1. Red meat and cancer research

   • WHO cancer agency report claimed red meat causes cancer.
   • Six supporting studies cited; four from one research group.
   • Three rodent studies: animals pre-injected with a carcinogen ("rocket fuel") known to cause rodent bowel cancer, then fed red meat or derivatives
   • No rodents developed bowel cancer; only precancerous lesions.

2. Vegan diets and B12

   • Debate on plant-only vs animal diets

3. Eggs

   • Contain all building blocks for a complete organism
   • Cooking cut undigested egg protein from 35.1% to 5.7%, a six-fold reduction
   • Cook eggs well if sensitive; eggs suit lacto-vegetarians

4. Iron deficiency

   • Ferritin is an acute phase reactant; infection raises it without adding iron
   • High ferritin with low usable iron is functional iron deficiency
   • Bacterial lipopolysaccharide injection dropped free serum iron about 50% within 2 hours
   • Dopamine, serotonin, and catecholamine synthesis require iron; the electron transport chain depends on it
   • Deficiency causes fatigue and cognitive symptoms

5. Assessing inflammation

   • Markers: CRP, ESR, serum amyloid A, hepcidin
   • Negative acute phase reactants: albumin falls as ferritin rises

6. Causes and treatment

   • Vegan or vegetarian diets lack heme iron; legume iron absorption is about 1 to 2%
   • Other causes: malabsorption and blood loss
   • Lactoferrin supplement, derived from breast milk, improves absorption and has antimicrobial activity

7. Red cell distribution width (RDW)

   • Iron deficiency causes microcytic anemia
   • Earliest sign is widening of red cell size spread

8. Vitamin B6

   • Deficiency and toxicity symptoms nearly identical
   • Gut microbes synthesize B6 and metabolize the amino acid serine
   • Nerve symptoms may come from serine deficiency, not high B6; serine supplemented case by case

9. Folate

   • Low folate common; linked strains: Streptococcus thermophilus, Lactobacillus plantarum, Bifidobacterium infantis, Lactobacillus reuteri, Akkermansia muciniphila

10. Food sequencing

    • Carbohydrates last lowers peak meal glucose by about one third

11. HbA1c

    • Weighted toward recent glucose and affected by red cell lifespan
    • Glycation inhibitors matter; carnosine from red meat; carnosine supplementation lowered HbA1c and glycation damage in type 1 diabetics

12. Continuous glucose monitors (CGM)

    • Good for trends, poor for absolute values; sensor sits in interstitial fluid with a diffusion delay
    • Hot showers cause spurious spikes
    • Dietary changes show within 24 hours; about 2 weeks to steady state; insulin or sulfonylurea users need close medical monitoring early

13. Low blood pressure

    • Underactive thyroid: most common undiagnosed cause
    • Adrenal insufficiency: low aldosterone reduces sodium retention, blood volume, and pressure

14. Hypertension overdiagnosis

    • Wrong cuff size inflates readings
    • JAMA 2023 study, 195 adults: regular cuff on extra-large arms read about 19.5 points high

15. Meal frequency and protein

    • Frequent eating does not stabilize blood sugar
    • Areta protein dose and frequency study; four daily doses of whey isolate sufficed
    • Whey leucine triggers the mTOR pathway for muscle and bone

16. Ketone monitoring

    • Frequent eating with carbs suppresses ketones
    • Keto-adapted people produce and use ketones at high, matched levels

17. Proton pump inhibitors (PPIs)

    • Post-heart-attack dual antiplatelet therapy guidance adds a PPI for 12 months
    • Icelandic study: over half of patients continued the PPI past the intended stop date

18. Gout and fructose

    • Sugar, not red meat, drives gout
    • Fructose metabolism depletes phosphate, raising uric acid
    • Over two soft drinks daily about doubles gout attack risk

I. Pre-Carnivore Health Background

• Age 17, pianist, classical performer
• Concerned about weight gain, concert dresses fitting tighter
• Discovered Freelee the Banana Girl online
• Adopted Raw Till 4 vegan diet (raw fruits/veggies until 4 PM, then cooked starches)
• Initial weight loss from eliminating seed oils, takeout, fast food
• Stayed vegan for 6 years due to community influence

II. Health Decline on Vegan Diet

• Lost period
• Skin damage (cystic acne, eczema, psoriasis)
• Brain fog
• Accepted to Juilliard for master's degree despite diet
• Performance suffered: anxiety attacks, memory slips on stage
• Blood test revealed deficiencies in B12, vitamin D
• Doctor advised supplementing or eating meat

III. Transition to Carnivore

• Inspired by Azra Conlu, KasumiKriss, Kelly Hogan
• First bite: scrambled eggs in Kerrygold butter
• Immediate sensation of "coming back to life"
• Progression: eggs → ground beef → fatty steaks (ribeye, NY strip)
• Full year of eggs, butter, ground beef, steaks

IV. Appetite Evolution

• Initial ravenous phase: up to 5 lbs beef/day, 48 eggs/day, 1 stick butter/day
• Lasted ~1.5 years, began settling after 6 months
• Natural progression: 5 meals/day → 4 → 3 → 2 meals/day → OMAD
• OMAD phase lasted ~1 year
• Eventually reached point of losing too much weight

V. Weight Gain and Loss Timeline

• Immediate weight gain on carnivore (3,000-5,000 calories/day)
• Period returned within 3 months
• Brain fog cleared within weeks
• Weight gain continued for 6 months, then stabilized
• Weight began dropping at 1 year
• Lean physique emerged at 2 years
• Year 3: experiments (raw organs, beef-only, ribeye-only, OMAD)
• Year 4: began weightlifting, significant weight loss
• Years 5-6: established workout routine
• Year 7 (current): raw dairy emphasis

VI. Raw Dairy Integration

• Previously lactose intolerant (common in Asians)
• Difference between raw and pasteurized dairy
• Current consumption: cottage cheese, kefir, raw cheese, raw butter, raw cream
• Tolerates raw dairy without flare-ups
• Pasteurized dairy causes skin issues
• Raw dairy helps build muscle, maintain healthy weight

VII. High-Fat Carnivore Approach

• Inspired by Dr. Elizabeth Bright
• Initial protocol: 1 stick of butter/day
• Fat-to-protein ratio: 1.5:1 to 2:1
• Symptom of insufficient fat: irritability
• Benefits: period return, fertility, feminine curves, reduced bloat
• No tracking of macros; listens to body signals

VIII. Ketosis and Blood Glucose

• Assumes ketosis most of the time
• Tested blood glucose during sardine fast: ~60
• Tested ketones: ~1.5
• Long-term carnivores become fat-adapted without need for tracking

IX. Sardine Fast Experiment

• Inspired by Dr. Boz
• Mistake: ate 4 cans first meal → nausea for remaining 72 hours
• Learned sardine satiation hits ~1 hour after eating
• Future approach: start with 1 can
• Did not experience intense mental clarity due to poor start

X. Beef-Only Experiment

• Inspired by Raymond Nazon, Mikhaila Peterson, Charlene and Joe Anderson
• Included all beef cuts: ground beef, flanken short ribs, ribeye, NY strip, chuck roasts
• Results: weight loss, intense mental clarity, glowing skin
• Exited experiment due to no debilitating diseases

XI. Raw Carnivore Experiment

• Inspired by Emily Penton (healing MS)
• One day of raw ribeye: 1 lb provided full satiation
• Raw meat requires much smaller portions
• Current trend among young people (looksmaxxing/facemaxxing)
• Bella prefers seared meat for enjoyment

XII. Raw Organs Experiment

• Goal: heal cystic acne
• Raw liver for 30 days straight
• Disliked taste; froze and swallowed with coffee
• Skin improved but not worth the suffering
• Current solution: braunschweiger from US Wellness Meats

XIII. Workout and Athletic Performance

• Year 4: began weightlifting
• Current: dumbbells, 1-hour sessions
• Recovery challenges on strict carnivore
• Husband thrives on carbs with intense athletic activity
• Open to experimenting with carbs during potential pregnancy

XIV. Common Newcomer Issues and Solutions

• Muscle cramps (charley horses): electrolytes, salt, magnesium spray
• Energy dips: adaptation period, don't undereat
• Sugar cravings/voice: part of withdrawal
• Irregular periods: adaptation phase
• Sleep issues: increase fat intake, bedside butter trick
• Raymond's priming protocol: 3 meals/day → 2 meals → OMAD → alternate-day fasting over 90 days

XV. Fat Alternatives to Butter

• Ghee (clarified butter, no lactose)
• Tallow (beef fat, highest smoke point)
• Suet (raw tallow, per Rebekah Heishman)
• Lard (less inflammatory for some)
• Duck fat
• Fat from fatty meats

XVI. Men vs. Women on Carnivore

• Men lose weight faster and more immediately
• Men tolerate advanced fasting better (Raymond's Level 3)
• Women need to prioritize eating enough
• Men withstand more physical stress while fasting

XVII. Menopausal and Perimenopausal Women

• Must prioritize high-fat carnivore
• Cannot do OMAD (causes hot flashes)
• Gentle priming recommended: grazing throughout day
• Also beneficial for gastric bypass/Roux-en-Y patients

XVIII. Bowel Movement Changes

• Less frequent bowel movements (normal)
• Constipation: electrolytes, more salt, magnesium, less cheese
• Loose stools/diarrhea: cut fat temporarily, taper up slowly
• Ox bile supplement for severe cases
• Adaptation period: 30-90 days

XIX. Supplements

• Currently takes none (year 7)
• Previously tried: vitamin D/K2 (Seattle), colostrum (1% improvement)
• Iodine: tried once with Dr. Bright, planning for pregnancy
• Ox bile: recommended for severe diarrhea cases

XX. Electrolytes and Salt Journey

• No-salt carnivore for 4 years (learned from Zeroing in on Health Facebook group)
• Felt great without salt initially
• Every salt experiment caused bloating, lethargy, puffiness
• Began salting to taste after starting intense workouts (year 5-6)
• Husband requires daily electrolytes
• Bella considers her no-salt success an anomaly

XXI. Typical Day (Current)

• Wake 6-7 AM
• Breakfast: 1 lb ground beef + 8 scrambled eggs in butter + 2-4 tbsp cold raw butter
• Black coffee after breakfast only
• Workout 1-2 PM
• Dinner 4-6 PM: flash-seared steak (NY strip/ribeye/flanken short ribs), 1-2 lbs
• Raw cottage cheese, raw kefir as dessert
• No eating past 6 PM
• Bed by 10 PM

XXII. Dietary Variety

• Seafood: raw oysters, sashimi, wild-caught salmon/tuna/yellowtail
• Rare lamb from BillyDoe Meats (no gaminess)
• Carnivore cake/pancakes for celebrations
• No cheat meals with sugar/carbs/fruit in 7 years

XXIII. Unexpected Benefits

• No body odor (no deodorant, no perfume, no body wash)
• Boundless energy
• Mental health transformation: confidence, motivation, genuine happiness
• Clear skin, high self-esteem
• Creativity and mental clarity restored

XXIV. Performance and Human Potential

• Juilliard acceptance was willpower, not diet
• Burned out on vegan diet
• Carnivore enables effortless performance
• Most people operate below potential due to brain fog from carbs/seed oils/processed foods

XXV. Non-Dietary Healing Factors

• Daily physical activity (adapted to ability level)
• Journaling symptoms and progress
• Mental health care
• Community support

XXVI. Cooking Fats by Application

• Butter: medium heat, scrambles
• Ghee: high smoke point, flash searing
• Tallow: deep frying, no flavor
• Raw butter: eaten cold to preserve enzymes/probiotics

XXVII. Beverages

• Black coffee (after breakfast only)
• Sparkling water, water (all temperatures)
• Raw kefir (dessert)
• Bone broth (winter); "jiggly jello" from oxtail/chicken drumsticks in Instant Pot

XXVIII. Food Sourcing Philosophy

• Avoids grocery chains and conventional brands (Tyson)
• Direct farm purchases: US Wellness Farms, Miller's Bio Farm, BillyDoe Meats, McCafferty Ranch
• Interviews local farmers and butchers for insider knowledge
• Supports American ranchers through content

XXIX. Pregnancy Preparation

• Plans higher-fat carnivore for fertility
• Husband adjusting diet (currently eats takeout daily)
• Iodine supplementation planned
• Working with Dr. Bright
• Timeline: ~1.5 years out

XXX. Navigating Relationships

• Husband: initially resistant, convinced through male carnivore figures (Dr. Baker, Dr. Chaffee)
• Attending carnivore events helpful
• Now husband is proactive about diet for baby's health
• Family: passive approach works best
• Mother: supportive of results
• Father: pancreatic cancer survivor on keto for 8 years
• Sisters: not interested, no health issues
• Little brother (18): increasingly influenced

XXXI. Transition Recommendations

• Bella went vegan-to-carnivore overnight (personality-driven)
• Recommends gradual transition for most: low carb → keto → carnivore
• Avoids adaptation suffering (leg cramps, oxalate dumping, low energy)

XXXII. Eating Out Strategies

• Chinese hot pot: request water broth, order all meats
• Brazilian steakhouses: all-you-can-eat picanha
• Korean BBQ: avoid pre-marinated meats
• Japanese: sashimi
• Fast food: burger patties alone (In-N-Out, McDonald's, Five Guys)
• Buffalo Wild Wings: chicken wings fried in beef tallow

XXXIII. Lab Work and Health Markers

• No recent labs (plans to do before pregnancy)
• Plans CAC scan to demonstrate clean arteries

XXXIV. Moving to Las Vegas

• Routine adjusted for extreme heat
• Morning/evening walks only
• Prefers blue/rare flash-seared meats in summer
• More chilled raw dairy
• Earlier sleep/wake schedule

XXXV. Getting Started Advice

• Join a community (Steak and Butter Gang, HomeSteadHow, Kelly Hogan, Dr. Berry, Dr. Chaffee)
• Hire a coach if preferred
• YouTube search: [disease] + carnivore diet
• Start a content channel to document journey and combat misinformation
• Social media as positive force for health advocacy

1. Introduction

   • The Dr. Paul Mason Show, episode two.
   • Hosts: Allison and Dr. Paul Mason.
   • Headphones are worn to improve audio quality after feedback on the pilot episode.
   • Allison explains she is helping Paul share information after 25 years of friendship.

2. Nutrition Masterclass for Doctors

   • Paul gave an online tutorial to sports and exercise medicine trainees.
   • The session lasted two hours.
   • It focused on distilling science and addressing falsehoods in mainstream medical education.
   • The goal was to help doctors provide evidence-based care.

3. Comment on Apples and Potatoes Diet

   • A viewer suggested eating only apples and potatoes would produce the same results as low-carb diets if weight is lost.
   • Paul disagrees.
   • Complex carbohydrates are chains of glucose molecules.
   • Potatoes contain starch, which is a complex carbohydrate.
   • Apples contain fructose, which Paul calls more deleterious.
   • Digestion releases glucose into the bloodstream, raising blood sugar and insulin.
   • High glucose and insulin drive production of palmitic acid, a saturated fat in blood.
   • Glycemic instability affects brain function and weight gain.
   • Low-carb diets stabilize blood sugar and reduce hunger.
   • Ad libitum trials show spontaneous calorie intake drops when sugar and insulin are controlled.
   • Apples and potatoes do not address satiety.
   • Vegan and vegetarian diets lack substantive nutrition.
   • Missing nutrients include B12, heme iron, retinol, K2, omega-3 fatty acids, and complete proteins rich in leucine and methionine.
   • Short-term metabolic improvements may occur from calorie restriction, but long-term nutrient deficiencies will cause harm.

4. Vitamin B12

   • B12 absorption requires an acidic stomach environment and intrinsic factor.
   • Absorption occurs in the ileum.
   • Pernicious anemia is a failure of B12 absorption.
   • Before injectable B12, pernicious anemia was universally fatal.
   • Animal foods are the only source of B12.
   • Paul questions how a diet requiring supplements to avoid death can be called the most healthful.
   • Reference ranges for B12 are often 95% confidence intervals based on the general population, not optimal levels.
   • One laboratory considers 135 to 650 adequate, but literature suggests levels below 400 are suspicious.
   • The elderly are at higher risk due to reduced stomach acid and proton pump inhibitor use.
   • B12 deficiency is linked to dementia, anemia, and impaired neurotransmitter synthesis.
   • Some patients diagnosed with dementia no longer met criteria after B12 supplementation.
   • Low B12 can cause depression and high cholesterol through molecular mechanisms.
   • Paul recommends annual B12 testing at minimum.
   • Supplements often do not require stomach acid for absorption.
   • Intrinsic factor deficiency may require injections.
   • Methylated B12 is preferred.
   • Hydroxocobalamin injections are acceptable.
   • Cyanocobalamin is considered less optimal.
   • Carnivore dieters often have B12 levels of 800 to 1000, which Paul says is healthy.

5. Weight Loss and Blood Pressure Medication

   • A viewer reported losing 35 lbs, stopping blood pressure medication, and ending indigestion and sciatica.
   • Paul quotes JH from 1931: "The greatest danger to a man with high blood pressure lies in its discovery because then some fool is certain to try and reduce it."
   • The caveat is that 1931 treatments included bromides and mercury.
   • Modern blood pressure targets encourage prescribing anti-hypertensives.
   • A 2018 British Medical Journal prospective cohort study examined over 4,500 elderly Chinese people with a mean age of 92, including 825 centenarians.
   • The optimal systolic blood pressure was about 129 mmHg.
   • Lower and higher pressures increased risk.
   • Diastolic blood pressure was nearly meaningless as a risk factor for all-cause mortality in that study.
   • A UK study of females over 80 found lowest death risk with blood pressure between 120 and 139.
   • A Korean study of over 68,000 adults found optimal range between 130 and 139.
   • The American Heart Association would classify 129 as just below stage 1 hypertension.
   • Paul views 130 as fine and desirable for most people.
   • Very low systolic pressure increases death risk.
   • In the last three months of life, blood pressure under 120 is common; under 110 carries the highest risk.
   • The theory that lifelong elevated blood pressure is harmful lacks convincing data.
   • Evidence for blood pressure medication improving mortality in younger people is weak, even up to 160 mmHg.

6. Deprescribing

   • A viewer commented that doctors are not interested in deprescribing.
   • Paul says deprescribing is hard and not taught in mainstream medical education.
   • Example: a diabetic on insulin who starts low-carb must have insulin reduced to avoid hypoglycemia.
   • Blood pressure medication must be reduced as blood pressure improves to avoid dizziness and falls.
   • Low blood pressure is more dangerous in the short term than moderately high blood pressure.
   • Doctors receive guidelines on starting drugs but not on stopping them.

7. Proton Pump Inhibitors

   • PPIs reduce stomach acid and impair B12 absorption.
   • Rebound acid hypersecretion occurs after stopping PPIs.
   • The body upregulates acid production to compensate for PPI suppression.
   • Stopping PPIs suddenly causes acid secretion to spike.
   • 40% of healthy adults develop reflux symptoms after abrupt PPI cessation.
   • Doctors often misinterpret withdrawal as persistent disease and restart the drug.
   • Paul was taught PPIs were safe for indefinite use, but guidelines recommend short-term use.
   • Long-term PPI use is linked to dementia, osteoporosis, and pneumonia.
   • Deprescribing requires gradual tapering to reset acid secretion.

8. Antidepressants and Deprescribing

   • Antidepressants are technically not addictive because tolerance does not require escalating doses.
   • Many patients experience withdrawal and cannot stop.
   • Dr. Mark Horowitz developed the Maudsley deprescribing protocol.
   • Antidepressant receptor occupancy follows a logarithmic curve.
   • Small doses at the end do disproportionate work.
   • Tapering should follow a logarithmic reduction, not a fixed percentage.
   • Tablets often do not come in small enough doses.
   • Compounding pharmacists can provide liquid formulations.
   • The process can take 12 months or longer.
   • Paul does not prescribe antidepressants.

9. Informed Consent and Eminence-Based Medicine

   • A dentist commented that patients ignore lifestyle advice because other doctors contradict it.
   • Paul calls this eminence-based medicine, defined in a 1999 British Medical Journal article.
   • Medical decisions are justified by the seniority of the advisor rather than evidence.
   • Patients should ask doctors for the evidence behind recommendations.
   • Informed consent requires full and accurate information on risks and benefits.
   • Doctors often confuse absolute risk reduction with relative risk reduction.
   • Example: a risk dropping from 0.1% to 0.05% is a 50% relative reduction but only 0.05% absolute reduction.
   • Patients should ask for the actual paper or data, not just guidelines.
   • Number needed to treat and realistic benefits should be disclosed.
   • Some treatments, such as certain peptides, rely on preclinical animal or cell-culture research.

10. Biofilms and H. pylori

    • A viewer compared microbial biofilms eating holes in stainless steel pipes to human abscesses.
    • Paul agrees.
    • Abscesses are acidic and have poor blood supply.
    • Antibiotics and local anesthetics often fail in abscesses due to acidity.
    • H. pylori was discovered by Barry Marshall and Robin Warren, who won the 2005 Nobel Prize.
    • Marshall infected himself, developed ulcers, and cured them with antibiotics.
    • Standard H. pylori therapy combines two antibiotics and a PPI, with a 70% to 80% success rate.
    • H. pylori may live inside Candida albicans, which shields it from immune cells and drugs.
    • Biofilm disruptors such as vitamin C and certain probiotics may improve treatment success.
    • Paul tests patients with reflux, bad breath, or epigastric tenderness.
    • Tests include urea breath test, fecal test, blood test, or biopsy.
    • Urea breath test results can be nuanced; borderline readings may indicate low-level H. pylori or other urease-producing microbes.
    • Second-line treatments include bismuth and fluoroquinolones, which have toxicities.
    • Antifungals such as amphotericin B lozenges or nystatin may help in resistant cases.

11. LDL Cholesterol Causes

    • A viewer asked what else raises LDL besides underactive thyroid.
    • Paul treats high cholesterol as a symptom with root causes.
    • B12, folate, betaine, and choline are methyl donors.
    • Undermethylation of genes regulating cholesterol production raises cholesterol.
    • Underactive thyroid is associated with undermethylation.
    • H. pylori can cause nutrient malabsorption and low B12.
    • LDL is part of the innate immune response and binds bacterial toxins.
    • Chronic infection is the most overlooked contributor to elevated LDL.

12. Water, Electrolytes, and Heart Palpitations

    • A 57-year-old viewer reported drinking 2 liters of water daily and having nighttime heart palpitations after starting carnivore.
    • Paul advises seeing a doctor for cardiac symptoms.
    • Drinking plain water can deplete electrolytes.
    • Low-carb and carnivore diets lower insulin, causing kidneys to excrete more sodium.
    • Reduced sodium lowers blood volume, which can reduce stroke volume and raise heart rate.
    • This is called keto flu or Atkins flu.
    • Paul recommends supplementing electrolytes, including sodium, when starting strict low-carb diets.
    • Magnesium loss can contribute to palpitations and arrhythmias.
    • Most magnesium is inside cells, so blood levels may not reflect total body status.
    • Beverage hydration index: adding electrolytes increases fluid retention.
    • Commercial electrolyte supplements often lack phosphate, calcium, and individualized ratios.
    • Iodized salt is good for iodine intake.
    • Paul prefers mined salt over sea salt due to concerns about microplastics and impurities.
    • Excessive iodine can cause the Wolff-Chaikoff effect and hypothyroidism.
    • Too much sodium increases urinary calcium loss.
    • Paul uses reverse osmosis filtered water to reduce microplastics, forever chemicals, and fluoride.

13. Diet While Traveling

    • A viewer found it challenging to maintain diet during a month in Japan and gave up.
    • Paul says do not let perfect be the enemy of good.
    • He uses a hierarchy: some foods are non-negotiable, others are flexible.
    • In Korea, he avoided seed oils but ate some sweet potato.
    • Travel requires more planning, supermarket visits, and food preparation.
    • Example: roasting a chicken in the morning and packing it in a cooler for theme parks.

14. Sugar Cravings and Dopamine

    • A viewer reported going full carnivore, losing cravings, and walking past bakery aisles without temptation.
    • Paul describes his own past sugar addiction, including Froot Loops, soft drinks, and up to six sugars in coffee.
    • Stabilizing blood sugar reduces hunger and hangry episodes.
    • Dopamine synthesis requires B12, iron, zinc, and low inflammation.
    • Improved nutrient status raises baseline dopamine and reduces cravings.
    • Ketones provide alternative brain fuel and improve energy.
    • Better sleep and stable glucose reduce comfort eating.
    • Leptin sensitivity improves when insulin is fixed.
    • Paul does not fast because he believes benefits mainly help those on poor diets.
    • He notes therapeutic fasting research by Dr. Matt Phillips for cancer.
    • Intense exercise may boost autophagy more effectively than fasting.

15. MCT Oil

    • MCT oil can boost ketones therapeutically.
    • It may help conditions such as dementia by raising ketone levels.
    • Paul cautions against coconut oil due to phytosterols.
    • C8 or C10 MCT oil is preferred.

16. Carbohydrates and Body Composition

    • A viewer asked whether 30 to 50 grams of carbs would slow muscle gain or fat loss on a high-meat diet.
    • Excess carbohydrates are converted to saturated fat via de novo lipogenesis.
    • The body stores about 400 grams of glycogen in muscles and 100 grams in the liver.
    • Glycogen stores deplete after 12 to 24 hours of fasting.
    • Exercise depletes glycogen faster.
    • Carbs consumed around training may refill glycogen without raising triglycerides.
    • Paul recommends continuous glucose monitors to observe individual responses.
    • A glucose spike that looks like something you would not want to sit on is probably excessive.
    • Bodybuilders with more muscle can tolerate more carbs than sedentary elderly people.

17. Phytonutrients and Herbal Medicine

    • A viewer reported craving phytonutrients after going keto.
    • Paul states phytonutrients have no known role in mammalian physiology.
    • There is no recommended daily intake or deficiency syndrome for phytonutrients.
    • Some plant chemicals may have pharmacological effects, which makes them drugs rather than nutrients.
    • Polyphenols such as resveratrol show benefits in lab studies but not in humans.
    • Herbal medicine can have utility as pharmacological agents.
    • Examples: aspirin from willow bark, digoxin from foxglove, artemisinin, morphine from poppies.
    • Oregano oil has antimicrobial properties.
    • Berberine may lower cholesterol through antimicrobial effects.
    • Nattokinase may act as a biofilm disruptor.
    • Plant substances used as drugs require awareness of dosing and side effects.

18. Boron Deficiency

    • A viewer raised boron deficiency as an important issue.
    • Boron is not classified as an essential nutrient, but Paul believes it should be.
    • Benefits include bone metabolism, reduced arthritis pain, parathyroid hormone regulation, vitamin D metabolism, and steroid hormone health.
    • Veterinarians and farmers recognize boron deficiency, such as hip problems in pigs.
    • Boron is the second most common deficiency Paul identifies in his patients.
    • High-rainfall areas leach boron from soil, affecting crops and animals raised there.
    • Testing is not covered by Medicare and is rarely done.
    • Common use cases for supplementation include low testosterone, osteoporosis, and osteoarthritis pain.
    • Dosing should be precise rather than a pinch.

19. Protein and Kidney Health

    • A viewer claimed eating too much animal protein destroys kidneys.
    • Paul says this common belief is unproven and likely false for healthy kidneys.
    • High protein intake does not damage healthy kidneys.
    • A landmark study restricting protein in kidney disease patients found no benefit.
    • Higher protein intake is associated with lower risk of chronic kidney disease in observational studies.
    • Advising protein restriction causes sarcopenia and malnutrition.
    • Meat provides protein and most micronutrients.
    • The myth arose from animal models showing hyperfiltration after high-protein meals, but this is an adaptation, not damage.
    • Damaged kidneys leak protein into urine.
    • Restricting protein reduces urinary protein simply by lowering circulating protein, but it does not improve kidney health.
    • Paul does not restrict protein in kidney disease.

20. Conclusion

    • Allison and Paul end episode two.
    • They encourage viewers to ask doctors for evidence and to seek informed consent.

1. Metabolic Psychiatry and Root Causes

• Many mental illnesses are driven by metabolic malfunction rather than mysterious chemical imbalances.
• Three key root causes are brain inflammation, oxidative stress, and insulin resistance.
• Over 90% of Americans have insulin resistance, which disrupts brain energy production.

2. The Ketogenic Diet as Intervention

• The ketogenic diet switches the brain's fuel from high-carb and high-insulin to low-carb and low-insulin.
• This shift allows brain cells to heal and function more efficiently.
• A study in Toulouse, France followed 31 inpatients with treatment-resistant bipolar, depression, or schizophrenia.
• 43% of those patients achieved clinical remission.
• 64% left the hospital on less psychiatric medication.
• Personalization is essential based on metabolic health, gut function, and individual preferences.

3. Ketosis and Mental Health

• Ketosis is the state where the body burns fat and produces ketones, an efficient fuel for the brain.
• Transitioning into ketosis can cause temporary headaches and discomfort known as "keto flu."
• Easing into the diet and supplementing electrolytes can reduce this discomfort.
• Processed foods are engineered to be addictive and unsatisfying.
• Whole foods stabilize appetite hormones and break the cycle of constant craving and hunger.

4. ADHD and Nutrition

• Older European "few foods" studies showed 62-82% response rates in children with ADHD.
• Some children showed a 70% cure rate within weeks.
• Major health organizations do not currently recommend dietary changes for ADHD due to a lack of large-scale randomized control trials.
• Two major studies at Oxford and the University of Michigan in 2025 will investigate the ketogenic diet for adults with ADHD.

5. Practical Application

• The benefit of dietary change comes mainly from subtracting harmful ingredients such as refined carbohydrates and vegetable oils.
• Continuous glucose monitors and ketone meters help patients objectively track metabolic response.
• Successful treatment works best as a team approach including a nutrition therapist, a prescribing doctor, and a coach or therapist.

I. Introduction and Background

A. Dr. Jaimela Dulaney's Professional Credentials

• Medical school: West Virginia University
• Cardiology fellowship: University of Pittsburgh
• As ultra-endurance athlete and cardiologist

B. Original Practice Philosophy

• Membership-based medical practice
• Strictly plant-based nutrition focus
• Emphasis on exercise and lifestyle interventions
• Value on physical exam over algorithm-based "menu doctoring"
• Individualized care approach

II. Personal Journey: The Catalyst for Change

A. Family History and Motivation

• Strong family history of diabetes and cardiovascular disease
• Grandparents died from complications related to these conditions
• Personal desire to avoid similar diagnoses

B. Athletic Pursuits and Dietary Approach

• Marathon and ultra-endurance running career
• Following standard plant-based, low-fat dietary advice
• Belief this was the optimal approach for both health and performance

C. Emerging Problems and Symptoms

• Frequent energy "bonks" during training and racing
• Debilitating fatigue after meals
• Post-meal symptomatic crashes
• Inability to effectively access fat stores despite high activity levels

D. Observing Patient Patterns

• Patients at healthy weight showing insulin resistance signs
• Rising Hemoglobin A1C levels
• Complaints of fatigue and abdominal weight gain
• Recognition that high-carbohydrate intake was preventing metabolic flexibility

E. Identifying Knowledge Gaps

• Discovery of dangerously low DHA levels in patients avoiding fish
• Recognition that insulin as a storage hormone was causing issues
• Realization that her previous dietary assumptions might be flawed

III. The Turning Point: Influences and New Information

A. Key Influential Works

• Dr. Tim Noakes: "The Lore of Nutrition"
• Nina Teicholz: "The Big Fat Surprise"
• Critical re-evaluation of plant-based dogma

B. Initial Experimentation

• Began low-carb fueling for ultra-running
• Immediate results: no "bonks," improved energy
• Surprising reduction in post-run muscle soreness

IV. The Continuous Glucose Monitor (CGM) Revelation

A. Concrete Data Acquisition

• Used CGM to obtain precise metabolic feedback
• Revealed significant glucose spikes from perceived "healthy" meals
• Example: poke bowls with white rice causing major spikes

B. Understanding Symptom Patterns

• Identified correlation between glucose peaks and symptomatic crashes
• Recognized that symptoms occurred during the drop after glucose spikes
• Data challenged previous beliefs about which foods were truly healthy

C. Personal Dietary Transformation

• Transitioned from plant-based to low-carb/ketogenic approach
• Re-introduced eggs, fish, and eventually meat
• Maintained non-starchy vegetables (greens, broccoli, cauliflower)
• Eliminated energy crashes and improved overall metabolic function

V. Clinical Practice Transition

A. Managing Change in Practice

• Total transparency with patients about her evolution
• Hosted "town halls" to explain reasoning
• Presented own data and clinical observations
• Framed change as adding "another tool in the toolbox"

B. Patient Reception

• Majority of patients appreciated willingness to evolve
• Patients valued transparency and evidence-based approach
• Many patients benefited from new dietary strategies

C. Shift in Treatment Philosophy

• From plant-based advocacy to individualized metabolic optimization
• New approach: personalized rather than one-size-fits-all
• Willingness to adapt based on individual patient responses

VI. New Clinical Approach and Insights

A. Metabolic Health Prioritization

• Shift from LDL cholesterol focus to comprehensive metabolic health
• Key markers now prioritized:
  • Fasting insulin levels
  • Triglyceride-to-HDL ratio
  • Hemoglobin A1C
  • Inflammation markers

B. Insulin Resistance as Primary Driver

• Recognition that insulin resistance is primary cardiovascular driver
• Traditional cardiology often ignores this factor
• Metabolic dysfunction occurs long before clinical diabetes diagnosis

C. Individualized Care Philosophy

• Medicine fails by treating patients as "average" rather than individuals
• Importance of listening to patients beyond "normal" lab ranges
• Need for early intervention using proper metabolic markers

VII. Specific Clinical Recommendations

A. Addressing LDL Concerns

• For cardiologists worried about LDL rising on low-carb diets
• Metabolic health improvements prioritized over LDL numbers
• Willingness to monitor rather than blindly treat with medication
• Focus on particle size and other cardiovascular risk markers

B. Performance and Ketones

• Experimentation with exogenous ketones for ultra-running
• Performance benefits observed
• ketone level requirements depend on patient goals:
  • Performance athletes vs. general metabolic health
• Different approaches for different objectives

VIII. Broader Professional Philosophy

A. Evidence-Based Evolution

• Importance of keeping an open mind
• Willingness to follow actual data vs. theoretical frameworks
• Learning from personal and patient experiences

B. Avoiding Dietary Dogma

• No "one size fits all" diet
• Risk of dietary "religions" over patient-centered care
• Need for flexibility and individualization

C. Patient-Centered Care

• Transparency about evolving understanding
• Sharing personal data and experiences
• Building trust through honesty about practice evolution

IX. Conclusion and Key Takeaways

A. Core Message

• Metabolic health is foundational to overall cardiovascular health
• Individual responses vary widely
• Data-driven approach superior to theoretical adherence

B. Professional Evolution

• Demonstrates importance of scientific openness
• Shows value of personal experimentation
• Models evidence-based practice for other clinicians

C. Resources and Further Information

• Website: doctordulaney.com
• Podcast: Jami Dulaney Wellness Podcast
• Instagram: @Jaimeladulaney