The Healthiest Way to Eat Paleo

There have been about a half dozen studies published on Paleo-type diets, starting around 20 years ago. For example, in what sounds like a reality TV show: ten diabetic Australian Aborigines were dropped off in a remote location to fend for themselves, hunting and gathering foods like figs and crocodiles.

In Modern Meat Not Ahead of the Game, my video on wild game, I showed that kangaroo meat causes a significantly smaller spike of inflammation compared to retail meat like beef. Of course, ideally we’d eat anti-inflammatory foods, but wild game is so low in fat that you can design a game-based diet with under 7 percent of calories from fat. Skinless chicken breast, in comparison, has 14 times more fat than kangaroo meat. So you can eat curried kangaroo with your cantaloupe (as they did in the study) and drop your cholesterol almost as much as eating vegetarian.

So, how did the “contestants” do? Well, nearly anything would have been preferable to the diet they were eating before, which was centered on refined carbs, soda, beer, milk, and cheap fatty meat. They did pretty well, though, showing a significantly better blood sugar response—but it was due to a ton of weight loss because they were starving. Evidently, they couldn’t catch enough kangaroos, so even if they had been running around the desert for seven weeks on 1,200 daily calories of their original junky diet, they may have done just as well. We’ll never know, though, because there was no control group.

Some of the other Paleo studies have the same problem: They’re small and short with no control groups, yet still report favorable results. The findings of one such study are no surprise, given that subjects cut their saturated fat intake in half, presumably because they cut out so much cheese, sausage, or ice cream. In another study, nine people went Paleo for ten days. They halved their saturated fat and salt intake, and, as one might expect, their cholesterol and blood pressure dropped.

The longest Paleo study had been only 3 months in duration, until a 15-month study was conducted—but it was done on pigs. The pigs did better because they gained less weight on the Paleo diet. Why? Because they fed the Paleo group 20 percent fewer calories. The improvement in insulin sensitivity in pigs was not reproduced in a study on people, however. Although, there were some benefits like improved glucose tolerance, thanks to these dietary changes: The Paleo group ate less dairy, cereals, oil, and margarine, and ate more fruits and nuts, with no significant change in meat consumption.

A follow-up study also failed to find improved glucose tolerance in the Paleo group over the control group, but did show other risk factor benefits. And no wonder! Any diet cutting out dairy, doughnuts, oil, sugar, candy, soda, beer, and salt is likely to make people healthier and feel better. In my video Paleo Diet Studies Show Benefits, you can see a day’s worth of food on the Standard American Diet, filled with pizza, soda, burgers, processed foods, and sweets, versus a Paleo diet, which, surprisingly, has lots of foods that actually grew out of the ground.

But the Paleo diet also prohibits beans. Should we really be telling people to stop eating beans? Well, it seems hardly anyone eats them anyway. Only about 1 in 200 middle-aged American women get enough, with more than 96 percent of Americans not even reaching the minimum recommended amount. So telling people to stop isn’t going to change their diet very much. I’m all for condemning the Standard American Diet’s refined carbs, “nonhuman mammalian milk”, and junk foods, but proscribing legumes is a mistake. As I’ve noted before, beans, split peas, chickpeas, and lentils may be the most important dietary predictor of survival. Beans and whole grains are the dietary cornerstones of the longest living populations on Earth. Plant-based diets in general and legumes in particular are a common thread among longevity blue zones around the world.

The bottom line may be that reaching for a serving of kangaroo may be better than a cheese danish, “but foraging for…[an] apple might prove to be the most therapeutic of all.”


I’ve reported previously on Paleo’s disappointing results in Paleo Diets May Negate Benefits of Exercise.

The underlying philosophy behind “caveman” diets may be flawed in the first place. See:

So, What’s the Natural Human Diet? Watch the video!

The wild game video I mentioned is Modern Meat Not Ahead of the Game. Kangaroo is kind of the Australian version of venison. Note that it also matters how the animals are killed. See Filled Full of Lead and Lead Contamination in Fish and Game.

And, for more on the musical fruit, see:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Vinegar Caveats

As I note in my chapter on greens in my book How Not to Die, vinegar may be one condiment that’s actually good for you. Randomized controlled trials involving both diabetic and non-diabetic individuals found that adding just two teaspoons of vinegar to a meal may improve blood sugar control, effectively blunting the blood sugar spike after a meal by about 20 percent. How? I discuss this in my video Vinegar Mechanisms and Side Effects.

Originally, we thought it was because vinegar delayed the gastric emptying rate, slowing the speed at which a meal leaves your stomach, which makes sense because there are acid receptors in the first part of the small intestine where the stomach acid is neutralized. So, if there is excess acid, the body slows down stomach emptying to give the intestine time to buffer it all. The acid in vinegar was thought to slow the rate at which food leaves the stomach, resulting in a blunted sugar spike. But then, studies were published where taking apple cider vinegar before bedtime resulted in lower blood sugars the next day. How does that work? That’s obviously not some acid-induced stomach-slowing effect. Indeed, anyone who actually went to the trouble of sticking an ultrasound probe on someone’s stomach could have told you that—no difference in stomach-emptying times was found comparing vinegar to neutralized vinegar. So, it’s not just an acid effect.

Back to square one.

Additional studies offered the next clue. Vinegar appeared to have no effect on blood sugars, but this was after giving people a straight glucose solution. Glucose is a byproduct of sugar and starch digestion, so if vinegar blunts the blood sugar spike from cotton candy and Wonder Bread but not glucose, maybe it works by suppressing the enzymes that digest sugars and starches. And, indeed, vinegar appears to block the enzyme that breaks down table sugar. It wasn’t just an acid effect, however. There appears to be something unique about acetic acid, the acid in vinegar. These findings were based on intestinal cells in a petri dish, though. What about in people? Feed people some mashed potatoes with or without vinegar, and glucose flows into the bloodstream at the same rate either way—so, there’s another theory shot down.

Let’s figure this out. If sugar enters the bloodstream at the same rate with or without vinegar, but vinegar leads to significantly less sugar in the blood, then logically it must be leaving the bloodstream faster. Indeed, vinegar ingestion appears to enhance sugar disposal by lowering insulin resistance (the cause of type 2 diabetes), and also appears to improve the action of insulin in diabetics. The mystery of how vinegar works appears to have been solved, at least in part.

So, diabetics can add vinegar to their mashed potatoes—or just not eat mashed potatoes. If you add vinegar to a high-fiber meal, nothing happens, which explains results such as no effects of vinegar in diabetics in response to a meal. That’s no surprise, because the meal in question in the study was mostly beans. If you are going to eat high glycemic index foods like refined grains, vinegar can help—though there are some caveats.

Don’t drink vinegar straight, as it may cause intractable hiccups and can burn your esophagus, as can apple cider vinegar tablets if they get lodged in your throat (not that apple cider vinegar tablets necessarily actually have any apple cider vinegar in them in the first place). Don’t pour it on your kid’s head to treat head lice either. It’s “not harmful except when it leaks on to the face or penetrates the eyes,” and it turns out it doesn’t even work. Vinegar can also cause third-degree burns if you soak a bandage with it and leave it on.

Though as many as a total of six tablespoons a day of vinegar was not associated with any side effects in the short-term, until we know more, we may want to stick with more common culinary type doses, like two tablespoons max a day. For example, drinking 2,000 cups of vinegar was found to be a bad idea.


Other good-for-you condiments include (salt-free) mustard and horseradish. You may be interested in my Second Strategy to Cooking Broccoli video. For more on my book, check out the trailer.

This is the final installment of my five-part series on vinegar. If you missed any, here they are:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

How Bariatric Surgery Reverses Diabetes

“Roux-en-Y gastric bypass surgery (RYGB) is one of the most successful treatment strategies for diabetes accompanying morbid obesity. Long-term diabetes remission rates of 83% have been reported.” These findings have led to the suggestion that the surgery improves diabetes by somehow altering digestive hormones, but this interpretation ignores the fact that patients are placed on a severely limited diet for a week or two after the operation just to recover from the major surgery. Severe caloric restriction alone can improve diabetes. So, is it the diet or the surgery?

To answer that question, researchers put diabetics on the exact same diet as one would eat post-RYGB surgery, with or without the actual surgery. As I discuss in Reversing Diabetes with Surgery, the researchers found that their diabetes improved rapidly on the surgery diet before they had the surgery. In fact, the improvement in blood sugar control was better on the diet alone than after the surgery.

Blood sugar control improved more in the absence of surgery.

This suggests that the whole surgical-diabetes-reversal is not due to the surgery at all, but rather because of the diet people have to go on in the hospital during recovery. So, the clinical implication is that nonsurgical interventions have just as much potential to resolve diabetes as major surgery does.

If you’re familiar with my video Diabetes as a Disease of Fat Toxicity, you’ll understand what is occurring. Namely, “[t]ype 2 diabetes can be understood as a potentially reversible metabolic state precipitated by the single cause of chronic excess intraorgan fat”—that is, too much fat in the cells of the liver, pancreas, and muscles. Within seven days of eating about 600 calories a day by either dietary intervention or bariatric surgery, fasting glucose levels (blood sugar levels) can normalize, thanks to a fall in liver fat. If you look at CT scans, you can actually see a 35 percent reduction in liver volume as all the fat is cleared out. Then, the body starts pulling fat out of the pancreas. When the cause of diabetes goes away, the diabetes goes away.

The insulin-producing beta cells of the pancreas “had woken up!… Clearly, the [beta] cells are not permanently damaged in Type 2 diabetes, but are merely metabolically inhibited.” Studies show a reversal of diabetes up to 28 years after diagnosis.

So, diabetics enough to starve themselves can regain normal health. This information should be available to all people with type 2 diabetes, even though it is unlikely many will be motivated enough to escape from the disease. It’s not easy to not eat. Diabetics should know that if they don’t reverse their diabetes, their future health is in jeopardy, although the serious consequences must be balanced against the difficulties and privations associated with starvation diets. “For many people, this may prove too high a price to pay,” as it’s hard to voluntarily restrict food intake that much.

In that case, how about involuntary food restriction? That’s what stomach stapling surgery is. When you essentially remove someone’s stomach, they’re forced into compulsory food restriction.

Of course, major surgery carries major risks—during the operation and afterwards. There can be bleeding, leakage, infections, erosions, herniation, and severe nutritional deficiencies. Surgery or starvation? There has got to be a better way. And there is!

Instead of changing the quantity of food eaten, whether voluntarily or involuntarily, is it possible to reverse diabetes by changing the quality of the food? Watch my videos Reversing Diabetes with Food and Diabetes Reversal: Is It the Calories or the Food? to get the complete picture.


For the lowdown on saturated fat, check out Lipotoxicity: How Saturated Fat Raises Blood Sugar.

Interested in taking a deeper dive into underlying causes of type 2 diabetes? You may be interested in these:

And, for an overview, see How Not to Die from Diabetes.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations: