Dear Mark: Ornish on Paleo, CrossFit Workout Recovery, Nightshades, and Dry Heels

TomatoesFor today’s edition of Dear Mark, we’ve got a four-parter. First, Dean Ornish rears his head once again, this time making the claim that even paleo eaters with stellar lipid numbers invariably have clogged arteries. Should we listen? Next, what’s a good strategy for improving recovery from CrossFit workouts? More carbs, more protein, pre workout, post workout — what’s the deal here? Third, are nightshades responsible for hidden inflammation in everyone who eats them? Or is it just the folks who get joint pain and other confirmed symptoms who have to worry? And finally, I give a few tips for a frequent barefooter suffering from dry, cracked heels.

Let’s go:

Hi Mark,

The current issue of Prevention has an article where a doctor says the Paleo patients he sees present with severely clogged arteries even when lipids are good. This is alarming and I wanted to hear your thoughts. Also – my husband and I had amazing success by following your plan, but now carbs are creeping back into my husband’s diet. He has high LDL and 45% of his particles are small/dense. Can you tell me something to tell him to get him back on track. I feel like we’re playing a dangerous game if we continue to eat Primal, but don’t cut our carbs. He has minor plaque already in the LAD. I want to be able to tell him…”Mark said you better {{fill in the blank}}… Thank you so much for everything you do.


That doctor is none other than our old frizzy-haired friend, Dr. Dean Ornish. Though an MD, Ornish doesn’t actually see patients, unless you count the celebrities he counsels, like Bill Clinton (who’s since renounced the veganism Ornish recommended and taken up a low-carb Paleo-esque diet). Instead, he writes columns and works the advisory boards of companies like McDonald’s, Pepsi, and Mars.

Don’t get me wrong. Dean Ornish means well, I think. He even put together an effective lifestyle management program for smokers with heart disease. Given his biases, though, he’s simply not equipped to comment on the Primal lifestyle. What’s funny is that we’re not that far apart from each other. Check out what he employed for the smokers in his heart health program:

  • Low-fat, plant-based, effectively vegan diet. There was a bit of fish oil in there.
  • Regular meditation.
  • Regular group psychosocial therapy.
  • Daily exercise.
  • Cessation of smoking.
  • Weight loss.

And yes, it worked. Smokers with heart disease who quit smoking, stopped eating a standard American diet, started meditating, hung out with people in similar situations to talk through their problems with a professional therapist in attendance, exercised regularly, and lost a lot of weight reduced their risk of cardiac events and even improved the amount of atherosclerosis in their arteries. The control group of smokers with heart disease, who did none of that stuff, saw no reduction in risk or atherosclerosis. You can’t take that away from Ornish, or try to ignore it.

However, it doesn’t mean his diet is “better” than anyone else’s. It means that all those interventions, including the diet, combine to improve heart health. It may be all of them or just one doing the trick. We can’t know. He’s assuming the diet’s the most important factor; I’m just not convinced it outweighs the other lifestyle inputs.

That said, a high-carb, high-fat diet is really tough to pull off without incurring health problems, like hyperlipidemia or overweight. High-carb, high-to-moderate fat is just about the worst kind of macronutrient ratio for heart health; it’s no accident that the standard American diet is high-(refined) carb, high-to-moderate (refined) fat. It’s notorious for elevating LDL particles, especially the small, dense ones. Professional athletes, high-performance CrossFitters, people training hard nearly every day of the week can get away with pairing large amounts of fat and carbs together, but most people cannot. If your husband wants to eat more Primal-friendly carbs like roots, tubers, and fruits, he should reduce his fat intake (or adjust his activity up) accordingly. Increasing the carbs is fine and can work with a Primal eating plan, just not if you keep the fat high.

Dear Mr. Sisson,

I was wondering what some good options would be before and after my CrossFit workout that might help me to recover. I take a 100% whey isolate shake right after my WOD but with little to no carbs, and eat a balanced meal about an hour after. Should I be having carbs in the shake? Thank you.


For most people, a mixed meal anywhere from an hour to several hours after a workout is sufficient. The post-workout period of heightened insulin sensitivity lasts for several hours, so you’ll still be taking advantage of the rapid glycogen replenishment.

A CrossFit WOD is a different beast than most typical workouts. It’s very demanding, utilizing the glycolytic pathway and burning lots of muscle glycogen. To recover, you need to replenish the glycogen and you might want to do it a little more rapidly. If you’re concerned primarily with workout recovery/performance (and it seems like you are), not fat loss, go for a small mixed meal 30-60 minutes beforehand. About 20 grams of carbs, 20 grams of protein, and whatever fat comes along for the ride. A few possibilities:

  • Three eggs and an apple.
  • 1/4 pound beef liver with a small sweet potato.
  • Small burger patty with a bowl of cherries.
  • 20 g whey isolate, water and/or coconut milk, and a frozen banana blended together.

These are all light meals that won’t sit heavy in your belly during a workout, but they provide enough carbs, protein, and fat to help you perform. They’ll also indirectly help your recovery by reducing the amount of endogenous carbohydrate you draw upon during the workout.

Don’t forget the coffee or strong tea, if you drink it; caffeine can really improve workout performance. One study even found that a pre-workout caffeine-rich amino acid supplement improved performance, recovery, and training adaptations throughout a three week high intensity interval training program.

Post workout? In theory, your balanced meal an hour after should be enough, but if you’re writing in asking for help with recovery, it’s probably not doing the trick. Keep the meal but add some carbs with your shake. Try that whey and banana shake. Then, go for the meal an hour later.

For those of you interested primarily in promoting muscle protein synthesis (a necessary step toward hypertrophy), protein alone is enough. Whey protein in particular works because it’s rich in leucine, an amino acid that stimulates enough insulin to promote muscle protein synthesis. Post workout carbs aren’t necessary for building muscle.

This article says tomatoes are nightshades and aggravate inflammation. This article says tomatoes suppress inflammation. Which is it?


Hello, Mark. I love your name.

The whole nightshade thing is really overblown. I wrote about it almost seven years ago, and my position hasn’t really changed. If tomatoes (or other nightshades) make your joints hurt, don’t eat them. If you can eat tomatoes (or other nightshades) without feeling any negative effects, eat them. Some people have bad, crippling reactions to nightshades, which include tomatoes, potatoes (but not sweet potatoes or yams), peppers, eggplant, and paprika. Most do not.

The vast majority of research shows that tomatoes, tomato products (juice, sauce, paste), and tomato extracts exert effects the thrust of which can be described as anti-inflammatory. As for the downsides?

The bulk of the solanine (a kind of pesticide manufactured by the plant than can inhibit the body’s breakdown of acetylcholine and trigger overactive nerves) in tomatoes is found in the leaves, not the fruit. (There is some solanine in potatoes, but it really only amounts to trouble if you eat green sprouting potatoes. Just avoid the green potatoes and you should be fine. Peeling also helps, as most solanine resides in or near the skin.)

There’s also speculation that highly potent vitamin D metabolites present in nightshades can lead to soft tissue calcification; this would explain the joint pain. As far as tomatoes go, however, the vitamin D metabolites are found in the leaves, not the fruit.

Some would suggest that the lycopene, an antioxidant compound found in tomatoes, is anti-inflammatory enough to overcome the toxicity of the tomato’s solanine. They’d be wrong. A review of clinical trials found that the lycopene and the “other tomato stuff” exert synergistic anti-inflammatory effects greater than just the lycopene. Besides, even if they were right and lycopene is the only anti-inflammatory aspect of the tomato, the net “load” of consuming a tomato is anti-inflammatory.

There really isn’t much, if any, published research on nightshade sensitivity. Don’t get me wrong, though. It definitely exists. But I think it’s rare enough — and self evident when it happens due to subjectively obvious symptoms like joint pain — that the average person who likes tomato sauce and hot peppers can happily enjoy them without worrying about hidden inflammation.

That said, anyone with arthritis (or joint pain in general), an autoimmune disease, or something with potentially numerous causes like fibromyalgia should consider a nightshade free diet trial. Just go without them for a month and see if you notice any improvements. Tomatoes are delicious, sure, but it’s worth a shot.

Dear Mark,

I am a huge follower of the barefoot movement and often do my walks shoeless (not even FiveFingers) as I have heard about the huge benefits of grounding. However after a couple of walks my heels start cracking. Though I’m not one to worry about the aesthetic nature of feet it does eventually lead to a very annoying pain.

I don’t believe that Grok often had to struggle with such problems and I would firstly like to know your opinion on it and if you have a solution to it.

Thanks, Mark, keep up the inspiring work.


Some degree of dry, cracking heels is normal. The feet aren’t particularly moist, and regularly going barefoot can produce calluses which may be prone to cracking. There are a few things to try if you’re not doing them already, though.

  • Eat fat. Our bodies make sebum, the endogenous moisturizer, from fat. Make sure you’re eating long chain omega-3s, from foods like salmon, sardines, and shellfish.
  • Eat egg yolks and liver. You may be slightly deficient in biotin, a nutrient involved in skin moisturizing; both foods are rich in biotin. Also, limit raw egg whites, which can deplete your biotin stores.
  • Pay attention to any other nutrients that contribute to skin health, strength, and resilience. Are you eating enough vitamin C (almost every fruit and vegetable), gelatin (bone broth, oxtail, shanks, feet), zinc (red meat, oysters, pumpkin seeds)?
  • Apply extra virgin olive oil to your heels after bathing. Really rub it in. Give yourself a foot massage, basically. Alternate oils like coconut could work as well. I even heard of someone who swore by raw grass fed butter for their cracked heels. Who knows? If it doesn’t work, you can just eat it.
  • Beeswax is supposed to help cracked heels. Look for a lotion or balm that contains beeswax. This one looks decent and gets good reviews.

Barefoot Ken Bob, a pioneer of barefooting, has an entire post devoted to solving the cracked heel issue (so at least you’re not alone in this). It may help you.

That’s it for today, everyone. Thanks for reading and be sure to help out in the comment section!

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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40 thoughts on “Dear Mark: Ornish on Paleo, CrossFit Workout Recovery, Nightshades, and Dry Heels”

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  1. Love your comments on nightshades. Those poor veggies have gotten such a bad rep recently.

  2. I think I’ve seen studies showing the high fat high carb thing is bad, but has there ever been an article on marksdailyapple about high fat high carb in a primal context and if so can someone link it? It would make me feel a lot better if I could eat sweet potatoes, bananas, nuts, and bacon without worrying I was ever hurting my heart health.

    1. Yeah, I am feeling a bit guilty just now about eating plantains sauteed in bacon fat, with eggs/kale and turkey sausage for breakfast. Is there a chart that outlines what constitutes high fat? Just when I start to get a handle on the amount of carbs I am eating then one has to think about fat. I often get a little grumpy that someone didn’t help sort this out for me when I was a kid by feeding me real food.

      1. That is not a high carb meal unless you’re eating a pile of plantains. I eat a handful of pistachios, four eggs, two teaspoons of fish oil, and a sweet potatoes with coconut oil and cinnamon everyday for breakfast. Hardly high carb by any standards.

    2. I would like that too. I love my plantain pancakes but now I’m feeling antsy. My carb intake is usually under 150g, though…

      1. You guys don’t need to worry! My hunch is that the levels he’s talking about are 350+g carbs per day. Just stay within Mark’s curve (which has stood the test of time amazingly well) and you’re good.

    3. Other inputs – Goods fats or bad fats ?, how much / what type of exercise, Stress / Sleep balance ?

      ..and yes, studies have indeed shown that the SAD is Bad…. (ie, the High fat high carb diet you referred to)

  3. Ornish’s work schedule sounds like the work schedules of Dr. Oz, Dr. Sanjay Gupta, and Dr. Phil–these men spend more time in the media than in the field which they are credentialed in!

    Gupta is the only outlier here: he DOES work on neuro patients, but only 1 day a week.

    So much money spent to become a doctor, and they all wind up TV celebrities. This is the only occupation (TV celebrity) where they’d make enough money to pay off their student loan debt in less than 10 years. But when the spotlight fades…

  4. “Doctor” Ornish or should we call him Mr. Agenda is not to be taken seriously. He’s several thousand steps behind Dr. OZ and that’s pretty freakin’ unimpressive.

  5. Is high fat/high carb bad mostly because that means high calories? It seems hard to eat “high” both of those things, usually one replaces the other.

    1. It’s not really that hard to eat high fat/high carb. Bread with butter, potatoes with sour cream, doughnuts with jam or frosting, cakes and cookies, waffles with butter and syrup, peanut butter with jelly…

      1. It’s pretty easy, actually. Mexican, Italian, Chinese, French food from restaurants and fast food are perfect examples of high carb/high fat. Pizza, enchiladas, etc. Standard American Diet.

      2. Well everything you eat is a ratio of fat/protein/carbohydrates. I guess “high carb/high fat” would be something like a 45/10/45 ratio and that would be bad? What about 40/20/40?

    2. I would be curious on this too.
      I am a fitness director so most days a lot of activity is in my day. I eat lots of starchy veggies like squash soup, sweet potatoes, baked parsnips. We make a root vegetable hash with eggs and bacon. I would assume it is just fine as my output during a day is quite high. But I would be curious to see you expand on this Mark?

    3. Brian, high carb means lots of insulin release, which means storage of both glucose and fat in the fat cells. Keep away from grains, legumes and high sugar fruits, and Mark’s carb curve will do you well. In other words, The Primal Blueprint.

  6. I had the cracked-heel issue; here’s how I fixed it:

    1. Stopped walking on my tile floors barefoot. I wear socks or slippers in the house. For whatever reason, the tile in my home seemed to suck all the moisture out of my feet.

    2. Upped my fat intake. An extra shot (or two) of olive or coconut oil seemed to help too.

    3. Cocoa butter (or some other oil/lotion) on the feet prior to putting on socks.

    Obviously, YMMV, but doing these three things worked for me. I live in AZ and it’s pretty dry here, but these helped.

    1. Climate makes a difference. Years ago we spent a couple of weeks in Las Vegas. My feet were chronically dry, as abrasive as sandpaper, and nothing helped. We went on to California, near the coast, and within a week the cracks and dryness disappeared like magic. Colorado, where I live, can be very dry in the winter, even if there’s snow on the ground. The only thing I’ve ever found that really works is a product called Aquaphor, applied after showering. That and wearing socks. (Yes, I know… Aquaphor isn’t PC here, but it’s cheap, effective, and available at any drugstore.)

      1. I quite agree. I have dry, cracking skin everywhere… I live in Calgary, AB and while I love many things about it the dryness can be a pain. It was never like this when I lived in Ontario.

    2. I’ve always loved going barefoot and have plenty of experience with hard, cracked heel calluses. About 20 years ago I worked 2 seasons packing parachutes (mostly tandems) for a drop zone – hot, physically intense full-body workout; 12 hour days; and barefoot the whole time (shoes can damage the chute) walking on gravel in the packing area, and on rounded river stones on the path out to the hangar. I knew the heels would be a problem if I let them, so I tried to prevent it – after work I’d shower, then rub my feet down with 100% pure Aloe Vera gel I got from a health food store. The kind you keep in the fridge. Worked like a charm! The skin on my heels thickened but never hardened, it stayed supple and flexible. I was actually surprised at just how well it worked, and try to keep some on hand ever since.
      Hope this helps.

  7. Well thanks Dr. Ornish, you’ve just saved people lots of time and the medical profession millions. Apparently we don’t need to take all of those lipid panel tests or take statins, because you say the blood work tests don’t mean anything!

    Probably the single greatest accomplishment in medical history.

    And those of you with high cholesterol numbers, worry not. The tests don’t mean anything.

  8. I have often wondered/worried about the Nightshade issue so thanks for addressing it today, appreciate your thoughts!

  9. I have a problem with dry heels in the winter. I take a cup of coconut oil, 1 tsp vitamin E oil, and 10-15 drops of tea tree oil and whip them together with the old KitchenAid mixer. Then I put it in a glass jar on the nightstand. I use it for my feet, and my husband swears by it for the itching of his psoriasis. It’s the only thing that will let him sleep through the night without waking up itching.

  10. Try ammonium lactate cream for dry cracked skin. It’s a humectant and it helps slough off dead skin layers.

  11. I’m barefoot all the time on stone, and sand. My heels have more than cracks they have fissures. I fixed it right away with a pair of sheepskin slippers. I put some lanolin into the fur inside the slipper and it worked like a charm.

    1. Actually, applying lanolin ointment directly to the skin is extremely effective. It is also excellent for chapped or cracked lips, and is the go-to treatment for breast feeding mothers struggling with cracked nipples as well!

  12. In terms of cross-fit recovery, all the books, research and my own practical experience lead to one thing – it takes at least 48 hours for your body to repair “ripped” muscle fibres – that just seems to be the way it is.

    There is no magic powder or diet on earth that will speed this up faster (of course, bad diet will extend recovery past this 48 hours).

    Sure, you can work out every day, but basically you won’t be able to put in the full effort, you will be in a continual state of half-recovery – this is this problem I have with the WOD principle – it can only lead to burnout and sub-optimal performance.

    The only exception is if you are working out to a level where you aren’t ripping your muscle fibres (i.e., your happy with your current strength, and are doing high reps/low weights, which is more of a “daily work” type of workout, that won’t really increase strength or fitness higher than you already are, and in fact will probably deteriorate your strength)

    If you are using good form (rare in cross fit), and lifting heavy loads (be it weights or body weight), for low reps but multiple sets (3-5), then your muscle fibres should get torn, and you will have to wait 48 hours, unless you are a never before seen genetic exception to the human race.

  13. “A dangerous game if we continue to eat primal” ?

    – just one problem with that, if your eating high carbs with little exercise, your not eating primal, your eating/doing some other type of diet.

    The comment should really be “A dangerous game if we continue to do a diet that is not primal, but we are calling primal”

  14. Thanks for the tip about biotin, I think I’ve found how to cure my husband dry and flaky skin and scalp, eczema and cracked feet and hands.

    The only thing he eats on the high biotin list is eggs.

  15. My heels crack in summer after wearing sandals fore a while. Tiger balm works almost over night. Once healed I’m usually good for the rest of of the summer.

  16. Reading Cordain’s book at the moment and I wonder if he is right with his approach to Paleo, He says High Protein, moderate fat and free in carbs as long as they come from fruit and vegetables… isn’t that the same as high-moderate fat and high-moderate carb in a diet that you are describing Mark?

  17. Love the article, but did you need to comment on Dr. Ornish’s hair? C’mon now, his hair, frizzy or not, is just not of consequence.

    1. That would be all those whole-grain bread crusts making his hair go curly as the old wives tale goes ?

  18. I make a salve for dry cracked skin from beeswax, honey, a bit of almond oil, and a few drops of lavender essential oil. Any nice oil will do as a moisturizer… I have used grapeseed oil and shea butter too, and I think that coconut oil would be fabulous (haven’t tried it yet). The honey and the lavender essential oil help to heal the skin, and the beeswax protects the skin while the honey and lavender are working. It’s not hard to mix up…. just melt a little beeswax, remove from heat, and stir the rest of the ingredients in. Stir until the beeswax solidifies, otherwise the ingredients will separate.

  19. It’s also pretty easy to make your own beeswax-based salve. 1 part beeswax to 4 parts oil (I often use a mix of jojoba, coconut, and shea butter). Warm in a double boiler just until the beeswax melts, then transfer to a jar. Whip it periodically with a fork as it cools to keep the mixture emulsified and fluffy. You can also add a few drops of aromatic oil if you want a perfumed version.

  20. Cracked heels can be a sign of a fungal infection. Stridex pads help treat the fungal infection because they contain salicylic acid. Sal3 soap helps too.

  21. The truly primal cure for cracked heels from native Americans is to pee in the grass and rub your heels in it. Works like a charm.
    Likely something to do with the urea in the urine. Works in the shower too.

  22. In regard to nightshades. They’re nice and tasty “if” you don’t have a problem with them.

    IMHO: If you have autoimmune issues stay clear of them.
    I ate, and enjoyed nightshades all my life in small doses and never realized they were a problem for me.

    I suggest eating a bunch of them to see how you feel. A small dose may not be enough to provoke a noticeable reaction.

    I had heard the term “autoimmune” bandied about for years, but I didn’t know for sure what an autoimmune condition really was, and didn’t equate what I was feeling with autoimmune. I knew it was something I was eating or coming in contact with, but I just thought I had a food sensitivity and kept looking to eliminate that one culprit that was wreaking havoc in my life.
    It wasn’t until Tara Grant’s book came out about H.S. that it became crystal clear to me that it wasn’t just one or two things making me ill.

    In the time sinceTara’s book came out, I’ve gotten to a place where I now feel well, but I had to go way out of the mainstream with a rigid Paleo AIP diet to get there.
    Eliminating some, but not all of the offenders helped, but I plateaued quickly, and knew it wasn’t enough.

    For me: No nightshades, eggs or dairy, except ghee and some whey isolate, grains and corn, legumes, sugar, and finally-most nuts and seeds, including spices from seeds.
    It wasn’t until I went to this extreme that the symptoms of lethargy, dizziness, aches and pains, and skin issues started to clear.
    I have much more energy and stamina now, and weight is finally coming off.
    My quality of life is substantially better by far.

    My takeaway is this: If you have any one of the multitude of autoimmune issues with leaky gut, don’t play around, get serious ,and get down to the bare essentials,
    plain meat and veg. The sacrifice and inconvenience is worth it. I always knew something was wrong with me, but nothing helped until I got rid of ALL the offenders.

    My thanks to the many folks who have been sharing their knowledge and experiences, because you have all contributed to my wellness.
    Aside from all the online resources and books, this has been a solitary endeavor.
    It would have been nice to have doctors and friends support, but having done it all myself has made me feel more self reliant, and less inclined to cave to peer pressure.
    I’m 52 and take a few vitamins, but no medications at all, not even over the counter stuff. Woohoo!