Medical training and a failed conventional diet

• Lies My Doctor Told Me [1] centers on nutrition advice repeated by physicians and the role of confirmation bias in making repeated dietary assumptions feel certain.
• Dulaney moved from long-term plant-based cardiology toward carnivore eating after developing health problems, challenging entrenched dietary beliefs.
• Berry graduated in 2000 after a half-semester nutrition class with 175 students; its predominantly plant-based instructor implied he had type 1 diabetes and used steel-cut oats and whole-grain pasta as examples of managing it.
• Residency, emergency-room shifts and convenience food coincided with Berry reaching 297 lb and an HbA1c of 5.9, creating a conflict between his own health and the weight-loss advice he gave patients.
• Ninety days of following an American Diabetes Association diet handout and jogging two or three times weekly coincided with an increase to 300 lb and an HbA1c of 6.1, motivating a change in dietary approach.
• Robert Atkins's Diet Revolution, Mark Sisson's The Primal Blueprint and Loren Cordain's The Paleo Diet [2][3][4] introduced low-carbohydrate approaches absent from Berry's medical-school instruction.

Plant-based beliefs and medical authority

• Berry's earlier diet was roughly 70–85% plant-based, with lean meat, reduced-fat dairy and fewer egg yolks. He also promoted blueberries as having "magic in plants" despite lacking evidence for that belief.
• A couple planted three blueberry bushes after Berry's community lecture, an example of nutrition advice affecting patient behavior even without a scientific basis.
• Dulaney's former plant-based diet was influenced by animal welfare, John Robbins's Diet for a New America [5], saturated-fat concerns and fears of animal-derived toxins. Her household garden did not produce enough vegetables to sustain her.
• Food-industry sponsorship of nutrition organizations adds a source of bias to conventional dietary guidance.
• Presumed comprehensive medical expertise is the central misconception: physicians lack complete nutrition and health knowledge, while strong patient trust can contribute to harmful advice.
• Medical instruction contains errors and uncertainty, captured by Berry's professor warning that half of the instruction could be wrong; clinical knowledge requires revision and candor about gaps.
• Nutrition research spanning archaeology, anthropology and non-English scientific literature expands the evidence available beyond English-language dietary research.
• USDA food-composition data [6] list zero vitamin C for red meat, in some cases by assumption, while Nordic, Japanese, European and British tables include roughly 1–3 mg in a substantial meat serving; extensive cooking reduces this amount.
• Medical professionals have an obligation to investigate nutrition evidence before giving confident advice; false answers delivered in professional practice can constitute "lies".

Grains, family history and food identity

• Grains are used to fatten farm animals yet are widely perceived as wholesome human staples, embedded in family customs, poverty diets, religion and inherited beliefs.
• Berry's great-grandmother lived mainly on cornbread and beans and died of pellagra, a B-vitamin deficiency, despite her community's positive view of that homegrown diet.
• Dulaney previously attributed her grandmother's diabetes to lard while giving less attention to bread, dumplings and sugar, illustrating the selectivity of dietary beliefs.
• The effects of Esselstyn's plant-based cardiac program cannot be isolated from accompanying changes in smoking, exercise and body weight; the effects of kale alone remain uncertain.

Diabetes research, hunger and sustainability

• A 24-week randomized trial involving Brenda Davis combined a whole-food plant-based diet with provided meals, exercise and classes during the first 12 weeks; weight and HbA1c improved during the early phase [7].
• By week 24, early changes in glucose, insulin, HOMA-IR and cholesterol were no longer maintained. Animal products and junk food returned as eating became less restricted, with hunger and renewed satiety central to the explanation.
• Hunger and eating until full are normal physiological functions; wild mammals eat their typical diets to satiety. Restricting intake can cause short-term weight loss but is difficult to maintain with persistent hunger.
• Ancel Keys's Minnesota starvation experiments documented food fixation and psychological distress during sustained underfeeding; energy restriction can temporarily reduce body weight and blood glucose [8].
• Virta Health's five-year ketogenic diabetes follow-up included ongoing participation, weight loss and reduced diabetes medication with carbohydrate restriction [9].
• Dulaney sought an egg-like sandwich made from tofu during her plant-based years; animal-food imitations can coexist with cravings for familiar animal foods and their nutrients.

Surrogate cholesterol outcomes and coronary interventions

• Short-term reductions in cholesterol on a Portfolio Diet do not establish long-term effects on mortality or heart attacks; LDL and total cholesterol are surrogate outcomes.
• Stent placement is influenced by clinical practice and procedural incentives, limiting its value as a health outcome. Sham-controlled stenting trials [10] subsequently tested benefits of coronary intervention; earlier preventive stenting could include 30–50% blockages.
• Bypass grafts on moderately narrowed arteries can fail, and a high number of bypass grafts or stents does not necessarily indicate full resolution of coronary disease.
• In a recent three-diet trial covered by JAMA, a ketogenic diet reduced liver fat and improved metabolic measures more than Mediterranean and very-low-fat plant-forward diets at similar weight loss [11]. Carbohydrate intake, not dietary fat, is the central dietary explanation for fatty liver here.

Lipid panels, HbA1c and individual physiology

• Dulaney's total cholesterol rose from approximately 180 to 315 and then 407 mg/dL after adopting a very-low-carbohydrate, meat-heavy diet; her LDL was 278, HDL 125 and triglycerides 52, consistent with a lean-mass hyper-responder pattern.
• A 10-year ApoB–HDL cardiovascular-risk study [12] linked higher HDL with a weaker association between elevated ApoB and cardiovascular events, supporting combined interpretation of HDL, triglycerides and ApoB.
• Low triglycerides, high HDL, fasting insulin near 3–7, HbA1c below 5.7 and normal hs-CRP form a metabolic profile in which ApoB, LDL and total cholesterol carry little risk significance.
• Dulaney's HbA1c remained 5.9 with fasting glucose around 110, insulin 3, C-peptide near 1 and negative autoimmune diabetes antibodies, a pattern inconsistent with adult-onset autoimmune diabetes.
• Glycated albumin tests were no longer available through Berry's laboratories, while Dulaney's fructosamine was normal despite an elevated HbA1c.
• Red blood cells normally circulate for roughly 110 days, and longer survival of about 115–125 days, potentially from less cell damage, could allow more glycation and a mildly elevated HbA1c in some lean carnivores even when fructosamine and insulin are low.
• The dawn effect can temporarily increase glucose on waking through cortisol and adrenaline; checking glucose one or two hours later can yield a lower value.
• Ketones differ between individuals and circumstances: Dulaney's rise with more fat or running, while Berry has values around 0.5–0.7 mmol/L after a three-day fast and his wife can exceed 2 after a brief meal delay. Isolated ketone or glucose readings are an incomplete metabolic picture.

References

1. [01:03] Lies My Doctor Told Me — https://drberry.com/products/lies-my-doctor-told-me
2. [07:26] Dr. Atkins' Diet Revolution — https://books.google.com/books/about/Dr_Atkins_Diet_Revolution.html?id=Cp-ozwEACAAJ
3. [07:32] The Primal Blueprint — https://www.primalkitchen.com/pages/primal-blueprint
4. [07:35] The Paleo Diet, Revised Edition — https://thepaleodiet.com/the-paleo-diet-revised-edition/
5. [13:45] Diet for a New America — https://redwheelweiser.com/book/diet-for-a-new-america-9781932073546/
6. [19:01] USDA FoodData Central — https://fdc.nal.usda.gov/
7. [30:07] A whole-food, plant-based intensive lifestyle intervention improves glycaemic control and reduces medications in individuals with type 2 diabetes: a randomised controlled trial — https://doi.org/10.1007/s00125-024-06272-8
8. [34:00] The Biology of Human Starvation (Volume I) — https://www.upress.umn.edu/9780816672349/the-biology-of-human-starvation/
9. [34:33] 5-Year effects of a novel continuous remote care model with carbohydrate-restricted nutrition therapy including nutritional ketosis in type 2 diabetes: An extension study — https://doi.org/10.1016/j.diabres.2024.111898
10. [38:01] Percutaneous coronary intervention in stable angina (ORBITA): a double-blind, randomised controlled trial — https://doi.org/10.1016/S0140-6736(17)32714-9
11. [39:48] Effect of diet macronutrient content on the cardiometabolic response to weight loss: A randomized clinical trial — https://doi.org/10.1016/j.cmet.2026.07.020
12. [41:47] Interplay of HDL cholesterol and apoB and the risk of incident atherosclerotic cardiovascular disease in UK Biobank — https://doi.org/10.1093/eurjpc/zwag400