A Cardiologist’s Thoughts on the Paleolithic Diet


I support a diet that has 12 servings of fruits and vegetables per day, with 8 vegetables of variable color and 4 fruits, mostly berries with low glycemic load and index.  This should be matched with high quality organic protein from a variety of sources, such as  wild (not farm raised) cold water fish without heavy metals or other contaminants, and organic range fed chicken, turkey (poultry), and red meat. Fats should be a proper balance of monounsaturated fatty acids (MUFA), omega-3 fatty acids, reduced saturated fatty acids (SFA) and no trans fatty acids (TFA). The fiber should be mixed and of high quality.  Carbohydrates (low glycemic load and index) should be less than 75 grams per day.

The Paleolithic diet is supported with good science.  References are below that I feel demonstrate the pros and cons of this diet, as well as some of the pros and cons of various vegetarian diets.


Roussell MA, Hill AM, Gaugler TL, West SG, Heuvel JP, et al. Beef in an Optimal Lean Diet study (BOLD): effects on lipids, lipoproteins, and apolipoproteins. Am J Clin Nutr 2012 Jan;95(1):9-16.

  • – A low SFA, heart healthy diet that contains lean beef elicits a favorable effect on CVD, lipids and lipoprotein risk factors that are comparable to the DASH diet.
  • – Is it related to amino acids in meat vs vegetables:  lysine and arginine content especially.


Lee JE, McLerran DF, Rolland B, Chen Y, Grant EJ, et al. Meat intake and cause-specific mortality: a pooled analysis of Asian prospective cohort studies. Am J Clin Nutr. 2013 Oct;98(4):1032-41.

  • – All meat ( including red meat, fish, seafood, poultry) had an inverse relationship to CVD mortality in men in Asian countries


Orlich MJ, Singh PN, Sabaté J, Jaceldo-Siegl K, Fan J, et al. Vegetarian dietary patterns and mortality in Adventist Health Study 2. JAMA Intern Med. 2013 Jul 8;173(13):1230-8.

  • – 96,469 Seventh –day Adventist men and women from 2002-2007
  • – 12 % decrease in total mortality
  • – 15% in vegans
  • – 9% in lacto-ovo vegetarians
  • – 19 % in pesco-vegetarian: note that adding fish improved CVD
  • – 8% in semi-vegetarians


Ingenbleek Y, McCully KS. Vegetarianism produces subclinical malnutrition, hyperhomocysteinemia and atherogenesis. Nutrition. 2012 Feb;28:148-53.

  • – No difference in plasma B6, B12 or folate or lipids
  • – Decreased sulfur amino acid intake
  • – Plasma methionine was similar
  • – Low elemental sulfur (S8)
  • – Homocysteine was significantly higher  ( p < 0.001) at 18. 6 umol/L
  • – Increased oxidative stress
  • – Cysteine (33%of control) and glutathione(63% of controls) levels were significantly decreased indicating   inhibition of trans-sulfuration pathway.
  • – Lean muscle mass was 10 % lower
  • – Increased risk of CVD
  • – Malnutrition  is subclinical

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