Dear Mark: Calorie Intake While Nursing, Tom Hanks and Type 2 Diabetes, and DHA Bad for Adults?

Fish OilFor today’s edition of Dear Mark, we’ve got a three question roundup. First, I hear from a nursing, weight-lifting, child-chasing mother of four who’s concerned about the amount of food she’s craving – even though she’s already at her pre-baby weight. I (hopefully) allay her concerns in my response. Next, I discuss the ridiculous nature of the conventional dietary advice we give to type 2 diabetics, as well as how there may be a light at the end of the tunnel. I also issue a formal invitation to Tom Hanks, who’s just been diagnosed with the disease. Finally, I explore whether or not DHA truly is bad for adults. Should we only give it to our kids after all?

Let’s go:

Dear Mark,

I absolutely love your website and blog. It has been a source of advice, inspiration and guidance to me over the last few months since I have been breastfeeding and running around after 3 other kids! I find I am always hungry though, especially as I am now weight training at least three times per week and pretty active with four kids. I am also still breastfeeding at night at least 2-3 times so sleep is an issue. I have read your blog posts on breastfeeding and also looked through the forum, but can you give me some suggestions on good foods to turn to to quell my constant appetite. I try to eat primally most of the time but I do find I get cravings for high fat foods like nuts and carb dense foods like sweet potatoes. Should I try to limit these or are they ok in the context of breastfeeding and training a lot? My baby is 4.5 months old and I was back to my pre baby weight within a few weeks of his birth.

Thank you so much,


Producing an ounce of breastmilk requires about 26 calories. To produce the average 25 ounces that an infant eats each day, then, you’ll need about 650 “extra” calories per day, so in this case, your appetite is warranted. “Giving into” the cravings is a good idea because they represent a very real physiological need at the moment; don’t feel guilty. Besides being a manufacturing plant for nutrient and calorie dense human growth serum, you’re also training regularly, chasing after three kids, and battling disrupted sleep. Those are all significant stressors that deserve a few extra calories.

It’s really awesome that you’re craving nuts and sweet potatoes rather than cookies and pasta. Start ignoring the cravings, though, and that’s when you’re liable to find yourself ear deep in a bowl of Cheerios in the middle of the night with no memory of how you got there.

(Although I would be careful with the nuts. You don’t want to overdo omega-6 fats, which will make it into your milk, nor do you want to consume too much phytic acid, which may reduce nutrient absorption. Consider eating more full-fat dairy, avocado, olive oil, or coconut to get your nutrient-dense fat fix. Eat nuts, just don’t make a meal of them.)

Plus, you’ve hit your pre-baby weight already? With no problems supplying your baby with milk (I figure you would have mentioned that in the question)? I think you’re doing great, Rebecca. I can’t think of anything you need to change. Calories aren’t going to hurt you if you’re not gaining weight.

Dear Mark,

I am a huge fan of the Primal Blueprint and do my best to incorporate it into my life every chance I get. At 29 years old, I initially subscribed to the Primal Blueprint to “lose the little belly fat” around my waste that had been accumulating over the years, and I succeeded in losing 23 lbs over 3 months. After reaching my initial goal and educating myself more on the subject, I found a new reason to live Primal… Diabetes.

I work as a paramedic and aside from having DM run in my family, I am constantly blown away by the sheer number of patients I meet that suffer from Type II Diabetes. I am convinced that Diabetes will reach “epidemic” status in the next 30 years and nobody in the “mainstream” seems to be doing anything about it.

Recently, Tom Hanks went on the “The Late Show” to announce that he has developed Type II Diabetes and the disease has been trending ever since. Finally! People are actually talking about this disease that can lead to so many other problems like heart attack, stroke, and amputation of limbs! But nobody seems to be addressing the elephant in the room… Insulin! Am I missing something here? I’ve heard doctors on the radio, read their advice in articles and here’s what they have to say: Exercise, lose weight, and watch what you eat. Call me crazy, but I have a feeling that most people suffering from Type II Diabetes have been trying this their whole lives with little success, and having the end result being Type II Diabetes. Why are no doctors coming out and saying “Stop eating foods high in sugar that cause insulin resistance”? It seems like such a simple solution. What am I missing?

Thank you,


In the public sphere, it seems pretty dire, I agree. The mainstream advice continues to let people down. Just look at this pitiful excuse for a “diabetic meal plan” that the Mayo Clinic recommends right after suggesting diabetics need to “count carbs”:

Breakfast – Whole-wheat pancakes or waffles, one piece of fruit or 3/4 cup of berries, 6 ounces of nonfat vanilla yogurt (in other words, a breakfast made entirely of carbohydrates).
Lunch – Cheese (what, no mention of “low-fat” cheese?) and veggie pita, medium apple with 2 tablespoons of almond butter.
Dinner – Beef stroganoff; 1/2 cup carrots; side salad with 1 1/2 cups spinach, 1/2 of a tomato, 1/4 cup chopped bell pepper, 2 teaspoons olive oil, 1 1/2 teaspoons red wine vinegar.
Snacks – Two unsalted rice cakes topped with 1 ounce of light spreadable cheese or one orange with 1/2 cup 1 percent low-fat cottage cheese (wow, a whole orange!).

I suppose that works if your goal is to count really high. To think that people actually try this is sad. I’m imagining a perpetually starving overweight woman with T2D measuring out her olive oil by the teaspoon, weighing low-fat cheese spread only to discard the quarter ounce that gets stuck on the knife after somehow willing herself not to lick it clean, dutifully limiting herself to half a tomato (and eagerly unwrapping the saran-wrapped uneaten second half the next day), and frantically scraping the salt off her rice cakes because she forgot to buy unsalted ones. What a miserable existence made all the more miserable and unfortunate because of its lack of efficacy.

But in private, in the trenches? From what I’ve heard from an admittedly biased cross section of folks in the medical field, increasing numbers of doctors are putting their diabetic patients on low or “lower” carb diets. Because it works. And because they want their patients to live healthy, long, enjoyable lives. That gives me hope. I hope it’s true.

Speaking of Tom Hanks, when the news hit, I was in Seattle en route to Philadelphia the next morning. It was the evening, and I spent the entire night sleepless in my Seattle hotel room, racking my brain trying to figure out how a guy with all the world’s knowledge and money at his disposal – one of the very lucky few in a league of their own – could miss the basics, and how I could actually be of service. It was frustrating. He didn’t deserve to walk the road to diabetic perdition lined with insulin shots, heart disease, and amputated limbs.

“Saving Tom Hanks,” I thought to myself, “could really make a splash.” It would be huge. Big, even. All he’d have to do was pay attention to the very basic advice I give, and all I’d have to do is do that thing I do so well. Plus, I have a feeling we’d get along. I’m not saying we’d become bosom buddies or move to the ‘burbs together or hit the town as a pair of ladykillers or anything, but we wouldn’t clash or have nothing in common. I certainly wouldn’t be cast away.

I’d love to wake up next morning, turn on the computer, and hear “You’ve Got Mail” because Tom Hanks’ rep read the post and shot me an email to help him get healthy. The real punchline of all this is that it wouldn’t even be that hard to get him to follow the 10 Primal Blueprint Laws. Eat lots of plants and animals, reduce carb intake, do some sensible exercise (like walking a green mile every day instead of riding in cars so much). To use his brain, Hanks could do stuff like study the works of Leonardo Da Vinci, code simple programs on the computer, or learn how to brew homemade hooch in his bathtub. There’d be no need to get extremely loud and incredibly close to him like some drill sergeant; the success would serve as effective motivation all by itself.

So, Tom, consider this an official offer: give me sixty days with The Primal Blueprint and I’ll turn your life around.

Hi Mark,

I’ve been reading your blogs for years and years now, and live a paleo/ primal lifestyle:) Someone recently sent me this article and was talking about EPA being great for adults, but DHA being only beneficial for children, and causing heart palpitations in adults. I take a good dose of fish oil daily, and feel great, and have no heart palpitations… but I don’t know if I’m possibly doing harm to my future, or if this is just nonsense….

Here’s the link to the article

Thanks for your time,


I don’t think you have anything to worry about, particularly if you’re already taking fish oil without suffering from heart palpitations. If anything, DHA and not EPA actually reduces the chance of developing atrial fibrillation, a serious condition that can be presaged by the presence of heart palpitations.

The article you linked actually doesn’t say anything about heart palpitations. It’s comparing the triglyceride-lowering prowess of a pharmaceutical EPA-only fish oil product to that of a pharmaceutical mostly-EPA-with-some-DHA fish oil product. The only “negative” aspect of DHA they mention is its tendency to increase LDL levels. That’s not even really a negative effect, since the LDL increase comes from an increase in LDL particle size which probably indicates a reduction in LDL particle number (larger LDL particles register as higher LDL-C without an increase in particle number).

As for DHA being good only for kids, that’s probably an honest misinterpretation. DHA, you see, is an especially important nutrient for children’s development. A considerable body of evidence suggests that DHA is crucial for brain growth and development in the last trimester and years of a kid’s life:

And that’s just a limited smattering of research. To relay it all would take several complete posts; that’s how important DHA is to fetuses and kids. Everyone knows this. Heck, every brand of baby formula includes DHA at this point. That doesn’t mean DHA is bad for adults, though. It’s just really, really important for kids. Adults, whether young and healthy or aging and at risk of neurodegenerative diseases, benefit from DHA supplementation, too.

I mean, if DHA is unhealthy for adults, that means none of us should be eating seafood, because most fish and shellfish contain more DHA than EPA. And yet study after study suggest that fish consumption is linked to improved health markers across a wide range of populations.

Adults, don’t worry about your DHA. Well, worry, but worry that you’re getting enough.

That’s it for today, guys. Thanks for reading and be sure to leave a comment or question!

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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106 thoughts on “Dear Mark: Calorie Intake While Nursing, Tom Hanks and Type 2 Diabetes, and DHA Bad for Adults?”

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  1. Okay, there’s a few missing movies in the Tom Hanks section! 🙂

    1. Surely we could have worked in a reference to eating some Bubba Gump shrimp!!!

  2. Tom Hanks may be a big star but I’m sure he’s far from the only one with diabetes and he’s only human so it’s not such a big deal (except for him). Any big star garnering attention to the real way to treat diabetes would be fantastic. Atkin’s finally decided to start using celebrities (and more than just a soap opera star) and I’m sure between that and the dieting/Paleo resurgence it’s really helped their bottom line. In some ways the notoriety is sadly more value than controlled double blind studies. People will be people and they will make foolish decisions and not want to stick their necks out.

    1. I wass nearly shouting at the tv watching the interview with Tom Hanks. He’s just accepting it as ‘one of those things’ which is so sad. What’s also strange is the amount of press it got, as though he was admitting a guilty hidden secret. Here’s hoping that he eventually finds this site!

      1. Why wasn’t anybody yelling for Paula Deen when SHE announced she had diabetes?

        1. Because Tom wasn’t teasing people with high carb, super refined, trans-fat laden garbage excuses for “meals” on TV for many years and hiding her resulting diabetes from the public until she could secure a deal with big pharma to be a spokeswoman for a diabetes drug?

  3. When I was diagnosed with Type 2, my doc sent me to not one but two plump dietitians who said I could eat three carb servings at each of three meals, plus two carb snacks, per day.

    1. Hope you don’t mind my asking, but were you overweight when you were diagnosed? Tom Hanks and Letterman (who also has blood sugar issues) appear to be on the thin side. I honestly have never heard of a thin person getting type II diabetes.

      1. Thin people have Type two and Heart attacks, strokes, etc it is not exclusively a fat person disease.

        1. Most of the people in the “stroke group” at my gym were on the thin side. I was always perplexed by that.

      2. Yep my Dad has never been overweight a day in his life ( 160 lbs at 5’10” ) but has T2D.

      3. Personally, I have noticed Tom Hanks looking bloated and puffy lately, not to mention showing his age, even though he is not “overweight”. Now it makes sense that his internal environment is not right. You go get him Mark! You are a celebrity, too, and can do it! I set a goal to meet Jane Fonda and go hiking with her and did it because I visualized being with her over and over in my mind 1st – it worked! We went on an 18 mile hike in the mountains of Montana. You are already imagining getting along well with him. It will happen and you will help him and spread your “good news” to many more people!

    2. Another thing you never hear the media (or doctors) really talk about when it comes to diabetes is alcohol intake in regards to DM2.

      Anyway, I work in a hospital and hospitals are so far behind when it comes to diabetic diets. I see patients getting 50g of white pasta for dinner and according to the dietitians who make the meal, it’s okay! I was talking to an endocrinologist who works with diabetics in the hospital and he is also amazed at the lack of responsibility when it comes to diabetic diets in the hospital environment.

      1. ugh so true! one of my greatest frustrations working at the hospital. those diabetic menus are nothing but crap. carbs, carbs, carbs, fake eggs, splenda, etc. not to mention, they force you to order a certain number of carbs. so you can’t just have roast beef, mashed potatoes and broccoli. you also have to order a cheesecake and apple juice. if you refuse, they’ll send you up a dinner roll and whatever else fits the minimum carb count. only the dietitians have a say as to what goes on the menus. so glad I don’t work in the hospital anymore.

    3. Well yeah…how else are you going to control your blood sugar?! 😉

  4. I tweeted Tom Hanks to get in touch with you… pretty sure that won’t help much, but if many people do, then maybe he will notice! “Life is like a box of Chocolates, you never know what you are gonna get…. except Diabetes… “

  5. Six degrees of separation. Surely there must be someone who reads this blog who knows someone who knows someone who knows someone… who knows Tom Hanks? And aren’t there plenty of other celebs (including friends of his) who have gone Paleo?

    1. Remember that old saying: You can lead a horse to water…? Maybe Tom Hanks does know how to eat better and he just doesn’t want to. Some people think T2D and other diseases are more a product of aging than lifestyle and diet, and nobody can convince them otherwise. They think illness is “normal” and is there to stay once a person hits a certain age, no matter what they do. You also have to consider that Mr. Hanks is both busy and affluent. This often means eating whatever, whenever, plus (perhaps) too much alcohol. Or maybe he has a sugar addiction, or a love for bagels and cinnamon rolls that he doesn’t want to give up.

      Somebody may very well be knowledgeable enough and close enough to advise Mr. Hanks on this issue, but whether he will heed the advice is really up to him. After all, there are people right here on MDA who are paleo-knowledgeable and know perfectly well how they should be eating/living…but they don’t.

      1. My dad was dx’ed Type 2 about 10 years ago, and while he had the financial means to pay for the best health care, diet and fitness consultants, and top-quality food, it hardly made a difference. He did try to go lower-carb, but he was a sugar junkie, a bread-head–hell, he was just a carb addict, full stop. He’d be compliant for a while, then binge on bread and pasta and boxes of chocolates, and no amount of patient explaining could get him to see that while he didn’t drink sodas, all the juice (or worse, Kern’s nectars) he drank were just as bad.

        He had all the money, all the access to good info, and both a PCP and an endocrinologist who urged going low-carb. And he still didn’t frigging do it in more than a half-assed fashion. No amount of privilege or resources could light a fire under him and make him see how urgent changing his habits was.

        Looking back, I suspect that the fatalism you’ve described was at work. He was almost 60, probably figured it was just a normal aging thing, and that if he was “good” part of the time, that would be good enough. And there was nothing his (intelligent, educated, geeky, adult) kids, or his physicians, could tell him to change his mind.

        The diabetes wasn’t what killed him; aggressive metastatic prostate cancer did it (and I admit I’ve pondered the role his chronically-elevated blood sugars played in that). But watching him spend almost a decade shrugging off diabetes as a matter of little consequence just baffled me. It still does, to this day.

        If any good came of it, it was my own waking up and realizing I could be next, because I take so strongly after him. I cleaned up my own act because I knew if I didn’t I’d be the next one getting a Type 2 diagnosis, and unlike my old man I just couldn’t be complacent or fatalistic about it.

        1. My father is now on dialysis. He’s 71. This is how he took care of his diabetes. He still eats huge amounts of sugar. I had to explain to him that a tsp of sugar is almost 5g of carb. He thought that 18g of sugar in 8oz of his beloved Fusion was okay. This is after having TIID for more than 20 years – he has read thousands of books and not one of them was about diabetes. And now my Mom is wearing down hard and fast taking care of him. Her life is taking care of him.

          Now I’m dealing with my older brother. He says he isn’t going to deprive himself just because he might lose a year off his life. I had to tell him it’s more like 10-15 years – you can see his mind close right up…he is so intelligent and a box of rocks at the same time. The docs don’t help. They tell him stay away from white potatoes (they’re dangerous!!) but it’s okay to get around 10g-15g of SUGAR a day from cookies (that’s safe). Stay away from carbs that actually have some nutrition but you can have some sugar if you get a sweet tooth. They tell him if his blood sugar drops below 100,g/dl eat some sugar to bring it back up – it’s too low. (I tried to explain to him the only reason 100mg/dl feel like hypo is because his body is used to hellaciously high blood sugar – 50mg/dl is low, not 100).

          I was next. I was diagnosed with “Fibromyalgia” which I believe was my body starting to break down – I gained 20lbs in a year without changing my crappy diet – starved 10lbs off myself and got the diagnosis. But it wasn’t. It was Reactive Hypoglycemia. I had to figure this one out myself and it took going Primal to find it out. (Heck I was becoming diabetic following the healthiest version of the SAD and while losing weight)

          Because I wasn’t overweight or obese, no doctor bothered to check my blood sugar or insulin levels. I call myself a thin diabetic. Pre-diabetic. Mildly diabetic. I know of a woman who has a Type 1 stepdaughter. She told me that “obesity causes Type II Diabetes”. She said that “Type I and Type II are completely/totally different”. She said “The American Diabetes Association said…” I stopped listening to her.

    2. One of my good long time friends is the aunt of an actress who lives next door to Tom Hanks and is a friend of his. So what is that? Two, three degrees of separation? The glitch is that my friend has totally bought into the low fat CW eat your whole grains way of eating and nothing I say can change her mind which is interesting because she has a high regard for my opinions in all other areas except, apparently, food.

      My friend has developed a whole host of medical problems that could be helped by a Primal Diet but she is so convinced that the fat and red meat will kill her that she will not even give it a 21 day try. So I think this path is closed.

  6. Tom Hanks claims it’s all because of the weight loss/gains he has to do for roles. Saw Matthew McConaughey on TV being asked if he was worried about the same thing happening to him, since he’s completely emaciated in his latest film—“No, I think the body is incredibly resilient and does a good job of taking care of itself if you take care of it.” I wasn’t surprised by his attitude, since he’s paleo…

    1. McConaughey is nuts. Yo-yoing up and down like that is incredibly hard on the various systems of the body, particularly the heart. Remember Karen Carpenter? Becoming so appallingly emaciated (yes, I’ve seen the movie previews), even for short duration, is NOT taking care of the body.

    2. “Edit” probably isn’t going to like my initial comment, so I’ll try again since I think it’s important enough to mention.

      Extreme weight loss, such as some actors choose to undergo for a movie role, followed by bulking back up again, is hard on the body. Even when done short-term–paleo or not–it can backfire. A number of years ago, the female singer in a popular brother-sister recording duo died at a relatively young age. She had been extremely emaciated due to anorexia (or bulimia, whichever was the case) and her heart gave out. The fact that an actor does it by choice, rather than because of mental/physical illness, doesn’t change the adverse effects.

  7. I’m not sure how many more Tom Hanks movie references you could have gotten in there. It is good exposure for diabetes. Much better than those diabetes commercials from Wilford Bremley.

    1. After wilford kicks the bucket (maybe he has I don’t know) tom hanks will be the new spokesmen for liberty medical.

  8. I always love turning people on to your website. Recently, when a friend saw my success after doing this year’s 21-day challenge, she decided to do her own Primal Blueprint 21-day challenge with me as I did my own “round 2” of the challenge. She is a nursing mother with two children, so I sent her the link to this post. I see the author of the nursing question mentioned that she’s read all the breastfeeding articles you have on the website, so I thought I’d look for them to send to my friend. I only found two. Do you have more that I missed? These are the two I found:

    Any other links about the paleo diet while breastfeeding would be greatly appreciated! Thanks!

    1. Archives -> *scroll down to ‘Archives by All Categories’* -> Raise Healthy Seedlings
      On the one hand, most of these posts are not about nursing. On the other hand, there are currently 29 pages (nearly 150 posts), and some of them are about breastfeeding. There are also numerous closely related topics.
      You are likely to find plenty of first-hand experience wisdom in the forum. And of course, google is your friend.

  9. … and be careful linking to Scientific American articles, they can be unreliable. Like those two articles trashing the Paleo diet, and bigging-up Marlene Zuk’s book.

  10. I’ve seen estimates that by 2030, 1/3 of Americans will have diabetes. Scary figures.

    The other person I’d love to see Mark do an intervention for is Oprah – she’s tried so many different “diets” but I bet Primal living would make a huge difference.

    1. She’s even had gastric bypass, but the mac-n-cheese keeps calling her.

  11. “It was the evening, and I spent the entire night sleepless in my Seattle hotel room, racking my brain trying to figure out how a guy with all the world’s knowledge and money at his disposal – one of the very lucky few in a league of their own – could miss the basics, and how I could actually be of service. It was frustrating. He didn’t deserve to walk the road to diabetic perdition lined with insulin shots, heart disease, and amputated limbs.”

    I can’t be as clever as you with the movie metaphors, but it’s my theory that his access to all the knowledge is part of the problem, because the high paid experts keep telling him that “state of the art” is to eat low fat, plenty of carbs, etc. There’s even some indication (not confirmed) that he’s a vegetarian.

    While the disease progresses he will be told that’s the “natural progression” of the disease and nothing can be done. And when (not if, sadly) he develops heart disease he’ll be encouraged to follow others to Ornish or McDougall.

    1. I agree. Oprah has the same problem. She’s surrounded by the “best” advice money can buy. That generally means faddish MDs whose primary characteristic is an exceptional beside manner. If they were forced into searching for themselves, they might at least have either tried low carb or Paleo.

      What’s interesting though is many of the “B list” type stars/models seem to get the carb/sugar->body fat connection. The South Beach diet was developed basically from observing how skinny girls stayed skinny in Miami if I recall.

      1. I think Jennifer Anniston has followed a relatively primal eating plan. Maybe she knows Tom.

  12. Haha! The content makes this site great, and the humour makes it GOLDEN! LOVE it!

  13. I’ve worked in retirement/nursing homes, the thing that struck me with the elderly that have type II is that none of them grew up on sweets. They grew up very active outside doing physical work, and ate almost all homemade meals. What changed was them switching to store bought pre-made bakery goods, after retirement. Not too long after that is when they tend to get diagnosed as diabetic. So note to self….don’t sit around eating lorna doone when retired!

    1. Speaking of retirement homes, I have a neighbor across the street who worked in one, and was very surprised at the patient age range–SHE WAS OLDER THAN THEY WERE! She didn’t even become a nurse until 50, and here she was a couple of decades later, caring for people in a nursing home younger than she was!

      Now that she’s officially retired, she crochets afghans for these same people.

      1. One of my friends, now in her late 80s, had a long career as an RN specializing in geriatrics. She eventually retired when most of the patients on her unit turned out to be her age or younger. She volunteers with hospice now, and she’s always surprised when she’s assigned a patient her age or older–they’re usually “young folks,” according to her (which she admits means “under 75”).

  14. its a shame how misled diabetics are these days. Im type 1 diagnosed a couple years ago, and I have been given some outrageous advice…like eat 300+ carbs/day, and its ok for my blood sugar to spike to 200 after eating. what??

    Luckily I found websites like this one and was able to learn how I should be taking care of myself, else who knows where I would be right now. Unfortunately, most of the diabetic population doesn’t care or know enough to self-educate, so until conventional wisdom figures out how flawed their advice is nothing is going to change.
    and for the record, by eliminating grains and sugar I am able to maintain better blood sugar control than most non-diabetics who follow conventional dietary advice.

    1. Like that good ole’ Exchange Diet? That’s what slowly killed off my F-I-L. That what he got for putting his life in the hands of the ADA and AMA.

  15. This article is already on the bottom of the first page of Google for “tom hanks diabetes”. Perhaps if you expand on the offer, and make it its own page, it may make it higher in the search results, and introduce more people to the Primal Blueprint!

  16. The real elephant in the room is that YOU CAN’T GET DIABETES IF YOU DON’T EAT SUGAR!

    The sugar industry could deny it. So could sugar addicted patients. So could children raised on sugary comfort food that we use to confront adult stressors.

    It’s the same with scurvy: you can’t get scurvy if you eat oranges, limes, lettuce, or any amount of raw vegetable matter. Simple stuff here.

    1. This is simply wrong, Lisa. Certainly there is a strong correlation with obese body habitus and the incidence of DMII, but eating sugar in and of itself will not give you diabetes, either type I or II.

  17. “To think that people actually try this is sad. I’m imagining a perpetually starving overweight woman with T2D measuring out her olive oil by the teaspoon, weighing low-fat cheese spread only to discard the quarter ounce that gets stuck on the knife after somehow willing herself not to lick it clean, dutifully limiting herself to half a tomato (and eagerly unwrapping the saran-wrapped uneaten second half the next day), and frantically scraping the salt off her rice cakes because she forgot to buy unsalted ones. What a miserable existence made all the more miserable and unfortunate because of its lack of efficacy.”

    I am weeping because this is so true. It is so horribly, terribly true!! And having been that woman in the past I can’t thank you enough for spreading the word.

    No, I am not magically thin thanks to primal–yet!, but yes, I am far healthier than I have been in the past thanks to primal. Some folks’ systems are more broken than others and it takes longer to reset them. But no matter how long it takes, I’d ten times rather eat my lunch I had today than go back to that Special K lifestyle.

    Keep on Grokking on, Mark! For all our sakes!

    1. Oh so, so true. Vitrually everyother woman I know lives in a state of permanent starvation, and they do measure out the food with a teaspoon. And have a tiny salad for lunch (with no protein) without dressing, with a wild look in their eyes. And then give in to the hunger pangs mid afternoon and stuff down a massive healping of something ‘tasty’, promising themselves that they’ll work it off later, or that they went for a swim last week! Such a sad, sad existence.

  18. I was diagnosed with Very high cholesterol 1 year ago, so I followed the low fat/high whole grain diet to bring it down. In March my cholesterol had actually gone up and I was now T2D as well!!! I started checking my numbers before and after every meal and eliminating the foods that sent my blood sugar through the roof. I know you will be shocked to hear that all grains had to be eliminated from my meals. After that conclusion I started researching paleo and now eat about 90%. Yes, I have my occasional treats, but no grain. Now my A1C is within 1 point of being normal, 1 more point and I will no longer be considered diabetic. Oh yeah, my cholesterol is also coming down. I also have very strong genetics on both sides for diabetes, so beating this is even more impressive. I was in the hospital last month, for 5 days, and they put me on the “diabetic diet”. I lost 5 lbs. because I refused to eat the oatmeal, rice, rolls, etc. that made up 1/2 the food they served me. It felt so good to eat real dood when I got home!

    1. Eat real Food! I would like to note that I am NOT obese, as a matter of fact my weight is perfectly normal. So the answer is, yes people who are not overweight can get diabetes.

  19. Couldn’t help noticing the line, “doctors are getting better at helping their diabetic patients”. My guess is that they will give you just the right amount of info. to keep you sick for as long as possible…to make more money of course.

    1. The pharma buys them (many of them) with cheap merchandising, and they feel they need to prescribe drugs to pay them back!
      Prescribing different diet that encourages local & organic food is not as profitable as telling to keep eating the same and to take this pill!

      1. I would also note that an awful lot of people refuse to change their diet and giving them meds at least allows them to do ‘something’.

        1. Yeah, this. Docs can advise dietary changes until they’re blue in the face, but getting patients to actually make those changes is another thing. A hell of a lot of them simply won’t do it, or they’ll half-ass it, or they’ll let themselves “cheat” a little. And that’s no surprise; after all, they ended up diabetic thanks to their favorite, hyperpalatable “comfort” foods–the foods they want to give up least.

          I’m more than happy to eschew cake and mac&cheese in favor of steaks and butter, but I’ve known people who just couldn’t–or wouldn’t–do it. And those are the kinds of folks who will gladly take the pills, as they keep on eating as always.

          I remember a friend telling me about her obese Type 2 MIL, who would take larger doses of insulin before big family meals so she could “indulge”–I thought that was insane, but I’ve heard enough similar stories over the years to know that for patients who refuse to be active partners and participants in their own healthcare, writing a prescription is about the best their doctor can do.

  20. Mark, your envisioned reality for many overweight diabetics is something I see on an almost weekly basis at work. They’re usually in the kitchen at work, making lunch for themselves, trying so hard to be careful about what they’re eating.

    I saw one woman just today, carefully spreading Jif on her one piece of whole wheat bread to go with her Yoplait.

    I remember last week seeing another portion off half her can of Progresso soup and put the rest in the refrigerator.

    All this while I’m reheating country style spare ribs and dropping Kerrygold onto steamed red cabbage — while listening to these women tell me how what I’m eating is going to “catch up with me one day” and kill me. It’s enough to make you cry.

  21. I think doctors have an understandably hard time taking health advice from non-doctors after all the money and time and effort they spent on their education. They have an awful lot invested in being wrong. It would kind of be like me taking my accounting degree in hand to tell Farmer Joe the ins and outs of how he can be better at soil conservation from stuff I read on a blog. I could be right all day long with all the personal experience and anecdotal evidence but somehow I doubt I would gain much hearing.

    1. Yeah, but they won’t even take advise from other MDs, if it’s not mainstream. Dr. Bernstein became an MD so someone would vaguely listen about the connection between diet and blood sugar. Its not like his diet solution has become the standard treatment for diabetes. Many low carb diet experts are in fact MDs.

      And Farmer Joe might listen *if* you can demonstrate what you’re talking about. He’s always on the look out for better methods. He may not care one whit where you got the info as long as you can demonstrate the method successfully.

      In contrast, many MDs are not generally results oriented. They get paid whether you get better or not and currently get paid more if you stay sick. 🙁

  22. Great timing to talk about diabetes. I have been on the Paleo diet for over two years. I do drink smoothies once in a while when I am out and about, and this week drank a 24 oz smoothie, and then headed over to where I work to a benefits fair, and was offered a blood sugar test. To my surprise my blood sugar was 163!!!. It was suppose to be no higher than about 124.
    No more 24 oz smoothies for me. The nurse said I had some issues with isulin resistance. I am a nurse, and have knowledge of diabetes, was not real happy with that result. So will continue my Paleo diet, but be more aware of treats of candy, and smoothies for now on.
    My fasting blood sugar was normal earlier this year.

    1. A more pronounced blood sugar spike following (simple) carbohydrate ingestion is actually a fairly typical result of low(ish)-carb dieting over long(ish) time periods – that is because a low carb intake induces physiological insulin resistance (hence the need for an “adequate” carbohydrate intake (i.e. 150-250 grams per day) starting at least 3 days prior to an oral glucose tolerance test; it does not generate usable data otherwise). Thus, your conclusion is not necessarily unequivocally correct: Instead of henceforth abstaining from “treats” altogether, you could also try eating more carbs more regularly (not necessarily simple sugars, of course) and see if your blood sugar response improves.

      1. Agree. You will get a higher response if you are very low carb (I think Jenny Ruhl and/or Chris Kresser say you can knock about 10mg/dl off it if you are low carb).

        Try this next time. Check blood sugar right before you eat. Then check one hour after you started eating. Then at 2 hours. Then at 3 hours. It should be back to baseline by then (possibly at baseline after 2 hours). Non diabetics won’t see blood sugars go above 140 at peak (more common to stay below 120). I even take into account that bs monitors are entirely accurate. They can be off by 10-20%.

        And liquid carbs will hit the bloodstream faster than solid carbs (fruit is mostly sugar which will become like liquid sugar in a smoothie). That could also have something to do with the number going higher than “normal”.

        Nothing wrong with physiological insulin resistance at all. Perfectly normal. You have nothing to worry about.

        1. I would not call a spike of 163 nothing to worry about. Regular post-meal spikes this high are already known to lead to diabetic complications. Someone who is experiencing these blood sugar swings unknowingly is at risk of certain health consequences.

        2. A huge spike in sugar that doesn’t cause a huge spike in insulin, sounds like a very healthy system. Labeling it ” physiological insulin resistance” sounds like conventional wisdom, double speak. Margie, keep doing what works. You can afford to treat yourself occasionally.

  23. So about diabetes …. My 69 year old in-laws are being told their fasting blood sugar is too high, which it is. Their argument is their results (measuring in the 100 – 110 range) was never mentioned to them as being too high until this year by the same doctor they’ve had for years. They also remember when the guidance for diabetes was higher than it is now. They believe Big Pharma is trying to label more people as diabetics to sell more drugs.

    Given the Paleo community’s general questioning of most CW medical advice and Big Pharma’s push to do exactly this kind of thing for other “conditions” (statins anyone?) I do see their point. I also see it as a way to deny the impacts of their SAD.

  24. My wife has type II diabetes. At her last checkup her level was 140. She is a good person and a hard worker, will do anything for her family, friends and colleagues. She “tries” to eat healthy, but thinks the “100 calorie” bags of chips, artificial ice cream treats, multi-grain bread and pasta is OK. She has seen me over the last 18 months lose 30 pounds, get pretty ripped for a 60 year old guy and lots of compliments from friends and family. I’ve tried to very non-judgmentally explain what the basis of a sound nutrition plan is, and try to set a good example. She claims she “can’t eat like me” and is now resentful of any suggestions however gentle, and resents when I don’t eat some of the high carb food she prepares. I don’t want to nag her, I have plenty of my own faults, but this truly life-and-death stuff. Don’t know what else I can do, it’s sad.

    1. Hi George, I share your frustration. I have exactly the same problem with my Mum. She is in her 60’s and has been ballooning up and down for 30 years. Recently when I went home for a wedding my Dad told me to “not talk to your Mum about her weight or her training”. It upsets me because my background is health and I have literally helped hundreds of people through the same problems but she won’t listen and won’t talk to me about it. My only hope is that one day she will come around, I know that she reads articles I post from time to time… but it is hard. I hope that in time you see some success with your wife, I have learnt the hard way that often the people closest to us, that we want to help the most, are the people that we can’t. Best of luck with it.

  25. This is off topic from the above article but I didn’t know where else to post. I just wanted to share an amazing recipe I created for dinner tonight! Myself, husband and children (naturally) are Northwest Coast Native American’s from Washington state. We made a choice to raise our children culturally traditional, including how we eat. We are lucky to live where we do with an abundance of beautiful food to hunt and gather. Of course there are some exceptions, such as garlic (which I can’t live without) spices, mainstream fruits, some chicken occasionaly, occasional cheeses, some mainstream veggies, olive oil, etc..We realized a while back while reading an article that we are Paleo without meaning to be. We eat the way we do because we are honoring our ancestors. We want to eat what they ate. It was obviously what we were meant to eat and have ate since the beginning of time. We are aware that “new” food (brought by Europeans) are the reason our people have a huge percentage of diabetes, obesity, and a multitude of other health issues. Just like alcohol, Native American’s have a hard time processing processed foods, grains, and sugars. We never had them until the 1850’s or so when the Oregon Trail made it’s way here to the Coast. When you do the math, that really isn’t that long ago. So, on to my recipe. I call it the Ultimate Northwest Coast Paleo Salad and it goes like this:

    1 large Avacodo cubed
    1/2 onion diced
    1/2 cup cubed Pickled Salmon
    1/2 cup cubed Elk steak or Backstrap
    1/4 cup fresh or saute’d Bear Candy (what we call young Salmon Berry shoots)
    A pinch of Salt
    Pinch of Pepper
    Dash of Oregano
    Dash of Thyme
    2 Tablespoons of Olive Oil
    1 Tablespoon of pickle juice from Salmon

    Mix together and enjoy!

    I imagine there are so many possibilities with this. You could add and subtract ingredients to your liking. I think I will try ommitting the Elk next time and add some smoked oysters. It would be fabulous with some Steamer Clams too! I also thought when it is seasonal, it would taste great with Fiddleheads or Wapato. Have fun with it!

  26. Despite being on a ‘healthy diet’ nearly my whole life, I was diagnosed T2D about 5 years ago. It runs in the family as does obesity. After following CW to try keep it under control, I got grumpy at my lack of success and finally, thankfully, discovered Primal about 18 months ago. I went 100% overnight and was off all meds within a month. My blood glucose levels are better than ‘normal’ and better than my doctor’s, according to him.

  27. Re: Skinny people with diabetes.
    I’ve been having a lot of medical tests done recently and have seen a lot of doctors. It was very surprising to me that many of the doctors asked if I had diabetes. I’ve always been skinny and thought that automatically ruled out diabetes. But the doctors don’t think so. Guess they’ve seen too many folks who have it without being overweight.

    1. 1 in 5 diabetics are thin. I think there are a lot more – they just aren’t being tested because they aren’t overweight or obese.

  28. That Mayo Clinic diet for Type 2 Diabetics is pathetic. It’s no wonder there is an epidemic, the Mayo Clinic is feeding it!

  29. Why did you not let my comment regarding your musings about Tom Hanks and his T2D pass moderation? It was critical, yes, but also evidence-based. I thought this site was about uncovering dietary truths by evaluating the available evidence as best we can without prejudice? How about actually responding to my critique and telling me where I went wrong instead of just sweeping it under the rug?

    1. I see your other comment above. Check again, I think the comment you speak about is actually posted?

      1. I am not referring to my reply to Margie, if that`s what you mean; what I am hinting at is that a rather lengthy post of mine about the evidence base regarding T2D and carbohydrates/sugar in the diet does not appear to have made it through moderation for reasons I can`t fathom. I just tried to post something similar again, and the same thing appears to be happening. Is linking to pubmed considered “spam”?

  30. Haha.. “I’d love to wake up next morning, turn on the computer, and hear “You’ve Got Mail” because Tom Hanks’ rep read the post and shot me an email to help him get healthy.”

    If he played chopsticks on the piano everyday with enough intensity, he may not even need a workout plan. =)

  31. “– one of the very lucky few in a league of their own – ”

    Intentional or not, I see what you did there 🙂

  32. I remember watching castaway and marveling at the main character’s loss of body fat due to eating what I now know to be a primal diet of mostly seafood. Tom Hanks just needs to get back on the Cast away diet!

  33. My mother was diagnosed Type II diabetes some 20 years ago. I immediately took her to a Zone lecture where they showed how a bowl of pasta = a bowl of sugar in your stomach. She got onto low GI foods and now at 77 has no diabetes. Her neighbour at the campground (on crutches and mobility scooter) brings her cookies and cakes and tells her off for eating cream on her strawberries! And sees no irony. Mum is amazed that all her diabetic friends think nothing of eating a pile of crackers (they’re low fat!) but won’t touch cheese or butter. They’ve all gone downhill, had strokes or died. So sad.

  34. FWIW, I have personally had heart palpitations that I believe were related to fish oil consumption. They began about 3 weeks after I began supplementation. After a couple of months, I decided to stop supplementing since I never had this sort of problem before and that was the only major change in my lifestyle. Within a couple of weeks, the palpitations stopped. OK, it’s an n=1, but my point is you might not want to just blow that correlation off.

  35. Never have I done a more dramatic facepalm than upon reading the Tom Hanks section.

  36. As always, great post! Your blog is outstanding, and I always love seeing the new things on it. I had absolutely no idea about the DHA thing- I’ll have to do some more research on that one.

  37. I thought I read somewhere that Colin Hanks grew up in Malibu and was a surfer, just like his Dad(Tom). Maybe he just needs to get back out in the lineup at Zuma Beach with you Mark. Make it happen!

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  39. It’s funny but I seem to be in the same boat as Rebecca. Just gave birth … have a couple of other kids who seem to have been running since they were born and I am breastfeeding a 2 month old baby and also, with this mad cravings for nuts all the time. So…Will take mark’s advice to Rebecca as well. Thanks.