Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
2 Sep

Dear Mark: Am I Eating Too Little Food or Too Much Iron?

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For today’s edition of Dear Mark, we’ve got a two-parter. First, Mathilde wonders whether she’s eating too little food. A high-fat, nutrient-dense Primal way of eating can have the effect of maximal satiation on fewer calories, and that’s usually fine, but there are instances where too few calories can have negative health effects. I tell her what symptoms to watch out for. After that, I discuss the issue of too much iron in the diet. It may be a concern for people with genetic tendencies to store excessive amount of iron, but what about regular people without those genetic variants?

Let’s go:

Dear Mark,

I will be as brief as possible icon wink I know we shouldn’t count calories when eating primal/paleo, but when I’m eating this way, I find myself not managing to eat more then 1000 maybe 1100 calories and that is by adding coconut and olive oil to my meals. Is so little calorie intake just fine if I’m not more hungry or will it spoil my effort by putting my body in a kind of “common restriction diet state”?

Thank you so much for all your eye opening information!

Best regards,

Mathilde

For the most part, I see the inadvertent reduction in calorie intake as a good thing. A feature of a nutrient-dense, satiating Primal way of eating. Many of us, particularly if we have excess fat to lose, are consuming more food than we require. It can go the other way, though. It can get messy and unpleasant and begin to have a negative effect on your health and quality of life.

Unfortunately, hunger isn’t always a reliable barometer to decide whether you’ve gone too low. During a calorie restricted diet, in fact, hunger doesn’t necessarily even increase, probably due to a reduced energy expenditure to match the reduced energy intake. If your body perceives the reduced calorie intake as the new normal, you’re not going to feel very hungry – even if you would be better served by more food. That’s not necessarily a bad thing, of course, and there’s some evidence that a slightly slower metabolism is optimal for longevity, but when you start seeing decidedly negative symptoms along with the reduction in hunger, it might herald a problem. After all, you want to enjoy your life, not live out a miserable, lengthy existence. Compression of morbidity, not extension, is what we want.

You might want to try eating more calories if:

You find yourself developing a newfound sensitivity to cold. Long term calorie restriction is a fantastic way to lower your core body temperature. Higher body temperatures act as a buffer against the elements; if your body temperature drops, you will be more sensitive to cold weather and you may perceive otherwise moderate temperatures as uncomfortably chilly.

Sex doesn’t interest you as much as it used to. In males, calorie restriction lowers testosterone, sexual impulses, and attraction to otherwise fetching females (albeit rodent females). Human calorie-restricted males also have lower testosterone. Since leptin lowers with calorie restriction, and libido is intimately tied to leptin levels, the same holds true for women as well. A loss of libido is a common side effect of chronic calorie restricters.

You never feel like doing anything. Since we need fuel to power our body to perform mental and physical tasks, under-eating can leave us listless.

You get dizzy when you stand up quickly. Calorie restriction is usually quite effective against hypertension, but if taken to the extreme it can lead to electrolyte imbalances/deficiencies and cause orthostatic hypotension, or postural hypotension. A common symptom is dizziness/head rushes upon standing.

Your performance in the gym is suffering. Interestingly enough, calorie restriction paired with resistance training prevents muscle atrophy (PDF), while calorie restriction paired with inactivity increases it. In other words, you gotta use it or lose it. Unfortunately, given the common side effect of not wanting to do anything at all, you might find it difficult to maintain a regular workout schedule.

Your wounds are taking longer to heal: Caloric restriction has been shown to impair collagen synthesis, which is how new skin forms as a wound heals.

You feel depressed (or worse). For a nice rundown on the possible psychological effects (including depression and suicidal thoughts) of super low-calorie intakes, check out this post by Dr. Emily Deans.

That last bit of belly fat just isn’t disappearing and even appears to be growing. Long term inadequate intake of food is, in essence, a major stressor on your body. It’s a mild form of starvation. And when your calories get too low, cortisol – one of the main stress hormones – goes up. Cortisol, as you probably know, is strongly associated with abdominal fat.

These are basically warning signs that your body is perceiving the chronically low calorie intake as a signal of famine. If none of this bothers you, or you find the tradeoffs to be worth the benefits, go ahead and keep going. But if the benefits aren’t worth it – or they’re increasingly nonexistent – you should probably eat more food. It’s a roundabout way of saying: do you feel good? If so, keep on keepin’ on.

Hi Mark,

My question is with regards to iron intake when eating Primal – I’m concerned I’m actually getting too much. After plugging my daily stats into Cronometer – I was constantly getting in excess of 500% my iron RDI, or close to 50mg/day. This was through eating very Primal friendly foods – red meat, and organs like hearts and liver (which seem to have the highest iron content of any foods).

So my question is, even though I’m pretty sure I don’t have haemochromatosis, is consuming this amount of iron on a daily basis safe? I’ve read that iron overload symptoms can be very similar to iron deficiency symptoms.

Mike

Should you worry? Well, iron is highly reactive. Its inherent proclivity for electron exchange can create free radicals that damage DNA, cells, and blood lipids. And observational studies linking iron intake and stored iron to diseases like type 2 diabetes, heart disease, and cancer do exist. Heme iron, the most bioavailable type and the easiest to absorb, is found exclusively in animal sources. Meanwhile, humans don’t absorb non-heme iron, found in plant foods like spinach, raisins, dried apricots, and lentils, nearly as efficiently.

Assuming you don’t have hemochromatosis, however, iron shouldn’t pose a problem, as humans have built-in mechanisms that regulate iron absorption. If you have low iron stores, you will absorb more from your food. If you have elevated iron stores, you will absorb less. It fluctuates on an as-needed basis. In hemochromatosis, this regulation gets thrown out of whack, but it works well in most people – provided they’re getting sufficient amounts of dietary iron. Most people don’t need to worry about their iron intake.

So first off, get tested for hemochromatosis. According to Chris Kresser, even heterozygous carriers (with only one copy of the gene) may still have an elevated risk of several disease states (especially if you’re eating lots of iron). Your doctor may not be aware of this, as the conventional wisdom is that only homozygous carriers (two copies of the gene) are at risk for iron overload-related conditions. If you are a carrier, you may have to reduce iron intake (although one study found no consistent connection between iron intake and ferritin levels in homozygotes), get regular phlebotomies, and stay up to date with your iron panels. Getting an iron panel done is a good idea regardless.

Second, what exactly are you eating to hit 50 mg of iron a day? That’s a lot of iron. A pound of steak has around 10 mg, depending on which cut. Are you eating five pounds? Liver and other offal will get you there faster, but you shouldn’t be eating liver every day anyway because of the vitamin A content. Remember, each animal has but a single liver. Shellfish also run pretty high, especially clams. Unless you’re eating a chicken liver, lamb spleen, and pork lung stir-fry for dinner every other day, a clam smoothie for breakfast, and a five pound chuck roast for lunch on the other days, though, it’s gonna be hard to hit 50 mg.

However, there are other things to consider when considering the possible danger of iron:

The unhealthy user effect: Strangely, when you differentiate between the various sources of heme iron, research suggests that only heme iron from red meat is associated with type 2 diabetes. This means one of two things. Maybe something about heme iron from red meat is particularly lethal. Or maybe, because red meat is universally considered to be unhealthy, those people who care the least about their health and show it by smoking more, drinking more, exercising less, and so on are more likely to eat more red meat. Even though studies try to account for the unhealthy user effect by adjusting for variables like tobacco and alcohol, they can’t adjust for everything that unhealthy people do. For instance, if data on “time spent sitting” was never even gathered, the researchers couldn’t have adjusted for it – even though sitting is a big predictor of type 2 diabetes risk. I’d imagine people who eat the most red meat also sit the most, while folks who eat lentils and chicken and wild salmon tend to walk more.

Inflammation: Another study found no link between heme iron (and total iron, for that matter) and pancreatic cancer, except in female smokers. If that link is causal, it could indicate that dietary iron only becomes carcinogenic in the presence of inflammation (from smoking, in this instance). Other research has found that inflammation increases ferritin levels, suggesting that elevated iron could be an indication of disease rather than a cause of it.

Interaction between iron and other nutrients. You might be aware of the various interactions between dietary minerals. For example, manganese competes with iron for absorption. Dietary calcium also reduces iron absorption. If you’re eating plenty of other nutrient-dense foods along with your sources of iron, iron absorption will be modulated.

Does that mean you, a healthy Primal eater, are out of the woods? Not necessarily. The connections between excess iron and various diseases warrant caution, and 50 mg seems unnecessarily high to me. Here’s what I’d do:

First, establish your hemochromatosis status.

Second, get a full iron panel from your doctor or other health professional.

Third, don’t eat 50 mg of iron a day, particularly heme iron. How do you manage that, anyway? Heck, I’m not even mad. That’s amazing!

Fourth, eat from a diverse swathe of the plant and animal kingdom. Eat red meat, white meat, fish meat, shellfish meat, nut meat, and the fibrous flesh of leafy greens. This will help you get plenty of nutrients that normalize your iron absorption.

And finally, consider giving blood on a regular basis, especially if you’ve established that your ferritin levels are higher than you’d like. It’s highly likely that humans evolved to regularly endure small amounts of blood loss, whether through parasites or cuts, scrapes, and wounds, and this would have provided a way for men to shed excess iron and prevent overload. That could be why regular blood donation is associated with a lower risk for both heart disease and cancer. Donating blood is a good move anyway, without accounting for potential health benefits.

That’s it for today, folks. Thanks for reading and be sure to chime in with your thoughts, experiences, stories, and comments!

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. Love the meal in the picture!

    Andy wrote on September 2nd, 2013
    • First! =)

      Andy wrote on September 2nd, 2013
  2. I like that you mentioned the signs of stress on the body in regard to eating too little. All of those things happen to me if I’m not eating enough.

    But, if you’re NOT having those signs of stress on the body, it’s possible you’re getting energy from your fat! Which is a good thing if you want to lose some :).

    Debbie wrote on September 2nd, 2013
    • Same here, I experience these things whenever I cut my calories too much. I’m still shocked that my macros were diminishing my joint health.

      I’ve been planning on writing about this for a while.Probably should get that done soon.

      Mark P wrote on September 2nd, 2013
      • Another great reason it’s important to keep a food diary from time to time.

        Matt wrote on September 3rd, 2013
    • I too like that you described the signs that you are eating too little. It may seem obvious, but you may not have a noticeable change if you are not looking for it. Another thing that I notice when I eat too little is headaches. But that may be because of too little liquid intake resulting in a little dehydration.
      RegularHealthyCompetition.com

      Tom T. wrote on September 3rd, 2013
  3. Wow, that’s not very many calories….I’d be in the no poop zone…

    Even IFing 16-20 hrs everyday, I still manage to get in 2500-3000 without really trying. Depends on activity level, I guess, and of course everyone is different…Like Mark said, all depends on how you’re feeling.

    Graham wrote on September 2nd, 2013
  4. Not to plug my own information, but I just wrote a new article on calorie counting and why it shouldn’t be a specific focus of people’s diets. However, a lot of my patients respond positively when they eat more food and stop thinking about food as a quantitative measure.

    Anthony Gustin wrote on September 2nd, 2013
  5. “Interaction between iron and other nutrients…”

    It might be worth mentioning here that while zinc might not interfere with iron absorption, it does interfere with copper absorption. Some supplements, such as the AREDS formula eye supplements, are extremely high in zinc. They also contain a token amount of copper, but not nearly enough, according to some sources, to offset the high zinc content. Also, zinc and copper should not be taken together because zinc is so efficient at blocking copper absorption. This fact is largely ignored by the makers of supplements.

    Supplementing with minerals that are meant to be trace elements in the body might not be a good idea unless blood tests show a definite deficiency. Even then, these trace minerals are probably best derived from foods, in which case a chemical imbalance is unlikely to occur.

    Shary wrote on September 2nd, 2013
  6. I’m a 60 year old 5′ 8″ male that went from 172 lbs to 141 lbs in about 18 months, was not trying to lose weight, just cut most of the grains and simple carbs out of my diet and started doing the leangains protocol and the weight fell off. I’m typically not “that guy” that gets freaked out every time he sees a list of symptoms and thinks “oh my gosh I have all of those” but I told my wife I have a bruise and I have a cut that seem to be taking forever to heal and I do seem to possibly have some of the other symptoms. I too started slathering some coconut oil on things to try to get a few more calories. I’d like to get up to “a buck fifty” if I could, mainly muscle being the goal of course. As always, some good food for thought (no pun intended) from Mark.,

    George wrote on September 2nd, 2013
    • Dont undereat your protein. Baby your digestion because stomach acid production goes down with age and the bod starts to breakdown. I make a conscious effort to eat gelatin or bone broth or collagen tablets everyday/frequently in addition to vitamin c therapy and egg yolks to combat the effects of stress (adrenal support). Raspberry/hibiscus teas for snack time, ascorbyl palmitate, acerola powder for smoothies, straight ascorbic acid pills. For cold or wound combatting I start off with adding 1000mg and then add an extra1000mg until bowel tolerance is reached…then back off gradually too. Zinc and sunshine too.
      Aloe Vera is also a little miracle worker for stimulating healing…to the point it shouldnt be put on a wound that needs draining.

      Olympicnoodle wrote on September 4th, 2013
  7. Isn’t watercress very high in iron?

    ben wrote on September 2nd, 2013
  8. There is a lot of literature out there today about nutritional ketosis. Particularly, reduced calorie nutritional ketosis (around 1200 kCal per day), is considered by many to be a good adjunct to cancer therapy. Check out the extensive research by Dr. Seyfried on cancer as a metabolic disease. There is also a lot of research being done on several cancers with nutritional ketosis.

    Of course, you can be in nutritional ketosis at higher calorie intake, as well. But it can be hard to eat too much!

    dkd2001 wrote on September 2nd, 2013
  9. I struggle with not getting enough calories routinely. Raised by an anorexic mother, a good for her was a banana and 8 cups of coffee. That can really mess with the perception of food. Two years ago I lost 34 pounds after my youngest turned 9. It was needed and I felt so much better for it. I was mostly overweight not so much with HOW much I ate, but WHAT I ate. After going primal my health and energy are never better, but I still struggle to get in 1000 calories a day. ( on the days I keep track and most days I don’t bother) I cook in coconut oil/olive oil/butter and saved animal fat. I enjoy all proteins mixed with greens. NOT a huge pastry lover but do need something sweet to finish a meal..( fruit is my choice) I just doesn’t take much to satisfy my hunger and because of that I struggle with keeping my weight closer to 120 than over 120. I suppose I worry that if I increase my food intake the scale will show a climb even more over 120 and at 5 foot tall and 47 years of age…120 looks healthy on me.

    brick

    brick Mckenna wrote on September 2nd, 2013
  10. I personally think an iron panel (with both TSAT and ferritin) is way more important than doing the genetic test for hemochromatosis. Happens to be significantly cheaper too (about 60 bucks compared to 270 if you buy the tests over the internet thru labcorp or something like that). High iron is problematic regardless of the cause, and it’s very possible to have high iron even if you don’t have hemochromatosis or one of the other genetic iron loading genes, especially if you are a male and consumed the SAD for any significant amount of time.

    I’m also kinda surprised Mark didn’t mention that forms of iron used in fortified grains and processed foods can be as well absorbed as heme iron, and some researchers are looking for ways to improve that absorption even more! On top of that, some cereals and such have been found to have iron levels up to 400% of what’s listed on the box.

    On top of all that, even high normal iron in man can be problematic. The Iron Hypothesis of heart disease is gaining ground, and could be the explanation of why women tend to live longer than men (women tend to have lower iron levels because of blood loss due to mentration). The RCTs so far have even shown that lowering your iron can increase insulin sensitivity and reduce fasting glucose levels (something I think most readers would be interested in).

    The Chris Kresser presentation that Mark linked to is excellent. Every male and postmenopausal female should watch it. Also “Exposing the Hidden Dangers of Iron” by E.D. Weinberg is excellent as well. If either of those don’t convince you to monitor you iron level and lower it via phlebotomy or blood donation if necessary, nothing will.

    John wrote on September 2nd, 2013
  11. Mark, your “Safe Cookware” post in 2009 says you really like to cook in cast iron. Dr. Neal Barnard, whose research and conclusions may well be very flawed, feels that too much dietary iron, copper, and zinc may be big contributors to Alzheimer’s. He suggests not taking supplements containing these minerals, not cooking in cast iron, and even promotes going vegan :-( . As an MDA devotee, I will admit that his veganism makes all of his other beliefs suspect. But, in trying to keep an open mind, I’m wondering how you feel about this possible Alzheimer’s connection, and, therefore, the continued use of cast iron by those who are consuming generous amounts of beef and occasional organ meats? Thank you, as always, Mark, for keeping all of us current on these important health issues.

    Margo wrote on September 2nd, 2013
    • Not familiar with Dr. Barnard, but I do believe that Alzheimer’s patients have a higher concentration of iron in their brains than non-Alzheimer’s patients do. I wouldn’t doubt that a high iron load could be a contributor. Personally, I found out I had high iron, and have been lowering it by blood donation. I have avoided iron supplements and avoided using cast iron cookware, but I still eat plenty of meat (it’s simply too nutrient dense to cut out of your diet… too tasty, as well). Grok almost certainly had low iron stores due to blood loss while hunting or fighting, or from intestinal parasites like hookworm (which where practically universal during our evolution, the current thinking goes). Eating meat and donating blood is probably a solid strategy, and it’s the one I use. And there wouldn’t really be a need to go vegan- both eggs and milk have iron binding elements in them, and would be great sources of protein for anyone lowering their iron stores.

      John wrote on September 2nd, 2013
      • There has to be a reason the body is stimulated to absorb extra iron. Like up taking radioactive iodide when iodine is low or aluminum in place of magnesium or lead in place of iron. The body is full of backup plans and worst case scenario only survival relationships to keep us going through deprivations or infections or toxic states until better times come.

        Olympicnoodle wrote on September 4th, 2013
  12. I too struggle with getting enough calories. Grains made it so much easier to do that. I cook in coconut oil, add ghee to everything, and drizzle big piles of veggies with olive oil, but still. The situation isn’t helped by having a hectic job that only occasionally affords me a lunch break. I’m slim and in shape and I look good, but I get lots of headaches, am often cold, and sometimes get dizzy when standing up! So now I’m worried…I guess I’ll try doubling my dinner and breakfast portions. Yikes. Time for some more paleo baked goods…I never seem to have a problem gobbling those.

    Kit wrote on September 2nd, 2013
    • Some people lose weight like crazy eating nothing but protein, fat, and veggies; others get sick. They don’t do well on 100 percent paleo, or even 80 or 70 percent. I don’t think baked goods are the answer. Try adding in some brown rice or a baked potato with butter and sour cream a couple of times a week, until you get your health issues straightened out. You might be slim and look good, but you don’t feel good. That means it’s time to tweak the diet a little so you can be both slim AND healthy.

      Shary wrote on September 2nd, 2013
      • I also agree 100% with the last part of you’re statement :)

        Joey G wrote on September 4th, 2013
      • I would agree with that, Shary. Thanks for the advice. The baked goods thing was more of a lighthearted joke…I make paleo muffins or a dessert about once a month, but that’s pretty much it because I’m usually too lazy. Hah. I read up on safe starches and am experimenting with adding potatoes and white rice to my diet, both of which I seem to handle well. (Brown rice doesn’t make me feel so hot.) But yes, I agree…the not feeling well is a problem, and it’s one I’m attempting to remedy.

        Kit wrote on September 8th, 2013
    • Coconut Oil and extra virgin olive oil should make getting calories easy theres the most calorie dense foods around!!!

      Joey G wrote on September 4th, 2013
  13. Apparently I don’t eat enough calories… I am each and every one of those negative items FFS.

    Daniel Ospina wrote on September 2nd, 2013
    • Kit and Daniel, are you guys working out? That should get the ‘ol hunger fired up. Lower stress too. Headaches, cold and dizzy is not good. The Primal Blueprint always says to listen to your body and if it’s not right, tweak something. Good luck and hope you find the answer soon.

      Nocona wrote on September 2nd, 2013
      • I do workout… not as much as I’d like however. Deadlifts, squats, presses, pullups and sprints. And I eat like a freaking pig while I’m not at work. But while I’m at work, I work 12.5 hours. I’m up VERY early to get to work. I also have a small ranch for beef, meat birds and eggs, so that keeps me up late. All this means I end up not cooking myself lunches for work cause I’m freaking exhausted, and I get too busy at work to leave and eat. So for 3-4 days a week, I fast almost all day, until night time.

        I need to stop being a lazy bastard and get up even earlier, and pack my lunch. Or stay up later, whichever… sigh.

        Daniel Ospina wrote on September 2nd, 2013
        • Hi Daniel,
          I would suggest on your day off making lunches for the week that you can grab and take with you. When I am hiking for the day, I carry primal pacs or some variety of nuts and jerky that are lightweight and don’t have to be heated or refrigerated.
          Rae

          Rae wrote on September 2nd, 2013
        • Keep coconut oil (and spoon) and protein powder & shaker cup at your desk for quick food. Don’t underestimate the power of dehydrated cooked foods either. Prepper/camping sites offer everything and anything dehydrated. Broth in a carton poured into a crock with rice noodles and canned meat + microwave. No home cookiing or assembly needed…just shopping for your mini desk pantry. Tuna packet + spoon = better than starvation or peanut m&ms from vending.

          Olympicnoodle wrote on September 4th, 2013
  14. I have really bad anxiety/depression currently. I know I’m not getting enough calories because I have completely lost my appetite. I try to make what I do eat count (healthy fats), but its hard. My blood tests came back with anemia even tho a lot of my meals include red meat and/or greens. So now I’m supplementing with floradix. I feel confused as to how to improve my situation at this point. My doctor suspects adrenal fatigue. Feeling overwhelmed. Tmi.

    Lisasaurus wrote on September 2nd, 2013
    • Avocados are a great source of calories and healthy fats! So are walnuts :)

      Joey G wrote on September 4th, 2013
    • I recommend “the diet cure” or the mood cure…she has a nice survey that will help isolate and pinpoint specific health issues: like candida or thyroid issues for example. Then a nifty chart of mental state to the associated neurotransmitter, possible cravings, then the amino acid therapy dose to take to counterbalance for immediate relief. Improved diet and supplements are the long term cure with a weaning from the AA or other supplements when able.

      There is only so much stress the body can take before it can’t go any more. I finally understood why superstars ended up in rehab for “exhaustion”…wwII they figured out the timeframe of exposure before combat soldiers were incapacitated. Stress support hormones come from the adrenal glands.
      Vitamin c and collagen and stabilizing blood sugar are biggies for adrenal gland support. Eat Salt if your hands are cold, drink water if they are warm. On a bad day with low blood pressure I might seek out/ allow aspartame drinks for the bp raise from the l-phenalanine content but otherwise I try to avoid stimulants plus that stuff causes rapid dependency at least for me.. I also opted to use pregnenelone cream in my case. Dr Lam has a great questionnaire and outline on his site that pinpointed the hormone relationships. Sex hormone steal to keep adrenaline family hormones well Stocked. All adds up to feeling horrible all around.

      Olympicnoodle wrote on September 4th, 2013
    • Hi Lisasaurus, I had adrenal fatigue and it isn’t fun. My Naturalpath fixed me with lots of supplements. It was a slow process, but I feel like a new person, so don’t give up. I’d say the safe stuff you could try without a Dr’s care is sea salt or pink himalayan salt in water (helps with dizziness when standing up), fish oil and Natural calm (magnesium supplement in powder form). Don’t push yourself physically, because if it is adrenal fatigue, excercise will actually work against you. If you are not on any depression drug, ask your Dr. about natural supplements for Seratonin support (should be 5 pills) which are way better for you than a drug anyway. I don’t remember my diet or hunger level when I was recovering from adrenal fatigue, but I know I wasn’t primal, so hopefully with the right care, you can rebound way quicker than I did.

      Cindy wrote on September 6th, 2013
  15. Thanks for answering my question! That’s 100 times more than one could find anywhere else… Content like this keeps me coming back here day after day. Just awesome.

    As for the 50mg – that was an ‘upper end’ figure – I was hitting between 350-500% of my RDI (maybe 35-50mg), but also also quite often 50.

    How did I do it? about 500g of chicken hearts some days, liver pate with every meal, and of course a big juicy steak every night…

    Whether it was the excess iron or not, during this time I was generally feeling rubbish – lethargic, and completely lacking energy. The danger (my thinking anyway), was that the same symptoms could spell a B12 deficiency, which is why I kept upping the B12 (and consequently, iron) rich foods. Talk about vicious cycle! Didn’t realize vitamin A could be a problem too.

    Balance is key :) and following advice here I’ve cut back to just 500g of hearts/liver per week, increased white meats and fish. Keeping track of your RDIs with Cronometer etc is something I’d recommend to every primal eater.

    I’m loving eating primal but it certainly is something that I’d call a ‘skill’ that needs to be ‘learned’ like any other… It’s a long road and there’s no turning back.

    Thanks once again,

    Mike

    Mike wrote on September 2nd, 2013
    • My pleasure, Mike!

      Mark Sisson wrote on September 2nd, 2013
    • hi
      im just wondering how 50mg is 500% when for a man over 19 yrs the daily intake should be 8mg and women between 19-50 it should be 18mg?
      The way it was explained to me was men need 1mg a day to be absorbed but need to eat around 8mg to get the 1mg.

      Hanna wrote on September 3rd, 2013
  16. Nice dish, thanks for sharing

    Airi wrote on September 2nd, 2013
  17. I have the majority of the symptoms associated with not getting enough calories. My problem is I have so little energy and no motivation to do anything that I just can’t get myself to cook most days. I’d rather not eat anything than eat something awful and it’s so time consuming to prepare all these meals. So I’m sure I am eating too few calories but not quite sure how to correct the problem. I currently have two wild caught salmon filets in the fridge and I’m hungry but no energy/desire to cook it. Maybe that’s partly why I can’t lose these last few pounds. I get so overwhelmed sometimes. It’s easier to eat out but that’s not much of a healthy choice usually either.

    Brianne wrote on September 2nd, 2013
    • I am in this same place. I’m hearing the suggestion to incorporate more carbs, and maybe that’s part of the solution.

      Lisasaurus wrote on September 2nd, 2013
      • Hm, maybe I’ll get back to eating more sweet potatoes. Thanks :)

        Brianne wrote on September 2nd, 2013
  18. I completely agree that eating less calories can be detrimental. I had nearly all of those signs in the beginning, although I was eating around 100 g of carbs per day, sometimes more. But factoring in that I still breast feed, it was probably not enough and my body responded with lethargy and increased anxiety. As soon as I upped my carbs with some bananas, sweet potatoes, more fruit and very occasionally white rice, I started to feel much better- way more energy and overally feeling calm, peaceful and focused.
    I also notice that on days when I thought I had eaten too much, I lose more weight. That is really eye opening.

    LondonIvy wrote on September 3rd, 2013
    • Breastfeeding really throws a wrench in! I am so hungry. All the time. I eat more than my husband, which is saying something. If I were eating this much and NOT nursing my voracious munchkin, I’d be a blimp. As it is, I’m skinnier than before I got pregnant!

      Moms, if you just had a baby and you plan on breastfeeding, PLEASE don’t restrict calories. You need ‘em to make that milk!

      Rebekah wrote on September 3rd, 2013
      • I agree. I would not do it in early days as well, I started primal when my girl was one and a half. It did not affect my supply much if at all, but, if it did, I would not care much at this stage as I would like to wean her soon anyway.

        Also I am from those whose body holds on fat while breastfeeding, but primal does help me lose weight. Standard dieting made me miserable- cold, hungry and I could not lose much. Primal was like a miracle, I lost a ton in the beginning and continue losing about a kilo per week. I was so tired of being so overweight and tired, I just had to do something. Now, 20 kilos lighter, I feel so much stronger and more optimistic! A lot of health niggles have disappeared too, but that’s a story for another time :)

        LondonIvy wrote on September 4th, 2013
    • Can’t agree more about this. I’m breastfeeding and doing a whole30 now and finding out that I desperately need more sweet potatoes, bananas, almond butter, and other dense or carb rich foods to SURVIVE. I have frequent dizzy spells or feel awful if I don’t amp up the food. It’s hard to keep up on the food!!! I also have noticed how I lose weight on days I eat the most.

      Christine wrote on March 13th, 2014
  19. What I wrote probably looks very confusing (thanks to my whiny little one). Yes, I had to up my carbs to feel better, but at the same time it increased my total calories. So for me it is the balance of macros that counts as well as total calories. So, if one has the above mentioned symptoms, one could play around with increasing calories and, if that does not bring relief, upping the good carbs.

    LondonIvy wrote on September 3rd, 2013
  20. I am so glad to see something here about not getting enough calories. I will preface all the things I am about to write by saying first that I love MDA. I read it every day, and recommend to to many people I know. I’ve read Mark’s book and go to it often as a reference. But I want to chime in here because I know that there are people out there like me that want to be healthy and eat healthy, but are lean to begin with.

    I just turned 43, am 5’9, 150 lbs. I’ve always been lean and active, and have had to always work to maintain 150 lbs weight. People always said, “wait till you get older, you’ll start to gain weight.” Well, that never happened. I discovered Crossfit about 3 years ago, and have been doing it 3 times a week ever since.

    The first year I started, I felt great, and kept seeing improvements in strength, speed, and skill. After that first year I decided that cleaning up my diet would bring my performance to the next level. That was not the case. The more I tried to go full paleo, the worse I felt. I lost muscle, could not recover from workouts, and my overall performance in the gym went downhill. (I thought it just might be that fact that I was getting older, but I saw people older than me doing better and still improving.)

    I’ve tried to wade into paleo several times, never believing that a good paleo diet could have a negative effect. I always figured it was something else. But every time I’ve gone more paleo, I only succeeded in loosing weight, and having many of the symptoms listed above. I finally had to put in a note in my workout journal that reads “Don’t go Paleo!! It doen’t work for you!”

    I love the IDEA of paleo, and I know it works miracles for a lot of people, but there is no way for me to get enough calories, regardless of how much coconut oil, sweet potatoes, and butter I add to meals. I’ve had to put the carbs back into my diet. I’m now adding raw eggs and ice cream to my recovery shakes, eating pasta and bread (Ezekiel), and basically eating like I did when I was in college — and feeling MUCH better. I still try to eat a variety of foods, vegetables, fruits, nuts, fats. But for me it would have to be a choice, Crossfit OR Paleo.

    And I can hear those on the paleo side saying – “Crossfit does not fit into the Paleo lifestyle, primitive man did not ‘workout’ like that.” But I think at 43, Crossfit 3 times a week is more than realistic.

    I also love Crossfit. It keeps me sane and happy, and acts as a counter measure to my computer programming job where I sit (stand, kneel) 8 hours a day. So my to sense for the hard gainers like me out there. For some people, 30% paleo works best.

    Mr. B wrote on September 3rd, 2013
    • It’s really comforting to read that this diet isn’t a miracle cure for everybody, and there is no set path for everybody. As soon as I felt myself slipping back into anxiety/depression, I upped my vigilance about strict primal eating. I also quit drinking alcohol to deal with my issues instead of self medicating. The results so far have been less than stellar. I have lost 35 pounds since June, I cannot sleep a wink without medication. I am anxious and teary most of the day. Tired and feeling sick to my stomach. I think at this point my thoughts about food have become a little disordered. I keep telling myself if I just eat more primally, I’ll have to get better. So it’s refreshing to hear this may not be the case for me. I guess I will try to force feed myself more foods in hopes that my appetite will return and my body will calm down some. (Also to add I have other strategies, weekly acupuncture, smart recovery meetings, and therapy).

      Lisasaurus wrote on September 3rd, 2013
      • Check your carb intake. My anxiety had increased a lot when I tried to bring my carbs down. If you are eating too less, your body may react by throwing out a lot of stress hormones. You could also try supplementing with some good Magnesium supplement. Jut my two cents.

        LondonIvy wrote on September 4th, 2013
      • You still may need more recovery time for your “gut” to resume healthy digestion. Sometimes when people have “stressed” themselves in some way through work, trauma or self medication it can change the bacteria in your digestive system. As a result the yeast can take over and that leads to anxiety, depression, out of character anger and other emotional upset.
        If that is the case with you, more carbs in for form of sugar like a lot of fruit or simple starches will add to the problem by feeding the out of control yeast. Also, when you start to get good bacteria that should be there there will be a die off of the yeast, not pleasant but worth the discomfort so that you feel better as you move the food through your system as well as a better mood, you’ll feel more in control of your emotions.
        One time when I couldn’t stop crying my herbalist told me to take 5 pro-biotic (the kind you find in the refrigerator at the store) 4 times a day for a few days. By the afternoon of the first day I felt better and by the end of the second day it seemed like just a bad dream. The other thing it helped was that I could sleep.
        I hope you can figure it out and get some relief (and some sleep)
        Oh, and another thing, I don’t know how old you are but as a woman, as we age sometime our hormones are a bit off as well. My chiropractor showed me a pressure point at the top of my ribs, under my arms to massage when I wake up about 3AM. That works for me like magic.
        So there you go, a little more information for your quest for information.

        2Rae wrote on September 4th, 2013
      • I just want to say I love your Username “Lisasaurus”. That just tickles me.

        Michael Maier wrote on September 4th, 2013
  21. “I’m not even mad. That’s amazing!”

    Who clicked on this link? Love the humor, Mark!

    Marisol wrote on September 3rd, 2013
  22. I’m astonished that so many people lack appetite on a primal diet and have difficulties on getting enough calories. In the beginning I had difficulties with digesting more fat, but a remedy like Enzygest solved the problem. I always look forward to my next meal, try to be creative with my food choices and ways of preparing it. Those who don’t like to cook, why don’t you try a crock pot (just throw food in and it prepares itself) or prepare four meals at once to safe time.

    Margit wrote on September 4th, 2013
  23. On the subject of high iron:
    I gotta say that I had ten times the “normal” amount of iron according to my last blood test result from back in 2011. Range is somewhere between 60mcg/dL to 170 mcg/dL and I had over 1.700!

    Strangely enough the doctor didn’t mention this back then and I only just found out when I had the results sent to me because I recently transferred to another doctor and wanted to have a new blood test taken after being paleo/primal for over six months now. We’ll see what happens this time, with even more meat in-take than before! O.O

    Stefan wrote on September 4th, 2013
  24. I’ve been on primal for the past eight months and despite strictly staying under 100grams of carbs, I was struggling to lose weight. I recently had my resting metabolic rate calculated. They hook you up to a machine and you rest/breath into it…it analyzes your VO2, etc. According to the calculations, the amount of calories I am burning while resting is 1900. On the paleo diet, I was only eating around 1300 (despite feeling very full). Additionally, I needed to also add back in any additional calories I was burning. I’ve been closely monitoring my calorie intake to make sure I’m hitting this level. Hard to make this adjustment as I was already filling full at 1300 calories, but I am finding myself having more energy especially for my strength training workouts. Now that I’m adding in more calories, I’m starting to feel more hungry. Perhaps getting your resting metabolic burn might be helpful in determining how much your body needs?

    Cara wrote on September 4th, 2013
  25. I disagree that you should test for Hemochromatosis before getting a full iron panel. A full iron panel can tell you whether Hemochromatosis is likely or not. It costs a lot less, and… ya’ll, HH is a genetic test. More people are becoming comfortable with having genetic testing, but the laws are still new and unclear concerning this stuff. Think about whether you want a genetic diagnosis in your medical chart before you get tested. I have HH and am glad I got the diagnosis (homozygous), but not everyone is comfortable with that.

    There is another condition called Iron Avidity that HH patients get… can have normal ferritin but still whacked-out iron panels.

    The Iron Disorders Institute is a good source for interpreting your iron panel numbers. I recommend visiting their website if you have any questions about iron deficiency, iron overload, or less common things like Thalassemia.

    Casey wrote on September 4th, 2013
  26. It’s true how much a calorie restricted diet can bring about negative benefits. I once worked with a client who complained that she have been trying to lose body fat especially in the abdominal region by increasing her calorie output and decreasing her calorie input. Put her on a plan that sees a little higher quality calories in and more strength training and results started coming in.

    Great post Mark.

    Aqilah wrote on September 4th, 2013
  27. I am thinking some of those symptoms apply to me – I have been wondering when I am going to have all this extra energy everyone keeps raving about, but I never seem to have much. I also have trouble sleeping and struggle with anxiety and depression.

    After reading this post, I decided I want to track my daily calories, carbs, protein, and fat so I am decide what is missing.

    I looked for an app for iPhone and bought Carb Manager. It is good for carbs (I have trouble getting enough carbs most days), but, although it gives the fat and protein counts for each food, it doesn’t add them up.

    Is there an app that will keep track of all of these? Some days I just feel like something is missing and I am never sure whether I need to eat more fat, protein, or what.

    Holly wrote on September 7th, 2013
  28. Hey folks, I know it has been several months since this blog post, but I need a little help…or at least confirmation of something I’m beginning to suspect.

    I’m 33y/o, 5’8″. I started eating Primal about 8 months ago, beginning at 190lbs. Within 5 months I had lost 50lbs, returning me to my college-aged weight when I was eating a SAD diet and running marathons. My workout regimen since going Primal has consisted of 3x/week weight lifting (linear progression), sprinting twice per week, and a 30-60min hike each day. I have been eating around 1g/lb of protein and 50-100g carbs each day, with enough fat to reach satiety. I eat until I’m full and then I’m good to go for another 4-5 hours.

    Now for the problems…I seem to be seeing several of the symptoms in the blog post. Most notably, while I was able to get lean (6-pack and all), now some belly fat has slowly been creeping in over the past several months. Also, my strength gains via linear progression training have been SLOW. I entered my typical day of eating into a journal and found I’m eating around 1800 total calories. Could this be the problem? Nothing else has changed. I get plenty of rest and maybe cheat once a month.

    Should I increase my overall intake? If so, should it just be more fat, or should I add more carbs too? At the same time, I really would like to trim off this belly fat accumulation. Thanks for the help!

    Justin wrote on January 13th, 2014
  29. I forgot to add…perhaps an occasional carb referring is in order?

    Justin wrote on January 13th, 2014
  30. ^refeeding

    Justin wrote on January 13th, 2014
  31. Thanks for your nice blog. I have got idea about paleo diet/ diet. Let me know if have any blog these related.

    Bipul Kumar wrote on January 28th, 2014
  32. I started Paleo to clean up my body and I wrecked my thyroid. I ate less than 1000 calories a day for about two months and I stopped getting my period. My FSH Level was 87 first reading and 101 second reading, that is menopausal and I’m 29. Obviously, the docs have no clue, so I will be treating this on my own, but….. I”m not convinced peanuts and beans are bad, healthy people have been eating them for quite some time. I quit eating them and suddenly got very ill. My throat hurts to swallow, my poor thyroid. We need calories, we need calories, not just nutrients. If you drank a glass of water with concentrated nutrients every day you would starve to death. I have read similar experiences of women doing this so called wonder diet. I think Weston A. Price is more on point, but I would just say, be careful. By the time you feel bad it may be very hard to fix your body.

    Morgan wrote on February 24th, 2014
    • It’s highly unlikely that cutting beans and peanuts caused your medical issues. Also, where did you get the idea that you were supposed to eat so little? Of course we need calories. I follow a strict paleo/whole30 guideline and I eat between 2500-3000 calories a day. The weight stays off. It’s about finding what’s right for you. Paleo is not dangerous.

      Tianna wrote on February 24th, 2014

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