The Health Paradox Paradox

The Health Paradox Paradox FinalA paradox is an observation that contradicts a previously-held assumption about reality. But assuming the observation is true, a paradox isn’t really a paradox. It’s not the new observation that’s wrong or faulty or misinterpreted; it’s the assumption that contradicts reality and needs reworking. The history of science is littered with paradoxes that dissolved when previously held assumptions were modified under the weight of new observations. The health, fitness, and nutrition spheres are rife with presumptions, conventional wisdom that pretty much everyone—from authorities and experts on down to laypeople—holds to be true. But we’re finding that these presumptions are increasingly challenged by the steady onslaught of new observations. Some of the most notable presumptions include but aren’t limited to:

The sun will kill you.

Saturated fat clogs arteries.

Animal protein gives you cancer.

Cardio makes you immortal.

Full-fat dairy will make you fat.

Vegetable oils are healthiest.

For what seems like a small eternity in today’s terms (the last 8-10 years), we were the only ones who saw through them. If you’ve been reading this blog and others in the ancestral health sphere for a long time, you know what it’s like to be part of a small tribe snickering at the foolish outsiders and their silly beliefs. These conventional canards of wisdom are familiar to you.

But that’s changing. Bread and margarine sales are down. Butter sales are up. Low-carb and gluten-free options exist on nearly every menu. The farmer’s market is more crowded every weekend and half the time the meat guy’s all sold out of liver and marrow bones before I get there. McDonald’s serves kale salad. Chipotle went GMO-free. The general population is figuring things out, and industry is responding.

The media is responding to these changes, too, but on a delayed schedule. The findings that reject these tenets of conventional wisdom are usually presented in the media, and sometimes even in medical journals, as “paradoxes.”

Let’s look at a few of them.

The French paradox

The most famous of health “paradoxes,” the French paradox describes the fact that despite logging the highest intake of saturated fat the French have some of the lowest rates of heart disease. And boy do people try to explain it away.

Maybe it’s the resveratrol in all the red wine they drink! Oh, there’s actually very little resveratrol in wine (and the highest concentrations occur in Argentine malbec, not French burgundy)? Well, maybe it’s the alcohol itself improving blood flow and endothelial function. Or what about the grape polyphenols found in wine…those are good for you, right?

Or maybe, just maybe, saturated fat isn’t the bogeyman you think it is? Maybe, just maybe, foods that are high in saturated fat, like eggs, goose liver pate and foie gras, butter, and dairy, contain important nutrients that protect our hearts and improve our health. Maybe they just eat a healthier diet, lead healthier lifestyles, and saturated fat is a component of that.

The Israeli paradox

Israel has one of the most lopsided polyunsaturated/saturated fat intake ratios of any country. They love their cholesterol-lowering PUFA-rich seed oils, so much that they carry more of it in their body fat than any other population. Conventional wisdom says they should therefore be almost immune to heart disease. Are they?

No. Israel has elevated rates of heart disease, diabetes, cancer, and other modern maladies despite their diet being low in total fat, low in saturated fat, and high in omega-6 PUFA. They call this the “Israeli paradox.”

The sunlight paradox

The sun kills. It gives you cancer, except for the inconvenient fact that people who get the most sun are the healthiest and live the longest.

I’m not saying you can’t get skin cancer from sun exposure. You can. But what the bulk of the research says is that this risk might be a worthwhile tradeoff for all the other health benefits you get from exposing your skin to the sun on a regular basis. Heck, “having skin cancer” reduces your risk of heart disease and osteoporosis and may even improve your longevity. It’s a marker for improved heart health, bone density, and protection from all cause mortality. Decent trade off, I’d say!

That’s why we have the “Scot’s Paradox,” where Scottish people with low sun exposure have a higher risk of dying early. Or why most recently researchers grappled with the “paradoxical” effects of sun avoidance on heart disease, death from all-causes, and death from cancer among Swedish women. They actually concluded that the reason sun worshippers had more cancer deaths than sun avoiders was that the sun was protecting against heart disease and letting them live long enough to get cancer!

The PUFA/cholesterol paradox

This goes alongside the Israeli paradox. Namely, omega-6 PUFAs (from nuts, seeds, and seed oils) are well-known to lower cholesterol. This, coupled with the fact that epidemiological studies sometimes show positive associations between their consumption and cardiovascular health markers, means they’re promoted as healthier fats. Guys like Walter Willet who will admit the supremacy of fats over refined carbs are quick to insist that one chooses PUFAs over saturated fats.

Yet when you actually give humans PUFA-based diets and pit them against SFA-based diets, cholesterol lowers but heart attacks do not. That’s what a re-evaluation of old, previously-missing data from a study revealed. Everything goes right on paper when you switch out SFA for PUFA, except for endpoints—heart attacks, deaths, and overall outcomes. You know, the stuff that matters.

The high-fat dairy paradox

All the experts say to choose low or non-fat dairy. Every official health recommendation, whether it’s from the AHA, the ADA, or the American Academy of Pediatrics, implores us to choose low-fat or non-fat dairy. Doing this will supposedly confer protection against heart disease, diabetes, and childhood obesity.

High-fat dairy has two big theoretical marks against it.

Too many calories (from all that fat). Since calories—and calories alone!—determine body weight, eating the high-calorie version of a food is always worse and will always cause more weight gain than the lower-calorie version.

Too much saturated fat. This’ll raise our cholesterol, clog our arteries, and predispose us to early, certain death.

Yet reality shows the opposite. People who eat high-fat dairy are thinner, less diabetic, and generally live longer than people who eat low-fat or non-fat dairy. It’s almost entirely correlative, but the consistency of the relationship indicates something causal may be occurring. This is the “high-fat dairy paradox.”

That’s just a few of the biggest. There are others, too.

Millions of people see through these, from the researchers performing the work that uncovers the “paradox” to people like you and me who read, accept, and integrate the new evidence. Why is it so hard for authorities, experts, and the media to accept evidence that counters previously-held assumptions?

These claims have the illusion of enjoying reams of supporting research. Why else would “everyone know” saturated fat clogs arteries? Why else would the ADA recommend avoiding high-fat dairy? These are the good guys, the experts, the authorities. They wouldn’t lead us astray. The “new” finding is singular and isn’t enough to disprove the years of evidence in support of the conventional wisdom we imagine exists.

You can find support for anything.” Yeah, this is sorta true. You can usually dig up a reference that seems to support your pet belief about the world, whether it’s veganism being the healthiest way to eat or the earth being flat. And no matter how crazy the claim is, you can make it sound pretty reasonable. If that’s true—and it is—it’s understandable that a person would be leery about accepting evidence that contradicts the presiding orthodoxy.

Basic ignorance. Journalists are paid for their production. Unless you’re doing long-form, most writing these days moves very quickly. They get something out to try to stay ahead of the news cycle, to stay relevant, get their page views, and before long they’re on to the next piece. There simply isn’t enough time or brain space for most journalists to stay abreast of every bit of research pertaining to the subjects they’re covering.

Caution. My hopeful guess is that many journalists are using the word “paradox” lightly. Rather than indicate a refutation of the known laws of space-time and Newtonian physics, they’re using the word to describe those observations that contradict previously-held beliefs and force us to consider new ones. They’re still grappling with this stuff, just like everyone else, only on a more public stage. They don’t quite know what to think.

In reality, there are no paradoxes. Instead, there are observations that don’t fit our beliefs and force us to re-evaluate previously-held positions and consider new evidence. And doing that is hard. Doubly so if your entire livelihood and sense of self-worth and identity are riding on those beliefs holding fast.

The world is much stranger and more complex than we can imagine, or predict, or model. We’re still unraveling biology. I certainly don’t have any answers. All we can do is continue looking, probing, observing, and integrating. We can’t ignore contrary evidence or throw up our hands and say “agree to disagree.” That’s not how this works. We must confront it head on.

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About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

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39 thoughts on “The Health Paradox Paradox”

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  1. These “paradoxes” should tell us that we really don’t know much about the human body after all. There are far too many factors to pin down and compartmentalize. One size does not fit all and never will. Revisit Mark’s article on research before buying into what you read or hear.

  2. Spot on as always, Mark. I’ve seen all of these “paradoxes” grace my news feed over time. I’m glad you’re around as a master debunker.

  3. Love this! What a great summary of some of the biggest “paradoxes” that shouldn’t be.

  4. CETP inhibitors drive down the mythical LDL-C and raise HDL, but have adverse all-cause mortality compared to doing nothing. One statin zealot described this as a paradoxical result. That the lipid theory of heart disease might be false is apparently not open for debate.

    When a consensus expert speaks of “paradox”, they are often admitting to being a “black swan denier”.

  5. Great article. Makes me wonder if there really is such a thing as a paradox.

    Too many options makes us unhappy, insecure and dissatisfied with the choices we do make. Yet limited choice ( perhaps 3 or 4 options) has the opposite effect. Is it a choice paradox or just the natural and predictable results if we truly understand how free agency and choice works?

    Arranged marriages have a higher success rates, no matter how you rate them, than ones people choose for themselves. Is this a true love paradox or the natural consequence that comes from arranged marriages which is strong family and cultural support that protects and nurtures the entire process of arranged marriages from birth to death?

    Exercise is great. Builds muscles, reduces inflammation, improves lipid markers, builds bones, strengthens the heart. Too much does the opposite. It breaks you down.

    Definitely going to rethink using the word paradox. Perhaps “seemingly paradoxical” is a more accurate way to describe these counter intuitive results.

    1. Arranged marriages generally take place in cultures where women have all the legal rights of gravel. There is your confounding factor right there for the so called success of arranged marriages. How many of those women in those cultures have a real choice?

      1. It’s true, as women’s rights increase arranged marriages tend to decrease but even in America, most Indian marriages are still arranged. Culture and tradition supersede civil law in private practice. And arranged marriages are not how people think they are. Most of the time the woman and the man are introduced to multiple potential partners until there is a good match. It’s in everyone’s interest to have a good match.

        This is how it’s been in every culture on the entire planet since the beginning of time. Marriage for love and lust is a really new concept. It was just too risky. Families needed to be extended and strengthened, alliances formed, babies made, crops planted, wars fought, skills learned…lots of stuff to do.

        The point I was making is that we are raised to think that we are the best ones to choose our mates and we should choose based upon passion. But it turns out people’s ability to choose a proper mate is indistinguishable from chance.

        You are no better at avoiding an abusive relationship, getting involved with a drug addict, getting left with a child, being cheated on, or being disrespected than if your parents just picked someone for you.

        And that’s kind of a bummer.

        1. “In reality, there are no paradoxes”

          What about Zeno’s paradoxes, hmmmmm???

        2. @ktm As far as I understand, Zeno’s paradoxes are either math problems that have already been solved or were based on false assumptions, or philosophical thought experiments of imaginary situations.

        3. I prefer personal accountability. I’m glad I was able to choose my own mate 27 years ago and counting. Believe it or not, you do have some level of control over the success of your marriage; based on your choice, how you nurture your partner, whether you bear your fair share of the load and add value, whether you “let yourself go” or keep yourself presentable, how ready (or not) you are to throw in the towel, how willing you are to pursue his/her interests as well as your own. Of course chance plays a part, there is bad luck; but I’d rather choose for myself and accept the consequences. I don’t think being stuck and having no alternative, as in some arranged marriages, necessarily constitutes “success.

          [But I’m impressed that you know how every culture, on every planet, since the beginning of time, has married.]

    2. It could be that families are better at choosing life partners than the people involved???

      Also people who accept arranged marriages where the mainstream culture does not demand it may have lower and hence more realistic expectations.

  6. Many years ago, I’ve told a dear friend that a day will come and the world will internalize, that it’s the fats that French people consume (the old generation anyway) that keeps them healthy and not the wine (not that there’s anything wrong with a glass of wine every now and then). So I am glad to read your take on this.

    With one exception: French foie gras isn’t that healthy, on account that it’s produced by force feeding ducks, which results in an inflamed liver (fatty liver disease). And granted, the French eat bread as well but mostly sourdough; albeit, it’s changing as well for the worse. Interestingly enough, Israel banned this practice years ago, in spit the fact that the country was was a big exporter of highly rated foie gras to France (big money). And just recently, Israel’s ministry of health called upon the likes of Coca Cola, MacDonald and food manufactures to clean up their act or else… (starting by cutting on adding sugar into everything).

    But true, Israelis consume a lot of unhealthy seeds oils instep of what’ “hot” in the States, but also, plenty of vegetables, nuts and olive oil. As a result, disease and obesity is on the rise and so is vegetarianism… On the other hand, the Paleo movement is here to stay and speaking of Paradoxes, so is longevity. But if to quote from you, I would rather die healthy then old and sick. The fact that my dear mom just passed away a few weeks ago, at the age of 99 without a disease to show for, is encouraging but who’s to say….

    Now here’s another Israeli paradox. If and in accordance with the Dimona study [] a high fat low Carbs diet showed the best results out of 3 given options, why not have the country adopt it as the diet of choice? Conflict of interest? By whom? Big Pharmaceutical companies and food manufactures on one hand and sleepy heads at the department of health on the other hand? And how is it, that the Mediterranean diet came at a respectable 2nd place, in spite the fact that it’s more in line with the geographical location? Not surprisingly, the high carbs low fat diet, came out last. Thanks!

    1. One thing missing from the French “paradox” is that they don’t snack and eat almost entirely whole natural foods ( at least compared to us). Euro Disney found that out the hard way many years ago. The snack bars and food courts were deserted. At least until 1pm on the nose, and then every single person in the park tried to eat and it was a disaster. They learned the hard way that Europeans don’t snack like Americans.

      As for why there is so much resistance to facts and diet I think it’s not so much a coordinated conspiracy as that telling people to go ahead and eat real fat is so counter intuitive that it will take many years of overwhelming evidence to swing it the other way. Can you imagine how hard it is for naturally risk averse institutions (insurance companies, the medical profession, government employees, agencies and researchers) who are responsible for developing our nutritional guidelines, to change course?

      Even the AMA ( American Heart Association) in response to the most comprehensive meta analysis ever conducted concluded no link between dietary cholesterol and serum cholesterol and no link between saturated fat and heart disease said that just because there’s no relationship doesn’t mean you can just go eat a bunch of eggs.

      Huh? Yes, that’s exactly what it means. So they said one egg a day is OK now instead of three per week.

      I think they have so much institutional effort, reputation and memory wrapped up in a false lipid hypothesis that they can’t let it go. It’s just too painful to go “ooops, we blew it, do the opposite now”.

      Maybe if the AMA was headed by a Zen master maybe they could handle that kind of self awareness and humility, abut a big board of a multi million dollar NGO has zero chance of handling the new information.

      1. I agree and furthermore, the French buy just enough fruits and vegetables for the day, instead of stuffing their refrigerators with large quantities that end up withering away in the back of the fridge.

        As far as addressing change by our governments and big business, I often compare it to a large aircraft carrier that it too, can not change course and turn on the dime (as oppose to a small speedboat) but takes a long time to re-maneuver itself into position. And yes, perhaps not a conspiracy but a conflict between wanting to turn a profit/collect taxes, while subsiding interest groups – agricultural included and trying not no cause harm to the populace at the same time. Not a simple task indeed.

      2. Your comments always make me nod my head and smile in agreement. We are *very* different people, yet look at things in similar ways. Could not agree more with what you said about eating eggs: “Huh? Yes, that’s exactly what it means.” ;D

      3. Science advances one funeral at a time (to quote somebody whose name I cannot remember).
        Basically, as the senior dominant stubborn scientists die so the innovative younger scientists change the reality of science. It is a slow process of many years. Though there is a hope that the internet and the non-scientist researchers of science will speed up the process of change.

        1. “Science advances one funeral at a time”
          Going to remember that one. I think it applies to more than just science.

  7. Fantastic summary. You’ve hit the nail on the head behind all these stupefied headlines. Misinformation about nutrition has a stickiness that’s taking a while to whittle down (hence the apparent paradoxes abound). Hopefully within the next decade, these titles will be seen as comical relics.

  8. Many of the low fat guru’s such as Dr. Joel Kahn cite Finland moving away from saturated fats to pufa’s and dropping heart attacks and stroke by like 80 percent. Is anyone familiar with that being debunked. I think it would have to be in order for this post to have merit?

    1. What else changed in Finland? Have rates of smoking, trans-fats & margarine consumption gone down significantly? From the available RCT’s, the positions of the low fat gurus need no debunking to give merit to the Primal case.

      There was a time when it simply made sense to those in the Primal world and the successes of the few MD who used it were considered anecdotes. Now there are more than enough RCT research results from the scientific community.

  9. I’m going to throw a wrench into things here. Lets stop looking at food as a measure of health but rather stress instead.

    French Paradox – Diet goes against conventional wisdom, yet are healthy as ever. Now as far as their work/rest schedule, France and the European countries; they can’t work over “x” amount of hours, France happens to be 39, they get at least 5 weeks off plus a number of them more. They have a lot of time off meaning stress is low.

    Israel Paradox – Diet goes with conventional wisdom yet they they have elevated rates of diseases; so what does their work/rest schedule look like? Those with a 5 day work week get only 10 days off per year. If you work 6 day work week, you get 12 days off. They get a max of 28 days after a long long time.

    Though it’s not on the U.S, the U.S is generally unhealthy and has conflicting diet principals due to people torn between whole and processed food. Either way, the country is generally unhealthy. So what does their work/rest schedule look like: There is no statutory minimum for any paid holidays in the U.S

    If you go through country by country and look at health vs how much time off they actually have to themselves, there is a connection between poor health and stress. It’s very evident

    1. Interesting. Along with all that work is more stress, less exercise and probably very bad sleep quality. Food, stress, exercise and sleep…the 4 biggies. Thanks for the connections Brian.
      My non-blood relatives in Switzerland get 1-2 months paid time off a year, and I believe they are right up there in the top 3 for longevity.

  10. Japanese eat very little fat and suffer fewer heart attacks than us.

    Mexicans eat a lot of fat and suffer fewer heart attacks than us.

    Chinese drink very little red wine and suffer fewer heart attacks than us.

    Italians drink excessive amounts of red wine and suffer fewer heart attacks than us.

    Germans drink beer and eat lots of sausages and fats and suffer fewer heart attacks than us.

    The French eat foie-gras, full fat cheese and drink red wine and suffer fewer heart attacks than us.

    CONCLUSION: Eat and drink what you like. Speaking English is apparently what kills you.

    Copy and Paste from

    1. Hmm… English people speak actual English, and suffer fewer heart attacks than you. Paradox?

      1. The author is from the UK, a Scot, I don’t know if he calls himself ‘English’. He is a Cardiologist of no mean standing in the Primal world.
        It’s a copy and paste and I credited him in the post.

    2. Speaking English as one’s birth tongue is correlated with being one of those wacky Americans who believe in, for examples, HCLF and high stress lifestyles.

  11. I recall hearing on radio about the “Australian Paradox” ( ie. sugar consumption in Australia has dropped yet obesity has risen) which was shown up for what it was by someone with sharp eyes and a healthy dose of skepticism. Turns out researchers had used WHO stats on how many bags of sugar bought by consumers….only WHO had long since given up collecting such data as they realized bags of sugar bought wasn’t a good indicator of sugar consumed because as Mark has long warned us hidden sugars are in EVERYTHING.

  12. Aren’t the French notorious for smoking as well? Their superior heart health is undoubtedly from a high intake of fat soluble vitamins such as vitamins a, d, and k2. I’ve also read that if you want proper assimilation of long chain omega 3s like EPA an DHA you need adequate amounts of saturated fat in your diet.

  13. Resveratrol – “highest concentrations occur in Argentine malbec”

    Anyone any data to support this? I thought the Pinot Noir grape easily exceeds all others….

  14. This also happens in the hard sciences including physics. When Ernest Rutherford showed the atom consisted of a nucleus surrounded by electrons the stability of (what we charmingly think of as) normal matter was paradoxical. But scientists continued to think that physics was almost complete. The paradox was resolved only by quantum mechanics, which of course changed everything.

    Indeed — the fact that your body and everything around you does not vanish in a burst of electromagnetic radiation is a quantum effect.

    Ignaz Semmelweis comes to mind also. The doctors could not believe the they were murdering their patients. Perhaps this is not a paradox, but it does show the limitations of consensus “wisdom”.

  15. I have always wondered why anyone thinks that we can chemically create something better than what has been around for millions of years.

  16. Yeah as a pale skinned redhead with Scottish parents living in sunny Durban south africa, i have to disagree with your stance on skin cancer being a decent trade off for a lower risk of heart disease and osteoporosis. i’m 29 & have just had surgery to remove my lymph nodes for stage 3 melanoma skin cancer. i still have to go through radiotherapy & immunothereapy to try & prevent the further spread of this cancer. given the choice i would rather get the heart disease and osteoporosis in 20 to 30 years time than die from skin cancer within the next 5 to 10 ( if i’m lucky). skin cancer doesn’t seem to have improved my longevity either.

  17. “In reality, there are no paradoxes”

    What about Zeno’s paradoxes, hmmmmm???

  18. Not techno enough to add URL but can someone please insert recent news article from ABC news as recently as April 2016 – “Australian Paradox under fire” seems it’s been a lot more newsworthy than I realised. Well done Rory Robertson…the sharp eyed skeptic I was referring to in previous post.

  19. The israelis eats very little omega 3 fats. With a lot of fish and non kosher seafood, flaxseeds and oil, coldpressed non GMO ECO canola oil , walnuts, the omega 6/3 ratio would change. High heat cooking is not healthy and old oxidised oils are not healthy. Why do they allways try to proof that LA is bad without seeing that the omega 6/3 is out of balance. All haters of LA fatty acid seems to be fond of foods with a very high level of ARA. I also think it is not healthy eating over 120 grams of fat and over 3000 calories a day sitting on you ass.