Thursday, November 5, 2009

Paleo Diet Q & A - 11.5.09

Dear Readers,

More Q & A from the Paleo Diet community:

Q: I believe in the Paleo Diet and want to introduce it into my lifestyle but I have a chronic renal condition (IgA nephropathy) which is still mild. Can I still follow this diet but eating moderate protein instead of high? Or do you have any other suggestions to how I can go about it? The doctors never advised me to restrict my protein intake but I have read many articles that says that restricting protein intake benefits renal disease sufferers.

A: Circumstantial data from the Inuit people, before westernization, suggests that they ate high protein diets for a lifetime, and likely had normal kidney function. The available human data suggests that the kidney responds to a higher protein diet by increasing the glomerular filtration rate (GFR). This response is not pathological, but rather a healthful response as the effective GFR remains constant as kidney mass increases. The analogy is like a muscle that responds to lifting more weight - it hypertrophies (gets larger) to adapt to the increased load.

Yes, people with pre-existing kidney disease will worsen on a higher protein diet. My recommendation for these people would be to reduce the glycemic load of their diet (e.g. get rid of most processed food) first and carefully monitor kidney function until it begins to improve. Ironically, it is likely a high glycemic load diet that worsens kidney function in the first place.

Q: I am not yet on the Paleo diet, though I would really like to be. I do not doubt the validity of the science or the biology that leads to the Paleolithic diet being so successful. However, living in the Western world means that just about everything has dairy and grains in it, along with unhealthy refined carbohydrates and trans fatty acids, therefore the most logical and reliable way to get a healthy Paleo diet is to buy the basic organic ingredients and make meals from them oneself.

Unfortunately, I don't know what the correct proportions of the food groups for a well-balanced Paleo diet are; i.e. how much fruit and vegetables compared with lean meat compared with nuts and seeds compared with fish, etc?

I also wanted to ask about the sorts of foods that should be eaten instead of grains and dairy. Although I am aware that calcium uptake is based on many factors besides just calcium intake, what is the source of calcium in the diet? Fish bones and the like? For grains, what should we eat instead for those meals: I know it has been said that vegetables of some kind (or fruit) should be eaten with every meal, but what does that make breakfast and lunch besides a pile of vegetables?

What else do we eat with them?

With this increase in fruit and veg consumption (about how many portions per day do you recommend?), how do we prevent ourselves getting massive diarrhoea? I personally had one point in my life where I was eating over 30 portions of fruit and five portions of veg per day. Is this too much, perhaps even to the point of being unhealthy?

Furthermore, with this increase in meat and seafood consumption, even with the reduction in grain and dairy production, will not an increased percentage of Paleo dieters hasten the trends of soil erosion and landscape damage due to the increase quantity of land required for farming to feed people?

Finally, with increased individual meat consumption, would not the risk of things like gout increase? Would it not at least potentially be risking the same health problems and complications of the Atkin's Diet?

Thank you for your help.

A: Regarding the optimal proportion of fruits, vegetables, lean meats and seafood there's not a consensus. Some studies made by Dr. Cordain et al. have shown plant to animal ratio ranges from 35:65 to 65:35 percent. This depends on latitude, season, climate, culture, etc. However, all ancestral diets shared key characteristics. Food sources were limited to unprocessed plants for ages, and unprocessed land and marine animals hunted from the proximate environment. We believe that the most common pattern was 30-35% protein (40% is the toxic ceiling), 30% fats and 40% carbohidrates. This means that lunch and dinner are based on lean meats or seafood and vegetables. Breakfast could be an opportunity to eat fruits, nuts, eggs or even vegetables and protein (turkey breast), see our newsletter v5_#39. Fruits and nuts are good options for snacks.

Grains and dairy are nutritionally poor when compared to fruits, vegetables, seafood and lean meats. So, grains and dairy have no natural substitute. Milk and grains are usually eaten with breakfast, and I've provided some ideas for breakfast. In our published research section on our website you can download Dr. Cordain's scientific paper regarding grains titled: Cereal grains: humanity's double edged sword.

Broccoli, cauliflower, kale and all green leaves are good calcium sources without the problematic issues that dairy has: they increase metabolic acidity which leads to bone calcium loss.

Yes, too much fruit consumption is not the healthiest choice. High fructose intake is related to many metabolic diseases, especially obesity. Diarrhea is usually associated to fructose intolerance.

So, one doesn't have to precisely count caloric intake from protein, fats and carbohydrates as long as you combine seafood and lean meats with vegetables in meals and use fruits and nuts as breakfast and snack options.

Regarding gout: gout is considered part of a metabolic syndrome and insulin resistance is at the root of gout illness. Along these lines, gout is rare among pre-agricultural populations (Hunter-gatherers). Serum uric acid levels depends on the amount entering the bloodstream and the amount leaving the bloodstream. The amount of uric acid entering the bloodstream depends on the amount of it produced by the liver (1/3 from diet and 2/3 from body turn-over of cells). The amount of uric acid leaving the bloodstream depends on the kidneys' excretion capacity. The metabolic syndrome and insulin resistance induce kidney underexcretion of uric acid. On the other hand, when the kidney is faced with high protein purine-containing foods, serum uric acid levels decrease because the kidney increases uric acid excretion (this is an evolutionary trade-off).

So, the real problem is increased liver production of uric acid and kidney uric acid underexcretion. High glycemic load foods (as found in the typical Western diet and not in The Paleo Diet), and subsequent hyperinsulinemia halts the kidney capacity to excrete uric acid. Regarding liver production of uric acid: fructose--and particularly High Fructose Corn Syrup (HFCS)--decreases inorganic phosphate in the liver, and this increases the production of uric acid from purines.

The Paleo Diet helps to fight gout as it is based on low-glycemic load foods, high protein, and no HCFS foods.

We hope this helps.


  1. One question: as far as nuts, do you recommend raw, dry-roasted, or oil-roasted?

  2. I have been on the Paleo program for almost 6 weeks. Within that time I have lost a total of 17 pounds and am completely off the heartburn medications I took every day. In regards to fruit, I find that if I eat the proper amount of lean meat and veggies, I don't feel the need to over eat on the fruit. I have 3-5 servings of fruit each day and 4-5 servings of veggies. It is more than enough to satisty hunger, which you don't seem to really experience on this program.

  3. Ok, so I am just starting the diet and have just a few questions. I know processed grain/rice is a no but what about wild rice? I'm from Minnesota and my dad and I harvest our own rice from wild patches that grow in lakes. The rice is just then shaken and boiled and not processed so would this be an acceptable food?

    Second question: my friend is the one who started me on this diet and she said that the only cheese that is OK is goat cheese. I know goat cheese is still dairy so I just wanted to confirm that it's a no-go and also if there are any cheese or cheese like substitutes.

  4. Hello,
    Does Dr. Cordain ever discuss the health/nutritional benefits of raw animal products, such as raw meat and raw egg consumption vs cooked?
    Thank you,

  5. Edwin Wiebes, Amsterdam, The NetherlandsNovember 16, 2009 at 1:36 PM

    Dear Sir/Madame,

    Firstly I would like to say that this diet has done me many good, eventhough I'm quite healthy. I feel very good, much better than on my previous grain and dairy loaded diet. As if my mind is clearer and 'lighter' and have lost foodcravings wich I used to have for fatty foods. So many thanks to the researchers!

    I would also like to react to the answer of the second question in this Q&A.

    I haven't found an answer in this post to the following wich I believe is also of quite a moral significance. It has partially been answered in previous posts though wich wrote about sweet potatoes being a better choice of carbohydrates than 'regular' ones instead of meat(?). But here is the part:

    "Furthermore, with this increase in meat and seafood consumption, even with the reduction in grain and dairy production, will not an increased percentage of Paleo dieters hasten the trends of soil erosion and landscape damage due to the increase quantity of land required for farming to feed people?"

    I think this is an important question. And a question formulated differently would be:
    How can we eat 'as paleo as we can' without being irresponsible to the enviroment?
    And apart from the enviroment, adding certain (for example) carb sources could cut costs. As a student and relatively enviromentally conscious person I would love to see some more information on that so it is even better suited to this day and certain situations.

    Many thanks. And I hope you can be tolerant since English is not my native language. ;-)

    Yours Sincerely,

    Edwin Wiebes

  6. You keep talking about "high glycemic" foods, this is like fingernails on a blackboard to me. You don't know why you're talking about. The issue is not the glycemic load of the food, the issue is your body's ability to assimilate the carbohydrates without the liver pumping out excess glucose. This happens when the liver cannot "hear" the pancreas telling it to stop via insulin. This in turn is caused by excess fructose consumption.

    Healthy cultures around the world have routinely worked very hard to increase the glycemic load of their starches, through hulling, mashing, soaking and fermenting. I agree to reduce modern processed foods, but it doesn't help via the mechanism you keep talking about.

    Fructose is at the heart of gout because it causes insulin resistance leading to hyperglycemia (from the liver! Key point!) and it produces uric acid. High starch (fructose-free) foods do not cause hyperglycemia in people with otherwise healthy liver function.

  7. Mr. French:

    Virtually all grains contain harmful substances namely lectins, alkylresorcinols, alpha-amylase inhibitors and protease inhibitors, independent of whether or not they are refined or whole grains. However, we believe that rice is probably the less harmful grain and wheat, barley, rye and maize the worst ones.

    Regarding your second question, goat cheese is still a dairy product. Cow milk proteins are well studied and have been consistently demonstrated to be harmful to humans, but there's not enough literature to scientifically demonstrate that dairy products derived from goats have the same deleterious health effects. We think that because goat milk contain proteins from a different species it may have immunity stimulating proteins, and may therefore increase the risk of allergies or autoimmune diseases.

  8. Posted on behalf of Pedro:

    Dear Ed, I refer you to Dr. Cordain's paper, available here:

    In this paper, Dr. Cordain explains that both high glycemic load foods and fructose both have the ability to cause insulin resistance through different mechanisms.

    So, it is true that Fructose causes insulin resistance and we completely agree with you on that, which is why we have a spreadsheet with the fructose content of various foods.

    Regarding gout, we have no doubt that fructose causes an elevation in uric acid levels and we have a newsletter dedicated to gout, where Dr. Cordain explain how fructose leads to elevated uric acid levels.

    Regarding the glycemic load of foods, there is evidence that genotype is important in terms of determining one's response to high or low glycemic load diets. This explains why some, like the aborigines, don't handle carbohydrates very well and why others, like the Kitava, do. A good paper on this is The Carnivorous Connection by Dr. Brand-Miller. Moreover, if someone is already insulin resistant (unfortunately, most of the people in the US today are) there is evidence that a low glycemic load diet, as well as a low fructose diet is more beneficial.

    Thank you for your excellent comment.

    Pedro Bastos

  9. I share the concerns of the readers that wrote:

    "...with this increase in meat and seafood consumption, even with the reduction in grain and dairy production, will not an increased percentage of Paleo dieters hasten the trends of soil erosion and landscape damage due to the increase quantity of land required for farming to feed people?"

    "I think this is an important question. And a question formulated differently would be:
    How can we eat 'as paleo as we can' without being irresponsible to the environment?"

    I think too that it's important finding ways for turning the paleo option an environmentally sound diet style. Mainly if we want to see increasingly more people following it - I guess most of us would agree that everybody should have access to good information on what a healthy lifestyle means from an evolutionary perspective, and should as well have the possibility to adopt a diet congruent with that.

    Personally, I've found that organic eggs are a good choice as a source of healthy animal protein. (New researches have showed eggs are healthy indeed, differently from which one believed some time ago.) Of course, it turns to be an issue of finding an...

  10. ... it turns to be an issue of finding an environmentally-responsible producer of organic eggs - or even taking charge of growing part of your food and beginning your own home production.

    A well managed chicken coop can yield much more protein per area, and at a daily basis, than a beef pasture. Indeed, most of the chicken's food can be produced in the very coop and its surroundings when planted with fast-growing bug-friendly green species (weeds are great for this). An intelligent division of the coop in plots for rotating chickens through them helps too, as it allows that some amount of greens is always at the proper stage for feeding the animals (meanwhile, the other plots will be at different stages of growth). Their feeding can be supplemented with kitchen scraps. And as an eventual bonus, now and then such a coop will also yield some antibiotics-free chicken meat.

    (A search on the web for "permaculture chicken coops" will return innumerable potential sources of original and useful ideas for such a design.)

  11. Think of it this way: herbivores are natures way of taking inedible grass and turning it into edible fats, proteins and vitamins.


    On ten acres of land, Joel Salatin’s grass-based husbandry produces:
    3000 eggs
    1000 broilers
    80 stewing hens
    2000 pounds of beef
    2500 pounds of pork
    100 turkeys
    50 rabbits

    This would support at least 9 people for a year, and as Keith points out, “in full health,” since people can live on a diet composed solely of the foods above, whereas none of the foods proposed by Vegfam form a complete diet.

    In addition, Salatin’s farm produces a few inches of topsoil per year whereas monocultures proposed by Vegfam destroy topsoil.


    The book Vegetarian Myths and the reviews of it are a counter-point to the idea that eating meat is bad for the environment. Grain-based monocultures kill the environment far more than pasture-based animal husbandry.


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