Wednesday, March 17, 2010

Book Review: The Primal Blueprint

Mark Sisson has been a central figure in the evolutionary health community since he began his weblog Mark's Daily Apple in 2006. He and his staff have been posting daily on his blog ever since. He has also written several other books, edited the Optimum Health newsletter, competed as a high-level endurance athlete, and served on the International Triathlon Union as the anti-doping chairman, all of which you can read about on his biography page. Mark is a practice-what-you-preach kind of guy, and if physical appearance means anything, he's on to something.

In 2009, Mark published his long-awaited book The Primal Blueprint. He self-published the book, which has advantages and disadvantages. The big advantage is that you aren't subject to the sometimes onerous demands of publishers, who attempt to maximize sales at Barnes and Noble. The front cover sports a simple picture of Mark, rather than a sunbaked swimsuit model, and the back cover offers no ridiculous claims of instant beauty and fat loss.

The drawback of self-publishing is it's more difficult to break into a wider market. That's why Mark has asked me to publish my review of his book today. He's trying to push it up in the Amazon.com rankings so that it gets a broader exposure. If you've been thinking about buying Mark's book, now is a good time to do it. If you order it from Amazon.com on March 17th, Mark is offering to sweeten the deal with some freebies on his site Mark's Daily Apple. Full disclosure: I'm not getting anything out of this, I'm simply mentioning it because I was reviewing Mark's book anyway and I thought some readers might enjoy it.

The Primal Blueprint is not a weight loss or diet book, it's a lifestyle program with an evolutionary slant. Mark uses the example of historical and contemporary hunter-gatherers as a model, and attempts to apply those lessons to life in the 21st century. He does it in a way that's empowering accessible to nearly everyone. To illustrate his points, he uses the example of an archetypal hunter-gatherer called Grok, and his 21st century mirror image, the Korg family.

The diet section will be familiar to anyone who has read about "paleolithic"-type diets. He advocates eating meats including organs, seafood, eggs, nuts, abundant vegetables, and fruit. He also suggests avoiding grains, legumes, dairy (although he's not very militant about this one), processed food in general, and reducing carbohydrate to less than 150 grams per day. I like his diet suggestions because they focus on real food. Mark is not a drill sergeant. He tries to create a plan that will be sustainable in the long run, by staying positive and allowing for cheats.

We part ways on the issue of carbohydrate. He suggests that eating more than 150 grams of carbohydrate per day leads to fat gain and disease, whereas I feel that position is untenable in light of what we know of non-industrial cultures (including some relatively high-carbohydrate hunter-gatherers). Although carbohydrate restriction (or at least wheat and sugar restriction) does have its place in treating obesity and metabolic dysfunction in modern populations, ultimately I don't think it's necessary for the prevention of those same problems, and it can even be counterproductive in some cases. Mark does acknowledge that refined carbohydrates are the main culprits.

The book's diet section also recommends nutritional supplements, including a multivitamin/mineral, antioxidant supplement, probiotics, protein powder and fish oil. I'm not a big proponent of supplementation. I'm also a bit of a hypocrite because I do take small doses of fish oil (when I haven't had seafood recently), and vitamin D in wintertime. But I can't get behind protein powders and antioxidant supplements.

Mark's suggestions for exercise, sun exposure, sleep and stress management make good sense to me. In a nutshell: do all three, but keep the exercise varied and don't overdo it. As a former high-level endurance athlete, he has a lot of credibility here. He puts everything in a format that's practical, accessible and empowering.

I think The Primal Blueprint is a useful book for a person who wants to maintain or improve her health. Although we disagree on the issue of carbohydrate, the diet and lifestyle advice is solid and will definitely be a vast improvement over what the average person is doing. The Primal Blueprint is not an academic book, nor does it attempt to be. It doesn't contain many references (although it does contain some), and it won't satisfy someone looking for an in-depth discussion of the scientific literature. However, it's perfect for someone who's getting started and needs guidance, or who simply wants a more comprehensive source than reading blog snippets. It would make a great gift for that family member or friend who's been asking how you stay in such good shape.

34 comments:

MangoManDan said...

Damn. I ordered the book yesterday, so I miss the freebies. I've asked my library system to buy it, but without reviews in journals it's a harder sell.

Jonathan Byron said...

I also find the carb restriction a curious situation ... on one hand, I often benefit from cutting the carbs. On the other hand, fruit is one of the best sources of potassium, anthocyanins, vitamin C, and other good things.

Also, a number of epidemiological studies have shown that the consumption of beans is clearly linked to reduced mortality/longer life span. Is it the fiber? Flavonoids? I don't know. But beans are relatively high in carbs and are hard to fit into a classic 'low-carb' menu.

MontyApollo said...

Jonathan -

2 cups of cooked black beans have 82g of carbs, 30g of which are fiber (52g "net carbs" if you follow net carbs)

3 cups = 123g carbs / 78g net carbs

You could easily fit 3 cups of beans a day into the 150g carb limit mentioned in Primal Blueprint (but it doesn't permit beans), and you could fit 2 cups a day into many "low carb" programs, depending of course on thier definition of low carb.

In my experience beans have been a good intermediate step just short of a strict very low carb diet. They are not Primal or Paleo though.

Matt Stone said...
This comment has been removed by the author.
Matt Stone said...

I believe "insidious weight gain" was the phrase used to describe a diet with over 150 grams of carbohydrate. I almost fell out of my chair when I read that. It was one of the greatest oversimplifications of how human physiology interacts with food that has ever been formatted into the written word. He should have said "causes insidious weight gain, unless you lived 100 years ago or are one of the 4 billion people on earth that eat over 150 grams of carbohydrates per day without being an ounce overweight."

I too, endorse most of his principles, and wrote a review of it a few months ago.

Aidyn said...

I think Mark did a great job at writing an accessible book that's still not devoid of scientific rigor.

GCBC doesn't make for a great gift. The Primal Blueprint does.

Emily said...

stephan;
do you have a link to a post of yours that goes into more detail on the carb theory of weight management/loss?

i know that most modern Asain cultures consume copious amounts of white rice, a very high carb food, and do not experience diseases of moderninity to nearly the same degree as cultures eating lots of wheat, sugar and processed foods.

i personally find that eating 80-120g total carbs daily helps me eat more nutrient-dense foods and maintain a weight, not to mention better digestion then when i was eating wheat and sugar.

Abe said...

@MangoManDan - Mark included at the end of the post on his site that if you've already ordered it, but can e-mail him the receipt, he will give you the freebies, too.

Patrick said...

Stephan, your main webpage is not accessible. Everyone is getting an error when trying to access it.

Patrick

Adolfo David said...

I will get this book. I am interested in knowing what kinds of supplements exactly he recommends, for example regarding antioxidants. since there are many of them.

Michael said...

Nice review Stephan,

You covered the high and lows of the book quite well. I also can go with Mark on most things except where he lands on carbohydrates and some supplements. But otherwise I think most of his principles are sound.

Clearly his book is far more approachable than GCBC and thus easier to recommend to others as a reading source.

zach said...

Perhaps Mark should expand upon his carb numbers. I see where he is coming from because 80% of the carbs on the SAD comes from sucrose and grains. Similarly, one can eat tons of n-6 pufa and this would be an unhealthy high fat diet. Where he is right on is when talking about former diabetics or people who had the metabolic syndrome. Many of these people must certainly restrict carbs, no matter what the source.

Some people can't tolerate dairy no matter what. Some people can't tolerate eggs, even though pastured they are the perfect food.So what? To recommend against consuming unprocessed grass fed milk, butter, and cheese for the masses is a common error in the paleo community. Again, too many traditional cultures devoid of the diseases of civilization used it as a staple, including the super long lived peoples on the border of eastern europe and central asia.

Robert Zemekis said...

Great review.. Yes, it seems that we should talk about healthy eating instead of weight loss or diets. Anyway the purpose of any diet is to move your eating habits to new healthy level.

Thanks for sharing and possibility to comment! Welcome to visit Ideal Weight Blog to find some recipes and great articles! Thanks!

Bruce W. Perry said...

This is a well-written and fair-minded review, giving credit where credit is due, and graciously delineating your differences.

I could be off-base but, Mark's 150 g carb/sugar ceiling *might* have something to do with your age differences, along with the different scientific analyses. I'm of his age group, and we tend to be more vociferous about our warnings (I actually know someone who recently died while running), and more prescriptive about dietary choices, because after 50+ more seems at stake. The chickens come home to roost.

lhef said...

Having become aware of Primal Blueprint 10 months ago and finding the clearly described lifestyle program, I embraced it readily because it fit where I was ready to go. As a physician I am continually astounded how little the medical profession acknowledges or even understands regarding current nutritional and medical research. I am 71 y/o and agree with the comment that the prescribed CHO level is not a burden for my age group or even 40+. What is really significant is the radical change our society needs to make to get back to well researched and documented nutritional principles and raise our level of physical and emotional health to new levels. Stephan, I do appreciate your continuing review of the literature and your consistent perspective on proper nutritional, biologic, and physiologic principles. Keep up the good work as it is hard to find your level of expertise elsewhere.

rob_scheuneman said...

Hi Stephan

I have a few questions and anecdotal information for you, and I’m sorry they do not follow this post.

I recently had some blood work done and yielded the following results:

fasting glucose: 4.8 mmol/l

hba1c: 0.049 **

total cholesterol: 3.65 mmol/l --> 141.14 mg/dl

ldl: 1.73 mmol/l --> 66.9 mg/dl

hdl: 1.57 mmol/l --> 60.71 mg/dl

cholesterol/hdl ratio: 2.325

triglycerides: 0.77 mmol/l --> 68.2 mg/dl

** The nurses at my clinic were unable to tell me the units for the hba1c reading. I’m from Canada, and I guess we don’t use the typical percentage measurement here. Whatever the measurement, I’m told my reading falls in the middle of the accepted range.

My readings are all ideal and I find this interesting considering my diet for well over a year now. Most of my meat intake has come from chicken and fish. However, I was often eating exorbitant amounts of fatty red meat and pork. I remember eating a 5 pound beef roast in a day after I gave up on veganism. Eggs have been a constant part of my diet, ranging from 2 to 8 a day. Bacon has made its appearances. I have a love/hate relationship with cheese. I always eat to satisfy myself.
Apercu: my cholesterol intake - by conventional recommendations - has either been outrageously high or slightly high. On average, my saturated fat intake has been on the high-end of low, but often times it too was very high. For 2 weeks before my blood was drawn, I was eating a ton of red meat, eggs and chesse.
At all times, my diet is set in a whole-foods, unprocessed context. I eat a lot of fruit, vegetables and nuts. I eat virtually no sugar, no trans-fat, no white flour, and other than a small amount of olive oil I eat no industrial vegetable oils of any sort. My greatest vice, in my opinion, is a relatively high grain intake -- I’ve been eating a lot of oatmeal and dark rye bread diluted with a bit of whole-wheat flour.
What I find interesting, is that my triglycerides are quite low, despite a heavy carbohydrate intake with significant amounts of fructose from fruit. I’ve read from various sources that such an intake of carbohydrates, with so much fructose, raises triglycerides. This is from the American Heart Association’s website blurb on triglycerides: “Many people have high triglyceride levels due to…a diet very high in carbohydrates (60 percent or more of calories)” I find this hard to believe and ironic considering that in their healthy eating guidelines they ask people to assume a diet with far more than 60 percent of calories coming from carbs.
It’s encouraging to me that my fasting glucose and hba1c readings are both pretty good, despite my heavy carb intake. I posted my concerns to you once before that I was becoming insulin resistant, and you doubted that unrefined carbs could have such an effect. It seems that you were right. Like you, I doubt the oversimplified theory that all carbs drive insulin drives diabetes/obesity. As you often mention, the truth is more likely to be found in the types of carbs.
I plan on maintaining a quite heavy red meat and egg intake over the next year or so, and then have the same blood work done again. It will be interesting to see where my numbers are at then.

In regards to this, I was wondering if you could answer these questions:

Do you have any idea what unit of measurement is being used for my h1abc reading?
Do you think my low cholesterol levels could be a residual effect from being on a vegan diet for a two-year period ending a year ago?
I’m 22 years old. Is it possible that my ideal readings are characteristic of anyone my age, regardless of diet?

I continue to enjoy your blog.

Thanks Stephan

Ryan Koch @ Health Matters to Me said...

Stephan wrote: We part ways on the issue of carbohydrate. He suggests that eating more than 150 grams of carbohydrate per day leads to fat gain and disease, whereas I feel that position is untenable in light of what we know of non-industrial cultures (including some relatively high-carbohydrate hunter-gatherers). Although carbohydrate restriction (or at least wheat and sugar restriction) does have its place in treating obesity and metabolic dysfunction in modern populations, ultimately I don't think it's necessary for the prevention of those same problems, and it can even be counterproductive in some cases.

Couldn't agree more, Stephan. Took the words right out of my mouth, especially the bold part.

Todd Hargrove said...

Stepahn ,

Would you care to comment on Dr. Davis' most recent post - says butter raises insulin and makes you fat:

http://heartscanblog.blogspot.com/2010/03/butter-and-insulin.html

Stephan said...

Yeah sure, here's my comment: show me the studies that demonstrate that butter actually causes fat gain. I'm not going to be satisfied with speculation based on a mechanism.

High glycemic index diets also increase insulin more than low GI diets, yet don't lead to weight gain. The whole spiking-insulin-leads-to-weight-gain thing is bunk. If that were the case, people all over the world eating super high-carb diets would be fat, but they're lean.

The largest observational study to date found that the people who ate the most saturated fat (Europeans, so probably mostly dairy fat) had a slower increase in waist circumference than those who ate the least. It was significant in women and a weak trend in men, after adjustment for other fats.

http://www.ncbi.nlm.nih.gov/pubmed/19828709

Ryan Koch @ Health Matters to Me said...

Re: Butter and Insulin

Wow, Stephan. Boo ya!

Todd Hargrove said...

That was quick! Thanks!

Michael said...

Someone posted it on twitter. I couldn't let it pass although I toned down my original response. :-)

Nonsense

rosenfeltc said...

Thank You Stephan for remaining the voice of reason and not falling into the whole paleo has to be low carb crowd. Plenty of evidence showing the importance of tubers and yet all these paleo bloggers say one needs to avoid starches to lose weight, ya right whatever...

Robert Andrew Brown said...

Todd

Thanks for that link.

The trial referred to is intriguing in terms of some of the questions it raises as to the effects of different fats.

However from a quick skim the control group ate many time less calories (5 times less another blogger suggested) as they only got given the pasta. If this is the case I am not sure the trial tells us much about the comparative merits of carbs and fats in insulin terms.

It does tell us if you eat lots of fats and a small amount of carbs, the carbs in their downstream form of glucose may have their path to metabolism by the liver restricted, which if you are eating 5? times as much fat as carbs is maybe unsurprising, and does not tell us much.

Per Peter at hyperlipid butter itself is unlikely to significantly raise insulin.

Robert Andrew Brown said...

Todd

Fat content of butter.
approx 50% sat 20% mono

http://www.nutritiondata.com/facts/dairy-and-egg-products/0/2


"The quality of fat in the diet and its impact on insulin sensitivity"

http://resources.metapress.com/pdf-preview.axd?code=t1l32xt1231j716r&size=largest

162 healthy adults on an isoenergetic high monosaturated or saturated fat diet for 3 months.

Result

No weight gain

SFA group - insulin resistance down 10% Mufa - no change

SFA group - fasting insulin no change Mufa group - declined 5.8%

Ray Sawhill said...

Thanks for the smart and fair review, Stephan.

Some of you may find a Q&A I did with Mark Sisson a while back interesting. It's in two parts, both of which you can get to here:

http://www.2blowhards.com/archives/2009/08/qa_with_mark_si_4.html

irvin said...

Recently (as many of you know), Sisson ran a special to buy his book within a prescribed 24 hour period in order to "pump" up its rating on Amazon and in exchange for your purchase you would get a free "secret" password to access his website. I purchased the book within the prescribed period and as asked forwarded my receipt to his company. After not receiving the promised password I then phoned the company and was directed to speak with "Brad" or "Bradford", or "Bradley", or whatever his name is (anyway, he told me he is in charge and has the final say!); and I learned buying the book was only part of the requirement, I also had to forward the receipt to Sisson within the same 24 hour period. Yeah, bad me!! I work for a living, so after taking time to purchase the book online I didn't stay on the computer and forward the receipt right away, instead I sent it in a couple of days latter.... Denied! So, LESSON LEARNED!! READ THE FINE PRINT! The book maybe ok, but if these people have to behave like snake oil salesmen and cheaters to persuade people to buy their products then I am getting some serious negative energy. Due to their negative Karma I will be avoid these cheaters AND thier products in the future!!! Buyer beware! If you could forward this to Mark that would be great.

trinkwasser said...

Very fair review!

Personally I'm somewhere between your "philosophies" simply because of what works for me and can be verified by BG tests and lipid panels, I do around 60g carbs and masses of sat fats, minimal Omega 6s and high Omega 3s and monounsaturates (Real Meat, fish, Real Butter and cheese): IMO you need feedback on what works best *for you*.

http://www.marksdailyapple.com/the-primal-carbohydrate-continuum/

I definitely need to be in the 50-100g zone.

"I recently had some blood work done and yielded the following results:

fasting glucose: 4.8 mmol/l

hba1c: 0.049 **

total cholesterol: 3.65 mmol/l --> 141.14 mg/dl

ldl: 1.73 mmol/l --> 66.9 mg/dl

hdl: 1.57 mmol/l --> 60.71 mg/dl

cholesterol/hdl ratio: 2.325

triglycerides: 0.77 mmol/l --> 68.2 mg/dl"

Nice numbers! Slightly better than mine. That A1c probably means 4.9% which is spot on.

Phil Baker said...

I just finished the book and am filled with excitement and wonderment. What's weird is that I'm not obese--I have trouble keeping on weight plus I'm a smoker. Still, I'm going to get into this (and ditch the smokes) and turn my wife onto it...the grain thing--no grains---really isn't an obvious thing to learn, and Sisson's got a wonderful writing style. In this book you can get your physiology and plain sense humor--and a ton of information in a gripping and well-organized book. His site's awesome also and he frequently refers to it. AWESOME contribution by a remarkable person..

Publishers said...

This comment could be posted anywhere on your blog, but I happen to be here right now. My comment is that I only discovered your site a few days ago, and I am not only grateful to find an intrepid researcher with a clear, balanced, and responsible view on topics so complex and confusing (with a thousand contradictions between various experts), but I'm also astonished at the intelligence and reasonableness (did I just make up that word?) of the people who comment. Wow.

I made a small donation; it would be useful if you set up a subscription sort of thing, where one could pledge a certain amount every month, as I can't contribute a lot at one time but could manage, say, $3-5 a month - the trouble is that unless I have some sort of subscription I am likely to forget. What do you think?

Toni, a regular as of NOW.

Jeremy said...

I downloaded the sample version of the Primal Blueprint on the Kindle. This gave me a chance to read the intro and the first chapter. I found it a little to colloquial for my taste so I did some more searching. This is when I came upon Evolution Rx By William Meller. I listened to the podcast posted here (the November episode is more interesting):

http://www.skeptic.com/podcasts/skepticality/episodes2009.html

I liked it, so I bought the book. It's a very easy read yet it is very informative and intuitive when you think about it in an evolutionary mindset. I would suggest reading this book before Mark's (if you still feel the need to read Mark's book), it will give you the tools you need to disarm Mark when he tries to sell you his supplements and protein powders.

sandi said...

I can't find anything regarding children and this diet. Is it safe for a two year old child?

Thanks

Jonathan Galt said...

I don't know much about the science behind living a primal lifestyle, but I can personally attest to its benefits.

I struggled for a few years with digestive issues completely vanished within months of changing my diet.

Perhaps it was because I drank two sodas a day, never exercised or drank water and ate extremely unhealthy, that any change for the better would have provided me with some relief.

I'll never know for sure, but I do know that I'll continue to eat grass fed meats, very low carbs, no sugar or HFC and continue to enjoy my new found lifestyle as it definitely is no fad diet.

Jonathan Galt said...

BTW, your captcha is a nightmare!