Do the Elderly Need Paleo More than the Young?

I also do work in economics and one of my favorite economics blogs is Evolving Economics by Jason Collins. He has an interest in biology and Paleo diets and recently linked to an interesting train of thought from evolutionary biologist Michael Rose.

Here is a summary from Peter Turchin, who adopted a Paleo diet this spring after talking to Rose:

We think of people having ‘traits,’ but actually we change quite dramatically as we age. … As an extreme example, consider reproductive ability, something of great interest to evolution. Humans do not reproduce until they reach a fairly advanced age of maturation (puberty). Young adults are not very good mothers or fathers, but they improve with age during their twenties. After that reproductive ability declines and eventually disappears. …

Ability to digest certain foods can also be age-dependent. I have already mentioned the ability to digest lactose, the sugar present in milk. Before we domesticated animals such as cows and sheep, only very young humans had this ability. Natural selection turned this ability off in adults because they never needed it (and it would be wasteful to continue producing the enzyme lactase that aids in the digestion of milk sugar). …

Because abilities to do something at the age of 10, 30, 50, etc. are separate (even if correlated) traits, they evolve relatively independently of each other. When grains became a large part of the diet, the ability of children to digest them (and detoxify the chemical compounds plants put into seeds to protect them against predators such as us) became critical. If you don’t have genes to help you deal with this new diet, you don’t survive to adulthood and don’t leave descendants. In other words, evolution worked very hard to adapt the young to the new diet. On the other hand, the intensity of selection on the old (e.g., 55 years old) was much less – in large part, because most people did not live to the age of 55 until very recently. …

The striking conclusion from this argument is that older people, even those coming from populations that have practiced agriculture for millennia, may suffer adverse health effects from the agricultural diet, despite having no problems when they were younger.

This is an intriguing argument. Several aspects of it are well supported: there has been recent evolution to enable people to cope with toxic diets, and there are substantial changes in how we respond to food as we age.

Recent Genetic Evolution

We know that there has been recent evolution for greater tolerance to evolutionarily novel foods such as wheat. This is (presumably) why peoples with a long history of grain agriculture are less obese and diabetic on “western” diets than people with a long history of eating healthy foods.

The Pacific islanders are a great example. The world’s highest obesity rates are in the Pacific – for instance, in the Kosrae district of Micronesia, 88% of adults are overweight and 59% obese – yet they were notably slim sixty years ago when still eating their traditional diets. [1]

In our book, we note that the traditional diets of Pacific Islanders are almost toxin-free. A logical inference is that because they have for millennia eaten the world’s least toxic diets, Pacific Islanders never needed to evolve (or lost) an ability to cope with toxin-rich diets, and now suffer much more harm from toxic foods than do peoples whose ancestors have eaten toxic diets.

Age-Based Differences in the Biological Response to Unhealthy Food

It’s also the case that we respond to food differently as we age.

It’s not only digestion, such as the age-related decline in lactase enzyme expression, that changes. There are metabolic changes.

The elderly consume far fewer calories than the young; presumably evolution selected for minimal food utilization so that they would not be a burden to those who had to hunt and gather on their behalf. Their contribution was likely cultural, which didn’t require extensive physical activity.

Another change is that the elderly become less likely than the young to store calories in adipose tissue. This has significant consequences.

We know from a broad range of evidence that adipose tissue protects other tissues from damage by lipotoxicity; and that when adipose tissue refuses to store fat, obesogenic diets lead to metabolic syndrome and diabetes. [2] So reduced storage of calories in adipose tissue in the elderly will lead to (a) reduced rates of obesity (as measured by adipose tissue accumulation), but (b) higher rates of metabolic syndrome and diabetes.

This is exactly what we see. Here are obesity rates by age group [3]:

Obesity rates for people over age 65 are lower than for people aged 30-64.

Here are diabetes rates by age group [4]:

Despite their lower obesity rates, the elderly have higher diabetes incidence.

This difference alone is sufficient to answer the question in our title: Yes, the elderly do need a Paleo (ie healthy) diet more than the young. Diabetes is much more dangerous than adipose tissue accumulation, so the elderly will suffer greater health impairment from an obesogenic (and diabetes-genic) diet than the young.

Is There Data Specifically Testing Rose’s Idea?

Rose’s idea that an evolved tolerance for toxin-rich diets will be specific to reproductively-aged persons with agriculturalist ancestors, is, so far as I know, not easily tested by available empirical evidence.

Studies in western populations alone will not be able to test Rose’s idea, because greater intolerance of toxic diets with higher age could simply be a result of an aging process that is universal in all populations. In order to find a process that recently evolved in agriculturalists, we would have to look at rates of aging or morbidity in different populations, both western and aboriginal, and see how aging rates or disease incidence depend on dietary toxicity:

  • Are Pacific Islanders more likely than westerners on similar diets to develop diabetes at reproductive ages, but equally likely at late ages? Are they more likely to become obese at younger ages than old?
  • Is aging more rapid in traditional peoples than in westerners during reproductive years, but similarly fast during elderly years, if they eat similar diets?

I am not aware of any such studies. Let me know if you are!

References

[1] Cassels S. Overweight in the Pacific: links between foreign dependence, global food trade, and obesity in the Federated States of Micronesia. Global Health. 2006 Jul 11;2:10. http://pmid.us/16834782.

[2] Unger RH, Scherer PE. Gluttony, sloth and the metabolic syndrome: a roadmap to lipotoxicity. Trends Endocrinol Metab. 2010 Jun;21(6):345-52. http://pmid.us/20223680. Sun K et al. Adipose tissue remodeling and obesity. J Clin Invest. 2011 Jun;121(6):2094-101. http://pmid.us/21633177.

[3] Health, United States, 2008: With Special Feature on the Health of Young Adults. National Center for Health Statistics (US). http://www.ncbi.nlm.nih.gov/books/NBK19623/.

[4] 2011 National Diabetes Fact Sheet, http://www.cdc.gov/diabetes/pubs/estimates11.htm.

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44 Comments.

  1. I am happy to see you posting again!

    This post is very interesting. Speaking of toxic foods, my mother in law recently gave up consuming wheat. She is in her upper 60’s now and has had really bad arthritis and lung problems for most of her life. It has become worse in recent years. Her pain and lung problems went away in a matter of weeks. Her doctor was shocked how much she improved and confirmed that she is allergic to wheat. Such a simple change had a powerful effect on her health. I often wonder how many people live life without ever knowing that certain foods are making them sick. it makes sense to me that paleo diets would be optimal for senior health along with lots of exercise.

    Hope all is well
    Erik

  2. Hi Paul,

    Interesting topic and one that I don’t think gets enough attention.

    Yes, the elderly most certainly need a Paleo diet if by Paleo we use your definition of non-toxic carbohydrate consumption. But I believe talk of diet without any discussion of the ability to actually digest it misses the point in those afflicted with small intestinal bacterial overgrowth or SIBO, a problem rampant in the Western geriatric population.

    As I explained in the first part of my SIBO series at my blog syontix.com, if you have SIBO, there is absolutely no hope that you are digesting your food properly regardless of the care you’ve taken to source and prepare it.

    In my most-recent blog post, I noted one study that found 90% of those aged 70 to 94 have SIBO. This doesn’t surprise me in the least. The elderly are especially vulnerable because

    a) their gastric-barrier function is compromised due to lowered production of hydrochloric acid, a normal process of aging,

    b) delayed stomach emptying caused by gluten opioids and gluten derived adenosine causes GERD which they treat with antacids or proton-pump inhibitors thus compromising their gastric defenses even further

    c) these same paralyzing gluten substances decrease intestinal motility predisposing to SIBO from migrating gram-negative pathogens from the colon,

    d) they have been exposed to multiple doses of gut-flora destroying antibiotics to treat many of the diseases caused by this dietary pattern and

    e) as a group, many tend to binge drink when partaking in alcohol. Excess alcohol consumption, like gluten grain consumption, predisposes to SIBO. And SIBO predisposes to endotoxemia that fuels bacterial translocation and inflammation everywhere.

    The only factor from the above list that would hold true for the elderly in Paleolithic societies would be the first one. Obviously, gluten, antibiotics and proton-pump inhibitors were never a factor for these cultures and their native gut flora. As for alcohol, let’s not forget that it, along with flour and sugar, was a novel “food” introduced by colonizers to many indigenous populations that are still reeling from its effects. When alcohol did exist in primitive cultures, it was consumed during a communal event and regulated by tribal or group customs no doubt to limit its negative impact on the group.

    As for the elderly being unable to store calories, I would maintain that malabsorption due to a digestive tract devastated by SIBO, gluten, alcohol, reduced beneficial gut flora and normal aging are all part of the problem. The elevated rates of diabetes are an indication of increased levels of endotoxemia caused by impaired gut-barrier and immune system function that results from this.

  3. In by gone decades, as people aged they became slimmer; our aging population today, seems to put on the pounds; just take a look at any 70 year old today: fat! Therefore, not sure about the elderly being unable to store calories.
    My view, now that i am in my young sixties is to follow a paleo template: meat,poultry,veggies, berries,dairy(no lactose problem at all) and limited starch in form of potatoes, and rice, but at low end, or maybe less than PHD recommends depending upon how much i exercise in a given day.

  4. Paul, very interesting post! I never had an issue with wheat or other toxic foods until just shy of my 51st birthday. Then it was as if a switch had turned off and I could no longer handle foods that had never been a problem.

    Your observations about older people having less adipose tissue also fits with my joke that aging is all about losing your baby fat, and that if someone could figure out how to let us keep some of that baby fat (especially on our faces, to fill out those darn wrinkles!), they’d be wealthy beyond measure.

  5. That is an interesting narrative that can also be explained by aging and the subsequent decline in metabolism as a result of many stressors. Diet is only one of many and it is unknown just how much it alone can influence outcomes long term.

  6. intriguing idea,

    makes sense to me that there is no selective pressure to tolerant toxins beyond certain age. those completely ill adapted all died.
    so we are only partially adapted to grains.
    it’s very parsimonious.

    but then as we become less tolerant (against toxic food, infection), as we age, it would be hard to conduct a study that separates the effect of true nature or years of abuse tho.

    incidentally, my friend’s mom became lactose intolerant in mid 60’s. but she eats whole wheat crackers every day for breakfast. so it’s hard to isolate the variable(s)

    regards,

  7. “This is (presumably) why peoples with a long history of grain agriculture are less obese and diabetic on “western” diets than people with a long history of eating healthy foods.”

    To which group of people are you referring?

    Fasano found that certain groups in Egypt have rates of Celiac disease approaching 50%. The Chinese and Indians are both undergoing epidemics of obesity and diabetes that rival or exceed those in the United States.

    And of course the leading Celiac researchers all seem to be Italian.

    I can’t think of a group for which your statement holds true…

    • Pick just about any aboriginal people. I was thinking of Pacific islanders, Pima Indians, and Australian aborigines, but I believe it holds generally for people without a tradition of agriculture.

      Fasano found the rate of celiac disease in Egypt to be 0.53% (http://www.ncbi.nlm.nih.gov/pubmed/18664863). That’s similar to other western populations. Sure, once you look at subgroups with autoimmune disease the rate goes up — why, because wheat sensitivity is a primary cause of autoimmune disease. Still I haven’t seen 50% in any group.

      In any case autoimmune disease is not a good marker for toxicity, since it depends on immune response more than overt toxicity.

      The Asian obesity/diabetes epidemic has the same cause as ours — increased consumption of omega-6 fats. That’s a somewhat distinct issue from the toxicity of grains, which is what Michael Rose brought up.

      • Neither the Pacific Islanders nor the Aborigines have a long history of grain agriculture, and they’ve both highly susceptible to diabetes. Not so sure about the Pima on their ancestral diet, but they don’t do well on US rations…

        “…why, because wheat sensitivity is a primary cause of autoimmune disease.”

        Agree 100%.

        “Still I haven’t seen 50% in any group.”

        From “Frontiers in Celiac Disease by Alessio Fasano, et al”:

        “We have recently completed a screening project on school children in Cairo City, Egypt. Blood samples were obtained from 1,500 children attending school in Cairo City between October 2001 and June 2004… The prevalence of [celiac disease] in this sample of Egyptian students was 53% (95% CI 0.17-0.89). This estimate may be low, as more CD cases could be diagnosed at the follow-up, e.g. in the group currently showing a positive tTG IgA and a negative EMA [partial CD symptoms].”

        My point is merely that I’ve never seen good evidence that ANY group is well-adapted to a diet high in grains. Starchy tubers, like Pacific Islanders, sure, but not to grains.

  8. ❓ Paul,I love foods with utmost simplicity and so I buy these small one serving microwaveable cups of rice at 40gms carbs per serving and 4gms fat consisting of sunflower oil.Do you think that two of these a day is to high to go in omega6?My other food choices will be pork and beef steaks,eggs and cheeses and olive oil mainly as fat source with some butter for flavor.

    • 8 gm sunflower oil = 72 calories * 65% omega-6 = 48 calories omega-6 = 2% of energy = 50% of allowable daily omega-6.

      I’d say that’s pushing it. Other foods will likely be more than 2% of the daily allotment of omega-6 so it wouldn’t take much to get total omega-6 intake over 4% of calories.

  9. “On the other hand, the intensity of selection on the old (e.g., 55 years old) was much less – in large part, because most people did not live to the age of 55 until very recently.”

    This is only true for agricultural populations: survival into old age is a robust feature of hunter-gatherer societies. (See e.g. Gurven and Kaplan 2007.)

    Therefore, we’d expect adaptations to a hunter-gatherer lifestyle to remain relatively consistent throughout human lifespan, while adaptations to an agricultural lifestyle would be concentrated amongst the young.

    JS

  10. Hello, I’m 14 weeks pregnant and to my surprise I have seen three fibroids that I did not know I had. I have 39 years and have never had menstrual problems, I’ve been pregnant quickly, I have not ever had chemical contraceptives. Is there anything I can do to take away, some need to avoid food or increase? I take I eliminated gluten, milk dairy and soy milk with coffee taking sparingly. I read something about calcium-D-glucarate, DIM and indole-3-carbinol, are safe during pregnancy or lactation or should wait for later?
    Thanks and sorry for my English.
    Luisa.

    • Hi Luisa,

      I think you just want to eat a healthy, nourishing diet, get plenty of sunshine on bare skin and some daily light exercise.

      Our diet should be excellent.

      It’s not known why fibroids develop but they probably have the same complex of causes as other conditions: toxic, malnourishing food; lack of sun exposure and activity to impair circadian rhythms and diminish vitamin D.

  11. Hi Paul — I love it when you juxtapose concepts that have escaped notice by the mainstream!

    In your discussion of whether Paleo is needed more for elderly, I can’t help but think of Weston Price’s discoveries, especially when it comes to nutrition in utero. And of course the cariogenicity (in childhood) and induction of periodontal disease (in adulthood) of non-Paleo diets. Your thoughts?

  12. Economics? Economist Thomas De Quincey called energy metabolism the “animal economy”.
    Eating a high-carb, insulin-elevating diet is like storing energy in a term-deposit account; you can’t access it easily, and interest keeps it growing.
    Whereas a ketogenic diet is like saving on a credit card; you can use it at any time, and it costs you a bit more.

    Pacific diets; coraline soil of atolls supports a very limited range of staples; coconut, pandanus, breadfruit, and swamp taro. Seafood – fish and crabs – supplies most nutrition.
    Pandanus:
    A large shrub or small tree of immense cultural, health, and economic importance in the Pacific, second only to coconut on atolls.
    The fruit can be eaten raw or cooked and is a major source of food in Micronesia, especially in the atolls. The fibrous nature of the fruit also serves as a natural dental floss. The tree’s leaves are often used as flavoring for sweet dishes such as kaya jam, and are also said to have medicinal properties. It is also used in Sri Lankan cookery, where the leaves are used to flavour a variety of curries.
    Swamp Taro – Pulaka – (I have this in my garden and never identified it as an edible taro).
    Pulaka makes up the bulk of the islanders’ traditional diet; it is usually supplemented by fish.[7] Since the unprocessed corms are toxic, they must always be cooked, usually in an earth oven. Many of the recipes call for the addition of coconut cream or toddy, or both. On Niutao, coconut cream (lolo) is poured over beaten pulp of pulaka, to make a dish called tulolo. A similar dish on Nukufetau, with halved corms, is called tulolo pulaka; with beaten corms the dish is called fakapapa. Fekei is made on all the islands, and consists of pulaka which is grated (typically this is woman’s work) with the aid of limestone with holes drilled in it. The resulting pulp is wrapped in pulaka leaves and steamed, and mixed with coconut cream.

    – If the toxin is oxalate or cyanide (as in cassava), this is removed by cooking and is not a toxin in the sense that lectins or gluten are.
    However, anyone following this template can easily choose non-toxic starches (sweet potato, rice, yams) or starches easy to prepare safely (potato, taro, green banana)

  13. On overweight in Micronesia: atolls can only support small populations with endogenous crops, especially when rainfall is low. As soon as you bring in more people, to cut copra, fish, make airfields, etc, you need to bring in food from outside. Large numbers died of famine during the Japanese occupation of the Gilberts because of the combination of overpopulation and naval blockade.
    Once you do import food, the population will keep growing, increasingly outrunning what the islands can produce themselves.

  14. It is my belief that everybody needs Paleo from birth to death. If we’re EVER gonna get a handle on health care costs, and numbers of people dying (young and broke) from preventable chronic diseases, a radical diet change is definitely in order–and the sooner, the better! If we were to all go Paleo tomorrow, we could clear our family trees of disease in 3 generations.

    Obamacare? No-PALEO!

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  16. Just imagine trying to eat a Paleo diet from the food served in the dining hall of the average retirement community (many of which serve one meal a day for the people in independent living). And it is even worse for those in assisted living and nursing homes. Is there any hope that is going to change before we get there?

  17. While I agree that there is more selective pressure to tolerant toxins at young ages. I fail to see any evolutionary pressure for an additional adaptation to turn this tolerance of at old age.

    An alternative hypothesis could be cumulative damage, as in metal fatigue. I once read that if a native population starts to eat a western diet it takes 2 to 3 decades until they get the same chronic deceases. I do not know anymore whether this came from a reliable source.

    • Hi Victor,

      Well, the idea is that dietary optima vary with age, all sorts of genes involved in food handling alter with age, and so many genetic changes may have a stronger impact at certain ages. The ones that improve toxin tolerance at younger ages will have been strongly selected for, ones that improve toxin tolerance at later ages poorly selected for. So only the younger age alleles will have reached fixation (spread through the population).

      Of course, alleles that work at all ages will have been selected too. Maybe those dominate.

      Another aspect is that the elderly naturally eat less food. Lower protein and nutrient intake means less tolerance to toxins, as the liver needs protein and nutrients to detoxify.

      So even there has been no significant evolution, the elderly may be more vulnerable.

      Best, Paul

  18. Paul, I assume that this chart reflects American reality. Sort of. I think it actually misses reality. I have yet to see an American who would go beyond eating or not eating.
    OK, let’s go.
    – Something has happened in America since the 1970s. What can it be? What can it be? Ah, I know. The dismantling of New Deal. Americans (known in the world as slaves) spend their “charming” lives attach to their computers some 12 hours a day in constant horror and terror – of their boss, of losing their job, housing, health care and come home only to collapse in front of TV with pizza in hand and “I love my job, I love my boss” on their lips.
    – Why should it be surprising that those who retire and who finally have some energy left to prepare a normal meal and take a walk are slimmer.
    – in other words, in spite of Thacher and Reagan “societies” do exist and their existence probably shouldn’t be ignored.

    • Hi anna,

      Well, if that were it, why do the retired elderly have more diabetes? Exercise and normal meals and lower stress should be more effective against diabetes than obesity.

      A lot has certainly changed since the 1970s, but I think declining food quality and rising omega-6 fats and sugar consumption are probably primary factors in obesity.

  19. My wife and I have been married fifty four years so we have experience in the effect of aging on nutritional needs. We have never had any difficulty with excess weight but now must eat very carefully to maintain a reasonable weight. I don’t think this has anything to do with evolution but is simply because long life is not a goal of evolution. For the last decade we both have followed a relatively high fat diet with not much grains.

    A study concerning the “anorexia of aging” attributes the cause of reduced food intake by the elderly to increased sensitivity to the the gut hormone cholecytokinin (CCK) which reduces the speed of travel of food through the gut in response to fat that reaches the ileum. One study found that the time of digestion of a meal is 50% longer in those over seventy compared to that of the young. As a consequence, food intake is reduced which can result in nutritional deficiencies. It is therefor important that the elderly consume a more nutrient dense diet.

    Inflammation reportedly increases with aging perhaps due in part to reduced synthesis of of coenzyme Q10 which, among other things,is a powerful antioxidant. A high carbohydrate diet increases inflammation so a low carbohydrate diet is more important to the elderly. CoQ10 supplements may be beneficial to the elderly.

    Based on one study, it appears that the amount of vitamin K2 required to maintain a given level of carboxylated osteocalcin, a measure of vitamin K2 adequacy, increases with age. In lieu of taking vitamin K2 supplements, we eat a lot of cheese which is the best readily available dietary source of K2.

    I am sure there are many other reasons why a high fat, relatively low carb diet is important to the elderly.

  20. To elaborate further on my experience of nutritional needs of the elderly I should mention that I followed the low fat fad (USDA) diet for a couple of decades prior to the year 2000. I began my conversion to a high fat diet after reading “Nutrition and Physical Degeneration” by Dr. Weston Price. Subsequently my TG gradually dropped from 130 to 70 and my HDL increased from 55 to 80.

    Because I had avoided animal fats while on the low fat fad I was severely deficient in vitamin K2 which is required for activation of the protein matrix Gla protein (MGP), “the only known inhibitor of vascular calcification”. The lack of vitamin K2 most likely was a major contributor the the calcification of my aortic valve and coronary arteries which required a valve replacement (pig valve) and triple bypass five years ago.

    Prior to the valve replacement to narrowed aortic valve put a heavy load on my heart which increased utilization of CoQ10. I therefore took CoQ10 supplements, 450 mg/day, which improved my heart function according to echo-cardiograms but could not prevent the need to eventually replace the aortic valve. CoQ10 was also helped my recovery from surgery as it has been found that while elderly do not recover from open heart surgery as quickly as the young, recovery time of the elderly on CoQ10 is comparable to the young. I recovered from the surgery quickly.

    Interestingly, while on the high dose CoQ10, my HDL increased to 110 and TG dropped to 40.

    After reading “Perfect Health Diet” I increased my intake of saturated fats and reduced intake of grains and legumes. After a few months on the improved diet I had an echocardiogram and a VAP test. The echo showed that my ejection fraction had increased from 65 two years earlier to 75 which is about as good as it gets. The VAP test showed by TG dropped from 66 to 60 and HDL increased from 80 to 88. Apo B dropped from 98 to 90. Blood pressure is now 110 over 60.

    I eat a lot of raw milk cheese from pastured cows to assure adequate intake of vitamin K2 rather than take the vitamin K2 supplement recommended in “Perfect Health Diet”. The cheese also provides all the calcium needed but is low in magnesium, so magnesium supplements are essential to prevent constipation.

  21. Fitness Wayne | paleo diet and exercise blog

    Interesting article. I have trying to get my elderly parents on the paleo diet for a while. I am worried they are going to have heart disease or alzheimers. Maybe this article will help.

  22. In healthy elderly, particularly women, elevated CCK (cholecisttokinin) triggered by undigested fat reaching the ileum results in delayed gastric emptying which may lead to caloric restriction and malnutrition.

    A recent study (PMID 14652359) found that dairy fat stimulates a greater increase in CCK than a comparable amount of fat with a similar (0.12:1) poly/sat ratio. The study did not address the cause of the lower CCK response by the non-dairy fat. The non-dairy fat components included coconut milk which contains a significant amounts of medium chain fatty acids that are absorbed directly from the gut whereas longer chain fatty acids must be broken down by bile before digestion.

    It is my opinion that the non-dairy fat resulted in a lower CCK response than dairy fat because the medium chain fats in the coconut milk are more rapidly digested and therefore less undigested fat reaches the ileum. Substituting coconut oil for dairy fat should therefore reduce the problem among the elderly of delayed gastric emptying caused by the the CCK response to dietary fat.

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  26. Becoming overweight is evidently a defense* against diabetes. As we age we lose the ability to put on weight in response to bad diets, so diabetes rises.

    It’s like high cholesterol is a defense against heat disease, so medicine fights heart disease by drugs that lower cholesterol.

  27. This article was well written and very informative. It answers my question on whether a paleo diet will still fit even to the elderly, like my parents. My parents, even at their age still dwell on a high carb diet- rice and bread particularly. Maybe through this article I can convince them, not really to adapt purely paleo diet, but simply a “low-carb diet. Thanks for this great post!

  28. Saturated and trans fat also must avoid. and start eating healthy foods that contains omega 3.

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