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Let me introduce myself. My name is Mark Sisson. I’m 63 years young. I live and work in Malibu, California. In a past life I was a professional marathoner and triathlete. Now my life goal is to help 100 million people get healthy. I started this blog in 2006 to empower people to take full responsibility for their own health and enjoyment of life by investigating, discussing, and critically rethinking everything we’ve assumed to be true about health and wellness...

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September 12, 2016

Dear Mark: Did Three New Studies Debunk the Primal Blueprint?

By Mark Sisson
25 Comments

Paleo Debunking real in lineFor today’s edition of Dear Mark, I’m answering three questions that at first glance appear to cast doubt on some of the founding tenets of the Primal Blueprint. First, did a recent study show that low-carb dieting is no better—and perhaps worse—than low-fat dieting at helping you lose body fat? The second is a two-parter: are we hypocrites for “ignoring” the insulinogenic effects of protein, and does a paleo diet actually abolish the beneficial effects of CrossFit?  And third, a new study found evidence of cereal grain consumption in a group of European hunter-gatherers. What gives?

Let’s go:

Dear Mark,

I am a long time follower of your site, and have been eating some sort of “primal blueprint-ish” for roughly 10 years. This lifestyle suits me, I am effortlessly lean and energetic despite pushing 40 and having a small boy and not exercising as much as I should. I like your site above the others, because of your scientific take (I am an engineer ;), always linking to the study you quote. I believe in you, and I believe that YOU believe in the primal blueprint – IMO you are not just a sales person trying to get rich.

However, lately I read a lot on the internet about the Nusi trials, I am sure you heard about it; proving that low carbs is no better than low fat in fat loss (not adressing all the other benefits of low carb). Could you adress this in a post? I would like to hear your comments on this.

Best regards,

Liv Vinter

Thanks for the kind words, Liv. I try to live up to your impression of me every day.

Ah, yes, the NuSi studies. Though you didn’t specify which study concerns you, I can guess.

It’s the most recent one, called “Energy expenditure and body composition changes after an isocaloric ketogenic diet in overweight and obese men.”

They put a bunch of people on an high-carb diet for four weeks, then moved them over to a low-carb, high-fat ketogenic diet for another four. Both diets were isocaloric, meaning they each provided the same number of calories, and were meant to keep their weight stable. These weren’t weight loss diets. They tracked energy expenditure, fat loss, and all the regular body composition markers you’d expect. Turns out that after going keto, fat loss slowed, energy expenditure increased, protein oxidation increased, and they lost a bit of lean mass. Fat loss picked up by the end but it was a wash.

From what I can see, they didn’t exercise. While that helps isolate the effect of the diet, it’s not how most people improve their body composition. Strength training in the absence of any other dietary intervention increases lean mass retention. You can diet anyway you want—low-carb, keto, low-fat, low-calorie, high-protein—but you’d better lift some heavy things if you want to keep your muscle. These people didn’t even lift, so it’s no wonder they lost a little lean mass on the keto diet.

Their protein intake was rather low. If you’re going to try a ketogenic diet without weight training, you’d better increase your protein intake.

They failed to give the diets in a randomized sequence, going from high-carb to low-carb.  We all know those first four weeks of a diet (any diet) are the best. The weight just flies off. After the first few weeks, though, weight loss slows down. These people transitioned to keto just as they were coming off the rapid fat loss. They’d exhausted their “newbie gains.” They’d already lost a good amount of weight, whereas they hadn’t lost any weight going into the high-carb period. If you flipped the timeline and had subjects go low-carb before going low-fat, you’d likely see the reverse happen: quicker weight loss on low-carb, slower weight loss on low-fat. I would have liked to see half the subjects start on low-fat and half start on low-carb.

The diets weren’t weight-loss diets and this wasn’t a fat loss study.

They were isocaloric weight maintenance diets. The primary objective of the study was to track any variation in energy expenditure between the two diets. Body composition changes were secondary outcomes. And since this wasn’t a fat loss study, it wasn’t designed to draw accurate conclusions about fat loss as the primary point of investigation. If it were, then there would/should have been different procedural methods in place.

One obvious confounding factor? There was inadequate time for fat-burning machinery to ramp up. Going from a high-carb (and high-sugar—almost 25% of calories) diet to a ketogenic diet isn’t seamless. It takes time to adapt. That’s why fat loss slowed for the first leg of the keto portion, only picking up speed after a couple weeks. It also explains the increased protein oxidation and loss of lean mass reported in the first leg of the keto arm: they had to sacrifice lean tissue to convert into glucose via gluconeogenesis until they achieved full ketoadapation and glucose homeostasis.

Coming into the keto diet fully carb-loaded is great for physcial performance, but impairs fat loss. You’ll burn off most of that glycogen before dipping into endogenous fat stores.

It’s a cool study, just not the utter demolition of low-carb people are claiming.

This article appeared on my newsfeed today on my phone and really messed me up mentally. Would love for your wise insights. This turned everything I know upside down. ahhhhh!

Jennifer

There are two parts to this article.

The first deals with the insulinogenic effects of dietary protein. Ignoring  the strawman the author lays out (“paleo people all say insulin is the root of all evil so why do they eat five pounds of insulinogenic animal flesh a day?”), I’ll address the insulin stuff.

Yeah, dietary protein increases insulin. So what? Insulin isn’t evil. I’ve never said that (remember the strawman thing?). Insulin helps drive glycogen and protein into muscles. Those are extremely important tasks.

And there is a ton of evidence that the most insulinogenic protein of all—whey—improves metabolic health and body composition.

For instance:

It spikes insulin initially but reduces the area under the curve, improving glucose tolerance in type 2 diabetics.

It reduces fasting insulin in overweight and obese adults. Every minute of elevated fasting insulin inhibits your ability to burn fat.

The second part is also laughable: the claim that a paleo diet nullifies the beneficial effects of doing CrossFit.

First of all, they were “asked” to follow an ad-libitum paleo diet. They weren’t monitored in a metabolic ward. The researchers didn’t prepare and deliver paleo meals to the subjects. There wasn’t a control group. It was a total slapdash affair—give them a few rough guidelines and hope for the best. That’s understandable, given that health major undergrads putting together a thesis rarely have access to the funding necessary for human randomized controlled trials.

Second, about those “deleterious changes” to blood lipids. Take a look at Dr. Andro’s take on the study. Pay close attention to the nifty charts he made.

Those with high HDL at the start lowered theirs. LDL and non-HDL cholesterol also increased a bit by study’s end. That’s it. Those are the “deleterious” (what a powerful word, that) changes. Oh, and subjects who had normal HDL at the start of the study increased their HDL by the end.

Some of the most vital and widely cited benefits of CrossFit are the improvements to physical fitness and body composition. Since paleo clearly “abolishes” CrossFit benefits, those must have taken a real beating. Right?

Actually, subjects lost an average of six pounds and 4% body fat while improving VO2max.

I’m not worried about a few minor changes to controversial biomarkers like LDL and HDL (that may actually be transient responses to weight loss) if it means improvements to the markers that we know have strong connections to health and heart disease risk—body fat, body weight, and physical fitness. What about you?

The REAL Paleo diet included bread: Ancient dental plaque reveals crops were on the menu in the Balkans 8,600 years ago.

Here they go again.

Mark

Indeed. Okay, okay.

Of course some hunter-gatherers ate grains. They had to. Someone had to.

It’s not as if one day every single hunter-gatherer across the world unstrung their bows, developed a healthy fear of animal protein and artery-clogging saturated fat, converted their spears to shovels, and began planting wheat, barley, and various other cereals. It was a transition happening all over the globe at different rates. That’s why you see folks in what’s now Israel experimenting with growing plants as early as 23000 years ago, legit-yet-nascent agriculture in the Levant by 10000 BC, wheat reaching the British Isles by 8000 BC, Arctic peoples subsisting almost exclusively on sea creatures and tundra animals until a hundred or so years ago, and small pockets of foragers still living as full-fledged hunter-gatherers today.

And that’s exactly what this group of Balkan hunter-gatherers was: a transition between the foraging hunter-gatherer lifestyle and the neolithic agricultural lifestyle. They’ve even got an era that describes this transition. The Mesolithic (middle or intermediate stone) era was the transition between the Paleolithic era (old stone) and Neolithic era (new stone). That’s precisely when many hunter gatherers were transitioning (there’s that word again) into new ways of life, experimenting with new food sources like grains and legumes, and figuring out how to raise them as crops. So this news doesn’t negate anything. It’s exciting, actually. We know this transition happened, and now we get to examine a group of people in the middle of it.

That’s it for today, everyone. Thanks for reading!

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25 Comments on "Dear Mark: Did Three New Studies Debunk the Primal Blueprint?"

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Alex
Alex
8 months 16 days ago

Short answer to the title’s question: nope! 😉

Dave
Dave
8 months 16 days ago

I love that. Of course someone had to have eaten grains along the evolutionary timeline. Otherwise, how did we get here, fully cultivating and consuming them in the abundance we do today? A few errant samples of dental plaque doesn’t negate the foundation of evolutionary based eating. Glad you touched on this, Mark

Hotstreak
Hotstreak
8 months 16 days ago

Time to shut down the site Mark, you’re debunked!

Frank
Frank
8 months 16 days ago

It’s amazing how misleading some of these studies can be without a measured analysis. But I guess people have the fill headlines, right?

Christine
Christine
8 months 16 days ago

Exactly. For the keto study, how do you not also have a group that transitions into each diets from the other direction (keto to high carb in addition to high carb to keto).

Victor
Victor
8 months 16 days ago

Hear hear… I had high hopes for NuSi’s studies because LCHF proponent and n=1 expriementer, Dr. Peter Attia was involved with it… was anyway… wonder if that’s why he left? I’m still interested in the other NUSI’s studies like the “Do Genotype Patterns Predict Weight Loss Success for Low Carb vs. Low Fat Diets?” study.
https://clinicaltrials.gov/ct2/show/NCT01826591

If anyone wants to back the studies on whether ketogenic diet inhibits cancer… here’s your chance.
https://experiment.com/projects/part-2-can-low-carbohydrate-ketogenic-diets-inhibit-cancers

Frank Danna
8 months 15 days ago

Thanks for the links, groundbreaking studies with the potential to save lives.

Rick
Rick
8 months 16 days ago

Nice job, Mark. Both good points about the CrossFit study: 1. Yes, protein can be insulingenic (and so what) and 2. The folks were not actually regulated to eat a real Paleo Diet!!!

Mitchell
8 months 16 days ago

It’s a bummer when the “findings” of studies like these get tossed around lightly by those who never actually read them through. People can be quick to jump on so-called results and throw them in the face of healthy eaters in order to make themselves feel better. In my experience, the people that do this are generally overweight and undertrained. Thanks for demonstrating how we need to scrutinize every study and think about results from different angles.

Primordial Ooze
Primordial Ooze
8 months 16 days ago

And so what if it affects CrossFit? When did CrossFit become the gold standard across the board for physical training?

Jessica O\'Neill
8 months 16 days ago

Great questions, and fantastic answers. I too was intrigued by the Balkan story, and have been fielding snarky comments from my local anti-primalites. I plan on using Mesolithic a lot in the near future.

BJJ Caveman
8 months 16 days ago

Loved your analysis of the first article. One of the statements that caught my eye was that after going keto, their “energy expenditure increased.”

That seems like a big piece of things and actually reinforce the idea that ketosis can be a metabolically inefficient process and can cause an elevation of BMR up to 10%… which can then facilitate fat loss, once all the machinery and adaptation is established.

Time Traveler
Time Traveler
8 months 16 days ago

“Of course some hunter-gatherers ate grains. They had to. Someone had to.” – Good one.

On the matter of LCHF, here’s a link to an article I read earlier today, that puts another nail in the coffin of the naysayers 🙂

[https://philmaffetone.com/case-study-reductions-training-load-dietary-carbohydrates-help-restore-health-improve-performance-ironman-triathlete/]

HealthyHombre
HealthyHombre
8 months 16 days ago

Feel free folks to follow a high carb, low fat diet if that’s what you really want to do. Get back with us in a couple of years and let us know how that’s workin’ out for ya …

HealthyHombre
HealthyHombre
8 months 16 days ago

By “folks” I meant the anti-paleo people. High carb low fat … did someone not understand … oh well so it goes sometimes LOL. 🙂

Elizabeth Resnick
8 months 16 days ago

Excellent questions and love Mark’s explanation. I like how Liv mentioned that she is effortlessly lean and energetic following a primal lifestyle, even though she is pushing 40 and doesn’t work out much. I feel the same way…it is so easy to stay in shape and have plenty of energy eating this way. And I’m 50 and also don’t really work out that much. Bottom line is…forget the studies. Listen to your body. If something is working, don’t mess with it. If it stops working, see what you need to change up a bit.

barry
barry
8 months 16 days ago

It’s kind of impossible to debunk a dieting strategy that implores you to only eat real foods. Reading between the lines, what this study is actually saying is, don’t eat meat, fish, vegetables, fruit, and nuts. Eat a bunch of low-fat processed foods that are high in sugar. I guess they can’t say it like that though, much less believable when they’re that straightforward.

Barry
Barry
8 months 16 days ago

Great report Mark and love the new site. The Primal Movement is growing in Canada. I am 56 and made the change in January. Went from 213 to 190 pounds, more energy at the gym and focus at work. What else is there to say, proof is in the results. Only downside was taking my suit pants in. Grok On, keep up the great work Mark! Barry

Jennifer L.
Jennifer L.
8 months 15 days ago

All this talk about food and I still have no idea what to eat for lunch.

Tiffany
Tiffany
8 months 15 days ago

Mark’s Daily Apple will always be my favorite place to come for health information. I love the way you break down studies and explain things. Easier to understand for me than a lot of other sites and never too drawn out. I can’t explain how perfect this website is, and I can’t thank you enough for making this site available to everyone for free. You do wonderful work.

Chris
Chris
8 months 15 days ago

Cultivating grains as a food source and domesticating animals may well have coincided with wiping out the local fauna. The accelerating wave of human caused extinctions started in the late Paleolithic: http://discovermagazine.com/1987/may/02-the-worst-mistake-in-the-history-of-the-human-race.

Jan Krassner
Jan Krassner
8 months 14 days ago
Personally, I am open to listening to good studies, but I am sticking with Paleo. First of all, I am able to eat foods I enjoy. As a type 2 diabetic, I am able to keep my my blood sugar in an acceptable range. I need to talk to my doctor about lowering my dosage, which is already pretty low to begin with. I have lost about 13 pounds over several months. Some of my meds make it difficult to lose weight, and I’m still not exercising. My triglycerides came down from almost 900, to about 300, in the first… Read more »
Anne
Anne
8 months 14 days ago

All’s fair- you should have a bit of a gloat over the latest study on linkages between sugar and serum cholesterol that have been hidden by the food industry for 60 years!

Luna
7 months 2 days ago

yes, hunters have to eat animals while hunting in order to survive.

zach rusk
6 months 4 days ago

I love Primal lyfe, but I think this wasn’t a very adequate rebuttal against the final study. It seems like evidence showing grains were eaten such a long time ago would support the consumption of grains in demographics of people hailing from those geographic regions.

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