Introduction
Dr. Eric Westman: It’s my pleasure to have Bart Kay today.
Prof. Bart Kay: Thank you very much. It’s an absolute privilege and a pleasure to be here. I’ve been looking forward to it for a long, long time, doctor.
Dr. Eric Westman: My pleasure. What is your background? How did you get into this area?
Prof. Bart Kay: In a former life before I saw the light, I was a professor of health science for just over two decades in total. Not all of that time at the professorial level, it’s something that you aspire to and get to at some point. I was one of these characters that was swimming against the current for the entire time I was there because I had the temerity to suggest to people crazy things like the exact requirement for carbohydrates on a daily basis for a human being is not one single gram ever. The same goes for fiber etcetera. These crazy things that I was saying to paying students that I was not prepared to stand up and tell lies to. My life in academia was not as easy as it might have been had I been someone who was prepared to just sing with the rest of the choir.
A few years back I decided better of that and left that world behind for all time. I was at a loose end and so a friend of mine suggested to me, why don’t you become one of these online YouTube influencers? I didn’t know there was a way you could even do that, do people make a living doing that? It turns out I was right that you can’t make a living doing that unless you’re one of these people who has millions of followers. Most of us mere mortals are not in that echelon. Nonetheless, here I am still telling the truth, still educating the general public these days about metabolic health, nutritional requirements and the falsehoods that have been fed to us quite literally for a generation. That’s what I do.
When I’m not doing that, I decided late last year that I was finally going to do it. I was going to buy a farm, a smallish farm. It’s about just over 40 acres. We’re running a number of heads of cattle and a number of heads of sheep and the rest of the animals as well, not just heads, bodies and legs too! This is in the Tasman district of New Zealand, which is near the top of the South Island. The nearest city is Nelson. For those who are interested as to where all that is. It’s a beautiful part of the world. But as we know, nature does have a dark side and last week we got flash flooded. Six months into my career as a farmer, I’m now chasing my tail having to clean up. It’s one of these hundred year floods, they say, that seem to be happening every other year. We’ve had a huge swathe, probably about a third of my land was submerged for the best part of a week under a torrent of water that moved through at a rate you couldn’t keep up with, running alongside whole trees and things going through there. It’s gouged out a swathe through the middle of my land that’s probably 12 feet deep and the best part of 40 yards wide. There’s a lot to do. Fences have been ripped out and trees have been deposited and we’ve got about two feet of silt. Anyway, that’s me in a nutshell.
Dr. Eric Westman: Patients of mine would say, you’ve got to watch and listen to Bart Kay. Finally, I started watching a lot of your things and I do like your approach to things. I was just trying to think where you’re teaching in New Zealand and it seems to me, at least the PhD folks I know from New Zealand, are pretty straight about the truth. Were you teaching at a collegiate level?
Prof. Bart Kay: I was yes, that’s right. I was teaching both at collegiate and university level. It’s a mixture of the polytechnical and the pure academic institutions. Not just in New Zealand. I also taught in Australia, the UK, and I taught remotely in a US institution for a short period as well. I have been around, if you like, and I’ve seen the way that various different countries do it and slightly different approaches to it both in person and as I say in the US situation that was a remote posting. All the teaching I was doing was online, which was quite a thing too. It was a different approach to things.
Beginnings of Bart Kay’s YouTube Channel
Dr. Eric Westman: I’m sorry you’re having to go through this with your land. What’s on your mind these days? What we are wrestling with other than the typical people aren’t up to speed on what we know to be true about food. Where are you focusing on speaking now?
Prof. Bart Kay: My offerings on YouTube, kind of under review. I’m changing my ways a bit. They’re purely on an audience basis, on an algorithm basis. My approach hitherto has been to play this character, if you like, who’s the grumpy professor who has this whole “Who’s wrong on the internet?” approach where what I’ll do is I’ll put up someone’s video where they’re spouting the accepted dogma or some nonsensical rubbish and just carve it up point by point. I did that very abrasively, not in a professional way at all and I used very short words often. The reason for that was it was a hook for clicks to get some notoriety, to get an audience established. It worked really well. It got me off to a flying start on my YouTube channel but that very same thing that got me that start was also the thing that then became a handbrake for two reasons. One, because the algorithm started to punish that a bit and two because if you take that approach and you use that kind of language, you get a cult following but then people go, “Mm, I can’t actually promote this guy, I can’t suggest this guy to others.” I’ve had to rethink it and go okay, time to do something a bit different now that I’ve got your attention sort of thing. Perhaps now I can behave in a way that might be more expected of a former academic and just teach the stuff.
I’ve got my main channel where I have been doing all that kind of stuff and it’s got a reasonable cult following, as I’ve said. I’ve actually got another channel that I’ve had all along that’s all collar and tie or professorial. Nobody watches it. If you’re the sort of person that really enjoys just the facts, just the education, none of the abrasiveness, none of the short words and no references to next Tuesday, this is your opportunity folks. You see me on Dr. Eric Westman’s podcast, come and subscribe. See what you think.
Dr. Eric Westman: We started doing “react videos”, partly because I’m in a clinic four days a week. It’s hard for me to generate the content. It takes time and for people who get massive following, they have other producers do most of it. I’m still doing most with a small team. I try to be diplomatic. The people coming to me in the clinic for their own personal reassurance that it’s okay to do keto or low-carb or carnivore say, “I’m happy with your style. You’re so calm, you’re so diplomatic.” But that doesn’t get the clicks.
Prof. Bart Kay: We’re damned if we do and we’re damned if we don’t is what it comes down to. At the end of the day the facts remain unaffected by how I explain them, how Dr. Eric Westman explains them or how anybody else attempts to explain whatever they believe to be the facts. The facts remain.
Dealing With Common Concerns and Fallacies
Dr. Eric Westman: How do you explain keto to someone who is brand new to this world? When someone comes to me, I explain that you can take a pill, you can take a shot, you can have surgery for weight loss, or you can just do what people have done for 150 years – the Banting, low-carb, keto diet and your hunger will be gone. The food noise is gone in a day
Prof. Bart Kay: For me the approach is to first deal with the objections around, “Won’t this kill me? Won’t I get cancer? Won’t I get heart disease? Won’t I get scurvy?”, etcetera, and you say, “No, no, and no. You won’t.” A low carbohydrate approach is not scary.
Dr. Eric Westman: I’m not interrupting to be brash but I can’t guarantee that. I can’t guarantee that you won’t get into a car accident if you do a keto diet, even if it’s not related at all. How will those objections finally be put to rest?
Prof. Bary Kay: All we can do is keep correcting and pointing to the flaws, foibles, and the fallacies involved in the arguments that the antithetical folks are putting forward. The folks who suggest that it’s more likely on a low-carbohydrate diet that you’re going to get heart disease because of all that fat. All we need to do is point to the absolute fallacy of suggesting that an associative data set of any size is able to inform on causality in any way shape or form. It’s actually the first thing you learn in your first half an hour of your first undergraduate degree if you went to anything like a decent school. The first thing that they teach you is that a lot of things are associated with a lot of things. For example, the sale of ice creams and the incidence of sunburn. Those things are highly correlated. We’re dealing with the sunburn scourge by banning ice cream… no. Drowning and swimming pools are highly associated with the release of movie star Nicolas Cage. Does that mean we should ban Nicolas Cage movies? I think we should, Eric! But it’s not because it’s got anything to do with swimming pools. Maybe it does!
Dr. Eric Westman: You’re reminding me of the little red book called Lies, Damned Lies and Statistics. Association does not prove causation. That should not be believed by the intelligent public that we are supposed to have by now. All people would be educated and then we have a great common good.
Prof. Bart Kay: They have this area which is referred to as an area of science. It’s actually an area of not only pseudoscience but it’s actually an area of anti-science. It’s called nutritional or health-based epidemiology which I’ve always referred to on my channel as edibility doodly middly moodly ology. Just to make out how ridiculous this stuff is. One of the things that I used to teach and one of the things that I’m absolutely a bona fide expert in is statistical inference and pure and applied statistics. I understand what’s being done here pretty well. What we’re doing in epidemiology is we’re told we’re looking at the association between incident disease in a population and some factor, the intake of that saturated fat, for example. The reality is in epidemiology number one, the intake of fat is not in fact measured at all in these studies. Why not? Because these studies are of millions of people over many, many decades. No, they are not measuring the intake of saturated fat in these people. What they’re doing is once every five years or so, they’re asking these people to fill in a survey about what they’re eating and they’re believing what people tell them in the survey.
Eric, could you tell me, please, what you had for breakfast last Tuesday?
Dr. Eric Westman: Well, that’s easy: nothing.
Prof. Bart Kay: Alright, but the average person is going to say, “Gee, I don’t know.” So how are they expected to be accurate about what they’ve eaten for the last five years? Even if they’re of a mind to be honest.
Dr. Eric Westman: Nutritional epidemiology is flawed in so many ways.
Prof. Bart Kay: Well, I’m not done yet. Number one, we’re not measuring fat. We’re believing what people say they ate over a lifetime. Then we’re looking at the incidence of disease, say heart disease or cancer or whatever it is. Are we? No. We’re not. Because what we’re doing is we’re taking the incidence rates that are actually recorded in the medical records of folks and we’re getting a number for that and then what we’re doing is we’re screwing that number up and we’re throwing it over our shoulder in the ash can and we’re adjusting that incidence to something else on the basis of a procedure called multiple linear regression.
What’s multiple linear regression? What that is is it’s saying okay, the association between X and Y is aligned with an intercept and a slope and an error and there’s a mathematical sum that we describe that with which says, pretty much X is related to Y according to this mathematical sum here with an error which is wider or narrower as the case may be. That’s what’s called a single variant regression, X versus Y. Sunburn versus the sale of ice creams. Then what we’re going to do is say, “Ah yes, but if you’re older, you’re more likely to get sunburn after you eat ice cream. So we’re going to take people’s age and we’re going to X that out of there. And socioeconomic status has an impact on sunburn. So we’re going to X that out of there.” (Whatever “socioeconomic status” is, by the way). And what we’re going to do is instead of having Y equals X plus intercept plus error, we’re going to say Y equals X1 minus X2 minus X3 minus X4 minus X5. All multiple single variant regressions stacked on top of each other mathematically, each one with an error. Not one of them is able to inform on causality because, remember, in the first half hour of your first undergraduate degree? So what we’re actually reporting in that epidemiological study is not even the incidence that occurred. There was some fantasy.
Example, the health study number two done by the fine folks at Loma Linda (University) a few years back where they said there are five groups of people, four quartiles of meat consumption and a different group who are vegans. They said the vegans had the lowest incidence of death, the lowest incidence of diseases of every kind that you can name. Veganism’s great, they said. Look, this is the proof. Until you look at the raw data, the actual incidence of disease and death. The actual raw data that that study showed was that the lowest incidence of death overall and the lowest incidence of death from all of each individual of the major causes was the lowest in the group of people who ate the most meat. Followed by the third quartile, the second quartile and the first quartile of meat. The highest incidence of death from every single one of those sub causes was in the vegans. And they adjusted the data set so hard that they turned the thing 180 degrees around on its face. They lied. They outright lied to suit their theology.
Dr. Eric Westman: You see what you want to see. Still today people come in talking about the China study. I want to shudder. I’m afraid these documentary films perpetuate some of the old nutritional epidemiology stuff.
I met a couple times with the nutritional epidemiology group at Harvard and I explained that in the evidence-based medicine world we say if there’s not a relative risk or hazard ratio of 2:1 then we don’t really know if this is clinically relevant. Dr. Willett looked at me and said, “We can’t find things that are powerfully associated,” and I said, “Then that’s not good enough.” He kind of looked at me because he created the field of nutritional epidemiology as the textbook, and what professor wants to be told that their life’s work should be thrown into the trash bin?
The McMaster group has the PURE study. They’re finding nutritional epidemiology findings that actually sugar is bad and saturated fat is fine and yet it’s still fraught with the measurement error and all that. It was reassuring to me. I looked to McMaster as one of the evidence-based medicine meccas of the world and yet they do clinical trials which can be flawed. Andrew Mente started coming to meetings saying, “Actually, we see sugar is bad in our nutritional epidemiology.” I’m like wait a sec. Maybe nutritional epidemiology isn’t so bad, because while they were finding things that I thought were probably true based on the other information that we developed. I’m not using that information to help deliver advice to my patients. It’s just not solid enough. You can talk about it and write books about this but it’s not clinically important to me.
Prof. Bart Kay: Exactly. Before we finish on the adjustment of data sets thing, the other thing that you learn in your first half an hour of learning about the statistics and how these multivariate regressions are done is that any statistical equation that you throw at any data set has assumptions. Any violation of those assumptions renders your ability to make conclusions on the basis of your statistical analysis tenuous at best. Outright invalid is actually the term you should use.
The first assumption of a multivariate regression is that your factors that you plug into the sum have no collinearity. They’re independent. The first thing that they do every single time in a health-based data set is they adjust outcomes for age. If you, for example, smoke cigarettes, is it true that the longer you smoke cigarettes the more likely it is that a health concern based on your cigarette smoking is going to rear its ugly head? Yes. Is it also true that the older you get the more likely it is that you are going to suffer a health concern of some kind? Yes it is. We’re done. So if you say you eat red meat for 20 years you’re more likely to have a disease but we’ll take age out of it. No. You can’t get eggs out of a fully baked cake. Neither can you X the age collinearity. That’s why the first assumption is there is no collinearity. As soon as you adjust for age, we’re done. Invalid data set.
Dr. Eric Westman: I try to teach and have my trainees and patients say it back to me that association does not mean causation. Cholesterol is not a disease. I finally saw Dr. Chris Knobbe give a talk and it was over at the Public Health Collaboration in London. I have to say I was really impressed with the new science by young young doctors and researchers who are not worried about fat in the food. There’s a whole new research wave. What’s interesting is it’s disruptive because people are either funding it themselves or it’s rich people funding it. It’s not coming from the top down. Dr. Knobbe is a retired ophthalmologist. He said seed oil consumption, diabetes, and obesity have gone up at similar rates so it’s from the seed oils. He even went further to say that because carbohydrate isn’t going up, it’s staying the same, and even though seed oil is going up as is diabetes, it must be seed oils. He never really said whether it’s correlation or not; he could have said that but he didn’t and the implication is that seed oils are the problem.
Afterwards, I got to talk to him and I tried to explain that, like you said, the sun isn’t changing; it’s constant and you can get more sunburn and more disease. You can actually have carbohydrate be the cause of atherosclerosis even though it’s not going up because there’s a finite area in an artery. If it’s causing the disease, it’s at a rate that it’s causing it. It doesn’t have to be going up to be the causative agent. He just couldn’t see that. This goes to basic logic and pathophysiology. Just because sugar isn’t going up, that doesn’t mean it’s not causing the disease. He even told me, “I don’t get money from this, Eric.” I said that’s fine but you get to travel around and talk about it and think, man! You can’t say it’s not carbs by saying that carbs aren’t going up yet diabetes is going up so it can’t be the carbs.
Prof. Bart Kay: What I can humbly suggest is that both cardiovascular pathophysiology and also the pathology of type two diabetes are both areas of absolute expertise of mine and we can absolutely talk about either one of those, if you like.
Dr. Eric Westman: We don’t measure seed oils when it comes to diabetes. We measure glucose.
Prof. Bart Kay: Let’s be clear about type two diabetes. Type two diabetes is chronically elevated blood glucose and it’s nothing else. That’s how it’s diagnosed.
Dr. Eric Westman: It’s been put into a different framework by drug companies. Even a patient coming to me now will say, “I’m not making enough insulin. That’s type two diabetes.” No, no, no.
Prof. Bart Kay: You’re insulin resistant. The phenomenon that the medical fraternity, the allopathic fraternity, talks about as “insulin resistance” and most of academia as well, number one they’re couching this thing as some kind of pathology. That is the etiology, the underlying explanation for diabetes. False.
Dr. Eric Westman: And then people are told that that can be fixed with a drug.
Prof. Bart Kay: Exactly. The phenomenon that they call insulin resistance and the thing that they just let everybody assume and indeed outright state is a pathology and the cause of the diabetes in the first place. No. That thing is the result of the functioning of the Randle cycle, which is encoded for by our genes, our genes being the peak of evolution to this point. Our genes know exactly what they’re doing to protect themselves from the damage of too much glucose inside those cells. This is not a pathology that explains diabetes. This is a symptom of diabetes—too much blood sugar.
Dr. Eric Westman: And that’s from too many carbs.
Prof. Bart Kay: Crazy talk, Eric. Crazy talk!
Misunderstandings Around Type Two Diabetes
Dr. Eric Westman: In talking to Gary Taubes, who writes books on this, I really admire his tenacity for staying on this topic. As a science writer and investigative journalist he could have done anything with his life. His book, Rethinking Diabetes, really hammered home that the idea of lowering the blood glucose with insulin was part of the practice pattern before you could measure insulin in the blood. By the 1960s when you could have the radio immunoassay and insulin was measured, it was already high. In people with type two diabetes, insulin was already high and Gary steps back in the book and says it in a way that I couldn’t. He basically said this is a violation of endocrinology principles. That if the insulin’s high, you lower it. You don’t give more of it. If the hormone is low, you give more of it; if it’s high you lower it. Giving insulin to someone who’s type two is violating endocrinology. It’s because we were giving insulin to people whether they were type one or type two and then came up with the idea of “insulin resistance” to explain, “Gosh, the insulin’s already high, why would they have a high glucose level? They must be resistant.”
In that paper they outline the things that seem logical. You would want to cut carbs out of the diet because the insulin’s high and you want to lower the insulin level. Yet I’m afraid no clinical people read the paper.
Prof. Bart Kay: I think you’ve already identified the problem, Eric. You can’t make money by telling people to stop pouring carbohydrates down their neck.
Dr. Eric Westman: I went out to learn from other doctors in the obesity world and there’s a method in our insurance pay system to actually do coding. I’m not sitting back seeing one person a day; I’m not as busy as a GP or primary care doctor, but there are ways to make money in an insurance system where we get paid fine salaries. I’m a medical doctor and most of my colleagues in the obesity world are in their own private practice, swiping credit cards and doing cash pay.
Companies that will flourish, I think, in the future, if this catches hold, are the device companies. If you can wear a device that shows you your blood glucose or even the ketones. The companies that sell food want you to eat more food. I don’t think they’re gonna want you to eat fewer burgers. I’m pretty confident that McDonald’s isn’t gonna say, “Hey, try our keto burger and you’ll eat less of them.” They could charge more for it to make as much money!
Issues With The Credibility of Science
Dr. Eric Westman: What are some solutions? I’m an optimist. I think that science will eventually come out. If you’re able to do all studies and if there’s equal funding for all studies (that’s the problem), science will eventually right itself and validate this. Do you still believe that?
Prof. Bart Kay: I too am an optimist but my optimism comes from my hope that I can get my message to more people who will appreciate that there is an absolute undeniable truth in what I say, despite maybe not liking the way I used to say it.
The fact about science is that science is a rigorous, disciplined, rule-based epistemology – a way of knowing things. What is coming out in recent generations is anything but actual science. The whole industry, especially health science, is absolutely rotten and filthy to its core. I’ve been in there myself for twenty something years until I gave up a few years ago. I’ve seen the thing from the inside from the coal face and I can assure your viewers, Eric, that there is no value in anything anyone’s doing in that industry. The truth always comes out but it’s not going to come out through peer-reviewed published works because they have all been bastardized by the almighty dollar. It’s as simple as that. What we all need to do now, folks, is turn our backs on that nonsense and stop deifying “science”.
The allopathic physician that is deified needs to stop. These people are human beings with flaws, faults, and foibles. In fact, I’m sorry to say – present company absolutely excepted, Eric – most doctors are trained monkey grinders. Not only do they not think, they are actually not allowed to think.
Any doctor that is practicing in many countries that steps out of line and says anything that’s not accepted by the fine folks at Big Pharma is going to find themselves struck off the medical register and hauled up in front of some arbitration. Look at what happened to Professor Tim Noakes, for goodness sake.
Dr. Eric Westman: That was a long time ago.
Prof. Bart Kay: It really wasn’t though, was it?
Dr. Eric Westman: The same happened with Gary Fettke.
Prof. Bart Kay: Yes, Gary Fettke. He got crucified, didn’t he?
Dr. Eric Westman: I was taught in the US and we have a tort-based system where someone has to prove that you’ve harmed them and in those cases there was no proof of harm. It was all professional standards boards. We then could sue back for damages, but that fear is there. I would have to say that most doctors are afraid of being outside the box. Diet is one of those things where they feel constrained. I teach my patients to just say that they’re doing a Mediterranean diet to their doctor, because most doctors think that’s great!
Prof. Bart Kay: Again, sorry to be a little bit controversial, but one of my things that I always say is that an allopathically trained physician has no business talking to people about their diet.
Dr. Eric Westman: Great point.
Prof. Bart Kay: Because if they’re trained as an allopathic physician, they don’t have any training in nutrition. I don’t mind anybody saying stuff about nutrition that is correct and demonstrably correct and valid and of utility to people, but especially in the American culture, it seems a physician can stand up and talk on any topic and everybody just goes, “Oh, doctor said.”
Dr. Eric Westman: I know. I review videos from these influencers who are massively popular and some are really young. They don’t have the gray hair of being told by their patients that what you told them was wrong. That’s always a great learning experience. You develop a rapport with a group of people, and they’ll come back and tell you, “No, you were wrong on that one.” I’ve learned to be quite respectful of what people learn, especially if it’s their own body. Allopathically trained doctors are trained in drugs.
Prof. Bart Kay: Drugs, surgery or some combination of those two, not preventative, not nutrition, not lifestyle. That’s not their training. I’ve said to people that another thing about nutrition, a subject about which I have a number of peer-reviewed publications as first author, and the person I’m speaking to turns around and says, “But you’re not a doctor, are you?”
Dr. Eric Westman: Well, you have a PhD – you’re a doctor.
Prof. Bart Kay: I actually have three advanced research degrees, mainly because I couldn’t stay on course for a whole career and indeed, I had to get out of that career altogether because I’d changed three times and still wasn’t happy! The first one was actually the physiology of rest and exercise. Then I did human nutrition for a few years and then I did cardiovascular pathophysiology. I’ve got three advanced research degrees and yet people will turn around and say, yeah, but you’re not a doctor. Well, actually, I’m Dr. Dr. Dr., if you like! But I’m not a physician, ergo I don’t know anything.
The other thing is I was once told by a very, very young man, a very misguided, sad young man, who happens to be a vegan and a very popular influencer online, for some reason, is that I wasn’t worth listening to and he knew more about everything than me because he could bench press more than me!
Dr. Eric Westman: There’s a delicious irony that’s happening. The heart doctors in the cardiologist field have been the most anti-fat. They, especially in certain pockets of organizations – the American Heart Association, for example – have come up with a drug that allows the urine to leak sugar – the SGLT2 inhibitors. The problem with that is bacteria and fungus and yeast like the sugar, too. Some people get infections down below and and die from it, but they have fewer heart failure events! It’s all the rage now to prescribe these SGLT2 inhibitors because of the randomized trials. Of course, you have to have a lot of thousands of people to show a very small absolute risk reduction. They’re all using it because what else do we have? It’s now being worked out that the drugs work because they cause ketosis. They’re giving SGLT2 inhibitors, but they also cause ketoacidosis and bump a few people off and have hospitalization, but that’s okay. People have fewer heart failure events!
Now, even locally, there are doctors being funded to give ketones either IV or by drink, in a research setting to look at the heart function, to see why ketones help the heart muscle and heart failure. The cardiology world is learning about ketones—not through keto diets, because there’s this big blinder where you can’t tell people to eat fat, can you? Now I have to explain that actually, on a diet, you can actually induce endogenous ketosis.
Steve Phinney and Jeff Volek, I believe, are still funded to do a keto diet heart failure study. That’s actually being funded and when that’s out, maybe other doctors will wake up to the idea that you could get that drug, the SGLT2 inhibitor effect, by just changing the food. Of course, they’ll say, “Where is the clinical trial of heart failure reversal?” And then we say, well, you also have the side effects of those drugs. I thought that was a delicious irony or twist that the allopathic doctor learns about ketosis from a drug that causes ketosis.
No Money To Be Made From Keto
Prof. Bart Kay: Yes. But the real problem of telling someone that they can get the same effect by changing their diet is, how do you monetize that?
Dr. Eric Westman: This is why it’s been a grassroots change. It’s not top down. But there are enough people who listen and learn about critical thinking and even statistics. It’s great to know the background of people like you because I find that, typically, even though the persona online might be extreme, it comes from a solid base. In Europe I just met Anthony Chaffee, for example. Talk about being super smart and a rugby player in the UK. He’s been a leader in the carnivore movement. I passively stick up for carnivore on my YouTube channel and I’m hearing stories of resolution of issues that I’m teaching a carnivore course that’s opening in August. This year, for the first time, at Adapt Your Life Academy, we’ll be talking about the carnivore diet.
Prof. Bart Kay: Are you actually going to come fully to the dark side, Eric? Join me. I will complete your training.
Dr. Eric Westman: It really is just: Just eat meat. But you can’t sell that. We are going to have our first carnivore course and part of our course is we get people in a Facebook group and help overcome some of those barriers of starting it and following it. I learned that in a residential treatment program here in Durham. I worked for a small period of time in a place where people came from all over the world. We weren’t using a keto diet, but all you had to do is not have them eat junk elsewhere. I would say I’m flirting with the dark side.
Prof. Bart Kay: Good, good, good, let it flow through you!
Thoughts on the Carnivore Diet
Dr. Eric Westman: What’s your take on carnivore?
Prof. Bart Kay: The thing about me is that the way I’ve behaved, the way I’ve performed, the character I’ve played, the abrasiveness, the sweariness, all of that, as part of that and also as part of swimming against the current for 20 something years in academia, what I do is I make sure that what I say is absolutely unassailable before I say it. I don’t say, “Last month, folks, I was telling you to eat this way, I was wrong. I’m brave for telling you that I was wrong and aren’t I so open-minded?” No. My message has been absolutely rock solid from the beginning, from the start. The absolutely appropriate species specific diet for a human being is 100% carnivore. Always has been, always will be.
Dr. Eric Westman: I just participated in a study at Duke – the results aren’t out – on this subject. I gave my fingernail and a little hair. They’re actually going to be looking at radioisotopes in the hair and the nails across a different dietary pattern. This is an anthropological group. The idea is then to take fossil samples of hair and see if you can really figure out what they ate back then because they were probably all doing a vegan diet, right?
Prof. Bart Kay: Well, there’s already nitrogen isotope testing studies available on human skeletal remains of everything up to 110,000 years old, which still have viable collagen in the long bones, and the results on that are in, and all human beings that they’ve ever tested of any skeletons over about 12,000 years old – i.e., pre-agrarian revolution – every single one of them comes back with the same number within about 5%. Humans frequently did eat 80% of their so-called calories in the form of animal products. The other 20% was fibrous tubers.
Dr. Eric Westman: It makes sense that they’re redoing what studies have probably already been done with modern technology or just because it’s fundable.
Prof. Bart Kay: The nitrogen isotope testing is a slam dunk. There’s no two ways about it because it tells us exactly what the trophic level of that animal was.
Dr. Eric Westman: I’ve been trying to stay away from that because I want human clinical trials to the day. I would still love to see a randomized trial of a carnivore diet versus whatever.
Prof. Bart Kay: Good luck getting it through ethics.
Dr. Eric Westman: I think we could.
Prof. Bart Kay: Here’s the thing though, Eric. Here’s the thing. If you want to talk about long-term health outcomes, hard health outcomes in human beings, you have to lock them in labs for decades. Science is a disciplined epistemology, a way of knowing things that requires you to follow certain rules. If you want to say cause, effect, or risk, you have to do an experimental interventional trial. If you want to talk about long-term health outcomes over multiple decades in human beings, then your subjects must be human beings and they must be under lock and key for observation and control.
Dr. Eric Westman: There’s a practicality.
Prof. Bart Kay: Exactly. It can’t be done. That’s what I mean by good luck getting it through ethics. Because if you’re going to do decent science, you have to do decent science, otherwise don’t bother.
Dr. Eric Westman: Okay, I agree and I disagree. You can start the clock now and follow people over time – we measure ketones, we do the food frequency questionnaire like the nutrition epidemiologists. I find in my clinic, the weight is a pretty good marker of adherence, as they’re losing weight. There are times where you can validate what someone’s eating in different ways. The reason I say it’s important to say this can be studied – although it may take time and money – to me, it’s the last vestige of the person who is not a scientist to say, well, you couldn’t study it, because then it’s just religion. If you’re saying that it would be difficult to study, I agree, but I think it could be done.
Prof. Bart Kay: What I’m saying, Eric, let me be very clear: once again, yes, you can do studies, you can look into things, you can make inferences of whatever quality. What you can’t do, what you absolutely can’t do, is talk about cause, effect or risk, because you have not done the experimental study because ethics won’t allow it.
Dr. Eric Westman: But if you had an alien come from another planet, you would study it. You wouldn’t say, oh, it’s not experimental.
Prof. Bart Kay: There’s a difference between studying something, looking at something, considering something, making inferences about something and doing the science that can tell us cause, effect and risk. What I’m saying is what we need to do is lose those words from our lexicon when we’re talking to people about health because we do not have the science to underpin that. It’s ill-disciplined to suggest that we do. It does not exist. Still.
Dr. Eric Westman: To summarize, don’t look to the powers that be, the authority, the research, the doctor who is allopathically trained for the answers. We can measure our own bodies and find data and how we feel outcomes.
Statistics matter and nutritional epidemiology as a field is not a great source of even hypothesis-generating information, although that’s where I put it. It’s not hypothesis-testing; it’s hypothesis generating at best. And yet, that’s where the governments have asked for advice from.
Prof. Bart Kay: That that does make sense, though, because at the end of the day, what the government generally is doing is holding the purse strings, and if they can get some indication of population outcomes, then they’ve got some idea of how to manipulate that population rather than how to look after it because is there anyone that thinks the government’s out there to look after us? No. That’s for another day, though.
I think where you’re getting to there, Eric, is that at the end of the day, the best arbiter, the best way for you to determine what is good, is to mess around and find out. Just give this thing a go, this low-carb or even better, fully carnivorous diet. Whatever your diet is now, do not hammer over and change your diet markedly overnight. That will mess you up. Don’t do that. Change your diet to where you want it to be slowly. Gradually. Your microbiome needs to adjust.
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Speaker Bios
Eric Westman, MD, MHS, is an Associate Professor of Medicine at Duke University, the Medical Director of Adapt Your Life Academy and the founder of the Duke Keto Medicine Clinic in Durham, North Carolina. He is board-certified in Internal Medicine and Obesity Medicine and has a master’s degree in clinical research. As a past President of the Obesity Medicine Association and a Fellow of the Obesity Society, Dr. Westman was named “Bariatrician of the Year” for his work in advancing the field of obesity medicine. He is a best-selling author of several books relating to ketogenic diets as well as co-author on over 100 peer-reviewed publications related to ketogenic diets, type 2 diabetes, obesity, smoking cessation, and more. He is an internationally recognized expert on the therapeutic use of dietary carbohydrate restriction and has helped thousands of people in his clinic and far beyond, by way of his famous “Page 4” food list.
Bart Kay
Retired academic Bart Kay spent decades working across 10 universities around the world, specialising in the fields of human nutrition, cardiovascular pathophysiology and exercise physiology. He has published a number of scientific papers and was a consultant to the famed New Zealand All Blacks rugby union team, the Australian Defence Force, the New Zealand Army and NRL referees’ association.
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