Carnivore/Keto Study, Integrative Medicine, and the Doc Associated | Rob Abbott EP 229
In a Nutshell
Dr. Rob Abbott is launching the first randomized controlled trial comparing a carnivore/lion diet, ketogenic diet, and waitlist control (delayed start) in patients with rheumatoid arthritis (RA) or inflammatory bowel disease (IBD: Crohn's or ulcerative colitis), using quality-of-life as the primary outcome and monitoring physiological markers for safety. The 24-week study features a 4-week low-carb paleo on-ramp, 8-week main phase, voluntary crossovers, and intention-to-treat/per-protocol analyses to assess real-world effectiveness for autoimmune conditions, motivated by clinical successes and funding challenges for non-patentable interventions. Carnivore diets are defended as nutrient-dense, temporary therapeutic tools—safer than vegan trials despite criticisms—aiming to improve symptoms better than immunosuppressive drugs.
These notes were generated by AI and may contain inaccuracies.
It is easier to be sick than to be well. As a clinician, day in and day out taking care of people, the goal is to make them feel better. The most logical daily intervention for meaningful health impact is diet. Carnivore diet and lion diet appear restrictive on the surface—how to study them safely? There are zero randomized trials of a vegan diet. Comparing nutritional profiles of vegan vs. carnivore diets side by side is damning. Primary outcome should be quality of life measure, not just physiological markers like inflammation, because if people do not feel better, they do not care. As a clinician, if someone does not feel better, that matters most.
Dr. Rob Abbott welcomes to the podcast. Interest in studying lion diet vs. keto diet vs. standard American diet stems from poor job studying interventions that create health.
Not pro-medicine or anti-medicine—different tools with tradeoffs. Drugs and supplements are passive therapies with limited potential for health creation. True health requires ownership and active engagement. Diet and lifestyle fall into this category. Current model focuses on indirect interventions like medicines that enable action but do not create health. Inspiring clinical practice is relieving suffering through daily meaningful impacts, starting with diet.
Unfortunately, it is easier to be sick than well. Takes more effort to stay well than get sick, despite abundance and comfort. Modern lives lack natural stressors and environments conducive to health—people artificially stress via workouts, meditate, or yoga to downregulate nervous systems. Removing gluten or processed foods helps but insufficient for metabolic or chronic autoimmune inflammatory disease burden. Elimination diets now target whole foods with nutritional benefits for specific individuals. No money in studying non-patentable foods, so academic institutions ignore them despite people like Dr. Terry Walls pushing forward with funding.
Someone must do this valid research rigorously. Thank you for that—comes down to funding. Crazy that subset feels better eating meat, removing nutritionally beneficial foods. If reactive to lettuce, greens, or carrots causing inflammation, that is not health—need to investigate why.
Studying elimination diets for specific period, context, therapeutic goal—not permanent way of eating. Venn diagram overlap with general healthy eating. From medical lens, treat like medicine or supplement: present options, expectations. Diet often obvious choice due to low risk, but restrictive versions require diligence. Critics view as lifestyle suggestion, but for systemic autoimmune conditions with disabling symptoms, stakes differ—not for everyone feeling fine. More animal foods and protein help many in practice.
Net negative when early enthusiasm pushes "everyone should try"—understandable after life-changing results, but pivoted to: anyone with psychiatric or autoimmune issues unhelped by medical system should try elimination diet. No harm vs. staying chronically ill on meds or new medications with problems.
Study on two systemic autoimmune conditions: rheumatoid arthritis (RA) and inflammatory bowel disease (IBD)—specifically Crohn's disease (affects any GI tract segment) and ulcerative colitis (large intestine/colon). Excludes microscopic colitis (trickier, sometimes singular cause like SSRI). Example: patient with microscopic colitis from SSRI—double taper with steroids, now off both doing great. Singular causes confound studies.
Include two conditions for more participants and disease subsets. IBD has most diet research; RA limited; others more so. Systemic despite tissue-specific—blood inflammation markers confirm. Future: include seronegative arthritis, lupus, others.
Frustrating: same root causes respond to same approaches, but classified differently—different specialists. Functional lens comfortable with any condition (kids, adults); looks at iceberg below surface—similar diets/environments manifest differently due to genetics/family history.
Treated by similar drugs despite categories/specialists, suggesting shared root causes.
Current treatments: hardcore medicines with serious effects/side effects (e.g., commercials for autoimmune drugs warn of TB testing). Presented as binary: serious condition needs powerful match—false dichotomy. Nutrition matters regardless.
Personal story: severe arthritis with joints replaced (hip/ankle at 17). Offended by early diet questions assuming candy diet—no one suggested meat-only. On methotrexate and Enbrel from ages 7-8; reduced inflammation (wheelchair to soccer), but no cartilage/bone damage persisted—not long-term. Side effects, offramp issues. Costs unfathomable (Canadian perspective).
Key: understand physiological changes. Clinician focus: make people feel better. Primary outcome: quality of life measure (multi-component, validated; captures physical/emotional/capacity). Critique: subjective, not inflammation marker—counter: if not feeling better (not just suppression), does not matter. Used in prior studies.
Secondary/safety: micronutrients, metabolic data, lipids (e.g., LDL varies on carnivore—some low, some high). Controlled randomized pilot vs. baseline diet. Larger sample to preempt "small n" critiques. Physiological data for safety/patterns (stool: calprotectin, microbiome, digestion). Budget prioritizes this.
Primary: does person feel better? Throw wide net for blood/stool markers—no known patterns on carnivore (LDL up/down/unchanged; microbiome?).
Design tests metabolic ketogenic state vs. eliminating plant foods. Randomize carnivore/lion vs. keto to control metabolic change; measure blood ketones/glucose. Nested cohort: delayed start subset.
The study includes a waitlist delayed start group, equivalent to a control, where participants receive no dietary guidance initially and continue their baseline diets while reporting intake. This allows observation of varied individual diets. At 12 weeks (halfway), they randomize to keto or lion diet groups, creating a nested cohort to compare changes against those starting keto or lion immediately. This tests sustainability.
Criticism about needing a year-long study is countered: this is the first randomized trial of a carnivore diet to the speaker's knowledge; start somewhere; responses are good; it's a pilot. Goal is temporary elimination to improve health, buy time for root causes like mold, not long-term elimination like permanent medication. Initial study is 6 months (24 weeks); plans for 12-month follow-up outside the study proper.
Comparatively, nutrition is better than immune suppressants, but still precarious without addressing other factors.
Speaker entered remission quickly on diet, felt great after stopping medications with unnoticed side effects mistaken for autoimmune symptoms. Optimized to avoid inflammatory reactions to trace herbs/spices on steak. Underlying issues like serious mold exposure needed fixing while in remission.
Diets buy time to address root causes and have real healing potential.
Criticism: carnivore/lion diets restrictive and dangerous ethically. Counter: numerous randomized trials of vegan diets (3-6 months, sample sizes 20-25, dozens to 30-40 trials). AI comparison shows vegan diet micronutrient/amino acid deficiencies unless supplemented; carnivore superior. Precedent set for studying restrictive vegan diets; carnivore more nutrient-dense, lacks fiber/phytonutrients but prioritizes preformed essentials like vitamin A, B12.
Labs monitored for changes. Guidelines favor plant-based despite poor long-term follow-up beyond lipids.
Carnivore established 8+ years publicly, longer anecdotally (10+ years thriving); lowers risk vs. new fad diets. Targets deadly diseases like IBD/RA; high stakes justify.
Participants stratified by disease (ulcerative colitis, Crohn's, IBD, RA) but in same program. First randomization to three groups: ketogenic diet, lion diet, waitlist delayed start.
On-Ramp Phase
Designed for real-life applicability: balance support vs. overload.
- First 4 weeks: low-carb paleo-type diet introducing principles, qualitative eliminations, metabolic adaptation.
- Keto includes dairy (nutrient-dense if tolerated).
- Prepares fork: keto (further carb restriction) or lion.
Provides practical support: electrolytes, food prep, decrease decision fatigue.
Main Diet Phase
- Weeks 5-12 (8 weeks): full keto or lion diet.
- Midpoint (12 weeks): repeat initial questionnaires/tests.
Waitlist starts on-ramp at 12 weeks, knows assignment.
Midpoint Adjustments
- One-on-one session to strategize.
- Voluntary crossover allowed: keto to lion or vice versa for final 12 weeks (models clinical practice).
Statistical Analyses
- Intention-to-treat: from start randomization to end, includes crossovers/dropouts (real-world effectiveness).
- Per-protocol: those who followed/completed assigned diet (efficacy for adherers).
Both planned upfront for fairness; avoids unethical forced crossovers if improving.
Efficient design for crowdfunded study to maximize data.
Two cohorts planned; first not reaching full sample size. Fill survey, share; rolling eligibility for second cohort to boost power. Study link in description (assume open).
Real-time data sharing as collected (conference-style), transparent due to crowdfunding. Full publication later.
Find Dr. Rob online (socials tagged in description). More participants needed; grateful for outreach.
"This is to my knowledge the first effort at any randomized trial of a carnivore diet."
"There have been so many randomized trials of vegan diets of similar duration."
"We're trying to balance... rigorous but also ethical."
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