Dear Mark: Fat Roundup

Butter. Traces of a knife. Question markLast week, I wrote about my 16 favorite fats. You had questions. For today’s edition of Dear Mark, I’ll answer some of them. First, I explain why my keto salad recipe didn’t include any dense protein. Second, I explain a few options for steaming heavy cream. Third, I tell where I get my mac nuts. Fourth, I discuss whether you should worry about dioxins in pastured eggs. And fifth, I address the question of dietary fat and fatty liver.

Let’s go:



Yep. I intentionally left it out of the recipe. About half the time I’ll throw in some hardboiled eggs, a can of sardines or tuna, or some leftover meat, fish, or fowl from the night before, but not always. As I mentioned in the Definitive Guide, dietary protein, along with glucose, is a source of oxaloacetate. It’s the absence of oxaloacetate that inhibits ATP generation via Krebs’ cycle and necessitates ketone production. Too much protein can inhibit ketone production.

That’s not to say you shouldn’t eat protein. Protein can really help curb appetite, retain lean mass during weight loss, and improve physical performance. In fact, most people eating standard diets probably need more. And certain populations, like seniors and the ill and infirm, require more protein than the general population for the same effect.

But people seeking deep ketosis, whether for health reasons or simple curiosity, will often need to eat less protein. That’s what I’m interested in, at least for the time being. Hence the somewhat lower protein intake.

I just learned about Steamed Heavy Cream. Any tips from anyone on the proper way to do that?


If you have an espresso machine, that’s the best way to steam it. Few have one at home.

Heat the cream on the stove, then whisk it furiously. Incorporate as much air as you desire and pour into coffee.

Heat the cream on the stove, then blend. Stick blenders and stand-up blenders both work.

Get a cheap milk frother. Froth away.

Get a better milk frother. Froth even more.

Heavy cream won’t foam up like milk or half-and-half. The bubbles are smaller, denser, and more velvety.

Mark, where do you buy macadamia nuts and what brand are they?


I have a few sources.

Trader Joe’s carries a nice dry-roasted, salted mac nut from Australia. If I’m there, I’ll grab a few bags.

These are good from Thrive.

Hawaii Costcos carry an incredible 2-pound (or so) bag of mac nuts. The brand escapes me, but it’s definitely not Mauna Loa or Kirkland. They’re the sweetest ones I’ve ever had. Not sure if they’re roasted or not. Whenever I’m on Maui or Kauai, I make sure to grab at least 5 bags to take home.

I don’t worry much about organic. Mac nuts are a low pesticide nut. Their shells are quite hardy, and most producers are able to grow them without using additional chemicals.

I do stick to raw or dry-roasted mac nuts. Just plain “roasted” usually means “fried in substandard vegetable oil” (that goes for any nut).

I am wondering, I eat quite a lot of eggs every day for my weight (woman, 55 kilograms). I eat about 4 eggs a day (local, pastured), but many sources say that mainly those eggs contain a lot of dioxin because chickens pick the polluted ground. What about the potential negative effects of higher dioxin in your pasture raised (also meats) food? Or is this effect negligible?


They used to think that grass-fed beef had more dioxins due to the cows ingesting more polluted soil. It turns out that the cows they tested were eating out of dioxin-contaminated troughs and had industrial waste mixed in with their feed. The same has been shown to happen with pastured-raised chickens and their eggs—living in contaminated hen houses spikes dioxin levels. Soil dioxin levels matter, but they’re not the only source of dioxins in eggs.

Besides: eggs and other animal foods that may be higher in dioxins possess more of the nutrients that reduce dioxin toxicity.

Vitamin A has been shown to protect against dioxin toxicity; pastured eggs are higher in vitamin A than other eggs.

Dioxins exert damage through lipid peroxidation; people who eat pastured eggs show less lipid peroxidation than people who eat normal eggs.

I don’t think it’s a big deal, but I’m also not one to worry too much about things you can’t really control. What’s the alternative—eating battery-farmed eggs and missing out on higher levels of vitamin E, omega-3s, vitamin A?

No thanks.

Mark, what is your take on what Art De Vany said on the Tim Ferriss in that interview you linked to a couple weeks back? He said paleo folks are eating too much fat, leading directly to fatty liver. He also wondered why they need all that energy. I was surprised to hear that after all the good things I’ve heard about fat from you and others.


Excess fat—fat that exceeds caloric requirements—does increase the chance of fatty liver. But it’s not the fat, specifically. It’s the excess. A recent study out of China found that the best predictors of non-alcoholic fatty liver were diets “higher in energy, protein, fat, saturated fatty acid (SFA), and polyunsaturated fatty acid (PUFA).” After adjusting for BMI and age, the best predictor was high “total energy intake.” In other words, people who ate a ton of just about everything were more likely to have fatty livers.

It can’t be the fat alone. De novo lipogenesis—the process by which carbs are converted into fat—plays an important and causative role in the development of non-alcoholic fatty liver disease.

And most significantly, the studies are quite clear that the best way to lose liver fat is to go low-carb, high-fat. You don’t have to do it that way. It’s just the way that the most people seem to find the most tolerable and sustainable.

A pilot study using the ketogenic diet helped non-alcoholic fatty liver disease patients lose weight and drastically improve liver health markers.

A Spanish ketogenic diet (keto with wine, basically) cured people of the metabolic syndrome and improved health markers of non-alcoholic fatty liver disease, with over 92% of subjects improving their liver health and 21% resolving it entirely.

Note that just because these were “high-fat” diets doesn’t mean they were eating “loads” of fat. Seeing as how they lost weight, they were most likely reducing calories overall. That’s just how low-carb, high-fat, ketogenic diets pan out. You inadvertently eat less. It’s how they work.

That’s it for today, folks. Thanks for reading.

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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27 thoughts on “Dear Mark: Fat Roundup”

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  1. Very good answers and thanks for always including the links to where you are getting the information. I have heard people talking about the dioxin in eggs but had a similar feeling to you. I’m not going to quit eating eggs just because of that and there is little I can do anyway to reduce it.

    1. Alcohol is a toxin (hence, “intoxicated”). I want to minimize toxins and maximize health – so I avoid it, don’t miss it, and feel better.

    2. I’m there! Been mixing sangria with my kombucha for awhile now?

    3. Who knew, I’ve apparently been doing Spanish kept since before it was cool!

    1. Hilarious article. Recommends eating more vegetable oils. Will this madness ever end? Nope!

      1. I stopped reading at “The American Heart Association.” (Well, I really didn’t, but perhaps I should have.) Same old predictable, thoughtless hatchet job against saturated fat via misguided preoccupation with nuance-free readings of cholesterol markers.

    2. The article is somewhat right about saturated fat tending to push up LDL, but as a whole leaves out many important aspects of coconut oil. As much as it’s heresy to say around here, saturated fat, from any source, can really do a job on your LDL. it can jack it up really high and far above what it does to improve your HDL – proportionally speaking. I know I’m a hyper responder to saturated fat.I’ve experimented quite a bit. It jacks my HDL way up (from 107 to 137 last check) which is good, but it took my LDL crazy high also (from 97 to 223). Even with good ratios and triglycerides at a low 40, that’s just too high. So it’s clear for me, that lots of fat is great – but slamming coconut oil, dark chocolate, pulled pork ,bacon, sausage and fatty meats is not the correct approach for me. A little goes a long way.

      1. Not denying that you know what’s best for your body. And I realize you might have left some details out for brevity. But just because your LDL is raised isn’t necessarily bad. Large particle? Small? Aren’t there something like 5 different types of LDL now that have different health implications? As well as types of HDL that also have differing health implications. I’m totally on the page where some people should avoid excess saturated fat (just as people have different tolerances to carbs, etc). I’m just not sure that “raised LDL” on its own is enough information to make a judgement either way.

        1. When your LDL hits 223 you don’t split hairs about partial size. We’ve been trained to be fat phobic for so long, and there’s so much ignorance about cholesterol levels, that I understand tendency to go the opposite direction and just dismiss it all as if numbers don’t even matter anymore as long as your particles are big and fluffy. I just don’t think that’s accurate. And I have two very progressive and in-the-know doctors and they have the same opinion that at a certain point you can’t just ignore numbers that are unusualy skewed in the wrong direction. He didn’t panic or want me to go on statins he just said back off on the fatty meats and keep eating the lean proteins. Which is unusual for a doctor to say when your total cholesterol hit 365. That would make most doctors frame out. It sounds reasonable to me because my current numbers are very different from my historical averages.

          1. Thanks, Clay. Way too many people have the idea that if a little is good then a lot (of anything) has to be better. Not so.

          2. Hello Clay,

            Indeed 365 is a bit high.. May I ask how many calories do you eat per day? What is your “Protein C-Reactive” number? Any ongoing inflammation?

    3. This from the source “advisory” document:

      “In summary, randomized controlled trials that lowered intake of dietary saturated fat and replaced it with polyunsaturated vegetable oil reduced CVD by ?30%, similar to the reduction achieved by statin treatment….we conclude strongly that lowering intake of saturated fat and replacing it with unsaturated fats, especially polyunsaturated fats, will lower the incidence of CVD”.

  2. Thanks for the skinny, on fat.

    About over eating fat, I think a lot of people went/go overboard. Probably stems from the low fat misery years (1980-2010). Now it’s, fat is good…I’m gonna eat it all day long now. There is a limit.

  3. I recently read that bullet-proof coffee is meant to replace a meal. If you are adding that fat when you are not hungry that is NOT a good thing.

  4. First thing I did was check financers of the study. Canola Oil Council. Merck. Pfizer and many more statin producers. Follow the money.

    1. Sorry, this was meant to go under the comments re negative Coconut Oil Study. I’m new to the site, sorry ?

  5. well thought out article! As a weekend warrior myself and retired athlete, I’ve been through several diets in my day. I wonder what the effects of Paleo vs Keto vs Raw diet have on the liver. They didn’t cover that part for us in medical school at least!

    looking forward to the next post!