Wednesday, May 15, 2013

A Peek at Paleo

I don't eat a paleo diet, I'm just a saturophile. If it's saturated fat and it happens to come from a neolithic block of butter, that's fine by me. But I hadn't realised going paleo could be actively worse for your health than eating some version of the SAD. You can download Eric Trexler's thesis from here. Catchy title is:

"Paleolithic Diet is Associated With Unfavorable Changes to Blood Lipids in Healthy Subjects"

Some people may have noticed that I have minimal interest in blood lipid levels. I know people angst about them, but I've yet to be convinced that they have anything to do with heart disease other than as a surrogate for how much sugar you eat.

The thesis reports pre and post diet lipids but only gives end-of-paleo-diet food breakdown, and only the fat/saturated fat at that. Go figure. Guess they forgot to ask what folks were eating to have better lipids than their study diet was going to produce! Perhaps they had a defective crystal ball.

I've always viewed HDL as a surrogate for saturated fat intake. The sub population with the best HDL on pre diet lifestyle (around 82mmol/l) dropped it to around 69mmol/l on paleo diet plus exercise and weight loss. My assumption is that these folks actually dropped their saturated fat intake or increased their PUFA intake by so much that even the exercise induced rise in HDL and weight loss induced rise in HDL couldn't offset the fall in HDL induced by the study diet. Impressive.

Triglyceridess rose non significantly. I view trigs as a surrogate for sugar intake. You have to guess how much SAD high fructose corn syrup was replaced by paleo fruit. Or whether fruit juice [Peter vomits quietly in the corner] was allowed. Well, the trigs went up (slightly), not down... Gathering was good that day, every day, for 10 weeks!

OK, so what sort of a paleo diet was this? Quote:

"Subjects were advised to increase their consumption of lean meat [Peter vomits quietly in the corner again], fish, eggs, nuts, fruit, and vegetables and were instructed to strictly avoid all grains, dairy products, and legumes."

Obviously spuds appear to have been on the menu in paleoland and animal fat is the devil incarnate!

What was their source material for these well thought out recommendations? They were based on Eaton and Konnor's 1985 paper:

"Paleolithic nutrition. A consideration of its nature and current implications"

You can't get at the full text or even an abstract on line. Luckily Anna, over at Lifextension, fills in the details for us. She pasted a copy of her information over on ItsTheWoo's blog here, explaining both where Eaton got the data and pointing out the 2000 correction he published, amending his paleo fat intake estimates (upwards of course). I get a faint impression that Anna may not be best impressed by Eaton's ideas. Or by Taterism in general. BTW, did anyone run through the list of references? Given a year or two I might try one day, but perhaps just sticking with simple saturophilia might be easier.

I rather like Anna's commentary. I like her suggestion that Eaton's ideas seem uncomfortably influenced by politically correct beliefs aligned with the AHA's diet advice. Reading Trexler's thesis I was also struck that it could easily have been written by an AHA cardiologist. The naked fear of LDL cholesterol shines through the whole text.

My take home message is that if you are going to align your paleolithic diet advice with the AHA, people are going to get hurt.

Peter

50 comments:

Bill said...

Archevore was the nearest to my eating habits that I could identify with, but saturophile is close too.
Sadly neither term will catch on.

In the land of the blind....

Charles Grashow said...

Might you post an average's day diet so we can see what a saturophile eats?

ThisisBetty said...

I'm curious about your own diet too Peter. Has it change at all over the past year or two?

Exceptionally Brash said...

Wasn't archevore just for people who eat at McD's?

Bill said...

http://www.archevore.com/get-started/

Bill said...

"Saturophile" - I like it. Whether it be by coconut oil, butter, or dark chocolate, I'm a fan.

On another note, I don't think that study supported or condemned "Paleo." For me, "Paleo" means no processed foods & carb-rich empty calories, etc., which are usually loaded with a variety of PUFAs.

Sam Knox said...

I have to say, I've never managed to vomit quietly.

George Henderson said...

I caught the lipid changes on another blog.
TC (168.8 ± 5.4 mg/dL to 178.9 ± 6.6 mg/dL; P < 0.05)
Total cholesterol was still low, but it had improved a little on "paleo".

lifextension said...

Peter,
I've emailed you a copy of Eaton's 1985 paper.
Anna.

Dr. Curmudgeon Gee said...

Peter, you're funny.

it does not seem a Ph.D thesis.

Dr. Curmudgeon Gee said...
This comment has been removed by the author.
Sidereal said...

Aw Peter, that's someone's undergraduate thesis. It takes a lil' more than that to get teh PhD.

George Henderson said...

You appraisal of what these basic, so-last-century lipid panels can really tell us seems accurate to me.
I might add one or two more -
if you eat a truckload of sugar and your TG shoots up, it shows your liver's still able to respond to the sugar. If it didn't, I'd check for steatosis.
In fact the reason "bad" lipids - high TG, low HDL - are a paradoxically good sign in chronic viral hepatitis B and C is, that they mean your liver is still responding like everyone else's to the culturally appropriate garbage it's expected to process. Either because it's not damaged or the virus isn't pervasive enough to have drastically altered hepatocyte function in a fit of self-promotion.
HDL might say something about peroxidation. Antioxidants tend to raise HDL, PUFA, which promotes peroxidation, decreases it. Might mean something.

Steve Parker, M.D. said...

For those interested, Eaton and Konner updated their conception of the ancestral diet in an article published in 2010. Here's the abstract:

http://ncp.sagepub.com/content/25/6/594.abstract

-Steve

ItsTheWooo said...

Peek a boo!
Who's that behind teh dish cloth?
Why it's paleo, and it sucks, lol!

Shocking discovery:

Banana guava mango coconut cakes made with sugar in the raw (and absolutely no animal meat ever cuz paleos were ethical vegans you know), still is garbage, even if you call it "paleo" and pay more $$ cuz its organic.

IcedCoffee said...

Minor detail, the patients also lost an average of 7 pounds (probably more fat loss with some muscle gain, they were Crossfitting), and we're presumably still losing for the final measurements. I've never seen any consistency in blood lipid panels when people are actively losing weight.

August said...

All my bloodwork was golden, except for the dreaded insulin resistance. Fortunately, I had read about that somewhere.
Unfortunately, I think I wasted money getting bloodwork that impressed the doctor. I should have read up on what to test, and then got some bloodwork that would impress me.

STG said...

Peter:

Insightful commentary and right on the mark!

ItsTheWooo:

So funny!

gallier2 said...

Saturophile? Someone who likes lead (yes I know, it would be saturnophile).

The right word would be koresmenophile but that wouldn't sound as cool.
Alternative: zoolipidophile for the animal fat lover.

Ok, I stop with my kitchen greek.

STG said...

Peter:

Insightful commentary and right on the mark!

ItsTheWooo:

So funny!

Mike said...

Here what Dr. Eades says:

"I knew the Paleolithic Prescription was out there, but it was written in an attempt to shoehorn the real Paleo diet into a low-fat framework. Which was bizarre because the authors of the book wrote a groundbreaking paper on the Paleo diet in the New England Journal of Medicine that got them much notoriety along with a book contract. From what I’ve since heard, their editor strong-armed them into making their diet low-fat, because that was what ‘everyone’ believed in then."

http://www.proteinpower.com/drmike/paleolithic-diet/books-that-changed-my-life/

Frankly, i think that's wishful thinking on Dr. Eade's (or his informant's) part. I don;t think there was an "strong-arming" I've heard Eaton speaking on a podcast (I can't recall which probably Rob Wolf's) and he pretty much said that he knew he was on the right track when he realised that what Palaeolithic Man would have been eating matched what dieticians were recommending. What I guess he missed was (a) the possibility that the dieticians could have been wrong (mostly on account of Keys's mistakes) and (b) that he was, perhaps unconsciously, bringing that perspective to what he was claiming to "find".

It's interesting that while Prof. Cordain has moved a little on saturated fat - in many places but particularly when in conversation with Andreas Eenfeldt (perhaps because he wanted to please him) - he is still peddling the "salt is bad" line. I think Gary Taubes essentially demolished that argument.

My feeling is that while Eaton (and Cordain) are intelligent, hardworking, and deeply learned men, they don't break windows. They assume the professional consensus is largely correct. Gary does break windows. Perhaps because of his wide general background in science and knowledge of the philosophy of science and how communities of scientists behave, he is far more sceptical than they.

I think the ladies at the WAPF blew up the notion of a low-fat, low-salt "caveman" diet a long while back. And It's interesting that they weren't coming from a low-carb position, but from a "fat is OK" position (on Mary Enig's part) and a natural whole foods/ethnographic angle on Sally Fallon's part. They're interesting on Australian Aborigines, some of whom do seem to have been eating quite a bit of plant food but who also seem to have gone to a great deal of trouble to get hold of fat, and particularly fat that would have been high in saturates.

As far as I can tell, this seeking out of fat seems to have been a universal human behaviour. It's all over our literature. The very phrase "fat of the land" used by Stefansson comes from the AV of the Bible. And the feeling of fat as valuable and opulent goes right through from that distant past to Victorian novels. AFAICT, people's view of fat only changed over the last 50 years with the Keysian hysteria.

And, of course, hunter-gatherers valued fat as much as people of the last few thousand years did. It's ALL OVER the ethnographic literature. Read Samuel Hearne on Canadian Indians and you find them roasting up paunches stuffed with offal and fat dishes over the fire. Read Selous and you come across Africans chopping out great lumps of fat with axes from elephant carcases, and on and on.

One can only suppose that the original Paleo theorists never looked at much of the ethnographic literature--strangely, considering they were in the U.S., they presumably hadn't read any of the exploration narratives, which one might have thought would be in the general reading background of any educated American.

Peter said...

Sid and Dr C, Ta for the heads up, minor edit done.

Charles and Betty, might update in a post, been quite philosophical since Barry Groves died.

Ta Anna, downloaded but not read.

Steve, if you want paleo to fail you choose to follow the 1985 flawed initial tentative fumblings. You wouldn't want something which actually works...

Peter

karl said...

"...blood lipid levels. I know people angst about them, but I've yet to be convinced that they have anything to do with heart disease other than as a surrogate for how much sugar you eat."

Quite true!

One other bit - these people were losing weight - which means lipids are being transfered out of adipose tissue - something known to mess up lipid numbers.

I'm curious to know the actual TG numbers?

My bet - they lost out of the fats in dairy - ate a lot of fruit to make up for it - and I bet non of them ate the amount of bugs our paleo ancestors ate..

The whole idea that one could eat a paleo diet from a grocery store is quite silly - Which foods can they buy that haven't been bred into something quite different?

Actually, the only number that is interesting is TG - eating the foods I eat I end up just under 50. The low-carb docs I've met use TG to monitor compliance... There is something about fructose that slams de-novo-lipogenesis into high gear - easily doubling TG - or more.


Krissie said...

WHAT, Barry Groves died?? That is so sad, he was such a dynamic man and fantastic speaker. I am glad you brought it to my attention.

amydavis121 said...

Petro, I'm really interested to see what a typical day looks like diet wise? I was doing Paleo but it wasn't for me, would be interested to give this diet a try :)

Amy
http://neosizexlwarning.com/

Chip Spitter said...

Mike, although the traditional Aboriginal numbers are sadly dwindling (in the sense of those that still hunt), I can attest that those in the north still value the dugong and turtle meat that is very fatty. I understand why they had to go looking for fat - the kangaroo, wallaby and magpie goose are ridiculously lean.

I have no idea what nutritional value a mangrove worm has, but I imagine there must have been some, given they look like a massive long glob of snot.

Hermes said...

The AHA cannot even do wrong right. Losers.

George Henderson said...

Looking for saturophilic kicks, look no further
http://www.food.com/recipe/south-african-sausage-boerewors-50588

This is my favourite sausage and has 39.2g fat to every 8.7g protein. It's preserved with wine or vinegar rather than nitrates.

karl said...

Thinking about diet from the new paradigm that PUFAs and MUFAs cause inappropriate insulin sensitivity - thus obesity and poor health.

I'm imagining what dietary experiment I would run if it was up to me - I'm thinking of a controlled experiment with 3 groups:

1 - Restriction of fructose containing sugars

2 - Restriction of fructose containing sugars and PUFA and MUFA consumption levels returned to those of the 1950's.

3 - Same as 2, but with carbohydrate restriction as well.


The experiment would be run until weights stabilized at new levels. (6 mo?)

I would want to see the changes of as many inflammation markers as possible including interleukins.


Jane said...

I remember reading Eaton & Konner many years ago and thinking these people are off their heads. They don't mention refined carbs. Why can't they see that humans will never be adapted to eating large amounts of carbs without the minerals needed for carbohydrate metabolism.

You'd have thought they wrote their 2010 paper to correct this ghastly mistake. But no. They do mention refined carbs but they think the problem is the glycemic index. This is a bit awkward because wholemeal flour has the same glycemic index as white flour. So all grains must be bad, and of course we know they're bad, don't we, because of the fibre and phytic acid. 'High fiber intake may adversely affect mineral bioavailability, especially in the presence of phytic acid...'

No guys, fibre HELPS mineral availability, as long as you have functioning gut bacteria. Which BTW have an enzyme that degrades phytic acid.

Bill said...

Jane,
The main problem with grains is the toxic gluten/gliadin. In my opinion the vast majority of humans are intolerant in varying degrees.
You can get your fibre from a high intake of vegetables.

Jane said...

Hi Bill
Gluten isn't really a toxin, it's a protein like other food proteins which should be broken down by gut enzymes. Some of these enzymes require metals for activation, so if you eat white bread and other refined carbs which have had most of these metals removed, you may not break down gluten very well.

Some of the metal-dependent enzymes can even break bonds involving proline, which is the particular problem in gluten.

Intolerance to gluten means failure of a complicated process called oral tolerance, in which the immune system is instructed not to react to food proteins. The immune system is dependent on the same metals which activate the gut enzymes.

As you say, there are many people intolerant to gluten. But it's difficult to conclude that this is the fault of the gluten rather than of the refining process considering the remarkable health of the bread-eating peoples of northern India studied by McCarrison 100 years ago. They did not eat white bread or other refined carbs.

Bill said...

Jane,

I recommend you read this old post and the comments from Peter.
http://high-fat-nutrition.blogspot.co.uk/2008/06/gluten-and-gall-bladders.html

I'll stick with my presumption that gluten is toxic. My alopecia areata has been in total remission for 5 years after going gluten free 7 years ago. Also arthritis/stiffness issues have gone.

You seem to imply some kind of mineral/metal deficiency or excess is the cause of intolerance? I'm sorry, I don't buy that.

Jane said...

I read it, and found no mention of oral tolerance. Are you suggesting intolerance is not caused by failure of oral tolerance? Had you heard of it before I mentioned it?

Bill said...

Jane,
I've read about oral intolerance and food allergies. I put it down to a limited/damaged gut flora more than anything else. Kids are too clean and cossetted,treated with gut bacteria destroying antibiotics too often, causing allergies, maybe oral tolerance comes into the mix, I don't know.

Gluten destroys or damages the intestinal villi to greater or lesser degrees. I believe this to be the case in humans and other non adapted mammals such as dogs and cats.

Point me to some good information that gluten intolerance is because of oral intolerance and I'll look into it.

My mantra is grain/lectin free, minimal sugar and maintain a healthy gut flora by not being obsessed with cleanliness. Eat diversely and don't wash the veggies too much. Exposure to different bacteria is essential for a good immune system. High fat low carb diet and good vitamin D levels.

Peter said...

Jane, I think that only microbial gliadinases can deal with double prolines in gliadin. The presence of this enzyme in the gut (and presumably its microbe) is positively associated with coeliac disease... The links are in this post:

http://high-fat-nutrition.blogspot.co.uk/2010/01/gluten-does-coeliac-disease-require.html

Peter

Jane said...

Peter, you said in that post 'Particularly difficult to deal with are pairs of adjacent prolines. In fact there are only a handful of mammalian enzymes known which can act at this point.' The paper you were discussing says one of them is dipeptidyl-peptidase II, and another is prolyl oligopeptidase. I can't understand why the authors didn't find these enzymes. Enterocytes have a lot of prolyl oligopeptidase. 'In the duodenum, intestine, and colon, high PREP [prolyl oligopeptidase] immunoreactivity was seen in the enterocytes facing the lumen..'
http://jhc.sagepub.com/content/60/9/706.long

Dipeptidyl-peptidase II is a lysosomal enzyme with a very low pH optimum, so I suppose it might have been inactive in the zymogram. Otherwise we have to say the only people in the world who can cleave Pro-Pro in gliadin are coeliac patients.

Jane said...

Bill, I found an article for you about oral tolerance and gluten.

'..Ivarsson and her team compared two groups of Swedish children: one born in 1993, during a time when the diagnosis of celiac disease increased four-fold, and the other group born in 1997, when it declined about the same amount. The children born later had a 25 percent lower risk of having celiac disease than those born earlier, they found.

"That's quite a lot," Ivarsson said.

While 2.9 percent of those in the earlier born group had the disease, 2.2 percent of those in the later-born group did.

The beginning and the end of the period in which the celiac disease diagnoses rose were both marked by changes in recommended feeding of infants, including the best age to introduce gluten-containing foods, the researchers noted.

In 1982, experts recommended that gluten-containing foods not be given until an infant was 6 months old. In 1996, the experts recommended that gluten be introduced from 4 months on.

Experts know that a baby develops what they call oral tolerance to an antigen (a substance that produces protective antibodies) early in life. Celiac disease "can be viewed as a failure to develop oral tolerance to gluten, or a later loss of this tolerance," Ivarsson wrote in her report.

In her study, babies born in the later group, who were introduced to gluten-containing foods at 4 months on, were less likely to develop celiac disease. ..'

http://www.webmd.com/digestive-disorders/celiac-disease/news/20130219/early-exposure-to-gluten-may-help-babies-avoid-celiac-risk-study

majkinetor said...

Eaton and Konnor's paper also suggest around 10x higher micronutrient input.

This fact alone totally invalidates any conclusions.

Peter said...

Hi Jane, thank goodness for mammalian proline splitting enzymes! Perhaps we really are all free to play with oral tolerance failure to gluten, no bacterium needed...

Peter

Jane said...

Good, isn't it. I wonder whether the prolyl oligopeptidase does most of it and then the bits remaining go into lysosomes and dipeptidyl-peptidase II finishes them off. I remember reading that grain lectins get taken up into enterocytes and (probably) degraded in lysosomes. Perhaps intolerance to grains means enterocyte lysosomes aren't being acidified properly.

twitchyfirefly said...

Bill—"Gluten destroys or damages the intestinal villi to greater or lesser degrees."

Isn't it the agglutinin rather than the gluten that does this?

A lot of people conflate "gluten" and "wheat", but I assume that Peter's commenters do not.

MikeMcKay said...

How do you define the word "saturophile"? And what does it eat on a daily basis?

Also, does a paleo diet have any other goal/benefits than eliminating processed foods and LDH-containing-foods?

I listed 5 items that we should not eat if we want to lose fat (but still consume HDL fat.

If I could categorize them as "not-paleo" or "not-saturophile's food", it would really help. They are : 1) Soda 2) Refined Bread 3) Cookies 4) Cheeseburgers 5) Beer
5 Foods To Avoid

Ty Fyter said...

@Bill or Peter (or anyone): what happened to the Archevore, Kurt Harris?? I really liked his blog...

Bill said...

@Ty Fyter
His website is there as a reference.
He seems to have disengaged but his wisdom is there to follow and suggest to people as a good starting point.

Eva said...

More interesting info, in this study, they took human twins where one was fat and one was was thin, took fecal samples from both and injected into rats. Rats that got thin person fecal material stayed thin and those that got fat person fecal material got fat. They then tried to look for the differences in the material and thin person material had a lot more bacteroides microbes: http://gizmodo.com/the-secret-to-weight-loss-might-be-poop-transplants-fro-1265888152 . Studies indicate that long-term diet is strongly associated with the gut microbiome composition and what diet yields more bacteroides growth? It's a diet with plenty of animal fat and protein: http://en.wikipedia.org/wiki/Bacteroides . They are saying that type of diet appears to be responsible for about 60 % of gut bacteria balance. This article shows that gut bacteria appear to be strongly correlated with just about all Western civilization problems from weight to mental health: http://en.wikipedia.org/wiki/Gut_flora .

P1 said...

I have been on Paleo diet for two years. I have eliminated all processed foods, all simple sugars, and all grains (e.g., wheat, corn, rice) that metabolize rapidly. I eat large amounts of meat, fish, eggs, whole vegetables, and one cup of fruit in morning.

To my shock, my blood lipid panel after two years on Paleo is quite bad. I don't worry so much about my cholesterol, which went from 170 to 250, or my LDL-C which went from 125 to 185. What I am really very concerned about is my LDL particle count (LDL-P) which has gone to 2300. Over 1500 is considered high risk.

It's LDL-P that correlates to high risk of death or cardiac disease. A nice graph from a peer reviewed article shows this:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2720529/figure/F2/

I do not have familial cholesterolimia, so I am not a statistical outlier with some unusual disease. I have read several places (I don't have the peer reviewed reference) that about 25% of population will respond to high saturated fat diets with large increases in LDL-P. My result suggests to me that I am in this 25% group, unfortunately.

I want to remain on a low carb diet, because the research clearly shows that carbs as they are used in modern diets cause very bad lipid changes. But I am really struggling at this point to understand how I should modify my fat intake.

My current thinking is to lower the saturated fat intake (I was drinking coconut creme and organic whipping cream frequently), while simultaneously raising my monounsaturated fat intake (olive oil with meals and avocado oil for cooking and baking because of its very high smoking point).

I will retest monthly for LDL-P after changing one aspect of diet at a time. Hopefully I will discover after experiment how *my* body responds to different levels of saturated and monounsaturated fat intake.

P1 said...

I have been on Paleo diet for two years. I have eliminated all processed foods, all simple sugars, and all grains (e.g., wheat, corn, rice) that metabolize rapidly. I eat large amounts of meat, fish, eggs, whole vegetables, and one cup of fruit in morning.

To my shock, my blood lipid panel after two years on Paleo is quite bad. I don't worry so much about my cholesterol, which went from 170 to 250, or my LDL-C which went from 125 to 185. What I am really very concerned about is my LDL particle count (LDL-P) which has gone to 2300. Over 1500 is considered high risk.

It's LDL-P that correlates to high risk of death or cardiac disease. A nice graph from a peer reviewed article shows this:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2720529/figure/F2/

I do not have familial cholesterolimia, so I am not a statistical outlier with some unusual disease. I have read several places (I don't have the peer reviewed reference) that about 25% of population will respond to high saturated fat diets with large increases in LDL-P. My result suggests to me that I am in this 25% group, unfortunately.

I want to remain on a low carb diet, because the research clearly shows that carbs as they are used in modern diets cause very bad lipid changes. But I am really struggling at this point to understand how I should modify my fat intake.

My current thinking is to lower the saturated fat intake (I was drinking coconut creme and organic whipping cream frequently), while simultaneously raising my monounsaturated fat intake (olive oil with meals and avocado oil for cooking and baking because of its very high smoking point).

I will retest monthly for LDL-P after changing one aspect of diet at a time. Hopefully I will discover after experiment how *my* body responds to different levels of saturated and monounsaturated fat intake.

P1 said...

I have been on Paleo diet for two years. I have eliminated all processed foods, all simple sugars, and all grains (e.g., wheat, corn, rice) that metabolize rapidly. I eat large amounts of meat, fish, eggs, whole vegetables, and one cup of fruit in morning.

To my shock, my blood lipid panel after two years on Paleo is quite bad. I don't worry so much about my cholesterol, which went from 170 to 250, or my LDL-C which went from 125 to 185. What I am really very concerned about is my LDL particle count (LDL-P) which has gone to 2300. Over 1500 is considered high risk.

It's LDL-P that correlates to high risk of death or cardiac disease. A nice graph from a peer reviewed article shows this:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2720529/figure/F2/

I do not have familial cholesterolimia, so I am not a statistical outlier with some unusual disease. I have read several places (I don't have the peer reviewed reference) that about 25% of population will respond to high saturated fat diets with large increases in LDL-P. My result suggests to me that I am in this 25% group, unfortunately.

I want to remain on a low carb diet, because the research clearly shows that carbs as they are used in modern diets cause very bad lipid changes. But I am really struggling at this point to understand how I should modify my fat intake.

My current thinking is to lower the saturated fat intake (I was drinking coconut creme and organic whipping cream frequently), while simultaneously raising my monounsaturated fat intake (olive oil with meals and avocado oil for cooking and baking because of its very high smoking point).

I will retest monthly for LDL-P after changing one aspect of diet at a time. Hopefully I will discover after experiment how *my* body responds to different levels of saturated and monounsaturated fat intake.

I would be very interested to hear how others here would modify diet in this situation.

Peter said...

Hi Pi, sorry I can't help, I'm a cholesterol skeptic. The neat graph is from people eating crapinabag. All bets are off if you are chronically normoglycaemic. Beats me how folks stress cholesterol and don't even mention HbA1c...

Peter