Talking to Patients About Diet: Is Carnivore Truly a Panacea?

Patients have anecdotally reported that the carnivore diet has cured diseases that were irreversible, such as type I diabetes. Are these outcomes simply one-off cases, or is there really something to this diet?

Diet is a major component of health. In fact, along with exercise, our dietary choices are arguably the biggest determinants of wellness.¹

Unfortunately, there is often confusion, fear, and misunderstanding about what clinicians can and cannot discuss with patients in terms of diet.² There have been many horror stories spread about clinicians acting outside of their scope of practice, leading to patient injuries and subsequent disciplinary actions taken by the relevant governing bodies.³

That being said, patients will often seek nutritional advice from clinicians whom they trust.⁴ These clinicians may or may not be comfortable, or even qualified, to weigh in on diet-related issues. But this fact will not dissuade patients who have developed a sense of rapport with said health professional.

The Carnivore Diet

In 2022, one of the most popular and controversial nutrition trends is the carnivore diet.⁵ Many patients have used meat-based diets to treat disease and dysfunction. In some cases, patients have anecdotally reported that carnivore has even cured diseases that we previously thought were irreversible, such as type I diabetes.⁶ This flies in the face of most common nutritional recommendations, which push for more plant-based lifestyles.

Are these patient outcomes simply one-off, random cases that shouldn’t be taken seriously, or is there really something to this carnivore lifestyle?

In this article, we will discuss how to ethically and safely discuss diet with patients, regardless of your area of healthcare expertise. Then we will examine the carnivore diet to see if it is truly a cure for all ailments, as many proponents have claimed.

How To Discuss Diet with Patients

Over time, healthcare providers have shifted from being generalists to specialists. This is true across the different areas of medicine, and even within specialties themselves.⁷

For this reason, many clinicians avoid the topic of nutrition, feeling that this area of health should be left to a select group of nutritionists and dieticians.⁸

However, as long as clinicians are accounting for the various applicable rules and regulations before discussing diet with a patient, there is unlikely to be a problem in terms of legality. There are many relevant authorities to defer to on a case by case basis. But, at a minimum, all clinicians should consider the following before discussing diet with patients:

• Their state practice acts.
• Any applicable federal rules and regulations.
• Any applicable local rules and regulations.
• Facility policies.
• Their own comfort level and knowledge surrounding nutrition.
• The individual patient’s ability to understand and follow instructions safely.

 

Say This, Not That

All clinicians can interpret information that is in the public domain. For example, if a patient asks a physical therapist what a carbohydrate is or why protein is important, the PT does not have to refer said patient to a specialist. Rather, she can provide education on this topic and empower the patient.⁹

Additionally, as patients become more and more tech-savvy, they will begin to stumble across various diet recommendations online. If you are their most trusted clinician, they are likely to ask for your input. As long as you are acting in good faith and adhering to all of the regulations discussed above, you should have no fear of discussing nutrition with patients.

On the other hand, there may be some clinicians who are tempted to broach the subject of diet themselves, unprompted by the patient. In these situations, caution is warranted.

For instance, a bariatric patient would likely benefit from some nutritional counseling, but he may display no interest in changing his diet. If a clinician overreaches and begins prescribing a specific diet to said patient, acting outside of his or her scope, the consequences could be dire.

Before we dive deeper into the carnivore diet, let’s establish a rule of thumb about dietary advice: clinicians can discuss general topics related to nutrition and they can help patients navigate confusing content surrounding nutritional science. They should not, however, prescribe specific, detailed diet plans to patients, unless they are qualified to do so.

More pithily put: clinicians can usually be descriptive when talking about diet, but they should rarely be prescriptive.

What Is The Carnivore Diet?

Like most diet plans, the carnivore diet comes in many different levels of strictness.⁵ On one end of the spectrum, those following an extremely restrictive carnivore diet will consume only meat, eggs, water, and salt. Put another way, they eat only animal products (along with naturally occurring substances such as water and salt) and nothing from plants.

Less strict carnivores may refer to their diet simply as “meat-based”. This means that the majority of their calories come from animal products, but they will also eat some select plant foods, such as fruits.

Is It Safe?

For most of us, we’ve been told our whole lives that we should limit our meat consumption in favor of heart-healthy plant foods. However, this recommendation has recently been challenged by proponents of the carnivore diet who have anecdotally demonstrated vastly improved health after cutting out all plant products.

Truthfully, there simply isn’t enough data at this time to definitively conclude whether or not the carnivore diet is safe for humans. But, data or not, many people have begun to try this diet on for size, with compelling results.

One of the common issues seen by those following a carnivore diet (and ketogenic diets, of which carnivore diets may or may not be a part) is a rise in LDL cholesterol.⁵ However, it is unclear if this elevated biomarker is necessarily as worrisome as we once thought. Some carnivore (and ketogenic diet) proponents have theorized that HDL level and insulin resistance¹⁰ may have to be considered alongside LDL level. It’s possible that we’ve incorrectly tried to isolate LDL as the major risk factor for heart disease, without considering the broader picture. With more study, the relationship between cholesterol, insulin resistance, and heart disease will hopefully become more clear.

Does It Improve Recovery?

Again, due to a lack of research, we are unable to determine whether or not recovery is improved with a carnivore diet. Anecdotally, some athletes have reported experiencing faster recovery times after injuries when increasing their meat intake. However, we cannot conclude at this time whether or not these findings are necessarily due to this dietary change.

Does It Improve Athletic Performance?

At the most elite levels of competition, all athletes are omnivores. That being said, we do see some high-level athletes who follow meat-based diets¹¹, as well as some athletes who adhere to vegan diets. Obviously, there are many factors when it comes to athletic performance. Each of these factors needs to be considered when attempting to create the ideal diet and training program for a given athlete.

Should Clinicians Promote Carnivore?

So, let’s say that you, as a clinician, have experienced incredible improvements in your health from switching to a carnivore diet. You feel so good, and you just want to spread the word about this miraculous change.

As we discussed before, you should be careful that you are discussing the general principles of diet and not actually prescribing a diet to a patient. If you recommend the carnivore diet to a patient who doesn’t follow it appropriately, you could put him or her at risk for numerous diseases and health issues.

Remember, there’s typically no harm in being descriptive about components of health, but you should always be very careful when being prescriptive in these areas.

 

Bennett Richardson, PT, DPT, CSCS

Bennett Richardson, PT, DPT, CSCS is a physical therapist and writer. He is the owner of Richardson PT LLC, a mobile, cash-based physical therapy service out of Pittsburgh, PA. Ben is passionate about many health-related topics including weight loss and athletic performance. To get in touch with Ben, visit www.richardsonpt.com

 

References

1. Cena, H., & Calder, P. C. (2020). Defining a Healthy Diet: Evidence for The Role of Contemporary Dietary Patterns in Health and Disease. Nutrients, 12(2), 334. https://doi.org/10.3390/nu12020334
2. Harkin, N., Johnston, E., Mathews, T., Guo, Y., Schwartzbard, A., Berger, J., & Gianos, E. (2018). Physicians’ Dietary Knowledge, Attitudes, and Counseling Practices: The Experience of a Single Health Care Center at Changing the Landscape for Dietary Education. American journal of lifestyle medicine, 13(3), 292–300. https://doi.org/10.1177/1559827618809934
3. Doobay-Persaud, A., Evert, J., DeCamp, M., Evans, C. T., Jacobsen, K. H., Sheneman, N. E., Goldstein, J. L., & Nelson, B. D. (2019). Extent, nature and consequences of performing outside scope of training in global health. Globalization and health, 15(1), 60. https://doi.org/10.1186/s12992-019-0506-6
4. Birkhäuer, J., Gaab, J., Kossowsky, J., Hasler, S., Krummenacher, P., Werner, C., & Gerger, H. (2017). Trust in the health care professional and health outcome: A meta-analysis. PloS one, 12(2), e0170988. https://doi.org/10.1371/journal.pone.0170988
5. Lennerz, B. S., Mey, J. T., Henn, O. H., & Ludwig, D. S. (2021). Behavioral Characteristics and Self-Reported Health Status among 2029 Adults Consuming a “Carnivore Diet”. Current developments in nutrition, 5(12), nzab133. https://doi.org/10.1093/cdn/nzab133
6. Tóth C, Clemens Z. Type 1 diabetes mellitus successfully managed with the paleolithic ketogenic diet. Int J Case Rep Images 2014;5(10):699–703.
7. Dalen, J.E., Ryan, K.J., Alpert, J.S. (2017). Where Have All the Generalists Gone? They Became Specialists, then Subspecialists. The American Journal of Medicine, 130(7), https://doi.org/10.1016/j.amjmed.2017.01.026
8. Downer, S., Berkowitz, S. A., Harlan, T. S., Olstad, D. L., & Mozaffarian, D. (2020). Food is medicine: actions to integrate food and nutrition into healthcare. BMJ (Clinical research ed.), 369, m2482. https://doi.org/10.1136/bmj.m2482
9. Chen, J., Mullins, C. D., Novak, P., & Thomas, S. B. (2016). Personalized Strategies to Activate and Empower Patients in Health Care and Reduce Health Disparities. Health education & behavior : the official publication of the Society for Public Health Education, 43(1), 25–34. https://doi.org/10.1177/1090198115579415
10. Ormazabal, V., Nair, S., Elfeky, O. et al. Association between insulin resistance and the development of cardiovascular disease. Cardiovasc Diabetol 17, 122 (2018). https://doi.org/10.1186/s12933-018-0762-4
11. “From Pain Management To Improved Performance | Dr. Shawn Baker & Seth Gross”. YouTube. Uploaded by: Dr. Shawn Baker Podcast. 2022. https://www.youtube.com/watch?v=g7iqsDiGK8s