How the carnivore diet works.

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So apparently Paul Saladinos and Mikhaila Peterson have recently been talking about me on a podcast.🤨

I haven’t had a chance to listen to the podcast, and I probably won’t. But apparently it had something to do with my statements that the benefits of the carnivore diet are caused by calorie restriction.

So I will make my thoughts clear about this. There are probably five main mechanisms of the carnivore diet.

Calorie restriction
Protein
Antigen elimination
FODMAPs, etc.
Placebo

First. Calorie restriction.

People might remember that @joerogan brought up that point with Mikhaila. @chriskresser agreed on a later podcast. And so did @foundmyfitness on yet another later podcast.

So I’m not alone.

Why? Because calorie restriction has long been robustly associated with anti-inflammatory effects. For instance, here from CALERIE 2: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4993339/

And this is only CHRONIC calorie restriction, producing a lean body type. Chronic calorie restriction causes chronic reductions in inflammation.

But what’s more, there is a long literature on the ACUTE effects of fasting on rheumatoid arthritis. You can find that literature here: cochranelibrary.com/cdsr/doi/10.10…

In a word, fasting has long been known to acutely cause remission of the symptoms of rheumatoid arthritis and other autoimmune conditions, almost immediately. Start fasting, and watch the symptoms disappear. It works for many people.

Of course it is not sustainable in the long-term without periodic refeeds, which will cause symptoms to return.

What are the mechanisms for this? It could be ketones. There is a conflicting literature on the supposed anti-inflammatory effects of ketones, which I am writing about for a review right now.

It could also be inhibition of many anabolic/inflammatory proteins associated with lower cellular energy levels.

It could also be the withdrawal of an antigen that the body responds to too strongly.

We do not know, but calorie restriction has profound anti-inflammatory effects and would be expected to help substantially for people with inflammatory conditions.

Incidentally, a ketogenic diet might also mimic some of the effects of the fasted state, and in doing so, might have an important therapeutic benefit for autoimmunity–similar to how it does for epilepsy.

But this still remains speculative. A definitive test for this might be done in a clinical trial:

A ketogenic diet
A diet that is carbohydrate-restricted with a very low glycemic load but no ketosis
A baseline diet with supplemental ketone esters
A baseline diet

Run it in random crossover format and watch the symptoms. Maintain stable bodyweight. Make sure the diets are as identical as possible except for the characteristics above.

An RCT like this would pick apart the antigenic effects, versus the ketotic effects, versus the glycemic effects, versus full ketosis. Somebody write a grant~

A pilot would just test ketogenic versus baseline diet. Anyway…

Mechanism two. Protein.

Protein has profound metabolic effects. It increases lean muscle mass. It causes isocaloric remission of fatty liver. It promotes improved overall body composition.

Through these mechanisms, protein is also anti-inflammatory. More muscle and less liver and muscle fat will increase the “energy sink” of the body, and this will increase the homeostatic regulatory capacity of the body in response to energy intake, i.e. smaller post-prandial fatty acid and glucose spikes. This will spare the cardiovascular system and the immune system will secrete fewer inflammatory molecules. The brain will “feel” this. So will the joints, etc.

How BIG the impact of this is is anyone’s guess. We don’t know.

However, a caveat: it probably depends on the source of protein.

Three. Antigenic restriction.

This one is obvious. The carnivore diet is hypo-antigenic. It is an elimination diet.

We have long known that elimination diets, e.g. the Elemental Diet, can be used to successfully treat inflammatory conditions. See: ncbi.nlm.nih.gov/pmc/articles/P…

The Elemental Diet is kind of like Medical Soylent. It is all the nutrients a person needs, but with no proteins–just dissociated amino acids. No complex carbs either–just glucose, etc. And vitamins, fatty acids, etc.

It is as hypo-antigenic as a diet can be.

I remember my Master’s advisor telling me about the elemental diet when I was a Paleoish Internet diet warrior. I was appalled. OMG NOT REAL FOOD.

It doesn’t matter.😆The point is that restricting antigens works. We know that.

Four. FODMAPs.

Fermentable oligosaccharides, disaccharides, monosaccharides and polyols, or FODMAPs, are carbohydrates in many plant foods that irritate the gut and cause inflammation. When restricted, they can treat irritable bowel syndrome, see here. FODMAPs and other carbohydrates like fiber might also modulate gut immunity in ways that science still has a long way to understanding.

Five. Placebo.

We know that the mind has a profound impact on immune function, predominantly via the vagus nerve. Example:

A really great book discussing this is Jo Marchant’s Cure. Highly recommended.

Incidentally, the same might be true for weight loss. Witness:

I do think that placebo might have a profound influence on how a diet is experienced. If a diet is expected to be anti-inflammatory, I do wonder if it might in fact be anti-inflammatory.

There is a psychological defense mechanism called conversion. I used to experience it. When I was a child, I used to have seizures. When the doctors gave me an EEG, we found that I was not having seizures.

I was having pseudoseizures. Thus the moniker “conversion”: conversion of psychological stress into bodily symptoms. According to psychoanalysts, conversion is an immature, narcissistic psychological defense. It focuses on the self.

So from my own personal experience, I really believe in the mind-body connection. It can be profound. It can create profound distortions in experience.

Jo Marchant’s book shows that these effects can extend beyond the psychological and manifest in physical illness (or cures) via modulation of immunity.

So these are my 4 mechanisms that I would hypothesize personally.

The reason this is important to talk about is that, once we know the mechanisms, we can then change and optimize the diet and have people helped even more by it.

There are stories floating about of people on a carnivore diet who are refusing statins but continuing to have CVD progression.

What if the carnivore diet does not work for everyone and could be harmful for some people? Does Mikhaila think that is possible?

If so, what if we could get all of the benefits of the carnivore diet by isolating mechanisms without some of the potential downsides?

I still strongly suspect that the high red meat content is not optimal. Red meat might be nutritious in some ways–sure–but I strongly suspect that large quantities are probably not optimal for whole body oxidative stress and cardiovascular disease risk.

So if we can pull apart the mechanisms and determine which are helping people on the carnivore diet, then we can use these mechanisms with more flexible dieting strategies, producing the same effect with fewer downsides.

Let me add one last thing.

There is a big difference in worldview between most doctors and many carnivore dieters (the same could probably be said of many plant-based dieters, etc.).

For the medical way of thinking, every intervention has benefits and risks. There is no perfect intervention. Knowing the mechanism of an intervention allows us to get rid of everything else that is not relevant to the mechanism, and thus reduce potential harms.

Thus, mechanisms are necessary to explore to try to maximize the benefits while minimizing the risks.

On the other hand, among many people in various dieting communities, lifestyle interventions are “wholly good”.

I don’t believe anything that humans do is wholly good. There are good and bad parts.

It is true that there are some things that humans do that are better than other things.

But I don’t think there are many “final goods” that solve all problems with no downsides, and I think we should be skeptical of anyone who claims to have found such a good.

And I think we are right to be skeptical. And I think if anyone says we shouldn’t be skeptical, that we should just believe–well, that is very problematic to say the least, and it is a lot like religion.

Science says that we should explore and understand. That is what I think we should do.

That is all.

This post was adapted and edited with some additional content from a popular Twitter thread, here.

Kevin

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1 Comment

  1. Keto carnivore still remains low in protein and high in fat.
    Also you describe the perfect health lifestyle.
    You say ketones are anti-inflammatory, plants could cause harm, carbs (especially refined) cause harm for sure
    and IF(intermittent fasting) comes together with this lifestyle, since you have said yourself that by ketogenic diet you reduce ghrelin, which has also anti-inflammatory effects. Calorie restriction is a different thing. Yes you might restrict calories when you do IF but not in the sense that you dont eat anything.
    Thus, being vegan or plant based or high carb or low fat are the opposites of what you are saying since all those diets do not provide such things unless done on a different way.

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