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Q&A time 
Q1: How about people who've had their gall bladder taken out. How can they do keto or carnivore diet? A from Clemens: no special needs. Q: don't they need to take enzymes? A (Clemens): No. A (Ben-Dor): I have no gall bladder. It's fine. A (Mason): your bile production adapts
A (Mason): I can't recall one patient without a gall bladder who had problems with a high-fat diet
Q2: What was that slide about colostrum? A (Mason): the left hand side was pre and post with colostrum, and the right hand side was pre and post with whey, an the active ingredient is stimulating [something or other]
Q3: for Mason, didn't get a shot of the slide but did you say there's actually medication that attempts to increase the permeability of the gut in order to achieve its delivery into the body. Is that right? A (Mason): Yeah, active area of pharma research.
Q4: about toxic compounds in chocolate and coffee. Are they water-soluble? A: (Diggs) I don't know about the solubility of those. Given molecular structure and that we take caffeine in aqueous solution, I would assume they're soluble in water.
Q: would xanthines make it past paper filters on coffee? A: absolutely, you still get caffeine.
Q5 for Clemens: I've heard you comment on the importance of organ meats especially brains and liver. In the United States its hard to find organ meats, and none of us know how to cook it. I don't. How do we prepare it. And why do you think it is so important.
A (Clemens): I do think it is important in patients. If you have a high level of inflammation, the inflammation is depleting [something] and [iron?]. That's why it's more important. To cook it, [something].
A (Peterson): Fry it in a pan til the blood kind of rises to the top, then flip it over. Q: about how long on each side? A: rough estimate, but maybe about 2 minutes. You can see the blood comes up to the surface then just flip it right away.
Q6: based on word of Thomas Seyfried, he says cancer cells use two fuels, glucose and glutamine. I just wondered how that fits into what you said about glutamine. A (Mason): yeah, I wonder if the glutamine that feeds the cancer comes from other cells, wonder if ingested ...
glutamine would be as avbailable. Haven't read any strong studies one way or the other, but I *suspect* that dietary glutamine is not pro-cancer.
Q7: Liver, toxicity, vitamin A, that it could throw your hormones out of balance. Is there an upper limit of liver that you should eat in a week, or no big deal no side effects. A (Clemens): there is no upper limit from the point of view of side-effects.
There is obviously a rational limit, that you won't have the right ratio of protein to [something]. You will not be able to overdose on vitamin A because there are two forms and a feedback regulation s that you cannot overeat vitamin A in a similar way thta you cannot vit D.
A (Mason): when I was in medical school there was a multiple choice question which was "an Arctic explorer died of which condition", and that was the only information we got. There was an arctic explorer who got vitamin A toxicity. It has been described.
A (Ben-Dor): there are ethnographic reports that bear liver is a problem.
(The arctic explorer ate polar bear liver.)
Q8: animal-based lectins that you mentioned. Does that tell us something about people who have problems with animal-based foods? A (Mason): recent research about [things] that stimulate reactions. One that stood out to me that I recall was mackerel, since I eat that.
(Mason) Every meat has a different composition. The meat-allergy from ticks in Australia is only for mammalian meats.
(Mason) In terms of lectins, [someone] describes lectins getting formed from A1 milks, but if you look at the research I think it is kind of wishy washy.
(Mason) [something spomething] receptor evolved 2 million years ago. ABout the same time we started eating meat.
Q: by the way I'm terrified of that tick.
A (Mason): it is a serious condition, it actually causes full-blown anaphylaxis. In Australia it is endemic.
A (Diggs): the tick is in the USA. At least in the southeastern U.S.
A (@KetoCarnivore): I've read that it is temporary, so all is not lost if that worst-case scenario happens to you. Maybe it'll go away.
Q9: Fiber, microbiome, probiotics, diversity in the microbiome. A (O'Hearn) As far as I know all of the studies that talk about microbiome diversity go back to a single study looking at the Hadza, comparing their microbiome to people in the West and saying "Oh more diverse".
A (O'Hearn): We don't know if there are other healthy communities with _low_ diversity. We don't know enough to recommend microbiome diversity.
A (O'Hearn): You don't need to support a biome that has the function of breaking down something that you don't eat. If you eat a lot of broccoli and you don't have the microbiome to break it down, then maybe promoting microbiome might help, but if you're not eating broccoli...
then why would you need to promote that microbiome.
A (Mason): artificial sugar called [something] in ice cream, introduced in the year 2000. Feeds [something] difficile. They've actually traced that back to the introduction of this particular substrate for it into the food supply.
A (Mason): beta-hydroxybutyrate is the metabolite ...
A (Peterson): anecdotal evidence that reducing your diet to meat doesn't necessarily reduce your microbiome diversity. Some people anecdotally have _higher_ diversity. There is a lot we don't know, and it is hard to figure out what to do with what we do know.
Q10: I follow your social media and see that Mikhaila visited Clemens's clinic recently. Any insights beside strict carnivory? I'm already a strict carnivore like Mikhaila.
A (Peterson): add in as much fat as I can tolerate, and eat liver. That's mostly what I learned when I went there.
Q11: for Clemens, I noticed there was "carnivore" and then there was "paleoketogenic". What's the difference, and in Crohn's disease, can there be a worsening if they start the diet at first before they get better, and if so how long should they stick with it?
[Ed: SEE!? —Ed]
A (Clemens): [didn't understand the answer]
Q: fatty meat is expensive. How do you get enough fat?
A (PEterson): when I first started off I had a hard time with all the fat, digesting it. I think it has to d with how much gut damage I had. I had leaner cuts at the beginning, then the longer I've done this the easier the fats have been to digest. Easier around 5 mo, then
easier again around 10 months. To save money, chuck roast is much chepaer than ribeye, and it should look, marbled, like it is about 1/3 fat. Chuck roast, or make friends with a local butcher and ask them for trimmings. Chop that up and fry it. Like bacon.
Q12: grain fed vs grass fed animals, omega-6 vs omega-3. omega-6 being much more available in today's marketplace. and anabolic effects of [something] vs reducing IGF-1. promoting growth. Ron Rosedale. lifespan. anabolic effects of too much protein, growth, cancer
[Yes, that was the question.]
A (O'Hearn): as for omega-6, if you don't eat seed oils, then the amount you're getting from meat is so little that it isn't a problem. Just because you have omega-6 doesn't mean it turns into inflammation and just because you have DHA doesn't mean it turns into anti-inflammation
A (O'Hearn): one thing that's really important to remember is that inflammation itself isn't bad. It's the response to damage, and it is a needed response. So what sounds very simple is actually quite complex. Not sure there's a huge difference between grass-fed and grain...
A (O'Hearn): mtor! We can have a whole day of talks about it. mtor is a signal of nutrition. You can't eat and not have mtor. Even fat, I think. As long as you're not eating 24/7 then the signal will stop and you'll go into fasting state. Which happens much faster in keto diet.
A (O'Hearn): so maybe 12 hours, so even overnight you'll get into the fasted state. So in the context of a low-carb diet, I think the importance of reducing mtor can be much overblown.
A (Diggs): I communicate a lot to college studnets. They are concerned about limited funds. I tell them concentrate on reducing the bad additionals: seed oils in salad dressing, donuts, etc. then don't worry about the mainstream store-bought meat.
A (Mason): [something something] shared enzymes that compete between [something and something]. Omega-6 side of the equation: vegetable and seed-oil that we actually medicate against because they cause symptoms. Prostglandins, asthma, [something something] heart attacks
A (Mason): [prospective studies heart attack deaths omega-3] risk of sudden cardiac deaths differed by about 10 times. For me that's pretty convincing. [Not to me —Ed]
A (O'Hearn): ketogenic diet also raises arachadonic acid so if that's a problem we're all in trouble [oh boy now they're arguing]
A (Mason): [something something]
Q13: odd question: pruning of the fingertips. Weird thing happens to me. More salt, less salt, more water. I've been keto for the last 9 months and probably 2 months into carnivore, and it happens less but it still happens.
A (Ben-Dor): just from personal experience, I had it but it passed.
Q14 for Zsofia, how your recommendations change across different populations, e.g. athletes. 2:1 ratio to achieve ketones I assume. Where did that come from.
A (Clemens): 2:1 fat to protein ratio is a quite general recommendation for all populations including athletes. There are different phases in the preparation of athletes. There may be a point where we change due to specific measurements to improve performance.
Q: how do you measure the 2:1? A: eat according to your hunger. [I think I missed something in this answer. —Ed]
Q15 I'm @raphaels7 I run the Nutrita web site. PhD student experimenting. What's your experience with carnivory or keto-carnivore when it comes to mental health, especially schizophrenia and bipolar.
A (Clemens) We do have patients. There is [something something] that interact. It is a tricky issue.
A (Mason): It just gets better. Patients improve quite significantly. Wait til George Ede speaks this afternoon. She knows much better.
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