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Overview

• Thousands of people were asked about unexpected bodily changes after going carnivore, with answers ranging from humorous minor changes to improvements that raise questions about what people accept as normal.
• The recurring pattern is that many day-to-day problems can change substantially with diet, including secretions, pain, skin, dental health, and digestion.

Bodily secretions

• Many people have less earwax buildup, less eye gunk, and less body odor after going carnivore.
• The exact reason diet changes earwax or these other secretions is uncertain, while having less of them is generally a positive change.

Pain

• A lot of people have less overall pain, including less joint pain, nerve pain, neuropathy, musculoskeletal pain, and tendon pain.
• Achy joints at age 50 or 60 may not simply be normal aging; diet may play a major role, and scientific literature supports dietary effects here, particularly around hypoglycemia.

Skin

• Itching, dry skin, psoriasis, eczema, dandruff, acne, and general rashes often improve substantially on carnivore.
• What enters the gut can show up through the skin, and skin problems are clearly connected in many cases with gut function or gut dysfunction.

Dental health

• Teeth are built to last a lifetime, so widespread cavities, gum disease, tooth loss, bridges, implants, and partials point to a diet humans are not suited for.
• Carnivore commonly improves gum and dental health, including less gum swelling and tooth sensitivity, and some people have tooth remineralization; dental health became very solid on keto and then carnivore.

Digestion

• Digestive health is one of the biggest improvements: reflux, IBS, bloating, gas, and hiccups can diminish, and many people essentially stop farting.
• Hiccups can disappear; gut distension from high-fiber foods or sugary foods may contribute to hiccups, although the exact cause is hard to know.
• Digestion should be silent, painless, comfortable, and smooth. Persistent pain, discomfort, bloating, gas, and foul smells are signs that digestion is not working as it should.

Core budget approach

• The goal is the best health people can afford through the best-quality meat they can afford, not premium grass-finished ribeye.
• A carnivore diet can still work with very little beef when money is tight, and cheap animal foods are far better than the boxed junk foods they displace.
• Larger packs, discount supermarkets, basic home cutting and preparation, and judging every food by "compared to what?" reduce costs.

Lowest-cost staples

• Ground beef is the best option when affordable; the store example is $8.97 per pound, and larger five- or ten-pound packs reduce the unit price.
• Bone-in, skin-on chicken thighs cost $1.17 per pound, while a ten-pound bag of leg quarters costs $7.84; the bones can also make broth.
• Sixty ordinary eggs cost $7.13, about 12 cents each, and premium omega-3 or darker-yolk marketing makes only a slight practical difference.
• Family packs of pork chops cost $3.38 per pound, while pork shoulder steaks cost $1.95 and provide a steak-like daily meal at a small fraction of ribeye prices.

Organ meats and collagen-rich foods

• Chicken liver costs about $1.50-$1.60 per pound and is a superfood supplying concentrated vitamins and minerals.
• Chicken gizzards cost $1.36 for 20 ounces and supply abundant protein and collagen, while chicken skin supplies excellent collagen building blocks.
• Preparations that make liver and gizzards enjoyable keep taste and texture from excluding them.

Processed budget meats

• Five-pound bologna costs $1.93 per pound, 24 hot dogs cost $4.46, and store-brand luncheon meat costs $1.84 per can; these foods are mostly meat even though their ingredients are not perfect.
• These foods can fill the remaining appetite when eggs and liver provide the vitamins and minerals, and they are better choices than cereal and boxed snack foods.
• Luncheon meat does not cause cancer and is not bad food; it is simply less good than expensive grass-finished ribeye.
• Food quality is relative: an item can be inferior to premium beef while still functioning as health food compared with ultra-processed carbohydrate foods.

Canned fish and added fat

• Canned fish is the main useful food in the center aisles, and inexpensive cans priced around 19 cents per ounce are often placed below eye level.
• Tuna or other fish packed in water avoids cheap packaged olive oil that is likely adulterated with soybean or canola oil.
• Drained fish with mustard gains missing fat from egg yolks, saved pork grease, butter, or lard.
• Hydrogenated lard is not equivalent to hydrogenated vegetable oil and remains a suitable cooking fat at about 14 cents per ounce.

Butter, snacks, and products to avoid

• Plain store-brand butter at about 39 cents per ounce is preferable to premium butter at roughly 58-60 cents, because the nutritional difference is very small.
• Spreads combining butter with canola oil, margarine, vegetable-seed-oil products sold as plant butter, and other imitation butter products are avoided.
• Pork rinds cost about 73 cents per ounce and can add occasional crunch to tuna or other meals while staying within carnivore eating.
• Protein chips and protein popcorn are expensive junk foods with added whey, not meaningful substitutes for meat, eggs, or canned fish.

Practical conclusion

• Meat, eggs, fish, organ meats, and animal fats fit within a household budget.
• Cheap supermarket animal foods are health foods compared with the junk foods they replace.
• Food quality improves when finances allow, but the best possible use of available money still makes cheap carnivore beneficial for health.

References None.

The epidemic and the practice

• Roughly the same 10,000 people were cared for over 40 years, while type 2 diabetes increased about tenfold and began affecting people in their twenties as well as older adults.
• Since low-carbohydrate groups began in 2013, the team has reached 159 cases of drug-free type 2 diabetes remission; about half of the patients choose this approach, while the others receive approaches suited to them.
• David Unwin is a scientific adviser to Abbott on continuous glucose-monitor education and access, not on promoting drugs, and CGM is central to helping people understand their own food responses.
• Andrew began with an HbA1c of 81 mmol/mol, reached 51 with low-carbohydrate eating and CGM, and drifted more than once; he then achieved remission over about four years with 16% weight loss, while his cholesterol-to-HDL ratio fell from 15.

Why glycaemic control matters

• Each year with HbA1c above 58 mmol/mol costs about 100 days of life, so average control can mean losing roughly a third of life expectancy, with especially serious consequences when type 2 diabetes begins young. [1]
• Diabetes increases cardiovascular and stroke risk and is associated with eight forms of cancer; insulin resistance and hyperinsulinaemia connect diabetes with those cancers, making prevention important.
• Retinopathy, nephropathy, neuropathy, and microalbuminuria all rise as HbA1c worsens, and a 10% HbA1c improvement such as 65 to 54 is associated with a 45% lower risk of microvascular complications. [2]
• Remission matters because the goal is normal blood glucose without medication; average control is inadequate when better control can prevent cumulative damage.

Prevention and early remission

• In the 2020 prediabetes evaluation, none of 71 people choosing a low-carbohydrate approach developed type 2 diabetes over about 22 months, and 93% reached normal HbA1c. [3]
• Drug-free remission occurred in 77% of people who began within the first year of type 2 diabetes, compared with 51% after five years, so delay makes remission harder. [4]
• Chronological age is not the decisive issue: the oldest remission patient was about 92, and resolving poorly controlled diabetes relieved polyuria and made daily life at home easier.
• Metabolic age matters, and prevention or early action is easier, faster, and more practical than waiting for prolonged hyperglycaemia to damage metabolic function.

How type 2 diabetes develops

• HbA1c measures average blood sugar over about three months, but high glucose can damage the endothelial glycocalyx within hours, so glucose spikes and time in range matter as well as the average. [5]
• Insulin lowers blood glucose by moving glucose into cells; when excess carbohydrate is not used for energy, it becomes triglyceride and fat, particularly in the abdomen and liver.
• Liver fat drives insulin resistance and hyperinsulinaemia, while pancreatic fat reduces insulin production; this twin process can progress for years before glucose control finally breaks down. [6]
• Reducing carbohydrate and weight can improve insulin sensitivity and pancreatic function, but remission is the right word because old habits can bring diabetes back; bariatric surgery, GLP-1 drugs, and low-carbohydrate eating reduce intake by different routes.

Making carbohydrate visible

• Productive consultations turn a problem into a puzzle: the food causing the glucose rise is identified without blame or negativity, and collaborative work keeps patients engaged in finding their own solution.
• Starch is sugar in metabolic terms, so bread, rice, potatoes, pasta, cereal, fruit juice, and other starchy or sugary foods belong in explanations of glycaemic consequences.
• A 150 g serving of boiled rice has approximately the glycaemic effect of just over 10 teaspoons of sugar; brown rice improves it by about one third, while salad, courgettes, meat, fish, eggs, and full-fat dairy barely raise CGM glucose. [7]
• The entire five-litre bloodstream contains only about one teaspoon of glucose, while a banana can supply five or six teaspoons, making CGM feedback and teaspoon-of-sugar infographics immediately understandable.

Practice outcomes and cardiovascular risk

• In the 186-patient low-carbohydrate cohort followed for nearly three years, average weight fell 12%, HbA1c improved, triglycerides fell 35%, total cholesterol fell 12%, and the cholesterol-to-HDL ratio improved by 2%. [4]
• Blood pressure also improved despite substantial deprescribing of antihypertensive drugs, so the visible result understates the physiological improvement. [8]
• Every cardiovascular marker routinely measured in the British health service improved despite higher intake of eggs, butter, cheese, red meat, protein, and fats within the low-carbohydrate approach.
• OpenPrescribing data have kept Norwood Avenue the lowest-cost local practice for diabetes drugs, with an estimated cumulative saving of £373,000 against the local average, although the practice receives none of it to fund the service.

CGM, relapse, and maintenance

• A latte doubled David Unwin's glucose to 11 mmol/L and impaired his thinking; cereal with banana and raisins doubled it and then produced an insulin-driven low with hunger and agitation, while a low-carbohydrate meal left it flat.
• CGM should be used earlier, before people become ill enough to need insulin, because it rapidly reveals problem foods; the average time to drug-free remission is about eight weeks and is planned for a forthcoming paper.
• Dan has maintained remission for years after identifying bread, rice, and potatoes with one CGM; another patient achieved remission three times over ten years, and a patient whose HbA1c reached 120 brought it down after identifying biscuits.
• Relapse usually means the person has left the diet and needs help returning, not that the diet has failed; unexpected HbA1c and weight patterns can signal insulin deficiency, pancreatic cancer, or misclassified type 1 diabetes; monthly group consultations for 30 or more people provide affordable long-term support.

Ultra-processed food addiction

• Repeated regain was once called "carb creep," but ultra-processed food can be seriously addictive for many people, like alcohol or nicotine, and ignoring addiction allows long-term results to deteriorate.
• Moderation does not work for everyone with carbohydrate addiction: one biscuit becomes ten, and intelligent people continue eating foods they know damage their health.
• Yale Food Addiction Scale data show a strong association between food addiction and type 2 diabetes, with affected people 6.7 times more likely to have type 2 diabetes. [9]
• Food addiction is a promising target for preventing type 2 diabetes in younger people, and Jen's CRAVED tool offers a way to screen for it.

References

1. [13:04] Estimating life years lost to diabetes: outcomes from analysis of National Diabetes Audit and Office of National Statistics data — https://doi.org/10.1097/XCE.0000000000000210
2. [17:37] The relationship of glycemic exposure (HbA1c) to the risk of development and progression of retinopathy in the Diabetes Control and Complications Trial — https://doi.org/10.2337/diab.44.8.968
3. [18:05] Insights from a general practice service evaluation supporting a lower carbohydrate diet in patients with type 2 diabetes mellitus and prediabetes: a secondary analysis of routine clinic data including HbA1c, weight and prescribing over 6 years — https://doi.org/10.1136/bmjnph-2020-000072
4. [19:30] What predicts drug-free type 2 diabetes remission? Insights from an 8-year general practice service evaluation of a lower carbohydrate diet with weight loss — https://doi.org/10.1136/bmjnph-2022-000544
5. [21:31] Loss of endothelial glycocalyx during acute hyperglycemia coincides with endothelial dysfunction and coagulation activation in vivo — https://doi.org/10.2337/diabetes.55.02.06.db05-1103
6. [23:55] Type 2 diabetes: etiology and reversibility — https://doi.org/10.2337/dc12-1805
7. [29:18] It is the glycaemic response to, not the carbohydrate content of food that matters in diabetes and obesity: The glycaemic index revisited — https://doi.org/10.4102/jir.v1i1.8
8. [37:55] Substantial and Sustained Improvements in Blood Pressure, Weight and Lipid Profiles from a Carbohydrate Restricted Diet: An Observational Study of Insulin Resistant Patients in Primary Care — https://doi.org/10.3390/ijerph16152680
9. [49:16] Food addiction is strongly associated with type 2 diabetes — https://doi.org/10.1016/j.clnu.2023.03.014

Brain evolution and fuel

• Human cranial-capacity analyses found a reduction of about 10-17% from the Mesolithic to modern times, while domesticated pigs had brains about 18% smaller than wild boars.[1][2]
• Dementia and neurodegeneration are largely preventable consequences of chronic shortages of ketones, cholesterol, and animal nutrients together with exposure to sugar and seed oils.
• Human fasting studies found that rising ketone availability lowers cerebral glucose use and supplies a major share of brain energy.[3][4]
• The neonatal period depends heavily on ketone metabolism; germline loss of ketone oxidation causes fatal postnatal metabolic failure in mice.[5]
• Pregnancy accelerates fasting ketosis, and breast-fed infants generate more ketones than formula-fed infants.[6][7]

Animal nutrients and brain maintenance

• Cholesterol, saturated fat, B12, D3, vitamin A, choline, creatine, carnitine, and DHA supply structural and metabolic materials for myelin, synapses, membranes, and mitochondria.
• An 18-person Alzheimer pilot found cognition improved after six weeks off statins and declined after six weeks back on them.[8]
• Severe infant B12 deficiency causes developmental regression and MRI-visible cerebral atrophy.[9]
• Lower B12 markers within conventional ranges predict faster brain-volume loss over five years.[10]
• Low maternal B12 intake during pregnancy predicts poorer speech and mathematical performance through childhood.[11]
• Adolescents raised on macrobiotic diets can retain marginal B12 status and cognitive deficits after changing to omnivorous diets.[12]

Aging and dietary injury

• MRI comparisons found age-related cerebral shrinkage in humans but not across 99 chimpanzees.[13]
• Long-lived whales and wild animals on natural diets do not show the same age-related brain shrinkage, making chronic malnutrition a better explanation than normal aging.
• Fructose, excess linoleic acid, brain insulin resistance, glycation, vitamin D deficiency, and inadequate DHA, EPA, creatine, carnitine, and vitamin A converge on mitochondrial dysfunction and neuroinflammation.
• Porphyromonas gingivalis antigens were detected in most examined Alzheimer brains and in a high proportion of glioblastoma tissue cores.[14][15]

Ketogenic interventions

• A randomized childhood epilepsy trial found substantial seizure reduction with a ketogenic diet.[16]
• Alzheimer brains retain acetoacetate metabolism despite reduced glucose uptake, and a randomized ketogenic-diet trial found improvement in clinical outcomes.[17][18]
• Randomized ketogenic and Mediterranean diet studies both improved Parkinson symptoms, with greater nonmotor improvement in the ketogenic trial.[19][20]
• Early autism data and a Huntington case study link ketogenic diets with functional improvement.[21][22]
• A multiple-sclerosis case series with symptom improvement and MRI lesion shrinkage is being prepared for publication.

Genetic risk and prevention

• In a 15-year cohort of 2,157 older adults, high meat intake was associated with slower cognitive decline and lower dementia risk among APOE epsilon-4 carriers.[23]
• Genes modify susceptibility, but correcting brain fuel and nutrient supply can prevent or reduce the metabolic conditions that drive neurodegeneration.

References

1. [00:09] Decrease of Human Skull Size in the Holocene — https://digitalcommons.wayne.edu/humbiol/vol60/iss3/5
2. [00:21] How domestication, feralization and experience-dependent plasticity affect brain size variation in Sus scrofa — https://doi.org/10.1098/rsos.240951
3. [01:07] Generalized decrease in brain glucose metabolism during fasting in humans studied by PET — https://doi.org/10.1152/ajpendo.1989.256.6.E805
4. [01:24] Brain Metabolism during Fasting — https://doi.org/10.1172/JCI105650
5. [01:49] Obligate Role for Ketone Body Oxidation in Neonatal Metabolic Homeostasis — https://doi.org/10.1074/jbc.M110.192369
6. [02:04] "Accelerated starvation" and the skipped breakfast in late normal pregnancy — https://doi.org/10.1016/S0140-6736(82)91750-0
7. [02:55] Higher Serum Carnitine Levels and Ketogenesis in Breast Fed as Compared to Formula Fed Infants — https://doi.org/10.1203/00006450-197804001-00848
8. [04:51] The effect of HMG-CoA reductase inhibitors on cognition in patients with Alzheimer's dementia: a prospective withdrawal and rechallenge pilot study — https://doi.org/10.1016/j.amjopharm.2012.08.002
9. [06:29] Cerebral atrophy in 21 hypotonic infants with severe vitamin B12 deficiency — https://doi.org/10.1111/jpc.14733
10. [06:45] Vitamin B12 status and rate of brain volume loss in community-dwelling elderly — https://doi.org/10.1212/01.wnl.0000325581.26991.f2
11. [07:48] Maternal prenatal vitamin B12 intake is associated with speech development and mathematical abilities in childhood — https://doi.org/10.1016/j.nutres.2020.12.005
12. [08:18] Signs of impaired cognitive function in adolescents with marginal cobalamin status — https://doi.org/10.1093/ajcn/72.3.762
13. [08:50] Aging of the cerebral cortex differs between humans and chimpanzees — https://doi.org/10.1073/pnas.1016709108
14. [11:02] Porphyromonas gingivalis in Alzheimer's disease brains: Evidence for disease causation and treatment with small-molecule inhibitors — https://doi.org/10.1126/sciadv.aau3333
15. [11:22] Identification of gingipains in glioblastoma tumors and evidence that P. gingivalis infection drives IL-6 and PD-L1 expression in glioma cells — https://doi.org/10.1101/2025.11.13.686868
16. [12:20] The ketogenic diet for the treatment of childhood epilepsy: a randomised controlled trial — https://doi.org/10.1016/S1474-4422(08)70092-9
17. [12:34] Lower Brain 18F-Fluorodeoxyglucose Uptake But Normal 11C-Acetoacetate Metabolism in Mild Alzheimer's Disease Dementia — https://doi.org/10.3233/JAD-141074
18. [12:45] Randomized crossover trial of a modified ketogenic diet in Alzheimer's disease — https://doi.org/10.1186/s13195-021-00783-x
19. [12:55] Low-fat versus ketogenic diet in Parkinson's disease: A pilot randomized controlled trial — https://doi.org/10.1002/mds.27390
20. [13:07] The effects of Mediterranean diet on severity of disease and serum Total Antioxidant Capacity in patients with Parkinson's disease — https://doi.org/10.1080/1028415X.2020.1751509
21. [13:41] A modified ketogenic gluten-free diet with MCT improves behavior in children with autism spectrum disorder — https://doi.org/10.1016/j.physbeh.2018.02.006
22. [14:01] Time-Restricted Ketogenic Diet in Huntington's Disease: A Case Study — https://doi.org/10.3389/fnbeh.2022.931636
23. [14:56] Meat Consumption and Cognitive Health by APOE Genotype — https://doi.org/10.1001/jamanetworkopen.2026.6489

GPT-5.6 Thinking - high

Career Formation and Medical Culture

• Lily Johnston entered medicine after three years as a government science-and-technology analyst, where conclusions required evidence, uncertainty, missing information, and plausible failure modes.
• Medical training shifted that merit-based analytical culture toward hierarchy, credential protection, compressed visits, and strong penalties for challenging senior authority.
• Disconnected follows the loss of autonomy, identity fusion with work, burnout, and repeated discovery that the next career milestone did not restore meaning.
• Aviation-safety work and the Institute of Medicine's medical-error analysis show that unsafe systems persist when junior personnel cannot raise concerns freely. [1]

Why Vascular Surgery Was Not Enough

• Vascular surgery offers immediate technical problem-solving, but a bypass, stent, or amputation repairs one anatomical consequence while systemic atherosclerosis and metabolic disease continue.
• Recurrent diabetic foot infection and bilateral amputation risk in relatively young patients made a purely procedural career morally and professionally intolerable.
• A prevention practice therefore addresses nutrition, movement, sleep, stress, social connection, medications, supplements, and the patient's capacity to sustain change.

Metabolic Prevention and Lipids

• Johnston's low-carbohydrate transition began with a New England Journal of Medicine paper on intermittent fasting and expanded through low-carbohydrate clinical education. [3]
• Insulin resistance, diabetes, smoking, blood pressure, lipids, and other injuries all contribute to vascular disease; LDL is relevant but cannot absorb the entire cardiovascular conversation.
• Lipid-lowering therapy has its clearest role in established plaque and prior events, while early disease and initial prevention require imaging, risk-benefit analysis, and shared decisions.

Plaque Imaging and Measurement

• The KETO trial uses serial coronary CT angiography in metabolically healthy people with diet-induced hypercholesterolemia, but very low baseline plaque creates a measurement noise floor that limits confident year-to-year change estimates. [2]
• CT angiography is valuable for anatomical plaque detection, yet cardiac motion, scanner variation, segmentation drift, contrast exposure, radiation, and minimal detectable change limit longitudinal precision.
• Carotid and femoral ultrasound can detect early wall thickening and plaque without radiation, while PESA imaging demonstrates that subclinical atherosclerosis often spans several vascular territories. [4]
• Ultrasound quality depends heavily on acquisition protocol, operator reproducibility, probe placement, pressure, image selection, and separation of plaque burden from intima-media thickness.

Nutrition, Pregnancy, and Individual Response

• Carbohydrate restriction often improves insulin resistance and diabetes, but some people improve with a low-fat, higher-carbohydrate pattern; the useful diet is metabolically effective, nutritionally complete, sustainable, and compatible with the individual.
• Pregnancy is a data-poor area for ketogenic diets: no identified human study establishes harm or safety, and confident carbohydrate prescriptions exceed the available evidence.
• Maternal health remains central before, during, and after pregnancy because neglect of the mother's nutrition, sleep, blood pressure, and recovery undermines both mother and child.
• Dietary identity should never block adaptation when physiology, pregnancy, age, activity, disease, or response changes.

AI, Guidelines, and Clinical Judgment

• AI can offload documentation, prior authorization, differential generation, literature retrieval, and repetitive cognitive work while clinicians preserve human attention for suffering, uncertainty, and shared decisions.
• Diagnostic systems can reduce fatigue, specialty bias, premature closure, and dependence on memory, but their outputs inherit the assumptions, omissions, and institutional rules embedded in their training data.
• Johnston's decade-long exercise-induced breathing disorder survived repeated cardiac, asthma, allergy, and specialty evaluations until rare published cases matched the heart-rate-triggered symptoms.
• Guidelines improve care near the lower end of clinical performance, yet they can compress expert judgment toward the average and may lag behind unusual phenotypes or new evidence.
• A guideline is not automatically the legal standard of care; documented risk-benefit dialogue and patient choice can support care outside a guideline.

Intervention Under Uncertainty

• Errors of commission feel more personal than errors of omission, but operating, prescribing, observing, or doing nothing can each produce harm.
• Existing plaque may retain local inflammatory and immune feedback after systemic metabolic improvement, creating uncertainty about whether a biomarker needs temporary, prolonged, or lifelong modification.
• Lean mass hyper-responders with no plaque, stable plaque, progressive plaque, or prior metabolic disease are not interchangeable populations, and serial imaging is necessary to learn their individual trajectories.
• Honest clinical work requires curiosity, explicit uncertainty, repeated measurement, and willingness to revise a plan without turning scientific identity into tribal loyalty.

Health Span, Mortality, and Meaningful Care

• Longer survival through surgery is not automatically beneficial when hospitalization leads to infection, thrombosis, pneumonia, malnutrition, deconditioning, institutionalization, and permanent loss of independence.
• Older patients need realistic conversations about function after intervention, not only technical survival or whether a procedure can be completed.
• Health span, unfinished life goals, pain, dignity, resuscitation preferences, and readiness for death belong inside ordinary medical care.
• A sustainable medical career and a meaningful patient life both require autonomy, honest limits, and choices that remain acceptable when time is shorter than expected.

References

1. [00:48] To Err Is Human: Building a Safer Health System — https://doi.org/10.17226/9728
2. [00:57] Plaque Begets Plaque, ApoB Does Not: Longitudinal Data From the KETO Trial — https://doi.org/10.1016/j.jacadv.2025.101686
3. [01:19] Effects of Intermittent Fasting on Health, Aging, and Disease — https://doi.org/10.1056/NEJMra1905136
4. [01:43] Prevalence, Vascular Distribution, and Multiterritorial Extent of Subclinical Atherosclerosis in a Middle-Aged Cohort: The PESA Study — https://doi.org/10.1161/CIRCULATIONAHA.114.014310

GPT-5.6 Thinking - high