This page provides information about PRIMAL EATING (paleo, primal. low-car, keto).
You’ve heard that losing weight is 80% food and 20% activity. Don’t get hung up on the numbers. What that means is that if you are obese, most of your habit changes will come from what you eat, but you also need to become more active. That doesn’t require a lot of gym time — or any, actually. In addition, how you sleep and handle stress can also affect your weight, fitness, and general health.
PRIMAL EATING – The 80%
This is a long page with a lot of information to read. It’s your start to understanding how and why we make poor food choices. Below you’ll find:
1. What is “Primal” and “Paleo”
2. What Do Critics Say?
3. What Do Primal People Actually Eat?
4. Because Insulin
5. How Can These Things Be True?
6. A Word to My Vegan & Vegetarian Friends
Our ancestors engaged in lifestyle practices that evolved over 2 million years for optimal gene expression, health, fitness, and longevity. That lifestyle changed 10,000 years ago and the change accelerated just a century ago, putting our health at risk. It’s time to reclaim the lifestyle that made our species strong. We can have the best of both worlds.
The Primal lifestyle is the best model for health and fitness in today’s modern world. Aligning our lifestyle more closely with what allowed our species to successfully evolve can improve our health and fitness. Our ancestors evolved as hunter-gatherers for over two million years. The lifestyle that came along with hunting and foraging changed dramatically about 10,000 years ago with the advent of agriculture, and again in the last century with the rapid increase of technology. We used to chase and forage. Now, we plant and cultivate. Or sit and watch.
This doesn’t mean everything was better back then or that everything we do now is bad. It simply means we’ve lost some things we need back. We’ve lost what made us strong. The changes in how we make and get our food supply helped the human population explode to over 7 billion people, but it’s causing our health to suffer. We’re told these changes also allowed us to escape the selection pressure of starvation and predator danger. That’s a great thing. Except it isn’t true.
You’re still starving and you still have predators. Let me show you why:
- Know Your Friends. Your body is starving. Most of us have no trouble getting calories, but we’re still starving for what feeds our bodies. When you feed your body foods with little nutrition and lots of calories (grains, seed oil, and sugar), your body stores the excess energy as fat while still craving the stuff it needs to build and repair, like good (saturated) fats and proteins. When you change from the standard American diet and away from what the USDA suggests you eat (My Plate), you’ll burn fat rather than carbohydrates for fuel. You’ll become “fat-adapted.” You’ll lose excess weight, decrease inflammation, and your hormones will work better. However, your best friend is sleep. If you’re not going to find a way to get more sleep, forget anything else because it won’t matter. But don’t forget your other good friend, protein. Sure, you hear protein is your pal, but you’ll want to get to know protein a whole lot better.
- Know Your Enemies. You still have predators. You’re still in danger. You’re not eating grain-based, dairy-laden, sugar-rich foods because some government agency told you to. You’re inviting these killers in because marketing made them appealing, price made them easy, and corporate laboratories added chemicals that tricked your mouth into believing they are food. And then, when you eat “healthy whole grains” and avoid things like beef, you hear you’re doing good from authoritative agencies. That’s a powerful affirmation coming from “experts.” You’re told you’re making good choices. So why are you still tired and fat? It’s no longer the lion that stalks us. Our enemy is the corporate fox with his clever lies and lobbying dollars, stealing our health from us.
- Protect Your Vitality. What are you doing watching television every night? You’ve given up because you think you have to join a gym and do hours of cardio classes or run a marathon? First-of-all, stop being lazy. Yes, it will take more work than sitting through sit-coms every night. Second, the work will come to be more like play once your body and energy starts to change. Third, stop being lazy! This is your life we’re talking about.
What is “Primal” and “Paleo”?
“Primal” refers to a lifestyle that includes activities and food more akin to what our ancient (paleolithic) ancestors experienced. Other names for this lifestyle are “Paleo,” “Evolutionary,” and “Ancestral.” Experts and bloggers will often interchange the words when explaining diet and lifestyle, but there are some differences. Paleo as envisioned by Loren Cordain is similar to Primal as envisioned by Mark Sisson, but he focuses on lean meats, avoids butter, and includes artificial sweeteners and canola oil. Mark Sisson’s Primal lifestyle, which we advocate here at WOMANSTRONG, emphasizes saturated fat and the whole animal, dairy for those who tolerate it, and his approach is more holistic.
Here at WOMANSTRONG, we use the word “Primal” most often, and follow Mark Sisson’s recommendations from The Primal Blueprint. (Mark’s Daily Apple)
Q&A: What Do Critics Say?
What About Cutting Calories? Cutting calories across the board can help you lose excess weight. However, cutting fat and protein calories will likely mean you also lose lean body (muscle) mass, increase inflammation due to insulin response and lack of nutrients, disturb normal hormone function, and remain hungry which means your diet will never become a lifestyle and your weight and health will fluctuate.
Primal focuses on grams of macronutrients rather than calories. When you cut out empty carbohydrates (see below), you’re often cutting the amount of calories you’re consuming. But this isn’t the goal. The goal of Primal is to consume plenty of calories from healthy, whole foods. Even if the calories remain the same when you cut out empty carbohydrates (by increasing protein and fat macronutrients), you will lose excess body fat and gain better health. Yes, you read that right.
What About Going Low-carb? Eating a low amount of carbohydrate foods can also help you lose excess weight. Primal encourages you to remove EMPTY carbohydrate foods. “Empty” means food with little to no nutritional benefit. Grains and sugars, for example, have many calories that provide energy for metabolic activity but few nutrients that help to build or repair your body. “Nutrient-dense” foods have both calories and nutrients that build and repair. When the media talks about “low-carb,” they often mean grains, but vegetables and fruits are also carbohydrates — and some are NUTRIENT-DENSE carbohydrates that can be helpful. Many are not. Don’t think fruits and vegetables are necessarily “healthy”. They are problematic for many people.
However, by removing grains, Primal essentially becomes a low-carb lifestyle when compared with the average American’s consumption of grain carbohydrates. Low is just a comparison! Why is 300g of carbohydrates (what many Americans consume) considered “normal”? You can eat plenty of vegetables and fruits, so the amount of your carbohydrates can vary significantly — and we’re never going to tell you to cut back on your veggies if you find them helpful. At the same time, if you don’t like them, you don’t have to eat them. Really.
What About Fiber, Vitamins, and Whole Grains? Some people object to removing an entire “food group” from one’s diet. First, let me say that grain is barely a food. We have come to rely on it for calories, but only after we have severely processed it. Whole grains, grain flours, and grain oils offer little nutrition. Most of the vitamins that grain flours claim to possess are added in factories, not derived from the plants themselves.
And grains are poisonous. That’s likely a surprise to you, since flour is thought of as a staple, as comfort food, as wholesome. But factors within grains interfere with absorption of necessary minerals and cause our bodies to produce antibodies. An unfortunately large number of people subsist on grains because they’re cheap and plentiful and calories are scarce, but that doesn’t mean it’s the best way to eat. For a detailed discussion and relevant research, start here.
Incidentally, those who object to Primal for “removing a food group” often endorse vegetarianism! There is no food more packed with nutrients for our bodies than meat and offal, with such vital nutrients as fat, amino acids, iron, vitamin D, B vitamins, and zinc — and some necessary nutrients you can’t even find in plant form, such as vitamin B12.
The following table is from “Nature’s Most Potent Super Food.”
|APPLE (100 g)||CARROTS (100 g)||RED MEAT (100 g)||BEEF LIVER (100 g)|
|Calcium||3.0 mg||3.3 mg||11.0 mg||11.0 mg|
|Phosphorus||6.0 mg||31.0 mg||140.0 mg||476.0 mg|
|Magnesium||4.8 mg||6.2 mg||15.0 mg||18.0 mg|
|Potassium||139.0 mg||222.0 mg||370.0 mg||380.0 mg|
|Iron||.1 mg||.6 mg||3.3 mg||8.8 mg|
|Zinc||.05 mg||.3 mg||4.4 mg||4.0 mg|
|Copper||.04 mg||.08 mg||.18 mg||12.0 mg|
|Vitamin A||None||None||40 IU||53,400 IU|
|Vitamin D||None||None||Trace||19 IU|
|Vitamin E||.37 mg||.11 mg||1.7 mg||.63 mg|
|Vitamin C||7.0 mg||6.0 mg||None||27.0 mg|
|Thiamin||.03 mg||.05 mg||.05 mg||.26 mg|
|Riboflavin||.02 mg||.05 mg||.20 mg||4.19 mg|
|Niacin||.10 mg||.60 mg||4.0 mg||16.5 mg|
|Pantothenic Acid||.11 mg||.19 mg||.42 mg||8.8 mg|
|Vitamin B6||.03 mg||.10 mg||.07 mg||.73 mg|
|Folic Acid||8.0 mcg||24.0 mcg||4.0 mcg||145.0 mcg|
|Biotin||None||.42 mcg||2.08 mcg||96.0 mcg|
|Vitamin B12||None||None||1.84 mcg||111.3 mcg|
Isn’t This Just Move More Eat Less? Yes and no. Moving more is essential to the Primal lifestyle. Eating less is not. When you go Primal, you change what you eat, how you eat, what you do, and how you do it.
Isn’t This an Artery-clogging Diet That Will Lead to Heart Disease? The lipid-heart hypothesis has been thoroughly discredited. The science was skewed and a commission based on politics codified it into our governmental recommendations. Eating saturated fats does not cause heart disease. Heart disease is caused by oxidation and inflammation in the bloodstream which is the result of poor diet and lifestyle factors. Saturated fat comprises half of our cell membranes, is used by metabolic and hormonal processes in the body, and is an abundant source of K2, A, and D. It’s also easily burned as free fatty acids in the bloodstream for those who are fat-adapted.
When fat is consumed by someone eating a high-carbohydrate (grain-based) diet, the excess insulin they generate more readily stores fat and prevents your body from using your own fat for fuel. High insulin also causes inflammation and oxidation that along with the presence of triglycerides, creates conditions for heart disease. In other words, its the high-insulin environment created by a high-carbohydrate (grain-based) diet that sets up the conditions for heart disease. For the fat-adapted Primal eater, fat is used as fuel rather than stored and there is no excess insulin to drive inflammation.
Isn’t This a Fad Diet For Rich People? Some people object to the emphasis on things like grass-fed beef, organic produce, and supplements as too expensive for the average consumer. These higher-priced items may cost more than most of us are used to spending, but they are not required. Primal can be pursued eating cheaper products like tuna, eggs, nuts, full fat dairy, offal, and conventional produce. Also, the volume of food a carb-addicted eater consumes regularly will not be what a fat-burning Primal eater needs. You’ll spend more money on less but better quality food and be satiated.
Do We Know What Paleolithic People Ate? Indeed, the names “primal” and “paleo” harken back to a time for which researchers disagree. Paleolithic people were hunter-gatherers, and regardless of what they actually ate and how active they were, we have modern hunter-gatherer cultures to compare. The fact is there are basic differences in activity, types of food, and the resultant health and fitness of hunter-gather cultures vs agrarian cultures. You can argue about the label, but the lifestyle has solid research behind it. The advent of agrarian civilization caused a DECREASE is body and brain size, as well as new health risks, like rotting teeth (Nice post that analyzes a poor critique of this finding). And there is more-and-more research like this: The Fat Hunters.
What Do Primal People Actually Eat?
Many features of Primal living will sound like common sense. They’ll be things other health and fitness advocates suggest who aren’t Primal: avoid processed food, exercise regularly, avoid stress, sleep more, etc. We all KNOW these things are good to do, but we don’t do them. The reason we don’t do them is the thing Primal is uniquely able to help with. We don’t do these things because it’s all about degree. We tell ourselves that we ate LESS processed food and exercised MORE and slept two MORE hours this week, so we’re doing good, right? Wrong.
Primal is going to help you get healthier and more fit because it’s not going to tell you to “do a little.” It’s going tell you to STOP. Primal is going to explain why even a little is not okay. But don’t worry. It’s also going to say “yes” to many things:
- Yes, eat all the meat and vegetables you want.
- Yes, take a nap instead of doing more housework.
- Yes, walk and play every day.
- Yes, trust your body’s cravings.
The Primal lifestyle encourages meat, fish, eggs, vegetables, nuts, and fruit. Primal encourages pastured, free-range, organic, and local food. Primal avoids grains, most added sweeteners, all grain oils, and legumes. Dairy is okay if you don’t have bad reactions to it. Lots of meats and vegetables and less nuts and fruits. Go for full fat. Coffees and teas are generally okay. The variety among Primal and Paleo choices can include whole foods groups, but the one thing they agree on is NO GRAIN and NO SUGAR.
Primal is not for weight loss. Weight loss is a side effect. A good one! If years of unhealthy eating have ruined your metabolism and you’re carrying around extra fat, switching to a Primal lifestyle will help your body composition and overall health. But the nutritional approach is about optimizing your health and wellness. We’ll always talk about eating well and being active, not shedding pounds.
Stick with it for at least 21 days. For many people, switching isn’t easy. Due to the sudden drop-off in dietary carbohydrates, folks who are used to bread, pasta, and sugar often report that they feel terrible for the first couple of weeks. When you get through a month, you’ll feel more energized and satiated at each meal.
Eat already! Don’t be afraid to try new recipes or experience new foods – including fats. Primal may feel restrictive at first, but you’ll soon find that this way of eating offers infinite variety.
Weight management, optimal health, and minimized disease risks are about moderating insulin production. The traditional approach is deeply flawed — cutting calories, focusing on lean meats, and aiming for half or more of your food to be grain products. 70% of our health care expenditures are for lifestyle-relate chronic diseases, such as obesity, diabetes, and heart disease.
The dominant system for feeding livestock is based on cheap grain. Under current US agriculture policy, the government provides subsidies to farmers who produce grains, particularly corn and soybeans. Livestock raisers use corn and soy as a base for their animal feed because grain fattens up their animals and because they’re incredibly cheap as a result of those government subsidies. Even grass-fed cattle are often grain-finished so the animals gain significant fat in the months before they’re sold. In other words, those whose livelihood depends on the weight of their product know to use GRAIN because it yields the fattest animals. So what do you think it’s doing to you?
Grains are the “Worst mistake in the history of the human race” (UCLA evolutionary biologist Jared Diamond). Grain drives excess insulin production, fat storage, and heart disease. It’s allergenic, immune-suppressing, nutritional value inferior to plants and animals. Whole grains are possibly worse due to “anti-nutrients” that compromise immune and digestive function and promote systemic inflamation.
Primal will help you to live in your body as much as you already live in your mind. Because that’s the problem we have these days. We’re not listening to our bodies. But, then, we can’t really trust our bodies when we’re addicted to grains and sugars. However, when you have become fat-adapted, you can.
Here’s the insulin picture:
Ingesting carbohydrates causes insulin to be released. Consuming many grams of carbohydrates throughout the day means your body is swimming in insulin for long periods of time. Insulin fills your cells with fat derived from the carbohydrates, and when the cells are full, they stop accepting more. But you still have carbohydrates in your blood, so your body dumps more insulin to overcome the cells’ resistance. This is how you become “insulin resistant.” Your body is now filled with inflammation from the excessive insulin, which compromises your heart health and puts you at risk for other diseases. Your body creates more insulin over longer periods of time in this cycle to build more fat, until after years of this, your pancreas stops producing insulin and you become a Type 2 diabetic requiring injections.
Once you are fat-adapted, fat and ketones become your body’s preferred fuel instead of carbs. Your hormone levels change, glycogen (glucose stored in muscles and liver) is lowered, and you carry less excess water. You stay feeling full longer and don’t experience severe hunger or dips in energy. This is the goal of Primal.
The benefits of eating Primal:
- You’re less reliant on regular meals, have more stable moods, concentration, appetite, and energy levels.
- You can easily reduce excess body fat without extreme measures, since fat is the preferred energy for your body.
- You’re able to engage in intermittent fasting on demand for accelerated fat loss and enhanced cell repair.
- You’ll delay aging by reducing oxidative damage from excess glucose and insulin pattern.
- You’ll reduce inflammation and receive protection from heart disease.
- You’ll improve stress management.
- You’ll self-regulate appetite because your appetite hormones will be balanced.
How Can These Things Be True?
I’m not a conspiracy theorist at heart. But I do recognize the influence of money and ideology on politics. There’s a lot of both invested in keeping you eating grains and avoiding animal products.
You have a bad scientist who hid data on multiple experiments, a political entity whose primary mission is to support economic development for grain farmers, and ideologues not listening to alternative voices and pushing philosophy through committees rather than science.
Is Everybody Lying?
Your doctor tells you to eat a low-fat diet whether she thinks it’s healthy or not. That’s because she was likely educated in a public university in America and listens to the American Medical Association (AMA), which listens to the United States Department of Agriculture (USDA), and has had little direct education in nutrition apart from what her licensing agencies tell her–as well as what she “learns” at luncheons and conferences sponsored by companies that sell medications. (I was once married to a physician and can tell you he received copious free lunches and gifts while receiving all this valuable “education” about what products would help his patients.) The government has great influence on what we believe, from the time we’re in 3rd grade coloring “My Plate” hand-outs to when we’re adults selecting among all the boxes that say “healthy whole grains” and “lean low fat snack” because corporations are cashing in on the government’s authority to influence us.
Still, everyone can’t be lying, can they?
No, it’s not like that. It’s a penchant to listen to authority and to seek protection from liability. Most of us listen to our doctors, who listen to their certifying agencies, who listen to their regulating agencies, who listen to the government so that if something bad happens, everyone can say, “But we followed standard of care, so not our fault.” It’s about having your butt covered from lawsuits. It’s not about science. The USDA, where the whole recommendations mess started, was not about science, either, but about economic improvement for the American farmer.
You can see the results of a doctor following his knowledge and experience rather than unsupported guidelines in the trial of Dr. Tim Noakes, who had to defend his license against the charges brought by the Association for Dietetics of South Africa. Many nations base their guidelines on USDA recommendations (as the USDA seeks markets for US grain) and stray very little, so this is truly an international issue.
Politics Not Science
The USDA is a political entity. The secretary is appointed by the president. Most secretaries have been governors or agriculture secretaries from states with significant agriculture and rural populations. The USDA’s first mission was to provide economic help to rural America and its farmers. It’s mission expanded to help regulate food safety. Then, it got into the recommendation game, and that’s where its conflict of interest began.
Since the 1970s the USDA has been telling us to eat mostly grains. The USDA has no business telling us what we should eat. Look, for example at statement of purpose from Tom Vilsack (formerly governor of Iowa):
Tom Vilsack serves as the Nation’s 30th Secretary of the Agriculture. As USDA’s leader, Vilsack is working hard to strengthen the American agricultural economy, build vibrant rural communities and secure a stronger future for the American middle class. (USDA Emphasis mine.)
It’s all about money for farmers not the general welfare. True, the USDA has divisions that have been created for health recommendations, but do you truly believe there is no conflict of interest when its primary mission is the economic welfare of farmers?
Economics for the farmer is an important goal. Think that translates into listening to science that says what the farmers want to sell is unhealthy? The USDA listens to many sources, including corporations, lobbyists, and nonprofits with fervent beliefs. How is the USDA regulated? How is conflict of interest weeded out? Can it ever be?
The USDA, which influences other agencies, such as the American Heart Association and the American Diabetes Association, has always been headed by a secretary invested in farm-state economics, and the agency has accepted compromised studies, corporate lobbying, and men with ideologies to make their recommendations. Research from both before and after the growth of the Primal movement does not support My Plate recommendations for health. It absolutely never has. You may have seen recent mainstream news headlines about this, but you can read the details here.
Bad Science and Bad Men
USDA recommendations started in the 1970s.
The Seven Countries Study (1956-70) by Ancel Keys has been thoroughly discredited as of 2016. Forty years ago, it was big news. This was an observational study, not the best kind of science because it allows biases, such as selection bias resulting from the way study subjects are recruited or from differing rates of study participation, information bias, confounders, and more. Aside from the limited reliability of such a study, the data was also cherry-picked. That is, Keys left out the data from countries that did not support his hypothesis. Even at the time of its release, scientists argued about its veracity, but competing voices were ignored. In the new millennium, the research was revisited with all data finally considered, and the results did not support the hypothesis. Keys was wrong. There was no evidence that low-fat eating prevented heart disease. Even so, the study became the foundation for the low-fat lipid-heart hypothesis that is still taught in school and preached by such entities as the USDA, Harvard, Mayo clinic, and WedMD. They warn you that consuming red meat and cholesterol-rich foods cause high blood-serum cholesterol and leads to heart disease. But they have NO EVIDENCE.
In 1977 the McGovern Committee enacted the first dietary guidelines based on Keys’ research. Those on the committee and the scientists they invited to testify had conflicts of interest. Many other scientists at the time objected to the process and to the result, but they were ignored. The USDA, whose purpose is supporting America’s farmers, picked up the recommendations and ran with them. And we’ve been lied to ever since.
Ancel Keys went on next to manage the Minnesota Coronary Experiment (1968-73), which was one of the largest, most rigorous experiments ever conducted on whether fatty foods affect our health. This research was based on a better kind of study, one that actually controlled the food eaten by institutionalized patients, a double blind randomized controlled trial. This experiment followed Keys’ earlier work and should have been a nail in the coffin for the theory that saturated fat was not harmful. There should have been fanfare and a Nobel Prize! Instead, there was silence. Why? What happened to this expensive study and its spectacular results? The results were not published until 1989 and then only partial results were made public. Until 2016.
A new look at this experiment with complete data was recently reported in the BMJ. As with Keys’ earlier work, he had left out the data that contradicted his hypothesis. The full results show that patients who lowered their cholesterol, presumably because of the special low-cholesterol diet, actually suffered MORE heart-related deaths than those who did not. Do you realize the significance of this? Hiding this outcome is nothing short of evil and worthy of being called murder in context of what was being pushed on the public at the time.
What Your Doctor Should Know
So why does your doctor tell you to cut back on fat and eat more whole grains? Because she was likely not educated in nutrition and hasn’t kept up with the literature since medical school. Her job, her education, is not about wellness but about repair. However, you may be fortunate and have a physician who does research and can tell you there is no scientific foundation for the Diet-Heart Myth. “We’ve learned a tremendous amount about what causes heart disease over the past decade, but the medical establishment is still operating on outdated science from 40-50 years ago.” (Chris Kresser)
Those who still support the low-fat guidelines often refer to authority (in the form of some person, agency, or educational institution). They don’t refer to the research. Because there is none. Keys’ low-fat research has been discredited and there have been numerous ones that contradict his, but institutions are slow to change. And then, there is the problem with human nature and saving face. Until the current leadership is retired and/or dead, they will not allow their life’s work to be judged a lie.
So what’s the harm in getting people to eat a little less red meat? This is likely what many of those agency personnel thought despite the lack of science to back up their claims. It’s the same kind of thing your doctor says when you ask her about vitamins. Certainly, you’ve heard, “There’s no evidence vitamins actually do anything, but it can’t hurt, so go ahead and take them.” Well, there are many reasons not to do things if we lack the evidence:
- There is wasting money and hope.
- There is how we come to rely on those ineffective things rather than seeking out what may actually be effective.
- And then, there is the possibility that those “it can’t hurt” things will actually be found to do harm. Such as the harm in avoiding red meat which is high in saturated fat that helps elevate HDL and makes LDL more resistant to oxidation. (And, incidentally, the harm in too much vitamin C.)
A Word to My Vegan & Vegetarian Friends
- I want humane and ethical treatment for animals, too.
If you’re a vegetarian or a vegan due to ethical principles, I respect your choice. There’s no argument from me that we can do better in our treatment of animals. Nor will I disagree that we can live without intentionally killing animals for meals. We absolutely can.
My philosophy on consuming animals is this:
I’m an animal, not different or somehow better. There are creatures seeking to consume me all the time and I, them, from microscopic life in my gut to anything hungry that can take a piece of me. I won’t vanish from the Earth without having killed to live and in turn being consumed by other creatures. I’m part of nature, all of which consumes life to sustain life. To thrive, I need both diverse and dense nutrients, and meat and other animal products provide abundant vitamins, proteins, and fats that are difficult or even impossible to find in plant form.
That said, I hate the gluttony and disconnection of modern food production and seek to support more humane and ethical practices.
This is the ethical argument, and I won’t disagree except to offer for consideration the ethics of monocropping, nonlocal eating, and the damage to done to subsistence farmers and wild animals lives and habitats by our modern approach to all-plant diets. Desertification is a new area of concern, as science is showing it the result of over cropping which herding can fix. (The Fern)
The health argument is very different. A vegan or vegetarian diet, even when done well–that is, eating whole plants and prioritizing fats and proteins while not consuming mostly fruits, grains, fried, and sugary foods–is still often deficient in maintaining lean mass and a thriving metabolism without considerable use of supplements, some derived from animal products anyway.
For these reasons, WOMANSTRONG provides recommendations for those who follow the Primal lifestyle, which includes consuming animal products. However, I hope you’ll explore alternatives to my recommendations and share your knowledge and experiences. As I say often…this is not dogma! Let’s evolve together.