Dietary Saturated Fat Doesn’t Influence Future Course of Coronary Heart Disease


Most heart attacks occur in folks with pre-existing coronary artery disease that’s been present for years

If you already have coronary artery disease, Dr. Axel Sigurdsson says that ongoing saturated fat intake probably doesn’t matter, in terms of future cardiac events (like heart attacks) or risk of death from any cause.

Dr. Sigurdsson is a cardiologist in Iceland.

Some quotes from his blog:

For decades, cardiologists have advised patients with heart disease to restrict the intake of saturated fats and dietary cholesterol. Many patients still believe this to be the cornerstone of their lifestyle modification.

The main reason for avoiding saturated fats is the assumption that they adversely affect the lipid profile of our patients.

*   *   *

Recent studies suggest that the recommendation to avoid saturated fats may have been premature and not based on solid scientific evidence.

Now, a recently published Norwegian study shows that dietary intake of saturated fatty acids was not associated with risk of future events or death among patients with established coronary artery disease.

It is important to keep in mind that most of the patients were receiving secondary prevention drug therapy including aspirin, beta blockers and statins.

Anyhow, the results of the study certainly suggest that high intake of saturated fats is not a risk factor among patients with coronary heart disease receiving modern-day treatment.

These recent scientific data don’t imply hat we should urge our patients to consume high amounts of saturated fats. They only tell us that there is no association and accordingly, restriction won’t help.

So, it’s certainly a lifeline for those who believe red meat, whole-fat milk, cheese, cream, butter and eggs can be a part of a healthy diet.

On the other hand we must realise that scientific studies often provide contradictory results. A US study published last year suggested that greater adherence to a low carbohydrate diet high in animal sources of fat and protein was associated with higher all-cause and cardiovascular mortality following acute heart attack.

It appears the jury is still out…


Steve Parker, M.D.

Book Review: “Stop the Clock: The Optimal Anti-Aging Strategy”

dementia, memory loss, Mediterranean diet, low-carb diet, glycemic index, dementia memory loss

“I wish we could have read PD Mangan’s book thirty years ago!”

I read P.D. Mangan’s 2015 book, Stop the Clock: The Optimal Anti-Aging Strategy. I give it five stars in Amazon’s rating system. High recommended.

♦   ♦   ♦

I approached this book with trepidation. I like PD Mangan even though I’ve never met him. We’ve interacted on Twitter and at our blogs. You can tell from his blogging that he’s very intelligent. I don’t know his educational background but wouldn’t be surprised if he has a doctorate degree. My apprehension about the book is that I was concerned it would be brimming with malarkey and scams. Fortunately, that’s not the case at all.

Twin studies have established that 25% of longevity is genetic. That leaves a lot of lifestyle factors for us to manipulate.

I’m not familiar with the anti-aging scientific literature and don’t expect it will ever be something I’ll spend much time on. But it’s an important topic. I’ll listen to what other smart analysts—like Mr. Mangan—have to say about it.

It’s quite difficult to do rigorous testing of anti-aging strategies on free-living humans. So the best studies we have were done with worms, rodents, and monkeys; the findings may or may not apply to us. For example, long-term calorie restriction—about 30% below expected energy needs—is known to prolong life span in certain worms and rodents, with mixed results in rhesus monkeys. It’s the rare person who would follow such a low-calorie diet for years as an experiment. I doubt I would do it even if proven to give me an extra five years of life. I like to eat.

There are several prominent theories of how and why animals age. The author thinks the major factors are:

  1. oxidative stress
  2. inflammation
  3. a decline in autophagy (perhaps most important)

An effective anti-aging program should address these issues.

In the anti-aging chapter of his book, The South Asian Health Solution, internist Ronesh Sinha says that “Lifestyle practices that reduce excess inflammation in the body will help delay the aging process.” Dr. Sinha is a huge exercise advocate and low-carb diet proponent.

Mr. Mangan makes a convincing argument that a good way to forestall aging is to apply hormetic stress. Hormesis is a phenomenon whereby a beneficial effect (e.g., improved health, stress tolerance, growth, or longevity) results from exposure to low doses of an agent or activity that is otherwise toxic or lethal when given at higher doses.

Needs a bit more hormetic stress

Needs a bit more hormetic stress

In case you’re not familiar with hormesis, here’s a major example. Lack of regular exercise leads is linked to premature death from heart disease and cancer. Starting and maintaining an exercise program leads to greater resistance to injury and disease and longer life span. On the other hand, too much exercise is harmful to health and longevity. We see that in professional athletes and excessive marathon runners. Something about exercise—in the right amount—enhances the body’s intrinsic repair mechanisms. That’s the hormetic effect of exercise; one mechanism is by turning on autophagy.

Autophagy is the body’s natural process for breaking down and removing or recycling worn-out cellular structures. This wearing-out occurs daily and at all ages.

If you’re thinking Mr. Mangan recommends exercise as an anti-aging strategy, you’re exactly right. Especially resistance training and high intensity training. His specific recommendations are perfectly in line with what I tell my patients.

Calorie restriction is another form of hormesis; the body reacts by up-regulating stress defense mechanisms. As a substitute for calorie restriction, the author recommends intermittent fasting. Intermittent fasting increases insulin sensitivity, which leads to enhanced autophagy. Fasting seems perfectly reasonable if you think about it, which very few do. Many of us eat every three or four hours while awake, whether a meal or a snack. If you think about it, that’s not a pattern that would be supported by evolution. In the Paleolithic era, we often must have gone 12–16 hours or even several days without food. Hominins without the resiliency to do that would have died off and not passed their genes down to us.

Steve Parker MD, Advanced Mediterranean DIet

Naturally low-carb Caprese salad: mozzarella cheese, tomatoes, basil, extra virgin olive oil

Another anti-aging trick is a low-carb diet, defined as under 130 grams/day, or under 20% of total calories. It may work via insulin signaling and weight control.

Glutathione within our cells is a tripeptide antioxidant critical for clearing harmful reactive oxygen species (free radicals). We need adequate glutathione to prevent or slow aging. Cysteine is the peptide that tends to limit our body’s production of glutathione. We increase our cysteine supply either through autophagy (which recycles protein peptides) or diet. Dietary sources of cysteine are proteins, especially from animal sources. Whey protein supplements and over-the-counter n-acetyl cysteine are other sources. Fasting is another trick that increases cysteine availability via autophagic recyling.

I don’t recall the author ever mentioning it, but if you hope to maximize longevity, don’t smoke. Even if it has hormetic effects. Maybe that goes without saying in 2015.

When I read a book like this, I always run across tidbits of information that I want to remember. Here are some:

  • those of us in the top third of muscular strength have a 40% lower risk of cancer (NB: you increase your strength through resistance training not aerobics)
  • exercise helps prevent cognitive decline and dementia, at least partially via enhanced autophagy
  • exercise increases brain volume (in preparing to do this review I learned that our brains after age 65 lose 7 cubic centimeters of volume yearly)
  • optimal BMI may be 20 or 21, not the 18.5-25 you’ll see elsewhere (higher BMI due to muscle mass rather than fat should not be a problem)
  • Scientist Cynthia Kenyon: “Sugar is the new tobacco.” (in terms of aging)
  • phytochemicals (from plants, by definition) activate AMPK, a cellular energy sensor that improves stress defense mechanisms and increases metabolic efficiency
  • curcumin (from the spice turmeric) activates AMPK
  • coffee promotes autophagy
  • he does not favor HGH supplementation
  • in the author’s style of intermittent fasting, you’re not reducing overall calorie intake, just bunching your calories together over a shorter time frame (e.g., all 2,500 calories over 6-8 hours instead of spread over 24)
  • mouse studies suggest that intermittent fasting could reduce risk of Alzheimer’s disease and Parkinsons disease
  • consider phytochemical supplements: curcumin, resveratrol, green tea extract
  • calorie-restriction mimetics include resveratrol, curcumin, nicotinamide, EGCG, and hydroxycitrate
  • supplemental resveratrol at 150 mg/day improved memory and cognition in humans

The author provides very specific anti-aging recommendations that could be followed by just about anyone. Read the book for details. Scientists are working feverishly to develop more effective anti-aging techniques. I look forward to a second edition of this book in three to five years.

Steve Parker, M.D.

PS: People with certain medical conditions, such as diabetics taking drugs that can cause hypoglycemia, should not do intermittent fasting without the blessing of their personal physician. If you have any question about your ability to fast safely, check with your doctor.

PPS: If you have diabetes or prediabetes and want to reduce your carbohydrate consumption, consider my Low-Carb Mediterranean Diet or Paleobetic Diet.

QOTD: Don’t Let Gravity Get You Down

Average age of study subjects was 71

A good resistance training program will strengthen her bones, improve her balance, and prevent that hip fracture 60 years from now

Adult life is a battle against gravity. Weight training postpones your inevitable defeat.

—Steve Parker, M.D.

8 Tips for Overcoming a Weight-Loss Stall

It’s common on any weight-loss program to be cruising along losing weight as promised, then suddenly the weight loss stops although you’re still far from goal weight. This is the mysterious and infamous stall.

Once you know the cause for the stall, the way to break it becomes obvious. The most common reasons are:

  • you’re not really following the full program any more; you’ve drifted off the path, often unconsciously
  • instead of eating just until you’re full or satisfied on a very-low-carb diet, you’re stuffing yourself
  • you need to start or intensify an exercise program
  • you’ve developed an interfering medical problem such as adrenal insufficiency (rare) or an underactive thyroid; see your doctor
  • you’re taking interfering medication such as a steroid; see your doctor
  • your strength training program is building new muscle that masks ongoing loss of fat (not a problem!).

If you still can’t figure out what’s causing your stall, do a nutritional analysis of one weeks’ worth of eating, with a focus on daily digestible carbs (net carbs) and calorie totals. You can do this analysis online at places like FitDay or Calorie Count .

How Does That Help?

What you do with your data depends on whether you’re losing weight through portion control (usually reflecting calorie restriction) or carb counting. Most people lose weight with one of these two methods. (Exercise alone is hardly ever effective for significant amounts of body fat loss.)

If you’re a carb counter, you may find you’ve been sabotaged by “carb creep”: excessive dietary carbs have insidiously invaded you. You need to cut back. Even if you’re eating very-low-carb, it’s still possible to have excess body fat, even gain new fat, if you eat too many calories from protein and fat. It’s not easy, but it’s possible.

Those who have followed a calorie-restriction weight loss model for awhile may have become lax in their record-keeping. The stall is a result of simply eating too much. Call it “portion creep.” You need to re-commit to observing portion sizes.

“Doc, I’m Doing Everything You Say and It’s Still Not Working. Help!”

A final possible cause for a weight loss stall is that you just don’t need as many calories as you once did. Think about this. Someone who weighs 300 lb (136 kg) is eating perhaps 3300 calories a day just to maintain a steady weight. He goes on a calorie-restricted diet (2800/day) and loses a pound (0.4 kg) a week. Eventually he’s down to 210 lb (95.5 kg) but stalled, aiming for 180 lb (82 kg). The 210-lb body (95.5 kg) doesn’t need 3300 calories a day to keep it alive and steady-state; it only needs 2800 and that’s what it’s getting. To restart the weight loss process, he has to reduce calories further, say down to 2300/day. This is not the “slowed down metabolism” we see with starvation or very-low-calorie diets. It’s simply the result of getting rid of 90 pounds of fat (41 kg) that he no longer needs to feed.

Steve Parker, M.D.

Even Mild Elevations of Fasting Blood Sugar Are Linked to Pancreatic Cancer

The pancreas produces digestive enzymes, insulin, and other hormones

The pancreas produces digestive enzymes, insulin, and other hormones

A recent meta-analysis found that elevated fasting blood glucose levels, even in the prediabetic range, are associated with higher risk of developing pancreatic cancer. This is important because you can take action today to lower your fasting blood sugar level, which may lower your risk of pancreatic cancer over the long-term. The researchers conclude that…

“Every 0.56 mmol/L [10 mg/dl] increase in fasting blood glucose is associated with a 14% increase in the rate of pancreatic cancer.”

In the developed world, your risk of getting an invasive cancer is roughly one in four. Pancreatic cancer is the most lethal. Surgery is the way to cure it, but at the time of diagnosis only two in 10 patients are candidates for surgery because the cancer has already spread. Pancreatic cancer is the fourth leading cause of cancer death in the USA and the fifth in the UK. Nevertheless, pancreas cancer is not terribly common; the US has 50,000 new cases annually. As a hospitalist, I run across one or two new cases of pancreas cancer annually.

We’ve known for years that type 2 diabetes is linked to pancreatic cancer, with diabetics having twice the risk of nondiabetics.

What if you have elevated fasting blood sugars? There’s no proof that reducing them to the normal range will reduce your risk of pancreatic cancer. But if it were me, that’s what I’d shoot for.

Other that type 2 diabetes and prediabetes, some other risk factors for pancreas cancer are:

  • heredity
  • smoking
  • sedentary lifestyle
  • body mass index over 30 (obesity in other words)

You can alter most of those risk factors. Why not get started today?

Steve Parker, M.D.

PS: If you’re not sure if your fasting blood sugar’s elevated, click here.

Please Help Support This Blog

You need a break. Enjoy.

I pay $3-12 to license many of the photos and diagrams here. I won’t steal someone else’s intellectual property.

Have you noticed how some blogs just fizzle out? No new posts for a year, then they’re gone?

One reason is that it costs money to maintain them. For instance, I pay WordPress $30/year to keep them from posting advertisements that would interfere with your reading pleasure. I also turn down many offers from advertisers who will pay me for access to my audience.

The biggest “cost” of the blog is my time that it takes to write posts.

I hope you find my writing worthwhile and interesting. You’ll find information here, at no cost, that should improve your health and longevity. What’s that worth?

If you’d like to support the blog, the best way is to buy one of my books, or recommend one to your friends or relatives. You may well be interested in the Paleobetic Diet book. The second best way is to post a review of the book at Even a brief one.

I’d be grateful for your support. Your continued readership is also encouraging to me.

Steve Parker, M.D.


Paleobetic Diet Book Now Available

Paleobetic Diet-FrontCover_300dpi_RGB_5.5x8.5




I started this blog four years ago as an exploration of the Paleolithic diet as a therapeutic option in diabetes and prediabetes. Scientific studies from Ryberg (2013), Mellberg (2014), Boers (2014), and Masharani (2015) have convinced me that the paleo diet indeed has true potential to improve these conditions.

A couple years ago I published a bare-bones preliminary version of the Paleobetic Diet. Here’s an outline. I just finished a comprehensive fleshed-out version in book format.

The central idea is to control blood sugars and eliminate or reduce diabetes drugs by working with Nature, not against her. This is the first-ever Paleolithic-style diet created specifically for people with diabetes and prediabetes.

Also known as the caveman, Stone Age, paleo, or ancestral diet, the Paleolithic diet provides the foods our bodies were originally designed to thrive on. You’ll not find the foods that cause modern diseases of civilization, such as concentrated refined sugars and grains, industrial seed oils, and over-processed Franken-foods. Our ancestors just five generations ago wouldn’t recognize many of the everyday foods that are harming us now. On the Paleolithic diet, you’ll enjoy a great variety of food, including nuts and seeds, vegetables, fruit, meat, seafood, and eggs.

In the book you’ll find one week of meal plans to get you started, plus additional special recipes. Meals are quick and easy to prepare with common ingredients. You’ll find detailed nutritional analysis of each meal, including carbohydrate grams.

All measurements are given in both U.S. customary and metric units. Blood glucose values are provided as both mmol/l and mg/dl. Also included is information and advice on exercise, weight loss, all 12 classes of diabetes drugs, management of hypoglycemia, and recommended drug dose adjustments. All recipes are gluten-free.


Availability and Formats

You’ll find Paleobetic Diet at all major online bookstores. For example, Amazon (290-page paperback book in U.S.), Kindle ebook, and multiple ebook formats at Smashwords.

If you have diabetes or prediabetes, please give this program careful consideration. Help me spread the word if you know someone else who might benefit. Thank you.

Steve Parker, M.D.

Do You Know Where Your Meat Comes From?

paleo diet, Steve Parker MD, diabetic diet

Our rooster, Chuck: handsome but mean!

I’m increasingly troubled by our treatment of the farm animals that eventually make it to our tabletops. I say “our treatment” because, even though I’m not a farmer, I eat animals and therefore contribute to perpetuation of whatever system delivers them to me. Have you heard of CAFOs—Concentrated Animal Feeding Operations? Click for the CAFO Wikipedia article. You might call it factory farming or industrial farming. Are these animals treated cruelly? I realize that small farms aren’t necessarily more humane. Click for an example of alleged cruelty to chickens in a CAFO.

I rarely publish guest posts. Here’s one from Beth Kelly, a graduate of DePaul University and a freelance writer and blogger. She is a passionate environmental and animal rights activist, as well as an active triathlete. You can reach her on Twitter @bkelly_88. (I don’t know Beth personally; this is what she shared via email.)

♦  ♦  ♦

Documentaries That Challenge the Meat You Eat

By now it’s fairly common knowledge that there are some major flaws in the average American diet. Obesity claims nearly 35% of all American adults and nearly 18% of all children, and these numbers are only increasing. Those are some frightening figures about the general state of our collective health. Undoubtedly, the situation is a complicated one, involving the government as much as it does corporations and individual consumers. With the Paleo lifestyle, eating high-quality meat is of utmost importance. And with factory farming more or less institutionalized in America, finding safe, healthy meat products can sometimes be a challenge. Awareness is the first step however, and the more you know about where your meat comes from the better you will feel about making other healthier choices. Documentaries are a great source of inspiration, and are also useful for spreading information to interested family members and friends. Read on for five of my own personal favorites!

Food Inc.

Documentary film’s answer to Upton Sinclair’s famous expose The Jungle, Food Inc. challenged everything we thought we knew about what’s in our fridge. The film looked at many different aspects of American food production and educated millions of Americans to facts they never even thought about; like the fact that a majority of meat sold in supermarkets only comes from four giant companies. It not only discussed the monopolistic business structure but also the methods used to create such cheap products, often at the expense of farmers and the animals.

Cock Fight

Taking aim at one of those four companies, Perdue, was chicken farm owner Craig Watts. In this documentary from DirecTV’s Fusion Network, the whistleblower gets to discuss why he called Perdue out and what happens after. After he spoke out against the inhumane treatment of chickens and unfair business practices Perdue sent twenty six inspectors to his farm in the following two months as well as a few visits from government officials, no doubt looking for any excuse to shut him down. It’s an eye opening look at what has happened to the much celebrated American farmer.

Indigestible: The Film

The product of a successful IndieGogo campaign, this documentary from Geri Atos shines a light not only on animal treatment in factory farms but also what it’s doing to our environment. It shatters the illusion so many have of those “happy cows” and the family farm many assume their food comes from. It not only shows the cramped, dirty, and unsanitary conditions farm animals are kept in but it also shows us how these farms are having a massive impact on the environment (methane emissions from cows comprise 10% of total methane emissions, the same amount as coal).

From Farm to Fridge

Created by Mercy for Animals, this 12 minute video looks to shock you into understanding. There’s no hand holding here, they show you the horrific abuse and injustice animals at factory farms are subjected to on a regular basis. Beyond that, the filmmakers embarked on a nationwide tour, hosting screenings and open panels to discuss the state of the American agricultural system. Obviously the push here is to get viewers to give up on eating meat altogether, but aside from that bias, it poses some serious questions to the viewer about what price our food really comes at.

tuna, fishing, Steve Parker MD, paleo diet, tuna salad

Free-range bluefin tuna

There is a big push towards eating “local” recently, making information easier to find than in past years. It’s up to you to do your research, and identify meat products that are sourced from local, independent farms. In the end, it’s worth it to be a conscious carnivore!



Paleolithic Diet Improves Metabolic Syndrome

…according to an article at American Journal of Clinical Nutrition.



“Metabolic syndrome” may be a new term for you. It’s a collection of clinical features that are associated with increased future risk of type 2 diabetes and atherosclerotic complications such as heart attack and stroke. One in six Americans has metabolic syndrome. Diagnosis requires at least three of the following five conditions:

  • high blood pressure (130/85 or higher, or using a high blood pressure medication)
  • low HDL cholesterol: under 40 mg/dl (1.03 mmol/l) in a man, under 50 mg/dl (1.28 mmol/l) in a women (or either sex taking a cholesterol-lowering drug)
  • triglycerides over 150 mg/dl (1.70 mmol/l) (or taking a cholesterol-lowering drug)
  • abdominal fat: waist circumference 40 inches (102 cm) or greater in a man, 35 inches (89 cm) or greater in a woman
    fasting blood glucose over 100 mg/dl (5.55 mmol/l)
  • fasting blood glucose over 100 mg/dl (5.55 mmol/l)

I don’t plan on reading the full text of the report because it’s a meta-analysis and I’ve likely reviewed the four component studies here already. Here are the results:

Four RCTs [randomized controlled trials] that involved 159 participants were included. The 4 control diets were based on distinct national nutrition guidelines but were broadly similar. Paleolithic nutrition resulted in greater short-term improvements than did the control diets (random-effects model) for waist circumference (mean difference: −2.38 cm; 95% CI: −4.73, −0.04 cm), triglycerides (−0.40 mmol/L; 95% CI: −0.76, −0.04 mmol/L), systolic blood pressure (−3.64 mm Hg; 95% CI: −7.36, 0.08 mm Hg), diastolic blood pressure (−2.48 mm Hg; 95% CI: −4.98, 0.02 mm Hg), HDL cholesterol (0.12 mmol/L; 95% CI: −0.03, 0.28 mmol/L), and fasting blood sugar (−0.16 mmol/L; 95% CI: −0.44, 0.11 mmol/L). The quality of the evidence for each of the 5 metabolic components was moderate. The home-delivery (n = 1) and dietary recommendation (n = 3) RCTs showed similar effects with the exception of greater improvements in triglycerides relative to the control with the home delivery. None of the RCTs evaluated an improvement in quality of life.

Ways to improve or cure metabolic syndrome include the paleo diet, Mediterranean diet, low-carb diets, ketogenic diets, and exercise. Losing excess fat weight with any reasonable diet would probably work. Enhance effectiveness with exercise.

Steve Parker, M.D.

Reference:Eric W Manheimer,  Esther J van Zuuren, Zbys Fedorowicz, and Hanno Pijl. Paleolithic nutrition for metabolic syndrome: systematic review and meta-analysis. AJCN. First published August 12, 2015, doi: 10.3945/​ajcn.115.113613

An Argument for Copious Carbohydrate Content In the Paleo Diet

Salivary amylase helps us digest starches like wheat

Salivary amylase helps us digest starches like wheat

A recent scientific paper proposes that carbohydrates—starches specifically—played a larger role in the ancestral human diet than previously thought. I’ll call this paper the Hardy study since she’s the first named author. The only author I recognize is Jennie Brand-Miller, of glycemic index fame.

A key part of the hypothesis is that our ancestors’ use of fire made starchy foods much more digestible. That’s not controversial. Wrangham thinks hominins have been using fire for cooking for over a million years. Humans, remember, arrived on the scene about 200,000 years ago.

I’m not saying I agree or disagree with the researchers. Read the paper and decide for yourself. I do feel somewhat vindicated in my inclusion of potatoes and other tubers in my version of the Paleolithic diet.


Steve Parker, M.D.

PS: The article references the Pleistocene Epoch. You’ll find various definitions of that, but the Pleistocene ranged from about 1.8 million to 11,000 years ago .