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 more than three decades 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 flavorful and delicious kitchen staples crafted with premium ingredients like avocado oil. With over 70 condiments, sauces, oils, and dressings in their lineup, Primal Kitchen makes it easy to prep mouthwatering meals that fit into your lifestyle.

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