Carnivore as an Elimination Diet Alternative: When Less Choice is More

Does the Carnivore Diet sound laughable to you? It did to me too, until I took a closer look and found it could be a valuable tool for many. Below is a paper I recently wrote for a school project aimed at demonstrating how the carnivore diet can be used by practitioners looking for an easier way to help clients stick to an elimination diet. Though written to other nutrition therapists, you can pull out information to help yourself on your own healing journey. Contact me if you need help and download my free Carnivore Starter Guide to get you on your path to healing!

Carnivore as an Elimination Diet Alternative: When Less Choice is More

Elimination diets strike fear in the hearts of practitioners and clients.  They are, by their very definition, restrictive and this often leads to low compliance, even when clients are in desperate need of healing. As a practitioner, it can be tempting to avoid recommending an elimination diet that promises results and instead suggest a less effective treatment because of low confidence in a client’s compliance or capabilities and real fear of their disappointment. You can almost see the anxiety hit a person when they hear how many foods they can’t eat on an elimination diet!  To truly identify what is causing reactions in a person suffering autoimmune or other highly sensitive conditions, restricting foods is unavoidable.  Yet, if someone can’t stick to a diet, they can’t reap the benefits, right?  Is there another way?  Could there be a scenario where being more restrictive could lead to greater compliance? Perhaps it is the complication more than the restriction that makes a diet hard for a client to stick with over time. This paper asks that question and considers whether the carnivore diet—which its greater in both restriction and simplicity—might be a viable option for an elimination diet for clients who struggle with more commonly recognized elimination diets, such as the Autoimmune Protocol (AIP), the GAPS Diet, and Six Food Elimination Diet (SFED).

Carnivore in its strictest form is simply meat and salt, but it can be expanded to include dairy and eggs if tolerated. This restrictive prescription fits the requirements for an elimination diet. Elimination diets often fail because clients find them both restrictive and complicated. To illustrate, try describing the GAPS or AIP diet in one sentence! Though more restrictive, the simplicity of carnivore may actually raise compliance rates by removing decision fatigue and other obstacles.  

Elimination Diets are Effective, When People Stick to Them

Elimination diets have proven success rates in treating conditions from ADHD[2], IBD (including Crohn’s and ulcerative colitis)[3],[4] Autism[5], Hashimoto’s[6] and more. They work by positively identifying triggering foods and in many cases, even allowing the gut and/or immune system to heal during their removal enough to allow reintroductions. This offers a lot of hope to people struggling with chronic illness!

Despite their efficacy, however, elimination diets are notoriously hard to maintain for long. In one assessment of adults with eosinophilic esophagitis (EoE)[7], 95.8% of patients on a strict elimination diet would recommend the protocol to other EoE sufferers despite low levels of long-term compliance due to diet-related anxiety and social situations. They saw enough relief of symptoms to believe in the efficacy of their protocol and recommend it to others, but not enough to stay on it for long because of compliance difficulties. In essence, they felt it worked in theory but was too hard in practice.  

After guiding several clients (and even family members) through different versions of elimination diets with varied degrees of compliance, I began to wonder if there was an easier way. Lately, the carnivore—or meat-based—diet has appeared more and more in forums, podcasts and social media buzz and it’s beginning to get more scientific consideration than ever before. After largely dismissing carnivore, it occurred to me that this could be more than a meat-head fad for extreme body builders; it could actually have therapeutic application as an elimination diet. The extreme-sounding diet could be set up to cut out all major (and minor) allergens while bypassing other elimination pitfalls and do so with simplicity.  Refer to “Foods Eliminated on 4 Protocols (Table 1)” to see three commonly used protocols alongside the carnivore diet. You can easily see how the carnivore diet (defined for the purposes of this paper simply as meat and salt) fits the parameters of an elimination diet. In fact, it is the strictest! The thought of using it as a therapeutic tool sparked my interest and led to a deep dive. Assuming it is a sound dietary strategy that can be done safely for a temporary amount of time, as other elimination diets are, could carnivore be presented as an alternative choice for those that struggle with elimination diets? Let’s consider other pain points—aside from restriction—that clients struggle with and how carnivore stacks up.

Elimination Pain Points Bypassed by Carnivore

Decision Fatigue.

Studies show more options result in lower outcomes. One research team[8] conducted a series of four experiments exposing groups to decisions either before or after making a series of choices. The aim was to test the hypothesis that “decision making depletes an internal resource that governs self-control. (Vohs et al, 2020. p.3)” Without fail, the groups making fewer choices performed better and reported less stress while the groups making more decisions performed poorer in skills tests, showed physical signs of wear, and reported less self-control.  This “decision fatigue” is a well-documented psychological phenomenon. It drives high pressure performers like Barack Obama and Mark Zuckerberg to, for example, wear the same outfits or eat the same meals day after day.[9] Each choice you make in a day diminishes will power. In the case of elimination diets which require a significant amount of determination, navigating a sea of complicated food choices can be exhaustive and lead to poor decision making and compliance. 

Rachael Link, MS RD summed up much of the difficulties of AIP compliance when she said, “With rules about everything, from the types of vegetables you can eat to the spices that you should put on your food, adhering to a strict AIP diet is not easy. Finding foods that are AIP-compliant can also be tedious and time-consuming.” It takes a lot of education, searching, and decision making to be successful at an elimination diet. As a practitioner I often hear questions like “where do I find coconut cream with no additives?” “What the heck is tigernut flour?” “How do I make butter or sour cream?” “Is black pepper allowed?” “What can I use to make pancakes?” etc.  With carnivore, the only question is “did it come from an animal?” If the answer is yes, you can eat it. A carnivore diet is one way to streamline options, allowing more energy to go into perseverance and healing.

Preparation Ease and Accessibility.

Another obstacle for compliance with elimination diets is the learning curve it takes to use unfamiliar foods and cooking techniques.  With GAPS, you find yourself learning to ferment foods and seeking a host of unfamiliar ingredients like duck fat and liver pâté. Elimination diets send clients headfirst into a world of gluten free baking and food substitutions. With carnivore, if you can sear a steak or brown ground beef, you pretty much have it made. You don’t have to scour health food stores for flours made from tubers or acceptable sweeteners, you only need to know a butcher and own a skillet.

Complications and Wasted Time.

Several times I have started an elimination diet with a client to find in time they weren’t getting the expected results. Further investigation revealed SIBO, candida, or a less common allergy that meant the diet had to be reassessed and even further restricted, causing discouragement and a sense of time and effort wasted. The ferments in GAPS can flare SIBO. The fruits and natural sweeteners in SFED can cause a candida bloom.  The complicated list of foods allowed on AIP can allow other allergens to creep in. A strict carnivore protocol bypasses these and other issues and cut a diet down to bare bones (or at least bone broth). There is nothing to cause a yeast or bacterial bloom. There are no FODMAPS in carnivore. You don’t have to be wary of hidden lectins or cross contamination of some kind.  You won’t accidentally react to a spice. Carnivore really is simple to navigate.

Undermining Cravings.

Cravings for sweets are quickly cut whereas the raw honey allowed in others diets and the dessert versions of compliant foods can perpetuate cravings. A study of the effects of very low carb diets on cravings showed that affinity for sweets all but disappear within 4 weeks of restriction. [11] Along these lines, a very low carb ketogenic diet (which carnivore qualifies as) was shown[12] to successfully treat binge eating behaviors in food addicts. Over the course of 12 months, subjects not only decreased binging behaviors significantly, but were able to drop weight and maintain results to date of 9-17 months after the initial trial. If food addicts and binge eaters can control their cravings on a very low carb model, it can be assumed compliance would be attainable for a client without that additional struggle.

But is it Sustainable?

Whether or not carnivore is sustainable as a long-term diet is beyond the scope of this paper. However, one study of two men who volunteered to eat nothing but meat for a year in order to prove concepts they’d learned among the Inuit[13] would suggest carnivore is safe for the temporary period required of eliminations. The subjects thrived and reported feeling vigorous while labs showed no abnormalities. Beyond merely surviving, carnivore may offer health benefits beyond simple elimination. Though carnivore itself is not studied extensively yet, carnivore is a low to zero carb diet and there are studies showing benefits of such. One review[14] of very low-carb diets showed improvements in conditions ranging from diabetes, polycystic ovary syndrome, acne, neurological diseases, and cancer to the alleviation of respiratory and cardiovascular disease risk factors. It even suggested that dietary intervention could replace higher risk pharmaceutical treatments, with their long list of side effects. These benefits are especially attractive to those with autoimmune diseases…the same clients who are most likely in need of elimination diets in the first place. It turns out that the high levels of amino acids present in a carnivore diet can offer just the anti-inflammatory and immunological support they are most in need of. These benefits are discussed in an article[15] about the role of vital amino acids present in meat, especially beef, and negligible or absent in plant foods.

In conclusion, one might assume that a restrictive dietary plan like a 10 week AIP intro or the notoriously slow GAPS program has low compliance because of the restricted list of available food options. But often, it is the complexity of the remaining choices that overwhelm people.  Combine that with unfamiliar cooking techniques, hard to find and use ingredients, the increase in food prep, and persistent cravings, and eliminations diets are overwhelming. Though the carnivore diet is actually more restrictive, the simplicity of the diet (meat and salt!) may give clients an effective elimination option that is more doable to them.

Hungry for more?

If this sparks your interest, check out my whole series on the carnivore diet!

A Carnivore Conversation: My podcast appearance discussing Carnivore

My 30 Day Carnivore Experiment

The Temporary Carnivore: when it might serve you to try a meat diet short term.

The Long Term Carnivore: could this be a sustainable lifestyle for you?

The Ethical Carnivore: is this lifestyle harmful to the planet? Is it sustainable?

And for a great quick read on some of the top perks of the carnivore diet, check out this post from Carnivore Guru, Carnivore Aurelius: 11 Carnivore Diet Benefits

References

[1] Lavey C. The Six Food Elimination Diet. https://connect.mayoclinic.org/. https://connect.mayoclinic.org/page/eosinophilic-esophagitis/newsfeed-post/the-six-food-elimination-diet/. Published 2019. Accessed May 19, 2020.

[2] Ly V, Bottelier M, Hoekstra PJ, Arias Vasquez A, Buitelaar JK, Rommelse NN. Elimination diets' efficacy and mechanisms in attention deficit hyperactivity disorder and autism spectrum disorder. Eur Child Adolesc Psychiatry. 2017;26(9):1067‐1079. doi:10.1007/s00787-017-0959-1

[3] Konijeti GG, Kim N, Lewis JD, et al. Efficacy of the Autoimmune Protocol Diet for Inflammatory Bowel Disease. Inflamm Bowel Dis. 2017;23(11):2054‐2060. doi:10.1097/MIB.0000000000001221

[4] Dugum M, Barco K, Garg S. Managing irritable bowel syndrome: The low-FODMAP diet. Cleve Clin J Med. 2016;83(9):655‐662. doi:10.3949/ccjm.83a.14159

[5] Campbell-McBride, N., Gut And Psychology Syndrome. Cambridge, UK: Medinform Publishing. 2012

[6] Wentz, I., 2017. Hashimoto's Protocol. New York, NY: HarperCollins.

[7] Wang R, Hirano I, Doerfler B, Zalewski A, Gonsalves N, Taft T. Assessing Adherence and Barriers to Long-Term Elimination Diet Therapy in Adults with Eosinophilic Esophagitis. Dig Dis Sci. 2018;63(7):1756‐1762. doi:10.1007/s10620-018-5045-0

[8] Vohs, K., Baumeister, R., Twenge, J., Schmeichel, B. and Tice, D., 2020. Decision Fatigue Exhausts Self-Regulatory Resources. [online] Psychologytoday.com. Available at: <https://www.psychologytoday.com/files/attachments/584/decision200602-15vohs.pdf> [Accessed 13 May 2020].

[9] Bauer, D., 2015. The Scientific Reason Why Barack Obama And Mark Zuckerberg Wear The Same Outfit Every Day. [online] Business Insider. Available at: <https://www.businessinsider.com/barack-obama-mark-zuckerberg-wear-the-same-outfit-2015-4>.

[10] 6. Link R. AIP Diet: Benefits of the Autoimmune Protocol. Dr. Axe. https://draxe.com/nutrition/aip-diet/. Published 2020. Accessed May 18, 2020. 

[11] Anguah KO-B, Syed-Abdul MM, Hu Q, Jacome-Sosa M, Heimowitz C, Cox V, Parks EJ. Changes in Food Cravings and Eating Behavior after a Dietary Carbohydrate Restriction Intervention Trial. Nutrients. 2020; 12(1):52.

[12] Carmen M, Safer DL, Saslow LR, et al. Treating binge eating and food addiction symptoms with low-carbohydrate Ketogenic diets: a case series. J Eat Disord. 2020;8:2. Published 2020 Jan 29. doi:10.1186/s40337-020-0278-7

[13] Lieb CW. The effects on human beings of a twelve months’ exclusive meat diet: based on intensive clinical and laboratory studies on two artic explorers living under average conditions in a New York climate. JAMA. 1929;93(1):20-22.

[14] Paoli A, Rubini A, Volek JS, Grimaldi KA. Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets [published correction appears in Eur J Clin Nutr. 2014 May;68(5):641]. Eur J Clin Nutr. 2013;67(8):789‐796. doi:10.1038/ejcn.2013.116

[15] Wu, G. Important roles of dietary taurine, creatine, carnosine, anserine and 4-hydroxyproline in human nutrition and health. Amino Acids 52, 329–360 (2020). https://doi.org/10.1007/s00726-020-02823-6