@murphai/murph 1.3.0 → 1.3.2

package/node_modules/@murphai/assistant-engine/skills/nutrition-strategy/references/daily-nutrition-card-goals.md

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+# Daily nutrition-card goals
+
+Use the target-authority and canonical-discovery rules below after every explicit
+interactive request to set nutrition targets or receive a numeric daily
+nutrition card, even when the visible context appears to contain a complete
+bundle. Use the proposal workflow only when the complete read proves that the
+member does not already have one unambiguous, unit- and comparator-compatible
+daily target for calories, protein, carbohydrate, fat, and fiber. The owning
+automatic-meal-capture skill may also use this workflow for one first eligible
+managed closeout when a complete all-status Goal read proves that no Goal with
+slug `murph-daily-nutrition-starting-targets` exists in any status. That
+scheduled exception may use only already-known responsible inputs, creates and
+explains one paused proposal in ordinary text, asks no question, attaches no
+card, and never activates the proposal. Once the managed Goal exists in any
+status, later scheduled closeouts may use an accepted active bundle but never
+create, change, or automatically repeat a numeric proposal.
+
+Start with the active target-authority read below. If it proves that no card or
+responsible proposal can be produced, stop on the owning non-numeric path.
+Apply the `murph.attach_response_card` prompt's concise numeric-suitability rule
+before deriving, surfacing, writing, or activating numeric goals, reading card
+totals, or attaching a card. Use context already known or read only what a
+concrete concern requires; do not fan out across unrelated clinical history.
+If known context suppresses numeric guidance, make no Goal or measurement
+mutation and leave an existing paused proposal unchanged.
+
+A numeric card request explicitly asks for Murph's goal-aware daily-card
+experience. It authorizes only the one paused canonical proposal below so the
+provisional values do not live in transient assistant state; it does not accept,
+activate, or use those targets. The explanation and explicit later acceptance
+remain required before the proposal can affect a card.
+
+An ordinary verified private meal log carries default attachment intent only.
+It may use an already accepted complete active bundle after the known-context
+suitability rule, authority, and totals reads, but it does not authorize this proposal workflow,
+target setting, or any Goal mutation. When that accepted bundle is absent or any
+card gate fails, return the owning food-journal skill's short truthful fallback.
+
+## Target authority
+
+- Before treating any target bundle as complete or deciding that a metric is
+  missing, run `vault-cli goal list --status active --limit 200 --format json`.
+  If it returns 200 records, the bounded read may be incomplete: fail closed
+  with ordinary text, no Goal or measurement mutation, and no card. Otherwise,
+  run `vault-cli goal show <goal-id> --format json` for every returned active
+  Goal whose list item reports a nonzero `data.metricTargetsCount`. Do not
+  select detail reads by title, slug, domain, context-snapshot visibility, or
+  the default list prefix. Resolve metric identity, unit, comparator, effective
+  date, conflicts, and the 1,200-kcal boundary only after inspecting that
+  complete detail set. Keep this active-target authority read separate from the
+  all-status lookup used below to reuse or honor Murph's managed paused or
+  abandoned proposal; neither read substitutes for the other.
+- Read already-known goals, body measurements, training, weight trend, activity,
+  and stated body-composition direction before asking. Never infer a missing
+  physiological sex input from a name, pronouns, or gender label, and never infer
+  usual activity from a few workouts or one wearable day.
+- A member- or clinician-chosen active target always wins for its metric. Do not
+  replace it, average conflicts, or create a default over it. A range or dynamic
+  target cannot be collapsed into the card's scalar target; ask one narrow
+  question or use ordinary text instead.
+- Comparator compatibility is part of target authority. This point-target card
+  and its managed derivation normally accept a target only when its evaluation
+  is `selected-value`, its comparator is `between`, and its numeric `value` and
+  `highValue` are identical. The complete same-Goal historical `daily-*`
+  nutrition set below has one read-only display-compatibility path when every
+  target instead uses `evaluation.kind: rolling-window` with `statistic: mean`
+  plus `selectionPolicyOverride.kind: daily-aggregate` with `statistic: mean`.
+  Copy each unchanged point bound into the card for the selected `localDate`,
+  preserve the Goal, and never extend this exception to another target identity
+  or workflow. A mixed evaluation bundle or any other rolling-window or
+  daily-aggregate statistic is incompatible.
+  A one-sided `<`, `<=`, `>`, or `>=` threshold, a non-identical `between`
+  range, or any other target shape remains authoritative canonical state but is
+  incompatible with this workflow. Never translate its bound into a point:
+  do not expose, compare, or copy it into the card; use it for the 1,200 kcal
+  boundary, residual-energy, or fiber calculations; or create, replace, or
+  remove managed targets around it. Use ordinary text or one narrow interactive
+  question without mutation; a scheduled closeout asks nothing and sends no
+  card. Apply this rule before any low-energy check or derivation. Multiple
+  active explicit owners are also ambiguous.
+- Calorie metric compatibility has one narrow read-only exception for an
+  existing complete nutrition Goal. New authoring uses `dietary-calories`.
+  First resolve applicable canonical `dietary-calories` authority under the
+  date, comparator, and unit rules here. When exactly one compatible canonical
+  owner remains, use it and ignore every `calories` target; that globally
+  ambiguous key neither overrides nor conflicts with canonical dietary
+  authority. Only when no canonical owner exists may the historical target
+  `daily-calories` with metric `calories` and unit `kcal` fill the card's calorie
+  slot. Its same containing Goal must also own exactly one applicable compatible
+  exact-point target for each historical id, metric, and unit pair:
+  `daily-protein` / `protein-grams` / `g`, `daily-carbohydrates` /
+  `carbs-grams` / `g`, `daily-fat` / `fat-grams` / `g`, and `daily-fiber` /
+  `fiber-grams` / `g`. Require exactly one complete historical set. Any other
+  `calories` target is not dietary authority, even when co-located with all four
+  macro and fiber metrics. Never combine the historical calorie target with
+  targets from another Goal or a managed proposal. Multiple qualifying sets or
+  ambiguity or incompatibility inside the qualifying Goal means no card and no
+  managed Goal mutation. Do not use titles, slugs, domains, descriptions, or
+  guessed intent as authority. Apply the 1,200-kcal boundary and residual-energy
+  calculations to the one resolved calorie value exactly as if it came from
+  `dietary-calories`. Never rename or mutate the Goal, extend this exception to
+  another workflow, or author new `calories` targets.
+- Unit compatibility is part of target authority. This fixed-unit workflow
+  accepts the resolved calorie owner above in `kcal`, and `protein-grams`,
+  `carbs-grams`, `fat-grams`, and `fiber-grams` in `g`. An explicit target in
+  another unit
+  remains authoritative and must not be overwritten, but its raw value must not
+  be compared with the 1,200 kcal boundary, copied into a card, or used by the
+  residual-energy or fiber calculations. Do not invent a card-specific
+  conversion. Without an existing owning conversion that yields the exact
+  canonical unit, treat the bundle as incomplete and incompatible: perform no
+  managed Goal mutation, use ordinary text or one narrow interactive question,
+  and let a scheduled closeout use ordinary text without a question or card.
+  Apply this rule before any low-energy check or derivation.
+- Effective dates are also part of target authority. Resolve them against the
+  exact card `localDate`: the selected capture date for a scheduled closeout,
+  which may be a historical catch-up date rather than the occurrence date, or
+  the explicitly requested date. Never use wall-clock today as a substitute.
+  The containing Goal applies only when
+  `window.startAt <= localDate` and its optional `window.targetAt` is absent or
+  `localDate <= window.targetAt`. A target inside it also applies only when its
+  optional `startAt` is absent or `startAt <= localDate`, and its optional
+  `targetAt` is absent or `localDate <= targetAt`; both boundaries are
+  inclusive. An out-of-window target remains canonical authority for its own
+  period, but it is not a current owner or conflict: do not copy or expose its
+  value, compare it with the 1,200 kcal boundary, derive from it, or let it
+  cause any managed Goal mutation. If one complete applicable bundle does not
+  remain, use ordinary text or one narrow interactive question with no
+  mutation; a scheduled closeout asks nothing and sends no card.
+- After explicit interactive target-setting intent, if one consolidated question
+  can collect the genuinely missing inputs, ask it once. The one scheduled
+  first-run exception asks no question: if already-known inputs cannot prove a
+  responsible calorie estimate and all five goals, write nothing and keep the
+  ordinary closeout. Until a responsible calorie estimate and all five goals
+  exist, save no active defaults and attach no card.
+
+## Derive a conservative proposal
+
+Keep population guidance separate from Murph's product judgment.
+
+1. **Calories.** Prefer representative measured total energy expenditure, or a
+   member-confirmed usual intake that coincided with a stable multi-week weight
+   trend and usual activity. Otherwise, for adults 19 and older, use the 2023
+   National Academies EER equation only when age, height in centimeters, current
+   weight in kilograms, the physiological sex input supplied for this
+   calculation, and a representative physical-activity category are known:
+
+   - Men: inactive `753.07 - 10.83*age + 6.50*height + 14.10*weight`; low active
+     `581.47 - 10.83*age + 8.30*height + 14.94*weight`; active
+     `1004.82 - 10.83*age + 6.52*height + 15.91*weight`; very active
+     `-517.88 - 10.83*age + 15.61*height + 19.11*weight`.
+   - Women: inactive `584.90 - 7.01*age + 5.72*height + 11.71*weight`; low active
+     `575.77 - 7.01*age + 6.60*height + 12.14*weight`; active
+     `710.25 - 7.01*age + 6.54*height + 12.34*weight`; very active
+     `511.83 - 7.01*age + 9.07*height + 12.56*weight`.
+
+   Treat the result as a starting estimate, not a measured requirement. Use it
+   unchanged for maintenance or recomp. For an explicit muscle-gain direction,
+   start conservatively around 5-10% above maintenance; for an explicit fat-loss
+   direction, start around 10-20% below maintenance and do not begin with a
+   deficit larger than about 500 kcal/day. These adjustments are Murph product
+   judgment informed by limited athlete literature, not DRI prescriptions.
+   Round the final target to the nearest 100 kcal and plan to adjust from a
+   multi-week trend, training performance, hunger, and recovery.
+   If the adjusted or rounded target is below 1,200 kcal/day, stop; do not floor
+   it upward, save a Goal, or attach a goal-comparison card.
+2. **Protein preference.** For a generally healthy adult with regular resistance
+   training or a muscle-gain goal, start near 1.6 g/kg/day. Use about 1.4
+   g/kg/day for other regularly exercising adults and 0.8 g/kg/day for a
+   generally healthy non-exercising adult when weight is a responsible
+   reference. Round to the nearest 5 g. This is the preferred derived protein
+   value when more than one macro is missing, not authority to override an
+   explicit metric or an energy-feasibility check.
+3. **One residual-energy algorithm.** Run this only after the calorie target and
+   every explicit protein, carbohydrate, and fat target are proven applicable
+   to the proposal's card date and exact points with comparator `between` and
+   identical endpoints, then prove the calorie target is in `kcal` and each
+   macro target is in `g`. Hold those applicable, compatible explicit targets
+   fixed. Use 4 kcal/g for protein and carbohydrate and 9 kcal/g for fat. Then
+   derive only missing macros:
+
+   - With exactly one macro missing, assign that macro the remaining energy.
+   - With protein plus another macro missing, start from the weight-based protein
+     preference, but clamp it to the feasible value nearest that preference
+     inside the 10-35% protein AMDR that leaves the other missing macro inside
+     its AMDR. If no such value exists, the bundle is infeasible.
+   - With fat and carbohydrate both missing, choose the feasible fat share
+     closest to 30%, or closest to 25% when running or another endurance demand
+     is material; carbohydrate receives the remainder. Fat must remain within
+     20-35% and carbohydrate within 45-65%.
+   - With all three macros missing, apply the protein rule first, then the
+     fat-and-carbohydrate rule.
+
+   Round each derived missing macro to the nearest 5 g, then recompute the full
+   bundle once. Every explicit value must remain unchanged, each macro must be
+   inside its adult AMDR, and `4*protein + 4*carbohydrate + 9*fat` must be within
+   50 kcal of the calorie target. Do not independently reapply percentage
+   defaults after an explicit value consumes part of the energy budget. If the
+   residual is negative, the feasible interval is empty, rounding breaks an
+   AMDR or the 50 kcal tolerance, or known inputs cannot prove one result, do
+   not write or update the Goal. Explain the conflict and ask which explicit
+   target the member wants to change.
+
+   Example: with explicit 2,000 kcal, 150 g protein, and 250 g carbohydrate,
+   fat is the sole missing macro. Residual energy gives about 44 g, which rounds
+   to 45 g; the 2,005 kcal macro total and all three shares pass. With the same
+   calories and protein but explicit 300 g carbohydrate, the residual fat is
+   below its 20% AMDR, so the bundle is infeasible and no Goal write is allowed.
+4. **Fiber.** Start from the adult reference density of 14 g per 1,000 kcal and
+   round to the nearest 5 g. This is population guidance, not a personalized
+   gastrointestinal prescription.
+
+## Save once, explain, then activate
+
+Use the existing canonical Goal owner; add no new state surface.
+
+1. Separately run `vault-cli goal list --limit 200 --format json`, then show only
+   candidate records, to find the managed Goal in any status. If this all-status
+   list is saturated or target authority is ambiguous, do not write or attach a
+   card. Do not use this lookup in place of the complete active-target authority
+   read above.
+2. Reuse at most one Goal with slug `murph-daily-nutrition-starting-targets`.
+   Create it only when absent, with title `Daily nutrition targets`, domain
+   `nutrition`, horizon `ongoing`, and status `paused`. Before that first write,
+   establish one proposal-effective local date. Use the member's explicitly
+   requested effective date when present; otherwise use the selected card
+   `localDate` for a dated card request, including a historical date; otherwise
+   use the engine-supplied current vault-local date for an undated target or
+   card request. Include `window: { startAt: <proposal-effective-localDate> }`
+   in the initial `goal import-json` payload. Do not rely on the Goal owner's
+   write-day default or substitute a wall-clock date. A paused record is the
+   proposal awaiting the member's review; an abandoned or completed record is
+   an opt-out and must not be recreated automatically.
+3. Save only metrics without an explicit owner through
+   `vault-cli goal import-json --input -`. Each point target uses `kind: "metric"`,
+   `evaluation.kind: "selected-value"`, comparator `between`, and identical
+   `value` and `highValue`. Use these stable target ids and metric/unit pairs:
+
+   - `murph-default-dietary-calories`: `dietary-calories`, `kcal`
+   - `murph-default-protein-grams`: `protein-grams`, `g`
+   - `murph-default-carbs-grams`: `carbs-grams`, `g`
+   - `murph-default-fat-grams`: `fat-grams`, `g`
+   - `murph-default-fiber-grams`: `fiber-grams`, `g`
+
+   Reuse the same Goal id and stable target ids on every update. Supplying
+   `metricTargets` replaces that Goal's stored array; every edit or overlap
+   removal must therefore send the complete intended post-update array for the
+   managed Goal. Preserve every unchanged target and stable target id, and omit
+   only a metric deliberately removed because an explicit owner now exists.
+   Never send only the changed or removed target. Read the Goal back and verify
+   the complete retained set and window; never create a duplicate or rewrite an
+   unchanged proposal. Preserve the existing Goal window on every later value,
+   overlap-removal, status, or card-request turn; omit `window` from those
+   patches and never silently rebase it to another requested card date. Change
+   the window only when the member explicitly changes the proposal's effective
+   date, then explain that revision and verify the complete record. Any write
+   that adds or changes a derived managed value must include `status: "paused"`
+   atomically, even when the same Goal was active; this keeps the revised bundle
+   a proposal until the member accepts it. Removing an overlapping metric
+   without adding or changing a derived value may leave the managed Goal active
+   because the explicit owner supplies that metric. A status-only update may
+   omit `metricTargets`.
+4. A turn that creates or changes the paused proposal must be ordinary text,
+   never a card. Briefly name all five effective values, which facts and labeled
+   assumptions materially drove them, and why calories, protein, carbohydrate,
+   fat, and fiber landed there. State the proposal-effective date, especially
+   when it is historical or future. Call the values provisional and invite
+   correction or acceptance. This explanation must happen before the first
+   goal-aware card.
+5. When the member accepts the proposal, reapply the card tool's known-context
+   numeric-suitability rule. If it suppresses numeric guidance, leave the
+   proposal paused and unchanged, surface no target values, use ordinary
+   non-numeric text, and attach no card. Otherwise re-read target authority. If
+   a metric has gained an explicit
+   owner, remove it from the managed proposal by sending the complete intended
+   post-update array and read the Goal back. Then run
+   `vault-cli goal save "Daily nutrition targets" --id <goal-id> --status active`
+   and read that same Goal back. When the member changes a proposed value, or a
+   missing metric needs a newly derived replacement after an explicit owner
+   disappears, send the complete intended post-update `metricTargets` array
+   with `status: "paused"` for the same Goal through `goal import-json`,
+   explain the revision briefly, and wait for acceptance. If the member
+   declines, update the same Goal to `abandoned`. Do not silently recalculate
+   accepted values later. If an explicit target appears after activation, send
+   the managed Goal's complete retained array without that overlapping metric;
+   never edit the explicit Goal.
+6. The proposal turn never attaches a card. If an explicit card request caused
+   the proposal, its next unambiguous acceptance may be the first later eligible
+   response: after the known-context suitability rule in step 5 passes,
+   activate and read back the Goal, re-read same-date canonical meal totals,
+   and attach exactly one card
+   in that acceptance response when the pending
+   request is still unambiguous and the card alone completes it. A
+   target-setting-only request, correction, decline, ambiguous acceptance, or
+   compound request remains ordinary text with no card. Otherwise, a later
+   eligible response may attach the card only when the target-authority read
+   above resolves one complete, unambiguous card-authorizing bundle. Consume
+   that resolved bundle directly; do not restate accepted metric keys or require
+   a second `dietary-calories` owner after calorie resolution. On an interactive
+   card request, explain an existing paused proposal again unless the member is
+   accepting or changing it.
+
+## Evidence register
+
+- [National Academies, 2023 adult EER equations and individual uncertainty](https://www.ncbi.nlm.nih.gov/books/NBK591034/)
+- [National Academies adult AMDR and DRI reference tables](https://www.ncbi.nlm.nih.gov/books/NBK208874/)
+- [ISSN position stand: protein and exercise](https://link.springer.com/article/10.1186/s12970-017-0177-8)
+- [National Academies fiber reference method](https://www.ncbi.nlm.nih.gov/books/NBK208887/)
+- [National Academies energy-risk context and the adult underweight boundary](https://www.ncbi.nlm.nih.gov/books/NBK591042/)
+- [NIH/NHLBI low-calorie diet guidance and nutrient-adequacy limits](https://www.ncbi.nlm.nih.gov/books/NBK278991/)
+- [Critical review of athlete weight-gain guidance and its evidence limits](https://pubmed.ncbi.nlm.nih.gov/35233712/)
+- [Off-season bodybuilding review: surplus and rate-of-gain context](https://pubmed.ncbi.nlm.nih.gov/31247944/)
+- [Meta-analysis: energy deficiency and resistance-training lean-mass gains](https://pubmed.ncbi.nlm.nih.gov/34623696/)

package/node_modules/@murphai/assistant-engine/skills/nutrition-strategy/references/named-diets/carnivore-animal-based.md

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+# Carnivore and animal-based diets
+
+Evidence reviewed: 2026-08-09.
+
+This is a progressive-disclosure reference, not a registered skill. Use it only after the parent `nutrition-strategy` contract. It adds diet-specific evidence, tradeoffs, harm reduction, and handoffs; it does not replace the parent's routing, universal safety, clinical boundaries, or lowest-tracking-burden rules.
+
+## Define the pattern before evaluating it
+
+These labels are informal and inconsistently used. Ask what the person actually eats rather than inferring one rule set.
+
+| Pattern | Common meaning | Material differences |
+| --- | --- | --- |
+| **Strict carnivore** | All or nearly all food comes from meat, fish, seafood, eggs, animal fats, and sometimes dairy; plant foods are excluded. | Provides essentially no dietary fiber. Carbohydrate is usually very low, but the label does not prove sustained nutritional ketosis. |
+| **Lion or ruminant-only** | One or a few ruminant meats, salt, and water. | The narrowest food variety and concentrated adequacy risk. It should not be treated as nutritionally equivalent to a mixed animal-food pattern. |
+| **Dairy-inclusive carnivore** | Adds milk, yogurt, cheese, cream, or butter while excluding plant foods. | The dairy choices change carbohydrate, calcium, iodine, saturated-fat, and tolerance tradeoffs. Raw dairy is a separate food-safety choice, not a requirement or recommendation. |
+| **Organ-inclusive or "nose-to-tail" carnivore** | Adds liver or other organs to muscle meat. | Organs change micronutrient exposure but do not guarantee adequacy and can create excesses. |
+| **Looser animal-based** | Animal foods predominate while selected plant foods remain--often fruit and honey, and sometimes tubers, rice, vegetables, or other tolerated foods. | There is no standard definition. Fiber, carbohydrate, fat quality, and micronutrient exposure can differ greatly from strict carnivore, so evidence and risks cannot be transferred between them as though they were one diet. Many versions are not ketogenic. |
+
+A carnivore diet is not automatically a therapeutic ketogenic diet. Clinician-managed ketogenic diets for epilepsy or another medical indication are separate, condition-specific care.
+
+## Evidence position
+
+**Bottom line:** direct evidence is too sparse and biased to establish that carnivore eating improves direct health outcomes or is safe long term. A 2026 scoping review found nine human studies in its search window: five case-based studies, two social-media surveys, one exploratory study, and one comparative modeling study. Samples were generally small, follow-up was short, definitions varied, and controlled comparisons were largely absent. Two later 2026 publications reviewed here--a single-patient diabetes case report and a cross-sectional microbiome study of 10 healthy, self-selected long-term adherents--do not change the certainty because neither is a randomized comparison or a long-term clinical-outcome study. No trial has established effects on cardiovascular events, cancer, fractures, kidney failure, mortality, or overall long-term safety.
+
+The largest commonly cited study was an online survey of 2,029 current adherents. It can describe what a self-selected group reported; it cannot show that the diet caused reported improvements or estimate harms among everyone who tried it. People who stopped because it did not help or caused problems were less likely to be represented. Recall, reporting, selection, survivorship, regression-to-the-mean, and community-expectation biases are material.
+
+| Question | What the evidence can support | What it cannot support |
+| --- | --- | --- |
+| **Weight, satiety, glucose, triglycerides, or symptoms** | Some adherents and small reports describe short-term improvement. Lower carbohydrate intake, higher protein, fewer ultra-processed foods, lower energy intake, early glycogen and water loss, or removal of a specific trigger are plausible explanations. | A carnivore-specific advantage, durable benefit, or proof that plant foods caused the original problem. Evidence from ketogenic or low-carbohydrate diets is adjacent and indirect; it does not test whether eliminating all plants adds benefit. |
+| **Nutrient adequacy** | Modeled menus show that animal foods can cover several nutrients, while common versions miss fiber and may fall short in vitamin C, thiamin, folate, calcium, magnesium, iodine, potassium, or other nutrients depending on the food list. | That a theoretical one-day menu predicts an individual's nutrient status, or that ketosis lowers human requirements enough to make identified gaps irrelevant. |
+| **Cardiometabolic safety** | LDL-C and total cholesterol have risen in several direct reports; broader evidence supports concern when a pattern is high in saturated fat and raises atherogenic lipoprotein burden. | That lower triglycerides, higher HDL-C, weight loss, or good subjective energy makes a marked LDL-C or apoB rise harmless. Direct carnivore studies have not tested cardiovascular events. |
+| **Athletic performance** | Very-low-carbohydrate intake can increase fat oxidation. Adjacent ketogenic-diet evidence often finds similar or worse performance than higher-carbohydrate comparators, depending on the task. | A direct carnivore performance advantage. Increased fat oxidation is a metabolic adaptation, not proof of better speed, power, work capacity, or recovery. |
+| **Disease treatment** | A person's symptom report can justify careful follow-up and a search for the least restrictive explanation. | Claims that carnivore cures autoimmune, gastrointestinal, metabolic, psychiatric, or malignant disease. It is not a guideline-supported substitute for diagnosis or treatment. |
+
+Treat the following as unsupported, not as established mechanisms: that plants or "antinutrients" are broadly toxic; fiber is unnecessary for everyone; symptoms during transition are "detox" or "oxalate dumping"; organs prevent every deficiency; an ancestral story proves optimality; high LDL-C or apoB is benign when triglycerides or HDL-C look favorable; or ketosis guarantees health or performance.
+
+## Why a user may choose it
+
+Common aims include simpler decisions, high satiety, preference for animal foods, avoiding ultra-processed foods, weight or glucose goals, a self-directed elimination experiment, hoped-for digestive or inflammatory symptom relief, and belonging or confidence from online testimonials. Validate the underlying aim without validating an unsupported explanation. Simplicity, a protein anchor, fewer ultra-processed foods, or removal of one true trigger can usually be preserved with less restriction.
+
+## Diet-specific tradeoffs
+
+### Fiber and digestive change
+
+Strict carnivore supplies essentially no dietary fiber. Stool volume or frequency may decrease without automatically meaning constipation; ask about hard stool, straining, pain, incomplete evacuation, or a meaningful change from baseline. Abrupt increases in fat, dairy intolerance, or foodborne illness can instead cause loose stool, urgency, or nausea. A 2026 cross-sectional study of 10 selected long-term adherents found a distinct microbiome without a simple reduction in alpha diversity, but its one-time sampling and predicted functions cannot show causation, clinical benefit or harm, or that fiber is unnecessary. Persistent constipation, diarrhea, pain, bleeding, or other digestive symptoms belong with `gut-digestion` and clinical care as appropriate. Do not explain symptoms away as adaptation.
+
+### Micronutrients and food variety
+
+Risk depends on the exact foods. A meat-and-butter pattern, a fish-and-dairy-inclusive pattern, and a fruit-inclusive animal-based pattern are not nutritionally interchangeable.
+
+- Muscle-meat-heavy versions can be low in vitamin C, folate, thiamin, magnesium, calcium, iodine, and potassium; strict versions also remove dietary fiber.
+- Pasteurized dairy can contribute calcium and iodine, and seafood can contribute iodine and long-chain omega-3 fats, but neither makes the whole pattern automatically adequate.
+- Liver and other organs are optional, not a universal fix. Frequent large liver servings can create excessive preformed vitamin A and copper exposure; excess preformed vitamin A is especially concerning during pregnancy.
+- Do not improvise supplement doses to "complete" the diet. Route supplement selection, labels, dose, interactions, and lab interpretation to `micronutrients-supplements` or clinical care.
+
+### Saturated fat, LDL-C, and apoB
+
+Versions built around fatty red meat, butter, cream, cheese, and processed meat can be high in saturated fat and may raise LDL-C, non-HDL-C, and apoB. Response is heterogeneous: the direction and size can vary with genetics, baseline risk, weight change, food selection, and other factors, and some people have large increases. Favorable changes in appetite, glucose, triglycerides, or HDL-C do not cancel an adverse rise in atherogenic particle burden.
+
+For harm reduction, emphasize fish and seafood, eggs, leaner or mixed-fat cuts, and lower-fat pasteurized dairy if tolerated rather than using butter, cream, cheese, bacon, or sausage as the main energy sources. A marked lipid change is a cardiometabolic handoff, not a debate to settle from diet identity or ratios alone.
+
+### Kidney stones, uric acid, and gout
+
+Direct carnivore data are insufficient to quantify risk. Adjacent ketogenic-diet evidence--much of it from clinician-managed therapeutic diets--finds kidney stones as a recognized complication, but it cannot provide an ordinary carnivore risk estimate. High animal-protein and purine exposure, high sodium intake, low urinary citrate or pH, and concentrated urine can matter in susceptible people. Organ meats and some seafood can be especially purine-rich.
+
+A history of kidney stones, gout, chronic kidney disease, or abnormal kidney function warrants clinical review before proceeding. Do not promise that extra water, salt, or electrolyte products neutralize the risk, and do not prescribe a universal fluid or sodium target.
+
+### Low carbohydrate and training demand
+
+Strict carnivore is usually very low in carbohydrate. Easy or lower-volume training may feel acceptable for some people, but repeated sprints, high-intensity intervals, high-volume lifting, team sport, and long sessions with hard efforts often depend more on carbohydrate availability. If output, recovery, mood, sleep, or appetite worsens, adding familiar carbohydrate is a lower-risk correction than waiting indefinitely for "fat adaptation." Flexible options include fruit, potatoes, rice, oats, bread, or another tolerated staple; using them means loosening the label, not failing.
+
+### Foodborne risk
+
+Raw or undercooked meat, poultry, seafood, eggs, and organs and unpasteurized milk or dairy can transmit serious infection. Use pasteurized dairy; keep raw and ready-to-eat foods separate; refrigerate promptly; and cook foods to official safe temperatures. Pregnancy, older age, young children, and immune compromise increase the stakes. "High quality," local sourcing, or a healthy animal does not make raw products pathogen-free.
+
+## Lowest-risk execution when a user proceeds
+
+1. **Name the actual pattern and goal.** Record the foods included, foods excluded, whether dairy or organs are used, the intended outcome, and what would count as no benefit. Do not turn the label into an identity test.
+2. **Prefer the least restrictive version that preserves the useful core.** Keep satisfying protein choices such as fish, eggs, poultry, meat, or pasteurized yogurt, and retain tolerated foods such as fruit, cooked vegetables, potatoes, oats, rice, beans, or olive oil when they fit the person's goal. A symptom-led elimination and reintroduction belongs with `gut-digestion`, not an indefinite all-food ban.
+3. **If strict carnivore remains the user's choice, make it bounded and adequacy-aware.** Avoid pairing it with fasting or intentional under-eating; use enough food; vary animal foods within tolerance, access, and budget; minimize processed meats; do not make butter, cream, cheese, or liver the bulk of intake; and use safe cooking and storage. This reduces some risks but does not establish long-term safety.
+4. **Choose one outcome and a few safety signals.** A useful test follows the target plus bowel comfort, energy, training or recovery, unintended weight change, menstrual function when relevant, and food preoccupation or social impairment. A brief food-list snapshot is usually more useful than full daily macro tracking.
+5. **Plan the off-ramp before starting.** Decide which tolerated food returns first and which result would end or loosen the experiment. Use `experiment-onboarding` only after the person has chosen a specific, safe test.
+
+## Common failure modes
+
+- Treating strict carnivore, dairy-heavy carnivore, and fruit-inclusive animal-based eating as the same exposure.
+- Calling early water loss proof of fat loss or long-term efficacy.
+- Building most meals from butter, cream, cheese, bacon, sausage, or very fatty meat while dismissing a lipid rise.
+- Adding fasting because appetite falls, then overlooking low energy, poor recovery, menstrual change, cold intolerance, or unintended rapid loss.
+- Using daily liver, organ concentrates, or multiple supplements as an unmeasured adequacy strategy.
+- Consuming raw milk, raw eggs, raw meat, or undercooked organs because of purity or nutrient claims.
+- Calling constipation, diarrhea, dizziness, palpitations, gout symptoms, or declining performance "detox" or mandatory adaptation.
+- Letting a broad elimination become indefinite because several things changed at once and no reintroduction was planned.
+- Escalating fear of plant foods, social avoidance, compulsive checking, or compensatory exercise.
+
+## Monitoring, stop conditions, and off-ramp
+
+Use the lowest burden that can detect benefit or harm. For someone continuing beyond a brief self-directed test--especially with known dyslipidemia, cardiovascular risk, or a family history of early cardiovascular disease--clinical review of a baseline and follow-up lipid panel is reasonable; apoB can help assess atherogenic particle burden when available. Kidney function, uric acid, or nutrient testing should be selected from history, food exposure, symptoms, and clinician judgment rather than ordered as a universal "carnivore panel." Glucose-lowering or blood-pressure medication may need prompt adjustment when carbohydrate intake, body mass, or fluid balance changes; arrange the medication plan before starting.
+
+Stop, loosen, or seek timely review for a marked or persistent LDL-C, non-HDL-C, or apoB rise; a gout flare or possible stone symptoms; persistent constipation, diarrhea, vomiting, or abdominal pain; weakness, dizziness, palpitations, or inability to train normally; menstrual change, reduced libido, unusual cold, or rapid or unwanted weight loss; or increasing food fear, rigidity, isolation, bingeing, purging, or compensatory exercise. Use the parent's urgent-escalation rules for acute deterioration.
+
+A nonjudgmental off-ramp can keep the parts that helped:
+
+- keep a preferred protein anchor and simple meals;
+- add one familiar, tolerated food at a time, such as fruit or berries, potatoes, oats or rice, cooked vegetables, beans or lentils, or pasteurized yogurt;
+- increase fiber gradually rather than making a large jump when digestive tolerance is uncertain;
+- replace some butter, cream, fatty processed meat, or very fatty cuts with fish, leaner meat, olive oil, nuts, avocado, or other tolerated unsaturated-fat sources; and
+- return to the next ordinary meal without compensation or a "reset."
+
+If symptom recurrence is the main concern, use `gut-digestion` for a structured reintroduction. Moving away from the label is information, not failure.
+
+## Groups needing extra caution
+
+Do not help tighten this pattern without appropriate clinical or dietetic involvement when the person is under 18; pregnant, trying to conceive, or breastfeeding; has current or past eating-disorder risk; is frail, under-fueled, or losing weight unintentionally; uses glucose-lowering medication; has chronic kidney disease, kidney stones, gout, advanced liver disease, significant cardiovascular disease, familial or severe hypercholesterolemia, or a relevant gastrointestinal condition; is post-bariatric surgery; or is using the diet as treatment for a diagnosed condition. Pregnancy adds nutrient-adequacy, foodborne, and liver-derived preformed-vitamin-A concerns and is not an appropriate setting for an unsupervised restrictive experiment.
+
+## Murph handoffs
+
+- Use `food-journal` for a low-pressure snapshot of the actual foods, preparation method, dairy or organ use, labels, and observed links with symptoms or performance.
+- Use `body-composition` when intentional weight, waist, fat-loss, muscle-gain, or recomposition strategy is the main job; return here only for food execution.
+- Use `gut-digestion` for constipation, diarrhea, pain, reflux, symptom-driven elimination, or reintroduction.
+- Use `cardiometabolic-health`, `chronic-illness-support`, care navigation, and the user's clinician for lipids, glucose, blood pressure, kidney function, stones, gout, medication changes, or disease treatment.
+- Use `micronutrients-supplements` for nutrient-gap assessment, supplement labels, dose, interactions, or lab interpretation.
+- Use `experiment-onboarding` after the person chooses one bounded, safe change with an outcome and stop conditions.
+- Use `behavior-followthrough` only when reminders, fallback planning, or ongoing support becomes the main job.
+
+## Source register
+
+Evidence review cutoff: **2026-08-09**. Direct carnivore evidence is labeled separately from adjacent or general evidence so it is not over-transferred.
+
+- **Direct evidence -- [Carnivore Diet: A Scoping Review of the Current Evidence, Potential Benefits and Risks (2026)](https://doi.org/10.3390/nu18020348).** Scoping review of nine human studies in its search window; the central source for the sparse, heterogeneous, short, and mostly uncontrolled evidence base.
+- **Direct evidence -- [Behavioral Characteristics and Self-Reported Health Status among 2029 Adults Consuming a "Carnivore Diet" (2021)](https://doi.org/10.1093/cdn/nzab133).** Large descriptive online survey; useful for reported practices and experiences, but not causal efficacy, incidence of harm, or long-term safety because of self-selection, survivorship, recall, and reporting bias.
+- **Direct observational evidence -- [Long-term adherence to the carnivore diet and its impact on the gut microbiota: a cross-sectional study (2026)](https://doi.org/10.1530/MAH-25-0015).** Ten healthy, self-selected long-term adherents were compared with matched omnivore controls at one time point; useful for hypothesis generation, not causation, clinical outcomes, or long-term safety.
+- **Direct case evidence -- [Reversing 20 years of diabetes using the carnivore diet in India: a case report (2026)](https://doi.org/10.7762/cnr.2025.0026).** One person's uncontrolled outcome; hypothesis-generating only, not evidence of general efficacy, comparative benefit, medication safety, or durable remission.
+- **Direct modeling -- [Assessing the Nutrient Composition of a Carnivore Diet: A Case Study Model (2025)](https://doi.org/10.3390/nu17010140).** Four hypothetical menus; useful for possible nutrient gaps and excesses, not measured nutrient status or health outcomes.
+- **Direct/adjacent sport review -- [Carnivore and Animal-Based Diets in Sport: A Critical Evaluation of Current Evidence and Future Perspectives for Precision Nutrition (2026)](https://doi.org/10.3390/nu18060998).** Clarifies inconsistent definitions and the absence of strong sport-specific trials; much of the performance discussion is extrapolated from low-carbohydrate and ketogenic research.
+- **General guideline -- [Carbohydrate intake for adults and children: WHO guideline (2023)](https://www.who.int/publications/i/item/9789240073593).** Guidance on carbohydrate quality, fiber, fruit, and vegetable intake; not a carnivore trial.
+- **General guideline -- [Saturated fatty acid and trans-fatty acid intake for adults and children: WHO guideline (2023)](https://www.who.int/publications/i/item/9789240073630).** Evidence-informed saturated-fat guidance; relevant to high-butter, high-cream, high-cheese, or fatty-meat implementations.
+- **Causal lipid evidence -- [Low-density lipoproteins cause atherosclerotic cardiovascular disease: evidence from genetic, epidemiologic, and clinical studies (2017)](https://doi.org/10.1093/eurheartj/ehx144).** Establishes the relevance of sustained LDL exposure; not specific to carnivore diets.
+- **Lipid consensus -- [Role of apolipoprotein B in the clinical management of cardiovascular risk in adults (2024)](https://doi.org/10.1016/j.jacl.2024.08.013).** Consensus on apoB as a measure of atherogenic lipoprotein burden; supports not dismissing discordant or marked responses.
+- **Adjacent sport evidence -- [International Society of Sports Nutrition position stand: ketogenic diets (2024)](https://doi.org/10.1080/15502783.2024.2368167).** Critical review in healthy exercising adults; indirect for carnivore and does not test complete plant exclusion.
+- **Adjacent kidney-stone evidence -- [Incidence and Characteristics of Kidney Stones in Patients on Ketogenic Diet: A Systematic Review and Meta-Analysis (2021)](https://doi.org/10.3390/diseases9020039).** Documents stones in ketogenic-diet studies, many in therapeutic settings; does not estimate ordinary carnivore risk.
+- **Stone guidance -- [European Association of Urology: Metabolic Evaluation and Recurrence Prevention](https://uroweb.org/guidelines/urolithiasis/chapter/metabolic-evaluation-and-recurrence-prevention) and [NIDDK: Eating, Diet, & Nutrition for Kidney Stones](https://www.niddk.nih.gov/health-information/urologic-diseases/kidney-stones/eating-diet-nutrition).** Current clinical and official guidance on excessive animal protein, sodium, and stone risk; condition-specific decisions require clinical ownership.
+- **Gout guideline -- [2020 American College of Rheumatology Guideline for the Management of Gout](https://doi.org/10.1002/acr.24180).** Supports a clinical handoff for gout and shows that diet is not a substitute for indicated medical management.
+- **Food safety -- [Safe Minimum Internal Temperatures](https://www.foodsafety.gov/food-safety-charts/safe-minimum-internal-temperatures), [CDC Raw Milk](https://www.cdc.gov/food-safety/foods/raw-milk.html), and [CDC Safer Food Choices for Pregnant Women](https://www.cdc.gov/food-safety/foods/pregnant-women.html).** Primary official sources for cooking, pasteurization, and high-risk groups.
+- **Pregnancy and vitamin A -- [NIH Office of Dietary Supplements: Pregnancy](https://ods.od.nih.gov/factsheets/Pregnancy-HealthProfessional/) and [Vitamin A and Carotenoids](https://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/).** Supports concern about restrictive adequacy and excess preformed vitamin A from liver or supplements, especially during pregnancy.