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Truth About Kidney Health and Gout

People who are emotionally invested in avoiding protein often state that protein damages the kidneys, particularly when that protein comes from animals. Where did this theory come from? Not from studying humans. On the podcast I share with ultra-endurance world-record holder, Zach Bitter, I was talking with Dr. Stuart Phillips, one of the world’s leading protein experts, and we got into this topic. The misconception about this issue evolved from some work researchers did on rats, but no research on humans has ever shown the same results.
Protein doesn’t damage kidneys, but damaged kidneys tend to leak protein, which is something that contributes to the confusion about the relationship between protein and the kidneys. Many physicians have bought into this myth that protein damages kidneys even though the assertion has almost no scientific support. As with other misconceptions, you can look at the treasure trove of nutritional epidemiology and find some relationship between a high-protein diet and an increased incidence of kidney disease, but, as always, you have to ask the question, “Does it apply to all people in all situations?”
In my experience, people who eat a high-protein carnivore diet aren’t finding that their kidneys are compromised. I’m not saying that no one who follows the carnivore diet will ever have kidney problems; they can occur for many reasons. But I do not think that an all-meat diet causes kidney issues. I know of some cases where chronic kidney dysfunction has started to get better for several people.
Let’s put this in perspective. Humans evolved in an environment where eating copious amounts of meat was likely a common occurrence. We have several historical accounts of humans consuming very large amounts of meat, and those accounts show no evidence that the people experienced kidney problems. As I mentioned earlier, the explorers on the Lewis and Clark expedition were noted to have eaten as much as 9 pounds of meat per day. Modern-day competitive eaters have sometimes eaten more than 20 pounds of meat in one sitting without damaging their kidneys. If protein did indeed damage our kidneys, humans would not have made it this far through history.
Another common myth about the consumption of meat is that it leads to the development of gout. This perception goes back to the days when gout was considered a “rich man’s” disease. Because the financially well off were diagnosed with gout more frequently than the less affluent population, and the rich also were the people who could afford to eat meat, the assumption was that meat was the cause of gout. However, what do you think we find when we look at people who eat only meat? They don’t get gout, and if they had it before they start the carnivore diet, the gout generally clears up.
One of the beautiful things about a carnivore diet is that it tends to make some things crystal clear. You can wallow around in pointless epidemiology or use some questionably applicable animal studies to try to interpret something about the effects of eating meat, or you can take the simpler route and look at people who eat only meat. When we look at populations of meat eaters, such as the Maasai, Mongols, or Sámi, we see that there’s no indication that they were hobbled by gout. Today I routinely observe people with gout who go on an all-meat diet; for them, gout becomes a distant memory within months.
So, what about those rich dudes from a few hundred years ago? Why did they have gout? Because they had access to something that the common folk did not. Sugar! The wealthy also had more access to alcohol, and both sugar and alcohol are strong drivers of gout. The traditional view of gout is that it’s caused by an increase in uric acid because we can see uric acid crystals when we view gouty tissue under a microscope. I’ve taken care of plenty of gout patients over the years, and I’ve even removed large gouty tophi (which are basically giant blobs of crystal deposits in the skin that resemble toothpaste when cut open) from all parts of the body. None of my gout-afflicted patients has said he was a pure carnivore.
We know that purines form as food breaks down, and they can lead to increased uric acid production. Meat is often high in purines, and thus experts concluded that meat was the reason for the rich man’s disease. The problem is that most food leads to purines being produced, and high uric acid levels do not always lead to gout. As with all things, the path to gout isn’t a simple route. Is uric acid more of a problem when an underlying inflammatory state exists?
If so, what drives the inflammation? What about hyperinsulinemia (excess insulin)? Because of the complex system that comprises the human body, we have to look at issues like gout from all angles. Fructose is a vital component of table sugar, making up 50 percent of the sucrose molecule; the other 50 percent is glucose. We’ve seen that as fructose consumption goes up, the incidence of gout also goes up. Coincidentally, markers of inflammation and uric acid levels also rise as fructose consumption increases. Alcohol is another major contributor to higher uric acid levels. Like fructose, higher alcohol consumption tends to increase the incidence of gout.
One caveat is that if someone already has gout or is strongly predisposed to it, that person may experience a flare up during the transition phase into a ketogenic or carnivore diet. The flare-up is likely a result of a preexisting inflamed state combined with entering into a state of nutritional ketosis, or it’s because a transient uric acid elevation is a likely reason for the short-term occurrence of gout. After a person has fully transitioned to an all-meat diet, the gout generally subsides for good.

Excerpted from The Carnivore Diet, By Dr. Shawn Baker.
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Might I Suggest the Carnivore Platter

I’m sure you’ve been thinking, “What food can I eat?” Generally, if a food comes from an animal, you can eat it: beef, lamb, chicken, turkey, deer, bison, fish, shellfish, pork, caribou, whale, shark, elephant, snake, crocodile, whatever. Most people on a carnivore diet limit what they eat to the animals that are available in the same geographic region where they live.
Eggs work for many people, but they’re problematic for other people. I recommend that you use eggs as a side dish, perhaps in the classic form of steak and eggs for breakfast. I eat eggs once in a while—often when I’m traveling. In general, they’re a nutrient-rich food, and they make for a nice addition to your meals if you tolerate them.
Dairy is unpredictable. Some people do poorly with it, perhaps because of lactose intolerance or some other sensitivity. Other people find they can handle nonbovine dairy foods, such as sheep’s or goat’s milk dairy. Other people claim to do better with raw dairy or A2 dairy (dairy that contains only A2 beta-casein). Remember: Like many plant foods, dairy was relatively a late addition to the human diet. If you struggle with health issues, I strongly recommend that you consider forgoing dairy for at least a trial period.
Aside from different tolerances to the various types of dairy, people sometimes find they tolerate some dairy styles better than others. For example, many people tolerate hard cheeses better than they tolerate softer cheeses or milk. Some people don’t tolerate cheese or milk, but butter and especially ghee don’t cause any problems for them. Fermented dairy products, such as kefir and yogurt, can be fine for some people but cause issues for others. If you choose to use these products, don’t use the varieties with added flavoring or sugars. I’m not convinced you always need to choose high-fat products versus other products; it depends on the ingredients. If the food includes a lot of gums, stabilizers, or sweeteners, I generally avoid it.
People often ask me about cooking oils. My simple answer is that you should use animal fats, period. Use butter, ghee, lard, tallow, suet, duck fat, and so on. Plant oils are generally garbage for us; there’s no need for them. And, honestly, the animal fats taste and cook better anyway. My apologies to any keto folks in the audience, but I suggest you dump the coconut oil, MCT oil, avocado oil, and olive oil. Although these oils are generally better options than corn, soybean, and canola oils, they still can contain compounds that might be problematic—for example, salicylates in coconut oil, which, cause a rash, digestive upset, headaches, or swelling for some people. Here’s a trick I often use when I’m cooking: Heat a pan. Touch the fatty edge of the meat I’m cooking to the pan until the fat melts. By doing this, I get a nice layer of fat to cook the meat in.
Spices and seasonings come in handy, especially for people who are transitioning into the carnivore diet. Many people do fine with spices and seasonings over the long term, although just as many people tend to find them less desirable over time. I often use only salt on my steaks, and I’m quite happy with that. Sometimes I add some spice to the meats and consider the meal to be a bit of a special occasion. I suggest you avoid sauces that are heavily laced with sugar, vegetable oils, soy, gluten, MSG, and other ingredients that have the potential for problems. If you want to add flavor to your meats, the best option is to make homemade rubs, spice blends, or marinades. Cooking with herbs or vegetables also can add a nice flavor, but you need to be objective about how they affect you and eliminate anything that causes a problem.

Excerpted from The Carnivore Diet, By Dr. Shawn Baker.
Learn more HERE

How Much Meat is too Much?

This question is perhaps more common than any other question I receive. My smart-aleck answer often is, “Enough.” Although that might sound flippant, it’s truly a very honest and simple answer. But how do you know what is enough?

I’m going to throw out some general numbers; don’t take these as gospel. I’m merely giving you some ballpark starting figures; they aren’t concrete:

  • Males: Around 2 pounds of meat per day
  • Females: Around 1.5 pounds of meat per day


When you first start, aim for the suggested amount and then adjust as needed. For instance, many small females can put away 4 to 5 pounds of meat in a day without a problem. I don’t think you should shy away from that quantity if your appetite directs you there for a while. More often than not, females have a long history with diet and caloric or nutrient restriction, and they have some catching up to do to replenish their bodies with nutrients.


Remember, protein is used to build our bones, internal organs, muscles, and skin. If those tissues are depleted, plenty of food is necessary to bring them back to normal function. Also, remember that weight loss is not the short-term goal of the carnivore diet; instead, get healthy and stop with the constant anxiety created by day-to-day fluctuations in weight. Just relax and enjoy the freedom of eating.


If you eat and find that you’re still hungry, eat more. If you find your energy or performance is lagging, then eat more. If you find your mood is low, then eat more. The typical gnawing in the stomach and the “I’ve gotta eat something in the next five seconds or someone is going to get hurt” sensation of hunger will go away. Hunger often becomes a subtle signal that maybe you should eat something soon rather than it being a sign of cellular crisis of impending glucose depletion.

How Often Should I Eat?

In the beginning, your meal frequency should be whatever it needs to be to keep you satisfied. Do you feel peckish an hour after throwing down a 24-ounce porterhouse steak? Fire up another steak or line up a pound of bacon. Do what it takes to quench your appetite. Beat back the craving demons and learn to fill up on nutrition, not entertainment. Over time, you’ll find that your cravings will diminish; eventually, they’ll likely disappear.

At that point, you’ll see the emergence of a regular, well-regulated appetite that meets your nutritional needs. I know I keep saying this over and over again, but the carnivore diet isn’t a quick-weight-loss scheme. Trying to fix a malnutrition problem by starving yourself is a recipe for disaster. If your goal is to lose 20 pounds, and instead you gain 5, but you now enjoy life, don’t have back pain, and are no longer a slave to processed food, you’re far better off with the 5 extra pounds for now.


Excerpted from The Carnivore Diet, By Dr. Shawn Baker.

Learn more HERE

Getting Hung Up on Health Markers

Often when people follow some form of a low-carb diet, they focus on monitoring certain things through blood testing to get some insight into the effects of diet. Blood testing provides some data and often can help to troubleshoot problematic health issues. Before I get into some of the common observations that I’ve made about carnivore dieters, let me put some things into perspective.

When you have your blood drawn, its contents are representative of what is being transported via your blood during that exact moment in time. Many, if not most, of the things that can be measured in the blood can change on a weekly, daily, hourly, and even momentary basis. For instance, blood cholesterol can change dramatically over a few days, hormones can change by the hour, and liver enzymes or inflammatory markers can go up or down based on recent activity or exercise levels. Lab values can be significantly affected by many things, including stress, sleep, illness, activity, exercise, weather, temperature, time of day, and time of year. So, trying to attribute any one particular laboratory reading exclusively to diet can be problematic.

Just as the nutrition science–based food recommended daily allowances were based on a population that was arguably sick from eating a high-carbohydrate, grain-based diet, many of the common laboratory reference ranges were based on that same population. We truly do not have a good set of reference ranges for the populations who follow the low-carbohydrate and carnivore diets. With this in mind, I want to share some of the areas where labs for carnivore dieters can diverge from the general population.

Blood Lipids

Blood lipids probably cause the most concern for both patients and their physicians. First of all, blood lipid levels are dynamic; they can vary fairly significantly over a matter of even a few days. Your total cholesterol on Wednesday may be remarkably different the following Tuesday. Let’s assume that the numbers you get represent a daily average. (However, this assumption is likely false.) When we look at the lipid number for a carnivore dieter, we often see elevated total and LDL cholesterol; this is not always the case, and often LDL/total cholesterol will be largely unchanged or even lower.

Another common finding among carnivore dieters is a general trend toward elevated HDL, the so-called good cholesterol, and generally lower triglycerides. In general, higher HDL and lower triglycerides are thought to represent an improvement in cardiovascular risk, but this is not absolute, particularly regarding the HDL. As I’ve already mentioned, it’s important that you realize that large energy shifts and weight loss can be responsible for unexpected numbers, such as higher than expected triglycerides, particularly at the beginning of a transition to the carnivore diet. I often suggest that people wait six months or more before getting routine labs after starting the diet, unless there’s a compelling reason to do it earlier, such as to address an illness.

Glucose

Glucose control is important, and generally speaking, a carnivore diet tends to lead to very well-controlled glucose numbers. If you’re going to talk about glucose, then you definitely need to be aware of your insulin status. When you look at a blood glucose reading in isolation, you leave out a major part of the story of blood sugar control, potential diabetes, and other chronic disease risks. If you’re going to worry about heart disease, insulin sensitivity is one of the most important modifiable risk factors you can be concerned with. It’s right up there with smoking, and it’s far more important than relative cholesterol levels. You can use a fasting insulin level with a fasting glucose level to calculate something called a HOMA-IR score, which is one of several reasonable measures of insulin sensitivity.

In general, a carnivore diet tends to lead to improved insulin sensitivity over the long term. Glucose tends to remain stable for people on the carnivore diet because the glucose the body is using is not being ingested; it’s being produced mostly from protein, a small amount of fat, and a few other sources, such as lactate, via a process generally described as gluconeogenesis. Gluconeogenesis is probably the most precise way to control glucose regulation, and in the long term, it leads to well-controlled and stable blood glucose numbers. People with both type 1 and type 2 diabetes also note that in the long term they tend to see excellent blood glucose control, although it may take a few months for the level to normalize.

Liver Function

Liver function studies tend to be normal for people on the carnivore diet, and the assumption that increased protein is damaging to the liver is based upon a fallacy. NAFLD (non-alcoholic fatty liver disease) is an increasingly common diagnosis. Fortunately, we know from observations of carnivore populations and by extrapolating data from low-carbohydrate studies that a carnivore diet tends to improve this problem. Liver function tests can be slightly elevated for several reasons, and if you’re having them evaluated, you should be aware of benign reasons for their elevation. One of the more common reasons is recent intense exercise, which can result in slight elevations of these enzymes for up to a week.

Inflammation

In a similar vein, markers of inflammation, such as C-reactive protein, can show a transient elevation after exercise or other acute stresses on the body. This marker and other inflammation labs can be used as risk factors for predicting cardiovascular or other disease potentials. Once again, it appears that a carnivore diet tends to lead to low levels of inflammatory markers.

Kidney Function

Kidney function is often a concern with higher protein diets, but the concern stems from data from animal studies that haven’t been replicated with humans. In general, the consensus is that high-protein diets do not damage kidneys. Some people still are concerned that an already damaged kidney will fail more quickly in the presence of higher levels of protein, but that data is tenuous at best. We have some reports of improved renal function in people who’ve followed a carnivore diet. If you have compromised renal function and are concerned that consuming too much protein while on a carnivore diet might be problematic, it’s worth your effort to track the function over time.

Hormone Levels

Thyroid function is generally improved on a carnivore diet, and we have observed improvements in autoimmune-related issues such as Hashimoto’s thyroiditis. One interesting thing to note is that thyroid hormone, particularly T3 levels, may seem to be low, but the clinical function is noted to be good. This likely represents a decreased requirement for circulation of the hormone or an increase in receptor sensitivity. Therefore, you should not need a supplement in the absence of a clinical need.

Similarly, when people follow a carnivore diet, reproductive hormones tend to normalize and function optimally. It becomes very important to consider clinical function as we assess particular hormone levels. Both men and women note improvements in libido and clinical testosterone function when they follow a carnivore diet, particularly after they’ve moved beyond the adaptation phase.

Iron Levels

Iron deficiency is one of the most common deficiency problems in the world, and a carnivore diet is undoubtedly the most efficacious way to prevent that problem because it’s tremendously high in bioavailable heme iron. On the other hand, too much iron, particularly when stored in excess quantities in the tissue, has been associated with some health problems, such as diabetes, cardiac disease, or liver disease.

Fortunately, excess iron levels don’t seem to occur to any significant degree on a carnivore diet. It’s likely that underlying metabolic disease and inflammatory states contribute to excess iron storage. In general, a carnivore diet tends to improve those conditions, and that may be the reason why high storage levels as assessed by serum ferritin don’t seem to be a problem, even though carnivore dieters have a relatively high iron intake.

Miscellaneous Health Markers

In general, you can expect both red and white blood cell counts to fall within the normal ranges. However, you may see slightly lower white blood cell counts, which may be associated with a generally lower inflammatory state. Levels of serum electrolytes, such as sodium, potassium, chloride, calcium, and magnesium, tend to be normal. Our bodies do a pretty good job of maintaining these in fairly narrow physiologic ranges.

Some people express concern that a carnivore diet can lead to an acidic environment, but our blood pH is aggressively controlled and very tightly regulated. As long as we have functioning lungs and kidneys, we can keep our blood pH right where it needs to be regardless of dietary input.

The concerns about acids leaching minerals from our bones for buffering purposes are unfounded. Higher protein diets ultimately lead to better long-term bone health, especially because our bones are approximately 40 percent protein.

Excerpted from The Carnivore Diet, By Dr. Shawn Baker.
Learn more HERE

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