes, or did they just manage to control their diabetes a little better? Did they get their total cholesterol level to under 150? And even more important, were they able to hit those health markers while also eliminating all of their medications. The answer is almost certainly not, and so they hit their target, it was just the wrong target.

  17. The Paleo WOE is a template not a diet. It can be low OR high carb, it can be mostly meat or mostly plants, whatever you need it to be.

    Why does Dr. Greger have to lie to promote something he says he believes in?

    Paleo for athletes is a much higher carb template. Why not simply be honest?

    1. so it comes out as the Paleo Diet and now all of a sudden it’s not a diet anymore? The first time Paleo became mainstream it was focused on meat and then some new comers realized how crazy the diet was and started making new Paleo diet plans including alot more veggies.

    1. Carol Orrell: Where do you get your definition of a Paleo diet? Can you link us to a recognized authoritative paleo site defining the diet? I would be interested to see what it says about what is allowed, not allowed, and “permitted”.

  18. As a CrossFitter, it is not about no insulin. It is about the ability to control how much is rampant in your body. You are attacking a culture you know nothing about. We as a community don’t believe in Atkins either. You should fact check your comments before you run your mouth. Come find me if you like. Dustin Sargent-Davis, find me on FB. We can have a realistic chat about your delusions.

    1. Dustin Sargent-Davis: 1) This is a place for respectful dialog. Watch the attitude please. Consider yourself warned. – Moderator.

      2) I’m honestly wondering if you read the blog post? The post never says that people who participate in CrossFit exercise “believe in Atkins”. The blog post is sharing the results of a scientific study that just happened to put people on a paleo diet *and* a CrossFit exercise program and watched what happened.

      In other words, this page is not about beliefs. It is about a study that shows that even an awesome exercise program like CrossFit is not enough to help someone overcome the disadvantages of including meat in their diet:

      “But a new study published in the International Journal of Exercise Science is pretty concerning. Researchers took young healthy people, put them on a Paleolithic diet along with a CrossFit-based, high-intensity circuit training exercise program.

      If you lose enough weight exercising, you can temporarily drop your cholesterol levels no matter what you eat. You can see that with stomach stapling surgery, tuberculosis, chemotherapy, a cocaine habit, etc. Just losing weight by any means can lower cholesterol, which makes the results of the Paleo/Crossfit study all the more troubling. After ten weeks of hardcore workouts and weight loss, the participants’ LDL cholesterol still went up. And it was even worse for those who started out the healthiest. Those starting out with excellent LDL’s (under 70), had a 20% elevation in LDL cholesterol, and their HDL dropped. Exercise is supposed to boost our good cholesterol, not lower it.

      The paleo diet’s deleterious impact on blood fats was not only significant, but substantial enough to counteract the improvements commonly seen with improved fitness and body composition. Exercise is supposed to make things better.

      On the other hand, if we put people instead on a plant-based diet and a modest exercise program, mostly just walking-based, within three weeks their bad cholesterol can drop 20% and their insulin levels 30%, despite a 75-80% carbohydrate diet, whereas the paleo diets appeared to “negate the positive effects of exercise.”

      Do you have a comment about the study?

  19. As far as I remember, the idea behind paleo diet was to eat like our ancestors did back when they were healthy, no idea why one blogger going on about insulin is supposed to represent all paleo dieters? It’s really funny how you use examples how meat produces more insulin than apple, when apple is far away from being prohibited on paleo diet. If you want to learn something about paleo diet w/o acting like an *** assuming stuff, you might wanna look up glycemic index, which is what paleo diet comes down to, and where both apples and meat fair excelent making them paleo choices,

    I do however like how while trying to undermine paleo diet for eating meat, you inadvertently showed just how unhealthy veganism is for not eating meat, and how it causes diabetes. Good work

  20. Does Dr. Berg have any actual evidence that eating fatty meat decreases any disease or premature death? All the real peer-reviewed published evidence clearly shows that people that eat fatty meat are at much higher risk for diabetes, heart attack, obesity, stroke, cancer and premature death.

    Dr. Ben

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