Why Is The Carnivore Diet Making People Diabetic?

Dr. Eric Westman introduces the topic of whether the carnivore diet is making some people diabetic, a claim that seems counterintuitive given its supposed metabolic benefits. He highlights Jenny Midich, a carnivore influencer, who will share her insights on this issue based on her personal experience and extensive research.

Jenny Midich shares her and her husband's contrasting experiences with the carnivore diet. While she experienced significant weight loss and improved health markers, her husband saw no weight loss and worsening blood pressure, insulin markers, and inflammation, despite eating the same foods. Dr. Westman notes that such differing outcomes are observed in clinical practice, often with men seeing more rapid weight loss on keto/carnivore diets than women.

Midich explains how someone eating almost zero carbohydrates can still have elevated blood sugar due to 'lipotoxicity.' This occurs when fat cells are overloaded, exceeding the 'personal fat threshold,' causing fat to spill into organs like the liver and pancreas, interfering with insulin signaling and glucose control. When cells are overloaded with fat, they become less responsive to insulin, leading to elevated blood sugar even without carb intake. Dr. Westman emphasizes that this is about fat inside the body, not dietary fat, and that calorie intake can still play a role.

Midich elaborates that for individuals with impaired fat metabolism and lipotoxicity, a high-fat carnivore diet can exacerbate the problem, acting like 'pouring more fuel into a system that's already backed up.' Dr. Westman reflects on his early teachings, which never advocated for adding excessive fat, unlike common 'internet keto' practices today. He stresses that if you have significant body fat, adding more dietary fat prevents your body from using its stored fat, hindering weight loss and diabetes reversal.

Midich outlines how to identify lipotoxicity, which often correlates with insulin resistance. She suggests looking at a standard lipid panel for high triglycerides (over 100), low HDL (under 50), and a triglyceride to HDL ratio above 2. Additionally, she recommends assessing visceral fat through a waist-to-height ratio (ideally under 0.5) or more precise methods like DEXA scans or MRIs. Dr. Westman notes that while these tests are informative, his clinical approach doesn't always rely on them if the treatment plan is already clear.

Midich offers practical solutions, inspired by Dr. Nadir Ali's clinical practice, which helped her husband reduce his visceral fat from nine pounds to under three. The key steps include temporarily lowering dietary fat, prioritizing protein, incorporating fasting (intermittent or longer water fasts), and engaging in movement like strength training and Zone 2 cardio to build muscle and improve mitochondrial function. Dr. Westman supports the principles but advises caution on long-term fasting for some patients and notes that exercise, while beneficial long-term, isn't always essential for initial dietary success.

Dr. Westman discusses the nuanced interpretation of blood sugar levels on a carnivore or low-carb diet. He clarifies that an elevated blood sugar under 150 mg/dL in the absence of carbohydrates does not necessarily equate to diabetes, as the body's glucose regulation system is adapting. While factors like lipotoxicity and gluconeogenesis play a role, he emphasizes that overall health is significantly improved by carbohydrate restriction, even if glucose levels are slightly higher than perceived 'normal.' He concludes by praising Midich's dedication to teaching and the effectiveness of reducing dietary fat for those with lipotoxicity.