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Exercise is medicine. I don’t say this in a cutesy way either. Exercise, just like any pill you can pop, initiates a number of chemical reactions within your body. It must be carefully applied so as to elicit the desired effect while minimizing any negative side effects.
Believe it or not, there is a time when exercise can be toxic for you. As my great human physiology professor often reminded us, “The dose makes the poison.” His most shocking example of this truth is when he would relate how endurance runners sometimes perish by drinking too much water after a race. (see hyponatremia)
Before I go any further, please let it be known that this will not be another cardio-bashing blog post. There are enough of those out there in the blogosphere. My purpose is only to attempt to pre-emptively justify why, after just receiving your payment for personal training, your personal trainer may now be telling you to stay out of the gym.
When I first attempt to explain this concept to my clients, they often ask me why I bothered studying exercise for so long if I’m telling them it is bad for them. In order to answer this, allow me to give some quick background on what a degree in Kinesiology entails.
My formal education has been full of studying athletes, seniors, stroke victims and cadavers in applied settings as well as exercise physiology labs. All of this after basically completing a pre-med track of courses. I’ve studied how the body responds to exercise in all conceivable environmental variations. Aside from all the anatomy, biochemistry and physiology, I have ultimately learned that exercise is nothing more than self-induced stress. Your hypothalamus and limbic system can not tell the difference between running in the park and getting yelled at by your boss.
The end result of too much stress is as varied as the possible sources. Every living being utilizes the awesome force of adaptation. Central to that force is the concept of hormesis: (as described at gettingstronger.org)
Hormesis is a biological phenomenon whereby a beneficial effect (improved health, stress tolerance, growth or longevity) results from exposure to low doses of an agent that is otherwise toxic or lethal when given at higher doses.
We realize that stressors can serve a purpose however when we fail to account for all possible stressors, we find ourselves writing checks our body can’t cash. Be it physical stress, chemical stress, emotional stress or financial stress, your body knows not the difference. The “stress pathway” within you is very complex and deserves its own post (soon to be linked here).
Exercise is only a stress-reducer when the one exercising is perfectly healthy and free from chronic stress in the first place.
The point is that it is most likely the case that you hired a personal trainer because you don’t feel and/or look as healthy as you would like to. This current state of dissatisfaction was not brought on by a sudden case of the “lazies”. It is probably closer to the truth that you have packed on some pounds due to an overload of stress in one form or another.
I hesitate to declare a rule of Wellness “Golden” this early in my life but I feel that even through my continuing exploration of all things in wellness and human performance, I will not have to revise the following statement. The single characteristic all humans operating at an optimal level of health and performance share is that they are honest with their bodies. The first truth they allow themselves to believe is that they are infinitely unique in mind, soul AND BODY. We all know we each possess a unique personality and spirituality yet we relinquish our authority when it comes to our biology. We let others tell us what healthy is rather than experiencing it for ourselves. Every major traditional system of medicine has respected the biochemical individuality of the patient despite having the technology necessary to articulate this principle in full. Our ability to break down everything to it’s biochemical pathway has left us with an inability to see the forrest for the trees.
To thrive is to realize that our physical bodies are but an intermediary to a causal universe. The world around us is always striving for homeostasis or balance. Our bodies do the same; we just have to listen to them. In order to acheive true wellness, we must learn to take every sub-clinical symptom (those idiopathic nagging headaches, bouts of brain fog, fatigue, gas, joint pain, etc) and use it as a means to discovering our own personal triggers.
For far too long, we have thought of weight gain in terms of sloth and gluttony. Ask your MD why you are overweight and they’ll tell you that your intake of calories must be greater than your level of physical activity. It’s simple Newtonian Physics as far as most obesity authorities are concerned. Thankfully, there are some prominent researchers who actually get it.
Fat is a symptom, not a cause of chronic disease. Gaining weight is the body’s way of preparing for drastic conditions. This change is brought on by real stressors perceived by our glands and organs. If we are honest with our bodies, we will notice this change and truly ask ourselves what factors may be contributing to the problem. Going straight to, “I need to eat less and exercise more” is an irresponsible knee-jerk reaction that will only pile more stress upon all the stress that got you fat in the first place. Be honest with your body. Pay it the respect it deserves by fully and truthfully investigating any and all causes of stress and imbalance in your life. Do not be afraid to start slow. Becoming a Mover takes time.
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As more of us live beyond our 80′s, our bones become an increasingly important element of healthy ageing. The statistics (found here) are just as dire as the obesity epidemic. The good news is that although we all stop accumulating bone mass at age 30, there are scientifically proven methods of maintaining a strong and functional skeleton for as long as you have breath in your lungs.
The average adult human skeleton is made up of 206 bones. The talus is the only bone in the body with no muscular attachments. This means that the other 204 bones you possess are under varying amounts of muscular force at any given time. Muscular force is the pulling, twisting or bending force that an attached muscle inflicts on the bone when it contracts. The other type of force is Ground Reaction Force (GRF). GRF is the force originating from the ground that is transferred upwards throughout our skeletal structure. There are more forces under these two classifications, i.e. torsional, shearing, axial compressing, etc. For the purpose of this concept, just know that the ground creates a force on our bones from the outside and our muscles create a force on our bones from the inside.
This is important to note because the demand (force) we impose on our bones in our daily lives is the only way we can encourage the remodeling of spongy bone to compact bone. Yes, remodeling is the true scientific term…look it up. Your bones are constantly being broken down by some cells (osteoclasts) and built up by other cells (osteoblasts). This is the body’s way of ensuring you only have as many precious minerals devoted to structural support as you need based on the current demands of your daily life. There is a finite amount of Calcium in your body. If it all was deposited in to your bones, there would be no way of contracting a muscle to act on said bone. This is why physicians tell their patients to walk and resistance train for their bone health. Through exercise, you communicate to those osteoclasts to leave a little bone tissue to keep you upright through all 18 holes this weekend.
Bone is a living, breathing organ. We tend to think of it more like a bunch of white rocks stacked up in a particular fashion. Even when we discuss supplementation (Calcium and/or Vitamin D), we still picture little particles of Calcium floating around in our blood and being deposited on various parts of our skeleton. The truth is, we have far greater ability to create a bone building environment within ourselves than we think.
Provided that you don’t overindulge on processed foods that lack minerals and/or blindly supplement your diet with random vitamins you find in the bargain bin of your local mega mart, your bones will stay dense enough to support your body in an upright position until you die. We do not need to rely on walkers, rascal scooters or robo legs to carry us across the finish line of this race called life. We seem to assume that osteoporosis and osteopenia are inevitabilities that we all must succumb to as soon as we reach a certain age. This is plain false. We didn’t go through millions of years of evolution to rise to the top of the food chain only to be limited to 70-90 years by a perpetually crumbling skeleton.
Several fractures such as this have been associated to use of bisphosphonates
Since all but one bone two bones (you’ve got one talus in each foot) are attached to muscles, this means that even if you are in outer space, you can maintain your bone density by regularly using your muscles and properly nourishing your body. You don’t have to spend all your money on medication that may or may not work. You may have heard of drugs like Fosamax after your doctor read your paltry numbers from your DEXA scan. Sure these drugs, called bisphosphonates, improve mineral density but what exactly does that mean? The only thing these drugs do is improve your DEXA score. They promote the retention of minerals in your bones but they do not work together with the innate wisdom of your body. They merely stop the resorption of bone by the osteoclasts. As you recall, osteoblasts work with osteoblasts to maintain healthy levels of bone density in proportion to the imposed structural demand. If you shut off the osteoclasts, you also shut down the osteoblasts. This can lead to more brittle bones and eventually to fractures.
Some health professionals promote walking for bone health. The idea is that the repeated impact with each step will signal to your bones that they need to “beef up”. The truth is that the evidence is just not there to support this low-intensity mode of exercise as an effective bone preservation strategy. I suppose that for somebody considered sedentary, (Click here to see if that’s you) walking would provide some positive bone remodeling effect in the first few weeks. My only fear is that in promoting walking for bone health, we may lull those at risk of fracture in to a false sense of security; just as improving your DEXA results with bisphosphonates does.
She's got healthy bones. Click to see how you can too.
It is crucial to incorporate a safe amount of running and resistance training in to your daily life. This is most effectively done with the coaching of an experienced fitness professional. If your bones are porous to begin with, your program must be fine tuned to weigh your needs with your abilities. If you are simply moving to prevent osteopenia, you needn’t be so structured. The beauty about moving for your bones is that you don’t need to worry about number or sets, duration or intensity like you do when training your cardiovascular system. Cardio training involves at least 3-5 systems at one time. The mode rate and volume of exercise must be carefully designed in order to evoke a desired adaptation response by the body. Bone density training however only involves one system; the musculoskeletal system. All you have to do is move your bones at any given point in the day. Of course you get out of it what you put in but any little bit adds up to a total daily demand that your body comes to expect. Demand more of your bones on a daily basis and your body will reward you with a couple hips that are less likely to fracture.
Wiggle your toes at your desk. Reach for the sky and pull on that shoulder girdle and ribcage. Every little bit helps and you get quite a stretch on your muscles at the same time.
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Well hello, you look familiar. It’s been quite some time since my last post but I have a great excuse. I have started a Masters program in Sport and Exercise Psychology. I figured that I know (and will still continue to learn) much about movement and physiology but can’t do much good with the knowledge if I can’t convince people to get out and move around. I studied Ayurveda under a man of great wisdom, Dr. Suhas Kshirsagar. He used to tell us that the one symptom he fears is a idiopathic, autoimmune deformity that looks like this:
Now to the story of the day….
I found this article in the July 19th, 2011 print edition of the New York Times. It was very revealing because like the proverbial boiling frog in the pot, I hadn’t noticed there was a political agenda at work on the playgrounds I grew up on. I had noticed that during my short childhood, we had gone from all metal to mostly plastic equipment. I had noticed the tall slides and “igloo made of metal bars” (I don’t know what the heck that thing is called) had vanished.
I figured this movement was to update and keep in line with ADA standards. I had no reason to complain at the time and found little fault with the new equipment……but I was 9 years old at the time.
Reflecting on this societal shift, I wold like to think I would have been one of those making a huge stink over the progressive policies that dug up our jungle gyms and tire swings and replaced them with those stupid tic-tac-toe squares and 5 foot slides.
Turns out that kids need to be exposed to the risk, fun and excitement that kids have enjoyed for millions of years. Sure we have replaced our clubs and spears for smart phones and lattes but we still need to learn how to approach challenging situations and face our fears. It’s a shame that we don’t listen to common sense until there is a study done to prove it. One common thread in all the medical research, nutrition recommendations and whatever else the CDC, FDA, HHS and WHO has to offer is that despite the most noble of intentions, there are always unintended consequences. It seems that we accept these words as a get-out-of-jail-free card for anyone who utters them.
Moving For Wellness is all about challenging yourself. Realizing that the threat does not come from the external, but rather resides within you. You must battle your nature whether it is to do good deeds when you don’t feel like it or get up and walk your dog after a long day at work. We allow ourselves to get too comfortable in a society that demands less and less responsibility of us individually. We as a species have evolved to the top because of our brilliant ability to adapt to adversity. Confronting a challenge is the only way in which you will grow in character, health, wealth or happiness.
That’s it for me tonight. I’ve got to challenge my natural inclination to sit here and go bust out a super-set of pushups.
Move and be Well,
BF
This story comes to me just as I finish up a conference call on nutrition. My work at the moment is in the management of chronic diseases. My team consists of people with PharmD, RN, RD and MPH after their names. I challenged the idea that we “need” to eat grains at all and got an interesting answer. The RD on the call said, “[if you exclude grains from your diet] you would miss out on some heart-healthy nutrients”
It’s amazing how some health professionals have such knee-jerk reactions to any approach that challenges their paradigm.
Please feel free to distribute widely per Dr. Cordain.
Hi Doc,
I’m not sure if you’ve seen this or not, but US News ranked Paleo last of 20 diets claiming a lack of scientific evidence and no-long term weight maintenance guidelines. I’m not sure if you’d be interested in defending it or not, but if you’d be willing to provide specific refutations of their claims, I’d like to write a response piece for the Colorado State University Collegian to run next Wednesday, my deadline is Saturday.
Thanks.
http://health.usnews.com/best-diet/paleo-diet
http://health.usnews.com/best-diet/best-overall-diets
Seth
June 8, 2011
Hi Seth,
Good to hear from you and many thanks for your continued support of the Paleo Diet. I hadn’t seen this piece, but I appreciate that you have brought it to my attention. It is obvious that whoever wrote this piece did not do their homework and has not read the peer review scientific papers which have examined contemporary diets based upon the Paleolithic food groups which shaped the genomes of our ancestors. Accordingly the writer’s conclusions are erroneous and misleading. I feel strongly that it is necessary to point out these errors and make this information known to a much wider audience than those reached by the readers of the U.S. News and World Report. You have my permission to syndicate my response and or your write up for the CSU Collegian to any of the major news services including AP and UPI. Additionally, I will copy a number of colleagues and scientists worldwide with this message to ensure that it will be widely circulated on the web, blogs and chat groups.
The writer of this article suggests that the Paleo Diet has only been scientifically tested in “one tiny study”. This quote is incorrect as five studies (1-7); four since 2007, have experimentally tested contemporary versions of ancestral human diets and have found them to be superior to Mediterranean diets, diabetic diets and typical western diets in regards to weight loss, cardiovascular disease risk factors and risk factors for type 2 diabetes.
The first study to experimentally test diets devoid of grains, dairy and processed foods was performed by Dr. Kerin O’Dea at the University of Melbourne and published in the Journal, Diabetes in 1984 (6). In this study Dr. O’Dea gathered together 10 middle aged Australian Aborigines who had been born in the “Outback”. They had lived their early days primarily as hunter gatherers until they had no choice but to finally settle into a rural community with access to western goods. Predictably, all ten subjects eventually became overweight and developed type 2 diabetes as they adopted western sedentary lifestyles in the community of Mowwanjum in the northern Kimberley region of Western Australia. However, inherent in their upbringing was the knowledge to live and survive in this seemingly desolate land without any of the trappings of the modern world.
Dr. O’Dea requested these 10 middle aged subjects to revert to their former lives as hunter gatherers for a seven week period. All agreed and traveled back into the isolated land from which they originated. Their daily sustenance came only from native foods that could be foraged, hunted or gathered. Instead of white bread, corn, sugar, powdered milk and canned foods, they began to eat the traditional fresh foods of their ancestral past: kangaroos, birds, crocodiles, turtles, shellfish, yams, figs, yabbies (freshwater crayfish), freshwater bream and bush honey. At the experiment’s conclusion, the results were spectacular, but not altogether unexpected given what known about Paleo diets, even then. The average weight loss in the group was 16.5 lbs; blood cholesterol dropped by 12 % and triglycerides were reduced by a whopping 72 %. Insulin and glucose metabolism became normal, and their diabetes effectively disappeared.
The first recent study to experimentally test contemporary Paleo diets was published in 2007 (5). Dr. Lindeberg and associates placed 29 patients with type 2 diabetes and heart disease on either a Paleo diet or a Mediterranean diet based upon whole grains, low-fat dairy products, vegetables, fruits, fish, oils, and margarines. Note that the Paleo diet excludes grains, dairy products and margarines while encouraging greater consumption of meat and fish. After 12 weeks on either diet blood glucose tolerance (a risk factor for heart disease) improved in both groups, but was better in the Paleo dieters. In a 2010 follow-up publication, of this same experiment the Paleo diet was shown to be more satiating on a calorie by calorie basis than the Mediterranean diet because it caused greater changes in leptin, a hormone which regulates appetite and body weight.
In the second modern study (2008) of Paleo Diets, Dr. Osterdahl and co-workers (7) put 14 healthy subjects on a Paleo diet. After only three weeks the subjects lost weight, reduced their waist size and experienced significant reductions in blood pressure, and plasminogen activator inhibitor (a substance in blood which promotes clotting and accelerates artery clogging). Because no control group was employed in this study, some scientists would argue that the beneficial changes might not necessarily be due to the Paleo diet. However, a better controlled more recent experiments showed similar results.
In 2009, Dr. Frasetto and co-workers (1) put nine inactive subjects on a Paleo diet for just 10 days. In this experiment, the Paleo diet was exactly matched in calories with the subjects’ usual diet. Anytime people eat diets that are calorically reduced, no matter what foods are involved, they exhibit beneficial health effects. So the beauty of this experiment was that any therapeutic changes in the subjects’ health could not be credited to reductions in calories, but rather to changes in the types of food eaten. While on the Paleo diet either eight or all nine participants experienced improvements in blood pressure, arterial function, insulin, total cholesterol, LDL cholesterol and triglycerides. What is striking about this experiment is how rapidly so many markers of health improved, and that they occurred in every single patient.
In an even more convincing recent (2009) experiment, Dr. Lindeberg and colleagues (2) compared the effects of a Paleo diet to a diabetes diet generally recommended for patients with type 2 diabetes. The diabetes diet was intended to reduce total fat by increasing whole grain bread and cereals, low fat dairy products, fruits and vegetables while restricting animal foods. In contrast, the Paleo diet was lower in cereals, dairy products, potatoes, beans, and bakery foods but higher in fruits, vegetables, meat, and eggs compared to the diabetes diet. The strength of this experiment was its cross over design in which all 13 diabetes patients first ate one diet for three months and then crossed over and ate the other diet for three months. Compared to the diabetes diet, the Paleo diet resulted in improved weight loss, waist size, blood pressure, HDL cholesterol, triglycerides, blood glucose and hemoglobin A1c (a marker for long term blood glucose control). This experiment represents the most powerful example to date of the Paleo diet’s effectiveness in treating people with serious health problems.
So, now that I have summarized the experimental evidence supporting the health and weight loss benefits of Paleo Diets, I would like to directly respond to the errors in the U.S. News and World Report article.
1. “Will you lose weight? No way to tell.”
Obviously, the author of this article did not read either the study by O’Dea (6) or the more powerful three month crossover experiment by Jonsson and colleagues (9) which demonstrated the superior weight loss potential of high protein, low glycemic load Paleo diets. Similar results of high protein, low glycemic load diets have recently been reported in the largest randomized controlled trials ever undertaken in both adults and children.
A 2010 randomized trial involving 773 subjects and published in the New England Journal of Medicine (8) confirmed that high protein, low glycemic index diets were the most effective strategy to keep weight off. The same beneficial effects of high protein, low glycemic index diets were dramatically demonstrated in largest nutritional trial, The DiOGenes Study (9), ever conducted in a sample of 827 children. Children assigned to low protein, high glycemic diets became significantly fatter over the 6 month experiment, whereas those overweight and obese children assigned to the high protein, low glycemic nutritional plan lost significant weight.
2. “Does it have cardiovascular benefits? Unknown.”
This comment shows just how uninformed this writer really is. Clearly, this person hasn’t read the following papers (1 – 6) which unequivocally show the therapeutic effects of Paleo Diets upon cardiovascular risk factors.
“And all that fat would worry most experts.”
This statement represents a “scare tactic” unsubstantiated by the data. As I, and almost the entire nutritional community, have previously pointed out, it is not the quantity of fat which increases the risk for cardiovascular disease or cancer, or any other health problem, but rather the quality. Contemporary Paleo Diets contain high concentrations of healthful omega 3 fatty acids, monounsaturated fatty acids and long chain polyunsaturated fatty acids that actually reduce the risk for chronic disease (10-18).
3. “Can it prevent or control diabetes? Unknown.”
Here is another example of irresponsible and biased journalism which doesn’t let the facts speak for themselves. Obviously, the author did not read the study by O’dea (6) or Jonsson et al. (2) which showed dramatic improvements in type 2 diabetics consuming Paleo diets.
“but most diabetes experts recommend a diet that includes whole grains and dairy products.”
If the truth be known, in a randomized controlled trial, 24 8-y-old boys were asked to take 53 g of protein as milk or meat daily (19). After only 7 days on the high milk diet, the boys became insulin resistant. This is a condition that precedes the development of type 2 diabetes. In contrast, In the meat-group, there was no increase in insulin and insulin resistance. Further, in the Jonsson et al. study (2) milk and grain free diets were shown to have superior results in improving disease symptoms in type 2 diabetics.
4. “Are there health risks? Possibly. By shunning dairy and grains, you’re at risk of missing out on a lot of nutrients.”
Once again, this statement shows the writer’s ignorance and blatant disregard for the facts. Because contemporary ancestral diets exclude processed foods, dairy and grains, they are actually more nutrient (vitamins, minerals and phytochemicals) dense than government recommended diets such as the food pyramid. I have pointed out these facts in a paper I published in the American Journal of Nutrition in 2005 (13) along with another paper in which I analyzed the nutrient content of modern day Paleo diets (12 ). Most nutritionists are aware that processed foods made with refined grains, sugars and vegetable oils have low concentrations of vitamins and minerals, but few realized that dairy products and whole grains contain significantly lower concentrations of the 13 vitamins and minerals most lacking in the U.S. diet compared to lean meats, fish and fresh fruit and vegetables (12, 13).
“Also, if you’re not careful about making lean meat choices, you’ll quickly ratchet up your risk for heart problems” .
Actually, the most recent comprehensive meta analyses do not show fresh meat consumption whether fat or lean to be a significant risk factor for cardiovascular disease (20-25), only processed meats such as salami, bologna, bacon and sausages (20).
References
1. Frassetto LA, Schloetter M, Mietus-Synder M, Morris RC, Jr., Sebastian A: Metabolic and physiologic improvements from consuming a paleolithic, hunter-gatherer type diet. Eur J Clin Nutr 2009.
2. Jönsson T, Granfeldt Y, Ahrén B, Branell UC, Pålsson G, Hansson A, Söderström M, Lindeberg S. Beneficial effects of a Paleolithic diet on cardiovascular risk factors in type 2 diabetes: a randomized cross-over pilot study. Cardiovasc Diabetol. 2009;8:35
3. Jonsson T, Granfeldt Y, Erlanson-Albertsson C, Ahren B, Lindeberg S. A Paleolithic diet is more satiating per calorie than a Mediterranean-like diet in individuals with ischemic heart disease. Nutr Metab (Lond). 2010 Nov 30;7(1):85
4. Jonsson T, Ahren B, Pacini G, Sundler F, Wierup N, Steen S, Sjoberg T, Ugander M, Frostegard J, Goransson Lindeberg S: A Paleolithic diet confers higher insulin sensitivity, lower C-reactive protein and lower blood pressure than a cereal-based diet in domestic pigs. Nutr Metab (Lond) 2006, 3:39.
5. Lindeberg S, Jonsson T, Granfeldt Y, Borgstrand E, Soffman J, Sjostrom K, Ahren B: A Palaeolithic diet improves glucose tolerance more than a Mediterranean-like diet in individuals with ischaemic heart disease. Diabetologia 2007, 50(9):1795-1807.
6. O’Dea K: Marked improvement in carbohydrate and lipid metabolism in diabetic Australian aborigines after temporary reversion to traditional lifestyle. Diabetes 1984, 33(6):596-603.
7. Osterdahl M, Kocturk T, Koochek A, Wandell PE: Effects of a short-term intervention with a paleolithic diet in healthy volunteers. Eur J Clin Nutr 2008, 62(5):682-685.
8. Larsen TM, Dalskov SM, van Baak M, Jebb SA, Papadaki A, Pfeiffer AF, Martinez JA, Handjieva-Darlenska T, Kunešová M, Pihlsgård M, Stender S, Holst C, Saris WH, Astrup A; Diet, Obesity, and Genes (Diogenes) Project. Diets with high or low protein content and glycemic index for weight-loss maintenance. N Engl J Med. 2010 Nov 25;363(22):2102-13
9. Papadaki A, Linardakis M, Larsen TM, van Baak MA, Lindroos AK, Pfeiffer AF, Martinez JA, Handjieva-Darlenska T, Kunesová M, Holst C, Astrup A, Saris WH, Kafatos A; DiOGenes Study Group. The effect of protein and glycemic index on children’s body composition: the DiOGenes randomized study. Pediatrics. 2010 Nov;126(5):e1143-52
10. Cordain L. Saturated fat consumption in ancestral human diets: implications for contemporary intakes. In: Phytochemicals, Nutrient-Gene Interactions, Meskin MS, Bidlack WR, Randolph RK (Eds.), CRC Press (Taylor & Francis Group), 2006, pp. 115-126.
11. Cordain L, Miller JB, Eaton SB, Mann N, Holt SH, Speth JD. Plant-animal subsistence ratios and macronutrient energy estimations in worldwide hunter-gatherer diets.Am J Clin Nutr. 2000 Mar;71(3):682-92.
12. Cordain L. The nutritional characteristics of a contemporary diet based upon Paleolithic food groups. J Am Nutraceut Assoc 2002; 5:15-24.
13. Cordain L, Eaton SB, Sebastian A, Mann N, Lindeberg S, Watkins BA, O’Keefe JH, Brand-Miller J. Origins and evolution of the Western diet: health implications for the 21st century. Am J Clin Nutr. 2005 Feb;81(2):341-54.
14. Kuipers RS, Luxwolda MF, Dijck-Brouwer DA, Eaton SB, Crawford MA, Cordain L, Muskiet FA. Estimated macronutrient and fatty acid intakes from an East African Paleolithic diet. Br J Nutr. 2010 Dec;104(11):1666-87.
15. Ramsden CE, Faurot KR, Carrera-Bastos P, Cordain L, De Lorgeril M, Sperling LS.Dietary fat quality and coronary heart disease prevention: a unified theory based on evolutionary, historical, global, and modern perspectives. Curr Treat Options Cardiovasc Med. 2009 Aug;11(4):289-301.
16. Cordain L, Eaton SB, Miller JB, Mann N, Hill K. The paradoxical nature of hunter-gatherer diets: meat-based, yet non-atherogenic. Eur J Clin Nutr. 2002 Mar;56 Suppl 1:S42-52
17. Cordain L, Watkins BA, Florant GL, Kelher M, Rogers L, Li Y. Fatty acid analysis of wild ruminant tissues: evolutionary implications for reducing diet-related chronic disease. Eur J Clin Nutr. 2002 Mar;56(3):181-91
18. Carrera-Bastos P, Fontes Villalba M, O’Keefe JH, Lindeberg S, Cordain L. The western diet and lifestyle and diseases of civilization. Res Rep Clin Cardiol 2011; 2: 215-235.
19. Hoppe C, Mølgaard C, Vaag A, Barkholt V, Michaelsen KF. High intakes of milk, but not meat, increase s-insulin and insulin resistance in 8-year-old boys. Eur J Clin Nutr. 2005 Mar;59(3):393-8.
20. Micha R, Wallace SK, Mozaffarian D. Red and processed meat consumption and risk of incident coronary heart disease, stroke, and diabetes mellitus: a systematic review and meta-analysis. Circulation. 2010 Jun 1;121(21):2271-83
21. Micha R, Mozaffarian D. Saturated fat and cardiometabolic risk factors, coronary heart disease, stroke, and diabetes: a fresh look at the evidence. Lipids. 2010 Oct;45(10):893-905. Epub 2010 Mar 31.
22. Mozaffarian D, Micha R, Wallace S. Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat: a systematic review and meta-analysis of randomized controlled trials. PLoS Med. 2010 Mar 23;7(3):e1000252.
23. Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Saturated fatty acids and risk of coronary heart disease: modulation by replacement nutrients. Curr Atheroscler Rep. 2010 Nov;12(6):384-90.
24. Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Saturated fat, carbohydrate, and cardiovascular disease. Am J Clin Nutr. 2010 Mar;91(3):502-9
25. Siri-Tarino PW, Sun Q, Hu FB, Krauss RM. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease. Am J Clin Nutr. 2010 Mar;91(3):535-46
