RHR: All about the Carnivore Diet, with Dr. Paul Saladino

In this episode, we discuss:

• How Dr. Saladino got rid of his eczema
• What the carnivore diet is
• What “well-raised animal foods” are
• Whether you can eat fish and seafood on the carnivore diet
• What a typical daily meal plan looks like on the carnivore diet
• If the carnivore diet is a good fit for you

Show notes:

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Hey, everybody, Chris Kresser here. Welcome to another episode of Revolution Health Radio. This week, I’m excited to welcome Dr. Paul Saladino as a guest.

Paul is a classically trained physician who completed his residency at the University of Washington. He’s board certified in psychiatry and is a certified Functional Medicine practitioner. He went to med[ical] school at [the] University of Arizona where he studied integrative medicine and nutritional biochemistry. Prior to med school, Paul worked for four years in cardiology as a physician assistant.

And as you may know, if you’ve heard of Dr. Saladino, he’s one of the foremost experts in the world on the carnivore diet, which is something that a lot of you have been asking me about recently. So I’m excited to share this podcast with you. Paul used the carnivore diet to help with his eczema and experienced a myriad of benefits, including resolution of his own autoimmune issues. He’s also worked with hundreds of clients who’ve been able to resolve long-standing health conditions with the carnivore diet.

Paul and I don’t agree on all aspects of the carnivore diet. He had me as a guest on his show where we talked about this, and I expressed some of my concerns about it long-term. And we’ll include that link to that episode in the show notes. Because in this episode, I wanted to do something a little different, and just cover the more practical elements of the carnivore diet. What is it, really? What foods should be included and excluded? And how does that differ from person to person? And which types of people tend to benefit most from a carnivore approach? So that’s what we’re going to talk about today. I really enjoyed the conversation with Paul, [and] I think you will, too. So, without further delay, let’s dive in.

Chris Kresser:  Dr. Paul Saladino, welcome to the show.

Paul Saladino:  Thanks so much for having me on, Chris. It’s good to see you again.

How Dr. Saladino Got Rid of His Eczema

Chris Kresser:  Pleasure. Yeah, it’s been a while. And what have you been up to? What’s new in your world?

Paul Saladino:  I’ve now moved to Austin, Texas. I’ve got some exciting things happening here that we can talk about in the show. I’ve got my book (a second edition is coming out in early August) and [I’m] just kind of settling into life in the southern part of the middle of the country and exploring the wilderness out here. Getting into some lakes and rivers and stuff.

Chris Kresser:  Yeah, now you’re a fellow California refugee.

Paul Saladino:  There’s many of us.

Chris Kresser:  So many of us. Yeah. Great state. I mean, I spent most of my life there, grew up there. Still love it, but it felt like it was time to go.

Paul Saladino:  And that’s exactly how I felt, too, that it was time to kind of try something else and we were just talking before the podcast about how much you love the outdoors in Utah. And I’ve been there a bunch and it’s beautiful there. And I’m excited to explore the outdoor stuff and a little bit of adventure here in Texas, too. So I think that’s what it’s about. More space.

Chris Kresser:  Yeah, a little more space. Let’s start from kind of the beginning. How did you get interested in what is now known as the carnivore diet? Was it even called the carnivore diet when you first started exploring it? Yeah, what led you down this path?

Paul Saladino:  It was kind of this progression, mostly spurred by my own medical issues, specifically, autoimmune issues, including eczema and asthma. I had moderate eczema growing up as a kid. I definitely had asthma at times that was limiting from time to time, especially with exercise. My dad is an internist. My mom is a nurse practitioner. And though they had great intentions, I think that they overmedicated me as a kid, which was sad. I remember them feeding me theophylline in applesauce growing up for my asthma and being forced to take short-acting beta-agonist inhalers like albuterol frequently as a kid, and it was just a bummer. And then some people grow out of those as they get older. Mine progressed.

The asthma wasn’t horrible, but the eczema got a lot worse as I got older. I finished college and didn’t want to go to medical school then. [I] took a bunch of time off, had some pretty severe eczema flares that were pretty debilitating, and eventually thought, you know what, maybe [I’ll] go into medicine. I started out as a physician assistant in cardiology, worked for four years doing that, and pretty quickly realized that the mainstream medical establishment, despite very intelligent physicians who were very well intentioned, wasn’t really resonating with what I wanted to do in my life. It was too pharmaceutical-based and symptom-focused for me. And I think that I just create constructs for medical illness more like an engineer, and I really want to know what’s at the root of things. That’s an obsession of mine.

And so I went back to medical school. And throughout that process of medical training, the second time I went to medical school, really, and then residency, I was always trying to understand if there was some commonality among chronic disease. I’m kind of fascinated by these ideas of unifying theories. I think it makes it so much easier. Of course, not everything can be explained by one thing. But if there’s a common cause of many illnesses, that’s an interesting point that we can press on or modify and help a lot of people.

So that was really my interest, and built around all of that was my own continued illness and thinking, well, if I want to understand what’s causing illness in other people, I should probably continue to think about what’s causing me to keep having eczema. I had a suspicion for many years that it was related to food and iterated multiple times on my diet. I had a six- to seven-month raw vegan phase, which didn’t help it, but resulted in 25 pounds of lean muscle mass loss, which was not a good thing. [I] went back to a Paleo diet. Pretty much an entirely organic Paleo diet for the ensuing 10 to 12 years and that seemed to help with body composition. It allowed me to gain more muscle when I wasn’t overtraining and running like a madman. But the eczema continued to get worse, and at times, it was so bad that it was all over my back.

As most people know who have skin conditions, they tend to occur in the same spot. So I get eczema [on] my lower back. I joke that it’s like my eczema tattoo or my eczema tramp stamp, and I’ll get it on my wrists. And I would just, it came and went. And at times, it got very severe. I remember one summer in Seattle where I was doing residency at the University of Washington that it was so bad that it was just weeping and just very hard to, it was right on my beltline. It was just weeping all over my pants and my belt. And I was like, man, this is so bad. What am I doing? I felt like I was eating a reasonably good diet. And I think a Paleolithic-type diet is a very reasonable type [of] diet, but it wasn’t working for me. And I went further down the rabbit hole and began learning. And this was probably four or five years ago, at this point, more about the things in plants and animal foods that can trigger immune reactions. And I thought, well, maybe it’s dairy. Let me cut out dairy, or maybe it’s egg whites. Let me cut that out. That helped a little bit, but it didn’t completely eliminate it.

So I thought, well, what else is there? Maybe it’s a histamine-producing food. Maybe it’s an oxalate; maybe it’s a lectin. And that was really the beginning of this sort of interesting thread of compounds in a variety of foods, both plant and animal foods that can trigger immunologic reactions in humans on a case-by-case basis, and don’t seem to affect everybody the same way but can be problematic. Personally, what I ended up with about two years ago was an entirely animal-based diet. And that was something that, from the beginning, was challenging for me ideologically because of my training in Functional Medicine, and all the things that I had been taught about [the] benefits of plant foods. And I thought this can’t be good. What about these compounds in plant foods that we think of as beneficial? What about fiber? And so I really had to challenge those paradigms, those dogmas that I had been taught.

And what I began to understand was something that was quite interesting for me. And that really led me into this world of an animal-based diet, with the research that I ended up doing and the book that I wrote, The Carnivore Code, again, the second edition is coming out August the fourth, [and] what I discovered was that with regard to a lot of that stuff, the story wasn’t quite as clear as I had been led to believe. And I didn’t feel like there was any necessary benefit to those compounds in human diets. And it was totally fine to leave them out; in fact, in some cases, [it’s] beneficial to leave them out.

So it’s a pretty controversial stance; it’s certainly challenging the status quo. But we can go down any of those rabbit holes that we want to go down. I know that you and I have talked about it a little bit on a previous podcast that we did on my podcast. But that was really how I ended up there, through my own personal journey of health.

Since eliminating plant foods from my diet two years ago, I haven’t had any recurrence of eczema, nor have I spontaneously combusted due to a polyphenol deficiency or pervasive, massive oxidative stress. So things are going pretty well for me making the entirety of my diet based on animal foods. And I know we’re going to get into how I do that in detail and the practicality of it. But it’s not just any animal foods. There’s definitely some intention around the way that I eat those animal foods in an effort to do it in the most ancestrally, evolutionarily, nutritionally consistent way that I can. So yeah, that’s how I’ve arrived here.

Chris Kresser:  Great. Yeah. I appreciate that. So many of us have arrived wherever we have arrived through our own personal experience. And I think that, of course, on its own isn’t enough to recommend something to somebody else. But the old n equals one, but I think that our own anecdotal experience is often unnecessarily diminished as a source of information. Because it can be. It can lead us down a road that we might not have chosen otherwise. And it’s not a stopping place; it’s more of a starting place, as you pointed out, right? It was something that got you interested in pursuing it even further. And then when you did, you found a lot of information that contradicted what you thought you knew about nutrition before.

So I’m going to just interject here and say that there’s a lot of directions we could go in this conversation. One is to talk about, and perhaps even debate, the finer points of plant foods and whether or not they’re harmful or necessary. We did a little bit of that on the show that I recorded with you, which we’re going to link to in the show notes of this

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. And you had two great podcasts with Chris Masterjohn, who’s a mutual friend, where you did [a] very deep dive into these questions. One show, I think, that you hosted and one show where he had you on, and we’ll link to those episodes, as well. Because I don’t want to just beat a dead horse and cover the same territory in this show. I would like to focus more on some of the practical application[s]. What exactly is a carnivore diet? How do you do it in a way that you feel is safer and less likely to avoid some of the potential nutrient deficiencies that could occur if it’s not done well? What kinds of changes have you seen in people that you’ve worked with above and beyond your own experience with eczema? What kind[s] of changes have you seen in the folks that you’ve worked with?

I can talk a little bit about what I’ve seen in my take. And then we can talk a little bit more about what you’ve learned in the last couple of years or the last year, maybe even more specifically, and how the next, which I assume you’ve incorporated in the second edition of your book, what people might find is different in that edition based on your evolving knowledge. So that’s kind of [the] agenda. If there’s anything else you want to throw in there, I’m happy to chat about that, too.

Paul Saladino:  No, that sounds great. And I’ll echo your point that n of one is just n of one. But I think that, as you say, we shouldn’t diminish those anecdotes. And I think we can use those experiences as jumping off points and the beginning of compelling hypotheses that we can then go test and research and understand. I do think that, as we’ll get into in this podcast, probably as we start in defining the way that I see a carnivore diet, the reasons that I think thinking about animal-based diets is valuable in 2020. And I definitely think there’s variability between individuals in terms of food tolerance and what can work best for different people. But my take on that is probably different than the mainstream, as well, and I’m happy to dig into that, as well.

Chris Kresser:  And there [are] also even just differences within the carnivore community, right? Of people who are out there recommending this diet and doing this diet. There’s a spectrum of what is recommended. So why don’t we just start with just a simple definition. What is included and not included in a typical, or what, because I imagine that can differ from person to person. What do you recommend as like a starting place that works for the most people that you’ve seen?

Do you have questions about the carnivore diet? In this episode of RHR, Dr. Paul Saladino covers all the basics: what to eat and what not to eat, who may benefit from going carnivore, and much, much more. #nutrition #wellness #chriskresser

What Is the Carnivore Diet?

Paul Saladino:  Yeah. So my real intention, and what I’ve really come to at this point in my work is, and I feel like talking about these ideas is so important because of really two pieces of the animal-based diet discussion that I think are critical and central to this. And these will, in a way, circumscribe how I consider a carnivore-type diet to be or how I consider discussions of an animal-based diet to be valuable.

And these two ideas are firstly that animal foods, specifically well-raised red meat and ruminants, grazing animals, are incredibly valuable and indispensable for human health, and have been incorrectly vilified for 60 years, much to the detriment of human health, and should not be feared. So that’s a hugely important point. If nothing else comes out of my work but people including more red meat in their diet and being less scared of red meat, that would be an incredibly meaningful thing for me to do. And a big success, I think, and significantly improve the health of the population. We are at a point in 2020 where, sadly, it seems like there is an ever-increasing amount of misinformation about red meat and saturated fat. And I think that these foods are foods that humans have been eating for millions of years. And, like I said, they are a critically valuable part of the human diet in all stages of our life. And to omit them is really to accept sub-optimal health and, in many cases, profoundly negatively affected health. So the first piece there is red meat, specifically saturated fat, valuable foods for humans. We’ve been eating them forever, incorrectly vilified.

And the second piece that I think really frames this discussion is that plants exist on a spectrum of toxicity. That they are rooted in the ground. They don’t really have mobile defense mechanisms; they don’t have mobility as a defense mechanism. They don’t have teeth. Some of them have thorns, so we can pretty much tell their intention. But if we consider that plants are rooted in the ground, then it’s not surprising and it’s not really debatable from a botanical science or botanical chemistry perspective that the plants have developed myriad hundreds of thousands of chemicals as defense mechanisms against fungi, insects, animals, and, more recently, in terms of their coevolution on this earth with humans, to prevent them from being eaten.

Now, that is to say, also, that they exist on a spectrum of toxicity, [and] some people may have more sensitivity to those chemicals than others. But it’s pretty undeniable that plants produce defense chemicals and we should not ignore this. And if we are not thriving or achieving levels of health that we hope for, then both of those premises are important to consider. Are we eating enough of what I would consider to be the most nutrient-rich foods on the planet? That would be well-raised animal foods. Today in 2020, that’s well-raised ruminant red meat and organs. And secondly, are there plant toxins in our diet that we are ignoring and could be affecting us negatively? Now, I don’t think many people debate the occurrence, the presence of these plant toxins. What Chris and I have talked about, Chris Masterjohn and I have talked about,and what I’ve talked about a little bit with my friend Tommy Wood on another podcast, is just how individually good we are at detoxifying them.

The existence of the phase one and phase two detoxification systems in the liver [is] pretty good evolutionary evidence that we’ve been detoxifying these things, and we’ve been in an arms race against plants or with plants for many, many years. And I think what’s more debatable, or what is more or less clear in this situation, is how good each of us is at actually doing that. And then if, like I said, if we are not thriving, could we do better by leaving some or the majority of these plants out of our diets? So that’s a long-winded answer and I’ll just summarize it to say that a carnivore diet is basically the perspective that prioritizes animal foods, specifically well-raised animal foods, eaten nose to tail, and gives some attention to a spectrum of plant toxicity.

In my book, The Carnivore Code, I’m pretty careful not to say that I think everyone on the planet needs to eliminate all plants. But I’ve created five tiers of a carnivore diet with the first tier being what I would consider to be carnivore-ish, and including the plant foods that I think of as the least toxic. Again, it’s just my perspective. It’s kind of my paradigm, but [I] did make an effort to give people a framework of the least toxic plant foods, if they choose to include some of those in their diet for flavor, variety, texture, color, things like that.

Chris Kresser:  Yeah. Okay, so lots to unpack there. I think we’ll skip over the further discussion on whether saturated fat and animal foods are harmful. Because, hopefully, unless someone just started listening to the show yesterday, they’ve heard me advocate for that many, many times, and have been reading my articles for many years; and that’s a very contentious view in the dominant paradigm, right, but not on this show. So I want to spend time talking about some of the other elements of what you described there starting with when you said well-raised animals, and today that mostly means ruminants. So tell us, and by that translating for folks who are listening, we’re talking about, I assume, beef and lamb as red meat, as the primary source, and then, of course, wild game like venison and elk and moose if people are hunting or able to access that some other way. Why are you not including, or if this is true, chicken, pork, and seafood?

Paul Saladino:  Yeah, great question. I just want to say I appreciate all your work. And I’m sure your listeners do, as well, to exonerate and to defend the red meats. So we are compatriots in that respect. And it’s been well-appreciated by many of us, Chris.

Chris Kresser:  Thank you.

What Are “Well-Raised Animal Foods”?

Paul Saladino:  So thank you for all of that. So I love that you draw this nuance out and it is something that is important to talk about. So when I say well-raised animal foods, we need to dig into this a little bit. And by well-raised animal foods, what I’m thinking of or really meaning is animals that are eating a “species-appropriate” diet. And in today’s world in 2020, you and I spoke before the podcast a little bit, you said you were learning to shoot a bow. I think that getting wild animals is what we’ve always done and bow hunting is a great way to do that. I actually went bow hunting in January of this year, and was able to respectfully, gratefully take a deer, and that was a very spiritual thing that I’ve talked about on other podcasts.

But we can’t all be hunters, though I think we all are traditionally ancestrally hunters. So, when we’re thinking about animals, ruminant animals, like you say, sheep, cows, bison, maybe people can get deer or elk that are raised on a farm and eating grass, things like this, these are the animals that are eating their most closely species-appropriate diet. And that’s drawn in stark distinction or contradistinction to things like chicken and pork. And this is something I’ve started talking about more recently, and will continue to unpack in a cookbook that I’m writing for the winter. But when we think about those foods, and people sometimes throw their hands up a little bit here and get flustered, but I just want to frame it from the perspective of knowledge is power. And the listeners can use this knowledge to make the best choices they can within their own framework of their own lives.

But chicken and pork are generally not eating a species-appropriate diet. And the main problem I see with chicken and pork in today’s world is that they are eating corn and soy. The problem with chickens and pork eating corn and soy is that those two things are very high in omega-six fatty acids, specifically linoleic acid, which is an 18-carbon, omega-six fatty acid. And that’s a very problematic molecule for humans when we consume it in excess. And this one point has been a fascinating rabbit hole that I’ve been going down in the last few weeks. It’s something I’ve talked about on my podcast previously with Ivor Cummins, and I think it’s a point that really cannot be overstated, and it’s complex. So it’s important to unpack. But humans do not make polyunsaturated fatty acids. We have a biochemical process known as de novo lipogenesis by which we make saturated fatty acids and then we have an enzyme called SCD1, stearoyl-CoA desaturase-1, which makes the saturated fatty acids into monounsaturated fatty acids. And, of course, I’m talking about the number of double bonds in these long-chain carbon fatty acid molecules.

But humans do not make polyunsaturated fatty acids. We don’t have the enzymes to do that. This is why we consider those molecules to be “essential.” But the amount of these molecules that we need is very low and, ancestrally, it’s pretty clear that we would have had a small amount of polyunsaturated fatty acids. This includes both omega-three and omega-six fatty acids in our diets. And the omega is just a designation that refers to the position of the first double bond from the end of the fatty acid molecule. So an omega-three has a double bond between carbons three and four from the end of [the] molecule and omega-six between carbons six and seven. It’s a little hard to visualize, but I think if people look up the difference between linoleic acid and an omega-three, like eicosapentaenoic acid (EPA), they’ll see what I’m talking about here.

So we can’t make polyunsaturated fatty acids, which means we should get them in our diet. But traditionally ancestrally, they’re not very present in animal foods. And they’re a little bit more present in plant foods, but not a whole lot based on what we would have, I think, traditionally ancestrally eaten. I think that the number that seems most reasonable to me is a consumption of maybe 2 percent of our dietary fat as linoleic acid. Now in 2020, most humans get 10 to 12 or 15, some even 20 percent of their dietary fat as linoleic acid.

Chris Kresser:  And a lot of that is from soybean oil, right?

Paul Saladino:  Soybean oil, corn, canola, safflower, peanut. These oils are.

Chris Kresser:  Cottonseed.

Paul Saladino:  Cottonseed. They’re pervasive. And human biochemistry appears to go off the rails when we exceed what is probably an ancestrally programmed amount of linoleic acid in our diet. Because these fat molecules actually serve very important signaling roles in the human body. And we can get into that, as well. There’s a lot of really interesting kind of esoteric biochemistry here. There’s a really great blogger named Peter Dobromylskyj who has a blog called Hyperlipid. He’s spoken about this in what he considers to be a protons model of obesity and insulin resistance.

But really, the high level here is that excess consumption of omega-six fatty acid in these vegetable oils, specifically linoleic acid, really appears to break human biochemistry badly. It’s very well demonstrated in animal models. And it’s something that isn’t really considered. There are lots of people doing great work here, Cate Shanahan and others, and it’s something I’ve been talking about a lot recently. But going back to the original point, it’s the idea that hey, if you’re eating a pig that is fed corn and soy, that pig’s fat is 12 to 14 percent linoleic acid. But if you’re eating a wild hog that you hunted in the wilderness, that pig’s fat is going to be maybe 4 percent linoleic acid. And if you are eating a grass-fed cow, the fat from that animal is 2 percent linoleic acid. So there’s a real[ly] big difference here.

And the same is true with chicken and poultry and birds. And chicken [is] not quite as fatty. But if someone were eating a duck or even the eggs from chickens that are fed corn and soy [and] are going to be enriched in linoleic acid, as well, with the same kind of proportions, we’re getting five to six times, sometimes 10 times, the amount of linoleic acid in the fat of these animals when we are eating them when they’re fed corn and soy. So most of your listeners, I suspect, [are] very savvy and are aware of the dangers of vegetable oils. Though even the [World Health Organization] (WHO) was recommending consumption of these oils during the coronavirus pandemic.

Chris Kresser:  Yeah, I saw that.

Paul Saladino:  Which is just crazy. And I think the mainstream is certainly not aware of this problem. But I think a lot of people are not aware of this kind of hidden source of linoleic acid in our diets. And even if they’re eating an animal-based diet, if they’re eating pork and chicken or eggs frequently that are fed corn and soy, they could be getting a little too much linoleic acid. And that can be a hidden source of these vegetable oils. So you can get vegetable oil in your chicken and pork, which is probably not the way we should be eating. And it kind of wraps back into something that I think you’ve been saying for a long time. It’s just, hey, eat like your ancestors, and we’ll be good. But that’s getting harder and harder in 2020.

Chris Kresser:  It’s definitely harder to do. Let’s assume somebody does have access to pasture-raised chicken. And by that, I mean truly pasture-raised chicken, not chicken[s] that are in a barn that [has], like, a little balcony that they can go out on, which, unfortunately, in some of the supermarkets, that’s what qualifies as free range.

Paul Saladino:  Yes.

Chris Kresser:  But they’re buying them from a local farm, let’s say, or a source where they know that they’re truly pasture-raised, and they’re eating grubs and worms and they’re out there, pretty much in a kind of ancestral chicken environment. And let’s say someone also has access to heritage pork, which is, fortunately, becoming a little bit more readily available than it probably was five or 10 years ago. Because the demand for it is growing. Is it your position still that because even in those ancestrally raised poultry and pork, the omega-six content will be higher than it is in pasture-raised beef? That beef or lamb should still comprise the majority of meat intake? But that chicken and pork might be okay in moderation, if it comes from, if it’s pasture-raised?

Paul Saladino:  Yeah, and I think, I like that you draw the details out there, that if you go to the supermarket and the eggs say pasture-raised, my understanding is that just is the amount of space that the chicken has. It doesn’t have anything to do with what the chicken is fed.

Chris Kresser:  Yeah.

Paul Saladino:  And so you’d want to get corn- and soy-free eggs, and then even inquire, if you could, what are you feeding your eggs to a local farmer? We’ve got a guy here in Austin at Shirttail Creek Farms and I asked him, what are you feeding your chickens? He has corn- and soy-free chickens. And you’d want those chickens to be eating as little bit of these grains as possible. And with pork, like you’re saying, there are more heritage breeds, and there’s a great farm in Georgia that I really appreciate, White Oak Pastures, and I called them up the other day. They’re doing amazing regenerative agriculture. And I called them up and said, “Hey, Jenny, what do you think about having a section of your chickens not eat corn and soy?” And she said, she had a Georgia accent, she said, “Well, we’ll do it. Let’s do it. Let’s work on it.” And they don’t feed their pigs soy, but I’m working with them to develop low polyunsaturated fatty acid (PUFA) pork and chicken kind of to start addressing this because it’s too rare. But it’s awesome when there are farms that are willing to do that. And I think in that situation, moderate consumption of those is probably fine. But in general, I think that just because of the way that ruminants are raised, it’s pretty hard to beat an animal eating a truly ancestral diet. And ruminants also have a unique biochemistry whereby they can control the amount of polyunsaturated fat in their body better than monogastric animals. So there’s some homology between the biochemistry of a chicken and a pig and a human because we are all monogastric animals. But ruminants don’t accumulate polyunsaturated fatty acids in the same way. So they’re going to have lower amounts of those.

Can You Eat Fish and Seafood on the Carnivore Diet?

Chris Kresser:  Okay, so we’ve talked about red meat, pork, and poultry. And also game meat. What about fish and other types of seafood like shellfish?

Paul Saladino:  Yeah, so I wish that I had a time capsule, and I could go back 500 years or [a] thousand years and scoop some tuna and salmon and shellfish out of the sea and do some analyses of the heavy metals and the toxic load of these animals. People may have heard the story of Tony Robbins as a pescatarian getting frank heavy metal toxicity. He’s talked about it on Tim Ferriss’ podcast. I think that it’s similar in this situation with these fish except that my concern, not being an oceanographer or [a] marine biologist, but my concern is that as you go into the ocean, it’s not so much that the fish are not eating their ancestral diet, or their species-appropriate diet, it’s that they are swimming in an increasingly toxic medium.

It’s kind of like the best thing I could compare it to would be like eating cows or chickens and pork raised in Wuhan, China, not because of coronavirus, but because that is one of the most polluted airstreams or air pockets in the world. So you can imagine that eating a cow raised in Tokyo may not be the best thing to do. Unfortunately, again, my sense is just that most fish now are living in something like the equivalent of Tokyo or Wuhan in terms of what they are “breathing.” I think small amounts of fish are fine, but clinically, what I’ve seen is that even in people who are eating wild Alaskan salmon, they will bump their mercury levels in the blood if they do that frequently. And I’ve seen repeatedly when people eat halibut, or larger fish, sea bass, Chilean sea bass or opal, that the mercury goes very high very quickly on some of these assays like Genova’s NutrEval and stuff. I think it’s probably organic mercury, methyl mercury as opposed to inorganic mercury, but it’s still probably not a good thing to be getting all that mercury. And as much as I love shellfish and shrimp and scallops, there’s just a lot of cadmium and some of them even accumulate mercury in those fish, too.

So it’s really with a lot of sadness and disappointment that I personally am cautious with those foods these days. And I think that a lot of mainstream “practitioners” will recommend fish and seafood because they fear red meat and saturated fat. Well, we don’t have to fear red meat and saturated fat, and I don’t necessarily believe that fish are a better option. I think that low-mercury, low-cadmium fish and shellfish are reasonable from time to time, but to make it the majority of our diet, in my opinion, would require pretty careful monitoring of heavy metal levels, and would be something that I would be a little concerned about. So it’s kind of, I mean, we live in a strange world, don’t we?

Chris Kresser:  We do. I think this is another situation where individual tolerance makes a big difference. We do a lot of heavy metal testing in our practice, and some people who eat predominantly fish as their protein source don’t develop metal toxicity at all. Other people who only eat seafood fairly sporadically seem to have more problems. And I think this is where things get very complex, as it does with any kind of dietary input or other input, because it’s not just the input that makes a difference; it’s how the internal ecosystem responds to that input.

So, in the case of metal toxicity, how effective is phase one and phase two and phase three detoxification that you mentioned before? Does that person have genes [that] make the biotransformation and detoxification of metals more difficult? What is the status of nutrients in that person that are essential for detoxification of metals and other toxins? So all these things go into determining whether the same amount of intake of a particular substance is going to cause problems. So, in other words, you could have 10 people that are eating the exact same amount of seafood and the exact type of seafood, and you would see maybe 10 different levels of toxicity in those people ranging from zero to significant.

Paul Saladino:  Yeah, I agree with you completely. And I think there are all those other factors. What is their glycine intake? What’s their glutathione status to detoxify it? Do they have a single-nucleotide polymorphism (SNP) in phase one or phase two, or are they constipated and not pooping? And that’s what we call the phase three detoxification, right? So yeah, there’s lots there to account for. But I think that there are many pieces to this equation in terms of practicality. Are we eating fish and shellfish because we fear red meat? And what information are we basing that on? Or are we eating it because we enjoy it? There’s lots to consider there.

What a Typical Daily Meal Plan Looks like on the Carnivore Diet

Chris Kresser:  Yeah. Okay, so I want to talk about, like, just even bring this, flesh this out even more for people, like a day in the life of your food intake and maybe just a typical carnivore diet intake both in terms of what you’re eating and the quantity that you’re eating. Because I think a lot of questions that people have around this are, like, “All right, so if I was eating meat, and then also other carbohydrate sources, which would include non-starchy vegetables or plant foods or fruit and also then starchy plants, like potatoes or sweet potatoes or something like that, how am I not just going to waste away to nothing?” Of course, some people want to lose weight, and that’s one of the potential benefits of a carnivore diet, but for someone who’s not necessarily wanting to lose weight, that’s a question that comes up a lot. So what do you eat on a daily basis? What [does] a typical day of food intake look like for you? And yeah, let’s start there and then I can ask some follow-up questions.

Paul Saladino:  So I, in the book, I created those five tiers of a carnivore diet to give people frameworks that allow for some fit to their own lifestyle. I think I’ll walk you through those. And the last one, tier five, is the way that I eat.

Chris Kresser:  Tier five being the most carnivore?

Paul Saladino:  Yeah, well, yeah.

Chris Kresser:  One is carnivore-ish.

Paul Saladino:  Yes.

Chris Kresser:  And five is the other end of that spectrum.

Paul Saladino:  Yeah, five is full nose to tail.

Chris Kresser:  Right.

Paul Saladino:  And as we get through that, we can talk about the organ meats, too. But if I, a lot of times when I talk about the way that I eat, I have to really create the overarching caveat that it’s not going to be for everyone. And I mean, I’m the astronaut, right? Like, I wrote a book. I wrote the book on the carnivore diet, so I’d better be living it in the best way. And I personally like to experiment with organ meats, but [I] realize that not everyone is going to be able to go there. It’s like Candyland. You don’t get to go to the end from the beginning. You’ve got to go through it unless you get a special card in Candyland. So the tier one carnivore diet, I think, is my framework that will be applicable to most people. And it is based and centered around animal foods. Mostly well-raised red meat ruminant foods, like we talked about, and eggs if they’re tolerated. And to that, the plant foods that I, the way that I think about plants, and this may be different between different people, and we may have differing opinions here.

When I think about a plant, it’s rooted in the ground and it really, this is anthropomorphization, but bear with me. It doesn’t really want leaves, stems, bark, [and] roots eaten. Especially not seeds eaten. And so I would consider,and in the book, I make the case with many studies and as much research as I could find at the time that I wrote it to kind of back these claims up, but I think that seeds, specifically the seeds, nuts, grains, and legumes, those are all plant babies, those are all plant seeds. Those are like the Moses that gets put on the River Nile, and it’s very susceptible. It’s very defenseless. So plants have had to encase that in many types of defense chemicals. And this is, again, sort of botanical fact and science; it’s not really conjecture. The seeds of plants are full of antinutrients and digestive enzyme inhibitors and oxalates and phytates and things that, from my perspective, are pretty clearly toxic and meant to be a dissuading factor for animals and humans to eat them.

So I think of plant seeds, seeds, nuts, grains, and legumes, as the most toxic parts of plants followed quickly thereafter by leaves, stems, and in some plants more than others, the roots. So, from my perspective, things like leafy greens cause a lot more problems for humans than they are beneficial to them. So now, the other end of the spectrum is the parts of plants that are less toxic, and people may be surprised at this, but I think of the fruit from plants as the least toxic part of plants. And this is the part of the plant that it wants you to eat. It’s asking you to eat this fruit. And some fruits have seeds encased in them and you can’t avoid the seeds, like a strawberry. But most fruit has a real clear clustering of seeds, like an apple, which are full of things like cyanogenic glycosides that are saying do not eat my seeds, or many other fruits, like a peach is a stone fruit and that little quote almond in the middle of a peach has, again, [this] hydrocyanic acid and these very toxic things in the “almond” in the middle of a stone fruit. Those are very toxic seeds.

And so plants want you to eat the fruit. I think it’s in the plant’s best interest to not put digestive enzyme inhibitors and other problematic things in the fruit. We can talk about fruit sugar and fructose and that kind of stuff in a moment. But I would consider the parts of plants that are fruit to be the least toxic parts of plants. Now, the nuance here is that many foods that we consider to be “vegetables” are actually fruit. Things like winter squash, and things like avocado, things like olive, these are all fruits, and we think of them as vegetables. Now, other fruits that I think people can probably tolerate are seasonal fruit, and berries are pretty reasonable.

So a carnivore-ish type diet is based on meat and those least toxic parts of plants. And I want that to be as broad for people as possible to make it reasonable but still to have some appreciation for which plants might be more toxic, and which parts of plants are least toxic. I don’t think that’s a crazy concept. Because even in Paleo spheres, the thinking, the paradigm is which plants are toxic, which plants are not toxic, AIP, autoimmune, Paleo, same sort of thinking. I’ve just advanced it a little bit or kind of put my spin on it saying, “Well, Paleo says this is okay. I don’t, from my perspective, that’s probably not the best type of food. But I would eat these foods instead.”

So it’s interesting because I actually had a conversation with Loren Cordain and his group recently, and they found an uncontacted tribe in the Amazon. And what they were saying was that that tribe was basically eating meat and fruit. I think that you see this pattern very frequently in indigenous hunter–gatherer groups unless they are starving, or unless they are really at a loss for food. That if they can get seasonal fruit, they will eat that. If they can get honey, they will eat that, and if they can hunt an animal, they will eat that. Those are sort of the staples. And in certain situations, if they are very low on food, they might go looking to dig up tubers, but that’s kind of the next one down the rung of the ladder. So in a tier one carnivore diet, you’ve got those, the meat and the eggs that make up the centerpiece and then the fruit and the non-sweet fruit, the berries, the avocado, the olives, the squash, the winter squash, as like the more palatable foods from the plant kingdom. So that’s kind of [the] plants that are least toxic plus animal foods.

Chris Kresser:  So can you give folks an idea of either using percentages or like a plate or meals, what that might look like in terms of intake in a given day?

Paul Saladino:  Yeah, so for that one, in The Carnivore Code, I talked about it being anywhere from 75 percent meat to 85 percent meat. I think it’s flexible with what people want to do with those things. I think that when you’re eating an animal-based diet, a lot of the food you’re eating is from animal foods, and that’s in my opinion, and I try, like I said, I backed this up with science in the book, that’s the most bioavailable source of nutrients for humans. So the majority of the food, more than 50 percent of your food, is animal food. And it depends whether you want to do that by calories or by actual weight of the food. And I think about it from, like, a caloric perspective. More than half of your calories are coming from animal food because that’s an easier way. And I think that the majority of the nutrients are coming from the animal food as well with the plant foods. And those amounts are fairly flexible with what people want to do. But ultimately, what we’re working, what we’re thinking about are adequate protein intake to allow for muscle protein synthesis and repair, adequate caloric intake, and then adequate micronutrient intake.

And I think that we will satisfy all those conditions most readily if we include more animal foods in our diet. If we go and eat, 70 percent of our diet is avocados, they might get enough calories, but we’re not going to get enough protein and we’re going to be certainly deficient in many nutrients. So one of the things that I think is incredible about animal foods, specifically when we’re eating animal foods nose to tail, is that nutrient availability is really high. And nutrient variety is also very high. So the more animal foods we can eat, the better. But I give some flexibility to people or I suggest some flexibility in terms of what they want to do in their diet. But I’ll say that the majority of the diet is animal foods, in terms of calories, macronutrients, and micronutrients. And then people can include the other things as they want to with the understanding that you want to meet a protein goal, you want to meet a calorie goal, and you want to meet micronutrient level goals, as well. Is that enough clarification?

Chris Kresser:  It is, yeah, and let me, we’ve only got about 10 minutes left. So I want to skip forward to number five, and then they can get the details in your book, which is excellent. And you can tell people where to find that at the end of the show. Because I want to ask another question I think is going to be [on] a lot [of] people’s minds just in terms of who should think about doing this. And we can finish up with that. But so first, a clarifying question about all phases before you go on to phase five, or the fifth tier, whatever you refer to it as. You mentioned calorie goals. Has it been your experience, is it your goal to eat the same amount of calories that somebody was eating prior to going to carnivore on the carnivore diet, assuming they want to maintain weight? Let’s leave weight loss or weight gain out of it for a second, but if somebody wants to eat the same, maintain their weight, has it been your experience that they need to eat the same number of calories, more calories, or fewer calories on this approach?

Paul Saladino:  Interestingly, this is one of the other places where things seem individual. I think you and I would agree that all calories are not created equal. And macronutrient intake [and] micronutrient intake can affect these, and that kind of mirrors the conversation about linoleic acid, as well, that certainly the quality of the food you eat, whether it’s [of] plant or animal origin, can affect the efficiency of your metabolism and your underlying insulin resistance.

So, though I’m saying you need to get enough calories, I’m saying that fairly loosely, and I don’t track calories strictly in my clients unless we’re having a real problem maintaining weight or a real problem losing weight, and we’re trying to really uncover something that we’ve missed. Most of the time, satiety is a good guide, and some people are going to eat more calories. Some people end up eating less calories, and some people end up eating about the same. But I do have to say that I think that the idea of calories is a very, it’s a crude estimate. But it’s kind of like walking around with one eye shut. You don’t really have a lot of depth perception. It can certainly have its drawbacks, and sometimes you walk into a table and it doesn’t work very well.

So it’s something, but it’s not the [be-all and end-all]. So there’s no specific metric that I use there. Mostly just satiety and body composition goals. And I think we all know that if somebody has obesity, we want to try and work toward a resolution of that. And I think that happens through increased satiety. So, and I apologize. I have so much stuff to talk about.

Chris Kresser:  No, no. It’s fine.

Paul Saladino:  I’m not, brevity is a skill that I’m working on.

Chris Kresser:  Yeah, there is a lot to talk about, for sure.

Paul Saladino:  Yeah. But I can talk about tier five if you want.

Chris Kresser:  Yeah, I mean, it’s interesting that I know some people from, in the intermittent fasting world, eat only one meal a day and I’m pretty sure they don’t eat 2,500 calories in that meal or whatever their maintenance level would be. And yet they still, they reach a steady state where they are maintaining weight and not losing weight. So I wonder if that happens in some cases with people on [the] carnivore [diet].

Paul Saladino:  And you bring up a great point that meal frequency and timing can also affect basal metabolic rate. Clinically, what I have seen is that in my younger clients, one meal a day is often inadequate and may result in a steady state of body composition but can have negative hormonal consequences.

Chris Kresser:  Yeah.

Paul Saladino:  So, though I think intermittent fasting and time-restricted feeding are incredibly valuable interventions, what I have found personally in my practice is that two meals a day and a little bit more reasonable eating window works best for the majority of people. One meal a day is pretty small. It’s a pretty large fasting window that’s great short-term, but I’m not a fan of it in most people long-term.

Chris Kresser:  I agree. Most people can’t do well with that. Yeah, so let’s go for the fifth hardcore, the most hardcore tier.

Paul Saladino:  Hardcore carnivore.

Chris Kresser:  Yeah, and then we’ll talk about who, as a sign-off, who might be a candidate. Like, which people with which conditions or goals have you seen do best or respond the best to this approach?

Paul Saladino:  Yeah, absolutely. So on my website, which is CarnivoreMD.com, there is a video of what I eat in a day, and people can see all this in its glory. When I am thinking about food for people, I generally think about protein macros to start and use it as an anchor. I’ve found that about one gram of protein per pound of goal bodyweight works well. I’m about 170 pounds and I eat about 170 to 200 grams of protein a day, which means about a little less than two pounds of meat per day. Right now, I’ve been eating a lot of stew meat from Belcampo or White Oak Pastures. These are grass-fed regenerative farms, and it’s affordable. I don’t eat $50 rib eyes at all my meals. And I’ll usually cook that twice a day [for] breakfast and early dinner. And I’ll cook it in bone broth that I’ve made myself with a lot of the connective tissue in it. And then I’ll drink the bone broth. Right now, I’ve been eating some egg yolks with that, maybe three to four egg yolks a day from corn- and soy-free chickens and I’ll use Redmond Real Salt to taste. I won’t overdo it with the salt. And I’ll have organ meats at every meal.

People have probably the hardest part with organ meats, but I’ve grown to really appreciate them. We’ve talked about that a little bit before. But the idea with organ meats is really that muscle meat is just a part of the equation nutritionally and if we want to get nutrients like riboflavin or enough choline or selenium, or copper or zinc, or even the peptides that are uniquely found in different organ meats, we can’t just be eating muscle meat. So, I’ll eat a variety of organ meats throughout the day. Many people are not familiar with these, which is another reason that I wanted to do the cookbook. And in August, I will be launching my own sort of supplement company known as Heart and Soil. It’s HeartandSoilSupplements.com. We’re making desiccated, so freeze-dried organ meat capsules for people that can’t eat the organ meats the way that I eat them, or I use these as a supplement, as well.

But I’m really passionate about getting people more of this nose-to-tail nutrition in their lives. And I think that any way we can do this is a step in the right direction. Personally, I’ll eat liver; I’ll eat heart. I’ll eat more exotic organ meats like spleen or pancreas.

Chris Kresser:  Don’t forget testicle.

Paul Saladino:  Testicle I do eat. It’s traditionally eaten by men for virility, and it’s actually pretty darn good. Hopefully, at some point, you and I will get to share a meal and I can give you some raw testicle. I gave some to Ben Greenfield the last time I saw him. It kind of tastes like sashimi scallops.

Chris Kresser:  Interesting.

Paul Saladino:  So it’s really not as gross as you’d think. But testicle I will eat and all kinds of things. And then, like I said, I was doing bone broth, and I will actually eat [it]. One of the amazing things that I’ve discovered, and this is pretty ancestrally consistent, is that when you make bone broth with the trabecular bones, meaning the knuckle bones, you can actually eat the bone. And the rib bones have red marrow in them, which you can eat. So I’ll eat, I’ll crunch on a little bit of bone with my meals and people are just like, “What? This guy’s crazy.” But, like I said, I’m the astronaut. I’m thinking about what works and trying to do it in the way of my ancestors and personally feel like I’m enjoying pretty good health. So that’s pretty much how I eat. I eat it twice a day.

And then just one more thing to add there. For a year and a half of doing a carnivore diet, I had essentially no carbohydrates or only the carbohydrates found in glycogen and liver. And recently, I’ve been incorporating some carbohydrates back [in]. Those sort of tier one carbohydrates. What I’ve grown to really appreciate is raw organic honey with both of my meals. And I did a whole episode on my podcast with a continuous glucose monitor from NutraSense and really showed that eating honey twice a day did not make me insulin resistant. It actually lowered my fasting blood glucose. This is something you may have spoken about before. I think that low-carbohydrate diets, ketogenic diets can be very helpful in the short term. But I’ve really grown to understand that cycling makes more sense both from an electrolyte perspective and other perspectives. And I sort of cycle in and out of ketosis on a daily basis now with the intermittent fasting.

Chris Masterjohn and I had long conversations about ketosis previously. And personally, I found that long-term ketosis without some cycling of carbohydrates led to some pretty challenging electrolyte issues. I don’t think that carbohydrates cause insulin resistance. I’ve been pretty vocal about that from the beginning. And I think that in the setting of insulin resistance, carbohydrates can worsen it through mechanisms I’ve been talking about on my social media recently. But I think that in the setting of metabolic health, most humans can eat carbohydrates and maintain pretty darn good metabolic health. And personally, I’ve found that honey without the fiber treats me the best. So, and I would even consider in sort of a tongue-in-cheek way, honey to be a carnivore carbohydrate since it’s from bees. It’s not really a plant food in that way.

Chris Kresser:  Right, yeah. That makes sense.

Is the Carnivore Diet a Good Fit for You?

Paul Saladino:  That is how I eat. Your second question was who is a carnivore diet appropriate for? And I think that, I suspect that you and I may have differing opinions on this. What I’ve said from the beginning is if people are listening to this and they are thriving, then do what you are doing and don’t change a thing. But if you are not, body composition, mood, autoimmune disease, skin issues, psychiatric disease, libido, energy levels, then think about what level needs to change and realize that something like an animal-based diet is a viable option. It’s not the only option. You can try other things and see what works for you. But that’s really the message that I want to put out there. That this is an option that I don’t think people are considering. Certainly not mainstream medicine is not considering it. And like we said, red meat has been so vilified, that to do all red meat is just anathema these days. But I do want people to know that it’s an option, that it can be used either as an elimination diet, as a reset, as a “cleanse,” or as a sustainable long-term thing, as I’ve seen in my own life, and many other people are seeing in their specific lives.

But ultimately, I think it’s about quality of life. And that’s what you and I are doing. We’re trying to help people attain higher quality of life. And who am I to define what someone else’s quality of life is? I’m just grateful to be able to offer another possible solution to people who are not attaining their highest quality of life in this moment as something to be considered and to try and make sure that it’s something that’s safe and doable and valuable within the sphere of health.

Chris Kresser:  Well, Paul, it’s been a pleasure to have this conversation. You and I, what we share in common, we have, I think, a lot in common, but we appreciate the value of being able to speak about issues like this in a respectful and open-minded way and even to agree to disagree on certain topics without turning it into a contentious vitriolic debate, which we’ve seen enough of, I think, at this point. And they don’t typically tend to help people very much. So that’s something I’ve always appreciated about you and your work and our conversations.

And I would love for you to tell people a little bit more about the second edition of your book. The first edition was a huge success, The Carnivore Code; you can get it on Amazon. Well over 500 five-star reviews. So what has changed? What have you added to the second edition that’s coming out in August?

Paul Saladino:  So the second edition is, yeah, it’ll be out August the fourth, and perhaps the most exciting thing about the second edition is that it’s got, it’s published by Houghton Mifflin. So with a big five publisher, we’ll be in more stores. We’ll be in Walmart; we’ll be in Target. We’ll be in these stores where I believe more people who may benefit from this message will see the book and will have access to the book. It will be in Hudson in airports.

And so the main goal with the second edition is just to get it into more people’s hands to challenge the status quo. In the second edition, we’ve gone through and cleaned up some of the recipes a little bit. Adjusted a few of the percentages in the book, and whenever you self-publish [anything], there’s always a few grammatical errors. And then we added an index in the second edition to make it easier to find all the scientific terms. I’m sure you’ve realized this, as well, as soon as you write a book, you start thinking, “Oh man, I should have put this in that book.” So I’ve got a lot of ideas for the second book, which will probably be, which is going to be a cookbook in the fall. And then probably a third book coming at some point in the future. Who knows?

But yeah, so there [are] lots of things coming. But the second edition has a new cover, an index, a few things cleaned up in the text, and a much broader distribution. You can find that at TheCarnivoreCodeBook.com and I’m super excited to see how it does with [a] broader distribution. I really can’t wait for more people in the mainstream to see this book with a steak on the cover and think, “What? You can eat all meat? How could this possibly be healthy?” And just really challenge some paradigms and, hopefully, help people get to a greater degree of health.

Chris Kresser:  Great. Well, thanks again for the work that you do, and I highly recommend, even if you have the, so if someone has the first edition, is there any content change? Or is this mostly about broader distribution of the book, which is a worthy goal and reason for publishing a second edition?

Paul Saladino:  Broader distribution and the index to make it more accessible. It was such a quick turnaround that we pretty much kept the inside of the book and the stuff that I talked about similar. Like I said, we cleaned up some stuff, but the index makes it more.

Chris Kresser:  Yeah, index is a lot of work.

Paul Saladino:  Yeah, yeah. It’s not easy to get it.

Chris Kresser:  For a book like that.

Paul Saladino:  Yeah, exactly.

Chris Kresser:  Great. Well, and then your website for people who want to check out some of the online resources.

Paul Saladino:  Yeah, so the website is CarnivoreMD.com. And you can find, like I said, those videos of what I eat in a day, how I work out, how I play outside, and a link to all the podcast stuff, of my podcast, which is Fundamental Health, are there.

Chris Kresser:  Well, thank you again, Paul, for coming on the show. It’s been a pleasure to speak with you, and thanks, everyone, for listening. Continue to send in your questions to ChrisKresser.com/podcastquestion and we’ll talk to you next time.