Written by Christopher Kelly
March 13, 2019
[0:00:00]
Christopher: Well, Amber, thank you so much for joining me today.
Amber: Thank you for having me.
Christopher: I'm delighted to have you. It's been far too long. You should've been on the podcast by now, probably several years ago, but here we are. This is great. We're recording in person at the Saguaro Hotel in Scottsdale, Arizona. We've just been attending the Physicians for Ancestral Health Winter Retreat, which has been fantastic, a group of like-minded physicians giving presentations on what they've been learning over the last year, and then some non-physicians like myself and Amber giving talks too. Not me though. I'm not really a talk person. I'm more of a podcast person, but it's been great, wouldn't you agree? It's lovely here in Scottsdale, Arizona and we're really hoping to get more people attending.
I just got back from a fantastic mountain bike ride. The riding here is great. We found a shop that rented me a bike and it was all super smooth and really great. The old town here in Scottsdale is great too. How's your trip been, Amber?
Amber: It's beautiful. It's peaceful here, very congenial. I love the group also because the atmosphere is very intimate and the talks are usually much more -- instead of trying to present what we already know, present what we're thinking about, what we're learning about now, so it feels very cutting-edge.
Christopher: Yeah. I've always thought that about these conferences that the best bit was outside of the talks. I could watch the talks on YouTube afterwards. What I couldn't do was walk up to the presenter and chat to them about stuff, anything you like, and of course, that is the main emphasis of this retreat, which I really enjoyed, but you can't do away with the talks completely because that's what ignites the conversation.
Amber: Exactly.
Christopher: Well, tell me -- I'm sure you're bored of telling this, but it's just so incredible, I'm going to force you to do it again. You know what's coming, don't you? So tell us about how you got into -- so you are a computer programmer in a previous life. I mean once a computer programmer, always a computer programmer. You said that you used to be a computer programmer when you began your talk, but let's face it, do you still write code on a daily, weekly, monthly basis?
Amber: I don't know. It varies from time to time. I never wanted to be a programmer, but it gets in your blood. I wanted to be a mathematician. I went to school for math when I first went to a university and I had to take a programming course as part of my math degree of all things, and then I realized that it was like math on steroids. Anything that you could get your slow brain to do, as long as you had an orderly way of organizing what you're going to do, you could ask a computer to do it for you. The sky is really the limit once you have that ability.
Christopher: That's incredible. How did a computer programmer come to discover the low carbohydrate diet? Because that is where you started. You're doing something slightly different. We'll get into that, but it all began with a low carbohydrate diet, right?
Amber: Very reluctantly. I was brought up vegetarian, and so all of my biases fit into this plant-based narrative that continues to go on today. When I was in university, I started having weight issues, which I really disliked. Of course, my first thought was that I should just return to a more plant-based diet, double down on it. When that didn't work and exercise didn't work, I actually tried veganism and that didn't help me either.
I had seen a little bit about low carb diets, but I immediately dismissed them because they were just so contrary to everything that I already believed. They just didn't even seem reasonable. It wasn't until -- actually, I had gone to study Russia in St. Petersburg and I was a vegan at the time and --
Christopher: How did that go? Are there many vegans in Russia?
Amber: It was nonexistent. Also, I was on a very limited budget. If I went to a store and I was going to live as a vegan, there just wasn't the variety. You can go and buy soymilk or something like that, so it was going to be pasta --
Christopher: Right, rice.
Amber: And moreover, I was staying with some people and I didn't want to reject their food, and so I thought okay, look, I'm just going to eat what they're eating here and when I go home, I can return to my diet because I've got other priorities right now, but then when I got home, I had actually lost some weight.
Christopher: Can you describe the diet that you're eating in Russia?
Amber: It was just an omnivorous diet. I was eating bread even, but it included meat.
Christopher: That was the first time, so you didn't have any -- that's pretty unusual for someone determined enough to be a vegan and you're at someone's house and they say, "Would you like a steak?" Usually, those people say no, right?
Amber: Well, I wasn't vegan for staunch, moralistic, or ethical reasons. I was just vegan because I thought it might solve my weight problem. I gave up on that and I was thinking of it very temporarily.
[0:05:03]
I'll eat these foods and I like them and I'll just return to my weight loss problem when I get home. When I got home, I had lost some weight and I could have very easily dismissed it and come up with a million reasons why I had lost weight that didn't have anything to do with diet, but something --
Christopher: Which should've been very reasonable when you're on holiday, right?
Amber: Sure, and it might not have been the reason that I lost weight frankly, but the fact of it just made me suddenly rethink, so I thought, well, maybe there's something wrong with my understanding and maybe I should look at it a different way. I thought back to the time when I had heard of a low carb diet and the timing was set up really well because when I went looking for a book in the bookstore, which is how you did it back then, Michael and Mary Eades just released "Protein Power", so it was on the front of the shelves and I picked that up and the rest is history for me.
Christopher: Okay, so why not something else? I've not been to a Barnes & Noble on the street for a long time, but aren't there a million different diet books when you walk into -- was it just pure chance? Did Michael Eades do a really good job on the front cover of "Protein Power" and you thought, "You know what? I quite fancy living on steak"?
Amber: Well, I think it's because I really was looking for something different because I had tried all these other things.
Christopher: Right. It can't be slightly different from what -- it needs to be something drastically different.
Amber: Yeah.
Christopher: So that was a low carbohydrate diet. How low carb? Can you describe what the new diet was like after the veganism?
Amber: What it was like for me experientially or what the diet was like?
Christopher: Yeah, what the diet was like. Tell me about both. What was the composition of the diet like?
Amber: Well, I haven't looked for a long time, but I think you were supposed to figure out your protein requirements and make sure you're hitting those based on some simple calculations about your frame and your gender and height and age, but then mostly you're cutting back your carbohydrates and there may have been a minimum of 20 grams or 30 grams, so it was all about figuring out what different foods we're composed of, so that was an educational piece for me, so everything that went into my body, I've read the label and I've looked up in tables and found out --
Christopher: And you've never done that before?
Amber: No.
Christopher: That's how far you've come.
Amber: Well, I don't do that now either.
Christopher: Well, I know, but you still have an intimate understanding of what's going in. What year was "Protein Power"?
Amber: 1997.
Christopher: Wow. I was only to start in university then and I can't even imagine what my -- well, a lot of cereal, pasta, bread, all that kind of stuff. I had no idea. It took me another 20 years to figure this stuff out. The reason I'm really interested to know how -- on paper, we have quite a lot in common. We're both programmers. You're definitely more theoretical and mathematics-based than I ever was, but why is it that it took me so long and suddenly with you, it's so different where you figure this stuff out so quickly relatively?
Amber: I don't know. I think it comes down to need. When you get to a point of --
Christopher: Yeah, just my need wasn't strong enough at that time and eventually, I had this crisis.
Amber: Right, crisis opportunity, right?
Christopher: Yeah. So what happened then, you eat enough protein, keep the carbs really low, and what happens is that suddenly, the weight all melted off. How much did you have to lose?
Amber: Absolutely. About 30 lbs I lost easily.
Christopher: Wow! So what you thought at this point, "Oh, this is great. I found my true diet for the rest of my life. This is all I have to do. It's sustainable. I can do it. No problem."
Amber: Yeah, I was really happy about it. That diet at the time, I included a lot of plants, a lot of salads. I could remember my first Christmas after I discovered that I modified all the foods that weren't going to be low carbohydrate, so I didn't touch the potatoes, but I made sure we had all the traditional things in my family like the brussels sprouts. I ate the turkey and I made some kind of a low carb trifle dessert. I was excited and enthusiastic because I felt like I had really learned something that most people that I knew of didn't understand about how you can actually affect your physiology through diet, so it was very exciting and it gave me such pleasure to have solved that problem for myself.
Christopher: When did Zooko come on to the scene? Zooko is your ex-husband and I feel bad for -- I don't know whether -- you're still good friends right now, right?
Amber: Absolutely.
Christopher: Yeah, I thought so.
Amber: He's one of my favorite people.
Christopher: That's great, so I feel okay about bringing that up. When did Zooko -- Zooko is an extraordinarily interesting person as I've only really discovered more recently, but I've been aware of your ketotic.org site for a very long time now. You've been doing that for a while, so when did Zooko come to -- were you already married?
Amber: No. We met in 1998, so not long after that. He tells a story in which we had met and we were very interested in each other, and then he found out about my low carb diet and he said, "Oh gosh, I was so disappointed that this woman that I met that I thought was so interesting and intelligent, it turns out she believes in this total quack weirdo thing and that I won't be able to date her."
[0:10:12]
But I was able to persuade him that there was a real intelligent thought behind that and real science, and so then he was pretty quickly onboard with it. He didn't take it on himself until later after we were living together. We ate low carb most of the time.
Christopher: So he didn't have any particular problems that he was trying to fix. It's super helpful when the whole family eats the same thing and I really feel bad for anyone that's trying to implement a diet that's different from what the other people they live with are eating right now because that is for me very challenging.
Amber: Yeah. There are two levels of problems, I think. Well, making different meals for everyone is difficult. It can be difficult if you have problems with willpower for example and if it's just hard for you to have those things in the house. In a moment of weakness, you eat them and then your diet's out the window, but then what's really a problem is something that I also never experienced fortunately, is outright sabotage or just disapproval where your spouse is saying every day, "You shouldn't be eating that." I've heard stories of people --
Christopher: They might not even need to say anything, right? It's just that kind of look where the spouse is rolling their eyes. It's the worst.
Amber: Yeah, or saying, "You're overweight, so you shouldn't be eating that bacon" or whatever it is.
Christopher: Tell us a bit about Zooko's background because like I said, he's a very interesting character.
Amber: Zooko and I met at a financial cryptography conference. He's been interested in the cryptographic potential of financial transactions for a really long time. He was working with David Chaum back in the days of -- I can't remember the name of the company where they were doing micro-payments. It's something he's been thinking about for a really long time. In the early days when we were together for fun, we would work out protocols trying to solve micropayment problems. For example, how would you make sure that if someone had a coin, they wouldn't double spend it? How would you make these kinds of mathematical guarantees over networks? It's just something that has captured both of our interests for a really long time, but obviously, something that he was definitely passionate about to a great degree.
Christopher: Can you tell us a little bit about Zcash, I think, since I've got you here?
Amber: Sure.
Christopher: I feel bad for making you do this. Zcash is a fascinating technology, isn't it?
Amber: No, I'm really happy to. When Bitcoin came along, we were all blown out of the water by the elegance of the way that it solved this problem that as I've said, we've been thinking about as a hobby for so long, and people much more dedicated to that as a discipline than I ever was were thinking about these problems.
When Bitcoin came out, we were fascinated by it. One of the things though that we noticed or that Zooko noticed was that the anonymity wasn't there. Well, it's anonymous, but what happens is that every coin has a history. So you could trace back where a coin has been and you can discriminate based on that. And because of histories, you can even theonomize it if you know enough about a person and what they do. You may be able to match patterns whereas what you really want in a currency is the ability for one unit to be completely "fungible" is the word that they use in finance, so one dollar is just as good as any other dollar and you can't tell one from another. Like cash, it has no history and one is completely exchangeable for another.
That's the vision that he had that helped him to create Zcash. He hired many brilliant cryptographers to make sure that that happened in a mathematically safe way and they called it Zcash. Originally, it was called Zerocoin because -- I don't remember exactly what the zero was for. Oh, how could I have forgotten? It's zero knowledge proofs. Zero knowledge proof, if I can just try to explain this in a non-technical way, you know something and you want to prove to someone else that you know it without telling them what it is.
Christopher: Right.
Amber: Think of this challenge like how are you going to prove to somebody that you know something without going through all the steps that reveals what it is, but there are ways to do this cryptographically, so the way the currency works is based on that.
Christopher: The reason I think this is important is that I think at some point, these technologies are going to be used for supporting user-paid content.
[0:15:03]
Let's suppose I believe that a low carbohydrate diet is superior for weight loss and blood levels of cholesterol have no effect on cardiovascular disease and somebody at Stripe or authorize.net or maybe someone at Visa or Mastercard completely disagrees with what I'm saying and they can just turn me off. Switch off your merchant account, you can't take payments anymore, delete you from the web. I'm wondering whether at some point these technologies are going to be super important to have freedom of speech and use a supported content, but it's really all speculation at the moment and perhaps a little bit scare-mongering. It does worry me when you see people starting to be deleted from Wikipedia and people closing that Patreon account because somebody disagree -- well, actually, the person I'm thinking of actually closed her account just in protest of the lack of freedom of speech, but I suppose it's all speculation on my part at this time.
Amber: It is, but those are exactly the kinds of appropriately paranoid ideas that the currency was designed to combat.
Christopher: Tell us about how you got started on ketotic.org because that was where I first became aware of your work. One of the things that really struck me about this blog -- as a software engineer, it's kind of interesting. When you do a computer science degree, you don't actually do science. Have you noticed that? Never did I use the scientific method to change what you think about a hypothesis. I was very unfamiliar with PubMed and any of these archives of papers, so I was used to that blogosphere level of information. That's what I used to getting information. I probably didn't even know that PubMed existed in 2012. Then I came across ketotic.org and suddenly, they had all these references at the end of the document and it wasn't just a list of citations where you had got your sources, but you had these things that I think you call like a double -- what do you call it?
Amber: End to end citations.
Christopher: End to end citations, so you actually pulled out the exact part of the paper that you had referenced as well as the paper itself, so you didn't have to -- I'd say the worst case scenario actually that we've seen a lot of recently from someone I won't mention is they'll write an article like saying something bad about the ketogenic diet and then they'll dump a bunch of references at the end and there's no citations in the body of the text. It's literally just a list of things that they've accessed and then it's kind of down to you to try and figure out where in the text these citations are used and then where in the paper they are even reading to form -- sorry, this is an incredibly leading --
Amber: No, that's exactly why that happened. It was born out of a particular frustration. Also, it was repeated, but there was one particular article that really set me off in such frustration where the person had made a really interesting but controversial, in my mind, claim. I thought where did they get this? Like you said, they didn't even have a match to a paper at the end. They just had something like 40 references at the end of the article and it was a long article with many things about it. I looked in all 40 of those papers and I could not find a single thing that would lead me to believe that claim. I was so frustrated and I thought I'm never doing that to my readers.
Christopher: Right, and then you start to wonder and I wonder what you thought whether Sarah Ballantyne -- sorry, did I just drop that name? Actually, whether she wanted to deliberately obfuscate the reference or whether it was just kind of careless and wasn't paying the appropriate amount of time and attention to that task.
Amber: I honestly think that it can be both and the reason that I say that is because there are things that I -- first of all, things that I felt I had read multiple times and that I was really sure of and I have said, well, I better put a reference in there because someone who's not familiar with this material isn't going to know. I'll be damned if I could not find a single reference to where I got this idea and I thought, am I making this up? Sometimes it seems like actually, maybe I am. I could not substantiate it, so that's been very humbling.
But then the other thing is that sometimes -- and I haven't been quite as deep as I probably should be if I were to be perfectionist about it, but sometimes I'll find a paper that has the claim that I want. Like you said with the end to end citation, I don't just give the paper, but I will excerpt the exact passage that I think where the paper is showing me that particular claim. So sometimes, the paper will say it, but they're not really supporting it. They're just repeating it, so I have to follow their citation. Sometimes, I follow a chain of citations and it doesn't really -- it's not going to end. It's been repeated over and over, so I think that even if you give complete benefit of the doubt, even the most whelming people can be misled by what they're reading.
[0:20:07]
Christopher: Did you come up with this scheme or is this something that's used in mathematics or somewhere else?
Amber: I did. I've never seen it anywhere else.
Christopher: Wow. What was your goal with ketotic.org? Did you have a specific agenda or were you just trying to share what you've learned? What was it about in the beginning?
Amber: Well, it was about sharing what we've learned, but we did have a vision. Back at the time, we had too much going on to make this happen, but what we had thought that that site was going to evolve into would be a site that went through all the different kinds of diseases and conditions or even non-conditions that ketogenic diet has promised to improve, and so that's why it was called -- the site's name is actually The Ketogenic Diet for Health and what we wanted to do was go through several different kinds of disease that a ketogenic diet might prove useful for as well as things that aren't diseases, so just optimizing could it be the case that a ketogenic diet actually improves your cognition compared to a non-ketogenic diet.
Then we also wanted to go through different myths that people were bringing forward to discount or argue against a ketogenic diet, and so that's what we had wanted the site to do. It ended up being way too large in undertaking for us, so we just have bits and pieces, but what it mostly became was finding what people were talking about in the blogosphere that seemed to us to be unsubstantiated and drilled down and find if there was scientific truth behind it. For example, there was one piece that I did early on about gluconeogenesis --
Christopher: I was going to say when your steak turns into chocolate cake is the moment you put an end to your stomach, isn't it?
Amber: Right. That's what people were saying, but it was really vague. They'd say, "Excess protein turns into glucose." What does that even mean? What's excess protein? When you're eating it, does your body suddenly say, "Oh, you've had your 60 grams. The rest of this is glucose." If so, how does it know? So I really wanted to find out what was behind that and it turns out not very much. Some people were actually making this argument based on the ratio of ketogenic to gluconeogenic amino acids and just saying the ones that are ketogenic are going to turn into ketones and the ones --
Christopher: This is purely theoretical. You say, "Oh, alanine is gluconeogenic. Therefore, if you eat too much alanine…"
Amber: Right, right, right, so I found out that just having the substrate there was not enough for the liver to go ahead and make it into glucose, so I went into this deep dive about when gluconeogenesis is actually happening, and it seemed to me that it was much more of a demand-driven process. I wrote about that and I chose it because it was a presumed truth and I didn't think that there was anything to it.
Christopher: Where do you think it came from? Do you think it was just people looking at biochemistry textbooks and coming up with ideas that were all theoretical? And then maybe some of that was taken out of context, and like you said, like the Chinese whispers in the references. Before you know it, it's like a golden rule of ketogenic diets, thou shall not have too much protein.
Amber: Well, at a certain level, protein is going to throw you out of ketosis, so there's some truth to it, but I surmise -- and it's just a conjecture -- that the reason why this started to be talked about is because on a ketogenic diet -- it's funny. If you look at studies of people on a high carb diet, if you give them protein, it has no effect on blood sugar, but if you're on a ketogenic diet or if you're diabetic and you have protein, it makes your blood sugar rise. So people are saying, "Where is this blood sugar coming from?" and their answer was, "Oh, protein can be turned into sugar, so it must be the protein being turned into sugar." I don't think that is what's happening in the blood sugar rise case at all. What's happening is -- because first of all, the sugar that you make out of protein isn't going directly into your cells. It's going into glycogen stores, so the rise in blood sugar that you see when you eat protein is coming from glycogenolysis. What's happening is that it's indirect, so when you eat some protein, your insulin rises and your glucagon also rises, and they rise in tandem if you're on a low carb diet and it doesn't actually change. That insulin to glucagon ratio doesn't change, I should say. That's the signal that's telling you whether to stay in ketosis or not. It's the insulin to glucagon ratio, not necessarily the sugar in your blood whereas if you are on a high carb diet or if you already have hyperglycemia and you eat protein, your response hormonally is going to be completely different.
[0:25:06]
Your insulin is going to go way up compared to your glucagon and that will send a completely different signal. That's why the blood sugar doesn't actually rise, so if the insulin and the glucagon are going up, you're getting a call for glucose. If you start using all that glucose, eventually the more your blood sugar goes up in response to protein, the more you're going to be in that other situation where protein is going to affect you, so it's more of a gradual thing that builds up.
Christopher: So where did you end up with all this? Sometimes I think you do a deep dive and you look at all the biochemistry and you think you know something, and then suddenly I have these moments where I think I don't know anything. When you get proven wrong like that and you have to admit it, you're like, "Jesus, we don't know anything." I'm not even going to measure blood glucose or ketones or anything. I'm just going to eat real food and hope for the best. Josh talked about that, the game level intervention. Let's just stop messing around with the details.
Amber: Oh yeah. Well, when you're looking at biochemistry and forming these theories, the pitfalls outnumber the right way. Richard Feinman, who I like quite a bit, Richard Feinman and the other, he describes it as playing biochemical pathway pool where you've got this pathway and it hits this other pathway and then it hits this other pathway and you're trying to get the ball in the hole, but in reality, you never know which of these pathways is going to be activated or is going to become predominant.
Yeah, every time I write an article, I go through the same process. It doesn't upset me as much as it used to, but I would come up with this idea and I would say, "Oh, wow, I bet it's actually like this" and I'd start doing research and I'd start putting together this article, and about three quarters of the way through, I'd go, "Oh my God, it doesn't work like this at all. This idea is totally crackpot. I've got nothing. I've got to throw this away. It's garbage." Eventually, I'll persuade myself back and I'll say, "Oh no, no, actually, this is a good idea. I'll write it up" but having seen that process where one new piece of information can completely discredit the whole idea, I've developed a little bit more relaxedness about being wrong.
What I try to do in the best way of putting it, I guess, what I'm doing when I write these things down is trying to figure out and remember for myself almost like documenting code why do I have the idea that I have, where did it come from, what were all the steps that I used to get there because if one of these steps is wrong, I want to know how to recover and where to go next whereas if I didn't write it down, I didn't go through that documentation of all that reasoning then when some new idea comes out, I might not even realize it impacts all these beliefs that I have. If the final conclusion is proven wrong then I want to say, well, that means that somewhere in this reasoning, something is broken. What happened there? Most of what I'm hoping to do is just capture the reasoning process and try to learn from that with the knowledge that half of what we think we know is wrong and we don't know which half.
Christopher: Is there anything that you thought was true five years ago that you think is wrong now?
Amber: Probably. I've been doing a lot of rethinking around salt. It's true that the recommendations for salt are probably wrong in that we shouldn't have to limit them. They certainly don't have the effect on blood pressure, but the media likes to tell us that it does. So yes, there is a scientifically, statistically significant effect on blood pressure, but the effect isn't significant in the sense that it's minute. If you really want to make a change in your blood pressure, a low carb diet can bring down a high blood pressure in a way that reducing salt never could, but then there was this whole hoopla about extra salt maybe being beneficial and it could be.
A lot of people who are on ketogenic diets have told me that as soon as they realized they could and should be taking in a lot more salt, these problems of fatigue or cramps that they had been struggling with for years suddenly went away, but then I decided that what might be happening with the salt is that there's a salt potassium balance and there's also a water factor about how much salt you need. So if you've been told to drink lots and lots and lots of water all the time, you might be flushing out electrolytes and need to replace them, or if you're using potassium because you've been told that you need to be taking that as an electrolyte then maybe you need more sodium to balance it.
[0:30:00]
That's one thing that I've been thinking about and I've been actually flipping back and forth on about my thoughts for quite a while, but one thing that I think I'm beginning to change my mind about right now in a sort of twisted, ironic way is about the needs for DHA, the fatty acid DHA because it's known that we can't convert much of the linolenic acid into DHA. I've been arguing, because I think about the brain a lot and infants need DHA to grow their brains, about the importance of animal foods especially in our evolution. I've been saying we needed to get this DHA in order to build our brain, and I still think that's true. However, it turns out that we may be able to convert more than I initially thought we could ironically when we're on a very low carb diet. I say ironically because it doesn't affect the evolutionary argument. It just affects it for different reasons. What I would like to be able to say to make this work out in my mind at least is that maybe we can get enough from conversion, but only if we're eating high meat in the first place.
Christopher: Right. Where does linolenic acid show up?
Amber: That would be the plant form of the omega-3. For example, vegetarians are often told to make sure they're eating a lot of flaxseed oil, which is a high omega-3 source, but it's very unlikely to do them any good because they can't convert it in their bodies to the DHA that we need.
Christopher: Right. In the UK, we use that for treating cricket bats.
Amber: For treating what?
Christopher: Cricket bats.
Amber: Oh yes, yes, I'm sure it's very good for the wood.
Christopher: It's basically furniture polish, but if you go to Trader Joe's, you'll see it on the outside of pretty much every cereal box, right?
Amber: Right. I don't actually think that we were eating a bunch of flaxseed oil back at that time, but I do think that maybe the animal form of the omega-3 that is just in subcutaneous fat, maybe we had a better rate of conversion for that into DHA than we now give ourselves credit for.
Christopher: You can get that from fish as well and eating the brain of another animal. Say you weren't anywhere near the ocean or a lake and you didn't have a ready supply of fish then couldn't you just eat the brain of another animal?
Amber: You could, yes. I should say that if you were determined to be vegan, there is a source that's derived from algae that is actually DHA itself. It's not the omega-3. That can be done if you really need to.
Christopher: If you don't mind having some heavy metals that are being sequestered by this [0:32:43] [Indiscernible].
Amber: Everything in the environment has got problems now. Fish is not even exempt.
Christopher: Tell us about -- I hope you don't mind talking about this -- the bipolar. So you're not eating that same low carbohydrate diet that you described earlier and you've since changed your diet quite a bit. Do you mind talking about the bipolar?
Amber: I don't mind. I used to tell my stories of weight loss story, and weight loss was certainly a big -- well, it was a big motivating factor for all the things that I've done and it was changed dramatically by the various things that I've done, but now when I look back at the history of it, every time that I had trouble with my weight, I was also having some kind of psychiatric problems.
The first time I had a weight problem was my first year in university. I think I gained all that 30 lbs maybe in one or one and a half semester, so it was really very quick and disturbing. It was also the first time I had a depressive episode that was very disruptive and I was diagnosed then. I was put on Prozac then and I was on Prozac for over a decade. That's a whole other part of the story. Then when I went on a low carb diet, it did help me with my mood, but it didn't completely solve the depression. The depression didn't go away. It kept coming back and it was called Treatment-Resistant Major Depressive Disorder was my diagnosis because nothing that I did really solved it.
And then later, it was after my second child was born, I was trying to get the order of things correct, so I was still suffering from depression. I saw a new doctor who said, "Well, the Prozac hasn't been working, so why don't we try something different?"
Christopher: You've only been doing it for ten years now and it's not working.
Amber: Yeah. It's hard to say. Maybe it was working. Maybe it was better than --
Christopher: Yeah, there's no counterfactual. There's no duplicate Amber walking around you can compare to.
Amber: Exactly, exactly. We tried first of all Effexor and then I think we added on Wellbutrin as an adjunct a little bit later, or we might have started them both at the same time.
[0:35:01]
What happened then was -- I didn't know it at the time, but I started having my first hypomanic episodes. I didn't know what hypomania was. I didn't know what mania was.
Christopher: Well, you better explain it.
Amber: "Hypo" of course means little, and so it's a little mania. It's not a psychotic episode, so the technical difference between a hypomania episode and a mania episode is psychosis. I had no psychosis, but I had what would lead to a mania in a person who has full-blown bipolar disorder type 1. It's characterized first of all by feelings of euphoria, which to me was fantastic. I hadn't felt that in as long as I could remember, and more rapid and pressured speech, excitement, and more flirtatious, sexual kind of behavior, all of these things that become if you go into a psychotic episode then suddenly you start having delusions of grandeur and you make these plans and you spend all your money and you think that you're going to solve everything by this idea that you have, but then you crash and burn.
It felt really great and I didn't recognize it as being pathological at all, but then it would always be followed by a depressive crash. It wasn't until this was mentioned to a doctor a couple of years later because I had had it a few times that he said, "That sounds like bipolar to me. I'm going to recommend you see this specialist." I was indeed diagnosed as having bipolar type 2, and bipolar type 2 specifically means that you don't have psychotic manias.
Christopher: Okay, so this is after your kids were born. You're working as a programmer or you just --
Amber: No, I wasn't working. I was a stay-at-home mom for a very long time, but it was after I had had two of my three children.
Christopher: How can you describe what an average day would look like when you -- I always wonder whether these words are misleading.
Amber: "What do you do all day?"
Christopher: No, I don't mean that. What does mania really look like? I sometimes wonder whether it's like manic compared to the opposite. I always wonder how many people are just like -- it's like coffee. People think that coffee or caffeine gives them a boost. It doesn't really. It just returns you to baseline. I have always wondered whether the bipolar was like that where you'd meet someone one day and they would seem completely normal and that was manic, and then what you didn't see was the depressive episode where they maybe felt like they couldn't even get up out of bed or something. Can you describe --
Amber: Yeah. Well, that's how I felt about it at first and the idea that these hypomanias were pathological was actually really offensive to me because I thought I feel good for the first time and now you're saying --
Christopher: Yeah, how dare you try and take this from me.
Amber: Yeah. In fact, if you talk to a lot of people who have bipolar disorder, staying in a perpetual state of hypomania is kind of the Holy Grail because it does. It does feel great.
Christopher: People pay a lot of money for nootropics with that, right?
Amber: It's funny that you mentioned coffee because when I was looking back later, I decided that it's not just my own theory, but medically antidepressants can induce mania, so I think the combination of antidepressants that I was taking as well as caffeine are what made this start to happen.
Christopher: Okay, interesting.
Amber: It precipitated the disease and we're making it worse, so it is a little bit like being on coffee, and especially the comparison doesn't end if you've had a little bit too much coffee and you start to feel a bit edgy.
Christopher: Yeah, jittery. It's not a good feeling.
Amber: No. This is actually how -- what started to develop for me is something called mixed states, so if it's stayed in a pure depression alternating with hypomania, I might have liked that a lot better, but what happens with mixed states is you start getting a sort of offset or a lack of synchronization between mood and energy, so you could have high energy, but you're irritated. Then you start feeling these things like irritability, anxiety, so the ups are no longer euphoria. Actually you're up but you feel bad.
Then also in terms of synchronization and cycling, I started developing what they call rapid cycling, so my mood would change -- someone with bipolar disorder type 1 may be depressed in the depressive phase for months or it could be a year, and then be in the manic phase. It could take months to develop before it ends up in hospitalization, but I was having within a single day very severe variations in mood.
[0:40:01]
After I got this diagnosis of bipolar, when I got over my initial reluctance about it, I felt actually very happy because I thought, well, of course the Prozac didn't help me. It was a drug for the wrong condition. Maybe now when I start trying these bipolar medications, this will actually help me. I was still of the mindset that a psychiatric disorder was a matter of -- they have this imbalance, chemical imbalance in the brain idea. I really abhor that idea now because to me, it sounds just like calories in, calories out.
Christopher: I think you'll find this a bit more complicated than that.
Amber: They just say, "Oh, you've got…" They can put it one of two ways. They can say, "You have too much unhappiness and too little unhappiness," but in the chemical sense, they'd say, "Oh, you have too much noradrenaline and too little serotonin" or something like that, and they say, "Okay. We'll just give you this drug and it will increase your serotonin levels and then that will deal with the imbalance" but what they don't realize is that you're unbalanced because your body is homeostatically at a set point that is the wrong set point. So if you try to just intervene by adding something that changes the level of serotonin then eventually your body is just going to adjust to that because it has its own idea of where it's supposed to be, so you have to get to something that's further upstream that's working on where that set point is coming from.
Christopher: Of course, there's no attempt to understand the underlying process that's leading to the problem in the first place. That for me is tinkering without knowing. We've just been listening to Josh talk about these tools for reducing environmental mismatch and how to categorize them, but yeah, it's tinkering at the source code level in Josh's nomenclature, and it's bad news, right?
Amber: Yeah, and I really like the way he put that because it's like messing with assembly code when you really need to be looking at the pattern or something. You want a much higher level of abstractions sometimes to solve a problem and if all you do is intervene at some very low level, in some cases, it can be really helpful. Like Josh said, if it's genetic, if there's some transcription problem and you're correcting it, that could make a world of difference, but if all you're doing is causing a whole bunch of responses at a different level then you're not getting anywhere.
Christopher: Right. Actually, what's happened to Tommy recently is a good example as well. I've watched the viper stick its freaking teeth in my ankle and I know there's an anti-venom for this venom. That's a kind of source code level intervention, but it's more than justified and it's a simple fix and a single cause and a single cure and it works just great, but when it's a complex system with many interacting factors, good luck with that source code level intervention. I'm wondering about what this is like for your kids. Kids don't have that type of control over there. They're just a state of mind like an adult can. They don't really have willpower. They don't really have the ability to rein in the thoughts and stuff, so what was it like for your kids trying to interact with an adult that was just all over the map?
Amber: I shudder to think.
Christopher: They don't talk about it now. How old were they?
Amber: I was diagnosed with major depressive disorder before I had any children and I was diagnosed -- I think my second child would've been three or four, so yeah, I think it was excruciatingly difficult for the whole family. It was a nightmare for all of us. I was doing the best that I could.
Christopher: Of course, yeah. It's kind of ridiculous to think that anything else was possible. Even to say that is like, of course, what else would you be doing?
Amber: I did a lot of good things. I think I made a pretty good home in some way, so I was a stay-at-home mom. I did a lot of extra education for my children. I taught them how to read and how to do prime factorization before they were in kindergarten. We were really geeky that way and it was fun. I cooked, but I was very malcontented because I wanted to be in academia and I was unable to juggle all those simultaneous responsibilities. I think that's not even -- someone without bipolar disorder would have probably the same issues. It's very hard. Parenting is a full-time job. Graduate school is a full-time job. Both of those jobs are things that you could work all day and never be done.
Christopher: Right, of course.
Amber: I was struggling with that and with the different things in my life that were competing for my attention.
[0:45:05]
And then the drugs, the bipolar drugs that I was so excited to start taking, they were worse than the disease. Each one of them came -- none of them helped. I tried four or five and they each came with their own side effects that were terrible. One of them gave me word access problems. I'm a very verbal person and I stumble over words and I forget about -- I have word recall issues too, but this was just very basic words I could not think of and I started feeling like I was suffering cognitive decline that I was losing my mind.
Then another one gave me something called akathisia, which means you're feeling very uncomfortable. You can't see me, but I'm wiggling my back because I'd be sitting in a chair and I'd feel like I just can't get my back into the right comfortable position. There was no comfortable position. It drove me crazy. There is also another one with a physical symptom. It's called brain zaps. You'd get this feeling periodically throughout the day like there's a shock going down the back of your head and that can't be good. That is only minimally disruptive, but it's certainly disconcerting.
The worst one for me was when that actually caused anxiety. It caused such anxiety that when I got out of bed, I felt like either I or one of my children was going to die during the course of normal activities at any point. My child would be out playing and everything seemed like an imminent danger. It's to the point where I thought I just have to accept the fact that I'm going to lose my child today. It was insane, completely irrational.
Christopher: Did you act on any of these thoughts and feelings?
Amber: I knew that they were irrational.
Christopher: Oh, interesting, so you still had this kind of "I don't know where these words and images in my head are coming from, but I can see that they're not…"
Amber: But I still believed them.
Christopher: You believed them, but you didn't --
Amber: But I didn't believe them.
Christopher: Yeah, you didn't believe them enough to act on them.
Amber: Maybe it begs the question of what belief is.
Christopher: And you weren't doing any -- was there any psychotherapy or any other kind of talk therapy that was helpful or anything you found that could help you deal with these thoughts and feelings?
Amber: You know, I went to a lot of different therapists over the many, many years and many of them were helpful. I learned a lot of skills. I learned a lot of cognitive behavioral techniques and really cool behavioral modification stuff, but none of it was really strong enough -- even before these bipolar meds, none of it was strong enough to pull me out of the hole of deep depression. So if I were feeling just a little bit depressed, I could maybe say, "Oh, that's all or nothing thinking and you can change your thought" or "Oh, you know that when you go outside for a walk, it makes you feel better even if the idea of it right now…" so I could use these ideas, but as soon as it got to a certain threshold, that was it. I'd be lying in my bed feeling like it would be better if I was dead and there's no cognitive therapy that I knew of could touch that. I'm really glad in retrospect that I went through all of that training because once my depression was under control then these techniques have really made vast improvements in my life as a kind of normal functioning person.
Christopher: Yeah, like the little ups and downs that everybody deals with. You've now got these ninja skills where you can see it and do something useful.
Amber: Yeah.
Christopher: You've mentioned going for a walk there. Is there anything else practical that you found to be really helpful?
Amber: Behaviorally, well, I think social activity is always better for me than I think it's going to be. I'm an introvert by nature and if there's something fun going on, I just have a really high activation level. It takes a lot before you'll get me out when I could be sitting home reading or something.
Christopher: Yeah. If someone invites you out for dinner, you'd think, "That's the worst idea I've ever heard. I'd rather not do anything apart from go out to dinner with you" and then you do it --
Amber: It'll take hours of my time.
Christopher: Yeah, and then on your way home, you're like, "That was great. Why didn't I do that more often?" but the next time it comes around, it's exactly the same again like, "Oh, this is a terrible idea. I'd much rather stay at home."
Amber: Exactly.
Christopher: What finally works then? Obviously, it wasn't any of the meds. It wasn't Prozac deficiency that you're suffering from. It was something else you figured out.
Amber: The motivation goes back to the weight loss. All this time, I'm getting sicker and sicker. I'm still on a low carb diet and I'm getting fatter and fatter. I know that I was over 195 lbs, but I stopped looking at the scale and I'm not sure how much over, and it was so frustrating because I knew that what I was doing -- because I've been doing all this studying of ketogenic diets -- it seemed to me that it was the best known intervention for weight, but at the same time, I felt like I was a terrible spokesperson for it.
[0:50:18]
Here I am saying try this for health and weight loss, but don't notice that I actually don't have control of my weight --
Christopher: That's a very slippery area though, I always think, because you have no idea. When you see someone speaking about controlling their weight with a low carbohydrate or any other type of diet for that matter, you have no idea where they started. By the way, the opposite is true too. You see some advocate of some diet posing on Instagram with no share on. You have no idea of what they were like. I want to see a picture of that person when they were 17 where they've never even thought about what a diet should or shouldn't be and they were probably ripped then too. It's such a --
Amber: Yes. We all know people who can eat whatever they want and at least for now, they look awesome, and you're absolutely right. I think that I'm struggling against many genetic factors for example that predispose me to obesity. Also, whenever I would go off a low carb diet -- because if it's not doing for you what you're hoping for it to do then why impose these restrictions on yourself? Many times, I thought, well, f--- it, right? I don't know if I'm allowed to swear.
Christopher: Yeah, I know. I definitely swear on the podcast.
Amber: Let's say "fuck it" because it's not helping me, so I'm going to go ahead and eat that ice cream or whatever it is, even just bread and potatoes or things that I really liked, but if I went off a low carb diet for any period, I would immediately be gaining substantially. I know the low carb diet was helping me. It just wasn't getting me to where I wanted to be. Because of that, I was always on the lookout for something else. I felt like there was some missing piece, and because there are people selling all kinds of missing pieces, I tried many, many things. I had this whole apothecary of just maybe I need more carnitine or creatine or maybe I need a liver cleanse.
Christopher: When you said that, I thought you were going down this route. The reason I said "Oh really?" because that's kind of what I think of Nourish Balance Thrive is being, is this very holistic approach to all problems related to health and performance. We're not just coming at it from the dietary perspective. In the beginning 2013, I just said "I could fix the world with a Paleo diet" and then I realized, oh, damn it, there's this sleep thing, then a year later, oh no, social isolation. That's a problem I can't even solve. Over the years, it's been the revealing of all these different dimensions and I'm starting to wonder whether there are any more dimensions left to discover, maybe not, perhaps there is, but that's why --
Amber: Well, I think there are dimensions and I think that the basis for many of the things that I tried were the real true missing piece for some people. Some people actually were not able to methylate their B vitamins and that made all the difference for them, but I started trying everything and I had this air of desperation. I was looking for the magic bullet that would solve the broken thing about me.
Christopher: Right. We see that all the time. We call it silver bullet thinking, thinking it's just going to be one thing. Which is it? Is it reishi or is it shitake mushroom that's going to solve all my problems? I'm guessing it's going to be probably neither.
Amber: Right. I was looking for ideas and it was all very focused on this weight loss piece, and at the end of 2008, I stumbled upon a forum called Zeroing In On Health, ZIOH. It doesn't exist anymore, but there's a Facebook successor of it that exists now with the same people and they were all with a similar background. To me, they had been on a low carb diet and it didn't get them all the way to where they wanted to be. When they went on this plant-free diet, suddenly they were able to lose weight again, and to boot, many of them were reporting all these other health improvements.
I very pragmatically thought okay, I'm going to try that and it's going to hopefully help me to lose weight. When I get to the weight that I want to be -- I was very much thinking of it as a diet in that kind of traditional sense. When I get to where I'm going to be, I'm going to go back to my regular eating, but to me, regular eating was low carb and I felt like the low carb diet, yes, I had gained weight, but it had taken many, many years. Maybe I could use it as a tune-up now and then. That's where I was imagining it was going to go. Even still, the idea of giving up plants not because I was worried about the health effects because it was very temporary, but just for the variety of it and the role that it played in my life, it was a very intimidating idea to give up plants even for a short period, but I thought about it.
[0:55:08]
I actually planned it for three weeks before I decided to do it, and then that plan was a short-term. I'm going to do this for three weeks and then I'm going to reassess and see if it helped me. It was just astounding how much it helped me. I started losing a pound every day or two in the first weeks that I did this.
Christopher: Wow. What was that? Was that just water? What do you think that was?
Amber: It must have been fat.
Christopher: Yeah. I'm sure some of it was, but I wonder why it's that rapid. I wonder whether some of it is water like you're carrying a bunch of --
Amber: I was already Keto-adapted, but maybe. Definitely fat contains water or adipose tissue does.
Christopher: A little bit, yeah. We've looked at this because we thought it might be the reason that people don't get thirsty when they're fat.
Amber: Well, yeah, it's like 50% you have this metabolic water. It's way more than is stored in glycogen.
Christopher: Right. Tommy looked at it and in the end, he thought that's enough water to really make any difference. Something we've noticed in endurance athletes is I can go -- I did it this afternoon. We went for a three-hour bike ride with Clay and I drank half a bottle, so probably only 20 ml or 50 ml of water. We're in the desert and it was 20 degrees Celsius. I just wasn't thirsty. I was fine. Why is that?
Amber: Yeah. Well, think about camels.
Christopher: Yeah. If I had been pounding down [0:56:28] [Indiscernible] that whole time, I would have [0:56:31] [Indiscernible].
Amber: Right, and that comes back to the speculation I was making earlier about salt where I think especially if you're athletic, you drink water because that's what you're supposed to do, and if you're drinking a lot of water, that can really upset your salt balance. Lots of people that I know in the zero carnivore community are endurance runners and many of them have said -- in particular, Charles Washington, who was the founder of that ZIOH group. He's a runner and he used to always say, "I don't drink while I run. All these other people drink and I don't drink," so I think there's definitely something to that. I'm very interested actually in dry fasting because of the metabolic water aspect of it where if you think about it, well, let's look at it this way. There are migratory birds who use ketosis. They do a fructose to build up fat stores while they're on land and then they use ketosis while they're in flight, and they don't drink. They're getting their water as metabolic water and that's what they do.
There are experiments in animals where if you put them on a fast with water and without water, the ones that are not drinking water burn way more fat and I think that your body says, "We need more water. We'll burn more fat" so that could really disrupt or at least change the way that your body is using fat if you pay attention to the water balance.
Christopher: It's got to be something to do with the osmolality of what you're consuming as well. You just consumed a bunch of really dehydrated stuff and then you get super thirsty just to bring it up to a level where it can be absorbed I think is some of it. It happens so quickly. I've done this in a bike race. You're like, you know what? Screw it. I'm having a joe. The caffeine and sugar is going to be great. You have it and all it does is makes you thirsty instantly. You're really, really thirsty and then it's a pain in the bum because you haven't got any water. All right. Okay. I got totally off track there.
Tell us about the weight loss return, which is great, but before that, we were talking about your neurological start. What changed that? Did you notice something right away?
Amber: I did notice that I was feeling happy, but at first, I didn't really notice because --
Christopher: It's a weight loss. Of course you'd be happy.
Amber: Yeah, exactly. That's exactly right. Here I am thrilled, but then I started realizing not only am I happy about this, but I feel good in a way that I haven't felt for a really long time and I just feel consistently good and not irritable, but one thing about bipolar is that it teaches you not to trust your mind.
We were talking about how did I respond to these feelings of anxiety when I was on -- that drug was Abilify. It's such a smarmy name. Aripiprazole, it's called generically. I was quite used to being flooded with emotions and thoughts that I knew full well if I waited, I would have a different thought about it, and so there's this disconnect between your brain now and you stop trusting yourself. It's the worst thing about it really. The medical community actually encourages that for good reason because one of the symptoms of bipolar disorder is to believe that you don't have it, which can be very frustrating for the people in your family.
[1:00:04]
Christopher: I can imagine, yeah.
Amber: Because when you're upset about something, there's always an object that that upset goes on to and it can be very legitimate. Just because I have bipolar disorder doesn't mean that this situation doesn't suck. So if someone tries to tell you, "That's your bipolar disorder talking," it's very insulting and off-putting because this is a legitimate issue in my life, so your medical support and your family is supposed to be encouraging in you to not believe your feelings and not believe your thoughts, and it's the worst position to be in. That's absolutely the worst thing about it.
Here I was feeling really good, but I knew that this could be just a phase or just part of a swing, a mood swing or something, but I did mention it to Zooko eventually many days like two weeks in. I've probably been feeling like that for most of the time.
Christopher: So how long ago is this now?
Amber: This is 2009.
Christopher: Oh wow, okay.
Amber: So ten years ago.
Christopher: Right.
Amber: Right about now.
Christopher: Wow. Congratulations. Ten years, good Lord.
Amber: Yeah.
Christopher: It's much longer ago than I thought. For some reason -- because I've been hearing you talk about the carnivore thing so much recently, I'm like oh well, this is something you started 15 minutes ago, but clearly not.
Amber: Well, it took me years to even start coming out.
Christopher: You don't want to jinx it.
Amber: Well, it wasn't just that, but first of all, I didn't want to write about it because I was worried about compromising my employability. I thought someone's going to look me up and they're going to say, "Oh, this person has bipolar. There's no way I'm hiring her. We're not going to look at that resume anymore" and I wouldn't blame them, so I was reluctant to talk about it for that reason and I was also reluctant to talk about it ironically because it's such an anecdote. I don't know what really happened and I wouldn't want to be embarrassed later to discover that I had fooled myself so thoroughly, so it did take me a long time to come around to talking about it.
When I first started speaking and writing, that's part of why I have these two separate blogs, one of them that's so science-focused. I did not want anything remotely about this personal experience. I had to taint that. Anyway, I was feeling really great and I broached it in conversation to Zooko. He stopped and looked at me very seriously and he said, "I haven't known how to bring this up with you, but your mood has been better and more stable than it's been in the entire length of time that I've known you."
Christopher: That's amazing.
Amber: That was already -- we were just a couple of weeks in. I knew that something profound was happening, so I decided -- I had made this plan, this three week plan ingeniously to end on my birthday so that I could have a low carb cake in celebration. By the time that birthday came, I didn't want cake. I was like, "No way. I'm on a roll. I'm not stopping this for anything."
Christopher: There's no cake that could make me feel this good.
Amber: Yeah. Sadly, I did end up stopping, so I don't count my carnivore birthday really now even though this is when I discovered it because within a couple of weeks after my birthday passed, I found out I was pregnant again and I was going to stay carnivore. I had looked into the whole ketogenic during pregnancy thing enough that I wasn't at all afraid of that aspect of it and I thought what's good for the mother is good for the baby. I had every intention to continue, but two problems intervened. One was -- well, three problems. It depends how you count. One was extreme carbohydrate cravings and I think that that just comes during that first trimester. Your body wants to get fat, and so insulin is just jacked up.
This whole time that I've been doing -- within days of starting the meat only diet, all cravings for carbohydrates went completely away, but then suddenly one day, I woke up and I was thinking about carbohydrates and I was thinking about them all day. The next day, I was just sitting on the couch trying not to think about carbohydrates.
Christopher: Good luck with that, or anything else.
Amber: At a certain point, it's just like, boom, I am gone. I went down to the local diner and I bought three entrees and I ate them all and they were not low carb, so there's that aspect. After that first trimester, that eased off and I was able to get back to low carb. I even had some --
[1:05:11]
Christopher: What happened to your mood when you reintroduced those carbs? What happened to your mood?
Amber: It's hard to disentangle that from the hormones of pregnancy.
Christopher: Yeah, also stuff going on.
Amber: Yeah. I wouldn't describe it as a very stable time. I wasn't suicidally depressed, but I was moody for sure.
Christopher: Okay.
Amber: The second component of it is that I come from a line of people with hyperemesis gravidarum, which is a pretty rare condition, but there's severe vomiting during pregnancy and not just the first trimester.
Christopher: It goes on, yeah. Julie has done a podcast with a woman that had that condition and the ketogenic diet I think has been shown to be quite helpful for it, isn't it?
Amber: Well, it may well have been -- because I was ketogenic at least before all of my pregnancies and none of my pregnancies was I remotely as sick as my sister was, as my mother was, as my mother's mother and my mother's sister. All of the female people in my family ancestors before me that I know of had severe -- my mother was hospitalized. I was sick, but I wasn't that sick, but it did affect my ability to eat. I couldn't look at a piece of steak. I couldn't buy it. We just basically ate whatever I could get down, so those two components really ruined that whole plan. It wasn't until after my third child was born that I got back on this carnivorous diet, but I never lost sight of it. I know I'm doing that the minute that I feel up to it.
Christopher: Did you ever look at any of those papers? Tommy has talked about this a little bit and he's actually done some experimental research that the milk contains medium-chain triglycerides that synthesize some carbohydrates and epithelial tissue in the breast, and I believe that Tommy has done some experiments where he looked at rats and the pups were less ketogenic when the mother was deprived of carbohydrates. A lot of it is conjecture, I think, but there is some stuff in the literature about it. It seems old like the papers I saw and I wondered whether you'd thought about that at all. If you haven't then we'll just move on, but just in case you have thought --
Amber: I feel like I have looked at those papers and wasn't persuaded, but I don't remember any of the details, so now I'm going to have to dive back into it.
Christopher: Yeah. It's out of my depth though. It's definitely Tommy that's dug that stuff up and has done some experimental research. Well, that sounds fantastic. What exactly does your carnivore diet look like? What happens? Keto has been around a long time and then suddenly -- so in 2016, we did the Keto Summit, and when Jeremy Hendon said to me, "We should do a Keto Summit. The time is now" and he'd been Atkins decades before, he was like, "Now is the time for Keto" and I thought, "Are you trying to tell me that no one has done a Keto Summit?" No, they hadn't done it. Everyone wanted to be a part of it and it was a great success and no one could really explain to me why was it that this diet that had been around for a very long time since the 1920s for epilepsy, refractory epilepsy, why was it in 2014 or something that it suddenly started to take off exponentially? Now, the same thing has happened with carnivores. We've been doing it for ten years and then suddenly, all I see all over the internet is that I'm trapped in a filter bubble and Facebook noticed I interacted with a post that has something to do with carnivore and now it's all I see everywhere I go. It follows me around like a bad smell.
Amber: Well, I don't know if you're in a bubble. I'm certainly in a bubble. I can't get away from it, so for me, it's been really extraordinary. You could point to all these factors and say, well, it was this person or it's this post or it's this site that made it more popular, but maybe it was just the time had come and the world was ready for it. I don't know.
We are in a position now that last year, I was doing a lot of ketogenic conferences. I was going to them. I was speaking at several, and it wasn't the case the year before, but suddenly, everyone wanted to know about the carnivore diet. There was one -- I gave a talk at Low Carb Breckenridge. It wasn't about the carnivore diet at all and all the questions to me were about the carnivore diet. Now, that's understandable because I'm known for that, but I wasn't the only one. Eric Westman was getting questions about the carnivore diet. Georgia Ede was getting questions about the carnivore diet. That's all anybody wanted to know about from my perspective suddenly, and so by the end of that summer circuit, I said, "You know what? We need a carnivore conference" and so I put one together --
[1:10:04]
Christopher: Oh, wow! I didn't even know.
Amber: Yeah, so it's happening in Boulder. It's on March 7th and it's the day before Low Carb Denver. I scheduled it so that if people were coming to Low Carb Denver, they could add on a day and get that if they are interested.
Christopher: Well, that's amazing, so I'll get this podcast out before that happens. If you're listening to this then presumably I can link in the show notes, or do you even know? Is there a domain where people can go and register?
Amber: Yes. It's carnivorycon.com.
Christopher: I love the way that Josh does this as well. He comes up with all these fantastic names. He's got his migraine academy that's called Migrai-Neverland.
Amber: Oh my goodness, that is a good one!
Christopher: Yeah, I love it. These smart people come up with all kinds of fantastic names. That's amazing. Describe the diet. What does it look like? I've seen some, what I think of like "I would not eat that." I wouldn't even eat one of those industrial feedlot steaks, let alone a diet consisting of them. I see that meat on a polystyrene tray with the cling film wrapped over the top of it from I don't know where. I don't even know the names of these supermarkets in the United States. Well, I'm not eating that. I would rather go back to your plant-based diet than eat that, a really good quality plant-based diet then eat feedlot meat, but I guess I've more than introduced my biases now, so I should ask you.
Amber: Well, my initial days were actually like that. We were on a low budget. We went to the regular grocery store that --
Christopher: That's the thing, isn't it? It's going to be so expensive.
Amber: Yeah, so I'll say two things about that. One is that the people that I know, including myself who were able to get such extraordinary benefits, weren't eating any special kind of meat, and maybe one of the reasons for that is all of the pollutants that are -- I'm hesitating because this is going to sound backwards because we know that the further you go up the chain, the more pollutants can concentrate, but on the other hand, there are certain kinds of toxins that actually animals are well developed evolutionarily to filter out. And so if you have problems with plants or if there are toxins in plants and you process it through a ruminant animal, suddenly they've dealt with all those and excreted them.
Well, just observationally, the fact is that I don't know anyone who needed the extra step of getting well sourced meat in order to get benefits from excluding plants, but that's not to say that it couldn't be a complete step up from there. What do I eat? I eat mainly beef actually. I eat beef and pork, but I still eat a variety. I like to call it my well balanced diet. I eat from all of the food groups.
Christopher: There's a steak in each hand. That's well-balanced.
Amber: No. What I mean, I eat ruminants. I eat poultry. I eat eggs. I eat fish. I eat shellfish. I do eat organs. That's me. If you look out into this newly exploded carnivore world, most of the things that you're going to see are going to be people eating, just factory-farmed steak, steak and bacon. Yeah, it's steak and bacon. It's absolutely amazing, the results that you can get just doing that, but then the carnivore world runs the spectrum of this kind of all you can eat -- I wouldn't say it's lean meat though. We'd still advocate for a kind of fattier cut because there's only so much percent protein that you can do well on. No matter what I say, there's going to be someone who's going to say the opposite, but I'm just making some sweeping generalizations here.
On the other end of the spectrum, there's a clinic in Hungary, the Paleomedicina Clinic or ICMNI as it's now called, they treat patients with chronic disease with a plant-free diet, and the way that they're treating patients, their diet, which they call a Paleolithic ketogenic diet, it's very high fat, lower protein, and they include organs mandatorily. It's not an option. Also, it has to be deeply ketogenic. We were talking earlier about how high protein levels can eventually subdue ketosis and I would say that even if you're eating very high protein, most of the people that I know who bother to measure it in the carnivore community are still at least in mild ketosis.
Christopher: Right. That's the question. Does it matter? Does the blood level of ketones even matter?
Amber: Once you get into the therapeutic zone, one millimole, is that worse than five millimoles? Where do you draw the line? Phinney has recently said that he now thinks or see benefits --
Christopher: He had a graphic artist -- I'm so sick of seeing that artist rendition.
[1:15:03]
I hired a graphic designer and this is what he came up with. It was never based in any empirical evidence whatsoever, was it?
Amber: Oh, you're talking about the optimum ketone levels?
Christopher: Yeah, that perfectly two -- the bell curve like the normal distribution curve and then it's being color-coded by a graphic -- somebody did that in Microsoft paint or something. There's no way that the diet could've looked like that.
Amber: The amusing thing about that graph is the Y-axis doesn't have anything on it.
Christopher: That's what I mean. That's how you know that a graphic designer made this for a book.
Amber: Right, but in his defense -- he's coming from those numbers -- is here's the numbers that we see correlated with benefits. So he used to peg it beginning at about 0.5 millimole. The last time I saw him speak, he said we now think that even as low as 0.4. So regardless, people who are eating only meat, sometimes their ketones are going to be down at that 0.5 level, just barely considered ketogenic, but others are going to be higher. Anecdotally, many people have been reporting that the amount of protein they can eat on a carnivore diet for a given level of ketosis is higher than on a low carb diet. One speculation that I have about why that is is just that for every gram of carbohydrate that you eat, even if you're eating only 20 grams, that's gluconeogenesis that isn't happening.
So if you're eating no carbohydrate whatsoever, you still need to make glucose. If you knew that you are at one millimole of ketosis when you're eating 20 grams of carbohydrate and suddenly you drop those carbohydrates to zero, you could potentially eat 40 grams more of protein and be at the same level of ketosis, and 40 grams of protein is really quite substantial because we're talking about minimum levels that might be somewhere around the 70 grams per day level, so in someone who's small enough, you could be nearly doubling your amount of protein allowance for the same amount of ketosis.
Christopher: Is the simple explanation that now you're restricting calories. So you've got this really restrictive diet. Probably another steak doesn't seem that appealing. There must be some -- so we see this every time. We talked about this this weekend, is that you put people on AIP and the calories just plummet. They're just not eating as much food and I think that's pretty common. Every time you eat an elimination diet, hyperpalatability goes down. This is kind of like the choice thing goes away and the palate fatigue, you might call it, and so you're not going to eat as much food. Sure, you can eat more protein just because you've also got a calorie deficit, and so anytime you impose a calorie deficit, it's going to be more ketogenic, right?
Amber: Well, that could be happening, but one thing that's funny about the carnivore community is that some of the groups encourage eating enormous amounts of food. It wouldn't be uncommon for -- I'm not even trying to overeat the way that some of these groups advocate for and I easily eat somewhere between one and a half and two pounds of meat a day.
Christopher: It's hard for me to gauge. What does that look like? I probably don't even know what it looks like on a plate.
Amber: Just think about a large rib eye steak that's probably a pound or more.
Christopher: Yeah. They had 48-ounce steaks in that place last night, didn't they?
Amber: Well, those are extraordinary, yeah. That might be a whole day's worth of food for a carnivore, but then there are people like Shawn Baker, for example, who says he eats four or five pounds a day.
Christopher: Wow.
Amber: That's where we're talking about the difference between the Paleomedicina style eating where it really is quite restricted that it's going to be maybe 400 to 600 grams of meat and extra fat on top of that, but then that's the limit whereas the -- I don't know, for lack of a better word, American carnivores are saying eat as much as you can and don't succumb to a low appetite. The reason, I think, that that historically has happened in those groups is that the diet has been a bit of a draw for people who are prone to abuse of calorie restriction.
People come because they say, "I'm hungry and I can't keep calorie-restricting. I have heard that if you eat only meat, you don't need to calorie-restrict anymore," but as soon as you get into this situation, like you said, where there's a lot of satiation ability of this diet partly because of the mono food thing, partly because it's protein and fat, which are very satiating, you get people who say, "Well, my primary goal is to get to as low a body fat as I can, and so I'm going to use this diet in conjunction with eating as little as possible" and that very often doesn't lead to the happy results that they're looking for.
[1:20:05]
So part of the culture along with carnivore that isn't exactly dietary has been you're here to feed your body and heal and forget about the weight loss for a little while. There's been a real encouragement to make sure that you're not undereating.
Christopher: I've always admired -- do you know Andrew Scarborough?
Amber: I do.
Christopher: I've always admired his diet. I don't know how I've ended up seeing a lot of pictures of his food, but he's eating stuff even though -- I'm pretty sure it's a carnivorous diet. He's not eating any plants.
Amber: Yeah. There's a bit of a history between him and Zooko actually because there was a time when I first encountered him, he had brain cancer and he was on a ketogenic diet for brain cancer and he felt like crap all the time. Zooko was saying -- because Zooko had a history of knowing someone who had brain cancer who was cured by the carnivore diet, a really extraordinary story. He was very sensitive to this and said, "Andrew, you really should try cutting out all the carbs." There was a Twitter exchange and Andrew was saying, "I don't see why that would make any difference. It doesn't make any sense. I'm just having a little bit of these fibrous things." He tried it and he was one of those people -- it's the first time that I heard this thing that I said where you can get the same level of ketosis for more protein. Now, Andrew had very strict ketosis requirements because he was trying to hit a therapeutic target, so there was no way he was going to do anything that would compromise that, but he found he could eat more protein and still hit that target and then suddenly wasn't tired anymore.
What I surmised is that many people who are on a ketogenic diet, in order to keep it ketogenic, you have to keep the protein so low that you're actually not getting enough protein, but if you can do something that allows you to eat more protein, suddenly you're getting all your needs met. That's how I started first learning about Andrew.
Christopher: Interesting. What I was going to say, I've seen pictures of his food and he was eating things that I've never even heard of even though he was staying within this domain that most people would consider to be highly restrictive like how many people do you know that are eating sweetbreads and oysters and all this --
Amber: Not to mention mealworms and any number of things.
Christopher: It's crazy.
Amber: Yeah, it's very cool.
Christopher: It's really inspiring. I think one of the special things about him was he had this feedback loop in health. It's the thing that's missing. You don't find out whether it's -- actually, yours is another good one, the bipolar. You found out pretty quickly that what you're doing is working. Weight loss could be one, but that can be highly non-monotonic. It's all over the place.
Amber: It is.
Christopher: Here's where I believe that he had auras. As soon as his ketone levels started to drop, he'd start getting auras. They're related to the --
Amber: A blessing and a curse, right?
Christopher: Yeah, blessing and a curse like, "oh shit, I'm doing it wrong, but that would be amazing." Maybe we all need that in order to make better decisions and that's what it is, is that feedback loop. It sounds like your diet is similar then in that you're eating nose to tail. There's a wide variety of different animal foods. It's not just all rib eye steak.
Amber: Yeah. I don't go out of my way and I'm not doing it necessarily for the principle of it, but I love food and I've always liked liver, and so I eat what I like.
Christopher: That's great. Good for you. Well, blimey, we didn't even get into your talk and I feel like it's getting dark where we are. We're outside in Scottsdale and I feel like I should take Amber to go and buy her a steak, but we didn't even talk about her at all. It's going to be on YouTube. I've got the video, so I'll link to that in the show notes, but perhaps we could give people a synopsis of what you talked about at the Physicians for Ancestral Health Winter Retreat.
Amber: Sure. The thing about that talk is you're not going to really sit until after the Carnivore Conference because I'm going to give a bigger and better presentation of the same thing.
Christopher: Okay. Well, maybe we won't talk about what you talked about --
Amber: But I'll tell you what it was about for your listeners. One of the things that people think about when they hear about a carnivorous diet is, "Well, that's very unbalanced. How can you possibly be getting all of your nutritional needs met?" One of the surprising things to me about it is that even people who've been on it for a very long time aren't getting the deficiencies that you might expect. Well, one of the reasons for that is really easy to discover and that's the meat is highly nutritious especially if you're going to include something like liver.
Vegetables get all this media around how nutritious they are, but I'm kind of cynical these days and I think, well, if we're trying to promote vegetables, since they have very few redeeming features, what can I say that they do have? Well, they do have vitamins and minerals. Now, plants are known for their vitamins and minerals, but that doesn't mean that meat doesn't have them. It's just that we never talk about them because meat has this other thing that those plants don't have, and that's that it has lots of high quality protein.
[1:25:07]
So when people think about a meat diet, they think, "Oh, you're just eating protein," that's not really the case at all.
Christopher: Right.
Amber: That's one reason, but it turns out that I don't have numbers for this. During my talk, I really only brought up questions more than specific answers, but what I did dive into was the fact that if you look at the specific cases of a variety of nutrients, you find out that a low carb diet or a plant-free diet or both can have pretty dramatic implications for nutrition actually in a subtractive way, so you could be eating a plant that actually makes you require more of certain nutrients or eating a high carb diet may require you to eat more of certain nutrients, and so I went into an exploration of that.
Christopher: An obvious example that we've talked about before on the podcast is phytates and iron, for example, or tannins that's in --
Amber: Yes. One of Georgia Ede's talks that I was really intrigued by, I had a slide showing the blood levels of zinc after you eat oysters, which goes up very high to some significant level and you've got a graph showing this line of it going way up. Then they show the same line, but if you ate it with a corn tortilla, it's almost back at the floor. It's really dramatic.
Christopher: Yeah. What do we know? It goes back to that kind of like, "What the hell do we know?" You think you know how much zinc is in this. You think you know how many calories are in that. Guess what? What do you eat it with, how it's processed, how it's cooked, that makes all the difference.
Amber: Everything can change, yeah.
Christopher: Yeah, goodness. Wow! That's fantastic. You're doing some amazing work. I think I've talked about how Stephanie -- well, she was one of the unsung heroes of the Ancestral Health Movement and I think of you as somewhat the same. It's not like you have a hundred thousand people following you on Instagram and seven New York Times bestselling books, but still, you're synthesizing some extremely important ideas that need to get out there into the world. Probably the best -- well, of course you do have a very good online presence, but I feel like the best way to get to know more of your work is to attend one of these conferences.
Amber: Well, that's very kind. Thank you.
Christopher: Ketotic.org is the first website that we talked about, and that was something that you co-authored with Zooko. This is like a more formal, less of your personal experience, and then your more personal experience website is empiri.ca. Is that right?
Amber: Yes, that's right.
Christopher: Are those the best places to connect with you online? Are you active on Twitter or anywhere else?
Amber: I am. I'm way too active on Twitter. I need to quit that habit.
Christopher: You'll probably go back into the major depressive --
Amber: My handle there is @ketocarnivore. I also have started writing a book and it's online.
Christopher: Oh, wow!
Amber: The address for that is facultativecarnivore.com.
Christopher: Oh, fantastic. Fantastic.
Amber: My story is there.
Christopher: Yeah, so you don't have to remember these things. We do a fantastic job on the show notes, and by "we", I mean Elaine does a fantastic job on the show notes. If you poke around inside of your podcast app, there's usually an info button and you'll find in there everything that's been mentioned in this podcast including a link to the conference she mentioned, Amber's book that she's working on. Everything else is all going to be there, any scientific reference.
Amber: Zcash.
Christopher: Yeah, Zcash, exactly. Get your Zcash online. Send me some Zcash. I won't be sad if you send me some Zcash. Well, Amber, thank you so much for your time. I very much appreciate you.
Amber: Thank you very much.
[1:28:46] End of Audio
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