That Paleo Study ...

Random bump because this is making the rounds again due to being published in the IJES this month: 

Original Publish Date:  5/14/2013

A student, Eric Trexler, at Ohio State did a study on the paleo "lifestyle" for what appears to be an undergraduate honors thesis towards his degree in Exercise Science.  Here is the link to the full text:  Paleolithic Diet is Associated With Unfavorable Changes to Blood Lipids in Healthy Subjects.  So I thought I'd put up a quick blog with some thoughts, because a tweet is just a tweet and I've seen a few comments reading into my supposed motivations for tweeting this.  So ... let's discuss a bit and include some criticisms I've seen elsewhere on the web.

1.  It's not a peer reviewed article or a graduate thesis.  This is true so it hasn't undergone rigorous scrutiny, that shouldn't stop you or I from reviewing it ourselves and seeing if it provides any worthwhile information.

2.  The study is confounded with participation in CrossFit, yet results are attributed to the diet only ... at least this is what the title implies.   Since there is at least a sizeable subset for whom CrossFit and Paleo are synonymous with "being paleo" I might suggest that the "Paleolithic Diet" be replaced with "Popular Paleo Lifestyle".

3.  "So the subjects were told to go forth and eat Paleo? Were guidelines more specific and compliance verified?"  -- this was a response on Twitter, and a valid one.  There is discussion of prior studies of the Paleo diet and the inconsistencies between the various prescribed diets.   Here is the diet description:
A Paleolithic diet, as first described by Eaton and Konner, was implemented for all study participants. Subjects were advised to increase their consumption of lean meat, fish, eggs, nuts, fruit, and vegetables and were instructed to strictly avoid all grains, dairy products, and legumes. All modern, processed foods including any form of processed sugar, soft drinks, and coffees were also excluded from the diets of the subjects.  
Say what??? No coffee!!!  There were no specific compositional recommendations for macro or plant v. animal intake.  As to compliance and evaluation:
Dietary recall logs were distributed to all subjects during the last [tenth] week of the dietary intervention and subjects were asked to record all food and liquids over three days, including a weekend day. 
For better or worse, this protocol is similar to that used in dietary interventions too numerous to count. However:
Our study does have some limitations. A low number of diet logs were returned and deemed sufficient for analysis (n = 8), which calls into question how accurately the returned logs portray the dietary intake of the entire group. Also, our study did not impose a high level of control over our subjects— meals were not prepared for subjects, nor did the subjects stay in a metabolic ward for the duration of the study.
I am concerned that such a small number of the participants returned dietary logs. Only 8 of 43 is less than 20% and I would say this brings into question the entire study in terms of the diet composition. Perhaps logs should have been distributed during week 5 so that those who failed to submit logs could be encouraged to do so during the following week. One wonders what the other 35 ate and/or if there was some reason (like "cheating" and having coffee with cream or butter) they didn't want to submit logs. In this regard this really is a weakness in this study that draws most of the results into question as to their usefulness.  I find that unfortunate as the relatively unstructured ad libitum nature of the diet prescribed, such as it was, already introduced this question of applicability.   However ... the authors stress that they wanted the diet to be "real life" and in this regard, it seems that all subjects at least followed some notion of the paleo diet.  

If any further publication of this study is in the works, I might suggest formally tabulating the dietary logs such as they are and perhaps doing the lipid analysis for reporters v. non-reporters to see if there are any significant differences.  The numbers might not be sufficient for statistical significance but it might be worth a look.  

4.  Unfavorable is In the Eye of the Beholder:  No doubt many will question the title of this article and it might surprise some that I would tend to agree.  The changes in lipids were not necessarily all that "significant" in the practical sense even though they reached the level of statistical significance in many categories.  Here are the results:  

The aerobic capacity and body fat improve while the unfavorable nature of the changes in TC, LDL and n-HDL are not so horrible as to be overly concerning.  Still, in most weight loss trials where participants lose 7 lbs = ~4% body weight, the trend for these lipids tends to be in the direction of lowering not raising.  Further, the unfavorable shifts are similar to the favorable shifts attributed to the paleo diet in other studies -- gotta take the bad with the good!  If you aren't "broken" to begin with, this study presents a cautionary tale as to what miraculous improvements one might expect to achieve by adopting the paleo/CF lifestyle.

5.  Eric Trexler is a Body Builder:  I saw an "oh noes" about this one ... to which I say "so what?"  If this were his n=1 experiment then it might have meaning, but he was only involved in conducting the study, not undergoing the intervention.  His background may have biased his hypothesis, but in the end the results are what they are.

Now ...  Speaking of criticisms like #5, and putting together some of the other points made, one sentiment I've been hearing is that collective brush off that some just want to be negative while this study isn't much if anything to write home about.   In a way I agree.  There simply isn't enough structure and/or documentation here regarding what the diet consumed really was, including variability among the subjects, etc.  That said, compared to other "studies", it can't be ignored.  What other studies?  Well, one issue from which most of the contention with Robb Wolf evolved was basically trying to get a straight answer on just what the diet involved is in his Reno first responder work.  Near as I can tell it's low carb as a general guideline and he's trying to steer it more to Lindeberg-style paleo.  Which brings me to a moment of giddiness for me when I tweeted to Staffan Lindeberg himself and he responded!  Preceding this tweet, someone had wondered if the CrossFit component might have impacted the results.

Eggs cooked in butter - coffee with butter.
 #mmmbutter #lccruise13
As I've discussed on this blog, the paleo diets used by Lindeberg's research group tend to bear little resemblance to the paleo diets we hear about coming from PaleoFX and various gurus in the community.  For starters, they are almost fruit-centric (by mass the largest component) and not fatty meat fests with butter on top!  It's almost laughable that Practical Paleo's Diane Sanfilippo posted the picture at right,  just two days before, of her breakfast on the LC cruise ... Can you say bacon, low-fruit, no-starch "paleo"??  There's more fat pictured at right than consumed in an entire day in the "classic" Lindeberg RCT or perhaps even the Jonsson (his research group) study, and certainly more saturated fat.

I would also mention that eggs are "overconsumed" in the paleo community if Lindeberg's studies are to be any benchmark for a paleo diet conveying health benefits.  In Lindeberg, average egg consumption was 29 g/day, vs 71 g/day for Jonsson ... that's basically one-half to one jumbo egg per day.  (I would note that negligible oils and no butter consumption were reported for each study).

Whatever one's position on saturated fats, if you're going to point to the research out there that is testing paleo, it is disingenuous to promote the diet depicted above as paleo yet point to any of the studies summarized in the table here and say they support your dietary advocacy.  

So in the Trexler study, with the caveat that these were logs for only 8 of 43 participants, the diet came to roughly 50% fat of which 13% was sat fat.  There's no indication of caloric intake but:  
Previous studies have shown positive effects of Paleo interventions on a number of health markers [2, 7-10], and in some cases blood lipids [2, 9]. However, these studies used more restrictive Paleo guidelines, and many used subjects that were initially overweight [2, 8, 9] and were either sedentary [2], had coronary artery disease [8], or had type 2 diabetes [9]. There is a general lack of literature pertaining to Paleo interventions in healthy, highly active populations, and there is reason to question whether previous Paleo studies accurately replicate the actual dietary intake of the free-living Paleo dieter.  
Diet log analysis revealed that subjects in our study reported higher intakes of total fat, saturated fat, and cholesterol than any of the previously mentioned human interventions [2, 8-10]. While our subjects reported daily intakes of 115 g total fat, 29 g saturated fat, and 673 mg cholesterol, the four previously mentioned studies averaged drastically lower daily intakes of total fat (67 g), saturated fat (15g), and cholesterol (426 mg) [2, 8-10].  {10 is the Osterdahl study I haven't included yet, Ryberg in my above table was fairly recent hence not included in Trexler}
So by my calculations, if 115g fat was ~50% of calories, caloric intake averaged 2070 cal/day.  If we presume 20% protein and 30% carbs this works out to roughly 105 and 155g respectively.  Not an over indulgent diet macrowise and the results weren't so bad.  Here's what I think is important:
When stratified by initial blood lipid levels based on the ATP III, there was a significant decrease of HDL among subjects with the highest initial HDL (82.1 ± 3.2 mg/dL to 68.6 ± 4.8 mg/dL; P < 0.05; Figure 2) and significant increases of n-HDL among subjects with the lowest levels of n-HDL (86.6 ± 3.9 mg/dL to 101.4 ± 4.8 mg/dL; P < 0.01; Figure 3).  Furthermore, significant increases of LDL (69.1 ± 3.1 mg/dL to 83.5 ± 4.1 mg/dL; P < 0.01; Figure 4), TC (157.2 ± 0.7 mg/dL to 168.2 ± 0.9 mg/dL; P < 0.05), and TC/HDL (2.5 ± 0.1 to 2.7 ± 0.1; P < 0.05; Figure 5) were observed among subjects with the most optimal initial levels of each respective outcome variable.
If one looks at a really short study, like Frasetto, and the improvements there (on a diet that resembles NO pop Paleo™ version) in 10 days, it is difficult to shrug off the trends seen in this study in a relatively short 10 weeks for those who are already in general good health.  The higher fat consumption at least points to these participants following a more pPaleo™ version of the diet.  This is not surprising to me.  Anyone who reads just a smattering of blog posts or forums like PaleoHacks is likely to encounter the far-more-frequent-than-most-care-to-admit posts about how egads their cholesterol went bananas when they gave up the bananas.  The response to these negative developments are predictable.  Either (1) you're doing it wrong, eat more fat and less carbs or, you may have SIBO or AF or quit the nightshades, or whatever ... just "paleo harder!" and get more sleep ... and if that fails, (2) these biomarkers are meaningless anyway.  Sometimes folks just skip to (2).   In the end, the negative impacts of paleo are rarely addressed seriously, because, after all, what harm can be done eating real food and rebelling against conventional wisdom?  Oh ... and look at all the people fill-in-the-blank-so-and-so is helping!!!

Then there's the knock over the lack of compliance control in this study.  Fair enough.  But many of the critics on this point are all too happy to tout the unverifiable n=1 success stories someone going by the handle IHeartPaleo scatters about the internet or various bloggers feature as success stories (where often we have just pictures and no bloodwork).  Or how about that crowd sourced data over at the Ancestral Weight Loss Registry where you don't even need to provide a real name or email address to be included?  At least here you have 43 people who signed on to a trial and submitted to testing before and after.  In the end, this study is a data point.  One that carries less weight than peer-reviewed RCT's but more than anecdotes on the internet where lipids are not often shared and/or cannot be verified.


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Steven said…
I agree with you in that the only somewhat valid criticism is the third point. Data is data.

This study is interesting in that it's inconsistent with other studies that measure changes in TC, HDL-C, LDL-C with isocaloric changes in carbs with SFA, MUFA or PUFA. With higher fat and higher SFA you would expect higher TC and LDL-C on this diet, but you would also expect higher HDL-C too.

Finding out why HDL-C was lower is the next step: maybe it was the weight loss, maybe LC paleo + Crossfit reduces thyroid function

I liked the idea behind the study: doing a Paleo diet study in otherwise healthy people

It does seem that most criticisms of Paleo - whether it's from someones experience, a study such as this or the media, etc - is a criticism of a low carb, high added fat diet, Paleo or otherwise
Bris vegas said…
The study is unmitigated garbage. Only in America could C-R-A-P like this be called an 'Honors' thesis. It should have been awarded an 'F' and thrown in the nearest rubbish bin.

The fact is that the participants actually IMPROVED in all meaningful parameters except LDL.

The reason the LDL seemed to "rise" is because The Friedewald Method (considerably) OVERESTIMATES LDL levels when triglyceride levels are low. Triglyceride levels fall significantly on LC diets.

LDL levels don't accurately predict risk of adverse cardiovascular events.

The reality is that the author and his supervisor are too stupid to even interpret their own results which are the OPPOSITE of the conclusion.
Nigel Kinbrum said…
"Prior to the intervention, body weight, body fat percentage (BF%), maximal oxygen consumption (VO2max), TC, TG, HDL, and LDL were measured." There's no mention of Friedewald anywhere in the study.
Assume makes an ass out of u and me. Just u, actually!
Sanjeev Sharma said…

> Only in America

kindergarten ... for prejudiced bigots?
Where in that study did TG levels fall to justify this pathetic LDL-denialist nonsense? Let's not berate education systems when basic reading comprehension becomes a shortfall in these ignorant diatribes.
carbsane said…
Triglycerides weren't measured, but for fasting lipids, in most normal people it is mostly VLDL that contains triglycerides. They did measure all non-HDL cholesterol which presumably includes the VLDL and it increased. From the table it looks like this is mostly if not all an increase in LDL, which would mean TG were unchanged.
Exactly, and there's even mention in the discussion about how they found a lack of favourable change in TG--at the very least--to be rather odd. And yet every time something like this gets posted--legitimate criticisms aside--some righteously indignated pinhead has to go on tangent based on an argument that doesn't even appropriately apply to the posted study in question.
eulerandothers said…
The prevailing thought is that LDL levels are a useful predictive tool (do predict risk) of adverse cardiovascular events. I think the key word here is 'accurately.' A word not often used in the conclusion statement of a study..

The Friedewald Method overestimates LDL in certain ranges - and I'm just going by a few pubmed abstracts in NCBI. However, one useful measure that has been suggested is non-HDL.

'LDL cholesterol concentrations are commonly estimated by the Friedewald
formula that requires only the measurement (after overnight fasting) of
plasma cholesterol and triglycerides along with high-density lipoprotein
(HDL) cholesterol. This value, however, is not in fact a true estimate
of LDL cholesterol but rather of LDL cholesterol along with variable,
usually smaller, amounts of intermediate-density lipoprotein (IDL)
cholesterol and lipoprotein(a). Estimation of LDL cholesterol levels by
the Friedewald formula becomes progressively less accurate as plasma
triglyceride concentrations increase, and the formula is generally
considered inapplicable when triglyceride levels exceed 400 mg/dL.'


'Unlike the estimation of LDL cholesterol levels by the Friedewald
formula, the estimation of non-HDL cholesterol concentrations requires
no assumptions about the relation of very-low-density (VLDL) cholesterol
levels to plasma triglyceride concentrations. This method includes all
of the cholesterol present in lipoprotein particles now considered to be
potentially atherogenic [VLDL, IDL, LDL, and lipoprotein(a)].'

It doesn't look like n-HDL 'improved' in the Trexler study. Perhaps you glanced at the table and thought that read, 'HDL'?

Non-HDL-C is Total Cholesterol - HDL.
Armistead Legge said…
Good article Evelyn.

The lipid results seem pretty non-significant as you stated. Nice breakdown. The study seems interesting, but overall it doesn't really lend support for or against paleo. It's surprising people are getting so worked up about it, but then again, it is paleo...

Hopefully they'll have a study one day where they look at actual disease outcomes.
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rudyInLA said…
These studies crack me up! What are we supposed to learn? What do they prove? What is the POINT?!?! I don't think of my oxygen burning rate when I shop or eat. I don't want a chemical reaction label on my food when I buy it! IT's actually a mass mental illness we are seeing! The world's biggest problem since the conception of life probably has been avoiding starvation. Now, as more and more of us are so distant from that fear ( in our minds anyway-food sources may be more fragile still than we imagine ) we come up with these mental gymnastics on "optimum." Get outta' here wid' dat'. With few exceptions, all handled and understood decades, maybe centuries ago in general, we inherently know what to do. Overly simplistic? Maybe. If we had never given any advice other than basic nutrition about essential nutrients and the food groups that have them, and packaged foods weren't engineered to death, would we be worse off? Did Kraft, Procter and Gamble, Cargill and the like really cause all of our problems? I really would like to hear if people think that's so. I say know but my view of that is perhaps biased. Maybe even blind. I think diversion, boredom, lack of togetherness at meal times has more to do with our "condition" than anything else. when people who loved us couldn't or wouldn't cook for and feed the family any longer, the decline began. Advertising helped that too!
Ancestral Chemist said…
The Lindberg approach to "Paleo" certainly seems like the most honest, and the one that will have the best results in the long term. This seems to point towards that.
However, it's easy to see the appeal of other brands of Paleo. When it sounds too good to be true, it usually is.
Hello_I_Love_You said…
You're referring to the opposite phenomenon -- how LDL is squeezed out by high Trigs as Trigs climb above 150 and approach 600. What the genius above is referring to is how the Friedenwald formula overestimates LDL because of low trigs, which is typical among those who low carb. However, that's only partially correct. The difference really is marginal and is only meaningful when you have super low trigs, like under 30, which some of these geniuses do have, since they usually starve themselves when implementing a VLC diet.

Check out p. 13 of the study. The mean trigs can be imputed from the figures:

Before: 70; After 73.

There's really no difference. This wasn't a weight loss fest as it is in most Paleo diets that resemble a VLC fest. It was ad libitum.

But what would be the impact of the oft-invoked Iranian formula at that level of trigs? The mean LDL is 106, which is the residually calculated LDL; Iranian = 98. It's about a 7.5% difference. Not really that meaningful. a difference considering the margin of error. If trigs were say 20, then the mean LDL of 106 would be 61. Significant, yes.

So the genius above reflexively summoned the old low-carb standby, that you're being discriminated against because your trigs are low. Well, not really. Not so much in this case, genius.
Hello_I_Love_You said…
Hey, genius, based on either Friedenwald or Iranian, the LDL difference is marginal: 106 vs. 98. That's because trigs are around 70-73, which you can impute if you can do algebra from the table on p. 13. Friedenwald really becomes an issue as trigs climb above 150; that's where the LDL starts to diverge significantly. And at the extreme low trig level under 40 or so. Even so, the disparity isn't as significant as they are at the really high level of trigs, which would crowd out LDL altogether. That's why your LDL shows up as "n/a" when trigs > 500. If you can do algebra, you'd understand this.
Hello_I_Love_You said…
Actually the more important point is that the mean trigs didn't really change before and after (70 vs. 73). Like many, this is a comparison study. That's why the study's measurement of LDL increase (13.4%) is not really biased by Friedenwald. The LDL % increase using Iranian would be even higher (15.1%).

You start listening to these low-carb geniuses, you wonder if they can do simple algebra. Friedenwald, bad! Iranian, good! VLDL bad! LDL-C means nothing!
Hello_I_Love_You said…
What does it show? Under non-isocaloric, ad libitum implementation of a quasi-Paleo diet by relatively healthy patients, lipids don't really improve. At least not over 2.5 months, even though you could lose some weight and breathe deeper in the process.

That confirms suspicions we've had about Paleo. Once you lose most of the weight, metabolic improvements stall or, in some cases, start to reverse. Unless you have blood sugar issues or have high cholesterol to begin with, Paleo isn't likely to improve your blood markers, even metabolic blood markers like triglycerides, which typically go down on a VLC diet.

Why would that be the case? Ad libitum, somewhat. But the important takeaway is that when a healthy person implements Paleo, there isn't likely to be much benefit except marginal weight loss. Remember, these people had low trigs (70) and very good TC/HDL (2.7) to begin with and were probably eating relatively healthy with normal carb levels. How much lower could they go? When you do a snow job by piling up morbidly obese and metabolically deranged diabetics and put them on an isocaloric or hypocaloric Paleo (read low-carb) diet, of course their lipids and BG will improve dramatically on a diet that approximates starvation. But even up the baseline and let everyone start from the same starting gate, there's no benefit and it actually gets a bit worse. I think we knew this from the beginning: those who're already healthy need not adopt Paleo, Paleo is a short-term, whip-yourself into-shape protocol that could actually moderately worsen your lipids, if you're already health.
rudyInLA said…
My totally non technical analysis. Even to my layman's eye, it's a poorly done study. Good enough for homework i suppose. I sense a study bias simply by virtue of the criteria chosen. Again speaking as a mortal, I have no such interest in such things. We're not supposed to have to think this hard just to eat. Can you imagine your grandparents discussing such things? When did this garbage view of health start? Ridiculous. Paraphrasing Bertram Russell, A fool is sure of everything while a wise man has his doubts. Sorry for the gender bias of the statement but it's from a different era! Anyway, other than curiosity i don't buy Paleo any more than 30 bananas a day and riding my bike like a mental patient for hours, or egg diets, or juice fasts, or starvation fasts, or web guru supplements, or quest bars or paleo bread. I don't think the government or the food companies are trying to kill me, even though i don't eat what they offer. I don't think any of these gurus, yes even the ones who have college credentials and written books, know a damn thing. ~~~~~~~~~ I sometimes feel as if my comments can seem to criticize this site and Evelyn and that is absolutely not true! When i don't like a site, i never look at it and wouldn't dream of being a troll on it no matter whose it is. She is a light scattering the roaches in my opinion and that, as i'm sure she'd admit is a Herculean task!
Hello_I_Love_You said…
The study is not well-designed but it was never meant to be. It confirms what happens when healthy people with healthy lipids adopt an ad libitum Paleo diet. There is no room for improvement. Heavier SAFA intake probably ups LDL a little in exchange for some weight loss due to the satiety-inducing effect of fat and protein. But that also presumably upped non-HDL cholesterol and pushed down HDL.

Lesson to be learned: if you're already healthy, keep what you're doing. No need to adopt Paleo. In fact, somewhat lower SAFA would be of benefit, as SAFA modestly increases LDL when not in drastic weight-loss mode.

Some of us knew this from the beginning. the lower LDL that happens in Paleo/LC is accompanied by simultaneous TG reduction; in other words, it's a weight-loss phenomenon. When there isn't much weight to lose, you'll be just treading water.
Bris Vegas said…
The reason why obesity was rare until the1970s was mostly financial. The average person simply couldn't afford to overeat on a regular basis. Real incomes in developed countries are 3-5x as high as they were 100 years ago. This means even the poor can now afford to eat as much junk as they want.

Ancel Keys was initially sent to Crete to help the people overcome chronic food shortages and perceived malnutrition. His discovery of the "Mediterranean Diet' was a serendipitous outcome.
Bris Vegas said…
"I don't think the government or the food companies are trying to kill me, even though i don't eat what they offer."

Many years ago I worked as food technologist. The reality is that most food technologists very rarely eat processed foods. The people who design processed foods are eating wholemeal bread and salads themselves.
rudyInLA said…
I don't doubt it. I don't eat that stuff either. That's not the same thing as saying that they're unconcerned with harming customers. Not to me anyway. I guarantee I could live on packaged foods if necessary and someday, it might be for all or many of us. Just because something tastes good, (really good sometimes!) doesn't mean a pint of ice cream, or a 15 oz bag of Doritos is a portion. Too much kale, brocolli and Brussels sprouts can cause thyroid problems and for some it doesn't take as much as you may think. Anyway, that was a sub-point in trying to understand how we go to the point where many average folks seem to think they understand nutrition at the atomic level, which is ridiculous on the face of it.
rudyInLA said…
I read that about that about Keys as well. As far as financial being the cause of obesity, that can be interpreted in many ways, and in fact is a beast of many arms. Food prices were out of control and Nixon panicked and basically declared price freezes, and sent Earl Butz out to increase crop acreage. Butz went to farms and basically told them to plant fenc to fence, no fallow ground. Fed subsidies went crazy heavily biased to Soy corn and wheat. Farmers obliged as the Feds told them to keep growing and they'd be supported no matter what. It worked on prices. We still have the cheapest "food" on the planet. Cheaper than it's ever been. it's a big problem and I think most people here know the big picture but I don't think we all believe the same thing. I think the decline in wages and inflation forcing families to lose one parent staying home, ok let's just say mom because that's who it was in the USA in times past, and marketing convincing families that it's OK to just pickup up a bucket of food on the way home. Now the pitch is "You're so busy these days! Who has time to cook?!?" Well, I still say people are nowhere as busy in general as they think they. They revel in the image of their daily struggle. Yeah sounds harsh but I find it so with some exceptions of course. So anyway, just because Dreyers Ice Cream is cheap doesn't mean I should eat it until I pass out. Pizza Hut has a 2 for 1 deal doesn't force me to eat 2 pizzas. You get the gist. Again, none of this has a darn thing to do with being scientific when someone in a store chooses a bag of Doritos over a Capresso Salad.
Hello_I_Love_You said…
Look, it's not the increase in real income. It is partially due to the relative change in the prices of raw ingredients which make up packaged foods. It's the decreasing food ingredient costs, inflation adjusted, which changed the available items in retail food distribution. If real income just increased 5 folds then we'll see people eating more of the same stuff as 100 years ago. More of the same stuff 100 years ago would not account for obesity, as food choices were limited around the turn of the century and people ate more or less wholefoods.

What you're trying to say is price deflation of raw ingredients and industrialization, which resulted in mass production. This increased the availability of packaged food products, which began to replace the proportion of whole foods consumed gradually. But that is only one factor, not all of it. That is why one-sided thinking and single villain mentality can lead you down a rabbit hole. It may seem right to you but it's a single variable and you've only captured ~30% of what's going on.
Susanne said…
I think diet observation studies nowadays should have participants take photos of everything they eat. At least studies of the type that use something like three 24-hour recalls to reconstruct a month or more of food intake. It's true that this would probably alter the outcomes a bit -- the journaling/self-observation phenomenon is shown to have an effect on food intake, Arya Sharma has featured studies on this several times in his blog. But it could hardly make them less accurate in knowing what people are actually eating over the time studied.

It's not as if taking photos of your food is weird these days. Food photos are a staple on Instagram, and I believe one of the requirements of joining Crossfit is starting a food blog. :) (Usually consisting of only three entries, with possibly a post a year later that says, "Wow, I had totally forgotten about this blog, and that whole Crossfit thing lasted about two weeks.")
So many people these days have phones with cameras, there are existing diet apps that use this functionality already. And for people who don't have camera-enabled phones, you could make it an incentive -- here's a phone, take photos on X percentage of days, and you get to keep it at the end of the study.
Come to think about it, it can be substantially cheaper getting whole ingredients, even under today's environment. What we don't get with that, however, is convenience and the illusion of a 'bargain' (your two for the price of one pizza example). Understanding, and perhaps dealing with, that psychological factor might be a worthwhile venture. Our market climate kind of over emphasises efficiency as some form of 'winning' over, say, practical, prudent and realistic thinking.
carbsane said…
LOL ... your description of the Crossfit food blog cracked me up!

In between other stuff I'm trying to write up a post on the latest LCK diet and diabetes study. 24 hour recall online survey there. It's almost like they don't even want to try anymore ;-)
rudyInLA said…
Yeah it's like a food version of the Heisenberg effect. Merely observing affects that which is being observed. Years ago I played with an iPhone app where you took a pic of a meal and it gave you a calorie and nutrition review of the photo. It was comically inaccurate. A bowl of Kale, with no size reference for the bowl mind you, came back at like 1200 calories or some such nonsense. Curious, I looked further into it. It seems the app upload the picture to a server and a HUMAN calculated the info and sent it back to the device. Brilliant.....NOT! What a stupid idea. I wonder if that app is still around. Probably an NSA tracking ploy.
carbsane said…
My major concern with posting on the paleo studies is that the paleos like to hold them up as proof for the superiority of their diet and/or to counter critics of the fat content of the mainstream interpretation. ALL paleo diets used in clinical trials are low in saturated fat. None contain any dairy or butter or even coconut oil. So it is outright dishonest to hold those studies up and say -- "see? this is healthy" when the diet consumed by most paleos bears no resemblance to those diets.

This study was mostly interesting in that it implemented the modern interpretation in otherwise healthy people.
charles grashow said…

"Anyway, Mr. Fitzgerald proposes a healthy eating hierarchy. The idea
is that, wherever a food lies on the scale, the aim is to eat more of
the foods that rank above it, and less of those ranked below it. In
other words, generally eat more of the foods at the top of the list.

nuts, seeds, and healthy oils
high-quality meat and seafood
whole grains
refined grains
low-quality meat and seafood
fried foods

Those top four items pretty much define a pure paleo diet."

Please tell me what "healthy oils" paleo man had access to.
Ancestral Chemist said…
That was what I meant by "honest," if that's not clear: Lindberg's Paleo bears the closest resemblance to actual hunter-gatherer diets, and it's the one that's actually been proven to have health benefits.
You're absolutely right that butter, dairy, and CO are not "paleo" in any meaningful sense. Either the so-called Paleo movement will come to its senses and move back towards Lindberg, or else it's bound for the dustbin of history.
carbsane said…
Yep was basically adding to your sentiments. -)
Lighthouse Keeper said…
Indeed, after the second world war "labour saving" in the home was in vogue " No more slaving over a hot stove " etc.
I could easily feed myself for a week or longer for the price of a decent size t-bone or a couple of deluxe supermarket ready meals by cooking from scratch with dried beans and lentils, rice, porridge, some mixed frozen veg and a few tins of sardines. You have to know what do with it and not see it as a chore robbing you of "valuable time".
Definitely, and it doesn't even need to be ultra-timely. Sure, it won't be an extravagant pizza, but it'll be just as much--if not more--nutritious with an even better bang in terms of calorie-to-buck value.

But o teh peasant foodz.

I can kind of sympathise with the poor peasant food analogy. It isn't entirely inaccurate, but the hyperbolic, snarky manner in which it is argued within this laughable food wars context, definitely takes a lot of credibility away from what little legitimate criticism one could establish.
Yeah, if one's intentionally downing those goitrogens uncooked like some OCD obsessed raw fooder as their primary source of calories. Last time I checked, there weren't a lot of people demolishing their thyroid with high vegetable intake in the context of general cooking and eating behaviour, and such behaviour was mostly producing positive results. This latest goitrogen scare is pretty much another incestuous product of the anti-veg/GMO/anti-mainstream movement and not worth much in terms of stock or real-life application value, unlike the more legitimate criticisms that can be levied at poorer food options or choices.

The guy who lived a long time also has the counfounding benefit of wealth and opulence on his side. And this would be the point where 'diet is everything' idea goes out the window because people seem to overlook the benefits of medical advances, including having access to the most quality medical care. Very few of of us--if any--can hope to even scratch the kind of distinct life that Buffet has managed.
carbsane said…
Speaking of peasant foods, it's quite ironic that obesity in the past was always associated with affluence, not poverty, so ....
rudyInLA said…
You might be surprised by the concern medicine is starting to signal over thyroid problems from people OVEREATING Kale, Brussels, Spinach in general. This is part of the US mental condition of if a little is good more is perfection! Dr Oz tells overweight women to eat the stuff, use Agave, avoid regular dairy, eat wheat bread eat/avoid eggs, drink/avoid coffee and blah blah blah not to mention all the totally idiotic herbs and things he hawks. Of course, generally less than a year later, it's the total opposite. As far as Buffet, plenty of wealthy people die young. Plenty of very poor people live to be quite ancient on the human scale. From all accounts, Buffets diet is hardly spectacular and probably mirrors the vilified SAD diet more than any other. He owns a lot of "junk food" ( a stupid term used by 1st world people with supermarkets ) and indulges regularly. Nathan Pritikin died of some cancer or other relatively young. I just think it's silly that in our desperation to find correlation in EVERYTHING we humans do, we actually start to believe we understand everything. I'm convinced we don't know as much as we think we do. Studies are only as effective as the questions studied allow. I still think we don't even know what to ask, never mind understanding the answers. I know this sounds stupid when I say it and it probably is but, We can't build a living complex entity yet. Let me know when we can "create" a bird or dog or hell a worm from scratch.
It's an interestingly dismissive perspective, but I do not share entirely in the cynicism, or perhaps I'm misreading. We are starting to refine our questions and learning more *.

Veggies outside the context of glam nonsense are still an excellent and favourable component to diet of rich and poor alike and don't result in problems when other aspects of diet are monitored. Goiterogens are a problem when people start to embark on gimmicky implementations of such diets, and even then, we can't be sure what's actually going on since many people who go to these gurus have come to the court with issues that would get them into a serious mess anyway. Chronic dieting and weight reduction in itself isn't a thyroid saver, either, throw in odd diets purely made of vegetable bulk and rather than embrace the obvious disaster that is to unfold, we defer to the goitrogenic argument, which is only valid in a very limited and exceptional context.

As for the deal about Buffet. Of course plenty of rich people die young and vice versa, ditto for the poor. But we also know that medical care and prevention are positive factors and this doesn't even need N=1 examples. It all just speaks to the futility of over relying on N=1 and doesn't answer the question as to how much better or worse he could've been had one of the other variables been different. Pritikin for example, had other issues that even pre-dated his diet. Regardless of other concerns that have yet to be tied to his diet, the man was actually free of atherosclerosis, and I believe there was even a brief discussion about this in the comments section of an earlier blog entry, something can be gleaned from this other than the moral absolute that the man died relatively young of cancer so everything else tied to his work--especially the subject of arterial health--is meaningless.

Of course, we still don't know a lot. However, I think you might appreciate the idea that this in itself isn't an excuse to abandon the progress that is being made and the growing understanding that we are developing, which is also--no doubt--bringing more questions.
rudyInLA said…
Well this discussion can get long and complicated. Briefly I'll say I don't claim we'll NEVER understand how we, or the Universe for that matter, work. I just think it all get's a little blurry and the true lack of understanding is masked by techno jargon and declarations of " Do this and THIS will happen." Well, at least put the word sometimes or often or rarely in there for cripe's sake. Pritikin is a sore spot for me because he advice caused me personal damage. Well, my following the advice did anyway. He didn't make me do it. I don't know if Buffet sees a doctor regularly, although he probably does, or if he takes medication at all. n=1 is silly indeed but to me caries as much weight as any study might because I never really KNOW enough about the study. I just don't think, other than for science and medicinal purposes all the wacky advice out there should be conveyed to us so casually as if it's a done deal. When we KNOW, and I mean KNOW how the body works, the debate will drop to a murmur, not the battle it is today. I think most of what we know about eating for good health is not very different at all from what we knew for decades, say since post WW2. Anyway, I actually agree with what you're saying but bigger picture there are differences. I don't claim to have the better position on the subject. I just believe in practical advice and don't need a chemistry lesson or heaven forbid a Dr Oz demonstration that looks like a 3 year old spade signed it to tell me not to eat a whole chocolate cake every night. Don't think people do that? I could tell you stories!!!!!
Sanjeev Sharma said…
sebaceous (more infamously Mediterranean than paleo) ...
Sanjeev Sharma said…
what fascinates me is that the vast majority of diet proponents brag about how good their chosen diet is.

Before Stephan a few scattered writers (all vegetarians in my vague recollection) spread out over the last 30 years of my reading of health & science & diet have written about "resetting your tastes to simpler food".
charles grashow said…
But can you cook with it??
charles grashow said…
Pritikin committed suicide after his leukemia returned.
abcdegh said…
"We're not supposed to have to think this hard just to eat. Can you imagine your grandparents discussing such things?"

No, but then they did not have to since any food they got was pretty much not processed crap anyway. My guess is, they typically sat down to a meal that consisted of a portion of meat, and a couple vegetables, which would probably fall under a Paleo, Zone, or South Beach diet. You aren't going to get fat off of those kinds of meals until you start laying on the biscuits, butter bread, and then ice cream, cake or pie after every meal.

I do think our problems started out slowly when we added baking with flour and sugar to every meal, and now it's even worse with all the microwave meals, chips, soft pretzels, and everything else that contain HFCS and vegetable oils.

If all the fad diets do is get people to stop eating so much sugar, vegetable oils, preservatives, flour, etc, then the normal carbs, protein, and fat really won't hurt us and neither will the occasional snack or dessert.
rudyInLA said…
Well fad might be the wrong word then just by definition right? You're talking more about the effectiveness of advertising /marketing more than the choice of foods available. Our ancestors snacked and ate deserts too I guarantee you. I don't even think packaged food is created by the devil. I've always said that even though I don't buy packaged foods, other than a package of Ezekial Breads one of which lasts me literally 6 months with 1/2 the packaged thrown away, I think I could easily and healthily live on the current choices and I'm not talking about organic Kale chips. I mean General Mills, Pillsbury, ConAgra and all of that ilk. I could life on McDonalds or Other fast food. I think so anyway but barring catastrophes, I don't think I'll ever have to find out. Anyway, it's tough to discuss in a forum isn't it? As interactive and interesting as it is, the back and forth is too slow and space/bandwidth consuming. I often think most of us agree on more than we disagree but space and time limits that discussion. ia get your points though I relly do.
abcdegh said…
No, I'm not saying anything about effectiveness of advertising, all I am saying is that the current fad diets all seem to have a couple things in common which is to NOT eat processed/refined carbs like sugar, white bread and pastas, corn syrup, etc. I think if you avoid these things, any of the diets will work because you won't get fat if you just eat the more natural things whether you avoid fat or carbs, it doesn't matter because those things won't cause your insulin to sky and stay there. My feeling is that the people that get into trouble are those that eat refined/processed food and food with un-natural chemicals all the time. They will eat them for meals and then sit in front of the TV and eat a bag of chips in the afternoon and a bag of malted milk balls in the evening, and you do that most days then you will keep gaining weight. So if the current popular diets at least get us to avoid those things, it's hard to eat too many calories and your insulin will stay down, you will lose weight if you are overweight, and your cardio will improve.

>> I could life on McDonalds or Other fast food.

You could, and it has been proven by someone, I forget who, that you can even lose weight eating at McDonalds as long as you keep the calories down (which isn't easy at McDonalds), but, I would not think you would get your nutrition and I would not think it would be good for your cardio because you end up with a lot of grease and oils in your meal. I think there are diets to lose weight and there are diets as a way of life for health. Sometimes if you need to lose lots of weight, you have to use a fad diet to do it even if it is not optimally healthy (VLC or VLF) because you have to find a way that allows you to restrict calories without affecting you mentally. But once you are at an optimal baseline weight-wise, (which is healthy unto itself), then your diet should probably shift to what is most healthy so that you stay that way.

>> it's tough to discuss in a forum isn't it?

Yes, but at least we get to have discussions that we wouldn't otherwise get to have. :-) Everybody doesn't have to come together at the same time, and we can even live half a world apart. And I love to read all the posts people have made. :-)
rudyInLA said…
Well, we disagree on most of the stuff but I understand that's how it goes. I like the format as well. I just look at the whole "diet" business in a totally different way. I don't think ther are many, if any, good guys. I know that's radical and don't really want to argue. I'm not a great debater and not into that. I believe what I believe and you believe what you say. I cpdon't buy into consensus in most subjects. I've seen the results of that before. It nice to hear everyone's views though.
abcdegh said…
And it is perfectly fine to disagree, and I am not trying to argue at all, especially in this field where there does not seem to be any real consensus. I am just basing what I feel on weeks of research, reading all of the conflicting information out there in books and on the Internet. It seems all of the diets do work for people for losing weight. And it seems that the common thing among them now is to stop eating processed foods so I have come to the conclusion that, that is why they all work.
Bris Vegas said…
There are several professional software programmes used by dietitians that automatically calculate a vast array of nutrients. However you still have to weigh all the food and manually enter the data.
Bris Vegas said…
The Lindeberg version is low fat and mostly plants. It doesn't allow participants to gorge on pig fat and butter. Hence most paleoistas can't use it to justify their unhealthy eating.
Bris Vegas said…
It is a myth that people were eating mostly unprocessed foods 100 years ago. People may have eaten more meals at home but they were using a great deal of packaged ingredients.

From the mid 1800s until the 1970s the typical Australian diet was "meat and three veg" - a huge slab of charred meat (usually mutton) and some potatoes, beans and carrots that had been boiled to mush. Bread was invariably white and most fruit came in tins.
Bris Vegas said…
In fact you don't even need to cook at all. Fruit and non starchy vegetables can be eaten raw. Sardines and baked beans can be eaten straight from the tin. Then throw the empty cans in the bin and the fruit and vegetable scraps in the compost.
Bris Vegas said…
It is more about snobbery than taste. Simple "peasant" foods are often far tastier and more enjoyable than anything served in an expensive restaurant.
Bris Vegas said…
Dr Ben Goldacre has written about the "wealth effect". Basically
rich/high status people live much longer on average than poor people even when you
account for confounding variables such as diet, exercise and health care.
[ Heads of State are practically immortal unless they are assassinated.]

High status rhesus monkeys live far longer than low status monkeys even when kept under identical conditions. Continual psychosocial stress causes immense damage to the body over a long period.
Bris Vegas said…
I'm NOT a low carb supporter.

The US is the only country where LDL subfractions are routinely tested. They are just one of the many meaningless, expensive and worthless tests performed by US doctors scared of lawsuits and pressured by patients who are bombarded with health-related advertising.

In Australia all treatments and diagnostic tests must be safe, evidence based and approved by the federal government. That's why we don't allow tests for LDL susbfractions or CAC scans.

Australia also bans all forms of drug advertising (except OTC) and prevents doctors from any form of advertising or self-promotion. So we don't have any Dr Oz type TV shows or publicity seeking diet doctors.
Lighthouse Keeper said…
I actually do like eating straight from the tin, boiled new potatoes spring to mind, currently in the U.K. in the Asda supermarket chain ( U.K. Wallmart division ) you can buy a 360g tin of the above in unsalted water ( drained weight ) for 14 pence and the standard sized tin of sardines in tomato sauce for 34 pence - that's less than the price of a can of coke for the two combined. That's a meal in itself though most people might turn their noses up at it especially eaten cold.
David Pete said…
charles grashow said…
Refined, unrefined, virgin or extra virgin?
Hello_I_Love_You said…
I don't care if you're a low-carb or vegan or high-carb supporter. You can't tell your ass from your elbow regarding cholesterol or lipid diagnostic procedures. Usually someone know when he's in over his head. You don't and continue to argue 1+1=3. That's why whatever camp you join, you're likely to be a liability, not an asset.
eulerandothers said…

Pritikin's leukemia was in remission for 27 years. He committed suicide when he was 70
Sanjeev Sharma said…
> But can you cook with it??

Ich habe nicht proof but pizza in certain neighbourhoods ... especially when the cook's hair's waaaayyyy too shiny