She's really become a sort of a go-to person to learn more about this carnivore movement and it's fascinating because on the one hand there are all these preconceptions that it shouldn't be, that people shouldn't be living this way, that there are all these risks, but they're mostly theoretical. And we're going to talk a lot about that.
Are there any proven risks, what do we need to be careful of, and what are the potential benefits and who can this be a wonderful thing for? And it's interesting to explore that especially as a cardiologist with 20 years of training saying that this would be something that's awful for people to do. But I think hopefully you'll learn a lot today from her balanced approach.
We'll also talk about evolution and of course about fiber, which is a very misconstrued component as well about how necessary and healthy that is. So I'm sure you'll appreciate Amber's approach, she's very thoughtful, and this is a very interesting feel that we don't know a lot about and we're continuing to learn a lot about from personal experiences and people sharing their very intimate personal experiences like Amber has. So please enjoy this interview with Amber O'Hearn.
Amber, thank you so much for joining me on the Diet Doctor podcast today.
And you have quite an amazing story that you've been very open and honest about that maybe sometimes can be difficult to talk about, but for you it doesn't seem so. And it's a story that involves weight loss and pregnancies, but then also some psychiatric challenges. So give us a brief introduction about your transition into the low-carb world.
So the first time that I tried low-carb it was for weight loss and that was just a regular low-carb diet and it was back in 1997 and I had tried other things, I tried to exercise, I tried veganism and they hadn't helped me with the weight loss and I finally thought, "Maybe there is something to this low-carb stuff."
So I had been on a low-carb diet very successfully for many years and I do think pregnancy had something to do that or maybe aging, but I was gaining weight over time. So I'm 5/6 and I would say my ideal weight is maybe around 130 pounds and by the time I got to the end of 2008, I guess I was about 35, I weighed almost 200 pounds. I'd actually stopped looking at the scale because it was too depressing.
I again was facing a weight loss issue, a weight gain issue, and I found some people talking on the Internet about doing what they were calling a zero-carb diet. That name is a little bit confusing because it really has to do with animal foods versus plant foods. And so it was an all meat diet, no plants included.
And I didn't think about it as a kind of lifestyle change. I thought well I could do that for a little while and lose this weight maybe if I'm lucky and then I could just return to my garden-variety low-carb diet.
So I was diagnosed with major depressive disorder when I was 20 in my first year of university... it was really disruptive. And then I was on antidepressants for a long time. And in my 30s I was re-diagnosed with a form of bipolar disorder called bipolar type 2 and the difference between that and traditional bipolar 1 is that you don't have the psychotic mania states.
So you have the depressive side and you have a milder form of mania called hypomania. And so then I was actually really happy to be diagnosed with that even though it sounds much scarier, because I thought, "Oh, this is why I haven't been able to get any real results with my depression treatment because they're treating the wrong disorder. And so I then went on this horrendous ride of a variety of bipolar medications which never really helped.
Another problem with bipolar disorder, and it's a clinical problem, is that people who have bipolar disorder often don't have the self-awareness to know what's going on or when they're in what state. And so I'd kind of learned to distrust my own mind. So it took a long time to regain that and to say, "Yes I really am better." But I've been med-free for nine years unless you count coffee.
But then you talk about the carnivore diet and the people in the keto community, someone called the carnivore diet restrictive and crazy and for you to be doing it for so long, did you have a part of this cognitive distance, like "I'm feeling better but I'm not supposed to be doing this and maybe I'm doing something wrong"? Have you been wrestling with that?
I think even when you're on a ketogenic diet you can see this. If you're in a bakery and walk past those cakes with the blue icing and you say, "Does that even register as food? Probably not."
I mean can you think of what-? And you've obviously done a lot of research into this and you approach things from a very intellectual standpoint. So what is your thought that you've come across as to why this has worked for you and for so many others?
And so at first when I've realized that I felt so well, I thought I'm feeling better in spite of the fact that I'm not eating vegetables. And it didn't occur to me for a little while to think, "I'm really feeling better because I'm not eating vegetables", even though obviously it has to be that in some way.
So one of the first insights that I gained about it was from reading Dr. Georgia Ede, who has written a lot about the fact that we evolved- plants evolved... in order to survive they had to have a kind of biochemical defense because they can't run away. And so there's been this arms race between herbivores including insects and plants on the other hand always trying to get this survival. And so it hadn't been until I saw her work that I thought, "The things that are in plants many of them are actually toxins."
And so maybe that could be part of the problem. One of the great things that I learned this year was I went to visit a clinic in Hungary, the paleo medicine clinic, and they are treating patients with chronic diseases using an all meat diet, a very ketogenic form of the all meat diet.
So on the one hand the difference between my feeling better and feeling worse had nothing to do with grains, I already wasn't eating grains. And on the other hand I didn't think of a psychiatric issue was having anything to do with autoimmunity. So I saw those papers and didn't look into them really.
But I didn't realize that many plants have the ability to cause intestinal permeability or on the other hand if you already have an intestinal permeability issue then the toxins in plants that might not even be causing it so much on their own can start causing problems that they wouldn't have if you didn't have intestinal permeability.
But I think that you get to a certain point where you have a certain amount of disorder and now you're no longer able to eat those carbs and still be healthy. So I think there's a parallel kind of situation where if you have a certain- maybe it's an intestinal permeability issue, maybe it's something else, but you've gotten to a point where the plants are no longer safe.
But the same thing can be said about the "Blue Zones" populations, that they eat their whole grains and their fruits, and their vegetables, but we have to factor in their whole lifestyle and just how they live their life with their relaxation and their connection, and their exercise and what the other quality of their food are that they're eating and possibly even their genetic.
So they're going to be a separate subset and we can't assume that we're all the same, that we're all going to be like that. So you've made this transition years ago. And would you ever think of going back?
So as an example, you do it short-term, it's elimination diet and then as you're feeling better you slowly start adding things in, like just some spinach, some broccoli or cauliflower, whatever the case may be, until you find something that's a trigger so that you can start experiencing and enjoying vegetables and find out what you can and can't eat.
Or just say, "I'm feeling better, I'm sticking with it." So I think the main question is, "Is there a danger? Is there a risk?" And obviously we don't know the answer to that question. Yet another million-dollar question.
Because the way I think of carnivores it's a great intervention to try and fix something, change something, but then I want to get people back to a variety of vegetables. Now why do I feel that way? Because again I've been ingrained for decades that this is not necessarily a healthy long-term option?
Do I have any data saying that? Do I know that for sure? I don't, but it's hard to overcome some of those personal beliefs and yet here you are 10 years later obviously doing just fine. So do you have any concerns for long-term health or sustainability for you?
So for example the Inuit, although their diet is quite different in terms of things like the polyunsaturated fatty acids. The Masai are often brought up, the Mongolians who at least before the introduction of wheat lived for very long time. They had two words for food; there was red food and white food. And that was meat and dairy and they basically didn't eat plants either and they were not known for their wimpiness. So I think we at least have some reasons to believe that it could be quite sustainable.
And you can say the same thing about vegans, there has been no society that existed as vegan, but yet somehow that seems more acceptable among the general population than the carnivore. The carnivore movement seems have created much more of an uproar again because of our dietary guidelines and where we've come from and what we think are healthy.
But when the question comes down to the nutrient deficiencies... So with a vegan diet, which is a very restrictive diet, it's well accepted that there are nutrient deficiencies and you need to supplement with B 12 and Omega-3's and maybe vitamin D and other. So with a carnivore diet there's the same concern, magnesium and selenium and a number of others. So do you find that you do supplement or that you would recommend people supplement if they are on a carnivore diet?
And as one of the speakers at the conference here was saying today when you are in a ketogenic state, a whole host of metabolic pathways become different. And what vitamins are technically, are enzymes for metabolic processes, or coenzymes I should say. And so if you're using a whole host of different metabolic pathways it shouldn't be a surprise that some of those coenzymatic needs are going to change in their levels.
And so in some ways I think we are back at the beginning, the RDAs are all based on high carb dieters and there are so many different factors. For example there are absorption factors. If you're eating grains or legumes then you're going to need a higher level of zinc than if you're not, because there are phytates for example that interfere with the absorption of zinc to a very large degree. And so if you remove the plants from your diet all of a sudden the balance of nutrients is going to change in ways that we can't necessarily predict.
And I don't know about you personally but a lot of people in the carnivore community eat sirloin steaks and ground beef and that's it, more of the muscle meat. Do you have concern from that standpoint? Do you think it should be more varied or even adding fish and eggs into that as well?
But even if you look at our use of plants, we don't eat the rinds necessarily and we were also, at least in certain times, possibly competing with other carnivores who might have for example gotten to the carcass first, so if we were scavengers at one point we might've been eating a whole different set of part of the body than the whole.
There are also anecdotes from Stefansson for example that the Inuit weren't eating the whole animal, that they were sharing a lot with their dogs and they were preferentially give organs. On the other side of the coin we know that organs tend to be high in certain nutrients that are important, critical for the brain in fact, so some people argue that you should be eating the liver and the brain and I feel I have to be a bit agnostic at this point; I eat organs myself because I like them, but I'm not really sure what the true importance of them is.
I think is a relatively fair oversimplification. But then when you go to carnivore your protein levels go up dramatically. Is there a concern of too much protein not only from a ketones standpoint but an overstimulation of mTOR and growth pathways and potential IGF-I cancer risk down the road? Because that's something that's been talked about and examined quite a bit as well.
And so there are people who I think eat so much protein on a carnivorous diet that they are in very mild ketosis or maybe more infrequent ketosis and yet they still seem to be getting the full benefit of that. So for example you could imagine that someone whose reason for being carnivore is that they have irritable bowel disease, they wouldn't necessarily have an insulin problem and so they wouldn't have as much therapeutic need for ketosis.
The other idea though that I would like to bring up is that maybe using a glucose based system that's on demand when you need it to be made from your liver is a still much healthier state than bringing in exogenous carbohydrates. So that you're always on this this kind of, "I've got too much" or "I've got too little" and having to adjust to the outside intake.
If you're eating protein, most of your metabolic processes are still being predominantly glucose, if that's coming from gluconeogenesis that still might be a healthier state than being on a high carb diet where you're always having these blood sugar swings.
So would that sort of be your go-to if somebody said, "Who do you recommend this with autoimmunity sort of top the list for you?"
So if you imagine that there's intestinal permeability that's affecting your immune system and you've got that compromised, so you have now agents that shouldn't be in your bloodstream and if you also have a permeability problem in your brain barrier then that could also have a similar kind of consequence.
But regardless of mechanism we have found, at least anecdotally, that there are people like me who have either bipolar disorder, anxiety disorder, depressive disorder. I haven't heard anecdotes about schizophrenia, but I have a high level suspicion that it could be helpful for those people as well.
This was an elderly person who had been schizophrenic with severe psychosis her entire life went on a ketogenic diet and had complete like no more hallucinations. They suspected that there might've been a role for gluten and the absence of gluten in that particular case. And so if gluten is a problem then maybe intestinal permeability is a problem and maybe a completely carnivorous diet would help people.
But if you've been through this process of trying a ketogenic diet and being really amazed at the, you know, half-dozen things that happened to you that you didn't expect and that nobody told you that you could expect, positive side effects if you will. The same kind of thing happens on a carnivorous diet and it sounds silly saying it, but it really has to be experienced to be believed.
And I've seen a number of papers recently saying that agriculture and grains happened far earlier than we thought they did, so maybe we evolved with grains and not without grains and then others saying our ancestors were mostly plant-based and we've got it all wrong and again it's hard to understand the science, because we're talking about something that happened thousands of years ago and it is hard to separate science from propaganda, from people just powering opinion.
So what have you learned in this process of studying evolution and trying to figure out the contributions of meat versus plants versus grains?
The thing about the ability to get the energy that we required in order to feed not just our bodies but our brains, which actually require a whole lot of energy; the more brain tissue you have, the more energy you need, because it's a very expensive tissue. In order to have been able to get that from grains and tubers we would've had to have a consistent supply of them and we would've had to have had cooking.
And there really isn't any evidence that we had the widespread controlled use of fire until maybe a hundred thousand years ago which is much later than when all this brain expansion took place. And so you know I think a lot of people get really excited when they find some grains at a site and say, "See? We had grains back then."
But just because we had a few- I mean obviously we had to have come to it gradually. We didn't just suddenly one day start farming grains. We had to have discovered grains and been using them a little bit and then using them more. There's a great theory that the reason that we wanted to use grains was actually because of the opioid effects and because or because of beer- That's a different story.
But whatever led us to be motivated to do grain agriculture was a gradual process. And so it shouldn't be surprising if we find some evidence of some use of grains going farther back than the onset of agriculture.
And there's actually evidence that agricultural societies had much worse and more frequent famines and I think that's because they were reliant on this supply that could be killed for an entire year.
And he noticed that they had more fiber, the one the particular people he was looking at had more fiber in their diets and so he proposed that as the reason. And I don't think it's really held up to scrutiny. So for example one reason that people have latched onto is that, "Oh, it lowers your blood glucose."
Well that may be true if you're eating a lot of digestible carbohydrates, but it absolutely has no bearing on someone on a low-carb diet. Another reason that I have heard it can actually fill your gut and thereby cause you to not over eat. And I think that you need to give your body a little bit more credit. If it's not getting the calories it needs, the signal will get there.
A lot of people point to butyrate in particular and say, "This is really important for the health of the colon." I've looked at a lot of the studies on the putative health benefits of butyrate in the colon and a lot of them seemed to come back to this idea of feeding with colonocyte. What happens when you give the butyrate to the colonocyte is that it breaks it down into the metabolite beta hydroxybutyrate.
So would you say that that's a short-term need and once it's developed in longer-term you don't need the same precursors more?
Another reason that we might think we need gut bacteria is because some people who have taken prebiotics have said that it's helped them with digestive problems. And my answer to that is if you're trying to digest something that you need certain bacteria to be able to digest it, then feeding prebiotics that help that strain grow might be useful.
But if you're not eating cabbage then why do you need the bacteria in sauerkraut? I guess this is the point. You don't need those particular bacteria because you're not trying to digest those particular foods.
So I think to try and use his labs and say, "This is what can happen on a carnivore diet." It's not such a great example. And that's where people like you and a more less extreme person on a carnivore diet would be very helpful. Are there communities where people are sharing their labs or sharing especially their hemoglobin A1c and their CRP's and the lipids and so forth about what happens?
I made two blogs because I was so averse to talking about this carnivore idea that I didn't want to put it on my main blog which was about the science of ketogenic diets. So I have written some articles about ketogenic diets and that's on ketotic.org. And then I started writing more personal experiences about the carnivore diet on empiri.ca.
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