Long-Term Study on the Paleo Diet: The Results

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Some good news for the Paleo community – in a new study, the Paleo diet proved superior to the Nordic Nutrition Recommendations (outdated low-fat dietary guidelines) in terms of greater improvements in weight, waistline and blood lipids (triglycerides).

The advantages were statistically significant after six months, but as always in diet studies the average differences decreases with time, as many people fall back into old habits. After two years the positive impact on blood lipids was still big enough that it was statistically significant. The low-fat diet, on the other hand, provided no benefits at all.

Now there are long-term studies (two or more years) showing that a low-fat diet is worse in many ways than an LCHF-similar diet, a higher-fat Mediterranean diet and the Paleo diet. Thus, it seems that our official dietary guidelines are worse for our long-term health than just about all sensible dietary recommendations.

More

The Stone Age Meets the Future

Did Your Ancestor Look Like This?

The Paleo Movement of a Hundred Years Ago

Low Carb Paleo With Mark Sisson

All on Paleo Diets

55 Comments

Top Comments

  1. mezzo
    The low-fat diet, on the other hand, provided no benefits at all. And that is almost the most important message!!
    Read more →
  2. Did they really "fall back into old habits"? If so, why?

    It's called "human nature". ;)

    Reply: #34
    Read more →

All Comments

  1. mezzo
    The low-fat diet, on the other hand, provided no benefits at all. And that is almost the most important message!!
  2. charles grashow
    Reading the FULL study might be of benefit

    https://docs.google.com/file/d/0Bz4TDaehOqMKZDd5YWtOeW4yc3ZWRmJFMmd5c...

    Both groups significantly decreased total fat mass at 6 months (−6.5 and−2.6 kg) and 24 months (−4.6 and−2.9 kg), with a more pronounced fat loss in the PD group at 6 months (P<0.001) but not at 24 months (P=0.095).

    Take a look at TAble 2

    The PD had 46.2% carbs - that's paleo??

    Reply: #17
  3. v
    "The advantages were statistically significant after six months, but as always in diet studies the average differences decreases with time, as many people fall back into old habits."

    Do you have any data supporting the claim that the differences decreased because people didn't comply as much as time went on?

    That is a claim I see often, but it is rarely investigated. Did they really "fall back into old habits"? If so, why?

    Replies: #5, #6
  4. FrankG
    Long-term dietary intervention trials: critical issues and challenges

    "Conclusion

    Attrition and adherence to study requirements present challenges to trials requiring longer-term dietary change. Including a run-in period to further assess the motivation, commitment and availability of participants, maintaining regular contact with participants during control phases, minimising time commitment, providing flexibility with dietary requirements, facilitating positive experiences, and stringent monitoring of diet are some key recommendations for future dietary intervention trials. "

    http://www.trialsjournal.com/content/13/1/111

    Do you have any evidence to the contrary?

  5. Did they really "fall back into old habits"? If so, why?

    It's called "human nature". ;)

    Reply: #34
  6. Zepp
    Here seven of the control group switch to the low carb group.. by there own demand!

    "Seven of the 15 controls switched to a 20% carbohydrate diet immediately after the 6 months follow-up period. For those we have data 32–34 months after the change."

    http://www.nutritionandmetabolism.com/content/5/1/14

    Soo.. there you have your compliance!

    Reply: #8
  7. FrankG
    Sure Zepp but please recognise the difference between a motivated individual making an informed free-choice outside the trial.. a person who is looking for results, likely based on what they learned from other participants during the trial, COMPARED to someone who is less motivated to "stick with it" but does so, at least at first. while the study is new, exciting and in full-swing. In this latter case as Dr Andreas points out, it is only human nature to fall back on old habits.

    For myself, where LCHF is literally a life-saver, I am very well motivated and have no trouble sticking with it for several years now -- so long in fact that LCHF has now become my "old habit" -- but for another person who sees less immediate feedback, has less to gain (or less to lose), things would very likely be different :-)

    I thoroughly enjoy what I eat, I find it varied, tasty and very satisfying but I do still recognise the pressures all around me to "conform" to what society sees as the "normal" Western diet, especially when I have to travel and eat away from home, for my work.

  8. Wade Henderson
    What you fail to include is that the Nordic Nutrition Recommendations have almost nothing to do with what is usually called the "low-fat" diets of Dean Ornish, John McDougall, and the rest of that low-fat crowd.

    They normally call for a fat intake of 10% to 15% of calories... with a very upper level of 20% on some of their "prevention" diet options.
    Say around 12.5% would be their average "low-fat" diet.

    On the other hand, depending on which version of the Nordic Nutrition Recommendations you use, here is how it is described

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3790914/
    ---------------------------------------------------------------------------------------------
    Nevertheless, some changes are noteworthy in this edition. These reflect shifts in knowledge with roots in 1996 to 2004 and later 2008. In 1996 (13), the recommendation for total fat intake was ‘not more than 30% in total energy intake (E%)’. In 2004 (14), the recommendation was given as a range (25–30 E%), and 30 E% (precisely, instead of less than) was given as the population planning. In the most recent edition, the recommended range is 25–40 E% and for planning 32–33 E%. This is an interesting trend towards gradually loosening restrictions in total fat intake. Looking at the changes in different types of fats, we see that the increase in total fat intake is associated mainly with an increased upper limit for mono-unsaturated fatty acids. I would no longer call the NNRs a ‘recommendation for low-fat intake’ – although this is still a misconception many (lay) individuals seem to have.
    ------------------------------------------------------------------------------------------------

    So you are throwing together the 12.5% and 32.5% "low-fat" diets and declaring them all less effective.
    It may be true, but there in nothing in the report that is available to us, to indicate such a advantage.

    How about you give us the "version" of low-fat that was actually used in the study?

    Reply: #51
  9. Galina L.
    I guess, the Paleo diet was too high in carbohydrates to cause a dramatic improvement in the health and the sense of a well-being for the people in the study to be motivated enough to stick with it long-term. I experienced dramatic change more that 6 years ago from a switching on a very LC diet, once in a while I eat something outside of my diet, but swollen feel and sluggishness next day motivate me to jump back promptly. I also use LCarbing as a migraine prevention.

    It is amazing that even high-carb Paleo diet was better than a low-fat one.

  10. Wade Henderson
    OK, I found out the details of the "low-fat" diet used in the Nordic Nutrition Recommendations group.

    Their baseline was 34.6% of calories as fat.

    Their 6 month was 32.3% of calories as fat.

    Their 2 year was 34.9% of calories as fat.

    Yes, that is quite some low-fat diet they were on.
    Ending up higher at the end then at the baseline.

    So the conclusion is that the paleo version worked better than "no change" ?

  11. Paul the rat
    For me weight is, as I stated many times here, a tertiary issue when LCHF is concerned, but it does not hurt to argue about it. About CICO; who lost when and what; how much and how; and such like. Endlessly.

    http://www.jlr.org/content/early/2014/02/06/jlr.R046797.full.pdf

  12. charles grashow
    From the full study

    "The PD provided 30% of energy intake (E%) from protein, 40 E% fat and 30 E% carbohydrates and included a recommendation for a high intake of MUFA and polyunsaturated fatty acids (PUFA). The diet was based on lean meat, fish, eggs, vegetables, fruits, berries and nuts. Additional fat sources were avocado and oils (rapeseed and olive oil) used in food preparation and dressing. Dairy products, cereals, added salt and refined fats and sugar were excluded.

    Reported daily energy intake decreased over time, without significant differences between groups (Table 2). The PD group had a 19% and 20% lower reported energy intake and the NNR group 18% and 12% lower reported energy intake at 6 and 24 months, respectively. The PD group reported a significantly lower intake (E% andg/day) of carbohydrates, higher intake (E% and g/day) of protein, MUFA, PUFA, cholesterol and higher total fat (E%), MUFA:SFA (saturated fatty acid) and PUFA:SFA ratios compared with the NNR group (Table 2). The PD group reported a more pronounced change in the ratio (E%) protein:carbohydrates:total fat from baseline to 6 and 24 months (17:46:33, 23:29:44 and 22:34:40, respectively) compared with the NNR group (17:45:35, 19:48:32 and 17:43:34, respectively). Target intakes were not fully achieved; the PD did not reach the target amounts of percentage energy of protein (30 E%) at 6 and 24 months, and the NNR group did not reach the target amounts of carbohydrates (55–60%)."

  13. Paul the rat
    even vegans become unsettled. fancy that.

    BMJ Open. 2014 Feb 5;4(2):e003505. doi: 10.1136/bmjopen-2013-003505.
    Effect of a 6-month vegan low-carbohydrate ('Eco-Atkins') diet on cardiovascular risk factors and body weight in hyperlipidaemic adults: a randomised controlled trial.
    Jenkins DJ, Wong JM, Kendall CW, Esfahani A, Ng VW, Leong TC, Faulkner DA, Vidgen E, Paul G, Mukherjea R, Krul ES, Singer W.
    Author information

    Abstract
    OBJECTIVE:
    Low-carbohydrate diets may be useful for weight loss. Diets high in vegetable proteins and oils may reduce the risk of coronary heart disease. The main objective was to determine the longer term effect of a diet that was both low-carbohydrate and plant-based on weight loss and low-density lipoprotein cholesterol (LDL-C).
    DESIGN, SETTING, PARTICIPANTS:
    A parallel design study of 39 overweight hyperlipidaemic men and postmenopausal women conducted at a Canadian university-affiliated hospital nutrition research centre from April 2005 to November 2006.
    INTERVENTION:
    Participants were advised to consume either a low-carbohydrate vegan diet or a high-carbohydrate lacto-ovo vegetarian diet for 6 months after completing 1-month metabolic (all foods provided) versions of these diets. The prescribed macronutrient intakes for the low-carbohydrate and high-carbohydrate diets were: 26% and 58% of energy from carbohydrate, 31% and 16% from protein and 43% and 25% from fat, respectively.
    PRIMARY OUTCOME:
    Change in body weight.
    RESULTS:
    23 participants (50% test, 68% control) completed the 6-month ad libitum study. The approximate 4 kg weight loss on the metabolic study was increased to -6.9 kg on low-carbohydrate and -5.8 kg on high-carbohydrate 6-month ad libitum treatments (treatment difference (95% CI) -1.1 kg (-2.1 to 0.0), p=0.047). The relative LDL-C and triglyceride reductions were also greater on the low-carbohydrate treatment (treatment difference (95% CI) -0.49 mmol/L (-0.70 to -0.28), p<0.001 and -0.34 mmol/L (-0.57 to -0.11), p=0.005, respectively), as were the total cholesterol:HDL-C and apolipoprotein B:A1 ratios (-0.57 (-0.83, -0.32), p<0.001 and -0.05 (-0.09, -0.02), p=0.003, respectively).

    CONCLUSIONS:
    A self-selected low-carbohydrate vegan diet, containing increased protein and fat from gluten and soy products, nuts and vegetable oils, had lipid lowering advantages over a high-carbohydrate, low-fat weight loss diet, thus improving heart disease risk factors.
    TRIAL REGISTRATION:
    clinicaltrials.gov (http://www.clinicaltrials.gov/), #NCT00256516.

  14. Rozzy
    Did anybody check out "low carb fraud" by Colin Campbell!
    Reply: #21
  15. charles grashow
    @Paul the rat

    What do you mean by " vegans become unsettled."

    BTW - here's the full study

    http://bmjopen.bmj.com/content/4/2/e003505.full

    "The study's strength is that the prescribed hypocaloric diet was self-selected, meaning the results are more in line with what can be expected under free-living conditions. The breadth of application of the plant-based low-carbohydrate diet, however, remains to be determined, but it may provide an option for some individuals for whom LDL-C reduction is an equal concern to weight loss. If low-carbohydrate dietary options become more generally available the number of individuals who will benefit is likely to increase.

    We conclude that a weight loss diet which reduced carbohydrate in exchange for increased intakes of vegetable sources of protein, such as gluten, soy and nuts, together with vegetable oils offers an opportunity to improve both LDL-C and body weight, both being risk factors for CHD. Further trials are warranted to evaluate low-carbohydrate diets, including more plant-based low-carbohydrate diets, on CHD risk factors and ultimately on CHD."

    Reply: #18
  16. Boundless
    > The PD had 46.2% carbs - that's paleo??

    I'm not the least bit surprised that you turned that up.

    My first reaction on reading the base article here was that "paleo" is very far from a specific diet, much less a necessarily low-carb high-fat diet. Heck, many paleos consume what they think is honey and so-called agave nectar, and even in the rare case the goo is authentic, it's still almost pure carb and loaded with free fructose.

    We may eventually get some trials vs. low fat that aren't confounded on the non-low-fat side (by excess/hidden carbs, adverse fats, and compliance issues). But I suspect by the time we do, every thinking person will have long since figured out what to eat on their own - and it will be a diet that is easy to stay on indefinitely.

  17. Paul the rat
    @ charles grashow
    I posted links to 2 papers (#12 and #14) you responded only to #14. You see, you never comment (as it is the case with other anti-LCHF campaigners) about health benefits (other than weight loss and blood chemistry) of ketogenic state. Reduction of cancer growth is one of many positive effects of ketosis on human physiology, however ketogenic state can be achieved (easiest) by LCHF and this is why you will never discuss these benefits - you simply do not have an argument, just CICO and weight. We all agree here that weight can be lost and managed by many means but only ketosis provides our bodies with unique benefits - which we discussed at dietdoctor at length.
  18. Galina L.
    Somehow I stopped receiving notifications about new comment from that blog even though I checked the box.
  19. charles grashow
    @Paul the rat

    If I were diagnosed with cancer I would certainly investigate a ketogenic diet as well as all other treatment options including chemotherapy and radiation - But I don't so I don't see what that study proves with regard to people who don't have cancer

    As to the unique benefits of ketosis - exactly what are they - please list them here

    Replies: #27, #29
  20. Galina L.
    Rozzy,
    Lori checked it out.http://relievemypain.blogspot.com/2013_11_01_archive.html a while ago.
  21. charles grashow
    @Galina L

    Did you bother to actually read the book?

    Reply: #24
  22. Galina L.
    @Charles, I never said I did, and I wouldn't bother for sure. The title is very suggestive, and I disagree with the suggestion. Unlike Dr.Campbell, I had a chance to find out for myself how well LC diet worked. It has limitations, but It changed my life, unlike any diet I tried before.
    It also caused more health improvement than just a weight-loss.
  23. Lori Miller
    I read The Low Carb Fraud very carefully. It's so full of inaccuracies that people given to drinking games could make a game out of reading it aloud and taking a shot every time they found a falsehood. Short as the book is, they wouldn't get through it before they were too drunk to stand up.
  24. Damocles
    I always wonder why these studie mix compliance with diet results.

    If I want to find effects of the factor "diet" I would filter out everyone who is not 100% complient.
    They dont represent the tested diet.

    If I want to test real-life compliance, I would arrange the goups into differenly advice-methods, rehersal groups and monitoring methods and see how well people stick to it, and how much support they need.

    Mixing several variables creates just to many interpretations.

  25. Oscar
    Paleo is not low carb.
  26. Paul the rat
    @ charles grashow

    more carbohydrates more insulin, more LCHF less insulin

    less insulin less cancer (onset- most importantly and growth)

    for details of above and other benefits of ketotic state go PubMed, your local library or surf dietdoctor

    Reply: #28
  27. murray
    Paul, personally I felt I had no reason to worry about heart disease, diabetes or cancer with a low-sat-fat, fairly low fat, real food diet (no acellular starch or sugar) with plenty of exercise. However, I found I could not shed that last 10-15 pounds no matter how hard I tried, working out daily, at least 30 minutes of shirt-drenching sweat. Then I discovered a cheese course and started doing research due to concerns about dairy sat fat, and eventually switched to a moderate LCHF diet with cheese. When I was laid up with a shoulder injury for a few weeks and stopped working out, I quickly lost 15 pounds without trying. So something about LCHF was different.

    LCHF produced numerous health benefits for me, even though comprehensive health physicals had pronounced me healthy on my earlier diet. (I had had the second best VO2 max recorded at the clinic, bested only by a professional triathlete.) Little things, like tinnitus disappeared. Much improved skin health, amazing my wife. There was a catalog of these kinds of improvements for me. Then my hair started greying so I went very low carb (about six years ago) and this reversed the greying. I have since gone keto and noticed even more health improvements, and still no greying, Unlike almost all my same-age peers in my profession. Osteoarthritis in my one foot that I had had for years after a sports injury (before LCHF days) has recently 90% recovered after implementing Dr. Shanahan's advice regarding bone-broth in the context of a keto diet, reversing loss of flexibility and stopping joint pain. (I never had inflammation, as LCHF is very anti-inflammatory. My CRP levels have always been near zero.).

    Reading Cynthia Kenyon's work and papers you have posted, it seems clear metabolically why this is the case, contrasting the metabolic effects of insulin and ketones. Insulin accelerates degeneration with age, whereas keto metabolically signals the body to enter a reparation mode, delaying or even reversing degeneration with age. This is what the metabolics suggest and this has been my experience.

    So I don't think keto-LCHF is necessary for maintaing healthy body fat or avoiding chronic disease, nor even LCHF for those that are not insulin resistant (with the "L" varying with the degree of insulin resistance). What I find intriguing, though, is the widespread hostility to the concepts of LCHF and keto-LCHF.

    Replies: #30, #31
  28. Zepp
    1.Less blood sugar.
    2. Less glycated blood cells.
    3 Even blood sugar.
    4. Less insulin
    5 Lower blood preasure
    6 Longer time betwen meals.. aka IF!
    7 Lower triglycerids.
    8 Higher HDL.
    9 Often bigger and boyant LDL.
    And soo on!
  29. Paul the rat
    @ murray & Zepp

    Gentlemen, no matter how many benefits of LCHF/ketosis you will list citing published scientific work or personal stories, such like GalinaL, yours Murray or mine, people like charles grashow will close their ears and run away for the reasons only they know (or do not know) themselves.
    I agree with you Murray, hostility toward LCHF is intriguing, but when you look at history of human-kind, there was always hostility towards, let us call it generally - goodness.

  30. FrankG
    "What I find intriguing, though, is the widespread hostility to the concepts of LCHF and keto-LCHF."

    Indeed.... and I find it perverse that there are those who apparently devote inordinate effort to follow, read (although I'm not so sure about this) and comment (invariably negatively) on LCHF blogs like this; when they are so clearly hostile to the concepts. What is their point? Do they think they are making converts or something? Is it their place to try and right the world as they see it?

    Frankly I have better things to do with my time that waste breath on sites like the screaming harpy Carb-Insane (AKA Evil-Lyn) or the slimy, manipulative Stephan Guyenet. I tried reading them, I tried reasoning with them... I learned my lesson and moved on.. let them stew in their own juice for all I care.

    I know what works for me and apparently it works for a great many others.

    All the unconvincing protestations and the constant child-like nit-picking from people like Charles, simply underline for me how wrong the status quo is and why we need to keep promoting LCHF and critical, free-thinking.

    ---

    “All truth passes through three stages: First, it is ridiculed; Second, it is violently opposed; Third, it is accepted as self-evident.” ― Arthur Schopenhauer

  31. Galina L.
    The problem with many diets - the adherence. People need to find ways how to motivate themselves, and I think Charles does what he does in order to feel he is right about his health choices, which many on a LC blog would find questionable.
    He recently tried to defend the use of statines on the Hyperlipid.
  32. v
    My questions were serious.

    Did they really fall back into old habits?
    Is there any data on that? Or did their appetite catch up with the lower caloric intake, and then they started to eat more (still within the rules)?

    If they did fall back into old habits, why?
    Did they feel bad, or get sick? Did they see so little benefit that they didn't see the point of continuing?

  33. charles grashow
    @FrankG
    "screaming harpy Carb-Insane (AKA Evil-Lyn) or the slimy, manipulative Stephan Guyenet"

    Name calling and personal insults shows you to be a very small person

    @Galina L
    I neither defend nor condemn statins - one needs to research BOTH sides with an OPEN mind in order to come to a proper conclusion

    Reply: #36
  34. FrankG
    "Name calling and personal insults shows you to be a very small person"

    ...and yet YOU provided a link to the screaming-harpy Carb-Insane's blog... a blog dripping in every post with vitriol, sarcasm, name calling and personal insults! LOL

    Double-standards much Charles? :-P

    And are YOU claiming to have an OPEN mind, willing to examine BOTH sides? LOL

  35. charles grashow
    screaming-harpy Carb-Insane's blog

    Pot calls kettle black?

    FrankG - how open minded are you??

    Reply: #38
  36. FrankG
    I am open-minded enough to critically apply the scientific method and follow where the evidence leads but I am not willing to slog through waist-high $hit in sewers like Carb-Insane's blog to read her biased interpretation of that evidence.

    I didn't summarily reach my opinion of Evil-Lyn but rather (as I do with everyone) gave her the benefit of the doubt. As I wrote earlier, I did read her blog, I listened to her podcast with Jimmy Moore... I tried a reasonable discourse with her. She quickly reverted to form and lost my respect.. just as you are doing.

    If you claim to be open-minded, then your comments thus far, make a liar of you.

  37. charles grashow
    "I am not willing to slog through waist-high $hit in sewers like Carb-Insane's blog to read her biased interpretation of that evidence."

    Bias is in the eye of the reader - if you think me a liar then further discourse is useless - have a nice life

    Replies: #40, #41
  38. FrankG
    I agree entirely that further discourse with you is useless and yet you persist with your obviously pro-statin agenda in the latest blog post here. Why? You're not convincing anyone, nor are you making any converts. You are just an annoying irritant... is that your intent?

    You wrote... "Lovastatin, simvastatin, pravastatin and atorvastatin are available as generic. Crestor can go generic as early as Jan 2016." ...now, who do you suppose has that kind of detailed information available to them just off the cuff like that?

  39. FrankG
    What did they make of you over at Hyperlipid..?

    Here's Peter's remark, "...look on the bright side. Where else would you find a statin-taking-vegan trying to save the world one LC blog at a time? I couldn’t make stuff up as funny as Charles."

    and STG offered, "You are so strident and combative about your health choices. What about the effects of emotions and personal interactions on heart disease and health in general? Being pissed-off at people who have chosen a different diet or approach to health seems like such a waste of your time. Do you think you are going to change anyone's perspective here? Get outdoors with like-minded souls and enjoy yourself! Or, write a book about your experience. "

    Seems I am not alone in my opinion of your input to these blogs...

  40. charles grashow
    @FrankG

    ""Lovastatin, simvastatin, pravastatin and atorvastatin are available as generic. Crestor can go generic as early as Jan 2016." ...now, who do you suppose has that kind of detailed information available to them just off the cuff like that?"

    It's called google - you might try it. As to why I have that kind of detailed information - it's very easy - when my TC went over 300 and my LD went over 200 on the paleo diet I took some tests which showed that I had some genetic problems with processing cholesterol (I'm Apo3/3 BTW) - so I started researching all of the ways to lower it - diet, supplements and yes DRUGS. So I read EVERYTHING I could find on statins - how they're made, potential side-effects, etc., and came to the conclusion that a modification of my diet (lower saturated fat but not to Ornish levels) and taking 10mgs Atorvastatin was the route I should take.

    Am I pro-statin - not really. What I am is anti- false information - SO - if you find a study that proves A and I find a study that proves B then who is right and who is wrong?

    Replies: #44, #46
  41. charles grashow
    @FrankG

    "Here's Peter's remark, "...look on the bright side. Where else would you find a statin-taking-vegan trying to save the world one LC blog at a time? I couldn’t make stuff up as funny as Charles."

    Vegan? Hardly - my daily diet includes 8-12 ounces of raw grass fed ground beef, raw goat milk, full fat goat milk yogurt/kefir and 1 whole raw egg (shell included) in my morning smoothie. So I laugh at the idea that people think I'm a vegan. I also eat nuts, seeds, fresh/frozen fruit, fresh/frozen veggies, raw cacao powder, etc.

    Reply: #45
  42. FrankG
    Yes I am well aware of Google and quite adept at using it. Just for larfs I tried to quickly recreate your list as provided above. It did not readily come out which leaves me with the same question as to why you have such detail off the cuff?

    Nice plausible story about all your research but I don't see why any of that has any relevance to you knowing which drugs are now generic and when others may become so.

    So you're still not fooling anyone and your agenda is still clear.

    If I present evidence of A and you of B why does that necessarily mean there is false evidence? Other than you building a false dichotomy of course. Evidence is evidence.

    As for being a vegan or not, I could really care less.. as ever you purposely missed the point: which is that others see through your little game and are not impressed by it... and yet you persist. Oh dear what a monumental waste of everyone's time.

  43. murray
    Charles, it sounds like "grass fed ground beef, raw goat milk, full fat goat milk yogurt/kefir and 1 whole raw egg (shell included) in my morning smoothie" has no shortage of saturated fat.

    Do you really put raw hamburger in your breakfast smoothie? Wow. And I get grief for having raw egg or yolk, avocado, kefir, sheep milk yoghurt, olive oil and some Roquefort cheese in my morning blend. (Mine is a thick emulsion in a small bowl with some cranberries and nuts or seeds sprinkled on top for texture). I don't eat the shell, but I get awesome duck eggs that have such hard shells I peel out the lining out and have that. You will be my new benchmark, as in "Hey, I am not as extreme as Charles Grashow of DietDoctor forum." Thanks for plowing the way.

  44. bill
    charles grashow said:

    "...when my TC went over 300 and my LD went over 200 on the paleo diet..."

    Who is talking about a paleo diet?

    This blog is about LCHF.

    You seem confused.

    Also, do you really know what cholesterol is? Try this ten part
    treatise on Dr Peter Attia's site:
    http://eatingacademy.com/nutrition/the-straight-dope-on-cholesterol-p...

    When you can comprehend that, come back and we'll talk.
    Thxbye

  45. coffeebrain
    Speaking of paleo....I love eating paleo! It's improved my health like nothing else. What I don't like are the elite authors ordering us to eat organic or grass fed ONLY...yeah, like the masses on a budget can really afford grass fed or organic.

    I found a wonderful little book on amazon titled The 3Word Diet by Sam Charles. This simplified paleo into simple guidelines that I can actually follow! I bought the kindle edition for 99 cents and liked it so much, I went and ordered the paperback (for only $4.49!) because I like hard copy. It's a little book, and worth its weight in gold.

    In this book the author says that grass fed is better than grain fed, but grain fed is better than no meat at all. I heartily agree! We need a plan that EVERYONE CAN FOLLOW! Would you tell a ghetto family to eat boxed mac and cheese with a side of canned corn, or just eat the cheapest, fattiest ground beef you can buy with a side of frozen broccoli? I know what my recommendation would be!

    Sorry for the rant, but honestly, some of these paleo book foodie authors just do not live in the world I live in.

  46. charles grashow
    @Bill

    The paleo diet I was on WAS LC. Also if youread Attila he gives great weight to LDL-P and reducing it to <1000

    Look at Parts IV and V.

    @Murray

    NO - the raw meat doesn't go in my morning smoothie - that's what I have for dinner - the smoothie(s) consist of fruits, veggies, nuts, seeds, comb honey, cacao powder, raw greed fed whey protein powder, the whole raw egg, stc.

    Replies: #49, #50
  47. murray
    I am a bit disappointed. (I am always curious as to what flavour combinations people enjoy, to guide my own flavour experiments.) The syntax in the sentence was misleading. I assume the raw goat milk and everything that followed is in the smoothie. Personally I use the yoghurt instead of whey powder, on the presumptive principle that real is better than processed.

    From what I have seen, all-cause mortality is minimized between 6.5 and 8.0 mmol/L total cholesterol (about 250-310 mg/dL), which makes sense, since cholesterol is ubiquitous in body tissue and a steady supply is essential for effective reparation. It also makes sense that total-C would rise in keto, as keto is a reparation metabolism for the body. So the studies showing mortality lowest between 6.5 and 8 are metabolically plausible.

    Of course it is important that other indicators are not out of line. As you note, the number of LDL particles can be a concern. However, even there, it seems the ratio of LDL particles to HDL particles, as well as the ratio of LDL cholesterol to HDL cholesterol matter more. If the CETP is not fully functional (cholesterol ester transfer protein) to keep moving cholesterol from HDL to LDL to keep the latter buoyant and resistant to oxidation, there could be trouble and the ratios may get out of line. One needs be concerned with signs of endothelial damage, from sugar glycation, sheer stress without sufficient recovery time, etc. (I have significantly reduced how often I do endurance exercise on this account.) The importance of endothelial health means blood pressure is important. Flexibility is important, as an indicator of arterial flexibility. Eating ample K2-D3-retinol is important for moving calcium out of arteries--total absence of dental calculus in the absence of flossing is a good indicator the diet has adequate k2-D3-retinol. LP(a) is important as an indicator of the extent of LDL particle oxidation. CRP is relevant as an indicator of systemic inflammation. These are all pieces of the puzzle. Fixating on one parameter is like focusing on one dot in a Seurat painting.

  48. bill
    charles grashow said:

    "... Attila..."

    Wow. You really are a nasty SOB.

    "...LDL-P and reducing it to <1000..."

    ...who apparently can't type, let alone think.

  49. Mark
    How does this E% concept make more sense than either mass% or molecules% ?

    The human body does not count "calories". It could, potentially, count molecules.

    Reply: #52
  50. Paul the rat
    "...The human body does not count "calories"…"

    It does. It 'counts' energy all the time, even as we speak.

    Different energy carrying molecules (fats, amino acids, carbohydrates) are just hydrogen (H) atoms carrying molecules. H atoms are combined with oxygen (O) we breathe to produce ATP - just like in Honda engine, except in engine H+O energy is not stored but used immediately. Carbon skeletons, to which H atoms are attached as C-H, are breathed out as carbon dioxide and nitrogen, in case of amino acids, is expelled as ammonia. ATP is used as energy money by the body. To bring H atom to O atom all the way from a bite of steak casseroled in lard (i.e. from protein - amino acids, and fats - e.g. stearate) or bite of banana requires different sets of digestive enzymes, cell-surface transport proteins et cetera et cetera. Thus, producing 1 unit of ATP requires x units of H, but to bring this x units of H from fat, protein or carbs requires different energy expenditure - spend to synthesize those enzymes and carrier proteins (plus whole plethora of different hormonal responses) - this is something which CICO crowd-to my amusement-can not grasp, for some strange and unexplained reason.

    J Appl Physiol (1985). 2007 Feb;102(2):529-40. Epub 2006 Nov 2.

    Energy sensing and regulation of gene expression in skeletal muscle.

    Freyssenet D.
    Author information

    Abstract
    Major modifications in energy homeostasis occur in skeletal muscle during exercise. Emerging evidence suggests that changes in energy homeostasis take part in the regulation of gene expression and contribute to muscle plasticity. A number of energy-sensing molecules have been shown to sense variations in energy homeostasis and trigger regulation of gene expression. The AMP-activated protein kinase, hypoxia-inducible factor 1, peroxisome proliferator-activated receptors, and Sirt1 proteins all contribute to altering skeletal muscle gene expression by sensing changes in the concentrations of AMP, molecular oxygen, intracellular free fatty acids, and NAD+, respectively. These molecules may therefore sense information relating to the intensity, duration, and frequency of muscle exercise. Mitochondria also contribute to the overall response, both by modulating the response of energy-sensing molecules and by generating their own signals. This review seeks to examine our current understanding of the roles that energy-sensing molecules and mitochondria can play in the regulation of gene expression in skeletal muscle.

  51. Paul the rat
    If I may add to the above; it is my personal understanding that the best energy source for humans, i.e the best carriers of hydrogen atoms, are the long saturated fatty acids, such as those found in animal fat, the worst is glucose. I follow what I preach for almost 20 years now, with excellent health results, personal and those I know who follow LCHF - to dismay of drug companies (ain't that right Charles Grashow?). But, it could be just bunch of lies, hypnotic delusions and 'boguses' - ain't that right Gray/Simmone?

    P.S. if you do not believe what I say, I might stick a gun to your head - ain't that right Simmone?

  52. Max22
    When people come from a super super high fat 60% fat standard American diet And switch to a super high fat 35% fat paleo diet of course they lose weight. But does it reverse diabetes? Does it prevent heart attack? Does it prevent Alzheimer's? Of course not. For this you would need to go on a 80/10/10 vegan diet
    Reply: #55
  53. Galina L.
    Why everybody assumes that their opponents lived on a junk food prior to the diet low in carbs? I am a good example of a person who ate whole foods, and improved health and lost weight when I added red meat, eggs and saturated fat into my diet, after almost removing grains and safe starches.
    I don't know in which way I would be dead, but I am free from all infections so far, don't catch seasonal flues, don't need asthma medications as before, my migraines are under control, I have more energy now than before now. Most people who went on a LC diet report the same, and many paleos are former vegetarians or vegans, Denis Minger is a good example.

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