Could the Carnivore Diet Revolutionize Inflammatory Bowel Disease Treatment?

Blood. Blood running out of a piece of rare meat onto the plate, sanguineous humor mixing with hot liquid fat. Or blood running down one's inner thigh as he bleeds in silent pain from ulcers in his colon, straining not to let loose his embarrassing secret in front of his peers or even in front of a live audience of 11,000 people. Blood in almost any setting is provocative, but isn't this a particularly potent contrast? It actually gives me goosebumps just to talk about and reflect upon because that latter scenario described me as well as multitudes of others who live or who lived in silent suffering with inflammatory bowel disease. Inflammatory bowel diseases include ulcerative colitis and Crohn's disease. And can be life-shattering conditions. I know for me, diagnosed at age 21, it completely upended my life and threw me from being an athlete and top academician into being a fragile, emotionally shattered, socially withdrawn shell of a human being. It's dramatic, but it's also true. And as much as I felt alone at that time, My suffering was—is—a common story, but for many others the story doesn't have a happy ending. I achieved remission through an experimental ketogenic diet. There's no doubt in my mind that it saved my life—or at least my colon. But because there are an absence of rigorous dietary trials for extreme diets for inflammatory bowel diseases, including and especially ketogenic diets and a form of elimination ketogenic diet called the carnivore diet—the name is self-explanatory there—physicians can't or won't recommend these diets to patients because they're not evidence-based. But absence of evidence isn't evidence of absence. In other words, the research question "Can a ketogenic and/or carnivore diet help treat inflammatory bowel disease?" even put it into remission, some might even say cure, hasn't been rigorously investigated. You can tell me why you think that is. However, there is solid biological plausibility to suggest these diets could help in inflammatory bowel diseases, including data showing therapeutic effects of ketones in animal models of inflammatory bowel disease, a correlation between lower colonic ketone levels and worse inflammatory bowel disease activity in humans, the fact that ketones stimulate anti-inflammatory pathways and can promote stem cell renewal in the gastrointestinal tract, and the fact that elimination of certain dietary components, including certain fibers, can shift microbiome metabolism in a therapeutic manner. Now, in this new study, new publication, a case series of 10 patients with histories of Inflammatory Bowel Disease, either Ulcerative Colitis or Crohn's Disease, we, my colleague and I, Adrienne Sotomayor, report on the remarkable stories of real people who live with real suffering, who lived with real suffering, only to go out on a limb and try something extreme that they report unequivocally improved their quality of life. All of these patients are now in remission on ketogenic, primarily carnivore diets for between 5 months and 5 years to date. With 8 out of 10 being in remission for at least a year despite severe prior disease. And they are also off all medications for inflammatory bowel disease. Of note, many of these patients did experiment with a litany of treatment options beforehand, including both pharmacotherapy and lifestyle therapy, including corticosteroids, various biologics and immunomodulators, specific carbohydrate diet, low FODMAP diet, many variations of whole food plant-based diets, and so on. But it wasn't until they tried their current ketogenic, primarily animal-based diet, that they went into near complete or complete clinical remission. And we quantified this using a validated inflammatory bowel disease quality of life questionnaire, the IBDQ-32, which scores across 4 domains: bowel symptoms, systemic symptoms, and emotional and social impacts, with a total possible score of 224, with 224 being ideal, i.e., no symptoms whatsoever. And the average score pre-diet was 95, which reflects horrible quality of life. And scores increased after diet adoption on average by a stunning 121 points to an average of 216 out of 224, i.e., clinical remission. These cases were also diverse, including 6 cases of ulcerative colitis and 4 of Crohn's disease, including male and female patients, patients aged in their 20s, 30s, 40s, 50s, and 60s with diverse dietary energy requirements, body shapes and sizes, and so on. However, at present, all of these patients consume a primarily animal-based ketogenic diet with between 67% and 82% calories from fat, 21 grams or less of dietary carbohydrates, with many strictly carnivore. These patients' diets saved their lives, and they speak to their own stories. For example, Patient 1 is a 62-year-old male. He was first diagnosed at age 30 as a second-year law student, and he suffered for decades. And he's now disease-free, as confirmed by colonoscopy. And he says that his keto carnivore diet let him forget that he had Crohn's disease. The decades that he dealt with Crohn's are like another lifetime, in his words. Patient 3 was a 31-year-old female— is a 31-year-old female— with an incredible family history of inflammatory bowel diseases, including in her brother and her sister and in 10 first cousins. I know, big family. Who herself was diagnosed at age 20 while pregnant and who experienced a fourfold drop in inflammatory markers over her first months on a carnivore diet and says, reports, within days my bowel movements changed from loose to normal, and within 2 weeks I have more energy than I did the past 10 years. When I last spoke to my doctor, he said that if I'm feeling incredible, he doesn't want to put me back on medications. She had previously been on anti-TNF-alpha biologics for years. And then she says, and that was so encouraging, especially since he had been really skeptical of the diet beforehand. I could go on giving the reports of the other 8 patients, although you can read those yourself, but you get the point. These are lives that were saved. And these stories have the potential to change lives, now and through inspiring future research. The fact remains, extreme diets are not socially accepted, patients are often dissuaded from experimentation, and standard of care cannot recommend these diets until rigorous controlled trials are performed, which this is not, and I'm not pretending it is. Of course, this is a retrospective case series with selection bias and without a control group. I'm not trying to brush that under the rug. It's what we could do with the resources available to us, by which I mean zero funding dollars, but access to a social network of real people whose lives have been saved and who want to tell their stories so they can save more lives. What this is, or what this should be, is a wake-up call. A PubMed ID screaming at medicine, "We need to invest in this work." Hopefully people will take interest with open minds rather than shut down and get defensive. I'd personally like to see a rigorous randomized controlled trial next of two extreme diets: whole food plant-based, possibly vegan, versus strict carnivore. Is this provocative? Absolutely it is. Would such a study provide important data? 100%. So let's put together a team of researchers to do this. People are certainly going to strawman this work. What I'd say to them is listen to what we—myself, Dr. Norwitz, and my colleague, Dr. Professor Adrienne Sotomayor—are actually arguing. We are not arguing that carnivore is the best human diet, that fiber is bad, that keto is supreme, or any of that. We are arguing that ketogenic, including carnivore diets, could have therapeutic efficacy for inflammatory bowel disease and very likely other autoimmune and inflammatory conditions. And we owe it to science and to patients to explore this possibility by investing in more research. I know there will be more discussions to come, and I welcome them. Stay curious, and please share this video, share this paper because I think it's important and I hope you agree.