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

Understanding Primal Blueprint Success from Crowdsourced Data

ScreenShot2014 02 18at32207PMThis is a guest article from Larry Istrail of the Ancestral Weight Loss Registry. Larry started AWLR to gain a better understanding of paleo and carbohydrate-restricted eating and bring the resulting data and trends into the mainstream medical community. He has presented the data at conferences around the country and today he is sharing his thoughts on data collected from Primal Blueprint adherents and how it compares to the medical literature. Enter Larry…

After two years, we at the Ancestral Weight Loss Registry (AWLR) are proud of what we’ve become. Over 3,100 people from all 50 states and over 55 countries have registered and shared the tribulations and triumphs populating their noble journey towards health, fueled by fatty meats with a side of buttered broccoli. A physician’s recommended eating strategy that, but for a few years ago, would at the very best be viewed as a data-less void of speculation, and at the worst, labeled utter quackery. Asking an overweight patient to eat foods high in calories does not pass the proverbial eyeball test, defying all common wisdom characterizing weight loss advice to date.

Coming up with a testable hypothesis for why we gain weight and how to lose it undoubtedly involves logic, intuition and researcher experience. As Nobel laureate Richard Feynman describes scientific discovery and hypothesis testing:

First we guess it…then we compute the consequences of the guess to see what it would imply. And then we compare those computation results directly to observation to see if it works. If it disagrees with the experiment, it’s wrong. In that simple statement is the key to science.

But what if we didn’t have to guess it? What if we had the capabilities to crowdsource hypothesis creation instead of relying on bias-confounded researcher intuition? This is the motivation for AWLR, and central to its success is you. Primal Blueprint (PB) followers make up 40% of registry members and from the bottom of my heart, I thank those who have registered thus far and urge those who have not to register here today to help make AWLR the largest weight loss registry the world has ever seen.

PB eaters have contributed a tremendous amount of data. The common experiences and behaviors that materialize by straining your conglomerate information through an algorithmic sieve become hypotheses that spawn a reverse engineering problem, beginning with clinical findings and searching for mechanisms of action. One of the most interesting such trends was that related to hunger.

After going primal, I just didn’t get so hungry any more. And when I did feel hunger, it wasn’t so pressing, and I could easily ignore it and it would go away for a while.

The ease of Primal Blueprint has surprised me the most. Fat tastes delicious, so I eat better-tasting food. I don’t go hungry because I simply eat until I’m full instead of counting calories.

See our testimonials page for hundreds of similar quotes. 95.8% of PB eaters report feeling “rarely or never hungry between meals” and of those who have tried a low fat diet in the past, 91% report feeling less hungry while eating PB. This satiety has led to an average of 33 pounds lost and over 31,000 pounds dropped total.

Could these findings be real? Or are they simply a function of the non-randomized, self-selected data that has accrued? Taking a journey through the medical literature may offer some insight.

They Starved, We Forgot

In 1944, Ancel Keys recruited 36 men into what would be known as the Minnesota starvation experiment, to study the physiologic and psychological effects of prolonged and severe dietary restriction. He documented his findings in a 1400 page tome, and shortly after the experiment began, the men quickly realized how difficult it might be. The predictable signs and symptoms quickly crept in: constant hunger, low body temperature, decreased libido and a total inability to think of anything but food. One subject offered a particularly chilling exposé of what it is like to eat such little food:

How does it feel to starve? It is something like this: I’m hungry. I’m always hungry – not like the hunger that comes when you miss lunch but a continual cry from the body for food. At times I can almost forget about it but there is nothing that can hold my interest for long. I wait for mealtime. When it comes I eat slowly and make the food last as long as possible. The menu never gets monotonous even if it is the same each day or is of poor quality. It is food and all food tastes good. Even dirty crusts of bread in the street look appetizing and I envy the fat pigeons picking at them.

So what were they eating? “The major food items served,” described Dr. Keys “were whole wheat bread, potatoes, cereals, and considerable amounts of turnips and cabbage. Only token amounts of meats and dairy products were provided,” with an average daily intake of 1570 calories, including about 50 grams of protein and 30 grams of fat.

Fast-forward 70 years

The director of Boston Medical Center’s weight management clinic and obesity consultant for Dr. Oz, Dr. Caroline Apovian describes in an interview how she treats her patients’ weight troubles.

“If somebody came into my clinic who had a BMI of 30—female—I would put them on a 1,200- to 1,500-calorie-a-day diet, and they usually would be eating 2,500. A normal, moderately active female eats 2,000 calories a day, and a male, 2,500.” But wouldn’t this “produce a chronic hunger?” the reporter aptly counters. “It does,” replies Apovian, “and it’s usually a hunger that people cannot tolerate. That is the reason most diet programs fail.”

So how did the “starvation diet” of 1944 become the standard of care today?

Protein, Hunger & Weight Loss

The Fat Trap, a popular New York Times article from 2011 profiles a study by Dr. Joseph Proietto, highlighting the difficulty in losing weight on a low calorie diet. Proietto recruited 50 obese men and women, studying the biological state of the body after weight loss. The patients were given 500 calories of a low fat Optifast shake each day for eight weeks. But after a year, the weight slowly came back and the subjects were haunted by their diet-induced hormonal changes, feeling “far more hungry and preoccupied with food than before they lost the weight.” Researchers also noticed that ghrelin, often dubbed the “hunger hormone,” was about 20 percent higher than at the start of the study. “What we see here is a coordinated defense mechanism with multiple components all directed toward making us put on weight,” Proietto says. “This, I think, explains the high failure rate in obesity treatment.”

However, this weight-loss-induced ghrelin rise is only observed when ketosis is absent. These same researchers three years later sung to a different tune:

Ketogenic low-carbohydrate diets are a popular means of weight loss, and in the short-term, often result in greater weight loss than low-fat diets…it is commonly proposed that ketones suppress appetite, and it has been observed that study participants on ad libitum ketogenic diets spontaneously restrict their energy intake.

And their randomized trial in the European journal of clinical nutrition confirmed this observation, demonstrating that “in mildly ketotic participants, the increase in the circulating concentration of ghrelin, a potent stimulator of appetite, which otherwise occurs as a result of diet-induced weight loss, was suppressed.”

This anorexic effect secondary to a high protein, high fat diet likely explains why PB eaters are so successful and happy with their new way of eating. It could also explain why in the majority of randomized clinical trials testing such diets, those highest in protein and fat systematically lead to more weight loss. There are at least 14 randomized clinical trials in which the people assigned to a calorie unlimited, high protein, high fat diet lose more weight than their low fat, calorie restricted counterparts.

Which begs the question: Where are the randomized clinical trials supporting low fat diets as the standard of care? The studies where a low fat, calorie restricted diet results in more weight loss than a calorie unlimited high fat diet. In fact, we at AWLR were so bewildered by the lack of evidence that we are running the “Low Fat Challenge” for anyone in the world to find such a trial, incentivized by a crowd-funded pot of cash. After nearly a year, hundreds of dollars have been raised with no winner to accept.

My wildest dream would be to make AWLR the largest weight loss registry in the world within the next year, overtaking the National Weight Control Registry that has a 15-year head start. They boast around 10,000 members after approximately 17 years of existence. At 3,100+ after two years, it is an ambitious but attainable goal; a dream that can only be achieved with your help. It would make a tremendously unbelievable statement to the dietary research community if Paleo and PB was so prominent and demonstrated such incredible improvements in health. If you have not registered yet, please take 10 minutes to do so here. And if you have, sharing this post with the world would make all the difference.

As you are reading these words, there is someone out there who is depressed, unhealthy and overweight. A poor soul being shunned by the medical community due to their “lack of willpower,” who struggles to get by on their 1400 calorie low-fat diet. A beautiful human being with boundless happiness trapped underneath the overwhelming heaviness of constant hunger and a label of “BMI > 30″, desperately searching for a real solution. With your help, I hope we can reach them and offer a gentle, heart-felt helping hand.

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. I’m so over the low fat craze. I’m sick of people looking at my basket like I’m nuts for buying real butter!

    Tamara (New Orleans) wrote on February 18th, 2014
    • I love people looking at what I buy. Especially at Whole Foods (the store is very close to my house). We know the co-founder of WF is about his vegan/vegetarian agenda, and the stores always display books like ‘Starch Solutions’ by McDougall, ‘Forks Over Knives’ by Esselstyn and ‘Engine #2′ by his son. So I love it when the chubby (and growing ever chubbier) check out gals, many of whom are likely vegan or vegetarian, seem to be scrutinizing my food purchases and probably wondering to themselves “How did this guy lose 70 pounds eating like this, and I’m on my way to gaining 70 pound while eating organic, non-GMO vegan?”

      Paul wrote on February 19th, 2014
      • Exactly. I have a large paleo group in New Orleans and Whole Foods was offering classes to us like canning and fermenting. That is until the vegetarian nutritionist decided to give us a lecture in how off course we were. She then past out a nutritional label and starting telling us how to read them. Her point was to show that we eat too much fat. I stopped her but then she got very defensive about how we were not educated in nutrition and steering people in the wrong direction. She said that we should trust the government, they create those labels for a reason! LOL. Of course that was the last class at Whole Foods. We still do classes but now they are at private estsablishments.

        Tamara (New Orleans) wrote on February 19th, 2014
        • Oh my. That must have been hard to back down from. As educated as she may think she is, she’s still the blind leading the blind. Anyone who says “trust the government” at this point can’t possibly be taken seriously.

          I do like the guys in the meat department at this WF. I think many of them have been made to feel guilty because they work in the “evil butchers and sellers of animal parts” department. They think I’m great for having lost all this weight while visiting them regularly for meat. Believe it or not, they will occasionally have 100% grass fed ground beef for $3.99 lb.

          Do you have Sprout’s in your area? Among their health and diet books, they have ‘The Paleo Diet,’ Wheat Belly,’ and ‘Good Calories Bad Calories.’ I do respect them for that. They sometimes have really great prices on grass fed meat and wild caught fish etc.

          Paul wrote on February 19th, 2014
  2. Regarding the depressed, unhealthy, and overweight, and the idea that all they need is a helping hand…

    I don’t advertise the fact that I follow a Primal/Paleo lifestyle. I’ve been asked a few times by overweight acquaintances how I stay so trim. They seem to think I have some rare and miraculous metabolism. When I tell them I don’t eat sweets and rarely eat grain products, they quickly lose interest because 1) they don’t want to believe me, and 2) they can’t stand the thought of giving up their favorite foods.

    Intense desire to change and the willpower to make it happen are absolutely crucial to weight loss. Unfortunately, without those elements, which can only come from within, all the coaching and encouragement in the world won’t help.

    Shary wrote on February 18th, 2014
    • Also, with all due respect to Larry Istrail of AWLR, who obviously has only the best of intentions, the questionnaire is way too long and wants way more personal information than anyone should be putting online. Just my opinion.

      Shary wrote on February 18th, 2014
      • Not only is the questionnaire too long, it also makes everything AWLR does subject to the same criticism we hear from Denise Minger all the time – people just can’t remember, and won’t report accurately, what they ate over the last couple of years. I wouldn’t believe any conclusions this organizations reports.

        Terry P wrote on February 18th, 2014
    • I have to agree completely, I have tried to help a few of my family and friends who are obese and they refuse to believe me. Even after my own exceptional weight loss due to PB they still think I am crazy. It takes a swift kick to get someone moving in the right direction, and the mainstream draws everyone one back to the CW. It takes a community to change someone.

      Josh wrote on February 18th, 2014
      • Reminds me of a silly old joke that I like.

        Q: How many psychiatrists does it take to change a light bulb?

        A: Only one, but the light bulb has to want to change first.

        D. M. Mitchell wrote on February 18th, 2014
    • You know, some people really struggle with weight. They are big from the time they are kids, so they think that’s the way they are supposed to be. This diet plan doesn’t make sense to them because it’s the opposite of what they have always been told. Other people are tired of trying because no low cal diet ever worked for them. Not everyone reads these web sites, they listen to their doctor because that’s what they think they are supposed to do. People do need a helping hand. We found health and I want to get the word out so others can find health too. To lots of people this is just another too-good-to-be-true fad diet. If we can get the word out with good data, I think a lot more people might get this message.

      Melissa wrote on February 18th, 2014
      • Melissa, people have to WANT a helping hand. Many don’t. They don’t want advice from anyone who isn’t an MD, even if that person giving the advice has lost 100 pounds, is off all meds, and is the picture of glowing health. As you say, they want to listen to their doctor, who gives them antiquated nutritional advice that doesn’t work.

        Paleo has made it into the mainstream. The word IS out. It’s out there in spades, available for anyone who wants to try it–free. I’ve seen tons of information on dozens of websites, on TV, in the newspapers and magazines. For those people who are too apathetic to change their mindset and do their own research, or do whatever is necessary to lose the weight, Primal/Paleo will always be just another fad.

        Shary wrote on February 18th, 2014
        • Agree Sharry…even though im hypothyroid with shot adrenals and hormones out of whack, so Im really not in good health at all, but Ive been primal since mid january. I have had ppl say I look 24 – 32, and the 32 guess was half way through a lonnnnnng nightshift. I am going on 38, and so they ask what do I do, I tell them, then the wall comes up. The thought of giving up processed carbs or other shite is too much to bear, even when in the presence of someone who looks alot younger naturally than their age or health conditions.

          I will not insist they try it, because if they want to, they would, and ask me for further details. I had a friend who is podgy and in bad health and I put this to him, and again, he baulked at it before carrying on whining about the state of his body and face. I guess he prefers his alcohol binges too much to actually do something about it *sigh*

          I am not looking to lose fat just yet until I have balanced my body with T3 25mg and some progesterone treatment and some reflexology. I am eating when I feel like it so my body can come out of its starvation memory thanks to the damage CW has done to it.It will come off when it is the right time and healed somewhat

          I am also considering unregistering from my drs because they are USELESS and not bothering going elsewhere. I am pissed off at the medical industry here in UK, who continually tout outdated, and wrong advice, with no evidence or critical thinking behind it. I am only a healthcare assistant and it is fristrating working in the nhs seeing this crap spouted all the time as gospel.

          So I only say im primal if asked and hope that they take it on board and go do their research, or get lead to primal some other way : )

          SoulFull WildHorse wrote on February 18th, 2014
        • I disagree. If you are pretty deep into this sub culture, you probably don’t realize, but a lot of people don’t know what paleo is and even more don’t really understand what primal living is really all about. I just started primal living for some pretty extreme GI issues a year and a half ago. There are a lot of really sick people out there that would jump at the chance to try anything to make them feel better, but they just never heard eating this way could help them. There are parents of sick kids out there that would be so happy to know this might help them. People have their colon removed because their doctor never mentioned this diet because they aren’t allowed. I really want to get the word out and science is a great way. I’m all for this research study.

          Melissa wrote on February 18th, 2014
    • I don’t advertise either, for the same reason. I recently uploaded a new picture on Facebook and almost immediately I had friends message me to ask how I had lost all the weight (40 lbs so far). I told some of them the truth but after a while I just got sick of the responses I was receiving.
      One of them is currently a nutrition major and she felt it was necessary to spend the next half hour lecturing me about how paleo can’t possibly work because I’m eliminating so many healthy foods like whole grains and dairy. I just laughed because moments earlier she was telling me how wonderful I looked. This is an extremely common response for me.
      The other one is a cousin of mine who said she’d rather find another way to get skinny that didn’t involve giving up pizza or ice cream.
      So yeah, for the most part I don’t say a word any more.

      SarahLouise wrote on February 18th, 2014
      • I had a 400 lbs guy insist that “the body NEEDS daily carb intake for ENERGY.” I kept explaining that in the absence of the carbs the body learns to use stored fat for energy. It made no difference.

        Jay wrote on February 19th, 2014
    • I was that person. Typical SAD. Tired, overweight, placing family before myself, actually cooking every night, but using the wrong oils and thinking i was cooking healthy foods.
      I started my new lifestyle with the encouragement of my son who is in college.
      I have l shed 90 lbs, eat clean and feel fantastic, and look 10 years younger than I did 10 years ago.
      People ask me how I did it!!!!!
      When I tell them no sugar and no grains, they instantly tune out.
      It is the instant conversation killer.
      I don’t even know what to say to them after that.
      I am living proof it works, but they don’t want to hear what they shouldn’t be eating.

      Bonnie kubacki wrote on February 19th, 2014
    • My same experience! It is as if at some point when you tell them about no grains and especially high (AND SATURATED, ANIMAL) fat their brains lock, they may assenting gestures, but the words slide off them.

      wildgrok wrote on February 19th, 2014
    • Lots of times they get mad. Have you had that happen? I have had people who I explained the diet to go around and tell others that it is all meat, and no fiber, which is completely different from what I really said. Most overweight people only pretend they want to be in shape.

      Jay wrote on February 19th, 2014
    • “Intense desire to change and the willpower to make it happen are absolutely crucial to weight loss. Unfortunately, without those elements, which can only come from within, all the coaching and encouragement in the world won’t help.”

      So sad, but so very true.

      KariVery wrote on February 19th, 2014
    • Isn’t is wild to watch people’s eyes glaze over when you say mention not eating grains? People are so addicted to grain products, that many would rather die than even consider that their grain treats might not be good for them.

      Paul wrote on February 19th, 2014
  3. I couldn’t help reading the last paragraph in Sarah mcgachlan’s voice, and hearing matching music in the background.

    Ryan wrote on February 18th, 2014
    • Nice

      Brooke wrote on February 18th, 2014
  4. Wow that “Low Fat Challenge” is crazy. It’s amazing what we all know as “true”. The world was flat at one time too.

    Luke wrote on February 18th, 2014
  5. It saddens me that there is so much conflicting information about health out there. At one point it was so overwhelming and discouraging to me. I really encourage people to experiment with what works best for them (and have Mark’s Daily Apple to thank for that).

    Florence wrote on February 18th, 2014
  6. It is hard to argue with week after week of success stories :).

    One doctor friend suggested a double blind trial was needed!! Why?

    Another puts it more simply: The proof of the treatment is at the bedside!!

    Paleo works.

    John

    John wrote on February 18th, 2014
    • Actually, it`s pretty easy to “argue with week after week of success stories”, seeing as the whole “success story” concept is inherently susceptible to confirmation and selection bias; in case you haven`t noticed, pretty much every dietary ideology out there manages to come up with an endless stream of “success stories” to present to potential acolytes.
      What nobody ever seems to mention are the “failure stories”. My personal foray into “optimizing my gene expression” in accordance with “Primal parameters”, for example, has thus far left me rather underwhelmed: Over several months, I have actually gained weight (and trust me – it isn`t muscle), most metabolic parameters have worsened slightly, and I feel no different otherwise (no signs of “boundless energy”, and my arthritis does not seem to have gotten the memo either); while some hope for a “breakthrough” still lingers, my enthusiasm for “evolutionary nutrition” has waned significantly, to say the least. I personally know several people who have had a similar experience with “Paleo/Primal”, and proceeded to file it away as “one of those fad diets which promise everything and deliver nothing”; since they (and, I assume, others like them) don`t hand in their stories/don`t register with the AWLR (whose name and structure clearly imply one thing – it is meant to document positive experiences only), the data generated by these endeavors are probably skewed.

      “Paleo works.” Unless it doesn`t. Which is why RCTs would still be a good idea.

      Justus wrote on February 18th, 2014
      • Maybe that’s when you pull in someone who has more knowledge (Chris Kresser? Another Paleo/Primal nutritionist/doctor? A naturopath? ) I think this “diet” can work, but everyone is different and sometimes a little guidance is needed. Maybe there’s something else going on that you haven’t had checked out yet!

        Kelsey wrote on February 18th, 2014
        • Thank you for the advice; I have already been thoroughly checked out by “someone who has more knowledge” , though: A good friend of mine is an endocrinologist with additional degrees in microbiology and biochemistry, and he has done pretty much every test known to man (I don`t have celiac disease or leaky gut, don`t suffer from hypogonadism, hypothyroidism, or a disruption of the HPA axis, am not insulin resistant and/or hyperinsulinemic,don`t have a genetic lipid metabolism disorder, there are no latent infections to be found, etc. etc.); with all due respect to Chris Kresser and the other “Primal docs” out there, I severely doubt that any one of them could bring anything more to the table. My main motivation for “going Primal” was the hope that it might improve my arthritis, which most of my relatives simply accept as the “family curse”; but after about half a year of rotating through ever more restrictive protocols (“run-of-the-mill Primal” ,followed by the autoimmune protocol, followed by autoimmune ketogenic) without even an iota of change as far as both objective and subjective rheumatological parameters are concerned, I can`t help but come to the conclusion that it simply isn`t working; all I have to show for my efforts is some superfluous blubber (I started out from a body fat percentage in the healthy range), accompanied by the usual metabolic downstream effects – probably because I am one of those allegedly rare people who unconsciously overconsume fat, not carbs.
          All in all, everything points to the conclusion that there is nothing happening in the “epigenetic magic department”, tweaking or no tweaking; I am probably just going to have to accept that, however much it may rankle.

          Justus wrote on February 18th, 2014
      • I believe you should meet with a physician or nutritionist with experience working with low carb diets to identify what your particular problem is. There are many variables that prevent a positive result from low carb dieting that can only be revealed by complete blood work and possible urine analysis.

        The diet will work. It is a biological fact that our bodies work better on a fat and animal protein diet with limited carbohydrates. Unless you have a clear understanding of your hormonal. lipid, and other factors you cannot predict success. Especially after a lifetime of poor eating habits. The last thing you should be doing is incorporating the dietary prescription of the latest book you read without proper testing.

        Michael wrote on February 18th, 2014
        • Thanks for the input; as mentioned above, I have been working with a physician who has a “clear understanding of… hormonal, lipid, and other factors”, and has provided me with “complete blood work and urine analysis” – unfortunately to no avail. As for your assertion that it “is a biological fact that our bodies work better on a fat and animal protein diet with limited carbohydrates”, the existence of genetic quirks like hereditary hemochromatosis pretty much refutes this as a universal claim. Black Swans aside,though, I am pretty sure you are overstating your case here even in a general sense, considering that traditional peoples who eat a (relatively) high-carb diet – like, for example, the Kitavans, Okinawans, Tukisenta, and Tarahumara – apppear to be just as healthy and long-lived as those predominantly dependent on fat and protein; in addition, the studies that have been done so far demonstrate no clinically meaningful advantage of low-carb diets in the long term, provided that protein intake is controlled for; and finally, my n=1 rather unambiguously demonstrates that a low carbohydrate intake doesn`t work for me personally, since it has improved literally nothing, and made several things worse. In fact, this whole “No true Scotsman-esque” line of reasoning of yours is eerily reminiscent of interactions I have had with dedicated vegans, whose version of the “one true human diet” did equally little for my arthritis (but more for my waistline). At this point, I severely doubt that there is a “universal diet”, or even “universal dietary template”, everyone should follow – but if there is, and if it is “Paleo/Primal”, that can be elucidated only by properly designed, methodologically sound RCTs – which, as of yet, haven`t been done – , not the AWLR.

          Justus wrote on February 18th, 2014
        • Well, Justus, you convinced me; primal eating does not work for you. I suggest you find something that works better and we here at MDA need to see that primal eating does not work for everyone. Good luck to you.

          Roy wrote on February 19th, 2014
      • Justus,
        Have you considered other factors such as stress, sleep, medication, or environmental factors such as exposure to toxins? Many medications can prevent weight loss. I don’t know what your diet is like, but some people think eating Paleo means eating a pound of bacon every day and never touching a vegetable. Do you eat 8-10 servings of green leafy non-starchy vegetables per day? Do you limit your total fruit intake and primarily limit fruits to just berries and citrus? Do you eat organic produce and pastured animals, eggs/dairy? Are you using Paleo approved fats? Are you afraid of dietary fat? Do you over-consume “Paleo” desserts or other foods such as honey or sweeter fruits that are technically Paleo, but shouldn’t be a regular part of anyone’s diet? Are you consuming too many/few calories or too many carbs? Have you tried eliminating any/all of the following: sugar and artificial sweeteners, artificial/processed/GMO ingredients, wheat, corn, eggs, peanuts, gluten, dairy? These foods can responsible for allergies/sensitivities that cause bloating and weight retention, head aches, arthritis, and other symptoms. If you exercise, how much and how long? Chronic exercise can cause a lower metabolism, increased hunger, joint issues, etc… Do you walk, lift, or do HIIT? If not, give those a try. You have to become a detective to find out what works for you. Good luck and don’t give up.

        Scott wrote on February 19th, 2014
        • Roy:
          Sorry for being a buzzkill; I am just “choking on my frustration” right now.

          Scott:
          Thanks for your pointers and encouragement; I am currently eating in accordance with the “autoimmune protocol” while striving for ketosis; that translates to pretty much exclusively non-starchy, non-nightshade veggies, coconut oil (so, no- I am not afraid of fat), and grass-fed meat (and no, that doesn`t mean bacon), plus some supplements to avoid common pitfalls/cover my nutritional bases; counting calories over the last week has revealed that “eating to satiety” has probably led me to slightly overshoot my previous maintenance intake over the past several months, which presumably explains my fat gain. As for exercise, what I do is pretty much directly out of the “Primal playbook”: I do some “gentle” resistance training twice a week ( can`t really lift heavy due to my arthritis), do “sprints” in the pool once a week, and take long walks daily. Sleep and stress level are as good as they are ever going to get, I take no medications that can negatively influence body composition, and avoid “toxins” as best I can (with regard to cosmetics, plastic containers,non-stick cookware, clothes, etc. etc.).
          I will keep tweaking for a while longer.

          Justus wrote on February 20th, 2014
        • Justus;
          I think your experience is extremely important for PB followers to hear. When I read about the myriad and dizzyingly complex biochemistry of nutrition, its makes sense that some imbalances might not correct or restore very easily, especially with decades of accumulated damage to structures like mitochondria. You are fortunate to realize that n=1 is your only true guide, your best shot at optimizing your situation. Can you mention if there are any objective measurements you are using to decide if things are improving – other than your observations of stiffness, pain etc ?

          Bruce wrote on February 21st, 2014
        • Bruce,

          yes, an endocrinologist friend of mine and the rheumatologist who is responsible for my treatment plan provide me with regular feedback on how I am faring as far as metabolic and rheumatological lab parameters are concerned. So far, the results have not been encouraging. Nothing has actually improved; in fact, several “key parameters” (FBG, HbA1c, HOMA-IR, AST, ALT, Gamma-GT, ApoB, ESR, hs-CRP, RF, ANA, ACPA) have been worsening – not to a clinically relevant degree (as of yet), but steadily and consistently; ironically, the supposed epitome of antiinflammatory diet protocols appears to be making me more instead of less inflamed (the (visceral) fat gain may be confounding things, though; we`ll see).

          Justus wrote on February 21st, 2014
        • Justus,

          Perhaps you are allergic/intolerant to something you are consuming on a consistent basis, seeing liver enzymes and CRP are worsening. that’s very interesting. I would definitely look into how environmental factors may be affecting your circumstances as well, not just toxins. But weather, elevation, possibly a sensitivity to something topical? I think keeping a daily journal and keeping track of pain score along with every possible related factor would help to realize a pattern. wow, I’m really interested in your story.

          Erin wrote on February 22nd, 2014
      • Hi Justus. Sorry you haven’t seen the success so many of us have experienced. What I’ve learned is that Primal is a starting point and depending on symptoms, body comp, and goals, continuous refinement and experimentation is required. I want to encourage you to checkout Aglaee Jacob and her book Digestive Health through Real Food. I know you said you were tested for leaky gut but maybe there is something still going on with your gut. Anyway, best of luck to you. Don’t give up! http://www.amazon.com/Digestive-Health-REAL-Aglaee-Jacob-ebook/dp/B00EPK7RZM/ref=sr_1_2?ie=UTF8&qid=1393061270&sr=8-2&keywords=aglaee+jacob

        Ara wrote on February 22nd, 2014
        • Thanks for your recommendation, but believe me: My gut health is – and has always been – fine (I have experimented with a downright obscene number of dietary (template) permutations and never managed to provoke even subtle changes, be they objective or subjective).

          Justus wrote on February 23rd, 2014
        • Erin:
          I don`t have any food allergies/sensitivities; that has been tested too (in so far as it can be tested; but non-celiac gluten sensitivity, for which a reliable test doesn`t yet exist, should be a non-issue anyway, seeing as I haven`t been eating grains for months).
          I actually have been keeping a daily journal for years; so far, I have not been able to identify any patterns with clinically meaningful impact.

          Justus wrote on February 23rd, 2014
      • Justus, Sorry to hear about your problems. I’ve eaten primal for about for 10 years. I view it as a very important part of a healthy life. There are other important parts that also need attention. I believe there is strong and growing evidence that most human aliments or diseases are caused by infections. These problems become more and more difficult as we get older and our defenses weaken. Ultimately an infection will get most of us. I believe the various types of arthritis are probably caused by infections. We are only at the very early stages of understanding our complex relationship with viruses, bacteria, and fungus. I encourage you to stay with the primal diet and lifestyle as a healthy foundation and continue your research and experimentation.

        James wrote on February 22nd, 2014
        • Nope, no infections in my case (well, none modern medicine can detect at this point in time, at least):
          1. I have been thoroughly tested.
          2. Arthritis runs in my family.

          Justus wrote on February 23rd, 2014
        • Justus,
          I don’t in any way want to come across as being casual about this with you. You have a very difficult problem. I think there is growing evidence that the primary cause of most illnesses is a pathogen or pathogens of some kind. It is only relatively recently that it was discovered most stomach ulcers are caused by a bacteria/s. It is now thought or known that 1 in 5 cancers are caused by a pathogen. I think in time that number will go way up; probably to most. There are an estimated 100 trillion bacterial, virus, fungus that live on, in and through us. Ten times our own DNA. Other environmental/diet factors play a role. We just don’t know very much about all of these interations.The first line of defense is our own healthy immune system, which depends on a healthy lifestyle. Here are some articles that might interest you: http://perfecthealthdiet.com/category/disease/arthritis/:

          James wrote on February 24th, 2014
      • “2. Arthritis runs in my family.”

        As anything that ends in “itis” is caused by inflammation, and inflammation tends to be caused by things we ingest, this would suggest that your family has a history of ingesting things that are inflammatory.

        Paul wrote on February 23rd, 2014
        • While I am certainly no expert on the topic, I have “battled my way through” several immunology textbooks in order to get a better grasp of why my body seems so hell-bent on destroying itself, and I am reasonably sure you are suffering from tunnel vision here: Yes, “things we ingest” can be important with regard to the etiology of inflammatory processes – to a greater or lesser degree, depending on the specific context, but on average this is just one piece of the puzzle among a veritable smorgasbord of factors.
          Considering that almost everybody in my corner of the world “has a history of ingesting things that are (purported to be universally) inflammatory”, and that most people I know don`t suffer from arhtritis despite this SAD eating behaviour while most everyone in my family does, there is clearly something else going on (a certain unsavory pattern of HLA-equipment, as it turns out). Nevertheless, one can, of course, hypothesize that a specific “antiinflammatory diet protocol” might be able to reduce the penetrance of this rather annoying genetic baggage, but – as I have desribed above – I have been in the process of testing this hypothesis for a while now – and, as of yet, no such luck.

          Justus wrote on February 23rd, 2014
        • …”don`t suffer from arthritis”…

          Justus wrote on February 23rd, 2014
      • “Considering that almost everybody in my corner of the world “has a history of ingesting things that are (purported to be universally) inflammatory”, and that most people I know don`t suffer from arhtritis despite this SAD eating behaviour while most everyone in my family does, there is clearly something else going on”

        Clearly.

        http://unchainedsoul.files.wordpress.com/2013/01/head-in-hands2a.jpg

        Paul wrote on February 23rd, 2014
        • I did concede that diet might play a role in the pathophysiology of (my) arthritis – but if “things we ingest” really are all there is to it, and I am just too much of a blockheaded cretin to see it – as your ever so elegantly caustic one-word comment in combination with the link to the “classic facepalm” appears to insinuate – , then riddle me this,oh Enlightened One: Why has eating in strict accordance with the “Paleo autoimmune protocol” for months not slowed the progression of my arthritis one iota (maybe even accelerated it slightly, as several “key lab parameters” seem to indicate), and how might me boasting a specific genetic make-up that is known to trigger arthritis figure into it?

          Justus wrote on February 24th, 2014
        • Justus,

          I am 33 and I have Psoriatic Arthritis. An Auto-Immune disease that KILLS my joints. Think Rheumatoid Arthritis for younger people but worse. I have been looking into Paleo and just bought the book. Unfortunately, half the stuff in Paleo I can’t eat either because it is known to cause inflammation. Nightshades for example. So, as you know (bc you have followed it), you don’t get many choices at all.

          I completely disagree that Arthritis is 100% food intake. That’s ridiculous. What kind of arthritis have you been diagnosed with if you don’t mind me asking?

          Jared wrote on February 24th, 2014
        • Hey Jared, my diagnosis is RF-positive Chronic Polyarthritis.
          Sorry about your PA; I know several people who suffer from that, and from what I gather it`s a real b**ch.

          Justus wrote on February 25th, 2014
  7. Way back in the 80’s I fasted for two weeks. Two weeks without any food whatsoever. I drank water but nothing else. Why? It would take too long to explain here. In any case, after about 2-1/2 days I wasn’t hungry anymore. My body had decided it wasn’t going to get anything down the pie hole and began cannibalizing itself. If you eat a small amount every day you stay hungry all the time. Then I went vegetarian, then I went back to the SAD diet, then I was 250 pounds for years (at 6′ 3″ tall), finally I found MDA and I’ve lost 25 pounds so far without calorie restriction.

    D. M. Mitchell wrote on February 18th, 2014
  8. When listing vegetables, AWLR needs to remember that corn is a grain and peas, a legume. This could make a difference to the research. Also, in case it’s in the questionnaire, peanuts are legumes as well.
    I’m a little sticky on this as I’ve had family meals where the only “vegetables” were corn and peas. Needless to say I stuck with just the protein.

    Susan wrote on February 18th, 2014
  9. The mainstream will never accept the simple formula ketosis=success

    Groktimus Primal wrote on February 18th, 2014
  10. I’ve been, more or less, on a primal program for about four months now. I find it easy to stick to and it is working, albeit slowly, for me. Recently my sister-in-law was diagnosed with diabetes. When she met with the diabetic nurse and the registered dietitian she was told that she should have about 40g of carbs per MEAL and that whole grain bread and rolls were OK as was a serving of potatoes and apparently everything else so long as she watched her serving size. Of course, since those folks were the experts and were telling her what she wanted to hear, she if following their advice regardless of how many times and ways I point out any number of studies that say that approach is wrong. While I understand it is her life, I’m really frustrated that people who should know better or at least know the research have not learned anything new since they finished their degree 25 years ago.

    glh2576 wrote on February 18th, 2014
    • Oh dear… As you know (since you’re on this website), that’s exactly the wrong sort of thing to be eating. Portion control and calorie counting result in such miserably slow weight loss and health gains, even if religiously adhered to, that most people just give up. Frustrating, but as you say, it’s her life.

      Shary wrote on February 18th, 2014
      • it is kind of “Fool me once, shame on you; fool me twice, shame on me.” Eating a high carb diet for the past 67 years is one of the things that got her to where she is. Staying with carbs under the advice of the RD and nurse will likely keep her there. You’d think that if you tried something that was not working that you might want to consider alternatives. The alternative might not be any improvement but at least you would have given it a shot. She has already had breast cancer, has neuropathy and is showing increasing signs of forgetfulness. While I am happy to listen to the medical professionals, I do so with a grain of salt and am more than happy to take an alternate approach to their recommendation if I believe the alternative is better. Doctors, nurses, and RDs are not infallible – I’ve see their errors up close and personal too often to follow their advice blindly.

        glh2576 wrote on February 19th, 2014
  11. But what about if we are only feeling better and healthier? There is no “healthier” registry? I was underweight all my life but I would be happy to contribute to the PB spreading further.

    Coco wrote on February 18th, 2014
    • I’m in that category as well, but I put my info in there anyway…

      Kelsey wrote on February 18th, 2014
    • Hi there,

      We would still love for you to register. I realize our name may be somewhat misleading but we collect data on anyone and everyone. You will see in the questionnaire you have the chance to select why you went primal a,d what health issues have improved or worsened.

      Larry wrote on February 18th, 2014
  12. I can’t count how many patients have come to me eating 1200 calories a day trying to lose weight then up their calories significantly and it melts away. Great post!

    Dr. Anthony Gustin wrote on February 18th, 2014
    • Thanks for taking the time to read it. 1200 calories should be illegal.

      Larry wrote on February 18th, 2014
  13. Great article, Thanks

    Mikka wrote on February 18th, 2014
    • Thanks for reading!

      Larry wrote on February 18th, 2014
  14. Why would the medical community in general promote the Paleo diet? So what that is works for weight loss and better health?

    This would take away money that surgeons make doing lap bands and gastric bypasses, rob Mediquick (or something like that) weight loss conglomerates of hard earned cash and drop pharma profits from BP, cholesterol and DM meds? Why rock the boat?

    paleocrush wrote on February 18th, 2014
    • I’d like to point out: not everyone in the medical community has a black heart that is strictly keen on giving advice and performing procedures for selfish gains. I hate that so many here have such disdain for medical professionals. it’s very bothersome. there are so many kind-hearted professionals who wish the best and prescribe the best for their patients, but sadly, some are blinded by CW because that is all they’ve ever been taught or have researched. let’s cut them some slack. we weren’t born knowing all the primal ways.

      Erin wrote on February 22nd, 2014
      • let me restate: “think they are prescribing the best”

        Erin wrote on February 22nd, 2014
        • preaching to the choir, Erin :) but quite seriously, 99% of med.prof’s, even if they are proponents of primal eating, will still in their a&p write “low fat diet” or “ADA diet” for pts c/ hl, dm, etc.
          maybe some of it is fear of going against guidelines, being sued, who knows?
          just think of a grieving son whose long time diabetic parent died of a massive heart attack telling someone how that parent’s doctor recommended they stop eating “healthy whole grains” just 6 months before their death.

          paleocrush wrote on February 23rd, 2014
  15. Today I was waiting in line and realized that I was the thinnest person in the line of women with ages from 70s to teens. I have lost 20 pounds eating primal and expecting to lose more, so to be thinner than women who are 25-40 years younger is amazing. I wanted to tell them all about PB, but it was not the time or place. I didn’t eat lunch today and had no hunger or loss of energy issues. The friend I was with was getting candy out regularly. She has weight and diabetes issues but says she won’t give up bread until she knows it will definitely kill her. All I can do is pray and set an example.

    Deanine wrote on February 18th, 2014
  16. This is for Justus – one of the most interesting things about me dropping wheat is that the goofy little bumps on my fingers (a doc confirmed my suspicion that they were pre-arthritic nodules) have gone down by more than half. I wish I had a picture of the befores. The swelling/stiffness in my right arm and fingers is gone too. I can actually feel it come back the next day if I have something to eat that I shouldn’t. Other than that I’ve lost 5 lbs in a year. I didn’t have much to lose and slow is better than fast anyway so I’m ok with that part.

    Vanessa wrote on February 18th, 2014
    • That is awesome!
      Stories like yours are what gave me the motivation to try eating “primally”, and I would gladly accept my weight gain if it came along with improvements in my arthritis – joint and soft tissue inflammation sucks – , but there just doesn`t seem to be anything happening in my case. I will probably keep trying for another couple of months, but I am not hopeful, to be honest. How long did it take for your symptoms to improve?

      Justus wrote on February 19th, 2014
      • Hey Justus, the arm swelling was gone within a couple of weeks, pretty darn quick really. The nodules have slowly decreased over the past year. They are still there but nobody but me notices them. My mom’s half sister had very severe RA when she was old. I look a bit like her. Honestly though I have only given up wheat and increased my saturated fats. I’ve always been a meat eater and sort of healthy. I’m really only partly paleo. I am considering giving up corn next. Good luck, it’s important that you stay curious.

        Vanessa wrote on February 19th, 2014
        • Ditch the corn and any other grains and legumes. You’ll never look back.

          Paul wrote on February 19th, 2014
        • Thanks, Vanessa; I´ll try to keep up the motivation to experiment.

          Paul: Did that months ago; hasn`t improved anything so far.

          Justus wrote on February 20th, 2014
    • This is a really interesting finding and exactly why I made AWLR, to crowd-source stories like yours and find common trends. If you haven’t had a chance to register yet, I’d sincerely appreciate it!

      Larry wrote on March 2nd, 2014
  17. I have managed to get my mum to go Paleo. She’s lost weight and her heartburn has completely gone. She’s been on anti acids for 20 years. Really powerful ones. Waking up every night drinking yoghurt just to be able to sleep.
    One month into her new life style – it’s all gone. she still goes on about butter and her cholesterol but is slowly giving in and enjoying eggs and butter for breakfast.
    She was an easy one.
    A friend at work has two young kids , both allergic to all sorts of stuff. Gluten, dairy etc. He insists on feeding them beans, gluten free breads/pastas etc. Kids have awful problems with their guts. I suggested so many times to make them go paleo for 30 days and see if their health improves.
    He prefers to have his kids having biopsies to determine whats wrong with them.
    he’s a fairly intelligent bloke. i’ve offered him books, pointed to this and other web sites and still he’d rather have his kids being poked and probed than try something as simple as a change in their diets.
    It’s actually quite annoying but I’ve given up.

    Jacob wrote on February 19th, 2014
  18. “As you are reading these words, there is someone out there who is depressed, unhealthy and overweight. A poor soul being shunned by the medical community due to their “lack of willpower,” who struggles to get by on their 1400 calorie low-fat diet. A beautiful human being with boundless happiness trapped underneath the overwhelming heaviness of constant hunger and a label of “BMI > 30″, desperately searching for a real solution.”

    I’m here!!! I’ve been on the diet treadmill for about 30 years, I’ve tried every diet given to me by doctors, dietician, nutritionist – all remarkably similar and all failures!

    I’ve been trying paleo/primal for over a year, and although I do feel a lot better there’s been no change in weight/size…

    Dianne wrote on February 19th, 2014
    • When we work with women at our clinic that have gone from sugar to fat adaption as primary energy system and still are maintaining unhealthy weight we find universally a hormonal system disfunction. And also low iodine, magnesium, vitamin D levels. There is also persistent dehydration.

      There is so much more to health than going low carb. What you eat, when you eat, how you prepare the food, the hormonal system, sleep patterns, exercise, exposure to artificial light, toxic chemical overload, poor relationships, poor working environment. The most powerful epigenetic influences are not food, though food is up there. Circadian rhythms, the changing seasons, a healthy relationship, etc.

      You have to critically examine everything in your life. Food is the easy part.

      Good luck!

      Michael wrote on February 19th, 2014
    • I’m here too, Dianne!! I’ve been an MDA follower for nearly two years now and am still at my same weight. I did lose about 20 pounds really quickly, but somehow, despite not changing my routine or commitment, they came right back. What makes it worse is that my husband recently came on board and lost 25 pounds in a matter of weeks! But I do have to say that the improved sleep, improved skin, improved joint pain, and improved outlook as well as the FREEDOM from hunger has stayed with me.

      So, I’m moving this to the next level. I recently did the 23andme genome test and discovered I have numerous MTHFR mutations, including the dreaded double C677T that inhibits folate metabolism. I am about to consult with a doctor who both specializes in this and is a paleo adherent. Maybe, just maybe, addressing this issue will rev my engine back up again. Right now I feel like I’m idling and that makes it hard to lose. But I wouldn’t give up the other benefits of paleo for anything! AS GOD AS MY WITNESS, I WILL NEVER GO HUNGRY AGAIN! (Thanks, Scarlett!)

      Rhonda the Red wrote on February 19th, 2014
  19. Great article and I love primal blueprint and love what it has done in my life. It allows me to eat stress free. I had every intention of sharing this until I got to the embarrassingly patronizing last paragraph. You’d think this was a religion. The messiah bit could have gladly been left out.

    Paula wrote on February 19th, 2014
  20. I love eating paleo and find the benefits quite obvious. I feel physically and mentally lighter, I sleep better, my digestion is flawless, etc. I’m flummoxed by the veg/vegan movement because it’s the one eating philosophy that seems to attract people hellbent on either convincing others that they should also eat that way or telling others how wrong they are. Eat how you want, share the benefits if you feel so inclined, but don’t force your POV on me – sometimes these folk resemble religious nuts more than healthy ones.

    bryan wrote on February 19th, 2014
    • I couldn’t agree more. I call them “veganistas.” It is more of a cult religion than anything. And the ones doing the high starch McDougall thing are the worst. It’s like all that grain and other starch has zombie-fied them, and all they can now think about is converting you and everyone else.

      Here’s a funny. One of my neighbors was talking with me about how astonishing my weight loss was and how good I looked. We were talking about Paleo concept when another neighbor who’s a “McDougaller” walked up and started saying things like “he’s doing that silly cave man diet.” Then he proceeded to tell the first neighbor how low carb diets never work. The first neighbor said “yeah, whatever. But look at him!” Pointing to me. That was priceless.

      Paul wrote on February 19th, 2014
  21. Larry, in an otherwise great piece, I have one bone to pick.

    I think you’re misreading the Proietto research.
    “These same researchers three years later sung to a different tune”

    They’re not singing a different tune. Both papers were reporting results from the same trial. They were correct in saying both that diets fail due to the persistent hormonal changes associated with weight loss and that ketosis appears to ameliorate some of these changes. The participants were only ketotic during the initial 8 week period of the trial. Lost weight was regained when the diet ceased being ketotic and those persistent hormonal changes kicked back in.

    kled456 wrote on February 20th, 2014
  22. As a person with science background, I believe that all studies are inherently a little flawed, as are all results. There is no *one* study I would ever trust. But getting the word out is still the best way to get anything noticed. Millions will reject the idea of Primal living. But millions won’t. Like anything, it will gain hold with those who are self-motivated. PBers and Primal lovers and paleo-dieters can do their thing and the ranks WILL grow. Will the whole world join in? I doubt it. Nothing is ever 100% successful. Even attempts to pass on the best of intentions and the best health advice one can give.

    But we can still make a difference. *THAT* is what matters. Good for Larry Istrail and Mark Sisson and others like them for wanting to share this information on Primal living (even if, as I read from some posts, there are too many questions on the AWLR survey)! I know good intentions are there, and I appreciate that, from one human being (who always hopes to make a difference in peoples’ lives) to others who share that same goal.

    Kevin Grokman wrote on February 20th, 2014
  23. Really awesome post. Thank you.

    Ara wrote on February 22nd, 2014
  24. Justus. Just seen that a lot of posts relating to your condition so just thought I’d put my thoughts in if it helps. If you’ve read Gary Taubes’ book (the big one not the abridged version) there was the chief medical officer from DuPont who put all of the executives on a Paleo type diet. All lost varying amounts of weight except one guy. When he ran blood tests on him just one piece of fruit sent his insulin levels through the roof. Weight loss therefore minimal but this guy may also have developed a far weaker immune system more than others. One reason why we all have different degrees of success. Recent programme here in the UK highlighting the number of cases of small babies being taken away from their parents due to suspected child abuse. The fractures and broken bones that doctors found were subsequently found to be due to Vit D deficiency – big problem now. I’m sure you have but check out Dr Hollick on youtube. Hope this helps

    Paul and Karen wrote on February 23rd, 2014
    • I am neither hyperinsulinemic nor insulin resistant (that has been tested; in addition, I have never been overweight/overfat on the SAD, yet actually gained fat on Paleo with a much lower carb intake), and my vitamin D status is fine too, but thanks for your pointers.

      Justus wrote on February 24th, 2014

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