In this episode of The Feldman Protocol, how should researchers and clinicians weigh insulin resistance against lipid markers when assessing cardiovascular risk? Dave Feldman sits down with Sameer Dossani (PhD, anthropology; health coach specializing in autoimmune and gut conditions) to explore human evolutionary dietary history, the origins of metabolic disease across ancient cultures, the lean mass hypersponder phenotype and ketone production, challenges in science communication, and the role of AI in personalized health.

::: spoiler generated summary

Personal history and the turn toward nutrition (01:05-14:40)

• My health coaching centers on autoimmune disease, especially gut conditions; a recently completed anthropology PhD and personal history shape this approach.
• A South Asian Khoja Ismaili family history runs through Gujarat, Calcutta and modern Bangladesh; the 1971 war preceded the family's long residence in the US and a Washington, DC, childhood.
• Human origins are African, with migrations out of Africa tens of thousands of years ago; mixed South Asian ancestry and a trading family history illustrate human mobility.
• An unhappy elite-school experience preceded university in Canada, philosophy and religion studies, participation in punk and vegan communities, and activism against international economic institutions.
• Roughly two decades in international economics and NGOs, including ActionAid, involved work across several countries; the 2015 move to South Africa, layoffs, and family health problems led toward doctoral work and health coaching.
• Medical-library reading contradicted earlier beliefs about plant-based nutrition; repeated failure to correct medical and dietary advice became more troubling than isolated error.
• Entrenched training, institutional incentives, and inherited assumptions can perpetuate a hypothesis despite contrary data, without requiring a coordinated group of individuals.

Diabetes before modern dietary guidelines (14:40-25:05)

• Medical training depends heavily on memorization, while anthropology and philosophy of science add questions about the origins and historical development of medical ideas.
• Ancient Indian descriptions of madhumeha associated diabetes with sweet urine and carbohydrate restriction; Chinese medical advice attributed to Sun Simiao also included avoidance of carbohydrates and alcohol.
• Carbohydrate restriction has a long history in diabetes care; modern diabetes organizations have also supported carbohydrate-inclusive diets and invoked the brain's carbohydrate requirements.
• A childhood type 1 diabetes diagnosis in North Africa or West Asia involved immediate restriction of bread, an emphasis on meat and above-ground vegetables, and concurrent insulin therapy.
• Carbohydrate restriction for children with type 1 diabetes can provoke concerns over social inclusion and quality of life, alongside the practice of dosing insulin for carbohydrate-containing foods.
• Food pleasure, social convenience and disease prevention can pull in different directions; a culturally popular food can still aggravate an existing health condition.

Comfort foods, ancestral diets and evolutionary hypotheses (25:05-48:30)

• Concern about eating disorders can lead to broad acceptance of every food; differentiating highly processed food-like substances from traditional foods is distinct from viewing all restrictions as disordered.
• A doughnut is a modern comfort food, not an ancestral necessity; enjoyment, dietary balancing and family tradition do not establish a health benefit.
• Highly rewarding processed foods and widespread social participation normalize consumption, with historical parallels to the social acceptance of smoking.
• Blood-pressure concerns coexist with strong family and Bangladeshi sweet-food traditions; allulose and homemade lower-carbohydrate ice cream are practical ways to accommodate these habits.
• Human brain expansion and a smaller gut began roughly 1.3-1.5 million years ago; cooking and greater consumption of animal fat are two explanations, while securely dated fire use occurs later in this chronology.
• Evolutionary diets provide the starting hypothesis; modern hunter-gatherer dietary variety supports a generalist model, while a specialist model centers large, fatty prey.
• [1] A July archaeological analysis across the Americas yields estimates of roughly 90-99% or more of edible animal biomass from megafauna; mammoths and other large prey anchor the specialist-hunter model.
• Megafaunal extinction around 12,000 years ago may have forced dietary diversification; the specialist-hunter account remains a working hypothesis about prehistory.
• Human gut proportions, stomach acidity, forward-facing eyes and sweating are compatible with a meat-oriented evolutionary account; persistence hunting among modern San communities can also have ritual or tourist functions.
• The evolutionary loss of fur and reliance on sweating increased the importance of skin pigmentation; melanin offers solar protection, while lighter skin supports vitamin D production under weaker sunlight.

Famine cuisine, dietary dependence and communication (48:30-01:03:00)

• Stress encourages self-soothing through food and other comforts; older recipes differ from modern products, and a diet useful during famine need not optimize health during abundance.
• Repeated South Asian famines under British rule form part of the history of inherited susceptibilities and starch-centered food customs, complicating current dietary change.
• Sweet cravings and prior stress can persist during dietary change; coffee and lower-carbohydrate substitutes can displace other foods, while a Quest cookie and eggs differ nutritionally and emotionally.
• Public communication connecting metabolic health with the 2020 infectious-disease crisis encountered platform restrictions; earlier videos were deleted after channel growth stalled, and roughly one in nine podcast episodes required removal from YouTube.
• Metabolic health was a correlate of severity and outcome during the infectious-disease crisis; opportunities for preventive dialogue existed amid polarized public reactions.
• Scientific uncertainty requires precise language; the evolutionary dietary model is a revisable starting hypothesis, and public audiences can imitate incidental choices such as diet soda or snack foods.

Veganism, personal illness and LDL (01:03:00-01:22:50)

• Veganism began around age 18 within a Montreal punk community, followed by ethical, environmental and health commitments; eggs and dairy entered the diet later, with intermittent returns to vegan eating.
• Vitiligo stabilized during part of the vegan period, while asthma did not improve alongside smoking; a vegetarian pregnancy was complicated by gestational diabetes.
• By 2015-2016, a largely plant-based diet coincided with knee pain, reduced night vision, severe reactions to milk, very low vitamin D, HbA1c around 6.5 and weight gain; other family members also had health problems.
• South African interest in Banting and Tim Noakes revived an earlier conflict between carbohydrate-centered and dietary-fat-centered explanations of metabolic illness.
• [2] A Gerald Reaven study separated participants by measured insulin resistance; clinical events clustered in the most insulin-resistant group, with none in the least-resistant group, while LDL had little discriminatory value within that analysis.
• Initial changes included elimination of seed oils, a five-day water fast, carbohydrate restriction, sun exposure and greater intake of animal foods; that abrupt sequence is not suitable for unprepared imitation.
• Weight fell from roughly 98 to 78 kg, with improvements in vitamin D and other measures; LDL increased to roughly 350 mg/dL and later above 400, creating concern despite concurrent improvements.
• A CAC score of zero and improved well-being coexist with markedly elevated LDL; the preferred starting point is physiological adaptation and evidence of disease rather than an isolated laboratory value.
• LDL responses to ketogenic eating vary even within a family; substantial subjective gains can bias interpretation of a laboratory marker moving in an unfavorable direction.
• [3] The identical-twin vegan-versus-omnivorous trial used LDL as its main outcome and found a between-group difference of roughly 14 mg/dL, a modest absolute change given its prominence in public debate.
• Work on religious influence within dietetics associations offers one explanation for persistence of plant-based assumptions; much nutritional epidemiology has small effect estimates and possible confounding.

Epidemiology, anomalies and unreleased trial data (01:22:50-01:41:15)

• [4] Bradford Hill's 1965 causality criteria include strength of association; doubling the relative risk of a rare disease can yield a small absolute increase.
• Relative risks around 1.15 often underpin headlines about meat and cancer; observational associations are useful for generating hypotheses without automatically establishing causation.
• Nurses' Health Study and Physicians' Health Study dietary analyses use questionnaire-based dietary intake and face healthy-user confounding through smoking, alcohol, exercise and related behaviors.
• [5] A Harvard doctoral analysis found an inverse association between ice-cream consumption and cardiovascular outcomes among people with diabetes, complicating attempts to isolate benefits of yogurt.
• The ice-cream association could involve dairy fat, intake-recording behavior, confounding or chance; post hoc analyses can preserve a favored yogurt hypothesis without resolving the anomaly.
• [6][7] Chris Ramsden reanalyzed recovered Minnesota Coronary Experiment and Sydney Diet Heart Study data; an original investigator withheld findings because the results were unwelcome.
• Incomplete publication of unfavorable trial findings undermines trust in nutrition research; falsifiable hypotheses, attempts at disproof and publication of negative results are central to scientific practice.
• [8] Metformin's interference with resistance-training muscle gains preceded a reversal in Peter Attia's personal use; confidence in earlier pharmaceutical interventions warrants scrutiny alongside willingness to update them.
• LDL goals often sit below the levels common in adults, sometimes with recommendations for early lowering; LDL had been mildly elevated even during a vegan diet and could be lowered with oatmeal.
• A large breakfast of oats, berries and honey preceded disabling hunger during tennis and a second large meal; dietary LDL reduction can coexist with undesirable glucose and appetite effects in insulin resistance.
• The full effects of an intervention matter beyond one biomarker; better LDL values can coexist with worsening glycemic control and other health indicators.

Medical institutions and the KETO-CTA results (01:41:15-02:08:30)

• Professional guidelines carry institutional authority, while the term fad diet can dismiss patient-led dietary changes undertaken after unsatisfactory diabetes management.
• Ketosis probably occurred repeatedly during human history under limited food availability; modern highly processed diets are more novel than periodic ketosis.
• A physician initially concerned about LDL later adopted low-carbohydrate eating; other doctors in the practice also changed habits, illustrating shifts in clinical assumptions through experience.
• [9] The KETO baseline analysis compared carbohydrate-restricted people with high LDL and favorable HDL and triglycerides against matched Miami Heart participants; this phenotype differs from insulin-resistant atherogenic dyslipidemia.
• [10] The longitudinal KETO-CTA analysis found an association of baseline plaque with later progression but no within-cohort association of LDL or ApoB with progression; average LDL was roughly 254 mg/dL following years of elevation.
• Lean mass hyper-responders are increasingly recognized in clinical practice but remain heterogeneous, with some individuals developing plaque or faster progression.
• [11] PARADIGM linked annualized percent atheroma volume growth around or above 1% to higher event risk; average progression was about 0.93% in event cases and 0.32% without events.
• In KETO-CTA, 21% under QAngio and 29% under HeartFlow exceeded the 1% threshold, while median progression was about 0.23% and 0.27%; individual outcomes cannot be inferred from the cohort median.
• A model in which cumulative ApoB exposure alone predicts individual plaque progression is incompatible with the absence of a direct ApoB-progression association within this cohort; additional factors remain relevant.
• [12] Maasai observations in George Mann's research include low recognized coronary mortality alongside arterial plaques at autopsy; plaque burden and clinical events are distinct outcomes.
• Insulin resistance changes HDL, triglycerides and LDL particle patterns while influencing cardiovascular risk, creating confounding in simple LDL-outcome associations.
• Statin therapy has beneficial outcomes in some high-risk populations, and PCSK9 therapy has relevant data; statins also influence inflammation and nitric oxide pathways, complicating mechanistic attribution.
• Antibiotics can be worthwhile during a serious infection, while preventive medication and population-wide exposure involve tradeoffs, informed consent and patient choice.

Muscle, exercise and dietary self-assessment (02:08:30-02:23:20)

• Resistance training is central to preserving muscle in older adults; increased meat, reduced carbohydrate intake and improved insulin sensitivity can accompany better DEXA measurements in coaching experience.
• Protein intake near one gram per pound of ideal body weight and slow-to-failure resistance sessions lasting roughly 15-20 minutes twice weekly form Dave's muscle-building routine.
• An L1 compression fracture during weight use underscores injury concerns; machines and regular lower-intensity exercise address safety and mental well-being alongside muscular strength.
• A dietary trial can reveal previously normalized symptoms; knee pain, dandruff and longstanding bowel irregularity improved following dietary change.
• A strict 30-, 60- or 90-day ancestral-style dietary trial offers a way to observe changes in symptoms and well-being against habitual eating.

Fiber, bowel health and autoimmune gut disease (02:23:20-02:34:15)

• [13] A 2012 chronic-constipation intervention compared differing fiber intakes and found complete relief in the no-fiber subgroup, challenging the assumption that increased fiber always helps.
• A high-fat, hypercarnivorous pattern combines meat with additional fat to approximate the fat content attributed to large wild prey.
• Abrupt fasting and carbohydrate restriction can produce digestive distress; a gradual four- to six-week transition to higher fat intake can reduce diarrhea and bile-related symptoms.
• Major carbohydrate restriction changes electrolyte needs; insufficient sodium, potassium or magnesium can accompany fatigue, nausea and malaise.
• Inflammatory bowel disease, including Crohn's disease and ulcerative colitis, is a focus of dietary coaching; multiple sclerosis also has a body of dietary intervention research.
• Childhood vitiligo worsened during stress and later improved during a period of carnivore eating, with continued improvement during a high-fat, animal-dominant diet that includes vegetables and spices.
• During inflammatory bowel disease flares, puréed meat, soup and broth can reduce the burden of large solid meals; two or three smaller meals can be easier than one large meal.
• Large late meals can disrupt sleep; food intake ending at least two to three hours before bed, or three to four hours in Dave's routine, supports better nighttime rest.

AI, expertise and limits of diagnosis (02:34:15-02:46:30)

• AI-assisted symptom analysis can expand the diagnostic possibilities for rare diseases but can also produce alarming, unlikely explanations and unnecessary medical visits.
• Refsum syndrome in two brothers involved impaired handling of phytanic acid from foods including beef and dairy; earlier identification could reduce cumulative exposure and related visual damage.
• AI outputs depend on training data, clinical guidelines and developer constraints; sustained dialogue can expose neglected factors while also generating agreement with a user's assumptions.
• An anthropology inquiry involving nitrogen-isotope evidence for omnivores initially produced an incorrect exclusion of a paper; more specific bibliographic clues corrected the retrieval, demonstrating the importance of domain expertise.
• Continuous AI-assisted debate about carbohydrates does not itself change diet or health; action requires a workable decision despite uncertainty.

Lean mass hyper-responders, ketones and VLDL (02:46:30-02:52:45)

• [14] The lipid energy model connects high LDL in lean, carbohydrate-restricted individuals to fatty-acid mobilization, hepatic VLDL production and delivery of triglycerides to peripheral tissues.
• Hepatic fatty acids can enter ketone production or triglyceride-rich VLDL synthesis; a modest shift toward VLDL can coexist with high LDL and low circulating beta-hydroxybutyrate.
• A highly fat-adapted person can have beta-hydroxybutyrate near 0.2-0.5 mmol/L while oxidizing fatty acids; ketone concentration alone does not quantify overall fat use.
• A respiratory quotient near 0.70-0.75 would be consistent with substantial fat oxidation despite low ketones; this mechanism remains testable and not universal.

Research corrections, interpretation and changing medicine (02:52:45-03:04:19)

• [10] The April 7 longitudinal KETO-CTA paper required a significant correction and was subsequently retracted after anomalies in the Cleerly plaque data; acknowledgment and correction of errors are essential to scientific practice.
• Anonymized raw Cleerly data contained implausible patterns; repeated requests for paid, blinded quality control were declined, while QAngio and HeartFlow provided independent plaque analyses.
• The independent plaque analyses also linked baseline plaque with subsequent progression and found no detectable LDL/ApoB-progression association within the cohort; anonymized data were released for external analysis.
• Several prominent critics continued to dispute the work without accepting the Cleerly anomalies; Steven Quartz subsequently acknowledged a problem, making consistency in data scrutiny a central concern.
• Publication alone does not rapidly change entrenched clinical beliefs; institutional communication and repeated conversations have increased recognition of the lean mass hyper-responder phenotype.
• Premature cardiovascular disease in a wider family motivates concern about risk prioritization; severe hyperglycemia and high LDL can coexist, making metabolic dysfunction a major therapeutic priority.
• With HbA1c initially at 10 and elevated LDL, reducing HbA1c to five yields a different metabolic risk pattern from lowering LDL while HbA1c stays at 10; persistent severe hyperglycemia remains consequential.
• Clinical emphasis on LDL and ApoB can overshadow insulin resistance, whose association with disease is especially important outside special lipid disorders such as homozygous familial hypercholesterolemia.
• Recognition of lean mass hyper-responders is growing among clinicians, with research debates progressing at a pace faster than some academic expectations but slower than engineering expectations.

References

1. [00:40] Hemisphere-wide evidence of Early Paleoindian megaherbivore specialization — https://doi.org/10.1126/sciadv.aef9628
2. [01:12] Insulin resistance as a predictor of age-related diseases — https://doi.org/10.1210/jcem.86.8.7763
3. [01:20] Cardiometabolic Effects of Omnivorous vs Vegan Diets in Identical Twins: A Randomized Clinical Trial — https://doi.org/10.1001/jamanetworkopen.2023.44457
4. [01:23] The Environment and Disease: Association or Causation? — https://doi.org/10.1177/003591576505800503
5. [01:28] Dairy Products and Cardiometabolic Health Outcomes — https://dash.harvard.edu/bitstreams/90ef08c0-57ce-4ff9-b6ef-3dc7cdc4f7a3/download
6. [01:33] Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968-73) — https://doi.org/10.1136/bmj.i1246
7. [01:33] Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: evaluation of recovered data from the Sydney Diet Heart Study and updated meta-analysis — https://doi.org/10.1136/bmj.e8707
8. [01:34] Metformin blunts muscle hypertrophy in response to progressive resistance exercise training in older adults: the MASTERS trial — https://doi.org/10.1111/acel.13039
9. [01:53] Carbohydrate Restriction-Induced Elevations in LDL-Cholesterol and Atherosclerosis: The KETO Trial — https://doi.org/10.1016/j.jacadv.2024.101109
10. [01:53] RETRACTED: Longitudinal Data From the KETO-CTA Study: Plaque Predicts Plaque, ApoB Does Not — https://doi.org/10.1016/j.jacadv.2025.101686
11. [01:55] Progression of whole-heart atherosclerosis by coronary CT and major adverse cardiovascular events — https://doi.org/10.1016/j.jcct.2020.12.007
12. [02:00] Atherosclerosis in the Masai — https://doi.org/10.1093/oxfordjournals.aje.a121365
13. [02:23] Stopping or reducing dietary fiber intake reduces constipation and its associated symptoms — https://doi.org/10.3748/wjg.v18.i33.4593
14. [02:47] The Lipid Energy Model: Reimagining Lipoprotein Function in the Context of Carbohydrate-Restricted Diets — https://doi.org/10.3390/metabo12050460 :::

::: spoiler Whole-Food Plant-Based Daily Menu

Breakfast

• Boiled potatoes: 350 g
• UV-exposed mushrooms: 200 g (raw weight)
• Orange: 200 g (edible portion)
• Ground flaxseed: 20 g

Lunch

• Calcium-set firm tofu: 400 g
• Cooked lentils: 180 g
• Cooked kale: 80 g
• Red bell pepper: 150 g

Dinner

• Tempeh: 120 g
• Cooked shelled edamame: 120 g
• Cooked broccoli: 250 g
• Cooked cauliflower: 400 g
• Carrots: 150 g

Snacks and Supplements

• Unsalted sunflower seeds: 85 g
• Iodized salt: 3.8 g
• Vitamin B12 (cyanocobalamin): 100 µg
• Vitamin D: From verified UV-exposed mushrooms, or 20 µg supplement if needed

Daily Nutritional Totals

:::

::: spoiler 70/30 Ground Beef Daily Menu

Daily Food

• Ground beef: 70% lean / 30% fat
• Quantity: Approximately 0.50 kg
• No additional foods or supplements

Daily Nutritional Totals

:::

the menus are taking into account bioavailabilty, diaas - and are nutritionally complete.

Yes its a best effort generated visualization

I have written on food menu weights before - https://discuss.online/post/39914520

Inverse associations of vegetarian diet with morbidity and mortality have been observed; however, the role of vegetarian diet on exceptional longevity remains unrevealed.

Objectives - This study aims to examine the association between a vegetarian diet and likelihood of becoming a centenarian in adults aged ≥80 y.

Methods - This prospective nested case-control study included 5203 participants aged 80+ y from the Chinese Longitudinal Healthy Longevity Survey, a nationally representative cohort initiated in 1998. Participants were classified as omnivores and vegetarians, and further into vegetarian subgroups (pesco-vegetarians, ovo-lacto-vegetarians, and vegans) based on consumption of animal-derived foods. The primary outcome was living to 100 y old by the end of follow-up (2018). Multivariable unconditional logistic regression models were used to evaluate the association analysis.

Results - The study identified 1459 centenarians and matched them with 3744 noncentenarians (who had deceased before reaching 100 y). Relative to omnivores, vegetarians had a lower likelihood of becoming centenarians [odds ratio (OR): 0.81, 95% confidence interval (CI): 0.69, 0.96], and similar patterns were observed for vegans (OR: 0.71, 95% CI: 0.54, 0.98), but not for pesco-vegetarians (OR: 0.84, 95% CI: 0.64, 1.09) and ovo-lacto-vegetarians (OR: 0.86, 95% CI: 0.67, 1.09). The significant association was seen in individuals with BMI <18.5 kg/m2 (OR: 0.72, 95% CI: 0.57, 0.91), but not for those with BMI ≥18.5 kg/m2 (OR: 0.92, 95% CI: 0.73, 1.17) (P-interaction = 0.08).

Conclusions - Targeting individuals of advanced age (80+ y) in China, we found that individuals following a vegetarian diet had a lower likelihood of becoming centenarians relative to omnivores, underscoring the importance of a balanced, high-quality diet with animal- and plant-derived food composition for exceptional longevity, especially in the underweight oldest-old.

https://doi.org/10.1016/j.ajcnut.2025.101136 - Not open access, but....

Full text - https://waltersport.com/wp-content/uploads/2026/02/Vegetarian-diet-and-likelihood-of-becoming-centenarians-in-Chinese-adults-aged-80-y-or-older-Li-et-al.-2026.pdf

ADHD is often described as a problem with attention or hyperactivity, but psychiatrist Dr. Georgia Ede argues that the condition is much more complex, involving executive function, dopamine regulation, and potentially brain energy metabolism.

In this episode of Metabolic Mind, Dr. Bret Scher and Dr. Georgia Ede take a deeper look at ADHD, from how it is diagnosed and treated to emerging research on nutrition and glucose metabolism, including questions about ketogenic therapy

Dr. Ede draws on years of experience treating ADHD, including her time at Harvard University, Smith College, and the Hallowell Center. She explains why some people living with ADHD can focus intensely on things that interest them while struggling with everyday tasks, why stimulants can be so effective for some people, and where lifestyle strategies may fit alongside conventional care.

::: spoiler generated summary

Background and what ADHD is

• Georgia Ede worked in college mental health for 13 years at Harvard and Smith and for over two years at the Hallowell Center, an ADHD specialty clinic. ADHD also occurs in her family.
• The name Attention Deficit Hyperactivity Disorder is misleading because attention can be intense for interesting activities and hyperactivity occurs in only about half of cases. The difficulty is directing attention to the needed task at the needed time and sustaining it.
• ADHD is a neurodevelopmental disorder beginning in childhood that affects executive function: motivation, decisions, planning, prioritization, task initiation, follow-through, boredom tolerance, and ordinary sustained-effort work.
• Being distracted during math yet absorbed in Star Wars is compatible with ADHD. Attention varies with context; insufficient dopamine activity and brain energy during uninteresting tasks can hinder focus. Some behavioral problems are voluntary, but ADHD itself is not merely a choice.

Diagnosis and prevalence

• No reliable laboratory diagnostic test exists. Symptom checklists alone have limited value, particularly when adults may rehearse criteria to access stimulants for academic advantage. Detailed childhood history and clinical judgment are more useful.
• Inattention is the low-energy cluster: forgetfulness, procrastination, lost items, disorganization, overwhelm, poor listening, and daydreaming, often associated with girls and women. Hyperactivity is the high-energy cluster: fidgeting, restlessness, impatience, impulsivity, and disruptive behavior, more visible in boys and men. Mixed symptoms form the combined type.
• Children must have at least six inattentive or hyperactive symptoms under the diagnostic checklist; childhood assignments, last-minute studying, messy rooms, forgotten tests, and repeated reminders give richer historical information.
• ADHD has been diagnosed in more than 11% of US children and around 6% of US adults, and many childhood cases continue in adulthood. [1][2]

Why diagnoses may be rising

• Higher diagnostic rates may reflect increased awareness and help-seeking together with actual increases. Potential environmental influences include stress, deteriorating diet, toxins, heavy metals, and prenatal exposures, with their relative contributions uncertain.
• Dietary hypotheses have long included sugar and additives. Lower iron, zinc, and omega-3 fatty acid levels are more common in children with ADHD, consistent with possible nutritional involvement. [3][4]
• Maternal type 1 and type 2 diabetes correlate with elevated ADHD risk in offspring, raising the possibility of a glucose-regulation component. Prenatal smoking and alcohol exposure are additional potential influences. [5]
• Dopamine dysregulation affects reward, pleasure, motivation, and concentration in ADHD. The novelty and immediate gratification of social media attract dopamine-seeking attention; repeated scrolling may increase the stimulation required to maintain attention.

Burden, comorbidities, and strengths

• ADHD ranges from minor challenges to serious impairment. High intelligence and motivation can coexist with difficulties meeting obligations, harming education, employment, relationships, self-esteem, and independence.
• Divorce occurs at roughly twice the usual rate, with elevated risks of substance use, addiction, depression, anxiety, bipolar disorder, learning disabilities, accidents, and suicide. Multiple difficulties commonly coexist with ADHD.
• Creativity, curiosity, humor, inventiveness, nonlinear thinking, and unusual conceptual connections can accompany ADHD. Stimulating or novel work is often a better match than a full day of repetitive paperwork.
• Some adults reach diagnosis only later in life. Numerous interests can make sustained progress on a single pursuit difficult, creating a sense of being a late bloomer despite strong abilities.

Conventional care and stimulant medication

• Cognitive behavioral therapy, ADHD coaching, skills development, and time management can help; stimulant drugs are among the most effective biological tools used in ADHD care.
• Adderall, Ritalin, Dexedrine, and Vyvanse are examples of amphetamine- and methylphenidate-based stimulants. They boost dopamine and norepinephrine activity, often taking effect within an hour.
• Non-stimulant medicines act on norepinephrine without the same dopamine-linked risks of misuse, tolerance, and addiction. They usually act more slowly and succeed less frequently than stimulants.
• Stimulants can worsen anxiety, psychosis, or mania alongside ADHD. Combining them with other drugs is sometimes possible under careful monitoring but entails risk.
• Stimulants can calm hyperactive ADHD through increased activity in brain regions governing inhibition and self-control, while a person without ADHD may feel accelerated. ADHD is also associated with measurable frontal-brain structural and glucose-use differences, independent of intelligence or effort.

External structure

• Calendars, reminders, task lists, assignment schedules, and smaller work intervals with breaks, movement, or rewards supply useful external structure. They reduce functional demands without eliminating ADHD-related difficulty.
• Some highly able students at Harvard and Smith needed two or three times the effort of peers to reach similar academic results; motivation and intelligence were not the limiting factors.

Few-foods dietary trials

• European groups investigated restrictive few-foods or oligoantigenic diets among children with moderate to severe ADHD, including severe cases requiring hospitalization. [6][7][8]
• Suspected dietary triggers, including chocolate, dairy, and nuts, were excluded. Meals mainly contained poultry, fruit, and vegetables, sometimes rice, apple juice, and dairy-free margarine; the diets were simpler, though not ideal.
• Approximately 62-82% improved within a few weeks in these studies, and some children ceased meeting ADHD diagnostic criteria. Dietary components could therefore contribute to symptoms, although the responsible foods were not isolated. [6][7][8]
• Severe restrictions are hard to implement for families, particularly when children eat at school. These barriers and the appeal of medication may contribute to limited interest in dietary research.

Brain energy and the metabolic hypothesis

• In addition to dopamine and norepinephrine dysregulation, ADHD has links with brain inflammation, mitochondrial dysfunction, and disrupted energy production.
• A 1990 National Institute of Mental Health PET study published in the New England Journal of Medicine found lower global and regional brain glucose metabolism in adults with hyperactivity since childhood, especially in premotor and superior frontal regions involved in attention and movement. [9]
• ADHD is linked with approximately 50% higher likelihood of obesity and about twice the risk of type 2 diabetes; maternal diabetes provides another metabolic association. [5][10][11]
• Associations and abnormalities in brain energy support a metabolic explanation, but clinical trials have not yet demonstrated that metabolic interventions improve ADHD symptoms.

What dietary changes look like clinically

• At the Hallowell Center, Ede used whole-food and paleo-style diets and removed junk food before incorporating ketogenic therapy. For some younger people with limited metabolic dysfunction, those changes substantially improved attention and task completion.
• Mental clarity and calm, usable mental energy are frequently among the earliest changes after starting ketogenic therapy, sometimes within days and ahead of improvement in other symptoms.
• A woman with persistent difficulty maintaining her home began cleaning her bathroom at 6 a.m. without planning it. She was calm, not manic, and could initiate a long-delayed activity.

Drawbacks of stimulant medication

• Stimulants can produce anxiety, irritability, muscle tension, restlessness, insomnia, and marked appetite suppression, especially concerning for children and underweight adults.
• Their effects end when the drug wears off. Afternoon energy crashes can severely hinder functioning at work or while driving; some people experience diminished creativity.
• Stimulants may create uncomfortable, wired energy, while exercise and metabolic approaches aim for calm concentration. Anxiety medicines may be added to counter stimulant effects; stimulants increase activity without correcting the underlying brain-energy and neurotransmitter dysregulation.

Environment, nutrition, and the Oxford trial

• Cognitive behavioral therapy, coaching, exercise, and mindfulness remain options, as do stimulating occupations aligned with ADHD abilities, including emergency medicine, journalism, art, entrepreneurship, comedy, and carpentry.
• Whole-food changes come first in Ede's dietary approach. Ketogenic therapy is worth exploring when difficulties persist at home or work, especially with coexisting metabolic or psychiatric problems.
• Ally Houston has a leading role in an Oxford randomized controlled trial investigating ketogenic dietary therapy for adults with ADHD and depressive symptoms, with Ede acting as an adviser. Results are expected to address questions left unanswered by clinical experience. [12]

Ketone levels and glucose stability

• One viewer cited feeling good at blood ketone levels of 4-7 mmol/L; no specific level has been established for ADHD, and most people do not reach that range.
• Fluctuating or elevated glucose can disrupt brain chemistry, increase inflammation and oxidative stress, and impair attention. Some individuals improve through whole foods and carbohydrate restriction without ongoing ketosis.
• Wearing a continuous glucose monitor for a couple of weeks can show the effects of different foods and guide changes that reduce excessive glucose elevations.
• A greater brain-energy deficit from impaired glucose use may require higher ketone concentrations as additional fuel. Requirements vary with symptom severity, duration, the individual, and inflammatory dietary factors; the needed level cannot yet be predicted.

Ketosis and medication adjustments

• Ketogenic therapy changes brain and body physiology sufficiently to affect psychiatric medications. Dietary changes of this kind can function as a substantial medical intervention.
• In Ede's clinical experience, combining ketosis with stimulants may lead to excessive energy, anxiety, jitteriness, and appetite loss. These effects can indicate that a lower stimulant dose or discontinuation is possible because dietary effects overlap with medication effects.
• Some patients take stimulants only when outside ketosis. In many cases, stimulants permit as-needed use or discontinuation without prolonged tapering, depending on individual circumstances.
• Dietary and medication changes require coordination with a clinician experienced in metabolic therapy. Eric Westman's term "keto medicine" conveys the intervention's substantial physiological effects.

Final guidance

• When attention is difficult, dietary quality is relevant regardless of whether ketosis is needed. Exercise, sleep, mindfulness, planning supports, and assistance managing demands are additional priorities.
• ADHD is rooted in brain development, with signs usually occurring before age seven and diagnostic criteria requiring evidence before age 12. Brain anatomy and chemistry differ, making self-blame unwarranted while practical responsibility for finding useful supports remains.

References

1. [08:47] ADHD Prevalence Among U.S. Children and Adolescents in 2022: Diagnosis, Severity, Co-Occurring Disorders, and Treatment — https://doi.org/10.1080/15374416.2024.2335625
2. [09:02] Attention-Deficit/Hyperactivity Disorder Diagnosis, Treatment, and Telehealth Use in Adults — National Center for Health Statistics Rapid Surveys System, United States, October–November 2023 — https://doi.org/10.15585/mmwr.mm7340a1
3. [11:15] Essential Trace Elements Zinc, Iron, Copper and Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: A Systematic Review and Meta-Analysis of Case-Control Studies — https://doi.org/10.3390/nu18111797
4. [11:15] Omega-3 fatty acid and ADHD: blood level analysis and meta-analytic extension of supplementation trials — https://doi.org/10.1016/j.cpr.2014.05.005
5. [11:35] Maternal Gestational Diabetes Mellitus, Type 1 Diabetes, and Type 2 Diabetes During Pregnancy and Risk of ADHD in Offspring — https://doi.org/10.2337/dc18-0733
6. [26:32] Controlled trial of oligoantigenic treatment in the hyperkinetic syndrome — https://doi.org/10.1016/S0140-6736(85)91206-1
7. [26:32] Effects of a few food diet in attention deficit disorder — https://doi.org/10.1136/adc.69.5.564
8. [26:32] Effects of a restricted elimination diet on the behaviour of children with attention-deficit hyperactivity disorder (INCA study): a randomised controlled trial — https://doi.org/10.1016/S0140-6736(10)62227-1
9. [30:22] Cerebral glucose metabolism in adults with hyperactivity of childhood onset — https://doi.org/10.1056/NEJM199011153232001
10. [31:22] Association Between ADHD and Obesity: A Systematic Review and Meta-Analysis — https://doi.org/10.1176/appi.ajp.2015.15020266
11. [31:27] Risk of Type 2 Diabetes in Adolescents and Young Adults With Attention-Deficit/Hyperactivity Disorder: A Nationwide Longitudinal Study — https://doi.org/10.4088/JCP.17m11607
12. [39:14] FAD - Food for ADHD and Depression (Oxford randomised controlled trial registry) — https://doi.org/10.1186/ISRCTN62698625 :::

zero carb - zero preservatives, zero additives, zero pesticides, zero lectins, zero oxalates, zero processed foods, zero highly processed industrial oils, zero gluten.... it's good to be essential.

Livestock wrecks the climate! Meat is the problem you can easily solve at dinner - so what’s stopping you? You have heard the line so often, it now seems self-evident. We are told the Science is settled. But what if it is not? This page cuts through the half-truths and oversimplified narratives.

The food system is responsible for anything between one fifth and one third of human-induced greenhouse gas emissions. Agriculture and fisheries contribute about 40% of these food system emissions, while the remainder is split equally between associated land use and land-use changes (30%) and supply chain activities (30%).

Within the food system, livestock represent the largest source of agricultural emissions, impacting climate and emission budgets. On average, animal-sourced foods have a higher carbon footprint than crops, which is why dietary policies often encourage a shift toward more plant-centric diets.

However, directly comparing individual foods is simplistic and can lead to misguided interventions. Dietary change can involve both benefits and trade-offs. Carbon tunnel vision, focusing solely on carbon reduction, risks ignoring other critical factors, such as water scarcity, biodiversity loss, ecotoxicity, and social impacts, which may arise from prioritizing low-carbon foods. A more effective approach is to assess overall dietary patterns, considering their broader ecological, nutritional, and societal consequences.

...Continued at the url...

• Global data should not be used to evaluate local contexts
• Further mitigation is possible and ongoing
• Restricting animal-sourced foods only leads to small gains (1-6%)
• Dietary focus distracts from more impactful interventions
• Nutrition should be factored in when comparing foods
• Co-product benefits of livestock should be accounted for
• Livestock farming also sequesters carbon
• Rewilding comes with its own climate impact
• Large-scale afforestation of grasslands: not a panacea
• Methane should be evaluated differently than CO2

i have this conversation all the time.... the food is delicious, nutritionally complete.... OMAD, same food every day.

Where India Went Wrong - and How to Fix It

Peter Ballerstedt (PhD) explores the connections between agriculture, protein, nutrition and metabolic health. He discusses how the way we think about food production and protein can influence both human nutrition and the wider conversation around metabolic health.

::: spoiler generated summary

From forage agronomy to metabolic health

• Forage agronomy and ruminant nutrition connect soil, plants, livestock, and food quality. Agricultural and human nutrition specialties contain complementary knowledge.
• In 2007, at age 51, Ballerstedt was obese and prediabetic. His wife had explored low-carbohydrate diets for five years. Gary Taubes's Good Calories, Bad Calories [1] and Michael and Mary Dan Eades's Protein Power [2] helped change his outlook.
• A subsequent Seattle metabolic-health conference for clinicians revealed gaps between agricultural expertise and clinical nutrition knowledge. Connecting the disciplines became his ongoing work.
• Large, long-term human nutrition experiments cannot fully control genetics and food intake in ways sometimes possible in animal experiments. Findings from human nutrition research can be interpreted with more certainty than their limitations permit.
• A concern that animal agriculture had been unfairly blamed for chronic disease led to efforts to connect agriculture, medicine, nutrition, public health, and environmental science.

Producing calories is not the same as nourishing people

• India combines high agricultural production with diabetes, obesity, anemia, protein inadequacy, and micronutrient deficiencies. Overfeeding and undernourishment coexist globally across income groups.
• Food systems need to provide affordable, accessible, culturally suitable nutrition beyond calories or isolated nutrient totals. Meals also have family and community roles.
• Packaged-food protein quantities generally measure crude protein: sample nitrogen multiplied by 6.25. This long-used proxy is comparatively easy to measure but does not establish protein quality.
• Identical crude-protein amounts from plants and animal-source foods are nutritionally different because of amino-acid composition, digestibility, and accompanying nutrients.
• Famine prevention and calorie supply were essential historical priorities. Calorie abundance alone does not establish nutrient adequacy or eliminate chronic illness.
• Malnutrition encompasses inadequate, excessive, or imbalanced nourishment and associated metabolic dysfunction. The undernutrition/overnutrition distinction can wrongly reduce obesity to overeating or inactivity.
• Food-system sustainability assessments often end at processors or retailers and use assumed healthy-diet standards. Population health and chronic-disease outcomes from therapeutic diet changes also belong in sustainability assessments.

Liebig's barrel and the public-health limiting factor

• Liebig's law of the minimum uses a barrel with unequal staves: its shortest stave determines capacity. Lengthening other staves does not increase capacity until the limiting stave changes. [3]
• Low insulin sensitivity and chronically high insulin are the current public-health limiting factors in this model. Greater insulin sensitivity enables improvements previously blocked by those factors.
• After insulin sensitivity increases, limiting factors can include indispensable amino acids, fatty-acid balance, minerals, micronutrients, environmental exposures, and chronic stress.
• In soil fertility, adding nonlimiting nutrients wastes money and can cause toxicity. Public-health interventions also depend on finding the actual constraint and evaluating outcomes.
• Advice favoring low-fat or largely plant-based diets influences consumer demand, agricultural output, and manufactured food choices.
• Protein-branded Pop-Tarts advertise 10 grams of protein alongside substantial sugars and starches. Reaching around 30 grams through them also brings a large carbohydrate load, which a protein figure alone conceals.

Agricultural production and dairy incentives

• India's Operation Flood illustrates how policy and coordinated production expanded milk supply. India is the world's largest dairy producer, with additional potential in cows and buffaloes. [4]
• Reducing carbohydrate-derived energy raises questions about which fats and oils provide energy. Dairy has an important role when animal fats are not automatically excluded.
• U.S. dairy production yields roughly as much animal fat as all meat production combined. Wider application of current livestock science could increase fat production beyond existing levels.
• Changing dietary guidance can alter consumer demand, agricultural investment, food availability, and producer incentives.

Protein quality in rice-, cereal-, and legume-based meals

• Protein comprises amino acids, including indispensable ones that humans cannot synthesize. Requirements vary by amino acid, so total protein is not a sufficient measure of adequacy. Ballerstedt's professional expertise is agronomy, not human nutrition.
• When lysine is limiting, other amino acids cannot be fully used for protein synthesis and a greater share is used as energy.
• Cereals such as wheat and rice are often limited in lysine; legumes such as lentils, peas, beans, and soybeans are often limited in sulfur-containing amino acids. Their combination improves balance, while digestion and absorption remain important.
• Browning wheat foods such as bread, biscuits, and cookies binds some lysine to sugars and reduces its nutritional availability. Chemical amino-acid content alone does not guarantee its utilization.
• Modest portions of dairy, eggs, meat, or another acceptable animal-source food added to rice and lentils improve amino-acid balance without large extra cereal and legume servings.
• Dietary protein requirements formerly cited at 0.8 g/kg body weight daily may be nearer 1.2 g/kg, and a meal containing approximately 30 grams of high-quality protein may stimulate protein synthesis.
• Achieving these protein targets with rice and lentils alone can require more than three meal-sized portions; including an egg or dairy allows a similar goal with fewer carbohydrate-rich servings.
• More cereal and legume servings can improve protein intake while making blood-glucose control harder. Adding paneer or another acceptable animal-source food and reducing cereal or legume quantities improves the balance.
• Minimally processed cereals and legumes are preferable. Animal-source foods also supply essential micronutrients, including some absent from entirely plant-based diets, in usable forms without certain plant antinutrients; their nutritional value goes beyond protein.

Animal-source foods and vegetarian choices

• Meat consumption is not mandatory. Religious and cultural restrictions can be accommodated using acceptable animal-source foods, including dairy in lacto-vegetarian diets.
• Diets with no animal-source foods require greater attention to supplements and medical monitoring for vitamin B12, iron, and other nutrient deficiencies.
• Individual experiences with dietary therapy sometimes conflict with official guidance. Environmental assertions about animal agriculture also require further scrutiny for better-informed choices.

Affordability, childhood development, and food-system priorities

• Higher costs of meat, eggs, and dairy relative to rice, wheat, and sugar can shift lower-income households toward starch-heavy diets. Affordable nutrient-dense food is a public-policy priority.
• Childhood nourishment at critical stages affects lifelong brain development and economic capacity. Approximately 20% to 25% of children under five worldwide are stunted, with rates above 40% in some countries. [5]
• Investment in appropriate nutrition can reduce later chronic-disease and healthcare costs. Policy must support consumer access alongside financially viable agricultural production.
• Almost 45% of the world uses under 1,000 kWh of electricity per person annually, comparable to a large North American refrigerator. Insufficient refrigeration limits the movement and storage of perishable meat, eggs, and dairy. [6]
• Dietary modeling estimates that around half of adults' dietary protein must be animal-derived to meet nonprotein nutrient requirements. [7]
• An additional analysis connects animal-source foods contributing below roughly 30% of dietary energy with increased population-level micronutrient inadequacies. [8]
• FAO food-balance figures place fewer than approximately 30% of people in populations receiving above both 30% of calories and 50% of protein from animal-source foods. Greater availability requires changes in production, distribution, marketing, and access. [9]

Daily foods and my own meals

• MEDS means meat, eggs, dairy, and seafood, consumed daily in culturally acceptable combinations. Dairy is included among animal-source foods.
• The usual pattern is two meals daily, sometimes three, aiming for at least 30 grams of high-quality protein each. Actual portions do not consistently supply 1.2 g/kg across the day.
• An omnivorous diet includes meat, eggs, dairy, and occasional seafood. Typical meals include three or four eggs with about one ounce of hard cheese, or cooked minced meat with vegetables, cheese, and sometimes olive oil.

References

1. [03:39] Good Calories, Bad Calories — https://www.penguinrandomhouse.com/books/176680/good-calories-bad-calories-by-gary-taubes/9781400033461/
2. [03:45] Protein Power — https://www.penguinrandomhouse.com/books/44448/protein-power-by-michael-r-eades-md-and-mary-dan-eades-md/
3. [15:22] On the Origin of the Theory of Mineral Nutrition of Plants and the Law of the Minimum — https://doi.org/10.2136/sssaj1999.6351055x
4. [20:31] Operation Flood — https://www.nddb.org/about/genesis/flood
5. [37:30] Levels and Trends in Child Malnutrition: UNICEF/WHO/World Bank Group Joint Child Malnutrition Estimates, 2025 Edition — https://www.who.int/publications/i/item/9789240112308
6. [38:51] Estimating the Modern Energy Minimum Gap — https://energyforgrowth.org/article/estimating-the-modern-energy-minimum-gap/
7. [39:26] Approximately Half of Total Protein Intake by Adults Must be Animal-Based to Meet Nonprotein, Nutrient-Based Recommendations, With Variations Due to Age and Sex — https://doi.org/10.1093/jn/nxac150
8. [39:49] The Role of Animal-Source Foods in Healthy, Sustainable, and Equitable Food Systems — https://doi.org/10.36072/dp.5
9. [40:08] FAOSTAT Food Balances — https://data.fao.org/catalog/iso/2f264bb6-1238-459a-bf8b-0e2d0a16804a :::

It's such a small thing, but being fully clean carnivore (no cheese) has totally removed all gas, all farting... life is super quiet now, and no smells.

Does perimenopause make ketosis harder? Can a carnivore diet provide too much protein? And which nutrient deficiencies matter most for mental health?

::: spoiler generated summary

Menopause, perimenopause, and ketosis

• Perimenopause may last for up to 10 years. Achieving and sustaining ketosis is more difficult during perimenopause and menopause, including in personal and clinical experience.
• Declining estrogen can increase insulin resistance. Previously lean women with stable weight may begin to gain weight and undergo body-composition changes.
• Estrogen supports intestinal lining integrity. Lower levels can impair gut health and coincide with new food intolerances or irritable bowel symptoms.
• Changing estrogen levels interact with histamine and can aggravate histamine intolerance during perimenopause; it is uncertain how carbohydrate cycling would help this problem.
• Ketogenic eating can improve insulin resistance. Histamine strategies include restricting aged cheeses and cured meats, using diamine oxidase for histamine breakdown, and avoiding grains and legumes that can damage the gut lining; the book contains further examples. [1]
• Estrogen replacement therapy can be beneficial for some women.
• Psychiatric conditions stable for 10–20 years can worsen during perimenopause, sometimes requiring larger medication doses. Existing illness may intensify or new illness begin; research on this is limited.
• A woman maintaining ketosis at 50 g carbohydrate daily might need to lower intake toward 20 g. More exercise, reduced food intake, or fewer carbohydrates may also become necessary amid changes in estrogen, growth hormone, testosterone, and other hormones.
• Hot flashes, night sweats, and insomnia interfere with sleep. Inadequate sleep and stress can elevate stress hormones and glucose, decrease ketones, and impair metabolic health.

Carnivore diets, protein levels, and ketosis

• Eating only animal foods need not mean excessive protein. Higher protein intake can suppress ketones when a particular ketone level is desired, and excess intake is undesirable across diets.
• Unrestricted carnivore eating has coincided with increased body fat, poor appetite regulation, infrequent ketosis, and absent psychiatric benefits in clinical experience, despite negligible visible carbohydrate.
• Ketogenic carnivore eating can include meat, seafood, poultry, and tolerated eggs, alongside an individualized protein target; the book contains guidance, meal plans, and recipes. [1]
• After years of 80–95% carnivore-ketogenic eating, a return to 100% carnivore occurred about three and a half weeks earlier. An example day contained half a pound of shrimp, a duck breast, eight ounces of sirloin tips, and three tablespoons of duck fat.
• The example provided about 1,550 calories, with ketone levels around 1.5 during that period, without excessive protein or dietary carbohydrate.
• Shrimp and sirloin contain less fat than ribeye. Adding fats such as duck fat can alter macronutrient ratios and support ketogenic dietary targets.
• The adult protein RDA is 0.8 g/kg of body weight used as a standard, serving as a lower limit; 1.6 g/kg is a useful goal for muscle growth and maintenance. [2]
• For higher ketones, a practical protein range is approximately 1–1.7 g/kg of ideal body weight daily. Intake near 2 g/kg exceeds what most people need and often feels unpleasant; individualized adjustments around an intermediate target are necessary.
• Intake around 0.6 g/kg can jeopardize lean mass. Ketosis and muscle preservation must both be maintained; properly constructed ketogenic diets can support muscle growth, without DEXA or bioimpedance being used in these clinical consultations.

Appetite, cravings, and satiety

• A properly constructed carnivore diet, particularly without dairy, can allow appetite to regulate varying daily intake with less need for counting.
• The refined-carbohydrate-rich Western diet interferes with satiety and makes hunger, nourishment needs, and cravings difficult to distinguish. Repeated eating without satisfaction is abnormal.
• Transitioning to ketogenic or carnivore eating can restore recognition of genuine hunger and confidence in appetite signals, sometimes as a new experience.

Nutritional deficiencies and psychiatric health

• Psychiatric medication may be initiated without thyroid or B-vitamin screening; underlying nutritional and medical problems require evaluation.
• Deficiencies in essential nutrients can raise risk of psychiatric illness because brain function depends on them. Quantifying the separate risks is ethically difficult, and consequences vary by timing, duration, and severity.
• During pregnancy in particular, B12, choline, folate, iron, iodine, EPA, and DHA are important deficiency concerns. Animal foods supply the richest sources other than folate, and many people have shortfalls during pregnancy; the book details their functions. [1]
• Correcting nutrient shortfalls can improve mental health, sometimes greatly, but one supplement will not necessarily resolve depression, schizophrenia, or another psychiatric disorder.
• Profound B12 deficiency can take years to arise, while correcting it can produce major improvement in psychiatric symptoms. Prolonged deficiencies in pregnancy or early childhood can also leave lasting injury.
• Some documented adult depression cases have improved markedly with methylfolate; most outcomes of nutritional correction are less complete.

Folate, methylation, and MTHFR

• Synthetic folic acid undergoes different processing from natural folate. The recommended choice is to avoid folic acid and use forms such as methylfolate.
• Common MTHFR variants are gene variations, not rare mutations, and slow the processing of synthetic folate. Methylfolate can substantially improve mental health for some individuals.

Iodine and brain development

• Choosing noniodized specialty salts over iodized salt can remove a dietary iodine source. Fish, seafood, and seaweed provide iodine; children may differ in their acceptance of these foods.
• Iodine deficiency is widespread worldwide, particularly among children in less-developed countries, and inadequate thyroid hormones during brain development can result in intellectual disability.
• Adult iodine deficiency is difficult to assess, leaving its frequency and supplementation needs uncertain. The hypothesis of globally declining environmental iodine and universal human deficiency remains unestablished.

References

1. [04:01] Change Your Diet, Change Your Mind — https://www.hachettebookgroup.com/titles/dr-georgia-ede-m-d/change-your-diet-change-your-mind/9781538739075/
2. [11:04] Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids — https://doi.org/10.17226/10490 :::

Pasture raised, pasture finished ruminants are probably the most sustainable thing you can do. Support your local source of sustainable ecology!

In this episode of The Feldman Protocol, can a for-profit assisted living home actually send residents back home healthier than when they arrived? Hal Cranmer (assisted living owner and metabolic health advocate) makes the case that ketogenic and carnivore nutrition, resistance training, hyperbaric oxygen therapy, and disciplined deprescribing can reverse diabetes, restore cognition, and rebuild independence — even in residents in their 80s and 90s. Dave and Hal also cover dementia and sugar addiction, the business model of senior care, and the future of AI in medicine.

::: spoiler generated summary

Assisted living and why I entered it (00:01–00:25)

• Hal: My three Phoenix-area assisted-living homes aim to restore residents’ health and independence sufficiently for a return home on their own terms.
• Hal: I entered assisted living for real-estate cash flow, before learning about keto or carnivore; monthly fees at some facilities reach $25,000.
• Hal: Luxury buildings, food, and activities can deliver a cruise-ship experience without necessarily improving residents’ health.
• Hal: Placement decisions often follow a fall, hospitalization, rehabilitation, or exhausted home caregiving, leaving families 48–72 hours to choose while parents resist moving.
• Hal: The sandwich generation often has sleepless caregiving duties for both children and parents; compassionate overnight care matters beyond a satisfactory regulatory audit.
• Hal: Initial priorities were staffing, occupancy, medication compliance, inspections, and cash flow; one resident had 54 prescriptions, and some bedbound residents needed mechanical lifts.
• Hal: I purchased Blue Sky Manor in Mesa in 2015 while employed in Minnesota, then four more homes in 2016; the move to Arizona exposed vacancies and understaffing.

Finding a viable model (00:25–00:47)

• Hal: Resident placement commonly runs through hospitals, rehabilitation centers, and referral agents charging roughly one month of rent; vacant beds also cost money.
• Hal: Around $70,000 went to referrals in an early year; a paid marketer did not end the expense, so I cultivated direct relationships with referral sources and families.
• Hal: I maintain about 200 referral contacts; meeting touring families personally builds trust, and some families remain involved after a resident dies.
• Hal: Residents included a Vietnam POW, a Berlin Airlift pilot, and people with notable family histories, adding personal meaning to the work.
• Dave: AI-powered searches could help families evaluate care for the first time and find suitable homes without depending entirely on referral intermediaries.
• Hal: Small homes cannot easily compete on buildings or corporate marketing; health improvement can differentiate their care and attract families from farther away.

The first person to move home (00:47–00:59)

• Hal: In about 2018, a wheelchair-using Berlin Airlift veteran with heart problems sought to leave; our goal was his walking roughly 30 feet and entering his wife’s car.
• Hal: Before adopting low-carb nutrition, I cut his sweets, used vegetables and lean meats, and hired a trainer for resistance exercises, walking, and supported squats.
• Hal: He practiced independently and went home after about seven or eight months; the outcome motivated more efforts to restore other residents’ independence.
• Hal: A path home distinguishes the service, although many residents do not want the required changes and large chains often lack flexibility over food and routines.
• Hal: Assisted living allows control of meals, activity, and food access, resembling the controlled food provision of metabolic-ward studies.

Vegan, carnivore, protein, and keto (01:00–01:16)

• Hal: I hired two PhD-qualified vegan nutritionists on the trainer’s advice, but difficult sourcing, labor-intensive meals, food refusal, and weight loss in frail residents ended the experiment.
• Hal: The vegan menus ended after roughly a month; we resumed lean meat and vegetables while retaining exercise because caregiver duties already consumed their time.
• Hal: John Jaquish’s book connected variable-resistance bands, strength ranges, bone loading, and carnivore eating for me. [1]
• Hal: After two years of persistent diarrhea despite scans, doctors, and probiotics, I tried carnivore; normal bowel movements returned within two weeks.
• Dave: In my plant-based meal-planning exercise, adequate amino acids such as leucine were difficult without supplements, while a steak supplied the full amino-acid profile.
• Hal: Low intake of protein and age-related sarcopenia undermine muscle, mobility, and independence; falls and broken hips can have severe consequences.
• Hal: I chose ketogenic meals with meat, fish, eggs, and vegetables because families accepted them more readily than an all-meat menu.

Dementia, the Bredesen protocol, and practical cooking (01:17–01:39)

• Hal: Around 60% of residents have dementia; Bredesen’s book connected keto, exercise, lab assessments, nutrient correction, and other therapies to cognitive care. [2]
• Hal: Bredesen’s model identifies 36 contributors across insulin resistance and inflammation, deficiencies, and toxins; a single amyloid-focused drug cannot repair every hole in the leaky roof.
• Hal: Bredesen’s ketogenic regimen is plant-predominant and includes fish; I retained substantial meat for bioavailable protein and did not adopt his complete licensed regimen.
• Hal: One resident entered Bredesen’s testing protocol; ketogenic menus gradually spread more broadly despite family preferences for unrestricted sweets.
• Hal: After an interview with Shawn Baker, Maria Emmerich supplied cookbooks with usable keto versions of familiar lasagna, sauces, casseroles, and desserts.
• Hal: Hiring a health coach and cooks separated lunch and dinner preparation from caregiver duties and made ketogenic meal service more practical.
• Hal: The food program brought inquiries from across the U.S. and abroad, including a hospice resident transported by road from Florida for about 30 hours.
• Hal: My portfolio decreased from five homes to three after two sales; remote coaching aims to help people remain independent before institutional care is necessary.

Hyperbaric oxygen and cognitive cases (01:41–01:53)

• Hal: Diet has been the largest contributor in my experience; two residents and one person living at home improved enough for me to call their dementia reversed, with hyperbaric oxygen among the interventions in the strongest cases.
• Hal: Sessions use about one hour at 1.5–2 atmospheres with concentrated oxygen; increased oxygen in plasma supports cellular energy and healing and can promote capillary growth, including in the brain.
• Hal: I learned to dive young and later taught in Okinawa; diving experience illustrates gas absorption under pressure, nitrogen decompression sickness, oxygen toxicity, and dive computers.
• Hal: After roughly 16–17 sessions, one man remembered his phone and wallet and independently found their locker, unlike his earlier memory performance.
• Hal: MoCA scores rose from 15 to 26 in one woman and from 14 to 24 in another; one woman has continued living independently since about 2023. [3]
• Hal: The hyperbaric clinician requires food, exercise, and other interventions alongside the oxygen sessions, not hyperbaric oxygen alone.

What we serve and how residents adapt (01:53–02:11)

• Hal: Meals use eggs, bacon or sausage for breakfast and meat, fish, low-carb wraps, lasagna, and casseroles for later meals; occasional pancakes or waffles add variety.
• Hal: The menu target is under 50 g of total carbohydrates daily; staff screen ingredient lists for sugars and periodically measure ketones.
• Hal: Desserts are generally homemade and served once or twice a week; family sweets are consumed privately during visits, with leftovers removed.
• Hal: Locked food storage reduces nighttime snacking; the health coach audits meals and incorporates residents’ preferred dishes into a shared menu.
• Hal: I advise families against an overnight stay during a difficult admission; three days of separation often allows adaptation to the staff, food, and daily routine.
• Hal: Family cooperation supports adherence; about nine or ten residents have moved home, although one or two returned and some resumed old habits.
• Hal: Two residents who left after large cognitive gains maintained the eating pattern especially well; occasional lapses have not necessarily ended adherence.
• Hal: I use the analogy of not pocketing someone else’s $20 to make food abstinence a settled decision; good health outweighs a brief taste reward.
• Dave: Removing highly tempting foods reduces repeated food decisions; I find sugary foods easy to overconsume and steak or eggs much harder to overconsume.

Diabetes, medications, and long-term health (02:12–02:20)

• Hal: Blood glucose has improved enough to reduce diabetes medication in many residents; high initial insulin doses require physician-led adjustments when carbohydrates decrease.
• Hal: Over ten years, nearly all incoming residents with dementia have had very strong sugar habits, including eating sugar packets when sweets were absent.
• Hal: Diabetes and insulin resistance frequently coexist with chronic illness in my homes; dementia risk rises with diabetes, but family history does not make dementia inevitable.
• Dave: Joseph Kraft’s insulin-response tests detected abnormal metabolic patterns before standard glucose levels became abnormal. [4]
• Dave: The documentary includes Richard Bernstein’s type 1 diabetes care using glucose monitoring and carbohydrate restriction. [5]
• Dave: Bernstein used personal glucose measurements to reduce insulin, earned a medical degree to practice the method, and testified in child-custody disputes involving low-carb type 1 diabetes care.
• Dave: Carbohydrate restriction is one option for type 2 diabetes and can reduce insulin needs in type 1; I associate higher externally administered insulin exposure with mortality.

Larger outcomes and a planned evaluation (02:20–02:34)

• Hal: A 600-bed operator planned a voluntary low-carb group, while Heather Sandison created a smaller assisted-living program using a Bredesen-style dementia regimen.
• Hal: Roughly six residents lost over 70 lb, and two women have lost over 240 lb; a former nurse arrived weighing 460 lb, unable to leave bed, and later walked with training.
• Dave: Multiple causes contribute to insulin resistance; carbohydrate reduction can directly lower glucose exposure when blood-glucose regulation is already impaired.
• Hal: The former nurse’s intended flight home to New York by August was still a goal at the time of the interview.
• Hal: A Baszucki-funded team including Tro Kalayjian, Laura Buchanan, and Kelly Curtis plans to follow 15 new residents for roughly 12–18 months, including labs and repeated cognitive and health measurements.
• Hal: Toward Health will supply medical care and continue follow-up after any return home, covering dementia, diabetes, obesity, Parkinson’s, and other conditions.
• Hal: Some residents, especially those entering hospice, cannot move home; mobility, fewer medications, travel, and daily independence remain meaningful outcomes.
• Hal: No residents died of COVID in my homes, and one home went roughly two years without deaths of any cause; meals, training, and outdoor time continued.
• Hal: A woman admitted with diabetes in a wheelchair in 2016 is no longer diabetic, walks and gardens, but prefers to stay; a 98-year-old went on a ten-day family cruise six months before dying.

Cholesterol, medication burden, and prescribing barriers (02:33–02:42)

• Hal: Families rarely focus on higher cholesterol when functional health improves; the clinical team follows triglycerides and HDL more closely than total cholesterol or LDL.
• Hal: Many residents arrive on statins; I ask physicians to reassess prescriptions, including statins, to reduce total pill burden without applying a universal anti-statin rule.
• Hal: Stopping statins usually produced no visible difference, with one cognitive improvement; a separate person’s cognition improved after discontinuing dementia medication.
• Hal: Drugs often accumulate through hospital, rehabilitation, and care transitions, sometimes reaching 20–30 or 54 prescriptions, without regular comprehensive reassessment.
• Dave and Hal: Psychiatric medications can require very slow late-stage tapering, while liability and insurance constraints discourage medication reduction.
• Hal: One physician declined hormone therapy for a deficient woman because of an insurer’s rules tied to breast-cancer risk research; I sought another clinician.

Research, open data, and institutional incentives (02:42–03:05)

• Dave: Anonymized laboratory and diet data could help examine drug interactions and health patterns; NHANES provides an example of population data. [6]
• Dave: KETO-CTA began with an observational single-arm design, and a controlled follow-up is planned; decisions can use evidence short of a definitive randomized trial. [7]
• Dave and Hal: Investigators, journals, insurers, institutions, and AI companies have incentives; sound protocols allow results to contradict the researchers’ expectations.
• Dave: AI tools, including locally hosted models, could analyze anonymized data, while provider influence and privacy restrictions remain concerns; clinical communications still rely on fax.
• Dave: Casino-based server requirements illustrated misplaced security controls; engineers can often correct senior colleagues more openly than staff in medical or academic hierarchies.
• Hal: The Air Force cockpit time-out could be initiated at any rank and saved lives; healthcare needs similar openness, complete adverse-event data, and scrutiny of drug combinations.

Agency, dementia, and illness (03:05–03:19)

• Dave and Hal: People with diabetes need access to the low-carb option; assumptions that it cannot be sustained limit informed choice despite long-term adherents.
• Hal: Businesses exist to solve problems; growth in chronic illness and drug burden makes me question the effectiveness of the medical system at its central task.
• Hal: A dementia diagnosis calls for active efforts against decline rather than resignation; Bredesen’s randomized trial supports multicomponent lifestyle changes without relying on a simple pill. [8]
• Dave: Keto has long been used for epilepsy; an acquaintance experienced recurrent seizures after raising carbohydrates and then returned to stricter keto.
• Dave: David Unwin offers medication and lifestyle intervention as genuine choices; nearly all patients choose the lifestyle option, and serious symptoms can motivate change.
• Hal: I have experienced very infrequent illness since carnivore; Dave has experienced fewer colds and infections during his ketogenic years.
• Dave: Lipoproteins carry vitamin E and participate in host defense; higher LDL has been associated with lower infection burden, without proof that my own LDL explains my fewer illnesses.
• Hal: UTIs became less frequent after ketogenic menus were introduced, with occasional infections still occurring, including after hospital stays.

References

1. [01:06] Weight Lifting Is a Waste of Time: So Is Cardio, and There’s a Better Way to Have the Body You Want — https://www.jaquishbiomedical.com/products/weightlifting-is-a-waste-of-time-book
2. [01:20] The End of Alzheimer’s — https://www.penguinrandomhouse.com/books/551532/the-end-of-alzheimers-by-dale-e-bredesen-md/9780735216228/
3. [01:46] The Montreal Cognitive Assessment, MoCA: A Brief Screening Tool for Mild Cognitive Impairment — https://doi.org/10.1111/j.1532-5415.2005.53221.x
4. [02:16] Detection of Diabetes Mellitus In Situ (Occult Diabetes) — https://doi.org/10.1093/labmed/6.2.10
5. [02:16] The Cholesterol Code — https://cholesterolcodemovie.com/the-film/
6. [02:44] National Health and Nutrition Examination Survey (NHANES) — https://www.cdc.gov/nchs/nhanes/
7. [02:45] RETRACTED: Longitudinal Data From the KETO-CTA Study: Plaque Predicts Plaque, ApoB Does Not — https://doi.org/10.1016/j.jacadv.2025.101686
8. [03:10] Precision Medicine Treatment of Alzheimer’s Disease: Successful Randomized Controlled Trial — https://doi.org/10.20944/preprints202512.2694.v3 :::

Why is it so hard to stop a behavior even when you know it’s hurting you? Whether it’s food addiction, sugar cravings, binge eating, scrolling, shopping, drinking, or another compulsive habit, knowing what you should do is often very different from actually being able to change. In this episode, I unpack why certain habits become so difficult to give up, why stress can pull us back into old behaviors, and why lasting behavior change may require looking beyond willpower, discipline, or simply removing the addictive behavior.

I also share what I learned through my own recovery from an eating disorder, why fear, certainty, identity, and self-sabotage can keep us stuck, and how our underlying needs may influence the behaviors we repeatedly turn to for relief, comfort, control, or escape. If you’ve ever asked, “Why do I keep doing this when I know better?”, this conversation explores what may actually be happening underneath addiction and what has to change for the pattern itself to finally lose its grip.

::: spoiler generated summary

Why changing food behavior is not simply about willpower (00:00–02:20)

• Sugar stimulates the body, but its effects do not fully explain why some people stop eating it while others repeatedly return. Knowing which foods to eat and knowing the benefits of carnivore do not ensure behavioral change.
• Repeated harmful behaviors are often driven by unmet needs, not weakness, insufficient discipline, or an inherent personal defect. Identifying these needs makes sustained changes possible.
• An adaptation of Maslow's hierarchy organizes six fundamental human needs that drive behavior, habits, and addictions. [1][2]

The six human needs (02:20–04:20)

• Certainty: Safety, control, stability, and predictability create security and knowledge of what to expect.
• Uncertainty or variety: Novelty, stimulation, adventure, and change fulfill a need that a strict beef, salt, and water diet may leave unmet, especially for people with a strong desire for variety.
• Significance: Feeling important, valued, special, needed, and meaningful to other people.
• Love and connection: Belonging, affection, emotional closeness, and meaningful relationships.
• Growth: Learning, healing, progressing, and developing beyond one's current capabilities.
• Contribution: Serving others, giving, and finding purpose beyond oneself and one's immediate family.
• The first four needs vary in relative importance between people; growth and contribution are higher fulfillment needs. All six influence behavior, and healthier actions can satisfy them.

Why habits and addictions become persistent (04:20–07:20)

• A behavior fulfilling at least three human needs becomes harder to give up, with greater persistence as more needs are fulfilled. Addiction develops when the habit continues despite being harmful. [2]
• A stable relationship fulfills certainty through reliability, significance through feeling valued, and love through emotional connection. These fulfilled needs help sustain the relationship.
• Unhealthy relationships can also fulfill several needs: unpredictable communication supplies uncertainty and stimulation, while occasional affection supplies significance and connection, sustaining attachment despite harm.
• Shame and self-criticism do not adequately explain persistent habits. They continue because they fulfill important needs despite their damaging consequences.

Why food addiction and binge eating persist (07:20–12:40)

• In Judy Cho's clinical practice, people who successfully followed carnivore often returned to carbohydrates and processed foods under stress. Sugar has stimulating effects, while eating also fulfills emotional needs.
• Certainty: Familiar foods provide predictable comfort, emotional responses, and temporary relief, making them reliable tools for coping or escape.
• Uncertainty: Food variety, unfamiliar flavors, availability, and different eating experiences can supply excitement and novelty, depending on individual needs.
• Love and connection: Foods associated with childhood, parents, grandparents, school, and happier memories provide nostalgia and an indirect sense of belonging during loneliness or disconnection.
• Escape, reward, and relief: Binges can numb painful emotions after difficult days, reward two weeks of disciplined eating, or provide pleasurable, dopamine-associated relief during exhaustion.
• Control: Decisions about which foods to eat and when provide a sense of control when other parts of life feel uncontrollable. Control is an important component of many eating disorders.
• Immediate comfort, relief, pleasure, numbing, or control can be followed by shame, physical discomfort, carbohydrate-related symptoms, diminished self-trust, fear, and renewed cravings. The immediate reward can sustain behavior despite later harm.

Meet the need through a healthier behavior (12:40–17:10)

• During COVID, previously successful carnivore dieters returned to processed foods amid widespread uncertainty, stress, and fight-or-flight responses; familiar food temporarily fulfilled their need for certainty.
• One pattern is stress, loneliness, or overwhelm followed by food, brief relief, and longer-term suffering. A healthier pattern involves identifying the underlying need and fulfilling it through regulation, support, nourishment, or other activities.
• Questions about a behavior's purpose, the feelings it avoids, and the need it fulfills identify where change is necessary more effectively than asking why self-control fails.
• Shame reinforces negative cycles. Repeated beliefs about weakness, incapacity, or inevitable failure direct the limbic system toward experiences that confirm those beliefs. Identifying unmet needs supports change without reinforcing a negative identity.
• Certainty can come from meal structure, routine, planning, and preparation. Uncertainty can come from varied movement, creativity, novelty, and anticipation of trips and new experiences.
• Connection can come from shared meals and supportive relationships. Significance can come from small commitments, such as ten consecutive days of meat-based breakfasts tracked on a calendar.
• Occasional setbacks need not produce shame. Small successes build self-respect, follow-through, and additional ways to fulfill underlying needs.

The needs jar: a practical tool for cravings (17:10–21:25)

• A needs jar contains four groups of color-coded slips for certainty, uncertainty, significance, and love and connection. Each slip contains a specific activity identified during a calm period as capable of fulfilling that need.
• During a strong craving or binge urge, emotional activation can impair logical decision-making. Drawing slips from the jar provides activities through which unmet needs can be fulfilled.
• When an urge persists and food is eaten, recording emotions, bodily sensations, anticipation, and thoughts before, during, and after eating makes the experience easier to examine.
• Dopamine and anticipation can make the time before a binge especially exciting. Attention to seeking food, traveling to obtain it, opening its packaging, its texture, the first bite, and accompanying emotions helps expose the sequence.
• Food choice can follow workplace stress, difficulty setting boundaries, or feeling unimportant to a boss. Eating can temporarily fulfill the resulting unmet need for significance or comfort.
• Identifying these connections repeatedly separates behavioral patterns from personal inadequacy and creates opportunities to fulfill needs through other actions.
• Boredom, frustration, and repetitive routines are yellow flags. Early recognition creates opportunities to fulfill unmet needs before the red flag of bingeing or returning to processed food.

The mind-body connection and chronic illness (21:25–25:55)

• Infections, toxins, mold, endotoxins, food sensitivities, inflammation, pain, and poor sleep activate immune and stress responses. Mast cells contribute to immune signaling, while the hypothalamus, autonomic nervous system, cortisol, adrenaline, blood pressure, and muscle tension participate in stress responses.
• Stress, fear, anxiety, trauma, negative beliefs, and interpretations of experience also activate the limbic system and influence hypothalamic, autonomic, and immune signaling.
• Eliminating dietary or environmental triggers may be insufficient for healing when psychological triggers continue activating stress pathways. Feedback loops can continue even after physical exposures stop.
• Nervous system regulation and limbic retraining modify habitual responses to people, environments, and memories. These learned changes require practice comparable to acquiring a language or musical skill.
• Physical recovery, nutrition, emotional regulation, and changes in processing experiences are interconnected elements of lasting recovery.

Certainty, self-sabotage, and fear of success (25:55–30:35)

• During divorce, bereavement, accidents, or major stress, familiar habits become automatic. Fear and anger can supply certainty because their emotional patterns are familiar.
• During eating disorder recovery, Judy Cho expected eventual relapse even during periods of success and sometimes almost brought that relapse about herself to fulfill familiar expectations.
• Self-sabotage can preserve familiar limitations and avoid testing personal potential. Removing obstacles such as illness, addiction, and excess weight can expose uncertainty about ambitions and abilities.
• Becoming an artist, author, successful speaker, or pursuing other aspirations involves the risk of failure. Familiar suffering can feel safer than discovering one's actual capabilities.
• Fear of failure and success can preserve the status quo. Healthier sources of certainty are necessary to stop familiar behaviors from undermining progress.

Decision, commitment, resolve, and belief (30:35–35:00)

• Tony Robbins' model of lasting change involves deciding, committing, and resolving. Decisions must produce concrete action, commitment, and determination to complete the change. [3]
• With a needs jar, the decision is to fulfill needs differently, the commitment is to acquire supplies and create the jar, and resolve includes a deadline for finishing it.
• Dietary commitment can involve removing all carbohydrate-containing foods from the house. Burning the boats removes easy routes back and reinforces an identity built around not eating those foods.
• People generally already know that frequent fast food, pizza, French fries, and candy consumption is harmful. Lack of nutritional information is not the fundamental barrier.
• Immediate rewards are attractive despite future harm. Strengthening belief that change will work, committing fully to carnivore or a chosen healing approach, and fulfilling underlying needs reduces reliance on old habits.

Growth, contribution, and hedonic adaptation (35:00–38:30)

• Certainty, uncertainty, significance, and connection are fundamental survival needs. Growth and contribution become the basis for deeper fulfillment after the first four needs are sufficiently met.
• Growth involves ongoing learning, development, and experience. Contribution involves serving others and pursuing purposes beyond personal health and family.
• Hedonic adaptation is the fading of the happiness initially produced by achieving a goal. Reaching an annual income of $50,000 may bring excitement that declines after several paychecks. [4]
• Diminishing satisfaction reflects the ongoing need for growth. Success with carnivore and recovery from illness or binge eating create time and energy for additional ambitions.
• New experiences, goals, challenges, and contributions continue beyond a single milestone, because the drive to progress continues throughout life.

Self-talk, mental imagery, and physiological responses (38:30–41:40)

• The first three adjectives or phrases used for self-definition may include being a failure, never succeeding, always starting over, or being stuck.
• Repeated self-definitions influence what the limbic system notices and predicts and how the body prepares to respond. Negative self-definitions reinforce perceptions that conform to the same negative identity.
• In an orchestra experiment also mentioned in Judy Cho's book Inflammation Fix, observing an orchestra and imagining it playing activated the same brain regions. [5]
• Thoughts and perceptions influence physiology. An imagined threat can produce bodily responses comparable to a real threat, and thoughts about conflict with colleagues or family members can cause muscle tension and stress without an external event occurring.
• Mental stress sustained over hours, weeks, months, or years can perpetuate physiological stress and contribute to chronic illness. Repeated words and thoughts influence nervous system responses.
• Recording negative self-definitions over several days helps identify repeated messages and their effects on emotional and physiological responses.

Practice, recovery, and lasting behavior change (41:40–46:05)

• Examining each recurring habit or addiction reveals which human needs it fulfills. Fulfilling three or more needs makes persistence easier to explain.
• A needs jar provides healthier activities to try whenever an urge arises. Repeated practice across several activities can continue until the craving passes, although cravings do not always resolve immediately.
• After a setback, acknowledging what happened and continuing without shame prevents reinforcement of a negative self-identity. Each successful response helps develop new habitual patterns.
• Judy Cho expected a lifelong eating disorder and constant reliance on willpower, but after seven or eight years of nutrition, nervous system regulation, limbic retraining, purpose, and service, stress no longer automatically triggers thoughts of food.
• Lasting change can require identifying deeper sources of unmet needs, including relationships, weak boundaries, or inadequate connection. These circumstances may require changes beyond dietary discipline.
• The central exercises are creating a needs jar and examining self-defining words. Recognizing early yellow flags and fulfilling needs in healthier ways reduces dependence on shame or willpower for controlling recurring food habits.

References

1. [01:53] A theory of human motivation — https://doi.org/10.1037/h0054346
2. [01:56] Why do we do what we do? — https://www.tonyrobbins.com/podcasts/why-we-do-what-we-do
3. [30:35] Making financial dreams a reality — https://www.tonyrobbins.com/blog/how-money-makes-dreams-reality
4. [36:03] Hedonic Adaptation — https://doi.org/10.1002/9781119547143.ch40
5. [39:15] Inflammation Fix — https://www.nutritionwithjudy.com/inflammation-fix/ :::

The carnivore diet exploded in popularity, with claims that eating nothing but meat could help you lose weight, reduce inflammation, heal your gut, and even reverse chronic disease. But what does the science actually say about the carnivore diet, and why has the hype started to fade?

In this episode of All or Something, we explore the rise and fall of the carnivore diet, tracing how an extreme animal-based diet became one of the most controversial nutrition trends on social media. We examine some of the biggest carnivore diet health claims, some of the biggest carnivore diet proponents and how some of the hype has already started to fizzle out.

From the rise of the carnivore movement and its most influential advocates to concerns about cholesterol, saturated fat, fiber, and long-term health, we separate what we know from what is still uncertain.

::: spoiler generated summary

Origins and early popularity

• The carnivore diet excludes all plant foods. It consists mainly of red meat but can include poultry, fish, eggs, and sometimes full-fat dairy; fruit, vegetables, legumes, nuts, seeds, and sugar are excluded.
• Google Trends shows little interest before late 2017. Shawn Baker's visit to Joe Rogan around December 2017 was a likely catalyst in its popularity, especially among men.
• In 2018, Jordan Peterson's and Mikhaila Peterson's guest spots and viral clips increased its visibility. Headlines said it cured his depression and fixed her arthritis; these were major unsupported health assertions.
• Podcast hosts have a responsibility to vet guests and challenge unsupported medical assertions. Publishing sensational excerpts without scrutiny helps spread misinformation.
• One carnivore follower said his health markers improved but LDL increased; when his doctor expressed concern, he dismissed the doctor as an ignorant drug pusher. Improvements elsewhere do not erase a worsening cardiovascular risk marker.
• Some carnivore supporters distrust doctors and reject unfavorable science while accepting evidence they believe supports their diet. This does not apply to every follower, but can prevent constructive exchanges.

Masculinity, influencers, and personal illness

• In a poll of roughly 1,000 American men, more than half viewed carnivore eating as masculine. Meat, raw organs, hunting imagery, and Joe Rogan's audience fit an alpha-male identity around the diet. [1]
• Comments have associated vegetables with homosexuality and soy with femininity. Only 18% of men in the poll viewed the Mediterranean diet as masculine, despite its reputation as a highly health-promoting pattern. [1]
• Carnivore books became popular in 2019–2020. Liver King's viral consumption of large quantities of raw meat and testicles added a muscular, supposedly ancestral image; the lifestyle was also seen as ironic and financially unrealistic beside ordinary shopping and cooking.
• Many people adopt carnivore because of illness, desperation, and fear of foods, not because of a glamorous ideal. Their symptom improvement is a meaningful personal experience.
• Crohn's disease led to a hospital-guided elimination of foods believed to aggravate digestive symptoms, eventually excluding many foods without knowing which restrictions were necessary.
• Fatty steak has caused diarrhea in the speaker, but this does not establish harm for everyone. Relief after excluding rice or plants likewise cannot justify universal dietary restrictions.
• Google Trends shows carnivore interest peaking in late 2024 and subsequently falling; the decline concerns search interest, not established discontinuation by every follower.

Why people can feel better

• Carnivore is simple: eat animal foods and remove almost everything else. This simplicity is appealing, even though chicken breast and deep-fried bacon have different nutritional profiles.
• It is a highly restrictive elimination diet. Moving from a typical American diet can remove sugary snacks, pizza, chips, deep-fried foods, and alcohol; benefits can follow changes in excluded foods as well as included foods.
• Narrower food choices often lower calorie intake. Reduced energy intake and weight loss can improve several health markers even when the chosen foods are not nutritionally optimal.
• Professor Mark Haub's Twinkie diet illustrates this: he ate largely junk food in a calorie deficit, lost weight, and had better blood lipids. Improved markers after dieting do not establish that the foods are optimal. [2]
• Research on low-carbohydrate and ketogenic diets finds that high-protein, restricted eating can reduce ad libitum calorie intake, meaning food intake falls without prescribed calorie limits.
• Reduced carbohydrate intake can also cause rapid water-weight loss. Someone starting carnivore may quickly lose weight, look different, and improve some markers, without demonstrating superiority over other diets.
• Long-term effects on food anxiety, social activities, restaurants, and adherence also matter. Mikhaila Peterson called her beef-salt-water approach the Lion Diet partly because the underlying restriction was socially awkward, not glamorous.

When health promises become extreme

• Paul Saladino's book The Carnivore Code advertises carnivore as scientifically proven to lower inflammation, improve sleep and mental clarity, reduce joint pain, and support weight loss. The wording "scientifically proven" is central.
• Eddie Abbew said carnivore can cure Crohn's disease and inflammatory bowel disease, using his daughter's relief from irritable bowel syndrome as support. IBS and IBD are different conditions; easing IBS symptoms is not evidence of curing Crohn's.
• Identifying this distinction drew angry reactions from supporters. Refusal to acknowledge an exaggeration protects a dietary identity without establishing medical validity.
• Jordan Peterson told Elon Musk carnivore would fix his back injury without knowing the injury's type. Musk resisted the assertion; improvement in another person's back pain cannot establish efficacy for an unspecified injury.
• Anthony Chaffee says plants are trying to kill humans, and Saladino has identified plants as a possible root of illness. The rationale involves plant defenses such as phytates, oxalates, and tannins.
• Plant defenses against insects do not establish harm from human consumption. Research connecting plant foods and dietary fiber with better health is much stronger than evidence favoring total plant exclusion.

What the carnivore evidence actually contains

• Direct research on strict carnivore eating is extremely sparse. Evidence from ketogenic or other low-carbohydrate diets is related but is not a direct carnivore comparison.
• A case series contains ten patients with inflammatory bowel disease whose symptoms improved on carnivore or ketogenic diets. The outcomes are encouraging, especially for people with Crohn's disease, but the evidence remains a case series. [3]
• Individual carnivore case literature also covers a patient with diabetes whose health improved; a single case cannot establish the best diet for every patient. [4]
• Another case involves one person with schizophrenia whose condition entered remission during carnivore-ketogenic metabolic therapy. [5]
• A further case involves a woman whose Candida vulvovaginitis improved during an all-meat ketogenic diet. [6]
• Inflammatory bowel disease case studies also exist for the specific carbohydrate diet, so benefits in a few carnivore cases do not demonstrate unique efficacy. [7]
• One case involved ulcerative colitis developing during a low-carbohydrate diet and improving after a switch to a plant-based diet. [8]
• Enteral nutrition, including tube feeding, also has published research on inducing remission in Crohn's disease. Positive cases from these dietary approaches also warrant attention under the same standard of evidence. [9]
• Moving from a poor baseline diet to carnivore and feeling better establishes improvement from that baseline, not superiority over every other dietary option.
• Shawn Baker and supporters sought donations for a proposed million-dollar carnivore randomized trial, raised a few hundred thousand dollars, and stopped. Promoters funding studies of their own diet also have potential conflicts of interest.
• A 2021 carnivore paper attracted widespread attention. Mikhaila Peterson said 90% of participants improved across all diseases, but the study recruited existing carnivore followers through social-media groups after at least six months on the diet. [10]
• This design excludes many who discontinued the diet early and preferentially samples satisfied adherents. It was a survey, not a randomized comparison with objectively measured before-and-after health outcomes. [10]
• In the survey, 93% followed carnivore for health, 85% ate red meat daily, fewer than 10% ate plant food more than monthly, 95% indicated improved overall health, and about 1–6% identified adverse effects, mostly gastrointestinal. These were self-assessments. [10]
• Participants also indicated lower BMI and reduced diabetes medication use. LDL cholesterol was elevated in some, an important cardiovascular risk marker alongside the favorable outcomes. [10]
• A 2026 scoping review included nine human studies, with possible short-term improvements in weight, satiety, and some metabolic measures, alongside risks of nutrient deficiencies, inadequate phytochemicals, and cardiovascular disease. Long-term carnivore adherence was not recommended. [11]

Prominent supporters moving away

• After about two years on strict carnivore, Paul Saladino experienced poor sleep, palpitations, muscle cramps, and testosterone around 500. He concluded long-term ketosis was poor for him and probably for humans generally, while The Carnivore Code remains on sale.
• After eight years, Mikhaila Peterson began reintroducing foods because her health had improved enough to tolerate them. Her experience fits a restrictive diet used during serious illness, not a lifetime ideal for everyone.
• Liver King later said he had been starving himself, had been wrong about carnivore, and wanted people to know. Drug use influenced his physique, so his muscularity did not establish dietary efficacy.
• Dr. Kiltz began softening his approach after about 15 years when his coronary artery calcium score rose and he developed acute colitis. He added foods such as fish, chicken, and potatoes beyond red meat.
• Podcast host Chris Williamson said strict carnivore felt mentally good but raised his cholesterol sharply. Subjective well-being and worse cardiovascular measurements can occur simultaneously.

Dogmatism, course corrections, and conclusion

• Cognitive dissonance can lead someone to defend a diet while dismissing adverse measurements. Similar contradictions occur when smokers or drinkers justify a risky behavior through stress relief or social benefits.
• For people who experienced illness followed by improvement, criticism of carnivore can feel like criticism of their recovery. This helps explain emotional attachment but does not establish the diet as optimal.
• An elevated LDL, blood pressure, or coronary calcium result can motivate reassessment and dietary changes. Some advocates dismiss the measurements or blame individuals for insufficient dietary adherence.
• Accounts of heart attacks after years on carnivore can attract replies questioning vegetable intake or saturated-fat consumption. Keto communities can similarly attribute adverse results to excessive carbohydrate consumption.
• Influencers often withdraw gradually without publicly retracting earlier assurances. Saladino now eats fruit, honey, and other plant foods after previously promoting strict carnivore.
• Carnivore can make many people feel substantially better, and the mechanisms behind improvement matter. Evidence on high saturated-fat intake, high red-meat intake, and the diet's long-term risks underlies the recommendation against strict carnivore.

References

1. [08:27] New Poll: More Than Half of Men Think Meat Is 'Masculine' — https://www.pcrm.org/news/news-releases/new-poll-more-half-men-think-meat-masculine
2. [20:39] Twinkie Diet class demonstration (Mark Haub) — https://experts.ksu.edu/mark.haub/professional
3. [32:23] Case report: Carnivore–ketogenic diet for the treatment of inflammatory bowel disease: a case series of 10 patients — https://doi.org/10.3389/fnut.2024.1467475
4. [32:29] Reversing 20 years of diabetes using the carnivore diet in India: a case report — https://doi.org/10.7762/cnr.2025.0026
5. [32:32] Case Report: Remission of schizophrenia using a carnivore ketogenic metabolic therapy with nutritional therapy practitioner support — https://doi.org/10.3389/fnut.2025.1591937
6. [32:33] Consuming an All-Meat Ketogenic Diet for the Long-Term Management of Candida Vulvovaginitis and Vaginal Hidradenitis Suppurativa: A 47-Month Follow-Up Case Report — https://doi.org/10.7759/cureus.30510
7. [33:45] The Specific Carbohydrate Diet for Inflammatory Bowel Disease: A Case Series — https://doi.org/10.1016/j.jand.2015.04.016
8. [33:49] Onset of Ulcerative Colitis during a Low-Carbohydrate Weight-Loss Diet and Treatment with a Plant-Based Diet: A Case Report — https://doi.org/10.7812/TPP/15-038
9. [33:57] Enteral nutritional therapy for induction of remission in Crohn's disease — https://doi.org/10.1002/14651858.CD000542.pub3
10. [37:20] Behavioral Characteristics and Self-Reported Health Status among 2029 Adults Consuming a “Carnivore Diet” — https://doi.org/10.1093/cdn/nzab133
11. [42:01] Carnivore Diet: A Scoping Review of the Current Evidence, Potential Benefits and Risks — https://doi.org/10.3390/nu18020348

:::

Dr. Lisa Wiedeman does an in depth review of eye floaters and current treatment protocols. This video will review surgical options such as a vitrectomy for floaters and laser vitreolysis.

::: spoiler generated summary

What floaters are

• In an optometric practice spanning over 30 years, floaters are among the most common concerns. They can look like transparent threads, dots, cobwebs, or floating blobs.
• Floaters are suspended inside the eye, not on its front surface. They move with eye movements, and trying to follow one with the eyes makes it seem to move away.
• The vitreous is the cushioning gel that helps maintain the eye's shape. It is about 98% water; collagen and hyaluronic acid make the rest resemble raw egg white.
• With age, sections of the vitreous liquefy and the gel shrinks. Collagen fibers clump into strands and spots, casting shadows on the retina that are perceived as floaters.
• How sharp or blurry a floater looks depends partly on its distance from the retina. The collagen clumps are visible when a slit-lamp beam passes through the vitreous.

When floaters signal danger

• A sudden shower of new floaters, peripheral flashes like a camera going off, or loss of vision needs an eye examination as quickly as possible to exclude retinal detachment.
• With age, the vitreous can pull safely away from the retina in a posterior vitreous detachment (PVD). This can produce a circular floater called a Weiss ring without harming vision.
• If the vitreous tugs a hole or tear in the retina, fluid can get underneath it and detach the retina. Laser or surgery can repair the damage, but action is needed before the detachment spreads.

Frequency and visual impact

• Most floaters are benign and very common. One survey found that 76% of people had seen them; they become especially common after age 50. [1]
• After a PVD in one eye, a PVD may eventually occur in the other eye.
• Some floaters are an occasional dot mistaken for a flying bug. A large collagen clump suspended centrally in the visual axis can make reading or driving difficult, although long-lasting, very large central floaters are uncommon.
• There is no eye drop or vitamin that makes floaters disappear. Management depends on how disruptive they are.

Observation and neuroadaptation

• For an uncomplicated floater or PVD, the usual approach is observation: wait, reassess in about six months or at the annual eye examination, and allow natural improvement.
• About 95% of all floaters improve on their own within roughly six months, without any intervention.
• Neuroadaptation helps because the brain learns to ignore a relatively small obstruction and fills in the image, so the floater becomes less noticeable even if it remains.

Laser vitreolysis

• For a persistent floater that seriously changes quality of life, office-based laser vitreolysis is an option. Improvement is put at 40–50%, while 7.7% became worse. [2]
• The laser targets and breaks apart the suspended floater. After numbing the eye and placing a special contact lens, the procedure takes around 15 minutes, is painless, and may require more than one visit.
• The possible complications include a retinal tear, retinal detachment, a spike in intraocular pressure, or a cataract if the laser reaches too close to the lens.
• Long-term safety data are lacking, not every surgeon recommends it, and the procedure is reserved for major, persistent visual disruption, not an occasionally annoying speck.

Vitrectomy

• Vitrectomy is the older, much more invasive operation. Instruments enter the eye, remove the vitreous gel along with the floaters, and put fluid in its place to maintain eye shape.
• About 90% of patients are satisfied after vitrectomy, but it is not a guarantee that floaters will never return. [3]
• For someone who has not undergone cataract surgery, the extra cataract risk is put at about 30%. Other risks include retinal tears or detachment, vitreous hemorrhage, glaucoma, and severe infection, with an approximately 2% risk cited for other complications. [3]
• Despite its high success rate, this operation is for people with substantially impaired daily life, not a tiny passing floater.

Floater supplements

• Products with names like 'Vitreous Health Eye Floaters Formula' are sold. The small placebo-controlled FLIES study, with 31 subjects, found a benefit from its supplement. [4]
• Marketing promises warrant skepticism, but someone with substantially bothersome floaters who is not ready for laser or surgery might try the supplement after reading the study and deciding for themselves.

The pineapple idea

• Pineapple contains bromelain, an enzyme thought to break down the collagen fibers in the vitreous and thereby reduce floaters. A pineapple-consumption study examined this possibility. [5]
• The pineapple work has not been independently replicated, and its regimens involve eating different amounts of pineapple each day. [5]
• If bromelain breaks down collagen in the eye, the same effect on collagen in skin, cartilage, and muscle is a concern.
• The pineapple cure is rejected because of concerns about loading the body with fruit sugars—glucose, fructose, and sucrose—and their effects on insulin and blood glucose.

Carnivore, food, and healing

• Messages received through Carnivore Doctor work include positive changes in eyesight and eye diseases after moving to keto or keto-carnivore eating.
• One person wrote that a large island of floaters interfering with vision disappeared after six months of carnivore eating.
• The dietary approach removes processed foods, seed oils, grains, and sugars. Its root-cause focus is to eliminate food viewed as toxic and give the body the opportunity to heal and move toward health.

Questions from viewers

• For someone seeing floaters after a steroid shot, if there is no sudden shower, flash, or change in vision, a simple floater is likely; an eye examination is still advised to rule out a small retinal hole or tear.
• A weight-loss stall on ketovore is unlikely to be caused directly by a prior detached retina, eye operations, or a cataract; many other factors affect weight loss.
• Floaters can be vivid against a plain blue sky. One floater visible since the early twenties resembled an armless stick figure; no personal PVD had occurred.
• Nearsightedness raises the chance of floaters and PVD: the eye has a longer axial length, leaving the vitreous to occupy more space and making separation more likely.
• Oral collagen supplements need not be avoided because of floaters. Collagen eaten for joints, muscles, or hair does not simply enter the vitreous and cause clumping.
• Type 2 diabetes need not be lifelong or require lifelong medication; it can be reversed, and even early diabetic retinopathy can reverse.

References

1. [07:00] Prevalence of vitreous floaters in a community sample of smartphone users — https://doi.org/10.3980/j.issn.2222-3959.2013.03.27
2. [10:38] Nd:YAG vitreolysis and pars plana vitrectomy: surgical treatment for vitreous floaters — https://doi.org/10.1038/sj.eye.6700026
3. [13:37] Efficacy and Safety of Pars Plana Vitrectomy for Primary Symptomatic Floaters: A Systematic Review with Meta-Analyses — https://doi.org/10.1007/s40123-022-00578-9
4. [15:08] Dietary Intervention With a Targeted Micronutrient Formulation Reduces the Visual Discomfort Associated With Vitreous Degeneration — https://doi.org/10.1167/tvst.10.12.19
5. [16:04] Pharmacologic vitreolysis of vitreous floaters by 3-month pineapple supplement in Taiwan: A pilot study — https://doi.org/10.7537/marsjas150419.03 :::

Kyle talks about his journey on the carnivore diet.

::: spoiler generated summary

Finding carnivore and earlier health problems (00:00–03:19)

• After COVID, Kyle found carnivore through Instagram health accounts while learning about health. His earlier diets included vegan, vegetarian, standard American, keto, and ketovore; he liked steak.
• Kyle remained fairly active but gained around one to three pounds annually. His later changes made earlier health problems more apparent.
• The roughly four-and-a-half-year carnivore period began with about two years of inconsistent adherence, including fast-food dishes such as orange chicken.
• The early, less strict diet coincided with some improvements before serious illness. A roughly one-year beef-and-water lion diet followed, and his current diet is broader traditional carnivore.

Severe idiopathic chronic neutropenia (03:27–06:18)

• Kyle developed idiopathic chronic neutropenia, involving very low infection-fighting neutrophils, an unknown cause, and a persistent course.
• His neutrophil count reached 0.01 against an expected level of at least 1.6, persisted for months, and fluctuated with brief increases followed by declines.
• The cause remained unknown; possible explanations included a viral process affecting the bone marrow, autoimmunity, and dietary factors.
• Short-lived drug- or virus-related neutropenia can resolve in seven to ten days, while Kyle’s low levels continued for months and raised concern about infection.
• About 10% of people with neutropenia die from a secondary infection. Investigations at OU Health and the Mayo Clinic, including checks for cancer and other causes, found no origin.

Moving to the strict lion diet (06:19–09:10)

• His initial diet was perhaps 70–80% carnivore, alongside weight loss and increased activity. Despite others connecting the illness to his diet, he moved toward stricter carnivore eating.
• Kyle used a small, informal collection of Facebook accounts from people with similar symptoms, examining individual experiences without statistical analysis.
• The online accounts associated improvement with fasting, ketogenic or carnivore eating, reduced sugar and processed food, sleep, and exercise; medication-based accounts did not show recovery in his comparison.
• An almost eight-day water fast preceded approximately one year of beef and water. Neutrophil counts recovered during the dietary regimen.
• Blood counts improved early and returned to normal over roughly six to nine months. Hematology visits ended; Kyle takes no medications, has lost approximately 75 pounds, and runs ultramarathons without carbohydrate intake.

Infection fears, medical care, and proposed splenectomy (09:11–13:23)

• During the illness, infection concerns affected ordinary activities, including exposure to coughing people, his children’s illnesses, yard work, and flowers.
• Bone-marrow biopsies and extensive testing preceded about one month of steroids, antibiotics, and antifungals. Neutrophil levels were lower at the end of that course.
• The hematologist proposed splenectomy for possible sequestration of neutrophils, without evidence of splenic enlargement. Kyle did not proceed with surgery.
• Kyle chose fasting and strict carnivore before further intervention. His hematologist did not recommend that approach but agreed to observe the course.
• Neutrophil levels rose across the first 30, 60, and 90 days, approached normal around six months, and reached normal by nine months.
• A Mayo Clinic blood-cell specialist said he never saw patients get better, encouraged continuation, and later held informal Zoom calls. The improved results persisted for at least another year.

Diet as part of a wider way of being (13:23–16:40)

• Carnivore eating accompanied a broader recovery routine of exercise, sleep, gratitude, spirituality, and social relationships, understood together as a way of being.
• After the lion diet, his food expanded to fatty beef, near-daily eggs, salmon, cod liver, some bacon, and hard cheese; he estimates roughly 99% carnivore adherence.
• Bread, tree nuts, and ice cream remain absent from his meals, while small amounts of pepper or restaurant marinade are acceptable.
• His usual intake is two meals, around noon to 1 p.m. and 5–6 p.m., occasionally one meal, creating an intermittent-fasting pattern without a deliberate schedule.
• He commonly runs four, eight, or twelve miles before his first meal, without pre-run food or carbohydrate fueling.

Unexpected mental and physical changes (16:40–19:40)

• Family and acquaintances see changes in Kyle’s health and disposition, while online strangers challenge his diet over saturated fat and cholesterol.
• Despite no prior mental-health diagnosis, Kyle experienced less anxiety and brain fog, with increased clarity and a calmer disposition.
• Daytime naps, sugar crashes, digestive urgency, and stomach problems subsided. Long runs no longer require planning around bathroom access or fiber.
• Previously worsening allergies also improved, making symptoms that had become familiar more apparent in retrospect.
• The interviewer also experienced improved clarity after earlier brain fog had felt normal.

Family and shared habits (19:40–25:02)

• Kyle plays sports with his sons and coaches four youth teams, including two head-coaching and two assistant-coaching roles.
• Family routines prioritize food, sleep, movement, sunlight, and outdoor time; his wider habits include heat and cold exposure, fresh air, contact with grass, gratitude, and consistency.
• The children learn through his daily actions rather than lectures about processed sugar; he avoids a mismatch between dietary commitments and weekend beer or pizza.
• His wife has followed carnivore intermittently and resumed it roughly four to five months earlier, after generally eating whole foods.
• They coordinate meals, with Kyle cooking meat on most evenings, hard cheeses included, and optional whole-food sides for the children.

Personal variation and testosterone (25:02–26:11)

• Some friends discontinue short trials after diarrhea. Kyle does not assume universal effectiveness, given differences in individual biology and background.
• Kyle and his wife prefer ketogenic eating and the sleep they experience with it; household members take no ongoing medications.
• His testosterone measurements increased from just under 400 to over 800 without TRT or other medication, a change he likens to testosterone replacement.

Running and its origins (26:11–30:30)

• Most days he covers four, eight, or twelve miles at a slow "hoofing" pace. Roughly quarterly, he completes 26- to 50-mile races, most recently a 50-miler.
• The goal is ongoing fitness, not competition. His Bernedoodle joins runs, his wife walks, the family does 5Ks, and he wants to continue racing into old age.
• In 2022, at about 35, he became breathless while wrestling with his sons, then about six and three, and recognized his low fitness.
• After a walked half marathon left him sore for weeks, he trained for and completed a full marathon later in 2022 while beginning a loose carnivore diet, then maintained a roughly quarterly racing schedule.
• Long runs bring a sense of mental clarity around miles 18–19. Training supplies discipline and outdoor sunshine, with the gym mainly used when weather prevents outdoor miles.

Motivation and coaching (30:30–34:42)

• Kyle works as an Oklahoma denominational executive director and coaches ministers and church founders, applying similar coaching principles to dietary change.
• His first coaching question is "Why?" A personal reason for changing eating habits is more important than an initial plan or a fast-versus-gradual transition.
• Early dietary transition can involve diarrhea, and lasting adherence depends on a sufficiently strong personal motivation.
• Kyle allows for ketogenic, ketovore, or other diets suited to different people; a short-term cosmetic goal may not sustain long-term dietary changes.
• Serious illness intensified his commitment and changed his priorities toward his wife, children, coaching their teams, and meaningful time, with less television and online conflict.
• His experience of carnivore communities links sustained commitment with pressing health concerns; his coaching focus is lasting life changes over short-term cosmetic goals.

Work, meaning, and a 90-day trial (34:42–40:00)

• Improved mental clarity helps him analyze systems, ask sharper questions in his professional work, and respond to audiences during amateur stand-up comedy.
• At home, he experiences greater patience and energy with his sons, and improvements across many areas of life.
• After roughly four and a half years of dietary changes, including two to two and a half years of stricter adherence, he intends to continue and expects further gains.
• His theology background shapes the comparison between the gospel as good news and his carnivore experience as a path forward after a severe diagnosis.
• He favors a 90-day trial over 30 days because dietary adjustment may outlast one month, while allowing a different diet if no major improvement occurs; he does not expect universal results.

References None — no published works are identifiable in the transcript. :::

I thought carnivore would be easier than this.

After more than four years of eating carnivore, I've learned that knowing what to eat is only part of the equation. Dealing with food temptations and navigating social situations can present their own challenges when you choose to eat differently from the people around you.

In this video, I'm sharing my perspective on two real-world challenges of carnivore and what it takes to make this way of eating work in everyday life.

Alzheimer’s disease is usually discussed in terms of plaques, tangles, and genetics. Dr. Stephen Cunnane has spent years studying another piece of the puzzle: what happens when the aging brain can no longer use glucose efficiently, and whether ketones can help fill that energy gap.

In this interview, Dr. Bret Scher and Dr. Cunnane discuss the metabolic side of cognitive decline, including insulin resistance, brain glucose metabolism, and why metabolic health may play an important role in both prevention and treatment.

::: spoiler generated summary

Why prevention is central

• Dementia, cognitive impairment, and Alzheimer's disease are increasingly prevalent and deeply feared because they can take away memory, thinking, independence, and the ability to relate to other people.
• Medical training gives far more attention to pharmacology than to metabolic health, lifestyle, and prevention, and the medical system makes prevention difficult to integrate into routine practice.
• Prevention is not miraculous, but hypertension, obesity, type 2 diabetes, cancer, and neurodegenerative disease can be pushed farther away by acting on modifiable risks earlier in life.
• Type 2 diabetes can be "cured" through prevention even after medications and insulin have begun.

Brain metabolism from infancy to aging

• The newborn brain is a "hybrid car": glucose and ketones are both normal fuels, ketones can supply about one-third of brain energy, and a healthy term infant's brain can consume about 75% of whole-body energy; premature or low-birthweight infants without adequate fat stores may therefore be vulnerable.
• Adult ketone therapy is connected to this normal infant physiology, while the modern pattern of rarely moving in and out of ketosis differs from the glucose-and-ketone cycling that would have been common across human life, and loss of that fuel switching is part of the dementia problem.
• Reduced brain glucose use in Alzheimer's disease has been known since early PET imaging, while George Cahill's 1967 fasting work established that ketones can become a major brain fuel during starvation. [1]
• The glucose problem begins before diagnosed Alzheimer's disease, including in genetic and sporadic forms and in otherwise healthy aging, so it cannot be explained only by neurons dying late in the disease.

The brain energy problem in Alzheimer's disease

• Aging together with carbohydrate-heavy diets, excess sugar, sedentary living, and insulin resistance can worsen low brain glucose use while suppressing endogenous ketone production, creating what amounts to chronic starvation of the brain.
• Plaques, tangles, amyloid, and tau are central to Alzheimer's neuropathology, but clearing plaque does not by itself restore the brain energy needed to learn, store information, and recover memories.
• Amyloid-directed drugs and metabolic approaches can be complementary; Alzheimer's disease is unlikely to be adequately addressed unless the brain energy deficit is addressed at the same time.

What the clinical trials show

• Trials of exogenous ketones, MCT, and ketogenic diets include unblinded and randomized studies, with some small successes and many neutral or negative outcomes; most have lasted only 8-12 weeks, while Alzheimer's changes slowly and long-term dietary adherence is difficult.
• Elizabeth Neal's ketogenic-diet randomized controlled trial in children with epilepsy demonstrates that such a diet trial can be done in neurology, although controlling diet in children is easier than maintaining a long ketogenic intervention in older adults. [2]
• Matthew Phillips's randomized crossover trial in Alzheimer's disease improved quality of life and daily function on a modified ketogenic diet, while specific memory and cognitive measures did not significantly improve. [3]
• Quality of life is often not measured, and attention, follow-up, group activity, and the sense that someone is caring for the participant can themselves produce a large placebo or control-group benefit.
• In two major multidomain prevention interventions in people at risk of Alzheimer's disease, the control-group effect was about three-quarters of the beneficial effect, consistent with exercise, cognitive training, social contact, and active care improving people's lives.
• Functional ability, communication with family and neighbors, and a better life matter more to patients than biomarker changes.

APOE4, disease stage, and heterogeneity

• One ketone-product study found cognitive benefit that was markedly weaker in APOE4 carriers, making genotype a plausible modifier of response.
• The roughly 40-versus-40, six-month MCT study in mild cognitive impairment found no APOE4 effect, but only about 10-12 APOE4 carriers were in each group, so the trial was not powered to settle that question. [4]
• APOE4 is currently more useful as a research tool than a clinical decision tool: noncarriers are not protected, homozygous carriers have higher risk, and testing can create misleading reassurance even though risk can still be mitigated.
• Prevention should start early because the same lifestyle risks also drive hypertension, obesity, cancer, and type 2 diabetes; severe type 2 diabetes is already occurring in teenagers, even to the point of kidney transplantation.
• Advanced Alzheimer's disease is not automatically beyond help: for most severely affected people the effort or cost may no longer be worthwhile, yet periods of lucidity and benefit are seen anecdotally, so there is no justified MMSE cutoff below which trying is automatically futile.
• Metabolic dysfunction is a contributing factor, not a guarantee that correcting metabolism will eliminate Alzheimer's disease; genetics, other diseases, infections, falls, head trauma, and concussion can all change the response.
• Beta-amyloid changes can be seen after concussion in university athletes in their twenties and can still leave a fingerprint decades later, illustrating how brain injuries and other exposures can accumulate alongside metabolic risk.

A multidomain lifestyle strategy

• Exercise, cognitive activity, sleep, stress, and metabolic health all matter, so multiple components are used because no single intervention has been shown to solve every case.
• A four-component intervention also hedges against imperfect adherence; insulin control is a major constraint, and overnight fasting, possibly around 16 hours, should allow endogenous ketone production to occur.
• Mild cognitive impairment changes slowly, so a statistically significant shift of one or two points on a memory test may not be clinically meaningful unless it changes daily life or quality of life.

Eric Sprott's funding and the new program

• Eric Sprott's donation creates the opportunity to combine research with public and clinician outreach; at age 81 he feels healthier on a mainly keto-carnivore diet, his partner has followed a ketogenic diet for more than 20 years, and the goal is for people and doctors to act on preventable risk.
• Useful action does not have to wait for another five years of research: refined carbohydrate can be reduced now, and exercise is important in part because it increases brain ketone uptake.
• Cutting carbohydrate intake by about 50% is already useful but may not raise ketones much, so MCT is added to increase ketone availability without demanding a strict ketogenic diet.
• A small retirement-home study showed that people in their eighties could sustain a reduced-carbohydrate diet while still receiving two smaller desserts a day by lowering the overall carbohydrate load, fruit juice, and soft drinks. [5]
• The main multidomain project combines reduced carbohydrate, MCT, exercise, and an omega-3 supplement, alongside knowledge mobilization through Keto Celebration and education designed to change health-professional practice.

Type 2 diabetes as an actionable Alzheimer's risk

• Prevention and slowing established disease are different goals, but type 2 diabetes is one of the top three or four modifiable risk factors for Alzheimer's disease and refined sugar intake is changeable.
• UK and North American type 2 diabetes programs, including Virta Health and David Unwin, can eliminate medications and insulin; the more precise terms are "remission" or "reversal," not "cure."
• Preventing or reversing type 2 diabetes does not guarantee prevention of Alzheimer's disease, but reducing a major risk factor should protect the heart, kidneys, and liver and is expected to delay memory problems: "forget Alzheimer's disease" and think below the neck.
• "Type 3 diabetes" draws attention to brain insulin resistance, but it may also steer attention toward diabetes drugs alone; reduced carbohydrate could potentially be combined with GLP-1, SGLT, or other appropriate drugs.
• Persistent medical resistance to reducing carbohydrate and sugar intake is the same century-long problem explored by Gary Taubes in Rethinking Diabetes. [6]

SPARCUS and the broader goal

• SPARCUS is the Sprott Prevent Alzheimer Research Collaboration at the University of Sherbrooke, built around research and getting the public to take prevention seriously.
• Clinician education can use CME, communities of practice, practitioner exchange, and the experience of patients who have succeeded with metabolic interventions.
• Metabolic health, mental health, and cognitive health are moving toward the same connected field, and philanthropy from people such as Eric Sprott and the Baszucki family can help change research priorities and medical practice.

References

1. [07:18] Brain Metabolism during Fasting — https://doi.org/10.1172/JCI105650
2. [12:27] The ketogenic diet for the treatment of childhood epilepsy: a randomised controlled trial — https://doi.org/10.1016/S1474-4422(08)70092-9
3. [13:18] Randomized crossover trial of a modified ketogenic diet in Alzheimer’s disease — https://doi.org/10.1186/s13195-021-00783-x
4. [16:20] A ketogenic drink improves cognition in mild cognitive impairment: Results of a 6-month RCT — https://doi.org/10.1002/alz.12206
5. [27:55] A reduced carbohydrate diet improves glycemic regulation in hyperglycemic older people in a retirement home: the SAGE study — https://doi.org/10.1139/apnm-2024-0277
6. [34:52] Rethinking Diabetes — https://www.penguinrandomhouse.com/books/561552/rethinking-diabetes-by-gary-taubes/ :::