• Clinical framing

  • Most clinical workload is tied to insulin resistance (~90%).
  • Pancreatic cancer and bowel cancer patients are virtually all insulin resistant in clinical experience; surgical pathways limit longitudinal dietary intervention.
  • Low-carbohydrate diets are used for over a decade and are the default diet for fatty liver.

• Metabolism and respiratory quotient

  • Human energy production is food oxidation to CO2, water, and energy; plant photosynthesis fixes CO2 into sugar using solar energy.
  • Ruminant digestion converts plant sugar to fat; CO2 release is CO2 previously fixed by plants.
  • A full ketogenic diet has an RQ ~0.7; pure carbohydrate oxidation has an RQ ~1.0; lower RQ corresponds to lower CO2 emitted per oxygen consumed.
  • Overnight fat oxidation maintains energy; sugar dependence produces overnight “running out of sugar” with sleep disturbance.
  • Morning triglycerides are low after overnight fat oxidation; high triglycerides point to insulin resistance.

• Gastroenterology-relevant applications

  • Fatty liver is common (~30% of the adult population) and responds to low-carbohydrate approaches.
  • Reflux is an early sign of metabolic dysfunction and improves with low-carbohydrate diets.
  • Irritable bowel symptoms improve with low-carbohydrate diets.
  • Ulcerative colitis and Crohn’s disease show improved symptom control as an adjunct; full remission not observed in described cases.
  • Constipation improves with low-fiber or zero-fiber diets in many cases; adequate fat intake is central; some individuals respond to adding some fiber.

• Fatty liver study example and mechanistic claims

  • A 10-patient intervention in significant fatty liver used <30 g/day carbohydrate for 2 weeks with attempted weight-stability; liver fat decreased by ~43–50% within 2 weeks.
  • Microbiome composition changed; folate-producing bacteria increased.
  • Some hepatic fat metabolism is folate dependent; increased folate production aligns with increased hepatic fat burning.
  • Liver tests normalize rapidly (example timeframe ~6 weeks).

• Guideline and evidence-process critiques

  • Slide text: “weight loss is more important than diet type”; “no macronutrient ratio makes any difference.”
  • Mediterranean diet and plant-based diets with minimal animal protein are in the guidance.
  • “Blue zones” evidence is confounded.
  • A society guideline has “diet” mentioned twice and limits detail to “diet and lifestyle,” with predominant focus on pharmacotherapy.
  • ≥50% of what is read in major journals is false, not reproducible, and corrupt; journal income streams bias results.
  • Consensus guideline-based medicine is linked with suppression of alternative views and regulatory constraints.

• Pharmacotherapy and economics

  • Semiglutamide has beneficial effects and costs about $500/month; scaling to ~30% of adults yields large public expenditure.
  • Pharmacotherapy is financially favorable for pharmaceutical companies.

• Diet composition, animal protein, and population health claims

  • Eat-Lancet per-day meat recommendations are linked to child growth stunting where meat affordability is limited.
  • Increased meat intake in low-income settings is linked to improved IQ and school performance.
  • The Eat-Lancet “planetary health” diet is at the expense of human health; the CO2 premise is wrong.

• Vegetable oils and environment/light exposure

  • Vegetable oil avoidance is recommended.
  • Diabetes reversal without avoiding vegetable oils is “proven” by the CSRO.
  • Vegetable oils start the process and take ~20 years to damage metabolism; carbohydrate avoidance largely fixes downstream effects.
  • Vegetable oil half-life is ~400 days; ~5 years is needed to meaningfully reduce levels; 5-year trials are needed for long-term metabolic outcomes.
  • LED lighting removes infrared; infrared supports mitochondrial function; infrared on the back lowers blood sugar.

• Lipids, risk markers, and statin use

  • LDL sometimes increases on low-carbohydrate diets; overall risk factors decrease.
  • High HDL makes LDL cholesterol less clinically important.
  • Triglyceride/HDL ratio is a risk predictor; statin benefit is absent with good triglyceride/HDL ratio or negative CAC.
  • Statin deprescribing occurs when it appears safe.

• Practical counseling heuristics

  • Routine diet questioning is used for patients with and without procedures.
  • Self-reported “healthy diet” is a red flag for high-compliance patients with ongoing metabolic harm from standard dietary guidance.
  • Alcohol guidance is keeping carbohydrates low and swapping carbohydrates for alcohol when abstinence is unlikely.

PAPERS/REPORTS NAMED

• [00:07] EAT–Lancet Commission “planetary health diet” report:
  • Willett W, et al. Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems (2019).
  • DOI: 10.1016/S0140-6736(18)31788-4

STUDIES DESCRIBED

• [00:11] Two-week <30 g/day carbohydrate intervention in ten fatty-liver patients with microbiome/folate changes (resolved from descriptor; search key: ten subjects NAFLD 14 days <30 g carbohydrates folate gut microbiota):
  • Mardinoglu A, et al. An Integrated Understanding of the Rapid Metabolic Benefits of a Carbohydrate-Restricted Diet on Hepatic Steatosis in Humans. Cell Metabolism (2018).
  • DOI: 10.1016/j.cmet.2018.01.005
• [00:06] Red/infrared light on back reducing blood glucose (candidate resolution from descriptor; search key: 670 nm light on back reduces blood glucose human glucose tolerance test):
  • Powner MB, Jeffery G. Light stimulation of mitochondria reduces blood glucose levels. Journal of Biophotonics (2024).
  • DOI: 10.1002/jbio.202300521