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Heart Health

Is Paleo diet right for you? Part 1: What Cardiologists Say

written by Vin Kutty

comments 30 comments

heart health

Paleo is all the rage.

Should you join the bandwagon?


But most cardiologists think it is nuts to warm up to eggs, butter or lard.

Most people have several incorrect assumptions about the Paleo diet. It is almost always misinterpreted.

Paleo should be an inspiration to eat and live in a simpler, cleaner, ancestral way. A rough guide. A template. That’s it.

It is not a low-carb carnivorous diet. It’s not Atkins with a spit shine. Technically, even vegans could be Paleo if they ate just fruits, vegetables and nuts.

True Paleolithic diets are almost never replicated because it would require eating bugs, grubs, reptiles and the like. But that’s not the point.

The point I’m trying to make is that you don’t have to go that far back in human history to find the ideal nutritional template. Eating the way people did even 100 years ago will have tremendous positive effects on your health.

My 30 Year Study

I’ve been quietly conducting an informal study/survey for the past 30+ years.

It involves talking to two groups of people about diet.

The first group: elderly people from remote and rural parts of the world

I asked them these questions:

  1. What did you eat as a child?
  2. What do you recall your grandparents or great-grandparents eating?
  3. Do your grandchildren still eat the same foods? If not, how is their diet different today?

Second group: cardiologists from all over the world

These are interventional cardiologists – the people trained to do bypass surgeries and put in stents. Cardio plumbers. To this group, I asked the following question: what dietary advice do you give your patients?

This survey wasn’t meant to be a secret. Initially, it was mostly to satisfy my curiosity. It’s where my love for off-the-beaten-path travel and interests in nutrition, anthropology and geopolitics met.

I traveled a lot as a child – with and without my parents. I spent 1980 in Nigeria and that was a springboard to my globetrotting. It seemed quite normal that I, a mere teenager, found myself traveling alone in Spain or Ghana. (Yes, my parents were concerned and no, they weren’t hippies.)

Everywhere I went, I noticed that the illnesses that people complained about were different.

My neighbors in Chicago seemed to be dealing with completely different health issues than the people I met in the Niger river delta of West Africa. The issues were chronic diseases in modern societies and infectious diseases in rural and forest societies. I just assumed that was a cultural and genetic difference.

The older I got, the more I started to suspect that diet had something to do with this.

As the 80s and 90s rolled on by, America was gripped in fat-phobia. By the time I graduated from Purdue Univ. (Indiana) in 1990, I was eating fat-free everything. So were most of my peers. Yet the student body was literally getting bigger.

Why were we getting fatter? Why wasn’t poor heart health fixed?

Strangely, people I met in rural parts of the world – Chiang Mai (Thailand), Zaragoza (Spain), and Beni (Bolivia), who weren’t on fat-free diets – were all thin and relatively healthy.

I found the diet in Basque and Catalonia regions of Spain to be particularly high in fat, with their cheeses, hams, cream, rabbit, and octopus specialties. Yet nobody in the rural areas was fat.

The city folk in Barcelona and Madrid were, however, starting to look soft and unhealthy like my neighbors in America.

The same for the gauchos in rural Artigas (Uruguay) versus the office workers in capital city, Montevideo.

Urban teenagers in Brazilian shopping malls were almost always heavier and had more acne than the indigenous rural tribes kids in the Amazon. The teenagers growing up deep in the Amazon jungle had insect bites but never any acne.

Apparently acne doesn’t have to be a rite of passage. I’d like to have known that at fifteen.

This got me thinking. Rural, working class, or forest-dwelling, hunter-gatherer people seem to eat a more conservative or ancestral diet than their city brethren.

Was there something in the way rural people ate that made them healthier?

My gut said ‘yes.’ So I kept asking questions till I felt I had some answers.

And I have some answers.

I hope to keep expanding this blog over the years. But I’ll share the punch line with you here.

Here is what all cardiologists the world over said:

‘Eat a low-fat diet.’

That’s it. Simple.

Every single cardiologist said the same thing. They all wanted me to avoid fat like it was poison. Many of them expanded on it and said that I’d be better off avoiding meat as well.

I met with cardiologists in Brazil, Nigeria, Spain, USA, Uruguay, Singapore, Korea, and India.

Universal egg avoidance

We usually met over breakfast and you’d be surprised how many of them left the eggs on their plates untouched. Many of them ate the egg white and left the yolk alone.

This often led to my eating their yolks (if I knew them well enough) and them thinking I was crazy. They all had the same puzzled, patronizing look when I ate their yolks or poured a generous amount of cream into my coffee. One advised me to stop embracing American counter-culture. And another said, ‘But…you’re a scientist! Why would you eat the yolks?’

But that’s exactly my point. I am a scientist. If the evidence against egg yolks was convincing (or even present), I’d eliminate it from my diet right now.

But there hasn’t been a single published scientific paper that conclusively proves eating egg yolks causes any disease. Yet there are dozens upon dozens of papers proving egg yolks are one of the richest and densest source of nutrients available to humans. It contains essential nutrients that most city dwellers are deficient in – choline, Vitamins A, and K2 come to mind.

But that’s just pesky science.

My goal wasn’t to change the minds of a few cardiologists – the point of this decades-long survey was to hear confirmation of what they thought. And now I know.

It’s as if cardiologists the world over were reading from the same notes. Notes disseminated by the US government and American Heart Association back in the 1970s.

‘Animal fat contains cholesterol and cholesterol is involved in atherosclerosis,’ summed up their collective view on butter, red meat, cream, lard, and certainly egg yolks. Egg whites got a reluctant approval. Some of them avoided egg whites too.

These foods rest on the Paleo altar thanks to their nutrient density and millennia of use. But it’s easy to see how the Paleo diet can be viewed as part of counter-culture. Sure, there are folks who’ve had enough of ‘low-fat’ and choose to defiantly wrap their middle fingers with bacon.

A New Breed of Cardiologists

There is something else you need to know: these opinions are from interventional cardiologists. They receive virtually no training in nutrition or food biochemistry. Everything they know about nutrition is from what they’ve heard from TV, news, pharmaceutical reps, and reading.

Interventional cardiologists are not paid for promoting heart health. They’re paid for roto-rootering you. They send you back out into the world, nutritionally naked and with a zipper on your chest. That’s what they do. And they do it well.

Preventive cardiology is different. It is an emerging field. So is functional cardiology. Cardiologists in this new branch of science are cut from a different cloth. And you will often hear them discussing healthy fats, refined grain and sugar avoidance, inflammation, etc.

Outside wealthy, westernized nations, preventive cardiology is almost unheard of. I’ve only spoken to a couple of preventive cardiologists and don’t yet have a grasp on how they collectively feel about diet. But so far, they seem more informed and fat-friendly.

This brings me to the diets of rural, ancestral, or forest-dwelling peoples. What can these people teach us? More in Part 2 of this series.



*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.


Join the conversation

  1. Great, I look forward to reading more! I’ve been a little depressed about the whole Paleo/Grass fed/etc movement. I’ve been eating like that for the past 8-10 years as well as exercising regularly—and I was just diagnosed with testicular cancer. It’s funny, I was the poster-boy for all the anti-cancer stuff one could do. I felt like I had wasted all this time trying to circumvent this disease, yet, those of my friends and family that eat junk every day and have no family history of this terrible disease are scott-free. Anyways, just a little upset about the whole thing…but I’ll be back on my feet in no time. Thanks for the blog and keep up the great work.

    • Hi NM – I can completely understand why you might be upset or feel it is unfair. After all, you were doing what you thought was right. Lots of ways to second guess yourself, but that’s a waste of energy. Lot of factors that contribute to illness are often out of our control. On the plus side, as much as I beat up on doctors and the state of modern medicine, it is in situations like this that they excel. To your health!

  2. Hi Brian – since this is mostly an opinion piece without any links and references to scientific papers, I will keep with that theme and give you my opinion: I think it is very difficult to prove direct causality when it comes to meat consumption and any kind of disease. Population studies and surveys simply do not generate the kind of data needed to establish cause and effect. It is also important to remember that virtually every food and beverage can be linked to cancer. It’s just too difficult to tease out all the variables.

    I have not read this particular study and I don’t know if it was conducted properly. But I certainly think you should dismiss the article and go straight to the study. It is difficult to point at the inflammation caused by the inability of humans to process this new-found sugar and say that it is responsible for cancer. Inflammation and cancer may be related, but there are dozens of sources of inflammation.

    Humans are not carnivores as this piece suggests. We are omnivores. Humans have been opportunistic meat eaters for a couple of million years. This means we ate mostly fruits, shoots, nuts, tubers, bugs, grubs, and if we got lucky, things that leap, crawl, run, or swim. Our species did this for a couple of million years. And we did just fine, thank you. Doctors mostly had to tend to infectious diseases until the last 50 years or so. Today, most of our misery is from chronic non-communicable diseases. Is modern diet and lifestyle to blame for our ills? Likely. This is the idea behind paleo.

    • Hi Sam – I avoid fermented cod liver oil. For SEVERAL reasons.

      The key reason fermented cod liver oil is popular with the hardcore paleo community is that it was used as a traditional food in northern Europe and it contains Vitamins A and D in highly absorbable forms. Given that the point of my article is to get people to eat more traditional foods, it will seem odd that I’m asking you to avoid fermented cod liver oil. 100 years ago this is what most northern Europeans drank a spoonfuls of to get better. I would MUCH rather you get your Vitamin A from liver and animal fats. And your D from sunshine or supplements. Get your Omega-3 from any other source besides fermented cod liver oil.

      ‘Fermented’ cod liver oil (FCLO) is not really fermented. It is more like pickled in brine. Traditionally, FCLO was made by letting the liver pile up in a vat, then pouring in brine and letting it putrefy under the sun until the livers release an oily goop. This oily goop is then skimmed off and filtered/centrifuged before bottling. ‘Modern’ FCLO is made in more appealing ways, but depending on your perspective, not much. Even the modern FCLO contains FAR MORE environmental pollutants and oxidation/rancidity byproducts than just about every pharmaceutical grade fish oil I’ve ever seen. FCLO will not pass any of the tests that modern fish oils have to. This is not my opinion. I’ve tested this stuff. It’s horrid.

      The unfermented, regular cod liver oil sold at drug stores are made similarly to regular fish oil.

      I’ve been following a ‘Paleo’ diet for 10+ years, since before it was called Paleo. I’ve also been in the fish oil industry for decades. There are very few people with my perspective. I’m a huge proponent of simple, ancestral eating and living. But you don’t have to drink FCLO to do this! Eat all kinds of fermented foods…paleo is great…but pass on the FCLO koolaid.

      • Hi Vin, if we can keep on the FCLO discussion for a bit longer…. I started taking the Blue ICE FCLO / high vitamin butter oil blend a couple of years ago and give it to my kids as well, daily. About a tablespoon a day or slightly less. Two bottles lasts the three of us almost exactly a month. My reasoning for giving it to them was to help their tooth development, as one was getting cavities. I was reading about the Vit. K2 ability to help with this, so we all went on it. My oldest that was getting the cavities has not gotten a single one since. They both also seem extremely resilient to getting sick (no missed school days now for either one due to sickness since taking it as well). So both of these things could be coincidence, I certainly cannot say that they aren’t. Is there anything else you would recommend that may impart the same supposed benefits to teeth and to overall health? My eldest eats a pretty terrible diet… so the fact that he isnt sick and even has great numbers (had his first blood checkup as part of his 10 y/o checkup recently with something in the 80+ range for HDL) seems to suggest something is doing some good. If the FLCO isnt it though, I am certainly willing to stop spending $100 a month on the stuff for the three of us.

        • Hi John – I give my kids liquid K2 (both MK-4 and MK-7 that I personally formulated for them) and occasionally liquid Vit A (when they haven’t eaten liver in a while) and liquid D3 during winter months. Everyone knows never to give my kids sunscreen during the summer. It’s Ok if people think I’m weird…my last laugh will reveal perfect teeth. The disappearance of your kid’s cavities and Vit K2 is not a coincidence at all. Sadly, liquid (or kid friendly) K2 products are not available on the market. I might do something about that someday. I also had candy company custom formulate me a chewable K2 + D3 candy for my kids. Ideally I should have had them add some Vit A to the product too. I hope you’ve noticed the lengths to which I go to give my kids A, D3 and K2, while avoiding fermented cod liver oil. Liver (grass-fed), sunshine, and grass-fed butter (Kerry Gold and local grass-fed stuff during the 3 months of the year when the grass is green here in California) will do the trick. If you’re really bored, make homemade yogurt with grass-fed milk – it’s a great source of K2. I just pissed off the Paleo-police for suggesting dairy, I know. When kids invariably fall short of these dietary and lifestyle ideals, it’s nice to have some supplements on hand.

          What else should you give your kids? Even with a good diet, people fall short on Omegas, magnesium, fat-soluble vitamins…and soluble fibers to keep the ratio of good:bad gut bacteria in your favor. So increase non-grain starches in their diet – mostly roots and shoots. Think a lot about probiotics.

          • great, thanks for the info. So would the kids likely be getting plenty of k2 by simply supplementing with the mk-7 in the nutrigold k2 brand plus mk-4 in the Kerry gold (we have used Kerry gold for a while now as well)? I liked that the A and D were “natural” in the fclo. The D in the pill is from lanolin which is supposedly natural as well.. Not as good as the sun of course but it’s winter in TN. So you think a quality A, D3, and k2 pill would adequately replace FCLo?

            • Hi John – the Nutrigold product + MK-4 in butter and hard cheeses will do the trick. Our sister company Innovix Labs is about to introduce an MK-4 + MK-7 formula in a month or two. Since most people who take FCLO take it for the A, D3 and K, then yes, a pill that approximates the ratios found in FLCO can replace that, assuming you are getting your Omegas elsewhere. It’s rare when a pill works better than the real food, but FLCO, in my opinion, is one of those cases.

              • Do you see any issue with getting K2 from soybeans and any possible effect on hormones from soy? Especially in boys about to hit puberty?

                I am doubtful that I will get my kids to eat liver. Outside of FCLO and liver, what is your suggestion for Vitamin A? Do you have a product suggestion that is as close to a natural source of that vitamin as possible?

                Lastly, I assume your comments about FCLO and environmental toxins/pollutants applies to all brands, even the “gold standard” Blue Ice?

                Thanks for all that you do!

                • Hi John – I don’t see any issues with K2 from soy, although I prefer everything to be soy-free. There isn’t enough soy in a few micrograms to cause anyone any harm. The benefits FAR OUTWEIGH harm if any.

                  NOW Foods has a few fish liver extracted Vitamin A products. Worth a try.

          • My son is 7 and has issues with his teeth and cavities. His doctor just started him on chewable Fluoride since we have a well. Where can I get the K2 product you give to your children? Also, how can I get the A and D3 as well. Would you say these are the 3 most important supplements to give to a child?

            He pretty much hates all forms of vegetables unless they are French cut and fried… His diet is mostly carb based unless its chicken and fried into strips and nuggets. I have gotten him to start eating steak, but will these 3 supplements help offset his mostly crappy diet. I know its my responsibility to have him eat better, but he wont eat what he does not like.

            I would like to add liver to our diet except for the taste. Would having a butcher add 1 pound of liver to 4-5 pounds of ground beef provide enough nutritional benefit? Would it be a good way of sneaking it in?

  3. I’ve been on the PALEO diet for about 3 months now. Feeling great! My body has de-sensitized itself from sugar and salt where now foods/drinks that used to taste bland are tasting too salty and too sweet. Which is a good thing….never knew how much salt they put in chipotle’s guacamole side dish until I had it 2 days ago for the first time in months.

    Anyway been eating just meats, vegetables, quinoa, eggs etc etc avoiding gluten/dairy and sugar. My number weakness is desserts. So I’ve been making lots of PALEO desserts which calls for honey as a sweetener. Does honey create the same havoc in your body as sugar does? Thanks Vin


    • Hi Sam – yes, in short, honey causes most of the same havoc that regular sugar does. I’ve been asked several times if honey is OK. My tongue-in-cheek answer usually is: yes, its fine…if you climb a tree and steal it from the bees yourself. Honey is fine. Our bodies can handle it. But it was PRECIOUS and RARE. A summer treat shared by the tribe. It wasn’t meant to be available in unlimited quantities in bear-shaped plastic bottles for $3 each. I think you get my gist.

      Yes, everything will taste extra sweet after a sugar detox. This is normal. You don’t have to avoid salt so much, unless you’re having blood pressure issues, as long as you are getting enough potassium. Try switching from Paleo desserts to a high-cocoa dark chocolate.

  4. Oh crap! If honey is not good as well, than is there any other sweetener we can use that won’t create problems? What about erythritol? I’ve read on some PALEO sites to even stay away from high % dark chocolate. Thanks

    • Hi Sam – I can see that you’re soon about to get confused and frustrated with this paleo thing. Everyone has a slightly different interpretation of ‘paleo.’ And that’s what causes confusion. Is dark chocolate bad? Not terribly. No self-respecting, knuckle-dragging caveman ever ate dark chocolate. Or butter. Or slept in comfy beds, used deodorant, experienced circadian rhythm busting ipads, probiotic-killing showers…but hey, you pick your battles and you draws your lines. Start with eliminating sugar, grains and vegetable seed oils. If you want to kick it up a notch, get rid of dairy and legumes. It’s up to you. I eat butter, heavy cream and cheese because IgE/IgG tests show I have no issues and I confirmed it with elimination diets. So I appear to be fine with dairy. Doesn’t mean this applies to you. I also occasionally eat legumes, especially if they’re soaked and sprouted. Pick your battles. It looks like you’re still sugar-addicted. It’s common and normal. Sugar stimulates the same reward centers as many recreational drugs. Pass on the erythritol.

  5. Curious. You said you’ve been eating PALEO style for a few years now. What does your daily typical meals look like? Breakfast Lunch and Dinner. And how are your blood panel numbers? Everything normal?

    • Hi Sam – I’ll write something up separately that covers this, as I get a lot of questions about my diet from readers, friends and family. I eat a fair amount of green leafy vegetables but what surprises most people is that I consume root vegetables and tubers and plantains almost every day. Leafy veggies alone isn’t enough carbs to keep me (and my thyroid) and gut bacteria happy. If I go too low on carbs, my thyroid levels, mood, energy and most likely my gut microbiome suffers. But if I go high carb, my previously-compromised metabolic health (and lousy genes) crank up the triglycerides. It’s took me a couple of years to figure this out on my own. Protein, well, grass fed beef, buffalo, and eggs make up the big chunk, with salmon, chicken and pork following in decreasing order. Fats – mostly butter, olive oil and coconut oil. I also have a stash of duck fat, beef tallow, avocado oil, and palm oil. My blood panel numbers are OK. Not perfect, but OK – my doctor indulges me in dozens and dozens of tests. I had a huge drop in inflammation and triglycerides after going Paleo. Increase in HDL too. LDL and Total Chol went up a bit. But particle size and number are not scary.

  6. Hi Vin,

    I would like to know what do u suggest to eat for very long endurance sport before, during and after. Some protein bar ? low or middle carb meats ?
    Any exemple ?


    • Hi Olivier – I am not an expert at this. Sorry. I don’t do any competitive endurance activity, so I have not bothered to change my diet or experiment to get a performance edge. But there are plenty of others who have tried it.

      • I just asked this because most scientists (who say that fat are bad) recommend to eat sugar like orange, bananas…
        I dont eat bananas anymore and I limit my fruit intake to 1 or 2 portions a day.
        I just want to have your opinion about what u have read on this, not to be the graal but to have an idea.

        • Hi Olivier – even if you’re not a competitive endurance athlete, there are only two reasons to avoid eating banana or oranges: allergies or pre-dibetes/diabetes. Barring those issues, there is no reason to avoid fruits. If I were an endurance athlete, I certainly would not avoid fruits! I would much rather you eat a banana than some processed beverage product designed for recovery. Most scientists who say fats are ‘bad’ do not realize that the data they base their opinions on is wobbly, weak, and biased. We have lived with anti-fat bias for almost two generations now. It’s time to end that.

  7. I have a paleo-ish diet but still consume some carbs in the morning to fuel my body with glycogen before a High-intensity interval training (HIIT) work out. I read fish oil is most beneficial when consumed with a fatty meal. I like to take all my supplements in the morning, would adding a boiled egg to my breakfast do the trick?

    • Hi Ohai – unless you have a compromised metabolic issue (obesity, high BP, high TG, high blood sugar, pre/diabetes, etc.) you don’t need to watch your carbs. Fat was the bogeyman in the 90s. Looks like carbs is today’s. Refined sugar is the real bogeyman. Watch the source of your carbs – preferable fruits, vegetables, buts mostly from roots and tubers. Read part 3 of this blog.

      Yes, fish oil is better absorbed with taken with a meal – eating triggers lipase enzyme secretion that help digest fats. Yes, a boiled egg along with some nuts and fruits will do the trick.

  8. I just recently purchased coconut oil. With all the reading I have been doing it sounded like coconut oil was very beneficial. When I made my purchase I bought 100%pure coconut oil(refined). Since the buying refined kind it sounds like I should have bought organic unrefined. Should I not use the refined oil and buy the unrefined? Will I still get the health benefits from the refined?

    • Hi Ben – you’re coconut oil is fine. Focus on big picture when it comes to diet – go back to eating whole foods. Don’t get caught up in the details – this will overwhelm you and derail you.

  9. Thank you for your work. I’ve been on pravastatin for nearly 20 years after finding moderate arterial plaque in a coronary calcium score scan (170 score). Cardiologist recommended risk modification including low fat, high fiber diet, exercise and statin medication to reduce LDL to <=100. After recently experiencing a rapid heart beat, I requested another test. Now score is 573 representing significant risk of cardiovascular event.. heart attack or stroke. Obviously, I've been on the wrong treatment plan. Cholesterol levels were never really high over the years. Sometimes LDL may have been a bit high, but triglycerides were low. It appears that statin medication may have caused it. Sorry for the long story to ask the question about when to take Vitamin K2, MK-4 supplements. Since it lasts only a few hours, wouldn't it be advisable to take with every meal and at bedtime?

    • Hi Greg – I cannot comment on whether you need statins or not. I’ll leave that up to your doctor. Having said that, here are a couple of things that could have contributed to your increased calcium score: 1) stains inhibit K2 synthesis This means that you either need to consumer foods with more K2 or take K2 supplements. 2) Low-fat foods. The science on this will be debated for a while, but I can state confidently that high fat foods are also a good source of Vitamin K2. If you avoid high fat foods, you are also reducing the amount of fat-soluble vitamins in your diet.

      You will need to compensate for the loss of Vitamin K2 in your diet with more K2-rich foods or take K2 supplements:

      Do not pay attention to the notion that MK-4 has a short plasma half life. That just means that MK-4 form of K2 is cleared quickly from your blood. Blood is not where K2 resides or does it work. MK-4 is shunted off to organs where it begins working. MK-4 provides health benefits long after it’s been removed from the blood. You do NOT need to take K2 at every meal to get benefits through out the day. I suggest you take MK-4 along with MK-7. They do different things in different parts of the body.

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