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Yellowish Nodules on a Man Consuming a Carnivore Diet (jamanetwork.com)
34 points by cebert on Jan 29, 2025 | hide | past | favorite | 84 comments


Great comment on the medical site:

RE: "6 to 9 lb of cheese, sticks of butter, and additional fat incorporated into his daily hamburgers"

This implies a daily intake of hamburgers (presumably ground meat only if it's a strict carnivore diet) with 6-9 pounds of butter and cheese extra per day? Is that time frame correct? Is there an approximate daily kcal for that? A pound of butter is 3200 calories, while a pound of mozzarella is 1200.


A good friend of mine did this; not so much cheese I think but loads of cream, butter, and meat. He ended up with cardiac arrest, followed by sepsis due to an operation. He's mostly ok now though.


Or, if you prefer, local Florida news that links to the journal article: https://www.wfla.com/news/hillsborough-county/tgh-patients-h...


Missed a trick not starting this title with Florida man.


This one has pictures of his hands if you would like to see.


Not sure if cheese and butter counts as meat…?


They’re calling this a carnivore diet but it’s really an animal fat diet. Should more properly be called lipivore diet. The man wasn’t consuming mostly meat.


I’m curious how this diet compared to traditional diets of Inuit people. These diets are also known to be high in animal fats and proteins.

(1) https://www.sciencedirect.com/science/article/abs/pii/004896...


They also live in an environment where you burn substantial calories maintaining body temperature.

I was going to make a joke sbout how I'd bet this gentleman lived in Florida...

... but it seems like 2/3 authors are in Tampa, with the other in Houston.

Florida Man is a thing. (So glad I don't live there anymore)


Throughout history, the stick of butter was a main prey of the human carnivore.


Often included in carnivore diets. But obviously they're not.


Note that the abstract (since I can't read the full article; not on sci-hub) mentions that he has hypercholesterolemia, and doesn't specify whether this was actually caused by diet alone or because of genetics.

I've likely had orders of magnitude more cheese and butter than this guy, and I've yet to have yellow nodules or the 10 heart attacks I apparently should have had by now. Both of us are N=1 case studies, so basically meaningless outside of identifying a particular clinical condition.


He was having 3kg of cheese per day. You saying that you were having 30kg (orders of magnitude) or more of cheese per day? I don't believe you.


That would be only a single order of magnitude. "Orders of magnitude", plural, implies at least two orders of magnitude, which would be at least 300kg of cheese per day. I think you are responding to someone who was not very concerned with whether what they were saying was true or false.


Listen guys, I don't even drink water, just liquid cheese, and after my daily cheese cleanse (don't ask, too graphic,) I feel great. People always ask where I get this sharp cheddar cologne, but the scent comes naturally.


Something is fishy. How is it physically possible to eat 12,000 calories of cheese per day plus hamburgers and lose weight? Somebody here is lying.


You could give yourself rabbit starvation: https://en.m.wikipedia.org/wiki/Protein_toxicity


This is from lean protein, add fat and your body is okay. You need either fat, carbs, or both. But you can’t just run on protein.


I thought the same, but an open question for me (now) is what happens if you eat 3000 calories of protein and 3000 calories of fat or even carbohydrate. You have sufficient calories that your body doesn't need to metabolize protein for energy, but what happens to all the excess protein you consumed?

I assumed the excess protein would be undigested, but can't back that up with a citation.


There should be enough fat in 12000 calories to avoid rabbit starvation. I did not consider the load of metabolizing all that protein and assumed the body would eliminate what it didn't need. They're might be something in protein toxicity here.


If the ratio of fat to protein is high, and exogenous carbohydrates is relatively low in contrast, insulin levels should be closer to baseline (than a standard diet), as well as blood glucose, thereby keeping the Randle cycle minimized and so consumed energy gets used more by an on-demand basis or it gets dumped (literally). Part of the reason we poop is because, if our bodies literally used all of the mass we consume, we would either get too large in short order or spontaneously combust.

I don't think someone here is lying. There may be some level of exaggeration, as in my experience a lot of cheese (particularly hard cheeses) can lead to extremely painful stools, but calories really aren't as meaningful as one might assume, especially when switching from a diet that directly supplies carbohydrate and one that doesn't.

The human body needs a certain amount of glucose in the blood, but it can't get that from fats (at least as far as I am aware). It can obtain it from protein through a process called gluconeogenesis, but that's a relatively expensive process that requires more ATP than what ultimately results from it. The human body also treats that process in a more demand-driven manner than one where exogenous carbohydrates are consumed. This isn't an absolute, but it's generally less supply-driven. If protein can't be used for glucose or building tissue, it's more likely to become waste eventually.

See "rabbit starvation":

https://hekint.org/2022/01/26/rabbit-starvation-protein-pois...


You've found Gaston.


No, that's not what I was saying. There have been times where I've eaten about that much cheese in a day, but I've been eating abundant amounts of butter and cheese for much longer than that gentleman and have yet to have encountered any hypercholesterolemic symptoms. I did an experiment for maybe ~4 months around 7 years ago where I ate pretty much nothing but cheese and butter, and I consumed substantial amounts of both. I wish I recorded it properly. It would have been in the multiple of pounds. But outside that experiment, it's not uncommon for me to eat more than a pound of cheese alone in a day.

If it were a given that eating lots of fat leads to extremely high levels of cholesterol, my irises would look at bit strange by now at the very least.

Now excuse me while I go eat about a pound of eggs and cheddar cheese for breakfast. (not a joke)


How do you even eat 3 kilograms of cheese in one day?


> How do you even eat 3 kilograms of cheese in one day?

You slice it in small pieces. And add some wine. And a friend to call 911. /s


Ok, so you ate less cheese over a much shorter duration.


During that particular experiment. Without knowing the further details about that subject, I have been eating multiple pounds of highly fatty meat and cheese with the addition of butter daily for several years. It would be surprising to me that 2 to 3 pounds wouldn't show signs of mild hypercholesterolemia but 6 pounds a day would suddenly result in yellow nodules all over the place. It also doesn't make sense for this to happen to someone who isn't hypercholesterolemic based on how cholesterol is normally handled by the liver. It's a tightly regulated system.


Speaking as someone with familial hyperlipidemia / hypercholesterolemia and based on many years of conversations with multiple lipidologists…

Heterozygous FH will typically put someone at a total cholesterol roughly around 500mg/dl, and homozygous will get them closer to the 1000mg/dl mark. Dietary factors for most people will affect their lipids up to +/- 40mg/dl, and medication is generally required for anything beyond that.

For the gentleman with cholesterol nodules, that’s a not-unheard of symptom of homozygous FH and the associated cholesterol levels. I’m sure his diet is exacerbating it, however I would be genuinely surprised if that were the primary cause of his count being > 1000mg/dl. (With homo-FH and an extremely restricted diet, he’d still be unlikely to get below 900mg/dl)


Anecdotal, but if you follow carnivore diet groups on Facebook/IG etc you'll frequently see posts from people with TC over 500mg/dl. For example, the carnivorecringe IG account posted someone's labs in December who had a TC of 669 and an LDL of 558.

It's quite possible that it's a combination of diet and genetics, but people can quite easily get to incredibly harmful LDL levels with diet alone.

Edit: here's a case study of someone getting to TC of 488.7mg/dL. I think you'll struggle to get higher quality data than case studies because these kinds of diets are (thankfully) fairly uncommon and no ethics board is going to sign off on an intervention study that's likely to raise blood lipids by this kind of level.

https://academic.oup.com/jes/article/5/Supplement_1/A37/6240...


It's pretty easy to induce hyperlipidemia in mice by feeding them a keto diet. Wouldn't be surprised at all if it was the same in people

https://pubmed.ncbi.nlm.nih.gov/38948738/


Edit: misread your comment, apologies… I’m not sure about inducing it in people based on diet, as that seems to go against any desirable outcome, but this is a link to another FH case presenting cholesterol nodules:

https://pmc.ncbi.nlm.nih.gov/articles/PMC4498853/


Scihub has not updated their index for years, and is effectively dead. The article is not on Annas-archive either, but at least there is a chance it will show up eventually.


You eat 6-9 lbs of cheese a day plus sticks of butter and meat on top of that?


I am calling BS on this as a daily consumption diet, you would have to have a helluva constitution to pull this off and definite competitive eating levels of body control. You would need to completely override your brain’s satiety center. I eat a keto diet and it’s impossible for me to eat even a tenth this amount daily.


the rest of that sentence is

> …significantly higher than his baseline of [sic] level of 210 to 300

so they measured before and 8 months after the diet change to find a 4x increase in cholesterol


We're primates, biologically. We have GI systems very similar to those of the Bonobos, Chimps and Utangs. They are classified as "onmivores", but more specifically "frugavorian omnivores", which means: they prefer to eat the bulk of their calories from fruit, but are also observed to eat animals.

In normal situations (enough food to be found) that means they eat some bugs on a daily basis. In bad situations (not fruit to be found), they are known to hunt for small vertebrates.

Besides fruit they eat a lot of green leaves, but due to the low caloric content of leaves this is often left out.

We humans probably have a similar species diet to them. But we also have tradition, and moved to colder climates by using a technologies know as "grain" (domesticated grasses with artificially large seeds) and "cooking".

Every species can find their food in nature. It will look tasty to them and they can eat it without cooking.

This man's symptoms are not so weird. We're not meat+dairy eaters (no animal takes dairy after the weaning stage, that only mammals have).


Humans aren't specialized for eating plants and especially not green leaves. That requires a wholly different type of metabolism.

Meanwhile a lot of humans have no trouble subsisting of just a carnivore diet without any negative symptoms.

It's pretty accurate to call humans omnivores.


> It's pretty accurate to call humans omnivores.

As said: all primates are omnivores. And what you eat is up to you. But biologically we are very close GI-wise to the "frugavorian omnivore" primates mentioned.

> Humans aren't specialized for eating plants and especially not green leaves. That requires a wholly different type of metabolism.

Where's your research? I mean we are not grass eaters, like cows. But we do really well on tender green leaves. If you dont eat tender green leaves 2x per day you are advised to take a magnesium supplement.

> Meanwhile a lot of humans have no trouble subsisting of just a carnivore diet without any negative symptoms.

Where's the long term research? Many claim this, but the populations that have many centenarians are not carnivores. Populations with really high meat intake (Inuit), do not get very old. Many biologists agree our intestine is too long (ans several other reasons I forgot). You seem to have no case here.

Are you sure you are not falling for the diet fad wrt carnivoreism?


>Meanwhile a lot of humans have no trouble subsisting of just a carnivore diet without any negative symptoms.

You have any large studies to support this or just "Trust me bro" science based around the idea that consuming other animals makes ya stronk?

There are plenty of dietary studies and science which show that a high meat diet is pretty unhealthy over the long term. GI and colon cancers rates go up, heart disease goes up, along with other cardiovascular diseases, diabetes, etc. Lots of very preventable diseases are VERY prevalent in high meat diets.

You can always find individuals who buck this trend but over a large number of people the data is very clear that a high meat diet tends to be pretty unhealthy for most people.

I grew up near logging towns and the whole "carnivore diet" cult thing reminds me of when rural men will drink motor oil to prove how it doesn't hurt them. They're a stronk guy who will survive anything.


Humans are opportunistic omnivores. Just like dogs and a ton of mammals. We eat what's available and we're very good at adapting.


Previous discussion (88 points, 7 days ago, 88 comments) https://news.ycombinator.com/item?id=42798051


He ate three kilograms of cheese per day?!


If what goes in and what comes out is 1:1 by weight, he was sitting on some hefty stools.


I'm jealous, too.


Huh, so the only side effect of eating more than 6lbs of cheese every day for almost a year is a minor painless cosmetic issue?


The atherosclerosis is invisible, until it suddenly isn't.

Everyone will have a little bit of plaque, even if you try to eat well. Teenagers will already have traces of it before they reach adulthood. All you can do is try to slow down the buildup. And, well, this ain't it.


Genuine question, as far as I can tell there seems to be some debate currently about weather high saturated fat diets are linked with heart disease. Does atherosclerosis fall into this debate too?


Yes, high SFA diets are associated with increased risk of CVD via atherosclerosis as a result of the increase in ApoB concentration in the blood (response to retention hypothesis).

This review paper is a really good overview of the model, and it's actually pretty approachable: https://academic.oup.com/eurheartj/article/41/24/2313/573522...


Thanks


I suppose that's true normally, but I was pleased to read that you can probably reverse it if you make radical enough changes:

https://www.health.harvard.edu/heart-health/ask_the_doctor_i...


... where "radical enough change" in this article refers to the period of starvation during WW2!

My understanding is that we don't have contemporary evidence of people successfully reverting arterial plaque, but I admit the studies probably didn't faithfully reproduce these starvation conditions!


There’s some evidence of a reduction of intima-media thickness of both common carotid arteries through a… less intense diet.

https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.120.0...


Thank you. Seems like between this and other results, the consensus is now that reversal has been demonstrated pretty conclusively. I've updated!


Gaza ? /s


That's not even a remotely good takeaway from this. The paper is specifically focused on the "yellowish nodules", ultimately diagnosed as xanthelasma. It's not meant to be a thorough assessment of the guy's health. It doesn't imply anything about other ailments or lack thereof.


And his cholesterol was 5 times normal.


That’s my question — the abstract says he seemed otherwise healthy except for this cosmetic issue.


What is normal?


> The patient’s cholesterol level exceeded 1000 mg/dL ...significantly higher than his baseline of level of 210 to 300 mg/dL.


Total less than 200 mg/dL.

... not 1000 mg/dL.


Until the cardiac arrest.


The abstract did not make that claim.


The abstract mentions the patients cholesterol level is 1000mg/dL which is at least 4 times more than the "highly dangerous" bracket. Evidence seems to show that xanthelasma (the nodules seen on this person) can have a link to a higher risk of atherosclerosis, which is linked to high cholesterol in the first place. This will not be "asymptomatic" for ever.


But others do


Any images of the hands?




... and it's not gout!


Nothing to see here. It’s just Oxalate dumping.

/s


Why Americans are so fond of strange diets instead of eating some simple balanced food and not caring much? Raw, carnivore, paleo, whatever. Here in Europe, we tremble in horror about the though that somebody can consume "raw milk", and there's a market for it. And, simultaneously, the same people have some issues with harmless blue cheese!


One reason is that, about 50 years ago, a global obesity pandemic began in the US, and nobody knows why exactly, but it seems to have something to do with their diets. Since then, it has become a worldwide public health crisis, responsible for a few percent of all death and disability. It's a bit later at affecting Europe, but it's happening there too. So people are trying all kinds of things to see if they can get better.

Another reason is that for about 300 years people in Europe who did things that made their neighbors tremble in horror† had to flee for their lives, and a lot of them fled to parts of America including Argentina and the US. Consequently the US is rather full of people who are inclined, culturally or possibly genetically, to put whatever crazy ideas they happen to believe into actual practice rather than following tradition or majority opinion. Diet fads in the US go back at least 200 years.

Myself, I dropped 17 kg on a carnivore diet starting a couple of years ago, and I've kept it off on a much more mixed diet since then.

______

† Quakers, Puritans, Anabaptists, Old Believers, Jews, etc.


The latter explanation is interesting, thank you. Experimentation is fine.


In your grandparent comment you said experimentation makes you tremble in horror. The experimentation in question is with raw milk, so not even a particularly extreme sort of experimentation, since that's what all milk was for thousands of years. It's difficult to imagine what sort of experimentation you think is fine if that's not it.


Well, “for thousands of years” is not an argument. People were living without brushing their teeth for thousands of years. There was no modern medicine for thousands of years. Children were routinely dying from infections for thousands of years. There’s this little thing called “progress”.


70 years ago meat was strictly rationed and 50% of calories came from victory gardens.

If the thesis is that obesity came from removing saturated fat from the diet, why is it that there wasn't problems with obesity during WWII when saturated was strictly rationed out of the general populations diet?

I mean, FFS, magazines sold magic powders to woman to help them become fatter. (Being too skinny was seen as unattractive).

https://en.wikipedia.org/wiki/Victory_garden?wprov=sfla1


> If the thesis is that obesity came from removing saturated fat from the diet

That thesis is clearly wrong, though there are still people who believe it. If you want to spend ten minutes getting better informed, you can read a chapter-length thorough rebuttal at https://slatestarcodex.com/2020/03/10/for-then-against-high-.... Reading the sources it cites will take you longer than that. But the very simple explanation is that it is well known that traditional diets that do not produce high levels of obesity include many different levels of both fat intake and saturated-fat intake. Whatever is unique about the modern industrial obesogenic diet of ultra-processed foods, it isn't that it contains uniquely low levels of saturated fats.


I apologize, I misread your initial argument. I thought you were defending the canavore diet, the subject of the article went through (there are definitely comments in this comments section making that claim).

The research behind ultra processing has legs from what I've read. My none expert take is that it has more to do with the fact that portion sizes are larger and caloric density is higher.

It doesn't take long to find videos of people from all over the world visiting the US and commenting on how much food is served.

That also jives with why drugs like semaglutide work so well at reducing weight.


Caloric density is also pretty high in traditional diets like those of the Hadza, the Inuit, the French, the Argentines, and the Italians, but those produce low levels of obesity. So that can't be it. Those diets also don't include semaglutide.

Large portion sizes are real, but they are downstream of whatever is unnaturally increasing US appetites. Restaurants, housewives, and househusbands in the US don't serve 1500-kcal meals because they're in some kind of conspiracy to fatten your kids up for slaughter. They serve them because people complain if they don't.

The "ultra-processed" meme is clearly pointing at something critical, but it can't itself be the answer, because it's ontologically incoherent. As the post I linked above says:

> I’ve previously found [this meme] frustrating – it reeks of a sort of unreflective technophobia. What part of processing makes food bad? How does mere contact with a machine turn food from healthy to unhealthy? What food counts as “processed” or “not processed”? Is ground beef processed, since you grind it? Are scrambled eggs processed, since you scramble them? Is bread processed, since wheat doesn’t grow in loaves? Is water processed, since it goes through water processing facilities? Is the Eucharist processed, even though the processing only changes its metaphysical essence and not its physical properties? Everybody I ask acts like the answers to these questions are obvious, but everyone has different answers, and nobody can tell me their decision procedure.

So, is it corn? Missing micronutrients? Industrial polysaccharide thickeners? Fungicides like propionate? Nanoparticles of titanium dioxide? Antinutrients like phytate and citrate reducing bioavailability of polyvalent-cation micronutrients? Some combination? Lots of people have promising hypotheses but nobody knows. Anybody who claims to know is either lying or insane, often both.


Agree that there are a lot of unknowns. Kevin Hall is carrying out some illuminating studies on the issue but, by his own admission, there’s simply not enough funding to do this at pace or scale.

I think we have some experimental evidence to suggest that at least some of the UPF associations are due to texture - those foods that you can basically inhale without chewing seem to drive higher caloric intake. We also have an incredibly strong signal of mass gain from sugar sweetened beverages which are also easy to consume with minimal effort.

I think it’s likely that cultural and economic factors play into this too. Japan has the same proliferation of UPFs, yet does not suffer the same obesity effects as the West does. There are probably a number of things that play into this: Japan has an incredible children’s food education policy, and they presumably have a different culture around food (many western cultures emphasise a “finish your plate or you’re ungrateful” approach).

I also have an intuition that the rise of two income households raising children is a factor in this. It’s a lot to ask of a couple that they both hold down full time jobs while cooking the kind of meals that used to be the domain of a stay-at-home parent.

Really interesting area to think about in terms of research and policies, but as you say we just don’t have strong evidence at the moment.

In the meantime it’s great that GLP-1 agonists are available to reduce the damage done, but it’s a shame we have to resort to such things in the first place.


We've had effective weight loss drugs for quite a long time; smoking tobacco and various phenethylamines are well known to work, for example, methamphetamine being the oldest. (I suspect chewing coca may also work.) Unfortunately, those also turned out to have harmful effects which weren't noticed until they had been in use for decades or centuries. It wouldn't be surprising if GLP-1 agonists also turned out to do more harm than good.


It’s certainly possible that there are long term side effects from GLP-1 agonists, but we can only go with the data we have. The five year data (which definitely has limitations in terms of the kind of inferences we can draw from it) is suggesting around a 4x reduction in mortality at the 5 year mark in non-diabetics IIRC (https://pubmed.ncbi.nlm.nih.gov/39171569/).

The changes in behaviour are also really interesting. Even after cessation of the drug, it seems like many patients keep healthier eating patterns and while they do put on weight, they tend to settle on a lower weight than baseline before intervention.

So we should absolutely keep an eye on outcomes as time goes on, but so far the results are overwhelmingly positive. These drugs are saving lives and the new ones in the pipeline look significantly more effective. It’s an exciting time to be alive!


For the same reason that management consultants are fond of the Next Big Thing: $$$$.

Pushing a new diet drives a ton of revenue. Advertising, TikTok, talk content, experts, books, etc.

There's a financial reason Dr. Oz was always on about some batshit crazy new one.


Because Americans glorified meat consumption back when the industrial revolution happened. Meat was traditionally was a rich person food. Once meat prices plummeted, if you were "someone" you ate meat. It became a status symbol.

You can see it in TV advertisements too. Once meat consumption took off in the US there was a proliferation of antidiarrheals, antacids, and other medications to deal with the symptoms of a high meat diet. You can see it on TV advertisements. Kind of interesting.

Even today, a high meat diet is a status symbol in the US.


Because there's a fairly large swath of American popular culture that has sprung up to "nuh uh" every perceived standard or best understanding.

"Avoid saturated fat" "nuh uh our ancestors were alpha males that ate nothing but raw meat and black coffee, we must have evolved for that diet!"

People fall for it because people like eating meat and there's enough bad studies to cherry pick to support that position.

It's not unlike a family member of mine who falls for every woo scam because whatever is being peddled from drum circles to breathwork makes them feel good so of course they spend $3k to become a "professional sound bath instructor".

American culture is increasingly distrusting experts and worshipping flim flam artists because they make a compelling podcast or YouTube video.




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