Paleo Diet Problems

It's time to tell you what I know and you may not want to hear. Unlike many or most other diet advocates, we don't hide from problems around here. We self-experiment, use evolutionarily-backed reason and principles, form reasonable hypotheses, experiment more, figure it out, and fix it. We're animals, and there will be a way, for everyone.

Don't be surprised, but not everyone reports all systems normal -- or even great -- on the Paleo-like diet long term; which, generally, is the elimination of grains, sugar, processed food, vegetable oils (eat meat, fish, fowl, natural fats in abundance, veggies, some fruit, some nuts). Some include dairy to tolerance and some -- including myself -- don't worry about starch so much, now that I'm at a normal weight and body composition. But most -- including myself -- still stay low to moderate carb. I probably average less than 100g per day, but that would be an average.

Having the blog I do, I get lots of comments and lots of emails. Here's a quick summary of the problems I've seen reported, and I'm generally going to go from most common to least, based on my general impression.

  1. Diarrhea. This is a big one, and one I've suffered from, time to time and rather inexplicably.
  2. Hypothyroidism. I was hypothyroid and on synthetic T4 for years before, even as I was gaining weight. When I rapidly began to lose and realized I didn't need the GERD or allergy meds anymore, I willy-nilly dumped the T meds as well. Then I tested 16 on TSH (you want about 1 or less). I stuck with the plan and TSH actually improved, but only to 11. Then I went on natural T, i.e., Armor (which includes T3, because sometimes the problem is an inability to convert from the inactive T4 to active T3). Now my numbers are pretty normal. But for others, hypothyroid seems to manifest after going on Paleo.
  3. Lack of motivation, depression. While I was losing fat, I was sky high exuberant All. The. Time. Once I got below 185 (5'10), things began to change for me and I didn't feel like I was on a high so much. There was even depression sometimes and I've heard this reported by others. In my case, futzing around with added fat seems to have done the trick and now I'm flying pretty high most of the time. I add butter -- lots -- to just about everything, and then there's the "Liquid Fat Bomb." For me, that's an "energy drink" like none other.
  4. Super high cholesterol. This is an issue I have not experienced at all, and my "numbers," for what they're worth, have only gotten better with HDLs in the 130s, LDL (direct measure) in the 60s, and Trigs -- what you would expect for a low-carber -- in the 50s. But I've gotten emails from a few people who have gone from total C in the low 200s pre-Paleo to over 500 and 600 and climbing. Heres' a recent example, the worst one (there are others, but less pronounced): pre-Paleo TC of 240, now nearly 600. He eats very LC and even Trigs have climbed from low 100s to nearly 170 (and LDL from 150s to 480s!!!).
  5. Weight gain. I've only had this reported by women, so far. My own gains have never been more than 3-4 pounds, and I've always considered that just noise. But a couple of women have recent reported gains of as much as 10 pounds, and these are people who weight less than 150.

I have a general speculation that I wanted to put out there, and then leave the whole shebang up to readers and myself to dig deep. There's some people who need help out there; and especially, I'd love some of my MD friends to weigh in if they can.

I speculate that the periodic diarrhea along the way some experience is a result of toxins stored in body fat being released. Funny, but I put this out there to an emailer the other day with this problem, and then just last night, I watched the latest episode of House...and at a point during his effort to diagnose, he speculated that the particular problem could be toxins stored in body fat being released due to reduced caloric intake. (I mainly watch House 'cause he's an arrogant, irreverent asshole, and therefore pretty cool.)

I'm wondering about the multi-faceted effect of losing fat. As I've blogged, no such thing as a low-fat diet; it's like eating lard. When you're losing weight, a lot of your energy is fat from your own body. I think perhaps the low-cal and low-fat dieters don't get the high that Paleos like myself did because they're losing weight through malnourishment (In terms of dietary intake, fat making up the balance). But a Paleo diet rich in meat & fat forms a great foundation, upon which the added fat from your own body just puts you over the top. The most common experience from Paleos initially losing weight? "I feel great!"

But what happens when the fat is gone?

Alright all you brains. Have at it.

Comments

  1. Erin in Flagstaff says:

    I think that going paleo works so very well, but for some of us our bodies aren’t prepared. I bet most of us on our high-carb/high-sugar diets have really bad gut flora. I’m thinking this because I just got diagnosed with gallstones. I bet those were created when I lost all the weight in a relatively short time. My bile probably couldn’t handle effectively the fat I ate. Now I make sure to eat fermented food and I bet have a lot more of the flora that handles how I eat. Still, I do have problems with diarrhea, especially with high-fat intake.

    So, it’s not only the toxins in the fat, but that some people may have done years of damage to their digestive systems, and it takes time to get everything up to speed. I do think you’re right. Oh, my triglycerides went higher after eating low-carb, but have settled back down to the 50s now. I read Dr. Davis’ posst “I Lost 30 Pounds and My Triglycerides Went…Up?” at http://heartscanblog.blogspot.com/2008/08/i-lost-30-lbs-and-my-triglycerides-went.html, which ties into your theory about the fat holding a lot of crap.

    My theory about hypothyroidism, is that paleo doesn’t solve this. I think we don’t get enough quality iodine in our normal diet, but much less in a paleo diet, unless you’re adding iodized salt or kelp to your food. We eat so healthy that we may be missing this nutrient. And yes, that’s just a theory.

    I know my cholesterol is much higher now than it ever was when I was a vegetarian, but it’s due to high HDL — my ratios are great. Once again, I think our bodies need help adapting. Vitamin D, fish oil, magnesium, iodine, fermented foods — supplementing is a good idea when starting out eating this way. I learned all of this about a year after going low-carb. I wish I knew it sooner.

    • John Campbell says:

      Erin, I agree with your take on kelp. Living in Canada, I experienced feeling cold last winter – my first full winter eating Paleo. I started taking kelp regularly and feel much warmer this winter. I have never been a person to feel cold frequently until last winter, even eating crap (normal for moderns) before my paleo days.

      With my current paleo diet and kelp, all is good. But is is still bloody cold at times in Canada – climate not diet is the cause. I want my money back from global warming.

  2. Your fat toxins idea is a good one, but it seems like a bit of kicking the can down the street. “Wait till ALL the fat is gone, THEN you’ll see this improve”. But if that is what it is, then it is what it is. My first thought on the depression is that it might be relative, not really depression, but just a let down from previous highs? Again, pure speculation.

    But two overall things came to mind right away. First, this technically isn’t a paleo diet. The macronutrient balance simulates a paleo diet, but most of the foods we eat are still modern foods. Could there be something about them that is not what it was 10,000+ years ago that can cause these problems?

    Second, two words: punctuated equilibrium. Evolution can happen fast under the right conditions, in the blink of a geologic eye. It is almost certain that, while our genes were fundamentally formed in the caves, there have been some new traits acquired even in the evolutionarily short timespan since. Dairy tolerance is likely to be one of them. Another aspect of this is genetic variation. You and I probably evolved from very different stock, and so we probably have some significant differences in our requirements, maybe in the area of micronutrients, things like that.

    A third possibility that comes to mind is that maybe after eating the SAD for so much of your life, something is just irreparably broken. Or broken badly enough that it will take a very long time to heal.

    Just layman’s speculation, maybe it will trigger some ideas for you or others. Unfortunately, none of these three scenarios lead to easy solutions.

    BTW, I’m not back on paleo yet, but one thing I’ve noticed as I get older is a laxative effect from coffee. Probably not from the caffeine, but from something else in the coffee, or maybe the artificial sweetener. Coffee and other things that are macronutritionally cool on paleo have things in them we are most likely not evolved to handle. Just another possibility to ponder.

    • Caffeine has that effect on many people, particularly when drunk in warm liquid form, such as coffee. Caffeine stimulates smooth muscle- such as the intestines, which means that peristalsis is strengthened or increased. A lot of people “open their bowels” after their morning coffee. Maybe some people are just more sensitive to its effects than others..

  3. Another thing I just remembered, probably not relevant here, but it could be in some wierd way related to the mood thing.

    First time I ate sushi, I got high. It was a very intense combination of euphoria and a massive hit of adrenaline. It was very, very primal, I felt like I could hunt down a wooly mammoth and kill it with my bare hands. Or that I could drag any woman in the place into my cave by her hair….

    It only lasted about 30 seconds, and didn’t happen again even though I am now totally hooked on sushi. Is there something about raw meat? Some trace of hormones released by the animal during the kill? Is there some other chemical in fresh meat that lights up our brains like a Christmas tree? I dunno, but it seems in some vague way to point to a part of the real paleo experience we rarely if every encounter in modern life.

  4. Lute Nikoley says:

    So far I haven’t experienced any of those problems mentioned. My cholesterol, Total/HDL are great, Tri-glycerides have gone from over 300 to 60. One persistent problem not mentioned is constipation, sometimes I think i’d rather have the diarrhea.

  5. I have thyroid cancer, but I don’t know if that started before going paleo or not. Since having half my thyroid out, I have gained a little weight back despite being mostly paleo most of the time.

    My digestion has improved, and other measures of health are fine, but mood has been an issue. I will have occasional treats and cheats and these seem to help!

  6. Glad to hear I am not the only one suffering from #1. I’ve been eating this way for a year and a 1/2 and I still go thru stretches of it. I just “came down” from a nasty 2 week bout of it.

    As for #4, my TC has been rising (up from 252 to 305 in 8 months), but my HDL is pretty high (62) and TRIG (72) and fasting insulin (2.3) are lowish. My C Protein was .5 which I assume is good but not really sure.

    Thanks for posting this. A lot of blogs of this type make it sound all peaches n’ cream so to speak yet. It’s good to hear it’s not just me.

    • Aaron Griffin says:

      Hmmm, #1 has been happening to me recently as well. It’s a bad sign, if you ask me. If the diet is making this happen regularly, we have to rethink something.

      Soo… anyone care to hypothesize why this happens?

      • Well Aaron, there’s 93 comments & counting and many of them do just that, hypothesize on the diarrhea issue.

        Just sayin’.

      • karen kyle says:

        Again, just an opinion. Thousands of years ago humans ate a much larger variety of plant and animal foods than we do now. Among some cultures living the primitive life in South America–they consume over 100 species of insects alone. This variety of foods may create a different type of intestinal environment, affecting nutrient absorption and intestinal motility. All of these can affect stools.

  7. My total cholesterol went from about 200 to 460, yikes. I made a couple of changes & it has been dropping. I added some more carbs back (from about 50 to perhaps 70, though it has been higher since the first weeks) and I started taking a LOT of CoQ10. One or both of those things has made a difference, but I don’t know which or how.

    There is some thought that it might be low T3 (mine is at the low end of normal), but the T3 hasn’t been retested, so I don’t know if it has gone up at the cholesterol has come down.

    Also, the trigs are about 50, HDL is about 100 (higher, but not much), it was mainly in LDL that the rise happened. The LDL is all pattern A, but also, it appears that Lp(a) may have gone up — or at least, it was high & seems to be going down.

    If anyone has suggestions on what happened, I am interested. I have a theory that perhaps the shift to pattern A LDL raised the requirement for CoQ10, which fed back into the synthesis loop to raise mevalonate, which increased LDL, which raised the need for CoQ10 & engender a positive feedback loop. Or it could have been low carbs interfering with the conversion of T4 to T3 — I gather that low T3 is known to raise cholesterol. Or both or something else entirely. Whatever happened, none of the doctors I have talked with have seen it before.

    Beth

  8. Regarding #3… most people will feel like crap if they don’t get enough energy. Most paleos have probably grown accustomed to eating less than required because internal fat stores make up the difference as noted. I would just point out that at <100 grams of carbs it is possible to be chronically short of glycogen, particularly on a serious training regimen. Many athletes that receive nutrition advice and regularly eat less than 100g carbs daily also have a *high carb* day which might be around 250 – 500 g. Doing so once a week before their more rigorous training helps restore glycogen stores in the muscle and assist with explosive performance. This is sometimes called carb cycling or refeeding.

    Second thought would be what is going on with exercise/movement? Once hitting ideal weight some might take it easy in that arena, like they reached the finish line. Since rigorous exercise stimulates the production of a number of feel good and look good hormones, that could be missing. Continuing to train for greater work capacity/strength/muscle/speed/agility might be important once body-weight is at the right level.

    My 2 cents.

  9. I think maintaining a healthy gut is first and foremost the most important thing. A good probiotic will do the trick.

  10. Now I have ABSOLUTELY no clue why any of this happens but I figured I would chime in with my experience here as it seemed appropriate.
    Since going primal I have gained quite a bit of weight yet I haven’t had my period (sorry if that’s tmi fellas) in over a year…I upped the carbs a bit this past fall but that just made me fatter…..so I’ve recently embarked on a more hyperlipidish diet and I’m waiting to see how this will pan out.
    Before my primal conversion I was actually a hard core vegan (I know, I know….but I was 17 years old when I started, give me a break!) and a junk food vegetarian for 15 years prior to that. I weighed less then but I did have more psychological probs then.
    I have battled on and off with fairly serious depression (ok not just fairly, pretty damn freakin scary depressive episodes in truth) since I was about 11 years old I think. It’s kinda hard to remember exactly when. Anywho….while my moods are more stable I have had some pretty bad depressed episodes whilst on the primal way of living. Not quite as bad as they used to be but that is also probably been a result of emerging from the angsty turmoil of teenage-land to the twenties as well as better health habits.
    Sooooooo I have kind of lost track of why I embarked upon this ramble. But yes, that is my story in a very small nutshell.
    So if anyone can elaborate on these issues presented that would be simply divine.

    p.s. Keep up the excellent work Richard!

    • redcatbicycliste says:

      Alex,

      I have found taking a few teaspoons (two to three) daily of Evening Primrose Oil makes my menstrual cycle regular (like clockwork!). Evening Primrose Oil (and Borage Seed Oil) are high in GLA-6. Borage Seed Oil is higher (and more expensive) in GLA-6 than Evening Primrose. Also, EPO helped clear up my eczema.

      I’ve just run out of EPO, so I’m going to try BSO this time. Mountain Rose Herbs [dot] com in Oregon sells a high-quality, cold-pressed EPO for a decent price.

    • Alex –

      You might want to look into Julia Ross books. I’ve heard her talk about recovering from veganism on Jimmy Moore’s podcast, and she mentions a lot of supplements (like 5htp and a couple of amino acids) that I don’t really know much about. I do know that 5htp is supposed to help regulate sleep and mood, but I cannot give any details of that as I’m OK on those scores and I wasn’t paying attention.

    • Travis says:

      Alex,
      If you haven’t already, you should read “The Vegetarian Myth,” which touches on some of the health issues you bring up.

  11. Hey Richard

    Kudos for telling what’s up, warts and all.

    I do not think paleo or LC per se cause hypothyroidism, although negative energy balance may suppress T function short term. Hashimoto’s is incredibly common on the SAD and underdiagnosed and when you start to get blood tests done you find it. I will elaborate in some upcoming posts on thyroid.

    Interesting about the Diarrhea. I occasionally have mild constipation that is I think is mostly psychosomatic – it only gets like the old days if I eat any wheat. Stress can mediate GI upset autonomically via the vagus nerve.

    Re: Depression – I think there is likely a euphoric effect to negative energy balance or maybe some stages of ketosis that could ameliorate depression. This would be adaptive to motivate you during a famine, for instance, but mood may return to baseline once energy balance is stable. Are you really more depressed now than before you started all this? Your thyroid issues may compound your interpretation of mood over time.

    My own minor mood disorders are moderately better on PaNu mostly because my IBS and allergies are so much better. Of course, I’m still the same person so now I just worry about different stuff.

    I don’t buy the toxins from fat theory just like most theories that vaguely use the word “toxin” or “detox”;)

    I recommend a little meditation after making sure your pre-existing thyroid problem is managed.

    When people in my daily life say “you meditate?” I say, you should have met me before!

    • Elizabeth Colon says:

      I was diagnosed with Hashimoto’s. My levels are improving, since I have been eating paleo/primal and my doctor recently lowered my dosasge of synthroid.

      I also have moderate to severe reactions to gluten.

      Both are issues of autoimmunity insofar as I understand them, so it makes sense that when one is compromised, other parts of our immune system will be affected. I’ll be interested in reading future blog posts at PaNu on the topic.

  12. I should have added two more tips:

    If you only are working out once a week, you could a get very big mood boost by adding some tennis, running (5 k or so) surfing, hiking., etc a couple of days a week to your one day of strength training.

    You should also read a book called Lifting Depression by Kelly Lambert (been meaning to review it for my blog) about how exercising the effort -driven rewards circuit can help with depression. Physical effort with your hands – woodworking, guitar, restoring old bicycles. etc.

    Blogging on a computer, even if your readers love you, does not count!

    • Yea, I walk a lot, by which I mean 3-4 miles on a typical day. Most days it’s an hour with the dogs first thing in the morning, in a wooded area. That’s great for mood.

      I’m not sure what caused the depressed mood but it seems to have passed and there’s too many variables to easily pin it on anything. I do think that added fat combined with less protein seems to be a factor. I also have upped the carbs from low to more moderate, but I do that with starch (potato), not sugar and certainly not fructose.

      • Dave, RN says:

        Isn’t starch just sugar anyway? What the difference between sugar from carbs and sugar from starch, besides the time it takes to convert?

      • Sugar includes fructose and glucose, whilst starch turns into glucose. Fructose appears to have a metabolic impact that is more dangerous than glucose.

  13. Ben Johnson says:

    Been (mostly) Paleo for about 6 weeks now, I still have dairy. Have definitely noticed a bit of diarrhea and, prompted by one of the other responses above, may be able to link that to specific higher-fat meals – like the rib eye I had on the weekend after not having a steak for years! It’s never been particularly uncomfortable, or continous, just a curiosity.

    I’ve had the low moods too and thought that may have been related to blood sugar levels after a particularly lean meal?

    Haven’t had any blood tests since beginning Paleo so I can’t comment on the Cholesterol levels.

    About a year ago a friend of mine put me on to Lugol’s Solution, which is basically an iodine solution. If you look it up on the net the info usually comes with an accompanying explanation of the depletion of iodine in the normal (read: average, not Paleo) diet. I do supplement with some regular multi-vitamins and B-vitamins as well. Haven’t had the blood tested for some time, but the last one didn’t show any irregularities in my iodine.

    Thanks for the honesty, Richard. It’s good to be able to relate elements of my own experience with others on a similar journey.

  14. It’s been said millions of times, but it bears repeating:

    “Everybody is different.”

    There is not, and never will be, a one-size fits all diet that works for everybody. The only way to find the best diet for you is to do a lot of self-experimenting.

    The diet that seems to work best for me is high-fat, low-carb, and no grains. Would I recommend it to anybody else? No, they need to find their own best diet.

  15. If you keep a healthy gut, #1 shouldn’t be a problem. I’ve made sure to include ample amounts of probiotic sources in my diet including yogurt, kimchi, apple cider vinegar etc and it has been pretty regular. And of course, the green leafy vegetables that are pretty prominent in Asian/Chinese diets help out a lot. I find that Western vegetables often lack the same fibrous stocks as say kale, Chinese broccoli, bok choy etc.

  16. Hi Richard,

    The good: my triglycerides and blood pressure went down on paleo, and my HDL increased. (Total cholesterol: 196, HDL: 85, LDL: 101, Triglycerides: 51)

    The BAD: Like Alex, I stopped getting my period and have not menstruated for 16 months now (despite still having some weight to lose). I just turned 33.

    I eat a lot of grassfed meat and fat, including high quality butter, coconut oil, raw cheese, fish oil, and fermented cod liver oil. I swallowed my pride and started taking a multivitamin, vitamin D, minerals, and probiotics. I gave up cardio and resistance train for 30 minutes 2-3 times a week.

    My GP and OB/GYN are flummoxed, as my hormone levels are normal. My bloodwork was recently called “great” and “textbook” by the techs at the blood lab. My iodine levels are normal (I only absorbed about 13 percent of what they gave me in a loading test). My vitamin D levels were low at 35 ng/ml.

    Yes, I’m often depressed. I’m not sure if this has more to do with my physiological state, or if it results from my situation of being evolutionarily non-viable.

    I have no answers, only questions. Thank you for posting this and providing a platform where I know I’m not alone. I’m documenting my own experience (slowly) at http://silentevidencespeaks.wordpress.com/

    If anyone feels like dropping by and offering me advice, I’m sure I could use it!

    • Messes, consider adding back some unrefined non-fructose carbs back into your diet! You may just need to eat more food also to get your BMI up. Don’t buy into ultra-low carb dogma — you might just benefit from 100-200 carbs a day.

      • Thanks Aaron! My BMI is a solid 22.8, and my bodyfat percentage is just a bit too high (according to my probably none-too-accurate Tanita scale) at 21-22%. This seems like an overabundance of weight and fat, but at least it’s at levels that should be conducive to fertility…

        I did try to increase my intake of starchy carbs with sweet potatoes, but I started to gain even more weight, and I just couldn’t deal with that.

  17. Diarrhea can be caused by eating too much fat, too fast for your body to process. Even eating paleo, you might be eating more than your body needs, and if that’s a lot of fat, your body will just run it right through your gut without absorbing it. Especially when those fats are in the form of oils. If you’re eating a lot of olive or coconut oil, you might think about cutting back on that and adding some animal fat to your diet, or just eating a little bit less.

  18. my $.02:

    #1, diarrhea: too much fat in the diet (or fat intolerance due to bile or intestinal problems) can cause a type of diarrhea called steatorrhea. If your stool is very foul-smelling, and there’s an oil slick in the toilet bowl, this may be what you have.

    #3, lack of motivation: Kurt and AJ mention under-training above, but for some people over-training could be the problem.

    #4, super high cholesterol: This could be a genetic dyslipidemia, of which there are many types. Some of these elevate different combinations of LDL, VLDL and/or triglycerides, and may be worsened with a high-fat diet. Niacin and statins may be beneficial in some types of dyslipidemia.

  19. Diarrhea could easily be the result of poor fat digestion because one is not fully adapted to a higher fat load such that on the day when the fat content of a meal if high enough, it will not be fully digested and uhm yeah slide out. Kinda like when people binge on White Castle (eeek Sliders!)

    I have been zero carb (high fat) for over a year. I still get the fat runs when I eat pemmican which has fat more fat per unit volume than most foods I eat. The effect has lessened over time.

    Gaining weight needs to be put in the context of the previous diet. If one’s previous diet was very calorie and fat/protein restricted, even in an overweight person, fat storage may be stimulated. I speculate that this is somewhat natural and a result of evolutionary adaption in that after periods of what could be considered relative starvation, flooding the system with lots of fat will end up getting stored because the body has shifted hormonally into survival mode.

    I suspect fat storage and muscle building (weight gain) could also be more highly stimulated in a person who is highly active. Aerobic activity put a high demand on fat stores and is known to stimulate fat storing hormones and if those hormones are still highly active, fat storage will occur more readily in a person switching to a high fat diet.

  20. “I don’t buy the toxins from fat theory just like most theories that vaguely use the word “toxin” or “detox”;)”

    I too loath the phrase “detox”, every tie someone tells me they are going on a 7 day detox I want to punch them in the face! (no, not really).

    Toxin is another word I think is overused but many chemicals that biodegrade slowly (like persistant organic pollutants POPs) can bio-accumulate. PCBs and dioxins have been detected in human fatty tissue and also in breast milk. If you lose 30 pounds of fat, do the POPs remain in your tissue thus giving you an overall higher concentration of “toxin” per pound or are they excreted, more likely to be mobilized to the liver for attempted detoxification and excretion?
    I’m not sure. Its something I’ll have to spend some time researching.

  21. Early in our paleo conversion, my wife and I both experienced mood upsets…some depression and some euphoria. But we have found that supplementation with Vit D3 gelcaps has almost eliminated the mood swings. 10,000IU/day brought us up to mid 60s ng/ml. And sprinting and lifting heavy objects for 15 min twice a week has also helped me and long walks with the wife are great.

  22. For people who have gone paleo and now avoid wheat religiously, I can pretty much guarantee you that episodic diarrhea is from inadvertent wheat exposure. When I say diarrhea I mean liquid poo. It generally takes 2-4 days after exposure to manifest with constipation beforehand.

    The better you are at avoiding gluten, the nastier the consequences when you don’t as your sensitivity increases. I sort of liken this from going from a smoke-belching ancient Lada diesel to a F1 race car. You can’t put the same crap you used to put in the Lada and expect the F1 not to blow up.

    For the ladies with the amenorrhea problem, I suspect this is a set-point problem with leptin and your body essentially believes you are anorexic. I just put a post up on this at my blog this afternoon. I don’t have a solution yet, sorry.

    • I’ve found this to be absolutely true. I discovered I couldn’t tolerate gluten when I developed lactose intolerance. Lactaid did absolutely nothing to solve the problem, so I went of gluten and lactose. In a few weeks, I could eat hard cheese again, and eventually, I could drink raw milk with no issues.

      But here’s the thing: I got super strict (GF) with my diet last summer, and after I lost some weight, I loosened up my diet again. I can no longer even tolerate something out of a shared fryer.

      I would imagine that most of you with gluten problems would probably get the runs from beer after abstaining from gluten grains. Beer has *always* given me trouble, especially high-quality beer consumed at the brewery, but I thought it happened to everyone, and it only looks clear now in the rear view mirror.

      I’ve been easing a more strict lacto-paleo diet, and I’ve also found that one indulgence in corn chips or corn tortillas puts 2 lbs. on my overnight. Rice isn’t as bad, but I still balloon up. That *can’t* be healthy, so I’m going to be more strictly limiting my “cheat” meals.

    • Aaron Griffin says:

      This is an interesting take. Having had the most recent experience compared to anyone else on here (I just returned from the bathroom, and loaded up this page to read), I think you might be on to something.

      I ate some sugary cookie things at my girlfriend’s father’s house on Sunday night. Monday I was all blocked up. Today, still blocked up.

      Then I went and ate some pork shoulder. Within maybe 15 minutes, I felt like I was ready to explode.

      Not sure if it was the super fatty pork, or the cookies a few days ago.

  23. It is typical to experience diarrhea in the first few months of going paleo, as the bacteria in our guts that previously fed on grains, sugar, etc… die off and get excreted.

    As to the question “what happens when the fat is gone?” — when coming to paleo from SAD, the body is conditioned to obtain energy primarily from sugars, as the result of having adapted to a high carb diet. Re-adapting to getting energy from dietary fat takes many many months, and since the body isn’t getting the high carb intake it’s used to, it turns to burning body fat stores. This typically results in rapid weight loss in the first several months of going paleo. Eventually, however, the body adapts to getting energy from dietary fat, and slowly but surely, you’ll put weight back on, but this time at a much more ideal fat:muscle ratio than before.

  24. Kudos for bringing this up. I feel people following the Paleo lifestyle too often shun some form of Aerobic Activity in favour of one or two intense weight sessions a week which will not cut it to increase mood and flush out stress hormones etc. As Dr Harris said earlier take up running a few times a week for 20-30 minutes or go surfing, play tennis, soccer etc try this if you have problems with depression or anxiety.

    Another tip I like to give for depression is to go buy 250 high quality fish oil capsules. (180EPA & 120DHA per cap) take 3 with every meal for the month or so they will last, see how that works for fixing moods………

    As for weight gain, this can simply come from eating too much. Gorge yourself on any foods and you will gain weight so long as you eat reasonable amounts and keep things like nuts, oil and butter/cream to a sensible level you should have no problem with weight gain.

  25. san fran J(formerly Minneapolis J says:

    3.Depression-the depression I had was that I peaked like many people on ths diet. When I first started fasting and keeping a tighter paleo diet, I saw huge changes, but for some nine months I didn’t make any progress. My problem was I wanted to be ripped to such a high degree that I wasn’t satisfied where I was at. After months of this, I realized that a caloric deficit was what I needed to have further weight and fat loss. Seems to do the trick.

    5.Weight gain, I gained weight when I seemingly ate the same. Well turns out at one point I tried training harder and when I did this I ate way more and didn’t fast. Once I realized that a caloric deficit does matter, I started getting where I wanted.

  26. Lots of good points on the cause of the diarrhea. My guess is that one other potential trigger is the increase in meat a low carb regimine entails. Unfortunately, factory farming is a great way to get cheap meat, but it’s also a great way to increase and spread potentially dangerous bacteria in the food supply. Both feedlot conditions and abbatoirs drastically increase the amount of e-coli and other bacteria on our meat. Going grassfed local meat is one way to ensure a safer meal. Those of use eating more meat to get protein and fat for energy also get more cases of mild food poisoning when we eat these factory farmed meats (eggs and dairy are also a problem when coming from this model of agriculture). YMMV.

    • Jon Thoroddsen says:

      I used to get diarrhea almost every time I pigged out on lamb. The lamb here in Iceland lives in the mountains all year long, so at least in my case it was not a question of bad conditions. I also noticed that this happened more surely if I ate a lot of the fat. Since going more in the paleo direction, I seem to handle eating a lot of lamb fat more easily, so I think, like others here, that it’s mostly a question of adaptation to fat.

      I’ve been having some trouble with this on and off, but it seems to be stabilizing. I’ve been eating a bit of yoghurt and other sour dairy, to make sure I have enough good bacteria in my gut as well.

      • I noticed the same effect with lamb. After almost a year of high fat paleo, I visited someone who roasted a big lamb and we spent the next 4 days eating it. people warned me about eating too much of the fat and they were right. I believe it was most severe when I ate a lot of the waxy suet fat.

  27. I just had to throw this out there….
    I don’t think I am particularly gorging myself or anything. In fact, I try to never get really full. I IF quite a bit and according to fitday consistently eat less than my needs.
    Just sayin…

    • Thats cool, You seem to be on track and if anything overtraining and being overstressed maybe causing your problems. Try for a while to stop the IF and just eat 3 square meals a day with snacks of nuts or cheese in between if you need. This WILL help you get your cortisol levels down and hopefully prompt weight loss and make you feel a load better, also try to go to bed at least 2-3 hours after the last meal.

      Step down the training (if you are training a lot), go for long walks try a few yoga classes have a big breakfast and get on with your day. I feel things like IF can be very is useful but they are also a double edged sword and can be detrimental so use with caution. Checkout some of Robb Wolfs Podcasts for more info on this topic.

  28. Hi Richard. I have a couple of thoughts on the issues you brought up:

    Could the diarrhea be due to something other than food, such as oil based supplements like fish oil, or a strong spice based supplement like curcumin? I have a hunch you may be taking both of these and I think both can cause diarrhea in some people.

    I wonder if your lack of motivation and depression could possibly be due to hypoglycemia. Do you fast or eat carbs without protein? If so you could be experiencing low blood sugar. It is said that hypoglycemia is very rare, but I am not sure I believe that. I have 3 family members, including myself who have experienced it. Many years ago I did a 500 calorie fasting diet for about 5 months. As a result I experienced pretty severe anxiety and depression which gradually decreased after about a year of eating real food again. Whether it is brought on by fasting, insulin resistance or the body trying to adjust to a major change in diet, I think its important to note that changes in blood sugar can have a psychological impact on some people. People who are prone to it need to keep blood sugar stable with small protein/low carb meals every few hours until the symptoms subside. Hypoglycemia is not a disease or illness, but a resulting condition in response to other factors. My thinking is that some low carbers may be insulin resistant to begin with, then possibly experiment with fasting and then have recurring insulin surges which result in low blood sugar.

    • I’m thinking in my case, now I’ve had time to consider it, is that the diarrhea seems to associate with eating too many nuts after dinner, while watching TV. Seems plausible as I long ago stopped having nuts around all the time. But every few weeks I’ll get some and we go through them pretty quick. About out now from this last batch so I’ll see what happens.

      At this point that is really my only issue of the 5 problems. The mild mood disorder was temporary and could be from a number of things not related to diet.

      I’ve been running on a pretty good high now for a while.

      • Yeah too much polyunsaturated fats can definitely cause loose stool. Try eating a bag of potato chips in one sitting and see what happens. I personally would not call this diarrhea, however.

  29. For the past few months, I’ve been experiencing all five of these problems, plus a few more.

    #1: If I try to fast — or do so much as skip a meal — I get terrible diarrhea. I don’t have any pain or cramping; my colon just seems to conduct a fire drill. I’ve been drinking at least a cup of homemade raw milk kefir every day for the last six months, so I’m good on the probiotics. Otherwise, my digestion is super-slow, and I’m often constipated. (That’s common with hypothyroidism.)

    On a related matter, my body hasn’t been managing my blood sugar terribly well for the past few months. I get faint and ravenous if I go without food, whereas I used to be able to skip meals without a second thought. I need to eat fairly often prevent myself from crashing. The last time I attempted to fast — for a mere 24 hours — I felt terribly weak and shaky by the 23rd hour. My blood sugar was 54 (a record low), and I could not raise it by exercise (as I used to do).

    #2: I was diagnosed as hypothyroid in November based on a somewhat elevated TSH of 3.2 in conjunction with a slew of standard symptoms. I’ve discovered that many of the women on both sides of the family are hypothyroid. Also, I recently developed a single-nodule goiter, something else that also runs in the family. As of tomorrow, I’m switching from Synthroid (which has done nothing for me) to desiccated thyroid. Iodine supplementation, which I’ve just begun in earnest, seems to be helping alleviate my symptoms.

    #3: I’ve definitely been depressed. Instead of feeling fabulous, I’ve been “meh” most of the time. I’ve had a few bouts of downright misery. Again, that’s a standard symptom of hypothyroidism.

    #4: My cholesterol numbers initially improved when I switched to paleo, but then my LDL and triglycerides began rising steadily. Again, that’s a symptom of hypothyroidism.

    #5: I lost 18 pounds over the course of 9 months, such that I was nearly my ideal weight. Then I stayed steady for another few months, despite trying very hard to lose the last three pounds. Then, in the last four to five months, I’ve gained about 13 pounds. Yikes! Again, that’s likely entirely due to my hypothyroidism.

    Basically, for me, #3 (depression), #4 (high cholesterol), and #5 (weight gain) are all traceable to #2 (hypothyroidism). Given when #1 (diarrhea) started, that seems somehow related too. And the poor blood sugar regulation came at about the same time too.

    So… Do I think that eating paleo caused my hypothyroidism? No, not in any direct way. (I’m open to evidence for that, but I’ve seen exactly none.) Looking back, I experienced many of my hypothyroid symptoms when I ate the Standard American Diet. In fact, I’ve often said that I feel like I’m back on that crappy diet, even though I’m eating as paleo as ever. Plus, something like one in ten women are hypothyroid, but almost all of those are eating SAD.

    Nonetheless, I do think that going paleo might have some causal connection to my hypothyroidism and related symptoms. For various reasons, I suspect that I’ve had a longstanding iodine deficiency. As Dr. Davis has warned, that would have exacerbated by my switch to paleo, because that’s when I switched from iodized salt to sea salt. Moreover, I suspect that the relatively rapid weight loss might have wrecked a bit of havoc with my metabolism, hormones, or whatnot. Also, I was under pretty serious stress in the spring and early summer of 2009: I was teaching and frantically finishing up my Ph.D dissertation. That surely didn’t help. This fall, my symptoms asserted themselves in a serious way when I began to get really busy with work again.

    Also, I’ve had amenorrhea since I went off the pill (after 16 years of nearly continuous use) in October 2008. (That was just a few months into eating paleo.) Going off the pill was somewhat traumatic for me. I was very quickly hit by a terrible spell of daily migraines. (Although I’ve suffered from migraines for years, those unbreakable spells of migraines are very rare.) I went on Topamax for about a month. That worked great, and I’ve only had a migraine or two since then. As for the amenorrhea, my estrogen levels are way low, but all the other tests ordered by my doctor were normal. I’m just 35, and I don’t have any other symptoms of (early) menopause. I’m not sure how that fits in to my hypothyroidism, if at all, but I’m scheduled to see a specialist in two weeks, so I hope to get some answers.

    Thank you, Richard, for the blunt honesty of this post! We’ve got to talk about these possible problems, not sweep them under the rug.

    • Diana:

      Have you considered dropping the kifir and perhaps all dairy except butter & cream for a while? If you get diarrhea while fasting, that suggests to me a gut bacteria die off. Possible that you have _overpopulated_ the gut? Is too much of a good thing a problem?

      I don’t know, but I’d sure try it.

      One principle or rule of thumb I like to follow is to not eat _anything_ all the time, or daily, except water & coffee. I even go days without eating eggs.

      • I’ve considered going off kefir and/or dairy for a while, but it’s complicated by the fact that I have a herdshare, so I pay for a gallon of raw milk per week whether I want it or not! However, I could work around that if I thought it necessary.

        Given the timing of the onset (and then worsening) of my GI problems, I’m nearly certain that my diarrhea is the product of my hypothyroidism. So if it doesn’t clear up as I get that fixed, I’ll definitely look to forgoing dairy for a while, to see if that has any effect.

        Notably, I don’t get diarrhea while fasting, but rather, shortly after I resume eating. (Sorry if that wasn’t clear. I didn’t want to be too detailed!) Also, I’m not super-religious about drinking kefir daily, but I will make a concerted effort to take a few days off from it semi-regularly. Like you, I do prefer to vary my diet within appropriate limits.

      • Sounds like a good opportunity to try cheese making. :D

      • Aaron Griffin says:

        Note that kombucha is a great non-dairy alternative to kefir, if you simply MUST have the probiotics. I love both

    • I’ve noticed diarrhea after fasting as well. I don’t know how that relates to other factors though.

    • I wanted to post an update to my bleak-seeming comment. In short, my various symptoms seem to be disappearing as I’ve gotten better treatment for my hypothyroidism — meaning desiccated thyroid and high-dose iodine. Within a few days of abandoning the conventional treatment of Synthroid for that, my lethargy and brain fog were mostly gone, and my periods resumed. You’ll find more details here:

      http://www.philosophyinaction.com/blog/?p=4013

      Sometime in the next few weeks, I hope to blog about the origins of hypothyroidism, including whether it’s related to eating paleo. I don’t think that it is, except incidentally. In my own case, I’m pretty certain that my hypothyroidism predated my switch to the paleo diet.

    • Looking back, I can see I had hypothyroid symptoms for a long time.
      When I started taking Topamax, it made them worse immediately and changed my cycles radically. This took several months to settle down and never completely went away until several months after I stopped the Topamax. (On Paleo, I no longer need Topamax).

      I saw a study on Pubmed linking all of the anti-epileptics to thyroid disruption. Worked though, I have to say, even though my neuro said I reported side effects at 50% of the normal dose.

      My weight loss/gain mirrors yours closely. Mood issues also. I have no info on cholesterol.

      Be sure to keep an eye on your vitamin D and look into the possibility of salicylate sensitivity for the D.

  30. Once again this demonstrates the convention-challenging nature of the Paleo crowd. Being open and honest about issues like these show that they are generally an intelligent bunch, rather than sticking their heads in the sand.

    I do occasionally get diarrhea – after a nut binge. The “excess fat sliding through” theory rings true with me. I’ve not experienced the other issues. I’ve always had super high cholesterol when overweight or slim, eating Paleo or not.

    With regard to the ladies period missing problems – this is puzzling. However – Alex, if I were you, I would throw in a gutbusting high-fat feast from time-to-time. Feasting in good times is surely as much a part of the Paleo way as IFing. And it’s damn good.

    • You comment really got me to thinking about nuts, since for some time I have eaten them intermittently, i.e., once we’re out of them I usually go several weeks before buying them again.

      Now I’m going to have to see if there’s a strong association, but it sure seems plausible.

      • I can confirm the nut effect. Besides the fact that roasted or rancid nuts have oxidized PUFAs, there are probably some lectin effects.

      • The funny thing is that, despite knowing the effect, I still eat a lot of nuts reasonably frequently. I just cannot resist their nutty goodness.

  31. I get diarrhoea quite badly if I eat more than about a teaspoon of coconut oil. If you search on the Internet for coconut oil+ diarrhoea you will find plenty of material that link the two.

    Whenever I suffer from depression it’s always because I’ve eaten neolithic foods and I’m ‘coming down’ and getting sick, just as a junkie would and it evens itself out over a day or three.

    My weight loss has been extremely slow – and I mean extremely slow – and I have 100 pounds to lose so I kind of thought it would be fast! I find that keeping calories around 1800 a day and keeping carbs below 30g a day really helps.

  32. My TC and LDL sky rocketed when doing high fat paelo for about 1.5 years. TC went from about 270 to 400mg/dl (HDL went from 48 to 80mg/dl).

  33. Apologies if I repeat anything that someone else has already written, but there’s a lot of stuff to read!

    1) Diarrhoea can be caused by excessive thyroid meds. Do you take your temperature 1st thing in the morning before getting out of bed? If so, what readings do you get? Another sign of excessive thyroid meds is mild tremor. If you sit with your feet on the floor and then lift both heels an inch off the floor, do your legs bounce up & down? If so, reduce your thyroid meds a bit & monitor.

    2) If you were hypothyroid pre-paleo, it’s very unlikely that you would be normal post-paleo, so give your wrist a slap for stopping your thyroid meds!

    3) If your serum Vit D is O.K. and you’re eating reasonable amounts of oily fish, do you have a lack of light during the day or conversely, too much light during the night?

    4) Refer people to The Heart Scan Blog High LDL isn’t a problem if the LDL is type A. High fasting TGs on low-carb is weird as TGs usually reduce on low-carb. Post-prandial TGs usually increase, though.

    5) I have a theory :-D

    Nige

  34. Alex Thorn says:

    1. Diarrhoea. The only time I get this is if I eat more than two raw eggs at a time! I also think, if the diet veers to predominantly protein as opposed to fat, this can bring on diarrhoea.

    2. Hypothyroidism. There has been research to suggest that what is considered ‘normal’ for thyroid function in modern times is an artefact of the predominant diet (high carbohydrate). It is posited that further back in human evolution when we ate less carbohydrate and more fat and protein our thyroid function was much different. Also, that it is a shortage of iodine that causes the thyroid problems and, very often, poor food choices on a ‘modern paleo diet’ may lead to iodine deficiency.

    3. Lack of motivation, depression. I think this may be a result of lowered serum cholesterol. There is quite a bit of research out there that shows people with very low cholesterol levels suffer from depression, psychosis, violence and suicidal tendencies!

    4. Super high cholesterol. Allied to the above. I’m betting these particular individuals won’t be reporting the problems with depression. I happen to be in this group. Just before I started a low carbohydrate/high fat dietary approach my total serum cholesterol was ~5.4 mmol/L (around 220 mg/dL). One of my latest readings show it has settled at ~7.6 mmol/L (around 304 mg/dL). However HDL is high and triglycerides are low, last measured at 1.01 mml/L (or ~89 mg/dL) so LDL, while high, is almost certainly made up of the large fluffy type A particles. Dr Barry Groves of THINCS has reported a total cholesterol level of more than 8 mmol/L (320 mg/dL) after following a high fat/low carbohydrate diet for 40 years and says he would much rather have a high than a low reading!

    5. Weight gain. Like you, Richard, it is usually a small amount of normal variation. My weight tends to stay within a range of 88-94 KG, SO I hover around the ‘normal’ BMI range of 24-25 for my height of 6′ 2″. My body-fat percentage pretty much remains constant at 14% or less – for a male of my age the charts say this is between lean and ideal! I think people who gain a large amount of fat should really have a good hard look at exactly what they are eating: are carbs creeping up? Is protein creeping up as a percentage of total calories compared to fat? Sometimes excess protein will convert to glucose and you are back to square one with the fat gain cycle!

    • #2 Finally someone has raised that issue, cause I keep asking: has anyone done thyroid panels on true H-G populations?

      Any way to explore that further? Seriously, even when my TSH was sky high at 16, then 11 the next test when I got T3 and 4 tested, the 3 & 4 were in the normal range and I felt just fine. It seems to me that my adverse mood began about the time I began taking Armor.

      Questions, questions.

      • Bear in mind that the Reference Ranges (RRs) for FT4 & FT3 are the ranges within which 98% of the population fits and are as wide as barn doors. E.g. where I live, RR for FT4 = 9 to 24pmol/L and RR for FT3 = 3.5 to 6.5pmol/L.

        Therefore, being “in the normal range” can be meaningless.

      • Alex Thorn says:

        I have read that a slow metabolism is actually a more efficient one! Most of the discussion in fitness ans weight loss circles revolve around speeding up metabolism but there are very few obese people that have truly slow metabolisms and often there is no difference between the overweight and the lean.

        From an evolutionary perspective, when food may have been scarce a lot of the time, it would make sense that metabolism may have been more efficient and we gain the maximum amount of energy from the foods we ate.

        In animal-based foods, milk (particularly fermented dairy products like yoghurt) and eggs are a good source of iodine. Selenium is also required for correct thyroid function and pork is a particularly good source. The uptake of iodine from food in the gut is very good but often its utilisation by the thyroid gland can be limited by other dietary factors like isoflavones from soy products and thiocyanates made from the glucosinolates found in cruciferous vegetables!

    • And, I should point out that even with the high TSH, that’s when I lost most of my weight most rapidly.

  35. I tried this diet for a few months last year and I wasn’t a fan. I was down and had no energy for daily life or training. My question to the group is this: Has anyone been on this diet for an extended period of time and at the same time trained (run, lift, cross train, other?) regularly (5x per week) while on it? I don’t think the two – paleo and training – work together in the long run.

    • I was training last summer whilst living this lifestyle, reliatively intensely – 5x 10 kms runs per week, plus some minor bodyweight work for definition and found that the balance needs to be kinda delicate.
      What worked for me was to have breakfast at the conventional time, after a morning run without fail, usually eggs or steak or something like that plus salad, sometimes with a protein shake. Then lunch would be medium size, same set up, good bit of meat / salad normally. Dinner, fish or meat plus loads of veggies. Its very easy not to obtain enough calories to sustain such intense training that’s why I refer to it as ‘delicate’. (ps. was still losing fat)
      In terms of IF, that’s a no no with high frequency aerobic training, I do not believe you will last. IF + Resistance, Martin Berkham at ‘leangains’ is the authority. Hope this helps and would definetely give it another go with higher cal intake (nuts could help you achieve that quite easily). cheers

    • Hugh,

      I’ve been doing Paleo/Primal for 6 months now and lift heavy, as well as do kettlebell swings, snatches, play basketball, train clients and am generally active. I eat high fat, moderate protein and low carb fuel and have never felt better. I sleep better. Workout better and have much better frame of mind. I speak only for myself as we are all different.

      Sandy Sommer RKC

    • Hugh,

      Hi there, I play soccer professionally and am on the paleo diet. It really sucked in the beginning, getting fat adapted, my performance suffered and I felt like hell. After about 4 weeks or so I started coming around. I was initially very low carb only using green veggies as my carbohydrate source. For me, this didn’t work. I have since started incorporating sweet potatoes, squash, and apple sauce post workout to help with glycogen refill and have been doing pretty well. I train 5 days and week and use Crossfit as my S&C program in conjunction with regular 90 minute sessions with the team. Also, I am unweighed and unmeasured so I eat a ton, just eat until I’m not hungry. I’ll throw in an IF session or two during the week and I seem to do OK there as well. I do believe the to each their own applies here, not everyone will do so well, the biggest factor I believe is carb levels for athletic performance. I think a rule of thumb is if you have 24+ hours to recover from your last workout refueling with some starchy carbs isn’t that necessary. Any time less than that you would be well advised to throw some in to help your glycogen stores along. For me, this is almost everyday so I make sure I have a nice clean source of starchy carbs available to me post workout and keep my non-post workout meals pretty low on carbs (usually spinach, brocolli, or any other green veggie).

      Hope this helps, I am just rambling on, but this is what works for me and I feel great. Conversely, there are plenty of guys eating pizza, bring mcdonalds breakfast to practice, and getting it done on the field. For me, that’s just not an option knowing what I know.

      Cheers,
      -Kevin

  36. I’ve been on the Paleo (or some variation of it) over the last 3 years. For the first 2.5 years I was lifting 4-6 times a week with no ill effects.

    I started playing soccer 2x a week and felt fine as well. In terms of “training” it depends on your goals. I can’t comment on whether or not you can maximize hypertrophy with a Paleo-esque diet, but in terms of performance, it really is sustainable.

    There are studies that show that increased fat intake increases your VO2 max. I’m not going to say they’re correlational, but if you think about it, it does show promise to high-fat diets if your body is set up that way.

  37. My two cents about #5, especially with women…
    Most American women tend to eat a lot of carbs and little fat and protein, and they tend to stay away from weight work. The body is very good at scavenging for needed amino acids and I wouldn’t be at all surprised if the added weight isn’t fat weight at all and more the body rebuilding lean muscle mass that had been diverted due to low protein intake. The body also likes a set point weight and the added lifting may be pushing their bodies to heavier muscle while taking it’s time to be willing to let go of the fat. I am a woman and, though I’ve seen changes in my body, my weight loss has been very slow. I’d say that 30 years of a SAD diet aren’t going to be wiped away by a few months of Paleo eating. It’s going to take a while for the body to adjust and to start working the way it should.

  38. anand srivastava says:

    1. Diarrhoea- I think high fat will cause it in the beginning when the body is not used to generate enough bile. Later it could be that we are eating too much fat. Some people may not be able to generate so much bile. My body also reacts this way sometimes, when there is too much fat. I am thinking of reducing it.

    2. Hypothyroid – People have already commented about the reduced iodized salt consumption problem without adequate supplementation. I luckily found about iodine’s importance before going into too much low salt. I did discover that Sodium is also important, and had to up the salt content.

    3. lack of motivation- That has not improved for me. I guess it depends on the psychology as well. Maybe it will improve if I go lower carb. I have not had the chance to test that out.

    4. Super high cholesterol – Could it be due to low Vitamin D. Read it today from DrBG. I am unfortunately on the low side, only 143 total :-(.

    5. Weight Gain – Possibly due to reduced iodine and hypothyroid. Must check that.

  39. I’m new to paleo and have been reading this blog from the start over the last few days. Did not expect this post from the author and I almost thought it was written by someone else. Hmmm. What’s the point eliminating grains etc if the paleo diet still has issues as mentioned in the article? I’m wondering if it’s better to just relax about food, eat all food types and remove the feelings of ‘can’t have’ oats, potatoes etc. Yep, no scientific or medical comments here, just Rambling from someone who is now even more confused after finally thinking paleo was the way.

    • I consider my self Primal.
      But still, eat anything when I’m out with friends, a party etc etc…
      Usually twice a week. This means I eat carbs, but they’re not anymore my all time food.

      I eat meat, fish and vegetables most of the time, milk at the morning and yoghurt before sleep. But no strict dogma, depends if I’m hungry.
      On top of that I do some intermitent fasting once or twice a week, skipping breakfast (about 14h only with coffee or tea for the morning).
      And once or twice a week lift heavy.

      I feel great, none of the mentioned problems with all positive effects of eating primal.
      I’ll keep crossing fingers I guess !)

      Thanks Richard for the inspiration

    • Jackie:

      Keep in mind that these are problems reported to me by a small handful out of thousands of Paleos here and elsewhere, and even for many of those, they only have 1 or 2 of the issues, and not all the time.

      Nonetheless, does no one any good to hide from them. Chances are you’ll do just fine, and if you do develop an issue, now there’s a wealth of info for reference.

      Good luck, and keep in mind that everyone has to figure out for themselves what works. Some people can stay low carb forever, once the weight is lost, but for some there seems to be obviously a point where more starch needs to be consumed (but never sugar and especially not fructose — hugely different than glucose promoting starch).

  40. great post!

    thank you for letting me discover the liquid fat bomb! Amazing for someone like me who has trouble keeping weight on (3000kcal a day and barely maintain 71kg at 6ft)

    Also well done on questioning your own beleifs. i used to think a low carb diet was ‘impossible’, but now I have been on it for 8 months and never felt better, and also am becoming entrenched in it, staunchly defending it and attacking eating bread and pasta, so its hard not to stick ones fingers in ones ears when some possible weakness is exposed.

    But I have experienced none of the above ill effects. I must be done losing fat as I didnt have much to start with and I’m around 11% now on a fairly high calorie weight gain program with resistance exercise.

    I have nothing but praise for low carb :0

  41. Thanks for this post. I’ve been on some version of low carb and/or paleo for the past 6 years and I have started experiencing a lot of this. For the first maybe 4 years I felt awesome, but it’s been a slow downhill slide since then culminating in hypothyroidism (with a bunch of other stuff I think is related to it, like digestive issues, menstrual issues, and lethargy). For awhile I thought it was because I wasn’t being strict enough, but weirdly going stricter seemed to make me feel worse and adding exercise to the mix was terrible awful bad.

    Going back over some low carb reading materials it seems like low carb is actually responsible for the hypothyroidism. Atkins mentions that LC will inhibit the conversion of T3 to T4, the Eades’s mention it, and Diana Schwarzbein preaches loudly against going too LC for exactly this reason. Schwarzbein says that one of the mechanisms by which this happens is that LC will elevate adrenaline (which is initially why you feel so awesome) but after years of high adrenaline it will suppress thyroid function. Another theory that I think is put forth by Matt Stone is that low carb diets will naturally cause you to reduce your calories, which will have a downregulating effect on your metabolism and slow down your thyroid.

    Anyway I don’t know what I’m going to do to fix it yet, but the 3 main sources I’ve read for naturally raising thyroid levels (Enig/Fallon, Schwarzbein, and Matt Stone) all seem to agree somewhat. I’ve distilled it to high fat, moderate carb, lowish protein (like 60/30/10 by calories), coconut products, preformed vitamin A, and more calories. I’ve been doing this halfassedly for a week, but I’m going to try in earnest now and track my progress with my basal temperature. If anyone has any other sources they’d like to share, please let me know. I’d like to read all I can.

    • Yup, suppression of the conversion of T4 to T3 is a side effect of low carb (or for that matter low calorie) dieting…this is part of why bodybuilders sometimes use Cytomel when dieting down.

      I can’t find the ref I want right now (http://www.bodyrecomposition.com/fat-loss/the-full-diet-break.html has a brief treatment of the material in the physiology section, but he’s written in more detail elsewhere), but Lyle McDonald talks about dealing with this. He does recommend going on a diet break for 10-14 days after a period of harder dieting. It’s not entirely clear to me if this is sufficient amid a long-term low-carb eating pattern or just after a shorter, harder diet.

  42. Mojo Yugen says:

    Lots of good info in the articles (and comments).

    I had problems with diarrhea BEFORE I converted to a low-carb, semi-paleo diet 8 months ago. I’m pretty sure it was a problem with my gut being messed up. Rebuilding it using probiotics and a good yogurt (usually Fage) most mornings has totally eliminated any diarrhea. I notice this most when I eat hot wings. Before, they were hot going in, sometimes upset my stomach, and were hot going out. Now? Well they are still hot going in but don’t seem to cause any other repercussions the rest of the way through me. I’m not positive if it was probiotics or not but, for me anyway, it seems like the most likely candidate.

  43. I lean towards the idea that if we ate Paleo from childhood, a lot of these problems might not exist. Twenty, thirty, forty years or more of our genes trying to cope with soy, corn oil, sugar and wheat and a dearth of fat soluble vitamins may leave its mark. What our mothers ate, and our mother’s mothers ate, also comes into the picture, since it affects what we are exposed to in the womb.

    There’s a difference between saying that people eating the paleo diet still sometimes have issues, and saying that the paleo diet itself has those issues.

    On the depression issue; here’s a theory. I’ve been reading about serotonin, and the theory that its regulation is involve in carbohydrate addiction. The basic bare bones is this; tryptophan is the raw material needed in the brain to make serotonin. Uptake of tryptophan into the brain depends partly on total blood concentrations of tryptophan, and partly on levels of other amino acids which compete with tryptophan for uptake. Lower the levels of these other aminos, more tryptophan goes into the brain, serotonin levels rise.
    If you eat carbohydrate, insulin rises, protein synthesis in muscle and other cells increases. The ratio of competing aminos to tryptophan goes down, leading to an increase in serotonin.
    Suppose that a person has a less than optimal muscle mass, as a result of eating a crappy modern diet. They eat those carbs, but their muscles are insulin resistant, so the change in the ratio of competing aminos to tryptophan is also compromised. So it takes more carbs to get that serotonin buzz.
    Now that person switches to a diet and lifestyle (low carb paleo and weightlifting will do) that increases muscle mass. Competing aminos are sucked out of the blood; this affects brain chemistry and mood. Eventually the person reaches their peak attainable muscle mass. It might become harder to achieve a ratio of competing aminos to tryptophan to get that serotonin high.
    So maybe being slightly below peak muscle mass would be better for mood than peak mass? If I’m not just blowing smoke out my butt here, intermittent fasting– regular partial depletion of muscle protein stores, followed by repletion, might make for higher levels of serotonin during the feeding period. “Keeping the calories up, without overdoing the protein,” would also be expected to affect the competing aminos to tryptophan ratio. I guess the relative levels of other amino acids needed for neurotransmitter production, like glutamine and phenylalanine, would also come into play here in determining the overall effect of the diet on mood.
    .

  44. Matthias says:

    “I lean towards the idea that if we ate Paleo from childhood, a lot of these problems might not exist.”

    I would like to disagree. I started eating paleo roughly a year ago, I was 18 back then and completely healthy. Ever since then my health got worse and for much too long, I have tried to blame it on something else than paleo, but that just wasn’t the case. I experienced/am experiencing pretty much all of the mentioned problem, except for the last one maybe.
    I’ve always been very lean and I am pretty much certain that the fact I was healthy/lean before aggeviated the harmful effect that paleo might have on some people, as there wasn’t much fat to lose anyways, which might have acted like some kind of buffer.

  45. @weight
    I noticed weight gain after being on the same weight about one year on Paleo. I used to weigh 84 KG and I ate a lot, I actually never limited myself in quantities of Paleo food. BUT….”suddenly” in September 2009 I started to gain weight. Why… Ok, I stopped drinking coffee and cappuccino in July….and I noticed that I got hungry 1 hour after diner at night, and although I was stuffed. I never had that before, except in my high carb days……I gave in by eating a lot of cheese and or natural fat yoghurt……. the weight gain was fat because my waist went from 80 to 85 cm…of course I was surprised, because my fasting insulin was very low all the time….I asked Art De Vany, and he suggested to stop eating cheese and yoghurt and do some push ups in stead and/or ignore the urge to eat, and maybe supplementing with a spoon of BCAAs…..I´m doing that now; also, I´m checking whether there are some old habits showing up and/or emotional stuff what could be a cause…….another theory is that gaining weight is normal in Autumn as a preparation for the cold Winter time (and that would explain a lot, because the Winter is this time extremely cold and long here in Holland).

  46. Nostril Damus says:

    Point 1:
    Why do you consider high cholesterol, as a condition in isolation, a problem ? Centenarians all have way higher cholesterol numbers than people who do not live past 100.

    Point 2:

    One problem that I see often in the Paleo clique is the idea to eat meat in abundance. In reality, if you eat more protein than your body needs, it is burned as glucose and has lots of ugly ammonia as a waste product.

    You should eat about a gram of protein per kg of body weight:

    Eat more protein than you need and your body learns to eat protein for energy… not a skill you want to be good at (to quote Ron Rosedale, the veritable master of this field) if you value your muscles and other protein based body parts.

    Eat less than you need and you do not have sufficient aminos for replacement of worn out tissues.

    Ron Rosedale is the man to look up here.

    Cheers
    Jordi

  47. I have had the diarrhea, pretty bad dosage too. I notice it only happened when i switched to Paleo and when i ate freely over Christmas. It happened again when i went back to my normal diet after the holidays. I put this down to the difficulty my body had adjusting to the dietary extremes. I don’t suffer at all from depression or mood swings, if anything my mood is better these days. I don’t know if i can relate it to diet.. perhaps its just being more at peace learning and having lots of information from blogs like this one to absorb. It keeps me occupied and amused. I did notice IBS or a similar type symptoms when sweets, beer and the like were introduced temporarily over Christmas.
    I have days when i feel sluggish, heavy feeling.. but conversely, when exercising, which i haven’t done much of the last 18 months, i amaze myself at what i can cope with.
    Overall I can’t complain at all, i love my diet. Oh .. one last thing. It was when my diet changed over Christmas that i felt mild anxiety. I was aware and thought it would disappear again when switching back to my diet.. sure enough. .gone. !

    • gallier2 says:

      Yes, I get diarrhea if after a long time on low-carb/quality food I switch back over to standard-crap diet (containing gluten grains).

  48. The diareah can be from too much bile released when fat intake excessive (gall bladder removal patients know this as ‘dumping’).

    There would be way too many variables in all of the readers emails to conclude the issues raised in this post can be fairly attributed to the paleo diet. Were they eating local, grassfed, conventional, organic? Were they eating too much dairy? Too low carb atkins style? Were the thyroid or depression conditions pre exisisting albeit undiagnosed? Were they taking paleo too strictly or loosely? Supplementing? Lifestyle stress? Personality … And so on…

  49. At the risk of being a supplement pusher, I’d suggest those new to a hyperlipid diet supplement with digestive enzymes to start, so as to be able to break down the excess fat until lipase production is up-regulated.

    Best,
    Skyler

    • Erin in Flagstaff says:

      I agree. I wish I had done that. I think my body couldn’t handle the fat I was throwing at it early on. Something like probiotics might have improved my bile production, which could have stopped my gallstones from forming. I think this happened in the first year of eating low-carb. Now I’m much better and getting probiotics in my diet, but now the gallstones are there. Eating too much fat isn’t handled at all well by my body.

      On the bright side, my mood is great, the weight loss fine.

  50. SassaFrass88 says:

    That’s why I’m more ‘Primal’ than Paleo. The fat keeps me less hungry and I’m never depressed anymore. If my fat levels are down, my brain (ie sanity) totally suffers.

    I’ve never had diarrhea though!!! That would suck!

  51. Weirdly enough, if I consume grains/sugars I get more on the constipated tip rather than diarrhea. Not sure why, but it seems to work that way.

  52. I’ll read that post after my workout, Matt.

    I’m assuming that by upping glucose, you mean from starch and not sugar or fructose. I also suspect that some people run into problems by combining low carb and too much protein, not enough fat. Right now, I’d say I’m moderate carb, getting most from potato and other roots, but probably well less than 150g per day on average. Protein is also now much lower than I used to consume (I don’t do the enormous ribeyes, anymore), and the balance is fat, lots of butter in particular.

  53. 1. Diarrhea or constipation: Gut can respond to stress either way. In my experience, aside from fiber-induced irritable bowel, stress is the main cause for changes in defecation quality. Otherwise, I would suspect excess fat intake relative to individual adaptation (weak bile flow relative to fat intake).

    2. Hypothyroidism. a) iodide — a paleo diet without adequate seafoods (animal or vegetable) could result in iodide deficiency. Price noted that several of the inland tribes he studied went out of their way to get seaweeds and seafoods, and reported to him that if they did not, they got “big neck” disease, ie goiter. b) too little carbohydrate (can cause decline in thyroid function, as I mentioned in my book). c) do you go by labs or by symptoms? Standard labs values are based on agricultural people. I have not had any decline in lab values, I remain normal, for 10 years paleo. But I maintain a moderate carb intake (100-150 g daily most days) and regularly eat seaweeds or take iodide.

    3. Lack of motivation, depression. Like Kurt, I also recommend and practice meditation, some form of which you will find in most H-G tribes. I think too low carb also contributes by depressing tryptophan delivery to brain, impairing neurotransmitter production.

    4. Super high cholesterol. Not really eating like primitive people, i.e. not enough bitter plant foods/herbs. I plan a post soon on this. Masai, for example, use more than 2 dozen herbs in soups and with milk, about 60% of which have some hypolipidemic activity.

    5. Weight gain. I think women have this due to excess fat, too little carbohydrate. Venus figurines from stone age northern Europe depict anatomically correct obesity, so likely those people had very fat women among them. I think that due to women being the primary gatherers, men the primary hunters, paleo women ate more plant food and less meat/fat.

  54. Constipation is my only slight problem. That, and the last 2,3, or 4 pounds of lower abdominal fat will simply not go away. I think constipation is somewhat in the head because on the SAD, we might be used to crapping like elephants with all the useless fiber, excess calories, and junk on a standard diet. Now, skipping a day could make one think “man I must be really bound up” when that isn’t the case. I also think that once all fat has been lost and you’re lean and mean, deregulating carb consumption (with the exception of sugar and wheat, of course) will not negatively impact a person’ s health-As long as a premium is placed on animal fat.

  55. After using various versions of a low-carb diet to treat a multitude of patients, I had an insight that I want to pass along. What follows is simply a general commentary meant to address the problems in general and not any specific problem.

    When people are not following a diet, i.e., they’re just going about their lives eating whatever they want to eat, most – if not all – experience various symptoms – occasional diarrhea, headache, sinus congestion, backache, rashes, sore throats, dandruff, etc. – that typically come and go. People don’t think much about these symptoms and generally regard them as just a part of life. (Unless, of course, these symptoms are serious and protracted.)

    But, when people go on a diet, especially a diet that is a little out of the mainstream, they tend to blame every symptom on the diet they are following. If they aren’t following a diet and they get a headache, they say, “Hmm, I’ve got a headache today; where is the aspirin?” If they’re following the (fill in the blank) diet, they say, “I’ve got a headache; it must be this diet.”

    If you’re kicking along on your regular diet and you get appendicitis, you figure you just had the bad luck to get appendicitis. If you’re on the Atkins diet and you get appendicitis, I guarantee you that you will attribute your appendicitis to the Atkins diet.

    I’m not saying at all that various diets don’t cause symptoms because they do. What I’m saying is that it’s often difficult to differentiate the normal aches, pains and rashes of life from symptoms attributable to a specific diet.

    • Took the words right out of my mouth.

      I Wish I a had a nickel for every patient I saw who claimed their malignant slow-growing tumor of the “fill in the blank” arose out of nowhere the day after they tripped over their dog, or had some other minor injury.

      I call this “surveillance bias” and I see it every day in my practice. You start paying attention to anything – a bodily function, a limb, a symptom, and you can suddenly notice something that has been there literally your whole life.

    • So true! I wish I had said it myself.

  56. First, thanks Dr. Mike for that insight. It’s a good point. It goes beyond the mere variable problems many of us have mentioned. So we pat ourselves on the back because we all make numerous changes and so validly can’t tell what is responsible for what. But we’re still tending to give more weight to the diet itself than may be warranted. …When the diet itself is also a variable in itself that may or may not be related.

    Second, Dr. Strephan Guyenet of Whole Health Source emailed to suggest I conduct a poll concerning various factors such as plaeo or low carb, how you feel, etc.. He suggested some questions and so I’m working on it. I suppose I need to strike a balance between “nice to know” and “blinding ourselves with science.”

    So, any of you skilled math types out there want to suggest some questions, structure, method? Email me. Address is on the About page.

    • I completely agree, I notice I do this as do clients.

      The other thing I notice for myself is that I have developed an attitude of – everything can be solved by diet, supplements and lifestyle, since I have discovered the power of diet – in particular in my case and combination of Paleo with a zone balance (slightly lower carbs, higher fat for me though), plus some supplements.

      So whereas in my prior SAD life (or should I say SNZD) health issues just happened and nothing could be done. I now ask – what am I doing wrong with my diet, what supplements do I need, what have I done to cause this?
      So everything whether related to diet or not becomes about diet.

      I am one of those who has been diagnosed with hashimotos about 3 months after going Paleo. I added iodine – but that made it worse quite quickly. To put this in context, I was following the Zone diet, the only change I made was taking out grains, legumes and diary. Food amount – fairly constant, slightly lower carbs. Lost about 1.0 kg, not a lot but all I needed to lose. Given that I have mild auto-immune issues (positive ANA) with joint issues, the thyroid has probably been there all along. Maybe it just decided to surface now perhaps because I am in peri-menopause? I’ve always had symptoms associated with low thyroid; easy weight gain, sensitive to cold, Raynauds, menstrual issues, reactive hypoglycemia.
      Okay so paleo (but only with restricted calories / Zone balance) has allowed me to lose weight. Un-measured eating for me – even paleo would definitely not work – I would easily put on weight, as I’ve noticed with others – particularly women.

      Also with paleo – nasty PMS and menstrual pain are gone (fish oil + exercise also helps). Oh and pre-menstrual spotting – gone. Joint issues gone – no more swollen knees, TMJ joints or sore neck, gut issues – in my case constipation – gone.

      Huge and I mean huge ganglion cyst that I had for 10 years shrank in weeks – has anyone else heard of this with paleo?

      Still have the thyroid issue though, (no meds needed yet though) and still get raynauds. So of course I am saying to myself – what else can I do to deal with this? Can I get rid of thyroid anti-bodies? Can I stop my fingers turning white when they get the slightest bit cold?

      Any answers much appreciated.

      I’d love to see the results of such a questionnaire if you do it Richard.

      • gallier2 says:

        That’s what Dr.Lutz noticed in his practice, that often after a certain age, changing to a low-carb diet worstens auto-immune issues. That’s because you need less cortisol, your inflammation recind but the innate imune system is still the buff one it was before switching, which hits everything much harder as it should. He managed these issues by transitionning to low-carb very slowly, to let the body adapt and by giving cortisone or other anti-inflammatory medication. He was not paleo but I suppose he would be today, may be he does as he’s still alive and he must have done it right because he’s 97 now.

  57. Dave, RN says:

    Exactly. Correlation is not causation.

  58. man_is_obsolete says:

    This guy covers the topic from time to time. Example: [link removed]

  59. man_is_obsolete says:

    Sorry, the above link wasn’t as relevant as I thought it was.
    [link removed]

  60. Thank you Dr. Eades for that wonderful comment.

    Marc

  61. I have had no problems whatsoever after 8 months. I was never overweight, but started this as an experiment to see what it’s effects would be on my sport results.

    I have not gained weight, and not lost one single pound. I do look leaner, so I guess I lost some fat and gained some muscle.

    I am not into the ultra low carb thing. I do eat starches like sweet potatoes, carrots, some fruit, topinambur etc. I also eat some (fermented) dairy. Once in a while I ‘cheat’ and have some occasional non-primal food. I don’t want this to be a diet. I want it to be a menu. Restricting yourself isn’t a very good idea, it can lead to frustration.

  62. Matthias– you say you were healthy before you ate paleo, after eighteen years of eating whatever it is you ate before then. Accepting what you say at face value, eighteen years of eating non-paleo followed by a switch to Paleo isn’t the same as eighteen years of Paleo followed by yet more Paleo. If groups that still ate the traditional paleo foods that their ancestors ate were wracked with modern illnesses, this blog wouldn’t even exist.
    You say you’re lean. How lean? Too lean? High cholesterol in a lean person can sometimes excessive weight loss.

    Diarrhea can be caused by too much fat causing malabsorption. But, rabbit starvation can be caused by too little fat in a low carb diet. One of the main symptoms of which is also diarrhea. And of course diarrhea could cause weight loss, for obvious reasons.

    From wikipedia;

    “The groups that depend on the blubber animals are the most fortunate in the hunting way of life, for they never suffer from fat-hunger. This trouble is worst, so far as North America is concerned, among those forest Indians who depend at times on rabbits, the leanest animal in the North, and who develop the extreme fat-hunger known as rabbit-starvation. Rabbit eaters, if they have no fat from another source–beaver, moose, fish–will develop diarrhoea in about a week, with headache, lassitude and vague discomfort. If there are enough rabbits, the people eat till their stomachs are distended; but no matter how much they eat they feel unsatisfied. Some think a man will die sooner if he eats continually of fat-free meat than if he eats nothing, but this is a belief on which sufficient evidence for a decision has not been gathered in the North. Deaths from rabbit-starvation, or from the eating of other skinny meat, are rare; for everyone understands the principle, and any possible preventive steps are naturally taken.”

    Lassitude –a lack of energy or motivation. Maybe even depression?

    • Matthias says:

      Hi, thanks for your comment. However, i do not really understand your first point. Before switching to paleo, I was eating a high carb, mderate protein low fat diet with quite some processed food in it, but not too much.

      My thoughts just are, that when after switching to a way more nutritious diet, my health rapidly declined and the only real big change was a drastic reduction in carbohydrates ( and a drastic increase in fat, but I don’t think this should be a problem), then it might very well be that low-carb induced all this.

      • Matthias says:

        Oh, forgot something.
        Before starting paleo I probably was just lean, probably at the very bottom BMI range that would still be considred normal, so I’d say I already was a bit underweight. Paleo didn’t help me get a little more bodyfat on, instead my weight decreased even further, but not too much, since I simply didn’t have that much fat to lose.

  63. I meant to say that high cholesterol in a lean person can sometimes be caused by excessive weight loss, in case that isn’t clear.

  64. John Campbell says:

    What a great post this is – and great comments. I think we are early along the path of discovering what’s best for our bodies. Paleo points the way, I believe, but there is much to be discovered.

    As you say Richard: “We self-experiment, use evolutionarily-backed reason and principles, form reasonable hypotheses, experiment more, figure it out, and fix it. We’re animals, and there will be a way, for everyone.”

    Brilliant – we are just beginning to learn and think about the implications of all this stuff. I suspect most of us are designed to live and eat in similar ways – evolution likely came to the same conclusions for most of us and our ancestors.

    But we live in different places, work under different conditions, and eat different foods even though we are “paleo”. I suspect the biggest differences amongst us all, leading to our different experiences, is that we have all eaten poorly in the past to varying degrees. We are all living with highly variable damage and legacies from the past. Our previous lifestyles have switched on and off genes making us more sensitive to some things and less sensitive to others. It takes time, and for some, likely more direct intervention than simply eating paleo.

    For me, this paleo journey has not been that difficult and infinitely rewarding. My biggest challenge right now is avoiding cravings – not for carbs or grains – but variety. I gotta get busier in the kitchen – Richard, you are an inspiration in so many ways, but in the kitchen most of all!

    Richard – this could be your best post yet. Great information and wonderful comments. Paleo is a land of a thousand paths – we all need to be kind to ourselves and persevere as we search for the right ones for us. Kudos to you Richard in helping provide some maps to this strange land of our ancestors.

    • Thank you John. I firmly believe the principles are sound. But they are only principles, not rules, not prescriptions, not really a diet. Paleo is a dietary framework. Each individual must figure out what works best for them.

      I fear that because a natural Paleo approach is low carb and because we have such strong allies in the low carb community that some may feel as though they are “cheating” by upping the carbs. Well, I say that virtually any amount of carbs can be Paleo — this is the beauty, not a disadvantage. It makes for a far bigger tent. Look: if someone, particularly many women just don’t care about visible abs, don’t mind the 20% BF, AND FEEL BETTER on a natural foods diet that’s maybe 150 or so g of carbs, who is anyone to argue with that. Toss the grains, refined sugar, processed food and veg/grain/seed oils and you are already 80% of the way there. For many, that’s likely enough and we all ought to guard against dogmatism and purity.

    • I think it’s a crying shame that we are in this position as a race, a species. First of all, our ancestors had this knowledge, accruing it over thousands of years. Then, I guess we lost that knowledge as we became “civilized”. And now, most of us are chest-deep in lies that we tell each other to sell more product.

      Our ancestors may have been primitive, but we’ve traded that ancient wisdom for the pursuit of money and material wealth at the expense of all sorts of things, including: community, social trust, mental and physical health.

  65. 8 months into my paleo experience (and now down 111 pounds, Richard, for my latest update) I haven’t experienced any of the listed problems. Admitedly, I haven’t reached goal weight, so that’s one factor. Mild to moderate depression has been an issue for me all my life & has been about the same pre & post paleo – actually slightly improved, if only because being slimmer & fitter has inherent advantages, mood-wise.

    • Chris, you’re one guy who I think might be inclined to say something like “give me those problems” in exchange for the 150 pounds (once you get there, and you will).

      Keep the reason, Chris. (That’s a turn of phrase)

  66. i am glad i dumped the low carb, paleo nonsense…. and just started eating everything again! I still think its a good way to lose weight, and keep satisfied for the short run.. but like matt180, i think carbs should be upped after the initial weight loss phase… I yo yoed with paleo and low carb, till i struck balance with the 180.

    troy

    • OK, Troy — I’ve upped carbs too. But the Kitavans are Paleo, are they not? They get 70% of energy from starchy tubers and are in pristine health.

      If you think this blog is about “low-carb” you’re going to be disappointed. I’ve clearly warmed to Matt after being a bit hostile — I mean, anyone who does his own Massaman is a friend of mine… (I have been a fan of Massaman curry since 1989). Mostly, this is all to the good. We all need to be cognizant of the fact that we are individuals and depending upon where your genetic lineage lies (from equator to pole), you’re going to find what works best for you.

      If you were to read my blog you would see that one of the things I say most often is that Paleo is anything from Equator to Pole, high carb to zero carb. But nobody can tell you what is going to work best or optimally for you. Incidentally, I think those represent Paleo extremes and neither is optimal.

      For me? High fat, moderate carb and fairly low protein. Looks like I’m going the way of hyperlipid Peter. But I may change. I always experiment. Most recently, I’ve been upping my experiments with fasting, high intensity workouts, and extreme cold (40 deg F cold plunge at the gym).

  67. I’ve always been somewhat scatological to the distress of family and friends so this post is a breathe of fresh air! I’ve been hard core paleo for a year now. I experienced some severe diarrhea in the first two months of conversion but it hasn’t been bad since. After cutting grains (and the tremendous amount of fiber that goes along with it) you’re stool will never quite be the same. If you want to firm it up a bit, eat lots of whole avocado. That will usually do the trick. Back when I believed that low fat was the way to go, I suffered bouts of constipation. That’s no longer a problem at all.

    If you feel depressed, run down or moody, there’s a good chance you aren’t eating enough fat. Get your meat from a local butcher and ask them not to trim any of the fat. Given a chance, ask them for the extra fatty parts. Ribeye is my favorite cut. When I get run down or start feeling depressed, a fatty ribeye solves the problem every time.

    My wife has had less success with weight control on a high fat Paleo type diet. Personally, I think it’s because she cheats but don’t tell her I said that! In any case, I expect that some women generally have a harder time switching from the glucose to fat metabolism. She typically choses to cut the fat off my special order ribeyes which just leaves more of the good stuff for me.

    Just my two cents worth – not at all scientific. Keep up the ball busting Richard! Love it :)

    ps – My mother has insisted I have my cholesterol checked on several occasions – it’s perfect. I expect that those high cholesterol issues are part of an altogether different problem. I also wonder if high cholesterol is really such a bad thing? Guaranteed, the statin medications that doctors are prescribing willy nilly are a VERY bad thing indeed!

  68. I haven’t been fully ‘primal’ (I eat very high fat, moderate protein, carbs vary but I know when I have overdone it because I start falling asleep sitting up or get a horrific headache) for very long. A few months – before I was eating pretty high-fat, but ate grains and sugar.

    As a very underweight hard-gaining girl, I’ve seen the opposite of several things you mentioned. I haven’t lost any weight – if I did I would stat carb-loading immediately. I have been around 100 lbs give or take 4-5 in either direction since I was 14 years old no matter what or how I eat or exercise.

    1] I hardly poop at all on paleo (couple times a week – used to be once or twice per day). No diarrhea, and stools are firmer than they used to be – since I used to eat gluten grains, which give me crazy gas and loose stools.
    2]On SAD I had some symptoms of hypothyroid (low energy, drowsiness, oversleeping, constantly cold). That has improved drastically on a paleo regimen. For the first time in my life I have warm hands and feet, even during this cold snap, and am able to wake refreshed from 6 hours of sleep (used to be 10 wasn’t enough).
    3]Cholesterol remains about the same – too low! But with good ratios. I have always tested under 160, non-fasting or fasting doesn’t make a difference. At last check total was 156, LDL was 74, HDL was 71, trigs 54.

    A couple minor menstrual irregularities that began with a poor decision to be vegetarian a few years ago before I was educated about nutrition – now gone. I have my 29-day cycle and 3 day period (no mid-cycle spotting!) back, praise Dog.

  69. Richard,

    Great post. Progress requires the strength and character to admit weakness and deal with cognitive dissonance. I respect what you are doing here. It will help everyone learn a little more by trial and error. And I think a poll would be a great idea.

    I think a poll would be a great way to get some data and learn more.

  70. Well once again, I have absolutely nothing scientific to contribute – just my own little thoughts.
    Tonight for the first time in forever I actually had some berries. I had a big bowl of em with a bit of cream and cinnamon and walnuts thrown in for good measure. And I’m actually satisfied and full. That hasn’t happened in AGES. Which is so weird since satisfaction came from eating more carbs….curiouser and curiouser…
    my ratios for the day ended up being 10/10/80 approx. Normally I’m higher in protein.
    Soooo this led me to some hypothesizing…
    Do you guys think women could have potentially evolved to eat less meat and more plant matter? My logic is that they typically were not the ones out hunting, correct? They would have been more of the gatherers back in the day, yes?
    Just a thought.

    • Often considered that very point – bit of a guess, but you can imagine the males out hunting a lot of the day and perhaps selfishly eating some of the best bits before bringing it back. And the females gathering what they could find in the local area and eating it. So perhaps the first chat up line from man to woman was “Me hunter, you gatherer” or words to that effect.

  71. I can’t even begin to comment on the Thyroid stuff but here are a few observations:….

    What many people think is a “Low Carb” diet is not Low Carb at all….just the other day one of my aathletes told me her overweight work colleague mentioned she was on Low Carb diet supervised by a Doctor and Nutritionist and their recommendations for Low Carb was 48 grams of carbohyrates per meal!….For a sedentary person 48 grams is high per day if they are serious about losing weight, for an athlete Low CArb can be 100-150 grams per day so you can see how the definition can vary….
    On the Triglycerides and Cholesterol…..if the Triglycerides are going up on a Paleo Diet one should have a healthy skepticism….this is because the central molecule of a Triglyceride is Glycerol 3-phosphate and is necessary to form the Triglyceride……guess where the source for this comes from…..carbs….so if the Trigycerides are high the first thing to look at is exactly what the person is eating ….they may be unknowingly eating a lot more carbs than they realize. This is also why when doing a “Proper Paleo” diet Triglyceride levels plummet even when Cholesterol levels remain relatively stable.

  72. Richard,
    Linked this post on my blog. I suspect we have not heard the last of this one. I tried in my own ‘unscientific” way to adress some of the issues. Thanks for posting!

    Dad just came back with a new supply of fish liver. That’s the only depression I suffer from…..when I run out and have to wait to get re-stocked ;-)

    Marc

  73. I haven’t had any of the listed problems. My only disappointment is that my body is a hardgainer that insists on keeping a soft padded layer of subcutaneous fat on the chest and around the waist, regardless of diet. I’ve been weight training with a trainer, 3 days a week, for 6 years, and after putting on almost 20 pounds of muscle in the first few years, strength is still slowly creeping up, but muscle gain has stopped. 15% body fat is certainly not excessive or unhealthy, but if it were 8-10%, I’d have the sexy body of a slender college-aged swimmer. 48 years old and wants to look like a youngin… mid-life crisis?

    • Alex, this is exactly my situation. Upon reading the various paleo websites, a male is left with the impression that 10% BF is inevitable if you simply stick with the program. Genetic variation applies here, too, unfortunately. I guess some bodies just prefer more fat, even though that set point amount is not not needed as an extra energy reserve, given how long we could survive on 10% BF. BTW, I’m 46, so almost the same age. And yes, we do start to cross a line into our perception of body image. But we still keep trying…sometimes because blogs keep promoting the idea that it should occur if you keep at it long enough, partly because we are the victim of advertising (but, then, women could tell us a thing or two about unrealistic body image and advertising!).

  74. Dr. Eades makes a very valid point, but I do think that some of the problems being reported are being caused by the diet.

    From an evolutionary standpoint, it makes little sense to go on an extended period of caloric restriction. (Just as it makes evolutionary little sense to consume large amounts of refined carbs and sugars.) And certain low carb diets, especially when practiced in a chronic manner, usually does lead to caloric restriction.

    Our ancestors certainly starved on a regular basis, but if they did so most of the time, our species would have developed better mechanisms to store energy. Several animal species go months without eating, after a large meal.

    I think that extended caloric restriction, like anything else, triggers compensatory mechanisms. Our body adapts through hormonal changes, which in the short term may feel great, but in the long term may put stress on the hormonal glands involved.

    Some low carb diets will typically be associated with caloric restriction because of the higher satiety of low carb foods (fat and protein). Caloric restriction will in turn lead to some hormonal responses – e.g., an increase in circulating adrenaline; probably an evolutionary response to improve foraging success.

    Over time, adrenal glands will be stressed, and several problems will ensue. The same can be said about the thyroid glands.

    If we really want to model our modern lives on the lives of our ancestors, we have to start by adding some randomness into our diet and lifestyle. Anything that is done in a chronic way is unlikely to be very natural.

  75. John Speno says:

    For the high cholesterol person, I’ll quote Dr. Kurt “PaleNü” Harris who said “You need to see an endocrinologist.”

  76. Richard,

    WRT diarrhea, another possible mechanism is the overwhelming of liver apoproteins. In order to be metabolized, intracellular triglycerides (mobilized from body fat) as well as dietary fats have to be attached to a lipid acceptor protein (called an apoprotein). This is needed to make the fat soluble in a liquid environment. Without this solubility, the fat cannot be absorbed for metabolic processing and will remain in the gut where it has both an osmotic and lubricating effect. This can produce an explosive diarrhea that is foul smelling and floats on the surface. This is the “steatorrhea” that someone mentioned earlier.

    Interestingly, the production of these lipid accepting proteins in the liver can be compromised by chronic consumption of fructose or alcohol. This is the reason that “fatty liver” occurs in alcoholism and those with chronic refined carb consumption. When someone in this condition goes paleo, they are both increasing their fat intake, and they are mobilizing body fat at the same time. This can present more fat through the splancnic circulation than can be processed at one time. Over time, this situation will correct itself, but there will be intermittent periods where “the system gets overwhelmed”. Consider it NOT a bad side effect of paleo as much as a withdrawl syndrome associated with going off the SAD.

    WRT the depression issue, I would track these symptoms in relation to your physical training. Commonly this is a sign of poor recovery. During high intensity exercise large amounts of catecholemines are consumed. Normally, these can be quickly replenished, but in an overtrained state, methyl groups can become in short supply as they are used to replinish peripheral catechol supplies. This is just my personal theory, but I believe this state can leave a shortage of methyl groups for recharging central serotonin and norepinephrine stores. I have found that 400-800mg of SAMe can donate enough methyl groups to snap me out of it. Regardless of my theory, my n=1 strongly correlates depression with overtraining.

    Great Post. Such honesty takes the “religiosity” out of the paleo approach.

    Doug McGuff

    • Dr. Doug:

      That explanation for the diarrhea is the most likely one I’ve heard. I’ve had it come on after a night of drinking alcohol, and I’ve been fine. But then you have to factor in dietary fat consumption for dinner, and, did you body happen to dump fat into your system owing to a fast, a heavy workout, or just cause it was time to go swoosh. Too many variables to easily track for me, but it makes a lot of sense.

      Thanks.

    • Jean Finet says:

      I’ve been seeing the term “n=1″ now at a couple of paleo/low-carb different sites. I have an idea of what is meant, but is there a more precise definition?

      Thanks.

    • Thank you Dr. McGuff, my own experience would seem to support your theory. I am Paleo for 120 days now, with no weight loss, but obvious body composition changes, and I think as my body processes the body fat I am experiencing exactly what you are saying.

      I have also begun to have gall bladder attacks, and have my own theory that increased bile production due to higher quality fat intake has begun to shift existing stones around, and perhaps begun to purge them. I did not know I had any until now, although some discomfort before I went Paleo is now explained (dull ache under right side of rib cage). I did not have an ultrasound but I did have the child-birth-like pain experience and I am not a woman. I do not have any symptoms of jaundice or anything else to indicate a stone is blocking a duct. I simply believe the diet change has caused some activity in the ‘ol gall bladder and would like to believe it is positive not dangerous. Does this make sense? I would rather not get an ultrasound, then given the inevitable prescription for surgery.

  77. Dr McGuff,

    Thank you for the “science” explanation behind it (diarrea). I did a post today on my blog about it. I did not know the science, but from personal experimentation, I came to the conclusion also.
    Thank you again!

    Marc

  78. Thanks V, but that’s going to be WAY too complex for this poll. Perhaps someone else can take that on.

  79. Kind of skimmed through all the responses but didn’t see any mention of diarrhea caused by overconsumption of the sugar alcohols such as xylitol. Only a couple of sticks of gum can make my gut explode shortly afterwards. There was a European study done not long ago that looked at people with weight loss and chronic diarrhea – wasn’t it concluded that it was all caused by relatively normal amounts of chewing gum?

  80. I used to chew sugarfree gum as a kid, and it did indeed give me the runs. Now they put the warning about digestive trouble right on the package of lots of things (my pre-diabetic mother-in-law eats a lot of it). I haven’t had artificial sweeteners in years though.

  81. Webster Webski says:

    Richard, could be one of your best posts ever, in my view! You’ve got the honesty to recognize that there might be certain problems with the way other people either react to or implement their version of “paleo” approach/lifestyle. And all this despite your own stellar blood work! In my view, the real contribution to the debate and the paleo lifestyle comes exactly from posts/question like the ones you posted here. For example, among other things, and as you and Don mentioned (there was also Cordain’s review paper on the subject), there is a quite a difference between LDL levels between real “primitives” (using WP’s definition) and many (not all) modern paleo eaters..
    Thank you for your good work and open mind!

  82. Thank you Richard for this honest and much needed post. After attempting Paleo twice and totally crashing within 3 weeks, I started to search for information on people that don’t do well eating this way, and could find essentially nothing. I know a lot of people do very well on a Paleo diet but it seems like those who don’t are hesitant to say it because the ones who do ar fiercely loyal.

    I’d say for most people just starting out if you give them the prescription: meat, eggs, veggies, nuts, seeds, some fruit, little starch, no sugar, that by default they end up on pretty low carb diet. Of course, as you mentioned, you can add starch back in an still follow a Paleo way of eating. After adding some sweet potato back daily at a couple meals I’m feeling lots better.

    I haven’t seen any commenters mention the effects of serotonin, particularly related to #’s 1 and 3. I have found that for me (granted, I’m a woman), eating a paleo diet (a fairly low carb one), really messes with my serotonin production. I also wanted to recommend the Julia Ross books, as I have found her research and amino acid protocol very helpful in alleviating troubling symptoms that can pop up with this type of lifestyle change.

    • Due to some private emails and other poking around, I’m highly suspicious that a lot of people go iodine deficient on paleo. Perhaps the high sodium content in many processed foods — if it’s iodized — at least keeps people in sufficient iodine, but that’s just speculation. There may be other factors of SAD that mask or ameliorate iodine deficiency.

      At any rate, I’ll blog about it once I’ve gathered more info and done some good ol’ self experimenting. I’ve got a bottle of Iodoral on order from Amazon. Each pill contains 12.5 mg iodine / iodide. That’s a HUGE amount compared to the USDA of something like 150 mcg. However, it’s about equivalent to the average iodine intake in Japan, from high consumption of seaweed.

      • I’m interested to know if you plan on starting iodine in combination with, or in place of, your Armour dose. And I think a great many people would be interested in hearing your experience with it =)

      • I’m going to add 12.5mg of iodine to the existing Armor dose. While my T panel is now good, I still have cold hands & feet very often.

  83. Interesting. I added an iodine supplement (kelp, actually) a week ago after someone told me it would help with another issue I had and it occurred to me that I only use sea salt and have been for some months.

    • The problem is that you’ve got to take a LOT of kelp to get even a few mg iodine. One person who emailed me had been on that sort of regime for a couple of weeks and got no results. Iodoral came and huge results overnight.

  84. About the depression aspect, is it possible that since all of us are health conscious (maybe excessively), that we’ve developed some sort of hyper-sensitivity to our bodies and expect that living the Paleo way will be a panacea? Hence, when we still have problems, it may lead to anxiety or depression.

    I know I’m one – definitely over-sensitive to my health and the way I’m feeling sometimes (eg. scanning my body for unusual sensations, pains, etc.).

  85. I’ve had some of the same problems, and reading over some of the comments I think you guys have some good points, I have had some problems with depression, anxiety and lack of motivation, It might be hypoglycemia or hypothyroidism or both, not sure which. Im going to try to take some iodine supplements as well as eat more fat. I did have depression really bad back when I was in high school and have had some pretty bad episodes recently.

    Though im primarily just speculating it could be from my transition to diet, I’ve lost 60 lbs total, and gained quite a bit of muscle mass, most of it was on a non paleo diet though, and only recently have gone paleo. I’ve combined a Paleo diet with HIT in order to lose more weight though, I should be happy though with results I’ve gotten thus far, I weigh less now then I did when I was in high school (im fairly young at 21 and was 260 lbs in high school and am now 240).

    I’ve only had one problem with diarrhea and that was once or twice after a day of drinking and having some carbs, I’ve been working on going as low carb as possible for weight loss purposes, though lately I’ve gotten off my diet.

    In response to Mike Palmer’s comment before me, it might be to some extent the truth, I’ve been on this quest for a long time to lose weight, since I’ve been overweight much of my life, and only in the past year or so been able to lose a lot of weight but am still not to my ideal, sexy toned muscular body. Thanks for the discussion and bringing this up though, lucky for me I found it at the right time!

    • Good for you Jared. At 21, you’re way ahead of the game. Most people aren’t educating themselves to this extent and self-experimenting until in their late 30s & 40s.

  86. Many of these problems can be solved by re-introducing a little starch daily at each meal. I have had good results cooking up a large Sweet Potato (Wrap in Foil) and cook for 1hour until soft. I split it into 2-3 portions and have it with each of my main meals daily (mash it up with coconut oil). It will take strain of your adrenal-thyroid axis and allow for better general functioning. I am talking 20-30 grams of starch with main meals. Limit the fruit and see how you feel I bet that energy and drive will be up as well as feel good. I think this is the way to go with Paleo especially after you have been on it a while and reached a desired level of weight and health.

    • Chris,

      Thanks for your tip – I’ve eaten a sweet potato (in parts as you mention) the last two days and I find that my energy levels are higher and stable. I think you may have found the missing link in my quest for healthy eating and feeling good. Cheers!

      Mike

  87. Great post Richard.

    I’ve been semi-Paleo (no grains, no plant-oils, but I do eat cheese and greek yoghurt) for 8 months. Trying to eat as much organic fare as I can find, at least for veggies, meat is usually still the usual grain fed stuff. Results:

    1. First 3 months: Much weight lost (150 down to 133) even though I’m 6’2″ (was too thin already, now way too thin, but can’t seem to add weight in spite of high fat intake). Last 2 months adding some extra carbs and added 2 pounds, but stable now at 135.
    2. Last 3 months: Continuous muscle ache in my legs and some stings in arms+legs regularly. Never heard of this before, maybe I lost too much weight? I stopped my intense weight training in the last 2 months but the continuous muscle ache remains. If anybody’s heard of this or has any idea I’m very interested…
    3. Prostate issues (at 30 years old), maybe caused by low estrogen+high testosterone? Will see a urologist shortly to see what’s going on, could certainly be unrelated to Paleo (surveillance bias etc).

    Maybe interesting for women reading this: My girlfriend is much less strict Paleo (eats bread for lunch, etc), but she’s on birth control pills and within 2 months, reported that her period was starting ever sooner, eventually by a full day (so it’s a full extra day now). Now, after 8 months, she reports some spotting as well. Maybe also related to low estrogen, since BCP works by increasing estrogen?

    • I hope you have e-mail notification or somehting you you can get this but sounds like you have a magnesium defficiency (Hard to detect on blood tests and most people are borderline deficient)…. or… too much potassium? but that’s almost impossible unless you’re on blood pressure meds or eating a ton of potassium-rich foods… so I blame the magnesium. If you’re on a low-salt diet perhaps that’s the problem too… Rapid weight loss also means rapid electrolyte loss. And it sounds like you need more electrolytes…

      Prostate issues? Very strange. Perhaps you’re a genetic outlier for prostate disease? That would suck.

      Is your gf (or you for that matter) eating soy? If so, stop immediately; reproductive/fertility irregularities is a side effect – so is brain shrinkage/memory loss/cognitive decline, iodine deficiency/hypothyroid, and disturbances in sex hormone regulation from the phytoestrogens soybeans have (designed to make both males and females infertile)

      I’ve heard paleo can change menses/make it heavier, this is a side-effect of being healthy and eating essential fats; menses gets lighter and more irregular/stops when people are on unhealthy diets. However, your gf’s troubles could be caused by a lot of things… like environmental toxins

      I’m replying almost 9 months later; hope your problems have been resolved.

  88. Guys, I have an interessting theory

    About the diaria problem, my dad told me that, you are only allowed to eat the meat of the male animal. And that this has been common in Arabic cultures for many centuries. He says that the meat of the female animal causes the diarhea.

    So how do you know if wether your meat is form male/female source?
    Its quite hard to tell, some people can see it by the eye directly from the meat, but 99% doesn’t .
    However, the structure of the meat is different, the taste also differs.

    Maybe somebody could do some experimenting
    with this? By only eating Male- meats for like 2 weeks and check if you still get diarhea.
    I really think this could be the part of the solution, if the theory seems to check out, I don’t know. But what I do know is that the paleo people eat so much meat that I wouldn’t be surprised if this would acutally solve the problem.

    At some “Halal” butchers you can buy male-meats
    give it a try, or ask them about it.

    I’

    • umm… wow, amazing…….. you actually believe unfounded folklore about female animals causing health problems… from a set of cultures that currently hates females as much as our own medieval cultures used to? The same arabic cultre that used to – and some still do – stone women to death for committing adultery? What a coincidence that female animals are also to blame…

      Seriously? And you believe this?

      At best, the growth, sex and stress hormones would have an effect on the shaping and taste of the muscle meat, as well as the nutrients and diet fed to the animal…

  89. my spouse is gluten intolerant (not celiac). Trace gluten exposure leads to depression even when eating plenty of fat. Other food intolerances (casein, egg) also. Digestive symptoms are rare. How do you know if you have identifies all your food intolerances? no idea….
    The cleaner the diet, the better. Obviously, YMMV.

    • Stan K. says:

      enterolab.com can do the lab analysis
      of food sensitivities.

      Please see Nora Gedgaudas’s book
      for more great info on primal diet.
      She is the leading expert on this IMHO.

  90. Probing further into this post and others experiences – does one derive moderate benefits from “moderate cardio” as opposed to low cardio if one is disciplined? If an abundance of processed sugars and overprocessed flours are still eliminated reduced.

    I’m still on my Paleo journey. The weight loss is good, didn’t need to lose to much but I look visibly different at 185 instead of 195.

    However, so far, the lack of variety from a strict PAleo is still driving me nuts.

    If one allows themselves to eat some carbs (sweet potatoes, rice, whole bread, etc) for example every other day does
    1. It still cause insulin spikes? and
    2. Will it cause a rapid weight gain and
    3. Will it cause the hunger cravings to return? and
    4. Will the infamous degenerative disease problems hit once I’m in my 40s?

    Regards,

    • William:

      Not sure what you mean by the moderate vs. low cardio, but onto your question, about adding in foods, it really depends on the individual. I stay away from grains because of the autoimmune=inflammation aspects (you don’t need to be full blown celiac to suffer). Otherwise, if you are at or near your weight goal, you ought to be able to experiment with some starches, i.e., potatoes of various kinds, squashes, and other starchy foods.

      Give it a shot. See how you feel, see how it performs.

  91. Richard,

    Firstly, excellent blog – love ya work!

    Just a comment on the diarrhoea (note – New Zealand spelling in case you think I can’t spell!). While it isn’t something I suffer from regularly (and certainly less so since going Paleo), I do wonder we have been conditioned into thinking it is abnormal & therefore we unneccessarily get a bit paranoid about it? Certainly, long term diarrhoea isn’t a normal state & will have an impact on health. However, short bouts occasionally are possibly part of the body’s defenses when it comes to eliminating something in the GI tract that shouldn’t be there.

    I strongly believe that following a Paleo dietery platform makes an individuals system a lot more sensitive to ‘disturbances’. I liken it to a formula one car… very highly tuned, great performance, but on a knife edge the whole time – it doesn’t take much to upset the overall balance. So things that might have been ‘tolerated’ previously, are immediately flushed out. And by tolerated, I mean that on a SAD, one’s system might have been so bunged up & sluggish that bouts of diarrhoea might not have occurred frequently (by comparison at least).

    Another theory could be that it takes some time for the GI tract to upregulate itself enough to handle the fat load. It may be similar to megadosing vitamin C – if you aren’t used to it, relatively low doses of vitamin C induce diarrhoea. But over time, tolerance can be increased & it isn’t unheard of for people to be taking 8-10g with no problems. Perhaps fat is the same.

    Lastly, how often does anyone really compare notes on their bowel moevements? One thing I have noticed with the ‘Paleo community’ is that they are a relatively open bunch. It might be easy for us to think that regular diarrhoea is a potential negative of our chosen eating plan when in actuality, we suffer far less than those loading up on junk day in, day out, swinging between bouts of diarrhoea & feeling like they are trying to pass a wardrobe.

    While we might not view this bodily function as pleasant, it may indeed be normal. There is a whole pharmacuetical industry based around supressing normal bodily functions that occur for a reason (coughing, snotty noses, etc).

    Cheers,

    Jamie
    Christchurch, New Zealand

  92. A third possibility that comes to mind is that maybe after eating the SAD for so much of your life, something is just irreparably broken. Or broken badly enough that it will take a very long time to heal.

  93. Stan K. says:

    Hello folks

    I just wanted to add that Hashimoto’s disease may be caused by an immune
    system problem, and not a malfunctioning thyroid gland. Dr. Datis Kharrazian has
    a book out on this and is probably the most knowledgeable guy
    out there on thyroid. He says the majority of Hashi folks
    do not need thyroid treatment, but immune system
    regulation.

  94. I’ve been having GI issues with Paleo as well.

    I’ve been doing the paleo diet since March 1 as part of a 30 day challenge, and my plan is to stick with it. I am training for an IronMan in November, and I wanted to kick it up a notch as far as diet and getting the most out of training. (Bob Seebohar from the OTC is putting his athletes on a diet very similar to the Paleo Diet for Athletes, which is what I’m training from.)

    I come from the blood type diet (type A) previously. Since I started Paleo for Athletes, I’ve dropped 16 pounds and leaned out to more of a triathlete’s build. (6’9″, 201 LBS as of this morning.) I was considering adding Brown Rice and oats back to my diet, but I don’t know if that would be a good idea at this point. I want to get the GI thing under control before August. My kineseologist and acupuncturist both say there’s something up with my liver and my gallbladder – I’m on two supplements before meals, and I’m also taking Jarro and Aminos in the morning. Even after all the adjustments, I’m still having the GI issues. The kineseiologist thinks that it’s stress related, and that I’m using my brain too much and not giving it enough rest with all the training I do.

    I haven’t had my blood work done for a little over a year, and it might be time to do it again while I’m on this part of the diet to see what’s up. Maybe I should slam a Kombucha and hope for the best. :

  95. Hello,

    I’ve just recently discovered the Paleo Diet – where have I been?

    The real reason I went on the PD was because of a severe case of hives. I’ve had hives (covering say 50%+ of all my skin) for almost 2 months now. They are getting markedly better – they come and go now and mostly break out at night (fun for me). I’ve only been on PD for 1 and 1/2 weeks so not sure if that is coincidental or not. However, they are not gone. I figured this was a good and quick way to determine if I have a dairy or wheat allergy (common allergens for hives). I’ve tried most western medicines including prednisone, dioxapin, hydroxizine and good old Benadryl (which incidentally seems to work the best). I’ve thrown all that out and am trying diet.

    I’m a convert to PD. It makes very good sense.

    Has anyone had experience with hives and PD? Fellow hive-sufferers, you know who you are!

    Thanks.
    Tina

  96. Perhaps a little late in commenting, but want to add that paleo’s not all fun and games for me anymore.
    Everything about it suits me philosophically and I’ve been eating this way for about 5 years. I lost 15 pounds initially and have recycled another 15 ever since then. I am nowhere near my goal and it’s difficult after this amount of time to hold my head up and say paleo is working. It is not working, and a ton of weight is lifted from my shoulders as I admit that.
    I have had energy highs and, starting this winter, energy lows. Something happened very recently that made me realize something serious was happening in my body, and that was extreme fatigue. Again, I have been following the same diet for 5 years. I am not perfect on it, but good enough. But now I think I’ve screwed up the adrenals and thyroid.
    I’ve seen comments above that suggest those with a similar story realized they had hypothyroidism prior to paleo, however, that is very much not the case with me. This dry skin, fatigue, incredible mood swings, poor sleep, foggy thinking etc. is new. And developed this winter, while eating paleo.
    I have tweaked and tweaked. I have fasted. I have added supplements and eliminated fruits. I have increased my activity and changed my attitude. I have spent copious amounts of money on whole, organic, free-range and grass fed foods and on a number of philosophical and diet-related books. I have accepted that it’s all my fault and must be doing something wrong in that I have not turned into Grokette.
    But now I’m just really upset that it’s not working and am realizing it will never work. How much more tweaking does a person have to do? How much more time do I have to put into it? How much more money? Do I have to buy the cookbook too?
    Theoretically, I should just be able to eat as my early ancestors did and I will have strength, stamina, courage, beauty, health, intelligence!
    But I think that is just available for people who have never had a weight problem, or have had a one time weight problem which they dealt with and were fit ever since.
    In any event, it’s not working for me- an insulin resistant, 30 year dieter.
    Philosophically it makes perfect sense, so I will continue to eat this way. But cure for what ails me? Nope.
    I’ve read the blogs of many people who, although they might not have had the exact experience I’ve had, are also struggling. Who knows what percentage of adherents are not succeeding? You can’t really tell from the blogosphere because I’ve noticed that many who don’t succeed just stop blogging.
    Anyway, it’s a Nikoley-style rant, admittedly not as interesting. But as you say, Richard, it’s important to admit the failures.

    • Andrea, have you tried upping your carb levels, via starch and perhaps some fruit, maybe up to 100-150g per day?

      While I didn’t have to go to that much, I did three things basically that completely reversed my issues with moodiness and cold hands/feet (I didn’t have energy problems other than normal occasional tiredness where just some extra sleep was called for):

      1. Iodine supps. Initially Iordoral at 12.5 mg which I have now cut in half. I just break the pill in half & toss the one half back in the bottle.

      2. More seafood & shellfish in my diet, at least twice per week in some form.

      3. More carbs via starch, usually potatoes and now, sweet potatoes.

      4. Liver and/or pate of some form 1-2 times per week. It’s nature’s multi-vitamin.

    • Also, fasting is stressful to your adrenals – stop fasting and don’t skip meals. Adding some fruit or starch helps too – like Richard said, 100-150g a day. I usually use fruit for two meals and root veggies for one meal, and I eat about 100g a carb a day, which includes all the green veggies I want. I’m also eating less muscle meat and more bone broths and more fat. I’m working up to organs, and I eat marrow now and then.

      Don’t crack the whip on yourself to exercise. I found that if I was fatigued and foggy, exercising pretty vigorously would make me feel better…for a while. Then I’d wake up at 4am all hot and have high (for me) blood glucose in the morning. These are symptoms of cortisol issues.

      The iodine helped me at first, and then I got worse. I wound up taking dessicated thyroid, and it’s really helping. I’ve had thyroid symptoms for at least fifteen years and had taken various glandulars on and off, but now I’m using them consistently and charting the results, and I’m sure I’m doing it right for me. I had to cut way, way back on iodine to stop my hair falling out and my neck from feeling kind of compressed(?).

      If you’ve been eating low-carb a long time, I know it sounds terrifying to add back tubers and fruit, but I actually have less hunger on *less* food over all. I never would have believed it if I hadn’t tried it. My weight is trending downwards. I exercise every other day, but only do my serious strength workout twice a week. The other exercise days are hiking (it’s hilly here, so it’s not just walking on a flat surface) and hatha yoga. I backpack for fun, and the yoga really helps with all the little muscles you use when rockhopping or hiking on uneven surfaces, especially if you’re carrying a pack.

  97. @Andrea: It sounds like me, after about three being completely happy with Paleo, I started to gain weight. I hadn’t changed anything, although I had been tweaking during my Paleo time a lot also. I was very happy with it: I lost weight until my ideal weight, I looked good, I felt good…I had found IT, after trying many ways of eating and dieting. BUT until September last year, I was hungry again and I slowly started to gain weight, not much, but still….and after reading The Gabriel Method, I realized that I had put a lot of stress on myself, just by being so strictly eating Paleo. Jon Gabriel explains very well that weight is not under the control of free will. It´s managed by UNconscious programs, and yes you may control it for a while, but not in the long run. So I let it all go and started to eat all the non Paleo food, like a lot fruit, pies, chocolate and I am happy: so much stress felt away from me. BUT I gained in 2 months about 10 Kilograms and 10 cm on my waist. My body wanted to be much fatter and I let it be. I still don´t eat junk food and no omega 6 oils, no bread, but a lot more sugar and fruit. I hadn´t noticed that I actually had longed for that stuff. I feel good, although I have to get used to my new looks. I am at a plateau now, so I reached my set point and don´t gain weight anymore. I still believe that unprocessed food is healthy, but my main point is that being strict with yourself is a battle, even when it is Paleo and it may hide the fact that you may have a lot higher set point then your artificial suppressed actual weight shows and someday the body takes over…..

  98. I notice that people assume that if X develops when on a paleo diet, the paleo diet caused X. This falls into post hoc ergo propter hoc (occurs after therefore caused by) fallacy. Funny how when people get diagnosed hypothyroid when on SAD, they don’t automatically say the SAD caused it, but if on an alternative diet, some seem inclined to blame the diet.

    While I agree that people may not get adequate iodide or other nutrients eating “paleo” depending on what they actually eat ( that’s why I provide sample diet analyses on my blog), I also recognize that we have many other influences on health, ranging from external toxin exposure to emotional distresses. Diet is very important to health but it is not everything, and I think many people underestimate the effect of cognitive-emotional factors on health.

    When you look at hunter-gatherer medicine, they use herbs and shamanism. The former treats physical ailments, and the latter treats ailments arising from pychological or social origins, using ritual and altered states of consciousness to induce a change of mind or release of pent psychological energy. Google Shamanism as neurotheology and evolutionary psychology to get a paper by Winkleman exploring this aspect of paleo life. http://www.public.asu.edu/~atmxw/absneuro.pdf

  99. diarrhea is an easy one: you aren’t eating enough fibrous veggies/fruit. they should make up about 2/3 of your food intake anyway to avoid acidity.

  100. AJBuendia says:

    I have experienced depression quite consistently and intensely, but in my case it came as a result of a dramatic change in lifestyle due to the minimal amount of cooking and food preparation that this diet requires for me, and due to having giving up liquor of all kinds.

    I do a version of this diet that is more strict and limited than anything I’ve read online, and I arrived at this way of doing it after experimenting with it in various forms since 2004.

    Cooking has always been my greatest pastime, and I have, for decades, enjoyed hours of cooking, drinking, and snacking in the evening, after work, in preparation for my always elaborate dinners. Since adopting the Paleo Diet, as I do it now, my nights have become pretty much “empty”. I have found myself with hours of nothing to do. This eventually forced me to look for new ways to spend my evenings, and it also forced me to get up, and to go to bed earlier, which for me, a late night person, for whom 2AM was the earliest bedtime, has been quite traumatizing.

    I feel the change also during the day, due to the fact that my lunches at work are mostly composed of fruit and nuts, and that I do not spend as much time eating (I eat my biggest, “meat meal of the day” at breakfast). I don’t really have meal times anymore, after breakfast, I pretty much just eat whenever I’m hungry, and it’s always a simple and small meal. Lunch is no longer a social activity either, since I can no longer find the right foods at restaurants and therefore, I don’t eat out anymore. I cook all my own food.

    Drinking, eating, cooking, shopping for food, occupies a lot of our time and is part of our social life. On this diet, at least the way I practice it, all this process is extremely simplified, and as a result, it leaves a lot of spare time in my life, that I never had before.

    I am slowly getting used to the new routine and lifestyle, but at first, I was so depressed that I was seriously assaulted by doubts as to my motivation for pursuing this diet. Thankfully, it’s gotten better, though occasionally I still miss my old routine.

  101. Max Hutchison says:

    Regarding # 4:

    I found this article on Dr. William Davis’ blog, The Heart Scan Blog:

    The Heart Scan Blog: “I lost 30 lbs and my triglycerides went . . . up?”

    http://heartscanblog.blogspot.com/2008/08/i-lost-30-lbs-and-my-triglycerides-went.html

    As others have similarly posted, Dr. Davis explains that when there is significant weight loss (hopefully due to a change to a healthier diet), there is a lot more mobilization of fat stores or triglycerides. This excess amount of triglycerides in the blood will lower HDL, dropping blood levels. But after some time, when the diet has been worked in and weight loss has leveled off/been stabilized, there will be less triglycerides in the blood and HDL will rise to normal levels again. Dr Davis calls this “transitional” changes in lipids.

  102. A Paleo diet rich in meat & fat forms a great foundation, upon which the added fat from your own body just puts you over the top. The most common experience from Paleos initially losing weight? “I feel great!”

  103. demmar says:

    i agree why don’t you try to go in this site…For more info

  104. I haven’t noticed any of the problems you mention, and I’ve been a Paleo eater for almost two years. Diarrhea is not an issue; I’m very regular and healthy in that department. I did lose a lot of weight — about 15 lbs., which for me was a lot, since I went from 125 lbs. to 110 lbs. But my energy has stayed high and I’m not depressed. I have a normal thyroid and my recent fasting cholesterol was 170 with an HDL of 81. My GERD went away too. I’m 58 years old! I look 45 and feel 25. I can’t explain the opposite kinds of problems you’re reporting, except that I do believe there is no “one size fits all” dietary approach. Genetics play a big role, ethnicity too… The only negative I’ve noticed with the Paleo approach is that I don’t have the kind of appetite I used to have and I have to force myself to eat sometimes. I have to work to keep my weight up and am working on strategies for doing that. One thing I know for sure is that I haven’t been exercising enough and addressing that will certainly increase my metabolism and my appetite. But gaining weight on the Paleo diet? Hard to believe. Not that I think you’re lying, I just think it comes back to the “one size fits all” fallacy. Unless of course the weight gainers are sneaking corn chips on the side…Ya never know.

  105. I’ve had problems with paleo. I don’t buy the whole “toxin” thing being released from fat. Before I did Paleo, I started a pretty healthful diet that was full of lean meat, some grains, good exercise, etc. I never had anything like diarrhea even though I’d lost 30 pounds and loads of fat from my body. I regained some of that weight and started to try to get back in the groove and try paleo. Why did I not have any intestinal problems when I lost a lot of weight and fat (where the toxins would supposedly be stored) when I kept eating grains and now that I’ve cut them entirely off I have big problems. I’m certainly no expert, but the toxin thing just doesn’t make sense for my own personal experience. Seems like the toxin thing is just s simple way that some people find to blame any problem upon. Just my own thought.

    • NoGluten says:

      Joe – it is possible that you have uncovered a food intolerance by changing your diet to Paleo. The most likely one is gluten, but it could be anything. If it is gluten, that could be a big factor in your on-going general health. So try to rule that one in or out first. If is gluten, even insanely small amounts could matter. By that I mean that taking the bun off of the burger may not work for you, using old kitchenware (pre-Paleo) may not work, vitamins with fillers may not work. Celiac.com has the details.

  106. I have seen fat release cause problems, and increase inflammation in some clients. It may be due to toxins or it may be arachidonic acid (a fatty acid stored in fat cells and when released into the blood stream becomes the building blocks of pro-inflammatory hormones) However it is usually bad for the first few weeks of dietary change and then it tends to settle.
    This issue usually causes constipation, headaches and flareups of any inflammation that person is prone to – like asthma or eczema. It can be dampened by large doses of omega 3 fish oil.

    Ongoing diarrhea probably has some other cause if weight is stable. Some fruits and veggies may be a problem in some people due to an inability to break them down properly.

  107. I experienced diarrhea for the first 3 or 4 weeks on a strict paleo diet. It was a pain in the ass (literally) but worth it. I’m regular now and never constipated. I suspect it might have something to do with the body getting used to less fiber from the grains? I ate “healthy” prior to eating Paleo as well but grains and legumes are horrible and should be eliminated from your diet 100%. Once you get thru the transition, you’ll love it. Once you’ve been paleo for 3+ months, grains will make you feel like complete crap :)

  108. Hi,
    I’ve been paleo for over a year now. And boy has it been great! I no longer have acne, but used to have very awful and inflamed acne and skin problems. While all of that is gone, I notice my sleep pattern has changed. I often wake up super early and go to bed really late. It’s like I have excess energy. I do crave carbs sometimes but I’m so scared that my acne will come back.

    If I were to have some type of carb, do you think I could have potatoes or sweet potatoes? Which one is better? I read that sweet potatoes are better. Also, what time should I eat them? I try to have fruit in the morning, and vegetables/nuts/ and protein the rest of the day.

    Any advice on acne and the paleo diet is welcome.

    • I’d say the likelihood is that your acne was caused by the inflammatory aspects of grains and or seed oils. That and refined sugar.

      Try the sweet potatoes. I don’t think it matters when you eat them.

      • Hi Richard,

        Thank you for replying. I haven’t tried adding it back into my diet yet. I tried parsnips, but I started breaking out. They tasted so good too, but I’m trying yams right now. I just had a very small one earlier. It was good and for some reason starchy carbs have been the only thing that fill me up. I’m never full on the paleo diet. I’m not sure if it’s all in my head or not. I guess I’m afraid of eating too much fat.

        I will try sweet potatoes next though.

        Thank you again. I’ll keep you updated! I’m glad I have someone to talk about this with that doesn’t think I’m crazy (dermatologist, doctor, ect).

  109. Great thread. As for the diarrhea issue, any one examined whether caffeine/coffee could be playing a role?

    I’ve experience periodic issues as well, seems like I get a cycle of it every week or so and my best guess is stress related so as a coffee drinker it has me thinking what I can do on that front to help?

  110. I am still having problems, but things seem to be getting much better, not sure if its more psychological or physical, ever since I’ve started dieting this way I havent quite felt the same. But I think it may have to do with a couple of factors.

    I though I may be lactose intolerant but I think my stomach doesnt like coconut milk or coconut products much, ive tried having coconut milk yogurt and adding coconut cream to my tea but have gotten sick a couple of times.

    I know this is a high fat diet, but is there any way you can have too much, I dont mean to be paranoid but it seems like my weight has been at about the same in some time. I also haven’t really had much of a paleo high. It could be I just need to get out and exercise more, im just not sure.

    I think my job has something to do with it, my job sorta makes me miserable and I am working on getting out of there ASAP.

    • Also, are you sleeping enough? 7-9 hours a night is required by most people, and the hours from 10pm-1am are when much of the important restorative work is done. If you aren’t getting proper sleep, all the dietary changes in the world won’t make you feel better.

      After you’ve lost weight, if you keep eating the same food and doing the same activities you will stop losing because your body adapts and also because you need less to carry around your new, lower weight. You need to change something up.

      Personally, I would shift some of my intake out of fat and into protein. If you’re consuming liquid calories (protein shakes or smoothies, etc), cut that. Cut back on fruit if you eat a lot of it.

  111. Am I confused? Oh yes. I really don’t know what to believe anymore, and I have no idea of what an optimal range — for me, personally — would be in terms of macronutrient breakdowns.

    But on my journey I’ve abandoned soda, cake, potato chips, and all that garbage loaded with unhealthy fats and refined carbs and sugars, and no matter where I go from here on out, I am infinitely better off than I was 5 years ago. It seems stupidly simple that junk food is junk, but I think a lot of people — myself included — who get deeply into nuances of nutrition tend to forget how our lives were if/when we lived on junk for food.

    Here I am worrying about macronutrient breakdowns, but look at me 5 years ago: scarfing down pepperoni, hot dogs, heavily processed cheese, potato chips, soda, fast food, getting little to no exercise, binging on candy…I was only a tiny bit overweight once in my life, and that was when I was on antipsychotic medication. For almost my entire life, my world has been a living psychological hell that I really can’t assign any other word to how it felt but “torture.”

    I don’t doubt for one second that my diet had a LOT to do with that. It obviously was definitely not the only thing, but since dropping all that crap and eating real food and exercising and actually feeling mental stability and clarity for the first time in my life at 20 years old…

    …well, let’s put it this way. I had pneumonia and scarlet fever as a kid, was sick ALL the time, physically and mentally, and that lasted all through middle school, high school, and my few months of college before I failed 4 out of 5 classes and dropped out and had multiple nervous breakdowns and recently a psychotic episode.

    I am really not meaning to get too much into my personal life here, but it’s important for realizing a major truth I see: look at the blessing of having already changed your lifestyle for the better.

    You can drop paleo or primal and go to something else, but it will never really leave you. These lessons stick with you. And if there are any repercussions of a paleo or primal diet, I can’t imagine that they’re worse than the SAD, especially filled with sugary cereals and stuff that I now can’t even imagine how it passes for “food.” It seems to me like any potential damage any diet can cause would pale in comparison to the damage done by regularly binging on soda, cake, chips, Twinkies and the like.

    To conclude: I’m not taking sides, and I still have a lot of thinking to do. But I would like anyone who reads this to just take a moment to appreciate what they already have: that you’re farther along in life than you were years ago, and have made progress. And even if your diet has permanently damaged you in some way or another, think of it this way: you care enough about your body and your life to value both of them. Not loving yourself at all and abusing yourself with reckless abandon without caring what happens to you — I’ve been there — is one of the saddest places I personally can imagine.

    I wish everyone here well, and keep researching and experimenting. I plan on doing the same :D Just trying to take a moment to collect myself by reminding myself that even though I am as confused as ever, I’m in a better place than I was before, if only on a spiritual level (though that very well may be the most important, after all; who knows?).

    Thanks for sharing :) Hope you’re doing well!

    • Mike Palmer says:

      Nice post, Matt. You’re right – it’s funny to step back from the fussing about a couple grams of carbs here or my Magnesium/Calcium levels, etc., when just a few years ago, it was an all-out assault on the body with nary a second thought. I guess it’s like climbing a mountain, you don’t appreciate the progress until you turn around see how far you’ve come.

      Also about the confusion, since embarking on this journey to healthier living, I have thrown out my original fact/non-fact dichotomy – realizing that all these “facts” about nutrition and health are theories, interpretations, biased opinions, or just personal accounts. It’s easy to forget that we are all individuals and that scientists are just human.

      Thank you for the sharing and good luck!

  112. NoGluten says:

    >I though I may be lactose intolerant but I think my stomach doesnt like coconut milk or coconut products >much, ive tried having coconut milk yogurt and adding coconut cream to my tea but have gotten sick a couple >of times.

    My spouse has the problem intermittently. If he makes a gluten mistake, he will have trouble with coconut (all forms) for about 2 weeks. Then he can go back to eating coconut without any issues. He reacts to very small, as in trace, amounts of gluten.

Trackbacks

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