what do you think about Carnival as a diet speaking of extremes that hate you um so I will give a devil's advocate argument for it that any diet that is going to get people to eat less processed foods and more filling satiating Foods is going to be a diet that does better than the standard American diet so I have no doubt that there are people who go on Carnivore and they get healthier the the question really becomes why did you need to do that could you do that and still have some dietary fiber and get the benefits of that um and so I have had Carnivor Carnivor carnist push back against me well dietary fiber is just it's just filler you don't even absorb it in fact in carnivore I don't even poop as much because uh you know I'm absorbing so many more nutrients and blah blah blah blah and I always find these really like Olympic level mental gymnastics interesting because it's not like we don't just have tons of studies in humans looking at this with actual hard human health outcomes and what they'll what the criticism of a lot of these studies is because one of the downsides of nutritional studies is it's hard to do multi-year randomized control trials you're going to lock someone in diet jail for three years at a time yeah I mean I think people have this misunderstanding that there's just like this random pool of people that are test subjects for different studies that just sit there waiting patiently for the researchers to come get them and that's their life's purpose and it's like no they're people like you and me who see a flyer and go I'll try that and you know a lot of them drop out why because the more controlled you try to make it the less likely people are to do it I mean a great example is people like why didn't they do more studies in bodybuilders and I'm like cuz they suck his test subjects cuz what happens when you're a bodybuilder who gets randomized to the low protein arm of a protein study you're immediately dropping out right yeah or if you've got a bias if maybe you think a low carb diet's really good and you get randomized to a high carb diet see you you know so it's hard to do these for long periods of time and keep a level of control so we have to rely on a lot of times shorter term randomized control trials looking at markers of Health that are hopefully predicting longer term Health outcomes and long-term cohort studies now cohort studies are uh kind of an arm epidemiology you have your cross-sectional studies which are we look at this population and this population who has a greater rate of X disease and what differences do they have well those are difficult because there's a lot of confounding variables cohort studies are a little bit better because what you're doing is you're tracking the same people over say 20 30 years you're not doing any intervention but you're seeing okay these people ate more fiber versus these people and had this outcome now what I'll say is the reason I became quite convinced of the healthfulness of dietary fiber is because are you familiar with a forest plot so a forest plot um this became famous because James wils was on Joe Rogan debating uh the game changers a long time ago and kept bringing up a forest plot cuz uh the person he was debating didn't know what it was uh essentially if you have a meta analysis of studies and you have a center line which means no effect no overall effect of treatment and then on one side of the line You'll have favors X treatment other side of the line favors why treatment and then you plot each of the studies where they land so if you have like this side is fabers dietary fiber for decreasing cardiovascular disease mortality cancer literally everything study is on this side positive yes right you might have some that like didn't show a significant effect or not a huge effect but they're all on this side um I am not aware of any cohort study that showed fiber or fruits and vegetables did not have at least a neutral and most of them show a very positive dose response effect on mortality cardiovascular disease and response so meaning uh if they do what's called a meta regression so they look at the different um levels of dietary fiber intake takes in these cohorts then try to compare that to their risk of mortality cardiovascular disease and cancer they can basically say for example in one metaanalysis that was recent I think it was with over a million subjects for every 10 G increase in dietary fiber there was a corresponding 10% decrease in the relative risk of mortality cancer and cardiovascular disease now before anybody goes well I'm just going to eat 100 grams of fber a and live forever we are talking about relative risk and it's important to point out the difference which a lot of people don't get when they hear these things reported on the on the news so when I say a 10% decrease in the risk of mortality if we're looking at say and I'm just making up numbers here but if we're looking at say a 60y old person and their risk of mortality in the next 10 years is 20% right it's probably not it's probably different than that but let's say it's 20% a 10% relative risk reduction is an absolute reduction of 2% because 2% is 10% of 20% so for every 10 G increment of increased fiber they showed a 10% decrease in the risk of these different diseases and mortality if there are other things that there are claims about like for example PE people on Carnivore it's so funny they'll be like why are you trying to you know discourage high quality animal protein consumption I'm like sorry not to sound Curt but do you know who I am like have you done any like background on me my research was funded my lab was funded by the national Dairy Council the egg nutrition center and the national Catalin beef Association if anybody has a bias towards highquality animal protein it's me I'm just not crazy and when we look at say a great example is red meat so even the who has categorized red meat as probably carcinogenic um I don't necessarily believe it's carcinogenic based on the research that's out there and the reason is a lot of studies don't show that it's carcinogenic a lot of these cohort studies don't see where the getting it from well I would say the the over half of them do but some of them don't and if you look at the confounding variables of people who are high red meat consumption it's not like we're talking about bodybuilders eating sirloin you know most of them are getting it from like processed sources of red meat and uh red meat one of the problems with these studies as well is if you are eating more of one thing you're typically eating less of another thing and actually red meat intake is actually quite a good proxy for poor diet quality so there was a really good study from I think maximova in Canada Alberta Canada in 2020 and they looked at trying to control for diet quality so they did uh basically tertile so three different levels of red meat intake with three different levels of fruit and vegetable intake and looking at the incidence of cancer and what they found was that at low intakes of fruit and vegetable intake yes there was an association of high meat red meat intake with cancer but at high levels of fruit and vegetable intake and high levels of red meat consumption the risk of cancer was actually lower than low red meat consumption with high fruit and vegetable consumption because people who are eating a lot of meat and a lot of fruit and vegetables they're probably not eating a lot of lowquality foods because you just don't have a a bunch left in your diet for that so is the primary concern or the biggest risk that you're worried about from carnivore low dietary fiber that's one and then a lot of them are choosing very fatty cuts of meat that are high and saturated fat and there is a big debate amongst diet tribes about the whether saturated fat is bad for you um because it raises LDL cholesterol and there's a debate around LDL cholesterol and I will give you the Devil's Advocate argument for that and then I will give you what the research says so in 2005 when I was in grad school I was in the camp of LDL doesn't really matter it's more about the ratio of HDL to LDL the good cholesterol to bad cholesterol and if you look at the research studies there was a lot of kind of disagreement in the research literature and a lot of the randomized control trials didn't really show an effect of lowering saturated fat on the risk of heart disease but here's the problem with randomized control trials is they're very short heart disease is not something that develops in two years it develops in 40 years heart disease is not the difference between you dying at age 40 and age 80 it's the difference between you dying at age 80 and age 72 and so a lot of these randomized control trials they're using I mean the Minnesota coronary experiment is one that gets cited by carnivore people a lot uh Paul alino sites a lot and it was a Ina and the big the strengths of it were it was impatient there were psychiatric patients and they either fed them high polyunsaturated fats or high saturated fat diets and looked at the differences in heart attack rates or heart disease now the the what they don't tell you about that experiment is those people were not housed consecutively the average duration of each sub of the subjects in that study which was two years and they were like I think the average age was like mid-40s it's not super common for people in their 40s to get heart attacks even those who are inclined to get it and they were in and out of these psychiatric Wards they weren't consecutively and the polyunsaturated fat group included trans fats which at the time now are largely out of the food supply but back then were a big part of the the food supply so it's not really an experiment that carries a lot of weight and again it's only two years it's hard to see differences if you and I invest in a mutual fund so with LDL cholesterol you're looking at a lifetime exposure risk really how much are courses through your arteries over the course of your life I like to compare it to investing if you and I invest in if you invest in a mutual fund that gets 8% and I invest in one that gets 9% if we look at out in two years I mean I'll have a little bit more money but practically you'll go it's no difference but if we look out in 40 years I'm G to have a lot more money than you right and so heart disease is kind of the same it takes time to really see these differences and people on Carnivore wall say well I feel great you can feel great right up until you have a heart attack like heart disease is not something you feel now so looking at LDL cholesterol what really changed my mind on it because again I was in that camp was what we called the melan randomization trials that started coming out around 2008 2009 now mandelian randomization is where they look at your your body people's bodies naturally have like polymorphisms on genes so you'll have people who secrete naturally more or less LDL but these polymorphisms don't affect other areas of metabolism so what you have is essentially is a great lifelong randomized control trial of people exposed to more LDL cholesterol versus people exposed to less LDL cholesterol and when you look at that the exposure to Lifetime LDL cholesterol you can basically draw a straight line through it between that and the incidence of heart disease and if we look at a mechanistic level LDL cholesterol they have shown mechanistically penetrates the endothelium it's actually not the LDL necessarily it's the fact that it contains a protein called apolipoprotein B which apolipoprotein D is what actually damages the indium and allows it to penetrate and then deposit the cholesterol there now some people have said well it's not LDL you don't have to worry about the large LDL gotta worry about the small oxidized Lal I don't know if you've ever heard this this argument it's a very popular argument um and so what is true is that small oxidized LDL can more easily penetrate the endothelium but it deposits less total cholesterol large LDL does not penetrate it as easily but it still penetrates it but it deposits more LDL or sorry it deposits more cholesterol per LDL particle the net effect is both are e equally atherogenic and so if it's funny I tell people when something aligns with our personal beliefs our level of skepticism is basically nothing when something opposes our personal beliefs it's like this right are we just are so skeptical and so I tell carnivores all the time if red meat had the the the data that fiber has behind it to support it being a health food you all would lose your freaking Minds anytime anyone even suggested that it might be bad for you but because it doesn't align with your personal belief system you won't hear a bar of it in other news this episode is brought to you by momentos trust is really everything when it comes to supplements a lot of Brands may 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