Continuation from Part 1 (on the Carnivore Diet)

Dr. Shawn Baker: I know there are people within this carnivore space that are making these very hyperbolic sort of proclamations. And, it’s a panacea, and it never fails. But I’ve seen people where this doesn’t work that well. I’m the first guy to admit that.

What I also see and know is that one of the big topics that everybody talks about is cardiovascular risk. Your cholesterol might go up, and I think we have a handle on that, thanks to guys like Dave Feldman and Nick Norwitz, who talk about lipid energy metabolism. We have to understand what the physiology is. If you get leaner and rely more heavily on lipid trafficking to supply your energy needs, your lipid numbers are going to be higher. I’m not the guy who’s saying ignore cholesterol. I’m saying let’s get some more nuance here. Let’s see what else is going on. Maybe get some imaging, periodic sequential imaging, and see what’s happening. And, five years from now, that topic may be completely different. We might be saying, “We were all wrong,” or “You can ignore this in this situation.” If X, Y, and Z are true, then LDL cholesterol becomes a non-issue. I don’t know that we’re there yet. It’s still something that has to be considered.

LDL cholesterol, glucose and more

Dr. Eric Westman: I think the competing hypothesis is metabolic syndrome, so high triglycerides, low HDL, abdominal circumference, blood sugar, and blood pressure. Even in recent studies, a lot of people looking at risk have found that metabolic syndrome is much more associated with cardiovascular risk than LDL cholesterol. So I focus on the glucose side of things and weight.

Dr. Shawn Baker: Was it Gerald Reaven who first described Syndrome X or metabolic syndrome? He did not include LDL cholesterol in his initial description. It was triglycerides, HDL, glucose, body fat, and hypertension. And you’re like, “Okay,”

Dr. Eric Westman: But he wasn’t respected and didn’t get that dominance in the medical world. It became all about LDL cholesterol and drug treatment. He was kind of marginalized.

I met him and chatted with him before he died at Stanford, where he was. He got mad at me when I said, “You’re saying exactly what Dr. Atkins is saying.” I knew Dr. Atkins before I met Dr. Reaven. And Dr. Reaven got all upset, “No, I’m not saying the same thing! You can’t eat all that fat!” So he was still in the old fear-of-fat paradigm, even though he knew about metabolic syndrome. I love the name of one of his papers, “Looking at the World Through LDL-Colored Glasses,” as kind of a skeptical argument. Even decades ago, just a focus on that type of cholesterol was misguided.

Discussion on Vitamin C

Now, the discussion in my clinic is, “My ferritin is high, and I’m going to get scurvy. I’m not getting any vitamin C.” How do I deal with this?

Dr. Shawn Baker: I think the scurvy concern should be obvious to people who have seen people who have been doing this for years. No one gets scurvy. Scurvy is a bad thing. You die from scurvy. It’s not like, “My gums got a little sore, I have scurvy.” No, it’s like you’ve got this petechial rash, and you’ve got hemorrhaging, blood in your joints, and your skin’s weeping open, and you die. That’s scurvy. No one’s getting that.

Dr. Eric Westman: Literally, one sketchy, I say, not in a weird way but more like it’s just a very sketchy anecdote, of a guy who came out of the Virginia mountains down to the hospital every now and then and had scurvy. He said he was doing a carnivore diet. These kinds of imperfect descriptions of what people do. Goodness knows what he’s doing when he’s away from the academic center. Then, the worst thing is, he said he was doing an Atkins diet. What does that mean? What was he eating?

Dr. Shawn Baker: There was a musician by the name of James Blunt, who claimed in the 1990s or 2000s, when he was in college, that he was supposedly diagnosed with scurvy. His diet was chicken and mayonnaise or something like that, which is strange in itself. There was no definitive proof. The doctor just said, “Maybe you got scurvy,” because the doctor probably had never seen scurvy in his life and said, “You eat meat? You must have scurvy.”

Dr. Eric Westman: Yes, a blood level was low or something.

I was listening to another carnivore pundit, Dr. Anthony Chaffee, and he talked about it. He quickly rolled out that vitamin C is used to make hydroxyproline and collagen, and since you’re eating so much of it, you don’t need the vitamin C to make it. I thought, “I’d never heard that before,” That’s a brilliant reason why you don’t need so much vitamin C because you’re consuming the thing that the vitamin C is helping you to make.

Dr. Shawn Baker: Hydroxyproline and hydroxylysine go into collage synthesis. I actually looked this up years ago, we do have transporters in our gut for those. They have these di- and tripeptide transporters, and so you can actually directly absorb that. Some people said, “It’s going to be all broken down in the gut,” but it’s actually absorbed intact.

Vitamin C involved in the function of carnitine

We can do that. Probably more importantly, I think the biggest benefit that we see is that vitamin C is involved in the function of carnitine. Carnitine has a role in lipid oxidation. Meat is very rich in carnitine, it’s a rich source of carnitine, this is another role that vitamin C would normally have, but it’s being augmented by having meat. We know that vitamin C and glucose are very similar in appearance. They differ very minutely if you look at them on a typical organic chemistry projection. I can’t remember the name of the projection for it, but they look identical. They share the same transporter, so they competitively compete with each other.

If your glucose is higher, vitamin C absorption across certain membranes is going to be lower. When you don’t have a lot of glucose floating around, vitamin C is more readily utilized. Vitamin C, as we all know, is an antioxidant. In low-carb situations, often our antioxidants are upregulated, so we don’t see as much need for them. Even things like uric acid, which is also an antioxidant. Most people don’t realize uric acid is an antioxidant. The red cell also can recycle vitamin C, which is something that capacity probably goes up. The bottom line is the observations they made during the polar explorations, South and North Pole 150 years ago, were that sailors who had access to fresh meat did not get scurvy, or if they had scurvy, fresh meat would cure them. What I mean by fresh meat is not meat that’s been dried or stuck in a can for six months like the British sailors might have had. They were eating hardtack, which is a bunch of carbohydrates and dried meat, and they got scurvy because it wasn’t fresh meat. So that’s the difference.

Dr. Eric Westman: There are guidelines for how much someone should consume. Of course, how much you should consume depends on what you eat and how you’re fueling your metabolism. That trips up a lot of people.

Dr. Shawn Baker: The analogy would be if you want to recommend how much gas you need for your gas car, except your car burns diesel. You’re like, “Well, it doesn’t apply.” Apples to oranges. It’s not the same thing. We, as carnivore-keto people, are probably running a diesel engine, and everybody else is running a gas engine or an electric one.

Dr. Eric Westman: Then when we check the fuel system or check the blood, which is carrying around waste and fuel. The blood levels can be different compared to those who eat carbohydrates. I see this in the keto-carnivore world, where the blood level of something might be low, and a doctor says, “Therefore, it’s deficient,” when, no, the blood level isn’t always a good marker of what’s in the cell.

Ferritin

Let’s talk about ferritin a little bit. Because in some cases, it’s typically elevated. Then also A1c, it can be higher than the normal range that people get from the doctor of carb eaters, and it causes some concern. And other doctors can hold on to this and say, “You shouldn’t be doing that.” Yet, I don’t see clinical evidence of harm.

How about the A1c? There was an issue with your A1c, I think. For a while, it was a little elevated, and I used that as reassurance to folks. These are two other blood tests that seem off.

Dr. Shawn Baker: I see a few things. Folate is often low, lowish, low-normal. But again, what does a folate deficiency look like? Megaloblastic anemia. There may be neural issues. Obviously, with women, it’s going to be neural tube defects. But we don’t see any on the clinical side of things. I think that’s the important thing when people are looking at labs. As a physician, you’re supposed to ask, “What is the clinical presentation?” The first thing we learn about is to look at the patient, not just the labs. If you run to the labs first, you are missing the forest for the trees. And that’s an important concept.

A1c

Dr. Eric Westman: Welcome to today’s internal medicine world, where often the lab is the first thing people see. Then my patients get grief for having a 10% elevation of LDL. So it varies, but that shouldn’t be the way it is.

What about the glucose A1c thing?

Dr. Shawn Baker: Hemoglobin A1c, and now that we have such ubiquitous usage of CGMs, we can see more and more examples of this. It’s predicated on the assumption that a red blood cell lives for 90 days. Sometimes, in a healthy person, they live longer, potentially giving you more exposure to glucose over time.

If you assume you’re measuring something that lasts for 90 days, but it’s actually lasting for 115 days, it’s not the same measurement. A lot of people will come to me saying, “My A1c before I started carnivore was 5.2, and now it’s 5.6. I’m really concerned.” I ask, “What does your CGM say?” They’ll respond, “It shows my blood glucose never goes above 94.” People will say, ‘You’re measuring the extracellular fluid, you’re not measuring blood,” but the reality is, we’re finding out a lot of things we previously held as being absolute.

Red blood cell life and survival time

Dr. Eric Westman: Has anyone ever tested that hypothesis? Let’s say we take 10 people who are following a low-carb, carnivore diet and have elevated A1cs, or even normal ones, and test the red blood cell lifespan. As I recall, this is something you can do with a nuclear scan. It’s been so long since I did that in training, but you can actually measure this. Has anyone tested red blood cell life before and after? Not just the mass, but the red blood cell life?

Dr. Shawn Baker: I have not seen anybody do it because it’s a very selected research study. It’s pretty expensive. People look at fructosamine. I’ve seen some fructosamines done. I’ve seen, obviously, the CGM comparisons. I’ve seen people look at retic counts. When a reticulocyte count is high, that usually means a high turnover, typically.

Dr. Eric Westman: That could be a PhD project. Looking at red blood cell survival time.

Another thought occurred to me. I’d like your impression on that. The elevated blood glucose in diabetes is pretty much– along with the consequences of amputations, kidney failure, heart disease, and atherosclerosis – associated with high-carb eating, often 200–300 grams of carbs a day, and the metabolism associated with carbohydrates. I’m less concerned with a blood glucose elevation when people are not eating carbohydrates.

Dr. Shawn Baker: I can expound on that a little bit. If you go way back to the 1920s when they were first doing studies, I think there was one called The Metabolism of Eskimos. What they found was that the Eskimo blood glucose was running about 120. Their fasting blood glucose was running about 120 mg/dL, which today we would consider pre-diabetic. But they exhibited zero evidence of kidney disease, diabetic retinopathy, or any of that stuff. I think you’re right in the fact that it is conditional, the same thing as we touched on in your earlier subject, talking about vitamins.

Vitamin D

They did a study on Eskimos up in, I think, Greenland, or it might have been Labrador, one of the two places. They were looking at two groups that had low vitamin D levels. Both had low serum vitamin D, because there’s no sun up there. But one group got rickets, and one group didn’t. Rickets is a vitamin D deficiency that shows up in kids with malformed bones. The group that got rickets was eating a Westernized diet with flour, sugar, and canned goods. The group that still had low vitamin D but didn’t get rickets was eating their standard, regular diet of seal, whale blubber, and caribou meat. So again, even the serum levels don’t necessarily indicate the full picture. To your point, is an elevated blood glucose in a carbohydrate-free metabolism the same thing as in a high-carb metabolism?

If you look at the physiology of animals like cats and dolphins, both carnivorous animals, both of them typically run higher blood glucose. Yet, they don’t normally have diabetes, at least as we would consider it. They don’t get any of the manifestations. Again, at the end of the day, we’re not treating a blood marker; we’re treating the effects of that. The same thing goes for LDL – it could be higher. Ferritin could be lower. A T3 thyroid level could be lower, and yet, you’re completely asymptomatic. We have to reframe. What does physiology mean, and what are the respective norms? At this point, we’re just speculating on this, of course.

Dr. Eric Westman: To really answer that question, you would follow a thousand people who are following a low-carb, keto, or carnivore diet over 20 years and see if they develop diabetes. No one is going to do that study, but you could take a smaller number of people and observe some of the short-term effects of higher blood glucose that are typically associated with diabetes to see if there are changes. These are testable sorts of things that people can explore.

What is health

Switching gears, people talk about history and evolution. We’re told that humans are supposed to be omnivores. Then there was the massively popular book, The Omnivore’s Dilemma, which ended up concluding that people should “eat mostly plants.” It wasn’t scientific, but it was hugely influential. I have often thought that I want the health of a carnivore because they don’t get diabetes or heart disease unless they’re eating carbs. Is that an appropriate estimation of it?

Dr. Shawn Baker: We have to reframe how we define health in many ways. What does it mean to be healthy?

To me, it means I feel good, I function well, and all my systems are working as designed for as long as possible. If you arbitrarily say, “Well, your kidneys aren’t working because your BUN’s is a little high, your creatinine is a little high, “I’d say there’s a reason for that. I’m eating a lot of protein, and it doesn’t necessarily mean my kidneys are failing.”

We have to, as physicians, understand what kind of “animal” we are examining. It’s very different to compare the labs of a person who eats a standard, processed food, high-carb diet, and lives a sedentary lifestyle to someone who follows a low-carb, whole-food diet. Their labs can be different for different reasons. I think Dave Feldman really put this point well: why is a lab value elevated? It’s not just that it’s elevated, but why is it elevated? If we can understand the why, we can determine if it’s problematic.

I often hear people say, “Oh, you’re on a low-carb diet, and you have diabetes? Well, you’re just masking the symptoms, your glucose isn’t high anymore.”

Explain to me why people are seeing retinopathy reverse. Why are they seeing nephropathy reverse if they’re just masking the symptoms? I’ve clearly seen it, and I’m sure you have as well. That’s not masking symptoms. That’s the reversal of objective disease.

Dr. Eric Westman: To echo that, the reversal of these diseases, maybe these are case studies and case series that need to be published. Short of the Virta Health study, which is the largest diabetes reversal study to date, people often think you need a very difficult, time-consuming, and expensive intervention when just changing the diet can give you a similar diabetes reversal.

Do we need to convince doctors

To me, it seems obvious, why would I want to waste time doing case studies on this? I’m afraid that’s where we are, lifting what we know in the YouTube world and the internet world into the medical world. Or do we need to do that? Do we need to convince doctors about this? I’m questioning that.

Dr. Shawn Baker: I don’t think we need to convince them because most people who have done this are already changing their diet. Your grandmother can tell you what to eat. We’re all big boys and girls; we can eat whatever we want. Some people look at this and say, “I see this anecdote, and maybe 20 anecdotes show the exact same outcome for people just like me. Maybe I should try that.”

Policies, studies and case series

I think the studies are more necessary for driving policy decisions. Policy decisions can hurt people – school kids, military personnel, anyone receiving federal dollars, hospital patients, and so on. You go to the hospital, and you get poisoned with their junk food. It’s crazy.

With regard to carnivore, we’ve got a case series on IBD that’s been published. We have one on anorexia, one on mental health disorders, and one on MS that’s going to be published soon. Another one on psoriasis is rolling. I’m in the background helping to organize the first interventional trials, which are going to happen. We’re probably going to start with interventional trials comparing carnivore versus diabetes. The scientific progression is: I have a hypothesis’ Let’s see if we can observe it, then we publish a case series, and then formally test it. You have to follow that pattern. No one is going to give you $20 million to study carnivore versus IBD if no one’s ever done it or if it’s never been seen before.

I stay optimistic that someone might give us $20 million. I do think it’s important to do this because there are a lot of physicians out there who are on the fence. They’re watching this and thinking, “I wish there were some studies so I can cover my butt.”

As an orthopedic doctor, I remember what Tim Noakes went through in South Africa. I was sitting there, making sure that when I noted discussions with patients, I would just write, “I had a discussion about nutrition with the patient.” That’s all. I didn’t document that I put them on a ketogenic diet. I just wrote, “We discussed nutrition,” and didn’t go into specifics. I was worried that someone would say, “You put this person on a dangerous diet.” You shouldn’t be in that position. You shouldn’t be forced to feel like that. You can prescribe a drug, a new drug that just got on the market six months ago, willy-nilly, and there’s no 30-year follow-up. And they’re like, “Where’s the 30-year follow-up on these carnivore patients?” I mean, where’s your 30-year follow-up on the drug you just prescribed? It’s not there.

Dr. Eric Westman: That’s the accepted paradigm, we just give drugs for things.

I’m not sure that doctors are the best target either. I think the YouTube and grassroots movement folks can learn, like you said, on their own what to eat. The resolution of problems that doctors can’t fix often happens fast.

What is the strategy

So, the issue is, how do we get people off the fence to try something like this? What’s your strategy to say, “You should consider it, and here’s how you give it a try”?

Dr. Shawn Baker: That obviously depends on how much time you have to offer these folks. People have reservations. What are the objections to this? If you can reasonably assure them that trying something for a month, or better yet, 90 days, is very unlikely to cause severe unintended consequences, that helps.

When you take medically fragile people who are on all kinds of medications and they’re trying to do the right thing, maybe fixing their lifestyle, that’s where a company like Revero or another similar company can help. They can walk them through the process and taper their meds appropriately because coming off medications can be dicey for some people. It can precipitate problems. That’s something that needs to be managed carefully.

One of the things a lot of patients experience is they get diagnosed with a chronic disease, whatever it might be, diabetes, lupus, or something else and they ask the doctor, “Why me? Why did this happen?” The doctor usually gives them a very unsatisfying answer: “Bad luck. Genetics. We don’t know.” That’s really unsatisfying for a patient. Then they ask, “What can I do about it?” The answer is usually, “You’re going to have to take this drug for the rest of your life.” Now they don’t know why it’s happening, and the only way they can manage it is by depending on someone else. They have to depend on the doctor writing the prescription, the pharmacy fulfilling it, having the money to pay for it, and so on. Now, they become dependent and disempowered. They’re really disempowered in this whole situation.

When you turn it around and say, “We think it’s probably because your lifestyle hasn’t been where it needs to be. Maybe the poor choice of food you’ve eaten for 20 years hasn’t been that good for you. We can cut that out,” then things start to change. You can, and there’s something you can do about it. That’s empowering to people. I think a lot of people want to take control of their health, they just don’t know what to do. We outsource our brains and thinking to our doctors. When you go to a doctor, it’s not necessarily to get healthier. You go to the doctor to mitigate disease and sickness. To get healthier, doctors aren’t the best place to go in many ways.

Dr. Eric Westman: At least non-surgeons. There was an orthopedic surgeon in Sydney who told me that he calculated, on the back of a napkin, that a third of his patients no longer needed knee replacements when he set up a low-carb practice. That’s tall knowledge. That inflammation reduction is affecting all other parts of the body as well.

Again, I think the carnivore diet, as an elimination diet for all these possible offenders, rang true with a recent patient I saw. For seven years, she had such bad iron deficiency that she finally needed IV iron because the pills didn’t work. She went to academic clinics and all these specialists, but no one ever did the perfect test to look for gluten and H. pylori in the small intestine. They scoped her, but you can’t quite see where the gluten is. The blood test was negative. So, she did carnivore and miraculously got better in a matter of weeks because she cut out the gluten that was causing this problem, which the medical world had a hard time diagnosing. I’m sure you see this over and over.

A medical tool

People can stumble upon fixing their gluten neuropathy by doing carnivore or removing the dietary preservative that’s causing their migraines or other issues. It’s really a remarkable medical tool.

Dr. Shawn Baker: From the elimination phase, it really is the ultimate elimination diet. You’re coming down to maybe one food, for some people who want to do this, just a ruminant meat diet. If there’s a nutritional problem, an irritant, or something that you’re reacting to, you can solve that problem. When you go on, say, a low-FODMAP diet, there are still a lot of variables.

Remember that old game, Clue? You had Colonel Mustard in the library with a candlestick. There were four or five characters, and it took an hour to play through the game. If you only had one character, in one room, with one weapon, you’d figure it out real quick. It’s like, “Okay, it’s Colonel Mustard with the candlestick in the library,” because that’s all that’s there! So, it’s a nice, easy way to simplify the problem and expedite the process. A lot of people say, “It must be dairy!” and they eliminate dairy. Maybe it was three things. Other things, too, and you never took those out.

Nutrition can impact every disease

In that sense, I believe that nutrition impacts every single disease. Whether it’s acute, chronic, or genetic, I see nutrition playing a role in all this stuff. Even in surgical patients who need surgery, nutrition before and after is still incredibly important.

As I was telling you, a lot of people were avoiding knee replacements with ketogenic diets. For the patients I had in the hospital, I would put them on the diet, and their recovery was so much better. They were like, “You know what, Doc? The knee doesn’t really hurt. I don’t have that much inflammation. I don’t have much swelling.”

Dr. Eric Westman: I hear that, too, from my orthopedic surgeon colleagues who do a lot of referrals to me before surgery and that’s great.

Thanks for taking the time to talk through that. Sometimes we get these boogeyman impressions or lampooning of folks when in reality, most of us have gone through either our own personal journey or a scientific background to get to this point. We want to help people, and that’s really why we got into this space. That rings so true with your story, and I’m so grateful that you’re continuing to do it. May we all be able to continue to do it and also make a living.

Some people think that it should all be free and that if you’re writing a book, you’ve “sold out” or something. I didn’t write a book until Walter Willett at Harvard wrote a book. I thought, “Well, if he can write a book, then maybe I, a Duke guy, can write a book, and I won’t lose total credibility.”

Any final thoughts on what you would like someone to do in real-time? Where to find you and what you’re doing?

Where to find Dr. Shawn Baker

Dr. Shawn Baker: I just think there is so much you can do about your own health. Don’t outsource it to other people. Empower yourself. Educate yourself.

If you need some assistance, obviously, our company, Revero, is what we do. We help people who need medical support with issues like metabolic disease, autoimmune disease, inflammatory disease, obesity, diabetes, and on and on. I’m all over social media. My social media is kind of goofy because I play around a lot. I do some goofy stuff, but it’s more to drive engagement so that people can get to the real message I have. All the goofy stuff is just, like I said, trying to get enough attention so that people see you and actually come to listen to what you have to say for real.

I’m at Revero.com for the company.

I’m Shawn Baker MD on YouTube and Facebook.

My Instagram is ShawnBaker1967.

I am also on X – Baker MD, which is the one I started with, the very first one I had. I haven’t changed that name. Thank you so much for having me on. Keep up the great work you’re doing. I think we’re making a difference. I really do. Compared to where it was. You can talk about what it was like 20-some years ago but it’s changed tremendously. We’re clearly making a difference in a lot of people’s lives for the better. Despite all the mudslinging and the criticism, we’ve just got to keep going forward.

Dr. Eric Westman: Thanks again.

You can watch the video here.