Paleo Principles by Sarah Ballantyne, PhD

Paleo Principles by Sarah Ballantyne, PhDBacon Phat
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Paleo Principles by Sarah Ballantyne is a mammoth tome that touches on every aspect of the paleo diet and lifestyle. Individual nutrients are broken down, and foods and hormonal processes are discussed at length. It is a great book for someone brand new to paleo or in need of a refresher.

In this episode, we discuss:, we:

It is nearly impossible to find a source that talks about the stomach reactions to plug-ins, but with ingredients like formaldehyde, plug-ins are definitely responsible for messing with your digestive tract. The lungs are a filter for outside particles, and because we breathe around plug-ins, people assume that the only effects on the body relate to the lungs. However, the digestive system is a tube that is open to the outside. When we breathe in harmful chemicals, we can also ingest them and damage the gut.


In Julia’s case, sitting in a room that had had 2 stupid plug-ins in the wall until she complained and asked for them to be removed was enough to send her home from work early with tummy problems. She had gas and bloating, which is typical for her, but she also had mild flu-like symptoms like chills, fatigue, and a depressed mood. The lingering effects of the plug-ins bothered her for at least 3 days afterward. Instead of stupid plug-ins, choose real products that aren’t created in a lab and actually benefit you rather than only make people sick.

Show notes:

Who is Sarah Ballantyne?


Sarah Ballantyne is a dope woman who got her phD in medical biophysics from the University of Western Ontario in 2003. She worked in academia for a few years before deciding to take a break to raise her first daughter. At the time, she was obese and suffering from a host of complaints including “Hashimoto’s thyroiditis, fibromyalgia, Irritable Bowel Syndrome, acid reflux, migraines, anxiety, asthma, allergies, psoriasis, [and] lichen planus”. She decided to use her medical background to research ways to mitigate her symptoms and improve her quality of life. Through the paleo diet, she lost 120 pounds and reversed her several autoimmune and inflammatory conditions. Julia met her at Paleo f(x) and was happy to have a few private conversations about shared experiences related to the diseases of civilization. One of the conversations they had was about ketosis because much of Paleo f(x) focused on it as a tool for combating disease and obesity

This book really doesn't like ketosis


In general, Sarah doesn’t like ketosis. She lists side effects that have been associated with ketosis including amenorrhea, i.e. the loss of menstruation. This article points to a few contributing factors involved with this effect; for example, leptin, which could be reduced on a ketogenic diet, has been linked to regulating 

menstrual cycles. Julia and Sasha wonder if the reduction in calories and carbohydrates tricks the body into thinking it’s in starvation mode in which the brain tells the ovaries to stop producing eggs. Or perhaps not enough carbohydrates are converted into fat to be stored in adipose tissue, so not enough hormones are created.

Next, she doesn’t like the argument that we should aim for ketosis because the Inuit consume a diet of mostly animal fat and protein. First of all, she writes that no elevated ketone levels have been found in Inuits, and they consume as much as 280 grams of protein a day, which makes the diet a high-protein rather than high-fat diet.

The Inuit's Gene Mutation

A cursory search of gene mutations for the Inuit at the time of recording revealed multiple studies that discuss gene mutations that allow the Inuit to metabolize fat and have lower levels of LDL cholesterol and insulin.


However, after recording, Julia found a Chris Masterjohn lecture on the gene mutation among the Inuit that Sarah describes in the book. As he explains, the mutation has now become the normal gene for Arctic populations, which means that evolution selected the mutation as beneficial for that environment. The gene greatly reduces activity of carnitine palmitoyltransferase IA (CPT-IA), an enzyme that directs fatty acids into mitochondria in the liver. Since fewer fatty acids enter the liver, most are used for gluconeogenesis, and very little is left for ketogenesis. He then explains that the fatty acids that cannot enter the liver at all are sent as triglycerides into the heart and skeletal muscle, which use CPT-IB (not affected by the gene mutation) to burn them as energy.

In a fasted state, this gene mutation is dangerous because much fewer ketones are produced for energy, and glucose stores are low. This is why Sarah says that infant mortality is higher in Inuit children. Chris’s point is that natural selection wouldn’t have wanted humans in ketosis all the time because the danger for ketoacidosis (acidification of the blood due to an excess of ketones) in the presence of scarce food sources, injury, disease, and other stressors (in other words, daily life for prehistoric man) is high.

Good keto vs bad keto

However, we are not convinced that this means that no one should consume a ketogenic diet. In an extreme environment like the Arctic with a lifestyle that mimics that of our ancestors, it probably would be beneficial to have this gene mutation. Without the risks of ketoacidosis, a good ketogenic diet should be fine. And, in fact, a search of “#keto” on Instagram reveals a lot of bad ketogenic diets. Way too many people think the keys to health are ordering a bunless cheeseburger from a fast food restaurant, eating “keto bread” made from eggs and conventional cream cheese, and guzzling processed protein powders and exogenous ketone supplements. We prefer eating real, organic food when we are hungry and letting our bodies be metabolically flexible.


Sarah also writes that during extreme diets, which include ketosis and calorie restriction, bodies can become leptin resistant, which means that the body and brain don’t respond to leptin signaling appropriately. Rather than receive the message that the body has enough fat and therefore enough energy stores to meet energy expenditure needs, the body thinks it is starving and decreases energy expenditure and increases feelings of hunger and fatigue. Ghrelin, leptin’s metabolic partner, stimulates hunger and appetite. Sarah argues that balancing the 2 hormones is necessary for maintaining a healthy body and weight.

What about IF and fewer meals?


According to Sarah, intermittent fasting and decreased meal frequency can decrease oxidative stress, increase leptin sensitivity, and stimulate autophagy. (Interestingly, IF is not recommended for people who are leptin resistant and can be counterproductive.) However, she really doesn't recommend either. She says 3-4 meals a day is optimal, and skipping breakfast leads to an increase in “cortisol in order to stimulate gluconeogenesis or glycolysis in order to raise our blood sugar”. We are confused by all this. We have both experienced benefits for our energy, gut health, metabolism, strength, pain management, and mood when reducing our meal frequency and practicing intermittent fasting.

Problems with these studies

The studies that Sarah uses to explain effects of ketogenic diets and fasting are largely associative. We lack the mechanistic explanation for many of the effects. For example, this study had 17 participants who did 3 one-day diet interventions. Sure, the effects of 3 one-day interventions on these participants can be attributed to the interventions, but the timeline is much too short, and the number of participants too small. There are no long-term effects, and the participants might be currently eating the Standard American Diet. Employing paleolithic tactics like intermittent fasting and decreased meal frequency when someone isn’t metabolically flexible and possibly leptin resistant will not tell us much about what could happen for someone who eats a clean, organic diet full of real, whole foods.


And as Sasha points out, people who “skip breakfast” are generally not the same people who “fast”. The former is said by people who are running late in the morning or think they are exercising some great self-control related to their diet. They tend to eat the same junk food as people who eat the Standard American Diet all day long. Associative studies show that people who skip breakfast have a “27 percent greater risk of heart attack or heart disease than those who” don’t. But remember, correlation does not mean causation. Just because the two things trend together does not mean one causes the other. People who “skip breakfast” due to sleeping in and running late probably have other unhealthy tendencies if their lack of attention to feeding themselves is any indication of how they care for their bodies otherwise. And if people skip breakfast because they think it will help them reduce overall calories for the day, then they might already be overweight—indeed 40% of American adults are—and the weight gain might cause the breakfast skipping, not the other way around.

We like intermittent fasting

People who “fast”, by contrast, report major benefits to their health and wellbeing. Because this cohort tends to be engaging in healthy behaviors in all aspects of their lives—increased exercise; eating organic, whole foods; reduction of environmental toxins; less alcohol and tobacco consumption; reduction in blue light exposure, etc—fasting is an asset rather than a liability.


When Julia first started training as a powerlifter in graduate school, she ate 6-8 meals a day. She ate breakfast with coffee in the morning, packed a lunch box with multiple snacks and meals, and carried a blender bottle full of powdered protein. She ate breakfast around 6 or 7 am, a snack around 10, a pre-workout “meal” around 11-11:30, post-workout lunch around 1 pm, snacks at 3, 4, and 5, and dinner around 7 or 8 pm. If she was up late working on homework, she would probably graze until bed around 11. She was hungry constantly, and she pooped a minimum of 4 times a day. She also drank at least 3 cups of caffeinated coffee a day.


In fact, it was due to listening to a Ben Greenfield podcast (Julia doesn’t think it was this one, but she can’t find any other podcast about AIP from 2016) during her last summer in graduate school that she changed her diet and stopped pooping all day long. Basically, the message she gleaned from the podcast was that she should be able to go at least 5 hours between meals without getting hungry or tired, which she definitely could not do at the time. She thought she was eating super healthfully, balancing macros and eating whole foods like nuts, meat, vegetables and fruits, homemade sourdough bread from einkorn wheat, and whole-milk dairy products. But if she didn’t have snacks with her at all times, she would get incredibly hungry and tired. In fact, she was afraid of falling asleep while driving any trip longer than 1 hour! She would have coffee, chocolate-covered raisins, and granola just in case. Now, however, with substantial time between meals, Julia’s ghrelin and leptin hormones are released as they should be. She gets properly hungry between meals and can go 12-24 hours without food without a problem.

Other things we liked

Next, Sarah talks extensively about the importance of fiber in the human diet. She argues that fiber is essential for gut health because the critters in our guts feed on fiber, and it adds bulk to stool. Poop consists of water, nutrients and salts, undigested food, and dead bacteria. In fact, it is mostly bacteria. Even though it is common to argue that fiber is necessary to have regular poop, poop can exist without it. Good poops rely on a healthy gut, sufficient electrolytes, proper hydration, reducing environmental toxins, regulated sleep schedule, and balanced hormones.


We like that Sarah advocates that people eat plenty of organs because they are the most nutrient-dense foods on the planet. Plenty of people worry about eating organs, especially liver, because they are filter organs, and they fear that the organs will sequester toxins. (When Julia worked at a farmers’ market in Indianapolis, a shopper told her the one food she avoids is organ meats, which surprised Julia—where are you eating that you have to work hard to avoid organ meats?) Organs do not store toxins; they just filter them into stool and urine. There are some livers (like those of polar bears) that are toxic to humans, however. But these are due to the incredibly high levels of vitamin A in these livers.

Some things we didn't like

The main critique we have of this book is that claims are made without biomechanical explanations. Studies are listed in one big group, but they are not cited alongside the factual claims. Sasha has several issues with the studies relied on in this book. First of all, in one study, the paleo diet is the intervention along with meditation and exercise. Any benefits attributed to the diet might also be attributed to the benefits of meditation and exercise. Introducing multiple interventions at a time is a common problem in medical trials, but it muddies the waters regarding the cause of the outcomes.


Next, she says that with large datasets, researchers can play with the data until they get the results they want, using things like chi-squares tests. Lastly, while anecdotal accounts are important for people in the carnivore community, for example, self-reporting can be a problem in big studies. Food-recall studies that rely on participants’ memories are rife with inaccuracies because people don’t fully remember what they ate, and people lie about what they ate to appear healthier and smarter to the study directors. Therefore, making claims about the healthfulness of diets and recommendations to people based off those claims is irresponsible.

Final thoughts

Overall, this is a great book to read if you currently eat the Standard American Diet and want to switch to paleo. Lack of scientific explanations notwithstanding, your health will definitely improve if you cut out processed food and junk and adopt a diet that comports with the recommendations and claims made in this book. If your studying is a bit more advanced, we suggest taking this book with a grain of salt. For example, Sarah talks about the Mediterranean Diet as if it was not invented in the 1980s with the help of the olive oil industry. And she leads you to believe that your plate should contain mostly plants even though she consistently lists eggs, meat, fish, and organs as the sources for most—if not all—of the micronutrients identified as being essential for health. While we were not 100% satisfied with her discussion of ketosis, we certainly have a better understanding of its criticisms now—not that it entirely matters to us; we both eat plenty of carbohydrates to prevent ketosis 100% of the time.


Sarah Ballantyne's expertise is largely unparalleled in the paleo world. With all her credentials and experience studying complex topics surrounding health and nutrition, she is one of our most trusted sources for information. We love this book for its encyclopedic style; we can pick up this book for a quick reference to any aspect of health or diet without needing to read the whole book.

We didn't like that the book didn't offer bio-mechanic explanations for every claim made, but we understand that most people go to textbooks and the like for such detailed science. Perhaps most people reading this book are unfamiliar with the paleo/ancestral world, and all of this information will be new to them.

If you are a seasoned paleo veteran looking for more nuanced information, then you'll want to buy a different book and rent this one from the library from time to time.